goldsilvermart01

[conscydraws]

I rarely share my jewelry pieces here. But this commission was particularly satisfying.

Crafted with silver, mother-of-pearl (black for the inner part and white for the eyes), synthetic opal, cold enamel, oil paint.

[iwanttobeliv]

Yo soy Betty, la fea (Now and then)

Man, I’ve been meaning to write something ever since I finished watching the very first episode of Betty la fea, la historia continua but there were too many thoughts and feelings and too little coherence to make it happen, and yet, here I am trying it anyway.

Even in Brazil, a country that culturally embraces telenovelas, every now and then when I said Betty, a feia was my favorite, people would look at me funny. And it’s kind of difficult to explain or make people understand that there is just so much more behind Betty’s fringe, braces, and very peculiar laughter. Yes, Armando did yell a lot. And there were perhaps too many episodes focused on Sofia and Efrain's drama or those final ones with Inesita’s ex-husband, and when I managed to rewatch the whole thing, boy was I glad to be able to fast-forward these parts. Some of the sets, like Betty’s room were very clearly low-budget and full of strange choices that I could never quite figure out, and yet, none of this really mattered because the writing was phenomenal. The characters were engaging. The actors were brilliant. And the love story, that was just the best.

So I watched and rewatched. I managed to come across friends who were happy to talk about it and dissect all the things that made it work so well, and so subtle is the distinction that despite the many many adaptations worldwide, to me, none have ever been better than the original Betty.

When Betty was first aired in Brazil, I was about 15 and I can’t begin to explain how seeing a young woman who never belonged anywhere due to her looks resonated with me. Someone who was made fun of for being different and used a sense of humor to keep going. Someone who had hopes and dreams and felt none of them were within reach. And someone who managed to survive all the terrible things life would throw her way in pursuit of her happy ending.

And I guess this feels like something that needs to be said first.

As far as I'm concerned, what makes Betty so fundamentally brilliant is the fact that in YSBLF, when it comes to the love story, the guy falls in love with her being exactly who she is. No more or less. There are so many stories about the ugly duckling who manages to be seen after becoming a swan, and yet there it was, a story that showed that the duckling didn’t have to be anything else to be deserving of love and happiness.

Watching her we went through all ranges of emotion. I remember closing my eyes as I tried to watch her going through her first ‘transformation’ and the disaster it was. I remember feeling joy for her, for having such a good friend in Nicolas and such loving parents. I remember watching Armando as he was, having his feelings change little by little, all while she became an essential part of his life and work. And then, watching expectantly as we had to go through the awful plan he and Mario came up with and all the repercussions that would come of it. I remember thinking that JEA had to be a pretty great actor and that Armando had to be very well-written otherwise it would be impossible to feel anything but disgust for him and what he did. And then watching him fall for Betty utterly and completely. I remember sharing her fury and thirst for revenge when she found the letter. And then drinking up on every interaction between the two of them, knowing what she knew and waiting for the bomb to go off. And then to watch Armando go through hell and lose everything that meant something to him, and Betty trying to pick up the pieces of herself and survive the worst of times. And finally her triumphal return and what would soon enough lead her to a happy ending.

Last year, when we got the news of the remake and the OG was made available on streaming, I watched it once again and felt all those things all over again. But now, almost two decades later, with a very different understanding. I still loved every minute of it, but there were things I would have liked to be different.

Like many soaps, as soon as the main couple manages to patch things up it’s a quick jump to the expected happy ending, and while I fully expected Betty to get one, I couldn’t help but wonder, how a relationship could ever work after such a thing. Sure we knew Armando’s feelings were real and there, and all of that way before Betty, the ugly was made beautiful. But she didn’t. How could she truly forgive and trust someone who managed to betray her trust and make her go through hell as a result of deliberate actions? I would have liked to see more of it. It’s the one thing I don’t particularly enjoy in so many love stories and most soaps. How they are always in such a hurry to end the story as if by being together there was nothing else to be told about these characters and their relationship. Oh the potential wasted by their need of getting to the wedding and a baby on the finish line.

And then, much to my surprise, they decide that there’s more to tell. That the story didn’t have to finish there. [Yes, I’m aware of ‘Ecomoda’ just as I’m aware of the universal consent that it never managed to do justice to the characters we loved and cared for. Which is why, I think, the sequel now also made the choice of ignoring it.]

So now I’ve watched the first four episodes. And I have thoughts I would very much like to share and discuss. Things that I don’t particularly like, but understand. Things I wish had been done differently. Things I absolutely love. But this post feels already much too long. For now, I just want to say, I never expected the sequel to be perfect or to perfectly preserve what the OG managed to perform. But I’m genuinely happy we get to see Betty again. And to be able to laugh and cry with her, with all of them. 

It takes me back and it fills me with expectation for what’s yet to come.

Is it Friday yet?

[not-poignant]

Merch Tier Revived!

As of this month, I've officially revived the Vexteria tier on Patreon and Ream as a Merch tier :D

This is the one you're looking for:

Memberships at Ream

Memberships at Patreon

I've been thinking about it for like a year and I've finally figured out a way to do it without breaking my brain (or the bank) and handling overseas postage.

While there are other bonuses in this tier, I've finally figured out how to get around overwhelming postage costs with twice-yearly drops of merch to those who subscribe for 4 consecutive months in the Evan & Vexteria tier within that period.

This is what shipped out to followers in the second half of 2023!

x 2 notebooks (lined) + postcards (with recycled paper envelopes) + vinyl stickers + a signed personalised individual letter. In this first instance, I am also the artist of this merch.

Here's me preparing everything :D

Each merch shipment will be different items and different themes - sometimes fanart, sometimes quotes, or focuses on different stories. The items can individually change too. It might be journals, more varied stickers, other forms of stationary, enamel pins, and more.

What do you get in this tier?

In this tier you get access to everything. All the early access, the merch, you get credits in all future books (which, with publishing hopefully kicking off in 2024 means seeing your name in print a fair bit!), and see any other extras I choose to share.

Why 4 consecutive months to be eligible for that 6 month drop?

To cover overseas shipping costs, which start at $20, and to also cover the raw cost of the merchandise, and also still be able to make an income off Patreon or Ream in this tier.

I like the look of an older merch bundle, can I get that instead?

Only if there's stock left over for that! And you can't get both at the same time, so if I can make a bundle based off past merchandise for you, it will be in lieu of the current bundle.

How is it shipped? How long does it take?

It's all shipped super safely. Before I worked as a writer, I worked as an artist selling fragile traditional art pieces. I've shipped over 500 worldwide. Your merch comes in a water resistant plastic sleeve that is sealed and very durable, and that goes into a thick envelope that has bubble wrap incorporated into it to make sure everything arrives safe and sound, even in inclement weather.

Because I'm shipping from Australia, items can take 2-6 weeks to arrive.

Could you ever send merch more often?

Not at the current price/s of this tier! Many overseas / non-US writers don't actually offer merch drops like this at all, and offer digital items, or only do Print-on-Demand which means nothing can be as personalised as writing you a letter of gratitude and celebration of your awesomeness.

Doing it this way means I can put a personal touch in there, and bundle everything, and know that everything's shipping safely with materials I really trust. :) It also means I can inspect every single item personally to make sure it's up to my standards before it goes to you!

Where do I check this out?

Go have a look at the memberships over on Patreon and Ream! You want the Vexteria & Evan tier. :D

Memberships at Ream (You can join for free here and follow me here without subscribing and just get a feel for it first!

Memberships at Patreon

--

A huge THANK YOU to the people who have been on this tier for ages even without these kinds of rewards. Your support is so incredibly invaluable, and I can't wait for you all to receive the first Augus & Gwyn themed merch drop. :D Y'all made this possible, and I appreciate you so much.

--

If anyone has any questions, hit me up! I'm super hyped for this. I fully understand if it's not something folks can afford, and I'm hoping to find a way to make merch more widely available in time, so that folks don't have to miss out, but until then, we have the Merch tier back up and running for the first time since about 2014!

Things like this keep the lights on, and keep the stories coming out to you over time, and more than anything, y'all have no idea how much fun I had writing individual letters to the folks in this tier, celebrating what I really loved / thought was awesome about them.

All right, thanks for your time, I'll get back to posting chapters now :D

[3gremlins]

saw that an older post of my coloring page previews was going around (sadly with my deadname T.T like it's the nature of the beast and the only way to fix it would be to delete old posts and even then? maybe not entirely but still :c ) and just wanted to let people know i'm still doing these and they're better (imho).

here's a few from last year and this year! if you like them, did you know that they are all available to all my patrons as downloads? plus you get access to lots of other cool stuff for the low low price of $3/month. They're all available at the mischief tier!

i'm also working on making a physical coloring book of all these (hopefully get it out this year, i wanted to round out the creatures to make it more worldwide inclusive so it's taking a bit longer than expected) which you would also be supporting and then get first dibs/discounts on as patrons

link: https://www.patreon.com/manicgremlin

many are also available as prints through my shop: https://ko-fi.com/manicgremlin/shop (if you see me post a piece anywhere and don't see it in the shop, you can also always ask about it! i'm usually happy to add them in)

[jacksonjb]

Revealing Jardeeling: Sculpting a Social Media Presence for my Star and Researching Social Media

Making My Star

In working through the creation of the digipak, and promotion of our artist, we were tasked with creating a social media page to create a representation of what an artist or band within the genre would promote themselves as, using the star of our own music video as the emerging artist.

Research

Before making my page I wanted to do a bit of research into effective social media marketing and promotion, specifically when it comes to promoting musical artists. Despite the fact the trip-hop scene isn't as popular and revered as it was in the 90s, I still wanted to implement some conventional modes of promotion used for trip-hop artists in the 90s, and translate them to a social media page, attempting to create an authentic image for my artist, as well as have a bit of fun in the exploration of 90s aesthetic and image.

I had a look through some articles like the one above, and learnt a little bit about some notable and effective social-media inclined marketing efforts. A lot these however pertained to some very high-budget and excessive marketing techniques that unfortunately wouldn't be available to me! So I kept researching.

From this article, I gained a little bit more insight that was more applicable to me and my project. Some of the tips that were most helpful to me were to:

Know my demographic

The article suggested I know "EXACTLY the type of person who will be into [my] music". It was pretty good advice! And one that I have followed extensively as is, having doing research into audience and genre conventions during the pre-production phase of my music video. It also helped me later streamline some of the content that should go on my blog, what I should focus on and how I should present it.

Share behind the scenes photos or videos

Another suggestion was to share a lot of content of the development and process of production of whats going on with my artist. Things like photoshoots, in studio sessions, demo tapes and generally what the artist is up to outside of music. The article suggests to make my content 'personal', and to 'tell your story'. This is something that creates a connection between artist and audiences, and reinforces a fondness towards them. However, it could also potentially clash with the enigmatic image I'm building of my artist, which is something to keep in mind.

Demand attention with my content

Another tip I found interesting was the idea that I should "make sure my music gets heard, every time". This segment argues that an artist using social media should make drastic efforts to ensure they are discriminating against the other multitudes of people and musical artists on social media. The idea of 'scroll-stopping' is mentioned a lot, producing content that will make consumers stop and look, a feat of which is notably difficult given the proliferation of short-form content on social media. It's one that I should keep in mind when making content for my page, I could do this through making alternative, weird and even grotesque posts that could capture my target audience, or just anyone scrolling by.

Choose which social media platform to be on

This was one of the tips I felt most important and fundamental to the development of my social media. The article suggested to "focus your energy on visual social platforms like TikTok and Instagram", which I felt was a good piece of advice. Using a primarily visually-based platform helps to convey the image and presentation of my artist, as well as working good for this task given its a good way to share the CD, music video and more that I create during the process of the digipak.

Making the Page and the Plan

After having chosen a specific social-media platform, and having a rough idea of the content I should be producing and uploading, I got to work on making my page. The first thing I did was adhere to the advice I got from the article and chose a visually inclined platform to make my page, Instagram. Then I decided to make a quick plan in terms of audience engagement:

Audience Engagement Plan

Appeal to my audience - moody tone, B&W imagery, behind-the-scenes content, produce work relating to trip-hop and edgier music

Make content that demands to be seen - interesting posts, weird posts, anything to build the image and tone of my artist

Post snippets and clips from the music vide - make a MV trailer/teaser?

Then finally, I decided to get to work on accumulating various types of content on my blog, from photoshoots to snippets of my MV and more.

Conclusion

Overall, after doing my research and preparation before starting my social media page, I got some pretty good advice and insight into how I should manage it, the type of content I should post, and how to make it seem like an authentic social-media page for the artist I was creating.

[npet-autos-clothes]

NPET belts are very popular in the worldwide

If you're on the job site, in the office, or just walking around the city, get a stylish look with our belts. NPET is available in many different styles, from belts, reversible belts and canvas belts. You are sure to find the perfect belt for your lifestyle. Leather strip, beautifully designed. Very durable and comfortable.

We sell tens of thousands of belts every year to popular in the USA, CANADA, EUROPE, JAPAN...

Our belts are very popular with our customers and many of them have left their positive comments.

NPET has a very good after-sales service to solve all kinds of after-sales problems for customers. Our belts are popular with people from all over the world and we are committed to providing even better quality belts.

“This belt performs way better than you would expect for 20 bucks. I am someone who gets down and works hard and needed a belt that would hold up to physical stress. Its really hard to find a tough reliable belt nowadays and i found this figuring if it sucks its cheap enough I wont care. I have been gladly suprised at how its been holding up. It has a weird chemical smell at first which I kinda expected as a remnant of the dye. The smell goes away after wearing it a few times you will never really notice if you don’t stick it in your face anyways. They say you should get a size 2 inches bigger than your waist but I like having a slightly longer flap at the end so I wish I ordered 4 inches larger than my size. Not a big issue though and I expect to continue to abuse this belt for years. The fact you can put any buckle you want is a nice bonus but the buckle it comes with is already great so I wont be doing that anytime soon.” 

We use genuine full grain cowhide leather. Genuine leather belt has cattle smell,so we add plant aromatic solvents to reduce that smell,no harm to people.

“I went online looking for a new belt because I’m allergic to every belt buckle I’ve ever owned. Someone told me try Brass. It’s been a week at work and there’s no rash! The quality is great and I got the belt with the buttons so you can easily remove the buckle just in case.. this is easily the best belt I’ve ever owned. So I thought I should write a review. The only complaint I have is it will leave a brown residue around your belt line. I use it for work everyday so it doesn’t bother me at all. Also I’m thinking if you just cleaned it when you first get the belt, it would probably take care of that problem. Otherwise great quality, affordable, no rash belt. I love it.”

The unique snap system makes it easy to change your favorite belt buckle, and our belts fit all kinds of 1.5inch belt buckles.

“I was looking for a belt to put a new found belt buckle on. This was great! Value for product is over the top. It fits great. Length and width matched my expectations. The description was also correct about the thickness, but I was surprised anyway. This is a dense leather belt, which is fabulous because thinner ones can easily be warped by how the fit pants when sitting. Not this belt. It holds its shape no matter what. The one adjustment I needed to make was to cinch a wee bit tighter to than i normally would so that the buckle would have the right tension to stay put. Still very comfortable and the belt offers enough buckle holes to make that step easy.”

Different waist sizes require different belt lengths, which means that the belt size should be chosen according to the waist size. Our belts come in a variety of sizes from 29 waist' to 46 waist' to fit a wide range of people. We recommend a belt that is two sizes larger than your jeans size.

“I've been looking for a belt like my grandpa had when I was a kid. He had one leather belt, and had it for years. I don't know much about fashion, so I wasn't aware this was what I needed. It's a simple, one piece of leather belt. It's been durable so far. No wear and tear like these other belts I get that are somehow stitched together. I'm using layman's terms because it's what I know. After a few months this belt had began to break in and loosen some of the new leather stiffness. It's becoming more enjoyable to wear. I'm going to get one more in brown.”

Made of genuine cowhide leather, our belts are durable and long lasting. This is extremely gorgeous and timeless with super function for for jeans, casual pants, Overalls, slacks

We continue to create quality belts and achieve the generation of quality belts

[hstylesloverr]

MAY.

dad!harry x singer!reader | the series’s masterlist | part two.

parining: dad!harry x singer!reader

warnings: pregnancy, mentions of pregnancy, vomiting, nausea, angst, baby denial. 

-

May, 2019.

Harry Styles was sleeping soundly in the king-size bed he shared with his girlfriend when the unpleasant sounds from the bathroom grew louder as Harry woke up. His eyes had to adjust to the morning light, and when he leaned down to look at the clock on his nightstand he saw that it was only a quarter past six in the morning. There was no way Y/N was up this early. Unless it was something really urgent.

Harry woke up quickly and apprehensively made his way to the bathroom, where he saw his girlfriend kneeling in front of the toilet, throwing up and making really nasty noises.

"Y/N, babe." Harry quickly knelt down beside her, twirling her hair to keep it from getting smeared with vomit and gently stroking her back.

After about a minute the vomiting stopped completely, Harry quickly handed her a piece of paper to clean up and a glass of water to get the vomit taste out of her mouth, Y/N smiled slightly at him in thanks and gladly accepted them.

Harry rubbed her back gently "Honey, maybe you should go to the doctor, I heard there's a stomach bug."

"It's nothing, Harry." Y/N shrugged. “I'm sure it's the pizza you cooked yesterday, I already told you that you put a lot of cheese on it.”

Harry pretended to be offended “The pizza was in perfect condition.”

"Whatever you say, cook." She kissed him on the cheek before getting up from the bathroom floor and going back to bed. Harry followed her after closing the bathroom door and making sure everything was in perfect order.

"I'm serious Y/N, maybe you should see a doctor."

Y/N rolled her eyes, but at Harry's seriousness she finally relented.

"Okay, I promise if I keep feeling bad I'll go to the doctor."

The topic was not mentioned again for the rest of the morning. Harry had to go into the studio early to finish perfecting some songs for his new album due out later that year, and Y/N was going to have lunch with her friends and bandmates, and then they'd have to start organizing events. for her tour that would start early next year.

Harry moved closer to Y/N to give her their usual goodbye kiss as she reached for the pair of sock in her hand, however, the girl scowled and quickly pushed him away.

“What's happening?” Harry said, surprised and offended at the same time.

“What perfume did you wear? It is awful.”

“It was the one you gave me for Valentine's Day!” Y/N frowned and moved closer to Harry to sniff him, however it was a bad idea as she immediately gagged.

"My God, I'm literally nauseated. It is impossible for it to be my perfume, I have good taste. Are you sure it's not the one Jeff gave you?”

Harry rolled his eyes in exasperation. And before Y/N could react he pulled her close to him and gave her a quick kiss on the lips.

“I'm leaving, I'm already late. Bye, I love you.”

Y/N smiled slightly.

"I love you too." As Harry opened the door to their apartment and started to leave, Y/N yelled at him. “Seriously, tell Jeff to learn how to pick better perfumes!”

She heard her boyfriend's light chuckle, followed by the sound of the door closing.

When Y/N took her car to go to the cafeteria where she would meet Rosé, Lisa and Jisoo, she saw her mother's incoming call on her mobile. She hurried to pick it up.

“Mom! how is everything?”

"It's all right, darling. And you?”

“Well, now I was going with the girls to have some breakfast, what are you doing now?”

“I was trying to make an appointment with a couple, the woman is pregnant and apparently all my available days this week coincide with her doctor, gynecologist and nutritionist appointments.”

Her mother worked in interior design, and even though she no longer needed to work as Y/N's fame had spread worldwide and money was not in short supply to speak in modest terms, Y/N's mother was really passionate about her job and didn't want to leave it before retirement.

“What does a nutritionist have to do with a pregnancy?” Y/N asked mockingly as she climbed into the driver's seat of his car.

“Nutrition during pregnancy is very important, darling. When I was pregnant with you, aside from nausea caused by any kind of smell, I had to stop eating peanuts, and you know how much I love peanuts.”

"Yeah, it must have been really hard for you," Y/N commented nonchalantly as she put the call on speaker and started his car. However, after making in the realization of what her mother had said, she frowned and said in a voice perhaps too shrill than it should have been. “Mom, did you have a lot of nausea when you were pregnant?”

"Of course, honey, I was throwing up at least five times a day during the first trimester. However, the second quarter was pretty good.”

“And you had nausea like... for example... with a perfume?”

"Oh yes, your father's perfumes really made me sick. I made him throw them all away the first week, why the question?”

"Ah, nothing is...just curious." Y/N cleared her throat and decided she couldn't drive anymore, so she headed to the nearest public garage so no fans or paparazzi could see her. “I have to hang up mom, uh... I'll call you later.”

"Sure, darling, bye. Say hi to Harry for me.”

Y/N just hung up and settled in the emptiest part of the garage. She turned off the engine and rested her forehead on the steering wheel, trying to control her breathing. She thought about calling Harry and telling him her worries, but was she really pregnant? what if she wasn't and it was just the pizza Harry cooked last night and she was worrying about nothing?

She quickly grabbed her phone and went to the calendar app where she had all her menstrual periods listed, since she wasn't very good at remembering those things. She frantically looked at the months of January, February, March, and April. Nothing in May. Her period was supposed to have come three weeks ago. Any. Y/N sank completely into her seat, suddenly feeling very cold.

She and Harry had a very active sex life, meaning they fucked almost every day. But they always took preventive measures. Apart from that, they had only been together for a year and a couple of months, isn't it supposed that to have a child you have to have been together for a longer time, like five years or so?

Then there were their careers. They were both singers and they were currently the most famous of the moment, they were busy with their songs, tours, meetings, photo shoots, recordings, interviews, how the hell was a child going to fit into all that? Harry and Y/N had barely had time to spend the last few months, how could they have time for a child?

Harry had always wanted children, he had known from a very young age, but was this really the time? What if Y/N is a bad mother and her son hates her for the rest of his life?

As Y/N was about to cry, her cell phone vibrated with an incoming call. Y/N looked at the name and saw that it's Lisa, so she hurriedly grabbed it.

“Y/N, pretty, we're all in the cafeteria, where are you?”

"I, uh... I'm coming, I'll be there in a moment," Y/N said with such a small voice that for a moment she thought Lisa hadn't heard her.

“Everything is alright?”

“Yes, everything is fine, calm down, I'm coming.”

“You don't sound good at all.”

Y/N cleared her throat.

“I'll be there in a moment.”

When Y/N arrives at the cafeteria, wearing a hat and glasses strategically placed so as not to be recognized, her friends are already waiting for her at a table and when Y/N sits next to them they greet each other affectionately.

"I think I'll order an American coffee," said Rosé as they looked at the menu to start ordering lunch. Lisa and Jisoo also ordered coffee and when Y/N nonchalantly said that she would go for a decaf Jisoo frowned.

“But if you hate decaf, you even got mad at Mitch for ordering a decaf, you said "why are you going to order a decaf, that's not even coffee!" "

Y/N was beginning to regret having so strongly professed her hatred of decaf coffee. But since she didn't know if she was pregnant or not, and wouldn't know until she bought two pairs of pregnancy tests, she couldn't take that chance.

"You're weird," Rosé observed, staring at her. “Are you sick?”

"Harry told us yesterday that you were sick to your stomach," Lisa commented, "you should go see a doctor, there's a stomach bug somewhere."

Y/N decided there was no point in lying to her friends, I mean, they'd known each other for over four years, and they'd been through all sorts of things together. Besides, she needed to vent to someone because if she didn't she thought she was going to go crazy.

“Actually, it's because...” Y/N wrung her hands nervously “I think I'm pregnant.”

A crushing silence fell over them. Jisoo was the first to react.

“Pregnant? You’re going to have a baby?”

"It's not... I'm not sure, but I've been waking up for a couple of days and running to the bathroom to throw up, and I'm constantly nauseous, and the perfume Harry was wearing today almost made me throw up, plus I was supposed to have gotten the period three weeks ago so... I don't know what to do guys, should I tell Harry? Or should I wait until I get tested to tell him?”

Lisa, who was at her side, gently placed a hand on her shoulder to comfort her.

”We are going to buy several pregnancy tests. That way you'll get out of doubt. And... whatever comes out, we'll work from that.”

Rosé and Jisoo immediately agreed. So they canceled all the meetings they had for the rest of the day and headed to the nearest pharmacy.

Since they were at risk of anyone seeing them, and seeing that they were buying pregnancy tests and chaos breaking out over Y/N and Harry, they decided that it would be better for neither of them to take off their hats and glasses and also buy other things to deflect the attention.

Jisoo was the one who took it upon herself to buy wrinkle creams first before quickly heading over to the pregnancy section and quickly grabbing four boxes, quickly throwing them into the shopping cart along with the creams, and pretending to be normal. Rosé and Y/N put in a couple of boxes of diarrhea pills and Lisa put in a large bottle of rubbing alcohol and gauze pads. They pretended to be completely normal and when they went to the register to pay they made sure not to look up at any time.

In the end they came out with three bags and the pregnancy tests well hidden in them. If by any chance someone had recognized them, they would only be seen with three pharmacy bags that could contain anything.

Harry wouldn't be home until five in the afternoon, so they had about five and a half hours to take the test and decide what they would do depending on the result. Y/N took the four boxes and entered the bathroom, while the others waited for her outside.

Since Y/N had never taken a pregnancy test before, she spent at least eight minutes reading the instructions. She followed all the instructions and when she finished all four tests she had to wait at least five minutes. Her hands were sweaty and she felt numb as she left the bathroom and announced to the others that now they would just wait.

She sat next to Rosé while Lisa set the timer. Her mind was in a kind of loop where she could only imagine herself telling Harry over and over again: I'm pregnant. Sometimes those repetitions alternated and the result was either Harry extremely happy telling Y/N and their son how much he loved them, or it was Harry getting mad at her, or it was Harry not saying a word and just walking away.

Her thoughts were interrupted by Lisa's cell phone, announcing that the five minutes had passed. The three gazes of her friends landed on Y/N, who without saying a word went back to the bathroom, to the sink, where the four tests were perfectly placed.

When Y/N came out of the bathroom again, so pale her skin was starting to turn purple, Lisa, Rosé, and Jisoo approached her worriedly.

Y/N didn't say anything, just handed the evidence to Jisoo and headed to her room, slamming the door shut. Jisoo raised her arm and the three of them looked worriedly at the word inscribed on each of them.

Pregnant.

[rockofeye]

I'm curious about what I've seen around the general make-up of Haiti and I guess who lives there. Is Haiti mostly rural farmers and people who live in poverty? How does that interact with Vodou? Is Vodou (and Haiti?) different in different areas and how does that get affected by what media says, knowing that the media is always biased?

Hi there,

This is an interesting and complex question!

Haiti is a pretty diverse country. Most media portrayal focuses on poverty and illustrations of what that looks like via photo/video of densely populated areas of folks living in really challenging circumstances. This is certainly a part of Haiti and a not-insignificant part, but it is not all of Haiti.

Haiti has burgeoning tech sectors and a recovering local business and entrepreneur community. A lot of localized business has struggled in the face of foreign aid and as a result of the earthquake, but its rebounding and growing quickly. Locally-owned hospitality-oriented businesses are huge in Haiti and focus in on the tourist and Diaspora communities, and it's something that Haiti is quite known for worldwide.

Haiti has a HUGE artisan community with a really well-known heritage of painters, sculptors, metal artists, traditional musicians, and artisans creating textile items with sacred themes. Haitian art and music is known worldwide...Haitian artists are some of the most widely sold artists in the world.

And, Haiti has a significant agrarian community. Farmers have been hit hard by foreign involvement, the earthquake, and the various hurricanes that have rolled through, but a lot of history and culture is tied into farming as a means of carrying a living memory of life in Haiti. Some farmers are subsistence farmers, who grow vegetables and raise animals to feed their families either directly or via selling at the marketplace, and there is a growing community of farmers who provide raw material to develop food items or goods for sale in country and via export. Haitian chocolate is a delicacy as is Haitian coffee, and products like cocoa butter, castor oil, and moringa are super popular. Haiti is also fairly well known for producing unique furniture from old growth hardwood and bamboo.

Vodou is connected to all parts of Haiti and all parts of how life plays out in Haiti; it doesn't privilege one way of life over another but it speaks to different parts of life in different ways. The religion is as diverse as the country is, and varies widely based on where you are physically in the country (Vodou from the mountains is different than Vodou from the north which is still different from Vodou from the south, Vodou from near the border, Vodou all the way out on the arm of Haiti, and on), what your local area is known for (for example, the area the lineage I am born from was founded is very heavily Kongo influenced and that is very visible in our ceremonies, and there are other parts of Haiti influenced similarly by other rites and cultural pieces from Africa), what rites are present and/or available to you, how you came to know Vodou, and a million other factors. Vodou and the larger religious foundations encompassing all the different Vodou and Vodou-adjacent rites speak to all those things. As diverse as the country is, Vodou is as diverse as well. There are some common agreements held among practitioners in general, but Vodou is not a monolith because Haiti and Haitians are not a monolith.

From my perspective, the only way Vodou gets affected by media is when Vodou gets blamed for a disaster or a situation where someone was harmed or was perceived to be harmed. Those things can have real, literal consequences; a rumor in Haiti that you 'sent Vodou' or sent spirits or had work done to someone can get you killed. That kind of seriousness ripples out culturally in the country; police harass and arrest vodouizan because they can, landlords turn people out of their homes if they think they are sèvitè, and Protestants attack folks on the street.

That kind of stuff alongside media overemphasis on animal sacrifice and possession can make a hard road. But, the religion itself keeps on doing its thing. Vodou as a whole has lived through a lot of stuff and media portrayal while damaging isn't going to change much of how the granmoun teach us to serve the lwa.

I hope this answers your question--it's broad strokes, so let me know if I can dial it down further in any areas.

[darlingdeadadornment]

Down to my last one😭

The mold for my nature cast octopus amulets finally kicked it after casting this piece.

Each of these nature cast pieces are made by basically making a death mask of the real specimen and each mold has a limited amount of uses which is why there are only a few of these floating around.

Because they are cast replicas they have all the natural details of the real thing without any animal material in the finished piece. This makes them vegan friendly and available to ship worldwide.

The octopus ones in particular are very time consuming with a lot of detail cleanup so I likely won't be working on anymore molds for future pieces as well as my donation connection for ethically sourced octos is unavailable at the moment but we'll see how I'm feeling in a few months.

Regardless, this is the last one of it's kind and it is available now in the online shop.

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#octopus #cephalopod #castingnature #tidepoollove #seawitch #curiositycabinet #vegan #taxidermy #biology #science #naturenerd #replica

[anitabyars]

"Kennedy Ryan weaves prose like a magician (or voodoo priestess) without sacrificing heat or page-turning angst to create authentic, living, breathing characters you want to root for to the end. Hook Shot is simply beautiful." -- Emma Scott, Bestselling Author

Hook Shot, a deeply emotional standalone set in the worlds of professional basketball and high fashion from Kennedy Ryan, is available now and FREE in Kindle Unlimited!

Enter the Release Giveaway for a $50 Gift Card +Signed HOOK SHOT Paperback here:

https://www.facebook.com/KennedyRyanAuthor/

Divorced. Single dad. Traded to a losing squad.

Cheated on, betrayed, exposed.

My perfect life blew up in my face and I'm still picking up the pieces.

The last thing I need is her.

A wildflower. A storm. A woman I can't resist.

Lotus DuPree is a kick to my gut and a wrench in my plans

from the moment our eyes meet.

I promised myself I wouldn't trust a woman again,

but I've never wanted anyone the way I want Lo.

She's not the plan I made, but she's the risk I have to take.

A warrior. A baller. The one they call Gladiator.

Kenan Ross charged into my life smelling all good, looking even better and snatching my breath from the moment we met.

The last thing I need is him.

I’m working on me. Facing my pain and conquering my demons.

I've seen what trusting a man gets you.

I. Don't. Have. Time. For. This.

But he just keeps coming for me.

Keeps knocking down my defenses and stealing my excuses

one by one.

He never gives up, and now...I'm not sure I want him to.

Download your copy today or read FREE in Kindle Unlimited!

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EXCERPT

After talking to Kenan for the last few minutes, and looking under his hood, so to speak, I’ve found that he’s a classic. They don’t make them like him anymore, and if I don’t change the subject, change the course of this conversation, I’ll fool myself that we don’t have to keep things simple and that we could be more than just friends, not just for the summer, but for a long time to come. As long as I’d like.

​“Okay,” I say, switching gears without a clutch and pulling a tie off another of Amanda’s racks. “I think that shirt could work really well with this tie.”

​He doesn’t look at the tie I’m holding up, but keeps his eyes fastened on me. He’s not playing along. I’ve boxed myself into a corner with him. And the quarters are too tight. His scent. His warmth. His intelligence. His thoughtfulness. He is pressing in on me, overtaking my good intentions in all the ways I never thought a man could.

​“Try this on,” I say, blindly shoving the mint green shirt at him.

​When I look at him, he’s already peeled one shirt off and is reaching for the one I chose. I didn’t think this through. Didn’t forecast that Kenan changing from one shirt into another would mean his naked chest. I lose my train of thought and all my chill. Besides my mouth dropping open at the sight of the sculpted terrain of his chest and abs, I give no other indication that he affects me. Taut, bronze skin stretches across his broad shoulders like supple canvas pulled over a frame, the foundation of a masterpiece. He’s a big man. Not bulky, but instead chiseled to the specifications of a master sculptor: arms roped with muscles, biceps like rocks under skin glowing with health. The forearms Chase raved about are lined with veins and sinew. And I die for a great chest. I’ve never seen one more spectacular than Kenan’s.

​Two words.

​Male. Nipples.

​Jesus, my mouth is literally watering at the thought of tasting them, sucking them, licking them. And if that pectoral perfection weren’t enough, the two columns of muscles, four each, are stacked over his lean stomach arrowing down to a narrow waist and hips. I can’t look away. I lick my lips, imagining how he would feel under my mouth. How I’d lick around his nipples and drag my tongue down that shallow path bisecting his abdominal muscles. I’d slip that belt off and sink to my knees. Unzip those pants and take him out. God, hold him in my hands and then take him all the way to the back of my throat. I’d choke on him. A man this big . . . I’d be so tight around him.

​“Lotus,” Kenan says, jarring me from my torso trance. “Should I go ahead and put this shirt on? Or did you need a little more time?”

​I snap a glance up to his face, embarrassed to find him laughing at me. Oh, God. I’m as bad as Amanda. I turn to leave, but he catches my elbow with a gentle hand and turns me back around, walking us behind two of the racks. He bends until he’s almost eye level with me.

​“Don’t be embarrassed,” he says, searching my face intently. “I’m glad you like my body.”

​“I didn’t say I . . .” My words trail off at his knowing grin. “Okay. So you have a nice body. I work in fashion. Do you have any idea how many great bodies I see on a daily basis?”

​“I’m sure many,” he says, his smile still firmly in place. “I can’t speak for any of them, only for the way you looked at me.”

​“And how do you think I looked at you?” I ask defensively, forcing myself not to look away.

​In the quiet that follows, his smile fades, and heat replaces the humor in his eyes. “You looked at me the way I bet I’ve looked at you every time you walk into a room,” he says, the timbre of his voice rolling over my sensitive skin like a caress. “Like I would eat you if I could. Head to toe, everything in between.”

​“Kenan,” I protest, closing my eyes on a groan. “We said friends. We said simple. This is not how you start a simple friendship.”

​His large hand cups my jaw and lifts my chin. I open my eyes, blinking dazedly at him. I wasn’t prepared for how his touch makes me feel. How I instantly crave more of it; want to lean into the warmth; to turn and trace his lifeline with my tongue. Tell him all the things I could discover just from reading his palm and looking into his eyes.

​How can such a large hand feel so gentle, like it’s capable of treasuring, cherishing?

​“Okay, Lotus,” he says, regret and reluctance woven around my name. “Simple. Friendship.”

About Kennedy

A Top 25 Amazon Bestseller, Kennedy Ryan writes about women from all walks of life, empowering them and placing them firmly at the center of each story and in charge of their own destinies. Her heroes respect, cherish and lose their minds for the women who capture their hearts.

She is a wife to her lifetime lover and mother to an extraordinary son. She has always leveraged her journalism background to write for charity and non-profit organizations, but enjoys writing to raise Autism awareness most. A contributor for Modern Mom Magazine and Frolic, Kennedy’s writings have appeared in Chicken Soup for the Soul, USA Today and many others. The founder and executive director of a foundation serving Atlanta Autism families, she has appeared on Headline News, Montel Williams, NPR and other media outlets as an advocate for families living with autism.

Connect with Kennedy

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My Review!

5 ⭐️⭐️⭐️⭐️⭐️

Phenomenal! Kennedy Ryan never ceases to deliver something completely unique, unforgettable, thought provoking, completely addictive, and completely mind-blowing. I was utterly mesmerized, by the characters and this story that enraptured me with its emotion, anticipation, hunger, frustration, conviction, and vitality. Beautifully penned this book is a insta-must read, and one you wont be able to put down.

You do not want to miss this one. Obsessed. That’s how I felt while reading this book. Every page was better than the previous one. Just try to put this one down. I dare you.

I voluntarily read and reviewed an advanced reader copy. All thoughts and opinions are my own.

[anythingisabookmark]

The Ministry for the Future - Kim Stanley Robinson

This recommendation has fundamentally changed the trajectory of my year. And possibly the next decade for me. I knew about the challenge facing us with climate change, I was well aware and delved into the movement in 2008 after Al Gore’s An Inconvenient Truth came out. Back then, I was actually a youth. One of the generations that would be directly affected by the impending climate disaster. I was energised and optimistic, but with only dead ends at a higher policy level, my steam soon ran out.

I avoided the resurgence in eco activism/awareness in the last few years. I saw headlines counselling the new ‘eco-anxiety’ that has come about from leaning too far into the science and politics of Climate Change. Why would I give myself more anxiety about something that I can’t fundamentally change, as an individual or even through an activist group? Isn’t that what the world doesn’t need - another privileged white woman buying activewear from recycled plastics and blaring on about beeswax wraps?

In this frame of mind, and also in an anti-sci-fi context, I came to The Ministry for the Future. The first chapter about the Indian Heatwave seemed like an interesting and plausible inclusion. It’s likely that the hottest places will keep getting hotter. These are countries closest to the equator. These are largely developing nations of black and brown people. Then the ‘Ministry for the Future’ is set out by the 2025 Paris Accord. Yes, also something that would come out of the UN. Unlikely to drive real change. Something else that Greta Thunberg to scold as well intentioned yet lacking real change.

The 7 or 9 (I returned the library book and can’t remember specifics now) areas within the department were fascinating. Each represented a key threat to the climate, and Robinson took us on a journey to explore the solutions that were mostly all existing ideas that were implemented as intended. I didn’t think glaciology would interest me as much as it did when reading those passages. The bit that was the turning point for me (and it seemed like the future world) was Saudi Arabia’s coup. (Spoiler alert coming). It seems like such a simple chain of events…. Saudi Arabia as a nation fails. New government keeps oil in the ground. Becomes rich from carbon coins. Oil prices skyrocket worldwide. Renewables and EVs suddenly become ridiculously affordable. Power grids worldwide are transformed.

To get the world’s grids to renewables that quickly is a huge idea. It could really transform the future of the planet. Don’t ask me how much, I’m not a scientist, but if anything these ideas and happenings in the projected future of the book make it clear that real change comes at a policy level. We need our lawmakers to start listening and doing better.

I didn’t really care for Mary and Vadim’s story arcs at all. I wasn’t in the book for great literary characters and didn’t want half baked ones. Mary lacked depth, and so did everyone around her.

I’ve recommended this book to everyone that will listen since. I’ve also listened to a few podcasts with Robinson, and added his other books to my reading list (though I won’t read too quickly, as I don’t want to get KSR-fatigue!). I also added a slew of other climate and environment related books to my list, as now it’s important to me, I need to read up and across the topic to understand as much as I can. I don’t consider myself an environmentalist, but it’s becoming clear that issues are intersectional. Helping the environment helps everyone.

Lateral reads and viewing

Project Drawdown explains how the solutions work in very accessible terms, with details available for the nerds.

How To Save a Planet podcast from Gimlet Media is one that I've heard about for awhile but never tried. Now I'm hooked. Alex Blumberg and Ayana Johnson are fantastic hosts and do a really good job.

Dense Discovery is a weekly newsletter that I've been subscribed to for some time that has great sustainability info.

Project Wren allows you to calculate your carbon footprint and offset in one go or in a monthly subscription. I'm now aware that there are many services that offer this, this is just one.

Anything David Attenborough is a good companion piece when learning about the environment.

Seaspiracy on Netflix has a bit of a vegan propaganda vibe to it, but worthwhile and makes me reflect on my power as a consumer to purchase sustainable (?) fish.

[csrgood]

Podcast: How Intelligence at the Healthcare Edge Saves Lives

When a patient contracts sepsis during a hospital stay, speed to diagnosis and treatment is critical: If the infection goes undetected, the patient could die within hours. Now, using an algorithm, along with edge sensors, Wi-Fi data networks, and artificial intelligence, hospital caregivers can more rapidly diagnose sepsis and other serious illnesses―not only saving lives but helping to detect health issues before they become life-threatening.

"The caregivers are now able to use the connected technology to take readings from all of the devices and analyze them at the speed of computers," says Rich Bird, industry marketing manager for healthcare and life sciences at Hewlett Packard Enterprise, which has partnered with Cerner on connecting bedside technology "to actionize data."

As Cerner's Missy Ostendorf explains, when a patient's vitals "fall outside of safe parameters, [the Cerner sepsis algorithm] automatically sends alerts to the care team so they can take immediate action. There is 80 percent to 90 percent improvement in lives saved when you can take that early intervention."

Listen to this HPE Voice of the Customer podcast with host Dana Gardner to learn how this intelligent edge technology is transforming patient care―throughout hospitals, across communities, and around the globe.

Dana Gardner: Hello, and welcome to the next edition of the BriefingsDirect Voice of the Customer podcast series. I'm Dana Gardner, principal analyst at Interarbor Solutions, your host and moderator for this ongoing discussion on the latest insights into the confluence of edge computing and artificial intelligence (AI).

Our next intelligent edge adoption benefits discussion focuses on how hospitals are gaining proactive alerts on patients at risk for contracting serious sepsis infections. An all-too-common affliction for patients around the world, sepsis can often be controlled when confronted early.

Now, using edge sensors, Wi-Fi data networks, and AI solutions that identify at-risk situations, caregivers at hospitals are rapidly alerted to susceptible patients so they can head-off sepsis episodes and reduce serious illness and deaths.

Stay with us now as we hear about a cutting-edge use case that puts near real-time AI to good use by outsmarting a deadly infectious scourge.

To learn how, please join me now in welcoming our guests, Missy Ostendorf, global sales and business development practice manager at Cerner Corp. Welcome to the show, Missy.

Missy Ostendorf: Thank you very much.

Gardner: We're also here with Deirdre Stewart, senior director and nursing executive at Cerner Europe. Welcome, Deirdre.

Deirdre Stewart: Thank you very much.

Gardner: And we're also here with Rich Bird, worldwide industry marketing manager for healthcare and life sciences at Hewlett Packard Enterprise (HPE). Welcome, Rich.

Rich Bird: Thank you, Dana, and hello everyone.

A new era of intelligent healthcare tech

Gardner: Missy, what are the major trends driving the need to leverage more technology and process improvements in healthcare? When we look at healthcare, what's driving the need to leverage better technology now?

Ostendorf: That's an easy question to answer. Across all industries resources always drive the need for technology to make things more efficient and cost-conservative―and healthcare is no different.

If we tend to lead more slowly with technology in healthcare, it's because we don't have mission-critical risk―we have life-critical risk. And the sepsis algorithm is a great example of that. If a patient turns septic, they have four hours and they can die. So, as you can imagine, that clock ticking is a really big deal in healthcare.

Gardner: And what has changed, Rich, in the nature of the technology that makes it so applicable now to things like this algorithm to intercept sepsis quickly?

Bird: The pace of the change in technology is quite shocking to hospitals. That's why they can really benefit when two globally recognized organizations such as HPE and Cerner can help them address problems.

When we look at the demand spike across the healthcare system, we see that people are living longer with complex long-term conditions. When they come into a hospital, there are points in time when they need the most help.

What [HPE and Cerner] are doing together is understanding how to use this connected technology at the bedside. We can integrate the Internet of Things (IoT) devices that the patients have on them at the bedside, medical devices traditionally not connected automatically but through the humans. The caregivers are now able to use the connected technology to take readings from all of the devices and analyze them at the speed of computers.

So we're certainly relying on the professionalism, expertise, and the care of the team on the ground, but we're also helping them with this new level of intelligence. It offers them and the patients more confidence in the fact that their care is being looked at from the people on the ground as well as the technology that's reading all of their life science indicators flowing into the Cerner applications.

Win against sepsis worldwide

Gardner: Deirdre, what is new and different about the technology and processes that make it easier to consume intelligence at the healthcare edge? How are nurses and other caregivers reacting to these new opportunities, such as the algorithm for sepsis?

Stewart: I have seen this growing around the world, having spent a number of years in the Middle East and looking at the sepsis algorithm gain traction in countries like Qatar, UAE, and Saudi Arabia. Now we're seeing it deployed across Europe, in Ireland, and the U.K.

Once nurses and clinicians get over the initial feeling of, "Hang on a second. Why is the computer telling me my business? I should know better." Once they understand how that all happens, they have benefited enormously.

But it's not just the clinicians who benefit, Dana, it's the patients. We have documented evidence now. We want to stop patients ever getting to the point of having sepsis. This algorithm and other similar algorithms alert the front-line staff earlier, and that allows us to prevent patients developing sepsis in the first place.

Some of the most impressive figures show the reduction in incidents of sepsis and the increase in the identification of the early sepsis stages, the severe inflammatory response part. When that data is fed back to the doctors and nurses, they understand the importance of such real-time documentation.

I remember in the early days of the electronic medical records; the nurses might be inclined to not do such real-time documentation. But when they understand how the algorithms work within the system to identify anything that is out of place or kilter, it really increases the adoption, and definitely the liking of the system and what it can provide for.

Gardner: Let's dig into what this system does before we look at some of the implications. Missy, what does the Cerner's CareAware platform approach do?

Ostendorf: The St. John Sepsis Surveillance Agent looks for early warning signs so that we can save lives. There are three pieces: monitoring, alerting, and then the prescribed intervention.

It goes to what Deirdre was speaking to about the documentation is being done in real time instead of the previous practice, where a nurse in the intensive care unit (ICU) might have had a piece of paper in her pocket and she would write down, for instance, the patients' vital signs.

And maybe four hours later, she would sit at a computer and put in four hours of vitals from every 15 minutes for that patient. Well, as you can imagine, a lot can happen in four hours in the ICU. By having all of the information flow into the electronic medical record, we can now have the sepsis agent algorithm continually monitoring that data.

It surveys the patient's temperature, heart rate, and glucose level, and if those change and fall outside of safe parameters, it automatically sends alerts to the care team so they can take immediate action. And with that immediate action, they can now change how they are treating that patient. They can give them intravenous antibiotics and fluids, and there is 80 percent to 90 percent improvement in lives saved when you can take that early intervention.

So, we're changing the game by leveraging the data that was already there, we are just taking advantage of it, and putting it into the hands of the clinicians so that action can be taken early. That's the most important part. We have been able to actionize the data.

Gardner: Rich, this sounds straightforward, but there is a lot going on to make this happen, to make the edge of where the patient exists able to deliver data, capture data, protect it, and make it secure and in compliance. What has had to come together in order to support what was just described by Missy in terms of the Cerner solution?

Healthcare tech progresses to next level

Bird: Focusing on the outcomes is very important. It delivers confidence to the clinical team, always at the front of mind. But it provides that in a way that is secured, real-time, and available, no matter where the care teams are. That's very, very important. And the fact that all of the devices are connected poses great potential opportunities in terms of the next evolution of healthcare technology.

Until now, we have been digitizing the workflows that have always existed. Now, for me, this represents the next evolution of that. It's taking paper and turning it into digital information. But then how do we get more value from that? Having Wi-Fi connectivity across the whole of a site is not something that's easy. It's something that we pride ourselves on making simple for our clients, but a key thing that you mentioned was security around that.

When you have everything speaking to everything else, that also introduces the potential of a bad actor. How do we protect against that, how do we ensure that all of the data is collected, transported, and recorded in a safe way? If a bad actor were to become a part of external network and internal network, how do we identify them and close it down?

Working together with our partners, that's something that we take great pride in doing. We spoke about mobility, and outside of healthcare, in other industries, mobility usually means people have wide access to things.

But within hospitals, of course, that mobility is about how clinicians can collect and access the data wherever they are. It's not just one workstation in a corner that the care team uses every now and again. The technology now for the care team gives them the confidence to know the data they are taking action on is collected correctly, protected correctly, and provided to them in a timely manner.

Gardner: Missy, another part of the foundational technology here is that algorithm. How are machine learning and AI coming to bear? What is it that allowed you to create that algorithm, and why is that a step further than simple reports or alerts?

Ostendorf: This is the most exciting part of what we're doing today at Cerner and in healthcare. While the St. John's Sepsis Algorithm is saving lives in a large-scale way―and it's getting most of the attention―there are many things we have been able to do around the world.

Deirdre brought up Ireland, and even way back in 2009, one of our clients there, St. James's Hospital in Dublin, was in the news because they made the decision to take the data and build decision-making questions into the front-end application that the clinicians use to order a CT scan. Unlike other X-rays, CT scans actually provide radiation in a way that's really not great. So we don't want to have a patient unnecessarily go through a CT scan. The more they have, the higher their risks go up.

By implementing three questions, the computer looks at the trends and why the clinicians thought they needed it based on previous patients' experiences. Did that CT scan make a difference and how they were diagnosed? And now with ML, it can tell the clinician on the front end that this really isn't necessary for what you are looking for to treat this patient.

Clinicians can always override that. They can always call the X-ray department and say, "Look, here's why I think this one is different." But in Ireland, they were able to lower the number of CT scans that they had always automatically ordered. So with ML, they are changing behaviors and making their community healthier. That's one example.

Another example of where we are using the data and ML is with the Cerner Opioid Toolkit in the U.S. We announced that in 2018, to help our healthcare system partners combat the opioid crisis that we're seeing across America.

Deirdre, you could probably speak to the study as a clinician.

Algorithm assisted opioid-addiction help

Stewart: Yes, indeed. It's interesting work being done in the U.S. on what they call opioid-induced respiratory depression (OIRD). It looks like approximately one in 200 hospitalized surgical patients can end up with an opioid-induced ventilatory impairment. This results in a large cost in healthcare. In the U.S. alone, it's estimated in 2011 that it cost $2 billion. And the joint commission has made some recommendations on how the assessment of patients should be personalized.

It's not just one single standardized form with a score that is generated based on questions that are answered. Instead, it looks at the patient's age, demographics, previous conditions, and any other history with opioid intake in the previous 24 hours. And according to the risks of the patient, it then recommends limiting the number of opioids they are given. They also looked at the patients who ended up in respiratory distress and they found that a drug agent to reverse that distress was being administered too many times and at too high a cost in relation to patient safety.

Now with the algorithm, they have managed to reduce the number of patients who end up in respiratory distress and limit the number of narcotics according to the specific patients. It's no longer a generalized rule. It looks at specific patients, alerts, and intervenes. I like the way our clients worldwide work in the willingness to share this information across the world. I have been on calls recently where they voiced interest in using this in Europe or the Middle East. So it's not just one hospital doing this and improving their outcomes―it's now something that could be looked at and done worldwide. That's the same whenever our clients devise a particular outcome to improve. We have seen many examples of those around the world.

Ostendorf: It's not just collecting data; it's being able to actualize the data. We see how that's creating not only great experiences for a partner but healthier communities.

Gardner: This is a great example of where we get the best of what people can do with their cognitive abilities and their ability to contextualize and the best of the machines to where they can do automation and orchestration of vast data and analytics. Rich, how do you view this balancing act between attaining the best of what people can do and machines can do? How do these medical use cases demonstrate that potential?

Machines plus, not instead of, people

Bird: When I think about AI, I grew up in the science fiction depiction where AI is a threat.

But we want to be clear. We're not replacing doctors or care teams with this technology. We're helping them make more informed and better decisions. As Missy said, they are still in control. We are providing data to them in a way that helps them improve the outcomes for their patients and reduce the cost of the care that they deliver.

It's all about using technology to reduce the amount of time and the amount of money care costs to increase patient outcomes and also to enhance the clinicians' professionalism.

Missy also talked about adding a few questions into the workflow. I used to work with a chief technology officer of a hospital who often talked about medicine as eminence-based, which is based on the individuals that deliver it. There are numerous and different healthcare systems based on the individuals delivering them. With this digital technology, we can nudge that a little bit. In essence, it says, "Don't just do what you've always done. Let's examine what you have done and see if we can do that a little bit better."

We know that personal healthcare data cannot be shared. But when we can show the value of the data when shared in a safe way, the clinical teams can see the value generated. It changes the conversation. It helps people provide better care.

The general topic we're talking about here is digitization. In this context we're talking about digitizing the analog human body's vital signs. Any successful digitization of any industry is driven by the users. So, we see that in the entertainment industry, driven by people choosing Netflix over DVDs from the store, for example.

When we talk about delivering healthcare technology in this context, we know that personal healthcare data cannot be shared. It is the most personal data in the world; we cannot share that. But when we can show the value of data when shared in a safe way―highly regulated but shared in a safe way―the clinical teams can then see the value generated from using the data. It changes the conversation to how much the technology costs. How much can we save by using this technology?

For me, the really exciting thing about this is technology that helps people provide better care and helps patients be protected while they're in hospital, and in some cases avoid having to come into the hospital in the first place.

Gardner: Getting back to the sepsis issue as a critical proof point of life-enhancing and life-saving benefits, Missy, tell us about the scale here. How is this paying huge dividends in terms of saved lives?

Life-saving game changer

Ostendorf: It really is. The World Health Organization statistics from 2018 show that 30 million people worldwide experience a sepsis event. In their classification, 6 million of those could lead to deaths. In 2018 in the U.K., there were 150,000 annual cases, with 44 of those ending in deaths.

You can see why this sepsis algorithm is a game changer, not just for a specific client, but for everyone around the world. It gives clinicians the information they need in a timely manner so that they can take immediate action―and they can save lives.

Rich talked about the resources that we save, the cost that's driven out―all those things are extremely important. When you are the patient or the patient's family, that translates into a person who actually gets to go home from the hospital. You can't put a dollar amount or an efficiency on that.

It's truly saving lives, and that's just amazing to think that. We're doing that by simply taking the data that was already being collected, running that through the St. John's sepsis algorithm, and alerting the clinicians so that they can take quick action.

Stewart: It was a profound moment for me after Hamad Medical Corp. in Qatar, where I had run the sepsis algorithm across their hospitals for about 11 months, did the data and they reckoned that they had potentially saved 64 lives.

And at the time when I was reading this, I was standing in a clinic there. I looked out at the clinic―it was a busy clinic―and I reckoned there were 60 to 70 people sitting there. And it just hit me like a bolt of lightning to think that what the sepsis algorithm had done for them could have meant the equivalent of every single person in that room being saved. Or, on the flipside, we could have lost every single person in that room.

Mothers, fathers, husbands, wives, sons, daughters, brothers, sisters―and it just hit me so forcefully and I thought, "Oh, my gosh, we have to keep doing this." We have to do more and find out all those different additional areas where we can help to make a difference and save lives.

Gardner: We have such a compelling rationale for employing these technologies and processes and getting people and AI to work together. In making that precedent, we're also setting up the opportunity to gather more data on a historical basis. As we know, the more data, the more opportunity for analysis. The more analysis, the more opportunity for people to use it and leverage it. We get into a virtuous, positive adoption cycle.

Rich, once we've established the ability to gather the data, we get a historical base of that data. Where do we go next? What are some of the opportunities to further save lives, improve patient outcomes, enhance patient experience, and reduce costs? What is the potential roadmap for the future?

Personalization improves patient care, policy

Bird: The exciting thing is, if we can take every piece of medical information about an individual and provide that in a way that the clinical team can see it from one end of the user's life right up to the present day, we can provide medicine that's more personalized―so, treating people specifically for the conditions that they have.

Missy was talking about evaluating more precisely whether to send a patient for a certain type of scan. There's also another side of that. Do we give a patient a certain type of medication?

When we're in a situation where we have the patient's whole data profile in front of us, clinical teams can make better decisions. Are they on a certain medication already? Are they allergic to a medication that you might prescribe to them? Will their DNA, the combination of their physiology, the condition that they have, the multiple conditions that they have―then we start to see that better clinical decisions can be made. We can treat people uniquely for the specific conditions.

At Hewlett Packard Labs, I was recently talking with an individual about how big data will revolutionize healthcare. You have certain types of patients with certain conditions in a cohort of patients, but how can we make better decisions on that cohort of patients with those co-conditions? You know, at a specific time in their life, but then also how do we do that from an individual level of individuals?

Rather than just thinking about patients as cohorts, how could policymakers and governments around the world make decisions based on impacts of preventative care, such as more health maintenance? We can give visibility into that data to make better decisions for populations over long periods of time.

It all sounds very complicated, but my hope is, as we get closer, as the power of computing improves, these insights are going to reveal themselves to the clinical team more so than ever.

There's also the population health side. Rather than just thinking about patients as individuals, or cohorts of patients, how could policymakers and governments around the world make decisions based on impacts of preventative care, such as incentivizing populations to do more health maintenance? How can we give visibility into that data, into the future, to make better decisions for populations over the longer period of time?

We want to bring all of this data together in a safe way that protects the security and the anonymity of the patients. It could provide those making clinical decisions about the people that are in front of them, as well as policymakers to look over the whole population, the means to make more informed decisions. We see massive potential around prevention. It could have an impact on how much healthcare costs before the patient actually needs treatment.

It's all very exciting. I don't think it's too far away. All of these data points we are collecting are in their own silos right now. There is still work to do in terms of interoperability, but soon everybody's data could interact with everybody else's data. Cerner, for example, is making some great strides around the population health element.

Gardner: Missy, where do you see accelerating benefits happening when we combine edge computing, healthcare requirements, and AI?

At the leading edge of disease prevention

Ostendorf: I honestly believe there are no limits. As we continue to take the data in in places like in northern England, where the healthcare system is on a peninsula, they're treating the entire population.

Rich spoke to population health management. Well, they're now able to look across the data and see how something that affects the population, like diabetes, specifically affects that community. Clinicians can work with their patients and treat them, and then work with the actual communities to reduce the amount of type 2 diabetes. It reduces the cost of healthcare and reduces the morbidity rate.

That's the next place where AI is going to make a massive impact. It will no longer be just saving a life with the sepsis algorithm running against those patients who are in the hospital. It will change entire communities and how they approach health as a community, as well as how they fund healthcare initiatives. We'll be able to see more proactive management of health community by community.

Gardner: Deirdre, what advice do you give to other practitioners to get them to understand the potential and what it takes to act on that now? What should people in the front lines of caregiving be thinking about on how to best utilize and exploit what can be done now with edge computing and AI services?

Stewart: Everybody should have the most basic analytical questions in their heads at all times. How can I make what I am doing better? How can I make what I am doing easier? How can I leverage the wealth of information that is available from people who have walked in my shoes and looked after patients in the same way as I'm looking after them, whether that's in the hospital or at home in the community? How do I access that in an easier fashion, and how do I make sure that I can help to make improvements in it?

Access to information at your fingertips means not having to remember everything. It's having it there and having suggestions made to me. I'm always going back and reviewing what those results and analytics are to help improve the next time, the next time around.

From bedside to boardroom, everybody should be asking themselves those questions. Have I got access to the information I need? And how can I make things better? What more do I need?

Gardner: I'm afraid we'll have to leave it there. We've been exploring how hospitals are gaining proactive alerts on patients at risk for contracting life-threatening sepsis infections. But we've also learned about a larger perspective of how edge computing and AI are enabling caregivers around the world to respond to more types of issues and become more intelligent about providing better care for people.

Please join me in thanking our guests, Missy Ostendorf, global sales and business development practice manager at Cerner Corp. Thank you so much, Missy.

Ostendorf: Thank you. It was fun to be here.

Gardner: We've also been joined by Deirdre Stewart, senior director and nursing executive at Cerner Europe. Thank you so much, Deirdre.

Stewart: It was an absolute pleasure. Thank you.

Gardner: And lastly, we've been here with Rich Bird, worldwide industry marketing manager for healthcare and life sciences at HPE. Thank you, Rich.

Bird: Thank you.

Gardner: And lastly, a thank you to our audience for joining this BriefingsDirect Voice of the Customer Internet of Things and AI strategies interview. I'm Dana Gardner, principal analyst at Interarbor Solutions, your host for this ongoing series of HPE-sponsored discussions.

Thanks again for listening. Please pass this on to your community, and do come back next time.

Saving lives with edge intelligence: Lessons for leaders

Healthcare providers are using a combination of edge computing, AI, and Wi-Fi data networks to rapidly detect, monitor, and treat deadly sepsis infections in hospitals.

Cerner and HPE have partnered to better connect bedside technology, making data more actionable.

In addition to helping treat sepsis more quickly, intelligent edge devices are improving treatments for other serious health conditions, including opioid addiction.

source: https://www.csrwire.com/press_releases/43855-Podcast-How-Intelligence-at-the-Healthcare-Edge-Saves-Lives?tracking_source=rss