This document provides an overview of Cerner's history from its beginnings in 1979 developing lab information systems to its current position as a leading provider of healthcare IT systems. It discusses Cerner's development of its Health Network Architecture (HNA) in the 1990s which expanded its offerings beyond labs into a full hospital information system. Key acquisitions and partnerships that helped grow Cerner's product portfolio are also summarized. The document concludes by teasing the story of McKesson's history which will be covered in the next episode.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Wonderful Book
• I must give credit for much of
the story of Cerner so far to
an amazing book (front cover
on the first slide, back cover
here) commissioned by Neal
& Co. to be written by Jeffrey
Rodengren circa 2006.
• Thanks again to April Martin
at Cerner who steered me to
this copy I found on eBay for
an obscene price, but it’s the
only case in HIS-tory where a
vendors’ founders cared
enough about their legacy to
have it professionally
documented – kudos!
3. “TableRock” Project in 1994
• And just what’s a “TableRock?” The
codename comes from a series of “table”
meetings that Neal Patterson chronicled in
an internal memo wherein he, Cliff and Paul
made a series of big decisions that guided
Cerner beyond LIS and into the HIS industry.
• It started out as a “client/server” version
of the Health Network Architecture (HNA)
that Cerner originally used to build its LIS
out into all of the various lab modules
beyond the LIS core: AP, Micro, etc.
• Cerner’s original hardware platform was
Dec VAX minis, which were the leading
mini platform for LIS systems, as shown in
this table from Dorenfest’s 1988 Guide.
4. Bold Vision
• In what must have seemed a daring vision back in the mid-90s,
Neal & Co. announced their “TableRock” project at Cerner’s 1994
users’ conference, that would entail many advanced capabilities:
– Support “community-based” delivery models (early IDNs)
– International requirements (PathNet ran in Canada since ‘85)
– Leverage desktop computing (PCs were just hitting their stride)
• The application side of this new TableRock vision,
which was later renamed HNA V500, included the
same series of applications and modules that
enabled HBO and Meditech to grow their HIS:
- Nursing Doc, Orders Entry & Results Reporting
- Census, ADT, MPI & OP Registration/scheduling
- Pharmacy, Radiology & other niche ancillaries
• As shown on the right, HNA sold well, eclipsing lab
revenue for Cerner by the end of the decade:
5. Amazing Growth
• The time-line below shows the evolution of Cerner’s product line
from its LIS beginnings in 1979 to today’s HIS, all self-developed.
Only Meditech, CPSI & Epic also built, rather than bought an HIS.
6. Acquisitions
• Even though the bulk of its Millennium HNA product line was self-
developed, with its enormous revenue growth and successful
public offering, Cerner used the capital to acquire other vendors:
• Citation – in May of 2000 was a
potential game-changer as Citation
ruled the small hospital LIS market
with over 300 sites on its C-LAB
product, just like PathNet did in the
large LIS market. Founded in 1979,
Citation rode the micro revolution with
its PC-based system selling well both in
the US and overseas: Canada, Latin
America & Asia. In the event, the
revenue potential was too small, and
Cerner instead offered remote hosting
over C-LAB’s PCs on a Novell LAN.
7. Mini and Mega Deals
• Other acquisitions & deals Cerner made over the years include:
– Megasource - In November, 1993 Cerner acquired this
Pharmacy niche player from Michigan for $6.7 million. Like
Citation, Megasource was big in the small hospital market with
its IBM PC-based “MS-Meds” product, interfaced to “foreign”
HIS systems via their “MS-Link” interface engine (IE). Cerner
then created an “Integration Products Group” to market this IE
as part of their Open Clinical Foundation (OCF) family.
– Cerner Alliance Program – back in 1994 while they were still
primarily clinical systems, Cerner struck a deal with SDK in
Boston (later acquired by Eclipsys), Medic from NC and Amisys
in MD to add administrative and financial systems to its suite.
– Clairvia in 2011, a purveyor of workforce management and
cloud-based predictive algorithms, with over 400 clients.
8. Other Deals
• ADAC – acquired in November of 2000 expanded Cerner’s
Radiology offering, adding the imaging system QuadRIS to RadNet
• DHT – in December, 2001, Cerner acquired Dynamic Healthcare
Technologies from Lake Mary, FL. DHT was best known for its
“CoPath” Anatomic Pathology system, and also offered the
“RadPlus” RIS and “Premier System LIS,” running in over 600 sites.
• Zynx Health Inc. – a subsidiary of Cedars-Sinai Medical Center was
acquired in May, 2002, for its knowledge and best practice
solutions that were considered the industry standard. For a while:
Cerner divested itself of Zynx in 2004…
• VitalWorks – in January, 2005, Cerner acquired this physician
practice vendor, bringing 30,000 private physician clients along.
• Axya – what, you never heard of them? Have you been asleep??
Acquired in May 2005, Axya was a Paris-based specialist in
hospital systems throughout France, Switzerland and Morocco.
9. Some Slip-Ups…
• No one is perfect, and Cerner had a few downs with its many ups:
– Re-name? – While Millennium’s name was evolving from
TableRock to V500, someone came up with the name “D3,” to
reflect the directory layouts they were working with. It didn’t
take long for some field people to point out to the marketers
back in KC that that term stood for decubitus, aka bedsores…
- Profit? – In 1996 Cerner finally ended its
“alliance” program with SDK & Co., and
released its own patient accounting
system called “ProFit,” a creative name
but a not-so-hot product. In this IT
industry, what vendor does not have a
dog (or two) in their portfolio? The name
has since been changed to “Revenue
Cycle Solutions” – much better, huh?
10. A Minor Gap?
• About the only application area where Cerner did not write a
system is in ERP (“General Financials” for we oldsters…). Is this a
drawback? Let’s have some fun and test your knowledge of the
industry: which of today’s 13 leading vendors (listed by order of
their 2012 annual revenue) offers an integrated ERP suite, i.e.,
written by them, rather than interfaced with a partner vendor:
____ McKesson
____ Cerner
____ Siemens
____ Epic
____ Allscripts
____ GE
____ Meditech
____ NextGen
____ CPSI
____ HMS
____ NTT (Keane)
____ Harris (QuadraMed)
____ Healthland
11. Next Week
• Stay tuned for the answer to the ERP question next week, as well
as the final episode on Cerner covering their C-Suite evolution
and amazing climb in terms of annual revenue, # of employees
(“associates” in KC parlance), international expansion, clients, etc.
• After Cerner, we’ll wrap-up the HIS-
tory of today’s vendors with the #1
on everyone’ annual revenue chart:
McKesson, who’s $3B+ started way
back in 1974 when three HIS-tory
heroes left McAuto to form HBO:
- Walter Huff, Bruce Barrington,
and Richard Owens
• If anyone knows their email address or
phone #, please call or write me at:
vciotti@hispros.com, 505/466-4958