Pages

Building Unity Farm - The Heat of Summer


In 2013, Boston had a wet spring and is having a very hot, humid Summer.   The 90 degree temps with
90% humidity typical of August arrived in June and July.   Last weekend, the discomfort index rose to 107F as temps soared to 93 with nearly 100% humidity for 5 successive days.

 Alpaca and Llama live in the Andes and are accustomed to dry, cold weather.  Great Pyrenees live in the alps and prefer cold snowy conditions.   Our chickens are optimized for the cold winters of the Northeast.  How do we care for a group of animals which would be happier in the Arctic than the tropics when the temperature feels like 107F?

 I wrote about water management last week and the various ways we have of keeping our paddocks and pastures moist.   Those same low flow rotors keep the alpacas cool in Summer.  Just as children run through sprinklers and gushing fire hydrants to cool off in Summer, the alpaca flock to flowing water, rolling in it, sitting on it and reveling in the cool of a water soaked belly.   Once they're drenched they roll in fine dusty soil to create a cooling layer of mud on their fiber.

Last year we mounted large barn fans in each stall and the animals compete for prime airflow spots.

We have 5 gallon buckets of fresh water hanging through the barn and paddock areas.

The chicken coop has a shaded 20x20 outdoor run, a large barn fan, two water supplies and windows to keep air circulating.

The dogs are a bit tougher.   We gently spread water on their heads and faces, but Great Pyrenees are not drawn to swimming.   Instead they dig wallows (pictured above) in the shadiest areas of the paddock.   The soil around the irrigation rotors is soft and moist.  They dogs dig foot deep dog sized holes and curl up in them to stay cool.   They have morning wallows and afternoon wallows, changing location as the sun tracks through the sky and alters shade patterns.

The bees work hard to keep the hives cool.   This week we added "supers" - a second story to the hives which provides an "attic" of insulation over the primary hive.   We keep a rock filled basin topped off with water nearby so they can access hydration.  Worker bees sit at the entrance to the hive and keep the entire colony cool by flapping their wings in unison, creating a natural fan.

The mushroom farm is in the shade house underneath a grove of pines, out of the heat of direct sunlight.

 For the humans, we recently pressure washed the 18 year old air conditioning compressors and replaced all the filters in the air handlers, so we're cooling the bedrooms as efficiently as we can.   In future years, we'll likely replace the air conditioners with heat pump technology.  Today's most advanced heat pumps match the efficiency of geothermal at a fraction of the cost.

This is our second heat wave of 2013.   So far, all the animals of Unity Farm have enough options to stay cool enough, if not perfectly comfortable.   I look forward to the cooler weather forecasted for next week.   Now that we've lived at Unity for every season, we're ready for whatever nature may bring.

reade more... Résuméabuiyad

4 Things to do and 4 Don'ts in the treatment of acne

Acne treatments do not always find on the counter and they do not always have to be prescribed by a doctor. The best way to treat acne is actually treated of in. Here are 4 things to do and 4 Don'ts in the treatment of acne from the inside.

4 Things to do:
1. Increase your consumption of fruits and vegetables. These natural foods that are loaded with vitamins and minerals are the best fighters from acne autour. For example, vegetables with leaves green and orange or yellow fruits are rich in vitamin a. vitamin A prevents the overproduction of sebum that is what causes acne. Oranges, strawberries, broccoli, peppers and lemon juice are rich in vitamin C foods that are also great acne treatments. Eat these types of foods fortified the defense system of the body against microbes that cause acne and AIDS more rapid healing of acne. In addition, vitamin C helps your body to restore its sources of vitamin E, which is essential to revitalize the skin and repair damaged skin.

2. Do drink plenty of water. Make sure that you get recommended 8-9 glasses of water per day. Drink plenty of water not only replenishes the body's water supply, but also flushes out toxins from the body which can cause acne.

3. Don't relax. Stress, anxiety and pressure can disrupt the natural balance of your body and cause problems such as acne. Avoid acne and skin problems occur you relaxing. Get a massage, go to the spa, take a long bath, getting enough sleep, or simply manage your time and calendar better are considered as acne treatments because they reduce stress inducing acne.

4. Have a skin care routine. Nip in the bud an acne problem by establishing a daily face wash, toning and moisturizing regime from the beginning. The non-comodegenic skin care products are specially formulated for sensitive skin with acne.

Now for the 4 Don'ts:
1. Not to touch your face unnecessarily. Touch your face, especially with dirty hands and fingers, could cause and worsen an acne problem. It also means choosing, squeeze, crush or rub the acne. This will traumatize the skin and make the slow healing process. It could also lead to unwanted acne scars and blemishes.

2. Do not consume sugary foods or sugary drinks. Keep away you cakes, biscuits, chocolates, candies, soft drinks and everything was refined sugar as the main ingredient. Sugar clogs pores and dries out the skin, which are the two main causes of acne.

3. Do not oil-based products. With acne, skin is already battling an overproduction of oil (sebum) in order to not aggravate the problem by using oil-based products. Beware of typically oily products such as creams, moisturizing creams for the face and including hair gels. Hair often gets face and hair products would certainly affect the skin on the face. There are many acne treatments and products water based and therefore softer and more suitable for acneic skin.

4. Do not scrub or exfoliate the skin with acne. Rough treatment of the skin with acne cause inflammation of the skin and aggravate the problem of acne. In addition, do not harsh chemicals, SOAP or cleaners on sensitive skin with acne.

Acne treatments are not limited to creams and gels that you purchase from pharmacies. You can effectively treat acne just simply to take care of your body.

 
reade more... Résuméabuiyad

10 Best acne Home Remedies

Do not look beyond the comfort of your home to treat acne problem. Your own kitchen is a rich source of breeze of acne. Below you will find 10 of the best home acne remedies that have been tested and proven effective by people

1. A simple way to bring down the swelling of acne is to put ice top. Ice not only reduce inflammation, but also reduces the size of the pores. Gently rub little ice on the face before going to bed.

2. The humble potato is one of the best home acne remedies. Grate a potato and apply it to the area for 30 minutes. Potatoes have acne incredible reduction in the swelling properties.
3. Puree about half a cup of a papaya and use the pulp as a facial mask. Leave it for 20-30 minutes before rinsing. Papaya fruit is an excellent source of vitamin a. This antioxidant vitamin inhibits the overproduction of sebum, which is the main causes of acne.

4. Mix the fresh milk with some ground nutmeg and apply the mixture directly on acne. The combination of milk and nutmeg does wonders for acne.

5 Crush some garlic and daub gently on acne several times per day. Garlic juice can also be applied on the face. Maybe it's not nice smell but many people swear that what garlic is one of the best home acne remedies that they tried.

6 Vinegar mixed with salt is a great facial scrub. Gently rub the vinegar and salt scrub on your face and leave it on for half an hour before washing. You can also use the clear apple cider vinegar as a facial cleanser. Put vinegar on a cotton ball and use it as you would with a toner.

7 Mint is another popular medicinal herb that effectively fight against acne. Crush some mint leaves to get juice and apply directly to the skin.

8. The lemons are loaded with vitamin C which stimulates the immune system. A strong immune system is essential in the fight against acne and other infections. Mix a lemon juice with rose water and apply with a cotton swab. Let skin absorb the lemon juice and rosewater for about 30 minutes. Make 2 - 3 times per day.

9 Cucumber can be used in various acne home remedies. Cucumber juice can be considered as a drink or applied directly to the face with a cotton. A paste is also out cucumber to be used as a mask.

10. The fruits that have a lot of acid are of large masks of the anti-acne face. Mangoes, Grapefruits, oranges, lawyers and tomatoes are rich in acid that helps treat acne problem. Combine a paste of the any of these fruits with oatmeal of oil absorption. Leave the Paste on the face for at least 20 minutes. Rinse with cold water.

These tried and tested the best acne home remedies show that acne treatment doesn't have to be difficult or expensive. These simple treatments that are rich in vitamins and minerals can help you naturally achieve healthy, glowing skin without acne.

 
reade more... Résuméabuiyad

The Innovator's Challenge


I've written many blog posts about our efforts along the path to ICD-10 that will enhance our inpatient clinical documentation.  We're hard at work planning the improvements we think are foundational to support care coordination, compliance, and quality measurement goals.

It's very challenging to create tools which simultaneously enable rapid, accurate, and complete clinical documentation.   We've deferred radical redesign of inpatient documentation for several years awaiting the alignment of technology, policy, and urgency to create the perfect storm for innovation.

BIDMC has had many firsts - early personal health record adoption, first in the country attestation for meaningful use, innovation in the use of web-based provider order entry, rapid adoption of iPads, and one of the first vendor neutral image archives.

Sometimes we're a leader and sometimes we're a follower.  Deciding which to be is the innovator's challenge.

BIDMC decided to ignore the entire client/server era in the mid 1990's.   As others were creating Visual Basic, Filemaker Pro, Delphi, and Access front ends to applications, we continued the use of roll and scroll terminal emulators.  When the web appeared, we jumped in with both feet and moved all our clinician facing applications to thin client, cloud hosted, web-service architectures in 1998.  That approach has served us well.   It still feels modern in 2013.

Recently we completed the implementation of a next generation electronic medical administration record (EMAR) using iPhones, iPads, and an Amazon-like shopping cart motif for choosing medications.   In the past, other organizations were first with EMAR designs, but they had to use computers on wheels and cumbersome user interfaces because the technology was not quite ready for a more streamlined approach.

We feel the same way about clinical documentation.   Offering clinicians an enhanced word processor does not result in orderly, complete, and readable documentation.   On the other hand, forcing structured input of every clinical observation may yield high quality data but usability will be poor.   We're working with 4 different companies to create next generation documentation tools that we think will benefit inpatient documentation the same way that waiting for the iPhone/iPad benefited EMAR.

Characteristics of this new approach include

*Natural Language Processing - the ability to prospectively or retrospectively identify key concepts in unstructured text
*Clinical documentation improvement - the ability to pop up templates just in time that offer structured input in the middle of unstructured text i.e. laterally and specific bone names for fractures
*Vocabulary crosswalks - linkage between problem lists, documentation, and billing diagnoses based on mapping SNOMED-CT to ICD-9,ICD-10, and CPT.
*Metadata markup - near real time SNOMED-CT markup of unstructured data so that structured clinical concepts are embedded within typed or dictated documents
*Computer assisted coding - suggesting ICD-10 codes to clinicians or coders based on the markup in current notes combined with structured data extracted from past notes

Also, we've considered social documentation  (group authoring) and patient generated data.

As with many IT innovations our stakeholders will feel that we lag existing commercial products while we're in the midst of developing these new ideas.   However, once we go live with the finished product, incorporating cutting edge built and bought technologies, no one will remember the days of the hybrid medical record that today includes many electronic features but paper-based progress notes.

Although the paperless hospital is about as realistic as the paperless bathroom, we will substantially reduce paper on our inpatient units in the next 18 months.  As a CIO, I look forward to the day when we've closed the last gap in our self built systems compared to commercial EHRs so that our users can revel in the innovation rather than describing the greener grass available elsewhere.   Luckily, we're as good as our latest go live and we're confident now is the time to implement advanced approaches to clinical documentation.  Tolerating impatience until technology, policy, and urgency align is what makes an innovator successful.
reade more... Résuméabuiyad

The Best Kept Secrets For Acne Prevention

There certainly is a lot of confusion out there regarding acne prevention and acne treatment. A lot of Medical research continues in this area, so there is the prospect adolescent acne prevention in the future, but for now there is no accepted acne treatment method of preventing adolescent acne.

Diet Diet does plays a vital role in acne prevention and consuming the wrong foods can quickly make a bad case of acne even worse. It is recommended for acne prevention and treatment that you try to minimize any rubbing or friction to the irritated area. Avoiding things that rub the skin -- such as backpacks and sporting goods -- can also be a helpful part of acne prevention.

Lifestyle Acne afflicts people of different ages, lifestyles and races. People suffering from acne need to pay attention to some simple lifestyle changes. In so far as acne prone skin is concerned, two major causes of acne are foods comprising refined sugar and a great deal of fat. It is noted that plentiful sums of fresh fruits and vegetables should be consumed daily by people suffering from acne. If you currently have acne be sure to seek out all natural products first and then try others. Natural Care A balanced diet is one of the best options we have to fight acne. Most skin experts now realize this fact and have developed guidelines for acne prevention. Similarly, it is better to use some elementary medicated soap with warm water to clean the acne infected skin instead of face wash, which has lots of chemicals and perhaps some fragrance. Its imperative to take great care of the skin when using this method to prevent infection. Medical Doctors are listening , but as much as they would love to spend quality time with acne sufferers by explaining everything about different acne treatments, they simply don't have the time. Everybody want to have clear, soft, smooth, and radiant looking skin, and there are various acne prevention treatments, and ointments available that can help to achieve just this. Your skin responds differently to soap, cleansers, and acne treatments as it would with someone else. Even after having tried all sorts of medications available on the market, including alternative acne treatments, many are all the same left with reddened, chafed skin. Prevention We all desire to have clean, soft, beaming skin, and there are respective acne prevention treatment discourses available such as, creams, gels, and balms that can help us to accomplish just this.

It's true that there is no miracle acne remedies, but it can be prevented with success using acne prevention techniques. Medicine's current power to prevent acne, and the expectations for acne prevention in the future, vary greatly between the different clinical types of acne. Solutions For cutting edge information and products, for the treatment and prevention of acne.

 
reade more... Résuméabuiyad

Pinning Public Health: A Spotlight on Hamilton County Public Health

On June 18, 2013 "How and Why Should We Pin Public Health?" became one of Pop Health's most popular blog posts.  So you can imagine my excitement to share a follow-up piece that spotlights the Pinterest work at the Hamilton County, Ohio Public Health Department! 

Today's post is written by Christy Cauley, M.Ed., an Electronic Communications Specialist, who is responsible for the department's social media strategy.  Hamilton County Public Health (HamCoHealth) was established in 1919 to serve more than 460,000 Hamilton County residents living outside the cities of Cincinnati, Norwood, Sharonville and Springdale. With a staff of more than 80, including sanitarians, plumbers, health educators, nurses and epidemiologists, Hamilton County Public Health strives to prevent disease and injury, promote wellness, and protect people from environmental hazards.  

I am very fortunate to work for a local public health department that understands the value of a strong social media presence. Hamilton County Public Health  has a strong presence on Facebook, Twitter and YouTube and now we’re expanding our presence on Google+ and Pinterest. The latter’s image-centered format poses many challenges to public health entities. After all, who wants to look at pictures of syphilis?

That simply means we have to get creative. Rather than pinning a picture of syphilis, I’ll pin a picture of a cute stuffed amoeba that represents syphilis. The photo still links to an article that lets everyone know there is a syphilis epidemic in Cincinnati and what they can do about it, but they are spared the sometimes graphic images that are associated with public health.

We also have to consider our audience. Our Pinterest audience is quite different from other social media outlets. For starters, there is a much stronger female presence on Pinterest. In fact, the vast majority of our followers are women. That affects our pins and our boards – we have a Women’s Health board for example. Our pins have much more to do with family health and safety than our other social media pages. We tend to focus on health, nutrition and fitness, things that matter more to women than men. We have many pins on Pinterest that do not make it to our Facebook or Google+ pages because the audience just isn’t right for it.

Growing our audience has been challenging on Pinterest. Few people outside the profession are really interested in public health until there is a reason to be interested – like an outbreak of West Nile Virus, for example. We take the usual steps – following others’ boards, liking, commenting and repinning when possible. But what we really want is interaction with our stakeholders on our own boards. We want to get our messages out and know that our audience is hearing them.

To help with that goal, we have “public” boards where we allow others to post to our boards (and we have been invited to do the same). This creates boards with people of similar interests who can share pins more easily. We are careful to include a disclaimer on these boards however, and we do monitor outside pins. Our public health and safety boards can only be pinned on by us, but our recipe and fitness boards are open for our followers to share their favorite pins and they do. We pin to a public board called Health Communication & Social Media from Raed Mansour, where social media and communications professionals can share their ideas. Before, our only interaction with these professionals was on Twitter.

Interestingly enough, the place where we receive the most interaction on Pinterest is one of the public boards we were invited to pin to – Cat World, a board by Joyce Egoodman. Yep, you read that right, Cat World. What does that have to do with public health, you ask? Not a lot, although we can connect pets to our emergency preparedness and heat safety topics quite easily. But, people who love cats are our stakeholders. Public health affects everyone, even our pets. And who doesn’t like cute cat pictures?

How it works is we will find the cutest cat picture on our following boards in the morning and repin it to Cat World with a message about public health or safety. That pin then gets repinned by anyone who likes the picture – not necessarily the message. In turn, our message gets disseminated all over Pinterest and it only took a few seconds of our time. Our Cat World pins get commented on, liked and repinned much more often than our other pins because that board has a wider audience (for now).

One of the Social Media for Public Health (#SM4PH) Twitter chat participants (@AmandaMPH) mentioned that there is a LOT of unhealthy dieting information on Pinterest and we have also found that to be the case. That’s one of the reasons it’s so important for health departments to have a presence on Pinterest, so we can put out accurate information that people can trust.

We’ve found that the image is as important as the message. As a result, we keep our messages short and sweet and we keep our pictures creative. For example, did you know Ryan Gosling is the poster boy for public health? There are hundreds, maybe even thousands of Ryan Gosling memes and many of them are public health centered. We try to utilize them on “Fun Friday” as much as possible.

Another small thing we do is change our board covers often. When new stakeholders visit our page, we want them to see a captivating image that makes them want to view the board, but we also want to make sure that the pin in question is toward the top of the board. I can’t tell you how many pages I’ve visited where I wanted to repin the board cover image, but once I clicked the board, it went on forever and the cover photo was nowhere to be found. We want our stakeholders to find things easily. It’s a small thing, but don’t underestimate its importance to the aesthetics of your page. And don’t neglect the description and category areas either.

We have also taken advantage of @PinGraphy, which allows us to schedule pins for certain times and days. When interaction matters so much and we do not have someone on social media on the weekends, this tool is invaluable. (We use HootSuite for scheduling our other social media sites.)

Getting our feet wet in Pinterest has been challenging. We have made a lot of changes to our boards since we started in response to feedback from users. We’re still learning, but we hope that Pinterest will be a valuable tool in spreading our messages about public health and safety issues in Hamilton County, Ohio and throughout the world.
reade more... Résuméabuiyad

What Matters


I've been at Beth Israel Deaconess Medical Center for 17 years this week.   I'm sometimes asked why BIDMC has been and will continue to be my long term career home.

 The answer is simple - it's a foundation for what matters.

1.  Colleagues matter
Loyalty to my staff is the number one reason I stay at BIDMC.  Together we've shared the network outage of 2002, security challenges, first in the country meaningful use attestation, hundreds of innovative application go lives, and the creation of a world class cloud computing infrastructure.    The average tenure of IS people at BIDMC is 17 years.   Many have been here over 30 years.   Turnover is never more than 10% per year across all IS divisions.

2.  Mentoring matters
The real world experience of operating large scale applications and infrastructure at BIDMC enables me to share lessons learned with students and professionals all over the world.  Whether I'm doing a Harvard Business School case study, helping a government in Asia, or empowering young investigators by connecting them to collaborators, it is my experience at BIDMC building and buying technology that gives me a broad base of successes and failures to share.

3.  Patients and Providers matter
Creating technology for technology's sake is not as impactful as using technologies to achieve policy goals.  BIDMC is a learning laboratory with 250,000 active patients, 3000 doctors, and 2 million patient records.   Every day we can iteratively improve quality, safety, and efficiency by listening to our stakeholders and testing new technologies in production environments.

4.  Innovation matters
BIDMC has a unique blend of built and bought technologies that enable us to control our own destiny.   If a new meaningful use idea needs to be piloted, a new technology investigated, or a new workflow trialed, we can move with agility, often without dependency on vendors.   When a vendor wants to accelerate innovation by testing new technologies we can be a development partner.  Many commercial infrastructure and application products had their start at BIDMC.

5.  Culture matters
For 30 years, BIDMC has had an impatience with the status quo.   The complaints we hear from our stakeholders often relate to problems that other organizations have not yet thought about.   There is never time to rest on our laurels.  At times it seems that memories of our successes fade fast, but the culture of impatience ensures we get rapid adoption of whatever new features we introduce.

While on the plane back from Osaka on Friday, I spoke with a gentleman who has worked in many companies throughout  his career.   At this point he's decided that he needs a company of the right size, right leadership, and right structure to empower problem solving - he has no tolerance for people and organizations that impede progress.    For me, BIDMC has all the characteristics which are foundational to a satisfying career.

As I reflect on my time in Japan, my most influential moments were those I spent teaching, talking with colleagues, listening to others' experiences, connecting people for collaboration, and sharing meals.    BIDMC provides me a base of operations that enables these international experiences, national committee membership, and regional cross institutional cooperation.

Life is complex, budgets are limited, and people are diverse.   Our careers will have their frustrations when there is competition for resources, ever-increasing regulatory pressure, and accelerating change.   However, if you have  great colleagues, remarkable students, a learning lab, a capacity to innovate, and a supportive culture, you have all the ingredients you need for a career home where you can make a difference.  That's what matters.  

reade more... Résuméabuiyad