Some acne treatments home that they can solve their problems of skin

There are very few home acne treatments that you can take to solve your acne problems. Most of us resort to buying products that work like magic on the shins and make them disappear forever. The truth is that most of these products only works temporarily and when you stop using them, your acne returns again. These products contain antibiotics and acids such as salicylic acid, benzoyl peroxide and sulfur which work by reducing bacteria and dry pimples.

What acne treatments home will work for you?

Some of the essential things you need to keep your skin clear of grains are a good cleaning regime, a healthy diet and plenty of drinking water. You can check with a dermatologist about the use of certain creams, medicated for your acne if it is very serious. But aside from that simple things can make a big difference in your skin.

You need to be sure that your skin is kept clean following a regular cleaning routine. You should wash your face with a mild cleanser at least twice a day. You can use a facial scrub twice a week. Do not rub the skin too much as it could make things worse. Even your hair needs to keep shampoo cleans so everyday and keep it away from your face. Drink plenty of water, at least 8 glasses a day to remove toxins. Be sure to eat enough fruits and vegetables every day. A healthy diet does wonders for your skin.

Another great way to keep acne is the exercise in any form. You can try running, jumping or even dancing. When sweat, your clogged pores and all oils out. You can see the difference after just one week of daily exercise.

These are changes that you can make to your lifestyle to ensure healthy and clear skin. But some acne treatments there real home that we can follow to get rid of pimples and blackheads? A very effective treatment burning face. You can do it three or four times a week. Steaming the face unblocks your pores and leaves all of the oil out easily so it does not accumulate under the skin.

Another important thing to remember is to avoid fatty foods as these can aggravate his condition. So the next time you are feeling as an appetizer, we have a fat free yogurt with fruit rather than grab a bag of potatoes oily wafers.

Apply honey on the wonders of work in the affected areas. Honey kills bacteria on the skin and prevents attack more. Application of other natural ingredients such as garlic, water pink and orange pasta may also help to clear up your acne.

In addition to these acne treatments home simple, you take certain supplements that are good for your skin. Vitamin A is good for the skin as it reduces the amount of sebum produced by oil glands. Zinc is another effective supplement because it helps reduce inflammation and heal imperfections. Of course, you will need to check with your doctor before taking any supplements.

Make sure that their creams and cosmetics are all water-based. Nothing will make your skin very oily. Keep your hands from your face. If he keeps touching my face, transferring bacteria more to it. As you can see, many acne treatments there is House you can follow to prevent and cure acne.

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Cures of adult acne - three important factors that should be aware of

If you have been looking for to get rid of what they all tend to see as a curse, this aggravating problem called acne, then you will want to stop what you're doing, comfortable and read this article immediately, because this is the start of your solution.

In the next few minutes, we will see three very important factors that you want to be aware of that will help you get rid of this curse of acne once for all. First, let's talk about the differences between internal and external cures. Then we will talk about the benefits you receive from using your hands to touch your face much less. Finally, we will discuss why hot water is a great source to use when it comes to get rid of acne.

First, let's talk about external cures, as acne face wash and expensive acne creams, and are not as effective as game internally. The source to all acne starts from inside of you. Many times can acne with the foods you eat, or stops eating. Washing of face creams for the face of acne that focus only acne and red spots and acne can be expensive and even acne will reappear within weeks, if not days. There are times that these products will have the feeling of dry skin and leaving it worse than it was before using the product.

How we use our hands much throughout the day, therefore, is not a surprise the hands can be a cause of acne. The benefits of touching your face much less will greatly help, however, we have our hands. Our hands carry more fat and dirt than any other part of our body. Think about it, give us the hands of other people, grabbed the handles of the door, everything we do with our hands. The thing is, we don't live in a world of health care. It is sad but true. When we touch the face, all that fat and dirt in our hands obstruct poured in our face, making it one of the causes of acne.

Finally, the hot water can become a great source to use when it comes to get rid of acne. Hot water and a cloth can work miracles. Place a warm face cloth until the fresco of cloth down on the face, then back under the hot water, then put it on your face for a second time until it cools. Do it twice every night and morning, and you immediately feel a difference in your skin. Hot water and cloth do is open your pours, allowing dirt and grease to escape without damaging the skin. Your skin will feel smooth and healthy.

This worked great for me!

These are the three things, if you keep in mind, you will help considerably to get rid of your acne for life. External cures such as acne wash and expensive acne creams can only worsen your skin it once was. From the inside, you will have lifetime benefits and you will have a better chance of never again see your acne. The hot water and cloth is a miracle-working. All acne is dirt and grease trapped in the casts, while the warm cloth and water only alleviates the dirt and grease, leaving the cleaner skin which was.

If you want to learn more ways to remove skin from severe acne and start now, immediately go to this site: http://www.adultpimplescure.com/

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Dispatch from London

I'm in London for 48 hours, working with a group of international experts to define telehealth, care management, and big data opportunities for the UK, Europe, Australia, and US.

During the afternoon break I had a remarkable experience.

Unity Farm apples (40+ heirloom varietals) produce a crisp, well-balanced fermented cider that includes sweet, tart, aromatic, and astringent components.

Kathy, my wife, searched the web for the best cider pub in London and asked me to stop by so I could compare Unity Farm cider making with traditional farmhouse ciders from the UK.

The Cider Tap, a remarkable place, is, by good karma, 100 yards from my hotel in Euston Square.

Professor Justin Beilby, Executive Dean of the Faculty of Health Sciences at the University of Adelaide, and I  tasted six still and four sparking ciders, fresh from the cask.

Still:
1.  Severn Perry (made from crushed pears) - 6.3% alcohol, aromatic, dry, with a subtle pear flavor.

2.  Sandford Bumbleberry - 4% alcohol, sweet with a mixture of herbs and berries.    It reminded me of a traditional spiced mead - a metheglin.

3.  Bleangawney - 6% alcohol, dry, with an almost lime-like flavor.

4.   Upper House Farm Oak Barrel aged - 6.5% alcohol, medium/sweet with a clean, crisp flavor.   This was my favorite still cider and a style that I've tried to replicate at Unity Farm.

5.   Severn Farmhouse - 6.2% alcohol, medium, a classic full bodied english farmhouse cider

6.  Burrow Hill Alf n Alf - 6.0% alcohol  with a very complex taste that leads me to think it is half dry cider/half medium cider.


Sparkling:
1. Aspalls Harry Sparrow  - 4.6% alcohol, dry, crisp and clean.  This was my favorite sparking cider, a true scrumpy

2. Lilley's Stargazer -  5% alcohol, medium/sweet, with a great apple flavor

3. Sheppy's Oakwood - 4.8% alcohol, medium/dry without any overtones of oak, despite the name

4. Somerset draught - 5.5% alcohol, medium, well balanced and complex

The proprietress of the Cider Tap explained that the still ciders change weekly, with new fresh products produced in small quantities from local farms.

Tasting living, complex, handcrafted ciders made with centuries of experience was the highlight of my trip.    I only wish we had the local cider tradition close to Boston.    I guess it is up to Unity Farm to bring handcrafted ciders to the Metrowest!

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What is the best way to prevent pimples quickly and naturally? (Raibeart Holy Holy)

All have gone through the problem of acne or pimples before, everyone wants to know how to prevent pimples, get rid of acne, get clear and radiant skin and stop outbreaks. Many of us have been working with wrong information. We all think that if you apply tons of chemicals on our face, we will be free of pimples. But this is not true.

Prevention

There are several reasons that cause pimples or acne. Digestive imbalances are the important ones among them. To prevent acne naturally, so it is recommended to control your diet. There is too much tension to consume foods rich in fiber such as fruits and vegetables. Red meat and processed foods should be avoided completely. Isabgol is one of the most effective natural remedies for pimples.

Isabgol is the plant called Psyllium husk and helps to get rid of constipation and balance the digestive system. Refined sugar, dairy products, vegetable oils, hydrogenated as well fried it. You should drink plenty of water, at least 8 glasses a day.

Solution to the problem

Natural methods are the best way to cure pimples. Many remedies that are available out of the market may contain hazardous chemicals. These chemicals can produce harmful side effects if used for a prolonged time. In addition, some can also leave permanent and unsightly marks. So it is better to deal with this problem in a natural way.

Vitamin A, C and E are very essential for the health and the formation of skin. Thus, the diet should include these crucial vitamins. If necessary, you can also take vitamin supplements. Zinc is another important and natural element to address the problem of the pimple. Help in the correction of hormonal imbalances and helps to prevent and cure the acne breakouts. Another element vital and common household that can be used in the treatment of acne is baking soda. Wash a baking soda in zone in soft skin & hair removal results.

Aloe vera is also a good herb that helps in the healing of grain in a natural way. It consists of 90% water and also has minerals that have antibiotic function. Aloe vera can be applied directly on the affected area, or you can also use a pasta of aloe vera. Pasta of Aloe vera is known to cure the problem of constipation.

Gold also shine capsules can be used to control the negative effects on the health of your skin, herbal ingredients used in these capsules are proven to cure the problem of grain. They work effectively and give you a brilliant natural skin. These capsules contain herbs such as turmeric or neem, azadirachta, and haritaki. These herbs are very popular and effective treatments to improve the health of skin and nourish the skin. All these herbs are mixed with a formula in appropriate doses to prepare gold capsules. Golden glow capsules are free of harmful side effects and that is the reason why they are highly recommended by many skin problems.

Processing of...

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Will Pistachios Prevent Blood Sugar Provoked Acne?

Pistachios contain the skin enriching nutrients vitamins A, C and E plus, zinc and folic acid. Yet, new research from University of Toronto's Department of Nutritional Sciences could add pistachios to a growing list of acne therapies that already includes benzoyl peroxide and antibiotics.

The study's observations revealed that pistachios could help regulate the body's blood sugar levels.
In addition to a diabetic therapy, pistachio's effect on the body's blood sugar levels also marks it as a potential acne preventative. Biological traits characterizing acne onset include improper skin cell shedding, inflammation and excess bacteria. However, because of a pistachio's effect on blood sugar levels, this nut could prevent acne resulting from excess facial oil secretion caused by a rise in circulating androgens.

Thus, pistachios could inhibit acne lesions induced by a condition called "insulin resistance".

The relationship between acne and insulin resistance
The pancreas secretes the hormone insulin. The body needs insulin to access its primary energy source- blood sugar (glucose). Insulin attaches to key receptors in the blood to free glucose as the body requires more energy.

Insulin resistance arises when the normal amount of insulin the pancreas secretes proves insufficient to signal the release of glucose. So, to compensate, the pancreas secretes more insulin in order to free the needed glucose.

Insulin resistance can cause acne lesions due to increased circulating androgens. Now, the Toronto study's findings suggest that pistachios can curtail androgen surges caused by blood sugar fluctuations.

Pistachios act as a blood sugar regulator
Dr. Cyril Kendall, lead researcher of the study explained, "…Our preliminary findings demonstrate that suppressing the glycemic (blood sugar) response of high carbohydrate foods may be part of the mechanism by which pistachios contribute to cardiovascular health and to the prevention and control of diabetes."

Other scientists like Loren Cordain, PhD have noticed a link between insulin resistance and acne. In his work, "Implications for the Role of Diet in Acne", Cordain writes, "Dietary interventions using low glycemic load carbohydrate may have therapeutic potential in the treatment of acne because of the beneficial endocrine effects these diets possess."

Most acne treatments typically act on one or two symptoms such as surplus bacteria or clogged pores. Supplementing a diet with pistachios could help create a more robust acne therapy by also counteracting blood sugar shifts that produce excess oils and pimples.

 

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Treatment of acne with the full face of makeup for the next Jubilee (Chua)

Winter, spring and fall are the time for the wedding and the most important is the time to look at extravagant. For those who are getting Wed, it is obviously time for bride and groom. In addition, for those who are invited to the occasion, the task of good appearance is as important as the bride or Novio - to be. While you go for a good cut of hair, a nice color for the hair and a good shave, it's time you have those removed from your face acne.

Acne is a swollen, red bead as the bump that appears mainly on the face and neck. Acne treatment is easily found in all beauty salons and treatment centers. Both women and men can have these rare lumps that grow on the face. Those with oily skin get maximum attack of acne, which can be very painful as they grow.

There are some problems with these skin bumps-

* If you break open, acne could bleed and leave a scar on the place.
* If dies acne on the skin, are produced deep marks on the face and mayform deep impressions in the face.
* Growth could lead to many more acnes growing around it.

Then, would rid of them? How to ensure that there is no pigmentation of the skin due to the problem of acne and pimples? Fortunately, much ofacne there are treatments that offer the majority of beauty salons. These are non-surgical treatments primarily related to cleaning the pores of the skin, which are quite painless. These treatments not only eliminate these abrasions but can also reduce and completely eliminate the acne scar, depending on how deep are scars.

If it has damaged your skin with absolute neglect for a long time, you need to have microdemabrasion probably. The beauticians in these rooms would be adequate proof of the skin and then suggest the best remedy for you. While you can receive the treatment of the acne of the fact, it is better to take precautions and learn how you can stay away from these eruptions until outside surface.

Some tips to keep acne away from erupting in the face

* Wash your face with a good face wash whenever you come somewhere outside the House.
* Keep a wet tissue to clean the face, every now and then.
* Those who have oily skin need to use cleaners and water based face lotions.
* Do not use SOAP on your face ever.
* Drink plenty of water within the AC to be aerated.
* Avoid fast foods and oily with many spices.
* Avoid too much meat and fat containing foods.
* Eat plenty of green vegetables, fresh fruits and juices.
* Wash your face at least three to four times a day.
* Go for the treatment of skin at least once in two months if not more.

Thus, while they prepare to the best of his suit, nice boots to match it with a good draw that enhances its getting, also have to take care of your face and neck. Go, get a nice facial hair spa, shave without oil, face massage and care for unwanted bumps and abrasions red away. Give yourself the full facial makeup for this season of wedd8ing!

The men face has been popular for the acne treatment and therapies of global beauty for men. Years ago, I work in the beauty of men and the industry of the care of the skin, offering suggestions and resources, which are genuine and long-lasting.

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Your Skin Can Benefit From Taking Flax Seed

Flax seed oils offer high amounts of both essential Omega 3 and Omega 6 fatty acids. You can consume them by eating flax seeds or by taking a flax seed supplement. Some people choose to apply it externally to benefit their skin. It is known to help with the healing of scars, reduces inflammation, and can reduce the effects of Psoriasis and Eczema. Many people choose to use flax oil if they have dry skin.

Most people who struggle with skin problems including acne, Eczema, and Psoriasis don’t eat a balanced diet so they are lacking the essential Omega 3 fatty acids to help there skin prevent such disorders from occurring. It is very simple to make a flax seed oil pack by grinding it up and then adding 3 times as much water to it. Let is sit for a while so that it can become a gel after the Mucilage leaves the seeds. Then apply the oil pack to the skin area.

In the book New Optimum Nutritional Bible, Partick Holford offers some great information on how a proper diet can assist you with getting all the essential Omega 3 and 6 fatty acids you need. The membrane of each cell is composed of essential fats and your skin is basically composed of too many cells to count. Having the right amount of fatty acids is essential for healthy skin. They will keep it looking smooth and feeling soft but they also control what comes in and goes out of the skin.

Those who don’t have enough fat in their skin cells can’t hold enough water to look healthy. To get softer skin make sure you consume plenty of food that contain fatty acids including fish, nuts, seeds, and the oils from them. If you decide to consume flax seed internally, grind it up and sprinkle it on your cereal or salad. You can also choose to mix it into a glass of water and then drink it. Make sure you drink it quickly though or it will solidify.

Another way flax seed oil helps the skin is by keeping the pores open. This prevents sebum from building up that causes acne. Psoriasis is a skin disorder that can be helped by adding flax seed to your diet. Since it contains Omega 3 fatty acid the body is able to convert it into EPA which reduces inflammation.

Essential Omega 3 fatty acids are necessary for you to have healthy skin. Taking flax seed will help you reduce the chances of various skin orders including acne, Psoriasis, and Eczema. You can choose to add flax seed to the foods you eat, add new foods to your diet, take flax seed supplements, and make an external flax seed oil pack.

 

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What to Do When Antiobiotics Fail to Treat Acne

Some call it the "acne antibiotic game". First comes tetracycline, then comes doxycycline, and then your doctor finally recommends erythromycin. But what do you do when these common antibiotics fail to control your acne outbreaks? Well typically, your dermatologist might suggest isotretinoin- the ultimate prescription acne drug.

But why is isotretinoin the final pharmaceutical answer for acne? It's probably because excessive or inappropriate usage of antibiotics could lead to gram-negative folliculitis. Gram-negative folliculitis is caused by bacterial interference, and replacement of the gram-positive bacteria on the face and within the mucous membranes of the nose, with gram-negative bacteria.

And while acne is readily diagnosed, according to a study in the American Journal of Clinical Dermatology, incidences of gram-negative folliculitis are probably underestimated in patients with re-occurring and difficult to treat acne.

Even though isotretinoin has been successfully used to treat gram-negative folliculitis, this potent acne drug is not always accessible to acne sufferers because of health or monetary reasons. So the question arises- are there other methods to control or destroy gram-negative bacteria and bring acne outbreaks under control?

Two proteins that bring acne aggravating bacteria under control Researchers from the Department of Veterans Affairs Medical Center at Denver, Colorado have discovered that the protein lactoferrin changes the outer membrane of gram-negative bacteria. As lactoferrin disrupts the protective barrier of the gram-negative bacterium, this new vulnerability allows another anti-microbial protein called lysozyme to further destroy the bacterium.

At-home acne remedy The gram-negative fighters lactoferrin and lysozyme occur naturally in products such as milk. Likewise, whey protein contains several anti-bacterial proteins including lactoferrin, lactoperoxidase, lysozyme and immunoglobulins. You can make an at-home acne mask to help abate pimple outbreaks by using whey protein. (Whey protein is widely available in health food stores.)

Step 1: Cleanse your face using warm water and a clean washcloth. Pat face dry.
Step 2: In a bowl, mix one tablespoon of whey protein with just enough water to create a paste.
Step 3: Apply the paste to your face and allow to dry for 5-10 minutes
Step 4: Rinse off the paste with warm water and a face cloth. Apply moisturizer.

 

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5 Reasons Why I Hate The New “Brosurance” Ad

Earlier this week, a “Brosurance” ad was launched as part of the “Got Insurance” Project.  The project is part of the Thanks Obamacare campaign, created by the Colorado Consumer Health Initiative and ProgressNow Colorado Education.  According to their website, the goal is to educate everyone about the benefits of the Affordable Care Act.  I checked out the ad after seeing mixed reviews from colleagues on Twitter.  I immediately hated it.

Here’s why:

1.  It is unoriginal.  “Got Insurance?” is simply a rip-off of the “Got Milk?” campaign tagline.  “Got Milk” has been around since the 1990’s and encourages the American public to consume more cows’ milk.

2.   It promotes unhealthy behaviors.  One unintended consequence of this campaign could be that the ad (featuring cool bros doing keg stands) promotes binge drinking as the norm for this population.  This norm is also promoted through the presence of red “keg cups” which appear in the bros hands, as well as surrounding them on the ground.  Binge drinking is associated with many public health problems from injuries to alcohol poisoning.

3.  It continues to brand the Affordable Care Act (ACA) as “Obamacare”.  The widespread branding of ACA as “Obamacare” has negatively impacted public health’s ability to effectively communicate about the law’s benefits and features.  Aligning the healthcare law solely with the President’s name has created a polarizing effect among the American public along party lines.  As demonstrated earlier this month by Jimmy Kimmel, the use of both names to describe the law has created a lot of confusion.  Many Americans actually think they are two completely separate healthcare policies.

4.  Its success depends on people understanding “Bro”- a term with unclear meaning.  What exactly is a “Bro”?  Does it mean the same thing to all people?  In health communication, it is important that we test out our terminology with the target audience to make sure that we have a clear definition of words and don’t offend anyone with our materials.  Interestingly, NPR used twitter in June 2013 to crowdsource some definitions for “Bro”.  As you might expect, there was wide variation in responses.  In addition to there being racial implications of the word, it can apparently be associated with anyone from a Jock to a Stoner.

5. Its target audience is unclear.  According to multiple articles, the target audience for this campaign is 25 year old healthy males.  Does the image portrayed match that population?  I saw the image and thought it represented young college students at a party.  If I was a part of the target audience, I would be offended by this image.  It makes me wonder if the image and message (“Keg stands are crazy.  Not having health insurance is crazier.  Don’t tap into your beer money to cover those medical bills.”) were ever tested with the target population.  Many 25 year olds have serious responsibilities from careers to academics to families to debt.  This ad makes them all look like a bunch of idiots going on a bender.  But don’t worry!  “Obamacare” (and the American people) will be there to pay for any injuries suffered when these “Bros” inevitably hurt themselves after being dropped from a keg stand.  

What Do You Think?

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Lessons Learned from the Health Insurance Exchange Launch

CIOs face many pressures - increase scope, reduce timelines, trim budgets.     After nearly 20 years as a CIO, I've learned a great deal about project success factors.

When faced with go live pressures, I tell my staff the following:

"If you go live months late when you're ready, no one will ever remember.

If you go live on time, when you're not ready, no one will ever forget."

I have hundreds of live clinical applications.    Does anyone remember their go live date?  Nope.

Were there delays in go live dates?  Many.

With even the best people, best planning, and appropriate budgets, large, complex projects encounter issues imposed by external factors (new regulations, competing unplanned events, requirements changes) that cannot be predicated during initial project scheduling.

It helps no one - the users, the business owners, or the IT department to slavishly adhere to a deadline when the project is not ready to go live.

I work on federal advisory committees in the Obama administration and truly believe in the goals of many administration programs - Meaningful Use, HIPAA Omnibus rule, and Affordable Care Act.

However, we've seen that in the interest of accelerating change, deadlines have been imposed that do not allow for sufficient testing, piloting and cultural change.  The result is that haste makes waste.

As I've written in my blog many times, ICD-10 will become a crisis for the Obama administration.   Payers and providers will not be ready by October 1, 2014.   Documentation systems and clinician billing process changes will not be mature enough to support a successful go live.   More time is needed.    My experience with IT crises is that you can survive one at a time, but a succession of problems creates a pattern that users and oversight bodies will no longer tolerate.   I hope the premature go live of the Health Insurance Exchange results in a review of ICD-10 go live dates.

Meaningful Use Stage 2 attestation criteria are good.   The certification scripts need very significant revision.   How did this happen?   They were created in a rush to adhere to an artificial deadline, not reviewed by the federal advisory committees, and not piloted tested/revised.     New regulation is needed fix them and that will take time.   Again, the lessons of the Health Insurance Exchange should cause us to extend Meaningful Use Stage 2 deadlines by a year, deferring future stages of Meaningful Use until we have consolidated our gains and understood our successes/failures with current stages.

The Office of Civil Rights is an important watchdog of patient privacy.   We all believe respecting patient privacy is one of our most sacred responsibilities.   However, at times government auditors have enforced policy for which the technology and infrastructure of the country was not ready.    Yesterday I received an email from Harvard Medical School noting that the laptop encryption software installed a few years ago was deemed too error prone and too hard to support so it would be retired.   Luckily in 2013, encryption is natively supported in current releases of Mac OSX, iOS, Android, and Windows.   The industry is ready to support robust device encryption now.    However, enforcement/breach penalties related to encryption on mobile devices started years ago when products were as stable as the Health Insurance Exchange.   We should have aligned enforcement with product maturity in the marketplace.   Similarly the HIPAA Omnibus Rule contains provisions like the self-pay redaction requirement that no hospital has figured out how to support.  However, enforcement is starting now.

Do we a see a pattern here?   Policies are good.   Policymakers are well meaning.  Timelines are set in such a way that none of these activities - Health Insurance Exchange, ICD-10, Meaningful Use Stage 2, or HIPAA Omnibus Rule have enough time for testing, piloting, and cultural change.

As I've written about previous in my post the Toad and the Snake, I'm not yet at that time in my life when I resist change or innovation.   I'm simply an IT leader and physician in the trenches who knows that 9 women cannot create a baby in a month.   There is a minimum gestation period for IT projects and our policymakers should learn from the lessons of the Health Insurance Exchange and re-calibrate the timelines shown in the graphic above so that everyone is successful.

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Building Unity Farm - Fall Hoop House Planting

It's Fall in New England and the weather is turning cold.  Nights are in the 30's and days are in the 50's and 60's.   All the ferns in the forest are brown and most of the insects are gone.   On the farm, the apples are harvested, cider made, mushrooms dried, paddocks/pastures readied for winter, and the pace of harvest-related food preservation projects is slowing down.

We now turn our attention to Fall and Winter plantings.  Our 48x21 foot hoop house heats to 80 degrees F during the day by trapping solar energy under a 6 millimeter roof of UV resistant plastic sheeting.  We use barn fans to circulate air and hand cranked rollers to open the sides and prevent overheating.    The roof has a "gothic" cathedral shape which sheds snow and resists wind.

Over the summer, we built fifteen 4x8x1 foot raised beds and a gardening bench.   We brought water and electricity to the hoop house via a 200 foot trench from the house.   We placed a foot deep foundation of alpaca manure under each raised bed and now we're filling the beds with compost, moss, and perlite http://en.wikipedia.org/wiki/Perlite

In our first 2 beds we planted 200 bulbs of garlic, which will overwinter and produce new bulbs in the spring.   We've grown garlic for many years and enjoy bulbs of oven roasted garlic brushed with olive oil.

In our second 2 beds we planted romaine and oak leaf lettuces.   The heat of the hoop house should enable us to pick fresh greens every day during the winter.

In our remaining beds, we'll plant additional lettuces, kale, spinach, chard and other cold tolerant plants, keeping our kitchen and our barnyard stocked with fresh greens.   The ducks and the alpaca really enjoy a fresh head of romaine.   For the ducks, we chop the lettuce and mix it with water, creating a soup which they can easily slurp.

As the days shorten, we'll have less light to work in the hoop house, so I'll add 2 pendant galvanized barn lights http://www.barnlightelectric.com/pendant-lighting/barn-pendant-lights/the-original-stem-mount-pendant.html which will enable us to pick fresh salad greens in the evening after the work day.

It's our goal to become increasingly self-reliant over the next year as well as sell many of our products - honey, mushrooms, apples, blueberries, and vegetables at local farmers markets.   Although we've been farmers for a year, this will be our first winter with a hoop house, so I'm sure there will be many lessons learned growing vegetables as the snow begins to fall.

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Reflections on My Trip to Asia

For 12 days, I served as guest professor in China, Japan and Taiwan, giving lectures, running meetings, and joining my colleagues for ceremonial meals.    In many ways, all three countries are trying to solve the same basic technology and policy challenges, but there are subtle differences.

China - China has a single payer system with universal, nationally funded healthcare in state operated hospitals and clinics.  Privately funded, entrepreneurial ventures  including high-end hospitals and clinics are emerging for those who want to purchase concierge care.   This article nicely summarizes the economic issues.

During this visit I had the opportunity to meet with Vice Minister of Health for China, as well as several hospital leaders, and informatics professionals.   Here's what I learned, although I will qualify my impressions with the fact that China is a large and diverse country and my visit was limited to Beijing, Hangzhou, and Shanghai.

There are over 500 vendors of EHR products and no market leader.   Many applications are home built or created by small, local companies which address the specific workflow needs of a single healthcare facility.    There is not a specific national healthcare IT policy, but there is recognition of the need for national interoperability standards and an incentive to use them.    Something like a certification program and meaningful use program may evolve.    There are many proprietary approaches to interoperability currently in use, and HL7 CDA is seen as a possible candidate for summary exchange.   Vocabularies such as SNOMED-CT, ICD9 or 10, and LOINC are not yet deployed but there is an understanding of the need for terminology services and an eagerness to work with US companies proving such services.  There are  pilots of healthcare information exchange, generally using a central repository model.   I asked an audience of 1000 people if they had ever used a PHR, and not a single hand was raised.   There is a desire to engage patients and families but no products in the marketplace yet.

The challenges faced by China include a population of 1.35 billion people, environmental concerns (air/water/land), an aging population, a significant migration of citizens from rural to city life,  and an increase in cancer/birth defects/respiratory diseases as a side of effect of rapid industrialization.

I look forward to next steps, which I hope include interoperability policy planning at the national level.  I've forwarded several US policy documents to the Chinese government and remain eager to work on Meaningful Use for 1.3 billion people and 20,000 hospitals.

Japan - Japan has broad healthcare coverage with a mixture of universal insurance and self pay.  This article nicely summarizes the economic issues.

There are a few large companies providing EHRs in China - Fujitsu, Mitsubishi, and NEC.  Hospital IT is frequently outsourced to such companies.   EHRs are typically client server architectures.   The web has not been widely embraced for EHRs, PHRs, or HIEs because of privacy concerns, but a few cloud computing pilots have been successful including an EHR for first responders in Fukushima.    There have been pilots of data sharing such as the Dolphin project in Kyoto and planning for PHR implementation.  

The challenges faced by Japan are an aging society, declining birth rate (1.4), lack of coordination of care because patients have access to any hospital/urgent care/clinician office on demand, creating a fractured record, and privacy policy that makes interoperability difficult.   Standards are emerging and there is an understanding of the need to use summary formats like CDA and controlled vocabularies.     A national policy requiring interoperability standards and encouraging data sharing with patient consent would significantly enhance quality, safety, and efficiency in Japan.

The government of Japan has recently changed and I'm told Mr. Abe will embrace innovation in healthcare IT as part of his economic recovery package.   Just as with China, I'm eager to help with a certification and meaningful use program, serving the 126 million citizens of Japan.

Taiwan - Taiwan has universal healthcare coverage with a mixture of universal insurance and self pay.  This article nicely summarizes the economic issues.

As with China, there are many small companies selling EHRs to local hospitals and clinician offices.  There's a long tradition of self-built systems as well.

Also, like China and Japan, most EHRs are client server, with little use of the web.

Privacy concerns restrict remote access, but I found the Taiwanese much more willing to embrace the internet and offer support for mobile devices, restricting information flows only to international locations because of privacy laws.

The hospitals I visited in Taiwan were high volume - 10,000 outpatients a day.  They implemented industrial process automation to help manage patient flow, laboratory specimen labeling, and medication dispensing.   I was impressed by their degree of EHR and ancillary system support.    Health Information Exchange and Personal Health Records are not widely used but there is a recognition of their importance for care coordination,

The challenges faced by Taiwan are an aging society, declining birth rate (.9), and ‘doctor shopping’ – patients visiting numerous practitioners simultaneously because of easy access to care at any facility without a primary care gatekeeper, creating a fractured medical record.

I look forward to further collaboration with my colleagues in Taiwan, helping create interoperability policy and technology to serve 23 million people.

In 12 days, I took 15 flights and worked long days to spend nearly 200 hours with government, academic and industry leaders.   I learned more than I taught.   Each country has its own unique history, culture and people.   However, the challenges of healthcare IT are very similar all over the world and the evolution that is taking place in our lifetime will ensure that Asia moves closer to the goal of  electronic health records for every citizen.

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Losing the Popularity Battle, but Winning the Career War

CIOs are typically not very popular and are not known for their charismatic leadership i.e.

How do you distinguish an introverted CIO from an extroverted CIO?

An introverted CIO stares at his shoes.   An extroverted CIO stares at your shoes.

In the past, I've been able to achieve reasonable levels of popularity through rapid innovation and responsive agile application development, often delivering discretionary projects to individual departments.

As I navigate FY14, creating project plans that allocate resources and time, it's clear that I cannot deliver any discretionary projects.   If the Main Thing about leadership is To Keep The Main Thing The Main Thing (Stephen Covey) then I have no choice to but to keep IS resources focused on the Federal regulatory agenda that has been prescribed for FY14 and nothing more.

Now that I'm back from China/Japan/Taiwan, I will accelerate my efforts to communicate with stakeholders at all levels that the Federal government has set the strategy for healthcare IT departments in FY14 and as unpleasant as it sounds, IT management and healthcare stakeholders really have no flexibility to prioritize departmental projects.    Here's what I mean:

ICD10 - this federal requirement is pass/fail and involves the entire inpatient/outpatient revenue cycle.   Every piece of software, workflow, and process needs to modified.    It will cost the country billions, have limited benefits, and should be considered high risk, given the coordination needed among payer/provider organizations.   It's bigger than Y2K for healthcare and has a firm October 1, 2014 deadline that no one in government is willing to change.    Assume ICD10 will consume a majority of your IT resources for the next year.

Meaningful Use Stage 2 - this federal requirement is focused on stimulus in the short term, but penalty avoidance in the long term.   Hospital margins throughout the country are slipping, so it's very hard to turn down millions in Medicare/Medicaid stimulus.    ICD10 trumps Meaningful Use work, but hospital management really expects IT departments to deliver Stage 2 Certified software for everyone to use.   Eligible professionals who have already attested to stage 1 are looking to IT departments to provided updated  software so they can attest and claim the remainder of their $44,000 stimulus.    Meaningful Use Stage 2 has a 2014 deadline for hospitals and clinicians who attested to Stage 1 in 2011.

HIPAA Omnibus Rule/Compliance and Audits -  not a day goes by without a new audit by someone - OCR, OIG, DPH, internal, CMS.   I've heard that some IT departments are hiring full time staff just to respond to audits.  As with ICD10, these audits have limited benefit and consume resources that would have been applied to innovation in the past.   However, the work must be done.

ACA - The Affordable Care Act has required many new IT applications - health insurance exchanges, health information exchanges, quality registries, care management systems, and business intelligence infrastructure.  The Affordable Care Act required work is likely to improve efficiency and value in American healthcare.   However, the work displaces departmental priorities by consuming resources that might have been applied to local workflow enhancement projects.

Business imperatives with deadlines that cannot be missed - Healthcare reform has spawned a flurry of mergers and acquisitions that include fixed IT deadlines such as opening a building, extending networks, installing phone systems, merging clinical data, and expanding email coverage.  Although these are beneficial, the effort to support mergers and acquisitions takes resources away from optimizing local workflow and infrastructure.

What is the implication for CIOs?   Spreading a message that ICD10, MU2, HIPAA/Audits, ACA, and mergers have consumed all available IT resources for the next year is not going to be popular.   I truly expect many stakeholders to acknowledge that these priorities are reasonable as long as their departmental needs are also met.   The needs of the many are good as long as they don't outweigh the needs of the few.   Unfortunately, the answer for the next year needs to be "not now" if institutional survival is the main thing.

So over the next few months, I expect my waning popularity to wane even further.   I will lose the popularity battle.   However, when the regulatory mandates are done and the institution's longevity is assured, my career will be intact.   Losing the popularity battle but winning the career war for the benefit of the institution sounds like right long term strategy but certainly will require strength of will, a thick skin, and constant communication.

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Clear Up Your Acne With These Simple Steps (clouie reyes)

It's horrible waking up to see a large, red spot on their face. Fortunately, with the right advice, it is much easier than you think to keep your acne under control. This article contains a number of tips on acne that will you help on your way to being acne-free.

If you're having acne problems, make sure you are not scrubbing your face too hard when washing. Since acne is caused by a build up of oils, not dirt and grime, you do not need to scrub your face. Rather, if you scrub your face all you do is irritate the skin and make problems worse.

Although acne is the subject of many jokes about teenagers, it is a condition that negatively affects the self-esteem and psychological well-being of many young people. If you are a parent who would like to help your child deal with the emotional aspects of acne, there are resources available to help you with this process. Finding a reputable dermatologist who is trained to recognize the psychological effects of skin conditions is an important first step in relieving both the cause and the result of the acne. A counselor or psychologist can teach your teen how to cope with his or her feelings and alert you if the child is having any thoughts of suicide. Find out if there are any acne support groups in your area or search for an online forum for acne sufferers, that you and your son or daughter could join together. These precautionary measures could turn your despondent youth into a happy, carefree teenager again.

It is important to reduce your stress levels if you are having difficulty getting rid of acne. Stress causes skin problems, so teaching yourself how to relax can cause a dramatic improvement in the way you look. Try exercising or using a breathing exercise to reduce your stress levels.

Wash your face immediately after working out or after you have sweated profusely. If you are absent from home for many hours of the day, you need to carry wipes with you on the go. This way, you will be able to clean bacteria and impurities easily. It is important to continue using your cleanser every morning rather than using wipes.

In the winter, try to avoid places that typically contain dry air. When there is little moisture in the air you are around, there is a good chance for your skin to react negatively and dry out. This can lead to excess acne and red blemishes, due to the irritation that dryness causes.

Instead of investing in an expensive cream for acne, look around at products you already have that may help alleviate breakouts. At night before you go to bed try dabbing a small amount of toothpaste, yes toothpaste, on your blemish. This will help you resist the urge to squeeze the pimples, and you will wake up with lessened redness and irritation.

For people with excessive acne or acne scars, it is wise to visit a dermatologist. They can have methods of helping to clear and prevent acne that cannot be bought in a store. Also, they can prescribe special creams and lotions that a person can use daily at home.

Hydrocortisone is a very effective natural treatment for acne. It will reduce the redness of any zit or cyst that you have. Do not use it too often or use too much of it. It can cause your skin to dry out and make your problems worse than they were before.

Like the beginning of this article mentioned, having acne is an unpleasant and dreaded experience. However, for those in the know, controlling acne and having beautiful skin is much easier to achieve than you might think. Use this article's advice and you will be well on your way to being free of acne.

If you are seeking for ways about acne free diet, then you can ask your doctor. You can also find other recommendations online.

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Building Unity Farm - The Poultry Grows Up

Last week I described our first year as farmers.   Just as we've grown, our animals have grown.

We started with 13 chicken chicks.   One was eaten by a hawk (Silver) and one died of egg impaction (Sunny).   The remaining 11 are happy and healthy, finishing their molt and preparing for winter

We started with 22 guinea fowl chicks.  11 have been eaten by predators because they have stayed out overnight sitting on nests or explored places they should not (fox dens, fisher cat habitat etc.).   However, we hatched 100 guinea fowl in August and kept 20 for ourselves.   They're now 8 weeks old and just about ready to leave the coop.   One alpha male (Mojo) was clearly very busy because 17 of the new guineas look just like him.

We received 10 ducks just 3 weeks ago and they've grown remarkably.  They enjoy eating a water soaked romaine lettuce and often stand in the bowl.   They live in a duck pen and spend the night in the duck house where it is warm.   Ducks don't care about wetness, so rain is not a motivator to go inside.    In another few weeks we'll let the ducks out to run around the property.  

Raising poultry is a remarkable experience.   All the chickens have distinct personalities and mannerisms.   There is definitely a pecking order.

Guineas are truly amazing to watch as they run around our 15 acres in search of ticks, worms, and other insects to eat.   They're excellent fliers and serve as a great alarm system, squawking whenever predators come close.  Their only downside is that are not skilled at survival in New England.   I'm sure that staying outside at night works in West Africa, but in the forests of New England, coyotes, foxes, raccoons, fisher cats, and weasels want nothing more than to eat Guinea fowl.

Ducks are remarkable.   They grow fast, live for water, and have distinct temperaments.  Some of ducks are calm, some of our ducks are nervous.  When we let the Indian Runner ducks out to circulate the property, it will be fascinating to see how they react to our wetlands.

At present we have 52 birds heading into the winter.  Hopefully all will survive until Spring.

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Attestation verses Certification for HISPs

Of all the Meaningful Use Stage 2 questions I'm asked by vendors, HISPs, and providers, many involve confusion between certification and attestation.

As I've written about several times, the certification criteria are so extensive, often in unnecessary and confusing ways, that few vendors have been able to get through them.   Certification criteria exceed attestation criteria in many scripts.

I was recently asked about transition of care data exchange using Direct and the need for message delivery notification (MDN).   Micky Tripathi wrote the following excellent analysis, the bottom-line of which is that MDN is a narrow certification criteria, not an attestation requirement.   In the future, I think certification must be simplified to include the bare minimum necessary to support attestation.     Many people on the Standards Committee feel the same way and we'll support whatever polishing strategy ONC deems appropriate.

Micky wrote:

"1)  Organizations with self-developed systems may depend on a HISP as part of their certification, but organizations with vendor-based EHRs will not
a.   Although organizations with self-developed systems may chose to use the HISP as part of their alternative certification, most organizations will rely on their EHR vendor's complete certification
b.   For example, for Beth Israel Deaconess Medical Center certification, the HISP, acting as modular certified technology, needs to generate MDNs in response to incoming messages.
c.   For everyone else, the HISP does NOT need to generate any type of MDNs.  Sending providers only need to have reasonable assurance that messages sent via the HISP have been delivered to the intended recipients.

2)      There are three requirements that are relevant here:  the transitions of care attestation requirement, the technology certification for receiving messages, and the technology certification for creating/transmitting messages:
a.       The Meaningful Use Stage 2 transitions of care attestation requirement is that “the summary of care record must be received by the provider to whom the sending provider is referring or transferring the patient” (see page 4 of the measure)
b.      2014 Edition certification requires that an EHR be able to receive a Direct-compliant message and send an MDN for successfully received message (see page 5 of the NIST test script)
c.       2014 Edition certification requires that an EHR be able to transmit a Direct-compliant message to a Direct address recipient.  There is no MDN requirement on the transmission certification.  (NIST test script).

3)      The MDN requirement is SOLELY a certification requirement (it is NOT an attestation requirement) and it applies only to the requirements regarding receiving messages.  There is no certification requirement for MDN in transmission transactions.  There is no attestation requirement for MDNs (or any other technical means) to demonstrate assurance of receipt of transmitted transitions of care.
a.     While attestation does require that the intended recipient actually receive the message, there are no requirements on what type of assurance the sending provider must have in order to meet the Meaningful Use transitions of care measure.  Indeed, the ONC commissioned white paper on the topic of assurance states that:  “It is up to the Certified EHR Technology vendor to determine how to assist its customers and provide them with assurance that transmissions have reached their intended recipients.  This assurance could include a presumption of success on the provider’s part of subsequent transmissions if they have reasonable certainty that initial transmissions were successful.”  (see page 2 of the white paper)

4)      The MDN issue thus applies only to organizations that are using alternative certification and using the HISP as relied upon software because they need to be able to meet the “receive” and “create/transmit” criteria.  It does NOT apply to users who are using off-the-shelf Certified EHR Technology to transmit Direct messages over the HISP.
a.      Any other organization with off-the-shelf Certified EHR Technology which wants to use the HISP for transitions of care transmission does NOT need the HISP to be certified
b.      Their own Certified EHR Technology will generate a Direct-compliant message and pass it to the HISP for delivery
c.       The sender will have met their transitions of care requirement at this point as long as they have reasonable assurance that the HISP delivered the message to its intended recipient
d.      This assurance could be provided by MDNs delivered back from the receiving EHRs, but it does not have to be, and indeed, since recipients are not required to be Meaningful Use compliant, many recipients won’t be able to generate an MDN anyway
e.      In any case, it is NOT a HISP responsibility to generate and transmit MDNs back to the sending EHRs (except in the case where the HISP is acting as relied upon software for alternative certification)

5)      Some organizations may want the HISP to be certified for their attestation purposes.  For the purposes of attestation, the HISP will be certified ONLY for “generate/transmit” and NOT for “receive”, and thus it has no obligation to create MDNs
a.       In order for the HISP to receive modular certification for “receive”, it would have to be able to display CCDA documents, accurately match patients, and consume structured information for medication, problems, and medication allergies.  That would require that the HISP to include EHR features beyond the scope of HISP operations.
b.      Any organization that would like to attest with the HISP could thus only use the HISP for the “generate/transmit” requirement.

6)      Regardless of whether the HISP is used as just a conduit (#4) or as a certified module for transmission (#5), the HISP does need to provide some type of assurance of delivery back to the senders
a.       The current plan for the Massachusetts State HISP is to send back MDNs to provide assurance of delivery, which is ideal – however, it is NOT required
b.      The HISP could assure delivery by contract such as a service level agreement
c.      And/or the HISP could make available transaction audit records back to senders periodically or on-demand"

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Dispatch From a Mysterious Island

Whenever I travel on business, I try to take a few hours to explore the road less traveled.   Whether that's climbing Mt. Fuji, hiking the Aonach Eagach ridge in Scotland, or crossing the Baltic Sea in a kayak, there's always an adventure to be found.

During my current Asia trip, I sought the help of several friends in Japan to arrange the trains, planes, and boats that would bring me to the shores of Yakushima, Japan's first World Heritage site, to explore the island's cloud forest and volcanoes.   Some of my colleagues who've heard about Yakushima, call it The Mysterious Island after the Jules Verne novel of the same name.

If I were to design the perfect Mysterious Island, here are the characteristics it would have:

1.   The approach should be difficult and ideally involve a small plane flying through miles of cloud cover with no visibility.    Check, did that.

2.   Ideally, crossing an active volcano should be involved.   Check, did that.

3.   The forest should be ancient, filled with giant trees over 5000 years old.   Check, Yakushima is filled with Yaku-sugi, cedar trees that are thousands of years old with circumferences exceeding 30 feet

4.   Make it wet so that the entire forest is covered with moss and waterfalls.   Check, Yakushima has the highest rainfall in the world, over 30 feet per year.

5.  Put it in the track of many typhoons to make staying there exciting.  I just flew from the island into Typhoon Wipha - the photo below shows the swirling vortex of the storm creating a strange split level sky.  My hiking clothes are saturated despite total body Gore-tex.

6.  Make it dark and misty with 6000 foot cloud-covered peaks topped with snow in the winter.   Check, here are a few shots of the cloud forest I hiked.

7.   Fill it with unusual animals, insects, and birds that are found nowhere else in the world, including miniature deer and walking sticks that look like a cross between a centipede and spider.  Check.   It also has leeches, giant hornets, enormous spiders, venomous centipedes and poisonous snakes

8.  Add monkeys, it must have monkeys.  Check.  Yakushima has its own species of Macaque Monkey

9.  Give the plants an almost human look with long finger-like roots. Add vines and exotic flowers.  Check.

10.  Add forest spirits.   Admittedly, that only happened in the movie inspired by Yakushima, the Miyazaki anime called Princess Mononoke.   Almost check.

My visit to the Mysterious Island included 20 miles of hiking/climbing with a 6000 foot elevation gain including scrambling over moss-covered rocks during a typhoon.  I stayed in a wonderful place called  Wa no Cottage Sen-no-ie  handcrafted of cedar.  I highly recommend staying there if you visit.  The people who run it are remarkable and speak English.

I think a visit to Yakushima qualifies as the road less traveled.   Priceless.

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Building Unity Farm - Reflections on our First Year as Farmers

While I'm traveling in Asia, my wife Kathy is running the farm, ensuring that all our animals are healthy, our last few harvest duties are done, and our preparations for winter have begun.

Before I left, I did everything possible to minimize her tasks.   I installed heating panels in the duck house so that she could move the duck babies from the brooder to the outside world.   I harvested mushrooms from all our fruiting logs.  I added yeast and nutrients to our fermenting apple cider.  I secured all our gates, cleaned the barn, and finished moving all our building materials into the hoop house.

Thinking about the past year, we're well on our way to a productive, self-sustaining farm.  Here's a status report

Mushrooms - we've gathered our first 25 pounds of oyster mushrooms from 144 poplar logs stacked in two forest locations.   We've finished inoculating Shitake spawn into 165 oak logs housed in the shade house plus 110 logs in the forest.   We've inoculated 10 logs with Lion's Mane.   Next year we should have commercial quantities of mushrooms to sell.

Bees - Our 8 hives built up their honey stores all summer , despite our harvesting of 160 ounces.   Our queens are healthy and the bees are disease free as we head into winter. Given the strength of our hives, we should substantial honey harvests next year.

Apples - we've placed an order for additional trees to add to the orchard in 2014
3 Kingston Black
1 Ashmead's Kernel
1 Newtown Pippin
1 Golden Russet
2 Wickson's Apple
1 Nehou
1 Baldwin
1 Blacktwig

bringing our total to 40 apple trees.   This year we crushed 250 pounds of apples and fermented enough juice for 75 bottles of still and sparkling hard cider.  Above is a look as the fermentation in progress.   In five years, we'll have nearly 7000 pounds of apples per year for eating, selling, and cider making.

Blueberries/Raspberries/Elderberries - our planting of 180 high bush/150 low bush blueberries and placement of permanent bird netting is complete.   The blueberries already yielded a few pounds, but we should have hundreds of pounds within a few years. The raspberries and elderberries should begin producing next year.

Alpaca/llama - Our 11 alpaca and 1 llama are in perfect health.  Two are pregnant.   They understand the routine of monthly "herd health" checkups and trust us to handle them with respect and gentleness.  The barn is fully stocked for winter with all the hay we need to last until next hay season.

Poultry - our 11 chickens, 31 guinea fowl (11 adults and 20 babies), and 10 ducks are completely adapted to their surroundings and the routine of going into their coops at night for protection.    Pecking orders are established, and our poultry community lives in harmony, eating wild foods throughout our 15 acres every day.   Our baby ducks are shown below.

Dogs - Our two Great Pyrenees are now fully grown and protect all our animals.  Admittedly since they weight nearly 200 pounds together, running with them (I weigh 165) can be an adventure

Hoophouse and Vegetable Garden - Our year round indoor and outdoor vegetable gardens are now complete along with watering, fertilizing, and harvesting infrastructure.   We'll grow lettuce, kale, and spinach all winter long.  Next spring we'll plant enough crops to supply half our food.

It's been a great first year on the farm and the daily activities caring for the animals/plants has become so integral to our lives that travel away (like my current responsibilities in Asia) seems completely out of balance.

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Dispatch from China

This week I'm in Asia providing advice to government, academic and industry leaders about leveraging IT investments to accelerate quality, safety and efficiency policy goals.

I flew from Boston to Beijing on Monday to Tuesday and met a team of Chinese industry leaders on Tuesday evening to discuss their plans for smart cities, home care, and wired hospitals.

On Wednesday, I joined several colleagues to celebrate the opening of a new state of the art ambulatory care facility for women and children.  They are implementing EHR products to automate clinical and administrative workflows including provider order entry.   Mitch Rabkin and I keynoted a conference describing the US experience with healthcare reform and healthcare IT reform.

On Thursday (I'm a day ahead because of the 12 hour time change), we met with central government officials including the health minister of China.   We discussed a collaboration that would enable US and Massachusetts experiences to inform Chinese healthcare policymaking.  Of particular interest to them is our HIT Standards and Certification program to enhance care coordination, patient/family engagement, and population health.   As I wrote about yesterday in my post offering advice to the new national coordinator, I look forward to considering the revisions needed in our regulations to highlight the good and minimize the burdensome.   We have a great opportunity to apply our revised regulations to 1.3 billion people in China!

On Friday, we'll run a symposium on healthcare IT and care management in Hangzhou.   On Saturday we'll have meetings with government leaders in Shanghai.

Then on Sunday, I head alone to Japan for the next phase of my trip, serving as guest professor in Kyushu, the southern part of Japan and keynoting in Taiwan before returning to Boston.

One of the great aspects of working in Asia is that the 12-13 hour time change enables me to have a full day with colleagues in China/Japan/Taiwan then have a full day with colleagues in Boston.   Keeping a 24 hour a day schedule for two weeks will require a bit of recharging, so while in Japan I am taking a day to climb 6000 foot volcanos and hike the wilderness of Yakushima island, one of the great ancient forests in the world.   As I dash from Asian city to Asian city, my carry-on baggage contains my full body Gore-tex, enabling me to tackle the 10 meters of annual rainfall in the wettest location of Japan.   Probably the only downside to the remarkable beauty is the predominance of giant leeches.    You only live once.   I'll post pictures.

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Clear Skin Secrets- eBook by Chris Simmons (Seriously, READ THIS eBOOK!)

This has been by far the most helpful eBook that I've found.  This is another eBook that I came across while researching all natural remedies, treatments, and cures for acne. 

This book was written by Chris Simmons, a world renown nutritionist and skin expert.  Chris also suffered acne for 14 years, so he has plenty of personal experience.

This eBook provides you with a guide on how to cure your acne in two weeks, guaranteed!  What I really enjoyed about this eBook was the fact that it is a no-nonsense guide on what WILL help with acne and what could possibly causing your acne...like certain foods, soaps, products, etc. 

If you're looking to go the natural route with your acne, this should be the first eBook that you read.  It's detailed and gives readers a step-by-step guide.

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The 14 Days Acne Cure- eBook

This eBook was written by a prior acne sufferer.  The eBook covers information on how to cure your acne naturally, in just 14 days! 

This breakthrough natural acne cure guide does what all the other treatments and medications that have failed you in the past DON’T do, which is provide you with an all-natural remedy that gets below the surface of your acne symptoms and aggressively attacks acne head-on and prevents your symptoms from reforming again.

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This eBook was an excellent guide for me when I started looking into all-natural alternatives for treating and preventing acne.  I highly recommend that you check it out if you're interested in going the all-natural route for your acne.  The information is priceless if you want to get rid of your acne.

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The Best Makeup for Acne Prone Skin

When you have acne prone skin it can be difficult to find makeup that doesn't worsen the problem.  Most makeup products have harsh and/or harmful ingredients that can cause breakouts, clog pores, or irritate your skin.  So, what's the best makeup for acne prone skin?

When choosing makeup products try to opt for natural makeup products.  Why?  Well, products that are made with natural ingredients will have less harmful chemicals and irritants, which means they are less likely to cause or worsen breakouts.  You also want to avoid makeup that contains added oil or SPF.  Both of these things can clog pores and lead to breakouts.  If you need SPF, try to find an all natural SPF and us it separately from your makeup.  Look for "oil free" on the product labels.  Since people with acne are prone to clogged pores, it is important that your makeup products are non-comedogenic.  This basically means that it will not clog your pores.  So, to sum it all up:

• Choose all-natural as often as possible
• Opt for oil-free makeup products
• Avoid added SPF
• Always be sure to use non-comedogenic products

So, what is the best makeup for acne prone skin?

Let's go over some of the best makeup products for acne prone skin....

Juice Beauty- Organics to Clear Skin

Juice Beauty is an amazing line of makeup and skincare products that are certified organic and all-natural.  They have organic foundations that are fruit based, how awesome is that?  Their Perfecting Foundation is a combination of organic aloe juice, fruit extracts and minerals which provide a cream to powder finish that will wear all day, while giving you a perfect airbrushed look and feel.

They also have an organic Blemish Clearing Powder.  This blemish clearing powder provides on the spot concealing that soothes, calms and clears blemishes with bamboo, minerals and certified organic fruit extracts leaving your skin healed and concealed. 

In addition to their powders and foundations they also have cheek colors, lip balms, and eye shadows that are all organic and all-natural.

To shop all Juice Beauty products, including their blemish clearing skincare line which includes cleansers, blemish serums, and masks, check out the Juice Beauty website.

100% Pure Skincare Product Line

This makeup line is another great all-natural, 100% pure product line of fruit pigmented makeup and skincare products. The 100% Pure fruit pigmented foundations, concealers, and powders are:

100% natural, 100% vegan, gluten free

Colored with fruit and vegetable pigments instead of minerals or synthetic dyes

Hydrating formula evens out skin tone and conceals imperfections

Natural SPF

Light to medium coverage

Antioxidants protect against environmental damage

100% Pure carries foundations, concealers, blushes, powders, lip gloss and balm, and eye shadows that are all fruit based and free from harmful ingredients so they won't irritate your skin.  Check out the 100% Pure website to browse their makeup and skincare products.

Other makeup lines that are great for acne prone skin:

Neutrogena Naturals
Physicians Formula Organic Wear makeup
Jes Organics
Burt's Bees Products
Kiss My Face
Ecco Bella

All of the makeup products shared above are mostly (if not completely) all-natural.  They don't contain harmful chemicals and irritants that most other makeup products may contain.  If you're looking for the best makeup for acne prone skin, check out some of the brands mentioned.  The price will vary from one brand to the next, so find one that is affordable for you!

Have suggestions on what the best makeup for acne prone skin may be?  Leave your comments to help others!

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