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Health Economics and Health Services Research
Research fields include economic evaluation of health care interventions as well as health services research, with a focus on care for the mentally ill and older populations. Currently, methods are developed and tested to measure preference-based valuations of health-related quality of life and costs in different diagnosis groups. In addition, cost-of-illness studies are carried out and disease models are developed as a basis for decision-analytic evaluation studies. Furthermore, cost-effectiveness analyses of new preventive, diagnostic and therapeutic health technologies for patients from different disease groups are conducted and new forms of funding for mental health care are evaluated. Moreover, one research focus is on the field of health care epidemiology. This research area is located at the interface of health services research, health economics and epidemiology. Interdisciplinary questions of health services research are investigated empirically, also with a focus on health services research in old age and mental illness, and mainly based on data from cohort studies.
Professorship for Interdisciplinary Health Care Epidemiology
Research Projects Related to Older Age and Long-Term Care
Entwicklung und Testung eines interprofessionellen patientenzentrierten Versorgungskonzeptes für zuhause lebende Patient*innen (Interprof HOME)
Sponsor: Innovationsfonds
Responsibility: Project group study data II
Interaction of Systemic Morbidity and Oral Health in Ambulatory Patients in Need of Home Care (InSeMaP)
For old and very old people in the need of long-term home care, it is increasingly challenging to handle daily oral care and to attend routine appointments at the dentist. As frailty increases, these problems intensify. Without adequate oral care and regular control checkups, oral health deteriorates which in turn can negatively affect those systemic diseases that caused the care dependency.
However, the consequences of a discontinuation of professional dental care for oral and general health are often unknown. Moreover, there is no mandatory correspondence between general practitioners, dentists, nurses, and relatives or patients. The InSEMaP projects tries to shed light on this precarious situation of people in the need of home care and aims to improve their dental health.Factors that are associated with the dental care of ambulatory patients will be identified and corresponding health care processes will be described. An analysis of routinely collected health insurance claims data will be used to investigate associations between the need for long-term care, dental care, morbidity, and health care costs. Furthermore, examination by a dentist and radiologicdiagnostic will reveal any undiscovered oral health issues of ambulatory long-term care patients. The knowledge drawn from these results will be used to create a new health care plan for this population in which all stakeholders of the health care process are considered.
The project is funded for three years with 1.363 Million EURO in total. If the novel health care approach is successful, it could be continued to consequently achieve an improved oral health care of persons in need of ambulatory care. Due to a mutual association of oral and systemic health, this could lead to an overall increase of health and life quality of ambulatory long-term care patient
Sponser: Innovationsfonds
Responsibility: Project group study data III (Study coordination); Project group routine data I
Prevention for more participation in old age (PromeTheus)
As part of a multicenter randomized controlled trial, a multidimensional program for more par-ticipation of community-dwelling and increasingly frail persons in old age will be investigated. The aim of this program is to delay further loss of function and to improve participation. The core component of the multidimensional program is a twelve-month training program. Addi-tional components, such as counselling in issues of social participation and psychosocial is-sues as well as nutrition and home environment will be provided, if required. Accompanying to this trial, the department of health economics and health services research of the University Medical Center Hamburg-Eppendorf will estimate the intervention costs. Furthermore, a health economic evaluation will be performed. For assessing health effects, quality-adjusted life years will be calculated based on the EQ-5D-5L. Based on these, incremental cost-effectiveness ratios will be calculated and cost-effectiveness acceptability curves will be constructed.
Responsibility: Project group study data I
Evaluation of the orthogeriatric co-management for osteoporotic fractures of older patients (EvaCoM)
In Germany, more than 400,000 hospital admissions per year are due to fractures of old and very old persons. These patients often suffer from functional impairment, multimorbidity or polypharmacy, which orthopaedic departments are increasingly faced with. To improve care in these geriatric patients a new health service approach of orthogeriatric comanagement has been recently implemented in several German hospitals. This project aims to analyse the influence of orthogeriatric comanagement on relevant outcomes like mortality, need of care, institutionalisation, rehospitalisation or costs in older patients after a fracture, and to conduct a health-economic evaluation. The study will be performed with routine data from a large health and long-term care insurance. The expected results will be of interest for countries with aging societies and will support the allocation of financial resources in Western health care systems.
Responsibility: Project group routine data I
A multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients (AgeWell)
The project targets community-dwelling individuals aged 60-77 years who have an increased for developing dementia. The intervention consists of seven components, e.g. nutritional counseling, cognitive training, optimization of medication. By conducting a multicenter, two-armed, observer-blinded cluster-randomized controlled trail this intervention is compared to treatment as usual. Primary endpoint is cognitive performance assessed by a battery of neuropsychological tests after 24 months.
The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. Direct costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve based on the net-benefit approach.
Sponsor: Bundesministerium für Bildung und Forschung (BMBF)
Responsability: Project group study data II
Effekte von Strategien zur Verbesserung ärztlich-pflegerischer Zusammenarbeit auf Krankenhausaufnahmen von Pflegeheimbewohnern (interprof ACT): Gesundheitsökonomische Evaluation
Responsibility: Project group study data III
Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (AgeQualiDe)
Sponsor: Federal Ministry of Education and Research
Responsibility: Project group study data II ,Professorship for Interdisciplinary Health Care Epidemiology
Improvement of the sustainability of geriatric rehabilitation outcomes (GeRas)
The project GeRas is a multicenter randomized controlled trial evaluating an intervention that aims to improve the sustainability of geriatric rehabilitation outcomes after discharge from inpatient rehabilitation clinics. Primary endpoints are improvement of physical function, participation and independence of the participants after returning to their homes. Participants are randomized into three study arms (2 intervention groups, 1 control group receiving regular care). The first intervention group consists of a structured training program, an interface management between the social service at the rehabilitation clinic and care managers ("Versorgungsmanager:innen") of the health insurance company, and a structured review of the person-environment fit. These components are delivered via in-home visits and telephone calls. In the second intervention group, the same components are delivered via a telemedicine platform. The Department of Health Economics and Health Services Research of the University Medical Center Hamburg-Eppendorf is responsible for the accompanying economic evaluation of the project. This includes determining the intervention costs and analyzing the cost-effectiveness of the intervention(s). Health effects are determined by quality-adjusted life years based on the EQ-5D-5L. Health-related resource utilization is assessed via questionnaires and monetarily valued based on standardized unit costs. Results are presented as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.
Sponsor: Innovationsfond
Funding period: 2022 – 2025
Responsiblity: Project group study data I
Health economic evaluation of (digital) exercise courses for older people - Ageing in Motion for People in Rural Areas (ABSCHaLoM)
Within ABSCHaLoM, a three-arm randomized controlled trial will be conducted to evaluate conventional and tele-exercise courses for older people living in the new eastern states of Germany in terms of prevention of falls and fall-related injuries as well as improvement of motor functionality and physical activity. More than 2,700 people aged 70 to 90 years will be enrolled in the study and randomly assigned to the conventional exercise group, the tele-exercise group, or the control group. In this context, the Department of Health Economics and Health Services Research of the University Medical Center Hamburg-Eppendorf conducts a health economic evaluation to compare the conventional and the tele-exercise courses with a control group. Health care utilization will be collected retrospectively over 12 months based on a questionnaire for health-related resource use in elderly populations. In addition, the health care utilization due to falls and the EQ-5D-5L to measure generic health-related quality of life will be assessed retrospectively every 3 months. Costs of health care utilization will be calculated from a societal perspective using standardized unit costs. Quality-adjusted life years (QALYs) will be calculated as health effects based on utilities derived from the EQ-5D-5L. Cost-effectiveness after 12 months will be determined by differences in costs and QALYs between the two intervention groups and the control group and related in the form of incremental cost-utility ratios. Non-parametric bootstrapping will be used to analyze its uncertainty. In addition, cost-effectiveness acceptability curves will be constructed on the basis of the net benefit regression method in order to visualize the statistical uncertainty of the cost-utility ratios.
Research Projects Related to Mental Health
Efficacy and safety of Thrombectomy in Stroke with extended lesion and extended time window: a randomized controlled trial (TENSION)
Sponser: European Union
Versorgungs- und Bedarfsanalyse zur barrierefreien Teilhabe an Diagnostik und Therapie von Erwachsenen mit Autismus-Spektrum-Störung (BarrierefreiASS)
Link: https://www.uke.de/barrierefreiass
Specialized Post-Inpatient Psychotherapy for sustained Recovery in Anorexia Nervosa via Videoconference - a randomized controlled Trial (SUSTAIN)
In a multicenter, prospective randomized controlled trial patients with anorexia nervosa, who underwent inpatient treatment, receive 20 sessions of an individual psychotherapy, mainly delivered by videoconference, after discharge from hospital. The control group is treated by optimized treatment-as-usual. Primary efficacy endpoint is the Body Mass Index at the end of treatment after 8 months.
The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. The analysis uses data from the 14-months assessment and will be performed from the societal perspective. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve (CEAC).
The efficacy of feedback after depression screening. A web-based randomized controlled trial
This web-based study is a three-arm observer-blinded randomized controlled trial with a six-months time horizon to assess the efficacy of feedback after depression screening. The control group only receives the depression screening, while the two intervention groups additionally receive a standard or a personalized feedback. Primary endpoint is depression severity after 6 month measured with the PHQ-9.
The Department of Health Economics and Health Services Research conducts a cost-utility analysis from the societal perspective based on interview data. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve (CEAC).
Sponsor: DLR
IMPROVE-MH: Improving mental health in refugee families with young children
The goal of IMPROVE-MH is to improve mental health in refugee families with young children. Mentally strained refugee parents (with children between 0-6 years) with Arabic language skills, who experience elevated stress, depressive or anxious symptoms are invited to take part in the study. The intervention is a 10 weeks program consisting of three aspects (4 consultations in the general practice, online parenting program and regular phone calls with a psychologist). By conducting a multicenter, two-armed, observer-blinded randomized controlled trail this intervention is compared to treatment as usual. Primary endpoints are parenting style and the mental health of parents and their child after 12 months.
Depression screening in Primary Care: Improving clinical effectiveness and cost-effectiveness by patient-oriented feedback (GET.FEEDBACK.GP): economic evaluation
The intervention implemented in GET.FEEDBACK.GP conducts routinely a depression screening in primary care and provides the patient and her/his primary care physician with feedback adapted to his/her specific requirements. By conducting a multicenter, three-armed, observer-blinded randomized controlled pragmatic trail this intervention is compared to feedback exclusively provided to the primary care physician and no feedback at all. Primary endpoint is depression severity assessed by the PHQ-9 after 6 months.
The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve based on the net-benefit approach.
Enhancing treatment and understanding of post-traumatic stress disorder related to child maltreatment (PTSD-CM) (ENHANCE)
In the project "ENHANCE", a multi-center randomized controlled trial for the treatment of posttrau-matic stress disorder related to childhood maltreatment will be conducted. Treatment consists of out-patient trauma-focused cognitive behavioral therapy (STAIR-Exposure) or outpatient trauma-focused psychodynamic therapy (TF-PDT). Patients in the control group are on a 6-months waiting list. Outcome measures will be assessed at baseline, after 8 and 16 sessions, post-therapy as well as 6 and 12 months post-therapy.
In this context, the department of health economics and health services research will conduct an economic evaluation comparing STAIR-Exposure and TF-PDT with a control group (waiting list). Direct and indirect costs will be calculated from the societal perspective based on health care utilization, reduced productivity at work and work loss days. For assessing health effects, quality-adjusted life years (QALYs) will be calculated based on utilities derived from the EQ-5D-5L. Incremental cost-effectiveness ratios (ICER) will be calculated and cost-effectiveness acceptability curves (CEAC) will be constructed based on net-benefit regressions.
Internet based refugee mental health care (I-REACH)
PREMA - eHealth supported case management for the mentally ill in GP primary care
Depression and anxiety disorders are among the most common diseases in primary care practice. Due to the often unspecific symptoms and the frequent multimorbidity of patients in the primary care setting, diagnostics are often difficult and tedious.
The aim of the project is to make a significant contribution to better and more needs-based care for the mentally ill from primary care practice. The GP should be helped to recognize depression and panic disorders earlier and more reliably and to be able to quickly develop an adequate treatment strategy, ie to decide whether the patient has to be referred to a specialist immediately or if he can first treat himself. For this purpose, digital tools are provided that support both diagnostics and treatment. The intervention will be carried out in the trio of family doctors - medical specialist - patient and includes a 12-month, eHealth-based case management program.
A cluster randomized study compares intervention and control groups for effects on symptoms, quality of life, and care costs. In the control group, patients are treated conventionally, while in the intervention group the 12-month case management program is carried out. A qualitative study examines whether the new form of careSeite 2/2works in everyday practice in primary care and brings a noticeable improvement in care for patients and practices. If successful, it can be assumed that the new form of care can also be extended to other regions and other mental illnesses. The project will be funded for four years with a total of about 4.9 million euros.
Responsibility: Project group routine data II
Modell der sektorenübergreifend-koordinierten, schweregradgestuften, evidenzbasierten Versorgung psychischer Erkrankungen (RECOVER): Gesundheitsökonomische Evaluation
Health economic evaluation of Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers (COMET)
COMET is a cluster randomized controlled intervention trial. The aim is to evaluate a multi-profes-sional, integrated and stepped health care model for primary care patients with depressive, anxiety, somatoform and/or alcohol abuse disorders. Primary care patients in the control group will receive standard care. Data collection is carried out as telephone interviews at four measurement points within one year (baseline, 3, 6, and 12 months post baseline). In this context, we perform an economic evaluation of COMET compared with standard care. Direct and indirect costs will be calculated from the societal perspective based on health care utilization, reduced productivity at work and work loss days. For assessing health effects, quality-adjusted life years (QALYs) will be calculated based on utili-ties derived from the EQ-5D-5L. Based on these, incremental cost-effectiveness ratios (ICER) will be calculated and cost-effectiveness acceptability curves (CEAC) will be constructed.
PTSD after ICU Survival, Caring for Patients with Traumatic Stress Sequelae following Intensive Medical Care (PICTURE)
In a bicenter (LMU Munich, Charité Berlin), prospective randomized controlled trial patientsposttraumatic stress disorder (PTSD) that developed after inpatient treatment at an intensive careunit, receive 3 sessions of an adapted version of narrative exposure therapy delivered by the primarycare physician. Additionally, a phone based case management conducted by the practice team will beimplemented. The control group is treated by optimized treatment-as-usual. Primary efficacyendpoint is the symptom severity of PTSD after 6 months.
The Department of Health Economics and Health Services Research conducts a cost-utility analysisbased on interview data. The analysis uses data from the 12-months assessment and will beperformed from the societal perspective. Direct and indirect costs are considered. Quality-adjustedlife years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are theincremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by acost-effectiveness-acceptability curve (CEAC).
Sponsor: Deutsche Forschungsgemeinschaft
Research Project Related to Somatic Diseases
INterdisziplinäre und sektorenübergreifende Versorgung in der HerzChiRurgiE am Beispiel von minimal-invASiven HErzklappeneingriffen (INCREASE)
Coordination and patient-centered evaluation of acute inpatient stroke treatment followed by neurological rehabilitation – StroCare
The pilot project StroCare involves the implementation and evaluation of cross-sectoral acute inpatient stroketreatment followed by neurological rehabilitation. The main advantage when compared to usual care is the explicitmanagement of the transition between acute treatment and subsequent rehabilitation. This transition isfacilitated by case-managers of the statutory health insurance company and an electronical portal solution,which supports the transfer of clinical data between providers.
The institute of health economics and health service research will determine how the costs for stroke carechange when compared to usual care. To that end, routine claims data of the statutory health insurance companyBarmer will be analyzed. Costs will also be assessed by sector to identify changes in individual cost segments(i.e. inpatient and outpatient costs, care expenses, costs for medications and remedies). To ensure comparabilitybetween groups, Entropy balancing will be used, in order to balance treatment and control group withrespect to sociodemographic and clinical sample characteristics. Subsequently, the costs in the different segmentswill be compared by employing two-part models and generalized linear models – with a difference in differenceapproach. To assess specific parameters of utilization such as the number of hospital days, count models(e.g. negative binomial models) will be employed.
Responsibility: Project group routine data II Project group routine data I
Evaluation of concept for strengthening inter- and transprofessional collaboration of physicians and nurses in palliative care (KOPAL): health economic evaluation
In the course of the project, a concept for a collaborative cross-professional and cross-sectoral case conference (KOPAL) for patients with severe congestive heart failure, advanced COPD and dementia will be developed. Based on a prospective multicentric cluster-randomized controlled intervention trial, the effectiveness, plausibility and acceptance of KOPAL in routine care will be investigated.
In this context, the department of health economics and health services research will conduct an eco-nomic evaluation in the form of a cost-effectiveness analysis, in order to compare costs from a societal perspective with effects of KOPAL and care as usual. Thereby, the effects will be measured by quality-adjusted life years gained based on EQ-5D-5L index values. Uncertainties in cost-effectiveness on the basis of different willingness to pay thresholds will be assessed based on the net-benefit approach using generalized linear mixed models, in order to adjust for sociodemographic differences and differ-ences in clinical parameters.
Periphere arterielle Verschlusskrankheit: Gesundheitscoaching und telemetrisch unterstütztes Gehtraining zur Steigerung der Lebensqualität (pAVK-TeGeCoach)
In Germany, 4.5 million adults currently have peripheral arterial disease (PAD). The disease has a serious impact on health and quality of life. 75 percent of those affected die from the consequences. The aim of the project is therefore to stop the progression of the disease, to improve walking impairment, to avoid amputations and to reduce hospital stays and thus care costs. Other goals include increasing the patient's quality of life as well as improving health literacy, patient activation and adherence.
PAD patients who have been diagnosed with stage IIa and IIb PAD in the past 12 months can participate in the coaching program. You will receive an activity tracker (fitness wristband) that records the walking distance and any heart rate and transmits it to health coaches trained in telemetry. Based on this data, they advise patients on pAD and support them in their daily walking training, which was created by the attending doctor. Since PAD with concomitant diseases and risk factors, such as B. Coronary heart disease, high blood pressure, diabetes, obesity and smoking, the coach motivates for lifestyle adjustment and therapy adherence. The measures are ultimately intended to change behavior.
A prospective randomized controlled study with a total of 2,244 participants was carried out to measure the effects. In particular, it is checked whether health coaching reduces care costs. Questionnaires are also used to examine whether quality of life, health literacy, activation and adherence to therapy can be positively influenced. The project will receive a total of around seven million euros for four years.
If successful, health coaching can continue to be offered on a selective contract basis. In addition, the telemedical solution can also be used for other diseases and indications.
Randomized, Multi-Center, Event-Driven Trial of TAVI versus SAVR in Patients with Symptomatic Severe Aortic Valve Stenosis and Intermediate Risk of Mortality, as assessed by STS-Score (Dedicate)
Sponsor: Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK)
PRECOVERY - Prehabilitation "Karl-Heinz" with a focus on cardiac and cognitive functions before cardiac interventions: an analysis of the state of health
Around 40 percent of people over the age of 75 in Germany suffer from cardiovascular diseases; it accounts for more than half of all deaths in this age group. In particular, the frequency of progressive heart valve disease and coronary heart disease increases with age. Older people with multiple diseases are also at increased risk for heart surgery, which often involves a long recovery period. Only about half of the patients are able to leave the hospital directly after such an operation; every tenth person affected requires long-term care.
A cardiac rehabilitation program is particularly advisable for people who have suffered a heart attack, have cardiac insufficiency or coronary artery disease. However, it can be just as useful to prepare patients over the age of 75 in a targeted manner for an upcoming major heart surgery. Such a cross-sectoral two-week "prehabilitation program" is to be developed and evaluated in the PRECOVERY project. The program examines whether the health of the patients participating in the prehabilitation measure called "Karl-Heinz" (Kognitiv & cArdiale PRehabiLitation vor HErZINterventionen) improves in the following year compared to the participating control group.
In addition, health economic aspects are taken into account and the intervention costs of the program are determined. The project is designed as a randomized controlled study in which 211 patients are randomly assigned to an intervention group and a control group. Eight cardiological/cardiosurgical specialist centers throughout Germany are taking part. The project will be funded for four years with a total of around 5.3 million euros.
If successful, the postoperative recovery process can be supported and accelerated and the program can be included in standard care. This would improve overall cardiac care.
Sponsor: Innovation Fund
Duration: 2022-2026
Methodological Research and other Research Projects
Junior research group Climate, Environment and Health: Health effects of Weather Conditions (HeWeCon)
Description: Climate change is associated with an increase in weather conditions that affect health. The aim of this retrospective cohort study is to investigate the effects of weather conditions on health, as well as to assess health attributable to weather conditions. Merging health insurance claims data and weather data enables an investigation at patient level where individual characteristics such as age, sex and care dependency, as well as pre-existing and current health conditions can be considered. We will use a broad and representative population sample to find associations between weather and health by using multilevel machine learning methods (WP 1). Based on these results, we will create a risk prediction tool based on both weather and health conditions to assess the risks for vulnerable groups and forecast health service use during health-affecting weather condition periods (WP 2). Furthermore, mortality, hospital admissions, sick leave days, DALYs and health care costs, that are directly attributable to weather conditions ("excess" effects), will be identified and separated from time trends and seasonal effects (WP 3) by applying the following analyses: Time-series analysis of persons over time and related weather conditions, and cross-sectional comparisons of all persons between periods with relevant and average weather conditions will be carried out.
We expect to reveal partly unknown associations between weather and health in Germany. The risk prediction tool will identify relevant weather conditions and vulnerable groups and assign risk scores accordingly, and may help to establish preventive lifestyles and forecast health service use. Moreover, we expect to estimate the amount of excess health care use, mortality, sick leave days and health care costs attributable to certain weather conditions.
Funding: German Federal Ministry of Education and Research
Associations between weather and health care usage in German inpatient care against the backdrop of climate change (FFM-Klima)
Climate change causes weather conditions of higher intensity and longer duration, which negatively affect population health. In this research project we investigate the associations between weather conditions and mortality, morbidity as well as health care costs in German inpatient care using data of the German Meteorological Service and the Diagnosis-related Group (DRG) statistic of 2010 - 2019 provided by the Federal Statistical Office of Germany. The latter offers a comprehensive, anonymized quantitative description of all German hospital cases in the observation period. Owing to the rich data, advanced statistical methods such as Generalized Linear Models can be applied, accounting for weather conditions as well as regional clusters. We will identify the excess health outcomes and health-economic burden of hospital admissions attributable to weather conditions, thereby enriching and further emphasizing discussion regarding climate change and climate change adaption with epidemiological and health-economic findings.
Sponsor: Forschungsförderungsfonds der Medizinischen Fakultät des UKE
Funding period: 05/2022 – 04/2023
Somatomedizinische Behandlung bei Geschlechtsdysphorie im Jugendalter: Verbesserung der Versorgung durch epidemiologische und gesundheitsökonomische Evidenz (Transkids-Care)
Responsibility: Project group routine data I ; Project group routine data II
Evaluation of an interdisciplinary, internet-based transgender healthcare (i2TransHealth): health economic evaluation
In the course of the pilot project i2TransHealth, a cross-sectoral, interdisciplinary and internet-based healthcare program for people with transgender (TG: ICD-10) and/or gender dysphoria (GD: DSM-5) will be established. The program shall reduce structural disadvantages for treatment seekers in regions with a lack of health care coverage. In the context of a prospective randomized-controlled intervention trial, the reduction of symptom severity of patients by establishing an initial access to expedient care through primary care physicians and specialist physicians located nearby will be investigated.
In this context, the department of health economics and health services research will conduct an economic evaluation of the i2TransHealth project compared with a control group (waiting list). Thereby, excess costs of TG and/or GD compared with the German general population will be determined. Health care utilization of the German general population and of people with TG and/or GD will be contrasted by means of entropy balancing. Differences between both will be determined by general-ized linear models and two-part models. Furthermore, a cost-effectiveness analysis based on quality-adjusted life years (QALY) gained will be conducted. The probability of cost-effectiveness will be calculated based on the net-benefit approach using generalized linear models.
Programme in costing, resource use measurement and outcome valuation for use in multi-sectoral national and international health economic evaluations (PECUNIA)
Sponsor: European Union
Translation, psychometric evaluation and calculation of preference-based value sets for the ReQoL questionnaire
Hamburg City Health Study (HCHS)
Sponsor: Eigenmittel des UKE, Industriesponsoren
Responsibility: Professorship for Interdisciplinary Health Care Epidemiology
Link: HCHS
A summary of completed projects can be found here
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text:
We run ten week terms, usually with two-week half terms. Our classes are taught with only students and teachers present therefore we have 'watching week' at the end of each term. This is an opportunity for parents/grandparents etc. to watch a class. We do ask that any photos taken at this time are used appropriately.
At the end of each term, a newsletter is sent out via email, giving dates for the following term and any dance school news.
Preferred method of communication is via email. It is important that we have up to date contact details.
Fees – these are payable within the first two weeks of term. Payment can be made by cash or cheque (payable to 'Jenny Reeds') and returned in class. Payment can also be made via BACS.
Notice – half term's notice is required where possible or half term's fee paid in lieu. This enables us to plan the class timetables more efficiently.
Photo policy – photos and videos may be taken in class occasionally for instruction purposes or for updating the Jenny Reeds website/Facebook pages. We do not tag students and generally use group photos of our younger students. Anyone not happy with this policy for their child should advise the school accordingly.
Safeguarding Policy – this is available upon request from Anne Napthine (administrator)
Health & Safety Policy – this is available upon request from Anne Napthine (administrator)
GDPR Policy – this is available upon request from Anne Napthine (administrator)
Jenny Reeds School of Dance
Jenny Reeds School of Dance is fully committed to safeguarding the welfare of all children and young people. It recognises its responsibility to take all reasonable steps to promote safe practice and to protect children from harm, abuse and exploitation. Jenny Reeds School of Dance acknowledges its duty to act appropriately to any allegations, reports or suspicions of abuse. Paid staff and volunteers will endeavour to work together to encourage the development of an ethos which embraces difference and diversity and respects the rights of children, young people and adults.
The Dance School recognises its duty of care under the Children and Young Persons Act 1963, the Children (Performances and Activities) (England) Regulations 2014, the Children Act 1989 and the Criminal Justice and Court Services Act 2000, Working Together to Safeguard Children 2013
The Dance School believes that:
• The welfare of the child is paramount;
• All children, whatever their age, culture, disability, gender, language, racial origin, religious beliefs and/or sexual identity have the right to protection from abuse;
• All suspicions and allegations of abuse should be taken seriously and responded to swiftly and appropriately;
• All staff should be clear on how to respond appropriately.
The Dance School will ensure that:
• all children will be treated equally and with respect and dignity;
• the welfare of each child will always be put first;
• a balanced relationship based on mutual trust will be built which empowers the children to share in the decision-making process;
• enthusiastic and constructive feedback will be given rather than negative criticism;
• bullying will not be accepted or condoned;
• all staff provide a positive role model for dealing with other people;
• action will be taken to stop any inappropriate verbal or physical behaviour;
• it will keep up-to-date with health & safety legislation;
• it will keep informed of changes in legislation and policies for the protection of children;
• it will undertake relevant development and training;
• it will hold a register of every child involved with the organisation and will retain a contact name and number close at hand in case of emergencies.
The Dance School has child protection procedures which accompany this policy.
The Dance School has a dedicated Child Protection/Welfare Officer, who is in charge of ensuring that the child protection policy and procedures are adhered to. The Child Protection/Welfare Officer is Anne Napthine and she can be contacted on 07413 321222.
In implementing this child protection policy, Jenny Reeds School of Dance will:
• Communicate to all staff their legal and moral responsibility to protect children and young people from harm, abuse and exploitation.
• Communicate to all staff their responsibility to work to the standards that are detailed in the Surrey Safeguarding Children Board and the need to work at all times towards maintaining high standards of practice in protection of children.
• Ensure that all staff understand their duty to report concerns that arise about a child or young person, or a fellow staff member's conduct towards a child/young person, to the organisation's named person for child protection.
• Ensure that the organisation's named person for child protection understands her responsibility to refer any child protection concerns to the statutory child protection agencies (i.e. Police and/or Children's Social Care).
• Ensure that any procedures relating to the conduct of staff are implemented in a consistent and equitable manner.
• Facilitate opportunities for children and young people to express their ideas and views on a wide range of issues in connection with the teaching they receive and to be aware of the reporting procedure for any concerns.
• Facilitate involvement of parents or carers in the work of the Dance School and to make child protection policies and procedures available to them.
This policy will be regularly monitored by the Elected Committee of the organisation and will be subject to annual review.
Date: 1 January 2020
Copyright © Jenny Reeds School of Dance

redpajama_set_name: RedPajamaCommonCrawl


Patented super lift and cut action.
Comfortable, enjoy this short shaving process.
Added sideburns cutter for your other need, also suitable for body use.
With 3D floating heads, the shaver could automatically adjust to every curve of the face.
- Press the button ON / OFF to start the shaver.
- Make the shaver head part move quickly on the skin in straight lines and circles.
- Cover the shaver protective cover after each use to avoid being damaged.
Бритва очень похожа на аналоги более дорогих брендов. Конечно сравнение не в ее пользу. Но как доступный вариант очень даже подойдет. Бреет не плохо,раздражений нет,есть щеточки,батарейки. Полный комплект.
Наверное то,что не очень хорошо бреет щетину в несколько дней.
The Rechargeable Electric Razor Shaver Beard us a good product for its good price, it shaves really good and I don't have any problem using it in a daily basis.
Would pay much much more for similar branded products, especially cordless ones . Works well and and great that it includes spare heads which with some brands can cost as much as the original shaver.
A little slow even when fully charged.
Mal producto, no sirve, no corta el bello, solo los arranca de tu piel, parece que va lastimar tu piel. Los materiales se ven de muy mala calidad, no cuenta con bolsa para transporte. No lo recomiendo.


"Even when the economy is down and the unemployment is up, refugees from Burma are coming to the United States every month at a steady rate. From January 2009 to September 2009, we have welcome and helped 22 new families with a total number of 107 people. These families are Karen and Karenni families who came from Thai-Burma border only. Due to the economic recession and the poor language and job skills of the refugees, many of them haven't found jobs and have survived so far only on welfare. Some of them have found seasonal farming jobs but their jobs ended when the farming season is over. A few families have moved to other states where the rent is cheaper and a job is available. Those who stay in Seattle have faced financial difficulty because the cash assistance they get from DSHS usually doesn't cover their rent. Besides the rent, they have to pay for utility, telephone and their travel loan. Life is not as easy as they thought it would be.
•	Bring furniture, clothes, shoes and food to 4 new families and warm clothes and shoes to 18 families.
•	During this reporting period, ( July – September ) we helped 8 families and 5 singles, altogether 43 people to get their Green Cards. The service we provided includes making civil surgeon's appointments, interpreting for them during the appointments, filling out the application forms and taking them to the immigration office for fingerprints. So far, 4 people have gotten their Green Cards, 34 people have finished their fingerprints process and 5 are waiting to have their fingerprints taken.
•	Took 7 families to license office to get their Washington ID cards. Altogether, 15 people got their Washington ID cards.
•	During this period, 5 people went to ER; 3 for acute diseases, 1 for childbirth, and 1 for domestic abuse. We provided transportation and interpretation for them.
•	Make routine medical appointments for 5 elderly people and take them to their appointments and interpret for them. One got his hearing aid and another one received surgery on both eyes for cataract and both eyes were totally healed.
•	Make routine dental and immunization appointments for 8 families; altogether 20 kids. Provide interpreter as needed.
•	2 families received Section 8 government housing voucher and we provided transportation when the families moved.
•	Work with 3 school districts as an emergency contact person and provide any assistance needed by both parties. This includes picking up sick children at school, replying calls and emails from school, and interpreting for the families at teacher parents conference.
There are 5 families who were resettled in another county , remote from the community. They face many problems that need to be addressed. For example, one family came in June 2009 but all the family members haven't received their social security number yet. We visited them only one time, talked about their problems and reported their problems to their caseworkers. Language problem is a big issue for them since their resettlement agency couldn't find an interpreter who can speak Karen or Karenni.
Why are the refugees here? This link to a story recently published in Utah, and this link to a video taken in Burma will help explain what it is they were seeking refuge from.
The following article by Katie Mattern, published on IPS, states that "Gaza, South Africa and Thailand are among the world's worst places to be a refugee according to the latest annual World Refugee Survey released here Wednesday by the US Committee for Refugees and Immigrants (USCRI)." (click IPS link above for rest of article). It goes on to say "15.2 million people qualified as refugees during 2008 – down from 16 million one year ago – and that more than 800,000 were currently seeking asylum in foreign countries." Some 26 million more people were internally displaced (IDPs- those who fled their homes but had not crossed an international border).
This month in Thailand, refugees from fighting in Burma faced threats of being pushed back across the border. The article here explains the threat. According to friends in the area, trucks carrying aid were being turned away by authorities and not allowed into the area. Fortunately, Thai authorities responded graciously, reassigning those responsible, (link here) and the situation for the newly arrived is improving-the threat of repatriation is diminished for now.
Thailand and the UNHCR have faced many years of dealing with the challenge of refugees from multiple countries. Many people have found shelter there which has saved their lives, and helped them and their families to move to a life of freedom (not without difficulties!) through resettlement in other countries. This article from the Irawaddy highlights some of the challenges to the whole system, which views refugees as a burden to the state they end up in, best solved by sending them home.
"The report gave Europe a grade of D and the U.S. a grade of F for refoulement or returning refugees to places where their lives or freedoms could be threatened. It also gave Europe and the U.S. grades of D for detention/access to courts." (IPS link above).
(We met Rainbow briefly several years ago, when, after we delivered rice donated from folks here in Seattle. We accidentally disrupted his class-our friend Noah (at about 6′ 2″+) stood out in the crowd. The kids were fascinated with this friendly big guy in the bright yellow shirt (and distracted from their lessons), so Rainbow told Noah to come teach them something).
A rainbow, in the Bible, was a sign God would not forget His promises, (and that the rain had stopped). Here, according to friends yesterday, they hope it keeps raining–the shelling stops when it rains…..
God, please remember Rainbow, and all the others under attack at the moment. They are not a news story-they are real people having families, having schools, doing life in a real hard place.


Cockerham - Lancashire , North of England . Self Catering Family Holidays and Short Breaks in Lancashire.
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Blackpool is 21 miles and a similar distance to the north lie the beautiful Lake District and Yorkshire Dales. Historic Lancaster can be found 7 miles away and golf and coarse fishing are within 10 miles. Luxurious and spacious contemporary caravan. One double with ensuite WC and one twin.
Holiday offers and last minute deals in North of England from only £205 - Don't miss out book your holiday with uk-holiday-offers.co.uk today!
...Sands. A fine family park surrounded by picturesque countryside on an inlet to the Irish Sea it boasts direct access to 15 miles of the Lancashire Coastal Walks. There is an outdoor heated swimming pool children's playground and Natterjacks Club.
...lake these perfectly positioned lodges offer relaxing rural tranquility with your own outdoor hot tub.Blackpool is just 4 miles away.Why not try a unique experience in a Lynx helicopter (LP11263) converted to sleep up to four.


We're in the early stages of creating a new membership system built on Microsoft Dynamics CRM 2015. This isn't a decision we've taken lightly – the decision to buy vs. build is always complex where software is concerned, as Mike Hadlow explains in this excellent blog post. In our case, though, there's two good reasons why we've decided to integrate an off-the-shelf solution.


Boyfriend Sandy McCalister died from injuries suffered from a drunk driving accident.
Arrested 1988 for a sit in protest for the firing of Coach Lubbock. She had perfect attendance until she was suppended from school as a punishment.


Use the following picture guide to easily change the display on your iPhone 5. You should make a backup of your iPhone before changing the display and then turn it off.
Drive the plectrum between frame and screen. Be careful not to insert it too far into the device in the area around the home button. Slowly lift up the screen, together with the inner metal frame it is attached to inside the device.
Carefully bend open the screen a little bit, just until you can remove these three screws securing the metal cover.
Underneath the metal cover you will find three connectors. Disconnect them carefully with the plastic spatula and you can simply remove your old screen.
Remove the protective film from the back of the screen. Now attach the three connectors to their respective slots on the logic board.
From this point on, do not bend the screen back further than absolutely necessary in order not to disconnect them again. Reattach the metal cover with its three screws. Carefully apply light pressure on the cover and make sure the cables stay connected.


Plate surfaces of evaporators are of several kinds. As a bare-tube evaporators, they are also called Prime surface coil. One popular version, as shown below, consists of two flat sheets of metal. One in the form of a coil pipe pressed into it, while other apartments. Two welded together, forming a circuit through which the refrigerant travel. Plate adds heat transfer surface area of the coil, but not to such an extent that the fins to do. This type of evaporator popular refrigerators and freezers.


text:
import mock
import ujson

from django.http import HttpRequest, HttpResponse
from typing import Any, Callable, Dict, Tuple

from zerver.lib.actions import do_mute_topic
from zerver.lib.test_classes import ZulipTestCase
from zerver.lib.test_helpers import POSTRequestMock
from zerver.models import Recipient, Subscription, UserProfile, get_stream
from zerver.tornado.event_queue import maybe_enqueue_notifications, \
    get_client_descriptor, missedmessage_hook
from zerver.tornado.views import get_events_backend

class MissedMessageNotificationsTest(ZulipTestCase):
    """Tests the logic for when missed-message notifications
    should be triggered, based on user settings"""
    def check_will_notify(self, *args: Any, **kwargs: Any) -> Tuple[str, str]:
        email_notice = None
        mobile_notice = None
        with mock.patch("zerver.tornado.event_queue.queue_json_publish") as mock_queue_publish:
            notified = maybe_enqueue_notifications(*args, **kwargs)
            for entry in mock_queue_publish.call_args_list:
                args = entry[0]
                if args[0] == "missedmessage_mobile_notifications":
                    mobile_notice = args[1]
                if args[0] == "missedmessage_emails":
                    email_notice = args[1]

            # Now verify the return value matches the queue actions
            if email_notice:
                self.assertTrue(notified['email_notified'])
            else:
                self.assertFalse(notified.get('email_notified', False))
            if mobile_notice:
                self.assertTrue(notified['push_notified'])
            else:
                self.assertFalse(notified.get('push_notified', False))
        return email_notice, mobile_notice

    def test_enqueue_notifications(self) -> None:
        user_profile = self.example_user("hamlet")
        message_id = 32

        # Boring message doesn't send a notice
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=False,
            mentioned=False, stream_push_notify=False, stream_name=None,
            always_push_notify=False, idle=True, already_notified={})
        self.assertTrue(email_notice is None)
        self.assertTrue(mobile_notice is None)

        # Private message sends a notice
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=True,
            mentioned=False, stream_push_notify=False, stream_name=None,
            always_push_notify=False, idle=True, already_notified={})
        self.assertTrue(email_notice is not None)
        self.assertTrue(mobile_notice is not None)

        # Private message won't double-send either notice if we've
        # already sent notices before.
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=True,
            mentioned=False, stream_push_notify=False, stream_name=None,
            always_push_notify=False, idle=True, already_notified={
                'push_notified': True,
                'email_notified': False,
            })
        self.assertTrue(email_notice is not None)
        self.assertTrue(mobile_notice is None)

        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=True,
            mentioned=False, stream_push_notify=False, stream_name=None,
            always_push_notify=False, idle=True, already_notified={
                'push_notified': False,
                'email_notified': True,
            })
        self.assertTrue(email_notice is None)
        self.assertTrue(mobile_notice is not None)

        # Mention sends a notice
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=False,
            mentioned=True, stream_push_notify=False, stream_name=None,
            always_push_notify=False, idle=True, already_notified={})
        self.assertTrue(email_notice is not None)
        self.assertTrue(mobile_notice is not None)

        # stream_push_notify pushes but doesn't email
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=False,
            mentioned=False, stream_push_notify=True, stream_name="Denmark",
            always_push_notify=False, idle=True, already_notified={})
        self.assertTrue(email_notice is None)
        self.assertTrue(mobile_notice is not None)

        # Private message doesn't send a notice if not idle
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=True,
            mentioned=False, stream_push_notify=False, stream_name=None,
            always_push_notify=False, idle=False, already_notified={})
        self.assertTrue(email_notice is None)
        self.assertTrue(mobile_notice is None)

        # Private message sends push but not email if not idle but always_push_notify
        email_notice, mobile_notice = self.check_will_notify(
            user_profile.id, message_id, private_message=True,
            mentioned=False, stream_push_notify=False, stream_name=None,
            always_push_notify=True, idle=False, already_notified={})
        self.assertTrue(email_notice is None)
        self.assertTrue(mobile_notice is not None)

    def tornado_call(self, view_func: Callable[[HttpRequest, UserProfile], HttpResponse],
                     user_profile: UserProfile, post_data: Dict[str, Any]) -> HttpResponse:
        request = POSTRequestMock(post_data, user_profile)
        return view_func(request, user_profile)

    def test_end_to_end_missedmessage_hook(self) -> None:
        """Tests what arguments missedmessage_hook passes into maybe_enqueue_notifications.
        Combined with the previous test, this ensures that the missedmessage_hook is correct"""
        user_profile = self.example_user('hamlet')
        email = user_profile.email
        self.login(email)

        result = self.tornado_call(get_events_backend, user_profile,
                                   {"apply_markdown": ujson.dumps(True),
                                    "client_gravatar": ujson.dumps(True),
                                    "event_types": ujson.dumps(["message"]),
                                    "user_client": "website",
                                    "dont_block": ujson.dumps(True),
                                    })
        self.assert_json_success(result)
        queue_id = ujson.loads(result.content)["queue_id"]
        client_descriptor = get_client_descriptor(queue_id)

        with mock.patch("zerver.tornado.event_queue.maybe_enqueue_notifications") as mock_enqueue:
            # To test the missed_message hook, we first need to send a message
            msg_id = self.send_stream_message(self.example_email("iago"), "Denmark")

            # Verify that nothing happens if you call it as not the
            # "last client descriptor", in which case the function
            # short-circuits, since the `missedmessage_hook` handler
            # for garbage-collection is only for the user's last queue.
            missedmessage_hook(user_profile.id, client_descriptor, False)
            mock_enqueue.assert_not_called()

            # Now verify that we called the appropriate enqueue function
            missedmessage_hook(user_profile.id, client_descriptor, True)
            mock_enqueue.assert_called_once()
            args_list = mock_enqueue.call_args_list[0][0]

            self.assertEqual(args_list, (user_profile.id, msg_id, False, False, False,
                                         "Denmark", False, True,
                                         {'email_notified': False, 'push_notified': False}))

        # Clear the event queue, before repeating with a private message
        client_descriptor.event_queue.pop()
        self.assertTrue(client_descriptor.event_queue.empty())
        msg_id = self.send_personal_message(self.example_email("iago"), email)
        with mock.patch("zerver.tornado.event_queue.maybe_enqueue_notifications") as mock_enqueue:
            missedmessage_hook(user_profile.id, client_descriptor, True)
            mock_enqueue.assert_called_once()
            args_list = mock_enqueue.call_args_list[0][0]

            self.assertEqual(args_list, (user_profile.id, msg_id, True, False,
                                         False, None, False, True,
                                         {'email_notified': True, 'push_notified': True}))

        # Clear the event queue, now repeat with a mention
        client_descriptor.event_queue.pop()
        self.assertTrue(client_descriptor.event_queue.empty())
        msg_id = self.send_stream_message(self.example_email("iago"), "Denmark",
                                          content="@**King Hamlet** what's up?")
        with mock.patch("zerver.tornado.event_queue.maybe_enqueue_notifications") as mock_enqueue:
            # Clear the event queue, before repeating with a private message
            missedmessage_hook(user_profile.id, client_descriptor, True)
            mock_enqueue.assert_called_once()
            args_list = mock_enqueue.call_args_list[0][0]

            self.assertEqual(args_list, (user_profile.id, msg_id, False, True,
                                         False, "Denmark", False, True,
                                         {'email_notified': True, 'push_notified': True}))

        # Clear the event queue, now repeat with stream message with stream_push_notify
        stream = get_stream("Denmark", user_profile.realm)
        sub = Subscription.objects.get(user_profile=user_profile, recipient__type=Recipient.STREAM,
                                       recipient__type_id=stream.id)
        sub.push_notifications = True
        sub.save()
        client_descriptor.event_queue.pop()
        self.assertTrue(client_descriptor.event_queue.empty())
        msg_id = self.send_stream_message(self.example_email("iago"), "Denmark",
                                          content="what's up everyone?")
        with mock.patch("zerver.tornado.event_queue.maybe_enqueue_notifications") as mock_enqueue:
            # Clear the event queue, before repeating with a private message
            missedmessage_hook(user_profile.id, client_descriptor, True)
            mock_enqueue.assert_called_once()
            args_list = mock_enqueue.call_args_list[0][0]

            self.assertEqual(args_list, (user_profile.id, msg_id, False, False,
                                         True, "Denmark", False, True,
                                         {'email_notified': False, 'push_notified': False}))

        # Clear the event queue, now repeat with stream message with stream_push_notify
        # on a muted topic, which we should not push notify for
        client_descriptor.event_queue.pop()
        self.assertTrue(client_descriptor.event_queue.empty())
        do_mute_topic(user_profile, stream, sub.recipient, "mutingtest")
        msg_id = self.send_stream_message(self.example_email("iago"), "Denmark",
                                          content="what's up everyone?", topic_name="mutingtest")
        with mock.patch("zerver.tornado.event_queue.maybe_enqueue_notifications") as mock_enqueue:
            # Clear the event queue, before repeating with a private message
            missedmessage_hook(user_profile.id, client_descriptor, True)
            mock_enqueue.assert_called_once()
            args_list = mock_enqueue.call_args_list[0][0]

            self.assertEqual(args_list, (user_profile.id, msg_id, False, False,
                                         False, "Denmark", False, True,
                                         {'email_notified': False, 'push_notified': False}))

        # Clear the event queue, now repeat with stream message with stream_push_notify
        # on a muted stream, which we should not push notify for
        client_descriptor.event_queue.pop()
        self.assertTrue(client_descriptor.event_queue.empty())
        sub.in_home_view = False
        sub.save()
        msg_id = self.send_stream_message(self.example_email("iago"), "Denmark",
                                          content="what's up everyone?")
        with mock.patch("zerver.tornado.event_queue.maybe_enqueue_notifications") as mock_enqueue:
            # Clear the event queue, before repeating with a private message
            missedmessage_hook(user_profile.id, client_descriptor, True)
            mock_enqueue.assert_called_once()
            args_list = mock_enqueue.call_args_list[0][0]

            self.assertEqual(args_list, (user_profile.id, msg_id, False, False,
                                         False, "Denmark", False, True,
                                         {'email_notified': False, 'push_notified': False}))

        # Clean up the state we just changed (not necessary unless we add more test code below)
        sub.push_notifications = True
        sub.in_home_view = True
        sub.save()

redpajama_set_name: RedPajamaGithub


ElectronicKitSchool. - Other version of Proteus 8 Professional is Proteus Professional version 8.1 SP1 advanced simulation for Windows system that we presented to you now and free download. Proteus provide the features that called with ISIS and ARES that allow you to design electronic circuit and simulate it and then you also can create PCB layout design at once using this software.
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Image credits: Akira Kurosawa, Rashomon Gate, 1950, film still; Felix Melia, Rashomon Gate, 2015, video still; samurai armor hoodie by Tokyo Otaku Mode (photographer unknown, dimensions variable). Courtesy of Felix Melia and Tokyo Otaku Mode; Akira Kurosawa, The Seven Samurai, 1954, film still.
Image credits: Rose Vickers, Sunsets and Coconuts, 2013, silver gelatin emulsion photographs on resin paper, 105 x 72 cm (diptych) in YAI-13, .M Contemporary, January 13 – February 2, 2013; Untitled 1, 2013, Lambda C-Type print, 105 x 148 cm; Untitled, 2, 2013, Lambda C-Type print, 105 x 1480 cm.


text:
Q: Protected member function address in derived class is not accessible #include <iostream>

class A {
protected:
    void foo()
    {}
};

class B : public A {
public:
    void bar()
    {
       std::cout << (&A::foo) << std::endl;
    }
};

int main()
{
    B b;
    b.bar();
}

Here I am trying to get address of protected member function of base class. I am getting this error.
main.cpp: In member function 'void B::bar()':
main.cpp:5: error: 'void A::foo()' is protected
main.cpp:13: error: within this context
make: *** [all] Error 1

Changing foo to public works. Also printing &B::foo works. Can you please explain why we can't get address of protected member function of base class?

A: B is allowed to access protected members of A as long as the access is performed through an object of type B. In your example you're trying to access foo through A, and in that context it is irrelevant whether B derives from A or not.
From N3337, §11.4/1 [class.protected]

An additional access check beyond those described earlier in Clause 11 is applied when a non-static data member or non-static member function is a protected member of its naming class (11.2) As described
  earlier, access to a protected member is granted because the reference occurs in a friend or member of some class C. If the access is to form a pointer to member (5.3.1), the nested-name-specifier shall denote C or a
  class derived from C. All other accesses involve a (possibly implicit) object expression (5.2.5). In this case, the class of the object expression shall be C or a class derived from C. [Example:
 class B {
 protected:
   int i;
   static int j;
 };
 class D1 : public B {
 };
 class D2 : public B {
   friend void fr(B*,D1*,D2*);
   void mem(B*,D1*);
 };
 // ...
 void D2::mem(B* pb, D1* p1) {
   // ...
   int B::* pmi_B = &B::i; // ill-formed
   int B::* pmi_B2 = &D2::i; // OK
   // ...
 }
 // ...

—end example]

Your example is very similar to the code in D2::mem, which shows that trying to form a pointer to a protected member through B instead of D2 is ill-formed.

A: Seems I found the answer. If we could get pointer of member function we can call it for other objects of type A (not this) which is not allowed.
It is not allowed to call protected member function in derived classes for objects other than this. Getting pointer would violent that.
We can do something like this:
#include <iostream>

class A {
protected:
    void foo()
    {}
};

class B : public A {
public:
    void bar()
    {
        void (A::*fptr)() = &A::foo;

        A obj;
        (obj.*fptr)();

        // obj.foo(); //this is not compiled too.
    }
};

int main()
{
    B b;
    b.bar();
}

A: I was curious and tried the following example:
#include <iostream>
using namespace std;

class A {
public:
    void foo()
    {
    }
};

class B : public A {
public:
    void bar()
    {
       printf("%p\n", (&A::foo));
       printf("%p\n", (&B::foo));
    }
};

int main()
{
    B b;
    b.bar();
}

Actually, I see that &A::foo == &B::foo, so for protected member of base class you can use derived class member to take address. I suppose in case of virtual functions this will not work

redpajama_set_name: RedPajamaStackExchange


The Cortland County Historical Society Gift Shop is open Tuesday through Saturday from 9:30 a.m. to 5 p.m. at 25 Homer Avenue in Cortland.
"Cortland County Remembers" from the forties to the seventies: a gathering of personal memories of life in Cortland County and its towns and villages covering the years 1946-1976. $20.
Several publications: "Images of America," "157th Remembered," "Adirondack Tragedy" and "Cooking Now and Then"


text:
RELEASE: Race and Beyond: Every (Black Man) an Obama?
Press Release Mar 15, 2011
Watch the live webscast of today's event Everyone Isn't Obama: Black Men and Social Policy.
By Sam Fulwood III
Almost immediately after Barack Obama was elected the 44th president of the United States, conservative pundits quickly shifted gears from predicting calamity to heralding the dawn of a post-racial society. Ah, if only it were so.
It's a cruel jujutsu of politics and sociology to listen to those voices, declaring that racism is dead and all is dandy across the land because of one election. Setting aside the tremendous historic accomplishment and emotional satisfaction, President Obama's election didn't lift the place of black Americans. For black men, in particular, a host of disparities continue to affect their life choices and chances despite the example of President Obama in the White House.
Recognizing the disconnect between perception and reality on this matter, my colleague Joy Moses organized a panel discussion titled Everyone Isn't Obama: Black Men and Social Policy to examine how one black man's success is no reason to assume that we no longer must think about disparities impacting black men when crafting public policies. . The discussion stems from Waldo E. Johnson Jr.'s important new book, Social Work with African American Males: Health, Mental Health, and Social Policy, which is a collection of reports on the plight of black men written by highly regarded scholars and social workers with hands-on experience with their subject material.
Moses, a Senior Policy Analyst with American Progress's Poverty and Prosperity program, invited Johnson and some of the contributors to his book to discuss their findings. She said the Washington-centric worlds of policy and politics have dabbled only sporadically in recent years into the discouraging social condition of some black men.
As Johnson's book makes clear, black men are less likely to graduate from high school than white men. Black men's lack of access to health care accounts for a life expectancy of 65.8 years, which is less than the 76.5 years for all U.S. ethnic and racial groups. And, most shockingly to me, Johnson notes that mental health issues are the ones most overlooked and ignored among black men. "The onset of chronic stress, depression, somatization and other forms of mental illness may be linked to particular social circumstances, including but not limited to experiences with racism/discrimination, homelessness, incarceration, poverty, and substance abuse," he writes.
During the Bush administration, some conservative social activists saw political opportunity in making an effort to address some of these issues. By offering federal grants to faith-based efforts aimed at fathers, the administration sought to make marriage a tool to addressing absent fathers and abandoned children in low-income and black communities. This effort offered simplistic notions about the barriers and real social pressures that some beleaguered black men face. It also alarmed many, including feminists groups who feared the government was, in effect, forcing couples to stay together even when their romantic relationships had ended.
All too often, Moses told me, people behind such policy recommendations—politicians, policy wonks, and think-tank experts—often lacked necessary and practical knowledge about the people for whom they were imposing their experimental ideas. "The voices of social workers and other knowing experts weren't represented enough in the D.C. conversations," she explains. "And, obviously, there weren't many men of color talking as experts. That needs to happen a lot more because there should be room for everyone to contribute to the dialogue."
If our nation ever is to approach that illusive goal of post-racial America, it must find a credible solution to the lingering disparities that burden the poor and other traditionally disadvantaged groups. The ideas can't be imposed by those who see only political solutions to a dire situation without getting up close and personal with the people in need.
And, to be sure, it won't happen by wishing and hoping on the pseudo-symbolism of one man—even if that man is the first black president of the United States.
Sam Fulwood III is a Senior Fellow at the Center for American Progress. His work with the Center's Progress 2050 examines the impact of policies on the nation when there will be no clear racial or ethnic majority by the year 2050.
Read this column online here.


text:
Palatal (fra latin palatum "gane") kan have flere betydninger:

 Palatalisering – en hævning af fortungen i retning mod den hårde gane; dansk /l/ er f.eks svagt palatiseret
 Palatal konsonant – konsonant der frembringes med tungeryggen løftet mod den hårde gane
I gastronomien bruges det om retter som fryder ganen, altså som er velsmagende.

redpajama_set_name: RedPajamaWikipedia


Sound is one of the most important aspects of home videos. It is difficult to hold a viewer's attention without a soundtrack, regardless of whether that is 'live sound' recorded at the same time as the video, or 'overdubbed' sound – for example incidental music. Just as difficult, however, is the actual process of recording. With or without expensive, professional equipment, there are a number of techniques that you should master in order to ensure you get the best possible sound on your recordings.
You cannot hope to produce good quality sound recordings unless you have a basic understanding of the equipment you are using. The microphone is the most important part of this equipment.
There is a wide variety of microphone types. Cheaper video cameras will, unsurprisingly, have less efficient microphones attached. Frequently these are built into the camera body, protected by only a grille. These microphones tend to react very badly to background noise; they will pick up every frequency and, as a result, the subjects may be drowned out.
Many cameras, however, allow the user to attach a separate microphone to the body. This is very useful, as you can choose a more efficient microphone than those that come as standard. Furthermore, you can choose a microphone to suit your specific requirements and environment.
To begin with, you should understand the difference between omnidirectional and unidirectional microphones. Omnidirectional mics pick up sound from every angle around them, while unidirectional versions only sense sound when it comes from one specific direction. Many camera microphones are unidirectional; they are frequently shaped like a pencil, and are sometimes known as bullet mics.
Unidirectional microphones are very useful if you want to isolate sound. For example, if you want to pick up speech from the individual on whom the camera is focused, a unidirectional mic will allow you to do this while filtering out extraneous noises. In contrast, an omnidirectional mic will provide a more accurate sense of the ambient sound, but will be less effective at isolating individual frequencies.
While the most important aspect of recording is capturing a good sound in the first place, the actions you take later can have a significant effect on the quality of your soundtrack. Most video editing software includes audio editing capabilities; the complexity of these will vary depending on the nature of the program.
While the most basic software may only include volume editing functions, manufacturers are increasingly offering the ability to alter the actual sound of your recording. Much of this is achieved through the use of EQ, or equalisers. This technique allows you to boost or reduce the volume of individual frequencies in your recording; this is particularly useful if you want to reduce background hiss, or increase the volume of your subject in relation to the background noise. EQ takes some practice, but can yield excellent results with a little work.
Finally, it is important to remember that great soundtracks can be achieved with relatively inexpensive equipment. The march of consumer technology continues apace, and tolls that can produce almost professional results are now available for very little money. As such, make sure you experiment with your existing equipment before shelling out for upgrades.


text:
Pragati Archives
Crafted with love by Madhu Menon
Panel contributors
Why Pragati?
A bill-of-fare
The National Food Security Bill
The National Food Security Bill has been introduced in Parliament and is being examined by the Standing Committee. There are several dimensions on which this Bill needs to be examined. In an earlier note written before the Bill was introduced (see Pragati, January 2012), we had discussed some essential elements that any food security law would need to address.
Photo: Gates Foundation
The Bill categorises the population into three groups: priority households, general households, and an implied group that is not entitled to any benefits. Priority households are entitled to receive seven kilograms of foodgrains per person per month, and general households are entitled to receive at least three kilograms of foodgrains per person per month. Up to 75 percent of the rural population and 50 percent of the urban population will be categorised as priority or general households. Of these, at least 46 percent of the rural population and 28 percent of the urban population will be categorised as priority households. The priority population will have to pay Rs 3 per kilogram of rice, Rs 2 for wheat and Re 1 for coarse grains. The general population will pay half the minimum support price for these foodgrains.
This formulation does not address one major shortcoming of the current system. Creating separate categories with differential entitlements has led to errors in identifying the correct categories for households. Influential groups (who should be in the excluded category) have the incentive and ability to manipulate the system to get themselves included as beneficiaries. As the total number of beneficiaries has been fixed, poorer households with less influence may be excluded. Indeed, the N C Saxena report (published in 2009) estimated that 61 percent of the eligible population is currently excluded from the BPL list, while 25 percent of non-poor households are included in the list.
The Bill also has a list of other entitlements. Pregnant women and lactating mothers will get meals through anganwadis and Rs 1,000 per month for six months. Children between the age of six months and six years will be entitled to an appropriate meal through the local Anganwadi, and those between the age of six years and fourteen years to one mid-day meal in all public and aided schools. It appears that some of these entitlements which are already available under other schemes (such as Integrated Child Development Services and Mid Day Meal Scheme) will be subsumed by this Bill. Also, destitute persons are entitled to one free meal, and those living in starvation to two free meals every day.
The state government is responsible for delivering these entitlements, and will pay a food security allowance in case of failure to supply the foodgrains or meals to the target population. The central government has the responsibility of supplying the required amount of foodgrains for all the above entitlements to the state government. In case of short supply, the central government shall provide funds to the state government to the extent of the shortfall.
The costs for other entitlements will be shared by the central and state governments. The Financial Memorandum to the Bill estimates the cost of providing foodgrains at Rs 800 billion assuming that the foodgrain procurement price as well as the number of beneficiaries remains constant. It estimates Rs 20 billion for maintenance of buffer stocks, and Rs 135 billion for maternity benefits. The Bill does not estimate other costs, including those to be borne by state governments. Some estimates indicate significantly higher costs. For example, Ashok Gulati and Jyoti Gujral have estimated the cost at Rs 2 trillion per year for the next three years. Food Minister KV Thomas has been quoted as stating that the total financial implication would be about Rs 3.5 trillion (including, among other costs, Rs 950 billion for food subsidy, Rs 350 billion for ICDS and Rs 1.1 trillion for raising agricultural production). The cost-sharing requirement also leads to another question. Does this law require state legislatures to allocate the required resources? If so, would that impinge on their legislative power to allocate resources according to their own priorities? On the other hand, what would happen to the legal entitlements in this Bill if state governments are unable or state legislatures are unwilling to provide the required funds?
The preferred mode of delivery of benefits is also not clear. Clause 3 of the Bill states that the foodgrain entitlements would be provided under the Targeted Public Distribution System (TPDS). Clause 18(1) of the Bill requires the central and state governments to progressively undertake certain reforms enumerated in Clause 18(2). These include, among others, two items that seem to be contradictory. Clause 18(2)(a) is a move towards "doorstep delivery of foodgrains to the TPDS outlets". Clause 18(2)(h) states "introducing schemes, such as, cash transfer, food coupons, or other schemes, to the targeted beneficiaries in lieu of their foodgrain entitlements…". This leaves open the question of whether, over the next few years, entitlements would be provided as foodgrains or as cash transfers or as food coupons.
The Bill also includes certain objectives that are not directly related to access to food. Clause 39 requires the central and state governments and local authorities to "strive to progressively realise the objectives specified in Schedule III". The Schedule includes steps such as agrarian reforms, expansion of line capacity of railways, access to health care, education for adolescent girls, and pension for senior citizens. The question here is whether these objectives, which fall under the purview of several ministries and under other schemes and Acts (for instance, the Right to Education Act guarantees education to all children between the age of six and 14 years, and would include adolescent girls in that age group) should be a feature of a Bill on food security.
The National Food Security Bill is now being examined by the standing committee and will later be debated in Parliament. There are several aspects that need detailed deliberation in order to achieve the main objective of providing food to every person. These would include the issue of coverage (whether universal or targeted), the pros and cons of different delivery mechanisms, and the overall budgetary costs of the different approaches. There is also a need to look at the division of responsibilities between the centre, states and local authorities, as well as, coordination required between different line ministries to achieve the stated objectives.
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text:
FAN LETTERS!
Fan Letters: The Donald In v Donald Out debate rumbles on amongst Sunderland supporters
Are you Donald In, or Donald Out? Sunderland fans debate the topic once again after watching the club's owner on the latest series of 'Sunderland Til I Die'. Got something to say? RokerReport@Yahoo.co.uk!
By Editor Gav Apr 15, 2020, 10:30am BST
Share All sharing options for: Fan Letters: The Donald In v Donald Out debate rumbles on amongst Sunderland supporters
Photo by Richard Sellers/PA Images via Getty Images
Email us: RokerReport@yahoo.co.uk
Got something you'd like to get off your chest? Send us an email, and we'll publish your thoughts here on the site!
Click here for our email!
Dear Roker Report,
Please could Roker Report find out off Stewart Donald if he really does want to sell the club or would he prefer to stay in charge and have one last crack at getting us promoted.
There have been a lot of harsh things said about Donald and Methven but I think watching Sunderland Til I Die shows they care about the club. Either that or they are good actors.
With what's been happening in the world is it now time for the fans and owners to take stock and decide what they really want.
It's all a moot point if Donald wants out anyway but should we not be trying to build bridges. Donald and Methven have no doubt been stung by the criticism they have received but it may not be too late.
I think everyone should swallow their pride and get round the table to decide what the future holds for us. I would be interested to hear what Donald wants to do really or does he feel there is no way back.
Is it time for the supporters groups and him to talk before we are sold to someone for the wrong reasons. Sometimes it's better the devil you know.
What does everyone else think, has anyone asked Donald, or Methven how they feel now.
I'd be interested in what he has to say.
Come on Roker Report ask the questions, you used to have a good relationship with him, is it not time for everyone's ego to take a back seat and think about what's important....SAFC
Paul Eden
Ed's Note [Gav]: Of course he wants to sell. He cannot afford to fund this club to the level it needs in order to be competitive without investment from elsewhere - he admitted that himself on Sunderland Til I Die!
That's the top and bottom of it, for me. He may have the best intentions and be a nice man, but do we honestly believe he's capable of giving this club the kind of boost it will need to be competitive over both the short and long term?
The issue of course is that there are some dodgy characters out there who may well have the money, but might not have the best intentions. Hopefully Stewart does right by the club and sells to people who are serious about investing in this club's structure. That's what we need.
Photo by Ian Horrocks/Sunderland AFC via Getty Images
Over the past few months I've had a divided opinion of the chairman Mr Donald, but having seen the latest STil I die 2 I've changed my opinion and now to be fair and honest, he is the perfect man for the job, and having met him last year at the Bristol Rovers semi final away, please stay and follow through your promise to the club... your the man for the job and guide the club back to the big time...
Vic Blakelock
Ed's Note [Gav]: I'm amazed people watched STID2 and came to the opinion that he's the perfect man for the job, but each to their own I suppose.
Photo by Owen Humphreys/PA Images via Getty Images
After watching series 2 of Sunderland Til I Die, I feel sorry for Stewart, I felt he came over as sincere and passionate about the club, the bits where he stood alongside the supporters at the away matches made me warm to him, he had/has a difficult job of trying to get the club back on track and where it belongs, unfortunately a portion of the fans were too quick to jump on his back as soon as we started to have a bad run of results. I don't think it was his or Charlie's fault that we lost Maja, it was obvious it was the agent that was controlling that, Maja wanted to stay but his agent was wanting a big fee.
I for one think we should all get behind Stewart.
John Earl
Ed's Note [Gav]: He did indeed come across as sincere and passionate, but it irks me that people think that makes him suitable to run the club. I think whilst those are commendable traits, he lacks clarity and is too emotive. Our club has no real structure and that's a problem. Stewart has clearly not got the money to push this club on his own, something he's admitted himself. That doesn't mean he doesn't deserve credit for turning around the business side of the club, but I can't help but wonder why people don't feel like we deserve better.


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Description: An " up " lively pop rock instrumental. Positive, feelgood, motivational. A sense of of every thing is just fine. Nice clean guitar soundscaping with nice effects, great bass guitar and steady drum groove. A nice flow. Multiple guitars nicely orchestrated. Great for any media needing positive friendly uplifting music.
Description: A positive feelgood pop / rock instrumental. A sense of happiness joy, everything feels alright. Upbeat uplifting bouncy melodic. 2 clean electric guitars interacting beautifully over a steady rhythm beat of bass guitar and drums. Flowing bright. Great for motivational , commercials and any media needing a catchy " up " positive vibe.