Quan tenia 8 anys ja era una noia desarrolladeta i la més alta de la meva classe. Però sempre tenia la sombra d'alguna nena més mona que jo i això em feia sentir malament.

En canvi, hi havia una nena de la meva edad que em tenia molta enveja i em va fer la vida imposible al colegi. Encara ara quan ens creuem pel carrer i em mira amb prepotencia penso que no se pas lo que li havia fet. En fi, que no se com em va posar tot el colegi en contra i al ser d'un poble no costa gaire. El que més gracia em fa es que no hi he perdut res.

Bé, on anava, el meu primer intent. Després de petita amb la pressió mediatica que es forma de manera ingenua amb el germà i els amics que et tracten de gorda quan t'hi enfades. Va començar el que diriem la bulimia. Tenin 14 anys vaig començar a produïm el vòmit.

Us preguntareu com va acabar la cosa.

Doncs molt fàcil, jo sempre he estat molt coqueta i era l'època que feien aquelles pel·lícules de noies bulímiques. Llavors, ensenyaven per la televisión com quedaven amb les cares deformades i vaig veure que aixó no era per mi.

Però aviat vam començar a sortir per les nit i els nois van començar a fixar-se amb mi.

Realment era una nena resultona.

In the June 2008 issue of Quality digest, there is an article by Jay Arthur entitled “Statistical Process Control for Healthcare” (1). After the usual boilerplate type of introduction, something caught my eye; namely, the so called good news that there is “inexpensive Excel based software to create control charts … .“ This made me go to the end of the article where sure enough the author just happens to sell such software. This may have been a good place for the author to introduce the term bias.

To understand a more serious problem with this article, consider a hospital process; namely analyzing blood glucose in a hospital laboratory. Because such a process has error, quality control samples are run. Say such a control has a target value of 100 mg/dL.  The values of the quality control samples are plotted by SPC software and rules are formulated. If the glucose control value is too high or too low, the process is said to be out of control and action is taken.

Now,  Mr. Arthur is trying to push SPC software not for a process but for errors in the process. For example, he uses the infection rate in a hospital. But the infection rate error is not a process that one wants to control – of course one does not want it to become worse - but its target is zero.

A more useful example than the hypothetical one provided by Mr. Arthur was published recently (2). Here, the authors were faced with an undesirable hospital infection error rate and set out to observe where errors occurred in the process of placing central lines. They then provided control measures and continued to track the error rate, which was reduced to zero. This is not SPC! It is much more like a FRACAS (Failure Reporting And Corrective Action System).

In another part of the article, Mr. Arthur suggests that “never events” can be tracked by SPC. Never events – a list of 28 such events have been put forth by the National Quality Forum – have as implied, targets of zero. Such an event is wrong site surgery. One should use something like FMEA (Failure Mode Effects Analysis) to reduce the risk of such events. It is silly to suggest SPC software for never events.

References

1.   See. http://www.qualitydigest.com/currentmag/articles/03_article.shtml

2.   An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C N Engl J Med 355:2725, December 28, 2006

I just returned from the Westgard quality Control Workshop, where I was a speaker and have a few blogs worth of comments – this is the first.

What’s Missing from Clinical Laboratory Inspections

At the Westgard Workshop, most of the participants were from clinical laboratories and I was impressed with how smart these people are. I also got a sense of a tremendous regulatory burden. From the CAP CD, I obtained at the Workshop:

      The mission statement of the CAP Laboratory Accreditation Program is:

“The CAP Laboratory Accreditation Program improves patient safety by advancing the quality of pathology and laboratory services through education and standard setting, and ensuring laboratories meet or exceed regulatory requirements.”

I have had mixed feelings about inspections that certify quality and have previously reported my experience with an industry quality program – ISO 9001 (1).

Here’s my assessment of clinical laboratory inspections to certify laboratories. It would seem that the premise of these inspections is to ensure that specific policies and procedures are in place and executed as proven largely by documentation, which guarantees high quality. So what’s missing? As far as I can tell – and it is with great difficulty to read through these materials – that there is no measurement of error rates. Without such measurements, quality is unknown.

Recommendation

The regulatory bodies would describe a list of errors and their associated severities. The severities would be given numerical values such as the VA hospital system which uses 1-4. Every clinical laboratory would record each error (failure mode) that occurs in their laboratory, its severity, and its frequency (default frequency is of course 1).  They would multiply frequency x severity for each unique error (failure mode), add this up and get a rate by dividing by the number of tests reported per year.

Failing to count errors would be a serious violation.

This would be the start of a new premise for the regulatory bodies. Measure quality – if it’s unacceptable, the clinical laboratory would suggest and implement process changes. It’s a simple closed loop process. With emphasis on measurement, reliance on documentation should decrease and inspections should be less burdensome.

References

1.       Krouwer JS. ISO 9001 has had no effect on quality in the in-vitro medical diagnostics industry. Accred. Qual. Assur. 2004;9:39-43

Indeed. The most prized part of this meat is the siphon, which may be eaten raw, consumed sashimi style with soy sauce and wasabi, or cooked up into a nice Chinese hot pot soup.

I can hear many of you now. Ouch?

What about grinding up this meat to the consistency of hamburger. Mix it with equal parts crumbs and an egg or two and make patties! Saute or grill and you've got one heck of a burger!

Now that I've got your attention, please take a deep breath and relax. Would I steer you wrong?

Come now.

Today's food porn is none other than the Geoduck Clam. Pronounced gooey-duck or gwee-duck, it's a species of large saltwater clam (Panope generosa), native to the northern Pacific coasts of Canada and the USA. The name seems to have originated from an Native American word meaning to dig deep, and indeed... check out this clip (originating from Fisheries Canada) to see how a Geoduck Clam is harvested.

Click the thumbnail images accompanying the recipe for a larger version of this week's Friday Food Porn... the Prized Meat of the Geoduck Clam. But please, only click if you're confident enough not to let it bother you; Fracas cares about your self-esteem! Well, maybe not all of you. Some of you over at Humor-Blogs seem to think you're all mighty. I'm sure you don't need me to care about your self esteem, so click away!

Pacific Rim Geoduck Carpaccio

Geoduck Carpaccio:
24 (1/2 to 1 ounce) thinly sliced pieces geoduck siphon, pounded (might I say... ouch)

2 green onions (scallions), green part only, thinly sliced
2 tablespoons sliced pickled ginger

In a large saucepan of boiling salted water, blanch the spinach for about 1 minute, or until leaves are just wilted. Drain and rinse under cold water until the spinach is thoroughly cooled. Drain well and wrap spinach in clean, dry towel. Squeeze to remove excess moisture. Place spinach in medium bowl, sprinkle on sesame oil, rice wine vinegar, and salt and toss to mix. Set aside until ready to use. Sprinkle with sesame seeds for garnish just before serving.

Place a portion of the Sesame Spinach in the center of 4 plates. Or, place spinach on 1 large platter for buffet or family-style serving. Arrange 6 geoduck slices around the spinach. Drizzle some sauce on the geoduck and garnish with a sprinkling of green onions. Serve a bit of the sauce on the side as a dipping sauce, if desired. Place pickled ginger in center of salad in a mound.

Dipping Sauce:
2 tablespoons chopped shallots
2 teaspoons minced garlic
1 tablespoon Asian barbecue sauce
2 teaspoons hot bean sauce
2 tablespoons hoisin sauce
2 tablespoons Chinese Shoaxing wine or dry Sherry
2 tablespoons soy sauce
1/4 cup chicken stock
1 teaspoon sugar

In a small saucepan over medium heat, combine shallots, garlic, Asian barbecue sauce, hot bean sauce, and hoisin sauce and cook for 30 seconds. Add wine and cook for 1 minute. Add soy sauce, stock and sugar and cook for 2 minutes. Adjust with sugar, to taste. Transfer mixture to a blender and process until liquefied. Let cool.

More information about Geoduck Clams can be found at Agriculture Canada

[Geoduck Images found here, and here. Images cropped or altered to protect identities while displayed at fracas.]

And though we all know size isn't everything... fracas is pretty sure there are some folks out there that will just want to compare, so click one or two of these little icons and share the mighty meat!

You see, I signed up for Humor-Blogs a short while ago, and while I thought I'd be happy to just get to the top 30 and make the main page, once I started climbing the page, I found that more and more, my thoughts revolved around getting to be on top. Briefly, I found myself in the #2 spot, behind Kevin from Pointless Banter, and it was good. I started scheming how I might topple a 15 Minute Lunch but before you know it, Kevin had risen again. Damn him. Damn, damn, damn.

It's not that I hadn't noticed or anything. I'd been begging fraccers to click me up again, even offering to post a picture of my new bra if they did... but to make the whole situation even more embarassing, the fraccy readers started talking about it.

So I shall explain how it works over at that haven for boobs.

Once upon a time, those who joined were reviewed and assigned a base score by the reviewer. Afterwards, the clicks from your site to theirs were are tracked and added to your base score to comprise your total score. As time went on, Humor-Blogs became popular and the reviews stopped, each entrant instead being assigned a base score of 50 with their clicks then added to that. The clicks are tabulated based on the last 30 days worth, so clicks must continue to happen... or the blog's score will go down as clicks older than 30 days drop off the tally.

I'm going to whine a bit now, because Kevin joined earlier than I, and so received a review giving him a base score of 68 whereas I have had to endure a base score of only 50. I happen to think my boobs are more entertaining than Kevin's, but be that as it may, I must suffer with a lower base score.

To continue whining... Kevin also, happened to be mentioned on CNN the other day, and thus will be receiving a 38F's worth of traffic while I, with my 36D's will have to compete against that for the click-throughs to add to my score.

So you see... poor, poor fracas battling mean old Kevin is like David battling Goliath.

(Is this working? Do you feel propelled to rush out to a library and log into every single computer there so you can visit fracas and click through to Humor-Blogs to boost my score? Of course, I would never ask anyone to do that...)

So as you can see by these lovely screen captured images of our standings last night, while I may have indeed (as Dagny put it) gone down on Humor-Blogs, I think I can still hold my head high. I have managed to stay very close in click-throughs, to a Goliath. I promise not to give up though. I promise that if you keep clicking, I'll keep trying. I may have to show more boobs in order to keep the clicks happening... but for my fraccy readers, I'll do just about anything... I will, as God as my witness... stop going down on Humor-Blogs!

But if you want to email (or otherwise contact) CNN and give them a dressing down for not doing a story where they could quote me... I won't complain. If you cc me your letter, I'll even write a post about you.

A couple of days ago, "I like to eat seafood" John fueled me over at Fuelmyblog (and really, if you haven't signed up yet, umm... why not?) and the sheer wit he rolls with (and why we love him so) on a daily basis, caused him to leave this for a comment.

Fracas is a male cross dresser! Pass it on!

Obviously, there was no way I could allow such a rumour to flourish unchecked, and so I, in a mass fuel (for you non-fuelers, it means you can fuel/vote for everyone on your list in one fell swoop.  Try that at other places. Hah! Fuel ruels) decided to leave everyone the following comment, just to make sure everyone is totally clear on what exactly, my intentions are online.

"Would someone please tell John C. I'm not a male cross dresser, I'm a female pretending to be a male cross dresser!"

It did not occur to me (note the earlier mention as to my barrel over the falls behaviour) that some people whom I fuel, might not actually be on John's list, and therefore wouldn't have one fraccing clue as to why I would send that message.

So I'm outing myself to the world. Hopefully this will end the mass confusion I've created.  

Fracas is not a male cross dresser, I'm a female pretending to be a male cross dresser!

That should be good for a few clicks over to Humor-Blogs. Hey.. I was #2 there for a couple of days and now I see that Kevin from Pointless Banter has managed to get on top of me again. Just because some silly reader of his somehow got the impression he was an expert on Bukkake.

Gads. The things I have to endure...

So click the fraccy boobs ok? I l prefer to be on top, and come hell or high water... Kevin's going down. Please?

Today's Gospel Reading is available in non kitty pidgin, by heading over to the EWTN site's page for today's reading.

John 3: 16-18

16 So liek teh Ceiling Cat lieks teh ppl lots and he sez 'Oh hai I givez u me only kitteh and ifs u beleevs in him u wont evr diez no moar, k?'

17 Cuz teh Ceiling Cat not snd hiz son 2 take all yur cookies, but so u cud maek moar cookies 4EVAR!

18 U beleevz him u getz cheezburgrs, but els you get invisibul error.

(Don't understand kitty pidgin? You can use the lolcat translator, or you could also get today's scripture here.)

Want to see what you've missed?

You can read the previous Lolcat Scripsher posts by visiting the Lolcat Scripsher page here at fracas.

{Image Source: I Can Has Cheezburger - created by fracas, go vote for it....]

If you like, please take the badge and use it to link to the page from your own blog. I bet Ceiling Cat will give you some points for that!

There are perfume legends, there are perfumer legends, and then there are perfumes that become obsessions. Fracas is all three, which is a hat trick less common that you'd think. Still more extraordinary, Fracas is built on a concept of tuberose, a small white flower (unrelated to rose; the name comes from the Latin word describing the plant's tuberous root system) that generates an overpowering scent and is notorious among perfumers for being a difficult raw material to master. Which is perhaps why Fracas's perfumer, Germaine Cellier, managed it.

Born in Bordeaux in 1909, Cellier was a pioneer in every sense: a professional woman, a chemist, an artist working in the olfactory medium, tall, beautiful, abrasive (and possibly lesbian), a brilliant and intellectually voracious friend of Cocteau, a proponent of synthetic raw materials. She was also the creator of a striking style. "She transposed Fauvism and Abstractionism into perfume," Jeannine Mongin has written. "She created in dissonance."

And the creations have lasted. During WWII, the designer Robert Piguet asked Cellier for a perfume. She created Bandit for him in 1944. In 1946, she did Coeur Joie for Nina Ricci, and in 1947 the landmark Vent Vert for Balmain. Then Piguet asked her for another scent.

It is possible that the secret of Fracas (1948) is an equilibrium between the power of Cellier's style and the power of tuberose. Perfumer Aurelien Guichard is the caretaker of the formula, which he calls "incredibly complex." (Due to bans on various raw materials for toxicology, no mid-century perfume is street legal in its original form, and Guichard is charged with conserving Cellier's vision while constantly updating it with non-allergenic materials.)

Cellier packed her formula with Indian tuberose absolute, which gives it huge power and "sillage" (the olfactory trail). Like all good perfumers, she was an illusionist. To achieve an even more lifelike, more raw tuberose (this flower smells of armpit, flesh and decay due to heavy molecules called indoles; jasmine is similarly loaded with them), she used an even larger quantity of Tunisian orange blossom absolute, plus some astronomically expensive French jasmine and Italian iris root butter. Add natural violet leaf to give the sweet, heavy scent a refreshingly harsh, wet green aspect, iris for a woody depth, synthetic civet (the smell of unwashed construction worker) for power, the synthetics C18 for an unctuous, milky, soft tropical quality and methyl anthranilate for fizz. The result is a signature, a persistence on skin, and a diffusion that are - all three - astonishing. Another hat trick.

(Five stars; Transcendent) | $105 for 100ml. At www.robertpiguetparfums.com.

Well, to certain Brits that is.

Daddy Papersurfer has yet again, written about me, and while telling the truth about what's behind his discovery might seem shameful to some, I have always been the kind of person that wants to help others by sharing what I've been through.

With that in mind, I shall explain to everyone, how I came to be immortalized as you see here (photo stolen credit to Daddy Papersurfer's site of course) Clicking the link will take you to his 357th post about me. I'm not sure what that means, but I certainly do appreciate the attention. It allows me so many opportunities for philanthropy.

Isn't it a good thing his lovely wife is such a goddess? Just poke around his blog for a while and you will undoubtedly agree with me on that.

However, the goal here is to explain the doll, and so I shall.

There's a reason for this doll. It was one of a very limited quantity that were crafted to remind me of a very different time in my life. I, after being maligned and teased by a former arch-enemy, decided that the only reasonable thing to do would be to, ummm... eat said enemy.

I'm not proud of it, and I do accept responsibility for my own actions, but it wouldn't be fair to say that I am the only one to blame. You see... our laws here are quite lax you know, and crimes for what others in other countries might spend the rest of their life in prison for, we Canadians simply get a pat on the rear.

In some cases, that pat is actually desired and so there is simply nothing to deter some from a life of crime.

I admit, in the past I let my emotions rule and when dealing with people who gave me a bad time, well, sometimes things just got out of control. I'm sure the world is a better place for their being gone though. Well, I suppose they aren't totally gone. When slimming down following my breakthrough, I did donate the excess (ok... so what, it was liposuction, so sue me) to Hollywood and to this day, countless budding celebrities that shall remain un-named have been helped through a groundbreaking procedure where people like me donate their excess.. umm... collagen to a bank where starving actresses can receive free lip injections in the hopes that  they too, can become Angelina Jolie.

I told you I like to help people. I thought it fitting too, that the departed fraccy arch-enemies would in the end (or the lips to be more accurate) be helping someone else.

Wanting to be a better person, I attended counseling where I learned that a better form of vengeance is to use the cauldron. I must say, choosing the cauldron does certainly keep one's figure a little more trim. It was after I became proficient at the use of the cauldron, that I commissioned those figurines and released them into the world. It was to help others who might otherwise end up suffering the same tragedy as that original arch-enemy of the fracas. I don't know if anyone else has noticed, but in North America, enemies are being eaten at an alarming pace. The news reports try to blame the increasing size of North Americans on fast food and a sedentary lifestyle, but we here know the real truth.

I made a change and wanted something better for my life. I released those dolls to try help others. To me, they aren't an embarassment, they are a testament to the fact that anyone can become a better person if they really want to! There may even be a charm or two attached to them as a result of my newfound cauldron skills. It's a good thing DP "stumbled" upon the figurine in that shop. I mean... it's not like I (or the cauldron) had anything to do with the strange desire he had to purchase it...

Now that the secret is out, you also might realize that even in the past, when (due to the high caloric content of arch-enemies) I was a tiny bit larger than I am now, I was still the same fracas. As Olga so adeptly noticed in her previous comment here, large or not, the fraccy style survives. I still have those black gloves; I just wear them with a slightly smaller swimsuit.  

And my favorite entree these days is now Lobster.

I hope this has helped someone out there. Quite rightly, I should also share this entry (not entree) with the good people over at Humor-Blogs. Sharing a secret means everyone. You can help others too. All you have to do is choose one of the following social network sites and share this post. Just think of the people you'll be saving!

I know.

You have no idea what I'm talking about.

That happens to me fairly often. (I think it's from spending too much time hanging around Daddy Papersurfer and John C.)

What I'm talking about, is how those folks over at Humor-Blogs knew that I am, no matter how hard I try to make people think otherwise... half evil.

Isn't that uncanny?

Check it out. A picture says a thousand words.

And just be glad I used a picture this time.

Addendum:

I told you so. No sooner had I posted this, than I found a post from none other than Diesel (Mr. Humor-Blog himself) about what?

Good and Evil.

It seems there is evil happening at his house too.

I like being right. It suits me.

I have a huge scotch pine in my front yard, taller than the house and wide like an entire family of fraccy arses. It, like people, has a side it looks best in photographs, but for the most part, is perfectly formed. (I know... just like fracas you're thinking.)

Two years ago a nasty woodpecker had dared to declare a turf war on the fraccy familial forest. We both wanted to claim the tree as our own. I, as the owner, would prune it when needed, water it, clean up it's 'droppings' and in general, be a good fraccy mother (all for the reward of merely appreciating its splendor) while the woodpecker seemed to only want to bore a pattern of holes up the trunk of my beloved pine... holes that leaked sap and would (if allowed to multipy unchecked) cause the demise of my lovely tree.

Thus, I reasoned that all Woodpeckers were evil.  I, though, not wanting to upset the fraccy son (who happens to love birds) decided to spare his woody life and merely frighten him away.

Which I did.

Two blissfully Woodpecker-free years later, you can't imagine my horror to be looking out the bedroom window and notice a strange bird in my back yard. This was not one of the millions of Robins that have overtaken the fraccy city this spring... no, this was a bird that seemed to have a beak long enough to be from that dastardly family of... of...

Peckers.

I was ready to call in the Military. A pecker in my yard? This would not do. I went into combat mode immediately and despite the obvious dilemna of having to shoot from behind a mesh window screen, did stealthily obtain a surveillance photo for evidence. Plotting what my next move would be, I thought about how he'd be sorry for stopping here.  He doesn't know what he's in for. I am fracas after all!

So I, after watching him for a time, wondered if he had by chance, filled up on the little bits of leftover (and by now fermented) crabapples that littered the ground under the apple tree after the winter. I mean, he seemed almost tipsy. There he was, a woodpecker who should be hammering away at my beloved pine, and he was on the ground, hammering instead, at the ground.

How easy would that be? Waging war on not just a bird, but a drunken bird? I was sure to win. I called Mr. Fracas as a witness and before heading out for a lovely dinner, vowed to deal with this invader the next day. How was I to know that by the next day, I'd be this bird's biggest fan?

You see, via this wonderful interweavy thing, I leaned that the pecker on my property was actually a Northern Flicker, and from Birdweb, I learned this:

"Northern Flickers feed principally on ants but also take other insects and some fruit, seeds, and berries."

A pecker who would eat the ants in my yard? Hallelujah! Make up the spare room and bring out the good china... this bird can stay. If there's anything I hate more than a Woodpecker who is wont to ruin my trees, it's ants. Reading on, I found that aside from being a natural born killer (of ants) there are several other reasons that the Northern Flicker is my new hero.

"Males do most of the excavation with some help from females. Both incubate the 5 to 8 eggs for about 11 days, then brood the newly hatched young for about 4 days more. Both sexes feed the young, which leave the nest after 24 to 27 days. The parents continue to feed the young once they fledge, and soon the young begin to follow the adults to foraging sites and gather their own food."

Honestly, this bird sounds too good to be true. He builds the home, helps incubate the eggs, helps take care of the young 'uns once born, helps find and bring home the food... and then actually feeds the tots too. I bet the female bird is out shopping while he's doing all that. Were this bird a human male, the womenfolk would be fighting to the death for the ability to keep him.

Sometimes, you need a good pecker. Indeed, this pecker is a keeper, and today, I'm proud to call him mine.

Admittedly, my photos are on the lousy side, so I looked for a nicer one online. I found several, and here's an awesome photo of the Northern Flicker but it's copyrighted, so all I can provide you with is a link. I've taken the liberty of making the link open in another window, so you don't actually have to leave fracas... since I know you'd probably find that to be a tragedy of monumental proportions.

If you enjoyed reading about my pecker, you know you should head over to Humor-Blogs. Not only will you find some great boobs over there, but I guarantee you, in that bunch, there's a few peckers too!

I'd like to thank you all for your patience and your support, and let you know that I promise to get over to both of these sites and update my listing soon.

You see, there was a time when I, like a fool who consumed enough energy drinks to keep an elephant awake for sixteen years, clicked my way into the directories of at least six hundred and eighty three directory sites. I mean, after all... I am fracas; I could keep up to that many listings... couldn't I?

And then, I realized that I was actually human, and there was no way I was going to be able to keep up to that many listings. It is no secret that my very favorite blogger community is Fuelmyblog, and so in the past several months while the fraccy family's life has been slightly hairy (to say the least) I have only been able to try keep up with Fuelmyblog.

Yet... I see that people over at a few other places have been kind, and I promise to repay that by making time to update my listings there, and give you all the linkage you so deserve. In the meanwhile though... why don't you mosey over to Fuelmyblog and check them out too? I'm sure you'll find the same thing I have; the people there are wonderful, it's a community of friend and if you give them a chance, you won't be sorry.

Hujan has been churning out infectious catchy and radio-ready tunes for the masses to hear and well the masses loved it, ask any teenager in Malaysia about Hujan i bet most of them would happily tell u that they enjoyed the band's tunes. Im not here in defence of Hujan or whatsoever but i felt that why do we have to be sour grapes when something good is happening. Why wouldnt we be happy if our fellow local bands get a few extra pennies in their pockets.. Is it a crime that could be subjected to death penalty ?. The answer is obviously NO

Feel free to liberate yourselves.

SUPPORT OUR LOCAL SCENE

OsMoz Notes:
Top: Bergamot, Orange Blossom, Green Notes
Heart: Tuberose, Jasmine, Lily of the Valley, Iris, Carnation
Base: Sandalwood, Vetiver, Cedar, Musk, Moss

Date: 4/8/08 Weather: 46 degrees, cloudy

Comments: Starts sweetly tropical. Quickly turns to a dense, indolic tuberose that will kill a man within 20 paces. Thankfully, I wore this sparingly. I can't imagine spraying this stuff. Calms down within 30 minutes. Still very tuberose, but not as suffocating. More jasmine and carnation in the mix. Instead of a tuberose bouquet - more variety. Within an hour - becomes creamier, sweeter. An hour and a half in - a honeyed note appears. The indolic tuberose has burned off. Violets, orange blossom, a clean jasmine. The drydown is a beautiful woody, vanillic, mossy thing. And that drydown lasts forever. One of those scents to wait an hour before leaving the house.

Subsequent comments - I'm finding that in warmer weather, with my nose bungied up by allergies, that I am craving this thing. There is something perfectly tropical about it that I am really digging. And maybe being slightly stuffy makes the scent not so overwhelming to wear. May wind up FBW once I'm done with my sample.

Purchased full bottle - 6/26/08

Bois de Jasmin
Makeup Alley
Now Smell This
Sweet Diva
Aromascope
Perfume Smellin Things
The Lipstick Page Forums Pt. 1
The Lipstick Page Forums Pt. 2
The Lipstick Page Forums - Revisit
The Moment - Chandler Burr
Perfume Smellin Things 2
Grain de Musc

This entry continues where the entry (Six Sigma can be dangerous to your health) left off. Given the problems with six sigma, what are some solutions to estimate the quality of an assay, using hCG as an example assay.

First, when total analytical error is calculated to estimate the values in zones A-C in an error grid, one should use conservative methods such as the empirical distributions suggested by the CLSI EP21A method, and where no data are deleted. Let’s say a clinical laboratory has done this evaluation with 40 patient samples for a new and reference method and found no results in zone C for an hCG assay. What can one conclude? Although there are 0% of the values in zone C, the 95% confidence interval extends to 7.2%. This means that for every million hCG results performed, up to 72,000 results could be in zone C. This is not very comforting and these types of evaluations don’t prove much, although one knows that the 7.2% rate is unlikely (because if this rate to occurred, it would be noticed).

FMEA is an approach that will provide an answer to the quality question but in its complete form, it requires considerable effort. To complete a FMEA analysis, one has to postulate all possible reasons why a result could fall into zone C. To get an idea of what is involved, take two possible failure modes, HAMA interference and a patient sample mix-up.

HAMA interference – To estimate the likelihood of a zone C result from HAMA interference, one needs to know the level of HAMA that will cause erroneous results in the assay and the probability of such levels in the population being sampled. Contacting the manufacturer might give one the level of HAMA to watch out for – I am not familiar with data about the distribution of HAMA in patient samples. Yet, one knows HAMA interference occurs (Clinical Chemistry. 2001;47:1332-1333).  

Patient sample mix-up – There are some data for patient sample mix-ups (Archives of Pathology and Laboratory Medicine: Vol. 130, No. 11, pp. 1662–1668). However, it seems that these cases are caught within the laboratory. One would need to determine how many cases actually are not caught within the laboratory. One could then model the likelihood of a zone C result by sampling from the empirical distribution of hCG results that are observed on the lab to see the likelihood of a mix-up causing a zone C result.

Because there are so many existing data in a clinical laboratory, one may also have the opportunity to perform FRACAS types of analyses. That is, in addition to modeling probabilities, once could use existing data to count actual failures.

One must then continue:

• with each other possible failure mode, calculate the probability of zone C results
• calculate the overall probability of zone C results (from all failure modes) and determine if that risk is acceptable
  • special software is typically used to perform these calculations
• construct a Pareto table if the overall probability of zone C results is too high and
• propose control measures to lower the overall risk to an acceptable level
  • the control measures must of course be affordable

At this point, one can get the idea that this level of effort is out of reach for clinical laboratories since the level of expertise and work need just to estimate the likelihood of a zone C result is huge. Even if a clinical laboratory could perform this task, it makes no sense to require every clinical laboratory to do so.

One possibility is to have a standards group tackle such a task., although this too has limitations as was shown for a (universal) control measure to prevent wrong site surgery.

Another possibility is to perhaps leverage resources beyond the clinical laboratory. For example, one could insist that before treatment for trophoblastic carcinoma, an hCG result should be confirmed either by performing a reference assay or perhaps by treating the sample and rerunning it. This requires an interaction between the clinical laboratory and clinicians.

So there are no easy answers to preventing severe, low frequency failures, (that cause patient harm) but as discussed before, coming up with a sigma estimate for an hCG assay, is also not the answer. Nor is doing nothing.

To find out how you too, can participate in The Monday Melee, please read the main Monday Melee page, grab The Monday Melee logo (and view the participant list too).

Fracas' The Monday Melee for March 17, 2008

Although I'm a little late, I'm going to take a cue from fraccy sis LindaC and do a Melee about St. Patrick's day. Well, not exactly. I'd hate for her to think I'm copying her idea (which was brilliant) so what I will do is answer my Melee questions with something Irish, and try to stay away from the things she used for her answers. I like a challenge, and hey... it's my own fault for being late (early bird getting that worm and all).  Oh. And I'll use green text, but only so no one pinches me. Yeah right. I know a couple of bloggers that are going to pinch me anyway.

1. The Magnificent: Name someone you absolutely adore, and tell us why.
It's a toss-up between Sean Connery and Daniel Day Lewis. Yes, I know most people think Connery is Scottish, but his father was of Irish descent so just suck it up and let me have my way here. If you really need me to explain why, then there simply isn't hope for you anyway.

2. The Muddy: Tell us something about life you just don’t “get”.
Corned Beef and Cabbage. It's not that it doesn't taste good, but why would anyone invent a dish that causes such, umm... offenses to happen later? Yeesh.

3. The Magnetic: Name something or someone good (or bad) you’re drawn to and you just can’t help it. Tell us if you want to change this or not.
Irish stepdance... aka riverdance. I find it fascinating. There's something haunting about the music too. I love Leahy. Why would I want to change this? It offers entertainment and the opportunity to escape into another land for a while.

4. The Mainstay: Who or what is something you just can’t live without? Why?
I can't live without the color green. Okay, green isn't officially only an Irish color, but well... aren't we all either wearing it, or consuming some food or beverage that's been colored with it today? Green is fracas. Fracas is green.

5. The Masquerade: Tell us something about yourself we wouldn’t already know.
I've never kissed the Blarney Stone.

6. The Mettle: Tell us about a time you showed courage in yourself, or tell us what you wish you had the courage to do.
I have a green thumb and landscaped my yard without professional help, to the delight of the neighbours, who still stop (after almost ten years of being able to walk by a park-like yard instead of the haunted house yard it was before we got here) to say kind things about how much they enjoy it. I know, that doesn't seem terribly courageous, but seriously... we bought the house when the yard was still under three feet of snow and we had no idea what we were getting ourselves into. In the spring, the snow melted and the runoff was rivaled only by my tears. It was a disaster and we didn't know where to start. One full rental dumpster and about ten loads by half-ton later, and we had a starting ground of no real grass (weeds and ants instead)  and a blank canvas to work with. The picture is what a small area of it looks like now. The other sides of the house are done in a similar fashion.

What's that white stuff on the lawn? Hail. And not as in Hail Mary, which is a Catholic prayer... and lots of Catholics are Irish....

Now it’s your turn.

You can take part in The Monday Melee, even make it a regular feature at your site by visiting The Monday Melee page and following the steps. Kick-start your brain on Mondays and meet other bloggers.

If your blog is listed below, it means you've at one time or another, done The Monday Melee. Head over to the main Melee page, grab a new badge for 2008 (or for the Movie Melee, etc.) and kick-start your week by throwing down a Melee again!

The Monday Melee Participants1. Fracas - creator of The Monday Melee | 2. Kate | 3. Rootietoot | 4. Dive | 5. Robyn | 6. Dear Prudence | 7. Lynn | 8. Iced Mocha | 9. Joey | 10. JerseyChick | 11. Tracey | 12. Vic | 13. Gaijin Girl | 14. LindaC | 15. Amber | 16. Krishanna | 17. Ma Titwonky | 18. sauer kraut | 19. kimberleyanne | 20. Ealasaid | 21. Cat | 22. lucy lemon | 23. hazel8500 | 24. Miz Minka’s Musings | 25. Gabrielle | 26. buttercup | 27. Marianne | 28. j u g g l i n g c a t s | 29. Sky Windows | 30. Vyxyn | 31. Mark - Blogitude | 32. Tendrils’ Ink | 33. Now Write, Right Now | 34. flowerchild | 35. ladycalliah | 36. Creation Junction | 37. A Blog of 2 Witches | 38. Meowminx | 39. The College Critic | 40. Winged Musings | 41. Missy Sue Hanson | 42. The Kat House | 43. Holocaust Labs | 44. no school, just learning | 45. Carrying Contraption | 46. Let Them Eat Cake | 47. Zacque - Blogitude | 48. Diva - Blogitude | 49. Modified at Random | 50. Jewel - Blogitude | 51. Get AMPed | 52. INDIEchouette | 53. Perky’s Perspective | 54. The Jaded Lotus | 55. Maiylah’s Snippets | 56. The Painted Veil | 57. Incurable Insomniac | 58. DivaThoughts | 59. Twenty Something And A Little Nutty | 60. PajamaMom | 61. Livin’ Life SandyStyl | 62. So This Is Growing Up | 63. Girliegeek | 64. Diary of a 70s Teen | 65.Your blog could be here!

Reports cbs5.com:

"Officer Hector Basurto, the vice president of the Latino Police Officers Association, recently learned about the site. "I'd like to see it gone," he said.

"Having a website like this out there puts a lot of law enforcement in danger," he said. "It exposes us out there."

Kevin Martin, the vice president of the San Francisco Police Officers Association, agrees.

"Will they be able to access our home addresses, home phone numbers, marital status, whether or not we have children? That's always a big concern for us," said Martin."

Fracas has asked you in the past, to leave your opinions about sites like these. The post I wrote about rottenneighbor.com was one. This new trend should concern us all. While on the surface, many of these types of sites, like ratemyprofessors.com and ratemyteacher.com to hold themselves up to be altruistic, they fail to acknowledge that they have no way of assuring us the data at their sites is legitimate and objective as opposed to being the vindictive and immature tantrums of students who, like the morons who have taken to goading classroom teachers with horrendous behaviour and then taping them for youtube, simply have no idea what it means to take responsibility for their own behaviour and instead choose to run to sites like ratemyprofessor and ratemyteacher and post bad reviews of someone who simply expected them to be responsible for their own behaviour and education?

Were I a teacher, a professor, a doctor or a cop, I'd be worried about the safety of my family once my name was added to one of these lists, however... then there's the side of those who believe anything in the public record should be provided freely online.

I wonder though. When good people start becoming too scared to become doctors, teachers and police officers because of these new risks, will it become like politics... where we all just laugh and joke about how everyone knows that "good" people don't go into it anymore because of the media risks?

I wonder also, how would everyone feel if the teachers and professors came up with a "Rate My Student" site and the doctors came up with a "Rate My Patient" site. Would we all be up in arms to suddenly, just as the potential is there with rottenneighbor.com, find ourselves listed somewhere with nary a good word to be said because someone who had their own agenda decided to humiliate us online?

What do you think?

You can have your say by posting a comment here, or heading over to the other fracas blog and voting in the poll (located in the sidebar) there. You see... if all these "Rate My" sites are so into the whole rating thing, then they shouldn't mind us rating them! Vote for the best "Rate My" site listed, and in the end, the results will show which you think is the best... and the worst.

In order to make your choice, here are some other "Rate My" sites for you to ponder. The descriptions are their own, not mine. Each will open in a new window. When done, just close the window and you'll still be here and able to click your way over to the poll to vote.

1. RateMyProfessors.com
   Students can browse and rate professors by state. Also contains a forum to discuss general topics.
2. Rate My Picture.com
   Rate the attractiveness of people on a scale from 1 to 10. Pictures are sorted by score. Includes personal profiles and personal message boards.
3. Rate My Teacher
   RateMyTeachers.com is changing the way the world looks at education by providing students with the unique opportunity to critique their teachers.
4. Rate My Life - How Are You Doing? Find Out If You Suck at Life.
   At Rate My Life, we rate your life using factors derived from what people want to accomplish in life after aggregating data from the entire Internet!
5. Rate My Boobs
   Please feel free to take a look around, rate some of the ladies, or fill out the registration.
6. Rate My Ink - Tattoo Pictures & Designs
   Rate 1000s of pictures of tattoos, submit your own tattoo picture or just rate others.
7. Rate My Puppy
   Rate cute little puppies or upload pictures of yours to be rated.
8. Rate My Puppy
   Rate My Kitten. ... Rate My Kitten 117179 pictures on-line.
9. RateMDs
   Give your doctor a checkup.
10. Doctor Sicko
    Find, add and rate your doctor.
11. Rate Your Doctor - Canadian Doctor Ratings
    Anonymous and free. You can rate your doctor here.

Finally... do the following even need a description? If you choose to click, you will see exactly what you'd think. I've included them to make a point. Just because one can place something on the internet, doesn't mean they should.

12. Rate My Vomit - Vomit Pictures
    Rate My Vomit - vomit pictures. Submit your favourite vomit and puke pictures.
13. Rate My Poo
    Rate My Poo - pictures of poo. Submit your favourite poo pictures.

This week I learned the word "donnybrook". I'd never heard it before. Apparently it refers to a fracas or brawl, and refers to the annual Donnybrook Fair in Dublin; an event renowned for extreme intoxication and brawling. According to Wikipedia, the fair was banned in 1855.

Based on personal observation, the scene is re-enacted New Year's Eve on Chippewa St in downtown Buffalo, NY. They don't call it Amateur Night for nothing. I literally saw someone thrown through a door and onto the street.

{this post from Razzbuffnik made me look it up: Donnybrook at a carny wedding}

{quote - George Bernard Shaw}

Withholding payment for adverse events is a financial incentive to promote patient safety. Whether this incentive makes financial sense is something I will comment on later or perhaps not at all. For now, my comments are about the policy as it recently appeared (1).

The authors suggest the following criteria to withhold payment.

·         Evidence demonstrates that the bulk of the adverse events in question can be prevented by widespread adoption of achievable practices.

·         The events can be measured accurately, in a way that is auditable.

·         The events resulted in clinically significant patient harm.

·         It is possible, through chart review, to differentiate the adverse events that began in the hospital from those that were “present on admission” (POA).

The problem is with the third bullet and can perhaps be illustrated by the following figure.

In this figure FMEA events are shown by the dashed line.  The red dashed line is before FMEA. The green dashed line shows that after a successful FMEA, risk of failures has been reduced. FRACAS events are shown by the solid lines. The green line shows a reduction in the failure rate after FRACAS.

Keep in mind, for the dashed lines (FMEA), no failures have occurred, while for the solid lines, failures have occurred.

Now the policy defines a failure as an adverse patient outcome. One can view outcomes as the end of  an event cascade as in the next figure.

Assume that event C is an adverse patient outcome. According to the policy, payment is withheld only when event C is observed. In the first figure, the relevant concern area is shown by the ellipse as it is assumed that these are all high severity (severe patient harm) events.

This policy therefore excludes the following cases:

All FMEA events. That is, a procedure with a correctable high risk will be excluded from this policy because the event has not yet occurred. Considered the case of the Duke transplant error (2), before it happened. One can infer that this was a high risk procedure that would have benefited from a FMEA. In essence, this policy waits for disasters to happen.

All near miss events. Consider the case of the patient who had an MRI (3). Blood pressure monitor tubing had to be disconnected for the MRI. After the procedure, the tubing was incorrectly connected to an IV line. Before air was delivered from the automated blood pressure monitor, a family member noticed that things didn’t look right and contacted a nurse, who corrected the problem. Thus, there was no adverse event.

All defective procedures that don’t result in severe patient harm. Consider a healthcare worker who violates hospital policy (at risk behavior according to Marx (4)), which results in a patient fall. In this case, the fall results in a minor injury.  This is an important case because the policy fails to properly reflect risk management principles.

For a procedure that has a problem (e.g., a failed event), one has to classify the severity of the failed event and its probability (FMEA) or frequency of occurrence (FRACAS). The severity is classified not necessarily by the failed event but by the effect of the failed event. The effect is itself an event and can be a spectrum of severities. In the case of a patient fall, there is a distribution of harm associated with the fall event – some falls will result in severe harm, some will result in minor harm. Traditionally, in risk management, if severe harm is possible, then severity is associated with severe harm, even if the probability of severe harm is low. In this sense, severity is equated with potential outcome, regardless of whether that specific outcome has occurred.

One also has to classify the probability (FMEA) or frequency of occurrence of the event (FRACAS). Here, assuming FMEA, one could choose between the probability of the failed event or the probability of the effect of the event (the adverse outcome). It is recommended to use the probability of the failed event, not the probability of the effect of the event. This is because one usually has control over the failed event and does not have control over the effect of the event.

Example: If a clinical laboratory provides a clinician with an erroneous result and the effect of that could be patient harm, the event is classified as severe. The probability is the probability of erroneous result, not the probability of patient harm, because patient harm is outside of control of the clinical laboratory (the clinician might not act on the result, might suspect it is erroneous and request it to be repeated, and so on).

Summary

This policy will miss many quality issues and deviates from traditional risk management.

References

1. Wachter RM ,Foster NE and Dudley RA Medicare’s Decision to Withhold Payment for Hospital Errors: The Devil Is in the Details The Joint Commission Journal on Quality and Patient Safety 2008;34: 116-123, see http://psnet.ahrq.gov/resource.aspx?resourceID=6760
2. See http://www.cbsnews.com/stories/2003/03/16/60minutes/main544162.shtml
3. See http://www.ismp.org/newsletters/acutecare/articles/20030612.asp
4. Marx, D. Patient Safety and the “Just Culture”: A Primer for Health Care Executives http://www.mers-tm.net/support/Marx_Primer.pdf

This week, Fracas has changed the questions in honor of the Melee turning a year old. After looking at the new questions, I really love them and I think I am back for a while anyway!

1. The Magnificent: Name someone you absolutely adore, and tell us why. 

I adore my husband, first and foremost. I loved him longer than I haven't (before I knew him). I met him when I was 15, and  I have loved him for almost 20 years now...(damn...now you all know my age!). He has always put me and my needs first. I especially love him today because he bought me a Chanel Bag (drool...drool....drool) for Valentines day. Who wouldn't love a man who understands a woman's need for a purse with a leather interior that feels like butter?

2. The Muddy: Tell us something about life you just don’t “get”.

I don't get the need to put other's down. What does that accomplish and why do people do it?

3. The Magnetic: Name something or someone good (or bad) you’re drawn to and you just can’t help it. Tell us if you want to change this or not. 

I am addicted to video games. I always have been, and I don't think it will ever change. I guess there are worse addictions to have in life.

4. The Mainstay: Who or what is something you just can’t live without? Why?

I can't live without air. For some reason, I have to have air to live. When it is gone, I start to choke. Maybe I am weird, but that is my reality... ;)

5. The Masquerade: Tell us something about yourself we wouldn’t already know.

I was told today by my doctor that I have the knees of a 50 yr old woman, I need to lose weight to get them better, and if I don't, I am looking at knee replacement surgery in 5 years time!!!!

6. The Mettle: Tell us about a time you showed courage in yourself, or tell us what you wish you had the courage to do.

The first time I ever had to have courage was when I was 12. I used to go to this public swimming pool and there was a high dive there. It was about 20 ft in the air. All the girls my age and older were doing back flips off of it, and I wanted to learn so bad, but I was horrified that I may hit my head on the board on the way down. Once I realized that if I hit my head I would be dead anyway, I decided to try it... and I did it... I still love diving but it has been years.

In that fracalicious way that I love to behave, I've found some photos to correspond to the items in a poll I've placed over at that other... more whore-y fracas blog at blogger. Wordpress does not allow for javascript... it's how they keep us safe from all those mean and nasties who would like to sic their java headaches upon all of us and in one fell swoop, bring down the world (as we know it) with their malicious code. (Please examine these photos closely before deciding on your vote; clicking on any photo will open up a new window with many more photos of that kind of piercing.)

Yeah, so Blogger allows it. No surprise, since nearly every blog scraper out there is on Blogger. I've put the poll there. I'm asking you to click over and vote for a body part you think I should pierce. It's not hard to find, right below my picture in the sidebar. I am quite serious. I will pierce the fracas. No "she's melted" photos instead of a wet t-shirt photo... no excuses... nope. Fracas will be pierced, and a photo for proof will be posted!

And why shouldn't I be? The fraccy daughter has several piercings... all in her face. It is quite special.  She doesn't wear the labret piercing all the time though... the fraccy future son-in-law finds it an annoyance when the kissing commences.

Note that I did not include "labret piercing" on the poll list.

Fracas is no fool. 

Please also note, that I did not include "nipple piercing" or "umentionables piercing" on the poll list either. How on earth would I show you a picture of it then? Mr. Fracas would be a little upset... and rightly so.   

So head over to the poll... you have limited time to have your say. Please, also... note that I encourage cheating. If you think you can convince others to head over there and vote for their favorite body part, so be it. Cheat, cheat, cheat. It's a good way to add some excitement to a cold and miserable winter.  

Disclaimers:

1. Please do not blame me if you choose to click on "hardcore" or any of the piercings on the menu that involve body parts normally covered by underwear.  
2. I had to post this next part... it was in the rules.

Tie breaker - Daddy Papersurfer is the bestest blogger in the world because ... he's willing to wear his old scouts uniform to detention and he's only slightly afraid of the coven. Quite remarkable!

This time is different.

Recently I'd learned that Daddypapersurfer had been added to the list of contributors for fuelmyblog's blog, and well, I was a little concerned for Kevin and Sylvie, so I thought I'd talk to some people about it.

People... a term used loosely.

I won't ruin it by posting it here. The conversations are worth a click over to fuelmyblog. And... while you're there, if you haven't joined, then why not? It's the best thing since sliced bread.

Seriously.

And Daddypapersurfer... honestly, we do welcome you. I couldn't think of a better way to do it.

Olga the Traveling Bra was consulted, opinions were posted, the Mounties were called in and it soon came out that despite the claims of the papersurfing grandpa, that bra most certainly had to be female. He... in all his 34C glory... was a she.

Petra to be correct.   

Not long after (and for reasons I simply cannot understand) it became public knowledge that dear daddypapersurfer was using poor Petra as a (gasp) jockstrap.

The horrors she must've endured.

We warned daddypapersurfer that the BOBHS (Bras of Britain Humane Society) had vowed to make an example of the next person caught abusing a bra, but well, he doesn't listen all that well. It must have something to do with age. (Or perhaps those inflamed kiwis?) You'd think he'd have been grateful for the ummm... heads up, but no. This was his reply.

"I shall now cast Petrov out into the streets and let him fend for himself. If I can't use him as I wish, and he's costing me a small fortune I can tell you, he will have to fend for himself."

Unbelievable, isn't it? Please, don't just take my word. Read it for yourself. It's how we got to the next part.

I was lying down yesterday, feeling quite ill myself, when the telephone rang. It was a friend who'd been down to the bus station to pick up a relative. Knowing about my blog, she couldn't believe it when she, upon leaving, happened upon none other than Petra, frozen stiff next to the brick wall behind the gates. Her little tin cup held but $1.73 and were it not for the tears, I'm sure she'd not have been frozen. My friend, recognizing her plea, brought her to my home where I and Mr. Fracas wrapped her in a blanket, set her up with a hot toddy and some television, making her comfortable and warm.

It wasn't much of a night for television, nothing but repeats you know... but Petra seemed quite happy to stumble across one of her favorites, Bridget Jones' Diary. In fact, the show so inspired her that she made me promise to run out and purchase a similar diary for her to record the ordeal she endured at the hands kiwis of the daddypapersurfer.  Understandably, she's still a tad angry so I'm not sure what she'll write will be fit to print here. She'd like to start it off with the photo I took of her with the sad little sign that had helped my dear friend recognize her at the bus station. That much, I shall do for her.

I imagine the BOBHS will be contacting us soon. Anyone who would like to donate to the fund to help Petra get some counselling, should click the "donation" link in the top right hand sidebar of the fracas blog. If there is an abundance of funds once she's well again, we'll let her and Olga decide what to do with it when Olga arrives for her visit this spring.

{ADDENDUM: In the interest of being a good humanitarian, Petra has asked if we could donate a pittance from that afore-mentioned fund, to help poor daddypapersurfer get some medical attention for those inflamed kiwis of his. It would seem that being fed, toddied and warmed has tempered her anger a bit and the compassionate side of her is coming out.  At the least, we might send him a real jockstrap. But please, don't tell him. Petra would like for it to be a surprise.}