text:
Van Helsing: "The strength of the vampire is that nobody will believe in him."
America's debt to Wall Street has soared since 1945 – and although the banks were rescued at public expense, the public's been left holding the bag for the recent drop in housing prices:
Hmm … How many times has the word "vampire" appeared in books during the same period [1]?
What does this mean? Does it reflect the public's subconscious response to predatory banking? Or is it just some guy having nerdy fun with data sets by juxtaposing two trend lines that have nothing to do with one another? We report, you decide.
Here's what we do know: Like their fictional counterparts, America's banks are revenants, re-animated creatures who were brought back from the dead through the public's generosity. Now they're feasting on the rest of us again, while politicians in Washington work to rob us of the few tools we can use to defend ourselves. With some Democratic complicity, Republicans are fulfilling the promise of Rep. Spencer Bachus, who said that "Washington and the regulators are there to serve the banks."
And what they're serving them is you.
The Count: "Listen to them! The creatures of the night. What music they make …"
The rap sheet against America's banks grows longer and longer. They keep stringing people along with phony foreclosure negotiations, and then foreclose anyway. And we're hearing more and more stories about bank agents who, as they're invading and padlocking illegally foreclosed homes, also steal the private property inside them. In a recent ghoulish case, they stole a box containing the ashes of the homeowner's husband – ironically enough, from a woman named Ms. Ash. Even vampires don't do that.
The states of Arizona and Nevada are suing Bank of America, one of corporate America's worst offenders, for repeatedly breaking the law as forecloses on homeowners. The Arizona suit says that the bank has "consistently misled homeowners about its home loan modification process."
Foreclosure fraud isn't the only kind of bank criminality, of course. Deutsche Bank just plea-bargained its way out of criminal charges for helping people get out of paying their taxes. There's that matter of laundering drug money. And countless other crimes, large and small. But the widespread criminality surrounding foreclosures strikes the closest to home, but literally and metaphorically. After their taxpayer-funded bailout, these revenants are literally biting the hand that fed them.
The financial reform bill passed this year was less than the public wanted, according to polls, and less than it needed, according to experts. But it was a start, and Wall Street didn't like it.
Renfield: "I'm loyal to you, Master! I didn't betray you!"
Fortunately for them, the bankers have friends in low places. First the GOP killed the omnibus spending bill that funded many of the financial reform bill's provisions for protecting the public against predatory bank policies. Senate Democrats are trying to avoid a shutdown of government by introducing a continuing resolution but, as Pat Garafolo points out, it doesn't include any of the additional money needed to enforce the financial reform bill.
The Democratic resolution adopts the classic right wing budget-cutting notion that government should avoid spending increases and keep its budget numbers flat – or, as their resolution puts it, "funding would continue at FY 2010 enacted levels for most programs." That's a terrible mistake, both tactically and practically.
The SEC would be particularly hard-hit but this resolution, just when it's starting to pursue foreclosure fraud more aggressively by issuing subpoenas to the big banks and loan servicers. (Is that a coincidence, too?)
One of the reforms blocked by this funding move include the appointment of an "Investor Advocate" to assist stockholders who have been misled by corporations. Apparently these "conservatives" are more than happy to interfere with a free market, even the stock market, if their paymasters direct them to do it. The broad category of "investors" includes pension plans and other plebeian organizations, after all – and private investors are merely wealthy, rather than the extremely wealthy they live to serve.
The Bacchanalians have also stalled the funding of a whistleblowers office. That action will ensure that bank criminals aren't interrupted in their wrongdoing just because some underling is struck with an excess of conscience. They've also blocked the Office for Credit Ratings,, so we're still stucked with the corrupt, rigged ratings game that led to the last economic collapse.
Our elected leaders aren't the only ones baring our necks to the predators' fangs. The Federal Reserve's also getting into the act. As the National Consumer Law Center puts it, the Fed has "proposed new rules that make it much harder for homeowners to escape abusive loans, avoid foreclosure or obtain refinancing." The timing's not coincidental. They're rushing to put this rule into place before responsibility for mortgages is transferred to the Consumer Financial Protection Bureau. In this vampire story, Elizabeth Warren is Professor Van Helsing and the Federal Reserve is Renfield, Dracula's eager human servant.
Van Helsing: "We are dealing with the undead."
We know what needs to be done. A roster of banking and economics professionals has signed an open letter to regulators asking them to step in and correct these systemic flaws and abuses. But they couldn't do that without money, even if they wanted to. The head of the Commodities Futures Trading Commission says he can't implement financial reform without these funds.
We realize that comparing bankers to vampires is harsh, excessive, and unfair … to vampires. Vampires only target one victim at a time, after all. Vampires have the common decency not to show themselves in broad daylight. And as we all know from the movies, they're charming, polite, elegant – and terrific dancers. (I used to work on Wall Street and believe me: Bankers aren't a pretty sight when they dance.)
What's more, vampires won't enter your house without an invitation. As Ms. Ash learned to her horror, bankers aren't that civilized.
1] Created with Google's nifty new NGram tool.
This post was produced as part of the Curbing Wall Street project.


text:
Polyvinylpolypyrrolidone is a synthetic highly cross-linked polymer of Polyvinylpyrrolidone (PVP) that produces an odourless off-white to yellow powder that is insoluble in water. Although it is insoluble in water, it readily absorbs water and swells very rapidly. It is used as a stabiliser and fining agent (clarifier) in white wine, beer, ciders and vinegar, and also as a colour retention agent to stabilise colours.
Synthetic polymer. May cause damage to kidneys and stay in the system for up to a year. Avoid it.
Common Uses
Used in beer and malt beverages, white wine, cider and perry, concentrates for water-based flavoured drinks, dairy-base drinks, chewing gum, tabletop sweetener, surface treated fresh fruit, vinegars, cream, condensed milk, cheese (ripened, unripened, processed, and analogues), dairy based desserts, processed fruit, cereals, and more.

subset: commoncrawl


text:
- Research article
- Open Access
- Open Peer Review
Cancer patients' needs during hospitalisation: a quantitative and qualitative study
© Tamburini et al; licensee BioMed Central Ltd. 2003
- Received: 5 February 2003
- Accepted: 23 April 2003
- Published: 23 April 2003
The evaluation of cancer patients needs, especially during that delicate period when they are hospitalized, allows the identification of those areas of care that require to be improved. Aims of the study were to evaluate the needs in cancer inpatients and to improve the understanding of the meanings of the needs expressed.
The study was conducted during a "sample day", with all the cancer patients involved having been hospitalized at the Istituto Nazionale Tumori of Milan (INT) for at least 48 hours beforehand. The study was carried out using quantitative and qualitative methodologies. The quantitative part of the study consisted in making use of the Needs Evaluation Questionnaire (NEQ), a standardized questionnaire administered by the INT Psychology Unit members, supported by a group of volunteers from the Milan section of the Italian League Against Cancer. The aim of the qualitative part of the study, by semi-structured interviews conducted with a small sample of 8 hospitalized patients, was to improve our understanding of the meanings, implications of the needs directly described from the point of view of the patients. Such an approach determines the reasons and conditions of the dissatisfaction in the patient, and provides additional information for the planning of improvement interventions.
Of the 224 eligible patients, 182 (81%) completed the questionnaire. Four of the top five needs expressed by 40% or more of the responders concerned information needs (diagnosis, future conditions, dialogue with doctors, economic-insurance solutions related to the disease). Only one of the 5 was concerned with improved "hotel" services (bathrooms, meals, cleanliness). Qualitative analysis showed that the most expressed need (to receive more information on their future conditions) has the meaning to know how their future life will be affected more than to know his/her actual prognosis.
Some of the needs which emerged from this investigation could be immediately satisfied (the need for psychological support, the need for economic aid, the need for spiritual support), while others will have to be faced in the longer term; for example, the presence of a high percentage of needs in patient-physician relationships and/or information-communication issues, could be resolved by setting up structured introductory training courses for all clinicians in the institution. On the other hand, the needs related to the living infrastructure (bathrooms, meals, etc...) could encourage the Institution to improve its services.
- Future Condition
- Primary Tumor Site
- Previous Admission
- Psychology Unit
- Hotel Service
Over recent years an important change has taken place regarding the caring of patients. The biomedical model characterized by an objective approach to patients, which considers both their bodies and their diseases as objects, has been replaced by the "bio-psycho-social" model. This model is characterized by an approach that considers patients holistically and their disease as a complex event consisting in an alteration of the system at several different but integrated levels, biological, psychological and social [1–3].
This transformation in the field of medicine has taken place, above all, with regard to chronic and degenerative diseases such as cancer [4]. Facing a long course of a disease that is often susceptible to control but never to a complete recovery, evaluation of the "the best possible treatment" concerns aspects which are not only necessarily or strictly clinical (undesirable effects of treatment, years of survival). These further aspects are directly linked to the patients' quality of life, to personal aspirations, values, and quality of their relations and needs. For clinicians, examination of these aspects means that they need to pay more attention to the patients themselves as individuals during the various stages of their disease, beginning from diagnosis until the terminal phase [5, 6].
Helping patients to make important decisions about their lives and their health means therefore helping them to be aware of the impact that different treatments may have upon their ability to look after their own families or continue to work [7–10].
Thus, in the caring of patients, an important task of the physician consists in informing him/herself and informing patients about what can be offered them in order to improve their independence and quality of life [7]. In order to reach this aim, the considerable amount of work that has been carried out on the development of instruments self-compiled by the patient, is in its own way an improvement upon the limits of physician centered evaluation of the physical, psychological and social problems of the patient. Doctors tended to attribute to these problems with their own personal hierarchy of values and priorities, which were, therefore, often truly different from the patients' own perceptions of the problems [11–15]. Furthermore, it has been observed that it is the patients' subjective evaluation of their illness, rather than scientific achievements in medicine, that play a major factor in determining their choices and decisions [8, 16]. Added to this has been the patients' difficulty in expressing their own needs. Personality, cultural and historical differences may make mutual comprehension between patient and doctor very difficult.
Until recently, the effort made to bring together these two "realities" (the world of the doctor and the world of the patient) has resulted in an exponential increase in the number of instruments available. These instruments were created to evaluate quality of life, needs and satisfaction of care. A recent review of 210 published articles identified 18 potential need assessment standardized instruments used in cancer research [17].
A careful attention was given to improve psychometric proprieties of these instruments (reliability, validity, responsiveness). Less attention, on the other hand, was given to understand the deep meaning of what patients express when they report aspects of their quality of life, satisfaction and needs [18].
This kind of in-depth studies, which include an analysis of the patients' language and of the connotations and meanings of their words, may well represent a further approach to understanding the patients' conditions and their necessities, and may act as a guide for all those who administer care. The interest in patients' needs, and the meanings that patients give them, led to the setting up of a qualitative study parallel to a quantitative one on psychosocial and assistance-related needs of hospitalized cancer patients, with the aim of inducing interventions that satisfy the majority of their present needs.
The aim of the study was to evaluate different needs' prevalence in cancer inpatients and to understand their deeper meanings in order to promote an improvement in the quality of care. Secondary aims of the study were: a) to confirm the structural validity and the internal consistency of the standardized questionnaire used; b) to evaluate the association between the needs expressed and the basic demographic and clinical characteristics of the sample.
The Quantitative study
The survey was conducted in most clinical units at the Istituto Nazionale Tumori (INT) of Milan. The Units excluded were pediatric (as the questionnaire is to be filled out by adults) intensive therapy and nuclear medicine (as physical condition of the patients of such patients does not permit an easy interaction), medical and surgical day-hospital (as patients are admitted for too short a time). All patients admitted to the hospital at least 48 hours before, were invited to participate in the study and asked to give oral (informed) consent. Data regarding sex, age, educational level, primary tumor site, number of previous admissions and days of hospitalization were gathered. The NEQ (Needs Evaluation Questionnaire) was used for needs assessment [19].
The Questionnaire
NEQ answers distribution missing data and reliability coefficients for each item (N = 182)
Item number
Item text
% of Yes
% of missing data
I need more information about my diagnosis
I need more information about my future conditions
I need more information about the exams I am undergoing
I need more explanations on treatments
I need to be more involved in the therapeutic choices
I need clinicians and nurses to give me more comprehensible information
I need clinicians to be more sincere with me
I need to have a better dialogue with clinicians
I need my symptoms (pain, nausea, insomnia, etc.) To be better controlled
I need more help for eating, dressing, and going to the bathroom
I need more respect for my intimacy
I need more attention from nurses
I need to be more reassured by the clinicians
I need better services from the hospital (bathrooms, meals, cleaning)
I need to have more economic-insurance information (tickets, invalidity, etc..) In relation to my illness
I need economic help
I need to speak with a psychologist
I need to speak with spiritual assistant
I need to speak with people who have had my same experience
I need to be more reassured by my relatives
I need to feel more useful in my family
I need to feel less abandoned to myself
I need to be less commiserated by other people
Statistical Analysis
We compared groups of responders and non-responders with regard to demographic and clinical characteristics, using Fischer 's exact test and Student's t-test.
Confirmatory factor analysis on thetracoric correlation among the observed variables was used to test the structure of the questionnaire described above. Estimation of the model parameters was obtained by means of weighted least squares (WLS) using the program LISREL 8.0 [20]. Evaluation of the model to be confirmed was based on the following criteria: the Chi-square statistic (χ2) [21], which indicates the lack of fit of the model (contrary to conventional significance paradigms, large values of chi-square, and small P-values, indicate poor fit and model performance, leading to the rejection of the hypothesis that the assumed model is 'true'); the Adjusted Goodness of Fit Index (AGFI) [22], which, contrary to χ2 does not depend on sample size and measures how much better the model fits compared to no model at all (it should lie between 0 and 1, large values being associated to good models); the range of the Squared multiple Correlations (SMC) [20, 23] or each of the observed variables in the model (each index shows how well an observed variable serves as measurement instrument for the latent variable, with large values (range 0–1) being associated with good fit). Cronbach's alpha indexes [23] were calculated to estimate the internal consistency of the four factors tested.
Association between each of the 23 items of NEQ and sex, age, primary tumor site, educational level, number of previous admissions, self-sufficiency in movement and hospitalization duration was examined by means of Fischer's exact test for rxc tables or Student's "t" test. Multiple comparison influence on Type I error was overcome by splitting the sample into two of equal size: the first, the "training" sample, was used to perform association analysis with an explorative aim and where p < 0.10 was considered significant; the second, the "validation" sample, was used to replicate the analysis and verify whether an association from the training sample still showed significance.
The Qualitative study
The qualitative part of the study was aimed at complementing the quantitative description of the patients' needs, showing the multiplicity and richness of meaning that the affirmations of the questionnaire had in the subjective world of the individual patient. According with this aim, among the patients who filled out the questionnaire (NEQ), we choose a purposeful sub-sample (eight patients) identifying those who answered YES to more than five items and among them those who demonstrated great skill in recognising and expressing the experiences relative to their condition as admitted patient.
This kind of sampling focuses more on the identification of information-rich cases than on the representativeness [24]. The objective of the study is not to generalise the results but to show and document the complexity of an experience.
By means of individual semi-structured interview, the selected patients were invited to examine the meaning of the need they expressed through the questionnaire.
The interview was constructed on the bases of the items of the NEQ questionnaire choosing those considered less deepened in the scientific literature or those who may lead to multiple interpretations by the patients.
The items were the following: n. 2, 5, 7, 11, 13, 17, 18 (the text of the items can be found in table 2). The interview started with the identification of a critical incident regarding the specific situation where the patient felt their needs been unsatisfied and, after this, the subjective meaning of the situation as well as the different implications of the needs were analysed and discussed. The interviews were tape-recorded and later transcribed.
Data analysis was carried out autonomously by three researchers, by means of successive steps, each of which represents an increasing level of generalisation:
Each researcher identified all propositions held personally to be significant, without considering their relations with other parts of the text, accompanying them with his own comments.
The comments were developed and contextualised along with the entire interview.
From each interview the researcher extrapolated the themes he/she felt were relevant.
Analyses of each interview were confronted with the others, with the aim of finding common themes and verifying conformities in similarity or contrast.
The three analytic processes were confronted with one another.
The results were presented following the NEQ major factor groups obtained in the previous validation:
1. Information 1st factor: refers to information relative to diagnosis and future conditions.
2. Information 2nd factor: refers to information on therapeutic choices and on results of tests.
3. Communication: predominantly regards relations with clinicians, in particular the feeling of being (or not) in a reassuring and sincere relation, based on dialogue.
4. Relational factor: regards the perception of patient's own position in a wider context (family, other patients, society in general).
5. The area of "intimacy" was also flanked beside these four factors.
Results of the quantitative study
Of the 224 eligible patients contacted in the sample day, 182 (81%) fully completed the questionnaire, 2 partially completed it (more than 3 items missing), and 40 did not completed it at all. The reasons for non-completion were the following: refusal to fill out the questionnaire (8 patients), physical and/or cognitive difficulties (12 patients), absence of the patient from his/her ward for surgery or other exams (17 patients), other organizational problems (3 patients). The questionnaire was filled in by 49% of the patients unassisted, while the remaining 51% asked for assistance (the interviewer read the questions to the patient and then wrote down the answers, without exerting any influence on the responder).
Basic demographic and clinical characteristics of the sample of 182 responders
Median (range)
Educational level
Primary school
Secondary school
High school
Primary tumor site
Head & Neck
Number of previous admissions
Two or more
Days of hospitalization (with regard to the present admission)
Median (range)
Autonomous movement
91% of the patients were self-sufficient in movement. No statistically significant differences emerged between the group of responders and non-responders as regards gender, age, primary tumor site and duration of hospitalization, while they differed in number of previous admissions: responders had a mean number of 1.5 previous admissions vs 0.7 of non responders (p = 0.018).
Table 2 presents the percentage frequency of positive answers and missing values for each item of the questionnaire. The percentages of missing values for each item are very low (range 0–3%) indicating a good comprehensibility and acceptability of the questionnaire by the responders. Among the five requests most frequently expressed by the patients, four regard information needs: concerning diagnosis (40%), about future conditions (61%), regarding a better dialogue with clinicians (45%), and about economic-insurance information (40%), while only one regarded the need for better services at the hospital (bathrooms, meals, cleaning) (59%).
Most of the support-assistance items remain under 30%. The need that was less frequently expressed concerned help for eating, dressing, and visiting the bathroom (11%), which is in accordance with the characteristics of a very low percentage of the sample presenting problems on movement. There was also a low level of request for better attention from nurses (13%).
Standardized Lisrel estimated factor loading for the validated model
Item number
Informative 1st (*) factor
Informative 2nd (**) factor
Communicative factor
Relational factor
Cronbach's alpha indexes
None of the association which proved statistically significant on the training sample was confirmed by the analysis on the validation sample. Since the power of tests performed may have been greatly limited by the splitting of the sample for the training and testing procedure, some of the associations thought not statistically significant which maintain their direction in both samples ought to be verified in future studies. The above associations indicate that, as the number of previous admissions grows, the level of information needs (all items except for better dialogue with doctors and better attention from nurses) diminishes; further, that the higher the educational level, the lower the need for economic help.
Results of the qualitative study
Factors 1. Information. Items: I need more information on my diagnosis; I need more information on the exams I am undergoing; I need more information on treatments
The Pros and Cons
In my opinion having information on my disease means knowing all there is to know about the illness. Knowing what are the pros and cons: what you can do after the operation, how my life and my eating habits will change; and what the effects will be of therapy. Knowing everything – no. Knowing everything would hurt you. But knowing the most important things is indispensable.
The Doctor's Round
Take the Doctor's Rounds in the morning when they tell us how the tests went or they sum up to that moment. In that time, I need information; but often this 'round' is characterized by a Hermetic language. I, at least, understand a little, thanks to my scientific background. Then they are extremely laconic when it comes to the outcome of a test that could determine a change of therapy because the result is less positive than expected. So I would say that not only do more things need to be said, but things need to be explained in more detail so that they can perhaps reassure the patient as to why such and such a test did not go so well.
But in a few words they tell you that the previous therapy did not have a great effect, that the results of the last exam showed a lack in efficacy, and so therapy must be changed.
Not long ago, after six months of being cured, they told me that this kind of therapy improved my cancer by 40%. They told me this was an extremely positive result because 1.) I had been getting worse and so the tendency was reversed. And 2.) for them, 40% was a lot; I was very distraught because I had thought that after six months of very heavy therapy, 40% for me was very little. Therefore not only did they not obtain the response they" desired" from me in communicating the result, but I was thinking that another 6 months of therapy was going to be necessary.
They communicated this to me with satisfaction; but considering how much I had suffered up until that moment and considering how long the therapy took, I thought the result was poor. From their medical point of view probably my observation was seen as unreasonable. What for them was a good result lost all meaning and became demoralizing for me when it reached me as simply a number.
Percentages 1
The idea of calling a doctor for a response in terms of percentages is not the kind of answer I would like. Yes, I would like to know I had lost about half the hair on my head; or that in a certain percentage of cases the stomach resumes its normal functions with great difficulties which need to be progressively overcome. This way of answering I consider to be fully satisfactory.
Percentages 2
"He/she told me straight away: 'In 80% of cases, these are things that cure.... You are in the other 20%. This means that you are unlucky...."'.
Future Conditions. Item: I need more information on my future conditions
Quality of Life
By 'future' I mean also the quality of life because someone can say "you will live for 10 years", but "how will I live?". More detailed information is needed; like, for example: "you must cope with this or that"; but doctors just give summarized information. This is true above all about oncologists.
Also I mean the possibility of being cured, but here everything is reported in statistical terms; it is very schematic: "50% responded like that; 30% like this". But no one knows what their own percentage will be. They don't consider your own case. This case must be considered; for with the same disease one patient may be in a bad state, while another feels OK. They cannot be equal; this should be considered. But they only consider the state of the disease and everything is related to that.
They tend not to speak. They don't open up. If you continue to ask questions maybe you will hear things said that you wouldn't want to hear. The answer, beyond a certain point, is not stimulating but soul destroying. It is worth asking questions, but only up to a certain point.
Length and Quality of Life
For me it is more important to think "the years that I have left to live will have a certain quality of life," rather than "I have so and so many years to live".... of course. While before I, who had never been ill, used to think that nothing could happen to me or, rather, I took it for granted instead of thinking about it, now, I don't take anything for granted and this illness changes my life a lot. You have to re-see everything. However, you lose 2 years of your life. You can see it is impossible to keep your old job, your place of responsibility, and then you choose to have a life different from the one before. You try to analyze what didn't go well before. I, now, would remedy a certain degree of superficiality of my old life. I am very attentive now; much more of my attention is focused on many things; many signs. Before, I used to pass over things that were important; things that would always be done 'afterwards'. Now I make different choices; of course I would not neglect so many signs any more. This cancer was discovered by chance; I had completely neglected to heed certain messages my body communicated to me...
Things Precise and Nearby
I feel great discomfort as I go along this winding path that changes from time to time; and from time to time my future conditions also change. From time to time cloudy and uncertain information is given to me, probably because my response to treatments is cloudy and uncertain; however, my future conditions are completely dependent on contingencies.
It's not about a far off future, but about things precise and nearby.
Factor 2. Involvement in Therapeutic Choices. Item: I need to be more involved in therapeutic choices
Adaptive to My Demands
For me, choosing the therapy together with a doctor means knowing what I will be up against with the therapy that the doctor decides to give me. And speaking about it together with him/her could help to find a more adaptive solution to my demands, perhaps changing a little of what he/she might administer to me. It would be good to be able to come up with a 50:50 understanding arrangement where I understand the doctors' demands who wishes to use therapy on me, and where he/she understands my demands too. Up to now I haven't taken part in such an arrangement.
The Choice
It is clear that therapeutic choice should be made by the doctor because I am not a doctor. However, the doctor must explain the purpose of the therapy he/she adopts so that I can make a distinction too. The doctor should make the choice, but he/she should also "listen" if the patient is willing to go through with such a choice. He/she should say: 'I propose this for this reason.' And I, who am the person directly involved will say: 'Yes. That's ok for me because I understand what it's supposed to do!
Factor 3. Communication. Items: I need doctors to be more sincere with me; I need to have more dialogues with doctors; I need to be more reassured by doctors
Hermetic Communication
Communication with the patient is hurried and fairly hermetic also for a person of average cultural background. Therefore given that this is an illness which has important psychological implications, communication in 'snatches' will not do.
Communications are given in a very formal context (the 'round'), but it is obvious that for the patient it is more difficult to ask for explanations from 10 doctors instead of just one.
They give the impression of speaking in abbreviations. They speak to one another about the results of tests in such a condensed way that it almost gives the impression they don't want to communicate to the patient at all; that the information is more or less for their own internal use. Sometimes they give contradictory information among themselves (depending on the doctor) and this worsens the situation. One time I said to one of them that because patients have so little time available (with the doctors) their 5 minutes of explanation in the morning is meditated on later on in the day, sometimes during the whole day, so they can try to interpret what was said. The doctor's reply was that they are so involved in a whole series of practical problems, urgencies, that they don't rate this aspect and that if they weren't made to observe it a second time they wouldn't even be aware of the damages that some of their words could cause to the patient. For me a more interactive, more simple and human situation needs to be created. First of all maybe it is necessary that there be one same version in the sense that sometimes three different doctors come and each one gives a different version of the same exam; this naturally doesn't help. And, apart from this problem, the way in which these communications are expressed is not like a dialogue, but like an authoritative lecture. And more often than not, it is expressed not for communication with the patient, but for communication among the specialists themselves in which the patient is lucky if he/she understands anything at all; otherwise... see you in another moment; maybe after three days.
Politeness First and Foremost
I have had the experience of being admitted to hospital wards in other institutions. There are enormous differences: in one of the two cases, no doctor came. Things were allowed a little to be like that. But a doctor coming and stopping for a time to speak to the patient is extremely important for me; otherwise people feel rather abandoned...I was there for what should have been three days; and then in one week I saw one doctor only pass by once. He was the consultant surgeon. The consultant surgeon didn't say hello; he didn't ask patients what they had. No – he asked the swarm of practitioners – young doctors who were learning – instead! I heard someone answer about my case: "He had a problem, but now it's been resolved!" But what problem? Why doesn't he ask me what I had? I was there for that mistaken experience .... Because they had made a mistake in a certain kind of operation... Then they moved on, without saying hello, without making eye contact.
This is lack of politeness first and foremost. I saw that they acted like this with all the beds in the room. This surely must be improved upon.
Sincerity is something one realizes subsequently; for, during the moment when it is verified that the things the doctor said really are what he said they would be, one understands a posteriori the sincerity of the doctor. A priori, a stronger act of trust is needed; for this it is important to have an empathetic rapport with patients.
Factor 4. Relational. Items: I need to talk to people who have had my same experience; I need to be more reassured by my family and relations; I need less commiseration from others
Dialogue Among Patients
Often what takes place among patients is a dialogue among 'deaf' (sic) people; for most of the time they don't listen to the others. They only have this need to communicate the horror that they are experiencing; a whole series of somber heavy feelings which, in that moment, they absolutely need to communicate and they don't even listen to what the other person is saying; so there is no real conversation. There is a passing of information; there is an irresistible urge to broadcast, to communicate. I often go to have breakfast in a common area and I hear myself asking 'Where do you have your cancer?' before asking me: 'What's your name?' or 'Where do you live?'. It is really absurd, but justified because I feel the fear that lies behind it and the necessity for recounting one's own story. It is an irresistible necessity; within about half an hour you can discover just about everything about such and such a person; and not only his/her illness, but also everything else that person had experienced previously.... But everything is centered on the disease, with extreme heaviness, with an extreme sense of claustrophobia.
By now I've got to the point where I listen to my walkman so as to avoid communication, so as not to listen to what the others are saying, and so as not to be involved in conversations with those who pretend to be interested in your disease, but who really wish to speak about their own.
The Rest of the World
The fact of being a cancer patient makes people enter into a role and makes them always speak about the same things. It makes others assume the belief that the rest of life, also of their life, is useless when faced with the gravity of the experience the patient is undergoing. There exists a disproportion. At times others, also friends, refuse to recount their things because of this disproportion of pain in mind; and this prevents the rapport from being on an equal level. Patients are seen as poor little animals who are 'people truly with a problem'; while the rest of the world has silly and inessential problems. This, therefore, causes others to always speak of the same things. So they speak not only of such and such a disease, but of everybody else's disease as well. What a nice catalogue of disasters and misfortune!! To sum up: our problems are vain; they're silly; they're frivolous; only you have true problems; let's speak only about your problems.
Intimacy. Items: I need more respect for my intimacy; I need more attention from the nursing staff; I need better services from the hospital (bathrooms, meals, cleaning)
A Very Physical Presence
I found the nursing staff reasonably attentive. I remember there being a very physical presence. Maybe if we understand it in a wider context, the fact of sharing living space with another person... well...this could be a violation of intimacy. Undergoing certain particularly heavy therapies while sharing your room with another person can, at times, create situations lacking in intimacy which only makes everything heavier to bear.
Involuntary Hearing
For example, when doctors come along on their rounds – I am in a room with four beds – it annoys me to hear everything about other people's diseases; just as it annoys me when the others hear things about my situation.
I don't think this is right. I feel uncomfortable when I can't get up because usually when the doctor finishes speaking to me I leave; but I have found myself in situations where I couldn't get up; where I had to stay there and listen to the doctor who maybe said some things which were a little unpleasant to another patient and I felt the patient's state of being ill at ease; he/she maybe felt embarrassed; maybe he/she couldn't express what he/she wanted to. I have noticed this both in myself and in other persons.
Being Seen Naked
...I mean, above all, the fact of being seen naked... Situations do exist where nurses wash a woman in the same room in front of you; or where a male nurse comes to wash you because it's his shift and involuntarily it wasn't thought of to send a female nurse.
...for example, when a person has a stoma and a person needs to be clean; because if you are operated on you shouldn't have to go and beg to the nursing staff for them to change you; it should be a logical thing; immediate. I have found myself having to beg for this. If I had been capable I would have done it myself.
This touches a person deeply, for it is his/her way of feeling, of being sensitive. Intimacy is not represented only by certain things, but it also consists in moving to touch a person in the area where he/she feels; touching his/her sensitivity.
Sensitivity is a very intimate property (part) of a person.
Dividing Men and Women
From the point of view of one's own intimacy, it is an infamy state of affairs. Last night I went in to the bathroom and there was a gentleman there: I felt inhibited. The doors don't close properly. And, anyway, I didn't particularly feel like going into the bathroom and seeing that man cleaning his set of false teeth. Again, one can't get undressed in order to wash properly. These are things that make you feel bad.
They could, at least, divide men and women: at least then (for me) it would be only women encountering one another in the bathroom.
Table 4 shows the need to obtain a diverse modality of communication between clinician and patient, and to redefine the setting in which this traditionally takes place. In addition, table 5 shows the need for making the scenario of a patients' future life intelligible and foreseeable; patients ask for personalized explanations shaped as much as possible to their individual needs, thus avoiding indeterminacy or generalization based on statistical reference or analysis. According to table 6 clinicians are requested to understand the patients' demands even though these demands are not always consonant with the clinician's own perspective on therapeutic choices. A less hurried, hermetic, and prudent, and a more sincere and polite form of communication was also requested (table 7). Some patients brought to attention the potential danger of communication between hospitalized patients themselves, through which anxiety might be exacerbated among "the deaf", rather than any reassuring exchange of experiences and reciprocal encouragement occurring (table 8). The patients' reflections on the theme of intimacy (table 9) – considered in all its multiple of facets – refer, among other things, to criticism of situations like the "doctors' rounds", perceived as a violation of the some of the most elementary principles of respect for privacy.
The analysis of the structural validity and the internal consistency of NEQ confirmed the psychometric properties shown in our previous study giving a further evidence of its value in assessing hospitalized patients' needs.
This study shows that some needs are unsatisfied in one out of two hospitalized cancer patients. Most of the needs concern the request to receive more information both about their future conditions (this is the most expressed need, reported by 6 patients out of 10) and their diagnosis (4 out of 10). These findings agree with data already reported [17, 25–27]. Besides the documented presence of this two needs and the importance of information in the doctor-patient relationship, some studies have underlined the necessity that clinicians help patients to understand information [25, 28, 29].
The patients' desire to know more about their own diagnosis and future conditions does not necessarily mean that the patients ask for an active role in medical decision-making. Less than a third of patients expressed the request for deeper involvement in therapeutic choices. Two recent studies on women with breast cancer gave similar results; about half of the women had a role in decision-making that matched their desired role, a quarter had a less active role than desired, and a quarter had a more active role than desired [30, 31].
The new trend that encourages self-determination and responsibility by the patients did not, in fact, take into account patients' disorientation, and therefore their inability to take at times a more active role in the management of their experience with the disease. The clinicians find themselves lacking guidelines for managing doctor-patient relationships. The traditional paternalistic doctor-patient relationship is no longer acceptable; however, the basis of a new clearer and "shared" model has yet to be found.
Clinicians should, therefore, consider the meanings (explicit and implicit) contained in a request for more information. The analysis of qualitative data of the study shows that the need for more information on their future conditions does not mean for patients "knowing all there is to know about prognosis". The patients' principal need appears to be receiving more information about the impact of their illness and treatment on their daily lives, with particular attention being paid to the realistic ability to carry out such activities; in brief "what will I be able to do or not do?", "what will I or won't I be able to eat?", "will I be able to move, work, love, have children and if "yes", how?". One important dimension, therefore, regards the quality and not just the quantity of life remaining. The appropriate care for patients will be the one that also considers the implications of the illness, and is capable of providing patients with assistance for the diverse problems [7].
Another aspect which emerges from the analysis of qualitative data concerning information on prognosis, regards the quantification of the risks of the therapy proposed by the doctor. In the quantification of the uncertainty of evolution and efficacy of a cure, the epidemiological and statistical tools might precisely and accurately render the expectations for a patient with similar characteristics without being able to give a deterministic estimation in specific cases. On the other hand it appears that it is more important for the patient to a) receive personalized information, which is commensurate with his/her physical and emotional situation, and b) to be considered within his/her own unique profile. Thus "expected time" can be different from "lived time", where the days and nights are diverse, some terrible, others welcoming, others without identity but all intrinsically offering some quality of life.
Furthermore, patients' observations suggest the necessity of an improvement regarding the circumstances under which personal information is discussed. Crowded, noisy ambulatory conditions too often provide the stage for delicate and important communications. Patients respond negatively also to "the doctor's round" on the ward; they are aware of being the object of the clinicians' deliberations and they feel inhibited about open communication.
The request for more dialogue, expressed by around half of the patients, emphasizes the importance of communication and listening skills necessary for selecting information considered relevant by patients. The clinician-patient relationship should, therefore, encompass and integrate listening more attentively to these expressed needs, and the provision of information. It should be a connection between the world of cancer as a 'biological entity' (disease) and the world of cancer as 'a lived experience' (illness). It is within this kind of relationship that the patients will find greater assurance. It will allow the patient to feel that the doctor is nearer to him/her about any future eventuality.
The need for reassurance is expressed by 4 patients out of 10, together with the desire to talk to people who have had similar experiences. Relations among hospitalized patients, however, are complex. Analysis of our qualitative data shows that the relationships between such patients cannot always be simply defined as "having company" or "sharing similar experiences"; it can also represent a moment of emotional engagement. Confrontation with others may sometimes generate an element of 'contagion'. Repartitioning of physical space in hospitals should, therefore, take into consideration the necessity for the setting up in some cases of protected areas in which the patient can expect intimacy.
The need for a more respect of intimacy (present in only 2 patients out of 10) appears to be not only manifested by patients being seen naked, or by their forced sharing of bathrooms. The patient is usually subordinated and in a weak position with regard to the rules and regulation of hospitalization that, at times, fails to respect their intimacy and privacy.
One last, but by no means least, aspect is the satisfaction of needs regarding services offered by the institution, both concerning assistance (control of symptoms and/or of practical help with functional problems) and hotel services (bathrooms, meals and cleanliness). While there seems to be little presence of needs concerning assistance and most patients are satisfied with hospital staff, the needs concerning hotel services were expressed as being not satisfactory by two patients out of three, indicating the need to improve these services.
The 'humanization movement' in hospitals, which in recent years is definitively culturally based, will be accomplished not only through education and training processes of health workers, but also by structural interventions aimed at rendering the experience of hospitalization more amenable and comfortable for patients [32].
It is difficult to evaluate the real impact of this research to meet the needs of the patients of our hospital. Preliminary data from this study were presented at a meeting of a large number of physicians and nurses working in the hospital. The data was commented upon by the directors and the members of the Ethical Committee of the hospital. The solutions suggested to meet the needs expressed by patients were published in the newsletter and the web site of the Institute, followed by articles on the Volunteer organizations, patients' right Associations newsletters and by popular magazines. This could be a first step in the direction of real change in cancer patient care.
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Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.


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Individual Retirement Accounts (IRAs)
Save money today, while ensuring a relaxing tomorrow, with an FCNB IRA. The money you set aside earns high interest — and can be deducted from your taxes.1 Choose from several IRA options to find the plan that suits you best. The most important choice, however, is simply the choice to get started.


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John is Senior Director of Telelogic Strategic Solutions for Telelogic, an IBM Company. He can be reached at [email protected]. Scott is Director of Modeling Solutions for Telelogic, an IBM Company. He can be reached at [email protected].
Application lifecycle management (ALM) has evolved into an ecosystem of integrated processes and domain technologies for the system and software development lifecycle. ALM establishes a framework that you can use to:
- Catalog and manage customer requirements.
- Plan a portfolio of development projects to address these requirements.
- Manage design, development, testing, and deployment.
- Manage change throughout the entire process.
MDD, on the other hand, lets you more accurately design, simulate, and validate the complex behavior of distributed, mission-critical systems. The model-driven process uses visual aids to accurately describe and define system objectives and solutions. Scientific and technical industries, such as aerospace, defense, and telecommunications, depend on MDD to increase the quality and efficiency of complex software and systems through modeling.
The combination of ALM and MDD creates a rich environment of connected processes and interacting solutions that are proving invaluable for successful systems and software development projects. This is a welcome advance, given the state of today's complex development environments. A major challenge for many organizations is finding a way of integrating all aspects of the development lifecycle in an intuitive, yet formal manner to deliver long lasting, business critical products, systems, and applications.
Moreover, in combination ALM and MDD provide exponential gains in the optimization of development lifecycle processes. MDD is a natural fit within the ALM framework. The integration of ALM and MDD lets you optimize products and services and serves as a framework for the fast, accurate, and coordinated design and development of architectures, applications, and products. The combined framework connects to an enterprise architecture at the highest level, helping organizations adopt more iterative development approaches. It also provides integrated products and best practices, as well as change management, so organizations can respond with greater agility as the pace of business changes.
Application Lifecycle Management
The concept of application lifecycle management (ALM) was introduced to help companies identify tools and technology to ensure software project success. Figure 1 shows the key components of the ALM ecosystem that focus on visibility, quality, and alignment in the development lifecycle.
Essentially, a defect, bug, story, feature, idea, or suggestion is a requirement if it results in a code change. Within the ALM ecosystem, requirements are the foundation from which all things evolvethey serve as the thread that ties together all phases of the product lifecycle. To maximize return on investment in the ALM environment, it is essential to align the organization's development efforts with internal and external customer requirements.
Because requirements are the key driver to align the business with engineering within software development lifecycle, a requirement-driven approach to ALM is fundamental. Whether you are developing a product, system, or an application, a requirements-driven approach lets you ensure that the goals of the business and your customers' needs are prioritized into requirements that remain persistent and auditable throughout every phase of the development process.
Another big piece of ALM is change management. Change requests, inevitable in any organization, can come from many sources and can take various forms; for example, bug fixes, customer proposals, enhancement requests, action items, platform changes, defects, and help-desk tickets. In addition, controlling changes to products, establishing relationships between them, managing different versions, assessing the impact of changes, and auditing and reporting the changes can overwhelm any organization. Producing or reproducing a product with controlled incremental changes, comparing different releases, and analyzing the differences are all activities essential to success.
Small teams may be able to manage changes in an ad-hoc manner. But, as the team grows and its development becomes more complex, lack of effective change and configuration management across all phases of the development lifecycle will cause changes to spiral out of control and jeopardize the success of the project.
A more robust approach to change management in ALM integrates software configuration management. A change-oriented approach for configuration management ensures the consistency of the development team's deliverables and workspaces through a workflow driven by logical changes (such as fixes and enhancements) that often span multiple files. It accelerates development by identifying and resolving integration problems. When integrated with change management, software configuration management lets change requests drive development tasks.
Configuration management, a discipline that is essential for success, supports parallel development, distributed development, factoring, and versioning. It encourages re-use through a single repository that contains a single version of the truth that reflects what is actually happening in the development process.
An integrated requirements-driven process for ALM makes is easy to prove requirements are traced to their implementation requests, which in turn are linked to development tasks and objects. This ensures that developers are focused on the right priorities, have the latest updated information, and also have access to the full context of their assignments. Analysts, business managers, and auditors have full real-time visibility into the implementation.
By connecting the development process, the right tool, and the people, a requirements-driven approach unifies traditionally separate processes of the development lifecycle into a single connected process that drives the entire development lifecycle. Unifying requirements across the entire ALM ecosystem enables information exchange and collaborative communications. It also accelerates response to changes in customer requirements, process, organization, and technology.
When it comes to implementation and delivery of requirements, you can take either a hand-coding or a model-based approach to ALM. However, if you decide to take the model-driven development path, you have access to all the benefits that MDD provides.


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Execute (real) shell commands from Groovy.
This post is about running shell commands from within Groovy, specifically bash but it is easy to adapt to other shells. You can already run commands with syntax like:
"ls -l".execute()
That is about as simple as it gets and works great for many situations. However, execute() runs the given command passing it the list of options, the options are NOT passed through the shell (e.g. bash) for expansion and so on. As a result, you can NOT do something like:
"ls *.groovy".execute()
In this case, no shell sees the * to expand it, and so it just gets passed to ls exactly as it is. To address this, we can create a shell process with ProcessBuilder and pass the command to the shell for execution. A common use case for me is to want to just pipe the shell command's output to stdout. With some Groovy meta-object programming we can make this a method of GString and String so that you can execute any kind of string simply by calling, for example, a .bash() method on the string. Below is a class that does that. This class (including improvements) is included in durbinlib.jar. With this class, one can not only properly execute the ls *.groovy example above, but can even execute shell scripts like:
for file in \$(ls);
echo \$file
To turn on this functionality it is necessary to call RunBash.enable() first. So a full example using the durbinlib implementation is:
#!/usr/bin/env groovy
for file in \$(ls);
echo \$file
A skeleton of the class itself follows:
static boolean bEchoCommand = false;
// Add a bash() method to GString and String
static def enable(){
GString.metaClass.bash = {->
String.metaClass.bash = {->
static def bash(cmd){
cmd = cmd as String
// create a process for the shell
ProcessBuilder pb = new ProcessBuilder("bash", "-c", cmd);
pb.redirectErrorStream(true); // use this to capture messages sent to stderr
Process shell = pb.start();
InputStream shellIn = shell.getInputStream(); // this captures the output from the command
// at this point you can process the output issued by the command
// for instance, this reads the output and writes it to System.out:
int c;
while ((c = shellIn.read()) != -1){
// wait for the shell to finish and get the return code
int shellExitStatus = shell.waitFor();
// close the stream
try {
pb = null;
shell = null;
} catch (IOException ignoreMe) {}
Labels: bash, groovy, ProcessBuilder


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Discover Bath & Stonehenge Day Tour
The Tour:
Visit two beautiful English places at an affordable low cost. This tour will take you to Bath & Stonehenge with a Professional guide and luxury coaches. The tour does not include entrance to the venues which gives you choice to choose if you wish to go inside or explore the city.
The tour departs early morning and passes through the beautiful & green plains of Salisbury to makes its first stop at Stonehenge. This 5,000 years old site is known as British Cultural Icon and has been to added to World Heritage Sites. These 4.1 meters tall stones have a lot of stories to tell along with its majestic views.
The tour then heads towards Bath, a city that depicts Roman and Georgian architecture with terraced houses. Bath is great historical city housing Roman Bath built by Romans in AD 60 featuring natural hot spring water. The city is also known for Bath Abbey first built in the 7th century. You can roam around the narrow streets of Windsor or enjoy a relaxed evening by the Putney bridge and the enjoy the views.
- The tour may change the sequence of visits to places during peak periods
- Entrance to Venues is not included but can be bought on the day
- All coaches have WiFi, however, during peak periods there may be coaches used without WiFi
- Please see tour instructions page for departure information
Tour can be canceled 2 days prior to tour date.
If you are not sure about the pickup point, you can always drop us an email and our dedicated team can guide you. We can also book a transfer from your hotel to tour departure time for an affordable price.
Tour Departure Information
Departure Days: Daily
Departure Time: 8: 30 AM Check-in: 8:15 AM
Return: Approx. 8:00 PM
Departure Point:
4 Fountain Square, 123 - 151 Buckingham Palace Road SW1W 9 SH
Tour return Point: The tour returns back to Victoria


text: According to The Hollywood Reporter, James Marsden will join Cameron Diaz and Frank Langella in THE BOX, Richard (DONNIE DARKO) Kelly's soon-to-roll film version of Richard Matheson's story "Button, Button." Diaz and Marsden will play an unhappily married couple who are told by a stranger (Langella) that if they push a button on a box he presents them with, they'll get a large amount of moneybut someone they don't know will die. Best known for playing Cyclops in the X-MEN movies and his recent appearances in SUPERMAN RETURNS and HAIRSPRAY, Marsden has also appeared in CAMPFIRE TALES and DISTURBING BEHAVIOR.


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Look no further! What wine lover hasn't dreamt of owning their own vineyard? By renting a row of vines you can give your someone special the year-round enjoyment of drinking the fruits of their very own vineyard.
In addition to renting a row of vines, the recipient of this gift can enjoy full membership to 3D Wines, giving them the choice of many exclusive, award-winning wines not available elsewhere in the UK.
Furthermore, they can visit their vineyard where they will receive an especially warm welcome and enjoy a tour and tasting with their winemaker who will reveal the fascinating world of some of the world's iconic crus.
Choose from our most popular vines
"We arrived as 3D vines partners and left as friends. Superb wines, and good value for money. Looking forward to the Loire weekend, this will be our third time and all have been different."
Mr & Mrs A Hewling, Cornwall – July 2017


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OBERHAUSEN, Germany — Seven months after a double hip replacement, Manuel Charr defeated Alexander Ustinov of Russia by unanimous decision for the vacant WBA heavyweight title on Saturday.
The judges awarded it 114-111, 116-111 and 115-112 in favour of Charr, who became the first German heavyweight champion since Max Schmeling in the early 1930s.
The Lebanese-born Charr, who was also shot in the stomach during an altercation at a kebab shop in 2015, said he would have been champion sooner had he undergone the hip operation before last April.
Charr arrived in Germany in 1989 as a refugee. He was stabbed in the back with a knife when he was 16.
"I have experienced much more than fits in a life," Charr said before the bout. "I'm like a cat with seven lives. I've used five so I have to change something."
Charr rocked Ustinov in the seventh round when he had the taller fighter against the ropes and tried to finish off the bout. The Russian weathered the punches but seemed disorientated, allowing Charr through again and again with his left.
Charr finished the eighth by catching Ustinov with a vicious left blow that left the Russian on his knees with blood streaming below his left eye. The bell provided respite.
Ustinov displayed remarkable resilience as he lumbered through the next rounds but Charr had already done enough.
Charr improved to 31-4 with 17 KOs, while Ustinov dropped to 34-2 (25 KOs).


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Womenswalkingshoereview.com is launched to provide appropriate advice for both serious walkers and those who include walking in their daily exercise plan.
State College, PA -- (SBWIRE) -- 01/16/2015 -- A recent article on the medical website "MayoClinic.org" entitled "Walking shoes: Features and fit that keep you moving" featured information on why these shoes are so important. The fitness writers at the Mayo Clinic report, "Walking shoes were created for a certain function and to be fit correctly onto the foot. Every walking shoe is built in a different way. Before making a purchase, prospective wearers should be familiar with several brands and styles."
The writers at the Mayo Clinic also note, "Buying the right shoe for one's foot can prevent common injuries to the feet like calluses and blisters. Shoes should be fit for comfort before beginning an exercise plan that involves daily walking. Among the options that footwear buyers should be aware of are gel pads, extra cushioning and roll bars that provide added stability."
Meeting the needs of female consumers who want to find the most perfect pair of walking shoes to fit their feet, is the aptly named website "Best Walking Shoes for Women." Spokesperson Sheryl Smith describes their goals, "Many women confuse running shoes for walking shoes. While this is not hard to do, running is very different from the act of walking. When we walk, our weight rolls from our heels, through the ball of the foot and then the contact with the ground continues to our toes. Due to the mechanics of this movement, the shoes women wear when walking need to be designed with this exact purpose in mind."
Sheryl Smith explains, "On the web pages of 'womenswalkingshoereview.com' we give consumers an education in finding the right footwear for their feet. Our readers become educated as to their arch type and what their level of pronation might be. In addition, we offer shoes in a variety of styles and with every budget level in mind. For many people the cost of their walking shoes will depend on whether they are a serious walker, walk on a daily basis or wish to wear shoes whose aesthetic design they prefer."
"Among the two most frequently asked questions on the website concern walkers with 'flat feet' and those who have higher than average arches." Sheryl elaborates, "Walking shoes built for flat or undeveloped arches are especially designed to provide the support and cushioning this foot does not have naturally. Additionally, these walking shoes often have an arch that is built into the insole to simulate the natural curve of the foot."
Sheryl Smith continues, "Likewise, a foot with a high arch has issues all its own. These feet tend to under-pronate when one is standing, which can result in greater strain when walking. A walking shoe for this type of foot optimally contains a softer midsole area, so the amount of weight on the feet can be distributed in a more equal fashion. When our readers visit Sally's site here at http://womenswalkingshoereview.com/best-walking-shoes-for-high-arches/ they can learn excellent tips on how to find and fit the right shoe for this type of foot. As with all foot types, we offer photographs, a detailed description of each shoe and our unbiased recommendations."
About Best Walking Shoes for Women
This website features a variety of walking shoes and fit tips so that every woman is able to find the right footwear for her walking needs. These web pages also contain discussions pertinent to the issues of women athletes and their quest for fitness. Each foot type is offered three sets of walking shoes; each of varying style, cost and manufacturer's brand. Walkaholics and women who merely enjoy taking a walk outdoors will appreciate the helpful information given on this user-friendly site.


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Of all the topics I create verbally about, weight-loss surgery is by far the furthermost problematic for me. I resembling to weigh up myself a "survivor" of a new Gastric Bypass surgery nightmare, a situation that I never seem to be to aftermath up from, and one I poorness to keep hold of my readers from ever having to have your home finished.
I had Gastric Bypass surgery vii geezerhood ago and 3 much associated surgeries since. I'm regular for a off next this yr to fixing a herniation along the impression smudge and to try and straighten out the event of reoccurring ulcers due to essential column leak.
I deprivation to lean you the nightmare of not with the sole purpose the bodily suffering you may promising go through, but the moral agony as very well. You see, should you have hitches resultant from your surgery, it is extraordinarily problematic to brainwave a dr. inclined to go rear in and operate to accurate another's mistakes. Most surgeons do not write off as it price the stake.Post ads:
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In fact, when I had a do split downbound of my essential file from the untested surgery, it took more than a year to brainwave a medical practitioner willing and able to help out me. During this time, bitter outflow from my old front nearly ate a together through with my new viscus feat the maximum agonizing symptom you could dream of.
I vomited individual present time a day and got so dried out and funny that I had to have a lasting row inserted into my veins to care fluids and cramp medicine at matrimonial. I was a close the living dead most of the instance and duration became very, intensely secure to one no longer price aware.
The sad sector of this undamaged substance though, is the reality that I wasn't obese or even a favourable entrant for the medical science. I was no more than than l pounds concluded weight at the case but vanity got the cream of the crop of me.Post ads:
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If you watch rock-hard enough, you can ever brainstorm being predisposed to do what's leaders for their sandbank vindication and curve a snow-blinded eye to what's top-grade for your bush. I saved such a individual and have been gainful for that fatal conclusion ever since.
The disdain of it all is that past I had gained my weight, which is a unconscious and customary event as we age and have children, I ever meditation my totally record-breaking dimension was my stone solid, and really hot belly. A tum I had long missing encampment of and very substantially looked-for stern.
After my surgery, I did mislay the weight but the scar was beyond doubt hideous. Add cardinal more surgeries to the aforesaid occupation and the later muscle loss and accessorial blotch tissue, and a two-piece is in perpetuity out of the question!
It goes so more than further, however, than amour propre for me these life. I am ever in stomach-ache and gripped next to the agitation of yet other surgery. I nigh died after my most basic revision because of a lung unhealthiness from the anesthesia. I was intubated for two weeks and suffered standing mental representation loss because of o poorness.
I expectancy that I have at smallest "scared" you ample to do a few investigating into weight-loss surgery, BEFORE you go beneath the stick. It is a outcome that may den you for the component part of your duration and one that should not be ready-made in hastiness or because of pridefulness.
If your strength is at risk, I follow how opportune we all are to have options in this day and age and this ground-breaking medical science baggage no problem store your enthusiasm and drastically enhance your aspect of breathing. But humour investigate your options and do your research.
A point about research, nevertheless. You have need of to brainstorm an sovereign wellspring for your gen. The hang-up next to this lies in the certainty that the people who know the utmost in the order of weight-loss medical science are those that actually accomplish it. It for sure would not be in their best possible wonder to talk over you opposed to something that is accountable for the large majority of their income, and I do not goddam them one bit for not direction on the antagonistic players of this issue. I am indisputably not implying any mistaken doing and have astonishing religious conviction actually in our overall welfare thinking system, but you necessitate the unreserved and fair romance.
I would resembling to spine you to the solely beginning I have saved for choice substance that is neither one-sided nor broken. In fact, I believe that this hearsay should change state hunted reading for a person considering any variety of weight-loss surgery. You owe it to yourself and to those who friendliness you to get this sensible facts...information that could salvage your enthusiasm.


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"Their idols are silver and gold, the work of men's hands." – Psalm 115:4
The psalmist records a vivid description of idol worship in Psalm 115. The psalmist contrasts false gods, or idols, with the one true God. The descriptions of these idols are of gods who are constructed with hands, gods who are made of silver and gold, inanimate objects. These false gods have mouths, but do not speak. They have eyes, but do not see. They have ears, but do not hear. They have noses, but do not smell. They have hands, but cannot handle. They have feet, but cannot walk. They cannot even utter sounds, or mutterings, from their throats. They are dead!
Those who construct these idols put their trust in them and become like them, according to the psalmist (115:8). The psalmist is saying that we become like what we worship. If we worship dead inanimate objects, then we, in effect, become dead and inanimate ourselves. We become lifeless like the false gods of our own making. Verse 17 echoes this sentiment when it declares, "The dead do not praise the Lord." The psalmist urges Israel to trust in the Lord, the one true God, and says that it is God who is their help, and it is God who is their shield (115:9).
As we come to know the one true God, we will become more and more like Him. Part of the reason many Christians do not look like Christ is that they do not know Him as they should, or see Him as He is. 1 John 3:2 says that "we are children of God" and "it has not yet been revealed what we shall be, but we know that when He is revealed, we will be like Him, for we shall see Him as He is." The more we see and know God, the more we will be like Him and the more we will be as we are supposed to be. Knowing God leads to worshiping God and leads us to life transformation and animation.
Are we like what we worship? Are we alive? Do we like what we are worshiping? Are we animated, or are we lifeless? What are we like? Do we look like our Lord Jesus, or do we resemble lesser loves?
Would we live lives of worship, transformation, and animation! May we see God as He is and be more and more conformed into the image of Jesus.


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Take a bite into the delicious Khmer cuisine and learn a little about how they add their own unique 'flavor' to life.
The cuisine of Cambodia has a certain element that it makes abundant use of known as Prahok. This is a kind of salted fermented fish paste which is the unique element that sets Cambodian cuisine apart. It produces a highly distinctive flavor to whatever it is added to. An all time favorite item the Prahok is widely used in Cambodia. Second only to the Prahok is Kapi which is a fermented shrimp paste.
Rice is also amongst the most popularly eaten food items in Cambodia. Traditionally the Cambodians produce two different kinds of rice dishes. One is the classic aromatic rice which is consumed with seafood items. Then there is the glutinous sticky rice which is more of a dessert item. Every Cambodian chef must know how to work wonders with rice if he is to be truly considered as a Cambodian chef. This is because rice is part of every meal in Cambodia.
Fish sauce is another must have item in every Cambodian meal. It is used in soups as well as a dipping sauce. A traditional Cambodian meal consists of up to four separate dishes. Each dish has its own unique taste ranging from sweet to salty and sour to bitter. The dishes are served with the option to add the chilies according to your taste.
The particular ingredient that is responsible for lending the Cambodian cuisine its uniqueness is kroeung. This is the flavoring agent that makes Cambodian food different from Thai and Vietnamese food. With regards to the vegetables most commonly used in Cambodian food we find them to be the same as those used in the Chinese cuisine. These include mushrooms, bamboo shoots, baby corn, fresh ginger and the like.
Fruits form an essential part of the Cambodian diet. They have their own selection of special fruits that they are very fond of. The durian is by far the most popular fruit of the nation. The sapodilla, coconut and mangoes are other popular fruits commonly consumed by the Cambodians.
When it comes to meat fish stands unparalleled in terms of its popularity. One of the most popular fish dishes is trei which consists of rice porridge and a dried salty fish. The amok fish made from codfish is another popular recipe that is one of the identity forming recipes of the nation.
Beef and chicken are also largely consumed in Cambodia but mostly in the form of stews. Clams, crayfish, cockles, squids and shrimps are also amongst the popularly eaten meats in the country. The Cambodians love to eat lobsters but not everybody can afford them.
There is also a selection of unorthodox meats that some Cambodian chefs prepare. For most non-Cambodians such dishes would seem rather repulsive. Amongst the most popularly eaten weird meats are turtles and frogs and in some cases the tarantula as well!


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Play Zone Pizza & Snacks 70-Piece Play Food Set
Mama Mia! This fun pizza play food set is perfect for your little one's play kitchen! Featuring yummy sliced pizza, fruits and veggies, the set has everything your child needs to create their famous make believe recipes.
- For ages 3 and up
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- Material: Plastic
- WARNING: CHOKING HAZARD - Small parts. Not for children under 3 years
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Maclean General Cemetery is laid out in denominational portions including Anglican, Baptist, Catholic, Methodist and Seventh Day Adventist and is entirely monumental. The monuments are generally in good condition with regard to age and, with the exception of some of the old sandstones, and the lichen growth on more recent granite stones, the inscriptions are mostly legible.
The site is gently sloping with mature shade trees and maintained in excellent condition by Council. The cemetery is in two areas, one either side of the high school in Cameron Street. There are no amenities or other facilities provided.
Cemetery Photos
|MADGWICK, Edward Charlton
b. Eng; son/Richard & unknown; h/Eliza; father
|MADGWICK, Eliza Love
b. Eng; dau/Edward Chalton & Eliza; w/John
|MADGWICK, Eliza Love
b. Eng; dau/Edward Chalton & Eliza; w/John


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The INSIDER Summary:
- Dr. Pimple Popper uploaded an excellent new blackhead video to Instagram.
- The blackhead in the video looks small — but it's hiding most of its contents below the surface of the skin.
In a short but spectacular new video shared on Instagram Wednesday, dermatologist Dr. Sandra Lee — also known by her Internet persona Dr. Pimple Popper— treated fans to a blackhead extraction for the ages.
At the start, the blackhead looks small and innocuous. But after unsuccessfully probing it with her trusty comedone extractor, Lee has to change her approach.
She moves on to a tweezer next, finally teasing out a massive clump of hardened skin oil and protein. It's hard to believe something so big was hiding out in a pore that small.
There's no real context in the Instagram caption, and there's no narration from Lee, so we're not entirely sure if this will end up as part of a longer video on her YouTube channel.
For now, the snippet alone is pretty satisfying. Watch it right here:


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Michelle and Cale | Sandalford Swan Valley
Michelle and Cale had the most incredible weather for their mid September wedding...it was like summer! Beautiful golden light for the portraits behind the vineyards at Sandalford :) On the day the Dockers won the prelim final against Sydney, I'm sure it was just an amazing coincidence that Michelle had chosen purple for her gorgeous bridesmaids dresses!
The underground cellar at Sandalford was just lovely, decorated with flowers from the amazing Natural Art Flowers by Rebecca Grace. Michelle's dress was by Amy Kuschel from San Francisco, bought in Hong Kong, with Jo Malone perfume (mmmmm) and Jimmy Choo heels.
Michelle and Cale had a gorgeous marquee overlooking the lake at Sandalford with lovely seating and floral arrangements for the ceremony. We didn't need to leave the venue for portraits as there is so much variety at the Estate. A wonderful reception ensued with fabulous speeches and everyone getting their groove on.
Congratulations! x


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Winter is almost here in Northern Ontario, so I may find the
time to spend more time at my computer.
What's new in my life lately? Hmmmm!
We had to move, and that was a nightmare. We moved from
a good sized 3 bedroom, 2 level apartment to a 2 bedroom box.
Not a lot of room here.
My dog, China, passed away in April. She was 15.5 yrs
old. I miss her every day. But, we did get a new dog.
He is a purebred standard Chihuahua, 2 years old,
and he is named Theo. Been looking for a small to
small/medium little girl dog, but as yet, haven't found
one. Theo is neutered, so it won't matter about the girl.
Anyhow, I spent a little bit of time playing in PSP,
and created a new cluster frame from an older scrap kit
that I found on one of my external drives.
Hadn't done a cluster frame in a while, so thought that
I would try my hand at it.
Hope that someone likes it.


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One of the special attractions of oceanic beaches is the rhythmic pounding of the waves, which are almost mesmerizing. I can sit on a beach for hours enjoying the sheer power of these waves as they give up their energy in spectacular displays upon breaking. Our concerns and problems seem to flow out with the tide as the wave action can be so soothing, restoring our spirit. Other people love to play in the waves, taking advantage of their power. But we need to know how to recognize the danger signs, such as shorebreak and rip currents (see Beach Safety).
Waves are undulating forms that move along the surface of the ocean. Waves are primarily caused by the wind blowing across the water; they range in size from ripples caused by a gentle breeze to giant sea waves caused by hurricane-force winds. But all waves are similar regardless of their size and can be described as follows:
Crest-the high point of a wave
Trough-low point of a wave
Wave height-vertical distance from trough to crest
Wavelength-horizontal distance between adjacent crests
Wave period-time in seconds for two adjacent wave crests to pass a fixed point
Waves cause an oscillatory motion of the water, but no real forward movement of the water itself until they come close to shore and break. On a calm day with no breeze, a stick thrown in the water will move up and down as the waves pass, but it will stay in the same location. This phenomena of wave motion is best illustrated by swaying seaweed caused by passing waves, which is indicative of the circular movement of the water particles.
When waves move into shallow water, this circular motion of the water particles cannot be maintained because of friction between the moving water and the sea bottom. Friction causes the lower part of the circular orbit of the wave to slow down relative to the upper part of the wave exposed to the air. Finally, the orbit cannot be closed, and the top of the wave plunges forward, causing breaking; the forward movement of the water is called swash as it rushes up the beach face. Wave movement in shallow water also causes the sand to move, which is apparent from the turbid (sand-filled) water in the breaker zone.
The speed of a wave is determined by the wavelength in deep water. The longer the wavelength, the faster the wave moves. Experienced sailors of yesteryears knew when a hurricane was approaching because of the arrival of the big swell waves. In shallow water where the waves are "feeling" bottom (e.g., friction between the wave motion and sea bottom is occurring), the speed of the wave is controlled solely by the water depth. Therefore, waves slow down as the move into shallower water until they are forced to break.
Waves are always changing the sea surface and the beach as they break onshore. Plunging breakers are the most spectacular as these waves fall forward trapping a cone of air that is compressed until it literally explodes. Large swell waves that encounter a reef or sand bar offshore become a surfer's delight as they break suddenly in a dramatic fashion. Plunging breakers are most common along the Pacific coast, giving rise to the surfing tradition in Southern California and Hawaii, especially the North Shore of Oahu. Spilling breakers are the most common along the U. S. East Coast; waves break over a long distance as the water become gradually shallower. These waves are far less dangerous and can give some good boogie boarding when the surf is really rolling ashore. Collapsing and surging breakers are much less common with the latter being restricted to very steep beaches, particularly rocky/pebbly (shingle) beaches in England.
Waves provide both the inner peace that comes with the quiet contemplation of gentle breakers rolling ashore on a calm day to the wild exhilaration of riding a big wave ashore on a long board or by body surfing. Waves and beaches are forever changing, which erases our footsteps in the sand while also cleansing our souls. And so it will always be–go and enjoy.


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Build a Catapult
Orland Park | Website
This event occurred in the past.
Map | Find Parking
See how far random objects can fly with the help of hand-made catapults. CarMax representatives will teach students how to make their own ballistic device out of cardboard, strings, pipes and other household items.


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Rob Young, who was appointed by the building contractor Gralio Precast (Pty) Ltd to investigate the collapse of part of the mall, said two columns, identified as columns 319 and 243, had severe "design deficiencies".
"The collapse is totally caused by the under-designed columns," he told the inquiry investigating the collapse, in Tongaat.
Two people were killed and 29 injured in the collapse on November 19 last year.
On Monday, the commission heard that a beam, identified as beam seven, had been responsible for the collapse. However, Young said that despite several of the reinforcing steel rods missing from the beam, he believed it still had sufficient strength and was not the cause of the collapse.
The two columns should have had double their carrying capacity.
"All these things [columns] were hovering around half their strength," he said.
He said once the collapse started it put pressure on beam seven, which collapsed. This put pressure on a neighbouring concrete slab that swung around. This slab collapsed as the columns under it could not handle the swinging motion.
Young said had the columns under this slab been braced, the collapse would have been limited.
The foundations of the two columns were not designed for the load they were meant to carry.
Young said the structural engineer Andre Ballack, who was responsible for the mall's structural design, should have exercised a greater role in checking that work followed the design.
"He didn't meet his professional obligations," said Young.
The inquiry resumes on Wednesday.
– Sapa