text:
Supplemental Radiologic Technologist - LBJ Hospital
Fellowship in Advanced Ventricular Arrhythmia Mapping and Ablation
St. George's NHS Foundation Trust
Applies radiographic procedures to patients for diagnostic purposes
H.S. Diploma or GED
Certified by State Health Department.
Graduate of an approved School of Radiologic Technology
If a new graduate, must be Registry-eligible and become registered by the American Registry of Radiologic Technologist and Certified by State of Texas Department of Health within 12 months of graduation date.
Communication Skills: Above Average Verbal (Heavy Public Contact), Writing/Composing Reports
Analytical, CRT, and Medical Terms
Work Schedule: Flexible
Equipment Operated:
All ionizing Radiation equipment
About Harris Health System
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.
Connections working at Harris Health System
https://careers.HRSonline.org/jobs/17989723/supplemental-radiologic-technologist-lbj-hospital

redpajama_set_name: RedPajamaCommonCrawl


text:
SYNONYM

#### According to
The Catalogue of Life, 3rd January 2011

#### Published in
Tabl. école bot. ed. 2:108. 1815, nom. nud.

#### Original name
null

### Remarks
null

redpajama_set_name: RedPajamaGithub


text:
Pensions and the European Semester: From National to Supranational Policy Domain?
By Igor Guardiancich and Mattia Guidi
The European Semester has proved to be more powerful than expected in shaping national pension debates and outcomes.
#Eu Commission
#European social model
#Pensions
#Welfare
Although national welfare states have been, historically, bastions of national sovereignty, European integration has eroded the their external boundaries and reduced the member states' capacity to control them. As Maurizio Ferrera and others predicted, these changes have both transformed European welfare states from sovereign to "semi-sovereign" entities, and created an unstable compound in the social protection sphere, which may lead to strains in terms of social cohesion, institutional coherence and political legitimacy. Nowhere has the erosion of national sovereignty in the welfare sphere been more visible than for old-age pensions in connection with the launch of the European Semester—the EU's key tool for economic policy guidance and surveillance—and, to a lesser extent, of the Europe 2020 agenda.
In general, the Commission sees pension reforms not as a one-off event but as a continuous process, which applies to Member States in a differentiated manner, like the Lisbon process: it does not matter where you are, but rather the distance that you have travelled.
The European Semester was introduced in 2011, at the height of the sovereign debt crisis, in order to increase coordination among EU member states' macroeconomic policies. With regard to pensions, one of the Semester's key programmatic documents, the first Annual Growth Survey (AGS), set the train in motion regarding measures to be adopted in order to increase the fiscal sustainability, but at the same time also adequacy of national pension systems. The first AGS contained five key measures: countries were invited to 1) increase the retirement age and link it with life expectancy; 2) reduce early retirement schemes, improve the employability of older workers and promote lifelong learning; 3) support complementary private savings to enhance retirement incomes; 4) avoid adopting pension-related measures that undermine the long term sustainability and adequacy of public finances; 5) review, on behalf of the Commission, the new measures in line with the 2010 Green Paper on Pensions and of the Directives on occupational pensions. The European Semester hence espoused a three-pronged strategy, based on higher retirement age and restricted eligibility, efficient labour markets for elderly workers and enhanced complementary savings. In general, the Commission sees pension reforms not as a one-off event but as a continuous process, which applies to Member States in a differentiated manner, like the Lisbon process: it does not matter where you are, but rather the distance that you have travelled.
As regards the need to increase coordination in social policies, the new Europe 2020 strategy replaced the Lisbon Strategy in 2010, including new instruments for re-calibrating social policy. Among the various domains falling under the vast social policy umbrella, old-age and disability pensions have been at the core of this policy-making exercise.
Since its inception, the European Semester has elicited a growing research agenda among scholars, who have analyzed several of its aspects, such as its democratic legitimacy, its role as part of EU economic governance, its socialization as experimentalist governance tool, and its openness towards the social partners. What has remained partly neglected is the impact of the European Semester on various aspects of social policy. There are few studies that cover most of the Semester's existence: Stefan Clauwert carried out the only comprehensive survey of the Country-Specific Recommendations (CSRs) in the social field. Sonia Bekker produced, for a shorter timespan, a more nuanced assessment, which differentiates between various legal bases, thereby providing a thorough analysis of the social aspects of CSRs. However, what is still missing is a critical assessment of the Semester's effectiveness and causality mechanisms.
Such a study should ideally identify the links between inputs (reflected through the evaluations present in the Country Reports and in a succinct way in the recitals of the CSRs), outputs (the recommendations themselves) and outcomes (the ensuing reforms at the member state level). Something of the kind has been pioneered by Azzopardi-Muscat et al. for healthcare. In the realm of pensions there are so far only impressionistic accounts that do not allow for generalizability. In this contribution we present some preliminary results of a broader assessment of the Semester's impact on national old-age pensions through research that combines content analysis with quantitative methods to find correlations between recommendations and structural factors in individual Member States.
Mapping pensions-related recommendations
Our qualitative content analysis (using the programme NVivo) of European Semester documents—both the CSRs and the Country Reports—has yielded two important findings, which partly corroborate past research, but at the same time shed new light on the new dynamics of European pension policymaking. First, the sheer complexity of the CSRs (which is further expanded in the recitals) requires detailed and policy-specific knowledge to be coded. As shown in the table below, we distinguished 15 different recommendations (first cluster in Table 1), which can be then regrouped into four larger categories (second cluster).
Table 1: A classification of European Semester recommendations on pensions
Second, a frequency chart of the recommendations (shown in Figure 1) confirms the "overt secret" that the two legal bases, i.e. the Stability and Growth Pact (SGP) and Europe 2020, weigh differently on the recommendations. The CSRs are biased in favour of sustainability as there is no real legal basis to push for improved adequacy (a matter for concern in several member states). Hence, adequacy is reinterpreted by the Commission as intervention on the labour market for elderly workers. Increasing the employability of workers before retirement, reducing the gaps in coverage as well as, as corollary, shifting the burden of financing from labour to general taxation are all part of the greater adequacy package.
Figure 1: Pensions-related recommendations by type, 2011-15.
Finally, as the sustainability agenda seems to have been particularly effective, fiscal recommendations are slowly slipping out of the CSRs. This is a consequence both of reform achievements and of the Juncker Commission's pledge to limit the number of recommendations and prioritize the most relevant points only (see Figure 2).
Figure 2: Total number of pensions-related recommendations per year
More stability, less adequacy
As for implementation, while it is true that causality is difficult to demonstrate, the 2015 Ageing Report unambiguously shows that the adoption of several types of Automatic Stabilizing Mechanisms (ASMs) has spread fast in recent years. The explicit recommendation thought up by the European Commission to link the statutory retirement age to life expectancy (and similar measures), based upon the pioneering reforms in Denmark, is a measure that balances future pension stability with its adequacy. As there is no silver bullet, beneficiaries have accepted to save more, receive lower benefits or work longer, thereby postponing retirement. Of the three, the latter option is the most palatable, provided that the labour markets are ready to brood into uncharted territory.
The recommended fiscal stability measures have undoubtedly borne their fruits. The flip side of the coin, however, is the ineffectiveness of the Semester's social leg. Benefit adequacy, for which an effective legal basis is missing, is becoming a pressing issue in several countries.
Note: * without automatic adjustment
Table 2: Stabilizing mechanisms by country.
Among other notable measures adopted with the Semester's framework, the statutory retirement age of women and men is being gradually equalized in all member states, except in Bulgaria and Romania. Only in the latter, plus Luxembourg and Sweden (whose system, however, is well balanced), is the effective retirement age not bound to increase between 2014 and 2060. The combined effect of reduced benefits, lesser access to early retirement and higher statutory retirement ages implies that for the first time the overall projection for the EU and, partly so, for the Eurozone is a reduction in average pension spending between 2013 and 2060. The peak is reached sometime around 2037, when expenditures are expected to start gradually declining.
Hence, the recommended fiscal stability measures have undoubtedly borne their fruits. The flip side of the coin, however, is the ineffectiveness of the Semester's social leg. Benefit adequacy, for which an effective legal basis is missing, is becoming a pressing issue in several countries. For example, in Latvia, overall old-age pension spending is bound to decline for an already low 7.7% of GDP to 4.6% by 2060 with severe repercussions on the poverty rates of pensioners. So far, most adequacy-related recommendations were contained in the more detailed Country Reports, but their implications have been disregarded by both the member states and the Commission in its assessments.
The overall lesson is clear and similar to the one highlighted by those studies that have analyzed the growing importance of the community method in influencing national pension debates. Social policy experts have, with some exceptions, such as the work of David Natali, Igor Guardiancich and Alexandra Hennessy, for too long disregarded the European dimension of pension policy-making. We are currently witnessing the dawn of a new era, where national retirement systems, similar to labour markets, are both subject to supranational monitoring and regulation as well as mutual, trans-national peer review and multilateral surveillance. Hence, it is time for academics and practitioners to take notice.
Photo Credits CC Pedro Ribeiro Simões
Is free movement a threat or a boost to welfare states?
By Maria Giulia Montanari
Mobile European citizens have been repeatedly alleged to represent a burden on national welfare systems. Nevertheless, this might not emerge to be the case when one considers real data. Leaving public misperceptions about migration aside, this article points out the pros and cons of EU free movement for national welfare budgets.
From cosmopolitans to "Eupolitans": citizens' attitudes on welfare before and after Maastricht
By Francesco Visconti
Attitudes towards access to social security benefits have gained importance with the increased salience of EU affairs and immigration. Trans-national solidarity has been reduced from a cosmopolitan to a "Eupolitan" dimension.
National welfare states Vs free movement: was Milton Friedman right? A look at the EU
By Clare Fenwick
In light of recent political movements such as Brexit and the support given to far-right political candidates in general, the issue has become more prevalent and controversial than ever. Thus, it is not hard to argue that increasing immigration presents difficulties and challenges for the future of European welfare states.
Why Current Restrictions on EU immigrants' Access to Welfare Rights should be Lifted
By Dimitrios Efthymiou
What restrictions in terms of access to its welfare system, would an EU member-state in a free movement Union opt for if it didn't know how the benefits and costs of freedom of movement would be distributed among the Union's member states?
«The REScEU Mass Survey provides evidence of the difference between Germans' and Italians' approval levels for financial bailouts and their views about who is to blame for the recent Eurozone crisis»


Jose Feliciano sang the Star Spangled Banner at a naturalization ceremony for 20 new American citizens at the Smithsonian National Museum of American History and later gave his Concerto Candelas guitar and other items from his personal collection to the Smithsonian.
Director Roman Polanski's film, "Rosemary's Baby," starring Mia Farrow, John Cassavetes and Ruth Gordon premiered in the United States.
American actress Yasmine Bleeth, who was in television's "Baywatch" and also in soap operas "Ryan's Hope" and "One Life to Live," was born in New York City.
Forty years ago members of the Off Soundings Club, with bases in Connecticut, Rhode Island, and Long Island, visited Shelter Island with 193 vessels, each with about five crew members aboard. It was part of the Off Soundings Club's spring series that filled Dering Harbor with colorful sails blowing in the wind during the races that started a bit late because of fog.
Members were hosted by the Shelter Island Yacht Club at cocktail parties during their two-day visit.
POSTSCRIPT: The Off Soundings Club will be back in local waters, sailing in Greenport Harbor and Gardiners Bay in mid-September.
The Chamber of Commerce fireworks display was in the seventh year in 1988 at Crescent Beach when Police Chief George Ferrer suggested maybe it was time to end the annual event. Some neighboring towns had ended their Fourth of July fireworks and the chief speculated that would lead to even more people coming to Shelter Island for fireworks here. He suggested the event caused too much disruption.
The result after his words to the Town Board were reported was to hear from a raft of Islanders saying how much they valued the annual fireworks display and didn't want the event ended.
It didn't end then. In its 58th year, the Chamber of Commerce was faced with a tough decision to abandon funding the fireworks since most of its time and energies were consumed by that one event.
That brought forward a group of Islanders who took over the annual fireworks display and since 2015 have raised the funding and arranged logistics to keep the event going.
POSTSCRIPT: This year, the annual fireworks display at Crescent Beach is scheduled for July 7 when Fireworks by Grucci will be celebrating the 60th straight year of the community event.
In 1998, Jim Richardson was race director, preparing for the upcoming Shelter Island 10K. He had been organizing the race initiated by South Ferry's Cliff Clark for a number of years and was as excited as ever about the race that would bring money to several charities.
At the same time, he told the Reporter that he wasn't anticipating many world-class runners in 1998, while predicting that would change for the next year when the race would celebrate its 20th anniversary.
POSTSCRIPT: This year's race is on June 16 and an estimated 2,000 are expected to participate in the 10K run or 5K walk with elite runners Joan Benoit-Samuelson and Bill Rodgers again expected to run.
Ms. Benoit-Samuelson won the 1984 Olympic Gold Medal in the Los Angeles-based race — the first women's Olympic marathon — beating famed runner Greta Weitz. She was subsequently elected to the U.S. Olympic Hall of Fame.
While a senior at Bowdoin College, she entered the 1979 Boston Marathon as a virtual unknown and won, setting a record for American women. Following surgery on her Achilles tendons, she again won the Boston Marathon in 1983.
Mr. Rodgers ran in the 1976 Olympics in Montreal, but was hampered by a metatarsal problem. He is a four-time winner of the Boston and New York marathons and a winner of the 1977 Fukuoka Marathon.
Lightning, 50 mph winds and rain that blew sideways in sheets left 38,000 Long Island customers without power with 2,998 of them here on Shelter Island. Many had their power restored that night, but for some it would be at least two days before they had service back.
POSTSCRIPT: This year, the Island has faced rain storms on a continual basis, although few electrical outages occurred since PSEG had cut back tree limbs that were touching wires and put up new poles in many areas, improving the viability of the system. Town officials have continually praised the responsiveness they receive from the utility company that has regularly stationed a crew on the Island whenever a major storm was due and responded quickly as they did this week when only five houses were without a power in the Ram Island Drive area.


text:
(226) 461 29 40 info@herseklagunu.com
HOW TO GO?
BIRD COUNTING TABLE
Hersek Lagoon has been designed as the first and only ''Accessible Protected Area'' which serves the handicapped and their families.
Hersek Lagoon also offers a suitable living space for summer migrants who come for breeding during the summer months. In the area, there are important bird species that breed in colonies, especially on the coastline between the sea and the lake.
Hersek Lagünü
It is 27 km away from Yalova and is located within the boundaries of Altınova District. The area is 167 hectares. It was registered as a Wetland with Local Importance on 23.02.2016. The lagoon is separated from the Marmara Sea by a thin coastline.
The Hersek Lagoon is Turkey's only lake that has a title deed certificate. According to the sources, the title deed of the lake was given to Hıfzı Bey, who settled in Lake Hersek from Thessaloniki. Refik Hıfzı Bey donated all his assets to Darülaceze in 1950.
Osmangazi Bridge is the crossing point of not only people but also birds
The Osmangazi Bridge, whose construction was completed after curving, enables large-winged migratory birds to pass easily with the heat wave it creates on it.
Bird species increased to 230 in Hersek Lagoon
Hersek Lagoon, which is one of the most important wetlands of the Marmara Region in terms of bird diversity ...
Turkey's project opened the Ministerial Pakdemirli
the first and only of its kind in Turkey Herzegovina Lagoon Nature Education And Disability Compatible Bird Observation Tower, Agriculture and Forestry Dr. It was put into service by Bekir Pakdemirli.
Hersek District Altınova / YALOVA (226) 461 29 40 info@herseklagunu.com
Daily: 13
Monthly: 137
Yearly: 1173
Canada Copyright 2020 © All rights reserved.


Discussion in 'Photos' started by jalil, Sep 8, 2016.
Mr.P, Fahad, Habz786 and 7 others like this.
WOW!!!!!! Steven, that is an amazing collection!!!
Oudamberlove, RisingPhoenix and Sproaty like this.
Oudamberlove, MzM, RisingPhoenix and 1 other person like this.
Kashmiri musk and a vintage 2002 Mysore sandalwood oil ( IO ).
That IO Mysuru 2002 is great on it's own and just perfect for blends...I tried it with some Turkish rose and the dry down was incredible!
MzM, Oudamberlove, Sproaty and 2 others like this.
MzM, Oudamberlove, RisingPhoenix and 1 other person like this.
Sproaty, RisingPhoenix, MzM and 1 other person like this.
Many of the agarwood collections I see here, like his one, are amazing and humbling. Some of you have a breadth of experience in the agarwood realm that is incredible. New or not new, it's what you are able to smell and experience that matters. Nice job building and organizing such a collection !
Rashid Javed, Hamza H, MzM and 4 others like this.
RisingPhoenix, MzM, Sproaty and 1 other person like this.
ahh now that's some next-level effort that I can't be bothered with!
Ersel, RisingPhoenix, tyson and 2 others like this.
RisingPhoenix, Tarik and Sproaty like this.
Tarik, MzM and Hamza H like this.
Ps: Behind Muana Royal its Oud Ayoub.
And behind ORSL it's Oud Ebrahim.
Sproaty, Fahad, MzM and 1 other person like this.


Nice Market Games is a mobile game developer based in Taipei. Focus on sports game particularly. Its target is build up a sports world let fans can campaign online. Nice Market Games has brought three games to the market Basketball Gangs 2, Basketball Gangs and Power Soccer since 2014.
Nice Market Games is a develop game company focus on sports game.
Basketball Gangs is the first product of Nice Market Games. R & D team hopes to simplify control of the basketball game. Make play basketball easier on smart phone.
Collect popular players. Build dream team.
Make play basketball easier on smart phone.
Focus on second generation product.
Through experience of generation one and background data analysis give second generation more resource.
Original skill card system. Strengthen degree of RPG.
Development network technology. Make players campaign online.
R & D team more and more strong.
Go game expo with computer associations, foreign trade associations, and game development association. Sell products and find overseas partners.
Copyright © 2018 Nice Market Games Ltd. All rights reserved.


text:
musings on womens health
Reflections on 40 years as a doctor in Women's Health
October 29, 2014 by gozzter
Uterine Transplants
I just knew it was going to happen; I could feel it in the air: a live and healthy baby delivered from a transplanted uterus.
It was the womb's turn. After all, people have been trying to transplant stuff since anatomy began. Unfortunately, before the concepts of physiology, infection and immune rejection were appreciated, they all failed. Miserably.
There were exceptions, of course, such as the successful kidney transplant between identical twins in 1954 -where their immune systems were obviously identical as well- but until the ability to avoid the toxicity of anti-rejection drugs was improved, organ exchanges were limited to the desperate or the foolhardy.
A few solitary successes occurred late in the 19th century with skin grafting, but until good immune suppressors like cyclosporin (1970) were developed, most organs –that is to say, most patients– didn't survive for more than two or three weeks.
And then it took off. Kidney transplants are now routine; heart transplants -while more dramatic because of the need for a healthy organ from an individual who is unfortunately unable to use it any more- no longer garner headlines like Dr. Christian Barnard's first success in 1967.
And the list of organs being transplanted is beginning to read like an anatomy textbook. Everything from pancreas to lung, combo packs like heart/lung, and even an entire face in 2013. If you can name it, somebody somewhere is trying to transplant it. So it was surprising that the poor uterus was left sitting in the shadows for so long.
In fairness, though, it had been attempted several times before in various medical centers, with little success –ie ability to do what the uterus was designed to do: incubate and deliver a live, healthy baby. Not until the 2013 transplant in Gothenburg Sweden, with Dr. Brannstrom's surgical team was a live baby born from a uterus a year after it was installed. Everything seemed to work –the recipient began to menstruate regularly- so one year after the transplant, having cryopreserved an embryo beforehand, it was placed into the uterus and followed closely as it developed.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61728-1/abstract
The baby was born prematurely (at 31 weeks and 5 days, rather than at the average 40 weeks) because, although blood supply to the uterus was apparently normal, the patient developed pre-eclampsia (pregnancy-related high blood pressure) and there were some problems with the baby's heart rate that apparently mandated delivery.
Were these complications the result of the transplanted organ (the donor was an unrelated 61 year old post-menopausal woman), the immosuppressants (she was on a triple therapy consisting of tacrolimus, azathioprine, and corticosteroids), or just bad luck? And would such a transplant be able to function normally –like a transplanted heart, say- and contract efficiently enough to enable labour and vaginal delivery? Or would a caesarian section be required in all cases? It's probably too early to say.
So congratulations to the parents and the transplant team. Fortunately, the need for uterine transplantation is uncommon, and adoption, or even surrogacy remain as other less drastic options. But it seems to me there are issues that, despite the success, have yet to be adequately addressed.
Ethical issues, for one thing. Unlike, say heart or kidney transplants where death may ensue if transplantation is not available in a timely fashion, the uterus is not essential for the continuation of life. And the procedure entails sophisticated, difficult and risky surgery that is frought with possible life-theatening complications in and of itself –including, of course, rejection of the organ despite the immunosuppressants. The surgery, by the way, is far more arduous and byzantine than the routine hysterectomies that are over-performed around the globe –extra tissue has to be obtained along with additional dissection to be able to reconnect the arteries and veins efficiently. So both donor and recipient are at increased risks…
But what troubles me the most I suppose, are the possible long term effects of the immunosuppressants on the developing foetus growing inside the transplanted organ. Azathioprine, for example. It interferes with DNA synthesis, and inhibits the proliferation of quickly growing cells… That seems a lot like what needs to happen in a rapidly growing foetus, doesn't it? Azathioprine is a pregnancy Category D substance: to be used in life-threatening emergencies only when no safer drug is available. And there is positive evidence of human foetal risk. Even tacrolimus doesn't have a lot of available human studies in pregnancy.
No doubt safer and more predictable immunosuppressants will be found, but for now I remain concerned that we may be trading something away. Just because we can do something, doesn't mean we should. Unlike other organ transplants where the risk is assumed by the recipient alone, uterine transplants for reproduction share the risks with a rapidly developing and vulnerable foetus which might not manifest any problems until years in the future.
I realize I may be dismissed as a male Cassandra, a person who cannot see dawn through the warp and weft of the cobwebs of his past, but sometimes we have to stand back for a moment. Sit down and think things through. Decide whether we've gained more than we've lost, and whether it will be too late to change our minds if and when some damage is revealed.
In this case, one would be well to think of Mabeth's dilemma:
I have no spur to prick the sides of my intent, but only Vaulting ambition, which o'erleaps itself
Tagged azathioprine, Cassandra, corticosteroids, cryopreserved embryo, Dr. Christian Barnard, Dr. Mats Brannstrom, immunosuppressants, medical ethics, pregnancy, tacrolimus, Uterine transplants
FHR: Fetal Heart Rap
When I was a child, I was fascinated with noise. Well, perhaps sounds would better describe what interested me. What were they –I mean really? And what happened to them after I heard them? When I was finished listening and if there was nobody else around to use them, what occurred then? Sounds told us stuff –information- and I didn't think Nature would just throw them away. So were they like the wind and simply moved on after touching my ears, or did the data get stored somewhere? Collected and saved –someplace chock-a-block with noise bouncing off every wall, or stacked neatly in little, labelled piles? Maybe there was a sound library somewhere. And when I discovered echoes, I thought I was getting close: recycled sound. It was like taking a book out of that library.
As I grew older –I was going to say matured, but that never really happens, does it?- the riddle of the information contained in sound only intensified for me. I mean, where is it? I even wrote a novel to explore my fascination with it (Sound Bites) that's published somewhere Googleable online, but that didn't quell the itch… I began to wonder if I was haunted by something –an idée fixe.
When we are enchanted by something, does that make it more likely we will find it? Or just more likely that we will look for it..? Seek, and ye shall find. But even more mysteriously, does it find us?
FHR. Every obstetrician –every nascent parent- knows what that stands for: Fetal Heart Rate. Along with uterine contractions, it's what we measure on our monitors in delivery rooms around the world. More importantly, it's the sound that connects us to that inner intrauterine environment. The hidden world. It's the baby talking to us, giving us a weather report directly from that moist, warm space where we all once lived.
And it's not a one-off either. Midwives, doctors -and increasingly, parents- are regularly tapping into it for news. Information. Meaning. It's a sound fraught with emotion and expectation –the unopened present.
But I recently got to unwrap the present in an unexpected venue, in an unforeseen medium: music.
"Would it be okay if my uncle came to one of my appointments?" Cynthia was a tiny little woman from the Caribbean that was seeing me for her first pregnancy. She spoke with a delightful accent and every sentence was embedded in an almost musical rhythm. It was as if she was singing to me… She was certainly one of my favourite patients and I looked forward to her visits.
With the notable exception of her husband –another small person who usually sat quietly at her side with an embarrassed smile on his face- I hadn't met any of her family. "Of course he can come with you, Cynthia," I said. "Your aunt, too, if you want…"
She shook her head, and ringlets of rich, shiny hair escaped from her headband like children at recess. "No, my aunt is no longer with us…" She blinked and then a huge smile invaded her face and her eyes twinkled like crumpled foil in the overhead lights. "Uncle Ed raised me pretty well by himself…" She seemed to hesitate for a moment before continuing. "But now he says he's curious."
"Curious?" Now I was curious.
She nodded her head, and her hair came out to play again. "About the sound."
"The sound? I don't…"
"You know, doctor. The sound!"
My face must have galvanized her husband because he realized he finally had a role to play: the interpreter. "She means the sound you play from the baby each time we come, doctor."
"The baby's heart rate?" I tried not to make it sound like a question. More like an acknowledgment of a point made. They both nodded their heads in a sort of random unity, and smiled. The doctor had understood.
"Well, I'll try to put on a good show for him, then."
Cynthia glanced at her husband and a surprised expression flitted briefly over her face; she suppressed it as she turned back to look at me. "Do you know my uncle?" she said, this time unable to disguise her curiosity at my seeming prescience.
I shrugged politely and smiled. "I don't think so… Should I?"
They exchanged looks again; secrets crept from eye to eye. "Well…" –her husband started to say something, but Cythia reached out and squeezed his hand.
"It'll be a surpise… Okay?" she said, the last word asking for my permission.
"Okay. I'll look forward to meeting him." I really was looking forward to it.
She was fairly far along in her pregnancy so I saw her again in a couple of weeks. It was, however, just long enough for me to forget the surprise. An office is busy, even chaotic at times. There are many surprises…
Cynthia was already in the examination room when I walked in and I noticed the uncle immediately. A tall, thin man with a patchy white beard, sat comfortably beside her –lounged might describe it more accurately. He looked entirely at ease in his rumpled brown fedora and clean but wrinkled blue suit, and his face lit up and immediately cracked into a thousand crevices when he noticed me and smiled. He stood up and extended his hand. "Thanks for letting me come," he said, his voice sonorous with a hint of gravel. "Cynthia's been bragging about you for some time now," he added, and his eyes locked on me like talons from under the brim of his hat.
He glanced at an expensive looking recording device he'd placed on the table by the sink and his smile widened. "Thought I'd record the baby –if that's okay with you…" He was asking permission, but his eyes knew my answer and relaxed their grip, caressing my face briefly as they returned to the recorder.
"Of course, of course," I found myself repeating, strangely nervous that my performance might not be up to the machine –or the uncle's- standards. Cynthia got onto the table and I proceeded to take her blood pressure and assess the size of the baby in her abdomen with my measuring tape. It was an old tape, the numbers worn thin by the years of use, and for some reason I felt embarrassed with it. Like I should have used the new one I had in another room…
And then came the time to listen to the heart. I positioned the doptone over the region of her abdomen I hoped would give the best sound and turned it on. Nervously again. With stage fright, almost. I got the area right and the sounds pounded out in their usual steady cadence –fast at first (I had disturbed the baby by measuring the abdomen) and then settled down into a steady, industrial rhythm. A horse galloping. One hundred and forty hooves per minute -I almost said that, I was so anxious.
Uncle Ed, for his part was entranced, and his eyes were focussed elsewhere –inside his head, if I had to guess. Then he closed them -closed the private door- and his whole body began to sway in sync with the beating heart. Even his feet began to tap. I almost thought he was going to get up and dance…
Finally he raised his head and opened his eyes, sated. Exhilarated. Then, like an orchestral conductor he nodded for me to stop the sounds as he reached for the machine to turn it off in tandem. The performance was over; I almost expected applause, but except for the delight, bordering on exaltation I could feel around me, that was it.
He shook my hand warmly, gathered up his instrument, and sidled out of the room as relaxed and in control as ever. He left Cynthia beaming and her husband wide-eyed. But she winked at me as she left –a show of silent appreciation of the concert.
The whole episode left me puzzled however. Why had I felt so nervous? It was like I'd been onstage the whole visit. I walked down the short corridor that led to the reception desk and discovered both my secretaries huddled together and whispering loudly. They both looked up in unison when I turned the corner, their eyes sparkling, their expressions, well, rapt I suppose. Another puzzle.
"Interesting chap that uncle, eh?" I said, to break the spell.
"Interesting?" one of them managed to gasp as they saw my entirely benign expression.
I felt naïve, for some reason. "Yeah, he was really into the fetal heart stuff. He even recorded it," I said, trying not to expose how strangely anxious his taping of it had made me, but I must have said it too loudly.
A patient I didn't recognize was sitting nearby in the waiting room and she rolled her eyes when she heard me. "Well, I guess so, eh?" she said, and exchanged glances with one of my secretaries. They both laughed.
"Do you even know who that was?" the patient said.
I shook my head slowly. But just then, my colleague, the other doctor in the office, called for the patient, and she disappeared through a door after winking at my secretaries with an enigmatic smile on her face.
"Well," I said to the now empty waiting room, trying to pretend I wasn't as curious as I must have looked. "Who was the uncle..?"
Another set of eye-rolls –this time from behind the counter. "Come on," one of them said when she finally found the strength to close her mouth. "Don't you ever listen to rap?" She pronounced it like an accusation, but I know she didn't mean it like that.
I am appreciated in the office –admired, maybe- but not for my musical insight. I am loved for other things… I hope.
Tagged Fetal heart rate, FHR, heart sounds, information, library, music, Noise, Rap, recording sound, Sound, Sound Bites, sound library
Medicine and Ideology
Some things are more definitive than others –less ambiguous, more predictable. Reliable, in other words. They lend themselves to yes-no answers, right-wrong judgements, good-bad characteristics. And some people prefer to see the world in black and white like this. Uncertainty is uncomfortable for them; they crave cognitive closure in the opinion of Arie Kruglanski, a professor of psychology at the University of Maryland.
It would seem that there are times in a life –usually inter regna, times of transition- when this eschewal of indeterminacy is more powerful: adolescence, retirement, divorce, and so on. And at those times, when everything seems unstable and unfamiliar, shelter from the maelstrom under any unmoving roof seems prudent. Rules and unequivocal, unchanging answers are tempting accessories. That something is either right or wrong can be comforting in times of stress.
One problem with this bichromatic need however, is that things are rarely static. They are continually modified by circumstance and context; the questions that need to be asked, and especially their answers, expand and mutate. They evolve over time, in other words. So, for example, that someone is, or is not pregnant, may be unambiguous and beyond dispute. But whether that pregnancy continues or miscarries, is healthy or complicated is not. Things change, are unpredictable, and answers –facts?- obtained at one stage may not obtain later. Life is flux -an ever moving current.
And, of course, context is almost as relevant as substance. Nothing is separate from its surroundings. A pregnant woman, say, is a member of a group –however tenuous- or at the very least, a member of a society. A culture. There are obligations and expectations unique to her milieu that may not be immediately apparent –especially to someone not a member of that group. And these conditions do not often lend themselves to a one-time appraisal, a permanent and unbending judgement, or a right/wrong approach. A rigid doctrine -established on whatever principles- does not always work. In fact it imprisons; it imposes an unchanging view on a constantly unfolding reality. It is dogma.
So it was with some concern that I read an article in the Sept.16/14 Canadian Medical Association Journal –in the news section- entitled 'US politics and ideology enter exam rooms'. In it was outlined some of the requirements in certain states that seem to impose political or moral ideologies on both patients seeking assistance, and medical staff trying to provide it –an arena that one would expect to be free of bias and coercion.
There are some American states, apparently, that require a woman seeking a pregnancy termination to be shown –not just offered- a view of the ultrasound of her fetus. In my opinion, this is just cruel –a punishment thinly disguised as help. Disclosure. An admonition clothed in the scarily garish colours of useful information. That there may have been extenuating circumstances –whether personal or social- that led to her decision to terminate would seem to be irrelevant. The choice the woman has to make is a painful one –it is seldom capricious, rarely if ever carelessly taken. That someone should be available to help her with her decision and counsel her before and after if she wishes is a given. But it should not be an impediment.
As the article observes, 'In such cases, it's not just the doctor and the patient in the room. In effect, it's the state government, too.' This is the not-so-thin edge of a wedge that seeks to modify behaviour –even behaviour condoned in law- by mandating seemingly reasonable adjuncts to the process. 'What could be wrong with offering to show the woman her fetus on an ultrasound?' one can almost hear them pontificate mellifluously with fists all the while clenched tightly behind their backs. But the operative word here is 'offer'. The term suggests choice. Not coercion. Bullying. Threat.
I recognize that I've chosen a contentious issue –pregnancy termination- to illustrate a much more fundamental point: the relational autonomy that should be a cornerstone in our dealings with others. And yet it forms –must form- an essential foundation if we are to reach out to those who, constrained by their own beliefs or cultures –their own experiences- are reluctant to seek our help. It seems to me that it is only humane to enable them -actively encourage them- to access whatever aid we are able to provide. It is not merely magnanimity on our part. Not generosity. Not accommodation. It is empathy; a recognition that despite our differences, we are all struggling. All seeking some path through the chaos of one transition or another. And the cognitive closure need not be punitive. Nor dogmatic.
In fact, it can be instructive. Insightful. As Shakespeare observed, It is not in the stars to hold our destiny, but in ourselves. And we must help others to see this. We must enable them, and so enable ourselves.
Tagged abortion, Arie Kruglanski, Canadian Medical Association Journal, cognitive closure, dogma, Ideology, medicine, politics, pregnancy termination, Relational autonomy, State laws, transition, ultrasound
October 8, 2014 by gozzter
The Crown Jewel
Ahh, those were the days! The days when naivete reigned. The once-upon-a-times when my practice was young and everyone around me seemed old. They spoke a language I had not anticipated in my training; they seem to have subscribed to different dictionaries, or the words were smudged so they did their best with what they could make out. I began to wonder if my background in the prairies had hidden me from modern descriptive English. Cloaked me in innocence. After all, it was the place where I was assured by a teacher in grade three that Winnipeg was the only place in the world where we did not speak with an accent.
Of course, since then I have lived in many places, and my vocabulary has expanded accordingly -but it is the jargon of common things by and large: words we might use with a person in the office, or a friend at a coffee shop. Every day things… Doctors generally do not unwrap their esoteria in public, and their user-unfriendly descriptives for particular bodily parts or conditions go largely untranslated. Unappreciated in the main. And anyway, most people have their own names for the stuff.
But when you're first starting and building a practice, the world is freshly scrubbed and terminology an adventure. I quickly discovered that patients are wont to try new doctors in a never ending quest for clarity –someone whose explanations they can understand. Someone who doesn't have to resort to pointing at the area in question. We are all under somebody's microscope.
It was only my second month in practice, and I wasn't very busy.
"Doctor, I hope you can help me," the olive-skinned woman said as soon as she sat down. Her long black hair was carefully pinned on her head, but as she gestured, little strands would escape and cross her eyes like windshield wiper blades. Far from annoying her, she hurried the transit in a trained fluid sweep of her head as if it was an integral part of her everyday speech.
She was a heavy woman, but dressed in a stunning green blouse and black jeans, she wore her weight, like her height, as a gift. The most striking feature about her, though, was her eyes. Intense and brown, they prowled the room in search of prey, then fastened upon me like a cat, and once engaged, stapled me to my chair.
I struggled to disengage and tried to focus on her chart for a moment. Usually there is an explanatory referral letter, but there were only three words scrawled in pencil –hurriedly, I think, because they were almost undecipherable.
My face must have fallen, because she unlatched her eyes, scanned the upside-down letters, and said, "Dr. Edwards is a man of few words, eh?"
I looked up, embarrassed at my inability to decipher the letters, and turned the page so she could read it. "Any idea what it says?"
She studied my face to see if I was kidding. "He was kind of puzzled by my stuff, so he told me to explain it to you… Anyway, it says 'something quadrant pain' –whatever that means." A mischievous look snuck onto her face and her body shivered ever so slightly, the movement slowly descending like a wave. "I've got pain in my parts… My private parts," she added quickly, concerned that fancy might draw me to more public venues.
"And when do you get pain… there?" I asked, hoping for more clarity.
She thought about it for a moment. "Well, mostly during my monthlies I suppose, but occasionally during his act." I must have looked blank, because her eyes dropped briefly as she searched for a more apt description. "You know,when he… walks through the door," she said, and sat back in her chair convinced she had simplified the term.
She struggled through her history with a litany of words I had never heard before. Things like 'tweenie-legs' and 'bloaty-stuff' surfaced briefly, then sank just as quickly after I'd made a stab at translating them into something I could dictate to her doctor.
But when we'd plodded through the symptoms and I'd had a chance to examine her, it seemed likely that she had endometriosis –a painful condition where some of the endometrial cells that normally line the uterus and are expelled during menstruation, are forced back through the Fallopian tubes into the abdominal cavity where they can grow.
The condition is usually diagnosed and treated with a laparoscope –a telescope inserted through the belly button under an anaesthetic. Pretty standard stuff. But this seemed to worry her more than the condition itself. "I'm kinda worried about my crown jewel," she said, her brown eyes watering.
I smiled and assured her that I would not be taking anything out of her. I had heard the expression 'crown jewels' before but always in the plural, and never referring to women. But, summoning up a vague memory of trash talk in the YMCA locker room, I assumed it was a code for ovary and not wanting to become entrapped in another of her semantic vortices, I left it at that.
The last thing she said to me in the OR before the anaesthesiologist put her to sleep was "Careful of the crown jewel, eh, doc?" I touched her shoulder reassuringly and watched her close her eyes as the medication took hold.
"What was that about?" the scrub nurse said as she was prepping her adomen.
I shrugged. "I was hoping I was the only one who didn't understand…"
Belly buttons are interesting areas, I have come to realize. They exist in all sizes and shapes. Their contours run the gamut from vertical alignment to transverse and since the laparoscope has to be inserted through it, the incision has to be similarly tailored so it is inapparent after it heals. Hers was distorted, however, so I found I had to be creative. I ended up cutting a short horizontal line about as long as my little finger nail on its lower edge much to the surprise of the resident doctor who was assisting me.
"I've only seen it cut vertically," she said with some hesitation evident in her voice. It wasn't exactly a criticism –residents don't usually criticize their staff- but I could hear the implied judgement in the tone. I smiled beneath my mask, and said something to justify my decision. But it was a bluff; I recognized my heresy all too clearly. If it healed with a ridge, or a scar, there might be complaints. It made me all the more determined to leave her ovaries unharmed.
And then, after dealing with the endometriosis, and dictating the operative report, I promptly forgot about the navel issue. Until, that is, she returned to see me several weeks later.
She sat down opposite me as she had that first time, but her eyes were so intense I could barely see her face. "What did you do, doctor?" she said in an accusatory tone before I could even open her chart.
"Do you still have the pain?" I asked carefully –almost shyly, given the spotlight of her eyes. I felt naked in their allegation. Like I had done something wrong.
She turned down the wattage and I could finally see the smile that had been in possession of her face all the while. "No, of course not…"
'Of course not'? I took a deep breath as the memory of her umbilical incision rose slowly and painfully into my chest; my resident had been right.
"How did you do it?" she said a little too loudly, her eyes firmly grasping my head. "My friends all noticed; everybody's been commenting."
"I'm sorry," I managed to mumble, my cheeks no doubt red with the effort. "I don't underst…"
"The belly button!" She interrupted and then almost jumped across the desk in her frenzy. As it was, she leaned so far she was almost touching me. Then she relented and retreated slowly into her chair. "You know what I do, don't you?"
Actually, I didn't –in those days I rarely noticed if a profession was written on the chart- but I could hear the word 'lawyer' humming softly in the background.
"I dance professionally," she said. "I specialize in the danse du ventre, to use my favorite description." I think I must have accidently raised an eyebrow, because she rolled her eyes impatiently and added "A belly dance!"
"I still don't…"
"My crown jewel," she said, carefully enunciating each word as if speaking to a slow child. "I wear a ruby in my belly button as part of my act." My face stayed blank. "It always falls out unless I glue it in. Those kittens are heavy, you know. Especially when you're moving everything around."
"So..?" I didn't know where she was going with this, so I tried to stay neutral. Sensitive.
"So whatever you did worked… Sits in there like a baby in a blanket now."
I allowed myself a smile.
"The girls in the troupe are all impressed," she said, positively beaming. "I told them to pretend they had pain in their parts so they could get to see you."
Well, I guess it's a start, eh?
Tagged belly button, belly dance, crown jewels, danse du ventre, endometriosis, incision, language, laparoscopy, lower quadrant pain, medical practice, monthlies, navel, Pain, parts, pelvic pain, vocabulary
Critical Thinking and Bullying
A few weeks ago, a young woman came in to see me to have her first Pap smear. While I was taking a routine sexual history, she admitted she had recently been bullied online. I'm not even sure how the topic came up, but she didn't seem very upset, so I asked her about it.
"The guy was a real dick," she said. And when I asked her how she reacted, she merely shrugged. "Everything he said was false and all my friends should know that… So I ignored him."
"And did he try it again?" I admired her reaction, but I have to admit I was curious.
She liberated a beautiful smile and shrugged mischievously. "Yeah, once… But then I guess he gave up." She allowed her eyes to roll upwards comically. "My mother always told me to ignore stuff that wasn't true."
It got me thinking about why some people are able to withstand that kind of thing, while others succumb. I don't pretend to know what motivates bullying, but I do suspect my patient was taught an effective remedy from an early age.
Critical thinking is a way of examining a statement or assertion in order to understand the background and motivating factors for its existence. Its credentials, in other words. It is a way of distancing oneself from the message and analysing everything that went into making it before either accepting or rejecting its content. Also, it is a way of avoiding confirmation bias –reading or assessing only those issues with which one already agrees, rather than sampling a variety of views and thinking of them as interesting, but as yet unproven assertions.
In important ways, this is what Science does: everything is open to checking and possible refutation. Nothing is spared re-examination. Carl Popper, the philosopher of science, suggested that an assertion, a theory, must be worded in such a way that it is testable, otherwise it can not be generalized -or as he would put it, it can only be considered scientifically valid if it is falsifiable- ie checkable. Anything else is merely an opinion -as, for example, the statement 'Red is the most beautiful colour'. It is not testable, and therefore certainly neither provable nor undeniably valid. This is the first simple rule of thumb we can teach: we must help children to parse input.
Young children tend to question everything- it is how they learn. But in the very young –under, say, six or seven years of age- they often use magical thinking: cause and effect are not necessarily demonstrable either by reason, or even observation. Past that age, however, they begin to understand agency. Causal chains. It is a good time to introduce the concept of validity: was something really a result of an action, or was the action merely associated in time or location so as to seem to have influenced it? And although this is a good first start it is nonetheless one that is not necessarily intuitive. For example it would be tempting to assume that a boy running past a crying girl had done something to her -it might fit with a previous experience. But maybe he was running to catch a bus and it was a coincidence that the two were in the same area at the time she was crying… It requires more proof. More examination.
The habit of questioning things before accepting them can be taught. It can be made into a reflex before reacting. But it needs to be developed early, before the temptation to interpret hastily, or even reciprocate mindlessly, has become entrenched.
The basic elements of simple logic can be taught. For example with inductive reasoning, one attempts to generalize from observations. So if all the crows you have ever seen were black, then you might conclude that all crows are black… Until somebody sees a white crow that is… It is falsifiable, in other words. Most taunts are of that variety -and with practice, easily refuted.
Or even with deductive reasoning which works the other way -from the general to the particular: All men are mortal; Socrates is a man; therefore Socrates is mortal -the classical example. But it only works if the premise is valid (ie. that all men are mortal). And it may only be somebody's opinion that it is valid…Once again, is it like that example of red being the most beautiful colour? We can all be taught to analyse things like this. We can all be taught to be wary of unsubstantiated statements. Rumours. Gossip. Taunts…
And the critical thinking approach can even apply to actions as well as assertions. A simple example: a young girl is hit by a snowball and another child, a boy, is standing nearby in a group of boys and staring at her. Was he to blame? Did he throw it? Maybe, but without further analysis, further investigation, there's no proof. No reason to jump to a conclusion. Why did she think it was him? Is her reason based on anger, or is it justified..? This is the basis for the idea that a person is innocent until proven guilty… It is an important concept to inculcate in the growing mind. It is a way of distancing oneself from the action, no matter how provocative, and setting it aside until it has been analysed further. We all judge input, we all react to issues we encounter. And some things do require an immediate response. But it's how we come to the judgement, how we analyse the data –how we react- that is critical.
You can see where this is leading I suspect: bullying. Bullying -whether on the playground or online, whether by deed or word- has the advantage of unfair leverage only if the process is unexamined. Only if the person being assailed is not used to subjecting taunts to the same questioning. Stepping back, if only momentarily, and processing the information. Checking it. Falsifying it. Refuting it -like my patient was able to do.
A difficult thing to do in the moment, for sure. But without any experience in dissecting assertions –deconstructing them, as PhD candidates are fond of saying- there are only reactive emotions. Victimization. Loss of self esteem that could and should withstand the storm. Self esteem, after all, is partly based on one's ability to see oneself as in control.
As in mathematics and science, critical thinking is a valuable tool for assessing what we experience in the world. It helps us to parse what we read, what we're told, what we think… It brings perspective to the unexpected, the hostile and the just plain annoying. It can and should be taught from grade school onwards, building on the simpler examples from year to year –class to class. Younger children may not understand the complexities of the Scientific Method, nor what Popper was on about, but with patience and persistence they will.
They deserve the chance…
Tagged analysing the message, bullying, Carl Popper, causal chains, Confirmation bias, Critical Thinking, deconstructing, deductive reasoning, distancing oneself, falsifiability, inductive reasoning, judging, logic, magical thinking, Pap smear, questioning, Science, Scientific method, Scientific thinking, self esteem, validity, victimization
More than kin and less than kind
Here's ado to lock up honesty
Lying down in green pastures
The Begging Bowl
Truth hath a quiet breast


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After today's decision by the Federal Reserve to maintain the target fed funds rate at zero to 25 basis points, Swiss Re's Chief Economist, Kurt Karl, commented that tapering off purchases of assets will keep yields on the 10-year Treasury note elevated through next year.
Karl added: "The tapering is expected to begin soon and end in the middle of 2014. Thus, yields on the 10-year Treasury note are likely to range between 2.5% and 3.5% for the rest of this year and through 2014."
Karl continued that expectations of real Gross Domestic Product (GDP) growth will be the key determinant of the yield, since the tapering has already been priced into the market. The current quarter will be weak, around 1.5%, but Q4 and next year will be more robust as the effects of the tax increases and spending cuts abate and housing continues its recovery.
He commented: "After six quarters of contraction, the euro area economy emerged from recession in Q2. Growth was driven by Germany (+0.7% q-o-q) and France (+0.5%) while the pace of contraction eased in Spain (-0.1%) and Italy (-0.3%). The euro area recovery is expected to continue at a moderate pace. A more robust upswing is likely to be prevented by fiscal austerity, private sector deleveraging, structural rigidities and tight credit conditions in the peripheral economies. Yields on the 10-year German bonds will rise to 2.3% by end-2014."
Karl added that the improvement in the UK economy has been particularly strong, with real GDP growth of 2.9% (SAAR) in Q2. "As a consequence, we have raised our GDP growth forecast to 2.2% for 2014 and the year-end 2014 yield on 10-year gilts to 3.3%", he explains.
He also said: "In Asia, Japan is expected to continue growing at about a 1.5% pace, despite the sales tax increase scheduled for April 2014 and inflation will pick up to 2%. China is also projected to have a modest improvement in growth to 7.8% next year. However, credit conditions remain worrisome and the risk of a hard-landing has increased because efforts to rein in credit growth could lead to a surge of loan defaults and trigger a sharp economic slowdown. "


D-STAR, the protocol, has no notion of linking, reflectors, etc. It was designed to be "stateless", meaning every transmission is complete in itself and has no inherent relationship to any other transmission. (For Internet Protocol folks, think of it as UDP or User Datagram Protocol). It is also an addressed protocol, meaning the field "MYCALL" is meant to be the address (callsign) that sent the transmission and the "URCALL" is meant to be the address (callsign) to which the transmission is intended. "CQCQCQ" is meant as a "broadcast" address, meaning that it is intended for any receiver. RPT1 and RPT2 are helper addresses (callsigns) to select relay (repeater) stations.
There is usually a button to set UR to CQCQCQ, for the operator to quickly switch to "broadcast" mode.
There are usually memories to store commonly called addresses (callsigns) that the operator wishes to reach.
Second generation radios (and subsequent generations) also provide an address (callsign) squelch, so the operator that only wants traffic addressed to them can filter out everything else.
This all works well on a local simplex or repeater conversation. It is not, however, intuitive to the person who is making voice transmissions. If they have not applied the callsign squelch, they simply hear all transmissions on the channel. It sounds like any other simplex or repeater voice transmission, except between the radios it travels as a bit stream and you have the benefits (and liabilities) of a digital voice transmission. So to the voice user the utility is the same as their analog counterparts. On the other hand, the D-STAR digital data user (e.g. Ethernet encapsulated in D-STAR packets, not the extra data bits in the digital voice stream), the URCALL and MYCALL addresses (callsigns) become integral to directing traffic to the right receiver.
Moving up from the simplex or local repeater mode to networked communication, these addresses become more powerful. For voice communications, the URCALL again represents the intended receiver of the traffic. The gateway systems that sit behind the repeaters are designed to keep track of all of the addresses (callsigns) of all stations heard on the network. (In the case of Icom G2 and G4ULF gateways, an unregistered transmitter address (callsign) will cause their transmissions to be filtered out before it is relayed to the network.) So when a gateway receives a transmission from an attached repeater, it examines the the URCALL (and MYCALL) and looks to see if the URCALL address was last heard on a remote repeater and, if so, it relays the transmission to the gateway where that remote repeater is connected. To the operator, regardless of digital voice or digital data, it means that the transmitting station doesn't need to know where the receiving station is located, the gateway system automatically and quietly forwards the transmission.
CQCQCQ is not a registered address, so it does not get relayed beyond the local gateway (and that is why you get an error message on your display when URCALL is CQCQCQ and the RPT2 address is active).
It is more efficient, since the only repeaters activated are those involved at the two endpoints for any given, over the network, transmission.
Since it is directed, uninterested or unintended, receivers do not receive traffic, unless they happen to be monitoring one of the repeaters at the end points.
It also means a station who receives a transmission and replies, is doing so "blind", not knowing if there is other traffic at the other end of the network.
This model does not work well, if at all, if you have a network of stations using digital voice and they are located at 3 or more repeaters (on 2 repeaters, each station just needs to have their URCALL set to either the address of the remote repeater, e.g. "/NW7DR B" or to the address of a station that is known to be located at the remote repeater).
Robin, AA4RC, looked at this issue, and came up with a solution, in the form of what we now know as DPLUS. DPLUS adopts the traditional notion of linking repeaters as can be found on analog repeaters. These analog repeaters use radio, wire, or voice over IP (VOIP) to relay voice from one repeater to the other and are usually symmetrical, i.e. if any repeater receives a signal it is relayed to all of the other repeaters that are on the link. For better efficiency when linking more than two repeaters, DPLUS adopted the notion found in the VOIP based linking systems, by creating conference bridges called reflectors which become the meeting place for small to very large collections of repeaters. This is a very powerful tool for enhancing wide area, even global, networks of stations, whether formal networks or simply "watering holes" where stations gather for random, non-directed, contacts. DPLUS is the application that is most responsible for the growth in use of digital voice radios in amateur radio over the last few years.
Since D-STAR has no facility, in the protocol, to perform this linking and because the Icom G2 gateway is closed source and proprietary, Robin was forced to create a method that would enable this linking. The Icom G2 system uses UDP port 40000 to relay digital voice between gateways on the Internet and all callsign addressed D-STAR digital voice uses this port on the Internet, and a different UDP port is used to talk to the Icom controller (and by extension, the repeaters), usually port 20000. DPLUS is able to use a technique called packet inspection (or packet sniffing) to watch all digital voice traffic between the controller and gateway, and between the gateway and Internet. DPLUS can then copy that traffic to another port to send it over a link to another gateway or reflector. Conversely, any traffic coming in over a link can be copied to the local controller, using packet insertion, to be sent over the air by the repeater. I will leave out a lot of the detail of the complexity required (some I don't know, but have an appreciation that its no small feat) to avoid routing loops, separate streams for different repeaters connected to the same controller, handling DVDongles, DVAPs, etc., but fundamentally this what DPLUS linking does. Additionally, DPLUS monitors the packet headers for URCALL addresses that have been overloaded as commands for linking, unlinking, and other housekeeping.
Any traffic whether from a repeater's receiver (if RPT2 is set), through the Internet, from an attached device like a DVDongle or DVAP, that keys the repeater's transmitter is automatically sent over the link associated to that repeater to any remote gateway or reflector on the other end of the link. In turn, a reflector copies that traffic to all attached repeaters and other devices. It does this without regard to the intended destination in the UR field.
Traffic is sent to all repeaters (and other device) attached to the link, directly or via a reflector, even if there is no interested receiver.
We are all aware that most repeaters, by themselves, are largely silent. In any given metropolitan area, it is likely that > 90% of repeater traffic is on a handful of repeaters. To provide traffic on a repeater, in hopes of keeping it interesting, some repeaters are always linked to a particular reflector and deny stations the ability to 'unlink' or have aggressive watchdog scripts that re-link the repeater to the reflector on failure or if no other link is present. Other systems use reflectors for regional networks.
Most reflectors are likewise mostly quiet with just a few carrying the bulk of traffic. Today, a reflector with 20+ attached repeaters may only see the traffic we saw on a single analog repeater 20 years ago. So there is a lot of "dead air" out there!
Station 1 addresses a direct transmission to Station 2. Station 1's local repeater does not have such a script installed and is connected to REF001 C. So Station 1's transmission is reflected to everyone listening to REF001 C. It arrives at Station 2's repeater, which is linked to REF014 C, and goes out on Station 2's repeater but is also copied to REF014 C, and in turn to every repeater linked to REF014 C. Since Station 1's repeater is linked to REF001 C, stations on REF001 C can reply and be heard by Station 1, but not by Station 2 or anyone on REF014 C. Stations on REF014 C (not on the same repeater as Station 2) will not be heard by Station 1.
As some have suggested, if DPLUS only copied traffic addressed to CQCQCQ (broadcast), then it would greatly reduce the impact to reflector users in the above cases, as every addressed transmission would only be heard on the 2 repeaters where Station 1 and Station 2 are operating and neither repeater would have to unlink. There might be an occasional collision between addressed and DPLUS traffic, but it would almost always be limited to only one repeater instead of the impact to many repeaters as seen in the above scenarios.
DPLUS is Robin's code and he is absolutely the one who makes the final call on how it works. This discussion is only intended to provide the information on what is happening in a gateway and how it interacts with linking. If you have suggestions on how DPLUS might address your concerns, you should share them with Robin.


With the latest development of WinTOTO toward the use of Pick 3, 4, 5, 6 system, the software can be customise to works for our 4D database as well. From version 2.7 onward, we have included a database named Sin4D to analyse the 1st prize number only.
Below is a section of the Nextgap display statistic where a lot of important information can be derived from it. Certainly, you will be able to play this game much more effectively with all this information.


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Schon heute die Gewinner von morgen unterstützen
Home » EOS Insight » Q&A: AI and financial services
Q&A: AI and financial services
21 st July 2020
EOS Governance Social Stewardship
In our latest Q&A, Janet Wong, an engager for EOS at Federated Hermes, talks to Dr David Hardoon, a senior AI adviser to the Union Bank of the Philippines, and the former chief data officer and senior AI adviser to the Monetary Authority of Singapore, about AI and data governance in financial services.
As the financial services sector has introduced artificial intelligence (AI) to various functions such as chatbots, hiring and lending, some controversies have arisen. This has prompted a debate about how AI is being deployed, touching on concerns around fairness, discrimination, and transparency. At the same time, regulators and policymakers around the globe are calling for greater AI governance. In this discussion, we will explore some of these issues.
Janet Wong, EOS: Why are AI and data governance important to financial institutions?
Dr David Hardoon, Union Bank of the Philippines: It is their fiduciary duty to oversee AI and data governance. Without adequate control and management, AI deployment can be financially material – as regulators have already imposed fines – as well as causing reputational damage.
In my previous role as chief data officer and special adviser (artificial intelligence) to the Monetary Authority of Singapore, I established the Fairness, Ethics, Accountability and Transparency (FEAT) principles, which provided a foundation for AI governance in the financial industry. Working with the FEAT committee, we set out the FEAT principles and best practice for the use of AI and data analytics. For example, for fairness, we said that individuals or groups of individuals should not be systematically disadvantaged through AI and data analytics-driven decisions, unless these decisions can be justified. Other details can be found here.
JW: In your view, what are the key challenges for boards of financial institutions in upholding AI governance? What would be your recommended solutions?
DH: AI governance touches on numerous technical and non-technical areas. In my view, there are two key challenges. First, AI may reveal core social and cultural dilemmas. There is no universal definition of fairness, as the perception of fairness depends on the context and varies across culture and geographies. For example, the definitions and classifications of marginalised or disadvantaged people vary across North America, Europe and Asia.
There are research studies showing people's different levels of sensitivity to AI ethical issues, reflected by media coverage in a particular country. For example, Chinese news reports focus more on safety and security, while the UK or the US put greater emphasis on fairness and data privacy1. Therefore, solutions must be pragmatic, realistic, and largely non-technical, and developed in collaboration with the relevant external government agencies.
Second, there is a challenge around providing end-to-end technical AI governance solutions for each application as these need to cover the different governance considerations of data quality, model development, model operationalisation and process governance. My recommendation is, as my mother used to tell me, not to boil the ocean to make a cup of tea. We should incorporate governance solutions as they become available. To address these challenges, at the Union Bank of the Philippines we are taking a pragmatic approach – we are developing common metrics but with different monitoring thresholds, and corrective actions for various applications in different markets. For example, it might be a 5% threshold that triggers further due diligence in Market A, but a 1% threshold in Market B.
JW: One of the actively discussed topics is how to translate AI ethical principles into practice. Can you give us some successful examples?
DH: It is important to have concrete and specific practical applications to begin with. This will allow the application of the principles in a more focused way. For example, what does "being fair" mean when we are trying to prevent fraud? When is it justifiable to be "unfair"? How do these differ when we are determining credit limits, and what does "fair" and "unfair" mean within this context? The specificity allows for practical implementation.
JW: How can financial institutions build internal capacity on AI ethics and governance?
DH: Capacity building would be a combination of training and mandating compliance requirements. Financial institutions can leverage standards developed by organisations such as the International Organization for Standardization (ISO) and the Institute of Electrical and Electronics Engineers (IEEE), if local legislation or regulations are silent.
I have observed different structures adopted by financial institutions to build capacity. Some have established an AI Centre of Excellence, while others take a more decentralised approach. There is no one-size-fits-all solution. Most importantly, the board and senior management need to understand why the structure is in place – is it for research-only purposes, knowledge transfer, or is it genuinely working towards digital transformation in a responsible manner? Setting the right expectations is key to furthering the integration of AI ethics and governance into the existing ethics and risk management framework.
JW: As the senior AI adviser at the Union Bank of the Philippines, can you share more about your work implementing AI safeguards, as well as the development of a set of fairness metrics?
DH: In my current role we have applied the fairness principle to a specific AI application, such as in marketing, fraud detection, and credit scoring, and developed an initial measurement that notifies bank staff to review any occurrence of potential inadvertent disadvantage ("unfairness"). We are taking an incremental approach by putting in place a series of safety nets to capture unfairness.
We are also partnering with Element AI, a global AI software provider, to ensure that we are walking the talk at the group level. Our goal is to publish case studies and a set of fairness metrics once they are available.
JW: Apart from your former role at the regulator, you are also a data scientist, getting your bachelor degree in computer science and AI in 2002 and a PhD in machine learning in 2006. How has the culture of safety and responsibility among AI researchers and data scientists changed in the past two decades?
DH: The culture has definitely shifted. Researchers are not only posing and addressing questions, such as on unfair bias, but have developed entire research areas that did not previously exist. For example, on top of the number of conferences dedicated to the topic of AI ethics, [conference organiser] NeurIPS has introduced a requirement that all paper submissions include a statement of the "potential broader impact of their work, including its ethical aspects and future societal consequences". There is a deeper appreciation of, and better attempt to understand, AI outcomes and what it means to us as individuals.
1Standard Human-centred Artificial Intelligence AI Index 2019 report: https://hai.stanford.edu/sites/default/files/ai_index_2019_report.pdf
Sectors: Consumer & Retail, Financial Services, Technology, Utilities
Janet Wong is part of the EOS at Federated Hermes Asia and global emerging markets stewardship team, engaging with listed companies on material ESG topics. She is also the global lead on responsible artificial intelligence and governance in financial services. Janet joined the team following the completion of her two-year Master of Public Administration degree in Social Impact from the London School of Economics and Political Science. Previously, she worked for HSBC Global Banking in Hong Kong overseeing global banking relationships with Hong Kong blue chip firms. Janet holds a Bachelor of Business Administration degree in Global Business and Management from the Hong Kong University of Science and Technology. She is fluent in Cantonese, Mandarin and English. She is also a CFA charter holder.


While the HTC One M9 does not sport a QHD display, it does have a very nice looking 1080p display. But no matter what the resolution of the display on a smartphone is, you're going to want to protect it. You'd have to see a big scratch in the middle of it, wouldn't you? That's where screen protectors come in. They come in all shapes and sizes, okay maybe not shapes and sizes but colors and materials. We've gathered ten of the top screen protectors for the HTC One M9 and have them listed below.
This screen protector from SuperShieldz is a tempered glass screen protector and is also high-definition. So it won't degrade the quality of the screen, or your experience in using the device. It's also cut to fit your HTC One M9 perfectly.
This is Spigen's Clear screen protector for the HTC One M9. It fits the device perfectly, and is crystal clear. Additionally, Spigen is offering you three screen protectors in this pack instead of the normal one.
Tempered Glass screen protectors are some of the best feeling screen protectors out there. And it feels natural, like you don't even have a screen protector on your device. Which is always a great feeling.
This screen protector from MP-Mall is another tempered Glass screen protector. It's an HD screen protector, so your display will still look amazing. It's also fingerprint resistant which is a really big deal.
This fingerprint resistant screen protector from roocase is also a tempered Glass screen protector. It also offers 99.9% touch screen accuracy and keeps your screen looking good. While some screen protectors degrade the quality of the display.
Here, LK is offering a 3-pack of screen protectors for the HTC One M9. These are premium, HD clear screen protectors for the HTC One M9. They are made from high-quality Japanese PET film as well.
This screen protector has 2.5D rounded corners for the HTC One M9, as well as anti-fingerprint, and is still HD quality. Meaning that it's crystal clear as you'd expect. Additionally, it is also made from Japanese PET film.
This pack of screen protectors from Invisible Defender gives you four HD screen protectors. Which are also made from Japanese PET Film. It is easy to install, and leaves no glue residue whatsoever.


All of this might cease to be available if Brexit negotiators don't manage to explicitly protect the status of au pairing in post-Brexit Britain. Clear arrangements need to be made to make sure that young people in the UK and the EU can continue to benefit from this once-in-a-lifetime opportunity and UK families can continue to welcome au pairs to help with childcare.
Show your support by signing the petition. Help to save Europe's oldest existing cultural exchange programme for young people and families in the UK!
SIGN THE PETITION: "Save au pairing in the UK"


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Bieg na 5000 metrów kobiet – jedna z konkurencji lekkoatletycznych rozgrywanych podczas igrzysk olimpijskich w Londynie.

Obrończynią tytułu mistrzowskiego z 2008 roku była Etiopka Tirunesh Dibaba, która w Londynie zdobyła brązowy medal.

Ustalone przez International Association of Athletics Federations minima kwalifikacyjne do igrzysk wynosiły 15:20,00 (minimum A) oraz 15:30,00 (minimum B).

Eliminacje biegu na 5000 metrów kobiet odbyły się 7 sierpnia, finał miał miejsce w piątek 10 sierpnia.

Rekordy

Rezultaty

Eliminacje

Bieg 1

Bieg 2

Finał

Przypisy

Bibliografia

Bieg na 5000 metrów kobiet

redpajama_set_name: RedPajamaWikipedia


The International Business and Trade Program offers the student much in the way of benefits and opportunities.
It was a few weeks ago that I was admitted to a PhD program right after successfully completing my MBA degree. My journey began at Richland College where I studied International Business and Trade. Whether you want to begin a career related to International Business or you plan to pursue higher education, this program is a good start for your journey. The program offers high quality training at an affordable cost. You also have access to good support and an advising team that helps you get practical experience. I completed my internship at the International Trade Center SBDC while I was in the program. I am always grateful for the new opportunities that this program opened for me.


Once Musa alayhi salam asked Allah ta'ala: O Allah! You have granted me the honour and privilege of talking to you directly, have you given this privilege to any other person? Allah ta'ala replied: O Musa! During the last period I am going to send an ummat, who will be the ummat of Muhammad (salla'Allahu alayhi wasalam) with dry lips, parched tongues, emaciated bodies with eyes sunken deep into their sockets, with livers dry and stomachs suffering the pangs of hunger, who will call out to me (in dua), they will be much closer to me than you O Musa! While you speak to me there are 70,000 veils between you and me but at the time of iftaar (breaking of fast) there will not be a single veil between me and the fasting ummati of Muhammad (salla'Allahu 'alayhi wasalam). O Musa! I have taken upon myself the responsibility that at the time of iftaar I will never refuse the dua of a fasting person!
Jazakallahukhairan for all your wonderful posts! I really love them and have benefitted from them! Alhamdulillah.
I really love this one. Thanks for sharing. Can I share this on my facebook ?
Wa-alaykum as-salam brother Muhammad- many thanks for sharing the link. Alhumdulilah you have benefitted from the posts- its all barakah from Allah.


Ever wished getting styled by celebrity stylists who work behind the scenes in Bollywood to turn your favourite actors into divas? Now, you too can get fashion tips, advice and style guidance from celebrated fashion designers like Anaita Shroff Adajania, Ekta Rajani, Niharika Khan, Ami Patel, Archana Walavalkar, Kushal Parmanand, Nitasha Gaurav and Mohit & Aastha.
The Collective, a multi brand retail concept, has launched the 'Stylist on Board' Program which bridges the gap between fashion, Bollywood and the consumer, allowing customers access to the stylists that are behind the fashion statements of Bollywood's best. The first initiative under the program was the launch of India's first Fashion Art Book in presence of Bollywood celebrities and corporate head honchos.
The Style Coffee Table Book titled The Green Room showcases The Collective Autumn/ Winter 2013 merchandise in the stylist's own unique style. It revolves around how the art of styling can tell a thousand stories. It is broken up into four sections – Chaos, Drama, Debauchery and Narcissism – with each stylist interpreting a theme in their own unique style. The end product is an edgy, stylish look book that tells the story of life behind the camera.


Designed in conjunction with Steve Taylor of Creative Outdoor Solutions this tennis court features an Omnicourt Pro court surface, green sand infill and a Spectra Ace floodlighting system. A draw-curtain perimeter allows the court to integrate with the adjacent garden areas whilst a basketball goal allows the court to be used as a versatile sporting area. The award winning "Level Court Drainage System" provides a uniform step down along the house side whilst allowing the surface to drain more effectively after rain.