5 Best Black Friday Laptop Deals At Walmart
November 29, 2019
5 Best Black Friday Laptop Deals At Walmart
It is time for Black Friday 2019, and laptops will be a hot commodity this year. Numerous outlets have been touting their sales heading into the huge shopping day. Those consumers anxious for laptop deals may want to take a look at Walmart before they make any firm purchasing decisions.
While Walmart is typically a popular store to shop at for in-person Black Friday deals, there are sales that can be taken advantage of from the comfort of one’s home, too. As Best Black Friday notes, Walmart’s deals are slated to begin online on Wednesday, November 27, at 10 p.m. Eastern.
All of Walmart’s Black Friday sale prices should remain in effect through the full day on Friday. Of course, inventory availability can quickly become an issue, both in stores and online. Walmart will open the doors at their physical locations at 6 p.m. local time on Thanksgiving evening.
When it comes to Walmart Black Friday laptop deals, there are some intriguing offers available. For shoppers who have basic needs and want a low price, there are some attractive options. Those who want something somewhat higher-end can find a couple of potentially enticing offers available as well.
Of course, the challenge often boils down to being able to act quickly enough to score the best deal before the inventory is snatched up. It’s worth noting that Walmart had plenty of great Cyber Monday deals last year, also. Those that miss the Black Friday rush can potentially look to Cyber Monday to get their items.
Acer Chromebook 14
According to Laptop, this is one of the cheapest laptop deals available this year. It regularly is priced at $299, but is marked down to $159. The site notes that the laptop has great user ratings, though it best serves those who expect to do fairly basic tasks.
Lenovo IdeaPad L340 Gaming 15.6-inch Laptop
This Lenovo IdeaPad is available in Gradient Blue and comes with Windows 10, 8GB of RAM, an Intel Core i5 processor, and a 256GB SSD. This highly-rated Lenovo is regularly priced at $750. However, it’s a steal at $549 on Black Friday.
HP 14-Inch Laptop
This HP 14-inch laptop is a great option for many shoppers. The unit has 256GB of storage, 8GB of RAM, and an Intel 10th Gen Core i5-1035G1 processor. Walmart is knocking $200 off the regular price for their sale. Rather than purchasing it at $599, lucky shoppers can scoop the laptop up for $399.
Acer Aspire 5 Laptop
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The Acer Aspire 5 has a 512GB SSD and a Core i7-8565U processor. This laptop comes with a 14-inch screen and Windows 10, and receives plenty of high ratings from users. Normally priced at $625, Walmart is offering a Black Friday deal for this laptop, at a price of $529.
Lenovo Legion Y540 Gaming Laptop
This Legion by Lenovo gaming laptop features a 15.6-inch screen and an Intel Core i7-9750H processor. The unit has 8GB of RAM, 12GB of SSD storage, and a 4GB graphics processor. Normally priced at $1,099, Walmart is offering this unit for just $799 via their Black Friday sales.


Popular Thoughts
Exploring Google Calendar Through The Combined View Of Distributed Cognition And Sociomateriality
This paper will examine Google Calendar, a widely used time management and schedule tracking tool, through the lens of a combination of two theories - Distributed Cognition [1] and Sociomateriality [2]. Google Calendar here is considered specifically in the organization context, the role of which is a work calendar in this case...
Read Morehow might we better design across differences with vulnerable users
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Read Moresample article
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VALIDATING
Indicates that this Synchronizer is actively validating new blocks that were downloaded from the server. Blocks need to be verified before they are scanned. This confirms that each block is chain-sequential, thereby detecting missing blocks and reorgs.


I'm a PhD student at UC Berkeley's School of Information and BAIR, working on natural language processing (NLP), computational social science, cultural analytics, and AI fairness. I'm supported by a NSF Graduate Research Fellowship and advised by David Bamman.
Katie Keith and I have a podcast, Diaries of Social Data Research, where we chat with researchers on the process behind interdisciplinary papers.
Prospective PhD applicants, especially those from underrepresented backgrounds, are welcome to email me questions about the application process or the PhD experience.
Pronouns: she/her
Here's my CV, which includes a non-exhaustive list of people from many institutions (Stanford, EPFL, Microsoft Research, Allen Institute for AI) who took a leap of faith to support, teach, and guide me in computing research.
I use NLP methods to quantify the discussion of individuals and social groups in text, including textbooks, fiction, and online forums. I've also mapped out landscapes of communities' vocabularies at scale, in domains such as science and social media. My work investigates two overarching questions:
How can NLP measure context-dependent depictions and expressions of people?
"Context" in NLP can operate at various levels of granularity. It can refer to a span of textual content surrounding a word, such as its sentence or paragraph. It can also refer to its social (or "ecological") context: who is producing or curating language, and how their lived experiences impact it.
In return, how can these measurements inform how we should build better models?
I leverage symbiotic relationships among fields adjacent to or within NLP to inform model development. A consideration of social aspects can make models more fair and user-friendly, and social scientific questions can motivate new tasks and approaches with interpretability in mind.
I publish with my name backwards, so citations should refer to "L. Lucy". I do this because my last name is one of the most common in the world, researchers are often recognized and remembered by last name, and computer vision researcher Fei-Fei Li does this, too. More thoughts from others about names and academia, here.
* = equal contribution
Words as Gatekeepers: Measuring Discipline-specific Terms and Meanings in Scholarly Publications
Li Lucy, Jesse Dodge, David Bamman, Katherine A. Keith.
Findings of ACL 2023.
Paper.
Discovering Differences in the Representation of People using Contextualized Semantic Axes
Li Lucy, Divya Tadimeti, David Bamman.
EMNLP 2022.
Paper. Code.
Characterizing English Variation across Social Media Communities with BERT
Li Lucy, David Bamman.
TACL 2021.
Paper. Code.
Gender and Representation Bias in GPT-3 Generated Stories
Li Lucy, David Bamman.
Narrative Understanding Workshop @ NAACL 2021.
Paper. Code.
Content Analysis of Textbooks via Natural Language Processing: Findings on Gender, Race, and Ethnicity in Texas U.S. History Textbooks
Li Lucy*, Dora Demszky*, Patricia Bromley, Dan Jurafsky.
AERA Open 2020.
Best Paper Award. Paper. Code. Slides.


--- layout: post title: Use the Symfony Workflow component author: vcomposieux date: '2016-09-29 10:04:20 +0200' date_gmt: '2016-09-29 08:04:20 +0200' categories: - Non classé tags: [] --- {% raw %}
Since Symfony 3.2, a new useful component was born: the Workflow component.
It is indeed really convenient and can simplify greatly your developments when you have to manage status workflows in your application, that occurs a lot.
Installation
In all cases, you have to install the following dependency:
"symfony/workflow": "~3.2@dev"
If you use an earlier version of Symfony but >=2.3 you are also able to use this component, but you have to install the following non-official bundle, which loads the component itself and add the required configuration under the bundle's namespace:
"fduch/workflow-bundle": "~0.2@dev"
Do not forget to enable the bundle in your kernel class.
Configuration
Time has come to write our workflow configuration. We will have to define all our places (statuses / states) and available transitions.
In this blog post, we will take a pull request status example. A pull request can have one of the following status: opened , closed , needs_review , reviewed or merged.
However, it cannot be, for instance, moved from the merged status without having the reviewed status before. The workflow component makes sense here.
Here is our full workflow configuration:
workflow: workflows: pull_request: marking_store: type: multiple_state arguments: - state supports: - AppBundle\Entity\PullRequest places: - opened - closed - needs_review - reviewed - merged transitions: feedback: from: opened to: needs_review review: from: [opened, needs_review] to: reviewed merge: from: reviewed to: merged close: from: [opened, needs_review, reviewed] to: closed
Here, we specify we want to use a multiple_state workflow. Please not that if you want to use a simple transition from one state to another, you can use a single_state .
For this example, we also have defined a AppBundle\Entity\PullRequest class which has a state property and associated setter and getter methods (component will use these methods to manage transitions):
<?php namespace AppBundle\Entity; use Doctrine\ORM\Mapping as ORM; /** * @ORM\Table(name="pull_request") */ class PullRequest { /** * @ORM\Column(type="json_array", nullable=true) */ protected $state; public function setState($state) { $this->state = $state; } public function getState() { return $this->state; } }
Everything is now ready, we can start to use the Workflow component!
Usage
First useful thing to do after you have written your workflow configuration is to generate a graph using the Symfony command. The command will generate one graph using the Graphviz format.
Here is the Symfony command you have to run:
$ bin/console workflow:dump pull_request
The generated Graphviz will give you the following diagram:
This one gives you a really clear vision of your workflow and allows everyone at every level (developers, product owners, customers, ...) to understand the business logic.
The Workflow component implements methods that allow you to verify if a transition is applicable and to later apply it depending on the current status and to also list all enabled transitions.
In order to check if you can apply a specific transition and apply it, simply use the following code:
<?php namespace AppBundle\Controller; use AppBundle\Manager\PullRequestManager; use Symfony\Bundle\FrameworkBundle\Controller\Controller; use Symfony\Component\HttpFoundation\RedirectResponse; class PullRequestController extends Controller { /** * @param int $identifier A pull request identifier. * * @return RedirectResponse */ public function update($identifier) { ... // Notre pull request est au statut "reviewed" $pullRequest = $this->getPullRequestManager()->find($identifier); // Nous obtenons le service "workflow.<nom du workflow>" $workflow = $this->get('workflow.pull_request'); if ($workflow->can($pullRequest, 'merge')) { $workflow->apply($pullRequest, 'merge'); } ... } }
In the case you do not want to use the can() method, the apply() one will throw an exception if the transition cannot be effectively done, so you will be able to catch exceptions on the Symfony\Component\Workflow\Exception\LogicException type.
To list all enabled transitions:
$workflow->getEnabledTransitions($pullRequest);
Overall, the component usage is just as simple as these 3 methods. As you can see, complex workflows are now easier to manage!
Tune in for events!
The component also dispatches multiple events, chronologically sorted as:
Finally, you have to know that these events also exist in a unique way for each workflow in order to allow you to tune in your workflow events only.
If you want to do that, you have to listen to the following name: workflow.pull_request.enter .
Let's do better than that: you are also able to listen to a specific transition or a state for a specific workflow:
Conclusion
The Workflow component is a really useful component to manage state or status on most of web applications.
Do not hesitate to use it because its simplicity of configuration and use will probably help you a lot on your projects.
Also, this component helps me a lot to give people I was working with a clear vision on a complex workflow we have to manage. The graph generation allows to clarify all of that for everyone!
{% endraw %}


Hello {{name}}
Welcome to the Moringa tribune newsletter. You will find the most exciting news about Moringa School


Before Change
// Internal inference function (for direct call)
def inference_internal(question):
answers = inference_helper(tokenize(question))[0]
answers = detokenize(answers)
answers = replace_in_answers(answers, "answers")
answers_score = score_answers(answers, "answers")
return (answers, answers_score)
After Change
def inference_internal(questions):
// Process questions and return
return process_questions(questions)
// Get index and score for best answer
def get_best_score(answers_score, include_blacklisted = True):


 Our main target is to research, develop, and invent solutions in collaboration with Digile N4S-Program partners.
More About N4SGet up, speed up!
 Our main target is to research, develop, and invent solutions in collaboration with Digile N4S-Program partners.
More About N4SMeet
our team
We build experiences
Yes, we build products and experiences. Here is collection of works done with N4S@JAMK and Challenge Factory 2014 teams during the N4S-Program.
Supported By
We are looking for talents all the time. If you have the urge to stay on top of the IT evolution, we would like to hear from you. And if you just want to come and say hello, we are in with that also. Let's improve the process of software delivery together. We have coffee, you can bring some korvapuusti!


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Media Aligned Text
The Hobbit - J.R.R Tokien
In
a
hole
in
the
ground
there
lived
a
hobbit.
Not
a
nasty,
dirty,
wet
hole,
filled
with
the
ends
of
worms
and
an
oozy
smell,
nor
yet
a
dry,
bare,
sandy
hole
with
nothing
in
it
to
sit
down
on
or
to
eat:
it
was
a
hobbit-hole,
and
that
means
comfort.
It
had
a
perfectly
round
door
like
a
porthole,
painted
green,
with
a
shiny
yellow
brass
knob
in
the
exact
middle.
The
door
opened
on
to
a
tube-shaped
hall
like
a
tunnel:
a
very
comfortable
tunnel
without
smoke,
with
panelled
walls,
and
floors
tiled
and
carpeted,
provided
with
polished
chairs,
and
lots
and
lots
of
pegs
for
hats
and
coats -
the
hobbit
was
fond
of
visitors.


|
Neonode zForce(TM) SDK
|
Struct representing an AirDevice. More...
#include <AirDevice.h>
Public Attributes | |
| zForce * | zForce |
| Pointer to zForce. | |
| Connection * | Connection |
| The Connection this Device is part of. | |
| DeviceType | DeviceType |
| Which type of Device this is. | |
| uint32_t | DeviceIndex |
| Device ** | StorageDevices |
| Future: List of Storage Devices. Will change type during implementation. | |
| uint32_t | NumberOfStorageDevices |
| Number of Storage Devices. | |
| void * | PrivateProtocolData |
| Private Protocol Data. | |
| void(* | Destructor )(Device *self) |
| Destructor. More... | |
| CartesianCoordinates | Resolution |
| Resolution of the device. | |
| TouchActiveArea | TouchActiveArea |
| Touch Active Area of the device. | |
| ReverseTouchActiveArea | ReverseTouchActiveArea |
| Reverse The Touch Active Area of the device. | |
| bool(* | GetEnable )(SensorDevice *self) |
| Ask the Device if it is enabled. More... | |
| bool(* | SetEnable )(SensorDevice *self, bool continuousMode, uint32_t numberOfMessages) |
| Enable the device. More... | |
| bool(* | GetDisable )(SensorDevice *self) |
| Ask the Device if it is disabled. More... | |
| bool(* | SetDisable )(SensorDevice *self) |
| Disable the device. More... | |
| bool(* | GetOperationModes )(SensorDevice *self) |
| Get the current Operating Modes of the Device. More... | |
| bool(* | SetOperationModes )(SensorDevice *self, OperationModes modeMask, OperationModes modeValues) |
| Set the current Operating Modes of the Device. More... | |
| bool(* | GetResolution )(SensorDevice *self) |
| Get the current Resolution of the Device. More... | |
| bool(* | SetResolution )(SensorDevice *self, uint32_t x, bool xIsValid, uint32_t y, bool yIsValid, uint32_t z, bool zIsValid) |
| Set the current Resolution of the Device. More... | |
| bool(* | GetReverseTouchActiveArea )(SensorDevice *self) |
| Gets the current reverse setting for the Touch Active Area. More... | |
| bool(* | SetReverseTouchActiveArea )(SensorDevice *self, bool xIsReversed, bool yIsReversed) |
| Reverse the Touch Active Area of the Device. More... | |
| bool(* | GetFlipXY )(SensorDevice *self) |
| Gets the current FlipXY setting. More... | |
| bool(* | SetFlipXY )(SensorDevice *self, bool axesAreFlipped) |
| Sets the FlipXY setting. More... | |
| bool(* | GetReflectiveEdgeFilter )(SensorDevice *self) |
| Gets the current ReflectiveEdgeFilter setting. More... | |
| bool(* | SetReflectiveEdgeFilter )(SensorDevice *self, bool isFilterOn) |
| Sets the ReflectiveEdgeFilter setting. More... | |
| bool(* | GetMergeTouches )(SensorDevice *self) |
| Gets the current MergeTouches setting. More... | |
| bool(* | SetMergeTouches )(SensorDevice *self, bool areTouchesMerged) |
| Sets the MergeTouches setting. More... | |
| bool(* | GetTouchActiveArea )(SensorDevice *self) |
| Get the current Touch Active Area of the Device. More... | |
| bool(* | SetTouchActiveArea )(SensorDevice *self, uint32_t lowerBoundaryX, uint32_t upperBoundaryX, bool xIsValid, uint32_t lowerBoundaryY, uint32_t upperBoundaryY, bool yIsValid) |
| Set the current Touch Active Area of the Device. More... | |
| bool(* | GetDetectedObjectSizeRestriction )(SensorDevice *self) |
| Get the current Detected Object Size Restriction of the Device. More... | |
| bool(* | SetDetectedObjectSizeRestriction )(SensorDevice *self, uint32_t minimumSize, uint32_t maximumSize, bool minimumSizeIsValid, bool maximumSizeIsValid) |
| Set the current Detected Object Size Restriction of the Device. More... | |
| bool(* | GetNumberOfTrackedObjects )(SensorDevice *self) |
| Get the number of tracked objects. More... | |
| bool(* | SetNumberOfTrackedObjects )(SensorDevice *self, uint32_t numberOfTrackedObjects) |
| Set the number of tracked objects. More... | |
| bool(* | GetOffset )(SensorDevice *self) |
| Get the X and Y offsets. More... | |
| bool(* | SetOffset )(SensorDevice *self, uint32_t offsetX, bool offsetXIsValid, uint32_t offsetY, bool offsetYIsValid) |
| Set the X and Y offsets. More... | |
| bool(* | GetHidDisplaySize )(SensorDevice *self) |
| Get the Hid Display Size. More... | |
| bool(* | SetHidDisplaySize )(SensorDevice *self, uint32_t sizeX, bool sizeXIsValid, uint32_t sizeY, bool sizeYIsValid) |
| Set the Hid Display Size. More... | |
| bool(* | GetTouchMode )(SensorDevice *self) |
| Get the Touch Mode. More... | |
| bool(* | SetTouchMode )(SensorDevice *self, TouchModes touchMode, bool touchModeIsValid, uint32_t clickOnTouchTime, bool clickOnTouchTimeIsValid, uint32_t clickOnTouchRadius, bool clickOnTouchRadiusIsValid) |
| Set the Touch Mode. More... | |
Struct representing an AirDevice.
Struct representing an AirDevice. AirDevice is a specific implementation of a SensorDevice for zForce Air(TM).
| void( * AirDevice::Destructor) (Device *self) |
Destructor.
Destructs the Device and all base structs.
| self | Pointer to the struct itself. |
| uint32_t AirDevice::DeviceIndex |
Which Device Index this device has.
| bool( * AirDevice::GetDetectedObjectSizeRestriction) (SensorDevice *self) |
Get the current Detected Object Size Restriction of the Device.
Gets the current Detected Object Size Restriction.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetDisable) (SensorDevice *self) |
Ask the Device if it is disabled.
Ask the device if it is disabled.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetEnable) (SensorDevice *self) |
Ask the Device if it is enabled.
Ask the Device if it is enabled. Also reports if the device is in continuous mode and number of messages left to receive.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetFlipXY) (SensorDevice *self) |
Gets the current FlipXY setting.
Gets the current FlipXY setting.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetHidDisplaySize) (SensorDevice *self) |
Get the Hid Display Size.
Get the Hid Display Size.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetMergeTouches) (SensorDevice *self) |
Gets the current MergeTouches setting.
Gets the current MergeTouches setting.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetNumberOfTrackedObjects) (SensorDevice *self) |
Get the number of tracked objects.
Get the number of tracked objects.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetOffset) (SensorDevice *self) |
Get the X and Y offsets.
Get the X and Y offsets.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetOperationModes) (SensorDevice *self) |
Get the current Operating Modes of the Device.
Gets the current Operating Modes of the Device as two bitmasks.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetReflectiveEdgeFilter) (SensorDevice *self) |
Gets the current ReflectiveEdgeFilter setting.
Gets the current ReflectiveEdgeFilter setting.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetResolution) (SensorDevice *self) |
Get the current Resolution of the Device.
Gets the current Resolution of the Device.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetReverseTouchActiveArea) (SensorDevice *self) |
Gets the current reverse setting for the Touch Active Area.
Gets the current reverse setting for the Touch Active Area.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetTouchActiveArea) (SensorDevice *self) |
Get the current Touch Active Area of the Device.
Gets the current Touch Active Area of the Device.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::GetTouchMode) (SensorDevice *self) |
Get the Touch Mode.
Get the Touch Mode.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::SetDetectedObjectSizeRestriction) (SensorDevice *self, uint32_t minimumSize, uint32_t maximumSize, bool minimumSizeIsValid, bool maximumSizeIsValid) |
Set the current Detected Object Size Restriction of the Device.
Sets the current Detected Object Size Restriction of the device.
On failure, errno is set.
| self | Pointer to the struct itself. |
| minimumSize | The minimum object size to detect by device. |
| maximumSize | The maximum object size to detect by device. |
| minimumSizeIsValid | Set to True to alter minimumSize detection. |
| maximumSizeIsValid | Set to True to alter maximumSize detection. |
| bool( * AirDevice::SetDisable) (SensorDevice *self) |
Disable the device.
Disable the device. Messages will stop arriving as soon as the Device processes the request, but Messages already in progress will still arrive as normal.
On failure, errno is set.
| self | Pointer to the struct itself. |
| bool( * AirDevice::SetEnable) (SensorDevice *self, bool continuousMode, uint32_t numberOfMessages) |
Enable the device.
Enable the device and set it to either continuous mode or a specified number of messages. Not all protocols handle non-continuous mode.
On failure, errno is set.
| self | Pointer to the struct itself. |
| continuousMode | Set to true for continuous mode. |
| numberOfMessages | When in non-continuous mode, specifies how many Messages to receive before the Device disables itself. May not be 0 when continuousMode == false. |
| bool( * AirDevice::SetFlipXY) (SensorDevice *self, bool axesAreFlipped) |
Sets the FlipXY setting.
Enables/Disables flipping the X-axis and Y-axis.
On failure, errno is set.
| self | Pointer to the struct itself. |
| axesAreflipped | True to flip the axes. |
| bool( * AirDevice::SetHidDisplaySize) (SensorDevice *self, uint32_t sizeX, bool sizeXIsValid, uint32_t sizeY, bool sizeYIsValid) |
Set the Hid Display Size.
Set the Hid Display Size.
On failure, errno is set.
| self | Pointer to the struct itself. |
| sizeX | X Size. |
| sizeXIsValid | X Size is valid, i.e. you want to set Size X. |
| sizeY | Y Size. |
| sizeYIsValid | Y Size is valid, i.e. you want to set Size Y. |
| bool( * AirDevice::SetMergeTouches) (SensorDevice *self, bool areTouchesMerged) |
Sets the MergeTouches setting.
Enables/Disables the MergeTouches setting in the sensor.
On failure, errno is set.
| self | Pointer to the struct itself. |
| areTouchesMerged | is true if the touches are merged, otherwise false. |
| bool( * AirDevice::SetNumberOfTrackedObjects) (SensorDevice *self, uint32_t numberOfTrackedObjects) |
Set the number of tracked objects.
Set the number of tracked objects.
On failure, errno is set.
| self | Pointer to the struct itself. |
| numberOfTrackedObjects | Tracked object count. |
| bool( * AirDevice::SetOffset) (SensorDevice *self, uint32_t offsetX, bool offsetXIsValid, uint32_t offsetY, bool offsetYIsValid) |
Set the X and Y offsets.
Set the X and Y offsets.
On failure, errno is set.
| self | Pointer to the struct itself. |
| offsetX | X Offset. |
| offsetXIsValid | Offset X is valid, i.e. you want to set X Offset. |
| offsetY | Y Offset. |
| offsetYIsValid | Offset Y is valid, i.e. you want to set Y Offset. |
| bool( * AirDevice::SetOperationModes) (SensorDevice *self, OperationModes modeMask, OperationModes modeValues) |
Set the current Operating Modes of the Device.
Sets the current Operating Modes of the Device as two bitmasks. Setting the modeMask bit for a specific Mode to 1 changes it to become the corresponding bit in modeValues but setting the bit to 0 does not change it.
On failure, errno is set.
| self | Pointer to the struct itself. |
| modeMask | A bit set to 1 means set to the corresponding bit in the modeValue field and 0 means do not change this bit. |
| modeValue | The value to set the bits to. |
| bool( * AirDevice::SetReflectiveEdgeFilter) (SensorDevice *self, bool isFilterOn) |
Sets the ReflectiveEdgeFilter setting.
Enables/Disables the ReflectiveEdgeFilter.
On failure, errno is set.
| self | Pointer to the struct itself. |
| isFilterOn | is true if the filter is on, otherwise false. |
| bool( * AirDevice::SetResolution) (SensorDevice *self, uint32_t x, bool xIsValid, uint32_t y, bool yIsValid, uint32_t z, bool zIsValid) |
Set the current Resolution of the Device.
Sets the current Resolution of the Device.
On failure, errno is set.
| self | Pointer to the struct itself. |
| x | The Resolution of the X axis. |
| xIsValid | Set to true to change this value or false to ignore it. Ignored on a Device that does not allow it. |
| y | The Resolution of the Y axis. |
| yIsValid | Set to true to change this value or false to ignore it. Ignored on a Device that does not allow it. |
| z | The Resolution of the Z axis. |
| zIsValid | Set to true to change this value or false to ignore it. Ignored on a Device that does not allow it. |
| bool( * AirDevice::SetReverseTouchActiveArea) (SensorDevice *self, bool xIsReversed, bool yIsReversed) |
Reverse the Touch Active Area of the Device.
Reverse the Touch Active Area of the Device.
On failure, errno is set.
| self | Pointer to the struct itself. |
| xIsReversed | True to reverse the X axis. |
| yIsReversed | True to reverse the Y axis. |
| bool( * AirDevice::SetTouchActiveArea) (SensorDevice *self, uint32_t lowerBoundaryX, uint32_t upperBoundaryX, bool xIsValid, uint32_t lowerBoundaryY, uint32_t upperBoundaryY, bool yIsValid) |
Set the current Touch Active Area of the Device.
Sets the current Touch Active Area of the Device.
On failure, errno is set.
| self | Pointer to the struct itself. |
| lowerBoundaryX | The lower boundary for the X axis to set. |
| upperBoundaryX | The upper boundary for teh X axis to set. |
| xIsValid | Set to true to change the values or false to ignore. |
| lowerBoundaryY | The lower boundary for the Y axis to set. |
| upperBoundaryY | The upper boundary for teh Y axis to set. |
| yIsValid | Set to true to change the values or false to ignore. |
| bool( * AirDevice::SetTouchMode) (SensorDevice *self, TouchModes touchMode, bool touchModeIsValid, uint32_t clickOnTouchTime, bool clickOnTouchTimeIsValid, uint32_t clickOnTouchRadius, bool clickOnTouchRadiusIsValid) |
Set the Touch Mode.
Set the Touch Mode.
On failure, errno is set.
| self | Pointer to the struct itself. |
| touchMode | Touch Mode to set. |
| touchModeIsValid | Touch Mode is valid, i.e. you want to set Touch Mode. |
| clickOnTouchTime | Click on Touch Time in ms. |
| clickOnTouchTimeIsValid | Click On Touch Time is valid, i.e. you want to set Click On Touch Time. |
| clickOnTouchRadius | Click on Touch Radius in ms. |
| clickOnTouchRadiusIsValid | Click On Touch Radius is valid, i.e. you want to set Click On Touch Radius. |


WeSwipes
Offer
Request
Location
Action
Another action
Something else here
Separated link
Usdan Marketplace
Usdan Cafe
Summerfields
Red & Black
Star & Crescent
Weswings
Pi Cafe
Now
15 Minutes
30 Minutes
1 Hour
All
Usdan Marketplace
Usdan Cafe
Pi Cafe
Summerfields
Star & Crescent
Red & Black Cafe
Weswings
usdan
weswings
red & black
star & crescent
summies
usdan
weswings


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wincolor_sink & | operator= (const wincolor_sink &other)=delete |
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void | set_color (level::level_enum level, WORD color) |
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void | log (const details::log_msg &msg) final override |
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void | flush () final override |
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void | set_pattern (const std::string &pattern) override final |
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void | set_formatter (std::unique_ptr< spdlog::formatter > sink_formatter) override final |
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| sink (std::unique_ptr< spdlog::pattern_formatter > formatter) |
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bool | should_log (level::level_enum msg_level) const |
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void | set_level (level::level_enum log_level) |
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level::level_enum | level () const |
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const WORD | BOLD = FOREGROUND_INTENSITY |
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const WORD | RED = FOREGROUND_RED |
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const WORD | GREEN = FOREGROUND_GREEN |
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const WORD | CYAN = FOREGROUND_GREEN | FOREGROUND_BLUE |
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const WORD | WHITE = FOREGROUND_RED | FOREGROUND_GREEN | FOREGROUND_BLUE |
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const WORD | YELLOW = FOREGROUND_RED | FOREGROUND_GREEN |
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using | mutex_t = typename ConsoleMutex::mutex_t |
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WORD | set_console_attribs (WORD attribs) |
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void | print_range_ (const fmt::memory_buffer &formatted, size_t start, size_t end) |
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HANDLE | out_handle_ |
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mutex_t & | mutex_ |
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std::unordered_map< level::level_enum, WORD, level::level_hasher > | colors_ |
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The documentation for this class was generated from the following file:


Looking for common divisor(Mathematics) - IchigoJam
What number is divisible by 182?
With "FOR" / "NEXT" command, while incrementing a variable X by 1 from 2, and repeat.
It is OK that "N=182" be also written as "LET N, 182"!
Let's check the "divisor", a number that came out.
It can divide properly!
What is the number that can divide 455?
It displays the number that can divide both 182 and 455.
The displayed numbers 7, 13, and 91 are the "common divisor" of 182 and 455.
The largest number 91 is the "greatest common divisor" of 182 and 455.
Try it!
1. Let's display the "common divisor" of 3432 and 2002.
2. Let's divide 3432 by "greatest common divisor" from (1).
3. Let's multiply the number calculated above (2) with "greatest common divisor".
4. Let's count how many "divisors" of 2002.
5. Let's look for the "prime numbers" that do not have "divisor" in a 4 digit number.
6. Let's confirm that there is no "common divisor" between "prime numbers" from (5).


ELECTRICAL AND COMPUTER ENGINEERING
SUMMER Quarter 2010 COURSE LIST
COURSE
TITLE
FACULTY
DAYS/TIMES
ROOM


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How-to guides, about market access and updates to the service.


|
LiteCore
Couchbase Lite cross-platform core implementation
|
Options for view queries. More...
#include <c4View.h>
Data Fields | |
| uint64_t | skip |
| Number of initial rows to skip. More... | |
| uint64_t | limit |
| Max number of rows to return (set to UINT_MAX for unlimited) More... | |
| bool | descending |
| If true, iteration is by descending key. More... | |
| bool | inclusiveStart |
| If true, rows with key equal to startKey are included. More... | |
| bool | inclusiveEnd |
| If true, rows with key equal to endKey are included. More... | |
| bool | rankFullText |
| Should full-text results be ranked by relevance? More... | |
| C4Key * | startKey |
| Key to start at (the minimum, or maximum if descending=true) More... | |
| C4Key * | endKey |
| Key to end at (the maximum, or minimum if descending=true) More... | |
| C4Slice | startKeyDocID |
| If multiple rows have startKey, start at one with this docID. More... | |
| C4Slice | endKeyDocID |
| If multiple rows have endKey, end at one with this docID. More... | |
| const C4Key ** | keys |
| List of keys to iterate (overrides start/endKey) More... | |
| size_t | keysCount |
Number of keys pointed to by keys More... | |
| const C4ReduceFunction * | reduce |
| Reduce function, or NULL for no reducing. More... | |
| uint32_t | groupLevel |
| Key grouping level, or 0 for no grouping. More... | |
Options for view queries.
| bool C4QueryOptions::descending |
If true, iteration is by descending key.
| C4Key* C4QueryOptions::endKey |
Key to end at (the maximum, or minimum if descending=true)
| C4Slice C4QueryOptions::endKeyDocID |
If multiple rows have endKey, end at one with this docID.
| uint32_t C4QueryOptions::groupLevel |
Key grouping level, or 0 for no grouping.
| bool C4QueryOptions::inclusiveEnd |
If true, rows with key equal to endKey are included.
| bool C4QueryOptions::inclusiveStart |
If true, rows with key equal to startKey are included.
| const C4Key** C4QueryOptions::keys |
List of keys to iterate (overrides start/endKey)
| size_t C4QueryOptions::keysCount |
Number of keys pointed to by keys
| uint64_t C4QueryOptions::limit |
Max number of rows to return (set to UINT_MAX for unlimited)
| bool C4QueryOptions::rankFullText |
Should full-text results be ranked by relevance?
| const C4ReduceFunction* C4QueryOptions::reduce |
Reduce function, or NULL for no reducing.
| uint64_t C4QueryOptions::skip |
Number of initial rows to skip.
| C4Key* C4QueryOptions::startKey |
Key to start at (the minimum, or maximum if descending=true)
| C4Slice C4QueryOptions::startKeyDocID |
If multiple rows have startKey, start at one with this docID.


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- If you typed the web address in by hand, double check that your spelling and capitalisation is correct.
- If you arrived here from a link on another website, their links might be out of date.
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To help find the information you are looking for, please select the relevant link from the navigation bar.


inputs/kamacitybus190401.zip
| Agencies: | 嘉麻市 |
|---|---|
| Routes: | 30 |
| Stops: | 276 |
| Trips: | 193 |
| Shapes: | 68 |
| Effective: | April 01, 2019 to March 31, 2020 |
| Average trips per date: | 142 |
|---|---|
| Most trips on a date: | 170, on 47 service dates (Tue May 07, Wed May 08, Thu May 09, ...) |
| Least trips on a date: | 44, on 9 service dates (Sun May 05, Sun May 12, Sun May 19, ...) |
| 3 warnings | ||||
|
route_jp.txt
was not expected.route_jp.txt
comment
in file calendar_dates.txt
. This might be a misspelled column name (capitalization matters!). Or it could be extra information (such as a proposed feed extension) that the validator doesn't know about yet. Extra information is fine; this warning is here to catch misspelled optional column names.calendar_dates.txt
| service_id | date | exception_type | comment |
|---|---|---|---|
stop_name
in file stop_times.txt
. This might be a misspelled column name (capitalization matters!). Or it could be extra information (such as a proposed feed extension) that the validator doesn't know about yet. Extra information is fine; this warning is here to catch misspelled optional column names.stop_times.txt
| trip_id | arrival_time | departure_time | stop_id | stop_sequence | stop_headsign | pickup_type | drop_off_type | shape_dist_traveled | timepoint | stop_name |
|---|---|---|---|---|---|---|---|---|---|---|


Notebooks
Story: The Lion star and other stars
The Lion star and other stars
Title
The Lion star and other stars
Collection
Summary
The (two) Lions, which was the name given to us (by our first informants) for the Pointers to the Southern Cross, were formerly men, and at the same time lions (LII.-1. 277 and 278).
Comments
1) Note on the inside of the back cover of this notebook: 'Finished correcting Sept 15/71 from Jantje Toorm himself', 2) p.282v: a note on things which are 'ander' ie: different (such as the Lions), 3) See also The Lion star and The two Lions: pointers to the Southern Cross, 4) This story is found in Book II-1
Contributors
Date
19 June 1871 (started)
Categories
Celestial bodies and aeroscopy, Transformation
Keywords
star (pointers to Southern Cross) , star (the Lion star) , star (and two Lions) , star (names of) , Lions (the two) , Lions (who are stars) , Lions (who were formerly men) , Lions (the Lion star) , Lions (and |gi and |ki) , Crow (his house) , Crow (and Lion star) , Crow (and two Lions) , transformation (of Lions, men and stars) , names (the two Lions) , names (of the Lion star) , names (of stars)
Story Pages
277-284, 278v-280v


Installation Guide
1. Download the extension file from the website and save it to your computer.
2. Click the hotdog icon to bring options menu on the browser toolbar.
(if you have an old version of Chrome, the icon is a wrench)
3. Select Tools > Extensions.
4. Locate the extension file on your computer and drag the file onto the Extensions page.
5. Review the list of permissions in the dialog that appears. If you would like to proceed, click Install.
6. Plugin icon should appear. Enjoy encrypting!
Why and How
Wha...? Reading an About page is OldSchool, here, it's a video!
Sharing
All there needs to be done is to have the public key shared to the recipients, e.g. friends, is to set any secret key and hit "Generate," and another encrypted keypass will be printed below. Copy that code and send to your recipients.
Once your friend receives the passkey, paste it in the textarea above "Add Friend," and enter in the Secret key. He/she will be permanently added to your listings which will be used in the future in encrypt any messages intended for that specific friend.
We are 4 students from Toronto participating in PenApps
We would like to share you our Github, LinkedIn, Google+, Facebook, Twitter, even Instagram! However we did too many embarassing things there so here's our hackathon team submission :P
Soon when we have our PayPal set up, you can buy us caffine and alcohol!
But most probably the money is going into our "Help 4 Poor Kids with Tuition Fund"
This is a project made in PennApps 2013 Fall. Many thanks to the PennApps Staff for the event, and food.


Former Arsenal manager Arsene Wenger to help Premier League improve VAR
Arsene Wenger was handed his first job in football since he left Arsenal recently when FIFA made him their new Chief of Global Football Development
by Alex SmithThe Premier League are ready to turn to Arsene Wenger to help improve the standards of VAR.
Legendary Arsenal manager Wenger was named as FIFA's new Chief of Global Football Development earlier this month.
The Frenchman is also on the International FA Board's Football and Technical Advisory Panels - which make changes to the Laws of the Game and look at ways to improve football through its rules.
The next meeting of IFAB is on December 3 in Belfast - with Wenger scheduled to be there.
As such, Mike Riley, who is the head of referees' Professional Game Match Officials Limited, is looking forward to talking to Wenger to see how VAR can be made better.
"Arsene's appointment is a really good opportunity to talk to people and influence them. I have no doubt those conversations will be taking place," said Riley.
VAR has been a controversial addition to the Premier League since it was incorporated into the division at the beginning of the season.
Riley admitted earlier this weekend that the video review system had incorrectly overturned four decisions what he on-field red had got right.
The Gunners were on the receiving end when Sokratis Papastathopoulos' late goal was ruled out against Crystal Palace in October.
Brighton were wrongly awarded a penalty against Everton and both Manchester United and Watford should not have been handed a spot kicks versus Norwich and Chelsea respectively.
"The worst outcome is when the referee on the field makes right decision and the VAR intervenes to make wrong decision," said Riley.
"It will happen. That is part of the balance of understanding what is clear and obvious.
"Look at any country that has put in VAR, everyone has to go through a learning curve. We are going through that now."
Despite the problems, Riley is pleading with fans to give the system more of a chance.
"Let's not look at what might have happened so far," he continued.
"Let's take all these learnings and go how do we improve the system going forward because we've all got a stake in making sure that happens."


Equivalent to selecting a view and clicking the Delete button in the Custom Views dialog box, which appears when you click the Custom Views command on the View menu. In Microsoft Excel 97 or later, the Custom Views command replaced the View Manager command that was available in Microsoft Excel 95 and earlier versions. Removes a view from the active workbook.
If this function is not available in Microsoft Excel 95 or in earlier versions, you must install the View Manager add-in.
Syntax
VIEW.DELETE(view_name)
View_name is text enclosed in quotation marks and specifies the name of the view in the current workbook that you want to delete.
Remarks
VIEW.DELETE returns the #VALUE error value if view_name is invalid or if the workbook is protected.
Related Functions
VIEW.DEFINE Creates or replaces a view
VIEW.SHOW Shows a view
Return to index


One of the nice things about SQL Server Management Studio (SSMS) is that you can highlight a table name in a script and press Alt + F1 to perform sp_help on it.
Unfortunately I've never been able to use that feature as the majority of the tables in our product belong to a schema other than dbo.
On a long train journey back to York I wondered if I could solve this problem by writing my own replacement for sp_help (which I’ve called sp_help_table_schemas).
My version works by first checking the system tables to find out which schemas the table belongs to
sql
SELECT s.Name --Find the schema
FROM sys.schemas s
JOIN sys.tables t on t.schema_id = s.schema_id
WHERE t.name = 'Orders'
It then dynamically calls the standard sp_help method but this time supplying the table owner as well.
sql
SET @cmd = 'EXEC sp_help ''' + QUOTENAME(@SchemaName) + '.' + QUOTENAME(@ObjectName) + ''' ;' ;
EXEC ( @cmd )
Once I had proved the basics worked I wrapped it up into a stored procedure and deployed it to the master database on my laptop. It was then just a question of going into Tools -> Options within SSMS and defining the keyboard short cut
A couple of notes
* You can’t amend the existing Alt+F1 entry so I went with Ctrl+F1 for my replacement.
* You need to open a new query window for the change to be picked up
So I can now highlight a table name and press Ctrl+F1
The completed script is sp_help_table_schemas.sql
Thanks go to Martin Bell who reviewed my stored procedure and give some valuable advice.
(Ported from https://sqlblogcasts.com/blogs/david-betteridge/archive/2012/03/20/sp-help.aspx)


Hematology/Oncology
Garth A. Beinart, M.D.
Sumitra Chari, M.D.
Willis H. Navarro, M.D.
Outpatient therapy for venous thromboembolism
Blood products – complications
Heparin-induced thrombocytopenia
Bone marrow transplant—potential complications
BMT—acute graft vs. host disease staging and grading
Common chemotherapy side effects
1. Symptoms of anemia include fatigue, dyspnea on exertion, and even angina. Physical exam findings include pallor, tachycardia, and jaundice.
2. To generate a differential diagnosis anemia, first categorize the type of anemia (microcytic, normocytic, macrocytic) by MCV and furthermore with the ferritin and reticulocyte count. Then, exam the peripheral smear: findings on the smear will narrow your differential, suggest additional medical problems the patient may have (i.e. target cells and liver disease, spur cells and uremia with uremic platelet dysfunction), and may reveal diagnoses such as microangiopathic hemolytic anemia (MAHA) in a timely fashion. Finally, order additional tests to confirm your diagnosis and remember to get your tests before transfusing the patient.
3. Factoids:
· Hospitalized patients will drop their hematocrit 1% per day from blood draws.
· Epogen® causes hypertension if the hematocrit is raised > 35% in ESRD and does not work in the setting of iron deficiency.
· Follow the hemoglobin and not the hematocrit. The hematocrit is calculated from two measured values and has a ± 3 point range for error.
1. Work-up: order iron, ferritin, transferrin, and if possible a red cell distribution width (RDW).
2. Iron deficiency: On physical exam, look for koilonychia, atrophic tongue. Iron deficiency usually does not cause a microcytic anemia until the hematocrit drops below 30%. Ferritin is useful for diagnosing iron deficiency. The likelihood ratios are as follows: for a ferritin <15 the LR=50 in favor of iron deficiency anemia; for a ferritin <25 the LR=10, specificity of 98%; for a ferritin >100 the LR=0.1. Since ferritin is an acute phase reactant, some say it should not be used in the setting of inflammation; others say that in chronic inflammation a ferritin < 50 is highly suggestive of iron deficiency. Iron is low and transferrin or TIBC (total iron binding capacity) is high, which makes the transferrin saturation (iron divided by transferrin) low: a saturation <10% has a specificity of 88%. The RDW (reflecting anisocytosis) is high. Once you’ve made the diagnosis, rule out GI bleeding: around 60% of patients will have GI lesions. Order stool guiaics, a colonoscopy, and possibly an EGD. With treatment, the hematocrit should be normal in 2 months; continue iron treatment 4-6 months to replete stores. Common side effect of oral iron is constipation. IV iron available if patient refractory to PO, but has increased risk of anaphylaxis. Each PRBC transfused contains 200 mg elemental iron.
3. Sideroblastic anemia: hereditary cases are usually microcytic while acquired sideroblastic anemia may be normocytic. Acquired causes include lead, INH, EtOH, B6 deficiency. Basophilic stippling and dimorphic RBC morphology is seen on peripheral blood smear.
4. Thalassemia: The Mentzer index may be helpful: (MCV/RBC count) < 13 favors thalassemia over iron deficiency. This test has a high sensitivity but low specificity. Basically in iron deficiency, the marrow can’t produce RBCs and they’re small so the RBC count will be low along with the MCV. In thalassemia, RBC production is preserved, though the cells are small and fragile. So the RBC count is normal with a low MCV. This concept may be more helpful than remembering the Mentzer index. The RDW in thalassemia, unlike iron deficiency, is normal and may be a more accurate discriminant function in differentiating between the two. Make the diagnosis of beta-thalassemia with hemoglobin electrophoresis. Alpha-thalassemia will not show up on electrophoresis: it is diagnosed by molecular diagnostic techniques. Order an “A-thal” on the lab slip. Think of Alpha thalassemia in Asians. Beta thal in Meditteraneans. Differential diagnosis for target cells on smear: beta thalassemia, hemoglobin C disease, liver disease, beta-lipoproteinemia. In general you should not see targets in sickle cell unless they are sickle-thalassemia or sickle-C.
5. Anemia of chronic disease: Chronic inflammatory diseases, that is, such as cancer and collagen-vascular diseases. Transferrin is decreased, saturation increased, iron low, ferritin normally increased (non specific for chronic disease). The MCV rarely falls below 78, though the patient can become microcytic because they are functionally deficient of iron.
Guyatt GH, Oxman AD, Ali M, Willan A, McIlroy W, Patterson C. Laboratory diagnosis of iron-deficiency anemia: an overview. J Gen Intern Med. 1992 Mar-Apr;7(2):145-53.
1. Reticulocytes:
2. Decreased reticulocyte count:
· Primary bone marrow failure:
- Aplastic anemia/red cell aplasia: diagnosed by bone marrow biopsy.
- Myelophthisis: (replacement of the bone marrow) tear drops on smear
- Myelodysplastic syndrome
· Secondary bone marrow failure:
- Anemia of chronic disease: Normal or increased platelets and WBCs support this is the diagnosis.
- Iron, B12, folate deficiency (nutritional deficiency)
- Chronic kidney disease: use erythropoeitin when the creatinine clearance drops below 30 ml/min.
- Hypersplenism: usually anemia is concomitant with mild pancytopenia.
- Hypothyroidism: especially in the elderly
- Multiple myeloma: check SPEP, UPEP
- HIV/AIDS
- Mixed: e.g. an alcoholic with megaloblastic anemia from folate deficiency, and iron deficiency from GI bleeding. The MCV is normal, but the RDW is increased reflecting anisocytosis (cells of varying sizes).
4. Increased reticulocyte count: check smear for schistocytes (intravascular hemolysis) and/or spherocytes (extravascular hemolysis).
· Acute blood loss: If you can’t find a source, don’t forget to rule out occult retroperitoneal bleed.
· Correction: of a production deficit. Peak MCV at 7-10 days.
· Hemolysis: see below.
5. Hemolysis:
- Site of hemolysis (intravascular vs. extravascular) or
- Intrinsic (RBC defect) vs. an acquired extrinsic mechanism (where transfused cells will have a shortened life span).
- Send LDH, total and direct bilirubin, and possibly haptoglobin (level < 25 is 96% specific for hemolysis). A normal LDH and haptoglobin > 25 helped rule out hemolysis in one small study. Haptoglobin overall is not very useful as it takes one week to return, is an acute phase reactant, and is very sensitive (leading to decreased specificity).
- Hypersplenism
- Antibody-mediated: warm (IgG) vs. cold (IgM) think Mono, Mycoplasma;check Coomb’s. Spherocytes are on the smear. Drugs are a big offender as well.
- Trauma/ Red Cell fragmentation: heart valve, hemodialysis, malignant HTN, vasculitis, HELLP, cardiopulmonary bypass, TTP/HUS, DIC. Look for schistocytes and helmet cells (even 1-2 per HPF), and spherocytes. Remember: DIC increases INR and PTT, HUS and TTP do not.
- Infection/toxin: malaria, babesiosis, clostridia, brown-recluse, copper (Wilson’s disease).
· Intrinsic defects: all are hereditary except PNH.
- Membrane: Hereditary spherocytosis, hereditary elliptocytosis.
- Enzyme: e.g. G6PD deficiency: normal smear and Coomb’s. Check G6PD levels, which may be normal after an acute hemolytic episode or post transfusion. Consider this in HIV patients, particularly African Americans, taking PCP prophylaxis. Although this is X-linked recessive, it may still occur in females due to lyonization.
- Hemoglobinopathy: sickle cell, thalassemias, Hgb C, Hgb E.
- PNH: complement-mediated lysis. Consider with pancytopenia, unexplained thrombosis (especially intra-abdominal) and an elevated reticulocyte count and LDH. A rare diagnosis.
Marchand A, Galen RS, Van Lente F. The predictive value of serum haptoglobin in hemolytic disease.
JAMA. 1980 May 16;243(19):1909-11.
1. Megaloblastic: hypersegmented neutrophils (> 5% of neutrophils with 5 lobes or > 1% with 6 lobes) are seen on the smear. An MCV > 120 is almost pathognomonic for megaloblastic anemia. Ovalocytes may be seen, but are nonspecific. On physical exam, look for atrophic tongue.
· B12 deficiency: diagnose with serum B12. This value may be falsely decreased secondary to folate deficiency or type 1 cryoglobulinemia (e.g. multiple myeloma, Waldenstrom’s macroglobulinemia). Look for subacute combined degeneration. Can send homocysteine and methylmalonic acid. Schilling test to look at source of deficiency. May have pancytopenia.
· Folate deficiency: diagnose with RBC-Folate level. (Serum folate fluctuates and is a poor proxy for folate stores). May be falsely low secondary to B12 deficiency.
· Drug-induced: chemo, methotrexate (MTX), hydroxyurea, azathioprine, etc.
· Note: repletion of vitamin B12 should always accompany folate and iron therapy until you are sure the patient does not have multiple deficiencies, in order to avoid aplastic-type crisis and/or high output CHF. In addition, folate may partially correct the megaloblastic anemia of B12 deficiency while the neurologic symptoms progress.
2. Non-megaloblastic: MCV < 110 in most cases.
· Alcoholism: most common cause of macrocytic anemia.
· Liver disease
· Hypothyroidism
· Reticulocytosis: although the reticulocyte MCV is 160 microns, reticulocytosis rarely causes an MCV above 110. Polychromasia is seen on smear.
· Spurious: hyperglycemia and hypernatremia, secondary to osmotic swelling.
· Aplastic anemia
· Myelodysplastic syndromes: giant platelets, hypogranulated neutrophils, bi-lobed neutrophils.
· Drugs: anticonvulsants, AZT.
Hoffbrand V, Provan D. ABC of clinical haematology. Macrocytic anaemias. BMJ. 1997 Feb 8;314(7078):430-3.
1. See also Pulmonary: Pulmonary embolism.
2. Over 9 in 10 pulmonary emboli originate from DVTs, and the treatment of PE and DVT are usually identical.
3. DVTs are associated with calf pain and tenderness. Homan’s sign—pain when dorsiflexing the foot with the knee extended—is neither sensitive nor specific and should be abandoned.
4. DVT prophylaxis should be addressed in all inpatients. Encourage early ambulation and order physical therapy when indicated. Obtain prophylaxis with sequential compression devices, low dose ultrafractionated heparin, or low molecular weight heparin (e.g. enoxaparin). See also Medical Consultation: DVT/PE prophylaxis.
5. Simple clinical model to diagnose DVT:
· Give the patient one (1) point for each of the following (if they are present): active cancer, immobilization, bedridden > than 3 days due to surgery, localized tenderness, entire leg swelling, asymmetric > 3 cm calf swelling, pitting edema, or collateral superficial veins (nonvaricose).
6. Work-up of suspected DVT:
· D-dimers: very useful if your local hospital has the ELISA test which is very sensitive (good for ruling out DVT). Some labs use the latex agglutination test, which is only 85-90% sensitive. Thus, in a patient with a non-diagnostic V/Q scan (for PE) or Doppler ultrasound (for DVT), a negative D-dimer (ELISA method) means it is probably safe not to anticoagulate if your clinical suspicion is low or moderate.
· Doppler ultrasound: This test is better at detecting DVTs above the knee (which, in fact, are the clinically significant ones as clots below the knee rarely cause pulmonary embolism). Ultrasound is 50% sensitive in an asymptomatic individual, and therefore cannot be used to rule out PE. Ultrasound is also less sensitive than venogram for calf DVT.
7. Hypercoagulability work-up:
· It is not necessary to begin the work up of anticoagulation at the time of the clot: the results won’t change your management and will take a while to come back anyway; therefore, consider an outpatient work-up.
· Guidelines for hypercoagulability work-up:
- Draw an extra blue top tube before starting heparin or warfarin if you suspect a hypercoaguable state: heparin will interfere with assays for antithrombin III and the lupus anticoagulant.
- Protein C, S, anticardiolipin antibodies, homocysteine, prothrombin 20210A, Factor V Leiden, and MTHFR mutations (leading to hyperhomocysteinemia) can be sent when patients are taking heparin. Note that Proteins C and S are vitamin K dependent factors and will be lowered by warfarin therapy.
- AT III, Protein C, and Protein S may be transiently depressed during the acute event, and only persistent lupus anticoagulants are associated with hypercoagulability. Therefore, repeat abnormal tests later to make an accurate diagnosis.
- Note that there is not a consensus that all patients with unprovoked DVT/PE should have a hypercoagulability work-up. The most common defects are not associated with recurrent disease, and the ones that are, are uncommon. A targeted work-up is likely a more reasonable approach (e.g. send antiphospholipid antibody as persistent lupus anticoagulant is associated with venous/arterial recurrence and may require a higher INR goal for warfarin therapy).
8. Treatment: typically involves heparin (or enoxaparin) and warfarin. Some advocate giving patients heparin for 5 days, even if their INR becomes therapeutic in less than 5 days. Patients should be therapeutically anticoagulated as soon as possible (within 24 hours). Thus, it is better to overshoot and risk bleeding than to undershoot and risk further embolic/thrombotic events. See Hematology/Oncology: Heparin and Hematology/Oncology: Warfarin (below).
Anand SS, Wells PS, et al. Does this patient have deep vein thrombosis? JAMA. 1998 Apr 8;279(14):1094-9.
Seligsohn U, Lubetsky A. Genetic susceptibility to venous thrombosis. N Engl J Med. 2001 Apr 19;344(16):1222-31
Hyers TM, Agnelli G, et al. Antithrombotic therapy for venous thromboembolic disease. Chest. 2001 Jan;119(1 Suppl):176S-193S..
· Surgery, trauma, or stroke within the previous 14 days.
· History of peptic ulcer disease, GI bleeding or GU bleeding.
· Platelets < 150K.
· Age > 70 years.
· Hepatic failure, uremia, bleeding diathesis, brain metastases.
2. When to use low molecular weight heparin (enoxaparin): LMWH eliminates the need to monitor PTT and adjust dosages. You may send selected patients home with enoxaparin and warfarin, rather than keeping them in-house on heparin for 5 days or until they are therapeutic on warfarin (see Hematology/Oncology: Outpatient therapy for venous thromboembolism). Moreover, LMWH is associated with a lower incidence of heparin-associated thrombocytopenia. Regular, ultrafractionated heparin is preferable when:
3. Consider a hematology consult before using LMWH in the following situations:
· Weight > 150 kg.
· Creatinine > 2, or creatinine clearance < 30 ml/min.
· Pregnancy.
4. For heparin sliding scale, see Sliding Scales: Heparin.
Hirsh J, Warkentin TE, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001 Jan;119(1 Suppl):64S-94S.
1. Give the warfarin on day one of heparin or enoxaparin if long-term anticoagulation is desired. Usually 5.0-7.5 mg PO at night (to ensure absorption on an empty stomach) on Day 1, then 2.5-7.5 mg PO QHS (most often 5 mg). Increase in the INR of > 0.3-0.4 units per day should result in a dose reduction (otherwise an INR overshoot is likely).
2. Goal for INR:
3. Information about the patient's past warfarin dosing history will help you titrate appropriately. Congestive heart failure, liver disease, vitamin K deficiency and certain medications influence warfarin response. Tailor the duration of warfarin therapy to the individual and the indication – usually three months to life.
Hirsh J, Dalen J, et al. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 2001 Jan;119(1 Suppl):8S-21S.
1. Indications:
· Clinically stable patients with DVT or PE documented with imaging study.
· Patients must be motivated and interested in home self-injection and frequent follow-up.
2. Contraindications:
· Co-morbid conditions: Active peptic ulcer disease, bleeding in last 14 days, brain metastases, CVA in last 10 days, blindness, CNS or cord injury/surgery in last 10 days, family bleeding diathesis, patient weight <35 kg, platelets < 80K or fall of > 40%.
· Anesthesia: Spinal or epidural anesthesia in past 3 days.
· Medication conflicts: prior sensitivity to heparin, concomitant thrombolytic therapy, need for high-dose NSAIDs other than ibuprofen, naproxen, or Celebrex®. Vioxx® may result in warfarin sensitivity.
· Cognition problems: inability to maintain diary, inject medications, reliably follow medication schedules, recognize change in health status, or understand directions from home health team.
3. Initial therapy: enoxaparin (1 mg/kg SQ q12h) plus warfarin (5 mg PO qhs; 7.5 mg PO qhs if > 85 kg).
4. Maintenance algorithm:
· Continue enoxaparin until patient has received five days of enoxaparin and has two consecutive INR > 2.0.
· Adjust warfarin to keep INR in desired range.
· Check PT/INR frequently after day 2 until patient is on stable dose of warfarin.
1. Differential diagnosis for prolonged PT: warfarin, liver disease, poor nutrition, vitamin K deficiency (antibiotics, nutritional, fat malabsorption), deficiency or inhibitor for factors II, V, VII, or X, DIC, heparin bolus.
2. Differential diagnosis for prolonged PTT: heparin, congenital deficiency of VIII, IX, XI, von Willebrand’s disease, anti-phospholipid antibody, inhibitor to any factor except VII, liver disease, DIC.
3. Use oral vitamin K to correct mild to moderate PT prolongation. Correction occurs within 10-12 hours. Subcutaneous vitamin K is as good as IV vitamin K, minus the risk of anaphylaxis.
4. FFP lasts 4-6 hours (need to give concomitant vitamin K).
5. Bebulin is a plasma-derived concentrate of factors II, VII, IX, and X. It should be used in life threatening bleeds associated with warfarin. Dose Bebulin ~50 U/kg IV push (need to give concomitant vitamin K).
6. For heparin associated bleeding:
· Unfractionated heparin: Protamine 1 mg for every 100 units heparin given. Dose by adding the amount given during each prior hour divided by 2 number of hours back. For example, a patient on a heparin drip at 500 units/hour for 3 hours (without a bolus) would have approximately (500/20)+(500/21)+(500/22) = 500 + (500/2) + (500/4) = 875 units of circulating heparin. Therfore, the patient should be given 8-9 mg of protamine.
· Enoxaparin: 1mg:1mg. Protamine may reverse 40-50% of the drug effect.
|
INR |
Bleeding |
Vitamin K |
FFP |
|
Normal – 5.9 |
None |
Not indicated |
Not indicated |
|
6.0 – 9.9 |
None |
Oral: 0.5 – 2.5 mg SC: 0.5 – 1.0 mg |
Not indicated |
|
> 10 |
None |
SC: 3 mg total, in divided doses of 1 mg |
Not indicated |
|
> 20 |
Yes |
SC: 10 mg |
10 – 20 cc/kg |
1. Tips:
· Keep hematocrit > 24%
· Keep platelets > 75K
· FFP may be helpful if bleeding occurs in the setting of an elevated INR
2. Therapies:
· Dialysis
· Conjugated estrogen 0.6 mg/kg IV QD x 5 days
· DDAVP 0.3 mcg/kg IV q12 hours x 2
1. Premeds: consider pre-medicating with Benadryl 25 mg PO/IV and Tylenol 650 mg PO/PR before each unit.
2. Packed red blood cells (PRBC):
· Most plasma removed. One unit should raise the hematocrit by 3 points or hemoglobin by 1 g/dL.
· Leuko-poor/leuko-filtered red blood cells have most WBCs removed to make it less antigenic. Use in patients prone to transfusion reactions and in patients requiring multiple transfusions (bone marrow transplant, leukemia, chemotherapy).
· Washed red blood cells have WBC almost all removed. Use as for leuko-poor RBC; note that they are more expensive. Used for patients with allergic reaction to transfusions.
· Irradiated blood cells have lymphocytes killed, decreasing likelihood of graft-versus host disease (GVHD) in bone marrow transplant patients.
· CMV negative blood used for patients who are CMV negative and are pre-transplant or post-transplant.
3. Platelets:
· A 6-pack should ideally raise platelet count by 50-60K; For dysfunctional platelets (e.g. in uremia), DDAVP is usually given at 0.3 mcg/kg IV q12-24 hours x 2. Do not correct platelets for paracentesis.
· Indications:
- Platelets < 10-20K for non-bleeding patient.
- Platelets < 50K for bleeding, pre-op, or pre-procedure.
- Platelets < 75K for uremic bleeding patients.
- Platelets < 100K for CNS or intraocular bleed.
· Cross-matched platelets may be used when patient has been sensitized to random-donor platelets and no longer bumps their platelet counts after transfusion; cross-matching typically takes at least 1-2 days as well as lab medicine approval at most institutions.
· Always check a 1 hour post-transfusion platelet count to ensure a response and to monitor for alloimmunization.
4. Fresh frozen plasma (FFP):
· A high PT is frequently encountered in end-stage liver disease. It is generally okay to leave a high PT alone when a patient is not bleeding. For those with refractory bleeding, use an FFP drip—the half-life of FFP is about 4-6 hours.
· FFP is indicated if the PT > 18 seconds and is associated with bleeding or planned procedures.
· Contains factor VIII, von Willebrand factor, and fibrinogen.
· Use is generally reserved for patients with quantitative fibrinogen deficiency (e.g. DIC) and qualitative fibrinogen deficits (e.g. acquired dysfibrinogenemia associated with liver disease). Its use in patients with hemophilia A (factor VIII deficiency) and von Willebrand disease has been supplanted by the use of specific factor products that are safer and more efficacious.
· Advantage: you can replete with less volume than FFP.
1. Work-up: for all transfusion reactions consider a workup for a hemolytic reaction: blood cultures and hemolysis labs, including purple top for Coombs and red top for repeat type and cross. The blood bank is required to investigate and will help. The different types of reactions are listed below.
2. Acute hemolytic transfusion reaction:
· Preexisting anti-RBC antibodies in the recipient hemolyze donated blood. Usually caused by ABO incompatibility due to a clerical error. Fever and hypotension occur early in the transfusion; chills, flank pain, and dyspnea may occur.
- Stop blood product immediately, as little as 30 cc can be fatal.
- Provide hemodynamic and renal support.
- Maintain diuresis with IV fluids and furosemide; consider alkalinization of urine with bicarbonate to prevent renal failure. Watch K+, CK.
3. Delayed hemolytic transfusion reaction:
· An extravascular immune-mediated process mediated by noncomplement-binding IgG. Ideally, the “screen” portion of the type and screen will identified patients susceptible to this complication. Fever, jaundice, and anemia occur 2 days to 2 weeks after transfusion.
4. Anaphylaxis:
· This is different from an acute hemolytic reaction. Interestingly, the reaction is not IgE mediated, but caused by immune-complex activation of complement – by “anaphylatoxins.” Symptoms are anaphylactoid, occur early in transfusion, and include laryngeal edema.
- Stop the transfusion
- Give epinephrine and steroids
- Wash subsequent blood products, and avoid FFP
5. Bacterial contamination:
· Look for endotoxemia—the onset of high fever/shock within 4 hours of transfusion. Platelets are far more likely to be contaminated with bacteria than blood, because they are stored are room temperature.
6. Acute lung injury:
· i.e. “noncardiogenic pulmonary edema”. Also termed “TRALI”—transfusion-related acute lung injury. This is caused by donor antibodies against recipient WBCs. Respiratory failure occurs within 6 hours of transfusion and treatment is supportive.
7. Febrile nonhemolytic transfusion reaction:
· This is characterized by fever > 1° C during or within 2 hours of completing transfusion. It occurs with 1 in 5 platelet transfusion reactions and is of limited clinical significance. It is questionable whether it is necessary to discontinue the transfusion. Caused by antibodies against foreign donor leukocyte antigens.
8. Urticarial reaction:
· Some say it is okay to continue transfusion if the patient responds to antihistamines. Again, this is different from—and does not progress to—an anaphylactiod reaction.
· For nonhemolytic reactions:
- Benadryl 25-50 mg and Tylenol 650 mg for mild transfusion reactions.
- Hydrocortisone 50-100 mg IV for moderate and severe reactions.
1. If patient has HIV, see Infectious Diseases: HIV and fever.
2. Non-bone marrow transplant patients:
· Obtain blood culture x 2, urine culture, sputum Gram stain and culture, C. difficile toxin if patient has been on antibiotics, and CXR.
· Order neutropenic precautions (no rectals, no flowers, no fruit), neutropenic diet, mouth care with Peridex 10 cc sw/sp bid, Nystatin 10 cc sw/sw qid or Mycelex troche 1 qid, and Tylenol 650 mg q 4-6 hour prn.
· Consider monotherapy with broad-spectrum antibiotics such as ceftazidime, cefipime or anti-pseudomonal beta-lactam. Cover for Gram negative bacteria including Pseudomonas. Also cover Gram positives such as Staph aureus and Strep viridans.
- If prolonged neutropenia, consider fungal infection and adding amphotericin B (typically 1 mg/kg IV qd).
- For nosocomial acquisition, suspected IV catheter infection, known colonization with MRSA/PRSP, (+) blood culture for Gram positive cocci, or a hypotensive patient, consider covering MRSA by adding vancomycin.
- Double-cover documented Pseudomonas by adding an aminoglycoside or a fluoroquinolone, such as ciprofloxacin. The fluoroquinolone is preferable given the renal toxicity of aminoglycosides.
Your hospital staff typically know these patients well. Often, the patient’s primary physician has contracted with the patient for an individualized pain protocol. Consider consultation with the hematologist or pain service to get the exact details (if they exist). Don’t be surprised by massive opiate tolerance and the need to rapidly escalate the analgesia dose required for relief: remember, physicians typically under-treat pain. Unlike most opioids, such as morphine and oxycodone, codeine and hydrocodone have ceilings beyond which increasing doses will not result in increasing analgesia.
1. Tips:
· Stroke, MI, persistent priapism, or intractable pain characterize acute vaso-occlusive crises. Exchange transfusion is indicated in these cases. Also, multi-organ failure requires urgent exchange transfusion.
· If patient with frequent episodes of pain crisis, consider hydroxyurea as prophylaxis.
· IV: moderate hypotonic (e.g. D5½NS) hydration. Aggressive hydration can lead to or exacerbate acute chest syndrome.
· DIET: NPO; advance diet as tolerated.
· NURSING: O2 0-4 L/min by NC. (If respiratory status is compromised, remember acute chest syndrome. A new pulmonary infiltrate, fever, chest pain, cough, tachypnea and cough are characteristic).
· LAB: CBC, reticulocyte count, cultures, electrolytes, BUN, creatinine, bilirubin, U/A, CXR. Draw red-top tube for type and hold. (If patient is to be transfused, alert the blood bank that the patient has sickle cell disease; these patients will be screened more thoroughly to avoid alloimmunization associated with frequent transfusions).
· MEDS:Folic acid 1 mg PO QD and analgesic du jour. Avoid Demerol: these patients will inevitably require huge doses, and are at greatly increased risk of seizures.
3. Try to determine precipitating factor(s): stress, dehydration, drug use, infection, hypoxia, MI, etc. Although, remember that many of these patients come in and out of the hospital for "routine" pain crises without specific precipitants. While pain crises often present with non-specific elevations in WBC and low-grade fevers, there always is the potential for something bad to be going on. Therefore complete work up of concomitant infection is important.
4. Acute chest syndrome: This is one of the dreaded complications of sickle cell disease and a leading cause of death in adults with this disease. You should think of this diagnosis in any patient with cough, chest pain, wheezing, shortness of breath, fever, and/or new infiltrate on CXR who has a history of sickle cell disease. Etiology is not fully known, but thought to involve micro/macro vascular infarction, pulmonary fat emboli, and concurrent viral/bacterial infection. Management primarily consists of supportive care, bronchodilators, treatment of coexisting infection, and transfusions if needed. In addition, a simple transfusion may be adequate, but if the patient’s clinical situation worsens an exchange transfusion may be needed.
Vichinsky EP, Neumayr LD, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med. 2000 Jun 22;342(25):1855-65.
1. Defined as platelet count < 150K. Generally, platelets > 50K are not associated with significant bleeding, and spontaneous bleeding rarely happens with platelets >10-20K in the absence of coagulopathy or qualitative platelet defect.
· Avoid intramuscular injections, rectal exams, suppositories, and enemas.
· Avoid drugs that interfere with platelet function (e.g. NSAIDs/ASA, certain beta-lactam antibiotics).
2. History: “B”-symptoms (such as fevers, night sweats, weight loss), GI bleed, epistaxis.
3. Physical examination: look for lymphadenopathy, splenomegaly, ecchymoses, petechiae, purpura. Petechiae indicate a significant risk for intracerebral hemorrhage.
4. Labs: peripheral smear, PT/PTT, LDH (MAHA), BUN/Cr (HUS/TTP). Get HIV, ANA when indicated, and consider toxoplasmosis, EBV, and CMV serology if lymphadenopathy, splenomegaly, or “B”-symptoms are detected.
- Aplastic anemia
- Megaloblastic anemia: B12 or folate deficiency
- Hematologic malignancies: myelodysplasia, leukemia, myeloma
- Marrow infiltration: lymphoma, myelofibrosis, metastatic tumor, TB, Gaucher's disease
- Drug-induced: EtOH, thiazides, estrogens, Septra, chemotherapy, cimetidine, famotidine
- Paroxysmal nocturnal hemoglobinuria (PNH): rare and associated with pancytopenia.
- Infections: mono, influenza, rubella, hemorrhagic fever, sepsis.
· Increased Destruction: classically associated with large platelets on the smear.
- Immune mediated:
o ITP: sending platelet associated antibody has low sens/spec, treat with steroids, IVIG, splenectomy
o Neoplasia-associated: CLL
o Drug-induced: quinidine, heparin (HIT), rifampin, sulfa, indomethacin, gold
o SLE, RA
o HIV-associated thrombocytopenia
o Post-transfusion purpura
- Non-immune mediated:
o DIC: increased PT/PTT and D-dimers, decreased platelet/fibrinogen, hemolytic anemia, prosthetic valves.
o HUS
o TTP: always increased LDH. Decreased platelet, and normal PT/PTT.
o Pre-ecclampsia/ecclampsia
o Toxic shock syndrome
o Vasculitis
o Infections: rickettsia, CMV, EBV, malaria, sepsis, etc.
· Pseudo-thrombocytopenia: Blood clumping on CBC, need to check smear to rule out
George JN, Raskob GE, et al. Drug-induced thrombocytopenia: a systematic review of published case reports.
Ann Intern Med. 1998 Dec 1;129(11):886-90.
|
|
Type 1 |
Type 2 |
|
Frequency |
10-20% |
1-3% |
|
Timing |
1-4 days |
5-10 days |
|
Nadir of platelet count |
100,000 |
30-55,000 |
|
Antibody mediated |
No |
Yes |
|
Thromboembolic sequelae |
None |
30-80% |
|
Hemorrhagic sequelae |
None |
Rarely |
|
Management |
Observe |
Discontinue heparin and start alternate anticoagulant. |
Brieger DB, Mak KH, Kottke-Marchant K, Topol EJ. Heparin-induced thrombocytopenia. J Am Coll Cardiol. 1998 Jun;31(7):1449-59.
|
Days post-BMT |
Complication |
|
-7 to 21 |
Toxicology of preparative regimens (nausea, vomiting, diarrhea, alopecia, mucositis, renal failure, skin breakdown, ARDS, cardiomyopathy) |
|
0 to 21 |
HSV reactivation, hepatic veno-occlusive disease |
|
0 to 28 |
Diffuse alveolar hemorrhage, particularly at engraftment |
|
0 to 49 |
Bacterial and fungal infections |
|
28 to 70 |
CMV infection |
|
14 to 100 |
Acute GVHD |
|
49 to 100 |
Interstitial pneumonitis |
|
100 to 180 |
Chronic GVHD, VZV, PCP |
|
Stage |
Skin |
Liver (total bilirubin) |
GI |
|
1+ |
maculopapular rash on < 25 % of BSA |
2-3 mg/dl |
diarrhea 500 – 1000 cc/day |
|
2+ |
maculopapular rash on 25-50 % of BSA |
3-6 mg/dl |
diarrhea 1000 – 1500 cc/day |
|
3+ |
generalized erythroderma |
6-15 mg/dl |
diarrhea > 1500 cc/day |
|
4+ |
generalized erythroderma and desquamation |
> 15 mg/dl |
severe abdominal pain ± ileus |
Use staging information above to determine clinical grade on chart below:
|
Clinical grade |
Skin |
Liver |
GI |
Decrease in clinical performance |
|
I |
1+ to 2+ |
0 |
0 |
None |
|
II |
1+ to 3+ |
1+ |
1+ |
Mild |
|
III |
1+ to 3+ |
2+ to 3+ |
2+ to 3+ |
Marked |
|
IV |
2+ to 4+ |
2+ to 4+ |
2+ to 4+ |
Extreme |
Armitage JO. Bone marrow transplantation. N Engl J Med. 1994 Mar 24;330(12):827-38.
1. Cord compression: see Neurology: Cord compression for more details. Remember early treatment is key—dexamethasone, radiation, and neurosurgical evaluation.
2. Neutropenic fever: see Hematology/Oncology: Neutropenic fever.
3. Cerebral metastases: can present as headache, seizures, altered mental status, or focal deficit. Common in breast and lung cancer. Diagnose with head CT. Treat with dexamethasone, radiation, and possible surgery. With edema, mass effect, and/or midline shift, consider measures to control the rise in intracranial pressure (ICP) such as mannitol and hyperventilation.
4. Carcinomatous meningitis: may present as seizures, focal neurologic deficits, peripheral neuropathy, or altered mental status. Occurs most often with breast cancer, lymphoma, and leukemia. Diagnose with spinal fluid cytology. Treat with intrathecal chemotherapy or whole brain radiation.
5. Superior vena cava (SVC) syndrome: presents with facial and/or upper extremity edema as well as dyspnea on exertion. Commonly seen with lung cancer and lymphoma. Diagnose with CT scan (gold standard). Treat with radiation and/or chemotherapy based on tumor type. Surgery is often risky and dangerous.
6. Hypercalcemia: Presents gradually with fatigue, anorexia, constipation, polyuria, and confusion.  Treat with hydration, lasix, calcitonin and pamidronate if needed. See also Acid-base/Electrolytes: Hypercalcemia.
7. Tumor lysis syndrome: findings include potassium, phosphorous, uric acid, creatinine, and ¯ calcium. Often occurs with tumors that are bulky and very chemotherapy-sensitive. Seen often in Burkitt’s lymphoma. Prevent with hydration and allopurinol. If patient develops syndrome, treat electrolyte abnormalities and continue hydration and allopurinol.
8. Hyperviscosity: patients present with nonspecific CNS symptoms such as headache, dizziness, somnolence, and blurry vision. More often occurs in patient with myeloma, Waldenstrom’s macroglobulinemia, and polycythemia vera. Obtain CSF, head CT to rule out other CNS processes. Treat with hydration, phlebotomy (for polycythemia vera), and chemotherapy.
9. Leukostasis: occurs with very high white blood cell count in acute leukemias. Symptoms include hypoxia, renal insufficiency, altered mental status, and somnolence. Can worsen during induction chemotherapy. Obtain CSF and head CT to rule out other diagnoses. Treat with leukopheresis, hydration, induction chemotherapy, and possibly hydroxyurea. Avoid blood product transfusions as this might worsen symptoms. Wait until after you white blood cells have been removed by leukopheresis.
10. DIC: often occurs in patients with AML (especially M3 variant) and adenocarcinoma patients. Diagnose by PT/PTT, fibrinogen, platelet count, and D-dimers. Treat by correcting deficits—platelet transfusions, FFP, vitamin K, cryoprecipitate. Treat the underlying cause. Heparin is occasionally used to suppress the consumptive process, but the data on this is limited.
UCSF Division of Hematology/Oncology Housestaff Handbook,1998.
Brigden ML. Hematologic and oncologic emergencies. Postgrad Med. 2001 Mar;109(3):143-6, 151-4, 157-8.
See Toxicology
· For nausea and vomiting, see Gastroenterology: Nausea.
· Anthracycline antibiotics: cardiac toxicity in accumulated dose (consider evaluation with pretreatment MUGA or echocardiogram).
· Cyclophosphamide: hemorrhagic cystitis (pre-treat with mesna).
· Etoposide: fever, hypotension during infusion, metabolic acidosis after infusion.
· Cytarabine: severe mucositis, pink rash that can desquamate, renal insufficiency.
· Cisplatin: renal toxicity, potassium and magnesium wasting.
· Vincristine: peripheral neuropathy.
· Bleomycin: pulmonary fibrosis.


Microsoft PowerPoint
Q1. When you create a new, blank presentation, you begin with one blank slide. What is the layout name of this slide?
- [ ] Blank
- [x] Title slide
- [ ] Title and Content
- [ ] Title Onty
Q2. What do you use to align objects on a slide to one another?
- [ ] Layout tools
- [x] Arrange tools
- [ ] Design Ideas feature
- [ ] Picture tools
In MS PP 2019 it's called "Drawing Tools". There is no such answer but there is a function called "Arrange"
Q3. Which option must be enabled if you want to manipulate the playback of a video file during a presentation?
- [ ] Record Side Show
- [ ] Use Presenter View
- [ ] Show Playback Controls
- [x] Show Media Controls
Q4. Which feature analyzes the content of your slides and offers suggested options?
- [x] Design ideas
- [ ] Smartart
- [ ] Browse for Themes
- [ ] Add-Ins
- [ ] the Options tab
- [ ] the Home tab
- [x] the Print dialog box
- [ ] the Share tab
Should be in the printer window not in the options menu
Q6. Which tab is best for adding various types of objects to slides?
- [ ] Animations
- [ ] view
- [ ] File
- [x] Insert
- [x] all of these answers
- [ ] Pyramid
- [ ] List
- [ ] Matrix
Q8. What is NOT checked when you run the Accessibility Checker?
- [ ] reading order
- [ ] slide titles
- [ ] missing alt text
- [x] grammar Source
Q9. How can you change the appearance of a table in one click?
- [ ] Apply a cell stye.
- [ ] Apply a graphic style.
- [x] Apply a table style.
- [ ] Right-click a table and choose a new style.
Table Tools -> Design Tab -> Table Styles
Q10. Which option changes a text box so that it automatically changes shape to fit longer text?
- [x] Resize shape to fit text
- [ ] Do not autofit
- [ ] none of these answers
- [ ] Shrink text on overflow
Q11. Which three shadow properties can be adjusted in PowerPoint?
A. Focal Point
B. Depth
C. Blur
D. Angle
E. Distance
- [ ] A, B, C
- [ ] A, C, E
- [ ] B, C, D
- [x] C, D, E
Q12. You want your presentation to play continuously on screen, What option must you set?
- [ ] Use Presenter view
- [ ] Advance slides manually
- [ ] Advance slides automatically
- [x] Loop continuously until ‘Esc'
Slide Show Tab -> Set Up Slide Show -> Show options -> Loop continuously until 'Esc'
Q13. Which statement about the Compress Pictures command is true?
- [x] You can compress all images at the same time.
- [ ] You cannot delete cropped areas.
- [ ] There are no options for print output.
- [ ] You can compress only one image at a time.
Q14. You have a Word document you would like to import as an outline into a PowerPoint presentation. How should you format the text in your Word document that you want to be the slide content?
- [x] Heading Style 2
- [ ] Subtitle
- [ ] Content Style
- [ ] List 2
Highlight the content you want to use as a slide title, and select Heading 1 in Styles.
Highlight the content you want to use as the slide text, and select Heading 2 in Styles.
If your Word document contains no Heading 1 or Heading 2 styles, PowerPoint will create a slide for each paragraph in your content.
- [ ] by length
- [x] by author
- [ ] by date
- [ ] by urgency
Q16. Which Arrow Options choice will hide the mouse cursor when presenting, except when the cursor is moved?
- [x] Automatic
- [ ] Hidden
- [ ] none of these answers
- [ ] Visible
If hidden is selected the courser stays hidden no matter what.
Q17. Which chart type is best suited for displaying annual financial data for a 10-year period?
- [ ] donut chart
- [x] line or area chart
- [ ] area chart
- [ ] pie chart
Q18. If you want to create an organizational chart, which SmartArt category works best?
- [ ] Pyramid
- [ ] Relationship
- [x] Hierarchy
- [ ] Matrix
Q19. When printing multiple handouts, which option will group multipage documents together and make them easier to distribute?
- [ ] Print on Both Sides
- [ ] Uncollated
- [ ] Print One-sided
- [x] Collated
Q20. How can you adjust which data in a table is used when working on a chart?
- [ ] Click the Switch Row/Column button.
- [ ] Click the Refresh Data button.
- [x] Click the Select Data button.
- [ ] Click the Edit Data button.
- [ ] Normal view
- [ ] Reading view
- [ ] Slide Sorter view
- [x] Presenter view
Q22. A picture looks good in your slide show but pixelated when you print it. How can you fix this?
- [ ] Compress the picture and use the Print (220 ppi) resolution setting.
- [ ] Select Best scale for slide show, increase the picture resolution and resize the picture to the original size
- [x] Remove picture compression.
- [ ] Change the printer property settings to print in a higher resolution.
Personal Hint: File Tab -> Options -> Advanced -> Image Size and Quality -> Do not compress images in file File Tab -> Options -> Advanced -> Print -> High quality
Q23. You have inserted s video on a slide and want the video to automaaticlly start 2 seconods after the associated slide appears. How can you accomplish this?
- [ ] Use playback timings.
- [x] Use animation timings.
- [ ] Use animation triggers.
- [ ] Use video timings.
Q24. When inserting pictures, how can you avoid distorting the pictureif it is resized later?
- [ ] Use best scale for slide show.
- [x] Lock the aspect ratio.
- [ ] Compress the picture.
- [ ] Set the picture to be relative to the orignal picture size.
Q25. Which Protect Presentation option protects a presentation from accidental changes?
- [x] Always Open Read-Only
- [ ] Add a Digital Signature
- [ ] Encrypt with Password
- [ ] Mark as Final
Q26. How can you change colors in your presentation all at once without changing the design?
- [ ] Apply a Color Template.
- [x] Apply a Color Theme.
- [ ] Apply a Color Palette.
- [ ] Customize the Color Fills.
Q27. What function allows you to borrow slides from a presentation fro an other presentation?
- [ ] Borrow Slides
- [ ] There is no special fuction. You must use Copy and Pase
- [x] Reuse Slides
- [ ] Find Slides
Q28. What is the term used for the arrangement of elements on a slide, such as Title and Content?
- [ ] theme
- [ ] design
- [ ] sheme
- [x] layout
Q29. How would you change a list of text to a visual diagram on a slide?
- [ ] Convert to WordArt.
- [ ] Convert to Shapes.
- [x] Convert to SmartArt.
- [ ] Convert to Picture.
Q30. You need to reorder the levels of shapes on a SmartArt diagram. How can this be done
- [ ] Retype the text
- [ ] Change the shapes from rifht to left.
- [x] Promote Shapes and/or Demote Shapes.
- [ ] Move the shapes up and down.
Q31. Why would you trim a video?
- [ ] To crop the video thumbnail.
- [ ] To resize the video.
- [ ] To remove background noise in the video.
- [x] To remove some of the beginning and/or end of the video.
Q32. How would you save your layouts, colors, fonts, effects, background styles and content for others to use with their presentations?
- [x] Export the file as a template.
- [ ] Save the file as a PDF.
- [ ] Save the file as a POTX.
- [ ] Save the file as a PPTX.
Personal Hint: There are multiple file suffixes for templates (.potx, .potm, .pot).
Q33. You are creating an industrial presentation of a new software program and would like to include an image of your program. How can you use PowerPoint to do this?
- [ ] Use the Copy command.
- [x] Use the Screenshot command. (Office2019)
- [ ] Use the Print key.
- [ ] Use the Capture Screen command.
Q34. How can you add more layouts to the Layout Gallery?
- [ ] Customize the Layout Gallery.
- [x] Add Slide Layouts to the Slide Master.
- [ ] Use the Add Layouts command.
- [ ] Use the Insert Layouts command.
Q35. Why would you use the Outline view?
- [x] To see only the text in placeholders.
- [ ] To present the slides at a high level.
- [ ] To add text from a Word document.
- [ ] To organize your slides.
Q36. The text on the left and right of the slide are cut off in print preview. How can you fix this in the printer settings?
- [ ] Unselect High Quality.
- [x] Select Scale to Fit Paper.
- [ ] Select Frame Slides.
- [ ] Select Frame Slides.
Q37. In addition to organizing your slides, how else can sections increase your productivity?
- [ ] In addition to organizing your slides, how else can sections increase your productivity?.
- [x] All the slides in a section can be selected at once to apply changes such as transitions, layouts or hiding slides.
- [ ] Sections can be exported as a separate presentation.
- [ ] You can resize all the slides in a section at once.
Q38. You have many slides that you need to reorder. How would you accomplish this?
- [ ] Move the slides in Slide Show view.
- [ ] Renumber the slides in Outline view.
- [x] Move the slides in the Slide Sorter view.
- [ ] Reset the slide footers.
Q39. What can be seen in Presenter view?
- [ ] Timer.
- [ ] Notes.
- [ ] Side Navigator.
- [x] all of these answers.
Q40. How can you format the entire contents of a text box?
- [ ] Click the dashed/dotted border of the text box.
- [ ] Right-click the text box and select Select All.
- [ ] Click the Fond button on the Home tab.
- [ ] Double-click any word in the text box.
Q41. You have a large number of objects on your slide. How can you use the selection pane to help you identify the objects quickly?
- [ ] Select the show/hide icons next to the objects.
- [x] Rename the objects with meaningful names.
- [ ] Drag and drop the objects.
- [ ] Tab through the objects and note each object as it's highlighted.
Q42. How would you ensure a consistent appearance and placement across your slides even though the content might be different?
- [x] Use fonts.
- [ ] Use styles.
- [ ] Use bullet points.
- [ ] Use layouts.
Q43. How can you add icons to SmartArt?
- [ ] Select the picture icon in a SmartArt Picture Diagram.
- [ ] Select the icon in a SmartArt Icon Diagram.
- [ ] Select Insert Icon and place it on top of the SmartArt Diagram.
- [ ] Select a SmartArt shape and select Insert Icon.


--- layout: default title: Calendar description: The latest events for volunteering, classroom celebrations, festivals, performances, movie nights, and monthly parent coffee talks. ---
The latest events for volunteering, classroom celebrations, festivals, performances, movie nights, and monthly parent coffee talks.


A small collection of convenience tools for reading text documents into R.
| Version: |
0.9.0 |
| Depends: |
R (≥ 3.2.2) |
| Imports: |
antiword, curl, data.table, pdftools, readxl, rvest, striprtf, textshape, tools, utils, xml2 |
| Suggests: |
tesseract, testthat |
| Published: |
2018-09-28 |
| Author: |
Tyler Rinker [aut, cre],
Bryan Goodrich [ctb],
Dason Kurkiewicz [ctb] |
| Maintainer: |
Tyler Rinker <tyler.rinker at gmail.com> |
| BugReports: |
https://github.com/trinker/textreadr/issues?state=open |
| License: |
GPL-2 |
| URL: |
https://github.com/trinker/textreadr |
| NeedsCompilation: |
no |
| Citation: |
textreadr citation info |
| Materials: |
README NEWS |
| CRAN checks: |
textreadr results |


{{ page.content | markdownify }}
Case studies and expertise may represent projects and engagements performed by SLKone team members prior to their employment at SLKone
--- layout: default --- {% assign case-study-slug = {{page.url | remove: '/' | remove_first: "case-studies"}}" %}


- ReceiveData(IData)
- Method in class Ports.InputPortBase
-
Receive data and save it as current data
- relocateToPoint(Point2D)
- Method in class Gui.GuiBlock
-
Method that relocate block to given coordinates
- relocateToPoint(Point2D)
- Method in class Gui.GuiPort
-
Method that relocate port to given coordinates
- RemoveBlock(IBlock)
- Method in interface Workspace.IWorkspace
-
Method that removes block to the collection and unsubscribe it
- RemoveBlock(IBlock)
- Method in class Workspace.Workspace
-
- Reset() - Method in class
Blocks.BlockBase
-
Method that reset block
- Reset() - Method in
class Blocks.ClockBlock
-
- Reset() - Method in
class Blocks.CounterBlock
-
- Reset() - Method
in class Blocks.LogicalInputBlock
-
- Reset() - Method
in class Blocks.NumericInputBlock
-
- Reset() - Method in
interface Common.IResetable
-
Method that do reset procedure
- Reset() - Method in
class Ports.InputPortBase
-
Set port data to null
- Reset() - Method in
class Ports.OutputPortBase
-
Method that reset port
- Reset() - Method in
interface Workspace.IWorkspace
-
Method that reset all blocks and ports
- Reset() - Method in
class Workspace.Workspace
-
- Reset() - Method in
class Gui.WorkSpaceConnector
-
Method that reset all blocks and ports
- ResetClicked() - Method
in class Gui.RootLayout
-
Method that handle click on reset button
- Gui.RootLayout - Class in <Unnamed>
-
- Gui.RootLayout() - Constructor
for class Gui.RootLayout
-
Constructor that load xml file
- Run() - Method in
interface Workspace.IWorkspace
-
Method that do step every 500ms
- Run(int) - Method in
interface Workspace.IWorkspace
-
Method that do step every msPerTick value
- Run() - Method in class
Workspace.Workspace
-
- Run(int) - Method in
class Workspace.Workspace
-
- Run() - Method in class
Gui.WorkSpaceConnector
-
Method that do step every 500ms
- Run(int) - Method in
class Gui.WorkSpaceConnector
-
Method that do step every msPerTick value


Member
Member View
FirstName:
LastName:
Email:
Phone:
Home:
Mobile:
Postion:
Expiry:
Address:
City:
Province,Country,PostCode:
#{' '}
#{' '}


Set up a call or virtual meeting with a J.P. Morgan Advisor to discuss your investment goals and help keep them on track. Together you can create a strategy that evolves with your needs.
Call 1-800-969-3161 to speak with a J.P. Morgan team member from Mon-Fri 9 AM - 6 PM EST.
Please complete the form below or sign in as a Chase customer to have your information pre-filled. Sign in here.
LEARN MORE ABOUT OUR FIRM AND INVESTMENT PROFESSIONALS AT FINRA BROKERCHECK.
To learn more about J. P. Morgan’s investment business, including our accounts, products and services, as well as our relationship with you, please review our Guide to Investment Services and Brokerage Products.
Investing in securities involves risks, and there is always the potential of losing money when you invest in securities. Past performance is not a guarantee of future results.
JPMorgan Chase and its affiliates do not provide tax, legal or accounting advice. This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, tax, legal or accounting advice. You should consult your personal tax, legal and accounting advisors before engaging in any transaction.
Asset allocation/diversification does not guarantee a profit or protect against a loss.
Investment products and services are offered through J.P. Morgan Securities LLC (JPMS), a registered broker-dealer and investment advisor, member of FINRA and SIPC. Annuities are made available through Chase Insurance Agency, Inc. (CIA), a licensed insurance agency, doing business as Chase Insurance Agency Services, Inc. in Florida. JPMS, CIA and JPMorgan Chase Bank, N.A. are affiliated companies under the common control of JPMorgan Chase & Co. Products not available in all states.


DeepRap is a Artificial Intelligence Model that uses LSTM networks to generate Eminem lyrics.
To use the DeepRap Eminem Lyric Generator, enter at least 100 characters into the Seed Input and press Generate!
Created by Rohan Ravindran.
Linkedin: https://www.linkedin.com/in/rohan-r-74506712b/
GitHub: https://github.com/rohanrav


ParticleSystem Extensions¶
You can avoid the pain of changing values on the particle system with these extensions. Think of when you want to change a single value in the Particle System - it’s a beureaucratic process that has to ve repeated every single time you want to modify something. Repetitive code is considered bad for a number of reasons. Bugs are way more common, and it’s much harder to manage so much repeated code in many places. Issues and errors slip through much easier than in a properly managed code. More extensions and other features will be added in the future. Visit the Roadmap to know more.
Overview¶
Other Extensions
Get Help
EXTENSIONS¶
SetMainStartColor¶
There are many variants of the above mentioned methods. They do all the work of changing the starting color values in the particle system for you.
SetMainStartColor(ParticleSystem.GradientMinMax grad) - Sets the main.startColor property.
SetMainStartColorConstant(Color color) - Sets the main.startColor.constant property.
SetMainStartGradientConstant(Gradient grad) - Sets the main.startColor.gradient property.
SetMainStartGradientMax(Gradient max) - Sets the main.startColor.gradientMax property.
SetMainStartGradientMin(Gradient min) - Sets the main.startColor.gradientMin property.
SetMainStartGradientMinMax(Gradient min, Gradient max) - Sets both the main.startColor.gradientMax and main.startColor.gradientMin properties.
SetMainStartColorMax(Color max) - Sets the main.startColor.colorMax property.
SetMainStartColorMin(Color min) - Sets the main.startColor.colorMin property.
SetMainStartColorMinMax(Color min, Color max) - Sets both the main.startColor.colorMin and main.startColor.colorMax properties.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 | using NutTools;
using UnityEngine;
public class MyClass: MonoBehaviour
{
ParticleSystem system;
void MyMethod()
{
system.SetMainStartColorConstant(Color.yellow); // Single extension example.
system.SetMainStartColorMin(Color.green)
.SetMainStartColorMax(Color.white); // Chaining example.
}
}
|
GET HELP¶
Join this Discord server to get help, suggest new features, and vote on future updates!
See also
Array and List Extensions <array-and-list> GameObject and Component Extensions <gameobject-and-component> Physics Extensions <physics> Value Extensions <value>


A new directive tells police in Manila not to pick their noses whilst on duty
Police in Australia find a loaded hangun wedged in the behind of a gang linked motorcyclist
Local police on the trail of a missing inflatable dog mess
An Austrian man has won a court case enabling him to change his family name back to 'Zebra'