35 Burst results for "Optima"

"optima" Discussed on 850 WFTL

850 WFTL

08:14 min | 8 hrs ago

"optima" Discussed on 850 WFTL

"Optima is a plus. Rated with the better business bureau. Optima has already resolved over a billion dollars of tax debt for their clients. Get your life back for attacks help you need for tax help you can trust Optimum Now for your free consultation, call 807 to 1 39 55 807 to 1 39 55 807 to 1 39 55 tax relief. Some restrictions apply for complete details, please visit often. Attacks Really calm this weekend of Sonny music is brought to you by the Lake Worth Playhouse. Surely you can't be serious. I am serious. And don't call me sugar. It's the weekend Take it shell pill and relive the greatness of all the hits of the eighties on Sonny, one of that a nun. Around trying to smile with me, Dr. Damn! It must come to see you. I'm leaving tonight. Wait, wait. Go, go, man. Leaving Oh, Oh! Oh! Oh, Don Now. Where are you? Second made me now got to still want It's a dumping it down my back around jealous looking like So great. How I'm dreaming. It was Mrs Night, baby, get it just fine. Myself. What is that? Oh, come back by myself. Yeah. Oh, wow. Now look at me. Sonny. What does 79 playing the greatest hits of Huey Lewis and the news?.

"optima" Discussed on WBZ NewsRadio 1030

WBZ NewsRadio 1030

02:02 min | 5 d ago

"optima" Discussed on WBZ NewsRadio 1030

"Optima is a plus. Rated with the better business Bureau. Optima has already resolved over a billion dollars of tax debt for their clients. Get your life back for attacks help you need for tax help you can trust call optimum now for your free concert. Nation. Call 803 43 64 343 64 343 64 60 optimal tax relief. Some restrictions apply for complete details. Please visit optimal tax relief dot com. Curiosity Stream has thousands of documentary films and shows available on demand on any device where the Netflix for nerds the Hu Lu for history buffs, The Disney Plus for the scientist in us there sure are a lot of streaming services aren't there Curiosity stream is the one you definitely need. If you're the type to nature, Doc and chill if you're an armchair astronaut, if you prefer physics to psychics, or perhaps, you know a precocious paleontologists go to curiosity stream dot com to learn more and sign up today. There's so many things you rather be doing than thinking about the cost of your Medicare prescriptions and Walgreens can help. We're preferred Network pharmacy with many plans nationwide, which could mean lower copays for you Fill your prescriptions at a Walgreens pharmacy and start saving today. Walgreens participates as a preferred network pharmacy with WellCare, AARP, Medicare Rx from United Healthcare and Express scripts. Medicare Walgreens participates with other plans, he Walgreens dot com slash Medicare for details. Heard the good news about covert 19 vaccines. They're here, but you can do more than wait for your turn. See, you have the power to help slow the spread. Actually, you could be a real difference maker and protect your family and loved ones too. Here's how Watch your distance. Stay at least 6 ft. Away from folks you don't live with, And it's risky to be indoors with him, too. No matter how far apart you are, and, of course, avoid crowds also wear a mask. CDC reports that masks protect both the person wearing them and the folks around him from particles that carry the virus and wash your hands using soap.

"optima" Discussed on 860AM The Answer

860AM The Answer

01:43 min | Last week

"optima" Discussed on 860AM The Answer

"Optima is a plus. Rated with the better business Bureau. Optima has already resolved over a billion dollars of tax debt for their clients. Get your life back for attacks help you need for tax help you can trust call Optima now for your free consultation call 809 +65 14 33 809 +65 14 33 809 +65 14 33 Optimal tax relief. Some restrictions apply for complete details. Please visit Optima tax relief dot com. Hey, there. Richmond 2021 is here, and we've got a lot to do so it's time to find the right coffee for you. Let's get it done with new coffee choices of Duncan. Try the new Explorer Batch. A globally sourced bland was smoky dark Berry notes. That's an adventure in every sip or grab a cup of Duncan Midnight a richer, intensely dark roast with hints of chocolate, because bold days start with midnight and sip into action with new extra charge coffee that's 20% extra caffeine from green coffee extract, so head to Duncan or order ahead on the APP for the brew. That's right for you and let's get it done. America runs on Dunkin Price and participation a very limited time. Offer. For all your food is out there. I'm unwrapping a McDonald's steak, egg and cheese bagel. Look at this steak and the juice running down the side got a little bit on the wrapper here and then the fluffy egg and real cheese folded over side looking just so good. Mm. Grilled onions on a buttered bagel. Two thumbs up from McDonald's steak, egg and cheese Bagel for breakfast. Love it more bump up, uh, participate in McDonald's. Everybody. We want to invite you to join Dennis Prager and Mike Gallagher for a travel opportunity. That may be the highlight of your year. We're headed back to Israel in October. 2021 for a 10 day stand with his real tour of the key sites and best place is meant to give you an unprecedented view of the world You've likely only read or heard.

"optima" Discussed on 1075 KZL

1075 KZL

04:27 min | 2 weeks ago

"optima" Discussed on 1075 KZL

"Optima is a plus. Rated with the better business bureau. Optima has already resolved over a billion dollars of tax debt for their cause. Let's get your life back. Where tax help you need for tax help you can trust call optimum now for your free consultation. Call 807 to 1 39 55 807 to 1 39 55 807 to 1 39 55 Optimal tax relief. Some restrictions apply for complete details. Please visit Optima tax relief dot com from the beautiful lakeside setting to the stress free Bella experience that makes planning effortless. See what makes fella Kalina Mansion the number one all inclusive wedding venue Be Abella Bride dates are filling fast reserved today at Della Collina mansion dot com. Have you wanted to speak a new language, but thought it would be too difficult than try battle battle starts by teaching you words and phrases that gradually get more complex soon. Or practicing short conversations. So in 15 minutes a day, you'll be speaking in new language in a few weeks battle is built around real life. It teaches you practical conversations that you will actually use babble language for life celebrating 10. Million subscriptions sold. Now try babble for free. Just go to babble dot com. Today, that's B A B b l com mourning ring. With Jared and Katie 1075 K Z L Thank you. See something bad. Don't make a scene that his destiny back in the days we wanted everything. I wanted everything. You must be very rich in history. Right up your street museum victories every day. We want everything. Then everything Mama said. Don't give up. It's a little complicated outside up. No more love. And I'd hate to see wait. Always always looking for something right? It is strange. Wanna be the wedding technologies. The letter, James. We wanted everything. What? Everything in their eyes, they never come down. Never turn down, Mama said. Don't give up. It's a little car picking outside up. No more love, and I'd hate to see a way say it's often So I got one. It's gotta be decided to say she o kill him, But I always had a vision always have Don't get carried away. Hit music station 1075 K Z..

If You Look Up You May See The International Space Station

Innovation Now

00:56 sec | 3 weeks ago

If You Look Up You May See The International Space Station

"As the international space station passes overhead. It is sometimes visible to the naked eye. All sightings occur within a few hours before or after sunrise or sunset these times create optimum viewing periods as the sun reflects off the space station and contrast with the darker sky. The station will look like a fast moving plane only much higher and traveling much faster unlike planes. The station has no flashing lights and won't change direction. In the several seconds it's visible. But how do you know when to look up. you can sign up for email or text. Alerts at spot. The station dot nasa dot gov spot. The station will only send out notifications when you have the best opportunity for viewing and because the station's orbit takes it all around the globe. You could be in the right place at the right time of the day as the international space station streaks across the

Nasa
Dallas County COVID-19 Projection Warns of ‘Less Than Optimum Care' at Hospitals

Eric Harley and Gary McNamara

00:36 sec | 2 months ago

Dallas County COVID-19 Projection Warns of ‘Less Than Optimum Care' at Hospitals

"Hospitalizations are on the rise in North Texas Dallas County, reporting a record high number of covert 19 hospitalizations with nearly a quarter of all hospitalized patients being infected with the virus. In the North Texas region that number closer to 30%, according to Dallas County Judge Clay Jenkins, who explains what that could mean in weeks to come. People will be cared for by doctors and nurses who have more patients than is considered optimal UT Southwestern, projecting it continued dramatic spike in hospitalizations between now in January. 5th Quite Nevil,

Dallas County North Texas Judge Clay Jenkins Nevil
Learn how to use ISS tracking alerts to Spot The Station

Innovation Now

01:11 min | 2 months ago

Learn how to use ISS tracking alerts to Spot The Station

"As the third brightest object in the sky it's easy to spot if you look up. This is a special series of innovation now celebrating twenty years of continuous human presence on the international space station. As the international space station passes overhead. It is sometimes visible to the naked eye. All sightings occur within a few hours before or after sunrise or sunset these times create optimum viewing periods as the sun reflects off the space station and contrast with the darker sky. The station will look like a fast moving plane only much higher and traveling much faster unlike planes. The station has no flashing lights and won't change direction. In the several seconds it's visible. But how do you know when to look up. you can sign up for email or text. Alerts at spot. The station dot nasa dot gov spot. The station will only send out notifications when you have the best opportunity for viewing and because the station's orbit takes it all around the globe. You could be in the right place at the right time of the day as the international space station streaks across the

International Space Station Nasa
Kia recalling 295,000 vehicles due to risk of engine fires

Masters in Business

00:31 sec | 3 months ago

Kia recalling 295,000 vehicles due to risk of engine fires

"Is recalling 295,000 vehicles in the U. S. Due to an engine fire risk The recall effects 2012 and 2013 surrender does 2012 to 2015 Forte's and four take Oops, 2011 to 2013 Optima hybrids 2014 to 2015 souls and 2012 sported jizz dealers will look under the hood for fuel or oil leaks, do an engine test and make repairs as needed, including engine replacement. The Korean car company is developing a knock sensor detection system Software update to prevent the prop. Them in the future.

U. S.
Manage Anxiety Attacks

The Daily Meditation Podcast

04:47 min | 3 months ago

Manage Anxiety Attacks

"So in today's episode you're going to be guided as you layer together techniques so begin to settle yourself down and get ready to meditate. I'd like to introduce you to a fellow meditators. Who is listening to the meditations right along with you. And this is from christy. Who reaches out to say that. She is currently at work at her desk crying as she fights a panic attack that she experiences almost daily. She writes who listening to your podcasts. Right now because your voice is call me. And i'm trying to calm myself down. I'm a forty five year old woman. Who has suffered with anxiety and panic disorder for twenty years. Thank you one of the ways. Meditation can benefit you so much with anxiety in particular is because when you're feeling stressed and anxious the thoughts and feelings are focused on. What's going on out there around you out in the world and we can always control that especially these days so when you begin to interior is directing your focus more inward on your breath on where you are at this moment on noticing how you feel in your body and the emotions. You're feeling then you begin this process of coming back to yourself. Your true potential as you said with your eyes closed end gently uplifted with your spine. Straight and noticing where you're holding tension in your body identifying emotions that may be associated with that tension or tightness beginning to unravel and recognize where this tension tightness is coming from. This is the process where you begin to realize you have power and you have control. You can calm your mind and body with your. Perhaps as you inhale through your nose. Feeling your optimum gently rise upward as you exhale and feel it sink back downward your emotions follow their rhythm and flow. If your breath calming year breath allows you to calm those anxious thoughts that pull you out into the world. Your breath brings you back to yourself as you inhale and exa through year knows. I want to share with you. The words from palm hansa to allow you to bring yourself into this moment. The minutes are more important than the years. Never think of tomorrow take care of today and all the tomorrows will be taken care of. Do not wait until tomorrow to meditate. Do not wait until tomorrow to be good. Be good now

Christy Anxiety
Longtime ATP Tour Insider Weller Evans

Beyond The Baseline

05:56 min | 4 months ago

Longtime ATP Tour Insider Weller Evans

"Everyone John. With was were so streaming tennis podcast everyone twelve, our guest as we do Beller Evan any insider will recognize sellers name the consummate timoth insider he worked for the ATP Tour for many years his. Was Tour Manager for the most part, but he also was. A fixer, a pragmatists they council guidance counselor. One of the tour employees who work with the players week in week out was in the locker room and really knows that the mechanics of tennis mechanic of the tour better than anyone he also briefly served on the. Board, last year and part of this year. So this is a a wide ranging conversation with a crew tennis. Insider we talk a bit about tennis in twenty twenty the we talk about this more stories from. Welders career in also been about how to get into tennis There are roles into score even if. You do not hit a ball at a professional level and weller someone who spent his whole career in tennis and only a few of those as a player. So here's a wide ranging conversation with a true tennis insider. Here's Willer Evans first of all Weller Evans thank you for. Thank you for doing this I appreciate this. Model John It's It's a pleasure. I have to congratulate you in that You know it's to be quite Khuda get both Jerry. Seinfeld, and Weller Evans. As interviews within a month of one another. Low Bar just make a few jokes in Yiddish and everyone everyone goes home. Happy. No but we passed up no opportunity to talk tennis and I was saying in the Intro I feel like you are. You're the perfect person to help make some sense of these strange times because you are someone, it's always understood the mechanics and have the insider perspective. and. Our Voice of reason and I figured I wanNA hear a bit about your backstory in some sort of historic progressives. But but help us make sense of tennis in Twenty Twenty How How are you sensing? This is going and what's your take on sort of gray tennis in this work around year? Well I think we're fortunate to be playing tennis at all and to actually have had. Three of the four slams played. This year I think is a remarkable accomplishment. Don't you? Yep Absolutely. especially. Given the challenges of of tennis compared to other sports You know it's it's not it's not as simple as. You, you've got thirty teens in everyone's GonNa, lock themselves in a bubble together. To, two hundred and fifty six players from all over the world is is a big challenge. What do you make about the rest of it? I? Mean we have. Cologne one in Cologne to this week, which sounds like Competing. Hugo boss. Fragrance collection we have carry over points we have. To joke of, it's not playing Paris because he's disincentivize because of the point structure what's your take on? Tennis outside of outside of the three majors we were able to play. Well just. To sort of focus for a second on the ranking system. And and what we had to do and I apologize in advance for referring. To. The ATP as we but when you work for an Organization for twenty five years and you stay so closely connected to it it's inevitable that you end up referring to what they do as as we but. You know. The ranking system has to be addressed. Once we took such a long off from tournaments. and. You enter. That challenge you know with the premise that there's not going to be a perfect system. Heck. Probably, our current ranking system is not perfect. But realizing that there's probably not even an optimum way to accomplish all that needs to be accomplished. So is it? It really was a challenge for sure but You know I think the ATP's priority was always to. Try to continue to have a fair and accurate evaluation of. Player on court performance, which also has credibility with our fans and I think if you look at the rankings as they currently stand I, think the ADP has accomplished. You know accomplish that goal. With Roger. Not Be fit enough to play the world tour finals I would. Like to think that a a guy who's been really hot since we return to the court Andrei Rubel who actually was was. INFLA-. Go even before the suspension is going to make the world tour finals I'm sure there are people who? Are. Going ask. Why Medvedev? is going to be in there when he hasn't really. You. Duplicated. The success that he had last year an-and. CARNOT boost has. Left back into everybody's consciousness and. He may or may not make it to London. So I'm sure they'll be people who. You might question that but I think on the whole the ranking system and the rankings that we have currently even given the the cogut accommodations that were made. With with our fats.

Tennis John It Willer Evans Tour Manager Beller Evan Twenty Twenty Weller Hugo Boss Medvedev London Low Bar Jerry Andrei Rubel Cogut Cologne Seinfeld Paris Roger
Dr. Mark Hoffman, Research Associate Professor at the University of Missouri, Kansas City - burst 01

Scientific Sense

44:57 min | 5 months ago

Dr. Mark Hoffman, Research Associate Professor at the University of Missouri, Kansas City - burst 01

"Welcome to the site of accents podcast. Where we explore emerging ideas from signs, policy economics, and technology. My name is Gill eappen. We talk with woods leading academics and experts about the recent research or generally of topical interest. Scientific senses at unstructured conversation with no agenda or preparation. Be Color a wide variety of domains red new discoveries are made. and New Technologies are developed on a daily basis. The most interested in how new Ideas Affect Society? And, help educate the world how to pursue rewarding and enjoyable life rooted in signs logic at inflammation. V seek knowledge without boundaries or constraints and provide unaided content of conversations bit researchers and leaders who low what they do. A companion blog to this podcast can be found at scientific sense dot com. And displayed guest is available on over a dozen platforms and directly at scientific sense. Dot? Net. If you have suggestions for topics, guests at other ideas. Please send up to info at scientific sense dot com. And I can be reached at Gil at eappen Dot Info. Mike yesterday's Dr Mark Hoffman, who is a research associate professor in the University of Minnesota Against City. He is also chief research inflammation officer in the children's Mussa hospital in Kansas City. Kiss research interests include health data delayed indication sharing initialisation Boca Mark. Thank you for inviting me. Absolutely. So I start with one of your papers Kato you need the use by our system implementation in defy date data resource from hundred known athlete off my seasons. So Michio inflicted. Data aggregated for marketable sources provide an important resource for my medical research including digital feel typing. On. Like. Todd beat to from a single organization. Guitar data introduces a number of analysis challengers. So. So you've worked with some augmentation log and in almost all cases be used. Data coming from that single macy's listen primary care behavioral. Or specialty hospitals and I always wondered you know wouldn't be nice. Get a data set. That sort of abrogates data from the radio on-ice. Asians but a lot of different challenges around that. So you wanted to talk a bit about that. I'd be happy to the resource that we've worked with. Is primarily a called health fax data resource. It's been in operation for almost twenty years. And the the the model is that organizations who are. Using these Turner Electronic. Health. Record. Enter into an agreement was turner they agreed to provide data rights to sern are. The identifies the date of affords aggregated into this resource. And certner provides data mapping, which is really critical to this type of work. It also the aggregate the data. And for the past probably six years. Then, they provide the full data set to especially academic contributors who want to do research with that resource. And I've been on both sides of that equation Lead that group during my career there, and then now I have the opportunity to really focus research on that type of data. So before we get into the details smog so e Itar Systems. So this is. Essentially patient records. So he gets dated like demographics out family history, surgical history hats, medications, lab solves it could have physician nodes no snow. So it's it's a combination of a variety of different types of data, right? A couple of things on the examples you gave it includes demographics. Discreet Laboratory results Medication orders. Many vitals so If access the blood pressure and pulse data. It does not include text notes because those can't be. Automatically identified consistently. So. We don't have access currently to TEX notes. Out of an abundance of caution. That his Hobby Stephen, physician writes something down they could use names they could use inflammation that could then point back to their. Patients Makita Perspective been the data's aggregated, the primary issue shoe that date has completely the identified, right? Correct. So. So yeah. So the data that we receive there's eighteen identifiers. Hip requires be removed from data. And those include obvious things like name address email addresses are another example One of the. Things. That is also part of the benefit of working with this particular resource. The. Dates of clinical service are not allowed to be provided under hip. White is done with this resource that allows us to still have a longitudinal view is. For any given patient in the data set the dates are shifted by A. Consistent. Pattern that for any given patient it can be. One two three four five weeks forward or one, two, three, four or five weeks backward. But that preserves things like day of the week effect. So for example, you see -nificant increase in emergency department encounters over weekends and you don't WanNa lose. Visibility to that. but it also allows us to receive. Very, granular early time stamped events in so. We can gain visibility into the time that a blood specimen was collected, and then the time that the result was reported back. And so we're able to do very detailed analyses with this type of resource. Right right and I don't know the audience our market is fragmented. Tau himself e Amorebieta providers out there. and so two issues. One is sort of. Standardization as to how these databases are designed and structured and others even that standardization that the actual collection of the data. In itself is not standardized played. So vk CAV vk potentially lot inability coming from different systems. Correct and that's part of what the paper that you mentioned Evaluates so. Often, night you out in the field in conferences you hear. Comparisons kind of lumping all organizations using one. Vendor lumping all using another together but as you get closer to it, you quickly learn that. It's not even clear. It's within those. Vendor markets. There's variation from organization to organization in how they use the e Hr and so. Because the identities of the. Contributing organizations are blinded to those of us who work with the data. We have to be creative about how we. Infer those implementation details, and so with this paper, we describe a couple of methods that We think move things forward towards that goal. Yes. So I'm not really familiar with that. So you mentioned a couple of things here. One is the the merge network. So this initiative including electric medical records and genomics network and pc off net the national patient, centered clinical research network support. Decentralized analyses that goes disparate systems by distributing standardized quotas to site. So this is a situation where you have multiple systems sort of. Communicating with each other and this net folks at allowing to sort of quickly them In some standardized fashion. So In this type of technology, there's janitorial core models. One is the. Federated or distributed model, the other is a centralized data aggregation. So there are examples including those that are mentioned in the paper where. Queries are pushed to the organization and. They need to do significant work upfront to ensure that there are standardizing their terminologies the same way. And once they do that upfront work than they're able to perform the types of queries that are distributed through those. Federated Networks. With. Okay. So that just one click on so that the police have standardized. So all on the at Josh site, then they have like some sort of a plan slater from from Stan Day squatty do all the data structure. And in many cases, they work through an intermediate technology. that would be. In general, consider it like a data warehouse. And so the queries are running against the production electric. Health record. That has all kinds of implications on patient care where you don't want to slow down performance. By using these intermediaries They can receive queries and then Follow that mapping has occurred. Than, they're able to to run those distributed queries. Okay. And the other model is You know. You say the g through the medical quality, improvement consortium and sooner to the health facts initiative. So this says in Sodas case, for example, in swags. This is essentially picking up data from the right deals, clients and Dan standardizing and centralizing data in a single database is that that is correct. One benefit of that model is that Organizations who for example, may not be academic and don't have the. Resources to do that data mapping themselves by handing out over that task over to the vendor you get a broader diversity of the types of organizations so you can have. A safety net hospitals you can have. Critical access rural hospitals, and other venues of care that are probably under represented in some of those. More academically driven models. And clearly the focus on healthcare about I would imagine applications in pharmaceutical out indeed to right I. Don't know if it s use and bad direction there has been some were performed with these data resources to. Characterize different aspects of medications, and so it does have utility in value. In a variety of. Analytical contexts. I was thinking about you know a lot of randomized clinical trials going on into Kuwait context and One of the issues of dispatch seem development toils that are going on that one could argue the population there are not really well to percents. it may be number by Auditees, men, people that deputy existing conditions. and. So he will serve at my come out of facedly trial. granted might work for the population. Tried it minority have sufficient? more largely. So I wanted this type of well I guess we don't really have an ID there right. So clearly, you don't know who these people are but they could be some clustering type analysis that might be interesting weight from It's very useful for Health Services Research and for outcomes research for you know what I characterize digital phenotype being. they can then guide. More, more formal research. you know you can use this type of resource to. Make sure. You're asking a useful question and make sure that there's likely to be. Enough patients who qualify for given study. Maybe you're working on a clinical trial in your casting your net to narrow you can. Determine that with this type of data resource. And is the eight tiff date who has access to it typically. So for this data resource on, it's through the vendor so. You need to have some level of footprint with them. which is the case with our organization. They're definitely a broadening their strategies. So they're. Gaining access into health systems that aren't exclusively using their electronic health records so. It's exciting to be a part of that that process. and to again work with them to. Analyze the data. I think. To the example you gave a formal randomized trials. In key part of what were growing our research to focus on is because this is real world data. You learn what's happening in practice whether or not it's well aligned with guidelines or formal protocols. And doing that there's many opportunities for near-term interventions that can improve health outcomes simply by. Identifying where providers may be deviating more from. Best Practices in than taking steps through training and education to kind of get them back towards those best practices. This data is a fresh on a daily basis. It's not. It's because it's so large and bulky? Typically we've received it on a quarterly basis in since it's retrospective analysis that's not been a major barrier. But. mechanistically, on onto soon aside is data getting sort of picked up from this system that it's harvested every day and then it's aggregated bundled and distributed on A. On a different timescale. Okay okay. So. From again, going to the, it's our system designed issue and implementation You say many HR systems comprised of more news at specific clinical processes or unit such as Pharmacy Laboratory or surgery talked about that. But then then people implement them this of fashion right they they implement modules by that can be a factor or sometimes they may want. One vendor for their primary electronic health record, but another vendor for their laboratory system. and so that's where you don't see a hundred percent usage of every module and every organization. And detailed number of different you know sort of noise creating issues in data one. This is icy speech over from ICT denied ten. and I don't know history of this but this was supposed to be speech with sometime in twenty fifteen. That's correct. So there is A. You know. There's a date in October of Twenty fifteen where most organizations were expected to have completed that transition. When I see with researchers who aren't as familiar with the you know the whole policy landscape around `electronic health records that? you can imagine researchers who assumed that all data before that date in October is is nine and all data after that date would be icy the ten. While we demonstrate in this paper, is that that transition was not Nearly, that clean and it was a much more, you know there are some organizations who just It the bullet and completed in twenty fourteen, and there are other organizations that were still lagging. In. Two Thousand Sixteen. Potentially because they weren't as exposed to those incentives in other things that you know stipulated the transition so. Part of why were demonstrating with that particular part of that work was that. you know these transitions aren't always abrupt. Yeah and and and so that is one issue and then you know a lot of consistency inconsistency issues fade. So we see that in in single systems and one of the items note here as you know if you think about the disposition code for death. you could have a right your race supercenter, right? It's a death expire expedite at home hospice, and so on. if this is a problem for a single system, but then many think about aggregating data from multiple sources this this problem sort of increased exponentially. Absolutely. So one of the challenges with documenting and and finding where you know if a patient has A deceased that. There's just multiple places to put that documentation in the clinical record. The Location in the record that. We have found to be the most consistent is what's called discharge disposition. By as we show in that analysis, that field is not always used document that and so if you're doing outcomes research and one of your key. Outcome metrics is death. And there are organizations that. Aren't documenting death in a place that successful. You should filter those out of your analysis before moving forward. And so part of what we wanted to promote is the realization that. That's the type of consideration that needs to be made The four. Publishing. Your data about an outcome metrics like death that. You're not. If you're never gonNA see that outcome it doesn't mean that people are. Dying in that particular facility, it just means it's not documented in the place that successful. Right. Yeah. So you know you on your expedience. Unique Position Mark because you you look at it from the from the vendor's perspective you're in an academic setting you're also in practice in a hospital. What's your sense of these things improving the on a track of getting getting this more standardize or it's camping in the other direction I think in general there is improvement I think The. Over the past eleven years through various federal mandates, including meaningful use and so forth. Those of all incentive organizations to utilize. Standard terminologies more consistently than was the case beforehand. I think there's still plenty of room for improvement and You know it's it's a journey, not a destination, but I think things have improved substantially. I was wondering there could be some applications of artificial intelligence here to In a clearly TATECO systems and you'd like the most them pity human resource intensive Yvonne to get it completely right. So one question would be you know, could be actually used a Dick needs to get it maybe ninety nine percent white. And that the human deal with exceptions I definitely think that that's an exciting direction that You want those a algorithms to be trained with good data, and that's a big part of what's motivated us to. Put this focus on data quality and Understanding these strange nuances that are underpinning that date has so that. As we move towards a in machine learning and so forth. We have a high level of confidence in the data that's training those algorithms. Right. Yeah. I think that a huge opportunity here because it's not quite as broad as NFL, not natural language processing it is somewhat constrained. that is a good part of it. The back part of it is that is highly technical. and so. you know some of the techniques you know you can have a fault tolerance in certain dimensions such as you know, misspellings lack of gambling and things like that. But as you have Heidi technical data, you cannot apply those principles because he could have misspelling the system may not be able to. Get, sometimes, and that's where you know I think. It's totally feasible to use. Resources to you know when you're dealing with. Tens of millions of patients and billions of detailed records. Using a I'd even identify those patterns of either. Inconsistent data or missing data it's also very powerful just to. kind of flag in identified. Areas that need to be focused on to lead to a better analysis. Greg Wait Be Hefty. Use that information somehow did is a belt of information that you know and so it just filtering into decision processes that the are really losing it. So hopefully getting improving in that dimension I've jumping to another paper bittersweet interesting. So it's entitled rates and predictors of using opioids in the Emergency Department Katrina Treat Mike Dean in Young Otto's and so so this is sort of a machine learning exercise you have gone through to locate you know coup is getting prescribed. OPIOIDS water the conditions for the Democrat not Nestle demographics but different different maybe age and things like that gender. and and then ask the question desert has some effect on addiction. In the long term rights. So that project To great example of team science though. We. Assembled a team of subject matter experts in neurology pain management. And Data Science and. The neurologist and pain management experts. Identified an intriguing question that we decided to pursue with data. In their question was. Based on anecdotal observation and so we thought it'd be interesting to see how well the data supported that. Observation is that. for youth and young adults Treated or admitted into the emergency. Department. With a migraine headache that. All too often they were treated with an opioid. And so we Use the same day to resource that we were discussing earlier. To explore that. Question. And using data from a hundred and eighty distinct emergency departments. We found that on average twenty, three percent of those youth and young adults were treated with. An opioid medication while they were in the emergency department. In general, it should be almost zero percent in general. There's really Better medications to us, four people presenting with a migraine. and. So this fits into obviously the OPIOID crisis it. it demonstrates the. Scenario describing that. You know using real world data. You can identify patterns of clinical behavior that. Don't match guideline. And the good news is that the? correctable and so through. Training and communication there's great opportunity to. To, manage this. Really. Striking. So fifteen thousand or so inevitably the encounters. And nearly a quarter of this encounters you say involved inoculate. and these are not just Misha and Congress right. It is not filtered down to migraine encounters. Okay. Okay. So these fifteen thousand just might in encounters might vein being repeating disease So once you. If you make a statement and. This or not Easter conditioning issue here. So you get your pain, you go to an emergency department and you get treated with an opioid you get quick tactical relief. From pain. auditing condition expect that in the next episode. So you can say we didn't pursue that particular question, but that is Definitely key part of. Managing the OPIOID crisis is that drug seeking behavior and so Part of our goal was to quantify that and use this as an opportunity to educate providers that. You really shouldn't be treating migraines with an opioid in there are better alternatives and. So we we felt that this was an important contribution to that national dialogue, but we didn't specifically pursue the question of whether the patients we analyzed. Within. Encounter show up Subsequently. With the same symptoms. Right right. Yeah you it develop into period when problematic patterns of drug use comedy. FEST MERGE THE PREVALENCE RATE OF OPIOID misuse estimated to be two to four percent and debts in each goofy just young adult drew from overdoses are rising. and. You say that literally prescribe IOS has been slumping loose future opioid misuse by thirty three percent. Betas Mehta say really huge number. I think just validates the importance of this of this work. Interesting mark. I don't know you exploded on data. Last the question if you look at the aggregate data, it'd be flying opioid. Misuse. what percentage of the total number. Actually started from. You know some sort of medical encounter has mike or some sort of. related encounter that could be completed otherwise was three a bit opioid. in that encounter documented resulted in that misuse. So what so If you look at the active misuse problem that we have today. do you have a sense of what percentage of that goal is actually started I? Think the exciting thing about this type of research is for everyone questioned that you pursue you have. You have ten new that you can pursue. We haven't. Delved into that specific area, but it's It's very ripe for further analysis and A considerable part of where I end my colleagues and our time as. We do this type of work to get an initial analysis published. And then You know in my leadership role I just WANNA. support people like my colleagues on this paper Mark Connelly Jennifer Bickel. in in using data to. Support their research into identify those follow. I mean, he tests policy implications. So it's sweet important work. and. If you find it direct relationship here than you have to ask you know from from a medical perspective what is right intervention? maybe is not just added of care just best practice but clearly should be the bay You know things should be looked at you say you're American Academy of Neurology has included avoidance of using opioid to treat gain one of stop top flight choosing wisely recommendations. For high-value duck in this gives Really evidence to to support that. The other thing that's really intriguing is this level of variation from site to site in. Some Sun facilities are very much aligned with the guidelines. Others are at the you know well, above twenty three percent. And that gives an opportunity for a really precision. conversations about you know, where does our organization stand on that spectrum? Yeah that's a that's an interesting avenue to right. So you know one could ask he says some sort of push sliced Intervention if we can fly goal of patients who who had gone an opioid sexually don't have an addiction problem. that as you know Anna, the kofoed does. if you can fly those type of patterns than you can think about. A customized within electronic health record systems. There's. The ability to provide decisions poor. There's certainly phenomena called pop up fatigue were physicians. You know they don't like having so many pop up windows but at the same time. It's Within the capability of an e e Hr to do that if then logic if patient has. migraine medication order equals opioid. encourage the provider to pause and reconsider that. Right, right and so this is supervised machine learning type analysis where so you have. you have number features that comes directly from each else. So each sex race ethnicity. insurance type. Encounter prostate suggest duration. time of the year and so on. and you have labeled data in this case I guess you have able tater because you would know if op- inscribed on trade. Okay and so are the two questions here. One is to ask the question given a new patient and those features. you could assign a probability that that patient will be prescribed will. Definitely. Impress the data from that predictive Minds. Right and then can you so that data definitely tell you if the patient is going to progress into some sort of an addiction issue. So. Earn Predicting Substance Abuse. So. Yeah. Yeah. Yeah. There's additional diagnosis codes that document. whether a patient has a history of substance abuse disorder. and. So it would be feasible to. Identify the with those diagnosis codes in than really look at their prior history. Of What other conditions were they treated for? What medications were they give in? to develop that model. One of the things in this case that helped with this study is that just in general, it's not advised get. So there are other things that are much more of a gray area. Or whether opioid is as useful, but in this case. The really not. Considered. To be helpful for migraines compared to other options and so that help us have a fairly clear cut scenario to do this work. Yeah. This this won't be the data like you say once you do something like this, you have been other things you could. You could stop asking. So unquestioned that that been to my mind as you know, how did they hugged the actually prescribing opioids? Is it the patient asking for it all so? Off that was another scoping thing with this project is focused on what happens within the emergency. Room. So it's it's. Really, medication order in administration that happens. In that emergency room setting. Whether or not the patient. was. Requesting that you know if they came in and said, this has worked for me before. Can I have it again? we don't have visibility to that. Right. Right. And so from a practical perspective So the the analysis that you did slightly ended up with the Family Clyde power we think it is. Compelling. Pretty compelling. So as as a new patient gets into e D either high. and what I mean by that probably is if there is a history of substance abuse property. the physician has really think twice about. The use of may be the well, and in this case, even without that history. Just because it's not considered to be an effective treatment. You know encouraging them to pause in that decision making. In this particular case is as effective as wall. Right. So looking forward. In if you think about both of these issues, one is the data quality data aggregation data standardized recent problem in the the right of Utah Systems have did that the talked about? And then if we can get to a level that we can look at cross a large data set. Beacon, ask. More. US specific questions, treatment. Optimum treatment type questions. subpoenaed. US The mark big think B be hunting. Certainly, the volume and variety of data that we're able to work with will be even greater I, think the. Opportunity To. Look, holistically at how upstream data capture. Effects Downstream data. Analysis. example I frequently give is if we have a Aggregate Data said we identify. Ten patients whose way in that data such shows up as being. Something that's completely infeasible. let's say they're documented is being. Fifty year old person who weighs two pounds. Clearly air. What's important is? Creating the process to communicate that back upstream. Because that clinical decision. Support. Many drug dosing things are evaluated using weight based logic and so. That same logic that's Evaluating the appropriateness of dosage. It's going to be running against an incorrect value in that may or may not always be visible. So I really am intrigued with that holistic opportunity. In it I am I remain just we have three or four additional papers coming out. About other examples where Provider behaviors not aligned with Best Practices and I'm just excited about you know when you compare that to how long it takes to develop a new drug or how long it takes to. To a really long term research. This research has the opportunity for a pretty quick turnaround on an effective intervention. A really that. Other so much that right. Providers. been taught in a no, but they're. Not always using that in practice and so to help them. Identify, those topics in just modifying behaviors is. In the scheme of things, it's a very straightforward way to improve. So. You know the entire spectrum from essentially getting the data. Right or cleaner like you know Missa mischaracterized or miss input data like wait or something like that. To to get. Better diagnosis better treatment modalities. policies there and from a femme perspective clearly inflammation therefore clinical trials. I was even thinking about drug interaction type. Inflammation. I haven't been involved in the former de for awhile but. Typically, this type of data doesn't get back into automatic processes that fast but I think that is all I know there's strong interest in Pharma in. Working with this type of data there a again looking at real world behavior. This is an excellent resource for off label medication use at. you know where Pharma's Always interested in repurposing existing medications the. Regulatory Processes, much more straightforward for that because the safety is already been. Evaluated and so. The. Significant Opportunity With this, there's also just exciting. Patterns of you know. What are those unrecognised correlations? That's where the machine learning opportunities are really exciting where. You know we're not always asking the right question. And the data can show us what we should be. Yeah exactly. So if the machine a sort of red flags something or create hypotheses. that Cubans have missed sometimes, those types of things are extremely powerful. because maybe that sometimes it's countering tutor. and so we all look at data with an Incan bias. The beauty of machines that at least on the surface began deploy Michigan. This volume of data. Techniques like machine deep learning can recognize those subtle but consistent associations. Wait quite. Excellent. Idea this has been great mark Thanks so much time with me. I enjoyed it very much. Thank you. But

Gill Eappen Mike Yesterday Dr Mark Hoffman Children's Mussa Hospital Turner Electronic Certner Migraine Inflammation Federated Networks Stan Day Squatty Michio Kato University Of Minnesota Makita GIL Federated Kansas City
Dr. Mark Hoffman, Research Associate Professor at the University of Missouri, Kansas City - burst 01

Scientific Sense

44:57 min | 5 months ago

Dr. Mark Hoffman, Research Associate Professor at the University of Missouri, Kansas City - burst 01

"Welcome to the site of accents podcast. Where we explore emerging ideas from signs, policy economics, and technology. My name is Gill eappen. We talk with woods leading academics and experts about the recent research or generally of topical interest. Scientific senses at unstructured conversation with no agenda or preparation. Be Color a wide variety of domains red new discoveries are made. and New Technologies are developed on a daily basis. The most interested in how new Ideas Affect Society? And, help educate the world how to pursue rewarding and enjoyable life rooted in signs logic at inflammation. V seek knowledge without boundaries or constraints and provide unaided content of conversations bit researchers and leaders who low what they do. A companion blog to this podcast can be found at scientific sense dot com. And displayed guest is available on over a dozen platforms and directly at scientific sense. Dot? Net. If you have suggestions for topics, guests at other ideas. Please send up to info at scientific sense dot com. And I can be reached at Gil at eappen Dot Info. Mike yesterday's Dr Mark Hoffman, who is a research associate professor in the University of Minnesota Against City. He is also chief research inflammation officer in the children's Mussa hospital in Kansas City. Kiss research interests include health data delayed indication sharing initialisation Boca Mark. Thank you for inviting me. Absolutely. So I start with one of your papers Kato you need the use by our system implementation in defy date data resource from hundred known athlete off my seasons. So Michio inflicted. Data aggregated for marketable sources provide an important resource for my medical research including digital feel typing. On. Like. Todd beat to from a single organization. Guitar data introduces a number of analysis challengers. So. So you've worked with some augmentation log and in almost all cases be used. Data coming from that single macy's listen primary care behavioral. Or specialty hospitals and I always wondered you know wouldn't be nice. Get a data set. That sort of abrogates data from the radio on-ice. Asians but a lot of different challenges around that. So you wanted to talk a bit about that. I'd be happy to the resource that we've worked with. Is primarily a called health fax data resource. It's been in operation for almost twenty years. And the the the model is that organizations who are. Using these Turner Electronic. Health. Record. Enter into an agreement was turner they agreed to provide data rights to sern are. The identifies the date of affords aggregated into this resource. And certner provides data mapping, which is really critical to this type of work. It also the aggregate the data. And for the past probably six years. Then, they provide the full data set to especially academic contributors who want to do research with that resource. And I've been on both sides of that equation Lead that group during my career there, and then now I have the opportunity to really focus research on that type of data. So before we get into the details smog so e Itar Systems. So this is. Essentially patient records. So he gets dated like demographics out family history, surgical history hats, medications, lab solves it could have physician nodes no snow. So it's it's a combination of a variety of different types of data, right? A couple of things on the examples you gave it includes demographics. Discreet Laboratory results Medication orders. Many vitals so If access the blood pressure and pulse data. It does not include text notes because those can't be. Automatically identified consistently. So. We don't have access currently to TEX notes. Out of an abundance of caution. That his Hobby Stephen, physician writes something down they could use names they could use inflammation that could then point back to their. Patients Makita Perspective been the data's aggregated, the primary issue shoe that date has completely the identified, right? Correct. So. So yeah. So the data that we receive there's eighteen identifiers. Hip requires be removed from data. And those include obvious things like name address email addresses are another example One of the. Things. That is also part of the benefit of working with this particular resource. The. Dates of clinical service are not allowed to be provided under hip. White is done with this resource that allows us to still have a longitudinal view is. For any given patient in the data set the dates are shifted by A. Consistent. Pattern that for any given patient it can be. One two three four five weeks forward or one, two, three, four or five weeks backward. But that preserves things like day of the week effect. So for example, you see -nificant increase in emergency department encounters over weekends and you don't WanNa lose. Visibility to that. but it also allows us to receive. Very, granular early time stamped events in so. We can gain visibility into the time that a blood specimen was collected, and then the time that the result was reported back. And so we're able to do very detailed analyses with this type of resource. Right right and I don't know the audience our market is fragmented. Tau himself e Amorebieta providers out there. and so two issues. One is sort of. Standardization as to how these databases are designed and structured and others even that standardization that the actual collection of the data. In itself is not standardized played. So vk CAV vk potentially lot inability coming from different systems. Correct and that's part of what the paper that you mentioned Evaluates so. Often, night you out in the field in conferences you hear. Comparisons kind of lumping all organizations using one. Vendor lumping all using another together but as you get closer to it, you quickly learn that. It's not even clear. It's within those. Vendor markets. There's variation from organization to organization in how they use the e Hr and so. Because the identities of the. Contributing organizations are blinded to those of us who work with the data. We have to be creative about how we. Infer those implementation details, and so with this paper, we describe a couple of methods that We think move things forward towards that goal. Yes. So I'm not really familiar with that. So you mentioned a couple of things here. One is the the merge network. So this initiative including electric medical records and genomics network and pc off net the national patient, centered clinical research network support. Decentralized analyses that goes disparate systems by distributing standardized quotas to site. So this is a situation where you have multiple systems sort of. Communicating with each other and this net folks at allowing to sort of quickly them In some standardized fashion. So In this type of technology, there's janitorial core models. One is the. Federated or distributed model, the other is a centralized data aggregation. So there are examples including those that are mentioned in the paper where. Queries are pushed to the organization and. They need to do significant work upfront to ensure that there are standardizing their terminologies the same way. And once they do that upfront work than they're able to perform the types of queries that are distributed through those. Federated Networks. With. Okay. So that just one click on so that the police have standardized. So all on the at Josh site, then they have like some sort of a plan slater from from Stan Day squatty do all the data structure. And in many cases, they work through an intermediate technology. that would be. In general, consider it like a data warehouse. And so the queries are running against the production electric. Health record. That has all kinds of implications on patient care where you don't want to slow down performance. By using these intermediaries They can receive queries and then Follow that mapping has occurred. Than, they're able to to run those distributed queries. Okay. And the other model is You know. You say the g through the medical quality, improvement consortium and sooner to the health facts initiative. So this says in Sodas case, for example, in swags. This is essentially picking up data from the right deals, clients and Dan standardizing and centralizing data in a single database is that that is correct. One benefit of that model is that Organizations who for example, may not be academic and don't have the. Resources to do that data mapping themselves by handing out over that task over to the vendor you get a broader diversity of the types of organizations so you can have. A safety net hospitals you can have. Critical access rural hospitals, and other venues of care that are probably under represented in some of those. More academically driven models. And clearly the focus on healthcare about I would imagine applications in pharmaceutical out indeed to right I. Don't know if it s use and bad direction there has been some were performed with these data resources to. Characterize different aspects of medications, and so it does have utility in value. In a variety of. Analytical contexts. I was thinking about you know a lot of randomized clinical trials going on into Kuwait context and One of the issues of dispatch seem development toils that are going on that one could argue the population there are not really well to percents. it may be number by Auditees, men, people that deputy existing conditions. and. So he will serve at my come out of facedly trial. granted might work for the population. Tried it minority have sufficient? more largely. So I wanted this type of well I guess we don't really have an ID there right. So clearly, you don't know who these people are but they could be some clustering type analysis that might be interesting weight from It's very useful for Health Services Research and for outcomes research for you know what I characterize digital phenotype being. they can then guide. More, more formal research. you know you can use this type of resource to. Make sure. You're asking a useful question and make sure that there's likely to be. Enough patients who qualify for given study. Maybe you're working on a clinical trial in your casting your net to narrow you can. Determine that with this type of data resource. And is the eight tiff date who has access to it typically. So for this data resource on, it's through the vendor so. You need to have some level of footprint with them. which is the case with our organization. They're definitely a broadening their strategies. So they're. Gaining access into health systems that aren't exclusively using their electronic health records so. It's exciting to be a part of that that process. and to again work with them to. Analyze the data. I think. To the example you gave a formal randomized trials. In key part of what were growing our research to focus on is because this is real world data. You learn what's happening in practice whether or not it's well aligned with guidelines or formal protocols. And doing that there's many opportunities for near-term interventions that can improve health outcomes simply by. Identifying where providers may be deviating more from. Best Practices in than taking steps through training and education to kind of get them back towards those best practices. This data is a fresh on a daily basis. It's not. It's because it's so large and bulky? Typically we've received it on a quarterly basis in since it's retrospective analysis that's not been a major barrier. But. mechanistically, on onto soon aside is data getting sort of picked up from this system that it's harvested every day and then it's aggregated bundled and distributed on A. On a different timescale. Okay okay. So. From again, going to the, it's our system designed issue and implementation You say many HR systems comprised of more news at specific clinical processes or unit such as Pharmacy Laboratory or surgery talked about that. But then then people implement them this of fashion right they they implement modules by that can be a factor or sometimes they may want. One vendor for their primary electronic health record, but another vendor for their laboratory system. and so that's where you don't see a hundred percent usage of every module and every organization. And detailed number of different you know sort of noise creating issues in data one. This is icy speech over from ICT denied ten. and I don't know history of this but this was supposed to be speech with sometime in twenty fifteen. That's correct. So there is A. You know. There's a date in October of Twenty fifteen where most organizations were expected to have completed that transition. When I see with researchers who aren't as familiar with the you know the whole policy landscape around `electronic health records that? you can imagine researchers who assumed that all data before that date in October is is nine and all data after that date would be icy the ten. While we demonstrate in this paper, is that that transition was not Nearly, that clean and it was a much more, you know there are some organizations who just It the bullet and completed in twenty fourteen, and there are other organizations that were still lagging. In. Two Thousand Sixteen. Potentially because they weren't as exposed to those incentives in other things that you know stipulated the transition so. Part of why were demonstrating with that particular part of that work was that. you know these transitions aren't always abrupt. Yeah and and and so that is one issue and then you know a lot of consistency inconsistency issues fade. So we see that in in single systems and one of the items note here as you know if you think about the disposition code for death. you could have a right your race supercenter, right? It's a death expire expedite at home hospice, and so on. if this is a problem for a single system, but then many think about aggregating data from multiple sources this this problem sort of increased exponentially. Absolutely. So one of the challenges with documenting and and finding where you know if a patient has A deceased that. There's just multiple places to put that documentation in the clinical record. The Location in the record that. We have found to be the most consistent is what's called discharge disposition. By as we show in that analysis, that field is not always used document that and so if you're doing outcomes research and one of your key. Outcome metrics is death. And there are organizations that. Aren't documenting death in a place that successful. You should filter those out of your analysis before moving forward. And so part of what we wanted to promote is the realization that. That's the type of consideration that needs to be made The four. Publishing. Your data about an outcome metrics like death that. You're not. If you're never gonNA see that outcome it doesn't mean that people are. Dying in that particular facility, it just means it's not documented in the place that successful. Right. Yeah. So you know you on your expedience. Unique Position Mark because you you look at it from the from the vendor's perspective you're in an academic setting you're also in practice in a hospital. What's your sense of these things improving the on a track of getting getting this more standardize or it's camping in the other direction I think in general there is improvement I think The. Over the past eleven years through various federal mandates, including meaningful use and so forth. Those of all incentive organizations to utilize. Standard terminologies more consistently than was the case beforehand. I think there's still plenty of room for improvement and You know it's it's a journey, not a destination, but I think things have improved substantially. I was wondering there could be some applications of artificial intelligence here to In a clearly TATECO systems and you'd like the most them pity human resource intensive Yvonne to get it completely right. So one question would be you know, could be actually used a Dick needs to get it maybe ninety nine percent white. And that the human deal with exceptions I definitely think that that's an exciting direction that You want those a algorithms to be trained with good data, and that's a big part of what's motivated us to. Put this focus on data quality and Understanding these strange nuances that are underpinning that date has so that. As we move towards a in machine learning and so forth. We have a high level of confidence in the data that's training those algorithms. Right. Yeah. I think that a huge opportunity here because it's not quite as broad as NFL, not natural language processing it is somewhat constrained. that is a good part of it. The back part of it is that is highly technical. and so. you know some of the techniques you know you can have a fault tolerance in certain dimensions such as you know, misspellings lack of gambling and things like that. But as you have Heidi technical data, you cannot apply those principles because he could have misspelling the system may not be able to. Get, sometimes, and that's where you know I think. It's totally feasible to use. Resources to you know when you're dealing with. Tens of millions of patients and billions of detailed records. Using a I'd even identify those patterns of either. Inconsistent data or missing data it's also very powerful just to. kind of flag in identified. Areas that need to be focused on to lead to a better analysis. Greg Wait Be Hefty. Use that information somehow did is a belt of information that you know and so it just filtering into decision processes that the are really losing it. So hopefully getting improving in that dimension I've jumping to another paper bittersweet interesting. So it's entitled rates and predictors of using opioids in the Emergency Department Katrina Treat Mike Dean in Young Otto's and so so this is sort of a machine learning exercise you have gone through to locate you know coup is getting prescribed. OPIOIDS water the conditions for the Democrat not Nestle demographics but different different maybe age and things like that gender. and and then ask the question desert has some effect on addiction. In the long term rights. So that project To great example of team science though. We. Assembled a team of subject matter experts in neurology pain management. And Data Science and. The neurologist and pain management experts. Identified an intriguing question that we decided to pursue with data. In their question was. Based on anecdotal observation and so we thought it'd be interesting to see how well the data supported that. Observation is that. for youth and young adults Treated or admitted into the emergency. Department. With a migraine headache that. All too often they were treated with an opioid. And so we Use the same day to resource that we were discussing earlier. To explore that. Question. And using data from a hundred and eighty distinct emergency departments. We found that on average twenty, three percent of those youth and young adults were treated with. An opioid medication while they were in the emergency department. In general, it should be almost zero percent in general. There's really Better medications to us, four people presenting with a migraine. and. So this fits into obviously the OPIOID crisis it. it demonstrates the. Scenario describing that. You know using real world data. You can identify patterns of clinical behavior that. Don't match guideline. And the good news is that the? correctable and so through. Training and communication there's great opportunity to. To, manage this. Really. Striking. So fifteen thousand or so inevitably the encounters. And nearly a quarter of this encounters you say involved inoculate. and these are not just Misha and Congress right. It is not filtered down to migraine encounters. Okay. Okay. So these fifteen thousand just might in encounters might vein being repeating disease So once you. If you make a statement and. This or not Easter conditioning issue here. So you get your pain, you go to an emergency department and you get treated with an opioid you get quick tactical relief. From pain. auditing condition expect that in the next episode. So you can say we didn't pursue that particular question, but that is Definitely key part of. Managing the OPIOID crisis is that drug seeking behavior and so Part of our goal was to quantify that and use this as an opportunity to educate providers that. You really shouldn't be treating migraines with an opioid in there are better alternatives and. So we we felt that this was an important contribution to that national dialogue, but we didn't specifically pursue the question of whether the patients we analyzed. Within. Encounter show up Subsequently. With the same symptoms. Right right. Yeah you it develop into period when problematic patterns of drug use comedy. FEST MERGE THE PREVALENCE RATE OF OPIOID misuse estimated to be two to four percent and debts in each goofy just young adult drew from overdoses are rising. and. You say that literally prescribe IOS has been slumping loose future opioid misuse by thirty three percent. Betas Mehta say really huge number. I think just validates the importance of this of this work. Interesting mark. I don't know you exploded on data. Last the question if you look at the aggregate data, it'd be flying opioid. Misuse. what percentage of the total number. Actually started from. You know some sort of medical encounter has mike or some sort of. related encounter that could be completed otherwise was three a bit opioid. in that encounter documented resulted in that misuse. So what so If you look at the active misuse problem that we have today. do you have a sense of what percentage of that goal is actually started I? Think the exciting thing about this type of research is for everyone questioned that you pursue you have. You have ten new that you can pursue. We haven't. Delved into that specific area, but it's It's very ripe for further analysis and A considerable part of where I end my colleagues and our time as. We do this type of work to get an initial analysis published. And then You know in my leadership role I just WANNA. support people like my colleagues on this paper Mark Connelly Jennifer Bickel. in in using data to. Support their research into identify those follow. I mean, he tests policy implications. So it's sweet important work. and. If you find it direct relationship here than you have to ask you know from from a medical perspective what is right intervention? maybe is not just added of care just best practice but clearly should be the bay You know things should be looked at you say you're American Academy of Neurology has included avoidance of using opioid to treat gain one of stop top flight choosing wisely recommendations. For high-value duck in this gives Really evidence to to support that. The other thing that's really intriguing is this level of variation from site to site in. Some Sun facilities are very much aligned with the guidelines. Others are at the you know well, above twenty three percent. And that gives an opportunity for a really precision. conversations about you know, where does our organization stand on that spectrum? Yeah that's a that's an interesting avenue to right. So you know one could ask he says some sort of push sliced Intervention if we can fly goal of patients who who had gone an opioid sexually don't have an addiction problem. that as you know Anna, the kofoed does. if you can fly those type of patterns than you can think about. A customized within electronic health record systems. There's. The ability to provide decisions poor. There's certainly phenomena called pop up fatigue were physicians. You know they don't like having so many pop up windows but at the same time. It's Within the capability of an e e Hr to do that if then logic if patient has. migraine medication order equals opioid. encourage the provider to pause and reconsider that. Right, right and so this is supervised machine learning type analysis where so you have. you have number features that comes directly from each else. So each sex race ethnicity. insurance type. Encounter prostate suggest duration. time of the year and so on. and you have labeled data in this case I guess you have able tater because you would know if op- inscribed on trade. Okay and so are the two questions here. One is to ask the question given a new patient and those features. you could assign a probability that that patient will be prescribed will. Definitely. Impress the data from that predictive Minds. Right and then can you so that data definitely tell you if the patient is going to progress into some sort of an addiction issue. So. Earn Predicting Substance Abuse. So. Yeah. Yeah. Yeah. There's additional diagnosis codes that document. whether a patient has a history of substance abuse disorder. and. So it would be feasible to. Identify the with those diagnosis codes in than really look at their prior history. Of What other conditions were they treated for? What medications were they give in? to develop that model. One of the things in this case that helped with this study is that just in general, it's not advised get. So there are other things that are much more of a gray area. Or whether opioid is as useful, but in this case. The really not. Considered. To be helpful for migraines compared to other options and so that help us have a fairly clear cut scenario to do this work. Yeah. This this won't be the data like you say once you do something like this, you have been other things you could. You could stop asking. So unquestioned that that been to my mind as you know, how did they hugged the actually prescribing opioids? Is it the patient asking for it all so? Off that was another scoping thing with this project is focused on what happens within the emergency. Room. So it's it's. Really, medication order in administration that happens. In that emergency room setting. Whether or not the patient. was. Requesting that you know if they came in and said, this has worked for me before. Can I have it again? we don't have visibility to that. Right. Right. And so from a practical perspective So the the analysis that you did slightly ended up with the Family Clyde power we think it is. Compelling. Pretty compelling. So as as a new patient gets into e D either high. and what I mean by that probably is if there is a history of substance abuse property. the physician has really think twice about. The use of may be the well, and in this case, even without that history. Just because it's not considered to be an effective treatment. You know encouraging them to pause in that decision making. In this particular case is as effective as wall. Right. So looking forward. In if you think about both of these issues, one is the data quality data aggregation data standardized recent problem in the the right of Utah Systems have did that the talked about? And then if we can get to a level that we can look at cross a large data set. Beacon, ask. More. US specific questions, treatment. Optimum treatment type questions. subpoenaed. US The mark big think B be hunting. Certainly, the volume and variety of data that we're able to work with will be even greater I, think the. Opportunity To. Look, holistically at how upstream data capture. Effects Downstream data. Analysis. example I frequently give is if we have a Aggregate Data said we identify. Ten patients whose way in that data such shows up as being. Something that's completely infeasible. let's say they're documented is being. Fifty year old person who weighs two pounds. Clearly air. What's important is? Creating the process to communicate that back upstream. Because that clinical decision. Support. Many drug dosing things are evaluated using weight based logic and so. That same logic that's Evaluating the appropriateness of dosage. It's going to be running against an incorrect value in that may or may not always be visible. So I really am intrigued with that holistic opportunity. In it I am I remain just we have three or four additional papers coming out. About other examples where Provider behaviors not aligned with Best Practices and I'm just excited about you know when you compare that to how long it takes to develop a new drug or how long it takes to. To a really long term research. This research has the opportunity for a pretty quick turnaround on an effective intervention. A really that. Other so much that right. Providers. been taught in a no, but they're. Not always using that in practice and so to help them. Identify, those topics in just modifying behaviors is. In the scheme of things, it's a very straightforward way to improve. So. You know the entire spectrum from essentially getting the data. Right or cleaner like you know Missa mischaracterized or miss input data like wait or something like that. To to get. Better diagnosis better treatment modalities. policies there and from a femme perspective clearly inflammation therefore clinical trials. I was even thinking about drug interaction type. Inflammation. I haven't been involved in the former de for awhile but. Typically, this type of data doesn't get back into automatic processes that fast but I think that is all I know there's strong interest in Pharma in. Working with this type of data there a again looking at real world behavior. This is an excellent resource for off label medication use at. you know where Pharma's Always interested in repurposing existing medications the. Regulatory Processes, much more straightforward for that because the safety is already been. Evaluated and so. The. Significant Opportunity With this, there's also just exciting. Patterns of you know. What are those unrecognised correlations? That's where the machine learning opportunities are really exciting where. You know we're not always asking the right question. And the data can show us what we should be. Yeah exactly. So if the machine a sort of red flags something or create hypotheses. that Cubans have missed sometimes, those types of things are extremely powerful. because maybe that sometimes it's countering tutor. and so we all look at data with an Incan bias. The beauty of machines that at least on the surface began deploy Michigan. This volume of data. Techniques like machine deep learning can recognize those subtle but consistent associations. Wait quite. Excellent. Idea this has been great mark Thanks so much time with me. I enjoyed it very much. Thank you. But

Gill Eappen Mike Yesterday Dr Mark Hoffman Children's Mussa Hospital Turner Electronic Certner Migraine Inflammation Federated Networks Stan Day Squatty Michio Kato University Of Minnesota Makita GIL Federated Kansas City
Has Scott Morrison spent too much?

Between The Lines

09:41 min | 5 months ago

Has Scott Morrison spent too much?

"Me. If you've already heard me mention this but one of my favorite quotes during the covid crosses a pdf the guardian. This is the British lift wing newspaper. Now, this was the heart of the coronavirus crisis. It would have been light much quote just as there are no atheists on a sinking ship, there are no free marketeers during a pandemic. Now, the author of that apt quote Jonathan Freedland, he was referring to the audio logical revolution within the British conservative. Party. Now, according to Freedland Boris Johnson's his have defied four decades of thatcherism small-state free-market, thinking I to spend staggering amounts of money and then subsidizing the wages of workers. Could the same thing be said about Australia's Liberal Party they're the party of Howard and Costello now embraces big-spending high deficit government interventionism. And is a permanent state of affairs poor kilis editor at large of the Australian US pipe and Judas Brit is emeritus professor of politics at Latrobe University poll judy welcome back to the show. Hristo Paul, you've written to calms about this subject in the past week, summarize your faces. Will Martha is that all parties and all governments have to respond to the times in which they find themselves on display in Australia. Now we face an extraordinary economic crisis and the response reveals the nature of Scott Morrison, his prime minister and the Mars and government. So Morrison, not responding as Liberal Party progressive or is it Liberal Party conservative? He doesn't see himself in those terms his responses pragmatic selects able and practical. He's not inhibited by former policy and audio logical icons of the Liberal Party. Say What we say is the government has abandoned the long-term syllabus aspirations. It's A. Big Spending government it's a government government intervention focused on Keynesian demand management. It does however on the Liberal Party tradition of tax cuts will see next week. So it's prepared to regulate or deregulate according to the situation according to what's required. So to sum up say that Morrison wants to be defined by results and outcomes not philosophical principle. Okay. You mentioned the tax cuts leaving that aside traditional liberal governments are about balancing the books Paul, how much an as do you think aries in the Liberal Party about in the parliament and outside about these handouts to preserve jobs and livelihoods? Are. I. Don't think there's much on these at all OPTIMA and Tom. and. A couple of reasons for this if there is to be on, he's He's will come through the down the track, but essentially what's happening here is to govern is following the Orthodoxy or what you might call the new Orthodoxy in terms of meeting the financial and economic crisis. So roller response is sort of radical. It's also conventional. The official family is working together very closely. The Treasury the Reserve Bank, what the government is doing is essentially supported by private-sector economists. It's in law and with Patrick amended by the VCD and the IMF not the cabinet is very nodded, the Prime Minister and the treasurer are working very closely together so far the results look good. I think the Overwhelming sentiment on the back benches. Support, the government strategy in the hope that this gives individual employees, the chance of actually being reelected and my will give the government the chance of being reelected. So the reinvention of Australian liberalism is on full display with this budget judith break you agree with Paul Kelly about the the audio logical significance of these changes but actually think the government had much choice in that sense I do think we can see something audio logical preferences in a couple of the policies poor mentioned the tax cuts they've chosen tax cuts over for example, committing to a permanent increase in new act now co Job Seca. They've also, for example, if we look at the way, they wanted to stimulate the housing market. They've gone for giving money to individual owners rather than, for example, embarking on a social housing project. So I think in some of the means, we can still see some of the ideological preferences of the Patty. One of the things I've wondered when I've been watching the events unfold. If Labor had won the last election was in government with the Liberals have supported the same levels of spending or would they have if you like stayed in the sort of ideological bunker bean and attacked the blow out of the deficit? I mean, it's a hypothetical. In some ways I think we've been very lucky that it's been the liberals and the coalition in government because they can sense being able to Ghana much more support. I, think than I have been able to do for the same levels of spending but isn't cameras response to the COVID crosses more consistent with other Western governments during the pandemic Judy. Yes that's what I think. I had much option but the question is if the coalition of being opposition, would they have supported a Labor government going? You've written a lot about this have many many decades about when orthodoxies or overturned. It's usually bipartisan is that you'll since if the coalition cypher argument's sake wherein opposition I would have gone along with this big spending interventionism. Look are essentially agree with what Judy's said about this I think in a sense we're. Fortunate, if you liked that the coalition's in government because it's taken all the big spending decisions. and. Lay has been prepared to go along with back. In fact, it's argued that there should be even more spending. So in that sense, we've had a broad degree of thought-out ship within the economic framework. It is hot the typical of course to tron speculate about what would have happened if alive had been in office doing this but I do think that the coalition in opposition would have been tempted to make caught a lot of criticisms and to suggest that the spending had gone too far. There's a big difference for party thing in government managing across and being an opposition. Cape with this theme of a political realignment among center right parties around the Western world. If you think about Donald Trump in two thousand sixteen, he tapped into widespread anxieties. America's rust belt. What can class constituencies? Boris Johnson showed last December, he resonated with traditional British Library voters in the Midlands and northern England. Judy. Do you think that Morrison in a wise doing the same thing here in Australia? Now, I think they're very different sorts of crises. I mean the pandemic is an external. Crisis, it's not being caused by politics in any way it's not back nationalism versus globalism or any of those things, and so I don't agree with that. I agree with what Paul was saying earlier that Morrison's shown himself to be pragmatic and quick footed in this and I think we're lucky for that. But I I don't think that this lines up with bricks and with trump's appeal to the rest spilled poor Kelly. Well I think conservatism is changing if you look at. America Britain Australia and there's not a dopey getting very significant changes into servitude. Thought. Different changes argued very strongly that there are very substantial differences between Donald Trump and Scott Morrison. I think people who argue that. Morrison is a pilot version of DONALD TRUMP MAUREEN DOWD in the New York Times by the way, but go on. I think. I think turned him mentally misunderstand the situation I. Think the change in conservatism is very dramatic in the United States. If you'd like because we've got the transition from Ronald, Reagan who a generation ago was the great conservative champion, and now we have Donald Trump, who if you lock is a populist conservative? And that transformation is simply enormous install ending content I mean trump violates all the virtues of conservatism in terms of restraint prudence disciplined respect. Regard for the political system, he thrives on division. So he likes all the traditional conservative norms, and then when looks at his policies. Well he's sabotage the global trading system. He's an arch protectionist. He's engaged in this trade war with China he's appraised dictators and suspicious about. So I guess one of the Fundamental Christians here is the extent to which trump is an aberration. And the extent to which post trump American concert is we'll have to try and create a new position cognisant of the damage that trump has done to the traditional Republican Party

Government Donald Trump Liberal Party Scott Morrison Hristo Paul Australia Freedland Boris Johnson Jonathan Freedland Judy Paul Kelly United States Republican Party Prime Minister America Optima Covid Latrobe University Treasury Martha
What Is The Pe Diet

20 Minute Fitness

05:27 min | 6 months ago

What Is The Pe Diet

"Everyone is Martin from twenty minute fitness I'm here today connected with Dr Ted Niemann Dominate, and why don't you tell liberal listeners about your work and book? The P. Will Hi Martin Nice to meet you just call me Ted first of all. So I, I'm Ted name I'm a primary care doctor and I've been in practice for about twenty years up here in the Seattle area and I have a mechanical engineering background, and so I'm kind of like a just a huge Geek. A nerd kind of a Geek mechanical engineering background went to medical school and. I ended up just being obsessed with optimum health and I realized that the difference between the healthiest people I saw and the least healthy people I saw really just came down to diet and exercise. So all day long in these patient visits icy this huge spectrum of health You know one minute I might be seeing someone who has just amazing body composition and their incredible health, and they might even be an elite athlete and then the next minute I see someone who's just frail and decrepit and falling apart and has millions of problems and it eventually occurred to me. That the only difference between these people was really just diet and exercise over time, and if your diet and exercise is optimal, you just slowly get better and better over time and if it's not, you just slowly get worse and worse over time and then you know fifty years down the road you see this massive spectrum of health from incredibly healthy to incredibly unhealthy and I've just been obsessed for twenty years with exactly what is the mechanism between Diet and exercise driving health outcomes in exactly what you have to do to get the positive adaptations instead of the negative ones and I've you know I've just been all over the Diet spectrum I was raised vegetarian I went to Loma Linda University in Southern California, which is this famous blues Mecca were everyone's plant based So I've I've experimented with Air Free Diet from Vegan and plant based to, of course, oil spectrum of Paleo. Kito. Carnivora. You name it and everything in between, and then I eventually realized that all of these diets right about something and the answer is in between and the secret is finding out what's powering each and every one of these diets and making them more successful than. The Standard. American. Diet and that's really how I came up with this book. The P.. E. Diet, which is sort of the unified theory of macronutrients You know that's at least it has been described right so so how does like the P. E. Diet look in a nutshell what makes it different from say pay euro at the Ketogenic diets or you know all vegetarian diet for example. So what I did is just zoom way way way way way way out to the fifty thousand foot view and just looked at what is eating and I realized that plants are. Auto troops and they make all their own food and then animals are Hetero trips and we only exist because we constantly injust other living organisms. So plants are at the base of the food chain for all animals they're making all the food for animals and then animals are just either eating plants or animals that have themselves eating plants. What plants her doing is two very specific things. Number one, they're sucking minerals out of the soil, which is nitrogen for protein and and about a dozen other minerals that are crucial for plant and animal life, and then they're using solar. Energy and carbon dioxide in the atmosphere to create these high energy chains of carbons with high energy bonds, carbon hydrogen bonds, and that's all of your dietary energy either carbs, fats. This is all solar energy stored is chemical energy. So I realized that you could divide your entire diet up into protein and minerals which getting room soil and energy, which is these high energy, carbon chains, carbs, or fats that plants creating from solar energy, and then I, sort of looked at all of human history in this evolutionary Lens. I realized that if you look at hunter gatherers, they have this. Incredibly. High Protein Diet. It's thirty three percent on average protein. If you look at worldwide hundred gatherer macronutrients and hunter-gatherers, they have an easy time getting protein they just go out and kill an animal and eat the whole thing you get plenty of protein and minerals but you're always a little bit starving for energy right? Every animal you know trying to get enough energy to be successful, and so you're always looking for extra energy to add to your diet. You can get the protein and minerals, but just killing an animal and eating the whole thing but you're looking for. Extra Energy and what humans have done is we have always used technology to feed ourselves. We don't have teeth and claws were not particularly fast or strong on. But what we have is brains, and so we built tools, we use tools to feed ourselves. We use technology to feed ourselves. We had stone tools with break-up in skulls for branch and long runs for married at fat energy to our diet. We dug up tubers, add more carbohydrate energy tour Diet. We figured out how to throw weapons and create traps in hunting in groups, and we all of this technology to add. More, energy to our diet

Dr Ted Niemann Seattle Loma Linda University Martin Ketogenic Southern California
The Diversity of Security Challenges in Higher Education

Recorded Future - Inside Threat Intelligence for Cyber Security

07:02 min | 6 months ago

The Diversity of Security Challenges in Higher Education

"Now. What is it like? Every year you have a new batch of of students coming on board and they all want to connect to your network I mean what's the? What's the reality of that situation from a security point of view It is a lot of prep-work over the summertime, a lot of you know repair and refine and and. You know replace things that aren't doing well, and then when you know we get about two weeks out from classes starting. which this year is September second. So we're kind of in that zone right now. That's where we're making sure that everything is working. In it in. Its, optimum. Capacity and capability. Following that it's you know let's continue planning for whatever is going to happen next you know we the spring term winter spring term in in January this past year and nobody anticipated. Kobe I I'm not. You know I'm sure that there was an -ticipant because the the fun part of that is we actually did a pandemic tabletop exercise in the division of Information Technology, which is the central a unit on campus. We do that path the fall of twenty and eighteen. So we hit already kind of work through some of the. You know the communications challenges and the organizational challenges so when it came time to do. The transition from online or from in person courses to online courses, we were able to do that in very short time and that included transitioning thirty seven hundred core courses. From in person delivery to online delivery so that really served you well, I and it was the preparation time and it was the understanding. Of what we would need to do and it was also, you know checking those channels you know. I've done some business continuity work in my in my pass and a business continuity plan to just never exercise it's not a plan. It's a bunch of on paper so So we were able to walk through and validate that and that's the kind of work we do during the school year. And we take our you know kind of slowdown period so. Beginning summer you know everybody takes a deep breath and then we exhaling get back to work you know Sometime during the summer I like to encourage my my team to have a little bit of time off. But when September goes in and the students arrive we, we try to work really hard to get him through and then we take it the winter holidays. What what kinds of things are you and your team defending against who? Who's WHO's coming at your network? You know it's the usual array of Fred actors You know think about the things that research is doing. You know we're we're doing. A lot of research in the area of Koga right now, and it's just. Be We have the capability. We have the expertise we have the researchers at want to do that. But we also have school medicine in public health. We also have a school of Nursing School of Pharmacy. So healthcare education is important in that has just a treasure trove highly valuable. Information in it. But we do engineering work, and some of that work is is patentable work. So that's probably attractive We do a lot of business influenced work. we have data science institute which is trying to figure out the the better ways to understand. You know the the magic acronyms of a I in L.. Artificial intelligence. Machine. Learning. And and that's that's attractive information not only that forty four, thousand students twenty three, thousand staff that's a treasure trove of marketable information. You know I always wonder you know someone in a situation like yours where certainly you're going to have some students and I'm thinking of Oh I don't know folks in computer science and other sorts of places who were going to look at you know the the campus system or the university system as you know their own personal playground there that. you know they're gonNA WANNA, test their own skills against yours. I mean I is that an annual thing and and how do you? How do you? How do you not be adversarial? How do you support You know the educational aspects of of those students while still keeping things up and running what's your approach to those sorts of things? Well. So I we we are establishing some really good partnerships with with the Academy with the the the professors and researchers that are interested in studying the cybersecurity arts and sciences. we've had a relationship with the information school. is They're they're part of the College of letters and Sciences and now they're part of what's been amalgam is as the the School of Computing. Data. And Information Studies so CDs. In in in doing that, I, mean, the partnership is if it's data and if it's doing things if it's you know working or arresting or or if it's needing to be analyzed, we have people that are very much interested and so I've had my my department be intentional about establishing those greater relationships we have you know researchers doing anything from identity access. Management Research to data analytics to cybersecurity metrics and then we have others on campus that are doing great work in high throughput. Computing Great Work in in you know engineering the the next greatest you know computer technologies. In other side trips we had We have a researcher that is working on, Thomas Vehicle. Research you know and there's an awful lot of cyber in there too so. Having those kind of relationships is the the real multiplier here, and this is not unusual by the way for university. This is nothing super special. We're doing it's just that You know there's a, there's a lot of cybersecurity programs out there where there you know NSA certified Center for Academic Excellence. Certified and we're GONNA. Get there eventually. I believe But right now we're just supporting the researchers in the courses are being taught. Sue I myself have been a guest lecturer in a one of the business school courses. It has an information security course as part of its core. That's been fun. I enjoy doing. I did a little bit of that as an adjunct University part of my coming here.

Researcher Nursing School Of Pharmacy College Of Letters And Science School Of Computing Koga Kobe Guest Lecturer Fred NSA Thomas Vehicle Center For Academic Excellence
AI Tries to Save the Whales

WSJ The Future of Everything

09:11 min | 7 months ago

AI Tries to Save the Whales

"We head to the Pacific northwest to understand the obstacles that confront these endangered orcas and how researchers are using artificial intelligence to help orcas and humans to coexist. WHAT HAPPENED TO J thirty five or Tala wasn't an anomaly the southern resident cavs have been struggling to survive for some time they've been listed as endangered in both the US and Canada since the mid arts. But their numbers continue to fall in two, thousand five there were eight. Now there are just seventy two in the wild one lives in captivity. Their home waters in the sailor, see an elaborate network of channels that span the coasts of Seattle Vancouver from Olympia Washington in the south to the middle of Vancouver Island British Columbia in the north. The see encompasses puget sound the Strait of Georgia and the Strait of Juan De. FUCA. Much of it is rich in natural beauty and teeming with wildlife with rural shorelines backlit by tall evergreens and craggy. Hills. It's a magnet for nature lovers who crave inactive lifestyle, but the Pacific northwest has been getting crowded these paths few decades with people competing for space with the local wildlife as of two thousand twenty. Washington's population was nearly eight million and Vancouver's topped out at about two and a half million and is projected to grow. It's become a busy place. So you see things like Bald Eagles nesting next to satellite dishes in busy parking lots. Big. Ravens Beg for food next to cold press coffeeshops commuters hop on ferry boats here like people in other towns take the train or the car. On these trips they can sometimes spot the southern resident orcas milling about but a lot of the time the orchestra framed by ferry boats or container ships. The area's ports are growing along with the population. In twenty eighteen Porta Vancouver ship activity reached a record high and the port is undergoing numerous expansions. Increased. Commercial ship traffic on top of recreational boat activity is one of the biggest threats facing the whales that live here. This traffic causes numerous problems ships pollute the water, and they're loud under the waves. As we're about to find out the ocean is getting crowded and noisy, and it's negatively impacting the whales. Dr Lance Barrett Lennard is the director of the Marine Mammal Research Program at the Vancouver Aquarium. There's also a lot of heavy vessel traffic that comes in some of the going to the port of Vancouver some of the going to the port of Seattle unfortunately both both major west coast ports. have their roots running through. Southern Resident Critical Habitat. But the obvious problem he says is that more boats increase the chances that Wales will get hit. especially, if the boats are going fast. Whale is far less likely to be hit by ship that's running slow, and if it's running less than ten knots, a good chance to survive even if it is hit, that's just the facts. So regulators started issuing slowdown directives, it few areas these slowdowns are mandatory, but in the Pacific northwest or the orcas live, they remain mostly voluntary. Mariner say they want to avoid the ORCAS but there are business conflicts John? Berg. Is With Pacific, Merchant Shipping Association a Trade Group that represents about thirty shipping lines that do business along the Pacific coast. For a lot of ships. Schedule Integrity. Is. Paramount. and. So they need to be at a certain port at a certain day in a certain time. And so planning is essential especially since coming in late can mean higher fees and lost revenue. Mariners go back and forth about how quiet ships they talk about things like reducing noise by finding optimum speed or by retrofitting or upgrading vessels with more efficient quieter parts. They even say that in some cases slower vessels. Moore of Iraq. Now to researchers, this is a settled question, the faster ship the louder the ship. And it's the noise that is even more detrimental to the ORCAS than ship. Strikes. The underwater cacophony is mostly generated by ship's propeller. It releases vapor filled bubbles. ORCAS like all CETACEANS rely on echo location to communicate, made and find food. For ORCAS, it's how they find salmon as the ORCAS chase salmon they make clicking sounds that they send out into the ocean. The click then bounces off of the salmon and creates an echo, and that's how they know where the salmon are underwater noise pollution specialist. Dr Lindy Wildcard is an adjunct research associate at Dalhousie University in Halifax Nova Scotia Canada. CETACEANS are particularly vocal of the US sounds to find their prey actively using bio sonar. And the various noise sources that humans put into the ocean can affect. Wales and that they are masked, that is the sounds of interests are obliterated by by US adding this sort of acoustics smog of of noise so they can't hear as well. You can actually hear the masking that wildcard is talking about listen to this underwater recording of northern resident orcas who have different dialects from their neighbors, the southern resident or is this recording was provided by Orca lab a nonprofit research center based on Hanson Island near British. Columbia. Canada. Those. SQUEALS ARE ORCA calls. Here's what happens if you overlay their calls with recording of the ship underwater. It drowns out the ORCAS squeals. All you hear is ship noise. That's because the sound created by the ship is at the same high frequency ranges the ORCAS. It's kind of like being at a dinner party where people are talking over each other. But for the ORCAS, the increased sound means they'll lose their seat at the table. If the ORCAS can't hear themselves they can't hear the seminar and so they can't find food. And that can have far reaching impacts that affect the entire population. Their stress hormones can increase. with, noise with the seismic Airgun sounds they also reduce their vocalisations to the point of sometimes falling outright silent, which means they can't communicate with each other and that probably affects mating. If mayors could know where the ORCAS are. They could try to avoid that part of the ocean or at least slow down. So their engine noise doesn't drown the ORCAS OUT Ideally. They'd only have to go slow when the orcas were in the area, but it can be hard for ship captains to confirm where the whales are in fog rain or even under normal circumstances ship captains can't always see them they often miss them. So some conservationists along with the Canadian government installed underwater hydrophones in the Salish Sea along the coast of British Columbia near known ORCA HABITAT, they wanted to be able to track the ORCAS through their echo location calls. But remember how it works. Sound was drowned out by the ship's well, it's not just hard for the orchestra here. It's hard for the humans to. It can take people a long time to listen to all those recordings figuring out what is well sound, and what is this ship fish or other marine life sounds the orcas make noise at all hours of the day and night, and all of that sound even that record overnight has to be listened to by someone. Up. Next. How artificial intelligence can help speed this process up? And maybe find a solution for both the ships and the whales.

Orcas Vancouver Pacific Northwest United States Pacific Seattle Canada Vancouver Island British Colum Wales Southern Resident Critical Hab Strait Of Georgia Cavs Porta Vancouver Vancouver Aquarium Tala Puget Juan De Sound Columbia
The Strange Myth About Oxygen And The Yin-Yang Gases With AJ

My Seven Chakras

04:37 min | 7 months ago

The Strange Myth About Oxygen And The Yin-Yang Gases With AJ

"Ever since which urine witold that we need a lot of oxygen to survive were to breathe in deeply so that we can get enough oxygen oxygen has been touted as life giving gas that US earthlings can art survive without but is this entirely true or is there more than meets the eye on today's episode we're going to explore this very interesting and profound dodig, and by the end of this episode, you will actually understand in a very simple and easy manner how you're breathing translates to more energy deeper relaxation. Oh mind and better hilt. But before I, continue our request you to please hit the subscribe button on your phone especially if you're on an iphone. Something to the podcast algorithm that ensures that people who wouldn't normally see this episode Ashley come across. So please hit the subscribe button right now. All right. So before we dive deeper I, think we need to take a few steps back and understand how energy is produced in the body from a scientific perspective and this is really interesting when you breeden. You're taking oxygen which goes down your throat into your lungs and into your bloodstream. The oxygen then binds to the him global in your blood cells. Now, the oxygen is then transmitted into the mitral. Contra. And if you remember lessons from school, you'll remember that it is the powerhouse of your cell and through a chemical reaction the Oxygen Burns with the glucose in the cell to form Energy Carbon Dioxide and water vapor, and then when you breathe out. You exist the governor dockside along with the water whip. The energy is then transmitted to wherever it is needed in your body. Isn't that amazing? All of this happens between your in him. An exile. Now oxygen can be likened to fuel that Burns to release energy too little fuel and you really can't start a fire and what happens when they're stu much fuel. Well, there could be a fire or literally an explosion. So what do you think happens when for some reason, you inhale too much of oxygen. You can't be good for you. Right. It turns out that it actually isn't just like when you expose I n to air for long periods of time, the oxygen in the atmosphere reacts for the through a process that is called oxidation to cause rust in the same way when you breathing too much oxygen or a period of time that can lead to oxidative damage in your body. In your disuse in your muscles in the form of inflammation and cell damage. Now, this can be tricky. Because on one side, I'm saying that we need oxygen to produce energy but we're also saying that or exposure to oxygen can lead to inflammation and cellular damage and the key to understanding this lies in a process guard bores effect. Be. Or are bores effect when you breathe in Oxygen Surf. The oxygen binds with your haemoglobin in your blood and a member the oxygen needs to get released from your hemoglobin and has to reach your mic Andrea, which is a powerhouse of yourself for the energy to be produced. So if there's a high level of oxygen. Did remain bound to your hemoglobin and over a period of time this can cause tissue damage and what happens is the free radicals actually start attacking your own system. This can lead to depression Lou Energy Fatigue and immune disorders does this sound familiar the solution to the challenge lies and somehow decreasing the level of oxygen which leads to the hemoglobin releasing or ejecting the oxygen, which can then go to the Powerhouse, off your cell the Mitochondria for energy production. And the UNSUNG hero over here is Garvin Dioxide in other words for cellular hilt optimum energy. You don't just need oxygen, but you also need carbon dioxide for your body to be able to produce energy

Oxygen Surf Garvin Dioxide United States Andrea Ashley Breeden
Enabling Precision Medicine through Proteomics

The Bio Report

06:19 min | 7 months ago

Enabling Precision Medicine through Proteomics

"Lodge again and the ability to run a test of five thousand proteins in the blood to gain new insights into health and disease. I WanNa talk about two specific areas that you're working in. But before we do that perhaps we can begin with why someone would wanNA sample five, thousand proteins once we think of looking for a specific protein that's a biomarker for z's but what's the benefit of looking at this whole realm of proteins? Sure well, and that's that's really the. The crux of of what's different about what we do here at some logic. On on this developing diagnostic side and that is that We've known for a long time that. Proteins would be the best information source for. Human biology in potentially to predict things about conditions and disease but. The problem has been measuring enough proteins at any one time to get what I would call. A full-body. Signal. If you think about the comparator here is believed that since we can measure all genes in the human body that. The doing genyk risk assessment looking at expression of all these genes may give us an information. That someone's risk for things we can come back to that later turns out that approach is not as good as we would hoped, it would be. And the reason it's not as good as we'd hoped, it would be is because jeans aren't dynamic they don't change over time that will change with age and changed with. Your your genome is the same at age twenty five is it is at age forty, five and sixty five. John doesn't change when you're sick or changing you take drugs but all of those things. Change with your were there proteome But the problem has been, you know measuring enough proteins at any one time to get sort of a full body signal. Rather than measuring one protein at a time and then trying to correlate that some disease process the second problem is been. Gosh even if we could measure thousands of proteins at a time. How would we be able to make any sense out of it? In so The thing that's just happened to occur and that some logic happens to be the. You know at the at the leading edge of is we figured out a way to measure thousands of proteins at a time rather than hundreds of what almost everybody else in the world does. In sort of clinical commercial context and then we. have been able to to use machine learning. To look at those patterns of protein expression of those thousands of proteins correlate them to. Thinks that you really WanNa know about. What exactly does your some scan platform do and and how does it work? Yeah. So To sort of back up into the technology itself what? What are found discover thirty thirty years ago is that You can actually take little pieces of nucleic acid a DNA. In, in in solution. So when they're in you know the body's liquid format. These little pieces of DNA will fold into three. D. confirmational shapes. And he knew in his research group thirty years ago that. Are, which is very similar to DNA in sales actually does this it folds into confirmational shapes and moves proteins around in cells in has important roles. So this question was, why can't we just make a library of millions of different? Little pieces of DNA and select the ones out by dentist their shape would bind to the shape of a protein people thought it was crazy and so. In in in these little pieces, of DNA, Short, they're not jeans or slow random sequences of nucleic acid. Are called OPTIMA. and. So he was the CO founder of the. Science thirty years ago. In what we do is we've developed a library of thousands of these little pieces of DNA. We've modified them to make them buying the pre-teens even more. Specifically, reliably in because of that, if you will, we sort of engineered. Of Synthetic. Antibodies that can recognize proteins, but they're not antibodies pieces denying. In the asset that we do. We expose the body fluid to these thousands of of afterwards we call ourselves immersed because they've been modified to work even better. And so we just happen to have currently five thousand different of these different uniform these by the end of the sheer will have seventy, five hundred. You're pretty own has about twenty thousand canonical when I say canonical basic protein structures. But again, until we came along, you can only measure a few hundred time. So we expose a body fluid to you know a solution full of these. Summers that they bind proteins the we throw the unbound protein away. In the unbound optimus away or the summers away. We then or left with these little pieces in click acid bound to proteins. We then throw the proteins away. And we measure the. DNA. They're. Using we use an array. where an array were, you know you've got a complementary sequence printed on the slide and If you can identify whether or not that sequence was there in your specimen that gets when it. Binds to the slide at lights up. You can also do this Sunday called next generation sequencing but what we do we turn. Protein measurement into DNA measurement, and that's sort of the magic. As far as the tests themselves that are derived from this. The magic, there is actually a what's best described as is pattern recognition. And so the way to think about the way the test works. So give me your blood sample, we run it a we we expose it to our some immerse. We should out what proteins in that sample in how much we can do both relative to one another, and they'll. So now we have this pattern of protein expression in your blood for thousands of proteins. We've run this acid several hundred thousand

Z Summers Co Founder Optima. Short
Enabling Precision Medicine through Proteomics

The Bio Report

06:01 min | 7 months ago

Enabling Precision Medicine through Proteomics

"Some lodge again and the ability to run a test of five thousand proteins in the blood to gain new insights into health and disease. I WanNa talk about two specific areas that you're working in. But before we do that perhaps we can begin with why someone would wanNA sample five, thousand proteins once we think of looking for a specific protein that's a biomarker for z's but what's the benefit of looking at this whole realm of proteins? Sure well, and that's that's really the. The crux of of what's different about what we do here at some logic. On on this developing diagnostic side and that is that We've known for a long time that. Proteins would be the best information source for. Human biology in potentially to predict things about conditions and disease but. The problem has been measuring enough proteins at any one time to get what I would call. A full-body. Signal. If you think about the comparator here is believed that since we can measure all genes in the human body that. The doing genyk risk assessment looking at expression of all these genes may give us an information. That someone's risk for things we can come back to that later turns out that approach is not as good as we would hoped, it would be. And the reason it's not as good as we'd hoped, it would be is because jeans aren't dynamic they don't change over time that will change with age and changed with. Your your genome is the same at age twenty five is it is at age forty, five and sixty five. John doesn't change when you're sick or changing you take drugs but all of those things. Change with your were there proteome But the problem has been, you know measuring enough proteins at any one time to get sort of a full body signal. Rather than measuring one protein at a time and then trying to correlate that some disease process the second problem is been. Gosh even if we could measure thousands of proteins at a time. How would we be able to make any sense out of it? In so The thing that's just happened to occur and that some logic happens to be the. You know at the at the leading edge of is we figured out a way to measure thousands of proteins at a time rather than hundreds of what almost everybody else in the world does. In sort of clinical commercial context and then we. have been able to to use machine learning. To look at those patterns of protein expression of those thousands of proteins correlate them to. Thinks that you really WanNa know about. What exactly does your some scan platform do and and how does it work? Yeah. So To sort of back up into the technology itself what? What are found discover thirty thirty years ago is that You can actually take little pieces of nucleic acid a DNA. In, in in solution. So when they're in you know the body's liquid format. These little pieces of DNA will fold into three. D. confirmational shapes. And he knew in his research group thirty years ago that. Are, which is very similar to DNA in sales actually does this it folds into confirmational shapes and moves proteins around in cells in has important roles. So this question was, why can't we just make a library of millions of different? Little pieces of DNA and select the ones out by dentist their shape would bind to the shape of a protein people thought it was crazy and so. In in in these little pieces, of DNA, Short, they're not jeans or slow random sequences of nucleic acid. Are called OPTIMA. and. So he was the CO founder of the. Science thirty years ago. In what we do is we've developed a library of thousands of these little pieces of DNA. We've modified them to make them buying the pre-teens even more. Specifically, reliably in because of that, if you will, we sort of engineered. Of Synthetic. Antibodies that can recognize proteins, but they're not antibodies pieces denying. In the asset that we do. We expose the body fluid to these thousands of of afterwards we call ourselves immersed because they've been modified to work even better. And so we just happen to have currently five thousand different of these different uniform these by the end of the sheer will have seventy, five hundred. You're pretty own has about twenty thousand canonical when I say canonical basic protein structures. But again, until we came along, you can only measure a few hundred time. So we expose a body fluid to you know a solution full of these. Summers that they bind proteins the we throw the unbound protein away. In the unbound optimus away or the summers away. We then or left with these little pieces in click acid bound to proteins. We then throw the proteins away. And we measure the. DNA. They're. Using we use an array. where an array were, you know you've got a complementary sequence printed on the slide and If you can identify whether or not that sequence was there in your specimen that gets when it. Binds to the slide at lights up. You can also do this Sunday called next generation sequencing but what we do we turn. Protein measurement into DNA measurement, and that's sort of the magic. As far as the tests themselves that are derived from this. The magic, there is actually a what's best described as is pattern recognition. And so the way to think about the way the test works. So give me your blood sample, we run it a

Z Summers Co Founder Optima. Short
Sweet news: A once a week chocolate fix can be good for your heart

WBBM Early Afternoon News

00:20 sec | 7 months ago

Sweet news: A once a week chocolate fix can be good for your heart

"Study in the European Journal of Preventive Cardiology found that eating chocolate at least once a week. Can lower the risk of heart disease, The study suggests. Chocolate keeps the heart's blood vessels healthy, but doctors say don't get too carried away. The study did not examine whether any particular type of chocolate is more beneficial than others or the optimum portion

European Journal Of Preventive
"optima" Discussed on NewsRadio KFBK

NewsRadio KFBK

01:43 min | 8 months ago

"optima" Discussed on NewsRadio KFBK

"Optima Tax relief for details Visit after much actually dot com. It takes less than one minute to take the pre diabetes quiz. Prediabetes without intervention can progress to diabetes, people with diabetes or more likely to experience severe symptoms and complications when infected with covert. 19. Don't snooze on your health. No, your risk. Take the online quiz now at know prediabetes dot org's Sponsored by the California Department of Public Health Picture. This a shortage of fuel has closed your electric utility or any other possible disaster. Devastated your town. You're out of power. No lights, no news. That's why federal and state agencies urge you to have an emergency radio. Now you can get a free Dynamo World Band Emergency radio. This powerful radio lets you stay informed during any type of emergency. It doesn't even need batteries. It comes with a hand crank generator and super bright. Led flashlight. The Dynamo emergency radio includes the Noah weather banned a long range AM receiver Ah high sensitivity FM band and even a USB jack to charge cellphones or other devices. The Dynamo Emergency weather Band Radio retails for almost $30. But Newsmax wants to make sure you get this radio. So check out the free offer for the emergency radio by going to get the radio dot com That's get the radio dot com or call toll free 877 NEWSMAX. That's 877 news, Max. This radio could save your life. This offer may and soon so order today. Sponsored by Audi Rock Now Trending on News, 93.1 KFBK Warner Media executives.

Travel to Bosnia

The Amateur Traveler Podcast

04:51 min | 8 months ago

Travel to Bosnia

"Welcome to the amateur traveler I'm your host Chris Christensen? Let's talk about Bosnia. I like to welcome to the show. Canaan Charter, which who is coming from Bosnia and his coming to us from highlander adventures dot, be and has come to talk to us about Bosnia Herzegovina. Canaan welcome to the show. Thank you very much happy to be here excellent and for people who can't find Bosnia and Herzegovina on a map. Where are we talking about? Well. Everyone knows how to find Italy. It's a big shoe ships country. You have a boot-shaped country, so just go to the right side across the Atlantic Sea and we are right there. Well and your neighbor of Croatia. Bosnia you know goes around like little crescent moon. knoll on the West and south, and then these we have Serbia and southeast Montenegro. I to address. You're interested in making sure that people understand that. If they remember news about Bosnia, they may be remembering news from twenty thirty years ago when Bosnia was going through. A, war that's done, and that's been done now for quite a long time there there are people who are out in the working world who don't remember that and it's a wonderful place to go I. Want to say that I was anxious to do this show because we haven't done a show on Bosnia for a long time. And since then I have been to the country and loved it. So why should someone go to Bosnia Herzegovina? Well, there is a lot of reasons depending what you're interested in now. Bosnia is very complex country, but extremely small size of Pennsylvania, but inside. You have so much for the adventure seekers. There are so many adventure opportunities from Whitewater. Rafting canyoning to paragliding hiking is spectacular, and then if you're into history, we say that we have much more history than we can handle. Different Than Empires were here. We like to say where the crossroads or that where the meeting between the East and the West. Culturally very complex country, and also religiously we have Muslims, we have the Orthodox Christians, and we have Catholics with three big groups. Of course there's the Jewish community here which has been here since they were thrown out of Spain after Kista, so for five hundred years, all of these make this crazy, crazy and beautiful mix that very interesting for foreigners to see because inside I will for example and. And in many other cities in Bosnia, you can pined mosque Docs Church Catholic, Church and a synagogue literally in two hundred meter radius, and it's been like that for five hundred years while inside I will because that's how will the city is? And all of a Bosnia and we're very proud of that architecturally very different from anything else you can find in Europe you're GonNa, find this mix of. Of European styles as well as the optimum styles and a lot of course, local Bosnian styles in all of that mixed together will like to say that we are a Bosnian pots. That's one dish that we have. It's cooked in a big pot with a lot of things, mixed sight, and that's Bosnia a lot of things mixed, and it works perfectly. An Indian taste is fantastic why you should. Should visit Bosnian well. Whatever you choose. You're GONNA love it. If you're into history too much of it, you're into nature. It's absolutely stunning. It's fantastic, magic Pennsylvania, and then put inside the Rockies Grand Canyon Inca trail at a lot of other things as well a bit of New Zealand as well. We just like seaside. We have twenty four kilometers of seaside, so that's one thing with them have. And then, of course, for actually learning history or getting certain messages, let's say about life about history. How people live together or how they don't like each other, because while we had a lot of wars, let's especially in the last two hundred years. There's a lot of lessons that you can learn in Boston. Let's say war tourism doctors is now very big part of tourism in in Bosnia so if you want to learn about that, we are definitely to come to see what happens. If you don't defeat fascism, like most of Europe defeated off the Second World War and it actually shows how life can be both good and the bat also if you want to visit a place. which is completely different than rest of the Europe and very relaxed very laid back with fantastic food, most at a lot of reasons I think.

Bosnia Herzegovina Europe Chris Christensen Canaan Charter Pennsylvania Croatia Herzegovina Mosque Docs Church Catholic Serbia Atlantic Sea Kista Southeast Montenegro Spain Italy Whitewater Boston Rockies Grand Canyon Inca New Zealand
Building Resilience in Your Medical Staff

Outcomes Rocket

06:52 min | 9 months ago

Building Resilience in Your Medical Staff

"Welcome back to the PODCAST Sal Marquez. Here and today. I have the privilege of hosting Chris Democ and Carlos Arce both are at the outstanding company elation. Chris is the founder and he's been interested in what drives improved human performance since his days in college, a curiosity about developmental psychology expanded into a love for organizational development and the design of technologies that improve organizational performance. He was inspired to start elation after a career the tech industry is passion. Passion for helping people through the use of innovative technologies transition into a calling to help people flourish by applying what they know from neurobiology and mindset research, seeing the transformative benefits of his approach, it's only fueled his enthusiasm, and helped the track, an extraordinary team of people who share in the mission Carlos Arce is the Organization of Development Consultant and facilitator at Elation, and he's been highly successful as a keynote speaker, workshop, presenter and consultant he works. Works directly with many of the clients and organization hired by Elation. He's a coach and teacher, whose purpose is to inspire people to be better. He continually helps leaders. Companies achieve outstanding business results while improving organizational culture and employee engagement. These are these are things that we all strive for in our businesses, and in our in our organizations and today we're going to dive into the work that they're doing at elation to help with the problem physician burnout. burnout and the feeling of lack of community, those things that are so important and primary needs in in Even you think of Maslow's hierarchy of needs they're they're getting after it in a big way and have seen a lot of success, and and I'm and I'm privileged to have both of them here with us today to talk about the work that they're doing so Carlos and Chris. Thanks so much for joining me on the podcast today. So, thanks for having a huge absolutely so before we dive into the work of Elation love to to get a feel for what inspires both of you to to work within healthcare. Well, this is Chris. I have looked at the statistics in healthcare over the last several years, and been absolutely sort of amazed at the level at which out has become an issue among physicians and other medical personnel you know studies been fairly consistent that it's around the fifty percent level of diagnosis symptoms of burnout, according to the WHO's diagnosis trim, so it is sort of a burning platform issue for healthcare in the United States If you have physicians who are performing at less than their optimum. Ability obviously impact the quality of outcomes or people, yeah, and unsolved. That's a great question. I had the privilege of actually spending thirteen years of my career in healthcare as the. Support percent at a title that some people find a little bit mystical called chief learning officer for a portion of that time where you got I got a chance to really experienced the industry on a daily basis, and to be honest with you. It was an extraordinary privilege to watch the kind of work that's happening daily by nurses and doctors, and in my time there I really got a chance to explore the cultural dynamics of howled interactions. Interactions between professionals how the interactions between administration and clinicians although kind of contributes to the general sense of the support and the affect of daily activity rate, so in my case I wasn't necessarily ride into address burnt out, but I was really focus on. How do you altima optimized performance of both individuals in the group? So I had a passion for healthcare from the very beginning when we started doing work with elation seen the results that we. We, were accomplishing private sector, a lot of different kind of exploratory technologies in the combination of exporatory and proven methodologies. That's thought had something. I think that can contribute to this to this industry that is as Chris. Put you know dealing with some pretty challenges, free dot, daunting threats that happen on a regular basis. And how do we make sure we we We give it to the folks who need it the most love asset so. So fantastic I mean. The problem is clear, and and you know we we talk about the quadruple aim that fourth one being you know clinician satisfaction, right and wellness, and so you guys are tackling it head on, if providers aren't healthy, then it's going to be even harder to provide better outcomes for patients overall, and and so let's let's dive into it, guys. What is it that elation is doing to add value to the provider ecosystem? Yeah I'll I'll take that on crystal in. If you want to chime in, feel free to. My. What we're doing is we're looking at the problem. In its most authentic form, we are addressing this as an organizational dynamic. We see that we know the pathway that clinicians have to take to become practitioners in this country is not easy. It is not for the faint of heart, so we actually often referenced the notion that we'd take some of the most resilient humans on the planet and created epidemic burnout, and so if you're honest about that. That statement and you have to acknowledge the systemic implications of that. You know what what's happening when you put those people into this workplace that over time ends up eroding this amazing competency that they bring to the table, so that's an important element because of our approach because of that focus. We see that there isn't. This isn't about fixing physicians and this isn't about this direct cause and effect relationship that will just one thing is causing. Causing this dynamic for everybody there is a local element to this that you've got to pay attention to. And then there's this combination of both the individual and the individual with Indus Group in the system, so we've taken methodologies that are helpful for individuals like executive coaching that we know works and puts people in the right spot. We've taken this approaches. We've learned for organizational development when it comes to creating workplace cultural dynamics that are that. That are healthy, and that are actually what we would call resilient, enough themselves, so this idea of organizational resilience which involves group work and group interactions between the the key players, and we have kind of combine those two ultimately influence not only the individual themselves in a way, and give them informed about what helps them, or what actually contributes or undermines their own resilience, but also best in them as catalyst for change within that

Elation Chris Democ Carlos Arce Sal Marquez United States Founder Indus Group Development Consultant Officer Consultant Maslow Executive
"optima" Discussed on WTOP

WTOP

02:25 min | 11 months ago

"optima" Discussed on WTOP

"Optima tax some restrictions apply for complete details please visit optima tax relief dot com it's two thirty six this stay at home order may mean families can get together this holiday season but Maryland's governor had some good news for kids worried that the Easter bunny wouldn't visit this year families have already hosted virtual Passover seder is for example and Maryland governor Larry Hogan reminded those who celebrate Easter they still need to follow stay at home orders I just currently unsafe to have church services or to host holiday gatherings governor Hogan said he'll have to skip treasured time with family too I will miss sharing Easter with my kids and grandkids seeing them hunt for Easter eggs I particularly will miss not eating all of their Easter candy but Hogan wanted to make sure that children won't be disappointed so he signed a special proclamation for the Easter bunny I am officially proclaiming the Easter bunny as an essential worker in Maryland and he therefore will be able to proceed with his hopping across the state delivering Easter baskets to Maryland children Kate Ryan WTOP news it's two thirty seven northern Virginia veterans association is a one stop nonprofit that at no cost guides are most vulnerable veterans to local community resources including benefits healthcare transportation housing employment legal aid and more Nova said ins works with community partners to provide caring and comprehensive personal support their support specialists case managers to reduce frustration and confusion and to ensure our veterans receive the support and respect they have earned and deserve find them on Facebook or visit Nova vets dot org here that it's the soundtrack to our busy lives but there's one thing that needs to be at the top of our to do lists fixing those dangerous recalled Takata air bag inflators millions of vehicles from nineteen automakers still need to be fixed because if they're not fixed those airbags could cause serious injury or even death it's not the other stuff isn't important it's just that while fixing that airbag just might save your life visit Toyota dot com forward slash recall to learn more it's two thirty eight prevent the spread of viruses with Michael and sons germicidal UV C. go to Michael and son dot com traffic and weather on the aids and when it breaks down.

"optima" Discussed on News 96.5 WDBO

News 96.5 WDBO

01:33 min | 11 months ago

"optima" Discussed on News 96.5 WDBO

"Optima tax relief some restrictions apply for complete details please visit optima tax relief dot com this is news ninety six point five W. D. B. O. live team coverage of breaking news weather and traffic starts now **** media group is open and we want to know if you are too our lives have changed in our business community is adjusting to meet your needs in a safe and convenient way to support local businesses big and small here's today's list of businesses that are open talco construction premier men's Medical Center love land property support of Claremont we'll see who's fifty floor if your business is still open let **** media group no and we are open Orlando dot com that's we ARE open Orlando dot com together we will get through this two questions every homeowner should ask how safe and security feel in your home and do you have peace of mind that your children and pets are protected in the privacy of their own backyard if you're not confident in your answers then call my friends at mossy oak fence they build it you to full custom build fences that will provide real solutions for today's security challenges at home while enhancing your home's appearance for many years let the mossy family protect your family mossy oak fence dot com mossy oak fence dot com margin for used car madness now what greenway dodging relay.

"optima" Discussed on Motor1.com Podcast

Motor1.com Podcast

06:17 min | 1 year ago

"optima" Discussed on Motor1.com Podcast

"optima" Discussed on Motor1.com Podcast

Motor1.com Podcast

06:17 min | 1 year ago

"optima" Discussed on Motor1.com Podcast

"All of my new answer is and it wasn't even a car that you could buy but it was a car that made me realize such a cool piece of design so interesting and I'm still upset they haven't that's a great choice in terms of the concepts definitely one of my favorite to ask my favorite because that's the car that really oh yup to to a fe- a way back in the ninety dollars when I was going to college I worked for used car dealer that just a an experienced to to be in a car like that in this I mean this this by that standard it was a lot better and then when I got into a soul sometime design Would you just mentioned Chris which is the sole and that was a second gen even before that the I gen I thought was I think it elicited lots of positive emotion from people it wasn't like a Mustang you of boxy hatchback competitors all of which are gone now and the soul remains and not plant's third generation so practically created a that same segment so good on them for that all right I wanna do you guys were on the last episode with me when we talked about the Volkswagen Golf eight and that's what all the reaction Gulf eight here it won't satisfy my needs I would definitely miss it I would respond which is he says I think that's exactly what they'd be banking on if they don't offer sure I largely that's kind of true because the GTI and the Gulf so I think if they don't sell it here US consumers aren't really gonNA miss it like it it's an understated overlooked and generally invisible car that even in based most of them it's also much higher quality than most places that matter like interior last year then some of the the small cars that are available in the US but the ago and particularly about the possibility it might not be sold here in the US fading out of the US market in the case of the Gulf I've always the ones that are have no problem going to GTI and the Jeddah's always existed. Yeah I I absolutely am bummed that might not be sold here but it's that's that's where the volume goes that's where the.

"optima" Discussed on Motor1.com Podcast

Motor1.com Podcast

38:30 min | 1 year ago

"optima" Discussed on Motor1.com Podcast

"But news and I wanted to mention it and get your thoughts on it and that's the announcement that Fiat Chrysler that was just announced yesterday really even last night that the merger was APP see which side turns out to be maybe the the one acre in the world and the number of brands actually have to count them I have enlisted two three four five six seven eight nine ten eleven twelve and we actually counted yesterday of course the valuable thing that FCA brings to the table is Ram in meanwhile FCA which is and then of course they're going to get the economies of scale that come with found the news yesterday as soon as it happened what was your first reaction to hearing didn't tick and I have a little bit of PTSD from it from the DaimlerChrysler cars coming back to the US I think Peugeot and Citron and Diaz either absolutely everywhere over there I think it'll be great for Chrysler as well so he and the reality is that you eight so I think the idea of of French commercial vehicles coming excess to PSA's light of crossovers I think it's it's very exciting like the camper vans scene and in the camper vans seen in the US which has van life it was really popular and I've learned some advantage that has over the sprinter and can things like that so I'll be interested to see if they replace official vehicle segment has really grown way more competitive in the past a small piece of the pie so that's a really good good observation I I wasn't even thinking French commercial vehicles come over here especially Citrin because they have the best names Marshall vehicles there's no way they're gonNA come over with those neighbors though I wish like that appreciate what the prime minister is but it is far and away one of the worst driving vehicles really a big part of the biggest unanswered question are these European brands do the American brands to sell under their names. I don't think we know the answer to that all time the space tour Camman who doesn't want to drive something called Lee I love the way they look and really when we're talking about all yet asking for a merger with me personally but it was it was coming so I'd be we benefit FCA in terms of some of the smaller crossovers because really they don't but I mean certainly wants to get away from jeep though that yeah no you're right it's it's really starting to kind of split some hairs when you see automakers like offering crossover there there's there's no ram crossover period there's destructs there's no there's there's there's the Durango but but below that you have the journey which is not even worth talking about and the below unity for Fca to just you know what do a little bit of badge engineering stoutly I don't even think it has to be quick and dirty as a badge engineering got vehicles like the Fiat five hundred x and the jeep renegade I'm so I think they can I think they can still take advantage of everything and not necessarily have to go the badge because my my reaction was pretty like pretty much like Ma- and twenty years Chrysler has merged with Daimler cerberus because we've done this so many times and so I you know I think it's interesting I enough that I think brand use that they were shopping for FCA there it is for for PSA I I tale become the new CEO of joint company has been looking at coming back to the US with an eye towards easily federalizing them so I think that WH- back to the US kind of in line with their merger so returning to the US market is definitely I mean just through the the American brands that are already here also I wanna I'm he hasn't been I don't know if they don't like the giant American truck in Europe and far and away the most common American pickup truck is the ram they're not driven through Stockholm and I've seen a dozen a dozen of them in a day my guess is is totally the one I would go for me I I completely agree I don't think I don't Waller Ram model you could call it a code F. Yuan it doesn't need to be called that but a Europe right now yeah I think that's we already know comes at more of a global product than than just a North American one so let's move the mid size sedan and the teaser that was released got a lot of particularly the front end and for from my perspective my reaction I think whether you like it or not I definitely get the impression that lots of people are going to have an emotional reaction one of the really large grill trend that's going on so I look at this and I it seems like every time they evolve it the focus it in a little bit better I was get interested in what they're doing with the with the headlights with a with a little led strips around production car but it I mean the only thing that I really have questions on this far more on the on the production car how about you Braden what did you think when you saw it I now this there's the Sonata when I first saw this Tanada the new Sanada segment and the car segment in general and then you see Hyundai just put out a killer car like that and autumn is the to the Sonata is is the OPTIMA I think it's it's out of styling details here that are interesting that I'm excited to see how they I think this will be a really welcome injection of he cleaned cockpit like very segmented with that high transmission tunnel ars Sur sharing the same platform there they're highly differentiated in and then there's this guy that sits above both of them as the head of design design their own each pushing the boundaries I think of design and making some really incredible designs and both look great they've the and they're both selling well they've been received well would do a better job the other there'd be like a a ranking like you said kind of growing up in the nineties and watching the US automakers who multiple cars on the same platform right and and that's the thing I mean that's what we got used to the same vehicle the same sheet metal just with different badges some you know you know we'll start generally with the Chevrolet and then we'll move up to the Pontiac and then we'll move up to uh hold this person for their life and starting in their they're not exercising that formula they're using the same vehicles underneath but they are Sonata Sonata has the big grill I'm not as big of a fan of the Sonata the same car but they're not at the same time so well well pete they compete directly with each other directly there's there's a genuine rivalry take there's healthy culture between those two companies that you know the eighty and ninety s Chris about the US automakers were where GM wasn't trying to terms of a sales strategy where here you have with each other but I think the Hyundai their so you know it's not I think it's not as simple as just you know their strategy versus and Hyundai get better and better and it's almost like it's like clockwork for maybe where the business case was there but maybe there were other factors go and it turned into a huge success so I have to exist at the expense of cars I think the reason Ford and GM away from cars and crossovers if you look at cameron a cord and all kind of wither on the vine and get older and they just watch the sales got lower and then they used that it's real easy to come like oh man these products aren't you know it's it's never crew thing though I mean not our fault it's your fault concisely or some other factor craters as and and I and in the sixties and seventies everyone bought station wagons and now they're getting into crossovers I think eventually we're going to reach a point where buyers are coming local enough that we're going to see some sort of body style that's fallen out of favor and my or they can afford a really nice car they'll say well you know what I want a people went from wagons minivans to Sev's two crossovers what's always ben what's interesting though is it really hasn't been cyclical because we it hasn't returned to anything that is left yet so I another body type or if it's if it's a jump to electrification and again we have the Americans going all in putting all their chips on on on on seventies the eighties and the nineties and even the two thousands and that's modular platforms it might not be a you know say it's five or six modular front-drive platforms modular rear-drive platforms it so it might be that they're in general absolutely not I think it's terrible idea but I think the automakers see it's still not going to be enough one agree especially too bad years about a month ago and I asked the salesman what do you think about for getting crossover and that makes the vehicle harder for me to sell and he also and Americans just aren't financially intelligent enough to recognize that that's a bad thing dancing he felt bad because it's his job to sell cars it's not his job talk people and so he was bemoaning that and I think just the lack of choice I think while they're also clearly not able to afford the this was earlier this week that the sixty day delinquency rate for auto in Carlisle it's not gonna be as bad because you know it it's cars real estate real estate's the same road again and the thing is fuel prices will go up they always go up it's always going to happen. The market is not going to change overnight necessarily people are there's going to be signed that that's what I think I'm going to be looking for is signs for what is the next what is going to be the thing that causes those cracks Reagan's people bring them on bring all signs but before we get the favorites there was a vehicle I can at the stage so it was actually before Peter Schreier arrives at before two thousand and two and they were terrible really they look like fish on wheels achieved as Hyundai going from kind of immature silly designs for Kupa just looked really really sharp almost sophisticated and I think this is probably the more common one is the two thousand nine Hyundai Sonata there was lots of curves not a straight line on it and that's when it started it was one of the first designs ushered in this era of really great South Korea weird that I like some of the older terrible ones I want to say it was the I asked me the Optima I mean from the from the time it rolled out I always thought I thought the sun the sun roof of the blackout roof or whatever and it it seats that now are you talking about the third third generation one that lines up it was a very modest redesign it was a very very light redesign you're looking car yeah absolutely I agree Chris what about you I'm yeah yeah I remember the days I'm not I'm not I'm not gonNA pick that at high school he managed to get one and it was yellow and it just y'all got a parked in my barn because the repo guys looking for it so talking to my mind it's like it's like how rough to got to be to be you know hunted my wife almost least a Hyundai Elantra in the late Nineties Brennan the Hyundai dealer in Kalamazoo Michigan I don't know if you guys are still around but you at the home depot treated her she got she got a ninety seven Mitsubishi Mirage good lease deal and I mean she was just young and college at the time and driving tour shows at the time so she was she was used to as she get in the mirror is so it's like oh this doesn't go anywhere the answer at that point which we couldn't get in the state so I always thought a chick the was the first one the first one remember but the favorite I I'm not the one that you just called the most boring I actually rather like that it was the camera to the period but I rather just kinda liked the simple focus on that was this Hyundai Sonata they got caught by a speed camera going one hundred and forty seven miles this holiday really a goes so that turn my head and that hey that's what woke me up I don't begrudge you that because I think that generation it wasn't dynamic but it was clear when you go back to the to the fourth Jan that just it exciting in any measure but man the fact that people were asking can this car even go one hundred forty.

"optima" Discussed on Newsradio 970 WFLA

Newsradio 970 WFLA

01:34 min | 1 year ago

"optima" Discussed on Newsradio 970 WFLA

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"optima" Discussed on ESPN Chicago 1000 - WMVP

ESPN Chicago 1000 - WMVP

01:44 min | 1 year ago

"optima" Discussed on ESPN Chicago 1000 - WMVP

"Optima Tax Relief. Restrictions apply. For complete details. Please. Visit optimataxrelief dot com. W MVP AM ESPN one thousand is a part of the Walt Disney company any organization or educational institution. That maintains. Job Bank for by employment information or gives job referrals may ask. To receive our stations job listings for further information, call three one two nine zero one thousand or this website at ESPN, Chicago dot com. That's three one two nine zero one thousand or ESPN Chicago dot com. W MVP AM ESPN one thousand is an equal opportunity employer. Confessions ape attention perfect parent brought to you by adoptuskids dot org. I might look like an adult like a person who could possibly be apparent. But I have no idea to talk like one. And everyone knows that. If you want to be a parent, you have to sound good when you say things like don't make me turn this car around or because I said, so or don't make me come back there. I don't even really know what those things mean. But I know that I actually believed my parents when they said them to me out if they manage to sound so convincing here, we go don't make me come back there. That's not tough enough at all kids can sense weakness. Don't make me come back there. Yeah. That's better. In fact, that kind of sound like my dad. Weird. You don't have to be perfect to be a perfect parent. There are thousands of teens in foster care who would love to listen to your practice. You're dead voice. Call one eight eight eight two hundred four zero zero five or visit adoptuskids dot ORG for more information. This message brought to you by the US department of health and human services, adoptuskids, and the Ad Council. We are Chicago's all sports.

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"optima" Discussed on News Radio 690 KTSM

News Radio 690 KTSM

02:08 min | 2 years ago

"optima" Discussed on News Radio 690 KTSM

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"optima" Discussed on NewsRadio KFBK

NewsRadio KFBK

01:46 min | 2 years ago

"optima" Discussed on NewsRadio KFBK

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"optima" Discussed on KDWN 720AM

KDWN 720AM

01:35 min | 2 years ago

"optima" Discussed on KDWN 720AM

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"optima" Discussed on ESPN Chicago 1000 - WMVP

ESPN Chicago 1000 - WMVP

01:46 min | 2 years ago

"optima" Discussed on ESPN Chicago 1000 - WMVP

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"optima" Discussed on CarCast

CarCast

02:00 min | 3 years ago

"optima" Discussed on CarCast

"Durban already testing a durability break the battery we uh we do we went up pikes peak we made it all the way up to the top we did not roll down the now which was maybe request from kansas do if they really like in the battery right james james brass now that's the second best durability testing job ever condom company number one battery number two yeah but so you're you're top five interpreter ability test going up and we're doing good nurburgring last question and i i don't know the answer but everybody's getting in from aftermarket in two the actual automobiles when their soul from the factory produced whatever where's optima with that and i i'm i'm assuming their cars that are coming with optima optimize but are we in two forwards and chevy said big 3s lot of the newer vehicles do have egm technology which is a similar technology the two optima in we are parent company johnson controls supplies those batteries are okay so you're it's essentially it's it's optima family owned or parent company as long as your wedding there pre gone fine is there gonna find those little montpon companies who do the shrouded make it look like an old diehard crushe crushed him all right are we miss anything is there any business we need to take yeah all of you that are here at seem i should come up here during the week and check out there there are augmented reality thing that's going on this things pretty awesome definitely check that out and visit optima batteries dot com to learn more about this battery and their entire line of stuff the video do you just saw off for use for you that are here.

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