Electronic Health Records Are NOT Ready For Prime Time!

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Despite wonderful advances electronic health record (EHR) technology eventually will bring, today’s systems have some serious flaws. (See my earlier post here on one of them.)

I recently had a personal run-in with another not-ready-for-primetime EHR feature: The system used by a major health care facility – an ‘academic medical center,’ according to its website – is described by the office of at least one physician there as “the best way to interact with your medical team.” There’s a very good chance that would be so, if there were a way for [a] providers to be advised/alerted when a patient sends in a message, and [b] patients to be notified – ideally by email, alternatively by an automated phone call – when a message is sent to them, their chart is updated, or an appointment needs to be rescheduled. (The latter presently are handled by U.S. Mail, a slow, unnecessarily-costly approach to communications of this sort in the year 2016!)

Jim Schroeder, a pediatric psychologist – perhaps one of the least-known specialties in medicine! – had a lot to say on this EHR flaw and others in a recent by-lined article on the KevinMD.com website. The basic problem, he said, revolves around what’s called “meaningful use” – “defined as using EHR technology to improve quality, safety, efficiency, and reduce health disparities.”

“The promise,” he went on, “is that meaningful use will help improve patient and provider communication and increase coordination while maintaining the privacy and confidentially of patients.”

He says this is impacting his highly specialized practice, actually “decreasing efficiently and staff/patient communications,” as he put it. Imagine, then, the types, levels and degrees of communication breakdowns cited in the second paragraph (above) are having across the broad swath of specialties – not to mention the practices of primary care physicians (PCPs) where EHRs are being introduced and even mandated.

Even something as straight-forward  as this appointment-fixing system really breaks down, all too often, because neither the medical staff nor the patient is prompted – in a way suggested above – that ‘the other side’ is reaching out to effect a change. Complicating factors, Dr. Schroeder points out in his article, are instances where a medical practice staffer has been temporarily or permanently reassigned and no one is designated, in their absence, to check the incoming mail ‘bucket’.

And, he notes, it gets worse:

But beyond the purely practical issues, there are psychological factors at play that likely speak to increased stress, burnout, and turnover that many are experiencing.  The first issue is that we, the staff and providers, are increasingly being disjointed by all the options available.  Previously in our office the only place a staff member had to monitor for potential cancellations was the phone lines; now suddenly, there are multiple circuits that they are responsible for checking, which increases the already fragmented nature of the position.

Previously when patients wanted to send a message, it could only [be done] in person, by phone, or by fax (or mailed letter); now, the electronic avenues being utilized (or explored) are growing exponentially in addition [to] the traditional ones that [still] exist.

It seems wonderful for patients to be able to communicate through whichever way they desire.  That is, until the communication becomes so scattered and decentralized that it repeatedly breaks down.

A second principle of concern is what I will call the “psychological distance X amount of information received” ratio.  Basically described, the further removed a communication gets from a direct, face-to-face interaction, the more contacts [are likely to be necessary].  Effort also interacts with this principle, as the more effort a message takes, the less likely it will [accomplish the intended objective].

Take a simple illustration: Most patients do not show up at your office to convey a message.  A few might send a letter. Some will call.  But open the lines of electronic access, whether they be through a portal, email, text or otherwise, and what you will find is that your messages will only start increasing.  Thoughts/worries that patients may have not felt were significant enough issues to justify a phone call or face-to-face meeting will now much more likely be transmitted. …  Suddenly, everyone seems to have something to say!

Whereas people may have previously communicated a message to their friends through a few phone calls, now hundreds of texts might be sent.”

Dr. Schroeder says he wants his patients to be able to communicate with him effectively, for their health and his ‘quality of practice’.  But there is no way, he says, “[that]  I can sustain my professional and personal life the way I should if the messages only increase from what already exist.

“Meanwhile, as EHR is supposedly creating a more efficient circumstance for all providers, we are finding that internal medicine residents are spending an average of five hours per day on electronic charts.  Is this really patient-centered, person-centered practice and learning done more efficiently?

I appreciate many of the advantages that technology has provided at work and home.  But as EHR and other systems further develop, it seems that technology is guiding people instead of people guiding technology.  Simply because a capacity exists does not mean it is best practice, or should be employed at all.  Simply because we are a consumerist health care industry does not mean that patients should be afforded every means possible to dictate how they communicate their health care needs.  Sometimes, even the tedious act of calling an office to communicate a message or reschedule an appointment is way more important than we think, and more efficient than we realize.

I am not saying this just as a licensed psychologist.  I am saying this as a married father of six young children.  Because when we get to the heart of the matter, I am first and foremost responsible for the people I pledge to love, care for and work with.  Technology may just have to wait.

While I fully appreciate and empathize with Dr. Schroeder’s concerns, which are very real, increasingly more real ones, it’s hard to avoid thinking that, in a way, this doctor ‘doth protest too much’: Six young children? So much for his time stresses!

(The late comedian Groucho Marx had a radio, then televised, quiz program called ‘You Bet Your Life’. In its earlier days, it was broadcast live – dangerous at the best of times, where Groucho was concerned, as he was always prone to say the first thing that popped into his mind – or which effectively by-passed his mind on its way to his mouth.

(He once had a contestant, a woman, who said, responding to his general warm-up questions, that she had a lot of children. (The precise number is lost in the mists of time – and it’s irrelevant, anyway. Numbers as high as 14 have been tossed around.) She responded, “Because I love my husband.”

(Groucho, who nearly always had a trademark cigar in his face and a leer on his lips, said, without missing a beat, “I love my cigar, too, but I take it out of my mouth once in a while!”)

I envision a day, not too far in the future, when medical offices will have to have a staffer whose prime responsibility is capturing in-coming electronic messages, getting answers for them, and doing the responding doctors and nurses simply don’t have time to do – not to mention, electronic message-answering isn’t in their job description.

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I will be very appreciative if you will encourage your friends, family and colleagues to check out what my two blogs – Food TradeTrends.com and YouSayWhat.info – do in the interest of providing information you might, otherwise, never become aware of. You never know: Some of my research could prove useful, or possibly amusing, to you, and/or them.

Medical Record-Keeping Advances Have Resulted in More (and more) Pregnancy Tests for Men

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Why would an Emergency Room physician order a pregnancy test for a male patient? Why would any doctor do so?

Dennis Bethel, an ER Room (increasingly referred to as an ER Department) physician, has provided an answer, and it’s not a pretty one.

The website KevinMD.com (< there and here) allowed doctors to explain why many care-givers are, increasingly, ordering pregnancy tests for men. Inadvertently, but ordering them, nevertheless.

First, note this: Physicians are not, in general, huge fans of electronic health records, because EHR systems require that they record way more about their patient interactions than they traditionally have done – when record-keeping was a paper-based operation.

Physicians often feel that the increasingly stringent EHR rules, which require entering patient diagnoses and treatment details into a computer, are too time-consuming and, somehow, too ‘judging’ of their actions as health care practitioners. EHR also necessitate using a computer, something many physicians – particularly older ones – want little if anything to do with.

As one doctor put it, in a testimonial for a specific EHR system, she wants to be “looking up at the patient, not down at a computer screen.”

A few years ago, I quit a particular physician because she was so intent on hand-writing notes that she didn’t even bother to look up at me when I was making a complaint about and describing a pain in my leg. “Oh, that’s just arthritis,” she said, without a moment’s hesitation, or even the slightest glance in my direction.

Her diagnosis was wrong. I confirmed that shortly thereafter when a different doctor diagnosed my condition as having nothing to do with my leg, per se: “It’s a pinched nerve in your back,” he said, correctly.

Several epidural shots and months of physical therapy later, I still have some ‘back issues’, and the leg pain comes back from time to time, too.

But the physician who couldn’t be bothered to look up from her note-taking or truly consider what might be causing my pain – a woman who will only be dragged, kicking and screaming, into the EHR era . . . well, actually, she probably never will be.

But she represents a mindset that is far from untypical in the medical community: While many are quick to embrace new techniques and procedures, there are far too many with the ‘we’ve always done it this way’ mentality.

Every time you walk into a small-practice doctor’s office, a place where you are likely to see a large wall or two filled with folders holding patients’ files, you get a small glimpse of the amount of time and effort your typical primary care physician (PCP) has traditionally put into record-keeping – and a glance at the vast amounts of paper the medical community has traditionally consumed on patients’ behalfs.

Modern day medical offices don’t have, or are attempting to evolve away from, those paper files. That’s a good thing, because EHRs can serve as diagnostic tools and, among other things, as a defenses when a physician has been accused in court of a misdiagnosis leading to . . . an ongoing trauma or death.

But here’s the thing, as Dr. Bethel points out:

“In almost 20 years of practicing emergency medicine, I can’t think of a single good reason to order a pregnancy test on a man in the emergency department. And yet, my colleagues and I still do it — and fairly regularly at that.

“In my case, the devil is the electronic medical record.

“Now this may sound funny to you, and I know the nurses love to read me the riot act when I do it, but truthfully this is no laughing matter.

“As easy as it is to order a pregnancy test on a man, it is equally as easy to give potassium to someone with hyperkalemia [a too-high level of serum potassium]. And causing an iatrogenic life-threatening arrhythmia is nothing to snicker about.

“The practice of medicine has become terrifying, [as doctors increasingly know] that the flawed technology forced upon us in many ways works against us and against patient care. And since doctors are no longer in charge, there isn’t much we can do about it.

“In the golden age of medicine, one thing was sacrosanct, and that was the patient-physician relationship. Unfortunately, the EMRs were neither built by or for doctors or their patients.

“Nevertheless, after bureaucrats and powerful third-party payers’ hijacked medicine, [their] electronic medical records were thrust upon us. It didn’t matter that a patient-centric, highly intuitive, easy to use system had not yet been created. It didn’t matter that the current systems were nowhere close to being ready for prime time.

“They had been green-lighted by the powers that be, and if patients were harmed in the process, I guess they figured that was just acceptable collateral damage. What else can I conclude given that I never even once ordered a pregnancy test on a man during the years I utilized the paper chart?

“This article would become a book if I had to list all of the problems with the electronic medical record system. Instead, let me just explain the pregnancy test problem.”

(Here’s the critical part:)

“Our EMR has a rolling patient screen. Unfortunately, that screen jumps up or down one space every time a patient is registered or discharged in the E.R. With 90,000 to 100,000 patient visits a year that happens almost continuously.

“In a misfortune of timing, if you go to put orders on your patient at the same time a new patient is registered, or an old patient is discharged, the screen can jump up or down without you knowing. The consequence of this is that you would click on the patient above or below the one you intended.

“It happens instantaneously — quite stealth-like in fact. As it turns out, it is not so easy to hit a moving target, especially when you don’t see it move. Unfortunately, all the doctors I’ve spoken with have had problems with it too.

“We’ve asked for a remedy from the manufacturer but apparently they have been unable to fix many of the flaws within their system. …

“It’s no longer good enough to be an excellent clinician well versed in disease processes and treatment.  Microbiology may have prepared you to deal with the various “bugs” that ravage patients.  Unfortunately, it did nothing to prepare you for the “bugs” in the computer system that sit there like landmines putting your patients in harm’s way.

“Now don’t get me wrong, I am not a technophobe. I have seen technology do great things. I also have no doubt that a high quality, highly intuitive, efficient, and safe electronic medical record can be built. Unfortunately, I fear that until we restore the patient-physician status back to its rightful place and put patient care before the almighty dollar, we’ll be stuck with the crap we currently have.

“Make no mistake; this stuff is dangerous and patients are being harmed.

“Until then, despite my best efforts, I guess it is inevitable that I will continue to order pregnancy tests on men. I pray that nothing worse than that slips by me.”

As a person, as a patient, I am appalled at this so-obvious breakdown in the ‘care system’. There is NO excuse for it.

I’m breaking this post into two parts. The second part also looks at EHRs, from a slightly different perspective.

I encourage you to ask your friends, family and colleagues to check out what my two blogs – Food TradeTrends.com and YouSayWhat.info – do in the interest of providing information you might, otherwise, never become aware of. You never know: Some of my research could prove useful, or possibly amusing, to you (and them).

The Automat Returns! Bon Chance, Eatsa!

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A story last month (February) in Business Insider described Eatsa, a new restaurant chain, as “unlike any fast-food chain we’ve seen before.”

The reporter, Hayley Peterson, who appears to be, in her photo, in her youngish thirties, clearly was using the ‘royal we’ – speaking as one as if she were, like the queen, somehow greater than the sum of her parts.

But then, no one of her generation ever had an opportunity to see Eatsa’s spiritual and practical predecessor, because Horn & Hardart, shut down its last New York City Automat in 1991 – a fact that Haley later alludes to in her well-done, highly-illustrated article.

Horn & Hardart, which opened its first restaurant in 1902 in Philadelphia, quickly caught the public’s attention for a couple of reasons. Its several walls of shiny glass-door compartments held individual portions of sandwiches, salads, desserts and more. Combinations of nickels (five-cent pieces) would be deposited in a slot by each door featuring a desired item. The door would unlock, and the item became yours!

On one side of the usually-large rooms – some seemed to be nearly the size of Rockefeller Center’s ice rink – there were steam tables where hot dishes were available. Whether you stopped by the hot tables or skipped them, you sat wherever you wanted – beside whomever happened to be there – and tipping was discouraged.

There was, after all, no service: You could enjoy a pretty good ‘fast food’ experience – this was, in fact, the nation’s first true fast-food restaurant chain – without once interacting with a person, with the possible exception of a ‘nickel thrower’: A woman who exchanged your larger coins and/or bills for their value in nickels.

The food was prepared either behind the scenes on the same location or at a central commissary elsewhere in either New York or Philadelphia, the two principal cities where Automats operated. The food was, by standards of the day, healthy and nutritious, and ordinarily pretty tasty, too.

So what happened to the Automats – which, by the way, were based on an earlier automat concept in Germany? A couple of things: The arrival of McDonald’s, Burger King and local variations on the same theme(s) provided a more ‘exciting’ atmosphere and, significantly, drive-thrus. At the same time, in the late- ‘60’s – early ‘70’s, as food costs rose, there weren’t a lot of things that could be offered for a combination of nickels.

Then there was the rent factor: For obvious reasons, Automats tended to located in high-traffic locations. Horn & Hardart at one time operated 40 of their restaurants in New York City, and as the rents rose – as they seem to do with tide-like regularity in ‘The Big Apple,’ their share of overhead, coupled with the higher food costs, made Automats economically unviable.

A company calling itself Bamn! attempted to revive the concept in New York City’s East Village in 2006.  It survived a mere 2.5 years – probably, in part, because the street it was on, St. Mark’s Place, has been ever-more ridiculously pricey real estate since the 1960’s, when it was a popular draw as home to Gerdy’s Folk City, when ‘folk music’ was all the range, then to clubs of more advanced genres, the kind of gift/memento stores tourists flock to, and, for a while, to one of NYC’s hottest jazz clubs, The Five Spot – frequently inhabited by Thelonious Monk.

(I often ‘hung’ there when Monk was in residence – selling nonsense poems written on bar napkins to tourists!)

Eatsa is a truly modern-day version of the automat-type restaurant. It’s brightly lit, it’s décor is plain but in tune will Millennials’ tastes.

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It’s computer-based ordering system – for the sole specialty, a bowl of quinoa priced at $6.96 and topped with whatever the customer orders, from a wide range of choices – is recorded and stored so when a customer returns, his/her previous preferences are  displayed and alternates are suggested as part of the approach to encouraging repeat visits.

So far, there are Eatsa locations in Los Angeles and San Francisco. Nation’s Restaurant News has reported that the chain plans to open at least ten more locations this year.

From that, point who knows?

 

Results of Sex? It’s Complicated – And it’s a VERY long story

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A happy Neanderthal

‘Got allergies? Blame your predecessors – your very distant predecessors.

Humans, as you know, were preceded in the evolution chain – the existence of whichsome continue to deny the existence of, despite the evidence – by several earlier life forms including one know as Neanderthals. That pre-human being expanded its presence as modern-day humans do: By mating with each other.

And like some – fortunately, relatively few – present-day humans, Neanderthals also sometimes mated with beings beyond their own ‘type’.  Just as the mating of a human with a different member of the primate order – a type of simian – infected humans with the virus leading to AIDS, Neanderthals who  mated with early humans passed on DNA causing present-day man to be allergic to the likes of cat dander, dust and pollen.

That,at least, is the suspicion described in an article published this month (March) in the journal Science. That report says that, more than is commonly believed – among people who’ve given this a second’s thought – Neanderthals and early humans (perhaps voluntarily) did things together that resulted in babies. (They might have been identified as Neandehumans, if speech were well enough developed then.)

As if that weren’t bad enough – like first sex in a bumper car wasn’t! – inherited DNA resulted in ‘the result’ having allergies that never would have cropped up in humans if . . . well, you get the picture. (Truth be told, humans might never have ‘cropped up’ either!)

The cited study has an attribution list nearly as long as the study itself — meaning, a lot of people worked on it, or double-checked its findings. And they collectively confirm early theories, Science says, that “our human ancestors interbred with other hominins after they left Africa more than 50,000 years ago . . . [and that] those sexual encounters may have played an important role in bestowing humans with biology that impacts our skin and hair, giving us infection-fighting advantages. Many of these genes are involved in immunity and likely helped our ancestors fight new pathogens that they were exposed to as they dispersed into new environments,” CNN later was told by University of Washington evolutionary geneticist Joshua Akey, who helped lead the study.

The research discovered that all who were analyzed, all of them non-Africans, had traces of Neanderthal, and different groups from Europe, Asia and Melanesia had distinctive blends of Neanderthal genes, which likely means humans repeatedly ran into these hominins, according to Benjamin Vernot, a postdoctoral student in genomic sciences at the University of Washington, who led the project.

“Studies like ours help to better understand the sources contributing to patterns of human genomic diversity,” Akey said.

While this study gives scientists new clues about the how that archaic DNA may have influenced various traits in modern humans, including their sensitivities that we describe as allergies, why those bits of DNA had that effect remain a mystery. Studies are, as you’d expect, ongoing.

Foolish ‘Student’ Sentenced to 15 ‘Hard’ Years in North Korea

 

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A 21-year old American, a student at the University of Virginia, has been sentenced to 15 years of ‘hard labor’ in North Korea for taking as a souvenir a poster featuring a political slogan.

At his age, Otto Warmbier should be aware enough of world affairs – particularly concerning a country he plans to visit – to know that the South Korean government is like few others: It is a based, in effect, on the concept that the country’s leader, no matter his (in-)experience or (lack-of-)knowledge level, is a deity – a walking, talking, bad-decisions-making god, of sorts. That, in a nut shell, is what Kim Jong-il – an overweight idiot with a bad haircut – is.

There was a case a couple of years ago where two/three ‘tourists’ were taken into custody while hiking through a remote part of … was it Iran? Probably. Iran’s leaders, like those in a few other countries, are fanatics with missions no right-thinking person can make a lot of sense of. And this is, or should be, general knowledge – to anyone who reads a newspaper or online news services. And especially to anyone intending to stroll into some such country!

So why, you have to wonder, would two twenty-somethings be wandering around on a magical mystery adventure tour, in the backyard of a country known full-well to abhor Americans and everything America stands for?

I grant you, 15 years is, even for North Korea, a pretty harsh sentence for someone who misappropriated a poster. And in all likelihood, a deal will somehow be worked out so that Warmbier serves only a fraction of the sentenced time.

But it’s hard to have much sympathy for someone who put themselves in that position – by [1] even being in North Korea (is he totally nuts?)  and [2] effectively defacing public – nee, ‘sacred’ – property by taking with intend to keep a political poster.

I know this is hardly comparable, but here’s the story: I was in Versailles, France, to visit the palace there – and a grand place it indeed is. Walking back to the train for Paris, I saw a poster in a butcher’s window for a Mozart concert that had taken place the night before. Knowing he really had no further use for it – and assuming he’d allowed it to be placed in his window as a favor to someone – I asked, in my petit Francais, if I could have the poster. He assented, and I carefully conveyed it back to the U.S., where it was, for a long time, a prized feature on one of my office walls. (I have no idea what ever happened to it. I’ve had 39 homes in two countries in my 73 years, and I’m sure most of them have seen something left behind.)

I took many photos in Russia and in Kosovo in 1974. Russia was just then opening itself up to tourists. Kosovo hosted me and a group of German journalists set on touring vineyards and sampling wine for six or so days. (Who keep track of time when you and your colleagues are consuming multiple bottles of wine daily at restaurants where you are a guest of the government – eating, by the way, essentially the same ‘local’ foods twice a day, because Kosovo is small, and most towns have the same or very similar ‘specialties’.)

Never, in either of those countries, both under more-or-less ‘communist’ governments at the time, did I have any problem with my capturing images of things the locals saw every day. Those governments may have been repressive in some ways, but they fully realized the value of hosting foreigners – tourists, in the case of Russia, guests of a wine-exporting company in the other.

North Korea is, or seems to be, bound and determined to remain a pariah nation – existing outside any ‘norm’s established elsewhere in the world, causing, for whatever reason, its people to suffer dietary and an assortment of other sufferings for … what?

The 1950-53 Korean War between the north and south entities on that peninsula was never ‘settled’, in that a truce was agreed, but peace never was. Meanwhile, under a democratic system, the south has prospered, and the north has struggled – hardly seeming to even attempt to overcome the hungers – for food, education, jobs and more – of its people.

Now that miniscule nation, such as it is, is messing around with developing nuclear bomb technology! One has to assume Kim Jong-il  is getting advice as wise in that area – in creating the ability to do nuclear bomb-related harm to neighboring countries, and even the U.S. –as what he hears from whomever is cutting his hair!

Otto Warmbier Humbles himself in N. Korean court, the just-sentence ‘student’

Good luck, Otto.  If you haven’t already, accept that kimchi is both a healthy (cabbage-based) side dish… and one more than likely to distract you, given its strong flavor, from other issues.

Homeless, He Spots Jail Escapees, Gets $100k Reward

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Homeless people, despite having not a lot they need to do, often follow fairly strict routines. Some of them say it keeps them sane. Sometimes a routine can do a lot more than that.

Matthew Hay-Chapman, who lived for a while in San Francisco’s Golden Gate Park, was following his routine one day in late January – a stop at the restroom at a Whole Foods store (“They have good restrooms,” he told the San Francisco Chronicle a few days later), then a stroll to a nearby McDonald’s.

Before going in for his coffee, he picked up a copy of the Chronicle from a vending machine, and started reading the news. An article about a jailbreak in Santa Ana, a town more than 300 miles south, near Los Angeles, caught his eye. Then he caught sight of a white van similar to one he’d once lived in. He noticed the windows were thick with condensation, suggesting to him, from his experience working in the heating, ventilation and air conditioning (HVAC) field, that someone was living in this van.

Soon, someone emerged from the van, and Hay-Chapman recognized a face he’d just seen in The Chronicle. It was one of the escapees.

It was his civic duty, he thought, to notify the police.

He did.

They caught two of the three men who’d escaped from the Orange County jail.

A reward had been offered by that county, and county officials were only too pleased to give him the lion’s share of it: $100,000. The balance of the $200,000  reward was split among several others who, in one way or another, contributed to authorities being able to locate and recapture the escapees.

Hay-Chapman, who says he reads The Chronicle every day (“It’s my favorite paper,” he told a reporter), intends to use the money to get his life back in order and to help his daughter, who is handicapped, and his son, who is battling substance abuse, the paper reported on March 16, a few days before Matthew is due to get his check.

Chances are that sweet taste in his mouth isn’t from sugar in his coffee!

Strange Bedfellows: China’s Security Chief, FBI’s Comey Meet in Beijing

 

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China’s Minister of Public Security met this morning (March 14) in Beijing with James Comey, director of the FBI. The two intend, according to Xinhau, the Chinese news service, to “enhance mutual trust and respect each others’ core interests to promote building a new model of major-country relationship.”

Gua told the news service he anticipates the two security agency leaders will “fully implement the consensus reached by [China President Xi Jinping and President Barack Obama]” when they met in Paris last November at the summit meeting on the climate.

At that meeting, the two nations’ leaders “agreed to have more pragmatic cooperation in cyber security and anti-terrorism,” Xinhau said today.

But on another area of security, the two countries are poles apart: The construction by China of military installations on disputed islands in the South China Sea. Tensions have ratcheted up recently as China has reclaimed land in massive dredging operations, turning sandbars into islands equipped with airfields, ports and lighthouses, CNN reported on March 8.

The Washington Post reported on November 30 that after arriving in Paris the day before, “President Obama’s motorcade glided along the Seine through largely deserted streets [the French were banned from driving in the capital while the summit was going on] before stopping in front of Le Bataclan, the concert hall were scores of people were killed in the terrorist attacks on Nov. 13.” He placed a white rose on the street atop “the mound of flowers and candles already there then, after a few minutes of silence with his hands folded before him, Obama walked away, briefly placing  hand on the shoulders of French President Francois Hollande and Paris Mayor Anne Hidalgo,” the Post reported.