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What does the ideal urgent and emergency care system look like? A qualitative study of service user perspectives
http://orcid.org/0000-0001-5340-9510Suzanne Ablard,
http://orcid.org/0000-0002-0774-8113Maxine Kuczawski,
http://orcid.org/0000-0003-2321-0302Fiona C Sampson,
http://orcid.org/0000-0002-1701-0577Suzanne M Mason
Centre for Urgent and Emergency Care Research (CURE), ScHARR, University of Sheffield, Sheffield, UK
Correspondence to Mrs Maxine Kuczawski, Centre for Urgent and Emergency Care Research (CURE), ScHARR, University of Sheffield, Sheffield S1 4DA, UK; m.kuczawski{at}sheffield.ac.uk
Background Policies aimed at diverting care from EDs to alternative services have not been successful in reducing ED attendances and have contributed to confusion for service users when making care-seeking decisions. It is important that service users are at the heart of decision making to ensure new services meet the needs of those who will be accessing them. In this study, service users were encouraged to think freely about the desirable qualities of an ideal urgent and emergency care (UEC) system.
Methods From September to February 2019, an open inductive methodology was used to conduct focus groups with service users who had used UK UEC services within the previous year. Service users that had contact with NHS111, ambulance service, General Practice out-of-hours, minor injuries unit, walk-in centre or ED were purposively sampled and stratified into the following groups: (1) 18–45 years; (2)≥75 years; (3) adults with young children; (4) adults with long-term conditions. Focus groups were structured around experiences of accessing UEC services and perspectives of an 'ideal' UEC system.
Results 30 service users took part in the study, across four focus groups. The ideal UEC system centred around three themes: a simplified UEC system (easier to understand and a single-point of access); more 'joined-up' UEC services and better communication between health staff and patients.
Conclusion Desirable qualities of an ideal UEC system from a service user perspective related to simplifying access for example, through a single point of access system where health professionals decide the appropriate service required and improving continuity of care through better integration of UEC services. Service users value reassurance and communication from health professionals about care pathways and care choices, and this helps service users feel more in control of their healthcare journey.
emergency care systems
http://dx.doi.org/10.1136/emermed-2019-208921
What is already known on this subject
Evidence has shown that policies aimed at shifting care away from EDs into alternative urgent care services have not achieved their intended effect of decreasing ED visits; as rather than helping people get to the most appropriate place for their health needs, they have resulted in further confusion.
It is becoming more widely acknowledged that service users are well placed to comment on changes to health services as they have the advantage of being able to take a whole systems perspective rather than focussing on individual services within the system; therefore being able to identify which elements of the system could benefit most from improvement to enable more streamlined access.
What this study adds
In this qualitative study of recent users of unscheduled care, there was confusion around the appropriate usage of services within the UEC system, with service users stating preference for a single point of access (which includes a number of co-located urgent and emergency care services) within which health professionals decide which service is most appropriate for the service user based on their presenting complaint.
Service users agreed that health services need to work more closely together to provide an efficient and joined up service; which may be supported by creating nationwide linked medical records.
Service users want reassurance early in their care pathway, and were prepared to accept long waits as long as they were given information about what was happening to them and why.
Globally, demand for urgent and emergency care (UEC) services has increased significantly over the past two decades, partly due to an ageing population, but also due to service users attending services which are not the most appropriate for their health needs.1 2 Alternative UEC services which are designed to see and treat service users with urgent but non-life threatening health conditions have been set up as an alternative to the ED. In the UK, these include: co-locating primary care services with EDs,3 walk-in centres,4 and telephone triage systems (eg, NHS 111).5 However, evidence shows these services have not achieved their intended effect of decreasing ED visits6; but have led to further confusion about the most appropriate services for particular health needs.7
To understand how services will be accepted and used, the NHS long-term plan emphasises the importance of putting service users at the heart of decision making.8 Service users are uniquely placed because they can comment on their journey through the whole UEC system, rather than focussing on individual services; therefore being able to identify which elements could benefit from improvement to enable more streamlined access to the help they need.9 While a number of studies have explored how service users negotiate their way through the UEC system,10–13 and described the factors appearing to influence patient satisfaction9 14–16; there is a paucity of studies directly asking service users what they would like from an ideal UEC system. Discussions about what service users want from the UEC system would help ensure new services are designed to meet the needs of service users who will be accessing them.
We undertook a study whereby participants were encouraged to think freely about the essential and desirable qualities of an ideal UEC system. Specifically, we aimed to explore service users' positive and negative experiences of accessing the UEC system and the key characteristics of an ideal UEC system.
Design and setting
We used an inductive approach and conducted focus groups with a purposive sample of service users who had accessed services within the UEC system. This methodology was used as it offers a degree of flexibility, whereby the researcher takes on a less directive and dominating role, enabling participants to comment on areas they believe are most important to them within a focussed discussion.
The study was undertaken in a large urban English city (Sheffield) between July 2018 and February 2019. The UEC system in Sheffield includes an adult-only (16 years and older) Type 1 ED which has an out-of-hours Primary Care Centre (accessible via NHS 111) located on the same site. There is a stand-alone Children's Hospital with an ED (0–15 years) and two separately located UEC centres in the City Centre a minor injuries unit and a primary care-led walk-in centre. Sheffield is served primarily by one ambulance service. Service users can also access a national healthcare telephone advice service (NHS 111); a 24 hours, 7 days a week service intended for urgent but not life-threatening' health issues.
Service users who fell into one of four cohorts (18–45 years; 75 years and over; adults with young children aged 5 years or under; and adults with long-term conditions) and had accessed the UEC system in Sheffield within 12 months prior to recruitment were eligible to participate. These cohorts were selected as they have been reported as accessing UEC services differently with higher rates of unnecessary attendance to UEC services. O'Keeffe et al reported significantly higher odds of non-urgent attendance to the ED for both younger patients (aged 16–44) and over 65 compared with those aged 45–64 years (OR 1.42 and 3.81 respectively).17 Increased non-urgent attendance to UEC services has also been reported in young children18 19 and those with long term conditions such as asthma, diabetes and mental illness.20
A range of recruitment techniques were employed to identify participants such as face to face, online advertising (Peopleinresearch.org; Gumtree; Facebook) email distribution lists and posters displayed in public areas. These techniques were used in the City Centre, public spaces (supermarkets, libraries, etc) and within the UEC services of interest. Members of the study team also approached community support groups where our target cohorts were known to attend (parent and toddler, coffee mornings) and information about the study was either distributed or a member of the study team visited to discuss the study.
Service users expressing an interest in participating were sent a study pack including a cover letter, information sheet, eligibility questionnaire and reply slip. The eligibility questionnaire included contact details, age group, long-term conditions, UEC services accessed in the previous 12 months and any children living with the responder. On completion of the reply slip and eligibility questionnaire a member of the study team contacted the service user to confirm the details of the focus group.
We used an open, inductive approach, with just two key questions to guide discussions during focus groups: (1) would anyone like to share their positive and negative experiences of accessing services within the UEC system? (2) In an 'ideal world' (ie, there are no funding constraints), what would your ideal UEC system look like? By asking service users to reflect on their previous encounters with the UEC system, it ensured the ideal UEC system generated was grounded in the service user's personal experiences and focussed on what was important to them rather than being influenced by the focus group facilitators.
Service users provided written informed consent at the beginning of the focus group. Focus groups were facilitated by two of the authors (SA and MK), were audio-recorded and took place in a private room at the University of Sheffield. The duration of the focus groups was 3 hours with a 20 min break; participants were asked the two key questions with time given to fully explore participants' responses and discuss among the group. During the focus groups, service users were provided with a buffet lunch or dinner and on completion they received a £30 shopping voucher to compensate them for their time.
Patient and public involvement (PPI)
The Sheffield Emergency Care Forum (SECF) PPI group were involved from the early stages of the study; the study team worked with the group who advised on the key questions, structure of the focus groups (including length and incentive offered), development of the study materials (poster, leaflet) and participant recruitment. Members of the SECF assisted with the displaying of study material and informing potential participants about the study. During the final report writing stage, the SECF reviewed the study findings and provided advice regarding the writing style and plain English language.
Focus group discussions were transcribed verbatim; as we were trying to understand service user perspectives of what was important to them, without preconceived ideas, we undertook an inductive approach to analysis, ensuring that themes were identified from the data themselves, rather than fitting into a pre-existing coding framework. The research was influenced by the paradigm of pragmatism, which focusses on 'what works' and values both subjective and objective knowledge.21 22
Reflexivity was performed to recognise and reflect the role of the researcher within the undertaking of the focus groups, and analysis of the data. Three of the research team (SA, MK and FCS) are social scientists with no clinical experience of working within the UEC system, but with previous experience of research within the area of UEC systems. SMM is an emergency consultant with significant research experience within the area of UEC systems.
A coding framework was developed after discussion with the research team, and initial coding was undertaken by one researcher (SA). Developing themes and emerging interpretations were discussed among the research team. NVivo V.12.0 (QSR International (UK) Limited, Daresbury, UK),23 was used to help structure the analysis. Data saturation was reached as the core themes generated from the data were consistent across all focus groups.
Thirty service users took part across four focus groups. Focus group sizes ranged from six to 11, taking place between September 2018 and February 2019 and included mixed cohorts partly due to logistical problems with arranging separate groups for different users but also because some service users stratified into more than one cohort (ie, aged 75 years or older and had a long-term condition) (table 1).
Overview of themes
The ideal UEC system was centred on three themes (table 2).
A simplified UEC system which is easier to understand and a single-point of access.
A more 'joined-up' UEC system.
Better communication from health staff to patients when accessing UEC services.
Overview of the themes and subthemes from the focus groups
A simplified UEC system which is easier to understand and a single-point of access
Dissatisfaction with health services was directed towards the system (eg, location of services) rather than the clinical care or clinicians who were treating them.
A story you hear quite a lot when you speak to people, it's the system and the processes that are, seem stressful but when you actually see the professional they are outstanding! (25–34 years; parent with young child)
While many service users (particularly those with long-term conditions) said they would prefer to see their own GP, as they receive the continuity of care not afforded to them in other parts of the system, difficulties getting an appointment within a timely manner meant they had to seek care elsewhere.
2 weeks it takes me to get an appointment, 2 weeks it would be for one! It's a joke, you're having a laugh. (55–64 years; long-term condition)
Service users expressed frustration at having to negotiate access to GP's via a receptionist who has no medical training and who was perceived as being unable to make a judgement about the seriousness of their health condition, thereby preventing easy access to the help they need.
One of the things I'd like to see, is your receptionist having a bit of medical knowledge. I'm not saying being as trained up as a doctor or a nurse, but, cos if you want triaging at our place you've got to actually tell the receptionist what's wrong with you and what is the point of telling them when they ain't got a clue what you're talking about. They'll just put it on computer. (45–54 years; long-term condition)
Service users said they want GP practices to extend opening times to accommodate patient demand.
I don't know why GPs shut on Saturday and Sundays because people don't stop being ill at the weekend. (45–54 years; long-term condition)
Service users were aware some health conditions did not warrant the services of an ED, but equally they could not wait until a GP appointment became available. While they did not want to burden overstretched EDs; due to a lack of information or knowledge about alternative services they did not feel confident they were able to make the correct choice.
I think there's too much. It's great that there are different services for different levels of care but that's not helpful if people don't know when to use what. (25–34 years; parent with young child)
Some of the difficulties there are that people are not always the best witnesses of their own distress or illness. They're not very good at reporting so….or find it very difficult to articulate. (45–54 years; long term condition)
Service users described unequal access to services within the UEC system. For example, service users living a greater distance away from the ED experienced considerable barriers to access, particularly if they did not have personal transport (eg, a car); whereas service users liked the central location of the walk-in centre because it is accessible to all and has good public transport links.
I live way down in the South of the city and if I had an aortic aneurysm I would never have got to [name of hospital] alive ok … That's one thing that I really do worry about. It's a long journey to get there, very traffic dependent whether you've got the two's and blues on or not, it takes time. (25–34 years)
In an ideal world, service users would like multiple UEC hubs spread out across the city so no one has to travel too far to get access to the help they need. Each of these hubs would have co-located services (including minor injuries, GP out-of-hours, ED) based on the same site. When someone enters the hub they would be streamed to the most appropriate service based on their health complaint by a health professional, as participants appeared to feel insecure about making their own decisions on where to go. Since the services would be based on one site it would be easy to switch between services if they were initially streamed to the wrong place.
Maybe we should have one in the East and one in the West or there should just be more than one….everyone should be able to get to this magic centre, whatever it's gonna be, within a certain time frame. (25–34 years; long term condition)
I think that the decision of where to go to shouldn't be made by you. It should be made by somebody that you see in the first place. The first point of call is some kind of reception, huge reception with multiple desks. (25–34 years; parent with young child)
I think everything in the same building is good cos then if you get referred you just walk like down the corridor or something. (25–34 years; long term condition)
Yeah, in an urgent care situation, the easiest route is the best route. (25–34 years; parent with young child)
Service users were keen to have a community transport system accessible to people who are unable to get to the hospital independently but who are not serious enough to warrant an ambulance.
It's that thing of your not independently having to travel on a bus, you can just ring up. As you say you might ring up through 111 and they go yes, ok, someone will be with you in 5 min, you know 10 min, 15 min. It's not urgent but yes being accompanied to make sure you're all right and your safe. It's not life threatening, life threatening. So it's a situation where you wouldn't ring 999 but equally you need immediate attention. (25–34 years; long term condition)
A more 'joined-up' UEC system
Frustrations were raised about the UEC system not having access to GP records, resulting in service users repeating key information (eg, medications, allergies) at every encounter with a clinician. Since service users are so connected in other areas of their lives, there was an assumption that health services should be connected in this way too and could not comprehend why this was not the case.
With tablets and things like that. Cos you call your doctor and they want to know all this and the other and then paramedics come out and they want to know all that. Then you get to A&E and they want to know all that. You get to the cubicle and they want to know all that. (65–74 years; long term condition)
Service users want a nationwide computer system which links together health services, so that whatever health service they access, health professionals will have a copy of their medical history to ensure continuity of care.
I think it would be nice if there was one centralised system for everyone for the whole of NHS, GP, everyone. Just so that when you go to A&E they can access everything. (25–34 years; long term condition)
Service users were asked whether they had concerns around data security but none were raised. While service users expressed confidence in the NHS' ability to protect their data; the linkage of services was seen as a greater priority which overrode concerns around data security. However, there were limits to the sharing of health information, with some stating they would not want this shared with external organisations.
I think we should have access to it, but then I'm also thinking, data breaches, the amount of, security attacks, cyber attacks, are you then going to, with your lack of funding for the NHS, if everything then goes digital, how many people are then going to sue the NHS because of data breach? Because someone left a USB on a bus? How secure are the connections? Personally I don't mind people having that data, if I'm in an emergency… (25–34 years; young adult)
I have concerns about information sharing. I don't want my medical data to be shared with the likes of insurance companies. It's medical! (35–44 years)
Some service users lacked confidence in the NHS' ability to create nationwide linked medical records. To overcome this, service users discussed the option of being in control of their own medical records (perhaps in the form of a USB or electronic bracelet), so when they access services they can hand over their health information to help facilitate continuity of care.
Well we have got mobile phones with, you know, like personal details, we have access to banking and things like that on our phones, almost like we should have, hold our own records. (25–34 years; parent with young child).
Better communication from health staff to patients when accessing UEC services
Service users shared stories about waiting for treatment for long periods of time with no information about what is happening and why, with feelings of anxiety exacerbated when services users were unaware of the standard journey through the ED. Assertiveness was described as a way to get more information but not all service users felt confident doing this for fear of being perceived as a nuisance. Once seen by a health professional, the clinical care received was often described as excellent; it was the lack of information between assessments that caused greatest concern.
I didn't know what the next step was. Like I didn't know that I was gonna be going into a little consultation room and having a triage, kind of, well I think that was where they were deciding who I was gonna see and whether it was needed or not, or whether they could send me home. But I just didn't know, and then I was told after doing the triage, it was like, well a doctor needs to see you. I was like, you're not a doctor? What are you? Who have I just spoken to? (25–34 years; parent with young child)
Service users justified long waits due to health professionals being under considerable pressure to see an increasing number of attendances; with an acceptance that other service users may be seen quicker because they are considered more urgent. Being kept updated about waiting times was considered more important than actual wait times.
Waiting times is long at hospital but they've got a hard job, a really hard job. They do well, so I commend them! (55–64 years; long-term condition)
If somebody came every half an hour and said sorry you've been waiting, you're third in the queue or whatever. Just a few updates. (65–74 years; long-term condition)
One solution proposed by service users was to have 'floor walkers' in waiting rooms who could set expectations about what is happening, check health complaints do not worsen and ensure the environment remains a safe space to wait.
I think having someone or a couple of people who are walking around. I dare say, patrolling the area that people are waiting, checking in with people. Again going back to managing expectations, keeping the environment calm, and helping people to kind of get through their time waiting. And using that to spot where there might be trouble brewing or where people might be getting agitated and being able to step in and deal with them before they get escalated. (35–44 years)
Other ideas included technological solutions to update service users where they are in the system and what the approximate wait times are; something visual to look at so they know they have not been forgotten. Service users discussed how big corporations are already using similar systems and queried whether they could be incorporated into health services.
What about an app that tells you the waiting times? I mean they do it at Alton Towers because I was there a few weeks ago. You can look at each one of the rides and think oh it's an hour and a half right, we won't do that one. (35–44 years; parent with young child)
However, technological solutions were not favoured by all
No. Terrifying! Put my hand up. Help! (over 75 years; long-term condition)
Ideas centred around three themes: (1) a simplified UEC system which is easier to understand and a single-point of access; (2) a more 'joined-up' UEC system; (3) better communication from health staff to patients when accessing UEC services. These ideas were directly influenced by service users past experiences of accessing the UEC system, whereby they attempted to identify solutions to problems encountered.
There are similarities to our research findings in literature relating to service user experience and satisfaction with services.9 14–16 A literature review found service users longed for more information from health professionals and became anxious when they were left alone for long periods of time; information about waiting times was more influential on the service user experience than the waiting time itself; and service users understood that people who were more critically ill than themselves would be seen as a priority.16 As in our study, service users are surprisingly accepting of long waits as they understand the health system is overstretched and prioritisation needs to take place, but what is important is that they are kept informed about what is happening to them and why. Service users were also keen to receive reassurance early in their clinical care pathway, especially if their condition is not considered (by clinicians) to be immediately 'life threatening' and that they are safe to be in the waiting room.
Frustrations experienced by service users in having to repeat their past medical history during numerous encounters with health professionals across the UEC system is not unique to our study.24 Solutions to this problem are being addressed in a number of government reports with plans to create personalised comprehensive care records for individuals that contain sufficient information to inform health professionals in their decision making about service users wherever they are seen.8 24 Service users in our study expressed overwhelming trust in the NHS' ability to protect their health data. However, this trust may be overstated when taking into consideration their strong desire for a more joined up UEC system and the fact that conversations were positioned in the context of an 'ideal world' where service users may assume breaches of data security are not a threat. Outside the focus group setting policy makers may encounter resistance to the sharing of health information unless concerns around data security are clearly addressed, especially when it comes to sharing personal health data beyond NHS-led organisations.
Too often the impetus for creating new services has been to re-direct patients into what is deemed a more appropriate health service based on their presenting complaint. Evidence has shown policies aimed at shifting care away from EDs into alternative urgent care services have not achieved their intended effect of decreasing ED visits6; as rather than helping people get to the most appropriate place for their health needs, these alternative services have resulted in further confusion.7 As shown in our study, service users do not want to deliberately burden the overstretched UEC system, but due to the multitude of obstacles encountered; it is perhaps no surprise they inadvertently end up using services in a manner labelled 'inappropriate'. Solutions designed by service users in our study involved taking the responsibility of where to be seen away from the service user, and putting it into the hands of the clinicians who will be treating them; so when someone is sick or injured all they are confronted with is a single point of access, within which they are streamed to the most appropriate place based on their health need.
Our study highlighted the importance of involving service users in the design of the UEC system. Service users are well placed to comment on the UEC system as they are able to take a whole systems approach, rather than focussing on individual services. Service users find it particularly difficult talking about services in isolation of each other and prefer to describe their experiences as a journey involving multiple decisions, encounters with health professionals and obstacles to overcome. By taking this approach, it is apparent that what happens in one section of the UEC system can have significant consequences later on. Policy makers and researchers should increase the involvement of service users in discussions around the reconfiguration of the UEC system, to ensure any changes made will be directly beneficial to those accessing it.
Because the structure of the focus groups was designed to encourage participants to reflect on their past experiences, this may have encouraged users to focus overly on the UEC system as it exists now, constraining any 'blue sky' thinking.
Every attempt was made to optimise recruitment for the study by employing a multitude of techniques. However difficulties were experienced; the study team was unable to recruit from the waiting room of The Children's Hospital due to delays in the approvals process and the final participant sample contained an under-representation by parents with young children and people aged over 75 years. The use of targeted recruitment to specific groups may also have led to potential selection bias. Reasons for non-recruitment may include lack of childcare or accessibility issues (eg, some over 75's may be housebound), which we were unable to overcome. When designing alternatives to the current UEC system it is important to include representation from all groups within society, including those that are traditionally hard to reach (eg, the homeless). This should be explored further in future research.
Finally, the research was undertaken on a limited number of participants in a large urban English city and therefore previous experience of the UEC system that participants referenced was based largely on the context of the NHS. The study findings thus may not reflect the thoughts of service users based elsewhere in the UK, and may limit transferability of findings to settings outside the UK.
Participants within this study identified three main elements to an ideal UEC system; a simplified UEC system with a single-point of access, a more 'joined-up' UEC system and better communication from health staff when accessing UEC services. Service users found that too many individual UEC services, and a lack of communication between them to be confusing and frustrating. Service users expressed a desire for individual UEC services to work closer together to provide an efficient and more 'joined-up' service, with a single point of access where health professionals decide the appropriate service required. Improved communication from health professionals to service users about what is happening and why would help service users feel more in control of their healthcare journey and provide reassurance. Future research should focus on understanding what communication service users prefer, when and from whom to help support them on the care pathway.
The authors would like to thank the Sheffield Emergency Care Forum (SECF) PPI group (https://secf.org.uk/) for their helpful feedback on the recruitment materials (cover letter, information sheet, leaflet and poster) developed for this project to ensure they were suitable for a lay audience and for helping the research team in distributing leaflets and posters advertising the study. We also thank our participants for giving up their valuable free time to share with us their experiences of accessing the UEC system, and for helping us to understand what it is they would like from an ideal UEC system.
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Twitter @fcsampson, @ProfSueMason
Contributors SA, MK and SMM contributed to the design of the work. SA and MK facilitated the focus groups and undertook the analysis and interpretation of data. All authors (SA, MK, FCS, SMM) contributed to drafting the work or revising it critically for important intellectual content.
Funding The research was funded by the National Institute for Health Research (NIHR) Collaboration and Leadership in Applied Health Research and Care, Yorkshire and Humber (CLAHRC YH): Avoiding Attendances and Admissions Theme (AAA) and Connected Health Cities which is a Northern Health Science Alliance Programme funded by the Department of Health and Social Care.
Ethics approval A UK National Research Ethics Committee granted ethical approval for the conduct of the research (18/NS/0076).
Data availability statement No data are available. It is not possible to fully anonymise the qualitative focus group transcripts and therefore no additional data is available.


text:
Friday,July 19
SACAA Kuwait "Fun in The Sun" – A successful family picnic
Kuwait, April 18,2017: St. Aloysius College Alumini Association (SACAA) held their first event "Fun in the Sun" on the Friday, 7th April 2017 at Mishref Garden, Kuwait under the leadership of Mr. Kiran Sunny, President for 2016-2018. The event was planned on the 24th March 2017 but had to be postponed due to unstable weather conditions. With God's grace in spite of dicey forecast we were blessed with good weather and the executive committee (EXCOM ) was all geared up to host the SACAA picnic. This was an event to bring together as many alumni as possible who studied under the Aloysius banner in Mangalore, India along with family and close friends.
The day began with a short address and prayer by General Secretary Darrell DSouza. Later on Vinutha Miranda, Ashley Dsilva, Kiran Sunny and Jaison Lasrado with their remarkable talents, wit and humor conducted lot of games and ensured that everyone was on their toes having fun. During the course of the day there were games for all age groups and it was really good to see fantastic participation with great enthusiasm from all attendees. The EXCOM and the volunteers ensured that the events went on seamlessly.
An abundant supply of snacks and drinks kept everyone energized throughout the day. While the children competed in sack race, collecting water balloons, balancing maximum coins on a biscuit, lemon and spoon and many other games the parents too were equally into it by cheering and encouraging all the children. Teens and parents too had their share of fun reliving old days with the sack race, catching the water balloons and more.
A deliciously sumptuous meal from Caesars Restaurant was the right treat to food lovers. While the heavy lunch definitely got people some well-deserved rest, this was followed by a game of Housie. We then had Dodge ball followed by our good old game "Dog and the bone". The crowd thoroughly enjoyed the games and kept asking for more. The requests were fulfilled by adding many more interesting games. The sportsman spirit and the total participation of everyone were commendable. Overall it was a day to remember with lots of fun, new friends and off course a song in our heart making us proud to be known as Aloysians from Mangalore.
Towards the end of the day winners of all the events were given exciting prizes along with lots of coupons from Al Thiqa Restaurants – Courtesy Lloyd Colaco. Special thanks to Caesars Restaurants and also our sponsors Bahrain Danish Dairy, FICO, Al Yasra, Ashley and Sujay. It would be unfair not to mention the support of the member's families, friends and well-wishers who all made this a very good outing.
The SACAA Executive committee wishes to also announce the Treasure Hunt and more exciting events to follow. Details will be circulated very soon. If you are an Aloysian join the SACAA Whats app group - 66181041. Follow and like our fb page www.facebook.com/sacaaq8/ for regular updates and also check your emails for upcoming events. More images and videos of the SACAA Fun in the Sun picnic is available on the fb page.

redpajama_set_name: RedPajamaCommonCrawl


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ATTIKA 7/Ex-BIOHAZARD Frontman Slams 'Lame Keyboard Ninjas'
July 14, 2012 0 Comment Attika 7
Bob Zerull of Zoiks! Online recently conducted an interview with former BIOHAZARD and current ATTIKA 7 frontman Evan Seinfeld. A couple of excerpts from the chat follow below.
Zoiks! Online: How would you describe the [ATTIKA 7] album "Blood Of My Enemies"?
Evan: "Blood Of My Enemies" is a collection of songs Rusty [Coones, guitar] wrote in prison and songs he and I wrote together, here in SoCal. It's dark, heavy, melodic, and extremely over the edge. It screams hope in the face of desperation and stinks of hatred, pain and revenge! The songs are authentic, genuine, and anthemic, [with] huge sing-along choruses and simply the most musical thing I have ever been a part of. A lot of people who have heard it have told me that I should have done something like this a long time ago.
Zoiks! Online: How was it working with [producer] Mudrock and what did he bring to the album?
Evan: Mudrock is a genius… he is like one of those guys with a strange bedside manner, but simply more meticulous than anyone I have ever worked with, and I have worked with a lot of amazing producers. Mud was the first guy to get me to reinvent myself as a singer, and use my voice as an instrument that would be growing. It's crazy — just listen to the record, drum, bass guitar sounds, vocal sounds, He really harnessed the raw power and emotion of the songs, especially Rusty's lead playing. he helped me so much with my guitar sound and gave us the metal that rocks. He helped me to find the next chapter in my reinvention of my voice. His incredible vintage gear mixed with his knowledge were just two of the keys to the special sauce that makes "Blood Of My Enemies" a phenomenal freshman effort for ATTIKA 7.?
Zoiks! Online: You've watched the music industry change over the years, Now that you've got this new band, what's it like trying to establish a new band with the state the music industry is in?
Evan: Is there really an industry? I have no expectations, just drive, motivation, and a love for music that I share with Rusty and my band brothers. It is certainly a different time, and to tell you the truth, I have a lot of great ideas on how to get our music out to the metal fans of the world, but ultimately, this is my life, i love to tour, sing, play and rock! The Internet is an amazing tool and it circumvents a lot of traditional means and mediums in which people used to access music and info. The most interesting difference is that way less people support bands and buy music than they did in my earlier years. What's kind of funny and pathetic is that many music "industry" people say bullshit like, "Now, we make our money touring and selling merchandise," which really means, people don't buy a lot of records anymore, but the truth is, bands always made money touring,… if they worked hard. ATTIKA 7 has a real hardcore, blue-collar work ethic, so I'm sure we will have a long and strong career. The thing I like least about nowadays is the lame keyboard ninjas that all have an opinion about everything and everyone and simply talk shit about everyone and everything.. so here are a few rules to live by 1.) If someone says something online, but they don't use their real name, and or address to back it up, they really didn't say anything. 2) People who talk shit about bands or other celebs online but have never actually achieved anything on their own, their opinions don't technically count, and 3) If someone calls you a douchebag, it just means that they are jealous of you, your success and or talent. The advent of social media and everyone having a voice is one of the greatest modern advances we have made as a society, but remember, if you are a nerd, and you dis everything that is cool, then all you have left is Jonah Hill and "Napoleon Dynamite". Wait, that is actually all we have left… ATTIKA 7 is here to change that! We are looking to make it cool to be badass again….
Read the entire interview from Zoiks! Online.
← SOUNDGARDEN Interviewed At London's 'Hard Rock Calling' (Video)
JANE'S ADDICTION Frontman Interviewed On 102.1 THE EDGE (Audio) →
ATTIKA 7 Announces New U.S. Tour Dates
EVAN SEINFELD Says Last BIOHAZARD Album Was Lyrically 'Very Uninspired'
ATTIKA 7 Featuring Former BIOHAZARD, STATIC-X Members: Video Footage Of Live Debut


Our global medical leadership teams design and deliver hands-on education programmes to train thousands of local medical professionals, so they can provide treatment within their own communities and share their expertise.
Since 2006, Operation Smile has partnered with Jimma University Specialized Hospital in the southwest region of Oromia, Ethiopia to establish a plastic surgery department and training programme. In this video, Mr Per Hall, Consultant Plastic Surgeon and long-standing UK volunteer, shows how this project will sustainably build the local surgical and overall medical capacity in Jimma.


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C. diff. Spores and More
Tuesday at 10 AM Pacific
November 2nd 2021: The Impact of Penicillin Allergy on a C. difficile Infection
Approximately 10% of all U.S. patients report having an allergic reaction to a penicillin class antibiotic in their past. 10% of the population reports a penicillin allergy but <1% of the whole population is truly allergic. People with a penicillin allergy on their medical record are not given penicillin, and may not be given any beta-lactam antibiotics because of concern that the allergy is shared across the antibiotic class. Instead, the antibiotics prescribed may be broader-spectrum. Broad-spectrum antibiotics may be as effective, but they often have more side effects and toxicities, such a
Tuesday at 10 AM Pacific Time on VoiceAmerica Health and Wellness Channel
Christopher Bland, Pharm.D., FCCP, FIDSA, BCPS
Christopher M. Bland, Pharm.D., is a Clinical Professor at the University of Georgia College of Pharmacy in Savannah, GA at the Southeast GA campus. He has over 20 years of clinical experience in a number of different practice areas with infectious diseases as his primary passion. He has been named both the Preceptor of the Year and Teacher of the Year at the University of Georgia College of Pharmacy and is a Fellow of IDSA and ACCP. He co-founded SERGE-45, a practice based research network across the Southeastern United States with currently over 80 members across 14 states and Washington D.C.
Bruce Jones, Pharm. D., BCPS
Bruce M. Jones is an Infectious Diseases Clinical Pharmacy Specialist at St. Joseph's/Candler Health System practicing in the Savannah City-Wide Antimicrobial Management Program. He also serves as an Adjunct Clinical Associate Professor for the University of Georgia College of Pharmacy and a Clinical Preceptor for Mercer University, University of Georgia, University of South Carolina, and South University Schools of Pharmacy. He received his Doctor of Pharmacy degree from East Tennessee State University Gatton College of Pharmacy in Johnson City, Tennessee. He then completed a Postgraduate Year One (PGY1) Pharmacy Practice Residency at St. Joseph's/Candler Health System. Dr. Jones is a membe
https://www.voiceamerica.com/show/2441/c-diff-spores-and-more 21/01/2022 08:00 21/01/2022 09:00 C. diff. Spores and More https://www.voiceamerica.com/show/2441/c-diff-spores-and-more Approximately 10% of all U.S. patients report having an allergic reaction to a penicillin class antibiotic in their past. 10% of the population reports a penicillin allergy but <1% of the whole population is truly allergic. People with a penicillin allergy on their medical record are not given penicillin, and may not be given any beta-lactam antibiotics because of concern that the allergy is shared across the antibiotic class. Instead, the antibiotics prescribed may be broader-spectrum. Broad-spectrum antibiotics may be as effective, but they often have more side effects and toxicities, such as increased risk of developing infections like C. diff (Clostridioides difficile, formerly called Clostridium difficile) or methicillin-resistant Staphylococcus aureus (MRSA). Our guests Christopher M. Bland, Pharm.D., FCCP, FIDSA, BCPS, Clinical Professor, University of Georgia College of Pharmacy and Bruce M. Jones, Pharm.D., BCPS, Adjunct Clinical Associate Professor for the University of Georgia College of Pharmacy will join us to discuss antibiotics, the different types, diagnostics, diagnosis, and the Impact of Penicillin Allergy on a C. difficile Infection. VoiceAmerica | Talk Radio | Online Talk Radio studio@voiceamerica.com false DD/MM/YYYY Add to Calendar


text:
2020 Program (COVID updated)
partofthingsriverland March 21, 2021 September 12, 2021 Uncategorized
Current and Upcoming Activities:
Riverland Skillin' It (working title)
Riverland Skillin' It is a community-based and locally-driven initiative to nurture a culture of skills and knowledge-sharing led by local young people for young people, and to build foundation small business skills in a lead cohort of young people (the squad). Applications are now open to join the squad. Full details and application form here.
Between January and August 2021 the selected squad will receive mentoring, support and training to create a small digital knowledge bank and a mini skills-sharing festival. The squad will be paid for their time (as freelancers based on negotiated hours) to deliver the project.
To apply to be one of the five selected squad you must meet the following criteria:
Be aged 18-26 as of 1st November 2020
Be currently living in any Riverland town
Be committed to learning, collaborating and delivering the project as a whole
Mixtape Mondays
We've invited creative Riverlanders to curate a playlist for our community on the Part of Things Spotify and we are sharing them on Mondays (via our Facebook and Instagram).
The curator for the week selects the songs, chooses a title for the playlist and is paid a fee of $60. We've left the theme, style and number of songs totally up to each curator.
Scroll through our Facebook page or Instagram posts to meet all of the Mixtape Monday curators so far and listen to all of the playlists via our Spotify.
Mixtape Mondays started in May in response to the restrictions and difficulties of COVID19 – we wanted to provide a small paid opportunity for creative people and something fun and uplifting for our community to experience. If you'd like to be a curator, get in touch.
Recent Activities (completed):
Letters to Blue
The Riverland swirls with magic — from the beds of Lake Bonney to the crowning leaves of the river's red gums.
From the mind and pen of local writer/illustrator Kirste Vandergiessen, Letters to Blue delivered a series of letters direct to participant's emails every day during Mental Health Week in October 2020.
Letters to Blue was supported by funding from the Mental Health Coalition of South Australia through their 2020 Mental Health Week Rural Grants program.
Soundwalks
Deep listening takes practice. Composer-performer and sound artist Dr Jesse Budel guided two sound walks in Barmera to tune in and listen deeply to the environments we take for granted in October 2020. Jesse also gave a talk about the 2019 Riverland Biosphere Soundscape Lab while he was in town.
Thinkers in Residence
The Thinker in Residence Program is about encouraging Riverlanders to give their big ideas time and space. All of us have ideas, those "we should do X" or "imagine if Y" ideas that could really have an impact if given the time and energy to develop. The Thinker in Residence Program is a four-week excuse for selected Thinkers to pursue one or more ideas.
Selected Thinkers in 2019 and 2020 received $500, free access to Part of Things spaces for one calendar month and 10 hours of support from our Chief Storyteller to think about about their idea.
Read more about the 2020 and 2019 Thinkers here.
Applications for the 2021 Thinker in Residence program will open in February 2021.
Check out our Facebook page for other upcoming happenings and the Projects tab for other past happenings.
*COVID19 Update*
Regional folk know all about isolation and all about community care. We're ready to reduce physical contact to take care of our most vulnerable and each other while still ensuring that we connect, reach out and gather in other ways.
Initially at Part of Things we decided to move and translate our existing 2020 programs online to enable connection and gathering under social distancing. We're really aware that there is so much happening online that it's actually overwhelming and hard to make sense of. Many folk in our local community have been reeling from job losses and trying to navigate other practical and psychological changes in their lives this year.
So what's actually useful? How can we contribute to community connection, wellbeing and future building? How can we invest in ideas and skills now and in preparation for whatever comes next?
We're not sure but we have some ideas we want to put time and energy into.
What does that mean for our original 2020 program? Great question. We've taken down our original program (and we are hoping to remount some of those ideas in 2021 instead) and we are taking a different approach to 2020. An approach that is true to our values and intentions. An approach that is gentle and thoughtful and appropriate for physical distancing as long as it lasts.
Instead of a full year program, we are going to take a mostly month by month approach. Instead of our original mix of experiences for thinkers, artists, participants and audiences, we are going to hone in on nurturing new ideas and skills that can lead to future outcomes for everyone. Online or in person we remain a gathering place and ideas hub.
Our selected 2020 Thinkers in Residence are a starting place for this period of reimagining and rethinking.
We'll continue hosting and supporting conversations in the Part of Things virtual hub – a hybrid of chatroom, email and direct messages – contact us for the link to access and get involved.
We remain unashamedly focused on Riverland tastes, interests, ideas and futures in everything we do.
If you'd like to make a contribution to keep our programs running and affordable, we have a virtual tip jar here.
If you're got an idea for a virtual or small in-person gathering/project/event that you'd like to deliver under our umbrella, get in touch here.
Previous World Mental Health Day
Next Taking Up Space (2021)
Published by partofthingsriverland
Our vision is that when people think of the Riverland, they think quirky and creative experiences in the same way that when people think of Melbourne, they think of fancy coffee. Our mission is to nurture a creative and connected generation of doers in the Riverland region of South Australia. We organise projects, events, gatherings, meetings, workshops, mentoring and everything in between to achieve this mission. We present quirky, unique and memorable experiences created and curated by Riverland artists and thinkers: audio walking tours, immersive theatre, collaborative writing projects, video game jams, intimate concerts and creative based workshop tasters. View all posts by partofthingsriverland


Pipe System is a company that is established on the Bulgarian construction market and offers a wide range of services related to the realization of different types of construction projects - commercial complexes, hotels, administrative, residential and industrial buildings and others. The company has more than 14 years of history in the market, with more than 500 objects. We are currently working on 54 projects across the country. We are a major contractor of several significant sites for the capital.
We also receive the prestigious "Building of the year" 2018 in the field of healthcare with the realization of "St. Sofia Hospital" - Corpus 2.
Design of bilding Water & Sewerage installations, on-site water supply and sewerage network, in-house water supply and sewerage connections, Automated Fire Extinguishing systems based on water, foam and water mist; Roof pressure drainage systems, water pool installations, etc.
In accordance with our customers' needs, we are constsntly expanding our product range, and our goal is to offer the best possible option at the best possible price.
Owing to our long-standing experience in construction, we are proud of having successfully executed many projects in various categories – office buildings, commercial projects, hotels, residencial buildings, industrial projects, etc.


The primary focus of the middle manager is executing tactics to achieve the organization's goals.
the essentials of effective coaching and counseling and how to build and maintain a high-performance team and reach your leadership potential.
Want to learn more about Mid Management Leadership Coaching?
Sign up for a FREE coaching call!
This robust coaching program provides the foundations of leadership and focuses on the areas that are critical for the success of a mid-level leader. The Middle manager spends energy and time achieving organizational objectives set by senior leaders. The primary focus of the middle manager is executing tactics to achieve the organization's goals.
The HPBS Mid-Level Coaching program focuses on the development of the critical skills for a mid level manager including General Managers, Regional and Branch Managers, Sales Mangers, etc. HPBS Middle Management Coaching focuses on the areas below to help producing managers effectively develop, implement, and execute strategy that will increase production along with team performance.
Develop and implement Strategy, to develop and execute on the strategy. Effectively translating the overall organizational objectives into an implementable strategy while obtaining the input of the team to ensure collective buy-in.
Identify and recruit the right people – to focus on building your team. Bringing on board "the right people on the bus and placing them on the right seats on the bus" Jim Collins, is a critical step. Further, effective recruiting will account for part of the growth strategy along with the organic growth strategy.
Executing strategy, knowing your business and the team, setting clear core purpose, ensuring implementation by having the right team and following through, validate, recognize and reward achievers and building a strong culture by expanding the autonomy and power of the team. It also requires the wise use of resources.
A mid level manager must always have a constant oversight of revenue and costs, ensure product quality, establish standards of performance, know the customer profiles, monitor productivity of the team, know the competition and maintain constant review of plan vs. actuals.
Design incentives that vary based on performance and create non-monetary rewards such as flexible work schedules.
Establish who will be responsible for tasks and define reporting relationships. In addition, establish how businesses functions will be defined (ex. by product line, geography, or customer segment).
Highly individualized weekly sessions with Principal and Coach, Paul de la Garza.
"The Four Agreements" by Don Miguel Ruiz.
Highly individualized bi-weekly sessions with Principal and Coach, Paul de la Garza.
"The Go-Giver Leader" by Bob Burg.
ENGAGE IN POWERFUL THOUGHT PROVOKING CONTENT THAT WILL SHARPEN YOUR SKILLS AND HAVE A UNIQUE IMPACT ON YOUR ABILITY TO GROW TO YOUR LEADERSHIP POTENTIAL.
Build a high performance leadership team by establishing a clear mission and values for your team, promoting communication and a culture of collaboration.
Develop skills in validating, empowering, recognizing/rewarding and accountability, the key skills in developing a strong leadership culture.
Our goal is to help you achieve higher heights in your performance, increase your income, and give your clients a higher level of value and service without having to invest more time in your work week.


Y Combinator is kicking off its 19th (!!!!) demo day today at the Computer History Museum in Mountain View, and the TechCrunch crew is on the ground to let you know which hot new startups investors will be clamoring over for the next few weeks and months.
Stick with us throughout the day as we update you on which companies are launched and which we think were the most impressive. In the meantime, here are the first 17 companies to demo their startups to investors.
Weave is a telephone service that better connects patients and their medical providers. Going to the dentist is roughly as fun as, well, going to the dentist. The company wants to make that better by helping dentists keep track of their patient information, and needs, integrating that into their communications system.
Before Y Combinator, Weave had yearly recurring revenue of $790,000. Post Y Combinator, that figure is now $1.8 million, up 38 percent per month during the period. Weave picked dentists to start because they are wealthy and low on regulation. The product will scale into other health verticals. Weave charges $300 per month per location for its service. There are 190,000 dental offices in North America, indicating that its addressable market is quite large.
Learn more about Weave on TechCrunch.
This startup wants to help companies to reduce churn, using machine learning to let them know when customers are going to leave and why. One customer is using Framed Data to reduce churn by 3 percent, which could be the difference between profit or loss.
Churn costs companies around the world $15.4 billion per year, and Framed Data believes that it can change that. The company has grown by 62.7 percent and is already being used by companies that include Twitch and Homejoy.
Read more about Framed Data here.
With 30 million low-income patients in the country, the need here is not small. CareMessage currently works with 100,000 patients in 16 states, growing at 100 percent per week over the past few months. The company is raising $2 million to reach 10 million patients. It wants to reach 1 million by Christmas.
"We're the Bloomberg of Bitcoin" says TradeBlock's co-founder. It's a subscription platform of digital currency trading tools that includes a real-time market info, a bitcoin-mining calculator, deep research of trends, and an extra-premium communication network and analysis platform for top bitcoin traders. TradeBlock sells its software to investment funds, exchange operators, and professional traders. With Bitcoin trading volume increasing from $50 million in February 2013 to $5 billion in February 2014, there's an increasing need for digital currency intelligence, and TradeBlock could position itself as the defacto tool for the industry.
Cambly provides a mobile app that connects students who want to learn a language with a native speaker who can help them learn. The company is growing fast thanks to the confluence of a couple of big trends — there are billions of people who want to learn English, and there are billions of people with smartphones.
Cambly charges students $20 an hour and pays $10 to native speakers who wish to talk with them. But they aren't professional teachers — they're just regular people, and students are more than willing to talk to them. Cambly is growing at a rate of 30 percent month over month since launch 10 months ago, and shows no sign of slowing down.
Learn more about Cambly on TechCrunch.
PiinPoint is a service that helps businesses pick their next physical location. From charging stations to coffee shops, picking up a new spot to nail down your new brick-and-mortar spot is a challenge.
The company charges $5,000 per month per seat. So, PiinPoint is not a low-dollar solution to a high-dollar problem. In the past three weeks of its paid pilot, PiinPoint went from having eight locations in its system, to having more than 16,000.
Learn more about PiinPoint here.
There are 30 million sellers on marketplaces like Airbnb and Etsy, and they all want more sales. Bettable makes it dead-simple for them to run ads promoting their apartment for rent, or homemade handicraft. Sellers just sign up and send Boostable the URL of their listing or item, and Boostable runs efficient, A/B-tested ad campaigns around the web using advanced retargeting to show them to the right people. And since each sale for these sellers also earns the marketplaces money, they're happy to connect Boostable to their sellers. Airbnb has already partnered with the startup. With its current deals, Boostable could reach 500,000 sellers. If it can convince advertising novices they need to spend money to make money, Boostable could pull in enough small ad contracts to see huge revenue.
SendWithUs optimizes transactional emails sent by businesses, boosting the number of emails that are opened and the overall revenue opportunity for customers. It's partnered with SendGrid, which sends 12 billion emails per month and is going after a $1.3 billion enterprise market.
With clients like Teespring and Homejoy, the company is seeing revenues grow by 12 percent every week for the past 10 weeks. Why? Because it works. One SendWithUs client saw an optimized email get 25 percent more opens and an 8.6 percent increase in transactions.
Read up on SendWithUs here.
Zinc is a browser plug-in that helps shoppers find the lowest price online. After shopping as they usually do, users click the Zinc button, and the app fills the order. Zinc then sources the item from any place online, presumably taking a cut of the differential between the price that the consumer was offered, and its final cost.
According to a graph shared on a slide by the company, its run rate is over the $2 million mark, and it has accreted 12,000 users in the first six weeks of its life as a public service. Zinc depends on both algorithms and humans to source its deals.
Learn more about Zinc on TechCrunch.
Taplytics lets mobile apps instantly try and track the success of A/B tests. An easy graphic user interface lets marketers, designers, or developers switch variables without having to ask for help or pay anyone. Taplytics worked with clothing e-commerce app KarmaLoop and increased its sales 125 percent in a single week. The startup is growing 55 percent a week, has 1000 users, and has signed deals with Intuit, 500 Pixels, and Pivotal Labs despite only being on iOS. It charges developers 1 cent per download, but hopes to make developers much more by optimizing their apps for e-commerce sales, usage or whatever metric a company wants. If you want to try it out, Tapyltics has an amazing, responsive demo on its site where you can try switching text, colors, and designs of an app in real time. Read more from TechCrunch about Taplytics.
AirPair is a marketplace that helps to double productivity by connecting developers with experts from companies whose APIs they're using. The API-ification of software has already occurred but not all developers know all the best ways to use those APIs.
AirPair sets up video chats with experts at companies like PayPal, Stripe, Heroku, and RackSpace. It allows those companies to monetize video time with partners and provide free distribution from mentions in their software development kits. All of which brings expert advice on-demand.
Read more about AirPair here.
According to BatteryOS, if you charge a battery to 100 percent, it rapidly degrades the battery itself. After many cycles, batteries' capacity declines. With BatteryOS, the company claims you will be able to charge your batteries to full capacity and not suffer that degradation.
The company claims that if the Chevy Volt used BatteryOS, it would have twice the range, and last 8 years longer. The company did not explain how its product works, but did allude to having orders for units in the tens of thousands.
Learn more about BatteryOS here.
You can make a lot of money renting out your house or apartment on Airbnb, but it also takes a lot of work. You have to respond to rental inquiries, vet guests, arrange meetups, do the key exchange, schedule a cleaning service between guests, and be on call to help your guests. Superhost takes care of all of that for you in exchange for a 3 percent commission. Revenue is growing 40 percent a week, and now hostels and small hotels are inquiring about Superhost's assistance. It's going up against similar services like Urban Bellhop. The management hassle is the biggest barrier to people renting on Airbnb, so if Superhost can gain mindshare, the startup, Airbnb, and renters could all make a lot more money. Read more from TechCrunch about Superhost.
Companies spend a lot of time qualifying leads, but StackLead has built technology that helps them identify the most valuable leads. Its customers typically contact 30 percent more leads because they don't waste time researching them; instead StackLead pulls up the information for them.
In the U.S., there are 2.5 million sales people, and about 250,000 of them just spend time qualifying leads. That adds up to a cost of more than $11 billion to pay humans to do what StackLead does in software.
Read up on StackLead here.
MemeBox is a cosmetics company that vends its products only on the web, and mobile, allowing it to shave costs. Selling between the high end, and the very low end, MemeBox wants to find value at profitable price points.
The company is currently generating $1.3 million in monthly sales and expects to end the year at a run rate of $150 million. Its lower-cost model of not having retail presence helps it have stronger margins than the traditional model would allow.
Read more about Memebox on TechCrunch.


text:
Q: How to prevent my function from delayed deleting in RemoveDirectory() WINAPI? How do I correct the piece of code below for it to work properly? The purpose of the function is only to delete directories and files inside of the directory.
Because when I run this function (even in a separate thread), it doesn't delete the folder passed in the first argument due to some handles existing (probably).
And Windows doesn't delete the folder until the end of the program, see code below.
How do I fix existing of handles before the RemoveDirectory is called?
I already tried to move the HANDLE variable (which is inside of the function below) out of stack when RemoveDirectory is called.
The problem is just in the delayed deleting of the folder (not other files, they delete normally).
int DeleteDirectory(const std::string &refcstrRootDirectory,
                    bool              bDeleteSubdirectories = true)
{
  bool            bSubdirectory = false;       // Flag, indicating whether
                                               // subdirectories have been found
  HANDLE          hFile;                       // Handle to directory
  std::string     strFilePath;                 // Filepath
  std::string     strPattern;                  // Pattern
  WIN32_FIND_DATA FileInformation;             // File information

  strPattern = refcstrRootDirectory + "\\*.*";
  hFile = ::FindFirstFile(strPattern.c_str(), &FileInformation);
  if(hFile != INVALID_HANDLE_VALUE)
  {
    do
    {
      if(FileInformation.cFileName[0] != '.')
      {
        strFilePath.erase();
        strFilePath = refcstrRootDirectory + "\\" + FileInformation.cFileName;

        if(FileInformation.dwFileAttributes & FILE_ATTRIBUTE_DIRECTORY)
        {
          if(bDeleteSubdirectories)
          {
            // Delete subdirectory
            int iRC = DeleteDirectory(strFilePath, bDeleteSubdirectories);
            if(iRC)
              return iRC;
          }
          else
            bSubdirectory = true;
        }
        else
        {
          // Set file attributes
          if(::SetFileAttributes(strFilePath.c_str(),
                                 FILE_ATTRIBUTE_NORMAL) == FALSE)
            return ::GetLastError();

          // Delete file
          if(::DeleteFile(strFilePath.c_str()) == FALSE)
            return ::GetLastError();
        }
      }
    } while(::FindNextFile(hFile, &FileInformation) == TRUE);

    // Close handle
    ::FindClose(hFile);

    DWORD dwError = ::GetLastError();
    if(dwError != ERROR_NO_MORE_FILES)
      return dwError;
    else
    {
      if(!bSubdirectory)
      {
        // Set directory attributes
        if(::SetFileAttributes(refcstrRootDirectory.c_str(),
                               FILE_ATTRIBUTE_NORMAL) == FALSE)
          return ::GetLastError();

        // Delete directory
        if(::RemoveDirectory(refcstrRootDirectory.c_str()) == FALSE)
          return ::GetLastError();
      }
    }
  }
  return 0;
}

p.s. the piece of code was taken from here:
How to delete a folder in C++?

A: First of all, I apologize for asking such a misleading question but...
I have found my mistake, It is not in the function that I posted in the question.
I have a project where I used my function DirectoryExists, and there was a function from the  header "opendir" (It is a portable version of linux header for Windows and there are probably WINAPI HANDLEs inside of it). And I forgot to close the directory after I've opened it to check if it exists.
bool DirectoryExists(const std::string & path)
{
    DIR *dir = opendir(path.c_str());
    if (dir) {
        return true;
    }
    else
        return false;
}

And I've corrected the error:
bool DirectoryExists(const std::string & path)
{
    DIR *dir = opendir(path.c_str());
    closedir(dir);
    if (dir) {
        return true;
    }
    else
        return false;
}

I hope that this question can help someone to understand why RemoveDirectory() could work as not expected. There could be some handles that you did not notice and It's not that clear If you're not a professional Windows programmer.

redpajama_set_name: RedPajamaStackExchange


Kibera is the biggest urban slum in Africa and one of the biggest slums in the world. The Government owns all of the land and only 10% of residents are shack owners. These owners let out their inventory of shacks to tenants, thus making the remaining 90% of residents tenants with no rights. The average size of a shack in this area is 12ft x 12ft built with mud walls, a corrugated tin roof with a dirt or concrete floor. These shacks often house up to 8 or more with many sleeping on the floor.
In most of Kibera there are no toilet facilities. One latrine (hole in the ground) is shared by up to 50 shacks. Once full, young boys are employed to empty the latrine and they take the contents to the river. Unsurprisingly, this practice has made the river water unclean to drink and the biggest cause of typhoid and cholera in the region.
The unemployment rate of Kibera residents is 50%, and even for residents that are employed, the average salary is less than $1 per day. Receiving an education is critical to these children if they are to have an opportunity to escape Kibera.


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I hope you have already familiarised with this website. Today it includes an article on the Black Death. Those of you interested in history, just click on the link below and enjoy it.


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text:
Q: Why can I substitute x = a sin θ? I am reading my Calculus book, Calculus 8th Edition by James Stewart, and in 7.3 (pp. 526), it explains that I can use the reverse substitution: $$x=a\sin(\theta)$$
for the integral: $$\int{\sqrt{a^{2}+x^{2}}dx}$$
My question is, how does this work? Is it some special relationship or identity I am missing, or is it just an arbitrary substitution that can be made temporarily to calculate the integral? If the latter, does that mean I can substitute or reverse substitute anything when integrating as long as the integration is consistent, even if it's completely unrelated to the process or has no relationship to anything in the integrand? If not, or even if so, is there a relationship between: $$x \text{ and } a\sin(\theta)$$
If there is a relationship, can someone please explain it, or at least point me to a source that explains it well.

A: Are you sure that you read it careful?
for $$\int{\sqrt{a^{2}-x^{2}}dx}\\x=a\sin(\theta) \to \int{\sqrt{a^{2}-a\sin^2(\theta)}a^2\cos(\theta)}d(\theta)=\\
\int a{\sqrt{1-\sin^2(\theta)}a\cos(\theta)}d(\theta)=$$and for
$$\int{\sqrt{a^{2}+x^{2}}dx}\\x=a\tan(\theta)\to \int{\sqrt{a^{2}+a^2\tan(\theta)^{2}}d(1+\tan^2(\theta))d\theta}\\x=a\tan(\theta)\\
\int{a\sqrt{\underbrace{1+\tan(\theta)^{2}}_{\frac{1}{\cos^2(\theta)}}}d(1+\tan^2(\theta))d\theta}$$

A: K.defaoite answered my question. It turns out I was looking at the concept the wrong way, and it's just an algebra trick for getting what you want in the integration process.


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Congratulations on your anniversary, enjoy your trip to Peru.
Thank you again for all your kindness.