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An Electrocardiogram (ECG) Domain Ontology Bernardo Gonçalves1, Giancarlo Guizzardi1,2, José Gonçalves Pereira Filho1 1 Computer Science Department, Federal University of Espírito Santo (UFES), Vitória, Brazil 2 Laboratory for Applied Ontology (ISTC-CNR) Trento, Italy {bgoncalves,firstname.lastname@example.com, email@example.com Abstract. This paper presents an ontology of the electrocardiogram domain. The ontology purpose is to bring in a theory of the electrocardiogram (ECG). The ECG is the most applied test for mapping the heart activity. Notably with the recent advances in information and communication technologies, new services in Healthcare have been provided, standing out remote reporting and telemonitoring. In this context the ECG has a key usefulness. However, the diversity of biomedical data combined to heterogeneous information systems have been inhibited these advances in Healthcare environments. This initiative then addresses the need for semantic interoperability, in general, and data integration, in particular, in Health Informatics. Besides, it also provides an approach for developing ECG automatic analysis systems. 1. Introduction In 1902, Electrocardiography was introduced by Einthoven following his invention of the string galvanometer, for which he received the Nobel Prize. Electrocardiography is the technique of recording the electrical signal generated the heart activity. This record is called electrocardiogram (ECG) [Geselowitz 1989], [Guyton & Hall 1996]. The ECG is the most frequently applied test for measuring the heart activity in Cardiology. Compared with other examination procedures, it is fast, cheap and non-invasive. The importance of the Electrocardiography is remarkable since heart diseases constitute one of the major causes of mortality in the world. According to estimates, more than 100 million ECGs are recorded annually in the Western Europe [SCP 2002]. Since Eintohven's invention, the measurement of bioelectric potentials generated in the human heart has been object of research by biomedical engineers leading to many improvements in instrumentation and digital computers. According to [Geselowitz 1989], ECG was possibly the first diagnostic signal to be studied with the purpose of automatic interpretation by computer programs. There are two characteristics for interpretation in the ECG: (i) the morphology of waves and complexes which compose a cardiac cycle; and (ii) the timing of events and variations in patterns over many beats. In this way, the analysis of the ECG waveform supports identifying a wide range of heart diseases. The characterization of each cardiopathy manifests itself by specific modifications on the characteristics (i) and (ii). In recent years, by taking advantage of information and communication technologies (ICT), the Telecardiology has found in the transmission of electrocardiogram (ECG) an economic and efficient way of rendering remote medical services. These services range from simple remote reporting through the transmission of a simple ECG record (by means of the latest mobile and wireless technologies) and the transmission of the ambulatory ECG (AECG) to the possibility of providing heart telemonitoring anytime, anywhere [Salvador et al. 2005], [Andreão et al. 2006]. In face of all this, the storage and transmission of ECG records have been object of some initiatives concerning standardization. Among the reference standards, AHA/MIT- BIH [Goldberger et al. 2000] and SCP-ECG [SCP 2002] were conceived regarding record's storage and transmission respectively. Furthermore, on account of the Internet popularization new standards have been conceived in order to integrate interoperable and user-driven solutions, standing out HL7 [HL7 2003], FDADF [Brown et al. 2002] and ecgML [Wang et al. 2003]. Nevertheless, despite the fact that such ECG formats are considered reference standards in Cardiology, these standards are not amenable to foster semantic interoperability, in general, and data integration, in particular, among ECG- based applications. This is either because they are strongly-coupled with specific programming languages and environments, not human readable (an important requirement to permit the analysis of the data from electrocardiography's domain experts), their metamodels mix-up domain concepts with presentation ones, or because they are represented as conceptual models of poor expressivity and clarity. With such issues in mind, we have developed an ontology of the ECG domain. The ontology purpose is to provide a theory of the ECG in order to: (i) address semantic interoperability and data/standard integration between health systems, which is the currently key point of the research on Health Informatics [Ackerman et al. 2002]; (ii) allow a novel artificial intelligence approach for ECG automatic analysis; and (iii) convey a knowledge repository about ECG. The proposed ontology covers the domain from multiple complementary viewpoints. In this way we provide an integral view of the heart activity from the microscopic perspective to the macroscopic one. The ECG ontology has been developed in the context of the TeleCardio project [Andreão et al. 2006]. TeleCardio is a telehomecare system for remote monitoring of patients with cardiological syndromes. This system is built on top of a middleware for mobile and context-aware applications as well as mechanisms for ECG signal analysis and for automatic alert generation. The remainder of this paper is organized as follows: Section 2 provides a brief description of the studied domain; Section 3 introduces the ontological engineering approach employed in this article; Section 4 presents the ECG ontology and its sub- ontologies; Section 5 discusses related work; and finally, Section 6 concludes the paper. 2. A Brief Description of the Electrocardiogram Domain Bioelectric sources spontaneously arise in the heart at the cellular level. For a short understanding, the heart cells are immersed in a fluid matrix that is separated of the interior of the cells by their membranes. These membranes carry out a control of ions transport. In the resting state, the interior of the cells has a negative potential w.r.t. the exterior, i.e., the cells are electrically polarized. However, particularly in the sinoatrial (SA) node and atrioventricular (AV) node, which are specific regions of the heart muscle (myocardial), cells abruptly depolarize and then return to its resting value. This phenomenon is a result of ions passing in either direction across the cells' membrane. Therefore, notably SA and AV node cells give rise to an electrical impulse which is propagated to its neighboring cells and normally reach the entire heart. That is why SA and AV nodes are called the heart pacemakers. However, because such electrical impulse arises in SA node at a faster rate and with a higher intensity than in AV node, the impulse generated in the latter is then overdriven [Geselowitz 1989]. For conveying the cardiac electrical impulse generated in the SA node around the heart, there are fiber cells beyond the SA and AV that compose a conduction system (see Figure 1-(i)). The major conduction pathway is called His-Purkinje system, which is composed by the bundle of His (separating the left bundle branch from the right one) and by the Purkinje fibers (indicated as the conduction pathways). Although those fiber cells also depolarize and repolarize, the electrical current generated by them has not a considerable outcome except to convey the cardiac impulse around heart tissues. The return path of this impulse often involves the entire body [Guyton & Hall 1996]. Figure 1. The human heart As a response for the electrical current that is conveyed around heart tissues, the myocardial holds contractions in atrial and ventricular areas that push blood respectively into the ventricles and either systemic or pulmonary circulation. In view of this blood transportation function by means of muscle contractions, the heart plays the role of a pump. With respect to blood storage, the heart plays the role of a blood container. It is able to carry out this function because it is a chamber, which is divided into four sub- chambers: left atrium, right atrium, left ventricle and right ventricle. The heart key function indeed is pumping blood either to systemic and pulmonary circulation. On the "left heart", as the arrows in Figure 1-(ii) indicate, the left atrium receives oxygenated blood from the lungs ready to be moved to the peripherals (head, torso and limbs) for conducting several resources (e.g. oxygen, proteins, etc.) to the body cells. When the left atrium is almost full of oxygenated blood, the mitral valve is opened by the blood pressure and the blood then is pushed to the left ventricle by an atrial contraction1. The left ventricle in turn moves the blood to the peripherals through a strong muscle contraction. On the "right heart" (Figure 1-(ii)), in the meantime, the right atrium receives de-oxygenated blood from the peripherals to be moved to the lungs for 1 Indeed, before the atrial contraction about 75% of the blood is already in ventricular chamber, remaining only about 25% of the blood which is pushed by the atrial contraction. For this reason, the atrial contraction is not vital for a well heart functioning. being oxygenated again. When the right atrium is almost full of de-oxygenated blood, the tricuspid valve is opened by the blood pressure and the blood then is pushed to the right ventricle. It moves then the blood to the lungs by a ventricular contraction. The heart activity can be mapped into an ECG. For this purpose, in a recording session one recording device performs observations evenly spaced in time for measuring electrical potential differences around the patient's body surface. These observations are made at the same time at different electrode positions (leads) through different device channels. These correlated observation series carried out in a recording session compose an ECG record, which provides direct evidence of cardiac rhythm and conduction, and indirect evidence of certain aspects of myocardial anatomy, blood supply and function. An ECG is composed by one or more cardiac cycles, i.e., heart beats (see Figure 2- (i), source: [ELC 2007]). A cycle, as introduced by Einthoven, has elementary forms, or waves, which he names PQRST and are outlined as P wave, QRS complex and T wave. The P wave and the QRS complex map the electrical potential generated by atrial and ventricular depolarization respectively. Atrial and ventricular muscle contractions start at the peak of these waves. The T wave maps the ventricular repolarization. The atrial repolarization can not be seen in the ECG waveform since its resulting potentials are small in amplitude and are overridden by the QRS complex. There is also a U wave, but its origin is still not completely known. The RR interval is used to measure the duration of a cycle. Through several cycles it is possible to obtain an average of the heart rate w.r.t. the time interval related to these cycles [Geselowitz 1989], [Guyton & Hall 1996]. Figure 2. Electrocardiography concepts ECG data are acquired from different manners for different purposes. The most commonly used method is the so-called 12-lead ECG. In this version, twelve leads are used to acquire the ECG. A lead is a specific arrangement of electrode(s), possibly using weighting resistors, that provides a viewpoint of the heart activity. In combination, multiple leads provide an accurate picture of the heart behavior. The twelve leads standardized in Electrocardiography are divided in limb leads and precordial leads. They are obtained by electrodes attachments as follows. Leads I, II and III are obtained by the potential difference between (i) left arm and right arm, (ii) left leg and right arm, and (iii) left leg and left arm respectively. By convention other leads are obtained through weighting resistors in combination with a common reference electrode placement at the chest called the Wilson central terminal (WCT). They are the augmented limb leads AVL, AVR and AVF; and the precordial leads V1, V2, V3, V4, V5 and V6. The former are obtained by opening the resistor attached to the limb in question. The latter are obtained by six electrodes placements at heart specified anatomically w.r.t. the rib cage in a suitable way to measure heart electrical signals at multiple angles (see Figure 2- (ii,iii)) [Geselowitz 1989]. For a more detailed description see [Guyton & Hall 1996]. On next section we introduce the approach used for developing the ECG ontology. 3. The Ontological Engineering Approach In order to develop the ontologies presented in Section 4, we have adopted a combination of two methodologies in the literature. Firstly, we have employed the SABIO method proposed in [Falbo 2004]. This method has been tested for the last ten years in the development of a number of domain ontologies in areas ranging from Harbor Management to Software Process to Media on Demand Management. SABIO prescribes an iterative process comprising the following activities: (i) the identification of the ontology purpose by means of competence questions; (ii) the capture of concepts existing in the domain as well as its relations and its properties; (iii) the ontology formalization, which is the definition of formal axioms by using First-Order Logic (FOL); (iv) the search for existing ontologies with reuse and integration in mind; (v) the evaluation of the ontology for identifying inconsistency as well as verifying the truthfulness with the ontology purpose; (vi) ontology documentation. It is important to highlight that competence questions play a prominent role in this methodology by: (1) defining the scope and purpose of the domain conceptualization being developed; (2) serving as a testbed for ontology evaluation – the competence questions are the questions the ontology are supposed to answer [Falbo 2004]. As discussed in depth in [Guizzardi 2007], as any engineering process, ontology engineering should include phases of conceptual modeling, design and codification. These phases, in turn, shall produce different artifacts with different objectives and, as consequence, require different types of modeling languages and methods with specific characteristics. As argued in that article, in a conceptual modeling phase, an ontology should strive for expressivity, clarity and truthfulness in representing the subject domain at hand. The same conceptual model can then give rise to different ontology codifications in different languages (e.g., F-Logic, OWL DL, RDF, ORM, Ontolingua) in order to satisfy different non-functional requirements such as computational tractability, decidability, etc. In [Guizzardi 2006], the author demonstrates that semantic web languages such as OWL and RDF are codification languages and fall short in serving as a language for the phase of ontology conceptual modeling. For the reasons just mentioned, in this paper, in order to represent our ECG ontology we have used an ontologically well-founded UML modeling profile proposed in [Guizzardi 2005]. This profile comprises a number of stereotyped classes and relations implanting a metamodel that reflect the structure and axiomatization of a foundational (and, thus, domain independent) ontology named UFO (Unified Foundation Ontology) [Guizzardi & Wagner 2005]. A complete description of UFO falls completely outside the scope of this paper. However, in the sequel we give a brief explanation of the elements of this ontology which will be used in the instances of the modeling profile employed in this paper. These elements are summarized in Figure 3. The model depicted in figure three shows only types of entities, i.e., from a philosophical standpoint, it is an ontology of universals, not one of particulars. A funda- Entity 2..* Event Type Atomic Event Type Complex Event Type Endurant Type Quality Structure 1 < associated with 1..* Monadic Endurant Type Relation Material Relation Object Type 1 Property * Formal Relation derived from Sortal Mixin Quality Relator 1 Parthood Participation Mediation Kind Collective Phase Role Category Simple Quality Complex Quality Essential Parthood Inseparable Parthood 2..* * Figure 3. Modeling profile used for developing the ontology mental distinction in this ontology is the one between endurants and events, which roughly reflects the common-sense distinction between objects (e.g., a car, a person) and an event (e.g., a race, a business transaction). Endurants persist in time maintaining their identity. Events, in contrast, unfolding in time with their multiple temporal parts and can be either atomic or complex, the latter which is composed of (possibly complex) events. A formal relation of participation is defined between endurants and events. Endurant types can be either types of monadic entities or relations. Monadic entities, in turn, can be further categorized into Objects (again, the stereotypical examples in natural language) and Properties. Property instances are entities which are existentially dependent on other entities, in the way, for example, that the color of an apple or the charge of a conductor depends on the apple (conductor) in order to exist. Property instances can be single entities (qualities) or multiple entities (relators). Examples of the latter include a marriage, a covalent bond, an employment, an enrollment. These entities are existentially dependent on multiple entities and, for this reason, provide the material connection between these entities. In other words, we can say that they are the foundation for material relations such as being married to, being connected to, working at, studying at, etc. Thus, material relations require relators in order to be established. Formal relations, in contrast, hold directly between individuals. In this paper, we consider the formal relations of parthood, participation and mediation (a type of existential dependence). For the relation of parthood we further recognize the case of essential parthood – in which a whole cannot exist without that specific part; and the case of inseparable parthood – in which a part cannot exist without that specific whole. Qualities can be either simple (e.g., weight, age, temperature) or complex (e.g., color). Every quality type is associated to a quality structure, which can be understood as a measurement structure (or a space of values) in which individual qualities can take their values. For instance, the quality type weight is associated to a space of values which is a liner structure isomorphic to the positive half-line of the real numbers. The color quality type instead is associated to a tridimensional quality structure composed of the dimensions of hue, saturation and brightness. Therefore, every individual color takes its value as a point in this tridimensional conceptual space. Finally, while persisting in time, objects can instantiate several object types. Some of these types an object instantiates necessarily (i.e., in every possible situation) and it defines (from a metaphysical standpoint) what the object is. These are the types named kind (for general objects) and Collective (for collection of entities). There are however types that an object instantiates in some circumstances but not in other circumstances. These are named phases and roles. Whilst phase is a type instantiated in given time period but not necessarily in all periods, a role is a type instantiated in a given context such as the context of a given event participation or a given relation. Finally, a category is a type that classifies entities that belong to different kinds but that share a common essential property (i.e., a property that they must not lack). Based on this approach, the ECG ontology is composed by (i) structural conceptual models, (ii) FOL axioms and (iii) a terms' dictionary. The next section presents (i) and (ii); for brevity, however, we do not present (iii) in this paper. 4. The Electrocardiogram Ontology Considering that the main goal of this ontology is to bring in an electrocardiogram theory which is independent of specific applications, the competency questions we have defined reflect this intent. In this way, they lead to a mapping between heart activity and electrocardiography concepts as follows. CQ1. What conditions must be satisfied for the heart to play the role of a blood pump? CQ2. What conditions must be satisfied for the heart is able to pump blood to both systemic and pulmonary circulation? CQ3. What is in the background of an ECG recording session? CQ4. What is the source of an ECG record? CQ5. How can one obtain the ECG records acquired in the scope of one treatment? CQ6. How does an ECG recording device acquire an ECG record? CQ7. What does the P wave represent in the ECG waveform? CQ8. What does the QRS complex represent in the ECG waveform? CQ9. What kind of information does a physician use to identify variations in the morphology and timing of events in the ECG for inferring an interpretation? For addressing those questions, we have developed the following sub-ontologies: (i) heart, (ii) bioelectric phenomena, (iii) circulatory phenomenon, (iv) ECG human protocol, and, lastly, (v) Electrocardiography (ECG2). These ontologies complement each other to constitute the electrocardiogram (ECG) ontology (Figure 4). They are connected by relations between their concepts as well as by formal axioms. These axioms answer the competency questions introduced above in order to allow: (i) a rich Figure 4. ECG ontology overview 2 ECG also stands for Electrocardiography. In this paper, however, the usage context makes unambiguous whether ECG is used for expressing the electrocardiogram or the Electrocardiography. expressivity that can not be reached only by the graphical model; (ii) inferences (by the ontology codification); (iii) an evaluation of the truthfulness with the ontology purpose; and (iv) identifying inconsistency. The next subsections elaborate on the sub-ontologies. The stereotypes of the modeling profile used are rendered in italics. 4.1. Heart Sub-ontology This sub-ontology captures the structure of the human heart at a high abstraction level, see Figure 5. As shown in this figure, for a given entity x, the UML ontological profile employed here makes explicit the distinction between a type that defines what an entity is in the ontological sense (e.g., the Kind heart) from types which merely describes properties that x shares with other entities of different kinds (e.g., the categories chamber and muscle). These distinctions among the categories of object types, renders the language a much higher expressive power than languages such as standard UML, EER or OWL typically used for conceptual modeling and domain ontology engineering. Figure 5. The heart sub-ontology A human heart has as essential parts left and right atriums and ventricles (represented by the essential=true tagged value in the part-whole relation notion). Both atriums and ventricles are also muscles and chambers and as kinds of entities, they are disjoint to each other. Finally, atriums and ventricles do not exist apart from the heart as a whole, i.e., they are inseparable parts of the heart they compose (represented by the inseparable=true tagged value). 4.2. Bioelectric Phenomena Sub-ontology Following the textual description laid up in Section 2, one may notice that the heart pumping activity is a natural consequence of bioelectric phenomena generated at special heart cells named pacemaker cells. The SA node and the AV node both constitute the main regions of the myocardial muscle where these cells spontaneously give rise to an electrical impulse generated by its excitation, see Figure 6. The atrium contractions in answer to the SA electrical impulse characterize material relations between the SA impulse and both atriums' role as a pump. These contractions are labeled with the relator stereotype. During these contractions the SA node electrical impulse is also conducted to the AV node. At this place, it overdrives the AV node impulse. The His-Purkinje electrical impulse then takes place as a composition of the SA impulse and the AV impulse. It has a phase on the bundle of His and a phase on the Purkinje fibers. The latter is responsible to left and right ventricles' contractions, characterizing this way, the ventricles' role as a pump (Figure 6). The axioms A1 and A2 formalize the characterization of the ventricles as pumps. The Figure 6. Bioelectric phenomena sub-ontology (A1) ∀x ( leftVentricleAsAPump(x) → ∃y,z ( purkinjeElectricalImpulse(y) ∧ lvContraction(z) ∧ mediates(z,x) ∧ mediates(z,y) ) ) (A2) ∀x ( rightVentricleAsAPump(x) → ∃y,z ( purkinjeElectricalImpulse(y) ∧ rvContraction(z) ∧ mediates(z,x) ∧ mediates(z,y) ) ) (A3) ∀x,y ( leftVentricleAsAPump(x) ∧ rightVentricleAsAPump(y) → ∃z heartAsPump(z) ∧ partOf(x,z) ∧ partOf(y,z)) atriums' roles as pumps do not interfere in the heart's role as a pump. The ventricles as pumps, rather, constitute the heart's role as a pump. This is captured by A3 as follows. These three axioms answer the CQ1 competency question. 4.3. Circulatory Phenomenon Sub-ontology As a consequence of the contractions performed by both atriums and ventricles, the heart as a pump is responsible for the blood circulation around the human body. The lungs and peripherals (i.e., head, torso and limbs) are chambers as well as the atriums and ventricles. The heart moves blood from its chambers to the peripherals and to the lungs as well as from the peripherals and the lungs to its chambers (see Figure 7). With the heart working as a pump, the whole blood in the human body moves from one of such chambers to another. It is difficult, however, to define an identity criterion to discern one "blood portion" entity in the human body. That is because a blood portion contained in one chamber at one time point will probably change all its properties (e.g. volume, oxygen level, etc.) and container (chamber) on the next time point. Thus, the problem of homeomerosity of quantities addressed in [Guizzardi 2005] is further complicated in the case of blood circulation. It is important to emphasize that the models produced here, i.e., domain ontologies, are intended to focus on structural aspects of the domain (as opposed to dynamic ones). For this reason, the representation of the blood circulation, which is an intrinsically dynamic phenomenon requires a non- trivial mode of representation, namely, the representation of blood portions (the entity located in each specific chamber at each specific timepoint) as snapshot entities that compose the entire blood contained in a human body. In this way, a human body plays the role of a container since it contains a part of the blood in human body. Therefore, the blood storing relator concept characterizes a material relation between the role of a body chamber as a blood container and a part of blood in the human body (Figure 7). Figure 7. Circulatory phenomenon sub-ontology (A4) ∀x leftVentricleAsABloodContainer(x) → ∃!y,z (bloodInLeftVentricle(y) ∧ lvBloodStoring(z) ∧ mediates(z,x) ∧ mediates(z,y) (A5) ∀x rightVentricleAsABloodContainer(x) → ∃!y,z (bloodInRightVentricle(y) ∧ rvBloodStoring(z) ∧ mediates(z,x) ∧ mediates(z,y) (A6) ∀x,y ( heartAsAPump(x) ∧ bloodInHumanBody(y) ∧ pumps(x,y) → ∃z,w ( leftVentricleAsABloodContainer(z) ∧ rightVentricleAsABloodContainer(w) ) ) The axioms A4, A5 and A6 state the conditions related to the heart as a blood pump. Once the heart is able to work as a pump (see Subsection 4.2), it is then able to realize its blood pumping function. Nevertheless, for this function to be actualized there must be blood in both of its ventricles, as A4 and A5 axioms state. The heart then may pump blood as it is conveyed by A6. These axioms address CQ2. 4.4. ECG Human Protocol Sub-ontology The human protocol drives the development of ECG recording sessions as follows (Figure 8). An ECG recording session is a complex event that may take place if the following conditions are met: (i) there is an ECG recording device which participates in it, (ii) there is a person that participates in it playing the role of patient, and (iii) there is a physician who is also a person that has requested it in the scope of a treatment of the patient (see axiom A7). Thus, the treatment relator mediates a patient and a physician by means of a material relation. Every ECG recording session produces exactly one ECG record. This record is acquired by the recording device used in the session. Moreover, this record belongs to the Figure 8. Human protocol sub-ontology (A7) ∀x (ecgRecordingSession(x) → ∃!rd,pt,ph,tr (ecgRecordingDevice(rd) ∧ patient(pt) ∧ physician(ph) ∧ treatment(tr)) ∧ (participates(rd,x) ∧ participates(pt,x) ∧ isRequestedBy(x,ph)) ∧ (isAssociatedWith(x,tr) ∧ mediates(tr, ph) ∧ mediates(tr, pt)) (A8) ∀x (ecgRecord(x) → ∃!rs,rd,pt (ecgRecordingSession(rs) ∧ ecgRecordingDevice(rd) ∧ patient(pt)) ∧ (produces(rs,x) ∧ isAcquiredBy(x,rd) ∧ belongsTo(x,pt)) (A9) ∀x,y (treatment(x) ∧ ecgRecord(y)) → (producedInScopeOf(y,x) ↔ ∃z ecgRecordingSession(z) ∧ isAssociatedWith(z,x) ∧ produces(z,y)) patient who was the subject of the session (see axiom A8). The ECG records of one patient may be aggregated in the electronic patient record (EPR) of the patient. Furthermore, a physician can see all the ECG records produced in the scope of one treatment as it is captured by the axiom A9. In other words, formula A9 states that an ECG record y is produced in the scope of treatment x iff y is produced by a recording session z associated with x. The competency questions CQ3, CQ4 and CQ5 are addressed by the axioms A7, A8 and A9 respectively. 4.5. Electrocardiography (ECG) Sub-ontology This sub-ontology conveys the concepts and relations of Electrocardiography itself. In doing so, it uses some concepts presented in the sub-ontologies previously discussed. As Figure 9 shows, an ECG recording session has a start time and date as well as time duration. Following the methodological guidelines in [Guizzardi 2005], these properties are represented by explicitly representing the conceptual spaces in which they are measured, i.e., in which they can take their values. These conceptual spaces can be either one-dimensional (e.g., sample rate, cardiac frequency) or multi-dimensional (e.g., time, date) and are represented in this modeling profile as simple and structured datatypes, respectively. An ECG recording device can measure the heart activity of a patient by means of electrodes. These electrodes are placed at the body surface of the patient accordingly to an ECG lead (see Section 2). This lead characterizes a material relation between the patient's body and one or two electrodes. Once this relation is established, the electrode(s) and the patient's body are ready for participating in an observation (an atomic event). This event occurs at one time point and gives rise to a sample, see axiom A10. The sample concept represents the record of the electrical potential value (in mV) taken by the ECG recording device through one observation. In an ECG recording session, however, the recording device performs multiple observations evenly spaced in time, i.e., an observation series (a complex event). These multiple observations then give Figure 9. Electrocardiography (ECG) ontology (A10) ∀x ( observation(x) → ∃et, ∃!rd,ld,hb,sp,tm ( ecgRecordingDevice(rd) ∧ performs(rd,x) ∧ electrode(et) ∧ isPartOf(et,rd) ∧ ecgLead(ld) ∧ mediates(ld,et) ∧ humanBody(hb) ∧ mediates(ld,hb) ∧ participates(et,x) ∧ participates(hb,x) ∧ sample(sp) ∧ givesRiseTo(x,sp) ∧ time(tm) ∧ isProprietyOf(tm,x) ) ) (A11) ∀x ( pWave(x) → ∃!y ( saElectricalImpulse(y) ∧ maps(x,y) ) ) (A12) ∀x ( qrsComplex(x) → ∃!y ( hisPurkinjeElectricalImpulse(y) ∧ maps(x,y) ) ) (A13) ∀x (elementaryForm(x) → ∃!y,z ( measurement(y) ∧ annotation(z) ∧ isPropertyOf(y,x) ∧ isPropertyOf(z,x) ) ) rise to multiple samples which are taken at one sample rate. As a result, an observation series constitutes a waveform which is composed by such samples. In addition, considering the different observation series which are taken at the same time at different ECG leads, we have a correlated observation series (another complex event). The result of this correlated observation series, i.e., a set of correlated waveforms, is the basic information laid up in an ECG record. A waveform of the heart activity, as a rule, has multiple cycles. Each cycle represents each heart beat. We can identify in a cycle both elementary forms and segments that compose the cycle, see Figure 2-(i). The elementary forms are the main characteristics of an electrocardiogram. Both morphology and duration of such waves are full of meaning to the reader of an ECG. That is what we have mapped through the sub- ontologies presented in this paper. The main elementary forms are P wave and QRS complex. The former maps the SA electrical impulse that is responsible for the atriums' contraction, see axiom A11. The latter maps the His-Purkinje electrical impulse that is responsible for the ventricles' contraction, see axiom A12. By putting together all the perspectives of the heart activity presented in this paper, we can notice the meaning of P wave and QRS complex elementary forms. An elementary form may be annotated as well as it may be measured. These two indications constitute complex properties of an elementary form. They are related to the morphology and the timing of events (in the waveform) that provide meaning to the physicians, see axiom A13. The segments of a cycle only have meaning w.r.t. the duration of events. This duration can be derived from the annotations of the elementary forms. Over multiple cycles, it is possible to obtain the cardiac frequency, i.e., a number of heart beats per time. This information is paramount to the physicians' analysis. The axioms A10, A11, A12 and A13 answer the questions CQ6, CQ7, CQ8 and CQ9 respectively. Thus all the nine CQ's introduced are answered by the axioms presented in this paper. 5. Related Work There are quite a few research initiatives committed with ontology-based model and formalization of the ECG. Nonetheless, as a rule such initiatives are committed to the use of technologies and tools such as OWL and Protégé (e.g. [Kokkinaki et al. 2005]) and, consequently, are obliged to rely on models of low expressivity. Moreover, they are remarked with specific purposes w.r.t. specific applications in information systems that restrict their conceptualizations. Finally, there are initiatives aimed to promote interoperability among ECG standards (see Section 1). An example is [Orgun 2003], an effort for allowing the exchange of HL7 messages between heterogeneous healthcare databases. However, as previously discussed, these initiatives tend to be too much driven by both requirements of specific applications and less committed to maximizing expressivity, clarity and truthfulness w.r.t. the domain. 6. Conclusions This work has presented an ontology of the electrocardiogram domain. This ontology focuses on structural concepts existing in this domain, leaving dynamic concerns as a matter of future work. We advocate that the theory of the ECG conveyed in this paper provides (i) a knowledge repository about this universe of discourse; (ii) a reference conceptual model that may be used for promoting interoperability in Health Informatics; and (iii) a usefulness formal model for ECG analysis systems. These contributions cover a gap in literature w.r.t. ontological approaches for modeling biomedical data. However, there is a need for future research on suitable languages to model biophysics phenomena such as the dynamics of the heart activity. Such enhanced languages may improve the results of ECG analysis systems. Additional future work includes: (i) the design and implementation of the ECG ontology in one ore more codification languages (e.g., OWL, F-Logic) as a proof of concept; (ii) a concrete case study of the use of ontology for interoperating existing ECG standards (e.g., HL7, FDADF, SCP-ECG) and (iii) the extension of the ontology for covering as far as possible pathological situations. 7. Acknowledgments The first author would like to thank Marcelle Olivier for fruitful discussions and for providing valuable input to the issues of this paper. This research has received financial support from FAPES (grant no. 31024866/2005) and CNPq (grant no. 50.6284/04-2). 8. References Ackerman, M., et al. (2002). "State-of-the-Art Telemedicine/Telehealth: An Internal Perspective". Proceedings of a symposium in Telemedicine Journal and e-Health, Chapter 6: Telemedicine Technology. Ann Arbor, Michigan, USA. Andreão, R., Pereira Filho, J., Calvi, C. (2006). "TeleCardio - Telecardiology for Patient Support in Hospital and Domicile Environments" (in Portuguese). In X Brazilian Conference in Health Informatics, Florianópolis, Brazil. Brown, B., et al. (2002). "FDA XML Data Format Design Specification". Retrieved July 9, 2007, from http://xml.coverpages.org/FDA-EGC-XMLDataFormat-C.pdf. Falbo, R. A, (2004). "Experiences in Using a Method for Building Domain Ontologies". In Proc. of 16th Conf. On Software Engineering and Knowledge Engineering (SEKE'04), pp. 474-477, Banff, Alberta, Canada. ELC (2007). ECG Learning Center. http://www.ecglibrary.com/. Geselowitz, D. (1989). "On the Theory of the Electrocardiogram". In Proceedings of the IEEE, v. 77, no 6, pp. 857-876. Goldberger A., et. al. (2000). "PhysioBank, PhysioToolkit, and PhysioNet: Components of a New Research Resource for Complex Physiologic Signals". In Circulation 101(23). Guizzardi, G. and Wagner, G. (2005). "Towards Ontological Foundations for Agent Modeling Concepts using UFO". In Agent-Oriented Information Systems (AOIS). Guizzardi, G. (2005). "Ontological Foundations for Structural Conceptual Models". Ph.D. Thesis, University of Twente, The Netherlands. Guizzardi, G. (2006). "The Role of Foundational Ontology for Conceptual Modeling and Domain Ontology Representation". In 7th International Baltic Conf. on Databases and Information Systems, Vilnius, Lithuania. Guizzardi, G. (2007). "On Ontology, ontologies, Conceptualizations, Modeling Languages, and (Meta)Models". In Frontiers in Artifical Intelligence and Applications, Databases and Information Systems IV, ISBN 978-1-58603-640-8, IOS Press, Amsterdam. Guyton, A. and Hall, J. (1996). Textbook of Medical Physiology. Ed. WB Saunders, 1996:803– 813. Philadelphia, 9th edition. HL7 (2003). "HL7 ECG Annotation Message v3". Retrieved July 9, 2007, from http://www.hl7.org/V3AnnECG/ index.htm. Kokkinaki, A., et al. (2005). "A Semantically Enhanced Environment for SCP-ECG Records". In 3rd European Medical and Biological Eng. Conf. (EMBEC'05), Prague, Czech Republic. Orgun, B. (2003). "Interoperability in Heterogeneous Medical Information Systems Using Smart Mobile Agents and HL7". M.Sc. Thesis, Macquarie University, Sydney, Australia. Salvador, C., et al. (2005). "Airmed-Cardio: A GSM and Internet Services-Based System for Out-of-Hospital Follow-up of Cardiac Patients". In IEEE Transactions on Information Technology in Biomedicine, vol. 9, n1. SCP (2002). "SCP-Computer-assisted electrocardiography N02-15". CEN/TC251 Secretariat. Retrieved August 8, 2006, from http://www.centc251.org/. Wang, H., et al. (2003). "A markup language for electrocardiogram data acquisition and analysis (ecgML)". In BMC Medical Informatics and Decision Making 3:4.
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Green Power Partnership
Green Power Partnership Program Updates
Many of the links listed on this page are not on the EPA website. Please see our disclaimer information.
Issue 29, March 10, 2015
- Application Period Now Open for the 2015 Green Power Leadership Awards!
- Upcoming Webinar: Navigating the Green Power Leadership Awards Application Process
- Green Power Partners Commit to On-Site Renewables as Part of White House Challenge
- Reminder: Top Partner Rankings and College & University Challenge Data Deadlines—April 6, 2015
- Congratulations to Partners Celebrating Their Ten-Year Anniversary with GPP!
- Partner Spotlight: Empire State Building
- You're a Green Power Partner—Share Your Story!
- Green Power Partners Win 2015 Climate Leadership Awards
- Best Practices for Solar Power Claims
- GPP Staffing
- Past Issues
Application Period Now Open for the 2015 Green Power Leadership Awards!
The annual Green Power Leadership Awards are competitive awards that recognize outstanding commitments and achievements in the green power marketplace. EPA's Partner Awards recognize leading Green Power Partners and Communities that have helped further the green power market through their green power purchase or use of on-site renewable energy applications, overall green power strategy, and impact on the green power market. EPA's Supplier Awards highlight the accomplishments of green power suppliers that are innovators and leaders in the voluntary renewable energy market. EPA co-sponsors the Green Power Leadership Awards with the Center for Resource Solutions. The awards will be presented in conjunction with the Renewable Energy Markets Conference (Fall 2015, date and location to be determined).
To apply for an award or to nominate an organization other than your own, please visit the Application Process web page. The application period closes on April 17, 2015.
Upcoming Webinar: Navigating the Green Power Leadership Awards Application Process
Green Power Leadership Awards Webinar: A Review of 2015 Categories, Eligibility, Criteria, and the Application Process
Wednesday, March 18, 2015
3:00 pm-4:00 PM EDT
The 2015 Green Power Leadership Awards application period is now open and will close on April 17. EPA co-sponsors the Awards in conjunction with the Center for Resource Solutions (CRS). The awards serve to recognize the leading actions of organizations, programs, suppliers, and individuals that significantly advance the development of green power sources.
In this webinar, EPA and CRS will provide information related to eligibility, evaluation criteria, and application content for each of the award categories, as well as answer questions.
- James Critchfield – Director, Green Power Partnership, U.S. EPA
- Roger Fernandez – Director, Corporate and Institutional Engagement, Energy Supply & Industry Branch, U.S. EPA
- Jeff Swenerton – Communications Director, Center for Resource Solutions
To view past recipients of this prestigious award, please visit http://www.epa.gov/greenpower/awards/index.htm; http://www.greenpowerleadershipawards.com/
Green Power Partners Commit to On-Site Renewables as Part of White House Challenge
As part of President Obama's Clean Power Plan, the White House, along with the support of several federal agencies, is calling on leaders across our economy to make tangible commitments that support the deployment and use of on-site renewable energy. In response, the Green Power Partnership has launched the On-Site Renewables Challenge. The Challenge's goal is to double Green Power Partners' on-site green power use by the end of the decade.
As a component of the On-site Renewables Challenge, EPA is highlighting Partners' increased commitments to deploy on-site renewable energy in support of the Challenge. As of January 2015, eight Green Power Partners – Apple, BD, Cisco, City of Beaverton (OR), Jackson Family Wines, Kaiser Permanente, USDA, and Wal-Mart – have made commitments to on-site green power.
The City of Beaverton, Oregon committed to building a solar array on top of the underground, city-owned water reservoir to be used by the local water pumping station. Jackson Family Wines committed to installing 6.5 megawatts of solar power generation at sites throughout California by 2016. Once complete, on-site solar will supply more than 60 percent of the organization's electricity use. Read more about Partner On-site Renewable Commitments here.
Are you interested in receiving support and recognition from the White House? Is your organization ready to make a commitment to the future deployment and use of on-site renewable energy? If so, complete the On-site Renewables Commitment form (PDF) (2 pp, 152K) today!
Tweet this fact: As of Jan. '15, #EPAGreenPower Partners are using more than 1 billion kWh of onsite renewable energy. More: http://1.usa.gov/1teK5fQ
Reminder: Top Partner Rankings and College & University Challenge Data Deadlines—April 6, 2015
The Green Power Partnership will release updated Top Partner and College & University Challenge Rankings on April 26. If your organization's green power use has recently changed, please submit any updates to your account manager no later than COB Monday, April 6 in order for the updated data to be reflected in the Top Partner Rankings and College & University Challenge updates. If your organization's green power use has not changed, there is no need to submit an update. Review the most current Top Partner and College & University Challenge rankings.
Congratulations to Partners Celebrating Their Ten-Year Anniversary with GPP!
Eight organizations are celebrating ten years of partnering with GPP in the first quarter of 2015.
- Education (Higher): American University (D.C.)
- Food & Beverage: Tazo Tea (Wash.)
- Recreation: Xanterra Parks & Resorts (Colo.)
- Restaurants & Cafes: Galactic Pizza (Minn.)
- Retail: Sephora NA (Calif.)
- Shipping: United Parcel Service (UPS) / 4 CA Facilities (Calif.)
- Technology & Telecom: Agilent Technologies / Santa Clara Operations (Calif.)
View the full list of Green Power Partners.
Partner Spotlight: Empire State Building
The Empire State Building is the one of the world's most famous office buildings and an iconic New York City landmark. The building purchases renewable energy to meet all of its electricity use as part of the building's nearly completed, groundbreaking $20 million energy efficiency retrofit work that was announced by President Bill Clinton and New York City Mayor Michael Bloomberg in 2009.
Q. Why did your organization decide to use green power? What do you see as the benefits of using green power and what role does it play in your company's broader business and environmental strategy?
A. Empire State Realty Trust (ESRT) does what is in our commercial interests. All of our energy efficiency and sustainability initiatives are benchmarked against commercial terms and returns for us, and that is a critical aspect of our work in demonstrating the competitive advantages of the same.
Q. Is your organization currently striving to achieve a green power goal and is there a timeframe? What steps are being taken to reach it?
A. The Empire State Building is currently purchasing green power in the form of renewable energy certificates (RECs) for 100 percent of its electricity needs.
Q. Describe any innovative green power strategies your organization has implemented or is planning. Do you have any upcoming projects or strategies that relate to your company's green power usage?
A. ESRT is an industry leader in demonstrating the business case for a holistic and quantitative approach to energy optimization, efficiency, and sustainability. We demonstrate performance through rigorous measurement and verification against the projects we develop and implement. The whole building retrofit of the Empire State Building, which began in 2010 and reduces energy usage 38 percent with a 3 year payback, delivers $4.4 million in savings annually and provides a modern, cutting edge, advanced infrastructure to tenants.
Q. What are two or three lessons you've learned in making the switch to green power or in increasing your green power use?
A. Our REC contract delivers high quality green power for an economically competitive price. This makes financial sense for ESRT, our investors, and our tenants.
Q. What advice would you give to other organizations interested in using green power, and is there anything you would do differently? What barriers did you encounter when switching to green power?
A. We researched our options in a deregulated market, and needed to be sure there was no "greenwashing" involved in our decision to purchase green power. Following this decision, the process becomes economically driven.
Read more about the Empire State Building's sustainability efforts.
You're a Green Power Partner—Share Your Story!
Share your status as a sustainability leader and Green Power Partner! Below are some sample tweets you can use to communicate your green power use to your stakeholders.
We're supporting the green power market by purchasing renewable energy! Learn more about #EPAgreenpower 1.usa.gov/1F9Ntgk
We're one of 1,300 #EPAGreenPower Partners being recognized for green power use. Find out more - 1.usa.gov/1F9Ntgk
Did you know we are recognized as an #EPAGreenPower Partner for our support of the green power market? 1.usa.gov/1F9Ntgk
Green Power Partners Win 2015 Climate Leadership Awards
In late February, the 2015 Climate Leadership Conference brought together thought leaders from business, government, academia, and the non-profit community to share best practices for integrating greenhouse gas (GHG) reduction and climate risk and resilience strategies into their organization's operations. The Conference, hosted in Arlington, Virginia, also featured the presentation of the EPA's fourth annual Climate Leadership Awards, which recognize organizations and individuals demonstrating that innovative actions to combat climate change are smart business decision. Of the 18 awardees this year, five are EPA Green Power Partners:
- EMC Corporation – Excellence in GHG Management (Goal Setting Certificate)
- Capital One Financial Corporation– Excellence in GHG Management (Goal Setting Certificate)
- CH2M HILL – Excellence in GHG Management (Goal Setting Certificate)
- SC Johnson – Excellence in GHG Management (Goal Achievement Award)
- UPS – Excellence in GHG Management (Goal Achievement Award)
"I am proud to recognize our Climate Leadership Award winners for their actions to reduce the harmful carbon pollution that's fueling climate change," said EPA Administrator Gina McCarthy. "Our winners are demonstrating that a healthy environment and a strong economy go hand in hand. These organizations are providing the leadership, commitment, and solutions needed to cut greenhouse gas emissions and meet head on the challenge of a changing climate."
Congratulations to all 18 awardees!
Best Practices for Solar Power Claims
What type of renewable energy and environmental claims can you make regarding your on-site solar system? This question and more have recently been addressed in a webinar by the Center for Resource Solutions (CRS), which included speakers from the National Renewable Energy Laboratory and OneEnergy Renewables. The webinar discussed how claims are highly dependent on who owns the renewable energy certificates (RECs) associated with the solar system's output, best practices in making claims, and specific examples of claims that can and cannot be made. A video of the webinar will be posted shortly at the CRS website as well as a new issue brief entitled Guidelines for Renewable Energy Claims.
GPP Staffing
The Green Power Partnership welcomes two new members to the team. Roger Fernandez has joined GPP staff from the EPA Natural Gas STAR program and Christopher Kent is on a six-month loan from EPA's ENERGY STAR program.
Past Issues
GPP Program Update, Issue 28, February 12, 2015
GPP Program Update, Issue 27, January 13, 2015
GPP Program Update, Issue 26, December 11, 2014
GPP Program Update, Issue 25, October 20, 2014
GPP Program Update, Issue 24, September 22, 2014
GPP Program Update, Issue 23, August 11, 2014
GPP Program Update, Issue 22, July 14, 2014
GPP Program Update, Issue 21, June 17, 2014
GPP Program Update, Issue 20, May 5, 2014
GPP Program Update, Issue 19, April 7, 2014
GPP Program Update, Issue 18, March 10, 2014
GPP Program Update, Issue 17, February 10, 2014
GPP Program Update, Issue 16, January 13, 2014
GPP Program Update, Issue 15, December 19, 2013
GPP Program Update, Issue 14, November 28, 2013
GPP Program Update, Issue 13, October 28, 2013
GPP Program Update, Issue 12, September 9, 2013
GPP Program Update, Issue 11, August 12, 2013
GPP Program Update, Issue 10, July 15, 2013
GPP Program Update, Issue 9, June 17, 2013
GPP Program Update, Issue 8, May 13, 2013
GPP Program Update, Issue 7, April 8, 2013
GPP Program Update, Issue 6, March 11, 2013
GPP Program Update, Issue 5, February 20, 2013
GPP Program Update, Issue 4, January 14, 2013
GPP Program Update, Issue 3, December 17, 2012
GPP Program Update, Issue 2, November 26, 2012
GPP Program Update, Issue 1, October 22, 2012


text:
Masons emerged in Fridge
This is the second year I've tried with masons and I'm still having trouble.
The first of the fruit trees are just beginning to show some white, so I went to the fridge to put out the bees. When I removed the tape, I discovered that four of the six tubes had a dead, adult bee in the end. (Two of the tubes still had mud plugs)
The fridge is quite cold (35 degrees on the shelf I kept them). If I would have put them out earlier, they would certainly have starved--*nothing* blooming for miles.
If I would have kept the fridge colder, *my* food would have frozen.
So, any idea how I time this thing better?
Also, do you think perhaps there are still some live, unemerged bees deeper in the tubes (they're six inch tubes)?
I know there are some native mason bee populations in this part of New Mexico, so it's not like I'm trying to raise them in Nome.
Temps are now in the high 50's, although still below freezing at night. They've been outside for about two days, with no signs of life.
I'd love some guidance.
Hi Don--I'm no expert but I have had Masons for a few years. I tried holding back half of my bees this year because the fruit tree bloom is a bit late. I kept that half in the frig for a few weeks. The day before I planned on putting them out I put them back in my outside shed. When I went to get them the next day (March 30) there was a bee crawling around under the lid.
I wonder if it has something to do with "time" not just "temps". I do think you have some live bees still as long as the one at the head of the tube is alive. If it's dead then the rest can't get out. Give them a few more days and make sure they are on the south side of the house where they get plenty of sun.
Happy gardening......................Tom


text:
Private Care Homes / Nursing Homes in and around Downside
Distances given are in a straight line from the centre of Downside but travel routes may be longer.
from 16 recommendations
Latest Recommendation
Kind & caring staff. Father is very happy. Happy atmosphere.… (Friday 20 Mar 2015)
43 Skinners Lane, Ashtead KT21 2NN 4.5 Miles
The Red House Care Home has a Care Quality Commission excellent rating and is located in a residential area between Leatherhead and Epsom, a few minutes walk of Ashtead village with all its amenities and shops. The home is ideally situated for the excellent… more
from 5 recommendations
Latest Recommendation
Graham has been in Ashtead Cottage since 2003. he has his own bedroom, basin, shower and toilet… (Friday 14 Jun 2013)
165 Barnett Wood Lane, Ashtead KT21 2LP 4.3 Miles
Care Group: Care Unlimited
Ashtead Cottage is part of Care Unlimited, a provider of specialist care for people with mental health and learning disabilities in Surrey. The home provides nursing and residential care for people with learning disabilities such as autism and Asperger's… more
from 12 recommendations
Latest Recommendation
Well run, good care and happy atmosphere.… (Thursday 3 Jul 2014)
42 Copsem Lane, Esher KT10 9HJ 3.3 Miles
Care Group: Sunrise Senior Living
This Sunrise of Esher residence is in a pleasant and convenient location for those living in north Surrey, being set on the edge of the woodland to the north of Oxshott and just south of the centre of the attractive and well appointed town of Esher –… more
View Full Details Bed Vacancies: 4 Bed Vacancies
from 8 recommendations
Latest Recommendation
Patient, friendliness and care. I and other family members visit weekly. The patience shown to… (Thursday 12 Feb 2015)
Ripley Lane, West Horsley, Leatherhead KT24 6JW 3.7 Miles
Care Group: Bupa Care Homes
At Dene Place Nursing Home, adults with care needs have access to specialist 24-hour care, tailored to their own requirements. There is a day care service at the home which focuses on nursing care, respite, convalescence and palliative care. The home… more
from 11 recommendations
Latest Recommendation
My father, William Beecher, came to St. George's Cobham in September. He is 90 and has always… (Wednesday 5 Nov 2014)
5 Byfleet Road, Cobham KT11 1DS 2.1 Miles
Care Group: Bupa Care Homes
St George's Nursing Home specialises in care for adults with dementia, together with specialist conditions such as Huntingdon's and Parkinson's disease, and Korsakov's syndrome. The facility is ideal for physical disabilities and carers are experienced… more
from 4 recommendations
Latest Recommendation
Very impressed with care and attention given to my dad. Staff were always attentive and patient… (Thursday 6 Feb 2014)
151 Old Woking Road, Pyrford, Woking GU22 8PD 4.8 Miles
Crann Mor is a Private Nursing Home, registered for a maximum of only 24 residents. They believe in providing person centred nursing support to older people from any background in a dignified and respectful manner. At Crann Mor the staff team work… more
from 4 recommendations
Latest Recommendation
Always a welcome when you visit. Home is warm, comfortable and clean, menus well thought out for… (Wednesday 4 Sep 2013)
41 Skinners Lane, Ashtead KT21 2NN 4.5 Miles
Alexander Lodge is situated in a quiet location close to the village of Ashsted. Residents benefit from person centred care packages which aim to fulfil and meet the individual's needs. As a team, Alexander Lodge are completely focused and decline… more
from 4 recommendations
Latest Recommendation
Beautiful setting, family atmosphere, several motivated caring staff. Excellent food and drink,… (Friday 19 Dec 2014)
36 Copsem Lane, Esher KT10 9HE 4.0 Miles
Care Group: Bupa Care Homes
Arbrook House Nursing Home's team of highly trained staff provide personalised care for a number of requirements, including long-term nursing, convalescence, respite and palliative care. As Arbrook House is a converted private home with landscaped… more
from 5 recommendations
Latest Recommendation
All the staff at Clare House are particularly welcoming, friendly and helpful. They do all they can… (Monday 19 Jan 2015)
36 Hersham Road, Walton-on-Thames KT12 1JJ 4.7 Miles
Care Group: Bupa Care Homes
Clare House Nursing Home, in Walton-on-Thames, employs highly trained care assistants and registered nurses to make a positive difference for adults with respite, convalescence and a range of other nursing needs. The care team also has expertise in palliative… more
from 6 recommendations
Latest Recommendation
My late father only experience Sunrise for three months before he passed away unexpectedly. I have… (Tuesday 17 Mar 2015)
Ellesmere Road, Weybridge KT13 0HY 3.8 Miles
Care Group: Sunrise Senior Living
Sunrise of Weybridge vibrant community is located in the prestigious Surrey town, close to Queens Road shops and restaurants. They offer a wonderful environment in which to live, however it's a vast, dedicated team of skilled care managers, housekeepers,… more
View Full Details Bed Vacancies: 3 Bed Vacancies
from 3 recommendations
Latest Recommendation
We are very pleased with the care our Mum receives at Oakcroft House. It is a very well run,… (Friday 27 Mar 2015)
Oakcroft Road, West Byfleet KT14 6JG 4.5 Miles
Care Group: Bupa Care Homes
Oakcroft House Nursing Home employs a professional team of dedicated staff who provide residents with a wide range of care provision, from long term to respite stays, all personalised to support the individual. The large house boasts many areas for… more
from 1 recommendation
Latest Recommendation
My mother was a resident for over 4 months then sadly passed away. The carers at Kings Lodge did… (Saturday 16 Aug 2014)
The Pavillions, Kings Head Lane, West Byfleet KT14 7BQ 3.8 Miles
Care Group: CHD Living Ltd
Kings Lodge Care Centre is a purpose built care centre with 42 beds providing nursing care and accommodation for older people, admitting a few residents diagnosed with dementia. The home is owned by CHD Living and is situated in a cul-de-sac near the… more
from 1 recommendation
Latest Recommendation
My husband moved from another care home to Silvermere Dementia Unit 6 weeks ago. He has settled… (Wednesday 30 Apr 2014)
Redhill Road, Cobham KT11 1EF 2.5 Miles
Care Group: Avery Healthcare Group
Silvermere Care Home has been purpose-built to welcome seventy-two residents, designed to achieve person-centred methods and with specialist provision available for adults with dementia. The vision is for a home-from-home atmosphere, with activities… more
1 Downside Road, Downside, Cobham KT11 3LZ 0.5 Miles
Care Group: brighterkind
Cossins House overlooks pretty countryside and is positioned in four acres of private garden. The home is conveniently situated for shops and other amenities, motorway (M25) connection and public transport. This splendid Georgian residence, has been… more
6 Windsor Walk, Weybridge KT13 9AP 4.2 Miles
The Pines is a Weybridge facility that offers a versatile range of care packages, being skilled in helping adults diagnosed with a form of dementia and many other nursing complications and impairments. All care delivery is personalised, with the team… more
42/44 Chertsey Road, West Byfleet KT14 7AN 3.7 Miles
Care Group: Downing Care
The Chestnuts: Downing (Chertsey Rd) Ltd is an 18 bedded home in Byfleet, Surrey, which specialises in providing 24 hour residential care for people with a learning disability and/or physical disability. They specialise in the care and development… more
Hogshill Lane, Cobham KT11 2AQ 1.4 Miles
Care Group: Care UK Nursing & Residential Care Services
Tiltwood is a Surrey care home that offers accommodation for up to 50 elderly people with various stages of dementia, who benefit from an efficient and innovative service. The home keeps strong links with the local community and also offers its facilities… more
30 Oakfield Road, Ashtead KT21 2RD 4.5 Miles
Care Group: Trilodge Ltd
Oakfield Nursing Home is a luxurious care home with nursing which is registered with the Care Quality Commission (CQC). The home specialises in the care of residents with mental health problems. The home is situated in an exclusive area near parkland,… more
Ermyn Way, Leatherhead KT22 8TX 4.6 Miles
Care Group: Care UK Nursing & Residential Care Services
Milner House care centre is a Victorian manor home that has been tastefully renovated into a comfortable care home, offering a spacious environment in which care can be practised effectively. Residents have a choice of communal and quiet lounges,… more
from 5 recommendations
19 Queens Road, Weybridge KT13 9UE 4.4 Miles
from 3 recommendations
16 Highfields, Ashtead KT21 2NL 4.4 Miles
from 4 recommendations
29 Mayfield Road, Walton-on-Thames KT12 5PL 4.2 Miles
from 3 recommendations
St George's Avenue, Weybridge KT13 0DA 4.1 Miles
Walton-on-Thames KT12 5PZ 4.2 Miles
22 Grange Road, New Haw, Addlestone KT15 3RQ 4.7 Miles
153 Barnett Wood Lane, Ashtead KT21 2LR 4.1 Miles
250 Cobham Road, Fetcham, Leatherhead KT22 9JF 2.6 Miles
67 Harriotts Lane, Ashtead KT21 2QE 4.3 Miles
Newark Lane, Ripley, Woking GU23 6DL 4.2 Miles
67 Byfleet Road, New Haw, Addlestone KT15 3JZ 4.3 Miles
6 Stoke Road, Cobham KT11 3AS 1.2 Miles
60 Cobham Road, Fetcham, Leatherhead KT22 9JS 3.0 Miles
Byfleet, West Byfleet KT14 7EN 3.0 Miles
Ashtead Woods Road, Ashtead KT21 2EQ 4.3 Miles
Ashtead KT21 2QB 4.2 Miles
Byfleet, West Byfleet KT14 7EN 3.0 Miles
Types of Care Homes in and around Downside: All Care Homes
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text:
Our purple room is in the quiet back garden looking out to the fish pond and lush nature.
The room shares a terrace with the orange room but has its own bathroom.
Towels, bed sheets, soap, and toilet paper
Continuous access in the listing
Breakfast is provided.
Space where guests can cook their own meals
Towels, bed sheets, soap, and toilet paper
Central heating or a heater in the listing
In the building, free or for a fee
In the building, free or for a fee
Continuous access in the listing
Breakfast is provided.
The listing can accommodate a gathering of 25 or more attendees
Easy access to the building and listing for guests in wheelchairs
Private or Shared
Free, in the building or nearby
Posted emergency information and resources
The Space
Balila guesthouse has 5 rooms in different locations.
All 5 rooms are lovely furnished, have hot water, fan and a private terrace looking into a green garden.
In the back garden are 2 rooms (purple and orange) next to each other in a little house that is surrounded from a tropical garden. Both rooms have their own semi open bathrooms with hot showers.
The purple and the orange room share one terrace.
This listing is for the purple room only!
Please look and book separately for our 4 other rooms:
'The orange room' is in the same bungalow like the purple room. This bungalow is in the very quiet back garden of our family house.
'Moon Room' is attached to the family's house and has a bath tub in the open bathroom.
'Hanuman Bungalow' is a little separated bungalow, with a little kitchen and a daybed on its terrace.
The king fisher hut is in the same back garden as the purple and orange room. it is a small but cozy wooden cottage.
We serve healthy breakfast and try to be environment friendly as much as possible.
The next and biggest yoga center (yoga barn) is only 7 min. walking distance away.
In our street are many international restaurants, galleries, mini markets, ATMs and art shops.
The famous 'ARMA Museum' is our direct neighbor and you can listen from the garden their daily dance performances. they can be a bit loud abut last only 1 hour and should not be missed on a Bali trip!
Our location is very close to the center but we are still surrounded from a tropical jungle with lots of birds, butterflies and frogs.
After heavy rains the frogs are happy and can be a bit loud!
My husband is also a driver an tour guide and he can bring you around all Bali.
With our knowledge about this island we can help you to find the best places!
The family consist of the parents(from Austria and Bali), a little girl, 1 dog and 2 cats.
Please come and have look!
Guest Access
We have an open kitchen in the main house which guest can use if wanted.
There is space for parking motorbikes or cars
Interaction with Guests
We are most of the time at home and can provide lots of information to our guests.
The Neighborhood
We are located next to the ARMA museum and so you can listen to their daily dance performances for free!
This is a cultural Must for Bali visitors!
But don't worry,it lasts only 1 hour and ends around 8.30pm.
Getting around
We can provide airport pick ups,other transports and tours.
No smoking allowed inside the rooms,but outside on the terrace.
Please refill your drinking bottles with the water we provide for you. so we all can reduce the plastic bottles on this island!
the terrasse with hammock and the 2 doors to the rooms. on the left, purple room;on the right orange room
The place is nested in greenery. Friendly staff. However it is further away from the city center than what we expected.
It was a good experience indeed! It is my first time stay in this purple room, it was good as usual, people in Birgit's house were all helpful and friendly. Love it :)
I had no trouble finding the place, and the home was just as described. Located a little off the main street it was quiet, except for the regular animal noises and the occasional music of the shows from next door. Everyone at the home stay was really nice and the breakfasts were amazing! I'd definitely recommend the stay here.
Had a very good stay in Balila. Very nice place and super peaceful. Only issue is there were so many mosquitoes. But it was all good. Birgit was also there to receive me when I arrived.
I started my 3 week Bali holiday at Birgit's Balila Purple Room and I could not have chosen a better place for that. It's in the centre still in a quiet hidden beautiful garden. Everything is of walking distance. Birgit and Made are both great hosts, they are there when you need help.
I definitely recommend the place!
I had a lovely stay at Balila. This time round, I needed something cheap and conveniently located in the heart of Ubud for quick travel to various meetings. The bonus was Bli Made's heartwarming hospitality as Air BnB co-host and cook and massage therapist Mbok Ade's kind and attentive spirit. The rooms are quaint and old-school homestay style, but one gets everything one really needs as a tropical traveler: a soft bed, thick mosquito net, strong fan, and hot water. Oh and bonus for writers: fast wifi! A true luxury in Ubud.
The accommodation is very simple but it is well located and quiet. Breakfast was nice and healthy. Hosts were helpful and kind.
This host has 177 reviews for other properties.View Other Reviews
hi friends,
we are a mixed family with Birgit, originally from Austria, Made her husband from Bali and Lila our beautiful daughter.
Birgit lives and loves in Bali already 11 years and enjoys every minute.
At the moment we have 1 dog, 1 cat and 4 chickens, but that can change all the time.
We are renting 5 rooms in and around our family house, which is surounded by a tropical jungle in the middle of Ubud.
Made is also offering transports and tours around Bali and will offer his big knowledge about Bali and its culture.
Wayan is our helper and the the 'real' boss in the house, because she prepares the breakfast, cleans the rooms and helps out wherever she can
Whatever you want to know about Bali ,we will try to give you the right answer.
Hope to see you soon in our little family compound!!!


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Posts tagged 'sesta di sopra'
2009 Brunello di Montalcino – Mixed Results
Montalcino (Photo ©Tom Hyland)
The 2009 Brunello di Montalcinos were released a few months ago and while a new vintage of this iconic Tuscan red should be great news for wine lovers, the results in this vintage reveal a year that while offering some very good, even excellent wines was one that was frankly a bit of a disappointment.
2009 was a very warm year in Montalcino. One of the blessings of this zone is that they do not get as much rain as in most of the Chianti districts; this is a warmer and drier area. So ripening is more consistent, although there are big years – such as 2006 – and more subdued years, such as 2008. 2009 was a year in which the warn to hot conditions ripened grapes quite well, but perhaps too well, as overall the wines do not have the pronounced perfumes of recent vintages such as 2001, 2004, 2006, 2007 or 2008. Also, the wines have a little extra alcohol – 14.5% is routine for the 2009 Brunellos, but I tasted a few with 15% alcohol. I realize that alcohol is just a number to some people, but I find these higher percentages a bit alarming, as the wines just do not have the balance of the finest years, as with 2004 or 2006-2008. Even the best producers made wines that, while flavorful, lack the complexity and above all, the finesse of the best examples of Brunello. Yes, Brunello can be a "big" wine, but bigness does not often equate to roundness and elegance.
Le Chiuse Estate
Here are brief notes on several of the best examples of 2009 Brunello di Montalcino I have recently tasted. These are among the best, but none of these wines represent their estates at their absolute best. A few are disappointing, while others are excellent, so keep in mind that 2009 is not a great vintage in Montalcino (as was 2004, 2006 and perhaps 2010; these last wines will be released in 2015). As with any well-made Brunello, these wines will drink well for another 10-12 years; it's just that for 2009, the wines are not at the highest level.
Le Chiuse – The very fact that this great estate is relatively unknown is a tremendous shame, as this acreage was once part of the famed Biondi-Santi holdings. Proprietors Simonetta Valiani and her husband Nicolo Magnelli have performed brilliantly over the past decade; in my opinion, Le Chiuse is not only one of the most consistent of all Brunello producers, but also one of the finest, period. The wines are made in a traditional style and reflect a great sense of place as well as displaying beautiful varietal purity.
The 2009 has beautiful aromas of marasca cherry, a hint of tar, thyme and dried red flowers. Medium-full with very good concentration, this is a lovely wine with impressive harmony, ideal ripeness and, as always, subdued oak. There is good acidity along with balanced tannins and impressive persistence. Although not as magnificently styled as their best offerings, this is nonetheless, a lovely wine that will be at its best in 10-12 years. Excellent (4 stars)
Maté "Campo Alto" - Husband and wife Ferenc and Candace Maté have been quietly producing some very fine examples of Brunello di Montalcino at their lovely estate near that of Gianfranco Soldera and Angelo Gaja for the past several years. This 2009 "Campo Alto" is a new bottling and for my thoughts, the best wine they have produced to date. Displaying rich aromas of morel cherry, tar, Damson plum and a hint of coffee, this is medium-full with a rich mid-palate. I am a bit concerned about the 15% alcohol (again, 2009 was quite warm), but the wine seems well balanced. it certainly is flavorful with very good varietal focus and the persistence is more pronounced in this wine as compared with previous efforts from this producer. Best in 12-15 years. Excellent (4 stars)
Sesta di Sopra – Another ultratraditional Brunello producer, this is a tiny estate, so these wines are limited to only a few large markets in America; they are, however, well worth the search. The 2009 has aromas of sage, wild cherry, tar and tree bark. Medium-full with very good to excellent concentration. Good acidity, medium weight tannins, impressive persistence. Very good varietal character, but not as focused or as pure as the best releases from this producer. Best in 10-12 years. Very Good to Excellent (3 and 1/2 stars)
Poggio di Sotto – Beautiful youthful garnet; fragrant aromas of red cherry, wild strawberry, carnation and cedar. Medium-full, this has good acidity and persistence along with very fine typicity. Well balanced wine with subdued wood notes. This is not as refined or as complex as the best vintages such as 2004, 2006 and 2008, but it is an impressive wine. Best in 12-15 years. Very Good to Excellent (3 and 1/2 stars)
Terralsole – Aromas of cedar, dried cherry, dried brown herbs and a hint of green olive. Medium-full with very good concentration. Good richness in the mid-palate, good acidity, youthful tannins and nicely integrated wood notes. Not as ripe as some 2009s (which frankly, is a good thing), nor as rich as previous years with this wine. Well made with good harmony. Best in 10-12 years – perhaps longer. Very Good to Excellent (3 and 1/2 stars)
Il Poggione – Deep garnet; aromas of red cherry, red plum, clove and cedar. Medium-full with very good concentration. Nice ripeness, slightly high tone fruit, but not overripe. Elegant tannins, good acidity and overall, nicely balanced. 14.5% alcohol, but not overpowering like some other examples of Brunello this year. Not a great Il Poggione Brunello, but a well made wine from a less than accomplished vintage. Best in 10-12 years. Very Good to Excellent (3 and 1/2 stars)
Col d'Orcia – Beautiful garnet; dried cherry, cedar and thyme aromas. Traditionally made with elegant tannins; good acidity, very good typicity. Medium-full with very good concentration. The alcohol (14.5%) shows through in the nose and in the finish, so the charms of this wine are somewhat dissipated. Best in 7-10 years. Very Good (3 stars)
Other wines:
Gianni Brunelli – Good (2 stars)
Eredi Fuligni – Good (2 stars)
Talenti – Good (2 stars)
Brunello Vintages
Brunello bottles at an enoteca in Montalcino (Photo ©Tom Hyland)
The new vintage of Brunello di Montalcino is 2006; the wines will be released over the coming months. I tasted several dozen bottlings last month in Montalcino and reported on these wines in a recent post. Here are a few thoughts on recent vintages of Brunello di Montalcino:
2001 – Outstanding. The wines from 2001 display excellent depth of fruit along with ideal acidity as well as nicely developed aromatics. These are classically made wines with plenty of persistence in the finish and have the stuffing to age for 25-30 years for the finest bottlings, while a few may last even longer. (Note: the Consorzio rated 2001 an excellent vintage, which is a 4-star rating according to their system.)
2002 - Poor to average. This was a difficult year in this area (as it was in many wine regions thoughout Italy) as there were problems with rain throughout the fall. Yields were quite low, but few grapes reached ideal ripeness. It's doubtful you'll find many bottlings anywhere these days – indeed many producers didn't even release a 2002 Brunello – so it won't be a problem, but it you do find one, drink it soon. (Consorzio rating – 2 stars).
2003 – Good to very good. The temperatures were quite hot during the growing season, resulting in overripe, tannic wines (the complete opposite of 2002). The wines are big, but too unwieldy and most lack elegance. Drink over the next 3-7 years, but keep in mind that the wines many not become better with time, due to the bitterness. (Consorzio rating – 4 stars or excellent)
Montalcino View (Photo ©Tom Hyland)
2004 – Outstanding. Big things were predicted for this vintage and overall, many producers delivered. The Brunellos from 2004 are among the most aromatic of the past decade and are also beautifully balanced with very good acidity. The structure is there to assure 20 years of aging at least in the finest wines. The bottlings from 2004 are not quite as powerful from 2001, but they will still age beautifully and offer gorgeous complexity as well as elegance. (Consorzio rating – 4 stars)
2005 - Very Good to Excellent. This is a vintage where the buyer has to take note of the producer, as some wines are lovely with impressive concentration, though others are only medium-weight. The wines, it should be noted, are well balanced across the board, offering beautifully defined acidity. This is not a powerful vintage, but there are dozens of very lovely wines. (Consorzio rating – 4 stars)
2006 – Excellent. As I noted recently, the 2006 Brunellos are excellent wines, taken as a whole. This is somewhat of an old-fashioned vintage, with big concentration and excellent aging potential. I tasted several outstanding wines (Il Poggione, Sesta di Sopra, Uccelliera, et al) with many more excellent. If the wines displayed the complex aromas of the 2004s, I would have rated this vintage even higher. (Consorzio rating – outstanding – 5 stars).
Please note that these are ratings for the regular bottlings of Brunello di Montalcino from these vintages. I don't taste enough riserva bottlings to offer a detailed analysis of those wines, but generally the quality of the normale bottlings as well as the riserva bottlings from the same vintage (the riserva bottlings are released at least one year later) tend to go hand in hand.
That said, I was quite impressed by the riserva bottlings of Brunello di Montalcino from 2004, especially the textbook Eredi Fuligni, with its remarkable suppleness and varietal purity along with the more deeply concentrated and slightly more tannic Il Poggione. Despite this powerful nature of the Il Poggione riserva (labeled with the vineyard name "Vigna Paganelli") the wine has impeccable balance and is elegant and charming with a vibrant backbone of fruit.
2006 Brunello di Montalcino – First Impressions
Montalcino landscape south of the town, as seen from the Il Poggione estate (Photo ©Tom Hyland)
I have just returned from a week in Toscana, of which two days were spent in Montalcino. This week the Benvenuto Brunello tasting is held for journalists around the world in the town of Montalcino and is an event I eagerly await each year. I've attended this event several times, but as I needed to be home for another special Italian wine event, I was able to arrange a private tasting of the soon-to-be-released bottlings of the 2006 vintage of Brunello di Montalcino this past Monday; my thanks to Stefania Tacconi of the Brunello Consorzio for her help – and that of her staff – in organizing this tasting around my schedule.
After tasting 31 bottlings of 2006 Brunello di Montalcino, my initial thoughts are this: 2006 is an excellent vintage with impressive concentration, beautiful complexity and the structure to age very well. 2006 was a warm vintage in the area, but not overly hot, and there were beneficial winds, especially for estates on the western edges of the appellation that are situated closer to the sea. The wines are much bigger than 2005 and as big or even richer in some instances from comparable bottlings from 2004, though slightly less forceful than those from the wonderful 2001 vintage.
The wines are also quite aromatic, comparing favorably in that category to the 2004s. Most of the wines I tried offer a generous mid-palate with layers of fruit, while the tannins are rich, yet rarely forceful. Look for most of the finest bottlings of 2006 Brunello di Montalcino to age well for 15-20 years, with a few of the finest targeted for optimal drinking around 2030.
Four of my favorite bottlings of 2006 Brunello di Montalcino
Among my favorites are the Il Poggione, which loyal readers know is one of my top two or three top wines each vintage; this 2006 is especially massive in its fruit concentration; the wine is superbly balanced. Look for this to be a 20 year-plus wine. The regular Poggio Antico bottling is another of my top wines each year; the 2006 offers especially lovely aromatics as well as excellent persistence. The "Altero" bottling from Poggio Antico, has a touch more wood and is not as open as the regular bottling; it is quite impressive however and should be at its best after 20 years.
The Le Chiuse offering is superb, with outstanding varietal purity; this estate excels in traditionally made Brunello and their 2006 is beautifully balanced- it is a must buy! The Ciacci Piccolomini normale bottling is also quite remarkable with its fresh morel cherry, cinnamon and nutmeg aromas, lengthy finish and graceful tannins; I actually preferred this to the more expensive "Pianrosso" bottling from this producer, though that wine is also quite well made and capable of long-term aging.
The Fuligni displays its typical class and graceful style, while the Col d'Orcia is another success; this time in a more full-bodied and tightly packed style than usual. The Silvio Nardi "Manachiara"is quite spicy with elegant tannins, while the Uccelliera displays lovely cherry fruit, silky tannins and outstanding complexity. It is not the most intense of the 2006 Brunellos (nor is it in most years), but it is one of the most subtle and harmonious.
Also look for the spicy, richly packed Maté, the supremely elegant Il Palazzone and the nicely crafted Casa Raia, which offers a nice combination of morel cherry fruit and spice such as nutmeg. This is the initial Brunello from this small estate, not far from the town of Montalcino; owners Pierre-Jean and Kalyna Monnoyer are off to an impressive start.
Finally, the Sesta di Sopra is an amazing success this year, which comes as no surprise if you've tasted their wines in previous vintages. This tiny estate is a traditional producer that emphasizes varietal character and elegance. This bottling offers some of the loveliest perfumes you'll ever find in a Brunello and an elegant mid-palate with a rich finish that sneaks up on you. The wood notes are quite subtle, the acidity is perfectly realized and the finish is extremely long with polished tannins. This wine represents its local terroir about as well as any Brunello I tasted from 2006; for this reason, this is highly recommended as one of the finest wines of the vintage.
My full reviews of the 2006 Brunellos will appear in the Spring issue of my Guide to Italian Wines, which will be sent to subscribers in late March. Email me at email@example.com for information on how to subscribe.


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Dear Friends,
For the month of April, Peli Peli is ecstatic to offer a blue plate special to our guests. When you opt for the blue plate special, for either two or four people, we will donate $4 to The Thread Alliance. This service project is a 501 (c) (3) non-profit organization founded by Sheila Aron, and is dedicated to ending child abuse in our community. For those seeking child abuse prevention, intervention, or treatment information and services, The Thread Alliance provides a central registry of local, state, and national resources.
The blue plate special is a top secret off the menu item called the Tour of South Africa. Our culinary tour guides will take your taste buds on a journey through out the dishes we have created by meshing American and South African culinary influences together.
The only thing you need to do is ask your tour guide for the blue plate special benefitting the Thread Alliance, sit back, relax and prepare for a food coma that benefits a great cause. (Only available at our Vintage Park location)
To learn about more information regarding The Thread Alliance please visit: http://www.thethreadalliance.org/.
Paul Friedman, Thomas Nguyen and Michael Tran
It started with an email blast.
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features authentic South African delicacies along with American steak, chicken and
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You don't have to leave Houston to have an Olympian dining experience.
The Diners' Choice Awards for the Top 100 American Fare Restaurants in the U.S.
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(a) See the graph. Equilibrium price level = 200. Equilibrium real output = $300 billion. No, the full-capacity level of GDP is more likely at $400 billion, where the AS curve starts to become steeper.
(b) At a price level of 150, real GDP supplied is a maximum of $200 billion, less than the real GDP demanded of $400 billion. The shortage of real output will drive the price level up. At a price level of 250, real GDP supplied is $400 billion, which is more than the real GDP demanded of $200 billion. The surplus of real output will drive down the price level. Equilibrium occurs at the price level at which AS and AD intersect.
(c) See the graph. Increases in consumer, investment, government, or net export spending might shift the AD curve rightward. New equilibrium price level = 250. New equilibrium GDP = $400 billion.
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- Publisher: Sphere
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- Dimensions: 152mm x 232mm x 22mm | 322g
- Publication date: 1 May 2012
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Is there a large arse-shaped dent in your sofa? Unwatched workout DVDs gathering dust on your shelves? An eye-wateringly expensive (and rarely used) gym membership burning a hole in your bank account? Does the sight of your wobbly thighs leave you cowering under the duvet? Then it's time you faced the truth: the only option is to lace up and hit the ground running. Straight-talking, funny and brutally honest, RUN FAT BITCH RUN will give you - yes, you - the push you need to get out of the door, pounding the pavements and shedding pounds in no time. Hate running? No worries. RUN FAT BITCH RUN will give you all the tools you need to transform that passion into real motivation. Locate your inner grit and long-lost energy Follow a fuss-free and completely foolproof beginners' programme Throw away the scales, stock up on pasta and enjoy carbs without guilt If you want to lose weight, get fit and become an ass-kicking, gets-things-done superwoman, there's only one thing left to do ...RUN!
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Ruth Field is a barrister and a passionate runner. She lives in North London with her husband and twin sons.
Customer reviews
By Rosie 27 Jan 2013
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If you're stuck in an exercise rut, this book will give you a rather rude kick up the backside ... it certainly shamed us into lacing up our Nikes! Closer Amusingly vicious ... Excellent advice all round. Emma Thompson Ruth is an inspiring running-buddy ... By the time I unpack my summer wardrobe, I'm sure my inner Grit Doctor will be my best friend -- Flic Everett Daily Express 20120227 A witty, no-nonsense read, it had us dusting off our trainers within seconds. Trust us when we say you'll be up and running in no time at all. Grazia 20120327 Refreshingly free of new-age jargon and psychoanalysis. It's about determination and the pursuit of the 'happy effect.' Herald Sun (Australia)


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