The
Villages Health
Inventing a New Paradigm for Care
Background
Health Care in the U.S. is complex, contradictory, and frequently exasperating to patient and provider alike. On the one hand, there is excellence, such that many travel from distant lands to undergo treatment within our hospitals and treatment centers (Ehrback, Ceani& Mango, 2008). On the other hand, we expend more financial resources on health care than any other people on the globe, only to find our clinical outcomes and overall health status to be far inferior to many systems which expend less. Squires, D. A. (2012). Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality. Issue brief (Commonwealth Fund), 10, 1-14.
In recent decades, as the biologic revolution
has fueled greater knowledge and medical specialties have evolved, sometimes
becoming silos unto themselves, the import and attraction of the traditional
doctor:patient relationship has declined (Dugdale, Epstein & Pantilat,
2001). Increasingly fewer physicians have been attracted to primary care (Geyman,
2011). Meanwhile, the business aspect of
health care has placed its top priority on technology, and given the
predominant fee-for-service payment model, on volume. The result, then,
presents no surprises: a health care “system” (note well the quotation marks)
characterized by voluminous and liberal application of technical services—both
diagnostic and therapeutic (in many cases “technology for technology’s sake”)
often independent of any measurable improvement in clinical outcome (Relman,
1980).
Diagrams, clinical programs, and federal
initiatives all seem to revolve around where the money goes, with hospitals and
academic health systems at the epicenter, surrounded by burgeoning surgery
centers, imaging centers, and the like. The “system” is provider-centered (Relman,
1980). Less real attention is paid to the formal, meaningful assessment of
quality or value or patient-satisfaction. Patients report feeling like the objects of the “system” rather than the
reason for it.
The upshot is that healthcare as it is
currently delivered in the U.S. is felt by many to be characterized as lacking intelligent design. It too
often lacks real integration. It is confusing to its users and even to its
providers. It is expensive. The
relationship between payor and provider is typically deeply dysfunctional. It
is provider-driven, delivering high volumes of high tech, and low volumes of
high touch (Lesniak, 2005). And its
ultimate “work-product” is disappointing both in terms of clinical outcomes and
patient-satisfaction.
The Vision
The Villages is a phenomenon, becoming the
largest over 55 community by far in the U.S in only 30 years. In a league of
its own, The Villages has taken the concept of a “planned community” to a level
never before seen—anywhere. Yet, The Villages has suffered what our nation
suffers: an unhealthy health care “system,” in which patients consistently
express considerable dissatisfaction with everything from care-access to
care-quality.
Thankfully, a new vision for a health care system
has been brought forth. Those who reside within and near The Villages can now enjoy
both a world-class model of a planned community, and a novel and profoundly
superior health care system, as noteworthy and exemplary as the community
itself. America’s Friendliest Hometown is becoming America’s Healthiest
Hometown.
The Villages Health replaces the current
paradigm with one that is delightfully simple. It is, Patient-Centered, where the components revolve around the patient’s
experience. It is Community-Based,
where the great majority of health care services are rendered close to home. It
is Primary Care-Driven, in which
each patient has a relationship with a primary care physician and receives care
delivered by a team led directly by that physician based in a Medical Home
model. It is Academically-Illuminated
in the sense that the care rendered enjoys the benefit of modern science and
ongoing learning through a formal relationship with a research university. It
is Innovative, routinely
implementing fresh ideas and methods—a process which has so consistently
characterized the culture behind The Villages’ success. It is Integrated in which the primary elements
of a comprehensive system are intelligently connected. And it is predicated
upon Value in which both quality and
cost remain the clear and unabashed focus of attention in the delivery of
care. In this respect, new and
innovative technology is embraced to the extent that it supports the creation
of greater value to the patients who are served.
Primary Care
The focus of this document is the primary care
component of the Villages Health System. While The Villages Health necessarily
involves numerous elements and components, the most prominent, most pervasive
and most visible incarnation of this new paradigm is the introduction of a
group of primary care physicians based in accredited PCMH’s, comprising a
primary care network in which residents—if they so choose—have access to a Care
Center within ten minutes by golf-cart from where they live. Care by medical
specialists other than primary care may involve travel to where such care is
clustered along with the supportive diagnostic and therapeutic technologies and
facilities that they employ. But a
patient’s Care Center is expected to be literally near one’s home where the
majority of health care the population requires is provided.
Today six such facilities operate (5 within
The Villages), each featuring 5-8 primary care physicians (and associated
professionals). Each is formally recognized as a Level 3 “Patient Centered
Medical Home” by the NCQA.
The service delivered through the primary care
component of the Villages Health embraces the six domains of care as
articulated by the Institute of Medicine: Patient-Centered, Safe, Effective,
Timely, Efficient, and Equitable (Institute of Medicine , 2001). For purposes
of the present state, several key themes are described so as to sketch something
of a “profile” of what is being delivered by the primary care component of the
system. What follows is by no means a comprehensive treatise of the primary
care component of The Villages Health as much as a collection of highlights
intended to represent the whole. In other words, there is more.
Portal of Entry
When care is needed, one starts with one’s Medical Home, even if the
services required do not fall within the realm of primary care. The initial,
intake visit for one hour is with the chosen primary care physician.
Subsequently, it depends on the patient’s needs. A patient who suspects that it
is time to undergo a knee replacement does not have to rely on billboards or
yellow-pages or anecdotal stories by acquaintances to choose a course of action.
Each patient should think of his or her Medical Home as the first call to make,
no matter what the topic or concern. Whether it be routine preventive care
(such as a flu shot in the Fall) or the obvious need for surgery for an
enlarging hernia, access into the health care system generally is through the
“front door.” Indeed, if appropriate or if a patient prefers, a call to the
primary care office may result first in a conversation or appointment with a
member of the team other than the physician, such as a nurse or health-coach
working under direct supervision of the physician.
Advocacy
Related to the above concept is the role of advocacy. Even a
well-designed health care system can seem overwhelming and even frightening to
many patients. The primary care provider, then, is intended to function as the
friendly, familiar face who might lift the allegorical lantern and say “I know
just where we to go with this. Come with me and I’ll get you where we need to
be.” Less allegorically, then, that role might translate into preceding any
referral to another specialist with written and/or personal communication
summarizing the work-up performed to date, background clinical information,
relevant personal information, and a defined question being put to the consultant—something
many providers of specialty care desperately wish would occur more regularly by
referring physicians.
Coordination and the
EHR
A coordinating role is also essential when numerous other providers of
care are concurrently required (Kaufer, 2000). Key to this role and to
the others specified above is the existence of a single information system that
ties together all the members of the
team serving patients in each of the Care Centers as well as to and from the
Specialty Center and finally to either the local community hospital or to the
tertiary care center. This IT
infrastructure (in the form of the eClinicalWorks electronic health record) is deployed and
operational in all Care Centers.
Empowerment
A Primary Care provider in one of The Villages Medical Homes might be
heard to say the following about the care rendered. The statement may beget a
double-take initially, but should eventually make complete sense:
“We do not treat diabetes here. We do not treat high cholesterol. We
do not treat heart failure. Or emphysema. Or gout. [pause for effect] Our patients do. We show them how.”
In other words, if there is a pole-vault athlete and a coach, it does
no one any good for the coach to throw the athlete over the bar at practice day
after day. The primary care physicians play a teaching role, convincing
patients of the absolute importance of gaining control of a given disease,
explaining how this can be done, and putting the whole process within the
patient’s reach. Compliance levels within such a model are found to be orders
of magnitude greater than in more paternalistic systems, with accompanying
superior clinical outcomes. For those patients who are in good health and
without chronic conditions, the empowerment focus is on primary prevention,
health promotion, and the maintenance of wellness (Menon, 2001).
Shared
Decision-making
Patients want to understand the medical issues affecting them
(Adams and
Drake, 2006). Rather than having a medical
assistant hand them a prescription written by a physician who scampered away
after only a few moments in the patient’s company, patients prefer to have
things explained fully. What are the other
diagnostic possibilities in need of ruling-in or out? What diagnostic or
therapeutic alternatives exist? What are the key pro’s and con’s of those
alternatives? What are the costs? Of course, there will be patients (becoming
rarer and rarer) who prefer to simply hand over the keys and say “Doc, just
tell me what to do. I trust you. No need to walk me through it all.” Most patients
prefer to function as active participants in their health care decision-making,
and the teams functioning in The Villages Health Care Centers embrace this
approach in all they do. To the extent desired by a patient, family is invited
into the medical decision-making process (Teno, Casey, Welch, Edgman- Levitan, 2001).
Zillion-Stop Shop
Patients are routinely delighted to discover a physician both expertly
capable and willing to treat most of
the patient’s health care needs. In the Medical Home, a patient is able to
undergo routine cervical cancer screening, yet also go to that same provider
about carpal tunnel syndrome, osteoarthritis, migraine headaches, depression,
or to discuss menopausal symptoms or asthma. While conceivable, addressing all
such items in a single visit could
perhaps be attempted, but is usually logistically quite unworkable, and both
patient and provider likely become overwhelmed. So the phrase “one-stop-shop”
would emphatically not apply to the
Medical Home. A very broad range of health matters are able to be expertly
managed through the Medical Home (with appropriate referral whenever patient
and physician agree it is appropriate). The point is that the “service line”
available through the Medical Home is as broad as it is expert, such that the
great majority of the most common health care services may be accessed again
and again at a local facility by patients seeing providers with whom there is
mutual familiarity.
Access
The Primary Care component of the Villages Health system sets a new
standard in access to care. Access to quality health care has been shown to
impact quality of life, life expectancy, and prevention of disease and
disability (U.S. Department of Health and Human Services, 2010). Whether it is
same-day urgent care, extended routine hours (mornings and evenings), weekend
hours, after-hours telephone availability, or even the opportunity for patients
to communicate electronically about anything from appointment management to
clinical concerns, the Medical Home and the care rendered therein is known for
its accessibility. Access is such a key element of the Medical Home that a bold
goal of The Villages Health from the start is to render the “urgent care
center” obsolete, and to revolutionize the status
quo in local hospital Emergency Departments such that the clinical material
addressed in that setting becomes almost exclusively, emergencies!
Population Health Management
While there may be any number of ways to approach a given disease
state or medical condition, there is usually a best way. More and more, certain well-studied approaches to the
care of specific conditions are emerging as clearly the most appropriate or
effective (Kitson, A., Harvey, G., McCormack, B., 1998). If it is appropriate
to manage a given diabetic patient according to a specific evidence-based
guideline or plan, then it is probably appropriate to manage all diabetics according to that same
plan (“population HEALTH management”) achieving optimal outcomes with minimized
variability from the standards of care. The providers of Primary Care at The
Villages Health implement Evidence-Based
guidelines in employing population health management. Similarly, active
awareness of ongoing Comparative
Effectiveness Research is maintained with plans to routinely implement
whatever modifications to existing care protocols appear appropriate, such that
patients enjoy the benefit of such knowledge.
Science of
Prevention and Lifestyle Modification
While the idea that it is better to prevent health problems than to
treat them is simple, preventive health care is surprisingly complex. Some preventive measures can themselves cause
harm. Still others are so expensive or
so unpleasant that their value is questionable, particularly when applied to
patients for whom risk of the target condition is low. Preventive services have traditionally been
provided indiscriminately, driven by the unsophisticated or naïve belief that
preventive services are, by definition, good so the more the better. Such is
certainly not the case. What’s more, personal ideology or preference plays a
prominent role in how aggressively or conservatively one may wish to utilize
certain preventive services. It is not the case that one-size-fits-all. The
Medical Homes host the incarnation of the science
of prevention, including primary, secondary, and tertiary prevention (Smith,
T., Jenkins, C., Orleans, C., 2004). The providers enthusiastically strive to
help individual patients implement preventive strategies appropriate for them.
Without question, the most underutilized interventions in the
treatment of the commonest medical conditions fall within the category of therapeutic
lifestyle change (TLC). Overwhelming evidence indicates that the first steps in
the management of the most prevalent and burdensome medical conditions do not
directly involve the provider, but the patient, the two most dominant being
cardiovascular fitness activity and consumptive selection (exercise and diet),
in that order. Whether treating chronic fatigue, high blood pressure, high
cholesterol, diabetes, obesity, depression, insomnia (the list is virtually
endless), the first and often most effective treatment is the participation in
regular, prudent, physical activity (Pate
RR, Pratt MP, Blair SN, et al, 1995).
Traditionally, a chasm has existed between health care provider and,
ironically, the implementation of the first
step in care, due primarily to the fact that such implementation does not directly involve the provider other than
in the role of recommending participation in such activity. One of the elements
which makes The Villages Health revolutionary is the fact that the promotion
and support of a vigorous, active lifestyle has been so central to the culture
created and nurtured in The Villages. It is only natural that The Villages
Health engineers a direct connection between its health care providers and the
participation in such a lifestyle.
Integration with
Hospital Care and colleagues in other medical specialties
There is a somewhat disconcerting trend in which many primary care
physicians are choosing to forego any involvement whatsoever in the care their
patients receive while hospitalized (Lakhan and Laird, 2009). Indeed, many of
the physicians who choose to practice within the Medical Home environment in
The Villages choose to restrict their care to the outpatient setting. They are
welcome. However, a core contingent of physicians within The Villages Health remain
actively involved in inpatient care such that when patients who routinely receive
their outpatient care from The Villages Health do eventually require
hospitalization, they will be cared for, at least in part, by physicians who
practice in the Medical Home network in addition to “hospitalists” who are not uninvolved
in outpatient care and principally engaged in the hospital setting. Similarly,
efforts are invested in maintaining relationships with specialist colleagues
including regular personal contact with those specialists as featured guests at
the Medical Homes addressing current issues, case presentations, and seeing
selected patients together.
Continuous Quality
Management
In addition to the medical conditions under the direct management of
the teams within the Medical Homes, an equally essential focus of management is management
itself. That is, an explicit strategy
of data collection operates whereby the Medical Homes continuously monitor the
effectiveness of their activities and initiatives, making strategic adjustments
based upon those data in a process of continuous quality improvement, a
hallmark of any excellent learning organization (Gaynes, et al, 2001).
A Community of
Lifetime Learners
It is envisioned that a culture can be maintained in which all members
of the care team are continuously and actively learning. Advantage is taken of
the university affiliation so that trainees – primarily medical students, and
nursing students, have opportunities to participate in the Care Centers
(Ogrinc, Headrick, Mutha, Coleman, O'Donnell,
Miles, 2003). The emphasis and systematic support of primary care in The
Villages Health may catalyze renewed interest in choosing a primary care career
for physicians and other health professionals (Cardarelli, R., 2009).
Cost-Control
The Villages Health system is structured
around the patient experience. The elements described exist in support of this
purpose. A convenient and concurrent result is the expected favorable impact
upon health care costs. In the status quo, when resources are focused
on heroic technical intervention (such as surgical repair of a broken hip),
providers capable of preventing hip fracture in the first place languish
without the necessary resources.
The initiatives of
The Villages Health, taken in their totality, are expected to reduce health
care expenditures. From the formal systematic application of evidence-based
guidelines in population health management by a large and organized physician
workforce to more effective implementation of preventive services, to same day
access—all of this may have a profound impact on medical costs (American College
of Physicians, 2008). Hospital admissions and readmissions may be obviated
while lengths of stay may be shortened. Inappropriate care will be decreased,
particularly unnecessary and repetitive diagnostic testing. Recurrent and costly visits to the hospital
emergency department will be avoided. It is expected that patient engagement
with the process and resulting compliance levels will become transformative.
It is the intent that a portion of these
savings will be reinvested in reimbursing the primary care services which
create such savings in the first place, correcting current financial inequities
in reimbursement which have had such a negative impact on the primary care
workforce (Cardarelli, 2009).
Primary
Care Done Right
The primary care component of The Villages
Health system represents a transformed delivery model where patients feel that
they get the service and the time they desire from their physicians. Similarly,
physicians have the time, tools, and support necessary to serve their patients
in a manner they find fulfilling and enjoyable.
This represents a departure from the typical scenario of the status quo in which primary care
physicians consistently report frustration at inadequate time resources,
unmanageable panel size (Oelke et al., 2006), and feeling more traffic
managers, gate-keepers, or triage officers than the caring providers they hoped
they could be.
The Program
Key programmatic activities have been referred
to in the immediately preceding section.
An abbreviated description of the sorts of activities that are happening
within the Care Centers/Medical Homes follows.
There’s
no place like home.
Within the confines of The Villages, there are
five freestanding facilities of approximately 20,000 square feet supporting the
delivery of medical care characterized above. The first site located at the
Colony shopping area, opened in December, 2012, followed soon thereafter by new
care centers at Mulberry, Pinellas, Spanish Springs, and Creekside, as well as
the renovation of the Belleview location, the only TVH site not located in The
Villages. A sixth care center in The Villages at Lake Deaton will open in 2016.
It is also likely that care actually rendered in the patient’s home (as
appropriate) will become a significant aspect of overall care delivery as well.
Marcus
Welby, MD lives. His nurse, however, has become an entire cast.
The central programmatic element remains the
personal encounter between patient and physician, but the spaces and activities
around that encounter represent a substantial evolution away from current,
typical, physician office experience. Care delivery within the Medical Home is a
team process (Kellerman & Kirk, 2007). . While there have always been
nurses, medical assistants, lab techs, transcriptionists, and Physician
Assistants and Nurse Practitioners, the team of caregivers is more robust, with
each team member, by design, functioning at the highest level of training
(and/or license). Group Health in
Seattle and the Indian Health Service, both embracing the patient-centered
medical home model, reported increased quality of care, increased patient
satisfaction and cost reduction as a result of building collaborative capacity
through teamwork (Miller and Cohen-Katz, 2010).
Appropriate
Application of Medical Technology
Sophisticated and uncommonly required
diagnostic services are not expected to be delivered in the Medical Home,
although chest and bone plain films and a range of more common ancillary
interventions (ECG, basic pulmonary function testing, audiology, etc.) are
conveniently available without requiring the patient to travel elsewhere. Limited-menu
lab testing is performed on site, but the specimens which are sent elsewhere
are still collected at the Medical
Home. Similarly, emerging personal medical technologies supporting
“tele-health” and other methods of patients contributing to and participating
in the gathering of medical information is anticipated shortly.
Continuous
Learning and Teaching
The Medical Home is a place of both teaching
and learning at all levels for patients and staff. Medical and nursing students
are currently involved in the process. Other academic programs could be
represented such that nursing and team-members-in-training could gain clinical
experience under direct supervision. To accommodate this function, each Care
Center features a Learning Center.
Stretching
the envelope
There is often considerable resistance on the
part of patients when referral to a behavioral science professional becomes
necessary. The sheer idea of walking into the office of a mental health
professional is profoundly stigmatizing to some—often to those who are most in
need of such care (Bathje & Pryor, 2011). The opportunity to receive
counseling services or related care at the very place where the patient
routinely goes regarding blood pressure or bronchitis can be a delightful
relief, enabling many to take advantage of such care who might otherwise have
declined. As such, providers of care that stretch beyond the traditional realm
of primary care have a place within the Medical Home, certainly involving
mental health providers but also
involving dietary counseling, audiology and other services needed by large
numbers of patients visiting the Care Center and that can effectively and
efficiently be delivered there.
The Place
The Care Centers of The Villages Health are unique.
They are not easily mistaken for any of the other professional spaces currently
in use in the community: They look
different from the curb. They feel
different on the interior. And they function
differently, in terms of internal operations.
They have a signature appearance at a distance
as identifying and self-declaratory as a Pizza Hut but which celebrates the
tasteful vitality and continuity so consistent throughout The Villages. Their
interior is warm, welcoming, open and feels like home.
Waiting is brief, but time spent in the lobby
and the attached living room is calm and pleasant.
The triage process (including obtaining vital
signs, weight, etc.) is efficient, respectful, and appropriately private.
Way-finding and navigation is intuitive and
functional. Flow is predominantly unidirectional such that the stream of
patients into the clinical care areas does not oppose the stream of those
completing their visit. While many patients are welcomed in the course of
service, at no point does a patient feel as if he or she is one of a crowd
being herded.
Something
Old, Something New
There is a strong resemblance to the
traditional outpatient physician office experience in the sense that there are
a reception function, examination rooms, procedure rooms, business/clerical
activity, and other familiar elements. However, these features are fresh in
their implementation. Reception, for example, is open, welcoming, and human,
specifically devoid of the frosted-glass window. While there is certainly a
“lobby” there is not a “waiting
room,” as idle time in the patient experience is intended to be minimized
First
Impressions
Distinctive branding is recognizable from the
street and conveys the ideology that this
is a place where patients come first.
Not only do patients intuitively understand that they receive the kind of
integrated care they need and want, this transpires with actively minimized
hassle and confusion. The living room adjacent to the reception area offers
multiple seating options. There is natural light and views of outdoors and nature. The focus is on life and wellness rather than
illness.
Rethinking
the Exam Room
Traditionally, the space in which the great
majority of outpatient medical care is rendered has been a room dominated by an
examination table at its epicenter, often without any other seating option
available for the patient. Such unspoken prominence of this medical tradition
may exacerbate patient anxiety or anticipation of unpleasant or uncomfortable
experiences. Lighting may be glaring, and any actual communication between
patient and physician almost seems secondary to the dreaded “exam.” In fact,
the very name of the space itself reflects this focus: the exam room.
Ironically, a complete physical examination is necessary in only a small
percentage of office encounters, whereas a fruitful conversation between
patient and physician is necessary in virtually every one.
As such, the space in which the patient and
physician accomplish their core activities is completely redesigned in the
Medical Home of The Villages Health. It is renamed the “Visit Room,” and its design reflects a more appropriate set of
priorities. While still completely
enabling examination of the patient, the focus is on bidirectional communication,
and this is reflected in everything from seating arrangements, to include one
or two family members, to furniture selection and lighting. A computer monitor
is placed such that physician and patient can easily view it together when
necessary. The physician and patient always face each other.
The
Huddle Zone
Present day health care facilities often
involve considerable segregation of the providers of care, where nurses might
be confined to nursing stations, physicians into physician dictating areas, while
still others such as ancillary technicians or schedulers may be relegated to
areas far away from those they are charged to support. Written into the DNA of
the Patient-Centered Medical Home is meaningful
integration of the caregiver team, such that powerful collaboration toward
superior collective work-product is enabled.
Toward that end, the Care
Center is designed in such a way that the members of the provider teams are
literally (and symbolically!) together, physically accessible to each other. Without
compromising the need for quiet concentration or personal work-space, effective
communication among providers of care is enhanced by proximity among a given
team, and even between teams. The routine, then, of literally “huddling up” at
the beginning and end of each work session is facilitated in an area termed,
obviously enough, the Huddle Zone.
This Huddle Zone is transparently nestled into the very epicenter of the visit
room area as an obvious demonstration to all that patient care is a direct function
of highly collaborative, integrated teamwork.
The
Learning Center
Whether it is an asthmatic patient being shown
the most effective technique for using an inhaler, or a set of nurses learning
a new feature of the electronic medical record, teaching and learning is a way
of life in the Patient Care Center. Reflective of this, space within the
facility is dedicated to the process. As such, in addition to what teaching
occurs in the Visit Room, a zone within the facility features a cluster of
contiguous spaces, collectively referred to as the “Learning Center:” This
space consists of a Seminar Room, a Health Coach Office, and a Knowledge
Pharmacy, each serving to support a specific element of the educational
program, summarized below. The Learning Center is accessible directly from the
Living Room as well as from the area where the Visit Rooms are located. The
components of The Learning Center are described here:
Seminar Room
This section of the Learning Center is versatile, accommodating up to
twelve people. It used for predominantly didactic sessions, such as nutrition
classes for a group of diabetic patients, “Welcome to the Practice” orientation
sessions for all new patients, or in-service training for a set of medical
assistants about the proper use of a new piece of medical equipment.
Health Coach Office
Some patients readily grasp the concept of keeping a “headache diary”
in planning migraine management, or a “log of basal body temperature data” in
the evaluation of infertility. Recommending such activity, then, by the
physician in the Visit Room is quick and mutually effortless. Other patients,
however, may require more time or personal attention, even for straightforward
material. In those situations, the physician needs someone to whom to pass the
baton—to pick up where the physician left off as a direct extension of the
physician’s intended plan of care.
A tremendous amount of what needs to happen in order for patients to
achieve optimal health involves lifestyle modification. Smoking cessation, for
example—if it is to be effective/successful—invariably requires close follow-up
with the patient, periodic updates, patient-specific advice, encouragement,
emotional support, and guidance as to how to navigate common pitfalls or
setbacks—the list of such care elements is long.
Physicians (and even their clinical assistants) report that such
services represent “a bridge too far”—more than they can reasonably attend to,
among the myriad other patient needs they strive to meet. The result, at least
traditionally, is that patient-compliance with such recommendations is
notoriously poor. The upshot is that—in the status
quo—patients do not receive as much support, guidance, or assistance in
implementing recommended care plans as they require. In order to actually achieve
intended clinical outcomes, patients want more help than can be provided in the
course of an office visit with the physician. Meanwhile, physicians and their
clinical assistants need a resource that can pick up where they leave off at
the end of a visit and in the interval between office visits.
In the Patient-Centered Medical Home that resource finally exists: the
“Health Coach.” The Health Coach Office
supports small (one-on-one or one-on-two) sessions, and considerable telephone
and electronic contact with patients between visits.
Knowledge Pharmacy
Often, what patients need from the physician more than a prescription
for medication is simply education
about a condition or answers to common questions (Kiesler, Auerbach, 2006).
Quite commonly, the information needed cannot
be delivered effectively in the course of a visit in the visit room
(Bodenheimer, 2006). It may require more time than is workable in that setting.
It may involve detail that requires that it be heard/reviewed more than once.
It may be best to receive the information in the company of others not present
during the appointment (Ballard-Reisch, Letner, 2003). To provide for this
reality, the Patient Care Centers feature a “Knowledge Pharmacy.” That is, the
physician can “prescribe” that a specific item (or items) of educational
content be delivered to the patient. This prescription, then, can be “filled”
at the Knowledge Pharmacy nearly exactly
the same as filling a traditional prescription for a medication, including
doing so when it “works” for the patient to do so: literally on the way out of
the office following a physician visit, or returning at a more convenient time.
A record is maintained of just what has been prescribed and filled (or not
filled!) so patient and physician can work together at achieving shared
decision-making and the empowerment that results when information is effectively conveyed.
Caring
about the Caregivers
If the needs of patients are to be met or even
exceeded, the needs of those serving their needs need to be met or exceeded (Joseph,
2006 West, et al, 2011). Toward that
end, care has been taken to provide the creature comforts of home and to
provide for simple human needs such as personal space, storage, a
kitchen/lounge, and private outdoor space, as examples. Communication and
idea-sharing among the staff is essential if continuous improvement is to
occur, and to the extent that the design of a facility can impact that process,
intense effort has been made to do so.
As a learning community, accommodations have
been provided to enable staff and trainees to assemble for teaching, learning,
and discussion in spaces throughout the building. Televideo conferencing is
available for access to “distance learning” with a special emphasis on
connecting to academic health center faculty whether in Tampa or even elsewhere.
Shower and changing areas for those who bike or run to work or exercise at
lunch is provided. There is even a “Quiet Room” for staff to “get away from it
all” for a private moment when the need arises. Those who choose to devote
their professional lives to the delivery of excellence in service to patients
will sense that their decision to do so is valued as evidenced by enthusiastic
effort to provide for the human needs of the team.
An
Efficient Home is a Successful Home
The decisions made in designing the Care
Center have been driven, first and foremost, by the patient experience. All
anticipated interactions or encounters have been deconstructed and
reconstructed to ensure that the environment is safe, effective, efficient,
equitable, and above all, patient-centered Rather than drawing attention to
itself as a striking structure, the facility functions more as the stage,
facilitating and enhancing the service being provided. The priority has been to create a place that
feels like what it is: home.
References
Adams. J. and
Drake, R. (2006)
Shared Decision-Making and Evidence-Based
Practice, Community Mental Health Journal,
42, 87-105.
American College of
Physicians. How Is a Shortage of Primary Care Physicians Affecting the Quality
and Cost of Medical Care? Philadelphia: American College of Physicians; 2008:
White Paper. (Available from American College of Physicians, 190 N.
Independence Mall West, Philadelphia, PA 19106.)
Allen, S. (2009). Tobacco smoking in older
people. Reviews In Clinical Gerontology. 19
(3). 185-192
Ballard-Reisch, D.S., Letner, J.A. (2003).
Centering families in cancer communication research: acknowledging the impact
of support, culture and process on client/provider communication in cancer
management. Patient Education and
Counseling, 50.
Bathje, G.J., Pryor, J.B.
(2011). The Relationships of Public and Self-Stigma to Seeking Mental Health
Services. Journal Of Mental Health
Counseling, 33(2), 161-176.
Bedenheimer, T. (2006) Primary Care—Will It
Survive? The New England Journal of
Medicine
Cardarelli, R. (2009) The primary care workforce: a critical element
in mending the fractured US health care system. Osteopathic Medicine
and Primary Care, 3.
Christoffel, K. (2000). Public health advocacy: process and product. American Journal of Public Health: 90,
722-726.
French, M., Homer, J., Klevay, S., Goldman,
E., Ellmann, S., &Kahn, B. (2010). Is the united states ready to embrace
concierge medicine? Population Health
Management. 13(4). 177-182
Gaynes, R., Richards, C. Edwards, J., Emori, G., Horan, T.,
Alonso-Echanove, J., Fridkin, S., Lawton, R., Peavy, G., Tolson, J.and the
National Nosocomial Infections Surveillance (NNIS) System Hospitals. (2001).
Feeding Back Surveillance Data To Prevent Hospital-Acquired Infections. Emerging Infectious Diseases, 296.
Institute of
Medicine. (2001). Crossing the quality chasm: A new health system for the 21st
century. Washington DC: National Academy Press.
Joseph, A. (2006). The Impact of Light on
Outcomes in Healthcare Settings. The
Center for Health Design, 2
Kellerman, R., & Kirk, L. (2007). Principles
of the patient-centered medical home. American Family Physician, 76(6),
774-775.
Kiesler, D.J., Auerbach, S.M. (2006). Optimal
matched of patient preferences for information decision-making and
interpersonal behavior: Evidence, models and interventions. Patient Education and Counseling, 61
Kitson, A., Harvey,
G., McCormack, B. (1998).Enabling the implementation of evidence based
practice: a conceptual framework, Quality in Health Care, 7, 149-158.
Lakhan S. and Laird C. (2009) Addressing the
primary care physician shortage in an evolving medical workforce. International Archives of Medicine,
2(1),14.
Menon ST. (2001) Employee empowerment: an integrative psychological approach. Applied
Psychology: An International Review. 50,153–180.
Miller,
W. L., & Cohen-Katz, J. (2010). Creating Collaborative Learning
Environments for Transforming Primary Care Practices Now. Families, Systems & Health: The Journal
Of Collaborative Family Healthcare, 28(4), 334-347.
McGlynn, E.
Asch, S, Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., and Kerr,
E. (2003) The Quality of Health Care
Delivered to Adults in the United States. New
England Journal of Medicine, 348, 2625-2645.
Oelke,
N. D., Thurston, W. E., Dipalma, R., Tink, W., Mazonde, J. N., Mak, A., &
Armitage, G. D. (2006). Understanding issues in primary care: perspectives of
primary care physicians. Quality In
Primary Care, 14(4), 253-258.
Ogrinc
G, Headrick LA, Mutha S, Coleman MT, O'Donnell J, Miles PV. (2003) A framework
for teaching medical students and residents about practice-based learning and
improvement, synthesized from a literature review. Academic Medicine. 78, (7),
748-56.
Pate, R., Pratt, M., Blair, S., Haskell,W., Macera, C., Bouchard, C., Buchner, D., Ettinger, W., Heath, G., King, A., Kriska, A., Leon, A., Marcus, B., Morris, J., Paffenbarger, R. Patrick, K., Pollock, M., Rippe, J., Sallis, J., and Wilmore, J. (1995)
Physical activity and public health: a recommendation from the Centers for
Disease Control and Prevention and the American College of Sports Medicine. Journal
of the American Medication Association, 273, 402–407.
Petrella, R. J., Koval, J.J., Cunningham, D.A.,
Paterson, D.H. (2003). Can primary care doctors prescribe exercise to improve
fitness? The step test exercise prescription (STEP) project. American
Journal of Preventive Medicine, 24 (4), 316-322
Smith, T., Jenkins,
C., Orleans, C. (2004). Prevention and Health Promotion: Decades of Progress,
New Challenges, and an Emerging Agenda, Health
Psychology, 23, 2, 126–131.
Teno, J., Casey, V., Welch, M.
Edgman- Levitan, S. (2001). Patient-Focused,
Family-Centered End-of-Life Medical Care: Journal of Pain and Symptom
Management, 22(3), 738-751.
U.S. Department of Health and Human
Services. Office of Disease Prevention and Health Promotion. Healthy People
2020. Washington, DC. Available at
[http://www.healthypeople.gov/2020/default.aspx]. Accessed [February 27, 2012].
Vanderklipp, M (2006) Develop a
Successful Wayfinding syster. Buildings,
100 (4), 28
West, M., Dawson, J., Admasachew, Topakas, A.
(2011) NHS Staff Management and Health Service Quality. Results from the NHS Staff Survey and Related Data
Woolf S. and Atkins D. (2001). The evolving role of prevention in
health care: Contributions of the U.S. Preventive Services Task Force. American
Journal of Preventative Medicine. 20, (3S):13-20.
(http://www.elsevier.com/locate/ajpmonline).


| 009:040 Khan | : |
If you help him (Muhammad SAW) not (it does not matter), for Allah did indeed help him when the disbelievers drove him out, the second of two, when they (Muhammad SAW and Abu Bakr radhiallahu'anhu) were in the cave, and he (SAW) said to his companion (Abu Bakr radhiallahu'anhu): "Be not sad (or afraid), surely Allah is with us." Then Allah sent down His Sakinah (calmness, tranquillity, peace, etc.) upon him, and strengthened him with forces (angels) which you saw not, and made the word of those who disbelieved the lowermost, while it was the Word of Allah that became the uppermost, and Allah is All-Mighty, All-Wise. |
| 009:040 Maulana | : |
If you help him not, Allah certainly helped him when those who disbelieved expelled him -- he being the second of the two when they were both in the cave, when he said to his companion: Grieve not, surely Allah is with us. So Allah sent down His tranquillity on him and strengthened him with hosts which you saw not, and made lowest the word of those who disbelieved. And the word of Allah, that is the uppermost. And Allah is Mighty, Wise. |
| 009:040 Pickthal | : |
If ye help him not, still Allah helped him when those who disbelieve drove him forth, the second of two; when they two were in the cave, when he said unto his comrade: Grieve not. Lo! Allah is with us. Then Allah caused His peace of reassurance to descend upon him and supported him with hosts ye cannot see, and made the word of those who disbelieved the nethermost, while Allah's Word it was that became the uppermost. Allah is Mighty, Wise. |
| 009:040 Rashad | : |
If you fail to support him (the messenger), GOD has already supported him. Thus, when the disbelievers chased him, and he was one of two in the cave, he said to his friend, "Do not worry; GOD is with us."  He made the word of the disbelievers lowly. GOD's word reigns supreme. GOD is Almighty, Most Wise. |
| 009:040 Sarwar | : |
If you do not help him, (Muhammad), God has already helped him. When the unbelievers expelled him and he was one of the two people in the cave telling his friend, "Do not worry; God is with us," then God gave him confidence and supported him with an army which you did not see and He defeated the cause of the disbelievers and made His own cause stand supreme. God is Majestic and All-wise. |
| 009:040 Shakir | : |
If you will not aid him, Allah certainly aided him when those who disbelieved expelled him, he being the second of the two, when they were both in the cave, when he said to his companion: Grieve not, surely Allah is with us. So Allah sent down His tranquillity upon him and strengthened him with hosts which you did not see, and made lowest the word of those who disbelieved; and the word of Allah, that is the highest; and Allah is Mighty, Wise. |
| 009:040 Sherali | : |
If you help him not, then know that ALLAH helped him even when the disbelievers drove him forth while he was one of the two, when they were both in the Cave, when he said to his Companion, 'Grieve not for ALLAH is with us.' Then ALLAH sent down HIS peace on him, and succoured him with hosts which you did not see, and humbled the word of those who disbelieved, and it is the word of ALLAH alone which is supreme. And ALLAH is Mighty, Wise. |
| 009:040 Yusufali | : |
If ye help not (your leader), (it is no matter): for Allah did indeed help him, when the Unbelievers drove him out: he had no more than one companion; they two were in the cave, and he said to his companion, "Have no fear, for Allah is with us": then Allah sent down His peace upon him, and strengthened him with forces which ye saw not, and humbled to the depths the word of the Unbelievers. But the word of Allah is exalted to the heights: for Allah is Exalted in might, Wise. |
Concepts/Themes Covered: أركان الإسلام > (محمد (صلى الله عليه وسلم > مآثره وخصائصه لله Pillars of Islam> The Blessed Muhammad(PBUH)> Memorable Qualities given to Him by Allah الجهاد > الجهاد في سبيل الإسلام > أشرار الجند Jihad> The Call to Jihad>The Wicked Soldiers الجهاد > الجهاد في سبيل الإسلام > الدعوة إلى الجهاد Jihad> The Call to Jihad>The Call for the Holy War الجهاد > الجهاد في سبيل الإسلام > ذم المتخاذلين عن الجهاد Jihad> The Call to Jihad>Dispraise the Reluctant for the Holy War الجهاد > الجهاد في سبيل الإسلام > مدح الجهاد Jihad> The Call to Jihad>Praising the Holy War العلاقات القضائية > علاقات قانونية ودستورية > الحق Judicial Relationships>Legal and Constitutional Relations>The Right
This tool uses eight English parallel translations for the Holy Quran imported from Mr. Clay Smith. You can also visit Qurany Concepts for browsing the Quran themes or topics. If you want to search the Holy Quran for keywords, please visit Qurany Keywords.


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Event is emitted when joining or switching voice channels.
event: "VOICE_SERVER_UPDATE"
VoiceHandler: VoiceHandler
The new VoiceHandler tied to that voice channel
This event is emitted when a guild's voice server is updated. It is sent when initially connecting to a voice channel and also when the current voice instance fails over to a new server.
| Connecting to Discord |
|


| | |
- create_rotation_gate(theta)
- :param theta: the rotation angle
:return: phase rotation gate for 1 qubit, rotating by theta
Matrix representation is:
|1 0 |
|0 e^(i*theta) |
- diffusion_gate(qubit_count)
- Grover diffusion operator, inverts around the
- hadamard()
- Hadamard gate for 1 qubit
- identity()
- Empty gate - identity matrix
- pauli_x()
- Pauli X gate (aka NOT) for 1 qubit
Matrix representation is:
|0 1|
|1 0|
- pauli_y()
- Pauli Y gate for 1 qubit
Matrix representation is:
|0 -i|
|i 0|
- pauli_z()
- Pauli Z gate for 1 qubit
Matrix representation is:
|1 0|
|0 -1|
- phase()
- Phase gate for 1 qubit
Matrix representation is:
|1 0|
|0 i|
- phase_flip_gate(qubit_count, key)
- Phase flip gate
Example for a key = 001
(the rightmost digit represents 0th qubit)
|1> -----Z-----
|0> --X--C--X--
|0> --X--C--X--
Need to add X gates around zero states
Middle line is controlled Z gate.
Does not mater to which qubit Z gate is applied.
- qft(qubit_count)
- Quantum Fourier Transform
|


| 80 | (A) | Sir owt of Surrye he sayde I ame sent to Nero |
| 77 | (C) | ¶ Syr out of surry he seyde . sayled haue we now |
| 78 | (D) | Sir out of Surye þei sayd saylid have we swiþe |
| 76 | (E) | ¶ Out of surry sere he seyde . yseyled haue y swithe . |
| (Ex) | ---- no text ---- | |
| 79 | (L) | sire out of surre he seide y am come |
| 74 | (P) | Sir oute of surry . he sayde I am comen |
| 77 | (U) | Sire out of Surre he seid / sailed haue we nowe |
| (V) | ---- no text ---- |


Not Your Average Pizza Company
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Order This Pizza
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Generate a random number
Minumum Number
Maxium Number
Generate
The number is
🙈
Coded by
Salahudin Ahammed
. Inspired from
App Ideas
. Part of
App Ideas Live
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Welcome to Tim Horton's
Number of Coffees:
Size:
Small
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How Many Creams?:
How Many sugars?:
Confirm Order
Slang


{{define "code"}}
Last Updated: {{.UpdatedForHumans}}
Create a {{ListDirs .Folders}} folder directly under your home directory. Other-readable files in this folder will show up here. Updated every 30 minutes.


Example form validation with Angular.
The form button is disabled unless all the fields are valid. Error messages are shown when the attached validation condition is not met.


{% extends 'base.html' %} {% block content %}
This may seem as an easy task but having a minute(60 sec) to impress someone can be a challenging task.
This may vary depending on the situation and the person you mean to impress.
Sign up and have a chance to communicate with other users. This will be a great chance to learn from others
View PitchesCreate your own pitches and post them to see how the others will react to them. The better the pitch the more likes you get.
Create a pitchSince you will have a chance to view other peoples pitches, this will be a great environment for you to learn more from others.
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Cropper.js with tracking.js
Image processing
Click
rotate right
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When you become a leader, success is about growing others.”


SQLAlchemy 0.6.3 Documentation
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Class Mapping
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sqlalchemy.ext
declarative
Synopsis
Defining Attributes
Association of Metadata and Engine
Configuring Relationships
Configuring Many-to-Many Relationships
Defining Synonyms
Table Configuration
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Mixin Classes
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associationproxy
Simplifying Relationships
Simplifying Association Object Relationships
Building Complex Views
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serializer
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Synopsis
Dialect-specific compilation rules
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154. Current Practice #2
Up: Motivating Examples
Next: (Approximate) Current Practice #3
Previous: Current Practice #1
int main(int argc, char *argv[])
{
int me, count;
void *data;
...
MPI_Init(&argc, &argv);
MPI_Comm_rank(MPI_COMM_WORLD, &me);
if(me == 0)
{
/* get input, create buffer ``data'' */
...
}
MPI_Bcast(data, count, MPI_BYTE, 0, MPI_COMM_WORLD);
...
MPI_Finalize();
return 0;
}
This example illustrates the use of a collective communication.
Up: Motivating Examples
Next: (Approximate) Current Practice #3
Previous: Current Practice #1
Return to MPI-3.1 Standard Index
Return to MPI Forum Home Page
(Unofficial) MPI-3.1 of June 4, 2015
HTML Generated on June 4, 2015


Spoilers: Kim takes bitter revenge in Emmerdale by revealing Graham's big secret
Kim Tate (Claire King) isn’t one for playing by the book in Emmerdale, so its was safe to assume that she wasn’t going to allow Graham Foster’s (Andrew Scarborough) secret relationship with Rhona Goskirk (Zoe Henry) to go unpunished. In the coming episodes, she sets about exacting revenge on Graham, and thus she reveals a pretty big secret.
With animosity aplenty between her and Graham, Kim sets about sabotaging her former lover’s relationship with Rhona — and she does so by implying to Marlon (Mark Charnock) that Graham shouldn’t be allowed around Leo. However, she hasn’t realised that Rhona has arrived and overheard everything.
Rhona’s less than pleased that Marlon was listening to Kim’s words and, as a result, he beings to ease up on Graham. Later, Rhona wastes little time in confronting Kim over her attempt to poison Marlon’s mind, but Kim shows little desire to back down, and suggests that Marlon will come to his senses soon enough.
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Graham reassures Rhona that she has nothing to worry about, but the subtext in his expression speaks volumes, as he deliberates over the damage that Kim could cause.
The following day, Kim sends Graham a text asking for all of her employees to meet her at the Woolpack, as she’s planning on making an announcement. However, upon his arrival, Graham works out just what it is that Kim’s planning.
Without wasting a second, Kim makes a shocking revelation about Graham — and Rhona is left reeling as a result. Later, Graham heads over to speak to Rhona, but he’s not given much opportunity to do so, as Marlon punches him.
The question is: what exactly is this big secret that Kim’s revealed?
Could she perhaps have discovered the truth about Graham possibly being the father of Jamie’s (Alexander Lincoln) child, Millie?
It’s a possibility for sure, but — judging by Marlon’s reaction — it’s something much closer to home.
What’s more, has Kim’s plan to split Graham and Rhona worked?


This is my second week into Dev Bootcamp’s web developer program, and so far so good. The program itself has been relatively easy to follow, although this is not the first time I’ve dabbled into HTML or coding in general.
It's been an interesting month. On June 23rd, I was laid off from the Boeing Company, yet believe it or not, I felt relieved. My last position at the Boeing Company was far more stressful than what I ever experience before, and although the work was cool, I did find myself often in a thankless position caught between the needs of mechanics and the requirements we are supposed to follow. It was a good experience, but one that I rather not go through again.
Simultaneously, I’ve had lots of visitors come over including my mom, some family from Baja, and an uncle from Texas. For me it’s always fun to have family and friends over, and they really timed it well, keeping me company during this interesting period in my life.
I haven’t necessarily had a tough time with the program at DBC, but I am sure that eventually I’ll be pushed with some tough challenges. HTML reminds me of my high school computer class where we learned about basics of website design. It’s been almost nostalgic remembering how we used to make website, and definitely fun creating my own personal GitHub page!
Been loving the experience so far, and look forward toward making some truly awesome looking websites in the near future!!!


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Welcome to the Ultra Mini-WebServer
Network Programming TP
Author: Shihang ZHOU
Some more info should be added here......


The only difference between oolong and wulong tea is the name. Oolong is the most recognised in Western countries, yet linguists would say that wulong is a more accurate romanisation of the original Chinese kanji. Oolong tea is also perhaps one of the widest categories of tea: according to Max Falkowitz in Serious Eats, oxidation can run between 8 and 85%. This means you will also come across vastly different flavours.
£50
The only difference between oolong and wulong tea is the name. Oolong is the most recognised in Western countries, yet linguists would say that wulong is a more accurate romanisation of the original Chinese kanji. Oolong tea is also perhaps one of the widest categories of tea: according to Max Falkowitz in Serious Eats, oxidation can run between 8 and 85%. This means you will also come across vastly different flavours.
£50
Green tea is only very lightly oxidised. After the initial withering, the leaves must be quickly fixed. This tends to give it a lighter profile, and it will also lose its flavour much quicker than black or oolong tea. While associated with Asia, there are significant differences between the offerings from the different Asian countries. To start with, Mary Lou and Robert J. Heiss emphasise that Chinese and Japanese green tea tastes vastly different thanks to the varieties and terroir (The Tea Enthusiast’s Handbook: A Guide to the World’s Best Teas).
£66
Yellow tea is a slightly obscure but prized type of tea produced in China. It’s similar to green tea but goes through an additional yellowing phase. Kerri Shadid explains in The Daily Tea that, after fixing, the leaves are wrapped in cloth which allows slight oxidation to occur a second time. They are then slowly charcoal dried, fixing the tea one final time.
£75
Quality
Tea Farm prides itself on its high quality artisan aracha teas. Combining elements of the whole tea plant, Obubu specializes in this method as we believe goodness of the whole tea plant, resulting in less waste. Aracha teas give our teas a signature green color and bold taste that isn’t found in any other teas.
Community
Tea Farm runs similarly to a non-profit organization, donating to several local charities and developing communities locally and globally. We strive to form a community of tea enthusiasts, businesses and farmer and bridge the gap between producer and consumer.
Education
Tea Farm seeks to educate its consumers on tea with its University of Tea initiative. Videos on different technical, cultural, and agriculture knowledge are provided to help introduce Japanese tea to the world! Obubu seeks to revitalize the tea industry in Wazuka, Japan and beyond.


Welcome to frontend workflow! Is this good?
My standard start state for any frontend project.
Built with grunt and using express as static file development server, this workflow is intended to optimize frontend productivity. Have fun!


The org.lwjgl.tools plugin provides an already configured library to be added to a projects build path. It does not only provide the JARs and native libraries, relieving developers from configuring extra VM arguments in the run configuration, but it also configures Javadoc and source code to be available in Java projects just as in plugin projects.
You will also need the org.lwjgl plugin. JavaDoc and source code are retrieved from the org.lwjgl.doc and org.lwjgl.source plugins.
You can now use the LWJGL library in your Java project, and you can simply start the project by selecting "Run As / Java Application..." in the context menu of a class containing a main method. That is, you do not have to configure some VM arguments in the run configuration anymore, which will hopefully make development much easier.
Note: At this moment, no further tools, e.g., for exporting an LWJGL application, exists. Feel free to write missing functions and contact us in order to add new functionalty.


Time
From:
To:
Key
Mode:
Chroma
Luma
Screen Color:
Weight:
0
Balance:
0
Clip Black:
0
Clip White:
0
Target:


Katherine Ryan (born 1983-06-30[ref]) has appeared in 48 episodes between 2012-2016. Katherine Ryan on IMDB. Katherine Ryan on Wikipedia. Katherine Ryan on Chortle.


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Revisit Isamu Noguchi's designs for several playgrounds,
as well as stand-alone play structures. Through models, sketches, set designs, and archival images,
the exhibition offers a view of Noguchi’s vision for new experiences of art, education, and humanity
through play. While few were realized, Noguchi’s playscapes continue to inspire contemporary designers
to consider play as a strategy for building community and stimulating creativity in the everyday.
Experience the website playscape
1. Click on any of the shapes.
2. Drag your mouse to move the camera.
3. Use the WASD Keys to move.
Isamu Noguchi, U.S. Pavilion Expo '70, 1968
Isamu Noguchi, Playground equipment for Ala Moana Park, Hawaii, 1940
Isamu Noguchi, Slide Mantra, 1966 - 1985


GROFF
Section: Environments, Tables, and Troff Macros (7)Updated: 29 June 2002
Index Return to Main Contents
NAME
groff - a short reference for the GNU roff languageDESCRIPTION
The name groff stands for GNU roff and is the free implementation of the roff type-setting system. See roff(7) for a survey and the background of the groff system. This document gives only short descriptions of the predefined roff language elements as used in groff. Both the classical features and the groff extensions are provided. Historically, the roff language was called troff. groff is compatible with the classical system and provides proper extensions. So in GNU, the terms roff, troff, and groff language could be used as synonyms. However troff slightly tends to refer more to the classical aspects, whereas groff emphasizes the GNU extensions, and roff is the general term for the language. This file is only a short version of the complete documentation that is found in the groff info(1) file, which contains more detailed, actual, and concise information. The general syntax for writing groff documents is relatively easy, but writing extensions to the roff language can be a bit harder. The roff language is line-oriented. There are only two kinds of lines, control lines and text lines. The control lines start with a control character, by default a period @m] "@s]R]" or a single quote @m] "@s]R]" all other lines are text lines. Control lines represent commands, optionally with arguments. They have the following syntax. The leading control character can be followed by a command name; arguments, if any, are separated by blanks from the command name and among themselves, for example,- 1.
- Printable backslashes must be denoted as To be more precise, represents the current escape character. To get a backslash glyph, use or
- 2.
- Double all backslashes.
- 3.
- Begin all text lines with the special non-spacing character This does not produce the most efficient code, but it should work as a first measure. For better strategies, see the groff info file and groff_tmac(5). Reading roff source files is easier, just reduce all double backslashes to a single one in all macro definitions.
GROFF ELEMENTS
The roff language elements add formatting information to a text file. The fundamental elements are predefined commands and variables that make roff a full-blown programming language. There are two kinds of roff commands, possibly with arguments. Requests are written on a line of their own starting with a dot @m] "@s]R]" or a @m] "@s]R]" whereas Escape sequences are in-line functions and in-word formatting elements starting with a backslash @m] "@s]R]" The user can define her own formatting commands using the ééâÿÿ=if request. These commands are called macros, but they are used exactly like requests. Macro packages are pre-defined sets of macros written in the groff language. A user's possibilities to create escape sequences herself is very limited, only special characters can be mapped. The groff language provides several kinds of variables with different interfaces. There are pre-defined variables, but the user can define her own variables as well. String variables store character sequences. They are set with the ééâÿÿ=if request and retrieved by the escape sequences. Strings can have variables. Register variables can store numerical values, numbers with a scale unit, and occasionally string-like objects. They are set with the ééâÿÿ=if request and retrieved by the escape sequences. Environments allow the user to temporarily store global formatting parameters like line length, font size, etc. for later reuse. This is done by the ééâÿÿ=if request. Fonts are identified either by a name or by an internal number. The current font is chosen by the ééâÿÿ=if request or by the escape sequences. Each device has special fonts, but the following fonts are available for all devices. R is the standard font Roman. B is its bold counterpart. The italic font is called I and is available everywhere, but on text devices it is displayed as an underlined Roman font. For the graphical output devices, there exist constant-width pendants of these fonts, CR, CI, and CB. On text devices, all characters have a constant width anyway. Moreover, there are some advanced roff elements. A diversion stores information into a macro for later usage. A trap is a positional condition like a certain number of lines from page top or in a diversion or in the input. Some action can be prescribed to be run automatically when the condition is met. More detailed information and examples can be found in the groff info file.CONTROL CHARACTERS
There is a small set of characters that have a special controlling task in certain conditions.- @m] "@s]R]"
- A dot is only special at the beginning of a line or after the condition in the requests ééâÿÿ=if ééâÿÿ=if ééâÿÿ=if and ééâÿÿ=if There it is the control character that introduces a request (or macro). The special behavior can be delayed by using the escape. By using the ééâÿÿ=if request, the control character can be set to a different character, making the dot @m] "@s]R]" a non-special character.
- In all other positions, it just means a dot character. In text paragraphs, it is advantageous to start each sentence at a line of its own.
- @m] "@s]R]"
- The single quote has two controlling tasks. At the beginning of a line and in the conditional requests it is the non-breaking control character. That means that it introduces a request like the dot, but with the additional property that this request doesn't cause a linebreak. By using the ééâÿÿ=if request, the non-break control character can be set to a different character.
- As a second task, it is the most commonly used argument separator in some functional escape sequences (but any pair of characters not part of the argument will work). In all other positions, it denotes the single quote or apostrophe character. Groff provides a printable representation with the escape sequence.
- @m] "@s]R]"
- The double quote is used to enclose arguments in requests, macros, and strings. In the ééâÿÿ=if and ééâÿÿ=if requests, a leading double quote in the argument will be stripped off, making everything else afterwards the string to be defined (enabling leading whitespace). The escaped double quote introduces a comment. Otherwise, it is not special. Groff provides a printable representation with the escape sequence.
- @m] "@s]R]"
- The backslash usually introduces an escape sequence (this can be changed with the ééâÿÿ=if request). A printed version of the escape character is the escape; a backslash glyph can be obtained by
- @m] "@s]R]"
- The open parenthesis is only special in escape sequences when introducing an escape name or argument consisting of exactly two characters. In groff, this behavior can be replaced by the CB][]] construct.
- @m] "@s]R]"
- The opening bracket is only special in groff escape sequences; there it is used to introduce a long escape name or long escape argument. Otherwise, it is non-special, e.g. in macro calls.
- @m] "@s]R]"
- The closing bracket is only special in groff escape sequences; there it terminates a long escape name or long escape argument. Otherwise, it is non-special.
- CI]space]
- Space characters are only functional characters. They separate the arguments in requests, macros, and strings, and the words in text lines. They are subject to groff's horizontal spacing calculations. To get a defined space width, escape sequences like @m] "@s]R]" (this is the escape character followed by a space), or should be used.
- CI]newline]
- In text paragraphs, newlines mostly behave like space characters. Continuation lines can be specified by an escaped newline, i.e., by specifying a backslash @m] "@s]R]" as the last character of a line.
- CI]tab]
- If a tab character occurs during text the interpreter makes a horizontal jump to the next pre-defined tab position. There is a sophisticated interface for handling tab positions.
NUMERICAL EXPRESSIONS
A numerical value is a signed or unsigned integer or float with or without an appended scaling indicator. A scaling indicator is a one-character abbreviation for a unit of measurement. A number followed by a scaling indicator signifies a size value. By default, numerical values do not have a scaling indicator, i.e., they are normal numbers. The roff language defines the following scaling indicators.-
- c
- Centimeter
- i
- Inch
- P
- Pica [eq] 1/6 inch
- p
- Point [eq] 1/72 inch
- m
- Em [eq] R]the font size in points (width of letter `CR]mR]')
- M
- 100th R]of an CR]Em
- n
- En [eq] Em/2
- u
- Basic unit for actual output device
- v
- Vertical line space in basic units scaled point [eq] 1/CI]sizescaleR] of a point (defined in font I]DESC] file)
- f
- Scale by 65536.
-
- +
- Addition
- -
- Subtraction
- *
- Multiplication
- /
- Division
- %
- Modulo
- =
- Equals
- ==
- Equals
- <
- Less than
- >
- Greater than
- <=
- Less or equal
- >=
- Greater or equal
- &
- Logical and
- :
- Logical or
- !
- Logical not
- (
- Grouping of expressions
- )
- Close current grouping
-
- @m] "@s]R]"
- The maximum of e1 and e2.
- @m] "@s]R]"
- The minimum of e1 and e2.
- @m] "@s]R]"
- Evaluate e using c as the default scaling indicator.
CONDITIONS
Conditions occur in tests raised by the ééâÿÿ=if ééâÿÿ=if and the ééâÿÿ=if requests. The following table characterizes the different types of conditions.-
- N
- A numerical expression N yields true if its value is greater than~0.
- !N
- True if the value of I is~0.
- 's1's2'
- True if string~s1 is identical to string~s2.
- !'s1's2'
- True if string~s1 is not identical to string~s2.
- cch
- True if there is a character~ch available.
- dname
- True if there is a string, macro, diversion, or request called name.
- e
- Current page number is even.
- o
- Current page number is odd.
- mname
- True if there is a color called name.
- n
- Formatter is nroff.
- rreg
- True if there is a register named reg.
- t
- Formatter is troff.
REQUESTS
This section provides a short reference for the predefined requests. In groff, request and macro names can be arbitrarily long. No bracketing or marking of long names is needed. Most requests take one or more arguments. The arguments are separated by space characters (no tabs!); there is no inherent limit for their length or number. An argument can be enclosed by a pair of double quotes. This is very handy if an argument contains space characters, e.g., [dq]arg with space[dq] denotes a single argument. Some requests have optional arguments with a different behaviour. Not all of these details are outlined here. Refer to the groff info file and groff_diff(7) for all details. In the following request specifications, most argument names were chosen to be descriptive. Only the following denotations need clarification.-
- c
- denotes a single character.
- font
- a font either specified as a font name or a font number.
- anything
- all characters up to the end of the line or within and
- n
- is a numerical expression that evaluates to an integer value.
- N
- is an arbitrary numerical expression, signed or unsigned.
- [+-]N
- has three meanings depending on its sign, described below.
Request Short Reference
Empty line, ignored. Useful for structuring documents. Complete line is a comment. Print string on standard error, exit program. Begin line adjustment for output lines in current adjust mode. Start line adjustment in mode c (CI]c]CR][eq]l,r,b,n]). Assign format c to register (CI]c]CR][eq]l,i,I,a,A]). Create alias name for register. Create alias name for request, string, macro, or diversion object. Append to macro until .. is encountered. Append to macro until ééâÿÿ=if is called. Append to a macro whose name is contained in the string register macro until .. is encountered. Append to a macro indirectly. macro and end are string registers whose contents are interpolated for the macro name and the end macro, respectively. Same as ééâÿÿ=if but with compatibility mode switched off during macro expansion. Same as ééâÿÿ=if but with compatibility mode switched off during macro expansion. Append anything to stringvar. Unformat ASCII characters, spaces, and some escape sequences in diversion. Same as ééâÿÿ=if but with compatibility mode switched off during string expansion. Print a backtrace of the input on stderr. Embolden font by N-1 units. Embolden Special Font S when current font is font. Unset the blank line macro. Set the blank line macro to macro. End current diversion. Divert to macro, omitting a partially filled line. End current diversion. Divert and append to macro, omitting a partially filled line. Eject current page and begin new page. Eject current page; next page number [+-]N. Line break. Break and spread output line. Same as Break out of a while loop. Reset no-break control character to @m] "@s]R]" Set no-break control character to c. Reset control character to @m] "@s]R]" Set control character to c. Center the next input line. Center following N input lines. Copy contents of file filename unprocessed to stdout or to the diversion. Treat characters c1, c2, ... according to mode number. Change trap location to N . Define character c as string anything. Chop the last character off macro, string, or diversion object. Close the stream. Enable colors. If N is zero disable colors, otherwise enable them. Finish the current iteration of a while loop. Enable compatibility mode. If N is zero disable compatibility mode, otherwise enable it. Set constant character width mode for font to N/36 ems with em M. Continuous underline in nroff, like ééâÿÿ=if in troff. End current diversion. Divert and append to macro. Define or redefine macro until .. is encountered. Define or redefine macro until ééâÿÿ=if is called. Same as ééâÿÿ=if but with compatibility mode switched off during macro expansion. Same as ééâÿÿ=if but with compatibility mode switched off during macro expansion. Define or redefine a color with name color. scheme can be rgb, cym, cymk, gray, or grey. component can be single components specified as fractions in the range 0 to 1 (default scaling indicator~ as a string of two-digit hexadecimal color components with a leading #, or as a string of four-digit hexadecimal components with two leading #. The color default can't be redefined. Define or redefine a macro whose name is contained in the string register macro until .. is encountered. Define or redefine a macro indirectly. macro and end are string registers whose contents are interpolated for the macro name and the end macro, respectively. End current diversion. Divert to macro . Interpret ééâÿÿ=if with compatibility mode disabled. Set stringvar to anything. Same as ééâÿÿ=if but with compatibility mode switched off during string expansion. Set diversion trap to position N (default scaling indicator~ Reset escape character to @m] "@s]R]" Set escape character to c. Restore escape character saved with ééâÿÿ=if Save current escape character. Else part for if-else ( ééâÿÿ=if request. The macro will be run after the end of input.  Switch to previous environment. Push down environment number or name env and switch to it. Copy the contents of environment env to the current environment. No pushing or popping. Exit from roff processing. Return to previous font family. Set the current font family to name. Disable field mechanism. Set field delimiter to a and pad character to space. Set field delimiter to a and pad character to b. Define fallback character c as string anything. Fill output lines. Flush output buffer. Mount font on position n. Mount font with long external name to short internal name on position n. When the current font is font, then the fonts s1, s2, ... will be special. Return to previous font. Same as ééâÿÿ=if or ééâÿÿ=if Change to font name or number font; same as escape sequence. Translate font1 to font2. Remove additional hyphenation indicator character. Set up additional hyphenation indicator character~c. Set the hyphenation code of character c1 to code1, that of c2 to code2, etc. Set the current hyphenation language to lang. Set the maximum number of consecutive hyphenated lines to n. Read hyphenation patterns from file. Append hyphenation patterns from file. Set input mapping for ééâÿÿ=if List of words with exceptional hyphenation. Switch to hyphenation mode N. Set the hyphenation margin to n (default scaling indicator~ Set the hyphenation space to n. If cond then anything else goto ééâÿÿ=if If cond then anything; otherwise do nothing. Ignore text until .. is encountered. Ignore text until ééâÿÿ=if Change to previous indent value. Change indent according to [+-]N (default scaling indicator~ Set an input-line count trap for the next N lines. Same as ééâÿÿ=if but count lines interrupted with as one line. Enable pairwise kerning. If n is zero, disable pairwise kerning, otherwise enable it. Remove leader repetition character. Set leader repetition character to~c. Write the length of the string anything in register. Enable line-tabs mode (i.e., calculate tab positions relative to output line). If n is zero, disable line-tabs mode, otherwise enable it. Set input line number to N and filename to file. Ligature mode on if N>0. Change to previous line length. Set line length according to [+-]N (default size default scaling indicator~ Change to the previous value of additional intra-line skip. Set additional intra-line skip value to N, i.e., N-1 blank lines are inserted after each text output line. Length of title (default scaling indicator~ Margin character off. Print character c after each text line at actual distance from right margin. Set margin character to c and distance to N from right margin (default scaling indicator~ Mark current vertical position in register. The same as the .so request except that file is searched in the tmac directories. No output-line adjusting. Need a one-line vertical space. Need N vertical space (default scaling indicator~ No filling or adjusting of output-lines. No hyphenation. Number mode off. In line number mode, set number, multiple, spacing, and indent. Do not number next line. Do not number next N lines. Always execute anything. Define or modify register using [+-]N with auto-increment M. Make the built-in condition n true and t false. Turn no-space mode on. Immediately jump to end of current file. Next file. Open ééâÿÿ=if for writing and associate the stream named ééâÿÿ=if with it. Like ééâÿÿ=if but append to it. Output vertical distance that was saved by the ééâÿÿ=if request. Emit string directly to intermediate output, allowing leading whitespace if string starts with @m] "@s]R]" (which will be stripped off). Reset page number character to~ @m] "@s]R]" Page number character. Pipe output to program (nroff only). Set page length to default The current page length is stored in ééâÿÿ=if Change page length to [+-]N (default scaling indicator~ Print macro names and sizes (number of blocks of 128 bytes). Print only total of sizes of macros (number of 128 bytes blocks). Next page number N. Print the names and contents of all currently defined number registers on stderr. Change to previous page offset. The current page offset is available in ééâÿÿ=if Page offset N. Return to previous point-size. Point size; same as Get the bounding box of a PostScript image filename. This behaves like the ééâÿÿ=if request except that input comes from the standard output of command. Print the names and positions of all traps (not including input line traps and diversion traps) on stderr. Change to previous post-vertical line spacing. Change post-vertical line spacing according to [+-]N (default scaling indicator~ Remove the definitions of characters c1, c2, ... Read insertion. Return from a macro. Right justify the next n input lines. Remove request, macro, or string name. Rename request, macro, or string old to new. Rename register reg1 to reg2. Remove register. Restore spacing; turn no-space mode off. Return (upward only) to marked vertical place (default scaling indicator~ Reset soft hyphen character to Set the soft hyphen character to c. In a macro, shift the arguments by n~positions. Set available font sizes similar to the sizes command in a DESC file. Include source file. Skip one line vertically. Space vertical distance N up or down according to sign of N (default scaling indicator~ Fonts s1, s2, etc. are special and will be searched for characters not in the current font. Toggle the spread warning on and off without changing its value. Emit a warning if each space in an output line is widened by limit or more (default scaling indicator~ Space-character size set to N/12 of the spacewidth in the current font. Space-character size set to N/12 and sentence space size set to M/12 of the spacewidth in the current font (CR][eq]1/3 em]). Associate style with font position n. Replace the string named xx with the substring defined by the indices n1 and n2. Save of vertical space. Save the vertical distance N for later output with ééâÿÿ=if request. Execute program command-line. Set tabs after every position that is a multiple of N (default scaling indicator~ Set tabs at positions n1, n2, nn, then set tabs at nn+r1, nn+r2, nn+rn, then at nn+rn+r1, nn+rn+r2, nn+rn+rn, and so on. Remove tab repition character. Set tab repetition character to~c. Temporary indent next line (default scaling indicator~ Enable track kerning for font. Three-part title. Print anything on terminal (UNIX standard message output). Print anything on terminal (UNIX standard message output), allowing leading whitespace if anything starts with @m] "@s]R]" (which will be stripped off). Similar to ééâÿÿ=if without emitting a final newline. Translate a to b, c to d, etc. on output. Transparently output the contents of file filename. This is the same as the ééâÿÿ=if request except that the asciify request will use the character code (if any) before the character translation. This is the same as the ééâÿÿ=if request except that the translations do not apply to text that is transparently throughput into a diversion with Make the built-in condition t true and n false. Underline font set to font (to be switched to by ééâÿÿ=if Underline (italicize in troff) N input lines. Unformat space characters and tabs, preserving font information in diversion. Enable vertical position traps if n is non-zero, disable them otherwise. Change to previous vertical base line spacing. Set vertical base line spacing according to [+-]N (default scaling indicator~ Default value is Set warnings code to n. Set scaling indicator used in warnings to si. Remove (first) trap at position N. Set location trap; negative means from page bottom. While condition cond is true, accept anything as input. Write anything to the stream named stream. Similar to ééâÿÿ=if without emitting a final newline. Write contents of macro or string xx to the stream named stream. Besides these standard groff requests, there might be further macro calls. They can originate from a macro package (see roff(7) for an overview) or from a preprocessor. Preprocessor macros are easy to be recognized. They enclose their code into a pair of characteristic macros.
|


--- layout: default ---
{{ post.date | date: "%b %-d, %Y" }} | Author: {{site.author.name}}
{{ post.excerpt }}
Read more...>


How not to write a massively multi-player game
Welcome to Page Explorer!
Click here to join! (no longer up)
Click here (again) to join! (yes, bug)
Now hit the CAPS LOCK key (to toggle view state)
After you have joined here are the controls:
Javascript Golfing
Zoggle
Welcome to my guide to Zoggle. Zoggle is not affiliated with Boggle. Zoggle is available...


Module xplnetpresence
Commandline utility to scan syslog output for MAC and IP addresses for domestic occupancy detection and notify through xPL. Use option -help
for a description.

Example:
xplnetpresence.lua -timeout=240 -port=53000 -instance=RANDOM -hub
Example setup using a wireless router with DD-WRT firmware (version 'DD-WRT v24-sp2 (08/12/10) std');
- Enable systemlog on tab 'service / services' of the admin console and set the target ip address where xplnetpresence.lua is listening.
- On tab 'security / firewall' enable logging, set level 'low' and all three options (Dropped/Rejected/Accepted) to 'Enabled'.
- Start xplnetpresence.lua using defaults
Copyright © 2012 Thijs Schreijer
Release: Version 0.1, commandline xPL network watch utility.


We have carried out a task that has taken XR Accessibility User Requirements and identified those that are relevant to captioning. Information on this task can be found on the XR Guideline Development - User Needs GitHub Project. Functional Needs are taken from EN301549. We class user requirements as being:
- Relevant for XR Captioning
- Support Internet relay chat (IRC) style interfaces in XR #115
- Distinguishing sent and received messages in XR #114
- Interaction speed #130
- Text description transformation #125
- Motion agnostic interactions #117
- Immersive personalisation #118
- Immersive semantics and customization #116
- Magnification context and resetting #122
- Relevant for Traditional but XR requires additional thought
- Routing and Communication Channel Control #113
- User ID and Status #112
- Subtitling customization #133
- Relevant for Traditional but XR should implement
- Relevant for captioning in XR but only at a minimal level


Welcome to
The corner of Venezuelan Dishes
Restaurant Specialized in Venezuelan Gastronomy..
Top products
Our services
Home delivery
Our dishes from our kitchen to your door quickly.
Catering Service
catering service for all kinds of events and celebrations.
Take Away
Place your order and pick it up when it's ready.
Subscribe to newsletter
And find out about our special promotions and events.
Contact us
Call us:
(+34) 123 456 789
E-mail :
<EMAIL_ADDRESS>Working Hours:
Mon - Sat (8.00am - 12.00am)


The Akan people of Ghana frequently name their children after the day of the week they were born and the order in which they were born
These "day names" have further meanings concerning the soul and the character of the person.
This website allows you to input your birth date and gives output of the day you were born and also your corresponding AKAN name. Cool, right?
Try it out down below.


Pharaohs take the trophy as Bafana Bafana book Africa's last Olympic ticket
by FIFA.com- South Africa qualify for Tokyo 2020 by beating Ghana on penalties
- Shootout required after a thrilling 2-2 draw in third-place play-off
- Egypt beat Côte d'Ivoire to secure the trophy, with both already qualified
South Africa have seized Africa's third and final ticket to next year's Men's Olympic Football Tournament in Tokyo. Bafana Bafana claimed the spot thanks to a thrilling penalty shootout victory over Ghana following a 2-2 draw in the third-place play-off of the CAF U-23 Africa Cup of Nations.
This was the last chance for these sides to qualify for the Olympics following semi-final defeats on Tuesday to Côte d'Ivoire and Egypt. The Pharaohs put the seal on a fine campaign by claiming the trophy in front an ecstatic Cairo crowd, beating Les Elephants 2-1 after extra time.
The hosts dominated for large spells and seemed on course for victory from the moment Karim El Eraki put them into a 37th-minute lead. But with the final seconds of the 90 ticking down, the Ivorians silenced the passionate home crowd through Aboubacar Doumbia's last-gasp equaliser.
Egypt needed a hero and Ramadan Sobhi stepped up with 114 minutes on the clock, sparking joyful celebrations that are sure to continue long into the Cairo night.
South Africa, who have now qualified for the Olympics for the second successive edition, came out on top after a dramatic encounter in which they were twice pegged back by the dogged Black Meteors.
Bafana Bafana edged the match in terms of efforts on goal and ball possession and took the lead after just 15 minutes when Ghana's Mohammed Habib put through his own goal.
Evans Mensah restored parity just four minutes into the second half though, and while Kamohelo Abel Mahlatsi reclaimed the advantage for South Africa on 62 minutes, Ghana struck back through Samuel Obeng to set up the shootout.
Even that decisive stage of the game proved to something of an epic, with 16 penalties in total taken - 11 of which were scored. The decisive kick belonged to Lyle Foster, who kept his cool to end Ghana's brave resistance and spark wild celebrations among the jubilant South African players.


3 writes to Host
System.Management.Automation (3)
engine\Modules\RemoteDiscoveryHelper.cs (1)
480
var invocationSettings = new PSInvocationSettings {
Host
= cmdlet.Host };
engine\remoting\commands\PushRunspaceCommand.cs (1)
1337
Host
= host
engine\remoting\server\ServerPowerShellDriver.cs (1)
237
settings.
Host
= _remoteHost;
10 references to Host
System.Management.Automation (10)
engine\hostifaces\LocalPipeline.cs (4)
562
if (InvocationSettings != null && InvocationSettings.
Host
!= null)
564
InternalHost internalHost = InvocationSettings.
Host
as InternalHost;
572
LocalRunspace.ExecutionContext.InternalHost.SetHostRef(InvocationSettings.
Host
);
636
if ((InvocationSettings != null && InvocationSettings.
Host
!= null) &&
engine\hostifaces\PowerShell.cs (2)
5460
if ((_settings != null) && (_settings.
Host
!= null))
5462
runspace = RunspaceFactory.CreateRunspace(_settings.
Host
);
engine\remoting\client\ClientRemotePowerShell.cs (2)
242
if (settings == null || settings.
Host
== null)
248
hostToUse = settings.
Host
;
engine\remoting\common\WireDataFormat\EncodeAndDecode.cs (2)
1119
hostInfo = new HostInfo(settings.
Host
);
1120
if (settings.
Host
== null)


Phi-losophy:
May 15th, 2009
If I am not frightened
If I am not sad
If nor am I mad
Then what is fear?
What is sadder or madder?
but a brush of electricity
the electromagnetic storm of a dream
the corporal grip of a nightmare
Happy birthday my sorrow
one year older my fear
how my sadness went quickly
When it comes to perception it’s hard to say there is any sense about it.
It breaks my heart it rips at me, it’s got me in its hold
I am cold
I’m cold blooded
cold hearted
selfish and old
my mind becomes weary
Absolute certainty that never is going anywhere
who are you ?
I am but a participle for a greater action
So, but the part of me that wills, to be
is frightened
frightened solely from what can be imagined
nothing can’t be
everything is contingent upon my being
when the justifier is external
I am not mine
and, so to be predicated by another
forever realized by nothing but ash and electricity,
water and sunlight and my paper
ground of being
rest in certainty


--- ---
Listed alphabetically by Last Name.
| M. S. Narasimhan, Ph.
D. (Bombay) NMI Distinguished Associate |
|
Algebraic Geometry |
|
| [P] +91-80-2360 5390 | |
| Kalyan B. Sinha, Ph. D. (Rochester) NMI Distinguished Associate |
|
Operator Theory, Operator Algebras |
|
| kbs_jaya[at]yahoo[dot]co[dot]in | |
| Vivek S. Borkar, Ph. D. (UC Berkeley) NMI Distinguished Associate |
|
Markov decision processes, controlled diffusions, stochastic algorithms, stochastic games |
|
[P] +91-80-2293 |
|
|<EMAIL_ADDRESS>| |
| http://www.tcs.tifr.res.in/~borkar/ | |
|
|
||
| Indian Institute of Science | Contact the Administrator | Disclaimer |


MS2 file format
The MS2 file format is used to record MS/MS spectra. A full description of the MS2 file format may be found in: McDonald,W.H. et al. MS1, MS2, and SQT-three unified, compact, and easily parsed file formats for the storage of shotgun proteomic spectra and identifications. Rapid Commun. Mass Spectrom. 18, 2162-2168 (2004).
An MS2 file consists of a header followed by one or more sets of scan data. The header and scan data are broken into records, one record per line. The fields within a record are separated by white space. The header records list information applicable to all the scans in the file. Each scan begins with a few records describing the parameters for that scan. This is followed by pairs of m/z and intensity values, one pair per line.
A sample MS2 file may be found here.
Header details
Each line in the header must begin with an H
.
This is followed by a field label, and then a field value,
all separated by white space.
The field label must be one of the labels listed below,
while the field value can be an aribrary string.
A typical header is shown below.
H CreationDate 2/14/2007 6:19:18 PM H Extractor MakeMS2 H ExtractorVersion 1.0 H Comments MakeMS2 written by Michael J. MacCoss, 2004 H ExtractorOptions MS2/MS1
The following field labels must appear in the header:
| Field Label | Description |
|---|---|
| CreationDate | The date and time when the file was created |
| Extractor | The name of the software used to create the MS2 file |
| ExtractorVersion | The version number of the Extractor software |
| ExtractorOptions | The options used in running the extractor software |
The following field labels are optional, and may appear in the header:
| Field Label | Description | |
|---|---|---|
| IAnalyzer | Name of software used to conduct charge-state independent analysis of the spectra | |
| IAnalyzerVersion | The version number of the IAnalyzer software | |
| IAnalyzerOptions | The options used in running the IAnalyzer software | |
| DAnalyzer | Name of software used to conduct charge-state dependent analysis of the spectra | |
| DAnalyzerVersion | The version number of the DAnalyzer software | |
| DAnalyzerOptions | The options used in running the DAnalyzer software | |
| SortedBy | Name of field use to sort spectra | |
| InstrumentType | The type of mass analyzer used | |
| Comment | Remarks. Multiple comment lines are allowed | |
| InstrumentSN | Serial number of the mass spectrometer used |
Scan details
Each scan begins with a few records listing the parameters describing the spectrum. These lines must begin with S, I, Z, or D. The records are followed by pairs of m/z and intensity values, one pair per line. A fragment of a typical scan is shown below.
S 10 10 636.34 Z 2 1271.67 187.4 12.5 193.1 19.5 194.3 13.7 198.3 29.8 199.1 12.2
| Symbol | Description | Generic form | Required |
|---|---|---|---|
| S | scan | S [first scan] [second scan] [pre m/z] |
yes |
| I | Charge independent analysis | I [field label] [field value] |
no |
| Z | Charge | I [charge] [mass] |
yes |
| D | Charge dependent analysis | I [field label] [field value] |
no |
| [data] | m/z intensity paris | [m/z] [intensity] |
yes |


BEL (Biological Expression Language) is a language for representing scientific findings in the life sciences in a computable form. BEL is designed to represent scientific findings by capturing causal and correlative relationships in context, where context can include information about the biological and experimental system in which the relationships were observed, the supporting publications cited and the process of curation.
| Time | Speaker | Title |
|---|---|---|
| 8:00-8:30 | Breakfast - provided | |
| 8:30-8:45 | William Hayes, PhD, BioDati | Introduction |
| 8:45-9:15 | Renee Deehan Kenney, PhD, PatientsLikeMe | Keynote: Digitizing Life with BEL |
| 9:15-10:00 | Natalie Catlett, PhD, PatientsLikeMe | BEL and the Phenome |
| 10:00-10:30 | Eric Neumann, PhD, AIDAKA | Leveraging the most from Graphs and Semantics for Deep Learning Applications |
| 10:30-10:45 | Break | |
| 10:45-11:15 | Marja Talikka, PhD, PMI | Crowd verification of BEL network models for xenobiotic metabolism in the liver |
| 11:15-11:45 | Sumit Madan, Fraunhofer-SCAI | BELIEF Project |
| 11:45-12:15 | William Hayes, PhD | BEL.bio, BioDati Studio |
| 12:15-2:00 | Lunch on your own | |
| 2:00-2:30 | Charlie Hoyt, Fraunhofer-SCAI | PyBEL |
| 2:30-3:00 | John Bachman & Benjamin Gyori, Harvard | INDRA, FamPlex and BEL |
BEL Language Workshop | ||
| 3:00-3:30 | Discussion | Updating BEL Language Process |
| 3:30-4:00 | William/Natalie | Proposal: Template for BEL Language Proposals |
| 4:00-5:30 | Working Session | BEL Language Proposal Development |
William Hayes (whayes at biodati dot com)


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