Unlike the Wii, Mouse-ke-TAG has kids running all over the house.
Very simple to play. There are 4 Disney characters with embedded RFID chips. Scatter these over a room or home and then set the kids loose with Mickey's Playhouse with embedded RFID reader. The Playhouse recognizes the characters when placed on top and tells the kids through clues which character to look for.
You can play different ways too. My kids (5 and 2.5) liked it best when they were on the timed mode and they had to run as fast as they could back and forth between characters.
They probably were running around for a good half hour.
Great game for a rainy day, snowy day or just an indoor day and supports up to 6 players.
Not sure how much fun it'd be for just one child to play but get a bunch together and this may well run them tired.
My only complaint? The characters fall of their bases too easily. I'd recommend gluing them down.
For ages 2 and up (the box says 3 but my 2.5 year old had no issues).
It's called "The Ryerson Declaration" and it stems from the 2009 Ryerson University workshop, Beyond Nutritionism: Rescuing Dietetics through Critical Dialogue and according to the Dietitians of Canada Practice Blog, the Ryerson workshop gave birth to a new focus in dietetics that attendees referred to as, "Critical Dietetics".
Unlike nutritionism, the aim of Critical Dietetics is to answer tough questions utilizing critical appraisal and an evidence based approach. Questions such as,
"What counts as “knowing” in dietetic practice? How do we, as nutrition professionals, come to know what we don’t know? How does the evidenced-based culture of dietetics give voice? Where does dietetic culture render silence? What is it that we have already accomplished as a profession? In what ways do we continue to evolve? How can we further build upon the rich roots of our profession? What do we envision for the future of our profession?"
The Ryerson Declaration then is a manifesto of sorts calling for change whereby,
"It invites constructive dialogue and challenges us to discuss, debate, and rethink what we know and how we know it. It is a generative and collective effort which understands that strength comes from diversity and debate."
It's this type of thinking that may see dietetics rise from the realm of belief based nutritionism to evidence based science and allow for debates with passion, but not anger, and end the current state of affairs where people take disagreements personally and emotionally rather than with thoughtful critical appraisal.
The post on the DC site is getting very little play. I know quite a few Canadian RDs read this blog - I hope you all take the time to pop over there read all about it and hopefully sign onto the declaration.
[Hat tip to blogging friend, Canadian RD and gastronomic explorer Vincci who linked to the declaration on her blog yesterday]
Ontario residents to wait even longer for bariatric surgery? 8.12.2009 10:30:0 +0000 Sure looks that way for as of November 1st there are new hoops to jump through for physicians trying to access a bariatric surgical consult for their patients.
On the surface, surgical criteria couldn't be more straightforward:
A. BMI >35 and <40 with at least one of -
Coronary heart disease.
Diabetes
Obstructive sleep apnea
Medical refractory hypertension despite optimal medical management
OR
B. BMI >40 for greater than 2 years
Meet those criteria and theoretically you should be cleared for surgery. Problem is in Ontario we have far more demand than we have supply. Consequently last year Ontario funded 1,660 out of province bariatric surgeries, triple the number from 2006. The rapid increase is likely due to the fact that more and more physicians (and patients) are recognizing the utility of bariatric surgery; spreading word of mouth from those who've had success; and the publication of long term results that undeniably demonstrate increased longevity and decreased morbidity post-operatively. In other words, physicians and patients are recognizing bariatric surgery for what for many it is - a quantity of life prolonging and quality of life improving procedure. Consequently demand will only be going up.
So how many Ontarians qualify for bariatric surgery?
Estimates put roughly 3% of Ontario's population as being appropriate bariatric surgical candidates - that'd be 345,000 people.
So what's our government doing about it?
On February 7th, 2007 the McGuinty liberals announced that they'd be increasing funding for Ontario based bariatric surgery and providing sufficient funding to support 225 additional annual bariatric surgeries at the Humber River Regional Hospital. That press release flaunted this statement,
"Today’s initiative is part of the McGuinty government’s plan for innovation in public health care, building a system that delivers on three priorities - keeping Ontarians healthy, reducing wait times and providing better access to doctors and nurses."
On February 23rd, 2009 this initiative was expanded upon and it was announced that Ontario would be spending an additional $75 million dollars so that by 2011/2012 Ontario's bariatric surgical capacity will be 2,085 cases per year.
Why spend the money?
Firstly there's the estimate that for every procedure done in Ontario rather than out-of-country the Province will save $10,000. Secondly there's this statement from the backgrounder put out along with the announcement,
"Bariatric surgery can help resolve several health conditions, such as diabetes, hypertension and dyslipidemias. Dyslipidemias is a condition that can lead to atherosclerosis, the hardening of the artery walls, which can restrict blood flow to the heart. Bariatric surgery can also reduce other obesity-related conditions, such as hypertension (high blood pressure), osteoarthritis (a painful joint disease), ischemic heart disease, stroke and some cancers."
Translation - it's a remarkably effective surgery that increases longevity and decreases co-morbidity (in fact eliminating most weight related co-morbidity).
So let's look at the initiative.
So far the Ministry has established a total of five regional assessment centres - locations where physicians are supposed to refer their patients if they're interested in bariatric surgery. The five are Humber River Regional Hospital in Scarborough, St. Joseph's Healthcare in Hamilton, Guelph's General Hospital, the Ottawa Hospital, and Windsor Regional Hospital. Once referred it's up to those centres to determine need. According to Ministry sources I spoke with, more are planned.
But wait a second, do we really need to have our patients seen by another physician to determine eligibility and won't that also markedly hamstring folks who don't happen to live in one of the cities with designated centres? Aren't the surgical criteria extremely straightforward? Shouldn't a minimum of 6 years of medical education equip physicians with the ability to determine suitability?
Personally I think so, and certainly doctors as a general rule are great at following flowcharts but given the added costs here, I readily agree that there should be a step to ensure that indeed the patients are suitable. Before the establishment of these centres there was a committee that reviewed applications and turnaround was in the neighbourhood of 4 weeks to approval. If the patient didn't meet criteria then the committee either rejected the application or requested further information from the referring physician.
Speaking to folks working with the committee they were getting swamped (not just with requests for bariatric surgery but also other out-of-country needs) and clearly something needed to change.
But is there really a need for a committee? Couldn't the Ministry with some of that $75 million create an online application, accessible by physicians, that in turn screens itself and would automatically eliminate those folks who weren't clear cut surgical candidates based off pre-determined and pre-programmed criteria, and in those cases where outright rejected or where other factors may necessitate further assessment - age, psychiatric history, etc., perhaps those could be the folks who should be assessed at a regional assessment centre?
Alright, so how are these centres working at reducing wait times like the press release suggested? Well, just 1 month ago when we didn't have these centres the wait would have been a maximum of 4 weeks to approval for a surgical consultation, what about now?
Our front-desk administrator Wendy called the assessment centres and here's what she found out:
Ottawa: They outright refused to provide us with any information. They refused to tell us the length of the waiting list or how many people were on it. Wendy was polite. She explained she was calling from a physician's office and she was told that their policy, regardless of who was calling, is not to divulge any information. They also told Wendy that if she were a patient on that list that it would be their policy not to tell her when they thought we might be seen.
Windsor: They didn't really know. They told Wendy that it would be a minimum of 1-3 months but when pressed they admitted that they really had no idea and that they had well over 100 consults that hadn't even been contacted for appointments yet.
Guelph: They were extremely helpful and pleasant. Wendy was told that if we had a patient to refer that the next available date would be May 10th (a 6 month wait). St. Joseph's Health Centre: Over the course of the past week Wendy called 4 times and left 2 messages. No one ever called us back and we were never able to reach a human being.
Humber River Regional: Wendy left 2 messages and I also had one of their staff surgeons email them a request on our behalf and so far, no one has gotten back to us.
Not exactly promising stuff.
So is there any way to get a patient to an out-of-country surgeon without the regional assessment unit? Yes. There's a criteria that the patient needs to be assessed by the unit OR needs to have failed a 3 month inter-disciplinary management of their obesity that specifically includes physicians and dietitians in patient care. That said, there are very few inter-disciplinary weight management programs in Ontario (mine being one of them, and off the top of my head I can only think of 4).
Now despite the fact that my patients will in fact still have timely access to out-of-country surgeries I am slightly uneasy with that requirement. Why? Well even though I'm incredibly proud of the services we provide in my offices, to date there has yet to be a medically managed program reproducible enough to serve as a "gold standard". What I mean is that medical weight management is a service that depends highly on the staff providing it and while good behavioural programs can indeed yield great outcomes, I feel that requiring a 3 month trial of such a program in the absence of a reproducible gold standard may be an unreasonable requirement which in some cases will just end up costing patients 3 months of time and some amount of money given that OHIP doesn't cover ancillary health care services like dietitians.
Given that the number of out-of-country bariatric surgery cases tripled since 2006 to 1,660 and with no reason to believe that the rise in demand won't continue to be extremely rapid, and given that the Ontario surgical centres established aren't yet at their 2011/2012 capacity I have no doubt that demand will continue to dramatically outstrip supply and consequently wait times will likely be far greater with this new system than when we physicians could access out-of-country bariatric surgery for our patients directly (rather than through the additional step of a regional assessment centre).
Having spoken to one person intricately involved in the establishment of these new rules I was given the impression that they viewed this surgery as comparable to a hip replacement, and just like hips, waits of 1-2 years to have the surgery are less than ideal but still completely acceptable. I disagreed. While living with a painful hip certainly impacts on quality of life, it doesn't impact on quantity. Living with severe obesity and its many co-morbidities certainly risks dying from weight-related complications prior to your surgical date and risks permanent damage as a consequence of disease processes and the physical effects of the weight itself.
At the end of the day I think this is all about money. At some point there was a high level discussion where somebody took a look at the ever increasing amount of money flowing South of the border and somebody said we've got to figure out a way to stop this flow. Given that we live in a nation of socialized medicine money's a very fair concern and even if each and every one of these surgeries in the long run saves the Province money by reducing long term health care costs for these patients and increasing their productivity and ability to work, if you don't have the money up front you can't make the investment.
I just wish the Ministry would have come out and said that it was wholly about money rather than suggest it was about wait lists and access to care since the waits are now much, much longer, and only likely to grow, and with the rare exceptions of folks like me with an inter-disciplinary program backing them up, access to care has become more difficult to obtain. Really, by not actually coming right out and saying it's about money the Province is far less likely to address money as a problem. and consequently it's less likely that people will be actively looking and advocating for novel solutions to increase Ontario based surgical availabilities such as the establishment of public-private partnerships (so called P3 hospitals) to build privately built and publicly funded baratric surgical hospitals and the public also won't see a great example of a massive crack in our publicly funded healthcare system and if you don't see cracks you tend not to look for ways to repair them.
I'm hoping this is just an example of growing pains and that my worries won't pan out but so far this new system, in its current state, effectively puts a cork in what was already a bottleneck.
RSS FEED
Debunking common email deliverability myths No matter what a service provider may claim, you control your own email destiny. Learn the truth behind these eight widespread misconceptions.
Fox hopes to flourish where Disney died Television networks' intrigue with digital studios is not a new concept, but it is one that has been generally tainted with disaster. Find out how Fox is learning from the mistakes of Disney's Stage 9.
The smart agency approach to website design Ready to demonstrate your understanding of key client objectives with websites that go beyond providing attractive creatives? Here are some tips to get you started.
If you fill your heart with regrets of yesterday and the worries of tomorrow, you have no today to be thankful for.
My Dearest Friend, if circumstance would allow at this time I would say let us walk together through our existence in this world. Thank you Cyn for the friendship :) Have a lovely weekend!
great! i have never heard of zigime, let me know im always open to anything especially if it is being brought to me by a friend. until then take care x
We all need someone to talk to in our life, a friend to whom we run in times of stress or strife: together we must each have ground that's where love's nourishment is found. Have a wonderful weekend my friend :)
Hi Cyne! In the Soo is getting cold, but, that is ok! I already look forward to ice fishing. Leaves starting to change colors and views are spectacular; fall is my favorite time of the year just like winter. Hunting season has started and plenty of time I’ll spend in the bush…yep! I love it. Where do you live? Enjoy your day and be grateful that is above the water. Warm hugs to you my friend.
MS Excel (or any spreed sheet program)would be great for that and you could also copy and paste when you need to use the links. make a columns for 'program name', 'referral link', 'ID', etc. then you can sort the columns by alphabet or whatever.
or
just create a notepad document for each program and name it after the program. Then use it like a 'notepad' for each program... keep the programs' affiliate links, user names, maybe passwords, listed on the document. Then you can put the notepad files you have for each program in a folder in 'your docs' and use the file sort features in your operating system. sort by date modified, name(alpha-numeric), file size ...etc.
Are you talking about me specifically or any one generally? what links are you referring to? you want then easy for others to find or for you to keep track of them?
9/24/2009
Cynergy Diva
47 years old Female South Eastern Ontario, Canada Hometown: Montreal QC
My nest is empty now and I'm looking for new endeavours to keep me busy.While recovering from my broken ankle, I've been let go from my office job, so I've been exploring ways to do something for myself in order to be free from the demands of other people. To that end, I've been looking at learning how to market online. Experimenting with a lot of different things - some of them turned out to be scams - I have stumbled on something that looks really intriguing that I'm going to examine further. (See MoreNiche blog)
I really like this online socializing. The internet really makes the world a small place, and I hope I can really broaden my horizons and meet a lot of new people. Lifelong learning and personal empowerment are important to me. I'm always looking for new ways to improve myself, and if anything I learn can be passed on for the benefit of others, then that makes me happy.
I love the girly stuff: knitting, sewing,quilting, crafting and shopping.
I love to read too, but I'm really passionate about seeing my fellow humans better themselves and their circumstances. Cynergy (Synergy) is my keyword.
R&B - New Country - Pop - Jazz
I like most music and I'm not fanatical about any one artist. About the only music I can't take is Opera and Heavy Metal. My favorite radio stations are: BBC Radio 2; KJAZZ; and the local oldies station AM 1220 Cornwall
Fave song as of Aug 2007 The Way I Are
Movies:
My faves are The Grapes of Wrath, Corrina, Corrina & Edward Scissor Hands - The last movie I saw was Stomp The Yard - 2 thumbs up!
TV:
My two favorites are British soaps Coronation Street and Eastenders; I love the Brit coms and westerns too
Books:
I like to read for personal development, and I love historical and generational sagas, but I'm not ashamed to say that I do enjoy trashy romance novels too. Some of the books that I have enjoyed are: The The Power of Intention by Dr Wayne Dyer - The Da Vinci Code by Dan Brown - Just about all of Danielle Steele's novels. Now Reading: The Power of Now: A Guide to Spiritual Enlightenment
by Eckhart Tolle
by Dr Wayne Dyer - The Da Vinci Code by Dan Brown - Just about all of Danielle Steele's novels. Now Reading: 
by Eckhart Tolle 