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HOW TO SURVIVE THE MEDICAL MISINFORMATION MESS
Knowledge / Articles / HOW TO SURVIVE THE MEDICAL MISINFORMATION MESS
John P. A. Ioannidis*,†,‡, Michael E. Stuart§,¶, Shannon Brownlee**,†† and Sheri A. Strite¶ *Departments of Medicine, Health Research and Policy, and Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA, †Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA, ‡Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA, §Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA, ¶Delfini Group LLC, Seattle, WA, USA, **Lown Institute, Brookline, MA, USA, ††Department of Health Policy, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
Most physicians and other healthcare professionals are unaware of the pervasiveness of poor-quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision-making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders.
Currently, there are nearly approximately 17 million articles in PubMed tagged with 'human(s)', with >700 000 articles identified as 'clinical trials', and >1_8 million as 'reviews' (approximately 160 000 as 'systematic reviews'). Nearly one million articles on humans are added each year [1]. Popular media also abound with medical stories and advice for patients.
Unfortunately, much of this information is unreliable or of uncertain reliability. Most clinical trials results may be misleading or not useful for patients [2,3]. Most guidelines (which many clinicians rely on to guide treatment decisions) do not fully acknowledge the poor quality of the data on which they are based [4]. Most medical stories in mass media do not meet criteria for accuracy [5], and many stories exaggerate benefit and minimise harms.
Clinicians and patients often do not recognise how pervasive this problem is and how profoundly it affects the care they deliver or receive. Twenty to 50 per cent of all healthcare services delivered in the United States is inappropriate, wasting resources and/ or harming patients [6–10]. Much of this waste is due to overuse of medical interventions, resulting in an unknown amount of preventable harms. Underuse of effective and safe interventions further compounds the system's failure to meet patients' needs [11–13]. While there are many causes for inappropriate care and waste, much of it may be attributed to the poor quality of information that clinicians and patients rely on to make decisions about the services they deliver or receive.
We use the term 'Medical Misinformation Mess' to encompass the set of issues that relate to the low quality of medical information deeply embedded in clinical processes and decisions.
Although the Medical Misinformation Mess affects multiple stakeholders – clinicians, patients, researchers, medical information content developers (e.g. producers of guidelines and decision aids), health journalists, professional associations, policymakers, politicians, hospitals, insurers, drug companies, healthcare advocates and others – here, our focus is mainly on clinician and patient issues, and on remedies for those aspects.
The Medical Misinformation Mess comprises four key problems:
Much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers.
Most healthcare professionals are not aware of this problem.
Even if they are aware of this problem, most healthcare professionals lack the skills necessary to evaluate the reliability and usefulness of medical evidence.
Patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making.
Problem 1. Much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients or is not useful to decision makers
With the ever-increasing number of publications, there is a growing need for well-designed and conducted systematic reviews and meta-analyses to provide valid, cumulative evidence on relevant topics. This need is not easy to meet. Although systematic reviews and secondary sources may accelerate evidence uptake [14], most systematic reviews and meta-analyses appear to be either not useful or of uncertain utility [3]. The majority are unnecessary (duplicative), inaccurate or misleading due to biases in the methodology and selective reporting of results, or they address questions that have no clinical value.
Underlying concerns about the methodology and bias of systematic reviews and meta-analyses is the quality of the published medical research on which they are based [2,3]. Usefulness of clinical research [15] requires existence of a real problem to address, proper context placement, sufficient information gain, patient-centeredness, pragmatism, reasonable value-for-money, nonfutility and transparency. Very few clinical studies meet at least six of the eight criteria [15]. In one survey of 60 352 studies, a meagre 7% passed criteria of high-quality methods and clinical relevancy [16] and fewer than 5% passed a validity screening for an evidence-based journal [17]. Uncertain or poor quality evidence leaves clinicians, often under pressure, without definitive information regarding possible treatments. For brevity, our focus here is on therapeutic interventions, but similar problems are found in publications dealing with diagnosis, prevention and other areas of medical care.
Many solutions have been proposed for making medical research more reliable [18,19] and more useful [15], and these will not be discussed in detail here as they have been covered elsewhere [15,18,19], but this problem is unlikely to be fixed imminently. Moreover, the large amount of accumulated misleading information is difficult to extract from the literature. Meanwhile, we need to work on the other three components of the misinformation mess to prevent misleading evidence from flowing downstream into clinical decisions.
Problem 2. Most healthcare professionals are not aware of this problem
Based on training thousands of attendees at our educational programmes and professional interactions with colleagues at all levels – from young trainees to top clinical and academic leadership – we are convinced that very few healthcare professionals are aware of the pervasiveness of biased and inaccurate medical literature. It is our combined experience that ignorance of this problem, even at the highest levels of academic and clinical leadership is profound.
Evidence for this ignorance emerges also in several studies and surveys. In a study of journal reading habits, internists (approximately half of whom were alumni of the Robert Wood Johnson Clinical Scholars Program) reported they obtained information mostly from abstracts and not the full articles, stating that they relied on editors to assure rigour and study quality [20]. Such trust may be misplaced. For example, a recent study showed that several editors of peer-reviewed journals could not tell whether a trial was randomised without a special checklist. Even then, of the 324 studies editorial staff considered as randomised trials, 127 (39%) were actually not randomized [21].
Many healthcare professionals put too much trust in abstracts for filtering the literature or expect that systematic reviews or guidelines will get rid of the unreliability and nonutility problem. Clearly, the reliability of a study's results cannot be accomplished solely by reading the abstract. One study found that nearly half of abstracts of randomised controlled trials contained biased reporting of study results, implying benefit when there was no statistically significant difference in the primary endpoint between study arms [22]. Flawed primary studies are compounded by flawed systematic reviews and lead to flawed clinical guidelines that make for conflicting recommendations unsupported by reliable evidence [23,24]. Most healthcare professionals are not even minimally aware of these issues.
Problem 3. Most healthcare professionals lack skills in being able to evaluate the reliability and usefulness of evidence
In our encounters with students, clinicians and others working in the healthcare industry (including academicians, researchers, editors, peer reviewers, pharmacists, regulators, politicians and employees of insurance companies, hospitals, the pharmaceutical industry and new technology companies), we have found a lack of the basic skills required for determining a study's reliability and applicability. For example, in a pretest administered to a sampling of more than 500 physicians, clinical pharmacists and other healthcare professionals attending evidence-based medicine (EBM) training programmes in 2002 and 2003, 70 per cent failed a simple three-question critical appraisal training programme test. The three pretest questions were designed to determine if attendees could recognise the absence of a control group, understand the issue of overestimating benefit when provided with relative risk reduction information without absolute difference information and determine whether an intention-to-treat analysis was performed. Surprisingly, among those who reported feeling confident to evaluate the medical literature, 72 per cent failed the test, even with generous criteria for correct answers [25]. We have repeated the same pretest with various groups each year with similar results. A well-designed and conducted trial reported similar findings: clinicians without formal EBM training score poorly on the 15-test question Berlin Questionnaire (mean score, 4_2 correct answers compared with EBM experts' mean score of 11_9) [26].
Critical appraisal skills matter greatly for assuring optimal patient care. When practicing clinicians cannot distinguish between valid and false results, they are at risk of delivering useless treatments, or worse, harming their patients. For example, evidence of a fourfold increased risk of myocardial infarction in patients receiving rofecoxib (Vioxx, Merck, Whitehouse Station, NJ, USA) as compared to naproxen (Novopharm Biotech, Toronto, Canada) was plainly available in the abstract of the VIGOR trial. However, peer reviewers, editors and readers of the New England Journal of Medicine accepted the spurious argument that naproxen was cardioprotective. The VIGOR investigators concluded that the increased risk of myocardial infarction with rofecoxib did not exist, stating without any supporting evidence that the '. . .results are consistent with the theory that naproxen has a coronary protective effect'. Millions of prescriptions were written before the drug was withdrawn from the market in 2004, after several studies reported significantly increased risks of cardiovascular events and death [27].
The potential risks of delivering poor care might be mitigated if healthcare professionals followed trustworthy clinical guidelines or based their actions on reliable systematic reviews and meta-analyses, which ought to weed out false results. However, lack of critical appraisal skills on the part of reviewers and guideline creators routinely leads to flawed systematic reviews and guidelines, leaving clinicians with few resources for sorting fact from fiction [3]. The teaching of appraisal skills in medical and other schools and other training programmes, such as residencies, appears at first glance to be fertile ground for providing clinicians with needed skills. However, studies assessing medical student competencies suggest they frequently do not see or are not taught the relevance of EBM to clinical care and are neither motivated nor prepared to apply EBM skills. Upon entry to residency programmes, their ability to appraise the medical literature critically is extremely limited [28].
Currently, strong evidence regarding the most effective training approach to equip healthcare professionals with the required knowledge and skills to consistently apply valid research evidence in their daily work is lacking. Studies of the effectiveness of teaching EBM and critical appraisal of medical evidence are heterogeneous in study designs, populations, intervention components, outcome measures, study settings, duration and other factors. Several systematic reviews have reported that teaching EBM is effective, but study details and methodological quality vary widely [29–31]. An overview of reviews [29] found 16 systematic reviews that have tried to cover this topic and more reviews were published since then [31]. Most systematic reviews have concluded in favour of the effectiveness of EBM teaching, but outcomes vary and focus mostly on knowledge and skills rather than practical applications, while randomized trials are relatively few. For example, a Cochrane review of EBM teaching effectiveness [32] concluded that EBM teaching does have positive impact on the knowledge and skills of physicians. This is based on only three RCTs [33–35] (with total sample size n = 270, shown along with risk of bias assessments [36] in Table 1) meeting the investigators' criteria after reviewing a total of 11 057 titles and abstracts yielding 148 potentially relevant studies. Another systematic review [31] of teaching EBM in healthcare professionals excluding physicians and medical students found only 13 eligible studies with a total of 1120 participants and of those only four (with 168 participants) were randomised. The durability of the effects and the optimal ways of maintaining acquired knowledge and skills are even less studied.
Problem 4. Patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making
People are bombarded with medical news stories, television and radio talk shows, social media, pop culture magazines, spurious websites, direct-to-consumer drug and medical device ads, hospital marketing messages and other media sources, much of which are incomplete or wildly inaccurate [37]. Some television shows hosted by physicians amount to hucksterism. Today, more media articles have begun to note problems in medical science: instances of biased medical research, a lack of evidence for both alternative and allopathic treatments and the problem of conflict of interest. But many health care and medical journalists appear to remain largely unaware of the degree to which the 'information' they gather for stories has been shaped by the interests of manufacturers and research universities. Mass media consumers have few means of determining the accuracy of any given news item and thus often view evidence through the lens of the mass media. We need to educate the public how to deal with these sources of misinformation [38–40].
Table 1 Randomized trials assessing the effectiveness of teaching evidence-based medicine or critical appraisal of medical evidence to physicians [32]
Reference Study design/size/population intervention Outcomes Effect size Risk of bias
Linzer et al (33)
44 internal medicine interns at Duke University who volunteered General medicine journal club that emphasized epidemiologic methods and critical appraisal ofmedical evidence; five journal club sessions (mean); conducted over average of 9_5 months led by general medicine faculty; control group received seminars dealing with ambulatory medicine issues. Per cent improvement in knowledge using a test instrument developed by the Delphi method. 26% improvement in the intervention group compared with 6% improvement in the control group (P = 0_02). Unclear risk of bias Small trial lacking in details of randomization and concealment of allocation; minimal loss to follow-p; assessors were blinded.
MacRae et al. (34)
81 members of the Canadian Association of General Surgeons who volunteered for 6-month internet based study; included surgeons from most provinces. Internet curriculum in critical appraisal skills; included a clinical and methodologic article, a listserve discussion of methodology; methodologic critiques; 16 articles assessed with critical appraisal guide; control group received articles to read and had access to online critical appraisal articles. Primary outcome measure: locally developed 51 item test to assess validity assessment and applicability skills Intervention group score on examination: 58_8% vs. control group score of 50% (P < 0_001). Unclear risk of bias Lacking in details of randomisation and concealment of allocation; attrition unbalanced and > 20%; adequate blinding of assessors.
Taylor et al, (35)
145 self-selected general practitioners, hospital physicians, allied health professionals, healthcare managers/administrators from the south-west of England. Half-day skills training based on the Critical Appraisal Skills Programme (CASP) developed from educational methods of McMaster University. control group: waiting list for workshop. Knowledge: validated tool – 18 multiple choice questions focused on knowledge of principles for appraising evidence. Skills assessment: appraisal of a systematic review. Knowledge score: mean difference 2_6 (95% CI: 0_6–4_6). Skills assessment: mean difference: 1_2 (95% CI: 0_01–2_4). Unclear risk of bias Computer generated randomisation codes; unclear concealment of allocation; balanced groups; attrition incompletely reported; adequate blinding of assessors.
*Risk of bias ratings based on Cochrane Collaboration's 'Risk of bias' assessment tool [36] that examines the following six criteria: sequence generation, allocation concealment, blinding of participants, personnel and outcome assessors, incomplete outcome data, selective outcome reporting and other sources of bias.
Informed or misinformed, patients eventually are at the core of making medical decisions [41]. The legal doctrine of informed consent requires that patients understand that they have treatment choices and the potential benefits and harms of each choice [42], while medical ethics recognises that their values and preferences must be honoured [41]. Shared decision-making (SDM) involves clinicians sharing medical evidence with patients, eliciting their values and preferences and deciding with their patients the best course of treatment. Ensuring that patients are adequately prepared to make decisions usually requires professional assistance to explore both the treatment options and the medical evidence, so that the potential outcomes that matter most to the patient can be accurately determined. This process depends on sufficient, relevant and valid information, and clarifying discussion that confers 'agency' – the capacity of an individual to make free choices [43,44].
Use of SDM and decision support materials (often called patient decision aids) improves decision-making around many different 'preference-sensitive' clinical choices. A systematic review of 115 randomised controlled trials involving more than 34 000 patients of the effects of SDM and exposure to decision aids (written, electronic, audiovisual or in webbased tool formats), reported that patients had greater knowledge gain, felt more confident regarding what mattered to them and had more accurate expectations about risks and benefits than patients who received usual care. Participants in the experimental arms participated more actively in the decision-making process and were on average ~20% more likely to make conservative choices when facing difficult decisions regarding surgical and nonsurgical interventions, resulting in no known adverse health outcomes, decreased satisfaction or anxiety [45].
Given the power of patient decision aids and clinician–patient dialogue, both need to be accurate if patients are to make properly informed decisions. Accuracy of decision aids depends upon the critical appraisal skills of their producers [46], while the effectiveness of clinician–patient conversations requires clinicians who are willing and able to engage and know the evidence. Barriers to implementing effective SDM include pervasive professional indifference, organizational inertia, lack of physician comfort with decision aids, time constraints, competing priorities, lack of training, lack of reimbursement and perceived work burden and cost [47]. Patients' preferences for a treatment often differ from those of clinicians [48,49], yet clinicians often underestimate patients' desires for information [50].
Not surprisingly, discussions with patients infrequently fulfil the criteria considered integral to informed decision-making and informed consent. A study of outpatient visits in primary care clinics assessed six elements of informed decision-making: description of the nature of the decision, discussion of alternatives; discussion of risks and benefits, discussion of related uncertainties; assessment of the patient's understanding and elicitation of the patient's preference. No discussions fulfilled all criteria. Physicians frequently described the nature of the decision (83%), but infrequently elicited patients' preferences (19%), discussed alternatives (14%), risks and benefits (9%), uncertainties (5%) and rarely (2%) assessed the patient's understanding of the decision [51]. In a similar study, only rarely (1_1–16_6%) did physicians relate to patients the uncertainty of evidence surrounding the recommended treatments [52]. The combination of unreliable medical evidence, the tsunami of misleading reports in the media, inadequate discussions between clinicians and patients and a culture of patients' trust in providers' recommendations and expectation of something to be done together produce massive medical misinformation, with suboptimal, nonpatient-centred decision-making.
We think that all healthcare professionals involved in medical decision-making should possess basic critical appraisal skills and be knowledgeable about which sources of information are likely to be accurate and relevant. As Glasziou et al. [53] have stated, 'a 21st century clinician who cannot critically read a study is as unprepared as one who cannot take a blood pressure or examine the cardiovascular system'. Such illiteracy is common and clinicians thus foster unrealistic expectations about medicine. A systematic review of 48 studies on clinician expectations on the benefits and/or harms of treatments, tests or screening tests showed that in most studies most physicians had inaccurate expectations. Moreover, it was far more common for clinicians to overestimate than underestimate benefits and to underestimate rather than overestimate harms [54]. Their inability to assess evidence further contributes to skewed views among patients, the media, policy makers and others.
The problem of having so much unreliable and nonuseful published medical research may be attacked at its root, that is by funding, conducting, publishing and disseminating more true and useful research. However, it is important in the meantime to make healthcare professionals, patients, journalists and others aware of the problem, provide them with critical appraisal skills and ensure that the best evidence available is included in clinician–patient discussions about treatment choices.
How to accomplish those three goals is neither obvious nor simple. We need additional high-quality RCTs on the effectiveness of specific interventions to teach EBM. Assessed interventions may include both fixed components (e.g. basic EBM concepts and skills) and variable components (e.g. contextual elements such as settings, leadership support, involvement of opinion leaders and other details regarding employed implementation strategies) [55]. It has not been decisively shown which implementation strategies are optimal for a given clinical practice change. Important barriers and considerations for successful clinical practice change may include personal factors (e.g. motivation, time, skills required to evaluate the relevance and validity of medical information), recommendation-related factors (access, complexity) and external factors (e.g. local clinical culture) [56].
We should also caution that any of the EBM critical appraisal tools can be subverted. For example, industry-sponsored trials may be performed and presented in a way that they tick all the boxes in the CONSORT checklist and on risk of bias tools, even as some fundamental aspects of their design, for example the question asked and how it is asked and answered (what comparators, outcomes or follow-up are used), may still be highly misleading. There is no standard package or automated training tool to substitute for thinking and some healthy scepticism. Similarly, while decision tools can enhance SDM, automated tools alone cannot address some additional fundamental challenges that weaken the position and involvement of patients in the decision-making. For example, patients typically have had little or no input to the design of the research that produced the available evidence, power imbalances may exist in the clinical consultation, and many people do not seek or cannot access care [57]. In addition, journalists must be trained to bring greater scepticism and some critical appraisal skills to reporting on medical research. Addressing these challenges requires rethinking medical research and care at large.
Acknowledging these broader challenges, agents of change could include journals, government agencies, professional groups, schools for healthcare professionals, payers, accreditation bodies, as well as fellow healthcare providers who can reinforce the importance of mastering critical appraisal and communication skills in every day's practice. The mass media have a special role to play in this regard, as all players in healthcare, from journals to clinicians to government agencies, may respond to criticism in the press.
Critical appraisal skills may have a short half-life and need continuous use and reinforcement. Moreover, given the vast and rapidly expanding nature of the literature and the limited time available to healthcare professionals, it may be easier to focus on using critically pre-appraised evidence, for example from well-done evidence synthesis efforts or guidelines, rather than try to appraise every single article. However, even systematic reviews, meta-analyses and guidelines are currently so numerous and often so poor, biased, conflicted or useless that building and maintaining skills to appraise them is not an easy task. Moreover, becoming proficient in dissecting the caveats of higher-level syntheses requires understanding the problems of primary studies.
As more journal editors recognise the Medical Misinformation Mess as an issue, they can promote awareness by publishing articles, commentaries and editorials on the subject. It seems astonishing that there is a need to point out that investigators should understand what constitutes good design, methodology, execution, performance and reporting in research; nevertheless, the need exists. Journals should require manuscripts to provide all information required for their critical appraisal. Government agencies and professional groupsmay also be influential stakeholders in ensuring that investigators possess key EBM skills. The press also needs training in critical thinking [58]. Schools of journalism should include basic epidemiology and statistics in their coursework for future healthcare and medical writers. Journalists and editors should also be aware of the evidence-based critiques of mass media stories, such as those offered by HealthNewsReview.org [38].
Schools for healthcare professionals could do a better job of ensuring that training in critical appraisal of the medical literature is integrated into the curricula and clinical care. Encouraging reports suggest that attitudes, knowledge and critical appraisal skills can improve through tightly integrated EBM teaching programmes [59,60]. Payers and accreditation bodies, such as the Accreditation Council for Graduate Medical Education, involved in the delivery of healthcare, could also require skills in critical appraisal of medical evidence.
Eventually, successful initiatives should be part of everyday clinical experience, not seen as an artificial formal imposed requirement. Teachers and trainers need ever sharper skills in critical appraisal of the medical literature [59]. Furthermore, all healthcare professionals can take up the responsibility to master skills and become teachers and trainers for themselves and for others during encounters with patients and decision making.
METRICS is funded by a grant from the Laura and John Arnold Foundation. The work of John Ioannidis is supported by an unrestricted gift from Sue and Bob O'Donnell.
Departments of Medicine, of Health Research and Policy, and of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305, USA (J. P. A. Ioannidis); Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA 94305, USA (J. P. A. Ioannidis); Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA 94305, USA (J. P. A. Ioannidis); Department of Family Medicine, University of Washington School of Medicine, Seattle, WA 98115, USA (M. E. Stuart); Delfini Group LLC, Seattle, WA 98229, USA (M. E. Stuart, S. A. Strite); Lown Institute, Brookline, MA 02446, USA (S. Brownlee); Department of Health Policy, Harvard T.H. Chan School of Public Health, Cambridge, MA 02115, USA (S. Brownlee).
Correspondence to: John P. A. Ioannidis, Department of Medicine, Meta-Research Innovation Center at Stanford and Stanford Prevention Research Center, 1265 Welch Rd, MSOB X306, Stanford CA 94305, USA. Tel.: +1 650 7045584; e-mail: jioannid@stanford.edu
Received 1 September 2017; accepted 1 September 201
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42 King JS, Moulton BW. Rethinking informed consent: the case for shared medical decision-making. Am J Law Med 2006;32:429–501.
43 Makoul G, Clayman ML. An integrative model of shared decisionmaking in medical encounters. Patient Educ Couns 2006;60:301–12.
44 Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P et al. Shared decision-making: a model for clinical practice. J Gen Intern Med 2012;27:1361–7.
45 Stacey D, L_egar_e F, Col NF, Bennett CL, Barry MJ, Eden KB et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014;(1). Art. No.: CD001431. https://doi.org/10.1002/14651858.cd001431.pub4.
46 Montori VM, LeBlanc A, Buchholz A, Stilwell DL, Tsapas A. Basing information on comprehensive, critically appraised, and up-to-date syntheses of the scientific evidence: a quality dimension of the International Patient Decision Aid Standards. BMC Med Inform DecisMak 2013;13(Suppl 2):S5. https://doi.org/10.1186/1472-6947-13-S2-S5.
47 Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AGK, Clay C et al. "Many miles to go . . .": a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak 2013;13(Suppl 2):S14. https://doi.org/10.1186/1472-6947-13-S2-S14.
48 Sepucha KR, Simmons LH, Barry MJ, Edgman-Levitan S, Licurse AM, Chaguturu SK. Ten years, forty decision aids, and thousands of patient uses: shared decision making at Massachusetts General Hospital. Health Aff (Millwood) 2016;35:630–6. https://doi.org/10. 1377/hlthaff.2015.1376.
49 Montgomery AA, Harding J, Fahey T. Shared decision making in hypertension: the impact of patient preferences on treatment choice. Fam Pract 2001;18:309–13.
50 Say RE, Thomson R. The importance of patient preferences in treatment decisions–challenges for doctors. BMJ 2003;327:542–5.
51 Braddock CH 3rd, Fihn SD, Levinson W, Jonsen AR, Pearlman RA. How doctors and patients discuss routine clinical decisions.Informed decision making in the outpatient setting. J Gen Intern Med 1997;12:339–45.
52 Braddock CH 3rd, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA 1999;282:2313–20.
53 Glasziou P, Burls A, Gilbert R. Evidence based medicine and the medical curriculum. BMJ 2008;337:a1253. https://doi.org/10.1136/bmj.a1253.
54 Hoffmann TC, Del Mar C. Clinicians' expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med 2017;177:407–19. https://doi.org/10.1001/jamainte rnmed.2016.8254.
55 Dizon JM, Grimmer-Somers K. Complex interventions required to comprehensively educate allied health practitioners on evidence based practice. Adv Med Educ Pract 2011;2:8. https://doi.org/10. 2147/AMEP.S19767.
56 Fischer F, Lange K, Klose K, Greiner W, Kraemer A Barriers and strategies in guideline implementation – a scoping review. Healthcare (Basel) 2016;4: pii: E36. https://doi.org/10.3390/healthcare 4030036.
57 Greenhalgh T, Snow R, Ryan S, Rees S, Salisbury H. Six 'biases' against patients and carers in evidence-based medicine. BMC Med 2015;1:200. https://doi.org/10.1186/s12916-015-0437-x.
58 PLoS Medicine Editors. False hopes, unwarranted fears: the trouble with medical news stories. PLoS Med 2008;5:e118.
59 Shaughnessy AF, Gupta PS, Erlich DR, Slawson DC. Ability of an information mastery curriculum to improve residents' skills and attitudes. Fam Med 2012;44:259–64.
60 Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ 2004;329:1017.
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I know that this isn't DMC related but I thought I would let you know that I am no longer on Facebook. The reason is purely as a security measure.
Aaron wrote: I know that this isn't DMC related but I thought I would let you know that I am no longer on Facebook. The reason is purely as a security measure.
Greetings from the U.S. I recently purchased a 1981 with auto transmission and black interior. I've wanted one of these cars for years. I'm excited to finally be part of the family!


text:
Q: Closing Sliding menu onItemClick So, I'm using jfeinstein10 library for my SlidingMenu. It works fine but I'm having a problem to toggle the menu when the user taps in one of the menu options.
I have the MainActivty where the slidingmenu is and a fragment called SampleListFragment where I set the menu options.
What I'm trying to do is call a function from the MainActivity when I click the option. This function should only toggle the menu, but instead I get a NullPointException error.
My MainActivity
public class MainActivity extends BaseActivity implements SlidingActivityBase {

private SlidingMenu menu;

private ImageButton btn_pesquisa;
private ImageButton btn_toggle;

private MakeMateria makeMat = new MakeMateria();

private static final int SCREEN_ORIENTATION_PORTRAIT = 1;

String id_test;

SampleListFragment listFragment = new SampleListFragment();

public MainActivity() {
    super(R.string.title_bar_content);
}

public void mainToggle() {
    Log.d("1", "" + this);
    toggle();
    Log.d("2", "" + this);
}

public static Intent newInstance(Activity activity, int pos) {
    Intent intent = new Intent(activity, MainActivity.class);
    intent.putExtra("pos", pos);
    return intent;
}

public void testeEvent(){
    Log.d("Funciona","works");

    toggle();
}

@Override
public void onCreate(Bundle savedInstanceState) {
    super.onCreate(savedInstanceState);
    setContentView(R.layout.activity_main);

    if (Build.VERSION.SDK_INT < Build.VERSION_CODES.ICE_CREAM_SANDWICH) {
        BitmapDrawable bg = (BitmapDrawable) getResources().getDrawable(
                R.drawable.titlebar);
        bg.setTileModeXY(TileMode.REPEAT, TileMode.REPEAT);
        getSupportActionBar().setBackgroundDrawable(bg);

        BitmapDrawable bgSplit = (BitmapDrawable) getResources()
                .getDrawable(R.drawable.titlebar);
        bgSplit.setTileModeXY(TileMode.REPEAT, TileMode.REPEAT);
        getSupportActionBar().setSplitBackgroundDrawable(bgSplit);
    }

    int pos = 0;
    if (getIntent().getExtras() != null) {
        pos = getIntent().getExtras().getInt("pos");
    }

    getSupportActionBar().setDisplayOptions(ActionBar.DISPLAY_SHOW_CUSTOM);
    getSupportActionBar().setCustomView(R.layout.abs_layout);

    menu = new SlidingMenu(this);
    menu.setTouchModeAbove(SlidingMenu.TOUCHMODE_FULLSCREEN);
    menu.setShadowWidthRes(R.dimen.shadow_width);
    menu.setShadowDrawable(R.drawable.shadow);
    menu.setBehindOffsetRes(R.dimen.slidingmenu_offset);
    menu.setFadeDegree(0.35f);
    menu.attachToActivity(this, SlidingMenu.SLIDING_CONTENT);
    menu.setBehindScrollScale((float) 1.0);
    menu.setMenu(R.layout.menu_frame);

    // set the Above View
    setContentView(R.layout.content_frame);
    getSupportFragmentManager().beginTransaction()
            .replace(R.id.content_frame, new MainFragment()).commit();

    setSlidingActionBarEnabled(true);

    btn_pesquisa = (ImageButton) findViewById(R.id.btnPesquisa);
    btn_toggle = (ImageButton) findViewById(R.id.btn_menu);

    btn_toggle.setOnClickListener(new OnClickListener() {

        @Override
        public void onClick(View v) {
            // TODO Auto-generated method stub
            toggle();

        }
    });

    btn_pesquisa.setOnClickListener(new OnClickListener() {

        @Override
        public void onClick(View v) {
            // TODO Auto-generated method stub
            Intent intent = new Intent(getApplicationContext(),
                    SearchActivity.class);
            //startActivity(intent);
            overridePendingTransition(R.anim.view_transition_in_left,
                    R.anim.view_transition_out_left);
        }
    });
}

public void getMenu(){
    menu.toggle();
}

@Override
public boolean onOptionsItemSelected(MenuItem item) {
    switch (item.getItemId()) {
    case android.R.id.home:
        toggle();
        return true;

    default:
        return super.onOptionsItemSelected(item);
    }
}

}
This part is from my fragment:
@Override
public void onListItemClick(ListView lv, View v, int position, long id) {

    Fragment newContent = null;

    android.support.v4.app.FragmentTransaction transaction = getFragmentManager().beginTransaction();

    switch (position) {
    case 0:
        Log.d("1", "1");

        getFragmentManager().beginTransaction().replace(R.id.content_frame, new MainFragment()).commit();
        mainActivity.getMenu();

        break;
    case 1:
        Log.d("2", "2");
        toggle();
        break;
    case 2:
        Log.d("3", "3");
        toggle();
        break;
    case 3:
        Log.d("4", "4");
        toggle();
        break;
    case 4:
        Log.d("5", "5");
        toggle();
        break;
    case 5:
        Log.d("6", "6");
        toggle();
        break;
    case 6:
        Log.d("7", "7");
        toggle();
        break;
    case 7:
        Log.d("8", "8");
        toggle();
        break;
    case 8:
        Log.d("9", "9");
        toggle();
        break;
    }
    if (newContent != null)
        switchFragment(newContent);
}

MainActivity mainActivity is global, and the insance of it I did in the onCreateView.
The NPE points to the lines where I call the function and where I call the toggle inside the function.
Many thanks.

A: I did this -> Android : Accessing container activity object from fragment using putExtra?
The problem was that I passing a null object, but when I did like this ->
((MainActivity) this.getActivity()).getMenu()

I was able to get the correct value from the object.
@Wenger thanks for the help.

redpajama_set_name: RedPajamaStackExchange


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text:
Disclosure: This article may contain affiliate links, meaning, at no additional cost to you, we will earn a commission if you click through and make a purchase.
Choice Hotels Expands Cambria Hotels Brand with A New Hotel Opening in Omaha
Özgür Töre
Choice Hotels International announced the expansion of its Cambria Hotels brand with a new hotel opening in Omaha, Nebraska.
The 128-room upscale Cambria Hotel Omaha Downtown is the first Cambria hotel to open in the state of Nebraska, joining the brand's growing presence in key Midwestern cities, such as Chicago, Indianapolis, Columbus, Ohio, and Madison, Wis. The Cambria brand pipeline also includes hotels in Cincinnati, Milwaukee, and Minneapolis.
The Cambria Hotel Omaha Downtown is located at 740 N.14th Street, minutes from numerous businesses and attractions. Nearby Fortune 500 companies include Mutual of Omaha and the headquarters of Berkshire Hathaway, Union Pacific Railroad and Kiewit Corporation. Major leisure draws for guests include the world-class Henry Doorly Zoo and Aquarium and the historic Old Market neighborhood, which features unique shops, boutiques, pubs, restaurants, and entertainment. The hotel is also a short distance from Omaha's international airport, Eppley Airfield, and the annual NCAA College World Series at TD Ameritrade Park.
"The Cambria Hotel Downtown Omaha's prime location offers travelers access to more than 45,000 businesses and the opportunity to immerse themselves in the vibrant local culture," said Janis Cannon, senior vice president, upscale brands, Choice Hotels. "This hotel underscores our commitment to expanding the Cambria Hotels brand in key urban markets throughout the country. We're proud to deliver another upscale lodging experience to the growing Midwest region."
The hotel amenities include:
Spa-style bathrooms with Bluetooth mirrors
Contemporary and sophisticated guest rooms, complete with modern fixtures, abundant lighting, and plush bedding
Onsite dining featuring freshly made food, local craft beer on tap, wine, specialty cocktails, and small bites
Multi-function meeting space
Locally inspired design
O'Reilly Hospitality Management, LLC, is a proven hospitality firm that collaborated on the development of this hotel. It has previously developed Cambria Hotels in North Scottsdale, Ariz. as well as Plano and McAllen, Texas, with additional Cambria Hotels arriving soon in Louisville, Ky. and Sarasota, Fla.
"Omaha hosts more than 12 million visitors annually, a number that continues to increase year after year, thanks to a thriving economy and tremendous local attractions. The Cambria Hotel Omaha Downtown is the perfect addition to the city to meet this demand, and we can't wait for business and leisure travelers to experience its upscale and modern amenities," said Tim O'Reilly, CEO of O'Reilly Hospitality Management.
A New Hilton Opens in New Jersey
A Hilton Hotel Opens on the Arkansas State University Campus
Hilton Opens In A Private-owned Island in China
JW Marriott Opens on China's Holiday Island
W Hotel to Open in Playa Del Carmen, Mexico
Hyatt Regency Brand Debuts in Kerala, India
Hyatt Opens Thompson Washington D.C.
ONYX To Open An Amari Hotel in Hangzhou
Swiss International Announces A New Hotel in Lagos, Nigeria
Radisson to Open First Hotel in Reunion Island
A New-Build Hilton Opens in China
Diamond Resorts Expands to New York City
Limited-Time Offer: Sleepover Inside A Bakery
KASA Hotel Collection Expands and Adds Investment Opportunities
Grand Canyon Lodge North Rim Offers Tranquility and Fewer Crowds
Hilton Launches A New Lifestyle Brand: Tempo by Hilton
Accor Brings its Mondrian Brand to Europe

redpajama_set_name: RedPajamaCommonCrawl


The famous plumber Mario is going hunting his enemies with a gun! Help him if you want him to survive. Use your arrows to move back and forth and find your target. You can press your spacebar when you are ready to shoot!


text:
El terme aniversari s'utilitza per a designar el dia que hom commemora un fet o esdeveniment digne de record. Generalment s'utilitza per a rememorar anualment el naixement d'una persona. En nombroses cultures, els aniversaris acostumen a venir acompanyats d'una festa i, en alguns casos, d'un ritu de pas. La paraula aniversari fou usada per primer cop en el catolicisme per a commemorar sants.
En català, les expressions natalici, cap d'any o fer els anys es poden utilitzar com a sinònims d'aniversari, especialment si es tracta del primer aniversari d'un fet.

Tipus d'aniversaris

Aniversaris de naixement

Els aniversaris de naixement o natalicis són els més comuns. A Catalunya, el Club Super 3 felicita cada dia tots els nens i nenes que fan anys.

En la celebració oficial del naixement de certs personatges, el dia de celebració de vegades pot ser mogut per raons pràctiques, com la de George Washington als Estats Units, o situar-se en una data que no necessàriament hi correspon, com en el cas de Jesucrist.

La celebració de natalicis no és universal: dins del cristianisme, algunes comunitats com els Testimonis de Jehovà consideren que aquestes festivitats són d'origen pagà i per tant contràries a les pràctiques cristianes; els ortodoxos prefereixen celebrar el dia del Sant, i altres comunitats, com els catòlics del món hispànic, celebren tant el Sant com l'aniversari de naixement.

Existeixen nombrosos sistemes astrològics que determinen el signe astrològic d'una persona a partir de la seva data de naixement, com el zodiacal. En alguns casos, el signe és determinat per l'hora o el lloc de naixement. Aquests signes astrològics pretenen deduir el caràcter de l'individu, les seves afinitats o, fins i tot, predir-ne el destí.

Aniversaris de casament
Els aniversaris de casament se solen celebrar el mateix dia de l'any en el qual tingué lloc el matrimoni. Emily Post, en el seu llibre Etiquette in Society, in Business, in Politics and at Home (1922) suggeria celebrar els aniversaris següents: 1, 5, 10, 15, 20, 25, 50 i 75 anys. Cada aniversari de bodes rep un nom especial; per exemple, els 25 anys són les noces de plata, els 50 anys les noces d'or, els 60 anys les noces de diamant i els 75 anys les noces de platí. Les designacions, però, són diferents segons el país o l'autor.

Aniversaris de mort
Els aniversaris de mort tenen molta importància pels asiàtics, sobretot en les cultures xinesa, pakistanesa, israelita, georgiana, índia, iraniana, japonesa, coreana, russa i vietnamita. Igual que els aniversaris de naixement, se celebren anualment, però en comptes de fer-ho el dia que l'individu va néixer es commemora el dia de la seva mort. Malgrat ser principalment considerat culte als avantpassats, aquesta tradició també ha estat associada amb el confucianisme, el budisme i l'hinduisme. En el judaisme, aquesta tradició s'anomena yahrtzeit. A occident en les esglésies catòlica i ortodoxa, se celebren tradicionalment els sants al dia de la seva mort, considerat com dies natalis, dia de naixement a la vida eterna.

Aniversaris nacionals

Els aniversaris nacionals se celebren a escala nacional; per exemple, es pot tractar de la independència d'un país, d'una victòria militar o de l'aprovació d'una constitució.

Aniversaris de fundació
La locució llatina dies natalis (literalment, dia de naixement) ha esdevingut comuna —sobretot en àmbits intel·lectuals— per l'aniversari de fundació d'institucions tals com l'alma mater. Fins i tot de l'antiga Roma se'n coneix el [dies] Aquilae natalis, és a dir, l'«aniversari de l'àguila» (aniversari de la fundació oficial d'una legió).

Referències

Festes

redpajama_set_name: RedPajamaWikipedia


text:
/*globals define, WebGMEGlobal, requirejs*/
/*jshint browser: true*/

/**
 * @author rkereskenyi / https://github.com/rkereskenyi
 * @author lattmann / https://github.com/lattmann
 * @author pmeijer / https://github.com/pmeijer
 */

define([
    'common/core/coreQ',
    'plugin/PluginManagerBase',
    'plugin/PluginResult',
    'plugin/PluginMessage',
    'blob/BlobClient',
    'js/Dialogs/PluginConfig/PluginConfigDialog',
    'js/logger',
    'js/Utils/ComponentSettings'
], function (Core, PluginManagerBase, PluginResult, PluginMessage, BlobClient, PluginConfigDialog, Logger,
             ComponentSettings) {

    'use strict';

    var InterpreterManager = function (client, gmeConfig) {
        this._client = client;
        //this._manager = new PluginManagerBase();
        this.gmeConfig = gmeConfig;
        this._savedConfigs = {};
        this.logger = Logger.create('gme:InterpreterManager', gmeConfig.client.log);
        this.logger.debug('InterpreterManager ctor');
    };

    InterpreterManager.prototype.GLOBAL_OPTIONS = 'Global Options';

    var getPlugin = function (name, callback) {
        if (typeof WebGMEGlobal !== 'undefined' && WebGMEGlobal.plugins && WebGMEGlobal.plugins.hasOwnProperty(name)) {
            callback(null, WebGMEGlobal.plugins[name]);
        } else {
            requirejs(['/plugin/' + name + '/' + name + '/' + name],
                function (InterpreterClass) {
                    callback(null, InterpreterClass);
                },
                function (err) {
                    callback(err, null);
                }
            );
        }
    };

    function getPluginErrorResult(pluginName, message, startTime, projectId) {
        var pluginResult = new PluginResult(),
            pluginMessage = new PluginMessage();
        pluginMessage.severity = 'error';
        pluginMessage.message = message;
        pluginResult.setSuccess(false);
        pluginResult.setPluginName(pluginName);
        pluginResult.setProjectId(projectId || 'N/A');
        pluginResult.addMessage(pluginMessage);
        pluginResult.setStartTime(startTime);
        pluginResult.setFinishTime((new Date()).toISOString());
        pluginResult.setError(pluginMessage.message);

        return pluginResult;
    }

    /**
     *
     * @param {string} name - name of plugin to be executed.
     * @param {object} silentPluginCfg - if falsy dialog window will be shown.
     * @param {object.string} silentPluginCfg.activeNode - Path to activeNode.
     * @param {object.Array.<string>} silentPluginCfg.activeSelection - Paths to nodes in activeSelection.
     * @param {object.boolean} silentPluginCfg.runOnServer - Whether to run the plugin on the server or not.
     * @param {object.object} silentPluginCfg.pluginConfig - Plugin specific options.
     * @param callback
     */
    InterpreterManager.prototype.run = function (name, silentPluginCfg, callback) {
        var self = this,
            projectId = self._client.getProjectObject().projectId,
            startTime = (new Date()).toISOString();
        getPlugin(name, function (err, plugin) {
            self.logger.debug('Getting getPlugin in run.');
            if (!err && plugin) {
                var plugins = {},
                    runWithConfiguration;
                plugins[name] = plugin;
                var pluginManager = new PluginManagerBase(self._client.getProjectObject(), Core, self.logger, plugins,
                    self.gmeConfig);
                pluginManager.notificationHandlers = [function (data, callback) {
                    self._client.dispatchPluginNotification(data);
                    callback(null);
                }];
                pluginManager.initialize(null, function (pluginConfigs, configSaveCallback) {
                    //#1: display config to user
                    var serverAllowedGlobal = self.gmeConfig.plugin.allowServerExecution === true,
                        serverAllowedPlugin = !plugin.disableServerExecution,
                        browserAllowedGlobal = self.gmeConfig.plugin.allowBrowserExecution === true,
                        browserAllowedPlugin = !plugin.disableBrowserExecution,
                        runOptions = {
                            name: 'runOnServer',
                            displayName: 'Execute on Server',
                            description: '',
                            value: false,
                            valueType: 'boolean',
                            readOnly: false
                        },
                        hackedConfig = {},
                        i, j, d, len;

                    hackedConfig[self.GLOBAL_OPTIONS] = [runOptions];

                    if (serverAllowedGlobal === false && browserAllowedGlobal === false) {
                        callback(getPluginErrorResult(name, 'Plugin execution is disabled!', startTime, projectId));
                        return;
                    }

                    if (serverAllowedPlugin === false && browserAllowedPlugin === false) {
                        callback(getPluginErrorResult(name, 'This plugin cannot run on the server nor in the browser!?',
                            startTime, projectId));
                        return;
                    }

                    if (browserAllowedGlobal) {
                        if (serverAllowedGlobal) {
                            if (browserAllowedPlugin) {
                                if (serverAllowedPlugin) {
                                    // This is the default
                                } else {
                                    runOptions.readOnly = true;
                                    runOptions.description = 'This plugin can not run on the server.';
                                }
                            } else {
                                runOptions.readOnly = true;
                                runOptions.value = true;
                                runOptions.description = 'This plugin can not run in the browser.';
                            }
                        } else {
                            if (browserAllowedPlugin) {
                                runOptions.readOnly = true;
                                runOptions.description = 'Server execution is disabled.';
                            } else {
                                callback(getPluginErrorResult(name,
                                    'This plugin can only run on the server which is disabled!', startTime, projectId));
                                return;
                            }
                        }
                    } else {
                        if (browserAllowedPlugin) {
                            runOptions.readOnly = true;
                            runOptions.value = true;
                            runOptions.description = 'Browser execution is disabled.';
                        } else {
                            callback(getPluginErrorResult(name,
                                'This plugin can only run on the server which is disabled!', startTime, projectId));
                            return;
                        }
                    }

                    for (i in pluginConfigs) {
                        if (pluginConfigs.hasOwnProperty(i)) {
                            hackedConfig[i] = pluginConfigs[i];

                            // retrieve user settings from previous run
                            var iConfig = self.getStoredConfiguration(i, plugin);
                            if (iConfig) {
                                len = hackedConfig[i].length;

                                while (len--) {
                                    if (iConfig.hasOwnProperty(hackedConfig[i][len].name)) {
                                        hackedConfig[i][len].value = iConfig[hackedConfig[i][len].name];
                                    }
                                }
                            }
                        }
                    }

                    runWithConfiguration = function (updatedConfig) {
                        //when Save&Run is clicked in the dialog (or silentPluginCfg was passed)
                        var globalconfig = updatedConfig['Global Options'],
                            activeNode,
                            errMessage,
                            activeSelection;
                        delete updatedConfig['Global Options'];

                        activeNode = silentPluginCfg.activeNode;
                        if (!activeNode && WebGMEGlobal && WebGMEGlobal.State) {
                            activeNode = WebGMEGlobal.State.getActiveObject();
                        }
                        activeSelection = silentPluginCfg.activeSelection;
                        if (!activeSelection && WebGMEGlobal && WebGMEGlobal.State) {
                            activeSelection = WebGMEGlobal.State.getActiveSelection();
                        }
                        // save config from user
                        for (i in updatedConfig) {
                            self._savedConfigs[i] = updatedConfig[i];
                        }

                        //#2: save it back and run the plugin
                        if (configSaveCallback) {
                            configSaveCallback(updatedConfig);

                            if (self._client.getBranchStatus() &&
                                self._client.getBranchStatus() !== self._client.CONSTANTS.BRANCH_STATUS.SYNC) {
                                errMessage = 'Not allowed to invoke plugin while local branch is AHEAD or ' +
                                    'PULLING changes from server.';
                                self.logger.error(errMessage);
                                callback(getPluginErrorResult(name, errMessage, startTime, projectId));
                                return;
                            }

                            // TODO: If global config says try to merge branch then we
                            // TODO: should pass the name of the branch.
                            var config = {
                                project: self._client.getActiveProjectId(),
                                token: '',
                                activeNode: activeNode, // active object in the editor
                                activeSelection: activeSelection || [],
                                commit: self._client.getActiveCommitHash(), //#668b3babcdf2ddcd7ba38b51acb62d63da859d90,
                                // This will get loaded too which will provide a sanity check on the client state.
                                rootHash: self._client.getActiveRootHash(),
                                branchName: self._client.getActiveBranchName()
                            };

                            if (globalconfig.runOnServer === true || silentPluginCfg.runOnServer === true) {
                                var context = {
                                    managerConfig: config,
                                    pluginConfig: updatedConfig[name]
                                };
                                self._client.runServerPlugin(name, context, function (err, result) {
                                    if (err) {
                                        self.logger.error(err);
                                        if (result) {
                                            callback(new PluginResult(result));
                                        } else {
                                            errMessage = 'Plugin execution resulted in error, err: ' + err;
                                            callback(getPluginErrorResult(name, errMessage, startTime, projectId));
                                        }
                                    } else {
                                        var resultObject = new PluginResult(result);
                                        callback(resultObject);
                                    }
                                });
                            } else {
                                config.blobClient = new BlobClient({logger: self.logger.fork('BlobClient')});

                                pluginManager.executePlugin(name, config, function (err, result) {
                                    if (err) {
                                        self.logger.error(err);
                                    }
                                    callback(result);
                                });
                            }
                        }
                    };

                    if (silentPluginCfg) {
                        var updatedConfig = {};
                        for (i in hackedConfig) {
                            updatedConfig[i] = {};
                            len = hackedConfig[i].length;
                            while (len--) {
                                updatedConfig[i][hackedConfig[i][len].name] = hackedConfig[i][len].value;
                            }

                            if (silentPluginCfg && silentPluginCfg.pluginConfig) {
                                for (j in silentPluginCfg.pluginConfig) {
                                    updatedConfig[i][j] = silentPluginCfg.pluginConfig[j];
                                }
                            }
                        }
                        runWithConfiguration(updatedConfig);
                    } else {
                        d = new PluginConfigDialog();
                        silentPluginCfg = {};
                        d.show(hackedConfig, plugin, function (userConfig, save) {
                            if (save === true) {
                                self.saveSettingsInUser(name, plugin, userConfig);
                            }

                            runWithConfiguration(userConfig);
                        });
                    }
                });
            } else {
                self.logger.error(err);
                self.logger.error('Unable to load plugin');
                callback(getPluginErrorResult(name, 'Unable to load plugin, err:' + err, startTime, projectId));
            }
        });
    };

    InterpreterManager.prototype.getStoredConfiguration = function (pluginId, plugin) {
        var config,
            componentId = this.getPluginComponentId(pluginId, plugin);

        // Always use the configuration stored from a previous run if it's available.
        if (this._savedConfigs.hasOwnProperty(pluginId)) {
            config = this._savedConfigs[pluginId];
        } else if (typeof WebGMEGlobal !== 'undefined') {
            config = {};
            ComponentSettings.resolveWithWebGMEGlobal(config, componentId);
        }

        return config;
    };

    InterpreterManager.prototype.saveSettingsInUser = function (pluginId, plugin, pluginConfig, callback) {
        var self = this,
            componentId = this.getPluginComponentId(pluginId, plugin);

        this.logger.debug('Saving plugin config in user', componentId, pluginConfig);

        ComponentSettings.overwriteComponentSettings(componentId, pluginConfig[pluginId], function (err, newSettings) {
            if (callback) {
                if (err) {
                    callback(err);
                } else {
                    callback(null, newSettings);
                }
            } else {
                if (err) {
                    self.logger.error(new Error('Failed storing settings for user'), err);
                } else {
                    self.logger.debug('Stored new settings for plugin at', componentId, newSettings);
                }
            }
        });
    };

    InterpreterManager.prototype.getPluginComponentId = function (pluginId, plugin) {
        var componentId = 'Plugin_' + pluginId + '__' + plugin.prototype.getVersion().split('.').join('_');
        this.logger.debug('Resolved componentId for plugin "' + componentId + '"');
        return componentId;
    };

    //TODO: Somehow it would feel more right if we do run in async mode, but if not then we should provide getState and
    //TODO: getResult synchronous functions as well.

    return InterpreterManager;
});

redpajama_set_name: RedPajamaGithub


Any Size Event You've Got Cookin'!
We bring plates of lip-smackin' barbeque to all occasions including: weddings, church picnics, banquets, parties, class reunions, family reunions, business lunches, graduation parties, holiday events, neighborhood gatherings, large corporate functions and more. You name it, we'll be there. No order too big or too small.
Famous Dave's has been nationally recognized for "Legendary Pit Bar-B-Que". You choose the location and we'll provide the award-winning food that will make your event a smokin' success.
We will deliver our award-winning barbeque or any catering menu item to your location within 100 miles of Hayward. Delivery fee is $25 for locations within a 25-mile drive of Famous Dave's.
Menu selections should be finalized seven days prior to your event's scheduled date, and a guaranteed number of guests is requested at least 72 hours prior to the event. Payment in full will be collected the date of the event.
All prices subject to 20% gratuity and current sales tax. All prices, services, equipment, facilities and terms subject to change and availability prior to entering into event terms and conditions.


Creating professional, polished typography requires an attentive eye. Lecture Three presents advanced type layout techniques including leading, kerning, tracking, baseline shift, and ligatures. Popping photographs through text and hiding portions of text with masks are also covered as creative ways to handle type in Photoshop.
Blending images to create unique composites is a hallmark of Photoshop. Lecture Four discusses layer mask gradients and blending sliders as techniques to meld images. Blend modes are also introduced and defined by how each one affects the image. You will wrap up this lecture with a discussion of the Select and Mask tool to create extremely precise selections.
Have portraits that need retouching? Lecture Five lays out methods of retouching and healing to make a photo picture-perfect (non-destructively!). You'll use faux burning and dodging to soften wrinkles and remove blemishes and use Content-Aware Fill to remove an entire area from an image. Finally, use shadow, highlight, blending, grayscale, and duotone controls are examined to create elegant imagery.
The flexibility and forgiveness of Photoshop is perfect for painting! You'll examine color theory as it applies to Photoshop tools such as Kuler, Swatches, and Color Libraries. The Mixer Brush is introduced as a method of painting a photograph or painting from scratch, and you'll learn how to customize special brushes to create unique effects and freehand art.
Draw and manipulate custom vector shapes using the Pen tool and shape tools.
Create precise selections in low-contrast images using vector masks and paths.
Use Smart Objects in Photoshop to non-destructively edit, link, update images.
Sharpen, blur, and vignette images using customizable and editable Smart Filters.
Apply professional-quality typography in Photoshop, considering leading, kerning, tracking, baseline shift, and ligatures.
Handle type creatively by applying textures to text, pushing photographs through text and other shapes, and hiding portions of text.
Combine multiple photographs using gradient masks, blending sliders, and displacement maps.
Utilize blend modes, gradients, and the Select and Mask tool to combine images seamlessly.
Retouch and alter photographs non-destructively, using faux dodging and burning, Content-Aware tools, and adjustment layers.
Create attractive grayscale, partial grayscale, and duotone images.
Use Adobe Color, the Swatches panel, and Color Libraries to effectively select and manage color schemes.
Create custom brushes, use the Mixer Brush for freehand painting in Photoshop, and turn images into paintings.
I really appreciated learning all of these non-destructive ways to manipulate photos in Photoshop.


text:
Q: how to execute a method based on a string which contains its name I have an Object which contains several methods and outside of it I have a list of strings where each of the strings value is the name of the Method. I would like to Execute the the method based on the name. From expirience, in python it is deadly simple. In c# I assume that it should be done with delegates I suposse. Or with methodInvoking?
I wanted to ignore reflection on this one.
i python you can store methods as objects, because it is an object.
def a():
    return 1
def b():
    return 2
def c():
    return 3

l= [a,b,c]

for i in l:
    print i()

The output would be:
>>> 1
>>> 2
>>> 3

A: If you want to ignore reflection, you can create a delegate for each method call and store in a Dictionary.
Heres how you do it:
var methods = new Dictionary<string, Action >() {
            {"Foo", () => Foo()},
            {"Moo", () => Moo()},
            {"Boo", () => Boo()}
        };

methods["Foo"].Invoke();

A: Note that in your Python example, you are not "[executing] a method based on a string which contains its name" but rather adding the method to a collection.
You can do basically the same thing as you are doing in Python in C#. Take a look at the Func delegate.
class FuncExample
{
    static void Main(string[] args)
    {
        var funcs = new List<Func<int>> { a, b, c };

        foreach (var f in funcs)
        {
            Console.WriteLine(f());
        }
    }

    private static int a()
    {
        return 1;
    }

    private static int b()
    {
        return 2;
    }

    private static int c()
    {
        return 3;
    }
}

and the output is
1
2
3

If you need to execute a function based on its name as a string, Uri-Abramson's answer to this very question is a good place to start, though you may want to reconsider not using reflection.


Around 11 p.m. at Apollina and Brad's wedding reception at Hacienda Cerritos, a guest sauntered over and asked me if it was normal for people to take their clothes off at weddings.
I laughed and said, "Well, it's normal for Mexico weddings.
– "You can't see my feet right now, but they are awesome." – Apollina to Ben, while dancing waist-deep in the hot tub in her wedding dress.
– Fog machines and colored laser lights all night long.
– Ben massaging Grandma Bonnie's feet in the hot tub at the end of the night.
– Joining the family the next night for a game of "Mafia" around the dining room table.


text:
Mum's emotional battle with son's shock diagnosis
LITTLE Charlie is Eileen's angelic first-born, the boy she had dreamed of having for years.
The first year of his life, the US mum spent hours marvelling at his calm nature, his easy laugh and gorgeous smile.
"I used to think how it was to see him occupy himself for hours with the same toy," Eileen first wrote on Love What Matters.
"What a fine attention span!
"I appreciated his ability to block people out, appearing peaceful, like a protective bubble was insulating him from the big, new, scary world around him.
"These little moments were like little nuggets of gold.
"The first year I didn't worry about Charlie's development at all."
In fact, Eileen's niggling doubts about Charlie's development didn't start until his 18-month check-up.
As she filled out the doctor's questionnaire, she began to feel concerned that Charlie wasn't meeting his developmental milestones.
"I love him with every fibre of my being." Source: Eileen Lamb
The little boy wasn't pointing, clapping, making eye contact or answering to his name. But when Eileen raised her concerns with the doctor, she was told not to worry.
"She had known Charlie for over a year - so she wasn't worried," Eileen said.
"She had given him his check-ups. She was an expert.
"So we went home, satisfied.
"Later, I learned how wrong she was."
Eileen's alarm bells seriously started ringing a few weeks later when Charlie became completely non-verbal.
Although he had never been talkative, Eileen had become used to hearing his adorable "thank you" when she gave him one of his favourite biscuits.
"But then he stopped speaking altogether and it seemed as if our connection was loosening," Eileen said.
"Something switched and while occasionally, before, he would sit with us, he now only seemed to want to be alone.
"He wouldn't even look at us anymore, and I was scared.
"I didn't recognise my child."
Even though Eileen suspected that Charlie was autistic, the diagnosis still came as a shock. Source: Eileen Lamb
Eileen took Charlie to speech and occupational therapy immediately - but it didn't seem to make much of a difference.
"The word 'autism' kept coming up in conversations," Eileen said.
"His therapists weren't qualified to diagnose autism, but they knew.
"They knew my son was autistic.
"But I needed definite answers, so I started doing my own research.
"The more I learned about autism, the more convinced I was Charlie was indeed on the spectrum.
"The thoughts crashed down on me like a wave knocking me to the ground. It was overwhelming."
Even though Eileen suspected that Charlie was autistic, the diagnosis still came as a shock.
Although it felt like a relief to finally have answers, Eileen had no idea where to go from there.
"She handed us the official written diagnosis. That was it. We were on our own now," she said.
"My entire world came crashing down, the walls caved in, the floor dropped out from under me, and every other metaphor to that effect.
Last week one of my followers told me "if you ain't got haters, you ain't doin' sh*t!" Well guys, I must really be doin' sh*t. 😂 How I wish people would understand that you can grieve your lost dreams while still loving your child with every fiber of your being. The attacks haven't stopped, but I can't stay off social media forever, so I'm back. ❤
A post shared by Eileen Lamb ⋒ (@theautismcafe) on May 9, 2019 at 4:03pm PDT
"I knew he was autistic and I was prepared to hear the diagnosis but it hit me hard.
"I still had so many unanswered questions.
"Questions no one had the answers to then - and questions I still don't have the answers to now, years later."
But over time Eileen made her peace with the fact that many of her questions would never be answered.
Charlie is now six - and is just as much the son Eileen dreamed of having.
"I don't have answers to my questions - will he ever be able to live an independent life? Will Charlie ever have a voice of his own?" she said.
"But but what I do know, and will always know, is that I love him with every fibre of my being.
"And I hope that's enough."
Eileen Lamb is the author of All Across The Spectrum and founder of The Autism Cafe.
This article originally appeared on Kidspot and has been reproduced here with permission.
autism editors picks parenting


14 April 2019, 12:52 Died on level 254 by a frost dragon.
13 April 2019, 11:26 Died on level 242 by Ram Low.
11 April 2019, 23:37 Died on level 209 by a frost dragon.
8 April 2019, 17:51 Died on level 204 by Kamasutra, Yagoftw and Lokiyo.
7 April 2019, 14:44 Died on level 183 by Da Boss and Magical Maggot.
6 April 2019, 19:40 Died on level 156 by a ancient scarab.
6 April 2019, 13:00 Died on level 127 by a scarab.
6 April 2019, 12:33 Died on level 127 by a wyrm.
4 April 2019, 17:56 Died on level 114 by a wyrm.
4 April 2019, 00:09 Died on level 107 by a ancient scarab.
3 April 2019, 20:43 Died on level 102 by Palli and Respect.


First Selectman Pat Mechare and her husband, Curt, enjoyed the speeches at the celebration on Saturday, Sept. 23.
FALLS VILLAGE — More than 160 people came to downtown Falls Village on Saturday afternoon, Sept. 23, to honor retiring First Selectman Pat Mechare.
Among them was Rep. Elizabeth Esty (D-5), who said, "Pat leads with her heart and her head.
Esty had a statement of congratulations that was published in the Congressional Record.
Similarly, state Rep. Brian Ohler (R-64) brought a citation from the state Legislature.


text:
Tarik Sečić (* 27. Februar 2000) ist ein bosnischer Fußballspieler.

Karriere
Sečić begann seine Karriere bei der SV Urfahr. Im September 2015 wechselte er zur Zweitmannschaft des FC Blau-Weiß Linz. Bis zum Ende der Saison 2015/16 kam er zu fünf Einsätzen für BW Linz II in der siebtklassigen 1. Klasse und erzielte dabei ein Tor. Zu Saisonende stieg er mit der Mannschaft in die Bezirksliga auf.

In der sechsthöchsten Spielklasse kam er in der Saison 2016/17 zu 17 Einsätzen, in denen er ohne Torerfolg blieb. In der Saison 2017/18 kam er lediglich zu einem Einsatz in der Bezirksliga. In der Saison 2018/19 kam er zu 16 Einsätzen, in denen er drei Tore erzielte. Im April 2019 stand er gegen die Kapfenberger SV zudem erstmals im Kader der Profis, kam jedoch zu keinem Einsatz. Mit den Amateuren stieg er zu Saisonende in die Landesliga auf.

Im Juni 2020 debütierte er für die Profis in der 2. Liga, als er am 24. Spieltag der Saison 2019/20 gegen den SC Austria Lustenau in der 87. Minute für Simon Gasperlmair eingewechselt wurde.

Weblinks

Fußballspieler (FC Blau-Weiß Linz)
Bosnier
Geboren 2000
Mann


Four innovative Indigenous entrepreneurs have been chosen for Barayamal's 3-month Budding entrepreneurs (entrepreneurship development) program at Australia's largest community of scalable tech startups, Fishburners.
In May 2017, Barayamal organised Give Backathon – a national charity hackathon that helped four Indigenous charities by providing tech-based solutions to increase their social impact (click here – full story).
The winning hackathon team received a 3-month membership at Fishburners valued at $900 per team member (total of $3,600). However, in the spirit of the event and giving back to the community, the hackathon team "paid it forward" by donating their prize back to Barayamal so four Indigenous Entrepreneurs could have the life-changing opportunity to work on their startup ideas and help their communities.
Annie Parker CEO of Fishburners said "paying it forward" is everything Fishburners is about.
"We are really proud to partner with Barayamal and welcome four new teams of Indigenous Entrepreneurs as members of Fishburners.
"Our values are centred on collaboration, brilliance, community and diversity, and all of our members contribute and give back to our community and I'm thrilled the winning hackathon team did just that, which now guarantees these four deserving Entrepreneurs will now join Fishburners", Ms Parker said.
According to the latest government employment study, the Indigenous unemployment rate is currently 21%, an increase of 4.3 percentage points since 2008, and is 4 times the current non-Indigenous unemployment rate of 5%. In addition, Indigenous businesses are 100 times more likely to hire Indigenous people, less than 1% of Australian businesses are Indigenous owned, despite representing 3% of the population.
Through disempowerment and lack of opportunity, the Indigenous community in Australia has the highest rate of suicide of any community in the world. By empowering Indigenous entrepreneurs, we could help re-shape these statistics and our communities.
Barayamal's Budding Entrepreneurs Program aims to accelerate the success of four Indigenous entrepreneurs by providing free 3-month memberships at Australia's leading tech startup hub and support will also include a world-class entrepreneur development program from Australia's Indigenous Business Accelerator, Barayamal and will provide one-on-one mentoring from successful Indigenous and non-Indigenous entrepreneurs. The program will officially kick off in January, 2018.
Founder of Barayamal, Dean Foley said Aboriginal and Torres Strait Islander entrepreneurs can make a valuable contribution to their communities and help close the gap through innovative businesses.
Barayamal means 'Black Swan' in Kamilaroi language and the goal of the program is to help Aboriginal & Torres Strait Islander people build successful businesses through entrepreneurship training and programs.
Black swans were first seen by Europeans in 1697 but before that, Europeans had only known of a white swan. In this instance, the black swan represents Indigenous entrepreneurs who have not been noticed in the world for their innovative businesses. Barayamal plans to show the world that Indigenous entrepreneurs exist and they can also build global businesses.


Haematomas are a common injury within contact sports such as American Football, and so is commonly something that both medical teams and athletes will encounter. Management of this injury needs to be done with care and caution so as not to cause further complications.
A haematoma is a local accumulation of blood in a tissue, space or organ.
Within the muscle there are two ways a haematoma can develop.
Intramuscular – here the muscle sheath remains intact, thus confining the bleed within the muscle. This causes intramuscular pressure which may compress capillary beds that counteract the bleed. In this case, signs and symptoms remain localised.
Intermuscular – in this case, the muscle fascia is torn, allowing the bleed to spread between muscles and fascia.
The patient reports of pain subsiding within the first 24 hrs.
A superficial haematoma can be identified through bruising, swelling and muscle impairment, whereas deeper haematomas can be more difficult to diagnose. It is advised that you should 'wait and see' the damage in the first few hours after injury, particularly in intramuscular haematomas, which can continue to develop over the first 3 days post-injury. It is believed that only after 12-72 hrs post-injury can a true diagnosis be made.
Rest – to prevent further haemorrhage and further aggravation of the injury. This will allow a stronger scar to form between the damaged muscle fibres and connective tissue. Some research advises the use of total rest, including the use of crutches for non-weight bearing mobility during the first 2 days. Once the athlete is able to move pain free they should do so.
Compression – there is currently no conclusive evidence that compression to the haematoma area has an impact on recovery time. However it is clear that compression can reduce the impact of swelling to the injured site through deduction of space available for fluid seepage, and encouraging fluid absorption. Therefore it would be advisable to use a compressive bandage in the case of a haematoma. The bandage should be applied from bottom to top. The patient should feel the firmness of the wrap but no throbbing sensation.
Elevation – there are no current conclusive studies that have reported its effectiveness, however it is known that elevation reduced arterial pressure and increases venous return. Therefore elevation is advised in the acute phase.
Please note that heat should not be applied within the acute injury stage for risk of bone growth within the muscle (also known as myositis ossificans).
Download your own Pitch-side Injury companion here.
Heat – heat is advised at during the resolution phase (3 days +) to accelerate the haematoma absorption and increase blood circulation.
Ultrasound – it is unclear whether the use of ultrasound treatment for haematomas has positive effects.
Massage – is not advised due to the risk of further increasing the haemorrhage. Research looking at the effectiveness of massage for haematomas has found no conclusive results. It is currently unclear when best to apply this method of treatment.
Depending on the severity of intramuscular bleeds, the injury needs to be treated with more caution due to risk of myositis ossificans (small bone growth within the muscle).
This complication is serious and relatively common. It has been suggested that recurrent contusions are more likely to result in myositis ossificans more often.
If not managed correctly surgical intervention might be needed.
Intramuscular haematomas are more severe than intermuscular haematomas, thus prognosis is longer.
If in doubt, always consult a health professional.
Smith, T.O., Hunt, N.J. & Wood, S.J. 2006, "The physiotherapy management of muscle haematomas", Physical Therapy in Sport, vol. 7, no. 4, pp. 201-209.
Stainsby, B.E., Piper, S.L. & Gringmuth, R. 2012, "Management approaches to acute muscular strain and hematoma in National level soccer players: a report of two cases", The Journal of the Canadian Chiropractic Association, vol. 56, no. 4, pp. 262.
Prentice, W.E. and Kaminski, T.W., 2004. Rehabilitation techniques for sports medicine and athletic training (pp. 406-408). New York:: McGraw-hill.
Anderson, M.K. and Parr, G.P., 2013. Foundations of athletic training: Prevention, assessment, and management. Wolters Kluwer Health/Lippincott Williams & Wilkins.
Previous Post What is Gridiron Strong?


text:
Q: How to use lead() and lag() on varchar2 fields? Oracle 11g
My work so far on SQL Fiddle
I'm using lead() and lag() functions on varchar2 columns.
Using the following rules, I'd like to generate the desired results.

*

*If  lag_val is null then '('

*If  lag_val is same as set_a then 'and'

*If  lag_val != set_a then 'or'

*If  lead_val is null then ')'

I get 'invalid number' when I use nvl() to convert null values so I can compare.
Desired Output
   SEQNO SET_A LAG_VAL  LEAD_VAL  MENU_ENTRY
   ------------------------------------------
   1      CAKE  <null>  CAKE      (
   2      CAKE  CAKE    BEER      AND
   3      BEER  CAKE    BRATS     OR
   4      BRATS BEER    <null>    )

A: Your problem is that you're using the "-" operator on strings, not with lead/lag.  I think you want this:
select  seqno,
         set_a,
         lag_val,
         lead_val
    , case
    when (lag_val ) is null then '('
    when (lead_val ) is null then ')'
    when (lag_val = set_a) then 'and'
    else  'or'
    end  as menu_entry
from ( select seqno,
        set_a,
        lag(set_a,1) over (order by seqno) as lag_val,
--        lag(to_number,'XX') over (order by seqno) as lag_val,
        lead(set_a,1) over (order by seqno) as lead_val
 from menu_items)
order by seqno


First came we have to register at the registration desk.
There is Skyn Analysis too! spot Tiffany face on screen.
The stage with some jewels as a decoration . Superrbbbb Pretty right?
Dr. Kizmed started introduce him self to us. then Dr. Kizmed asked " Is the beautifull skin always should be white?
But in fact many indonesian people thinking that a beautifull skin is a white skin . its a wrong perception ! Really, did u ever see a person that have a tan / medium skin . I called them exotic like Farah Queen as a example. she have a beautifull skin because her skin is healthy ,right?
Dr kismed said "Same with diamond , skin must also be brightly shining . The meaning of Healthy Skin here is Clean, NO Acne and blackheads, spots , Flecks and Other problems"
Also explained about some of the treatments that can be done to overcome of skin problems such as peeling, laser, injection and cream program.
Skin problem are common in indonesian is Sagging, Acne and Pigmentation.
Every people will definitely grow old but this process can be slow down so that aging doesn't happen fast.
Then how to resolve ?
Many things can do to get a beautifull skin. like a therapy combination.
Whitening injection is a Injecting a vitamin C and Antioxidant.
After Dr Kismed had finished all of his presentation.
The rarest diamond color is red, and most expensive color too.
Rapaport is show the latest price guidelines , So if u want to buy diamond . Go ask for the latest Rapaport.


text:
<!DOCTYPE html>

    <title>Technical Blogs</title>
          <meta charset="utf-8">
      <meta name="viewport" content="width=device-width, initial-scale=1">
       <link href="https://fonts.googleapis.com/css?family=Exo+2" rel="stylesheet">
       <link rel="stylesheet" type="text/css" href="https://cdnjs.cloudflare.com/ajax/libs/normalize/5.0.0/normalize.css">
       <link rel="stylesheet" type="text/css" href="https://cdnjs.cloudflare.com/ajax/libs/skeleton/2.0.4/skeleton.css">
       <link rel="stylesheet" type="text/css" href="../styles/main.css">

  Journey to Code

 About me

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 Technical Blogs

 How would I explain DOM, HTML & CSS to a non-technical friend?

                    I would use the analogy of a house. The DOM is the section which the house is built on. The HTML is the structure of the building and the CSS is the furnishings; the colour of the walls, size of the cupboards and pictures on the walls.

 What is meant by boxifying text?

                    The process of boxifying design is splitting a page into boxes to provide a clear lay out for the designer and user.

 What is the box model?

                    The box model controls the layout of a webpage. Every HTML element is inside a box. The box model consists of content, padding, border, margin. The size of each of these can be adjusted using CSS

 What is grid based design?

                    Grid based design is the concept of laying out a webpage using a grid. These grids are made up of columns and rows, which make it much easier to keep content organised and balanced. Typically pages are split up into 12 columns because the number 12 is divisable by 1, 2, 3, 4, 6 & 12.

 Whats all the hype about responsive web pages?

                    Responsive pages change size based on the users screen size. Many people now use phones and ipads to access web pages. These pages need to be clear and readable for the user, hence why responsive web pages have become a hit.

 What is semantic structure?

                    semantic element tells the browser and developer more about the content inside the tag than other elements. For example h1 is a semantic tag because it indicates that there is a large heading into the tag, where as div is non-semantic because it tells us nothing about what is inside the tag.

              Simon O'Leary 2017