Healthcare IT News and Opinion. Bimal Desai, MD, MBI is co- founder of Haystack Informatics and AVP/chief health informatics officer at Children’s Hospital of Philadelphia. Tell me about yourself and your jobs. I’m the chief health informatics officer at Children’s Hospital of Philadelphia. I came to CHOP for residency and then stuck around, so this is my 1. I have oversight over the clinical informatics program, which includes the physician informaticists who interface with the Epic team. I oversee analytics and reporting as my second area of responsibility.
The financial crisis of 2007–2008, also known as the global financial crisis and the 2008 financial crisis, is considered by many economists to have been the worst. Wealth Management Price(Cdn$) Canadian Securities Course (CSC ®) Online, interactive version with online textbook (PDF) $ 995.00: Online, interactive version with. The third program that I oversee is a newly- launched digital health program — we’re celebrating our one- year anniversary this month. We partnered with Dreamit Health, a health IT accelerator that has a branch in Philadelphia. This idea that I pitched for privacy protection using EHR data was accepted to go to the accelerator. That became Haystack Informatics. There’s malicious access with intent to identify private information about patients. For example, an employee who’s trying to obtain Social Security numbers and things like that. Then there’s the more casual privacy violations, like your neighbor or a celebrity is admitted, and just out of curiosity, you take a look. Some institutions take it seriously and will announce formally, “You may have heard the news that we have a celebrity admitted to the hospital. Be aware that we’re monitoring access, and if anyone is found in that chart, they’ll be terminated from the institution.” Some institutions take a hard stance on that and others don’t. RULE 2900 PROFICIENCY AND EDUCATION: PART I – PROFICIENCY REQUIREMENTS INTRODUCTION This Part I outlines the proficiency requirements for Approved Persons. 4000+ educational games, videos and teaching resources for schools and students. Free Primary and Secondary resources covering history, science, English, maths and more. It’s hard to say what the scope of the problem is. To some degree, just having a privacy monitoring solution can be a deterrent. For example, if I were an employee and I kept getting calls from the privacy office for false positive alerts, “Were you supposed to be in this patient’s chart?” I would start to quickly distrust the privacy office. But if the true positive rate of those alerts in their system was high enough, employees would start to recognize that these guys have a legitimate solution in place. They will be able to find out if I’m snooping around in my neighbor’s chart. There’s no useful way to do it manually. All these technologies that we’ve developed simplify their work, allowing them to focus on the small subset of truly suspicious events. I asked a question — how many rows of audit log data would you expect to see for this patient for a two- week hospitalization? It was hundreds of thousands of rows of data. In the absence of tools, the privacy officer couldn’t do it manually, even for just this one patient. They empower your privacy officer. They also help your staff employees stay on the right side of HIPAA regulations. I think people underestimate what it takes to start a company. Many physician entrepreneurs probably think that a good idea is sufficient enough. But it’s a lot of sweat equity. It’s a lot of work to build a company. Because this was a CHOP- sponsored project in that first year, especially, I was able to take a mini- sabbatical. It’s not something you can really do in your spare time. The one affordance that my employer gave me was two days a week for the first few months to dedicate to Haystack. There was a lot of negotiation that first year. That was probably the trickiest part. Not to diminish the work of the safety and quality offices themselves, but when it comes to actually crystallizing a workflow or suggesting that people take the right course of action, we’ve found that the electronic health record ends up really helping. They’re struggling to understand what this tool does to help them standardize care. We’ve been very fortunate. We’ve got a strong partnership between my group of clinical informaticists as well as the offices of quality and safety and medical operations. It’s been fruitful. As much work as they’ve put into the development of the clinical pathways and the clinical quality metrics and tools to standardize care, there’s almost as much work in redesigning the EHR to support that workflow. That’s probably been the most positive structure that we’ve put in place. We have 2. 0 board- certified informaticists at CHOP. They’re embedded in every kind of quality and safety or workflow redesign project throughout the institution. That’s the part that’s worrisome to me, that an institution that doesn’t have the kind of informatics resources that some of the big academic medical centers have. It is going to be a heavier lift for them. But their fallback is the content provided by the EHR vendor or external decision support vendors that provide canned order sets, simple protocols and things like that. I don’t know of many other hospitals that have 2. We’ve been successful in lobbying for those resources and making the argument for why it’s valuable to have them. But I think that that’s the hardest part. I remember Carl Dvorak saying that the EHR is a manifestation of your systems of care. The way you take care of patients at some level is reflected in how you design that tool. The double- edge sword of that is that if all of your systems of care rely on the EHR, then it’s really hard when the EHR is down. It’s really hard when you want to transport your model of care to another institution, for example, a partner institution. There is a benefit, but also potentially a vulnerability. Neither part works without the other. Without some sort of EHR representation of a pathway, it’s hard to get people to standardize their work. On the flip side, just introducing a new order set is not going to improve the quality of a clinical process. To say, “We can all agree that we have this clinical quality problem. We can all agree that these are our clinical goals. Here are the tools to help you do it, or at minimum, help us design tools that you would find useful and usable.” It’s a dialog. You can’t really slap it in from the EHR side. It’s a common theme in the field. An order set is not just an order set. The way you roll it out is just as important. One of my other hats is that I help teach the board review course in clinical informatics for AMIA. In the course of doing that for the past four or five years, I’ve met hundreds of informaticists and have heard stories from them about how CDS implementations have gone awry or pathways weren’t as successful as they anticipated. You’re right, part of the problem is that if your staff are not employed, that’s a challenge because it’s harder to get people aligned to the right goals. If you look at our emergency department, for example, at any given time, less than half of the people there are CHOP emergency medicine docs. The rest might be rotating residents from adjacent adult ER programs, trauma programs, or family practice programs. For any physician who steps into the institution — whether they’re a rotating surgeon from University of Pennsylvania or rotating emergency doc from Temple University –this system should be something they should be able to pick up and run with. The ED is probably the one place where we’ve put the most thought into that design for non- pediatricians. I don’t know if I know the answer for that, but I would think that probably yes. Designing for all users is probably a good thing. Across the country, we’re not universally successful, but we at least know some of the pitfalls of what makes clinician decision support useful and what makes it a challenge at different institutions. Once you’ve had an electronic health record in place for a decade, you’ve got terabytes of data that you can plow through. A lot of it is machine data, a lot of it is clinical data. The useful analytics derived from the EHR data and other sources. Genomic information, for example, is intriguing. The portals are a snapshot or a window, but I don’t think we yet know the best techniques for participatory medicine and involving patients and families in their care. For us in pediatrics, we’ve got an interesting opportunity. All of our patients and their parents are, for the most part, digital natives. We don’t have to persuade them to use a smart phone to get access their health records. In fact, they’re asking us, when can we see this information on a mobile view or in a tablet? It’s the next wave. We know about order sets, pathways, and decision support. Where else can we start to derive value from using technologies? Financial crisis of 2. Wikipedia. This article is about the financial crisis that peaked in 2. For the global recession triggered by the financial crisis, see Great Recession. The crisis was nonetheless followed by a global economic downturn, the Great Recession. The European debt crisis, a crisis in the banking system of the European countries using the euro, followed later. The Dodd–Frank Act. The expansion of this sector was encouraged by the following factors. Low interest rates. The Community Reinvestment Act (CRA). Many mortgages were bundled together and formed into new financial instruments called mortgage- backed securities, which could be sold as (ostensibly) low- risk securities partly because they were often backed by credit default swaps insurance. This appreciation in value led large numbers of homeowners (subprime or not) to borrow against their homes as an apparent windfall. As the value of these assets plummeted, the market (buyers) for these securities evaporated and banks who were heavily invested in these assets began to experience a liquidity crisis. Freddie Mac and Fannie Mae were taken over by the federal government on September 7, 2. Lehman Brothers filed for bankruptcy on September 1. Merrill Lynch, AIG, HBOS, Royal Bank of Scotland, Bradford & Bingley, Fortis, Hypo Real Estate, and Alliance & Leicester were all expected to follow – with a U. S. In spite of trillions. The resulting decrease in buyers caused housing prices to plummet. Consequences. In many areas, the housing market also suffered, resulting in evictions, foreclosures, and prolonged unemployment. The crisis played a significant role in the failure of key businesses, declines in consumer wealth estimated in trillions of US dollars, and a downturn in economic activity leading to the Great Recession of 2. European sovereign- debt crisis. Economies worldwide slowed during this period, as credit tightened and international trade declined. When the market for such securities became volatile and collapsed, the resulting loss of value had a major financial effect upon the institutions holding them even if they had no immediate plans to sell them. As banks began to give out more loans to potential home owners, housing prices began to rise. Lax lending standards and rising real estate prices also contributed to the real estate bubble. Loans of various types (e. As housing prices declined, major global financial institutions that had borrowed and invested heavily in subprime MBS reported significant losses. Defaults and losses on other loan types also increased significantly as the crisis expanded from the housing market to other parts of the economy. Total losses are estimated in the trillions of US dollars globally. US Government policy from the 1. Thus, policymakers did not immediately recognize the increasingly important role played by financial institutions such as investment banks and hedge funds, also known as the shadow banking system. Some experts believe these institutions had become as important as commercial (depository) banks in providing credit to the US economy, but they were not subject to the same regulations. Concerns regarding the stability of key financial institutions drove central banks to provide funds to encourage lending and restore faith in the commercial paper markets, which are integral to funding business operations. Governments also bailed out key financial institutions and implemented economic stimulus programs, assuming significant additional financial commitments. The US Financial Crisis Inquiry Commission reported its findings in January 2. The relaxing of credit lending standards by investment banks and commercial banks drove this about- face. Subprime did not become magically less risky; Wall Street just accepted this higher risk. However, as market power shifted from securitizers to originators and as intense competition from private securitizers undermined GSE power, mortgage standards declined and risky loans proliferated. Major US investment banks and GSEs such as Fannie Mae played an important role in the expansion of lending, with GSEs eventually relaxing their standards to try to catch up with the private banks. Later, based upon information in the SEC's December 2. Fannie and Freddie, Peter Wallison and Edward Pinto estimated that, in 2. Fannie and Freddie held 1. On September 1. 0, 2. House Financial Services Committee held a hearing at the urging of the administration to assess safety and soundness issues and to review a recent report by the Office of Federal Housing Enterprise Oversight (OFHEO) that had uncovered accounting discrepancies within the two entities. The majority of these were prime loans. Sub- prime loans made by CRA- covered institutions constituted a 3% market share of LMI loans in 1. They contend that there were two, connected causes to the crisis: the relaxation of underwriting standards in 1. Federal Reserve after the terrorist attack on September 1. Both causes had to be in place before the crisis could take place. In an article in Portfolio Magazine, Michael Lewis spoke with one trader who noted that . In other words, bubbles in both markets developed even though only the residential market was affected by these potential causes. Wallison wrote: . After researching the default of commercial loans during the financial crisis, Xudong An and Anthony B. Sanders reported (in December 2. Business journalist Kimberly Amadeo reports: . Three years later, commercial real estate started feeling the effects. Gierach, a real estate attorney and CPA, wrote.. In other words, the borrowers did not cause the loans to go bad, it was the economy. This ratio rose to 4. This pool of money had roughly doubled in size from 2. Investment banks on Wall Street answered this demand with products such as the mortgage- backed security and the collateralized debt obligation that were assigned safe ratings by the credit rating agencies. By approximately 2. This essentially places cash payments from multiple mortgages or other debt obligations into a single pool from which specific securities draw in a specific sequence of priority. Those securities first in line received investment- grade ratings from rating agencies. Securities with lower priority had lower credit ratings but theoretically a higher rate of return on the amount invested. During 2. 00. 7, lenders began foreclosure proceedings on nearly 1. From 2. 00. 0 to 2. Federal Reserve lowered the federal funds rate target from 6. Federal Reserve chairman Ben Bernanke explained how trade deficits required the US to borrow money from abroad, in the process bidding up bond prices and lowering interest rates. Financing these deficits required the country to borrow large sums from abroad, much of it from countries running trade surpluses. These were mainly the emerging economies in Asia and oil- exporting nations. The balance of paymentsidentity requires that a country (such as the US) running a current account deficit also have a capital account (investment) surplus of the same amount. Hence large and growing amounts of foreign funds (capital) flowed into the US to finance its imports. All of this created demand for various types of financial assets, raising the prices of those assets while lowering interest rates. Foreign investors had these funds to lend either because they had very high personal savings rates (as high as 4. China) or because of high oil prices. Ben Bernanke has referred to this as a . Foreign governments supplied funds by purchasing Treasury bonds and thus avoided much of the direct effect of the crisis. US households, on the other hand, used funds borrowed from foreigners to finance consumption or to bid up the prices of housing and financial assets. Financial institutions invested foreign funds in mortgage- backed securities. The Fed then raised the Fed funds rate significantly between July 2. July 2. 00. 6. By 2. FICO score to 6. 20, making it much easier to qualify for prime loans and making subprime lending a riskier business. Proof of income and assets were de- emphasized. Loans moved from full documentation to low documentation to no documentation. One subprime mortgage product that gained wide acceptance was the no income, no job, no asset verification required (NINJA) mortgage. Informally, these loans were aptly referred to as . Bowen III on events during his tenure as the Business Chief Underwriter for Correspondent Lending in the Consumer Lending Group for Citigroup (where he was responsible for over 2. US housing bubble (2. His testimony stated that by 2. Citi from some 1,6. Moreover, during 2. The analysis (conducted on behalf of 2. Clayton's analysis further showed that 3. By contrast, private securitizers have been far less aggressive and less effective in recovering losses from originators on behalf of investors. Such loans were covered by very detailed contracts, and swapped for more expensive loan products on the day of closing. Whereas the advertisement might state that 1% or 1. ARM) in which the interest charged would be greater than the mortgage payments, creating negative amortization which the credit consumer might not notice until long after the loan transaction had been consummated. Countrywide, sued by California Attorney General Jerry Brown for . This caused Countrywide's financial condition to deteriorate, ultimately resulting in a decision by the Office of Thrift Supervision to seize the lender. One Countrywide employee—who would later plead guilty to two counts of wire fraud and spent 1. If you had a pulse, we gave you a loan. In other cases, laws were changed or enforcement weakened in parts of the financial system. Key examples include: Jimmy Carter's Depository Institutions Deregulation and Monetary Control Act of 1. DIDMCA) phased out a number of restrictions on banks' financial practices, broadened their lending powers, allowed credit unions and savings and loans to offer checkable deposits, and raised the deposit insurance limit from $4.
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El cuento recrea situaciones. Recopilación de Libros Digitales en DOC y PDF para descargar gratis. Ebooks para descargar en paquetes ordenados por la letra inicial del apellido de cada autor. Masaru Emoto y sus ¿¿¡¡CRISTALES DE AGUA!!?? El gran FRAUE del AGUA ALCALINA??!!! La novela recrea mundos y personajes (su psicolog. En la novela, y aun en lo que se llama novela corta, la trama desarrolla conflictos secundarios, lo que generalmente no acontece con el cuento, ya que este sobre todo debe ser conciso. Los l. Una novela corta es una narraci. Tiene tres subdivisiones: los cuentos de hadas, los cuentos de animales, y los cuentos de costumbres. El mito y la leyenda son tambi. El autor en este caso suele ser conocido. El texto, fijado por escrito, se presenta generalmente en una sola versi. Se conserva un corpus importante de cuentos del Antiguo Egipto, que constituyen la primera muestra conocida del g. Una de las primeras manifestaciones de este tipo en lengua castellana es la obra El conde Lucanor, que re. Lo que se presenta en la introducci. La introducci. El nudo surge a partir de un quiebre o alteraci. Incluso en los textos con final abierto hay un desenlace, e incluso hay casos que dentro del cuento puedes encontrar el cl. La estructura de la novela permite, en cambio, leerla por partes, y por otra parte, la extensi. Veiga, Dalton Trevisan, y Rubem Fonseca. E. Uno de los pocos reductos en el que el cuento sobrevive bien, y m. ![]() ![]() A finales de 1971 comenzó a desarrollarse lo que hoy denominamos libro digital o electrónico. Michael Hart fue el impulsor del Proyecto Gutenberg, que consistía en. El folclorista Vlad. Es de presumir que el cuento se desarroll. Presumiblemente por ello, la suspensi. C.) y el llamado Libro de los Muertos (hacia el 1. C.)— la que tiene una cl. A los mencionados obviamente tambi. Pero de un modo general, Luciano de Samosata (1. De la misma . Otro nombre importante de esa primera . Con posterioridad y en Persia, surgi. Boccaccio dio una estructura exterior a los relatos, la llamada cornice: una serie de narradores que se re. Por su parte Miguel de Cervantes (1. En cuanto a Jean de La Fontaine (1. Corresponde se. Los hermanos Grimm (Jacob 1. Wilhelm 1. 78. 6- 1. Blancanieves, Rapunzel, El gato con botas, La bella durmiente, Pulgarcito, Caperucita roja, etc. Lo cierto es que el cuento no vende. El motivo posiblemente sea la excesiva oferta que se tiene a trav. Tal vez la falsa idea de que el cuento ser. Mas, cada vez que me vejo livre dessas press. Pero cada vez que me deshago de estas presiones editoriales, vuelve al cuento.. Joaquim Machado de Assis, citado por N. Num romance, pode o escritor ser mais descuidado e deixar esc. Mas num conto.. En una novela, el escritor puede ser m. Pero en un cuento .. Em termos de cria. Eu me lembro de v. En terminos de creativos, el cuento requiere mucho m. Dietrich Gumbel. ANTECEDENTES DE LA AROMATERAPIA. Kiwan Ti, emperador chino, inició el estudio de los.Recuerdo varias novelas en que salt. Mientras que el cuento no tiene t. Es un reto fant. Las limitaciones deel cuento est. Por su parte, Italo Calvino (1. Pienso que, no por casualidad, nuestra . Por que ler os cl. Italo Calvino, Seis propostas para o pr. Al mismo tiempo, siempre fui un lector y relector de cuentos. Como escritor, pens. Finalmente, fue gracias a la prensa escrita, que el g. Y por su parte en la introducci. Creio que o sucesso do conto nos . Y en el siglo xx, ese estilo de informar sin duda fue impulsado por el periodismo y por el libro. Y hacia el . Indudablemente es por lo expresado que en su inicio, tanto en Brasil como en Estados Unidos y como en otros pa. Se tiene la impresi. En definitiva, una revista popular o el suplemento de alg. Estas preocupaciones y estas reflexiones, a su vez acent. Por este lado muy posiblemente es que hayan surgido ciertos preconceptos en contra de los cuentos. Las influencias en un principio tal vez positivas ejercidas por la prensa escrita (revistas, semanarios, suplementos), unida a cierta difusi. Los escritores procuraron la renovaci. Actualmente, se entiende como usual o normal que pueda variar entre un m. La citada obra, como sabemos, tiene m. No obstante, las caracter. Henry, Anatole France, Virginia Woolf, Katherine Mansfield, Kafka, James Joyce, William Faulkner, Ernest Hemingway, M. Veiga, Luiz Vilela, Sergio Faraco, Victor Giudice, Lygia Fagundes Telles, Miguel Sanches Neto. En Portugal por su parte se destacan, entre otros, Alejandro Herculano y E. Jorge Luis Borges (1. Sin llegar a tanto, Julio Cort. Aspectos del cuento. Claro que hay que tener cuidado con los excesos de formalismo, para no caer en personajes acartonados ni en esquemas excesivamente r. En Brasil, cultivan este subg. Veiga, de Ant. Lo esencial en un cuento est. En el libro ? El pasado y el futuro en el cuento tienen una significaci. Asimismo, no se puede negar que el final en el cuento mayoritariamente siempre es m. Y como ejemplo, puede ponerse el cuento A missa do galo, de Joaquim Machado de Assis. Reproduz a busca sempre renovada de uma experi. Tal vez por lo que acaba de decirse, David Herbert Lawrence dijo que el lector deb. Desde este punto de vista, la sorpresa se produce cuando, al final del relato, la historia secreta o escondida viene a la superficie. En el cuento, la trama es lineal y objetiva, pues el cuento, dada su brevedad, ya desde el inicio no est. Si en la novela el espacio/tiempo es saltar. Con posterioridad entra en acci. El cuento es un problema y una soluci. Considerado el mayor autor brasile. Otro ejemplo del mismo tipo son las 1. Los personajes conversan entre s. Es cuando el escritor resume el habla del personaje en forma narrativa. O sea, es cuando el personaje cuenta c. Tanto el di. Es una fusi? Este tipo de discurso permite exportar o expresar los pensamientos del personaje, sin que el narrador pierda su poder y su condici. Corresponde se. Por su parte, la conocida obra Lazarillo de Tormes, de autor desconocido, tambi. En Ulises, James Joyce (inspirado en . El observador es imparcial y objetivo dentro de lo que puede esperarse, limit. Cosa parecida a la tela de Pen. Esta animosa griega, a quien se cre. Noticia de que se apodera el vulgo y que va desfigurando y adicionando basta desfigurarla y hacerla ap. Locuciones dirigidas a cortar alguna disputa, especie o conversaci. Equivalen a las usual. Significa igualmente no mezclarse en chismes, no intervenir en asuntos ajenos, prescindir, en fin, de cuanto pueda alterar la paz en lo m. Llegar oportunamente para alcanzar alguna cosa, sacar provecho o presenciar alg. Convenir o no un objeto a otro u otros de que se trate. Poner en cuentos: comprometer a alguno, exponerlo a un riesgo o peligro, a un disgusto o cosa equivalente, dando lugar o pretexto para que hablen de ! Se usa ponderando la extra! Sacar a colaci. El que es pendenciero y busca continuas ocasiones de disputa o pendencia. ISBN 9. 78- 8. 4- 3. Ahora que soy viejo, ! Y me puse a improvisar unos ensayos breves sobre cuentos ajenos y m. Con facilidad, con felicidad, me deslizaba cuesta abajo por el camino, cantando y borroneando p? No te olvides de que tambi. Consultado el 1. 0 de noviembre de 2. Monasterios, Vidas secas de Graciliano Ramos: Una visi. El citado es profesor catedr. Sus ensayos y sus libros — entre los que ya hay cl. ![]() ![]() PDF Download - Free download and software reviews. The problem with opening PDF files in Firefox is that it tends to slow down your performance, especially if you open several of them. UpdateStar is compatible with Windows platforms. 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