I'm writing this on the plane back from a seven-day silent retreat offered by the Institute for Jewish Spirituality. It's the first of three I will attend as part of a Jewish Mindfulness Meditation Teachers program. The retreat was at Isabella Freedman, a rustic but beautiful Jewish camp, built around a small lake in New England's Berkshire Mountains, 70 miles northeast of Hartford.
Modeled after Buddhist silent retreats, the schedule was deceptively simple—essentially meals, meditation and prayer—while the actual program was grueling. The first "sit" (seated meditation) was at 6:30AM, followed by breakfast and then an alternating sequence of sitting and walking meditations punctuated only by lunch and Mincha (afternoon prayers). After dinner there was a teaching of some kind, followed by Maariv (evening prayers) and then more sitting and walking meditation until bed. All in silence! Hardly a vacation, unless you count the unplugging from all electronics, including email. Hallelujah!
I arrived at the retreat feeling "blue". It's been a tough year. Whether you lost your home or not, we are all singed in one way or another by the fire, and pulling into the Isabella Freedman parking lot, the weight of all we've been through seemed to catch up with me. As I settled into the retreat and the chatter of daily routine began to fade, the weight I had been carrying these past months turned into a spiritual and emotional pain I was not aware of before I arrived.
I came to understand that the fire had sent me into a spiritual tailspin. For the first time in memory, my doubts about God overwhelmed any sense I had of God's presence, and without that spirit the world had come to feel mechanical. Even the worth of Jewish tradition and practice, which I have often argued (and still believe) has value regardless of belief, was suddenly nebulous to me. I was stunned to realize how alienated and alone I felt.
The first couple of days were tough. I felt more broken than "broken open". It really wasn't until Shabbat that a tikkun, a healing, began to emerge. The 42 participants in the program gathered around a table of Shabbat candles, two for each of us, and we were told to light our candles and take whatever time was necessary to pray for whatever we needed. At first, I flinched at the sight of all those flames, but then closed my eyes and opened my heart. No words were said—we were still in silence. But by the light of those 84 candles and the loving warmth of the group, I felt something shift. A weight lifted, an invisible hand clasping mine.
I would love to tell you that "I am all better", but that would not be the truth. I still feel shaken by the fire and its aftermath. The questioning that so rattled me has not ceased, but it has changed.
Rabbi David Hartman, z'l , told me once that to be a religious person in our age was to never turn your back on God or from the struggle for a meaningful Jewish life. As long as you are faced forward and engaged, you are "in the game". Without even knowing it, I had begun to turn away (it is hard for me to admit this, let alone share it with you!). The retreat enabled me to feel the pain of alienation, see what was actually happening, and face forward again.
Thanks RG. Your courage to tell your truth is so appreciated and rare. It is so very authentic. As a result it is real, not abstract. It resonates with me, and therefore is so useful to apply in my own wrestling.
As I type this I notice that inside the word "wrestling" is the word "rest". Hmmmm!?
Time to stop thinking, quiet my mind, open my heart, breathe and rest.
Your pain is palpable and totally understandable! Your honesty and openness is heartfelt. Thanks for sharing. We are blessed to have you as our spiritual leader.
Thank you for sharing your turmoil, for trusting us.
I am reminded of Trappist monk Thomas Merton (z"l) who, as I recall, suffered a long-lasting profound "loss of faith" all the while staying with his order, his practices, his intellectual pursuits.
I was really touched by your blog.
We are all in this together. I, for one, am so glad that you are my spiritual leader.
What a amazing heartfelt admission especially from a rabbi. I have asked several rabbies in the past can I Jewish and agnostic? I asked again can I be Jewish and a atheist? The answer was of course. We are the only religion that questions everything this make us stronger and not weaker! Through all the zorres in my life and the world around me, I knew that my job was to put one foot in front of the other, with my head up and looking at clouds or stars for inspiration. Louis Armstrong' s don't " What a Wonderful World" says it all. Thank you for being our Shepherd in this crazy wonderful thing called life.
Thanks Rabbi George. Your honesty provided a space for me to notice a similar lingering angst left by the fires. This healing is not a quick fix even if I wish it would be. The Berkshires are the best place for retreat.
Your blog is another reminder that we do not always know what others suffer. Glad you found a shift. We all shift with you.
Rabbi George you may recall I spent several days at Isabelle Friedman in August for the HazonJeeish Food Conference. I also had some powerful experiences there.
Tonight at our Shabbat dinner I asked my girls to lead a Shabbat song. Noa–who has been preparing for weeks to play a single song over and over on her snare drum in the Rose parade– started playing it…. "Don't stop believin'" by Journey. We discussed whether that would qualify as a Shabbat song. I had to agree it did. It's pop culture short hand for what Rabbi Hartman would call facing forward.
Thank you for your honesty and reflecting so much of what I, and so many of us, feel as well. Your courage to share gives me the courage to acknowledge my own pain, doubts and fears. So grateful to have you as our Rabbi.
Thank you for your honesty and for being vulnerable. I so admire your willingness to face the fears so many of us have, but are not able to admit, much less confront. We need these qualities in our leaders, so I'm glad you're here to be one of mine.
I believe your candid remarks reflect how many of us are feeling. Questioning has become even more prevalent for me since the fires but at the same time has brought defining spiritually to the forefront. Yesterday as I was getting ready to go through security at the airport to go on a quick trip, a man near me went into cardiac arrest. I and others tried to assist with cpr and AED unit.but it did not look good. To say it was upsetting is an understatement but at the same time later offered the opportunity for my family to talk and question the meaning of it all. Thank you for opening your heart to us thereby allowing us to open ours.
I am so glad you were able to go, that you were able to stay with the pain and emptiness that emerged, and that you were open to the shift. This is a hard piece of work, still evolving, and I deeply respect your willingness to do it and to share it with us.


Five gharials (fish eating crocodiles) were released at Chief Minister Mamata Banerjee's dream project "Bengal Wildlife Safari Park", in Siliguri a day ago. The gharials were brought from Betuyadohory wildlife Sanctuary recently of Nadia district and released in a water cage in Safari park. Bengal Wildlife Safari Park authorities are planning for tiger, leopard and bear safari in the near future. It must be noted that the Bengal safari was set up over 700 acres of forest land having various animals like sambar deer, barking deer, wild boars, jungle fowl, jungle cats and birds.


I thought "Ahh shoot, it's 90+ degrees outside, this is going to be a tough session for my couple." However, I couldn't have been more wrong! Despite the heat, we all had such a blast! This past Sunday, I met Ali and Jake at the Boerner Botanical Gardens for their engagement session. Boerner is one of my all time favorite locations to shoot but truly it's my couples that make it come alive!
Now when you look at these pictures, you're going to notice how incredibly stunning they are! They're such a gorgeous couple! But what I wish I could show (and hopefully it comes across in the pictures!) is how genuine and kind hearted these two are! They made me feel like we were old friends, and for that I'm so thankful! I already knew that I loved Ali from the first time we chatted on the phone. I remember hanging up with her after our first call & doing a little happy dance because I was so thankful that I get to work with the BEST COUPLES. Meeting Jake and seeing them together was the sprinkles on top! They kept stealing the cutest glances & kisses that made my heart smile so big (making me completely forget about the heat!). I absolutely loved our time together Sunday evening and I cannot WAIT to share some favorites!! Ali & Jake you guys are amazing!! September CAN'T come soon enough!


Digg founder Kevin Rose has resigned from his role in the company, according to a report published on Friday by TechCrunch.
UPDATE: Rose has confirmed this news in a tweet, which reads in part, "I'll continue advising Digg [and serve] on the board of directors and taping Diggnation (as I have been since [Matt Williams] joined)."
Rose founded Digg in December of 2004, and quickly saw the social news site become one of the hottest in the then burgeoning Web 2.0 space. Over the years, however, Digg's prominence has declined, and Rose has spent less time with the company and more time on other projects, like the newsletter/podcast "Foundation."
TechCrunch says that Rose is close to completing funding for a new startup.
Rumors of Rose's departure from Digg have swirled around the echo chamber for months. In light of the various challenges faced by the company — including layoffs, management changes and plummeting traffic — we aren't especially surprised to see Rose moving on.
Almost immediately after the launch of "New Digg" in August, users responded by revolting and leaving the service en masse. Competitors like Reddit and StumbleUpon have benefited from the user exodus, and though Digg has tried to realign its vision, it hasn't had much success in winning back users.
We've reached out to Digg for comment and will update if we learn more.


text:
Q: Selenium chromedriver no longer opens command prompt I'm not sure what I've done but all off the sudden my selenium stopped opening the command prompt when opening with the browser..
I've tried setting
 driverService.HideCommandPromptWindow = false;
but that didn't seem to work! I really need the cmd to open as I use it for cleanup!

A: Today GoogleChrome updted maybe if you download the last version of chrome driver:
https://chromedriver.chromium.org/downloads

redpajama_set_name: RedPajamaStackExchange


text:
Disrupting Health Care with Ginger.io
By Jon Callaghan, November 28, 2012
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In August 2011, we led the Seed round for a small team out of the MIT Media Lab who wanted to use passively collected data from mobile phones to detect and help treat health conditions. They called their company Ginger.io, and their goal was built upon Co-Founder Anmol Madan's research at MIT, which demonstrated that it was possible to predict an individual's health status by interpreting passively collected mobile data related to location, movement, phone calls, text messages and time of day. It was a gutsy investment decision: an incredibly smart team pursuing a big, bold vision in an enormous but complex market. Exactly the kind of deal we love.
Since our initial investment, Ginger.io has more than tripled in size, absorbed the Rock Health startup Pipette and opened a San Francisco office in addition to their Cambridge location. They have partnered with Cincinnati Children's Hospital's Chronic Collaborative Care Network (C3N) and the Carolinas-based hospital system Novant. They have also received industry recognition with awards from Sanofi's 2011 Data Design Diabetes contest and Jannsen's 2012 Alzheimer's Challenge with their platform targeted at supporting individuals living with those conditions and their caregivers.
And, as they announced today, they have raised a $6.5 million Series A round. As Ginger.io's first institutional shareholder, we couldn't be more ecstatic about their banner year.
One of the secrets to Ginger.io's success in the health care market is that its founders have used their non-healthcare expertise (Co-Founders Anmol Madan and Karan Singh have a PhD and MBA from MIT, respectively) to approach the market in an entirely new way. Using Anmol's algorithms to passively collect data and infer an individual's health status—and even suggesting that it can be done, and done well—is a significant disruption of a $2.8 trillion industry.
Ginger.io is extraordinarily inexpensive and far more effective than traditional patient data collection methods. Currently, billion-dollar research and clinical decisions are made based on patient data of dubious, and often poor, quality. Patient-reported outcomes (PROs) are the standard collection method for obtaining information about patient mental, physical and social health status and are used to assess risk, aid in clinical decision-making and serve as endpoints in clinical research for the discovery of new therapies. Despite their importance, PROs are burdensome, incomplete and biased, compromising clinical research and care decisions. Of much more value are healthcare insights drawn from objective data.
Before Ginger.io, getting continuous, objective data about an individual's health-related behavior required expensive, proprietary hardware, or a full-time team to monitor the patient. Both approaches expensive and improbable. With Ginger.io, for essentially $0, health care providers can track in almost real-time how people are feeling, and are able to gain the same insights into who may be sick at a much lower cost basis.
At True, we love companies that represent what we call "D2": disrupt the existing business model by democratizing access to technology that was not previously available. Ginger.io is essentially breaking the old health care model of episode -> treatment -> monitor. As healthy people begin to use Ginger.io, they have a better chance of catching when something is wrong earlier, and health care becomes much more about prevention than treatment. It's a big, big shift, and one we're proud to be behind.
It has been pleasure working with Anmol, Karan and the Ginger.io team over the past year and a half. Ginger.io is exactly the kind of mission-driven company we love to work with at True, and we are thrilled to continue to support them in this round.
Anmol, Karan and team, congratulations on your Series A! Welcome, Khosla, to Ginger. We look forward to more great things for you all in the year ahead.

redpajama_set_name: RedPajamaCommonCrawl


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Several milling sessions using 5mm, 1mm and 0.2 mm grinding ball were carried out to produce alumina nanoparticle while water . Speed (rpm) 300 rpm .. Dmitry Permin: FYI I'm using Alumina alfa phase 100 mesh 99% (sigma aldrich).
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TM 300 XL . reproducible results; suitable for long term operations; ball mill and rod mill modules available; easy tilt to.
Exporter of Minerals Grinding Pulveriser Machine, Mesh Separator, Double Toggle Jaw Crusher and . 200/300/500 . Functions as a small wire mesh; Separates the mesh completely; Used for mixing of raw materials for ball mill; Process of.


A device is disclosed for continuous in vivo measurement of blood glucose concentrations in arterial blood. A quantity of glucose oxidase enzyme is confined within at least one elongate double-lumened tube by means of a semi-permeable membrane tubule permeable to permit diffusion of glucose from blood passing through an inner lumen of the tube into an outer lumen in which the enzyme is confined. The enzyme catalyzes the oxidation of glucose to produce heat. The tube is insulated so that the heat produced by the glucose oxidation is transferred to the blood flowing through the inner lumen. Either micro-thermocouples or solid state temperature sensors are positioned to measure the increase in temperature of the blood to produce a signal that is a function of the glucose concentration in the blood.
This invention relates to glucose measuring devices, and more specifically relates to a device for continuous in vivo measurement of blood glucose concentrations.
Measurement of blood glucose concentration is an important tool for diagnosing, treating or controlling a variety of disorders in which the glucose concentration is known to be an indicator of the existence or severity the condition. In the diabetic state, elevated levels of glucose in the blood are known to be indicative of diabetes mellitus characterized by hyperglycemia and glycosuria, and resulting from inadequate production or utilization of insulin. At the other extreme, abnormally low glucose concentrations are an indication of hypoglycemia or a deficiency of sugar in the blood which can be caused by over production of insulin. Substantial research efforts have been directed to the cause or causes of the diabetic condition, as well as methods and devices for treating and controlling the disease. Of the latter efforts, particular attention has been directed to methods and devices for measuring the levels of glucose present in the blood for use in controlling dietary intake; or where insulin is required, for controlling the frequency and amount of insulin which may be required to maintain the blood glucose concentration within an acceptable range. Adequate control of blood glucose is known to permit those afflicted with diabetes to lead a substantially normal life, delaying or eliminating the onset and reducing the severity of its devastating complications.
Various methods and devices employing measurement of either oxygen depletion or hydrogen peroxide production according to the reaction above are disclosed in U.S. Pat. Nos. 4,240,438 to Updike et al, 4,431,004 to Bessman et al, and 4,458,686 to Clark. These patents generally employ some type of selectively permeable membrane to separate the blood or body fluid from the enzyme, permitting blood constituents such as glucose to pass into the area of the enzyme where the oxidation reaction occurs. However, measurement of oxidation depletion is an indirect measurement of glucose concentration, and it is known that substantial problems exist with measurement of oxygen concentrations in the presence of other interfering biological substances, such as urea and amino acids which may also diffuse through the membrane.
Of the patents listed above, only Bessman suggests that the sensor is implantable. But the disclosure therein points out no means by which the sensor could be implanted to produce in vivo continuous measurement of blood glucose concentration.
In U.S. Pat. No. 4,436,094 to Cerami an in vivo glucose monitor is disclosed employing a charge transfer medium comprising a reversible complex of a binding macromolecular component, and an electrical charge bearing carbohydrate component. Increases in glucose level are reflected in the release of the charge-bearing carbohydrate to the electrical field of the monitor. Again, Cerami involves the use of an electrode in a complicated chemical environment and the attendant problems that exist with electrodes, such as discussed above. Further variations in the use of electrodes have been proposed by Richter et al in U.S. Pat. Nos. 4,366,033 and 4,477,314.
A membrane electrode for direct potentiometric or polarographic measurement of glucose is disclosed in U.S. Pat. No. 4,440,175 to Wilkins which is said to offer advantages over indirect measurement of glucose such as those which employ oxygen sensitive electrodes. However, Wilkins is still another application of species-sensitive electrodes with their known problems.
Of the above patents, only Bessman et al, Cerami, and Wilkens speak of application of the sensor in vivo. But none of the disclosures say how their technique would be performed in vivo.
Another potentially useful measurement for glucose involves measurement of the heat generated by the glucose oxidase reaction. See, Danielsson, B., Mattieson, B., Karlsson, R., and Winquist, F. "Bio-technology and Bio-engineering" Vol. XXI, page 1749-1766 (1979) John Wiley and Sons, Inc. The above reference was incorporated into the disclosure of Bessman et al. However, the Danielsson et al reference discloses only an enzyme thermiston for a continuous measurement of glucose with no mention therein of in vivo measurements. Also, the thermiston requires an independent current source making it ill-suited for in vivo applications.
The above shortcomings present in methods and devices for measuring glucose have tended to limit the usefulness of such devices for in vivo continuous measurement of glucose concentrations. The devices are relatively complex, and are subject to a number of inaccuracies due to their sensitivities and the complicated bio-chemical environment in which in vivo measurements must be made.
Thus, a need exists for a device for continuous, in vivo measurement of blood glucose concentrations which is not subject to the inherent inaccuracies and instabilities which have heretofore been attendant glucose measuring devices and methods. The present invention meets these needs, among others, through provision of a device for continuous in vivo measurement of blood glucose concentration, the device being capable of independently producing a signal which is a function of the glucose concentration without the inherent inaccuracies and instabilities which have heretofore plagued glucose monitoring devices, especially those employing electrodes.
In accordance with a preferred form of the invention, a device is disclosed for continuous in vivo measurement of blood glucose concentration. At least one elongate double passageway is preferably a double-lumened tube having a first lumen thereof in flow communication with one or more small arteries to receive and conduct a flow of blood through the tube, and to deliver the flow of blood out of the tube and back to one or more veins. A semi-permeable membrane wall is located within the double-lumened tube to separate the first limen from a second lumen, with the membrane wall being permeable to permit diffusion therethrough of glucose. A quantity of enzyme, preferably glucose oxidase, is located within the second lumen for catalyzing the oxidation of glucose diffusing into the second lumen to generate heat. The double-lumened tube is insulated to substantially eliminate radial heat transfer out of the tube. Means are provided for measuring the increase in temperature of blood passing through the first lumen, preferably entry and exit micro-thermocouple junctions or solid state temperature sensors with the entry micro-thermocouple junction being positioned in the vicinity of the entrance of blood into the first lumen and the exit micro-thermocouple junction being positioned in the vicinity of the exit of blood from the first lumen, the micro-thermocouple junctions being interconnected to produce a voltage signal. When the device is located in vivo with the first lumen configured as described, glucose within the blood flowing in the first lumen diffuses through the membrane wall into the second lumen and is oxidized, generating heat and causing an increase in the temperature of blood flowing in the first lumen. The magnitude of the temperature increase measured by the thermocouples is a function of the glucose concentration in the blood and can then be utilized to control an insulin reservoir pump to maintain a proper glucose concentration in the blood. Since the double-lumened tube is insulated, the heat generated by the oxidation reaction is transferred into the blood flowing in the first lumen so that substantially all of the heat generated is reflected in a temperature rise of the blood as it passes through the first lumen giving a reliable indicator of the glucose concentration. And, the signal produced by the thermocouples is a direct function of the glucose consumed and is not subject to the inaccuracies and sensitivities which plague specie-sensitive electrodes which have been used in the past.
In accordance with another aspect of the invention, the second lumen of the tube is an outer lumen having an elongate, annular configuration and the first lumen is an inner lumen having an elongate, cylindrical configuration with the outer lumen being generally concentrically located about the inner lumen. The semi-permeable membrane wall is configured as a tubule and is located between the inner and outer lumens. The diameter of the inner lumen is small compared to its length so that blood flowing through the inner lumen is exposed to a relatively large surface area of membrane and the glucose is permitted to diffuse symmetrically radially outwardly of the inner lumen through the membrane to enable more complete diffusion and oxidation of the glucose within the blood. Preferably the length to diameter ratio of the inner lumen is on the order of 25 to 1, or greater.
In accordance with a further aspect of the invention, a subcutaneous reservoir is provided for receiving and containing by injection through the skin a supply of replacement enzyme and an enzyme delivery tube interconnects the reservoir and the outer lumen. This permits periodic introduction of fresh enzyme into the outer lumen to insure that a relatively constant degree of glucose conversion is maintained.
In accordance with yet another aspect of the invention, a device is disclosed for continuous, in vivo measurement of glucose concentration and includes a module having a plurality of elongate, double-lumened tubes with the tubes extending through the module from an entry end thereof to an exit end thereof. The tubes have outer lumens generally concentrically disposed of inner lumens with the inner and outer lumens being separated by semi-permeable membrane tubules permeable to permit diffusion of glucose from the inner lumens to the outer lumens. The inner lumens are configured to be in flow communication with one or more small arteries to receive and conduct a flow of blood through the double-lumened tubes, and to deliver the flow of blood back to one or more veins. A quantity of enzyme, preferably glucose oxidase, is located in the outer lumens for catalyzing the oxidation of glucose diffusing into the outer lumens to generate heat and means are provided for substantially eliminating heat transfer out of each of the tubes, preferably by selection of a material for the module which is substantially non-heat conducting. Further means are provided for producing a signal having a magnitude proportionate to the magnitude of the temperature increase of blood flowing through the inner lumens, preferably a series connection of thermocouple junctions. When the device is located in vivo with the inner lumens configured as described, glucose within the blood flowing in the inner lumens diffuses through the membrane tubules into the outer lumens and is oxidized, generating heat and causing an increase in the temperature of blood flowing in the inner lumens. The magnitude of the signal produced by the series connection of thermocouple junctions or solid state temperature sensors is a function of the glucose concentration in the blood. Among the advantages offered by this aspect of the invention is the capability of obtaining a signal proportionate to the glucose concentration which is approximately equal to the combined magnitudes of the signals produced by the individual thermocouple junctions so that even small temperature increases within the individual double-lumened tubes can be utilized collectively to produce a signal that is a reliable indicator of the blood glucose concentration. Further, the collective surface area of membrane exposed to the blood flow as provided by the individual membrane tubules results in substantially complete diffusion of glucose within the blood into the outer lumens whereupon oxidation of the glucose that has diffused into the outer lumens and the consequent temperature increase of the blood in the inner lumens produces a signal which is an reliable indicator of the absolute blood glucose concentration.
FIG. 6 is a fragmentary cross sectional view of the module of FIG. 5 illustrating a preferred form of attaching the membrane tubules to cylindrical walls defining the double-lumened tubes.
Referring now to the drawings in which like reference characters refer to like or similar parts throughout the several views, there are shown in FIGS. 1 through 3 various views of a glucose measuring device 10 according to a preferred form of the present invention. A double-lumened tube 12 includes an inner lumen 14 and an outer lumen 16 with a membrane tubule 18 separating the outer lumen 16 from the inner lumen 14. A flow of arterial blood is conducted to the inner lumen 14 from an anastomosis with a small artery (not shown) and is conducted therefrom to an anastomosis with a small vein (not shown). The membrane tubule 18 is selectively permeable to blood constituents of lower molecular weight, including glucose. Suitable membranes for use in the device 10 are prefabricated tubules formed from materials such as cellulose, cellulose acetate, cuprammonium rayon, or similar synthetic material having a preferred thickness of about 10 to 20×10-6 m with a diffusion rate of glucose in the range of 100 to 120 ml/min/m2.
A quantity of enzyme E, preferably glucose oxidase stabilized in a suitable buffer solution, is confined between the membrane tubule 18 and an inner wall 19 of an outer cylindrical, non-porous tube 20 defining the overall diameter of the double-lumen tube 12. Enzyme E is delivered to the device 10 by means of a non-porous delivery tube 22 connected to a subcutaneous reservoir 24 (see FIG. 4) to which is delivered a supply of enzyme E for replenishing spent enzyme E contained within the device 10. A pair of micro-thermocouple junctions 26 and 28 are located adjacent an entrance opening 30 of the inner lumen 14 and an exit opening 32 of the inner lumen 14, respectively. Glucose within the blood passing from the entrance opening 30 of the inner lumen 14 to the exit opening 32 thereof diffuses through the membrane 18 into the outer lumen 16 where the enzyme E catalyzes the oxidation of the glucose into gluconic acid and hydrogen peroxide with a attendant release of energy in the form of heat. The gluconic acid and hydrogen peroxide diffuse away from the outer lumen 16 through the membrane tubule tube 18 and back into the blood flow. If desired, a quantity of catalase can be added to the enzyme E for decomposing the hydrogen peroxide. An insulation wrap 34 surrounds the device 10 at least from a point ahead of the micro-thermocouple junction 26 to a point downstream of the micro-thermocouple junction 28 so that the heat liberated by the oxidation of glucose cannot pass outwardly of the device 10, but instead is transferred to the blood flowing in the inner lumen 14. The resulting heat transfer causes a rise in temperature of the blood which is detected by the arrangement of the micro-thermocouples 26 and 28. This increase in temperature is a function of the glucose concentration in the blood.
Referring now to FIG. 2, the area of the device 10 adjacent the entry opening 30 of the inner lumen 14 is illustrated. The insulation 34 is removed for clarity. As is shown, the membrane tubule 18 is expanded somewhat at its forward end 36 and bonded by application of heat or a suitable adhesive around its periphery at its forward end 36 to the inner wall 19 of the outer tube 20. This bonding location of the membrane tubule 18 to the outer tube 20 constitutes a preferred form of confining the enzyme E within the outer lumen 16. To enable bonding, the membrane tubule 18 may be stretched radially outwardly adjacent a forward opening 40 of the tube 20 against the inner surface 19 of the tube 20 subsequent to application of adhesive along the inner surface 19 into the tube 20 a sufficient distance to insure an adequate bond. Then, any remaining portion of the membrane tubule 18 extending out of the open end 40 of the tube 20 can be trimmed so that the membrane tubule 18 is flush with the outer tube 20. An arterial adapting tube 42 has one of its ends stretched over the open end 40 of the outer tube 20 and is sealably connected thereto such as by use of a suitable adhesive to bond the arterial adapter 42 to the outer tube 20. The other end of the arterial adapter 42 is connected to a small artery by anastomosis according to well known surgical procedures. It is seen that with the membrane tubule 18 attached to the outer tube 20 in this manner, the blood entering the inner lumen 14 is prevented from contacting the enzyme E contained within the outer lumen 16. This substantially eliminates any possibility of the enzyme E contaminating the blood, providing one means by which the device 10 is biologically compatible for in vivo glucose measurements. The micro-thermocouple junction 26 adjacent the entrance opening 30 is positioned a sufficient distance upstream of the area of enzymatic activity so that any heat generated by the glucose oxidation cannot migrate into the area of the micro-thermocouple junction 26 and thereby affect its reading.
Reference is now had to FIG. 3 where the configuration of the device 10 in the area of the exit opening 32 of the inner lumen 14 is shown in detail. The membrane tubule 18 is seen extending out of an open end 44 of the outer tube 20 through an opening 46 in the wall of the enzyme delivery tube 22. A non-porous sleeve 48 may be employed to connect the membrane tubule 18 to a venous delivery tube 50 which is connected to a small vein by anastomosis according to well known surgical procedures. Alternately, the venous delivery tube 50 may extend through the wall of the enzyme delivery tube 22 to receive within the venous delivery tube 50 the exit end of the membrane tubule 18. In any case, provision is made to insure that the membrane tubule 18 is not exposed to the biological tissue in which the device 10 is embedded to prevent undesired diffusion of blood constituents through the membrane tubule 18. The membrane tubule 18, sleeve 48, and venous deliver tube 50 are preferably connected by forming a bond between the surfaces in contact using a suitable adhesive. The exit of the sleeve 48 or the venous delivery tube 50 from the enzyme delivery tube 22, as the case may be, through the opening 46 is sealed such as by application of adhesive thereat or by applying heat to the area of the opening 46 to partially melt the material so that a bond is formed therebetween. The enzyme delivery tube 22 is positioned over the open end 44 of the outer tube 20 in substantially the same manner as described above in FIG. 2 with reference to the arterial tube 42. The micro-thermocouple junction 28 is positioned just downstream of the exit opening 32 of the membrane tubule 18. And, as was described above with reference to FIG. 1, the device 10 is insulated at least to a point downstream of the micro-thermocouple junction 28. Thus, substantially all of the heat generated by the oxidation of glucose in the outer lumen 16 will be reflected in a rise of the temperature of of blood flowing in the inner lumen 14.
Referring now to FIG. 4, the subcutaneous reservoir 24 is illustrated surgically embedded beneath a skin surface 52 for storing a supply of enzyme E to replenish spent enzyme within the outer lumen 16. In a known manner, enzyme E is injected into the reservoir 24 by use of a needle 54, the reservoir 24 having self-sealing walls 56 to prevent escape of enzyme after withdrawal of the needle 54 from the reservoir 24.
Referring now generally to FIGS. 1 through 4 where various aspects of one form of the glucose monitoring device 10 have been described, it is to be appreciated that the double-lumened tube 12 and its insulation covering 34 combine to form an overall diameter of the device 10, excluding the insulation 34, that is preferably in the neighborhood of 0.5 to 2.0 mm. The overall length of the device 10 is preferably 50 to 100 mm, wherein it is seen that the double-lumened tube 12 is sized so that when surgically embedded, it is practically unnoticed.
The length of the inner lumen 14 is approximately equal to the length of the device 10 and its diameter is selected to provide sufficient surface area along an inner wall 58 of the membrane tubule 18 to insure diffusion of a substantial portion of the glucose within the blood into the outer lumen 16. To this end, the membrane tubule 18 preferably has an inner diameter of about 0.3 to 1. mm and thus a surface area of about 50 to 500 mm2 along its inner surface 58.
An artery of suitable size and flow is selected to obtain a preferred blood flow through the inner lumen of about 20 ml/min, the pressure loss between the entrance and exit locations of the inner lumen 14 being advantageously maintained at about 60 to 80 mm Hg. Through the use of a suitable membrane material for the tubule 18, examples of which were given above, this should provide a glucose clearance value in the order of 5 to 10 ml/min; that is, 50 to 10 ml of blood in the total blood flow through the device 10 will be cleared of glucose. Thus, with a blood glucose concentration of about 1 mg/ml and a clearance value of about 5 ml/min, approximately 5 mg of glucose per minute should diffuse through the tubule 18 into the outer lumen 16, and when the clearance value is about 10 ml/min, approximately 10 mg of glucose per minute will diffuse.
Whatever clearance value is obtained through the arrangement as described, it is substantially constant, so that increases in blood glucose concentration produce a corresponding proportional increase in the amount of glucose diffusing into the outer lumen 16. Further, a substantially constant rate of oxidation of glucose in the outer lumen 16 is insured by maintaining a relatively large excess of enzyme E within the outer lumen 16 over that which would be expected to produce complete oxidation under these conditions. This excess of enzyme E, in combination with the length of the tubule 18, aids in maintaining a continual gradient of glucose concentration across the wall of the tubule 18 to induce a mass transfer of glucose into the outer lumen 16 generally along the entire length of inner lumen 14.
The micro-thermocouple junctions 26 and 28 are arranged in a conventional manner in that the junctions 26 and 28 are interconnected by a wire 27 constructed of a B type metal and lead wires 27 and 29 are constructed of an A type metal. The A and B metal types are chosen to produce the thermocouple junctions that produce an EMF proportional to the temperature difference between the junction. For example the A and B type metals may be alumel and chromel. In the circuit shown in FIG. 1, the EMF produced by the junctions 26 and 28 are of opposite polarity so that the voltage V between lead wires 29 and 31 is a differential voltage whose magnitude is proportional to the difference in temperature between junctions 26 and 28. Thus, the voltage V between lead wires 29 and 31 is proportional to the amount of glucose in the blood. This voltage V may be monitored by appropriate instruments, such as an appropriately calibrated volt meter, to provide a continuous indication of the glucose levels in the blood. Alternately, the voltage V can be applied directly to an insulin reservoir/pump circuit with the latter having incorporated therein appropriate logic to cause the insulin pump to supply an amount of insulin to the blood as needed.
An alternate embodiment of the glucose measuring device 10' will now be described with reference to FIGS. 5 and 6. The device 10' includes an elongate cylindrical module 60 having a forward end 62, preferably defined by a planar surface, and a rearward end 64, also a planar surface. Incorporated within the module 60 and extending longitudinally therethrough are a plurality of double-lumened tubes 66, only two of which are indicated by the number 66 for the purposes of clarity. Each of the double-lumened tubes 66 comprises an inner lumen 68 and an outer lumen 70 with an elongate membrane tubule 72 being located within the double-lumened tube 66 concentric with a cylindrical wall 74 defining the outer diameter of the double-lumened tube 66 to separate the inner lumen 68 from the outer lumen 70 to contain a quantity of enzyme E within the outer lumens 70. As shown in FIG. 6, the membrane tubule 72 is attached to the inner wall 74 in much the same manner as is the membrane tubule 18 described with reference to FIG. 2.
A cavity 76 of the module 60 communicates with the outer lumens 70 and contains a supply of replacement enzyme E. The cavity 76 is formed inside of the rearward end 64 and extends axially from an inside wall 78 of the end 64 to a front wall 80, spaced forwardly of and oriented generally co-planar with the inside wall 78. A cylindrical band 82 circumferentially encloses the cavity 76 with an opening 84 being formed in the band 82 to permit communication between the cavity 76 and an enzyme delivery tube 86. The band 82 and rearward end 64 are preferably constructed separately of a body portion 88 of the module 60 to form a cap portion 75 thereof. A plurality of circular openings 90 are formed in the rearward end 64 and are spaced and arranged across the surface of the end 64 complementary of the open ends of the double-lumened tubes 66 at the front wall 80 of the cavity 76. The cap 75 is attached to the body 88 with the openings 90 aligned with the open ends of the double-lumened tubes 66. In manufacturing the module 60, the membrane tubules 72 may first be bonded to the walls 74 as shown in FIG. 6 with the initial length of the membrane tubules 72 being somewhat longer than that of the module 60. Prior to attachment of the cap 75 to the body 88, each individual membrane tubule 72 is positioned within one of the openings 90 in the cap 75. Then, the cap 75 is attached to the body 88 and the membrane tubules 72 are pulled rearwardly of the openings 90 so that they are relatively taut and generally concentrically located of the walls 74. Then, the membrane tubules 72 are bonded to the openings 90, thereby preventing escape of the enzyme from the cavity 76 into the blood exiting the inner lumens 68 at the rearward end 64 of the module 60.
A non-porous arterial delivery tube 92 is stretched over the front end 62 of the module 60 and is connected to a small artery by anastomosis as described above with reference to FIG. 1. Likewise, a non-porous venous delivery tube 94 delivers blood exiting the inner lumens 68 of the module 60 to a small vein and is connected thereto by an anastomosis.
The enzyme delivery tube 86 delivers the supply of enzyme E, preferably glucose oxidase and catalase, from a subcutaneous reservoir such as the reservoir 24 illustrated in FIG. 4 into the cavity 76. The outer lumens 70 are open to the cavity 76 at the front wall 80 of the cavity 76 to permit movement of enzyme E from the cavity 76 into the annular areas of the outer lumens 70. Preferably, the enzyme delivery tube 86 is formed as part of the venous delivery tube 94 and opens into the inner cylindrical wall of the venous delivery tube 94 for being positioned in communication with the opening 84 of the cylindrical band as shown. The cavity 76 is maintained substantially full of replacement enzyme E at all times to create an excess of enzyme E within the outer lumens 70 which helps to insure substantially complete oxidation of glucose.
In a preferred form of the module 60, 50 to 100 double-lumened tubes 66 are formed within the body 88. Preferably, the material forming the body 88 is a non-porous material which is substantially non-heat conducting, such as the synthetic material sold under the trdemark Dacron, to substantially eliminate the existence of a heat sink for absorbing heat produced during the oxidation of glucose within the outer lumens 70. In this regard, an insulating layer (not shown) should also be employed surrounding the glucose measuring device 10' to substantially eliminate heat transfer radially outwardly from the module 60.
The module 60 has a preferred diameter of about 2 cm with the outer diameter of each individual outer lumen 70 as defined by the diameters of the cylindrical walls 74 of the double-lumened tubes 66 being in the neighborhood of 0.5 to 2.0 mm. The membrane tubules 77 are preferably constructed and proportioned generally the same as the tubule 18 described above so that each tubule 77 has an inside surface area of approximately 50 to 500 mm2 for a total available surface area of membrane within the module 60 for diffusion of glucose into an area of enzymatic activity of about 25 to 500 cm2.
Thus, there exists in the preferred form of the device 10' a relatively large surface area of membrane in contact with the blood in proportion to the overall length of the device 10', which offers a much greater glucose clearance value than a single tube having the same or similar length. This offers an advantage over the use of a single tube where it is desired to measure the glucose concentration at a higher clearance value than can be achieved with a single tube arrangement.
A preferred means for producing a signal which is a function of the blood glucose concentration is provided by a series of micro-thermocouple junctions connected between lead wires 98 and 99, only two locations of which are illustrated in FIG. 5 for the purpose of clarity. Forward junctions 96 are located adjacent the entrance of blood into each of the inner lumens 68 and rearward junctions 100 are located adjacent the exit of blood from the inner lumens 68. The junctions 96 and 100 are formed by connections between A and B type material as previously described with regard to FIG. 1. The junctions 96 and 100 for each lumen 68 is a junction pair, and each junction pair are connected by a wire of B type material. The junction pairs are connected in series so that the differential voltages produced by each junction pair are added providing for a voltage V' between lead wires 98 and 99 which is the sum of the voltages produced by the junction pairs. To create the series connection, each rearward junction 100 is connected by an A type wire to a forward junction 96 of a different lumen 68, except that the first forward junction 96 in the series is connected to lead wire 98 and the last rearward junction 100 in the series is connected to lead wire 99. This arrangement makes it possible to obtain a signal from the device 10' even when the temperature increase of the blood flowing through the inner lumens 68 is very small. Also, the series connection of numerous thermocouple junction pairs has an averaging effect. If one pair produced an erroneous signal, that one erroneous signal would be only a part of the total voltage V' between lead wires 98 and 99.
Alternately, a single pair of micro-thermocouple junctions 104 are employed having an entrance junction 106 and an exit junction 108 which function generally in the same manner as the junctions 26 and 28 shown in FIG. 1 to produce a single voltage V' representative of the blood glucose concentration.
All of the materials employed in constructing the device 10 are selected to be biologically compatible for in vivo residence, and many such materials are known to be suitable and commonly available. Also, the wires forming the micro-thermocouple arrangements are insulated so that thermocouple junctions are electrically isolated from blood and other body fluids, and other necessary provisions are made, where necessary, to eliminate biological interferences with the operation of the device 10.
Although particular embodiments of the glucose measuring device have been described in the foregoing detailed description, it will be understood that the device is capable of numerous rearrangements, modifications and substitutions of parts without departing form the scope of the invention according to what is claimed below.
means for measuring the increase in temperature of blood passing through said first passageway, whereby glucose within the blood flowing in said first passageway diffuses through said membrane wall into said second passageway and is oxidized, generating heat and causing an increase in the temperature of blood flowing in said first passageway, with the magnitude of the increase measured by said means for measuring being a function of the glucose concentration in the blood.
2. The device of claim 1, wherein said means for measuring comprises entry and exit micro-thermocouple junctions, said entry micro-thermocouple junction being positioned in the vicinity of the entrance of blood into said first passageway and said exit micro-thermocouple junction being positioned in the vicinity of the exit of blood from said first passageway, said micro-thermocouple junctions being interconnected to produce a voltage signal corresponding to the increase in temperature of blood flowing through said first passageway.
said semi-permeable membrane wall being configured as a tubule and located between said inner and outer lumens.
4. The device of claim 3, wherein said means for measuring comprises entry and exit micro-thermocouple junctions, said entry micro-thermocouple junction being positioned in the vicinity of the entrance of blood into said first lumen and said exit micro-themocouple junction being positioned in the vicinity of the exit of blood from said first lumen, said micro-thermocouple junctions being interconnected to produce a voltage signal corresponding to the increase in temperature of blood flowing through said first lumen.
5. The device of claim 1, further comprising means for delivering replacement enzyme to said second passageway.
an enzyme delivery tube interconnecting said reservoir and said second passageway.
7. The device of claim 1, wherein said enzyme comprises glucose oxidase.
8. The device of claim 1, wherein said enzyme comprises glucose oxidase with catalase being added to decompose hydrogen peroxide produced when the glucose is oxidized.
means for producing a signal having a magnitude proportionate to the magnitude of the temperature increase of blood flowing through said inner lumens, whereby glucose within the blood flowing in said inner lumens diffuses through said membrane tubules into said outer lumens and is oxidized, generating heat and causing an increase in the temperatue of blood flowing in said inner lumens, with the magnitude of said signal being a function of the glucose concentration in the blood.
10. The device of claim 9, wherein said means for producing a signal comprises a plurality of micro-thermocouple junctions with one entry junction being located in the vicinity of the entrance of blood into each one of said inner lumens and one exit junction being located in the vicinity of the exit of blood out of each of said inner lumens, said plurality of micro-thermocouple junctions being interconnected in series with each entry junction being individually connected to the corresponding exit junction of the same inner lumen at which the junctions are positioned to form a junction pair, said junction pairs being connected in series, whereby the magnitude of the voltage signal produced by said plurality of micro-thermocouple junctions is equal to the combined magnitudes of the voltage signals produced by the junction pairs.
11. The device of claim 9, further comprising a cavity formed in said module for receiving and containing a supply of enzyme, said outer lumens being in communication with said cavity so that enzyme within said cavity enters and fills said outer lumens to maintain an excess of enzyme in said outer lumens.
an enzyme delivery tube inteconnecting said reservoir and said cavity of said module for delivering enzyme to said cavity from said reservoir.
Article entitled "Use of an Enzyme Thermister in Continuous Measurements and Enzyme Reactor Control", by Bengt Danielsson, Bo Mattiasson, Roland Karlsson, and Fredrik Winqvist, Biochemistry 2, Chemical Center, University of Lund, Box 740, S-220 07 Lund 7, Sweden, published in the magazine Biotechnology and Bioengineering, vol. XXI, pp. 1749-1766, (1979)--Accepted for publication Nov. 27, 1978.


I have been "gaming" in one form or another since childhood. Somewhere around my 8th birthday, my dad took my brothers and I to his place and let us play his new Pong system. It was the most amazing thing we'd ever seen. Then came our ColecoVision, which introduced us to Donkey Kong played over the TV. Then the multiple Atari 400 systems we received from Santa guaranteed my life-long obsession. Allowing me to lose myself to alternate realities of countless digital games.
Fast forward to 2013. Yes, I am still at it, much to the chagrin of my wife. After so many years and hours of glorious playtime, I have decided to profess my addiction with vehicle graffiti.
I have a few favorite games of all time. Of them all, I confess the Half-Life and Portal series by Valve have together successfully consumed well over a hundred hours of my life.
I now have my Half-life and Aperture Science logo stickers proudly displayed on my old-but-still-running 1995 Pathfinder XL.
Official web site for Jason Skowronek and the Skowronek Family.


text:
Critical Intelligence Unit
Evidence Check
System capacity and evaluation
COVID-19 Critical Intelligence Unit
Evidence Check - System capacity and evaluation
Infrastructure, hospital capacity, human resources, supplies, monitoring, surveillance, prediction, evaluation, post-pandemic
Routine border screening evidence check
Added: 7 Dec 2020
What is the evidence or existing policy for routine asymptomatic screening for COVID-19 in exposed workers at border settings (such as airports, seaports, hotel quarantine)?
Is there evidence for which workers should be screened (such as all staff, cleaning staff, compliance staff, security, catering, health)?
What is the most effective frequency of screening?
What is the most effective type of screening (such as saliva, nasopharyngeal swabs, serology)?
Show summary | Download full Evidence Check (PDF 485 KB)
No studies were identified in the peer reviewed literature for routine asymptomatic screening for COVID-19 in exposed workers at border settings. Many articles on asymptomatic screening for travellers were identified, but not included in this review.
Many documents outline action plans, including monitoring and reporting of COVID-19 symptoms of workers and encouraging testing if workers have symptoms, without mentioning routine testing.
In Australia, hotel quarantine has been identified as a major risk for the reintroduction of COVID-19 to Australia and as a result, state health authorities have introduced weekly testing of quarantine staff.
Asymptomatic workers at Western Australia's borders and in quarantine hotels will be able to take up weekly COVID-19 testing (from 11 September until 30 November). This includes testing staff at: - quarantine hotels including
hotel employees, security staff working at the hotel, health staff, drivers of transport of quarantine guests, WA police and others such as the defence force - Perth airport including
workers on site, airport or airline staff, WA police, security, federal agencies, drivers of hotel quarantine buses - sea ports and border crossings including
anyone involved with close contact of people arriving from overseas or interstate.
In New Zealand, an asymptomatic testing program for higher-risk workers includes: - managed quarantine facilities and transport (testing once every 7 days) - managed isolation facilities and transport (testing once every 14 days) - Ports of Auckland, Port of Tauranga and Auckland International Airport (testing once every 14 days) - people who work in managed isolation or quarantine facilities, including those who drive people entering the country from the airport to the facilities, border workers in customs, biosecurity, immigration and aviation security at airports, people who clean in areas used by arriving travellers, or who clean the aircraft, and people working in airside services such as food-halls where people in transit may be waiting. Border workers at maritime ports such as ship pilots, stevedores and those providing seafarer welfare support as well as people working in customs, immigration and public health at maritime ports and air crew.
In Singapore, staff at Changi Airport who come into close contact with passengers are tested for COVID-19 every two weeks.
The United States - Department of Transportation have guidance for air carriers and staff based around health monitoring and screening for symptoms at the start of duty - Delta airlines announced it will start offering rapid response COVID-19 tests to its flight attendants. The optional tests will be performed by a clinician via nasal swab with results taking fewer than 15 minutes (news article) - In high-density critical infrastructure workplaces, the Centers for Disease Control and Prevention recommend a risk-based approach to testing co-workers of a person with confirmed COVID-19. General practices should include pre-screening (temperature and symptom assessment) and regular monitoring of symptoms.
Wastewater surveillance for COVID-19 evidence check
Added: 11 Nov 2020
What is the evidence for monitoring wastewater as a surveillance strategy for COVID-19?
The presence of SARS-CoV-2 in the faeces of infected patients and wastewater has drawn attention to the use of wastewater as an epidemiological tool. Wastewater surveillance of COVID-19 can be an efficient, cost-effective way to survey transmission dynamics of communities as a complementary approach to assessing the prevalence of COVID-19 in a community.
SARS-CoV-2 has been detected in wastewater samples from many regions around the world including
Australia, Spain, Italy, Netherlands, China, the United States of America, Germany, Japan, India, Czech Republic, Brazil and Ecuador.
Often in these reports wastewater samples tested positive before, at the same time, or soon after positive COVID-19 cases were reported in the respective areas. In one study, the viral titers observed were significantly higher than expected based on clinically confirmed cases.
While the majority of studies detect positive SARS-CoV-2 in raw wastewater, there have been some positive tests in treated wastewater. This needs to be balanced against studies that did not detect positive SARS-CoV-2 in treated wastewater.
The World Health Organization outlines major potential use cases for environmental surveillance for SARS-CoV-2 including: early warning, detection in locations with limited clinical surveillance, monitoring circulation of SARS-CoV-2 and research. Considerations outlined by the World Health Organization for implementing environmental surveillance include: representativeness, coordination, cost-effectiveness, ethical and legal considerations and quality assurance.
In Australia, the Commonwealth Scientific and Industrial Research Organisation (CSIRO) has a method for monitoring sewage for early detection of COVID-19 outbreaks over 14 days, from people being exposed to SARS-CoV-2, wastewater samples collected and tested, reporting to public health officials, through to clinical nasal swab tests for people who begin to show symptoms.
Elective surgical procedures, non-surgical alternatives and shared decision-making evidence check
Added: 7 Oct 2020
What non-surgical alternatives to elective surgery have been reported in literature?
What evidence is available on the impact of shared decision-making interventions and tools on decisions regarding elective surgical procedures?
Non-surgical alternatives management refers to treatments that avoid surgery and other invasive procedures.
This review identified 151 surgical procedures for which non-surgical alternatives have been reported in recent systematic reviews (2015-present).
The most common types of conditions reporting non-surgical alternatives to elective surgery were orthopaedic injuries and degenerative conditions, cardiovascular conditions, and cancers.
Non-surgical options include active surveillance (or 'watchful waiting'), delayed surgery, and (non-operative) medical treatment.
This review is about shared decision-making between clinicians and patients for management of patients by surgical treatment or non-surgical alternatives.
to promote or integrate shared decision-making for elective surgical treatments and procedures included: o a decision-making checklist, which led to an informed decision to defer urogenital sinus surgery. patient education provided by a multidisciplinary team, which led to more informed and confident decision-making in patients considering treatment options for prostate cancer
Waste from personal protective equipment evidence check
Is there any evidence or data about the amount of waste produced from personal protective equipment (PPE) during the COVID-19 pandemic?
There are widespread concerns that the requirements for use of PPE during COVID-19 have resulted in a significant increase in plastic pollution.
A recent study estimated a global monthly use of 129 billion face masks and 65 billion gloves.
A pre-peer review article reported an estimated carbon footprint of the PPE supplied during the first six months of the pandemic in England of 158,838 tonnes of carbon dioxide equivalent, with greatest contributions from gloves, aprons, face shields, and Type IIR surgical masks. The consequences of this pollution included a loss of 314 disability adjusted life years, a 0.67 loss of local species per year, and resource depletion equivalent to US$20.4 million.
Local studies focused on estimating medical waste during the pandemic have been undertaken in China, South Korea and Italy.
As well as concerns about the volume of waste generated, is the question of safe disposal. The United Nations Environment Program reviewed practices for managing waste from healthcare facilities, households and quarantine locations accommodating people with confirmed or suspected cases of COVID-19 and provides recommendations for policy makers and practitioners to improve waste management.
Resuming elective surgery – volume-outcome relationships in surgery evidence check
Added: 28 Aug 2020
What is the evidence regarding a volume-outcome relationship for surgical interventions?
For some surgical procedures, there is evidence of a volume-outcome relationship – a correlation between lower number of cases and poorer outcomes.
Volume-outcome relationships have been evaluated at both a surgeon and hospital level. For procedures with a shorter length of stay and specific intraoperative processes and skills, the volume of procedures performed by the surgeon are more likely to influence outcomes, while for procedures with longer lengths of stay, the volume of procedures performed at the hospital is more likely to be important.
Definitions of what constitutes a 'low volume' varies across studies, countries and conditions. Reporting of definitions of volumes is often inadequate and not consistent across studies.
Outcomes reported include mortality, postoperative complications, length of stay, cost of hospital stay, and readmissions and reoperations/revisions.
The quality of studies and strength of association between volumes and outcomes varies.
Conditions where a volume-outcome relationship has been reported in systematic reviews include: pancreaticoduodenectomy, colon, rectal and colorectal cancer, bariatric surgery, breast cancer, abdominal aortic aneurysm, spinal surgery, cystectomy, oesophageal cancer, stomach cancer, head and neck cancer, lung cancer, radical prostatectomy, gynaecology surgery, carotid endarterectomy, paediatric heart surgery, AIDS, hysterectomy, thyroidectomy, transcatheter aortic valve implantation, nephrectomy, hernia, acute aortic syndrome, revascularisation of the lower limbs, hip and shoulder arthroplasty.
Conditions where volume-outcome relationship has not been clearly established include liver resections, Norwood procedure, adrenocortical carcinoma and thoracic aortic aneurysms
There is mixed evidence across reviews regarding percutaneous coronary intervention, hernia, trauma and injury, and coronary artery bypass grafting.
Resuming elective surgery – the evidence for prehabilitation evidence check
Added: 16 Jul 2020
What is the evidence that 'prehabilitation' or preoperative rehabilitation before surgery improves value or outcomes for patients?
Prehabilitation is a process of enhancing patients' physical functionality preoperatively to support them to deal with major surgery.
Studies vary widely in terms of types of intervention, study population, and outcomes assessed.
Resuming elective surgery - post-surgery innovations evidence check
What is the evidence for post-surgery innovations in an outpatient setting, such as virtual follow up and rehabilitation, in improving outcomes for patients who have undergone surgery?
Telerehabilitation has been shown to reduce pain and improve function, with no differences observed in rates of hospital readmissions or treatment-related adverse events following total hip or knee replacement for people with osteoarthritis, compared to usual care. A further review on knee arthroplasty found that compared with face-to-face rehabilitation, telerehabilitation could achieve comparable pain relief, better Western Ontario and McMaster Universities Osteoarthritis Index improvement, significantly higher extension range and quadriceps strength. Another review for this condition found patients experienced high levels of satisfaction with the use of telerehabilitation alone.
A hybrid model, consisting home-based cardiac rehabilitation with direct supervised centrebased cardiac rehabilitation showed similar improvement in functional capacity, no significant difference in changes in exercise duration, systolic or diastolic blood pressure or health-related quality of life compared to standard cardiac rehabilitation programs.
Physiotherapy with telerehabilitation has the potential to increase quality of life, is feasible, and is at least equally effective as usual care in surgical populations.
Evidence on telerehabilitation after surgical procedures on orthopaedic conditions were in favour of telerehabilitation in patients following total knee and hip arthroplasty. There was limited evidence in the upper limb interventions.
One review examined the feasibility of remote telemedicine connection to provide in auditory rehabilitation services through hearing aids and cochlear implants. There are significant concerns regarding internet bandwidth limitations for remote clinics and a paucity of research examining reimbursement and cost-effectiveness for services.
Resuming elective surgery – productivity and efficiency approaches evidence check
What evidence is available about ways to increase productivity or efficiency in operating theatres and managing elective surgery waiting lists?
COVID-19 has led to postponement of elective surgery in many jurisdictions. This has resulted in an immediate increase in waiting times and a significant backlog of patients.
Both supply and demand side interventions are implemented in OECD countries to reduce waiting lists and increase productivity and efficiency in elective surgery.
Lean, and Six Sigma methods can increase productivity – and point to the importance of transformational leadership and workforce flexibility in achieving productivity gains.
Scenario and optimisation modelling have been used to identify and quantify potential productivity gains.
In England, a 2019 study estimated that theatre time lost to late starts, early finishes and delays between operations could have been used to perform 16.8% more operations.
A number of studies have demonstrated modest efficiency gains associated with interventions to improve start times and change-over times.
An English regulator identified five key levers to improve theatre productivity: 1. stratifying patients by risk 2. extending clinical roles 3. increasing throughput by explicitly measuring, communicating and managing the number of procedures per theatre session 4. implementing enhanced and rapid recovery practices to reduce length of stay 5. providing virtual follow-up for uncomplicated patients.
In New Zealand, one district health board introduced an incentive-based and clinically led model of care in 2012, which was associated with increases in productivity and reduced costs.
A Queensland study found that day-long sessions (as opposed to separate morning or afternoon sessions), mid-week sessions, certain specialties (e.g. neurosurgery sessions) and not scheduling long cases first were most beneficial to theatre utilisation.
Specialty approaches to improving efficiency have been adopted by the Getting it Right First Time program in the UK and estimated significant potential efficiency gains.
In NSW an operating theatre productivity index was developed in 2014 and was piloted in four site
Epidemiology and transmission
Community transmission and hospital infection, stages of pandemic, immunity, vaccination
Asymptomatic, disease progression, ambulance, drugs, community, hospitalisation, recovery, palliative care, death
Clinical models of care
Triage, virtual care, temporary hospitals, ethics
Enter keywords to search Evidence Checks
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Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health.


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GKN and Melrose – The Great British Takeover
Jack Hickman
The protracted and only recently concluded hostile takeover of engineering giant GKN by turnaround specialists Melrose dominated the business pages from start to finish, as the largest contested takeover since Kraft bought Cadbury in 2009, and was a throwback to old-school hostile takeovers and corporate raids.
Central to the battle were the competing communications strategies of the two sides, with each trying to convince shareholders of the merits of their respective turnaround plans for the venerable engineer. Here, we look at two key questions from a communications standpoint: why was it so close, and why did Melrose eventually win?
Why was the vote so close?
On the face of it, one might have expected Melrose's bid to have been a no-brainer for the shareholders of GKN. The engineer had been struggling in recent years, culminating in a series of profit warnings in 2017 and an embarrassing U-turn on the appointment of a new CEO in November.
By contrast Melrose had delivered a 3000% return to shareholders since its inception in 2003, and had only failed to turn around one business in that time. Yet on March 29th, with a Brexit-esque winning margin, only 52.43% of investors holding voting rights backed the bid.
From a communications perspective, the reasons for this are two-fold. Firstly, despite its travails, GKN has an evocative history to call upon. The 259-year old engineer made cannonballs to fight against Napoleon, and Spitfires in the Second World War – albeit less than 5% of those produced. The prospect of an old and nationally historic firm losing its independence in a more protectionist political and media environment post-Brexit was a bitter pill for some to swallow.
Despite this, as we now know, Melrose won. In terms of messaging, GKN's defence had three key issues: complexity, inconsistency, and lack of differentiation
Secondly, Melrose had some messaging challenges of their own. Their usual model has been to turn around and sell businesses within five to six years, raising the question of whether they could be suitable stewards of a long-standing business, in an industry where long-term contracts and commitments are the norm. Similarly, their tendency to sell businesses on to the highest bidder and then pay their four chiefs handsome bonus packages left them open to accusations of corporate raiding and asset stripping.
Why did Melrose win?
Despite this, as we now know, Melrose won. In terms of messaging, GKN's defence had three key issues: complexity, inconsistency, and lack of differentiation.
GKN's defence of its independence was complicated.
It started by arguing that Melrose's initial offer was a 'false premium' that would see the business broken up before proposing the sale of first its Powder Metallurgy business, and then its Driveline operations (the latter of which would have saddled its investors with shares in a complex, dual listed business). It then raised future dividend targets while still pointing towards pension fund deficits for GKN workers, and cited national security concerns, even though GKN does not rank in the top 50 suppliers to the British military.
Contrasted with Melrose's mantra of 'Buy. Improve. Sell.', and its fundamental message that its management could do a better job than the GKN incumbents, and its clear to see why GKN's multi-pronged attacks fell short in the face of Melrose's more consistent and structured approach.
Similarly, GKN's attempts to wrap itself in the Union Jack while painting Melrose as hostile asset strippers also failed to hit home, given Melrose's own British credentials and the fact that less than 10% of GKN's total workforce is based in the UK (with its hastily appointed CEO, Anne Stevens, an American).
To add insult to injury, in the final week of the debate, GKN declared that it had the support of a majority of its shareholders in an ill-advised Sunday newspaper interview only to be forced to retract this statement a day later as it emerged that they couldn't verify the claims.
However, perhaps GKN's biggest communications failing was that it simply didn't do enough to differentiate its plan from that of Melrose. Both essentially entailed selling some non-core and underperforming assets in order to raise margins and pump money into GKN's pension schemes.
With the substance of the plans relatively similar, the decision for shareholders came down to which management they preferred: the incumbent, who were tainted by association with GKN's struggles, or Melrose, a credible challenger offering a fresh start.
What can be learned?
The first lesson is that no matter the spin, a firm's intrinsic qualities come to the fore. GKN was fundamentally underperforming while Melrose, despite their strong track record, could never shake accusations of profiteering.
Secondly, and perhaps most importantly, a simpler message that is consistently delivered trumps a complex and multifaceted narrative.
And finally, if you're going to emphasise your British credentials and cite national security concerns, you need to be able to support your argument with facts as well as emotional rhetoric.
Strategic asset M&A
Spotlight On: M&A Defence Positioning


The eLearning Work Group, comprised of dedicated faculty and support staff across the institution, reviewed best practices in the field of distance education. The work group evaluated multiple programs to discover common criteria, created a set of recommended categories for online courses, and generated a faculty checklist to support faculty teaching online at MVC.
How does the checklist support online faculty and students?
Designed as a self-support resource the faculty checklist provides a standardized set of attributes, 17 in total, that support student success in online courses. The checklist includes attributes (simple YES/NO checkboxes) related to Course Overview, Design and Layout, Course Alignment, Learner Engagement, and Universal Design and Accessibility. Utilization of the checklist is part of a continuous effort to support quality in online course design.
What professional development courses will be offered to support this effort?
"Best Practices for Teaching Online" will be designed and developed in a continued collaborative effort and feature faculty and students across NISOD member institutions. This professional development program will be delivered via a competency-based online course, to be developed during summer and fall 2018, with an official launch date set for early 2019.
A competency-based online course, collaboratively developed, featuring online students and faculty at multiple institutions, and officially recognized by NISOD!
How will faculty who complete this professional development be recognized?
As recommended by the eLearning Work Group, MVC and the National Institute for Staff and Organizational Development (NISOD) are joining forces to design, develop, and promote a nationally recognized professional development program that supports faculty and instructional initiatives. The idea of this partnership is to increase awareness of best practices at higher education institution across the country and provide external recognition to online faculty via NISOD.
The official announcement occurred at the NISOD 2018 International Conference on Teaching and Leadership Excellence and a joint press release was released shortly thereafter. If interested in being a part of the first cohort of MVC faculty to successfully complete this program and receive national recognition, please initiate a conversation with your Instructional Dean. If you are a NISOD member institution wishing to collaborate and feature a faculty and student at your institution, please reach out to Steve Sosa, Dean of eLearning and Instructional Support.


Particularly suited to heavy machining of work pieces up to 8 metres long, the compact Univers 6000 combines high accuracy with a large work envelope. The unique right angle head allows for multi-sided machining to increase production flexibility. The sizeable working area can also be divided into two work zones for pendulum machining. Uniquely, the vertical main spindle of this travelling column machine can be gearbox driven, bringing increased torque of up to 1.000 Nm. This makes it possible to mill toughened materials and use larger tools.
The Univers 6000 is easily installed and can be operational very quickly. The raised guide ways and large work envelope make it the perfect machine for big and especially long work pieces such as beams and traverses, truck axles and trailer side members. Advantages like remote machine monitoring from Unisign's own service centre ensure high uptime and a good ROI.
On the one hand this is a powerful multi-use machining centre with a large work envelope. On the other hand it can be used as the basic platform for a variety of customer specific solutions. Usability is enhanced thanks to rotary tables as well as clamping tables, which are available in various lengths and capable of handling different loads. The work envelope also enables pendulum machining for added flexibility.
Several design aspects of the Univers 6000 contribute to its amazing accuracy. It starts with precise machine geometry. Another factor is the short distance between the spindle centre line and the Z-axis guide ways, which creates high rigidity. And then there is the water-cooled main drive that ensures thermal stability. In addition, the rigid build means repeatable production of complex work pieces is possible. Operators and work preparers can be confident that parts will be manufactured within the drawing tolerances at all times.


text:
52nd CONVENTION
Today, National Black Law Student Association ("NBLSA"), is a national organization formed to articulate and promote the needs and goals of Black law students to effectuate change in the legal community. We are proud to be one of the largest student-run organizations in the United States.
questions@nblsa.org
INTERESTED IN SPONSORSHIP?
For information regarding sponsorship and advertising opportunities for NBLSA, please contact our National Director of Corporate Engagement at corporate@nblsa.org.
© 2018 by NBLSA.
Welcome from the 48th NBLSA National Chair Mark A. Dunham, Jr.
On behalf of the National and Regional Boards of the National Black Law Students Association (NBLSA), I bring you greetings and welcome students, alumni, and partners alike to the 2017-2018 NBLSA Year, where we will commemorate 50 years of service! I am honored to serve you as NBLSA's National Chair, but more importantly, I am exceedingly proud to be in this amazing organization of brilliant, talented, culturally-conscious, and successful Black and minority law students.
We begin this year in the midst of a stormy time for the United States. While our hearts and thoughts are with the members of our Southwest Region as they weather Hurricane Harvey, we also think of the social, political, and cultural storms that pervade our Nation.
Our storm includes a President who by word and deed has abdicated moral leadership in the face of rising white supremacist, nationalist, and Neo-Nazi elements and has used the powers of the Presidency to condone the evisceration of the very Constitutional protections he swore to uphold. These acts only cover this month. Since January, we have observed while those in high and low places work to turn back the clock on the progress for which our mothers, fathers, grandmothers, grandfathers, civil rights leaders, and ancestors marched, sang, prayed, worked, sacrificed, bled, and died.
Nevertheless, like them, we march on undeterred and unbowed.
The vision of our Founder, Algernon J. Cooper, was of an organization that rises up in times of adversity, speaks out against injustice, and works as one despite those that would seek to divide us. NBLSA has been that organization, and I fully believe that we - students, alumni, and external partners - will continue to come together to lift each other up and propel each other forward, both now and for years to come.
As we mark our 50th Anniversary throughout the year, culminating in our 50th NBLSA National Convention on March 13-18, 2018 in Brooklyn, NY , we will celebrate both the legacy of our organization and the mission NBLSA continues to advance. Stay tuned for developments on the 50th National Convention, including registration and hotel information.
How can I get involved in NBLSA?
For students, that's easy - join NBLSA! Download and share our 2017-2018 Membership Packet to gain information on joining NBLSA and contact your local law school BLSA chapter or email Mary Pickard, National Director of Membership, at membership@nblsa.org . We are excited to welcome you into the NBLSA family.
For our alumni, contact our National Alumni Relations Team so we can connect you with the events, programs, and exciting developments NBLSA has planned for this year. This includes networking events, CLE opportunities, and NBLSA student -alumni mentorship programs across the nation. We value our continuing relationship with those who paved our way.
For our external partners, I invite you to learn more about NBLSA - who we are, what we do, and how we serve our membership and our community - and partner with us as we prepare the next generation of legal leaders. Our brief "About NBLSA" Presentationprovides a snapshot of our organization.
This is a very special NBLSA year. Together, we will remember a half century of dedication by students and alumni, and rededicate ourselves to the critical calling of our Founder's vision:
"To increase the number of culturally responsible Black and minority attorneys who excel academically, succeed professionally, and positively impact the community."
I thank you for the great work that we will do together for NBLSA, our members, and our community. If there is any way in which I may be of service to you, never hesitate to call upon me.
In NBLSA Service,
Mark A. Dunham, Jr.
National Chair
chair@nblsa.org | (202) 907-4753
NBLSA National Chair's Mid-Year Message
NBLSA Stands with Black Women Victimized by State Violence
You're Invited -- Upcoming Webinar: Law Firm Marketing 101


I have 1 10c ticket to Seattle 1 - Section 118, Row 9.
Still available. Face Value. Section 118 - Row 9.
I won't be there unfortunately, so I need to do something beforehand.
Lots of good Mexican food joints close by, too. El Chile, Vivo, Mi Madres...all just a 5 minute drive from the Venue. Texas Chili Parlor is also a good possibility for pre-game....great margaritas and of course, chili.


text:
2013 DoD Per Diem Rates for Netherlands - PerDiem101.com
Per diem rates in Netherlands are set by the Department of Defense (DoD), and apply to U.S. Government personnel, or the employees of private companies that use DoD per diem rates, travelling to Netherlands for business.
OCONUS World Per Diem Rates
No Rates Set
Per diem rates for each region in Netherlands are set on a month-by-month basis to reflect seasonal changes in cost of living. The per diem rates shown here are averages - to view the month-by-month breakdown of actual per diem rates, choose the region in which you will be travelling.
Number of Cities
Meals & Incidentals Rate
Lodging Rate
Amsterdam 1 $161.00 $263.00
Coevorden 1 $132.00 $178.00
Eindhoven 1 $125.00 $238.00
Lisse 1 $142.00 $196.00
Maastricht 1 $153.00 $268.00
Noordwijk 1 $117.00 $217.00
Papendrecht 1 $144.00 $217.00
Rotterdam 18 $144.00 $217.00
Schiphol 1 $132.00 $230.00
The Hague 1 $128.00 $224.00
Utrecht 1 $131.00 $187.00
Ypenburg 1 $128.00 $224.00
[other] 3 $131.00 $210.00
© 2022 PerDiem101. All rights reserved. Usage is subject to our Terms and Privacy Policy.
PerDiem101 is a free public resource site, and is not affiliated with the United States government or any Government agency
** This Document Provided By PerDiem101 **
Source: https://www.perdiem101.com/oconus/2013/netherlands


text:
<?php

namespace Test\Mentions\Listener;

use Flarum\Api\Serializer\PostBasicSerializer;
use Flarum\Core\Notification\NotificationSyncer;
use Flarum\Core\Post;
use Flarum\Event\ConfigureNotificationTypes;
use Flarum\Event\PostWasDeleted;
use Flarum\Event\PostWasHidden;
use Flarum\Event\PostWasPosted;
use Flarum\Event\PostWasRestored;
use Flarum\Event\PostWasRevised;
use Test\Mentions\Notification\PostMentionedBlueprint;
use Illuminate\Contracts\Events\Dispatcher;
use s9e\TextFormatter\Utils;

class UpdatePostMentionsMetadata
{
    /**
     * @var NotificationSyncer
     */
    protected $notifications;

    /**
     * @param NotificationSyncer $notifications
     */
    public function __construct(NotificationSyncer $notifications)
    {
        $this->notifications = $notifications;
    }

    /**
     * @param Dispatcher $events
     */
    public function subscribe(Dispatcher $events)
    {
        $events->listen(ConfigureNotificationTypes::class, [$this, 'addNotificationType']);
        $events->listen(PostWasPosted::class, [$this, 'whenPostWasPosted']);
        $events->listen(PostWasRevised::class, [$this, 'whenPostWasRevised']);
        $events->listen(PostWasHidden::class, [$this, 'whenPostWasHidden']);
        $events->listen(PostWasRestored::class, [$this, 'whenPostWasRestored']);
        $events->listen(PostWasDeleted::class, [$this, 'whenPostWasDeleted']);
    }

    /**
     * @param ConfigureNotificationTypes $event
     */
    public function addNotificationType(ConfigureNotificationTypes $event)
    {
        $event->add(PostMentionedBlueprint::class, PostBasicSerializer::class, ['alert']);
    }

    /**
     * @param PostWasPosted $event
     */
    public function whenPostWasPosted(PostWasPosted $event)
    {
        $this->replyBecameVisible($event->post);
    }

    /**
     * @param PostWasRevised $event
     */
    public function whenPostWasRevised(PostWasRevised $event)
    {
        $this->replyBecameVisible($event->post);
    }

    /**
     * @param PostWasHidden $event
     */
    public function whenPostWasHidden(PostWasHidden $event)
    {
        $this->replyBecameInvisible($event->post);
    }

    /**
     * @param PostWasRestored $event
     */
    public function whenPostWasRestored(PostWasRestored $event)
    {
        $this->replyBecameVisible($event->post);
    }

    /**
     * @param PostWasDeleted $event
     */
    public function whenPostWasDeleted(PostWasDeleted $event)
    {
        $this->replyBecameInvisible($event->post);
    }

    /**
     * @param Post $reply
     */
    protected function replyBecameVisible(Post $reply)
    {
        $mentioned = Utils::getAttributeValues($reply->parsedContent, 'POSTMENTION', 'id');
        $this->sync($reply, $mentioned);
    }

    /**
     * @param Post $reply
     */
    protected function replyBecameInvisible(Post $reply)
    {
        $this->sync($reply, []);
    }

    /**
     * @param Post $reply
     * @param array $mentioned
     */
    protected function sync(Post $reply, array $mentioned)
    {
        $reply->mentionsPosts()->sync($mentioned);
        $posts = Post::with('user')
            ->whereIn('id', $mentioned)
            ->get()
            ->filter(function ($post) use ($reply) {
                return $post->user && $post->user->id !== $reply->user_id;
            })
            ->all();
        foreach ($posts as $post) {
            $this->notifications->sync(new PostMentionedBlueprint($post, $reply), [$post->user]);
        }
    }
}

redpajama_set_name: RedPajamaGithub


text:
Eye trackers
E-Prime Extensions
Safety Lenses
External Processing Unit
Additional Mounting Brackets
StimTracker
Training and Education Services
Lab Setup and Method Development
Tobii Pro Classroom
Infant and Child Research
Human Factors and Engineering Research
Marketing and Consumer Research
Wearable eye tracking research
Screen-based eye tracking research
Marketing and User Research
Shopper Research
Packaging Research
Industry and Human Performance
Productivity and Quality
Research Funding Support Services
Press images and videos
Training Conference & Expo 2020
The Quirk's Event
The Quirk's Global Event 2021
SPSP Annual Convention
Printemps des études
Webinar: Introduction to Tobii Pro Fusion - 10 AM CET time zone
Webinar: Understanding the customer journey through eye tracking
HSE EU Congress
Webinar: Eye tracking the user experience in and outside the lab
Webinar: A beginner's guide - Wearable eye trackers
How eye tracking can reveal the effectiveness of advertisements at sporting events
How science can help us understand art
Dating with Tobii Pro Glasses 2
How eye tracking gives insight into musical minds
What's the formula behind an f1 driver? Eye tracking could uncover the recipe for success
Contact Insight Services
Customer Spotlight: How Eye Tracking Helps Avanza Create a Seamless User Experience
Take the guesswork out of UX and optimize your products and services.
Expectations have never been higher among consumers for products and services that 'just work'. It's no longer enough to have something that's simply good enough; and delivering a website or digital service that's anything short of intuitive to use will send customers into the arms of competitors. Companies have realized the importance of UX testing and design, and those who work in this field are embracing a raft of new technology which is enabling them to get a deeper level of understanding into how users interact with their products.
Eye tracking has long been tied to UX research and revered for its ability to reveal the WHY behind people's actions and deliver a great breadth of quantitative data on human behavior and interaction. Now this technology is becoming more accessible to the wider community of UX designers.
We sat down with Teresia Schullström, a UX designer at Avanza, Sweden's largest online stockbroker, to discuss how the company uses eye tracking in the design and development of their services.
Q: How important is user experience testing for Avanza?
A: It's vitally important for us that a user's experience is virtually seamless; that's what sets us apart from the competition and we want to take advantage of that. We operate solely in an online environment, so we depend on having not only a fully functioning platform, but one which our customers can depend on and feel confident using.
Q: What role does user experience testing play in ensuring your services are optimized?
A: We user test everything, and the more important features we test many times. It's not just in the beginning either, we are continually reviewing and making changes to ensure we keep up with customers' needs, and also stay one step ahead in coming up with new features or ways to make it easier for people to manage their finances with us. When you're dealing with something as important and emotive as people's money, you need to make sure customers have the confidence in you to make big financial decisions; and delivering a reliable and easy to use platform is a crucial part of that.
Q: What methods do you currently use?
A: We have a range of tools; one-on-one observations, interviews, surveys, and now eye tracking is a huge complement to these. It answers a lot of questions which come up from other testing methods and even highlights some questions we weren't aware of.
Q: How have you incorporated eye tracking into your UX testing and design process?
A: We use eye tracking at several stages; from the initial testing to ongoing optimization. We generally have the test participant complete set tasks using our website on a computer with the eye tracker while a moderator sits with him or her, we also generally have our broader UX team, designers, and sometimes other stakeholders watching the live-view of the data from another part of the office. When they have questions, they're able to message the moderator who asks the participant to clarify why they did something, or what they thought about particular things.
Q: What would you say are the biggest benefits of eye tracking?
A: Eye tracking is useful to understand the customers better than they understand themselves sometimes. Often, it can be difficult for them to remember exactly what they were doing or thinking and why, but because you see exactly what they looked at you can pause and ask them to explain their train of thought in the moment and that's incredibly valuable to truly understand user experience.
Q: How has eye tracking helped the way in which you conduct user testing?
A: We use eye tracking alongside many of our existing tools to complete the missing pieces of the puzzle. For example if the user is given a task like creating and opening an account, we might be able to see from the eye tracking that they looked at the menu or button which takes them to that feature, but they didn't complete the task, so from this we can see that the feature was visible, but we need to improve the communication around how to complete this task. Eye tracking can also help reveal where people naturally gravitate to when searching for particular information like the 'contacts' or 'help' section and even how they search for more complex information like definitions and explanations of some of our products.
Q: Has eye tracking improved the way your UX and design team operates?
A: For us the live-viewing feature is great. As we're a bank dealing with sensitive information we can't record any of our sessions, but the live-view allows us to show the broader design team what happens during user testing and it really gives them greater empathy with our customers. It also delivers clear evidence of design flaws or usability problems, so it removes the need for a lot of internal debate – the eye tracking information says it all and because you can see what they are looking at in real-time you can ask questions and get immediate answers as they are completing the given task, it's really helpful.
Teresia Schullström is a UX designer for Avanza. She has a Masters in Media Technology and Human Computer Interaction and has 6 years experiencing working with user research and UX design.
What is eye tracking?
Google study - TV and YouTube ads
Tools to deal with the shift to Industry 4.0
Differences aren't deficiencies: Eye tracking reveals the strengths of individuals with autism.
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