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One more mistake many people doing EOModelling with WebObjects make - unnecessarily locking attributes.

In the EOModeller tool, all new attributes come with the locking option set to 'on'. I have no idea why. This really should have a default of 'off'. The locking attribute is used when an update is being made to the database. During the actual update, the attributes that are set as 'locked' are used in the 'where' clause of the update query being sent to the database.

Typically, you would only need the primary key when you are updating a single row. Now, if you have set another attribute to be locked and you are trying to update that same attribute, you will get a 'GeneralAdaptorException'. That's because, you set the attribute to be locked and you are trying to update it!

The problem is the tool sets everything to be locked by default. What I have started doing is to set everything to unlocked except the primary and foreign keys which you never ever update in WebObjects. That has worked well for me.

Does anyone have any more insight into this?

... http://www.kamaldshah.com/2011/02/make-sure-you-do-not-lock-unnecessary.html


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I have made this mistake more than once in the past.

In WebObjects, when you create a relationship between two entities using the EO Modeller, the tendency is to create the reverse relationship as well. Let me give you an example. Let's say you have two entities - Programmer and Project. One programmer can belong to only one project and a project can have many programmers (unless of course, the programmer is Shravan Kumar Mahankali, who usually can finish off entire projects, especially WO ones, single handedly!)

So, here, we need to create a to-one relationship from Programmer to Project. In the process, you have an option to create the reverse relationship (a to-many) from Project to Programmer. The advantage of creating these relationships is you can get the desired destination object(s) of the relationships by a simple method call - programmerObject.project() or projectObject.programmers(). This can be a great convenience. Without this, you would have to manually write code that would create the fetch specification and then call it - a good few lines of code!

The reason behind this is in the good old days of WebObjects, when everyone and his uncle used Apple's EOModeller tool, the reverse would always be checked by default. For all you rookies who have started using this fantabulous development platform recently, the EOModeller tool that comes with WOLips has an option that you need to select manually.

Think hard before creating the reverse relationship. Are you going to ever need the reverse relationship? Actually, even better, are you going to be using the reverse relationship frequently? After all, if ever you need the reverse relationship objects, you can always write the code for a fetch specification and get them.

The reason I am stressing on this so much is that WebObjects gets the reverse relationships in anticipation of them being used, even if they are not actually ever used. So, if you get the project object at any point in your code, WO will automatically get the programmer objects as well if the reverse relationship is defined. This may be all right if you have a few programmer objects associated with the project. However, if the number of objects can get large, this could be a recipe for disaster!


... http://www.kamaldshah.com/2011/02/beware-of-reverse-relationship-in.html


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Monday, 21 February 2011 05:02

Arrival of the NxStage

Written by Steve Bone
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The East Midlands renal group are to test the NxStage machine and I’m delighted to say it is coming to me. Kimal, the UK partner to NxStage and sole supplier are to install the machine in the Peterborough unit in the next 2 to 3 weeks (give or take) and I will then be trained on it along with a couple of the team who support the home hemo patients at home (or, ‘in the community’ as they like to say. (feel a bit like I might I am being released back ‘into the community’ – probably with a tag on my ankle!!)) Once trained, Kimal will then instal the machine at home, where, I am pleased to say, my landlord has given permission for me to have this installed in my office. (One up for decent landlords).

The NxStage itself though is still generally disliked and I can find only really two reasons for this. It is not as efficient at overall clearance than say the Fresenius 4008′s in use in the Peterborough unit, and other ‘grown up’ machines, but as I am going to do daily dialysis of 3 hours at a time while I work, then this becomes less of an issue as I will more than make up the inefficiency which is said to be around 12.5% less. I will be doing 50% more dialysis at 18 hours a week (6 hours more then in the unit), which counters the inefficiency of about 1.5 hours across the week).

The second issue in the argument against the machine is the way it is sold and maintained. The majority of renal areas in the UK buy machines and service/maintain them through their own teams of technicians, they can also shop around for the consumables from a variety of suppliers. Kimal lease and maintain the machines, so bypassing the local teams, not a popular move I’ll suggest. Also, consumables are only available from one source and they’re expensive. A more collaborative approach with the UK renal teams with NxStage would challenge all this and make way for the machine that solves problems for a number of UK renal patients who can’t go to home hemo as they can’t have the full blown installation. The Quanta machine will not achieve this in place of the NxStage machine in the more problematic installations as it still requires an RO. (But of course the NHS has been actively engaged in the development in the Quanta machine)

An open mind is required on the part of the renal teams and Kimal. Come on guys, bang heads!!

I’ll write posts once the machine arrives and give a first hand view of it and how it works etc.

Just a quick note on the benefits to me: dialysis at home while I work gets me back 16 hours a week dialysis on the unit and travelling time  etc (what will I do with myself?) and I get to greatly improve my dialysis clearance and overall results – all good to maintaining good health. I highly recommend it!!

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... http://mydialysis.co.uk/blog/2011/02/21/arrival-of-the-nxstage/


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In India, dialysis professionals do not refrain from using cell phones during procedures such as starting and closing sessions. I am not sure about other countries.

This is totally unacceptable. You may be an expert at what you are doing. But please spare a thought for the poor soul on the bed. He has had a life-changing diagnosis. He is trying to come to terms with this. The procedure may be painful. It is quite daunting for him. Is your call that important that it cannot wait until the procedure is over? Ok, it might be another patient. Even if it is another patient, can it not wait for a while, until the procedure is over?

Heck, using cell phones while driving a vehicle is banned in our country! Then why is it allowed to be used during medical procedures?? Isn't this much more serious? There is a life literally in your hands!

This is something that medical professionals should really take seriously. A blanket ban on cell phones during medical procedures. That is the only solution.

... http://www.kamaldshah.com/2011/02/make-using-cell-phones-during-medical.html


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Saturday, 19 February 2011 03:54

Uremic minds

Written by Kamal Shah
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I wrote about the mental aspects of kidney disease earlier too here and here. I find myself thinking about this in the past few days again. There have been, undeniably, some changes in my mental make up all along my journey with kidney disease. Isn't it natural?

When my peers were busy completing their master's in this field or that, I was grappling with basic survival - my initial diagnosis and a transplant. When my peers were getting married, I was trying to get a handle on my life by switching to Peritoneal Dialysis and get some period of sanity. When they started having kids, I had to switch to hemo and then get my home hemo setup done. Now, when I see them planning their kids' futures, I am battling comorbidities of long term kidney disease. With all this, can anyone be surprised that there are mental changes in me?

What are these mental changes? I tend to react strongly to small things. Two swallows do not make a summer. For me, often, one is enough to conclude that its summer. One small incident and I tend to generalize that that is how things are always. Working full time has probably limited that to some extent. The more someone thinks about his kidney disease, the stronger this warped thinking becomes.

People who are dealing with people with kidney disease on dialysis should always remember this. Families of people on dialysis, doctors, nurses, techs - please remember this. Please give them some leeway. Do not judge them based on such actions. Needles take their toll. They cause bumps on the hand - and the mind as well.

... http://www.kamaldshah.com/2011/02/uremic-minds.html


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For the last 6 months or so, I have been placing my needles on the two crests of my fistula, for ease of access and to help keep my fistula arm relatively unencumbered (so I could type and generally do things with both hands).  The total distance between the two points was a little over 6cm (2.5 in).

In the back of my mind I wondered if this was a little too close and that maybe there was some recycling going on in the space between the needles.  That is, clean blood from the machine entering by body via the venous needle was being sucked back to the machine by the arterial needle, rather than being circulated to the rest of my body.

If that was the case, my dialysis efficiency would not be as good as it appeared.  The volume of blood processed would be fine, but unbeknown to me, not all of the toxin-laden blood was being cleaned while cleaned blood was being re-cleaned. If this was the case, I would feel gradually less well as time progressed (because I was being underdialysed), even though I put in the time.

I don’t know if was my imagination, but over the last month I was feeling gradually less well.  Tired, aching bones: the usual when you don’t get enough (dialysis).

 

Good and bad needle spacing on the fistula

So about a week ago I decided to move the sites further apart – in fact as far apart as comfortable and possible, which ended up being 22cm (8.5in) – I wanted to be sure I was getting the best dialysis possible.  See the pic.

 

I still want to use buttonholes and blunt needles on these new sites, but for the first 10 days or so, I must use sharp needles, to start creating the “tunnel” at each site.  This is a bit of a pain initially: with new sites it takes a while to find the best spot and the new holes tend to bleed a little until the needle is fully in.  This is because both are old sites, with lots of scar tissue that I used a lot before I switched to buttonholing.  However, now after a week, the sites are becoming a little tougher and easier to use.  I will try blunt needles for the first time around the middle of next week.

I am still getting used to having less movement in my fistula arm.  Especially while I am using sharp needles, bending my elbow too far may result in a puncture at venous needle site, in the fistula wall and a Blowout”.  Not for me thank you.  I am perhaps a little over-protective, but things will change when I graduate to blunts next week.

But there is good news.  I am feeling fitter and healthier.  No so many aches and pains, and I have more energy.  As far as I am concerned, this is good enough evidence that the needles were a little too close.

With the BigD, it the same old story: don’t get complacent; keep looking for improvements; you are sure to find them.

By the way, my video series of the month is Lost.  I started Boston Legal, Series 1 in December, which I enjoyed immensely, but I decided to have a break and started Lost in January.  I’m now at Series 5 and soldiering on.  It is great as long as you can suspend any modicum of disbelief, which I can and do with pleasure. Especially during my not-bending-my-elbow period.

My all time favourites so far are Arrested Development, and Battlestar Gallactica for Sci Fi.  Fortunately, there are lots more to come so favourites may be a moving feast.

... http://bigdandme.wordpress.com/2011/02/18/improving-dialysis-quality-by-greater-separation-of-fistula-needles/


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Saturday, 12 February 2011 18:20

Back under the scalpel

Written by Kamal Shah
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I will be back on the operating table soon. I will be undergoing a minor surgery on Monday at 10 a.m. at Medwin Hospitals. This is unrelated to my kidney disease.

I trust Dr. M. G. Rama Rao, the surgeon who is going to perform the surgery. I have been seeing him for this problem for the last three years. He is a down-to-earth, gentle and kind doctor. Dr. Girish Narayen, my nephrologist recommended him.

The surgery in itself is not major. The thing that bothers me about these surgeries (and I have had more than my fair share) is the part where you have to fast the entire morning until well after the surgery. The other bothering thing is the part when you wake up from the general anesthesia. For a while, you wonder why the surgery has not yet started and then when you start feeling sore at the point of surgery, you realize that the surgery is over. Then you have to wait until they let you go. This wait is horrible. You are feeling sore, there is pain, you start feeling thirsty. But you have to wait for a few hours before they let you go.

At the point of the surgery itself, there will be this stabbing pain that lasts for a few days. They will put me on pain killers and antibiotics. Slowly the pain will start wearing off and hopefully, the original problem I have been operated for will be a thing of the past.

I am going to Poorna tiffins this morning as usual. I will have a few extra idlis, however so that I can bear the hunger the following morning with fortitude!

... http://www.kamaldshah.com/2011/02/back-under-scalpel.html


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Friday, 11 February 2011 22:20

Aashayein - in pictures

Written by Kamal Shah
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Here is a link to some pictures from the Aashayein event. The pictures really bring out beautifully the entire event. I especially liked the pictures that showed the smiles on the faces of the patients - true, genuine, full blown smiles!


... http://www.kamaldshah.com/2011/02/aashayein-in-pictures.html


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Thursday, 10 February 2011 18:58

Aashayein - from the sidelines

Written by Kamal Shah
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Here are a few incidents/comments/whatever from the sidelines of Aashayein:


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I was chatting with a fellow dialysis patient, probably in his late thirties, during the lunch break. We discussed the lunch and that it was great. I asked him how many salt packets he used? (The lunch was entirely salt free and patients could take a salt sachet and sprinkle it over whatever they chose.) He told me he took two sachets since he could not eat food without salt. He asked me how many I took. I told him I also took two. Both of us burst out laughing! "Namak ke bina khaana aur woh sab - doosre patients ke liye hai, hamare liye thodi hai!", he said. (All the salt free food advice is for other patients, not for you and me!)

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One of the doctors spoke in English. Vikram translated the key points of his speech to Telugu. One of the patients called me and complained about why the speech wasn't translated to Hindi. I said that we were trying to have a mix of all three languages so that everyone would benefit. He wasn't satisfied and felt we were being partial to the Telugu speaking audience.

A little later, the next speaker started speaking in Telugu. I requested her to switch to Hindi so that those patients would also benefit. Sure enough, within a few minutes, a lady called me and complained that they could not understand anything and that we should be more mindful of the Telugu participants!

I guess you cannot satisfy everyone together!


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After the dietician, Dr. Haritha Sham concluded her talk, this was a question asked by one of the patients: "Is kidney disease a life long thing?" Huh? Now what has that got to do with the diet??

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After one of the nephrologists concluded his talk, one patient got up to ask a question: It went something like this: What is Peritoneal Dialysis? What is Hemodialysis? What is the difference? What diet can a person on dialysis take? What exercise can a dialysis patient do? Can someone on dialysis eat horse gram? Can you please reduce the rate of Cresp?

All very valid questions. And I appreciate the patient's quest for knowledge. However, sir, you must understand that this is a forum where we have extremely limited time. These questions could take up almost half a semester of an MBBS nephrology course! We can't have a speaker answer these questions at the end of a 4 minute talk! To the nephrologist's credit, he gave a quick summary in about 3-4 lines!


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I ended up getting a lot of undue credit. It all started with Vikram mentioning that I came up with the idea of this event. Actually, to be very honest with you, it was his (or Sandeep's?) idea. I was definitely very excited when I heard about it. But the idea was not mine. Vikram and Sandeep have this habit of giving me credit for things I have not done!

Then Dr. Gopal Kishen took the bait and thanked me for doing this. The patients that were attending followed suit. By the end of the day, almost everyone in the hall believed that I was responsible for all this. That was ok, to some extent. The problem started, when in all the commotion, even I started believing that!! 

When you hear something again and again (even if it is not true and especially when you like what's being said!), you tend to start believing that it is true. But since you are reading my blog, I thought you should know the inside story. 

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In the end, of course, patients had a great day. We continue to receive compliments for the successful event. Of course, we intend to make Hyderabad Kidney Foundation what people expect it to be. May be I did not actually come up with this idea. I will, however, take it to fruition.

... http://www.kamaldshah.com/2011/02/aashayein-from-sidelines.html

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