Protective Style Lookbook || Glam Updo on Stretched Hair

By popular demand, this is a series showcasing various protective hair styles.  Protective styling does not have to be boring. :o)

Model: Mz_tammy

Difficulty level: 3/5

Skin Care || Eliminating Under Eye Bags

Do you have annoying bags under your eyes?  Well, depending on the cause of the bags, there may be a fix.  Here is a snippet of a few of these causes and fixes:

"Switch your sleep position. Your sleep position may be contributing to under-eye bags. Thanks to gravity, sleeping on your side or stomach can encourage fluids to collect under your eyes. If you're a side sleeper, you may notice a heavier bag on the side you sleep on. [Dermatologist Valerie Goldburt, MD, PhD, of NYU Langone Medical Center] advises her patients who wake up with puffy eyes to sleep on their back and add an extra pillow under their head. 
.... 

Other everyday habits, including rubbing your eyes frequently, going to bed with makeup on, and excessive drinking, can contribute to under-eye bags, too. "Sleeping in eye makeup can irritate your eyes, causing fluids to pool," Goldburt says. Heavy alcohol drinking causes dehydration. That weakens the delicate skin around the eyes, making it more likely to sink into a pouch.
.... 

Eye bags are very common, and are usually not related to your health. But if your bags appear suddenly and you're not suffering from allergies, a sinus infection, or a cold -- and they don't ease up when you try the lifestyle steps mentioned above -- it's a good idea to see your doctor. Some thyroid or kidney problems can cause under-eye fluid retention, notes New York dermatologist Craig Austin, MD."

For the remainder of the article, check out WEBMD.

Food Variety, Calorie Intake, and Weight Gain

Let's kick off this post with a quote from a 2001 review paper (1):

Increased variety in the food supply may contribute to the development and maintenance of obesity.  Thirty-nine studies examining dietary variety, energy intake, and body composition are reviewed. Animal and human studies show that food consumption increases when there is more variety in a meal or diet and that greater dietary variety is associated with increased body weight and fat.

This may seem counterintuitive, since variety in the diet is generally seen as a good thing.  In some ways, it is a good thing, however in this post we'll see that it can have a downside.
Read more »

Food Reward Friday

This week's lucky "winner"... ice cream!!

Read more »

The Myth of the Tough Prosecutor as a Distraction from Health Care Corporate Executives' Impunity

The tragic case of the Boston Marathon bombing illustrates how myth making about tough law enforcement obscures the impunity enjoyed by top health care executives.

A "Tough to a Fault" Prosecutor

A recent Reuters article touted the toughness of the prosecutor who will take on the case of the surviving accused Boston terrorist:

As the top federal law enforcer in Massachusetts, U.S. Attorney Carmen Ortiz has taken heat for being tough to a fault and coming down too hard on some defendants.

But as she builds a possible death penalty case against suspected Boston Marathon bomber Dzhokhar Tsarnaev, 19, the unflinching approach that earned her opponents in the past could become a legal asset for the biggest case of her career, said attorneys who have faced off against her.

'The criticism lately has been that they've over-charged some people and been overly harsh,' said Peter Elikann, a Boston defense attorney.'I don't think that's relevant for Tsarnaev because no one is going to accuse any prosecutor of making too big a deal out of this case.'

Similarly, an article in Bloomberg included this:

Ortiz’s former bosses insist that she’s ready for her moment on the big stage.

'She’s tough-minded and exceptionally professional,' [former Massachusetts Attorney General Scott] Harshbarger said. 

One of the cases cited as an example of Ms Ortiz's toughness was her prosecution of electronic information freedom activist Aaron Swart.  As Rueters noted,

One of Ortiz's best-known cases to date was her prosecution of Aaron Swartz on wire fraud and hacking allegations for downloading millions of articles from an academic database.

Swartz, a 26-year-old computer prodigy, hanged himself in his Brooklyn, New York, apartment in January, prompting friends and family to partly blame Ortiz's prosecution for his death.

At the time, Ms Ortiz was criticized for being unreasonably harsh, but then as now toughness was touted as her style.

Not So Tough on Corporate Crime

However, as we pointed out then, while Ms Ortiz was noted for being tough on individuals accused of various offenses, she was notably not so tough on individuals involved in alleged corporate health care wrong doing.

In particular, as we wrote before, Ms Ortiz was involved in three settlements of notably bad behavior by large health care corporations, none of which involved prosecution of, or any penalties for the individuals at the corporations who authorized, directed or implemented the bad behavior.

Forest Pharmaceuticals
In September, 2010, how Ms Ortiz led the pursuit of a settlement with Forest Pharmaceuticals became apparent (look here).   The company was accused of promoting its anti-depressant Celexa for use in adolescents and children.  Such drugs have since been shown to increase the risk of suicide by such young patients, and this drug was only approved for adults.  At the time, Ms Ortiz said, "Forest Pharmaceuticals deliberately chose to pursue corporate profits over its obligations to the F.D.A. and the American public."  Although the offense may have lead to use of the drug by many adolescents and children, and hence may have lead to some of them attempting or committing suicide, the case was settled only with fines.  As is usual in such legal settlements, no individual corporate executive who authorized or lead the off-label and potentially dangerous marketing of the drug was arrested, or accused, and none suffered any negative consequences.
GlaxoSmithKline
In October, 2010, how Ms Ortiz led the pursuit of a settlement with GlaxoSmithKline became apparent (look here.)  The company was accused of selling drugs that were not what they appeared to be, apparently because the wrong drugs were put in labelled containers.  Obviously, taking one drug, like Paxil, GSK's anti-depressant which has a number of known adverse effects, including suicide risk for adolescents and children as noted above, when a patient is supposed to be taking a wholly different drug could lead to patient harm.  At that time, Ms Ortiz said, "We will not tolerate corporate attempts to profit at the expense of the ill and needy in our society -- or those who cut corners that result in potentially dangerous consequences to consumers."   Again, while the settlement involved a guilty plea by a GSK subsidiary, again no individual corporate executive who had authority over the drug manufacturing was arrested or accused, much less suffered any negative consequences.
St Jude Medical
In January, 2011, Ms Ortiz led the pursuit of a settlement with St Jude Medical (look here).  The company was accused of paying kickbacks to doctors to implant its cardiac defibrillators (ICDs) and pacemakers.  Obviously, providing kickbacks to doctors may have lead them to plant devices in patients who did not really need them, yet the devices and the implantation procedures can have adverse effects.  At that time, Ms Ortiz said, "The United States alleges that St Jude solicited physicians for the studies in order to retain their business and/or convert their business from a competitor's product."  Again, as is usual, the settlement did not require any executive who authorized or directed the activities leading to the kickbacks suffered any negative consequences.


Despite this, note that Bloomberg in its recent coverage of the Tsarnaev prosecution even tried to make Ms Ortiz failure to hold any individuals accountable for this health care corporate misbehavior seem like tough prosecution.

The office has been a leader in health-care fraud prosecutions, securing $4 billion in civil and health-care recoveries in 2012. Those included a $3 billion payment from GlaxoSmithKline Plc (GSK), which pleaded guilty to charges that it illegally promoted prescription drugs. 

Again, note that apparently being a "leader" in health care fraud prosecution involved pushing for big fines to be paid by the corporations involved in actions that may have harmed many patients, but no punishment for  the individuals who may have authorized, directed or implemented the bad behavior, but being "tough" on Aaron Swartz involved pushing for a long imprisonment of someone whose alleged crime was not violent, and did not result in anyone being hurt.


Summary

As we have noted again and again and again, leaders of large health care organizations, particularly the largest health care corporations, seem to enjoy virtual impunity.  No matter how bad the behavior of the corporations which they are supposed to be leading, and no matter whether such behavior might have harmed patients, they almost never have to face any negative consequences, especially not fines they must pay themselves, much less prison time.  We have documented many legal settlements of often egregiously bad alleged behavior that did not involve any penalties for top corporate leaders.

One way corporate leaders thus escape accountability seems to be the cultivation of myths that distract the public from what is going on.  One such urban legend seems to be the toughness of government prosecutors.  If prosecutors are believed to be uniformly tough and uncompromising, then the public may be lead to believe either that they are tough and uncompromising on corporate crime   

As we have said repeatedly, true health care reform would require making the leaders of health care organizations accountable, especially for the effects of their actions on patients' and the public's health.

Healthy Body || Get BIKINI ready by June!

By Stephanie of Infinite Life Fitness

Do you keep staring at your favorite bikini every time you go out shopping?

Why not find a reason to buy it plus more new items for your new sexy body?

I am here today to share some tips that should help you get your body bikini ready for this summer!

1. Ditch the soda and start drinking water! Studies have proven that individuals that drink more carbonated or sugary beverages will gain weight or have troubles losing the unwanted weight you currently have. Drinking water will help flush your system as well as keep your body properly hydrated. I would suggest starting with 2 Liters and start working your way up to about a gallon of water a day. YES I SAID A GALLON! 
2. Ditch the fast food! Take a stand NOW to start cooking your meals and try not to “grab something that is easy”. Cooking your own meals allows you to see exactly what you are putting in your body. And, it also allows you the chance to plan your meals and possibly SAVE money! Try having 5 small meals a day. Start with breakfast and have a meal every 3 hours. Each meal should be around 400 calories. You should have a good source of protein (like chicken or fish and for breakfast things like egg whites or whole eggs), a nice serving of veggies, and one good carbohydrate source (like brown rice, whole grain bread, sweet potatoes). 
3. WORK OUT!!! Yes get up and get active! You want to try to work out 5 days a week. Try NOT to take more than two days off in a row. You should spend 30-45 minutes of cardio and getting your heart rate up. And you also need a good strength training program. YES LADIES YOU NEED TO LIFT WEIGHTS! No you will not get big and bulky. Strength training will allow you to build your muscles and start to get more tone. 
   
   
   
4. HAVE A PLAN! Ladies you should plan out your meals, workouts, trips to the store, and anything else! If you FAIL TO PLAN you PLAN TO FAIL. If you plan these things out you will be prepared and ready for your meals and workouts during the week. This will allow you the chance to not make excuses when you are running late or need to find food to eat. Keep a journal so you are able to keep track of what all is going on. You want to be able to visually keep track of what is going on. 
   
   
   
5. Find and keep your own motivation. You have to find something that keeps you motivated. It can be images, quotes, bible verses, or anything! You have to keep things so that you can keep yourself motivated on the days you do not feel motivated. Sometimes you need someone to keep you motivated or someone to help hold you accountable for your actions. This can be a friend, co-worker, or family member.

These are all very important tools that you can use to help you get ready for the summer. There are no magic pills or crash diets that can help you. Try to eat fresh whole foods (stay away from processed foods) and drink plenty of water. You want to cut back on drinking alcohol and increase your activity levels. You do not have to belong to a gym to get a good workout. You can find many workouts online that you can do at home!

You have the tools to reach your goals! So why not start NOW so you can flaunt your confidence and new body this summer. This is Stephanie from Infinite Life Fitness. Please feel free to stop by my blog for more health and fitness tips!

Johns Hopkins: Thanks to EHRs, time with patients seems “squeezed out” of medical training, investigator says

Question:  Who would have thought it?  That there is yet another potentially deadly unintended consequence of bad health IT and health IT hyper-enthusiasm?

Suggested answer:  anyone who truly understands the issues at the intersection of medicine, information science, information technology, and Social Informatics - which probably excludes 95% of the health IT "experts", pundits and opportunists.

Which only goes to show how dense such people can be - as the medical trainees of today will be treating them, their families, and their children in the future:

Johns Hopkins Medicine

Release Date: 04/23/2013

Time with patients seems “squeezed out” of training, investigator says 

Medical interns spend just 12 percent of their time examining and talking with patients, and more than 40 percent of their time behind a computer, according to a new Johns Hopkins study that closely followed first-year residents at Baltimore’s two large academic medical centers. Indeed, the study found, interns spent nearly as much time walking (7 percent) as they did caring for patients at the bedside.

I can honestly say much if not most of my time in training, several decades ago, was spent at the bedside.

Compared with similar time-tracking studies done before 2003, when hospitals were first required to limit the number of consecutive working hours for trainees, the researchers found that interns since then spend significantly less time in direct contact with patients. Changes to the 2003 rules limited interns to no more than 30 consecutive hours on duty, and further restrictions in 2011 allow them to work only 16 hours in a row.

“One of the most important learning opportunities in residency is direct interaction with patients,” says Lauren Block, M.D., M.P.H., a clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and leader of the study published online in the Journal of General Internal Medicine. “Spending an average of eight minutes a day with each patient just doesn’t seem like enough time to me.”

An understatement, as most critical information comes from the H&P and ongoing patient interaction - not from cybernetics.  Further, that's probably all the time a butcher spends processing a slab of meat...

“Most of us went into medicine because we love spending time with the patients. Our systems have squeezed this out of medical training,” says Leonard Feldman, M.D., the study’s senior author and a hospitalist at The Johns Hopkins Hospital (JHH).

For the study, trained observers followed 29 internal medicine interns — doctors in their first year out of medical school — at JHH and the University of Maryland Medical Center for three weeks during January 2012, for a total of 873 hours. The observers used an iPod Touch app to mark down what the interns were doing at every minute of their shifts. If they were multi-tasking, the observers were told to count the activity most closely related to direct patient care.

The researchers found that interns spent 12 percent of their time talking with and examining patients; 64 percent on indirect patient care, such as placing orders, researching patient history and filling out electronic paperwork; 15 percent on educational activities, such as medical rounds; and 9 percent on miscellaneous activities. 

Researching the history is made more complex by today's low-usability EHR systems, so much so that I personally know of cases (through my legal work) where trainees and even attendings did not know the patient's history.  In the past, this would have been considered a severe medical faux pas.

The researchers acknowledge that it’s unclear what proportion of time spent at the bedside is ideal, or whether the interns they studied in the first year of a three-year internal medicine training program make up the time lost with patients later in residency. But 12 percent, Feldman says, “seems shockingly low at face value. Interns spend almost four more times as long reviewing charts than directly engaging patients.”

Not to be critical of the Hopkins piece, it is excellent - but academics often use disclaimers and softeners in their conclusions as a custom and tradition.  At a blog I can be more direct:  12% is shockingly low.  No "seems" is actually necessary.

Feldman says questions raised by his study aren’t just about whether the patients are getting enough time with their doctors, but whether the time spent with patients is enough to give interns the experience they need to practice excellent medicine. 

Personally, I would really be nervous under the care of graduates who'd only spent a tenth of their clinical hours actually seeing, speaking to and examining patients, and a majority of their time frittering around with computers.

With fewer hours spent in the hospital, protocols need to be put in place to ensure that vital parts of training aren’t lost, the researchers say.

“As residency changes, we need to find ways to preserve the patient-doctor relationship,” Block says. “Getting to know patients better can improve diagnoses and care and reduce medical errors.” 

As opposed to getting to know the (needlessly complex and confusing) EHR better, which adds little.

The researchers say better electronic medical records may help reduce time spent combing through patient histories on the computer.

After several decades of the health IT industry being in business,  it's sad that an organization of the (deserved) stature of Johns Hopkins has to provide remedial education 101 to that industry in 2013.

Perhaps that's the most important finding of all in this study.

There's some wisdom in this comic strip.  Click to enlarge.

-- SS
 

WellPoint's Former Manager-Queen Got $20.6 Million and Its Nobility Got Millions

Score another for our new would be royalty, that is, for the hired managers who run big corporations.  Early this month a few scattered reports came out showing just how much even apparently failed executives of big health care organizations can make on their way out the door. 

A New Fortune for the Abdicating Queen of WellPoint

Last year we discussed the abdication of Angela Braly, the former queen of giant insurance company WellPoint.  We then speculated about how much she might abscond with.  Now the Associated Press has reported:

 The compensation paid to outgoing Wellpoint Inc. CEO Angela Braly last year rose 56 percent, even as the company's shares slid on lower enrollment in its Blue Cross Blue Shield health plans.

Braly, who resigned in August, received 2012 compensation valued at $20.6 million, according to an Associated Press analysis of the company's annual proxy statement. Most of the increase came from stock options.

Braly, 51, became CEO in 2007. She received a $1.2 million salary last year, up slightly from $1.1 million in 2011. Her compensation included a performance-related bonus of nearly $1.4 million. More than 85 percent of Braly's compensation came from stock options and awards, which totaled $17.8 million. That total was up from about $10 million the year before.

She also received $179,618 in other compensation, including $3,700 spent on security measures for her and her family due to concerns about her safety 'as a result of the national health care debate,' according to the proxy, which was filed Tuesday with the Securities and Exchange Commission.

Despite Bad Financial Performance and Investors' Losses

Remember, though, that Braly was asked to leave:

 investors had grown frustrated with the company's performance, leading Braly to resign last August. 

In particular, in terms of financial performance

shares fell 8 percent last year to close 2012 at $60.92, while the Standard & Poor's 500 index rose more than 13 percent.

WellPoint's 2012 earnings were nearly flat compared to 2011. The insurer earned $2.65 billion, or $8.18 per share, last year, as total revenue climbed 1.6 percent to $61.71 billion.

A slightly different analysis by the Indianapolis Business Journal came up with similar results,

 WellPoint’s membership growth came mainly from its acquisition of Virginia-based Amerigroup Corp., which operates Medicaid managed care plans for states. The rest of WellPoint’s existing business lost customers during 2012.

And while WellPoint has boosted earnings per share by continuing to buy back shares, overall profit was unchanged last year compared with about $2.6 billion in 2011.

WellPoint raised its dividend in 2012 and acquired 1-800-Contacts Inc. But its stock price fell 8 percent to close the year at $60.92 per share. Even taking into account dividends, WellPoint shares lost 6.3 percent of their value during the year.

So while the nominal owners of the company, the investors, lost money on their investments, the CEO who presided over this loss left with a huge pile of cash.

The Royal Court of WellPoint Also Prospered

Incidentally, the Indianapolis Business Journal also showed that WellPoint executives who did not leave generally got big increases in their compensation, again while the company owners to whom they ostensibly report lost money,

WellPoint Inc.’s top brass all enjoyed double-digit bumps in 2012 compensation, according to a proxy released April 2, even though the stock price fell and the company admittedly did not meet its financial goals.

The Indianapolis-based health insurer’s board of directors approved higher salaries and larger potential stock awards heading into 2012 after most of its top executives saw their pay hold steady or decline in 2011.

The company’s performance merited its executives receiving only 83 percent of their target stock awards. But because the board had already established larger pools of stock to award to executives, the value of those awards still rose over previous years. Bonus amounts fell in 2012 compared with the previous year.

The extra cash and stock drove up Chief Financial Officer Wayne DeVeydt's overall pay 11.9 percent to nearly $4.4 million.

Ken Goulet, executive vice president of WellPoint's commercial insurance business, saw his total compensation rise 18.2 percent to nearly $4.4 million.

And Lori Beer, executive vice president of information technology, enjoyed a 17.9-percent boost. She earned $3.2 million, although that was still below the nearly $4.5 million she received in 2010.

John Cannon, the general counsel, saw his compensation more than double to nearly $6.5 million. But that was partly because WellPoint hiked his salary by $350,000 and gave him a $500,000 bonus for agreeing to serve as interim CEO after the August resignation of former CEO Angela Braly.

Despite Angry Policy-Holders and Ethical Missteps

So the compensation given the outgoing CEO and some of the remaining top hired managers seemed wildly out of proportion to the company's financial results.  Could the generosity they received be based on how well the company performed in other dimensions?  That, of course, seems equally improbable.

The Los Angeles Times noted,

 Braly had also caught the ire of consumers and even President Obama in 2010 for trying to raise rates by up to 39% in California. The national outrage that ensued helped Obama win approval for his healthcare overhaul in Congress.

Furthermore, as we have discussed again and again, most recently here, WellPoint has a very sorry record of ethical misadventures.   (The updated list is at the end of this post.)  So one could certainly not justify the huge payments given WellPoint hired managers by their upstanding ethical leadership.

Summary

In a new book just published by Robert A G Monks, entitled Citizens Disunited, the author describes one of the biggest problems affecting the US economy and society as the rise of "manager-kings."  Clearly, Angela Braly could be called the former "manager-queen" of WellPoint.  The company seemed to be run primarily for the benefit of the queen and her court, while its investors lost money, its customers became outraged, and it stumbled from one ethical quandary to another.

In the eighteenth century, British colonial subjects in North America succeeded in a revolution that lead them out from under the rule of a British King.  How many examples do we have to have before there is action to repudiate the rule of our new manager-kings and queens?  And to turn health care back into a calling meant to put patients' and the public's health first, rather than a feudal society meant to benefit its nobility?

As we have said again, again, again,...

True health care reform would decrease the size and scope of health care organizations, and make their leaders accountable to ownership, when appropriate, and to the community at large for patients' and the public health. 



Appendix: WellPoint's Ethical Misadventures

• settled a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see 2005 post here).
• subsidiary New York Empire Blue Cross and Blue Shield misplaced a computer disc containing confidential information on 75,000 policy-holders (see 2007 story here).
• California Anthem Blue Cross subsidiary cancelled individual insurance policies after their owners made large claims (a practices sometimes called rescission).  The company was ordered to pay a million dollar fine in early 2007 for this (see post here).  A state agency charged that some of these cancellations by another WellPoint subsidiary were improper (see post here).  WellPoint was alleged to have pushed physicians to look for patients' medical problems that would allow rescission (see post here).  It turned out that California never collected the 2007 fine noted above, allegedly because the state agency feared that WellPoint had become too powerful to take on (see post here). But in 2008, WellPoint agreed to pay more fines for its rescission practices (see post here).  In 2009, WellPoint executives were defiant about their continued intention to make rescission in hearings before the US congress (see post here).
• California Blue Cross subsidiary allegedly attempted to get physicians to sign contracts whose confidentiality provisions would have prevented them from consulting lawyers about the contracts (see 2007 post here).
• formerly acclaimed CFO was fired for unclear reasons, and then allegations from numerous women of what now might be called Tiger Woods-like activities surfaced (see post here).
• announced that its investment portfolio was hardly immune from the losses prevalent in late 2008 (see post here).
• was sanctioned by the US government in early 2009 for erroneously denying coverage to senior patients who subscribed to its Medicare drug plans (see 2009 post here).
• settled charges that it had used a questionable data-base (built by Ingenix, a subsidiary of ostensible WellPoint competitor UnitedHealth) to determine fees paid to physicians for out-of-network care (see 2009 post here). 
• violated state law more than 700 times over a three-year period by failing to pay medical claims on time and misrepresenting policy provisions to customers, according to the California health insurance commissioner (see 2010 post here).
• exposed confidential data from about 470,000 patients (see 2010 post here) and settled the resulting lawsuit in 2011 (see post here).
• fired a top executive who publicly apologized for the company's excessively high charges (see 2010 post here).
• California Anthem subsidiary was fined for systematically failing to make fair and timely payments to doctors and hospitals (see 2010 post here).
• management was accused of hiding the company's political contributions from the company's own stock-holders (see 2012 posts here and here).
• settled charges that its Anthem subsidiary cheated former policy-holders out of money owed when that company was converted from a mutual insurance company (see 2012 post here)

Book Review: Salt, Sugar, Fat

Michael Moss is a Pulitzer prize-winning journalist who has made a career writing about the US food system.  In his latest book, Salt, Sugar, Fat: How the Food Giants Hooked Us, he attempts to explain how the processed food industry has been so successful at increasing its control over US "stomach share".  Although the book doesn't focus on the obesity epidemic, the relevance is obvious.  Salt, Sugar, Fat is required reading for anyone who wants to understand why obesity is becoming more common in the US and throughout the world.

Read more »

Hair Diary || Scissor Happy and More ...

It has been a while since I posted a chapter in the "Hair Diary".  Well, up until recently, I had been wearing small twists (see the "Twist Series") for about 4 weeks.  Prior to that, I had another set of twists.  Now I'm taking a break and alternating between braid-outs and braided updos on straightened hair for the next three weeks.

LEFT: What I would I call an example of what healthy, layered ends look like.
RIGHT: An example of a blunt cut.  Even when our hair is cut in such a manner, it will gradually grow out of the blunt cut (and similar to what we see in the LEFT photo).

These ladies have some of the longest hair in the world, but what do you think about their ends?   (I leave it up to you to decide.)

Oh, and what is this about being "scissor happy"?  Well, I cut (not trimmed) about 2+ inches off my hair.  The ends were not visibly damaged but they were thin to me, which naturally happens as our strands can longer and experience more wear.  Additionally, I have been desiring a short, blunt cut for some weeks now.  Thinking I'm just going through a phase, I decided to cut my hair somewhat blunt and a bit shorter rather than go all the way.  Now I'm officially MBL (mid-back length) again.  It was hard to stop cutting further so I had to really talk myself out it. :o)

And now for more hair pics:

Though split ends were minimal, I felt like the ends of my twists needed a good trim because they were thin.  I gave them one ... and some.  I cut 2+ inches total (maybe more, I don't know since I stopped measuring after a while).

(Twist shot from Aug. 2012.)  This gives an idea of the ends I have been holding onto for almost two years now (aside from a few dusting sessions). 

The final product.  (After a light flat-iron, braids, and another cut included in the 2+ inches.)  I had to talk myself out of cutting another couple of inches.

The final product.  (After a light flat-iron, braids, and another cut included in the 2+ inches.)  Tried to get a complete shot of the ends but after several attempts, I gave up for the day.  I'll try again in the near future.

Winner of the ZELO Giveaway AND Another Giveaway!!

... And the winner for the Zelo Giveaway is Afro Age!

Please leave a comment below that you have seen this post AND use the "Contact Me" button above to send me your mailing address.  You have until April 25 to claim your prize.

For those who want another opportunity to win, check out the $100 Target Card Giveaway below:

SILVERSTEIN v. ABINGTON MEMORIAL HOSPITAL: MOTION TO PROHIBIT COMMENTARY ABOUT THIS LITIGATION TO ANY PUBLIC CONTEXT: Do computers have more rights than patients?

Herein is an issue of potential Internet censorship and/or attempted prior restraint of the rights of a citizen to express him/herself freely:

At my post "Hospital defense maliciousness, aided and abetted by attorneys who ignore the ABA and Pennsylvania's Ethical Rules of Conduct Regarding "Candor Towards the Tribunal" I wrote about how a defense attorney in a case I unfortunately am substitute plaintiff in, that involving EHRs and the injury and the death of my mother, violated the requirement under the Code of Conduct of lawyers to exhibit candor before the tribunal, and perhaps 18 Pa.C.S. §4904 relating to unsworn falsification to authorities as well.

As also mentioned, the lawfirm was displeased, but did not respond to my offer to consider amending any factually erroneous assertions at that post.

Now here is their response:

4/19/2013

Motion

BY ABINGTON MEMORIAL HOSPITAL MOTION TO PROHIBIT COMMENTARY ABOUT THIS LITIGATION TO ANY PUBLIC CONTEXT WITH MEMORANDUM OF LAW WITH SERVICE ON 04/19/2013

The Motion text is here in PDF (it is a public document available to anyone on the Montgomery County, PA Prothonotary website).

The court has yet to rule on this new motion and Substitute Plaintiff's (me) replies.

I will, of course, abide by the Court's decision.

First: I note that I have been writing about issues of court process, not the substance of the case's actual issues.   I think citizens have a right to know about process in their courtrooms.  I am also Joe Public, exercising my rights to freedom of expression; I am not an attorney breaking some rule of case publicity.  I am not even the suit's initiator.  What rule(s) am I breaking, exactly, I'd like to know from the Defense.

Further, in my opinion, considering that multiple authorities including the Institute of Medicine of the National Academies (link), FDA (link), Joint Commission (link), ECRI Institute (link), National Institute of Standards and Technology (link), AHRQ-Agency for Healthcare Research and Quality at HHS itself (link) and others have written about risks of health IT to patients and the need for far more study and data on the issue, in my view there is a compelling public interest in being informed about the progress of this lawsuit.

We have not reached the day yet, I hope, when computers have more rights than patients.

I note that if the involved lawfirm, Marshall Dennehey Warner Coleman Goggin, would stick to the Rules of Conduct for attorneys, it would seem they have nothing to fear.

I note the remarkable statement about "unjustified and malicious personal attacks against Moving Defendant and defense counsel", i.e., pointing out exactly what they did.  Namely, fail to provide the required Candor towards the Tribunal regarding the undisclosed 2008 Stroud v. AMH decision on COM's, known to them (same hospital, same counsel) at the time multiple, frivolous contrary claims about COM's to harm my mother's case were made to the courts from 2010 to just recently in 2013. 

In fact, that statement itself may be an example of legal misconduct - rendering false charges and certifying them in writing to a court as true.  I note that I didn't write the Rules of Professional Conduct for attorneys; attorneys did, including Rule 3.3: "Candor before the Tribunal" whose obvious violation and my pointing it out is certainly not an "unjustified and malicious personal attack."

As far as "fair trials" go - their stated concern in this latest filing - the defense should have thought about that before breaking the aforementioned Rule of Professional Conduct, causing numerous delays.  (I wonder how many med mal cases with proper paperwork are stalled more than 2 years before Discovery even begins - the case was filed 7/16/2010.)

It seems to me that my mother deserved to be alive at the time of her fair trial ("Justice delayed is justice denied.")  I would certainly like to know if the Defense thinks otherwise.


-- SS

Apr. 19, 2013 Addendum:

As noted at Wikipedia regarding what appears to be a Motion for Prior Restraint:

Prior restraint is often considered a particularly oppressive form of censorship in Anglo-American jurisprudence because it prevents the restricted material from being heard or distributed at all. Other forms of restrictions on expression (such as actions for libel or criminal libel, slander, defamation, and contempt of court) implement criminal or civil sanctions only after the offending material has been published. While such sanctions might lead to a chilling effect, legal commentators argue that at least such actions do not directly impoverish the marketplace of ideas. Prior restraint, on the other hand, takes an idea or material completely out of the marketplace. Thus it is often considered to be the most extreme form of censorship. The United States Supreme Court expressed this view in Nebraska Press Assn. v. Stuart by noting:

The thread running through all these cases is that prior restraints on speech and publication are the most serious and the least tolerable infringement on First Amendment rights. A criminal penalty or a judgment in a defamation case is subject to the whole panoply of protections afforded by deferring the impact of the judgment until all avenues of appellate review have been exhausted. Only after judgment has become final, correct or otherwise, does the law's sanction become fully operative.

A prior restraint, by contrast and by definition, has an immediate and irreversible sanction. If it can be said that a threat of criminal or civil sanctions after publication 'chills' speech, prior restraint 'freezes' it at least for the time.

Also, most of the early struggles for freedom of the press were against forms of prior restraint. Thus prior restraint came to be looked upon with a particular horror, and Anglo-American courts became particularly unwilling to approve it, when they might approve other forms of press restriction.

-- SS

Healthy Hair Feature: Yolande

1. What made you go natural? 

I went natural by accident really.. my hair was severely damaged and the middle was close to bald. i had just removed micro braids and the new growth i experienced was immaculate..:) so i said to myself wow my hair has some potential to be thick and healthy..my decision at that point was immediate. To be honest I think I was led by the holy spirit to YouTube and typed in transitioning from relaxed to natural, there I found Nikki Mae, Natural Chica and she became my main inspiration. My journey began In 2008 and i am happy to be nappy.  How long have you been natural? I've been natural for 5 years.

2. Did you transition? If so, for how long?   

I transitioned at first not knowing I was transitioning.  My hair was damaged from the perm and I just started braiding my hair as I did a lot when I was younger, at that point not knowing it was a protective style and therefore the reason my hair would grow so much when braided.:), I did this giving up two perms and each braid would have lasted me 2 months so that would be 4 months with braids and two months without. I chopped the permed ends in September 2008.

3. What is your HEALTHY HAIR routine?

My routine is very simple since learning the basics of caring for my natural hair. I co wash  once every week (I shampoo only when I have severe build up, once a month)
I deep treat every week whether protein or moisture (keeping balance)

Moisturize weekly with products from my own line that I have developed Kumea's Hair Perspective soft and Creamy Hair Smoothie (water-based moisturizer) and Kumea's Hair Perspective extra Virgin Coconut Hair Oil (Oil based moisturizer). 

Sleep at nights with a satin bonnet..that's it..:) I just recently had my first child and so my regime was non existent for months during my pregnancy because I was very sick.. But I did ensure it was in a protective style most times.

4. Do you have a HEALTHY BODY routine? 

Yes I do, I eat right and drink lots of water to keep hydrated. Fruits and veges are my best friend even after a baby. I walk up and down my driveway (on a hill) twice daily..but that's the most exercise for now 3 months post pregnancy.

5. What advice and warnings do you have for naturals? 

Don't be afraid to embrace who you are and what you think you will look like if you go natural. Look at your baby pics for inspiration and other naturals. Think "healthy hair" and I'm sure that will lead you to natural:).. If you don't see your hair growing as fast as someone else..Do not despair or give up, your hair is unique and will reach the goals you set for it in its own good time.

Remember hair care is really very simple : wash, deep condition, detangle, moisturize and seal.

6. Where can we find you?  

Visit my page at www.facebook.com/KumeasHairPerspective. or email me @kumeashp@gmail.com

Mixology || Recipe for Organic Makeup

In the following video,  SparkWisdom discusses how to make your own "mineral powder".  Check it out!

Ingredients:
arrowroot powder
organic cocoa powder

Healthcare computing 'glitch' time again: 15 patients possibly given wrong antibiotic after lab error at Regina General Hospital

Just another computer "glitch", that innocuous euphemism for a catastrophe-promoting IT defect, this time causing patients to receive the wrong antibiotics:

Regina Leader-Post
April 17, 2013

15 patients possibly given wrong antibiotic after lab error at Regina General Hospital 

Fifteen patients in southern Saskatchewan were potentially treated with the wrong antibiotic stemming from a lab error at Regina General Hospital, the Regina Qu'Appelle Health Region announced Tuesday.

According to the RQHR, lab reports between late January and late March erroneously deemed Clindamycin would effectively treat the patients' infections when those bugs were actually resistant to the drug.  [The biological bugs, not the cybernetic bugs, that is - ed.]

Only one of the 15 patients suffered adverse effects. The 15th patient, an adult male, experienced short-term negative effects but has since been switched to another antibiotic. Citing patient confidentiality, the health region would not elaborate on the man's condition.

Dr. Jessica Minion, a medical microbiologist in the General Hospital's laboratory, said a computer glitch caused the faulty reports between Jan. 23 and March 28. 

Need I add that this "glitch" could very easily have killed people?

Minion added she and other medical staff will now cross-check lab reports against lab tests after a change has been made within the computer system.

Wait - if the "glitch" is fixed, why is cross-checking still needed?  Doesn't sound like there's much confidence in this computing system...

The lab became aware of the problem on March 28 when the doctor treating the man who experienced problems notified the hospital, Minion said. Lab staff then sifted through records and determined a total of 15 people had been prescribed Clindamycin since the erroneous reports began Jan. 23. 

Clindamycin itself is not an innocuous drug, with many potential serious side effects.

"It was a very identifiable mistake that was being made in the computer system, and there is a very clear trail of who exactly it affected," she said. "So we are quite confident that we have identified everybody that would have been affected."

Only by the grace of God, none of those affected are six feet (2 meters) under, either due to their primary infections or drug adverse events from a drug they should never have been given.

At least this time the oft-heard refrain "but patient safety was not compromised" was not proffered.

-- SS

Food Reward Friday

This week's lucky "winner"... energy bars!

Read more »

Guest Post: the Slow Grind of Justice

 Health Care Renewal presents a guest blog by Steve Lucas, a retired businessman who formerly worked in real estate and construction who has a long standing interest in business ethics, and has long observed the health care scene.

The March 14, 2013 Akron Beacon Journal print edition highlights what I am sure Mercy Medical Center hopes is the end of a long legal battle with Aultman Health Foundation. 

Cheryl Powell writes in "High court throws out appeal by Aultman" highlights the Ohio Supreme Courts dismissal of Aultman’s suit brought in regards to a 2010 court ruling that Aultman pay Mercy $6.1 million for unfair business practices. 

A review of that legal action can be found on this Health Care Renewal post.

The legal battle centers on 'secret ´bonuses paid to select brokers for switching employers from other insurance plans to Aultman’s insurance company, AultCare.

Aultman Hospital is AultCare’s only in-network hospital in Canton.'

It is important to remember that AultCare is an aggressive for-profit insurance company.

At the end of the two-month trial in Stark County Common Please Court, jurors decided Aultman should pay Mercy more than $6.1 million in damages for engaging n a pattern of corrupt activity by influencing brokers with money.

'Evidence during the trial showed that for a period of time, brokers weren’t allowed to disclose the payments to anyone, even the clients they represented.

Aultman officials have said the confidentiality requirement was dropped in 2004, well before Mercy filed its lawsuit.

We see an all too familiar behavior pattern: someone sensing that he or she is about to be caught drops an activity and then feigns innocence for our past transgressions. How often have we seen a drug company sign a consent agreement only then to return to court to sigh another consent agreement? How often are we told that an activity was committed by a low level sales person and that person is no longer with the company?

Aultman has continued to criticize the case Mercy filed, calling it a waste of resource for the non-profit health-care organizations.

'We have always felt that this case was not positive for our community, that resources were shifted in a way that was not beneficial to the community' [the attorney representing Aultman, Allen] Schulman said. 'I don’t think that it serves the community well.'

[ Mercy President and Chief Executive Thomas] Cecconi said Mercy felt an obligation to fight Aultman’s business practices for the community’s sake.

Conclusion

Once again we find the use of the legal system perverted by one party in an effort to gain a business advantage over another entity.

Aultman has used its non-profit status to shield the activities of a for-profit insurance subsidiary.  Perhaps someone thought that no one would sue a large non-profit hospital for the actions of the subsidiary.

Aultman used the tired old refrain that “we don’t do that anymore” as a defense for past business practices that garnered questionable profits. This after the fact admission does not absolve them of responsibility for those actions.

When all else fails Aultman uses the appeal that it reflects badly on the community. It really does not matter that they were the ones who engaged in this activity. Additionally they make the claim this will result in a decline in resources available when they profited from the original activity.

These are old concepts to HCR readers. The use of the legal system, from law suits being filed against those who would blow the whistle, to grinding out appeals to bleed a person or organization dry, all in an effort to protect a questionable or even illegal activity. In this case there is still the issue of Mercy’s legal fees involved in Aultman’s appeal.

Smaller markets are seeing a consolidation of hospitals and medical practices. The opportunity for one party to take advantage of this is growing as patients and doctors are presented with limited opportunities to seek appropriate medical care. When the hospital owns the insurance company, and your care will be dictated by the policy available through only one company, the opportunity for abuse has to be acknowledged.

Mercy has begun to grow again by offering the community a less corporate medical experience. Interestingly, Mercy and Aultman have collaborated on securing scarce oncology drugs. It appears some doctors still feel it is about caring for the patient, and less about loyalty to a corporate logo.

Steve Lucas

Protective Style Lookbook || Two Styles from One Twist-out

By popular demand, this is a series showcasing various protective hair styles.  Protective styling does not have to be boring. :o)

Model: Nalia

Style description: Two updos (one chic and one traditional) on hair stretched via a twist-out.

Difficulty level: 2-3/5

How to Avoid "Hand-in-The-Hair" Disease

Some of you probably know the definition of "hand-in-the-hair" disease, but for those of you who do not, it is essentially the following:

(Definition by Loo) A severe case of frequent touching, twirling, pulling (or any other form of manipulation) of the hair, especially the ends.

It is not an actual disease but a phrase coined in the hair care world for this bad habit.

For years, I have had this bad habit, which oddly enough, developed when I first went natural.  (I believe the reason is because my kinks and coils were -- and still are -- new to me.)  However, the following tips have helped me to curb the habit for the most part.  If you suffer from "hand-in-hair-disease", you may want to try these techniques to "treat" it:

For longer hair - Wear pinned updos or buns
These styles will make it difficult for you to keep your hands in your hair since your hair is ... well ...  tucked away.

For shorter hair - Wear twist/braid extensions or a beanie 
Like the above styles, these ones will make it difficult to reach your actual hair.

Wear a bonnet or scarf while at home
After a long day, you may want to let your hair down or take off that beanie, and this is understandable.    Give yourself about ten to twenty minutes of "free" time then put on that satin bonnet or scarf.

Occupy your hands with another object
This is my least useful avoidance technique, but when I do use it I find that pliable objects (like an ouchless band) work nicely.

Fred Schulte: "GOP senators call for overhaul of electronic health records program"

Fred Schulte, investigative reporter at the Center for Public Integrity (link to bio), has authored a new article worth reading in its entirety:

GOP senators call for overhaul of electronic health records program
Lawmakers say Obama's $35 billion initiative pushing health information technology isn't working.

Six U.S. Senators are calling for an overhaul of the federal government’s $35 billion plan for doctors and hospitals to switch from paper to electronic medical records, citing concerns from patient privacy to possible Medicare billing fraud.

The report issued Tuesday by the half-dozen Republicans concedes that many lawmakers and medical experts believe the digital systems can reduce health care costs and improve the quality of care by reducing duplicative testing and cutting down on medical errors.  [Eventually, and with great effort the details of which many in the field lacking appropriate education and expertise are painfully unaware - ed.]

But the report asserts that the Obama administration’s push to use billions of dollars in stimulus money helping doctors and hospitals buy digital systems needs to be “recalibrated.”

“Now, nearly four years after the enactment…and after hundreds of pages of regulations implementing the program,” the document says, “we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process.”

I've been calling for a "recalibration" (i.e., a cessation of putting the cart before the horse) and slowing down, for years.  See for instance my July 2010 post "Meaningful Use Final Rule: Have the Administration and ONC Put the Cart Before the Horse on Health IT?" and its hyperlinks at http://hcrenewal.blogspot.com/2010/07/meaningful-use-final-rule-have.html.

Among the report’s conclusions:

• Despite expectations of cost savings, the digital systems may be increasing unnecessary medical tests and billings to Medicare.
• The government has not demanded that the various digital systems be able to share medical information, a critical element to their success.
• Few controls exist to prevent fraud and abuse. Many doctors and hospitals are receiving money by simply attesting that they are meeting required standards.
• Procedures to protect the privacy of patient records are “lax and may jeopardize sensitive patient data.”
• It remains unclear whether doctors and hospitals that have accepted stimulus funding will be able to maintain the systems without government money.

I have as an even larger concern the quality and fitness (and hence safety) of today's health IT systems.  In what may be the first robust study, the findings as I have pointed out on this blog are of great concern:

Health Leaders Media
April 5, 2013
HIT Errors 'Tip of the Iceberg,' Says ECRI 

Healthcare systems' transitions from paper records to electronic ones are causing harm and in so many serious ways, providers are only now beginning to understand the scope.  [I understood the scope years ago as reflected in my writings - ed.]

Computer programs truncated dosage fields, leading to morphine-caused respiratory arrest; lab test and transplant surgery records didn't talk to each other, leading to organ rejection and patient death; and an electronic systems' misinterpretation of the time "midnight" meant an infant received antibiotics one dangerous day too late.

These are among the 171 health information technology malfunctions and disconnects that caused or could have caused patient harm in a report to the ECRI Institute's Patient Safety Organization. Thirty-six participating hospitals reported the data under a special voluntary program conducted last year.

Karen Zimmer, MD, medical director of the institute, says the reports of so many types of errors and harm got the staff's attention in part because the program captured so many serious errors within just a nine-week project last spring.  [Including 8 injures and 3 possible deaths in just 9 weeks as I wrote at "Peering Underneath the Iceberg's Water Level: AMNews on the New ECRI Deep Dive Study of Health IT Events" here - ed.]

The volume of errors in the voluntary reports was she says, "an awareness raiser."

"If we're seeing this much under a voluntary reporting program, we know this is just the tip of the iceberg; we know these events are very much underreported."

... ECRI is currently evaluating a similar, and much larger list of reports from many of the 800 hospitals that contract with ECRI's PSO services.

The fact that only GOP Senators so far have made this call is perhaps somewhat surprising, considering the abuse that side of the aisle often takes for being pro-business and anti-citizen rights.

On the other hand, hospital accidents are a truly non-partisan issue.  A Democrat or Republican (or member of any other poitical party), and their loved ones, are all in the same boat.

As this point in time, I recommend any patient have a strong advocate following everything done, not done, supposed to be done, not supposed to be done, med and allergy lists and fulfillment, action on lab and imaging reports, etc. -- importantly, not depending on IT-dependent clinicians to do so.

-- SS