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Medline Search
Medico-legal implications in hernia surgery
Reinhard Bittner
Department of Hospital Surgery, Sechenov University, Moscow, Russia; Department of Surgery, Marienhospital Stuttgart, Stuttgart, Germany
Date of Submission 14-Jul-2019
Date of Acceptance 15-Jul-2019
Dr. Reinhard Bittner
Supperstr. 19, 70565 Stuttgart
DOI: 10.4103/ijawhs.ijawhs_27_19
AIM: Litigation is always a severe burden for every surgeon who is involved. The study aims to show the most important reasons for an allegation and how to prevent a lawsuit.
METHODS: Based on the own experience as a medical advisor, ten medico-legal cases are analyzed and a systematic overview of the corresponding literature is given.
RESULTS: Allegation for malpractice is not very frequent; in hernia surgery, <1% of the patients are involved. Furthermore, only in 20%–40% of these cases, the decision is in favor of the claimant. However, every case is associated with compensation ranging from roughly between $19,000 and $8,000,000. Totally the author had to perform 10 reports in legal cases for the court: In three cases, compensation had been refused, because informed consent had correctly been done, and the operative situs was clearly documented, and in the third case, the preoperative diagnostics and the operative performance had been according to the medical standard. The claim was successful in three patients because of technical failure, in two cases because of wrong indication, and in two cases because of delayed reoperation.
DISCUSSION: There are five key features in the prevention of a lawsuit in surgery: (1) "informed consent:" Take the time, use a standard form, show pictures and make handwritten notes to explain in detail the indication for surgery, the technical performance of the planned intervention, and the steps of aftercare; (2) "technical performance" of the operation should follow the generally accepted medical standard. Deep knowledge of anatomy is an indispensable precondition of perfect operation; (3) a "delay in timely response" to a complication is not excusable; (4) "careful documentation" of all steps of the treatment may possibly avoid a legal case; and (5) "establishing an empathic relationship" between the surgeon and the patient and his/her relatives as well is essential for avoiding an accusation.
CONCLUSION: Medico-legal implications in hernia surgery are rare, but a severe burden for every surgeon concerned and may be associated with damage to the reputation of the surgeon and high costs. The best ways of preventing such a disaster are the correct indications and operative performance according to the current medical standard and empathic aftercare.
Keywords: Complications, endoscopic hernia repair, hernia repair, inguinal hernia repair, laparoscopic hernia repair, lawsuits, litigation, malpractice, medico-legal aspects
Bittner R. Medico-legal implications in hernia surgery. Int J Abdom Wall Hernia Surg 2019;2:105-13
Bittner R. Medico-legal implications in hernia surgery. Int J Abdom Wall Hernia Surg [serial online] 2019 [cited 2022 Jan 19];2:105-13. Available from: http://www.herniasurgeryjournal.org/text.asp?2019/2/3/105/265864
Complications during and after surgical interventions may happen; however, in most of the cases, they are not caused by malpractice. On the other hand, malpractice does not inevitably lead to a litigation case. Some patients who are not satisfied with their surgical treatment claim for compensation of their suffering due to complicated course. Fortunately, in many cases, these claims are not justified, but the differentiation between a complication which can happen and a treatment failure may be difficult. Anyway, a litigation case is always a severe burden for a surgeon who is accused.
The aim of the present study is to analyze several legal cases, to advise how to avoid this burden, and to review the literature accordingly.
The study is based on the experience of the author as a Medical Advisor for the Court and the Conciliation and Compensation Commission of the German Medical Association in ten cases of patient claims. For review of the literature, a PubMed research was done using the following research terms: "litigation AND hernia repair," "malpractice AND hernia repair," "litigation AND laparoscopic hernia repair," "litigation AND open hernia repair," "malpractice AND laparoscopic hernia repair," "malpractice AND open hernia repair," "mishaps AND hernia repair," and "mistakes AND hernia repair."
Using these search terms, a total of 280 hits were found; however, due to double mentioning, non-English language, or not related to the topic of this study, only 32 publications seemed to be useful.
A 49-year-old male patient was admitted in the department for general and visceral surgery for repair of a right-sided scrotal inguinal hernia. The surgical approach was by transabdominal preperitoneal patch plasty (TAPP). After establishing the pneumoperitoneum and the first laparoscopic view to the groin, the diagnosis "scrotal hernia" could be confirmed. Furthermore, the operating surgeon found extensive adhesions between the large hernia sac and the omentum, respectively, the small bowel. After introducing the working trocars, an operator describes in his report a meticulous detachment of all these adhesions. A lesion to the bowel did not happen according to this report. During the following days, the patient complained of some unusual severe pain in the region of the right lower abdomen and of the flank. Therefore, he was kept in the hospital for observation. At the 3rd day, after the operation, because of increasing right-sided pain, a urologist was consulted who recommended a computed tomographic (CT) scan. In the CT scan, an inflammatory mass in the right lower abdomen/flank was suspected. Despite increasing signs of sepsis not before 2 more days later, the patient was reoperated: intraoperatively, two lesions to the small bowel and fecal peritonitis were found. During the operation, resuscitation because of a septic shock was necessary. A hemicolectomy was done and the abdominal cavity was lavaged. One day later, the patient died.
An adhesiolysis of some hernia content from the hernia sac is unnecessary and carries the risk of an injury to the hernia content. In the case you find severe adhesions between the hernia content and the peritoneum, it is advisable not to try adhesiolysis, but start the operation as usual, dissect the preperitoneal space, expose the hernia ring, incise the ring and reduce the sac inclusive the hernia content "en bloc".
In case of unusual pain, do not wait such a long time, do a relaparoscopy, and you will find the reason and can repair in time and avoid a septic course. A relaparoscopy is not a severe burden for the patient, you can use the old openings, and you can do it even in the bed of the patient on the intensive care unit. However, the real severe mistake, in this case, was that the urologist found in the CT scan suspicion of an abscess formation, but the surgeon operated not before 2 days later. In the litigation process, the surgeon was found guilty and had to pay compensation to the relatives of the patient. Reason for being guilty was delay in treatment of the complication.
A 46-year-old male patient was admitted in the hospital because of a bilateral inguinal hernia. He was treated by TAPP. The meshes were fixed by fibrin glue. Operation and early postoperative course were uncomplicated. However, 8 days later, a recurrence was detected on the right side. Re-TAPP was done. Intraoperatively, a direct recurrence was found because of dislocation of the mesh toward the right lateral compartment. Removal of the primary implanted mesh was not possible; therefore, the surgeon implanted a second mesh; however, this time, he fixed the mesh with tacks. At the evening after the operation and the next day, the patient suffered from urinary retention and gross hematuria. He was treated with a Foley catheter for 24 h. After ceasing of the hematuria, the catheter was removed, and the patient dismissed at home. Three months later, when the patient was jogging the hematuria recurred. Now, he visited a urologist. The urologist performed a cystoscopy which showed a foreign body penetrating the wall of the urinary bladder [Figure 1]. In the following operation, the urologist resected that part of the bladder containing the foreign body. The pathologic-histologic investigation of the specimen revealed a section of the wall of the urinary bladder, in which parts of a mesh with metallic tacks were incorporated. The postoperative course was uncomplicated, but the patient claimed for compensation. The Court accepted his claim.
Figure 1: Parts of the mesh inside the urinary bladder
Use of glue is an excellent technique for mesh fixation; however, for a sustainable success, a complete dissection of the groin is required starting at the spina iliaca anterior superior (Spina iliaca ant. sup.) and ending about 1–2 cm beyond the symphysis at the contralateral side. In the case of bilateral hernia, there should be an overlapping of both meshes in the midline. Pubic bone and rectus muscle must be clearly exposed; only in this case, the mesh can safely be fixed to these structures even with tacks. In his operating report, the surgeon does not describe the view neither of the mesh which was implanted on the contralateral side nor the view of the midline constituting by the rectus muscle and the symphysis. We concluded the technical failure of the surgeon, i.e., the surgeon had missed the right plane and fixed the mesh to the urinary bladder.
A 53-year-old male patient was admitted in a surgical unit because of an umbilical and an epigastric Hernia. Intraoperatively, the surgeon cut the bridge between the two hernia openings. This resulted in a fascial defect in the midline of 5–6 cm. Although the surgeon describes a very thin fascia and a concomitant rectus diastasis, he closed the defect by suture according to Mayo. Already 2 months later, a large recurrence was observed and the patient was reoperated. This time a mesh was implanted; however, the size of the mesh was not documented. One year later, a third operation because of a second recurrence was performed. Intraoperatively, a defect of 2.2 cm × 1.3 cm was detected and again closed with a mesh. According to the report of the Medical Advisor of the Compensation Commission of the German Medical Association, the patients claim for compensation was justified.
According to multiple comparative studies and the data from registries, it is recommended to implant a mesh in primary ventral hernias except in cases the umbilical hernia is very small (diameter < 1–2 cm) and occurs within the midline of a dense linea alba of a quite normal stabile abdominal wall. Furthermore, one study could demonstrate a very high recurrence rate in patients presenting with a hernia in the midline and a concomitant rectus diastasis, but the implanted mesh was not large enough to stabilize the whole midline.[1] The surgeon was convicted to pay compensation because his performance was not adequate to the clinical standard at that time.
A 63-year-old female patient was submitted to the hospital because of a recurrence nearly 2 years after open sublay repair of an incisional ventral hernia in the midline. By ultrasound, a hernia defect of 3.5 cm × 4 cm was described. A laparoscopic repair using the IPOM technique was planned. Intraoperatively, extensive adhesions were found which had to be detached from the abdominal wall inclusive of the hernia defect for implantation of the onlay mesh. During adhesiolysis, two lesions to the transverse colon had to be overstitched what according to the operation report could be done safely. The immediate postoperative course was uneventful; however, already the next day, the patient complained of severe abdominal pain and nausea which persisted for the following days. Not at least due to the demanding of the relatives of the patient, a reoperation was done not before the 3rd postoperative day. During the interval between the operation and the reoperation, no description of an investigation of the abdomen can be found in the medical record. During the first reoperation, two openings of the small bowel (ileum) were found and a severe fecal peritonitis was also found. A resection of the part of the injured ileum and a lavage of the abdominal cavity were done. Again, the postoperative course was complicated; no control of the septic process was possible despite a total of 18 revisional operations. Remarkable eight surgeons were involved and 12 of the reoperation were done during emergency time. At the end, the patient died 53 days after the primary operation. The Medical Advisor agreed to the claim of the relatives and requested compensation, because an adequate postoperative care had not been provided by the surgeon.
Injuries to the bowel during an adhesiolysis may happen; every surgeon has to be aware of this complication. However, this complication becomes a litigation case, if the surgeon does not react adequately according to the medical standard. Keep in mind, all aberrations from normal postoperative course must be carefully documented, and the reoperation has to be in time. Revisional operations are the most difficult in surgery; they must be done by the most experienced surgeon during the prime operation time and not during duty time by the surgeon on call.
A 43-year-old male patient was admitted because of a painful right-sided recurrent inguinal hernia after an open repair (Lichtenstein) 4 years ago. The surgeon performed a laparoscopic reoperation (TAPP). Intraoperatively, he found very dense adhesions between the vas deferens and the hernia sac. During parietalization of the hernia sac and taking down these adhesions, the Ascalenia spermatica was damaged. When attempting to control the bleeding, a thermic lesion to the vas did happen. Apart from that, the further operation ran uncomplicated. Immediately, after the operation, the patient was informed of the complication which had happened. Moreover, a urologist was consulted. The urologist found a swollen right scrotum, but the testis showed still some perfusion. Two months later, ultrasound showed homogeneous parenchyma with normal perfusion of both of the testes. Nevertheless, the patient claimed for compensation.
Damage to the testicular vessels is a well-known complication in inguinal hernia repair and may result in painful orchitis and atrophy of the testes in the latter course. Therefore, it is extremely important to get preoperatively the informed consent of the patient, document the clinical evidence, and talk to the patient postoperatively. The surgeon had done all these requirements; moreover, the testes recovered completely. The claim of the patient was refused.
During a postoperative routine check after an orthopedic operation of his shoulder, a 55-year-old male patient complained of some numbness at the lateral/proximal part of the skin of the right thigh when remaining in an upright position for a longer time. The patient was transferred to a general surgeon who diagnosed a "17-mm" inguinal hernia by ultrasound. Furthermore, corresponding to the complaints of the patient, he suspected a meralgia paresthetica and admitted the patient to a hospital for hernia repair. A Lichtenstein repair was performed but unfortunately not by the surgeon who had admitted the patient. Intraoperatively, no hernia sac was found but lipoma at atypical location. Lipoma was removed, and because of the complaints, a neurectomy of the N. ileo-inguinalis (ilioinguinal nerve) was performed. Postoperatively, the patient reported not only persistent numbness at the thigh but now also in the inguinal region. He complained of problems when shaving this region and during sexual activities.
Meralgia paresthetica was described for the first time by Bernhardt in 1895[2] and is caused exclusively by a compression of the nervus cutaneous femoris lateralis (N. cut. fem. lat) [Figure 2] when perforating the muscles of the abdominal wall. Maybe, the operating surgeon was not well informed, and therefore, he had mismatched the nerves. Without deep knowledge of the course of the nerves and their manifold variations, a safe inguinal hernia repair is not possible neither openly nor laparoscopically.[3] Furthermore, keep in mind, do not operate on a patient presenting with a small hernia but complaining about unusual severe pain (>visual analog score [VAS] 3) or about pain located to an atypical region. The decision of the Medical Advisor is that the surgeon had to pay compensation because of not indicated hernia operation with resection of the N. ileo-inguinalis.
Figure 2: Laparoscopic view of the nervus cutaneous femoris lateralis
A 50-year-old male patient was operated on because of a bilateral inguinal hernia. The operative technique was TAPP. The peritoneal incision was closed by running sutures. Operation and early postoperative course were uncomplicated. However, 19 days later, the patient was readmitted as an emergency case. The diagnostics showed an incomplete small bowel ileus. Immediately after admission and finishing the diagnostics, the patient was reoperated by open approach. Intraoperatively, incarceration of a loop of the small bowel into a small defect in the peritoneal suture line was found. The bowel was reduced and recovered rapidly. The defect in the suture line was closed by suture again. The postoperative course was uneventful.
In the literature, there are many cases reported presenting with ileus due to incarceration of small bowel into a defect within the insufficiently closed peritoneal suture line. A defect size of 1 cm is enough to cause this life-threatening complication. A carefully done tight closure best by running suture without any gap is essential to avoid this mishap. Fortunately, the surgeon had photo-documented the groin after peritoneal suture showing a tight closure; therefore, the claim of the patient for compensation was refused. Keep in mind, careful documentation of all treatment data is the best way to avoid a lawsuit.
A 37-year-old male patient visited an orthopedic surgeon because of pain in the right groin which had been persisting for >6 months. As clinically no significant pathology was found, the orthopedic specialist ordered an MRT which showed "a hernia defect with protrusion of fatty tissue into the inguinal canal." According to this MRT finding, the patient was submitted to a general surgeon who performed a laparoscopic hernia repair (TAPP). Intraoperatively, a very small right-sided indirect hernia was found. The implanted light-weight mesh was fixed by absorbable tacks. The day after the operation, the patient was dismissed at home without any complaints; however, a few days later, the pain occurred again. Because of this pain, the patient visited, for several times, his surgeon who gave advice and injected a local anesthetic to the groin. Unfortunately, the surgeon did not document his findings and respective treatment. Moreover, he did not charge any money and confessed to the patient that using tacks in his case had been a mistake. Not at least because of the surgeons' confession of some "failure," the patient was encouraged to claim for compensation. A total of 14 visits to various kinds of specialists followed, inclusively a second MRT which showed an unchanged finding in the groin. A recurrence was diagnosed. In the end, about 10 months after the primary operation, a second surgical intervention because of pain and suspected recurrence was performed with the attempt to remove the mesh. Remarkably, only some parts of the mesh could be removed, but it was a Shouldice operation added. Postoperatively, the complaints persisted.
Obviously, the patient complaint of pain in the groin; however, he had no significant hernia, if any, then a very small one which could not be detected clinically. In such cases, MRT may be helpful especially for the detection of other pathologies; however, for diagnosis of a hernia, except the incarcerated, a dynamic MRT must be performed, "dynamic" means during rest and during Valsalva maneuver like it is usually done in ultrasound. The operation was performed according to the medical standard at that time. In the postoperative period, the surgeon did medical care without charging and accused himself in front of the patient not to have used the best fixation technique in the first operation. Keep in mind: (1) Do not operate on a patient complaining about pain in the groin but without proof of a significant hernia; (2) MRT is only helpful when it is performed as a dynamic MRT; (3) always tell honestly the facts to the patients and express your compassion with the patients suffering, but do not accuse yourself or do treatment without documentation or charging. When doing in this way, you may induce a feeling in the patient that something had gone wrong. Because the surgeon had relied on the firm diagnosis of the radiologist, he could not be accused of malpractice and the claim of the patient for compensation was refused.
A 50-year-old male patient was operated laparoscopically (TAPP) because of a right-sided indirect inguinal hernia. The mesh was fixed with clips, and further, the peritoneum was closed with clips. The operation was uncomplicated; however, immediately after the operation, the patient complained about pain in the region of the lateral/proximal part of the thigh. Despite pain management, no improvement was observed; therefore, 3 days after the primary operation, a laparoscopic revision was done. During this operation, the lateral part of the mesh and eight clips were removed. Nevertheless, the pain persisted. After multiple consultations of experts, a ½ year later, he was operated again by a neurosurgeon. An open approach to the preperitoneal space was chosen. Intraoperatively, the neurosurgeon found a clip sticking to the N. cut. fem. lat. The clip was removed as well as parts of the nerve damaged by the clip. After the operation, the condition of the patient improved, but some complaints persisted.
In open inguinal hernia repair, most of the risks for an injury are the N. ileo-inguinalis, the nervus hypogastricus and the nervus genitofemoralis (N. genitofemoralis). In laparoscopic inguinal hernia repair, most of the risks are the N. cut. fem. lat. [Figure 2] and N. genito-femoralis. All surgeons who are doing hernia repair must be familiar with the location of these nerves and the multiple variations in their course. Moreover, every surgeon must be familiar with the skin areas the sensitivity is provided by these nerves. Without any doubts, the skin of the lateral part of the thigh is provided by the N. cut. fem. lat. Therefore, in the first revisional operation, the surgeon should have searched for this nerve to identify the reason for the pain and treat the patient accordingly. As the neurosurgeon did not find any mesh in that region he found the nerve, it is suspected that the nerve was damaged when closing the peritoneum by clips near the Spina iliaca ant. sup. and not due to the fixation of the mesh. The partial removal of the mesh inclusive of the eight clips had been unnecessary. The Medical Advisor decided that the surgeon had to pay compensation. Keep in mind, deep knowledge of the anatomy of the groin is an indispensable precondition for uncomplicated operation.
An 81-year-old male patient visited an orthopedic surgeon because of pain in the right groin. He submitted the patient to a well-known hospital for hernia repair; however, the consulted surgeon did not find any hernia. Twelve days later, the patient visited another hospital because of persisting pain. In this hospital, the surgeon diagnosed clinically and by ultrasound an inguinal hernia and performed a laparoscopic repair (TAPP). Intraoperatively, the surgeon reported a right-sided indirect hernia, grade II (defect size <3 cm), according to the EHS classification. In the operation report, there is no hernia sac described, but a cord lipoma only. The lipoma was removed and a 10 cm × 15 cm mesh without fixation implanted. The operation run uncomplicated, but the pain remained and occasionally even increased and reached a VAS of 8–9. He visited the surgeon who had operated on him several times; however, neither clinically nor by ultrasound and dynamic MRT, a recurrence or another cause for the pain was found. The MRT was repeated several days later in another setting. Again, a recurrent hernia could not be confirmed; however, in both investigations, degenerative changes of the hip joint and some liquid within the capsule of the joint were found. Nevertheless, 3 weeks after the first operation, the patient was reoperated in another hospital with the intention to remove the mesh by open approach. However, the surgeon was not able to remove the mesh; instead, incomprehensibly, he implanted a second mesh because of suspicion of a recurrence.
This case shows several mistakes which can be done in hernia surgery. The patient complained of pain in the groin, but it was difficult to prove a significant hernia. It is generally accepted that preoperative pain is the most important risk factor for postoperative chronic pain.[4] Furthermore, the small hernia (defect size <1.5 cm [EHS I] and <3 cm [EHS II]) is a significant risk factor as well.[5] Therefore, a comprehensive diagnostic is necessary to exclude other reasons for pain before a hernia repair is performed. In addition, it is important to know that in hernia patients, pain scores higher than VAS 3 are highly suspicious for another disease. However, in patients who quite clear present with a hernia in combination with unusual severe pain, besides hernia repair, search for other causes for pain and special psychologic assistance is necessary. Again keep in mind, do not do a hernia repair in patients having no hernia (difficult to diagnose) or a small hernia only but presenting with unusual severe pain.
Litigation cases in hernia repair in Germany
In 2018, in the German hospitals and in medical praxis outside the hospitals, a total of 19.5 million patients were treated. Of this number, 5972 alleged malpractice cases (0.03%) were settled; however, only in 1499 cases (25%), compensation was accepted. In most of these cases, the patients recovered completely, but in 482 patients (0.0024%), the damage was minor or moderate permanent, and in only 127 cases (0.00065%), the damage was severe and permanent. Eighty-eight patients (0.00044%) died because of malpractice. Mostly, orthopedic/trauma patients were affected (2092 cases), 816 patients treated in general surgery, and 684 cases in internal medicine. In total, since 2014, the claims were decreasing by 11% from 12,053 in that year down to 10,839 in 2018.[6] In hernia surgery, the data are quite similar; in 23.2% of claims, compensation was accepted. The Conciliation and Compensation Commission found malpractice in only 0.007% of the cases. The Commission decided that in four cases, the operative technique were not adequate to the current medical standard; in three cases, the indication for surgery was wrong, in 2 cases a foreign body was left in the wound; and in one patient, there was insufficient postoperative care. In the region around Stuttgart in 2006, there were six claims registered: three in open and three in laparoscopic hernia repair. In laparoscopic repair, the reasons for claim were twice small bowel lesions, and in one patient with bilateral hernia, only one side was operated on. In open surgery, the reasons were in two cases of atrophy of testes and one case with chronic pain. Interestingly, only the patient with the bilateral hernia received compensation.
Litigation cases – Review of the literature
In general, the review of the literature shows similar results like in Germany, but there are also some national peculiarities. Of the 32 publications mentioned above, only 19 presented precise data regarding litigation or informed consent practice. Interestingly, nearly half of the papers, namely seven,[7] came from the UK, three from the USA, two from Sweden, two from Finland, and each from Germany, France, Nigeria, and Singapore.
Comparable to Germany, the overall frequency of litigation is low. A recent publication from the UK analyzed the cases of the Westlaw database, which were registered between 1991 and 2016. Forty-six cases met the selection criteria and were included for the review. The most frequent legal argument was improper performance (n = 35, 76%), followed by failure of informed consent (n = 14, 30%). The most common complications were nerve/chronic pain (n = 20, 45%) and testicular damage (n = 10, 23%). Successful litigation after inguinal hernia surgery was relatively infrequent – only 21.7% – with an additional 10.9% resulting in settlement awards.[8]
An earlier paper analyzed the data from the NHS Litigation Authority about all claims made between 1995 and 2009. In total, 398 claims were made. Of these, 209 cases had been settled, of which 144 (46.6%) were in favor of the claimant to a cost of 7.35 million GBP/12 million USD/7.93 million Euros. Testicular injury and chronic pain featured in 40% of all claims. Visceral injuries and injuries requiring corrective procedures were the only predictors of a successful claim (P = 0.015 and P= 0.002, respectively). Claims associated with visceral and vascular injuries were more likely to occur in laparoscopic than in open repairs. Sexual dysfunction and chronic pain resulted in the highest average payouts of 85,467 GBP/140,565 USD/92,177 Euros and 81,288 GBP/133,693 USD/87,674 Euros, respectively. In detail, in 76.8%, the reason for claim was some kind of intraoperative error; in 17.6% delay in recognition of the complication; in 14.4%, substandard in postoperative care; and in 13.1%, not sufficiently done inform consent.[7] Another study from the NHS Litigation Authority, which covered 2002–2007, revealed a total of 223 claims following inguinal hernia repair.[9] Out of the 159 cases which were closed at the time of that analysis most frequently the patients claimed because of ischemic orchitis in 35 cases (22%). In 21 cases (13.2%), the reason was visceral injury; in 19 cases (12%), operative failure; and in 17 cases (10.6%), infection. Successful litigation was in 64 cases (40%). Interestingly, 13 patients based their claim exclusively on "failure to be warned on the potential complications of the procedure." Consequentially, there are five papers from the UK,[10],[11],[12],[13],[14] one paper each from Germany,[15] one from the USA,[16] and one from Singapore[17] dealing with the problem how to improve informed consent and documentation. Hard to believe, but the study from Germany in 55 patients showed in a reevaluation questionnaire after informed consent had been performed that 45.3% of the patients could not even recall a single mentioned complication and only 18.2% were able to mention two or more complications. A similar result was reported by the study from the UK; Uzzaman et al.[10] have published. A recall in 86 patients revealed that only two patients (2.3%) had been aware of developing chronic pain and only ten patients (11.5%) realized the potential for testicular problems. However, in another study, it is reported that the consenting surgeons had recorded the risk for bleeding and infection in 100% of the patients, but serious complications such as chronic pain, testicular complications, and visceral injuries were poorly accounted in only 14%, 45.3%, and 52.1%, respectively. Moreover, special emphasis is necessary when consenting elderly patients. Chia et al.[17] showed that 26.7% of elderly patients (>65 years) claimed that they did not understand the indication for surgery. In summary, informed consent is a key feature in perioperative management; therefore, there is an urgent need for standardized forms to achieve consistency and effectiveness of the consenting practice. In countries already using such kind of forms, it is advisable for better understanding of the patients to add some pictures and some handwritten comments.
In Finland, the situation is in some way different because the Finnish National Patient Insurance Center handles financial compensation for patients' injuries without proof of malpractice. During the study years (2003–2010), 25,738 ventral hernia operations were performed, and 127 claims from the whole country were reported to the Patient Insurance Centre. The overall rate of claims was 4.9/1000 hernia procedures. For primary hernias(16,243 operations), 41 claims (0.25%) were reported. The most common complication was infection (n = 28, 68%) followed by pain and hernia recurrence (n = 6, 15% in both). In incisional hernioplasties (9495 operations), 86 claims (0.9%) were registered. The most common complication reported was infection (n = 42, 49%) followed by hernia recurrence in 25 cases (29%) and bowel lesion in 24 cases (28%). Major complications (n = 15, 17%) consisted mainly of bowel lesions in laparoscopic operations. There were significantly more claims after laparoscopic than open hernioplasties (P = 0.001).[18] A second study from Finland investigated the database during the same period for urologic complications which had resulted in 62 claims (0.07%) (from 335 litigations) of 92 000 inguinal hernia repairs.[19] The distribution of claimed urological complications consisted of 34 (55%) testicular injuries, ten (16%) bladder perforations, and seven (11.3%) massive scrotal hemorrhage.
In Sweden, all alleged cases of malpractice are regulated by the Swedish National Patient Insurance Company (LÖF). Between 2010 and 2015, 290 cases (0.85%) out of a total of approximately 34,000 cases with repair of a ventral hernia were identified.[20] Interestingly, 57 cases (20%) were related to anesthetic mishaps, a problem which was also pointed out by an author from Nigeria.[21] A total of 207 claims were related to surgical complications. In total, 116 litigations (40%) were compensated. Out of the surgical claims, 24.4% were due to infection, 16.4% due to poor cosmesis, 15.4% recurrence, and 12.5% pain, and in 12.1%, the claim was caused by an inadvertent enterotomy.[20] Another study from Sweden analyzed litigation claims related to groin hernia repair.[22] The authors used the Swedish Hernia Registry (2008–2010) and found 130 claims (0.26%) out of a total of 48,574 cases with repair of groin hernias, 26 cases (20%) dealt with bleeding, and 7 (5.4%) with intestinal injury. Eighty cases (62%) presenting with complications had been considered malpractice.
In a study from the USA,[23] 460 malpractice claims against general surgeons which were closed between 2003 or 2004 were analyzed by the American College of Surgeons. Surgeon reviewers identified deficiencies in care that fell below accepted standards more often before and after operations than during them. These deficiencies were often the result of a failure to recognize surgical injuries, and many of these deficiencies were preventable. The quality of surgical care was satisfactorily met in 36% of cases. The most frequent events leading to claims included delayed diagnosis, failure to diagnose, failure to order diagnostic tests, technical misadventure, delayed treatment, and failure to treat. Another study from the USA[24] did a retrospective analysis of 44 published cases from 25 states of the US. The causes for claim were as follows: 16% failure to obtain informed consent, 16% retained foreign body, 11% death, and 9% infection. The Court ruled in favor of the plaintiff 27% suits with compensation ranging from roughly between $19,000 and $ 8,000,000.
A very recently published paper present factual data on the medico-legal aspects of medico-legal claims after abdominal wall surgery in France.[25] In total, 180 claims (123 open and 57 laparoscopic surgery) were analyzed and mainly heard by the Conciliation and Compensation Commission (CCI) (82 patients) and the High Court (79 patients). The incidents motivating patient complaints after groin hernia surgery (n = 85) were chronic pain (31.7%), infection (28.2%), and testicular damage (8.5%). Seven patients (8.2%) died as a result of this surgery (including one fetus). Claims after ventral hernia repair (n = 95) were motivated by infections (48.4%) and postoperative peritonitis or bowel obstruction (12.6%). Nine patients (9.5%) died following these ventral hernia repairs. Surgical error was identified in 59 of the 168 cases analyzed (35.1%) and compensated; 44% of recognized faults were surgical site infections, 27% linked to delay in reoperation, and 20% were related to the operating room environment.
A lawsuit because of alleged malpractice is always a severe burden for the surgeon, not only because of possible financial implication but also because of danger of loss of reputation. In total, according to the situation in Germany and according to the review of the literature, the frequency of recognized malpractice is far below 1%; however, one case might be enough to ruin the whole career of a surgeon. Therefore, for a young surgeon, it is of essential importance to be familiar with the reasons for an accusation and to learn how to prevent such a disaster which may destroy the future as a surgeon. Most frequently, there are five fields the surgeon may fail (1) related to the indication; (2) informed consent; (3) preoperative preparation; (4) operative performance; and (5) postoperative care.
Ad 1: Five of the cases, the author as Medical Advisor was confronted with, were related to the indication. It is an absolute must, not to operate on patients having severe pain but only a small or even no hernia.[5] If there is a need for a CT scan or MRT, both of these diagnostics must be done as dynamic investigation. Basically, the indication for surgery must be according to the current medical standard, or if provided according to generally accepted guidelines. Ad 2: "Informed consent" is a key feature, even a special standardized form is often not sufficient, especially in elderly patients. Take the time, show pictures, and make handwritten notes to explain in detail the indication for surgery, the technical performance of the planned intervention, and the steps of aftercare. Ad 3: Besides the usual preparation for surgery, mark the side the intervention is planned. This is important even in laparoendoscopic treatment. Ad 4: The technical performance of the operation should follow the generally accepted medical standard. In three of the cases reported above, the failure of the surgeon led to a severe complication. A complication does not inevitably lead to a lawsuit if the patient had given his consent; however, if there is an inadequate reaction of the surgeon or the surgeon is not familiar with the nerve anatomy like in two of the cases described above, the complication may become a legal case. Deep knowledge of anatomy is a second key feature of perfect operation. Ad 5: In two of the cases described above, a fatal result was reported due to an inadequate delay of the re-operation. A delay in timely response to a complication is a third key feature and is not excusable. It is important to keep in mind that to do a reoperation is not to esteem as a real defeat but shows responsible treatment. Furthermore, with the possibility of diagnostic laparoscopy, this kind of reintervention is not a severe burden for the patient but can give precise information about the intra-abdominal situation.
As case 7 showed, the careful documentation of all steps of the treatment is the fourth key feature for avoiding a legal case. Last but not the least, the fifth key feature for the prevention of a medico-legal implication is to establish an empathic relationship between the surgeon and the patient. This is especially important in the presence of a complication. The complication as well as the needed reactions should be explained to the patient and also to his relatives very frankly and in a friendly way without any accusation of anyone or anything what unfortunately the surgeon in case 8 had done. It is of paramount importance that the surgeon must not convey to the patient a feeling that he is hiding something.
To avoid or at least to reduce medico-legal implications, it seems to be necessary to develop a specific error management culture.
Köhler G, Luketina RR, Emmanuel K. Sutured repair of primary small umbilical and epigastric hernias: Concomitant rectus diastasis is a significant risk factor for recurrence. World J Surg 2015;39:121-6.
Bernhardt M. About isolated in the region of the N. cut. fem. ext. observed paraesthesias. Neurol Centrabl 1895;14:242-4.
Rosenberger RJ, Loeweneck H, Meyer G. The cutaneous nerves encountered during laparoscopic repair of inguinal hernia: New anatomical findings for the surgeon. Surg Endosc 2000;14:731-5.
Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology 2010;112:957-69.
Hoffmann H, Walther D, Bittner R, Köckerling F, Adolf D, Kirchhoff P. Smaller inguinal hernias are independent risk factors for developing chronic postoperative inguinal pain (CPIP): A registry-based multivariable analysis of 57, 999 patients. Ann Surg 2018. doi: 10.1097/SLA.0000000000003065. [Epub ahead of print].
Osterloh F. Quality Control. Doctors make less mistakes. Dtsch Arztebl 2019;116:298-9.
Alkhaffaf B, Decadt B. Litigation following groin hernia repair in England. Hernia 2010;14:181-6.
Grayson CT, Criman ET, Cefalu LM, Roedel EQ, Hong SS, Yheulon CG. Litigation patterns in inguinal hernia surgery: A 25 Year review. J Surg Res 2018;232:266-70.
Pawa N, Ypsilantis E. Inguinal hernia repair – trends in litigation. Ann R Coll Surg Engl 2009;91:180.
Uzzaman MM, Sinha S, Shaygi B, Vitish-Sharma P, Loizides S, Myint F. Evaluation of patient's understanding and recall of the consent process after open inguinal hernia repairs. Int J Surg 2012;10:5-10.
Hoosein MM, Towse H, Conn G, Stoker DL. Consenting practice for open inguinal hernia repairs – Are we failing to warn patients of serious complications? Ann R Coll Surg Engl 2008;90:643-6.
Paily A, Thornton M. Chronic pain following a Lichtenstein inguinal hernia repair: A clinical and legal dilemma. ANZ J Surg 2009;79:517-20.
Shiwani MH, Gosling J. Variations in the quality of consent for open mesh repair of inguinal hernia. Hernia 2009;13:73-6.
Courtney MJ, Royle TJ. Pre-made consent for elective inguinal hernia repair: The need for standardisation-a survey of all UK NHS trusts. Hernia 2018;22:549-53.
Chiapponi C, Meyer F, Kersten F, Bruns C. "STeP" ("Students teaching patients"): Medical students following up on informed consent discussions. Results of a methodological change and further considerations. Zentralbl Chir 2016;141:645-51.
Thompson BM, Sparks RA, Seavey J, Wallace MD, Irvan J, Raines AR, et al. Informed consent training improves surgery resident performance in simulated encounters with standardized patients. Am J Surg 2015;210:578-84.
Chia CL, Chan KS, Ng MJ, Rao AD, Singaporewalla R. Assessing adequacy of informed consent for elective surgery by student-administered interview. ANZ J Surg 2019;89:677-82.
Ahonen-Siirtola M, Vironen J, Mäkelä J, Paajanen H. Surgery-related complications of ventral hernia reported to the Finnish Patient Insurance Centre. Scand J Surg 2015;104:66-71.
Rönkä K, Vironen J, Kokki H, Liukkonen T, Paajanen H. Role of orchiectomy in severe testicular pain after inguinal hernia surgery: Audit of the Finnish Patient Insurance Centre. Hernia 2015;19:53-9.
Lindmark M, Strigård K, Nordin P, Gunnarsson U. Patient reported injuries after ventral hernia repair. Scand J Surg 2019;108:30-5.
Ogboli-Nwasor E. Medication errors in anaesthetic practice: A report of two cases and review of the literature. Afr Health Sci 2013;13:845-9.
Nordin P, Ahlberg J, Johansson H, Holmberg H, Hafström L. Risk factors for injuries associated with damage claims following groin hernia repair. Hernia 2017;21:215-21.
Griffen FD, Stephens LS, Alexander JB, Bailey HR, Maizel SE, Sutton BH, et al. The American College of Surgeons' closed claims study: New insights for improving care. J Am Coll Surg 2007;204:561-9.
Walters AL, Dacey KT, Zemlyak AY, Lincourt AE, Heniford BT. Medical malpractice and hernia repair: An analysis of case law. J Surg Res 2013;180:196-200.
Cardin JL, Johanet H. Malpractice claims and abdominal wall hernia repair. J Visc Surg 2019. pii: S1878-7886(19)30035-9.
1 Development of hernia and abdominal wall surgery and Hernia Registry in China
Changfu Qin, Huiqi Yang, Yingmo Shen, Lili Cheng, Reinhard Bittner, Jie Chen
Surgery in Practice and Science. 2021; : 100043
2 Umbilical hernia repair and recurrence: need for a clinical trial?
Jennifer Mannion, Mohamed Khalid Hamed, Ritu Negi, Alison Johnston, Magda Bucholc, Michael Sugrue
BMC Surgery. 2021; 21(1)
3 Where is the nerve? Review of operation note documentation practice for inguinal hernia repair
BJ Farquharson,V Sivarajah,S Mahdi,H Bergman,S Jeyarajah
The Annals of The Royal College of Surgeons of England. 2021;
4 A multistage process leading to the development of a structured consent form and patient information leaflet for complex abdominal wall reconstruction (CAWR)
M. Asarbakhsh,O. Smith,P. Chitsabesan,T. MacLeod,P. Lim,S. Chintapatla
Hernia. 2020;
Bittner R
endoscopic hernia repair
inguinal hernia repair
laparoscopic hernia repair
medico-legal aspects
© International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow
Online since 26th Feb, 2018


It may not be a country that crossed your mind to visit, but for the discerning traveller looking to expand their experiences and create some amazing memories, Mongolia should be at the top of your list.
What is often overlooked in the history of the world, is that it was Mongolia who created the first national park, and to this day the nature reserves and protected areas of this amazing country are amongst the earth's most beautiful sights and travel must-dos. Our packages to Mongolia, offer travellers an opportunity to explore and fall in love with this magnificent country. Whether you're a fan of picturesque landscapes, up close encounters with wildlife, or enjoying authentic local experiences, Mongolia has everything you're looking for and more.
If you're looking for the local experience, then all packages include visiting a true Mongolian Nomad. In some ways, life moves slowly upon the steppes, and for the nomad, little has changed in the hundreds of years they've lived on the land. Roughly one third of Mongolia's population are still nomadic, living in their traditional Ger tents, working their livestock, and moving several times a year.
If you're looking for more local experiences, then our Great Naadam package should be at the top of your bucket list. Naadam is the "three games of men" – archery, horse racing and wrestling. All three of these activities might sound fairly normal in the western world, but witnessing the Naadam Festival will give you a whole new appreciation.
Unlike western archers, who use three fingers to draw a bow and fire at a target, the Mongolian athletes use only their thumb and fire into the air, to hit targets on the ground, something western archers would definitely struggle with. Their jockeys race at breakneck speeds, covering 20 kilometers in close to ten minutes, after having walked their horses 20 kilometers to the starting line, and their wrestlers compete in a no-holds barred cross between the styles of Sumo, Mixed Martial Arts and WWF.
The Naadam Festival takes place over two days in July, and our Naadam Festival package guarantees you experiences you will not easily forget.
The landscapes of Mongolia are exquisite and include a variety of options, ranging from snow-capped mountains to the grassy plains of the Gobi Desert, an emerging city to Grand Canyon style gorges, stunning forests and national parks – and everything in between.
One destination you need to visit is the Gobi Desert which includes the Flaming Cliffs of Bayanzag, the Sand Dunes of Moltsog and Yoliin Am Gorge. This is also an amazing opportunity to see wildlife including wild horses and eagles. Gun-Galuut Nature Reserve is another wildlife haven, famed for local birdlife. It's also a fantastic opportunity to meet and visit with local nomads, who still live the lives of their ancestors.
Terelj National Park, not far from the capital city of Ulaanbaatar, is another opportunity to see how beautiful a country can be when left untouched.
West of Ulaanbataar is Karakorum, the lost capital of Genghis Khan (Chinggis Khaan is how he's known locally) and is a must-visit for anyone interested in history or beautiful photography. The region around Karakorum includes the Bayan Gobi sand dunes, temples, monasteries, ruins of the walled city that was the capital of the once mighty Mongol Empire and more national parks and wildlife, including the stunning Hustai National Park, a beautiful mountain-ringed forest and meadow region renowned for wildlife, including the endangered Takhi.
Much of the accommodation for travellers to Mongolia will be in the traditional Ger tent. These are remarkably comfortable and warm and offer you a unique opportunity to live like a Nomad, even for a night.
The hospitality in Mongolia is second to none, it's considered very impolite to refuse anything offered to you, which means you'll have ample opportunity to taste local dishes, milks and Airag, a local beverage made of fermented mares milk.
Regardless of what draws you to travel, what inspires you to see the world and what motivates you to explore, you'll find it in Mongolia.


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Morocco blames suspected vaccine death on cannabis, tobacco
Published by Al-ArabyRabat - Morocco's ministry of health blamed the recent death of a 30-year-old citizen on cannabis addiction and post-tuberculosis complications....
Iran, Venezuela and Sudan Lose UN Voting Rights With 5 More
UNITED NATIONS — Iran, Venezuela and Sudan are in arrears on paying dues to the United Nations' operating budget and are among eight nations that will lose their voting rights in the 193-member General Assembly, the U.N. chief said in a letter circulat...
Somalia Humanitarian Bulletin, December 2021
Humanitarian partners release the 2022 Somalia Humanitarian Response Plan. The plan seeks close to US$1.5 billion to assist 5.5 million of the most vulnerable people in the country.• Drought worsens in Somalia with the number of affected people increas...
UN Chief: 'Race Against Time' to Save Afghan Economy
Secretary-General Antonio Guterres said Thursday the United Nations is "in a race against time" to prevent millions of Afghans from falling deeper into a severe economic and humanitarian crisis."Livelihoods across the country have been lost. More than ...
Sinopec Fuling Shale Gas Field Sets New Cumulative Production Record of 40 Billion Cubic Meters
BEIJING, Oct. 9, 2021 /PRNewswire/ — China Petroleum & Chemical Corporation's (HKG: 0386, "Sinopec") Fuling Shale Gas Field – the first commercially developed and operated large-scale shale gas field in China – announced on October 8 that it has produced 40 billion cubic meters of shale gas, setting a new record for the cumulative production […]
ITR, Schaeffler and MAHLE unveil DTM Electric Design Model at Norisring
Next step towards fully electric race series DTM Electric Design Model shows what the race cars will look like Outlook on prototype that is currently being developed NUREMBERG, Germany, Oct. 9, 2021 /PRNewswire/ — The future of electrified motorsport is looking good! During DTM Norisring powered by BWT, ITR GmbH and series' partners Schaeffler and […]
Le Huawei Global Digital Power Summit 2021 ouvrira ses portes le 16 octobre à Dubaï
Le Huawei Global Digital Power Summit 2021 ouvrira ses portes le 16 octobre à Dubaï avec plus de 300 participants, dont des dirigeants de Dubai Electricity & Water Authority (DEWA), Group42, ACWA Power, du, Uptime Institute et Engie. Huawei annoncera des actions conjointes dans toute la chaîne de l'industrie de l'énergie et des TIC pour libérer le […]
Lack of Funds Will Force Aid Cuts to DRC, UN Official Says
GENEVA — A U.N. official says a funding shortage means humanitarian aid will have to be cut for many of the nearly 10 million people in Democratic Republic of Congo facing multiple crises because of lack of money.Conflict in the eastern DRC has forced ...
Cameroon Nurses Seek Extra Care for the Terminally Ill
BAMENDA, CAMEROON — Nurses in Cameroon are marking this year's World Hospice and Palliative Care Day (October 9) with visits to terminally ill patients in the country's restive North-West and South-West regions. The regions' ongoing separatist conflict...
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Czech president opposes abuse of Olympic idea for political aims
PRAGUE, Czech President Milos Zeman has spoken out against a boycott of the upcoming 2022 Winter Olympics."I am fundamentally against the misuse of the Olympic idea for political purposes," Zeman said in a statement on the Prague Castle website.Accordi...
Morocco to receive new German ambassador as ties improve
Published by Al-ArabyMorocco is set to approve of Germany's appointment of Thomas Peter Zahnseisen as its new ambassador to Rabat, signaling that the two countries are returning to normal diplomatic...

redpajama_set_name: RedPajamaCommonCrawl


text:
/**
 *
 */
package com.thinkbiganalytics.alerts.api.core;

/*-
 * #%L
 * thinkbig-alerts-core
 * %%
 * Copyright (C) 2017 ThinkBig Analytics
 * %%
 * Licensed under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License.
 * You may obtain a copy of the License at
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 *     http://www.apache.org/licenses/LICENSE-2.0
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 * distributed under the License is distributed on an "AS IS" BASIS,
 * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
 * See the License for the specific language governing permissions and
 * limitations under the License.
 * #L%
 */

import org.springframework.context.annotation.Bean;
import org.springframework.context.annotation.Configuration;

@Configuration
public class AlertProviderConfiguration {

    @Bean(name = "alertProvider")
    public AggregatingAlertProvider alertProvider() {
        return new AggregatingAlertProvider();
    }
}

redpajama_set_name: RedPajamaGithub


text:
HomeArts & Entertainment'Welcome' to Slaughter Beach, Jacob Ewald will be your guide
'Welcome' to Slaughter Beach, Jacob Ewald will be your guide
September 29, 2016 Sydney Shaw Arts & Entertainment, Reviews 0
By Sydney Shaw
Twenty-two-year-old Annie lives in a town called Slaughter Beach, where she navigates the trials of post-adolescence while juggling a blossoming relationship, self-doubt and the chagrin of still living with her parents.
Although Annie is a fictional character, her story comes to life by way of "Welcome," the debut LP from Jacob Ewald's band, Slaughter Beach, Dog. While the album is set to be released on Friday, Sept. 30, via Lame-O Records, it has been streaming on The A.V. Club since last week.
'Welcome' is set to be released on Friday, Sept. 30. (Photo courtesy of Slaughter Beach, Dog)
Ewald is best known as one of the voices of the Philadelphia pop punk group Modern Baseball. On the band's most recent record, "Holy Ghost," Ewald bares all as he tackles intimate topics like the death of his grandfather and missing the person he loves while he's away on tour.
While he's proven he has a knack for penning honest, deep-reaching lyrics, Ewald departs from that candor on "Welcome" with the creation of a constructed world and the fictitious folks who live there.
"When I wrote the Slaughter Beach, Dog songs, I had been stuck with writer's block for multiple months, but writing about fictional scenarios as opposed to personal scenarios helped me jump out of it and get my brain going again," Ewald told The Signal.
His first fictitious scene is introduced on the opening track, "Mallrat Semi-Annual," where Annie meets a young man at a house party.
"This ain't so bad now, darling. It's nice to meet you here. We've got a lot in common. I'd like to keep you near," Ewald sings on the track — this time as a male character — moments after pep-talking himself to "stand up straight, walk her way and say hello."
Their relationship's progression is evidenced on "Toronto Mug," where Ewald details what happens after the party dies down.
"Note that our friends have gone home," he sings as the male narrator. "I offer to leave, and you make coffee."
Ewald succeeds in injecting his lyrics with short sucker punches like these, while longer verses, such as one in the song "Monsters," have already found new life as social media status updates.
"I keep trying to outline a better life, but the pen's run dry. The lines never come out right, anyway," Ewald sings on the track. "There are monsters everywhere I turn in disguises my young self couldn't discern."
Ewald is convincing in his role as Annie. (Photo courtesy of Dana Gorab)
Hearing Ewald sing "I am the girl that I thought I outgrew" in his low-tone voice is surprising, but only at first listen. Through poignant lyrics and emotive playing, he convincingly pulls off his role as Annie.
Flipping the narrative from his usual male perspective to a feminine vista was no easy task. This new angle required brilliant self-awareness paired with the ability to concoct a compelling narrative.
"The coolest part about writing the fictional songs is that you can create incredibly interesting characters and relationships, but the difficult part is that you have to conjure all of their intricacies and life experiences out of thin air before you can write a song about them," Ewald said.
"A lot of the songs came together slower than Modern Baseball songs usually do for me just because I had to come up with whole life stories before writing each song. I couldn't just tap into my memory bank."
Even so, Ewald said he pulled from his own experiences when he shaped his characters.
"I don't really like going into details about the storyline because then it doesn't let the songs speak for themselves," Ewald said. "Of course, the Slaughter Beach, Dog songs still have a lot of influence from my own experiences, but shaping the characters was a pretty long and interesting process."
Slaughter Beach, Dog is scheduled to play a CUB Alt show at the College on Friday, Nov. 18, alongside Sorority Noise and Weller.
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MERRY CHRISTMAS MR LAWRENCE (1983) DVD
Languages: English; Japanese
Aspect ratio: 16:09
Release Date: 29/3/08
The Oshima Gang Featurette (The Making Of Merry Christmas Mr Lawrence)
An Interview With Jeremy Thomas
An Interview With Ryuichi Sakamoto
This powerful prisoner-of-war drama features a stunning cast - including David Bowie in one of his greatest roles - and is the first English-language film by acclaimed Japanese director Nagisa Oshima (In the Realm of the Senses).
Set in Java at a Japanese POW camp in 1942, a war of wills - and unspoken erotic attraction - unfolds between a rebellious prisoner, David Bowie, and camp commandant Ryuichi Sakomoto, who is impressed by Bowie's defiance while bilingual prisoner Tom Conti (Mr. Lawrence) engages in a more adversarial relationship with sadistic sergeant Takeshi Kitano (Hana Bi), who finally offers Lawrence a sinister 'Christmas' present.
Fine performances by Conti, Kitano (his first dramatic role), Sakamoto (his acting debut, he also contributed the memorable score) and Bowie, combined with stunning cinematography and brilliant direction by one of Japan's finest filmmakers, make this a memorable and compelling war drama.
Director: Nagisa Ôshima
Cast: David Bowie,Tom Conti, Ryuichi Sakamoto


Every now and then Jesus took time away from the crowd. You might even say He took a vacation.
If you had $86,400 and someone stole $10 would you throw the remaining $86,390 away for revenge?
Social media can be both bad and good.


The new California Federal Milk Marketing Order – an effort supported by Land O'Lakes and other industry leaders in California – took effect on November 1.
This is good news for our California dairy members, who will generally see an advantage in their pay price moving from the California State Order to FMMO. The policy will also help address disparities between farm gate prices in California and the rest of the nation.
On Nov. 7, to mark the launch of the new policy, USDA Under Secretary Greg Ibach joined more than 60 dairy industry stakeholders at the farm of Land O'Lakes, Inc. Board Director Cornell Kasbergen in Tulare, CA. Following a farm tour led by Cornell, Under Secretary Ibach noted the importance of the Federal Milk Marketing Order for California's dairy industry.


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Geoffrey Schotter
Amy Millican
Anna Masilela
Joel Fredericson
Maria Oyola
Marc Albritton
Marcy Agreen
Najae Brock
Construction Workers' Compensation Claims
Work-Related Car Accident Claims
Healthcare Workers' Compensation Claims
Workplace Repetitive Strain Injuries
Harmful Occupational Exposure
Occupational Hearing Loss
9/11 Ground Zero Participant Claims
Workplace Assaults
Mental Stress Claims
Covid-19 Workers' Compensation Claims
Workers' Compensation Death Benefits
Workers' Compensation Retaliation
In 1980 Marc started his career as a federally licensed aircraft mechanic. Marc holds three ratings in aircraft maintenance technology: airframe, powerplant, and 2nd class radio operation. He worked for Pan American Airlines for 10 years. In 1990, he was hired by New York City Transit as a track equipment maintainer where he worked at a union shop steward and vice-chairman for Transport Workers Union Local 100 for 25 out of his 27 years.
During his career at Transit, Marc became interested in law and earned a paralegal certificate from York College, CUNY. While in the union, Marc met Joel Fredericson and came to work for him in 2013 as a paralegal after attending Abraham Lincoln University School of Law. In 2015, Marc left Joel's office and returned in 2018 after retiring from Transit in 2017. In 2020, he completed his master's degree in Dispute Resolution from Touro University.
As a former shop steward, and elected officer; Marc's life has been a career of service to others. Helping people navigate through troubled waters is his specialty and dedication. The firm recently interviewed a potential claimant. When Marc found out the claimant had the same form of aggressive brain cancer that killed his father, he recommend her her personal doctor. Today, although her comp case is not established, the claimant's brain cancer is in total remission and her surgeons are in disbelief. Recently, she spoke to Marc and said that she ran up a flight of stairs in the subway. She is 68 years old and said, " I haven't ran up a flight of stairs in 20 years." This is the type of case that Marc lives for. This is what makes working at Schotter Millican, LLP the most rewarding job in Marc's 41 years of working. It is truly, " law for workers."
Brooklyn Office
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Home / Hebron / Beit Kahlil: Tear gas flies as Israel demolishes home
Beit Kahlil: Tear gas flies as Israel demolishes home
in Hebron, Reports October 7, 2011
6 October 2011 | International Solidarity Movement, West Bank
Demolitions in Beit Kahlil - Click here for more images
At 5:00 AM on the morning of the 6th October, approximately 30 armed soldiers came to demolish a house in Beit Kahil. The IOF woke up the family living in the neighbouring house and informed them about the demolition and declared the entire area a closed military zone. When he arrived, Omar Ahmad Hussan Abdel Din, the owner of the house, informed the soldiers about his lawyers appeal to the Israeli Court for getting the demolition order postponed until he had an official response to his application for building permission, but with no effect.
A member of the Abdel Din family said, "Why do we need a permission from Israel to build this is Palestine and Palestinian land? Though this is considered area C by the Israeli authorities, I do not recognise their authority, and anyways it is their bureaucratic way of stealing land."
While a bulldozer was demolishing the Abdel Din house residence, the neighbourhood tried to prevent the demolition by throwing stones. The soldiers prevented them getting any way near by using sound bombs and shooting tear gas grenades. During the protest one of the tear gas canisters broke the window and entered a house resulting in three women and four children being taken to the hospital and treated for tear gas inhalation. An additional 2 people were injured by the tear gas cannisters, requiring 1 person who needed 3 stitches.
The village of Beit Kahil is divided by a valley with the road running to Hebron. In 2009 the houses on the one same side of the valley as an Israeli military base got demolition orders at once. Including the house of Omar Abdel Din, demolition orders were given to around 15 houses which are inhabited by around 100 citizens.
http://www.youtube.com/watch?v=r–KuGzPVww
One of the neighbours said, "Obviously when we saw the Occupation Forces and bulldozers we were shocked and feared that they would demolish all our houses."
In 2011 14 houses were demolished in the Hebron area, leaving 104 Palestinian homeless including 50 minors. Area C and B are the areas where Palestinians need to seek permission from Israeli authorities to build, accounting for 83 % of the West Bank.
According to the Israel Civil Administration, more than 93 % of the applications for a building permission are refused, and many Palestinians do not even bother to ask permission to build knowing they will be refused.
Beit Kahlil Caterpillar Hebron House Demolition 2011-10-07
Tagged with: Beit Kahlil Caterpillar Hebron House Demolition
Waiting at a checkpoint


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Workshop: Intro to Figma for Content Designers – February 9
2:00 pm to 4:00 pm PST (UTC-8)
4:00 pm to 6:00 pm CST (UTC-6)
5:00 pm to 7:00 pm EDT (UTC-5)
9:00 am to 11.00 am AEDT (UTC+11) (February, February 10)
Workshop: Intro to Figma for Content Designers – July 28
12:00 pm–2:00 pm PDT (UTC-7)
3:00 pm–5:00 pm EDT (UTC-4)
8:00 pm–10:00 pm BST (UTC+1)
Workshop: Intro to Figma for Content Designers – June 25
June 25, Saturday
Workshop: Intro to Figma for Content Designers – October 25
October 25, Tuesday
12:00 pm to 2:00 pm PDT (UTC-7)
2:00 pm to 4:00 pm CDT (UTC-5)
Workshop: Intro to Figma for Content Designers – September 7
September 7, Wednesday
6:00 am to 8:00 am PDT (UTC-7)
9:00 am to 11:00 am EDT (UTC-4)
2:00 pm to 4:00 pm BST (UTC+1)
3:00 pm to 5:00 pm CEST (UTC+2)
Workshop: Naming For Product Elements – August 11
August 11, Thursday
9:00 am–1:00 pm PDT (UTC-7)
12:00 pm–4:00 pm EDT (UTC-4)


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Q: Prove that $ \intop_{\gamma}fdz=0 $ for a complex function Let $ f: \mathbb{C} \to \mathbb{C} $ be holomorphic and $ C_{\mathbb{C}}^{1} $ function. Let $ \gamma $ be a paramaterization of rectangle boundary (with clockwise direction). Prove that $$ \intop_{\gamma}f\left(z\right)dz=0 $$
Using Green's theorem.
I know that I should write $ f\left(x,y\right)=u\left(x,y\right)+iv\left(x,y\right) $ and then probably after Using Green's theorem, Cauchy Riemmman equation would give me that the integral vanish, but Im not sure how to get there. if $\gamma $ is the rectangle boundary, and say $ z(t), a\leq t\leq b $ is the paramaterization, then by definition $$ \intop_{\gamma}f\left(z\right)dz=\intop_{a}^{b}f\left(z\left(t\right)\right)z'\left(t\right)dt $$
Now we can write $ z\left(t\right)=x\left(t\right)+iy\left(t\right) $ and $ f\left(x,y\right)=u\left(x,y\right)+iv\left(x,y\right) $ which will lead us to $$ \intop_{a}^{b}f\left(z\left(t\right)\right)z'\left(t\right)dt=\intop_{a}^{b}[u\left(x\left(t\right),y\left(t\right)\right)+iv\left(x\left(t\right),y\left(t\right)\right)][x'\left(t\right)+iy'\left(t\right)]dt $$
$$ =\intop_{a}^{b}u\left(x\left(t\right),y\left(t\right)\right)x'\left(t\right)-v\left(x\left(t\right),y\left(t\right)\right)y'\left(t\right)dt+i\intop_{a}^{b}u\left(x\left(t\right),y\left(t\right)\right)y'\left(t\right)+v\left(x\left(t\right),y\left(t\right)\right)x'\left(t\right)dt $$
$$ =\intop_{\gamma}u\left(x,y\right)dx-v\left(x,y\right)dy+i\intop_{\gamma}u\left(x,y\right)dy+v\left(x,y\right)dx $$
And using Green's theorem:
$$ =\intop_{R}\left(\frac{d}{dx}u\left(x,y\right)+\frac{d}{dy}v\left(x,y\right)\right)dxdy+i\intop_{R}\left(\frac{d}{dx}v\left(x,y\right)-\frac{d}{dy}u\left(x,y\right)\right)dxdy $$
By Cauchy-Riemman we have
$$ \frac{d}{dx}u\left(x,y\right)=\frac{d}{dy}v\left(x,y\right),\thinspace\thinspace\thinspace\thinspace\frac{d}{dy}u\left(x,y\right)=-\frac{d}{dx}v\left(x,y\right) $$
Which would be exactly what I need if it were multiplied by $-1$. So where is my mistake?
If you have simpler way, I'd love to see it.
Note that this is just the beggining of the complex analysis course that Im taking, so we are not allowed to use the fact that holomorphic function is analytic.

A: The error comes from using Green's theorem incorrectly. It should be
$$
\int_\gamma Adx + Bdy = \int_R \left(\frac{\partial}{\partial x}B - \frac{\partial}{\partial y}A\right)dxdy.
$$
Applying this to your formula, you should obtain
\begin{align}
\intop_{\gamma}u\left(x,y\right)dx-v\left(x,y\right)dy =\intop_{R}\left(-\frac{d}{dx}v\left(x,y\right)-\frac{d}{dx}u\left(x,y\right)\right)dxdy\\
i\intop_{\gamma}u\left(x,y\right)dy+v\left(x,y\right)dx = i\intop_{R}\left(\frac{d}{dx}u\left(x,y\right)-\frac{d}{dy}v\left(x,y\right)\right)dxdy.
\end{align}

redpajama_set_name: RedPajamaStackExchange


text:
@interface AppDelegate : UIResponder <UIApplicationDelegate, UIAlertViewDelegate>

- (void)transitionToRootViewController:(UIViewController*)viewController animated:(BOOL)animated;

- (void)presentRootViewController:(BOOL)animated withSplash:(BOOL)withSplash;

@end


text:
Beam Reach is a redevelopment area in London, England and part of the London Riverside section of the Thames Gateway. It is an industrial area adjacent to the new neighbourhood of Beam Park.

Geography
It is located in the southern part of the London Borough of Havering, next to the River Thames and the River Beam. GLA Land and Property owns 40 hectares of land in the area and promotes it for intensification of manufacturing companies, to complement the nearby commercial and residential redevelopment areas, including Beam Park. Beam Reach is the location of Centre for Engineering and Manufacturing Excellence.

Transport
The A1306 road forms the northern perimeter and the A13 road runs through the site east to west. Havering London Borough Council propose that Beam Park railway station should be built in the area, to be served by c2c trains.

References

External links
Beam Reach

Thames Gateway
Areas of London
Geography of the London Borough of Havering

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text:
Q: Why do I get a Pioneer badge for following and then unfollowing an Area51 proposal? I clicked on Engineering's "Follow" button, did not check the verification e-mail, and promptly unfollowed it. Yet I still got the "Pioneer" badge. Why?
Don't think I deserve a badge for that (although I'm looking forward to the launch of the site).

A: There's no email verification requirement for the badge.
Following a proposal isn't exactly a hard thing to do and the badge's goal is just to introduce the feature in the first place. Now you know you can follow a proposal! This is working as intended.


The Galaxy S2 is defined by Samsung and carriers with a two sentences: "ultra-powerful, ultra-thin, ultra brilliant" or "vidid, fast, slim". It's true that the Galaxy S2 is the best that Samsung has to offer today and benefits from improvements such as a dual-core application processor (also called system on a chip, or SoC), and large 4.3" Super AMOLED Plus display with a Gorilla glass. Additionally, everything has been integrated in a 8.49mm thin body that is very light (116g). The Samsung Galaxy S2 looks good, but does it live up to the legend in the real-world? Let's find out.
We all use smartphones differently, so it's important that I tell you what I do with my smartphone: I typically check my email often with the built-in email app (via Microsoft Exchange), and I reply moderately because the virtual keyboard is slow, even on large displays. I browse the web several times a day to check on news sites, but I rarely watch movies or play music. I don't call much – maybe 10mn a day, if at all. On the "apps" side, I have a couple of social networks, but I rarely play games or do something super-intensive. This usage pattern will affect battery life and the perception of what features are useful.
Dual-core system on a chip (SoC): The Galaxy S2 is powered by a dual-core system on a chip (or SoC) with a Samsung Exynos (GT-i9100) running at 1.2Ghz. Although Samsung doesn't communicate about sub-components, the graphics processor is believed to be a Mali-400MP, which is a capable GPU, but it is not as fast as NVIDIA's Tegra 2. This new hardware platform should lift the Galaxy S2 to the top of the performance charts, but we will get back to this later on.
HSPA+ (21Mbps): I really consider this to be 3.5G, but some carriers like T-Mobile USA may simply call it "4G", so keep in mind that while it is better than 3G, it is not as fast as 4G LTE (as deployed by Verizon in the US). That said, HSPA+ phones don't use nearly as much power as today's LTE phones when transmitting data, although things are getting slowly better. For more information, read my post about the different 4G networks.
1080p video recording: the Galaxy S2 is the first smartphone that records in 1080p with very good results. It's surprising because usually I dismiss even 720p recording in real-world usage, because many phones don't do a good job with it. Strangely, I found 1080p to be the most usable video recording mode… I'll get back to that later.
Low-light photography: Samsung didn't make much noise about this, but they should.The Galaxy S2 has much better low-light photography capabilities than the original Galaxy S Series. It maybe a combination of sensor and software, but I like what I'm seeing, even if the S2 probably doesn't beat the XPERIA Arc in that domain.
NFC: Near Field Communication (NFC) has been included to this phone. At the moment, it's not really useful, but some users are really excited about this tech, so I thought that I would mention it.
Chassis: we had seen it during Mobile World Congress in February, and I'm glad to see that this phone came out as it was announced. The design is very clean (I prefer the unlocked version without any carrier markings…) and the display is big (4.3"). But the most noticeable thing is how light the handset is. Even with the battery inside, the phone weighs a mere 116g, which is noticeably lighter than the 137g of the smaller 3.5″ iPhone 4.
The USB port is conveniently located at the bottom of the device, which makes the phone easy to use while charging or during a computer sync.
Of course, the light weight comes from using plastic instead of glass/metal in many places. This may sound bad, but I haven't noticed any differences in rigidity while I was using it. I'm not sure how it would resist if you were to drop it on a solid surface, but I'm pretty sure that it is less likely to shatter than an iPhone 4. There is simply less glass to break (the iPhone 4 has glass on the front and the back). Of course, the front glass is still a sensitive part, but unlike the iPhone 4, if the phone lands on a corner, the glass is not in direct contact with the landing surface. The lighter weight should help too as there would be less force on impact.
Now, I really love the "feel" of touching glass and aluminum, and in an ideal world, I would surely want such a design in a lightweight and less fragile form. But in reality, that is not possible, at least today. Yes, it's about making compromises (again). As a user, you will have to choose between a very light phone that may have a "plastic" feel, or a glass/metal phone that is much heavier for its size.
I have also heard from a number of people (especially HTC users) that the light weight makes them feel like the Galaxy S2 is not solid. I wish that we could crash-test the phones, but this sounds to me like a matter of personal preferences more than a matter of sturdiness. When in doubt, get one in your hands before you pull that credit card out of your pocket.
The Galaxy S2 comes with a Super AMOLED Plus display which can be found on a number of Samsung on the market, like the Samsung Infuse 4G that we reviewed recently. Typically, AMOLED displays have extremely saturated colors, which always trigger a "wow" when you show them to someone.
However, the colors aren't accurate and often don't reflect the original colors that the content was designed with. That said, I have hardly heard anyone complain about over-saturation but it's a good thing to know if you care about color accuracy. IPS LCD displays, or LCD displays would be better at this.
Indoors, the Super AMOLED Plus screen does very well, and watching movies or viewing photos are a real treat. Contrast and brightness are great. I can't wait to see the 7.7″ version of the Galaxy Tab with an AMOLED display.
Outdoors, on a sunny day, it's a different story. The screen can be very difficult to read in direct sunlight, especially if you are using a dark wall paper and lock screen. For optimum readability in direct sunlight, I always recommend using a light (if not white!) background on your home page or applications.
There's a catch, however: AMOLED displays tend to use more power when displaying bright images, so a good chunk of the Android user interface and application interfaces on Samsung AMOLED devices are usually dark, and there is not always possible to change that.
In terms of sheer display resolution, the Galaxy S2 is still using a 800×480 resolution, which is inferior to today's qHD 960×540 resolution that many high-end Android phones are using. Obviously, this won't cripple the user experience, but the display does matter a lot, and it would have been nice to get a resolution upgrade.
I personally don't use them much because some tend to consume power to stay updated, but I really like the Task Manager Widget as it lets me know how many applications are currently running. If I feel like there are too many, I can quickly go into the task manager app and shut them all off (except the ones that Samsung deems as "part of the system").
Kies 2.0: To put it simply, Kies is Samsung's equivalent of iTunes. It lets users synchronize with a PC over WIFI, sync contacts with Outlook, Yahoo and Google, manage songs and playlists, backup photos and files.
For Outlook users, the synchronization of over USB is undoubtedly the biggest value. This is an option that few Android phones have, as Android has been designed to be synchronized over the air.
I bumped into connectivity problems with Kies, and the sync does not work. At the moment, I will assume that it is something related to my configuration, but if you have the same issue, leave a comment at the bottom of this page.
Dialing: no problem there, dialing a number directly from the numeric pad, or doing so from one of the contact is easy. If there are a couple of numbers that you call on a regular basis, I recommend create a "direct shortcut" on the home screen. That makes it a one-tap call. You can't be any faster than that.
Contacts (syncs with Outlook over USB): Contacts can be synchronized from many sources. Google of course, but also Facebook, Exchange and more. Those who use Outlook without using Microsoft Exchange will be happy as Samsung Kies utility can synchronize contacts, calendar, todo lists and memos from Outlook.
Call Audio Quality (Good): The audio quality is good, although I tend to think that the Nexus S is still has the best audio quality. I have had a number of phone conversations with the Galaxy S2, and it's good enough that it doesn't get in the way, there's no complaint on that front.
Virtual Keyboard (Android+Swype): A good keyboard is really important because most users are using apps that are text-based, like Email, Chat, Social Networks and more. In the AT&T Galaxy S2 users have the choice between the stock Android keyboard, the Samsung Keypad and Swype. Frankly, the Android and Samsung keyboard are so similar that I don't really see the point of having a Samsung keyboard.
For standard virtual keyboards, the most important factor (other than size) is response time (the lag between a tap, and the phone's action). I often find Android phones to be slower than the iPhone 4, but the fastest are still Windows Phone 7 (WP7) devices. It's fundamentally a software thing because the WP7 aren't particularly more powerful than their Android and iOS counterpart. The WP7 keyboard is amazingly responsive.
However, Swype is truly different. Instead of "tapping" on virtual keys, you can swipe your finger from one letter to the next to form complete words. Instead of going into a long description, here's a video that shows how Swype works.
Obviously Flash (10.3) is supported and it will let you access many websites from small business and restaurants. You can also play with select casual games, which opens a new realm of games to your android device. That said, don't expect any miracles: only games that use light computing power can be played. Also, there is no decent "fullscreen" mode, which is annoying.
Email with Exchange (good): the overall email experience is good. Unlike many Samsung phones, the background is actually white, which makes the text much more readable in direct sunlight (phew). As I said in the "display" section, Samsung uses a lot of dark colors because AMOLED displays consume more power with bright images. The Email app does not support actions on multiple items, which is too bad because that makes the Motorola Android phones like the Photon 4G a bit better for email curation.
For those who work in a company that uses virtual private networks (VPN), Samsung supports Cisco AnyConnect. In terms of security, the Samsung Galaxy S2 has on-device encryption which would free up some CPU cycles. This phone also supports WebEx, but I have not tested it. For more information, you can go to their mobile business site.
Microsoft Office Documents: The Samsung Galaxy S2 comes with QuickOffice, an app that can open and edit Word, Excel and Powerpoint documents. It can also read PDF files too. Quick office can be handy to view and possibly edit documents, but honestly most people don't edit Office documents on a phone, unless there is no other option. Still, it's free, so it's hard to complain.
Google Docs: depending on your work habits, Google Docs can be an alternative to Office documents. It works too and Google has put a lot of efforts to make it phone-friendly. There are a few downsides. Google Docs is very weak when it comes to formatting. Also, many companies don't actually use Google Docs for important documents. Finally, it requires a network connection.
GMail: As usual, GMail is very good and has features like "stars", multi-items action and labels. It is the same on every Android phone, so there is no surprise here.
Email / Others: popular email services can be setup very quickly. Just enter your email address and the Email app will try to configure itself. If it does not know how to do that, you can always enter the address and port of your email server. It's usually pretty easy.
Video playback (excellent): The Samsung Galaxy S can play videos without any difficulty. I tried to play the 1080p Gran Turismo 5 trailer that I downloaded directly from the web, and it played without a hitch.
The video quality and the AMOLED contrast are exemplary. Even if the color saturation is a bit over the top, it's clear that the image quality of the Galaxy S2 is awesome.
Games (very good): The Samsung Galaxy S has certainly enough muscles to play. I tried games like Raging Thunder 2 Lite, and the framerate was very good. It is clearly one of the fastest phones that I have tried to date. I wish that there were better gaming benchmarks because I would like to see how well it does against NVIDIA's Tegra 2. In theory, the graphics processor (GPU) used in Samsung's processor should be a bit slower.
NVIDIA was smart enough to secure many exclusive games, which is still the best way to "win". Recent games like Sprinkles aren't available on other devices. Maybe that's why Samsung is using Tegra 2 in a number of upcoming phones. Check TegraZone.com to see the exclusive.
Speaker Quality (good, but not best): when in speaker mode, the sound comes from a tiny speakers in the back of the phone. Surprisingly, the sound is pretty decent and the speaker does its job in a relatively quiet environment. However, I was not blown away by the sound quality. The audio has some echo in it, and at maximum volume it starts getting distorted. The LG Optimus 2X, the iPhone 4 and select Motorola phones do have better speakers.
The Samsung Galaxy S is very good at digital imaging in general. In broad daylight, the photos are less noisy than on competing phones, especially the iPhone 4. I don't say that often for smartphone photos, but daylight photos could be nicely printed on an 4×6. The Galaxy S2 definitely sits at the top of the food chain in terms of mobile photography.
In low-light situations, the Galaxy S2 also does a good job. In our tests, the colors were captured fairly well and it even bests the iPhone 4 which is a reference for low-light mobile photography (I don't have an XPERIA Arc on hand, but I wish that I did).
The iPhone 4 still has a slight advantage when the light is extremely low, but overall, I have to give it to the Galaxy S2. Samsung is *finally* learning that mobile photography is about the trade-off between absolute quality and low-light abilities. It's OK to add noise for the sake of seeing something… Hopefully, others will learn too. Low-light is the next frontier.
The video capture on the Samsung Galaxy S is excellent. So far, this is the best HD 1080p (yes "p") video capture that I have seen on a smartphone. It is actually better than the video recording on my Panasonic GF1 in terms of resolution and framerate (The GF1 still holds the advantage of having a superior lens). Here's a 720p sample: I've uploaded the 1080p version to our Flickr account too.
In short, the Samsung Galaxy S2 is an excellent mobile camera if you take into account its performance in broad daylight, low-light and video recording (in low-light as well).
Although the Galaxy S2 is a fast phone, other leading phones are slightly faster at this particular benchmark. That said, the difference among the leaders is pretty small.
In the Flash benchmark, the Samsung Galaxy S2 stands with the leading group at above 20 frames per second, but the Motorola Atrix still leads by a big margin.
Update: I've abandoned Neocore for the graphics benchmark because it is simply too old, and some phones seem to cap the FPS to 60, while others don't. I've replaced it with Nenamark 2, and you can see the results in my Epic 4G Touch Review: the Galaxy S2 platform wins hands-down against Tegra 2.
Perceptively, the Samsung Galaxy S2 is a very fast smartphone. Its user interface is responsive and I have not experienced any hiccups. Although it is not the fastest, Most users won't feel any difference with what's best out there – except possibly for gaming and Flash usage, so keep that in mind.
With very moderate usage, I have seen this phone hold for 2.5 days. However, with the usage that I have described above, it's more likely that I will need to recharge it every other day, which is very good by mobile phone standards. I have compiled numbers gathered from typical use cases. Keep in mind that while these will give you an indication, actual performance may vary quite a bit depending on your own configuration of applications and settings.
You can do your part in making the battery life better. For example, it's easy to install the Power Control Android widget, and the Samsung Task Manager (very convenient!) to keep an eye on what's running in the background. Also keep in mind that the display is one of the largest contributors to battery depletion.
USB connectivity: The USB connectivity of the recent Samsung devices has been a bit strange. Both the Galaxy Tab 10.1 and the Galaxy S2 don't naturally show up as USB mass storage (USB disks) devices. This is completely artificial since Android supports that feature out of the box. I don't know if this is intentional so that users have to connect with Kies, but why not do both?
To connect via USB mass storage, one needs to go to Settings>Applications>Development>USB Debugging (check). From there, the Galaxy S2 can show up as a USB drive.
Samsung, please let us use the USB Mass Storage feature. Everyone else supports it properly.
Display: While I love the contrast and brightness, it would have been really nice to get a qHD or even 720p resolution. I'm not sure if the color accuracy can be improved, but it looks like LCD IPS if the way to go if you need colors to be accurate.
Samsung's original break in smartphones was due to the Galaxy S hardware platform, and it is clear that Samsung took it to the next level with the Galaxy S2. The hardware has been improved on many points, including additional horsepower, faster graphics and faster HSPA+ "4G" access. The chassis has been improved too: it's much thinner and lighter.
Detractors will be quick to point out that the manufacturing is "cheap" and "fragile". It is true that there is a "plastic" feel, especially in the back, and I can understand where the criticism comes from. However, that's also the price to pay to get an extremely light phone.
In the end, I found the Galaxy S2 to be an excellent phone. It is light, very fast, can capture great images and has a good battery life. These attributes are what most users would want in a modern Android smartphone. Wouldn't you?
I hope that this review has given you a good overview of the Samsung Galaxy S2 (for AT&T). I tried to cover most of the areas that one may want to know, but if there is something else that you would like to ask, or if you simply want to provide some feedback, please leave a comment below. I'll try to reply as soon as I can.
Don't miss those reviews:Atrix 2 Review, iPhone 4S Review, Epic Touch 4G Review, Motorola Droid Bionic, HTC Wildfire S Review, Photon 4G Review, HTC Sensation Review, Droid Incredible 2 Review, iPhone 4 Review, Samsung Epic 4G Review, Samsung Infuse 4G Review.
Filed in Cellphones >Featured >Reviews. Read more about Galaxy S2, Reviews and Samsung.


Four international students who are studying at HAMK as an exchange and double degree students shared their thought about studying in Finland and at HAMK. Why did they choose HAMK and how have they liked it so far? Read their thoughts about studying in Finland and vibes about HAMK!
Who are you and what do you study? Why did you come to HAMK?
Henrik Schill exchange student from Germany studying Business Administration and three other guys studying Business IT: Yves Einfeldt Double Degree student from Switzerland, Dejan Trifunovic Double Degree student from Switzerland and Mattias De Coninck exchange student. They choose HAMK because of a possibility to make a Double Degree abroad and because of improving their English skills. Also all of the interesting projects that have been made in HAMK were one of the key factors of choosing HAMK.
What has been the best thing studying at HAMK?
Studying has been a lot more project oriented and self-studying. Practical oriented self-studying is more intense learning than the traditional going to school to learn theory and learning for exams method. It is nice to learn this way and not learning something by heart. Participating to online courses is also different way to learn because you have to do all by your own. Here you really have to be into it to learn it. In Business IT, students get to work with the latest technology and using the equipment in the projects for example the VR set for developing VR-game.
What was the most challenging thing in exchange?
At least compared to Switzerland the methods are different. In Switzerland, you get all the information beginning of the semester during the first week and here you get it partially in modules but it wasn't that bad when you got used to it.
Why would you recommend others to come exchange at HAMK?
Definitely the practical part but also the modules itself. They are much more time accurate and up to date topics and methods than in our own school. The technology that we are using is new and we can talk to the teachers which project would fit for you. You can use the knowledge that you have learned in practical projects. The buildings and the campus is also nice and homey. Also the contact with teachers. Specially in Business Administration in start-up course the teacher knows my name and I can just go to him and talk with him about my thoughts and ideas about the project and studies. School gym is nice plus to have that budget price and we are playing futsal as well and going bouldering in Hämeenlinna.
How did you manage with accommodation and money issues in exchange?
Everything was organized from school and it went really well. Our coordinator was helpful. The price is good for the space that you're getting for it. The accommodation costs about 300€ per month.
Anything else? Tell some funny story about your exchange for example.
It is very nice that there is a lot of stuff happening. There is every week a party and having a good time. Contact to the tutors is also really nice because they keep you posted about what is happening all the time. The trips to St. Petersburg to Russia was amazing and it's really nice because it is so close to Finland. The Lapland was also amazing and the northern lights, that was super nice!
I had just arrived and it was my first night at my apartment and my flat mate was like "Hey I just made some spaghetti would you like some? And we are going to the party tonight if you want to join?" And I met them in the first night and since then we are buddies! Exchange students are communicating by Whatsapp and we organized barbeque together and stuff like that. We are still about to make trip to Oslo, to Stockholm and to Island. Travelling to northern countries is easier from here. It is nice that Finnish students have overalls and it is unique.


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