Warung Bebas

Senin, 04 Februari 2013

Pemberian Makanan Bergizi Anak Pra Sekolah

Jika Anda memintanya, seorang anak 4-6 tahun mungkin mau mencoba makanan-makanan baru – khususnya jika Anda memakan makanan yang sama. Tidak ada yang salah dalam menghidangkan makanan yang disukai anak Anda, namun pastikan untuk menghidangkan beragam makanan yang memperluas selera anak Anda. Jangan jatuh ke dalam perangkap menyediakan makanan yang berbeda khususnya untuk anak Anda – sebelum Anda mengetahuinya, Anda akan menyediakan dua kali makan malam setiap hari. Lebih baik menyediakan serangkaian makanan, meskipun anak Anda kadang-kadang menolak memakan sesuatu yang ada di atas piring. Normal menginginkan anak Anda makan pada waktu makan malam, namun juga penting untuk mengetahui bahwa tidak makan satu kali tidak akan membahayakan anak yang sehat. Bila anak Anda menolak memakan makanan atau kudapan yang biasa dan kemudian kembali ke dapur setelah makanan habis untuk minta sesuatu buat dimakan, katakan kepadanya secara menyenangkan bahwa makanan atau kudapan berikutnya akan disediakan pada waktu yang biasa.
Anak-anak tidak akan kelaparan dalam waktu yang singkat itu dan akan belajar memperhatikan jadwal makan mereka.
Ini adalah waktu yang baik untuk mengajarkan kepada anak Anda bagaimana menghidangkan makanan untuk dirinya sendiri dan menggunakan keterampilan-keterampilan bahasa seperti ‘tolong’ dan ‘terima kasih’ ketika minta makanan. Anak-anak 4-6 tahun juga senang membantu di dapur dan membereskan meja.

Makanan yang cocok untuk anak 4-6 tahun:

  • Ganti makanan-makanan bergizi rendah dan berkalori tinggi (kue kering, permen, keripik dan minuman ringan) dengan makanan-makanan bergizi tinggi
  • Sediakan buah-buahan dan sayur-sayuran mentah (cobalah potongan-potongan tipis zukini, paprika, seledri dan wortel yang disajikan dengan keju lembut, olesan yoghurt atau bumbu kuah selada rendah lemak)
  • Minum jus 100% buah-buahan dan sayur-sayuran asli ketimbang minuman-minuman dan soda-soda buah artifisial tinggi gula dan rendah gizi
  • Simpan persediaan kudapan cepat dan bergizi yang mudah diambil untuk anak-anak yang lapar dan bila Anda kekurangan waktu
  • Berikan zat-zat gizi yang diperlukan dengan menghidangkan buah-buahan, yoghurt dan puding
  • Hindari memberikan makanan pencuci mulut sebagai hadiah atau insentif untuk makan

Membentuk kebiasaan makan sehat seumur hidup:

  • Ajarkan kepada anak Anda bahwa nutrisi dan makanan sehat mempengaruhi pertumbuhan dan kesehatan
  • Semangati anak-anak untuk mencoba makanan-makanan baru.
  • Mengelola pertambahan berat badan dengan menyarankan olahraga dan bukan kegiatan banyak duduk seperti menonton televisi
  • Menggunakan panutan orang terkenal untuk mendorong makan makanan sehat
  • Mengizinkan anak-anak membantu memilih dan mempersiapkan makanan mereka (menyobek selada) dan mempersiapkan tata cara makan (membereskan meja)
  • Membuat jadwal untuk makanan dan kudapan sehari-hari guna membatasi makan sepanjang hari dan mematuhi waktu-waktu makan yang biasa untuk seluruh keluarga.
  • Jadilah panutan yang sebaik mungkin untuk anak-anak Anda
  • Duduklah bersama anak Anda karena anak-anak pada umumnya makan lebih baik bila ada orang dewasa duduk bersama mereka
  • Bersabarlah selalu terhadap anak-anak yang lambat makan dan singkirkan pengganggu seperti televisi, mainan atau kegiatan-kegiatan lain
sumber :  http://abbottmama.co.id/nutrition/preschool

Why Do We Eat? A Neurobiological Perspective. Part VII

Welcome back to the series, after a bit of a hiatus!  In previous posts, we covered the fact that humans eat because we're motivated to eat, and many things can motivate us to eat.  These include factors related to energy need (homeostatic factors), such as hunger, and factors that have little to do with energy need or hunger (non-homeostatic factors).  These many factors are all processed in specialized brain 'modules' that ultimately converge on a central action selection system (part of the reward system); this is the part of you that decides whether or not to initiate eating behaviors.

This will be somewhat of a catch-all post in which I discuss cognitive, emotional, and habit influences on food intake.  Since these factors are not my specialty, I'll keep it brief, but I don't mean to suggest they aren't important.

Food 'Cost'

Read more »

The Story of CPRIT, Part 6: Reactions

There has been a lot of dismay in Texas as all this has become public (with the word "cronyism" being mentioned very frequently). As the Houston Chronicle asked in May:
Why is CPRIT even funding commercial enterprises? Didn't voters expect the bond money to support research?
[Answer: Voters did, and there was no mention of commercialization in the ballot measure. Legislators did get language about commercialization into the enabling legislation, however.]

Newspapers and bloggers have not been happy with what is going on. Nor have some former supporters. Cathy Bonner, a cancer survivor and activist who had worked hard to get the agency established, said succinctly: 
The vision was to make Texas the center for curing cancer. It wasn't to make Texas the center for capitalizing on cancer.

But those in power show few signs of giving ground. After the resignations in October, a joint letter from the governor, lieutenant governor and speaker of the House urged more commercialization:
It is now time for CPRIT to take further steps to fulfill its statutory mission and expedite innovation that will deliver new cancer treatments to patients within three to five years.

In an October appearance at CPRIT, Perry stated:
Since CPRIT's creation, you all have helped lay a sound foundation to establish one of the greatest cancer-fighting tools in human history. The challenge that remains before us is to build on that foundation and finally begin curing cancer once and for all.
As The Cancer Letter tartly observed :
This statement could mean either that (a) Perry doesn’t realize that his claim that Texas has done all the basic science required to proceed to cranking out cancer cures would not gain wide traction among scientists and clinicians, or (b) CPRIT has become precisely what the governor and others in Texas politics want it to be: a pot of public money that can be dispensed for commercial or political purposes.
Interviewed by the Houston Chronicle in January, Perry continued in the same vein
The way that the Legislature intended it was to get cures into the public's area as soon as possible and at the same time create economic avenues (from) which wealth can be created. Basic research takes a long time and may or may not ever create wealth.
Matt Winkler, a member of CPRIT's Scientific and Prevention Advisory Council, last week expressed his opinion to the Austin Statesman that the criticism of commercialization -- Winkler prefers the term "product development" -- was totally on the wrong track. "Continuing to short-change commercialization, Winkler said, comes at the expense of patients because money for basic research is unlikely to benefit patients during the 10-year lifetime of CPRIT. Winkler says lawmakers should insist on more investment in commercialization companies, not less." According to Winkler:
Much of the essential basic research that has given us our fundamental understanding of cancer has been done. The challenge now is to fill in the details and to move this knowledge into the clinic.

Disagreeing strongly with these ways of thinking,Walt Goodpastor, who lost a son to cancer, angrily wrote: 
I don't know where Perry studied economics. But CPRIT's wealth has already been created. It was created by the productive citizens of Texas. What Perry wants to do is transfer that wealth into the pockets of private corporations.
I do not believe the industry is particularly interested in finding true cures. Its business model is based on treating cancer. As in prevention, there is little profit to be made in a cure. Treating cancer provides an ongoing stream of revenue. Curing or preventing cancer would end that revenue stream.
I believe that the most bang for our buck would come from awarding grants to independent individual scientists who are working on promising leads.

And the Houston Chronicle editorialized on January 15:
To get the most cancer-fighting bang for its bucks, CPRIT ought to focus on important research that private companies won't do: the slow, might-not-pay-off basic research that sometimes yields enormous breakthroughs; and research on cheap therapies and prevention measures - stuff that, even if it works beautifully against cancer, won't yield a patentable, profitable drug.
     If there's a high probability that a given line of research will create wealth in a short amount of time, you can bet that a pharmaceutical company will bankroll that project on its own - no government help needed.

Nobel laureates Gilman and Sharp, who had led the walkout, wrote their own editorial, which says in part: 
Texans deserve to hear the truth about cancer. They must understand that miracles will not happen in a short time. Progress will not be made by those who simply proclaim without explanation that they can do better than hundreds of skillfully staffed and well-financed pharmaceutical and biotechnology companies. . .
Reliance on peer review to identify the best science must continue to guide CPRIT in the future. Of course, there are other ways to distribute public funds, but they are worse. 

Ini Dia Video Gameplay God of War Ascension, yang Tersebar di Youtube

Limit Komputer | Ini Dia Video Gameplay God of War Ascension, yang Tersebar di Internet - Kepopuleran Kratos dalam game God of War memang tidak usah diragukan lagi. setelah sukses yang didapatkan dari seri-seri sebelumnya, membuat Sony selaku pengembang game ini, berencena akan merilis seri God of War terbaru yang tak kalah menarik dari seri-seri sebelumnya. kabarnya pihak sony akan merilisnya pada tanggal 12 Maret 2013 Mendatang.

Tetapi saya masih bingung, kenapa game ini memiliki video Gameplay God of War Ascension resmi yang tersebar di youtube ? padahal gamenya saja belum dirilis sampai hari ini. ternyata pihak sony telah merilis versi pendek dari God of War Ascension untuk para tester dan game viewer.



Para tester game ini pun telah mencobanya, kemudian mereka menguploadnya di youtube dengan durasi 31.07. namun dalam video tersebut tidak semua adegan dapat kalian lihat, soalnya para tester memotong sebagian adegan pertarungan.




Selain itu, God of War Ascension bukan merupakan sekuel dari seri-seri sebelumnya, karena pada akhir God Of War III sempat menampilkan video dimana didalamnya terdapat bahwa God of War III adalah seri terakhir dari petualangan Kratos. jadi God of War Ascension bisa dikatakan prekuel dari seri God of War.

The Story of CPRIT, Part 5: A Can of Worms

The publicity engendered by the walkout caused more attention to various aspects of the Cancer Prevention & Research Institute of Texas (CPRIT). This turned up a number of other real or potential issues, as a compliance officer reviewed all past commercialization grants and a state audit was done. (As well, investigations by the Travis County DA and the Attorney General of Texas are ongoing.)

The Dallas Morning News discovered that commercialization awards had been going to companies with connections to Perry and Dewhurst campaign contributors. A CPRIT commercialization award had gone to a firm, Caliber Biotherapeutics, associated with a Dallas businessman who made substantial contributions to the campaigns of Governor Perry and Lieutenant Governor Dewhurst.

When the paper probed about what sort of review scores the commercialization awards had received, it was discovered that one commercialization award, $11 million to Peloton Therapeutics in 2010, had been made with no formal review or scoring of any kind. It was simply placed on the Oversight Committee's agenda by Jerry Cobb, the Chief Commercialization Officer, and approved. Philanthropist Peter O'Donnell, an investor in Peloton, had contributed around a couple of hundred thousand dollars each to Governor Perry and to David Dewhurst. As well, his O'Donnell Foundation had contributed $1.6 million to the CPRIT Foundation. (However, it may have been that O’Donnell bought the Peloton stock after the company was funded, and had transferred the stock to UT Southwestern.)

Jerry Cobb, the Chief Commercialization Officer, resigned in November. Bill Gimson resigned as executive director of CPRIT in December. And a freeze, requested by political officials, was placed on new grants in December.  

Questions were raised about the CPRIT Foundation, which raised private money for CPRIT for various purposes including $609,000 used for supplementation of salaries of CPRIT's top officials, including Dr. Gilman. The Foundation maintained it had no obligation to disclose donors or file tax returns, but after pressure, names of donors were revealed. These included donations from pharmaceutical and drug development companies, and from people associated with companies that had received CPRIT awards.

And a state audit came out in late January, raising still further questions. The state audit was very critical of  a number of things, including a third grant that had been approved without proper review, for $25.2 million, to CTNeT (Statewide Clinical Trials Network of Texas, "a non-profit company whose purpose is to develop an efficient cancer clinical trial network for evaluating therapeutic drugs and treatments for cancer in adults and children"). The award was made before the company was formed to M.D. Anderson, and then the money was transferred to CPRIT once the company was established. The executive director of the O'Donnell Foundation, mentioned above, was the registered agent for CTNeT rather than anyone from M.D. Anderson. Also, constitutional requirements about matching funds were not being complied with, and funds were dispersed for purposes not appropriate for a research grant.

Six months after the Games by Professor Laura McAllister

After a memorable 2012 comes a new year of challenges in Welsh sport. Professor Laura McAllister explains how Wales is focussing its legacy effort.



Six months on since the floodlights were turned off at the spectacular Olympic Park in Stratford and I am keen to reflect on the progress that has been made towards achieving our Vision for Sport in Wales.
I am genuinely pleased with many of the reports of the surge of interest at our grassroots clubs across the country. You can find evidence of this from Welsh Gymnastics (20%) and Swim Wales (39%) who have both seen big increases in their membership levels in the last quarter of the year (link to hot topic story). Pleasingly, reports of more boys wanting to take up gymnastics shows the power of how watching their new heroes medal in London can instantly transfer to interest in our communities.

Other sports - athletics (12%), cycling (24%), Boxing (33%) and hockey (32% of clubs) – have also reported significant increases, while we have also been impressed by other sports like canoeing who have told us of the 30 new clubs that have been established in Wales, as well as the big numbers now on Welsh Sailing’s learn to sail programme, and the legacy plans in disability sport such as their focus on the inSport programme.
On the other hand, there are sports that have not seen the same initial growth, which is a cause for great disappointment. Why have some sports and clubs managed to prepare and market themselves so well and held the door open to new participants, while in other sports the unique opportunities presented by London 2012 would seem to have been lost?

Thankfully, the overall picture is positive but, as we develop our new Partner Investment Principles, let me be clear that it is those who have shown they can be successful by planning and boosting the numbers of young people involved in sport who will be looked on as strong and reliable partners in achieving our vision when we have to make difficult funding decisions.

We must always remember that public funding is a privilege and not a right, and we will look at every penny that we invest in Welsh sport to ensure that we make the most of the resources we have to get every child hooked on sport and to punch above our weight on the elite stage.
As a Board Member of UK Sport I know how difficult decisions on funding can be. The recent funding announcements leading up to the next Olympics and Paralympics in Rio 2016 give an indication of the culture which exists in sport. Those who show they can achieve are rewarded, while those who do not meet expectations and targets will not be allowed to drift.

This attitude is something our Board at Sport Wales are fully behind as we move forward over the coming months and years, particularly as we have another fantastic opportunity to promote sport with the Commonwealth Games in 2014.
Returning to the grassroots again, I am still slightly concerned at the lack of evidence from some partners on planning for our workforce needs in Wales. It is all well and good coming up with targets and ambitions for increases in participants, but this must be married with detailed planning for coaches, volunteers and the paid workforce to support it.

We have seen positive gains in our work to develop young leaders and to support elite coaches, just for two examples. Around 1700 Young Ambassadors have been recruited across our primary and secondary schools, colleges and universities this year to act as sporting role models, while working in partnership with Sports Leaders UK and several governing bodies we have trained around 6,000 young people in leadership skills to be able to deliver and assist sporting opportunities in schools and communities.

On the high performance side, we have nine elite or aspiring coaches part of the UK-wide Inspire/Aspire coach mentoring programme – including Welsh Gymnastics coach Olivia Bryl, who was recently named Young Coach of the Year at the UK Coaching Awards.

But until the workforce agenda is a regular item at every board meeting, and prominent in every business plan for partners, then we are missing the opportunity for real progress. Make no mistake, Sport Wales will be scrutinising our own work in this area too, particularly as we look at how we can support the grassroots so that they have access to information, support and funding when they need it. At the moment, research is showing that this knowledge and support is the exception rather than the rule.

More than ever, the last six months have focused on the importance of schools and the whole education sector to our work for sport.

You will all know that we now have a Joint Ministerial Task and Finish Group which will be reporting on its work later in the year and again highlighting the vital importance of PE and physical literacy.
I am very much of the opinion that a school with sport at its heart is a high performing school.
And on the subject of evidence, we are now making final preparations for our biennial School Sport Survey.

To achieve the largest survey of school pupils in Wales in 2011 was very encouraging for us, particularly leading up to 2012. But there were also many local authorities and schools who did not get the appropriate data because they did not get sufficient response rates.
It is a fair question to ask: how they can plan to grow, resource and invest without this detailed picture of sport for young people?

The level of data collected through the School Sport Survey in 2013 will allow us to make considerable headway in understanding what is happening ‘on the ground’ and understanding pupils’ attitudes towards sport and physical recreation. It will also inform decisions we make on planning, which is why it is so important for our partners – particularly in local authorities – as we look to build on the major events in London in 2012 and Glasgow 2014.

More than ever, we will be using this evidence-based research to influence the decisions we make on our resources – as I’ve touched on above.

2013 will see us continue to push forward with an added emphasis on women and girls, ensuring child poverty and sport is at the fore of our work and making inroads into getting other under-represented groups participating in sport. Sports plans without these areas included are not sports plans that are meeting the needs of all of our citizens.

Finally, I want to end this latest blog with a word on Dr Huw Jones, our Chief Executive who has just announced his intention to retire from his position later this year.

Huw has made such an incredible impact on sport during his time at Sport Wales, including 15 years as Chief Executive, and the fruits of his hard work, enthusiasm and professionalism will be a lasting legacy. Huw has been a superb colleague to me and to you all, and he will be a hard act to follow. On all of your behalfs, I would like to thank Huw for his fantastic work for Welsh sport.

But this is an opportunity for us too and we look ahead to the recruitment process for a new CEO at a time when Sport Wales’s stock is sky high and the profile of sport in Wales is so positive. I will have more updates on progress as we continue to find the right person with the energy and drive to continue to propel us towards our Vision for Sport in Wales.

Sport has never had such a high profile, but with that comes even greater scrutiny.  Huw has steered the organisation through significant cultural change, setting a new ambitious vision and targets along the way. I can reassure you all that we will not be diverted from the strategic direction that has been put in place, for the simple reason that it is the right one.

Mae’n chwe mis ers diffodd y llifoleuadau yn y Parc Olympaidd trawiadol yn Stratford ac rydw i’n awyddus i edrych ar y cynnydd sydd wedi cael ei wneud tuag at gyflawni ein Gweledigaeth ar gyfer Chwaraeon yng Nghymru.
Rydw i wir yn falch o glywed am y cynnydd yn y diddordeb yn ein clybiau ni ar lawr gwlad ar hyd a lled Cymru. Mae tystiolaeth o hyn i’w gael gan Gymnasteg Cymru (20%) a Nofio Cymru (39%), dau gorff sydd wedi gweld cynnydd mawr yn lefel eu haelodau yn ystod chwarter olaf y flwyddyn (link to hot topic story). Ac mae’n bleser clywed yr adroddiadau am fwy o fechgyn eisiau cymryd rhan mewn gymnasteg, sy’n dangos bod gwylio eu harwyr newydd yn cipio medalau yn Llundain yn gallu trosglwyddo’n uniongyrchol yn ddiddordeb newydd yn ein cymunedau ni.
Mae chwaraeon eraill - athletau (12%), beicio (24%), bocsio (33%) a hoci (32%) – i gyd wedi cofnodi cynnydd sylweddol hefyd. Ac mae sawl camp wedi gwneud argraff fawr, fel canŵio, sydd wedi dweud wrthym am y 30 o glybiau newydd sydd wedi cael eu sefydlu yng Nghymru, yn ogystal â’r nifer fawr sy’n rhan o raglen dysgu hwylio Hwylio Cymru yn awr, a’r cynlluniau treftadaeth mewn chwaraeon anabledd, fel eu ffocws ar y rhaglen inSport.                
Ar y llaw arall, mae yna chwaraeon nad ydynt wedi gweld yr un twf, sy’n siom fawr i ni. Sut mae rhai chwaraeon a chlybiau wedi llwyddo i baratoi a marchnata eu hunain mor dda, ac wedi agor y drws i gyfranogwyr newydd, ac eto mewn chwaraeon eraill mae’r cyfleoedd unigryw a gyflwynwyd gan Lundain 2012 wedi’u colli yn ôl pob tebyg?   
Rhaid diolch bod y darlun cyffredinol yn un cadarnhaol ond, wrth i ni ddatblygu Egwyddorion Buddsoddiad Partner newydd, gadewch i mi ddatgan yn glir mai’r rhai sydd wedi dangos eu bod yn gallu bod yn llwyddiannus drwy gynllunio a rhoi hwb i nifer y bobl ifanc sy’n cymryd rhan mewn chwaraeon fydd yn cael eu hystyried fel partneriaid cryf a dibynadwy ar gyfer cyflawni ein gweledigaeth pan fydd raid i ni wneud penderfyniadau cyllido anodd.
Mae’n rhaid i ni gofio bob amser mai braint, ac nid hawl, yw arian cyhoeddus, a byddwn yn edrych yn fanwl ar bob ceiniog y byddwn yn ei buddsoddi mewn chwaraeon yng Nghymru, er mwyn sicrhau ein bod yn gwneud yn fawr o’r adnoddau sydd gennym ni i gael pob plentyn i wirioni ar chwaraeon ac i ragori ar ein disgwyliadau ar y llwyfan elitaidd.
Fel aelod o Fwrdd UK Sport, rydw i’n gwybod pa mor anodd yw gwneud penderfyniadau am gyllid. Mae’r cyhoeddiadau cyllido diweddar sy’n arwain at y Gemau Olympaidd a Pharlympaidd nesaf yn Rio 2016 yn arwydd o’r diwylliant sy’n bodoli mewn chwaraeon. Mae’r rhai sy’n dangos eu bod yn cyflawni’n cael eu gwobrwyo ac ni fydd y rhai nad ydynt yn bodloni’r disgwyliadau a’r targedau’n cael llithro o’n gafael.          
Mae ein Bwrdd ni yn Chwaraeon Cymru’n gefnogol i’r agwedd hon wrth i ni symud ymlaen yn ystod y misoedd a’r blynyddoedd nesaf, yn enwedig gan fod gennym ni gyfle ffantastig arall i hybu chwaraeon gyda Gemau’r Gymanwlad yn 2014.
Gan ddychwelyd at lawr gwlad unwaith eto, rydw i dal yn poeni braidd am y diffyg tystiolaeth gan rai partneriaid o gynllunio ar gyfer anghenion ein gweithlu yng Nghymru. Mae meddwl am dargedau ac uchelgais ar gyfer cyfranogiad yn dderbyniol iawn, ond mae’n rhaid priodi hyn â chynlluniau manwl ar gyfer hyfforddwyr, gwirfoddolwyr a’r gweithlu di-dâl, i’w cefnogi.  
Rydyn ni wedi gweld cynnydd cadarnhaol yn ein gwaith ni i ddatblygu arweinwyr ifanc ac i gefnogi hyfforddwyr elitaidd, fel dwy enghraifft. Mae tua 1700 o Lysgenhadon Ifanc wedi cael eu recriwtio eleni yn ein hysgolion cynradd ac uwchradd ni, ac yn y colegau a’r prifysgolion, i weithredu fel modelau rôl mewn chwaraeon. Hefyd, gan weithio mewn partneriaeth â Sports Leaders UK a sawl corff rheoli arall, rydyn ni wedi hyfforddi tua 6,000 o bobl ifanc mewn sgiliau arwain, i allu cyflwyno a helpu gyda chyfleoedd chwaraeon mewn ysgolion a chymunedau.                  
O ran perfformio ar lefel uchel, mae gennym ni yn awr hyfforddwyr elitaidd, neu hyfforddwyr sy’n anelu at fod yn rhai elitaidd, ar raglen mentora hyfforddwyr Inspire/Aspire y DU – gan gynnwys hyfforddwraig Gymnasteg Cymru, Olivia Bryl, a gafodd ei henwi’n ddiweddar yn Hyfforddwr Ifanc y Flwyddyn yng Ngwobrau Hyfforddi’r DU.
Ond hyd nes bod agenda’r gweithlu yn eitem reolaidd ym mhob cyfarfod bwrdd, ac yn amlwg ym mhob cynllun busnes gan bartneriaid, yna rydyn ni’n colli cyfleoedd i sicrhau cynnydd go iawn. A chofiwch, bydd Chwaraeon Cymru’n edrych yn fanwl iawn ar ein gwaith ni ein hunain yn y maes hwn hefyd, yn enwedig os ydyn ni am edrych ar sut gallwn ni gefnogi chwaraeon ar lawr gwlad, fel bod ganddynt wybodaeth, cefnogaeth a chyllid pan mae arnynt eu hangen. Ar hyn o bryd, mae’r gwaith ymchwil yn dangos mai eithriad yw’r wybodaeth a’r gefnogaeth hon, yn hytrach na rheol.                        
Yn fwy nag erioed, mae’r chwe mis diwethaf wedi canolbwyntio ar bwysigrwydd ysgolion a’r sector addysg yn ei gyfanrwydd i’n gwaith ni dros chwaraeon.
Rydych chi i gyd yn gwybod bod gennym ni Grŵp Gorchwyl a Gorffen ar y cyd â Gweinidogion yn ei le erbyn hyn, a bydd yn adrodd yn ôl ar ei waith yn nes ymlaen eleni.     
Rydw  i o’r farn bod ysgol sy’n rhoi lle canolog ac allweddol i chwaraeon yn ysgol sy’n perfformio ar lefel uchel.
Ac wrth gyfeirio at dystiolaeth, rydyn ni ar hyn o bryd yn gwneud y paratoadau terfynol ar gyfer yr Arolwg yr ydym yn ei gynnal bob dwy flynedd ar Chwaraeon Ysgol. 
Roedd sicrhau’r arolwg mwyaf ar ddisgyblion ysgol yng Nghymru yn 2011 yn galonogol iawn i ni, yn enwedig yn ystod y cyfnod yn arwain at 2012. Ond hefyd roedd llawer o awdurdodau lleol ac ysgolion na chawsant y data priodol am nad oeddent wedi sicrhau cyfraddau ymateb digonol.         
Mae’n gwestiwn teg i’w ofyn: sut gallant gynllunio i ehangu, darparu adnoddau a buddsoddi heb y darlun manwl yma o chwaraeon ar gyfer pobl ifanc?
Bydd lefel y data a gaiff eu casglu drwy Arolwg 2013 ar Chwaraeon Ysgol yn galluogi i ni wneud cynnydd sylweddol o ran deall beth sy’n digwydd ‘ar y tir’, a deall agweddau disgyblion tuag at chwaraeon a hamdden gorfforol. Bydd hefyd yn sail i’n penderfyniadau ni ar gynllunio, a dyna pam mae mor bwysig i’n partneriaid ni – yn enwedig mewn awdurdodau lleol – wrth i ni edrych ar adeiladu ar y digwyddiadau mawr yn Llundain yn 2012 a Glasgow 2014.
Yn fwy nag erioed, byddwn yn defnyddio’r ymchwil yma sy’n seiliedig ar dystiolaeth i ddylanwadu ar y penderfyniadau rydyn ni’n eu gwneud am adnoddau – fel rydw i wedi’i grybwyll uchod.
Yn 2013 byddwn yn dal ati i wthio ymlaen gyda phwyslais cryfach ar ferched a genethod, gan sicrhau bod tlodi plant a chwaraeon yn cael lle blaenllaw yn ein gwaith ni hefyd, a sicrhau cynnydd o ran cael grwpiau eraill a dangynrychiolir i gymryd rhan mewn chwaraeon. Nid yw cynlluniau chwaraeon nad ydynt yn cynnwys y meysydd hyn yn gynlluniau chwaraeon sy’n diwallu anghenion ein dinasyddion ni i gyd.       
Yn olaf, fe hoffwn i orffen y blog diweddaraf yma gyda gair am Dr Huw Jones, ein Prif Weithredwr ni sydd newydd gyhoeddi ei fwriad i ymddeol o’i swydd yn nes ymlaen eleni.            
Mae Huw wedi cael effaith anhygoel ar chwaraeon yn ystod ei gyfnod yn Chwaraeon Cymru, gan gynnwys 15 mlynedd fel Prif Weithredwr, a bydd ffrwyth ei waith caled, ei frwdfrydedd a’i broffesiynoldeb yn dreftadaeth barhaus. Mae Huw wedi bod yn gydweithiwr rhagorol i mi ac i bob un ohonoch chi, a bydd yn anodd llenwi’r bwlch mae’n ei adael ar ei ôl. Ar eich rhan chi i gyd, hoffwn ddiolch i Huw am ei waith rhagorol dros chwaraeon yng Nghymru.
Ond mae hwn yn gyfle i ni hefyd edrych ymlaen at y broses recriwtio ar gyfer Prif Swyddog Gweithredol newydd, ar adeg pan mae Chwaraeon Cymru yn uchel iawn ei barch a phroffil chwaraeon yng Nghymru mor gadarnhaol. Bydd gen i fwy o newyddion am y cynnydd wrth i ni barhau i chwilio am y person mwyaf priodol; person sydd ag egni a brwdfrydedd i barhau i’n symud ni tuag at ein Gweledigaeth ar gyfer Chwaraeon yng Nghymru.
Dydi chwaraeon erioed wedi mwynhau proffil mor uchel, ond ynghlwm wrth hynny mae mwy fyth o graffu. Mae Huw wedi llywio’r sefydliad drwy newid diwylliannol sylweddol, gan bennu gweledigaeth a thargedau newydd uchelgeisiol ar hyd y daith. Gallaf eich sicrhau chi na fyddwn yn gwyro oddi wrth y cyfeiriad strategol sydd wedi cael ei roi yn ei le, am y rheswm syml mai hwn yw’r un iawn.                


February Blues


Is it just me....but don't you just look forward to the runs where you don't have to be all bundled up.
Ok, so I have decided that I would run all this winter in shorts as I did last year. But let me tell you, that there  have been more -20 wind chill days in January as there was all last year. So next year when I have this brain storm again, please remind me to read this entry on the blog.

Wednesday January 30th Komoka night run was in +14 degree weather with the trail being one part river and the one part she sucking mud. So you ended up wet and coated in thick mud, and yes I loved it.
The following morning on my way to the gym, there was 10 cm of snow and a temperature of -5 and falling.

I was thinking of having some sort of trail runners get together so we can tell tale tails of former greatness as well as sipping on a beverage some place. Just something to celebrate half way through winter or something. I will keep you posted.

American Medical News: Dangers of "EHR Sloppy and Paste"

An American Medical News (amednews.com) article by Kevin O'Reilly appeared entitled "EHRs: 'Sloppy and paste' endures despite patient safety risk."

It addresses the dangers of a common feature of EHR's used recklessly:  copy-and-paste.

EHRs: “Sloppy and paste” endures despite patient safety risk

Copying and pasting information is common within EHRs, but the practice sometimes can lead to confusion and endanger patient care.

By Kevin B. O'Reilly, amednews staff. Posted Feb. 4, 2013.

During the winter holidays, a patient at Yale-New Haven Hospital in Connecticut had a large pressure ulcer with an abscess. A surgical intern made a note in the patient’s electronic health record that said, “Patient needs drainage, may need OR.”

The problem? The same note appeared for several consecutive days, even after a surgical team successfully drained the abscess. The intern had copied and pasted the previous day’s note, but failed to appropriately update it to reflect the fact that the drainage was done. The note confused the consulting infectious disease team and nearly led to an unneeded change in the patient’s antibiotic regimen.

That's somewhat ironic I performed my postdoc at Yale Center for Medical Informatics where we discussed, among other issues, potential drawbacks of badly-designed or implemented EHRs.   Unfortunately, I hear from people who've left that the Center is relatively marginalized these days with respect to influence.  (Actually, the marginalization goes way back; if they'd listened to us in the mid 1990's they might have avoided this multimillion-dollar federal lawsuit for billing fraud.)

Mr. O'Reilly continues:

The practice of carelessly copying and pasting previous information, often dubbed “sloppy and paste,” is on the decline at Yale-New Haven Hospital but is widespread across medicine and can lead to mix-ups that sometimes harm patients, research shows.

“It’s especially problematic when you have multiple teams taking care of the patient and we’re communicating through the chart, which happens very often nowadays because physicians don’t see each other as often as we used to,” said Dr. Horwitz [General internist Leora Horwitz, MD], assistant professor of medicine at Yale University School of Medicine. “We do rely on the chart in many cases, and it can lead to genuine confusion.”

When you rely on an information system and the information system contains incorrect information (for whatever reason), patients are put at risk.  That the systems are implemented without simple controls on copy-and-paste (such as permanently embedding substantive metadata in the output) is a significant flaw.

From Sec. II of Aguilar v. Immigration and Customs Enforcement Div. of U.S. Dept. of Homeland Sec. 2008 WL 5062700 (S.D.N.Y. Nov. 21, 2008), available at this link:

... Substantive metadata, also known as application metadata, is “created as a function of the application software used to create the document or file” and reflects substantive changes made by the user. Sedona Principles 2d Cmt. 12a; Md. Protocol 26. This category of metadata reflects modifications to a document, such as prior edits or editorial comments, and includes data that instructs the computer how to display the fonts and spacing in a document. Sedona Principles 2d Cmt. 12a. Substantive metadata is embedded in the document it describes and remains with the document when it is moved or copied. Id

Microsoft Word's "Track Changes" feature is an example of substantive metadata being displayed.

The available stats on the phenomenon are of great concern:

... A study in February’s Critical Care Medicine found that copying and pasting is the rule in EHRs rather than the exception.

Using a software program that can detect identical matching word sequences, researchers examined the assessment-and-plan portions of more than 2,000 progress notes for 135 patients created by 62 residents and 11 attending physicians working in a Cleveland medical intensive care unit. For the residents, 82% of the notes contained 20% or more copied text, while 74% of attending doctors’ notes also exceeded that rate of copying and pasting.

A similar study in the January-February 2010 issue of Journal of the American Medical Informatics Assn. found a copy-and-paste rate of 78% in sign-out notes generated by internal medicine residents. The rate of copied text in progress notes was 54%, the study said.

An example of physician embarrassment at relaying quite outdated information to a patient's family due to repeated note-copying was cited, and then a case of actual harm:

... Other times, patients are harmed. In a July/August 2007 case study in AHRQ WebM&M, an online patient safety journal, William Hersh, MD, described the case of a 77-year-old woman hospitalized for diarrhea and dehydration after chemotherapy.

An intern noted that the patient would receive heparin to prevent venous thromboembolism. The note was copied and pasted for four days in a row and signed by a resident and an attending physician, who appeared to believe the heparin had been ordered and administered. Ultimately, the patient was discharged without ever receiving the preventive medicine and two days later was rehospitalized and diagnosed with a pulmonary embolism. Only then did physicians realize the patient never got the correct prophylaxis.

“The problem is getting worse now with the rise of EHRs,” said Dr. Hersh, professor and chair of the Dept. of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University in Portland.

The American Medical News article continues:

HHS OIG (Office of the Inspector General) announced that it plans to review multiple EHR notes for the same patient by the same physician to see whether doctors are copying and pasting the identical note from visit to visit. The practice is sometimes called cloning and could be implicated in fraudulent coding and billing practices.

That might serve to partially stem the process, but the HHS OIG's resources are not infinite.

The article concludes:

John Halamka, MD, calls for a more radical fix.

“The way we document in medicine has grown up over decades for medical reasons, for billing, for medical-legal justification,” said Dr. Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston. “You wind up with 17 pages of replicated and duplicated and challenging-to-read documentation. I propose we blow up the way we do documentation altogether and replace it with a Wikipedia-like structure.”

Such an approach would allow physicians to edit the progress note collaboratively, just as the popular open-source encyclopedia is updated. Dr. Halamka hopes to pilot-test the idea within the next year. “With that concept, you wouldn’t ever really need to copy and paste,” he said.

An interesting concept and experiment.  My questions:

  • Do we first rigorously investigate and understand the causes of the copying, i.e., cryptic and difficult-to-use data entry methods that significantly slow clinicians down?  
  • Do we get informed consent from patients for the experiment?
  • If so, what do we tell them?  We are conducting an experiment in charting, risk unknown, to solve cheating and risks due to poorly-designed EMRs?
  • Would not simpler solutions (such as the embedded-metadata identifiers indicating text has been copied as I described above)  be important to implement first, before experimenting with medical documentation?

That said, I believe the practice - an unintended and potentially adverse side effect of a new information technology, HIT - must stop.  I think Mr. O'Reilly makes that point clear.  Read his article at the link above.

-- SS

The Story of CPRIT Continued, Part 4: The Walkout

Gilman’s resignation, though tendered in May, was effective in October. He wanted to shepherd grants that had already been through peer review but which were not yet actually funded through funding if possible, particularly as they had been delayed in the spring at the same time as the IACS grant was approved. He asked his peer reviewers to hang in with him through October. It is clear that he really tried his hardest to get a change in the new revised course of CPRIT – but he lost, and completely. He tried to get agreement that future commercialization projects would be subject to scientific review – and he got absolutely nowhere on this. He did succeed in getting delayed grants seen through the funding process; and then, in October, he left – and so did most of the peer review panelists he had assembled. Seven of eight scientific review council members resigned, and so did probably around 70 of the approximately 100 out-of-state cancer researchers and clinicians who comprised the peer review panels.

Some of the resignation letters make interesting reading. Scott Kern of Johns Hopkins said he had had an eerily similar experience in the past:
It is ironic that I again find myself in the undesirable position of resigning from a hard-working and highest-quality scientific study section. . . . Ten years ago. I served on the scienfific review board of a private philanthropic organization. In an unusual development, I was asked to review two special grant applications that had arrived out-of-cycle. After my review I was informed by the organiztion that they had beforehand decided to fund the two grants, a decision made prior to obtaining the reviews from the scientific board. They had in this instance perhaps operated as a direct money conduit and not as a peer review-guided granting operation. Owing to the deprecated role of scientific review under such procedures, I regretfully resigned from their board. . . . I now find that a somewhat similar situation exists at CPRIT. 
The irony is as follows. The PI of a grant receiving questionable dispensation ten years ago, and a PI of a grant recently under critical scrutiny for improper dispensation at CPRIT, were the identical person.

Bryan Dylnacht, NYU School of Medicine, wrote:
You may find that it was not worth subverting the entire scientific enterprise – and my understanding was that the intended goal of CPRIT was to fund the best cancer research in Texas – on account of this ostensibly new, politically-driven, commercialization-based mission. . .[S]uch a policy – wherein science that has been judged meritorious by a highly esteemed group of scientists is discounted at the expense of science that has not been methodically reviewed . . . will in fact succumb to mediocrity.

William Kaelin of Harvard noted that
Trying to commercialize flawed science is a prescription for failure and waste.

William C Hahn of Dana-Farber/Harvard Cancer Center wrote that::
I am troubled by the Oversight Committee’s recent request that those of us that participated in the scientific review of commercialization applications reconsider our scoring in the absence of any additional substantive information or progress by the applicants to strengthen what were wholly naïve and underdeveloped applications. These actions make it clear that the CPRIT Oversight Committee has elected to disregard scientific review to pursue a different agenda.

John Petrini of Memorial Sloan-Kettering Cancer Center stated that
CPRIT leadership has begun to assert an agenda in which commercialization and salesmanship are rewarded and scientific quality devalued. This is a disservice to the people of your state that will inhibit the prosecution of fruitful scientific endeavors focused on cancer.

 The Cancer Letter summed it up:
The scientific review council members are being followed by the vast majority of rank-and-file reviewers, . . . all from outside Texas. . . .
MD Anderson officials withdrew the incubator grant, pledging to resubmit it for review later. Yet, scientists are leaving because they have no confidence in a post-Gilman CPRIT. 
This walkout is an extraordinary act of solidarity on a scale never before observed in cancer science in the U.S. Even when former NCI director Andrew von Eschenbach was making patently absurd statements about eliminating suffering and death due to cancer by the year 2015, he encountered no open opposition from scientists.
     The walkout—and, perhaps more so, the letters—send a powerful signal that CPRIT is now outside mainstream cancer science.

 

ZOOM UNIK::UNIK DAN UNIK Copyright © 2012 Fast Loading -- Powered by Blogger