Ideas to take the Puerto Rico VC Industry (or any country for that matter) to the next level. Policies, ecosystem development, think globally, liquidity and trust.
What do your users want? Do you have a clue? Track your data and increase engagement - lessons by Netflix. Don't be short-sighted, try new experiences!
Ideas to take the Puerto Rico VC Industry (or any country for that matter) to the next level. Policies, ecosystem development, think globally, liquidity and trust.
What do your users want? Do you have a clue? Track your data and increase engagement - lessons by Netflix. Don't be short-sighted, try new experiences!
Lets face it – we are all liars. We often lie unintentionally and most of all – we lie to ourselves. I’ve spent the last 10 years working with enterprise architects intent on modernizing their data infrastructure, and I’ve heard many “facts” that turned out to be… less than perfectly accurate.
Lets face it – we are all liars. We often lie unintentionally and most of all – we lie to ourselves. I’ve spent the last 10 years working with enterprise architects intent on modernizing their data infrastructure, and I’ve heard many “facts” that turned out to be… less than perfectly accurate. Self-deception about state of the industry, our requirements and our capabilities can lead us to make bad choices, which leads us to build bad architectures and often leads to bad business outcomes.
If you say or hear phrases like “we have big data”, “we don’t have big data”, “this business app must be real-time” and “hybrid-cloud doesn’t exist” – you may work for an organization that can use a bit of reality check. In this talk, Gwen Shapira, principal data architect at Confluent, will share common enterprise architecture myths that did not survive contact with reality and offer some advice on how to design good data architecture given our inherent capacity for self-deception.
These days, you can’t swing a dry erase marker without hitting someone talking about microservices. Developers are studying Eric Evans' prescient book, Domain-Driven Design. Teams are refactoring monolithic apps, looking for bounded contexts and defining a ubiquitous language. And although there have been countless articles, videos, and talks to help you convert to microservices, few have spent any appreciable time asking if a given application should be a microservice. In this talk, I‘ll show you a set of factors you can apply to help you decide if something deserves to be a microservice or not. We’ll also look at what we need to do to maintain a healthy micro(services)biome.
Philly ETE 2016: Securing Software by Constructionjxyz
The high-profile attacks and data-breaches of the last few years have shown us the importance of securing our software. While it is good that we are seeing more tools that can analyze systems for vulnerabilities, this does not help the programmer write secure code in the first place. To prevent security from becoming a bottleneck–and expensive security mistakes from becoming increasingly probable–we need to look to techniques that allow us to secure software by construction.
This talk has two parts. First, I will present technical ideas from research, including my own, that help secure software by construction. Even though these are reasonable ideas, however, the gap between academia and industry often prevents these ideas from becoming realized in practice. Second, I will discuss what prevents longer-term security solutions from being commercialized, how we started the Cybersecurity Factory accelerator bridge the research/industry gap, and how we can work together to address the issues that remain.
http://2016.phillyemergingtech.com/session/securing-software-by-construction/
Achieving Virtual Desktop Success in Healthcare: Experts in healthcare IT discuss the ways you can accelerate virtualized desktop adoption, speed clinician access to Electronic Health Records (EHR), and enhance desktop performance and user experience. Delivering compliant and high performing clinician workspaces depends on creating a consistent desktop experience and remediating bottlenecks that impact performance and user productivity.
This webinar will show you how to deliver "lean" clinician workspaces and assure high levels of user satisfaction:
. Best practices to leverage and pitfalls to avoid when deploying VDI in a hospital
. Architect a virtual workspace that meets your organization's requirements
. Gain total performance visibility of all IT domains to improve user experience
. Preemptively detect and resolve issues before users are effected
. Optimize current infrastructure usage
#NoEstimates - Stop lying to yourself and your customers, and stop estimatinggerardbeckerleg
After his successful session last year on Agile Scrum, our resident Scrum White Robe Gerard Beckerleg is at it again, except this time he's taking on one of the most divisive topics in software development: Estimation.
In this video recorded at the Sydney SSW offices, Gerard Beckerleg takes a dive into the depths of this controversial topic and extracts the most interesting ideas and raises some very difficult questions about the big white elephant in the room that is Software Estimation.
After examining the pros and cons of estimation Gerard lays the blueprint for a better way to help you and your clients get what they are really looking for.
2017 Melbourne YOW! CTO Summit - Monolith to micro-services with CQRS & Event...Douglas English
These are the slides I presented at the Melbourne 2017 YOW! CTO Summit. The talk followed Culture Amp's steps and miss-steps on our journey to micro-services, and how we came to find CQRS and Event Sourcing fantastic tools.
Seattle Interactive Conference presentation by Vectorform's Director of Product Vision, Kevin Foreman.
While smart home technologies have existed for over 20 years, they continue to struggle with gaining a foothold within the average home, as many homeowners are skeptical to the benefits and advantages of the connected home lifestyle. Kevin will provide an insightful look at the journey from concept to delivery that re-invents the smart home experience.
#SIC2014
Contact us for more information and how we can help you on your next project sales@vectorform.com
While smart home technologies have existed for over 20 years, they continue to struggle with gaining a foothold within the average home, as many homeowners are skeptical to the benefits and advantages of the connected home lifestyle. Kevin will provide an insightful look at the journey from concept to delivery that re-invents the smart home experience.
Cloud-Mobile Mega Trends Point to Rapid Need for Radical Application Transfor...Dana Gardner
Transcript of a Briefings Direct podcast on how consumer-driven platform variety is affecting how enterprises must adjust their approach to architecture.
Building Products with Customers by fmr Uber Product ManagerProduct School
- Deeply understanding your customer's needs is critical to designing a compelling product
- The best products aren't designed and built in labs, they are constantly iterated on as customer needs are better understood
- Darrell will talk through strategies to engage with customers, sharing practical examples from the Uber driver app re-design's global Beta and his experience working with community leaders as the Product Manager for Citizen's core app
Know how Cygnet Infotech delivered a robust #ProjectManagement solution that addressed client's daily project planning and management challenges saving cost, manual work and time while improving efficiency.
After diving deep into the client’s business challenges, Cygnet conceptualized a Project Management Solution for effective resource allocation and added transparency in operations.
The Five-Week Transformation: How the Department of Defense’s Public Web Serv...Atlassian
The Defense Media Activity’s Public web program supports more than 10,000 soldiers, sailors, airmen and Marines globally with the ability to rapidly move news, images and video to worldwide audiences via official military websites and the ability to integrate that content on social media sites. In September 2014, DMA's CIO Leslie Benito realized that to deliver world-class service, DMA needed to transform its Public Web service desk. In this session, Leslie will explain how they completed that within weeks, under stringent security requirements, while improving IT productivity and customer satisfaction. carried out the projects and what we achieved along the way.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Lets face it – we are all liars. We often lie unintentionally and most of all – we lie to ourselves. I’ve spent the last 10 years working with enterprise architects intent on modernizing their data infrastructure, and I’ve heard many “facts” that turned out to be… less than perfectly accurate.
Lets face it – we are all liars. We often lie unintentionally and most of all – we lie to ourselves. I’ve spent the last 10 years working with enterprise architects intent on modernizing their data infrastructure, and I’ve heard many “facts” that turned out to be… less than perfectly accurate. Self-deception about state of the industry, our requirements and our capabilities can lead us to make bad choices, which leads us to build bad architectures and often leads to bad business outcomes.
If you say or hear phrases like “we have big data”, “we don’t have big data”, “this business app must be real-time” and “hybrid-cloud doesn’t exist” – you may work for an organization that can use a bit of reality check. In this talk, Gwen Shapira, principal data architect at Confluent, will share common enterprise architecture myths that did not survive contact with reality and offer some advice on how to design good data architecture given our inherent capacity for self-deception.
These days, you can’t swing a dry erase marker without hitting someone talking about microservices. Developers are studying Eric Evans' prescient book, Domain-Driven Design. Teams are refactoring monolithic apps, looking for bounded contexts and defining a ubiquitous language. And although there have been countless articles, videos, and talks to help you convert to microservices, few have spent any appreciable time asking if a given application should be a microservice. In this talk, I‘ll show you a set of factors you can apply to help you decide if something deserves to be a microservice or not. We’ll also look at what we need to do to maintain a healthy micro(services)biome.
Philly ETE 2016: Securing Software by Constructionjxyz
The high-profile attacks and data-breaches of the last few years have shown us the importance of securing our software. While it is good that we are seeing more tools that can analyze systems for vulnerabilities, this does not help the programmer write secure code in the first place. To prevent security from becoming a bottleneck–and expensive security mistakes from becoming increasingly probable–we need to look to techniques that allow us to secure software by construction.
This talk has two parts. First, I will present technical ideas from research, including my own, that help secure software by construction. Even though these are reasonable ideas, however, the gap between academia and industry often prevents these ideas from becoming realized in practice. Second, I will discuss what prevents longer-term security solutions from being commercialized, how we started the Cybersecurity Factory accelerator bridge the research/industry gap, and how we can work together to address the issues that remain.
http://2016.phillyemergingtech.com/session/securing-software-by-construction/
Achieving Virtual Desktop Success in Healthcare: Experts in healthcare IT discuss the ways you can accelerate virtualized desktop adoption, speed clinician access to Electronic Health Records (EHR), and enhance desktop performance and user experience. Delivering compliant and high performing clinician workspaces depends on creating a consistent desktop experience and remediating bottlenecks that impact performance and user productivity.
This webinar will show you how to deliver "lean" clinician workspaces and assure high levels of user satisfaction:
. Best practices to leverage and pitfalls to avoid when deploying VDI in a hospital
. Architect a virtual workspace that meets your organization's requirements
. Gain total performance visibility of all IT domains to improve user experience
. Preemptively detect and resolve issues before users are effected
. Optimize current infrastructure usage
#NoEstimates - Stop lying to yourself and your customers, and stop estimatinggerardbeckerleg
After his successful session last year on Agile Scrum, our resident Scrum White Robe Gerard Beckerleg is at it again, except this time he's taking on one of the most divisive topics in software development: Estimation.
In this video recorded at the Sydney SSW offices, Gerard Beckerleg takes a dive into the depths of this controversial topic and extracts the most interesting ideas and raises some very difficult questions about the big white elephant in the room that is Software Estimation.
After examining the pros and cons of estimation Gerard lays the blueprint for a better way to help you and your clients get what they are really looking for.
2017 Melbourne YOW! CTO Summit - Monolith to micro-services with CQRS & Event...Douglas English
These are the slides I presented at the Melbourne 2017 YOW! CTO Summit. The talk followed Culture Amp's steps and miss-steps on our journey to micro-services, and how we came to find CQRS and Event Sourcing fantastic tools.
Seattle Interactive Conference presentation by Vectorform's Director of Product Vision, Kevin Foreman.
While smart home technologies have existed for over 20 years, they continue to struggle with gaining a foothold within the average home, as many homeowners are skeptical to the benefits and advantages of the connected home lifestyle. Kevin will provide an insightful look at the journey from concept to delivery that re-invents the smart home experience.
#SIC2014
Contact us for more information and how we can help you on your next project sales@vectorform.com
While smart home technologies have existed for over 20 years, they continue to struggle with gaining a foothold within the average home, as many homeowners are skeptical to the benefits and advantages of the connected home lifestyle. Kevin will provide an insightful look at the journey from concept to delivery that re-invents the smart home experience.
Cloud-Mobile Mega Trends Point to Rapid Need for Radical Application Transfor...Dana Gardner
Transcript of a Briefings Direct podcast on how consumer-driven platform variety is affecting how enterprises must adjust their approach to architecture.
Building Products with Customers by fmr Uber Product ManagerProduct School
- Deeply understanding your customer's needs is critical to designing a compelling product
- The best products aren't designed and built in labs, they are constantly iterated on as customer needs are better understood
- Darrell will talk through strategies to engage with customers, sharing practical examples from the Uber driver app re-design's global Beta and his experience working with community leaders as the Product Manager for Citizen's core app
Know how Cygnet Infotech delivered a robust #ProjectManagement solution that addressed client's daily project planning and management challenges saving cost, manual work and time while improving efficiency.
After diving deep into the client’s business challenges, Cygnet conceptualized a Project Management Solution for effective resource allocation and added transparency in operations.
The Five-Week Transformation: How the Department of Defense’s Public Web Serv...Atlassian
The Defense Media Activity’s Public web program supports more than 10,000 soldiers, sailors, airmen and Marines globally with the ability to rapidly move news, images and video to worldwide audiences via official military websites and the ability to integrate that content on social media sites. In September 2014, DMA's CIO Leslie Benito realized that to deliver world-class service, DMA needed to transform its Public Web service desk. In this session, Leslie will explain how they completed that within weeks, under stringent security requirements, while improving IT productivity and customer satisfaction. carried out the projects and what we achieved along the way.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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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
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
20. You don’t have to throw everything away
to start over again.
21. Legacy system
• 4-6 weeks for new
infrastructure
• 4+* hour maintenance
windows
• Sticky sessions
• Not mobile friendly
App 2.0: under the hood
App 2.0
• 30 minutes for a new
virtual data center
• Zero downtime deploys
• Stateless servers
• Responsive
• Throttled roll-out
22. CMS staff, OIG report on HealthCare.gov
App 2.0 went into production 30 days early so
we could see it in the wild during special
enrollment. It was very successful.”
“
23. Immutable infrastructure
Bake binaries + code into image
Auto-scaling
Rollbacks
Generalized infrastructure
Reuse code across apps / microservices
CoreVPC: PaaS for government
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7,754 transactions per second was attained for
one hour with 128 millisecond response times
and zero errors.”
“
Introduction
Rohan, CEO of Nava
Thank you for having me here...
Today I’ll be sharing with you some of Nava’s experiences with rebuilding HealthCare.gov, and what happens after a crisis
This is us. Well, some of us.
Nava is a public benefit corporation of 20 people headquartered in Washington DC, with offices in San Francisco and New York
Our mission is to “Radically improve how our government serves people”
Navigating a crisis
Nava was born out of the effort to move beyond a HealthCare.gov that was merely stabilized; our goal was to build our way out of trouble, towards a service that was robust, flexible, and a model for user-centered design
Crisis can often be pivotal moments, and navigating those periods is not easy. There are no easy answers, no quick fixes.
With the intense, acute focus on the crisis, larger questions can fall away.
What happens after
And so what I want to talk about what happens after the crisis
After the bright lights have dimmed a bit and the adrenaline is gone
How do we build a better future? How do we start looking further out?
How do we build lasting change? What kind of strategies and tactics get us there?
At Nava, we spend a lot of time on this question
And we’ll talk about some of our experiences and strategies we’ve used, that you may find helpful
What’s more important is not the strategies and tactics I talk about today, but that you ask these sorts of questions about the organizations and systems that you’re working on
And I want to acknowledge that this question is incredibly broad, even within our world of government digital services: the answer spans policy, procurement practices, culture, product practices, politics, and more
Where we are now
Healthcare.gov is on solid ground
Hard work across Centers for Medicare and Medicaid Services, etc.
Call center representatives
In the process, Nava has begun to help other agencies
Similar stories everywhere
At SSA...At Census...federal level...state level...
We’ve begun to see a pattern in the complexity after a crisis – folks feel caught, trapped…
I’m here to say that in that complexity, there is a huge amount of hope for creating firm, future-facing foundations
First things first – where do you start?
Folks that we talk to who are responsible for large, complex, government programs feel caught:
Caught between a rock and commercial off the shelf software
"we tried custom – it didn't work, it's complex, it's costly, it's insecure, we got locked into one vendor"
"we are trying COTS, we can't get the product to change for what we need it to do"
Going incremental with legacy systems? Takes forever, costs a lot
Start over? Low success rate, throw away lots of investments that are working
And what Nava has found is that
We can modernize complex architecture and systems without throwing away all your existing investments
These struggles are shared:
Policy people working on legislation for decades watch the implementation fall flat on its face without any way to steer
Folks on the IT side within gov struggling with requirements…
Auditing legacy systems only to find a fractal-like complexity
CIOs guide modern RFPs but contracting officers are unable to distinguish true skill from skillful RFP responses…
Meanwhile, the systems causing issues become more and more urgent
The feeling of having no good options
The only way to start over is to throw everything away or do something so marginalized it has effectively zero impact
Or just not knowing where the inefficiencies in the entire lifecycle are, only knowing costs in terms of production (lines of code or etc)
A playbook for building the future
I’m going to share our strategies and some tactical examples at HealthCare.gov about how to move from crisis management to firm foundations
At a high level, it’s not rocket science
The first thing we do, is close the distance
Government work is made more complicated by the complexity of the organization: multiple contractors
Combat that by getting really close in your collaboration
Product, development, design, requirements: tight loops of agile, research, prototyping
What you’re searching for is to adapt quickly, as a substitute for knowing the truth upfront.
Agile isn’t just a label, it’s a way of responding to changing requirements
“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Richard Feynman (on the Challenger explosion)
Cut through to the core of user needs, requirements
[sha’s note from rohan speaking: closing the distance is a way of managing complexity, closing the distance across multiple dimensions is very important]
What you’re searching for is to adapt quickly, as a substitute for knowing the truth upfront.
Agile isn’t just a label, it’s a way of responding to changing requirements
“For a successful technology, reality must take precedence over public relations, for nature cannot be fooled.” Richard Feynman (on the Challenger explosion)
Cut through to the core of user needs, requirements
In the last two years, Nava has worked together with CMS to redesign the health insurance application from top to bottom – from the infrastructure all the way up to the user experience
Working directly with requirements people let us work find simple paths through the legislation
76 screens → 16 screens
Call center complaints down
Fully responsive design
Big deal nowadays - 20% of traffic on mobile
And a big portion of the population doesn’t have access to a computer but they still have a smartphone for their work
Conversion rate 65% → 95%
We lose a 1/7 of the number of people we used to lose, 7x improvement in terms of people that decide to pull out their hair
Time to completion 21 min → 9 min
Faster than Geico
Build proof of concepts to answer doubts
Give people something to react to
Working software >> excel or word
Something is wrong when:
“We can start once we document the requirements”
“We’ll have that in 6 months”
“That will take 10,000 additional hours”
This one is close to my heart
And where complexity becomes opportunity in a concrete sense
Find the threads to pull on that let you move through the problem one meaningful step at a time
Business process seam, technical seam, use case seam
Soft launching
[not sure if this quote is good] http://www.shirky.com/weblog/2013/11/healthcare-gov-and-the-gulf-between-planning-and-reality/ “It is hard for policy people to imagine that Healthcare.gov could have had a phased rollout, even while it is having one.” - Clay Shirky
Find the seam
Create account page -> SLS -> account flows
You can use what you have, you don’t have to throw everything away to start over
Soft launch
http://www.shirky.com/weblog/2013/11/healthcare-gov-and-the-gulf-between-planning-and-reality/ “It is hard for policy people to imagine that Healthcare.gov could have had a phased rollout, even while it is having one.” - Clay Shirky (not sure if this quote is good :P)
Find the seam
Create account page -> SLS -> account flows
App 2.0
65% of the most common case of users
Slow rollout: 0%, 1%, 10%, 50%, 100%
A/B testing
Strangler pattern
SLS
Hot swap at the interface
Data migration
65% of consumers: found the seam
Throttled the roll out so that we could gradually go from 0%, to 1%, to 10%, etc to 100% eventually, with minimal risk
Found the other seam at the DevOps layer, built our own PaaS
Made sure that our work here was simultaneously government compliant, and fully modern
Reliable, scalable, secure, flexible
Ultimately, these investment result in UX improvements, even if infrastructure doesn’t seem to directly affect users
[Find the investments that start paying off immediately]
Set records
SLS supporting 20 million accounts, great
Set the right metrics,
Planned downtime is still downtime
How far can we push this?
Thinking proactively to see how systems will break
Billion user load test
Drop-in replacement
1/100th the cost, 1000x performance
Backend system, not sexy, critical to user experience
How far can we push this?
7754 tps was attained for 1 hour with the 90th percentile at 128ms and zero errors.
7754 tps was attained for 1 hour with the 90th percentile at 128ms and zero errors.
Build ambition
Going up the hierarchy of needs (Program Integrity to Futureproofing to Prototyping)
Magic: emergent effects
Build new foundations
this is a dramatic time in IT modernization efforts
this is a moment for gov to lead in terms of scalability, security, privacy, etc
Promote good behavior don’t police bad behavior
Celebrate successes, learn from failures