Implementing an Electronic Health Record System

Implementing an Electronic Health Record System Implementing Electronic Health Record System Based on HL7 RIM -Reusing the RIM Model Archetypes Nancy Mittal Abstract: It is difficult to exchange healthcare information between different HealthCare Systems. Health Level Seven is a universal standard to facilitate the communication between different HealthCare Systems. Electronic Health Record System is a software platform that store patient health data which maintained by hospital and medical practice. Health Level 7 Reference Information Model was studied to provide the interoperability between different HealthCare Systems. In this paper, we studied about the various version of Health Level Seven standard including HL7 v2.x, HL7 v3.0, HL7 RIM. This paper focused on how the existing structure of HL7 is improved by reusing the HL7 RIM classes such as Act, Role, and Entity etc each are associated with set of attributes. It explains to modify the existing structure of HL7, need to modify the HL7 RIM because HL7 RIM model provide the structure of HL7. This paper also explained the role based queries are performed by the interested stakeholders like pati ents, doctors and hospitals. In this new structural form, role based information is maintained in the centralize database. This research fills the gap between skilled and semi-skilled users and query is performed on role base. Keywords: HL7, RIM, Role, Archetypes 1. Introduction: With the continuous development of health records, maintain and exchange the information in different HealthCare systems has become unavoidable. So, the communication between different hospitals or between different HealthCare system need to improved. Electronic Health Record is a repository of health information in a digital format about an individual patient or population managed by hospitals or medical practice that shared across different HealthCare Systems. It reduces the chances of data replication. More organizations adopt EHR; physicians, nurses and clinicians have greater access to patient information which helps in accurate diagnosis and complete data helps to ensure the best possible care. Electronic Health Record (EHR) system is needed to focus on two requirements: dynamic involvement of different hospitals, patients and HealthCare Systems And the way of maintaining the information. Standard compliant EHR provide facility of communication and to exchange information of patients between different hospitals, doctors, HealthCare systems. Each patient has his own queries respective to their role in the system. The query interface is designed to provide the effective knowledge among different kind of patients, hospitals. Health Level Seven: Heath Level Seven is a standard developing organisation accredited by ANSI (American National Standard Institute) founded in 1987. HL7[1] name refers the top layer of the OSI (Open System Interconnection) layer protocol for the health environment. HL7 specifies a number of various standards health information and also provide communication between different HealthCare System. Standard are the set of rules that allow information to be shared in standardized and reliable manner. HL7 messaging standard: There are two main HL7 messaging standard HL7 v2.x and HL7 v3.0. HL7 v2.x is also called as pipe hat. This standard provides the interoperability specification for health and medical transaction. HL7 v2.x message format are in human readable ASCII and non XML encoding syntax. It supports administrative, logistical, financial as well as clinical messages. HL7 v3.0 provides the interoperability specification for health and medical transaction based on RIM (Reference Information Model). HL7 v3.0 message format based on XML encoding syntax and also on HDF (formal methodology) and object oriented principle. It supports only clinical data. Movement from HL7 v2 to HL7 v3 is that v3 would be model driven methodology means v3 standard support healthcare workflows through modelling; the end result maximize reuse and increase consistency in HL7 specification. Another[2] HL7 v2.7 supports all HealthCare department data for exchange between different HealthCare systems. It reduces the custom interface programming. But it is not plug and play; and not support transaction processing feature. Table1.Difference between HL7 v2.x and HL7 v3.0 HL7 RIM[3] (Reference Information Model): The HL7 Reference Information Model provides the structural information of HL7 in the form of information classes. HL7 RIM is an object oriented model to make compatible the HL7 specification interoperability to all domains. It is important part of the HL7 v3.0 development model. It increases precision and reducing implementation costs. HL7 RIM is based on UML (Unified Modelling Language). Reference information model has five components: Subject Area (major part of am model), class (about which information is collected), Relationship (relation between classes), attribute (information about class), and data type (specification of the format of an attribute). RIM has six main important classes: Act- It represents actions that are executed by entity. Entity: These are the physical things that take part in health care. Role: Role that entity plays as they participate in health care Participation: It represent context for an act such as who perform, for whom and where. ActRelationship: It represents the relationship between actions. RoleLink: It represents the relationship between roles. 2. Related Work: Electronic health record system based on health level seven, and HL7 used to provide the communication between different HealthCare systems, most of the research studies show perplexing which is further discussed in this paper review. Tung Tran, Hwa-Sun Kim[[1]] studied the research on,†A Development of HL7 Middleware for Medical Device Communication† to developed HL7 compliant middleware. Researcher used HL7 as a middleware to facilitate data transfer to information system in hospitals. Middleware has capability of receiving data from monitoring device and converting into HL7 data type format. It receive raw data from medical devices and convert to HL7 data and passed to HIS based on HL7 interface engine. Li-Fan Ko, Jen-Chiun Lin, Chi-Huang Chen, Jie-Sheng Chang, Faipei Lai[[2]] concluded the research on,†HL7 Middleware Framework for Healthcare Information System. Researchers introduce HL7 and web services standard into framework which is basically Service Oriented Architecture (SOA). HL7 directly transmitted data over transport layer protocol TCP/IP: for small application HL7 message over TCP are simple and easy to implement; for larger application, system become complex and attacker increases. This research solved that problem by introducing web services which provide interoperation between software systems. Jennifer Munnelly[[3]] in his research study on, HL7 Healthcare Information Management Using Aspect-Oriented Programming focused the modification in application department without the requirement modification into complete structure by using HL7.Researcher suggested introduce HL7 functionality into exiting application without any modification through AOP. Wooshik Kim[[4]] studied the research on, Integration of IEEE 1451 and HL7 Exchanging Information for Patients’ Sensor Data showed the IEEE 1451 concerned with smart transducer and having plug –play capabilities. Patients wear sensors that measure the patient’s status in real time and transmitted these data to remote sites such as hospital. HL7 accepted this kind of data and interpreted with various online sensor data. Pasquale De Meo[[5]] studied on, Integration of the HL7 Standard in a Multiagent System to Support Personalized Access to e-Health Services. In this paper, he presented a system which has multi agents to maintain patients in seek of health related services in e-health care by using various algorithms PPB, DS-PPB, AB. This proposed system increases the quality service and effectiveness. Maqbool Hussain[[6]] concluded his research on, Healthcare Applications Interoperability through Implementation of HL7 Web Service Basic Profile studied all phases of web service component that implement HL7 Web Service Basic Profile. It is branch of the transportation subsystem progressed at NUST School of Electrical Engineering and Computer Science, Pakistan. Naeem Khalid Janjua[[7]] in research study presented work on, Digital Health Care Ecosystem: SOA Compliant HL7 based Health Care Information Interchange and proposed Service Oriented Architecture (SOA) based HL7 system design for patient information and showed the translation from HL7 V2 to V3 and mapping between database and user query. Sara Gaion[[8]] researched on, Design of a Domain Model for Clinical Engineering within the HL7 Reference Information Model. This paper develop a DIM (Domain Information Model) by providing the HL7 RIM to clinical engineering in a particular domain. This paper represent clinical engineering information in the HL7 RIM (Reference Information Model) with the reason of developing a HL7 v3 RIM model based on DIM (Domain Information Model) dedicated to CE(Clinical Engineering) by reuse of standard healthcare information models and show the process of repairing and maintenance of device used in hospital. N.A. Mamani Macedo[[9]] studied the research on, Electronic Health Record: Comparative Analysis of HL7 and Open EHR Approaches. This paper showed the comparison between HL7 and openEHR to automatism a Patient’s Record in any hospital which adopted: HL7 and OpenEHR. The method includes analyzing each way, defining some criteria of evaluation, design a comparative chart. 3. Design model: The work is defined with the specification of the hospital and the relative attributes and the functional specification. It defines the role and requirement to specify the functional dependencies and its requirements. The role is defined for all the interested patients and hospitals and all interested users are connected to it along with their specified roles. The hospital is responsible for the information updating as well as to generate the query that queried by patients to obtain the information access about the patient, disease or diagnose. Complete information is defined in the form of centralized repository. Model is in the form of a query interface in which the communication to the system and different hospitals maintain the information in different way so that the mapping is required between the query set and the hospitals. To establish this mapping, the structural constructs for the system are defined so that the functional based information transition will be take place. Steps in implementation model First step is role identification and analysis: Users in this system are patients and hospitals(health organization). Role is defined for all the interested users ,patients and hospitals and they are coonnected to it along with their hospitals. Second step is role specific query generation: Hospitals is reasponsible for the information updating as wel as to generate the query that queried by patients to obtain the information access about the patient,disease and diagnose. Third step is query filteration and mapping done by RIM model: Complete information is defined in the form of centralized dataset.Model in the form of query interface in which the communication to the system and diff hospitals maintain the information in diff way. So that mapping is required between query set and hospitals. Last step query result are extraced. 4. Conclusion: In changing the structure of HL7 and increasing the reusability over existing HL7 RIM model by reuse the RIM model archetypes. HL7 standard facilitate to exchange and sharing the healthcare information among different hospitals or in between different healthcare systems. We concluded that we extract the existing HL7 RIM model and improve the reusability over existing model by reusing the classes of RIM model and implement the user interface to accept request from different users and process the role base Queries. References: [1] Health Level Seven (HL7), http://www.hl7.org. [2] Explorative study of healthcare data Interchange standards [3]http://www.openhre.org/local/rim202/rim.htm#Acts-sbj [[1]] Tung, Kim, Cho,† A Development of HL7 Middleware for Medical Device Communication†, Fifth International Conference on Software Engineering Research, Management and Applications [[2]] Li-Fan Ko, Jen-Chiun Lin, Chi-Huang Chen, Jie-Sheng Chang, Faipei Lai,† HL7 Middleware Framework for Healthcare Information System†. Basically framework is service oriented architecture (SOA)†. [[3]] Jennifer Munnelly, HL7 Healthcare Information Management Using Aspect-Oriented Programming, International Symposium on Computer-Based Medical Systems, pp 1 – 4 ¸2009 [[4]] Wooshik Kim, Integration of IEEE 1451 and HL7 Exchanging Information for Patients’ Sensor Data, J Med Syst, pp 1033–1041, 2010 [[5]] Pasquale De Meo, Integration of the HL7 Standard in a Multiagent System to Support Personalized Access to e-Health Services, IEEE Transactions on Knowledge and Data Engineering, pp 1244 1260, 2011 [[6]] Maqbool Hussain, Healthcare Applications Interoperability through Implementation of HL7 Web Service Basic Profile, Sixth International Conference on Information Technology: New Generations, pp 308 313 ¸2009 [[7]][7] Naeem Khalid Janjua, Digital Health Care Ecosystem: SOA Compliant HL7 based Health Care Information Interchange, 3rd IEEE International Conference on Digital Ecosystems and Technologies, pp 329 – 334, 2009 [[8]] [8] Sara Gaion, Design of a Domain Model for Clinical Engineering within the HL7 Reference Information Model, IEEE Workshop on Health Care Management, pp 1 6 , 2010 [[9]] N.A. Mamani Macedo, Electronic Health Record: Comparative Analysis of HL7 and Open EHR Approaches, Pan American Health Care Exchange, pp 105 – 110, 2010

My Last Day in California Essay -- Personal Narrative, essay about mys

  My eyes opened very early that morning. I looked out of window and saw beautiful weather outside.   It was cold wind.   The flowers in my garden were smiling at me.   All of a sudden my eyes got watery.   I remembered that this was my last day in California.   I was going to America early the next day morning with my parents and family.   The day was Saturday, 20th December.   Tears were running down my face.   I went downstairs; everybody in the house was sleeping.   They had been packing until late night and I didn't want to them wake them up.   Therefore, I went back upstairs.   I just started thinking about how I was going to leave my house, my friends, my relatives, and my country.   The place where I grew up, the people with whom I had grown up, how I was going to leave without them?   It was going to be very hard for me to leave something that I had used to.   I took out my album and started looking at pictures with my friends and r elatives.   I looked at the life that I had enjoyed with them.   The moments of happiness and sorrow that we had shared together.      Ã‚  Ã‚  Ã‚  Ã‚   The day begins, but it didn't begin as usual. Finally about 10 o'clock in the morning, I went down stairs.   Everybody was awake by that time.   They were busy in their work.   Nobody had time to hear me.   I saw a couple of guests sitting our drawing room so I went back upstairs again.   In a few minutes, the intercom in my room rang and I heard my mom tell me to get ready to go to the temple.   I took a bath and dressed up like a pretty Californian girl.   When I get downstairs, everybody was ready to g... ...The luggage was already in the car then we got in.   As we pulled away, I kept looking at my house as far as I could see it.   All of our friends and relatives were coming to the airport.   We got to the airport.   We were running little bit late.   Therefore, we had to hurry to get our luggage and check in.   No one else could enter the airport but customers so I looked at all of my relatives and friends one last time.   They all were crying.   We had never lived that far from each other.   We boarded the plane, and all I could do was cry.   I made my flight to Ohio.      Ã‚  Ã‚  Ã‚  Ã‚   Leaving my home was the saddest day of my life.   I am in Ohio now, still missing the life I enjoyed in California with my friends and family, still believing there is nothing better than home.   

Difference Between Subjective and Objective Forms of Appraisal

Difference between subjective and objective forms of appraisal Subjective appraisal is of where the appraisal is evaluated on the feelings of the evaluator. This isn’t judged on criteria as the objective appraisal is judged on set criteria and has no basis on how the evaluator feels about the performance, just how he views each select sector. Explain the process of creating movement. There are many steps that are relevant to the sport of rugby league in creating movement.There are many elements that influence and create the process of movement; these include coaches, improvising, motivating factors, rules and variations. Coaches play a large amount in the structure of a team, so therefore they play are large part in the what movement is done by the individual players. Often the coaches and administrators will practice what movements they want their chargers to do. Improvising is an integral part of movement in rugby league as the dynamics of the general play is always changing and often you cannot stick to a set play that is practiced.This is because you have direct opposition and it is unpredictable of what they are going to do. Motivating factors are another major factor in the process of movement. Often this is directly related to the score of the game. A good example is in rugby league upon a field goal is a great idea at equal scores with a minute left. The main motivating factor of sport is to win and therefore all movements are drawn on accordingly. Rules govern how the game is played and have an immense impact on the decisions made by the players and coaches and what movements are done.In rugby league, it is well known to go for the legs or the midriff in a tackle so you don’t slip and go around the head which results in a penalty. Variations are small differences in plays, this is normally attributed to the opposition understand what you are trying to, and varying to get a different outcome. These can often include different and more diff icult changes to the basic skills, like look away passing. These elements of rugby league and many others create a basis of which movement is created in game.The elements not only affect movement but are an integral part of the process and the creation of movement. Each sport is different and has different examples of what elements affect the process of movement. Using a movement medium of your choice critically analyse how each of the elements of composition can be applied to the activity when comprising and performing Combining and arranging movement so that it is fluent and unpredictable to the defence. This is the main component of creating successful movement in the sport of Rugby League.Some of the things that effect composing and performing in rugby league include the space, dynamics, time and rhythm and relationships. Space plays a big part in the game of Rugby League. Playmakers in the game are always trying to exploit space to use it to the team’s advantage to score points. This use of space is personsified no better than with the kick and chase. This uses the space behind the defensive line and uses a small chip kick over the line with the player chasing through the line to attempt to catch the ball and make a run to the tryline.This type of play utilizes the space that is often not thought about and can often make a large difference to the mindset of the opposing players. Patterns and Formations play a large key in the sport of Rugby League. A lot of the the attacking and defensive plays are practiced rigiously and in detail at training. They are used to correct any possible faults that would usually occur during a defensive position that was unplanned. A usual formation that occurs in defence is the fullback staying behind the play in case of a line break through the defensive line.Also having the wing players drop back to align with the fullback on the 5th tackle is another ploy to stop the effectiveness of an attacking kick that attempts to gain field position. Dynamics is an important part of rugby league, most notably in defence when force and flow can create a strong tackle to stop the attacking player. This can often change the feeling of the game and the team morale, as well as the momentum of the general play that is current. Force can also help you break tackles as the defenders arms cannot react to the physical contact they receive in the tackle.Flow is the degree of control of movement through time and space. This is imperative in the success of an attacking team as having bound flow usually presents a positive effect in a rugby league team. Timing and rhythm is imperative in the game of rugby league. Many aspect of this are more important than other, momentum is crucial as an attacking player, as the defensive player rarely has more momentum, the attacking player often needs to use this to his advantage. Timing of the run and timing of the pass is also important for a play to work successfully.If the timin g of either the runner or the passer is out of the zone then often the pass will be unsuccessful and the play will break down due to either a failed pass or a failed catch. Timing is something that is picked up to almost a telepathic event after much time spent as partners or teammates, a lot also derives from direct communication. Relationships are a huge key to a positive performance in a rugby league game. Having positive relationships with your fellow teammates can have them help you to be in position and create a movement they need for what they are trying to achieve.This can stem back to team formations and positional play. Often knowing your teammates positive attributes and their strengths can result in better movements suited to them and their style. In conclusion, these elements of composition can easily be applied to the sport of Rugby League in many different ways. All of the elements are important and can have a profound effect on the overall performance and the result of the game. The positive use of all elements of compositions can maximise the potential of the performance and all of the possible results that can occur.

Biography of Marilyn Monroe, Model and Actress

Marilyn Monroe (born Norma Jean Mortenson; June 1, 1926–Aug. 5, 1962) was an American model turned singer/actress whose career spanned the late 1940s to the early 1960s. Monroe appeared in a number of what are now considered classic films prior to her unexpected death at age 36. Fast Facts: Marilyn Monroe Known For: Model, pinup, actressAlso Known As: Norma Jeane Mortenson, Norma Jeane BakerBorn: June 1, 1926 in Los Angeles, CaliforniaParents: Gladys Baker Mortenson; father unknownDied: Aug. 5, 1962 in Brentwood, CaliforniaEducation: Attended Van Nuys and University High School in Los Angeles, California; dropped out at 15Selected Films: Some Like It Hot, The Seven Year Itch, Gentlemen Prefer Blondes, How to Marry a Millionaire, Bus Stop, The MisfitsAwards and Honors: Three Golden Globes, star on the Holly Walk of FameSpouse(s): James Dougherty (m. 1942–1946), Joe DiMaggio (m. 1954–1955),  Arthur Miller (m. 1956–1961)  Notable Quote:  I dont mind living in a mans world as long as I can be a woman in it. Early Life Monroe was born Norma Jeane Mortenson—and later baptized as Norma Jeane Baker—in Los Angeles, California to Gladys Baker Mortenson (nà ©e Monroe). No one knows the identity of Monroe’s biological father, but some biographers speculate it was Gladys’ second husband, Martin Mortenson, although they were separated prior to Monroe’s birth. Others have suggested Monroe’s father was a co-worker of Gladys’ at RKO Pictures named Charles Stanley Gifford. In any case, Monroe was regarded as an illegitimate child and grew up not knowing her father. As a single parent, Gladys worked during the day and left her daughter with neighbors. Unfortunately, Gladys was not well; she was in and out of mental hospitals until she was institutionalized at the Norwalk State Hospital for Mental Diseases in 1935. At age 9, Marilyn was taken in by Gladys’ friend Grace McKee. Within the year, however, McKee was no longer able to care for the girl and took her to the Los Angeles Orphanage. Monroe spent two years there and then lived in a succession of foster homes. Its believed that during this time, Monroe was molested. In 1937, 11-year-old Monroe found a home with â€Å"Aunt† Ana Lower, a relative of McKee’s, where she had a stable home life until Lower developed health problems. Subsequently, McKee arranged a marriage between 16-year-old Monroe and Jim Dougherty, a 21-year-old neighbor. The two were married on June 19, 1942. From War Bride to Model In 1943, as Americas involvement in World War II gripped the nation, Dougherty joined the Merchant Marines. He shipped out to Shanghai one year later. With her husband overseas, Monroe took a job at the Radio Plane Munitions Factory, where she was discovered by photographer David Conover who was taking pictures of women working for the war effort. Conover’s shots of Monroe appeared in Yank magazine in 1945. Impressed by what he saw, Conover showed Monroe’s photos to commercial photographer Potter Hueth. Hueth and Monroe struck a deal: Hueth would take pictures of Monroe, however, shed only be paid if magazines bought her photos. This arrangement allowed Monroe to keep her day job at Radio Plane and model at night. Hueth’s photos of Monroe piqued the interest of Emmeline Snively, the head of Blue Book Modeling Agency, the largest modeling agency in Los Angeles at the time. Snively offered Monroe a chance at a full-time modeling career—with the proviso that Monroe must attend Snivelys three-month modeling school classes.   Monroe agreed and was soon working diligently to perfect her new craft. While under contract to Snively, Monroe changed her hair color from light brown to blonde. Dougherty, who was still overseas, wasnt happy to learn about his wifes new line of work. The Transition from Modeling to Movies to Marilyn By this time, several photographers were taking pictures of Monroe for pinup magazines, often showcasing her hourglass figure in two-piece bathing suits. Monroe became so popular, her picture could be found on the covers of several pinup magazines in the same month. In July 1946, her photos attracted the attention of casting director Ben Lyon of 20th Century Fox who called Monroe for a screen test. In August, 20th Century Fox offered Monroe a six-month contract with an option to renew every six months. After Dougherty finished his tour of duty and returned stateside, he became increasingly frustrated by his wifes new career. The situation eventually came to a head and the couple divorced in 1946. Until that time, Monroe had been using her married name, Norma Jeane Dougherty, professionally. It was Lyon who helped her come up with her now legendary screen name by suggesting she take the first name of popular 1920s stage performer Marilyn Miller. Monroe adopted her mother’s maiden name for her surname, and the alliterative Marilyn Monroe was born. Career Struggles and Scandal Earning $75 per week, 20-year-old Monroe attended free acting, dancing, and singing classes at the 20th Century Fox studio. She appeared as an extra in a few movies and had a single line in the highly forgettable Scudda Hoo! Scudda Hay! (1948). When Monroes initial six months were up, her contract wasnt renewed. Monroe began receiving unemployment benefits and continued taking acting classes. Six months later, Columbia Pictures hired her as a $125-a-week contract player. Monroe was given second billing and a featured role in Ladies of the Chorus (1948) but despite positive reviews, her contract at Columbia wasnt picked up. In 1949, Tom Kelley, a photographer whod worked with Monroe previously, offered her $50 to pose nude for a calendar. Monroe, who was broke, agreed to take the job. Kelley subsequently sold the shots to Western Lithograph Co. for $900. The calendar, Golden Dreams, made millions. In 1952, word of Monroes nude photos surfaced, threatening to ruin her career. To combat the negative publicity, Monroe told the press about her troubled childhood. She revealed that shed posed for the photos when she was destitute, and never received as much as a thank-you note from the people who made so much money off her $50 humiliation. (In 1953, Hugh Hefner bought one of the photos for $500 and published it in his first issue of Playboy magazine.) Big Break When Monroe got wind that the Marx brothers needed a blonde for their new movie, Love Happy (1949), she auditioned and got the part. The role called for Monroe to sashay by Groucho Marx in a sultry manner and say, â€Å"I want you to help me. Some men are following me.† Although she was only on screen for 60 seconds and was paid, according to Marx, $100, Monroe’s performance caught the eye of the producer, Lester Cowan, who decided that Monroe should go on the five-week publicity tour for the film. Her bit part was also noted by major talent agent Johnny Hyde, who wrangled an audition for her at Metro-Goldwyn-Mayer for a small part in Asphalt Jungle (1950). The film, directed by Oscar-winning actor/director/screenwriter John Huston, was nominated for four Academy Awards.  Although Monroe had only a minor role, it was a memorable one. Monroe’s performances, including a small but juicy turn in the Bette Davis classic All About Eve (1950), led studio executive Darryl Zanuck to offer her a contract to return to 20th Century Fox. When studio publicist Roy Craft capitalized on Monroes image as a pinup girl, the studio received thousands of fan letters, many eagerly wanting to know what Monroes next film appearance would be. Sensing a potential box-office goldmine, Zanuck ordered producers to find parts for her. She played her first leading role as a mentally unbalanced babysitter in Dont Bother to Knock (1952). Over the next two years, Monroe made some of her most memorable movies: Niagara (1953), Gentlemen Prefer Blondes (1953), How to Marry a Millionaire (1953), River of No Return (1954), and There’s No Business Like Show Business (1954). Marriage to Joe DiMaggio On January 14, 1954, legendary New York Yankees baseball star Joe DiMaggio and Monroe tied the knot. As two rags-to-riches kids, their marriage made headlines. DiMaggio was ready to settle down, but Monroe, who was set on a career and also had professional commitments, planned to continue acting while fulfilling a recording contract with RCA Victor Records. DiMaggio and Monroe’s troubled marriage reached a boiling point in September 1954 during the filming of The  Seven Year Itch,  which was released the following year. Monroe, who had top billing, was standing over a subway grate when a gust blew the skirt of her white dress into the air while excited onlookers whistled and clapped. Director Billy Wilder turned it into a publicity stunt and shot the legendary scene again. DiMaggio, who was on the set, flew into a rage. The couple separated and were divorced after only nine months of marriage. Career Transition and The Actors Studio Monroe was now a major movie star, but with the exception of Niagara, in which shed played a cunning murderess harkening back to classic noir films such as The Postman Always Rings Twice (1946) and Double Indemnity (1944), she was beginning to chafe at the limited range of roles she was being offered by the studio. Not content to be seen as merely a pretty face attached to a voluptuous figure, Monroe set her sights on becoming a serious actress. In 1954, at odds with her studio contract and seeking more control of her career, Monroe formed her own production company. The following year, she moved to New York City and enrolled at the prestigious Actors Studio run by Method Acting guru Lee Strasberg and his wife, Paula. The three formed a strong bond and a sometimes troubling symbiotic relationship that endured for the remainder of Monroes life. On the plus side, Monroes acting talents were honed and refined under Strasbergs tutelage. Critics generally agree that her performances were more powerful and nuanced thanks to the training she received. On the downside, Lee Strasberg was accused of playing on Monroes insecurities and exerting a Svengali-like influence over her both personally and professionally. For a time, Monroe actually moved into the Strasbergs Manhattan apartment, and when she did return to her film career, Paula notoriously accompanied her on every movie set—much to the dismay of directors including Laurence Olivier and George Cukor whose artistic sensibilities did not mesh with Method Acting. Marriage to Arthur Miller Monroes third marriage took place on June 29, 1956, when she wed noted American playwright Arthur Miller. Monroe converted to Judaism in order to marry Miller, who was of Polish-Jewish descent. (Monroe’s 1922 edition of the prayerbook, â€Å"The Form of Daily Prayers: According to the Custom of the German and Polish Jews sold at auction in 2018 for a total of $26,250. In 1999, a copy of â€Å"A Union Prayer Book for Jewish Worship† with the name â€Å"Marilyn Monroe Miller†Ã‚  inscribed on its cover sold for $19,250.) During her marriage to Miller, Monroe suffered two miscarriages and once again turned to sleeping pills to cope with her emotional turmoil. She also starred in two of her most legendary movies: Bus Stop (1956) and Some Like it Hot (1959). The latter netted her a Golden Globe Award for best comedy actress. Miller wrote the screenplay for The Misfits (1961) as a vehicle for Monroe. The film re-teamed Monroe with director John Huston and co-starred legendary leading man Clark Gable and fellow Actors Studio alum Montgomery Clift. (The Misfits marked the final screen appearances for Monroe and Gable; Clift died of a heart attack five years later in 1966 at age 45.) During filming in Nevada, Monroes frequent illnesses held up production. Monroes condition was exacerbated by the consumption of sleeping pills and alcohol. She was eventually hospitalized for what was then termed a nervous breakdown. Monroe and Miller ended their five-year marriage after the completion of the film. Downward Spiral On February 2, 1961, Monroe was admitted to Payne Whitney Psychiatric Hospital in New York. DiMaggio flew to her side and had her moved to Columbia Presbyterian Hospital, where in addition to psychiatric treatment, she also underwent gall bladder surgery and lost a substantial amount of weight as a result. DiMaggios attentiveness to Monroe during her illnesses triggered rumors that the couple might reconcile. Near the end of April 1962, Monroe was scheduled to begin shooting Something’s Got to Give, a film comedy helmed by veteran director George Cukor and co-starring Dean Martin and Wally Cox. Due to a serious sinus infection, Monroe was unable to report for work, so Cukor was forced to shoot around her as much as he could. Despite her illnesses, on May 19, 1962, Monroe, wearing a sheer, flesh-colored, rhinestone-studded dress, sang â€Å"Happy Birthday, Mr. President† at a Madison Square Garden Gala for President John F. Kennedy. Her sultry performance sparked rumors that the two were having an affair, followed by a subsequent rumor that Monroe was also having an affair with the President’s brother, U.S. Attorney General Robert Kennedy. When Monroe returned to California to resume shooting Somethings Got to Give, her health had not improved. Further prolonged absences from the set led 20th Century Fox to fire her and file suit for breach of contract. While she was eventually rehired, the film was never finished. Death Monroes reliance on sleeping pills and alcohol has been documented, yet it was still shocking when the 36-year-old was found dead in her Brentwood, California home on August 5, 1962. The coroners death certificate lists Monroes cause of death as acute barbiturate poisoning, ingestion of overdose (later determined to be a combination of Nembutal and chloral hydrate, a knockout drug commonly known as a Mickey Finn). After an autopsy, Monroes body was released to DiMaggio and a private funeral was held. Conspiracy Theories The death of Marilyn Monroe has spawned its own fertile mythology. While the coroner labeled her death a â€Å"probable suicide† and closed the case, there was no definitive proof that Monroe took her own life. Some sources close to the actress contested the finding. The question of whether or not the actress ingested the drugs has been a topic of debate since, according to the autopsy report, no trace evidence of Nembutal was found in her urine. (Had she swallowed a sufficient number of pills to result in an overdose, its argued that the coloring from the capsules should have been evident.) According to John W. Miner, one of the members of the autopsy team, relevant evidence including Monroes stomach contents, organ samples, and pertinent smear materials went missing and were never found. He concluded, however, that the high concentration of narcotics in Monroes liver suggested that the fatal dosage had been delivered via suppository rather than ingestion. So while some speculate Monroe died from an accidental overdose, others believe she was murdered. One scenario suggests Monroe was silenced to stop her from revealing intimate information on her alleged liaisons with President Kennedy and his brother Robert; another posits her death was an organized hit by the mob. In this version, Robert Kennedy was said to have been with Monroe in the hours prior to her death. Framing him for her murder would derail the escalating war against organized crime the Attorney General was waging, however, the scene was supposedly sanitized by government-sanctioned cleaners before RFK could be implicated. While several sources have confessed to participating in the hit, theres no conclusive proof to support such claims. The events of Monroes final hours will likely remain a mystery, however, those who believe she was murdered say the missing autopsy evidence points to a well-choreographed coverup. Legacy Decades after her death, Marilyn Monroes incandescent performances along with her personal backstory continue to captivate the publics imagination. The iconic picture of Monroe standing over the subway grate in The Seven Year Itch—ironically the last straw in her troubled marriage to Joe DiMaggio—is easily one of the most recognizable images in the landscape of modern popular culture. Along with Michael Jackson, Elvis Presley, and Elizabeth Taylor, Monroe is one of the most prominent delebs (a term coined by the entertainment industry in connection with deceased celebrities whose estates continue to generate substantial revenues after the celebrity has passed away) in the world. With the aid of CGI (computer-generated imagery), in 2011 Monroe appeared in an ad alongside Grace Kelly, Marlene Deitrich, and Charlize Theron for Christian Diors perfume JAdore. Three years later, Chanel No. 5 tapped Monroe as their celebrity spokesperson—this time, thanks to archival footage, and more accurately, since Chanel No. 5 was Monroes signature scent—five decades after her death. But theres more to Monroes legacy than just the licensing of her image and a catalog of classic films. One of a cadre of mid-century zaftig screen sirens that included Jayne Mansfield and Mamie Van Doren, as she matured, only Monroe was able to shatter the stereotype of dumb blonde by reinventing the trope as something more complex and three-dimensional—a human being worth knowing. Monroes humanity and vulnerability are two traits cited by film historians that clearly come across in a number of her most memorable film portrayals. In addition to her undeniable allure, the little girl lost quality she never fully outgrew onscreen is ultimately what many believe makes Monroes performances magnetic, irresistible, and ultimately enduring. Goodbye, Norma JeaneThough I never knew you at allYou had the grace to hold yourselfWhile those around you crawledThey crawled out of the woodworkAnd they whispered into your brainThey set you on the treadmillAnd they made you change your name And it seems to me you lived your lifeLike a candle in the windNever knowing who to cling toWhen the rain set inAnd I wouldve liked to known youBut I was just a kidYour candle burned out long beforeYour legend ever did—From Candle in the Wind by Elton John, 1973 Sources Marilyn Monroe. Biography.com.Norma Jean Baker 1942 Yearbook. MarilynMonroe.ca.Marilyn Monroe’s Legacy Is Way More Than Curves and a Blonde Bob. HuffPost.Marilyn Monroe. How Stuff Works.Miner, John W. Miners Account of Monroes Death from The Marilyn Monroe Story. The Los Angeles Times. August 4, 2005Kahn, Erik W.; Pou, â€Å"Bonnie† Lee.â€Å"‘Delebs’ and Postmortem Right of Publicity.† Landslide, Vol. 8, No. 3. American Bar Association. January/February 2016. Marilyn Monroe and the Actors Studio (Documentary)Marilyn Monroe: The Mortal Goddess. AE Biography, 2002