Friday, December 30, 2011

The Rain of God's Favor

 Wishing all my readers peace to you n your family in the coming year.
May it bring wonderful surprises!

Taking a break from medical stuff to personal reflections:

     its ability to percolate and find,
     all the dry places,
and behold,
     the dry dead-looking seed,
     breaks forth, new shoot.
Life revealed,
     hidden and protected,
     for such a time as this.
Your rain O God,
    falling alike on sinners and man of ill will,
    the same ability to cause dryness to flee.
You are - power concealed,
    power revealed, in us.
Rising on the winds of the favor of a great and loving God,
   to achieve ,
   that which already is.
Our life, a canvas, not blank.
  already in existence in the artist's imagination.
Already, a completed work of art.
Beautiful and complete.

poh tin 30th Dec 2011

Wednesday, December 28, 2011

Current Status of Knowledge on Public-speaking Anxiety

From Current Opinion in Psychiatry Charles B. Pull 12/19/2011; Curr Opin Psychiatry. 2012;25(1):32-38. © 2012 Lippincott Williams & Wilkins Abstract Purpose of review: This review examines the current knowledge on public-speaking anxiety, that is, the fear of speaking in front of others. This article summarizes the findings from previous review articles and describes new research findings on basic science aspects, prevalence rates, classification, and treatment that have been published between August 2008 and August 2011. Recent findings: Recent findings highlight the major aspects of psychological and physiological reactivity to public speaking in individuals who are afraid to speak in front of others, confirm high prevalence rates of the disorder, contribute to identifying the disorder as a possibly distinct subtype of social anxiety disorder (SAD), and give support to the efficacy of treatment programs using virtual reality exposure and Internet-based self-help. Summary: Public-speaking anxiety is a highly prevalent disorder, leading to excessive psychological and physiological reactivity. It is present in a majority of individuals with SAD and there is substantial evidence that it may be a distinct subtype of SAD. It is amenable to treatment including, in particular, new technologies such as exposure to virtual environments and the use of cognitive–behavioral self-help programs delivered on the Internet. Introduction Public-speaking anxiety, also termed fear of speaking in public, fear of public speaking, or fear of speaking in front of others, is a highly prevalent disorder. The fear causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. This article reports on the recent data concerning the psychological and physiological reactivity to public speaking in individuals who are afraid of speaking in front of others, prevalence rates, the position of the disorder as a possibly distinct subtype of social anxiety disorder (SAD), and the development of new treatment modalities, including, in particular, exposure in virtual reality environments and Internet-based self-help programs.

Wednesday, November 16, 2011

Who Is Governing Whom? Senior Managers, Governance and the Structure of Generosity in Large U.S. Firms

Published: July 29, 2011 Paper Released: May 2011 Authors: Christopher Marquis and Matthew Lee Executive Summary: Analyzing several Fortune 500 firms over the period of 10 years, Christopher Marquis and Matthew Lee discuss the factors that influence corporate philanthropy, using the subject to theorize about and test how structural features of organizations help senior leaders to shape firm strategy. Key concepts include: Many practitioners today view corporate philanthropy as a strategic activity that addresses both social and economic goals. Corporate philanthropy is highest in corporations with new CEOs, and decreases with the length of CEO tenure. The greater the proportion of female senior managers in a company, the greater the corporate philanthropic contributions will be. Companies with larger boards tend to have higher philanthropic contributions. Christopher Marquis is an associate professor in the Organizational Behavior unit at Harvard Business School. Abstract We examine how organizational structure influences strategies over which corporate leaders have significant discretion. Corporate philanthropy is our setting to study how a differentiated structural element, the corporate foundation, constrains the influence of individual senior managers and directors on corporate strategy. Our analysis of Fortune 500 firms from 1996 to 2006 shows that leader characteristics at both the senior management and director levels affect corporate philanthropic contributions. We also find that organizational structure constrains the philanthropic influence of board members, but not senior managers, a result that is contrary to what existing theory would predict. We discuss how these findings advance understanding of how organizational structure and corporate leadership interact, and how organizations can more effectively realize the strategic value of corporate social responsibility activities. Paper Information

Creating a Positive Professional Image

Q&A with: Laura Morgan Roberts Published: June 20, 2005 Author: Mallory Stark Executive Summary: In today’s diverse workplace, your actions and motives are constantly under scrutiny. Time to manage your own professional image before others do it for you. An interview with professor Laura Morgan Roberts. As HBS (Harvard Business School) professor Laura Morgan Roberts sees it, if you aren't managing your own professional image, others are. "People are constantly observing your behavior and forming theories about your competence, character, and commitment, which are rapidly disseminated throughout your workplace," she says. "It is only wise to add your voice in framing others' theories about who you are and what you can accomplish." There are plenty of books telling you how to "dress for success" and control your body language. But keeping on top of your personal traits is only part of the story of managing your professional image, says Roberts. You also belong to a social identity group—African American male, working mother—that brings its own stereotyping from the people you work with, especially in today's diverse workplaces. You can put on a suit and cut your hair to improve your appearance, but how do you manage something like skin color? Roberts will present her research, called "Changing Faces: Professional Image Construction in Diverse Organizational Settings," in the October issue of the Academy of Management Review. She discusses her research in this interview. Mallory Stark: What is a professional image? Laura Morgan Roberts: Your professional image is the set of qualities and characteristics that represent perceptions of your competence and character as judged by your key constituents (i.e., clients, superiors, subordinates, colleagues). Q: What is the difference between "desired professional image" and "perceived professional image?" A: It is important to distinguish between the image you want others to have of you and the image that you think people currently have of you. Most people want to be described as technically competent, socially skilled, of strong character and integrity, and committed to your work, your team, and your company. Research shows that the most favorably regarded traits are trustworthiness, caring, humility, and capability. Ask yourself the question: What do I want my key constituents to say about me when I'm not in the room? This description is your desired professional image. Likewise, you might ask yourself the question: What am I concerned that my key constituents might say about me when I'm not in the room? The answer to this question represents your undesired professional image. You can never know exactly what all of your key constituents think about you, or how they would describe you when you aren't in the room. You can, however, draw inferences about your current professional image based on your interactions with key constituents. People often give you direct feedback about your persona that tells you what they think about your level of competence, character, and commitment. Other times, you may receive indirect signals about your image, through job assignments or referrals and recommendations. Taken together, these direct and indirect signals shape your perceived professional image, your best guess of how you think your key constituents perceive you. Q: How do stereotypes affect perceived professional image? A: In the increasingly diverse, twenty-first century workplace, people face a number of complex challenges to creating a positive professional image. They often experience a significant incongruence between their desired professional image and their perceived professional image. In short, they are not perceived in the manner they desire; instead, their undesired professional image may be more closely aligned with how their key constituents actually perceive them. What lies at the source of this incongruence? Three types of identity threats—predicaments, devaluation, and illegitimacy—compromise key constituents' perceptions of technical competence, social competence, character, and commitment. All professionals will experience a "predicament" or event that reflects poorly on their competence, character, or commitment at some point in time, due to mistakes they have made in the past that have become public knowledge, or competency gaps (e.g., shortcomings or limitations in skill set or style). Members of negatively stereotyped identity groups may experience an additional form of identity threat known as "devaluation." Identity devaluation occurs when negative attributions about your social identity group(s) undermine key constituents' perceptions of your competence, character, or commitment. For example, African American men are stereotyped as being less intelligent and more likely to engage in criminal behavior than Caucasian men. Asian Americans are stereotyped as technically competent, but lacking in the social skills required to lead effectively. Working mothers are stereotyped as being less committed to their profession and less loyal to their employing organizations. All of these stereotypes pose obstacles for creating a positive professional image. Even positive stereotypes can pose a challenge for creating a positive professional image if someone is perceived as being unable to live up to favorable expectations of their social identity group(s). For example, clients may question the qualifications of a freshly minted MBA who is representing a prominent strategic consulting firm. Similarly, female medical students and residents are often mistaken for nurses or orderlies and challenged by patients who do not believe they are legitimate physicians. Q: What is impression management and what are its potential benefits? A: Despite the added complexity of managing stereotypes while also demonstrating competence, character, and commitment, there is promising news for creating your professional image! Impression management strategies enable you to explain predicaments, counter devaluation, and demonstrate legitimacy. People manage impressions through their non-verbal behavior (appearance, demeanor), verbal cues (vocal pitch, tone, and rate of speech, grammar and diction, disclosures), and demonstrative acts (citizenship, job performance). My research suggests that, in addition to using these traditional impression management strategies, people also use social identity-based impression management (SIM) to create a positive professional image. SIM refers to the process of strategically presenting yourself in a manner that communicates the meaning and significance you associate with your social identities. There are two overarching SIM strategies: positive distinctiveness and social recategorization. Positive distinctiveness means using verbal and non-verbal cues to claim aspects of your identity that are personally and/or socially valued, in an attempt to create a new, more positive meaning for that identity. Positive distinctiveness usually involves attempts to educate others about the positive qualities of your identity group, advocate on behalf of members of your identity group, and incorporate your background and identity-related experiences into your workplace interactions and innovation. Social recategorization means using verbal and non-verbal cues to suppress other aspects of your identity that are personally and/or socially devalued, in an attempt to distance yourself from negative stereotypes associated with that group. Social recategorization involves minimization and avoidance strategies, such as physically and mentally conforming to the dominant workplace culture while being careful not to draw attention to identity group differences and one's unique cultural background. Rather than adopting one strategy wholesale, most people use a variety of strategies for managing impressions of their social identities. In some situations, they choose to draw attention to a social identity, if they think it will benefit them personally or professionally. Even members of devalued social identity groups, such as African American professionals, will draw attention to their race if it creates mutual understanding with colleagues, generates high-quality connections with clients, or enhances their experience of authenticity and fulfillment in their work. In other situations, these same individuals may choose to minimize their race in order to draw attention to an alternate identity, such as gender, profession, or religion, if they feel their race inhibits their ability to connect with colleagues or clients. Successful impression management can generate a number of important personal and organizational benefits, including career advancement, client satisfaction, better work relationships (trust, intimacy, avoiding offense), group cohesiveness, a more pleasant organizational climate, and a more fulfilling work experience. However, when unsuccessfully employed, impression management attempts can lead to feelings of deception, delusion, preoccupation, distraction, futility, and manipulation. Q: How do authenticity and credibility influence the positive outcomes of impression management attempts? A: In order to create a positive professional image, impression management must effectively accomplish two tasks: build credibility and maintain authenticity. When you present yourself in a manner that is both true to self and valued and believed by others, impression management can yield a host of favorable outcomes for you, your team, and your organization. On the other hand, when you present yourself in an inauthentic and non-credible manner, you are likely to undermine your health, relationships, and performance. Most people use a variety of strategies for managing impressions of their social identities. Most often, people attempt to build credibility and maintain authenticity simultaneously, but they must negotiate the tension that can arise between the two. Your "true self," or authentic self-portrayal, will not always be consistent with your key constituents' expectations for professional competence and character. Building credibility can involve being who others want you to be, gaining social approval and professional benefits, and leveraging your strengths. If you suppress or contradict your personal values or identity characteristics for the sake of meeting societal expectations for professionalism, you might receive certain professional benefits, but you might compromise other psychological, relational, and organizational outcomes. Q: What are the steps individuals should take to manage their professional image? A: First, you must realize that if you aren't managing your own professional image, someone else is. People are constantly observing your behavior and forming theories about your competence, character, and commitment, which are rapidly disseminated throughout your workplace. It is only wise to add your voice in framing others' theories about who you are and what you can accomplish. Be the author of your own identity. Take a strategic, proactive approach to managing your image: Identify your ideal state. What are the core competencies and character traits you want people to associate with you? Which of your social identities do you want to emphasize and incorporate into your workplace interactions, and which would you rather minimize? Assess your current image, culture, and audience. What are the expectations for professionalism? How do others currently perceive you? Conduct a cost-benefit analysis for image change. Do you care about others' perceptions of you? Are you capable of changing your image? Are the benefits worth the costs? (Cognitive, psychological, emotional, physical effort) Use strategic self-presentation to manage impressions and change your image. Employ appropriate traditional and social identity-based impression management strategies. Pay attention to the balancing act—build credibility while maintaining authenticity. Manage the effort you invest in the process. Monitoring others' perceptions of you Monitoring your own behavior Strategic self-disclosure Preoccupation with proving worth and legitimacy About the author Mallory Stark is a career information librarian at Baker Library.

The Ultimate Question in Management

November 3, 2011 Author: James Heskett Executive Summary: Forum Open: Is there one key to management success, an ultimate question that needs to be answered? Jim Heskett has a nominee. What's yours? James Heskett is a Baker Foundation Professor, Emeritus, at Harvard Business School. The publication this month of The Ultimate Question 2.0 (revised from an earlier edition) provides us with an opportunity to ask ourselves just what is the ultimate question in management. In their book, Fred Reichheld and Rob Markey remind us of the simplicity of the Net Promoter Score (NPS). It's the product of answers to one question, "How likely is it you would recommend us to a friend?" The NPS has become so popular that, as a customer, you quite likely have been asked that question in the past couple of months. Those replying with a 9 or 10 (the most positive) on an 11-point scale (0 to 10) are "promoters"; a 7 or 8 labels you as a "passive"; and anything from a 0 to a 6 makes you a "detractor." Subtract the proportion of detractors from the proportion of promoters and you get a "net promoter score" that can range anywhere from +100 to -100. And that's it. Tracking the net promoter score, according to the authors, can lead to improvements in both management and performance. As managers and students of management, we have a tendency to want to simplify things. Evidence of this is the plethora of management books with single word titles such as Accountability, Transparency, and Teamwork. We search for the one key to management success. Based on recent research, I have my own candidate for that "one key thing:" trust. (There's precious little trust in government, Wall Street, and business in general these days.) I found a strong correlation between trust, loyalty, engagement, and "ownership" among employees in a sample of organizations I examined. Respondents in the study made a convincing case that trust was absolutely essential to the successful implementation of policies and practices necessary to implement any strategy. For example, several managers testified to the importance of the relationship between trust and the ability to achieve speed in getting things done. It's a topic that Stephen M. R. Covey wrote persuasively about several years ago in his book, The Speed of Trust. So for me one candidate "ultimate question" would be "Do you trust your manager?" or "Do you trust your organization?" My study led to an exploration of the underpinnings of trust, as suggested by related survey data. One major determinant is whether a manager or the organization does what it says it will do, whether it lives up to "the deal" on things important to an employee, whether it meets that employee's expectations. So another "ultimate question" might well be "Does your manager do what she says she will do?" or "Does your organization do what it says it will do?" What is the ultimate question in management? Or do you object to playing this game?--The Net Promoter Score certainly has its detractors. All of these are efforts to provide simple guideposts in a very complex process. Performance measurement can be a confusing process, leading to inaction or, worse yet, inappropriate action. Can an "ultimate question" have a useful management function? If so, what's yours? What do you think? To read more: Stephen M. R. Covey with Rebecca R. Merrill, The Speed of Trust: The One Thing That Changes Everything (New York: Free Press, 2006). Fred Reichheld and Rob Markey, The Ultimate Question 2.0 (Revised and Expanded Edition): How Net Promoter Companies Thrive in a Customer- Driven World (Boston: Harvard Business Press, 2011). Jim Heskett's latest book,The Culture Cycle, was published in September.

Thursday, November 3, 2011

The Most Powerful Workplace Motivator

The Most Powerful Workplace Motivator October 31, 2011 Author: Carmen Nobel Executive Summary: When evaluating compensation issues, economists often assume that both an employer and an employee make rational, albeit self-interested choices while working toward a goal. The problem, says Assistant Professor Ian Larkin, is that the most powerful workplace motivator is our natural tendency to measure our own performance against the performance of others. Key concepts include: The most powerful workplace motivator is our natural tendency to measure our own performance against the performance of others. Salespeople will actually give up the chance to make extra money if doing so will garner positive recognition from their peers. In the age of social networking, employees are more likely than ever to share salary information with each other. Employers need to keep this fact in mind when designing compensation plans. HBS Faculty Member Ian I. Larkin is an assistant professor in the Negotiation, Organizations and Markets unit at Harvard Business School. Any parent can tell you that a surefire way to turn joy into rage is to offer your child a big candy bar—and then turn around and offer an even bigger one to his sister. Suddenly, a special treat turns into a great injustice. "Hey! How come she got more? That's not fair!" And any hiring manager can tell you that the world of business is not so different. "It really was all about the recognition of and comparison with their peers, and many of them were willing to pay for it." "This is why MBA programs send out lists of average salaries, and why students spend hours poring over those lists," says Ian Larkin, an assistant professor in the Negotiation, Organizations & Markets Unit at Harvard Business School. "You should see the angry e-mails I get from students when they find out that a job offer turns out to be $10,000 per year below the average. It's not that they really feel like an annual salary offer of $115,000 is unfair on its own. They might be perfectly happy with that salary if it weren't for the information that it's below average." And it's not just a matter of money. In several studies of social comparison in the workplace, Larkin has found that the most powerful workplace motivator is our natural tendency to measure our own performance against the performance of others. "Traditionally, [the field of] economics has held a very rational view of people, and there's a gigantic amount of literature focusing on financial incentives and the idea that simply having financial incentives causes people to work harder," he says. "But my research suggests that in deciding how hard we work and how well we think we're performing, social comparisons matter just as much." The $30,000 gold star The power of social comparison can lead to irrational financial decisions, according to Larkin's 2009 paper "Paying $30,000 for a Gold Star: An Empirical Investigation into the Value of Peer Recognition to Software Salespeople." The paper describes a field study at a large enterprise software firm, where salespeople's salaries are largely based on commissions. The firm also features another common sales incentive--a "president's club" membership for those employees who sell more software than 90 percent of their peers in a given year. The software firm uses a "commission accelerator" program over the course of each financial quarter, meaning that a salesperson expecting a high-volume sale at the beginning of a quarter would receive a higher commission on any additional sales in the same quarter. A salesperson expecting a large sale early in the first quarter of the year would rationally want to delay any other potential sales until later in that quarter, so as to take advantage of the accelerating commission schedule. However, making the sale right away, before the end of the year, could help the salesperson achieve special recognition as a member of the club. Thus, the salesperson faces a choice: delay the sale and garner eventual commission boosts, or make the sale right away and improve the chance of attaining club membership. In the paper, Larkin uses actual choices of hundreds of salespeople facing this decision to statistically estimate the average salesperson's "willingness to pay" for club induction—the point at which a salesperson is indifferent to waiting for greater commissions and closing the deal now and getting inducted into the club. The willingness-to-pay statistic at the software firm is calculated to be nearly $30,000, or approximately 5 percent of take-home pay. "My research shows that salespeople who are right on the margin of club induction are actually willing to pay to get over the margin and into the club," Larkin says. Importantly, Larkin observed that there were no apparent financial benefits to attaining club membership. Recipients received a gold star on their name card, companywide recognition, an e-mail from the CEO, and a weekend trip to a tropical destination with the other club members. (Granted, the trip was worth several hundred dollars, but was far less financially valuable than a large commission.) Club members "were not more likely to be promoted, leave for a better job, or make higher commissions in the future," Larkin says. "It really was all about the recognition of and comparison with their peers, and many of them were willing to pay for it." Insecurity leads to dishonesty Social comparison also can lead to insecurity-driven cheating, as Larkin details in a 2009 paper co-written with HBS colleague Benjamin Edelman, Demographics, Career Concerns or Social Comparison: Who Games SSRN Download Counts? The paper addresses an issue near and dear to academics worldwide: the relative popularity of working papers in the Social Science Research Network (SSRN) repository. The SSRN is a huge academic paper repository, with more than 100,000 authors and 500,000 registered users who have the opportunity to view or download every paper on the site. For each paper, SSRN creates a web page that includes statistics on how many times the paper has been downloaded and viewed. The SSRN site also publishes various "top 10" lists in numerous fields, ranked according to how many times the paper has been viewed, downloaded, or cited elsewhere on SSRN. Some scholars paid a lot of attention to the reported download counts of their papers; Larkin reports that one prominent legal academic described the monitoring of his own paper's download counts as "like crack for me." Historically, SSRN allowed unlimited downloads of papers, and most of those downloads were reflected in the reported download count on each paper's web page. It became apparent that many authors were gaming the download count system by repeatedly downloading their own papers, so that others would see the high download count and assume that these particular papers were very popular. SSRN maintains detailed historical records of every paper download and is able to determine when papers appear to be downloaded over and over by the same person. "It's like having a convenience store that's not manned, and everyone who comes in can either steal or pay, but there's a video camera that nobody knows about, and it's tracking everyone's every move," Larkin says. "For years, some academics got away with inflating their own download count numbers, but we were able to see exactly who was doing this, and in what circumstances." In their research, Larkin and Edelman teamed up with the SSRN and set out to determine the factors that would make academics inflate the download counts of their own papers. "As economists, we thought, hmmm, it's probably people who are up for tenure soon, or maybe it's the people who just graduated, and they want to get their name out there," Larkin says. "We were thinking very much along the traditional economic model--people doing things for rational, career-promoting reasons." Larkin shared these hypotheses with HBS colleague and mentor Max Bazerman, a leading ethics scholar, who had a different theory. "Max told me, 'I'll bet people are doing this because they feel bad that their papers aren't being downloaded as much as their colleagues' papers,' " Larkin says. "So we looked at that." It turned out Bazerman was right. The researchers found that authors were more likely to download their own papers repeatedly when a colleague's paper was performing especially well on the site, or when a very similar paper to an author's was newly released and received significant downloads. Deceptive downloads also increased during times when a paper was close to gaining (or losing) placement on a top 10 list. (Ironically, one of the most downloaded SSRN papers of all time is 'I've Got Nothing to Hide' and Other Misunderstandings of Privacy.) "Again, what was surprising to us was how little we found in terms of the economic reasons for doing this," Larkin says. "By far, the biggest predictor of this behavior was fear of being socially inferior to one's peers." (Those tempted to boost a paper's usage stats should note that SSRN's terms of service now state that the attempted manipulation of download counts is against site rules, and that the organization retains the right to ban anyone caught abusing the system.) Ramifications for salary managers The field evidence from the worlds of software sales and academia indicates that companies need to bear social comparison in mind when designing compensation plans. Larkin discusses the issue in The Psychological Costs of Pay-for-Performance: Implications for the Strategic Compensation of Employees, a paper he cowrote with HBS colleague Francesca Gino and Washington University's Lamar Pierce. The authors argue that paying each employee solely according to his or her performance is actually an inefficient strategy; it can lead to resentment or even sabotage on the part of employees who believe they are underpaid compared with their colleagues. Thus, a standardized salary scale, combined with ancillary incentive programs, may be the best way to motivate employees. "When deciding how much effort to exude, workers not only respond to their own compensation, but also respond to pay relative to their peers as they socially compare," the paper states. That's important food for thought, considering that Facebook, LinkedIn, and other such sites have made it de rigueur to share information that we used to keep to ourselves. "It used to be that our salaries were very secret, but they're getting less and less secret because of social networking," Larkin says. "And people get upset quickly when they realize that there are large variances in how much other people are paid. Companies need to realize that with the overflow of information these days, paying peers differently is going to affect not only how those people feel but how their colleagues feel as well." About the author Carmen Nobel is senior editor of HBS Working Knowledge.

Horrible Boss Workarounds

October 27, 2011 Author: Carmen Nobel Executive Summary: Bad bosses are generally more inept than evil, and often aren't purposefully bad, says Professor Rosabeth Moss Kanter. She discusses common bad-boss behaviors, and how good colleagues can mobilize to overcome the roadblocks. Key concepts include: Common traits of bad bosses include a failure to communicate goals effectively, if at all; a failure to realize that employees have more to offer than their job descriptions dictate, and a tendency to get caught up in the details to the detriment of the big picture. Employees can work around bad-boss roadblocks by proactively mobilizing their peers toward a common goal. About Faculty in this Article: HBS Faculty Member Rosabeth Moss Kanter is the Ernest L. Arbuckle Professor of Business Administration at Harvard Business School. On film, few characters are more obviously villainous than the extremely bad boss. There's Star Wars' Darth Vader (who manages a disrespectful underling by strangling him with his mind), Katharine Parker in Working Girl (who shamelessly steals ideas from the movie's hero), John Milton in The Devil's Advocate (who is literally the devil incarnate), the eponymous villains in the recent hit Horrible Bosses (whose infractions include cocaine abuse and sexual harassment) …the list goes on and on. Reality is more nebulous, of course. Bad bosses are generally more inept than they are evil, and often aren't purposefully bad, says Harvard Business School Professor Rosabeth Moss Kanter, who has authored several business management books, including Confidence: How Winning and Losing Streaks Begin and End and SuperCorp: How Vanguard Companies Create Innovation, Profits, Growth, and Social Good "What's horrible is often in the eye of the beholder," she says. "There are many people who complain about their bosses without taking a look at themselves, and vice versa." Kanter recently sat down with HBS Working Knowledge to discuss some of the factors that create bad bosses—and what employees can do to resist them. As she states in a recent column in Harvard Business Review, "The best cure for horrible bosses is wonderful colleagues." Bad boss behavior #1: failure to communicate. At any level of management, it's important that bosses effectively communicate company or team goals from the get-go. "Empowerment can happen only when there's a consensus on goals and an agreement that certain standards have to be met," Kanter says. "If there isn't agreement in the beginning, that's when certain situations start to unravel." But problems arise when bosses fail to realize that they're not communicating clearly. Kanter cites an old joke as an example: A man drives to a gas station to fill up his tank, and the attendant can't help noticing that there's a penguin in the backseat of the car. "Yes," the man says. "I found him there this morning, and I don't know what to do with him." The attendant suggests that the man take the penguin to the zoo right away, and the man agrees that this is an excellent idea. But the next day, when the man returns to the same gas station, the clerk notices that the penguin is still in the backseat of the car—only this time it's wearing sunglasses. "Hey," the clerk says. "I thought I told you to take the penguin to the zoo." The man nods and says, "I did take him to the zoo. He had such a great time that I decided to take him to the beach, too!" Miscommunication often leads to situations in which bosses throw up their hands in frustration, believing that their employees are incapable of delivering good ideas, when in fact the problem is that the employees just aren't clear on the mission. "Sometimes [bosses] have it in their head that they know what they're driving at, but they don't always bother to tell everyone what's in their head, and if they do, the translation is not always clear," Kanter says. "So CEOs make speeches all the time and think everyone is interpreting their words in the exact same way, and they're not. And they're surprised later to find out that what they thought was going to happen didn't exactly happen. Constant, consistent communication is important." Bad boss behavior #2: pigeonholing. Another common bad-boss trait is the inability to accept the idea that employees' skills and talents probably exceed their job descriptions. Not only is this attitude demoralizing for employees, but it discourages collaboration and idea sharing as well. For example, "there was one CEO of a company in the IT industry who kept everyone on his executive team confined to narrow little boxes," Kanter says. "One member of the team had actually built several successful IT companies and so knew a lot about marketing. But because he had been hired for a technology job, the CEO would listen to him only on technology matters." Bad boss behavior #3: inability to zoom in and out. Kanter also stresses the importance of zooming—the ability to view the world through an adjustable lens as the situation demands, examining particular details in certain situations and maintaining a broad view of the mission in others. Talented bosses know how and when to adjust their lenses. But for those who can't or won't adjust, staying stuck on zoomed out is the lesser of two evils, Kanter says. "If I had to choose between getting too close to the details or getting too far out and losing the situation in the clouds, I would always go for zooming out," Kanter says. "If employees are forced to stay too focused on the details, without thorough preparation, without clear goals, without a larger vision, without a sense of purpose, then they are left to be dependent on the daily moods or whims of a boss. Bosses who spend too much time zooming in on the details are more likely to lose sight of the big picture and the goals." In those cases, Kanter says, it's up to the employees to keep each other on track. Working around a bad-boss roadblock In situations where the boss is obviously impeding progress or morale, Kanter recommends that employees try to mobilize their peers to create a course of action. She acknowledges that this is easier said than done, especially when a bad boss has created a culture of fear. But teaming up to effect change need not require a palace coup. "If you test the waters in very small and diplomatic ways, you're more likely to get a hearing at higher levels when you come with a constructive solution—not one that is a demand, but rather one that has alternatives and options associated with it," she says. "Self-organizing is the new mode for getting things done in companies. Yes, you have a set area of responsibility in your job, but you also have the ability to see an issue or a problem, to find a few other people who see the issue or problem, and to try to find a constructive solution. If you start small, then you can overcome the courage gap. People are timid and scared that people are too set in their ways. But in fact the boss may not be sure what the solution should be and is just waiting for someone to come forward." In her classes, Kanter teaches the case of the upscale cookware retailer Williams-Sonoma, where the CEO repeatedly eschewed the idea of online sales. He wasn't a terrible boss, but he didn't use computers himself and didn't see the value in the strategy. So a group of self-starters went ahead and designed a small, low-risk e-commerce pilot anyway. It tested well, the CEO was at last impressed, and the project moved forward. "Williams-Sonoma ended up with one of the best e-commerce sites on the web in the early years of e-commerce," she says. "And it was a small group of believers that made that happen." Ideally, of course, collaboration is borne of shared excitement over a shared goal rather than shared frustration over a lousy boss. Kanter notes that many well-meaning companies attempt to encourage collaboration by assembling groups of employees with shared traits rather than shared goals. "I've seen a lot of people try to form networks in companies: Let's get all the women together, let's get all the working parents together, let's get all the Asian Americans together. That's usually good for one or two lunches if there's no agenda. The secret of collaboration is that you have a task that you care about together." Carmen Nobel is senior editor of HBS Working Knowledge.

Four Ways Christians Can Influence the World

Discipleship John Stott: Four Ways Christians Can Influence the World How we can be salt and light. John R. W. Stott | posted 10/20/2011 10:15AM Alienation was originally a Marxist word, and Karl Marx meant by it the alienation of the worker from the product of his labors. When what he produces is sold by the factory owner, he is alienated from the fruits of his work. But nowadays the word alienation has a much broader meaning of powerlessness. Whenever you feel politically or economically powerless, you are feeling alienated. Jimmy Reid, the well-known Marxist counselor in Glasgow and leader of the Clydeside Ship Workers, when he was rector of Glasgow University, said, "Alienation is the cry of men who feel themselves to be the victims of blind economic forces beyond their control. Alienation is the frustration of ordinary people who are excluded from the processes of decision-making." Have we any influence? Have we any power? That's the question. The word influence can sometimes be used for a self-centered thirst for power, like in Dale Carnegie's famous book How to Make Friends and Influence People. But it can also be used in an unselfish way of the desire of Christians who refuse to acquiesce to the status quo, who are determined to see things changed in society and long to have some influence for Jesus Christ. Are we powerless? Is the quest for social change hopeless before we begin? Or can Christians exert some influence for Jesus Christ? There is a great deal of pessimism around today that grips and even paralyzes people. They wring their hands in a holy kind of dismay. Society is rotten to the core, they say. Everything is hopeless; there is no hope but the return of Jesus Christ. As Edward Norman, dean of Peter-house in Cambridge, once said in a radio interview, "People are rubbish." People are not rubbish. People are made in the image of God. Indeed they are fallen, but the image of God has not been destroyed. Are they capable of doing no good? But people are not rubbish. People are men and women made in the image of God. Indeed they are fallen, but the image of God has not been destroyed. Are they capable of doing no good? The doctrine of total depravity, which means that every part of our human being has been tainted by the Fall, does not mean that we're incapable of doing any good. Jesus himself said that although you are evil, you are able to do good things and give good gifts to your children. Now, of course we believe in the Fall. We believe that when Christ comes again he is going to put things right. If you develop a Christian mind, you don't concentrate exclusively on the fall of man and the return of Christ. You also think about the creation and about the redemption through Jesus Christ. And we have to allow the creation to be, as it were, qualified by the Fall, and the Fall by the Redemption, and the Redemption by the Consummation. And the Christian mind thinks in terms of this total purpose of God, which includes the Creation, the Fall, the Redemption, and the Consummation. If we are pessimists and think we are capable of doing nothing in human society today, I venture to say that we are theologically extremely unbalanced, if not actually heretical and harmful. It's ludicrous to say Christians can have no influence in society. It's biblically and historically mistaken. Christianity has had an enormous influence on society down through its long and checkered history. Look at this conclusion of Kenneth Latourette in his seven-volume work on the history of the expansion of Christianity: No life ever lived on this planet has been so influential in the affairs of men like the life of Jesus Christ. From that brief life and its apparent frustration has flowed a more powerful force for the triumphant waging of man's long battle than any other ever known by the human race. By it millions have been lifted from illiteracy and ignorance and have been placed upon the road of growing intellectual freedom and control over the physical environment. It has done more to allay the physical ills of disease and famine than any other impulse known to man. It's emancipated millions from chattel slavery and millions of others from addiction to vice. It has protected tens of millions in exploitation by their fellows. It's been the most fruitful source of movement to lessen the horrors of war and to put the relations of men and nations on the basis of justice and of peace. rest of article go to

Tuesday, November 1, 2011

Should the Screening Age for Colorectal Cancer Be Lowered?

Albert B. Lowenfels, MD Posted: 10/21/2011 Is It Time to Lower the Recommended Screening Age for Colorectal Cancer? Davis DM, Marcet JE, Frattini JC, Prather AD, Mateka JJ, Nfonsam VN J Am Coll Surg. 2011;213:352-361 Summary The authors used cancer incidence data from the SEER database to analyze age-specific changes in the incidence of colorectal cancer in the United States. A marked increase in the incidence of colorectal cancer was found in the 40- to 44-year age group. In 1987, the incidence was 10.7 per 100,000; in 2006, the incidence had climbed to 17.9 per 100,000, an increase of 67%. The increase was even more pronounced for rectal cancer, amounting to over 3% per year. However, incidence rates for colorectal cancer in the > 50 age group decreased. Viewpoint The currently accepted screening age for colorectal cancer is 50 years. The authors of this report suggested that lowering the screening age may be appropriate on the basis of data that showed a significant increase in the incidence of colorectal cancer in younger individuals, especially in the rectum. Although sigmoidoscopy would be adequate for detecting rectal tumors, many tumors in the colon would escape detection. The authors pointed out that the incidence of colorectal cancer in younger individuals resembles the incidence rate of similarly aged patients with cervical cancer -- a group that is routinely screened. Estimates of the cost of lowering the screening age were not included and still need to be obtained.

Consistent Exercise Linked to Lower Risk for Death From Colon Cancer

From Medscape Medical News > Oncology Fran Lowry January 7, 2011 — Add another study to the body of literature that says exercise is good for you, especially with regard to modifying cancer risk and outcomes. The latest research, carried out by at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri, shows that regular long-term physical activity is associated with a lower risk for colon cancer mortality. The study appears in the December issue of Cancer Epidemiology, Biomarkers & Prevention. "This study is among the first to show that physical activity can make the disease less deadly," lead author Kathleen Y. Wolin, ScD, told Medscape Medical News. "It supports an existing body of research that suggests that physically active lifestyles have a host of benefits, both for cancer prevention and cancer-related death." However, an expert not involved in this research who was approached for comment said the study was negative, because it fails to show that exercise reduces the risk of getting colon cancer. Previous Studies There is already a body of literature showing the benefits of exercise on both physical and mental well-being, including several studies showing a reduction in the risk for cancer, as reported recently by Medscape Medical News. In November 2010, it was reported that women who exercised for at least 150 minutes a week might have a reduced risk for endometrial and postmenopausal breast cancer. In addition, new guidelines from the American College of Sports Medicine highlighted the benefits to cancer patients of exercise training both during and after cancer treatments to improve physical functioning, quality of life, and cancer-related fatigue. Effect on Colon Cancer In the latest study, Dr. Wolin and her colleagues sought to examine whether changes in physical activity alter the risk for colon cancer incidence and mortality. "We know people will be active when they are younger, but then work or family obligations get in the way, and they tend to become less active. Others may not have been that active in young adulthood, but then in their 30s or 40s, when the pounds start creeping on, or when they start to be more concerned about their health and wanting to live longer, they become physically active," Dr. Wolin explained. "In this study, we were able to look at people's behaviors at multiple time points." The researchers used data from the American Cancer Society Cancer Prevention Study II (CPS-II) Nutrition Cohort to look at whether changes in physical activity influenced either the incidence of colon cancer diagnosis or the risk for death from the disease. CPS-II comprised more than 150,000 men and women. To determine how exercise affected colon cancer, the researchers compared levels of physical activity between 1982 and 1997, and linked those activity levels to the number of colon cancer diagnoses between 1998 and 2005 and to the number of colon cancer deaths that occurred between 1998 and 2006. Physical activity included walking, jogging/running, lap swimming, tennis, racquetball, bicycling, stationary biking, aerobics/calisthenics, and dancing. The study found that people who were consistently active for at least 10 years had a significantly lower risk of dying from their colon cancer than those who were consistently inactive (multivariable hazard ratio, 0.45; 95% confidence interval, 0.34 to 0.59). This held after adjustment for body mass index. People who were consistently active over 15 years had half the risk for colon cancer death as those who were more sedentary. However, being physically active did not appear to reduce their risk of getting colon cancer, Dr. Wolin said. "Regular long-term physical activity was associated with a lower risk of colon cancer mortality," she said. "People often wonder around the start of a new year whether exercise really will help them stay healthy or whether it's already too late. It's never too late to start exercising, but it's also never too early to start being active. That's the message we hope people will take away from this study." A Negative Study That Fails to Show That Exercise Reduces Risk Asked to comment on this study for Medscape Medical News, Susan G. Fisher, MS, PhD, professor and chair of the Department of Community and Preventive Medicine at the University of Rochester in New York, said that it was well done, but because the data were not collected prospectively, it has limitations. "It's a negative study. It fails to show that increasing physical activity over a 10- to 15-year period reduces an individual's risk of developing colon cancer," she said. "While this study does suggest that individuals who consistently participate in vigorous regular exercise throughout adulthood are less likely to die from colon cancer, the risk of developing colon cancer does not appear to be reduced," she said. Because these results are extracted from data that were previously collected, there are potential limitations in the methods used to measure the amount of physical exercise over a 10- to 15-year period, Dr. Fisher added. "These measurement difficulties may alter the study results. For instance, if I exercised 3 or 4 times a week and developed colon cancer, it's not unreasonable to think I would begin to have some symptoms, some indigestion or maybe fatigue, even before my diagnosis, and I would end up decreasing my exercise program. So people may be decreasing their exercise because they're feeling sick; I don't think they controlled for that perfectly," she said. Cancer Epidemiol Biomarkers Prev. 2010;19:3000-3004. Abstract

Wednesday, October 26, 2011

Bahrain Condemned Over Doctors' Jail Terms

From Reuters Health Information By Stephanie Nebehay GENEVA (Reuters) Oct 03 - Bahrain's handing down of harsh sentences to 20 doctors followed flawed trials that failed to meet international standards of transparency and due process, the United Nations human rights office said on Friday. The World Medical Association also condemned as "totally unacceptable" the jail terms imposed by a military court, while the World Health Organization said medical personnel should never be punished for doing their duty of treating all patients. A security court sentenced 20 doctors to jail on Thursday for between five and 15 years on theft and other charges, the state news agency said, in what critics claimed was reprisal for treating injured protesters during unrest in the Gulf kingdom this year. "For such harsh sentences to be handed down to civilians in a military court with serious due process irregularities raises severe concerns," Rupert Colville, spokesman for U.N. High Commissioner for Human Rights Navi Pillay, told a news briefing. Defendants had limited access to lawyers and most lawyers did not have enough time to prepare properly, he said. "We've even heard reports of detainees calling their families the day before their hearing asking them to appoint a lawyer," he said. The hearing itself had taken less than 10 minutes, according to a defense lawyer. The court -- whose three judges are appointed by the military -- "has also not been investigating torture allegations and has not permitted recordings of the proceedings," Colville said. The doctors denied the charges, saying they were invented by the authorities to punish medical staff for treating people who took part in anti-government protests. They were among dozens of medical staff arrested during protests led by the Shi'ite majority demanding an end to sectarian discrimination and a greater say in government. Bahrain's Sunni Muslim rulers quashed the protests in March, with the help of troops from fellow Sunni neighbors Saudi Arab and the United Arab Emirates. At least 30 people were killed, hundreds wounded and more than 1,000 detained -- mostly Shi'ites -- in the crackdown. On September 26th, Bahrain sentenced 32 men to 15 years in jail over violent protests and handed the head of a teachers' union a 10-year prison term for calling for the overthrow of the Gulf Arab monarchy. Two days later, a military court upheld life sentences against Shi'ite opposition leaders Colville, referring to the doctors, said: "The charges have varied from illegal gatherings or expressing hatred of the government to what one normally consider actual crimes such as murder and destruction of property. So quite a lot of these charges related to freedom of expression and freedom of assembly." Bahrain's government had announced that all cases would be referred to civilian courts in October, but it was not clear how appeals by those convicted in military courts would be handled, he said. "It is a sad day for medicine when physicians are incarcerated for treating patients. Physicians have an ethical duty to care for all patients in situations of conflict irrespective of the political circumstances," World Medical Association President Wonchat Subhachaturas said in a statement. The body links eight million physicians in 97 countries. "In times of conflict, medical neutrality must be respected under the Geneva Conventions," Fadela Chaib, spokeswoman of the WHO, a United Nations agency, said. "This means that injured people must be allowed to receive treatment regardless of their affiliation, health care workers must be allowed to access them and treat them and medical facilities including transport and personnel must all be protected," she told reporters.

Smoking Set to Cause 40 Million Extra Tuberculosis Deaths

From Medscape Medical News Kate Johnson October, 4, 2011 — If worldwide smoking trends continue to 2050, tuberculosis (TB) mortality rates could jump by 40 million, according to a study published online today in the British Medical Journal. "Aggressive tobacco control measures could avert millions of deaths from tuberculosis over the next four decades if these predictions are correct," write Sanjay Basu, MD, from the University of California, San Francisco, and colleagues. "In the past, multinational tobacco companies have attempted to persuade health organisations to focus on infectious diseases rather than tobacco control. Our results show that this is a false dichotomy: tobacco control is tuberculosis control," they note. Smoking increases the rate of latent TB by a factor of 1.9, active TB by 2.0, and death from TB by 2.6, after adjustment for socioeconomic status, they explain. The researchers used a mathematical model to predict the effect of various worldwide smoking scenarios on the rates of TB and death between 2010 and 2050. The model predicted that if smoking rates continue along the same trajectory as they did between 2005 and 2010, there will be a 7% increase, or 18 million excess cases of TB, by 2050 (from 256 million to 274 million) and a 66% increase, or 40 million excess deaths (from 61 million to 101 million), compared to a nonsmoking model. This would translate to a 20-year delay in meeting the Millennium Development Goal target of reducing TB mortality by half between 1990 and 2015, they reported. In a more pessimistic scenario, the model predicted that if smoking rates were to increase at twice the current rate (to a maximum of 50% prevalence), there would be a 6% increase in TB cases (reaching a total of 290 million) and a 12% increase in TB deaths (to a total of 114 million) compared to the impact of current smoking trends. If aggressive tobacco control efforts were to reduce smoking prevalence by 1% per year until eradication, the TB infection and mortality rate could be reduced by 13% and 27%, respectively, from the current trajectory, they added. The authors have disclosed no relevant financial relationships. BMJ. Published online October 4, 2011.

The Year's Best Medical Practice Management Tips: 2011

From Medscape Business of Medicine Leslie Kane, MA Posted: 10/24/2011 Medical practices are going through seismic changes, and physicians are looking for ways to increase revenue or lower costs. There are many tactics that address the myriad ways to do both of those: by changing practice strategy; adding services; solving patient-flow and workflow problems that have been ignored; and focusing more on getting money that is owed to you. Throughout the year, Medscape has offered expert advice on ways to build a more successful practice. Here are some of the tips that physician readers found most helpful. 1. Offer Your Patients One-Stop Shopping For your patients' convenience, do everything possible in-house: Draw blood, conduct urinalyses and stool guaiac tests, and so forth on your own. You should be able to bill for these items, and your patients won't have to wait at an outside lab to get the services that they need. When your patients need outpatient procedures that you cannot offer in-house, help them schedule appointments while they are in your office so that they won't have to hassle with the bureaucracy. Make their lives easier and they will reward you for it. 2. Get New Patients by Creating a Niche You'll go broke if you wait for sick patients to walk through the door. There aren't enough of them to go around. Consider doing wellness medicine, which widens the scope of potential patients to include everyone. Develop a subspecialty such as in dermatology, thyroid disorders, diabetes, or geriatrics. Get into occupational health -- pre-employment physicals, drivers' physicals, flight physicals, workers' compensation for minor injuries, drug screening, etc -- and advertise that you offer these services. A river of money may run by lawyers, but it doesn't run by physicians. We have only rivulets, but add them up and you will have a mighty stream. 3. Avoid Gaps in the Schedule Due to No-Shows Start with the basics: Have a no-show policy that charges patients either for the first or the second no-show appointment. It may be difficult to collect, but if patients wish to return to the practice, collect it via credit card when booking an appointment. Communicate the no-show policy to patients. Confirm all new patient visits 36 hours prior to the visit. If a patient cancels, that gives the practice time to fill the slot. Develop a cancellation list of patients who want to be seen sooner, and call them for cancellations. Track no-show patient characteristics. Are they emergency department referrals? Follow-ups? Is the no-show rate so high that the group needs to book extra patients to keep gaps from the schedule? Monitor the number of no-shows at baseline, implement changes, and set a goal that reduces the number. Graph your progress, and involve all staff members in meeting this goal. 4. Try to Get Paid on the Basis of RVUs Rather Than Collections, if You're in a Hospital or Large Group Many hospital billing services are really bad. Relative-value units (RVUs) are directly tied to the coding. It's a better measure of patient acuity than collections, and it eliminates contractual discounts. One problem for doctors starting a new job is that they may not get a productivity bonus in the first year if their incentive is based on collections that are measured annually. Because there's typically a 3-month lag before their charges are collected, the extra revenue that they generated through hard work won't show up in the first year. In contrast, they can get a productivity bonus in the first year if they're rewarded for hitting RVU targets, notes Tommy Bohannon, Senior Director of Recruiting and Development Training for Merritt Hawkins & Associates in Dallas, Texas. If a hospital or group includes quality metrics in its payment calculation, that will usually constitute about 10% of compensation. Sometimes a contract will specify that various percentages of the potential productivity bonus be paid to doctors, depending on how well they score on the quality measures. Intangible factors may account for another 10%. Among those factors are patient satisfaction, participating in committees, doing community service or community education, and public speaking, he says. In some cases, physicians who work harder and see more patients can earn more than those who spend a lot of time being good citizens. 5. Make Sure That All Physicians Are Pulling Their Own Weight, and Deal With Those Who Aren't Though a daunting prospect, you must have a frank discussion with the physicians who are dodging a share of the duties, regardless of seniority. "The senior doctor shouldn't carry more weight than the other partners. We should all be even stakeholders who are looking out for the common good of the practice," says Practice Management Expert Judy Capko, of Capko & Company, in Thousand Oaks, California. Advance preparation is essential. "There's a certain baseline cost for carrying a doctor, whether 10 or 20 patients are being seen. You need to gather a lot of data to see what the financial impact of this physician's routine is on the practice," Capko says. Determine what you need an underperforming physician to do; discuss the best way to lay out your position; and present it as a united group. The group spokesman should be someone who this physician greatly respects. Although some practices engage a management consultant as a facilitator, "you have a much better chance of succeeding if a physician expresses the group's viewpoint than if the consultant is given the role of dealing with this. Otherwise, the doctor who feels challenged is just going to attack the consultant. He or she is not going to see that the doctors agree with that consultant unless that's voiced," Capko says. Steer the discussion away from the physician's behavior and focus on the long-term health of the practice. Capko recommends: "You have been the foundation of this practice. We owe you a lot, but this practice -- your practice -- is struggling with some issues, and we need to address these for the future." Then you can delineate your concerns. 6. Get Payment Even if Your Patient's Check Bounces Your practice's financial policy needs to include your policy on bounced checks and what steps the practice will take to recover that payment. If there are bank charges, stipulate that the patient will be charged for those fees. If you're in a state that allows you to collect a processing fee above the bank charges, that needs to be stipulated in the financial policy that a patient signs. For example, in Illinois the value of what can be collected is 3 times the face value of the check plus court costs if litigated. In North Carolina it is the cash amount of the check, bank fees, plus $35 for the handling fees. In Florida, you're only allowed to charge $20 above the check value and bank fees. The National Check Fraud Center lists the bad-check laws for each state. It is helpful to publish or reference the consumer credit laws in your financial policy. These simple steps will keep everyone on the same page and establish the financial component of the medical care relationship. Successful practices will make every method available for patients to pay bills. Cash, checks, postdated checks, credit cards, debit cards, and online services such as PayPal are all viable means for patients to settle their debts. Postdated checks are a good collection tool unless they bounce. Postdated checks are considered "promissory notes" rather than checks unless they are truly held until the date written on the check by the debtor before deposit. Consider using a check-scanning system from a company that guarantees the check if it clears. This will protect the practice as well. The monies are immediately deposited into your practice's bank account without the added burden of a trip to the bank. Almost all of these payment methods have some amount of service fee attached to them. However, the fees paid are a small price to pay for the general practice's cash flow. The smart practice will shop around for the bank with the best small-business service package available or will look to build a hybrid system with a couple of different vendors for the various services needed. No matter how you build your financial recovery process, you're wise to make as many methods available as possible as long as those methods protect the practice. 7. Be Money Smart When You Move to an EHR Take a closer look at application service provider (ASP) technology. ASP technology means that the electronic health record (EHR) program and data are housed securely at a vendor's or an institution's location; you don't need to have expensive servers and tech support in your office if you have high-speed Internet access. The ASP EHR model will range from about $350 to $650 per month, plus training. Billing software will be an additional cost. The other option is buying an EHR that requires an in-house server and software. Systems like this that I reviewed averaged between $40,000 and $60,000 depending on the amount of bells and whistles added. With ASP models, benefit changes and software improvements are continually updated on your site so that your practice is always using the most recent data and advanced software. You don't need proprietary hardware or additional servers. You do not need to house your own server, and many systems have a minimal cost up front. You also will be able to log in from home to view patient data and reports. The downside to ASP technology is that when the Internet is down, so are you. Make sure that you have good, stable Internet service before considering this option. 8. Think About a Professional Services Agreement if You're Considering Employment Professional services agreements (PSAs) have been around for many years but are now growing in popularity. Physicians may view a PSA as a way to get the advantages of employment without selling their practices, and hospitals see it as a mechanism for controlling doctors without employing them directly. "In a PSA, the physicians maintain their own professional corporation," explains Alice Gosfield, a Philadelphia, Pennsylvania, healthcare attorney. "The physicians assign the right to payment to the hospital; the hospital bills for them; and the physicians receive a base salary, usually with productivity bonuses. In more and more PSAs, the physicians also get bonuses that are based on quality metrics." Despite doctors' retention of practice ownership, Gray Tuttle, a practice management consultant in Lansing, Michigan, says that a PSA "is very similar to an employment relationship. The end results financially are close to identical. The difference is that the physicians are employed by a practice that they own. Typically the hospital will employ everybody else including the receptionists, nurses, and technicians. The providers -- physicians and even midlevels -- retain their relationship with the professional corporation." The physicians still own the practice assets including ancillary services, which, notes Tuttle, they lease to the hospital. The hospital must factor revenues from those ancillaries into the amount that it agrees to pay the physicians or the doctors won't sign up, he adds. "Typically the hospitals provide reasonably long guarantees with no pay cuts and, in many cases, enhanced reimbursement," says Tuttle, adding that the guarantees may last up to 5 years for specialists and 3 years for primary care doctors. One reason why PSA reimbursement may be higher than what the doctors previously earned is that the hospital can often negotiate higher rates than most practices could on their own. In addition, some hospitals will pay doctors extra for quality and efficiency. 9. Be Aware of Which Aspects of Prevention Care Are Now Reimbursed The Patient Protection and Affordable Care Act has given physicians new tools to offer patients easier access to preventive care. Starting in January 2012, Medicare will eliminate its Part B deductible and copayments for a host of proven preventive services including bone mass measurement; some cancer screenings; diabetes and cholesterol tests; and flu, pneumonia, and hepatitis B vaccinations -- among other services. Medicare now covers annual wellness visits. It covers smoking cessation counseling. It began paying a 50% rebate for the brand-name medications that seniors need to manage chronic conditions when they reach the coverage gap known as the "doughnut hole." Your patients in new private insurance plans also won't pay out of pocket for many preventive services including screening blood pressure, diabetes, cholesterol, and for certain cancer screenings; counseling to quit smoking or cut alcohol consumption; routine vaccinations; and regular well-baby and well-child visits from birth to 21 years of age. The Centers for Medicare & Medicaid Services is working to make sure that you and your patients have the support that you need to achieve better health. Our investment in prevention takes a big step in that direction. If you or your patients are looking for more detailed information, go to and click on "Learn About Prevention" at the top.

Thursday, October 20, 2011

10 Lessons I Learned From Steve Jobs

Jason Scharz Authors the popular investment newsletter, Economic Weather Station, which is available at During this time of reflection I think we all feel a profound sense of gratitude for the life of Steve Jobs. He was exemplary in so many ways. For me, it’s about so much more than the iUniverse he created. It’s the way he did it. Some of the priceless pearls of wisdom that he left behind include the following life lessons: 1- Don’t be afraid to fail. “I didn’t see it then, but it turned out that getting fired from Apple (AAPL) was the best thing that could have ever happened to me. The heaviness of being successful was replaced by the lightness of being a beginner again, less sure about everything. It freed me to enter one of the most creative periods of my life.” Steve Jobs, June 12, 2005. 2- Stay in the game. The real breakthrough moments in Steve’s career happened after 25 years of struggle. “Sometimes when you’re in the middle of one of these crises, you’re not sure you’re going to make it to the other end. But we’ve always made it, and so we have a certain degree of confidence, although sometimes you wonder.” Steve Jobs, March 7, 2008. “I’m convinced that about half of what separates the successful entrepreneurs from the non-successful ones is pure perseverance.” Steve Jobs interview, 1995. 3- Follow your passion wherever it leads. “Being the richest man in the cemetery doesn’t matter to me … Going to bed at night saying we’ve done something wonderful… that’s what matters to me.” Steve Jobs, May 25, 1993. “Almost everything–all external expectations, all pride, all fear of embarrassment or failure–these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart.” Steve Jobs, June 12, 2005. 4- Just say no. “People think focus means saying yes to the thing you’ve got to focus on. But that’s not what it means at all. It means saying no to the hundred other good ideas that there are. You have to pick carefully.” Steve Jobs, June 2003. “I’m as proud of what we don’t do as I am of what we do.” Steve Jobs, February 6, 2006. 5- Expect excellence. No company innovates on a regular schedule like Apple. “My job is to not be easy on people. My job is to make them better.” “Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” 6- A master architect builds a platform upon which others are given the capacity to thrive. Apple’s ecosystem and especially its App Store enabled creativity to flourish. 7- Love and passion come first. Everything else will take care of itself. “My job is to make the whole executive team good enough to be successors, so that’s what I try to do.” “When I hire somebody really senior, competence is the ante. They have to be really smart. But the real issue for me is, Are they going to fall in love with Apple? Because if they fall in love with Apple, everything else will take care of itself. They’ll want to do what’s best for Apple, not what’s best for them, what’s best for Steve, or anybody else.” Steve Jobs, March 7, 2008. 8- Too many of us fail to reach our potential because of the bureaucracy that binds us. “Why join the navy if you can be a pirate?” Steve Jobs, September 1982. 9- Quality vs. quantity? Steve understands it. “Quality is more important than quantity. One home run is much better than two doubles.” Steve Jobs, February 6, 2006. 10- Progress comes from within. “The cure for Apple is not cost-cutting. The cure for Apple is to innovate its way out of its current predicament.” Steve Jobs, 2004. There will never be another Steve Jobs. It has been a pleasure covering Apple with him at the helm and I look forward to continued greatness coming from the innovative company that he built. The scope of the Information Age and the evolution of the mobile revolution is still in its infancy. To honor Steve, we have organized an event that will include a who’s who of Apple investors, analysts, and commentators to provide hedge fund style research for individual investors. It is the first event of its kind. We’re calling it the AAPL Investor Summit and we hope it will provide you with profitable investment strategies for the years to come. For more information, please visit A portion of the proceeds will be donated to the Huntsman Cancer Research Foundation. RIP Steve Jobs.

Monday Morning Atheist

Source: Book Monday Morning Atheist by Doug Spada & Dave Scott ISBN978-0-9839628-0-9 Monday Morning Atheist: Someone who believes in God but who works like He does not exist Six Life in Work Principles The work of the righteous leads to life ... Proverbs 10 v16 The personal objective is to have: 1. Clarity – awareness of God’s original purpose for work that helps you live your whole life with greater clarity Genesis 2, Exodus 20 : 8 -11 2. Calling – affirmation of your unique design and how God has strategically placed you at work to fulfill his calling Eph 2 v 10, Psalm 139 3. Balance - alignment with the role of work that allows you to pursue biblical priorities and life balance Colossians 3 v 17 – 4 v1 4. Skills – ability to please God and serve others through the development and excellence of your work skills Proverbs 22v29, 1 Cor 10v31 5. Influence – authenticity in personal character at work as u experience purposeful faith conversations and grow your influence titus 2 v 9 – 10, Matt 5 v16 6. Relationship – alliance with Christ helping you effectively navigate work issues and develop healthy relationships Heb 3v13, James 2v15-17 Action ideas 1. Pray for 3 people you work with – pray privately for his blessings n intervention 2. Begin your day with God – read bible, begin with few verses – may use devotional, or a chapter of proverbs a day over one month (there are 31 chapters) 3. Commit to a higher standard of work – decide to glorify god with your work, better attitude, better service or product 4. Cut out complaints – Complaining is not part of God’s will. Talk to God about the area u want to complain about, seek his help to develop better response 5. Go the extra mile –if u are used to doing the bare minimum – take it one step further – higher than what others require of u – do it every day for one week 6. Cultivate gratitude – be thankful for whatever blessings. At the end of the day, say aloud what u are thankful for each hour of the working day 7. Be slow to anger – when u are frustrated or angry – try reciting a bible verse e.g. Micah 6v8 tells what God expects of u – to do justice, love mercy and walk humbly with your God 8. Work with friends, family or a spiritual mentor to help u identify specific habits or attitudes in your work life god may want to change – commit prayerfully to a small action u can do each day.

Wednesday, October 19, 2011

How 'Hybrid' Nonprofits Can Stay on Mission

Published: October 17, 2011 Author: Carmen Nobel Executive Summary: As nonprofits add more for-profit elements to their business models, they can suffer mission drift. Associate Professor Julie Battilana says hybrid organizations can stay on target if they focus on two factors: the employees they hire and the way they socialize those employees. Key concepts include: In order to avoid mission drift, hybrid organizations need to focus on whom they hire and whether their employees are open to socialization. Because early socialization is so important, hybrid firms may be better off hiring new college graduates with no work background rather than a mix of seasoned bankers and social workers. The longer their tenure in a hybrid organization, the more likely top managers may be to hire junior people. HBS Faculty Member Julie Battilana Julie Battilana is an associate professor in the Organizational Behavior unit at Harvard Business School. For those who like to view things in black and white, it's tempting to divide the working world into two camps. There is the for-profit sector, primarily driven by the prospect of financial success. And then there's the not-for-profit world, which eschews the almighty dollar in the pursuit of curing societal ills. In reality, though, the line between the two is growing blurrier. "In the not-for-profit sector, a number of organizations are trying to be less dependent on donations and grants," says Julie Battilana, an associate professor at Harvard Business School. "In the meantime, facing increased public pressure to help address societal problems, for-profit firms have adopted social responsibility policies, which have pushed them to focus more on social initiatives." "Some of them have been accused of losing sight of their social mission, or even having a negative impact on the populations they were trying to help" In the wake of this evolution over the past decade, more organizations have adopted a hybrid business model in which a social mission is the primary goal, but they still aim to generate enough commercial revenue so they can survive and thrive without depending on charitable donations like a typical nonprofit would. Commercial microfinance organizations often adopt a hybrid model, for example: they provide business loans to poor people who wouldn't traditionally qualify, but they still depend on the loan recipients paying them back with interest. The main problem with the model is that hybrid organizations run the risk of suffering from so-called mission drift—meaning that they stray from their original goals—usually by focusing on profits to the detriment of the social good, but sometimes vice versa. "Mission drift has been identified as a potential problem among microfinance organizations," says Battilana, who has been studying hybrid organizations for several years. "Some of them have been accused of losing sight of their social mission, or even having a negative impact on the populations they were trying to help." According to Battilana, there are two key questions that leaders must address to keep the mission on course while still making enough money to sustain that mission: One, whom should you hire to strike a healthy balance between idealism and the bottom line? And two, what's the best way to socialize new hires to stay focused? Lessons from Bolivia In a recent Academy of Management Journal article, Battilana and Silvia Dorado from the University of Rhode Island tell the true tale of two Bolivian microfinancing organizations, Banco Solidario and Caja de Ahorro y PrĂ©stamo Los Andes. Both were hybrid orgs created in the early 1990s as spin-offs from existing NGOs. Both set out to avoid mission drift. But each took a different tack in hiring new employees. BancoSol hired employees based on their previous experience and proven capabilities. Because the mission required know-how in both profit making and social work, the organization ended up hiring a mix of social workers, sociologists, anthropologists, bankers, and economists. The idea was that these seasoned employees would complement each other with their disparate backgrounds, after training them to work together toward the common good. But the reality was that their single-purpose backgrounds made it hard for them to adjust to the hybrid model. Those with social work experience and those with a financial background ended up resenting each other to the point of constant fighting, such that the organization could hardly operate. Loan officers quit left and right, the number of active borrowers plummeted, and the profit margin dropped, too. "They basically had to deal with conflict that became intractable," Battilana says. Los Andes's launch in 1995 came three years after that of BancoSol's, meaning that Los Andes would learn from BancoSol's hiring woes. Los Andes took what Battilana and Dorado call a "socializability-focused" approach to hiring. Rather than looking for job candidates with experience in either social welfare work or finance, Los Andes hired people with essentially no work experience at all—recent college graduates—and then trained them specifically to be microfinance loan officers. The idea was that it would be easier for the employees to adhere to the hybrid mission if they were not hampered by their preexisting work logics, be they either social-based or profit-based. Whereas BancoSol was more focused on the dual end-goal of helping loan applicants while still making a profit, Los Andes was more concentrated on the means to an end—the process of training and managing the novice employees. Because it took longer to train newbies than it would take to coach seasoned professionals, measurable progress was slow, but steady at Los Andes. "Instead of relying on commitment to the end pursued by the organization (i.e., its mission), Los Andes's approach to socialization thus relied on commitment to the means used to achieve this end," Battilana and Dorado write. "You might be better off hiring blanker slates" In the end, in addition to avoiding interpersonal strife, Los Andes was more successful than BancoSol in avoiding mission drift. By the turn of the century, Los Andes had both lower average loans and a lower percentage of delinquent loans than its predecessor. (Higher values on either are signs of mission drift.) "So what we found was that in the early days, you might be better off hiring blanker slates and then try to socialize them in the way that you want them to work in the hybrid organization," Battilana says Managers have baggage, too Be that as it may, top managers at hybrid organizations may find it difficult to make the best hiring decisions because of their own preexisting biases. Battilana explains the problem in a yet-to-be-published paper, tentatively titled "Neither Corporations Nor Not-For-Profits…But a Combination of the Two: The Challenges of Sustaining Hybrid Work Contexts." "In the same way as new hires' work habitus influences the way in which they will enact the market and social welfare logics within hybrids, the work habitus of top managers influences the way in which they enact both logics in their daily practices," the paper states. Thus, even knowing the importance of the hybrid mission, a manager with a strong background in the nonprofit social sector is likely to be drawn toward candidates who also have a social sector background. And a manager with a background in finance is more likely to hire a financier over a social worker, all else being equal. Firms can address this inherent bias problem by enacting strict and scientific hiring mechanisms. For instance, rather than vetting possible hires via job interviews, Los Andes both hired and promoted its employees almost solely on the basis of how the candidates performed on written exams. This prevented the possibility that hiring managers would be swayed by their own backgrounds, meaning that sporting either a finance degree or a social work degree didn't result in preferential treatment for a potential candidate. But Battilana's research also suggests that managers are likely to learn from experience; the longer their tenure at a hybrid organization, the more probable it is that top managers hire junior employees. "What we expect is that the more time they spend in a hybrid context, the more likely the managers are to become familiar with the problem of hiring, say, both bankers and socially minded employees," Battilana says. "The more experienced they are, the more likely they may be to hire blanker slates, especially in the early days of the organization when its hybrid culture is not yet strongly established." About the author Carmen Nobel is senior editor of HBS Working Knowledge.

Tuesday, October 18, 2011

Keeping Older Drivers Safe

Medscape Medical News from the Gerontological Advanced Practice Nurses Association (GAPNA) 30th Annual Conference An Expert Interview With David Carr, MD Elizabeth McGann, DNSc, RN September 30, 2011 — Editor's note: Older drivers are generally considered safe drivers, in contrast to drivers who have specific medical impairments. More education geared toward older drivers and healthcare professionals is needed. Attention must be directed toward proper assessment and interventions to promote driver safety among older Americans. A podium presentation, entitled Driving the Older Adult: State of the Science, was featured at the Gerontological Advanced Practice Nurses Association (GAPNA) 30th Annual Conference, held September 14 to 17 in Washington, DC. To find out more about older driver safety, Medscape Medical News interviewed David Carr, MD, who is associate professor in the Department of Medicine and Neurology at Washington University at St. Louis, Missouri. He is a board-certified internist and geriatrician, and medical director of The Rehabilitation Institute of St. Louis. He has assisted in the development and operations of the driving connections clinic there. His research interests are in medical conditions that affect driving, especially issues of assessing driving safety and cessation in the older drivers with dementia and stroke. Medscape:What are the data for national crash and injuries in older drivers? Dr. Carr: Older drivers have the lowest rate of crasher per year, compared with any other age group. However, they have an increased crash rate per miles driven, which approaches that of the teenaged driver. Therefore, for the amount of time they are on the road, they are at an elevated risk, compared with middle-aged drivers. They are at increased risk for injury and death regardless, when you look at this statistic per licensed driver or based on exposure. Medscape: What is the current state of the science related to older drivers? Dr. Carr: Older drivers are, in general, a very good risk behind the wheel. Age should not be an indicator for driving retirement, nor for mandatory testing during licensure. The focus should be on the medically impaired drivers. We need more education for all types of health professionals to be comfortable discussing, evaluating, and counseling older drivers who have age-related medical diseases. Medscape: What are the best approaches to assess impaired older drivers? Dr. Carr: The best approaches will use a good history of driving behavior and any changes in driving habits that may have occurred related to a chronic medical illness. The physical examination should focus on visual acuity, visual fields, muscle testing, joint range of motion, and various cognitive abilities such as processing speed, reaction time, attention, judgment, and visuo-spatial ability. Medscape: What are some of the instruments used to assess risk? Dr. Carr: Some of the commonly used instruments are the clock drawing task, Trail Making Test A and B, maze completion tests, the useful field of view measure, the motor-free visual perceptual test, and a measure of contrast sensitivity. Medscape: What resources are available to older drivers and healthcare professionals? Dr. Carr: There is a variety of online resources for providers and older drivers. The American Medical Association has an online resource called the Physician's Guide to Assessing and Counseling Older Drivers, developed in cooperation with the National Highway Traffic Safety Administration. The American Automobile Association offers an online program called Roadwise Review, designed to allow senior drivers to test their functional abilities related to driving. There is also an online driver safety program sponsored by the American Association of Retired Persons. Medscape: What major challenges do providers and families face when getting the older driver to give up driving? Dr. Carr: There may be resistance because of a lack of insight from an underlying dementing illness. In general, many older adults will give up driving voluntarily if they believe they are putting themselves or others at risk while driving. Of course, this depends on viable alternatives to driving, which may not be readily available or accessible to older adults, especially in rural communities. Medscape: What are the 2 most significant aspects of your presentation? Dr. Carr: The 2 most important take-home messages are that older adults, in general, are safe drivers, and the focus should be on medically impaired drivers; and that instruments are being developed for the clinician to use in the office that can be useful in determining driving safety. Dr. Carr reports relationships with the National Institute on Aging, the Missouri Department of Transportation, the American Medical Association, and Advanced Drivers Education Products & Training, Inc. (ADEPT).

Tuesday, October 11, 2011

Social media: What parents should know

Children and teens are creating and sharing information more than ever using digital media such as cell phones, smart phones, and computers. They send text messages, use Facebook and Twitter, write blogs, share photos and video to stay in touch with friends and family and to make new friends. Social media offers lots of opportunity to help your child and teen be creative and stay connected and informed. But it’s important to learn about the different technologies and how your children use them so you can help keep them safe online. The social media landscape changes quickly. Because this document is only an introduction, we’ve included links to other websites you might find helpful. What is social media? Social media refers to the online tools that connect people with common interests on the Internet. Unlike traditional media (TV, radio, newspapers and so on), social media allow users to interact with each other. Popular social networking websites include Facebook, Twitter, YouTube, Flickr, and MySpace. There are many different ways that people use social media: Online profiles: Most social media sites require users to set up a profile. A profile usually includes a name, e-mail address, birth date, interests and a photo. Friends: Depending on the kind of social media, users “follow” or “request friends” from people they know such as classmates or family. They may also use social media sites to find and meet new friends. Messaging: Sending short text messages over the Internet, using instant messaging and between cell phones. Walls and boards: Social media sites allow people to post or send messages in many different ways. On Facebook, for example, information is posted to a “wall”. Some messages are visible to a wider audience, while others can be sent privately like e-mail. Photo and video sharing: Social networking sites allow users to upload personal photos and videos. Some sites, such as Flickr for photos and YouTube for videos, are used solely to share images. Blogs: A blog is a website kept by an individual who updates it with regular entries of text or photos and videos. It is a lot like a journal, only on the web. People who read blogs can comment and share published content among their own online networks. Joining groups: Many kinds of social media allow users to create groups. People join, “like” or follow these groups to get access to information and have conversations with other members. To play games: Children and teens visit online sites to play games, alone or with their friends. Some, like Facebook, include free online gambling applications. How can I keep my children safe using social media? Learn about the technologies your children and teens are using. Ask how they communicate with friends online. Tell them that you are willing and interested to learn about it. Keep computers in common areas where you can watch while your children use them. Be clear about the rules for using the computer and set limits on the amount of time and how they can be used. Set limits on cell and smart phone use. Talk about when it’s a good time to use a cell phone. Your child or teen’s school, for example, likely has rules about where and when they can or can’t be used. Teach them the value of “unplugging” from devices and computers for technology free time. Reinforce that no e-mail or message is so important that it can’t wait until the morning. Get online protection for your family. Programs that provide parental controls can block websites, enforce time limits, monitor the websites your child visits, and their online conversations. Tell your children and teens that you are monitoring their online activity. Be aware that some parent control programs will block information about puberty and sexuality that you might want your teen to look for. Ask your children and teens about the people they “meet” online. Showing genuine interest will help them feel comfortable talking about it. Explain that it’s easy for someone on the Internet to pretend to be someone they are not. Discuss what’s okay and safe to post online and what isn’t. People can’t always control the information others post about them. Explain that information and photos available online can turn up again years later. Ask your children and teens where else they access the Internet. Talk to teachers, caregivers and other parents about your rules for social media. Because people are not always who they pretend to be online, talk about the importance of keeping online friendships in the virtual world and how it can be dangerous to meet online friends face-to-face. Make it clear that if your child wants to meet a virtual friend in person, it must be with a trusted adult. If your child or teen is playing online games, join them (even if only to sit and watch) so you can see exactly what they are doing and talk to them about it. What should I know about online privacy? Social media websites have privacy policies and settings, but they are all different. Some sites are completely public, meaning that anyone can read or look at anything, anytime. Other sites let you control who has access to your information. Read a website’s privacy policy before providing any personal information. Some social media websites, like Facebook for example, don’t allow children under 13 to joint their site. Check your child’s privacy policy settings to make sure he isn’t sharing more information than you want. The following suggestions will help your children protect their online privacy: For some social media sites it is a good idea to choose an online nickname, instead of using a real name. Keep everything password protected, and change passwords often. Don’t accept friend requests from people you don’t know in real life. Think carefully about what you post online. Remember: things that are posted online stay online forever. As a general rule, don’t post anything you wouldn’t want a parent or teacher to see or read. Remember to protect a friend’s privacy too. Ask permission before posting something about a friend, a photo or a video. Be aware of what your friends are posting about you. If you use a GPS-enabled smart phone or a digital camera, you could be posting status updates, photos and videos with geotags. Geotags provide the exact location of where your photo was taken. Make sure these are turned off on your device. What is cyber-bullying? Just as some people are bullied in real life, people are bullied online. It happens many ways: by sending mean messages by e-mail or posting them in an online forum or by sharing photos and videos without permission. Talk to your children about cyber-bullying. If it isn’t too serious, suggest that they ignore it at first. If it doesn’t stop, is violent or sexually explicit or your child gets scared, encourage them to talk to you or another trusted adult. The Media Awareness Network has some more information on cyber-bulling at: What is sexting? Sexting is a term used to describe sending sexually explicit messages, photos or videos between cell phones. It can also happen using e-mail or on social media websites. Ask your teen what she knows about sexting. Talk about the dangers of sexting. Remind her that words and photos posted online can easily be shared among many different people. Remind your teen that nothing is ever really deleted online. Friends, enemies, parents, teachers, coaches, strangers, and potential employers can find past postings. Posted: July 2011 This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances. Canadian Paediatric Society 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8 Phone: 613-526-9397, fax: 613-526-3332