Southeastern U.S. Braces For Heavy Termite Season

Here are five types of termite species to be aware of at the turn of the season if you reside in the southeastern United States:

  1. Subterranean Termites

    44 Termite (E. Subterranean Termite).jpg

    This termite species is extremely common in southern states and hotter climates. Subterranean termites live in underground colonies with as many as two million members and are also found in moist, secluded areas above ground. They build distinctive tunnels, often referred to as "mud tubes," to reach food sources and protect themselves from open air. Subterranean termites are by far the most destructive termite species — their hard, saw-toothed jaws work like shears and are able to bite off extremely small fragments of wood, one piece at a time. Over time, they can collapse a building entirely, meaning possible financial ruin for a homeowner.

  2. Drywood Termites

    Drywood termite swarmer.jpg

    Largely found coastally from South Carolina westward to Texas, these types of termites form colonies of up to 2,500 members and primarily attack wood structures, frames, furniture and flooring, as they receive all of their nutrition from wood. Unlike other termites, drywood termites do not require moisture from soil. They typically swarm on sunny, warm days after a sudden rise in temperature and can be difficult to treat because they have the ability to create multiple colonies within a home.

  3. Dampwood Termite

    Dampwood Termite - NPMA.jpg

    Occasionally found in Southwest and Southern Florida, dampwood termites are attracted to wood with high moisture content and have a preference for decaying wood, areas with leaks and woodpiles. These termites create a series of chambers in wood, which are connected by tunnels with smooth walls, as if sandpapered, and are usually found in logs, stumps, dead trees, fence posts and utility poles. Dampwood termites do not usually infest structures because of their need for excessive moisture.

  4. Formosan Termite

    Formosan termite workers.jpg

    This species lives in huge underground colonies with an average of 350,000 workers and can be found in several Southeastern states, including North Carolina, South Carolina, Georgia, Virginia, Alabama, Florida and Tennessee.

    In addition to structures, they also infest trees, shrubs, utility poles, timber, railroad trusses and even boats. Formosans build intricate mud nests in the ground and can chew through wood, flooring and even wallpaper. The average formosan termite colony can consume one foot of 2X4 wood in less than a month.

  5. Conehead Termites

    47 Tree termite (Nasutitermes spp.).jpg

    Originally called "tree termites," this species was renamed conehead termites to alleviate the misconception that this pest is only found in trees. These termites— most prevalent in the Broward County, Fla. region — build dark brown "mud" tubes and freestanding nests on the ground, in trees or in wooden structures. The nests can be up to 3 feet in diameter and have a hard surface of chewed wood. Unlike most termites, the conehead termite does not rely on underground tunneling to travel. Instead, they forage on the ground like ants, allowing them to spread quickly.

Termites are not a pest that can be effectively controlled with do it yourself measures. If you live in an area prone to termites, it’s important to have regular, annual termite inspections. Contact a licensed pest control professional or click here to view our top 10 tips for preventing termites and getting rid of a termite infestation.


Amir Zaki, Carving 8, 2016, ©Amir Zaki, courtesy of the artist and ACME Los Angeles.

Amir Zaki

Amir Zaki’s lushly photographed black-and-white landscapes introduce tension between formalist notions of timeless beauty and suspicions of digital photography’s reliability—or lack thereof. These photos of California’s coast, drawn from a series aptly named “Rocks,” comprise eight of the 12 images shown in “Formal Matter,” his exhibition of photographs from two distinct, but conceptually and formally interrelated bodies of work. The remaining four, from the series “Carvings,” convey the appearance of carved wooden forms, and extend Zaki’s interest in considering photography’s presumptive veracity.

“Rocks” invites comparisons with antecedents like Edward Weston, for example, who began photographing Point Lobos nearly 90 years ago. Weston was a master of framing the image, as is Zaki. Yet their methodologies—and their intentions, it would seem—are vastly different. Zaki photographs with a GigaPan device, enabling him to seamlessly stitch together multiple images, making his landscapes suspect in a way that working in analog media never was—despite the availability of darkroom tricks and retouching. Yet it is not entirely the digital that creates this crisis; it resides as much in the act of making the photograph.

AZaki Rock 12 2016 60x78 Amir Zaki

Amir Zaki, Rock 12, 2016, ©Amir Zaki, courtesy of the artist and ACME Los Angeles.

Zaki composes to limit references of scale, imbuing the images with a sense of grandeur, and prompting the question: How much do we believe in the mythology of the monumental image? Some of the photographs, Rock #12 (all works 2016), for example, seem fantastic, as if the massiveness of the formations tests the limits of credibility. However, details reveal themselves on close inspection; birds perch on a craggy promontory in Rock #29, or a distant cliff provides perspective in Rock #69.

Zaki sustains this tension by exploiting the ambiguity between presenting an idealized vision of nature and deconstructing it. As with all photography, the abundance of detail and complexity of the image suggests the presence of the thing itself. The substantial scale of the prints offers an almost encompassing visual field, and as such, these photographs absorb the viewer.
The “Carvings” series, a body of manipulated digital images that appear to depict contorted planar forms, also stretch the boundaries of believability, but much more brazenly. The gnarled forms resemble elaborate carvings, or perhaps planks that have been steamed and sun-dried, contracting in on themselves.

These planar forms convey a beauty and formality that make each image beguiling, as does the sense that these works, more than their counterparts in the “Rocks” series, resemble graphite drawings (all of the photographs are printed on rag paper, and the surfaces, matte and supple, suggest the sensuousness of drawing). In Carving #8, an area of shadow has been darkened uniformly to eliminate nearly all detail of grain. The subtle play of surface and edge is full of deliberation and choice, and is both artificial and ambiguous, so that we’re never sure what we are seeing. Despite the illusion of drawing, photography is never far off. “Carvings” suggest a possible ironic take on an earlier era’s idealized forms, recalling Weston’s peppers or Imogen Cunningham’s flora, for example Magnolia Blossom (1925). The interplay of the two series activates Zaki’s theoretical concerns, but as objects, the photos are sublime.


Posted on February 26, 2017

Tips for potential Computer Science undergrads in Singapore

As there has been growing interest in CS undergraduate courses over the past few years, I would like to share my experience as a CS major in National University of Singapore, and also shed light on the common misconceptions that people may have.

My background: I’m a fourth year CS major. Prior to this, I graduated from Ngee Ann Polytechnic with a Diploma in Network Systems & Security.

I made the decision to read CS upon realising the gaps in my knowledge of technology.

I felt confident in designing and implementing network systems, but never understood why network protocols were designed in that manner.

A quick search on Wikipedia on a network protocol algorithm, Djikstra’s Shortest Path, inundated me with so much math that it quickly made me realize that a CS education will provide the foundational theoretical knowledge to understand these algorithms.

Should I study CS?

You know how to use computers as a tool to get things done.

However, you’ve probably never learnt why and how they work behind the scenes.

Consider Google Search. Have you ever wondered why it seems to know everything and how it works behind the scenes?

CS is the science of computational processes, like how Physics is the science of nature. It’s a foundational science that enables you to solve problems across disciplines and subfields.

It’s about taking problems, figuring out what needs to be solved, and providing a step-by-step solution to compute the solution.

These problems come from other fields like healthcare, finance, environmental science, space exploration, game development, or something that you have an interest in. Anything.

If you’re a problem solver, CS will sharpen your mind to produce articulate and well-reasoned solutions, and to communicate them across domains.

If you’re not, CS will equip you with the mental toolbox to approach complex problems with confidence.

You’ll learn to break down complex problems into little problems that can be solved systematically.

I recommend reading CS if you’ve enjoyed mathematical and logical challenges.

If this sounds interesting to you, then yes, go forth and study CS.

Computer Science is difficult.

CS is not a walk in the park.

No decent undergraduate degree program is a walk in the park.

A well-designed curriculum will begin with battle-tested fundamental courses. They will expand your mind and change the way you think about the world.

Don’t assume that you’re just going to learn how to program; you can do that in 2 weeks with an online course.

CS will flex your brain muscles and teach you how to reason rigorously in the various subfields, such as computer graphics, artificial intelligence and even programming languages themselves.

Wikipedia has a good outline of the subfields in CS.

What is CS at National University of Singapore like?

CS is taught in the School of Computing (SoC).

There are about 1300 undergraduates in SoC (as of 2017) across CS, Information Systems, Information Security, Business Analytics and Computational Biology.

As a freshman, you’ll do lot of common modules, so the first year tend to be similar with other majors.

The full SoC CS curriculum is available on the website.

The fundamental modules include introductory programming, data structures and algorithms, calculus, discrete mathematics, linear algebra and software engineering.

CS1010 (or its variants like CS1101S) teaches basic programming methodologies, while CS1020/CS2010 (or CS2020) teaches how to solve algorithmic problems with data structures.

After these, it’s generally assumed that you know how to code and are able to pick up the languages as needed.

For example, a parallel programming module will assume that you know how to code in C, or can pick it up in 1-2 weeks, since the syllabus is focussed on parallelism concepts.

The most hardware oriented module is CS2100, Computer Organisation. You’ll learn lower level concepts like logic, CPU design and basic assembly programming. Anything lower than that enters the realm of Computer Engineering, where modules are coded with CG instead of CS.

CS students are not required to do electrical and electronic engineering modules.

From the second year onwards, you’ll specialize into a technical area of study called a Focus Area. There are ten of them.

Most students will spend their summer vacations on internships and exchanges. NUS Overseas Colleges is a popular choice for the entrepreneurial minded.

I highly recommend doing internships that are self-sourced, and not on the list provided in the faculty internship portal. Self-sourced internships usually result in more interesting companies and projects.

A SoC alumnus has compiled information on self-sourcing internships in Project Intern.

Don’t worry about a lack of programming background.

Most come in fresh – I didn’t (I learnt programming in NP), but I didn’t feel advantaged at any point in time.

I felt challenged by the first programming module I took in SoC, CS1101S, which I highly recommend freshmen to take, if you have the opportunity. It replaces CS1010.

If you want to prepare yourself, start reading /r/programming, Hacker News, and familiarize yourself with the idea that CS is not solely about programming but understanding how to compute things.

Programming is a tool to implement computations to solve a problem, like a hammer as the tool to drive nails into a piece of wood to create something.

However, disliking programming may lead to difficulty understanding CS materials, as they are intertwined.

Most NUS CS undergraduates will do Java at some point, especially in the Data Structures & Algorithms module. While that is a good starting point, don’t be afraid to branch out to other languages once you feel that you know Java well enough.

A quick glance at will show you the plethora of programming languages out there.

Popular programming languages are typically general purpose - meaning they can be used in many applications - but each language has its own niche area. For example, Python and Ruby are used for scripting languages, while Java is used for building enterprise systems.

There are many guides on what language to learn first — I will not delve into that here.

Learning one language well makes learning successive languages easier.

But I’m bad at mathematics!

CS has an enormous intersection with mathematics.

I disliked mathematics prior to University. The lack of interest and curiosity stemmed from rote learning formulas in secondary school and tuition classes. It just didn’t seem like an interesting subject and I associated it with boredom and dread.

However, mathematics pedagogy in University is on a whole other level. You will finally understand why certain things in math are the way they are, and maybe it’ll start to seem more interesting to you.

Your teachers are now passionate professors who are experts in their research fields, and are usually patient enough to explain concepts to you if you ask.

I’m still not great at mathematics, but NUS CS has made me see math in a different light.

For example, matrices in linear algebra are used heavily in Computer Graphics and Game Development, and graph theory is used in databases and computer program analysis.

Both CS and mathematics force you to think in terms of abstractions. Improving in one domain helps in the other.

Do grades matter in CS?

The idea of studying for grades is probably ingrained deep into you after the 10-something years toiling through the Singapore education system. It’s time to get rid of that.

In CS, grades serve as your personal benchmark.

Being able to score well in a module gives you a sense of confidence that you have understood the subject materials.

It does not mean you can mess school up and get away with it. Scoring consistent C’s and D’s is a signal that you have not understood the material intuitively, and will pose problems when you’re taking higher level modules.

Grades do not mean much when applying for industry roles, such as software engineering. No interviewers have ever asked me for grades.

Relevant internships and side-projects, on the other hand, are great ways to convey your skills to potential employers.

Potential employers can derive your willingness to learn and try new things, which translates to a potentially great attitude in the working environment. Self-directed learning is important in CS.

However, grades are still relatively important for graduate school applications, along with a research portfolio.

What are my job prospects?

CS is one of the most versatile degrees to find work with.

It signifies that you’ve been through a rigorous curriculum and possess the ability to take on large and complex problems.

It is up to you to prove that you’re able to do it.

You can be a web developer, AI researcher, data scientist, software engineer, devops engineer, mobile app developer… the list goes on.

Each of those roles requires a specialized skill set, but CS forms the foundation of all of them.

CS is a field that has an ubiquitous nature.

It manifests itself in many different forms, and in many cases, it doesn’t even involve a computer.

To succeed in University, you’ll need to learn how to learn. That is, identify your gaps in knowledge and figure out how to fill them up efficiently.

The Singapore technology and research ecosystem is expanding rapidly with massive government support — there has never been a better time to pursue CS.

Feel free to ping me on Twitter or Email with questions or comments.

All the best!

Notes to NUS CS Freshmen, from the future - List of technology meetup groups in Singapore - Meetup video recordings in Singapore

Plug: NUS Hackers

I’m part of the NUS Hackers coreteam.

We’re a group of people who wants to spread the hacker culture.

The idea of not hesitating to build and break stuff for fun and knowledge, sharing and just being curious about how things work. Our weekly Friday Hacks have very different topics – the idea is to expose the NUS community to various technical topics they wouldn’t have otherwise learnt in class.

We also run a hackerspace in NUS.

What about Information Systems?

IS is a degree that sits in the intersection of business and IT, while CS is deeply grounded in mathematics and logic. Many CS graduates eventually exit academia into engineering roles though.

It’s easier to see the difference between the core modules of these majors:


Home > Syntax Error > Qb64 Commands

Qb64 Commands

SCREEN 1: 320 x 200 Resolution. It goes just before (I think), your PRINT statement. Check it out yourself. The newer method looks similar to other programming languages, which is a single word followed by a colon.

John Fields12-23-2012 Re: QBasic syntax error? CONST PI2 = 2 * PI PI must be assigned a value before it is used to calculate PI2. All you need to know about parentheses is that the deepest nested parentheses calculate first. this makes the data statements out of whack after that trying to read a string as a numeric and vice versa.

Qb64 Commands

DATA is not an executable statement. John Larkin12-23-2012 Re: Re: QBasic syntax error? LOOP[edit] DO [program] LOOP UNTIL [test condition becomes TRUE] Used to create a loop in the program. Within the function, the return value is created by using the function name as a variable - the return value is then passed to the calling expression.

none 11 Division by zero You cannot divide any value by zero! Here is a list of some character codes:- 07 Beep (same as BEEP) 08 Backspace 09 Tab 27 Esc 34 Double quote 72 Up Arrow 75 Left Arrow 77 Right Arrow WEND[edit] WHILE {NOT} [test condition is true] [program code to execute] WEND The condition is tested and if true (or NOT true) the [program] code is executed until WEND is reached, All centered around the PRINT statement.

none 35 Subprogram not defined. none 14 Out of string space A module has exceeded the 32767 text character limit. The Reason why we put 13 is that the program stops at that point and does not continue the loop. Displays text to the screen.

The fifth line changes the tip from a percent to the correct decimal by dividing by 100 (ex. 20%=.2 because 20/100=.2) the next line takes that percent and turns it into You can only upload files of type PNG, JPG, or JPEG. There are ten main types of screen modes that can be used in QBasic depending on the resolution that you want. FOR ..

What Is Qb64

Valid values are from 0 to 84. (0 is a pause.) Cannot use with sharp and flat. The code I wanted to test came with some sample data but was a bit limited having only 40 odd variables. Qb64 Commands As such, any error checking or flags will have to be handled through the use of variables that are shared with the main module. Qbasic Tutorial Where did I go wrong?

Not a member yet? Try breaking the code up to smaller modules. Strings can be 'declared' using $ sign (Integers with the '%' sign). Use SUB print procedures.

none 38 Array not defined Arrays using more than 10 elements must be DIMensioned. WRITEME N/A 57 Device I/O error. This is a good example of a complete program. LET[edit] LET [variable] = [value] Early versions of the QBasic.exe command interpreter required use of the 'LET' command to assign values to variables.

It is very easy to overlook such small mistakes. How do I reassure myself that I am a worthy candidate for a tenure-track position, when department would likely have interviewed me even if I wasn't? If this is not specified, the array takes the Type defined by the variable name suffix - INTEGER (%), LONG(&) integer, SINGLE(!) float, DOUBLE(#), STRING($) - or INTEGER if none.

If omitted the default is +1. EXIT DO Exits from a DO loop, execution continues with the command directly after the LOOP command EXIT FOR Exits from a FOR loop, execution continues with the command directly after The variable n does not indicate an actual duration amount but rather a note type; L1 - whole note, L2 - half note, L4 - quarter note, etc. (L8, L16, L32, In the second use, length% characters of string$ are replaced by b$ starting at start%.

EXIT[edit] Allows the immediate exit from a subroutine or a loop, without processing the rest of that subroutine or loop code EXIT DEF Exits from a DEF FN function. What do you do with all the bodies? Forum New Posts FAQ Calendar Community Groups Forum Actions Mark Forums Read Quick Links Today's Posts View Site Leaders What's New? Example 1 A little while ago I wanted to test some sort algorithms.

show more I have to write a program that calculates the total pay earned at a job. $7.50 for the first 8 hours and each hour spent after that pays at FOR I = 1 TO 6 'reads 6 lines of data GOSUB ReadData PRINT Nam$, Num, AmountOwed NEXT END ReadData: READ Nam$, Num, AmountOwed RETURN MyData: DATA ABC company, 5 $80.00 N/A Other Errors Syntax errors: QB64 will display most statement syntax and parameter errors in the Status area below the editing area in the IDE.


75 million CPU hours

The EU Partnership for Advanced Computing in Europe (PRACE) provides access to world-class resources by allocating computing time at the five largest computers in Europe to research and industry. Leading an international team of researchers, Troels Haugbølle has been awarded 75 million CPU hours. It is the second largest EU computing grant given to any European research group, and represents 27% of all EU computing time at the largest super-computer in Europe.

If a corresponding amount of computing power would be acquired by buying computers or computing time at commercial data centers it would cost more than 3.5 million Dkr. The grant will allow Troels and his collaborators at the Natural History Museum and the Niels Bohr Institute to make groundbreaking models of how stars are formed from dense molecular gas, and better understand how accretion discs made of gas and dust, that eventually become planets, evolve around newborn stars.


Varnish request histogram

Manual section:1

varnishhist [-B <factor>] [-C] [-d] [-g <request|vxid>] [-h] [-L <limit>] [-n <dir>] [-p <period>] [-P responsetime] [-P size] [-P Bereqtime] [-P Beresptime] [-P BerespBodytime] [-P Besize] [-P <[cb:]tag:field_num:min:max>] [-q <query>] [-r <filename>] [-t <seconds|off>] [-T <seconds>] [-V]

The following options are available:

-B <factor> Factor to bend time by. Particularly useful when [-r]eading from a vsl file. =1 process in near real time, <1 slow-motion, >1 time-lapse (useless unless reading from a file). At runtime, < halves and > doubles.
-C Do all regular expression and string matching caseless.
-g <request|vxid>
-h Print program usage and exit
-n <dir> Specify the varnishd working directory (also known as instance name) to get logs from. If -n is not specified, the host name is used.
-p <period> Specified the number of seconds between screen refreshes. Default is 1 second, and can be changed at runtime by pressing the [0-9] keys (powers of 2 in seconds or + and - (double/halve the speed).
-P responsetime
 Predefined client profile: graph the total time from start of request processing (first byte received) until ready to deliver the client response (field 3 of SLT_Timestamp Process: VSL tag).
-P size Predefined client profile: graph the size of responses (field 5 of SLT_ReqAcct VSL tag).
-P Bereqtime Predefined backend profile: graph the time from beginning of backend processing until a backend request is sent completely (field 3 of SLT_Timestamp Bereq: VSL tag).
-P Beresptime Predefined backend profile: graph the time from beginning of backend processing until the response headers are being received completely (field 3 of SLT_Timestamp Beresp: VSL tag).
-P BerespBodytime
 Predefined backend profile: graph the time from beginning of backend processing until the response body has been received (field 3 of SLT_Timestamp BerespBody: VSL tag).
-P Besize Predefined backend profile: graph the backend response body size (field 5 of SLT_BereqAcct VSL tag).
-P <[cb:]tag:field_num:min:max>
 Graph the given custom definition defined as: an optional (c)lient or (b)ackend filter (defaults to client), the tag we'll look for, and the field number of the value we are interested in. min and max are the boundaries of the graph (these are power of ten).
-q <query> Specifies the VSL query to use.
-r <filename> Read log in binary file format from this file. The file can be created with varnishlog -w filename.
-t <seconds|off>
-V Print version information and exit.


Love in the Rain - New release

The author has developed an obsession about BODY HEAT and has a book by that title.  But this is different as two characters, a writer and a lawyer, get caught in an unexpected tropical storm by the sea with not much to keep them warm.  It's the lawyer who suggests standing close to one another, and it does begin to work, but there are other complications.

This is just the start of the story, set in south east Asia, and culminating in modern day Singapore.  Things go wrong and others go right, but you the reader will have to read a copy to find out, and don't be too fussy.  The writer is a wild Irishman, and the lawyer has a Filipino-American background.

It's on offer at Amazon & Smashwords until the end of November 2017.


A pilot who passed out in a cockpit before a scheduled flight in Canada has pleaded guilty to being impaired while in control of an aircraft.

Miroslav Gronych, who was employed by Sunwing Airlines on a work visa from Slovakia, was due to leave Calgary, Alberta, on December 31 with four stops through Canada before continuing to Cancun, Mexico.

The 37-year-old was found slumped over in his seat and escorted off the plane.

"I can't even describe how ashamed I am," he told court.

A statement of facts read in court said police saw his pilot's wings were attached upside down on his uniform and a maid discovered an empty bottle of vodka in his hotel room.

It also said he was an hour late for check-in and when he got on the plane around 7am, the court was told, he struggled to hang up his coat, was slurring his words and was staggering.

When the co-pilot suggested Gronych was impaired and should leave the plane, "he seemed very nonchalant and said 'OK, if that's what you feel',".

But Gronych returned to the cockpit, sat in the pilot's chair and appeared to pass out "resting his face on the window", the statement said.

The prosecution asked the judge for a one-year sentence and pointed to a similar case in the United States where the pilot received five years.

"Mr Gronych put the lives of 105 people at risk," prosecutor Rose Greenwood said.
"Hopefully he will never be permitted to fly again."

Defence lawyer Susan Karpa told court Gronych could not sleep the night before his flight and felt like he was coming down with a cold.

He took a couple of shots of vodka and a Tylenol, and planned to wake up in time to let people know he wouldn't make the flight.

He didn't set an alarm and was awakened by a call asking him where he was, Karpa said.

Gronych, who lost his job, has been in treatment while out on bail, has abstained from alcohol and wants to refrain from drinking for the rest of his life.

"He wants his children to be proud of him," Karpa said.

"He wants to do everything he can to conquer his addiction."

Sunwing, a low-cost Canadian carrier, has said it has a zero-tolerance policy on crew members consuming alcohol within 12 hours of going on duty. It said it also trains all employees to report any unusual behaviour.


EbayXpress (Prestashop)

Ebay is likely one of the hottest marketplaces for ecommerce .
This plugin lets you import the product content material and pictures from Ebay.com on to your retailer, selecting from tens of millions of various merchandise organized by classes , nations and lots of different filters .
You’ll even have the liberty to set your costs ,amount and lots of different particulars .


// archives

This tag is associated with 9 posts

Project Euler 288 Solution

Find the number of factors in an enormous factorial.

Project Euler 231 Solution

The prime factorisation of binomial coefficients

SPOJ Problem 11. Factorial (FCTRL) Trailing zeros in factorials

Find the number of trailing zeros in a factorial

Project Euler 121 Solution

Investigate the game of chance involving colored discs.

Project Euler 20 Solution

Find the sum of the digits in 100!

Project Euler 15 Solution

Find the number of routes from the top left corner to the bottom right corner in a rectangular grid.

Project Euler 53 Solution

Count the values of C(n,r), for 1 ≤ n ≤ 100, that exceed one-million.

Project Euler 74 Solution

Project Euler 34 Solution


We don’t need fail safe systems, we need fault tolerant systems : Dr. Clive Fernandes

Achieving the desired outcomes of patient care is directly proportional to the emphasis placed on patient safety.
We don’t need fail safe systems, we need fault tolerant systems : Dr. Clive FernandesHospitals in India have come ahead for accreditation, and though this number is small, it is definitely a step in the right direction.  Dr. Clive Fernandes, Group Clinical Director, Wockhardt Group of hospitals, Mumbai, talks to ETHealthworld about the need and impact of pateint safety that goes hand in hand with hospital accreditation. Edited excerpts :

How has 'patient safety' in India evolved over the years?

Over the last decade, there has been a positive shift in the mindset of healthcare organizations across the globe towards patient safety and India has been part of this trend. One of the key reasons for this transition is the recognition and acceptance of accreditation bodies like JCI and NABH by healthcare organizations. They have been instrumental in introducing safe systems and creating awareness among patients for quality and safe patient care.

In the last decade, hospitals in India have come ahead for accreditation, and though this number is small it is definitely a step in the right direction. One of the most motivating factors is that even hospitals in the government sector are going in for accreditation as they understand patient safety is the way forward and accreditation helps you to get there.

What are the current tools for improvement of patient safety?

There are many tools that can be used to deliver safe patient care; a detailing of that in itself would require a separate article. A few factors that help determine what tools are necessary are the type of healthcare facility, the care provided, and the resources available.

I believe that just as one size does not fit all, tools have to be customised to individual organizations. These tools range from simple checklists to practicing published evidence based guidelines like bundles to prevent infections like VAP, SSI, SSI UTI and CRBSI. Practicing something as simple as proper hand hygiene as defined by CDC or WHO i.e. the correct technique for the specified time, in all defined instances in itself can make a positive difference towards patient safety. Apart from this, the large organizations providing complex tertiary and quaternary care, can opt for more technologically enhanced solutions to improve patient safety like CPOE i.e. computerised physician order entry for medications, electronic medical records with stringent control on the overriding privileges, bar coding and shute system to deliver medications and lab samples which drastically reduces the turnaround time and collection and dispensing errors.

However, a little caution would be prudent as no matter how good and effective the tools, if they are not used in the way intended, they will fail to provide the safety that they were intended to provide. For example, to prevent prescribing errors in medication, the CPOE was designed wherein the treating physicians orders the medication by directly entering into the system. In many organizations across the globe, I have noticed the CPOE not delivering the desired results as the physician delegates this job to his associate or resident which negates the whole purpose of the tool.

How do we know we are making any progress in patient safety? Is there a way to measure this improvement?

Quality and patient safety is not a destination, but a journey which will go on. We have to move from one level to the next while delivering safe patient care. As Peter Drucker once said "What gets measured, gets managed". Yes, there are ways to measure this improvement. The key steps of measuring improvement will be to define what we want to measure. For example, compliance to a particular process like hand hygiene.

We need to measure accurately where we currently are, this is the most important step as many times reality brings in some self denial. Once we have accurately defined where we are, we need to be practical while setting targets of where we want to be in the defined timeframes. Benchmarking with what our peer hospitals are doing would be a good way to set targets. Benchmarking should begin with hospitals in and around our community, then we can move to hospitals in the region followed by the country and finally internationally.

Do we encourage the reporting of incidents and is there any learning for such reported incidents?

Another good question though the answer is not so simple. Any healthcare organization that wants to evolve and improve should encourage voluntary reporting of incidents. I often hear the phrase "we have a non-punitive culture and we encourage voluntary reporting". Yes there has been a lot that has been achieved towards this but I feel there is still a long way to go in this regard. Every process has two components – firstly the human component which is the tip of the iceberg, and secondly the system component which is the iceberg itself. As the name suggests, the tip most of the times is the only thing visible, and it is easier to name, shame and train the person however we all know the damage is done by the iceberg.

Correcting the person does not guarantee that the same incident will not occur at another place and time with another individual. Recognising that every incident is caused due to system failure will cause a paradigm shift in the way we address the problem as we then address the system issues ensuring the same incident never occurs anywhere in the organization. We don’t need fail safe systems, we need fault Tolerant systems. In such a system, errors are more difficult to commit and more easily detected and corrected. It is up to you to decide which organization learnt from its mistakes - the one that addressed the person or the one that addressed the system.

Steps taken at Wockhardt Hospitals in this direction?

At Wockhardt Hospitals, we don't do things for accreditation; we do it because we believe it is the right way of doing things. Accreditation is the means and not the end. A few of the things that we do include the following; we have indicators defined for safe patient care which are reviewed by me on a monthly basis for performance and course correction, whenever required. The same is reviewed by the MD and top management every 6 months.

Having a group of hospitals ensures we have talent across the group that we leverage in the form of cross Unit Quality audits done every 6 months. I travel extensively to all units and review performance on the ground as sometimes data can be deceptive if not periodically validated. We conduct quarterly awareness activities across the group like patient safety week, medication week, RRT week wherein through different ways of employee engagement we reinforce our policies and practices in the form of quiz contest, mock audits, what’s wrong with the picture, do you know our policy etc. We have a Group Quality conclave annually where all senior leaders across all our hospitals personally present to the top management including the MD, President and myself, all the quality related initiatives including the "hits and misses" of the year gone by.

How do you see 'patient safety' five years from now?

A difficult and easy question. Difficult as in this era of rapidly enhancing technological innovation things are changing at a rapid pace, it is difficult to predict what new technology will come next. Easy because I know going forward customer awareness is only going to increase and with it comes the increased expectation of quality and patient safety which cannot be taken for granted anymore, and with the number of new healthcare facilities coming up the customer has his options. In short, in the next 5 years I see healthcare organizations striving to improve their practices and laying more emphasis on patient safety. There will be more voluntary disclosures of incidents, more focus on improving systems which translates to healthcare across the globe becoming more safer.

appiIMAIDAHealthcare Federation of IndiaAIMENeoCon2015


Feline Four or Five?

The article I chose to review was:

It is published in an open-access online journal here.

A few words on personality profiling in humans

  • Openness to experience
  • Conscientiousness
  • Extroversion
  • Agreeableness
  • Neuroticism
Who wrote the article and why?

Methods used

What did they find? (results)

  • Neuroticism
  • Dominance
  • Impulsiveness
  • Agreeableness
  • Extraversion

Why cat personality?

The main issues we had with this article

    Reflecting on ANZCVS Science Week 2017

    I have already written a blog post about the Australian and New Zealand College of Veterinary Scientists (ANZCVS) Membership exams. The oral examinations (membership & fellowship) are sat by candidates each year on the Gold Coast in Australia. After the exams, there is a conference to complete the veterinary ‘Science Week’. Each chapter within the college has its own stream of presentations. Veterinarians and scientists are invited to attend and present.

    I was fortunate enough to be asked to present to the welfare chapter this year. The theme was ‘One Welfare – key drivers and new technologies’. The One Welfare concept is like that of One Health; interdisciplinary collaboration and solutions are important. #OneWelfare recognises the interconnections between animal and human wellbeing and the environment. Here I will summarise the presentations in the animal welfare chapter.

    My lanyard

    The first two speakers were asked to provide updates after attending conferences. Amy Little from the Australian Government spoke to us about the OIE global conference in Mexico, while Anne Fawcett of Small Animal Talk regaled us with stories of different coloured glitter in the faeces of polar bears in Canada – something she saw while attending the inaugural international One Welfare conference. Anne also emphasised the need to remember the conservation focus of One Welfare. For them to be truly interdisciplinary, ecologists and geographers should be invited to speak at these conferences. She also reminded us of the One Welfare portal and showed us how the Chatterbox tool can be used in teaching: to explore ethical questions.

    My presentation was on the first day within the ‘companion animal’ section. It was based on my PhD project that explores end-of-life decision-making in owners of older and chronically ill cats and their vets. I was excited to present my research and preliminary findings to vets, animal welfare scientists, and others in attendance. Mags Awad (of PetSure, formerly with RSPCA Australia) also gave an excellent presentation on shelter welfare assessment and how it relates to One Welfare. Mags spoke about the ‘No Kill’ shelter movement and what it means for animals. There is the potential for animals to be kept alive when their welfare is compromised (e.g. with severe behavioural/anxiety issues). She spoke about the ‘Drives for Lives’ project, where animals are moved from an area in a state where there is an oversupply of animals to one where more are needed for adoption. Mags reminded us that the shelter environment is novel for many animals and that there is a need to remove fear and anxiety. Improving cat housing in shelters has the greatest impact on their wellbeing.

    In the afternoon, Nat Waran from EIT in the Hawkes Bay told us what One Welfare means to her. If the people in developing countries are not enjoying good welfare, then how can we/they focus on companion animal welfare? She emphasised the need to make animal welfare relevant to people that may not be thinking about it. Becky Murphy from Dogs NZ (formerly The New Zealand Kennel Club) completed the companion animal section by talking about ethical breeding standards. Becky has the difficult task of working as the canine health and welfare officer for an organisation in the spotlight for (un)ethical breeding standards. The 2008 ‘Pedigree Dogs Exposed’ exposé and the 2010 Bateson Report rocked the pedigree dog world by emphasising how selective breeding has changed the shape of breeds: features are exaggerated to the point of threatening health and welfare. The National Animal Welfare Advisory Committee (NAWAC)’s report on animal welfare issues associated with selective breeding has also drawn attention to issues with breeding standards. Unfortunately, brachycephalic dog ownership is still on the rise in New Zealand. And a brachycephalic breed sold online will fetch three to four times as much as a Labrador puppy. But Becky wants us to be clear with our terminology. A ‘pedigree’ dog is one with a three-generation pedigree from the Kennel Club, while ‘purebred’ can mean the same thing, but is often used to refer to ‘backyard’ bred unregistered dogs with no pedigree. The problem is that referring to issues in ‘purebred dogs’, without being specific about which animals we are talking about, results in purebred breeding problems becoming pedigree problems. The blame is then lumped onto organisations such as the Kennel Club who have no control over unregistered breeders. This then results in extreme defensiveness and backlash from these groups who feel like they are being vilified. Becky admits that breed standards need to be updated to discourage extremes and the good news is that the bulldog breed standard is currently being reviewed in New Zealand.

    Virginia Williams, representing MPI, spoke about the regulatory framework for animals in research and how it has been progressed. The definition of ‘manipulation’ has been broadened to include killing an animal for research, testing, and teaching. Genetically modified animals have also been incorporated.

    Day 2 – Production & Food animal species

    Day two began with the pork industry – Kirsty Chidgey from Massey University gave an overview of the New Zealand perspective with a focus on farrowing systems. While gestation stalls have been phased out, crates are still being used for parturition and lactation. Farrowing crates are in the best interests of piglet welfare as they reduce crushing injuries, but are detrimental to the sow’s behavioural wellbeing. Kirsty investigated alternative systems for her doctoral studies and gave us a run-down of the use of pens at different stages of parturition and lactation. Kate Plush from SunPork Solutions summarised the two periods of compromised welfare for sows in farrowing crates: during nest-building and parturition, and in late lactation when no respite from piglets is provided. The dairy industry was next, with presentations from Jess Spatz Shelgren of Fonterra, Suzanne Dowling of AgResearch, and Cameron Clark from The University of Sydney. Andrew Fisher from The University of Melbourne Animal Welfare Science Centre concluded with an overview of welfare assessment toolkits. Paul Hardy-Smith from Panaquatic Health Solutions took us through quality and welfare aspects of how we kill fish. The poultry industry was represented by talks from Kate Hartcher from RSPCA Australia and Kerry Mulqueen who provides technical advice to the NZ poultry industry.

    Day 3 – A busy day of welfare

    Day three was jam-packed with talks ranging from ‘What’s really happening down on the farm?’ by Nita Harding from DairyNZ, to hoarding issues presented by Rosemary Elliott from Sentient. Nita spoke about farm monitoring; why it is necessary, how it is done, what is being found out, and how the information is being used. Kate Blaszak from WAP spoke about advocacy in animal welfare driving change. Virginia Williams spoke again for MPI about the factors underlying animal welfare offending. She gave a candid account of the types of offenders presented to MPI with some case studies. Nat Waran from Napier spoke again about One Welfare and Veterinary Education. There is a reluctance to get rid of old topics in veterinary curricula and replace them with new topics – particularly animal welfare. It takes a passion for subjects to drive them into the curriculum. There is very little integration and applied relevance with animal welfare teaching. She spoke about the difference between welfare and ethics and the need to take the ethical part ‘out of it’. “Welfare is about the subjective experience of the animal, while ethics is about what we think about the animal’s situation based on our own morals/viewpoint”. Jen Jamieson from MPI concluded the talks for the animal welfare chapter with a brilliant discussion of her PhD research. She looked at how human behaviour changes starts with schools – by exploring adolescent views of farm animal welfare. They are the next generation of animal consumers and so their views matter. I highly recommend you check out the YouTube recording of her talk given at the First International Conference on Human Behaviour Change for Animal Welfare here.

    What did I learn from Science Week?

    Too much to mention! I thoroughly enjoyed my time and having the chance to learn from so many interesting people. The awards dinner on the final night was truly inspiring. I enjoyed hearing about peoples’ achievements and everything they were doing in their various fields of veterinary science. The most important take-home is a reconfirmation that animal welfare is what drives me. I am re-invigorated to study for the membership examination next year.

    ***I would like to thank Massey University’s Institute of Veterinary, Animal, and Biomedical Sciences (Postgraduate) for generously sponsoring my attendance at Science Week this year***

    Dr Rebecca Ledger uses the Five Domains Model for forensic animal behaviour analysis

    {this post was co-authored by David Mellor}

    How can we prosecute cases of animal cruelty when there is no physical evidence? Dr Rebecca Ledger told us. She uses the Five Domains Model, developed here in New Zealand, to explain the mental experiences of animals for cruelty prosecutions mounted in Canada.

    The background

    Retained as an expert witness by the British Columbia SPCA, Dr Ledger uses animal behaviour to demonstrate suffering. In a recent visit to New Zealand, jointly hosted by the Animal Welfare Science and Bioethics Centre at Massey University, the SPCA, MPI, NZVA, VCNZ and VPIS, she gave a series of talks of particular relevance to those who may be called upon to be expert witnesses in animal cruelty cases.

    Historically, prosecutions for animal cruelty relied on proving an animal suffered because of physical harm (e.g. injury, disease, malnourishment). But Dr Ledger has been able to demonstrate emotional suffering using behavioural evidence. She emphasised that welfare assessment using behaviour is not ‘fluffy science’ just because there is no physical evidence. However, there is a need to educate prosecutors and courts about the ways supportable inferences can be made about the emotional experiences of animals. This helps the legal system see cruelty cases through the same ‘lens’ as animal welfare and behaviour experts.

    Dr Ledger explained how she writes her Expert Opinions and then described some case studies. Her Opinions begin with a brief summary of how scientific understanding of animal behaviour has developed and now allows the experiences animals can have to be cautiously inferred. Scientific references supporting these inferences are particularly important for this section. She also references the Five Domains Model for animal welfare assessment [1] and then goes on to use the Model to retrospectively assess the welfare of the animal(s) in question.

    How is it done

    Dr Ledger outlined eight questions we should ask and then answer for the courts. First, whether the animal can suffer i.e. is it sentient? This is where Rebecca shows judges that animals have the ability to suffer both physically and mentally. She has had better results when her Opinions started with these details. Here, the New Zealand Animal Welfare Amendment Act (No. 2) 2015, which recognises animals as sentient, should be immensely beneficial.

    Question two asks if New Zealand legislation recognises suffering in animals – clearly it does. The definitions of ‘suffering’ all include mental states or experiences. The third and fourth questions ask if conditions are present that would cause the animal to suffer and which negative experiences (affective states) the animal would likely have. By using the Five Domains Model, she shows that her Opinion is science-based and this enhances the judges’ confidence in what is being concluded. The Model also encourages judges to think about the psychological impacts of specific impositions on the animal.

    Questions five and six are to provide insight into the animal’s experiences at the time of the mistreatment. By focusing on the physical and/or behavioural evidence of suffering and how severe and/or protracted the suffering is, these questions help the court appreciate the importance of behavioural evidence. Emphasised here is that behaviours and their associated mental experiences have a function (e.g. fear enables an animal to respond to a perceived threat; aggression creates distance from what it is afraid of).

    The seventh question asks if the suffering was necessary – could it have been avoided? For example, dog trainer claims that shock collars are the only way for dogs to learn. An expert witness here would need to be prepared with humane alternatives as examples. The final question focuses on intent – was the suffering inflicted wilfully?

    An important caveat

    Dr Ledger made it clear that there is a need to ‘choose our battles’. Losing a case may set a precedent that condones the cruelty that has occurred. Rebecca recommends starting with ‘easy wins’ and gradually moving forward from there. She purposely chose dogs because, as companion animals, they are often better understood and more people are sympathetic towards them.

    1. Mellor, D.J. and N.J. Beausoleil, Extending the ‘Five Domains’ model for animal welfare assessment to incorporate positive welfare states. Animal Welfare, 2015. 24(3): p. 241-253.

    Positive affective engagement: the link between animal welfare science and training for rewards

    What better way to celebrate my tenth blog post (it’s still early days for Kat Welfare Matters!) than by taking part in a blog party organised by the wonderful Zazie of Companion Animal Psychology?

    The blog party theme is something I wholeheartedly support: ‘training for rewards’. Reward-based training, or positive reinforcement as it is also known, is a form of ‘operant conditioning’[1]. This is just a fancy way of saying it is a training method that involves an animal learning to do something because of the consequences its behaviour has. When animals behave in a certain way they are ‘operating on’ their environment. The positive or negative consequences of that behaviour affects the frequency with which the animal will perform that behaviour in the future. In other words, if the animal does something (e.g. the cat sits) and the consequence of this is positive (e.g. a yummy treat that the cat loves) it results in them doing that more in the future. We can add commands as well, but the basic idea is that the animal does something and we provide the ‘consequence’ of their behaviour.

    There is a lot of great evidence for the benefits of reward-based training. I strongly suggest you check out the list of reasons to go positive at Companion Animal Psychology. It makes sense that rewarding animals for a behaviour is more likely to result in better trained animals than punishing them. The escape/avoidance approach to training that was developed in the 1940s relies on negative reinforcement and punishment; animals escape the aversive consequence by changing behaviour. In contrast, positive reinforcement is a ‘modern’ approach to learning and training, as it provides specific information to the animal about the exact behaviour that is required. In doing so, it enhances the human-animal bond.

    Linking reward-based training and animal welfare science using the concept of positive affective engagement

    Training for rewards emphasises the idea of giving an animal something they find rewarding or enjoyable. These rewards may be different for different animals, but should result in the animal experiencing positives emotions. This links directly with the concept of positive experiences, or affects, that is being increasingly emphasised in animal welfare science.

    While animal welfare scientists used to concentrate their efforts on the negative experiences of animals, we are looking more and more at the potential for positive experiences. Back when animal welfare science began, people were worried about how badly animals were being treated and their potential negative experiences – especially animals confined in intensive production systems. But now that we have learnt more about how to keep animals and what they might need to minimise their negative experiences, we are able to look at providing them with opportunities for positive experiences e.g. play and/or exploration. Ensuring animals are receiving good nutrition (food and water), that their environment is suitable, and that they are healthy typically only moves them from negative/poor welfare towards neutral. None of these ‘survival-related’ provisions [2] are enough to result in overall positive welfare. However, when we start to look at how animals are behaving and provide them with opportunities to behave in ways they find rewarding, we can start to move them towards an overall positive welfare state.

    Rewarding animals for a behaviour that we want them to do and that they enjoy could result in heightened states of positive welfare. Hence asking a dog to ‘sit’ becomes ‘playing sit’; the dog starts to associate the command and their response with a positive reward (e.g. food and/or your happy voice). We know that play is a positive experience for most animals, so why would we not want to make training positive for them?

    ‘Positive affective engagement’ is the experience animals may have when they respond to motivations to engage in rewarding behaviours. The concept includes all experiences that are positive [3]. In reward-based training, the concept could include the state of engagement that results from an animal’s goal-directed, energised performance of a learned task that it enjoys. The enjoyment may result from the task itself and/or be due to the associated reward. A 2015 review by Mellor [4] emphasises the scientific support (via ‘affective neuroscience’) for the existence of positive experiences and their assessment using behaviours we observe in animals. In other words, training for rewards is not only a very effective training method, but there is good evidence to suggest that it could improve the lives (or welfare) of our animals.

    My Jäger cat sits for a food treat

    1. Stafford, K., ed. The welfare of dogs. Animal Welfare, ed. C. Phillips. Vol. 4. 2006, Springer: Dordrecht, The Netherlands.
    4. Mellor, D.J., Positive animal welfare states and encouraging environment-focused and animal-to-animal interactive behaviours. New Zealand Veterinary Journal, 2015. 63(1): p. 9-16.

    Exploring end-of-life management of old and chronically ill cats

    My second study towards my PhD is well under way. The recruitment phase started on social media (Facebook and Twitter) with a call for cat owners to participate. Interested cat owners who have put down their cat in the last 6 months are redirected to an online survey which takes them through a few quick questions. These are to help us interview the right people.

    We want to make sure we are interviewing cat owners who recently euthanased their pet. If it was too long ago then the vet involved may not remember enough details for their (separate) interview. The cat owners, and their vet, must also be in New Zealand. The interviews are done in person so I need to be able to visit them. We are also asking owners to tell us why the cat was put down. If it was due to a disease that lasted a long time, or because the cat was older, then we might get more information about tricky decisions that were made. On the other hand, a cat that was put down because it was involved in an accident would probably provide much less information. The owners also need to give us permission to contact their vet for interview and leave us enough information to contact them.

    We have also had a write-up about the study in VetScript – the magazine for The New Zealand Veterinary Association (NZVA). An email has also gone out to all NZVA members. Massey University has got on board with an article on their website and the study has been shared through their social media channels. These various initiatives are helping get the word out about the importance of the study and how to participate.

    Why am I doing the study?

    The research seeks to uncover how the owners of older cats or cats with chronic disease perceive the role their vets have played in the euthanasia process, before comparing this to the vet’s own understanding of their involvement. We are also looking at the decision-making process and how cat owners, and their vets, are making euthanasia decisions. This improved understanding of what drives owner behaviour would safeguard older cat welfare and further inform vets of their role in end-of-life management.

    How can you get involved?

    If you are a cat owner who meets our criteria, or you know someone that might, please take the time to visit our online recruitment page and answer a few questions. This should only take 5-10 minutes of your time.

    If you are a veterinarian and you think you might have a client that would be happy to chat to me then please direct them to our online recruitment page.

    If anyone has questions about the study they can get in touch with me at: K.Littlewood@massey.ac.nz

    Reflecting on the March for Science 2017 and when Science goes wrong

    Blog post 8 image

    • The meetings are fortnightly

    The New Zealand National Cat Management Strategy Draft

    Blog post 7 image

    Edit (30th April 2017):

    I recommend those that fit over the cat’s current (quick release or breakaway) collar and are open at one end – so that both collars release if the cat gets caught. An example of them can be found here: https://www.birdsbesafe.com/ and can be made yourself with instructions found here:


How to Avoid Common Overuse Injuries

Tenosynovitis: With tenosynovitis, the tendon is not inflamed but rather the surrounding lining, known as the tendon sheath. As the tendons slide through this inflamed lining during movement, it causes inflammation of the sheath surrounding a tendon. It can be accompanied by a grinding sensation on the tendon when joint movement is occurring. If the tendon sheath becomes inflamed, the tendon inside will rub against the irritated sheath causing pain and discomfort. Each one of these is accompanied by pain but can be treated differently. Ice and rest will help alleviate pain and inflammation but may not solve the problem. Rest alone may not solve the problem, but combined with light resistive exercises the tendons will adapt and repair themselves.

Examples of light resistive exercises are leg extensions performed with very light weight; double leg squats with little to no extra weight; aqua aerobics or deep water aqua jogging with a flotation belt; and riding a bicycle or stationary bike. These exercises should be performed three times per week and used in conjunction with anti-inflammatory treatments. If the problems persist you should seek treatment from a qualified medical professional.

The most common non-tendon related overuse injury is known as shin splints. This is a catch-all term used by athletes when describing any pain in the front of the lower leg. Technically called medial tibial stress syndrome, or MTSS, it is caused by micro-traumas along the medial or inner border of the tibia (large shin bone). MTSS is usually associated with general pain and discomfort along the shin and can be treated with ice and rest. Most MTSS can be avoided with the use of proper footwear.

Athletic shoes should be supportive and should fit perfectly on the date of purchase and not require a break in period. If the shoes require a break in period, they are not the right shoes. Most running specific stores can do a foot analysis and determine the right training shoes for you. If the shin pain becomes more localized or specific to one area, you should seek advice from a qualified medical professional, because MTSS can develop into stress fractures if left untreated.

Most overuse injuries can be prevented by taking certain precautions. A proper amount of recovery time is crucial when training for any sport. By allowing your body to naturally recover and heal injuries caused by chronic use can be avoided.

There are many misconceptions about what proper recovery is. Many athletes think that a light workout helps them recover from the more intense training days. This can be true over short periods of time. For example, a light workout once a week can cause the body to feel rested, but if this is persistent over the course of a few months, your body will continue to break down and overuse injuries can still occur.

A more useful form of recovery is to take one day off per week. This is a day when there is no workout performed. During this day off, the body has time to adapt to the training program that is being performed. By allowing the body one day of recovery, you are allowing damaged muscles and tendons to begin repairing themselves without further damage.

The right amount of sleep can also help you to avoid overuse injuries since the body repairs itself during sleep. Hormones are released in larger quantities during sleep which allow natural healing to occur. Periods of prolonged rest during the training season can also allow the body to heal and adapt to the training. Taking a week to have multiple days off and to train at a very light intensity can let your body fully recover and also prepare it for more intense training in the future. Rest and recovery is the key to avoiding overuse injuries.

If you are experiencing problems caused by chronic exercise, you should seek advice from a qualified medical professional such as an orthopedist, podiatrist, physical therapist, or a certified athletic trainer. They can help you get over your injury and keep you pain-free.

Athletic trainers are health care professionals who collaborate with physicians to optimize activity and participation of patients and clients. Athletic training encompasses the prevention, diagnosis, and intervention of emergency, acute, and chronic medical conditions involving impairment, functional limitations and disabilities. The California Athletic Trainers Association represents and supports members of the athletic training profession through communication and education.

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Francisco Toledo, ‘Pescado y caballo’, 1974, MLA Gallery

This is a two sided drawing. The other side has a serpent like image. The front side is signed by Toledo. This lovely drawing was acquired directly from the artist's studio, in 1974, and has outstanding provenance.

We guarantee the authenticity. This work is beautifully framed, with a lovely moulding, silk matting, and hardwood filets. All archival material. Please inquire, and we would be happy to send you an image of the other side of the drawing.

Francisco Toledo is widely regarded as the most important, elusive and controversial artist working in Mexico today. His art draws on human, animal and mineral life and explores both indigenous,
Zapotec, and worldwide cultures. He freely associates direct observations from nature with metaphors from literature and art. The work of Blake, Goya, and the writings of Kafka and Borges have been especially influential.

A protege of Rufino Tamayo, Toledo traveled and lived in Europe, where he worked briefly with William Stanley Hayter, in Atelier 17. He is a printmaker, painter and sculptor. Toledo is a great patron of the arts in Oaxaca, his native state, where he, as the driving force behind Oaxaca's cultural renaissance, has founded museums and art centers. Toledo is passionately engaged with the history and religion of the indigenous Mexican peoples. His work deals with themes of creation, potency, sensuality and metamorphosis, and is often located in the worlds of the spirit where animals and humans freely comingle.
Toledo arrived in Paris aged 19, and was showing in leading galleries throughout Europe and New York within 5 years. Despite his success he returned to Mexico in 1965, with a deep interest in recovering elements of his native Zapotec ethnicity and the cultural mixes particular to the Isthmus region. He has since explored both indigenous and worldwide cultures in his work, freely associating direct observations from nature with metaphors from literature and art. References to Blake, Goya, Ensor, Dürer, Kice, Miró, and writers like Kafka and Borges, become entwined with imagery from popular Indian fables and the political history of Mexico to create strange, harrowing visions like a woman overwhelmed by predatory fish and a human skeleton trapped within a grasshopper. More recently he has concentrated on self-portraits, close anatomical studies of small creatures and clay reliefs that erode in the rain.
Since the eighties Toledo has led a parallel life, actively engaged in social projects, running a publishing house and transforming colonial buildings in Oaxaca into cultural centres. They now house remarkable collections of graphics and photographs, as well as spaces for exhibitions and films and a library for the blind, used by locals and visitors. His original artistic vision, zealous insistence on the holistic role of artists in society and radical cultural interventions have been admired and emulated by younger artists and curators such as Gabriel Orozco, Francis Alÿs, Cuauhtémoc Medina and Olivier Debroise.

Signature: signed lower right.

MLA Gallery, Los Angeles, CA>

Our collector acquired this work directly from Toledo's studio in the mid 1970's.

About Francisco Toledo

Mexican, b. 1940, Minatitlan, Oaxaca, Mexico


NUMEROLOGY:  LOVE, ROMANCE AND RELATIONSHIPSMost of the people would have heard about the numerology, it is all about numbers. In numerology the number is your birth date or the sum of your birth date from 1 to 9.  All these numbers tells about the characteristics of a person.  Every number introduces the different quality of a person according to his number.  Numerology helps us to know about the nature of a person of his/her preference when we talk about love or romance. The nature of a people differs from each other some are sensitive or some are of jolly nature or some of the people serious about their life.

You can know about your numerology number as below:

If you are born on 1st, 10th, 19th, and 28th then the number is 1.

If you are born on 2nd, 11th, 20th and 29th then the number is 2

If you are born on 3rd, 12th, 21st and 30th then the number is 3

If you are born on 4th, 13th, 22nd and 31st then the number is 4

If you are born on 5th, 14th and 23rd then the number is 5

If you are born on 6th, 15th and 24th then the number is 6

If you are born on 7th, 16th and 25th then the number is 7

If you are born on 8th, 17th, and 26th then the number is 8

If you are born on 9th, 18th and 27 then the number is 9

We can talk about the nature of a person by the numeric digit 1 to 9 in respect to their love life.  Let us know about the nature of 1 to 9.

Number 1 :  The people associated with number 1 are born leaders and always they love to lead. They want to rule their partners and think what they said is the last word. If these people don’t want to do something then it is impossible to force them to do. These people are practical and emotional and they love beauty.

Number 2: The people rule over by the number 2 is sensitive and moody. They give less important to physical relationships than emotional. These people have mood swings so it is necessary for the partners to have stable mind. Number 2 people are more imaginative. If we talk about love, romance or marriage they follow their heart. If they attached someone it is very difficult for them to live without the person.

Number 3 : Opposite to number 2 the people of number 3 don’t follow their heart when deciding about the partners. These people are ambitious and they made their own laws. Number 3 people give much importance to their career only and always try to show superiority everywhere.

Number 4 :  Number 4 people are not romantic but they have relationships outside the marriage. These people are short tempered and because of this they can go for divorce. Most of the cases they keep relationships outside marriage but the same time they remain loyal to their partner. It is advised to number 4 people to be careful while marrying as the most of the people don’t find perfect match when we talk about marriage.

Number 5 :  People of number 5 keep several relations before marriage. They are flexible and they experiment a lot as they love to do it. As they are impetuous and they should have stable partner. For number 5 the match will be good with the number 8. They are practical while taking decision about relation and marriage.

Number 6 : The peopled ruled by number 6 are very emotional. They are polite and attractive when we talk about love and peace. Due to their manipulative nature they may have relationships with many women. On the other side they are emotionally attached with the partner.

Number 7 : Number 7 people talk less because they are imaginary. They are dreamy and always think about their life like what they want to be in life.    It is very important for them to connect emotionally with the partners. These people make big issue over small things as they over scrutinize(over analyzed) the issue.

Number 8 : The people of number 8 follow their heart when it comes to love and relation. They are more loyal than others. These people are emotional but they are strong too. They don’t get attracted to someone easily but once they attached them believe on their partner too much.

Number 9 :  The number 9 people have violent behavior and they have powerful also. They gave more importance to sexual relationships as they are than any other number demanding when it comes to sex.

Numerology plays an important role in our love life and also help us to find perfect match for leading a happy life. So don’t forget to know about your love compatibility before getting married.

( Kanchan Rastogi )

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Fri, January 19, 2018

Hyryder strives musically to create an authentic Grateful Dead experience, paying close attention to detail. The band routinely performs "monster" 3 set shows, weaving in and out from one song to the next. While paying tribute to the original compositions, Hyryder indeed craft's their own unique take on the music focusing on extended improvisational jamming. The band prides itself on its ever changing progressive jams and set lists that are unique to each particular show. Hyryder performs multiple night runs without ever repeating any material giving fans an intimately different experience each time they take the stage.
Venue Information:
Lafayette Theater
600 Main Street
Lafayette, IN, 47901


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A dolmen—also known as a portal tomb, portal grave, cromlech (Welsh), anta (Portuguese), Hünengrab/Hünenbett (German), Adamra (Abkhazian), Ispun (Circassian), Hunebed (Dutch), dös (Swedish), goindol (Korean) or quoit—is a type of single-chamber megalithic tomb, usually consisting of three or more upright stones supporting a large flat horizontal capstone (table). Most date from the early Neolithic period (4000 to 3000 BCE). Dolmens were usually covered with earth or smaller stones to form a barrow, though in many cases that covering has weathered away, leaving only the stone "skeleton" of the burial mound intact.

"Dolmen" originates from the expression taol maen, which means "stone table" in Breton, and was first used archaeologically in Théophile Corret de la Tour d'Auvergne's Origines gauloises.[1] The etymology of the German Hünenbett or Hünengrab and Dutch Hunebed all evoke the image of giants building the structures. Of other Celtic languages, "cromlech" derives from Welsh and "quoit" is commonly used in Cornwall. Anta is the term used in Portugal, and dös or dyss in Sweden.

Dolmen sites

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It takes a village to combat errors and omissions that cause millions of deaths and sickness in our nation’s hospitals and care facilities. That’s the message that sets apart Your Patient Safety Survival Guide (Rowman & Littlefied Publishers, August 2017).

How Hospital Care Harms Patients

One out of every three hospital patients in the United States are harmed by the care they receive. Each year, over 400,000 die as a result. Most of these deaths are due to human and system errors—not faulty medical decisions or diagnoses—and they could be cut in half through the use of simple and nearly cost-free safety behaviors.

Your Patient Safety Survival Guide delivers a patient-centered blueprint on how to transform the patient safety movement so that millions of unnecessary illnesses and deaths in hospitals, outpatient facilities, and nursing homes can be avoided. It provides key safety habits that people must learn to recognize so they can be sure hospital personnel use them during every patient encounter. It also explains how addressing the most common safety problems will set the stage for tackling a wide range of issues, including healthcare’s role in the overuse of opiate painkillers and its related heroin epidemic.

Fortune 500 Countries Helped Launch the Patient Safety Movement

To understand why employers must help solve this problem, consider how the patient safety movement started. In1999, the Institute of Medicine released a report, aptly called To Err is Human. The report represented the first time the field of medicine disclosed to the public the extent to which hospital patients are needlessly harmed by the care they receive. It’s findings shocked people inside and outside the healthcare industry.

Leaders of Fortune 500 companies and other large public and private purchasers of healthcare benefits weighed in on the report. They were distraught over paying for healthcare coverage for their employees when such coverage might actually lead to harm. Concerned that they had no way to determine which hospitals were more likely to be associated with bad outcomes for their employees and high costs to their businesses, the following year they coalesced to form what is known as The Leapfrog Group.

Increasing Transparency for Informed Choice

Leapfrog is a powerful consumer-oriented consortium of business leaders with a mission to trigger giant leaps forward in healthcare safety. Leapfrog continually presses the envelope with respect to hospital transparency and public reporting of safety and quality metrics, making it easier for businesses and individuals to be more informed when choosing their healthcare providers.

As summed up by Leapfrog’s President and CEO, Leah Binder, who has been repeatedly named as one of the 50 most influential people in healthcare, “I run an organization…with a membership of highly impatient business leaders fed up with problems of injuries, accidents, and errors in hospitals.”

Leapfrog issues letter grades rating hospitals on how safety they are for patients, an A, B, C, D, or F on how well they protect patients from errors, injuries, and infections. Although hospitals have earnestly sought to reduce medical errors, there has been no widespread evidence of improvement.

More Regulation is Not the Answer

In 2013, the president and vice president of The Joint Commission declared that performance of American hospitals was predictably unreliable and unsafe and that no amount of regulation could make them safe. It’s an extraordinary day when leaders of the most significant healthcare regulatory agency assert that more regulation will not solve the problem at hand.

Doing Less to Achieve More

Your Patient Safety Survival Guide calls for a paradigm shift that centers on engaging patients for the purpose of collaborating with healthcare providers to eliminate a small but powerful subset of patient safety’s most frequently recurring problems—a decidedly narrow focus that simultaneously engages those who receive and deliver healthcare.

Three issues that make sense to immediately tackle through public engagement are hospital-acquired infections, procedural mix-ups (also called wrong site surgeries or off-the-mark procedures involving the wrong patient, wrong body part, wrong spot on a body part, or wrong procedure), and medication administration errors. Together, these three categories of harm represent the most prevalent, predictable, and preventable medical mistakes—a trifecta of sorts.

If it seems hard to believe that tackling just three problems alone could dramatically downshift the magnitude of the crisis, consider the fact that each year 100,000 people die from infections that they pick up as a result of their hospital care. That is a sizable portion of all preventable instances of hospital-induced harm. Medication errors are another leading cause of preventable death in hospitals, with a third of all such errors occurring during the bedside administration of drugs. As a category, procedural mix-ups don’t occur nearly as often as medication errors or hospital-acquired infections; however, every off-the-mark procedure signals, like a bellwether, that something may be seriously wrong with the facility's care delivery system.

Its About Behavior, Not Medicine

Moreover, these categories of harm can be avoided with simple, quick, and essentially cost-free behaviors that are performed during almost every patient encounter and in eyeshot of patients. They are essential and visible routines; however, for a myriad of reasons, providers don’t employ them or don’t do so consistently. If the public were to realize the use of these habits could mean the difference between life and death, who wouldn’t make sure they were used?

According to a recent Forbes article, a top workplace trend is more creative use of wellness programs to save on healthcare costs. With medical errors costing between employers and employees between $32 and $52 billion annually, businesses would be wise to advise employees that they can help combat common medical errors.

Praise for a Long Overdue Resource for Patients and Professionals

Binder described Your Patient Safety Survival Guide as “an accessible and definitive overview of the key issues in hospital safety, including what families, hospitals, clinicians, and communities can do to protect patients.” The book “provides a useful action plan, including concrete steps and actual scripts patients and families can use to become more effective advocates for their own safety,” according to Dr. Albert Wu Director of the Center for Health Service Outcomes at Johns Hopkins Bloomberg School of Public Health.

Susan Dentzer, President and CEO of the Network for Excellence in Health Innovation and former editor of Health Affairs says, “Anyone who anticipates undergoing health care, or who cares for loved ones who do, should read this book.”

Once American employees know how to better protect themselves and others from medical errors, we will be able to cut medical errors by 50 percent over a five year period—a national goal that was set in 2000 and that we’ve never come close to achieving.

Business Case and Blueprint for Engaging Employees

Your Patient Safety Survival Guide clearly outlines the business case and blueprint for engaging the public in hospital efforts to improve patient safety. “Someday all hospitals will earn an A, and our families will not have to endure unnecessary suffering…This book will guide us there, and help us to persevere,” according to Binder. American employers may be key to helping this happen.

Kohn, LT, JM Corrigan, and MS Donaldson (1999). "To Err Is Human: Building a Safer Health System." Washington, D.C.: Institute of Medicine.

Watson, GL (2016). "The Hospital Safety Crisis: Unifying Efforts of Healthcare Systems, Public Health, and Society." Society 53, no. 4: 1-7.

Watson, Gretchen LeFever (2017). Your Patient Safety Survival Guide: How to Protect Yourself and Others from Medical Errors. Lantham, MD: Rowman & Littlefied.

You are reading

Extraordinary People

Propaganda that Masqueraded as Pharmaceutical Marketing

Those who benefited from the opioid epidemic must fund efforts to stop it.

New Strategy and Overdue Resource to Combat Medical Errors

Now let's get business leaders to share the message with their employees.

Don't Let Safety Advice Fall on Deaf Ears

Make it easier for people to do the right thing.


Bonus Coins

Available on April 5th

Four Most Important Things That Fans Want To Be Fixed In FIFA 18

2017-06-24 05:32

We collected the most important things that fans want to fix in the FIFA 18. Let’s see the details below:

Goal line technology and Keepers Mechanics

Even though they jump within the right direction, the keepers occasionally don't conserve the ball in fines.
During the time that gameplay was available, additionally, they get confused once they capture or must strike a ball. The Goal line technology can also be extremely inconsistent.

Long-Shots – from 45 yards

These usually discover the back of the web far. The main reason is because of the goalkeeper AI could not be hurt which also means they invest too frequently before trying a plunge standing. Therefore, the error  will also become true while more and more people participate in.

Player animations

Whenever there is a participant fouled, the cartoon requires a long time. The efficient way is to take them out from the game for an apparent time. This must be reduced.

Defensive AI

It is too proficient at protecting in the CPU AI. Therefore, it will be more efficient to place the control and allow it to do the work.

This must be toned-down, therefore it doesn’t mean you’re attempting to defeat the computer same like the human opponent. A feature fan wants to delete the auto blocking and auto tackles too.

The customer has bought: FIFA 18 Coins
The customer has bought: FIFA 18 Coins
The customer has bought: FIFA 18 Coins
The customer has bought: FIFA 18 Coins
The customer has bought: FIFA 18 Coins

FIFA 18 Packs

Play Station4

FIFA 18 Packs

Xbox One

FIFA 18 Packs


Air Power

Air units are of two types: combat and recon. Recon units are flagged with the word RECON when they are listed in the Air Mission Dialog. All other air units are combat units.

Air Strikes

To perform an air strike against an enemy position, click on the enemy location to make it the current Hot Spot hex and then click on the Air Mission button in the Toolbar. This will display the Air Mission Dialog so that the air unit can be selected. Select any non-RECON air unit in the list. The target hex must be Spotted and contain enemy units and the current visibility must exceed 1 hex. (In Dawn or Dusk turns where the nominal visibility is 2, but the effective visibility is 1, air missions are still possible.)

All enemy units capable of firing Anti-Aircraft fire on the target hex will automatically do so. The distance from the firing unit to the target hex must be within the AA range for that unit, but there are no Line-of-Sight limitations. Range effects are applied to the fire with fire at range 0 being normal, fire at range 1 being 1/3, and in general, fire at range R being 1 / (2 * R + 1). Units which are Disrupted, have Low Ammo, or are in Travel Mode fire AA at half value. Standard Combat Results are applied to the air unit.

Anti-aircraft units consist of regular AA units and Heavy AA units. High flying air units such as Recon and Heavy Bomber air units are only affected by fire from Heavy AA units.

The target unit in the hex is determined using an internal algorithm. Depending on the type of target unit, either the Hard or Soft attack value of the air unit is used for the strike. The attack value of the air unit is doubled and then standard Combat Results are applied to the target unit. If the target hex is Village, Town, City, or Industrial, then it is possible for the air strike to create Rubble in the target hex (based on Parameter Data).

Carpet Bombing

Air strikes from Heavy Bomber air units affect all units in the target hex and no target unit selection occurs in this case. Such bombing is considered to be "Carpet Bombing" and has an increased effect on causing Disruption in the target hex. Such air units are flagged with the word CARPET in the Air Mission Dialog . Carpet Bombing does not require that the target hex be spotted by a friendly unit. When a Carpet Bombing air strike is called, the program will randomly scatter the designated target hex up to 2 hexes away. This may result in the air strike hitting friendly units. Also note that Heavy Bombers are often designated as Single Use units and when this is the case, they will only be available for a single mission.

Air Unit Availability

After being used in an air strike, air units must become available before they can be used in another air strike. The time required for an air unit to become available is variable and depends on Parameter Data. In addition, if the AA fire associated with the air strike caused the air unit to become Disrupted or Broken, then this represents partial damage to the air unit associated with the strike and this must be recovered from before the air unit becomes available again. Normal Fatigue accumulation and recovery effects apply to air units and although these do not affect the availability of the air unit, they do affect the effectiveness of the air strike.

Example: with an Air Availability value of 20%, an air unit that has carried out a mission will have a 20% chance of being available on the next turn. If it were to fail the availability check, it remains unavailable and rechecks for availablity at the start of each turn until it returns to available status. With a 20% Air Availability value you might expect an air unit to be available on average for 2 air missions per day (assuming 1 day = 10 turns), not counting other combat effects like Disruption and Broken.

The availability of an air unit can also be affected by specific changes to availability as part of the scenario. The Units Menu in the Main Program and Scenario Editor display the changes in air availability that have been defined and allow these changes to be edited.

Low Visibility Air Effects

This is an Optional Rule that causes conditions of low visibility to result in reductions in air unit availability. The exact reductions are determined by parameter data. See the Parameter Data Dialog to determine the exact values that apply to a given scenario.

Air Recon

To perform an Air Recon mission, select the target hex for the mission, invoke the Air Mission command, and select a RECON air unit from the list of available air units. Note: the target hex can be any hex on the map. Since Air Recon missions are considered to take place at a higher altitude than an Air Strike, Air Recon units are only vulnerable to AA fire from Heavy AA units.

The recon mission will then randomly provide spotting information on enemy units within the current Visibility range of the target hex. There are two types of spotting results: the enemy unit may be spotted in detail, or it may simply be spotted as an Unknown unit. An Unknown unit is marked with question mark graphics. An Unknown unit may be targeted for Indirect Fire and Air Strikes, but the combat results will not be known.

The probability that an enemy unit within the visibility range of the Recon Mission target hex will be spotted is based on several factors.

  • Range: The Range from Mission Target Hex to location of enemy unit being checked for spotting is based on formula 1 / (R + 1) where R = the range from the Mission target hex to the enemy unit.
  • Terrain: Any terrain modifier associated with the hex modifies the Spotting probability. That is, when the terrain modifier is M%, then the spotting probability is multiplied by (100% + M).
  • Strength: the probability depends on the strength S of the air unit as defined in the formula S / (S + 5) where S = number of Aircraft.
  • Unit Status: If the air unit is Disrupted, the probability is 1/2 and if the air unit is Broken, the probability is 0.
  • Given the combined probability, there is a half chance that the enemy hex will be spotted in detail and a half chance that the enemy hex will spotted as Unknown.

In addition, the following modifier is applied to the spotting probability based on the Quality of the air unit.

  • Quality A units have a modifier of 150%.
  • Quality B units have a modifier of 125%.
  • Quality D units have a modifier of 80%.
  • Quality E units have a modifier of 60%.
  • Quality F units have a modifier of 40%.

Air Interdiction

As units move on the map in Travel or Rail Mode, there is a chance that their movement will be Interdicted by enemy air units. This probability is based on Parameter data per side. The probability is based on the total number of units in Travel or Rail Mode in the hex being moved into. The probability is modified by any terrain modifier of the hex being moved into. The probability is half during Dawn and Dusk turns. If Interdiction occurs, then an Air Strike occurs against a unit in the target hex using an air unit that is representative of the type of air unit available to the enemy side. However, this air strike does not count against the air units available by the enemy. Note in addition, that movement by units in Deployed Mode into hexes occupied by units in Travel or Rail Mode can also trigger an interdiction attack against the units in Travel or Rail Mode.

The probability that an Air Interdiction attack will Disrupt the unit being attacked is double that of a normal attack and in addition, there is the chance that the unit being attacked can lose some of its movement points up to a maximum of half its movement allowance.

Air Interception

Each side in a scenario has an Air Interception probability determined by the Parameter Data for that scenario. This Air Interception value determines the probability that an air mission against that side will be Intercepted. An Intercepted air mission results in no affect against the targeted side, but does require that the air units involved go through the process of becoming Available before being used for another air mission. Both combat and air recon missions are subject to Interception. If the Air Interception probability for a given side is 0 in a scenario, then no air missions against that side will be Intercepted.

It is possible for air units to be classified as Jet Aircraft in the Order of Battle file. The probability of Air Interception against air missions of Jet Aircraft air units is half that of the normal air interception probability in the Panzer Campaigns games.

Air Ownership

Depending on the structure of the Order-of-Battle file for a particular scenario, certain air units may be classified as being owned by a particular ground organization. When this occurs, air combat missions by those units can only be performed against hexes that are spotted by the owning organization. The units doing the spotting cannot be Broken. If only Detached units are available for spotting, the air strike is at half value. The Air Mission Dialog displays the ownership of air units.

Air Strike Hex Limitation

If the Air Strike Hex Limit Parameter Data value is nonzero, then the number of air strikes that are allowed in any one hex per player turn is limited. Once the total number of airplanes committed to an air strike in a given hex reaches the Air Strike Hex Limit value, then no further air strikes are possible in that hex in the same player turn.

The Air Strike Hex Limitation restriction does not apply to Carpet Bombing or Air Recon.