Running Away to Join the Circus

Last night I joined the circus and danced center stage in Cirque du Soleil's Alegria with the White Singer.

My family tells me that the contrast of my all black clothing with her all white clothing looked elegant and refined, making up for my complete lack of ballroom dancing skills.

The story about how this happened is an amazing chain of events, illustrating the powerful forces of fate that shape our lives.

Here's the tale:

In September of 1980, I arrived at Stanford and moved into Granada, a dorm that's part of the Lagunita complex. I met a woman named Kathy Greene who lived in Eucalypto, another Lagunita dorm. She was Korean American, an artist, and could do everything I could not. She had a perfect right brain to complement my clumsy left brain. We've never been apart since and just celebrated our 25th wedding anniversary. She introduced me to Asian culture, food, and traditions. In my youth, I traveled by car throughout the continental United States, but I had no experience with the Orient.

Our daughter, Lara (named after the Dr. Zhivago character, not Lara Croft/Tomb Raider) was born in 1993 and she has always travelled with us around the world. She's been to Japan six times in her 16 years of life and has developed a love of people, the country, and the language.

This summer, she spent 8 weeks in Japan doing intensive language study. While she was there, one of her fellow students was Sam Allen, a high school senior who happens to live in Brookline, Massachusetts. They had great experiences together and shared anime, Akihabara, and Asakusa. After a month they decided to become a couple, going out together.

Which brings us to Cirque du Soleil. Early in the summer, we bought tickets to the August 30 performance of Alegria in Boston.

Lara and Sam are back from Japan and Lara invited him to the show. However, we lacked a ticket. We went online and found a seat available, but it was a single in the front row.

Being a devoted Dad, I volunteered to sit apart in the single seat. When we arrived at the theater, I was amazed to discover the single seat was 3 feet from the stage, next to the main stage entrance, on a corner, making it the most likely seat to host a "volunteer" from the audience.

Having attended Cirque du Soleil performances a few times in the past, I knew the audience members could be picked to join clown routines, magic acts, and various skits.

I waited in the hot seat for my moment of fame. After intermission, all the major characters assembled on the stage and the White Singer walked throughout the audience. She approached my chair and reached for my hand.

She led me to the center of the stage and we danced, surrounded by all the other characters. No photography was allowed, so alas, there is no evidence other than the several thousand people (including my family and Sam) who watched. At the end of our dance, the main character, Fleur, tapped me on the shoulder and motioned me back to my seat. I bowed and waved, then headed off stage.

The moral of the story? There is a direct causal thread between meeting my wife in 1980, developing a love of Japan which I passed on to my daughter, enabling her to meet Sam, resulting in my being placed in the one seat of thousands that would be selected for the on stage appearance.

My professional life is very similar. Becoming a CIO was the culmination of hundreds of events over 20 years that resulted in my being in the right place at the right time with the right colleagues and the right experience.

I believe that life is a wonderful combination of genetics and nurturing, planning and random chance, and a spiritual thread that leads us in and out of various eddies of opportunity throughout our lives.

Last night I joined the circus. I do not know what tomorrow will bring, but I'm looking forward to it!

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Milk Allergy Study in Boston

We've been hearing about peanut desensitization studies in the news recently. I'm thrilled to report that Children's Hospital in Boston is conducting the first ever milk desensitization study. Check out this video and follow along each week as 11 year-old Brett goes through the study.

This is great news!

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Friday Fare: Caramel Popcorn

Plan a movie night this week-end and pop up some sweet delicious popcorn!

Caramel Popcorn

free of dairy, eggs, peanuts, tree nuts, wheat and soy

4 quarts popped popcorn- use "natural" microwave popcorn or simply pop some kernels in a tablespoon of oil in a pan on your stove top.
1 cup brown sugar
1/2 cup margarine (I use Fleischmann's Unsalted sticks which are dairy-free but contain soy. Could use soy-free Earth Balance if soy allergic)
1/4 cup light corn syrup
1/2 teaspoon salt
1 teaspoon vanilla extract
1/2 teaspoon baking soda

Place the popped popcorn into a large brown paper bag. Set aside.

In a 2 quart microwave safe dish, combine the brown sugar, margarine, corn syrup, salt and vanilla. Heat for 3 minutes in the microwave, then take out and stir until well blended. Return to the microwave, and cook for 1 1/2 minutes. Remove from microwave, and stir in the baking soda.

Pour syrup over the popcorn in the bag. Roll down the top once or twice to close the bag, and shake to coat the corn. Place bag into the microwave, and cook for 1 minute and 10 seconds. Remove, shake, flip the bag over, and return it to the microwave. Cook for another 1 minute and 10 seconds.

Dump the popcorn out onto waxed paper, and let cool until coating is set.

Enjoy!

If there are any left-overs, store in an airtight container.

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Quality, Meaningful Use, and Interoperability

A reporter recently asked me to describe the quality measures and standards that are part of meaningful use. Floyd Eisenberg, Senior Vice President, Health Information Technology at the National Quality Forum, summarized the work nicely:

"The National Quality Forum (NQF), with support from the Agency for Healthcare Research and Quality (AHRQ) convened the Health Information Technology Expert Panel (HITEP) to develop a data model for quality measurement. The HITEP developed a framework, the quality data set (QDS), to manage the terms (value set), the context of use (quality data type) and the data flow (data source, recorder, setting, health record field) for each element used to build a quality measure. A quality data element combines the value set with the quality data type to directly express the definition of every term used to calculate a measure. HITEP finalized the quality data types July 31, 2009. During the August 25-27 face-to-face meeting HITSP reviewed all of these data types, defining the standard interoperable segment and taxonomy to represent each. While some areas require harmonization and others represent gaps, a significant portion of data types were sufficiently defined to allow their use in quality measures in the near term. These findings are reflected in updates to the IS 06 Quality Interoperability Specification to be presented to the HITSP Panel September 15. These data type interoperability determinations will also be used in the retooling process for those quality measures recommended for meaningful use by the HIT Standards Committee based on areas for measurement identified by the HIT Policy Committee. Completion of the retooling effort before the end of 2009 will allow time for EHR vendors and local EHR implementations to address these retooled measures in 2010 for reporting in 2011.

HITSP has also established constructs to address two prior gaps in the IS 06 interoperability specifications. There had previously been no standard for reporting of quality measures to a requesting entity. HITSP has now completed public comment for C105 (Patient Level Quality Document Using HL7 Quality Reporting Document Architecture (QRDA)) and revisions will be presented to the HITSP Panel on September 15. This component allows standardization of reporting structure. The HIT Standards Committee elected to allow more testing of QRDA before requiring its use will reconsider it for 2013 based on testing. HITSP also published a provisional component, C106 (Measure Criteria Document) that addresses a currently balloted HL7 to standardize the structure of all quality measures. The HL7 ballot, eMeasure, addresses the HITEP quality data types mentioned above.

In addition to these efforts, under contract from ONC, HITSP has retooled 16 inpatient measures for electronic use, each has also addressed the HITEP data types. A technical note with the details of these retooled measures will be available for public comment in September. Two of these measures are in the list of meaningful use measures suggested by the HIT Policy and Standards Committees. "

Thanks Floyd!

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Homes To View

My new website is now live! http://www.homestoview.net

The new site is a branch of Flair Films and geared for people who are interested in having an online video of their business, or real estate listing. It is also a great idea for motivational speakers or people that want to have a quick look at what you do online. We also do instructional DVD's. Check it out!

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A HITSP Town Hall

Today at 2pm, I'll be running a HITSP Town Hall public webinar about ARRA, health information exchange, and standards.

Here are a few resources I'll reference:

My Slides

The approved HIT Standards Committee Clinical Quality Standards Matrix

The approved HIT Standards Committee Clinical Operations Standards Matrix

The approved HIT Standards Committee Security and Privacy Matrix

The approved HIT Policy Committee Meaningful Use Matrix

The approved HIT Policy Committee HIE priorities which are:

2011
Lab results delivery
ePrescribing
Claims and eligibility checking
Quality & immunization reporting

2013
Registry reporting and reporting to public health
Electronic ordering
Health summaries for continuity of care
Receive public health alerts
Home monitoring
Populate PHRs

2015
Access comprehensive data from all available sources
Experience of care reporting
Medical device interoperability

All of these materials have been transmitted from the HIT Policy and Standards Committees to ONC where they are being used to write the regulations which will be issued by HHS on December 31, 2009.

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A Milestone for Device Interoperability

What is standards harmonization?

I describe it as the parsimonious number of standards required to meet the requirements of stakeholders. It is achieved by closing gaps and eliminating redundancy.

Can we always reduce the number of standards in a domain to 1? Not necessarily. Sometimes the best we can achieve is 2 with mapping between them or 2 initially converging over time to 1.

In the past, we've had multiple interoperability standards for devices. Earlier this year, HITSP challenged IHE and Continua to converge their work as part of the HITSP Remote Monitoring Use Case.

The Continua Alliance, a non-profit, open industry coalition of the more than 200 healthcare and technology companies joined together in collaboration to improve the quality of personal healthcare, has been focused on interoperability standards for consumer products. It wanted "fast and light" device standards that could easily be deployed with products in the home.

Integrating the Healthcare Enterprise (IHE), an initiative of healthcare professionals and industry to improve the way computer systems in healthcare share information, has focused on more complex devices such as those used by providers in hospitals and clinics.

Yesterday, Continua and IHE announced a breakthrough. They have agreed to a single set of content, transport, and vocabulary standards that work for all devices - home-based and hospital-based, simple and complex. This means that the industry is free to innovate and regardless of the devices created, they will be interoperable.

What standards did they choose?

Content - HL7 v2.6 messages using IHE PCD-01
Vocabulary - Constrained to IEEE/ISO 11073-20601/11073-104xx nomenclature
Transport - Web Services transport based on WS-I Basic Profile

Here are few comments by the leaders of this effort:

"IHE believes that this collaborative breakthrough offers enormous benefits to US citizens and their physicians. This helps accelerate the deployment of convenient and reliable home-based health monitoring and care, and facilitates many other forms of remote monitoring as well. Together, Continua and IHE have finally made it possible for vendors of Medical Devices and Personal Health Devices to efficiently send patient data to the Personal and Electronic Health Records vendors using a single unified interoperability standard that is endorsed by HITSP."

Elliot B. Sloane, PhD
Co-Chair, Integrating the Healthcare Enterprise (IHE) International Executive Director, Center for Healthcare Information Research and Policy


"The Continua Health Alliance appreciates the opportunity HITSP has afforded to work with IHE to provide a harmonized approach for the Remote Patient Monitoring Use Case with an open architecture, international, standards-based solution. This will facilitate an ecosystem of connected technologies, devices, and services that provide a compelling way to meet the challenges of increased access, improve outcomes for patients, and ultimately reduce overall healthcare costs."

Rick Cnossen
Director, Personal Health Enabling, Intel Digital Health Group (DHeG)
President, Continua Health Alliance (www.continuaalliance.org)


I want to offer my congratulations and thanks to IHE and Continua for this achievement. Their leadership illustrates the finest characteristics of harmonization achieved by assembling smart technical people, aligning mutual interests, then moving forward to converge on a single approach.

Bravo! All device stakeholders will now benefit from a single universal set of standards used to connect devices to EHRs and PHRs.

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The FY10 HMS IT Operating Plan

Every year I work with all the stakeholders at Harvard Medical School to develop an operating plan. Here are a few observations about the process:

-In an economic downturn, governance is very important to triage projects, set timelines, and allocate resources. Budgets define the supply of resources. Governance helps balance supply and demand. During my tenure as CIO, we've had workgroups for research, education, and administrative customers, but this year I'm formalizing governance by creating an overall IT Steering Committee comprised of research faculty, educational leadership, and administrative Deans. My educational, administrative and research workgroups will report to this overall IT Steering Committee.

-I have 5 direct reports at HMS who serve as the single point of accountability for Administration/Finance, Education, Research/Customer Service, Infrastructure, and Technology. Each is responsible for translating the strategic and business priorities of their customers into the tactics listed in the operating plan.

-Once the operating plan is complete, my role as CIO is to ensure appropriate capital budgets, operating budgets, and staffing are in place to execute the plan. 2010 will require especially close collaboration with the leaders at HMS to balance the necessary resources with the need to be frugal in a challenging economy.

-Major themes in the FY10 IT Operating Plan include enhanced enterprise infrastructure (especially storage), workflow applications to promote departmental efficiency, and web-based software as a service tools that reduce costs while improving service to all stakeholders.

-I summarize the yearly effort to develop the plan as

Strategy - document the goals and business strategy of all stakeholders, translating them into operating tactics.

Structure - ensure the IT organization is optimally configured to execute the tactics.

Staffing - populate the structure with the best people to do the work.

Budget - put the capital and operating budgets in place so that the necessary resources are available to execute the scope of work in the timeline needed.

Processes - Define the workflow and procedures that are needed to support project management, customer service, and continuous improvement.

Here's the initial version of the FY10 HMS IT Operating Plan. I look forward to a great year ahead.

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Cool Technology of the Week

Before my trip to Japan, I attended the New England Healthcare Institute Medication Adherence Expert Roundtable on Thursday July 23rd, 2009. The purpose of the roundtable was to prioritize activities that would encourage patients to be more compliant with the medications, especially those with chronic diseases such as diabetes, congestive heart failure and COPD. Recommendations from the group included better patient education, enhanced use of IT such as medication reconciliation, and healthcare reform which ensures clinicians have the time and incentives to coordinate and manage all medications for their patients.

One technology that we discussed was an intelligent pill bottle for the home from rxvitality.com and it's my cool technology of the week. Using technology similar to the Ambient Orb, the intelligent pill bottle flashes to indicate when it's time to take the medication inside the bottle. When the bottle is opened it sends telemetry back to a portal which can be used to track patient medication adherence.

The device includes a small wireless access point for the home, making the device plug and play. No cell phone plan, configuration or special software is needed - just an internet connection.

A pill bottle that notifies the patient when medications are to be taken and informs the clinician when medications are actually taken.

That's cool!

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Friday Fare: Banana Crumb-Topped Muffins

Just made a batch of these delicious muffins!

Banana Crumb Muffins

free of dairy, eggs, peanuts, tree nuts
contains wheat and soy

1 1/2 cups all-purpose flour
1 teaspoon baking soda
1 teaspoon baking powder
1/2 teaspoon salt
3 bananas, mashed
3/4 cup white sugar
1 1/2 tablespoon warm water, 1 1/2 tablespoon canola oil, 1 teaspoon baking powder mixed until bubbly

Topping:

1/3 cup packed brown sugar
2 tablespoons all-purpose flour
1/8 teaspoon ground cinnamon
1 tablespoon margarine (I use Fleischmann's Unsalted sticks)

Preheat oven to 375 degrees.
Prepare muffin cups.
In a large bowl, mix together 1 1/2 cups flour, baking soda, baking powder and salt. In another bowl, beat together bananas, sugar, and water/oil/baking powder mixture. Stir the banana mixture into the flour mixture just until moistened*. Spoon batter into prepared muffin cups.

Topping:
In a small bowl, mix together brown sugar, 2 tablespoons flour and cinnamon. Cut in 1 tablespoon butter until mixture resembles coarse cornmeal. Sprinkle topping over muffins.
Bake in preheated oven for 18 to 20 minutes, until a toothpick inserted into center of a muffin comes out clean. Makes 10- 12 muffins.

*Can add dairy-free chocolate chips to batter*

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Funding for HIEs and RHITECs arrives

Yesterday was a landmark day - the HIT Standards Committee approved the quality, clinical care, and privacy/security standards that serve as certification criteria and support meaningful use. At the same time, HHS released $564 million for Healthcare Information Exchange to be given to States/State Designated Entities to accelerate interoperability implementation and $598 million for Regional Healthcare IT Extension Centers (RHITECs) which are applied for competitively (not distributed via state government) to accelerate EHR adoption.

Of interest, the range of award for HIE is $4,000,000 to $40,000,000. Fifty awards will be given.

The range of award for RHITECs is $1,000,000 to $30,000,000 with an average of 8,543,000
Award Floor $ 1,000,000. Seventy awards will be given.

The press release is below.

CHICAGO, IL � Vice President Joe Biden today announced the availability of grants worth nearly $1.2 billion to help hospitals and health care providers implement and use electronic health records. The grants will be funded by the American Recovery and Reinvestment Act of 2009 (ARRA) and will help health care providers qualify for new incentives that will be made available in 2010 to doctors and hospitals that meaningfully use electronic health records.

�With electronic health records, we are making health care safer; we�re making it more efficient; we�re making you healthier; and we�re saving money along the way, �said Vice President Biden. �These are four necessities we need for healthcare in the 21st-century.�

�Expanding the use of electronic health records is fundamental to reforming our health care system,� said HHS Secretary Sebelius. �Electronic health records can help reduce medical errors, make health care more efficient and improve the quality of medical care for all Americans. These grants will help ensure more doctors and hospitals have the tools they need to use this critical technology.�

The grants made available today include:

Grants totaling $598 million to establish approximately 70 Health Information Technology Regional Extension Centers, which will provide hospitals and clinicians with hands-on technical assistance in the selection, acquisition, implementation, and meaningful use of certified electronic health record systems.

Grants totaling $564 million to States and Qualified State Designated Entities (SDEs) to support the development of mechanisms for information sharing within an emerging nationwide system of networks.

The Extension Center grants will be awarded on a rolling basis, with the first awards being issued in fiscal year 2010. Grants to States will be made in fiscal year 2010. Those interested in applying for these grants may visit http://HealthIT.HHS.gov for more information.

�With these programs, we begin the process of creating a national, private and secure electronic health information system. The grants are designed to help doctors and hospitals acquire electronic health records and use them in meaningful ways to improve the health of patients and reduce waste and inefficiency,� said Dr. David Blumenthal, National Coordinator for Health Information Technology. �They will also help states lead the way in creating the infrastructure for health information exchange, which enables information to follow patients within and across communities, wherever the information is needed to help doctors and patients make the best decisions about medical care.�

The Department of Health and Human Services will also provide additional assistance to health care providers through the Health Information Technology Research Center (HITRC). The HITRC will gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Extension Centers collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support.

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The Next Deliverables of the HIT Standards Committee

Today in Washington the HIT Standards Committee met to discuss the latest deliverables from its workgroups - Clinical Quality, Clinical Operations and Privacy/Security.

A few highlights:

*The workgroups presented the standards needed to support meaningful use and certification criteria. A certified EHR must meet the functionality criteria currently being developed by ONC but also must be capable of supporting the standards defined by the HIT Standards Committee workgroups.

*The standards themselves apply to capabilities that need to be included in the products for certification, and the use of those capabilities to codify patient data, and to calculate and report quality measures constitutes the 'meaningful use'.

*The theme for the meeting was convergence - after countless hours of work, today's deliverables included the synthesis of the efforts of all three workgroups, recommendations of the policy committee, and public comment.

The Clinical Quality workgroup presented 30 measures of quality and the data types required for each. Working collaboratively with Clinical Operations, specific content and vocabulary standards were selected all but 6 data elements, 3 of which are for one quality measure.

The Clinical Operations workgroup presented the content and vocabulary standards supporting meaningful use. Importantly, there were no gaps in standards needed to support all 2011 meaningful use criteria. The workgroup was very thoughtful about the maturity of standards and presented a gradual transition plan, allowing some variation (PDF, document images, free text) in 2011, but eliminating these unstructured documents for 2013. Their work included messaging formats (such as HL7 2.51) and document formats (such CDA/CCD), and all the vocabularies necessary for semantic interoperability (such as SNOMED-CT, RXNORM, UNII for allergies, and LOINC for labs). Note that the work of Clinical Operations describes the exchange of data between organizations, not the data model, architecture or implementation details within an organization.

The Privacy and Security workgroup presented the authentication, authorization, auditing and secure data transmission standards. Note that Privacy and Security includes standards for use in EHR products, the infrastructure that hosts them and best practices. Their work does include protecting data inside an enterprise as well as data exchange between enterprises because security is an end to end process. Security is as strong as the weakest link in the data exchange. Just as with the Clinical Operations workgroup, a great deal of thought went into the timeline when standards should be adopted, enabling a glide path from the present to stronger security. There were no gaps in the standards needed for 2011, although additional work on consent management and consumer preferences will be done to support later years, ONC, the Standards Committee and HITSP will work on consumer preference standards together in upcoming meetings.

The HIT Standards Committee also decided to establish a workgroup to focus on adoption/implementation issues.

All of the workgroup deliverables were accepted by the Committee and have been submitted to ONC as guidance for the regulation writing process.

A very impressive body of work. Thanks to all the workgroup members, the HITSP tiger teams, and ONC for making it all possible.

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The Road Less Traveled

I'm back from Japan, physically and spiritually refreshed, ready to embrace my jobs , my blogging, and my outdoor activities with new vigor.

In previous years, my vacations have been about movement - hiking the John Muir trail, climbing in Yosemite, and exploring the outdoors with my family.

This year's trip to Japan was about people. My family and I had remarkable experiences that were not about traveling to every tourist spot, taking a few photographs, then shuttling to the next location. Instead, we based our ourselves in Kyoto for 2 weeks and in the Inland Sea (Miyajima) for 3 days, spending time with shopkeepers, craftsman and friends. Here a few examples:

We had the opportunity to spend a few hours with the President of Shoyeido Incense, Masataka Hata, the 12th generation leader of the company. He led us in a traditional Japanese incense ceremony (Koh-do), teaching us the details of refined arts from the 1600's.

We had the opportunity to meet with the owner of Horaido Tea, Nagahiro Yasumori, whose family has sold tea in Kyoto since 1803. He taught us how to make the ideal cup of Gyokuro and Sencha green tea.

We spent an afternoon with Ken-ichi Utsuki, owner of Aizenkobo workshop, a traditional Japanese natural indigo dying and textile firm. He and his son fitted me with a Samue (Japanese workclothes for Zen monks and tradespeople).

We met with Kunimi Naito and her family, makers of traditional Japanese Geta (wooden sandals) in the Gion (Geisha) district of Kyoto. They carefully studied my feet and are making a custom pair of geta for my 27cm western-sized foot.

We met with a Sake brewer and tasted the range of his handmade Ginjo and Daiginjo sakes.

We viewed the bonfires of Obon with faculty members from Kyoto and Keio University.

I played Shakuhachi in a 500 year old mountaintop temple overlooking the Inland Sea with a Zen monk who played a Conch shell.

We made traditional Japanese sweets (Wagashi) with a master craftsman.

We had incredible Zen meals in small family run restaurants such as Kiko

I want to thank our Japanese hosts, Dr. Hiroyuki Yoshihara and Michiko Yoshida for making it all possible.

There are so many memories and spiritual experiences to describe that I will use the next several months on my Thursday blogs to share everything I learned about traditional Japanese culture from the master craftsman who taught me over the past two weeks.

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Philly's Holding 1st Annual Food Allergy Fair

On Thursday, Sept. 24 from 11 am to 2 pm, Philadelphia will hold its first Food Allergy Fair. The fair is being hosted by Allergy and Asthma Specialists and Prototype Advertising. I contacted the organizers to find out the purpose of the event. Here's what I was told:

"This is an educational experience for adults with food allergies or caring for someone with food allergies. The adult with food allergies or the adult caring for individuals is often overlooked. We are trying to give Moms the opportunity to explore food allergy options without the kids around. Also, we hope to offer grown up food options to food allergy sufferers."

Area chefs, nutritionists and doctors will be on-hand to talk to visitors.

I plan to attend. Anyone want to meet up?

Here's the website for the Food Allergy Fair.

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Food Allergy Twitter Party

The third Food Allergy Twitter Party is scheduled for Friday, Oct. 2. If you've never participated in a Twitter party, they're fast, fun and filled with lots of great info. There are even prizes too!

Here's how to join us:
1. You'll need a Twitter account. Sign-up is free.
2. On Oct. 2 (time has not yet be decided- check back), you'll need to go to tweetgrid.com and type in #foodallergy.
3. You'll see the conversation on your screen. Jump in any time, but type #foodallergy in every message so everyone else can see it.

Hope to see you there!

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Friday Fare: Granola Bars

We love these granola bars. As soon as the batch runs out, I make another. They're super easy to make and, believe me, after you eat these, you'll never go back to packaged granola bars filled with preservatives, chemicals, and lots of allergens again. Give them a try this week-end.

Granola Bars
free of dairy, eggs, soy, peanuts, tree nuts




Ingredients:

2 cups rolled oats
3/4 cup packed brown sugar
1/2 cup wheat germ
3/4 teaspoon ground cinnamon
1 cup all-purpose flour (I use ¾ regular flour and ¼ whole wheat flour)
3/4 cup raisins, marshmallows, mini chocolate chips, or any other add-ins you prefer (check labels for allergens)
3/4 teaspoon salt
1/2 cup honey
1 1/2 tablespoon warm water, 1 1/2 tablespoon canola oil, 1 teaspoon baking powder mixed until bubbly (this is the substitute for one egg)
1/4 cup vegetable oil
1/4 cup applesauce
2 teaspoons vanilla extract

How to Prepare:

Preheat the oven to 350 degrees.
Grease a 9x13 inch baking pan.
In a large bowl, mix together the oats, brown sugar, wheat germ, cinnamon, flour, raisins and salt.
Make a well in the center, and pour in the honey, water/oil/baking powder mixture, oil and vanilla. Mix well.
Spread the mixture evenly into the prepared pan.
Bake for 30 to 35 minutes in the preheated oven, until the bars begin to turn golden at the edges.
Cool for 5 minutes, then cut into bars while still warm.
Enjoy!

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One Person Can Make A Difference

Polly Green - show reel

This is my current show reel which includes footage from my award winning documentary Nomads and footage from Running For Water, the first ever around the world relay race. My mission as a videographer is to tell stories that are inspiring and make a positive difference in the world. I do promotional videos for NGO's, not for profits, businesses, musicians, artists, authors, and real estate. Please feel free to contact me for your video needs. polly@flairfilms.com

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New Location for Jimmie's Blog

Hello Everyone,

This will be my last post to this blog location. Having my blog on my web site, rather than on Google's blogspot has caused increasing difficulty getting my posts to finally publish. This is because Google's blogger software republishes the entire blog history every single time you post -- this is an issue for blog sites like mine that are directed at my web site, not so with those with blogspot blogs.

For the next little while, click on the title link above, or click here, for my new blogspot. It has all of my old blog posts imported over to it, and it allows me to use lots of the new widgets and gadgets that make blog pages more interesting.

Thanks for reading my blog, and best regards to all....

Jimmie

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Halifax Agricultural Show - cattle section: Say hello to a rare native who's looking good

Over the past few days I have had to go through the tiresome explanation of just exactly what British White cattle are, and even explain that the American British White Park cattle were not wild things. This afternoon this article popped up and it seemed well-timed. The "White Park" cow in the photo (click the article link above for the photo) is a horned beautiful white cow with black points, with a gentle look about her, and a fat and beefy look about her -- sound familiar? You can clearly see in her photo that she is halter broke, and she and the humans about her look quite agreeably comfortable at her side.

In no way is this cow some fearsome "wild" white park creature, not now, and not ever in her genetics. The cow is said to be 11 years old -- are we supposed to believe that in those 11 years she hasn't managed to knock someone over and have her halter privileges pulled forever -- if she's from "wild" stock, that surely should have happened along the way.

In England the horned White Park is considered the oldest native breed of Britain. Your polled British White cows are also the oldest native breed of Britain, and don't ever forget that. Don't let the pocket book politics of the likes of the British author Lawrence Alderson forever change history to suit his goals and the goals of a select few highbrows in England.

Yes, the polled breeders of the old Park cattle (that's what both horned and polled were called when the first registration was established for them, until about the 40's) implemented a breed up program to save the breed and increase their numbers. In no way does that justify the absurd notion of Alderson's that the two varieties are genetically distinct, it's not even scientifically supportable -- but he doesn't really care!

(Great efforts have been made, both in the early years of the breeds establishment to the present, to bring both full pedigree semen and live polled Park cattle from the UK to the USA, to both preserve and integrate the best genetics available. In England, they have curtailed their breed-up program and I applaud that, and hope to see that happen in the USA. But in the meantime, the BWCAA American Fullblood program has successfully encouraged the pursuit of Fullblood herds.)

The reality is that both horned and polled Park cattle were found on the same farms and on separate farms for hundreds of documented years. The reality is the White Park of today in England was mixed with English Longhorn and Welsh Black, among other breeds. The fact that they stopped this at some point 40 years or so ago, makes them in no way significantly purer in the grand scheme of things. The genetics of Park cattle are powerfully strong and heritable. These cattle have been treasured and bred in the lands of the British Isles for a millennia of time. We know this from their presence in the ancient oral tales that have come down to us from Ireland, Wales, and Scotland - not England.


If I had my way the polled Park cattle in my pastures would bear a breed name that reflects their fine heritage and place in history -- Park Cattle. And if I have to see or hear another person use the word "whites" in reference to my beloved breed, I sometimes think I'll break my computer screen or punch someone. The breed deserves a high degree of respect, and referring to them as "whites" is demeaning slang that curls my lips and it shouldn't be perpetuated.

I have no idea, and doubt anyone alive today does either, why the folks in England decided to call my polled Park cows, British White. I sometimes feel like simply saying they are Park cattle. England is across the ocean, we already know following their lead leads to societal ruin, or at least it looks that way right now. So I no longer see any need to label my cows anything but what they historically were called in Britain before modern pocket book politics and meddling intervened to create a new breed name.


EXCERPT from the UK Article: (Click title link above for full text and photo.)Published Date: 11 August 2009
THIS rare breed was among an impressive turnout at the cattle section of the Halifax Agricultural Show. More than 150 animals were shown by 43 exhibitors � including standout White Park cow Freiya.

David Graveston, who was showing her, said: "She's 11 and a half years old � but she looks good for her age. White Parks are the oldest native breed in the country, and they are an endangered species as well."

There are only about 450 breeding adults in the UK, he said � 35 of which are part of his herd at his family's Park House Farm in Lancashire.

Mr Graveston, who was at the show with 16-year-old daughter Catherine, said: "We've only had the herd three years, so we've never really shown any before."

David Hamer, cattle section secretary, said it was a first for the show, too.
He said: "We've never seen this breed here at Halifax before."

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Did You Know? Cash for Clunkers $ Taken from Alternative Energy Stimulus Dollars

In the midst of this really bad economy, at least corn prices have backed off their record highs, though how much that's reflected in the price of a bag of feed at your local feed store is quite variable. Once a higher price point is reached, it takes a while for the retail products to see a matching decline, if ever. While I don't feed corn to my cattle, I'm very aware of how the rising price of corn and other grains used in ethanol production has negatively impacted the value of livestock in the USA.

One possible hint of relief from the disastrous impact of increasing corn ethanol production is the growing research and ingenuity in designing electric cars, and getting our vehicles and machinery out of the lead acid battery dark ages (Lead-acid batteries were invented in 1859 by French physicist Gaston Plant�.) Also a possible source of relief from dependence on ethanol and fossil fuels is solar energy.

These collective alternative energy areas received much play in the days of the last presidential campaign. Theoretically, we now have an administration and Congress that has provided for the subsidy of these expensive new technologies (In most of Europe, the government has subsidized alternative energy growth with great success.) However, of the mere $6 Billion or so that was designated for alternative energy in the Trillion Dollar Stimulus Bill, Congress now proposes to riddle the original concept with red tape and wrinkles, and even worse they propose to take ~$2 Billion dollars of the $6 Billion, and divert those monies to the Cash for Clunkers money pit (IMO). Where is the logic there? I've not even noticed this focused on in the news!

Alternative energy companies are a natural to put folks back to work in places like Michigan where solar companies are already positioned and there is a ready labor force for production of solar panels and batteries, etc... Yet, this piddling bit of $6 Billion dollars for alternative energy has not only been NOT disbursed, it is now in danger of being given away to a program that pulls money out of your pocket and straight into the pocket of the automotive industry. In no way does this help the USA get off the ethanol track and put our corn back to use as Food for ourselves and our livestock.

August 10th Credit Suisse Alternative Energy Report:
Solar US market: Developments in the last week diminish the positive impact of the DOE's loan guarantee program for commercially viable solar PV technologies. There is a possibility that only ~$750mm is available to cover credit subsidy costs for commercially proven technologies (versus $6bb we thought 3 months ago). $2bb from the $6bb allocated for DOE loan guarantee program could be diverted to "cash for clunkers.�

Ethanol crush spreads have strengthened over the past few months, driven by lower natural gas and corn prices plus stable ethanol prices. Ethanol production volumes have been kept in check, helping to support ethanol pricing. Cash margins for ethanol producers have again turned positive.

Follow this link for the full Credit Suisse comments and analysis regarding the Cash for Clunkers ripping off the Alternative Energy sector.

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You Can Make Dairy Free Pudding

I've tried it, so don't bother...you cannot substitute a non-dairy milk for the milk called for on the box of Jell-O® pudding. It doesn't "set".

But here's a recipe to try using Silk Soymilk, a staple in our house.

Sure, it's not as easy as mixing up some pudding using the powder from the box, but those of us who cook allergy-friendly foods are used to that, right? Happy cooking!

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Mothers of Food Allergic Children Speak Up

Check out this six-part series of four mothers who have food allergic children. Part of a roundtable discussion with ABCNews Health, the moms talk about warning signs, coping, convincing others, school and special events, guilt and hurt and the bright side.

Those of us who deal with food allergies every day will really relate to what these women talk about. There may be a section or two that you may want to forward to a grandparent, baby-sitter or teacher. It sometimes help to have others back up your message.

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The Economics of AI Breeding vs. Natural Breeding in Beef Heifers

Suggested Guidelines for Beef Heifer Selection

**Moderate frame & milk - 425 lbs at Weaning, 600 lbs at Yearling, 700 lbs at breeding, Frame Score of 4
**Large frame & milk - 500 lbs at Weaning, 750 lbs at Yearling, 875 lbs at breeding, Frame Score of 5

"The University of Minnesota maintained records and summarized the net profit or loss for heifers sold during a developmental period during a three-year period. Heifers culled on the basis of pelvic area, average daily gain, reproductive tract scores, disposition, or structural soundness at the time of the prebreeding exams and finished in a feedlot had a 3-year average net profit of $9, whereas heifers diagnosed as nonpregnant shortly after the breeding season were sold for a net loss of $86. The loss for pregnant heifers that were then diagnosed nonpregnant after wintering on native pasture and sold at a sale barn was $133."


"These figures indicate the importance of identifying heifers that will not breed during the breeding season and culling those heifers before they become an economic liability. Heifers that were diagnosed pregnant during the breeding season were allocated to three groups: first-service AI, second-service AI, or natural mating. Average profits were $163 for first-service AI heifers, $139 for second-service heifers, and $83 for heifers naturally mated. These figures take into account all synchronization costs."

"Therefore, the advantage of AI over natural mating is certainly evident from these analyses, but without sound data these results could not have been noticed. In fact, many people would (and still do) shy away from AI because of the initial costs associated with synchronization, management, and an AI technician. Nonetheless, these results would encourage a producer to seriously consider AI, realizing that the profit potential is far greater than just using natural mating.

Net Profit or Loss Associated with the Sale of Heifers at Various Stages of Reproduction . . . follow the link in the article title above for the remainder of the cost analysis provided by this Cattle Network article.

Source: Steve Boyles OSU Extension Beef Team

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Pending Legislation That Will Impact the Family Farm and Rural Landowners

The Texas and Southwestern Cattle Raisers Association (TSCRA) email update yesterday included a call to members to contact their Congressman during this August recess to express their Support and Opposition to critical legislation that will have a huge impact on our economic lives as cattle raisers. I've included links where I could find them, to the actual text of the bills at issue. Perusing the actual text of the bills is enlightening, and something I think we all should do more often in these days of minimal debate and rapid passage of bills which will effect our lives in both Texas and the USA.

SUPPORT

The Affordable Food and Fuel for America Act ". . .would phase out government subsidies for corn-based ethanol over five years and promote the commercial development of second generation biofuels. This legislation would force corn-based ethanol to become commercially viable without the assistance of government dollars and eliminate competition with other commodities that use corn"

In 2008, I blogged on the devastation that I percieve has been and will continue to occur in the USA as a result of the government's blind and dumb subsidy of corn ethanol. Not only is it forever changing the landscape and air quality of states such as Nebraska and Minnesota, it is forever changing the economics of our food supply. In particular to cattle raisers, it has increased the input cost of feedlots to a point of zero profitability at times, and thus the value of our feeder calf crops at market is reduced.

The Family Farm Preservation and Conservation Estate Tax Act(couldn't find a direct link to this bill) ". . .would exempt working farm and ranch land from the death tax, as long as the land is kept in production agriculture. The bill also provides estate tax relief for land under qualified conservation easements." I could find no link to the text of this bill, instead I found references to it being from the 2007/2008 legislative sessions. TSCRA's summation of it's benefits to the continuation of family farms, rather than their liquidation due to death, makes it clear this is a bill we should all want passed.

OPPOSE

The Clean Water Restoration Act ". . .would expand federal control over all wet areas within Texas including stock tanks, drainage ditches, ponds, small and intermittent streams, creek beds, playa lakes and mud holes." The impact of this legislation on every day life in rural America is boundless, and would mire the average family farm, the average hunter or fisherman, in red tape and legalities that will forever change our historical and current concept of private land ownership and freedom to live as we wish on our land.

The American Clean Energy and Security Act (the Cap & Trade Bill) ". . .will drastically increase the costs of fuel, electricity, feed, fertilizer, equipment and other production costs necessary to run a successful ranching business. The costs to ranchers far outweigh any benefits this legislation offers."

I absolutely need to read and try to understand for myself the impact of this bill. It is somehow still shrouded in mystery to me despite my obsession with the news. One has the sense that it is the ultimate boogey-man of bills, without even understanding the actual mechanics of its impact on our economy today and in the future. One thing that is abundantly clear, is major corporations such as General Electric stand to benefit hugely from the passage of this bill.

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The Misconceptions of Food Allergy

In a news release from the American College of Allergy, Asthma and Immunology, Dr. Ruchi S. Gupta revealed that an online survey of 2148 U.S. adults shows many misconceptions about food allergy.

More than 66% of those surveyed believe that a daily medicine can be taken to prevent a food allergy reaction.
Nearly half of the respondents said there is a cure for food allergy.
Over 40% said that food allergy reactions could be prevented by means other than strict avoidance.

Hmmm...we're not doing a very good job of educating others about food allergy. These people are our teachers, principals, nurses, grandparents, bus drivers, neighbors, babysitters, coaches, scout leaders. Many of them are not getting it and that can be dangerous to our children.

Take every opportunity to inform others of the facts:

There is no cure for food allergy.
There are no medicines available to prevent a food allergy reaction.
Avoidance of the food is the only way to prevent a reaction.

Read the full news article here.

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Back to School With Food Allergies

Back to school is on my mind as we enter the final month of summer vacation. I plan to request a 504 plan for my FA 4th grader as I was unhappy with the communication (lack of) related to the Healthcare Plan we used last year. Anyone have any experience with 504 Plans for food allergy?

Also, take a look at Alison's all-inclusiveBack to School Tips for Gluten-Free and Allergy -Free Kids. It's a great checklist, especially if you're sending your FA child to school for the first time.

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Food Allergy Quiz

Check out this true/false quiz from ACAAI (American College of Allergy, Asthma and Immunology). My readers may find it fairly elementary, but I think it would make for some great talking points with grandparents and older food allergic children.

Did any of the questions stump you? I got number 6 wrong. I knew that exercise could lead to anaphylaxis, but I didn't realize the food allergy link. Always learning...

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On the Road

For the next two weeks my wife and I will be on the road in Japan, meeting our 16 year old daughter in Japan, where she's spent the summer in intensive Japanese language study. My blog entries will be episodic but I'll remain connected via my 3G Blackberry. I'll be giving a lecture at Kyoto University but most of the trip will be seeing a side of traditional Japan that most tourists will not see.

We'll celebrate our 25th wedding anniversary in temples with a history of bringing good luck to relationships.

We'll make traditional Japanese rice confections in a small shop in the Gion.

We'll eat blue-green Tofu, okara in yuba handmade in a 10 seat restaurant on the banks of the Kamagawa.

We'll join a sake maker on the roof of his factory for a view of the bonfires of Obon lit on the mountains around Kyoto.

We'll shop for mountain yam and daikon pickles in the mile long farmers market hidden in the arcades of Teramachi.

We'll drink Green Tea at Uji in the oldest teashop on the planet.

We'll stroll Zen gardens in Ohara north of Kyoto.

We'll explore the temples west of Kyoto and then board a small boat to ride the rapids back to the city

We'll travel to Miyajima and kayak the Inland Sea and visit shrines only accessible by boat built by fisherman and pirates.

I'll play the Shakuhachi from the top of Mt. Misen near the fire that Kobo Daishi lit in the 1600's and is still burning.

During our entire trip, we'll stay in small traditional Japanese inns - Ryokan.

Normally, I would go climbing in the Eastern Sierra for my yearly August time away, but the opportunity to travel with my wife and daughter in Japan is a very special opportunity. My daughter heads off to college in 2 more years, so we'll treasure the time with her as our Japanese interpreter and sometimes tour guide, given her experience spending the entire summer there.

I'm hoping the new few weeks are quiet in Washington, as HHS moves to regulation writing mode. You can be sure I'll keep you informed via my blog and Twitter.

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