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Does Hatsune Miku's newest top the charts?
A virtual mainstay of Japanese culture, Hatsune Miku is a Vocaloid- software that can 'sing' music via a sound modulator and synthesizer. In video games, she has had an excellent run, thanks to some great rhythm titles by Sega published on PlayStation platforms. This year's Hatsune Miku: Project Mirai DX marks the (western) debut of the franchise on Nintendo systems- and the developers have really gone all out to create a highly extensive game, that rhythm game fans would be remiss to not at least give a serious look. Others, however, will probably hear all the hubbub, and try to take a serious look at the game- and possibly come away confused.
This Nintendo 3DS game can be hard to get a handle on, especially when it is booted up at first. Whereas anyone with at least a faint knowledge of the series would be going in expecting a rhythm game, first impressions differ almost entirely at first: you are presented with what seems to be a sort of life simulator game, in the essence of Tamodachi Life, asking you to pick a 'partner' (of which the eponymous Miku is only one), an apartment to live with her in, and then which tasks you with furnishing said apartment. You are presented with an overwhelming array of options- feeding your 'partner,' buying clothes for her, just chatting with her, giving her gifts, and so on.
The actual meat of the game, the rhythm game portion, is actually tucked away at the bottom corner of the menu- and when you click it, you realize that your partner is actually an idol. You're presented with a list of songs to choose to perform, and you're on the road.
"Whereas anyone with at least a faint knowledge of the series would be going in expecting a rhythm game, first impressions differ almost entirely at first: you are presented with what seems to be a sort of life simulator game."
Project Mirai DX plays like a standard rhythm game- there's not much to talk about here. It's a single rail system (meaning that all inputs appear in the same spot on the screen), which makes life easier for people who may be intimidated by multi rail rhythm games. The input timing detection seems to be very lenient- I found it possible to keep going and not miss a beat even when I mistimed my button press by a second in several instances.
The one interesting thing to note about the rhythm gameplay is the new touchscreen mode. For players who are possibly daunted at the prospect of having to juggle multiple button presses, the touch screen mode provides something of a compromise- you are only asked to perform inputs via the touch screen. These are largely simple, such as taps, and long presses, and mostly all occur on the same spot on the screen, meaning that anybody who is completely lacking confidence in their coordination skills probably wants to start out here.
It's a well done alternative to the traditional mode, and completely viable- you can easily go through all the tracks in the game with just touch screen inputs, though after a while, you will probably feel confident enough to want to make the switch.
"The input timing detection seems to be very lenient- I found it possible to keep going and not miss a beat even when I mistimed my button press by a second in several instances."
Of course, any rhythm game is only as good as the songs that it includes, and for western audiences, therein lies Project Mirai DX's greatest advantage- and disadvantage too. Project Mirai DX includes a staggering variety of content for the player to make their way through (a grand total of 48 songs are included; these songs cover a wide variety of genres, and are usually different enough from each other for there to be no repetition across the entire track list), and with each player probably wanting to best their own performance on each track, there will be no shortage of playtime that one will be able to get from the game.
But whether or not you like the music comes entirely down to the Vocaloid singing. For many, it's charming, trying to hear the synthesized words, in Japanese and in English, singing in all sorts of odd pitches, and can definitely add to the appeal to the game. To others, however, it might seem odd, or even ultimately an audio representation of uncanny valley- just uncomfortable enough that they want to stop. Personally, I didn't have much issues with the music at all, and enjoyed a fair few tracks by the end of my time with the game- but just in case you're a first timer looking to jump into the series with this game, remember, your mileage may vary. It may be a good idea to look up some YouTube videos, or play the demo on the eShop, first.
Project Mirai DX looks as unusual as it sounds. The game has ditched the usual series aesthetic for a more chibi, cuter look – again, probably done in an attempt to appeal to a wider audience beyond just the rhythm game enthusiasts that these games usually cater to. The game looks great on the 3DS, playing to the system's strengths, with vibrant colors and a clean UI, and the art style usually does it well- if you are not one of the people who are immediately turned off by the chibi look.
The entire package ultimately comes down to being very elaborate dressing for a very competent and recommended rhythm game- sure, you can play it as an apartment virtual life simulator, moving in with your favorite idol, playing games with her, buying her gifts, making her food, getting better furniture, and for many, that may be reason enough to look into buying the game. Thanks to titles such as Animal Crossing, Tamodachi Life, Fantasy Life, and Disney Magical World, the 3DS has an audience for that kind of a game, and Project Mirai is certainly elaborate and well made enough on that front to appeal to that demographic. However, underneath all of that is a very well done rhythm game too, one that is accessible enough to hook some new fans in, and ultimately deep enough to also appeal to genre enthusiasts.
This game was reviewed on Nintendo 3DS.
Elaborate rhythm game, extremely well done touch screen mode, a well done life simulation mode, a huge list of 48 songs with a good variety across the track list
The life simulation can almost distract from the rhythm modes, the game might just look and sound weird enough to turn people off
The most accessible Hatsune Miku game yet is also probably the most extensive one, and is an easy recommendation for newcomers and fans alike.
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Timetable trouble on NDMC's website
People coming from outside the city for vaccines rely on the information given on the civic agency's site and have to suffer because of clash of timings
People coming from outside the city for vaccines rely on the information given on the civic agency's site and have to suffer because of clash of timings
Rakesh Pundir, 34, came all the way from Dehradun to Delhi to get the yellow fever vaccine as he will soon be going to South Africa. Just like everyone, he had also searched on the Internet about vaccination centres in the city and their timings. Sadly, what he saw was not what he got when he reached one of the centres in the city.
Vaccine woes: Yellow fever vaccination centre at Dr Ram Manohar
Lohia Hospital. Rakesh Pundir, Anuj Leekha and Haokip Helam outside
the centre in New Delhi on Wednesday. Pics/Subhash Barolia
Pundir went to Ram Manohar Lohia (RML) Hospital to get the vaccine. The other centres in the city are International Inoculation centre, near Mandir Marg, Palam Airport and Delhi Public Health Laboratory, Alipur Road. Among all the centres, RML is the only centre which is centrally located. Due to its location, most of the people come here for the vaccination.
About time
Many people have been facing problems as the timings mentioned on the website are different from the actual timings. According to the timings available on the NDMC website, the vaccination is done on Wednesdays and Saturdays from 9.30 am to 12, while the timings written on the RML board outside the hospital are Wednesday- 10am to 11.30 am and Saturday- 9.30 am to 11 am.
"I came here this Saturday, but couldn't get the vaccine, just because of this clash in timings. Wherever I checked about the timings, they were all different. As I could not get the vaccine that day, I had to stay here and wait till Wednesday. Finally I got the vaccination today," said Pundir. According to NDMC officials, the civic agency may have not updated the timings and confirmed the timings with the hospitals.
'Don't blame us'
"They don't check with the hospitals. Hospitals keep on updating their timings according to the availability. Once they have updated it on the website, they don't bother to have a look at them again," said one of the NDMC officials on condition of anonymity. Similarly, Haokip Helam, who came from Manipur, faced the same problem. "It's so chaotic here. Nothing is organised. I was doubtful whether I would get it today or not. They are giving the vaccine to only 100 people at one time. Correct information should be provided on the website," said Haokip.
Did you know?
The vaccine consists of a live, but attenuated, strain of the yellow fever virus called 17D. The 17D vaccine has been used commercially since the 1950s. The mechanisms of attenuation and immunogenicity for the 17D strain are not known. However, this vaccine is very safe, with few adverse reactions having been reported and millions of doses administered and highly effective with over 90% of vaccine0073 developing a measurable immune response after the first dose. Yellow fever vaccination certificate is issued for 10 years but becomes valid only after 10 days of vaccination.
The other side
Amit Prasad, official spokesperson, NDMC, said "I have to check with concerned department. If there are any such discrepancies, we will definitely take some action." Dr T S Sidhu, medical superintendent, RML, was not available for comment.
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subset: commoncrawl


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Ever wondered what would happen if two characters from your two favourite books meet? I do that all the time. Reet Singh, has gone a yard ahead and has written this lively conversation between two of her protagonists – Mita from 'Take One Fake Fiancé' meets Mohini from 'No Escape from Love'.
Read the conversation below and Take your pick. I'd say pick both books of hers 🙂
'Excuse me, but I think I know you from somewhere…'
'Oh,' Mita looks up from the Lehenga she's admiring and shakes her head politely. 'I don't know – I would remember if we'd met before.'
She would – the girl standing to one side and gazing at her with perplexed curiosity has a face that would launch a thousand ships. Difficult to forget – and then there's her hair – gorgeous and dark and cascading all the way to her waist.
Read more on Saiswaroopa's blog: When two worlds collide – A #ReleaseDay post by Author Reet Singh


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Murraya exotica is my favorite shrub. Its powerful fragrance fills the air and makes you enchanted with it. Growing in a large clay pot, its strongly perfumed flowers attract lots of bees and butterflies. Strangely, with the change of season, butterflies have also changed. I think previous ones just migrated to some more warm region. And the ones coming here are more cold tolerant. Here are some of the pics i captured of this pretty shrub and do i need to tell you that the fragrance made me not to move away for a long, pretty long time actually.
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22 Responses
Nice photos. I think my mom has a similar plant in her garden. I still remember the strong sweet smell of the tiny white blooms.
I wouldn't have thought that was a butterfly – ?? Do you know exactly what it is?
Obviously the insects love the flowers! I wish I could smell the fragrance too.
Lovely shrub…good shots of the bees too. I wish I could smell it.
Magic indeed, Muhammad! Marvelous to get such lovely fragrance and enjoy the garden visitors flocking in too! And, to capture them is another treat altogether! Is Murraya paniculata a close relative of your plant? I was introduced to it a couple of months ago and it has a strong fragrance too. Your butterfly looks quite similar to Lerema accius (Clouded Skipper), one that visits our garden quite regularly…is it the same?
Hi~~ It looks like a cross between a Star Jasmine and a Choysia ternata. Probably not hardy in my neck of the woods. Too bad. I love fragrant flowers. It looks like the bees do too. I desperately need [want] a heated greenhouse.
Orange Jasmine, the common name of Murraya around here is one of Liz's favorite plants. We keep one grown as a standard in a pot on our balcony
I love bushes like that. The smell fills the garden and brings a rare treat to the senses. Nice photos of your favorite.
The bloom looks a little like a citrus flower. I love fragrant plants, especially those that attract butterflies. Thank you for sharing.
I can literally 'feel' your post as I have a Murraya plant growing in my garden and I too am a willing victim of its aromatic magic.
Those white flowers just look like they would smell good. I agree with Grace that it reminds me a lot of Choysia.
This plant has a nice name, beautiful flowers of pure white that smells good. What more can we ask for? Wow!
Love your flowers, I understand what you mean of not moving away..
its simply amazing a fragrant isn't it?
Rally nice pics of such a nice fragrant plant 🙂
What a nice flower and beautiful foliage too! I love the perfect shape of those flowers. Wish I could catch the fragrance!
What a lovely plant for a balcony. I love white flowers and having a wonderful aroma is a plus.
Always Growing
Your Murraya seems to be very popular in the inset-world! I love plants with fragrant flowers. I've always felt that the unscented ones are only half as beautiful, no matter how good they look.
Lovely pictures and what a large bee like insect in the last few photos. Val
Oh what a treat that must be! That scent must make you swoon. I know it would me but I am a such a sucker for great smelling plants. Funny, now I want to linger on this post as if I might actually be able to smell those blossoms too. LOL
What a gorgeous plant..and wow..those bees..huge! Lovely post as always.
My murraya plant is also producing lotsa blooms now and the fragrance makes my garden smells so nice. I love going nearby the plant and enjoy the sweet scent.
I live in a block of units surrounded by these shrubs an some fully grown Murraya trees. They are flowering abundantly now and the smell is overwhelming and repugnant because it's just too much; and living in a bit of a gully between other houses and units, the smell doesn't get moved around or blown away easily. Murrayas are ok if they're trimmed and looked after properly but to just let them go wild is irresponsible, especially to one's neighbours. One should research one's plants carefully before buying and planting to make sure they aren't allergenic like Murraya obviously are.


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MOST people in Slovakia want to live in a country in which the state is on the side of decent and hard-working people, said President Andrej Kiska in his New Year's address. The address has been welcomed by political analysts.
"Most people want a state that would be responsive to their social needs, not only in the form of slogans and campaigns, but by taking measures with respect to specific cases of people who find themselves in an insolvable situation due to life's adversities," Kiska said in his address, as quoted by the TASR newswire, claiming that if many other countries have developed effective and well-targeted support schemes, Slovakia should follow suit.
Kiska went on to say that Slovaks also need a well-functioning state that would be able to respond quickly to various problems and to provide flexible support for meaningful projects and good ideas that would contribute to the country's advancement.
The president also pointed to a number of unjust social and regional disparities and to problems that ail Slovakia. However, he added that these are not unsolvable.
"We have gradually introduced complex rules to prevent the embezzlement of state finances, but – despite these complex measures – instances of illicit enrichment to the detriment of patients and/or public resources still occur," Kiska said, as quoted by TASR, adding that people are complaining about the fact that these "complex rules" make it very difficult for many meaningful projects to be implemented. "It is not rare for proactive people to be unable to overcome obstacles in a incorrupt way, while others manage to do it using corrupt practices."
Kiska further called on all people to create effective pressure on politicians to come up with ways to improve the management of state and public institutions in the year ahead, which will most probably be marked by the run-up to the 2016 general election.
"We will have a good opportunity to listen carefully to what has been accomplished [by politicians], to what is being stated and to how politicians view their future," the president added.
The president's speech also broached the situation in Ukraine. Kiska stated that there are no guidelines on how to react to this situation, but he added that nobody has the right to challenge the fundamental principles of sovereignty, self-determination and the right to make one's own decisions.
"It is in our own interest to contribute towards the unity of Europe in this principal issue by our actions," he emphasised, as quoted by TASR.
Political analyst Ján Baránek highlighted Kiska's appeal that the state should be on the side of decent people and all those who need its assistance.
"I consider this message to be very important, as such statements are unusual in presidential speeches," Baránek said, as quoted by TASR.
He went on to compare Kiska's address with those of former president Ivan Gašparovič. While both presidents referred to the hard-working nature of Slovaks and unjust social disparities in the country, Kiska – unlike his predecessor – also talked about excessive bureaucracy.
"He also urged all people, telling them that they can contribute to change," Baránek added.
He however views it as quite controversial for Kiska to state that people have not given in to mistrust altogether.
"What I found missing was the identification of a source for this trust, why people who are disgusted with corruption [...] should have confidence," Baránek stated, as quoted by TASR.
Political scientist Michal Horský told TASR that he views Kiska's message as compassionate. He claimed that Kiska gave up on political evaluations, paying attention to the problems of society and the people instead.
"Kiska first pointed to humanity, the need to have a just state, well-functioning social mechanisms, and social solidarity," Horský said. "These appeals correspond to a certain extent with the hopes held by the vast majority of people in Slovakia."
What was rather surprising for the analyst was the fact that the president broached the issue of the Ukrainian conflict and called on Slovaks to endorse international law.
Source: TASR
Compiled by Radka Minarechová from press reports
The Slovak Spectator cannot vouch for the accuracy of the information presented in its Flash News postings.
2. Jan 2015 at 13:00


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Young Citizens: A Case Study of Institutionalizing Children's Participation in Community Decision-making
This article provides empirical evidence from Moshi, Tanzania that children as young as ten years old have the capacity to participate in community decision-making around complex issues such as children's safety. It identifies a collective capability set for children's citizenship and the structural conditions necessary for their safe and meaningful participation. It then addresses the practical question of how to create a legal framework to implement children's citizenship. Placing the evidence in the context of deliberative citizenship and modern child development psychology theory, the article arrives at a new concept of citizenship as developmental and accessible to all ages.


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Prince Philip was due to leave before Orkian got on stage but as soon as Prince Philip heard the comedy sketch, he stayed for the entire performance. Portabella mushrooms are sold both with the stem or just as caps. One of the slowest internet providers in the country is dial-up internet providers.
Posted by: หาเพื่อน | 2015.06.03 04:49


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IT Administration
-- Network Tools
Web Services
IT Management
IT Administration
Network Tools
DCRE Labs
originally developed this section of the site to provide a handy, web-based reference resource for network development. However, the sudden rise of DDOS attacks required us to remove most of the tools (Actually, they have been relocated to our partner group over at
, but registered access is required.) The only debugging tool we have opted to leave behind is a simple IP reporting mechanism:
Hi there.... I believe you hail from
220.127.116.11 (port 34628)
via something that gives me no REFERER info
as of Sat, 11:44 AM (PST) October 24th, 2020
We apologize for having to remove the toolset but our "free" services were interfering with those "non-free" clients who pay the bills and let us offer other "free", less alluring targets, thus the decision.
CIDR Reference sheet
(new window)
The CIDR (Classless Inter-Domain Router) assignment style of netmask and IP references is a convenient shortcut but for those who are new (or old!) to this style, we've provided a pop-up window with a
CIDR Reference sheet
for your use. li>
Geographic/IP lookup
(new window)
This site is incredibly useful though not 100% accurate. For larger ISPs and providers, it tends to locate the corporate address. Nonetheless, for quick lookups to get a country or timezone location, this isn't half bad... li>


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I am very thankful to have a family where everyone likes to try new things! Lately, we have been testing our palates with a variety of Asian cuisines.
When I start to see items like fruits or vegetables that are nearing the end of their freshness level, that's when I get creative and try to re-purpose them into a new recipe, hence my very easy to make Cauliflower and Potato Gobi.
I had tried this dish at a local Winnipeg East Indian restaurant during one of their amazing cooking classes and I was hooked! I am SO glad I know how to make it myself now. I'm sure I may be missing a few "traditional" ingredients but whatever, it tastes good to me and my family LOVED it!
Are you looking for other vegetarian dishes? Here a few others from my bloggy friends that you should check out!
- Crispy Bok Choy Slaw from Shannon's View From Here
- Herb Roasted Potatoes from Tales of a Ranting Ginger
- Spicy Barley Vegetable Soup from Frugal Mom Eh
- Quinoa Salad with Chili Lime Dressing from Family, Food and Travel
- 1 small cauliflower head chopped into small florets
- 2 - 3 small potatoes boiled and diced
- 2 - 3 small plum/roma tomatoes cut into small pieces
- 1 small onion diced
- 2 tbsp fresh cilantro minced
- 2 tbsp olive oil extra virgin
- 1 tbsp ginger ground
- 1 tsp cumin seeds
- 1 tsp turmeric
- 1/2 cup water (optional)
- 1 tsp chilies ground
- Add the olive oil to the skillet or wok (I used a wok). Warm the oil using medium-high heat.
- In a separate bowl toss the tomato and ground ginger together and saute in the wok.
- Add the turmeric, cumin, chili mixture and continue to saute for a couple of minutes.
- Add the cauliflower and cook for about 15 minutes (covered). For a 'sauce', add the water.
- Add the potatoes and cook for another 5 minutes uncovered.
- Transfer to a serving bowl and garnish with cilantro.
**Substitution - Use fresh sliced ginger instead of ground ginger for more flavour (unfortunately I didn't have any)**


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Xtenders 7.2m Beachlander
T/T Umm Alhoul
The story
The custom 7.2m tender is one of our most versatile tenders of this length that can be used for guest transfers, day trips and watersports.
One of the key-features of the project was keeping the weight down. Minimising the total weight to 1450kg allowed for a smaller 180hp engine without compromising the performance. Having the engine amidships and a U-bench at the aft deck for maximum comfort created the space for 12 guests.
Beachlanding bow mechanism is a great addition to the design that expands your reach and boarding options. Manual and automatic options are available.
Her lines are dictated by the storage space of the mothership. Among the storage features are fold-down bimini top, folding console and custom lifting arrangement. Styling details were refined in collaboration with her mothership's designers, Pastrovich design.
- Design Xtenders
- Engineering Xtenders
- LOA 7.2m
- Beam 2.6m
- Height for storage 1.4m
- Hull weight 1450kg
- Weight 1650kg
- Drivetrain Yanmar 4BY
- Power 180
- Max. speed 40knts
- Capacity 12 people incl. crew
- Ce Category C


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Polska Liga Piłkarska vector logo
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74 Results Found
ITIL is one of the most sought-after certifications among IT professionals—nearly one in five is ITIL-certified. Find out how ITIL students apply what they learned to their job.
ITIL® is still recognised as the de facto standard in delivering end-to-end, holistic IT services. The 4th iteration retains ITIL's place as one of the key tools at the disposal of organization's seeking to manage digital transformations.
The ITIL 4 update is the first since 2011, and will address the new processes, vocabulary, and methods used in modern IT, including DevOps, Agile, and Lean IT development.
ITIL® 4 Foundation Bridge is a new Global Knowledge course that addresses the specific needs of professionals who have already achieved the ITIL v3 Foundation certification and wish to upgrade to ITIL 4.
The Red Hat® Learning Subscription delivers 12-months of unlimited access to all Red Hat Online Training courses. The Standard RHLS subscription is a higher tier with access to 5 certification exams and up to 2 retakes.
Global Knowledge subject matter experts know certification exams inside and out. They understand the study methods and test-taking techniques that pay off the most when it's exam time. Here are 10 certification exam tips and tricks, directly from our experts and Certification Prep Guides, that will best position you for certification success.
How do you measure the experience and knowledge of an IT professional? One way is through certifications. Earning any certification is a notable achievement, though not all certifications carry the same perceived worth.
IT is a very fast changing industry – what is hot today may be a tiny niche market in only a few years and lesser known things may turn out to be huge trends. That having been said, there are many certifications that will be around for a long time. However, this does not imply that recertification and/or continuing education credits are not required to maintain certification. Predicting the future is always challenging, including in IT, but these certifications are good bets.
Digital transformation means different things to different people. One fact they all agree on is that the capability needed to manage this new paradigm will lead to new ways of working, new skills, new technology and embracing more collaborative ways of co-creating value. That challenge has been the driving force for the latest iteration of ITIL®.
ITIL® 4 reflects new ways of working that have accompanied the digital revolution. Service Management, and ITIL in particular, is still an important toolset but you are now integrating its adoption and use with a vast array of new ways of working (DevOps, Agile, SIAM, Site Reliability Engineering). Since ITIL v3 was released in 2006, a large number of new and updated technologies (Cloud, Serverless Computing, Software-Defined Networking, AI, etc.) have emerged that now need managing. ITIL 4 reflects these changes. Here are some frequently asked questions about ITIL 4, as well as answers that explain what it entails, why we need it and how it differs from ITIL v3.


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The inline four-cylinder 2.0 liter TDI engine in the A4 saloon and A4 Avant sips diesel fuel at a miserly rate of 19.6 kms per liter (based on in-house extra urban cycle testing) while developing 140 bhp and 320 Nm of torque, available all the way between 1,750 and 2,500 rpm. Acceleration of the A4 (using the Multitronic gearbox) from 0-100 kph is just 9.7 seconds and can comfortably attain a top speed of 206 kph. Tree-huggers will also appreciate that the A4 sedan/Avant TDI complies with EU4 emissions standards.
The refinement of this four-cylinder unit in the new Audi A4 is equally outstanding. The balancing shaft module with two shafts rotating in opposite directions helps to reduce engine vibration to an absolute minimum particularly at high engine speeds, with second-order vibrations being reduced to more than 80 percent.
A unique feature of the A6 TDI is the fact that it totes piezo injectors for its third generation common-rail diesel setup. The aforementioned setup includes a common rail system that has one high-pressure pump and one rail per cylinder bank, allowing boost pressure (and, by extension, power output) to increase nearly 30-40 percent more than previous common rail systems.
With Audi's new TDI technology, the number of injection processes per combustion cycles can thus be varied almost at will. The 3.0 V6 TDI engine, for example, has up to five injection processes: in addition to the main injection process, double pilot injection takes place at the lower end of the speed range and single pilot injection in the medium speed range. On top of this, single post-injection takes place up to around 2,500 rpm and at maximum part-load. This reduces emissions and ensures a smoother combustion process.
With the A6 sedan, the V6 3.0 liter TDI engine develops 225 bhp and 450 Nm of torque. 0-100 kph time is just 7.3 seconds and top speed is 243 kmh. Despite higher power output and larger engine displacement, its consumption is still impressive at 12 kms per liter of diesel fuel (based on in-house extra urban driving cycle testing). Audi also leads the way as a luxury automobile with a low operating cost. Oil and filter changes are also significantly reduced all contributing to lesser environmental impact.
The turbocharger built into the TDI engine optimizes the charging of the combustion chambers and makes the most out of the space available in the engine. Two intercoolers that run parallel lower the temperature of the air within the engine to improve efficiency of the engine and lowering the emissions of the car.
With Audi's high performance character, comfort and safety never take a passenger seat. The A6's ESP (Electronic Stability Program) assures you of precise steering and braking especially in adverse driving situations. The Audi chassis design provides comfort and stability when driven dynamically. Two-stage, full-size front air bags and active head restraints compliment its array of already impressive safety features. The A6 sedan comes with Quattro permanent all-wheel drive that results in perfect traction in even in adverse driving conditions.
Functional design and high-quality materials in the interior maximize comfort for the occupants. Luxurious leather upholstery, premium sound system and automatic air conditioning ensure that you travel in style and luxury.
To experience TDI Power, you may request for a test drive appointment by calling PGA Cars thru telephone numbers 727-0381 up to 85, or you may visit the PGA Cars Audi showroom along 201 EDSA, Mandaluyong. You may also send an e-mail to [email protected] or visit PGA Cars' website www.audi.ph. Go for a test drive at PGA Cars and say, "Make mine a diesel."


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I regret that at the present time my practice is not accepting new clients. The following is provided for informational purposes only:
In addition to my general psychiatric practice, I also provide Suboxone (buprenorphine) treatment for opiate dependence. Click here to download complete information about Suboxone treatment in my practice. This describes criteria for beginning Suboxone treatment with me. Please read the information document completely BEFORE contacting me to discuss treatment.
More information about buprenorphine
Details about Suboxone are available on the manufacturer's website, and from the National Alliance of Advocates for Buprenorphine Treatment.


text:
How to Use the Collison Mitigation Braking System
Collison Mitigation Braking System (CMBS) is designed to alert drivers when it determines the potential for a frontal collision and, if one is imminent, to apply the brakes to mitigate the severity of impact.
This video shows you how the system works and interacts with the driver, as well as how to adjust the distance from a detected vehicle at which it will begin to issue alerts. Plus, there are instructions for turning the system off and back on.
CMBS cannot detect all objects ahead and may not detect a given object; accuracy will vary based on weather, speed and other factors. System operation affected by extreme interior heat. System designed to mitigate crash forces. Driver remains responsible for safely operating vehicle and avoiding collisions.
For more information on the innovative new features available on the Honda line-up, please give us a call at (866) 822-9314 or to shop our online inventory of new Honda vehicles, please click here


text: A manager of a French SME suspected certain former employees of unfair competition. Before pursuing any legal action, CEIS added to the case file factual and convincing elements demonstrating the offending individuals' slavish copying and unfair behaviour. This evidence fed into the client's legal strategy and led to a decision in ex parte proceedings.


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Health and health care in the 21st-century United States can be partially characterized by a few indisputable trends. The country is devoting a large and growing share of its resources to medical care, spending $2.3 trillion, or 16 percent of gross domestic product (GDP), on it in 2007. That figure is projected to rise to perhaps $4.2 trillion, or 20 percent of GDP, by 2016 (Poisal et al., 2007). Not only is this spending massive in an absolute sense, it is also high comparatively, as the median expenditure of Organisation for Economic Co-operation and Development countries is around 8.5 percent of GDP. The budgetary pressures being created by this allocation—at individual, organizational, and national levels—have led to growing criticism of the productivity of U.S. health care. As the population continues to age, the strain that will be put on publicly funded programs such as Medicare will only elevate the debate about how best to meet the nation's health care needs.
One factor contributing to the trend of rising expenditures is the ever-expanding and increasingly sophisticated array of life-extending and life-enhancing treatments produced by medical research for the range of conditions and diseases that afflict the population.2 In addition, the body of knowledge about the effect of
nonmedical factors—such things as diet, exercise, and environment—on people's health continues to grow.
For all these advances, a gaping hole in information still exists. Relative to knowledge about health care expenditure and medical science, much less is known about the return that individuals, and society in general, receive for the investment in health. Given the massive amount of resources that are spent publicly and privately, it is astonishing that so little effort has been made to systematically assess what we are buying for this investment.
At the heart of this information chasm is the need for data on how inputs into medical care translate into outputs—completed treatments and procedures—that, in combination with other factors, ultimately affect the population's health. While some studies have suggested that productivity growth in medical care is reasonable in aggregate (Cutler and McClellan, 2001; Cutler, Rosen, and Vijan, 2006), others argue that there is substantial waste at the margin (Fisher et al., 2003; Skinner, Staiger, and Fisher, 2006). In this report, we provide guidance about what data are needed to measure the outputs produced by the medical care sector. Without this kind of information, it is impossible to credibly assess whether the nation spends too much or too little on medical care relative to, say, public health measures, and, perhaps more importantly, whether we purchase something close to the right mix of medical care goods and services for a given level of resources expended. In order for policy makers to pursue actions that reduce costs sensibly, improve performance, and, in general, enhance the efficiency of the national approach to health and medical care, a more systematic approach to compiling data for the purpose of tracking productivity in the sector is needed.
The National Income and Product Accounts (NIPAs) produced by the Bureau of Economic Analysis (BEA) and the National Health Expenditure Accounts (NHEAs) produced by the Centers for Medicare & Medicaid Services (CMS) are the foundational components of the U.S. health care data infrastructure. While the virtues and utility of these data sources are well known, they are not sufficient on their own to inform policy. The national accounts have particular difficulty decomposing medical spending increases into price, quantity, and quality change elements. For example, an increase (or decrease) in the observed price of treating a disease may reflect a change in the price of unchanged treatment inputs, a change in the amount of inputs (e.g., a surgeon's time) required, the development and use of new drugs or procedures that alter outcomes, or simultaneous changes in more than one of these factors (National Research Council, 2005, pp. 117-118).
In this report, we offer guidance for extending these important data sources, at first in an experimental or satellite account setting, to better inform national decisions about resource allocations to health care. A health data system built on
economic accounting principles has the potential to provide a comprehensive picture of population health in relation to health care spending within an integrated framework in which consistent definitions, measurement tools, and analytic conventions are used (Rosen and Cutler, 2007). Economic accounts provide the key data infrastructure for measuring productivity, which, in turn, can be used to identify high-return spending and investment areas.
Given the wide range of statistical and research measurement needs, creating health data systems that will adequately inform policy requires a multipronged effort. Economic accounting (as practiced by BEA), price and productivity measurement (Bureau of Labor Statistics [BLS]), medical and health-oriented research (e.g., funded by the National Institute on Aging [NIA], National Institutes of Health), and health monitoring (e.g., National Center for Health Statistics, [NCHS], Centers for Disease Control and Prevention [CDC]) are all data driven, but requirements vary in terms of needed characteristics and complexity. BEA's top priority is to measure medical care inputs and outputs correctly, since this is a major component of the market economy; the needs of BLS are similar. However, many health policy researchers are interested in establishing links between population health and its determinants—medical and otherwise—in order to develop strategies for improving care in a cost-effective manner. These efforts demand data on the multitude of factors affecting population health and on health status itself.
Because of the nation's need for more accurate information on its health care system costs and benefits, it is essential to improve the data infrastructure.
Recommendation 1.1: Work should proceed on two projects that are distinct but complementary in nature. One accounts for inputs and outputs in the medical care sector; the other involves developing a data system designed to track current population health and coordinate information on the determinants of health (including but not limited to medical care).
Groundbreaking work that will create a foundation for the first type of account is indeed already under way at the statistical agencies. Research programs that will contribute toward fulfilling the second objective are still in their infancy (and taking place predominantly in academic settings) and will take much longer to mature. Ideally, though, the national health data system should eventually be maintained by the statistical system.
Constructing a fully developed set of national health accounts involves three broad steps, which define the topics of interest in this report: (1) compiling detailed and comprehensive data covering the nation's expenditures on and utilization of health care, organized in such a way that prices and quantities of
meaningfully defined units of goods and services can be measured; (2) assessing summary measures that allow the changing state of the population's health to be tracked along a number of dimensions, and identifying those that are most appropriate for use in a health accounting framework; and (3) developing an integrated data system that allows researchers to investigate links between medical interventions and other health-related activities on one hand and population health on the other.
At the outset, we recognize (and consider it a positive) that work to improve health data within a national accounting framework is moving forward along several fronts and is motivated by multiple objectives. One strain of research is focusing on the inputs and outputs of the medical sector. Here, as would be consistent with the market-oriented NIPAs, units of medical care produced (however defined) can rightly be considered the output. This work is of immediate concern to statistical agencies such as BEA, BLS, and CMS that are responsible for producing expenditure, price, and productivity statistics.
A second strain of research is oriented toward developing statistical data for relating the population's health status to an array of factors that affect that status in a kind of health production function. Inputs include medical care, time spent by people investing in their own health (e.g., exercise), consumption items (e.g., food), research and development, and the quality of the environment. The output—better health—produced from investments in these inputs includes both length and quality of life dimensions, which can be conceptualized jointly in summary measures of population health. In the broad-concept account, medical care is an input in the production of "health"—treatments are pursued with the objective of extending or enhancing a patient's years of life.
The two projects are complementary; the analytic pieces for which the statistical agencies are responsible—e.g., medical care expenditure accounts and price indexes—are intermediate building blocks for a comprehensive health data system. Such a system would in turn provide a foundation for developing a national health account, such as that envisioned in the report Beyond the Market: Designing Nonmarket Accounts for the United States (National Research Council, 2005). An initial task for both lines of work is to accurately categorize nominal expenditure estimates into meaningful production units to which prices and quantities can be attached. Even those topical areas for which the statistical agency and research community objectives appear to diverge may do so for only a period. For example, for some time, researchers have investigated the health impact on the population of various disease treatments produced by the medical sector; at the moment, this is not an active area for BEA. However, ultimately, both BEA (NIPAs) and BLS (price index work) should be interested in integrating medical outcome data into their analytic apparatus in order to track changes in the quality of service, which, along with the quantity, determines the value of the industry's output. The most methodologically advanced components of the NIPAs, and of the various price indexes and productivity measures, already track the changing
quality of goods and services and facilitate the ability to break out nominal price changes into real price and quality change components.
In thinking about next steps of these research programs, we argue that, among the inputs to health, the medical care piece should initially be given priority. For policy purposes, the most pressing need is to measure medical care expenditures and related outputs and outcomes as well as possible. In addition, accurate expenditure and price data on medical care are essential both for developing broader health accounts and for improving the medical care component of the NIPAs. Thus, the panel supports the idea that, at least initially, BEA's satellite health accounting program should focus on input and output data relevant to the provision of the nation's medical care.
The satellite account should include all inputs to the production of medical care, whether they are purchased by the medical "industry" or by households and regardless of how directly they affect health. In addition to clear cases of life-saving medical interventions, treatments that improve quality of life (e.g., knee repair), that are preventive in nature (e.g., a routine physical), or even that have ambiguous links to health (e.g., some over-the-counter medications) should be included so long as they are part of the medical care sector. For setting account scope, we deemphasize concerns about the extent to which the procedures improve health (physical or mental). Ideally, however, outcomes research will indicate quantitatively—in an accounting framework that values system output in terms of improvements in quality or quantity of life—which medical services are more and less productive. Arguments in favor of this approach are that it creates a relatively clear line of demarcation and that it maintains historical comparability. Also, for policy, it is important to know expenditure totals for the sector and to have an idea what people are getting for that spending.
In building a broadly useful national health accounting system, the question of how to define the unit of measurement must be tackled. Ideally, medical sector goods and services would be defined in such a way that (1) expenditures could be estimated each period for every good or service produced by the industry, (2) meaningful quantities and prices (nominal and real) could be tracked, and (3) quality change of the goods and services could be monitored. One way to proceed that embodies these three goals is to identify the output of the medical care sector as completed treatments or procedures.
A treatments-based organizing framework coordinates logically with a broader health data system because, in principle, it creates a unit of analysis for which changes in the effectiveness of various medical services may be monitored. It provides a mechanism whereby prices can be adjusted to reflect changing quality, the substitution of inputs can be handled better than they are currently, and the introduction of new treatments can be dealt with on a disease-by-disease
basis. At the present time, however, health expenditure and outcomes data are not organized in a way that feeds naturally into this accounting framework, and so their structure needs to be modified.
Although the logic of a treatment-of-disease approach is clear, it will not be easy to execute in a comprehensive national data system. It requires defining episode groups and then dealing with population heterogeneity within condition categories. A first step is to agree on a crosswalk between existing classification systems and a version that is at the right level of detail for a national health account—one logical option would be an aggregation of International Classification of Diseases-Tenth Revision categories although the final version might be arranged quite differently. Even then, problematic conceptual issues associated with using a treatment-of-disease approach remain, such as those created by the presence of comorbidities. A reasonable starting point is to treat common clusters of comorbidities (e.g., diabetes and vascular complications) as distinct disease categories; in addition, methods exist for allocating expenditures on patients with multiple conditions based on ratios of costs estimated from patients with single diagnoses. A special advisory committee could be convened by BEA to provide guidance on these conceptual and definitional tasks.
Another hurdle to implementing a disease treatment approach is the problem of defining a measurement unit for chronic episodes or any kind of service that involves a long treatment period. In the literature, episode-based price indexes have defined the good as a completed episode (e.g., the price of treating a heart attack). At the end of that episode, expenditures on the treatment are collected and that is the price of the unit. For the purpose of pricing the treatment of chronic illnesses, which may span several statistical reporting periods, the unit of measurement should include all spending on the disease for some designated and consistent period of time, most likely a year.
A large portion of medical care activities, in terms of costs, can be accounted for by looking at treatments of specific diseases. Roehrig et al. (2009) produced estimates of national health spending by medical condition using 260 categories defined in the Agency for Healthcare Research and Quality (AHRQ) Clinical Classification Software, which groups the numerous International Classification of Diseases-Ninth Revision codes into broader categories that are "clinically meaningful." Reallocating the NHEA totals using data from the Medical Expenditure Panel Survey (MEPS), the research team found that the largest eight expenditure categories (circulatory system, mental disorders, musculoskeletal, injury and poisoning, digestive, neoplasms, respiratory, and nervous system) accounted for almost 70 percent of total expenditures. By contrast, prevention, exams, and dental—which would not fit cleanly into disease-specific categories—accounted for around 6 percent of personal health
spending; another 6 percent of total personal health expenditures from the NHEA went unallocated.
Although disease treatment categories are clearly important, it is obvious that not all medical services (and certainly not all health-related services) can be captured in them. Due to the presence of these other aspects of care, including those that may take place before and after treatments, it would not be desirable to shoehorn all medical care spending (and associated health effects) into disease categories. These areas of care might be better considered separately. We envision that, ultimately, some catch-all categories will need to be created for nondisease-specific health care and also for episodes of management—such as screening, diagnosis, and prevention.
Recommendation 2.11: Although starting with medical care on a disease-by-disease basis is a realistic way to proceed in order to begin accounting for a very significant share of the medical care economy, work should also begin on estimating the costs of, and eventually the health return from, interventions other than treating specific diseases (e.g., management, preventive, diagnostic, screening) and long-term medical services.
The idea would be to track quantities and prices of items in these categories over time, just as one would track direct disease treatment. In some cases, it may be possible to link diagnostic tests and the other forms of care backward from an eventual resulting treatment. The task of setting up the nondisease treatment categories could again be assisted by an advisory committee convened under the auspices of some combination of CMS, AHRQ, and NCHS, although one office will need to take the lead.
The first major task in developing a national health account—whether it is BEA's satellite version or the broader health type—is to devise a method for allocating economy-wide spending on medical care into the treatment-of-disease categories described above. Because they serve as building blocks for many kinds of health data systems, improving the methodology for organizing and tracking health care expenditures is an immediate priority.3
Given the number of different disease classification schemas currently in use in the U.S. health care system, it is essential for all players, in both public and private sectors, to participate in and come to a consensus on the development of a single unified version.
Recommendation 3.1: A concerted effort is needed to reach consensus on how to classify diseases and about what the criteria are by which diseases are disaggregated from the very broad International Classification of Diseases chapters. The National Center for Health Statistics should lead the effort, working with the Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services, the Bureau of Economic Analysis, and other relevant statistical agencies. As part of this effort, U.S. agencies should participate in ongoing standardization efforts (such as those sponsored by the Organisation for Economic Co-operation and Development or the World Health Organization) to benefit from international expertise, to consider these as the basis for a national system, and to facilitate international comparisons.
Once an agreed-on classification system has been established, several options exist for attributing spending across treatment episodes for the range of disease categories. One is an encounter-based method in which spending is attributed to one or to several diagnoses as reflected by data extracted from patient claims. A second, broader approach involves constructing episodes of treatment—which may include numerous encounters over a predefined period—then adding up dollars spent nationally on each of the range of diseases and conditions. A third possibility is a person-based approach, in which spending on various treatments is tracked on a person-by-person basis over a set period of time.
BEA, for its part, is working both internally and with outside researchers to establish what the allocations look like under the different methods and whether it matters for estimating aggregate expenditures and prices. These researchers (Rosen and Cutler, 2007) have already begun producing episodes-of-treatment cost estimates for the different methods, demonstrating that it can be done; spending could also be further broken down into additional subcategories such as disease prevention, diagnosis, and screening activities. Whichever method of allocating expenditures is chosen, it has to offer a solution to the comorbidity problem.
At this point, the panel cannot definitively recommend one method for tracking expenditures and output (and eventually outcomes) associated with medical treatments over all others. And the appropriate concept depends a great deal on the specific application. For example, if the goal is to compare costs and health effects for a given disease, as is done in cost-effectiveness analyses, a person-based approach is likely to be most appropriate. In contrast, if price index construction is the goal, federal agencies may find an episode-of-treatment approach more meaningful. For managers of a health plan trying to understand why emergency room spending patterns have changed, real-time answers may be possible only with an encounter-based approach. What is needed is more empirical work to compare different approaches and to determine more definitively which is best under different conditions.
Recommendation 3.3: The Bureau of Economic Analysis (working with academic researchers and with the Bureau of Labor Statistics) should continue to investigate the impact of different expenditure allocation approaches— particularly the episode- and person-based methods—on price index construction and performance. Research is needed to determine which method is best under different circumstances.
As part of this effort, BEA (perhaps in coordination with AHRQ and NIA) should sponsor a workshop during which private-sector vendors that produce various disease-grouping systems could present their products, identify how they are used in the marketplace, and describe the underlying rules and logic.
At this point, a cautious approach is warranted, as it is too early for BEA to buy into a particular method for aggregating treatment costs. This means that there may need to be parallel sets of accounts going on, at least on a research basis, for some time. The statistical agencies should continue to experiment with competing methods, and research should be designed to test variation in results from different data sources.
Recommendation 3.4: The Bureau of Economic Analysis, working with academic researchers (and perhaps other agencies, such as the Centers for Medicare & Medicaid Services and other parts of the Department of Health and Human Services), should collaborate on work to move incrementally toward the goal of creating disease-based expenditure accounts by attempting a "proof of concept" prototype. Using a subgroup of the population with good data coverage, the prototype would attempt to demonstrate that dollars spent in the economy on medical care can be allocated into disease categories in a fashion that yields meaningful information.
The Medicare population, the military, or veterans—groups for which there is available spending and health data (and for whom a lot of the medical care action takes place)—would be logical choices. Alternatively, a disease-costing pilot could be done for a well-defined, geographically (and administratively) complete group, such as found in parts of Intermountain Healthcare, the Geisinger Health Care System, or one of the Hawaiian islands before attempting it on a national basis.
Much of what is required to develop health and health care accounts has to do with medical care price deflation. Once the nominal expenditure flows for the sector have been figured out correctly, a daunting problem in itself, the next task is to begin estimating disease-based price indexes. In this report, we take the
position, expressed by many other health economists, that price indexes organized by treatments of disease or episodes of illness should be used as deflators for the medical sector components of the national accounts.
Health economists have developed the conceptual tools that are needed to construct price indexes for medical care goods and services demanded by consumers. Much of the academic literature has relied on patient claims data to provide a picture of price trends for treating specific conditions (e.g., Berndt, Busch, and Frank, 1998). In these studies, the goods and services have been defined as a completed episode; this parallels the conceptual approach described above on how to categorize nominal expenditures. For example, for a heart attack patient, this may involve time and expenditures on a series of initial treatments plus those that take place during the recovery period. At the end of that episode, data are collected to estimate all dollars spent over the entire period; this forms the basis for pricing a completed episode.
Under optimal conditions, a price index will embed a capability to pick up the substitution of inputs that takes place over time. For its satellite medical care account, BEA proposes to take the system-wide spending over some period of time on treatments of each condition (such as for depression), regardless of treatment mode (e.g., drug versus talk therapy), and divide it by the number of patients treated. The idea is to calculate a unit value that includes all spending and then allows for substitution across treatment types as well as for the introduction of new drugs or other therapies.
A number of examples can be cited from the literature of how spending by traditionally defined medical care industries is handled to form the price of a specific treatment. Pricing of cataract treatment is one of the most prominent of these (Shapiro, Shapiro, and Wilcox, 2001). If price indexes track industries in a way that segregates by type of service facility, then surgeries taking place in a hospital are sampled to generate one price index, whereas surgeries taking place in clinics are sampled in the estimation of another. A traditional industry-based index of this sort will miss the price effect that accompanies a scenario in which people switch from the more expensive hospital surgery to a less expensive ambulatory care facility or an office. Assuming quality remains constant (i.e., treatment outcomes are comparable), then a direct comparison price index capable of capturing the facility shift would more accurately estimate the decrease in price.
Even though the BLS Producer Price Index (PPI) for hospitals has been available with a cost-of-disease classification for more than 15 years, BEA does not deflate (adjust for price inflation) at the disease treatment level. Expenditure data are not available by cost of disease, so there is nothing for BEA to deflate. For that reason, BEA uses the aggregate PPI for hospitals as the deflator. Clearly, the units of analysis should be the same for price and expenditure data used in a medical care account (or any economic account for that matter). In the future, this problem could be resolved by using new data from the Census Bureau and from the PPI, and the U.S. statistical system will have gone a long way toward
providing expenditures and price indexes for medical care that are harmonized around a cost-of-disease framework.
Recommendation 4.3: The Census Bureau should give high priority to providing annual data for hospitals and other medical care industries, grouped by a cost-of-disease system that matches the one used in the 2007 Economic Census and in the Producer Price Index. The panel notes the welcome provision of new data on receipts categorized by disease that accompany publication of the 2007 Economic Census, though a considerable amount of work remains to be done to bring the quality of these data up to the standards needed for use in official statistics.
As a first step to improving price measurement for medical care, it is useful to account for the reduction in costs resulting from the substitution of inputs in treatments. However, in order to tell the full story, we must turn to the (probably more quantitatively significant) question, "Is the new treatment technology better, worse, or the same as the old one?" Although BEA's plan is to defer some aspects of price work until a greater consensus about methods emerges, it is essential to think about quality change from the beginning. Improvement in medical procedures creates a major measurement issue, and any price index that does not confront it will ultimately be less than satisfactory. BEA is aware of the importance of quality adjustment but, at the moment, reasonably claims to not have a systematic way of dealing with it for medical care. Perhaps, however, there are some cases that can be addressed on the basis of the existing literature and that BEA could get started on sooner rather than later.
Thinking seriously about how to measure changes in the quality and, in turn, the real cost of medical care requires the monitoring of information about outcomes associated with that care. These efforts will require expertise from medical researchers. Information about medical care outcomes and the changing quality of treatments is also essential for balanced policy discussions about resource allocation, which have focused nearly exclusively on the cost side while neglecting the changes in value that accrue as a result of the expenditures. As an example, the price of treating heart attack patients has increased dramatically, but so too has the desirability of outcomes. Fifty years ago, heart attack patients were told to rest—a practically free treatment for cases in which that rest was done at home. Treatments now exist that, while much more expensive, most would consider preferable because they have greatly extended life expectancy (rest is now thought to be counterproductive). When measuring prices of treating heart attack patients, the changes in the efficacy of the treatment must be monitored along with its cost. This kind of quality adjustment is a well-established component of accurate price measurement.
Collecting outcomes data that can be linked to spending is a big challenge, but it is not impossible. Although data are already quite good for a few specific diseases, the reality is that this research will have to draw from a patchwork of data sources, public and private. Pharmaceutical companies collect extensive data on the comparative effectiveness of new technologies versus old ones in order to make the case for reimbursement. Many of these data are collected as part of clinical trials that, while generally not done as head-to-head comparisons of alternative therapies, provide evidence about quality changes occurring in medical care. The current focus on "comparative effectiveness research" at AHRQ and other agencies is also producing further evidence on this front. Data on outcomes are going to continue to improve over time—ideally, BLS, BEA, and academic researchers would be able to take advantage of the millions of dollars spent collecting these data. Integrating emerging information from the research community is an essential enhancement that can be made to the data infrastructure.
Recommendation 6.7: Significant analytic value could be added to Medicare data compiled by the Centers for Medicare & Medicaid Services if more clinical information on outcomes and patient characteristics were included. It is possible that the addition of only a few clinical items to claim forms could greatly enhance performance measurement. The National Committee on Vital and Health Statistics, an advisory body to the secretary of health and human services, could provide guidance on this. The linking of tests and procedures to diagnoses would also be useful for confronting the comorbidity problem. Even though adding lines to claim forms involves major political hurdles, the panel recommends that it be done.
Serving as an example (and providing encouragement that the task is feasible), three decades ago, RAND developed an experimental claim form that included clinical information (Newhouse and the Insurance Experiment Group, 1993), and it proved effective in defining patient episodes.
In developing a national data system designed to track current population health and coordinate information on its determinants, the novel challenge is measuring health. In order to answer the question "What are people getting for their health care dollar?" it is necessary (though not sufficient) to be able to track changes in the health of the population accurately. Furthermore, the conceptual framework requires monitoring changes in the population's health status using metrics that include both mortality and morbidity effects. Although such measures are already widely used for identifying unmet or underaddressed health needs, there is no undisputed definition of or method for measuring population health (Kindig and Stoddart, 2003; McDowell, Spasoff, and Kristjansson, 2004). How-
ever, in cost-effectiveness analysis of medical interventions, it is now standard to combine impacts on survival and the health of survivors into quality-adjusted life years (QALYs) (Gold, 1996).
Historically, population health has been summarized by life expectancy at various ages and other statistics based solely on deaths. Recently, however, a number of summary measures of health-related quality of life (HRQoL) have been collected in population data sets in the United States. These measures can be used to adjust life expectancy for quality to obtain a more complete measure of health. As with ordinary life expectancy, quality-adjusted life expectancy (QALE) measures do not predict future health but instead summarize health in the current year. Two inputs are needed: (1) a life table describing mortality experience in the population, and (2) the average HRQoL per year of age in a population. Age-specific death rates from NCHS would be needed as the first input. Data from population surveys using HRQoL indexes would suffice for the second. Given that multiple surveys (each with a somewhat different population scope) are required to adequately measure health across the population broadly, the statistical agencies should agree on a common quality of life instrument to use in the different surveys.
Recommendation 5.1: A committee of members from agencies responsible for collecting population health data (Agency for Healthcare Research and Quality, National Center for Health Statistics, Census Bureau, etc.) should be charged with identifying and putting in place a single standard population health measurement tool (or set of tools) to use in a wide range of surveys. The best instrument, which is situation specific, may simply be the one that can be added to enough surveys collected over time so that most of the population is covered.
Ideally, agencies would collaborate and choose at least one instrument that can be followed over time for the purpose of having a comparable measure across years. For example, it would be useful if a generic quality of life measure were added to the Medicare Current Beneficiary Survey (MCBS). MEPS and MCBS should have at least one instrument in common that both will use consistently over time. The advantage of standardization is that it avoids problematic comparisons across instruments.
All things considered, the panel thinks that QALE is the most appropriate metric for summarizing population health for a national health account. Although life expectancy is currently the most widely used metric for this purpose in the United States and other developed countries, the underlying methods needed to move to QALE have become the subject of extensive scientific investigation (and were developed in particular for the health questions typically asked in ongoing surveys).
Economic accounts are in the business of organizing data for measuring the value of goods and services generated in the economy, so it makes sense to
think in terms of QALYs, which are a measure of the good that is being generated from medical care and other health-affecting activities. And, presumably, data should be of sufficient quality to estimate QALE in the United States using QALY methods.
Recommendation 5.3: Initially, the national health account should focus on quality-adjusted life expectancy measured in quality-adjusted life years as the best summary measure of health in each year.
Throughout this report, we focus on methods for identifying, quantifying, and valuing inputs to health—beginning with treatments of specific medical conditions—and for measuring changes in the population's health. We cannot predict the accuracy of future efforts to quantify the causal links between medical care, health-enhancing activities, and other inputs to changes in the population's health. However, we can say that a major issue driving this area of research will be how to gauge the productivity of the medical care system. For this purpose, it is important that investigators have data that allow them to attribute population health effects to factors that work separately or interactively with medical care. It is advisable to begin with medical care, but the elements included in a broader boundary of health goods, services, and activities become more important when trying to determine causality for outcomes.
For example, data on important risk factors that impact future health should also be collected. Risk factors are characteristics of individuals or individual behaviors that are associated with future changes in population health. A comprehensive list of these is beyond the scope of this report. However, an accounting of health gains from current medical investments should recognize that reductions in risk factors in the present can improve QALYs in the future. We suggest several criteria for choosing among which, if any, data on inputs to future health to collect: (1) there should be feasible or actual reasonable national estimates available, (2) solid scientific links should exist between changes in the risk factor and future health, (3) the impact on future health should be big enough to make data collection worthwhile, and (4) interventions to change the risk factor should be reflected in the expenditure side of the national health account. Many of the relevant variables are already collected regularly through the CDC's Behavioral Risk Factor Surveillance System.
Integrating health expenditure and health outcome data is a long-term project that has only begun. It will require time-consuming disease modeling—estimating interaction between risk factors, specific diseases, and health outcomes. This kind of scientific endeavor is beyond the scope of traditional (or even satellite) accounting. A full accounting of nonmedical factors affecting health seems futuristic at
this point because only scant data exist that would allow modeling of the joint distribution of environmental and other factors. Nonetheless, researchers would benefit if the national health accounts program began accumulating data on time use in health-improving preventive activities, consumption trends and other risk factors, behavioral trends, and the environment in a centralized and accessible way.
In constructing a data infrastructure to underlie the national health and health care accounts, the ultimate objective is to maintain a set of minimum common data on the entire population—or as close to it as possible. The United States has a decentralized statistical system, and it is a complex task to determine the best roles for AHRQ, CMS, NCHS/CDC, and other agencies developing a coordinated health data system. The national health account envisioned by the panel would rest on a foundation linking information across many data sources—government/private, administrative/survey, national/local. Efforts are successfully under way to combine data sources (see Rosen and Cutler, 2007), showing that it can be done. For example, because NHEA data are reported as aggregate spending by payer and service category but not at the disease level, the Cutler/Rosen project team has linked them to expenditure surveys—MEPS and its precursor survey, the National Medical Expenditures Survey, both collected by AHRQ—in order to gain the level of detail needed on several aspects of health (including quality of life and the presence of diseases) and health care utilization. It is also important to consider how nonstatistical agency data (military, veterans affairs, etc.) as well as nongovernment data (e.g., those maintained by health plans and drug companies) can be exploited.
One important purpose of this report is to begin identifying key data sources and to provide an indication of how they can be combined or better organized to add value to the national data infrastructure needed to move forward in a cost-effective manner; this report does so through a number of specifically targeted recommendations. Because surveys are expensive and burdensome, cost efficiency requires linking survey data to administrative records whenever possible. One potentially rich source of case-by-case information on expenditures and treatments is patient claims data. Medicare and Medicaid would provide coverage of large portions of the population. If claim forms included the "right" information, they would go a long way in satisfying some health accounting data needs. A lot could be done with claims data for the insured population because of their enormous size and wide coverage.
For constructing a core data set to underlie national health and health care accounts, it is reasonable to use MEPS supplemented by claims information wherever population or disease coverage gaps appear. Survey and claims data
are complementary because of the trade-off that exists between sample size and representativeness. Survey data are essential to the accounting project because of the detailed patient information they can provide. However, their sample sizes are adequate only for high-prevalence conditions such as cardiovascular disease and risk factors. In contrast, insurance claims data provide a large sample, but at the expense of representativeness—no single source provides a national sample.


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The Human Glowstick – Part 2
Even though I began this project in August, attempting to adapt a OctoWS2811 implementation to be wireless; controlled by my phone...
What I'm actually going to walk through here is the end result. Which is simply a Adafruit WS2801 implementation on top of the Adafruit nRF8001 "callbackEcho" demo sketch.
PLEASE NOTE: At the time of writing this, the Adafruit WS2801 library does not include the Color() method... and as such, I branched it, created the method, and have made my modified version available on GitHub: Here (in all likelihood the change will have been merged into their mainline by the time you are reading this)
To give you an accurate idea on the scope of the software, remember that there are 4 parts to this project:
Whenever I start a project like this, I always try to make sure I have the basic understanding of any one component correct before moving on. (That's why each of those links above refer to a test that specifically targets one thing at a time).
One interesting tidbit that I continually forget: If you want to run your project without a console attached, you should probably not wait for a console to be attached... Basically, many Arduino example sketches run a setup() something like the following:
void setup(void) { Serial.begin(9600); while(!Serial); Serial.println("Setup complete"); }
Only trouble is that when I take this setup into a costume, it will STILL require me to connect a serial console to it before I can continue past that while loop. It can be incredibly helpful to know that your sketch wont start till you connect the console to it... but on the other hand, you can spend an awful lot of time debugging why your sketch is not running when you "hide it away in your project"... but then mysteriously runs when you "look at it"...
As the bare-minimum "glowstick" costume, you have to be able to glow... and given that the previous tests 1 & 2 above both passed... I decided to create the bare-minimum program using the Adafruit Controller ColorPicker.
What this allowed me to do was create another simple test program:
The nRF8001 + WS2801 Color Picker Test
Basically the only educational part of this demo is the breakup of "color picking" to "color setting" (the first being the action done on the App, and the second being the action done by the Teensy 3.2 to the WS2801 LED modules)
The main idea is to never block the main loop. An example of how I do this is to make sure that, instead of using delay functions, I instead just return to the main loop until a certain amount of time has passed.
Another example is inside the mechanism of color-picking. Every loop() starts with reading inputs (like the color #FF0000) and setting modes (in this case seeing a "!C" prefix in the BLE buffer immediately sets the mode to "color picker"). Every loop() ends with implementation of a single mode.
The Human Glowstick – Part 1
As I know there was a significant interest in my costume this year, I am going to try and put together all of the directions on how I both constructed the foam exterior to the costume, and hooked up the 338 LED modules + Teensy + Bluetooth LE + SPL meter electronics to make the costume what it was.
As a first post, I will provide you with my electronics shopping list (that made the final production), getting into the foam in a later post.
Shopping list:
- Two 12V/20A DC regulators for powering the LEDs
- One 5V/3A DC regulator for powering the electronics
- Two Turnigy 4S 5000mAh 25C LiPo Batteries
- Two HXT LiPoly Battery Monitors for 4S packs
- Two 4mm HXT to 6x3.5mm Bullet breakout cables
- Ten 3.5mm Bullet Extension packs (pack of 3 wires)
- Eight pairs of 4-pin JST SM Plug/Receptacle Cable Sets
- One pair of 2-pin JST SM Plug/Receptacle Cable Sets
- Ten feet of 12AWG Silicone Wire
- Two 4mm HXT 10cm Silicone Wire extensions (battery side) - would actually recommend NOT using the same for battery/ESC...
- Two 4mm HXT 10cm Silicone Wire extensions (ESC side) - would actually recommend NOT using the same for battery/ESC...
- 400 (only used 238) WS2801 12v 4xLED modules
- One MOSFET power Control kit
- One SparkFun Sound Detector
- One Bluetooth LE (nRF8001) module
- One Teensy 3.2 (32-bit ARM processor) Microcontroller
- One 74HCT245 bus transceiver chip
Additional but unknown quantities:
- Rosin-core solder
- Solder-wick
- Solderless breadboards
- Jumper Kit
- Heat shrink tubing
- Zip ties (6 inch & 12 inch)
- Resistors of various values (for tuning mic sensitivity)
I will try to go step-by-step with the directions as soon as I can, but I hope this starts you off with a "big picture" of how much time/effort/money is involved in such a project... really that is it though, cause most of the difficult things have been taken care of by using "off the shelf" modules from people like SparkFun & Adafruit. 🙂


text: Eclipse Community Forums - RDF feed https://www.eclipse.org/forums/ Eclipse Community Forums java.lang.NoClassDefFoundError: org/eclipse/swt/widgets/Canvas https://www.eclipse.org/forums/index.php/mv/msg/180683/573206/#msg_573206 Originally posted by: ira.greenstein.austin.rr.com OK, i need to eat some humble pie on this one. (newbie alert) I am running Eclipse 3.2 within a Callisto distro. If i run any of the Nebula widget example snippets, everything works as specified. However, as i write a simple RCP application, and i run it from the IDE, i get the error message java.lang.NoClassDefFoundError: org/eclipse/swt/widgets/Canvas Such as when i execute the lines: public class FilterView extends ViewPart { ...... public void createPartControl( Composite parent ) { PShelf shelf = new PShelf(parent, SWT.BORDER); } What do i need to include in the run time plug-ins or classpath to get by this error. I have already selected all plug-ins and this error was still generated. Obviously, i am missing something simple. Thanks!]]> 2006-12-26T20:33:41-00:00


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Lee A. Monts a native of Chapin, South Carolina, his formal education is in geology. He has been a resident of Columbia, South Carolina, since 1987 and is employed full time by the South Carolina Department of Health and Environmental Control. Lee began painting in 2002 and has had no formal art training. He has shown extensively in South Carolina since 2003. "Testimony", the artist's premier solo show was on exhibit July 23 – August 21, 2009, at the Gallery at DuPre in Columbia, SC. A feature article by nationally known writer Cynthia Boiter titled "Artist come lately…" appeared in the January 2010 issue of Lake Murray Magazine and Northeast Columbia Magazine. The artist was selected as one of six artists for Street Gallery III, a rotating billboard project in 2010 sponsored by the Cultural Council of Richland and Lexington Counties and Lamar Advertising. Monts also received the "In Memory of Lena Massara" Award in 2010 for his entry in the 33rd Annual South Carolina Watermedia Society Show. Monts will be featured along with nine other selected artists in a limited edition Capital City Art Book to be released in Spring 2011. The artist's work can also be seen at www.323art.blogspot.com
"Art is about an innate need to create and the process that results from this need.The application of color and the use or non-use of texture helps control the direction of the painting. The process is exciting as I rarely have a preconceived notion or complete expectation of the outcome. Often a completed painting will result from one continuous session. However, in many cases, certain challenges within the creative process may require multiple sessions and reevaluations. It is important to always allow the creative process to continue, and this may lead me on a different path…there are often sacrifices of the good for the better. Unlike many artists, I prefer to use a limited palette with colors that produce a wide range of hues and values. The end result is generally an abstracted landscape that, while often ambiguous, creates a feeling of familiarity for the viewer or relates to some shared life experience."


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Team India clinch series in Nagpur with one Test to go
Man of the match Ravichandran Ashwin's 7 for 66 in the second innings helps India beat South Africa by 124 runs
Nagpur: For a while on Day Three, there was a glimmer of hope for a South African fightback when Hashim Amla and Faf du Plessis battled it out.
However, South Africa were up against overwhelming odds, chasing 310 on a difficult surface, and once the duo was dismissed, it was all too easy for the hosts.
Virat Kohli
Ravichandran Ashwin (7 for 66) was on song yet again as he helped India clinch victory by 124 runs. This was after he had taken five in the first innings, making it 12 in the match. With this victory, India have won the series and ended South Africa's nine-year long unbeaten streak overseas.
Tough going for SA
For Amla's men, this was perhaps the ultimate challenge. They may have felt confident after bowling India out for 215 in the first innings, but they were then shot out for 79 by the Indian spinners. The tourists were always behind after that performance.
They started Day Three needing 278 more to win, with eight wickets in hand. Amla and du Plessis' patient 72-run stand for the fifth wicket was a saving grace but not enough. Ashwin and Amit Mishra (3 for 51) used the conditions to weave their web.
"The surface was probably the toughest I have had as well, and the cricket itself was really difficult," Amla said. However, Amla stopped short of criticising the pitch. "It's difficult for me to comment, to be honest with you, especially being on the losing side. So I will have to try and reserve my comments if that's okay with you," he said when asked if this wicket was a bad advertisement for Test cricket.
Meanwhile, Kohli and his team can celebrate victory for they have vanquished the No 1 ranked Test side in the world. This has generally been a low-scoring series, with the Mohali Test also ending in three days.
When Kohli was asked if we can expect India to maintain a policy of playing on turning tracks, he said, "It is not a policy; it is the conditions that you get in India.
Otherwise, you will just play Test matches which will get you 500 runs in an innings." The debate over the pitch has been raging since South Africa got bowled out for 79 on Day Two.
"I don't know why is there so much hype created around the issue," Kohli said, maintaining his stand from the
first Test.
Scorecard: Day 3
India (1st innings) 215
SA (1st innings) 79
India (2nd innings) 173
SA (2nd innings) overnight 32-2
D Elgar lbw b Ashwin 18
S van Zyl c R Sharma b Ashwin 5
Imran Tahir lbw b Mishra 8
H Amla c Kohli b Mishra 39
AB de Villiers lbw b Ashwin 9
F du Plessis b Mishra 39
JP Duminy lbw b Ashwin 19
D Vilas c Saha b Ashwin 12
S Harmer not out 8
K Rabada c Kohli b Ashwin 6
M Morkel b Ashwin 4
Extras (b 9, lb 5, nb 4) 18
Total (all out; 89.5 overs) 185
Fall of wickets 1-17, 2-29, 3-40, 4-58, 5-130, 6-135, 7-164, 8-167, 9-177
I Sharma 15-6-20-0
R Ashwin 29.5-7-66-7
R Jadeja 25-12-34-0
A Mishra 20-2-51-3
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Moonrise Festival 2018
Moonrise Festival
Saturday, August 11, 2018 at 11:00 AM - Sunday, August 12, 2018 at 11:00 PM (EDT)
Baltimore's flagship electronic music festival, Moonrise, is set to return to the historic Pimlico Race Course in Maryland this summer on Saturday, August 11 and Sunday, August 12.
Since the festival's initial debut in 2014, Moonrise has grown to be one of the most anticipated east coast festivals of the summer, with more than 30,000 fans in attendance each day last year. Boasting star-studded lineups with artists such as Bassnectar, Marshmello, The Chainsmokers, Excision, Zedd, STS9, Flosstradamus and Claude Vonstroke returning to play the festival year after year, Moonrise touches all corners of the dance floor featuring styles spanning from heavy-hitting bass to progressive electro beats and everything in between. Presented by local festival organizers Steez Promo and Club Glow, this year's event promises to be the best one yet with a diverse lineup, new stages, art installations, local vendors and more.
In order to purchase these tickets in installments, you'll need an Eventbrite account. Log in or sign up for a free account to continue.


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Sencha Forum
Sencha Touch 1.x Forums - Unsupported
Sencha Touch 1.x: Discussion
> Should the toolbars indicate "more" buttons?
View Full Version :
Should the toolbars indicate "more" buttons?
[email protected]
9 Jun 2010, 10:39 AM
9 Jun 2010, 1:35 PM
Generally, Apple does not. The most common way is to size things such that half of an item in a list is show. For example, in the iPhone settings app, you can see a partial item shown at the bottom. They don't have scrollbars as an indicator without first touching, and they never have more toolbar buttons than can be shown at once. Content scrolls, not the chrome.
9 Jun 2010, 6:32 PM
Yeah, in general I think you should make sure you dont have more buttons in your toolbar then you can see. We enabled scrolling on those toolbars just to make the example work on both the phone and the iPad.
15 Jun 2010, 10:56 AM
How does one enable the scrolling for the toolbar if it has more buttons than are visible?
I would personally like to see the "more" icon as an option, or some other indicator that there are more buttons if you swipe/scroll.
15 Jun 2010, 11:14 AM
oh i think i figured it out:
var tabPanel = new Ext.TabPanel({
tabBar: {
scroll: 'horizontal'
however, I still feel that users will not know to scroll if there are more items, it needs some visual indicator that there are more...
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An article in Business Day calls into question what progress really is.
The article highlights what progress isn't: the strain of both parents having to work, rising debt and huge interest payments, increased environmental degradation from houses that are getting bigger and bigger, the stress of job security in an economic system that is based on making money and not based on making people happy (NB These are not the same thing, no matter what the free-market ideologues say!)
The article states:
The rampant cost of living means two-income families are increasingly worse off than single-income families were a generation ago – and it is threatening to put them under.
While median incomes and the number of women in the workforce has risen substantially, the money that families are putting into servicing the long-term commitments of a standard middle class lifestyle – comprehensive health insurance, a house in the right suburb and investment in education – has soared.
"It is increasingly clear that two incomes have trapped many families under a mountain of long-term financial commitments," said economist Gareth Morgan.
And goes on to say:
Infometrics economist Matt Nolan said all recent government policy had been about getting second earners into the labour market, but that extra income – thanks to easy credit – was simply going into extra debt in the form of larger and flasher houses.
That income has gone into building bigger and better houses than they had before. The square metreage has doubled.


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The Ministry of Health has total responsibility for ensuring that quality, appropriate, price efficient and well timed health providers are available for all British Columbians. James recently sold his excessive tech business. Now he's putting his appreciable culinary abilities to work along with his associate Clarina Bradshaw. Together they host Desk of Life uncooked meals potlucks and are planning to open a restaurant soon. And in the case of the health of bizarre folks, Joyner talks about actual-world studies , which present that walking or biking to work has four- or fivefold extra affect on an individual's body mass index than that person's genetic profile. Illness and illness do not must be your genetic destiny. You have the flexibility to get pleasure from optimum health all through your complete life. Let Entire Meals American Favorites, and my different cookbook Complete Meals Goodness, aid you to achieve superior health for all times.
Grants for the Arts is the ACE open access funding programme for people, art organisations and different individuals who use the arts of their work. It affords awards from £1,000 to £a hundred,000 to assist all kinds of arts-related actions, from dance to visual arts, literature to theatre, music to mixed arts. Grants for the Arts is a rolling programme with no deadlines. Selections on functions for £15,000 or less take six weeks. Decisions on applications of over £15,000 take 12 weeks. Click on HERE.
Whereas PCPs are core to the care delivery process in both models, a single unbiased PCP observe heads a PCMH; that is unlike an ACO wherein many coordinated PCP practices working collectively headed a single group that's typically a hospital or health plan. Meaning a PCMH is accountable for care value and quality rendered by one PCP and the specialists treating a selected patient. In distinction, an ACO is accountable for care delivered across a number of PCPs, specialists and hospitals.
Ought to we belief pharmaceutical companies to innovate in such a light-contact regulatory local weather? On Health Care Renewal we have now famous ethical violations by a lot of the major pharmaceutical corporations, typically involving deception in advertising and marketing , manipulation and suppression of clinical analysis , and distortions of dissemination of medical data, akin to articles ghost-written by authors paid by industry. Now we have documented quite a few authorized settlements of instances arising out of such misbehavior.
Brian wanted his insurance coverage company's preauthorization for an upcoming surgery, so he referred to as Health Advocate for help. The individual usually spends three to four days in hospital and then goes dwelling to get better and recuperate. Some individuals want a couple of weeks off work. Others need longer relying on how they're recovering and the form of work they are doing. The donors have observe up after the surgery to verify they're healthy. Health: is revealed six times per yr and makes an attempt in every quantity to offer a mix of articles that inform or that provoke debate. The readership of the journal is vast and drawn from different disciplines and from workers both inside and outside the health care professions. Broadly abstracted, Health: ensures authors an extensive and knowledgeable readership for his or her work.