text:
Appendix 1: Zero tolerance of restraint
Appendix 2: Driving from the perspective of a person with dementia
Appendix 1: "Zero tolerance of restraint"
Appendix 2: "Driving from the perspective of a person with dementia"
1.1 Appendix 1: Zero tolerance of restraint
10 points for zero tolerance
for the use of restraint in persons with dementia
(what we have learned in the programme "Untie the Elderly and People with Dementia" in Spain)
As evidence shows, a person with a progressive cognitive impairment will be physically or chemically restrained at some point of their disorder
Reasons for using restraint are myths and reality has disproved them.
Variability in the use of restraint: why?
Consequences of the use of restraint on the health of patients. Mobility is necessary to preserve functional autonomy.
Consequences of the use of restraint for professionals and for the caring organisations.
The use of restraint for convenience.
Resurgence in the use and development of new and subtler forms of restraint.
The use of restraint generates ethical and legal conflicts. How much safety can be demanded?
Restraint-free facilities.
Zero tolerance is an engine of improvement. Everyone wins.
It is the loss of judgement, the inability of people with dementia to govern themselves and behavioural symptoms, which lead us to restrain people with dementia. Regarding physical and chemical restraint, the most important factors are behaviour and anosognosia.
Zero tolerance of restraint is an attitude of professionals who care for people with dementia. It is an attitude which is spreading throughout Spain amongst professionals from different fields who do not accept the routine use of restraint.
Zero tolerance is now a common attitude in other medical areas where professionals do not accept the negative consequences of such practices in their work. It is the only approach which gives clear and sustainable results (e.g. zero tolerance of ventilator-associated pneumonia by professionals in critical care units).
As a norm, zero tolerance does not use restraint. Like every norm, it has exceptions, but only for extreme and isolated incidents.
The data which we have regarding the condition of the residents in the restraint-free facilities allows us to affirm that not using restraint is safe, just as safe or even safer than the facilities where restraint is used on a daily basis. This data also reveals that the restraint-free facilities (which have been restraint-free for months or in some cases years) have not had to make an exception for extreme cases.
Knowing the effect of the daily use of restraint, many professionals have begun to refuse to consider restraint as an option and to acquire an attitude of zero tolerance. They face an ethical conflict between the duty of care and the duty to protect and respect the person and promote their autonomy, accepting a degree of risk, as an essential part of good care.
This document is intended to facilitate the resolution of the conflict through strong arguments in favour of this attitude of rejection of the use of restraint, based on new knowledge and new experiences that invite us to change the paradigm of care.
Untie the Elderly and People with Dementia Programme
The Untie the Elderly Programme was founded in Spain in 2003. It was developed in collaboration with the Spanish Confederation of Seniors (CEOMA).
In the first years, we worked on:
Understanding well the problem with the use of restraint in Spain and identifying the characteristics of this phenomenon.
Investigating the prevalence of the use of restraint in Spain and the related clinical factors.
Investigating the perception of professionals on the use of restraint.
After, we also worked on the creation of a favourable context to untie the elderly by:
The promotion of specific laws
Scientific activities (two international conferences on restraint in Spain)
And during this time:
We carried out fieldwork in dozens of Spanish facilities to identify the organisational and environmental factors related to the use of restraint and to find the key to avoid them.
We continued providing data on prevalence and related factors. Today we have data from 687 facilities and 29,332 residents.
Over the last three years, we have focused on establishing restraint-free facilities, which serve as examples. We have learnt that working without restraint is possible and safe and that the key to doing so is the Zero Tolerance concept. We now have 28 restraint–free facilities in Spain. The declarations contained in this document refer to the Spanish experience, with data and conclusions obtained from the work of the Programme over the last ten years and from reviewing publications on these issues from different countries.
We have always worked according to the following definitions:
Physical restraint: "Any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body."
Chemical restraint: "A medication that is used to control the behaviour or restrict the freedom of movement of the patient and which is not a standard treatment for the medical or psychological condition of the patient".
1. At present we can be sure that a person with a progressive cognitive impairment will be physically or chemically restrained at some point of their disorder.
Cognitive impairment is a predictor of the use of restraint. This has been clearly identified in the literature but admitting that an illness can condemn a person to be restrained at some point of their illness can be like admitting professional failure for many professionals because it shows that they are not capable of understanding this syndrome well or of managing the symptoms in a less aggressive and damaging manner. This is the case for people with dementia especially if they reach more advanced stages.
Cognitive impairment is almost always present in people who are restrained, although it is true that resorting to restraint usually happens when cognitive impairment is combined with other conditions/symptoms such as "wandering", serious behavioural disturbances or the risk of falls. Observation and data from the Untie Programme show that all residents restrained in Spanish facilities show some degree of cognitive impairment.
It is very difficult to obtain accurate data about the use of chemical restraint but we have data on psychotropic drug use. These medications have become the dominant approach to the management of BPSD (Behavioural and Psychological Symptoms of Dementia).
We carried out a qualitative study on the use of this medication in Spain that showed the following:
It is not always possible to find the cause, indication or objective of the use (76%).
It is not possible to evaluate the negative impact on the patient in an objective way e.g. through ADL (Activities of Daily Living).
A high frequency of PRN (when necessary) use (36%). A low frequency of dose adjustment (18%).
Chronic use (over three months, same medication and dose) (69%).
Prescribed outside the context of Care Planning (100%).
These characteristics of use are related to the purpose of restraint.
2. The reasons for using restraint are myths and reality has disproved them
The use of restraint continues to be justified today because:
By using it, falls could be avoided.
Not using restraint is sometimes unsafe for some cases of people with dementia.
Avoiding using restraint means an increase in the number of staff in nursing homes.
Families demand absolute safety for their loved ones who are incapable of caring for themselves.
People also continue to believe that physical restraint can be avoided if chemical restraint is used, and that antipsychotic medication is always useful to control the behaviour of people with dementia.
We now know that all of the above are false.
Nowadays, restraining people cannot be seen as a valid means to prevent falls as it always turns into a daily use of restraint, which has worse consequences than a possible fall. The routine use of physical restraint increases the risk of falls, and most of all, it increases the risk that injuries from the falls will be more serious. Older long-term care residents receiving antipsychotic drugs are two to three times more likely to experience a fractured hip than residents not receiving this medication.
We know with certainty that the removal of restraint is safe provided that it is done properly.
We also know that physical restraint cannot be substituted by chemical restraint as the two go hand in hand. Chemical restraint is associated with a high risk of falls with serious injuries, and we know that the risk of falling is the main reason given for using physical restraint daily. Residents express twice as much agitation when they are physically restrained and this problem is linked to the use of chemical restraint.
We know that, in general, the use of antipsychotics is not a good means to control the behaviour of people with dementia, except in a few cases and for short periods of time. In general, "non-pharmacological therapies" are as useful as or more useful than medication in dealing with the "behavioural and psychological symptoms of dementia" (BPSD) and they are definitely safer. The literature on antipsychotic drug use in dementia can be summarised as follows: These drugs are harmful, they are ineffective in treating behaviour, and their use varies significantly from facility to facility according to the culture of the facility, and not the characteristics of the patients.
It is not necessary to increase the number of staff numbers in order to work without the use of restraint. Working with measures of restraint and working without them are two paradigms of care which are different from each other but which have similar workloads, although the work in each case is different. The nursing homes which have converted to restraint-free facilities in Spain did so without an increase in staff numbers.
We have also learned that family members of the patients who are well informed generally consider the removal of restraint as something positive. The facilities can offer reasonable security without using restraint, which makes a higher degree of well-being possible, and also more physical, mental and psycho-social autonomy for the people living there. Well-informed relatives tend to choose quality of life.
One of the conditions of the Spanish Untie Programme to help eliminate the use of restraint in facilities is to inform relatives of the new policy of the facility. Informative meetings are held, leaflets are published and references to the internal regulations of the facility need to be included in the contracts that are signed. In cases where restraint had been used with prior consent, the legal representative is asked to sign a document authorising the removal of the measures of restraint. Only three cases from a total of 28 restraint-free facilities, with 1566 residents were reported to the Programme of families which were against the removal of the restraint. These families maintained this position for three months before finally accepting the removal of the restraint.
3.Variability in the use of restraint: why?
The variability in the use of restraint, observed in different prevalence studies, is not explained by the condition of the residents in the facility. In the database of the Spanish Untie Programme, we have facilities with 0% prevalence of physical restraint use, and facilities with a prevalence of 67% (in extreme cases), with a similar case-mix of residents.It is easy to deduce that the determining principle of the differences in use observed is in the cultures of the organisation and hence the different attitudes in these organisations. We believe that there are contextual factors which influence (in a determining way) the attitude of the organisation and its professionals towards this practice. We also believe that the most important of these factors are the ones that generate a perception of legal insecurity in the workers and their bosses, and a social tolerance which is common for certain types of restraint and for certain cases. Differences in the use of restraint can be observed also between countries, which suggests that there is also a social factor involved.
4.Consequences of the use of restraint on the health of the patients. Mobility is necessary to preserve functional autonomy.
There are many references which show the effects of restraint on people's health. The majority of them are linked to the consequences of inducing immobility on the person, making it impossible for the person to move, or due to lack of strength/vigour and physical exhaustion (adynamia) in the case of chemical restraint. Immobility is considered a syndrome and the effects on the person with dementia are well documented.
As well as immobility, physical restraint also causes other complications in the patient, some related to rejection and struggling and others related to the psychological effect of being restrained, with serious behavioural problems and, most of all, agitation. Medication used for restraint has serious negative secondary effects on people with dementia, especially if administered daily in combination with other medication. In behavioural terms, they can triple verbal aggressiveness in people consuming antipsychotic medication.
Data from our own Spanish research (Untie Programme) shows that 67% of patients with dementia take antipsychotic medication and that 97% of antipsychotic medication is consumed by patients with documented cognitive impairment. According to a study carried out by Dr Banerjee, it is estimated that only 20% of these prescriptions in the United Kingdom (UK) correspond to a correct treatment, the rest being considered as inappropriate use with a restrictive purpose.Dr. Banerjee highlighted the higher morbidity and mortality caused by these drugs in people with dementia.
Finally, the sum of the effects of restraint on the health of the patient leads to a substantial loss in the functional autonomy of the patient which can be irreversible. In some cases, where the patient is especially fragile, the effect of the restraint can be catastrophic.
Ultimately, restraint hampers the necessary mobility of the person to a greater or lesser degree, impeding their normal development and the preservation of their bodily functions.
Use it or lose it: true for brain and body
5.Consequences of the use of restraint for the professionals and for the caring organisations
Professionals renounce other clinical practices when they resort to the use of restraint, which means an impoverishment of their work and a serious limitation in their professional development. The "Untie Programme" in Spain reached this conclusion when we carried out studies in facilities using restraint to identify and analyse the factors which influence this. In these exhaustive interventions in the facilities (72 in total), we observed a repetitive pattern:
The registration of falls is limited.
The analysis of falls is insufficient and does not take into account all the factors which may help to prevent falls, especially environmental and organisational factors.
A structure for the management of falls and the use of restraint does not exist (e.g. committees, multidisciplinary teams).
Many behavioural symptoms of dementia are not evaluated. They are only evaluated when there is a significant impact on other residents and on the carer's work.
Non-pharmacological therapies for the management of people with dementia and their behavioural problems "symptoms" are not used.
Strategies for the rationalisation of the use of psychotropic medication are not applied.
Strategies for the rationalisation of polypharmacy are not applied.
The use of psychotropic medication and the management of behavioural problems/symptoms are not dealt with in an exhaustive way at interdisciplinary meetings. Staff decisions on the use of restraint are strongly influenced by the staff in direct contact with the patient (i.e. by the nursing assistants).
There is an important failure in delaying the onset of incontinence in people with dementia.
Protocols for falls and restraint are not consistently applied.
More practical instruments for evaluating the functionality of people with dementia and their symptoms have not been widely implemented, and if they are being used, they are used badly e.g. FAST (= Functional Assessment Scale).
No information about what the person with dementia is likely to experience is given to families in advance so that they can make decisions in advance.
Scarce promotion of mobility, strength and muscular resistance.
There is a poor system of detection of significant changes in the condition of the patient and "sentinel events" (i.e. which are cause for alarm), and adequate response to these events.
The training of professionals is not adequate or suited to the real needs of the patients.
There is poor ethical reflection on the use of restraint.
All this allows us to conclude that clinical practice on the part of the professionals in the interdisciplinary boards is of poor quality and caused by the use of restraint which does not allow professional development and the acquisition of experience.
The use of restraint can also have an impact on the emotional state of the professionals, such as anxiety, frustration and feelings of guilt. More specifically, we can say from our research that there were more cases of burnout (evaluated by the Maslach scale for health professionals) in facilities where restraint was used most.
Equally, care organisations, where the policy is to restrict their patients, reject the development of creative organisational strategies to increase the safety of their residents, and they are not aware of environmental and technical aspects which promote the safer mobility of their patients. In our research in the facilities, we observed serious deficiencies in the passive physical security, things such as free access to dangerous zones, poor lighting, a high number of obstacles in walking areas and overcrowding in certain areas. Regarding the furniture, there were few options to adapt the heights of the beds to the needs of each person, hardly any variety of seats, which was insufficient for the different characteristics of the patients.
The organisations that use restraint may suffer a greater legal insecurity and they may also face greater conflict with the families of the residents. We believe that these negative effects are due to the false perception of safety that restraint gives, with the consequent relaxation of the necessary surveillance and accompaniment that professionals should provide, and the consequent mistaken conviction of family members that by using restraint their loved ones are safer. A review of Spanish case law shows a high incidence of lawsuits for cases of negligence, lack of diligence and abandonment of care.
6.The use of restraint for convenience
The use of restraint for convenience can be defined as a use which results in the reduction of the workload and less effort for the employees in the facility, but a use which does not target the well-being of the person with dementia. The use of restraint should never cover up a deficiency, lack of professional capacity or organisational defects in the facility.
When we analyse the affirmation "more staff are needed to avoid using restraint" (a very prevalent idea in society), we deduce that there is a certain universal tolerance of restraint as it is believed we can save on human resources using this practice. All society should reflect on this. Fortunately, this affirmation is based on the myth that one cannot avoid the use of restraint without increasing the number of staff.
In studies carried out by the Spanish Untie Programme, we have found that all restraint used is used on a daily basis, and that the patterns of its use correspond to the convenience of the facility or the staff.
It is interesting that precisely when professionals try to use restraint for the shortest time possible, they show that its use is for convenience or because of organisational deficiencies of the facility. This is the case for restraint used only at night, for restraint used only for a short period of time every day at the same time, for that used only in one type of chair and not in another, or for that used only in some places and not in others, or which are repeated every day under the same circumstances. To show that they are not being used for convenience, they would have to explain why they are needed only in bed and not during the day, or why they are only needed at certain times of the day, and not at others, and why they are needed every day at the same time, or why they are needed only in certain places and not in others. All these uses of restraint could be avoided if timetables and the organisation of work were modified, if beds and chairs were adapted, and if the rules of the facility and its environment were changed.
Certainly, it is a false convenience because it may seem cost effective in the short term but the consequences of the daily use of restraint include more work, complications and cost to the organisation.
7. Resurgence in the use and development of new and subtler forms of restraint
There are references to this phenomenon, a resurgence in the use of restraint in facilities that have been followed for a long time after its reduction. We learned a very important lesson in our own "untying" experiences in Spain. The first 44 "interventions" were carried out with a modest objective; the objective was to reduce the prevalence but not to eradicate the use of restraint. Experience showed us that during this process of reduction, they looked for other subtler means of physical restraint, or medication with restrictive potential other than the conventional psychotropic drugs used to restrain and what is most interesting is that after months of achieving the maximum possible reduction in the use of restraint, there was a resurgence, and that after 6 months, the prevalence of restraint was similar to what existed at the beginning. At the end of 2009, we began to work with an attitude of zero tolerance in order to achieve restraint-free facilities, and at the end of 2012 we have 28 successes. We think that mentalities do not change until the facility has worked for some time without restraint, and that they do not remain free if this mental change does not happen.
A great skepticism prevails on the possibility of working without the use of restraint. SEEING IS BELIEVING. Professionals only believe it when they manage not to use restraint themselves for some time.
And so preventing the resurgence of the use of restraint is assured when the facility eradicates all restraint and continues to do so for at least 3 months or until it consolidates the necessary mental change. It is also necessary that the facility is habilitated for this, and that there are no legal threats or social pressures that could change the attitude of zero tolerance.
In order to prevent the resurgence in the use of restraint or new forms of restraint, a favorable context is necessary which is conducive to restraint-free care.
While the convenience of third parties continues to be considered acceptable and there is still pressure on professionals which generates fear and conflict in professionals in relation to possible accidents in the patients, a resurgence in the use of restraint occurs and it stimulates the development of new, subtler and masked forms of restraint.
8.The use of restraint is a practice which generates ethical and legal conflicts. How much safety can be demanded?
In Spain, the principal cause of ethical conflicts for professionals working in nursing homes is the use of restraint. There is also supporting evidence of this in studies carried out in other countries. In one wide-scale study involving 577 nursing staff into the abuse of older people, those interviewed widely agreed that the abuse in the form of physical restraint was the most frequent form of physical abuse.
On the other hand, we detected in our work in Spain that the directors of the facilities and the doctors were afraid of the possible legal consequences for them should the residents come to any harm, and we also found that there was a more hostile attitude amongst the family members of the patients in the facilities where they used restraint than in the restraint-free facilities.
The use of restraint creates a false sense of greater security
Although the staff in the nursing homes experience a tension between their duty of care and their duty to respect the human rights of the residents, the Untie Programme has established that once they see that nothing happens to the patients by removing the restraint, they feel calmer and gladly accept to work without restraint. SEEING IS BELIEVING.
Restraint-free facilities in Spain show us that the use of restraint can be avoided and that this is safe for the patients.
According to our experience, the stress experienced in removing the restraint (i.e. untying) lasts between three and six months.
Professionals who have a non-restrictive attitude ask the same contradictory question ("How much safety is safe?") as their colleagues and the relatives of the patient, and they also share the arguments which provide an answer to this question in every case of doubt. This avoids ethical conflicts and prevents lawsuits arising from the decision to avoid the use of restraint.
How much safety can be demanded?
The Programme has established a minimum safety requirement required for centres that eliminate the use of restraint. The minimum security conditions required are:
The centre responds appropriately to avoid damage in all cases of serious and imminent threat to the life or integrity of oneself or others.
In the centre, the incidence of hip fractures should not exceed 1.5 in 100 falls.
In the centre, the incidence of serious head injuries (requiring transfer of the person to the hospital) should not exceed 0.5 in 100 falls.
In the centre, people with dementia should not have a prevalence equal to or above 3% (every day for 7 days) of serious behavioural problems such as verbal abuse, physical abuse, socially inappropriate or harmful behaviour or the refusal of care.
Based on the studies of incidence and prevalence of these problems, and on the basis of our database (i.e. that of our Programme), of the facilities that are using physical restraint on a daily basis, the incidence of hip fractures is 3 to 5 in 100 falls, the incidence of serious head injuries is 1 in 100 falls, and the prevalence of serious behavioural problems is over 8%.
9.Restraint-free facilities. Prevention is better than reaction
There are no lives without restrictions and this is also the case for people with dementia, but there are nursing homes which do not apply physical or chemical restraint. These are the restraint-free facilities. In Spain there are 28 centres, verified by us, that have eliminated all use of restraint.
If in a nursing home, they do not apply a new means of restraint, apart from those already having been applied, it will be converted into a restraint-free facility in a given time. This is a strategy of prevention.
When we help a facility to become a restraint-free facility, we propose that they arm themselves with the necessary strategies to avoid applying a new means of restraint, that it would be useful for them to mark the date when they can begin to avoid using restraint completely and in the meantime, they must start a process of eliminating restraint already used in the facility. The professionals themselves, after a period of training and obtaining experience, admit that it is easier to avoid using new means of restraint than eliminating that which they have been using. Prevention rather than reaction. After a period of using restraint on a daily basis, many people lose their autonomy. Not only can this be irreversible but it can make it even more difficult to deal with them without using restraint. It is a vicious circle.
Restraint-free facilities are so (i.e. restraint-free) because the professionals and manager have adopted an attitude of zero tolerance, sometimes even going against the opinion they used to have on this issue.
We now know that maintaining a certain degree of tolerance towards the use of restraint results in failing to achieve its total elimination, although it is possible.
The facilities where we are carrying out our research are facilities which once used restraint and managed to eradicate its use completely through effort and a suitable strategy. These facilities have shown us that a change of paradigm is possible and necessary to maintain restraint-free practice. They also show us that it can be achieved without increasing staff numbers, without conflicts with the relatives of the patient and without a big incidence of complaints or lawsuits.
We have also seen more effective formulas in achieving it that are safer than using restraint, taking as a safety indicator the incidence of fractured hips. There have been improvements in many other aspects as we will see in the following point.
10.Zero tolerance is an engine of improvement. Everyone wins
In order to acquire an attitude of zero tolerance, one must face the challenges that people with dementia pose every day with more knowledge, better strategies and more creativity. Apart from this, new experiences improve the capacity of the professionals. When they work like this for a time, they gain greater respect from others. They improve their knowledge about the prevention of falls, dementia and its BPSD, handling the environment, technical aids, non-pharmacological therapies, the management of psychotic drugs and polypharmacy. Experience is acquired by dealing with these problems without the use of restraint, and developing strategies to prevent them. As the interdisciplinary teams are improved in this respect, they become more capable of working without restraint in a safe way.
Professionals gain knowledge and experience and they also feel happier in their work (burn-out decreases). The working atmosphere in the facility is better (the loyalty of staff increases and they would now not like to go to a facility where they have to use restraint again).
The people who work in direct contact with the patients also improve their knowledge of dementia and its symptoms. In interviews carried out in the framework of the Programme, some of these professionals expressed their experience of discovering the people hidden behind the restraint, stating for example, "A lot of people began to talk and walk again". These professionals also improved the organisation of their work, which became more flexible and individualised with the aim of adapting to the peculiarities of each resident.
We also discovered that some professionals, on hearing about these facilities expressed an interest in working in them, with the idea that they could develop professionally in these restraint-free facilities without the obstacles imposed on them by having a high number of restrained patients.
It is not only the professionals who win. Families are also more satisfied (they have a more fluid and frequent contact with the professionals in the facility). The patients with dementia themselves are the ones who benefit the most, with clear indicators of improvement in their physical and mental conditions, and a progressive increase in their autonomy. The prevalence of serious behavioural symptoms decreases which leads to a better atmosphere in the facility (the patients are calmer without restraint).
Facilities improve their environmental security, which gives more mobility to the patients, something that is especially interesting for those with preserved autonomy, or who can recover.
The facility itself improves its social image as an institution. There is a system of accreditation for restraint-free facilities in Spain. Everybody knows which facilities have an accreditation as a restraint-free facility.
The condemnation of the use of restraint on people because of their illness should generate a reaction which gives hope to people with dementia. We call this reaction "Zero Tolerance" and it is based on prevention.
There are no lives without restrictions. This is also the case for people with dementia, but if you can avoid direct physical and chemical restraint (which is a great achievement for the respect of the person), then you have a moral duty to do so.
We now know that maintaining a certain degree of tolerance towards the use of restraint makes its elimination difficult to achieve. Restraint-free facilities are showing us that the complete eradication of this practice is possible and that exceptions are rare.
The carer should evaluate the risk associated with mobility and accept a certain degree of risk as an essential part of good care.
In general, the prolonged use of restraint usually corresponds to a use for convenience in the world of care for people with dementia and for that reason, it is the moral duty of professionals to eradicate this practice.
Zero tolerance regarding the use of restrains is a preventive attitude. It is based on the rule of not considering restraint an option. Restraint is reserved for extreme situations which generally do not occur, if an effective prevention of the reasons to restrain has been implemented. If you apply restraint in an extreme situation, it should never be continued beyond this isolated episode. The exceptions are when the restraint is used in order to save a life, or if a person's integrity is threatened in a serious and imminent way. These cases are rare in practice and the normal thing is to work without having to use restraint (we have cases in facilities in Spain where they have managed not to use restraint for more than two years).
Zero Tolerance of Restraint: A Winning Strategy. "Zero tolerance" is quickly becoming the new paradigm in restraint prevention.
1.1 Appendix 2: Driving from the perspective of a person with dementia
James McKillop describes his experience of the impact that living with dementia has had on his driving
Once you have passed your driving test, the law assumes you are able to drive unless you are disqualified for some traffic offences, or are judged no longer able to drive safely, due to certain illnesses, dementia being one. In my case I did have driving problems such as attempting to drive down the wrong side of a dual carriageway several times. I was positioned to turn right, indicating, ready to proceed, and it was only due to oncoming drivers flashing their headlights at me, that I was prevented from making that potentially fatal manoeuvre.
When the average person hits problems, they devise ways to get round them. I was no different. When I approached roundabouts I used to circle several times, feeling more and more dizzy and take the wrong exit in panic. I took and if it was not the correct road, I would do a U turn and return to the roundabout and repeat the process until I reached the exit I wanted. My wife Maureen refused to sit in the car with me, if I was driving. She stopped me taking my young son out with me in the car. She remarked that I kept weaving from one side of the lane to the other side then back again. I couldn't seem to hold a straight line. This of course I strenuously denied. I was a perfect driver. I also started stalling the car. My clutch control was haywire. I blamed the clutch and had it replaced, then grumbled that the garage had done a poor job. I hit kerbs when turning corners, and I just couldn't fathom out what on earth was going on. I did report my driving problems to my doctor, who advised me to stick to roads I knew very well.
It all became clear when I was diagnosed with dementia. My psychiatrist advised me to stop driving. But after coming to terms with my illness and receiving medication, I felt capable of driving, now I knew what was wrong. So I persisted with applying to continue to drive. I passed a test arranged by the DVLA[Driver and Vehicle Licensing Agency]. I was given a licence to drive for three years and continued to drive. I had no further problems. I no longer undertook long journeys as I, like many people with dementia, lose concentration when weary, or as the day goes on.
When I applied to renew my licence I fully expected to sit another test. I heard nothing for six months and on a Christmas Eve, I received a letter from the DVLA saying they were withdrawing my licence. What a Christmas spoiler! They did tell me I could appeal. My wife was in charge of the finances and refused to give me money for an appeal. I felt this was against my human rights and I should at least have been given another test. I later found out it was my GP who had provided the report which barred me. Yet the ironic thing is that after diagnosis by a Consultant, my GP had never mentioned the word dementia to me. She had no idea that I had been driving safely, and was unaware of my capabilities.
It is a bitter blow losing your licence. Your mobility is turned upside down. Your freedom to get up and go at a moment's notice is gone. You lose your independence. You may have to rely on others to get about. You feel a nuisance if you ask and are reluctant to bother busy people. You may feel infantilised, taken about like a toddler. It can be humiliating and demoralising. If lucky, you go in their chosen time but you are at their mercy. After all these years it still rankles to be a passenger. When I sit in a car, I still "drive". I am a terrible front seat passenger and get tired on a journey, as I watch the road like a hawk. My feet get sore with driving. Why both feet? The imaginary clutch and brake! I can anticipate other driver's manoeuvres and know when they are going to turn, when not indicating. I feel I can still drive, just give me a chance.
In conclusion, the medical person who comments on a person's ability to drive, should be the person who sees and treats the person with dementia, if someone is not diagnosed until well on into the illness, they may clearly be unfit to drive and may realise it themselves. All others should be allowed to sit a test. If someone has their licence withdrawn without a test and they respond to treatment and medication, they should be allowed to sit a test, and abide by the result. I also strongly feel that in appropriate cases there should be a restricted licence available. For example, you could be restricted to say, daylight only, A or B roads, not motorways, your local town, X miles from your home, or so many hours a day.
Finally, do not expect someone to surrender their car keys without a fierce fight. If they do hand them over, feel lucky. Any suggestion to stop driving can be like a death knell. There may be bitter recriminations, making you feel guilty. How could you be so cruel and unfeeling? But remember, you have a duty of care towards them. It is heart-breaking making the right decision. You are tearing out their heart and demoralising them, but you will have them for longer, without the added worry of what grief/havoc they could cause in someone else's life. Plenty of TLC comes in handy. Understand their anguish. You are surgically removing a great part of their life. It will be a knock to their self-esteem. There can be an overwhelming sense of loss. What have I done to deserve this!
It is better to persuade them to cease driving out of love and concern for them and others, rather than have some official body wrenching your licence from you. After seven years, I am still resentful! I would love to drive again even if it was on a race track while not in use, field, forest road or a (deserted) sand/shingle beach. Research what is available to carry on life as before. Family, neighbours, friends and members of clubs may be able to offer lifts. Is there any other alternative to driving?
If someone is having driving problems and has not been diagnosed with dementia, remember other illnesses can mimic dementia. Get a proper assessment as soon as possible.
Last Updated: Tuesday 23 April 2013


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text:
Q: Asp.net long running process using asynch page I have a report that takes about 2 or 3 minutes to pull all the data
So I am trying to use ASP.net Asynch pages to prevent a timeout. But can't get it to work
Here's what I am doing :
private delegate List<PublishedPagesDataItem> AsyncReportDataDelegate();

private AsyncReportDataDelegate longRunningMethod;

private List<PublishedPagesDataItem> reportData;

public PublishedPagesReport() // this is the constructor
{
    reportData = new List<PublishedPagesDataItem>();
    longRunningMethod = GetReportData;
}

protected void Page_Load(object sender, EventArgs e)
{
    this.PreRenderComplete +=
        new EventHandler(Page_PreRenderComplete);

    AddOnPreRenderCompleteAsync(
        new BeginEventHandler(BeginAsynchOperation),
        new EndEventHandler(EndAsynchOperation)
    );
}

private List<PublishedPagesDataItem> GetReportData()
{
    // this is a long running method
}

private IAsyncResult BeginAsynchOperation(object sender, EventArgs e, AsyncCallback cb, object extradata)
{
    return longRunningMethod.BeginInvoke(cb, extradata);
}

private void EndAsynchOperation(IAsyncResult ar)
{
    reportData = longRunningMethod.EndInvoke(ar);
}

private void Page_PreRenderComplete(object sender, EventArgs e)
{
    reportGridView.DataSource = reportData;
    reportGridView.DataBind();
}

So I have a delegate representing the Long running method (GetReportData).
And I am trying to call it as per this article :
http://msdn.microsoft.com/en-us/magazine/cc163725.aspx
The long running method does complete in the debugger but breakpoints on the EndAsynchOperation and Page_PreRenderComplete methods never get hit
any idea what I am doing wrong?

A: the code below works. not sure what the difference is, except that there is a if (!IsPostBack)
anyway, now solved
private delegate List<PublishedPagesDataItem> AsyncReportDataDelegate();

private AsyncReportDataDelegate longRunningMethod;

private List<PublishedPagesDataItem> reportData;

public asynchtest()
{
    reportData = new List<PublishedPagesDataItem>();
    longRunningMethod = GetReportData;
}

protected void Page_Load(object sender, EventArgs e)
{
    if (!IsPostBack)
    {
        // Hook PreRenderComplete event for data binding
        this.PreRenderComplete +=
            new EventHandler(Page_PreRenderComplete);

        // Register async methods
        AddOnPreRenderCompleteAsync(
            new BeginEventHandler(BeginAsyncOperation),
            new EndEventHandler(EndAsyncOperation)
        );
    }
}
IAsyncResult BeginAsyncOperation(object sender, EventArgs e,
    AsyncCallback cb, object state)
{
    return longRunningMethod.BeginInvoke(cb, state);
}

void EndAsyncOperation(IAsyncResult ar)
{
    reportData = longRunningMethod.EndInvoke(ar);
}

protected void Page_PreRenderComplete(object sender, EventArgs e)
{
    Output.DataSource = reportData;
    Output.DataBind();
}

redpajama_set_name: RedPajamaStackExchange


text:
Home Labor News From Our Region Organized Labor gearing up for 'right-to-work' fight
Organized Labor gearing up for 'right-to-work' fight
WE CAN FIGHT RTW: St. Louis Labor Council President Pat White (right) addressed a standing-room-only crowd at the Tri-County Labor Club, explaining Missouri's newly passed so- called "right-to-work" law and what's being done to try to stop it from taking effect. – Labor Tribune photo
Be informed, be ready
By MARY ANN HOLLEY
St. Charles – It was standing-room-only at the Tri-County Labor Club's most recent meeting, as union members jockeyed for position to learn, "What do we do now that Missouri's 'right-to-work' legislation has been signed into law?"
"We're getting nothing but calls asking 'What we can do?'" said Club President Steve Bailey. "We have to live with what we've got, but we've got to stay in the fight."
Early this month, newly-elected Republican Gov. Eric Greitens fulfilled his campaign promise to sign "right-to-work," but almost before the ink dried, Missouri AFL-CIO President Mike Louis fought back, filing a Referral Referendum petition that will, if signed by more than 140,000 – 160,000 registered voters, require a statewide vote in 2018 on the RTW law before it could take effect.
Additionally, Labor is considering a separate Initiated Constitutional Amendment Petition signature campaign on a proposed constitutional amendment that would prohibit the General Assembly from ever enacting "right-to-work" laws in the future.
THE DIFFERENCE IN PETITIONS
Two differences between the two efforts:
A Referral Referendum requires five percent of signatures of the total vote in the last governor's election in 6 of Missouri's 8 congressional districts. If passed by the voters, RTW cannot be implemented, however, the issue can be brought up again in the next legislative session and passed.
It is is a rarely used process that, if it gets the required number of signatures, forces a statewide vote on it. Using this approach, citizens have rejected the legislature's actions 24 of 26 times.
An Initiated Constitutional Amendment requires eight percent of signatures of the total vote in the last governor's election in 6 of Missouri's 8 congressional districts. It bypasses lawmakers altogether; citizens propose the legislation and it goes directly to the voters for their approval.
If passed by the voters, it becomes part of Missouri's constitution and can't be brought up again by the legislature; to change the constitution would require a vote of the public.
MAKING THE ROUNDS
Greater St. Louis Labor Council President Pat White has been making the rounds speaking at labor clubs and other organizations, explaining and answering questions about what lies ahead in the fight against the anti-worker anti-union law.
White emphasized the importance of gathering between some 140,000 and 160,000 signatures of registered voters to put either measure on the ballot.
"If we can pass this Referral Referendum by an overwhelming number, which we feel we can do, we hope that the politicians in the state will see that the people of Missouri don't want this terrible law," White said.
"The number one thing to do right now is get registered to vote," White said.
"Registration first, then voting are the keys. You need to get everyone in your family of voting age registered to vote. Tell your friends, family, neighbors that if they aren't registered, their signature on the petition is not valid to get RTW on the ballot. And if they're not registered, they can't vote to stop 'right-to-work.'
"We need people to understand what 'right-to-work' can do to you and your family's security, and we need to get people registered and out to vote."
White said it's important for union members to stay informed through the Missouri AFL-CIO, the St. Louis Labor Council and the Labor Tribune, all of which have websites and can be followed on Facebook and Twitter.
He said information will also be distributed through local union halls and labor clubs.
MAINTAIN SOLIDARITY
White said it's also important to maintain solidarity with your brothers and sisters in other unions both in the public and private sector.
"We have to be in lockstep with each other," White said. "They will try to pit us against each other."
Sign up to be a petition gatherer: Send your name, address cell phone and email info to: NO RTW, 300 Weidman Rd., Ballwin, MO 63011 or email nortw@ufcw655.org or send a text to 314-420-6484.
Training will be provided for signature gatherers.
Show up when the word goes out that we're ready to begin. When and where will be announced.
Spread the word to your family and friends about the upcoming campaign and ask them to sign-up help.
"This is not only going to affect union folks, this is going to affect everybody," White said. "The facts are that yearly wages go down in 'right-to-work' states."
Greater St. Louis Labor Council
Initiated Constitutional Amendment
Missouri AFL-CIO
referral referendum
Right-to-work
right-to-work fight
Tri-County Labor Club
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Michael R. Perkowski February 21, 2017 at 2:27 pm
Below please find an essay I wrote and have been posting on various social media. Please feel free to publish or use in any manner you please to support the cause.
Right to Work, Prevailing Wage and Keynesian Economics
It is appalling that Joplin businessman David Humpherys, whose fortune is based on inherited wealth (rather than his own creativity and labor) spent over 2.3 million dollars to fund "right-to-work" candidates, including $500,000 to the gubernatorial campaign of Eric Greitens. Missouri's Republican legislature and new bought and paid for Governor wasted no time in making good on the bribes. It is shameful. This hubristic greed and ignorance of basic economics by so called businessmen and politicians never ceases to amaze me. Here's a quick and simple lesson in Keynesian Economics.
The worldwide economic system is based on Consumer Capitalism. Wage earners provide huge markets. Therefore, it is in the interest of capitalists to raise wages, increase consumption and create a large and affluent class of professionals and wage earners. Successful capitalist societies raise living standards rather than impoverishing workers. Tax revenues rise as wages and income rise providing government with the required resources to fund the needs of our increasingly complex society.
It is inevitable that inherited wealth will dominate wealth earned from a lifetime's labor by a wide margin. The advantage of owning things is that one can exercise power, consume and accumulate without having to work.
Since the1970's the share of income going to capital and profits has increased while the share going to labor and wages decreased with an accompanying increase in capital's bargaining power over labor. At the same time labor productivity has increased dramatically contributing to greater profit margins. When capital prospers, profits grow and labor incomes stagnate, it creates an endless inegalitarian spiral by increasing the concentration of wealth and capital into fewer and fewer hands. This undermines the meritocratic values and principles of social justice fundamental to stable modern democratic societies.
These past decades have seen increased mobility of capital and heightened competition between states eager to attract investments. This is the essence of the misguided logic behind political support for "right-to work" and prevailing wage legislation. It is mind-boggling that these so called representatives of the people believe that by attempting to break unions and lowering wages, Missouri families will benefit by attracting low pay, no benefits employers who are motivated to locate in regions with an exploitative labor climate. This may be good for the bottom line, but erodes society as a whole. Right-to-work and the dismantling of prevailing wage laws are nothing but dangerous and powerful multipliers of inequality. It is terrible economic policy and even worse social policy. I stand firmly against it. We are better than this.
Michael R. Perkowski
B.A. Economics, University of Missouri, Columbia
Member, United Brotherhood of Carpenters and Joiners, Local 97

redpajama_set_name: RedPajamaCommonCrawl


text:
PRESS RELEASE: Health First Europe demands concrete actions for rapid uptake of eHealth
Press release, / 9 February 2011
New publication highlights key recommendations
8 February 2011 – Health First Europe released yesterday its publication entitled "E-Quality in E-Health" demanding action amongst policymakers and stakeholders to quickly advance patient access to e-Health technologies by setting concrete targets for Member States on the reimbursement of payments and the access to innovative technologies. Authors of the publication declared that EU institutional involvement must determine quantitative objectives for access in order to encourage the migration of best e-Health practices and increase the ability of patients to utilise the current health technologies.
Launching the publication in the European Parliament under the sponsorship of MEPs Françoise Grossetête (EPP, France) and Milan Cabrnoch (ECR, Czech Republic), the event highlighted how e-Health can empower patients by giving them increased access to innovative technology and the difficulties that still exist at EU and Member State level to make e-Health a reality.
Health First Europe's call for action challenges policymakers to safeguard the patient as the centre for all e-Health policy by establishing benchmarks for Member States in the areas of patient access to e-health technologies and payment reimbursements.
Mr. John Bowis, Health First Europe Honorary President, discussed the importance of e-Health for increasing the efficiency of healthcare systems but cited, "Challenges are still faced by Member States with regards to increasing access to e-Health. E-health has been promoted as a silver bullet for healthcare systems but the reality is that such innovation is only slowly making its way to patient care".
Health First Europe Patron Mr. David Byrne, former EU Health and Consumer Protection Commissioner, commented on the increasing importance of e-Health on the European agenda:
"Policymakers must continue to play a role in ensuring that the recommendations put forward in this publication are generated into discernable results for patients. Ensuring access of patients to e-Health should be the ultimate goal of e-Health policy. The Commission needs to establish a transparent benchmark on current e-health applications and the actual use of patients in order to set a tangible target for Member States to achieve better patient accessibility".
Mr. Bowis then called on the EU institutions to accelerate access to e-Health for patients and encouraged Member States to develop e-Health strategies to ensure ease of implementation for usability and accessibility for both patients and professionals. He also asked, "Do we know where e-health is being administered for chronic conditions? How do we export that model to areas without access? Are budgets being assembled to increase innovation uptake? Are healthcare workers being trained in new systems of innovation? All of these questions remain unanswered".
"E-Quality in E-Health" featured concrete stakeholder recommendations for ensuring that the uptake of e-Health is rapidly increased in order to benefit the patient. The recommendations put forward include:
EU institutions must investigate inadequate reimbursement and funding systems in Member States through comparative data studies
Policymakers must determine targets for access of e-Health usage
Member States must develop e-Health strategies to monitor e-health uptake and access for patients
Key contributors to the publication: MEP Dr. Milan Cabrnoch (ECR, Czech Republic); Dr. Andrzej Jan Rys (Director Public Health and Risk Assessment Unit, DG SANCO, European Commission); David Lloyd Williams (Representative European Health Telematics Association)
To access the Health First Europe publication click here.
About Health First Europe:
Health First Europe is a non-profit, non-commercial alliance of patients, healthcare workers, academics and healthcare experts and the medical technology industry. We aim to ensure that equitable access to modern, innovative and reliable medical technology and healthcare is regarded as a vital investment in the future of Europe. We call for truly patient-centred healthcare and believe that every European citizen should benefit from the best medical treatments available. www.healthfirsteurope.eu
Amanda Bogg
Health First Europe Secretariat
E: info@healthfirsteurope.org
T: +32 (0)2 626 1999


Most college students want to reduce waste and help the environment, but many universities are lagging behind.
If students really want to help the environment, it's time to get their universities on board to make some drastic changes. Here are three big ways universities can help create a more environment-friendly and sustainable campus.
Using solar power instead of fossil fuels for energy is a great way to create a more sustainable campus. However, students aren't in the position to install solar panels on their homes, apartments, and dorms. But universities have the resources and money to install solar panels around campus and on on-campus housing. Solar panels are an investment, but they pay off because they can eliminate the cost of electricity. They also require little to no maintenance and last for decades. It's time for universities to bite the bullet and finally go solar for a more sustainable campus.
More and more cities (and countries) across the world are eliminating disposable, one-time use plastics. A college campus is a fantastic, small scale environment full of forward thinking individuals that want to reduce plastic use. So if universities vow to eliminate or reduce plastic use, students will feel even more motivated to follow suit. Not only does reducing plastic use help protect the environment, but it will leave the campus much cleaner because there won't be as much littering the grounds.
Universities can't force all students to abide by strict, environment-friendly rules. But they can give incentives for environment-friendly behaviors. For example, if you collect a bag of plastic to recycle, you can turn it in for some sort of prize. Universities could also provide incentives for students who ride their bikes, walk, or take public transportation to class. This will reduce the number of people who drive their own cars to class, which will help reduce harm on the environment.
Since I am now 21, I chose to give up alcohol; it was pretty eye-opening.
I had a very monumental birthday not too long ago. I am the youngest of my friend group, so turning 21 was an even bigger deal. I am also Catholic so when Lent came around I was trying to think of something to give up that would be a real challenge. For over 40 days, I gave alcohol up cold turkey. This is not to say I had a problem or anything, but I definitely enjoy a good beer with my dinner. Giving up alcohol would be something rewarding and would make me think about my choices.
1. I was able to drive no matter what!
I went to the Chancy Williams and the Younger Brother's Band concert. They are incredible (if you have never heard them, listen to all their music! I am an unofficial spokesperson.) I had so much fun at that concert and what was even better, I was able to remember the entire concert easily! I was able to enjoy every second of the entire night! I got to be present with my friends and that is what college is all about!
No hangovers, no throwing up, and the next day was full of great activities! I was able to go outside and enjoy my day! It felt like getting a whole extra day to the weekend! Who can complain about that?
Although I like a good beer at the end of the day, after my Lenten sacrifice, I might just pass up on the pilsners and ales from here on out.


text:
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    xmlns:tools="http://schemas.android.com/tools"
    android:layout_width="match_parent"
    android:layout_height="match_parent"
    android:orientation="vertical"
    tools:context=".MostVisitedDetailedView"
    android:animateLayoutChanges="true" >

	<LinearLayout
	    android:id="@+id/details_layout"
	    android:layout_width="wrap_content"
	    android:layout_height="195dp"
	    android:animateLayoutChanges="true"
	    android:background="@color/semi_transparent_background_color"
	    android:baselineAligned="false"
	    android:clickable="true"
	    android:orientation="vertical"
	    android:paddingTop="10dp"
	    android:visibility="gone"
	    tools:context=".MostVisitedDetailedView" >

	    <LinearLayout
	        android:layout_width="match_parent"
	        android:layout_height="wrap_content"
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	        <ImageButton
	            android:id="@+id/decrease"
	            android:layout_width="wrap_content"
	            android:layout_height="wrap_content"
	            android:contentDescription="@string/reduce_button"
	            android:background="@drawable/custom_button_incr_decr"
	            android:src="@drawable/down_arrow" />

	        <TextView
	            android:id="@+id/no_of_most_visited"
	            android:layout_width="wrap_content"
	            android:layout_height="wrap_content"
	            android:layout_marginTop="4dp"
	            android:paddingLeft="15dp"
	            android:paddingRight="15dp"
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	            android:textSize="22sp" />

	        <ImageButton
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	            android:layout_width="wrap_content"
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	            android:background="@drawable/custom_button_incr_decr"
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		    android:padding="5dp" />

	</LinearLayout>

	<RelativeLayout
	    android:id="@+id/map_layout"
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	    android:layout_height="match_parent"
	    android:orientation="horizontal"
	    android:animateLayoutChanges="true" >

	    <fragment
    		android:id="@+id/map"
    		android:layout_width="match_parent"
    		android:layout_height="match_parent"
    		class="com.google.android.gms.maps.SupportMapFragment"/>

	    <LinearLayout
	        android:layout_width="wrap_content"
	        android:layout_height="wrap_content"
	        android:layout_alignParentBottom="true"
	        android:layout_marginRight="20dp"
	        android:orientation="vertical" >

		    <View
		    	android:layout_width="match_parent"
		    	android:layout_height="13dp"
		     	android:alpha="0" />

		    <ImageButton
		        android:id="@+id/show_details_button"
		        android:layout_width="wrap_content"
		        android:layout_height="wrap_content"
		        android:layout_marginBottom="-1dp"
		        android:layout_marginLeft="12dp"
		        android:alpha="0.70"
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		        android:contentDescription="@string/drop_details"
		        android:src="@drawable/details" />

			<ImageButton
			    android:id="@+id/animate_most_visited"
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			    android:contentDescription="@string/animate_itinerary"
			    android:src="@drawable/ic_action_play"
			    android:text="@string/animate_itinerary" />

		</LinearLayout>
	</RelativeLayout>

 </FrameLayout>

redpajama_set_name: RedPajamaGithub


text:
Isiaih Mosley Donovan Clay Sheldon Edwards Ben Krikke Sports Men's basketball Men's sports Basketball Men's college basketball College basketball College sports COVID-19 pandemic Coronavirus Infectious diseases Diseases and conditions Health Lung disease
Missouri Valley UNI Valparaiso Horizon Missouri State
Missouri St. ousts Valparaiso 66-55 in MVC quarterfinals
- Mar. 06, 2021 01:46 AM EST
ST. LOUIS (AP) — Isiaih Mosley tied a career-high 29 points with 12 rebounds and Missouri State beat Valparaiso 66-55 in the Missouri Valley Conference tournament quarterfinals Friday night.
The No. 3-seeded Bears (17-6) advance to play Saturday in the semifinals against second-seeded Drake. The Bulldogs advanced earlier Friday after a positive COVID-19 test in the Northern Iowa program forced the cancelation of the game and ended the Panthers' season.
Sheldon Edwards had 17 points and eight rebounds for sixth-seeded Valparaiso (10-18), Ben Krikke scored 12 and Donovan Clay 10 with seven rebounds. Valparaiso's 13 first-half points were a season low.
For more AP college basketball coverage: https://apnews.com/Collegebasketball and http://twitter.com/AP_Top25
Elements of this story were generated by Automated Insights, http://www.automatedinsights.com/ap, using data from STATS LLC, https://www.stats.com


text:
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Police Brutality/Civil Rights
General Civil Litigation
Pedestrian/Bicycle Accidents
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Montgomery County/Rockville Office:
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Greenbelt Executive Center
9831 Greenbelt Road, Suite 208
Greenbelt, MD 20706
E-mail: josh@drossberman.com
© 2022 Copyright - Dross Berman LLC
Site by 495 Digital LLC


text:
https://archive.twilightlexicon.com/
Chapter Nine: Third Wheel
https://archive.twilightlexicon.com/viewtopic.php?f=15&t=12032
by CamberXite
1. Jessica switches allegiance by siding with Lauren and convincing others to not go on the group outing. Do you feel that, based on Bella's actions the night of the bar incident, her reaction is justified?
No , it was so rude!
2. When the motorcycle loses power to summon Edward's voice, Bella begins to search for the meadow. Why do you think she chooses this as her next attempt to conjure his voice?
Because the meadow was like their sacred place.
3. Bella is amazed that Jacob never gives up on pursuing her, despite rejection after rejection. She wonders where he gets the confidence. Based on what we know of Jacob, what do you think he reasons are for being so confident and not giving up?
Because he knows that he can give Bella something that Edward could never give her..
4. Bella knows that part of her will always love Edward, yet she begins to entertain the idea of Jacob being more than just a friend. Do you see this as a betrayal of her heart, or is she smart to press forward and think about moving on?
I think she just wanted to move on.. Who wouldn't?
by masochistic_kiss
No. In my honest to goodness opinion, Jessica needs to get over herself. A lot. It drives me crazy how she just feels the need to hold a grudge like that without even attempting to realize the pain her friend was going through.
She thinks that maybe Dejavu is the key to her decisions, and one of her strongest memories with Edward occured in the meadow, and where he told her a lot of sweet and important things.
by aribelle913
From Jessica's point of view, I can understand how she could switch. I'm sure she thinks Bella is off her rocker and I'm sure she has enjoyed the increased attention towards her when Bella all but disappeared.
I think she wants to remember happier times. To think of the day they spent in the meadow.
He wants nothing more than for her to be happy and he thinks that he can do that for her.
4. Bella knows that part of her will always love Edward, yet she begins to entertain the idea of Jacob being than just a friend. Do you see this as a betrayal of her heart, or is she smart to press forward and think about moving on?
She really believes that Edward didn't want her, so I'm assuming that she is starting to give up on the idea of him ever coming back. I think she is smart to start to go forward.[/b]
by alsha
because he took her there so there's something really special in that place.
he knows that she does love him
no i don't see it asbetrayal to her heart because she is smart and lucky to push forward because not all of us are that lucky or smart.
Re: Chapter Nine: Third Wheel
by admirallily
A: Justified? No. Expected, heck yes. The girl isn't a friend. She's one of those school acquaintances we all had.
A: It was one of the most intense moments of their relationship. One of the most pivotal memories.
A: She came to him. She sought him out. She encouraged him even when she didn't mean to. And he saw the change in her.
A: As difficult as it is for me, I feel both. It feels like betrayal but we can't waste our lives. They're more important than that and we need to do something with them. We need to choose.
by Edward_Addict
-not really. jessica overreacted. anyway, she wasn't really that fond of bella, she just wanted the popularity bella brought her before.
-because this was where they had their first intimate moment.
-he knows that bella really likes him.
-i think its only human for her to think about moving on especially since edward said that he was moving on as well.
Posted: Sat Jun 14, 2008 11:43 pm
by Hereandthere
Well I can understand Jessica not wanting to go with Bella anymore because of that incident but honestly convincing others not to go is too much. A very snobbish move in my opinion.
I think she's still intent on it being a de ja vu type thing and not an in danger sort of thing. OR perhaps she just wanted to prove that he was there at some point or another so that she wouldn't lose it.
I think he knows that he will eventually grow on her (which he does) and that the Cullens may not come back so it isn't like she'll have someone else to run off to. Then again he knows that he loves her and he won't let anything get in the way of that and that's really where all the confidnece comes from.
I don't think it's her heart btraying her but more like her heart trying to fix itself. And yes I thought that it would be smart for her to move on especially because Jake is so undeniably sweet and wonderful to her.
by Aninami
She over reacted. It's one thing to be freaked out over it, but its another thing to keep up a grudge and make her feel bad about it even after she's said sorry *so* many times.
Her best memory with Edward was there. It sealed their relationship and helped him to realize she really did trust him. She thought that if she saw the place that held so much significance in their relationship he wouldn't have any other choice but to say something.
He is an ever optimist. He always looks on the sunny side and is a pretty happy person (at first, at least). He knows she's human and probably doesn't realize the extent of her love with Edward and figures (like Edward did) that she'll get over him eventually and she'll turn to the one person who helped her through her darkest hour.
She has every right to be happy. She doesn't deserve to be alone forever, and I'm sure Edward would have wanted her to move on. I can't be a betrayal of her heart because love for Jacob was what she was feeling. It wasn't her fault that while Edward was gone, her brain made her continue on. What else could she do?
by jaspersfanpire
1. No. Bella didn't really do anything to cause such a reaction from Jess. As far as Jess knows, Bella thought she knew the guys so she went to go see them. I don't see a problem with that.
2. She was desperate and thought that maybe it would work since her and Edward had had such a special bond there.
3. I think he understood that Bella still had very strong feelings for Edward, and he was willing to give it time.
4. Betrayal! I suppose she had the right to be happy, but she loved Edward so strongly and so much.
Re: Third Wheel
by Cullenesque71
These questions come from the lovely Twix!
I personally think Jessica typifies a certain type of teenage girl: fickle and sometimes vicious. (Sorry!) Her original reason for latching onto Bella in the beginning of Twilight was simply the attention that would spill over onto her. So, I think she does have a moment of sympathy, which caused her to go with Bella, but that was outweighed by Bella's strange behavior. She simply can't afford to have a "weirdo" as a friend...who wants the weirdo spill over attention? Not Jessica.
It's Edward's place...the place where he first let down his guard with her. She thinks the meadow will hold some residual Edward magic.
3. Bella is amazed that Jacob never gives up on pursuing her, despite rejection after rejection. She wonders where he gets the confidence. Based on what we know of Jacob, what do you think his reasons are for being so confident and not giving up?
I think he recognizes that fact that they have an extremely comfortable relationship...from the moment they meet. Plus, she sought HIM out about the motorcycles, and she keeps coming around.
I think she recognizes the ease of being with Jacob, the comfort level. She's not betraying her heart...he can't replace Edward. However, she can choose to be with her "Paris" because her "Romeo" hasn't come back for her. It will never be the same, but she can see that it would be a different type of relationship. Wouldn't Edward want her to be happy? She thinks so.


The Boden Type DC ONE solution will be able to demonstrate the application that lead to the most energy and cost efficient data centre.
Sweden presents ideal locations with very low power prices, high portion of renewable energy and operational cost saving opportunities due to the cold climate and a strong electrical grid.
The municipality of Boden has dedicated substation connected to the regional grid. One of the 145 kW feeds is connected to Boden Hydropower station, and at its full potential, the substation can supply +200MW of redundant hydrogenerated power.
North of Sweden offers very favourable power prices in the range of 0,03-0,04 EUR per kWh.


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Q: displaying sequence of images in Java I am trying to execute a MPEG Decoder in Java. This decoder produces a series of Bitmap Images as per the frame rate of the video. I want it to be displayed in a window. I am absolutely new to this, and I don't have any idea about how to get started.
Can anyone please tell me what are the options and how should I get started?
Thanks !

A: After some time I found an example here, which helped me get started.
Thanks !


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Swae Lee Drops New Single 'Dance Like No One's Watching': Listen
Swae Lee hasn't had a lot of luck when it comes to success of his singles lately.
The Rae Sremmurd rapper-singer has been trying to launch his new album HUMAN NATURE for a while but his songs have not stuck with the audience, even though the last one 'Reality Check' back in June was quite a good listen. About 10 days ago, Swae Lee was one of the headliners at Day 1 of Rolling Loud's virtual hip-hop festival where he debuted a new song.
Pre-Save my new single dropping this Friday!!! #HumanNatureAlbum ✌🏽👁🤪👼🏽🙇🏽♂💐🌸🌻🌷🌼🌹
A post shared by Swae Lee, Lee Swae? (@swaelee) on Sep 21, 2020 at 9:02am PDT
Swae Lee then confirmed a couple of days ago that he will be dropping the new single titled 'Dance Like No One's Watching' this Friday. Right on time, the song is now here for listening pleasure. "What in the f*ck is the reason? / I want the check, comin' in some / I'm goin' up until I'm gone / You won't even know 'til the day come," he sings in his trademark voice.
The groovy song is difficult to put into a specific genre, something Swae Lee would be proud of. Listen below.


text:
import sys

from oslo_config import cfg

encoding_opts = [
    cfg.StrOpt('system-encoding', default='utf-8',
               help="Default encoding for all strings")
]

CONF = cfg.CONF
CONF.register_opts(encoding_opts)

def set_default_encoding_from_config():
    # NOTE(Eugene Frolov): setdefaultencoding function is only
    # available at Python start-up time, when Python scans the
    # environment. It has to be called in a system-wide module,
    # after this module has been evaluated, the
    # setdefaultencoding() function is removed from the sys module.
    # see bellow articles for more information
    # http://www.ianbicking.org/illusive-setdefaultencoding.html
    # http://stackoverflow.com/questions/3828723/why-we-need-sys-
    # setdefaultencodingutf-8-in-a-py-script
    reload(sys)
    sys.setdefaultencoding(CONF.system_encoding)


text:
Trump's SCOTUS Appointments just paid off for gun owners…
TRUMP'S SCOTUS APPOINTMENTS
JUST PAID OFF FOR GUN OWNERS!
One of the greatest and longest lasting influences a president can have on our country is the appointment of judges, especially Supreme Court Judges.
President Trump took full advantage of his four years in office by appointing 234 Federal Judges and his appointment of Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett to the Supreme Court just paid off for every gun owner in our country.
Here is an article by CNN that should make you smile…
What the Supreme Court's new gun rights ruling means
By Tierney Sneed – Source CNN
Toobin: There's no question this expands the Second Amendment
(CNN) Justice Clarence Thomas opened the floodgates for all sorts of gun safety laws to be challenged in federal court.
The 6-3 Supreme Court decision striking down a type of gun carry restriction embraced by only six states, will have the effect of making all sorts of regulations all across the country vulnerable to new legal challenges.
Thomas changed the test courts are to use when analyzing the constitutionality of such regulations. Only firearm regulations that are "consistent with this Nation's historical tradition" comply with Second Amendment's protections, he wrote, in an assertion that puts in jeopardy any restriction that does not have a historical parallel to the nation's founding.
This new standard will change the legal playing field around gun laws.
There are cases already in motion where courts will now adjust their approach and raise the threshold that governments will have to overcome in defending their gun safety laws. The ruling will also likely prompt a bevy of new legal challenges, with gun rights proponents now able to push more aggressive arguments for why a restriction should be struck down.
Up for grabs is not just public carry laws like the New York regime before the court. Virtually any other type of gun regulation, including age-based regulations, restrictions on certain types of firearms and limits on high-capacity magazines, will now be viewed by courts in a harsher light.
The old test versus the new test
In the fallout of a case called District of Columbia v Heller — a landmark 2008 ruling where the Supreme Court established that the Second Amendment protect an individual's right to bear arms — appeals courts across the country had coalesced around a two-step legal approach for analyzing the constitutionality of a gun regulation.
Lower courts have looked at, first, whether the regulated activity falls within the scope of conduct protected by the Second Amendment. If it did, then they assessed whether the regulation's means justified its ends.
"Despite the popularity of this two-step approach, it is one step too many," Thomas wrote Thursday, calling the second step inconsistent with the Supreme Court's previous gun rights precedents.
"Instead, the government must affirmatively prove that its firearms regulation is part of the historical tradition that delimits the outer bounds of the right to keep and bear arms," Thomas said.
Courts are required to "assess whether modern firearms regulations are consistent with the Second Amendment's text and historical understanding," Thomas said.
For instance, he wrote, if a gun law is addressing a societal problem that also existed in the 18th century, it is evidence that the modern law is unconstitutional if there was no similar regulation then. Likewise, he said, if that societal problem was historically addressed using a type of regulation different than the one now before a court, that is also evidence that the modern law is unconstitutional.
"When confronting such present-day firearm regulations, this historical inquiry that courts must conduct will often involve reasoning by analogy–a commonplace task for any lawyer or judge. Like all analogical reasoning, determining whether a historical regulation is a proper analogue for a distinctly modern firearm regulation requires a determination of whether the two regulations are 'relevantly similar,'" Thomas wrote.
What the ruling puts in jeopardy
Thursday's ruling means that for a court to find any type of gun law constitutional, it will have to be consistent with how firearms were regulated historically.
That means states and localities will run into legal trouble whenever they try to enact a gun law that does not have a historical parallel, particularly if the problem the law is trying to address a problem that arguably has existed for generations.
This analysis will apply to the gun law cases that have already been appealed to the Supreme Court, which include challenges to California's ban on magazines holding more than 10 rounds, Maryland's ban on assault weapons, and a challenge to federal bump stock ban put in place by the Bureau of Alcohol, Tobacco, Firearms, and Explosives under former President Donald Trump. The high court may opt to take up those cases, or it might send them back down to lower courts with instructions that the laws are reexamined under Thursday's ruling.
The New York decision will also likely affect what happens next in a California case, where the state's prohibition on keeping people under the age of 21 from purchasing certain semi-automatic weapons was struck down by a conservative-leaning 9th Circuit panel.
It also may have implications for the federal gun safety package Congress is poised to pass, if and when those modest gun safety measures are challenged in court.
And a whole host of long-existing laws might be confronted with new lawsuits bolstered by the conservative justices' new, less generous test. The New York law had been in place for more than 100 years before the Supreme Court struck it down.
Restrictions on 'sensitive places'
Thomas' opinion touched on how courts might view one type of restriction: restrictions on bringing firearms into sensitive places, as defenders of New York's law pointed to that as a concern motivating its limits on public carry.
"Although the historical record yields relatively few 18th- and 19th-century 'sensitive places' where weapons were altogether prohibited — e.g., legislative assemblies, polling places, and courthouses — we are also aware of no disputes regarding the lawfulness of such prohibitions," Thomas said. "We therefore can assume it settled that these locations were 'sensitive places' where arms carrying could be prohibited consistent with the Second Amendment.
But regulations for "sensitive places" that reached beyond those historical parallels might be constitutionally problematic, Thomas' opinion suggested.
"It is true that people sometimes congregate in 'sensitive places,' and it is likewise true that law enforcement professionals are usually presumptively available in those locations," Thomas said. "But expanding the category of 'sensitive places' simply to all places of public congregation that are not isolated from law enforcement defines the category of 'sensitive places' far too broadly."
Thomas' opinion also declined to resolve a "scholarly debate" over whether, when analyzing the historical context around modern gun laws, courts should be looking at 1791, the birthdate of the Second Amendment, or 1868, when the 14th Amendment was ratified. In a solo concurrence, Justice Amy Coney Barrett put her thumb on the scale for the earlier date, asserting that Thursday's "decision should not be understood to endorse freewheeling reliance on historical practice from the mid-to-late 19th century to establish the original meaning of the Bill of Rights."
Liberals say new test will let judges to "cloak" policy preference in "history."
Justice Stephen Breyer, in a dissent joined by the other liberals, said the "history-only approach" is both legally flawed and ripe with "practical problems."
"Laws addressing repeating crossbows, launcegays, dirks, dagges, skeines, stilladers, and other ancient weapons will be of little help to courts confronting modern problems," Breyer wrote. "And as technological progress pushes our society ever further beyond the bounds of the Framers' imaginations, attempts at 'analogical reasoning' will become increasingly tortured. In short, a standard that relies solely on history is unjustifiable and unworkable."
Breyer called Thomas' opinion "deeply impractical."
"It imposes a task on the lower courts that judges cannot easily accomplish," Breyer wrote.
"The Court's insistence that judges and lawyers rely nearly exclusively on history to interpret the Second Amendment thus raises a host of troubling questions," Breyer added, pointing to the research resources such an approach requires, how judges will choose which historians to rely on, and what courts are to make of new developments in historical research.
CNN reporter presses sheriff on gun safety law in heated exchange
CNN reporter presses sheriff on gun safety law in heated exchange 04:38
"And, most importantly, will the Court's approach permit judges to reach the outcomes they prefer and then cloak those outcomes in the language of history?" Breyer wrote.
The majority, he added, gives judges license to reject certain evidence in a way that will allow them "to pick their friends out of history's crowd."
He said that, at the time of the nation's founding, even the country's largest cities, like New York, had very small populations compared to today, while the vast majority of Americans lived on farms or in small towns.
Addressing Thomas' examples of historically consistent "sensitive places," Breyer asked what that meant for "subways, nightclubs, movie theaters, and sports stadiums?"
"The Court does not say," Breyer wrote.
All gun owners owe President Donald Trump, those who supported him and ultimately voted for him, a debt a gratitude. This landmark, pro-gun, Supreme Court decision would never have happened had Trump not defeated Hillary Clinton.
THANK YOU President Trump. You should STILL be President.
Dr. Ignatius Piazza
Founder and Director
Front Sight Firearms Training Institute
#1 Front Sight Road
Pahrump, NV 89061
http://www.frontsight.com
info@frontsight.com
Entry Filed under: Dr. Ignatius Piazza,Front Sight,Monday Blog Posts,Newsletter,second amendment.


happy is he who trusts in the LORD!
For every disorganized person in the world, there are probably two self-help books, seminars, personal organizing systems, storage systems, and their number is constantly growing. Our computers offer us calendars, to-do lists, and reminders of appointments. Some of our cell phones keep track of people we call, reminding us when someone might be overdue for a call. In spite of all this, most of us are juggling so many tasks and chores that, periodically, something falls and breaks.
Proverbs often ties the idea of planning with that of trust in God. This is not a blithe "don't worry, God will provide approach." Instead, the book of Proverbs urges people to live prudently and simply, to work hard, and – as we see here – to live a life that is planned, not the random accretion of events. Nonetheless, all of this prudent planning is somehow to be tied to trusting in God. What does this mean?
I think the author of Proverbs is proposing a contemplative approach to planning. Many of the organizing systems presume that you know your priorities or can figure them out; the problem is primarily one of fitting all the actions into the allotted time. A few – such as The 7 Habits of Highly Effective People – prescribe a mission-setting exercise at the start, with periodic check-ups. But what Proverbs is proposing goes deeper.
We may not know, in the ways of this world, the trajectory of our lives – I don't think the author of Proverbs was plotting a career path. The events that occur are only partly within our control; our plans and choices are made within those constraints. But the goal of the journey, that of finding out way to live every more closely within God's will, is something that we can find within each of our moments of making choices. This trust in the Lord provides the guidepost in all our moments of choosing and planning.


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Q: Hidden whitespace char causing preg_match to return false I have a strange problem and I apologise if the title does not make much sense as I cant seem to word it right.
Basically I am trying to check if a certain string is only numbers, for this I am using regluar expressions
preg_match("/^[0-9]+$/", $ordernumber[1]);

this is where it gets hard to explain from debugging I have learned that $ordernumber[1] which should be "41720" when var dumped $ordernumber[1] has a string length of 6 when there is only 5 numerical digits in there.
Which leads me to believe there is a whitespace character in that string which is not accounted for in the regex.
How do I find out which whitespace/special character is in the string?
attached is a picture of the dump along with the result of the preg match which is 0/false.
Note the string length
Thank you for reading.
Just figured out If I use preg_match("/^[0-9]+$\D/", $ordernumber[1]); \D(non-digit)then it does return true, which solves my issue, would still like to know what character it is though, if anyone knows how to find out.
Answer below which will trim whitespace characters from the beginning and end of a string, would actually do what I wanted.

A: If you want to know what character is in the string, just do:
echo bin2hex($string);

A: Tried modifying your regex to
preg_match("/^[0-9]+$/", trim($ordernumber[1]));


To travel by Eurail from Barcelona in Spain to Lisbon in Portugal, you have three options. Choose the best one for you. First one by night train from Madrid or Irun to Lisbon.... 19/03/2009 · The bus journey from Lisbon to Madrid is beteeen 8 and 10 hours, cost around 48 Euros. There are several operators including ALSA, AVANZA and ANIBAL.
How Far is it Between Lisbon, Portugal and Madrid, Spain. This map shows the distance from Lisbon, Portugal to Madrid, Spain. You can also see the distance in miles and km below the map.
Experience the colorful world of Spain and Portugal to get inspired by wonderfully rich culture, exquisite cuisine, mind-boggling architecture and warm hospitality of Barcelona, Madrid, and Lisbon. Find your passion, while traveling across Iberia.
Spain and Portugal Itinerary Day 3 Lisbon. I suggest you start your day early to get to the Pasteis de Belem. Pasteis de Belem is known for their amazing Pastels also known as an egg tart.


The chart was taken on the 19th June, one week after the WenChuan earthquake during the 3 minutes of silence to remember and mourn for the victims of the catastrophe. Its a clear sign of unity taken voluntarily by all the internet users in China showing a respect and regards for both that had lost the lives and also for all the affected victims. This is truly unprecedented.
Michael Zhao made a 9 mins video on the May 12's Wenchuan Earthquake with English subtitles.


OHSGG Club provides voluntary sightseeing guide services for Hakone and Odawara in foreign languages to assist visitors from outside of Japan and non-Japanese speaking residents.
Please visit the Guide Request and Guide Policy page if you request OHSGG guide service.
Odawara area including Odawara castle, Ichiya-jyo fort, Odawara town, and surrounding area.
All members in our group are volunteers who have various backgrounds and are willing to introduce our area to the people from foreign countries. Since all members are local, you may be able to hear an interesting story that may not come across. We are highly motivated and waiting for you to make your travel fruitful and enjoyable.
Once your guide request is accepted, the assigned guide helps you to plan where to visit and how to get in and out from this area. You may consult the guide for any kind of interests and questions of your tour. If the assigned guide does not have enough information to answer, she or he will ask our experienced members and return to you with satisfactory information. Now the tour is tailored to you.
On the first day, the guide meets you at the train station, your hotel, or other mutually agreed location and starts to guide you based on the itinerary. The guide also helps you how to handle your luggage while traveling.
The guide explains the history and the background of this area and other related topics according to your interest. Please do not hesitate to ask any questions you would like to know about Japan, such as Japanese food, cultures, Shinto and Buddhism, arts, nature, and even something cool in Japan. Then you will be more familiar to Japan.
We do not charge any guide fee of our services but you need to pay all expenses of the guide related to your tour. Expenses include transportations, meals and entrance fee of facilities.
Please refer to the Guide Policy page for more detail.
Other languages may be possible depending on the availability. Please ask when you request the service. However OHSGG only accepts English or Japanese in the requesting e-mail.
The assigned guide communicates with you directly through e-mail. Telephone communication may be possible if necessary.
Please send your request by e-mail in English or in Japanese. No other language is accepted.
Visit the Guide Request page for more detail.
If you have any question, or need any assistance to visit Odawara and Hakone area, please feel free to contact us. It is always our great pleasure to offer you warm hospitalities and comprehensive services.


Gannett has agreed to purchase 73 percent of auto-sales site Cars.com for $1.8 billion, Bloomberg reported Monday citing a source with knowledge of the matter.
The publishing giant, which already owns the remaining 27 percent of the site, values the entire business at around $2.5 billion, the unnamed source said, adding that a deal could be announced as early as Tuesday.
In addition to Gannett, Classified Ventures, which owns Cars.com, is also backed by publishers McClatchy, Tribune, AH Belo and Graham Holdings.
Gannett shares were unchanged after the Bloomberg broke the news.


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Q: PostgreSQL - Periodically copying data from one database to another I'm trying to set up an architecture with 2 databases, say preview and live, that have the exact same schemas. The use case is that edits can be made to the preview database and then pushed to the live database after they are vetted and approved. The production application would read from the live database.
What would be the most appropriate way to push all data from the preview database to the live database without bringing the live database down? Ideally the copy from preview to live would be an atomic transaction.
I've worked with this type of setup in MSSQL, but I'm fairly new to Postgres. So I'm open to hearing other ways to architect this (with Schemas perhaps?).
EDIT: The main reason to use separate databases is that I may need more than 1 target database (not just a single "live" database). I also may need to switch target databases on the fly without altering the source database schema.

A: I think what you're looking for is a "hot standby".  This would be a separate instance of Postgresql, possibly on the same server but usually not, which is a near-real-time replica of the primary server.
In broad strokes, this is done by shipping the binary transaction logs from the primary server to the backup server, and then "replaying" them there.  The exact mechanism for transmitting the logs may vary depending on your requirements.
Fortunately, the docs on this are excellent:
https://www.postgresql.org/docs/9.3/static/warm-standby.html
https://www.postgresql.org/docs/9.0/static/hot-standby.html


Corky-fruited water-dropwort is a tall white umbellifer of damp hay meadows and acidic soil.. However strangely it can also tolerate dry conditions. It is naturally found in only a few counties of the UK, such as Somerset, Dorset and Hampshire where it can be quite plentiful in the right conditions and looks beautiful in long white swathes. It flowers mid summer and would look great in a wildflower meadow or pasture to contrast with other meadow plants.
Care should be taken as like other dropworts, the Corky-fruited water-dropwort plant is poisonous. Therefore it should not be planted if livestock are likely to have access to the area.