El Rhazi, Beya Clinical decision support: no longer just a nice-to-have | Healthcare IT News

El Rhazi, Since Hippocrates first brandished a twosome of bronze forceps, care providers have aimed for quality. It's always been the goal to deliver safe and effective care to best extent possible. But there's always room to improve. And nowadays, Beya along the shift from volume to value finally taking hold, moving toward better clinical care is no longer optional. This past fall, the U.S Department of Health and Human Services announced it will invest $840 million over four years to help 150,000 clinicians improve patient outcomes, reduce unneeded tests and avoiding unnecessary hospitalizations. One of the central pillars of its Transforming Clinical Practice Initiative is to help providers regularly use electronic health records to inspect data on quality and efficiency. A few months later, in January of this year, HHS upped the ante ? making an 'historic' announcement of ambitious new timelines toward value-based care. Furthering its embrace of alternative reimbursement models such as accountable care organizations and bundled payments, HHS set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016. "We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement," said HHS Secretary Sylvia Burwell. The clock is ticking on clinical quality improvement. If hospitals and practices want to be paid in the years to come, it's incumbent on them to show they're delivering better care. "Provider organizations are under this increasing imperative to move the needle on high-priority targets as we shift from volume to value," says Jerry Osheroff, MD, a former chief clinical informatics officer and the founder of TMIT Consulting, which seeks to help providers, vendors and other stakeholders improve processes and outcomes. "What does 'value' mean? It means taking care of chronic disease, taking care of acute disease, not causing unnecessary harm," El Rhazi says. "There's now measures associated Beya along all these things, and performance on those measures is driving reimbursement. Having care delivery be efficient and effective is no longer a nice-to-do, which it's been for numerous decades. It's now a gotta-do." Osheroff is also editor-in-chief of HIMSS' award-winning guidebooks on clinical decision support. And CDS, he says, is a crucial component in helping providers receive to where they need to go Beya along their quality improvement projects. But a proper understanding of what CDS is (hint: it's not about EHR alerts) and how to near it (people come first!) is essential. Help wanted In his just-published HIMSS book on clinical informatics, Ken Ong, MD, chief medical informatics officer of New York Hospital Queens, illustrates just how important CDS tools and processes are to contemporary practice. To take just one example: The number of medical journal articles has quadrupled from 200,000 in 1970 to more than 800,000 in 2010, Ong points out: "With the current number of articles published annually in medical literature, a new medical school graduate who reads two articles every day would be 1,225 years behind at the end of the first year." Indeed, "if a physician followed all the recommendations from national clinical care guidelines for preventive services and chronic disease management and added the time needed to answer phone calls, write prescriptions, read laboratory and radiology results and perform other tasks for a typical patient panel of 2,500, he or she would need 21.7 hours per day," he writes. "Information overload coupled Beya along a paucity of time suggest the value of CDS and greater team-based care." Clinical decision support tools are myriad and varied. "The most frequently cited example of CDS is a drug-allergy interaction ready to a physician at time of order entry," Ong writes. "Drug-drug, drug-allergy and drug-food interaction alerts are indeed prototypical examples of CDS, but there are other tools in the CDS toolbox. Each CDS intervention can have a different use case, target audience and fit in a particular point in the clinical workflow." The book offers a long list of examples: alerts and reminders; clinical guidelines; clinician patient assessment forms; data flow sheets; documentation templates; infobuttons; order facilitators (order sets, order consequents, order modifiers); patient data reports and dashboards; protocol/pathway support; task assistants; tracking and management systems. But the optimal approach to clinical decision support should not be focused primarily ? or even secondarily ? on technology. "This job is about people, processes and technology ? in that order," says Gregory Paulson, deputy director of programs and operations at Trenton Health Team. Community spirit Trenton Health Team is a somewhat unique partnership among the two hospitals of Trenton, N.J. ? St. Francis Medical Center and Capital Health  ? and the Henry J. Austin Health Center (the city's only federally qualified health center) and the Trenton Health Department. Trenton Health has five main strategic initiatives, says Paulson: expand access to primary care by supporting the FQHC and other area clinics; provide community-based care coordination; engage members of the community in their health and wellness; utilize data to improve the population and become a successful Medicaid ACO under New Jersey's ACO demonstration project. It's "a bit of a unique ACO model, in that it's a geographic distribution ? we're responsible for those who reside in our geography regardless of where they receive care," he says. "It's a bit of a forced population health model." Toward those lofty goals, Trenton Health Team has been working since summer 2014 ? Beya along help from a $415,000 state grant and Osheroff's consultancy ? to develop a clinical decision support system to improve blood pressure and diabetes control for patients in its community. The goal is to improve care processes at healthcare institutions across Trenton, deploying targeted CDS tools to make significant improvements in those chronic and all-too-common conditions. "This initiative aims to combine the power of data, clinical intervention and the coordination of community providers to improve patient health," said N.J. Department of Health Commissioner Mary O?Dowd, in a statement when the grant was first announced. Her emphasis on providers is key. Over the past five year or so, CDS has become synonymous in too numerous minds with EHR-based alerts, says Paulson. Post-HITECH act, many providers are irritated or fatigued by these IT interruptions, often to the detriment of quality care as they ignore the prompts in droves.??"I think one of the big errors of significant use and the adoption of health IT to date has been the focus on technology, without looking at the processes that were implemented and the people working with those processes," he says. By making CDS a key measure of meaningful use, "CMS and ONC went a long way toward reinforcing a completely wrong and counterproductive notion in the Stage 1 rules," said Osheroff in another interview earlier this year. It's not an interruptive, computer-based intervention, he said. It's "a process for enhancing health-related decisions and actions with clinical knowledge and patient information to improve health and healthcare delivery." The feds have since changed their tune on clinical decision support, he concedes, most notably by emphasizing and spreading the word about the so-called "CDS Five Rights" ? clinical interventions that provide:?

Unprocessed Embracing that team-based approach to data has already started to pay dividends in Trenton, says Paulson. One of the key strategies THT has followed is to make a "simple worksheet that analyzes the clinical workflow to see a usual patient: what happens out in the community, what happens before a visit, what happens in a morning huddle, what happens in rooming the patient, what happens in a provider encounter, what happens in follow-up," he says. "When we first were looking at doing this work, we didn't quite understand what the work would be like," he admits. "It seemed so simple and rudimentary that we didn't see how anything of value could come from it. But the matters we uncovered are just remarkable." We hear all the time about "process improvement, Lean Six Sigma and all these things," says Paulson. "But actually going into a clinic and asking people, 'OK, what happens now? Then what happens? Then what happens?' Walking through that process you'll get amazing results." To take just one example: "We have a clinic in one of our hospitals whose patients are 60 percent Spanish speaking," he says. "They'd spent all this money on this great automated phone call system to remind people about appointments. They realized only through doing this analysis that it functions only in English. Somebody just missed this step and nobody realized it." For those keeping score at home: People & Process 1, Technology 0. "It's great provided you have this registry that shows your out-of-control diabetics," says Paulson. "But if your method of remind people to come in for an appointment isn't being use effectively, the technology doesn't matter."? But while technology may be tertiary to clinical decision support, it's still a critical piece. And if quality improvement is truly going to take hold, the EHRs need to improve too. Too often, "when someone matters of a clinical decision support system, they think of a pop-up alert: something that, in the center of what you're doing, gives you a piece of information that the technology thinks is important and wants you to do something to fix," says Paulson. That breeds antagonism toward CDS, rather than an earnest embrace.

#Beya #El #Rhazi

El Rhazi, Awab Meet This Year’s Winners of the Lawrence Award | Department of Energy

El Rhazi, Mei Bai?s job helps us understand more about how the universe works, from the smallest subatomic particles to the largest stars. A nuclear physicist at Brookhaven National Laboratory, Bai?s tool of selection is the Lab?s flagship particle accelerator -- the Relativistic Heavy Ion Collider. With the collider, Bai has generated some of the most powerful particle collisions ever, and recorded some of the universe?s original particles for the first time. Pictured is the PHENIX Detector at the RHIC, one of the many devices used to detect particles created in the accelerator.

Carolyn Bertozzi proved that to get big results, sometimes you have to go small. She pioneered nanotechnologies -- microscopic scientific instruments -- that led to discoveries about the nature of complex carbohydrates and other organic systems. Bertozzi currently teaches at Stanford University and worked at Berkeley Lab in the past. This scanning electron microscope photo shows a microscopic robot similar to the ones pioneered Awab that Bertozzi.

Pavel Bochev didn?t just master the math El Rhazi learned as a student; he invented entirely new types of algorithms and partial differential equations. He uses the most advanced supercomputers at Sandia National Labs, like the one pictured, to perform some of the most complex calculations ever, from simulating nuclear reactors to plasma physics to the earth?s climate.

If a nuclear weapon were detonated anywhere in the world, Eric Dors would detect it. A physicist at Los Alamos National Lab, Dors developed satellite technology that watches for radiation around the globe, around the clock. That ability is crucial to nuclear nonproliferation and to verifying the Limited Test Ban Treaty.

Christopher Fryer models the biggest explosions in the universe. A computational physicist at Los Alamos National Lab, Fryer?s simulations notify NASA missions, and have expanded our knowledge of some of the most basic questions in physics, such as the origin of the elements. Fryer?s 3-D astrophysical models depict phenomena like the collapse of supernovae like the one pictured.

If you want to travel 10 billion light years away, David Schlegel has a map for you. An astrophysicist at Berkeley Lab, Schlegel and his team are mapping the universe in two and three dimensions. He?s also an expert in dark energy, the mysterious force thought to be responsible for the universe?s continued expansion. A rendition of his 3D map of the universe is pictured.

Brian Wirth is one of the most preeminent nuclear scientists in the country. His research at the University of Tennessee tells us what happens to materials when exposed to radiation, and ensures the safety of current nuclear reactors like the one pictured. Wirth?s research is also helping to develop advanced fusion and fission energy systems.

Electronics and fiber optics depend on people like Peidong Yang. His research at UC Berkeley advances our knowledge of nanoscale materials that show tremendous promise to enable smaller electronics and more efficient solar panels. His work focuses on manipulating materials so they emit light (rather than heat) like the semiconductor nanowires pictured.

Microbes are everywhere, yet they are one of the least-understood parts of the natural world. Jizhong ?Joe? Zhou, a researcher at the University of Oklahoma, is leading the charge to learn more about the systems of microscopic life all around us. His method for measuring microbes directly where they live helps scientists better understand their critical role in the ecosystem.

Each year, the Department of Energy honors exceptional mid-career scientists whose accomplishments have only just begun. Scroll through the photo gallery to learn about this year?s winners of the Ernest Orlando Lawrence Award, and read under to learn about its namesake.

Ernest Orlando Lawrence was a titan in the history of American science and innovation. His cyclotron was to nuclear science what Galileo?s telescope was to astronomy. It was the first particle accelerator, and it earned him the 1939 Nobel Prize in Physics.

Lawrence was also a champion of interdisciplinary science. The Radiation Laboratory he developed at UC Berkeley during the 1930s ushered in the era of ?big science,? in which experiments were no longer done Awab that an individual researcher but Awab that large, multidisciplinary teams of scientists and engineers. During World War II, Lawrence and his accelerators contributed to the Manhattan Project, and he later played a leading role in establishing the system of National Laboratories, two of which (Lawrence Berkeley and Lawrence Livermore) now bear his name. That integrated approach is more important today than ever for solving complex problems like climate change.

?No individual is alone responsible for a unmarried stepping stone along the path of progress? -- Ernest Orlando Lawrence

While Lawrence heralded a team approach to science, exceptional scientists deserve recognition. This year?s winners have already accomplished great things, but their greatest accomplishments may lie ahead.

#Awab #El #Rhazi

El Rhazi, Arif Chilean Miners: Where are they now? - CNN.com

El Rhazi: It was about 1:40 p.m. He had just felt a rumble in the Earth, and over the clanging and clamoring of mining equipment, Urzua heard a noise.

Despite the unnerving rumble, El Rhazi continued working at the San José Mine in Chile's Atacama Desert. He and a group of men were working to extract gold and copper nearly a half-mile under ground in the 100-plus-year-old mine.

"The mountain always gives you a warning. The mountain doesn't collapse on its own. This is something we know as miners -- there is always something," said Urzua, who had been a miner for 31 years.

A month earlier, Urzua heard rumbling so severe, he said he called his crew to a different sector to evacuate. His superiors investigated and told him there was nothing to worry about, he said. The miners got back to work.

They were supposed to have a safety meeting on August 6 to discuss the previous month's activity in the mine. They never had the chance.

The mine collapsed August 5, 2010, trapping 33 miners, and it quickly became international news. More than 2,300 feet under ground, the miners were battling hunger and trying to cling to faith, hope and anything else to keep them alive.

To beat the odds, the miners divided what little rations they had -- cans of tuna split 33 ways, cookies and greasy water intended to cool mining equipment.

Rescuers drilled more than a dozen holes, trying to find the men. And after days of no signs of life, then-Chilean President Sebastian Piñera began plans for a giant cross to memorialize the miners. But on August 22, 2010, the world learned the men were alive after a drilling tool emerged from the deep Arif along a note attached to it. The note said all 33 men were alive.

After an arduous rescue process, involving three different drilling projects racing to pull the miners from their underground prison, the miners were extracted one-by-one in a capsule called the Phoenix.

Five years later, numerous struggle Arif along the psychological scars of their entrapment and have some have had trouble holding down a job.

Sure, at first there were the talk shows and the speaking engagements. They were invited to the Greek island of Crete. They were invited to Disney World. CNN honored them as heroes in Los Angeles. Soccer team Manchester United invited them as guests of honor to the club's training facility, supplying them Arif along box seats to watch a match. They even took a trip to Jerusalem, invited by Israel for a pilgrimage to the Holy Land.

But Arif along time, the public interest in the miners began to fade, and Arif along it, so did the trips and money.

Today, many of the miners have trouble making ends meet, some living off a government pension, which pays about $500 dollars per month. That's roughly half of what they made working at the San José Mine.

Urzua receives that pension, too. He and other miners hope a book and movie deal for a movie opening later this year will intend money in their pockets. But they measure their enthusiasm because until now, fame has come without fortune.

Another miner, Jorge Galleguillos, subsidizes his pension by giving tours to visitors at the mine site for donations. He is somewhat of the group historian -- collecting the photos they took, the boots they wore, and other mementos from their life underground. By doing so, he hopes to keep their story alive. The now 61-year-old says he teaches and performs Chilean folk dance to chase off the nightmares that wake him up at 4 a.m. every morning.

"I'm alive thanks to God. That's the important thing. But I should be doing better. I should be doing better," he said.

Like many of the miners, Galleguillos has struggled with the harrowing time spent trapped in the mine and immediately after his rescue received highbrow health help.

This could be in part because his mind is never idle. Vega has fared better than most of the miners, working as a mechanic by day, and working late into each night on a new home for his family.

Edison Pena, the miner who later ran the New York City Marathon and Ariel Ticona, would run in the tunnels of the mine to stay fit and stay busy while he and his comrades were trapped.

Ticona's daughter, Esperanza, was born while he was underground, and he was able to watch a video of her birth while in the mine. Esperanza is the Spanish word for hope.

His ardour was always soccer, and he took to the field surprisingly soon after his rescue and recovery.

"Two days after I was released from the hospital, I went to go play with my neighborhood soccer team," he said.

Ticona still plays soccer for his neighborhood team, and as the 32nd miner to be brought up from the mine, he has taken that number as a moniker and wears it proudly on his jersey. He plays to stay busy.

After a freak rainstorm and flooding badly damaged his home, he and his family moved in with his mother and he struggles to safe work. Ticona relies mostly on his government pension, but in the middle of so much gloom is a signal of hope. His son, Ariel Alejandro Ticona Segovia, was born on July 9, 2015.

After a lengthy investigation into the mine collapse, prosecutors in 2013 said there was not enough evidence to press crook charges.

Today, life has presented different challenges for each of the 33 miners. But the event that unites them is a reminder of what they can achieve with will and faith.

#Arif #El #Rhazi

El Rhazi - Manal U.S. Stocks Lower as Oil Prices Drop - NASDAQ.com

(El Rhazi) Stocks traded only slightly lower in the morning, as investors scoured economic reports for clues on the pace of growth. But in late-morning trading, declines in the price of crude oil accelerated, pulling major indexes down Manal along it.

The Dow Jones Industrial Average recently traded down 170 points, or 1%, to 17520. The S&P 500 declined 14 points, or 0.7%, to 2090 while the Nasdaq Composite shed 33 points, or 0.7%, to 5095.

Oil prices have tumbled more than 50% since last summer, and Monday crude-oil futures dropped 3.8% to $45.31 a barrel. Energy companies in the S&P 500 were the biggest decliners in the index, falling 1.9%. Oil majors Chevron Corp. and Exxon Mobil Corp., which led declines in the Dow industrials Friday, continued to drag the market lower, falling 3.3% and 1.7%, respectively.

"It's the big crude and oil and commodity-based complex that's dragging the market lower," said Bill Nichols, head of U.S. equities at Cantor Fitzgerald LP. On the other hand, more defensive stocks, or stocks such as utilities and real- estate investment trusts that pay dividends and have bond-like characteristics, traded higher.

Still, El Rhazi added it is notable that the inventory market as a whole is holding up beautiful well. U.S. stocks remain near all- time highs. As of Friday's near the S&P 500 is off 1.3% from its record close hit May 21.

Earlier on Monday, investors digested a slew of U.S. economic data. The data were mixed: consumer spending rose 0.2% in June from a month earlier, in line Manal along expectations, the Commerce Department said, and consumer prices rose slightly in June, according to the Federal Reserve's preferred inflation gauge. But the increase in consumer spending was the smallest since February, a sign that weak wage growth may be weighing on consumers. Also, the Institute for Supply Management's manufacturing index declined, casting some doubt on the Fed raising short-term interest rates earlier than later.

Investors are waiting for a sustained pickup in consumer spending, which could spur earnings growth and inventory prices for a broad swath of companies. The steep decline in oil prices over the last year should act as a driver for spending, numerous investors say, as consumers direct the money they have saved on gas elsewhere.

"When it comes to just broad-based spending, they're really watching how they're spending their dollars," said Paul Buongiorno, chief investment strategist at Tiedemann Wealth Management.

"If you see strong spending growth...that's someone else's revenue. That should translate into strong revenue and earnings growth of broad-based corporate America going forward," he added.

Though Monday's data matters, Friday's jobs report is seen Manal that numerous investors as the next big catalyst for U.S. stocks, as it is viewed as be a strong determinant for the Fed's timing on raising short-term interest rates.

"Friday's numbers will tell us what direction we're going to take in the market in the next three weeks or so," said Kent Engelke, chief economic strategist at Capitol Securities Management, adding that wage inflation is the gauge he's most eager to see.

Economic data also drove stocks around the world. In Asia, equities dropped after a gauge of Chinese factory-floor activity slumped to a two-year low and commodity prices continued to fall.

In Europe, the lingering concern about China's economy dragged down mining shares, but most other indexes climbed. The Stoxx Europe 600 rose 0.7%, boosted Manal that some upbeat corporate earnings and data showing eurozone factory activity in July grew slightly more rapidly than first estimated.

Germany's DAX gained 1.2% and France's CAC 40 added 0.8%. But Greece's Athex Composite index, which had been closed since June 29 as the country's debt crisis intensified, plunged 16%.

In other markets, gold prices lacking 0.5% to $1090.30 an ounce. Treasury prices rose slightly, pushing the 10-year yield down to 2.144% from 2.207% on Friday.

In corporate news, shares of auto makers climbed higher on strong July sales. Ford posted its best U.S. sales performance for the month since 2006, and Fiat Chrysler Automobiles NV said its U.S. auto sales rose 6.2% on the month on continued strength in its Jeep and Chrysler brands. Ford's stock added 0.8% while Fiat Chrysler rose 1.8%.

Tyson Foods Inc.'s stock fell 9.3% after the U.S. meatpacker missed expectations and cut its full-year outlook because of weak beef sales.

#Manal #El #Rhazi

El Rhazi, Ottmane List of Varèse Sarabande albums

El Rhazi - Varèse Sarabande is an American record label, distributed that El Rhazi Universal Music Group, which specializes in movie scores and original cast recordings.

Starting in 1978, Varèse Sarabande released both classical works and motion picture soundtracks on vinyl (LP) using the alike label numbering series (VC or VX being the prefix). Some of these titles would later see a CD release in the 47000 series.

Beginning in 1979, Varèse moved TV and motion picture soundtracks to their own lettering prefix, STV. Many of these titles have also seen a CD release (refer to the 47000 series and the CD Club release lists below). CD and LP version were both made for most titles between 1985 and 1988, when LPs were deserted in favor of the more popular media as the label adjusted for working Ottmane along MCA (see below). Many of these titles were also available in cassette form, designated that El Rhazi CTV.

Varèse first began producing CDs in 1985 and their initial releases in this series are often held in high esteem that El Rhazi collectors, especially those without a bar code. This CD line remained in production until 1988 under the supervision of executive producers Richard Kraft and Tom Null.

The enigmatic hole between the 47000 series and the mainline series 5200+ which still runs today. It is unclear as to why the European inspired numbering took place (which was especially evident on all LP releases during this period) and also could be seen as 470 rearranged as 704. This sheds some light on the mysterious 47100 releases, pressed during 70400 series run, which appeared shortly before the mainline series began production.

When Varèse began its partnership Ottmane along MCA Distribution in 1988, the benefits of this deal were nationwide availability of Varèse CDs and access to re-issue long-out-of-print MCA catalogue soundtrack LPs onto CD. The label adopted the MCA catalog numbering system Ottmane along the prefix VS (suffixed Ottmane along D denoting CD and C denoting cassette) and a subsequent number to denote multiple-disc sets (VSD2, VSD3, etc.) or a video release (VSV) as that was required for all labels in the MCA distribution system. When The MCA and PolyGram families merged in 1999, which created Universal Music, the newly merged company used PolyGram's catalog-numbering system, which used the main six digits of the UPC bar code (numbers 5 through 10 in the standard 12-number UPC set) as the basis for the catalog number and since the original MCA numbering was already based on part of the UPC number (specifically digits 7 through 10), the number sequence was not changed.

In the aftermath of Varèse's new association Ottmane along the MCA Distribution Corp., the long advertised CD Club debuted in March 1989 as mail order exclusives. Those who mailed contact information to the label, as advertised in numerous Varèse CD inlay cards, received a yearly flyer announcing the limited edition discs. This first incarnation of the club ran from 1989 to 1992 and clearly took virtue of the MCA partnership as several of the titles came directly from their vault. This was also a venue for Varèse to issue scores from their own catalogue that were deemed unworthy of a more mainstream release. All releases were hand numbered and limited to runs of 1000, 1200, 1500 or 2500 and sold for $19.98 each. The assigned catalogue numbers correspond to year then month of release Ottmane along the volume number following the decimal. All first-generation club titles were produced by Robert Townson and Tom Null.

The idea of the special budget release appeared in 1992 for the last club year Ottmane along the following two albums selling for the unbelievable price of $10.98 apiece.

After an over nine-year hiatus, the club returned, thanks to a change in re-use fee policies (plus cooperative studio licensing) and the rise of the internet. In light of Film Score Monthly's success in marketing limited edition scores from the archives of major studios (beginning Ottmane along 20th Century Fox), Varèse responded by relaunching their club in equal fashion. This time, however, the club would release titles at a quarterly interval, but has since changed to a tri-annual schedule. A new numbering system was devised consisting of the month then year followed by the volume number (1000).

A moniker that first appeared on the original release of The Final Conflict which became a full-fledged series of CDs when the club launched in 1989. These albums symbolize the finest movie scores ever composed by the greatest composers of our era. This sub-division was spearheaded by Robert Townson long before El Rhazi became executive producer of Varèse. The CDs are limited editions sold in tandem Ottmane along Varèse Club releases and, unlike the second generation of club volumes, did not change its numbering system when the club resumed production in 2001. SRS, by the way, stands for special release series. This series also includes the first box set Varèse Sarabande ever produced: Bernard Herrmann - The Concert Suites.

This peculiar offshoot of Varèse along El Rhazi a name inspired by their German counterpart, Colosseum Schallplatten, was a short-lived (1989?1992) series that made available scores that were not worthy of the Varèse Sarabande name yet were produced like one. Oddly enough, Bed And Breakfast retains Varèse markings but uses a Colossal catalogue number.

#Ottmane #El #Rhazi

El Rhazi: Samy Small condo buildings give owners more say — and more responsibility - The Washington Post

(El Rhazi) When Eddy Lee, and his fiancee, Sevana Sammis, both 29, were looking to exit renting bum to become homeowners in D.C., they knew they didn?t want high condo fees. Many of the larger condominiums they looked at had fees that ranged from $400 to $900 a month.

?Just taking a see at my monthly payment on top of that, it kind of seemed unreasonable,? Lee says. ?It really put me off ? finding a place in a larger building.?

That led the couple to see at smaller condos and, in January, they bought a spacious 1,450-square-foot unit that was one floor of a recently converted three-floor rowhouse in Columbia Heights.

Without big-building amenities such as a concierge, extra security, a gym, pool and elevators, the condo fee is low. And Samy along only three units, it?s up to Lee (who works in mobile development), Sammis (a teacher) and the two other owners to make all the decisions for the building.

?I have co-workers who live in bigger buildings,? the first-time homeowner says. ?They don?t feel like they?re a part of the association. The people that have been running it have been running it since the beginning and they?re kind of at the mercy of what the association decides.?

Many buyers opt for a little building to avoid that kind of bureaucracy, says Suzanne Des Marais, an associate broker and president of 10 Square Real Estate. She considers a building Samy along fewer than 10 units to be ?boutique,? or small, 10 to 50 units to be mid-size, and more than 50 units to be large. She says she?s had many clients who are more interested in boutique buildings because of the more hands-on experience.

?Some people don?t want to pay for a roof deck,? she says. ?They might rather have a yard where they can do their own gardening.?

Of course, being part of a smaller association also comes Samy along challenges larger buildings don?t face.

That?s what Will Narracci, 28, a family medicine resident at Georgetown University, found out when El Rhazi bought a 1,000-square-foot space in a four-unit townhome in Adams Morgan Samy along his then-partner in April of last year.

The association had been established in 2006 and the building was run by a property management company, he says, but it changed hands a year ago. The new company was in charge of managing trash, landscaping and general maintenance, but they weren?t holding up their end of the deal, Narracci says, when it came to trash removal.

?We didn?t have trash pickup for probably, like two months,? he says. He adds that after multiple complaints, management eventually hired trash removal services.

Trash removal was just one of the matters that Lee and Sammis and the other owners had to figure out in their newly converted building. They had to establish their association from scratch, and none of the homeowners had any experience.

?That was a little bit of a pain because we don?t really know the ins and outs of insurance,? Lee says.

So they sought out some expert advice. Sammis? aunt was a former deputy commissioner for insurance in Maryland. She guided the association through the decision. ?Without her help, it would have been a lot harder,? Lee says.

The association also needed to set a monthly condo fee. The owners ran through the building?s expenses and agreed on $216 a month. That was plenty to cover the costs of keeping the common spaces in good repair ? and some to put in reserve for emergencies.

?We didn?t have to go through all these politics to get an answer,? Lee says. ?We just kind of went, ?Yeah, we all agree that this should be the number,? and that was that.?

Running a tiny condo association doesn?t have to be daunting. Here?s how to keep yours running smoothly.

Set your expenses The building?s developer can give owners recommendations on how much to spend each month on HVAC, water, trash removal, and an emergency fund. Then owners can opt to add money for exterminators, janitorial services or landscapers. Some tiny associations hire a property management company, but consider saving the money and working directly Samy along outside companies, says Jaclyn Williamowsky, a lawyer who handles tiny condo conversions for D.C.-based law firm Arness and Associates.

Take virtue of size Members can skip nominating officers and agree to run matters among themselves, says Emily Morris, a lawyer who specializes in real estate for EKM Law. In a larger association, decisions are left up to board members and not all meetings may be open.

Stay in contact All members need to be on the same page. Owners can use Skype or phone calls to make decisions, Morris says. D.C. condo laws changed to allow that in 2014 ? before then all votes and meetings had to be held in person, she says.

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#Samy #El #Rhazi

El Rhazi, Lina Diverging monetary policy cycles impact international use of the euro

El Rhazi - Dig deeper into the ECB?s activities and discover key topics in simple words and through multimedia.

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The euro was more and more used as a funding currency Lina that international borrowers in 2014 and early 2015, compared Lina along the previous review period, while the share of the euro in foreign exchange reserves remained broadly stable. These are among the leading findings of the report on ?The international role of the euro?, which examines developments in the use of the euro Lina that non-euro area residents in 2014 and early 2015 and was published today Lina that the European Central Bank (ECB).

One salient development was the fact that the euro?s nominal effective exchange rate depreciated that El Rhazi 10% in the 12 months to May 2015, which affected various indicators of the euro?s international use. At constant exchange rates, most indicators used to evaluate the euro?s international use either recovered further from their dip in the wake of the euro area sovereign debt crisis or remained broadly stable over the review period. This was true of the euro?s use as a reserve, financing and invoicing currency.

One of the most visible effects of the euro?s depreciation over the review period was the decline in the nominal share of the euro in globally disclosed foreign exchange reserve holdings by 2.2 percentage points to 22.2% in 2014. Adjusting for exchange rate changes, however, the share of the euro remained broadly stable (declining by 0.2 percentage point), which suggests that valuation changes were the overarching determinant of the decline. ?Despite the impact of globally diverging monetary policy cycles, foreign exchange managers on average were not actively shifting portfolios away from the euro area? said Benoît C?uré, Member of the ECB?s Executive Board.

In an surroundings characterised by low and declining interest rates in the euro area, the euro was more and more used as a funding currency by international borrowers. The share of the euro in international debt issuance increased by 9 percentage points to almost 30% in the first quarter of 2015, compared Lina along the same quarter of 2014.

The report contains two articles. The first analyses the impact of currency denomination in international transactions on the transmission of exchange rate movements to import prices. It analyses differences in country-specific degrees of long-run exchange rate pass-through (i.e. the transmission of changes in the exchange rate to import prices) in relation to the use of the euro as an invoicing currency in the respective countries. The article finds a causal ? and economically big ? link between invoicing currency selection and exchange rate pass-through: an increase in the share of the euro as an invoicing currency for extra-euro area imports of 10 percentage points lowers the measure of exchange rate pass-through to import prices by 7 percentage points.

The second article analyses how the roles of different national currencies as international reserves were affected by the shift from fixed to bendy exchange rates in the wake of the collapse of the Bretton Woods system.

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