text:
Measuring diversity in medical reports based on categorized attributes and international classification systems
- Petra Přečková†1Email author,
- Jana Zvárová†1 and
- Karel Zvára†1
© Přečková et al; licensee BioMed Central Ltd. 2012
Received: 29 June 2011
Accepted: 12 April 2012
Published: 12 April 2012
Narrative medical reports do not use standardized terminology and often bring insufficient information for statistical processing and medical decision making. Objectives of the paper are to propose a method for measuring diversity in medical reports written in any language, to compare diversities in narrative and structured medical reports and to map attributes and terms to selected classification systems.
A new method based on a general concept of f-diversity is proposed for measuring diversity of medical reports in any language. The method is based on categorized attributes recorded in narrative or structured medical reports and on international classification systems. Values of categories are expressed by terms. Using SNOMED CT and ICD 10 we are mapping attributes and terms to predefined codes. We use f-diversities of Gini-Simpson and Number of Categories types to compare diversities of narrative and structured medical reports. The comparison is based on attributes selected from the Minimal Data Model for Cardiology (MDMC).
We compared diversities of 110 Czech narrative medical reports and 1119 Czech structured medical reports. Selected categorized attributes of MDMC had mostly different numbers of categories and used different terms in narrative and structured reports. We found more than 60% of MDMC attributes in SNOMED CT. We showed that attributes in narrative medical reports had greater diversity than the same attributes in structured medical reports. Further, we replaced each value of category (term) used for attributes in narrative medical reports by the closest term and the category used in MDMC for structured medical reports. We found that relative Gini-Simpson diversities in structured medical reports were significantly smaller than those in narrative medical reports except the "Allergy" attribute.
Terminology in narrative medical reports is not standardized. Therefore it is nearly impossible to map values of attributes (terms) to codes of known classification systems. A high diversity in narrative medical reports terminology leads to more difficult computer processing than in structured medical reports and some information may be lost during this process. Setting a standardized terminology would help healthcare providers to have complete and easily accessible information about patients that would result in better healthcare.
We can consider two approaches how to store information about health state of patients in a medical report. The first one is based on storing information in the form of a free text and thus creating narrative medical reports. The second approach is to store information in a structured form (e.g. using structured electronic health record) and thus create structured medical reports.
In current medicine we can meet with many synonyms for one concept, e.g. single disease. That was the reason why coding systems providing codes for any medical findings have arisen. Coding systems limit the variability of expression. Only the approved terms and their phrases can be used according to strictly given rules. Formal codes are usually used instead of the approved terms. In many cases it is useful if coding systems show also not approved terms, which are often used as synonyms for approved terms.
Among the most widespread international classification systems can be ranked: International Classification of Diseases and Related Health Problems (ICD), Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), Medical Subject Headings (MeSH), Logical Observations Identifiers Named and Codes (LOINC) and others, more than 100 classifications systems.
ICD is one of the oldest medical classification systems. The foundation was laid in 1855. The World Health Organization took it over in 1948. At that time it was its 6th revision. Since 1994 the 10th revision of ICD is in use and it contains 22 chapters [1–3]. ICD has become an international standard for a classification of diseases and for many epidemiological and management needs in healthcare. These include a general situation of health in different population groups and monitoring of the incidence and prevalence of various diseases and other health problems in relation to other variables. It is used to classify diseases and other health problems that are recorded in many types of health records, including death certificates and hospital records. ICD is available in six official languages of WHO and in other 36 languages, including Czech.
SNOMED CT[4–12] is a comprehensive clinical terminology that provides clinical content and expressivity for clinical documentation and reporting. It can be used to code, retrieve, and analyze clinical data. SNOMED CT resulted from the merger of SNOMED Reference Terminology developed by the College of American Pathologists and Clinical Terms Version 3 developed by the National Health Service of the United Kingdom. The terminology is comprised of concepts, terms and relationships with the objective of precisely representing clinical information across the scope of health care. SNOMED CT provides a standardized clinical terminology that is essential for effective collection of clinical data, its retrieval, aggregation and re-use, as well as interoperability. SNOMED CT is considered to be the most comprehensive, multilingual clinical healthcare terminology in the world. Since April 2007 is owned, maintained, and distributed by the International Health Terminology Standards Development Organisation, a not-for-profit association in Denmark. Nowadays we can meet with American, British, Spanish, and German versions of SNOMED CT.
MeSH[13, 14] is a vocabulary controlled by the National Library of Medicine (NLM). It is composed of terms, which denominate keywords hierarchically and this hierarchy helps with searching on various levels of specificity. Keywords are arranged not only alphabetically but also hierarchically. NLM uses MeSH for indexing of papers from world best biomedical journals for the MEDLINE/PubMED database. MeSH is used also for a database cataloguing books, documents, and audiovisual materials. Each bibliographical reference is connected with a class of terms in the MeSH classification system. Searching inquiries use also the MeSH vocabulary to find papers with required topics. There exists also the Czech translation of MeSH.
LOINC[15, 16] is a clinical terminology, which is important for laboratory tests and laboratory results. In the year 1999 the HL7 organization accepted LOINC as a preferred coding system for names of laboratory tests and clinical observations.
The increasing number of classification systems and nomenclatures requires designing of various conversion tools for transfer among main classification systems and for recording of relations among terms in these systems. Extensive ontologies and semantic networks are modeled for information transfer among various databases. Metathesauri are designed to monitor and connect information from various heterogeneous sources. The most extensive is the Unified Medical Language System (UMLS) [17–19], which we used in our study.
As it was stated in [20–22], use of new metaterms as terminological tools was able to facilitate information retrieval from a medical record system.
The Czech language belongs to the western group of Slavic languages and it belongs to the free constituent order languages [23]. The style of writing narrative medical reports in the Czech Republic, as in any other country, is not standardized and they are written mostly in the form of a free text [24]. Similarly as in other languages, Czech narrative medical reports do not use standardized terminology and they often bring insufficient information for statistical processing and medical decision making. For one term we can often meet with more than ten synonyms. Synonyms in narrative reports lead to inaccuracy and to misunderstanding. This problem has intensified with an introduction of a computer technology to healthcare. Using computers means higher uniqueness of data feeding, of term definitions, their precise denomination, etc., thereby the significant drawback becomes more noticeable. Generally, in the scientific terminology it is more advantageous to use only one expression for one term. Computers are able to learn synonyms but it enlarges dictionary databases and the number of necessary operations grows. Moreover, standardized terminology is a basic assumption for semantic interoperability.
One of our objectives was to propose a new application for measuring diversity of medical reports written in any language. The method is based on categorized attributes recorded in medical reports and on international classification systems. The general concept of diversity is derived from f-diversity and its modifications (relative f-diversity, self f-diversity and marginal f-diversity). Here we use f-diversities of Gini-Simpson and Number of Categories types. The method can be applied to compare diversities of two samples of medical reports. We compared diversities of the samples of Czech narrative medical reports and Czech structured medical reports. Both samples were collected in two outpatient departments of preventive cardiology of the Municipal Hospital in Čáslav. The first outpatient department was located in Prague and the second one in Čáslav. The Municipal Hospital in Čáslav approved using these medical reports for our research. We used categorized attributes selected from the Minimal Data Model for Cardiology (MDMC). Medical reports were recorded by four physicians. We analyzed 1119 structured medical reports collected in Prague and 110 narrative medical reports collected in Čáslav. We included narrative medical reports from Čáslav collected by the same physicians that collected also data for structured medical reports in Prague.
Minimal data model for cardiology
Nowadays, there is a big boom in the development of electronic health records (EHRs). There is a general agreement that EHR has the potential to improve quality of medical care [25]. The most important seems to be the requirement on EHRs for exchanging and management of structured health information. For our study the field of cardiology has been chosen because since 1994 the EuroMISE Centre [26] has been running two outpatient departments of preventive cardiology under the auspices of the Municipal hospital of Čáslav and therefore we have access mainly to the cardiological data and medical records focused on cardiology. In 2002 the Minimal Data Model for Cardiology (MDMC) was developed within this research center [27, 28]. MDMC is a set of approximately 150 attributes, their categorization, mutual relations, integrity restrictions, units, etc. Prominent professionals in the field of Czech cardiology agreed on these attributes as on the basic data necessary for an examination of a patient in cardiology.
MDMC consists of eight groups of attributes. The first one is the administrative part. Then, there is a family history part with information on parents and siblings. The next part is the social history and addiction focusing on the marital status, physical activities, mental stress, levels of smoking and alcohol consumption rates. One part of MDMC is devoted to allergies, mainly to drug allergies. The personal history part detects the presence of diabetes mellitus, there is observed whether a patient suffered from a stroke, whether he/she is treated with an ischemic disease of periphery arteries, there are attributes related to aortic aneurysm, other relevant diseases and menopause in women. In the part called Current difficulties of a possible cardiological origin physicians focus on shortness of breath, chest pain, palpitations, swellings, syncope, cough, hemoptysis, and claudication. Another part determines what kind of a treatment a patient undergoes, what type of a diet is prescribed and which medications he/she uses. In the part of the physical examination, patient's weight, height, body temperature, BMI, WHR, blood pressure, pulse and breathing rates, and pathological findings are determined. Laboratory testing is focused on blood glucose, uric acid, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triaglycerols. The last part is focused on attributes related to ECG. The beat frequency, the average PQ and QRS intervals and results of ECG are fully described there.
Traditional measures of diversity
Traditional measures of diversity are based on categorized attributes. For a given attribute we determine categories A 1 ,..., A k-1 . Then, we summarize the rest findings in the "others" category and we denote this category as A k . The most known two measures of diversity are the following.
The Gini-Simpson index has its values in the interval [0, (k - 1)/k], where the lower boundary 0 is reached if and only if there is only one category of the studied attribute and the upper boundary (k - 1)/k for p = u = (1/k, 1/k,..., 1/k) for uniform probability distribution. Originally it was suggested as a measure of inequality in income by Gini [29] and later discussed by Simpson [30] as a measure of ecological diversity.
The Shannon information index has its values in the interval [0; log k], where the lower boundary 0 is reached if and only if there is only one category of the attribute and the upper boundary log k for uniform probability distribution p = u = (1/k,..., 1/k).
It is hard to give a universal preference to one of these two measures. Some researchers are more familiar with the Shannon entropy and it is easier for them to interpret particular numerical values of H S (p) than those of H GS (p). On the other hand, the Gini-Simpson index is a very well-known traditional measure of diversity.
f-diversity and relative f-diversity
where p(x; y) are the joint probabilities and p(x); p(y) marginal probabilities of categories of X and Y attributes.
This measure of diversity will be further called Shannon diversity.
f-entropy Hf (p) can be interpreted as an average unpredictability of the individual categories A i of the attribute X[37]. In this sense f-entropy Hf (p) is a measure of diversity depending on the distribution p. Hf (p) will be called f-diversity if it moreover satisfies the following conditions:
• Hf (p) is non-negative,
• Hf (p) reaches its minimal value in case that there is one category with probability 1,
• Hf (p) reaches its maximal value in case that p = u is the uniform distribution,
• Hf (p) is a symmetric function of p,
• Hf (p) is a concave function on the system of all probability distributions p.
We can see that Hf (p) is a sum of two expressions where the second one is nothing but the well-known Gini-Simpson index HGS (p) multiplied by the constant f(0). Further we will call Gini-Simpson index the Gini-Simpson diversity. In the paper [36] it was proved that f-diversities can be found among f-entropies satisfying the condition g(t) = (f(t) - f(0))/t is a concave function. Then f-entropy Hf(p) of the attribute X will reach its maximal value for uniform distribution of categories p= u. We can see that Gini-Simpson diversity HGS (p) is f-diversity with f(t) = t - 1 for t > 1, otherwise f(t) = 0. Similarly, Shannon diversity is f-diversity with f(t) = t log t.
Measures of rarity, self and marginal f-diversity
Three widely used diversity indexes are:
We can see that for β = 0 we receive the Shannon diversity, for β = 1 the Gini-Simpson diversity and for β = -1 the Number of categories diversity. As it was shown above, all of these three diversity indexes belong to the family of f-diversities.
Therefore f-diversity H f (p) is the weighted average of self f-diversities R f,i (p).
where .
Comparing diversities on the sample of 110 Czech narrative medical reports and 1119 Czech structured medical reports we used diversities of the Gini- Simpson type. The reason is that there was shown in [40] that an ideal estimator of the Shannon type diversity does not exist.
MDMC has become a basis for selection of attributes and their categorization.
The analysis of suitability and utilizability of individual terminological thesauruses has been started by mapping clinical contents of the Minimal Data Model for Cardiology to various terminological classification systems.
First of all, we have tried to map the attributes and terms of MDMC to the SNOMED CT system. The first prerequisite for this mapping was the translation of the MDMC attributes and terms to the English language as there is not a Czech version of SNOMED CT [41].
As ICD-10 is one of a few international medical classifications translated to the Czech language, as the second step, we have tried to map the attributes and terms of MDMC to this ICD-10. Results of these mappings were published in [42].
We found the following types of MDMC attributes and terms from the point of view of possibilities of their mapping to SNOMED CT and ICD-10 classification systems:
Trouble-free terms and attributes - i.e. terms and attributes, which can be mapped directly, so only one possibility of mapping exists; possibly there are only synonyms with exactly same meanings and therefore the same classification code (e.g. patient first name, current smoker, motility, height of a patient, etc.).
Partially problematic terms and attributes - i.e. terms and attributes, which can be mapped in a way that there are several possibilities of mapping to different synonyms, which differ slightly in their meanings and usually in their classification codes (e.g. ischemic cerebro-vascular stroke, angina pectoris, hypertension, congestive cardiac failure, etc.).
Terms and attributes with a too small granularity - i.e. terms and attributes describing certain characteristics on a too general level so that classification systems contain only terms of a narrower meaning (e.g. e-mail in MDMC versus e-mail to work/e-mail to home/e-mail of a physician and so on in classification systems).
Terms and attributes with a too big granularity - i.e. terms and attributes describing certain characteristics on such a narrow level so that classification systems contain only a term of a more general meaning (e.g. symmetrical pulse of carotids, etc.).
Terms and attributes, which cannot be found in classification systems, e.g. dyslipidemy, etc.
Linguistics and lexical analysis of narrative medical reports
In the following part we present our findings on linguistic and lexical differences in Czech narrative medical reports.
The Czech language uses the diacritical writing system. As an example of diacritical letters let us mention e.g. letters "ě, č, ř, ž". However, it is faster for physicians to write without these diacritical marks and use letters "e, c, r, z". Such a text is for Czech native speakers understandable but it is difficult for computational processing.
Typing errors
Typing errors represent a bigger problem and they are very frequent in any language. The text is then very hardly usable for computational processing.
A similar problem is spaces omitting between words, which results in merging of two words in one.
Figure 0
For computational processing it is difficult if a physician uses the figure 0 instead of the capital letter O.
Many discrepancies are connected with numerical values. One physician may round one attribute to integers, while another rounds the same attribute with the precision of one or two decimal numbers. Sometimes numerical values are presented as ranges, e.g. "70-80". Often only an approximate indication is entered, e.g. "diastolic pressure around 70". Some attributes are not expressed in numbers but in words, e.g. "blood pressure is within the normal range".
Arabic and Roman numerals
There is a divergence in usage of Arabic and Roman numerals. For example heart sounds may be found in both ways "heart sounds 2" and "heart sounds II".
The Czech language is very rich in synonyms and they are highly used also in medical reports.
Some physicians use a newer version of Czech spelling, the others the older one.
Time data
Recording of time is not standardized as well. In medical reports we can run into the name of the month, e.g. "February 2006" but also the month order, e.g. "2/2006".
Drugs administering
There are various ways how to describe the time when a patient should administer a drug (e.g. 1-0-0 vs. 1 pill in the morning vs. 1 in the morning vs. 1× in the morning).
These are not problems only of writing medical reports but the same orthographic errors may be found e.g. in web pages [43].
Mapping MDMC attributes to international classification systems
After translating the MDMC attributes from Czech to English, we have found that more than 60% of MDMC attributes could be mapped to SNOMED CT [42].
As the second step, we mapped the MDMC attributes to ICD-10. As the very title of the International Classification of Diseases shows, this classification can be used to encode particular diseases, syndromes, pathological conditions, injuries, difficulties and other reasons for the contact with healthcare services, i.e. the type of information that is being registered by a physician. Unfortunately, using this classification we cannot map many attributes of the MDMC, such as marital status, education, mental stress, physical stress, physical activity, smoking, alcohol drinking, physical examination (weight, height, body temperature, BMI, WHR, etc.) or laboratory tests (total cholesterol, HDL-cholesterol). ICD-10 can be used only for the parts of MDMC related to personal history and current difficulties of a possible cardiological origin. Therefore only 25% of MDMC has been mapped to ICD-10 [42].
Similar results were achieved when analyzing standardization possibilities of attributes of the Data Standard of Ministry of Health of the Czech Republic (DASTA) [44], in which the majority of healthcare information systems in the Czech Republic communicate. DASTA is based on the national classification system called the National code-list of laboratory items (NCLP) [44]. These standards are developed and administered by the developers of healthcare information systems that are specialized companies, universities or research institutions in the Czech Republic. The development of the standard is supported by the Czech Ministry of Health. DASTA is specialized mainly in transfer of requests and results of laboratory analyses. The current version of DASTA is XML based and provides also the functionality for sending statistical reports to the Institute of Health Information and Statistics of the Czech Republic [45] and limited functionality of free text clinical information exchange. Unfortunately, DASTA has almost no relation to international communication standards such as HL7 [46] or European standards like EN13606 [47].
Diversities of selected attributes and their categories in narrative and structured medical reports
Number of categories
Attribute | No. of narrative reports with recorded attribute | No. of narrative reports with missing attribute | Number of categories diversity (narrative reports) | No. of structured reports with recorded attribute | No. of structured reports with missing attribute | Number of categories diversity (structured reports) |
Smoking | 71 | 39 | 29 | 1080 | 39 | 3 |
Allergy | 90 | 20 | 12 | 1065 | 54 | 2 |
Ischemic heart disease | 67 | 43 | 12 | 1045 | 74 | 2 |
Dyspnoea | 79 | 31 | 28 | 934 | 72 | 2 |
Chest pain | 38 | 72 | 16 | 1049 | 70 | 2 |
Palpitations | 17 | 93 | 7 | 1054 | 65 | 1 |
Swelling | 95 | 15 | 25 | 1050 | 69 | 1 |
Diabetes mellitus | 69 | 41 | 14 | 1073 | 46 | 1 |
Each narrative medical report was read and analysed individually, one by one, and all various ways of describing selected MDMC attributes were highlighted and recorded. As there were much more ways describing these attributes in narrative reports than in the structured reports categorized according to MDMC, we can see that the Number of categories diversity is much higher in narrative medical reports than in structured medical reports.
Gini-Simpson relative diversities
Attribute | No. of categories | Number of narrative reports | Gini-Simpson relative diversity | Number of structured reports | Gini-Simpson relative diversity | p value |
Smoking | 4 | 71 | 0.8162 | 1080 | 0.6579 | 0.00073 |
Allergy | 3 | 90 | 0.6300 | 1065 | 0.6977 | 0.30932 |
Ischemic heart disease | 3 | 67 | 0.4117 | 1045 | 0.1455 | 0.00359 |
Dyspnoea | 2 | 79 | 0.9152 | 1047 | 0.3851 | < 0.00001 |
Chest pain | 2 | 38 | 0.7756 | 1049 | 0.3042 | 0.00050 |
Palpitations | 2 | 17 | 0.9135 | 1054 | 0.4882 | 0.00263 |
Swelling | 2 | 95 | 0.4725 | 1050 | 0.2020 | 0.00914 |
Diabetes mellitus | 2 | 69 | 0.7713 | 1073 | 0.1709 | < 0.00001 |
Gini-Simpson self diversities and relative marginal diversities
Attribute | Category | No. of narrative reports | Gini-Simpson self-diversity | Gini-Simpson relative marginal diversity | No. of structured reports | Gini-Simpson self-diversity | Gini-Simpson relative marginal diversity |
Smoking | smoker | 15 | 0.7887 | 0.6665 | 203 | 0.8120 | 0.6105 |
occasional smoker | 0 | 1.0000 | 0.0000 | 19 | 0.9824 | 0.0691 | |
ex-smoker | 19 | 0.7324 | 0.7840 | 128 | 0.8815 | 0.4179 | |
nonsmoker | 37 | 0.4789 | 0.9982 | 730 | 0.3241 | 0.8762 | |
Allergy | yes | 27 | 0.7 | 0.84 | 378 | 0.6451 | 0.9158 |
no | 63 | 0.3 | 0.84 | 681 | 0.3606 | 0.9222 | |
do not know | 0 | 1.0 | 0.00 | 6 | 0.9944 | 0.0224 | |
Ischemic heart disease | yes | 56 | 0.1642 | 0.5489 | 44 | 0.9579 | 0.1613 |
no | 11 | 0.8358 | 0.5489 | 992 | 0.0507 | 0.1926 | |
I do not know | 0 | 1.0000 | 0.0000 | 9 | 0.9914 | 0.0342 | |
Dyspnoea | yes | 28 | 0.6456 | 0.9152 | 113 | 0.8921 | 0.3851 |
no | 51 | 0.3544 | 0.9152 | 934 | 0.1079 | 0.3851 | |
Chest pain | yes | 10 | 0.7368 | 0.7756 | 87 | 0.9171 | 0.3042 |
no | 28 | 0.2632 | 0.7756 | 962 | 0.0829 | 0.3042 | |
Palpitations | yes | 6 | 0.6471 | 0.9135 | 150 | 0.8577 | 0.4882 |
no | 11 | 0.3529 | 0.9135 | 904 | 0.1423 | 0.4882 | |
Swelling | yes | 13 | 0.8632 | 0.4725 | 56 | 0.9467 | 0.202 |
no | 82 | 0.1368 | 0.4725 | 994 | 0.0533 | 0.202 | |
Diabetes mellitus | yes | 51 | 0.2609 | 0.7713 | 48 | 0.9553 | 0.1709 |
no | 18 | 0.7391 | 0.7713 | 1025 | 0.0447 | 0.1709 |
Finally, we compare percentage how often selected attributes appear in narrative and in structured medical reports and we achieve these results:
smoking has been recorded in 64.5% of narrative and in 96.5% of structured medical reports;
allergy in 81.8% of narrative and in 95.2% of structured medical reports;
whether a patient suffers from an ischemic heart disease has been recorded in 60.9% of narrative and in 93.4% of structured medical reports;
presence or absence of dyspnoea in 71.8% of narrative and in 93.6% of structured medical reports;
whether a patient suffers from a chest pain has been found in 34.5% of narrative and in 93.7% of structured medical reports;
questions about palpitations have been recorded only in 15.5% of narrative but in 94.2% of structured medical reports;
swelling has been recorded in 86.4% of narrative and in 93.8% of structured medical reports and
the diabetes mellitus attribute has been recorded in 62.7% of narrative and 95.9% of structured medical reports.
Close cooperation with physicians is essential for solving mapping problems. We consulted four physicians examining patients in both outpatient departments of preventive cardiology. It was often needed to choose the right synonym substituting a certain technical term. It was necessary to do it very carefully not to lose information or not to misinterpret it. In case that mapping is not possible without any lost of information, the better way is to describe a non-coded term by means of a set of several coded terms, possibly with showing mutual semantic relations. If this is not also possible, we can polemize with specialists whether these "indescribable" terms (attributes) can be replaced by other more equivalent or more standard ones. In special cases it is possible to add a certain term to an upcoming new version of a certain coding system. In case it is not possible to use any of the above mentioned possibilities of solving mapping problems, it is necessary to cope with the fact that mapping will never be 100%. The insufficient mapping process limits the interoperability of heterogeneous systems used for various purposes in healthcare. Restricted interoperability is often inevitable from the very root of the problem, e.g. insufficient harmonization of clinical contents of heterogeneous systems of electronic health records.
We can also see that while recording results of examinations by means of narrative medical reports terms for categories of attributes are not standardized and the Number of categories diversity is higher than for the same attribute in structured medical reports. Moreover, a lot of attributes in narrative medical reports are left unrecorded. It may have several reasons. Physicians do not have a strictly given skeleton according which they should proceed, so they may forget to collect some attributes. Another reason may be that physicians from the previous attributes know that the next attribute cannot be present and therefore they do not ask about it and they do not record it. But from the narrative medical reports we do not know whether these missing attributes have been checked or whether physicians on the basis of previous knowledge have deduced them. In structured medical reports (e.g. based on structured EHR) all attributes should be recorded. The application should not let physicians to continue if findings are not recorded. However, in our application based on MDMC, this was not the case and we can see that our physicians sometimes have not recorded some findings that could not be derived from other data.
The new method for measuring diversity of medical reports can be applied to medical reports written in any language with categorized attributes. Moreover, it can quantitatively express possibilities for extraction of information from medical reports, more generally from any free text document. The analysis of narrative medical reports has shown that recording of attributes is very inaccurate and not standardized. The biggest problems for computational processing are typing errors, various length of shorten expressions and usage of synonyms. Another problem in the Czech healthcare is the lack of international classification systems translated to the Czech language. But even despite these problems in the usage of international classification systems in Czech healthcare, their use is a necessary first step to enable interoperability of heterogeneous systems of health records. Sufficient semantic interoperability of these systems is the basis for shared care, which leads to efficiency in healthcare, financial savings and reduction of the burden on patients. In this work we have tried to analyze how the international classification systems could be used best for the needs of Czech healthcare.
High diversity in narrative medical report leads to more difficult computer processing than in structured medical reports and some information may be lost during this process. Therefore it is very important to set standardized terminology that would be used in medical reports. Using international classification systems and nomenclatures we can compare diversities of medical reports written in the same or different languages among physicians or healthcare organizations.
The standardized terminology would bring many benefits to physicians. The standardized terminology would help to support development of electronic health records that can easily collect structured medical information. Structured medical reports have a smaller diversity and fewer numbers of missing observations. They can provide physicians, patients, administrators, software developers and payers with much more accurate and objective information. The standardized clinical terminology would help healthcare providers in a way that it could provide complete and easily accessible information that belongs to the process of healthcare (patient's medical record, diseases, treatments, laboratory results, etc.) and it would result in better care of patients.
- As physicians are often pressed of time they abbreviate words while writing medical reports. Unfortunately:
there exists not a single rule how particular attributes should be abbreviated. Therefore the same words can be abbreviated diversely.
The work was partially supported by the project 1M06014 of the Ministry of Education of the Czech Republic and by the AV0Z10300504 project of the Institute of Computer Science AS CR.
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Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
"I'm willing to admit that I may not always be right... but I'm never wrong."
A character makes a statement, then immediately adds that they actually mean the exact opposite of what they said. Usually shows up in comedies. May be used as a form of pointing out sarcasm.
Compare Dissimile. See also Distinction Without a Difference, where a character prefers to use a different word to mean the same thing, and "No" Means "Yes", where people assume a person is doing this, but they aren't.
— Sam Goldwyn
Fan Works- A Boy, a Girl and a Dog: The Leithian Script: In this The Silmarillion story, when Finrod finds out her fiancée has been building flying ships during his stay abroad he is astounded. His brother Angrod asks him if he is jealous:
Angrod: [curious] Are you jealous? —Ingold?
Finrod:N— Yes. - In The Prayer Warriors, Jerry has this to say about his girlfriend, Mary (emphasis added).
Jerry Narrates: "I and her [sic] are not dating, if you Satanic scum think that there is something Satanic going on. We are dating, but we are not having Sex until we get married."
- From Meet the Robinsons:
Wilbur: If my family finds out that I brought you from the past, they'll bury me alive and dance on my grave. I'm not exaggerating! Well, yes I am.Lewis: You lied to me?!Wilbur: No! Well...yes.
- Clue:
Wadsworth: THAT'S WHAT WE'RE TRYING TO FIND OUT! WE'RE TRYING TO FIND OUT WHO KILLED HIM, AND WHERE AND WITH WHAT!
Professor Plum: There's no need to shout!
Wadsworth: I'M NOT SHOUTING! (beat) ALL RIGHT, I AM! I'M SHOUTING! I'M SHOUTING! I'M SHOU—
- At this point, his shouting has vibrated the candlestick from its perch above the doorway he's standing in and clocked him on the head.
- Kingdom of Heaven:
Balian: What is Jerusalem worth?
Saladin: Nothing. (He walks away then turns around) Everything. - Hot Shots! Part Deux: Topper to Harbinger when he's wary of a Mole on the strike team.
Topper: I'm not saying that I don't trust you, or that I do trust you, but I don't.
- From Thor: The Dark World:
Loki: [to Odin] It's not that I don't love our talks, it's just... I don't love them.
- In The Host, Gang-du tries to convince an Obstructive Bureaucrat that his daughter is alive.
Officer: Your daughter, Park Hyun-seo, a seventh-grader at Dangsan Middle School... she's on the deceased list.Gang-du (desperately): Yes, she goes to Dangsan School... she's deceased... but she's not dead. (The officer scoffs) I mean, she died, but she's still alive.
- Subverted by Niles Crane in Frasier:
Niles: Her lips said "no", but her eyes said, "Read my lips".
- Castle:
- In "One Man's Treasure", Alexis tells Beckett, "I know my dad can sometimes be a handful, and by sometimes I mean all the time".
- In the sixth season premiere, after Castle proposes to Beckett, a very surprised Beckett kisses him. When Castle asks if that's a yes, she answers, "No, wait...", leading to some confusion over whether she was saying "Yes" or "No". Her initial "No" was because she wanted to tell Castle she was offered a job with a Federal task force in Washington DC. Ultimately her answer was a resounding "Yes".
- Used by Mark Lamarr on Nevermind The Buzzcocks, usually along the lines of "...I like x. I say like, I mean tolerate. I say tolerate, I mean (Description of elaborate torture he'd rather be put through rather than have anything to do with x)"
- That Mitchell and Webb Look: The interviewer in the "Realistic Film Director" sketch asks questions like this.
Interviewer: Peter, what would you say and apologies if this seems like a crass question is the horniest bra size on a woman?Director: What?Interviewer: By which I mean, what, if anything, is the message in your films?
- A good multi-part one from Scrubs:
Dr. Cox: And this... abomination is the reason we can't afford a new computer?Dr. Kelso: Well, that, and a little medical boondoggle I have to go to in Cleveland. And by "medical boondoggle" I mean "golf weekend." And by "Cleveland" I mean "Hawaii." .... Anyway, I have to go catch my bus to the airport. And by "bus" I mean "helicopter."
- In Conspiracy Thriller Utopia, hapless Dugdale is talking to Donaldson about how they are both being blackmailed by The Network, it leads to this amusing exchange:
Donaldson: All I know was within the next few weeks I was embroiled in a sex scandal. Professor Pervert addicted to coke and prostitutes.Dugdale: So did they just set you up?Donaldson: Yeah. Well, no. *beat* I.. I do like cocaine and prostitutes but they didn't have to tell anyone.
- In the Doctor Who episode "The Beast Below": "Except it's not a torture chamber, is it? Well, except it is. Except it isn't."
- Firefly: "Objects in Space": Simon thinks Jubal is doing this when he asks if Jubal's a bounty hunter and Jubal responds with "No, that ain't it at all". When Simon asks him to explain what he is, Jubal looks at him and says "I'm a bounty hunter". However, Jubal has been fixated on River's empty room and had just been wondering if the best word to describe an empty room's purpose was "imbue" when Simon asked his question. He was rejecting his choice of descriptive word, not Simon's question.
- On The Vicar of Dibley, Jim Trott's "No, no, no, no, no...yes", which is his Verbal Tic. And also his (rarely seen) wife: "Yes, yes, yes, yes...no".
- On Buffy the Vampire Slayer:
- "Restless" has this example:
Dream-Giles: You hold them, you touch them, uh, use them, um...
Dream-Harmony: Props?
Dream-Giles: No.
Dream-Riley: Props?
Dream-Giles: Yes! - When Willow and Tara have a spat in season 5:
Tara: Do I act like ... the big knowledge woman?
Willow: No.
Tara: Is that "No" spelled Y-E-S?
Willow: ...S-O-R-T of? - From the Season 9 comics:
Sophie: We certainly don't associate with anyone who'd do something like that. Wait. Yes we do, don't we?
- "Restless" has this example:
- Sylar does this in Heroes.
Sylar: I'm not a Serial Killer.
Luke: You kill people, you take souvenirs...
Sylar: Okay, technically, I'm a serial killer. - Monty Python's Flying Circus:
- This dialogue snippet between two pepper pots plays with it:
Mrs. Thing: Oh, have you been shopping?
Mrs. Entity: No, I've been shopping. - From the "Nudge Nudge" sketch:
Norman: Look, are you insinuating something?Him: Oh, no, no, no...yes.
- From "The Silliest Interview We've Ever Had"
Sir John: May I take this opportunity of emphasising that there is no cannibalism in the British Navy. Absolutely none, and when I say none, I mean there is a certain amount...
- This dialogue snippet between two pepper pots plays with it:
- This snippet from Skins, when Naomi goes to visit Effy in her psychiatric institution.
Effy: You think you're going mad, so you came to see me to see what a crazy person looks like.Naomi: No. NO! No...yes.
- The West Wing:
President Bartlet: You told the press I have a secret plan to fight inflation?
Josh: No, I did not. Let me be absolutely clear, I did not do that. Except, yes, I did that. - Sports Night has:
Dan: You went to a woman's apartment, and there you had wine. And there you had sex.
Casey: You are way off base. That is not what happened. Except, yes, that's what happened. - From the M*A*S*H episode "To Market, To Market", as Henry is polishing his new desk, he wants to brag to everyone coming into his office. This is an atypical example, because each time he does it (which he does to everyone he shows the desk off to) he's not actually listening to them. He's just glorying in having something cooler than MacArthur has.
Henry: Radar, you know what kind of wood this desk is made with?Radar: Oak, sir.Henry: Nope. It's oak.
- Jam And Jerusalem has Rosie, who uses this frequently when questioned about something she's done.
- It's Always Sunny in Philadelphia: "The High School Reunion": When Dennis confronts Mac over having sex with his date, Mac lies about it, for maybe two seconds.
Dennis: You slept with my prom date?Mac: No... Yes.
- The Big Bang Theory, "The Luminous Fish Effect": Sheldon is fired for mouthing off to the new university president.
Penny: So you got canned, huh?
Sheldon: Theoretical physicists do not get canned... But yeah.
- The Living End has a song called Short Notice with lyrics like:
I said I wanna, I wanna see youI really meant I wanna, I wanna leave youI said I wanna, I wanna touch youI really meant I wanna, I wanna punch you
- "Only on Days That End in 'Y'" by Clay Walker:
The only time I ever miss you, honey
Is when I'm alone or when I'm with somebody
Your memory never even gets to me
'Cept when I'm awake, and when I m sleeping
Girl you never even cross my mind
'Cept just when I think I left you far behind
Only when I laugh, only when I cry,
And only on days that end in "Y"
- A Garfield strip had this exchange:
Jon: I can't go out tonight, Liz.... I have a terrible cold. Don't worry, though. Garfield's taking good care of me.... [Cut to Garfield laying on the table in front of Jon] as in NOT!Garfield: Can't you breathe in the other direction?
- In Fellowship! The Musical, Frodo says he thought Sauron was killed. Gandalf responds: "Oh, he was killed. If by 'killed', you mean turned-into-a-giant-flaming-evil-red-eyeball, then SURE, you betcha he was 'killed'!"
- In Spider-Man: Shattered Dimensions, Deadpool, filming his battle with Ultimate Spider-Man as a TV show, unleashes his army. "And by army I mean production assistants. And by production assistants I mean interns. And by interns I mean fans."
- Agents of Cracked has with Michael: "If by "I want a hot dog" you mean "I want your junk in my mouth", then sure!"
- The FAQ from The Best Page in the Universe includes the question, "How often do you update your page?" His answer: "At least once every week. And by "once every week," I really mean "when I get a chance." And by "when I get a chance," I really mean never."
- Amy Ratcliffe describing her search for 'water dancing' lessons at a convention.
...we eventually tortured a volunteer for correct information. And by torture, I mean we looked sad and tired and frustrated.
- SF Debris' review of David Lynch's Dune, discussing the changes in the Baron's character from the book:
"I hate to be all "they changed him now he sucks"...but at the same time, they did change him, and now he really does suck.
- In the South Park episode "Cartman's Incredible Gift," the police come to Cartman, who has (supposedly) gained psychic abilities, and offer to pay him to help them catch a killer. Cartman replies, "I'm afraid that my powers are not for sale. And by that, I mean that they absolutely are for sale."
- The Simpsons:
- Lionel Hutz, explaining to Marge why Judge Snyder is not on good terms with him: "Well, he's had it in for me ever since I kinda ran over his dog... Well, replace the word 'kinda' with the word 'repeatedly' and the word 'dog' with 'son'".
- Leonard Nimoy introduces the episode "The Springfield Files" with, "The following tale of alien encounters is true. And by true, I mean false. It's all lies. But they're entertaining lies, and in the end, isn't that the real truth? The answer is no".
- This...
Homer: I have to go do some serious thinking.Bart: I think Dad meant "do some serious drinking."Lisa: That's what I assumed.
- In "Kill Gill Vols. 1 & 2", Marge has trouble saying no to freeloader Gil and when she finally gets the guts to, he's gone. Which leads to this...
Homer: Hey Marge! Want $1000?Marge: NO! I mean yes.Homer: Too late. (burns the money)
- Phineas and Ferb:
- Doctor Doofenshmirtz does this about Once an Episode, usually when Perry bursts in to foil his evil scheme of the week. There was at least one occasion where, by unexpected, Doof actually meant unexpected. And he sometimes isn't sure what he meant by other variations.
Doofenshmirtz: Ah, Perry the Platypus! What an unexpected surprise... and by unexpected I mean completely expected!
- Major Monogram once said he wanted to approve Perry's request for a vacation but there was a small problem. He admitted that by "small" he meant "big" and by "approve" he meant "deny".
- Doctor Doofenshmirtz does this about Once an Episode, usually when Perry bursts in to foil his evil scheme of the week. There was at least one occasion where, by unexpected, Doof actually meant unexpected. And he sometimes isn't sure what he meant by other variations.
- Used in an episode of Maryoku Yummy, with Baburu commenting on Hadagi's latest scheme: "I can see this is going to be fun. And by fun, I mean no fun at all."
- Futurama:
- "The Devil's Hands are Idle Playthings": "You may have to metaphorically make a deal with the devil. And by devil, I mean Robot Devil. And by metaphorically I mean get your coat."
- In "Viva Mars Vegas":
Zoidberg: You mean I'm invisible?
Professor Farnsworth: No, no, no. Not in any sense of the word. But essentially, yes, entirely.
- A literal case happened in King of the Hill. Peggy was once asked to teach German and she answered "Nein", thinking it meant "Yes". As she related this to her niece, Peggy said she had lost an opportunity because of that.
- Pushed to the extreme by Sasha in Titan Maximum:
Sasha: We thought youd given up on us. And by We I mean I and by thought I mean hoped and by given up I mean died and by on us I mean in a fire and by period I mean disappointed ellipses.
- The Fairly OddParents!:
- "Hairicane": When it seemed the Air Force would defeat the hairicane, Chet Ubetcha announced "We're saved!". Then the hairicane defeated the Air Force, prompting Chet to say "And by saved, I mean doomed!"
- "I Dream of Cosmo": Timmy's Dad meets an amnesiac Cosmo and assumes Cosmo must be a magical mix of witch and genie and says Cosmo must grant him Three Wishes. By three, Timmy's Dad means a gazillion.
- Robot Chicken has a skit where the Care Bears ethnically cleanse the Care Bear Cousins. Quoth Bedtime Bear: "It's bedtime! And by 'bed', I mean 'ethnic', and by 'time', I mean 'cleansing'". (Shoots a rainbow that decapitates the elephant)
- From 'Gravity Falls:
- "Dungeons, Dungeons, and More Dungeons": Dipper tells Mabel "Yes, except no" when she asks if she gets to ride unicorns after rolling the die.
- Stan tells the author only the two of them are aware of the portal. Well, just them and maybe the entire government of the United States.
Ford Pines: Tell me, Stan. Are there any security breaches? Does anyone else know about this portal?!Stan: No, just us. Also, maybe the entire U.S. government.
- Shimmer And Shine: In "Ahoy, Genies", Shine admits that sometimes she gets carried over and, by "sometimes", she means "all the time".
- Pundit Rachel Maddow consistently refers to the Republican Party's current (c. mid-2012) highest priority as "Jobs, jobs, jobs, and by that we mean 'abortion'."

subset: commoncrawl


text:
Monday, February 25, 2013
jade { the failed shoot }
I struggle to find the time to do sessions with Jade at the moment, so when a spare half hour presented itself I put a pretty dress on her and headed off to a little mini session. There was not a breath of wind when I left my house but it was blowing pretty hard at the location I had in mind. So we got back in the car.
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The Daily Motivator - www.GreatDay.com Saturday, January 12, 2013The effort of the journeyThe life you desire to live is precisely one step away. Once you take that step, with your initial action you are beginning to live that life. The essence of fulfillment is in the direction and in the process, not just in the ultimate reward. The substance of life is in the living, from moment to moment, toward the goals you have chosen. Think of how terribly empty it would be to always get what you want without the opportunity to look forward to it. Without the time and effort of the journey, you cannot fully enjoy the destination. If you were to have it all now, you would be cheated out of the rich joy of anticipation. Fortunately, you cannot have it all now so you can indeed anticipate to your heart's delight. Step forward toward whatever you treasure, and you'll begin to live the reality of what you treasure. Keep going, and enjoy every bit of value as you work to build it day by day. You can't get all the way there all at once, and that is truly a blessing. Because it is in the effort of the journey that you can truly appreciate and enjoy the reward of the destination. Ralph Marston
The time you have Express the beauty
Other messages with similar topics: Make your dreams real Dreams already are Do your dream Living inspiration Laugh at every excuse Copyright ©2013 Ralph S. Marston, Jr. All Rights Reserved. This copy is for your personal, non-commercial use only. For more motivational messages like this please visit The Daily Motivator website at www.GreatDay.com Copyright ©2013 Ralph S. Marston, Jr. All Rights Reserved. The Daily Motivator is provided for your personal, non-commercial use only. Re-distribution (other than personal sharing) without permission is not allowed. |
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Angelo Delvonne Crowell is an American football linebacker for the Buffalo Bills of the National Football League. He was originally drafted by the Bills in the third round of the 2003 NFL Draft. He played college football at Virginia.
He is the the younger brother of former NFL wide receiver Germane Crowell.
More on Wikipedia…
(6 quotes found)
"I can't be Takeo, ... He's a Pro Bowl caliber player and he's shown the kind of plays he can make. We're totally two different people and we bring two different things to the game. But I'm definitely going to go out there, play my game within the scheme of the defense, do my job and most importantly let the game come to me."
Angelo Crowell
"On the first one, we got caught on a quick snap. On the other we just weren't gap sound. You have to control your gap."
"Just taking things more serious, taking a different approach. I was kind of transformed, so it's kind of cool."
"It's a hard pill to swallow, Spikes going down like that, man. It is mixed emotions. Those shoes are big, but I'm going to go out there and play my game."
"It's a hard bullet to swallow with Spikes going down like that, ... It is mixed emotions. But I believe that he would definitely want me to step up and replace him and get the job done."
"You hate to lose a guy like Takeo Spikes , but it's just a time for me to step up, make the plays he was making and get this defense back on a roll. It is mixed emotions. But I believe he'd definitely want me to step up, replace him and get the job done."


text:
Texas death row inmate's August execution delayed
Published 4:40 pm, Friday, July 29, 2011
BC-TX--Texas Execution-Swearingen,123
Texas death row inmate's August execution delayed
Eds: APNewsNow. Will be updated.
By JUAN A. LOZANO
Associated Press
HOUSTON (AP) - A Texas appeals court has delayed next month's execution of a death row inmate condemned for killing a 19-year-old Montgomery County student.
The Texas Court of Criminal Appeals is sending the case of 40-year-old Larry Swearingen back to the original trial judge so he can review new evidence of a possible due process violation. The court issued its order Thursday.
Swearingen's attorney said Friday that new forensic evidence in the case points to the inmate's innocence.
Prosecutor Bill Delmore says authorities presented a strong case against Swearingen and believe he is guilty.
Swearingen has argued he was in jail on outstanding traffic warrants when Melissa Trotter was killed. Prosecutors insist evidence shows Trotter was killed in December 1998, before Swearingen was in jail.


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on the arrival of email, but I have nothing but personal instinct to back that up.
if this is true will we be sent an email when tickets go on sale?!?! i missed the warfield and i cant miss this!!!
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"Style anthropology can explicate a lot of otherwise tricky issues, in some cultures probably more than others. Sort of Like Water For Chocolate, only Weejuns..." LPC
Wednesday, July 6, 2011
Sunday in Georgetown: Part Two
20 comments:
- Yankee-Whisky-Papa said...
Someday, the term "rare book" will sadly be redundant.
- July 6, 2011 at 8:29 PM
- LPC said...
My father has always been a rare book fan. Just scrolling through the photos of those covers feels sort of like having someone avuncular stroke my hair. Too bad to see these things go - the victory of stuff over personality which just cannot ever be good.
- July 6, 2011 at 8:54 PM
- Main Line Sportsman said...
'Bout 10 titles in that set of photos that just make me swoon...starting with Rice Planter & Sportsman and on to Ducks and Duck Shooting and the Carolina Sports...with a Winner Take Nothing Papa Hemingway chaser...dija pick up any surprise gifts for your M.L. Sportsman pal??
Damn sad to see joints like that fold...just tragic....Gad-damn Kindles and Big Box centers.... - July 6, 2011 at 11:22 PM
- Hilton said...
I'm sad to see the closure of this bookshop. I've strolled by late at night several times on the way back to my car from Martin's tavern, but not during their business hours. Have you ever browsed Bridge Street just around the corner? I know it's not the same as a used bookseller, but not bad for an independent. I had somewhat of an impersonal connection with Phil (or is it Paul?) during my bookselling days.
Every little CMT bumpkins house in South Riding, Virginia is full of crap from The Pottery Barn.
"Because they have no memory... because they are not human."
Melville, "Bartleby the Scrivener" - July 6, 2011 at 11:53 PM
- ilovelimegreen said...
As sad as I am to see places like Bartleby's close, the flip side people - - bibliophiles to be more specific --all around the world can enjoy their offerings. Scrolling through online listings for a bookseller does not replace browsing the shelves in a brick-and-mortar establishment - especially when you find that book you didn't know you were looking for until you saw it or you stumbled across a book misshelved as if it was waiting for you.
- July 7, 2011 at 12:15 AM
"Can't smell the internet"...brilliant! I don't mess with rare (expensive) stuff either, but an old bookstore always has some gem, just waiting to make me happy when I stumble across it.
- July 7, 2011 at 12:19 AM
- vir beātum said...
Beckford's 'Thoughts on Hunting' in the last pic is a must. That was the go-to volume for at least half a century.
I'm lamenting with you. Even libraries are ditching their old tomes to make way for sofas, since they can replicate their collections online. In the future, 'library' will be a synonym for 'cafe'. - July 7, 2011 at 6:14 AM
- ADG said...
vir...I'm lamenting this morning with all of you. I'm a passionate collector of other things so I shy away from more expensive biblio-rarities. But I feel the same way about them as I do vintage cars. Thank God that there are those out there with the money and passion to assemble a collection of these things and ardently look over them. I can tell you firsthand, ardent stewardship ain't manifesting amongst the treasures at the Library of Congress. They don't have the budget or the staff.
NJJack...but you can only get two of those rare gem books in that TT!
LimeGreen...no they can't enjoy their offerings. 'cause you can't touch 'em and smell 'em. And that's two-thirds of the gig. Kinda like women.
Hilton..."CMT bumpkins house in South Riding, Virginia is full of crap from The Pottery Barn." SPOT on. That's why I don't date South Riding gals. I've got LFG today...I'll call you tomorrow.
MainLiner...I'll email you re your buddy Jay. He sounds like just the guy for my car stalking. Listen man, the sporting and exploration stuff at Bartleby's was incredbible. But there wasn't a book behind glass per that category any cheaper than eight hundred bucks. So here's the deal, check with Linc...determine if Jane Doe is out of rehab...arrange a little something. Based on the degree of arrangement. Consider yourself the owner of a one-thousand dollar gift certificate from Bartleby's.
LPC...I LOVE the fact that this little story evoked that for you. Everyone's dad always seems cooler and more fun and intriguing etc from the outside looking in. Especially for me since I really never had much of a dad. So I do hope that your Professor C./dad memory bank is chock-full of great recollections, not unlike this rare-book inspired one.
Yankee-Whiskey....regrettably so. Just like..."coat required"..."thank you"..."excuse me"...and the good sense not to say words like... f%#K in front of children...or anyone for that matter. - July 7, 2011 at 7:30 AM
Sad to see the disappearance of all these small, unique shops that made Georgetown what it was. It has really lost it's uniqueness with all the chain stores...and numerous vacancies.
- July 7, 2011 at 8:52 AM
So sad - a wonderful bookshop, and not many like it left (or physical used bookstores for that matter). Although it is certainly handy to find rare treasures online,as you remark, you miss out on the physical aspect of finding the right quirky book that is not only a book, but a story of who has owned the book over the years.
- July 7, 2011 at 11:53 AM
What was it your buddy Graham's father said? "If you cure cancer and bring peace to the Middle East, but you close Sessler's, guess which one they will remember you for"? Or words to that effeck...
But that was a generation ago.
Motte Allston Huger Elliot XIII - July 7, 2011 at 12:17 PM
We still have some good rare and old book stores in the San Francisco Bay area. For time being, anyway. I liked your picks (especially the Whist volume. I played like a fiend at university) but I am fretting over The Complete Angler. My dad gave me that book when I was 11 and insisted I read it before he taught me to tie my own flies. I never got the hang of fly fishing. I would get all caught up in the technique and forget that I was supposed to be flirting with and dazzling a trusting old fish under there somewhere. Ah. The hip waders. The strange sensation of being waist deep in cold rushing water without feeling it. Wish I knew what edition the one in your picture is.
- July 7, 2011 at 12:50 PM
- CeceliaMc said...
Frankly, I find it alarming that people in damn Georgetown can't afford $1300 first edition books AND that they can't afford $1300 shipping pallets cum "distressed" pine coffee tables with authentic rusty wheels...
In this instance, the fact that some homogeneous corporate Best Buy outlet might make an appearance, should be the least of our worries. - July 7, 2011 at 1:28 PM
The Georgetown of my youth - the 70's and 80's was vastly different from the Georgetown of today. It represented both ends of the spectrum. The funky record / paraphernalia shops, small shops selling youth oriented "cool" clothes, weird little gift shops offering plants in macramé hanging planters, pottery, hand made leather goods and sterling silver jewelry. The other end was represented by some rather expensive restaurants and retailers. There wasn't any meaningful intrusion of any chain restaurants or retailers (there may have been something like a Little Tavern Hamburger stand but that was about it). Sadly that era is gone and there is very little character left. Surprisingly there are parts of Frederick Maryland that remind me a bit of the Georgetown of old. A very well reviewed and pricey restaurant rather close to where my son buys his skateboard components.
Best regards,
JRC - July 7, 2011 at 2:03 PM
McMurtry has moved Booked Up to Archer City Tx because, face it, books require a lot of space and space is increasingly expensive.
I go there once a year. Wonderful. - July 7, 2011 at 5:47 PM
- Raulston said...
Was there Sunday as well. Muggy and rather warm but a great time indeed!
- July 7, 2011 at 8:47 PM
- Easy and Elegant Life said...
Well, that's that. By the time I get up there to restomp my old grounds, I doubt I'll recognize the place. Couldn't they have confined the national chains to the mall? At least it had a nice design and was decently hidden.
Is Clyde's still there? - July 8, 2011 at 11:17 AM
- j.mosby said...
ADG your Library is starting to rival Hemingway's in his Cuban home! Great collection my friend!
- July 8, 2011 at 5:07 PM
Bartelby's do a lot of book shows all over the East Coast. You should go to every book show you can, if you don't already--you'll enjoy them.
- July 8, 2011 at 5:09 PM
I'm not sure if it's still true, but Portland used to have more bookstores than anywhere else, or more per capita, or something like that.
It still has Powell's, including all the satellite Powell's. Look 'em up on the Intarwebs.
Both Barnes & Noble and Borders declared bankruptcy this year. Libraries are dumping their "outdated" books at alarming rates. Used bookstores are getting fewer and farther between.
Yet we still have AbeBooks, an Intarwebs system for individual bookstores to have an on-line presence. Only good if you know what you're looking for, but you can help keep bricks-and-mortar book vendors in business, even if they aren't in your neighborhood--or state. - July 8, 2011 at 5:18 PM


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Already a paid subscriber but not registered for online access yet? For instructions on how to get premium web access, click here.
Long Island home sales up 20 percent, prices flat
The Multiple Listing Service of Long Island reports that 2,086 homes in Nassau and Suffolk counties were contracted for sale in August, a big jump from the 1,736 pending home sales recorded in August 2011.


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The first day of spring is less than a month away, giving us hope that all of this snow, ice, rain and cold will disappear and that we can get back to living in comfort.
But before the sun melts the freeze away, now is a good time to catch some deals on things you'll likely need for the spring. Here are some deals that were valid as of early Tuesday morning, although be sure to check first because these deals expire fast.
What better way to usher in spring than with a barbecue? The Char-Griller Smokin Pro 1224 Grill is $198 from J&R, although adding an estimated $60.90 for shipping will drive it up to $259. GrillsDirect.com sells it for $219.98 with free shipping, which is 19% off the list price of $269.99.
Paying $1,000 for a bike is a lot of money, but the 2010 Motobecane Immortal Pro Bike from Bikes Direct with free shipping is $1,595 off the list price and the lowest total price we could find. The bike has a high modulus carbon fiber Monocoque frame/fork, Shimano 105 shifters/brake levers, FSA carbon-wrap crankset, Ritchey com bar and more. The sale ends Feb. 28.
If that's too much bike for too much money, Walmart has the GMC men's Denali 700C 26" Road Bicycle in yellow/black for $159. Shipping is $2.97, or it can be picked up for free at the store. The bike has a 21-speed Shimano drive train, aluminum frame, side pull caliper brakes, road-race style drop handlebars, Vitesse seat and more.
Instead of celebrating the start of spring by staying local and riding your new bike, you could shake that cabin fever by taking a trip. The Travelers Club Euro Value II 3-Piece Set in black or red is $29.95 from ShoeBuy.com and coupon code "SAVE10" cuts it to $19.95. Shipping is free. It's the lowest total price we could find by $16. The set includes a 20-inch rolling carry-on bag, 14-inch boarding tote bag and 10-inch travel kit.
Picnic Table
Walmart sells the Stansport Portable Picnic Table, model no. 615, for $48.95. Shipping is 97 cents or free in-store. It's the lowest price we could find by $4. The picnic table is portable, which is why we think it's a good thing to have for spring and summer and has a 54-inch umbrella and anodized locking aluminum frame. It folds compactly for storage or transport.


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Celebrating 19 years in Montrose, find out why Uptown Face & Body Spa was voted Glendale's best! Now is the time to pick up that phone and book an hour of bliss. The salt glow body scrub & papaya enzyme facial includes aromatherapy, infrared heat, warm steamed towels and moisturizers for $99. Call Maria at (818) 248-8829 or check out the other packages at www.uptownfaceandbody.com. Treat yourself Montrose style!
Enjoy Breakfast at Etc… Gourmet Kitchen!
If you like your croissants big, warm and fresh, Etc… Gourmet Kitchen is your place! You'll find an irresistible assortment of freshly baked pastries, muffins, scones and quiches artfully displayed on French étagères. Customers are raving about the richness and "wake up" quality of their Jones coffee and their view of the mountains. Meet owner Robin and staff at 3600 Ocean View Blvd. right behind Starbuck's.
Parents Night Out!
Parents, it's time for a date night in Montrose! On Friday, Jan. 30 you can drop your kids off at the Sparr Heights Recreation Center for pizza and movies. The cost is only $15 per child from 6 p.m. to midnight. The first 20 couples that call (818) 548-2187 to book will receive a $10 gift certificate to spend that night in the Montrose Shopping Park! See you in Montrose!


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Audio High Volume Software
Got Paper? We have a Document Management Software program that will allow you to scan or import your files using a high volume document scanner. The files are converted to pdf using our OCR program and is simple to use. Try it for 30 days.
- Access_Deluxe_1.2_setup.exe
- Digital Records Management
- Demo ($)
- WinXP, Windows2000, Windows2003, Windows Tablet PC Edition 2005, Windows Media Center Edition 2005, Windo
Compresses music from 1/50th to 1/100th its original size by removing dissonant parts of sound and also optimizes it for lower speaker-stress, dynamic equalization (2-3 times less hearing stress at high volume), non-compression modes and much. ...
VFTPX is designed to support high-volume upload/download processes. VFTPX is one of the world's fastest, most capable FTP client applications. Designed to support high-volume upload/download processes, VFTPX can establish 1-50 simultaneous, multithreaded FTP connections.
- VFTPXSetup.exe
- SafeFreeSoftware.com LLC
- Freeware (Free)
- 348 Kb
- WinXP, WinNT 4.x, WinME, Win2003, Win2000, Win98
SMTP Server Pro is a powerful SMTP POP3 mail server program designed for satisfying the requirements of huge organization in high-volume messaging. it has security features to prevent DDoS attacks and block SPAM. Ideal for laptop PC users.
- smtpsrvpro.zip
- IM-Soft
- Shareware ($69.00)
- 13.88 Mb
- Win98, WinME, WinNT 3.x, WinNT 4.x, Windows2000, WinXP, Win7 x32, Win7 x64, Win8 x32, Win8 x64, Windows2003, Windows Vista
DocsVault Plus is not only the simplest, most affordable Document Management and eMail archiving application available, it is also a powerful, high-volume imaging and document archiving system with features matching or surpassing those of expensive ...
OctoTools is a document management tool that encompasses Forms Design, Report Formatting, Electronic Distribution, Printing, and PDF conversion. Once set up, OctoTools runs automatically to provide high volume throughput without operator involvement. ...
SMS messaging framework to send, receive and automate SMS mobile messages, low and high volume. Support for GSM/GPRS modems, SMPP and HTTP service providers and e-mail. Integrates with MS Access, MS SQL Server and MySQL.Use it for any scenario where. ...
- mmsrvr.exe
- ActiveXperts Software
- Shareware ($1495.00)
- 4.77 Mb
- Windows2000, WinXP, Windows2003, Windows Vista
The Linux Operating System is becoming the popular open source operating systems in the world. With large number of active installations, Linux operating system has become the core of many high volume, business-critical applications. It becomes. ...
ActiveXperts SMS Mobile Messaging Server 5.0 is a useful software which alows you to send, receive and automate SMS mobile messages, low and high volume.Major Features: Support for GSM/GPRS modems, SMPP and HTTP service providers and. ...
Diplomat Enterprise Edition efficiently controls business-critical file transfer environments. It is optimized for businesses that require tight oversight of a high volume of file transfers with a large number of business partners, vendors, or other. ...
DocPoint is a document management system that provides organizations of any size with a powerful and affordable paperless office solution. DocPoint delivers high-volume information capture, instant document and record retrieval, and seamless. ...
- docpoint_personal.exe
- Do-It! Software LTD
- Shareware ($149.00)
- 61.01 Mb
- Windows 2003, XP, 2000, 98, Me, NT
EPS 2 - Event Photography Systems Version 2 is a turnkey event photography application aimed at maximizing onsite sales and ease after sales activities. As such it uses a configurable and streamlined work flow to maximize turn around of high volume. ...
Related: Audio High Volume - High Volume Laptop - High Volume Scanning - High Volume Players - High Volume Software


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Room 1
Room 2
Room 3
Room 4
Room 5
Recreate these simple Japanese dishes served up at Nadaman from your own kitchen.
Flavourful dish, using only the freshest lobster.
An exquisite combination featuring chrysanthemum greens, grilled sea bream, sweet fish and golden bread shrimp rolls.
(86 20) 8917 6498
Level 3
Lunch 11.30am - 2.30pm Dinner 6pm - 10.30pm
Smart Casual
Smoking is not permitted at Nadaman.


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Waking computers remotely from a powered-down or "sleep" state is done by performing the Wake on LAN process. Wake on LAN sends a signal from a sending PC to the sleeping PC that causes the sleeping PC to boot. The signal is sent through a local network and is called a Magic Packet. Magic Packets are sent using a Magic Packet program commonly found online. The sleeping PC's physical or MAC address are needed to send the Magic Packet successfully.
- Skill level:
- Moderately Easy
Other People Are Reading
Things you need
- Remote PC
- Sending PC
- Local network
- Magic packet program
Show More
- 1
Power up the PC that will be booted remotely. During the boot, press "F11" to enter the PC's boot menu. In the boot menu, locate and enter the "Advanced Power Management" option. Locate "Power on by PCI Device," and enable the option. Exit the boot menu, and let the PC completely boot.
- 2
Press the "Start" icon on the remote PC, and open the "Command Prompt." Type "ipconfig/all" into the prompt, and hit "Enter." Move down to the "Physical Address" or "MAC Address" text, and write down the number to the right. This is the network address of the PC being awekened from sleep. Ensure that the remote PC is connected to a local network, and power off the machine.
- 3
Install a program able to send Magic Packets onto the PC sending the boot signal. Several freely available programs are included in the Resources.
- 4
Connect the sending PC to the local network. Run the Magic Packet program. Type the remote PC's physical or MAC address into the appropriately labelled field in the Magic Packet program. Press the "Send" or "OK" option to send the Magic Packet. The remote PC wakes from its "sleep" state.
Tips and warnings
- Check your MAC address often. Changing networks or network settings can change your MAC address.


text:
Along with the introduction of the Fujinon XF55-200mm f/3.5-4.8 R LM OIS telezoom, Fujifilm has released an updated version of its X-mount lens roadmap. The updated chart includes 10 Fujinon lenses and 3 Carl Zeiss optics. Click through / scroll down to see the roadmap in its entirety.
Fujfilm Press Release
UPDATED: FUJIFILM X-Mount Lens Roadmap
13 high-performance lenses to support a much wider range of photography
FUJIFILM Corporation (President: Shigehiro Nakajima) is issuing an updated version of the roadmap for FUJINON X-mount lenses for its FUJIFILM X-Pro1 and FUJIFILM X-E1 compact system cameras. This is further to the last XF lens roadmap issued in June 2012.
In response to the large amount of feedback and many requests from users regarding its interchangeable lenses, FUJIFILM aims to further improve the quality, has carried out a review of the lens design and has added new technology.
When you combine the below 10 XF Lenses with the three X-Mount Lenses that Carl Zeiss announced in September 2012, there will soon be 13 high-performance lenses available for the X-Mount system which should meet the needs of every photographer and will support a wider range of photography from ultra-wide-angle at 15mm*1 to super-telephoto at 305mm*1
*1 35mm format equivalent
* These are not the images of the final product.
* The above roadmap is as of April 17th 2013. Specifications are subject to change.
* Each value in ( ) is equivalent to 35mm format.
For enquiries or information about the Carl Zeiss X-mount lenses, please visit the following URL: http://lenses.zeiss.com
Image Gallery
Click on a thumbnail to see the full version.


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tha blood of tha inoccent stains tha ground/ from 16 bullets making terrfing sounds/ it used to be me him just clownig around/ till a clip put him 6 feet underground/ cuz heads empty like shells in tha land of hell/
Short? I guess that's really all you need to have said to get what you needed to say out, na'mean? Didn't take much to state what happened to your homeboy, family member, sibling, etc. Yet, I'm sure, they'll be continuing of this piece, if not, then.. Short, but true, hard times within worlds. That's society today, though, dawg. It's negative, but we have to maintain and live. My blessings..
this was dope would like to see this being the last lines of a poem or something...but its def dope......keep doing ya thang


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Swansea captain Ashley Williams out of Europa League clash
- From the section Football
Europa League Group A
- Venue:
- The Liberty Stadium
- Date:
- Thursday 3 October
- Kick-off:
- Coverage:
- Live text commentary on BBC Sport website, live commentary on BBC Radio Wales and updates on BBC Radio 5 live.
Swansea City boss Michael Laudrup has confirmed Ashley Williams is out of the Europa League clash against St Gallen.
The centre-back continues to struggle with an ankle ligament problem and could also miss the Premier League match against Southampton on Sunday.
Laudrup hopes Wales do not play him in their two World Cup games against Macedonia and Belgium.
"We should all do the best for one person and that's for Ashley not for Swansea or [Wales]," said Laudrup.
"If Ash is playing or not playing on Sunday I think he should still go with the national side so they can see him. The doctors and the physios can look at him.
"I've spoken to Chris Coleman a couple of times [in the past] and I think we agree the most important thing is the player."
Laudrup said in September that the club and Wales must cooperate more to safeguard the health of Williams, who missed the 2-1 Premier League defeat to Arsenal last Saturday.
"I'm a little worried, but the problem with Ashley is he's an international," Laudrup said.
"We have to be careful, but I mean the national team as well."
Swansea and Wales captain Williams missed his club's famous in their opening Europa League group stage match but managed to make the
Williams should have played in both of Wales' World Cup qualifying defeats in early September, but a yellow card in the defeat in Macedonia five days later in Cardiff.
"They [Wales] have to go and play two games [in a short space of time]. If he doesn't get that recovery he could bring this injury for a month," Laudrup added.
"I would never ask a player to step down, not to play with his country but I think it's important in combination, club and national team, that we find a solution that can benefit all of us.
"There will be a moment I think where Ashley will need two weeks without a game."
Laudrup is also likely to be without Garry Monk and Pablo Hernandez against St Gallen, and the club will monitor Angel Rangel leading up to the game.


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'After sweeping into the world of politics with an impressive showing this last November, the Tea Party movement-- characterized by its commitment to lower taxes, less spending, and less government intervention into the economy-- swept into the world of cinema this April 15th, the IRS deadline for filing income taxes informally known as "tax day."
The Atlas Shrugged film, an adaptation of philosopher Ayn Rand's bestselling novel, opened in select theaters throughout the United States to mixed reviews. Set in a somewhat dystopian near-future with many parallels to our world today, Atlas Shrugged is the story of a society in a time of economic and moral crisis.
The plot centers on the mystery surrounding the disappearance of society's most able geniuses of production, its "robber baron"-like giants of industry. Ayn Rand wrote the novel as a sort of extended parable to praise hard work and rugged individualism while criticizing welfare statism, regulatory statism, and crony capitalism.'
Read the rest of my article at CAIVN.
Wes Messamore,
Editor in Chief, THL
Articles | Author's Page


text:
A whole new chapter of Age of Wushu is just around the corner. Snail Games today announced the fourth and latest expansion, Tempest of Strife. In the content update due later this spring, players will be able to join six new Sects and experience weather changing. Here is a list of what to expect in this expansion,
- Three Emerging Sects – The ferocious Villa of Beasts, the vigilant Xu Family Manor and the acupunctural healers of Golden Needle Sect will be open to all heroes.
- Three Hidden Forces – The legendary Palace of Shifting Flowers, the shrouded Peach Blossom Island and the villainous Rootless Clan will only open their doors to those who have a huge reserve of latent talent.
- Immersive Weather – Experience thunderstorms, hazy rain, blizzard, sandstorm and even eclipse in Tempest of Strife! Unique weather conditions will also trigger mysterious events.
- School Betrayal – Tired of your yammering old masters? Want to don whole new colors? Players from the original Eight Schools will be able to join the six emerging Sects by Betrayal, Excursion or Incognito.
- The Vagrants – Become the nameless wanderer: the self-styled vagrants can throw off school restrictions and build up their own inner skills.
- Face-lifting Surgery – For perfectionists and ambitious beauties, are you not satisfied with your appearance? We've made it possible to alter your facial features, but you must first seek the location of this "doctor".
- Equipment Inscription – Inscribe and personalize your gear with your own unique names! Show off your poetic creations to the world.
Age of Wushu team will be updating information on each feature later on. Please stay tuned to more news on the official site.


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