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Annals of General Psychiatry
Psychological distress among patients of an orthopaedic outpatient clinic: a study from a low-income country
Nusrat Husain1,2,
Syed M Humail3,
Imran B Chaudhry1,2,
Raza Rahman3,
Holly Robinson1 &
Francis Creed1
Annals of General Psychiatry volume 9, Article number: 9 (2010) Cite this article
Depression is common among general trauma patients and is associated with a poor outcome. We evaluated the relationship of psychological distress to physical injury, musculoskeletal complaints, and social factors in a low-income country.
We administered the Self-Rating Questionnaire (SRQ), the Oslo social support questionnaire, and the Brief Disability Questionnaire (BDQ).
An SRQ score of 9 or more, which indicates probable depressive disorder, occurred in 45.6% of men and 76.1% of women. A high SRQ score was associated with female sex, little or no education, low income and little social support. Even after these were controlled for there was a significantly higher SRQ score in patients with arthritis, backache/prolapsed disc, major fracture and other bone pathology.
Depressive disorder appears to be very common in orthopaedic outpatients in Pakistan; both social circumstances and nature of bone pathology are associated with such depression.
An estimated 340 million people across the world have major depressive disorder at any given time [1]. This disorder is projected to be the leading cause of disability in the developing world by 2020 and leads to greatly increased healthcare costs even after excluding direct mental healthcare expenses [2]. Depressed people are more likely than others to seek medical treatment in the general health sector where underdiagnosis and undertreatment of depression is common. The combination of a physical illness and depressive disorder is a particularly potent cause of disability [3]. Musculoskeletal complaints are the most common self-reported problems in the community [4]. Chronic pain is also one of the most common presentations for healthcare and it is reported that such patients are five times more likely to utilise health than the general population [5, 6]. Both regional (for example, in the limbs) and widespread pain are increased in people of Pakistani, Indian and Bangladeshi origin relative to the local white European population in the UK [7, 8].
In high-income countries increased rates of depression have been reported in general trauma patients [9–11] and in one US orthopaedic population the rate of depression was 45% [12]. Depression does not appear to be associated with severity of the physical illness or injury but it tends to be persistent and predicts a poor outcome [11, 13–15]. To our knowledge there are no reports from any developing country evaluating the relationship of psychological distress, physical injury and musculoskeletal complaints. Since depression is common in Pakistan [16, 17], including among attendees at a medical outpatient clinic [18] one might expect a high rate of depression associated with physical injury and musculoskeletal issues presenting at orthopaedic clinics.
In this study we aimed to study the prevalence of depressive symptoms in patients presenting to the orthopaedic outpatient clinic in a large teaching hospital in Karachi, Pakistan. We hypothesised that the prevalence of depression would be greater in the patients with medically unexplained musculoskeletal symptoms compared to those with organic disease in patients attending an orthopaedic clinic in Pakistan even after adjusting for the sociodemographic features known to be associated with depression.
Study setting
The study was conducted over 3 months (January to March 2007) at an orthopaedic outpatient clinic at Civil Hospital in Karachi, Pakistan. Karachi is the largest city in Pakistan; the literacy rate is over 60% compared to 40% for the rest of the country. Poverty is common. The Civil Hospital is one of the largest government hospitals in Pakistan and is a university hospital attached to the Dow Medical College. It has about 1,700 beds and over 35,000 patients are admitted per year. The hospital maintains 37 wards, 11 operation theatres, 15 outpatient departments (OPDs) and 30 other departments including CT scan, mortuary and x ray. The OPD treats over 600,000 patients per year, at a flat rate of 1 rupee per person (€0.008) and approximately 170,000 patients are seen annually in the emergency department.
In Pakistan the system of family practice is not well developed. The majority of the patients attend their local area doctor, a homeopathist or a traditional healer. Patients who do not improve, or who are not able to afford further private treatment, refer themselves to one of the government hospitals. It is known that approximately 25% of patients reaching the psychiatric service do so after being seen in the general hospital [19]. The patients first present to the outpatient clerk who will direct all patients with musculoskeletal complaints to the orthopaedic outpatient department. The Research Ethics Committee of the Pakistan Institute of Learning and Living approved the study.
The study was conducted in the orthopaedic outpatient clinic for 1 day a week over 12 consecutive weeks. All patients aged 16 to 65 years who came to consult the doctor were invited to complete the Self-Rating Questionnaire (SRQ) [20] in Urdu (the national language of Pakistan), while waiting for the doctor. The approach to the patients was made by one of six research assistants, three male and three female, (three doctors and three nurses) so that each patient was interviewed by a research assistant of the same sex. The explanation indicated that the doctor would like the patient to complete the questionnaires as part of a survey of general health being carried out on all patients seeing the doctor that day.
After explaining the study in full and obtaining written informed consent, the research assistants administered the Urdu translation of the screening instruments: the SRQ to detect minor psychiatric disorders, Oslo scale for social support and Brief Disability Questionnaire (BDQ) for disability. The research assistants attempted to ensure that the SRQ was completed before the patient left the building. The research assistants also recorded the patient's name, sex, marital status, employment, and the patients' stated reason of consultation with the doctor. The research assistants were trained by the author (NH) in the use of the SRQ and other measures. The surgeon documented the diagnosis and whether the presenting issue was medically explained or not.
The SRQ was developed by the World Health Organization and has been widely used in studies in Pakistan [21] and in other developing countries [20]. It is a self-administered questionnaire, which consists of 20 questions with yes/no answers exploring symptoms of depression, anxiety, and somatic manifestations of distress. It has been validated for use in many developing countries [20] and has good psychometric properties. In this study the research assistants read out the SRQ questions to all patients whether they were literate or not in order to maintain consistency. In a rural setting in Pakistan we found that a cut-off of 8/9 had a sensitivity of 80% and a specificity of 85.4% for detecting depressive disorder [16, 21]. ROC analysis was used to estimate the optimal threshold score for SRQ.
Social support was measured using the Oslo-3 scale which includes three questions identifying the number of people who are very close and offer support when needed, the degree of concern shown by others to the individual and the degree of support received from neighbours when necessary. This has been used in several studies including Pakistanis living in Norway and in Pakistan [22]. The three individual items (each scored 0 to 4) are used in this study with a high score indicating greater social support.
Disability was assessed using the crossculturally validated BDQ, which includes six items from the Short-Form 36 item (SF-36) questionnaire [23], asking participants whether they had been limited in various everyday activities during the last month and four questions concerning daily functioning [5]. This has been used in several international studies including Pakistan [21, 22]. A total score is used in this study with a high score indicating greater disability.
An organic diagnosis was defined as a physical condition where an objective finding was present, which was considered by the surgeon as a likely explanation for the presenting condition. Most of those listed in Table 1 are self-explanatory. 'Other bone pathology' includes ostoemyelitis, cysts, tumours, osteoporosis and TB. Where there was no evidence of an organic disease that could explain the presenting symptoms, the symptom was described as a medically unexplained symptom; these complaints were usually of the chest, ribs, body, muscle, joint or bone pains.
Table 1 Mean (standard deviation) of Self-Rating Questionnaire (SRQ) scores by orthopaedic diagnosis
All data were entered and analysed on SPSS version 14.0 (SPSS, Chicago, IL, USA). In order to assess the variables that were significantly associated with SRQ scores we used analysis of variance (ANOVA) for ordinal variables and Pearson's correlations coefficient for continuous variables as SRQ scores were normally distributed and homogeneity of their variance was confirmed. Variables found to be significantly associated with SRQ score were then added as covariates in an analysis of covariance (ANCOVA), which examined the relationship between orthopaedic diagnosis and SRQ score. Post hoc (Bonferroni) tests were subsequently performed to identify which particular orthopaedic diagnoses were associated with higher SRQ scores. Linear regression analysis was used to examine the association between total SRQ score (dependent variable) and all the sociodemographic variables, pain, disability score and orthopaedic diagnostic groups as independent variables.
Data were collected from 978 participants (response rate of 90.5%) 408 male and 570 female. Table 2 shows that the mean SRQ score was higher for females, participants who were divorced, separated or widowed, for those with little or no education, and with a low income. Significant positive associations were also found between SRQ total score and age (r = 0.16, P < 0.001), number of children (r = 0.18, P < 0.001) and the three social support scale scores indicating low support: item 1 (r = -0.30, P < 0.001), item 2 (r = -0.23, P < 0.001) and item 3 (r = -0.25, P < 0.001). After controlling for age and sex, SRQ score was associated with disability score (r = -0.098, P = 0.002) but not with pain severity (r = 0.05, P = 0.12). There was no difference in SRQ score between patients with medically explained (by trauma or organic disease) or unexplained symptoms (Table 2).
Table 2 Mean (standard deviation) Self-Rating Questionnaire (SRQ) total scores by demographic variables
An SRQ score of 9 or more, which indicates probable depressive disorder, occurred in 46.8% of men and 76.0% of women. Among men with medically unexplained symptoms 19/35 (54.3%) had an SRQ score of 9 or more compared with 172/373 (46.1%) of those with symptoms explained by organic pathology (χ2 = 0.868; P = 0.35). Corresponding figures for women were 42/55 (76.4%) and 391/515 (75.9%) (χ2 = 0.00; P = 0.92). Overall, 233/978 (23.8%) of our sample reported that they had entertained ideas of ending their life: 219/624 (35.1%) of those who scored more than 9 on SRQ and 14/354 (4.0%) of the remainder.
There were significant differences in total SRQ score between the diagnoses made by the orthopaedic surgeon (F = 4.59, P < 0.001) (Table 1). The patients with a diagnosis of other bone pathology, arthritis, or backache had the highest scores and Bonferroni comparisons revealed that these scores were significantly higher than the 'major fracture' group. Using ANCOVA that controlled for the effects of the participants' gender, age, marital status, level of education, number of children and monthly income, the significant difference by diagnostic group remained (P = 0.016) (Table 3).
Table 3 Mean (standard error) of the mean Self-Rating Questionnaire (SRQ) scores by orthopaedic diagnosis adjusted for age, sex, years of education, marital status, number of children and income
In linear regression analysis when we controlled for all sociodemographic characteristics, disability and pain, arthritis, backache/prolapsed intervertebral disc, other bone pathology and major fracture continued to be associated with a raised SRQ scores indicating greater psychological distress (Table 4). Medically unexplained symptoms were associated with lower SRQ score but this failed to reach significance.
Table 4 Multiple regression to predict Self-Rating Questionnaire (SRQ) score
This is, we believe, the first study from a low-income country concerning depression in a large sample of orthopaedic outpatients. The prevalence of depression in our sample was high with an SRQ score of 9 or more, which indicates probable depressive disorder, occurring in 45.6% of men and 76.1% of women. These proportions are almost identical to those we recorded in a similar consecutive sample of patients attending medical clinics at the same hospital (47% of men and 63% of women) [18] and are much higher than those we previously found in a population-based sample in rural Pakistan (17.5% of men and 44.1% of women) [24]. In the latter study all but one of the people who scored nine or more on the SRQ had depressive disorder ascertained by research interview. Thus this cut-off point appears to indicate probable depressive disorder rather than emotional distress.
Our results are consistent with studies from the West, which have reported that the prevalence of psychological disorder following physical trauma in a variety of settings is 23% to 41% [9, 11, 12, 15, 25]. Such proportions are much higher than those found in the general population and somewhat higher than those reported in some medical clinics in the West [12]. As a result of methodological differences our results cannot be directly compared with those reported from the west but it is notable that in both USA and Pakistan trauma patients have a very high prevalence of probable depressive disorder.
Our primary hypothesis that the prevalence of depression would be higher in patients with medically unexplained musculoskeletal symptoms was disproved. Although patients with medically unexplained musculoskeletal pains experienced great psychological distress the level was even higher in patients with arthritis, backache and other bone pathology. This is different from studies in high-income countries [26], and our own previous study in medical clinics in Pakistan [18], which indicated that depression is often associated with 'medically unexplained symptoms'. The patients included in this study are clearly very distressed with a high proportion entertaining suicidal ideas: 24% compared to 5% in our previous population study [16]. Thus we anticipate that many of these patients need treatment for depression.
It is apparent that the usual sociodemographic factors are clearly associated with a high SRQ score (female, little education, financial difficulties, lack of social support, divorced, separated or widowed status, numerous children) [16]. It is probable that many of these people may have been depressed before their fracture or illness because of their life circumstances. It is impressive, therefore, that several orthopaedic diagnoses added additional variance to the explanation of SRQ score in multiple regression. This indicates that the presence of such illness is associated with even greater distress than can be accounted for by sociodemographic circumstances. This may be understandable in terms of the further hardship such illness brings in a setting of poverty and hardship. These orthopaedic diagnoses will probably have prevented these patients from earning a living or doing their usual household and other tasks.
The main limitation of this study is the fact that we did not perform second stage interviews to ascertain definite psychiatric diagnoses. It is possible that physical symptoms could have inflated the SRQ score but we controlled for severity of pain and level of physical disability in the multiple regression analysis and still we found that the diagnoses of arthritis, other bone pathology, backache/pelvic inflammatory disease (PID) and major fracture were significantly associated with increased SRQ score. Our previous work indicates that the cut-off of 8/9 is the most appropriate to detect psychiatric disorder in primary care clinics in Pakistan. The high proportion with suicidal ideas testifies to the very high level of distress, and probable depressive disorder experienced by many of these patients. A further limitation of only using the SRQ as a measure of depression is the gender differences in the psychometric properties of the SRQ. In our earlier work a cut-off score of 5/6 was found to be better for males and, had we used this cut-off in the present study the prevalence figure for men would be higher. Since our main findings in this study are concerned with the total SRQ score, the cut-off is not affecting our main results concerned with the relationship between total SRQ and correlated features. We used the conventional cut-off so that our prevalence figures are consistent with all the previous studies from Pakistan, which have used the same cut-off scores for both men and women.
The main strength of the present study is the high response rate and we believe that our sample is not biased towards those patients who might have been prepared to undergo a more detailed research interview at the clinic visit, which would have been required to establish psychiatric diagnosis with certainty. As this is a cross-sectional study we cannot establish for certainty the level of distress that these patients experienced before their current illness, although we know the level of depression in the population is high [17]. It is possible that they were depressed prior to their injury and actually experienced injury as a result of their depression. We were not made aware of any participants who had actually injured themselves deliberately; accidents are more common while someone is depressed and preoccupied. It is very likely that the injury and illnesses exacerbated pre-existing depressive illness.
Depressive disorder appears to be very common in orthopaedic outpatients in Pakistan. Orthopaedic surgeons may need assistance to develop methods of screening for depression either by using a questionnaire, such as SRQ, or by asking pertinent questions. Patients who screen positive can be treated immediately with antidepressants and/or referred for further assessment and treatment by the mental health professionals. Treatment of depression in this population should aid complete recovery, though prospective and treatment studies are required to demonstrate this. We need to develop ways of achieving this in a manner that is compatible with the brief time available to doctors in outpatient clinics in Pakistan. This study demonstrates again the massive unmet mental health need in developing countries [3, 27, 28] and that novel forms of treatment are required.
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We thank Professor Salahuddin Afsar, Pro Vice Chancellor, Dow University of Health Sciences and Principal, Dow Medical College, for his support. We also thank Mr Sami ul Haq for data entry and the Pakistan Institute of Learning and Living for logistic support.
University of Manchester, Manchester, UK
Nusrat Husain, Imran B Chaudhry, Holly Robinson & Francis Creed
Lancashire Care NHS Foundation Trust, Preston, UK
Nusrat Husain & Imran B Chaudhry
Dow University of Health Sciences, Karachi, Pakistan
Syed M Humail & Raza Rahman
Nusrat Husain
Syed M Humail
Imran B Chaudhry
Raza Rahman
Francis Creed
Correspondence to Nusrat Husain.
All authors contributed to the conception and design of study. NH, SMH, IBC, HR and FC wrote the protocol. SMH and RR collected the data. NH, IBC, HR, RR and FC undertook the statistical analysis and NH wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.
Nusrat Husain, Syed M Humail, Imran B Chaudhry, Raza Rahman, Holly Robinson and Francis Creed contributed equally to this work.
Husain, N., Humail, S.M., Chaudhry, I.B. et al. Psychological distress among patients of an orthopaedic outpatient clinic: a study from a low-income country. Ann Gen Psychiatry 9, 9 (2010). https://0-doi-org.brum.beds.ac.uk/10.1186/1744-859X-9-9
DOI: https://0-doi-org.brum.beds.ac.uk/10.1186/1744-859X-9-9
Musculoskeletal Complaint
Bone Pathology
Unexplained Symptom
Great Psychological Distress
Suicidal Idea


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Q: Write to a file and read it simultaneously, reading by spreadsheet viewer like excel not the same code? Well the thing is my code writes some data to a spreadsheet file, but if anyone tries to open it "File Is being used by some other process" error appears... to work around this I created a temp file write to it blah blah blah ... but this does not seem like a good method, is there a method where I would be able to write to the  spreadsheet file through my program and still be able to "VIEW ONLY" the spreadsheet simultaneously...

A: Use the four-parameter version of System::IO::File::Open(), it allows you to specify a FileShare so you can allow reading while your file is open for writing.
Be mindful of the synchronization issues that can cause, however: One process could try reading the file while it is in an inconsistent state.

redpajama_set_name: RedPajamaStackExchange


Since moving into our new home, we have worked diligently to minimize everything and organize what we do have. I've learned that a cleaner, more organized home means less stress on everyone. Clutter simply doesn't work well for my wife and I think I've finally understand that. Even simple things such as hanging cords can cause her to be unhappy. Therefore, the Legrand in-wall power kit from Best Buy was a life-saver for us!
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text:
Gent vs Shakhtar: player comments
The Pitmen reflect on the match against the Belgians
Bernard, Shakhtar midfielder:
- Today's game against Gent was difficult enough, but we managed to win. We've been preparing to perform successfully in the league and advance as far as possible in the Champions League. In general, this has been a difficult week, we worked a lot. But the team are learning something new, we try to use a different playing model, which is very important. The coaching staff support us and help us to recover from training. I feel a great responsibility. I try to give my all to show the coach that I understand him, being ready to dedicate myself to work and delivering what he wants to see on the pitch.
The game was good and intense. We step it up with every game and better understand each other
Ivan Petryak, Shakhtar midfielder:
- Today's opponents have been stronger than the previous ones. The game was good and intense. We step it up with every game and better understand each other. Thank God, so far we've had only positive outcomes. In training, we continuously work on tactics, then trying to reproduce it in the match. It's hard to play under permanent workloads. But we try to recover just in time. It's nice that we've won today. In any game, it is important to win. Then you train and prepare for the next game in a good mood.

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Custom logger and monolog formatter in symfony2 - configure services.xml I have started learning Symfony2 and currently I am dealing with a command that I want to log separately.
My goal is to use a custom logger and get a clean log file for my command.
I work on a project that uses xml configuration files but I don't get how to translate some .yml parameters and options.
I have read How to write logs from one service into separate file? and got a working separate log file.
<?xml version="1.0" ?>
<container xmlns="http://symfony.com/schema/dic/services"
    xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
    xsi:schemaLocation="http://symfony.com/schema/dic/services http://symfony.com/schema/dic/services/services-1.0.xsd">

    <services>
        <service id="myproject_mycommand.logger" class="Symfony\Bridge\Monolog\Logger">
            <argument>myproject_mycommand.logger</argument>
            <call method="pushHandler">
                <argument type="service" id="myproject_mycommand.logger_handler" />
            </call>
        </service>

        <service id="myproject_mycommand.logger_handler" class="Monolog\Handler\StreamHandler">
            <argument>%kernel.logs_dir%/my_custom_file_log.log</argument>
        </service>
    </services>
</container>

After looking Symfony2 : use Processors while logging in different files I'm trying to pass only my desired fields to the monolog line formatter, something like "[%%datetime%%] %%message%%\n"
I guess that I would have to add something like:
container
...
    xmlns:monolog="http://symfony.com/schema/dic/monolog"
...

and
<service id="myproject_mycommand.logger.formatter" class="Monolog\Formatter\LineFormatter">
    <argument>"[%%datetime%%] %%message%%\n"</argument>
</service>

but I don't get how to configure this simple formatter in the xml file.
Thanks for your help!

A: You need to create your formatter and extend it from FormatterInterface and implement format and formatBatch.
Then add service definition
<service id="myproject_mycommand.logger.formatter" class="MyBundle\Formatter\XmlFormatter">
    <argument>some arguments if you need one</argument>
</service>

<service id="myproject_mycommand.logger_handler" class="Monolog\Handler\StreamHandler">
    <argument>%kernel.logs_dir%/my_custom_file_log.log</argument>
    <call method="setFormatter">
        <argument type="service" id="myproject_mycommand.logger.formatter"/>
    </call>
</service>

That's about it. For idea of how to format you can check examples of different formatters inside monolog bundle sources.


Mr Vegas-Heads High With Lyrics.
Mr. Vegas Fan MEG RICKARDS sings Acoustic Version of HEADS HIGH!
He catapulted to the top of the Jamaican charts in 1997 with the dancehall boomshots "Heads High" and "Nike Air", his distinctive vocals fusing melodious singing with precision deejaying (rapping). Since then he has built an international fan base with hit singles like "Pull Up", "Tamale" and "Hot Gal Today" but it is on his latest CD "Constant Spring" that Mr. Vegas' spectacular sing-jay approach and cleverly crafted lyrics dazzle with the intensity of an evening in, well, Las Vegas. Read Full BioHe catapulted to the top of the Jamaican charts in 1997 with the dancehall boomshots "Heads High" and "Nike Air", his distinctive vocals fusing melodious singing with precision deejaying (rapping). Since then he has built an international fan base with hit singles like "Pull Up", "Tamale" and "Hot Gal Today" but it is on his latest CD "Constant Spring" that Mr. Vegas' spectacular sing-jay approach and cleverly crafted lyrics dazzle with the intensity of an evening in, well, Las Vegas.
Born Clifford Smith in Kingston, Jamaica, he was given the nickname Mr. Vegas by his cousin for the neon pink shorts he wore on the football field; in addition to his athletic skills Mr. Vegas also demonstrated musical talents early on. However an unfortunate dispute over the ownership of a DAT resulted in Vegas being hit in the jaw with an iron pipe; after the assault Vegas' mouth was wired shut so he was forced to create a unique method of vocalizing through his teeth. That style was first heard on "Nike Air", the song that initially positioned Vegas on the dancehall charts. Characterized by uplifting lyrics aimed (especially) at young women, he followed "Nike Air" with another affirming and very appealing tune "Heads High" which reached number one in Jamaica, hit the British Top Ten and found its way onto several urban stations across America.
Vegas' 1997 debut album "Heads High" (Greensleeves Records) further displayed his captivating vocal capabilities on songs like "Jacket", "Sweet Pineapple" and "Everywhere I Go"; it also earned him a British Mobo Award as Best Reggae artist, while establishing his fan base beyond the Jamaican dancehall.
However Vegas demonstrated even greater versatility on his 2001 sophomore release "Damn Right" (Greensleeves) which featured a stronger R&B and hip-hop flavor on the hits "Girls Time" and "She's A Ho", sensitive singing on the roots rocking "Rise" and a sensational duet with Sean Paul "Hot Gal Today".
With his move to the Los Angeles based independent label Delicious Vinyl Vegas released his third CD "Pull Up". The title track was recorded on Scatta Burrell's wildly popular Coolie Dance riddim, entered the Billboard charts and took Vegas' music into previously uncharted territory. Another single from "Pull Up" "Tamale" also did well, particularly in Europe.
"I walk these Kingston streets, everyday a bare a beat/I can't get no sleep all I hear is AKs when they speak/ I walk Spanish town all I hear is people get gunned down, when I look around all I see is bodies on the ground. My shadow's afraid to even walk beside me, my shadow's afraid to even walk this city gun dawg and his friend full the morgue in Kingston city/too many guns in town."
"Crime, violence, war, it affects everyone," Vegas says, "and there is nothing in that song that doesn't relate to what is going on everywhere, especially Kingston. We want this album to be versatile so a Latino person a hip hop person, urban kids or all nationalities will listen to it."
Reflecting the ongoing changes within the music industry, Vegas and his manager Leslie Cooney of the Los Angeles based company Addict Management will be taking a very different approach regarding the release of "Constant Spring": they will not be signing to just one label. "We have found that as an independent artist Vegas can better exploit his appeal in every territory without the expectations and limitations of being signed to one label," says Ms. Cooney. "Instead, we will directly supply his fans with music worldwide and will seek licenses with different labels in their respective territories. Whether by an actual record or digital distribution, if there is a demand for Vegas it can now be met without waiting for the record label machinery to spring into action. We are taking matters in our own hands and Vegas is planning his own future."


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Spellacy – obszar niemunicypalny w hrabstwie Kern, w Kalifornii (Stany Zjednoczone), na wysokości 511 m.

Linki zewnętrzne

Obszary niemunicypalne w stanie Kalifornia

redpajama_set_name: RedPajamaWikipedia


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Thoughts on a Sunday…
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It is 6AM on a relatively bright and crisp Thanksgiving weekend. Alpana checks her patient list as she heads to work to see a host of patients, some with COVID19 and others with the usual ailments that fill our plates at work. We talk about how the pandemic has affected us and its impact on society in general. The CNN headline on Japanese suicide rates, the resignation of a local health official over threats to her family and the increase in local spread among the community feature, as we look to the winter ahead with trepidation.
A bright spot in our thoughts, is the possibility that a vaccine might be a savior. But will it be too little, too late? Only time will tell. As more of our colleagues test positive, we look to our own safety. As more and more public officials, on both sides of the political spectrum, show support for preventative and safety measures, we look at the increasing fatigue that we (as much as everyone else) are experiencing in this new reality.
But wait, masks, distancing, washing hands? Restrictions? What restrictions?
As a proceduralist, these aren't restrictions, these are my every day activities. As they would be for welders, mechanics, sanitation workers, doctors, nurses, respiratory therapists… you name it. And every occupation has its own.
When do these rules of behaviors become a restrictive burden?
I think the answer is in us.
They are "restrictive" as much as we want them to be.
We are "restricted" to breathe air, want for food, desire shelter and companionship.
We are "restricted" to need to care for family and friends.
We are "restricted" to the boundaries of our locale, city, state, country, planet, solar system and galaxy.
Most of all, we are "restricted" to the confines of this body, the most precious gift endowed us by our Creator.
In the face of these restrictions, what of the mere mask, the "6-foot rule" and the hand-washing? When seen from this overarchingly "restricted" life, these seem like just a fraction. But are they "just an increment" or "the last straw"?
Again, the answer lies in us. Despite the profusion of death and disease all around, many, including friends and family, move to the latter. Their attitude, one of defiance in the face of logic, as they abandon all pretense. Social media, the bane and savior of our isolated world, relays videos and pictures of indoor get-togethers, as families and friends gather in close embrace, singing and sharing.
How will this end?
Maybe the naysayers are right. Maybe this is all fake. Or #fake. Maybe this is just physicians trying to whip up panic to demonstrate their power.
Smart people discuss the ethics of caring for individuals that don't isolate or take precautions. They even suggest that only "good" people deserve to be treated.
My take on this is as follows:
I am a physician who provides a service to those who need it. No part of this involves my judging their behavior or character. What's more meaningful is that I am PAID to deliver said service. Just like, smoking, sloth, gluttony and pollution that keep our clinics humming, the pandemic is just another, newer, source of activity.
I plan to keep doing what I do for each patient.
Be the best physician I can be.
Dispense the right advice – for THEM to make the best decision.
Do what I can to help them, and let them do what they wish to do. The day that I am paid to police their activity and make their decisions for them, that is the day I leave medicine.
That said, as an individual I can judge and decide who I want to be friends with. That includes family members that I want to relate to and those that I don't. Like any individual, I retain the freedom to be as arbitrary as I please in doing so.
If you don't want to wash hands, if you want to make a point of posting pictures and videos of indoor maskless groups, holding hands and in close proximity and if you think you are "tired" of this pandemic and all the "restrictions", I am happy to be your physician, just not your friend.
Serpentine adventures…
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Hello, again. Our Cobra adventure is now three days in. After the torrid rainstorm, that was the St. Louis Diwali, a bright, crisp and windy Sunday meant 2 drives with the Blue Snake.
After waiting till the sun was truly in the clear (and neighbours likely awake from their slumber), it was two pumps on the gas pedal and a push on the starter pedal to awake the beast. From the usual explosion of noise, her engine settles into a Brrump-Brrump-Brrump rhythm. Strapped in my four point harness, like a biplane pilot, I gingerly engage reverse as I crawl out onto my driveway. Pedestrians enjoying the morning walk regard me with disdain as I try to enter the roadway.
Surprisingly, the clutch is light, the transmission precise as I gently advance through first, second and third as I trudge down Wydown – just under the limit. Shouting a big "Thank you" to the county of St. Louis for fixing Big Bend, I traverse the segment from Wydown to the 40 without the usual bone-shaking that the ultra-stiff suspension of this replica of a 60s racer has. With the smoothness of a P-51 taking wing in the crisp November air, she delights as I gently advance the gas pedal to match the expressway speed as she settles into her overdrive at a meager 1800 rpm and 60 mph. Occasionally buffeted by the near gale-force winds that remained from the prior night's storm, she continues unabated, her steering light (and a little numb – thanks to the power assistance) and drawing on easy reserves of power to climb inclines without even the thought of a downshift.
Despite the balmy 50o weather, freezing air rips through the cabin as it creeps through the tiny spaces in the soft top. Notwithstanding my relaxed grip, my fingers are numb on the moto lita at 11 and 2 as we coast to the exit towards the Chesterfield Airport. Returning back to the expressway from the overpass, she eases into roadways speeds with the easy alacrity of an old hand, gently reminding me of how outmatched I am to what she is capable of, yet welcoming me to enjoying her thoroughbred power as she flexed her considerable muscle. Her dimunitive proportions (the same as the Mazda Miata) make her a dream to point and steer as she switches lanes accurately and without complaint.
Thundering back up our driveway, she returns to her abode with a clatter and a clang as I remove the battery-kill tag. I enter to find her angry namesake, looking in askance to being left behind. Apologies delivered, I head to work in my trusty Golf.
Returning from work, I find both ladies ready to embark again. The cobra ready to dance, and Alpana dressed in biking gear. A smile on the latter, broader than the Chesapeake Bay greets me as I start up the 4-wheeled one. Accompanied by the thunder of her exhaust, we go through a gentle drive through the quiet Clayton Sunday, as the smiles continue to grow.
Trundling home, my wife looks at me. Of all the cars I've had, this would be the first time, her face was both content, yet excited, as she pronounced that this was her favorite car ever.
Which would make sense.
Of all the cars I've owned, this is by far the prettiest, meanest, most characterful car that carries a streak of mischief but remains responsible, gentle and smart. Probably my second best choice in all my life.
BDR#2122
RT4 with an Iconic 427 ci engine. 488 bhp/533 lbft on the dyno. BMW E91 rear independent suspension with coilovers. 4 piston 13 inch brakes in front and single piston in the back. 18 inch 245/40 (front) and 295/40 (rear). Heated seats and interior with cloth soft top.
Move over Eagle Speedster, THIS is the prettiest car in the world.
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The rarefied club of readers of this blog will recognize my many prior ululations in salute of my erstwhile Carrera 3.2. These astute few may also remember that a few months ago, that car had left our families fold, as we searched anew for a replacement. One, distinct from the stark and dull 80s look to a more chrome laden, but new car. Discerning readers might think that a Porsche reimagined by Singer might meet these criteria, but to an untrained eye (and we have many in our family), they still seem like an acquired taste. As cars go, built with Germanic precision, with crisp handling and accurate dynamics, nothing comes close to a Porsche in maximizing the drivability and performance to price ratio. However, the real price you pay, is the push-me, pull-you bug-eyed appearance. Despite my many efforts to portray it otherwise, the beholder that finds a Porsche pretty is rare.
Which is why, the aesthete of the family and love of my life, never really warmed up to it. Also, growing up in a middle-class household, we could never really think of a "used" car as special. On a jaunt to Fastlane Cars in St. Charles, MO, we came upon a gorgeous Porsche Blue Shelby Cobra Replica made by Backdraft Racing in Boynton Beach FL. Coming on the heels of watching Matt Damon and Christian Bale in Ford vs. Ferrari, she was familiar with the shape but enamored of the brightwork and the colors of this beautiful car.
Looking more into BDR, I found that like a modern-day iteration of Carroll Shelby, this was a company with a strong racing heritage, who were not trying to replicate a Cobra, but build a beautiful modern classic racecar inspired by both the spirit as well as the shape of the Classic Cobra. While Shelby American continues to sell "authorized" continuation copies (both in aluminum and fiberglass), there are several manufacturers that build "replica" cars. I would like to briefly review my thoughts on them from my research on the internet and why one could choose to buy on of them and how it influenced my decision to go with a Backdraft.
Shelby American: These are continuation cars with both aluminum and fiberglass bodies sold as rollers (i.e. rolling chassis with everything minus the engine and transmission). Shelby does make a variety of Ford derived engines that fit these. They do have independent front and rear supsensions with updates to make them more modern, but the original top-loader four and the 427FE engine (while classic – tend to be a bit of a 60s handful). These are also at a significant premium with a take-home cost of $150k (fiberglass) and $250K (aluminum) with a typical engine set up. Cost aside, these do represent a good value when it comes to resale.
Superformance. Licensed by Carrol Shelby (after a lawsuit), these are honest copies of the Shelby with a variety of modern accoutrements to make the Serpent less of a threat. No, you don't get ABS or traction control, but still. With jewel like precision and superb fit and finish, they seem to have become the industry standard. From the 289 "slab side", the 289 FIA, the 427 roadster and the 427 s/c, they make Cobras in all flavors and shapes. While respected both as a car as well as with resale, I was some what put off by the unashamed similarities to the original and did not want to come of as a poser. Plus, the original Hi-Tech company and Superformance were originally a collision company restoring old damaged cars, not really a Carroll Shelby esque racing heritage. FWIW, all the cars used in Ford v. Ferrari were SPF replicas.
ERA. With Everrett Morrison, probably one of the oldest acts, these are well respected replicas sold as owner assembled kits. I lack the sophistication to assemble one, nor the confidence to drive something I put together in the garage, a car with an enormous engine trying every second to swallow me whole. That said, a well put together ERA is a beautiful sight, but the key is finding one that is well put together. Also, the whole point was to move away from a used car.
Everret Morrison. Also good cars but IMHO in the second or third rung.
Factory Five Racing. Initially building these cars by putting a fiberglass body on an old Mustang 'donor', these have moved to modern chassis with wonderful attributes. The fact that several builders will deliver a turnkey product, does not change the fact that something in their appearance or prior stigma – does not really look right to me.
Backdraft Racing is a South Africa based company with strong racing roots. As winners of Daytona in 1984, Reg Dodd and Tony Martin, imbue these cars with the raw spirit and character of the original car that inspired these. With a subtly different shape, these pay an homage to the artistry of the AC Ace body (originally circa 1953) modified by Carroll Shelby in 1965 with flared front and rear fenders, a giant maw and huge side-pipe exhausts. And yet, looking at the car, it does not look like someone cloning a car but creating a different inspired original. Unlike many of the replicas above, these were built to race first, drive or show last. With a typical ladder suspension bonded to a beautifully painted fiberglass shell, these cars represent the best ideals of the performance of the original Cobra without the weakness of the aluminum body. Fiberglass, the shell used in Carroll Shelby's first choice, the Corvette.
And what is it like?
Glorious. Simply glorious.
As I gingerly, sat down and was briefed by Dan Hillebrandt, the sales manager at FastLane Cars, the horror stories of crazy cobras and drivers out of their depth, filled my mind. Turning the key and pressing the starter button seemed to unleash Surtur as the entire world began to shake and tremble. Passers-by took a step back. Abashed by the drama, I bid farewell to my guide, engaging first and letting out the clutch as the newest member of our household rolled forwards towards the exit of the lot. It is at this point that I realized that the drivers and passenger side, RayDot mirrors were a wonderful cosmetic addition, with no purpose. The only thing scarier than driving a 2400lb pound car with 7.0L V8 engine with 488 bhp and 533 lb ft of torque, is doing so without knowing who else might be on the road.
Gingerly, easing myself on to the highway, I was immediately pleased to see that the more "novice" T5 gearbox, allowed me to shift quickly through the gears to settle into a legal cruise, while traffic seemed to zip around me. Still, noone seemed to come as close as they are wont (in my other vehicles). I would like to believe that the fearsome thunder emanating from this Reptile had something to do with it. The price of all that thunder? Refueling halfway from home. With an uneventful ride back home, this Indigo Blue RT4 with it's white racing stripes, noisily slipped up our driveway and joined our family, welcomed by her new namesake, her dog and the two kids as they posed for pics.


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text:
Krim World
Krim World Home
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Gift of the Meatheads
Time of the Meatheads
Farewell, My Krim
The Assassin's Assassin
The Pocoto Investment
Heartburgh
Bridge Over the River Krim
For Krim the Bell Tolls
Kriminal Assault
Bridge Over the River Krim: Chapter 31
Krimspiracy
Read all previous installments here.
Ellison left Matilda with her dinner. His dinner. All three of them. Afterwards, she would check in on the mercenaries they'd hired to watch the newspaper, just in case the Nightingale showed up. Then she'd go and recruit some assassins, starting with a couple of people they knew from a previous job for the Paladins of Death. The trick was to make sure that word didn't get out that they were having Benjamin Goldberg and Griffin the Squint followed. If anyone knew how to keep people from talking, it was Matilda. Even the assassins were afraid of her.
The Barley Mow Inn was conveniently located. The central post office was across the street and a block down, where Leadenhall met Banking Street. He turned right on Banking and the central square was just a block ahead, along with city hall and the King's Arms. He considered stopping in at the King's Arm's for dinner as he walked past, but he could see by looking in through the front window that the place was packed.
The central plaza was packed too, mostly with tourists, but he could see the faint blue glow of the main gate at the far end. He'd be on FacePage soon enough and all thoughts of work were replaced by the taste of friend potatoes. He was deciding between spicy curly fries and potato soup when he felt someone bump into him from behind. He stepped to the side to get out of the way in case the stranger behind him was going to kill him, or throw up on him. On Krim, it could easily go either way. He didn't recognize the man who pushed him, who was now shaking a fist in Ellison's face.
"We don't want your kind around here," the man said. It looked like he was wearing a noob fighter outfit, but Ellison didn't focus on the man's appearance. That was too easy to change. His aura, though. That was something Ellison wouldn't forget.
"What kind is that?" Ellison raised his hands and backed away. The fighter leaned in towards Ellison and glowered and before he could say anything else, he was pulled into the dark, narrow alley behind the King's Arms.
"The kind who's about to die a slow, painful death."
Ellison felt the cold edge of a knife at his throat as the second attacker pulled him deeper into the alley.
"We want you to leave Krim and never come back. We'll know if you try, even if get a different avatar. We've got people in grid admin."
Ellison didn't believe him. Anyway, wearing a different avatar wasn't an option, since his clients wouldn't be able to find him if he did that.
"Oy! Working here!"
The three of them turned to find a mugger holding a dagger on a tourist.
"Sorry, Midge," said the second attacker. "Didn't see you there."
"Please save me!" the tourist squeaked. He was holding a hand tight around his upper arm, blood seeping between his fingers. "This really hurts. It hurts so much."
"It's just a scratch," said Midge. "Now give me all your gold."
"We're just passing through," said Ellison's first attacker.
Midge squeezed up against his victim to let the three of them past. "Next time, pick your own alley," he said. "Everyone knows this one's mine."
"You're right, I should have remembered that," said the second attacker. "I'll keep that in mind next time."
"The one across the way, by the yarn store, is usually empty," Midge called after them. "Now, where were we?"
"I don't have any gold," said the tourist.
"I could hear you jangling," said Midge. The tourist screamed and Ellison involuntarily glanced back. Midge had sliced the tourist's breastplate off. The default armor that the tourists liked had little benefit for close-in fighting.
"Did you hear how that noob was squealing?" one of the attackers growled into Ellison's ear. "You're going to be screaming ten times as loud. And this is Krim. Nobody's going to come help you."
"You don't have to tell me," said Ellison. "I've been killed on Krim before."
"Well, this time it's going to be worse," said the attacker.
"Really?" asked Ellison. "I was tortured by the Armforge Guild once. Can you do better?"
The attackers looked at each other.
"Maybe if we had some tools," one of them said.
"I've got an idea," said the other, and dragged Ellison around the corner. They were behind the King's Arms now. "I bet there are all kind of things in their kitchen. Boiling oil, hot pokers, those kind of things."
"You think they'll just let you walk in there and take them?" said the first attacker.
"I'm just going to borrow them for a little while."
"During dinner rush?"
They were near the back door when it opened and an assistant cook came out with a bucket of scraps and opened the lid on the trash chute next to the rear entrance. Then he glanced up and saw the attackers in the shadows and shrieked. The second attacker was closest and got a bucket of scraps in his face. He roared and chased the cook into the tavern.
Ellison took the opportunity to jump into the open chute. He'd had to do this before and had the technique down. His cloak ripped where the other attacker was holding on to him, then he was free and diving head first down the narrow stone-lined shaft.
The attacker caught his foot and Ellison's forward motion stopped with his head and upper body hanging down but his legs still up and outside the chute. He jacknifed and pushed against the wall. It was slippery and there was nothing to grab onto but the push gave him just enough extra momentum. At the same time, he kicked out with his feet and he was free.
The stone walls were covered with slime and rotting remains of years' worth of kitchen garbage. Ellison held his arms wrapped tightly against himself as he fell into the dark. If he flailed, there was a good chance he might rip an arm off in the descent.
2 thoughts on "Bridge Over the River Krim: Chapter 31"
Noreen Brenner
The story is getting very suspenseful. Who is after Ellison? He was very lucky to escape!
Omg totes suspenseful
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15-year-old on bicycle dies after collision with USPS vehicle
Accident remains under investigation
Updated: 5:03 PM CDT Jul 1, 2020
KMBC 9 News Staff
KMBC
Police lights
SOURCE: KMBC
A 15-year-old boy died after an accident Wednesday morning with a Postal Service vehicle.Kansas City police said the collision happened just after 10 a.m. near 20th Street and Denver Avenue.Accident investigators said the teenager lost control and fell into the path of the vehicle after emerging from an alleyway west of Denver Avenue.The driver of the USPS vehicle stopped.Police said the boy was taken to a hospital, but died a short time later.The accident remains under investigation.
KANSAS CITY, Mo. —
A 15-year-old boy died after an accident Wednesday morning with a Postal Service vehicle.
Kansas City police said the collision happened just after 10 a.m. near 20th Street and Denver Avenue.
Accident investigators said the teenager lost control and fell into the path of the vehicle after emerging from an alleyway west of Denver Avenue.
The driver of the USPS vehicle stopped.
Police said the boy was taken to a hospital, but died a short time later.
The accident remains under investigation.


Over the last couple of years, the comedy genre has been rejuvenated with recent hits like Crazy Rich Asians, Blockers, The Favourite, Sorry to Bother You and To All the Boys I've Loved Before. It's likely not a coincidence that this breath of fresh air has coincided with the use of stronger female characters and an increased number of diverse storytellers at the helm. The latest addition to this list is Little, written and directed by Tina Gordon (What Men Want) and starring the winning trifecta of Regina Hall (Girls Trip), Issa Rae (Insecure) and Marsai Martin (who, at 10 years old, pitched the film to Black-ish creator Kenya Barris and, at 14, became the youngest film producer in Hollywood history).
A reverse on 1988's Big, Little follows Jordan Sanders (Hall), a tech queen and nightmare boss, who wakes up one day to find that she's been transformed into her awkward 13-year-old self (Martin), who was relentlessly bullied (before she became the bully). The conceit, of course, is that she must change her prickly ways before she can be magically turned back. All the while, Rae plays April, Jordan's long suffering assistant. When Jordan comes running to April for help, she finds the opportunity to take charge at work – and put Jordan in her place.
It's all very predictable. But there isn't five minutes that go by without a laugh-out-loud moment, an impressive feat for a story told many times before. A comedy confection, Little is colourful and bright in so many ways, alive and heartfelt as opposed to saccharine. That's hugely thanks to Rae and Martin's slapstick chemistry. Hall, unfortunately, is only around for about a third of the film; you'll feel a pang of disappointment when she disappears from the screen after viciously stomping across it.
Martin, who is best known for playing the youngest daughter on Black-ish, never veers toward cloying or precocious while playing a woman inside a child's body. Instead, she goes toe-to-toe with Rae, an established comedy star and writer. Diminutive as she may be, Martin's performance is anything but little in one particular standout bit when, after being enrolled in public school, she relentlessly flirts up a fire with her teacher, played by This Is Us's Justin Hartley.
Plot holes are customary for stories like this, but if you're willing to suspend disbelief, you won't notice. Each character arc is smoothly paced and even the romantic subplots are just right, adding an appropriate dose of heat.
A commentary on the ripple effect of bullying, Little calls to mind last year's Eighth Grade, once again giving representation to girls of a certain age. On the surface, it may seem like just another comedy, but Little comes across as something special with Big ambitions.


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Nature / Animals / Wolves
Butterflies & Moths


If you are a fan of Bram Stoker's Dracula, then Whitby Abbey was the place to be this Halloween. Seen as never before, Whitby Abbey was lit up in different colours, from Blue, Green Red and Purple creating a chilling atmosphere.
I decided to have a walk around the Abbey on Wednesday night to see what all the fuss was about, and was glad I did! Adding to the atmosphere was a spectacular full moon which made the night even more memorable.
After paying to get in, you take the long walk round to bring you round to what must be the most famous image of the Abbey, that by Frank Meadow Sutcliffe, taken in front of the Abbey with the lake in the foreground. If you stood in the right place you were able to see the Abbey's reflection in the water, as the lights were shining through the bottom windows with the top of the ruins blending into the blackness of the night.
As you keep walking round the ruins, the lights all of a sudden change colour creating a different, moodier atmosphere to the last one.
At each end of the ruins there were different actors, all dressed up in various different outfits, telling all sorts of tales like that of Sweeney Todd and other gruesome stories which fit in nicely with it being Halloween.
At about 8.15pm, the crowds started to gather round the actors in the middle of the ruins. What came next was a dramatic recital of part of Bram Stoker's Dracula. The actors were amazing and got the whole audience involved with the retelling, and what better back drop to have than that of the Abbey all lit up creating the spooky atmosphere needed for the telling of Dracula!
There was also a few stall around selling all sort of different wonderful things. If you were feeling a bit thirsty you could also get a nice cup of mulled wine or cider to warm you up, as it was a bit on the chilly side.
I could have spent all night there just taking photos from different angles in the different lights as every picture you took was different!.
It is really hard to describe just what an experience it was as it is one of those where you have to be there to experience it. There are just no words to describe what it felt like standing amongst those ruins in the pitch black and dark moody lights lighting up the ruins.
This spectacular light display also coincided with the annual Goth Weekend in Whitby. So not only were we hunting for Dracula amongst the ruins but also looking out for the Goths and their amazing outfits!!
I certainly hope that they do this again next year as i will definitely be going to look round again!


text:
UC San Diego developing biosensor that monitors alcohol in people struggling with substance abuse
By Gary Robbins
May 7, 2018 8:40 AM PT
UC San Diego has made an important technical advance in its effort to develop a tiny biosensor that could be placed beneath a person's skin for long-term alcohol monitoring in patients being treated for substance abuse.
A team led by engineer Drew Hall created a prototype of the sensor that worked when it was placed in a simulated environment in the laboratory.
The device now has to be refined so that it can be tested in live animals and, eventually, humans.
Hall is trying to create a low-power sensor that can be injected blow the surface of the skin, where it would draw power from a smartwatch or some other type of wearable device.
"A tiny injectable sensor—that can be administered in a clinic without surgery—could make it easier for patients to follow a prescribed course of monitoring for extended periods of time," Hall said in a statement.
Hall is collaborating with Dr. Carla Marienfeld, an addiction psychiatrist at UC San Diego, and CARI Therapeutics, a startup that's operating out of the university's Qualcomm Institute.
Gary Robbins
Heavy snow expected in San Diego County's mountains Monday; I-8 in East County should be a slippery mess
Fierce Santa Ana winds flip big rigs, prompt the closure of Balboa Park after trees fall
Santa Ana winds might cause power outages Wednesday and Thursday in San Diego County
Temperatures will drop into 30s, 40s across most of San Diego County Sunday night
Two mass shootings in three days. Are these copycat crimes?
Suicides tend to occur in clusters that suggest contagion, but there is little evidence that murders or mass shootings follow the same pattern, experts say.
San Diego biotech lands $46M for treatment targeting life-threatening swelling attacks
ADARx Pharmaceuticals is working on an RNA precision medicine platform spanning multiple therapeutic areas.
Biological Dynamics spent more than a decade validating cancer diagnostic process spun out of UC San Diego and now has launched a study for people at high risk of pancreatic cancer
Column: Local biotech leader promotes STEM careers for minorities
Entrepreneur Bill Rastetter co-founded and chairs a nonprofit that encourages STEM training and careers for students in underserved local communities
Shane Crotty nominated for pioneering research into B cell immunity, a pivotal topic during the cronavirus pandemic
Maybe adults should act more like children when it comes to fairness


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Marketing Performance Measures
David M. Raab
DM Review
Marketing departments are under increasing pressure to report on their activities. The obvious solution is to develop a marketing performance dashboard. But this merely begs the question of what data the dashboard should present. The answer, check of course, sale depends on why the dashboard is being created. Broadly speaking, help marketers are asked to answer three kinds of questions:
– what value is marketing contributing to the organization? (Or, more pointedly, what return are we getting on our marketing investments?) Call this "return on marketing."
– are marketing activities aligned with our corporate strategy?
– is marketing operating as efficiently and effectively as possible?
Each question leads to a different set of measures.
1. Return on Marketing
This is the ultimate question, but it has no simple answer. One set of relevant measures shows the outcomes that marketing is expected to affect. These include:
– financial results (sales, profits, cash flow, return on capital);
– market results (market share, consumer awareness, brand value, customer equity);
– customer measures (lifetime value, satisfaction levels, retention rates, cross-purchase rates)
The other set of measures shows the marketing investments themselves. The total marketing budget itself is easy enough to report, but not very useful: there is little meaning in a ratio between, say, total revenue and marketing expense. This is because any outcome measure reflects many factors outside marketing (most obviously, customer experience with the products and services themselves). And the effects of marketing expenditures are spread over many periods, so current results reflect the past and current activities impact the future.
Teasing apart all these factors is an exercise in advanced dynamic modeling, requiring both deep business insight and sophisticated statistical techniques. At a minimum, dashboard designers need to recognize that current activities can have only an incremental effect on current results. This means they should focus on changes in targeted values rather than their absolute levels. Realistically, dashboards need tools like marketing mix models and business simulators to estimate the combined results of multiple marketing programs.
An alternative (or complementary) approach is to relate specific marketing activities to specific intended results—for example, matching a particular ad campaign to brand awareness goals in a particular market segment. This results in many more data points than a top-level dashboard should display, so aggregation is required. It also requires a disciplined marketing planning process to identify these relationships in the first place.
2. Strategic Alignment
Showing alignment with corporate strategy means marketers must identify how their efforts support larger company goals. Or, more precisely, the team responsible for corporate strategy must determine what role marketing will play and then work jointly with marketing to select measures that show marketing is meeting its objectives. For example, a corporate strategy based on selling a new electronic gadget to at a high price to early adopters would include specific objectives for marketing based on awareness and customer attitudes in the target market segments. The marketing plan would include projects to achieve these goals. The strategic alignment dashboard would show spending on these projects (absolute and as a percentage of total marketing budget) and the values of target measures.
3. Marketing Operations
Managers both inside and outside of marketing want to know that money is being spent as wisely as possible. The first step in understanding this is having an effective control system to track planned and actual activities. Therefore, one set of measures should monitor the utilization of such a system, through metrics such as percentage of marketing projects with complete data in the planning system. Since all other reporting depends on planning system data, this is more important than it may sound.
A more conventional set of measures will report on concrete marketing activities and results, such as calls made, response rates, cost per thousand mail pieces, cost per new customer, and revenue by campaign. These can be calculated directly from operational statistics—in contrast to metrics like lifetime value, which may involve quite a few assumptions. Such concrete measures are easy to grasp and less susceptible to manipulation, although their absolute significance is often limited. Managers are used to seeing and planning against them. They can be valuable monitoring tools when checked for variances against plans, budgets and similar projects.
Another set of measures tracks internal efficiency, such as staff hours to set up a campaign or number of days to execute a direct mail program. Again, these are easy to monitor and can provide useful targets for improvement. They must often be paired with other measures to avoid negative consequences: for example, pressure to reduce time-per-call in a call center can result in a decline in service levels unless the company also keeps track of customer satisfaction.
A final set of operational measures aims to show that resources within marketing are being allocated properly. Like high-level "return on marketing," this requires some way to measure the long-term value of different decisions, which reintroduces business models and statistical projections. Again, tools like marketing mix models and optimization routines must be used to identify optimal marketing decisions and to compare these with actual results. The goal at this level is to ensure that marketers adjust as quickly as possible to changes such as productive new channels or falling response rates. Suitable measures could include number of campaigns evaluated through such systems or estimated improvement in results from system-recommended reallocations.
David M. Raab is a Principal at Raab Associates Inc., a consultancy specializing in marketing technology and analytics. He can be reached at draab@raabassociates.com.
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Q: DeployOnBuild not taking effect when building web app in Visual Studio 2017 I have a web application in VS 2017 for which I've defined a publish profile which works, happily, deploying / publishing the website to a location on the file system.
I understood that this was possible as part of the regular build process, i.e. just building the solution in Visual Studio or TFS build - and that this was achievable with a section like this:
<PropertyGroup Condition=" '$(Configuration)|$(Platform)' == 'Release|x86' ">
    <DeployOnBuild>True</DeployOnBuild>
    <PublishProfile>ProfileName</PublishProfile>
</PropertyGroup>

However, this has no effect whatsoever, the build output log just shows the regular build happening and no attempt to publish.
Should this work as suggested in various answers on here and MSDN - and if so, what is wrong with the above?
(In case anybody is wondering, the reason for doing this is that a single solution being built by TFS cannot separately publish > 1 web application with separate publish profiles as required with the build definition MSBuildArguments setting).

A: I want to credit @Andy-MSFT who posted a very close answer, but in the end there were some vital details missing and some corrections required to make it work.
First off, the working solution was:
<Target Name="Deploy" AfterTargets="Build">
    <MSBuild
      Condition="'$(DeployOnBuild)'!='true' And '$(Configuration)|$(Platform)' == 'Release|AnyCPU'"
      Projects="$(ProjectPath)"
      Targets="WebPublish"
      Properties="DeployOnBuild=true;PublishProfile=FolderProfile"/>
</Target>

The WebPublish target will only work on a TFS build server if the "Web Developer Tools" of Visual Studio (2017 in my case, as per the question) are installed.  Note that the "Projects" attribute had to be set with $(ProjectPath) which is also different to Andy's answer and was also needed for this to work.

A: The DeployOnBuild property specifically was ignored when set statically in  the project file.  Apparently it is a special property that must be set globally on the commandline.
As a workaround, you could call MSBuild again to pass the property. See How to: Extend the Visual Studio Build Process

*

*Open the .csproj file with text editor.

*Add below snippet at the end, then save it.
<Target Name="AfterBuild">
  <MSBuild Condition="'$(DeployOnBuild)'!='true'" Projects="$(MSBuildProjectFullPath)" Properties="DeployOnBuild=true;PublishProfile=YourPublishProfile;BuildingInsideVisualStudio=False"/>
</Target>
Below threads for your reference:

*

*Publish WebDeploy Automatically with VS Build

*Visual Studio 2013 Build and Publish


Non-alcoholic wines and non-alcoholic sparkling wines are not produced from grape juice; they are produced by dealcoholizing normal wine.
The "Carl-Jung-Method" of careful dealcoholization was developed in 1908 by Dr. Carl Jung and has since then undergone continuous improvement.
Alcohol is removed from the wine by a special distillation method at 28°C under vacuum.
The aromatic products are collected separately and re-introduced into the non-alcoholic wine thereby, preserving taste, aroma and character of the original wine.
Non-alcoholic drinks may (by law) not contain more than 0.5% vol alcohol. The non-alcoholic wines of Carl Jung GmbH exhibit a residual alcohol content of max. 0.3 % vol. Normal wine usually contains 10 to 14 % vol alcohol.


A year ago I had no idea I would be the proud owner of a successful travel blog (with a new bloggers Liebster award no less!) I was happy enough working as a GP (family doctor) but I craved a creative outlet. Fast forward a few months an idea which formed over a few too many cocktails, to start a travel blog, actually came to fruition. I couldn't be happier, working towards a perfect career balance of 50:50 medicine: travel writing.
Read more about why I blog in my article Why Blog?!
I can't deny at times it was challenging. I'm a self-confessed technophobe and being so technically challenged as I am, setting up a website was not always a straightforward task! Tech support at Siteground were probably seriously sick of the sound of my voice after the first week! But now, looking back, I have realised that I've learned so much, obtained so many new skills and I would like to share those skills and that knowledge with you now so that you can start your own blog – no matter how technically challenged you may be!
11 Now it's time to Monetise your blog.
There's no point blogging for the sake of it. Blogging is hard work – you have to be passionate about your subject otherwise you will soon lose interest. Don't blog about what you think you should blog about – blog about what you love. When you've decided on your topic, try to narrow it down a little. Niche blogs with loyal followers become successful far quicker than generalised blogs where the niche is not obvious.
So you've decided you love travel enough to blog about it, think about what type of travel inspires you the most? Which type do you have the most experience/expertise in? Perhaps you've personally travelled the world on a shoestring budget? Or perhaps you have a passion for sustainable travel. Are you a vegetarian who has eaten your way around the world finding amazing vegetarian restaurants? Do you travel with children or as a couple?
Decide what your niche is and brand yourself accordingly. It doesn't mean you can only post about your specialised niche but you need to make it obvious that is your area of speciality so that your followers know why they should be following you! You can have more than one niche but try not to have too many and make sure they are all related to each other! My personal niches as travel health and travel photography but I will write articles on all aspects of mid-budget travel.
Deciding on a name can be tricky. You need it to be something which reflects you and what you're about. It needs to be catchy, not too long and memorable. It needs to be unique. It needs to be future proof. If you make the title too specific like 'Solo World Travel,' should you meet a partner and continue to travel as a couple, your blog name will no longer be suitable. Changing your domain name and branding down the line is something you really want to avoid if you can! It's a sure fire way to confuse and lose followers.
I chose my name The Globetrotter GP for several reasons. I wanted to put my other profession as a doctor in there somewhere because my target audience is other professionals who travel in their time off. It also helps give me some credibility when I talk about travel health – one of my niches! The use of alliteration with Globetrotter and GP makes it catchy. It's not too long and is easy to remember.
How to think of a blog name.
Think about your favourite travel bloggers – what was it about the name that attracted your attention?
Try mixing these words together.
Try using words that start with the same letter or rhyme or sound good together.
Avoid hyphens numbers etc – it'll make it harder to remember.
Once you've come up with a name, don't rush into it. Ask family and friends their opinion, make sure you are 100% happy with your choice – it's difficult to go back!
Once you've decided on a blog name, you will need to check the domain is available – start with GoDaddy.com to check there are no domains that are too similar to your own. Try typing in various similar names. You don't want something that is too similar to your own.
What on earth is a web host you ask? I was baffled by the concept myself. But the best way I've heard it be described is like a web landlord – you effectively rent your space on the internet from them. Just like with a house landlord, if you have a problem with the space you rent, they can help case helping to keep your website safe and fast. They assist with firewalls and security, site speed, access to email, registering your domain and a lot of other things that would take way too long to list here!
I use SiteGround for this and they have been totally amazing! As a complete and utter technophobe, I found setting up a website totally baffling at first! SiteGround have an AMAZING customer support service and can be contacted 24 hours a day via an online chat service. Even at stupid-o-clock in the morning, I could ask a question and have an answer within a few minutes.
It will ask you to choose your plan. You can upgrade at a later time so I recommend starting with Start Up or Grow Big. Personally, I went for Grow Big as I have lots of pictures and some videos on my site so I wanted the extra speed! It'll ask you to register your domain name and ask for payment details.
Now you have registered for your host server and domain name, it's time to download wordpress. There are other website creation tools but WordPress.org is by far the best! Please note that wordpress.com and wordpress.org are different. The wordpress.org version will be better long-term for your blog as it'll give you more options for customising it to your needs. (WordPress.com is more for people who want a super simple website for hobby purposes only) Through Siteground, you will automatically be able to download wordpress.org.
Start by going to site panel – my account tab. Here click on cPanel. Always choose to access it securely when it asks.
From here, find WordPress under auto installers and click on it. From here you can download wordpress easily!
Now for the fun part! It's time to make your website look pretty!
Have a think about what sort of people you are attracting first. Do you think your audience will be mostly women? Mostly older or younger? Are they very active outdoorsy people or are they professionals? Design your website around your target audience. Now not to be controversially stereotypical here BUT, if your target audience is adventure seeking men, you probably don't want a pastel themed website with lots of feminine images…!
In order to start customising your website, you will need to choose a theme. There are so many to choose from and many are completely free. Have a look through the ones already downloaded on wordpress, but if you don't like any, just do a google search for 'free wordpress themes' and you will find plenty more! If you decide to go looking for a different theme, download it to your computer and then in the wordpress dashboard choose appearances – theme – add new. You can then choose to upload a new theme or search the available themes. It's super easy!
Now that you have chosen a theme, you will want to customize it and make it unique to you! Under the Appearance tab, click on customize. It will take you to the customize screen where you can change lots of different elements such as Site name and tagline, colours, layout, logos, background images, fonts, menus… Have fun and enjoy making something which reflects you and your brand.
Akismet anti-spam – this has blocked countless spam attempts on my blog.
Yoast SEO – when you edit your post in wordpress dashboard, a yoast search engine optimisation box will appear beneath your article. Type in the main key word/phrase (e.g. start a blog) and it will scan your draft and let you know if you need to make any changes to help get your article higher up the google ranking and seen more often!
Sassy social share – allows your readers to share articles directly with their social media accounts.
Shortcodes Ultimate – a great tool for editing your posts and making them look professional. Add drop down boxes, quotes etc. I use this plugin all the time!
There are loads more but this should get you started! There are plugins for almost any function you can think of so just do a google search if you can't find what you are looking for.
How to add plugins: In wordpress dashboard, you will find plugins under appearance. Again you can search for plugins via wordpress or download and install a plugin directly using the same technique as for themes. Don't forget to press activate once you have installed it!
Where have you been? Consider including a map here.
Where are you going? Any big trips planned or do you have a bucket list? Let your readers know what to expect.
Who might enjoy reading your blog?
What can they expect? I.e what are your niches?
How can they contact you? What are your social media handles?
I also include 3 random fun facts about me – it makes my page more personal!
Now make your 'about me' page visible by placing it in your top menu.
Now you can finally write your very first blog post! Here are my top tips for writing a great article.
Answer a problem. Think of something that your readers would like to know or find out more about and answer that query. Is it how to book cheap flights? How to travel cheaply? How to pack efficiently for a trip to a cold climate? What are the best things to do in Berlin?
Make sure your title is clear and states what the purpose of the article is. It also needs to be catchy and draw the reader in.
Write clearly, try not to waffle on too long! Keep your sentences short when you can. Also, break up long sections of text into short paragraphs.
Use subheadings, tables, graphs, bullet points and lists to keep your readers engaged.
Once it's finished, choose a featured image and click publish.
Register on Pinterest, Instagram, Twitter and Facebook as a minimum. Set up business pages with the name of your blog, not your personal name. Post regularly to these, sharing your own and other peoples content. To build a loyal following you will need to interact a lot! Like, comment and share other peoples articles if you think it's relevant to your readers. Follow people in your own niche. Join Facebook groups for bloggers and join in a social media feed. For example, you may have to retweet 20 peoples posts in return for those same people retweeting your own post. Be active in these groups and you will find your traffic increasing quickly!
I use mailerlite for this. They are a great way to create opt in's for your email list. Choose from embedded sign up boxes, pop up boxes or landing pages. Create a product which your followers will love which will encourage them to sign up for your newsletter. For example, I created a printable travel planner and a photography e-course for beginners. Once you have a mailing list, you have a group of people who are already interested in what you have to say whom you can contact directly and remind them why they should revisit your site! Tell them whats new, whats coming soon. Tell them about an offer or a giveaway or include useful travel tips to keep them engaged.
Now it's time to Monetise your blog.
1/ Affiliate marketing – if you refer someone to a product or service you love and they sign up, you get paid commission. There are many programs you can sign up which work with various publishers such as Awin and CJ. Another option is skimlinks where the affiliate company will turn any links you naturally sue into affiliate links which is super handy for lazy people!
3/ Sponsored Posts – companies pay you to write a post which helps promote their own business. You will always need to state when something an article is sponsored – it's the law.
Although you can start making money straight away with affiliate marketing, do not expect to get rich quick! You will need large numbers of traffic and a to build a solid reputation before you start to notice people actually signing up for the products you recommend! Paid adverts and sponsored posts are likely only to come your way after you've built up an established website with a steady stream of monthly traffic.
3- If you have a large engaged audience, it is now time to monetize your blog. Realistically most blogs will not make a single penny for the first 6-12 months. Starting a profitable blog is not easy, it will take a lot of hard work and it won't usually give fast results. But, if you stick with it and create a great website which is useful for your followers, you have the potential to make an earning from doing something which you love and how cool is that?!
So all that's left to say is Good luck, work hard and enjoy yourself! If you have any questions, posts below and I will do my best to help with them.
If you'd like to hear more about how to make your blog an instant success, please read my article about how I achieved 3000 views in my first ever month of blogging! It's packed with tips on SEO and social media marketing which I think you'll find really useful!
Enjoy this article? Find it useful? Use this picture to save it for later to Pinterest!
Wow, this is quite the comprehensive guide to starting a blog. I'm a technophobe too and wished this was around when I started blogging 6 years ago!
I wish I would have had your guide before I started! I had no clue. Lol. Congrats on your success!
Great guide! Some good tips in here!
hey, starting a travel blog is really awesome and it can attract a lot of people to your blog especially the travellers but there are some niches which are as good as travel blog.
As an example, make money from the facebook page, how to make money online, make money from PayPal etc these niche website contains high CPC keywords as well as ads.