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Why go to the GP when you could send your health avatar instead?
Fri 26 Apr 2019 | Iain Buchan
The health avatar will harmonise machine learning, data analytics, and cloud technologies to make healthcare more interactive, personalised, and fulfilling
Professor Iain Buchan, public health and clinical informatics researcher at the University of Liverpool, coined the term health avatar. It describes a "digital mirror" of the future, that will cultivate an accurate picture of a user's health and lifestyle over time using interoperable online services, new data streams and machine learning.
Among the many potential benefits of this digital reflection is the ability to match an individual's health fingerprint to the care optimal to it; enabling individuals to "shop around" for treatment. A community of digitised selves will also enable individuals to connect with their "avatar kin" and specialist researchers.
Techerati asked Iain to outline health avatar fundamentals and its implications for the future of healthcare, wellbeing and fulfilment.
Why health avatars are the future of healthcare provision
A person's health avatar is the interactive combination of their health and care records, programs, and preferences.
Sometimes it is a digital mirror, enabling a person to discover different potential health futures depending on lifestyle or self-care choices such as diet and physical activity alongside medication for type 2 diabetes. This digital mirror also allows a person to correct or fill in missing information through interaction, creating a more accurate picture of themselves, which in turn improves the record that guides their health professionals' decisions.
Sometimes the avatar is a personal assistant, transacting on a person's behalf, maybe ordering a repeat prescription or booking a visit for a blood test or consultation (which may be hastened or delayed, or moved between online or face-to-face, based on remote monitoring, and care pathway criteria).
Sometimes the avatar is the tutor of personal assistants, personalising interactions in ways that different assistants can learn from one another, leaving different signatures of your basic underlying "habit engine", needs and life-contexts.
There may be no initial business incentive for competing companies/clouds with different AIs to cross-fertilise in this way, so the avatar is necessarily disruptive. Indeed, in Europe, the GDPR right to personal data portability might be interpreted as covering such personal 'habit engines', meaning a person's health avatar must not be held hostage by being unreasonably binded to a single company's technologies.
"I haven't used the term "digital twin" as the data feasibly captured about a person's health & care journey are very sparse"
Collaboration doesn't naturally scale as competition does, but in a world facing increasing pressures on healthcare budgets, avatars that can 'shop around' for the best value care could be extremely valuable to society.
Why health avatar is a more appropriate term than digital twin
I haven't used the term "digital twin" as the data feasibly captured about a person's health and care journey are very sparse – future data will be more "high definition" but not conceivably close to a "twin". Measurement error and missing data will remain a challenge for machine learning and humans trying to distil the models that constitute a person's health 'programs'.
Most current models that predict disease risks and treatment outcomes have been developed for looking at one disease at a time and making decisions about improving services for the average patient with that disease.
Real patients may have multiple interacting diseases and life-contexts. Science and technology are a long way from understanding how to build the union of models that accurately reflect a person's health journey, learning more predictive accuracy with the data cumulating over a lifetime.
This kind of digital twinning is an important grand challenge, but long before it is achieved, relatively simple avatars can achieve much progress.
It may, however, be reasonable to characterise a person's avatar as a digital twin if it attends a virtual clinic appointment on their behalf – the ease with which a multi-disciplinary team could review a patients "health journey" in a timely way may have great value.
A representation of how personal health records can integrate with healthcare, commercial governance, and research entities:
Source: Big data hurdles in precision medicine and precision public health, BMC Medical Informatics and Decision Making, 18(1) · December 2018
Interactions also extend beyond care providers. A person may wish their avatar to interact with researchers or their 'avatar kin' (people with similar health journeys) to advance knowledge and personal fulfilment. As a person's avatar becomes a more "high definition" view of their health it will overlap with wider wellbeing and happiness. So, the avatar starts to broker a value chain cutting across many markets.
The ethics and governance challenges ahead
If health is top of the ethical tree then the health avatar is the acid test of ethics and governance for the personal assistant of personal assistants. I suspect pursuit of the health avatar will need something akin to W3C very soon – the economic implications of avatar communities may become profound. A long journey, but the first few practical steps are ready to take.
The UK's formation of a grid of integrated care systems is a very promising nursery for the future health avatar. We need to focus that combination of personal records, programs, and preferences on bridging the care divides that commonly cause harm (e.g. discontinuities between social, primary and secondary care).
Experts featured:
Iain Buchan
Professor of Public Health and Clinical Informatics
University of Liverpool
AI data healthcare machine learning public health
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It merely means once you begin to see some signs and symptoms relating to your health, you quickly contact or visit your primary care physician. Being proactive also means acting upon the advice to prevent or reverse a chronic disease before it gets out of hand.
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STOTT PILATES® Ultimate Body Sculpting - Flex-Band® Level 3
Learn Intermediate-level exercises that challenge core and peripheral strength, and add variety and multi-dimensional joint movements to the basic Flex-Band® exerciser routine. This intense full-body workout, developed by the Merrithew team, emphasizes the upper and lower body working together while maintaining correct alignment and form. Exercises mimic those from the Reformer repertoire featuring the same movement essence and breath and movement patterns. Cues and corrections for safety and effectiveness are also covered.
Learning objectives
 1. Apply the Five Basic Principles of STOTT PILATES® to more challenging moves with the Flex-Band exerciser
 2. Understand movement essence and exercise goals
 3. Learn how the Flex-Band can intensify a routine and make it more three-dimensional
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Brining is not a new concept. Curing meat is recorded throughout history, dating back thousands of years, and as long as there have been curing techniques, brining has been alongside. It was originally used to preserve meat for later consumption. But what is wet brining and how does it fit into today's world? Together with the benefit of preservation came a few other bonuses. Adding flavor was a big perk since a good wet brine recipe soaks salt deeply into the meat.
What Is Wet Brining
Wet Brining
Now that refrigeration is so accessible, wet brining isn't used for preservation as often. Instead, it is a culinary tool to improve the meat people are planning to cook. It is a simple process, with high-end results. One of the most important necessities with brining is patience. It is a slow process, requiring plenty of wait time. But be assured, the end result is worth planning ahead for.
What Is Wet Brining?
Wet brining is basically the process of soaking your meat in a salt water bath. Using a salt water brine ratio that both extracts moisture from the piece of meat and helps the meat absorb other moisture, the bath helps to deeply season the meat. So what is wet brining? It's a culinary art to help season and perfect your meat.
What Does Brining Meat Do
What Is Wet Brining
What Does Brining Meat Do?
Brining meat does several things. By placing the meat in water that has a high solution of salt (higher than the air at least) the meat's juice and water are drawn out. At the same time, the meat continues to absorb other water, basically swapping the moisture inside. By swapping the water, the seasonings in the brine (salt and whatever else you'd like) soak through the meat and season it to the core.
What is Gained By Brining Meat?
Meat that has been brined gains a few characteristics. The first thing you will notice is immediately after brining meat, the piece of meat will have gained a bit of water weight. That is great because that can help keep the meat from drying out when it's cooked. If the meat even lost as much weight as usual when getting cooked, it would be left with the extra moisture it started with.
Can You Over Salt When Brining?
While you don't want to over-salt the water, a good salt water brine ratio has an awesome effect on the meat. The salt water acts as a loosening agent to the muscles within the brined meat. Think of it as a relaxer for all the muscles. When the muscles are loosened they don't tighten up as much during the cooking process. This is yet another way the brine helps keep meat moist. Since it isn't tightening up so much, the moisture isn't squeezed out of the meat, keeping it super juicy. Beyond keeping the meat juicy, the relaxed muscles also have a nice texture. Loosened muscles tend to be less chewy and rubbery… nice!
Because of the soaking process, the seasoning you put into your brine absorbs all throughout the piece of meat. It is a much better season compared to a basic surface seasoning. You can be sure it will be seasoned evenly as well since there aren't any nooks or crannies that water won't find. Brining is great because it works with slow cooked meats or meats for stews as well. There isn't much point to surface seasoning a chicken breast that is going into a slow cooker since it will be washed right off. By brining the breast first it gets the seasoning throughout the meat, and won't be rinsed away so easily.
Wet Brine Recipe
Salt Water Brine Ratio
Getting Ready To Boil The Water To Dissolve The Salt
Wet brining recipes are great because they are so versatile. The basic brining recipe is based on using about 1 cup of salt for every gallon of water necessary to completely submerge your meat. To be completely sure that the salt is dissolved into the water, I suggest heating it to a simmer, stirring until the salt is totally dissolved, then letting it cool again. Don't set your meat into the water before it is at least as cool as room temperature. You don't want the water to start cooking your meat.
Be Creative With Your Brining Solution
The reason wet brine recipes are so versatile is because any seasoning you add into the brine alongside the salt will be absorbed into the meat you are soaking. It is a great way to be creative with your cooking. Make sure to keep the salt as the main seasoning though. It is the only essential ingredient (besides water) in the process.
Wet Brine Recipe
A Salt Brine With Added Seasoning For Awesome Flavor
If you are going to brine a small amount of meat, say a few chicken breasts, it is possible to do it in a Ziplock bag. I still recommend placing the bag in a crockpot or other large pot to make sure any leaked water is contained.
Once you have the water seasoned and cooled, you can place your meat in. The amount of time you should leave the meat to soak will depend on the weight of the meat. An accepted idea is to leave the meat in for about one hour for every pound of meat. I tend to lean a little longer than that, pushing closer to 1.5 hours for every pound. It is possible to soak your meat too long, so don't push it too far, lest the meat turns mushy and unappetizing.
Brining Safety
A word to the wise, I always brine my food in the fridge. It isn't worth the risk of bacteria growing in my food to leave it out on the counter. I know it can be a pain to fit something so large in the refrigerator, but it is well worth the annoyance to avoid excess bacteria. Yuck!
Remove The Excess Surface Moisture For Better Browning
When your meat is done soaking, pull it out and pat it dry with a dish towel. Paper towels will work too. If you have time, let the meat sit on a plate in the refrigerator for an hour or so to let it air dry further. The wet surface can slow the meat from browning, so drying it will add even better texture in the long run.
The brining process can easily take a full day, but luckily most of it is very hands off. If you don't have much time, pat drying the meat instead of letting it air dry should be the first time you trim off. Try not to shorten the time in the brine too much. It takes quite a while to soak all the way through a piece of meat, especially larger pieces. It is well worth the patience as well. Starting the day before is a wonderful way to ensure you are getting the best amount of time possible in the brine.
To finish off, here is a quick recap.
What is wet brining? An awesome technique to make your meat juicier, tastier, and give it a great texture.
Soak your meat in a salt water brine ratio of 1 cup water to 1-gallon water.
Add any additional spices you would like in the water as well.
Soak it for 1 to 1.5 hours per pound of meat.
Pat it dry when you are done soaking it.
This simple technique is well worth the extra time, and the patience necessary. After you learn your favorite seasonings, wet brining will be a must for any meat in your household.
You can also check out this article on How To Brine Meat – An Intro And Guide To Brining for a more in depth introduction to wet and dry brining meat.
As always, if you or someone you know find this information on What Is Wet Brining; please consider sharing it with your Grilling friends and on social media!
If you would like to leave a comment or have useful tips of your own to share on how to wet brine meat, please do so below. We always welcome your input.
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What is Homenetmen
Homenetmen is the abbreviation of the first letters of the Armenian words for "Armenian General Union for Physical Education and Scouts".
Homenetmen is a Non-Governmental Organization that runs operations both in scouting and sports. Homenetmen consists of 108 chapters and units in 24 countries around the world.
Established in 1918, Homenetmen has a global structure. The organization's Armenian branch is called Homenetmen-HASK (Armenian National Scouts Organization) and represents the country's national scouting movement. As such, Homenetmen-HASK is a member to the World Organization of the Scout Movement.
Homenetmen Membership is open to all Armenians, regardless of their gender or faith.


Can You Eat Coffee Beans?
Coffee beans come from the roasted seeds of coffee plants. And, you can eat them! That's rightthey're not just for brewing a cup of Joe.
The flavor is similar to a green pea (but with an earthy taste). You can also roast and grind your own coffee beans at home in order to get that fresh-ground flavor in your drink or on your food.
In this article, we'll go over the different benefits of eating coffee beans and you can make your own decisions on if they are good for you.
What Are Coffee Beans?
can you eat coffee beans
Coffee beans are actually the seeds of the coffee plant. The seeds are covered in an outer layer called a "cherry", which is harvested while still ripe and red. The seeds are dried and then roasted to give coffee beans their flavor, aroma, and color.
Can You Actually Eat Them?
Well yes, you can eat coffee beans. The flavor is not always appealing, so they aren't eaten as a snack food like sunflower seeds or almonds but it has to be in moderation.
Coffee Beans Benefits
Even though coffee beans are not usually eaten on their own, they do have some nutritional benefits that can make them an interesting addition to foods like oatmeal and salads.
The main benefit of coffee beans is their high caffeine content. Coffee is a known stimulant, and coffee beans are an easy way to get that boost in the morning if you need it.
To add this superfood into your diet, you can grind the beans into a powder and use them as a spice, or just put a dash in your smoothie or oatmeal.
When eaten in moderation over time, coffee beans may help with:
Increased Energy Levels (caused by caffeine)
They can increase energy levels since they contain caffeine. This can be helpful if you need an energy boost in the morning but don't want to reach for a sugary drink that will cause your blood sugar to spike and then crash.
Weight Loss (linked to increased metabolism)
Coffee beans may help you lose weight by increasing your metabolism over time. This can be beneficial if you do not want to change your diet but just need an extra boost of energy.
Improve Mental Focus
Studies have shown that caffeine may improve mental focus. Since coffee beans contain caffeine, they can be used to help you stay alert and focused.
Improve Athletic Performance
Coffee beans may help you have more endurance and energy to stay active. Similar to the mental focus, coffee beans can give you a little boost to get through your next workout or weight training sessions.
How Many Coffee Beans Can You Eat?
Eating from 10-20 coffee beans a day is fine, but avoid eating more than 25 coffee beans a day, since they can cause digestive issues and stomach discomfort.
What's The Taste?
Raw coffee beans have a very bitter taste, much like raw green beans or cucumber. Roasting the coffee beans over high heat makes them crunchy and easy to chew, they taste similar to roasted peanuts with a hint of spice.
But Can You Eat Ground Coffee?
Yes, you can eat ground coffee. It is typically added to foods as a cooking spice. Ground coffee can be used in baking, sauces, and other recipes that call for cocoa powder or nutmeg. You can also add ground coffee to recipes like pancakes for a unique flavor twist!
Do You Eat The Coffee Beans In An Espresso Martini?
Yes, you can eat the three coffee beans that are in an espresso martini. They are whole beans, so you would chew and eat them the same way you would a regular coffee bean.
What Are The 4 Types of Coffee Beans?
The 4 main types of coffee beans are Arabica, Robusta, Excelsa, and Liberica. All of these coffee beans have different tastes that range from bitter to sweet to nutty.
What Is The Taste of Coffee Beans?
The taste of a coffee bean can range from sweet to bitter. This depends on how you roasted the beans. A lighter roast will be sweeter and have a smoother taste than a light roast, which is bitter and has a stronger taste.
Last Thoughts
It's about time you tried coffee beans. You'll be pleasantly surprised by the health benefits of this superfood, and how easy it is to get started with these earthy-tasting little snacks.
Coffee beans are available in a variety of forms, so no matter what your budget or preference for taste might be there should be something that suits you just right!


16 Jul 2013, 02:25
Dave_gnome_head_isolated_pragsmall
Dave Thomas (344 posts)
 - I'm thinking of a number between 1 and 1000…
 The most efficient way to find the number is to guess halfway between the low and high numbers of the range. If our guess is too big, then the answer lies between the bottom of the range and one less than our guess. If it is too small, then the answer lies between one more than our guess and the end of the range.
 Code this up. Your API will be guess(actual, range), where range is an Elixir range.
 Your output should look similar to:
 iex> Chop.guess(273, 1..1000)
 Is it 500
 Is it 250
 Is it 375
 Is it 312
 Is it 281
 Is it 265
 Is it 273
 273

 Hints:
 - You may need to implement helper functions with an additional parameter (the currently guessed number).
 - the div(a,b) function performs integer division
 - guard clauses are your friends
 - patterns can match the low and high parts of a range (a..b=4..8) === {::comment} defmodule Chop do def guess(actual, range = low..high) do guess = div(low+high, 2) IO.puts "Is it #{guess}" guess(actual, guess, range) end
 def guess(actual, actual, _), do: actual def guess(actual, guess, _low..high) when guess < actual, do: guess(actual, guess+1..high) def guess(actual, guess, low.._high) when guess > actual, do: guess(actual, low..guess-1) end {:/comment}
</yourturn>
A Possible Solution</summary>
defmodule Chop do
 def guess(actual, range = low..high) do
 guess = div(low+high, 2)
 IO.puts "Is it #{guess}?"
 _guess(actual, guess, range)
 end
 defp _guess(actual, actual, _),
 do: IO.puts "Yes, it's #{actual}"
 defp _guess(actual, guess, _low..high)
 when guess < actual,
 do: guess(actual, guess+1..high)
 defp _guess(actual, guess, low.._high)
 when guess > actual,
 do: guess(actual, low..guess-1)
end
Chop.guess(273, 1..1000)
</details>
01 Aug 2013, 20:32
Generic-user-small
Luke Imhoff (6 posts)
My solution:
defmodule Chop do
 def guess(actual, range) do
 n = next_guess(range)
 check_guess(actual, range, n)
 end
 defp next_guess(low..high) do
 difference = high - low
 guess = div(difference, 2) + low

 IO.puts "Is it #{guess}"

 guess
 end

 defp check_guess(actual, _, current_guess) when current_guess == actual do
 actual
 end

 defp check_guess(actual, low.._, current_guess) when current_guess > actual do
 high = current_guess - 1
 n = next_guess(low..high)
 check_guess(actual, low..high, n)
 end

 defp check_guess(actual, _..high, current_guess) when current_guess < actual do
 low = current_guess + 1
 n = next_guess(low..high)
 check_guess(actual, low..high, n)
 end
end ---
P.S. What mark up do I use to make a hidden thing Dave like your "A Possible Solution"? It's not standard Markdown, so it must be something specific to this forum.
02 Aug 2013, 14:09
Dave_gnome_head_isolated_pragsmall
Dave Thomas (344 posts)
I use details/summary tags
29 Aug 2013, 12:03
Generic-user-small
Nathan J Schunemann (1 post)
I can't figure out how to hide a code block with details/summary tags. Elixir 0.10.1
defmodule Chop do
 def guess(actual, low..high)
 when actual == div(low+high, 2) do
 IO.puts "Is it #{actual}?"
 IO.puts "Yes, it's #{actual}."
 end

 def guess(actual, low..high)
 when actual < div(low+high, 2) do
 IO.puts "Is it #{div(low+high, 2)}?"
 guess(actual, low..div(low+high, 2))
 end

 def guess(actual, low..high)
 when actual > div(low+high, 2) do
 IO.puts "Is it #{div(low+high, 2)}?"
 guess(actual, div(low+high, 2)..high)
 end
end
15 Oct 2013, 15:08
Generic-user-small
Raoul JP Bonnal (1 post)
Hi Dave, your solution uses defp which is described later in chapter 7. I figured it out only looking the solution into this forum.
29 Nov 2013, 18:02
Generic-user-small
Kit Ko (2 posts)
The syntax of defining a function that calls itself is also described later in chapter 7.
24 Dec 2013, 06:26
Snapshot_2008101_248x248_pragsmall
Rafael Rosa (2 posts)
I'm still on chapter 6, but when I looked at your proposed solution I was stunned with the matching of parameters on the right hand of the = sign (range = low..high), it's amazing but it only works on parameter definition and I didn't see any explanation on that so far. Granted, it isn't necessary to answer the Chop exercise, but I would expect such explanation under "Function Calls and Pattern Matching" that starts on page 45.
As a side note, so far I'm enjoying the book very much, thanks a bunch.
05 Feb 2014, 03:34
Mva.2008.05_pragsmall
Manuel E Vidaurre Arenas (7 posts)
My solution:
defmodule Chop do
 def guess(x, a..b) when x == div(a+b, 2) do
 IO.puts "Is it #{x}"
 IO.puts "#{x}"
 end
 def guess(x, a..b) when x < div(a+b, 2) do
 n = div(a+b, 2)
 IO.puts "Is it #{n}"
 guess(x, a..n)
 end
 def guess(x, a..b) when x > div(a+b, 2) do
 n = div(a+b, 2)
 IO.puts "Is it #{n}"
 guess(x, n..b)
 end
end
It's very similar to Nathan J Schunemann solution
26 Mar 2014, 18:01
Generic-user-small
Christian Broomfield (1 post)
My solution is virtually identical with Luke's answer, but I didn't use defp. Not sure if that's important, but the program compiled just fine (0.12.5).
I tried to code a similar solution in Kotlin and ended up with this:
tailRecursive
fun guess(answer: Int, range: Range<Int>, candidate: Int = (range.end - range.start) / 2 + range.start): Int =
 when {
 answer == candidate -> candidate
 answer > candidate -> guess(answer, (candidate + 1)..range.end)
 answer < candidate -> guess(answer, range.start..(candidate - 1))
 else -> throw IllegalArgumentException("Computational error occurred; check the math please.")
 }
I like this solution a lot and attempted to code this solution in Elixir:
defmodule Chop do
 def guess(answer, from..to, candidate \\ div(to - from, 2) + from) when candidate == answer do
 answer
 end
 def guess(answer, from..to, candidate \\ div(to - from, 2) + from) when candidate > answer do
 guess(answer, (candidate + 1)..to)
 end
 def guess(answer, from..to, candidate \\ div(to - from, 2) + from) when candidate < answer do
 guess(answer, from..(candidate - 1))
 end
 def guess(answer, from..to) do
 guess(answer, from..to)
 end
end
The first thing that struck me is, "There has to be an easier way" than defining four function and separating them with almost nothing but a different operator in the when clause. Secondly, the code fails with the error message:
** (CaseClauseError) no case clause matching: nil
 (elixir) src/elixir_scope.erl:22: :elixir_scope.translate_var/4
 (elixir) src/elixir_translator.erl:302: :elixir_translator


text:
The Dakehl (Carrier) peoples are from the Central Interior of British Columbia. The term 'Carrier' comes from a Sekani (Northern Interior, Finlay and Parsnip River drainages) name for the Dakelh people that has to do with the mourning processes of the Dakelh women in which they carried their deceased husbands ashes. The Sekani people were the first to come into contact with European explorers and so the name 'Carrier' became established with foreign European parties. Dakelh is the term used by the Carrier people to refer to both their language (of the Athabaskan family) and their people. Their traditional territory includes "the area along the Fraser River from north of Prince George to south of Quesnel, the Nechako Valley, the areas around Stuart Lake, Trembleur Lake, and Fraser Lake, and the region along the West Road and Blackwater Rivers, west to the Coast Range, including the Kluskus Lakes, Ootsa Lake and Cheslatta Lake. Prince George, Vanderhoof, Fort Saint James, Fraser Lake and Quesnel are all in Dakehl territory."1
Dakelh or Carrier artists in the University of Victoria's Art Collections include Lawrence J Rosso and Walter Joseph Jr.

source: HuggingFaceFW/fineweb-edu


text:
In Freehand you can hi-lite an object and then go to the layers pallett and double click on a layer to copy the object to that layer. Basically transfering
the object from one layer to another.
Is there a way in Illustrator CS4 to do the same thing? Freehand does in in a very simple way. I'm hoping that Illustrator has a simular feature.
When you select the object, a small rectangle to the right of the layer shwos in the palette. Just drag it to the desired layer. Or drag the object's entry in the layer palette to the desired layer (the object doesn't even need to be selected for that).
Or you can use the Object > Arrange > Send to Current Layer command. You can even assign a keyboard shortcut to it if you use this operation frequently.

source: m-a-p/FineFineWeb


text:
Tianyun Society's Kunqu Opera Opern
Tianyun Society is a Kunqu Opera singing organization (without makeup and acting) boasting a long history. The society was originally founded in Wuxi during Tianqi and Chongzhen Period of Ming Dynasty (1621—1644) by the name "Wuxi Kunqu Club". In 1920, the organization determined its name as "Tianyun Society". The conventional activities of the society were once interrupted due to the Counter Japanese War (1937—1945) and revived after the victory. However the irresistible aging and successive passing away of the members made the society gradually lost its activity. The 1950s finally witnessed the dissolution of Tianyun Society.
 is a set of materials specially compiled for the society's practical use. Revised and transcribed by Wu Wanqing(1847—1927), a chief of the society, The first edition of the opern was printed and published in 1921 by the national musician Yang Yinliu(1899—1984). The opern provides a large amount of both popular and rare opera highlights in humble handwriting. With the distinguishing features of some time-honoured Kunqu Opera notations well conserved and recorded, the opern was recognized as a valuable piece of reference for Kunqu Opera studies. The book begins with Wu Wanqing's essay , which brings forward eight notations to identify the methodologies of pronunciation and phonological process: U、从、巳、吳、△、戈、□、閉. These notations are recognized as the prime standard and theoretical basis of Tianyun Society's Kunqu Opera singing practice. To emphasize that, the cover pattern of this new edition are created based on Wu Wanqing's handwriting of these notations.
Editor: Rongli Lv
Editorial Design: Jiayan He
Publish: Shanghai Lexicographical Publishing House

source: openbmb/Ultra-FineWeb


text:
View the Current Catalog View Foreign Rights Catalog
An exploration of christological doctrine with a focus on liberationism, feminism and religious pluralism.
Inspirational profiles of white Americans who fought against racial injustice at great risk.
Reflections on the meaning of God and the meaning of the human being in a world of terror.
The bestselling author illuminates a spiritual journey that transcends inherited beliefs and makes them relevant for the twenty-first century.
An inspiring exploration of how happiness and holiness can exist in the midst of poverty and illness.
Shows how black Christianity can recover the true message of the gospel.
What Maryknoll missioners have learned from the people of God around the world.
The author of Anatomy of Inculturation offers a compelling argument that despite missionary Christianity's refusal to acknowledge the worth of traditional African religious culture, the incarnational spirituality of those cultures remains vibrant and visible today.
Argues the African's role as agent of religious adaptation superseded that of his Western missionary counterpart in the development and growth of Christianity in West Africa.
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How to Start in Leatherworking
Leatherworking can be intimidating at first. Seeing all the complicated leather works online might even discouraged you from starting out. What most don't know is that starting do leather working is easy. Here are the 5 steps to get you started.
1. Pick out a project
Obviously, you have to pick a leatherworking project or something that interests you to start. Keeping the project simple will help you stay motivated once you complete it. I do not advise you to do something complicated at the start. You will just get frustrated and quit midway. A wallet or a belt is a simple enough project to get your feet wet.
2. Learn the skills
There are a few basic skills that you need to get you started in leather working like saddle stitching, cutting, and edge finishing. Try to find projects that would only need these skills for you to practice. The more advanced skills like skiving, knife sharpening, and unique stitching patterns can be learned after you have mastered the basic skills.
3. Learn to use the tools
After you have learned the basic skills to start a project, you need to learn how to use the tools needed. The basic leatherworking tools needed for most projects is the needle, thread, stitching chisel and the leather itself.
4. Purchase the materials needed
Now it's time to start buying the materials needed for the project. There are a lot of options online on what brand or type of materials or tools that you can buy. It is best if you can buy the cheapest leather you can find to practice on and buy good quality tools so that they will last you a long time.
5. Start your first project
Finally, you can start on your first leather working project! Do not forget to have fun while doing your project. It is okay to fail so do not get frustrated if things do not go your way. I assure you that mistakes will be made on your journey. Just remember to keep practicing and you can even make your own leather armor someday.


How Much Does a Beheading Hurt and How Long Is a Severed Head Conscious After a Beheading?
Beheading hurts. How much it hurts depends on the executioner's skill, or lack of it.
When Mary, Queen of Scots, was executed at Fotheringay Castle in 1587, a clumsy headsman gave her three strokes without quite managing to sever her head.
The headsman then had to saw though the skin and gristle with his sheath knife before the job could be regarded as complete.
The profound, protracted groan Mary gave when the ax first hit left the horrified witnesses in no doubt that her pain was excruciating.
Reportedly, their heads blinked for up to 30 seconds after decapitation. How much of this was voluntary and how much due to reflex nerve action is speculation.
Antoine Lavoisier, the French chemist who lived between 1743 and 1794, was caught up in the revolution and faced beheading. He asked friends to observe closely as he would continue blinking as long as possible after being killed. He was reported to have blinked for 15 seconds after decapitation.
The story of Antoine Lavoisier's last heroic service for science has been reported many times but unfortunately appears to have no basis in fact.
It is not given in any contemporary account we have been able to find, or in the standard accounts of his life and death. As pointed out above, however, there have been attempts to ascertain if a severed head retains consciousness.
The most reliable account appears to be that given below.
A particularly detailed report comes from Dr. Beaurieux, who, under perfect circumstances, experimented with the head of the murderer Languille, guillotined at 5:30 A.M. on June 28, 1905. From A History of the Guillotine by Alister Kershaw. His source is Archives d'Anthropologie Criminelle, 1905.
Here, then, is what I was able to note immediately after the decapitation: the eyelids and lips of the guillotined man worked in irregularly rhythmic contractions for about five or six seconds. I waited for several seconds.
If indeed a severed head remains conscious for a short while, then the following procedure might be regarded as humane, assuming the purpose was to convince the dying man he was flying to heaven.
Dr. Livingstone wrote that Africans he encountered were aware that consciousness is not lost immediately. He recounts how they bent a springy sapling and tied cords from it under the ears of a man to be decapitated so that his last few moments of awareness would be of flying through the air.
However quickly consciousness is lost, there is little doubt that the procedure must produce a painful few seconds.
In 1983, Harold Hillman, then reader in physiology at the University of Surrey, wrote an account of the suffering caused by different methods of execution for New Scientist at the time when the World Medical Association had just discussed attitudes of physicians to capital punishment. This is what Hillman said about the guillotine:
The guillotine was named after the French deputy who proposed the use of the device in 1789. It was tested on corpses at the Bicetre Hospital in Paris, and employed by the French Revolution in 1792.
It was introduced as a swift and painless device, as Joseph-Ignace Guillotin believed, to extend to all citizens the advantages of a technique used only on noblemen. Although people believe that Guillotin invented the device, it had been used in Italy, Germany, France, and Scotland in the sixteenth century.
Guillotining was considered more humane because the blade was sharper and execution was more rapid than that accomplished with an ax.
Death occurs due to separation of the brain and spinal cord, after transection of the surrounding tissues. This must cause acute and possibly severe pain. Consciousness is probably lost within 2 to 3 seconds, owing to a rapid fall of intracranial perfusion of blood.
There are accounts of the eyes looking around from the severed head, and animals may do this when they are guillotined for experiments in which their organs are to be excised or their brain biochemistry is to be examined rapidly.
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This guide will show you how to use the Nreal Light controller and Nreal phone controller. The tutorial will demonstrate how to create apps using Nreal Light controller as an interaction model.
Controllers provide a simple way for users to navigate in mixed reality. In the latest version, NRSDK supports two types of controlling methods: Nreal Light controller and Nreal phone controller. The Nreal Light controller can be paired with a Nreal Light computing unit or a mobile phone through Bluetooth. The Nreal phone controller is only available when using the phone as Nreal Light's computing unit.
Currently, only the Nreal Light controller (available in the Nreal Developer Kit) is available to developers. The Nreal phone controller will serve as a second input choice for users in the future.
How to Use the Nreal Light Controller
The Nreal Light Controller
 - On the front
Controller Features Description
3DoF Tracking 3 degrees of freedom
Touchpad Press = Trigger Button. Can detect touching and clicking. Customizable for your app, e.g. scrolling.
App Button Press and hold to recenter your controller. Press can be customized for your app, e.g. opening an in-app menu or performing a special action. ( Pay attention: For Nreal Light Controller, pressing the App Button equals to pressing the Touchpad Button)
Home Button Press and hold to open Exit App Window. Press can be customized for in-app action, e.g. return to the previous step.
LED Light Display controller status
 - On the back
Controller Features Description
Charging pins The three bottom-facing charging pins connect the controller with the computing unit. It is also used to send data from the computing unit to the controller.
Power Switch The Nreal Light controller on/off switch is below the charging spots. Green means the power is on, and red means the power is off.
 - Nreal Light Controller LED Guide
See LED demo below:
 - Connecting the Nreal Light Controller
 1. Make sure the Bluetooth on your Neal Light computing unit/or Android mobile phone is on. (The Bluetooth on Nreal Light computing unit is on as default.)
 2. Turn the Nreal Light controller power switch on. Long press the touchpad until the green light starts blinking.
 3. Put the Nreal Light controller on the computing unit, and they will be paired automatically.
 4. If pairing is successful, the LED will stop blinking and become solid green. If you cannot complete this step, remove all other controllers in the Bluetooth record list and try again.
 - Charging the Nreal Light Controller
Magnetically attach to the Nreal Light computing unit. Battery power will be shared between the two whether the controller is on or off.
The lithium battery in the controller is not removable. Please do not attempt to open the controller. Damage caused this way cannot be fixed.
How to Use Your Phone as a Controller
Controller Features Description
3DoF Tracking 3 degrees of freedom
Home Button Press and hold to open Exit App Window. Press can be customized for in-app action, e.g. return to the previous step.
Tutorial： Nreal Light Controller
Input in Unity
These following points will help you better understand the Input from NRSDK in Unity.
ControllerProvider: This provides various controller state information to NRInput, including rotation, button press, button up, battery, and gyro. There is a default provider for Nreal controllers. You can also write a custom controller provider.
EventSystem: Integration with Unity's standard EventSystem supports user interaction with GUI and other physical objects. NRIput will automatically generate an EventSystem when the application runs.
Visualizations: Default visualizations, such as controller visual, ray visual, and reticle visual, are already included. There is also an interface for you to reskin visualizations.
Enabling NRInput
To enable NRInput, simply drag the NRInput prefab into your scene hierarchy. If you already have a Main Camera set up, drag it onto Override Camera Center in the NRInput prefab. Otherwise, the prefab will find the Main Camera. Users can now interact in the app using Nreal Light controllers.
Raycast Modes in NRInput
There are two raycasting modes included in the NRInput: the Gaze Mode and the Ray Mode.
The Ray Mode is the default raycasting mode most apps will be based on. In this mode, the ray will start from the center of the controller.
When in Gaze Mode, the raycast will start from the center of the user's forehead and emanate in a forward direction. Thus, the ray will be invisible.
Current Controller Features
Since NRSDK supports multiple types of controllers, a method was scripted to help you understand the features your current controller supports.
 - Sample Use Case:
bool supportsPosition = NRInput.GetControllerAvailableFeature(ControllerAvailableFeature.CONTROLLER_AVAILABLE_FEATURE_POSITION);
bool supportsGyro = NRInput.GetControllerAvailableFeature(ControllerAvailableFeature.CONTROLLER_AVAILABLE_FEATURE_GYRO);
Some Common Usage of NRInput
 - Sample Use Case:
void Update()
 //returns a int value of how many available controllers currently
 //returns true if a Trigger button is currently pressed
 //returns true if a Trigger button was pressed down this frame
 //returns true if a Trigger button was released this frame
 //returns if controller is 3DoF, otherwise returns the position of the domain controller
 //returns the rotation of the domain controller
 //returns the ControllerType of the domain controller
 ControllerType controllerType = NRInput.GetControllerType();
 //returns true if the touchpad is being touched
 //returns a Vector2 value of the touchpad, x(-1f ~ 1f), y(-1f ~ 1f)
 //returns a Vector3 value of gyro if supports
 //to get what hand mode is using now, left-hand or right-hand
 ControllerHandEnum domainHand = NRInput.DomainHand;
 //the same as NRInput.GetRotation()
 //returns the rotaion of the left hand controller
Get Frequently Used Anchors
The NRInput provides an easy way to get frequently used anchors quickly.
 - Sample Use Case:
Transform gazeAnchor = NRInput.AnchorsHelper.GetAnchor(ControllerAnchorEnum.GazePoseTrackerAnchor);
Transform leftRayAnchor = NRInput.AnchorsHelper.GetAnchor(ControllerAnchorEnum.LeftRayAnchor);
Raycasters in NRInput
Three raycasters are included in the NRInput prefab. One of which for Gaze Mode, and the other two for Ray Mode. The raycaster class inherits from Unity's BaseRaycaster class. A chosen raycaster's farthest raycasting distance can be modified directly from the Inspector window. You can also define which objects are interactable by changing the parameter of its Mask.
Building a Project with User Input
To help you get started with integrating control into your own app, we have prepared a sample case study.
By reading the study you will be able to:
 1. Select a range of appropriate inputs to use with the controller.
 2. Write code in C# to receive user inputs such as the Home, Bumper, Trigger and Touchpad.
 3. Activate, rotate, and move a GameObject by using the input.
 4. Interact with physical objects and UGUI in the unity environment.
 1. When pointing the controller at the cube, its color will change to green.
 2. The color of the cube will randomly change when you press the trigger button.
 3. The cube will rotate with the controller.
 4. Activate or deactivate the cube for rotation by pressing the UGUI button.
 1. Drag NRCameraRig and the NRInput prefab to the scene hierarchy.
 1. Create a cube. In the Inspector window, set its position to (0, 0.1, 3), and scale to (0.3, 0.3, 0.3).
 1. Create a script named "CubeInteractiveTest.cs" as follows and add it to the cube.
 public class CubeInteractiveTest : MonoBehaviour, IPointerClickHandler, IPointerEnterHandler, IPointerExitHandler
 private MeshRenderer m_MeshRender;
 void Awake () {
 m_MeshRender = transform.GetComponent();
 void Update()
 //get controller rotation, and set the value to the cube transform
 transform.rotation = NRInput.GetRotation();
 //when pointer click, set the cube color to random color
 public void OnPointerClick(PointerEventData eventData)
 m_MeshRender.material.color = new Color(Random.Range(0f, 1f), Random.Range(0f, 1f), Random.Range(0f, 1f));
 //when pointer hover, set the cube color to green
 public void OnPointerEnter(PointerEventData eventData)
 m_MeshRender.material.color =;
 //when pointer exit hover, set the cube color to white
 public void OnPointerExit(PointerEventData eventData)
 m_MeshRender.material.color = Color.white;
 2. Add a DirectLight to brighten the cube.
 1. Add a Canvas and delete the EventSystem.
 1. Set the Canvas RenderMode to WorldSpace, and then set its position and scale to an appropriate value such as that listed below.
 1. Remove the "Graphic Raycaster" component from it and add Canvas Raycast Target.
 1. Add two buttons to the Canvas as its children. Name one button activeBtn and the other deactive. Remember to also change the


the referent is not a (scripted) proxy, return undefined.
proxyHandler
If the referent is a non-revoked (scripted) proxy, return a Debugger.Object instance referring to the ECMAScript [[ProxyHandler]] of the referent. If the referent is a revoked (scripted) proxy, return null. If the referent is not a (scripted) proxy, return undefined.
promiseState
If the referent is a Promise, return a string indicating whether the Promise is pending, or has been fulfilled or rejected. This string takes one of the following values:
 - "pending", if the Promise is pending.
 - "fulfilled", if the Promise has been fulfilled.
 - "rejected", if the Promise has been rejected.
If the referent is not a Promise, throw a TypeError.
promiseValue
Return a debuggee value representing the value the Promise has been fulfilled with.
If the referent is not a Promise, or the Promise has not been fulfilled, throw a TypeError.
promiseReason
Return a debuggee value representing the value the Promise has been rejected with.
If the referent is not a Promise, or the Promise has not been rejected, throw a TypeError.
promiseAllocationSite
If the referent is a Promise, this is the JavaScript execution stack captured at the time of the promise's allocation. This can return null if the promise was not created from script. If the referent is not a Promise, throw a TypeError exception.
promiseResolutionSite
If the referent is a Promise, this is the JavaScript execution stack captured at the time of the promise's resolution. This can return null if the promise was not resolved by calling its resolve or reject resolving functions from script. If the referent is not a Promise, throw a TypeError exception.
promiseID
If the referent is a Promise, this is a process-unique identifier for the Promise. With e10s, the same id can potentially be assigned to multiple Promise instances, if those instances were created in different processes. If the referent is not a Promise, throw a TypeError exception.
promiseDependentPromises
If the referent is a Promise, this is an Array of Debugger.Objects referring to the promises directly depending on the referent Promise. These are:
 1. Return values of then() calls on the promise.
 2. Return values of Promise.all() if the referent Promise was passed in as one of the arguments.
 3. Return values of Promise.race() if the referent Promise was passed in as one of the arguments.
Once a Promise is settled, it will generally notify its dependent promises and forget about them, so this is most useful on pending promises.
Note that the Array only contains the promises that directly depend on the referent Promise. It does not contain promises that depend on promises that depend on the referent Promise.
If the referent is not a Promise, throw a TypeError exception.
promiseLifetime
If the referent is a Promise, this is the number of milliseconds elapsed since the Promise was created. If the referent is not a Promise, throw a TypeError exception.
promiseTimeToResolution
If the referent is a Promise, this is the number of milliseconds elapsed between when the Promise was created and when it was resolved. If the referent hasn't been resolved or is not a Promise, throw a TypeError exception.
global
A Debugger.Object instance referring to the global object in whose scope the referent was allocated. This does not unwrap cross-compartment wrappers: if the referent is a wrapper, the result refers to the wrapper's global, not the wrapped object's global. The result refers to the global directly, not via a wrapper.
allocationSite
If object allocation site tracking was enabled when this Debugger.Object's referent was allocated, return the JavaScript execution stack captured at the time of the allocation. Otherwise, return null.
Function Properties of the Debugger.Object prototype
The functions described below may only be called with a this value referring to a Debugger.Object instance; they may not be used as methods of other kinds of objects. The descriptions use "referent" to mean "the referent of this Debugger.Object instance".
Unless otherwise specified, these methods are not invocation functions; if a call would cause debuggee code to run (say, because it gets or sets an accessor property whose handler is debuggee code, or because the referent is a proxy whose traps are debuggee code), the call throws a Debugger.DebuggeeWouldRun exception.
getProperty(name)
Return the value of the referent's property namedname, or undefined if it has no such property.Name must be a string. The result is a debuggee value.
setProperty(name,value)
Storevalue as the value of the referent's property namedname, creating the property if it does not exist.Name must be a string;value must be a debuggee value.
getOwnPropertyDescriptor(name)
Return a property descriptor for the property namedname of the referent. If the referent has no such property, return undefined. (This function behaves like the standard Object.getOwnPropertyDescriptor function, except that the object being inspected is implicit; the property descriptor returned is allocated as if by code scoped to the debugger's global object (and is thus in the debugger's compartment); and its value, get, and set properties, if present, are debuggee values.)
getOwnPropertyNames()
Return an array of strings naming all the referent's own properties, as if Object.getOwnPropertyNames(referent) had been called in the debuggee, and the result copied in the scope of the debugger's global object.
getOwnPropertySymbols()
Return an array of strings naming all the referent's own symbols, as if Object.getOwnPropertySymbols(referent) had been called in the debuggee, and the result copied in the scope of the debugger's global object.
defineProperty(name,attributes)
Define a property on the referent namedname, as described by the property descriptordescriptor. Any value, get, and set properties ofattributes must be debuggee values. (This function behaves like Object.defineProperty, except that the target object is implicit, and in a different compartment from the function and descriptor.)
defineProperties(properties)
Add the properties given byproperties to the referent. (This function behaves like Object.defineProperties, except that the target object is implicit, and in a different compartment from theproperties argument.)
deleteProperty(name)
Remove the referent's property namedname. Return true if the property was successfully removed, or if the referent has no such property. Return false if the property is non-configurable.
seal()
Prevent properties from being added to or deleted from the referent. Return this Debugger.Object instance. (This function behaves like the standard Object.seal function, except that the object to be sealed is implicit and in a different compartment from the caller.)
freeze()
Prevent properties from being added to or deleted from the referent, and mark each property as non-writable. Return this Debugger.Object instance. (This function behaves like the standard Object.freeze function, except that the object to be sealed is implicit and in a different compartment from the caller.)
preventExtensions()
Prevent properties from being added to the referent. (This function behaves like the standard Object.preventExtensions function, except that the object to operate on is implicit and in a different compartment from the caller.)
isSealed()
Return true if the referent is sealed—that is, if it is not extensible, and all its properties have been marked as non-configurable. (This function behaves like the standard Object.isSealed function, except that the object inspected is implicit and in a different compartment from the caller.)
isFrozen()
Return true if the referent is frozen—that is, if it is not extensible, and all its properties have been marked as non-configurable and read-only. (This function behaves like the standard Object.isFrozen function, except that the object inspected is implicit and in a different compartment from the caller.)
isExtensible()
Return true if the referent is extensible—that is, if it can have new properties defined on it. (This function behaves like the standard Object.isExtensible function, except that the object inspected is implicit and in a different compartment from the caller.)
copy(value)
Apply the HTML5 "structured cloning" algorithm to create a copy ofvalue in the referent's global object (and thus in the referent's compartment), and return a Debugger.Object instance referring to the copy.
Note that this returns


IGC CODE 1983 | The Marine Study
IGC CODE 1983
CHAPTER 8 | VENT SYSTEMS
8.2 PRESSURE RELIEF SYSTEMS
[For ships constructed from 01-Jul-2016, Applicable from 01-Jan-2016]

8.2.1 Cargo tanks, including deck tanks, shall be fitted with a minimum of two pressure relief valves (PRVs), each being of equal size within manufacturer's tolerances and suitably designed and constructed for the prescribed service.
8.2.2 Inter barrier spaces shall be provided with pressure relief devices. For membrane systems, the designer shall demonstrate adequate sizing of inter barrier space PRVs.
8.2.3 The setting of the PRVs shall not be higher than the vapour pressure that has been used in the design of the tank. Where two or more PRVs are fitted, valves comprising not more than 50% of the total relieving capacity may be set at a pressure up to 5% above MARVS to allow sequential lifting, minimizing unnecessary release of vapour.
8.2.4 The following temperature requirements apply to PRVs fitted to pressure relief systems:
1. PRVs on cargo tanks with a design temperature below 0oC shall be designed and arranged to prevent their becoming inoperative due to ice formation;
2. The effects of ice formation due to ambient temperatures shall be considered in the construction and arrangement of PRVs;
3. PRVs shall be constructed of materials with a melting point above 925°C. Lower melting point materials for internal parts and seals may be accepted, provided that failsafe operation of the PRV is not compromised; and
4. Sensing and exhaust lines on pilot operated relief valves shall be of suitably robust construction to prevent damage.
8.2.5 Valve testing
8.2.5.1 PRVs shall be type tested. Type tests shall include:
1. Verification of relieving capacity;
2. Cryogenic testing when operating at design temperatures colder than 55° C;
3. Seat tightness testing; and
4. Pressure containing parts are pressure tested to at least 1.5 times the design pressure.
PRVs shall be tested in accordance with recognized standards.
8.2.5.2 Each PRV shall be tested to ensure that:
1. It opens at the prescribed pressure setting, with an allowance not exceeding ± 10% for 0 to 0.15 MPa, ± 6% for 0.15 to 0.3 MPa, ± 3% for 0.3 MPa and above;
2. Seat tightness is acceptable; and
3. Pressure containing parts will withstand at least 1.5 times the design pressure.
8.2.6 PRVs shall be set and sealed by the Administration or recognized organization acting on its behalf, and a record of this action, including the valves' set pressure, shall be retained on board the ship.
8.2.7 Cargo tanks may be permitted to have more than one relief valve set pressure in the following cases:
1. Installing two or more properly set and sealed PRVs and providing means, as necessary, for isolating the valves not in use from the cargo tank; or
2. Installing relief valves whose settings may be changed by the use of a previously approved device not requiring pressure testing to verify the new set pressure. All other valve adjustments shall be sealed.
8.2.8 Changing the set pressure under the provisions of 8.2.7 and the corresponding resetting of the alarms referred to in 13.4.2 shall be carried out under the supervision of the master in accordance with approved procedures and as specified in the ship's operating manual. Changes in set pressure shall be recorded in the ship's log and a sign shall be posted in the cargo control room, if provided, and at each relief valve, stating the set pressure.
8.2.9 In the event of a failure of a cargo tank installed PRV, a safe means of emergency isolation shall be available:
1. Procedures shall be provided and included in the cargo operation manual (see 18.2).
2. The procedures shall allow only one of the cargo tank installed PRVs to be isolated.
3. Isolation of the PRV shall be carried out under the supervision of the master. This action shall be recorded in the ship's log and a sign posted in the cargo control room, if provided, and at the PRV.
4. The tank shall not be loaded until the full relieving capacity is restored.
8.2.10 Each PRV installed on a cargo tank shall be connected to a venting system, which shall be:
1. So constructed that the discharge will be unimpeded and directed vertically upwards at the exit;
2. Arranged to minimize the possibility of water or snow entering the vent system;
3. Arranged such that the height of vent exits shall not be less than B/3 or 6 m, whichever is the greater, above the weather deck ; and
4. 6 m above working areas and walkways.
8.2.11
8.2.11.1 Cargo PRV vent exits shall be arranged at a distance at least equal to B or 25 m, whichever is less, from the nearest air intake, outlet or opening to accommodation spaces, service spaces and control stations, or other nonhazardous areas. For ships less than 90 m in length, smaller distances may be permitted.
8.2.11.2 All other vent outlets connected to the cargo containment system shall be arranged at a distance of at least 10 m from the nearest air intake, outlet or opening to accommodation spaces, service spaces and control stations, or other nonhazardous areas.
8.2.12 All other cargo vent outlets not dealt with in other chapters shall be arranged in accordance with 8.2.10, 8.2.11.1 and 8.2.11.2. Means shall be provided to prevent liquid overflow from vent mast outlets, due to hydrostatic pressure from spaces to which they are connected.
8.2.13 If cargoes that react in a dangerous manner with each other are carried simultaneously, a separate pressure relief system shall be fitted for each one.
8.2.14 In the vent piping system, means for draining liquid from places where it may accumulate shall be provided. The PRVs and piping shall be arranged so that liquid can, under no circumstances, accumulate in or near the PRVs.
8.2.15 Suitable protection screens of not more than 13 mm square mesh shall be fitted on vent outlets to prevent the ingress of extraneous objects without adversely affecting the flow. Other requirements for protection screens apply when carrying specific cargoes (see 17.9 and 17.21).
8.2.16 All vent piping shall be designed and arranged not to be damaged by the temperature variations to which it may be exposed, forces due to flow or the ship's motions.
8.2.17 PRVs shall be connected to the highest part of the cargo tank above deck level. PRVs shall be positioned on the cargo tank so that they will remain in the vapour phase at the filling limit (FL) as defined in chapter 15, under conditions of 15° list and 0.015L trim, where L is defined in 1.2.31.
8.2.18 The adequacy of the vent system fitted on tanks loaded in accordance with 15.5.2 shall be demonstrated, taking into account the recommendations developed by the Organization. A relevant certificate shall be permanently kept on board the ship. For the purposes of this paragraph, vent system means:
1. The tank outlet and the piping to the PRV;
2. The PRV; and
3. The piping from the PRVs to the location of discharge to the atmosphere, including any interconnections and piping that joins other tanks.

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text:
What is Earobics?
Earobics is a software program that systematically teaches the listening skills required for reading and academic success. Research has shown that phonological awareness is the best predictor of success in reading. Research has also shown that this ability to identify and manipulate the sounds of language can actually be developed through systematic instructions.
Who is involved in Earobics?
Children struggling with reading, demonstrating auditory processing challenges, or presenting with delayed speech and language are candidates for this program. There are two Earobics steps: Step 1 is for developmental ages four to seven years; and Step 2 is for developmental ages seven to ten years.
How does it work?
Earobics features sophisticated adaptive technology, which automatically adjusts instruction to the child's skill level and progress. Using systematic instruction and repetition, new neural pathways are developed to improve the ability to identify and manipulate sound of language.
- Figure ground perception
- Sound blending and sequencing
- Recognize rhyming sound patterns
- Improve comprehension of words
- Follow spoken instruction
Requirements to begin:
- Developmental age of four years
- Ability to understand basic directions
- Tolerate wearing headphones
- Understand how to use the mouse on a computer
– Computer based, language-learning program
– Teaches phonics and auditory processing
– Experience shows most children show dramatic skill improvement with a 3x/week regimen


History of Japan
This week, we cover the short yet fascinating history of Islam in Japan. What factors led to a connection between the Islamic world and Japan? Who led the efforts to build bridges between the two? And why is the history of this relationship so generally unknown?
Show notes here.
Direct download: History_of_Japan_348_mixdown.mp3
Category:History -- posted at: 4:00am PST


Amir Raminfar Amir Raminfar - 1 year ago 85
Groovy Question
What does the question mark mean in GSP/Grails?
I saw this in my generated GSP pages. What does the ? mean?
<g:textField name="name" value="${phoneInstance?.name}" />
Answer Source
It's the "Safe Navigation Operator", which is a Groovy feature that concisely avoids null pointer exceptions. See _URL_
In this case, if phoneInstance is null, then it doesn't try to get the name property and cause a NPE - it just sets the value of the field tag to null.


text:
The British government mounted a major offensive in 1755 to end the French control of Fort Duquesne and destroy other French strongholds in the region. As the British army, led by Major General Edward Braddock, moved westward from Virginia, they were forced to widen the Nemacolin path and build a roadway to accommodate the 200 wagons, heavy artillery and over 2000 troops. This roadway, known as Braddock's Road, can today be traveled easily along modern highways, much of it following present day Route through Maryland and Pennsylvania. However, the original road trace is barely recognizable and much has been destroyed, over grown or is located on private property.
For more information, visit the following websites:


This nice infographic shows the entire history of computer interface evolution over a half century, from the early punched-card days of the 1950s, through the typed command lines of the 1960s, to the well known operating systems of the present.
In the last 30 years the most important device in human-computer interaction was undoubtedly the mouse, but recently touch screen and technologies that allow users to control their computers with body gestures (like Wii or Kinect) have become incredibly popular too. The reason why we publish this infograph is located at the bottom of the image, where thought control technology and brain-computer interfaces are predicted as the ultimate computer interface of the future. Do you agree with this prediction? Leave your opinion in a comment!
BCI Infographic of Human Computer Interface Evolution


the keyboard.
Connect the C button's touch up inside event to the clearDisplay method in Interface Builder.
Step 10: Number Input
Time to handle numeric input. When you open the keyboard it shows 0 on the display. If you tap a number key, it should replace the display to that number. Create a property named shouldClearDisplayBeforeInserting to implement this behavior.
Create a method named didTapNumber and connect it in Interface Builder to all the number buttons for the touch up inside event. The method uses the titleLabel of the button to determine which number was tapped.
Update the clearDisplay method as shown below.
The keyboard code is in a different target than your app. Because of this the debug logs aren't visible. To see the logs for the Calculator target, open the system log from the iOS Simulator.
Step 11: Dot Input
The button to insert a dot should add a dot to the display, but only if there isn't a dot present yet.
Step 12: Inserting Text
The button to insert text should add the calculator display text to the insertion point. To do this, we use the textDocumentProxy property as shown below.
Step 13: Handling Operations
Because we're implementing a simple keyboard that doesn't support expression trees, 1 + 2 * 3 will equal 9. We're going to use a simpler model in which the calculator has an internal memory slot on which it can apply operations.
Let's take a simple input in order to understand how the calculator algorithm works:
 - user taps 1, the display should change from 0 to 1
 - user taps +, the calculator should remember to add the next inputted number to 1
 - user taps 2, the display should change from 1 to 2
 - user taps *, the display and the internal memory of the calculator should change to 3, the calculator should remember to multiply the internal memory with the next inputted number
 - user taps 3, the display should remain 3
 - user taps =, the calculator should apply the last operation and the display should change to 9
Observations:
 - the calculator should remember the next operation to apply
 - after inputting a number if an operation or equal is pressed, the calculator should apply the last remembered operation
 - if the user presses two or more operations without inputting a number, the calculator should remember the last one
 - after an operation is applied, the display should update with the result
 - after a result is displayed, the display should clear before writing another number
In order to implement the calculator, we are going to need:
 - an internalMemory property that stores the temporary result
 - a property that stores the nextOperation
 - another one that to remember if it should apply the nextOperation after an operation is pressed
Create a method named didTapOperation and connect it to the operation buttons touch up inside event in Interface Builder. The method will use the button title to determine which operation was pressed.
Create and implement the computeLastOperation method.
Update the clearDisplayMethod as shown below. When the user starts to write the first number, the internal memory should be set to 0 and nextOperation should be addition. That way, after the user inputs the first number and presses an operation, the calculator will remember the inputted number.
Step 14: Finishing Touches
Let's use the IBInspectable declaration attribute to add a corner radius to the buttons and display. First, create a subclass of UIButton and UILabel.
In Interface Builder, select the buttons and change their class to RoundButton in the Identity Inspector. In the Attributes inspector, you should see the new corner radius attribute.
Do the same for the display label. Your keyboard should now look like this.
Conclusion
You should now be able to make a custom keyboard in iOS using the app extension APIs. Remember that every custom keyboard must have a way to switch to the next keyboard and that your keyboard cannot connect to the internet, access location services, or talk with its containing app by default, but you can request these capabilities.
The system will use the default keyboard for secure fields, such as password and phone number fields. Don't forget that the code for the custom keyboard lives in a separate target. Because of this the debug logs aren't visible. To see them, open the system log from the iOS Simulator.
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A Bowl of Cereal Just as Good for Sports Recovery
Back in 2008, nutritionists and sports enthusiasts agreed that protein drinks offered the best chance of improving an athlete's performance. Current studies, however, show that a bowl of high-fiber, whole-grain cereal is just as helpful to an athlete recovering from exercise.
Why Protein Sports Drinks?
In 2008, a study was published in the Journal of International Society of Sports Nutrition that concluded that consuming sports drinks that consisted of both protein and carbohydrates were better for athletes than drinking carbohydrate-only beverages. When these supplements were consumed over the six-hour period after exercise, the participants experienced a better recovery period. In other words, athletes who drank a beverage that was mix of protein and carbohydrates were more apt to ease back into exercise quicker than those who did not.
Participants cycled on exercise bikes for a morning session, after which they rested and drank either a protein-carbohydrate beverage or a carbohydrate-only beverage. After the rest period was over, the participants got back on the exercises bikes for another session. While both groups did not show a performance level as high as they did in the morning session, those who consumed the protein-carbohydrate beverages did significantly better than participants who drank the carbohydrate-only beverages.
Why is Cereal Just as Good?
New research shows that consuming a bowl of whole-grain cereal provides the same benefits as a sports drink that contains carbohydrates. The difference between this study and the study that was previously conducted was that the participants, eight men and four women, were to endure a workout more similar to a traditional exercise session. While all of the participants were trained cyclists and fully capable of undergoing a difficult exercise session, researchers wanted to make the study as close to a typical workout as possible. There was a warm-up period followed by a two hours cycling session at a rate that was comfortable for the participants. After the session was over, the participants were allowed to rest. Previous studies focused mainly on exerting participants to the point of exhaustion.
The main goal of the study was to discover whether or not whole-grain cereals were better or worse than carbohydrate-based sports drinks. Researchers found that whole-grain cereals replenished muscle fuel at either the same rate or better than the sports beverages.
In another study, researchers found that the muscles in the body can be stimulated or manipulated in different ways through changes in the athlete's diet. They found that the most beneficial time for an individual to consume high-quality protein, including milk, was immediately after the exercise session. Muscles have to be encouraged to get stronger through exercise and nourished through food consumption since they cannot build themselves back up on their own.
The benefit to this conclusion is that whole-grain cereals and nonfat or low-fat Recovery foods, workout, exercise, cerealmilk cost much less than sports drinks. Not only does the body receive the necessary nutrients from fiber in the whole-grain cereals, but the milk provides proteins that are easy to digest. The proteins can also help to increase the athlete's rate of adapting to training sessions, as well as promote protein synthesis within the body.
Which Is Better?
Athletes who thrive on intensive workouts and push themselves to the limit may not feel the benefit of a bowl of whole-grain cereal and milk and may need an extra boost to recover fully from their workouts. However, other individuals who are not as active such as amateur athletes and those who participate in moderate activities to stay in shape may find that they get the extra boost they need by eating cereal instead.


then one or more of the nuts in the burr will not be filled in.
When there is a complete pollination failure, the burrs could have anywhere from the normal number of nuts in them but are all blanks, to as many as 7 or 8 blank nuts in each burr. This condition happens when the chestnut trees are healthy, have the right amount of moisture in the soil but the weather was too cold for nut set.
To produce a nice crop of chestnuts, a chestnut farmer has to make sure there is enough viable pollen present at the right time, the chestnut trees are not stressed, and the day time high temperatures are above 68 degrees F. Having the wind blow from the right direction or having insects move the pollen at the right time is also helpful too. The simplest approach to reducing the risk of pollination failure is to plant several pollen producing chestnut trees that cover all 3 periods of the chestnut bloom period.


Huffpost UK uk
False Widow Spider Bite Left Bromley Grandfather John Catlin 'Wanting To Die' (GRAPHIC PICTURES)
Posted: Updated:
A grandfather has revealed how a bite from a false widow spider left him in so much pain he "just wanted to die".
John Catlin was bitten by one of the venomous arachnids in his garden in Bromley, last year.
Within hours, the 66-year-old's temperature was topping 40C and he was rushed to hospital.
WARNING: Graphic pictures below
false widow spider bite john catlin
John Catlin was bitten on the toe by a false widow spider in his garden in Bromley
The pensioner told the Daily Star: "Over the two weeks I stayed in hospital, I was all swollen up and my leg turned dark red with huge blisters. At one point my organs started shutting down and I had real problems with my kidneys."
Catlin was told he had a streptococcal infection in the bite and was diagnosed with cellulitis, a severe skin infection.
He added: "One night my heart was racing like a marathon runner and I needed injections from doctors.
"I thought: 'I just want to die.' I was later told I came very close to losing my foot."
false widow spider bite
Catlin developed an streptococcal infection in the bite and was diagnosed with cellulitis
Catlin revealed his experience after Essex decorator Ricki Whitmore told of how he nearly lost a leg after a bite from a false widow spider as he worked at a school.
The 39-year-old must have his wounds cleaned daily by a nurse and six months of physiotherapy are on the cards before he is expected to walk again.
false widow spider
Six species of false widow spider have been recorded in the UK
Unlike the black widow, the false widow spider is known to live in Britain and was first spotted in Devon in the late 1800s.
It tends to populate the coastal areas of southern England and London and it is likely the increase in its numbers is in response to climate change.
According to Stuart Hine of the Natural History Museum's (NHM) Insect Information Service, no one has ever died of a spider bite in Britain and the number of reported bites from spiders in general is minimal.
The false widow is amongst only a dozen or so of the UK's 650 species of spider that are capable of biting humans.
The NHM says reports from people believed to have been bitten by the false widow describe varying levels of burning, discomfort or numbness and associated swelling in the area surrounding the bite.
Symptoms usually disappear within one to three days, though some like Catlin and Whitmore have experienced severe reactions to the arachnid's venom.


Question: How Do You Use UPI?
Is UPI pin same for all bank account?
Is debit card necessary for UPI?
What is UPI and how do you use it?
UPI is a bank account linked instant payment system. It enables you to transact money between two bank accounts. If you have a bank account with UPI-enabled member bank and a mobile phone, you can start using UPI. But before that you need to download the UPI-enabled app.
What is the function of UPI?
UPI or Unified Payments Interface is an immediate real-time payment system that helps in instantly transferring the funds between the two bank accounts through a mobile platform. Hence, UPI is a concept that allows multiple bank accounts to get into a single mobile application.
How do I use UPI ID?
You can make direct bank payments to anyone on UPI using their UPI ID or scanning their QR with the BHIM app. You can also request money through the app from a UPI ID. Send money by entering UPI ID, account number, aadhaar or by scanning a QR. Request money from other UPI users by entering their UPI ID.
Do you need net banking for UPI?


text:
If you're looking for family-friendly fun in the Dominican Republic, head to Manatí Park for a 2-hour tour of animal exhibits with an informative guide. This theme park includes a selection of animal shows and cultural performances throughout the day. Be entertained by sea lions, dolphins and parrots, and watch Taino dancers and artisans recreate the life of their indigenous ancestors.
Once you're picked up from your hotel in Punta Cana and arrive at Manatí Park, your knowledgeable guide leads you on a 2-hour tour of the landscaped theme park. You'll be introduced to native fauna including orchids and other tropical plants.
Stop by animal exhibits featuring fauna of the Dominican Republic such as caimans, iguanas, tropical birds, flamingos and snakes, and learn about their behaviors from the keepers. You can opt to see several animal shows scheduled throughout the day.
Watch dolphins follow the commands of their trainer, see horses perform equestrian tricks and be amused by the antics of comical parrots. Immerse yourself in the indigenous culture of the Dominican Republic at the Taino Village.
Observe the choreographed steps of Taino dances that showcase their rituals and folklore, and see craftspeople fashioning the art of their ancestors—with paintings, statues and traditional clothing on display at the museum.


text:
An increasing number of colleges and universities across the United States are making Giving Days an important part of their overall fundraising strategies.
These 24-hour fundraising challenges go beyond inspiring alumni to give, with participation seen from faculty, students, and even non-affiliated members of their local communities.
An impressive example was Canisius College's first Giving Day, with over $200,000 raised from more than 1,000 donors in a single day! Here's how Giving Days benefit both higher education organizations AND their donors:
BENEFITS FOR HIGHER ED ORGANIZATIONS
1. Improved Alumni Engagement
Successful Giving Days rely heavily on an enhanced online presence and social media engagement that leads supporters to a simple way to give back through online donations. Essentially with a Giving Day what you're doing is:
"Meeting donors where they already are – on social media and online" – Canisius
2. New Donor Acquisition
Studies from higher education Giving Days have revealed that they can (and often do) attract new donors of all age levels. See the stats from this higher ed Giving Day report!
It's important to also keep in mind the number of post-graduates who have accumulated student loan debt and who would normally not be appropriate to reach out to for donations.
With a Giving Day, more emphasis is placed on increasing the number of people that are involved in giving what they are able to give (known as "the crowdfunding game"), rather than a small number of wealthy people giving in large quantities. Because of this, everyone can feel as though they contributed to the grand total. 🙂
3. Improved Awareness / Understanding of Your Organization's Needs
With an amplified online presence through your Giving Day website and social media campaigns, you're improving both the number of people you're reaching with your message and the quality of that message. The better your cause is understood, the more people will relate to it and want to provide their support.
4. Raise Much-Needed Funds
As Canisius mentioned following their successful Giving Day, a lot of the funds they saw during this event may have never come in otherwise. Having a sense of urgency (24-hour timeframe!) really does encourage giving.
5. Rising Popularity and Success Amongst Universities as a Whole
More and more colleges and universities are seeing incredible results by implementing a Giving Day into their fundraising plan. Their strategies for success throughout the day are often shared openly and can be implemented by other institutions in order to see similar results.
6. They almost always Exceed Expectations
If you look at the Giving Day performance statistics for higher education organizations, the majority of them have surpassed their fundraising goals!
BENEFITS FOR DONORS
7. Strengthened Sense of Pride in Your Organization
Whether it be in the college itself or within certain groups they were associated with, donors can feel a strengthened sense of pride by contributing during the Giving Day. For example, a specific sports team could be recognized for giving the most as a group for that day or for having the most donors. These numbers are reflected in the Giving Day Leaderboards, one of the many great features offered through GiveGab.
When you have an established day dedicated to giving back to your college or university, you can get the entire community – beyond just your alumni – involved! When fundraising isn't only targeting your alumni, you're casting a larger net and establishing a bigger community of supporters that your alumni, faculty, students, and so on, can ALL feel a deeper connection to!
8. Increased Philanthropic Spirit
As most donors can attest to, there's a lot of joy that comes from contributing to something greater than ourselves. When an organization of higher learning has provided us with the skills and experience to succeed in life or with invaluable personal connections, a collaborative giving event can ignite a widespread spirit of philanthropy.
Giving to higher education has increased every year since 2010, according to The Chronicle of Philanthropy. Your college or university can be a part of this growing trend by implementing a Day of Giving into your overall fundraising strategy!


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MARTIN, JONY (2009) VARIABILITAS JENIS IKAN KARANG DI PERAIRAN WATU LAWANG DAN KARANG PON-PON PASIR PUTIH KECAMATAN BUNGATAN KABUPATEN SITUBONDO. Other thesis, University of Muhammadiyah Malang.
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Rock fish is a specific fish which lived in around rock ridge area. The increasing of rock ridge area exploitation and the catch of ridge rok fish which didn't pay attention to the environment, cause a wide-spread damage, especially in region where rock fish lived, the rock ridge area. In this area, rock fish has large amount and a large organism. With its large quantity fulfilling rock ridge area, there could be seen that rock fish was a supporter of relation in rock ridge ecosystem. White Sand beach was known as a beach which rich of fish and rock ridge. But as time goes by, the fish variant and the beauty of rock ridge was decreasing. It caused by continuous exploitation by people around which caused the higher damage of rock ridge area. Opening white sand as tourism object and lack of sea protection area could decrease the rock fish population. Based on the fact, there needed a population record about the amount and the kind of rock fish, especially in Watu Lawang and Pon-pon rock, white sand, Bungatan sub-district, Situbondo residence. The research aimed to find out about the various kind and amount of rock fish, to find out physical, chemical, and biological condition to the rock fish habitat and also find out factors damaging rock fish ecosystem in Watu Lawang and Pon-Pon rock water area White sand beach, Bungatan Sub-district, Situbondo Residence. The benefit of this research was: to increase knowledge in rock ridge monitoring using Reef Check method. It could be an information used as consideration for related policy to protect the species of rock fish, it also could be used as further research to use, develop, and keep the sea source in continuous and unity way. The research was done in November – December 2008, while primary data was taken in 15-16 November 2008 in Watu Lawang water area and Pon-Pon rock, White Sand beach, Bungatan sub-district Situbondo residence. In this research, the investigated object was kind and amount of rock fish, using Reef Check method. This method was done in 2 depth, 3 m and 10 m according to the lowest lessened data. From the research, the kind and amount of rock fish, that was Watu lawang in Site 1 (Watu Lawang) in 3 meters depth, there found Butterfly fish species, Haemulidae, Snapper and Parrotfish. In 10 meters depth, there found more rock fish. They were Butterflyfish, Haemulidae, Snapper, Barramundi cod, Grouper, Humphead wrasse and Parrotfish. In Site 2 (Pon-pon rock) at 10 meters depth, there found several species fishes, they were: Butterflyfish, Haemulidae, Snapper and Parrotfish. In 3 meters depth there found rock fishes: Butterflyfish, Haemulidae, Snapper and Parrotfish and Grouper. Water quality which was measured at location (Watu Lawang and Pon-Pon rock) showed temperature 26 - 280C, salinity 31 - 32‰, flow around 7 – 9,2 m/detik, DO in average 4,56 – 6,601mg/l and pH around 8 – 9. From the water quality measurement at location, it was still in normal rate for rock fish life. Ecosystem around Watu Lawang and Pon-Pon rock water area was not worth for rock fish life, since in the location could not found padang lamun ecosystem and mangrove ecosystem. In this location, rock ridge placed behind local villagers and there was not much shrimp pond which dominated the sea-shore, where the household waste was thrown to the sea and influenced the rock ridge life as the ecosystem of rock fish. Fishermen's boat was also influenced the life of rock ridge, since the anchor brought down by the fishermen could damage the rock ridge which lived in the area. The researcher suggest to do illuminatio to the society around and tourists about the importance of rock ridge life for rock fish and there was needed a monitoring of rock fish population each year, to find out the development of rock fish ecosystem so that the population and amount was not decreasing.
|Item Type:||Thesis (Other)|
|Subjects:||S Agriculture > SH Aquaculture. Fisheries. Angling|
|Divisions:||Faculty of Agriculture & Animal Husbandry > Department of Animal Scince|
|Depositing User:||Anggit Aldila|
|Date Deposited:||18 Jun 2012 03:06|
|Last Modified:||18 Jun 2012 03:06|
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3 Ways To Profit Through Insurance Billing
Grow your practice, your people, your purpose, and your profit by following this model of taking insurance
The Cost of Billing Insurance in Private Practice
The expenses related to insurance and medical billing has reached $282 billion every year according to the Center for American Progress.
Anyone interacting with the U.S. health care system is bound to encounter examples
of unnecessary administrative complexity—from filling out duplicative intake forms
to transferring medical records between providers to sorting out insurance bills. This
administrative complexity, with its associated high costs, is often cited as one reason
the United States spends double the amount per capita on health care compared
with other high-income countries even though utilization rates are similar.
This reality is no different in the world of private practice for mental health providers. In fact, the Practice Solutions team sees this on a daily basis. In one circumstance, a biller working with a group practice in Michigan spent 6 hours on the phone with a large insurance company in Michigan arguing with representatives about the credentialing status of a clinician that had been in-network for 8 months.
The biller was able to get $4,000.00 worth of claims paid.
Imagine though, had the provider spent that time on the phone with the insurance company.
Here is a list of things that the therapist could have done with those 6 hours:
 - Seen 5 patients
 - Read a book on their preferred method of therapy to be a better clinician
 - Engage in self-care
 - Take a nap
 - Focus on their family
 - Spend time focusing on building their practice instead of working in it
 - Traveling
Each year, health care payers and providers in the United States spend about $496 billion on billing and insurance-related (BIR) costs, according to Center for American Progress estimates presented in this issue brief. As health care costs continue to rise, a logical starting point for potential savings is addressing waste. A 2010 report by the National Academy of Medicine (NAM) estimated that the United States spends about twice as much as necessary on BIR costs. That administrative excess currently amounts to $248 billion annually, according to CAP's calculations.
This is an incredible statistic!
Think about this for a moment: According to Business Insider, the life expectancy of Americans has decreased for the third year in a row. What are the top causes of the decrease in life expectancy?
Here are the top reasons why the life expectancy in the United States has decreased for the third year in a row:
 1. Suicides
 2. Drug overdoses
 3. Alcohol-related diseases
This is quite a counterintuitive trend. A first-world country that spends more on privatized healthcare than any other affluent country in the world is dying at higher rates due to mental health-related causes. The need for mental health providers can hardly be overstated, but one of the biggest barriers to solving this problem is maintaining profitability in private practice by taking insurance and billing private and public healthcare.
Imagine if private practices and healthcare organizations operated so efficiently that they were able to take that $500 billion worth of waste and actually impact the overwhelming mental healthcare need in the United States? We believe that by educating around best revenue cycle management practices that we can see a meaningful difference in people's lives.
Understanding the Biggest Costs of Taking Insurance
The first place to look to understand billing and insurance-related costs is part of the administrative overhead that is insurance premiums and providers' reimbursements. It includes the overhead costs for the health insurance industry and providers' costs for claims submission, claims reconciliation, and payment processing. The health care system also requires administration beyond billing and insurance-related activities, including medical record-keeping; business management; initiatives that monitor and improve care quality; and programs to combat fraud and abuse.
To date, few studies have estimated the systemwide cost of healthcare administration extending beyond billing and insurance-related activities. In a 2003 article in The New England Journal of Medicine, researchers Steffie Woolhandler, Terry Campbell, and David Himmelstein concluded that overall administrative costs in 1999 amounted to 31 percent of total health care expenditures or $294 billion—roughly $569 billion today when adjusted for medical care inflation. A more recent paper by Woolhandler and Himmelstein, which looked at 2017 spending levels, placed the total cost of administration at $1.1 trillion.
At this point you might be thinking, "Okay, this is very interesting, but how does this apply to my private practice?" That is a great question. Thanks for asking!
According to the same study, the researchers found that about 50% of your administrative costs will be billing and insurance-related.
In Figure 2, you can see that providers and hospitals have a significant amount of money going to the billing and insurance-related expenses of their business. You might look at that figure and think that this is a huge problem, but really this is a huge opportunity for you to think about how to improve your practice, your people, your processes, and your purpose.
It is likely that you did not become an expert on human behavior and the treatment of mental health disorders for your own edification, but likely to make a big impact in the lives of individuals and families.
This is a huge blessing to our society!
It is important that we think together about the various ways that you can continue to make a profit and help as many people as possible in your private practice. There are really three ways to take insurance and maintain your profitability in the long-run. This blog is not for the private practice owner that is looking to scale as quickly as possible and then sell their private practice. No, this blog is for the private practice owner that lives and breathes helping people and is looking to build a legacy for their community, their staff, and for their family.
Here are the three ways that we have seen private practice owners take insurance and maintain their fiscal health while helping people at scale!
3 Ways to Take Insurance and Be Profitable
Each of these three ways to take insurance and be profitable have a couple of assumptions.
The first assumption is that you are a provider in private practice that is in-network with at least 1 insurance company.
The second assumption that we are making is that you might be feeling like you are treading water or feel as though you are not making as much profit as you ought to be given your busy schedule and the level of clients that you are seeing.
The third assumption that we are making is that you might have a wide range of processes and procedures in place to handle billing and insurance revenue.
With those in mind, let's begin looking at the three ways that you can take insurance and be profitable in your private practice.
The First Way to Take Insurance and Be Profitable
The first way that you can take insurance and be profitable is to take the smallest amount of in-network payers as possible with the highest level of reimbursement. What does this mean?
This means that you have evaluated the highest paying insurance companies in your area and you are only going to engage with that 1 or 2 insurance companies in your area. This could mean that you are only in-network with one commercial payer and one government payer or just one commercial payer.
What are the benefits to this way to take insurance?
The first benefit is that you are going to automatically exclude a certain number of people that don't have that insurance. This is a tough truth to grasp, but the benefit is that the time you do spend with insurance-based clients will be of maximum benefit to your business. The contrast is that you have lower paying insurance clients compared to a higher paying insurance client. In terms of time, you make less per hour with some clients than others, but this particular strategy means that you are maximizing your time per patient.
The second benefit of this way to take insurance means that you will have less credentialing hurdles as you scale up. Let's say you are starting to want to scale in terms of clinical staff. It is much MUCH easier to credential 10 clinicians with 1 insurance than 10 clinicians with 10 insurances. This benefit can be better understood by looking at the math in terms of individual panels that you credential therapists with.
Let's say you have 1 insurance company that you are in-network with. You have a 1 to 1 ratio in terms of credentialing. If you are in-network with 10 insurance companies, you now have a 10 to 1 ratio, which becomes a multiplication problem. In one circumstance you will engage in credentialing 10 providers 1 time with 1 insurance company. In the other circumstance you will actually be conducting 100 credentialing activities to get 10 clinicians in-network with 10 panels.
Your expenses will obviously increase if you have to engage in 100 credentialing activities versus 10 credentialing activities. If you are a group practice this becomes even more important because the complexity of credentialing and paneling only increases as you grow.
The third benefit of this strategy for taking insurance is that by limiting the number of insurances that you take means that your overall billing processes are leaner and simpler than your counterparts. Remember above that the billing and insurance related costs for a private practice owner revolve around claims submission, claims reconciliation, and payment processing.
By engaging one insurance company on an in-network basis you lean your processes to the simplest common denominator around these three areas. The delays and reduces your administrative burden and allows you to operate as simply as possible.
The downside here is that you limit the number of highly-clinical clients that you take and that can rub against your "why" in getting involved in private practice, which is why there is a second strategy to take insurance and remain profitable.
The Second Way to Take Insurance and Be Profitable
This strategy