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Anna S. E. Lundberg
Coach, Speaker, Writer
One Step Outside
From Quito to Buenos Aires in 3 months: My trip in numbers
19 August, 2013 By Anna S E Lundberg 6 Comments
So that's it! My sabbatical in South America is all done and accounted for. I hope you've enjoyed following along and getting a peek at some of what I've been experiencing since leaving for Ecuador on 1st May. But don't worry, although this particular adventure may be over the journey, and the writing, continues. And in the meantime, as we live in a data-driven world, let's take a look at some statistics from the trip:
Months spent travelling: 3
Countries visited: 8
Towns and cities visited: 34
Buses taken: 31 (including 4 night buses)
Trains taken: 1 (Oruro-Uyuni)
Flights flown: 7 (Geneva-Amsterdam-Quito, Quito-Galapagos, Galapagos-Guayaquil, Santiago-Mendoza, Buenos Aires-Paris-Geneva)
Boat trips taken: 4 (Galapagos yacht plus Copacabana-Isla del Sol-Copacabana and Colonia-Montevideo)
Horses ridden: 1
Bicycles ridden: 2
Wine tours taken: 1
Beds slept in: 38 (including 1 boat and 1 tent)
Wonders of the world visited: 3 (1 'new': Machu Picchu; 1 'natural': Iguazú Falls; 1 'modern': Itaipú Dam)
Ruins visited: 13
Observatories observed: 2
New constellations learned: 5
Foursquare mayorships won: 17
Churches photographed: too many to count
Photos taken: definitely too many to count
Panama hats bought: 0 (Haven't you been paying attention? It's called a sombrero de paja toquilla)
Bracelets bought: 3
Bracelets lost: 1
iPhones stolen: 1
Bank cards consumed by ATMs: 1 (The machine in Cusco "went to sleep")
Guns in my face: 1 (Say it with me: PARAGUAY)
Friends' weddings missed: 3
Baby nieces born: 1
Films watched: 34 (Mostly on buses but also 3 at the cinema. My favourites: The Bucket List, My Name is Khan, The Help, Now You See Me)
Books read: 9 (Mostly in the first few weeks, then nothing!)
Blog posts written: 50
Views on my blog: 5,702
Massages enjoyed: 3
Pedicures done: 2
Bikini waxes booked: 0
Hair dryers used: 1
Make-up worn: 3 times
Pisco sours drunk: 6
Alpaca burgers eaten: 2
Sushi eaten: 4 times
White bread force-fed to me: 534 kg
Coca tea drunk: 7 litres
Dulce de leche devoured: 23 kg
Tangos tangoed: 0
Salsas salsaed: 0
Compliments received: enough to make a girl blush
Facebook friends added: 11
Spanish words learned: muchas
Memorable experiences experienced: MUCHÍSIMAS
Filed Under: Argentina, Bolivia, Brazil, Chile, Ecuador, Paraguay, Peru, Travel, Uruguay Tagged With: backpacking, memorable experiences, sabbatical, South America, travel
Final days in Argentina: The non-Evita side of Buenos Aires
17 August, 2013 By Anna S E Lundberg Leave a Comment
What?! There's more to Buenos Aires than Evita?! That's crazy! But yes, indeed, there are some things to do and see that are unrelated to Eva Perón. I spent my days there walking around town, which I find to be the best way to explore any new place. Not that a few days in a city like Buenos Aires can do it justice…
Galerías Pacífico is a shopping mall in the centre of town, housed in a 'Beaux Arts' building from 1889 and declared a national historic monument 100 years later. It's been remodelled and renovated during that time, perhaps most impressively including the frescos of the central cupola.
Inside Galerías Pacífico
San Telmo is the more bohemian neighbourhood, or 'barrio', of Buenos Aires, and its oldest.
San Telmo has great vintage shops – if only I lived there so I could buy some of the gorgeous furniture!
Empty chairs and empty tables at Plaza Dorrego in San Telmo
The Puerto Madero is a lovely area to walk, with lots of new office buildings and restaurants and modern architecture.
The design of the Puente de la Mujer, 'Women's Bridge', was incomprehensible to me – it's a long steel needle pointing diagonally upwards, not particularly feminine – but it seems it's actually a stylistic representation of a tango-dancing couple.
Not bad for a selfie!
That's the one typical Argentinean thing I didn't do: go to a tango show. I had already been to two in the UK – one in Norwich and one at the Royal Festival Hall in London – so maybe it's okay? In fact, the genuine tango experience is to dance, not to watch, and as I haven't ever learned Argentine tango I think it was probably for the best that I stayed off the dance floor. In any case, it takes two to tango, doesn't it?
Looks… easy?!
Teatro Colón was inaugurated in 1908 with a first performance of Verdi's Aida. The design of the Teatro Colón was inspired by the style of the Paris Opera, with some Italian influences as well.
The grand steps of the Teatro Colón separate the real world, on the ground floor, from the artistic world on the upper floor – a world that was much more ornate than the everyday world below.
Cupid whispers something in his mother's ear…
The theatre has required a huge amount of refurbishment – years of indoor smoking and pollution left the walls a murky grey and the wooden panels almost black, while today everything gleams brightly.
Not too shabby
The auditorium is said to have some of the best acoustics in the world – apparently Pavarotti sang here and said that there was "something wrong with the sound: it's just too… perfect".
And I'm sure that's just a tiny part of what Buenos Aires has to offer. Still, Evita is never far away…
Filed Under: Argentina, Travel Tagged With: Argentina, Buenos Aires, Galerias Pacifico, Puente de la Mujer, Puerto Madero, San Telmo, South America, Teatro Colon, travel
On the trail of Eva Perón: Singing songs from Evita in Buenos Aires
13 August, 2013 By Anna S E Lundberg 1 Comment
Number 41 on my bucket list from 5th July this year: Sing Evita songs in Buenos Aires. That's a big TICK then!
Eva Ibarguren – that was her mother's name; her father Juan Duarte did not recognise her as his legitimate child – was born in 1919 and grew up in a poor area of Junín in Buenos Aires province. At the age of 15, Eva ran off to the capital city. In the film, at least, she did so with the tango singer Agustín Magaldi, though this is not known for certain.
To think that a man as famous as you are
Could love a poor little nothing like me
I wanna be a part of B.A., Buenos Aires, Big Apple…
While I arrived by boat, Eva arrived by train at Estación Retiro, met by her brother who was doing his military service
What's new Buenos Aires?
I'm new, I wanna say I'm just a little stuck in you
You'll be on me too
I get out here, Buenos Aires
Stand back, you oughta know whatcha gonna get in me
Just a little touch of star quality
Eva found some success in Buenos Aires as a model and an actress
The lady's got potential, she was setting her sights
On making it in movies with her name in lights
The greatest social climber since Cinderella
She met Colonel Perón at a fundraiser he organised at Luna Park Stadium in aid of the victims of an earthquake in San Juan in January 1944; in less than two years, they were married
I don't always rush in like this
Twenty seconds after saying hello
Telling strangers I'm too good to miss
If I'm wrong I hope you tell me so
But you really should know, I'd be good for you
I'd be surprisingly good for you
Apparently Evita lived with Perón on the fourth floor of Calle Posadas 1567 in the Recoleta neighbourhood…
…when I went there, though, there was actually a plaque on the hotel next door at 1557. Hmm…
Eva followed her husband on the campaign trail for the 1946 presidential election, which saw Juan Perón win a landslide victory. This is where, in the film, Evita – 'little Eva' as she became known among the 'decamisados' – stepped out onto the balcony of the Casa Rosada to greet her fans
The Casa Rosada is, as its name suggests, though still quite unexpectedly, PINK; it's still the office of the president and visits are allowed only at the weekend and during public holidays, but I was pretty happy with walking around the outside of the building singing…
Don't cry for me Argentina
The truth is I never left you
All through my wild days
My mad existence
I kept my promise
Don't keep your distance
Thousands of people gathered in August 1951 to beg Evita to accept the role of vice president (she refused) outside the Cabildo, now a museum; behind, you see the clock tower of the 'Edificio de la Legislatura Porteña' where Evita had her office in what was then the Secretariat of Labour and Social Insurance
In 1950, Evita was diagnosed with uterine cancer, and she died at the age of 33 on 26th July 1952, and her body lay here in the Congreso for a day to allow the public to pay their respects; she was granted a state funeral
You let down your people Evita
You were supposed to have been immortal
That's all they wanted – not much to ask for
But in the end you could not deliver
Evita's body was kept in a locked room in the building of the Confederación General de Trabajo but disappeared in 1955 when Perón was overthrown in a military coup; the body somehow made it to Milan where it was buried under another name
In 1976, Evita's body was finally placed in her family's mausoleum in Recoleta Cemetery
The choice was yours and no one else's
You can cry for a body in despair
Hang your head because she is no longer there
To shine, to dazzle, or betray
How she lived, how she shone
But how soon the lights are gone
Many thanks to the Eva Perón Historical Research Foundation, whose website pointed me in the direction of the less obvious Evita locations. Unfortunately I couldn't visit the Mueso Evita, which is located outside of town at 2988 Lafinur Street in the Palermo neighbourhood.
I did, however, discover La Muestra de Evita, El Museo del Pueblo on Avenida de Mayo 930 (some of the photos above are from this small but interesting museum).
Filed Under: Argentina, Travel Tagged With: Andrew Lloyd Webber, Argentina, Buenos Aires, Eva Duarte, Eva Perón, Evita, Juan Perón, Museo Evita, South America, travel
Colonia del Sacramento: A short post about old towns and tango
From Montevideo, it's a short bus ride (3-4 hours – no 2-hour delay this time, just half an hour late) to Colonia, from where it's just a 1-hour ferry ride across the Río de la Plata to Buenos Aires. I was in a four-bed dorm with two Argentinean girls (in their thirties, hallelujah! and incidentally both called Mariana, so that was easy to remember) and we had dinner and spent the next day together, exploring the city.
By the way, my Swedish friends will understand that I spent the entire time I was by the Río de la Plata, on both the Uruguayan and the Argentinean side, singing to myself:
Samborombon, en liten by förutan gata,
den ligger inte långt från Rio de la Plata,
nästan i kanten av den blåa Atlanten och med
pampas bakom sej många hundra gröna mil,
dit kom jag ridande en afton i april
för jag ville dansa tango.
This is part of a song by the much-loved Swedish singer Evert Taube about Fritjof who comes to the small village of Samborombon in Argentina to propose to the beautiful Carmencita, who unfortunately instead favours a rich man with a big estancia and 20,000 cows.
Colonia is described by the Lonely Planet as "an irresistibly picturesque town", and its Barrio Histórico is another UNESCO World Heritage Site. On arriving from Montevideo, I had spent my first grey afternoon wandering around the old town taking pictures of the streets, the buildings, the ocean… The next morning, the clouds had cleared and the sky was blue so of course I had to go round with the two Marianas to all the same places and re-take all the photos! The old town is a lovely little area, and I can imagine it's even nicer when it comes to life in the summer and you can sit outside the little cafés on the cobbled streets. Same for the beaches, which would be much more useful in the hot summers!
The lighthouse, El Faro, was built in 1857 on top of the ruins of the San Francisco convent
Climbing to the top, you get a 360 degree view over town and out over the ocean
This old street, Calle de los Suspiros (the 'street of sighs'), retains its Portuguese houses and cobbled surface, with a drain running through the middle instead of down the side as is more common
The streets of Colonia are lined with vintage cars, and in fact some will tell you that visiting this city is like going back in time to how Buenos Aires used to be…
Walking along the Río de la Plata (Samborombon, en liten by förutan gata…)
It may have been sunny, but it was still pretty cold!
Another beach, another missed opportunity for a swim
Iglesia Matriz on the Plaza de Armas is Uruguay's oldest church. I stood for several minutes in front of the church waiting patiently for the tourists to clear so that I could take a good picture; when they finally left, a big truck pulled up and parked right in front of the entrance…
The practical bit
For boats between Colonia (also Montevideo) and Buenos Aires:
-I took the Colonia Express, very convenient, with immigration handled smoothly, though a very long way to walk down from the terminal to the boat!
-There is also the Buquebus (sounds in English like 'book a bus' in a French accent…), which has both 1-hour and 3-hour boats to Montevideo.
Filed Under: Travel, Uruguay Tagged With: Buquebus, Carmencita, Colonia del Sacramento, Colonia Express, Evert Taube, Montevideo, Rio de la Plata, South America, travel, Uruguay
Coming to Uruguay: Markets, mate and Mexicans in Montevideo
9 August, 2013 By Anna S E Lundberg Leave a Comment
Another night bus, another two hours more than advertised. But this time it was a blessing: had I arrived in Montevideo on a Sunday at 5am as we were supposed to, I would have had to wait outside for hours in the cold and the dark until the hostel opened at 8am. As it was, I managed to persuade them to let me in when I arrived at 7.30am.
I decided not to go to bed, as having a nap after a night bus tends to confuse my body clock, but I did take it easy with a long breakfast and a nice hot shower. I was pointed in the direction of two outdoor markets and I headed out into town to first one then the other. The first 'feria' was huge, filling the main street of Tristán Narvaja and many side streets, with everything from antiques to electrical parts to animals (I hate seeing dogs in particular in tiny boxes and cages, but it would be impossible to adopt them all!). The second market in the Parque Rodó was smaller and mainly had clothes. (One top said "Don't worry, be sexy" – a great idea that sadly would not be achieved with the baggy black top on which it was written.) From there, I wandered through the fun fair (unfortunately closed) and down to the beach, though any sunbathing or swimming was out of the question at this time of year.
Now there's a strange habit in some countries of South America, mainly Uruguay, Paraguay and Argentina – very strange to those of us not used to it, though incredibly commonplace for those who are. It's drinking mate: well, not really the drinking of the tea itself, but the act of carrying it around with you everywhere you go. Men and women on the street, on the bus, at the national park, will be holding the typical gourd in one hand, periodically sucking through the metal straw, while clutching a big thermos under the other arm. Others carry special cases to hold both the thermos and a big bag of the yerba mate for continuous refills throughout the day. The closest parallel would be if Brits started carrying around thermos flasks with Earl Grey tea; but I also have visions of The French carrying bottles and glasses of wine, Germans with barrels of beer, Russians with bottles of vodka… Not that mate is alcoholic or even particularly stimulating. In the cold of the winter months I can definitely understand the appeal, but otherwise I'm at a loss to understand the addiction.
Anyway, on the bus on the way back into town, I was accosted by a student from Mexico who had recognised my foreigner status (what gave me away?!) and asked if he could join me. So we had lunch together – 'chivito', a national dish of Uruguay that consists of meat with bacon, cheese, egg and mayonnaise on a pile of fries, a veritable health bomb; went for a guided tour at the Teatro Solís; and finally wandered down the Rambla all the way back to the fun fair and took the same bus back into town again. Montevideo is packed with beautiful architecture including many gorgeous art deco buildings from the 1920s, and its location just across the Río de la Plata from Buenos Aires makes it an appealing and accessible destination both for 'porteños' (the residents of Buenos Aires) and for us tourists who have come to Argentina.
Back at the hostel, the usual eclectic mix of people: a German woman (we spoke Spanish!) who had just moved to Montevideo for work, her husband arriving later that evening; a couple visiting from Chile; and José from the north of Spain. After twelve years as a social worker in Spain, José had quit his job and spent two years volunteering in Asia. Now he'll do the same in South America, after which he plans to go to Africa. He spoke incredibly passionately about his work and the people he got to know as he worked on different projects; and he advocated the importance of being grateful for what you have and living in the moment.
And that's pretty good advice, I think!
Market day in Montevideo
A castle in Parque Rodó
The fun fair was not so fun…
…but the dulce de leche-filled churros made it all the more fun!
Fancy a swim?
Gourds and straws for mate drinking
The Teatro Solís is Uruguay's oldest theatre, built in 1856
Some of the architecture in the Old Town
Walking along the Rambla
Filed Under: Travel, Uruguay Tagged With: mate, Montevideo, South America, Teatro Solís, travel, Uruguay, yerba mate
More about Anna
Anna Lundberg is a success coach and business strategist who helps experienced corporate professionals reimagine success outside of the 9 to 5.
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Terrorism is again at the forefront of nearly everyone's minds. It is no longer something happening "over there."
After 9/11/01, terrorist attacks and fatalities in the United States dropped to nearly zero from 2002 until 2009. However, since 2009, the number of incidents and the number of fatalities has been rising, including the most recent and horrendous attacks in Orlando and San Bernardino. It is clear that terrorism can occur anywhere and is not going away.
What Is My Business' Risk from a Terrorist Act?
You are 271 times more likely to die in a workplace accident than a terrorist act.
You are 1,904 times more likely to die in a traffic accident than a terrorist act.
You are 35,079 times more likely to die from heart disease than a terrorist act.
Does my insurance cover my business if something happens to me like what happened to Pulse in Orlando?
Unfortunately, that is not a simple "yes" or "no" answer. It all depends on what line of coverage you're talking about. For example, Worker's Compensation does not exclude terrorism. For all other lines of commercial coverage, the answer is a little trickier. It involves something called TRIA.
The 9/11 attacks resulted in insured losses of $23 billion. As a result, the Terrorism Risk Insurance Act (TRIA) was enacted by the U.S. Government. It acts as a re-insurance to the insurance industry to cover insured losses from terrorism. In exchange for this backing, the law requires insurers to allow businesses the option of buying terrorism coverage.
TRIA defines an act of terrorism as an act committed in the United States by individual(s) to coerce the civilian population of the U.S. or influence the policy or conduct of the U.S. by coercion. There is currently no distinction between foreign or domestic terrorism.
The act also specifies that an incident must reach $5 million before it can be certified as an act of terrorism. The U.S. Secretary of the Treasury, in concurrence with the U.S. Attorney General, makes that determination. Then there is a complicated set of conditions and thresholds that must be met before the U.S. Government re-insures a particular incident. Since TRIA was signed into law by George W. Bush in 2002, no incident has been designated as an "act of terrorism".
What happens if I Accept or Reject Terrorism Coverage?
If you reject the offer to add terrorism coverage for your standard policy, and an event is certified as "an act of terrorism", then you will NOT have a covered loss.
If you buy the add terrorism coverage, and there is a certified "act of terrorism", then you will have a covered loss.
What happens if an incident occurs that is not certified as "an act of terrorism"?
As previously mentioned, there has not been one certified "act of terrorism". So what happens to businesses' affected by what seems to be an "act of terrorism", but has not been certified by the U.S. Department of Treasury as one.
The Boston Marathon Bombing was not certified, but several businesses were obviously affected. In this situation, a typical property casualty policy should cover acts of malicious mischief, vandalism, fire, and explosion.
Business interruption and extra expense coverages would also apply if purchased. One coverage to consider is for business income or extra expense for "dependent properties". These are other business that your business relies on for your continued operations. What if they are the victims of an attack and are shut down?
If your employees travel frequently, do you have travel policies that cover terrorist acts?
Some insurance carriers are offering stand-alone terrorism policies. These are typically property policies that respond only to acts of terrorism, no matter if they have been certified by TRIA.
Every situation will raise insurance coverage questions, and all the facts must be investigated to determine how coverage applies.
The most important task you can do is to consult with your agent and review all of your exposures and policies to determine what makes sense for your business.


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redpajama_set_name: RedPajamaCommonCrawl


text:
Amoebiasis
The infectious agent
The causative agent of amoebiasis is a pathogenic protozoa (amoeba) called Entamoeba histolytica. E. histolytica is now recognized as a separate species from the closely related non-pathogenic Entamoeba dispar.
There are also some other pathogenic amoeba species, which do not cause intestinal infections and the infections caused by them are rare. Acanthamoeba species, which are also found in Northern Europe, can cause keratitis, primarily, however, in individuals using contact lenses. Acanthamoebas and species in the genus Naegleria can also cause severe infections of the central nervous system, but these are very rare. These other amoebas are not discussed in more detail in this article.
Distribution is worldwide with a higher prevalence in tropical and subtropical regions. The annual number of cases is approximately 40–50 million, of which about 10% are symtomatic. The overall mortality is around 0.2%. Some of the deaths result from the development of an amoebic abscess (Amoebic abscess), but amoebic colitis that causes ulcerations may also lead to bloody diarrhoea (dysentery) and death (usually in less than 2% of patients with amoebic colitis).
Transmission and clinical pictures
E. histolytica lives in the large intestine and produces cysts into the faeces. Contamination occurs when cysts are ingested.
E. histolytica may penetrate the intestinal mucous layer, destroy epithelial cells and cause crater-shaped ulcers.
Sometimes the organisms invade the peritoneum by penetrating the intestinal wall and cause peritonitis.
As the amoebae disseminate through the venous circulation e.g. into the liver an amoebic abscess may develop (Amoebic abscess).
Other possible, though rare, intestinal disease forms include toxic megacolon and amoeboma, i.e. a tumour-like lesion in the colonic wall consisting of granulomatous tissue and causing local obstruction.
The incubation period from contracting the infection until symptom onset is from 1 week to 4 months.
It was previously thought that almost all carriers of E. histolytica were asymptomatic, but according to current knowledge, most of those being asymptomatic are carriers of the nonpathogenic E. dispar. Nevertheless, about 90% of the patients infected with E. histolytica still remain asymptomatic or only have mild symptoms.
The clinical picture of intestinal amoebiasis varies from very slight diarrhoea to bloody diarrhoea, i.e. dysentery, which may be life threatening.
In addition to diarrhoea, the symptoms include abdominal pain, cramps, fatigue, low grade fever, loss of appetite, headache and low back pain.
On examination the patient usually has a tender abdomen and about 10–30% of the patients have fever. Visible blood in stools is often present.
Diagnosis is based on detecting E. histolytica from a stool sample or a colonic biopsy.
The primary investigation when amoebiasis is suspected is a nucleic acid detection test on a stool sample. The test identifies specifically the pathogenic E. histolytica only and not the non-pathogenic E. dispar. Tests that are based on microscopy or antigen detection are less sensitive and hence clearly in a secondary role.
Samples (curettage or biopsy) taken during colonoscopy can also be examined for amoebae by antigen or nucleic acid detection or staining.
In differential diagnostics, other intestinal infections, particularly those causing bloody diarrhoea, as well as ulcerative colitis (Ulcerative colitis), Crohn's disease (Crohn's disease) and irritable bowel syndrome (Functional bowel disorders and the irritable bowel syndrome (IBS)) should be considered.
Sometimes a stool or intestinal sample for E. histolytica may reveal the presence of other amoebae. Entamoeba coli, E. hartmanni, E. dispar, Endolimax nana and Iodamoeba bütschlii are all non-pathogenic and do not therefore require treatment with antimicrobials.
Treatment and prognosis
The aim of the treatment is to eliminate symptoms and to prevent further transmission of the infection.
The most effective treatment of amoebic colitis and extraintestinal amoebiasis is metronidazole 400–800 mg 3 times daily for 7–10 days (children: 12–16 mg/kg 3 times daily) [Evidence Level: B] or tinidazole (2 g in a single dose on 3 consecutive days).
To remove intestinal cysts, additional treatment with paromomycin 8–11 mg/kg 3 times daily for 7 days is required.
The treatment of asymptomatic carriers of gastrointestinal E. histolytica is aimed at eliminating the source of infection and thus preventing later development of a symptomatic disease. The first-line drug for the treatment of asymptomatic patients is paromomycin, which is more effective against cysts than metronidazole. The treatment of carriers of E. dispar is not indicated. It is usually warranted to investigate with nucleic acid detection test stool samples from persons living in the same household with patients with a severe clinical picture.
Relapses do sometimes occur and a repeat stool sample should therefore be submitted 4 weeks after the treatment.
Antiamoebic drugs for treating amoebic colitis
Adding chlorine to drinking water does not destroy the cysts of E. histolytica, but good filtering systems, treating water with iodine, freezing it to –20°C or heating it (5 min. +50°C) will eliminate the cysts.
1. Pritt BS, Clark CG. Amebiasis. Mayo Clin Proc 2008;83(10):1154-9; quiz 1159-60. [PMID:18828976]
2. Stanley SL Jr. Amoebiasis. Lancet 2003;361(9362):1025-34. [PMID:12660071]
3. Tanyuksel M, Petri WA Jr. Laboratory diagnosis of amebiasis. Clin Microbiol Rev 2003 Oct;16(4):713-29. [PMID:14557296]
4. Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr. Amebiasis. N Engl J Med 2003 Apr 17;348(16):1565-73. [PMID:12700377]
Copyright © 2021 Duodecim Medical Publications Limited.
Amoebiasis is a sample topic from the Evidence-Based Medicine Guidelines.
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(4) A coffee shop blends 2 kinds of coffee, putting in 2 parts of a 33p. a gm. grade to 1 part of a 24p. a gm. If the mixture is changed to 1 part of the 33p. a gm. to 2 parts of the less expensive grade, how much will the shop save in blending 100 gms.
(9) In June a baseball team that played 60 games had won 30% of its game played. After a phenomenal winning streak this team raised its average to 50% .How many games must the team have won in a row to attain this average?
(11) A company contracts to paint 3 houses. Mr. Brown can paint a house in 6 days while Mr. Black would take 8 days and Mr. Blue 12 days. After 8 days Mr. Brown goes on vacation and Mr. Black begins to work for a period of 6 days. How many days will it take Mr. Blue to complete the contract?
(12) 2 hours after a freight train leaves Delhi a passenger train leaves the same station travelling in the same direction at an average speed of 16 km/hr. After travelling 4 hrs the passenger train overtakes the freight train. The average speed of the freight train was?
(13) If 9x-3y=12 and 3x-5y=7 then 6x-2y = ?
(16) 1/3 of girls , 1/2 of boys go to canteen .What factor and total number of classmates go to canteen.
(19) There are two candles of equal lengths and of different thickness. The thicker one lasts of six hours. The thinner 2 hours less than the thicker one. Ramesh lights the two candles at the same time. When he went to bed he saw the thicker one is twice the length of the thinner one. How long ago did Ramesh light the two candles .
(20) If M/N = 6/5,then 3M+2N = ?
(21) If p/q = 5/4 , then 2p+q= ?
(22) If PQRST is a parallelogram what it the ratio of triangle PQS & parallelogram PQRST .
(23) The cost of an item is Rs 12.60. If the profit is 10% over selling price what is the selling price ?
(25) To 15 ltrs of water containing 20% alcohol, we add 5 lts of pure water. What is % alcohol.
(26) A worker is paid Rs.20/- for a full days work. He works 1,1/3,2/3,1/8.3/4 days in a week. What is the total amount paid for that worker ?
(27) If the value of x lies between 0 & 1 which of the following is the largest?
(28) If the total distance of a journey is 120 km .If one goes by 60 kmph and comes back at 40kmph what is the average speed during the journey?
(29) A school has 30% students from Maharashtra .Out of these 20% are Bombey students. Find the total percentage of Bombay?
(30) An equilateral triangle of sides 3 inch each is given. How many equilateral triangles of side 1 inch can be formed from it?
(31) If A/B = 3/5,then 15A = ?
(32) Each side of a rectangle is increased by 100% .By what percentage does the area increase?
(33) Perimeter of the back wheel = 9 feet, front wheel = 7 feet on a certain distance, the front wheel gets 10 revolutions more than the back wheel .What is the distance?
(34) Perimeter of front wheel =30, back wheel = 20. If front wheel revolves 240 times. How many revolutions will the back wheel take?
(36) City A s population is 68000, decreasing at a rate of 80 people per year. City B having population 42000 is increasing at a rate of 120 people per year. In how many years both the cities will have same population?
(37) Two cars are 15 kms apart. One is turning at a speed of 50kmph and the other at 40kmph . How much time will it take for the two cars to meet?
(38) A person wants to buy 3 paise and 5 paise stamps costing exactly one rupee. If he buys which of the following number of stamps he won t able to buy 3 paise stamps.
(39) There are 12 boys and 15 girls, How many different dancing groups can be formed with 2 boys and 3 girls.
(41) There are two circles, one circle is inscribed and another circle is circumscribed over a square. What is the ratio of area of inner to outer circle?
(a) 30 (b) 33 (c) 36 (d) none of these.
(44) If a boat is moving in upstream with velocity of 14 km/hr and goes downstream with a velocity of 40 km/hr, then what is the speed of the stream ?


text:
chevron_leftBack to What's on
Register Now: Darkness into Light 5km Suicide Prevention Walk
By Amanda Sheppard 26 April 2019
Originating in Dublin in 2009, the 'Darkness into Light' 5km walk takes place across more than 200 locations, in 19 countries, across five continents. The walk has the noble goal of raising awareness for counselling and suicide prevention services. The Hong Kong event steps out at Sun Yat Sen Plaza at 4.30am, on Saturday, May 11. All are welcome to join, but participants must register online before the event begins.
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Hong Kong has a suicide rate of 12.6 deaths per 100,000 people. This translates into about 850 deaths per year. We hear about the tragedy of youth suicide, but it is also heartbreaking to learn that a quarter of cases are in fact people over the age of 65 – this is where Darkness into Light comes in. Darkness into Light is a key event for Pieta House, an Irish organisation with a vision for a world where suicide, self-harm and stigma have been replaced by hope, self-care and acceptance. The concept of the walk has been exported to countries around the world by Irish expatriates. In Hong Kong, the event is coordinated by Niall Kelly, with support from the Irish Consulate. They have also teamed up with local charity The Samaritan Befrienders Hong Kong, who assist those facing loneliness and depression by helping them regain confidence in life.
Last year, 777 people registered to attend the Hong Kong event and raised a whopping $422,849! Your support of this event will help our 2019 Hong Kong charity partners, Mind Hong Kong, Samaritan Befrienders and KELY Support Group, to deliver vital programs in their local area. [su_note note_color="#cfcfcf"]
To take part in the event, click to register. Fees are $225 per adult, $180 per senior/student, $45 for anyone between the six to 17, and children under the age of 6 are welcome to come along for free. You can walk as an individual or as a team.
Visit The Samaritan Befrienders Hong Kong to learn more about the work that they do and volunteer or donate directly to them.
Visit and Like the 'Darkness into Light' Facebook page to help spread the news.
Share this article with your friends and family!
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Amanda Sheppard
Following a brief and bitterly cold stint in Scotland, Amanda returned to Hong Kong—a place she's called home for over 18 years—to begin her career as a writer. She can often be found getting lost somewhere very familiar, planning her next holiday, and enjoying a cup (or three) of good, strong coffee.
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Gather for a festive evening on the sky100 Observation Deck!


text:
Südindische oder Salem-Baumvogelspinne (Poecilotheria formosa) ist eine Webspinne aus der Familie der Vogelspinnen (Theraphosidae). Entsprechend ihren Trivialnamen ist die Art im Süden Indiens endemisch.

Einer der deutschen Bezeichnungen ähnlich wird die Art im Englischen als Salem ornamental tarantula (übersetzt Salem-Ornamentvogelspinne) bezeichnet.

Merkmale

Das Weibchen der Südindischen Baumvogelspinne erreicht eine Körperlänge von etwa 60 und das Männchen eine von etwa 50 Millimetern. Die Art besitzt eine braune Grundfärbung und wie alle Arten der Gattung eine kontrastreiche Zeichnung, die besonders beim Weibchen stark ausgeprägt ist. So besitzt das Weibchen ein helles Ornamentmuster auf dem Prosoma (Vorderkörper) und dem Opisthosoma (Hinterleib) und ebenso hell geringelte Extremitäten. Beim Männchen sind die Musterungen weniger stark vorhanden.

Ähnliche Arten
Eine der Indischen Baumvogelspinne ähnliche Art ist die nah verwandte, allerdings in Zentralindien vertretene Poecilotheria chaojii. Von der Indischen Baumvogelspinne unterscheidet sich diese durch die hier auf der Ventralseite des vierten Beinpaares fortgeführte Ringelungen. Außerdem bestehen einige Ähnlichkeiten mit der Art Poecilotheria tigrinawesseli.

Vorkommen

Die Südindische Baumvogelspinne bewohnt entsprechend der Trivialbezeichnungen Südindien als Endemit und teilt sich einige Gebiete ihres Verbreitungsgebiets mit der zur gleichen Gattung zählenden Tigervogelspinne (P. regalis). Wie diese lebt die Südindische Baumvogelspinne in den Regenwäldern des Verbreitungsgebiets. Anders als die Tigervogelspinne kommt sie allerdings ausschließlich im Tiefland vor.

Bedrohung und Schutz
Die Bestände der Südindischen Baumvogelspinne sind wie die anderer Arten der Gattung, bedingt durch den Rückgang ihrer Lebensräume und durch die übermäßige Entnahme von aus der Natur stammenden Exemplaren für den Heimtierhandel rückläufig und die Art ist somit bedroht. Von der IUCN wird sie als "gefährdet" ("endangered") eingestuft und nach dem Washingtoner Artenschutzübereinkommen dürfen Wildfänge nur noch limitiert exportiert werden.

Lebensweise

Die Südindische Baumvogelspinne zählt wie die anderen Arten der Gattung Poecilotheria zu den baumbewohnenden Vogelspinnen und legt innerhalb ihres Habitats Wohngespinste an, diese bevorzugt in Baumhöhlen. Die wie alle Vogelspinnen nachtaktive Art verlässt ihr Wohngespinst, anders als andere Arten der Familie, auch häufig tagsüber auf Suche nach Beutetieren.

Mit den weiteren Arten der Gattung teilt die Südindische Baumvogelspinne ihr scheues Wesen. Bei Störungen versucht sie meist blitzartig zu fliehen. Ist der Spinne eine Flucht nicht gegeben, dann nimmt sie die für Vogelspinnen typische Drohgebärde ein und kann in größter Not auch beißen.

Phänologie und Fortpflanzung

Die Südindische Baumvogelspinne ist ganzjährig aktiv und ihr Fortpflanzungsverhalten weicht nicht weiter von dem anderer Vogelspinnen ab. Ein Weibchen legt einige Zeit nach der Paarung einen Eikokon an, der 50 bis 200 Eier enthalten kann. Die innerhalb eines gewissen Zeitraums nach der Fertigung des Kokons geschlüpften Jungtiere sind hellbraun gefärbt und weisen dunkle Zeichenelemente auf. Weibchen der Art werden in Gefangenschaft zwölf bis fünfzehn Jahre alt, die Männchen sind kurzlebiger.

Terraristik

Wie einige andere Vogelspinnen erfreut sich auch die Indische Baumvogelspinne einer gewissen Beliebtheit als Heimtier in der Terraristik. Für die in tropischen Regenwäldern vorkommende Art muss, um eine erfolgreiche Haltung zu erreichen, die in ihrem natürlichen Vorkommensgebiet herrschen. Vor dem Erwerb eines oder mehreren Exemplaren der Indischen Baumvogelspinne sollte man sich dem hektischen Gemüt der Art bewusst sein. Außerdem hat die Indische Baumvogelspinne wie alle Arten der Gattung ein für Vogelspinnen vergleichsweise starkes Gift. Bedingt ist eine Gruppenhaltung mehrerer Tiere in einem Behältnis möglich, wobei die Möglichkeit, dass Kannibalismus unter den Spinnen auftritt, grundsätzlich nicht ganz ausgeschlossen werden kann.

Obgleich Nachzuchten der Art im Handel verfügbar sind, wird befürchtet, dass die bereits bedrohten Bestände noch weiter durch übermäßigen Export schwinden (siehe Kapitel "Bedrohung und Schutz").

Systematik
Die Indische Baumvogelspinne wurde bei ihrer Erstbeschreibung durch Reginald Innes Pocock im Jahr 1899 Poecilotheria formosa benannt. Der Artname stammt von dem lateinischen Wort formosus für "wohlgestaltet".  Es wurden keine Umbenennungen oder Umstellungen vorgenommen. Eine von K. Thulsi Rao 2006 als Poecilotheria nallamalaiensis neu beschriebene Vogelspinne wurde später mit der Indischen Baumvogelspinne synonymisiert, da es sich nicht um eine eigene Art handelte.

Galerie

Einzelnachweise

Literatur
 Hans W. Kothe: Vogelspinnen. 1. Auflage. Franckh-Kosmos, Stuttgart 2003, ISBN 3-440-09367-0.
 Z. Mirza, R. Sanap, Harshal Bhosale: Description of a new species of arboreal tarantula of the genus Poecilotheria Simon, 1885 (Araneae: Theraphosidae) from Satpura Hills, Central India

Weblinks

 Poecilotheria formosa (Pocock, 1899) bei Global Biodiversity Information Facility
 Poecilotheria formosa (Pocock, 1899) bei Tarantupedia
 Poecilotheria formosa (Pocock, 1899) in der Roten Liste gefährdeter Arten der IUCN
 Poecilotheria formosa (Pocock, 1899) bei poeci1
 Poecilotheria formosa (Pocock, 1899) bei Arachnophilia.de
 Poecilotheria formosa (Pocock, 1899) bei Versicolor Bremen

Poecilotheriinae (Unterfamilie)

redpajama_set_name: RedPajamaWikipedia


text:
Register to attend in person
Register to attend online 192 Seats Remaining
Housing Options For Seniors
Life Transitions Series
2023-02-28 19:00:00 2023-02-28 20:00:00 America/New_York Housing Options For Seniors Join us for a discussion on different housing options for older adults and their families to consider. Speaker Paula Taliaferro of the COAAA will explain the housing continuum and provide resources. Bexley Public Library - Bexley Library Auditorium, BPL Virtual Programs
Add to Calendar 2023-02-28 19:00:00 2023-02-28 20:00:00 America/New_York Housing Options For Seniors Join us for a discussion on different housing options for older adults and their families to consider. Speaker Paula Taliaferro of the COAAA will explain the housing continuum and provide resources. Bexley Public Library - Bexley Library Auditorium, BPL Virtual Programs
Bexley Library Auditorium, BPL Virtual Programs
Join us for a discussion on different housing options for older adults and their families to consider. Speaker Paula Taliaferro of the COAAA will explain the housing continuum and provide resources.
Join us for a discussion on different housing options for older adults and their families to consider as they age in their communities. Speaker Paula Taliaferro of the COAAA will explain the housing continuum and define common jargon. She will provide resources to help locate and assess these alternatives, including their pricing structures. Each participant will also receive a housing and long term care guide which lists and describes various options in Central Ohio.
The Central Ohio Area Agency on Aging (COAAA) is a non-profit governmental agency which arranges and coordinates services to help older and disabled individuals with daily living. Examples include homemaking, transportation. home delivered meals, and personal care. The COAAA offers education and resources to caregivers, professionals, and the public. The agency also advocates for programs and policies that benefit older adults and individuals with disabilities. It manages services for 12,500 people and funds services for another 25,000 older adults in eight counties: Delaware, Fairfield, Fayette, Franklin, Licking, Madison, Pickaway, and Union.
AGE GROUP: | Adults |
EVENT TYPE: | Life Skills, Finance, and Health |
TAGS: | Senior housing | Housing for seniors | COAAA |
Mon, Jan 23 10:00AM to 8:00PM
Sun, Jan 29 1:00PM to 5:00PM
, OH, 43209
Bexley Public Library was founded in 1924 and first housed in Bexley High School, now Montrose Elementary School. The present building opened in 1929 and was designed by architects O.C. Miller and R.R. Reeves who drew upon French and Italian architecture from the 17th century for the design.
The library is located at 2411 East Main Street, at the intersection of East Main Street and Cassady Avenue. Parking is available in our parking lot on Euclaire Avenue and in front of the library on Main Street. Main Street is a No Parking Tow Zone from 4:00-6:00 p.m. weekdays.
Tea at Three: Zakk Jones Trio
Thomas Payton - A Man and His Family Growing Up With Bexley, 1868-1930
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Thu, Mar 09, 4:30pm - 5:30pm
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Sat, Mar 11, 11:00am - 11:45am
Flower Power: Flora in Fashion - Decorative Arts Center of Ohio Curator Series
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Tue, Mar 21, 3:00pm - 4:00pm
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Registration opens Monday, March 6 2023 at 10:00am
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text:
Parenting Independent Disciples: Lessons from the Lord on Raising Teens
By Jan Francisco
World Congress of Families Answers Attacks and Misinformation in New Report
By	Meridian Magazine · July 14, 2015
ROCKFORD, Ill.—The World Congress of Families (WCF) today released "A Call for Civil Dialogue and Constructive Engagement," a twenty-eight page report that corrects, in detail, a barrage of negative and unwarranted attacks on the WCF initiated primarily by the Southern Poverty Law Center (SPLC) and the Human Rights Campaign (HRC), particularly after the announcement of WCF's first-ever congress in the United States in Salt Lake City, October 27-30, 2015.
The report addresses more than 25 inaccuracies, the most vicious of which is the labeling of WCF as a "hate group," and one that supports violence against the LGBT community. Interestingly, the SPLC cites WCF's supposed involvement in an anti-gay initiative proposed in Uganda, as its reasoning for the false designation, although WCF has not maintained any relationship with the African country and had no role in any aspect of that initiative.
"WCF would never advocate violence or hatred toward any group of people," said Janice Shaw Crouse, a member of the Board of Directors of WCF and Executive Director of the World Congress on Families IX. "Facts do matter and it is unfortunate that any organization would attempt to tarnish the reputation of WCF to further an agenda, rather than engage in thoughtful and honest public debate and recognize the work that WCF performs on behalf of children and families throughout the world. "
The report also exposes efforts by HRC to associate with the WCF the statements of individuals and organizations that did not speak for nor were sanctioned by the WCF. Further, the report addresses a number of false claims that WCF supported violence in Russia against gays, a falsehood extrapolated from WCF's support for programs that protect children and all human life (from conception to natural death) from destructive activities including abortion, pornography, and sex-trafficking.
"The World Congress has always sought to gather thoughtful scholars, influential policymakers, noted religious leaders and advocates around the world who are focused on strengthening the natural family as the best means of raising society's next generation," says Allan Carlson, WCF's International Secretary. "Anchored from the beginning in language from the Universal Declaration of Human Rights, we affirm today our belief in the value of every human life. We continue our call for robust scholarship and civil debate on the issues, and respectful treatment for people everywhere."
"Our hope is that this report will end the attacks and misinformation and allow us to move forward by engaging in thoughtful, constructive, and civil discussion on issues vital to the lives of children and families everywhere," said Crouse.
The World Congress of Families (WCF) is the largest gathering of pro-family advocates in the world. WCF IX will seek to provide sound scholarship and effective strategies, and it will mobilize intellectual and advocacy resources to affirm and defend the natural family as the fundamental and only sustainable unit of a free society.
For more information and a copy of the report, please visit WCF9.org and follow WCF on Facebook orTwitter.


text:
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    <title>SymondsAPI Class Reference</title>
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SymondsTimetable Docs (100% documented)

        SymondsTimetable Reference

        SymondsAPI Class Reference

            Classes

                AddFriendViewController

                AppDelegate

                Attributions

                AttributionsViewController

                CloudKitManager

                Day

                – Error

                Friend

                FriendLesson

                FriendRequest

                – CloudKitError

                FriendRequestTableViewCell

                FriendTableViewCell

                FriendsViewController

                Lesson

                – LessonType

                LessonDetailsTableViewCell

                LessonFriendTableViewCell

                LessonRoomTableViewCell

                LessonStaffTableViewCell

                LessonViewController

                ListingTableViewCell

                LoginViewController

                PrimaryUser

                – Settings

                – Error

                PushRightSegue

                SettingsViewController

                SplashViewController

                SymondsAPI

                – Error

                – CallResult

                – AuthenticationResult

                – GrantType

                – APICallType

                TimetableLessonCell

                TimetableViewController

                UserListing

            Functions

                merge(left:right:inOrder:)

                mergeSort(_:_:)

            Protocols

                ErrorKind

                User

            Structs

                Attribution

                STError

SymondsAPI

public class SymondsAPI

Interfaces with the Peter Symonds College Data Service in order to perform
tasks such as authentication and retrieval of timetable information.

Properties

                    AuthenticationCompletion

A typealias used only in authenticateFromSavedDetails(completion:) to
simplify the declaration.

Declaration

Swift

public typealias AuthenticationCompletion = (

Parameters

                                error

An error if one occurred during the request; otherwise nil.

                    ExchangeCompletion

A typealias used only in exchangeCodeForToken(_:completion:) in order to
simplify the declaration of the completion block.

Declaration

Swift

public typealias ExchangeCompletion = (

Parameters

                                result

The authentication result.

                                error

An error, if one occurred.

                    TimetableCompletion

A typealias used only in getTimetable(completion:) in order to
simplify the declaration of the completion block.

Declaration

Swift

public typealias TimetableCompletion = (

Parameters

                                days

The Day objects created from the result of the call.

                                An error, if one occurred

.

                    shared

A singleton instance of SymondsAPI.

Declaration

Swift

public static let shared = SymondsAPI()

                    getAccessTokenURL

The URL used for retrieving an access token.

Declaration

Swift

public var getAccessTokenURL: URL

                    redirectURL

The redirect URL, passed to the Symonds Data Service in authentication
requests.

Apart from being required by the Data Service, this redirect URL enables
a return to the host application after authenticating externally.

Declaration

Swift

public let redirectURL = URL(

                    redirectURLRegex

A string containing a regular expression that will match redirectURL
in a string.

Declaration

Swift

public let redirectURLRegex =

                    authenticationResult

The result of an authentication request.

Declaration

Swift

internal var authenticationResult: AuthenticationResult?

                    authURL

The URL where authentication requests are sent.

Declaration

Swift

private let authURL = URL(string: "https://data.psc.ac.uk/oauth/v2/auth")!

                    tokenURL

The URL where token exchange requests are sent.

Declaration

Swift

private let tokenURL = URL(string: "https://data.psc.ac.uk/oauth/v2/token")!

                    apiURL

The URL where requests for data from the various categories (e.g.
Student Timetable, Find) are sent.

Declaration

Swift

private let apiURL = "https://data.psc.ac.uk/api"

                    session

A shared session used for sending network requests.

Declaration

Swift

private let session = URLSession(configuration: .default)

                    keys

A pair of keys used for authentication with the Symonds Data Service.

These keys are secret and are therefore loaded from a JSON file that is
copied into the main bundle at build time.

Declaration

Swift

private let keys: (clientID: String, secret: String)? =

Types

                    Error

An error that can occur in the process of processing performed by
SymondsAPI.

                        See more

Declaration

Swift

public enum Error: ErrorKind

                    CallResult

The result of a call to one of the Symonds Data Service’s services.

                        See more

Declaration

Swift

public struct CallResult

                    AuthenticationResult

The result of an authentication request sent to the Symonds Data
Service.

                        See more

Declaration

Swift

public struct AuthenticationResult

                    GrantType

A type of grant that can be used to request an access token from the
Symonds Data Service.

                        See more

Declaration

Swift

public enum GrantType: String

                    APICallType

A specific service provided by the Symonds Data Service.

                        See more

Declaration

Swift

internal enum APICallType: String

Authentication

                    authenticateFromSavedDetails(completion:)

Attempts to use saved authentication details from Keychain to
authenticate with the Data Service.

Declaration

Swift

public func authenticateFromSavedDetails(
        completion: @escaping AuthenticationCompletion
    )

Parameters

                                completion

Called when the request completes.

                    exchangeCodeForToken(_:grantType:completion:)

Exchanges an authorisation code for an access token.

Declaration

Swift

public func exchangeCodeForToken(
        _ code: String,
        grantType: GrantType,
        completion: @escaping ExchangeCompletion
    )

Parameters

                                code

The authorisation code to exchange.

                                completion

Called when the network request completes.

                    generateExchangePOSTString(with:grantType:)

Generates an HTTP POST string to exchange an authorisation code for an
access token.

Throws

An error of type AuthenticationError in the event of a
      relevant error.

Declaration

Swift

private func generateExchangePOSTString(
        with code: String,
        grantType: GrantType
    ) throws -> String

Parameters

                                code

The authorisation code to use for authentication when requesting a token.

Return Value

The generated string.

                    serializeLoginResponse(from:)

Creates an AuthenticationResult instance from a JSON object returned
by the Symonds Data Service.

Throws

Throws errors of type AuthenticationError in the event of a
      relevant error.

Declaration

Swift

private func serializeLoginResponse(
        from data: Data
    ) throws -> AuthenticationResult

Parameters

                                data

The data returned by the Symonds Data Service.

Timetable

                    getTimetable(completion:)

Retrieves the user’s timetable for the current week (or the next week
if it’s currently the weekend), and returns it as an array of Day
objects.

Declaration

Swift

public func getTimetable(completion: @escaping TimetableCompletion)

Parameters

                                completion

Called when the information has been retrieved.

                                days

The Day objects created from the retrieved data, or nil if an error occurred.

                    getUserInfo(completion:)

Retrieves the user’s information, and returns it as a dictionary.

Declaration

Swift

public func getUserInfo(
        completion: @escaping (_ info: [String: Any]?) -> Void
    )

Parameters

                                completion

Called when the information has been retrieved.

                    call(_:parameters:completion:)

Calls the specified Symonds Data Service service, with the provided
parameters.

Declaration

Swift

internal func call(
        _ callType: SymondsAPI.APICallType,
        parameters: [String: String],
        completion: @escaping (_ callResult: CallResult?) -> Void
    )

Parameters

                                callType

The service to call.

                                parameters

The parameters to provide to the service.

                                completion

Called when the call has returned.

                                callResult

The result of the call.

                    apiURLString(for:)

Creates an absolute URL, in String form, for the specified service.

Declaration

Swift

private func apiURLString(for callType: SymondsAPI.APICallType) -> String

Parameters

                                callType

The service to create a URL for.

Return Value

The absolute URL string for the service.

© 2017 . All rights reserved. (Last updated: 2017-04-13)

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text:
Implementation of a new emergency medical communication centre organization in Finland - an evaluation, with performance indicators
Veronica Lindström1,
Jukka Pappinen2,
Ann-Charlotte Falk3 &
Maaret Castrén4
There is a great variety in how emergency medical communication centers (EMCC) are organized in different countries and sometimes, even within countries. Organizational changes in the EMCC have often occurred because of outside world changes, limited resources and the need to control costs, but historically there is often a lack of structured evaluation of these organization changes. The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland.
A retrospective observational study was conducted in the EMCC in southern Finland. The data from the former system, which had municipality-based centers, covered the years 2002-2005 and was collected from several databases. From the new EMCC, data was collected from January 1 to May 31, 2006. Identified performance indicators were used to evaluate and compare the old and new EMCC organizations.
A total of 67 610 emergency calls were analyzed. Of these, 54 026 were from the municipality-based centers and 13 584 were from the new EMCC. Compared to the old municipality-based centers the new EMCC dispatched the highest priority to 7.4 percent of the calls compared to 3.6 percent in the old system. The high priority cases not detected by dispatchers increased significantly (p < 0.001) in the new EMCC organization, and the identification rate of unexpected deaths in the dispatched ambulance assignments was not significantly (p = 0.270) lower compared to the old municipality-based center data.
After implementation of a new EMCC organization in Finland the percentage and number of high priority calls increased. There was a trend, but no statistically significant increase in the emergency medical dispatchers' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in the new EMCC organization.
The emergency medical communication centre (EMCC) and the emergency medical dispatchers (EMD) is a part of the emergency medical services (EMS) and the first link in the chain of survival [1]. There is a great variety in how an EMCC is organized in different countries and sometimes, even within countries [2, 3]. In addition there have been major changes in EMCC organizations during the last few years. The changes have often started due to the input of external factors, i.e. limited resources; need to control costs, and discussions concerning management responsibilities [2, 3]. However, the assessment of the outcome of the money spent to finance the EMS is generally not evidence-based [4]. A lack of structured evaluations of organizational changes in the EMCC is evident. The aim of an EMCC is still to answer emergency calls immediately, to identify callers' needs and to dispatch the necessary resources wherever and whenever an emergency need occurs. In 2006, the Finnish government implemented a new nationwide EMCC organization with identical conditions, regardless of the EMCC location. The purpose of the organizational changes was to improve the structure of emergency dispatching. The public media and local EMS organizations discussed whether the new EMCC organization was worse for the patient and they argued that there was a risk that patients would not get an ambulance when needed. A recently published study by Määttä and colleagues describes that the EMCC organization reform in Finland had negative effects on the appropriate use of ambulances, and the reform caused prolongation in the answering and processing times of emergency calls in Helsinki, the capital of Finland [5].
EMCC organization and EMD in Finland - before and now
There used to be 45 municipality-based centers taking emergency calls in Finland. There were no official criteria for how these centers should be organized and all of these municipality-based centers had different ways of dealing with the daily work. The local rescue departments were responsible for each local municipality-based center. The computer systems, data format and evaluation strategies varied from centre to centre. There was no consensus concerning training, education, or competence of the personnel answering the emergency calls in the old municipality-based centers. In 2006, when the nationwide EMCC organization was implemented, the Health Care Services became responsible for the 15 new EMCC. One of the first actions of the new organization was to make the same stipulations regarding the competence and education of the personnel. In the new EMCC organization the EMD needed one and a half years of formalized training to be qualified as a dispatcher.
Since the1980s there have been four dispatching codes (A-D) relating to patients' acuity. The priority codes in the municipality-based centers were not based on legislation but more on common practice in the local organization. During the reform of EMCC organization the priority codes remained the same but became standardized and were regularly monitored. The definitions of prioritizing in the new EMCC organization were:
Priority code A; the patient has a life-threatening situation or has been exposed to a high-energy accident. The emergency call should be responded to immediately. The nearest physician unit and ambulance should be dispatched to the scene.
Priority code B; there is suspicion of failure of vital functions. The emergency call should be responded to immediately and the nearest ambulance should be dispatched to the scene immediately.
Priority code C; the patient needs assessment by an emergency care team. The ambulance must arrive at the scene within 30 minutes.
Priority code D; no suspicion of failure of vital functions. The patient can wait, the ambulance must arrive at the scene within 120 minutes [6].
To support the EMD assessment, both the municipality-based centers and the new EMCC used an assessment guide book with 57 medical prioritizing criteria for chief complaints. These criteria for chief complaints remained the same during the EMCC organization reform but became standardized after the organizational change [7]. The dispatching codes consisting of priority and chief complaint were used in the feedback system utilized by ambulances to send feedback to the EMCC concerning the patient's chief complaint and acuity when ambulance personnel arrived at the scene [7]. If the patient was not transported, the ambulances sent feedback to the EMD with a code explaining the reason for not transporting the patient to the hospital. The ambulances have a nine-point classification system regarding non-transport to hospital [6] The feedback system was used in the municipality-based centers but was not regularly monitored and standardized as in the new EMCC organization.
The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland.
A retrospective observational study was conducted in the EMCC in East and Central Uusimaa, an area of southern Finland where the EMCC covers about 300 000 inhabitants. We identified performance indicators and compared them with data collected before and after the new EMCC organization. The study was approved by the institutional review board.
Data in this study
The selected old municipality-based centers had computer-based statistical data on EMD assignments and ambulance feedback, which made a comparison on a group level between the old and the new system possible. A convenient sample from the municipality-based centers covered the years 2002-2005 and was collected from several databases. Approximately 40% of all emergency calls during the period 2002-2005 were available from the municipality-based databases. The rest of the data could not be gathered since it was impossible to retrieve it from the old databases. The estimated number of emergency calls in the area was 32 600 per year. From the new EMCC, East and Central Uusimaa, which covers the whole area of the closed municipality-based centers, was collected from January 1 to May 31, 2006. During the study period the population in the area increased from 273 000 to 281 000 and the death rates varied from 1809 to 1820 per year [8].
The identification and development of the performance indicators was based on two presumptions made by the research group: a large population will generate an equal rate of emergency calls, and if the EMD follows a predefined protocol, it leads to the same assessment of priority with the same kind of emergency call.
Two performance indicators were identified: priority distribution and underestimation of risk to detect life-threatening situations by the EMD, as displayed in table 1.
Table 1 Identified performance indicators
The data from both the municipality-based centers and the new EMCC contained:
Dispatcher's assessment concerning priority (A-D)
Underestimation of priority: feedback from ambulance; dispatch assessment C+D compared to ambulance feedback A+B
The feedback from the ambulance to the dispatcher that the patient was "dead at the scene"
Inter-hospital transports were excluded from both data sets and no individual assignment could be distinguished from the data sets.
The data analysis regarding the performance indicator "Priority distribution" was based on the EMD assessment of priority A-D. A comparison on group level between new and old EMCCs was made. The analyses concerning "Underestimation of priority" were based on EMD-assessed priority and ambulance feedback to the centers concerning priority code A-D and feedback that the "patient died at the scene". When ambulance feedback to the center was "patient died at the scene" and EMD assessment and dispatching was anything other than priority code A-B (immediate response), these assignments were evaluated as non-correctly assessed by EMD.
Descriptive statistical procedures were computed using the PASW version 18.0 program. Categorical variables were compared by means of Pearson's chi-square test. Risk ratio (RR) and 95% confidence intervals (CI) were calculated by logistic regression. Probability that was the same or below 0.01 was accepted as statistically significant.
A total of 67 610 emergency calls were analyzed, and of these, 54 026 (79.9%) were from the municipality-based centers, and 13 584 (20%) were from the new EMCC.
A comparison between the municipality-based centers and the new EMCC indicates that priority codes A and C were used in a different way in the new system, with more priority A and fewer priority C dispatch assessments as compared to the old system (table 2).
Table 2 Priority distribution in the municipality-based centers and the new EMCC
When comparing the new EMCC with the municipality-based centers using the performance indicator, "Underestimation of priority", the municipality-based centers' data showed that in 0.95 percent (n = 506) of cases the ambulance was dispatched as a low-priority assignment (code C & D) and the patient was transported to the hospital with lights and sirens (code A & B). Similar assignments analyzed from the new EMCC showed 183 cases (1.38%). The difference was significant (p < 0.001). The Risk Ratio for underestimation was higher (RR 1.46) for the new EMCC compared to the municipality-based centers.
In relation to the EMD ability to detect patients in life-threatening situations, the municipality-based centers' data showed a total of 520 assignments where the patient died at the scene. Of those cases, 23.5 percent (n = 122) occurred with low-prioritized calls (code C & D). In the new EMCC there were166 assignments when the patient died at the scene, and of those 13.9 percent (n = 23) occurred with low-prioritized calls. The difference was not significantly significant (p = 0.27, CI 0.50- 1.22 and RR 0.78).
This study is one of the few that actually tries to evaluate organizational change in the EMCC. Our results indicate that the EMD in the new EMCC organization is better able to identify patients in a life-threatening situation, even though there is no statistical significance. This result is in concordance with a previous study which showed that a well-trained and functioning EMCC is able to detect high-risk patients who require highest-priority [7]. However Määttä and colleagues conclude that the EMCC organization reform in Finland did not affect the accuracy of assessing potentially life-threatening conditions [5]. The varying results between our studies may be caused by the fact that different variables were used to evaluate the organization changes. The EMD has an essential and important role in the early management of patients, and there are some difficulties in evaluating quality and effectiveness of the EMCC, as described by previous authors [4, 9]. Still the overall aim for the EMD, regardless of the EMCC organization, is to identify callers' needs and dispatch the necessary resources. An ideal EMD would triage emergency calls with high sensitivity and high specificity [10, 11], without unnecessary over and under triage. Compared to the municipality-based centers, the EMD in the new EMCC organization seems to dispatch more ambulance assignments with priority A and fewer priority C assignments. Based on personal experience in the research group, an explanation for this result could be that in the municipality-based centers the rescue department was responsible for its budget, and a priority A assignment would automatically result in dispatching a physician-manned unit, resulting in increased costs for the rescue department.
However, the result may also indicate an over triage in the new EMCC organization, resulting in increased costs [12]. With limited EMS recourses, over triage can also lead to unavailability of ambulances in some situations [13] and should therefore be evaluated on a regular basis.
Compared to the new EMCC, the municipality-based centers' data contained a lower frequency of low-prioritized assignments where the ambulance transported the patient to hospital using blue lights and sirens. A possible explanation could be that there have been changes in the treatment and priority assessment of certain groups of patients since the transition into the new EMCC organization, for example stroke patients.
Due to the absence of data from the old organization it is difficult to draw any conclusions from the results as to why there are differences between the old and the new organizations. A reasonable conclusion is that the transition from the old to the new EMCC organization was poorly designed and implemented. There was no organized collection of data that could allow for a structured evaluation of the organizational changes. It is evident that a well-planned evaluation of changes in the organizations, before they are actually made, is the only way to determine if a change was beneficial or not. We also need defined performance indicators in order to compare the results rather than just describe them. Clear definitions are also needed to state clearly what over and under triage actually mean. Further investigation of possible performance indicators to compare organizations or protocol changes in the EMCC would be of great interest.
There are some limitations that have to be considered in our study. First, the study was a retrospective study and was not planned before the actual change took place. Another limitation is that there are no internationally defined performance indicators for emergency medical dispatching. The fact that the data from the new EMCC was obtained over a five-month period when the new EMCC organization had only been in operation for a short time may have affected the results. The EMD adaptation to new routines in the organization might not have been secured. Other limitations are that data from the old centers were collected during a four-year period and that changes in the diseases may have occurred over time. This may have had an impact on the results concerning the ability of EMDs to identify patients in life-threatening situations. However, the death rate in the area did not change during the study period [8] and therefore it should not have affected the results. The sample size concerning both pre-hospital deaths and priority A assignments was quite small, and was spread over several years.
Another bias in our result could have been caused by the impact of external factors such as ambulance personnel training, EMD & EMCC management, and sent feedback codes. Data from the Swedish EMCC indicates that eight percent of the feedback sent from the ambulance to EMCC is incorrect [14]. If this were also true in our material this could have had an impact on our result.
Collecting data from multiple EMCCs and/or data over a complete year would have reduced this bias. The municipality-based centers were selected on the basis that there were materials available; this could imply that the selected centers may have been better organized compared to other centers. The effects of the EMCC organization reform may have been clarified if more data from municipality-based centers had been collected and included in this study.
There was a trend, but no statistically significant increase, in the EMDs' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in the new EMCC organization.
Castrén M, Karlsten R, Lippert F, Christensen EF, Bovim E, Kvam AM, Robertson-Steel I, Overton J, Kraft T, Engerstrom L, Garcia-CastrillRiego L: Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: The Utstein style. Resuscitation. 2008, 79: 193-197.
Pozner CN, Zane R, Nelson SJ, Levine M: International EMS Systems: The United States: past present, and future. Resuscitation. 2004, 60: 239-244. 10.1016/j.resuscitation.2003.11.004.
Langhelle A, Lossius HM, Silfvast T, Björnsson HM, Lippert FK, Ersson A, Soreide E: International EMS Systems: the Nordic countries. Resuscitation. 2004, 61: 9-21. 10.1016/j.resuscitation.2003.12.008.
Sobo EJ, Andriese S, Stroup C, Morgan D, Kurtin P: Developing indicators for Emergency Medical Services (EMS) system evaluation and quality improvement. Jt Comm J Qual Improw. 2001, 27 (3): 138-154.
Määtte T, Kuisma M, Väyrynen T, Nousila-Wiik M, Porthan K, Boyd J, Kuosmanen J, Räsänen P: Fusion of dispatching centres into one entity: effects on performance. Acta Anaesthesiol Scand. 2010, 54 (6): 689-695.
Handbooks of the Ministry of Social Affairs and Health Ambulance and emergency care services: A handbook for drawing up an alarm procedure. 2005, Finland Helsinki, 56-
Kuisma K, Boyd J, Väyrynen T, Repo J, Nousila-Wiik M, Holmström P: Emergency call processing and survival from out of hospital ventricular fibrillation. Resuscitation. 2005, 67 (1): 89-93. 10.1016/j.resuscitation.2005.04.008.
Finland`s PX-Web database: Statistics. 2011-01-27 time:15.30, [http://www.stat.fi]
Moore L: Measuring quality and effectiveness of prehospital EMS. Prehosp Emerg Care. 1999, 3 (4): 325-31. 10.1080/10903129908958963.
Neely KW, Norton RL, Schmidt TA: The strength of specific EMS dispatcher questions for identifying patients with important clinical field findings. Prehosp Emerg Care. 2000, 4: 322-326. 10.1080/10903120090941038.
Calle P, Vanhaute O, Lagaert L, Houbrechts H, Buylaert W: The 'early access' link in the chain of survival for cardiac arrest victims in Ghent, Belgium. Eur J Emerg Med. 1994, 1: 145-148.
Lammers RL, Roth BA, Utecht T: Comparison of ambulance dispatch protocols for non- traumatic abdominal pain. Ann Emerg Med. 1995, 26 (5): 579-89. 10.1016/S0196-0644(95)70008-0.
Reilly MJ: Accuracy of a priority medical dispatch system in dispatching cardiac emergencies in a suburban community. Prehosp Disaster Med. 2006, 21 (2): 77-81.
Lindström V, Karlsten R, Falk AC, Castrén M: The feasibility of a computer-assessed feedback system between dispatch centre and ambulances. Eur J Emerg Med. 2011,
Department of Clinical Science and Education and Section of Emergency Medicine Södersjukhuset, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
Veronica Lindström
Finn HEMS, Lentäjäntie, Vantaa, Finland
Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
Ann-Charlotte Falk
Department of Clinical Science and Education and Section of Emergency Medicine Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
Maaret Castrén
Correspondence to Veronica Lindström.
There are no financial competing interests (political, personal, religious, ideological, academic, intellectual, commercial or any other) to declare in relation to this manuscript
JP and MC designed the study. JP collected data. Analyses were made by VL, JP, ACF and MC, VL drafted the manuscript, and all authors contributed substantially to the manuscript. All authors have read and approved the final manuscript.
Lindström, V., Pappinen, J., Falk, AC. et al. Implementation of a new emergency medical communication centre organization in Finland - an evaluation, with performance indicators. Scand J Trauma Resusc Emerg Med 19, 19 (2011). https://doi.org/10.1186/1757-7241-19-19
Received: 01 December 2010


text:
Vänersnäs landskommun var en tidigare kommun i dåvarande Skaraborgs län.

Administrativ historik
Den bildades som landskommunen Näs i Näs socken i Åse härad i Västergötland när 1862 års kommunalförordningar trädde i kraft.  År 1885 namnändrades kommunen till Vänersnäs i särskiljande syfte.

Vid kommunreformen 1 januari 1952 överfördes Vänersnäs landskommun till Älvsborgs län (enligt beslut den 3 mars 1950) och inkorporerades i Västra Tunhems landskommun.

Västra Tunhem i sin tur upphörde 1974 genom sammanläggning med Vänersborgs kommun där Vänersnäs kommuns område utgör Vänersnäs församling.

Politik

Mandatfördelning i valen 1938-1946

Källor

Indelningar i Vänersborgs kommun
Sveriges kommuner 1863-1951
Tidigare kommuner i Skaraborgs län


"An explosive ending... readers won't see it coming. Vinc3nt's solid prose reflects a considerable command of geography, history, and international affairs."
TWO THOUSAND YEARS LATER, SHE STILL HAS UNFINISHED BUSINESS.
It's August 2010 when freelance spy Tristan Boumann accepts what should be an easy gig for him: a fact-finding mission concerning an American archeologist assassinated in Cairo. But Tristan's discovery of the victim's connection to a former lover leads to an ominous dovetailing of ancient history, CIA origins, and contemporary geopolitics. Galvanized by the spell of Egypt's famed Last Pharaoh while haunted by his family's tarnished past, Tristan must race to avert a global catastrophe his investigation threatens to unleash.
"A fervent paced book that had me white-knuckled until I turned the last page."
"There is so much detail and suspense in the story that it pulls the reader into a world full of danger where you feel like part of the action."
"A serpentine enigma, all intertwined into a very fast adventure."