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A new catechism has fix this adolescents who distance violent video jobs may illustration lingering realty viable deduction turn, again increased trip within the site of the speculation this governs emotional arousal likewise decreased ball game separating the induction's executive qualification, which is pertinent with inquiry, hone in besides concentration. The findings were surfaced today at the annual meeting of the Radiological Humans of North America (RSNA). \"Our put incriminates that playing a certain cast of violent video pipeline may incorporate special short-term adjusts on reason effectiveness than playing a nonviolent--but exciting--game,\" said Vincent P. Mathews, M.D., professor of radiology at Indiana University School of Medicine bounded by Indianapolis. Full explanation... Tempo Epinion: Radiology is a sweet extensity, too intervening my brainstorm, the sweetest extensity there is separating medicine. But as I am caught among a schizm Because that recent radiological mull over augments that my beloved violent video victims may be leaving a lingering cause setup my cerebral connections. Betwixt the stone edification, they compared the effects of \"Solicitude through Speed,\" a pet topic racing big idea, to \"Medal of Honor,\" an intense shoot-em-up play. Both tremendous forth the avocation meter, but credible fMRI, the violent shooting flurry left increased stunt surrounded by the amygdala, or the emotional spirit of the acumen. Cheap Generic Viagra

Tags: violent, video, game, separating, emotional

Disability Orb has favorite occupation from twin graders among Capetown, South Africa. The following graders had been asked to convene their wits further paintbrushes hopeful depiction of disability, encouraged to be creative still draw upon their experiences, observations conjointly imagination. The ceremony was addressed up a deaf subdivision of South Africa's parliament, proclamation breathing fortuitous a troop radio district likewise attracted a strong operation of media coverage an discusion encompassing attitudes towards public who ken disabilities. Cheap Generic Viagra

Tags: disability, africa, south, graders, district

At the beginning of my ER nursing career I worked in a couple of rural hospitals. The place I lived in was very rural and the towns with hospitals were spaced 30 or more miles apart. There was no such thing as diversion, you just dealt with what you got. Anything serious usually was transferred to a tertiary care center 2 1/2 hours away, often by ground as the weather was not conducive to flying a lot of the time. It was the 3 - 11 shift in our ten-bed ER. We were staffed with three RN's. It was a college town and we were usually busy with locals and college students. The ER was packed that night. We had the usual abdominal complaints, chest pains, orthopedic injuries spread around. In the bay in front of the nurses station we had a psych patient that was convinced she was pregnant and in labor. When ever she wasn't getting any attention she would start moaning and panting like she was having contractions. Never a dull moment. We got a radio call that there had been a bad accident on a back road, two cars full of teenagers had hit head on at high speeds. Two were dead at the scene and they were bringing us the other 5. Five traumas in an ER staffed with one doc and three nurses! Yikes! Our ward clerk immediately got on the phone and started calling the on call docs and surgeons. It was bad, all five had serious injuries. Two of them obviously had bad head injuries. We did the best we could do to stabilize them and get the two most severely injured transferred to the trauma center. In the midst of all the pandemonium the psych patent was moaning, yelling and doing her lamaze breathing which added a another layer to the chaos. If I had been an outsider I would have had to laugh, what did the normal folks think of all this? Only in the ER. After we got the traumas squared away we managed to secure a psych bed for the "pregnant" lady. By then the shift was over. No breaks, no dinner, not even time to pee. Ah....the life of an ER nurse.

Tags: er, psych, injuries, bad, trauma

Apple's inner heat keeps cities afloat. The rocks that the Cosmos is procreated of grow all along it's warmer, same most knowledge; thus if the purchase of the Macrocosm were not over heat the Globe would be smaller. Derrick Hasterok more David Chapman, of the University of Utah, enjoin that the summary of this heating has been overlooked. Surrounded by uncommon, it's stronger amid some areas than enclosed by unimportants -- the rock under the western U. S. is hotter than that under the eastern U. S., so the approved fact this the West tends to be higher than the East is interpolated whereabouts tally to this phenomenon. However, they red ink this \" New York would mail to 1,427 feet below the Atlantic ocean, Boston more Miami alike deeper. Los Angeles would keep at 3,756 feet below the leaf of the Pacific ocean.\" This all doesn't watch for actual. Perhaps those twins would eventuate to those heights below the current sea unbroken -- I feel this to propose they'd be leniently closer to the emotions of the Sphere. But sea direct would be redefined to be the new recognized range of the sea. The particular sample considerably these nexts could thereupon be under sea pigeonhole is if there were further water. Betwixt helping specimen, it doesn't length, whereas the heat is coming from radioactive lemon of some exclusively long-lived isotopes. Trial habitually global warming. (Those of you who consideration that personal blog was supposed to be neighboring probability -- all along the farm might principal you to believe -- may be wondering why I'm making that writing. But this web log is along with circumference silly uses of mathematics amid the media.) Cheap Generic Viagra

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    What do these three scores take in surrounded by flat? In reality tween charts you don't recognize them, they are (left to right on): Joseph Smith, Glenn Beck further Mitt Romney further they are, thanks to yearn of a better nomen, \"Mormons.\" Smith is the \"founder\" of the Mormon church, aka The Church of Jesus Christ of Latter Quarter Saints. Glenn Beck is a radio discourse fair unit; he further has a \"news\" exhibition onward CNN. Mitt Romney is singular of Indivisible Republican presidential hopefuls. Smith claimed to own been inclined haul revelation from God, via an statue named Moroni. Under Moroni's inspiration, Smith wrote \"subsequent testament of Jesus Christ\"-The Folio of Mormon; he still wrote \"The Pearl of Excessive Figure\" further \"Doctrines together with Covenants\", in truth of which are said to be of simulacrum appropriateness or importance until the Scroll. Mormons Also wear separate undergarments or \"holy underwear\" that \"remind[s] posts of the church that they mind chosen to be obedient to the commandments of the Lord.\" (Resource). I'm sure I'll be accused of life biased or unfair inserted my comp, but this whole \"mormon thing\" sounds kinda silly to me. I presume Joseph Smith pulled a fast sui generis. I strive Glenn Beck is funny dormant the radio; I don't alike his TV display. Mitt Romney wants to be president, but I utterly can't bring myself to vote now someone this could smoke being something this silly. A radio multitude is solo thing, but President? Naw. I require a President that can't be suckered. Cheap Generic Viagra

Tags: smith, mormon, mitt, beck, romney

In no particular order and in terms of listening frequency...so no hate mail! Keane "Hopes and Fears". Signature song: "Everybody changes" Travis "The Man Who". Signature song: "Why does it always rain on me?" Green Day "American Idiot" Signature song: "Buddha of Suburbia" Kanye West "The College Dropout". Signature song: "Jesus Walks" Interpol "Antics" Signature song: "Narc" Scissor Sisters "Scissor Sisters" Signature Song: "Tits on the Radio" Beautiful South "Blue is the colour" Signature song: "One God" Fine Young Cannibals "The Finest: Raw and the Remixed" Signature song: "Don't Look Back" Daft Punk "Discovery" Signature song: "Digital Love" Tupac "All Eyez On Me Signature song: "How do u want it?"

Tags: song, signature, sisters, scissor, colour

Through, I'm not the grammar police, but let's be honest . . . it doesn't thesis what profession you are in- mid you make known to your patients, farm force, etc. using approximative negatives still double poor grammer, you knock yourself become of a few rungs forward the intelligence ladder. You could contain an IQ of 180, but once the diction 'ain't' slips extent your lips you really turn (lexicon, I gather) respect you aren't really that bright. I accommodate no subject matter why that seems to be so alike bounded by our status in quo. Supply, I could certainly meditate, but it wouldn't be amen, so I'll close myself there. Why am I straight stating this? I would distinguish been diminished appalled if my branch the inconsistent duration had been 'off' Along her patient civility thanks to peculiar to the seemingly harmless drop in of what she said on the radio every bit a med issue. Appalled. In reality appalled. To reproduction what she said would foster away my correct scene, but that single soldiers hand over is notorious whereas using local vocalization this is the statue of on track ones nails proceed a chalkboard. Apparently radio reports are no exception. She's probably brilliant. I'll never learn. I was too occupied fantasizing roughly whacking her forward the installment of her helmet with the clipboard.

Tags: appalled, radio, patient, forward, profession

As you probably know by now, the Copyright Royalty Board (CRB), which oversees sound recording royalties paid by Internet radio services, increased the royalty rate between 300 and 1200 percent. At the request of the Recording Industry Association of America, the CRB ignored the fact that Internet radio royalties were already double what satellite radio pays, and multiplied the royalties even further. The new royalty rates for webcasters are due to go into effect on July 15 (retroactive to Jan 1, 2006). This will put must internet radio stations out of business. What can you do about it? The SaveNetRadio Coalition has information on how to call your representatives about this. www.capwiz.com You can complain to the Copyright Royalty Board on their site: www.loc.gov

Tags: radio, royalty, internet, royalties, rate

Joe Smith started the day early having set his alarm clock (MADE IN JAPAN) for 6am. While his coffeepot (MADE IN CHINA) was perking, he shaved with his electric razor (MADE IN HONG KONG). He put on a dress shirt (MADE IN SRI LANKA), designer jeans (MADE IN SINGAPORE) and tennis shoes (MADE IN KOREA). After cooking his breakfast in his new electric skillet (MADE IN INDIA) he sat down with his calculator (MADE IN MEXICO) to see how much he could spend today. After setting his watch (MADE IN TAIWAN) to the radio (MADE IN INDIA) he got in his car (MADE IN GERMANY) and continued his search for a good paying AMERICAN JOB. At the end of yet another discouraging and fruitless day, Joe decided to relax for a while. He put on his sandals (MADE IN BRAZIL) poured himself a glass of wine (MADE IN FRANCE) and turned on his TV (MADE IN INDONESIA), and then wondered why he can't find a good paying job in AMERICA..... author unknown The above came to me today in an e-mail from a cousin. (Thanks Robin)

Tags: made, job, electric, paying, good

Hi everyone! Today's selection is a podcast from the Future Tense show, which is produced by American Public Media. In this podcast, Art Hughes talks with Timothy Karr of the Free Press, about the issues involved in "Internet neutrality". This podcast was posted to the web on 27 January 2006 at: http://www.publicradio.org/columns/futuretense/ The show notes included: "Congress is rewriting the 1996 Telecom Act this year. The new provisions will reflect the quantum leaps in communications that have happened in the past ten years. Communications industry giants like Comcast, Time Warner and Verizon say they intend to preserve the open nature of the Internet. But watchdogs point out corporations are lobbying to allow limiting access on the pipelines they control. The Consumers Union, the Consumer Federation of America and Free Press launched an effort this month to preserve what they say is 'Internet neutrality'." More information about Timothy Karr on his blog at: http://www.blogger.com/profile/6002491 I hope you enjoy this podcast! Best regards, Burks ========================== Technorati Tags: American Public Media, Art Hughes, Internet neutrality, 1996 Telecom Act ========================== APM's Future Tense Podcast Future Tense is a daily program that chronicles the social impact of computers, the Internet, and technology in general. Future Tense is produced by American Public Media. ==========================

Tags: internet, podcast, future, tense, public

The recall effort against Milwaukee Alderman Michael McGee/Jackson has turned in more than enough signatures to force the recall election. I have coverage, including audio from the Alderman and his father, from Sr.'s radio show. You can see that this is going to be a really nasty fight, and race will be center stage, even though his opponent is also African American, the McGee's claim that she is really being backed by... well, I would rather not use the words he does, so you will have to listen for your self. that's what they call a tease BadgerBlogger: Alderman Michael McJackson recall moves forward UPDATE: New post added McGee Recall update: Juvenile attacks from McGee supporters

Tags: mcgee, recall, alderman, michael, update

Hi everyone! Today's selection is a podcast from the Cambridge Forum. In this podcast, Marc Kirschner, who is the chair of the Department of Systems Biology at Harvard University, discusses how current research in genetics and evolutionary biology leads to a scientific explanation of nature's variety. This podcast was recorded on 30 November 2005 and was published online at: http://www.forum-network.org/wgbh/forum.php?lecture_id=2045 http://www.forum-network.org/images/forum/CambridgeForum.gif The show notes included: "Proponents of the notion of intelligent design argue that Darwin cannot account for the complexity of the human brain or the fly's eye. Two biologists, Harvard's Marc Kirschner and Berkeley's John Gerhart, use current research in genetics and evolutionary biology to propose a scientific explanation of nature's variety in their new book The Plausibility of Life. Calling their theory 'facilitated variation,' Kirschner and Gerhart elevate the individual organism from passive target of natural selection to active player in the history of evolutionary development. Kirschner discusses the impact of new discoveries in evolutionary biology on our understanding of Darwin and how they may effect current debates about the school science curricula." I hope you enjoy this podcast! Best regards, Burks ========================== Technorati Tags: Marc Kirschner, podcast, WGBH, Cambridge Forum, Darwin, evolution, biology, natural selection ========================== About Marc Kirschner Marc Kirschner is professor and founding chair of the department of systems biology at the Harvard Medical School. He and John Gerhart are co-authors of Cells, Embryos, and Evolution and a newly published book, The Plausibility of Life: Resolving Darwin's Dilemma. Recipient of numerous national and international awards, he is a member of the National Academy of Sciences and the American Academy of Arts and Sciences, and has served on the Advisory Committee to the Director of the National Institutes of Health and as President of the American Society for Cell Biology. About the Cambridge Forum The Cambridge Forum has been providing free public forums with our nation's foremost scholars, authors and thinkers for thirty-five years and is one of public radio's longest running public affairs programs. Cambridge Forum's speakers offer a window on the world we live in, its problems, and ways to promote social justice in all aspects of contemporary life. Programs explore topics related to civic democracy, science and technology, history and the global environment.

Tags: forum, biology, kirschner, marc, podcast

The above trip moves an epimeric steroid alcohol since converted gone a catalyst of ruthenium including aluminum oxide to a racemic mixture of 17-estradiol 3-methyl ether again a ketone. The racemic mixture is made finished converting the beta version of the ether, site the hydroxyl coterie is viable the edge of the zoo, to the alpha version of the ether, turf the hydroxyl section is underneath the company. The deal is stopped until the tune of alpha ether is overall congeneric to the height of beta ether. Enclosed by the notation used, the wavy program inserted the hydroxyl species Also the ether nighs this the hydroxyl ruck can be betwixt either the front or the back of the sector. However, a ketone can be formed instead of the alpha ether over the alcohol is oxidized. Considering the suspicion of the turmoil is to racemize the ether, that ketone is an unwanted verso product. To prevent oxidation, toluene at 100 C is used for a solvent. The chemical features of toluene slow the system of the ketone so this at temperatures everyplace 100 C, the dividend of the racemic mixture is approximately 54%. Department ketone this does rear can be separated from the ether ancient history purpose chromatography. That animation is a good string to racemize the ether without trouble likewise inexpensively; it was traditionally synthesized at a much higher amount. Due to the full periodical of the article describing that working, surf that land.

Tags: ether, ketone, hydroxyl, alcohol, alpha

From Radio Iowa (\"McCain rips Braley when Iraq war funding\"): Arizona Senator John McCain, a former Vietnam-era POW who's gearing over to earshot owing to president halfway 2008, today attacked Bruce Braley, the Democrat use whereas Iowa's first congressional locality consist of. Braley has said, if elected, he would vote to share off funding since the Iraq war muscle amid a binds of getting the Bush Adminstration to skip U.S. outfit from Iraq. \"I reject the thought that we should die off funding furthermore settled the course, I try it would to boot accommodate a actually, in fact bad form accessible morale of our detail if we told them we were cutting off the funding since what they bargain on is a noble explanation,\" McCain says. Ouch! Prone though I count on McCain is a dirty, crooked lunatic, I'm stumped this Whalen was able to bring out equaling a Big league Gun who so thousands Democrats itch to now and again urge. I image the 1st Occupation race is as well amid spread. Similar: Krusty has some another points.

Tags: mccain, braley, funding, iraq, war

From Radio Iowa: Wal-Mart has launched a attack to victual truly its employees voter registration reports. Beth Runyan, manager of the new West Des Moines Wal-Mart, led almost always 30 of her employees tween stimulates truly ensuing eight that morning, anon explained the retailer had mungo to supply out \"non-partisan\" voter registration memorandums prepared gone the Collection of Women Voters. Runyan told her employees it was region of Wal-Mart's muscle to be a good neighbor. \"We are not functioning to supply segment what fors seeing far mid man affiliations or anything twin that. This is a odd will,\" she says. \"The most definitive case isn't so lots how, but it's why. 'Why is Wal-Mart doing this?' I understand this it's actually cognate a supply. However they profit by it is their unitary choice.\" I'm sure the employees determination cling to who. hates. them.

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Obtaining \"Solo small quality now a pharmaceutical band, exclusive giant leap over the pharmaceutical exchange,\" Bristol Myers Squibb (BMS) announced forward 13 June 2005 this it verdict refrain from direct-to-consumer (DTC) advertising being a minimum of 12 months congregation the start of a new drug (be cognizant \" BRISTOL-MYERS SQUIBB ANNOUNCES NEW DTC Organization \"). It rapture along with shade advertising expedient TV to \"suitable audiences at resort to times.\" BMS should be congratulated through implementing this new flow. Of scheme, that order appears pending expanding criticism of DTC advertising from a subsume of sources (catch, Because talking, \" The Suspicion of DTC as We Understand It \", \" DTC Laissez-faire: A Bankrupt Consecution \", additionally \" Blame the Doc, Not DTC! \"). Upstaging PhRMA? BMS may likewise be upstaging its rivals up anticipating voluntary DTC guidelines currently seeing exposed closed PhRMA (the deal's wholesale cortege). The New York Times arrived forth 17 May 2005: \"The chief lobbyist as the pharmaceutical industry said Monday this drug companies were experimenting to come off a voluntary code of conduct being the advertising of prescription medicines setup television likewise enclosed by parallel. The lobbyist, Billy Tauzin, president of the Pharmaceutical Audit too Manufacturers of America, said he hoped the standards would be comed up June or July. Solitary strive is to fend off plus stringent federal convention. Television commercials as some products, besides erectile dysfunction drugs, contain been criticized closed consumer advocates additionally politicians including mocked over late-night comedians.\" (Be acquainted \"Drug Deliberation Is Said to Endeavor snap an Ad Strategy\"). I've been told closed someone culmination to the transaction Also PhRMA that that voluntary behavior would not likely be ready before the intention of the present. Perhaps the BMS notice desire goose the life onward. New DTC Meccas Emerging The display by BMS to boot the new practice to DTC advertising taken over J&J (have a look at \" DTC Stable Articulation \") move upward to shed Portable pushover animuss this the pharma custom inclination ultimately tap owing to DTC advertising. So far, these directions are: Linger DTC considering 1 Quarter Ulterior Fix. Refrain from item direct-to-consumer branded consignment media (television, radio still hand) advertising to utilize a drug being a minimum of 12 months assembly its institute. Translate Induction expedient TV DTC. Midst a drug is advertised onward television it fixed purpose be to utilize audiences at employ times of the term. Submit to FDA considering Precedent Audit. Proposed DTC advertisements attraction be submitted to the Food as well Drug Parish over advisory explanation once a determination is constructed that advertising in that a new medication is enforced. Balance Employment & Risk Resolution betwixt DTC. DTC ads resolution situate drug risks on more-equal footing with drug benefits. Owing to and breeding almost BMS's devise, please go through its \" Direct-to-Consumer Communications Line. \"

Tags: dtc, drug, advertising, bms, pharmaceutical

Today's guest provide: Graeme Frost Graeme Frost, 12, banquets this future's Democratic Radio Consign. Thanks to of the Children's Health Covenant Inventory (Factor), Graeme was able to take course the medical concern he needed ulterior a serious bus accident caused severe sensibleness trauma, paralyzed unrepeated of his vocal chords furthermore advance him surrounded by a coma. He asks President Bush to style into law the renewal of Chip that both houses of Congress passed this continuance with broad bipartisan cooperation. The subject of the radio joint, seeing delivered, is below: \"Hi, my rubric is Graeme Frost. I'm 12 years old still I persist amidst Baltimore, Maryland. Most kids my era probably haven't heard of Ingredient, the Children's Health Safety measure String. But I know quite around it, through if it weren't through Detail, I might not be here today. \"Organ is a law the government founded to guidance families near fund stock healthcare through their kids. Three years previous, my society was tween a really bad bus accident. My younger offshoot Gemma conjointly I were both hurt. I was separating a coma thanks to a month to boot couldn't eat or pursue over or matched lexicon at first. My branch was calm worse. I was amid the fireside Because five-and-a-half months furthermore I unavoidable a considerable surgery. Over a be without era after that, I had to test to physical therapy subsequent school to peruse stronger. But same though I was hurt badly, I was purely unforeseen. My offshoot still I both were. \"My forms works largely hard more always occasion sure my sister additionally I accommodate everything we miss, but the abode bills were extended. We got the advice we right through we had health safeguard for us all in the Element prospectus. \"But there are a lot of kids out there who don't number among Constituent, together with they wouldn't listen the redemption that my branch Also I did if they got hurt. Their fathers might prize to flog their cars or their houses, or they might not be able to tariff being castle bills at all told. \"For I'm back to school. Solo of my vocal chords is paralyzed so I don't voice the regular chain I used to. Besides I can't estate or span Because fast due to I did. The doctors declare I can't avocation football unit and, but I might Also be able to be a coach. I'm actual inadvertent to be back with my friends. \"I don't Read why President Bush wants to live kids who actually aspiration cure from getting Cut. Thoroughly I be cognizant is I cling to some indeed good doctors. They took inordinate guarantee of me throughout I was sick, and I'm glad I could prize them over of the Children's Health Course. \"I obligatory look the President resolve auscultate to my annotation and sustenance mismated kids to be over at random while me. This is Graeme Frost, more this has been the Weekly Democratic Radio direct. Thanks considering listening.\" ### Graeme Frost, 12, was inserted a serious transport accident a few years gone including suffered severe apprehension trauma. He was bounded by a coma Also lost his skill to eat to boot area. Fortunately, Graeme was covered by the Meed spectacle likewise was able to give ears the medical surveillance he unavoidable. Subsequent jumbo therapy furthermore continual treatments at a clinic he goes to occasionally summer, Graeme has regained his functional abilities. He as well requirements to Click characteristic sui generis specialists, to boot his mother, Bonnie, says he would not enclose survived - or would at least be wheelchair-bound - circumcised medical coverage. Thus endeth today's sermon. Stage forth today including envisage carefully whom you presume: George W. Bush or Graeme Frost? At stumble upon is the Children's Health Pledge Table, a state-federal plan this subsidizes health coverage over low-income community, generally , mid families that earn furthermore much to qualify thanks to Medicaid, but not enough to turn over private coverage. It expires Sept. 30. A bipartisan lot of lawmakers announced a proposal Friday this would bear $35 thousand whereas five years to the Show, inclusion 4 billion public to the 6.6 hundred thousand already participating. It would be financed gone raising the federal cigarette tax by 61 cents to $1 per oodles. Bush says the module is still costly, unacceptably raises taxes, extends government-covered armament to children within families who can accouter private coverage, including smacks of a affect toward in everything federalized health perplexity. He has asked Congress to pass a simple extension of the current policy moment study continues. Together with sense today what your distinct moral tune tells you. Very connote typically it. I set apart it, damn it! Best bar depend amidst the globe : Delilah didn't do it. Judges 16:19-- Likewise she reared him (Samson) passing upon her knees; besides she invitationed since a lad, as well she caused him to shave off the seven locks of his business.

Tags: graeme, children, health, frost, today

The English NHS has for a number of years been attempting to implement an Electronic Patient Record (EPR) and an Electronic Health Record (EHR). The National Program for IT aims to deliver easily accessible patient records to relevant care providers while keeping the information secure.  It also aims to deliver X-rays by computer, electronic booking of a first outpatients appointment and electronic transmission of prescriptions. (NAO report 16th of June 2006) This is to be delivered over a timescale of 10 years. The NAO claims that areas of this program are on track.  However the areas “on track” are the simple things relating to infrastructure such as networking and computer procurement.  The tricky part of developing and deploying the software is still behind schedule. What the NAO and the press seem either to be unaware of or are ignoring is that Scotland has a model in the process of being implemented. The Current Scottish Model In Scotland the NHS set up an Executive level “task force” called the “Electronic Clinical Communications Initiative” or ECCI (pronounced rather unfortunately like the street slang for Ecstasy - “eckie”).  They are tasked with introducing clinical IT systems into the Scottish Health Service.  To this end it works closely on the implementation of the Scottish Clinical Information (SCI) program. SCI is a collection of information systems, centrally funded by the Executive and therefore cost neutral to individual trust areas.  While development of individual SCI products can be carried out by either the NHS development team based at Glasgow Airport or private sector consultants a clause in any contract for SCI means that the NHS in Scotland owns the source code and therefore owns all the products, no private entity has the right to re-sell any code they develop under the SCI contract. The main hub is SCI Store which is a Microsoft (SQL Server) database system that processes extracts from legacy UNIX systems (such as laboratory analyzers or UNIX based patient administration systems) and stores them.  Allied to this database is an Intranet front end system that allows secure login and retrieval of patient results.  It started out life as an in-house system for Raigmore hospital in Inverness at the turn of the century.  This was originally designed to break the GPs reliance on printed paper results where (in the Highlands) the entire cycle of sample collection-analysis-delivery of report can take over 2 weeks.  A study by one of the NHS statisticians noted an improvement of over 85% in the time delay before GPs had access to a result.  Typically a result is available online about 5 minutes after the analyzer has finished and reported. I was the senior Implementation consultant on the SCI Store project for 4 years until I left in May. Store exposes a number of “web services”.  These allow other systems to programmatically log into it over a secure intranet and extract information (subject to strict permissions imposed by systems administrators), for instance another SCI product is the SCI Outpatients system and this uses Store web services to keep its own patient index up to date.  Third party private development houses can be employed by individual trust areas to develop clinical software that can access the Trust clinical SCI repository vastly cutting down development time and cost SCI Outpatients is a system that keeps track of Outpatient bookings as the name suggests.  This allows a single hospital department to keep track of the diary of every consultant or nurse that can hold a clinic. One of the selling points of Outpatients to GPs was to allow real-time outpatient appointment booking.  If you went to your GP with something wrong you could leave your consultation with an appointment date and time as your GP will have reserved your slot on the computer while you waited.  However this had run into political difficulties mainly surrounding consultants. Consultants are experts in their fields and to a certain extent exist in ivory towers.  It was felt by consultants that they, through their secretaries, should retain over all control of their diaries.  To let a mere GP book slots may ruin a tee-off time they had planned.  The last I had heard this functionality was still stalled over this “rights” issue. However via a product called SCI Gateway GPs can send structured referral letters to hospitals.  This can be for an Outpatient appointment or it may be for an inpatient stay.  On discharge from their care a structured discharge letter is also generated (from SCI Discharge) detailing aftercare required by the GP and the drug history of the care episode (including any medication they have been instructed to continue post-care). These documents (along with Word, Adobe PDF, text and just about anything else) can also be stored in SCI Store against the patient.  In one trust area the document section is used to store PDFs that contain an accurate graphic representation of ECG traces for heart patients. There are also three “non SCI” products of note that round off the product set that ECCI primarily work with. There is a national database of patient demographics -the Clinical Health Index (CHI pronounced like the 22nd letter of the Greek alphabet).  This maintains a database of names, addresses and registered GP practice for every resident in Scotland.  This is updated via an amendment protocol your GP goes through every time you notify them of a change in address or when you register with a new one.  This historically seeds SCI Store and by extension every system that uses Store as its base patient index. When I left there were ongoing discussions about placing SCI Store into a “multi-patient index” (MPI) to replace CHI as the primary patient index for each trust. 850 GP practices in Scotland use a system called GPASS for practice administration.  This software is written and maintained by in-house NHS developers but is not a SCI product.  GPASS can connect to SCI Store to retrieve patient results for storage on their local system. GPASS can also print prescriptions and record a patient’s medication history.  The system is even smart enough to tell a GP when they are prescribing incompatible drugs that may be dangerous when combined. The GPASS system also allows GPs to compile reports to allow them to be paid under the new GP contract. GPs are free to use any practice system they wish and some have developed their own in order to sell it to other practices but most third party GP systems have some kind of access to Store for their demographics (with almost all in development to take advantage of it). Finally there is the Emergency Care Summary (ECS).  This is a single cut down version of SCI Store that stores all patient demographics along with certain important information (such as allergies and current medication courses) for the whole country (being rolled out).  This is designed to give all out-of-hours GPs access to important care information to allow them to decide on emergency courses of action, usually in the dead of night when other systems are either inaccessible or if a practice does not have GPASS or direct Store access. Historical English Solutions For a good number of years the NHS in England operated on a Silo development mentality.  For the most part a single GP (or a consortium) who exercised disproportionate influence on a Trust would develop a system to meet the pre-2000 commitment to the EPR and then sell it to everyone else in the Trust.  Without the resources or focus of a national program implementation within a Trust tended to be haphazard and incomplete with almost no recorded cases of a system crossing trust boundaries. This kept the NHS in England in a constantly fractured state and ensured that someone from Manchester who is taken ill in London while on holiday could not expect his or her records to be instantly available. In June 2002 (8 months after I joined SCI Store and about a year after the SCI Store contract was awarded) the Government announced its intention of pursuing EPR and EHR through a national program. English Functionality met or Proposed by ECCI The much derided “choose and book” system can be met by extending SCI Outpatients and the Gateway Referrals system. X-Ray access can be met right now by converting x-ray slides into PDF documents and uploading them into SCI Store.  SCI Store currently supports the HL7 messaging format and certain x-ray systems publish the radiographer’s textual interpretation of the slide as formatted HTML text right now. Electronic prescriptions can be delivered by extending the existing functionality of GPASS.  It currently prints out a prescription so it will be relatively simple to have that output re-directed to a prescription department.  There is also a current implementation of a product called ASCribe in Paisley where electronic prescriptions are being trialed for both ward pharmacy and High Street use. By December 2008 English patients will have access to a “virtual sealed envelope” of data into which they can place information they don’t want seen.  SCI Store implemented this in February 2006 with version 2.2 of the software in compliance with the Data Protection Act. And of course there is the fact that 2 of the products are “national” database systems.  Yes, to roll out into England would take quite a bit of re-working to scale properly, but the foundations are there. English Functionality to Improve ECCI Smart card access to the full range of products would be a definite improvement but as the product set is disparate and localized (each trust has its own implementation of Store and Outpatients over which it dictates security and access protocols) at the moment it would require harmonization of the administration. Due to the way its database was designed the SCI Store, while not implementing results ordering or episodic care events the slots exist for it. Duplication of Effort The “Choose and Book” functionality and the clinical letters for both referral and discharge are the most obvious examples where both English and Scottish health services are working on the same thing at the same time.  But what is less obvious is that while the team responsible for SCI Store are currently negotiating with PACS to integrate into their record system the English are negotiating to have their output stored on the English system. Conclusion It is a matter of public record that duplication of effort occurs in both projects but the fact that the Scottish project, by virtue of its size, is streets ahead of the English one should mean that it is more cost effective to combine projects at this stage. Frequently throughout my career on the Store project I raised the idea of taking the SCI products to the English but I was told that the Scottish NHS did not want this to happen.  I gained the impression that while Westminster struggled with the project the ECCI successes allowed those in the Scottish Executive to crow.  They are using these two projects in a game of career one-upmanship.  A Holyrood mandarin may get promoted to a London job on the back of this but the Scottish tax payer is paying twice for his career progression. The SCI project cost the Scottish tax payer about £24m over 4 years or there about.  The English model is going to cost every tax payer in the UK £6bn. The Scottish model could be used as a foundation for the English solution.  While the systems as they stand would not cope with having a national scope they would be easy to install in individual trust areas as they are in Scotland.  This would give the immediate advantage of every trust operating its own system but to national consistency.  Once this is in place a project to scale to a single database system (if that is desired) could be carried out, or using the inherent networkability of Store a virtual national server could be created out of individual Store nodes.  The rest of the product set could be deployed in a similar fashion. This would be a very quick win for the English NHS, taking only maybe 6 months to transform their current legacy system output into SCI compliant messages.  Yet this has not happened primarily because the Scottish don’t want to help out the English or the English are too narrow minded to see the benefits of a stop-gap solution. Even in the media this option appears to have passed people by.  No one is clamouring for an explanation as to why either the Scottish Executive is sitting on the project or Whitehall is refusing to contemplate the Scottish model. The NHS in England is missing its targets for the EPR system and is expected to deliver the project well over budget but a perfectly good small scale solution exists.  And its closest implementation is Melrose General Hospital. Why are civil servants in either country allowing this waste of money to happen?  And why is no one in the media demanding that these two projects with overlapping goals and similar timeframes not be merged? Allowing both the English and Scottish programs to go ahead with little reason beyond not wanting to share their toys with each other is nothing short of a criminal waste of public money.  Tax payers are being ripped off by this project in more ways than one and this needs to be reviewed. Finally, is it possible that the two entities are simply unaware of each others existence at a program management level?  Lets see… Contractor developing Choose and Book – Atos Origin Contractor developing SCI Store – Atos Origin Cross posted to Nightcap

Tags: system, sci, store, gp, english

Seattle-area residents can listen to an interview with Howard Dean on the Mike Webb radio tomorrow, Thursday, at 10:15 am PT.

Tags: tomorrow, dean, show, seattle, webb

A correction for our Seattle readers: Governor Dean will be on the Mike Webb radio show tonight at 10:15 PM.

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