text:
To the editor:
In 2009, in a parallel almost too good to be true, neighborhood watchman Roderick Scott, a black man from Greece, N.Y., was acquitted, by reason of self-defense, in the shooting death of white, 17-year-old Christopher Cervini.
Where was the outrage? The T-shirts? Where were the divisive opportunists turning a quick buck, fanning the flames of bogus fury?
The left is suffering frustrated indignation over its inability to railroad a "racist," "white-Hispanic" who, in self-defense, took the life of an "innocent" black teenager. The more agenda-driven, activist far left is even more disenchanted because of its failure to incite America's burning over the tragedy's outcome.
This, I hope, is because most everyone with more than a few functioning brain cells realizes that George Zimmerman was innocent of any direct wrongdoing, much less of being a racist. He was, as columnist Thomas Sowell aptly described, the victim of "orchestrated hate," hate generated and encouraged by sleazy, manipulative race-baiters who, for their own self-interests, continue to prop up institutionalized racism, because if they didn't they wouldn't have any influence or, likely, any income.
The media misrepresented the issue from the very beginning, broadcasting five-year-old school pictures of a sweet, fresh-faced, 12-year-old Trayvon Martin, and slovenly, poor pictures of Zimmerman.
Intellectually honest people realize the only racist component here was crowbarred in by the sensationalist liberal media and its allies, to whom the not-minority-enough Zimmerman - who not only has black family members, but mentored black children and complained when local police beat a homeless black man - was guilty until proven guilty.
Granted, neither was an angel in the case.
It seems Zimmerman may have had something of a "Napoleon complex" within his neighborhood watch group, and a reputation for making annoying, nuisance calls to police. Martin, 17, however, was a drug-using truant and borderline juvenile delinquent.
Despite Zimmerman's acquittal by jury, President Barack Obama wants his Justice Department to waste more time and taxpayer dollars to investigate, digging for potential civil rights violations, violations they'd certainly find, regardless.
There's so much else that should be investigated: Benghazi; the IRS scandal; Fast and Furious; Solyndra; NSA spying.
It's said that we "need a serious discussion about race in America."
In the 513 days between the shooting and Zimmerman's acquittal, more than 11,000 black Americans murdered other black Americans. Why hasn't Obama taken to his teleprompter, decrying this tragedy?
How many blacks killed whites - statistically, much more likely - in that time, with no national outcry or media circus?
Sorry - am I racist, for asking such logical questions?
Instead of using the phony Zimmerman/Martin issue as a blatant diversion, let's seriously discuss a $17 trillion national debt, soon to be made $19 trillion, by the imposed fiasco of Obamacare. Let's discuss 47 million welfare recipients and unemployment hovering around 8 to 10 percent - exactly what the $800 billion stimulus of 2009 was passed to prevent?
Roderick Scott and George Zimmerman - the same, yet so very different.
Rob Denham


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Medical Examiners perform postmortem examinations on decedents. They review medical records and investigator reports. They examine glass slides of tissue samples under a microscope to identify diseases or anomalies. They review toxicology reports for evidence of chemical abnormalities or drug use or abuse. They dictate a report of findings as to the cause and manner of death. They meet with law enforcement officers, attorneys and family members to explain my findings. They appear in court to testify as an expert witness.
What education is required to qualify as a specialist in your work?
Post graduate education and training include four years of medical school, a five year residency in anatomic and clinical pathology, and a one year fellowship in forensic pathology. Following the residency you must pass Medical Boards in Anatomic Pathology and following the fellowship you need to pass Boards in Forensic Pathology. A medical doctor is also required to take a minimum of 20 hours of approved medical education every year to maintain their medical license.
Describe the kind of person it takes to be a Medical Examiner.
There are many different types of people in forensic pathology. In general, most doctors tend to be very objective, analytical and overachievers. Doctors that go into forensic pathology must like both the medical and the legal aspects of the work, they must be observant and like to put all the information and clues together to find the reason why a person died. This is true whether the person died of natural or accidental causes or a homicide.
What happens when you arrive at the scene of a crime?
An understanding of the scene of death is frequently critical to an accurate assessment of the cause and manner of death. Generally there are medical investigators who go to the scene and collect information to report back to the medical examiner. The steps taken at the scene depend on what type of case is being investigated. In the case of an infant who has died in his or her sleep, where the infant was found and the type of bedding around the infant are important factors. If it is suspected that the death is related to the dead person becoming too hot (hyperthermia), the temperature where they were found would be important.
Do Medical Examiners become immune to what they see?
No, but it is important to maintain a clinical detachment in order to do the job.
What is the difference between an ME and Coroner?
A medical examiner is always a medical doctor, usually a forensic pathologist who has received training in this specialty. A medical examiner certifies a death based on his or her expert opinion following an investigation and medical examination or an autopsy of the decedent. A medical examiner also completes a report to document and support his or her findings. Most medical examiners are appointed to their positions. A coroner is an elected official. Coroners are usually not required to be doctors, but the requirements depend on the laws governing the jurisdiction. Usually coroners come from law enforcement or funeral home backgrounds, but they may also be doctors who have run for the office of coroner. Coroners may hold public inquests to determine the cause and manner of death. They may have a doctor examine the body and report their findings at the inquest. Usually coroners have some law enforcement or legal powers, such as subpoena powers, but it varies depending on the laws in their jurisdiction. Medical examiners are usually not a part of law enforcement. Generally medical examiners are in agencies separate from law enforcement and the criminal justice system to preserve their objectivity. For example, in Maricopa County the Office of the Medical Examiner is under the County Health Department. This is not unusual. The Maricopa County Office of the Medical Examiner handles over 5,000 cases a year, but only about 10% are homicides. Arizona State statutes provide for a medical examiner system based in each county. There is no coroner in Arizona. Each state has different laws and each jurisdiction operates differently, but these are the basic differences between a medical examiner and a coroner.
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subset: commoncrawl


text:
Hi everybody,
This is my first question so I hope I will correctly be following the rules!
I am looking for a simplification of the expression
$$ m! \sum_{k=0}^n \binom{n}{k} \binom{\alpha k}{m} x^k, $$ where $n,m$ are integers and $0 < \alpha < 1$. Is it a known generating function? Or does it exist a simpler expression?
In the same order I am also trying to simplify the expression
$$ \sum_{k=1}^n k! \binom{\alpha l}{k} S(n,k) x^k,$$
where $l$ is an integer?
Many thanks for your answers!


text:
Im posting to my wall with the below code, and it is visible on my wall with text and thumbnail image, but why isnt it visible on my friends startpage?
If I post from within facebook then it is visible on my friends walls-startpage aswell as mine, but not if I post with the api?
What can I do to post to my wall and that is posted on all my friends walls aswell?
Im posting with the below.
FB.api('myfacebookid/feed/, '{.....
I know there is FB.api('FRIENDS_ID/feed/... aswell, but that only post on one of my friends, doesnt it?


text:
How offensive is the expression 他妈的? What is an English expression with a similar degree of offensiveness? In what situations is this expression appropriate / not appropriate?
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It is very common and, in my personal experience, has similar offensiveness as the f word in English.
It can be offensive and quite rude: e.g. in a business negotiation, when the deal is finally broken and one side says:
It may be used in irony among close friends which is not offensive then: E.g. when two close friends meet after a long time, one may say:
Hope this help to get the points.
There is a restaurant in the Ximending district of Taipei, Taiwan, with a giant banner exclaiming;
I equate it to the British "bloody". "That's bloody tasty".
Offensive in a formal context, but a commonly accepted expletive.
In every formal environment, is not appropriate like fxxking & shxt in english.
Unofficially, in oral, people also use 他妈的 equivalent to VERY.
when used isolated, just means damn it and the same degree of offensiveness.
I believe that 他妈的 would be a general curse like "f--k!" (or "damn"), but not an insult , whereas 你妈的 would be a personal insult like "f--k you" or "you mother(truck)er."
Think of 他, in this context, as a generic form of "you", much like "on" in French. In other words, "one's mother" or "someone's mother" (although could also specifically be "his mother" - depends on context).
Correct me if I'm wrong, but I believe the particular insult is an euphemistic omission of the female genital organ after "的"...
I think 他妈的 is perfectly normal and not offensive just liking fucking. It is used to emphasize something but people may regard you rude and uneducated if you say this in some formal situation.
I think it has the exactly same meaning as 'fucking', not more offensive or less. It should only be used between people about the same age and who meet each other very often.
Since new swearing tag appears thick and fast...
Quote from http://languagehat.com/tamade/
It is a highly offensive expression comparable in meaning and offensiveness to "s-o-b" in English. It refers to coming out of one's mother (one's birth), and not for the better.
It means, she's a "b, because you're an "s-o-b."
It's very offensive and strange to talk to strangers or in a formal situation. It also depends on users' level of social class I think. I never use it to describe something good or when I miss somebody. Speaking of that, I never use f..k in English to talk to my friends either. I guess it depends on the people's personality. I could imagine the gangsters using 他妈的 all the time to address their buddies.
But using 他妈的 to describe a pain is really common. like if I bump my head, I would say '操,他妈的真疼'


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Installing Sway-BarsWritten by on January 1, 1998 Step-by-step How-To on A-body Antisway Bars
No smoke and mirrors here. Installing these GM A-body front and rear antisway bars is almost as easy as picking up the phone and ordering them from Original Parts Group. We had the 1-1/8-inch front and 1-inch rear bars installed on our never-say-die Cheap Street Chevelle in about 90 minutes. Made by Addco and also offered in 1-1/4-inch front and 1-1/8-inch rear sizes, the bars are a legit handling upgrade and truly qualify as an easy performance bolt-on. We made a few changes to hook the rear bar to our aftermarket Hotchkis rear lower control arms, but it only concerned fastening hardware and required just one trip to the local auto parts store for longer bolts. The only reason we had the car on a hoist was so we could clearly photograph exactly what needs to be done--a floor jack and a sturdy pair of jackstands will easily enable you to install the bars in your driveway.
More Photos From This Article View Slideshow
OPG offers front and rear antisway bars for 1964-1977 GM A-body cars. We also replaced the front bar endlink bolts and bushings with a kit that includes urethane bushings. A new antisway bar bushing kit was also used. If your existing hardware is in decent shape and you don't want to nickel-and-dime yourself to death, you can order just the bars and still come in at under 200 bucks for both--even after factoring in the $9.95 freight charge for each bar.While some A-bodies came stock without a front sway bar, our Chevelle already had a 7/8-inch front bar. With the car securely elevated, removing it is a cinch. Loosen the endlink bolts and bushings from both sides. As shown in this photo, you can butt the wrench up against part of the car (the disc brake dust shield in this case), and while it holds the nut in place, turn the bolt with the ratchet.Unbolt the antisway bar mounts from the frame with a ratchet. On rusty Midwest cars, some rust penetrant may be required.With the endlink bolts and mounts unbolted, the bar drops right out in your hands. The whole removal process takes about 10 minutes.The optional endlink kit (left) and antisway bar bushings (center) replace all front mounting hardware. Reuse the existing bolts for the mounting brackets. The endlink hardware installs on the car exactly as shown, with the lower control arm and the bar itself sandwiched between the two pairs of bushings. Install the pieces in this order: bolt, washer, and bushing up through the bottom of the control arm; bushing, washer, spacer tube, washer, and bushing between the lower control arm and sway bar endlink; and the fourth bushing, washer, and nut on top of the sway bar endlink. Be sure you install the bushings so the flanged sides are facing in toward the lower control arms and antisway bar endlinks, and the washers with their curved-up sides seated against the bushings. The supplied washers that came with the antisway bar mounting brackets weren't large enough to cover the holes, so during our auto parts store run we got larger 3/8-inch diameter washers to fit over the bolts (right).The antisway bar mounting bracket and bushing kit comes with special grease to prevent squeaking. It's just enough to coat the insides of both bushings. Be sure to use all of it before slipping the bushings over the new bar as shown.It's a good idea to clean out the threads in the frame for the mounting brackets with some spray lubricant (such as WD-40) before installing the new bar. The new bar attaches to the frame in the exact same way as the old one coming off in step three. If the car didn't come with a stock swaybar, the holes will probably be there anyway. You may need to clean them out. Worst case, you'll have to drill new ones using the bracket as a template.
With both endlinks and mounting brackets attached, there is a little bit of front-to-rear adjustment in the bar by way of elongated holes in the new mounting brackets. We found that by pushing the bar toward the rear of the car as far as it'll go, we were able to get the endlink bolts to stand up straight and not place any angled preload on the endlink bushings. Once the bar is positioned, securely tighten the four mounting brackets and two endlink bolts.The rear bar comes with all the hardware needed to install it on stock lower control arms (left). However, boxed lower control arms, like our Hotchkis lowers, eliminate the need for the supplied spacers but require the procurement of longer bolts (right). At the parts store, we grabbed four 3/8-shank, 3-inch-long bolts to replace the spacers and 2-1/2-inch-long bolts. We also picked up four additional washers to fit under the supplied aircraft-style lock nuts.If you're installing the rear antisway bar on stock lower control arms, the spacers install inside the arms as shown to keep them from collapsing when tightening the nut and bolts. Chances are that the holes will need to be drilled in your stock lower arms.At first we wondered about the fit of the bar between the lower control arms and anticipated a struggle in getting the holes in the bar and the arms to line up. However, a few whacks on the bar with a rubber hammer was all the coercion needed to get the holes lined up very close. To line them up enough to get the bolt through, we used a Phillips head screwdriver through the mounting holes to pry the bar into position. Be sure to get both bolts started on the other side of the bar before commencing with the hammer trick.Install the bolts and washers through the bar and control arm and attach at the other side with the other washers and lock nuts.


text: I have linux experience, but I'm new to xubuntu. I'm running 12.04 and have run apt-get update, so everything should be up to date. My problem is that I've gone into Window Manager and set my Focus Model to "Click to focus" however when I move the mouse off of any window the mouse wheel stops scrolling the window with focus. In fact it will scroll which ever window the mouse is over. My focus isn't changing. The window that had focus still has focus, I just lose the ability to use the mouse wheel to scroll the window with focus. Is there a setting somewhere to change this?


text:
News Archives
Back to NS Everett - Marysville News & Events
Monday, September 29, 2008
(COLUMBIA, Mo.) -- Columbia College unveiled a new philanthropic model Sept. 26 at a "Tradition meets Tomorrow" event for benefactors and friends of the college.
Dr. Gerald Brouder, president, announced that the college has moved from a traditional "donor recognition" model to an innovative "contributor appreciation" model to better reflect the college's appreciation of those who make a contribution to its mission.
"We believe that we have created a unique way in which to convey our gratitude to contributors," he said. "To our knowledge, we are the first institution of higher education to adopt this model."
Michael Kateman, executive director of Development, Alumni and Public Relations, explained that 'donor' simply means one who gives, but 'contributor' implies one who shares in the giving. "Likewise, 'recognition' can be impersonal, but 'appreciation' goes beyond recognition to include gratitude," he said.
The college also introduced new logos -- developed with the help of ME&V Advertising and Consulting of Cedar Rapids, Iowa -- and presented the new contributor appreciation societies.
Guests who attended the event were excited to learn that alumni and friends have given a total of $35.5 million to Columbia College. "We�re excited about the direction we're heading," said Kateman. "Financial contributions from our supporters allow this fine institution to continue to improve its facilities, services and academic programs."
Kateman also said he wouldn't be surprised if other colleges and universities follow suit in revamping their donor recognition programs. "This very well could be the start of a trend in the philanthropy field," he said. "In tough economic times, it is especially important to be cognizant of the financial gifts our supporters make to the college in support of its mission."
Lindsay Young Lopez, senior director of development, said the contributor appreciation model allows the college to set a precedent. "Philanthropy has historically played an important role at Columbia College," she said. "This new structure allows us to better acknowledge our contributors, who form a lifelong relationship with the college and are integral to its success."
"Columbia College has a rich and storied past," said Brouder. "It goes now into a very bright and opportunity-filled future."


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What's the right terminology here for when God's allowing something, but not blessing it? I once had it, but now I forgot. It's something about two different types of God's will. One is kind of "allowing" will, for example, in such things like earthquakes, in which children die, and the other one is a "good-pleasure" will, for example, in such things like preaching the gospel and saving people. So, what are the correct words here?
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I think that's considered His passive will as opposed to His active will
There is no universally accepted terminology for this idea. While some circles have distinctions they make, the lines between them and the terminology are not ubiquitous. Whatever terms you use, you would do well to define what you mean by them as part of your own content.
That being said, the most common terms I have heard are Will of Decree and Will of Desire or Will of Command.
We life in the "now and not yet" period where it is not always clear to use how these two wills converge. To continue with our example, we know that God ordains the number of a man's days and that it would be impossible for a man to live longer or shorter than God wills for them, but that murder (which can be the physical cause of their "early" termination) is against God's will. In this sense his commands can be broken while not violating his sovereignty. There is an apparent tension between these that with our limited view of only the physical world we are unable to resolve.
A time will come when all that is wrong will be made right. This means that these two forms of "will" will eventually become one. When death is disposed and Jesus is given permanent reign over the new Jerusalem (we're talking about heaven here) then there will be no more murder (his desire will be decreed).
Just to add another version I have mostly heard: Sovereign Will and Moral Will
Here's a really good article for reference - http://www.desiringgod.org/blog/posts/gods-moral-will-and-sovereign-will
In summary, God's sovereign will, will be accomplished and cannot be changed. His moral will consists of morals He has prescribed for us, but His moral will can be disobeyed. Such as it isn't God's moral will that we murder, but yet we do. But it is God's sovereign will that Jesus came and died for our sins, this couldn't have been changed.


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KILLEEN (February 1, 2013) -- An accident left an apartment heavily damaged and one person under arrest.
Around 11 p.m. on Thursday night, Killeen police responded to the apartment off Florence Drive.
When they arrived they found an SUV completely crashed through the residence.
The driver and passenger were uninjured, police say the driver had been drinking and was arrested.
No one was home at the time of the accident.


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Ben and Tina Lamb live on Greenhill Road in Warren County, and they're having to defend that's where they live, not run a business.
They were fined in November for a zoning violation that Ben Lamb's tree trimming business was operating there.
"No proof of any violation here, and all the pictures you were shown, like I said at the beginning I honestly don't think you would have cited us had you had the facts before they cited," said Tina Lamb.
Tonight, the Warren County Code Enforcement amended there previous ruling and said it wasn't a zoning violation, but not before they heard evidence from the investigating code enforcement officer.
"I feel like after going out there yesterday. I felt like they've cleaned up. There wasn't all that equipment that had been seen previously, and I was just proud of the fact, it looked that good," said Sandy Clark, Code Enforcement Officer.
"We've done everything the zoning commission has asked us to do, and I feel strongly since we got in compliance last year, we've maintained that to the best of our ability," said Tina Lamb.
This all began about a year ago, when the Lambs didn't get a zoning permit because of neighbor disapproval, so they had to clean-up the area.
Some neighbors were upset because they thought they were still operating, and now wished there had been better communication between everyone involved including the board.
"They were to e-mail us so we could tell all the neighbors that there would be trucks, there would be equipment during this clean-up."
If the Lambs did not win their appeal tonight, they were looking at a 200 hundred dollar a day fine amounting to several thousand dollars.
Ben Lamb now operates the Tree Man business, and says all of his equipment is not at his home but at another location.


text:
I have a chat room for a Rails app is implemented the old-fashioned way, using Ajax Polling. This is not scaling, and it is cluttering my log, so I want to reimplement using either EventMachine + HTML5 websocket/degrade to flash, or Node.js. Given that the rest of the app is in Rails, what are the the pros and cons of each of these two alternatives?
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I only just started to play with Node.js, but I have experience as a Ruby programmer, and have been delving deeper into EM, a lot lately, I will admit if you don't have a lot of experience with it or the reactor pattern it will have a bit of a learning curve from your normal synchronous ruby code. With node.js out of the box it has some great tools for running everything asynchronously.
Or you can alway go a little be easier, and use a simple prebuilt system for handling pubsub sort of jobs like a chat room, and use Faye http://faye.jcoglan.com/ which you run as a separate Rack app using Thin as a server... or if you like this approach, but don't want to manage Faye, you can use an external service like Pusher http://pusher.com/ which expose API's for you do do real time messaging.
Rails + EventMachine
Even though you would be introducing something outside the normal rails, I would consider node.js or Erlang for this. Erlang will also scale like nobody's business for this sort of thing. Erlang isn't as good for some of the other web app stuff though, sticking with rails for that is a good call.
I would use Node.js. Considering the amount of fame Node.js and Socket.io have been gaining in the recent days, I can say that it will stay for a long while. Its really easy to learn and program, somewhat easier to debug than EventMachine. Lastly the huge usage and community ensures that it pretty much works on every browser and OS. This is a big plus for me as I spend days solving mundane IE bugs because of the way out application was written.
At the moment I will be Weary of using HTML 5 in an applications used by 100's of people cause not every one uses the latest browser.
Flash, no. Unless you have a lot of flash developers.
I think both Node.js and EvenMachine will get the job done, I would really suggest you to go with the language you are more familiar with or even better the one you like working with :)


text:
Eat like a player: Sea bass and salmon rice
- 18 January 2012 13:55
- Posted by David Clayton
Ever wanted to eat like a City player? Well now you can, with the Carrington City chefs revealing some of their secret recipes so everyone can enjoy the food the players are served after training.
The food is generally low fat and high in nutrients - as well as being quick and easy to prepare.
Here's the next dish in our series - a favourite meal of Joleon Lescott and Roberto Mancini, no less. Let us know on our official Facebook or Twitter pages if you give the meals a try, plus any twists you add!
(Serves two)
Ingredients needed :
Fillet of sea bass
30g basmati rice
½ fillet of salmon
2 tsp sweetcorn
6 cucumber slices
2 chopped sunblush tomatoes
1 tsp parsley
1 tsp lemon zest
½ squeezed lemon
Salt and pepper
1 sweet potato
1 tsp olive oil
First, boil the basmati rice for 11 minutes and then allow to cool down in a bowl. Then add the sweetcorn, salmon, cucumber, tomatoes, parsley, lemon zest and squeezed lemon and combine together.
Peel and dice the sweet potato and boil for 11 minutes. Roast the potato on high for three minutes until golden brown. Finally, pan-fry the sea bass in olive oil for six minutes on each side and season with salt and pepper either side.
Recipe created by Carrington chef Emma McAnaw.
Look out for new recipes every month in the latest issue of ManC - the official magazine of MCFC..


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Our Price:£62.35
Quantity: 28ml
Restore skins equilibrium with this light, de-stressing facial treatment formulated to be easily absorbed without blocking pores. Clarifying Lemon and Rose Geranium help purify and balance oil, while Rose Damascena soothes unruly problematic skin. Sweet Almond and Avocado hydrate and nourish for a soft, supple finish.
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WACO (December 27, 2012)—A Waco man pleaded guilty Thursday to a November 2011 aggravated robbery that happened near the Baylor campus.
Judge Ralph Strother sentenced Rodney Darrell Scott, 36, to serve 5 years in state prison on one count of robbery.
Rodney admitted that on November 30, 2011, he reached into a man's car while the victim was at a fast food restaurant and took money from the man.
A police report from the day of the robbery showed at about 11:30 p.m. Nov. 30 the 18-year-old victim was in the drive through at the Taco Bell at 824 South 6th Street when a man walked up to his car and asked for money, Waco police Sgt. W. Patrick Swanton said.
The victim found a $1 bill in the console of his car and gave it to the man, but the man reached into his pocket as if he had a gun and demanded more money, Swanton said.
The victim found some change in the car, but before he could hand it to the robber, the assailant reached into the car and grabbed the money and then walked away.
The victim got his order and drove to his apartment before he called police.
He described the robber and a short time later, officers spotted a man who matched the description at a near-by McDonald's.
They identified the man as Scott and found that he had been warned away from the McDonald's before.
Police did not recover a weapon.


text:
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- Inside the betas: A sneak peek at what's new in tvOS 10
- Filling the Gap: A look at third-party HomeKit apps
- Instant Expert: Secrets & Features of tvOS 9.2
- Instant Expert: Secrets & Features of iOS 9.3
- Opinion: Why Apple needs a dedicated HomeKit app


text:
Please enter a maximum of 5 recipients. Use ; to separate more than one email address.
| Bloch, H. P., Hydrocarbon Processing Staff,
[asset management]
HP editors frequently attend technical conferences
to keep informed on the many factors impacting the hydrocarbon processing industry (HPI).
The focus of these conferences often differs. However, one
particular conference on failure analysis stands out. No
exhibitors were present at the event; the majority of the
presenters were users or beneficiaries of best-of-class (BOC)
root-cause failure analysis methods. The core of the program
concentrated on two or three best root-cause failure analysis
methods available.
The HPI still struggles with accidents according to a
Chemical Safety Board (CSB) statistic. In the report, the CSB
noted the considerable frequency of significant and
deadly incidents at refineries over the last decade. In
2012 alone, the CSB tracked 125 significant incidents at US
petroleum refineries.1 These are disappointing
findings. One solution is encouraging HPI management to invest
more in training budgets such as technical conferences and
workshops. Failure avoidance and safety are inseparable. The
mix is a key ingredient to responsibly achieving and sustaining
HP editors also attend reliability-focused forums. These
conferences offer different programs. A recent conference
incorporated about 80 vendor-exhibitors. A high percentage of
the event presentations were closely associated with the
exhibitors. Impressive products on view included compact
accelerometers and underwater velocity sensors. These and other
components have migrated from the aerospace industry to the
process and manufacturing industries. Much of this technology transfer will benefit the
HPI. More importantly, there are an impressive number of new
companies and consultancies now entering the reliability
Exhibitors often use attention-getting terms in their quest
to attract clients. The old lean and mean mantra
has run its course. A number of exhibitors now select company
names or designations that promise optimization,
detection, compliance,
management, reliability ecosystems,
automated and so forth. There is a market for
collective, as well as detailed reliability-focused,
Vendors want to sell new initiatives that are
really older products or programs with updated names. Using an
admittedly sweeping generalization, we characterize these
companies as upbeat purveyors of implementation strategies for
unrealistically optimistic clients. Both purveyors and clients
obviously desire low-budget fixes for persistent problems. But
to the experienced and informed, the clients problems are
often very deeply rooted in past indifference and
neglectwhich begs the question: Who will do the
Some conferences give much visibility to newly formed
consultancies. These companies offer expertise in operational
excellence (OE), a close cousin to asset management. There is
nothing wrong with parties seeking, and offering, such
visibility. Yet, the existing and potential OE consumer-clients
will make progress only if they finally start to address the
more fundamental issues. These companies should implement
well-focused efforts to learn and become more fully
The word learning prompts another key point on
OEbe fully aware of your conditions that will shape
the final outcome. There are a few solid prerequisites to
developing meaningful and sustainable OE programs.
Prerequisites to successful initiatives and pursuits are never
optional; they are unalterable and non-negotiable requirements.
These prerequisite requirements involve hiring, grooming,
empowering, compensating, retaining and rewarding the right
people. The men and women who will move entire facilities from being average to
becoming BOC performers have to be ethical, competent and
highly motivated. Such employees and their managers must make
important contributions before either project content or monetary
appropriations are finalized. These employees will ensure that
the projects include safety and reliability and are solidly
based on the cost of reliable equipment, and not just on the
lowest initial bid. In other words, the cost-estimating manuals
at the core of such projects must reflect pricing for a
reliable plantespecially reliable machinery.
A realistic project budget estimate must also
include the cost of machinery quality assessments
(MQAs).2 Remember: You get what you
inspect, not what you expect. Implementing and conducting MQAs
will typically require a 5% addition to the as-purchased cost
for reliable machines. This incremental outlay will often be
retrieved within a year.
When examining reliability improvement and failure
avoidance needs for an HPI facility, lets be sure of one
fact: The next initiativeby any name or
acronymcan be successful only if and when the stated
prerequisites are in place. These prerequisites involve
intelligent hiring, nurturing, empowering, compensating,
retaining and rewarding the right people. The managers
authorizing the prerequisites mentioned above must give
guidance by demonstrating personal ethics, competence and
persistently high motivation.
Every one of these commendable attributes is required from
the top to bottom layers for a successful organization. Because
people with these attributes cannot be acquired or trained on
short notice, each prerequisite is a highly tangible long-range
action step. Companies and management must stop looking for the
magic bullet, and organizations must cultivate a
new environment for OE and reliability.
Unfortunately, there will still be those managers who still
seek out a magic bullet solution. In truth, there
really is no cheap implementation route. There are no
effective, yet previously unknown, quick-fix initiatives.
To achieve effective results, HPI companies must use only
the best available investigation and root-cause failure
analysis (RCFA) processes. No one single RCFA process suits all
situations. Organizations must discover and report the root
causes of failures, whether they are equipment or process
related. Once uncovered, do not rest until the sources of these
root causes are eliminated. Modify the management strategy and
steer training dollars to the right direction.
This editorial is critical of how certain issues are now
addressed by HPI companies. The purpose is not to gloss over
misdirected efforts, especially when addressing safety.
Caution is warranted. To always seek salvation in new
initiatives will have a price in wasted time and money.
Irrespective of names, designations and code letters, any
initiative whatsoever will succeed only if it is tightly
interwoven with highly motivated and competent employees.
Because these men and women are the prerequisites to success,
our industry must continue sending young engineers to technical
conferences that teach both incident investigation and incident
Finally, an important suggestion to organizers of
reliability-focused conferences: When selecting motivational
speakers, pick the ones who can lay out the full story. At two
recent conferences, the keynote speakers spoke about our
shrinking world and the marvels of building the
latest-generation passenger plane. The speakers reminded their
respective audiences that suppliers from 17 nations around the
globe provided major components and subassemblies for the new
plane. Glitches with onboard batteries were solved in less than
one year by competent contributors stepping up to whiteboards
and doing sketches for ease of visualization. Yes,
but, some of us mumbled; it is also known that the
new-generation passenger plane experienced years of delivery
delays. Neither that fact nor its underlying causes were
mentioned, and, more importantly, learning opportunities were
missed at these conferences. Most conference attendees want to
hear the full story and nothing less will do.
1 Investigation shines new light on fatal
2010 Tesoro refinery explosion,
Hydrocarbon Processing, March 2014,
pp. 1214.
2 Bloch, H. P. and F. K. Geitner, Compressors:
How to achieve high reliability and availability,
McGraw-Hill Publishing, New York, New York, 2012.
All comments are subject to editorial review.
All fields are compulsory.
I believe the above article is one of the best articles I have ever read about companies and organizations search for success. The author made it clear to attain success you have to have ethical, competent, and highly motivated personal to achieve that success. An incident that happened at one of a Technology Engineering College (Oil & Gas Focused Institution) without mentioning its name, the President of the College in a general meeting for the Faculty and Staff says and I am quoting exactly what he Said " I don't care of you are the Best Researcher and I do not care if you are the BEST Ph.Ds., I do not need you. I still can carry a stick and show you the door. I am happy to get a Preparatory School Teachers and High School Teachers to do the Job for me" unquote. That was his approach for "the quick-fix" and for hiring and retaining and rewarding the right people.Thank you for such an article and thank you to spell it out "the road to success" very clear for the management of any organization.Please make my comments "ANONYMOUS" because I still would like to work for a couple of more years.
Sign-up for the Free Daily HP Enewsletter!
A searchable database of project activity in the global hydrocarbon processing industry
Engineers and designers are highly skilled individuals. Forcing them to enter design changes using tables, forms and spreadsheets is unproductive and uneconomical, and it increases the likelihood of human error—this is the way that most instrumentation software systems currently work. For too long, software vendors have denied engineers and designers the simple practicality of a graphical visual engineering interface with "drag and drop" capability and inbuilt intelligence, ensuring changes are automatically replicated into all the associated data and databases.
Is 2016 the peak for US gasoline demand?
Too soon to tell
July 2016


text:
I've got an obscure cryptographic USB token that works pretty good with Lion except I need to run...
sudo /usr/sbin/pcscd -adf
...each time I want to use it because it doesn't load automatically.
How to make it load at startup?
The problem happens, because securityd (which is supposed to load pcscd) does not start it when you insert your card. Try editing
The section should look like this:
and then reboot.
This should set securityd in aggressive card detection mode. If there is a
Hope this helps.
add the symbol & in the end of the line


text:
The Bowling Green Fire Department showed off their new pink shirts for breast cancer awareness tonight at the Annual Fire Prevention Week Festival.
Activities like fire demonstrations and fire truck tours gave an inside look into a firefighter's job.
Marlee Boeing with the Bowling Green Fire Department says the festival is a fun way to teach kids about safety.
She says, most importantly, people need to continually check their smoke detectors.
"So many people have smoke alarms and then they don't know whether they work or not. They don't replace the batteries when they should, so we really want to drive that point home. And then we also want to make sure that people have a plan in place so the whole family knows how to get out and know where to meet, and the kids especially know how to get out and call 911," she says.
National Fire Prevention week ended today.


text:
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The Walter A. Shaw Young Investigator Award in Lipid Research, established by ASBMB's Lipid Research Division, recognizes outstanding research contributions in the area of lipids by young investigators who are an Assistant professor or equivalent and with no more than 10 years of experience since receiving their degree (PhD and/or MD). Nominations must be originated by Society members, but the nominees need not be ASBMB members. Self nominations are acceptable. The award consists of a plaque, $2,000 and transportation and expenses to present a lecture at the 2015 ASBMB Annual Meeting.
Recipients:2016 - Christer S. Ejsing 2015 - Britta Brügger2014 - Mary L. Kraft 2013 - Tobias Walther2012 - Peter Espenshade2011 - Charles E. Chalfant2010 - Sarah Keller
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text: Ice Skating & Ice Hockey Winter Trail MapEnjoy ice skating on the pond all winter long. We even have a Zamboni machine to keep the surface of the ice smooth for your ice skating and hockey pleasure! Ice skating is a favorite with kids and adults alike, and hockey is a winter tradition at the ranch. Skate during the day or enjoy a night skate with toasty hot chocolate and marshmallows. This activity is available any time ice conditions permit. The Concierge will help you get set up with skates. All necessary equipment for on-ranch activities is provided for your convenience.


text:
riders were approaching, the wind began to howl.
My boy's got a brand new toy.
(Well, newish.)
Here, in the land where fantastical dreams become our ridiculous realities, B is outside in the thick midday heat, tearing apart his new bike. Fenders are flying, girlfriends are stressing over tetanus, sweat is pouring, and B is loving it.
Second only to building a jetpack, gutting a motorcycle has been a major lifelong aspiration for him. And everyone here thinks he's completely nuts for it. If you have a new bike, why do you want an old crap one?
We're currently working on getting the correct translation for, cause it's badass, duh.
Tags: crazy americans, motorbikes, projects


text:
29 May 2012 12:12 AM #1
Store.destroy() doesn't remove store from stores's cache (Ext.StoreManager.map)
Ext version tested:
- Sencha 2.0.1
- Chrome 19.0
- When a store is created it is added to Ext.StoreManager.map by storeId as a key.
- However store.destroy() doesn't remove it from the store's cache. So, the longer the application is used, the more memory is consumed as none of stores is actually released.
- Calling Ext.StoreManager.unregister(store.getStoreId()) explicitly removes store reference from the cache. However I suppose that this should be done in destroy() method as even DataView relies on it when updating store to new (DataView.updateStore()) or am I missing anything?
- Create a store
- Check Ext.StoreManager.map -> store is added
- Call store.destroy()
- Check Ext.StoreManager.map -> store is still there, only isDestroyed flag is set to true
Ext.define('User', { extend: 'Ext.data.Model', config: { fields: [ {name: 'firstName', type: 'string'}, {name: 'lastName', type: 'string'}, {name: 'age', type: 'int'}, {name: 'eyeColor', type: 'string'} ] } }); var data = [ {firstName: 'Ed', lastName: 'Spencer'}, {firstName: 'Tommy', lastName: 'Maintz'}, {firstName: 'Aaron', lastName: 'Conran'}, {firstName: 'Jamie', lastName: 'Avins'} ]; var store1 = Ext.create('Ext.data.Store', { model: 'User', storeId: 'test-store-1', data : data }); Ext.StoreManager.map // 'test-store-1' is added to cache store1.destroy() Ext.StoreManager.map // 'test-store-1' is still in cache //// var store2 = Ext.create('Ext.data.Store', { model: 'User', storeId: 'test-store-2', data : data }); store2.autoDestroy = true; var touchTeam = Ext.create('Ext.DataView', { fullscreen: true, store: store2, itemTpl: '{name} is {age} years old' }); Ext.StoreManager.map // 'test-store-2' is in cache var store3 = Ext.create('Ext.data.Store', { model: 'User', autoDestroy: true, storeId: 'test-store-3', data : data }); touchTeam.setStore(store3) Ext.StoreManager.map // 'test-store-2' is still in cache though shouldn't, as expected to be destroyed
29 May 2012 6:23 AM #2
- Join Date
- Mar 2007
- Location
- Gainesville, FL
- Posts
- 39,174
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- 1258
Thanks for the report.Mitchell Simoens @LikelyMitch
Sencha Inc, Senior Software Engineer
Check out my GitHub, lots of nice things for Ext JS 4 and Sencha Touch 2
Think my support is good? Get more personalized support via a support subscription. https://www.sencha.com/store/
Need more help with your app? Hire Sencha Services email@example.com
Want to learn Sencha Touch 2? Check out Sencha Touch in Action that is in print!
When posting code, please use BBCode's CODE tags.
8 Jun 2012 1:50 AM #3
Do you have any plans on when this issue will be fixed?
14 Jun 2012 7:28 AM #4
This has been fixed and will be part of the next release. Thanks for the report.
2 Jul 2012 2:02 AM #5
Is there any hotfix or override for this bug?
BTW, when 2.0.2 will be released? It is important to know 'cause we're in production and we can't still continue by searching for bugs and fixes of ST2 (we already update to ST220.127.116.11).
5 Jul 2012 12:29 AM #6
We're using the following override for now (it just calls 'unregister' method of StoreManager to release store on destroy):
Ext.define('MyApp.override.Store', { override: 'Ext.data.Store', destroy: function () { this.callParent(); Ext.StoreManager.unregister(this); } });
5 Jul 2012 1:52 AM #7


text:
Tuesday, October 2, 2012
Tofu Pot Pie
these directions.
Makes nine 4.5 inch deep dish pies
- 1/4 cup margarine
- 1 large onion, diced
- 2 cloves garlic, minced
- 2 stalk celery, chopped
- 1 cup chopped white mushrooms
- 1 pkg tofu, small dice
- 2 tbsp all purpose flour
- 1 tsp poultry spice
- 1/2 tsp sage
- 1/2 tsp rosemary, crushed
- 1 cup plain soy milk
- 1 cup hot water (from cooking veggies above)
- 1 cooking apple, shredded
- 1 cup peas
- salt and pepper to taste
- 2 cups small diced potatoes
- 1 cup small diced carrots
- 1 cup small diced butternut squash
- 1 cup chopped yellow beans
- 1.5 recipe pie dough, minus the sugar
- nine 4.5 inch deep dish aluminum pie plates
1. Get a large pot of salted water boiling.
2. Melt margarine in a large frying pan over medium heat. Saute onion, garlic and celery for 10 mins, until a nice golden brown. Add mushrooms and fry for another 3 mins. Add tofu and fry for 2 mins. Sprinkle flour over and mix/fry for another 2 mins.
3. Add spices, then slowly add soy milk and stir well. Mixture will thicken.
4. Meanwhile, add potatoes, carrots, squash, and beans to the boiling water. Boil for about 5 mins, or until potatoes and carrots are slightly tender. Remove from water (but save the water) and add to tofu mixture. Slowly mix in 1 cup of the water you used to boil the veggies. Add shredded apple and peas. Season to taste with salt and pepper and remove from heat. Let mixture fully cool in the fridge.
5. While mixture is cooling, make your pie dough. Roll out slightly more than half of the dough (for the bottom crusts) and cut to fit the pie plates your are using. Make sure to cut a big enough circle to leave you some overhang. Fill each crust with cooled filling. Roll out remaining dough for the top crusts and seal as you would any pie. Poke some vent holes in the top.
6. Place pies in the fridge to cool down and firm up. Preheat oven to 400 degrees, with your rack in the bottom 1/3 of the oven.
7. Bake for 45-60 mins, or until filling is bubbling and crust is golden.
11 comments:
- Mary Vivit said...
Oooo - can't wait to try this! Thanks!
- October 2, 2012 at 8:50 PM
- BLD in MT said...
Yummy! And that IS some scenery!
- October 3, 2012 at 12:53 PM
- Meg said...
These look great! I always buy those Amy's frozen nondairy pies for emergency dinners, I'll have to make and freeze some of these.
I hate mushrooms, though - would peas work as a replacement?
Thanks for the wonderful blog!
- October 3, 2012 at 3:59 PM
- Meg said...
Aw crap, I just saw there are peas in it already. Fine to just leave the mushies out?
- October 3, 2012 at 4:00 PM
- Karen's Vegan Kitchen said...
What gorgeous little pies! refined coconut oil? I'm trying to avoid margarine...
- October 3, 2012 at 4:40 PM
- Cole said...
I love pot pies and can't wait to try making this on the weekend! Looks so tasty!
- October 3, 2012 at 9:21 PM
- Rachel said...
Happy Canadian Thanksgiving! Whatever do Canadians give thanks for? Probably this pie.
This is the most amazingly delicious looking thing. I just want to eat it while its too hot and burn my tongue but keep eating anyway. NOMNOMNOM
- October 8, 2012 at 7:45 PM
- Linda G said...
This tofu pot pie is soooooo delicious! My husband is not a fan of tofu, so I made half with, half without - both were equally as delicious. One of the few changes I made is that, when I cooked up the vegetables, I cooked them in veggie broth instead of water and then used that water later in the recipe. I also chose not to put apples in and used green beans instead of yellow - just a personal taste preference. My husband's response: Oh my God! These are the most DELICIOUS pot pies I have ever had! :) Thanks, Vegan Dad. Your recipes are simply amazing.
- October 9, 2012 at 2:58 PM
- Jessica Gossard said...
Love all your recipes! Everything of yours that I have ever made was delicious first time around! I LOVE LOVE LOVE your blog thank you so much.......I really believe that if not for your blog I would struggle to remain vegan!!!!!! You make veganism very easy for me and my family of four!
- October 9, 2012 at 3:25 PM
- Timmy Campbell said...
I soooo have to give this a try.
- October 15, 2012 at 11:20 PM
- Alison said...
This is my third time making it (its been requested twice after the first time I made it.) It's SO delicious. I make just one 9 inch pot pie. Thanks for the recipe!
- March 23, 2014 at 12:17 PM


text:
These formulas are ideal for supporting healthy skin in pets with conditions responsive to miconazole and/or chlorhexidine. MiconaHex + Triz products provide antimicrobial and antifungal activity, as well as moisturizing agents to support soft, supple skin. The effectiveness of the antimicrobial activity is enhanced with the addition of TrizEDTA. 2% Miconazole provides an antifungal agent, 2% Chlorhexidine Gluconate is used frequently for bacterial skin conditions caused by Gram-positive and Gram-negative bacteria. TrizEDTA has antimicrobial and antibiotic potentiating activity. Ceramides aid in moisturizing dry, damaged skin. Each of these formulas is made in the USA. For dogs, cats, and horses.
Shampoo can be used up to 4 times per week (or as directed by veterinarian) to address skin conditions during bathing. Spray is ideal for dry or after-bath application on paws and other hard-to-reach areas. Wipes offer fast acting, anytime use and are also great for travel.
Please click on "More Information" for complete ingredients and use directions.


text:
Enroll Now!
I really enjoyed the content of the course and the way it was presented. I gained a lot of scientific knowledge that I perhaps had forgotten. I also gained valuable techniques in conducting not only a science class, but will be able to integrate them into my other contents. Thank you.
I really enjoyed this class! The instructor's teaching style was very clear, direct, and methodical. She covered all of the topics thoroughly, and wrote in a very friendly and interesting style. As I finished each lesson, I was already looking forward to the next! Also, the supplementary materials and resources at the end of each lesson are so valuable and will be very useful to me. I am sure I will refer to all the materials in this course over and over again.
I enjoyed this class and found it useful. The writing style used in the lessons made it easy to understand and interesting to follow. It was great to brush up on scientific knowledge, learn some new information, and review some best practices to help me better meet the instructional needs of my students.
The instructor, Holly Trimble, is very good at getting to the core of instruction. In the past, I had felt like I was teaching bits and pieces of scientific information. It was not until I read the chapter on the drive for equilibrium that I saw it all tied together. But, I had never been able to put that into words to let my students understand that concept. I teach high school science and math, and I found this course invaluable. I will use what I learned in these lessons every day in class!
This was the best education course I have ever taken. The lessons were great and the resources given at the end of each lesson were terrific. I wish I had taken this course many years ago - my students would have benefited from it!
This was a very helpful course and the instructor was wonderful! She broke down the information into manageable chunks and included real classroom stories. She also included a ton of supplementary information to help us research anything we might need to use in our classrooms. I made a notebook of all the lessons, and I know it will be a very useful guide for me this year!
I have taken many science courses in my teaching career, but no course has really taught me science and how to use it in my classroom like this one! It has been previously hard for me to teach science because I never understood it myself. Science concepts were never explained in a way that I could understand them until now. I will never again dread teaching science. Thank you so much!
This was a great course to not only refresh one's science knowledge, but also to gain a ton of great science teaching ideas, both in terms of content and execution. The instructor provides lots of great checklists and worksheets for both the students and teacher. I highly recommend this course. If you still rely on just worksheets and the "occasional" activity or experiment this course will change how you approach teaching science and make science the most exciting part of the day for your students.
The instructor did an outstanding job of presenting a comprehensive, insightful science class for teachers of fourth to sixth graders. She truly led by example. The class has been such a boost for me, and I'm sure for the others who've taken it. I am more knowledgeable and have more tools to start using with my students tomorrow! Her willingness to share such complete resource lists and expertise tell of her love for students and teachers alike. Thank you!
I was so pleased with this class. So much was covered that helped me to become a better teacher: science concepts, lesson planning, organizing units, classroom management. and more. I appreciated the knowledgeable, common-sense approach of the teacher and am excited to share this love of science with my students in a more coherent way this fall. Thank you!!


text:
what do i have to do in sept to get a jumbowoot coupon?
I have never got a coupon. I want one bad.
14 Answers answer
Crap... you asked a question about how to get a coupon... Now your account has been blocked from getting coupons. bummer...
JK, see related questions over here ----------------------------------------------------------------------------------->
Or here:
You must find and delivery a cast-iron work desk to @inkycatz.
The list is long and distinguished, but lets start with @agingdragqueen
I kid.....Just stay active in the community. Post deals when you see them and answer questions when you have something to add (on the internets everyone has something to add).
Good luck!
Yo, Bravehair! The first rule of jumbowoot coupons is DON'T ASK FOR OR ABOUT JUMBOWOOT COUPONS.
Be active on deals.woot and cross your fingers that you perform the mystery task of the month and if you receive a jumbowoot coupon, say "thank you"
@colonelpuffpuff: +1 for Bravehair.
@fierytresses: You came to the right place!
All you have to do is follow these 10 simple steps!
It's as if millions of voices suddenly cried out in terror and were suddenly silenced…
You must make a pilgrimage to Carrollton Texas, Woot mecca, in July or August. Once there you must sit zen style on the outdoor loading dock from 9am- 6pm, never moving. Sometime during the last hour you will begin to see "visions" the "visions" will lead you to that which you desire.
You have to tattle on any deal that may or may not contain an item that is red, or has any red on it.
@capguncowboy: AND do it on a day of the week that contains an A
You guys are funny.
@fierytresses: Some are funny, most are just sad.
Especially the down-vote brigade.
Down-vote this post if you hate Jesus.
You've been blessed so far. The real smarta$$es don't show up for their shift until a couple of hours from now. I am currently assigned to every 3rd Wednesday at 9 PM woot time.


text:
See images from Himawari-8 in the new satellite viewer
This demonstration product is most suitable for people
with fast internet connection and high data allowance.
Low-definition satellite images
Satellite View Selection
06:00 ACST on Friday 29 July 2016 | Cloud/surface composite, Australia
Images from Japan Meteorological Agency satellite Himawari 8 via Bureau of Meteorology.
IDY28000 Australian Government Bureau of Meteorology Bureau National Operations Centre Satellite Notes for the 0600UTC Chart on 29 July 2016 Issued at 5:00 pm EST Friday on 29 July 2016 A high pressure system located over southeast Australia extends a ridge across the country. Clear skies are evident across the eastern and northern interior of Australia. Southeasterly winds are bringing patches of low cloud along the Queensland coast while an upper trough is responsible for the cloud streaming from north Queensland across the Coral Sea. Further south, low cloud is visible over southern parts of South Australia, Victoria and parts of New South Wales due to a westerly airstream. A cold front embedded in the westerly airstream is over Tasmania. Middle to high level cloud extends over southern districts of Western Australia and the Bight while a strong cold front is visible to the southwest of Western Australia.


text:
Editorial Staff And Contributors
Cold sores have very recognizable features. They are most often diagnosed by physical exam and by your medical history. If your doctor is not sure, a sample of the fluid or tissue from the blister may be taken. A blood sample may also be taken for testing.
Testing may include any of the following:
Cold sores. Nemours Kids Health website. Available at:
http://kidshealth.org/parent/infections/common/cold_sores.html. Updated October 2010. Accessed March 30, 2013.
Herpes labialis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated May 27, 2011. Accessed March 20, 2013.
Herpes simplex: Diagnosis, treatment, and outcome.
American Academy of Dermatology
website. Available at:
http://www.aad.org/skin-conditions/dermatology-a-to-z/herpes-simplex/diagnosis-treatment/herpes-simplex-diagnosis-treatment-and-outcome. Accessed March 20, 2012.
Last reviewed March 2015 by David L. Horn, MD, FACP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.


text:
National Cancer Institute
Posted Date: Apr 27, 2014
Expert-reviewed information summary about planning for transitions in level of care (e.g., inpatient to outpatient) for individuals who have cancer.
Transitional Care Planning
This patient summary on transitional care planning is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. This summary describes transitional care, assessment, and care options.
This summary is about planning for changes in level of care for adults with cancer.
What Is Transitional Care Planning?
Transitional care planning helps the patientâs cancer care continue without interruption through different phases of the cancer experience.
Transition means passage from one phase to another. Transitional care planning is the bridge between two phases of care. As the cancer patient's treatment goals change or the place of care changes, the patient may encounter problems during the transition. Patients will need to make decisions that balance disease status and treatment options with family needs, finances, employment, spiritual or religious beliefs, and quality of life. There may be practical problems such as finding an appropriate rehabilitation center, obtaining special equipment, or paying for needed care. There may be mental health problems such as depression or anxiety. Transitional care planning helps identify and manage these problems so the transition can go smoothly, without interruption of care. This can reduce stress on the patient and family and improve the patientâs health outcome.
See the following PDQ summaries for more information:
- Adjustment to Cancer: Anxiety and Distress
- Depression
- Pain
Transitional care planning may include support and education for the patient and family and referral to resources. Ideally, it involves a team approach by the patient's health care providers. It is important that there be close communication between members of the team and that this communication include the patient and family.
Goals of cancer care may change as the disease changes.
Each type of cancer requires different care and the goals of a patientâs treatment may change as his or her disease gets better or worse. Cancer care may include any of the following:
- Active treatment: Treatment given to cure the cancer.
- Supportive care: Care given to prevent or treat as early as possible the symptoms of the disease; side effects caused by treatment of the disease; and psychological, social, and spiritual problems related to the disease or its treatment.
- Palliative therapy: Treatment given to relieve symptoms and improve the patient's quality of life. Palliative therapy may be given along with other cancer treatments or when treatment is no longer curative, to make the patient comfortable at the end of life.
Transitional care planning can help the patient and family with medical, practical, and emotional issues that arise as they adjust to these different levels and goals of care.
A patient may receive care in several different settings during the course of the illness.
Most of the care received by people with cancer is provided in places other than a hospital. The place where the patient receives treatment may change several times during the course of the illness. Patients may go from receiving care in a hospital or as an outpatient to receiving care at home, in a nursing home, at a rehabilitation center (a place for special training, such as help in regaining strength or movement), or from a hospice team for end-of-life care. When a patient moves from one place of care to another, the process of planning for the move is often called discharge planning. This may involve a case manager who acts on the patient's behalf when dealing with the hospital, visiting nurses, health care companies, rehabilitation facilities, nursing homes, and other groups that provide the care needed. The case manager is a link to resources and services in the community and can arrange for the provision of services, including patient and family education and referrals.
Transitional Care Planning Assessments
An assessment collects information that helps the health care team identify and manage problems a patient may have in adjusting to a change in care.
Having cancer affects more than the patient's physical condition. It also affects mental health, family life, ability to work, financial planning, social relationships, and faith. Many patients will encounter problems in one or more of these areas as they transfer from one level of care to another. For example, a patientâs family may have problems obtaining special home equipment or learning to use special equipment. Another patient may have a difficult time accepting the change from anticancer care to symptom relief alone, such as that provided with some types of palliative or hospice care. Transitional care planning is unique to each patient and family. Assessments help identify patients who may have problems during the transition and help determine the kind of support they will need to make the change go smoothly. The assessments may include a complete medical history; a physical exam; a test of learning skills; tests to determine ability to perform activities of daily living; a mental health evaluation; a review of social support available to the patient; and referral to community resources as needed to assist with issues such as transportation, home care, healthy eating, and medication management.
Assessments are done many times during the patient's cancer experience, as a routine part of care.
Assessments are done when the patient moves from one facility to another, such as from hospital to home. They are also done at regular times during the course of the disease, usually at the time of diagnosis, after completing a course of treatment, when there is a relapse, when curative treatment stops, and when treatment is discontinued (end-of-life care begins). The patient may feel added emotional stress at these times. Regular assessments can identify these and other causes of distress in the patient, such as job loss or the death or illness of a patient's loved one or caretaker. (See the PDQ summary on Grief, Bereavement, and Coping With Loss for more information.)
Because no one knows what the patientâs needs will be in the future, assessments are done many times during the cancer experience as a routine part of care. This is helps ensure the patient receives the right services at the right times.
All members of the patientâs health care team are involved in the assessment process.
In planning for a change in cancer care, doctors, nurses, and other members of the patientâs health care team will consider all the areas of a patientâs life that may be affected. The following professionals may each conduct different parts of the transitional care planning assessment:
- Doctor.
- Nurse.
- Dietitian.
- Social worker.
- Psychologist.
- Chaplain.
- Physical therapist.
- Occupational therapist.
The following types of assessments will be done for transitional care planning:
Physical assessment
A physical assessment will look at the patient's general health, treatment plan, and changes in disease status, including the following factors:
- Type and stage of the cancer.
- Symptoms of the cancer.
- Side effects of treatment.
- Whether the patient smokes.
- Nutrition-related side effects and complications.
- Ability to perform activities of daily living.
See the following PDQ summaries for more information:
- Nutrition in Cancer Care
- Smoking in Cancer Care
Family and home assessment
Factors such as the patient's age and living arrangements may affect how easily a change in level of care can be accomplished. The assessment will look at the following:
- Age of the patient and family members.
- Living arrangements.
- Whether the patient has a spouse or children.
- Level of education of the patient and family.
- Language spoken in the home.
- Cultural beliefs and practices.
- Whether family and friends are able to help during treatment.
- The age and floor plan of the home. Will medical equipment (such as a hospital bed, oxygen tank, or portable monitor) fit in the bedroom, if needed, and is wiring adequate? Can a person in a wheelchair move through the house easily?
Mental health assessment
Change can be a stressful time for both the patient and family. The nature of the relationship between the patient and his or her family and others helps determine the kinds of services the family may need to cope with the transition. The following questions may be asked:
- How do the patient and family feel about the cancer, the treatment, and the treatment goals? Sometimes patients develop serious problems such as depression or anxiety. Family members also may need help dealing with their feelings. These problems are often treatable. The doctor or health care professional can make referrals to a support group, counselor, or mental health care worker.
- What beliefs and values are important to the patient and do they affect the patientâs treatment decisions?
- How has the family coped with stress and crisis in the past? This may be helpful in predicting how they will react to the stress caused by the changes in the patient's treatment.
- Are there problems in the home that are unrelated to the cancer but may affect how well the patient and family can handle the change?
- Are there current or past mental health problems in the family?
- Has there been physical or sexual abuse in the patient's past?
- In the case of a patient considering home care, does the patient or any family member smoke or use drugs or alcohol? Smoking is not safe around oxygen equipment. Family members responsible for giving the patient medicines or other care must be clear-headed and not under the influence of any substance that could affect their ability to provide care in the prescribed way.
See the following PDQ summaries for more information:
- Cognitive Disorders and Delirium
- Depression
- Adjustment to Cancer: Anxiety and Distress
- Post-traumatic Stress Disorder
Social assessment
Doctors and other health care professionals can provide referrals to supportive services available to the patient. A review of the kinds of social services already available to the patient will be done:
- What kind of support is available in the home and community? How will the patient travel to medical appointments or other places? Who can the patient call on for help if necessary? Where the patient lives may affect what services are available and how the patient can get to appointments. Referrals can be made to local providers of services such as home nursing, food and medication delivery, and transportation to and from treatment centers.
- Does the patient understand hospice care and palliative care and know about available programs in the community? (See the PDQ summary on Last Days of Life for more information.)
- Before home care is considered, the availability of in-home help must be determined. Is there someone at home who can help the patient or will outside help be needed?
- Will the primary caregiver have anyone to help with the caregiving duties and make it possible to take time off?
- How will the change affect the patientâs ability to work?
- Does the patient have insurance coverage (group coverage from a job, Medicare, Medicaid, veteranâs benefits, or other)?
- What are the patientâs financial resources? How will the cost of care be paid?
Spiritual assessment
Knowing the role that religion and spirituality play in the patient's life help the health care team understand how these beliefs may affect the patient's transition to a new level of care. A spiritual assessment may include the following questions:
- Does the patient consider himself or herself to be a spiritual person?
- What is the importance of religion to the patient?
- Is the cancer or its treatment causing spiritual distress?
- Is support available from the patientâs religious group? Many patients find visits from members of their religious group valuable. A patient may want to talk to a spiritual advisor (for example, a priest, rabbi, or minister) during treatment.
Most hospitals, especially larger ones, employ hospital chaplains who are trained to work with medical patients and their families. Hospital chaplains are trained to be sensitive to a range of religious and spiritual beliefs and concerns.
(See the PDQ summary on Spirituality in Cancer Care for more information.)
Legal assessment
Advance directives and other legal documents can help doctors and family members make decisions about treatment should the patient become unable to communicate his or her wishes. The patient may be asked if he or she has prepared any of the following documents:
- Advance directive: A general term for different types of documents that state what an individual's wishes are concerning certain medical treatments when the patient can no longer communicate those wishes. The patient may declare the wish to be given all possible treatments that are medically appropriate, only some treatments, or no treatment at all. Advance directives are most effective when the patient and doctor talk about the decisions made by the patient and make plans to ensure the directives are followed.
- Health care proxy ( HCP): A document in which the patient identifies a person (called a proxy) to make medical decisions if the patient becomes unable to do so. The form may not need to be notarized, but it must be witnessed by two other people. The patient does not have to state specific decisions about individual treatments, only that the proxy may make medical decisions for him or her. HCP is also known as durable power of attorney for health care (DPOAHC) or medical power of attorney (MPOA).
- living will: A living will is a legal document in which a person states that they want certain life-saving medical treatments to be either withheld or withdrawn under certain circumstances. A living will is a type of advance directive. Living wills are not legal in all states.
- Durable power of attorney: A document in which the patient names another person to make legal decisions for him or her.
- Do Not Resuscitate (DNR) order: A document in which the patient instructs doctors not to perform cardiopulmonary resuscitation (restart the heart) at the moment of death, so that the natural process of dying occurs. A DNR order may be medically appropriate when cardiopulmonary resuscitation is not likely to save the patient's life.
Transitional Care Options
Different types of care are available for different types of needs. Transitional care may include management of the patient's medical condition and rehabilitation, plus supportive services to ensure basic needs such as comfort, hygiene, safety, and nutrition. It may also include supportive services for educational, social, spiritual, and financial needs. The following is a list of some of the care options that meet the assessed needs of patients during transition:
Place of care
- Hospital.
- Nursing home.
- Rehabilitation unit or facility.
- Patient's home.
- Home of family caregiver.
- Hospice.May be in an inpatient setting specified by the hospice or in the patient's home.(See the PDQ summary on Last Days of Life for more information.)
- May be in an inpatient setting specified by the hospice or in the patient's home.
Health care specialists and other caregivers work as a team, providing services to patients in their homes, clinics, and other settings. These may include the following:
- Doctor.
- Nurse.
- Dietitian.
- Physical therapist.
- Occupational therapist.
- Social worker.
- Mental health professional.
- Clergy or other religious leader.
- Companions.
- Home care aides.
Programs that provide care may include the following:
- Bereavement programs.
- Community support groups.
- Employment counseling agencies.
- Home health agencies.
- Home infusion agencies.
- Hospice programs.
- Legal aid organizations.
- Palliative care programs.
Medication support
- Pain and symptom management. (See the PDQ summary on Pain for more information.)
- Chemotherapy.
- Blood transfusions.
- Medications that cause blood cells to grow and mature.
- Antibiotics ( drugs used to treat infections).
- Treatments that help improve or restore lung function.
- Wound and skin care.
Nutrition support
The patient may be able to eat normally or may need supplemental nutrition by mouth, by tubefeeding, or by delivery into a vein. (See the PDQ summary on Nutrition in Cancer Care for more information.)
Special equipment
The type of equipment needed, if any, will depend on the patient's condition. Some commonly needed devices include the following:
- Medical appliances (such as catheters, tubes for drainage, and bags for colostomies).
- Assistive devices (wheelchairs, walkers, special beds and mattresses).
- Pumps to deliver medication into the body.
- Respirators (machines that help the patient breathe).
Special Considerations
Caring for a patient at home can increase the physical and emotional burdens on the patient's caregivers.
The stress and responsibility of in-home care can be hard on family relationships and should be carefully considered. Day-to-day routines may change for everyone. Many families have trouble getting used to the role changes that result. Patients and families may be referred to counseling to help them with these issues.
Pain control is a key factor in successful home care. Pain medications are given to help patients feel better and are often a part of cancer care. Controlling the patient's symptoms, especially pain, can make things easier on both the patient and the caregivers. It is important that the family and caregivers understand the use of pain control medications and other treatments that keep the patient comfortable.
See the following PDQ summaries for more information:
- Cardiopulmonary Syndromes
- Fatigue
- Hot Flashes and Night Sweats
- Gastrointestinal Complications
- Nausea and Vomiting
- Pain
If home care is to be considered, the following factors and others will be assessed:
- The kind of care to be given.
- The decision-making skills required by the patient and caregiver.
- Whether equipment needed will fit in the home.
- The family's ability and desire to provide the care, alone or with the aid of home care workers.
This assessment will help determine if care at home is a workable option for the patient.
Transitional care planning will help the patient explore ways to pay for services and care needed.
Medical insurance, Medicare, veteran's benefits, and/or Medicaid may pay some of a patient's medical expenses. These have limits to their coverage, however, and patients may need to find other ways to pay for costs not covered. The costs of home care, for example, are usually covered only under certain conditions and for a limited time.
Transitional care planning will include referrals to community resources that can help the patient plan for treatment costs not met by insurance. Social service agencies may be available to help with certain care needs. Some organizations lend medical equipment (such as wheelchairs and hospital beds), provide short-term assistance with a nursing aid or housekeeper, or provide transportation to and from the doctorâs office or clinic.
For more information about financial resources, contact the National Cancer Information Service ( CIS) at 1-800-4-CANCER. The CIS offices have information about cancer-related services and resources that are available in different parts of the country.
Transitional care may include employment counseling for the patient.
People with cancer often want to get back to work. Their jobs give them not only an income but also a sense of routine. Some people feel well enough to work while they are having treatment. Others need to wait until their treatments are over. Patients who have disabilities or other special needs after treatment may not be able to return to their old jobs at all.
Referrals can be made to services that help the patient with job-related issues. These services may include employment counseling, education and skills training, and help in obtaining and using assistive technology and tools.
If a patient does return to work, coworkers may not know what to say or may not know if the patient wants to talk about the cancer. Education of the patient's coworkers about the cancer can help ease this transition.
Advance directives need to move with the patient.
During transitions in care, the patient's advance directives, health care proxy form, and durable power of attorney document need to be given to the appropriate caregivers. This step will ensure that the patient's wishes are known through all disease stages and places of care. (See the Legal Assessment section for information about these forms.)
End-of-Life Decisions
Caring for a person with cancer starts after symptoms begin and the diagnosis is made and continues until the patient is in remission, is cured, or has died. (See the PDQ summaries on Last Days of Life and Grief, Bereavement, and Coping With Loss for more information.) End-of-life decisions should be made soon after the diagnosis, before there is a need for them. These issues are not pleasant or easy to think about, but planning for them can help relieve the burden on family members to make major decisions for the patient at a time when they are likely to be emotionally upset.
A patient's views may reflect his or her philosophical, moral, religious, or spiritual background. If a person has certain feelings about end-of-life issues, these feelings should be made known so that they can be carried out. Since these are sensitive issues, they are often not discussed by patients, families, or doctors. People often feel that there will be plenty of time to talk later about the issues. Many times, though, when the end-of-life decisions are necessary, they must be made by people who do not know the patientâs wishes. A patient should talk with the doctor and other caregivers about resuscitation decisions as early as possible (for example, when being admitted to the hospital); he or she may not be able to make these decisions later. Advance directives can ensure the patient's wishes are known ahead of time. (See the Legal Assessment section for information about these forms.)
These issues are important to discuss whether a patient is being cared for at home; in a hospital, nursing home, or hospice; or elsewhere.
Changes to This Summary (04/16/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
About This PDQ Summary
About PDQ
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
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Purpose of This Summary
This PDQ cancer information summary has current information about patient transition from inpatient to outpatient. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.
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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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