I believe it would be a mistake to raise the net worth requirement for investing in hedge funds. Why should this investment tool be available only to the already wealthy? The rich get richer (and hedge funds are one of their greatest tools for getting richer), but I believe the wise who are not already wealthy also deserve an opportunity toward that end. Why not?
To assume hedge funds are too dangerous for the average investor is too simplistic. Although hedge funds can utilize greater leverage than most other investment vehicles, hedge funds are typically managed by professionals who know enough not to over-utilize leverage, and thereby to put their subscriber's investment at unreasonable risk. Of course, we have all heard of hedge funds which have over-leveraged and failed. I acknowledge such fund managers made grave errors in judgment. However, many (supposedly safer) equity funds have also failed in the past through management error, so the factor is not unique to hedge funds.
Hedge fund investment, rather than becoming limited to the top one percent (by net worth) of investors, should instead become an investment tool the average investor can employ for a portion of their diversified portfolio. To simply assume average investors are not sophistocated or savvy enough to know how to utilize this tool would be an infraction of democracy. By law, we cannot discriminate because of one's gender, race, or sexual preference. Neither should we discriminate because of one's financial worth.
If we are going to change the rules, let's instead go the other direction to level the playing field; make the rules for investing in hedge funds similar to the rules for investing in equities.


A factory produces products packed in square packets of the same height h and of the sizes , , , , , . These products are always delivered to customers in the square parcels of the same height h as the products have and of the size . Because of the expenses it is the interest of the factory as well as of the customer to minimize the number of parcels necessary to deliver the ordered products from the factory to the customer. A good program solving the problem of finding the minimal number of parcels necessary to deliver the given products according to an order would save a lot of money. You are asked to make such a program.
The input file consists of several lines specifying orders. Each line specifies one order. Orders are described by six integers separated by one space representing successively the number of packets of individual size from the smallest size to the biggest size . The end of the input file is indicated by the line containing six zeros.
The output file contains one line for each line in the input file. This line contains the minimal number of parcels into which the order from the corresponding line of the input file can be packed. There is no line in the output file corresponding to the last ``null'' line of the input file.


Sophie is hard of hearing and has vision issues which make some tasks a challenge for her, such as stairs. She can manage 1 or 2, but any more are difficult for her, regardless of whether they are indoors, outdoors, well lit, etc. Although her foster family has been working with her on this for a few weeks, there has been no progress. Also, she needs to be taught another method of recall other than oral or visual before she can be let off leash in any unsecured area..
She is looking for a home that will understand and cope with her special needs, a home with a secured yard where she can sit out on the lawn or deck while her family works in the garden, and a family who will take her for walks and playdates with other dogs.


TUCSON, Ariz. — Arizona Republican Congresswoman Martha McSally called on the national GOP to "grow a pair of ovaries" as she launched her bid for the U.S. Senate on Friday, joining the race to replace retiring GOP Sen. Jeff Flake by embracing President Trump and his outsider playbook in one of the nation's premier Senate contests.
Like few others, the Arizona election is expected to showcase the feud between the Republican Party's establishment and its fiery anti-immigration wing in particular — all in a border state that features one of the nation's largest Hispanic populations.
McSally, a two-term congresswoman already backed by many GOP leaders in Arizona and Washington, described herself as anything but an establishment candidate in a fiery announcement video that touched on border security and Sharia law and featured Trump himself.
"Like our president, I'm tired of PC politicians and their BS excuses," McSally charged in in the video. "I'm a fighter pilot and I talk like one."
"That's why I told Washington Republicans to grow a pair of ovaries and get the job done," she added. "Now, I am running for the Senate to fight the fights that must be won — on national security, economic security and border security."
Later in the day, McSally, a retired Air Force colonel and the first female fighter pilot to fly a combat mission, plans to fly herself across Arizona to announce her candidacy before voters in Tucson, Phoenix and Prescott.
The election will test the appeal of the Trump political playbook — which emphasizes the dangers of illegal immigration and demands border security above all else — in a state where nearly 1 in 3 residents is Hispanic and roughly 1 million are eligible to vote, according to the Pew Research Center. Trump won Arizona in 2016 by less than 4 points.
McSally, 51, enters a dynamic Republican primary field that features a nationally celebrated immigration hardliner, 85-year-old former Arizona Sheriff Joe Arpaio, who was pardoned by Trump himself last year after intentionally defying a judge's order to stop traffic patrols that targeted immigrants. The primary also includes former state Sen. Kelli Ward, an outspoken Trump advocate who was an early favorite of now-disgraced former Trump adviser Steve Bannon.
Despite the aggressive rhetoric in her announcement video, some of McSally's conservative critics dismiss her as an establishment favorite whose record doesn't match the tough talk in her announcement.
She refused to endorse Trump in the 2016 presidential campaign. "That's just not how leaders carry themselves," she said at the time.
Yet she has tacked right in recent months and aligned herself with Trump as the 2018 campaign season neared.
McSally co-sponsored an immigration plan released by House conservatives this week that would reduce legal immigration levels by 25 percent, block federal grants to "sanctuary cities" and restrict the number of relatives that immigrants already in the U.S. can bring here. The bill, which is unlikely to survive the GOP-controlled Senate, also provides temporary legal status for young immigrants enrolled in the Deferred Action for Childhood Arrivals, or DACA, program.
Democrats see Arizona as a rare opportunity to pick up a Senate seat in 2018 as their party struggles to defend vulnerable incumbents in several other Republican-leaning states. Democrats have another advantage: Their party's leading candidate early on, three-term incumbent Rep. Kyrsten Sinema, faces a relatively weak Democratic field, while McSally and her Republican opponents are expected to wage a bloody and bruising Republican contest until the state's late August primary elections.
But McSally avoids her Republican opponents altogether in her announcement video, focusing instead on her military service while adding a jab at Sharia law — a reference to her fight against a military policy that required female soldiers in some Muslim-majority countries to wear robes over their service uniforms.
"I absolutely refused to bow down to Sharia law," she said. "After eight years of fighting, I won my battle for the religious freedom of American servicewomen."
She added, "After taking on terrorists in combat, the liberals in the Senate won't scare me one bit."
While some Trump loyalists and conservative groups don't necessarily agree, McSally is viewed as the stronger Republican candidate in a general election, when successful candidates extend their appeal beyond their party's most passionate voters.
McSally is the only "truly viable candidate" so far, said Jay Heiler, a Republican who has been considering jumping into the race.
Yet backed by a cult-like nationwide following, Arpaio could be a major factor.
Former state GOP chair Robert Graham, said the former sheriff's candidacy fundamentally changed the primary dynamics.
"When he goes into those rural communities, he is just mobbed, and in a positive way," Graham said. "They really embrace him."
Democrats, meanwhile, are practically giddy about what they view as a race to the right in the Republican field that could make it difficult for the primary winner to prevail in November.
"Whoever escapes the GOP primary in August, they will be held accountable for touting their radical stripes at every opportunity and willingness to take stances on issues that are simply out of touch with Arizonan voters," state Democratic Party spokesman Drew Anderson said.


WHAT’S INVOLVED: Made famous by celebrity trainer Tracy Anderson, the baby food diet essentially involves eating small controlled meals of puréed fruit and vegetables. On average you will consume nine to 14 jars of baby food per day.
Breakfast: Eat one to two jars of baby food.
Lunch: One to two more jars of baby food.
Dinner: You can either continue with the baby food for dinner or have a high protein dish of fish, leafy green vegetables and low fat milk.
Snacks: Substitute your usual snacks with baby food.
VERDICT: Tracy Anderson recommended the Baby Food Diet for Jen and said she “developed a cleanse where you can still eat. Liquid cleanses do help you lose weight, but you will gain more the next week. I wanted something where you can eliminate toxicity and break bad habits but still have your digestive system going. That is when the baby good cleanse was born. You get to eat all day these little puréed things, and the chocolate pudding I did is pretty killer.” Meanwhile, Ryan Penny, Clinical Nutritionist and Conditioning Coach for The Wellness Brothers, had this to say: “A whole food diet of fruit and vegetables regularly consumed through the day is certainly a good way to reduce weight and improve general health. The idea of mushing it all up and largely eliminating the need to chew is certainly novel but might lead to a few potential problems. The major one that comes to mind is appetite control. Solid food, and especially solid protein, seems to have the greatest appetite-suppressing effect. Eating the exact same number of calories in a liquefied form will typically not result in the same level of satisfaction. Remember that soft food is typically more rapidly consumed and absorbed which could further contribute to the tendency to overeat. This squishy approach would certainly be great for re-fueling after a workout but is probably unlikely to be sustainable.
Don’t forget that chewing is really a good thing for your teeth and jaw muscles, and when done properly can naturally result in eating less at each meal. That’s ultimately the aim of any weight loss diet isn’t it?


RORATE CÆLI: 1-A 6,000-word document in 1 day? A previously prepared text, of course 2 - The Teleguided Synod 3 - Müller on Censorship: "I say what I must say"
Or was it all simply prepared and translated beforehand, to create "facts on the ground" that could not be reversed and created pressure on the Synod Fathers during this second week?
Of course it was the second option: and it was all part of the manipulation plan by The Cardinal Pianist (who could also be called The 2013 Conclave Kingmaker), that he had unwittingly revealed at a fancy dinner some weeks ago.
The conservative and Wojtylian majority that all Synod Fathers can clearly see at work, and whose number was not at all represented in the manipulated document prepared beforehand, must be extremely careful in protecting the Catholic Faith in the upcoming votes, especially in the ballots leading to the final October 18 vote on the end report.
Speaking of which, since the censored secret Synod is only available according to what the Masters and the Pianist-Kingmaker allow to be published, we only hear of curious facts through leaks. And Marco Tosatti has just such a leak: how, by way of tiny paper notes, Francis guides the Synod Secretary. The Synod Fathers just see it, without understanding anything that is going on behind the scenes.
It is a mostly unaccomplishable wish, but I would pay not a small amount to know what was written in the little notes that pope Francis, in the Synod Hall, would write and then send to the general secretary of the Synod, Cardinal Lorenzo Baldisseri.
But Müller returned to the issue of censorship: "I find that the fact that outside the Synod Hall the bishops may grant free interviews, while their interventions in the hall are not public, a clear contradiction," - he maintained. "There was the will, additionally, to break this way with a tradition that is proper to the Church... it doesn't matter if some are not in agreement with this opinion of mine," Muller added. "I say what I want, but above all I say what I must say as Prefect of the Congregation for the Doctrine of the Faith. Furthermore, I haven't done anything else than to give voice to the protests of many faithful who have written me regarding this from many nations, and who have the right to know the thinking of their bishops. Why - the cardinal asked - was it necessary to change it?"
On the final relatio of the works of the Synod, Müller said: "I think it will be sent directly to the Pope, but I'm not a member of the direction anymore." Details said directly to some journalists with the clear intent to criticize once more the Synodal "censorship".


Each job will vary from project to project depending on the scope. The steps outlined below are to give you a brief idea of our process and what to expect.
1. To ensure that work is completed on time in an efficient manner, the day prior to the start of the project, we will stop by to unload the equipment and supplies necessary to commence work. Things such as ladders, paint, drop sheets and tool boxes will be stored in a discrete spot on the property to avoid being visually intrusive.
2. Our team will arrive early in the morning on the starting day of the project. They will begin setting up and will alert you of their presence. Drop sheets will be placed around the house and ladders will be erected.
- Scraping : Loose paint must be removed to ensure that the new paint is applied to a solid foundation.
- Sanding : All surfaces will receive a light sand to smooth the area and open the pores of wooden surfaces. This makes wood and dry wall much more receptive to the paint and primer.
- Spackling : For areas that have ridges and holes, spackle (wood fill) will be applied to create the appearance of a smoother surface. The substance is pink when wet so you may see pink spots throughout the job site. Once dry, the spackle will be sanded to create an even surface.
- Priming : Any bare wooden areas must be primed to ensure proper adhesion of the paint. Certain surfaces of special material may also require priming. You will see white spots throughout the house where the surface is being primed.
4. Once the prep-work is completed and the primer is dry, the team will begin the application of the finish coats. Depending on the colour chosen, several coats may be required. We always recommend a minimum of 2 coats to ensure consistency and longevity. Do not be alarmed if you can see through the colour. That just means another coat of paint is required! Some colours such as red are notorious for requiring many coats.
5. At this point, the crew will begin to clean up the job-site to ensure that everything is as clean as it was before they arrived. All paint chips will be vacuumed and garbage disposed of. If the job takes several days, the crew will clean up at the end of each day.
6. Finally, once everything is cleaned up, we will alert you that the job is completed. Our job site manager will walk you accompany you around the job site to ensure that you are satisfied with the work. Any concerns or questions you have will also be addressed.


I was wondering if there was a cut cycle that I could do next year that would remove any orals. I worry about the effects on my liver with oral winny and I have read the tbol and dbol cause too much water retention for a cut (not to mention also being liver toxic). I plan on sticking with the test prop EOD, however I might increase the dosage / length of time I am on cycle. I did a previous cycle where I used adex instead of nolva on cycle, but had nolva on-hand just in case. I am dabbling with this again for my bulk through the winter. So depending on how that goes the noval ED may be replaced with adex ED or EOD. T3 and clen will remain as-is (however clen might be moved to 2 on 2 off).
TL;DR: Is there another compound I can pin instead of using an oral, or should I just up my dosage of var (probably double up to 80mg)?
Big L - I have thought about tren, I even put together a mock cycle with it. I just really worry about the sides. In addition I have read, and heard, that you should pin ED with tren ace, any thoughts on that?
JkW - That was one of my choices. Have you had any experience with it?
Thanks! I may bite the bullet and do a tren ace cycle for my cut next year. That is the route I am leaning towards, but I have some time to think about it.
I'm thinking of running the same thing. What did your cycle look like?? What do you think of a mast, prop, tren a blend??


1. Golden State Warriors (56-6) Last week: 1 - We'll give 'em a pass for the stinker against the Lakers. And sure enough one game later they were back to celebrating Steph Curry's shots before they even left his hand. Looking at you, Andrew Bogut.
2. San Antonio Spurs (53-10) Last week: 2 - Their eight-game losing streak is over courtesy of the Pacers, which is a shame because they could have gained a game on the Warriors. Even so, they're about as safe as you can be in the No. 2 spot.
3. Toronto Raptors (41-20) Last week: 3 - In what has to be one of the biggest shockers of the NBA season, the Houston Rockets came back from 15 down in the third quarter to beat the Raptors. Still plenty of reasons to be high on the Raptors.
4. Cleveland Cavaliers (44-18) Last week: 4 - The Cavs had a nice win over the Celtics, but then dropped a game to the Grizzlies who were missing four starters. That had LeBron James saying they weren't ready for the playoffs. Translation: They aren't ready for the Raptors.
5. Oklahoma City Thunder (43-20) Last week: 5 - We can probably all agree that the Thunder are good, but not good enough to beat the Warriors, Spurs, and maybe even Clippers. The question is, will Kevin Durant want to keep at them after this season?
6. Boston Celtics (38-26) Last week: 6 - The Cavs snapped their five-game winning streak, but the Celtics are still playing strong basketball. The question: Can they keep their emotions in check when the playoffs come? They need to find the right balance.
7. Los Angeles Clippers (41-21) Last week: 7 - You've got to like what the Clippers have been doing post-All-Star Break. Wins over the Spurs, Thunder, and Mavericks - all without Blake Griffin - have them in a good place.
8. Atlanta Hawks (35-28) Last week: 9 - Have the Hawks become the under-the-radar team in the East? Maybe. They went from a team that was almost blown up at the trade deadline to one that's starting to put it together. Tough first round opponent.
9. Portland Trail Blazers (33-31) Last week: 8 - The Blazers appear to be coming back down to earth, having lost the last three games of their road trip after winning the first three. The road only gets harder with a trip to Golden State on Friday.
10. Indiana Pacers (34-30) Last week: 10 - After a 1-4 stretch, the Pacers have won three of four, including a very impressive win over the Spurs on Monday. Now get this: They don't play again until Saturday in Dallas. That's quite the break this late in the season.
11. Miami Heat (37-26) Last week: 12 - The Heat are riding a five-game winning streak, but their wins aren't exactly against the cream of the crop: 76ers (twice) Suns, Bulls, and Knicks. Still, it's good to rack up wins without Chris Bosh right now.
12. Memphis Grizzlies (38-25) Last week: 13 - Reason No. 173 why I won't try to figure out the Grizzlies: They lose to the Suns at home and then in the next game beat the Cavs on the road.
13. Charlotte Hornets (34-28) Last week: 16 - The Hornets are 10-2 over their last 12 games, including four straight wins. More good news? They've got five straight home games and seven of their next eight.
14. Dallas Mavericks (33-31) Last week: 11 - The Mavericks have lost three straight and that has some people doubting they can roll with the West's best. But Dirk Nowitzki is just focused on making the playoffs first - that isn't a guarantee.
15. Detroit Pistons (32-31) Last week: 14 - After a bad loss to the Knicks on Saturday, the Pistons rebounded with a 20-point win over the Blazers the next day. The consistency still isn't there, but you'd think they'd have enough to overtake the Bulls in the playoffs.
16. Utah Jazz (29-33) Last week: 15 - The Jazz might still be on the outside looking in, but they're jus three games behind the No. 6 seed Mavericks with plenty of time remaining in the season. They have the talent to make a push.
17. Washington Wizards (30-32) Last week: 17 - It's now or never for the Wizards who have lost two straight, as it looks like just one playoff spot will be up for grabs down the stretch. It'll be between them, the Pistons, and the Bulls.
18. Chicago Bulls (32-30) Last week: 18 - The Bulls are doing everything they can to keep their heads above water. Jimmy Butler is back, which is hugely important. But do they have enough in the tank to hold off the Pistons and Wizards?
19. Houston Rockets (31-32) Last week: 19 - Credit where it's due: To come back from 15 points down in the third quarter and beat the Raptors is pretty impressive. Or is it more frustrating? This team went to the Western Conference Finals last year and is now fighting for a playoff spot.
20. Orlando Magic (27-35) Last week: 20 - The playoffs aren't happening for the Magic this season. A 2-15 stretch for all of January and the beginning of February just did them in.
21. Denver Nuggets (25-38) Last week: 23 - The Nuggets were a Brook Lopez tip-in from being 3-0 over the last week, but they had a nice win over the Mavericks in which Kenneth Faried dropped a 25 and 20 stat line.
22. Sacramento Kings (25-37) Last week: 21 - Just as we thought, the Kings are struggling on this tough stretch of games. They've lost to the Spurs twice, Clippers, Thunder, and Grizzlies. The Cavaliers are next.
23. Milwaukee Bucks (26-38) Last week: 22 - On Sunday, Giannis Antetokounmpo raced the length of the court and threw down a ferocious dunk on Serge Ibaka. Bucks fans should just replay that over and over again until the season ends.
24. New Orleans Pelicans (24-38) Last week: 24 - The Pelicans are officially looking towards the future. That's good, because their present stinks. They've gotta build a better team around Anthony Davis… and keep it healthy.
25. New York Knicks (26-38) Last week: 25 - Carmelo Anthony thinks he can recruit players to the Knicks and plans on taking part in free agent pitches this offseason. Big city, superstar player, offense nobody seems to want to play in. Tough sell.
26. Minnesota Timberwolves (20-44) Last Week: 26 - The Wolves shot a franchise-record 68.4-percent against the Nets on Saturday. Karl-Anthony Towns was 14-for-18, Andrew Wiggins was 10-for-14 and Zach laVine was 9-for-12. That's pretty.
27. Brooklyn Nets (18-45) Last week: 27 - Markel Brown is finally getting some playing time. The second-year guard has 23 points and 21 points over this last two games.
28. Phoenix Suns (17-46) Last week: 30 - Alright, Suns. Two straight wins will get you out of the basement. It's good to see Devin Booker getting some burn and making the most of it.
29. Los Angeles Lakers (13-51) Last week: 29 - They somehow, some way just beat the Golden State Warriors, and that's probably going to be Kobe's last best win of his career.
30. Philadelphia 76ers (8-55) Last week: 28 - The 76ers find themselves in a very, very familiar spot again. They are who we thought they were!


As an increasing number of drugs gain approval for patients whose cancers have certain molecular characteristics, the promise of truly personalised medicine is edging closer towards reality.
However, the realisation that every patient's cancer is different - and that these differences can be detected with in vitro diagnostic tests and exploited with tailored therapies - has led to a rapid fragmentation of the anti-cancer drug landscape. This, in turn, has led to a significantly more complicated decision-making process for oncologists.
Molecular diagnostics testing is at the far end of a long and evolving spectrum of narrowing down the nature of a disease. This starts with the clinical observation of (often visual) symptoms, moves on to more advanced visualisation techniques involving x-rays and other imaging machinery, pulls in pathologists and their microscopes to examine the overall cell structure, involves dyes and stains to quantify the expression of certain markers on cell membranes, and finally moves deep within the cell nucleus to look for specific changes in the cancer's DNA. DNA changes can only be detected with sophisticated machinery that relies on advanced techniques such as real time polymerase chain reactions (PCR) and, increasingly, full gene sequencing.
Despite the obvious advantage of identifying patients for whom specific targeted therapies are most likely to lead to a good response, the growing number of companion diagnostics is causing ever-increasing levels of complexity. This has potentially profound effects, from hampering the uptake of certain drugs, to patients not receiving therapies that could be of benefit to them. This delicate balance between companion diagnostics' clinical utility and their potential confounding impact on patient treatment is a growing dilemma.
Predicting response: perfection or guesswork?
The first and biggest question concerning companion diagnostics is, do they increase a drug's usage due to its demonstrably superior effects in a specific patient population, or do they limit a drug's uptake due to the exclusion of (often large) groups of patients who lack the required biomarker status?
Answering this question in full requires a scientific journey to better understand what a companion diagnostic test is measuring. That is outside the scope of this article, but the key point is this: because companion diagnostics often measure non-binary indicators, such as protein expression levels, cell surface receptors and gene amplification, they do not always yield definitive yes/no answers. What's more, results are further affected by method of measurement and brand of test and, currently, these are many and varied. In other words, CDx testing and the treatment decisions that result are subject to a degree of interpretation, either by the pathologist or the oncologist or both. Although this complex field is constantly evolving alongside our own understanding of disease and human genetics, it is not yet an exact science.
However, doctors' stated perceptions of these tests and observed testing behaviour strongly suggest that a marker does not have to be perfect for it to be useful for making informed treatment choices. For many doctors, the fact that some patients may miss out on a drug that could potentially work for them is more than compensated for by the fact that the patients they do prescribe the drug to are more likely to benefit as a result of their biomarker status. Targeted therapies carry a significant financial cost, and sometimes come with potential side effects. Having a tool (biomarker) to help make a benefit vs. cost assessment is generally seen as a positive attribute.
It should be pointed out that, ultimately, this type of assessment is carried out at a much higher level by authorities such as the FDA when it comes to making a decision on drug approval. Based on all the available clinical trial data to date - including response rates in specific sub-types - the approval bodies must decide whether it is better for the drug to be approved for all patients (and hence risk additional expenses/toxicities from these drugs in patient groups that have low probability of gaining a benefit) or only in patients with certain mutations/overexpression profiles (and hence risk excluding a potentially large percentage of the population for whom a small, but non-zero, likelihood of benefit exists).
In all this, it should be noted that the relative importance of each of these factors in this intricate balancing act can be very different depending on whose point of view you consider: the patient, the physician, the drug manufacturer, the payer or the government.
Despite the increasing fragmentation and growing number of clinically meaningful markers, the current state of molecular diagnostics cannot yet be considered true personalised medicine - but this is all about to change. This transition period of single-marker testing is a necessary, but likely brief, stepping stone towards mass profiling/sequencing of large numbers of genes, and making treatment decisions based on patients' detailed genetic profiles. Next Generation Sequencing has been gradually increasing in use over the past few years, and is getting close to being widely adopted. Also known as massively parallel sequencing or high-throughput sequencing, it allows many different genes - often in the hundreds - to be sequenced in one run, making it much more efficient than existing techniques.
While more established methodologies still dominate, Next Generation Sequencing is starting to make an impact in the Oncology CDx world, as this breakdown of methodologies used for EGFR mutation testing in the US illustrates (Figure 1).
There have been two major barriers to widespread adoption of NGS in the past: (1) its cost; and (2) its clinical utility. The first barrier is rapidly disappearing, as the cost of NGS is decreasing significantly each month. The second barrier is harder to address, and comes down to the fact that many of the genes profiled through NGS panels have not yet been extensively studied in clinical trials, leaving doctors unsure as to what to do with all that data.
Cancer is, ultimately, a genetic disease: it is always caused by genetic changes. We cannot hope to conquer cancer unless we fully understand the intricate relationship between the myriad genes and proteins that control the cell cycle and which, through random mutations, can and do lead to malignancies. As we uncover more and more of these genes and proteins, we are starting to realise that they hold the key to successful treatment: no two cancers are the same, and their subtle differences can only be identified by probing deep into their submicroscopic worlds. The tools that enable us to do so are constantly evolving, allowing us to map those molecular differences more efficiently, in much larger numbers, less invasively and more accurately.
It is easy to become overwhelmed by this flood of new data, new techniques, new methodologies, new targets and even entirely new paradigms. This is a challenge not just faced by oncologists and pathologists, but also by those researching, developing and marketing new targeted anticancer therapies. Drug manufacturers now operate in a very different world from just a decade ago, and a solid CDx launch strategy is of vital importance. Such a strategy must ideally incorporate all the new advances, anticipate the upcoming revolutions and ensure being a prescription driver - rather than a barrier - by navigating the ever-increasing complexity.
Cancer is complex and an understanding of this complexity leads to opportunities: for doctors, for drug and diagnostics manufacturers and - most importantly - for patients.


What she does: Yiadom-Boakye, a Londoner of Ghanaian descent and a graduate last year from the Royal Academy Schools, has three paintings in this year's New Contemporaries, another in the John Moores biannual exhibition and yet more in an international group show at the Mannheim Kunsthalle in Germany. Her portraits are a cast list of grinning Grammy winners, a self-satisfied towel-robed hunk, a ditzy middle-aged woman, comfortable in her body and with a shocking red bra. But the paintings aren't merely humorous black stereotypes. They are painted with a loose and disbelieving swagger that seems to comment both on the characters of her subjects and what we might want from portraiture in the first place.
She says: "I like the decadence of oil paint. I like decadence in general. I wanted to paint the person that soul singers have written love poetry for, or the type that missionaries would like to teach. In the end, the history and act of painting is what matters."
We say: Seeing Yiadom-Boakye's work for the first time was like a punch in the stomach. Her paintings have a raw edginess, but a lot of sophistication and complications in them. And complications are the best thing a young artist can have.
What he does: Williams, a winner of this year's Paul Hamlyn award, and artist-in-residence at next year's Venice Biennale, lives outside Caernarfon in north Wales. He mines the territory of Welshness and provincial life. In 2003, he set up the Blenau Vista Social Club in the back of a caravan, and his recent show in Cardiff represented the cultural collision of model railway enthusiasts and snooker players. He wants to hit golf balls through a harp, while wearing plus-fours, which, he says, are an excuse for white people to dress up like pimps.
He says: "My work is a mixture of performance and video - I don't like looking at it but I like doing it. The English can't step back from themselves, but as a bilingual Welshman I can. I built a Teasmade that drowned a Welsh village in tea every morning. It represented the building of reservoirs in Wales to provide the water for England."
We say: Williams strikes a blow for anti-metropolitanism. He'll be coming across the border soon if we're not careful. For all his buffoonery, he is truly inventive and his art makes a very serious point.
What he does: It is night. A streetlamp illuminates the snow beneath. The artist wanders on to the scene, climbs the lamppost and disappears from view. There's a slight metallic sound, as he unscrews the bulb and the light goes out. End. Matt Calderwood undoubtedly follows Wittgenstein's dictum: "One must, so to speak, pull up the ladder." His sometimes life-threatening videos, which he has been making since 1998, are as much about sculpture and the material conditions of the world, as they are related to performance or film, and are as scary as they are funny.
He says: "I get queasy thinking about and showing what I've done. The first time I've done some things I've thought, 'Will it work or will it kill me?' It is impossible to rehearse my pieces. In 2000 I videoed myself climbing a ladder, chopping out the rungs beneath me with an axe as I went. My work has what you could call an escape vibe."
We say: I have watched Calderwood's videos and thought to myself, "Please don't do that." You question whether these things are art - but they also have a lovely, physical poetic grace.
What he does: Kambalu's art is a reflection on his origins and education, and the relationship between Europe and Africa. Born in Malawi, he moved to Nottingham in 2000, after working in the Netherlands. Following his marriage to a Scot, the former lecturer began work on How to Get a British Passport - a literary narrative, artwork and portrait of the artist as young man. His recent exhibition in Nottingham, Holyballism, included footballs covered in the pages of the Bible, and was accompanied by a manifesto in which he wrote: "I am developing an expressionist art form called Holyballism, centred on the Holyball, a football covered with the pages of the Holy Bible ... My vision is that in the future all Holy Books of the world will be made into Holy Balls exercising and exorcising people into everlasting happiness." He recently won a Decibel award for black and Asian artists.
He says: "I became an artist at the age of seven in an arithmetic class. When I first came to Europe people asked me what is African art - and I showed them the Bible. What is Rothko in Africa, who is Warhol? Yet I'm also an African who grew up with MTV and football. Both the Bible and football are lowest common denominators. In any case, Christianity appropriated the Roman cross, so why not appropriate a football?"
We say: Neitzsche, continental philosophy, football, post-colonialism and lapsed faith are a heady stew, and Kambalu wants to use all of them. My head spins, full of words, just like one of those balls.
What he does: Rather than sculpture, Kiaer refers to his works as models. Trained at the Royal College of Art as a painter, he is influenced by the architectural models and the radical 19th-century theatre designs of Frederick Keisler. Kiaer creates small worlds from blocks of polystyrene, rubber, plastic bowls and soiled cardboard boxes. A rubber bladder from inside a football beside little cubes of tinfoil makes you think of pigeons pecking underfoot in a city - but the cubes could also be houses, the bladder a giant boulder. At the last Venice Biennale Kiaer's work was partially destroyed by a cleaner who mistook his models for rubbish left lying about.
He says: "I went to Seoul in Korea and stepped into the void, in this city where everything seemed contingent, fast, temporary. My works have something of the same feel. Models can be illusionistic, utopian, diagramatic - I like the idea that one can move from one language to another, always enlarging one's repertoire."
We say: Kiaer's is an art of transformation and contingencies. His interests are focused on what it is like to live in cities, and how we find meaning in the confusion of stuff around us, both as theatre and as a labyrinth of meanings at every scale.
What she does: Japanese artist Nobuko Tsuchiya came to London in 2001 and has been showing at Anthony Reynolds Gallery since completing a postgraduate course at Goldsmith's College. She makes alarming, delicate sculptures with titles such as Insect Surgery Machine, Catheter and Parking Fish Project, using old chair frames, saucepans and whisks, dismantled lamps and what looks like hi-tech medical detritus. Her highly wrought agglomerations have an air of lab experiments, yet they are also images, their titles leading us to view the work in relation to the body, to animal behaviour, to sexuality. Although she shows in Japan, she has no plans to leave London.
She says: "Not everything is as it appears in my work, not everything is done on purpose. My decisions are made by using what you could call a different form of thinking, and are made to operate between harmony and discord, control and the lack of it. I always try to develop the conversation between the things in my work and myself. Maybe this sounds idiotic, but it is my honest feeling."
We say: There is nothing idiotic about Tsuchiya's art, even if one cannot always understand quite what it is about. Maybe that's part of the point. Her "different form of thinking" and quietly dramatic feel for her materials result in works that are at once threatening and beguiling. Part of me dreads to think what she'll do next.
What he does: After leaving St Martins, Edinburgh-born Grassie spent years not knowing what sort of painter to be, until he got out all his old work, photographed it and started painstakingly copying the photos. He paints only about 15 works a year, mostly very small scale. He won a prize at this year's John Moores exhibition for a depiction of his studio, where he made the painting, which can be seen propped on his desk. Next year he has a show at the Tate's Art Now room, for which he will paint a "virtual show" of works from the Tate.
He says: "The question for me has always been what to paint. My early works went from style to style, they were sad testaments to ambition. I reached a point where I thought, what's the point of painting another picture? Turning the question to my advantage, I turned to blind copying. I'm also fascinated by the fact that what you see is like reality but not."
We say: We look at Grassie's paintings with much the same concentration that he spent in making them. His art is like being trapped by your reflection in a mirror, caught in some fixating loop. There's a sly subplot about art and narcissism here that is hypnotic and disturbing.


Task 1.18 F) (r-5s)^2 + 7(2x-3r)^2 - (r-5s)(2s-3r)= 67r^2 - 111rs + 63s^2.
I get confused of the letters and i get bad answers when i try to solve the task.
You appear to have a typo (x should be s). Could you show your work. The expression is correct.
(r-5s)^2 + 7(2s-3r)^2 - (r-5s)(2s-3r) = 67r^2 - 111rs + 63s^2.
handle it properly and you'll end up with 67r^2 - 111rs + 63s^2 as shown.


How can I describe the 3D effect that is caused by rotating lines inside a circle?
I noticed an optical illusion of a 3D globe caused by rotating lines around a circle. As demonstrated by this codepen. Especially at Multiplayer time 22, 24, 27 when the number of points are increased to maximum. Here is a screenshot of it: The effect is much more pronounced when the lines are in motion.
Is there a way I can invoke this effect intentionally?
I'm curious if this effect has ever been used strategically for visualizations or graphic design?
Every line can be a projection of an arc along the surface of a sphere. Those arcs are drawn for ex. from equator to equator and you watch them from far above the north pole. All arcs happen to be in planes which are seen exactly sideways.
Actually the arcs can be also deeper inside the sphere or outside it as long as they are in the planes which are parallel with the watching direction and the seen projections happen to reach from equator to equator.
The arcs can be arbitarily complex, even discontinuous curves as long as their twists are seen only sideways and the discontinuities are hidden by seen overlaps.
So, it's not the image of an unique 3D composition. There are infinitely different 3D compositions which can produce the same seen 2D projection. The composition contains the curves and the used 2D projection.
I believe the family of ALL possible 3D causes for the seen 2D result has no commonly used name. But this is only a belief.
In 2D the lines are all possible chords drawn to equally spaced directions from equally spaced points on a circle curve. In 3D one of the possiblities is the same drawing that you already have in XY plane, but the plane is watched from Z direction.
I see it's also possible that this pattern can be seen as a western misconception of some Indian graphic art style.
You may see the pattern as a shaded sphere. That's not nonsensense because one possible 3D cause of the pattern is a bunch of arcs along the surface of a sphere. Free holes between the seen lines are biggest in the middle and smallest at the edge. With some tough math or numerical analysis one could tell how well the lines approximate some generally used shading formula of a sphere.
Though straight lines are formed by the string, the slightly different angles and metric positions at which strings intersect gives the appearance of Bézier curves (as in the mathematical concept of envelope of a family of straight lines). Quadratic Bézier curve are obtained from strings based on two intersecting segments.
Not the answer you're looking for? Browse other questions tagged optical-illusion or ask your own question.
How can the “dress” optical illusion be accurately reproduced on other images?
Optical illusion caused by gradient. How can I avoid this effect?


June 12th, 2007 - Mr. President, I thank the Senator from Colorado for his courtesy in arranging for me to speak next. The Senator from Colorado and I and the Senator from New Mexico, Mr. Bingaman, who is here, the chairman of the Energy Committee, Senator Domenici, the ranking member, and Senator Lieberman, who has already spoken, were at breakfast this morning at our usual Tuesday morning bipartisan breakfast. And Senator Bingaman expressed the hope, as I am sure he will on the Senate floor when he speaks, that we can make the kind of progress this year that we made 2 years ago on the Energy bill. And I hope so too.
He talked about how difficult it was and how impressive it was for four committees, plus the Finance Committee, all to make a contribution and how we might be able to make progress with alternative fuels, with energy efficiency. The more we learn about energy efficiency, such as with appliances and lighting, and the more we can do in accelerating research on how to recapture carbon, the better off we will be.
Earlier this morning, Senator Lieberman of Connecticut said in that spirit of bipartisanship that he hoped one amendment would not be added to this bill, and that would be an amendment calling for the drilling for oil in the Alaska wildlife area. That is a controversial piece of legislation.
I want to make a similar suggestion in the spirit of bipartisanship. I note my friend from New Mexico is on the Senate floor, and I hope the Senate would not agree to and maybe we would not even have to debate, the amendment that Senator Bingaman offered before in the last Congress and which he plans to offer again which would require a 15-percent so-called renewable portfolio standard in every State. I wish to spend a few minutes this morning talking about why I believe it is important that we not adopt that amendment.
I am reminded of a story about a Tennessee mountaineer who was convicted of murder, and the judge sentenced him and told him his choice was to be hanged or be shot.
The defendant thought a minute and said: May I ask a question, judge?
The judge said: Of course.
My question is, Do I have another choice?
Mr. President, we Tennesseans feel the same way about Senator Bingaman's proposed renewable portfolio standard which would require us to make 15 percent of our electricity from renewable fuels, mostly wind power. That would raise our taxes, it would raise our electric rates, it would run away jobs, and it would ruin our mountaintops. That is not the kind of choice we like to have.
Forcing Tennesseans to build 40-story wind turbines on our pristine mountaintops or pay billions of dollars in penalty taxes to the Federal Government amounts to a judge giving a defendant the choice of being hanged or shot.
In Tennessee, the wind simply doesn't blow enough to produce much electric power. Residential homeowners cannot afford these new taxes, industries will take their jobs to States with cheaper power, and tourists will spend their dollars where they can see the mountaintops instead of giant wind turbines.
There is, in this case, a better choice, fortunately, and that choice is for clean, reasonably priced energy in the Tennessee Valley from conservation and efficiency, from nuclear reactors -- a new one of which just opened within the last few weeks in our region by TVA -- and by clean coal. Because of its nuclear and hydro plants, Tennessee is already on the honor roll, ranking 16th among States in production of carbon-free electricity. But we are one of 27 States that would not meet the standards under Senator Bingaman's amendment, which he expects to offer during this debate.
This is real money. The Tennessee Valley Authority suggests that by the last year that this new standard is in effect, it would cost Tennesseans at least 410 million new dollars a year.
What could we do with that kind of money? If the goal were clean air, we could give away 205 million in $2 fluorescent lightbulbs per year, producing energy savings equal to the combined output of almost two of the three units of TVA's Browns Ferry nuclear plant. In other words, the $410 million could buy enough fluorescent lightbulbs to equal two nuclear reactors. Or the $410 million would be the equivalent of 3,700 megawatt wind turbines that would span a 550-mile ridge line, more than twice the distance from Bristol in the northeast part of Tennessee to Chattanooga, which is about the only place in Tennessee that wind power could actually go, along those ridgetops.
Or with $410 million, we could pay the $100 per month electric bill for Tennessee's 2.5 million residential TVA customers for 1 1/2 months each year. Or if the goal is simply clean air, it would be better, I respectfully submit, to spend the $410 million purchasing one new scrubber each 9 months to clean emissions from TVA's coal-fired powerplants.
I strongly back renewable power wherever it makes sense. In our State, I have worked hard to expand solar energy. The solar energy industry gave me an award last year for that work. I was the principal sponsor of the tax credit for homeowners to put solar panels on their homes. I have worked with the Tennessee Farm Bureau to encourage the use of biomass as a renewable energy. But this -- and I will try to be a little bit more specific in the next 10 or 12 minutes -- this proposal amounts to a wind portfolio standard which simply does not fit the Tennessee Valley nor, I submit, any other part of our region. It simply does not work in the Southeast.
Why is there a wind portfolio standard? There are other forms of renewable energy, of course, but they don't all fit in the definition, nor do all types of clean, carbon-free energy fit within the definition.
Seventy percent of our carbon-free electricity in America comes from nuclear power. About 33 percent of TVA's power is carbon-free nuclear power. That doesn't count within the Bingaman definition. Neither does the existing 7 percent of clean, completely clean power that comes from hydro, from dams.
That makes about 40 percent of TVA’s electricity carbon, sulfur, mercury, and nitrogen free, ranking it 16th among all the States in terms of producing carbon-free energy. As I said, Tennessee is on the honor roll.
Yet we Tennesseans would still be subjected either to these taxes or putting these wind turbines along our scenic mountains, which I will discuss.
According to the Energy Information Agency assessment of the Bingaman proposal, 4 years ago, wind and, to a lesser extent, biomass are projected to be the most important renewable resources stimulated by the renewable portfolio standard.
There is some other evidence that biomass will be stimulated, but I think it is a fair comment to say that this is mostly a wind portfolio standard. And my argument is, that may be fine in North Dakota -- which the Senator from North Dakota says is the Saudi Arabia of wind -- maybe it works there, and maybe North Dakotans want to see the wind turbines there, but it doesn't work in Tennessee and in most of the Southeast because the wind simply doesn't blow enough to produce much electricity.
The National Academy of Sciences says 93 percent of potential wind energy capacity occurs west of the Mississippi River. We can see on this chart that in this white area, that is where there is the least amount of wind.
There may be plenty of it somewhere else but not in Tennessee and not in the South. There is only one wind farm in this entire southeastern part of the United States. That is a TVA wind farm on Buffalo Mountain, which I will show in just a moment.
TVA had hoped that the wind on Buffalo Mountain would blow to produce electricity about 35 to 38 percent of the time. They have been disappointed that it only blows about 19 to 24 percent of the time. And in August, when we are sitting on the porches sweating, perspiring, and wanting our fans on and air-conditioning on, the winds on the only wind farm in the southeast – Buffalo Mountain – blew just 7 percent of the time. That is not an estimate. That is an actual count from TVA and the wind farm.
So the only places in the southeast region, if we can go to the next chart, that have wind resources are the ridges and the crests. Maybe unlike Iowa and North Dakota where they can have large wind farms, maybe even in Colorado they can have large wind farms, but in Tennessee, the only places that wind possibly works are on the ridges and the crests.
In addition to being the places with the most wind, the ridges and the crests are also in the most visited national park in the United States, the Great Smoky Mountains National Park. Those are the highest mountains in the Eastern United States. They run up through Pennsylvania as well.
They are the Great Smoky Mountains and the mountains around them. They are the reason most of us live in those areas.
It is quite a sight to see when you put wind turbines on top of those mountains. It is a sight that I would rather not see. Here is West Virginia, which is north of the southeastern part of the United States.
Basically it cuts off the whole tops of those mountains. In my opinion, it makes strip mining look like a decorative art. These are 400- or 300-feet turbines. These are not your grandmother's windmills. They are white and large and have flashing red lights on top of them. You can see them for 10, 12, 14 miles away.
Then, since they are on remote ridgetops, they have to dig large power lines down through whomever's backyard to get there. It is quite a dislocation in the scenery. So one would think there would have to be a big payoff before we would take some of the most beautiful parts of the United States and basically ruin the mountaintops.
Here is what it looks like in Tennessee. You can get a little sense of how big these turbines are. In Tennessee, we like football and we can put things in perspective, sometimes putting things in football terms.
Each of these wind turbines is twice as tall as the skyboxes at Neyland Stadium, which is the second largest football stadium in the United States. Penn State has one, I guess, about the same size. These rotor blades, which go round and round, stretch from the 10-yard line to the 10-yard line. I can see these turbines from the Pellissippi Parkway in Tennessee from about 14 miles away. This is at about 3,500 feet. These are some of our most beautiful vistas in Tennessee.
The problem is, even here, which ought to be a prime spot -- this is the reason TVA put the turbines here -- it didn't work very well. It was a disappointment. As I mentioned, in August, the wind turbines only operated 7 percent of the time. Wind tends to be strongest during the winter months and at dawn and dusk, but demand for electricity is highest during the summer and during the day. Basically, when we need the wind, it doesn't blow. And a point that many people often miss is that you can't store it. Unlike more conventional forms of power, you use it or you lose it. So it is of minimal help.
Also, it is more expensive. I have a chart showing the expense. Let's take nuclear power which produces 70 percent of the carbon-free electricity in the United States today, and wind, which is also carbon free. Actually, both are completely free of carbon, sulfur, mercury, and nitrogen, which are the problems for clean air in the Tennessee region.
Let's compare a 1,000-watt nuclear plant reactor and a 1,000-megawatt capacity wind farm. The 1,000-megawatts is about the size of a new nuclear reactor. The new Browns Ferry plant in Tennessee that opened the other day is 1,280 megawatts. This column is the number of hours per year for both nuclear and wind. And this second column is the capacity factor.
In plain English, this is how much they operate. For TVA, its nuclear powerplants, which produce about one-third of our electricity and most of our carbon-free electricity, the nuclear powerplants operate 92 percent of the time. The wind turbines operate, at best, 24 percent of the time in the Southeast, in the area we know about. Remember, there is only one wind farm in the Southeast. We have it, and that is what it does.
The cost of electricity is up to twice as much for wind over nuclear.
That is what people in the utility industry call the all-in cost -- that is, including the cost of building the facility and the cost of operating the facility.
So the brief analysis is that wind is more expensive, on a per unit energy generated basis, and produces much less energy than nuclear power, for example. In addition to that, if we build the wind turbines, we still have to build and operate the nuclear powerplant because, as we pointed out, the wind turbines only operate about 22 percent of the time.
My hope would be that we would not have a one-size-fits-all national mandate on States that are seeking to create clean energy. Tennessee wants to do its part. As I said, nuclear power creates 70 percent of the carbon-free energy in the United States. It produces 33 percent of the carbon-free energy in the Tennessee Valley through TVA, and TVA just opened a new reactor and they are planning more. Why would we impose on a State which is already leading the country in terms of helping to produce clean energy, carbon-free energy -- why would we impose a mandate on that State that would raise its rates or impose new taxes and drive away jobs from industries that cannot afford to pay the higher rates and at the same time put on our mountain tops, from Bristol to Chattanooga, these huge wind machines that destroy the view?
We have 10 million people every year who come to Great Smoky Mountains National Park, nearly three times as many as come to Yellowstone. They come to see the mountains; they don't come to see the wind turbines. I guarantee, if we continue to provide incentives and mandates to put up these 300-, 400-, 500-foot-tall wind turbines with red flashing lights, that is all the visitors will see when they come to Tennessee. They will not be able to see anything else.
I am eager to work with Senators Bingaman and Domenici on the Energy bill. I had the pleasure, the last 4 years, of serving with them on that committee. I admire the way they work together. They made a point 2 years ago of saying that when we go too far in either direction, we will pull back a little bit so we can make sure we have a good, strong bill. I believe the bill in 2005 was underestimated.
I believe the bill produced in 2005, produced by Senators Domenici and Bingaman and the Senate working with the House, literally set America on a different course in terms of producing large amounts of reliable, affordable, clean energy. It helped us do that in a way that would keep the costs of natural gas down, which was very important to us at that time and still is today.
I ask unanimous consent to have printed in the Record a letter from the Southeastern Association of Regulatory Utility Commissioners expressing the same views I have just expressed, that such a mandate would cause us to end up paying higher electric prices with nothing to show for it. I ask unanimous consent that it be printed in the Record following my remarks.
Finally, I would like to reiterate what we could better do with the money. I see the Senator from North Dakota here. I mentioned a little earlier that he has said North Dakota is the Saudi Arabia of wind, and I admire North Dakota for that, I admire him for his outspoken advocacy of that, and I hope all the giant wind machines go to North Dakota. That is where I would like them to be, just not in Tennessee -- not just because of how they look but because in our neck of the woods they do not work. They raise our taxes, or they raise our rates, or they destroy our mountains, or they run away jobs from industries and tourists who do not want to be part of that. I would rather see us look for better ways to spend those dollars.
As I suggested earlier, we could take the same amount of money we would be taxed, if we choose not to build these, by providing 205 million $2 light bulbs, which would be the equivalent energy savings of almost 2 nuclear reactors, or it would be the equivalent of 3,700 of these wind turbines, which would run along the ridge tops from Bristol to Chattanooga, or it would pay the monthly electric bill for Tennessee’s 2.5 million TVA residential customers, every Tennessee residential customer, for a month and a half, or it would put a new scrubber on TVA's coal-fired powerplants every 9 month period.
I am afraid this is an idea looking for a problem to solve. It may solve it in North Dakota, it might solve it in New Mexico and perhaps it does in Colorado, but it does not in Tennessee. It raises our taxes, raises our rates, ruins our mountains, and it sends jobs away, runs them away.
I hope, in a spirit of bipartisanship, perhaps the Senator from New Mexico, one of our most thoughtful Senators, the leader of this debate, will decide there are other things we can focus on rather than a one-size-fits-all mandate which may work in some States but does not in my State.


It can be hard to think about winter-proofing your home when the weather is still mild, but now is the best time to prepare your home. Many winter-related disasters can be prevented if you take a few simple steps to protect your home from freezing temperatures, snow and wind, according to the Insurance Information Institute.
How do I insure this one??
This is the oldest car that still runs in the world. It is steam powered and recently sold for 4.6 million dollars.
The auction company, RM Auctions, had estimated that the car would sell for about half that much. It represents the highest price ever paid for an early automobile at auction. The price includes a 10% "buyer's premium" which goes to the auction company.
The name of the buyer has not been made public.
The car was built in France in 1884, about a year before Gottlieb Daimler and Karl Benz of Germany, who went on to found the carmakers that would become Daimler, maker of Mercedes-Benz luxury cars, built their first experimental gasoline-powered cars. (The two were working independently of one another.) Henry Ford finished his first garage-built car 12 years after this one. He later went on to found the Ford Motor Company and incidentally, he also founded the carmaker that would ultimately become the Cadillac division of General Motors.
The four-wheeled De Dion-Bouton et Trepardoux, nicknamed "La Marquise," was originally built for the French Count De Dion, one of the founders of the company that built it.
Fueled by coal, wood and bits of paper, the car takes about a half-hour to work up enough steam to drive. Top speed is 38 miles per hour. The car came close to that speed during what has been billed as the world's first automobile race in 1887, according to RM Auctions.
The car had last been sold in 2007 for about $3.5 million at a Pebble Beach, Calif. auction.
(from the collection of Lincoln's papers in the Library of America series, Vol II, pp. 520-521).


Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia.
Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA) and internal reliability testing (Cronbach's alpha) were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent).
The PCA identified five scales with acceptable levels of internal consistency were: (1) social support (ten items), alpha 0.86; (2) perceived interpersonal care (five items), alpha 0.87, (3) concerns about availability of health care and accessibility to health care (eight items), alpha 0.80, (4) value of good health (five items), alpha 0.79, and (5) attitudes towards health care (three items), alpha 0.75.
The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.
Considerable international research has examined the factors that influence people's use of preventive health services delivered by health professionals such as general practitioners (GPs). This research demonstrates that many of the most salient factors occur not just at the individual level, but also at the interpersonal, organisational/environmental and system levels [1–6]. At the individual level, patients' attitudes and beliefs have been clearly demonstrated to be related to their access and use of preventive health services provided by GPs and various kinds of clinics. For example, belief in regular physical check-ups was positively associated with self-reported utilisation of outpatient medical care . Studies in the US and UK found that a lack of appropriate knowledge and understanding about screening mammography were key factors in women not seeking out screening [8, 9].
At the interpersonal or social level, factors can be classified into two groups that include family resources such as health insurance coverage and accessibility of a regular source of health care, and social support from family, friends and other social groups. For example, people with a regular source of care and appropriate medical insurance are more likely to have a routine medical check-up than those without a regular source of care or medical insurance [10–15]. A number of Australian studies have also suggested that patients who utilise the same GPs on repeat occasions are more likely to receive appropriate preventive care [16, 17]. Different US studies have demonstrated the importance of social network variables in accounting for differences in the use of preventive health services such as medical check-ups, dental care and immunisations [18, 19]. In addition, Australian studies suggest that family and social support are important influences on people's use of preventive health services. For example, men with lower social support were less likely to contact a GP .
At the environmental/organisational level, access to a car, short distance and travel time to health services and waiting time in health services are positive determinants of preventive health utilisation [8, 21, 22]. Finally, at the system level, health services utilisation behaviour is also strongly influenced by societal resources, priorities and policies. For example, in Australia, the Medicare rebate system supports (almost) universal access to GP services compared to other countries such as the US ; however, even in this system, the majority of GPs still require a co-payment to be paid by their patients and there are also other (in)direct costs associated with visiting a GP [24, 25]. Young et al.  found that lower socioeconomic position was associated with lower out-of-pocket costs per consultation and was inversely related to use of preventive health services.
Andersen's Behavioral Model of Health Services Utilisation has been widely used for many years as a theoretical model for understanding individuals' use of health services (including preventive health services) . This model was initially developed and empirically tested in a series of studies to help understand why families use health services and also to define and measure equitable access to health care and to assist in developing policies to promote equitable access. The model has been updated a number of times since the 1960's [1, 4]. It purports to identify the multiple factors that influence health services use . The theoretical framework used for the present study was based primarily on Andersen's Behavioural Model of Health Services Utilisation, but also included some additional elements from other models (such as the Health Belief Model). It focused on four levels of factors, with these being at the system, organisational/environmental, interpersonal and individual levels of influence, with a particular focus on those factors which might best predict socioeconomic differences in use of preventive health services. This adapted model was used in the current study to inform the further development and psychometric evaluation of measures of those key influences of health services related to the aforementioned four levels, including: perceived availability of and accessibility to health care; perceived interpersonal care from GPs; regular source of care; social support; and attitudes and beliefs towards health care and GPs. Given that relatively little attention has been given to the development of valid and reliable scales for measuring these kinds of influences, the current study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia.
The scales and questionnaire were developed according to the following steps: (1) identification of relevant and salient domains; (2) identification and/or adaptation of existing items and where necessary, development of new items; (3) development of a draft questionnaire and review by an expert panel; (4) pre-testing and piloting of the reviewed questionnaire; (5) collection of data using a mail survey; and (6) evaluation of the psychometric properties of the scales. Each of these critical steps and the results are discussed in the following section.
In order to identify relevant domains of influences on GP preventive health services utilisation, a literature review was conducted. The key search terms used were: 'primary health care' or 'general practice', 'prevention' or 'preventive activities', 'preventive health services or preventive health care', and determinants of health services utilisation'. The search was conducted via the EBSCO HOST search engine, including Medline, PsychINFO, Primary Search and PsycARTICLES databases. The most commonly investigated determinants of GP preventive health services utilisation have been: (1) the type of health care system as a system-level determinant, such as bulk-billing services; (2) environmental/organisational-level factors affecting access, including transport, travel time and cost; the number of doctors or health professionals to choose from, being able to see a preferred doctor, appointment time, waiting time and length of consultation time; (3) interpersonal-level factors such as family sources and patient social support variables; and finally, (4) the individual's attitudes and beliefs towards different aspects of health and health care. Table 1 summarises these four domains and gives examples of the kinds concepts relevant to each domain.
Transport to GP clinic: public/own car to access to health services.
Travel time to the regular source of medical care.
Out-of-pocket cost from patients related to the consultation fee.
Available doctors for patients to choose e.g. female doctors.
A doctor who patients would like to see.
Elapsed time between initial request and the date of the appointment to see a GP.
Waiting time in GP's office or clinic.
How long GP consults with the patient.
GP's perceived attitude towards patients.
Regularly visit GPs at one practice or one doctor.
Patients' perceptions towards health care.
Patients' attitudes towards doctor's advice about improving their health.
Once the domains were identified, a further literature search was conducted in order to identify scales and questionnaire items relevant to each of the domains listed in Table 1. The key search terms used to identify potentially relevant questionnaires, questions and/or scales were, 'preventive health services or preventive health care and beliefs or attitudes or behaviours and instrument or scales'. The search was conducted via the EBSCO HOST search engine, including Medline, PsychINFO, Primary Search and PsycARTICLES databases. The search was also conducted through international and Australian instrument web sites, including the Australian Centre on Quality of Life Instrument Database at http://acqol.deakin.edu.au/instruments/index.htm and BUROS Institute of Mental Measurements at http://www.unl.edu/buros. Key researchers names were also searched for their publications.
Potentially relevant scales and questions relating to each domain were then extracted from a review of all the existing questionnaires and formative studies. The authors of the relevant scales and questions were contacted, and permission was sought to use and/or adapt the previously developed measures. Additional psychometric information and any other relevant information for each of these scales were also requested from the researchers. The criteria we used for determining whether a scale was suitable and appropriate for use in the present study included: the scale had been previously tested psychometrically and validated; the content of the scale was suitable for the new research purpose; and the questionnaire items and permission could be obtained from the author. Subsequently, six scales were identified. They included: (1) concerns about availability of and accessibility to health care [27, 28]; (2) perceived interpersonal care [29, 30]; (3) value of health care, (4) value of doctors and (5) value of good health ; and (6) social support [31–33]. These scales measured people's attitudes and perceptions towards preventive health care and health services at individual, interpersonal, environmental/organisational and system levels.
The items for the scale measuring "concerns about availability and accessibility to health care" were adapted from a previous study . Three items previously used to assess accessibility to health care [27, 28] were adapted and re-worded. For example, to obtain more specific information, the original item 'Number of GPs you have to choose from' was changed to 'Having a number of doctors to choose from in the one medical practice/centre'; 'Ease of seeing the GP of your choice' was changed to 'Being able to see my preferred doctor every time'; and 'How long you wait to get a GP appointment' was changed to 'The amount of time it takes to get an appointment to see a doctor'. In order to assess availability of "bulk billing" in general practice, one new item was developed to fit into the scale to assess the availability and accessibility of GP services. Items used previously to assess GP's attitudes towards patients (inter-personal care scale) [29, 30] were included in their original form. Items used to measure social support from family and friends [31, 32] were slightly reworded such as 'confide in' was changed to 'talk to' and 'come to visit' into 'visit' in order to make the sentence simple and easy understand. Under the domain of individual-level factors, items from previous scales assessing patients' attitudes and beliefs including value of doctors, value of health care and value of good health  were reworded based on Australian health system and language. The scale names were changed from "value of doctors" to "value of GPs", from "value of health care" to "Attitudes towards health care", while "value of good health" was left unchanged.
Six scales were developed for further psychometric evaluation. This includes one original scale and five adapted and further developed scales: (1) concerns about availability and accessibility to health care (nine items), (2) perceived interpersonal care (three items) (original scale), (3) attitude towards health care (five items), (4) value of general practitioners (four items) and (5)value of good health (five items), and (6)social support (ten items). Items of concerns about availability and accessibility to health care used a six-point response format with responses including 'very important', 'fairly important', 'not important', 'not at all important', 'I don't think about it' and 'not applicable'. Items of perceived interpersonal care used a five-point response format comprising 'excellent', 'very good', 'good', 'fair' and 'poor'. Items of attitude towards health care, value of general practitioners and social support used a seven-point response format with responses ranging from 'strongly agree' to 'strongly disagree'. Finally, items concerning the value of good health used four-point response format with responses ranging from 'very likely' to 'very unlikely'.
The items for the 6 scales (36 items) were then combined together with 12 socio-demographic items, 10 items assessing health status, disease conditions and smoking status, 20 items assessing use of health services and finally one item assessing regular source of health care. Combined together, the items from the 6 scales and all the additional items formed the GP Preventive Health Services Utilisation Questionnaire (GP-PHSUQ). This draft questionnaire was then reviewed by six "expert" national and international researchers working in one or more of the fields of health services, primary health care or public health research. The experts were requested to consider two main issues: first, whether the proposed scales and questions provided sufficient coverage of the required domain areas; and, secondly, whether the expert was aware of other existing measures or questionnaires that might further inform item and scale development. Most of the feedback related to specific suggestions about the reading level required to understand some of the questions, formatting of the questionnaire, and the wording and sequencing of questions. Consequently, a number of terms were re-worded so as to reduce the required reading age. A revised version of GP-PHSUQ was developed following the incorporation of the experts' feedback.
The revised questionnaire was then pre-tested with a small, purposive community sample in Brisbane in order to evaluate and further improve the wording of the questions and the presentation of the questionnaire. Twenty two individuals aged from 25 to 64 years, and from different socioeconomic backgrounds were selected for pre-testing. The average age of participants for the pre-testing was 37. Twelve males and ten females participated in this pre-testing. A questionnaire was distributed to each participant, with an accompanying invitation letter and checklist. Feedback and comments provided by participants related to clarity of instructions, repetition of some items, irrelevancy of items, length of questions, similarity of items and sensitivity of questions such as income. Further modification was made to the questionnaire following this feedback.
On completion of the above steps, the final GP-PHSUQ consisted of a 10-page A4 booklet (the questionnaire is available from the first author on request). The questionnaire included 79 items made up of: 12 socio-demographic items; 10 items assessing health status, disease conditions and smoking status; 20 items assessing use of health services; and 37 items assessing the factors that might affect health services utilisation.
A mailed survey was then conducted to test reliability and validity of the scales in the general population. A sample of individuals aged 25-64 years of age (N = 800) from Brisbane municipal area was randomly drawn from the Australian Electoral Roll in 2004. The sample included all eligible citizens 18 years of age and over who are registered to vote in Australian elections. The questionnaire was mailed to each selected participant during November 2004. We used Dillman's mail survey methodology  as outlined here. Eight hundred surveys were mailed, with each package containing a personalised cover letter, a survey, an instant lottery ticket, as well as a pre-addressed and prepaid reply envelope. After one week, a thank-you and reminder postcard was sent to all participants. A replacement questionnaire with cover letters was sent to non-respondents four weeks after the first questionnaire mail-out. Finally, a reminder letter was sent to those people who had still not returned their survey six weeks after the first mail-out. There were 1453 questionnaires sent out to participants in the three subsequent mailings over six weeks. A final useable response rate of 65.6 per cent was achieved, which included a sample of 519 respondents.
There were 381 respondents' surveys that were eligible to be used for the final data analysis after exclusion of those respondents who already had a pre-existing cardiovascular diseases, diabetes or other self-identified chronic condition (n = 138). The rationale for excluding the latter group from this analysis was that the purpose of this study was to investigate the utilisation of preventive health services by different social economic individuals who did not have any (known) chronic illness at the time of questionnaire completion. There were a total of 381 respondents 25-64 year old, including 155 males (40.7 per cent) and 226 females (59.3 per cent). The average age of the sample was 42. Table 2 summarises the socio-demographic profile of the respondents (N = 381) in terms of their age, gender, education, and household income.
Face and content validity were evaluated for each scale during their development. Face validity was assessed by the research team and the expert review panel. Content validity of the scales and items was evaluated utilising the conceptual framework used for measurement development. Principal Components Analyses (PCA) were conducted in order to extract the maximum amount of variance from the loadings within components across all of the scale items . An initial PCA was performed to determine how many underlying factors were in the complete set of scale items. The number of factors was derived based on eigenvalus greater than 1 and also a scree test of eigenvalues plotted against factors. After the number of factors had been determined, Varimax rotation was used to extract and rotate the final loadings. Items were excluded if the loading of the coefficients was less than 0.5, to allow for a moderate level (20-30 per cent) of overlapping variance .
The internal consistency of each factorially derived scale was assessed by calculating Cronbach's alpha reliability coefficients for each scale. A Cronbach's alpha coefficient of greater than 0.7 was considered acceptable . Mean scores and standard deviations for each factorial scale were used to assess the variation in response within the sample population. The following steps were used to generate a total score for each scale. Firstly, each item of the scale was assigned a number from high to low, based on each scale format. For example, if the scale response format was strongly agree, moderately agree, agree, disagree, moderately disagree and strongly disagree, then the numbers were assigned as 6, 5, 4, 3, 2 and 1. Secondly, negatively worded items were reversed before a total score was calculated for the scales in order to check reliability. Thirdly, 'not applicable' was excluded from the items. Fourthly, treating each of the items as an interval-level measure, the scores for each were added up to give an overall score for each scale.
Two types of missing values required attention in this study. The first involved item non-response, where there was no response to a particular question or item. The second occurred when the answer was marked in a way that was unclear, or fell outside the range of permissible responses for each item. In order to minimise the amount of missing data for each item, a 'best estimation' method was used whereby respondents with missing data were assigned the item-score of a respondent with a similar age, gender, income, and education level [37–39].
Statistical Package for Social Science (SPSS) 12.01 was used for PCA and for the calculation of Cronbach's alpha.
Ethical approval was obtained from the Human Research Ethics Committee, Queensland University of Technology (QUT) before conducting the above described pre-testing and the following mailed survey (QUT Ref No 3642H).
The initial PCA produced eleven factor components with eigenvalues above 1 (range: 1.022 -5.352), which explain a total of 68.67 per cent of the variance. Using the screeplot provided by SPSS (not shown), there was quite a clear break between the fifth and sixth components. Components 1 to 5 captured much more of the variance (48.46%) than the remaining components. Therefore, five factor components were determined.
The final PCA rotation then produced five factors that measured social support, perceived interpersonal care, concerns about availability of and accessibility to health care, value of good health, and attitudes towards health care, which explained 12.8%, 10.9%, 10%, 7.9% and 6.8% of the variance, respectively.
Table 3 presents the final component loadings for all of the complete scale items and the retained factor loadings are highlighted in bold. All ten items of the "social support" scale were retained. All three items of the scale "perceived interpersonal care" were retained, which were loaded together with one item (item (a)) from the scale "value of general practitioners" along with the item (c) from the scale "concerns about availability of and accessibility to health care". The new scale was created with five items and was still named "perceived interpersonal care". It should be noted that the response format for the new scale "perceived interpersonal care" was combined with other two items from two different response formats. The final response format suggested for this scale was "Excellent, very good, good, fair and poor". The rest of items (b-e) from the scale "Value of GPs" were removed because they had a factor loading less than 0.5. The scale "concerns about availability of and accessibility to health care" became eight items. All five items of "value of good health" were also retained. Three items (a-c) from "attitudes towards health care" were retained, but item (d) was removed.
People don't visit me as often as I would like.
I don't have anyone that I can really talk to.
I have no one to lean on in times of trouble.
I often feel very lonely.
When I need someone to help me, I can usually find someone.
The amount of time the doctor spends with you?
The doctor's patience with your questions or worries?
The doctor's caring and concern for you?
Notes: a. The score for this item has been reversely converted from original score, which gave a negative coefficient.
Table 4 presents the results of the internal reliability test for each scale, including mean scores, standard deviations and Cronbach's Alpha reliability coefficients. The reliability coefficients for the scales of social support (alpha 0.86), perceived interpersonal care (alpha 0.87), concerns about availability of and accessibility to health care (alpha 0.80), value of good health (alpha 0.79), and attitudes towards health care (alpha 0.75) were all acceptable.
Notes: a. 'Not applicable' was excluded from the scales.
This research has identified five scales that measure some important factors related to people's use of GP preventive health services in Australia. Scale development and testing were conducted according to six key steps, that included: (1) identifying and conceptualising the domains to be measured; (2) identifying and/or adapting existing scales and additional scales to be developed; (3) revising the scales and items and then constructing the questionnaire and having this reviewed by experts; (4) further pre-testing and refining the scales and pilot questionnaire; (5) collecting data using a population-based survey methodology; and finally, (6) conducting a formal psychometric evaluation of the scales. The six derived scales were formally tested for their validity and reliability. Subsequently, five relevant scales were identified: (1) social support, (2) perceived interpersonal care, (3) concerns about availability of health care and accessibility to health care, (4) value of good health, and (5) attitudes towards health care. Each of the scales was also found to have an acceptable reliability coefficient .
There are three specific strengths to this research. Firstly, the research used a theoretical framework derived mainly from Anderson's Health Services Utilisation Model , to guide domain and scale identification, scale development and validation. Secondly, the study used a socio-economically diverse and randomly selected population-based sample, so as to ensure the future generalizability of the developed scales. Finally, the study provided evidence of both factorial validity and internal reliability for the scales, which can be used by researchers in future research, particularly in Australia and potentially also, in other countries.
However, there are also a number of methodological shortcomings that need to be considered. The study sample was drawn from the electoral roll in the local government area of Brisbane, using a method which has been previously shown to under-represent socially disadvantaged individuals [41, 42]. The results from the representativeness analysis indicated that the respondents with a higher level of education in the study sample were over-represented, whereas respondents with a lower level of education were underrepresented when compared to the 2001 census of the Local Government area of Brisbane. The use of the scales needs to be further evaluated in low socioeconomic individuals or communities. Data were based on self-report which is a commonly used method of collecting data about individuals' health and risk-factor status . Newell et al.  critically reviewed 66 studies based on self-reports of health behaviours and risk factors relating to cancer and cardiovascular diseases in the general population. They concluded that self-reported data consistently underestimated the proportion of individuals considered 'at-risk'. Furthermore, the research findings relate primarily to GP-based utilisation of preventive health services by the general adult population in Australia and we do not really know the applicability or relevance of these scales for use in other population with different health care systems in other counties. Future research in different utilisations of different health care systems may be needed, as well as the salient factors for each of the systems.
The five scales are suitable for further use by researchers and practitioners interested in measuring people's perception, attitudes and beliefs towards GP preventive health services utilisation at individual, interpersonal, organisational/environmental and systems level. Given this study used people's perceptions of these factors, more direct (objective) measures to assess these are necessary in the future. Nevertheless, it is imperative to identify such factors impacting people's use of preventive health services, in order to prevent chronic diseases. It is especially important for those groups where there is poorer access and utilisation of the services [45–47].
This research was supported by the National Health and Medical Research Council (NHMRC), Public Health Scholarship, and was conducted at the QUT School of Public Health in Queensland Australia. At the time of this research, Jianzhen Zhang was a PhD candidate and Brian Oldenburg was employed at QUT, and Gavin Turrell was a Senior Research Fellow supported by a National Health and Medical Research Council/National Heart Foundation Career Development Award. We would like to thank to all participants in the pre-testing and mailed survey and to the experts who contributed to the development of questionnaire as well as the authors who gave us permission to use and adapt their scale items.
JZ: Made substantial contributions to conception and study design, carried out data collection and performed the statistical analysis and interpretation of data. Has also been involved in drafting the manuscript, revised it critically for important intellectual content and given final approval for the version to be published. BO: Made substantial contributions to conception and study design. Has also been involved in drafting the manuscript, revised it critically for important intellectual content and given final approval for the version to be published. GT: Made substantial contributions to study design, data analysis and interpretation of data. Has been involved in drafting the manuscript, revised it critically for important intellectual content and given final approval for the version to be published.