question:Answer the following question: Context: Lee played after school with the other kids in the park. Question: How would you describe Lee? Which one of these answers best answers the question according to the context? A: feeling bored B: feeling strong C: feeling lazy Answer:

question:Here is a news article: When Lisa Morrise gave birth to her youngest daughter Kirsten, doctors told her the baby was experiencing serious respiratory problems but they weren't sure why. "She just wasn't getting enough oxygen," Morrise told CBS News. "She had a purple and bluish tinge to her color." Morrise later learned that Kirsten was born with Pierre Robin Sequence, a rare set of abnormalities affecting the head and face, consisting of a small lower jaw, a tongue placed further back than normal, and cleft palate which obstructs breathing and swallowing. The condition affects an estimated one in every 8,500 to 20,000 babies and requires immediate resuscitation at birth. Kirsten Morrise was born Feb. 15, 1993, bluish in color and retracting at the sternum, making an extra effort to move air. Lisa Morrise But since Kirsten's condition wasn't immediately diagnosed, she did not get the treatment she needed. Once doctors determined she was breathing, they sent her to the normal nursery, but two hours later a nurse noticed Kirsten was still under distress and rushed her to the NICU. There, she was diagnosed and treated correctly, but Morrise believes that the two hours in which Kirsten did not have sufficient oxygen was a factor in her developing mild cerebral palsy. Kirsten's story is just one of many who have suffered as a result of a diagnostic error. Such inaccurate or delayed diagnoses are far from uncommon and urgently need to be addressed by the medical community, according to a new report released today by the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine. In fact, most people will experience at least one diagnostic error -- an inaccurate or delayed diagnosis -- in their lifetime, sometimes with devastating consequences, the authors report. The paper is a continuation of the Institute of Medicine's Quality Chasm Series. The committee that wrote the study found that data on diagnostic errors are sparse, there are few measures to accurately track them and most errors are found only in retrospect. "Despite the pervasiveness of diagnostic error and the risk for patient harm, they have been largely unappreciated within the quality safety movement in health care and this cannot and must not continue," Dr. Victor Dzau, the president of the National Academy of Medicine, said in a press conference this morning. "The time has come to address diagnostic errors," Dr. Mark Graber, founder and president of the Society to Improve Diagnosis in Medicine, told CBS News. His organization petitioned the IOM to undertake an investigation of diagnostic errors. "Diagnostic errors are nothing new, they've been happening all along and this report emphasizes how significant they are," he said The report identified several common causes for diagnostic errors, including: Inadequate collaboration and communication among clinicians, patients, and their families Limited feedback to doctors about the accuracy of diagnoses A culture that discourages transparency and disclosure of diagnostic errors, which impedes attempts to learn and improve in the medical community As health care continues to grow more complex, experts say the problem of diagnostic errors will likely worsen unless steps are taken to address it. The committee makes several recommendations, but admits it's a complicated problem to solve. "Diagnosis is a collective effort that often involves a team of health care professionals -- from primary care physicians, to nurses, to pathologists and radiologists," Dr. John R. Ball, committee chair and executive vice president emeritus of the American College of Physicians, said in a statement. "The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error. Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis made." The committee first calls for patients and their families to be more involved in the diagnostic process. To help them do so, they say doctors and health care organizations should provide patients with greater opportunities to learn about diagnosis. They should also get improved access to electronic health records, including clinical notes and test results. The report says it's important to create an environment where patients and their family can share feedback and concerns about possible diagnostic errors. Currently, most health care organizations do not have systems in place to identify diagnostic errors, and the culture of many of these organizations discourages such identification, the authors say. They recommend reforms to the medical liability system, to help encourage transparency and disclosure of diagnostic errors in an effort to learn from them and prevent them from happening again. Currently, fear of lawsuits often has the effect of discouraging doctors or health care organizations from admitting problems to patients. In Morrise's case, she never received confirmation from the hospital that Kirsten's delayed diagnosis was the cause of further health problems. But years later, she learned from the nurses who had cared for her daughter that after the incident, yearly training was implemented in identifying the signs of Pierre Robin Sequence and how to administer appropriate treatment. "That was difficult for me to process because I realized in that moment that the hospital had known that they had made a mistake, and what took years for me to figure out what the impact had been, they had known and never said anything," Morrise said. Kirsten Morrise during a hike in Brighton, Utah in August 2015. Lisa Morrise Kirsten, now 22 and a student at Utah State studying social work, has undergone a total of 44 surgeries and spent a large part of her life with a tracheotomy tube. After three major procedures, she can now breathe fairly well. Both she and her mother have become patient advocates, giving regular talks on the subject and working with local hospitals to provide the patients' perspective on improving care. The authors of the report also highlight the importance of medical education reform in preventing diagnostic errors. They call for changes to the curriculum emphasizing clinical reasoning, teamwork, communication and diagnostic testing. Additionally, they say it's important to improve health information technology and support for both health care professionals and patients. "In the end improving the diagnostic process is not only possible, but it does represent a moral professional public health imperative," Ball said. "Achieving the goal will require a significant re-envisioning of the diagnostic process and widespread commitment to change." ||||| A daily crawl of more than 200,000 home pages of news sites, including the pages linked from those home pages. Site list provided by The GDELT Project These crawls are part of an effort to archive pages as they are created and archive the pages that they refer to. That way, as the pages that are referenced are changed or taken from the web, a link to the version that was live when the page was written will be preserved.Then the Internet Archive hopes that references to these archived pages will be put in place of a link that would be otherwise be broken, or a companion link to allow people to see what was originally intended by a page's authors.The goal is to fix all broken links on the web . Crawls of supported "No More 404" sites. Date: Sept. 22, 2015 prefix = "o" ns = "urn:schemas-microsoft-com:office:office" / Urgent Change Needed to Improve Diagnosis in Health Care or Diagnostic Errors Will Likely Worsen, Says New Report WASHINGTON – Most people will experience at least one diagnostic error -- an inaccurate or delayed diagnosis -- in their lifetime, sometimes with devastating consequences, says a new report from the Institute of Medicine of the National Academies of Sciences, Engineering, and Medicine. The committee that conducted the study and wrote the report found that although getting the right diagnosis is a key aspect of health care, efforts to improve diagnosis and reduce diagnostic errors have been quite limited. Improving diagnosis is a complex challenge, partly because making a diagnosis is a collaborative and inherently inexact process that may unfold over time and across different health care settings. To improve diagnosis and reduce errors, the committee called for more effective teamwork among health care professionals, patients, and families; enhanced training for health care professionals; more emphasis on identifying and learning from diagnostic errors and near misses in clinical practice; a payment and care delivery environment that supports the diagnostic process; and a dedicated focus on new research. This report is a continuation of the Institute of Medicine’s Quality Chasm Series , which includes reports such as To Err Is Human: Building a Safer Health System , Crossing the Quality Chasm: A New Health System for the 21st Century , and Preventing Medication Errors . “These landmark IOM reports reverberated throughout the health care community and were the impetus for system-wide improvements in patient safety and quality care,” said Victor J. Dzau, president of the National Academy of Medicine. “But this latest report is a serious wake-up call that we still have a long way to go. Diagnostic errors are a significant contributor to patient harm that has received far too little attention until now. I am confident that Improving Diagnosis in Health Care, like the earlier reports in the IOM series, will have a profound effect not only on the way our health care system operates but also on the lives of patients.” Data on diagnostic errors are sparse, few reliable measures exist, and errors are often found in retrospect, the committee found. However, from the available evidence, the committee determined that diagnostic errors stem from a wide variety of causes that include inadequate collaboration and communication among clinicians, patients, and their families; a health care work system ill-designed to support the diagnostic process; limited feedback to clinicians about the accuracy of diagnoses; and a culture that discourages transparency and disclosure of diagnostic errors, which impedes attempts to learn and improve. Errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity, the committee concluded. To improve diagnosis, a significant re-envisioning of the diagnostic process and a widespread commitment to change from a variety of stakeholders will be required. “Diagnosis is a collective effort that often involves a team of health care professionals -- from primary care physicians, to nurses, to pathologists and radiologists,” said John R. Ball, chair of the committee and executive vice president emeritus, American College of Physicians. “The stereotype of a single physician contemplating a patient case and discerning a diagnosis is not always accurate, and a diagnostic error is not always due to human error. Therefore, to make the changes necessary to reduce diagnostic errors in our health care system, we have to look more broadly at improving the entire process of how a diagnosis made.” Critical partners in improving the diagnostic process are patients and their families, because they contribute valuable input that informs diagnosis and decisions about their care. To help them actively engage in the process, the committee recommended that health care organizations and professionals provide patients with opportunities to learn about diagnosis, as well as improved access to electronic health records, including clinical notes and test results. In addition, health care organizations and professionals should create environments in which patients and families are comfortable sharing feedback and concerns about possible diagnostic errors. Few health care organizations have processes in place to identify diagnostic errors and near misses in clinical practice. However, collecting this information, learning from these experiences, and implementing changes are critical for achieving progress. The culture of health care organizations can also discourage identification and learning. Therefore, the committee called for these institutions to promote a non-punitive culture that values open discussions and feedback on diagnostic performance. Reforms to the medical liability system are needed to make health care safer by encouraging transparency and disclosure of diagnostic errors. States, in collaboration with other stakeholders, should promote a legal environment that facilitates the timely identification, disclosure, and learning from diagnostic errors. Voluntary reporting efforts should also be encouraged and evaluated for their effectiveness. Payment and care delivery models also likely influence the diagnostic process and the occurrence of diagnostic errors, but information about their impact is limited and this is an important area for research, the committee said. It recommended changes to fee-for-service payment to improve collaboration and emphasize important tasks in the diagnostic process. For example, the Centers for Medicare & Medicaid Services and other payers should create codes and provide coverage for evaluation and management activities, such as time spent by pathologists and radiologists in advising treating physicians on testing for specific patients. Moreover, payers should reduce distortions in the fee schedule that place greater emphasis on procedure-oriented care than on cognitive-oriented care, because they may be diverting attention from important tasks in diagnosis, such as preforming a thorough clinical history, interview, and physical exam, or decision making in the diagnostic process. Additionally, the committee recommended that health care professional education and training emphasize clinical reasoning, teamwork, communication, and diagnostic testing. The committee also urged better alignment of health information technology with the diagnostic process. Furthermore, federal agencies should develop a coordinated research agenda on the diagnostic process and diagnostic errors by the end of 2016. The report presents resources to help patients better engage in the diagnostic process. One resource, a checklist for getting the right diagnosis, advises patients about how to effectively tell their story, be a good historian, keep good records, be an informed consumer, take charge of managing their health care, follow up with their clinicians, and encourage clinicians to think about other potential explanations for their illness. The study was sponsored by the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, American College of Radiology, American Society for Clinical Pathology, Cautious Patient Foundation, College of American Pathologists, The Doctors Company Foundation, Janet and Barry Lang, Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation, and Robert Wood Johnson Foundation. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. The Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit http://national-academies.org . A committee roster follows. Social Media: #improvingdiagnosis http://nas.edu/improvingdiagnosis Resources: Report in Brief List of Recommendations Select Figures Resources for Improving Communications PDF of Communication Resources Video Contacts: Jennifer Walsh, Senior Media Relations Officer Chelsea Dickson, Media Relations Associate Office of News and Public Information 202-334-2138; e-mail [email protected] http://www.nas.edu/newsroom/index.html Twitter: @NASciences RSS feed: http://www.nationalacademies.org/rss/index.html Flickr: http://www.flickr.com/photos/nationalacademyofsciences/sets Pre-publication copies of Improving Diagnosis in Health Care are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). THE NATIONAL ACADEMIES OF SCIENCES, ENGINEERING, AND MEDICINE Institute of Medicine Board on Health Care Services Committee on Diagnostic Error in Medicine John R. Ball, M.D., J.D.* (chair) Executive Vice President Emeritus American College of Physicians Asheville, N.C. Elisabeth Belmont, J.D. Corporate Counsel MaineHealth Portland Robert A. Berenson, M.D. Institute Fellow The Urban Institute Washington, D.C. Pascale Carayon, Ph.D. Proctor & Gamble Bascom Professor in Total Quality Department of Industrial and Systems Engineering, and Director Center for Quality and Productivity Improvement University of Wisconsin Madison Christine K. Cassel, M.D.* President and CEO National Quality Forum Washington, D.C. Carolyn M. Clancy, M.D.* Chief Medical Officer Veterans Health Administration Washington, D.C. Michael B. Cohen, M.D. Medical Director Anatomic Pathology and Oncology Division ARUP Laboratories, Professor and Vice Chair for Faculty Development and Ombudperson, Health Sciences Center University of Utah Salt Lake City Patrick Croskerry, M.D., Ph.D., FRCP(Edin) Professor of Emergency Medicine Director, Critical Thinking Program Dalhousie University Medical School Dalhousie University Nova Scotia, Canada Thomas H. Gallagher, M.D. Professor and Associate Chair, Department of Medicine Director, Hospital Medicine Program and Center for Scholarship in Patient Care Quality Improvement, Safety and Value University of Washington Seattle Christine A. Goeschel, Sc.D., M.P.A., M.P.S., R.N., F.A.A.N. Assistant Vice President for Quality Medstar Health Columbia, Md. Mark L. Graber, M.D. Senior Fellow RTI International Plymouth, Mass. Hedvig Hricak, M.D., Ph.D.* Chair Department of Radiology Memorial Sloan-Kettering Cancer Center New York City Anupam B. Jena, M.D., Ph.D. Associate Professor Health Care Policy and Medicine Harvard Medical School; and Assistant Physician Massachusetts General Hospital Boston Ashish K. Jha, M.D., M.P.H.* K.T. Li Professor of International Health, and Director Harvard Global Health Institute Department of Health Policy and Management Harvard School of Public Health Boston Michael Laposata, M.D., Ph.D. Professor and Chair Department of Pathology University of Texas Medical Branch Galveston Kathryn M. McDonald, M.M. Executive Director and Senior Scholar Center for Health Policy and Center for Primary Care and Outcomes Research Stanford University Stanford, Calif. Elizabeth A. McGlynn, Ph.D.* Director Center for Effectiveness and Safety Research Kaiser Permanente Pasadena, Calif. Michelle Rogers, Ph.D. Associate Professor College of Computing and Informatics Drexel University Philadelphia Urmimala Sarkar, M.D., M.P.H. Associate Professor Division of General Internal Medicine University of California, and Primary Care Physician San Francisco General Hospital San Francisco George E. Thibault, M.D.* President Josiah Macy Jr. Foundation, and Daniel D. Federman Professor of Medicine and Medical Education Emeritus Harvard Medical School New York City John B. Wong, M.D. Chief Division of Clinical Decision Making Institute for Clinical Research and Health Policy Studies School of Medicine Tufts University Boston STAFF Erin Balogh Study Director _________________________ *Member, National Academy of Medicine # # # ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. Most Americans will get a wrong or late diagnosis in their lifetimes, a new report finds — often with devastating effects. It’s almost impossible to quantify, but the problem is serious, and the lack of a coherent medical system helps keep it under the radar, the National Academy of Medicine finds in a new report. The solution involves getting pathologists and radiologists more actively involved in a patient’s diagnosis, the Academy, formerly the Institute of Medicine, recommends. It's also calling for changes to medical malpractice laws so professionals aren’t afraid to own up to mistakes, and going back to doing autopsies, culture changes at hospitals, clinics and institutions and better use of technology. “Everyone will experience one meaningful diagnostic error in their lifetime,” Dr. John Ball, chairman of the Committee on Diagnostic Error in Medicine, which wrote the report, told NBC News. “Everyone will experience one meaningful diagnostic error in their lifetime." “We simply don’t know what the incidence of it is. We need to study it more to be able to do anything about it. It’s an under-represented, understudied area in medicine and we need to shine a light on it.” According to the report: At least 5 percent of U.S. adults who seek outpatient care each year experience a diagnostic error. Postmortem exams suggest diagnostic errors contribute to 10 percent of patient deaths. Medical records suggest diagnostic errors account for 6 to 17 percent of adverse events in hospitals. Sometimes people suffer from more than one error. Susan Sheridan of Boise, Idaho, lost her husband to a late cancer diagnosis and has a permanently disabled son because no one noticed his serious jaundice as a newborn. She knew something was badly wrong soon after her son Cal, who is now 20, was born. He was a little jaundiced, which is normal for a newborn, but Sheridan noticed more alarming symptoms. “When he was about three or four days old, he began to show signs of being super sleepy,” Sheridan said. He’d been a strong feeder, but was weak and floppy. Sheridan called St. Luke’s Hospital in Boise, where Cal had been born, for advice. “They said, ‘Are you a first time mom?’ I said yeah. They said, ‘Don’t worry — this is normal’,” Sheridan said. She remained worried and her pediatrician reluctantly told her to bring Cal in. “He was so yellow he was turning a kind of orange color. The receptionist called him the pumpkin baby because he was so yellow orange,” Sheridan said. These are all classic signs of too-high bilirubin. Newborns have tiny livers that cannot easily process this compound. When levels get too high, bilirubin can damage the brain. Many hospitals now routinely test for it, but in 1995, when Cal was born, it had fallen out of fashion. Cal was given an antibiotic for an ear infection and sent home. His bilirubin continued to soar, damaging his brain. A level of 20 is considered dangerous. Cal’s was 34. It’s easy to treat by putting the baby under special lights for a few days or, if it gets worse, with a blood transfusion. Time after time Sheridan’s worries were dismissed, even as she begged for help. Cal developed kernicterus, the brain damage caused by bilirubin. His body arched backwards and he wailed and trembled. Sheridan demanded that a neurologist examine Cal. But the neurologist, too, failed to see the danger. Sheridan and her husband Pat did not give up. They eventually got Cal diagnosed and treated at the University of Washington. But it was too late. “Cal has really significant cerebral palsy,” Sheridan, who is now 55, said. “He can walk with a walker. He is very speech impaired, hearing impaired. His eyes kind of shoot all over the place.” He will require lifetime care. The Sheridans settled with St. Luke. “What happened to Cal is unacceptable,” Sheridan said. Sheridan became a patient activist and testified in Washington about the need for better diagnosis of jaundice, and some guidelines to prevent such errors from happening again. She works with the Society to Improve Diagnosis in Medicine, which pressed for Tuesday's report. The report calls for guidelines, too, and better training. Hospitals, healthcare systems, organizations and others should “develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice,” the report recommends. “If people are afraid to speak up, then bad things can continue to happen." Ball says it’s important to create a culture where hospitals and doctors should feel free to admit their mistakes. “If people are afraid to speak up, then bad things can continue to happen,” he said. The Institute of Medicine called for this same culture of confession in its landmark 1998 report on medical errors that found tens of thousands of Americans die from medical mistakes such as botched surgery or infections acquired in the hospital. Almost unbelievably, the country’s disjointed medical system struck the Sheridan family again. As Susan embarked on a new career advocating for better patient involvement, Patrick developed a pain in his neck. Doctors prescribed physical therapy, offered pain pills, tried acupuncture. Nothing helped. An orthopedic specialist ordered an MRI scan and found a mass on his spine. “We went to a very well-known hospital in Arizona,” Sheridan said. A surgeon got the tumor out and told the Sheridans it was benign. But Susan didn’t trust this, not after what she went through with Cal. “I asked for the surgical report and pathology and got (a frozen section of tissue from the tumor),” she said. She took everything to their own general practitioner. “What we didn’t know is that the pathologist had ordered additional stains, that he was doing additional testing on my husband’s tumor,” she said. “It was a significant, aggressive tumor.” The pathologist faxed his report to Sheridan’s doctor 23 days later. “It got put into my husband’s chart without the doctor ever seeing it,” Sheridan said. Her family celebrated what they thought was Patrick’s recovery, little suspecting that malignant tumor cells were spreading in his body. Six months later, the pain was back. It was sarcoma. “During the six months of non-treatment, the tumor metastasized and penetrated his spinal cord,” Sheridan said. Patrick went to MD Anderson Cancer Center in Houston for round after round of surgery and chemotherapy. “He didn’t make it,” she said. “That diagnostic error ended his life.” Patrick died in 2002, at 45. “He said he knew it was cancer and he thought everyone else did. I guess that he trusted the system would close the loop somehow." Why didn’t the pathologist make sure the neurosurgeon saw the report about the tumor? “What if he had picked up the phone and called the doctor and say, ‘We have got something bad on our hands’?” Sheridan asked. She even asked the pathologist directly. “He said he knew it was cancer and he thought everyone else did. I guess that he trusted the system would close the loop somehow,” she said. “I learned that doctors don’t get reimbursed or paid for talking to each other. Our system prevents the doctors from talking to each other." Tuesday’s report addresses this issue directly. Right now, they’re not encouraged or paid to do so. But they should be, Ball says. The report calls for this type of consultation to be paid for, and given its own medical code for billing the insurance company. “Radiologists and pathologists need to be much more involved in clinical care,” Ball said. “There are 30,000 diagnostic tests (and) 10,000 of those are molecular tests. No single physician can figure out which tests do I use on this particular patient.” The report also calls for a return to the lost art of the autopsy, another procedure that doctors and hospitals have dropped. Patients are almost certainly dying of missed diagnoses, and no one knows, the report says. “The incidence of autopsies is falling off tremendously, in part because it’s not paid for and in large part because people think that the diagnostic technologies that we have now have supplanted the autopsy, that we should know ahead of time what the patient had,” Ball said. Electronic medical records will help, if and when they ever become widely used, the report says. But there’s still not a system that ensures one hospital’s system can talk to another’s, and many doctors are reluctant to use even basic electronic tools. "Our system prevents the doctors from talking to each other." The Affordable Care Act’s provisions to encourage teams to get paid for caring for patients, instead of getting reimbursed piecemeal for each test, each visit and each diagnosis, should also help, Ball says. Sheridan, who is now director of patient engagement for the Patient-Centered Outcomes Research Institute (PCORI), wants more. “Our healthcare system…I have no clue who is in charge,” she said. “I assumed somebody was in charge of keeping us safe.” And there needs to be a body keeping tabs on errors. “There is no place for us to report when things go wrong,” Sheridan said. “The first thing I wanted to do was tell somebody, so they could make sure that will never happen again.” ||||| A summary of this is?

question:In this task, you're given a review from Amazon's food products. Your task is to generate a rating for the product on a scale of 1-5 based on the review. The rating means 1: extremely poor, 2: poor, 3: neutral or mixed, 4: good, 5: extremely good. Q: I am 76 years old and I have eaten these nuts for many years. The ones mailed to me are very tastey. The only problem is that they were jostled around and a lot of the red skins came off and went to the bottom of the can. No big deal but it would have been better if they had stayed on the nuts. I will order from Amazon again. A:

question:Imagine a question and stream-of-consciousness explanation for which this is the answer: Sentence B