text:
Monday, July 12, 2010
Two midwives are there. One of them says "We are not very fine, doctor. We have this lady with APH [Antepartum Hemorrhage] and…..it must be….abruptio placenta?"
Abruptio placenta (placental abruption) is when the placenta partially or completely comes off the uterus while the fetus is still inside. It can be fatal for the fetus, and even sometimes for the pregnant women if the blood loss is severe enough.
She hands me the patient's file, and I see the results of an ultrasound that was done today. It shows a placenta previa. The scans aren't very reliable here, but I would tend to believe this type of finding. I am wondering if I should re-scan, when I walk over to look at the patient. There is a pool of blood with clots about 3 feet from the bed. She is lying on her side. There is old blood covering her legs, down to the bottom of her feet. Her pink skirt is not pink – it's white, but covered in blood.
When I see the skirt, I realize she needs a cesarean NOW. She doesn't have time for me to go and get the ultrasound and start dilly-dallying. At home we would be doing a crash c-section, which means that we would load her onto a stretcher and literally run the stretcher into the OR. We would have all hands on deck. There would be people available to move the patient, set up the OR, arrange for blood to be available, notify pediatrics, help anesthesia, and do the crash. It would be organized but effective chaos. It works.
Here, there is no such thing as a crash c-section. I go to the midwife who told me about the patient and tell her that I agree – the patient needs a cesarean urgently. I ask her to prepare the patient immediately, including consent and an IV. She agrees, then walks over to another patient, looking very unhurried. Another midwife arrives, and I tell her as well. She agrees too, but doesn't really take action either.
I know that they will do it eventually – they always do. But there is no sense of urgency here. I have had so many situations already where I have seen that even the most urgent situations can take 1-2 hours to get into the OR. At home, I would do it myself. But here, I can't consent the patient because I don't speak Japadhola. I can't put in the IV because I can't access the supplies.
I see a third midwife who has just come from theatre, from another cesarean. She still needs to bring her patient back to the ward. I tell her about the bleeding previa. She is distracted because she is thinking about her other patient.
I come back to the clinic because there are people waiting to be seen by me that I want to manage before I go to theatre. When I get back to my office, I know I need to push more to get this patient to theatre. I call the third midwife because I know she is effective (and I have her phone number) and I re-emphasize the need to move this patient to theatre immediately. I can tell she gets the urgency this time.
In the clinic, I treat a patient who is still having bleeding after an illegal abortion. Just as I am finishing, another midwife comes by to show me the lab result of the bleeding patient. Her hemoglobin is 8.8, which is actually not that bad (for here). However, we don't trust it very much. The lab is sometimes unreliable and what's more, the patient is still actively bleeding, so by the time we are getting her to theatre, she will be lower.
She tells me that they have moved the patient to theatre. I walk over, and find the anesthetist preparing the materials for the cesarean. The patient is there. The anesthetist speaks basic Japadhola. As a formality, I ask him to ask her if she wants a tubal ligation. I ask almost as a reflex – because most of the time when I am doing a cesarean, the women have had a lot of children already. She says she wants one, but when I look at her chart, I realize that she is only 23 years old. She had given birth to 2 children, but only 1 is alive. I try to counsel her through the anesthetist, but his Japadhola is limited. She keeps insisting she wants me to cut the tubes, even if this baby dies.
Even in the US, this would give me pause. I would seriously try to discourage a 23-year-old from a tubal ligation. There is the problem of regret – she has at least 20 more years of potential fertility ahead of her, and she may change her mind in that time. Or she might end up with a different partner, and decide she wants children with that person. Or she might just want the option of fertility, even if she doesn't ever have another child.
But here, it's even more concerning. Fertility is paramount. A woman who can't/doesn't produce many children is considered inferior. Of course, maybe she doesn't care. Maybe she genuinely doesn't want more children, and I can't blame her for that. But what if her husband leaves her for that reason, or beats her, or takes another wife? Can she support herself?
I tell the anesthetist to ask her husband. In my opinion, I don't need his permission to do it, but I am thinking that if they discuss it together, maybe he will get her to realize what she is asking for. The husband answers that he doesn't want her to have a tubal ligation. As I am trying to get the anesthetist to have the husband discuss it with the patient, the patient again calls out that she definitely wants the tubal ligation. The husband changes his mind. "Do what she wants," he tells the anesthetist.
Aargh. Even more confusing. Does that mean he's just scared right now, but later he'll leave her when she can't have any more children? Or does he really agree?
The anesthetist encourages me to do it. His argument is that in the next pregnancy, she could have another antepartum hemorrhage, but she will be in the village and will not be able to get a cesarean, and she will die. Infertile is better than dead.
The scrub tech agrees, although he is more timid about his opinion.
I open the sutures I will need for a tubal ligation. I am feeling really nervous about this. Should I do it? Should I not?
We move the patient onto the operating table from the stretcher. I realize that perhaps I can convince her to accept an IUD – I can even put one in during the c-section. I know that there is cultural resistance to IUDs, though, and convincing someone to accept one takes good translation and good counseling, neither of which I can give her right now. I tell the scrub tech, who can also speak Japadhola, to offer an IUD. She answers tersely. "She wants you to cut her tubes," he translates.
Sigh. What to do?
A midwife arrives. I tell her the situation. She immediately offers her opinion.
"Don't cut her tubes! In Africa, we women must have children. She has only one, if she can't have more, he will leave her. She is just saying that now because she is in pain, but she doesn't know what she wants. If you do it, then she will wake up, and she will realize she didn't want it. She is just scared now. Don't do it."
Oh nooooo, what do I do? The anesthetist makes his point again. The midwife makes her point again. Both, I have to admit, are good points.
The worst part about this, for me, is that either way is completely paternalistic. In medical school and residency, there is a huge effort to emphasize patient autonomy. Patients should always be aware of and agree to the course of action. If a patient is making a bad decision, you sit down and discuss it with them. Of course you can decline to do things that are medically unsound (for example, I would decline to do a elective cesarean section with no medical basis, but I would refer the patient to someone who was willing if she wanted.)
Even in a situation like this, with a 23 year old wanting a tubal ligation, I would probably refuse to do it (except under very special circumstances), but I would have a long discussion with the patient. I would explain my concerns. I would explain the risk of regret, the risks of the procedure, the fact that there are alternatives that are just as effective and that are reversible. I would never, ever just make a decision and not explain it to the patient as much as possible beforehand.
But here I have no choice. I don't have adequate translation. I don't have people who understand how to counsel for contraception. I don't even have an emotional connection with the patient – she won't make eye contact with me. I am cursing myself for even offering a stupid tubal ligation. Why didn't I look at her chart first?
I try to get the midwife to talk the patient into an IUD, but the midwife doesn't speak Japadhola. The midwife encourages me to just do the IUD. She goes over to the family planning clinic to get one. The scrub tech tries to convince her again.
While he is talking, I look at the blood pressure monitor and realize that her blood pressure is 60/40. Holy shit. I'm here hemming and hawing over contraception, and she's bleeding to death. What am I doing?
I race over to the sink to scrub. Just as the anesthetist has put her to sleep, the midwife arrives with the IUD. I tell her to open it.
"It is the right thing, doctor," the midwife encourages me. "She can remove it later if she wants."
I'm still not sure, but I can't think about it right now because I'm thinking about her bleeding previa and how it took us an hour and a half to get her to the OR.
When I reach her uterus, it is small (she is 36 weeks pregnant), but there is enough space between her uterine arteries to make the normal, horizontal incision on the uterus. Because of the placenta previa, I consider for one second doing a classical (vertical) incision, but I decide that there is no indication. I can deliver the infant through the horizontal incision, and if she ever gets pregnant again, it will be safer for her.
I cut, and luckily where I make my incision is just above the placenta. I can see it filling the lower uterine segment, still intact. The infant is breech, as expected. I need to pull out both legs to bring the hips out. I can reach the left leg, but I can't find the right. The hips are oriented strangely, the baby is curled up on itself in an odd position. I decide to bring the hips out first, but they won't move. The placenta has taken up a lot of space within the uterus, and it is really hard to move the baby around.
I try all of the maneuvers I learned in residency – I try to pull one foot out, hoping the second will come. It doesn't. I try to move the hips toward the incision. They are stuck. I reach my hand way in, and try to turn the baby so that I can deliver the head-first. It won't move. I try to extend my uterine incision. The scissors are dull and it's difficult, but it doesn't help anyway.
At this point, I start to curse. It helps me focus. I kept trying the maneuvers, but it becomes clear that they are not going to work. It has now been several minutes. Given the severe hemorrhage from the placenta previa, this baby might have already been compromised. It won't tolerate much longer inside the uterus like this.
I know what I need to do, but I am really unhappy that I need to do it. I decide to T the incision. That means that rather than extending the sides horizontally (which runs the risk of cutting into the uterine arteries), I will cut upward from the center of the incision into the thick muscular uterine tissue. It forms an upside-down T on the uterus.
This is never good. Making a T-incision means that the point where the 2 lines meet will always be a weak point. Because of that weak point, and because a vertical incision on the uterus is much weaker than a horizontal one, the patient can never try to labor in the future because the risk of uterine rupture is too high. We always have to counsel such patients strongly that they must not try to labor, and they will require a planned cesarean delivery before going into labor.
The problem is that this is a poor patient who lives in some village somewhere. Will she be able to make it to a planned cesarean in advance of labor? If she does go into labor, will she be able to come emergently from her village to the hospital? Will she be able to communicate to her providers then that she requires a cesarean, and why? Will she even make it for antenatal care at all in the next pregnancy?
Well, I can't worry about that now because her baby is going to die if I don't get it out soon. I grab the dull scissors, protect the baby's body, and cut vertically.
Finally, I can grab the right leg and pull it out. I deliver the infant breech. The baby is alive, but very weak. I pass her to the midwife, and turn back to the patient.
The uterus looks terrible. The T-incision is never pretty, but the horizontal portion has extended due to my multiple attempts to deliver the baby, and it looks almost as if the uterus is partially amputated from the cervix, with only the posterior portion attached. Miraculously, the uterine vessels are intact. This is going to be a difficult repair. I briefly consider doing a cesarean hysterectomy, but that seems crazy since I just spent so much energy trying not to have to tie her tubes.
I look at the blood pressure monitor. Her blood pressure, which had improved to 70/40 with some fluid before the surgery, is now 58/28. Good grief. I tell the anesthetist, but he is helping the midwife resuscitate the infant, who is also looking crappy.
I can't decide if I should insist that he attend to the patient immediately, or keep helping the infant.
Just then, the power goes out. Fan*$%@#tastic.
I have no choice, I have to sew now or she will bleed to death. I can see just enough from the natural light coming in through the windows. It will have to do. I stitch as fast as possible, but I have to be careful to avoid the engorged blood vessels nearby, and to re-approximate the extensive uterine incision. I have to close the vertical portion and the horizontal portion separately. All the while, I am looking at the patient's blood pressure.
I ask the anesthetist to check the patient's heart rate. He puts a finger on her wrist and tells me "The pulse is there." I wasn't asking to see if she was alive, although the thought that we even need to is rather frightening.
I ask the anesthetist to put in a second IV in order to run in more fluid while we call for blood. Fluid resuscitation can maintain her temporarily, although she will need the blood to survive.
It is difficult to put in a second IV. We can't put it in her other arm because that is where the blood pressure cuff is attached. There is lots of wandering around and delay without putting in the IV, and I am focused on stopping the bleeding and getting the patient's abdomen closed, so I don't notice for a while. General anesthesia could also be artificially lowering her blood pressure, so the sooner I can get her finished and out from under anesthesia, the better.
Once I am suturing the skin, I can stop and ask again. I can see that no second IV has been placed. "There are no giving sets," I am told. Without the IV tubing to attach fluid, there is no point in putting in the IV needle. Sigh. I ask them to run the fluid as fast as possible, and recheck the blood pressure. I will put in the second IV after I finish.
When we are finally done with the surgery, I write the operative note, change out of my scrubs, and head to the Labor Ward to discuss this patient with the midwife in person. It is now evening, and the evening midwife is usually on alone, which means that she doesn't have time for the delivered patients because she has to worry more about the laboring ones. But this one needs urgent attention.
When I reach the Labor Ward, I am happy to see one of my favorite midwives, H, who is very hardworking and always greets me with a broad smile. She is already with my patient, receiving her on the postnatal ward. I tell her about the antepartum hemorrhage, the surgery, about the T-incision, the low blood pressure. I see that the blood is already hanging – the anesthetist must have drawn the blood for crossmatching and requested the blood while we were in theatre. But it seems that the giving set is faulty, and we cannot see whether the blood is running into the tubing or not. The midwife and I try to adjust it, but it doesn't work. If it is not running, it could sit there all night and the patient will get no blood. She dashes off to find fresh IV tubing somewhere. I am glad this midwife is on – she gets things done.
The patient's husband is there, kneeling at her bedside and holding her hand as if he is holding onto her life. Her mother is on the other side of the bed, holding the patient's other hand. They are both staring intently at her as if something might happen. They are terrified. I try to reassure them, but I know that this is not the time to talk about details like IUDs and T-incisions. I tell them to watch the blood carefully and make sure it all goes in tonight.
The next day, I go to see the patient. I am relieved to see her alive, but she still look weak and sick. I take her pulse, and it is elevated. (The baby, luckily, looks fine.) I look at the patient's conjunctivae – the inside of her lower eyelid – to check for anemia. If someone is not anemic, the conjunctivae are pink and have visible tiny red blood vessels coursing through. Someone who is slightly anemic might have conjunctivae that are a lighter shade of pink. If someone is extremely anemic, the conjunctivae are deathly white. This patient's conjunctivae are very, very white.
Not all patients need a transfusion at the same hemoglobin level. The most important factor in whether or not to transfuse is how she is feeling. This patient is weak and has a high heart rate, which means she is not tolerating the anemia well. Just to make sure that these symptoms are, in fact, from anemia and not infection, I ask the midwife to draw a sample of blood to check the hemoglobin level.
In the US, the minimum level of hemoglobin that we generally tolerate without recommending transfusion (regardless of symptoms) is around 7. Americans are not typically very anemic, because our nutrition is so much better. Even patients who are considered to have "severe" anemia in the US are pretty much average here. Depending on the circumstances, someone with a hemoglobin of 5 may or may not require transfusion, and the level needs to get to 4 or lower to be really compelling.
My patient's hemoglobin, after the single unit that was transfused postoperatively, was 3.2. A level that low would kill most Americans. I can only imagine what it was during the surgery. I go back to the ward to ask the midwife to crossmatch her for more blood and transfuse another unit. The midwife I encounter is not the most motivated person, and she doesn't really move when I tell her. It is mid-afternoon and the evening person will be arriving in an hour or so. This midwife tends to slow down around this time and let the evening person take care of it. I have the feeling it won't get done, so I make a mental note to come back.
When I return in late afternoon, the same evening midwife is on, who had transfused the blood the day before. Before I say anything, I see she is already heading toward the patient with a syringe and needle to draw blood for crossmatching.
An hour later, I run into her on the hospital grounds. "Doctor," she says, "the lab has refused to give the blood. They have said that the hemoglobin level is 5.3, and it is too high for transfusion."
You have got to be kidding me. This woman just bled out 90% of her blood volume and underwent surgery yesterday. Not needed?? Obtaining accurate hemoglobin levels is difficult because the tube that the blood is collected in has an anticoagulant, which can sometimes affect the hemoglobin reading. So it's hard to know whether our lab was correct or theirs was. But regardless, the patient is clearly symptomatic and nees blood. Unfortunately, it is now 6pm and the blood bank is closed for the night. The patient will have to make it through the night. I instruct the midwife to give more fluid as needed and to watch her closely.
The next day, I am relieved to see her looking better. The blood bank won't budge on giving the blood, but her heart rate is improving, and she looks less weak. I encourage her to start eating food and sitting up.
Her recovery is slower than most, but she progressively improves each day, and is out of bed relatively rapidly. One day I come to her bedside to find her sitting up and smiling. Every time I operate on a patient here, I know they have turned the corner when the smile reappears.
Now I need to explain to her about the T-incision and the IUD. I had already briefly mentioned to the husband before that I didn't cut the tubes, and he looked stricken and said "But I told you to cut them." The patient was still weak at the time, so I felt it would be better to talk about it once she had improved.
Now I need a translator in order to talk to her. The midwife comes over to translate, but she doesn't speak Japadhola. The midwife brings over another patient from a neighboring bed who does speak the language. I speak to the midwife in English, who translates into Luganda, and then the neighbor-patient translates into Japadhola. Yes, these are optimal circumstances under which to discuss life-threatening hemorrhage and family planning options.
I start to explain, and, as usual, there is a lot of back-and-forth before anything is translated back into English for me. At this point, I have realized that when people translate for me here, they are not just language translators, but cultural translators as well. If they were to translate what I say word-for-word, it would still be an awkward and highly unnatural conversation because the way that I think and express myself is so foreign. As long as the translator knows what needs to be communicated, I give them leeway.
I get enough translated to understand that the patient still feels that she does not want more children, especially because she almost died this time. That's good. Now I need to explain the IUD. I need to tell her that it is as effective as cutting the tubes, and that if she doesn't want more children, she can leave it in place. But because I put it in without asking her, I feel that I need to express to her that she has every right to have it removed, and I will do it myself if she wants. The midwife responds to me (before translating) that the patient should leave it in so she doesn't get pregnant. I tell the midwife that I agree, but I want the patient to have options, because I didn't give her any when I did the surgery.
The midwife understands and explains this to the patient. It sounds like it is going well, when a patient from another bed (who I did a cesarean on the day before this patient) chimes in. She seems to be giving strong words of advice to the patient in Japadhola. Then other people in the ward also shout in comments. I ask the midwife what they are saying. She explains that they are all advising her to keep the IUD in, and they are telling her their own life-threatening birth experiences and how dangerous it is, and how she should accept the family planning so she doesn't die.
I chuckle a little because this situation is the opposite of what I had been taught to do. No privacy, people shouting random advice about their own experience, a telephone-game of translation, and a sullen patient. But then, she seems to be coming around to the advice, and she finally agrees that she will keep the IUD in for now, and that if they ever decide to have another child, she knows she can remove it later. I am still uncomfortable about the lack of privacy, but who am I to say that my culture's counseling methods should be imposed here? Sometimes I just need to go with the flow and hope it all works out for the better.
The patient steadily recovers, and the baby does well. The husband seems content, and finally she is ready to go home. This patient was the closest I have come to having someone die under my care in Uganda, and she survived by a hair. I hope she keeps that IUD in.
4 comments:
You're doing amazing work. And the way you capture it here is fantastic.
I spread the word a bit on this blog if you don't mind and am looking forward to more updates.
I'm rooting for you.
- July 14, 2010 at 11:20 AM
- Lara said...
God, it's unbelievable how many steps in the process fall apart... I can just picture the scenario you describe. I assume all the time the anesthetist was resuscitating the newborn, no one was manually ventilating the pt? That was the weirdest experience, realizing that the 'pulse' in the 60s was actually an O2 sat! I'm impressed you've stuck it out so long - it's draining over time. Take care and say hi to everyone for me. Best, Lara
- July 16, 2010 at 5:44 PM
- aaaapquik said...
- This comment has been removed by the author.
- August 4, 2010 at 3:32 PM
- Chris said...
I'm so impressed you do all of this and then have the wherewithal to write it so clearly and compellingly. This is some of the best perspective I've gotten on another culture, and I imagine it's just a piece of what it's really like. Thank you so much for sharing this.
-Chris R.
- August 4, 2010 at 3:55 PM


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(760) 520-8200
Below is the volunteer information for NEIGHBORHOOD HEALTHCARE - GRAND AVENUE.Contact Name: Ruth Manzano
Volunteer Phone: (760) 520-8324
Volunteer URL: http://www.nhcare.org/careers-internships-and-volunteer-opportunities/volunteer-positions
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subset: commoncrawl


text:
parametric design project olympic games information pavillon | london _great britain
competition brief of the AC-CA: 'the olympic games sees the biggest and most prestigious sporting event in the world being staged for an unprecedented third time in london next year, thus making london the first city in the world to host the modern summer games for a third time. london is the largest urban zone in the european union with a cosmopolitan population of over 7.7 million residence. the london games is being eagerly anticipated by millions of sporting fans around the world. the games, which officially kicks off on the 27th july 2012 will see the arrival of the world's top athletes and their team officials representing their various participating nations, international dignitar- ies, the games officials and not to mention millions of supporters and fans.
the aim of this competition is to design a temporary, free standing information pavillon within the world famous trafalgar square in the heart of london during the 2012 games.the competition hopes to achieve the following:
1. encourage and reward design excellence at a small scale which integrates function, structure, details and the spirit of the games.
2. research, respond to and highlight the unique aspects of designing an information pavilion that will be used by visitors during the games.
3. encourage the employment of sustainable design in all aspects of the proposal.'
design concept column meets canopy: the project's goal is to get a sheltered but open and extremely communicative urban space. the semipermeable glazed wooden roof generates a permanent atmospheric change of light and shadow. the formal dialog with the nelson column, dominating the trafalgar square, transforms the theme of 'needle and globe', to be seen at the 'new york world's fair 1939'. two fundamental spatial protoypes are temporarily inspiring the site.
designed by _matthias karch


text:
A deadlock describes the scenario where two or more threads are mutually blocking each other. Each waits for the other to release its lock which will never happen as no thread can perform any action. Consider the following figure for illustration this. Thread #1 holds locks a, b and c and waits for lock d. Thread #2 holds locks d and e and waits for lock b. As lock d is owner by Thread #2, Thread #1 can not continue before Thread #2 releases it. Now Thread #2 waits for lock b which is turn is owner by Thread #1.
Neither thread will ever be able to release any locks as both executions are blocked: the whole scene is dead!
Theoretically, deadlock detection is pretty simple. First you have threads that own locks, then you have threads that wait for locks to acquire. Now you can think of a directed graph where you have threads and locks being nodes and each lock ownership and lock wait is a vertex that connects those nodes. When you have a cycle in that graph, i.e. when you can traverse the (directed!) graph starting from a certain node and you can reach that node again, you have a deadlock. This means a thread waits for itself to release a lock to finally acquire a desired lock. Obviously, this will never happen without taking additional actions from the outside. Such an action could be to release the block for one thread telling it that there was a deadlock and the thread shall resolve it now it is able to perform actions.
This can be illustrated with the above figure. Traversing the graph starting from Thread #1 going over lock b, Thread #2, lock d and finally Thread #1 (again) reveals the cycle and thus the deadlock. Note that of course you could just as well have started with Thread #2 and would have revealed the same cycle.
In case of commons transaction things are a bit more complicated as a lock can have multiple (compatible) threads or better to say owners - lock ownership is not directly tied to the thread accessing the lock, but to an Object called owner. It can well be possible that an owner can both (partially) own a lock and wait for it as well. This may sound confusing, but actually becomes pretty obvious when you look at this example. There is a read/write lock and both owner #1 and #2 hold a read lock which of course is compatible. Now when owner #1 ties to acquire a write lock it will have to wait for owner #2 to release its read lock. In such a case owner #1 both (partially) holds the lock and waits for it as illustrated by the following figure.
The above algorithm would detect a deadlock. This of course is not there as owner #1 is blocked, but owner #2 is not and may finally release the read lock. This means the scenario is not dead.
Obviously, the wait set of the lock is the problem. The graph does not tell us why owner #1 is waiting. In fact it does not wait for owner #1, but only for owner #2. Lookig at the next figure we see this. Both owners only own part of the lock and owner #1 is waiting for that part of the lock that owner #2 owns.
Thus the algorithm has to be modified in such a way that only the real conflicting parts of the locks are taken into consideration.
This algorithm checks if the given owner is part of a deadlock. by traversing all paths of the lock/owner depedency graph as described above. The graph is directed, so it is clear in which direction we are traversing it. Please note that no physical graph is constructed, but is implicite in the code and the stack structure.
1 : protected boolean wouldDeadlock(Object ownerId, Set path) { 2 : path.add(ownerId); 3 : Set locks = (Set) globalOwners.get(ownerId); 4 : for (Iterator i = locks.iterator(); i.hasNext();) { 5 : GenericLock mylock = (GenericLock) i.next(); 6 : Collection conflicts = mylock.getConflictingWaiters(ownerId); 7 : for (Iterator j = conflicts.iterator(); j.hasNext();) { 8 : Object waitingOwnerId = j.next(); 9 : if (path.contains(waitingOwnerId)) { 10: return true; 11: } else if (wouldDeadlock(waitingOwnerId, path)) { 12: return true; 13: } 14: } 15: } 16: path.remove(ownerId); 17: return false; 18: }
In lines 3-5 it inspects all locks it (partially) holds and finds the owners that are currently waiting for given owner. As explained above lines 6-8 GenericLock#getConflictingWaiters does not traverse all owners waiting for the lock, but only those that are waiting for the part of the lock acquired by the given owner. Those owners will need investigation if the current owner - or anyone else waiting for it - is also waiting for them. If so we have a deadlock.
Both to guarantee termination and actually find out if there is such a cycle indicating a deadlock in the graph lines 2 and 16 we remember the owners of all paths we traverse. As the sequence is not important we store them in a set for fast access. In lines 9-10 we check if the owner already is in our path and if so we have been here before which means there is a cycle in the graph and we thus have a deadlock. If not, in lines 11-12 we recursively repeat the check for each owner that waits for us. As the graph is directed and finite this algorithm either terminates with false in line 17 or there is a cycle in it which will be detected as explained above and will lead to a termination with true. You can see that in both cases the algorithm terminates.


text:
Transform your photos into one-of-a-kind, hand painted masterpieces!
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by Tanja Ware
The more you buy... the more you save.
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Mim Eisenberg
August 13th, 2018
Kat Strickland
August 13th, 2018
Hello! My name is Tanja Ware and I have been an artist, in one way or another, for most of my life. I was thirteen when my first illustration was printed and commissioned portraits provided extra money all through school. Next came a 23 year career as a commercial illustratior/graphic designer. After an early retirement, I decided to try my hand at fine arts. Currently I am working in oil, watercolor & pastels with pastels being my preferred medium. I work in the realism style, although not photo realism. I am not an abstract painter, however, I do enjoy the abstractions that come with painting subjects realistically but in a close focus format or from unusual angles. I work in a variety of genres including still life, landscape,...
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Time is running out for Russian activists hoping to stop the construction of a highway through an old growth forest outside of Moscow. In an eleventh hour campaign, the Movement to Defend Khimki Forest is targeting the French company overseeing the controversial project. Vinci, one of Europe's largest corporations, signed the contract for the Moscow-St. Petersburg motorway in 2009 and could begin the first phase of development this month. The 43-kilometer section will slice through the heart of an old growth oak forest, an important corridor for large game and home to numerous endangered plant species, as well as a cherished greenbelt on the edge of one of the world's most polluted cities.
The campaign to save the forest has met with brutal reprisals from armed thugs and state security services. It has also been remarkably successful in rallying international attention as well as building broad based support within Russia (an overwhelming majority of Russians oppose the planned route). The activists are now calling on Vinci to withdraw in the hope that it will force a reappraisal of the project.
"We want to put pressure on Vinci because it is the only European company participating in the project," Yaroslav Nikitenko, one of the leaders of Defend Khimki, wrote in an email. "In contrast to the Russian government, Vinci has a reputation and it has shareholders who shape its policies. We want to show the world just what kind of project it is taking part in."
After a week of international actions and a petition on Change.org that generated more than 20,000 responses, Defend Khimki's leader Yevgenia Chirikova traveled to Paris herself to deliver the petition to Vinci at the company's annual shareholders meeting May 2. Until recently the company, which pulled in profits of more than $46 billion in 2010, has been conspicuously silent on the question of human rights abuses, corruption, and lack of transparency associated with the highway project, which is hailed as Russia's first public-private partnership in the area of road construction.
Since its inception the highway project has been marred by vicious attacks directed at journalists who have investigated the issue and the opposition movement. Activists have been repeatedly attacked, often by armed thugs, and arrested for simply demanding greater accountability. It is widely believed that the savage beating of journalist Mikhail Beketov in 2008 was tied to his reporting on the issue and his outspoken criticism of Khimki Mayor Vladimir Strelchenko.
In late March Bankwatch Network and Defend Khimki appealed to the United Nations Global Compact, to which Vinci is a signatory, asserting that the company has violated its commitment to human rights and the environment. Vinci finally responded last week in a letter to the Business and Human Rights Network condemning the use of violence and denying any link whatsoever between the project and the attacks that have occurred.
"They are partly washing their hands of it and partly ignoring the whole thing completely," says Pippa Gallop of Bankwatch, an NGO active in the campaign. "There is no evidence to link Vinci directly to the violence, that's for sure. But we see them as a beneficiary of this violence. To deny that there's any link at all between the whole project and violence that has occurred is pretty brave of them."


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Long you live and high you fly
Smiles you'll give and tears you'll cry
All you touch and all you see
Is all your life will ever be. -Pink Floyd
In part I of this series, we talked about a number of different ways — all using gravity — to measure the amount of matter in galaxies, clusters of galaxies, and the entire Universe. We got the same measurement no matter which method we used, finding out that 25-30% of the total energy of the Universe is in some type of matter. But, only about 0.5% of the total energy is in stars, which means that nearly all of this matter doesn't give off light! So what is the rest of this matter?
Well, one possibility could be that it's just normal matter like us: protons, neutrons, and electrons. After all, we are massive and we don't give off light! Maybe our Solar System — where over 99% of the mass is in the Sun — is a rarity? Or, as one commenter put it:
Why would it be surprising that there is mass in the universe that does not emit appreciable light? If that's all that's meant by 'dark matter', it seems obvious that it exists (Phobos and Pluto don't emit much light, for instance).
Well, as a cosmologist, there are a few tricks we can use to put this to the test. In fact, off the top of my head, I can think of four tests we can do to find out how much of this gravitational matter is made up of the conventional stuff: protons, neutrons, and electrons.
1.) Gas fraction of clusters. When we look at clusters of galaxies, many of them emit X-rays. The X-rays are created by hot, energetic gas at different temperatures throughout the clusters. From this information, we can deduce what percentage of the mass in a galaxy cluster comes from gas and dust, which is all normal matter. The answer — pretty much always — comes out to 13-15% for every cluster. This is much more than the 2% that's in stars, but still much less than the 100% total.
2.) Cosmological clustering of galaxies. Galaxies and clusters group together due to gravity, but the way they group together is highly dependent on what they're made out of. You make everything out of normal matter (what's called baryons by physicists), and things group together differently than if they're made out of dark matter. In this graph from one of my favorite cosmology textbooks, you can see the drastic difference between a Universe made up of normal matter (with the baryons label) and a Universe made up of either Hot Dark Matter (HDM), Cold Dark Matter (CDM), or a mixture of these (MDM):
What do we actually observe? Something that matches up very well with the CDM graph, but actually has some small, tiny wiggles in it. Altogether, we can draw the conclusion that the mass in the Universe is about one-sixth baryons and about five-sixths Cold Dark Matter.
3.) Nucleosynthesis. This is my favorite method of discriminating between baryons and "other" matter, perhaps because it's been around the longest. It's also one of the simplest. In the very early Universe, things are hot and dense enough that nuclei haven't formed yet; everything is just a bath of free photons, protons, neutrons, and electrons. When the Universe cools enough, however, protons and neutrons come together to form Deuterium, Helium, and Lithium. How much of these elements will be formed? That is highly dependent on how much normal matter (i.e., baryons) is in the Universe. In fact, that's pretty much all it depends on. We do our measurements, and then our calculations, and we find that no more than about 4-5% of the total energy in the Universe can be baryons, otherwise the abundances of these elements would be off by too much.
4.) The Cosmic Microwave Background. These tiny little temperature fluctuations — just a few millionths of a degree — can tell us an incredible amount about what's in the Universe. You can generate for yourself (using CMBfast) what these temperature fluctuations would look like in a Universe filled with 25-30% baryons as the matter in the Universe, and what it would look like with 4-5% baryons and the rest of the matter being something else. The differences are here, and they leave no doubt: the matter we're looking for cannot all be baryons.
So you can pick any one of these observations, or you can (like me) listen to all four. Any way you slice it, all of this matter can not be made up of the normal stuff we know and love. So, you would conclude, this means that there's some new type of matter out there, exerting its gravity but not emitting any light.
But all of these observations are based on an assumption: that we've got the right theory of gravity. Do we really? Or is it possible to tweak gravity to explain these observations without introducing a new type of matter? You'll have to come back for part 3 to find out.


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Out of the Blue
Eat Your Noodles Or Play With Them: An Amazing Stop Motion Video
By FDL on
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What could happen in a bowl of noodles? Director Tyler Nicolson answers with No Noodles, a fun and short stop motion film about noodles: small creatures explore and inhabit an even smaller world.
For all you kids out there watching, this is an exception to the rule of no playing with your food.


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Mexican Authorities Rescue 458 Children From Refuge, Believed To Have Been Sexually Abused
Mexican authorities raided a home in the western state of Michoacan and rescued 458 children who were found to be living in filthy conditions and are believed to have been forced to beg for money while some allegedly also suffered sexual abuse, local officials announced Tuesday.
The home known as "La Gran Familia," or "The Big Family," in the western city of Zamora, provided refuge to 278 boys, 174 girls and six infants as young as three years old, Reuters reported, adding that authorities searched the home after receiving at least 50 complaints about its operators. Mexican police also rescued 138 adults from the facility.
"I'm in utter dismay because we weren't expecting the conditions we found at the group home," Associated Press, or AP, quoted Salvador Jara, Michoacan's governor, as saying.
According to an attorney general, the residents of the home were kept in terrible conditions, AP reported, adding that the operators allegedly gave the inmates rotten food and made them sleep on the floor among rats, ticks and fleas, and confined some of them to the premises.
Rosa Verduzco, the home's owner, and eight employees accused of keeping children in the refuge against their will, have reportedly been arrested.
According to La Gran Familia's Facebook page, the refuge was founded in 1947 and cares for children abandoned by troubled parents, reports said.
The refuge is funded by charitable donations, as well as companies and the government, Reuters reported, adding that the rescued children are being treated for psychological and sexual abuse, while authorities are searching for suitable homes for the victims.


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Standing on the steps of Constitution Hall, holding a sign reading, "MLK is smiling today" was Medina Thiam, 30, who came all the way from Guinea for the historic event.
She is not an American but was holding an American flag.
"It's for the world," she said of the day.
People descended on the Mall outfitted like they were on an expedition to Kathmandu.
When they arrived, a few sat down, as if on a winter picnic.
Charlotte Durante, 64, from Delray Beach, Fla., stepped across the soft ground of the Mall with a walker. She remembers being in Montgomery, Ala., in 1965 when civil rights marchers made it from Selma to Montgomery.


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It is one of the underappreciated advantages of the digital age that when certain prominent people pass away, we need not be held captive to amnesiac, white-washing eulogies. So while President Obama lauds the late Margaret Thatcher as "one of the great champions of freedom and liberty," it only takes a quick spin through The Nation's archives to recall the magazine's running critique of Thatcher and her ideology and, more generally, the great complexities in the folds of history now being steamed away.
In 1980, before his move to the United States and to The Nation, Christopher Hitchens profiled life in his native Britain—scornfully dubbed "Maggie's Farm"—after "one calendar year of neoconservative governance." Following the economic and social policies of Milton Friedman and Friedrich von Hayek, Thatcher and her fellow Conservatives had begun to tear up the fabric of British life they claimed to be protecting: prices skyrocketed, services were drastically cut, and the rich received massive tax cuts, all in the name of restoring national greatness. "There are no reliable reports on whether or not this enhanced national pride has made the unemployed feel any better," Hitchens quipped. "Nothing concentrates the mind like a little poverty," as Hitchens quotes one Conservative official saying.
In February 1985, New Statesman reporter Jane Dibblin wrote about the British miners' strike, then approaching its one-year anniversary, which was perceived by many, including Thatcher herself, as the ultimate battle between the forces of austerity and the forces of resistance in Britain. Thatcher boasted of having already defeated the "enemy without," in the Falklands War, and was now going after the "enemy within," the miners. The strike cost the British government $123 million per week, but as Dibblin noted, that price was seen by Thatcher and her allies as "a worthwhile political investment." When the miners voted to end their strike just one month later, The Nation editorialized that Thatcher had shown yet again that "her policies can only sharpen divisions, not heal them"—though the hope that her popularity was "finally waning" proved five years premature.
In 1989, Daniel Singer, the magazine's longtime Europe correspondent, wrote about France's preparations for celebrating the bicentennial of its 1789 revolution. He noted that Francois Mitterand would play host to the newly-elected President George Bush, Margaret Thatcher, and German chancellor Helmut Kohl—"a party that appears more suited to honor Marie Antoinette than commemorate the storming of the Bastille." Singer wrote that these politicians and their neoconservative/neoliberal intellectual counterparts, "preach the 'end of ideology,'" yet "positively ooze their own brand of it."


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Quick Reference
A tactile illusion, discovered in 1972 by the US psychologist Frank A. Geldard (1904–84), that occurs if the forearm or other area of the body is given a light tap, then a second and third tap are delivered in quick succession (about one-tenth of a second apart), the second tap in the same spot as the first and the third a few centimetres away. The effect is that the second tap is felt very distinctly to have occurred at a point somewhere between the first and the third taps. Saltatory areas within which the phenomenon occurs differ in size and shape in different parts of the body, but they never cross the midsagittal plane of the body, and within these areas saltation is experienced even if the area of skin between the taps is anaesthetized, showing that the illusion arises not in the skin but at a higher level of the sensory system. Also called cutaneous rabbit illusion, saltation. [From Latin saltus a leap, from saltare to dance + -ation indicating a process or condition]
Subjects: Psychology.
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CRA Engage is an online engagement tool created to help Canadians provide feedback on various Canada Revenue Agency programs, policies and initiatives.
Your feedback is important to us and will help us make decisions that are informed and reflective of your needs and concerns.
In order to participate in the conversation, you must register for an account using a valid email address.
Please note, comments will be reviewed prior to showing on the site. All comments that do not violate the Terms of Use and Privacy Notice will be posted. Review will take place Monday to Friday from 8:00 am to 6:00 pm Eastern Standard Time.
July 2016 - Launch of the online component of the CRA's Serving You Better consultations with small businesses
July 2016 - Launch of the CRA Engage website


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* Processed food market increasingly complex
* Consumers worried about little-regulated industry
* Britain: "This is a conspiracy"
* Lawmaker calls for ban on meat imports from EU
* Processed food market increasingly complex
* Consumers worried about little-regulated industry
* Britain: "This is a conspiracy"
* Lawmaker calls for ban on meat imports from EU
By Tim Castle and Maria Golovnina
LONDON, Feb 10 (Reuters) - As Britons choke on discovering
they may have eaten horse that was imported as beef, and
ministers blame an "international criminal conspiracy", this new
scandal has exposed the sometimes murky labyrinth by which food
reaches Europe's dinner tables.
Lurid headlines reveal a culinary gulf between distaste for
the notion of horsemeat in Britain and its status as a delicacy
elsewhere in Europe. But as governments play down the health
risks, a greater impact may stem from a shattering of public
confidence in EU systems of labelling and quality control
introduced after previous threats hit the human food chain.
As details emerge of a complex network of slaughterhouses
and middlemen standing between the farm and the supermarkets
across Europe, France and Britain have vowed to punish those
found responsible for selling horsemeat purporting to be beef.
With DNA tests needed to tell the two kinds of flesh apart,
retailers and makers of processed meals complain of being duped
by suppliers; one French firm has pointed a finger at Romania.
"This is a conspiracy against the public," said British farm
minister Owen Paterson. "I've got an increasing feeling that it
is actually a case of an international criminal conspiracy."
Prime Minister David Cameron has called it "very shocking".
Adding to concerns are indications that some horsemeat,
perfectly edible in itself, may contain a drug known as bute - a
common, anti-inflammatory painkiller for sporting horses but
banned for animals intended for eventual human consumption.
Britain's Food Standards Agency said it was checking whether
horse carcasses exported from Britain contained phenylbutazone.
It said five such animals were sold abroad last year and it had
told foreign agencies. French media said the horses went there.
One firm hit by the British horsemeat scandal, frozen foods
group Findus, said it was recalling its beef lasagne product
after discovering they included horsemeat. Its French supplier,
Comigel, said the questionable meat came from EU member Romania.
An EU-wide alert has been sent out and governments debated
how to bring the increasingly complex industry under control.
Food experts say globalisation has brought benefits to food
supply, with exotic items now available from around the world
all year round, but it has also created a system that is so
complex it has increased the risks of adulteration, whether by
design, to use cheaper inputs, or through neglect of standards.
The "mad cow" crisis, which saw British beef banned in the
EU in the 1990s over fears of a degenerative brain disease, left
a legacy of tight controls on the identity of European animals,
intended to ensure the origins of fresh meat are traceable.
But in meat minced into processed product, while hygiene
checks are the norm, testing for something as seemingly basic as
which species it came from is complex and not widely undertaken.
Mystery over the contents of a sausage is far from new, but
mass production means any problem can escalate rapidly:
"Food adulteration has been going on for as long as it has
been prepared, for thousands of years," said Chris Elliot, a
professor working on food safety at Queen's University Belfast.
"We are at the stage now where whenever this adulteration
happens, it tends to happen on a very large scale, extremely
well organised."
Doubts over quality controls in processed food could damage
sales across Europe, but the greatest impact of this scandal may
be in Britain, where assurances that horsemeat is safe have done
little to lessen the disgust felt by many, or suspicions that it
reflects another unpopular aspect of membership of the EU bloc.
One leading British lawmaker called for a ban on EU imports.
"Nabbed, stabbed and beaten: wild horses to go in our beef,"
ran the headline on Sunday's mass-selling Sun newspaper over a
story alleging cruelty to horses to be slaughtered in Romania.
From Queen Elizabeth downwards, Britons cast themselves as a
nation of horse lovers, treating sporting thoroughbreds with no
less reverence than human athletes and viewing the species as
whole with an affection rivaled only by that for the family dog.
There are only a handful of licensed horse abattoirs in
Britain, and these mostly export carcasses to the continent,
where Italy leads consumption tables with an unsentimental taste
for both horse and donkey; horsemeat also has a niche in the
cuisine of France and of many other European nations.
At a Sunday market in north London, where shoppers strolled
among rain-soaked stalls selling vegetables, sausage and cheeses
direct from the small farms that produce them, many said they
would buy fewer frozen ready-meals after the revelations.


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When Oprah Met Cormac
He's no Salinger.
Did you catch the Onion-quality headline under which the New York Times ran a Celia Dugger story on Bono's debt-relief advocacy? May 15, 2007: "Rock Star Still Hasn't Found the African Aid He's Looking For." Yeah, well, Bono put on his Bono specs and went on The Oprah Winfrey Show yesterday to speak with America's eternal angel. He followed Michael Moore, who had donned a pair of eyeglasses perhaps a touch too narrow for his face to promote Sicko, his forthcoming indictment of the U.S. health-care system. But these two slick activists were the mere undercard for the media naif at the centerpiece of the episode, Cormac McCarthy.
Did you know that McCarthy—whose most recent novel, The Road, is Oprah's most recent book-club selection—had never done TV before? Oprah did, as evidenced by her proud boasts that she had scored "an interview that people thought would be impossible to get" and "his first television interview ever" and, my favorite, "his first television interview ev-ah!" The segment promised to be a bit like a prophet coming down from the mountain and a bit like Bill Gray, the literary recluse in Don DeLillo's Mao II, consenting to have his soul snatched by that Swedish photographer. In fact, it was a bit like your shy-ish grandpa acting gracious with the whippersnappers at a birthday brunch and a bit like Dylan coming out of hiding after his alleged motorcycle crash: He, too, must move units.
Oprah played an embarrassing short film inspired by the novel (about a father-son trek through the post-apocalypse) that even featured shots of singed pages of its text—a sight that called to mind the elementary-school assignment in which you reproduce the, like, Magna Carta on typing paper and steep the sheet in tea and have your mom take a kitchen match to its edges. Then the proper interview began. It proved to be absurd, of course, but not quite so much as one might hope. Oprah wore a sky-blue V-neck and lipstick of a fuchsia shade perhaps deliberately de trop. One rather hoped that her guest—the maestro of high-literary horse operas and a man whose last really good book was Blood Meridian—would show up for their Santa Fe rendezvous looking like so much tumbleweed. Instead, he resembled J. Peterman's idea of a wise ol' ranch hand: bright blue work shirt, handsome chinos, and boots that I don't think I can afford. Cormac—may I call you Cormac, now?—slumped tolerantly in his deep leather chair, hand on head.
Oprah asked questions, many of them not stupid, and she slipped into her pretentious Jessye Norman intonation when reminding her audience that the book had won the Pulitzer Prize. Stay-at-home moms from Roxbury to La Jolla doubtlessly went gaga for this; others of us were simply happy to be reminded of a fine line by William Gass: "The Pulitzer Prize in fiction takes dead aim at mediocrity and almost never misses."
Cormac crinkled and twinkled—avuncular, patient, not entirely unsassy. He spilled forth the twang and soft grit of his voice in a seducer's hush you wanted to lean into. If he ever abandons his skepticism about pursuing publicity—"I don't think it's good for your head," he told Oprah—he'd be a natural on CBS Sunday Morning. The byplay was flirty enough to put you in mind of those moments that pass, every evening around 7, over book-party chardonnay or publishing-course sherry: The gray eminence delivers patient answers to a dewy literary bud as if her questions—Do you write every day? Or just when inspiration strikes?—had never before nuzzled his hairy ears. She smiles understandingly and waits for a chance to call him out for blushing. "What do you want us to get from this book?" Oprah asked Cormac. "You should be thankful for what you have," he said, causing me to wonder if a collaboration with Mitch Albom is coming down the pike.
What do Bono and Michael Moore and Cormac McCarthy have in common in this context? Have they materialized in our family rooms so that we can do our part—for Africa, for health care, for Lit-ra-chur—without giving a dime or breaking a sweat? If Jerome David Salinger descended from his own private ashram in New Hampshire to greet Oprah with a hug, would she waste our time by asking questions about "identifying" with Franny Glass? What does she want us to get from this show?


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Of all the things I love about my job (and there are many many things I love about my job), our annual retreats have to be right up at the top of the list.
They're an oasis in time, not only for the attendees, but for us as well. Because something special happens when a
whole bunch of kindness of knitters come together: We let the rest of the world go, and soak up gorgeous surroundings, beautiful materials, and the inspiration of being around 80 other people who are our people.
We learn. We try new things and new ideas. I've felt privileged to be a part of that for the retreats we've run on the coast of Maine these past two years. At the same time, I understand that coastal Maine is just too far for some to travel, even for knitting.
So there was really only one thing for it: I knew we needed to add a retreat to our list in 2015, on the West Coast, in another beautiful coastal location I was lucky enough to call home, once: Pacific Grove, CA.
We hope you'll join us at the first make. wear. love retreat: west coast edition. It will be held on May 1 – 4, 2015, at the Asilomar State Beach and Conference Grounds.
The festivities will begin with dinner on Friday, followed by an evening welcome reception. The rest of your time will be a combination of traditional classes, intimate focus sessions, personal consultations, lectures, a curated marketplace… …and of course, quiet downtime to knit with friends old and new.
We're very lucky to have three special teachers joining me to be your knitting guides for the weekend:
(Fiona Ellis, Clara Parkes, and Stephanie Pearl-McPhee.)
Excited? We sure are. Stephanie, Fiona, and Clara represent an incredible powerhouse of knitting information and are wonderful teachers, all. (Not to mention the fact that they're awesome people, and fantastic to spend the weekend with!) Combined with an exciting – but not exhausting – curriculum in a stunning setting with tons of great yarn near at hand?
A heady thought, for sure. Get more specifics by downloading our brochure, and here's a quick timeline:
- Registration will open at 12pm Eastern on Monday, November 10. We'll link to a google form here on the blog. At that time, you'll need to give us basic information like your name and email, tell us which classes you'd most like to take, and tell us a little bit about your knitting skill level. (Are you a newsletter subscriber? Check your mail, because subscribers will receive advanced access to the sign-up form starting at 9am Eastern.)
- Attendance confirmation, class assignments, and schedule will be sent on Wednesday, November 19. A non-refundable deposit of $250 will be due at this time (we'll send you a Paypal invoice when we send your confirmation).
- In mid-January, we'll finalize the remaining details of your retreat weekend (including meal preferences and personal consults) – and start counting down the days to the beach bonfire!
We hope you can join us. We can't wait to pull up a chair in one of the most gorgeous places on earth, and dive into all things sweater.


text: Robert Kingswood Howe, 67, a retired manufacturer of industrial refrigeration, died Tuesday in his home in Maitland, Fla. Mr. Howe, a Chicago native, moved from Hoffman Estates to Florida in 1979. He was a Navy veteran of World War II and the Korean War. Survivors include his wife, Elaine; two sons, Steven P. and Scott W.; two sisters; and a brother. Services will be held at 10 a.m. Friday in the First Presbyterian Church in Maitland.


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Lipper has revised its weekly municipal bond fund flows lower for the week ending Nov. 21 after an error with Goldman Sachs led the company to report higher flows.
For the week ending Nov. 21, inflows into municipal bond funds that report weekly were $1.1 billion down from the originally reported $1.8 billion. The discrepancy came from the Goldman Sachs Short Duration Tax Free series funds. The A-class ticker GSDTX moved 70% of its assets into the I-share class ticker GSDUX and the inflows were recorded but the outflows were not. The GSDTX saw a drop in assets to $320 million from $1.1 billion while the GSDUX saw an increase in assets to $3.87 billion from $3.1 billion, Lipper analysts said Tuesday.
A share exchange in a large short term fund was reported as a $902 million inflow with no corresponding outflow from the fund shares being exchanged, wrote Chris Mauro at RBC Capital Markets. This accounting issue has been corrected and total muni fund inflows for the week now total $2.2 billion while outflows are reported at $1.15 billion for a net inflow total of $1.07 billion.
He added, We note that this is still a significant level of inflows for municipals and is the highest net inflow total since early August. Long term funds continue to draw significant investor interest, accounting for 60% of all municipal bond fund flows last week.
Indeed, long-term funds saw $642 million of inflows this week, bringing the year to date total to $23.6 billion, said Peter DeGroot at JPMorgan. High Yield funds saw $256 million of inflows, bringing the year to date inflows to $10 billion. Intermediate funds saw $82 million of inflows, recording $12 billion in inflows year to date.
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text: The Foundation believes the rising tide lifts all boats and therefore, believes a part of its mission is to build capacity with local nonprofits. With that in mind, RCF occasionally provides critical capacity building education to local nonprofits. As an example, RCF tries to provide an annual seminar on planned giving, marketing or fund-raising to help nonprofits advance their knowledge in these areas.


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Clinical Services Plan - Transforming our Health Services
Why should I be interested in the Clinical Service Plan?
If you live in Hawke's Bay, then you have a very important role in helping us to determine what our future health system should look like - what services will be delivered, how they will be delivered and where they will be delivered. Health affects everyone.
Why is the DHB undertaking this work now?
Future planning is important to sustain a growing population and a healthier Hawke's Bay. The results of this work will aid us to review our models of care and facilities we use to help us deliver services across the region both hospital and community. The Clinical Services Plan will help us to define what works well, what needs improvement and new opportunities to best meet our needs. Planning a ten year outlook on services for community, primary and hospital services is imperative for reducing inequity and ensuring we meet the basic and most comprehensive needs of our customers.
Does this just relate to hospital services?
No. This work has many touch points across sectors and affects the whole Hawke's Bay health system. General practice (doctor clinics) are the first part of the sector to contribute to the plan, as it is the place most people go to for health care assistance. Its an important step for the sector to understand through primary care, what our customer needs are and how we plan for these. This planning has a very strong focus on hearing the voice of both the customers and the providers of service.
Does this just affect clinicians?
No. Clinicians are just as keen to hear from the customer. Therefore a key part of this plan is gaining feedback from customers of health care, as well as the community at large. We all care about what health services look like and what's available to us therefore we all need to be able to have a say including those who wouldn't normally engage with our service. We must find ways to hear from a large cross-section of our society.
When will this work be complete?
We have scheduled for this to be signed off in 2018. However, this is just the first step. Following the completion of the plan, we will move into how the findings will be implemented and scheduling the implementation over a ten year period.


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Somehow, we're already at the semi-finals, and we have a very special treat this week - Maksim Chmerkovskiy is here as a guest judge! Admittedly, the panel is looking a little bit cramped (though Bruno doesn't seem to mind that too much). As for Maks, he's determined not to be a hypocrite in his judging after his experience as a pro, while Tom jokes that he's not wearing any pants under the judges' desk. Phew!
Anyway, after a stunning Mandy Moore-choreographed opening number from the troupe, it's time to get things going. There are two rounds this week - but each pair will be dancing two different dances to a different arrangement of the same song! Let's get the competition started...
Round One
Leah Remini & Tony Dovolani - Paso Doble
Leah is thrilled that she got three 9s last week, but now she has to get to work, especially as there are two routines to learn this time around. Tony is good friends with Maks, so he's hoping that will help them, but there's nothing that can be done about the duo's frankly bizarre 'sexy faces'. Goodness me. Anyway, can Leah knock this out of the park and make it to the finals, as she hopes? Well, her 'Bad Romance'-set paso doble is a bit stiff at the start, but I'm actually quite impressed - maybe because she's improved so much. I'm not sure it quite fits the music, but it's fine - until she slips during the turns at the end. What a shame - she got caught in her dress.
Len: Len congratulates everyone on making it this far, and says Leah's paso was neat and precise. But he does say he would have liked more shaping in her body, and says it was a bit too "careful" - Leah needs to really "give it some welly"!
Bruno: Bruno agrees with Len, and yearns for the "aggressive untamed girl" he's seen before. He also points out the turns that Leah missed and advises her to lift her sternum and separate her shoulders. But he thinks her next dance will be hot, so there's that.
Carrie Ann: Carrie Ann says that while Leah brought drama, she was too "internalised" - and she also picks up on the "out of control" turns (though she expresses sympathy that anyone could have tripped on their dress). She says she has to be tough now that it's the semi-finals.
Maks: Maks says he liked the dance, commenting that Leah had the rhythm and shape that the paso demands. He also dismisses the fact that Leah stepped in her skirt because it wasn't a technical mistake, but agrees that Leah needs to show more emotion (joking that Tony looks crazy because he's giving the feelings while Leah isn't! "I don't think her being emotional would make Tony look any less crazy," Tom jokes). In the end, each judge gives Leah an 8 for a total of 32 out of 40.
Corbin Bleu & Karina Smirnoff - Tango
Corbin is feeling thrilled about getting a perfect score last week, but he's also very, very nervous - Elizabeth got one and still went home! That means he's determined to put together a really entertaining, good dance to help him stick around. He's worried when Karina suggests a jump ("It's not a lift!" she insists), but since Karina is Maks's ex-fiancée, she thinks she knows what he will accept. Still, she does joke that their former relationship means that it "could go either way". Their tango is actually kind of terrifying - it's very angry and passionate and fast, with fire and Corbin blowing glitter and super amounts of intensity. It's incredible, but also kind of frantic.
Bruno: When the audience finally calms down, Bruno yells: "The dark knight rises with the power of an exploding volcano!" He praises Corbin's drive, intent and "almost untameable" passion - though he does warn that Corbin lost his frame at times because it was so fast and intense.
Carrie Ann: Carrie Ann wants to see the dance again! She admits she's never seen a dance with that much fury, speed and intensity, but says they did it "beautifully".
Maksim: Maksim says that Dancing with the Stars is different to your standard dancing competition, and he doesn't seem too worried about Corbin's frame, saying it was "great". He praises the content - saying it was like two tangos in one - and he loved Corbin's fairy dust. He decides to overlook Corbin's sticky-out butt, joking he has a similar issue!
Len: Uh oh - Len says this isn't "Manic Monday" and says that the tango was too "full on"! While the audience boos, he says that the tango is about a mixture of attack and calm, but this was all attack. He also complains that Corbin's frame got too wide. "It was good as a performance," he adds. "But as a tango it wasn't really my cup of tea." He scores the duo an 8, but it's a 9 from the other three judges for a total of 35 out of 40.
Jack Obsourne & Cheryl Burke - Jazz
Jack has already told us that his dances this week see him playing a gentleman and Cheryl a "woman that you pay to enjoy" ("I tried to keep that PC," he tells Brooke). That all sounds exciting, but then Jack reveals in the training footage that he's not feeling well - he's been having vision problems, headaches and shooting pains related to his MS. You can tell that Cheryl is really worried about him, but they take the training slowly and Jack is very determined and kind of brushes off the concerns. His jazz dance isn't the best - he's really going for it, and some of it is pretty smooth, and there are good lifts and spins, but it's just not his best dance. His mom Sharon, though, is crying her eyes out and sister Kelly is on her feet clapping!
Carrie Ann: Carrie Ann starts off by praising Cheryl for nailing the dance, but says that Jack was out of his comfort zone of ballroom, and didn't quite get his weight placement right. Still, she praises him for going "full out".
Maksim: Maksim thought the dance was great and says Jack is very deceiving - at the beginning of dances he can seem a bit slow and like he has problems with syncopation or intricate choreography, but then he blasts it out!
Len: Len praises Jack's commitment and the fact that he gives it all a go, but says there wasn't much finesse or quality in this routine. (Maksim gives him a thumbs down at this point!)
Bruno: Bruno jokes that it must be hard for Jack to keep up with a hottie (and then looks at Maks). More seriously, he says the routine was tough for someone not used to jazz and says he needed to extend his moves more - the dance was kind of like he was trying to catch a hot potato! But he says the interpretation was good. Maksim gives Jack a 9, but the other judges score him 8 for a total of 33 out of 40. Tom wants to know about Jack's MS symptoms, but Jack is very humble and says he just has to live with it and do what he can. He is so likeable.
Bill Engvall & Emma Slater - Cha Cha Cha
Bill is thrilled that he's still in the competition, and he wants to finish this "bad boy". But it seems like the training is getting to him this week; Emma's very encouraging, but he wants to make it to the finals on the strength of his dancing ("I don't want another week like last week," he says). Poor Bill! Things get even worse when he strains his groin during a lift in rehearsals, and the problem intensifies during camera blocking. Bill is determined to keep going, though. Still, his cha cha cha is not his best - he has improved a little, but there's hardly any hip action, his wiggles aren't the best, and he actually seems a little unsure at times.
Maksim: Maks says that Bill inspires a lot of people and praises him for all of his hard work. He does acknowledge that there were a lot of holes and issues in the dance, but says he's amazing and a lot of people are looking up to him even just for attempting this.
Len: Len firstly congratulates Emma on her choreography and for the way she's brought out the best in Bill, and says that while Bill isn't the judges' champion, he is the people's champion. Aww.
Bruno: Bruno says Bill was "splendid in polyester" (yikes) and says that while he isn't a great dancer, he does give them laughs and "pure enjoyment".
Carrie Ann: Carrie Ann admits that she came into the semi-finals vowing to be super picky and spotted problems with footwork, timing, posture, "almost everything". But she still can't stop smiling, and thanks Bill for bringing "joy" back to the ballroom! It's a 7 from each judge for a total of 28 out of 40. Bill admits that he's still hurting after straining his groin, but says he's having the time of his life and praises Emma, too.
Amber Riley & Derek Hough - Jazz
Derek is disappointed that the duo got lower scores last week because of Amber's knee, but Amber has been to the doctor and found out that she should be able to dance okay now. She's feeling super motivated and wants to "redeem" herself, while Derek comes up with some choreography that will save Amber's knees a little bit. They're both feeling pretty confident, and it shows in their fantastic dance: while a lot of it sees Amber sitting down, it's very intricate and tricky and perfectly in sync. Amber's body movement is great, and it's packed with personality.
Len: Len has one thing to say: "Do it again!"
Bruno: Bruno says Amber is incredible, describing the dance as "fierce", "rich" and "constantly surprising"; he also praises the duo for being so in sync. "Your versatility is astonishing," he adds.
Carrie Ann: Carrie Ann says Amber is in a class of her own and gets mocked by Tom when she says that if Einstein danced, he would dance like Amber! (She explains it's because the dance was as intricate as a long math equation that goes on and on... but the duo solved it!)
Maksim: Maks also thinks the performance was amazing and intricate, saying Bob Fossey would be proud. He adds that Amber makes it look like dancing comes easy. In the end, though, he scores her a 9 while the other judges give her a 10 - that's a total of 39 out of 40.
Round Two
After Round One, Amber and Derek are in the lead with 39 points, while Bill and Emma are at the bottom with 28. But will that change after the second round of dancing?
Leah Remini & Tony Dovolani - Argentine Tango
In this round, we're getting to see the contestants' friends and family talking about their lives before Dancing with the Stars, so we hear a little about Leah dropping out of school to support her family and how she dealt with the failure of her first show, Living Dolls. But her mom says she's tough and got through it, while friend Chelsea Handler says Leah has a fighting spirit. Meanwhile, Leah says she never joined DWTS to inspire people - she thought she would do the opposite! But now she's improving, she's so happy. And the package finishes with a super cute message from her daughter, who says Leah is "outstanding", "sweet" and "powerful" (which almost makes her cry, right before her dance!). In the end, Leah's Argentine tango is slinky and competent, but I'm just left a little bored by it.
Len: Len says the dance was "fine" and there weren't any "glaring blunders", but he feels like Leah never really got into dance or embraced it fully. He obviously gets booed.
Bruno: Bruno says he liked the sensitive, intimate side of the dance, adding that there are plenty of ways to play the Argentine tango and he liked this way to do it. He also praises Leah's "very good" lines and says the dance was pretty, though he points out a couple of problems with her feet.
Carrie Ann: Carrie Ann says Leah has come so far in the competition from kind of the bottom of the pack at the start, but says Leah now needs to have more confidence - she's stopping her movements short, and she knows Leah is a bigger personality than that.
Maksim: Maksim says that after meeting Leah, he knows she's an "amazing real woman" and has what this competition needs, but advises her to step it up a gear and let her personality come out, instead of worrying about messing up too much. In the end, it's an 8 from Carrie Ann, Len and Maks and a 9 from Bruno for a total of 33 out of 40 (or overall score of 65/80).
Corbin Bleu & Karina Smirnoff - Rumba
We learn about Corbin growing up as a child; he always wanted to be an entertainer and was working early. Debbie Allen even pops up to praise his work ethic, saying she always knew that he would succeed because of it. Elsewhere, Corbin says that he got in to Stanford to become a paediatrician, but chose High School Musical instead, while choreographer Kenny Ortega says Corbin's family kept him grounded. His mom, certainly, is very proud of him, and I'm sure she will be after his rumba (with vocals from Kerli). He is just so good, he looks like a pro - and his hip action and style are basically perfect.
Bruno: Bruno describes the quality of movement in Corbin's dance as "unbelievable", saying it was like watching "stunning sculptures in perpetual motion". He also praises the "flawless" storyline, describing Corbin as a "virtuoso performer".
Carrie Ann: Carrie Ann says Corbin's body is a "wonderland" - steady on! She also says she's glad he took his shirt off - calm down now! No, what she really means is that she could see every undulation and the way he controlled all of his muscles, which transported her to another world. She liked it, I think...
Maksim: Maksim says that he thinks Corbin has a huge advantage in the competition... because Karina is one of the top five best female dancers of all time! Aww, isn't that sweet? So sweet, in fact, that Karina runs over to kiss him! Anyway, back to Corbin, who Maks thinks was "amazing".
Len: Len says he loves "light and shade" in dance, and this rumba had bits that were quiet, calm and understated, and then loud, vibrant and full parts. He praises Corbin's technique and ability, saying the dance was great. It's a 10 from each judge - yep, a perfect score of 40 out of 40 (or an overall total of 75 out of 80).
Jack Osbourne & Cheryl Burke - Argentine Tango
Jack clearly has the most emotional video package. He speaks about moving from London to LA when he was 12, explaining that he felt "super insecure" - which is why he turned to drink and drugs (Sharon kind of suggests that doing the reality show was a lot for him to handle, while Kelly says she "numbed" herself to deal with things). Sharon recalls a moment when she found Jack with shallow breathing and couldn't wake him up properly, while Jack admits that he tried to overdose. But Jack went into rehab at 17 and turned things around, getting sober and setting up a production company and marrying and having a daughter... only to be diagnosed with MS. Kelly is really emotional at this point, saying she hates how he has to live with this, but Jack speaks about his determined attitude and decision to work hard. His wife Lisa says he proves that the only limitations are the ones you put on yourself, while Ozzy is basically bursting with pride. Luckily, Jack backs all this up with a super passionate, exciting, mixed-speed Argentine tango. The audience is loving it - as are Sharon, Kelly and Lisa!
Carrie Ann: Carrie Ann speaks about Jack's video, saying that he is so inspiring, but that unfortunately she has to judge him on his dancing. Wait - she says it's unfortunate for everyone else, because Jack was "in the zone"! She says his hold was incredible, every move was done with passion, and it had a lot of intensity.
Maksim: Maks says he has a friend going through the same thing as Jack, thanking him for giving people hope. And he says Jack's dancing will help him into the final, as it was a no-nonsense, straightforward, great routine (and Cheryl at her best!)
Len: Len says Jack is back, adding that this was much better than his first dance. He's wowed by the fact that while Jack isn't an actor, he can come out and sell the dance. He says there were a couple of "little scruffy moments", but overall Jack's personality, drama and drive impressed.
Bruno: Bruno says Jack was as "slick as a prowling panther" - in control, and light on his feet. He's thrilled with the shapes Jack pulled and says this was a "great achievement". He and Carrie Ann both give Jack a 10 while Len and Maksim go for a 9 for a total of 38 out of 40 (or a total of 71 out of 80). Nice work!
Bill Engvall & Emma Slater - Argentine Tango
Bill's video is quite sweet - he speaks about meeting his wife, who kept things together when he started drinking a lot on the club circuit. He speaks about how his career started taking off, and there are lots of comments from fellow comedians and celebrities about what a nice guy he is and how much he's enjoying this. As for Gail, she couldn't be prouder: "I love that people love him." And I have to say, I'm pretty impressed by his Argentine tango. Don't quote me on this, but it's almost... sexy? He's up close with Emma and he's not playing around; it's very serious, and it's good. Sure, Emma's doing a lot of the fancy work, but I'm impressed with Bill.
Maksim: Maks says the musical interpretation was "amazing" and that the physical interpretation was just as good. Bill actually has a tear in his eye! Maks also gives credit to Emma for doing such a good job with Bill, and says that the dance had a lot of passion, emotion and character. Plus, he didn't mess anything up!
Len: Len says he doesn't know if Bill has the skill to win, but he has the will to win! He praises him for being "full of heart" and also congratulates Emma on the way she's nurtured him.
Bruno: Bruno says Bill set the mood and played it straight, with his most content yet. He thinks everything that is supposed to be in the Argentine tango was there.
Carrie Ann: Carrie Ann says she was captivated, praising Bill for not joking around and says he went straight to everyone's heart, never missing a beat. The judges each give Bill an 8, for a total of 32 out of 40 (and overall score of 60 out of 80).
Amber Riley & Derek Hough - Viennese Waltz
Amber's video package is also pretty moving; she talks about how she always wanted to sing or dance but could only afford singing lessons. She admits that she heard terrible things from casting directors when she was a teenager, from how she was "a little too dark" to how her hair was a "little too kinky" to how she could lose a little weight. Meanwhile, her dad remembers how devastated she was about being rejected from American Idol, though says it made her more determined. There are also sweet comments from Glee creator Ryan Murphy and stars Kevin McHale and Chris Colfer, while Amber says that she has learnt about strength and vulnerability from being on DWTS. I'm actually not sure about her Viennese waltz - it's fine, but that's one of my favourite genres, and I expected a bit more.
Len: Len disagrees with me, saying the power had "fire", and adds that while not too much was out of hold, the turns were great and it was a "terrific" performance.
Bruno: Bruno says Amber danced like an angel - and that's it!
Carrie Ann: Carrie Ann says Amber is special in the way that she interprets the music and in her movement. She admits that she was almost brought to tears by the dance, saying that she adds her own "special spice" to things.
Maksim: Maks agrees with all that, and says Amber has a good shot because Derek knows how to win! All she has to do is keep pulling out performances like that, because she's "amazing". It's actually four 10s for Amber, for a perfect 40 out of 40 (and overall score of 79 out of 80).
Who's Going Home?
Well, it's all been very nice, but someone has to go home now! Amber is at the top of the leaderboard this week, while Bill is at the bottom. But of course, that might not mean anything... In fact, Corbin's the first to be called safe, followed by Amber and then Jack. Cheryl is so thrilled she sits on the floor as Jack tells her to get up, while Lisa falls on a sobbing Sharon!
That means it's between Bill and Leah, and the couple going home is... Leah and Tony. Still, Leah is super graceful and says she'll "take away so much" from her time on the show. She also thanks Tony and everybody there, especially her family and her fans who have supported her. Meanwhile, Tony says he's never looked forward to practice so much as when he's been working with Leah! Leah's daughter is really upset her mom won't be dancing anymore, but there's a sweet goodbye best bits package for Leah and Tony. They won't be competing in next week's finals, but we're so close to the winner now... Who do you want it to be?
Dancing with the Stars airs on ABC.


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Fill up the tank; we're going to a baseball game!
Michael Davis, Associate Professor, Economics, Missouri S&T
Summertime means a car stocked with watermelon and lemonade, a seventh-inning stretch, "Take Me Out to the Ballgame," and the crackle of fireworks after a home run. As an associate professor of economics at the Missouri University of Science and Technology, Michael Davis takes a unique approach to participating in America's favorite pastimes of baseball and road-trips.
The UMRB grant has been absolutely essential for my gasoline research. Much data is not freely available, and without this funding I couldn't have afforded it.