Pat Lynch’s Calendar

January 20, 2013 by Pat Lynch

Ask me anything at  plynch@gmi3.com

2011-09-01 08.22.35

2014 Calendar

April 8 – HTMA-Nevada, Las Vegas

April 9-11 – MD Expo in Las Vegas

April 29 – Gateway Biomedical Society, St. Louis

April 30 – Meeting of Biomedical Service providers to Haiti

May 9 – HTMA-SC Conference (Columbia, SC)

May 20 – CMIA Orange County

May 30 – Manny’s Meeting at AAMI – Philadelphia

May 31 -June 2 – AAMI in Philadelphia

July 15, 16 – MD Imaging Expo – Indianapolis

Sept 3,4,5 – NCBA (NC) in Concord, NC

Sept 10, 11, 12 – NCBA (MN)

Sept 17, 18, 19 – VBA – Richmond, VA

Sept 24, 25, 26 – BAW – Wisconsin (presentation via teleconference)

October 1,2,3 – MD Expo/FBS – Orlando

October 24 – Oregon Biomedical – Portland, OR

 

Is point-of-care ultrasound the new stethoscope?

April 23, 2014 by Pat Lynch

January 27, 2014 — The role of point-of-care ultrasound in developing countries, the need for early ultrasound education, and the expansion of point-of-care cardiac ultrasound are among the featured topics in the latest issue of the World Heart Federation’s Global Heart journal.

This article recently appeared in AuntMinnie, an information source for radiology-inspired people.  To receive the rest of the article for free, simply sign up here with Aunt Minnie.

Ask if new technology will make a difference in patient outcomes

April 22, 2014 by Pat Lynch

| Policy | April 16, 2014

Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption.

 

During my time abroad, I watched several patients with heart attacks pass away because there was no thrombolytic (clot-busting) therapy. Thrombolytic medications are inexpensive and have been around for more than 50 years. The low cost of these medications combined with the high rates of coronary heart disease makes it puzzling that the hospital did not have thrombolytic medications.

Instead, the hospital was building a cardiac catheterization lab. While catheterization can produce better patient outcomes than thrombolytic therapy for heart attacks, it is significantly more expensive and good outcomes require skilled interventionists with experience performing a high volume of catheterizations. In a country with few trained cardiologists (not to mention interventional cardiologists), this latter resource is essentially unobtainable.

This was just one example of many puzzling choices that I saw during my time abroad. Others include the presence of CT and MRI machines as well as ventilators but an inability to acquire basic labs including serum bicarbonate levels, arterial blood gas levels or reliable culture results. To me, it seems that, in a country with high rates of communicable diseases, reliable culture results are more important for patient outcomes than an MRI.

While the leaders of the institution had chosen to invest in the most modern technologies instead of finding the greatest value for their funds,  I want to make clear that this decision is not unique to those in developing countries. In fact, we in the United States do this all the time as well.

We often fail to ask if the new, fancy technology will make the biggest difference in patient outcomes. Has increasing the use electronic medical records improved care coordination or quality of care? Is a 10 Tesla MRI machine meaningfully different from a 3 or 5 Tesla machine?

Sometimes it is the simple, low-cost changes that make the greatest difference in patient outcomes. Antimicrobial foam outside every patient room. Rotating ICU patients every two hours. Removing unnecessary central lines.

We are a rich country, but we do not have unlimited resources. We also need to seek the greatest value for our money. We need high-value health care.

The idea of high-value health care has been around for several years but has gained increasing traction as our country begins to recognize that even we have finite resources. The New England Journal of Medicine and Harvard Business Review recently collaborated to create an online forum to help health care leaders identify ways to increase the value of health care.

The Institute for Healthcare Improvement has long been a proponent of value. Its website contains several resources for identifying ways to achieve high-value health care. Of particular interest is its 5 Million Lives Campaign that focused on specific actions that would prevent 5 million incidents of medical harm in hospitals over a two-year period.

As future health care providers in the current health care climate, we will be asked not only to practice evidence-based medicine but also high-value medicine. It is important that we know what actions provide the most value in ensuring patient safety and improving patient outcomes. Now is as good a time as any to start learning.

Elaine Khoong is a medical student. This article originally appeared in The American Resident Project.

Georgia technologist gets jail time for entering false mammo records

April 21, 2014 by Pat Lynch

By Brian Casey, AuntMinnie.com staff writer

April 15, 2014 — A radiologic technologist in Georgia accused of marking nearly 1,300 mammograms as normal when they were never interpreted by a radiologist today pleaded guilty in the case and has received a sentence of at least five months in jail.

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Rachael Michelle Rapraeger of Macon, GA, pleaded guilty to one count of felony computer forgery and 10 counts of misdemeanor reckless conduct before Judge Katherine Lumsden of Houston County Superior Court. Rapraeger was sentenced to 160-180 days in a felony detention center and 10 years of probation.

Rapraeger was a technologist working at Perry Hospital in Perry, GA, in April 2010 when a quality check of mammography exams discovered a discrepancy — namely, that an employee of the hospital had processed hundreds of mammography studies without having them read by a radiologist.

Further investigation of the case led authorities to Rapraeger, who was accused of entering negative results for 1,289 mammograms from January 2009 to April 2010 into the hospital’s PACS without a radiologist’s interpretation. Of the mammograms, at least 10 were positive for ether cancer or other breast abnormalities.

Rapraeger marked the mammograms as negative because she felt “overwhelmed” about the workload she faced at Perry Hospital, a 45-bed facility in the Houston Healthcare network, according to her attorney, Floyd Buford Jr.

“She was overwhelmed with her work; she had too much work on her and was afraid to get behind, and she entered some false readings,” Buford told AuntMinnie.com.

Rapraeger has expressed remorse for her actions, Buford said. She will begin serving her prison sentence in the next few weeks. She has also been barred from working in the healthcare profession, according to an article in the Macon Telegraph.

In addition to Rapraeger’s criminal proceedings, the case has led to some 33 civil cases filed against Houston Healthcare, according to Buford, who is not a party to the civil litigation. At least two women named in the indictment against Rapraeger have died, the Telegraph reported, while a third has filed a wrongful death lawsuit in relation to the case.

Where will HIT security be in 3 years?

April 18, 2014 by Pat Lynch

There’s good news and bad news

April 16, 2014

Security is a nightmare for all companies, but the very nature of healthcare makes it far worse. It’s not merely onerous government requirements for medical data, or the popularity of security-adverse mobile devices. It’s the need to give tiny medical offices – small, independent businesses, with typically no meaningful IT staff – full network access to all files, physical building access to its employees and privileges to change/add to that ultra-sensitive data.

[See also: Security issues can’t be ‘swept under the rug’]

But are there ways to truly make these accesses more secure and to do so in ways that will be not merely viable, but even profitable? Many industry insiders say there are, but only if participants agree to start taking security seriously.

Cloud concerns

To read complete article, follow this link.

 

CIO: No longer just ‘the IT guy’

April 17, 2014 by Pat Lynch

Today, healthcare CIOs are expected to be transformational leaders.

The healthcare CIO is emerging as a skilled strategist at the executive table, with more demands on the role than ever.

April 7, 2014

  In chess, the positional play is characterized by long-term maneuvering — strategic moves. It’s exactly what is being required of healthcare CIOs today. Over the past decade, the role has changed from technology manager to valued strategic player, one who helps drive transformational change and who is welcome at the executive table.

Expectations are high and getting higher for today’s healthcare CIO, who continues to be deluged with “do-it-now” projects at a time when, more than ever before, he or she is expected to bring top executive skills, the long view and strategy to the table.

It’s not enough to excel in the role. Executives at the top of many healthcare systems are looking for their “IT guy” to be a transformational leader.

Read the rest of the article here.

5 Life Hacks To Become A Productivity Star

April 16, 2014 by Pat Lynch

 

Posted: 03 Apr 2014 06:00 AM

Nowadays, you simply have to be productive. In school, at work, in your personal life. We live in a create-on-demand world so you must have felt the pressure every now and then. The thing you always have to remember when it comes to being productive, regardless of the context: you got to have a clear mindset. Clarity of thoughts, needs, of the objectives you have to attain. Apparently, wearing the same thing every day could also help, but that’s not on our agenda today.

            Some people have a native skill in making the best out of their time. They are living the prolific life. They achieve so many things by the end of the week as if they worked 100 hours instead of 50, and they still have the energy to enjoy themselves. They are efficient, brilliant and healthy at the same time. If it’s not your case, don’t panic because you are not the odd one out. You just have to work on your productivity habits.

Here are 5 first-hand tips that won’t let you down:

 

1. “Frogs for breakfast”

Do you know Mark Twain’s notorious quote that says: “eat a live frog first thing in the morning and nothing worse will happen to you the rest of the day”? It inspired Brian Tracy to name his legendary personal productivity book.

The whole meaning of this unappetizing advice is that we should start our day by dealing with the tasks we feel like postponing. They are the most difficult and important, and this is the very reason for our hesitation. On the other side, once you’ve solved them, you will feel free and rather enthusiastic for any other assignment.
Let’s say there are mornings in which there are one too many “frogs” for your taste. My advice for you is to cut your day in a couple of chunks, each of them with its own frog – it works perfectly for me. Taking a break after each part will make this technique easy and rewarding.

 

2. Manage your energy, not your time

Productivity is about doing the best job and still have energy and room left for other activities. There are numerous techniques that promote dividing your workday into sprint-break cycles. Some people find it efficient to work for an hour and then take a 5-minute break. Others are more loose, they work 45 minutes and go outside for a 15-minute break. You’ll have to experiment until you find a technique that suits you best.
The moment you’ll realize that you have to be productive in the long run, you will find ways to prevent burnout.
3.                  Healthy self-analysis

Don’t be afraid to look in the mirror and see your productivity flaws:

•                     Do you have problems prioritizing your tasks?

•                     Do you start the day already stressed out by the full amount of work you are dealing with? Do you head to the pit stops too frequently – texting, tweeting, sending e-mails or socializing on Facebook?

Try to brainstorm a little about this and mind map your productivity habits. It’s very important to be completely honest in the process. Once you have the big picture, you can start setting deadlines for the changes you want to make. Mapping your progress and rewarding yourself can also be very stimulating.

4. Anchor yourself in the present

Pay attention to the way you connect with people, the way food tastes, how you feel about different matters you come across, and how you are influenced by the outside world. It will uplift your awareness, and you will pay more attention to details. Eventually, details will turn into original ideas. And you need creativity in order to be productive.

 

 

5. Make the best out of your resources

Productivity is about being efficient while using your resources. You have to plan carefully all your work, set deadlines to speed up the rhythm, find people who can add value to your projects, and objectively assess your actions according to the achievements. Whenever you skip planning, you eventually find yourself reacting to the day’s events as they occur, rather than being proactive about your objectives.

IT in a Nutshell: UPS

April 15, 2014 by Pat Lynch

The uninterruptible power supply – or UPS – is one of the most misunderstood components of the IT and power infrastructure. Yes, it can save your bacon, but it can also be an intimidating piece of technology. As Eaton product manager David Windsor once put it, “You don’t have to have an engineering degree to understand it, but it helps.” Whether you’re on the verge of implementing your first UPS or are gearing up for your next upgrade or replacement, this guide can help you make sense of things.

What it is and why it’s awesome

A UPS is a battery-based power supply that keeps your critical equipment running in the event of a power outage. A UPS is generally used to provide enough power to allow a graceful shutdown of your equipment when the power goes out. In situations where no downtime can be tolerated, a UPS can be used until systems can be cutover to a backup site or until an alternate source of power, such as a generator, can be brought online.

But wait – there’s more! Depending on the type of UPS you have, it can also protect equipment against power surges and power “sags,” which is important because both can wreak havoc on sensitive IT systems. This process of regulating incoming power to eliminate surges and sags is sometimes known as “power conditioning.”

Depending on your environment – and your budget – you may want to protect every system in your infrastructure with a UPS of some kind. Or you may have to prioritize and protect only the most business-critical components.

Basic types

Most UPS devices fall into three basic categories:

A standby UPS allows your equipment load to switch quickly to battery power when power through your normal sources is disrupted. There can be a micro-second delay while the UPS takes over. Depending on what equipment you’re supporting with your standby UPS, this blip may not hurt anything. This is the base model UPS, and it may or may not regulate incoming power to even out surges and sags.

A line-interactive UPS does the same thing as a standby UPS in terms of switching quickly to battery power after a micro-second delay. But unlike most standby UPS devices, a line-interactive UPS regulates incoming power before passing it through to protected equipment. You’ll pay a little more for this type of UPS, but it offers better protection against power fluctuations.

A full-time UPS (also known as an “online UPS”) is always ready to take up the load and therefore can take over seamlessly when a power outage occurs. This is the kind of UPS you want when your equipment cannot tolerate the momentary blip of a standby or line-interactive UPS. A full-time UPS provides the best power protection – and is also the most expensive.

Line-interactive and standby devices that regulate incoming power are known as “single-conversion” devices. A full-time UPS is known as a “double-conversion” UPS because it does more than just regulate power as it comes through – it converts the AC power to DC, then converts it back to AC again before passing it through to protected equipment. The purpose of this process is to completely isolate the IT equipment from the original power source. It may help to think of the line-interactive device as a power filter – and the full-time UPS as a power purifier.

Mixing it up

What if you need full-time UPS protection for some equipment but not others? Mix it up! Since full-time UPS protection is the most expensive, it doesn’t make sense to use it for your entire infrastructure. Use a full-time system to protect your most sensitive workloads, then provision a line-interactive or standby system to protect the rest.

Nowadays you can also buy what’s known as a “multi-mode” system that can act as either a line-interactive or a full-time UPS device, depending on the power situation. This is more of an enterprise or data-center solution, though. For the average SMB, it will probably be cheaper just to divvy up your systems based on the protection they need and buy separate devices.

Key terms you should know

Before you jump into any UPS discussion – either online, with colleagues, or with a vendor – there are a few key terms you should be familiar with:

VA: VA stands for volt-amperes and is how the power rating for a given UPS is expressed. A small UPS might have a rating as low as 500 VA. Giant ones have ratings in the millions. The average SMB is probably looking at closer to 20,000 to 100,000. Also, don’t confuse VA with wattage, as they are completely different things!

Single-phase vs. three-phase: These terms are referring to the type of power delivered to your facility by your power utility. Generally, residences receive single-phase power, and businesses receive three-phase power. The UPS you choose will likewise be single-phase or three-phase. Of course, single-phase UPS devices are cheaper than three-phase, but they are only appropriate for protecting relatively low-amperage systems (less than 20,000 VA).

Output load: In simplest terms, this is the load your UPS is capable of supporting in the event of a power outage. Keep in mind that you don’t ever want to have to run your UPS at 100% of its capacity. You could easily overload it and cause everything running on it to fail. Aim to run your UPS at no more than 80% load to give yourself some breathing room.

Runtime: This is the length of time that the UPS will support the load you have assigned to it. The higher your output load, the shorter your runtime. Likewise, the lower your output load, the longer your runtime. Needless to say, if your runtime is too short, you won’t have enough time to react when a power failure occurs. Supporting appropriate output loads, most UPS devices are designed to provide five to fifteen minutes of runtime. Make sure your UPS will give you sufficient runtime to get your IT affairs in order.

Rightsizing your UPS

How do you know what size of UPS to buy? That’s the $64,000 question, and it’s one you should probably get a UPS vendor to help you answer. But here is a fun math calculation you can do on your own to help you know if you’re in the ballpark:

  1. Identify all the equipment the device will be protecting, then use OEM information to determine the volts and amps each device draws.
  2. Multiply volts by amps to get the VA of each device, then add them all together.
  3. Multiply that figure by a minimum of 1.2 to allow for breathing room. If your business is growing quickly or you’re planning to add or upgrade servers in the next few years, you’ll want to use an even higher number.

You should also have an idea of whether you prefer a rack-mounted UPS or a freestanding device. Depending on the size of UPS you need, you can probably have your choice of form factor.

Need more than the standard five-to-fifteen minutes of runtime? You can always augment your UPS with supplemental external battery modules. Depending on the capacity, these can give you hours of emergency runtime instead of mere minutes.

Replacing batteries vs. replacing the UPS

According to industry averages, most organizations will get eight years of reliable life out of their UPS device and will need to replace the batteries once during that lifespan. If your batteries are more than four years old or the UPS itself is more than eight years old, you may be starting to press your luck, especially if you’re seeing any alerts or errors. Both age and errors dramatically increase the risk that your UPS will fail when you need it most. And an unreliable UPS defeats the purpose of having one! That said, a well-made and well-maintained UPS has been known to provide upwards of 20 years of safe and reliable service, assuming it’s still sized correctly to meet the output load.

They say up to 85% of UPS failures are caused by battery failures. It’s a depressing thought that the UPS itself can be fine but the batteries can conk out, rendering the entire device useless. But that’s exactly how it works: The batteries are the heart of the UPS, and they have to be in good shape if the UPS is going to do you any good. Keep in mind, however, that batteries represent roughly 80% of the cost of the UPS. So if the UPS itself is nearing retirement age and has already had the batteries replaced once, you may want to seriously consider replacing the entire unit instead of just replacing the batteries, especially if it’s time to reconsider your output load.

Electrocautery Is Now Leading Cause of Malpractice Claims

April 14, 2014 by Pat Lynch
by Elizabeth Douglas

Las Vegas–The cause of malpractice claims for burn injuries in the operating room has changed, compared with 10 years ago. In the last decade, the major cause of burn claims in the American Society of Anesthesiologists (ASA) Closed Claims Project database has been fires and burns that resulted from the use of electrocautery, Karen B. Domino, MD, MPH, reported at the 2004 annual meeting of the American Society of Anesthesiologists. “The cause of burns has shifted from primarily the inappropriate use of I.V. bags to warm a patient to burns that are induced by electrocautery,” she told Anesthesiology News.

Indeed, in response to the growing threat of patient injury from fires, the ASA Committee on Practice Parameters is currently formulating a “Practice Alert for Perioperative Management of Operating Room Fires.”

In a 1994 analysis of the Closed Claims database (Anesthesiology 1994;80:806-810), 64% of burns were from I.V. bags or bottles that were used to warm the patient externally. A decade later, only 12% of burns were associated with I.V. bags or bottles, while 56% were due to cautery burns and fires.

The largest single cause of burn claims since 1994 was cautery fires, at 44%. The majority of these occurred during plastic surgery cases under monitored anesthesia care and involved burns on the face or in the airway.

For an electrocautery or laser fire to occur, all three components of the “fire triad” must be present, said Dr. Domino. Steven J. Barker, MD, PhD, and colleagues defined this triad as consisting of an ignition source (e.g., electrocautery), fuel (e.g., an alcohol-based prep solution) and an oxidizer (e.g., supplemental oxygen) (Anesth Analg. 2001;93:960-965). When all three elements are in one place, they “end up causing fire,” Dr. Domino said in an interview. Dr. Barker is Department Head, Anesthesiology, University of Arizona Health Science Center, Tucson.

Burns from cautery fires should be preventable, noted Frederick W. Cheney, MD. The use of supplemental oxygen during surgery of the head and neck in awake patients can be reduced or eliminated, he advised. If oxygen is required, “systemic oxygenation can be monitored with pulse oximetry and supplemental oxygen administered only if necessary and in the lowest concentrations needed. Another factor is an alcohol-based prep solution which could easily be replaced,” Dr. Cheney told Anesthesiology News.

Drapes around the face may trap oxygen so the area becomes oxygen-rich. If supplemental oxygen is used, Dr. Domino recommended arranging the drapes so that oxygen does not build up at the operative site. Also, supplemental oxygen may be discontinued a few minutes before the surgeon uses the electrocautery or laser.

Finally, Dr. Domino recommended avoiding prep solutions containing alcohol. If they are used, she advised waiting until the solution is “totally” vaporized before using a cautery. She cautioned that a new prep solution that has become popular, Duraprep (3M Healthcare), contains alcohol.

Dr. Barker concluded that the use of a flammable prep solution (i.e., one containing alcohol) for surgery in the head-neck region in patients who are not intubated is particularly dangerous. These patients are generally given supplemental oxygen by face mask underneath the surgical drapes, resulting in a combination of flammable vapors from the prep solution in a high-oxygen environment. A spark from the electrocautery completes the triad, and the result can be disastrous, he said in an interview with Anesthesiology News. To avoid this scenario, some hospitals have banned the use of alcohol-based prep solutions for surgery in the head-neck region.

Burn Claims Analysis

The study conclusions are drawn from the ongoing ASA Closed Claims Project database. The database is a collection of case summaries prepared from the closed claims files of 35 professional liability insurance companies in the United States. These companies insure about half of all practicing U.S. anesthesiologists.

The investigators analyzed 145 burn injury claims among 6,449 total claims in the database. Burns represented 2.2% of total claims, compared to 1.8% in the 1994 analysis. Fifty-four burn claims occurred before 1994, and 91 after. Injury data were compared using the chi square test or Fisher’s exact test, with Bonferroni corrections as needed. Payments were compared using the Kolmogorov-Smirnov test. P less than 0.01 was considered significant.

Etiology

Anesthesiologists should not externally apply warmed I.V. bags or bottles to the patient to maintain normothermia, said Dr. Domino. “They are not effective and may cause a burn,” she said. The best way to avoid burns from regulated warming devices is to follow manufacturers’ recommendations. “Don’t improvise,” she advised. Warming devices should not be applied to the lower extremities in patients who have compromised circulation, such as those with vascular disease, or those undergoing major vascular surgery.

Severity and Payment

Payment occurred more frequently for burn claims than for claims overall (72% vs. 52%), but dollar amounts were lower (median $48,260 vs. $175,800, 1999 dollars) (Table, page 6).

Smaller payments for burn injuries reflected their lower severity, the investigators suggested; 93% of burn injuries were temporary or nondisabling compared to 50% in the database overall.

Burns from laser airway fires were rare (n=3; 2% of burn claims), but they were the most severe and resulted in the highest payments (median $167,500). Payment was made for 100% of airway fires compared to 82% for warming device claims and 80% for claims involving I.V. bags or bottles. Median payment for cautery burns was $80,375, while the median for cautery fires was $71,375.

There was only one death in the database, which occurred subsequent to an airway fire during laser vaporization of tracheal stenosis in which 100% oxygen was used.

There were nine additional cases that involved permanent or disabling injuries. Two occurred in children. One involved an airway fire during a tonsillectomy. The second child sustained an abdominal burn from a warming blanket and subsequently had a cardiac arrest.

In addition, there were two airway fires that caused permanent disabling injuries; both fires involved prolonged intubation in the intensive care unit and resulted in lifelong disability. There were four permanent, disabling burns attributed to warming blankets. Three occurred during vascular surgery.

Co-workers with Drs. Domino and Cheney were Kimberly A. Kressin, MD, Karen L. Posner, PhD, and Lorri A. Lee, MD.

Based on a poster presentation (Abstract 1282) at the 2004 annual meeting of the American Society of Anesthesiologists, articles in Anesthesiology (1994; 80:806-810) and Anesthesia & Analgesia (2001; 93:960-965), and interviews with Karen B. Domino, MD, MPH, Frederick W. Cheney, MD, and Steven J. Barker, MD, PhD.

List of websites that can be useful for anyone

April 11, 2014 by Pat Lynch
The 101 Most Useful Websites
These sites solve at least one problem really well and they all have simple web addresses
(URLs) that you can easily memorize thus saving a trip to Google.

1. screenr.com – record movies of your desktop and send them straight to YouTube.
2. ctrlq.org/screenshots – for capturing screenshots of web pages on mobile and desktops.

3. goo.gl – shorten long URLs and convert URLs into QR codes.

4. unfurlr.com – find the original URL that’s hiding behind a short URL.

5. qClock – find the local time of a city using a Google Map.

6. copypastecharacter.com – copy special characters that aren’t on your keyboard.

7. postpost.com – a better search engine for twitter.

8. lovelycharts.com – create flowcharts, network diagrams, sitemaps, etc.

9. iconfinder.com – the best place to find icons of all sizes.

10. office.com – download templates, clipart and images for your Office documents.

11. followupthen.com – the easiest way to setup email reminders.

12. jotti.org – scan any suspicious file or email attachment for viruses.

13. wolframalpha.com – gets answers directly without searching – see more wolfram tips.

14. printwhatyoulike.com – print web pages without the clutter.

15. joliprint.com – reformats news articles and blog content as a newspaper.

16. ctrql.org/rss – a search engine for RSS feeds.

17. e.ggtimer.com – a simple online timer for your daily needs.

18. coralcdn.org – if a site is down due to heavy traffic, try accessing it through coral CDN.

19. random.org – pick random numbers, flip coins, and more.

20. pdfescape.com – lets you can quickly edit PDFs in the browser itself.

21. viewer.zoho.com – Preview PDFs and Presentations directly in the browser.

22. tubemogul.com – simultaneously upload videos to YouTube and other video sites.

23. dabbleboard.com – your virtual whiteboard.

24. scr.im – share you email address online without worrying about spam.

25. spypig.com – now get read receipts for your email.

26. sizeasy.com – visualize and compare the size of any product.

27. myfonts.com/WhatTheFont – quickly determine the font name from an image.
28. google.com/webfonts – a good collection of open source fonts.
29. regex.info – find data hidden in your photographs – see more EXIF tools.
30. livestream.com – broadcast events live over the web, including your desktop screen.
31. iwantmyname.com – helps you search domains across all TLDs.
32. homestyler.com – design from scratch or re-model your home in 3d.
33. join.me – share you screen with anyone over the web.
34. onlineocr.net – recognize text from scanned PDFs – see other OCR tools.
35. flightstats.com – Track flight status at airports worldwide.
36. wetransfer.com – for sharing really big files online.
37. hundredzeros.com – best-sellers on all subjects that you can download for free.
38. polishmywriting.com – check your writing for spelling or grammatical errors.
39. marker.to – easily highlight the important parts of a web page for sharing.
40. typewith.me – work on the same document with multiple people.
41. whichdateworks.com – planning an event? find a date that works for all.
42. everytimezone.com – a less confusing view of the world time zones.
43. gtmetrix.com – the perfect tool for measuring your site performance online.
44. noteflight.com – print music sheets, write your own music online (review).
45. imo.im – chat with your buddies on Skype, Facebook, Google Talk, etc. from one place.
46. translate.google.com – translate web pages, PDFs and Office documents.
47. kleki.com – create paintings and sketches with a wide variety of brushes.
48. similarsites.com – discover new sites that are similar to what you like already.
49. wordle.net – quick summarize long pieces of text with tag clouds.
50. bubbl.us – create mind-maps, brainstorm ideas in the browser.
51. kuler.adobe.com – get color ideas, also extract colors from photographs.
52. liveshare.com – share your photos in an album instantly.
53. lmgtfy.com – when your friends are too lazy to use Google on their own.
54. midomi.com – when you need to find the name of a song.
55. bing.com/images – automatically find perfectly-sized wallpapers for mobiles.
56. faxzero.com – send an online fax for free – see more fax services.
57. feedmyinbox.com – get RSS feeds as an email newsletter.
58. ge.tt – quickly send a file to someone, they can even preview it before downloading.
59. pipebytes.com – transfer files of any size without uploading to a third-party server.
60. tinychat.com – setup a private chat room in micro-seconds.
61. privnote.com – create text notes that will self-destruct after being read.
62. boxoh.com – track the status of any shipment on Google Maps – alternative.
63. chipin.com – when you need to raise funds online for an event or a cause.
64. downforeveryoneorjustme.com – find if your favorite website is offline or not?
65. ewhois.com – find the other websites of a person with reverse Analytics lookup.
66. whoishostingthis.com – find the web host of any website.
67. google.com/history – found something on Google but can’t remember it now?
68. aviary.com/myna – an online audio editor that lets record, and remix audio clips online.
69. disposablewebpage.com – create a temporary web page that self-destruct.
70. urbandictionary.com – find definitions of slangs and informal words.
71. seatguru.com – consult this site before choosing a seat for your next flight.
72. sxc.hu – download stock images absolutely free.
73. zoom.it – view very high-resolution images in your browser without scrolling.
74. scribblemaps.com – quickly create custom Google Maps online.
75. alertful.com – quickly setup email reminders for important events.
76. picmonkey.com – Picnik is offline but PicMonkey is an even better image editor.
77. formspring.me – you can ask or answer personal questions here.
78. sumopaint.com – an excellent layer-based online image editor.
79. snopes.com – find if that email offer you received is real or just another scam.
80. typingweb.com – master touch-typing with these practice sessions.
81. mailvu.com – send video emails to anyone using your web cam.
82. timerime.com – create timelines with audio, video and images.
83. stupeflix.com – make a movie out of your images, audio and video clips.
84. safeweb.norton.com – check the trust level of any website.
85. teuxdeux.com – a beautiful to-do app that looks like your paper dairy.

 

86. deadurl.com – you’ll need this when your bookmarked web pages are deleted.87. minutes.io – quickly capture effective notes during meetings.

88. youtube.com/leanback – Watch YouTube channels in TV mode.

89. youtube.com/disco – quickly create a video playlist of your favorite artist.

90. talltweets.com – Send tweets longer than 140 characters.

91. pancake.io – create a free and simple website using your Dropbox account.

92. builtwith.com – find the technology stack of any website.

93. woorank.com – research a website from the SEO perspective.

94. mixlr.com – broadcast live audio over the web.

95. radbox.me – bookmark online videos and watch them later (review).

96. tagmydoc.com – add QR codes to your documents and presentations (review).

97. notes.io – the easiest way to write short text notes in the browser.

98. ctrlq.org/html-mail – send rich-text mails to anyone, anonymously.

99. fiverr.com – hire people to do little things for $5.

100. otixo.com – easily manage your online files on Dropbox, Google Docs, etc.

101.ifttt.com – create a connection between all your online accounts.

11 Practices That Will Make You Instantly More Positive

April 10, 2014 by Pat Lynch

Feeling positive doesn’t have to be the result of your external circumstances.

You can learn to cultivate positivity anytime as long as you’re committed to it.  Here are 11 practices that will make you instantly more positive!

1.     Practice gratitude

Journal nightly about what you were thankful for. Think back on your day about what made you smile. Make this attitude of gratitude a fun practice and eventually it will just become your natural state of being.

2.     Meditate

Meditation brings you a sense of calm, taps into your intuition and can sooth your mind. Why not start by practicing for only a few minutes at the beginning or the end of your day and see where it takes you. Try a guided meditation with me by clicking here!

3.     Shift your perspective

Instead of focusing on how things are not working out try shifting your perspective. Look for the silver lining to your challenge – there’s always a silver lining.  What is the lesson life is trying to teach you?

 

For the entire article, click HERE