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Physicians' approach to end of life care: comparison of two tertiary care university hospitals in Lebanon
George Dabar1,
Imad Bou Akl2 &
Mirella Sader3
The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture.
Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data.
The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group.
Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.
The rising incidence of incurable populations spurred research into the conceptualization and characterization of optimal end-of-life (EOL) planning and enactment. Delivering optimal ethical care has become a prevailing concern in healthcare systems strained in the life-limiting context of older age and incurable chronic illness [1]. In this regard, palliative and terminal care rises in prominence as an avenue for cost-effective improved EOL medical care and quality of living [2]. EOL decisions involve consideration of preferences and priorities in terms of life prolonging or life limiting interventions, palliative treatment as well as preferred care/death settings.
Theoretically, terminal care implicates the incorporation of a premeditated medical, spiritual and psychological supportive niche for patients and their families facing life-limiting conditions. It thus falls to primary care physicians to assess patients' situations and establish optimal care strategies to limit the physical, emotional, psychological and financial burden of EOL situations on both patients and their caregivers. However, the care of terminally ill patients is fraught with ethical and medical challenges in actual practice. In the absence of advance directives from patients, healthcare professionals are often left with the daunting task of initiating and authorizing life-determining decisions. Physicians thus become surrogates for EOL decisions, funneling them through considerations of what the patient would have chosen if mentally competent (substituted judgment) or optimal patient-centric outcomes (best interest of the patient) [3].
From a caregiver perspective, a procession of deliberation, resolution and decision enactment underlies EOL decisions [4]. In the Netherlands, patient relatives implicated in EOL decisions actually seemed to exhibit more permissive attitudes towards death than physicians [5]. However, healthcare professionals, such as physicians, remain among the primary influencers of the thoughts and attitudes of patient relatives and caretakers facing decisions to withhold or stop life-sustaining medical interventions [4]. Nurses and physicians can optimize EOL experiences for both patients and their caretakers [6] and resolve decisional and religious conflicts that could arise among families [7].
Regardless, the opportunity to engage in EOL decisions before terminally ill patients lose their decisional capacity is often missed [8]. Physicians are generally held accountable for EOL decisions and continue to be challenged by various factors [9]. Among these, role ambiguity, communication issues and discussion initiation remain the most notable barriers to EOL discussions [9]. In fact, healthcare professionals in developing countries often lack confidence in their EOL care skills and shy away from initiating EOL discussions [10]. The need to improve care staff self-efficacy and confidence in aspects related to EOL patient care is thus evident, even in the context of developed countries [11, 12].
The subjectivity of surrogate EOL and treatment discontinuation decisions fuels considerable legal and moral dilemmas borne primarily by physicians. Physician-related factors , such as religiosity and education, thus contribute to existing patient-centric considerations and influence physician attitude towards the initiation and enactment of EOL decisions [5, 13]. In the middle east, cultural, religious, educational and clinical factors have all been reported to affect physician attitudes towards EOL considerations [14, 15]. However, evidence from the region remains limited, with much remaining to be explored and determined in terms of EOL decision making processes and their influencing factors in individual countries.
The present study thus aims to explore the approaches of Lebanese attending physicians towards palliative care, EOL care and patient management in two tertiary care university hospitals with distinct medical culture. Attitudes towards the limitation or discontinuation of active therapeutics in patients reaching EOL will be explored, in addition to the implication of the patient in the decisional process and the factors that could affect physician attitude.
A collaborative study was conducted between two research sites: the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF). Attending physicians from the two tertiary care academic hospitals were recruited to participate in a survey of attitudes towards EOL decisions and their contributing factors. Participants were Medical Doctors of either gender (male or female) that are practicing at AUBMC or HDF. Attending physicians must have direct contact with adult patients that could be subject to EOL situations, which excluded radiologists, laboratory medicine specialists, and pediatricians from the study.
Participants provided demographic data including age, gender as well as familial educational attainment and information pertaining to religiosity. Physicians' educational background and training setting was also explored, in addition to their attitude towards EOL care and the personal, medical or patient-centric factors that affect the ethical decision-making process in these two institutions. These include patient-related and clinical data such as the availability of advance directives, family opinion, economic considerations and patient prognosis.
Ethical considerations and data handling
The main survey tool consisted of a questionnaire targeting around 400 attending physicians at the AUBMC, 100/200 replied and at HDF 67 out of 200 answered to our solicitation over a period of four months. Primary data was collected specifically for the research paper, and no secondary data was generated or used. Data collection was completed through a three-page hard copy or digital questionnaire distributed by the primary investigators through departmental offices or by email. Study participation was strictly voluntary. Once completed, all questionnaires were submitted to the primary investigators and anonymous data containing no identifiers was used for secondary analysis. Institutional review board approval was obtained from the HDF and AUBMC ethics committees prior to the initiation of the study and all the methods were performed in accordance with the relevant guidelines and regulations. An informed consent was obtained from all the subjects who participated in the study.
Data were analyzed using SPSS software (IBM Corp., SPSS Statistics for Windows Version 26·0, Armonk, NY). Categorical variables were presented as frequencies and percentages and compared using the Pearson Chi square test. Continuous variables not departing from normality assumptions were presented as mean ± standard deviation (SD) and compared using the independent samples t-test. Ordinal variables and continuous variables departing from normality assumptions were expressed as median with interquartile range (1st quartile – 3rd quartile) and compared using the Mann-Whitney U test. All the statistical tests were 2-sided and the level of significance was set to 0.05.
One hundred practicing physicians from the AUBMC and 67 from HDF hospital participated in this study. Sociodemographic data revealed that study samples were comparable in some regards while showing distinct variability, as shown in Table 1. The male gender overshadowed female gender as approximately three quarters of physicians were males in both samples. Comparable age was reported in both study settings and participants were middle aged physicians aged close to 52 years on average. On a familial level, sibling distribution and the highest educational level of participants' mothers were similar, while highest paternal educational attainment varied significantly between the two samples, with a higher proportion of post-graduate fathers reported among physicians from the AUBMC. While the degree of religiosity was comparable in both settings, the vast majority of physicians were Christian in the HDF hospital sample (98.5%), while the AUB exhibited a religiously diverse population that remained predominately formed of Christian (35.3%) and Muslim (45.9%) physicians. As for training background, the majority of physicians practicing in HDF hospital specialized in a Lebanese/French curriculum, while their counterparts in the AUBMC predominately studied between Lebanon and the United States.
Table 1 Sociodemographic, religious, and medical training characteristics of attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) participating in the study
More than 80% of participating physicians in both samples reported having been previously exposed to Do-Not-Resuscitate (DNR) decisions. Uncertainty when handling DNR decisions was not frequent in both establishments (p=0.313). However, notable differences could be observed in the attitudes of practicing physicians in regards to EOL decisions. Physicians attending AUBMC were significantly more likely than HDF physicians to exhibit readiness to initiate and discuss DNR with patients retaining the mental competence to be involved in such decisions (68 vs 34.3%, p<0.0001). HDF physicians had a higher preference towards patient-initiated discussions regarding DNR directives when compared to their counterparts in AUBMC (43.3 vs 21%, p=0.002). The hesitancy of HDF physicians to initiate DNR decision-making was also reflected in their apparent preference of delaying DNR discussions until serious clinical deterioration and excluding the patient from these considerations.
A notable number of physicians in both AUBMC and HDF remains uncomfortable with the decision to stop or limit resuscitation. While some physicians perceived the patients to not want to be included in the decision, lack of time and refusal to discuss the prognosis with patients infrequently limited patient inclusion in both establishments. The paternalistic medicinal approach was prevalent among respondents from both groups with more than 30% of physicians in either sample believing they are better placed than the patient to make the DNR decision. In addition to lack of physician comfort, the most frequent barriers to patient participation in DNR decision in AUBMC were reported to be acting upon family wishes to exclude patient from decision (46.2%), and personal belief that the experience will be traumatic to the patient.
While generally comparable, the barriers preventing the inclusion of patients in DNR decisions showed some distinct variability between study group. Physicians from the HDF were significantly more likely to refuse patient involvement based on family wishes than AUBMC physicians (71.9 vs 46.2%, p<0.0001). Moreover, HDF physicians were more likely to exclude patients from the decision in order to spare them from a traumatic and anxiety-inducing situation (42.9 vs. 32.7%, p=0.003), further highlighting the paternalistic predilection of this group. While approximately 15% of physicians attending AUBMC considered patient ethnicity, culture, religion or other patient characteristic when handling DNR decisions, HDF physicians were more likely to consider them limiting factors in regards to patient participation (24.6%, p=0.016)
Table 2 also presents perceptions of attending physicians regarding the role or implication of medical staff, be it the attending physician or the medical team in general, on DNR decisions. Physicians from either establishment agreed on the importance of the attending physician's opinion when it comes to DNR decisions. In fact, close to 40% of physicians accorded high importance to the attending physician's opinion, while 28.6 and 34.8% of respondents from AUBMC and HDF, respectively, thought it was fundamental. On the other hand, physicians did not exhibit comparable opinions regarding the role of the medical team in DNR decisions. Physicians from the HDF seemed to accord more value to the medical team's opinion than their counterparts in AUBMC, where approximately 16% of physicians thought it was of little importance.
Table 2 Physician experience, attitude and barriers to EOL decisions, such as DNR, among practicing physicians in the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) participating in the study
In regards to patient-related factors (Table 3), the opinion of a patient's family was considered very important by 44 and 31.3% of physicians from the AUBMC and HDF, respectively. More than 70% of both samples agreed that previous directives from the patient were fundamental to the DNR or active treatment discontinuation decisions, with no physicians considering it inconsequential. However, significant inconsistencies could be observed in medical and clinical aspects pertaining to these EOL decisions. In fact, physicians from the HDF were more concerned about patients' life expectancy when formulating their attitude towards EOL decisions. This was evidenced on the level of both pre- and post-admission life expectancy, while the same variations were not extended to patients' quality of life. Concerning the latter, comparable results were reported in both samples, where high importance was accorded to pre- and post-admission quality of life.
Table 3 Patient- and clinical-related factors affecting DNR decisions, as reported by attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) participating in the study
While gender of the patient had no implication in EOL decisions across study groups, significant differences in the perception of age and other factors could be discerned. In the AUBMC, physicians were less concerned about patient age and gravity score when formulating their EOL decisions when compared to their counterparts in HDF. Actually, almost 40% of attending physicians in HDF reported patient age to be very important in EOL decisions, compared to 16.2% in the AUBMC sample. AUBMC physicians were similarly less concerned about socioeconomic status and economic constraints. While the majority of physicians attending AUBMC thought socioeconomic status and economic issues were of little to no importance, 27.3% of HDF physicians reported economic constraints to be important influencers of their decisions.
To the best of our knowledge, the present study was the first to explore the approach of Lebanese physicians towards EOL decisions. in general, Lebanese physicians seemed to be well-versed in EOL situations, such as Do-Not-Resuscitate (DNR) decisions. Uncertainty when handling DNR decisions was infrequent in both studied establishments. Regardless, a clear preference towards patient-initiated and delayed EOL discussions could be observed in the French establishment (European training). Literature shows that hesitancy in EOL care might not be restricted to particular countries or cultures. Despite the increasing legalization of EOL practices such as euthanasia and physician assisted suicide, physician and public support of these interventions remains tentative [16]. In fact, such interventions remain widely debated and remain rarely practiced even in countries and American states where they have been legalized [17].
Consistently with our study, reluctance to initiate EOL discussions seems rampant among European physicians [18]. In fact, physicians were reported to be often ready to respond to patient requests and initiatives but hesitate to take the initiate upon themselves [18]. A study from France has shown that the reluctance of physicians towards EOL practices, such as physician assisted death and treatment withdrawal, could be mediated by their lack of training and perceived inadequate professional competence in this regard [19]. It thus becomes difficult for physicians to discern the optimal ethical and legal choice, which promotes feelings of uncertainty and ambivalence towards EOL care practices [20].
Providing training is thus critical to facilitate the navigation of the moral, ethical and practical dilemmas posed by EOL care. Evidence from the Middle East revealed that training background accounted for the variability of physician's interpretation of concepts related to EOL care, such as DNR orders [14], while inadequate training prevented effective EOL discussions [21]. Education targeting terminal care discussions could not only boost the confidence of medical professionals implicated in the care of terminally ill patients but also emphasize the importance of early EOL discussions [22]. Updating available course offerings could also help to promote patient-centric considerations of preferences in terms of EOL care and dying. Training should address the need for early individualized approaches to EOL discussion, and their integration into existing care structures [23], which would ultimately promote favorable attitudes towards EOL practices among physicians [18].
Regardless of the establishment they practiced in, Lebanese physicians reported being uncomfortable with the decision to stop or limit resuscitation. EOL care is an immature concept in Lebanon with little to no guidance provided to physicians in this regard. This could explain the attitude of Lebanese physicians seeing as insecurities among medical care staff often lead to delayed discussions with either patients or their relatives [23]. Shared decisions in the context of EOL also reflect societal, educational, cultural, and religious values in both patients and physicians. In our study, religiosity was comparable in both study samples. Religiosity was previously shown to carry a significant negative influence on the attitude of physicians towards EOL and physician-assisted dying practices [18]. This was emphasized in the Middle East, where religion was an important consideration in physicians' DNR decisions despite their exposure to Western curriculums [14]. When provided, EOL care guidance in this region must account for religious beliefs considering that its population remains deeply entrenched in religion. EOL practices such as euthanasia and assisted suicide are actually forbidden in Islam. Regardless, Islamic guidance in the form of Fatwa has accorded medical professionals with the ability to undertake DNR decisions in hopeless medical cases irrespective of family and patient preferences [24]. This could account for studies reporting that Muslim religiosity does not affect views of the religious feasibility of DNR decisions [25] and palliative medicine among physicians [26], which highlights the need to account for the capacity of other factors, such as country of origin and country of practice, to overshadow religious beliefs [25].
Paternalistic intervention overrides individual autonomy in our study despite physicians from both samples having been exposed to western curriculums and spent a considerable portion of their specialization abroad. Similarly, almost half of physicians surveyed in the middle east preferred having the ultimate authority in DNR decisions [14]. Even in Western countries, it remains debated whether palliative care and EOL practices alleviate suffering or cause it. Physicians thus continue to exhibit paternalistic and death-denying predilections, preferring life-prolonging and curative approaches to patient care [27]. Regardless, Anglo-Saxon medical professionals lean towards patient autonomy, while French physicians considering EOL decisions remain constrained by rationalistic, paternalistic, and religious traditions in addition to fears of legal prosecution [28].
As opposed to patient autonomy-oriented states, considerations of patient autonomy are disregarded in most countries in favor of delivering culturally sensitive medical care [29]. Consistently, physicians exposed to the French curriculum were significantly more likely to exclude patients from EOL decisions due to familial preferences and cultural (e.g. religion, ethnicity) considerations. This translates into physicians believing they are better placed to make the DNR decision than the patient, or even families and medical staff as was reported in Hungary [30]. Cultural and religious backgrounds most likely contribute to this paternalistic approach to EOL, seeing as similar issues are observed in religious societies such as India [31]. In Saudi Arabia, cultural factors and lack of understanding from the patient and family side were reported as notable barriers to the initiation of DNR orders and effective EOL discussions, respectively [21].
Regardless, it should be noted that paternalistic EOL practices were reported in physicians both study groups. Personal physician characteristics have been previously shown to affect attitudes towards EOL decisions [32]. In our study, physicians were predominately male and middle aged. This could have further potentiated paternalistic behavior seeing as older Arab physicians were actually reported to be more likely to perceive DNR orders as taboo and were less likely to undertake them [15]. Another of the frequent barriers to patient participation in DNR decision in our study was the personal belief that the experience will be traumatic to the patient. Avoidance of the negative psychological sequelae of EOL discussion among patients seem to be a frequent deterrent among medical care staff [22]. Physicians were reported to recognize the psycho-existential suffering that terminal illnesses carry and integrate them into their EOL decisions, albeit in variable manners [18].
Regardless, physicians from the French university were more likely to exclude patients from the decision in order to spare them from a traumatic and anxiety-inducing situation (42.9 vs. 32.7%, p=0.003), further highlighting the paternalistic predilection of this group.
Graduates from the French university were more significantly concerned by patient and clinical factors, such as prognosis, age, and gravity of disease in EOL situations, reflecting their preference of the nonmaleficence ethical approach. They also seemed more concerned about patient age, socioeconomic status and economic constraints when formulating their EOL decisions when compared to their counterparts in the American curriculum. Poor prognosis actually remains a prevalent facilitator of DNR orders and treatment discontinuation decisions among physicians in different contexts [33, 34]. Consistently, European physicians seemed to consider EOL practices such as euthanasia and forgoing artificial nutrition and hydration more favorably should patients be known to be near death [18]. This reflects the preference of Saudi Arabian outpatients, who preferred to discuss DNR directives when suffering from illness [35]. A study from Saudi Arabia showed that while medical expenses were not prevailing concerns in EOL decisions among physicians, the dignity and prognosis of elderly patients played an important role in issuing DNR orders [36]. In another study, Saudi Arabian physicians reported the implication of debilitating patient diagnosis, particularly neurological diseases, in determining the likelihood of DNR orders being issued [15]. When facing EOL situations, it seems that preparing for death while managing pain and disease symptoms are prioritized by both physicians and patients, with the latter exhibiting additional concerns of not being a burden on the family and coming to peace with God [37].
While EOL decisions are prevalent in Lebanese hospitals, they are differentially approached by attending physicians. Early physician-initiated EOL discussions are challenged in both American and French institutions in Lebanon by several clinical, personal and patient-related considerations. Paternalistic attitudes frequently preclude shared decision making and are most evident in French-oriented physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon. Supported by educational interventions promoting physician confidence and emphasizing the integration of patient autonomy, such strategies should ensure the improvement and facilitation of EOL care.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
AUBMC:
American University of Beirut Medical Center
DNR:
Do-Not-Resuscitate
EOL:
HDF:
Hôtel Dieu de France
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The authors would like to thank Nancy Al Akkary (MSc.) and Bachir Atallah (MCh) for writing and editorial assistance.
Pulmonary and Critical Care Division, Hotel Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache Achrafieh, PO Box 166830, Beirut, Lebanon
George Dabar
Pulmonary and Critical Care Division, American University of Beirut Medical Center, Beirut, Lebanon
Imad Bou Akl
Anesthesia and Critical Care Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
Mirella Sader
GD: concept, analysis, interpretation, writing. IBA: interpretation, writing. MS: interpretation, writing. All authors have read and approved the manuscript
Correspondence to George Dabar.
Institutional review board approval was obtained from the Hotel de France Hospital ethics committee prior to the initiation of the study. This research was conducted in accordance with the declaration of Helsinki and was approved by our institution ethic committee, decision letter N°CEHDF590. An informed consent was obtained from all the subjects who participated in the study. Physicians consent to participate was considered obtained if they replied to our questionnaire
Dabar, G., Akl, I.B. & Sader, M. Physicians' approach to end of life care: comparison of two tertiary care university hospitals in Lebanon. BMC Med Educ 21, 592 (2021). https://doi.org/10.1186/s12909-021-03022-x
End-of-life decisions
Terminal care
Medical culture


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Cindy Knupp joined CNU staff as the part-time Coordinator of the Presidential Leadership Program.
Yvonne Clark is a new accountant.
Brandon Austin and Karen Shuler are police officers.
Susanne Moore joins CNU staff as the Project Manager in Ferguson Hall.
Angela Boyd will be working as an Assistant Director of Admissions.
Peggy Thomas is a University Police Officer.
Chun K. Saul is an accountant in the Business Office.
Hollie R. Minidis is a new Admissions Officer.
Stevalynn R. Adams is a graphic designer.
Michelle C. Carpenter is a Public Relations Specialist.


In this clear introduction to Deuteronomy aimed for preachers, pastors and Bible students, Paul Barker covers the major themes and issues of the fifth book of the Bible. Helpful study questions at the end of each chapter provide opportunity for discussion in groups. This integral Old Testament book comes alive in this very useful guide. In Deuteronomy we discover the rich theology of the God who keeps promises, for Deuteronomy is a book which encourages and persuades us to trust in a faithful God.
About "Deuteronomy: The God Who Keeps Promises"


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Samthing Soweto admits that he struggles with reading & writing
Samthing Soweto is one of the most talented artists in this part of the world, the Akanamali hit-maker started off his career as one of the lead members on The Soil before leaving the acapella group.
Instagram.com/samthingsoweto
In a recent interview with Mo Flava, the talented musician opened about his struggles to read & write, "People don't know this about me' but I have a problem with reading and writing' so school was really tough for me. It was a nightmare but I went back nonetheless," he said.
Recommended: Buhle Ndala from The Soil is a traditional healer
He then went on to say that after he came out of jail a while back' it was hard convincing the people around him that he was a new person and that he knew that completing his education was the sign that people needed to see that he was willing to become a better person, "I finally matriculated' it was hard but I did it. I had to memorise a lot of the words and I'm constantly spelling things wrong. Even to this day' I have a real problem with that. If you read some of the things I write' you'll probably find a lot of mistakes in there."
Despite finding it challenging to read or even write, Samthing Soweto has proven that it is possible to do anything your heart desires and that makes him an inspiration.
You might also like to read: Getting to know Samthing Soweto
Image credit: Instagram/@samthingsoweto

redpajama_set_name: RedPajamaCommonCrawl


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text:
Athripsodes – owad, chruścik z rodziny Leptoceridae. Larwy prowadzą wodny tryb życia,  budują przenośne domki z piasku. Występują w rzekach (Athripsodes albifrons, Athripsodes bilineatus) oraz wodach stojących (Athripsodes aterrimus).

Gatunki występujące w Polsce:

 Athripsodes albifrons (Linnaeus, 1758)
 Athripsodes aterrimus (Stephens, 1836)
 Athripsodes bilineatus (Linnaeus, 1758)
 Athripsodes cinereus (Curtis, 1834)
 Athripsodes commutatus (Rostock, 1873)

Przypisy

Leptoceridae

redpajama_set_name: RedPajamaWikipedia


Abstract : In this paper a multi-modal approach is presented and validated on real data to estimate the brain neuronal sources based on EEG and fMRI. Combining these two modalities can lead to source estimations with high spatio-temporal resolution. The joint method is based on the idea of linear model already presented in the literature where each of the data modalities are first modeled linearly based on the sources. Afterwards, they are integrated in a joint framework which also considers the sparsity of sources. The sources are then estimated with the proximal algorithm. The results are validated on real data and show the efficiency of the joint model compared to the uni-modal ones. We also provide a calibration solution for the system and demonstrate the effect of the parameter values for uni-and multi-modal estimations on 8 subjects.


How to determine the date of production/manufacture or age of Atherion® HVAC Systems.
The date of production/manufacture or age of Atherion® HVAC equipment can be determined from the serial number located on the data plate.
Description: Fourteen (14) character Serial number begins with six (6) numerical digits followed by three (3) letters and ends with five (5) numerical digits.
Description: Nine (9) character Serial number begins with two (2) numerical digits followed by five (5) letters and ends with three (3) numerical digits.
Description: Nine (9) character Serial number begins with four (4) letters followed by five (5) numerical digits.


By teaching what you already know about your profession or hobby, you'll learn more, potentially gain some notoriety as an up-and-coming expert, make new connections with people, and find new opportunities. And you'll have some fun.
I read a story recently about two developers. Both had roughly the same expertise and learned at about the same rate. As they improved their skills, one of the developers shared everything he learned on a blog. The blog soon became so popular that he grew a huge audience and raised thousands of dollars in a related Kickstarter campaign.
The other developer, having shared nothing he learned, had barely an audience to speak of.
What I love about this story is that the developer who didn't share what he learned thought little of the other developer's blog. For him, the blog posts were useless, because it didn't teach him anything he didn't already know. What he failed to realize was that a huge number of people didn't know all those things yet, and were interested to lean. The first developer took advantage of the fact that there's always someone who doesn't know as much as you.
If you know anything—and I know you do—you should be teaching what you know right now.
Not convinced? Here are three big reasons to get started straight away.
Have you ever thought about teaching others what you know, only to be held back by the feeling that you're not an expert yet? That you don't have the experience, the qualifications, or the visibility to start teaching yet?
Remember those two developers I told you about? The one who shared what he was learning was not an expert when he started teaching. He taught other people what he knew, and there were enough people who weren't at his level yet (but wanted to be) that his teaching helped propel him to become seen as an expert in his field.
The more you teach, the more people will see you as an expert. And the more people see you as an expert, the more opportunities you'll get to teach—you might be asked to give talks or lectures, to contribute to books or magazines, or to be interviewed on blogs, podcasts or radio shows. And each time you're teaching more people, and more people are discovering your expertise. This sort of exposure is especially invaluable if you work as a freelancer and want big clients to seek you out.
The second way to get past the feeling that you're not "expert enough" to teach others is to reframe the process. I like to think of it as sharing, rather than teaching. There's less pressure in sharing what you've learned or experienced than teaching on a topic.
It's okay to not have all the answers, and it's okay to be wrong. Framing the process as "sharing what you know" gives you more leeway to feel comfortable making mistakes, changing your mind, and sharing your knowledge in the context of your own experiences. It doesn't make it any less valuable to your "students," but it can make it easier to get started.
Another reason you shouldn't wait to start teaching others is that it will help you learn. Research has shown that when we explain something to other people, we come to understand it better ourselves. The process of teaching others helps us recognize gaps in our own understanding and better organize information in our minds.
We're also better at taking in the information initially, when we've been primed to think we'll be teaching it to someone else later. It seems that this comes from a different way of approaching the learning material. We know we need to pay attention to the most important points and organize them in our minds, if we're going to teach someone else.
Surprisingly, it's even been shown that first-born children sometimes perform better on intelligence tests than their younger brothers and sisters—potentially due to their efforts to share knowledge and experience with younger siblings.
So, if nothing else, teach others for your own sake. Even if you have an audience of zero, start blogging, pod-casting or creating videos to share the knowledge you're learning. You'll reap the benefits in your own learning progress, regardless of whether you're helping others (yet) or not.
Just like the chicken-or-the-egg problem of being an expert before you can teach, you don't have to have an audience before you start teaching. Not only will you be reaping the benefits of better learning from putting effort into teaching others, but it's a great way to grow your audience.
When you create content that is practically useful, it helps build an audience better than any other type of content.
As Mikael points out, readers prefer to share content that offers some practical utility.
There are plenty of examples of brands that have grown as a result of teaching what they knew. 37Signals is a great example. Nate Kontny has been sharing lessons he's learned while working on Draft to great effect. Sean McCabe's brand, Seanwes, is all about sharing everything he knows about business and creativity—and his brand is growing every day as a direct result of teaching.
Something I learned quickly after joining the Buffer team, a company that has grown to support hundreds of thousands of customers, was that our readers wanted actionable advice. They came to us to learn, and because we delivered time after time, our brand continued to grow.
As James Clear has pointed out, successful people start before they feel ready. Teaching is no exception.
Don't worry about whether you've hit "expert" status yet, or how big (or small) your audience is. Focus on what you've learned, or what you're learning right now, and how you can share those lessons in a way that will help others. If it helps, imagine you're teaching your former self, before you'd learned these lessons.
Start sharing what you know. And don't forget, there's always someone who knows less than you. Go help them.


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Peerless Rooms Building
Photo by Visitor7, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17283914
243 Fourth Street. Ashland, OR
The Peerless Rooms Building was built in 1904 by Oscar and Lucinda Ganiard, who built many commercial buildings in Ashland, including the Ganiard Opera House. Long used for lodging in the railroad district (and known as "The Ganiard Building"), the vernacular "brick front" commercial style building is typical of the once prevalent rooming houses developed to serve the working-class men and women drawn to Ashland in the early years of the 20th century. It was during this time when such single-room occupancy was the norm for residents of a working-class community.
Following the 1887 completion of a north-south rail link over the formidable Siskyiou Mountains to the south, the Southern Pacific Company and its employees assumed a major role in the Ashland economy. Since Ashland's primary business district was located along Ashland Creek, over a mile distant from the tracks, a second commercial area developed along Fourth Street in what became known as "the railroad district." Given the transitory nature of railroad employment, many of Southern Pacific's employees kept to themselves, avoiding the Ashland community at large. The large number of rooming houses in the Railroad District also provided low-cost housing for a number of young laborers, single women, and traveling salesmen who were drawn to Ashland by the booming economy that the railroad stimulated.
It was under the ownership of Sarah Meekly that the building received the name, "Peerless Rooms," in 1910. A significant element of the building is the sign painted on the brick proclaiming "Peerless Rooms" (probably dating from around 1915) with an early "Coca-Cola" advertisement. Long considered a "ghost" sign, it now has been restored. In late 1991 the Ganiard Building was purchased for restoration to its original use, although considerably upgraded from its working-class status. As "The Peerless Hotel" it is a luxury enterprise that strives to recreate the aura of a Victorian upper-class inn that now caters to Ashland's tourist population. The Peerless Rooms is the single best surviving example of the two-story brick storefront associated with the development of the commercial area centered on Ashland's railroad depot.
The Peerless Rooms Building, now the Peerless Hotel, is located at 243 Fourth Street.
Discover more Oregon history by visiting the Ashland, OR travel itinerary.
oregon history
nrhp listing
discover our shared heritage travel itineraries
heritage travel


A recent theft from a student living on Gerald Road in Brighton included bags from Prada, Tumi and Chanel, three(!) coats from Burberry, and a few other items that ring in for a total of $6050. Ka-ching, ka-ching, the girl likes to shop. Just don't ever complain about your student loans, OK?


text:
Topics: Data Center Transformation
Animation Company "Fast Forwards" Production with HP Utility Data Center
Film Built Using Adaptive Enterprise Framework Enabled by Shared, Virtual Resources
HP (NYSE:HPQ) today announced that a commercial-quality animated film has been produced using an experimental rendering service from HP Labs and running on an HP Utility Data Center (UDC).
The four-minute film, "The Painter," was created by the award-winning production company 422, which is based in Bristol, England, and worked closely with researchers from the Bristol site of HP Labs. HP plans to submit "The Painter" to the world-famous Sundance Film Festival and other animation competitions in Europe.
The project demonstrates how computing resources can be assembled, organized and managed virtually using the flexibility of the UDC, a key component of the HP Adaptive Enterprise architecture. It also illustrates the value of utility computing, in which an end-user taps into a large pool of virtual resources, but pays only for what is used.
The film was rendered using a prototype utility rendering service developed by researchers at HP Labs Bristol and run on the Labs' UDC. Commercially available rendering software also ran on the utility service.
Rendering is the process that turns animators' computer-generated wire models into finished frames by adding color, light, texture and other details. It is highly compute-intensive and usually requires a substantial investment in dedicated servers and specialized software: there are 24 frames per second in a film and each frame can take from a few minutes to several hours to render.
By using HP's utility rendering service, 422 rendered the high-quality film in about 17 days, instead of the two months it would have taken without the use of the UDC – about three times faster.
"Despite the film's complexity, 422 was able to take full advantage of the UDC by bringing online an increasingly large number of extra resources for rendering to match the rising demand as production reached the final stages," said Andy Power, 422's head of animation, who directed "The Painter."
HP's proprietary software used on the UDC to render the images is an experimental program and not currently commercially available. It was created as a way to test an HP Labs Bristol technology called SmartFrog, which can be used to create many different kinds of services to run on a UDC. The HP Labs team was looking for an experimental service to test SmartFrog and the HP UDC.
"We believe in learning by doing," said Steve Hinde, project manager for the prototype utility rendering service at HP Labs Bristol. "So we spent a long time talking to the many media companies that we have in Bristol and they told us that rendering can be a tricky problem. For us, it's interesting -- it uses lots of computing power and it's expensive because of the amount of high-level hardware required and the cost of the rendering software licenses. It's an excellent test case for the utility computing concept and the HP UDC in particular."
Usually, animation companies have racks of servers dedicated to rendering. But during production, there are peaks and valleys of demand for the servers: at the peaks, there are never enough computers for the jobs; in the valleys, expensive equipment and rendering software lie idle. Using the dynamic reallocation capability of the HP UDC, 422 was able to obtain more computer power for rendering at peak processing times and then release those servers for other tasks when they weren't needed.
"This project shows how technological innovation can drive new utility computing services, building on the pay-as-you-go model," said John Sontag, manager of HP Labs' worldwide UDC installation. "Like gas or electricity, customers can 'turn on' more computing resources as needed and pay only for what they use. In many ways, the UDC may be an ideal infrastructure for the animation market -- which is expected to hit $50 billion in the next few years - because users require varying degrees of processing power throughout the production cycle."
HP has a long tradition of working with the animation industry. The first products the company sold in 1939 were audio oscillators used by Walt Disney Studios for the film "Fantasia." The company also has formed a technology alliance with Dreamworks SKG and played a key role in the technology used to create "Shrek," which won the first Academy Award for animation in 2002. HP has been involved with other productions, including "Spirit: Stallion of the Cimarron," "Sinbad: Legend of the Seven Seas" and the forthcoming "Shrek 2."
The HP UDC is extremely versatile and provides advantages across many industries, especially those where compute power needs to be moved in real time. It is the industry's only comprehensive virtualization solution for data centers that is available and shipping today.
Within HP Labs, the UDC has enabled a fourfold increase in capacity without the need to add additional space or personnel, which could result in millions of dollars of savings annually. It is being used to consolidate the Labs' worldwide IT infrastructure and will serve as a platform for ongoing research, as well as handling day-to-day IT tasks. Plans also call for sharing the resource with university and other scientific labs, such as CERN, the European particle physics laboratory.
Founded in 1988, 422 is one of the most respected specialist providers of design and computer-generated graphics to broadcast television producers. It has won three Emmy awards, four British Academy of Film and Television Arts (BAFTA) nominations and numerous other international accolades. Broadcast clients include the major UK TV channels as well as European and U.S. organizations such as National Geographic TV, The Discovery Channel and independent producers around the world.
HP delivers vital technology for business and life. The company's solutions span IT infrastructure, personal computing and access devices, global services and imaging and printing for consumers, enterprises and small and medium business. For the last four reported quarters, HP revenue totaled $70.4 billion. More information about HP is available at http://www.hp.com.
Intel and Pentium are U.S. registered trademarks of Intel Corp.


text:
Collaural fistula or cervico-aural fistula is a type of fistula whose openings are at external auditory canal and the neck, usually in the upper part of anterior border of sternocleidomastoid muscle. It occurs at birth because the defect is in the embryological branchial cleft.  It is rare, and accounts for 8% of the branchial cleft anomalies, which is why it is sometimes misdiagnosed.

Diagnosis
The patient presents with non-healing ulcers of the neck and one of the external auditory canals. Diagnosis is confirmed by injecting methylene blue dye into the neck opening, and dye coming out of the opening in the external auditory canal. Computerized tomography fistulogram can yield more accurate results regarding the course of the fistula.

Treatment
Treatment of collaural fistula is done by surgical exploration and excision. The fistulous track is removed with skin and cartilage. Split thickness skin grafting and stenting is done if more than 30% of the external canal's circumference has been removed. The potential complications following
fistula removal surgery are facial nerve paralysis and recurrence.

References

Diseases of the ear and mastoid process
Fistulas


text:
Samantha Bee interviews women world leaders about misogyny
Christian Holub
By Christian Holub Updated October 25, 2016 at 12:33 PM EDT
Credit: TBS
If Hillary Clinton wins the election next month, she will become the first woman president in U.S. history — but she would be far from the first female leader on the current world stage. Chile, Norway, Croatia, and other countries all have female leaders. On Monday's Full Frontal, Samantha Bee interviewed some of them at the United Nations to see if they faced the same misogyny in their own countries that Clinton does in the U.S. The short answer: yes.
"I have seen misogyny come down, but it did not disappear," Chilean President Michelle Bachelet told Bee. "For example, if a president would be moved by something, his eyes would be full of tears, he would be sensitive. If you do something like that, you're hysterical… You have to be active but calm, and I can do that."
Bee determined that one of Grabar-Kitarović's photoshopped doppelgänger was Coco Austin, and subsequently had Austin on the show to hilariously refute the similarity.
"That's Coco, and I'm not the president of Croatia," Austin said. "Honestly, I'm tired of having to defend her pro-Eurozone debt reduction policies. I don't have an opinion."
Bee also spoke with former Secretary of State Madeleine Albright. "Why are men afraid of women?" asked Albright. "I think we're seen in whatever previous relationship they have had, like the third grade teacher who told Johnny to be nicer."
Watch the clip below.


For years, Tanglewood has been a destination—for top musicians, for eager audiences, for performers in training, and for friends and families alike. So many landmark moments in musical history have occurred on campus, and so many generations of listeners have experienced them in an unparalleled environment.
The many physical improvements and programmatic innovations supported by Tanglewood Forever donors will expand Tanglewood's unique position among leading music festivals now and in the future. To ensure that the BSO can continue to capitalize on Tanglewood's unique elements through ongoing infrastructure and programmatic initiatives, Tanglewood Forever endowment donors will allow the BSO to continue its investment in creating new cultural and intellectual pursuits through music and education for its community of Fellows, alumni, faculty, artistic partners, and patrons forever.
To safeguard Tanglewood's unique position among leading music festivals, Tanglewood Forever endowment donors will help bolster Tanglewood's future as a home for music, education, and community by robustly supporting future capital and programming initiatives.


text:
Q: Mean of each column in dataframe Working with a dataframe that contain an specific binary column (all in numpy array), in example:
[1. 0. 0. 1. 0. 0. 0. 0. 1. 0. 0. 0. 0.]
[1. 0. 0. 0. 0. 0. 0. 1. 1. 0. 1. 0. 0.]
[1. 0. 0. 0. 0. 0. 0. 1. 1. 0. 0. 0. 0.]
[0. 0. 0. 1. 0. 0. 0. 1. 1. 0. 0. 0. 0.]
[1. 0. 0. 1. 0. 0. 0. 1. 0. 0. 0. 0. 0.]
[0. 0. 0. 1. 0. 0. 0. 0. 1. 0. 0. 1. 0.]
[1. 0. 0. 0. 0. 0. 0. 1. 1. 0. 0. 0. 0.]
[1. 0. 0. 1. 0. 0. 0. 1. 0. 0. 1. 0. 0.]
[1. 0. 0. 1. 0. 0. 0. 0. 1. 0. 0. 0. 0.]
[0. 0. 0. 0. 0. 0. 1. 1. 1. 0. 0. 0. 0.]

That's possible to apply a loop for iterate all columns inside that column?
i.e
In my case i need to get the mean of values in each column, like:
# Mean of position [0]           # Mean of position[3]
    1.                               1.
    1.                               0.
    1.                               0.
    0.                               1.
    1.                               1.
    0.                               1.
    1.                               0.
    1.                               1.
    1.                               1.
    0.                               0.

There is any way to do that?
Thanks!

A: Just use iloc with mean:
meanZero = df.iloc[0].mean()
meanThird= df.iloc[3].mean()

A: You can use the mean function from numpy.
https://docs.scipy.org/doc/numpy/reference/generated/numpy.mean.html
So in your case, I think you are looking for np.mean(a, axis=1)

redpajama_set_name: RedPajamaStackExchange


With Sprite Kit you can create multiple scenes, one for each screen of the app. It is also possible to use animation transition between your scenes. In this tutorial we will create two scenes and create a transition. This tutorial is made with Xcode 10 and built for iOS 12.
With Sprite Kit you can display text in your game using Labels. These labels are of type SKLabelNode and its main function is to display a string. In this tutorial we will display a label and add the functionality to drag it around the screen. This tutorial is made with Xcode 10 and built for iOS 12.


Periodically check the position of your left hand. When you look up the fingerboard at the fingers and thumb of your left hand you should see a backwards letter C, not a U.
Make sure that your wrist is in the correct position, and that you have not allowed the violin to slip down to the web between your thumb and your first finger.
Remember, if your fingers are free to move, not hold up the instrument, your playing can improve greatly!


Webster- Santos Bonilla age 63 died Friday August 24, 2018 at Harrington Memorial at Hubbard, Webster. She leaves her daughter Yessieca Rivera and her husband Javier Hernandez of Webster and with which her mother made her home, three sons; Hector Rivera of Florida, Jorge and Alberto Rivera both of Illinois and twelve grandchildren. Santos also leaves her father Sabino Bonilla of Puerto Rico She also leavers a brother, Jerry Bonilla of Ill., three sisters; Sabina, Betsy and Jeanette Bonilla all of Puerto Rico. She was born in Illinois daughter of Sabino Bonilla and the late Digna (Diaz) Bonilla and lived here for the past four months prior to that living in Puerto Rico. She was a avid reader and got great joy out of making bows for ladies hair. Final disposition will be held in Puerto Rico. There are no calling hours. Donations in her memory may be made to the American Cancer Society.
The Shaw-Majercik Funeral Home, 48 School St., Webster, MA has been entrusted with her arrangements. A guest book is available at www.shaw-majercik.com where you may post a condolence or light a candle.


A new independent company has been established to secure the future of the Belfast Festival and to deliver the 2015 edition. Returning in October it will be renamed as Ulster Bank Belfast International Arts Festival.
Making the announcement, Festival Director Richard Wakely said, 'I am delighted to be able to confirm that the Belfast Festival is very much alive and kicking and that the show must go on! With the generous support of our public and private sector funders and partners, we have come together to launch a new international festival that reflects both the changing city around us and the continuing evolution of creative practice from around the world'.
The Festival's ambition is to work with a range of partners across the city to create a genuinely civic event of arts and ideas of international stature and appeal.
'This is a festival about togetherness, uniting people from all walks of life to experience and celebrate the best in world class arts and culture. At its core are a set of values that reflect the importance of global connectivity; access and participation; contemporary and inter-disciplinary arts practice and community.
'Building on the success of festival outreach and participatory events in the last few years, the 2015 programme will see events, installations and performances taking place in an array of venues across the city, some traditional and some a little more surprising, which will be revealed in due course.
This year's Festival Artist in Residence is Amanda Coogan, one of the most exciting contemporary visual artists practicing in the arena of performance art today. Her work is challenging, provocative and always visually stimulating. In recent years she has performed and exhibited at The Venice Biennale, Liverpool Biennial, New York and The Irish Museum of Modern Art. Amanda will be researching and developing a new work to premiere at the 2016 Festival.
Hallo: Martin Zimmermann is a pioneer of the nouveau cirque movement that has swept Europe in the last couple of decades with its blend of acrobatic feats, theatre, dance and comedy. The visual flair and sharp wit of his latest work, Hallo, can be seen in a unique UK and Irish premiere at The MAC.
The Kitchen: A show about the healing power of cooking, The Kitchen is a sumptuous, multi-sensory spectacle from India of arresting sights, smells and sounds, culminating in something for your tastebuds too, at the Grand Opera House.
Corners: a series of multi-disciplinary and site specific artist residencies, installations and projects that will take place across Belfast in unusual locations and venues. Designed and driven by cultural organisations at the fringes of Europe and linking cities and artists across the continent including Stockholm, Donostia / San Sebastián, Newcastle upon Tyne, Zagreb, Ljubljana, Rijeka, Belgrade, Gdańsk, Bari and of course Belfast. This project is co-presented with the Arts Council of Northern Ireland.
The diverse and eclectic programme of events will run from Friday 9 October to Sunday 1 November.


text:
ONWARD reveals positive topline results of LIFT Home study
ONWARD Medical has reported topline results from the LIFT Home study, which reported no serious adverse events and a 97% rate of successful session completion, thus supporting the home use of its ARC-EX therapy.
ARC-EX therapy is a proprietary non-invasive spinal cord stimulation technology designed to restore movement and other functions in people with spinal cord injury (SCI) and other movement disabilities.
The LIFT Home study is a single-arm observational study. The main objective of the study is to evaluate the safety and feasibility of ARC-EX therapy when used at home. A total of 17 people were enrolled at five leading SCI research centres in the USA.
Participants performed training on activities of daily living three times a week over a one-month period. According to ONWARD, approximately 97% of these sessions were completed without usability issues, supporting the feasibility of home-based treatment. The absence of any device-related adverse events confirmed the favourable safety results observed during the Up-LIFT study when ARC-EX therapy was used in clinics.
Dave Marver, CEO of ONWARD, said: "Today's results from the LIFT Home study support the potential for ARC-EX therapy to be used safely at home, which would enable people with SCI to live even more independently. We expect to launch first in clinics, but as the community gains more experience with ARC-EX therapy, we envision many patients will also want to use this technology at home."
Candy Tefertiller, principal investigator of the study and executive director of research and evaluation at Craig Hospital (Denver, USA), added: "To maximise recovery after SCI, it's critical that we develop treatments that can be safely and effectively delivered in the home environment. Integrating home-based therapy not only facilitates opportunities for ongoing recovery, but also allows therapy to focus on more relevant activities for that specific individual."
ARC-EX
LIFT Home
ONWARD Medical
Time is spine: A paradigm shift in the management of spinal cord injury
Onward awarded grant to continue developing Brain-Computer Interface technology
Onward reports positive study results in restoring arm and hand function with SCS therapy
Empirical Spine completes full premarket approval submission to FDA for LimiFlex...


The film's an error, a continuity error.
I've always enjoyed the Bond series of movies but when Pierce Brosnan was swapped for Daniel Craig I started having my doubts over whether or not I wanted to see the next movie.
The problem I first had was that the new bond did not have the same cool, collected yet highly aware persona of the previous Bonds, but that concern was soon lessened by the revelation that Daniel Craig is playing in a prequel (Casino Royale) to the other James Bond films and therefore he can have a much rougher character.
Ofcourse, this makes Casino Royale a different kind of 007 movie from all the others, because we are watching a man still learning the ropes as a 00 agent, rather than Britain's top ranking secret agent that James Bond has become for the rest of the movies.
I have watched the trailers get better at www.casinoroyalemovie.com, trying to convince myself that it could be a good film, perhaps a film that shows the mental torment that built Bond to be what he became, but watching the trailer has left me unconvinced and I have suffered having to see Daniel Craig come out of the sea in his swimming trunks several times (apparantly he's already winning a gay following for the next Bond film).
But what most bothers me about the new bond film is that they haven't made it easy to accept Daniel Craig as the new Bond because the decision to have a prequel – that might have justified having a different kind of Bond – throws up continuity errors before the film has even started. The most obvious of which is the role of Judi Dench as M, a character who was introduced as a new M in Goldeneye.
I hate spending good money on a film where the plot doesn't hold up to scrutiny or a twist is made far too obvious early on, at least we've been pre-warned that this film is not going to have the same stunning visual effects and funny one-liners, and we know it doesn't fit in properly with the series it is supposed to prequel… so can it possibly offer anything that should pull existing fans of the James Bond series into the cinemas?
If you can answer yes, please tell me why.
i think that Daniel Craig is only second to Pierce Brosnan when playing the role of James Bond.


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EMC: Q2 Revenue Lags Forecast
By CIO Staff
CIO	 Jul 10, 2006 8:00 am PDT
EMC, the world's leading producer of corporate data storage hardware, said on Monday that its second-quarter revenue lagged behind its own previous prediction, based on preliminary numbers, Reuters reports.
Hopkinton, Mass.-based EMC said its total revenue was about $2.58 billion, roughly $91 million less than its forecasted $2.67 billion, according to Reuters. EMC also plans to report a net income of 12 cents per share, one cent less than the 13 cents per share it previously predicted for Q2 net income, Reuters reports.
The storage giant is expected to release its full financials on Friday, July 14, according to Reuters.
Related Link:
EMC to Purchase RSA for $2.1B
Check out our CIO News Alerts and Tech Informer pages for more updated news coverage.


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'Hand to God' Theater Review: Humans Are Here Simply to Service Their Puppets
Playwright Robert Askins will probably take this as a compliment, but by far the most interesting characters are the puppets
Robert Hofler | April 7, 2015 @ 6:00 PM
As scenarios go, the one about the dummy that takes over the life of the ventriloquist is nearly foolproof. My favorite variation is the old "Alfred Hitchcock Presents" episode in which the ventriloquist is revealed to be a life-size doll and the dummy turns out to be a midget.
In Robert Askins' new play "Hand to God," which had its Broadway premiere Tuesday at the Booth Theatre in New York, the playwright doesn't deliver a major twist to the venerable ventriloquist/dummy story, but in act two of this raunchy comedy, he and his able director Moritz von Stuelpnagel do introduce two hand puppets that very convincingly masturbate, perform oral sex on each other and then copulate in a series of strikingly human positions. There's also a hint of bestiality, because the puppet Tyrone looks like Kermit the Frog and the puppet Jolene is definitely human, with large breasts, which she exposes often. While the story of "Hand to God" proceeds in a most linear fashion, the sex is novel, and the whole shebang ends in a maelstrom of self-inflicted violence that stops the laughter in your throat.
Tyrone and Jolene meet in a church basement because a teenager named Jessica (Sarah Stiles) doesn't get the response she wants from the very meek Jason (Steven Boyer), who's also taking the puppetry class taught by his mother, Margery (Geneva Carr). Both Jason and Margery are grieving the death of their father and husband, respectively, and take solace in religious puppetry. For Jason, however, the hand puppet he names Tyrone becomes something more. It's how he vents what he really feels, and soon the kindly pastor (Marc Kudisch), who also has the hots for Margery, believes that Tyrone might be the devil and needs to be exorcised. No, the pastor is not Roman Catholic, but that doesn't stop Tyrone from realizing the pastor's worst nightmare when he crucifies a number of stuffed animals in the church basement.
Also Read: 'On the Twentieth Century' Theater Review: Kristin Chenoweth Is Back on the Fast Track
Tyrone turns devilish very early in the play, which gives "Hand to God" most of its blasphemous humor and drive. It also helps that Askins has created another delightfully irreverent character in the macho classmate Timothy (Michael Oberholtzer), who has no need for puppets since he makes his desires very evident, especially the one to screw Margery, which he does — much to the pastor's horror and humiliation. Tyrone and Timothy make a great case for unbridled aggression, and Oberholtzer and Boyer, who nearly induces whiplash in his quick transitions from Tyrone to Jason and back, fully realize their roles.
Since Askins possesses such a warped sense of humor, he'll probably take this as a compliment, but by far the most interesting characters in "Hand to God" are the puppets, not the humans. Except for Timothy, they aren't that vivid, although Stiles is outrageously droll when it comes to having her hand puppet Jolene service Tyrone.
"Hand to God" is a good night in the theater, but it does not offer the consistently inspired insanity of Christopher Durang's "Vanya and Sonia and Masha and Spike," wherein all the characters rivet us with their individual madness. The big difference, of course, is that Durang is a veteran and Askins, at age 34, is making his Broadway debut. The theater of the absurd (or the ridiculous, the bizarre, or whatever it's being called today) is in good hands, and the mantle has been passed to very capable hands.
11 Hollywood Stars Who Did Big Business on Broadway in 2014 (Photos)
Neil Patrick Harris won a Tony award for "Hedwig and the Angry Inch," and was later replaced by Andrew Rannells and Michael C. Hall.
Broadway.com
Denzel Washington brought in grosses of more than a $1 million a week for "A Raisin in the Sun."
When his "Houdini" musical didn't materialize, Hugh Jackman switched to a new play, "The River."
Bradley Cooper debuts in "The Elephant Man," selling out every seat from the first preview.
Megan Mullally, Matthew Broderick and Nathan Lane have made "It's Only a Play" one of the season's top grossers.
James Franco sparked controversy with "Of Mice and Men" when he called a New York Times critic "a little bitch."
John Lithgow and Glenn Close turn "A Delicate Balance" into the highest grossing revival of an Edward Albee play.
Bryan Cranston won the Tony for his Broadway debut and "All the Way" recouped its investment.
These movie and TV veterans filled seats and drew legions of fans to the Great White Way


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Nathalie Paris and her nrother Matt got matching tattoos of their birth years (1999 and 1998) in roman numerals on their fingers.
Nathalie Paris has a wing tattooed behind her right ear by LA tattoo artist Romeo Lacoste.
Nathalie Paris has a tiny butterfly inked on her right rib cage.
Nathalie Paris has the word "princeza" which stands for "princess" in Spanish inked on the side of her right hand. Tattoo by Rafael Valdez.


Lake Peten Itza is on the road to Tikal, Peten, Guatemala. I'm not sure if many people that go to Tikal realize that this beautiful gem is just waiting for you to take a refreshing dip or just sit and enjoy the almost unbelivable Caribbean colours.
I spent almost a week here exploring her secrets. There used to be fresh water crocodiles living here, sadly they are gone now. But the local people remember the "time of the crocodiles" with almost mythical memory. In the middle of the Peten jungle that is not hard to envision.
There are several small towns dotting the shores of the lake. All sleepy and slow in the jungle heat, and alive with life forms of different kinds. Birds so many as to remain a constant background of a cacaphony. Insects bigger than most humming birds.
Turtles and fish in the lake still dance to the rythms of time.
It seeps into your marrow and fills your soul with the timeless life of the jungle. And a refreshing dip into the lake watching the heat lightening displays at night are something out of a fairy tale.


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Madison Movie
Rob Thomas' movie blog.
"Captain America: Civil War": What do the saviors owe to the saved?
Some may find it a little silly to ascribe deeper meanings to a movie like "Captain America: Civil War," which after is meant primarily to be a source of entertainment and profit, a summer blockbuster to maintain ongoing Marvel franchises and jumpstart new ones.
On the other hand, his name is Captain America . . .
It's hard not to see the red, white and blue superhero as a stand-in for American values, sometimes even if that means standing against American policy; the last film in the series, "Winter Soldier," put Cap on the wrong site of government forces who wanted unlimited power to spy on ordinary citizens, and assassinate them remotely if necessary.
"Civil War" is interesting because it continues a conversation that's been going on both inside and outside of superhero movies over the last few years. Essentially it boils down to collateral damage – what do the powerful owe to the powerless? What do the saviors owe to the saved? The answers "Civil War" offers up are interesting – and not a little disquieting.
This debate over collateral damage began in the first "Avengers" movie and, over at DC, "Man of Steel," in which cities became battlegrounds for good vs. evil, citizens fleeing in terror as skyscrapers toppled in CGI glory. "Man of Steel" was particularly targeted by some critics, with Superman seemingly showing indifference to the almost certain suffering of victims on the ground.
The second "Avengers" movie, "Age of Ultron," explicitly rebuked "Man of Steel" by showing its heroes spending time in the middle of battle evacuating innocent Sokovians as Ultron lifted their city into the air. Then "Batman Vs. Superman: Dawn of Justice" did its own sort of commentary – Batman's rage at Superman is fueled by the destruction wrought in "Man of Steel," and in particular the loss of life at his own Wayne Enterprises.
Now comes "Civil War," which arises from the same moral gray areas. In the exciting opening sequences, Captain America and his team are in Lagos, Nigeria trying to stop the supervillain Crossbones from stealing a biological agent that could cause mass casualties. They succeed, but when the Crossbones turns himself into a human bomb, Scarlet Witch errs in trying to telekinetically move the bomb out of harm's way. It explodes in an office building, killing 11 and wounding more.
The Avengers are blamed for not preventing the casualties, and, adding this to the carnage in Sokovia and New York City, governments around the world push the group to make themselves subservient to the United Nations, a weapon to be used rather than an independent force. The movie does a good job showing the different arguments for and against the move (Iron Man is for, Captain America is against), but there does seem to be an underlying whiff of ingratitude here. Us puny humans are upset that the Avengers didn't save the world enough.
It's an idea we see again and again in the film. A mother (Alfre Woodard) tells Iron Man that he murdered his son, who died during the fighting in "Ultron." The film's major bad guy Zemo (Daniel Bruhl) is motivated by grief at losing his family in the same fight. In both cases, the actual villains who started the fight are rarely if ever mentioned. It's left to the viewer to fill in that blank space and say "Hey, c'mon!"
Which is what we're led to say, because Captain America and the Avengers are too noble to do so. That's the part about "Civil War" that bothers me a little. Because it's not hard to extrapolate from that to defending America's actions around the world with a similar "Hey, they started it!" mindset. Wars begun on false pretenses, civil liberties violated, innocents killed in drone strikes? Hey, they started it.
It's interesting that, just down the hall from where "Civil War" was playing, audiences could still see "Eye in the Sky," a tense thriller about the closed-door arguments over whether to launch a drone strike in Nairobi that would definitely kill terrorists, but might kill innocents as well.
That film presented all sides of the argument very persuasively, and didn't let the audience off the hook with easy platitudes or obvious villains. Instead, we saw how different versions of the "truth" could exist uneasily side by side, each perfectly valid. "Eye in the Sky" didn't give us any answers, but subtly reminded us that we need to take ownership of the questions, since what our politicians are doing is in our name, for our protection.
Meanwhile, Captain America tells Scarlet Witch in the film something to the effect of "We can't save everybody, and if we don't learn to live with that, maybe we won't be able to save anybody." There's something about that "for the greater good" argument that's a little pat, a little smug in a way I didn't like to see in a Captain America film, which have been the most thoughtful of the Marvel universe.
Which is not to say that we expect our heroes to be perfect, or to not make mistakes. They're more interesting when they do. But when they do, it brings them closer to being human, and it seems like they ought to take the opportunity to deal with the consequences in a more substantive, human way.
Posted by madisonmovie in Feature
Tagged: captain america: civil war, eye in the sky, iron man, scarlet witch
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LEAV Aviation ist eine deutsche Fluggesellschaft mit Sitz in Köln und Basis auf dem Flughafen Köln/Bonn.

Geschichte
Im September 2020 wurde das Unternehmen als JOOT Aviation Project GmbH unter der Führung des ehemaligen Easyjet-Piloten Daniel Broda und des ehemaligen Germania-Managers Johannes Klinsmann gegründet und im Mai 2021 in LEAV Aviation GmbH umbenannt. Das erste Flugzeug, ein Airbus A320-200, welcher von Standard Chartered Aviation Finance geleast und zuvor von Tigerair Australia betrieben worden war, wurde im September 2021 zum Flughafen Köln-Bonn überführt und im Februar 2022 auf die Gesellschaft zugelassen.

Das Luftverkehrsbetreiberzeugnis – auch AOC genannt – wurde am 4. Mai 2022 durch das Luftfahrt-Bundesamt erteilt.

Dienstleistungen
LEAV Aviation bietet Charter- und ACMI-Dienste an. Zu den bisherigen Kunden zählen unter anderem TUIfly, Corendon Airlines Europe und Transavia.

Flotte
Mit Stand August 2022 besteht die Flotte der LEAV Aviation aus zwei Flugzeugen mit einem Durchschnittsalter von 12,8 Jahren:

Weblinks
 Webpräsenz der Leav Aviation

Einzelnachweise

Fluggesellschaft (Deutschland)
Verkehrsunternehmen (Köln)
Gegründet 2020


Questions? Email [email protected]ly.co.uk or Call Us!
Keystone X – a bold new twist on the classic Ludwig sound.
Rather than merely revisiting the sound that made them famous, Keystone Series Drums carve a new niche in Ludwig's sonic identity. In fusing of their Classic Maple shell core with American Red Oak, Keystone's "pre-EQ'd" tone sculpts focus and articulation for the drummer seeking volume, attack, and power.
Three-ply Classic Maple core with 1/16″ inner and outer plys of American Red Oak.
Keystone's 5-ply combination of a Classic Maple three-ply core between inner and outer 1/16″ plys of American Red Oak creates a thin, dense shell that speaks loudly with quick, even decay. To draw further resonance from this unique hybrid, the dual 45-degree bearing edge is pulled to the center of the shell to seat perfectly into the head.
*Shell pack only – stands not included.