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Ambulance emergency services for patients with coronary heart disease in Lancashire: achieving standards and improving performance
Prehospital care
B Stoykova1,
R Dowie1,
P Bastow2,
K V Rowsell3,
R P F Gregory4
1Health Economics Research Group, Brunel University, Uxbridge, UK
2Lancashire Ambulance Service NHS Trust, Preston, UK
3University of Central Lancashire, Preston, UK
4University of Manchester, Manchester, UK
Correspondence to:
Mrs B Stoykova
Health Economics Research Group, Brunel University, Uxbridge UB8 3PH, UK; Boyka.Stoykovabrunel.ac.uk
Objectives: To examine the performance of a rural ambulance trust during two time periods, 1996/97 and 2001, with respect to achieving standards for ambulance journey times and delivery of clinical care for patients with suspected acute myocardial infarction (AMI).
Methods: Audit datasets on two cohorts of patients with chest pain and suspected AMI were assembled by the Lancashire Ambulance Service NHS Trust in north west England: 3706 patients during 1996/97 and 3423 in 2001. They were transported to four hospitals. The analyses covered journey timings, role of rapid response vehicles (RRV), and clinical procedures and the results were compared with prevailing national standards.
Results: Hourly and daily usage patterns were similar in the two periods. During 1996/97 the national rural target of 95% of response times being within 19 minutes was achieved (96% of calls), unlike the target of 50% within eight minutes (45.3% of calls). During 2001, 2684 (78.4%) calls had response times within eight minutes thus exceeding the revised national target of 75%. RRVs were despatched for 1214 (35.5%) of calls in 2001, and the mean response time (SD) for these vehicles was significantly shorter than for front line ambulances (0:05:53 (0:02:49) versus 0:07:04 (0:04:19), p<0.001), likewise the mean call to hospital time (0:32:38 (0:09:28) v 0:35:01 (0:12:09), p<0.001). Patients in 2001 were more likely to be given aspirin by the ambulance crews (74% of cases), while the rate of cannulation was lower.
Conclusion: A significant improvement has been achieved in the performance of ambulance services in Lancashire since 1996, because of recently introduced strategies, notably RRVs, and in the presence of more demanding national standards and targets.
first responder vehicles
AMI, acute myocardial infarction
RRV, rapid response vehicle
NSF, national service framework
IV, intravenous
ECG, electrodardiogram
BVH, Blackpool Victoria Hospital
http://dx.doi.org/10.1136/emj.2003.001701
The national service framework (NSF) for coronary heart disease, published by the Department of Health in March 2000,1 covered the role of ambulance service NHS trusts in dealing with patients with suspected acute myocardial infarction (AMI) and set out organisational goals and milestones. Ambulance performance standards for all emergency calls had first been set at a national level in 1974 and they were revised in 1996.2 The standards were applicable to over 30 ambulance trusts in England, with trusts being classified as "urban services" if the population density of the geographical area that they covered was greater than 2.5 persons per square acre in 1991 or "rural services" if the density was lower.3
A number of strategies have been adopted by ambulance trusts to meet the cardiac standards. Paramedic crew members and defibrillator units are now available on front line ambulances, community first responder schemes have been introduced, and service coverage has been improved with the introduction of "rapid response" vehicles (RRV) (one person motorcycle or vehicle). But an assessment of the impact of such strategies on the performance of an ambulance trust has not been available. This paper examines the performance of the Lancashire Ambulance Service NHS Trust (LAS), a rural service in north west England, during two time periods, 1996/97 and 2001, with respect to achieving standards of timeliness and delivery of clinical care for patients with suspected AMI.
Identification of standards
In England in 1996 calls for ambulances were categorised as "emergency" or "urgent". All 999 calls were classified as emergency calls. Urgent calls were made only by general practitioners (GP) and ambulance services were expected to respond within one or two hours. Prioritisation of emergency calls as category A or category B was introduced from 1997 onwards4 to ensure that immediately life threatening cases would get the fastest response. LAS introduced the system in October 1997. By 2001 the call prioritisation system required that ambulance calls were assessed as category A if the circumstances were immediately life threatening, as category B for other emergency calls, and as category C if the circumstances were not life threatening or serious. The prioritisation was done by ambulance despatch personnel according to the information provided by callers. Targets for response times according to category of call were set nationally. Targets for 1996 and 2001 are shown in table 1.
Performance standards valid during the two periods of data collection
During the 1990s performance standards for calls to patients with suspected AMI were identified locally in contracts for clinical audit between ambulance trusts and health authorities purchasing their services. The standards in the 1997 contract between the North West Lancashire Health Authority and LAS included taking basic observations, recording a 3 lead electrocardiogram (ECG), administering aspirin as appropriate, and intravenous (IV) cannulation5 (table 1).
During 2001 standards were redefined nationally in accordance with the NSF recommendations. All calls for suspected AMI were to be classified as category A. Patients should receive, unless contraindicated, cardiopulmonary resuscitation and defibrillation in the event of cardiac arrests, high concentration oxygen, pain relief, aspirin (at least 300 mg orally), and immediate transfer to hospital. The Joint Royal Colleges Ambulance Service Liaison Committee developed further detailed guidelines on the prehospital care, which patients with suspected cardiac chest pain should receive.6
LAS provides community emergency services for the county of Lancashire, which has a population of 1.4 million people and an area of 1100 square miles.7 There are 24 ambulance stations strategically located across the county. Forty three emergency ambulances and 10 RRVs (one motorcycle and nine cars), all equipped with a paramedic and defibrillator, are used at peak times. Since 1999 community first responder schemes have been operating in the Blackpool area. They include GPs and trained members of the public.8
Patients with chest pain and symptoms indicative of ischaemic heart disease and possible AMI, who were attended by an ambulance crew, were eligible for the study. Data were collected over two periods of time: between 1 August 1996 and 31 October 1997 (group A) and from 1 January to 31 December 2001 (group B). The 1996/97 data collection exercise was an audit for a research project.910 The audit was undertaken in 12 stations covered by the North West and South Lancashire Health Authorities. Patients were transported mainly to four district hospitals: Blackpool Victoria Hospital (BVH), Chorley District Hospital, Ormskirk General Hospital, and Royal Preston Hospital. The group A data were extracted from patient report forms by ambulance personnel and entered onto a computer program written in Visual Basic 3.0. The 2001 data collection exercise was a routinely conducted audit recommended by the NSF for coronary heart disease.1 This exercise covered all eligible patients transported to BVH only. Data were collected for five ambulance stations in the Blackpool area. During this period three RRVs were based at the Blackpool station seven days a week. The motorcycle was used between 09.00 and 17.00, weather permitting, while the cars were available between 08.00 and 24.00. The group B data were extracted from patient report forms by PB and entered on a Microsoft Excel spreadsheet.
The following items were recorded over both observation periods: age and sex of patients; person who called for help (GP or other caller); category of call; ambulance timings (time of call, response time, time at scene, and time to reach hospital); and procedures carried out by the ambulance crew. During the second observation period the involvement of a RRV or a community responder was also recorded.
The two observation periods differed in the methods of recording time intervals. During 1996/97 all times were recorded to the nearest minute only, unlike in 2001 when time was recorded in minutes and seconds. Also, before April 1998 response time was defined as starting from receipt of the emergency call, while in 2001 it started after the address had been taken.
Analyses were conducted at two levels. The first level applied to the full datasets for the two observation periods (group A for 1996/97 and group B for 2001). These analyses focused on ambulance usage patterns and journey timings. To minimise possible biases, second level analyses on journey timings and clinical procedures were carried out on two subgroups within group A and group B. Patients with cardiac arrest, both witnessed and unwitnessed, were excluded from the analyses.
The two datasets were analysed using a statistical software package (SPSS 9.0). Results are reported in descriptive statistics, or as mean, standard deviation (SD) and median. Analysis of variance (F) and χ2 significance tests were applied where appropriate. As the response time measurements were not strictly comparable across the two periods, the analyses exclude comparative assessments of mean and median response rates.
Baseline characteristics of group A and group B
Over the first observation period, 1996/97, 3706 journeys were recorded in 12 ambulance stations for patients with eligible chest pain symptoms. A total of 3337 calls (90%) were emergency 999 calls and 369 (10%) were calls classified by GPs as urgent: 311 (8.4%) were urgent within one hour and 58 (1.6%) were urgent within two hours. During the second observation period, 2001, 3423 eligible patients were transported by ambulance to BVH. All calls were classified as category A.
Patterns in the ambulance workloads
There was little variation in the patterns of the ambulance workloads during the two study periods. The mean (SD) numbers of calls per month were 261.1 (56.8) calls during 1996/97 and 285.3 (62.7) calls in 2001. The daily call patterns were similar with Mondays receiving 15% and Sundays 14% of calls in both periods. The hourly workloads, likewise, were similar: in both periods the demand for ambulance services was at its peak between 08.00 and 13.00. GPs placed significantly fewer calls in the more recent period, 18.0% (616) compared with 31.0% (1149) in 1996/97 (p<0.001, χ2 = 160.77). A small number of the 2001 calls were via NHS Direct (107, 3.1%).
Comparative response times
During 1996/97, 3201 (96%) of all 3337 emergency calls had response times within 19 minutes thus achieving the 95% national target for rural areas shown in table 1. The response time target of eight minutes for 50% of calls was nearly achieved as there were 1510 calls (45.3%) within eight minutes. During 2001, using the more precise timing practice, 2684 (78.4%) calls had response times within the current target of 8 minutes 0 seconds thus exceeding the national target of 75%.
A community first responder or a RRV arrived at the scene for 1377 (40.2%) of all calls in 2001; for 1214 (88.2%) of these calls it was a RRV. Table 2 shows that the RRV calls had a significantly shorter mean response (p<0.001). As a result, the response time of calls with a dispatched RRV was within the 8 min 0 s target for 88.2% of the calls, compared with 72.9% achieved by the remainder of the calls (p<0.001, χ2 = 108.01). Both the mean and median time at scene recorded for RRV patients was a minute longer (p<0.001) (see table 2), partly because the time at scene measurement included the interval between the arrival of the RRV and the ambulance following behind. Nevertheless, the overall call to hospital time was significantly shorter for the RRV cases (p<0.001).
Time intervals for rapid response vehicles and others: group B (2001)
Subgroup comparison
To assess the management of the patients against the prevailing standards for suspected AMI, analyses were carried out at a subgroup level. The subgroups for 1996/97 and 2001 were patients transported to BVH who were treated by ambulance crews according to LAS protocols for chest pain of cardiac origin and suspected AMI. Subgroup A (1996/97) had 2247 patients and subgroup B (2001) had 1234 patients. The two subgroups were similar in terms of the ratio between men and women and their average ages (table 3).
Comparison of baseline characteristics, times and procedures at subgroup level
The national standard in 2001 for the total time from call to reaching hospital for patients eligible for thrombolysis was 30 minutes 0 seconds (table 1). For all patients in subgroup A in 1996/97, this time interval was achieved for 24.6% (552) of calls; the rate five years later for all subgroup B patients was significantly higher at 38.6% (476 calls) (p<0.001)—see table 3.
Mean time at scene was the same for the two subgroups whereas mean journey time to hospital was shorter in 2001 by two minutes (p<0.001). Time reductions also occurred during the response phase as 79% of subgroup B patients were reached within 8 minutes 0 seconds.
Table 3 compares the rates for procedures and medications given to the subgroup patients in the two time periods. Aspirin was given to 74% of subgroup B patients compared with the earlier rate of 55% for subgroup A patients, although 15% in this earlier period had contraindications. The rates for IV cannulation were the reverse of the aspirin rates. Administration of high concentration oxygen was audited in 2001 and it was given to 89% of subgroup B patients.
Effect of RRVs on times and procedures
As 39% (483) of subgroup B patients were attended by rapid response paramedics, we assessed their impact. As expected from the analysis of group B patients for 2001 in table 2, there was a significant reduction in response time and call to hospital time when a RRV was despatched to the scene of a suspected AMI (table 4). No statistically significant differences were found however in the comparative rates for clinical procedures performed by ambulance crews who were first on scene and crews who followed a rapid response paramedic.
Response times and procedures for rapid response vehicles and others: subgroup B (2001)
This study represents an opportunity to examine changes in the performance of ambulance services in Lancashire for patients with symptoms indicative of ischaemic heart disease. Although the two datasets differed in geographical coverage and timescales for data collection, by undertaking subgroup analyses for patients managed according to AMI protocols we were able to deal with these differences and minimise possible biases. Policies for recording journey time changed between the study periods. In 2001 the clock was started later for measuring response times (that is, after the address was ascertained), while precision was improved by recording both minutes and seconds. These changed practices meant that strict comparisons between response rates could not be made. Nevertheless, the results for each time period, 1996/7 or 2001, were robust and they could be compared with the appropriate targets. Both datasets were compiled prospectively, which contributed to their quality and completeness.
Progress towards meeting current standards
Although the time elapsed between the two study periods was comparatively short, in the intervening period there were important developments in the provision and performance of community emergency services. National standards were redefined based on NHS priorities and on existing research evidence and they posed new challenges to ambulance trusts over providing faster services and delivering optimal clinical care.
We found that over five years the rate achieved by LAS for meeting the eight minutes response time target rose from less than half to four fifths of calls. Improvements in performance were partly attributable to the new arrangements for deploying RRVs. For instance, in the Blackpool area in 2001, RRVs conformed to the eight minute response time standard on almost 90% of occasions. This finding suggests that RRV schemes are a powerful means for achieving standards set by the NSF for coronary heart disease.
Hassan and Barnett11 recently reported that there was a consensus among a group of experts from ambulance trusts in the United Kingdom that a first responder system should be trained and fully integrated into an emergency medical service system. In addition, RRVs have been introduced in an increasing number of ambulance services in the past decade, but their effect on quality improvement of the services has not yet been studied in sufficient detail. The current Department of Heath routine data collection form (form KA34) does not require separate entries for calls attended by RRVs or approved first responders, thus relevant statistics are not reported in the annual national statistics bulletin.12 If further evidence was made available it could support decisions made locally by NHS ambulance trusts with regard to purchasing new vehicles as well as developing local first responder schemes. In Lancashire funding for these services has been provided by charities (by the "Heart of Lancashire" Appeal and other locally raised funds).8 Elsewhere, similar service innovation may carry a significant budgetary impact if unsupported by charitable funds.
The NSF 30 minute target from the time of call until reaching hospital seemed to be a challenge during 2001. Although we observed shorter call to hospital times in 2001 compared with 1996/97, they still exceeded the target (the median was nearly 33 minutes). As the framework's standard for call to hospital time was intended for patients eligible for thrombolysis, our results really cannot be judged against the target because assessments of patients' suitability for thrombolysis were not recorded. Indeed, it would be difficult for ambulance services to collect information about eligibility for thrombolytic treatment, as assessments need to be made retrospectively after confirmation of the diagnosis. The framework should provide instructions on how these data should best be collected and reported.
Although studies reporting response times and other time intervals achieved by comparable ambulance services in the British Isles have been published, they have been concerned primarily with the overall performance of a service over a single time period,13 specific time intervals, such as call to needle time14 and time on scene,15 or have focused on out of hospital cardiac arrests.1617 We have not found other time series data on ambulance performances with which to compare the performances of LAS.
Standards for treating suspected AMI
This study identified some differences between the clinical care delivered in 1996/97 and 2001. The clinical guidelines used in LAS during both periods,56 required obtaining IV access if AMI was suspected. Still the proportions of cannulated patients decreased significantly between 1996/97 and 2001. A possible explanation of this observation could be the improved training of paramedics, so that they are now able to exercise judgement over appropriate treatments rather than systematically following instructions from clinical protocols.
Patients were more likely to be given aspirin in 2001 because, according to the prevailing LAS protocol, only major contraindications were to be taken into consideration. The optimal level in 2001 was 300 mg. Patients who had already taken smaller amounts of aspirin were given a supplement and this practice also contributed to the higher recorded rate for aspirin administration in 2001. Woollard and colleagues surveyed protocols on aspirin use followed by nine ambulance services in England and Wales and found wide variation in the identification of contraindications. They concluded that a standardised protocol should be devised that minimised the number of contraindications.18
Future improvements for ambulance services
The NSF for coronary heart disease suggested that prehospital thrombolysis for patients with AMI should be considered under certain circumstances, but the policy would have resource implications for ambulance trusts. LAS is considering prehospital thrombolysis and has provided additional training for paramedics and begun installing 12 lead ECG machines and telemetry on front line ambulances for establishing contact and obtaining advice from a hospital cardiologist.19 In Lancashire an electronic patient report system is being introduced, whereby LAS ambulance crews enter the patients' clinical details on handheld personal computers and the details are transferred electronically to the receiving hospital department. Giovas and colleagues demonstrated the benefits of shortening the time to reach an AMI diagnosis and starting thrombolysis when ECGs are transmitted from a moving ambulance to a hospital based cardiologist.20 The LAS electronic patient record system will also facilitate more comprehensive, faster and easier audits in accordance with another requirement of the NSF that ambulance trusts should undertake routine audits.1
In May 2002 the Department of Health in England announced an investment of £14 million to provide ambulances with 12 lead ECG machines and to enable the introduction of communications equipment for transmitting information while on route to hospital.21 The benefits of this investment should be studied. It would be useful also to undertake a comparative analysis of rural and urban ambulance services to establish if any amendments in current standards are appropriate, especially with respect to call to hospital times. But for the benefits of improved ambulance services in the provision of AMI care to be fully appreciated, a comprehensive evaluation is needed covering appropriate follow up periods and measuring health outcomes in the treated populations.
We wish to thank members of staff at the Lancashire Ambulance Service NHS Trust for their assistance in the two data collection periods and the North West Research and Development Directorate for funding the 1996/97 cardiac research project. We are grateful to Dr C J Harrison, Director of Public Health in the South Lancashire Health Authority at the time of setting up the 1996 survey, for help and encouragement. The Health Economics Research Group at Brunel University receives funding from the Department of Health Policy Research Programme.
Department of Health. National service framework for coronary heart disease: modern standards and service models. London: Department of Health, 2000.
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Economic Development Group. Area profiles. http://www.lancashireprofile.com/ (accessed 13 May 2002).
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Dowie R, Gregory RP, Rowsell KV, et al. A decision analytic approach to commissioning ambulance cardiac services. Journal of Management and Medicine1998;12:81–91.
Hassan TB, Barnett DB. Delphi type methodology to develop consensus on the future design of EMS systems in the United Kingdom. Emerg Med J2002;19:155–9.
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Breen N, Woods J, Bury G, et al. A national census of ambulance response times to emergency calls in Ireland. J Accid Emerg Med2000;17:392–5.
Rawles J, Sinclair C, Jennings K, et al. Call to needle time after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study. BMJ1998;317:576–8.
Barrett B, Guly HR. On scene time in incidents responded by urban and rural ambulances. Pre-hospital Immediate Care1999;3:145–8.
Dowie R, Campbell H, Donohoe R, et al. "Event-tree" analysis of out-of-hospital cardiac arrest data: confirming the importance of bystander CPR. Resuscitation (in press).
Pell JP, Sirel JM, Marsden AK, et al. Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study. BMJ2001;322:1385–8.
Woollard M, Smith A, Elwood P. Pre-hospital aspirin for suspected myocardial infarction and acute coronary syndromes: a headache for paramedics? Emerg Med J2001;18:478–81.
Bastow P. Handheld PCs help ambulance staff deliver better patient care. NHS Information Authority News—March 2002. http://www.lancashireambulance.com/downloads/inform_03021.pdf (accessed 30 Apr 2002).
Giovas P, Pappadoyannis D, Thomakos D, et al. Transmission of electrocardiograms from a moving ambulance. J Telemed Telecare1998;4 (suppl 1):5–7.
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Copyright 2004 by the Emergency Medicine Journal
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"Many of Simon Smith's poems are anchored firmly in the concrete but it is the spaces between the pictures, the cadences, the quiet and unjudging adjacency of people and objects that make their reality moving."
Simon Smith's series of poetry journals is a plate of spinning, stunning experience. With his renowned poetic skill, Smith quietly and carefully shifts from the panoramic into the still frame of the inner life with its familiar daily worries. . . . Day In, Day Out is washed in the meals of new potatoes, sautèd cabbage leaves, the wine of Château Moulin de Honternieux Médoc (2012), Dogfish Head IPA, pizza salad with sparkling wine. It's a delicious journey. —Elaine Randell
There's a history of English language poets transplanted to places ostensibly sharing the same tongue (Ronald Johnson, Jonathan Williams, Kenneth Rexroth in the UK; Charles Tomlinson, Thom Gunn in the USA). For these writers, the ordinary becomes the exotic. Their responses might be like those of a Martial transported from Spain to the Roman capital, with an outsider's ability to detect the fine (or gross) echoes of Empire amid the detritus. Simon Smith joins these ranks. He is a Paul Blackburn for the information age. —Laurie Duggan
Simon Smith's work continues to be an essential reminder of the possibilities of poetry in the present moment. Day In, Day Out serves up quickly paced journal poems bursting with the details of the everyday life of travel, transience, and self-imposed displacement. Ghosted by his recently deceased father and Paul Blackburn's own journal poetry, Smith generously tells "everything I know" about time, impermanence, and the ordinary scintilla of the moment grasped as at once fleeting and overwhelmingly real. The devil—and the divine—is in the details. —Stephen Collis
Day In, Day Out is a book of journal poems mapping the time period between 11 April 2012 and 27 June 2014—on the track of American poet/translator Paul Blackburn – between San Diego and Brooklyn, with stop offs in New York City, London, Vancouver, L.A., and Glasgow. Each poem is in the moment of its detail and the materiality of its experience, which only these foreign eyes passing through and about and around those distant places can realise. Its pacing is breakneck and nonchalant, hysterical and insouciant, blurred, with a pin-sharp focus. This is poetry fully alive to its particular time and place, steeped in the precision of its perceptions and the act of perceiving. This is a book that telescopes the long-distance of the past into the talismanic immediate, articulating and attending to particularity over generality in the process. It is a book that explores and interrogates the world by plane rather than road, tips straight ahead, attuned to attention itself.
Simon Smith has published five collections of poetry. His third collection, Mercury (Salt Publications), was long-listed for the Costa Prize in 2007. A selected poems, More Flowers Than You Could Possibly Carry, appeared from Shearsman Books in 2016, and his latest pamphlet is Salon Noir (Equipage, 2016). He holds a PhD from the University of Glasgow.
CONTENTS: Acknowledgments, ZEROFOURZEROFIVEZEROSIXTWENTYTWELVE, Airlane Avenue, 12/4/12, Friday, Thirteenth, 4/14/12, Venice Beach, 11781 W. Sunset Blvd. (reprise), 04/17/12, 'and close your eyes with holy dread', 4/19/12, Poem with a Line Altered from a Translation by Paul Blackburn, International Date Line, Two Days Old, Twenty-Three-Oh-Four-Twelve, 24/4/12, NFT, Canterbury Tales, Rehearsal, Letter, Yesterday's: with a Poem Attached by Paul Blackburn, & my Entry for the Day Before Yesterday , Rain, Miles, Ode in the Shape of a Lament, May Day, Brooklyn-Manhattan Transit, Monday's Blues , Greenwich Meridian, 'Fullset £10', Jubilee, Begin Again, The Queen's Speech, The Music of Sauchiehall Street, Feedback, Song Thrush, Days , Stan's Day, Heritage Hotel , Monday's Blues (Part II) , Leaving , Last Leg, Due North , Allen Fisher / PLACE, Travelodge, At Table Eight, ZEROSEVEN, I, II, III, 26 POEMS: CALIFORNIALAND IN WINTER, Solo – in Memory of His Father, Amsterdam, Arrival/New World, First Day in a New World, 12th February 2014, Out Walking, Sunday, Big Pink, 100% Happy, Pool, Flâneur, La Jolla Inventory, Temescal Canyon, The Canyons, Attention, California, Human Scale, Superba, Vancouver, Sunset, The Order of Things, 11781 W. Sunset Blvd. Reprise Reprised, Towards, Californialand in Winter, Poem Beginning and Ending with Today, Goodbye, La Jolla, THE F TRAIN, Delancey Street, May Twenty-First Twenty Fourteen, Storm, Hang a Left, Memorial Day, Twenty Fourteen, The 'F' Train, Lunch Poems, Church Avenue, Riding the F Train, Transcontinental, Morning, Flatbush, Corner of E. 10th and Church Avenue, Hudson, Lunch Follows Dinner, Philadelphia, Downtown/Uptown, Midtown, a Friday, Chelsea, Sunday, Sunday, The Blue Note, Seen from the 'Q' Train, Free Verse Editions, About the Author
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1 edition of Chicago psychoanalytic literature index 1971-1974. found in the catalog.
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It has occupied a central position in the educational programs of the Institute For Psychoanalysis since Dutton, - Literature - pages 0 Reviews Sixteen essays by psychoanalysts and literary critics on the influence of psychoanalysis on literature: the drama.
Top 10 books about psychoanalysis. Freud's work changed fiction and philosophy as well as ideas of psychology and sexuality. From Michel. Welcome to the therapist finder service of the Chicago Association for Psychoanalytic Psychology. This is a free service provided to the public by our organization.
Our members are all. : Psychoanalytic Literary Criticism (Longman Critical Readers) (): Ellmann, Maud: BooksCited by: "Cultural Graphology" could be the name of a new human science: this was Derrida's speculation when, in the late s, he imagined a discipline that combined psychoanalysis, deconstruction, and a commitment to the topic of writing.
He never undertook the project himself but did leave two brief sketches of how he thought cultural graphology might proceed. In this book, Juliet Fleming. "the most interesting psychoanalytic publication in the world today." –Josh Hoffs.
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The Unconscious, the Desires, and the Defenses. Freud began his psychoanalytic work in the s while attempting to treat. Upcoming Program. Chicago Psychoanalytic Society. Thetis R Cromie, PhD, DMn is a graduate of the Chicago Psychoanalytic Institute, the Institute for Clinical Social Work, the School of Social Service administration AND the Divinity School of the University of Chicago.
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Six score and 30 years ago, the 16th president of the United States delivered an address at the site of the major Civil War battle in Gettysburg, Pennsylvania. Thousands gathered at the site Tuesday to commemorate the 150th anniversary of Lincoln's Gettysburg Address, delivered on November 19, 1863. The speech would become part of the canon of American political compositions, ranking just below the Declaration of Independence, the Constitution, and the Bill of Rights in the hierarchy of America's "political scriptures."
Civil War historian James McPherson, Secretary of the Interior Sally Jewell, and Pennsylvania Gov. Tom Corbett were among the dignitaries who spoke at the anniversary observance. "Lincoln's timeless words embodied and galvanized us as a nation," Congressman Scott Perry (R-Pa), said at the event. "Everything we've achieved since that time ... was born out of the sacrifice of the soldiers that fought here and the patriots that followed through their footsteps throughout history."
The reverence accorded Lincoln's words in later years would no doubt have surprised many of those present at the event, as well as those who commented upon it in the highly partisan newspapers of the day. The prime speaking slot had been reserved for Harvard professor and celebrated orator Edward Everett, who made the most of it, speaking for two hours on that late November day. Lincoln's remarks, constituting a mere 268 words, were dismissed by some and ridiculed by others. The Democratic-leaning Chicago Times was notably scornful of the president's brief oration.
"The cheek of every American must tingle with shame," the Times scoffed,"as he reads the silly, flat and dishwatery utterances of the man who has to be pointed out to intelligent foreigners as the President of the United States." The Republican-leaning New York Times,on the other hand, reviewed the speech favorably, as did the Springfield Republican in Lincoln's home state of Illinois, praising the address as "deep in feeling, compact in thought and expression, and tasteful and elegant in every word and comma." What became the verdict of history was best expressed by the now mostly forgotten star orator of the day. In a letter to Lincoln, Everett said, "I should be glad if I could flatter myself that I came as near to the central idea of the occasion, in two hours, as you did in two minutes."
Lincoln is perhaps the most quoted of all American presidents, owing to the pivotal role he played in our nation's history and to his virtually unmatched talent for putting words together in succinct and memorable phrases. At Gettysburg he combined borrowed phrasing from the King James Bible ("Four score" seems somehow a more elevated way of counting years than a mere "eighty") with his own talent for juxtaposing words and syllable in a cadence and rhythm that appeals to the ear as much as, or more than, the mind. As Gary Wills noted in Lincoln at Gettysburg, Lincoln, in composing a phrase like "The world will little note nor long remember what we say here" has virtually guaranteed that the world would long remember and frequently quote what he said there.
But the historical accuracy of Lincoln's address remains open to debate. Was it, after all "Four score and seven years earlier" that "a new nation" was "conceived in liberty and dedicated to the proposition that all men are created equal"? Eighty-seven years from 1863 brings us, of course, back to 1776 and the Declaration of Independence. But were the signers of that document really dedicating themselves to the "proposition" of legal equality among men? Many of them, including the Declaration's primary author, Thomas Jefferson, were and would remain slave owners. And the Declaration, not being a legal document, did not bind them to the principles enshrined therein. Its purpose was to proclaim the rectitude of the colonists to a (supposedly) "candid world" in the hope of drawing support from other nations, mainly Great Britain's long-time adversary, France.
In 1776, the colonists were still a long way from achieving the independence they had declared, and further still from having "brought forth" a "new nation." The year, 1781, when the Articles of Confederation were adopted, announcing the formation of a "permanent union" might have a better claim to the starting point of a new nation. Better still would be adoption of the Constitution in 1787.
If the signers of the Declaration had "brought forth a new nation," they appear to have been unaware of it. They announced to the world "That these United Colonies are, and of right ought to be Free and Independent States," with all the rights and powers belonging to the same. The use of the plural was quite deliberate. What they "brought forth" was not a new nation, but "Independent States." Indeed in the treaty ending the war, Great Britain agreed to the terms of peace not with one nation, but with each of her former colonies.
Lincoln's conduct during the Civil War included the suspension of habeus corpus and the imprisonment without trial of editors, publishers, and legislators. Lincoln was much influenced in thought and rhetorical style by his favorite literary sources: the King James Bible, Aesop's Fables, Shakespeare's plays, especially Macbeth, and Pilgrim's Progress. The Constitution and its Bill of rights, not so much.
The Declaration, on the other hand, was something Lincoln held up as the American creed, claiming to have never had a political thought or sentiment that didn't spring forth from that noble document. Yet the Declaration of Independence was essentially a secessionist document, declaring the right of a people to free themselves of the political bands that bind them to another and to establish for themselves an independent government that "to them shall seem most likely to effect their Safety and Happiness." When the new Constitution was proposed in 1787, some states attached conditions to their ratification of it, including, in the case of New York and Virginia, the right to leave the Union if they saw fit.
That was the right Jefferson Davis was looking to test when he resigned from the U.S. Senate, after his state, Mississippi, declared its secession. After making his farewell speech in the Senate, Davis remained in Washington, waiting to be arrested and tried for treason. He hoped to have the question of whether states had the right to secede be decided in a court of law rather than on fields of battle. Davis, who became President of the Confederate States of America, was captured and imprisoned for a time after the war, but authorities of the United States never did charge and try him for treason. Perhaps they were afraid he would be found not guilty. It would have been, to say the least, embarrassing, if after a war costing the lives of some 600,000 on both sides, had been fought against secession, should be followed by a verdict declaring secession to be no crime.
A new nation was in fact created by the Civil War, but it was a nation at variance with the principles of independence espoused in the Declaration. It was a union, not "conceived in liberty" but imposed by blood and conquest, rather than a by voluntary association based on shared principles and aspirations.


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Home Leadership BOSTON CONFLAGRATION HAZARD STILL SERIOUS
BOSTON CONFLAGRATION HAZARD STILL SERIOUS
The engineers of the Committee on Fire Prevention of the National Board of Fire Underwriters have made public their report on their reinspection of the conflagration hazard and tire protection of Boston. The reinspection visit was made last December, when the engineers found that, despite improvements made in recent construction, the hazard in the congested value district continues serious. According to the report, this situation is due to weak structural conditions in the older buildings: the inaccessibility of interior blocks and frequent unprotected openings which also atld materially to the danger of sweeping fires. The report says in part:
"The features which make the potential hazard high in the congested value district are the grouping of seriously exposed, poorly accessible and structurally weak buildings, many with multiple occupancy, the lack of horizontal and vertical opening protection where especially needed, the many very large floor areas and the narrow streets, from which it would be difficult to make a stand against a conflagration. Across the center of the district is a grouping of fireproof buildings which should form a fire barrier; their efficiency as such, however, is greatly reduced by the large proportion of unprotected windows, and although they might prove barriers for a local conflagration, their efficiency in cutting off a fire of large proportions is very doubtful. The probability of sweeping fires occurring is largely dependent on the facilities provided to suppress them; the water supply is adequate and reliable, but at pressure only sufficient for engine supply, and the lire department, though efficient, is liable to be undermanned at certain times of day to such an extent as to be unable to cope with simultaneous fires in the congested value district without withdrawing the protection from the other parts of the city. An important mitigating feature is found in the many automatic sprinkler equipments and the window-opening protection. The conflagration hazard is considerably more marked in the section along either side and west of Washington street, where there are many high values, and the prevailing direction of winds would tend to carry a fire to the parts to the eastward. The probability of a conflagration extending over a considerable part of the district is serious. In the wharf district of Boston proper the conflagration hazard is moderate. The lumber district is liable to fires of conflagration proportions and exposes groups of congested joisted brick wood-working plants. Charlestown, South and East Boston have stretches of wharf properties in which serious fires are liable to occur and otherwise are built up with congested frame structures, which in many places afford opportunity for local conflagrations. In the congested parts of Dorchester and Roxbury, where three-story frame flat buildings are separated by narrow spaces affording many mutual exposures, the possibility of fires extending over considerable areas is very pronounced, and the hazard from flying-brand fires in those sections in which buildings are roofed with shingles is serious."
The city, which is credited with a population of about 680,000, covers an area of 12.08 square miles, of which 4.02 miles are unreclaimed flats and water service. The highest elevation in the city is 380 feet above sea level. There are 518 miles of streets, generally in good condition. The waterworks are under the jurisdiction of the Metropolitan Water and Sewerage Board These works also supply in whole or in part seventeen other cities and towns in the vicinity. Work on the construction was begun by the city in 1818 and have thus far cost about $41,000,000. The board is composed of Henry II. Sprague, chairman; Henry P. Wolcott and James A. Bailey, Jr., appointed by the Governor of Massachusetts, with the advice and consent of the council, for a term of three years. The consulting engineers of the board are: Joseph P. Davis, Hiram F. Mills and Frederic P. Stearns, the latter chief engineer from 1895 to 1007. Chief Engineer Dexter Brackett has been connected with the works since their inception, and has held his present position for the past four years. He is in charge of construction, maintenance and operation of the system. On February 1 of the present year the water department, together with several other city departments, was reorganized and placed under a commissioner of public works. Louis K. Rourke having been appointed to the position; F. A McInnes, who has been connected with the city engineer's office for the past twenty-one years, was made division engineer in charge of the water and sewer departments. C. J. Carven is engineer of maintenance. Supply is from works built by the city of Boston previous to 1895, and from the Nashua river watershed, developed by construction of the Wachusett reservoir by the Metropolitan Water Board since that time. The works formerly owned by the city consist of Lake Coehituate and seven reservoirs on the Sudbury river watershed, from which supply is delivered to the Metropolitan water district through the Cochituate and Sudbury aqueducts. Supply from Wachusett reservoir is conveyed by the Wachusett aqueduct to storage reservoirs on the Sudbury watershed, and thence by the Sudbury and Weston aqueducts to the distribution. From the terminals of the aqueducts water flows by gravity or is pumped through cast-iron pipes into distributing reservoirs for the supply of six services, five of which furnish water to parts of Boston. Elevations in this report are above Boston city base. The following description of the drainage areas which contribute to the supply are given in the order of their development:
Coehituate.—Area of watershed, 17.80 square miles; the yield per square mile is approximately as given below for the Sudbury watershed.
Sudbury.—Area of watershed is 75.2 square miles; average yield for the past thirty-six years, about 77,175,000 gallons per day. The lowest recorded yields were 1880 and 1883, when the average per day per square mile was 578,000 and 583,000 gallons, respectively. The driest six months of record was in 1910, when the yield for this period was at the rate of 29,000 gallons per square mile per day.
Wachusett.—Area of watershed. 118.90 square miles; average yield for the past fourteen years, about 134,362,000 gallons per day. Lowest recorded yield for a year was in 1910, when the average was 820,000 gallons per day per square mile. The driest six months of record occurred in 1910, the yield being at the average rate of 193,000 gallons per day per square mile.
There are ten storage reservoirs on the three watersheds, with combined storage capacity of about 81,000,000,000 gallons. All have well constructed dams, provided with waste ways and other appurtenances. They are maintained in excellent condition. Framingham No. 1 has a muddy bottom and is not much used; about 1,500,000 gallons per day are wasted to the river to meet power demands. Farm pond is not now an integral part of the system. The Coehituate aqueduct, built in 1848, from Lake Coehituate to Chestnut Hill reservoir, 13.3 miles; of eggshaped section, 5 feet in width and C feet 4 inches in height. Capacity under ordinary con ditions is 18,000,000 gallons in twenty-four hours; maximum capacity under head, 23,000,000 gallons. The Sudbury aqueduct has a capacity of 109,000,000 gallons per day; and the Weston aqueduct a maximum capacity of 320,000,000 gallons per day. Of the five pumping stations four supply water to the city of Boston. At the West Roxbury station the pumps take suction from the southern high service under a head of 80 feet and discharge against a head of 220 feel, supplying the southern extra high service by direct pumpage with an equalizing standpipe. Three pumps with an aggregate capacity of 3,750,000 gallons per day and three boilers aggregating 180 horsepower. The large unit is operated in the summer and one of the smaller in the win ter; one steam line supplies the larger and another the two smaller. Chestnut llill low servicestation is located about 5 miles west of the center of the city, near Chestnut llill reservoir. File station, supplemented by the gravity flow from the Weston aqueduct, supplies by direct pumpage the southern low service and Spot pond and Mystic reservoir, both distributing reservoirs of the northern low service. Suction is taken from a well fed through two 60-inch pipes from the reservoir, a 48-inch from the Cochituatc aqueduct, or a 48-inch from the effluent gate house. The equipment consists of three pumps with a combined rated capacity of 105,000,000 gallons per day. The three units serving the southern low service are connected to an equalizing tank in the station, with top at elevation 192; one is generally in reserve A 40,000,000-gallon high service pump is being installed. The three boilers in service aggregate 525 horsepower, which provides tor a proper reserve; two 300horsepower boilers are being installed. Steam piping in duplicate. Chestnut Hill high service station is located alamt 35n feet southwest of the low service station, supplies by direct pumpage the southern high service with equalizing reservoirs and the water repumped at the West Roxbury station to the southern extra high service. Equipment consists of four pumps with a combined rated capacity of 66,000.000 gallons per day. The larger unit is usually in use and the three smaller held in reserve; these latter are so connected that they can discharge in the southern low service. The seven boilers, aggregating 1,050 horsepower, allow a safe reserve. A single steam line feeds the two smaller units and each of the other units is fed by a single line: these three lines are well cross-connected in the boiler room The Spot pond pumping station pumps water to the northern high service, which includes in the city a small residential district in Breed's Island in East Boston. This station is equipped with a 20,000,000-gallon and a 10,000,000-gallon pump; average daily pumpage about 8,000,000 gallons. Of the ten distributing reservoirs there are five on services supplying some parts of the city of Boston, besides Fisher Hill reservoir and the standpipes on Bellevue Hill and Orient Heights, owned and maintained by the city. Stages of water are determined by self-registering devices either at the reservoirs or transmitted by cable to electric gage at the pumping stations. The larger reservoirs occupy natural basins, with earth dams, usually rip-rapped and paved : the smaller are in excavation and embankment. All are in good condition and kept full. Chestnut Hill reservoir, in addition to supplying the pumping station of the same name, can feed the southern low service by gravity. Consumption in each service in all of the cities and towns supplied is determined by meters, 73 of which are in use. Boston alone uses an average of 77.!> per cent, of the water used in the Metropolitan district. The average daily pumpage is about 104,000,000 gallons. In 1907 the daily rate of consumption far exceeded this amount and in order to cheek the enormous waste all cities and towns were ordered to meter all new services and 5 per cent, yearly of all old services, except those used for fire or public purposes. As a result the daily consumption in 1909 was reduced 6,305,100 gallons. Last year a still larger reduction was effected. The maximum daily consumption for the city of Boston occurred on February 10, 1910, and was 123,690,000 gallons, or 183 gallons per capita. The drop in pressure in times of maximum consumption between the low service pumping station to Boston Common has been reduced from 18 to 11 pounds. The general distribution is in five services; southern low and northern low, both supplied mainly by pumpage supplemented by gravity, southern high, northern high and southern extra high, all supplied by pumpage, the two former to reservoirs and the latter with an equalizing standpipe. Flevations throughout the area served range from tide water to 336. The southern low service supplies about one third of the area south of the Charles river, serving the greater part of the city proper, including over one-half of the congested value district, the principal lumber, warehouse and shipping districts, besides numerous important minor mercantile sections It also supplies most of South Boston, two-thirds of Brighton and small sections in the northeasterly part of Box bury and Dorchester, in all covering an area of about 9 square miles, in which elevations range from tidewater to 65. Three 18-inch mains extend easterly from the low service pumping sta tion, for distances of from 1 to 3 1/2 miles, where they divide into pipes of smaller size; two 30-inch and a 40-inch enter the congested value district, which is girdled by a 16, 24, 30 and 36 inch loop; a 24 and a 30-inch pass easterly through Roxbury and Dorchester, two 20-inch and two 30-inch mains supply South Boston and a 16 and 20-inch feed part of Brighton, which further receives a supply from a 16-inch connection to the 48-inch Metropolitan main which passes through this section. These feeders are well looped and are cross-connected when opportunity affords. The supply to this service can be reinforced from the northern low service through pipes 20 and 30 inches in diameter extending across the Warren street bridge from Charlestown. The entire area is well sub-divided by secondary feeders, 10, 12 and 10 inches in diameter, well looped and connected to larger mains. In the congested value district 65 per cent, of the mains arc 10 inches or larger in diameter; they are well cross-connected at street intersections and the block lengths are short. In the remainder of the city proper and in Roxbury there are about equal parts of 6 and 8-inch, with a fair proportion of 10-inch; and in South Boston and Brighton 6-inch predominates, with a small percentage of 8 and 10-inch; much of the pipe in the former district is over fifty years old. The system is generally well cross-connected,' with few dead ends, except in Brighton and the eastern part of Dorchester. The northern low service supplies by gravity from Spot pond and Mystic reservoir Hast Boston and the greater part of Charlestown and Breed's Island, comprising a total area of about 2.5 square miles, in which elevation ranges from tidewater to 75; generally compactly built up and mostly residential in character, although there are dock and warehouses sections of considerable importance, besides scattered minor mercantiles and manufactories. A loop of 16, 20 and 24-inch pipe extends about the area served in Charlestown and is fed by three Metropolitan mains, two, a 24 and a 30-inch, entering from the west and a 30-inch from the north. Secondary feeders, 12 and lb inches in diameter, are fairly well arranged. Three Metropolitan mains, a 20, 24 and a 30-inch, supply well arranged loops of 12, 10, 2o and 30-inch pipes in Hast Boston which in turn supply Breed's Island through two 12-inch lines. Secondary feeders are generally installed where needed. About equally divided between 6 and 8-inch, with 12-inch in the more important streets; mains well gridironed, with few dead ends. The southern high service supplies Beacon Hill in the city proper, including a portion of the congested value district, and by extension of mains furnishes sprinkler and standpipe supply to buildings in a considerable portion of the congested value district where supply for other purposes is from mains of the southern low service. Also supplies sections in the higher parts of ( harlestown and South Boston, mainly of thickly built-up frame residences, about onethird of Brighton and nearly all of Roxbury, West Roxbury and Dorchester, the last four mainly frame residential sections with occasional areas compactly built up. Supply pumped at Chestnut Hill high service station into the distribution system, with Fisher Hill reservoir, holding about six hours' supply when filled, as an equalizer. Elevations range from 20 to 180 throughout the area served, which is about 12.5 square miles. From the pumping station, two mains, a 30 and 36-inch, extend to Fisher Hill reservoir and continue easterly to the city limits as a 30 and 48-inch. They are cross-connected near the reservoir to a 48-inch Metropolitan supply main which extends from the high service station southeasterly through the city for the supply of territory beyond its limits, and three other similar connections are made to the city distribution system along its route. The supply to the city proper is furnished by one 12-inch and two 20-inch mains which unite on the Common and branch into five 16-inch mains. Roxbury, West Roxbury and Dorchester are served by 24, 30 and 36-inch mains, which, considering the connections with the Metropolitan supply mains, are ample for the service required. The areas in Brighton, South Boston and Charlestown are each supplied by a single 10-inch main. Secondary feeders in the Jamaica Plain section of Roxbury and in West Roxbury are incomplete; in other sections fairly well arranged.
The distribution system of the Metropolitan Waterworks which contribute to the supply of Boston comprises the following mains: From the terminal chamber of the Weston aqueduct a 60-inch main extends across the Charles river, there reducing to a 18-inch, which is laid to the Chestnut Hill reservoir; the portion east of the river is being paralleled by a 60-inch, about twothirds of which is laid, but only a short length mar the reservoir is in service: at the Chestnut Hill reservoir this line and the discharge mains from the low service pumps connect to three mains of the southern low service. Two 48-inch mains from the low service pumping station, supplied also from the Weston aqueduct, feed Spot pond, each connected by a 24 and 30-inch pipe to Mystic reservoir; the two latter extend easterly to Charlestown, supplying the northern low service; a 48-inch branch from the easterly 48-inch runs through Everett to Chelsea, where it divides into a 20, 24 and 30-inch, which cross Chelsea creek, supplying the northern low service in East Boston, and a 24-inch connects to a 3o-inch, which crosses the Mystic river into Charlestown. From the high service pumping station a 30 and 36-inch force main feeds Fisher Hill reservoir; a 48-inch rtms through West Roxbury, reduces to 30-inch and continues through Dorchester; a 30-inch feeds Waban reservoir; these mains are connected at numerous points to the city distribution system. Of about 94.5 miles of supply mains from 12 to 60 inches in diameter, about 44 miles, mostly 48 and 36-inch mains, contribute in whole or in part to supply Boston. These mains, with the exception of some short lengths acquired from municipalities, are less than fifteen years old; about 10 miles have been laid during the past six years. There are 701 miles of pipe, 40 miles of which have done service for sixty years; 8,103 public and 307 private hydrants and 10,278 gate valves in service. The average linear spacing of hydrants in the congested value district is 125 feet, and the area served by each hydrant is 40,000 square feet. In a representative residential district the spacing was found to be 290 feet and the area served by each hydrant 78,000 square feet. The flow from 70 hydrants in 14 groups, located within congested frame areas was measured by engineers of the National Board in March, 1911, to determine the probable fire engine supply available. Five or six hydrants were opened simultaneously and the discharge measured by means of Pitot tubes. The quantities obtained were in general sufficient for the protection of the surrounding areas. Nine hydrants, or 12 per cent, of those opened, failed to deliver 000 gallons per minute, a fair supply for a second size fire engine. These small discharges were due to the condition of the old 6-inch mains, as in all cases the residual pressure observed on the adjacent large mains showed that their ultimate carrying capacity had not been reached. That the carrying capacity of the supply lines to the congested value district is ample was shown by the break in the 30-inch main on Tremont street, when the consumption rate on the southern low service reached 100,000,000 gallons per day, which was 45,000,000 gallons in excess of the rate previous to the break; during this high rate of flow the recording gage on the Common showed a drop from 42 pounds to 5 pounds and that at Engine House No. 38, on Congress street, a drop from 49 pounds to 21 pounds. During the progress of the simultaneous fires on Albany and Purchase streets in August, 1910, the maximum hourly fire draft showed a fire flow of 20,000 gallons per minute. 4,000 gallons of which was used on the latter fire.
BOSTON FIRE DEPARTMENT.
The Boston fire department is organized on a full paid basis and is worked on a district basis. Each division consists of seven districts and is under the direct supervision of a deputy chief. The senior deputy chief is acting chief as occasion requires. The city is divided into one marine and thirteen land districts with a district chief assigned to each, who is held responsible for the condition and operation of the companies in the district; each takes charge at fires in his own district until relieved by a superior officer. There are six to eight companies in each closely built-up district and from five to nine in outlying districts. Total, 1,006. Fire force, 897. The total maintenance last year was 1,508,763. There are 11 engine. 2 fireboat. 27 ladder, 3 water tower and 13 chemical companies. Four of the engine companies are in two stations, forming double companies. Each double company has 3 officers, 2 engineers, 2 assistant engineers and 15 or 20 firemen, each of the other engine companies in the closely built-up districts has 2 officers, an engineer and assistant engineer and 8 to 10 hosemen, and in the suburban districts from 5 to 8 hosemen. Each fireboat has 2 officers, 5 pilots, 5 engineers and 4 hosemen. The aerial and ordinary ladder trucks, except No. 14. have companies of 11 to 14 members, including 2 officers; the combination ladder trucks have 7 to 9 men, including a lieutenant. The chemical engines are manned by 3 to 6 and the water towers by 3 to 5 men. including in each case a lieutenant. There are 44 engines in service and 10 in reserve. The engines are of double piston pump types and with three exceptions have been purchased or rebuilt within 11 years. Boilers are usually replaced after about 12 years' service; as a whole, the engines are in good condition. Each engine is provided with a hand relief and, in most cases, with a compound suction gage and rubber tires. They are uniformly equipped, each carrying two lengths of 4 or 4 1/2-inch hard suction with 4 1/2inch couplings, one length of 3 or 3 1/2-inch soft suction, a reducer connection, hydrant heads, gates and fresh water connections and hose. Three-horse teams are provided except for the two largest engines, which are self-propelling and seldom respond except to second alarm fires. Eleven of the engines in service were tested during February and March, 1911, by engineers of the National Board to ascertain their condition and capacity, and the ability of the crews. In general, they were in good working condition and delivered, on an average, 95 per cent, of their total rating, only one delivering less than 90 per cent. The engineers were mainly skilful, although several did not regulate feed water closely enough for operating to capacity. Stokers in several cases were not sufficiently familiar with the requirements of firing at capacity, and required instruction by the supervisor of engines. The need of a third man, trained in stoking, for duty when regular engineer or assistant engineers are off, was apparent. Engine 44, a fireboat, is equipped with electric lights and steam steering gear. Total rated capacity is 6,000 gallons per minute at 175 pounds water pressure. Engine 47, also a fireboat, is equipped with steam steering gear and electric lights. The total rated capacity of fire pumps is 6,000 gallons per minute at 175 pounds water pressure. A new fireboat will soon be put in service as Engine 31. Both fireboats in service were tested in hebruary, 1911, to ascertain their pumping capacity, the condition of the machinery and the ability of the crews. Engine 44 could deliver only 77 per cent, of its rated capacity, due mostly to the inability of the boilers to supply sufficient steam, but partly to the manner in which the boilers were stoked. One of the fire pumps showed excessive slip and connecting rods were rather free for full speed operating. There are also in service 3 water towers; 7 chemical engines, with 3 in reserve; I combination and 44 plain hose wagons, with 1 combination and 5 plain hose wagons in reserve; 104,150 feet of 2 1/2, 3 and 3 1/2-inch hose, aside from all minor equipments.
GENERAL SUMMARY.
Water Supply.—Supply works under jurisdiction of Metropolitan Water and Sewerage Board, an efficient organization. Supply ample, conveyed to the city bv gravity through conduits of sufficient capacity, and distributed in five services, partly by gravity and partly by pumping; nonfireproof stations, ample in capacity; distributing reservoirs contain 20 days' supply, those on the two Low services of ample capacity. Distribution system owned and operated by the municipality; water department recently reorganized. Consumption somewhat excessive, but being reduced by the installation of meters. Pressures moderate, well maintained under heavy drafts. Provision made for supply to sprinkler equipments in most high value districts. Large mains generally adequate and well arranged, except in unimportant outlying districts ; minor distributers of fair size, generally well gridironed and being improved. Carrying capacity of mains considerably affected; electrolytic conditions well handled. Gate valves regularly inspected; generally well spaced. Hydrants of good size, subject to moderately efficient inspection and well distributed.
Fire Department.—Full paid, under good supervision ; financial support liberal. Civil service regulations for appointments; training of members thorough, discipline good. Companies seriously undermanned during meal hours in vacation periods. Apparatus well distributed, of good type, generally in excellent condition and well supplied with minor equipment. Engines of satisfactory sizes and mainly in good condition. Three fireboats for additional protection along the water fronts. Excellent equipment for large streams. Hose mainly in good condition and regularly tested; supply ample. New repair shop in course of construction. Fire stations mainly well located. Response to alarms generally prompt and satisfactory; a general alarm leaves insufficient protection for other fires. Fire methods thoroughly modern. Inspections of buildings good; records are well kept.
FE Volume 49 Issue 18
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Fireground Pump Operations: Mastering the Panel
MASKS AND FOG STREAMS SERVE IN CONTROLLING STUBBORN BLAZE


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Segmented water consumption for leak identification and optimization of the decision-making process.
Return on investment after 1-3 years only based on energy savings.
User friendly platform with customizable interfaces to provide the best user experience.
Full assistance and after-sale service to platform users by mail, phone or remote access.
Provides the most appropriate oxygen dynamic set point and N/DN strategy to optimize nitrogen removal performance with minimum energy cost.of nutrient levels is delivered at the lowest energy prices.
Based on real-time oxygen demand, provides a strategy that guarantees oxygen levels applying dynamic pressure control, ensuring the maximum aeration system efficiency at a suitable MOV scenario.
Adjusts internal recirculation pumping according to nitrate levels, treated flow and retention in the anoxic chambers.
Optimizes sludge recirculation according to plant's treatment flow and sludge settlement conditions.
Based on theoretical measurements, records information and feeds the other controls with the most appropriate energy consumption practice according to the energy tariff plan (cost kWh).
Tracking energy measurements, provides information to the other controls and determines specific process/equipment ratios that enables problem detection, breakdowns and deviations.
Adjusts coagulant dosage to the evolution of the orthophosphate concentration or total phosphate in the treatment- plant influent/effluent.
Ensures N-removal efficiency with optimal external carbon source dosing in WWTPs that shows limited denitrification capacity due to shortage of organic matter availability in influent wastewater (low COD/N ratio).
Adjusts dosage of an external source of nitrogen in WWTPs with an excessive COD/N ratio, which hinders cell synthesis due to lack of nutrients.
In order to widen the scope of the nitrogen removal control system, the homogenization tank operates as a time-of-use tariff, storing water when energy costs are more expensive and feeding it to the biological treatment system when the energy tariff is cheaper.
Based on nitrification performance and water temperature, the system adjusts the sludge waste flow (or gives recommendations) to operate the process at the minimum sludge age required for achieving the desired effluent quality levels.
Design and implementation of controls to meet the specific needs of each process.
Based on real-time monitoring of the main operating parameters (mass load, VFA/ALK ratio, biogas production, etc.), water treatment capacity is optimized and the reduction of organic matter and biogas production are maximized. Energy usage is minimized in the subsequent aerobic treatment. This control significantly increases process robustness and reliability.
Optimizes polymer dose in real time, stabilizing the thickening process, increasing solids capture while reducing chemical dosing costs.
Optimizes polymer dose in real time, increase solids capture while saving money on sludge disposal and polymer costs.
Based on biogas production, storage and kWh cost, defines the cogeneration engine operating strategy to maximize power generation and/or adapt it to plant consumption patterns.


text:
import { Component, ViewEncapsulation } from '@angular/core';
import { NgbPopoverModule } from '@ng-bootstrap/ng-bootstrap';

@Component({
	selector: 'ngbd-popover-customclass',
	standalone: true,
	imports: [NgbPopoverModule],
	templateUrl: './popover-customclass.html',
	encapsulation: ViewEncapsulation.None,
	styles: [
		`
			.my-custom-class {
				background: aliceblue;
				font-size: 125%;
			}
			.my-custom-class .arrow::after {
				border-top-color: aliceblue;
			}
		`,
	],
})
export class NgbdPopoverCustomclass {}

redpajama_set_name: RedPajamaGithub


First in a series of "tech primers" on a range of topics. Created for a technical audience, that might be new to a particular topic or domain. I wanted to solve several things with these primers, combining both introductory overview content, but also technical reference material and deeper dives into various key areas.
This content can be used for presentations, used in labs & exercises but also given as handout/reading material.
I've been using Node.js quite a lot lately as I find it a nice quick way to get web projects started easily, and one of the things I've been doing is deploying and running my Node.js apps in Azure. Azure provides a number of ways of to run Node.js code within the platform, but I'll be focusing on the PaaS Azure App Services or Web Apps (more info), rather than VMs or anything strange.
I've done a live demo and run through of building and deploying a Node.js app to Azure using VSTS It also covers things like infrastructure as code (ARM templates) and the Azure CLI.
Recently I decided to move my Wordpress blog from where it is hosted in a virtual shared Linux environment (TSO Host) into Azure. The current hosting is fine and has served me well over the years, but seeing as my current job is working with Azure I wanted to experiment. In particular my role is focused on the PaaS web & app hosting services in Azure, so I wanted to see first hand what the experience was like, particularly for a non enterprise user.


text:
Organising Partners
Speakers and Moderators
Successful Drug Policies
Activist Summit
Harm Reduction Services
26-27 MARCH, 2019
Finger on a Trigger
Harm Reduction Conference 2019 - aims to mobilize local, regional and international stakeholders and create a platform for dialogue on priority issues, with key focus on ensuring sustainable access of People who Use Drugs to essential services in Transition period of donor funding, as well as Repressive Drug Policies limiting access to these services.
Conference is targeted towards government, policy makers, researchers, practitioners and affected communities.
Conference is envisioned to act as an advocacy instrument to influence national decision makers in implementation of obligations of sustainable state funding for harm reduction, as well as decriminalization of drug policy.
Conference is fighting for equal access to health and human rights for criminalized, repressed and forgotten communities.
Medecins Du Monde (MDM) Representation in Georgia
For more than 30 years, Medecins Du Monde, a campaigning medical organization committed to international solidarity, has been caring for the most vulnerable populations at home and abroad.
Open Society Georgia Foundation - OSGF
Founded in 1994 as a part of the Open Society Foundations' global network, the Open Society Georgia Foundation (OSGF) works to build vibrant and vocal civil society capable of holding government accountable to its citizens.
Georgian Harm Reduction Network - GHRN
GHRN was established in 2006 and currently network unites 26 Non-governmental organizations, whose activities are directly connected to the field of harm reduction, advocacy of human rights and related issues.
National Center for Disease Control and Public Health - Ncdc
Protection and improvement of health of Georgian population through scientific, evidence-based prevention, preparedness, and timely response to public health threats is a mission of NCDC.
Communico society
Communico Society, a Tbilisi-based CSO working on communications and civic campaigning, is responsible for developing and implementing communications strategy for the 2019 National Harm Reduction Conference.
info@harmreductiontbilisi.com
Created by Communico Society
© National Harm Raduction Conference Tbilisi 2019


OK, so it's not every day that we have celebrities check in at Paardeplaats Nature Retreat! All the way from Middelburg, came farmer Piet Schoeman and bean counters Chris du Plessis and Charmaine van der Merwe. And not light weights, these three. The Sudwala marathon on Saturday 5 May was just one of the regulars on their running menu, in preparation for Comrades. Piet did the Longtom Marathon in March – Chris and Charmaine couldn't come because they were trail running elsewhere.
Brian and Gerda had a look at some of their crazy runs through tough country – Rhodes, Golden Gate, you name it, they've done it!
Paardeplaats, they say, would make a good trail running venue, they say. What with it's 25kms of tractor paths and its high altitude. Good for the extra oxygen in your cells!


Laser whitening sounds appealing to many people, but it comes with its own risks. You will get to hear this even at the top dental clinic in Dubai. Let's have a look at what effects laser whitening has.
When you go for this option, don't assume that it will be permanent. With time the whitening fades away. There are customized trays that the dentists offer which you can use after the prescribed time to maintain the whiteness.
The treatments done at the dentist's office are more effective than the ones you do at home later.
Your fading time will be different from the other people. For some it can take as long as 6 months while others have to go for the treatment again within a month.
You have to bear this is mind that laser whitening is not for everyone. Even if you look for best teeth whitening in Dubai, you have to realize that it may or may not work for you. It has to do with the genetic makeup of ever individual, so you don't have to blame yourself if you are not the kind of person on whom it will work. Some have dark teeth due to their eating habits and carelessness while for others it is the genetic makeup.
The surface stains are easy to remove and come off effortlessly. On the other hand, the internal stains that are embedded deeper are hard to come off. You will have to go for an in-office treatment to get the deeper stains off.
The effective and fastest way to get the whitening done is going to the office. The zoom light in the office stimulates the hydrogen peroxide which then releases oxygen. These oxygen molecules get the stains off your teeth.
You have to be careful to not eat a list of foods and beverages for a week so that you don't spoil your whitening. Especially the coloured food has to be avoided. If you are a tea drinker, who is addicted to the drink, use a straw so that your teeth aren't stained with it.
There are many home-made recipes that can help you keep your teeth white as well.


text:
PisethSophannak Soun2020-01-09T17:21:03+07:00
Piseth
Year started at CFI: 2013
Education and previous experience: Piseth graduated secondary school in 1982. He worked as a solider in 1988 and became a motorcycle taxi in 1990, now he works at CFI.
What do you like about your job? "I love all kids and staff at CFI, they are friendly and kind."
How do you like to have fun? "I like helping my family doing house work and I like to watch sports"


Join us in this brain training game! Guide color particles from the container to the capacitor. Rotate bumpers to direct and alter particles' pathway. Carefully calculate the path to fill all the capacitors!
A fun logic puzzle where you have to explode blobs of water to clear the game field. Play strategically and cause huge chain reactions!


text:
Occupations Brutalise
The atrocities in Iraq surprise us only because we ignore colonial history.
By George Monbiot. Published in the Guardian 6th June 2006
That they have not seen his film is no impediment. That it has won the Palme d'Or at Cannes only quickens their desire for reprisals. Ken Loach has been placed in preventive detention and is having his fingernails pulled out.
Writing in the Times, Tim Luckhurst compares him – unfavourably – to Leni Riefenstahl. His new film is a "poisonously anti-British corruption of the history of the war of Irish independence. … The Wind that Shakes the Barley is not just wrong. It infantilises its subject matter and reawakens ancient feuds."(1) I checked with the production company. The film has not yet been released. They can find no record that Luckhurst has attended a screening. Last night he said he was "not prepared to discuss the matter".
At least Simon Heffer, writing in the Telegraph, admits he doesn't know what he's talking about. Loach, he says, "hates this country, yet leeches off it, using public funds to make his repulsive films. And no, I haven't seen it, any more than I need to read Mein Kampf to know what a louse Hitler was."(2) The Sun says it's "a brutally anti-British film … designed to drag the reputation of our nation through the mud."(3) Ruth Dudley Edwards in the Daily Mail pronounced it "old-fashioned propaganda" and "a melange of half-truths"(4). She hasn't seen the film either. Nor, it seems, has Michael Gove, who told his readers in the Times that it helps to "legitimise the actions of gangsters"(5).
Are these people claiming that events of the kind Loach portrays did not happen? Reprisals by members of the Royal Irish Constabulary and the Auxiliary division are documented by historians of all political stripes. During the period the film covers (1920-1921), policemen visited homes in places such as Thurles, Cork, Upperchurch and Galway and shot or bayoneted their unarmed inhabitants(6). Nor does any historian deny that they fired into crowds or threw grenades or beat people up in the streets or set fire to homes and businesses in Dublin, Cork, Limerick, Bantry, Kilmallock, Balbriggan, Miltown Malbay, Lahinch, Ennistymon, Trim and other towns(7). Nor can the fact that the constabulary tortured and killed some of its prisoners be seriously disputed(8).
It is also clear that some of these attacks were sanctioned by senior officers and politicians. In June 1920, in the presence of the commander of the Royal Irish Constabulary, the force's Divisional Commissioner in Munster (Colonel G.B. Smyth) told his men "You may make mistakes occasionally and innocent people may be shot but that cannot be helped … The more you shoot, the better I will like you, and I assure you no policeman will get in trouble for shooting any man." He advised that "when civilians are seen approaching, shout "Hands up!" Should the order be not immediately obeyed, shoot and shoot with effect. If the persons approaching carry their hands in their pockets, or are in any way suspicious looking, shoot them down."(9) Sir Henry Wilson, the director of operations in the War Office, complained that he had warned his minister – Winston Churchill – that "indiscriminate reprisals will play the devil in Ireland, but he won't listen or agree."(10) There was even a policy of "official reprisals": the homes of people who lived close to the scene of an ambush and had failed to warn the authorities could be legally destroyed(11).
Loach's hero, Damien, as many Irishmen were, is radicalised by a raid by the Black and Tans, who were members of the constabulary recruited from outside Ireland. As the film shows, they were responsible for much of the police brutality. The historian Robert Kee, who is a fierce critic of the IRA, remarks that while the police were at first slow to retaliate, their vengeance – exercised against innocent people – "further consolidated national feeling in Ireland. It made the Irish people feel more and more in sympathy with fighting men of their own"(12). The fighter Edward MacLysaght recorded that "what probably drove a peacefully-inclined man like myself into rebellion was the British attitude towards us: the assumption that the whole lot of us were a pack of murdering corner boys"(13).
There is no question that the IRA also killed ruthlessly – not just police and soldiers but also people they deemed to be informers and collaborators. But Loach shows this too (I have seen the film). The press hates him because he admits that the people who committed these acts were not evil automata, but human beings capable of grief, anger, love and pity. So too, of course, were the British forces, whose humanity is always emphasised by the newspapers. Ken's crime is to have told the other side of the story.
The other side – whether it concerns Ireland, India, Kenya or Malaya – is always inadmissable. The torture and killing of the colonised is ignored or excused, while their violent responses to occupation are never forgotten. The only aggressors permitted to exist are those who fight back.
Does it matter what people say about a conflict that took place 85 years ago? It does. For the same one-sided story is being told about the occupation of Iraq. The execution of 24 civilians in Haditha allegedly carried out by US Marines in November is being discussed as a disgraceful anomaly: the work of a few "bad apples" or "rogue elements". Donald Rumsfeld claims "we know that 99.9% of our forces conduct themselves in an exemplary manner"(14), and most of the press seems to agree. But if it chose to look, it would find evidence of scores of such massacres.
In March Jody Casey, a veteran of the war in Iraq, told Newsnight that when insurgents have let off a bomb, "you just zap any farmer that is close to you … when we first got down there, you could basically kill whoever you wanted, it was that easy."(15) On Sunday another veteran told the Observer that cold-blooded killings by US forces "are widespread. This is the norm. These are not the exceptions."(16) There is powerful evidence to suggest that US soldiers tied up and executed 11 people – again including small children – in Ishaqi in March(17). Iraqi officers say that US troops executed two women and a mentally handicapped man in a house in Samarra last month(18). In 2004, US forces are alleged to have bombed a wedding party at Makr al-Deeb and then shot the survivors, killing 42 people(19). No one has any idea what happened in Falluja, as the destruction of the city and its remaining inhabitants was so thorough. Even the Iraqi Prime Minister, who depends on coalition troops for his protection, complained last week that their attacks on civilians are a "regular occurrence … They crush them with their vehicles and kill them just on suspicion."(20) But like the Black and Tans the US troops have little fear of investigation or punishment.
Why should we be surprised by these events? This is what happens when one country occupies another. When troops are far from home, exercising power over people they don't understand, knowing that the population harbours those who would kill them if they could, their anger and fear and frustration turns into a hatred of all "micks" or "gooks" or "hajjis". Occupations brutalise both the occupiers and the occupied. It is our refusal to learn that lesson which allows new colonial adventures to take place. If we knew more about Ireland, the invasion of Iraq might never have happened.
1. Tim Luckhurst, 31st May 2006. Director in a class of his own. The Times.
2. Simon Heffer, 3rd June 2006. More poison from Loach the leech. Daily Telegraph.
3. Harry Macadam, 30th May 2006. Top Cannes film is most pro-IRA ever. The Sun.
4. Ruth Dudley Edwards, 30th May 2006. Why DOES Ken Loach loathe his country so much? Daily Mail.
5. Michael Gove, 31st May 2005. A truly radical film would dare to tell the truth. The Times.
6. Eg Robert Kee, 2000 edition (first published 1972). The Green Flag: a history of Irish nationalism. Penguin, London; Liz Curtis, 1994. The Caue of Ireland from the United Irishmen to Partition. Beyond the Pale, Belfast; Margaret Ward, 2001. In their own voice: women and Irish nationalism. Attic Press, Cork.
8. Eg Robert Kee – see note 6, pp 689 & 703.
9. Dorothy Macardle, 1951. The Irish Republic: A documented chronicle of the Anglo-Irish conflict and the partitioning of Ireland, with a detailed account of the period 1916-1923. Irish Press, Dublin, p361.
10. David McKittrick, 21st April 2006. Ireland's War of Independence: The chilling story of the Black and Tans. The Independent.
11. Robert Kee – see note 6, pp691-692 & 706.
12. Robert Kee – see note 6, p672.
13. Quoted by Robert Kee – see note 6, p674.
14. Julian Borger, 3rd June 2006. US soldiers cleared of murdering Iraqi civilians in raid. The Guardian.
15. Newsnight, 29th March 2006. Quoted by Medialens, 19th April 2006. 'You Could Kill Whoever You Wanted': War Crimes And The Struggle For Truth. http://www.medialens.org/alerts/06/060419_you_could_kill.php
16. Camilo Mejia, quoted by Paul Harris, Peter Beaumont and Mohammed al-Ubeidy, 4th June 2006. US confronts brutal culture among its finest sons. The Observer.
17. Julian Borger, 21st March 2006. Iraqi police claim US troops executed family. The Guardian.
18. By Reuters, 1st June 2006. In another town, Iraqis say US killed civilians. http://www.informationclearinghouse.info/article13459.htm
19. Neil Mackay, 23rd May 2004. The Wedding Party Massacre. The Herald.
20. Richard Oppel Jr, 2nd June 2006. Iraqi Assails U.S. for Strikes on Civilians. New york Times. (Corrected version: http://www.nytimes.com/2006/06/02/world/middleeast/02iraq.html?ex=1306900800&en=05f6623de51d300f&ei=5088&partner=rssnyt&emc=rss)
Posted in media, war - iraq


text:
Oberbek is a river of Mecklenburg-Vorpommern, Germany. It connects the Vilzsee with the Rätzsee.

See also
List of rivers of Mecklenburg-Vorpommern

Rivers of Mecklenburg-Western Pomerania
Rivers of Germany

redpajama_set_name: RedPajamaWikipedia


text:
The New York Society Library
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Books by Nicholas Romayne
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Nicholas Romayne (9/1/1756 - 7/21/1817)
Borrowing activity from 10/17/1791 to 5/19/1792.
Nicholas Romayne (September 1756, in Hackensack, New Jersey – 21 July 1817, in New York City) was a physician of the United States.
read this on wikipedia.org
Nicholas Romayne Library Average
Circulation records from 1793-1799 are lost.
Books by subject area
As classified in the 1813 Library Catalog.
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Rep.
The life of Jane de St. Remy de Valois, heretofore Countess de la Motte. containing a circumstantial and exact Detail of the many extraordinary Events which have attended this unfortunate Lady from her Birth, and contributed to raise her to the Dignity of Confidante and Favorite of the Queen of France; Some further particulars relative to the Mysterious Transaction of the diamond necklace; Her Trial, Condemnation, and Imprisonment in the Salpetriere; her almost miraculous Escape from thence
Transcribed: Memoirs de la Motte Jeanne de Saint-Rémy de Valois 10/17/1791 10/24/1791
Coombe Wood; a novel
Transcribed: Combe Wood Mrs. Susannah Gunning 10/26/1791 10/28/1791
The history of the American Revolution. By David Ramsay, M.D. In two volumes. ...
Transcribed: Ramsays war David Ramsay Volume 1 10/28/1791 11/7/1791
Transcribed: " David Ramsay Volume 2 11/7/1791 11/12/1791
The casket; or, double discovery
Transcribed: Casket 11/22/1791 11/23/1791
The works of Laurence Sterne. In ten volumes complete. Containing, I. The life and opinions of Tristram Shandy, gent. II. A sentimental journey through France and Italy. III. Sermons.-IV. Letters. With a life of the author, Written by himself. Volume the first.
Transcribed: Sterne Laurence Sterne Volume 9 11/23/1791 11/29/1791
Transactions for which no related book has been identified.
Transcribed: Essays 12/7/1791 12/15/1791
Transcribed: Cullins Pr... 1/23/1792
Harrison's British classicks.
Transcribed: Classics Volume 4 4/4/1792 4/5/1792
Transcribed: " Volume 5 4/5/1792 4/7/1792
Transcribed: " Volume 6 4/7/1792 4/10/1792
The history of Sir Charles Grandison. In a series of letters. By Mr. Samuel Richardson. In seven volumes.
Transcribed: Grandison Samuel Richardson Volume 1 4/12/1792 4/17/1792
Transcribed: " Samuel Richardson Volume 2 4/14/1792 4/19/1792
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Charging Ledger: 1789-1792
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