text:
Medication discrepancies and associated risk factors identified among elderly patients discharged from a tertiary hospital in Singapore
Farooq Akram1,2, FAMS, MRCP, Paul J Huggan3, FRACP, Valencia Lim2, MBBS, Yufang Huang2, MBBS, Fahad Javaid Siddiqui4,5, MSc, Pryseley Nkouibert Assam4,5, PhD, Reshma A Merchant1,2, FAMS, MRCP
1University Medicine Cluster, National University Health System, Singapore
2Yong Loo Lin School of Medicine, National University of Singapore, Singapore
3Waikato District Health Board, Hamilton, New Zealand
4Duke-NUS Graduate Medical School, Centre for Quantitative Medicine, Singapore
5Singapore Clinical Research Institute, Singapore
Correspondence: Dr Farooq Akram, Associate Consultant, Advanced Internal Medicine, National University Health System and National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore 119228. drfarooqakrammd@gmail.com
Medication discrepancies and poor documentation of medication changes (e.g. lack of justification for medication change) in physician discharge summaries can lead to preventable medication errors and adverse outcomes. This study aimed to identify and characterise discrepancies between preadmission and discharge medication lists, to identify associated risk factors, and in cases of intentional medication discrepancies, to determine the adequacy of the physician discharge summaries in documenting reasons for the changes.
A retrospective clinical record review of 150 consecutive elderly patients was done to estimate the number of medication discrepancies between preadmission and discharge medication lists. The two lists were compared for discrepancies (addition, omission or duplication of medications, and/or a change in dosage, frequency or formulation of medication). The patients' clinical records and physician discharge summaries were reviewed to determine whether the discrepancies found were intentional or unintentional. Physician discharge summaries were reviewed to determine if the physicians endorsed and documented reasons for all intentional medication changes.
A total of 279 medication discrepancies were identified, of which 42 were unintentional medication discrepancies (35 were related to omission/addition of a medication and seven were related to a change in medication dosage/frequency) and 237 were documented intentional discrepancies. Omission of the baseline medication was the most common unintentional discrepancy. No reasons were provided in the physician discharge summaries for 54 (22.8%) of the intentional discrepancies.
Unintentional medication discrepancies are a common occurrence at hospital discharge. Physician discharge summaries often do not have adequate information on the reasons for medication changes.
Keywords: documentation of reasons, medication discrepancies, physician discharge summaries
Medication discrepancies are defined as inconsistencies between two or more medication lists; they commonly occur among geriatric patients at the time of hospital discharge.(1) Discrepancies can lead to preventable medication errors and adverse events.(2-5) In a recent study by Coleman et al, 14.1% of elderly patients experienced more than one medication discrepancy post-hospitalisation.(6) Other studies found that 23%–49% of hospitalised patients experience more than one medical error following discharge from a teaching hospital, 72% of which are related to medications.(3,7,8)
Unintentional medication discrepancies, which often result from unintended medication changes, pose a risk to patient safety. Even intentional discrepancies, if poorly communicated and inadequately documented in physician discharge summaries, can leave the next care providers with unanswered questions. Preventable errors can then occur, which may affect patient safety, especially during early post-discharge.(9) Notably, it has been reported that information regarding discharge medications are absent from 2%–40% of discharge summaries.(10,11)
One way to reduce medication discrepancy risk and promote patient safety is to have medication reconciliation at all interfaces of care.(1) This was a designated national patient safety goal in 2005 by The Joint Commission, the United States.(12,13) In order for reconciliation efforts to be effective, institutions need a more thorough understanding of the nature of the problem that reconciliation aims to prevent.(14) The present study was designed to identify and characterise the discrepancies between preadmission and discharge medication lists, in order to define the associated risk factors, and to determine whether physicians document and provide reasons for the medication changes in discharge summaries. To the best of our knowledge, this is the first study in Singapore to address this patient safety issue in the setting of an acute tertiary hospital.
Approval to carry out a retrospective clinical record review of 150 patients was obtained from the National Healthcare Group, Domain Specific Review Board, Singapore. A total of 229 consecutive patients aged ≥ 65 years and admitted to any of the two Internal Medicine wards in National University Hospital, Singapore, between 25 May 2011 and 28 June 2011 were screened. Of these 229 patients, only 150 fulfilled the inclusion criteria. To be eligible for this study, patients had to have a traceable prescription in the National Healthcare Group's Cluster Patients Record System (CPRS), with evidence of a prescription refill for a pre-specified set of 21 chronic diseases. These 21 chronic diseases were identified in a previous study at the same institution (unpublished data) and the patients were on treatment for them at the time of admission (Table I). Patients were excluded if they were transferred to other wards, taken over by other subspecialties or expired before hospital discharge.
The 21 chronic diseases used in the present study to define preadmission medications.
The following patient data was collected: age, gender, number of comorbidities, functional status, number of preadmission and discharge medications, length of stay, number of past hospitalisations, documentation of dedicated clinical rounds carried out on the day before discharge or on the day of discharge (early morning), and whether discharge was carried out on a weekend or a public holiday. All non-electronic preadmission medication prescriptions, which are usually obtained from private general practitioners (GPs), were excluded because information related to such prescriptions was not consistently available in the clinical records. The lists of preadmission and discharge medications were obtained from the CPRS and physician discharge summaries. Computerised provider order entry and pharmacy records are typically documented and available in the CPRS. Medications obtained from private GPs and over-the-counter medications were manually entered by clinicians, as such information is not automatically populated or updated.
In our institution, the general medicine clinical pharmacists caring for patients routinely perform admission and discharge medication reconciliation. Our electronic system has features that facilitate electronic collection and transfer of detailed medication information obtained through medication reconciliation (from the time of admission to discharge). This detailed medical information is routinely available to the discharging teams for the preparation of discharge prescriptions.
Preadmission and discharge medication lists were compared for any discrepancy (e.g. addition, omission, duplication and/or changes in dose, frequency or formulation of medication). Patient clinical records and physician discharge summaries were reviewed to determine if the discrepancies found were intentional or unintentional. A discrepancy was defined as an inconsistency between the two medication lists of a patient, regarding the presence, absence, dosage, route, frequency or formulation of a medication. An unintentional discrepancy was defined as one that lacked any documentation of medication change in either the clinical record or the physician discharge summary. An intentional discrepancy was defined as one associated with clear documentation of the intended change in the clinical record and/or the physician discharge summary. An intentional discrepancy was considered conflicting if the discharge medication was found to be different in any way from the physician's orders in the clinical order or discharge summary. A discrepancy was deemed inconclusive if there were limitations to the determination of the physician's intent (e.g. illegible or faded handwritten inpatient case notes). Finally, we documented whether intentional discrepancies were communicated in the discharge summaries.
Discrepancies in the preadmission and discharge medication lists were assessed by noting the overall presence of differences between the two lists and enumerating the type of discrepancies between the two lists. Assignment of reasons for the observed discrepancies was also assessed. 95% confidence intervals (CIs) were calculated using the normal approximation method.(15,16) The association between the various risk factors and the presence of unintentional or conflicting discrepancy (UCD) was characterised using odds ratios (ORs) and their respective 95% CIs. Univariate and multivariate logistic regression models were used to estimate the unadjusted and adjusted ORs between the risk factors and the incidence of UCDs.(15,16)
Due to the exploratory nature of this study, a rigorous model-building approach was adopted. First, univariate logistic regression models were employed to assess the association between each of the potential risk factors (i.e. age, gender, number of preadmission and discharge medications, number of comorbidities and functional status as reflected by the Barthel index) and the incidence of UCDs. Second, stepwise, forward and backward automated variable selection methods were used to identify the independent risk factors for UCDs.(17-19) The significance level for a risk factor to enter or stay in the model was set at 0.20. Third, variables that were selected by any of the automated variable selection methods were included in a multivariate logistic regression model, and a backward elimination procedure was performed by the statistician based on a significance level of 0.05. The effect of sensible interactions between independent risk factors was also evaluated. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the multivariate logistic regression model.(20) The significance level, which was adjusted for multiple testing, was set at 5% unless stated otherwise. Analysis was performed using the Statistical Analysis System version 9.2 (SAS Institute Inc, Cary, NC, USA).
The characteristics of the study population are shown in Table II. Among the 150 consecutive patients in the study cohort, 89 (59.3%) were female and 61 (40.7%) were male. They had a median age (interquartile range [IQR]) of 78 (72–83) years. The mean (IQR) number of preadmission medications was 5 (3–7) and the mean (IQR) number of baseline comorbidities was 4 (2–5). Among the patients, 18.0% presented with severe baseline functional dependency (i.e. Barthel index score ≤ 4). The median (IQR) length of stay was 5 (4–9) days.
Characteristics of the study population (n = 150).
For the 760 preadmission medications in our cohort, 42 unintentional medication discrepancies (35 were related to omission or addition of a medication and seven were related to a change in dosage and frequency) were found in 35 (23.3%) patients. Omission of the baseline medication was the most common unintentional discrepancy. 237 documented intentional discrepancies were found in 115 (76.7%) patients. Among the 237 documented intentional discrepancies, 5 (2.1%) were intentional with conflict. No reasons were assigned in the discharge summaries for 54 (22.8%) of the intentional discrepancies (Fig. 1). Dedicated 'day before discharge' and 'day of discharge early morning' clinical rounds were documented for 90.0% and 97.3% of the study patients, respectively; 27 (18.0%) patients were discharged on a weekend or public holiday (Table II).
Chart shows the characteristics and types of medication discrepancies. *Assignment of reasons for intentional medication discrepancies in physician discharge summaries is considered the best medical practice. †Discrepancies (both intentional and unintentional) with conflict represent medication error and are considered undesirable.
The incidence of UCDs was not significantly related to the patients' age, number of preadmission and discharge medications, number of comorbidities or baseline functional status. However, the incidence of UCDs was significantly related to the number of discrepancies per patient on discharge (OR 1.29, 95% CI 1.06–1.56, p = 0.009), indicating that patients with a higher number of medication changes during admission are more likely to have a UCD (Table III).
Binary logistic regression analysis of patient-related risk factors for unintentional medication discrepancies at hospital discharge.
The present study is one of the few studies that examine the prevalence of medication discrepancies among elderly patients discharged from a tertiary care hospital; to the best of our knowledge, it is the first such study conducted in Singapore. Among the hospitalised elderly in our study, we found that 23.3% had at least one actual unintentional medication discrepancy on discharge. This value is much higher than that (14.1%) reported by Coleman et al in their prospective study.(6) In that study, the medication discrepancies were identified in the post-discharge setting. Several other studies have reported higher incidences of medication discrepancies (between 41% and 56%);(4,22-24) these differences in the incidence of medication discrepancies are likely due to the different study designs and study settings.
Omission and addition of a new medication were the most common actual unintentional discrepancies identified in the present study. This is consistent with the findings of other studies.(4,22,24) Although intentional discrepancies with conflict occurred less frequently than unintentional discrepancies in our study, they are equally undesirable and represent medication error. Such discrepancies are significant as they may confuse both the patients and their community clinicians. Nickerson et al found that 90.9% of discrepancies have a potentially significant or very significant clinical impact,(24) while other studies have shown that medication discrepancies are associated with increased rates of rehospitalisation(25) and increased healthcare-associated costs.(26) Although we did not assess the risk of possible negative outcomes caused by such discrepancies, the implications and risk of adverse events can be inferred.
In contrast to previous studies,(1,6,27) we did not find any associations between number of unintentional medication discrepancies and patient age, number of comorbidities present and number of medications at admission. The absence of these associations may be due to the small sample size, the different patient population or the different study setting. It may have also been due to our unit's robust system of dedicated clinical rounds, which are carried out on the day before discharge or in the early morning of the day of discharge. These clinical rounds may have resulted in a lower overall incidence of unintentional medication discrepancy among patients with complex medical problems.
One of the objectives of the present study was to audit the adequacy of the physician discharge summaries and to identify gaps in the current discharge process, for the purpose of enabling targeted improvement. In the present study, 29 of the patients with intentional medication changes were discharged without justification given in the physician discharge summaries. It was logical that no patient with an unintentional medication discrepancy had justification documented for the discrepancy. If any discrepancy in the preadmission medications was noted, the pharmacist overseeing the discharge prescriptions would call the discharging physician to enquire whether the change was intentional. Despite this measure and the dedicated discharge rounds, one out of four patients in the present study was discharged with at least one unintentional medication discrepancy.
The findings of the present study provide important insights into the performance of the current medication reconciliation process and its inadequacies. Firstly, medication reconciliation was done mainly by acquiring preadmission medication lists from electronic medication records, which are often inaccurate.(28) A recent study, which was conducted in a well-established healthcare system that has broadly integrated electronic health records, showed that 60% of the patients had one or more medication discrepancies.(28) Electronic health records are currently not widely accessible in Singapore; the records are not linked to community pharmacies and private healthcare providers, which constitute the bulk of primary healthcare in Singapore.(29) Secondly, we did not find any documented evidence to suggest that a comprehensive medication history, which includes multiple sources of information, was obtained in all patients to generate an accurate preadmission medication list. Thirdly, a recent study conducted in the Netherlands showed that insufficient knowledge among healthcare professionals, unclear task allocations and lack of collaboration among the multidisciplinary stakeholders were important barriers to successful implementation of medication reconciliation.(30) Even though we could not assess these factors in the present study due to its retrospective nature, concerns can be raised regarding adequacy of communication and collaboration among members of the multidisciplinary team, in view of the significant number of unintentional discrepancies. Finally, we noted a lack of documentation regarding medication changes in the physician discharge summaries. These summaries, which serve as the primary document for communicating a patient's care plan to post-hospital healthcare providers, may leave the next healthcare provider with limited information regarding medications that were stopped and reasons for their discontinuation, and reasons for the introduction of new medications (if any). This finding points toward a system of care that places the burden of transcription and clinical documentation on a limited number of clinical staff who face competing responsibilities. Residents are particularly vulnerable to lapses that may result from time demands, workload and exhaustion.(31)
The findings of the present study should be interpreted in light of several limitations. The review of the two medication lists of each patient was carried out retrospectively; in other words, the investigators were not able to speak with the physician, the patient or their family members (which would have been possible if the study was done prospectively). In addition, the review of the medications prescribed was limited to the 21 pre-specified chronic medical conditions. The medication prescription lists were obtained from an electronic patient record system and only medications with a refill supply that was sufficient to last till the day of index admission were included. This step was taken to ensure that the list obtained was the most accurate preadmission medication list. However, this may have resulted in a relatively lower overall incidence of unintentional discrepancy, as many medications were excluded from review. Furthermore, we did not review the outpatient clinic notes. These notes may contain information about dose adjustments or changes in medications. It is possible that some patients had dose adjustments or changes in medications, such as drug omission, during their visits to hospital clinics. These changes would not have been reflected in the electronic medication records as the changes may not have required new prescriptions.
The findings of the present study support the need for a comprehensive, structured and multidisciplinary team approach to ensure the best possible practice of medication reconciliation at all transitions of care. The High 5s, a medication reconciliation standard operating procedure,(32) is one of the five patient safety protocols developed by the Institute for Safe Medication Practice, Canada. It consists of a standardised, two-step process. The first step outlines the acquisition of a 'best possible medication history' that is more comprehensive than a routine primary medication history, which is often a quick preliminary medication history that may not include multiple sources of information. The second step deals with the resolution of inaccuracies in the current medication history (i.e. medication discrepancies) in consultation with the principal practitioner. It should lead to the development of a 'best possible discharge medication list', which should then be compared against discharge prescriptions. Kwan et al showed that the number of patients with inaccuracies in their current medication history can be halved with the introduction of this intervention.(33)
It is essential to recognise that effective communication and partnership among hospital staff, community healthcare providers and patients is the key to a successful medication reconciliation process. Patient empowerment through medication education, which ensures that the patient comprehends the medication instructions, should be an endpoint of discharge counselling; the endpoint should not just be the act of delivering the information. Moving forward, there should be plans to develop a single and updated system of reconciled medication lists and care plans that is electronically and manually accessible to patients, their caregivers, physicians, alternative care practitioners, clinics, hospitals, home health aides, nursing homes and other people who participate in the care of a patient. The development of such a system would be an important milestone in medication safety.
To conclude, we found that medication discrepancies are a common occurrence in elderly patients at the time of discharge in our hospital. Physician discharge summaries did not adequately document and justify medication changes. We support and recommend the trial and implementation of the 'best possible medication reconciliation' practice model and other effective strategies, for the purpose of improving the quality of discharge communication in relation to patient medication.
1. Stitt DM, Elliott DP, Thompson SN.Medication discrepancies identified at time of hospital discharge in a geriatric population. Am J Geriatr Pharmacother. 2011;9:234-40.
2. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424-9.
3. Forster AJ, Murff HJ, Peterson JG, Gandhi TK, Bates DW.The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-7.
4. Vira T, Colquhoun M, Etchells E.Reconcilable differences:correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15:122-6.
5. Kripalani S, Jackson AT, Schnipper JL, Coleman EA.Promoting effective transitions of care at hospital discharge:a review of key issues for hospitalists. J Hosp Med. 2007;2:314-23.
6. Coleman EA, Smith JD, Raha D, Min SJ.Posthospital medication discrepancies:prevalence and contributing factors. Arch Intern Med. 2005;165:1842-7.
7. Moore C, Wisnivesky J, Williams S, McGinn T.Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646-51.
8. Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170:345-9.
9. Cua YM, Kripalani S.Medication use in the transition from hospital to home. Ann Acad Med Singapore. 2008;37:136-6.
10. Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians:implications for patient safety and continuity of care. JAMA. 2007;297:831-41.
11. van Walraven C, Weinberg AL.Quality assessment of a discharge summary system. CMAJ. 1995;152:1437-42.
12. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW.Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20:317-23.
13. The Joint Commission. Ambulatory Health Care National Patient Safety Goals 2015.. Available at: http://www.jointcommission.org/assets/1/6/2015_NPSG_AHC1.PDF. Accessed January 5 2015.
14. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23:1414-22.
15. Agresti A. Categorical Data Analysis. 2002;2nd edNew York John Wiley & Sons.
16. Agresti A.An Introduction to Categorical Data Analysis.. 2007;2nd edNew York John Wiley & Sons.
17. Hocking RR.A biometrics invited paper. The analysis and selection of variables in linear regression. Biometrics. 1976;32:1-49.
18. Miller AJ.Selection of subsets of regression variables. J R Stat Soc Series A. 1984;147:389-425.
19. Miller A.Subset Selection in Regression.. 2002;2nd edBoca Raton, FL Chapman & Hall/CRC.
20. Hosmer DW, Lemeshow S.Applied Logistic Regression.. 2004;New York John Wiley & Sons.
21. Collin C, Wade DT, Davies S, Horne V.The Barthel ADL Index:a reliability study. Int Disabil Stud. 1988;10:61-3.
22. Bolas H, Brookes K, Scott M, McElnay J.Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland. Pharm World Sci. 2004;26:114-20.
23. Whittington J, Cohen H.OSF healthcare's journey in patient safety. Qual Manag Health Care. 2004;13:53-9.
24. Nickerson A, MacKinnon NJ, Roberts N, Saulnier L.Drug-therapy problems, inconsistencies and omissions identified dang a medication reconciliation and seamless care service. Healthc Q. 2006;8:65-72.
25. Walker PC, Berstein SJ, Jones JN, et al. Impact of a pharmacist-facilitated hospital discharge program:a quasi-experimental study. Arch Intern Med. 2009;169:2003-10.
26. Dedhia P, Kravet S, Bluger J, et al. A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes. J Am Geriatr Soc. 2009;57:1540-6.
27. Unroe KT, Pfeiffenberger T, Riegelhaupt S, et al. Inpatient medication reconciliation at admission and discharge:A retrospective cohort study of age and other risk factors or medication discrepancies. Am J Geriatr Pharmacother. 2010;8:115-26.
28. Linsky A, Simon SR.Medication discrepancies in integrated electronic health records. BMJ Qual Saf. 2013;22:103-9.
29. Lee KH.The hospitalist movement--a complex adaptive response to fragmentation of care in hospitals. Ann Acad Med Singapore. 2008;37:145-50.
30. van Sluisveld N, Zegers M, Natsch S, Wollersheim H.Medication reconciliation at hospital admission and discharge:insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety. BMC Health Serv Res. 2012;12:170.
31. Haney EM, Nicolaidis C, Hunter A, et al. Relationship between resident workload and self-perceived learning on inpatient medicine wards:a longitudinal study. BMC Med Educ. 2006;6:35.
32. World Health Organization. Assang medication accuracy at transitions in care:medication reconciliation. High 5's project:Action on patient safety Standard Protocol. Available at: http://www.who.int/patientsafety/implementationsolution/high5s-sop.pdf. Accessed January 1 2014.
33. Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;167:1034-40.
1. Stitt DM, Elliott DP, Thompson SN. Medication discrepancies identified at time of hospital discharge in a geriatric population. Am J Geriatr Pharmacother 2011; 9:234-40.
http://dx.doi.org/10.1016/j.amjopharm.2011.06.002
2. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005; 165:424-9.
http://dx.doi.org/10.1001/archinte.165.4.424
3. Forster AJ, Murff HJ, Peterson JG, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003; 138:161-7.
4. Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care 2006; 15:122-6.
http://dx.doi.org/10.1136/qshc.2005.015347
5. Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med 2007; 2:314-23.
http://dx.doi.org/10.1002/jhm.228
6. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med 2005; 165:1842-7.
7. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003; 18:646-51.
8. Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ 2004; 170:345-9.
PMid:14757670 PMCid:PMC331384
9. Cua YM, Kripalani S. Medication use in the transition from hospital to home. Ann Acad Med Singapore 2008; 37:136-6.
PMid:18327350 PMCid:PMC3575742
10. Kripalani S, LeFevre F, Phillips CO, et al. Defi cits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 2007; 297:831-41.
11. van Walraven C, Weinberg AL. Quality assessment of a discharge summary system. CMAJ 1995; 152:1437-42.
PMid:7728692 PMCid:PMC1337907
12. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. Adverse drug events occurring following hospital discharge. J Gen Intern Med 2005; 20:317-23.
13. The Joint Commission. Ambulatory Health Care National Patient Safety Goals 2015. Available at: http://www.jointcommission.org/assets/1/6/2015_NPSG_AHC1.PDF. Accessed January 5, 2015.
14. Pippins JR, Gandhi TK, Hamann C, et al. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med 2008; 23:1414-22.
15. Agresti A. Categorical Data Analysis. 2nd ed. New York: John Wiley & Sons, 2002.
http://dx.doi.org/10.1002/0471249688
16. Agresti A. An Introduction to Categorical Data Analysis. 2nd ed. New York: John Wiley & Sons, 2007.
17. Hocking RR. A biometrics invited paper. The analysis and selection of variables in linear regression. Biometrics 1976; 32:1-49.
http://dx.doi.org/10.2307/2529336
18. Miller AJ. Selection of subsets of regression variables. J R Stat Soc Series A 1984; 147:389-425.
19. Miller A. Subset Selection in Regression. 2nd ed. Boca Raton, FL: Chapman Hall/CRC, 2002.
http://dx.doi.org/10.1201/9781420035933
20. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons, 2004.
PMCid:PMC1449835
21. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988; 10:61–3.
22. Bolas H, Brookes K, Scott M, McElnay J. Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland. Pharm World Sci 2004; 26:114-20.
http://dx.doi.org/10.1023/B:PHAR.0000018601.11248.89
23. Whittington J, Cohen H. OSF healthcare's journey in patient safety. Qual Manag Health Care 2004; 13:53-9.
http://dx.doi.org/10.1097/00019514-200401000-00005
24. Nickerson A, MacKinnon NJ, Roberts N, Saulnier L. Drug-therapy problems, inconsistencies and omissions identified during a medication reconciliation and seamless care service. Healthc Q 2006; 8:65-72.
http://dx.doi.org/10.12927/hcq..17667
25. Walker PC, Berstein SJ, Jones JN, et al. Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study. Arch Intern Med 2009; 169:2003-10.
http://dx.doi.org/10.1001/archinternmed.2009.398
26. Dedhia P, Kravet S, Bluger J, et al. A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes. J Am Geriatr Soc 2009; 57:1540-6.
27. Unroe KT, Pfeiffenberger T, Riegelhaupt S, et al. Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors or medication discrepancies. Am J Geriatr Pharmacother 2010; 8:115-26.
28. Linsky A, Simon SR. Medication discrepancies in integrated electronic health records. BMJ Qual Saf 2013; 22:103-9.
http://dx.doi.org/10.1136/bmjqs-2012-001301
29. Lee KH. The hospitalist movement--a complex adaptive response to fragmentation of care in hospitals. Ann Acad Med Singapore 2008; 37:145-50.
30. van Sluisveld N, Zegers M, Natsch S, Wollersheim H. Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety. BMC Health Serv Res 2012; 12:170.
http://dx.doi.org/10.1186/1472-6963-12-170
31. Haney EM, Nicolaidis C, Hunter A, et al. Relationship between resident workload and self-perceived learning on inpatient medicine wards: a longitudinal study. BMC Med Educ 2006; 6:35.
32. World Health Organization. Assuring medication accuracy at transitions in care: medication reconciliation. High 5's project: Action on patient safety Standard Protocol. Available at: http://www.who.int/patientsafety/implementationsolution/high5s-sop.pdf. Accessed January 1, 2014.
33. Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med 2007; 167:1034-40.


The mission of The White Mountains Regional School District is to form a partnership with parents and the community to prepare all students to become lifelong learners in a safe environment with high expectations so that they will become responsible, productive citizens in an ever-changing society.
The White Mountains Regional School District is dedicated to developing responsible and ethical citizens who are academically, socially, and physically prepared to meet and shape the future of our community and society as a whole.
Respect for self and others so as to provide an environment where students can excel.
Commitment to Excellence to enable all students to strive to reach their personal best through persistence.
Accountability of ourselves and others to hold all community members of WMRSD to high standards.
Integrity and honesty produce trust in ourselves and those around us.
1. Create a district culture that encourages community involvement where the focus is on improving our education system as a whole and is not hampered by individual agendas.
2. Implement standards based instruction and reporting to include benchmark assessments, to ensure all students achieve NH state standards.
3. Institute financial policies and practices that ensure public transparency and enforce sound cost management.
4. Develop a Communications Plan that promotes parental and community support and involvement through clear, open, and timely communication.


The mission of the Greensburg Hempfield Area Library is to enrich our community by promoting literacy and fostering lifelong learning.
As a favorite virtual and physical destination, the Greensburg Hempfield Area Library preserves our history and transforms our community by inspiring collaboration, curiosity, creativity, and change.
We honor diversity, individual perspectives and choices, privacy, and free speech. We encourage courtesy and civility in actions and attitudes.
We value lifelong learning and literacy education and are committed to facilitating the quest for knowledge of any interested individual or group. We strive to serve as trustworthy and fair source of knowledge both historical and current.
We believe the library resources and information are essential to a learning society because information and knowledge are indispensable to the development of human potential. To that end we provide free and unhindered access to all forms of information while respecting and preserving an individual's right to privacy, autonomy, and freedom or inquiry.
We value the opportunity to be a vital and engaged member of the community in which we serve, live, and work. To that end we encourage lifelong learning, offer a safe space for people and ideas to come together, and provide materials and programs that educate, entertain and inspire.
We strive to be forward thinking and are committed to providing leadership in innovative services, technology, and facilities for the benefit of our users. In our desire to provide exceptional service, we are constantly exploring new ways of doing things better and doing better things.
Subscribe to our email news to learn about events, programs, resources, and more!!


text:
95bFM
7 October 2020 | Paul Capewell
After listening to 95bFM for the first time in a while, albeit as an on-demand podcast of the top ten, this morning I am listening live – to the end of the top ten show, and now to Freak the Sheep (the NZ music show). Haven't listened live to 95bFM in so long.
95bFM is an Auckland-based student radio station, one of a nationwide network. They play great music, from ambient chillout and hip-hop to rock and metal. I've been listening to bFM for the best part of two decades* (their website and online streaming has always been quite ahead of global trends for radio stations, particularly of their size).
* The first mention in my diary of bFM is from November 2004, by which time I apparently felt cosy enough with listening online to text the overnight DJ and request a song, which they kindly played for me.
It also has that 'I keep getting older, they stay the same age' vibe that all good student radio stations can have – bFM seems simultaneously not to have changed in the time I've been listening to it, and yet they still seem fresh and cool, and they engage in fresh talent in their DJs and the songs they play, as well as not forgetting to look back.
Like all good radio, listening live to a station like this is where it's at: brief mentions of local news and affairs, plus ads for local events and businesses, it all makes it feel very local and takes you right there.
An ad for a camera rental firm in Newmarket, sent me straight to Google Maps trying to see where it fits into my very patchy mental map of Parnell and Newmarket, where I was based for a few months in late 2008. This was initially very confusing, but it was quite a nice sensation feeling the bits slip into place as my brain wrapped itself around the physical map/streetview.
I'm also struck by something I know I've felt before, but perhaps never written down, which is that I tend to find myself gravitating towards checking out 95bFM as the seasons change – rarely in deep winter or the height of summer (though I've always enjoyed the mental juxtaposition of hearing about surf conditions out at Piha in mid-December or ski conditions at Cardrona while I'm experiencing a heat wave).
Rather, it's more when there's a noticeable change in the weather and my mind seems to wander to the other side of the world where a similar change is happening, albeit in reverse. Can't put my finger on the cause of this, but it's something that I've always been half aware of.
On a related note, I've often likened music from the early 1980s by Dunedin and Christchurch bands – early Flying Nun releases, the so-called Dunedin Sound – with what I imagine were drafty, damp student digs in the winter term.
Inevitably there's a lot of poetic licence and leaps of imagination in this: the truth is probably far less 'neat', but I do find myself conjuring images of a frosty morning in Christchurch, or emerging from a foggy, cold street into a pub in Dunedin when I listen to the Chills (hah!), the Clean or the Verlaines. Woolly jumpers and smoking a fag in the cold night air, or trying to get the car started first thing in the morning with steamy breath visible.
I got the Roger Shepherd book about Flying Nun Records for Christmas a couple of years ago and haven't read it yet. Haven't found myself in the right mood to really dig in. Want to give it my full attention and wallow in a book that, a few years ago, I'd have lapped up. Perhaps that's part of it: I listen to 1980s NZ music far less nowadays than I used to. But it's still in my bones.
And so I want to crank that up a little bit more, get it more into the foreground, and get into the right headspace to read the book, my mind all the more receptive to every morsel and anecdote. And as the nights draw in (we haven't done the clocks yet, but with gloomier weather, the evenings do feel that bit darker suddenly), perhaps it's becoming a good time to get back into that mood.
Back to the original thread, and that's one other thing I love about occasionally dipping into 95bFM (and the other bnet stations): I can hear brand new and even unreleased demos by up and coming NZ bands played alongside the kind of stuff I hear daily on BBC 6 Music, and then occasional plays of proper NZ alternative classics – legendary tracks by some of the bands I mentioned earlier – just dropped into the playlist because they're part of the fabric of NZ radio and popular culture (or at least alternative pop culture, perhaps not quite the mainstream). Hearing a track by someone like the Chills on 6 Music is almost unheard of – almost, because every few years they seem to play some of their Peel Session recordings at an obscure hour. But that's pretty much it.
Oh – one more thing while I'm at it: a thing I want someone to invent, which feels like it should exist, but I haven't even Googled yet to see if it does:
I want to have a database of loads of global radio stations (ideally with good streaming), and an input form where I drop in a few bands I'm digging lately. The database holds all these stations' playlists. It then returns stations which have played those bands I love recently. Some sort of background algorithm so that it doesn't just find a station that played one Deftones track yesterday, but nothing else for months, but actually 'weights' the results by stations that more consistently play tracks by artists I'm into.
Better yet: let me plug my last.fm or Spotify library into the database: scrape my favourite artists and show me which radio station – anywhere in the world – aligns most closely to my taste in music.
This feels like it could exist, but would necessarily depend on radio stations accurately logging their playlists in a common format. Which seems… unlikely. Unless there was an over-arching authority like PRS that did a better job of this. But still. Seems as unlikely as it does a cool concept. I can dream.
Beggars Arkive
25 January 2017 | paulcapewell
In a former life, I attended a one day seminar at the British Library on the subject of the archival of sound recordings. It ran the gamut from wax cylinders to re-releasing seminal records from recent decades to the automatic digital archival of a national broadcaster.
One of the guests was a representative of Beggars Group, who talked excitedly about the value of their own archive, and their blossoming attempts to sort it all out, preserve it, and, ultimately, better monetise it.
So it was nice to recently stumble across the Beggars online store and have a look at some of the releases they've made available. It's mostly back catalogue stuff, but there are a few hidden gems and some releases I didn't realise would still be available on vinyl. (Hello Biffy b-sides collections and 1-disc version of mcluskyism. Will I ever find you, Effloresce?)
There doesn't seem to be the option to buy downloads, but perhaps they're focussing on physical releases that collectors will want, while making the digital stuff available via streaming services. I'm not sure how many people still really collect CDs – although a nicely packaged collection of previously unavailable stuff accompanied with well-done liner notes and artwork remains a worthwhile object in my view.
Overall though, it's the approach that I like. The Beggars Arkive Instagram account has regular juicy updates, like shots of master tapes of important sessions, as well as highlights from the store.
It all strikes the right balance between the commercial potential and the cultural importance of the label's output over the years via various indie labels. As Beggars' Lesley Bleakley said at the British Library seminar: "It's music… It's culture… It's not 'ours'… We do need to look after our copyright though!"
Some Gary Numan tapes from the Archive. Per request by @andy_preston #garynuman #beggarsbanquet
A post shared by Beggars Arkive (@beggars_arkive) on Nov 14, 2016 at 7:00am PST
A similar project is Flying Out, the online store of New Zealand indie labels including Flying Nun and Arch Hill. They sell a mix of digital and physical music, as well as books, t-shirts and other merchandise. They also have a focus on re-issuing classic albums on various formats. There are probably a number of other similar projects from indie labels around the world. I'd hope so, anyway.
Anyway. It's all heartening stuff. And it reminded me of that day spent at the British Library, scribbling pages of notes like I was at university again. I'll keep my eyes peeled for similar opportunities because they're great fun and very stimulating. I want another one.

redpajama_set_name: RedPajamaCommonCrawl


thin driveway pavers full color natural stone by legends architectural stone thin driveway pavers uk.
thin driveway pavers slide image 1 thin driveway pavers uk.
thin driveway pavers thin in antique reclaimed cobblestone thin driveway pavers uk.
thin driveway pavers laying thin over concrete pool decks thin driveway pavers uk.
thin driveway pavers how to lay block paving driveway video home decor brick on sand slabs laying concrete thin driveway pavers uk.
thin driveway pavers medium size of over concrete patio image concept thin driveway vs thick thin driveway pavers uk.
thin driveway pavers cobblestone to beautiful add interlocking driveway to beautiful add block paving driveway to beautiful thin driveway pavers uk.
thin driveway pavers amazing design for driveway beauteous driveway thin driveway pavers uk.
thin driveway pavers perfect decoration for driveway exquisite images about driveways on thin driveway pavers uk.
thin driveway pavers central brick offers sales and installation of brick for driveways patio and new or remodel thin driveway pavers uk.
thin driveway pavers laying thin over concrete decks in thin driveway pavers uk.
thin driveway pavers interlocking are tiles made of concrete that simulate cobblestone paths thin driveway pavers uk.
thin driveway pavers large size of exciting home depot for inspiring your landscape patio thin driveway pavers uk.
thin driveway pavers driveway traditional exterior granite cobblestone thin antique reclaimed old granite thin driveway pavers uk.
thin driveway pavers peach white gray on a driveway thin driveway pavers uk.
thin driveway pavers thin repair services in thin driveway pavers uk.
thin driveway pavers driveway be equipped block paving stones be equipped interlocking brick be equipped driveway paving companies pouring concrete as driveway thin driveway pavers uk.
thin driveway pavers thin hexagon flagstone slate driveway mesh yard irregular shaped slate thin driveway pavers uk.
thin driveway pavers standard concrete patio thickness standard concrete block paving co on thin over concrete driveway thin driveway pavers uk.
thin driveway pavers black limestone s thin driveway pavers uk.
thin driveway pavers laying over concrete thin driveway pavers uk.
thin driveway pavers standard colors thin driveway pavers uk.
thin driveway pavers thin over concrete slide image 2 thin driveway pavers uk.
thin driveway pavers images of thin over concrete driveway vs thick brick bay thin driveway pavers uk.
thin driveway pavers thin driveway pavers uk.
thin driveway pavers flagstone inspiration for driveway paving slabs inspiration for large concrete inspiration for block paving bricks flagstone for thin driveway pavers uk.
thin driveway pavers thin brick home depot patio thin brick thin driveway pavers uk.
thin driveway pavers how to lay pol deck thin driveway pavers uk.
thin driveway pavers other types thin driveway pavers uk.
thin driveway pavers there are many differences between thick and thin concrete driveway thin driveway pavers uk.
thin driveway pavers thin brick for porch thin brick home depot thin brick for driveway picture thin driveway pavers uk.
thin driveway pavers home thin driveway pavers uk.
thin driveway pavers herringbone brick on porch google search thin driveway pavers uk.
thin driveway pavers unique ideas for driveway charming driveway stone paving with interlocking thin driveway pavers uk.
thin driveway pavers clay brick patio thin patio thin driveway pavers uk.
thin driveway pavers bent creek on a driveway thin driveway pavers uk.
thin driveway pavers fl pool brick thin driveway thin driveway pavers uk.
thin driveway pavers large size of over concrete patio image concept thin to install brick thin driveway pavers uk.
thin driveway pavers thin brick thin brick over concrete thin brick thin driveway pavers uk.


Let us hope that the release of this album is not completely in vain for the Germans. Otherwise, what is the point? Previously on Gutter Records, Soul Demise has upgraded to Season Of Mist and, armed with new front man Roman Zimmerharkel (although there was a Thomas chap in the meanwhile after previous singer Eumel), recorded an impressive album at Berno Studio (Deranged, Seance, etc.) up in Sweden. Which, perhaps not so coincidentally, is where these Germans' collective heads is. German Swedeath is a status normally associated with Fleshcrawl, but Soul Demise does the term proud. The closest comparison for Soul Demise is early The Crown/Crown Of Thorns perhaps. Soul Demise is five long-haired guys putting the pedal to metal and delivering a mix of power and melody. The band uses the growl/shriek dual-vocal system of which there are too many examples now, but it is not of course to the detriment of the metal. The sound is clear yet heavy, the guitars are up front, as are the vocals, and the snare packs a punch. Finally, the cover artwork is an H.R. Geiger rip-off dressed in blue.... The band has already spent 1998 on the road with Soilwork and Krisiun, 1999 with Deranged, 2002 with Napalm Death and this year is doing the same with Illdisposed which is impressive for such a little-known outfit. That probably means we will hear more and more from this band. - Ali "The Metallian"
METALLIAN: Andreas, thank you for calling to speak to Metallian. Nine years is a long time. For a band this old you are little-known.
ANDREAS: It is a pleasure to be speaking to Metallian Towers. We celebrated our tenth anniversary this year. We started back in 1993 using the name Inhuman. In 1994 we released our first and only demo tape which was called Incantation. In 1996 we released our first CD called Inner Fears. During 1997 we did our first two tours with the Polish gods Vader. We arranged everything ourselves and were very proud when everything turned out to be satisfactory. In 1998 we changed our name to Soul Demise due to the problem of other bands using the name Inhuman as well. At the same time we released the Farewell To The Flesh MCD to make our new name known. We toured with Krisiun and Soilwork throughout Europe. Again the tour was arranged by ourselves. In 1999 we did a tour with Deranged through Germany and a year later Beyond Human Perception was released through Gutter Records. That album was our first release with a label and helped us move forward. In 2001 we did another tour through Europe with Immolation, Deranged, Destroyer 666 and Decapitated. It was fun for us and enabled us to establish the name Soul Demise in several countries. In 2002 we toured twice with Napalm Death and in 2003 we released In Vain through Season of Mist.
The reason we are not as popular as other bands is quite simple. Firstly, when we began making music we had to improve our technical abilities. This took quite a while especially since nowadays bands are often measured by their technical abilities a lot.
Secondly, we are a German band and it's quite hard to get a deal over here unless you are from Sweden (laughs actually). The record firms and the fans are not that interested in native German bands. It's a pity but unfortunately I can't change that attitude.
METALLIAN: Would you disagree that labels sign Swedish bands simply because Swedish bands are better? As evidence, Soul Demise is actually doing a cover version of an At The Gates song.
ANDREAS: In my opinion, Swedish bands generally are not better than most German bands, but they are considered exotic and hence are more attractive to Germans obviously. Most German bands never get the chance to show how good they really are. They don't get the same support and don't have the same opportunities as the Swedes. It's a pity. I hope you don't get me wrong. Many Swedish bands are excellent; there is no doubt about that. Having said that, German bands can be excellent too.
METALLIAN: How much is the German media to blame for a lack of support for German bands?
ANDREAS: The media must write about things in which people are interested. Otherwise they wouldn't sell. So they are not to blame. As long as they still support the bands from their own country and don't follow every stupid trend or hype then that is OK.
METALLIAN: This may be true of a media guided by and beholden to the shackles of Capitalism. On the other hand, media done properly would be one that is supportive of whatever is worthy and takes the lead in introducing as opposed to following. That though, is a discussion for another day. Since we are chatting in recognition of the recent release of In Vain, What do you reckon is the difference between the current release and the previous ones?
ANDREAS: Well, on the one hand the sound is much better because this time around it was possible for the whole band to be in the studio the whole time. That made things much easier. Elsewhere, the songs are more aggressive, faster and get to the point more directly. Those are the main things I suppose. By the way, the singer is different and we also have a new guitar player who also writes songs.
METALLIAN: That was the next question. Why did the line-up changes come about?
ANDREAS: Well, some members decided to leave the band for personal reasons and some had to leave because they didn't fit in the band any longer. The latter behaved differently in the beginning and changed their attitude and behaviour later. That is not good. Playing in a band means teamwork and not that one could rule all others. Nevertheless, it was much too many line-up changes. We actually were weary of the changes because it is always a step back and takes a lot of time to return to the normal state of things, but some things one can't be avoided.
METALLIAN: In that context, why did you change labels?
ANDREAS: Gutter Records was the proper label to support the Beyond Human Perception album, but with its successor we wanted to take the next step forward. We didn't want to stay little-known (laughs). The distribution system of Season Of Mist is much better which allows them to spread the word much better. I mean, when one improves as a band then why wouldn't everything else improve as well? It is just logical. When you're working hard for something, you don't want things to stay at the same level forever.
METALLIAN: What was your experience with Gutter Records?
ANDREAS: They did what they could. Sometimes it was a problem when it came to monetary matters, but I guess this is typical for most labels. The band is vulnerable and not able to defend itself. All in all though, they were OK and they did push us forward They made shirts, pictures, etc. for us and that is quite cool.
METALLIAN: How did you come to sign with Season Of Mist in France?
ANDREAS: I am not quite sure about this. I guess our former label's manager got in contact with Season Of Mist and helped us in this matter. He was dealing with them at that time and asked them to listen to our CD. They did and obviously like it. Sometimes life is quite strange (laughs heartily). By the way, Season Of Mist was not the only offer we got. There were three in all, but Season's made the most sense.
METALLIAN: Are you saying that you owed Gutter Records more albums and they sold your contract to Season Of Mist? Furthermore, how many albums will you record for SOM?
ANDREAS: No, we signed with Gutter for only one album. The next one should have been discussed, but we didn't want to sign with Gutter again. We wanted to reach a higher level. I hope we did by signing with SOM.
We singed with SOM for just two records. We don't want to be bound to one label for more than two records. I mean, look at Napalm Death. They signed for seven albums with Earache at one point and were not satisfied with the work the label did even for their very first release. Such a situation could mean death for a band like us.
METALLIAN: You have chosen to name your album In Vain. The album's title strikes one as an odd choice. Are you natural pessimists?
ANDREAS: No, we are not pessimists (laughs), but realists. If you look around at this world you could get to the point where you might think that all your efforts to improve it are in vain. This is quite depressing I think because the way we behave is very dangerous. Moreover, the title belongs to the title track which is about people being so greedy and not giving anything to those who really need it. They don't want to realize that when they die everything remains on this planet. Actually it is quite simple - maybe too simple.
METALLIAN: Given that line of thought what do you think of the current global situation?
ANDREAS: The world is going down! There are too many people living on this planet who behave badly. If we would treat Earth like the worthiest thing we have, she could bear double the current population easily. But as it is now, we will kill ourselves sooner or later. It's just a question of time. There should be an awareness about this problem in everybody's mind, but unfortunately there is not. Especially when those who have the power care the least.
METALLIAN: Is your assessment of death metal's state in 2003 equally bleak?
ANDREAS: We are rising. Death metal is coming back, as is thrash metal. I am very fond of this development. The funny thing is that all the new bands made it possible. Don't get me wrong, I don't like their music, but with their heavy sounds they made metal more popular. The new generation starts to question how and why do these bands use such sounds. Korn once said that they were total fans of Sepultura's Beneath The Remains - I mean. This is killer news to me. Since their fans will undoubtedly check out the said album. Slayer might be next and after a while it will maybe even be Soul Demise's turn (laughs triumphantly).
METALLIAN: As much as the last statement seems inaccurate to me, let us banish the visions of mallcore aside seeing the late hour in Germany. What is the latest news with the band?
ANDREAS: We have recorded a song called Forever Blind from the Terminal Spirit Disease album for an At The Gates tribute album which will be released at the end of 2003. Watch out for it. It is going to be killer. That's actually all, Metallian. Thank you very much for the interview and thanks to everybody supporting Soul Demise and Metal in any way. You rule!
Singer Roman Zimmerhackel, guitarists Andreas Schuhmeier and Alex Hagenauer, bassist Andreas Bradl and drummer Roland Jahoda can be heard on the Season-Of-Mist issued In Vain. The album was recorded at Berno Studio and is recommended to fans of death metal. For more information please visit www.souldemise.de.


With its aluminium chassis and rangefinder style, the Panasonic Lumix DMC-GX1 is likely to appeal to enthusiast photographers. In use, the camera does not disappoint, either. Its touchscreen enhances its handling and I have not come across a more rapid way to accurately meter and focus for a scene. Also, with four function buttons, the GX1 is a breeze to use.
As the GX1's sensor is essentially the same as that found in the Lumix DMC-G3, its image quality is equally impressive and the best yet for a Panasonic four thirds model. However, the sensor size means that performance at higher sensitivities does not quite match up to the current crop of APS-C-sized sensors, particularly regarding dynamic range.
The 'X' kit lens complements the size of the GX1 body beautifully, and I like the option to have a smaller body and attach a viewfinder as and when it is needed. However, with the 'X' lens and LVF2 viewfinder included, the combination is almost double the price of the G3. When choosing between the two, therefore, it is a matter of what counts more – your wallet or the size of the camera.
The double-hinge design of the built-in flash means it pops up to a reasonable 20mm (approx) from the body. It has an output of GN 7.6m @ ISO 160 (GN 6.3m @ ISO 100).
Like the G3, the GX1 features a 3in, 460,000-dot screen, but in this case it is a fixed type, whereas the G3 screen is articulated.
This port is compatible with the LVF2 viewfinder only, and will not support use with the LVF1. If a viewfinder is not in use, then any of Panasonic's FL220, FL360, FL500 or third-party flash units can be used.
Two function buttons on the body and two extra function controls in the touchscreen menu make the GX1 the most customisable version of the G-series cameras yet.
Stereo sound is available, and the GX1 offers a microphone-level adjustment for louder or quieter scenes, and the levels can be displayed on-screen. Furthermore, a wind-cut function reduces the distracting noise created by wind blowing into the microphone.
There is a wealth of information available on-screen, such as a histogram, level gauge (for the first time in a Lumix G model), highlights and also guide lines, including rule of thirds.
Sensor clean and pixel refresh are available through the main menu, and are achieved manually, not automatically on start up or shut down.
In playback mode, favourite images can be flagged with a star for easy reference, converted to an alternate aspect ratio, resized, cropped and rotated.


Image Title: Hunter Fan 54 Weathered Zinc Outdoor Ceiling With A Clear Glass Regard To Light And Remote Remodel 11. Filename: hunter-fan-54-weathered-zinc-outdoor-ceiling-with-a-clear-glass-regard-to-light-and-remote-remodel-11.jpg. Image Dimension: 425 x 425 pixels. Images Format: jpg/jpeg. Publisher/Author: Dedrick Mohr. Uploaded Date: Monday - May 21st. 2018 01:38:22 AM. Category: Architecture. Image Source: houseandgarden.co.uk.
Tap The Thumbnail Bellow to See Related Gallery of "Hunter Fan 54 Weathered Zinc Outdoor Ceiling With A Clear Glass Regard To Light And Remote Remodel 11"


Strong welded industrial cupboards offer excellent security whilst keeping products clean and safe. Choice of two sizes that come complete with fully adjustable shelves, locks with two keys all finished in a high quality anti-bacterial paint finish. The doors come with additional strengthened doors and a secure two point locking bar and recessed door handle. All delivered within 5 days. 1780 x 915 x 460 (mm). Made in EU. Comes with 3 shelves.


Daniel Wagner is is the Founder of Country Risk Solutions and Managing Director of Risk Cooperative. He has three decades of experience managing cross-border risk, including 15 years of underwriting experience with AIG, GE, the Asian Development Bank, and World Bank Group. Daniel has lectured at more than 15 universities around the world, is a regular speaker at conferences, and a frequent commentator on global affairs in visual media.
He has authored four books – Virtual Terror, Global Risk Agility and Decision Making (co-authored), Managing Country Risk, and Political Risk Insurance Guide — and has published more than 500 articles on current affairs and risk management in a plethora of platforms.
Following the release of his latest book, Virtual Terror, I reached out to Wagner to talk about his book and cybersecurity in general. Our interview, conducted over email, has been edited for flow, is below.
First and foremost, what inspired you to write your new book, Virtual Terror: 21st Century Cyber Warfare?
I surveyed some of the literature on cybersecurity and felt that much of what I read was dated and based on conventional definitions of terrorism. The cyber arena has changed all that. I have crafted a new definition for cyberterrorism ("Virtual Terrorism") and put some real thought into writing a book that educates people on what the phenomenon is really all about. My view is that the best way to fight it is to help ensure that as many people as possible understand what it is, what some of the challenges are in fighting it, and what can we do about it. The subjects covered in the book range from governments and the private sector to drones and robots to social media and some psychological implications of cyberterrorism.
80% of North Korea's missile tests have failed, with a lot of those failures being attributed to American hackers. How soon do you think it will be before major military powers like the US and China have to worry about their deadly hardware being hacked and used in terrorist attacks?
Regarding North Korea, it is really a testament to what the Kim regime has achieved that it has endured so much in the way of sanctions and anti-missile hacking and has still been able to successfully create a nuclear weapons program and test intercontinental ballistic missiles. One of the characteristics of Virtual Terrorism is that it allows countries like North Korea (and Iran) to punch well above their weight in the cyber arena, and conduct their own form of 'diplomacy' on the cyber battlefield. These countries have already attacked the US and other countries – all countries with the capability to do so, do so. The real challenge is to be able to identify when such cyberattacks occur, and then to be able to block them. It's an ongoing battle.
A rogue actor could potentially kill thousands of hospital patients by shutting down their power or threaten mass starvation by knocking out the food supply chain's servers and equipment. Will civil infrastructure e-terror attacks become commonplace in the near future?
As is discussed in the book, the medical profession endures a significant portion of cyberattacks. The personal information medical services routinely require from patients makes it a target rich environment. Hospitals have already been the subject of numerous ransomware attacks, and they often pay the ransom because critical infrastructure necessary to operate and sustain life has been threatened or forced to stop functioning. It is a certainty that more and more civil infrastructure will become the subject of cyberattacks in the future. The question really becomes, whether any type of infrastructure is safe from cyberattacks?
How big a threat are hackers to electronic payment systems like PayPal & e-currencies like Bitcoin? Are they no more of a nuisance than bank robbers or could they potentially steal billions at a time from companies and consumers?
In the concluding chapter of your book, you talk about imposing legal liabilities on software companies whose software gets hacked. Where would you draw the line on this complex, amorphous issue?
This is a great example of how the nexus between the lobbying business in Washington can end up making an already difficult challenge even worse. It is the desire of software companies and other firms in the cyber sphere to avoid legal liability in general that prevents more progress from being made in crafting a more robust response to virtual terrorists. My view is that it is incumbent upon these developers to take greater responsibility when things go wrong with their products. If they are doing their jobs well, the likelihood of being attacked would be greatly reduced. If their products are knowingly produced with flaws, it seems reasonable to me that they be held to account. That said, they cannot be held responsible for every instance of hacking, or for product flaws that were not known when they were produced. As is often the case with 'the law', we should seek to introduce the concept of reasonableness in an attempt to get everyone to agree to a more palatable approach to this important issue.
What advice would you give to lawmakers & law enforcement officials wishing to crack down on The Deep Web's international contraband markets?
I was heartened to learn, earlier this summer, that the US government had closed AlphaBay – one of the largest and best known "Dark Web" marketplaces. It illustrated that it is indeed possible to crack down on thriving underground marketplaces. The issue boils down to how many resources can be devoted to fighting a single marketplace, how the Dark Web can be monitored, and whether meaningful laws can be crafted and enforced. This evolving landscape is so broad and deep that it is tough to imagine them all being shut down, but I would certainly like to see more, and additional significant marketplaces, similarly shut down to force both buyers and sellers to modify their sales and purchasing habits.
You briefly mention the fact that AI will revolutionize the labor force. Will AI merely enhance the average worker's experience & create new job opportunities like in The Jetsons, create unparalleled income inequality like in Elysium, or wipe out all work and create a race of infantilized humans like in Wall-E and The Time Machine?
I should think it will be some combination of the three, with varying degrees of labor force penetration by sector and job type. While I do not believe that AI will 'wipe out' work, I do think there is every reason to believe that it will ultimately make humans generally less essential to getting things done. In the book I discuss the dangers of hacking robots, drones, and AI. Anything linked to the Internet can be hacked, so as AI becomes more prominent and more powerful, the potential ramifications of such hacks have frightening implications.
You mentioned in passing China's "social-credit system." Can you go more in depth about what it tried to accomplish and why it failed?
China is attempting to create a system in which it 'knows all' about its citizens – from their spending habits to their political persuasions – and it is doing so by combining data with extremely personal applications. While currently being deployed on a limited basis, the Chinese government intends to roll the idea out nationwide. Since India's Aadhaar national electronic identification system has been successfully used to register more than one billion Indians in a central electronic data system, there is no reason to believe that the Chinese government's intentions in this regard cannot be achieved. Earlier versions of the social credit system failed for a variety of reasons, but the government intends to learn from earlier mistakes to generate a system that is even broader in scope.
How does China's Great Firewall work?
China's censorship system, known as the Great Firewall (also known as the Golden Shield), is its effort to attempt to restrict the free flow of information in and out of the country via the Internet. The Chinese government is doubling down on its effort to maintain control of the Internet within its borders, while also endeavoring to increase the amount of control it has over the Internet outside of its borders.
How can VPNs (virtual private networks) help individuals protect the online security of individuals?
Millions of Chinese citizens have for years circumvented the Great Firewall by using a VPN, which allows unfettered access to any website…The Chinese government will completely block access to much of the Internet inside the country as part of its effort to suppress dissent and maintain the Chinese Communist Party's control on power. In 2017, the government ordered China's three telecommunications companies—China Mobile, China Telecom, and China Unicom (all state-owned)—to block access to VPNs by February 2018.
What are the particular benefits of VPNs for people in Internet-censored countries like China and Saudi Arabia?
Individual Internet users can benefit from use of a VPN to circumvent government censorship or connect to proxy servers for the purpose of protecting personal identity and location. However, some Internet sites block access to known VPN technology.


text:
package fp4g.data;

import fp4g.core.IValue;
import fp4g.core.Line;

public class DeclVar extends Line
{
	public final VarType type;
	public final String name;
	public final IValue<?> initValue;
	public DeclVar(VarType type, String name)
	{
		this(type,name,null);
	}
	public DeclVar(VarType type, String name, IValue<?> initValue)
	{
		this.type = type;
		this.name = name;
		this.initValue = initValue;
	}
}

redpajama_set_name: RedPajamaGithub


I've decided to start selling papercuts to help fund a redesign of Philly Love Notes. The website needs to be more functional as a Philly resource, and to put it bluntly, it needs to look nicer. I don't feel comfortable putting advertisements or sponsored posts on the blog, and I'm still not completely sold on Kickstarter. If you've been following me on Instagram, Twitter or the blog, you've seen the evolution of my papercuts, which I've decided to start selling.
Below are some examples of custom pieces. They are all hand cut, and therefore take many hours each (and have been priced accordingly). The maps and home portraits are completely customizable in relation to size, paper color, and location, but don't come framed. I'll be taking limited commissions at a time, so if you're interested, send me an email at phillylovenotes@gmail.com.
I'm also working with NextFab to learn how to lasercut. Once I've gotten a hang of that, I'll be making copies of the large Philly map made earlier this summer and some more detailed neighborhood maps. Having access to all the machines brings up tons of possibilities for Philly-centric things to make, so if you have suggestions of what you'd like to see, please let me know.
It feels like most people who were born in Philly and the suburbs spent at least a day each summer at the Jersey shore. There are the outliers who made their way down to the beaches of Delaware or Maryland, but it seems like Jersey was the primary destination. And they weren't just trips to a random beach. Most people have "their" beach. Ours was Ocean City — a week in one of the small motels, days at the beach or Gillian's Water Park (which I only just recently discovered was not Gilligan's as I had been pronouncing all these years), and nights walking along the boardwalk eating Johnson's popcorn and going on the Tilt-A-Whirl at Wonderland Pier.
As I've gotten older, the family beach vacations have become more infrequent and we've broadened our horizons. My Philly tradition may have changed slightly, but a summer would not be complete without the beach. What's your tradition? What's your beach?
After a much needed post-party and post-Spruce Street Harbor Park opening vacation, I've returned to the land of Philly Love Notes. First, I wanted to thank everyone who came out to the #whyilovephilly Summer Party and second I promise to begin posting love notes again (starting tomorrow). I've slacked, but I have a ton ready to go thanks to the Philly Papercut Contest (congrats again Leigh and Aaron!).
Fear not attendees, it looks like the rain will blow over in time for the party to happen tomorrow. If for some reason mother nature tries to screw with us, we'll make a last minute rain call, pushing it back to July 3, because really, no one wants to watch concerts or drink for 4 hours in the rain.
1. Bring cash. Your first drink is on us, but after that, two out of three bars will only be accepting cash. There are a couple ATMs on the premise just in case you find yourself short on dollars. Drinks for the night will include: Yards Brawler, Yards Philly Pale Ale, Yards Saison, Victory Summer Love, PBC Walt Wit, Neshaminy Creek Trauger Pilsner, House-made sangria, and a Root + Rye cocktail made from Bulleit Rye, Root from Art in the Age, Orange bitters, and fresh orange.
2. Bring cash. There will be a bunch of vendors at the party selling their amazing Philly wares, and we're hoping you'll support them. They include Duke & Winston, US*U.S., Art Star, Dear Adelaide Design, Philadelphia Independents, Hog Island Press and Eyes Habit, and Wear Liberty.
3. Enter the Instagram Contest. Rachel Hara and I will be choosing four winners today to receive two tickets, and an amazing Philly swag bag filled with gifts from our vendors PLUS Pilot and Captain, Quirk Books, and Girls Can Tell. To win, tag your old and new Philly photos with #whyilovephilly_SSHP and add in a short line about why you love the city.
4. Come hungry. We'll be sampling the #whyilovephilly Little Baby's ice cream called Strawberry Mansion Shortcake. In addition, our concessionaire will be selling all types of boardwalk snacks, and the Garces Group will be soft launching the Blue Anchor, the pop-up restaurant on the floating barges with a menu TBA.
5. Be prepared to be filmed, so look nice (or not, just be ready to have your photos taken). Poseybooth, Skout Media, P'unk Ave, and our very talented photographer Matt Stanley have very generously donated their services to provide you with tons of photos and videos.
6. Listen to some amazing music. XPN welcomes the release of Ron Gallo's solo album, "Ronny," with sets by The Lawsuits and Up the Chain. Check 'em out before the show and support Philly's local music scene.
7. Take public transit, bike, or walk. If you need to drive, we have paid parking lots at Walnut and Lombard Streets at Columbus Blvd, and there is some street parking in the area.
8. Get ready to have your mind blown. It has been an honor to work on Spruce Street Harbor Park with a team of incredibly talented artists, craftsmen, site operations, and hell, even our security. The park would not exist without them, and for that, I am and you should be eternally grateful. The site is fantastically beautiful, better than I think any of us could have expected. When I saw it last night with all the lights on, I nearly cried. So welcome to your new summer home.
9. Thank our sponsors. We'd like to give an enormous thanks to our sponsors. A bunch of them will be on-site for the party, and we couldn't have done it without them. Please be sure to visit them, say hi, and learn about what they're doing to make our fair city even better.
Sponsors: FringeArts, Green Mountain Energy Company, United by Blue, TicketLeap, Enterprise Car Share, Sixers Cave, SEER Interactive, Young Involved Philadelphia, I-Site, Think Brownstone, NextFab, P'unk Ave, Hooley, Wash Cycle Laundry, Little Baby's Ice Cream, PHL Made, and Philly Bike Tour Co.
The next #whyilovephilly ice cream flavor!
Introducing the next #whyilovephilly flavor ice cream from Little Baby's!
Each year Martin and I make a new flavor for the #whyilovephilly party (tickets HERE). Last year it was Philly soft pretzel ice cream with a soft pretzel swirl, Butterscotch Krimpets and topped with Goldenberg's Peanut Chews.
This year we've done a Philly-themed strawberry shortcake, and as always, there will be free samples at the party.
We're still looking for a good name. Anyone got suggestions?
Finally finished the Philly papercut this past weekend. Check out the progress below and the contest to win it. And don't forget to get tickets for the summer #whyilovephilly Party!
Josh and Philly Bike Tour Co. are joining the #whyilovephilly Summer Party team, and have created a special bike tour just for the occasion. This 2.5 mile, one-hour BYOB(bike) tour highlights over 300 years of Philly's history and culture, starting in Rittenhouse Square Park and ending at Spruce Street Harbor Park, just in time for the #whyilovephilly party! For full details, and to sign up, visit the Philly Bike Tour Co. website.
I am: A teacher. A cyclist. A tour guide for Philly Bike Tours. A lover of all things Philly. A soon-to-be husband (now husband). A dog owner.
Years in Philly: 29 years in and around Philly; 12 years proper.
What: #whyilovephilly Summer Party and Spruce Street Harbor Park Preview. PLUS, the debut of Ron Gallo's new album "Ronny" + The Lawsuits + Up the Chain, presented by XPN.
Where: The new Spruce Street Harbor Park at Spruce and Columbus Blvd.
How to get there: Walk, transit, bike, drive, or take the #whyilovephilly bike tour from Rittenhouse Square to the party, courtesy of Philly Bike Tour Co.


Tamil Institute of Science and Management has been established in the year of 2015.The Tamil Institute of Science and Management is involved with a primary focus on the provision of Catering Science & Hotel Management, Diploma in Catering Technology, Food Production, Food & Beverage Service, Front Office and Hotel Operational Management, B.Sc and Diploma in Lab Technician. Tamil Institute of Science and Management is one of the largest training institutes with best result opened faculties providing education and training.
Tamil Institute of Science and Management is a friendly Modern community dedicated to provide best possible opportunities for learning, excellent opportunities for learners in life and this is an ideal choice for your studies. Our aim is to give a quality learning and environment for all of our students, ensuring you have support systems in place to allow you to reach your potential and achieve your ambitions. In the pages of this website you will find a wealth of information about the facilities and support services available to you, as well as the range of courses we have to offer. Tamil Institute of Science and Management is committed to hiring the outstanding talents in catering industry and developed them into passionate professionals.
Tamil Institute of Science and Management provides you real conducive educational environment and world class technical expertise for the fulfillment of your cherished dreams of attaining academic and professional excellence. Our Courses are regularly reviewed and updated to and ensure that they have a cutting edge.
This is my immense pleasure to give a cup of talk about the institute. I have a huge experience in this industrial field. I worked as a principal in Oscar Institute of catering Sivakasi, Srivilliputhur, Kovilpatti and Thoothukudi. Under my vision this industrial school started in Vilathikulam in the year of 2015.since this area lacks such industrial school our staff members creates awareness among the students and parents. We highlight the opportunities of employability. Our primary mission is to impart quality education to this area. Industrial school helps to uplift the society and enhance employability of this remote area. Our institution gives adequate opportunity to improve their communication skills. We have experienced staff members to handle the classes. We provide a comprehensive set of laboratories and training facilities. The ambience of the institution cultivates higher standard and provides a new opening.
This institute is driven towards meeting the challengers and dynamic evolutions in the business world and enabling students to take the world in the stride.
Tamil institute thrives on a mission to create leaders, winners and achievers in a global corporate world. It does not only and here but it also wishes to open new vistas of opportunities for its students by understanding their needs and providing them meaningful education.
The University named after the great national poet Subramania Bharathi is enshrined with the motto "Educate to Elevate". In the University, every effort is harnessed to realize his dream of making educational institutions as temple of learning.
It is the aim of the University to participate in the task of inculcating necessary Knowledge, Skills and Creative Attitudes and values among the youth of the country to contribute more effectively towards establishing an equitable social and economic and secular ideal of our nation.
Tamil Institute of Science and Management has been established in the year of 2015.The Tamil Institute of Science and Management is involved with a primary focus on the provision of Catering Science & Hotel Management, Diploma in Catering Technology, Food Production, Food & Beverage Service, Front Office and Hotel Operational Management, B.Sc and Diploma in Lab Technician.


Surface occurrence of bitumen in Albania were recorded by the Greeks and Romans. In 1875 the Turkish Government granted rights to exploration in the Selenica region to a French company which mined and exported asphalt for road construction until 1918. Meanwhile surface mapping by Austrians and Italians was carried out and a geological map was compiled for northern Albania. An oil seep seen at Drashovica near Vlora led to the first well in 1918.
The well produced 20 to 30 bbls per day for 2 years from Oligocene flysch at shallow depths. It was abandoned in 1920. In 1925 the Albanian government awarded further concessions and drilling was carried out in the areas where seeps and bitumen impregnation had been mapped. The wells identified a number of potential fields including Europe's largest onshore oil and gas field, Patos (later Patos Marinze), drilled in 1926 in the Durresi Basin, and the nearby Kucova field, both with reservoirs in Miocene sandstones.
Kucova was developed in 1935 however, most oil has been produced from Patos since 1939. In 1951 Russians acquired the first onshore seismic data and in 1957 the Marinze field was discovered adjacent to Patos, followed in the early 1960s by a number of other oil and gas discoveries with deep carbonate reservoirs such as Visoka in 1963, Gorisht in 1966 and Ballsh in 1967.
Gas discoveries were also made in molasse sediments including Divjaka in 1963 and Frakulla in 1965. In the 1980s the Albanian state company DPNG took responsibility for mapping the coastal zone and further gas discoveries were Balaj-Kryevidh in 1983, Durresi in 1986, Povelca in 1987, Panaja in 1988 and the Delvina gas and condensate field in the south in 1989. Operations in all the developed fields relied on ancient Russian and later Chinese built vehicles, pumps and facilities until the 1990s when Western companies were first allowed to invest.
Albania lies within a tectonically active and complex geologic region associated with thrust faulting along the Adriatic-Apulian plate boundary. It is a foreland fold and thrust belt system that includes Mesozoic to Eocene carbonate sequences of the Ionian Basin in the south and overlying foreland basin deposits of the Durresi Basin in the centre and north.
The lower sequences are deformed within three Tertiary thrust sheets that verge towards the Apulian foreland and produce mountain ranges along the Balkan Peninsula.
The Durresi/Ionian Basin - Anticlockwise rotation of the Apulian foreland along with its uplifted promontory in the southwest of Albania provided a buffer to the Ionian basin thrusts during the Oligocene to Pliocene. The thrusts were uplifted and exhumed in the south while propagating in the north towards the foreland before being overlain by the Durresi foredeep basin during the Miocene and Pliocene.
Oil source rocks are present in Triassic and Jurassic sediments of the Ionian Basin buried beneath the southern part of the Durresi Basin. The beginning of oil generation is related to this burial. Two types of reservoirs exist. Deep water carbonates of Late Cretaceous to Eocene age are fractured with vuggy porosity whilst flysch and molasse deposits of the foreland basin also act as reservoirs.
After 1990 the country opened itself to foreign investment. A number of companies took out onshore and offshore licences, and large volumes of seismic were acquired followed by several exploration wells.
A small non-commercial discovery of condensate and biogenic gas in Upper Miocene sandstones was made offshore by the A4-1X well drilled in 1983 by Agip and Chevron. The first onshore discovery by western companies was Shpirag in 2001 within the Sqepuri subthrust which contained light oil in a fractured reservoir of Late Cretaceous to Eocene age.
A number of companies now have licenses to operate onshore and offshore which has led to a tripling of the country's heavy oil production since 2004 using modern pumping systems and horizontal drilling.
Exploration activities have increased, both onshore and offshore, with operators using modern seismic data. Shell is also evaluating the potentially significant, light oil discoveries in the Shpirag and Molisht areas.
Production of oil from Albania probably peaked in 1974 and Globalshift does not forecast any future growth from existing or new developments.
Gas output, however, currently at a low level, could grow significantly as new investment in associated gas and complex free gas fields in the Ionian Basin are developed.


Air Ambulance Demonstrator SEA has utilised its aviation simulator technology to provide the Midlands Air Ambulance Charity with an interactive helicopter system aimed at bolstering public engagement.
Sonar 2076 TAHS Operator Maintainer Trainer SEA developed the Towed Array Handling System trainer which is installed at the Astute Training Facility. The trainer adopts the same 'look and feel' as the BAE Systems VORTEX training environment.
Common Simulation Framework (CSF) SEA is under contract to MoD for the delivery of a Common Simulation Framework (CSF) to enhance training in the Land environment.
NATO Submarine Rescue System (NSRS) Simulation Capability The submarine rescue system community faces unique risk and safety management challenges relating to the performance of safe, timely rescues using vessels of opportunity in a wide range of environmental conditions.
Simulated Sonar Data for 2054 Inboard Replacement SEA generated simulated acoustic signals and noise for testing the Sonar 2054 Inboard Replacement (S2054IR) system, under contract to Dstl.
Ship/Air Interface Framework The development of a ground-breaking simulation capability has for the first time allowed the safe operating limits for a helicopter operating from a new ship type to be predicted, years before the ship even sets sail.


text:
Q: Switch to Gnome from KDE without logging out Right now I'm using the KDE desktop on Fedora, but I want to switch to Gnome. Problem is, I have many things open right now (xterms, xemacs, etc, etc), and I don't want to close all of them, log out, switch, then reopen everything...that'd take way too long.
So my question is: is it possible to switch to Gnome without having to log out?? Or switch but NOT have to close and reopen everything?

A: I'd say ultimately no.  Many things can be swapped out or used together like having both Gnome Terminal and Konsole open.  You can also have Dolphin/Konqueror open with Nautilus.  You can probably kill the Gnome Panel and start KDE's version of it, but switching the whole desktop is complicated by the session manager.  The session manager is the one process started by the login manager that represents the session.  If it exits, the session ends regardless of anything else running.  When X11 sees the session end it will kill any existing connections to programs and restart the X server.  Also, the session manager will restart any processes like Gnome Panel that it believes is vital to the session.  You can change this for each process under preferences, but these settings will be saved making it difficult to try to restore your desktop to normal.

A: Back before session managers and desktop environments like Gnome and KDE, it was possible to swap out the running window manager. Sway you were switching from twm to blackbox, you could run killall twm && blackbox to kill off the old and without terminating the session, launch a new one.
These days with the complexity and layers going on, I don't think that is practical to do. In fact I wouldn't bother trying, you will just end up with a messy environment.
Instead if you if you frequently need access to the full environment provided by each (say for testing software) look into the fact that you can run more than one X server at once. You could get one going and login to Gnome on console 7 and have another full blown X server on console 8 with KDE, and switch back and forth on a wim with Ctrl+Alt+F7.
Another suggestion would be to run a Xephyr server which will basically allow you to run a second whole desktop environment inside a window of the first.

A: Digging through some OLD distro docs, it seems that once upon a time there was a utility called switchdesk that took care of the leg work needed to change Desktop Environments mid-stride. Several distros seem to still have it around, but the project doesn't seem to have a home on the web any more. If your distro has packages you might try it, but your millage will probably vary (for the worse).

A: FWIW you can switch from KDE (running Xorg) to Sway (or from anything Xorg to Sway for that matter). First launch your X DE, then open a new terminal Ctrl+Alt+F3 for example, type sway and voila. Beware of duplicate processes launching at startup though.

redpajama_set_name: RedPajamaStackExchange


text:
Obituaries » Lucille C. Moreno
Lucille C. Moreno
Burial Date October 31, 2015
Cemetery St. Joseph Catholic Cemetery
Church St. John Berchmans Cathedral
SHREVEPORT, LA – Services for Lucille C. Moreno will be held at 10:00 a.m. on Saturday, October 31, 2015 at St. John Berchmans Cathedral with Monsignor Carson LaCaze officiating. Burial will follow at St. Joseph Cemetery.
Lucille was born on April 11, 1932 in Dilley, Texas. She was a loving mother who has lived a full life and was a fighter until the end. She raised her nine children and many grandchildren and great-grandchildren. She will be missed by all who knew and loved her.
She is preceded in death by her mother, Alice Polk; father, Charlie Corona; husband, Frank Moreno; son, Julian Soto; and daughter Junita Buchanan.
Left to cherish her memory are her sons, Richard DeLeon, Robert Moreno, David Corona, Romaldo Garcia, Jessie Moreno, and Joe Corona; daughters, Mary Fatheree, Frances Clevenger, and Elizabeth Moreno; her siblings, Alice Garcia, Julie Garcia, Nellie Garcia, Mark DeLeon, Roosevett DeLeon, and Joe Deleon; and 16 grandchildren and 32 great-grandchildren.
Honoring Lucille as pallbearers will be Charles Corona, Darien Corona, Joseph Wayne DeLeon, Mark DeLeon, Shane Moreno, Joshua Schnider, and Savarra Thomas.


We advise and act on behalf of associations and societies in all legal aspects of their activities.
We support their establishment, attend to the associations' work in matters pertaining to legal policy and to the legal aspect of public relations. We provide expert opinions and legal documents, contribute to workshops and further education events and act on behalf of the associations in negotiations and proceedings.