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The stigmas associated with HIV/AIDS is largely related to the story of origin. Acquired Immune Deficiency Syndrome was first recognized as an emerging disease in 1981 when young homosexual men became victim to unusual infections (Sharp). Ever since HIV-1 was initially discovered, the cause of its sudden birth and spread have been studied intensely. In an article published by anatomy research students from the University of California on SexInfoOnline, the origin on HIV/AIDS is discussed in detail. The study begins by discussing the first reported cases of AIDS in the United States, going on to account for the infamous "patient zero" of this virus. In this, a report was claimed to blame the spread of the HIV/AIDS on the sexual relationships between homosexual men. According to the student's gatherings, patient zero, later identified as Gaetan Dugas, was tied to about sixteen percent of the first reported cases in the United States. For this reason, hysteria surrounding AIDS in the United States was primarily against homosexual men.
But, as research progressed it is found that scientists deem the first strain of the virus was transmitted from monkeys to humans. According to The AIDS Institute, the earliest known case of infection with HIV was a man from the Democratic Republic of the Congo – where hunters became exposed to infected blood as early as 1960. (AIDS institute). A first inkling came about in 1986 when a similar virus was found to cause AIDS in patients in western Africa (Clavel et al). Through hunting and close interaction with monkeys carrying the virus, it is believed to have been transmitted by means of ingestion. Surprisingly, these viruses appeared to be quite harmless in their natural hosts, whereas very deadly in humans (Sharp). Developing countries have experienced the greatest HIV/AIDS cases and mortality, with the highest prevalence rates in young adults found in sub-Saharan Africa (UNIAIDS).
Though for South Africa specifically, HIV/AIDS came about in 1983 , two patients were found to have carried the disease (Sharp). Just three years later, almost fifty additional cases of AIDS were diagnosed (Sharp). Initially the spread of the disease, like in the United States, was determined to be much more prevalent within the homosexual community – but as the years went on, the infection began to reach pandemic levels (Sharp). This can be widely correlated with lack of knowledge for the disease, as means of infection and treatment were being discovered as the disease spread. Currently, South Africa is home to the largest HIV prevalence in the world, with more than three-quarters of Aids related deaths occurring in South Africa (UNIAIDS). Based on a study done by Shula Marks, the spread of this disease can be based on both historical and social contexts.
HSRC-Figure 1: HIV prevalence by age and sex, South Africa, 2012
Shula Marks, a professor at the University of London publishes an article in which she expounds upon the various aspects through which HIV/AIDS has spread. In this, Marks begins by comparing the spread of past diseases with our current way of life. "Epidemic disease has always accompanied long-distance movement, but the numbers of people traveling around the world today, and the speed at which they are doing so, is surely on a scale beyond conception of our grandparents." (Marks) In this, it is clear that the worldwide spread of this disease occurs through travel. And in Africa specifically, with such a large population and innate human behavior, it does not take much to correlate the pandemic with migration.
It is also noted, that the way in which the world has grown politically, has a large effect on the disease as well. In most developing countries, such as South Africa, impoverishment is connected to the influx and use of monetary value. As the world's poorest countries are paying millions in debt, less that a third of that money is returned for uses such as foreign aid (Marks). Given the impoverishment of Africa, and its political and military instability as the years have progressed, it is perhaps not surprising that the continent has been hardest hit by AIDS (Marks). More focus should be placed upon the systematic debt and impoverishment that these countries are in, as compared to other ''developed'' countries. As human beings, the population of Africa, more specifically sub-Saharan and South Africa, is being plagued with a virus that can be controlled. Years ago, Zwi and Cabral posed that we should identify a term to denote the range of social, economic and political forces that put such groups at particularly high risk of infection with HIV/AIDS.
The migrant labor system in South Africa, in which individuals frequently move from place to place for seasonal employment is fairly prevalent. This system brings forth large numbers of men to industrial mining centers for a means of work. They almost always abandon their families, seeing them infrequently, and are housed in single rooms. (Zwi and Cabral) These men often seek a means of companionship with women nearby – subsequently posing a risk for sex with multiple partners and the spread of sexually transmitted diseases and HIV/AIDS. On the other hand, the women left behind may resort to commercial sex in order to fill the void of financial dependency as well as affection. (Zwi and Cabral) This cycle of sexual partners is the main means through which HIV is spread. There are said to be over 1,500 new infections everyday in South Africa alone, most of them young women. (Marks)
According to South Africa's Human Sciences Research Center, one in three women is a victim of some kind of abuse and the medical research council says that one South African women is killed by an intimate partner every six hours. Alex Mattews, writes a post in which he addresses the atrocity that has been going on and continues to go on in South Africa. Thousand of rapes are reported in South Africa annually, and little has been done by those in power to improve the lives of these women. Misogyny and patriarchy are instilled cultural normalities among men in this country (Mattews). As young women grow up to see there mothers being beaten, they know no better, so the cycle continues.
A study done in done in the Eastern Cape province of South Africa show the correlation between gender power inequity and intimate partner violence. Research focusing on the quality of life in South Africa show that the patriarchal nature of society and masculinity standards are based on control of women, which in turn celebrates male toughness (Jewkes, et al). This allows for men to have multiple sexual partners and to be in control of their sexual encounters (Jewkes et al).
Figure. Pathways through which gender-based violence and gender and relationship power inequity might place women at risk of HIV infection
Apartheid has left South Africa with an odd ideal for family structure. Traditional marriage is more-so a socially arranged relationship between families, through payment, wheres as most South Africans never marry (Morell et al). Though families are typically headed by women, with the father being absent. The male-dominant hierarchy allows for the constant abuse and ill treatment of women, leading to greater detrimental effects (Morell et al).
Oftentimes, the stigmatizing beliefs that associated with HIV/AIDS are the consequence of various social factors (Simbayi, Leickness C., et al.). These stigmas include the common belief that people infected with HIV/AIDS are tainted, they are often deemed as less than or contaminated. Sociologist Erving Goffman writes a novel in which he composes an analysis how how a person feels about themselves and their relationship to others. These feels are based on what society deems as normal. Three features of stigma that are characteristic of HIV/AIDS include flaws of personal character, damaged social identity, and physical deformity or defects. (Goffman). In this, many women, as well as men, that are infected with HIV/AIDS feel somewhat cast out of societal norms. Infection with HIV/AIDS can lead to others looking at those infected in a degrading manner, as there is an immediate denounce of character/integrity once infected. Furthermore, with narrow-minded views of the disease, people infected are often looked down upon by peers and civilians, leading to a decrease of social interaction and dealings. This, as well as the physical deformities associated with the sickness, often make it easy for others to see that one had fallen ill. These interpersonal stigmas cause further means of depression and sadness in those infected.
HIV/AIDS stigmas also often reproduce inequity amongst class, race, and gender. People with HIV/AIDS infection are often ascribed responsibility for their condition due to the fact that it is usually contracted through mannerisms that are considered avoidable, specifically unprotected sexual relations and drug use practices (Herek et al). While in South Africa, however, many of these mannerisms are not necessarily avoidable. As women are usually placed in abusive situations from a young age, they don't usually have a say when it comes to the man in control wanting sex. Of this, one may wonder why, in South African environments, is there still a stigma placed upon this disease, but its as simple as to say that its apart of human interaction and implicit hierarchy. AIDS ignominy is also inescapably tangled with other stigmas paired with risque behavior such as sexual promiscuity, homosexuality, and explicit drug use (Novick). Unsurprisingly, those that have contracted the illness by means of injection drug practices or multiple sex partners are blamed more than those that have contracted the infection by having only one sex partner (G.M. Herek et al.)
In the study conducted by Simbayi, it was predicted that with a general population having such a high HIV/AIDS infection rate, stigmas would be associated with depressive symptoms (Simbayi et al). The surveys were completed by over four hundred HIV-positive men, and and over six hundred HIV-positive women in Cape Town, South Africa. The Republic of South Africa has one of the world's worst HIV/AIDS epidemics, as five and a half million people suffer from the virus (UNIAIDS). In the study, a survey was given with questions regarding whether or not they have been treated differently since disclosing status of infection, and further queries regarding the seven internalized stigmas items (Simbayi et al).
Thirty percent of the general South African population reported feeling depressed in the past year compared to Forty-two percent of people living with HIV/AIDS (O. Shisana et al). It was found that thirty percent of the people in the study, admitted to having depression within the past week (O. Shisana et al). This rates of depression have a lot to do with environmental factors in terms of living among the illness and in impoverishment in certain areas.
Internalized stigmas were prevalent in the sample of people living with HIV/AIDS. More than one in three men and women endorsed AIDS-related self-abasing views. In fact, people living with HIV infection have internalized AIDS stigmas to a far greater extent than these beliefs are held in the broader community (S.C. Kalichman et al).
Support groups can be used as a starting place for the development of social support interventions. However, the ultimate solution to AIDS stigmas does not lie in the hands of people living with HIV/AIDS.
Lack of Education
As it relates to most epidemics, education plays a large role in terms of prevention and possible eradication. Given this, it is common in many traditional African cultures for individuals to attribute illness to spirits and supernatural forces (AC van).
As it relates to HIV/AIDS, about four percent of South Africans believe that AIDS is cause by witchcraft and about fourteen percent are unsure (O. Shisana et al). These beliefs are typically more present in rural areas where traditions are upheld. The study conducted in the Kalachiman study are quite shocking. Results of the study found that individuals that believed that HIV/ADS is caused by spirits/supernatural forces had significantly less years of formal education, were more likely to be unemployed, and were less likely to be married. These individuals were also less likely to use condoms (S.C Kalchiman).
Placing the cause of HIV/AIDS on ancestral spirits leads directly to narrow-minded, stigmatizing beliefs about people with HIV/AIDS being that they are believed to have brought this condition upon themselves and their community (Goffman). This ideals however, are typically maintained in rural traditional areas and cannot account for entire country.
Within Sub-Saharan Africa, a significant amount of adolescents are sexually active, leading these young people to account for half of all new HIV infections (Corneli et al). In this, it is imperative that something is done to educate the youth on substantive measures of which to not become infected. These early and unsafe sexual behaviors are associated with high school dropout, which pulls at the need for prevention programs aimed towards earlier grades. (Corneli et al)
While there have been attempts to implement education into schools, many problems arise in terms of how to implement education in to curricula as well as how to go about teaching it. (Ahmed). According to The curricula seemed to have a positive effect of students' knowledge of HIV, but they do not necessarily meet the goals of national policy in terms of promoting long term mental and physical lifestyles (Visser).
The Problem(s)
Throughout these multiple factors, it is evident that the cause and further spread of the disease goes hand-in-hand. It is quite sad to see that this epidemic has been becoming more and more of a problem in South Africa. There should be more urgent and direct aid sent to help those in need. In the continuation of this analysis, there will be a different perspective in terms of these factors as it relates to another culture.


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Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705)
Karen N Barnett1,
Marion Bennie2,
Shaun Treweek3,
Christopher Robertson4,
Dennis J Petrie5,
Lewis D Ritchie6 &
Bruce Guthrie7
High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions have small/moderate effects on clinical practice, but few trials explicitly compare different forms of feedback. There is growing recognition that intervention development should be theory-informed, and that comprehensive reporting of intervention design is required by potential users of trial findings. The paper describes intervention development for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study, a pragmatic three-arm cluster randomised trial in 262 Scottish general practices.
The NHS chose to implement a feedback intervention to utilise a new resource, new Prescribing Information System (newPIS). The development phase required selection of high-risk prescribing outcome measures and design of intervention components: (1) educational material (the usual care comparison), (2) feedback of practice rates of high-risk prescribing received by both intervention arms and (3) a theory-informed behaviour change component to be received by one intervention arm. Outcome measures, educational material and feedback design, were developed with a National Health Service Advisory Group. The behaviour change component was informed by the Theory of Planned Behaviour and the Health Action Process Approach. A focus group elicitation study and an email Delphi study with general practitioners (GPs) identified key attitudes and barriers of responding to the prescribing feedback. Behaviour change techniques were mapped to the psychological constructs, and the content was informed by the results of the elicitation and Delphi study.
Six high-risk prescribing measures were selected in a consensus process based on importance and feasibility. Educational material and feedback design were based on current NHS Scotland practice and Advisory Group recommendations. The behaviour change component was resource constrained in development, mirroring what is feasible in an NHS context. Four behaviour change interventions were developed and embedded in five quarterly rounds of feedback targeting attitudes, subjective norms, perceived behavioural control and action planning (2×).
The paper describes a process which is feasible to use in the resource-constrained environment of NHS-led intervention development and documents the intervention to make its design and implementation explicit to potential users of the trial findings.
ClinicalTrials.gov: NCT01602705
Appropriate use of prescription drugs has considerable benefit to individual patients, but prescription drugs are also a major cause of avoidable harm [1]-[3]. Approximately 6.5% of all hospital admissions are caused by adverse drug events (ADEs), [1] and at least half of these are judged to be preventable [3]. Reducing primary care high-risk prescribing is therefore an important issue for health services. Implementing interventions have been difficult due to the complexity of defining appropriate measures of high-risk prescribing and identifying interventions that are known to be effective.
A number of measures of potentially inappropriate or high-risk prescribing have been used in research and service improvement. Examples include indicators from the Assessing Care of Vulnerable Elders (ACOVE) project, [4] the Screening Tool of Older Persons' Potentially inappropriate Prescriptions (STOPP), and the Beers Criteria [5]-[7]. ACOVE and STOPP rely on manual record review and are costly to implement on a large scale. The Beers Criteria can be relatively easily measured using routine health-care data, but the drugs listed do not include those most commonly implicated in serious harm. More recently, new measures of potentially inappropriate prescribing have been defined using consensus methods [8],[9] and have been shown to be both common and highly variable between practices [10]. Although not all of these prescriptions will be inappropriate, the high prevalence and variation indicates that improvement is attainable.
The PINCER trial showed that a complex intervention, combining pharmacist-facilitated improvement based on measurement of high-risk prescribing using data held in practices' own clinical IT systems, was effective at reducing targeted prescribing [2]. Potentially, more cost effective improvement methods have been made possible by the ongoing development of centrally held patient-level prescribing datasets. NHS Scotland has implemented an ePrescribing programme which has created a Scotland-wide, patient-level prescribing data warehouse (the new Prescribing Information System (newPIS)), in which ~95% of prescribed items have a unique patient identifier attached. This makes it feasible to provide ongoing feedback on rates of high-risk prescribing to practices. If shown to be effective, providing feedback of performance with the aim of improving prescribing safety is an attractive approach because it is easily scalable and relatively inexpensive, allowing more expensive interventions to be more selective.
There is evidence that providing feedback can be effective. At the time of designing the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study in 2010, the most recent Cochrane review (2006) identified 118 studies of clinical audit and feedback, although many were small and 80% were methodologically flawed or weak [11]. The median effect size was a 5% absolute improvement in binary indicators of guideline compliance, varying between studies from a 16% absolute worsening to a 70% absolute improvement. Only a very small number of studies examined feedback of safety data, mostly relating to benzodiazepine prescribing in the elderly [11]. The review identified key gaps in the literature relating to feedback, with a need for more theory-informed design [12] and `for head-to-head comparisons of different ways of doing audit and feedback: [11]. This review was updated in 2012 with similar findings, concluding that there is still a need for future studies of audit and feedback to directly compare different ways of providing feedback [13].
The need for more theory-informed interventions is becoming increasingly recognised. New guidelines on behaviour change recommend the need to `specify the theoretical link between the intervention or programme and its outcome' [14]. Key papers on behaviour change research have been published to help researchers apply psychological theory in developing interventions and implementing evidence-based practice [15]-[17].
The EFIPPS study is a joint academic and NHS initiative that aimed to develop two theory-informed formats for prescribing safety feedback, for evaluation of effectiveness (including cost) compared to simple `factual' educational material in a large, cluster randomised trial [18]. This paper describes the development of the intervention which was intended to be feasible to implement at a large scale, replicated in a resource-constrained NHS context, embedded in NHS data systems from the outset and informed by both NHS priorities and behaviour change theory.
This has been described in detail elsewhere, [18] but in brief, the trial is a pragmatic three-arm cluster randomised trial conducted in general medical practices in three Scottish Health Boards. General practices are randomised to one of the three arms, and the research outcomes (prescribing indicators) will be analysed at the patient level. This paper describes the initial development phase of the study including the selection of research outcomes and the development and design of each of the intervention components. The decision to implement a feedback design was driven by the intention of the NHS to use a familiar improvement method utilising the new patient-level prescribing resource, newPIS and feed back prescribing data to GP practices to enable them to monitor their own performance.
The components delivered in each arm of the trial are shown in Figure 1. An Advisory Group was convened with representatives from the three participating Health Boards (senior GPs and pharmacists) and the technical team at NHS Scotland Information Services Division who were responsible for creating the feedback from NHS data. This NHS-led Advisory Group was responsible for selecting high-risk prescribing measures for feedback and advising on feedback design.
Effective feedback to improve primary care prescribing safety trial design.
Outcomes had to be feasible in terms of implementation in newPIS, and consensus had to be reached among the Advisory Group as to what was important to NHS Scotland. Selection of outcomes drew on the findings of a prior RAND appropriateness method consensus study involving GPs and primary care pharmacists which identified candidate indicators [9] and evidence that the targeted prescribing was reasonably common [10]. Selection of outcomes for this trial used independent ranking of a list of candidate outcome measures by the Advisory Group members followed by in-depth face-to-face group discussion to reach consensus.
Intervention components
This was a pragmatic trial with an overall aim of designing an intervention that could be feasibly replicated in a typically resource-constrained NHS context. As well as being plausibly effective in terms of being likely to cause a measurable change in prescribing, the intervention had to be developed over a 6-month period with relatively limited resources, deliverable within the existing IT systems at NHS Scotland Information Services Division and be acceptable to all GPs rather than a subset of research volunteers. The three intervention components included (1) educational material received by all practices (the usual care comparison), (2) feedback of practice rates of high-risk prescribing received by both intervention arms and (3) a theory-informed intervention embedded in the feedback received by only one of the intervention arms.
Educational intervention and support for searching (same in all three arms). All educational materials were created by the research team in collaboration with the Advisory Group and where necessary topic-specific experts. Support for searching in each practice's own IT system was also provided via the study website which made accessible to a set of downloadable searches for the general practice clinical IT systems in use in Scotland.
Feedback of performance on the targeted indicators (arms two and three only). All practices in the two treatment arms were sent prescribing feedback, with arm three additionally receiving the psychology theory-informed intervention described in the next section. Based on the data available in newPIS, the Advisory Group specified that practices should be emailed five rounds of quarterly written feedback of their rate of high-risk prescribing to mirror most prescribing initiatives that are delivered over an approximate 12-month period (and allowing for a three-month data lag in the ePrescribing Information System). Feedback was iteratively designed by the research team working with the Advisory Group. Of note is that several of the Advisory Group's recommendations are `theory-informed' in the sense that elements of behaviour change research evidence have already become `normal practice'. For example, several members of the Advisory Group emphasised the need for educational material to provide clear advice on what action to take and the importance of having a credible messenger in terms of who signs emails and branding of feedback. These behaviour change techniques are included in the extensive list of techniques provided by Michie and colleagues 2008 [17]. The intention was that the feedback-only arm of the trial (arm two) should represent `best practice' as it would be implemented by NHS Scotland. The theory-informed intervention therefore had to implement techniques over and above those already implemented in `normal practice' to allow proper assessment of the more resource intensive intervention in arm three.
Theory-informed behaviour change intervention (arm three only). A number of social cognition models have been developed to help predict and understand health behaviours [19]. The Theory of Planned Behaviour (TPB) is [20] a motivational model that focuses predominantly on behavioural intention provided the conceptual framework that guided the development of the psychology-informed component of the intervention. TPB is one of the more commonly used social cognition models and has been validated and used rigorously in various health settings [21],[22]. While other psychological models of behaviour change could also have been considered, TPB was selected for use in the current study due to both its evidence base and the support available for health professionals to use this theory should the trial be rolled out at a national level. To predict behavioural intentions, TPB focuses on the three psychological constructs that are amenable to change: attitude, subjective norms and perceived behavioural control. A comprehensive TPB manual has been developed to help researchers construct questionnaires to measure these constructs that can then be used to inform intervention design and development [23]. While TPB is predominantly a motivational model to predict intention, perceived behavioural control is a determinant of both behavioural intention and behaviour. A meta-analysis of 87 studies looking at health behaviours found TPB accounted for 41% of the variance in intention and 34% of the variance in behaviour [21]. However, a criticism of TPB and other motivational models is the implicit assumption assuming near perfect correspondence between intention and behaviour, and studies have shown that a much larger proportion of the variance in intention is explained compared to that in behaviour [24]. To address the gap between intention and behaviour, we also drew on the Health Action Process Approach (HAPA) [25]. HAPA proposes that the process of behaviour change can be explained by two distinct phases: a motivational phase (e.g. social cognition models such as TPB) and a planning or volitional phase that focuses on action-controlled strategies. The volitional phase has three overlapping stages: planning, action and maintenance, and describes a post-intention and pre-actionable process that has a direct correlation with carrying out the action (or behaviour).
Target behaviours
The TPB manual highlights the importance of defining the target behaviour in specific terms, although questionnaires using TPB can also be developed to target more general behaviours [23]. The target behaviour we hoped to elicit from our intervention was that GPs would `respond to feedback' by searching in their IT system for patients receiving a high-risk prescription and reviewing their prescribing. Due to the nature of the targeted behaviour, how GPs `respond to feedback' could include a composite of individual behaviours that vary both by practice and for individual patients. For example, behaviours carried out by the GP might include searching for and identifying patients receiving a high-risk prescribing indicator, reviewing patient records, arranging telephone or face-to-face consultations and changing patient prescribing where appropriate. Ultimately, the decision, as to whether or not a change in medication is required, remains with the GP since some high-risk prescribing could be appropriate in the sense of the benefit outweighing the risks for a particular individual. Based on pilot work for a different trial and other published studies, [2],[26] the research team and the Advisory Group strongly believed that reviewing high-risk prescribing was likely to lead to a change in medication in a significant proportion of patients. For this reason, the psychology-informed intervention has been purposefully targeted at the behaviour of `searching for and reviewing patients with high-risk prescriptions' with the assumption that this behaviour will be highly correlated with a change in prescribing (the primary outcome of the trial is a composite measure of all six high-risk prescribing indicators).
Elicitation study (focus groups)
An elicitation study consisting of four focus groups, each comprising between six and ten health professionals was carried out to develop the measures for the three TPB psychological constructs (attitude, subjective norms and perceived behavioural control). Two focus groups were carried out with GPs: one in Tayside and one in Lothian (including members of the General Practice Prescribing Committee) and two with primary care pharmacists: one in Lothian and one in Tayside. Primary care pharmacists were invited to take part as they are often involved in initiatives to change GPs' prescribing behaviour and could provide additional insights to those provided by GPs. Focus groups were facilitated by two members of the research team (KB, BG). The primary purpose of the focus groups was to elicit a broad range of attitudes and potential barriers to carrying out the targeted behaviour, the results of which would be used to help develop statements relating to the three TPB constructs. For example, GPs and pharmacists were asked to discuss the advantages and disadvantages of responding to the prescribing feedback, the social pressures that GPs might experience when reviewing high-risk prescribing and changing medications, the potential barriers or the facilitating factors of responding to the prescribing feedback.
Email Delphi questionnaire study
A two-stage email Delphi study was conducted with GPs to prioritise which questionnaire items (or statements) collated from the elicitation study were the most important (or influential) to GPs in terms of carrying out the targeted behaviour, searching for patients in their IT system and reviewing their prescribing. An invitation letter to take part in the study, including a participant information leaflet and a copy of the questionnaire, was emailed to 500 randomly selected GPs from an email address list of GPs working in Scotland (excluding GPs working in the three Health Boards taking part in the trial). GPs were asked to rate each questionnaire item, on a five-point Likert scale, their level of agreement with each statement from strongly agree to strongly disagree according to their own personal beliefs. Completed responses were received from 48 GPs (10% response rate). The 48 GPs who completed the first questionnaire were then sent the questionnaire a second time, this time including the median, minimum and maximum response scores for each statement received in round one, and a reminder of how they had personally scored each item in the first round. GPs were asked to rescore each statement using the additional knowledge of their colleagues' collective response. In round two, 24 of the 48 GPs responded (50% response rate). Statements were deemed to be potential candidate variables if a) there was consensus of positive agreement with the importance of a statement or b) there was evidence of significant disagreement among the GP responses (>25%; if more than six GPs were outliers). Questionnaire items were excluded if there was agreement that a statement was not important in relation to reviewing patient prescribing (≥75%) or if more than 50% of GPs gave a neutral response.
The median scores from the questionnaires completed in round two were then used to identify the questionnaire items most likely to influence GPs behaviour.
Mapping targeted variables to behaviour change techniques
The next stage was to map the psychology constructs within each of our two models of behaviour change (TPB, HAPA) to appropriate behaviour change techniques based on the evidence as described by Michie and colleagues [17]. In this paper, Michie and colleagues generated an extensive list of behaviour change techniques and definitions from techniques published in two systematic reviews, `brain storming' and a systematic search of relevant textbooks. Four experts judged which techniques would be effective at changing 11 theoretical constructs associated with behaviour change. The first step in the present study was to map the four psychological constructs: attitude, subjective norms, PBC and action planning to the corresponding constructs among the 11 identified by Michie et al. The next step was to list the techniques where the experts had reached consensus of `agreed use' or were `uncertain' based on the level of evidence. Techniques where there was `disagreement' among the experts or `agreed non-use' were not considered.
The feedback intervention in its entirety had been designed to represent `best practice' and was informed by an expert Advisory Group. As a result, a number of the listed techniques were, to varying degrees, already being utilised in the feedback intervention. Examples of these included monitoring, feedback, provision of information regarding the behaviour/outcome and objects to facilitate the behaviour (e.g. support for searching in GP IT systems). The psychology-informed intervention therefore had to include techniques that were not already embedded in the other components of the feedback. This was in order that any additional effectiveness of the more resource intensive (in terms of development) theory-informed intervention could be assessed.
It is also important to note that the choice of techniques was further constrained by the nature of the trial—the theory-informed intervention had to be delivered as part of the quarterly feedback to GP practices and was limited to one A4 page (a balance between the additional time cost for GPs engaging with the intervention and encouraging behaviour change). The list of behaviour change techniques is provided in Table 1
Table 1 TPB constructs and behaviour change techniques
Six prescribing indicators were selected by the Advisory Group to be targeted by the intervention and measured at the end of the trial. The selected prescribing indicators are shown in Table 2.
Table 2 Prescribing indicators selected by the Advisory Group to be used in the trial
Educational intervention (same in all three arms). A two-page written educational intervention was designed to be delivered to all practices by email in the month before the trial started. This mirrored existing prescribing information sent to practices in overall length and style. The Advisory Group recommended that it emphasises that high-risk prescribing is common and that it is good practice to regularly identify and review patients receiving high-risk drugs, that it clearly lists the prescribing indicators targeted, that it summarises the risk that the targeted prescribing poses and that it provides clear advice as to what actions to take. A link to an NHS Scotland hosted website with additional information for those who wish to read more is provided. [see Additional file 1: Short two-page educational material and Additional file 2: Supplementary education material available on the website].
Feedback of performance on the targeted indicators (arms two and three only). The research team designed the feedback based on the Advisory Group specification that feedback should include (1) a clear statement of its nature (the first page has the title `High-risk Prescribing Feedback for Your Practice', the practice name, a statement of the purpose of feedback and a list of the indicators); (2) a graphical summary for each indicator that shows the change in their practice's prescribing over time for each indicator, compared to a national benchmark (which was set as the lower quartile for all Scottish practices in the year before the study started, which was NHS Scotland preferred practice at the time); (3) a summary of all six indicators on a single page; (4) a detailed one-page description of each indicator, consisting of the graphical summary, a statement of why the indicator matters and what practices should do, for example, to avoid particular combinations of drugs or review patients with particular prescribing (this text is the same for all practices), and an interpretation of what the graph shows for the practice receiving the feedback (this text is automatically generated depending on the data and is unique to each practice stating, for example, the number of patients affected in the practice and a warning about sensitivity of the measure to small numbers of patients where appropriate) and (5) the emails sent should be signed by both the Health Board Medical Director and a named professional from NHS Scotland Information Services Division (ISD), and that the feedback should be branded with Health Board and ISD logos. This is also how the intervention would be implemented in practice if it was not part of a research study.
Theory-informed behaviour change intervention (arm three only). Two psychological models of behaviour, TPB and HAPA, were selected to inform an intervention that was designed to target the behaviour of `searching for and reviewing patients with high-risk prescriptions' in general practice.
The focus groups with GPs and pharmacists generated a broad range of responses regarding the advantages and disadvantages of responding to the prescribing feedback, the social pressures that GPs might experience when reviewing high-risk prescribing and changing medications, and the potential barriers/or the facilitating factors of responding to the prescribing feedback. For example, three out of the four focus groups discussed the attraction of being able to compare prescribing performance with other practices as an advantage to taking part in the intervention and reviewing patient prescribing. The fear that high-risk prescribing could lead to potential harm for the practice as well as the patient, particularly if the prescribing results in a significant event, was also thought to be an important factor that would encourage GPs to review patient prescribing. The key disadvantage that was raised in the focus group discussions was the impact on GP's time and work load. The practice pharmacist and local GP committees were felt to have the most influence over whether or not GP practices would endorse the intervention. Patients currently doing well on their medication and carers/care workers (regarding dementia patients) were thought to the groups most likely to oppose a change in medication. The key barriers of responding to the prescribing feedback identified in the focus groups were if the instructions provided with the feedback were confusing, there was too much information or if the message was not in keeping with current advice from secondary care. The key facilitators of responding to the prescribing feedback were if GPs believed that the feedback was important and clearly branded, could be delivered face-to-face e.g. via the practice pharmacist and if the feedback was related to research and improving patient safety rather than cost-effectiveness.
The broad ranges of responses obtained in the focus groups were transcribed into statements corresponding to the three TPB constructs. For example:
Attitude—If I respond to prescribing feedback I will feel like I am doing something positive for the patient.
Subjective norms— Approval from other GPs in my Practice is important to me.
Perceived behavioural control—It would be difficult for me to respond to prescribing feedback due to limited practice resources.
A total of 59 statements were collated and included in the Delphi questionnaire. Twenty-four GPs from various Scottish Health Boards completed both rounds of the Delphi questionnaire, scoring each statement in terms of their own beliefs of the importance or influence of the statement on the targeted behaviour: responding to feedback by searching for patients in their IT system and reviewing their prescribed medications. Consensus was reached on 50 of the 59 statements, only two statements received a neutral response where more than 50% of respondents neither agreed nor disagreed with the importance of the statement, and consensus was not met for seven of the 59 statements. A summary of the statements that reached consensus and those where there was disagreement are shown in Table 3. Neutral responses were received for two statements whether the pharmaceutical industry had an influence on a GP's decision to review patient prescribing and whether approval from the press was important to GPs.
Table 3 Summary table of the key results from the Delphi questionnaire
The research team selected behaviour change techniques from an evidence-based list, [17] for each of the four constructs within the two psychological models that had been selected to inform the intervention: attitude, subjective norms, perceived behavioural control and action planning. The Advisory Group recommended that the psychology-informed intervention should be different for each round of feedback since they believed that this would maximise the potential of it to change behaviour. It was evident from the elicitation study that the behaviour sequence that practices would engage in to `respond to the prescribing feedback' would vary across practices. Of note is that the pragmatic nature of the delivery of the feedback meant that the intervention would first be sent to the practice managers' who would then choose how to disseminate the information to the GPs. This reflects how such feedback would be implemented in the `real world' but makes it harder to identify `specific' behaviours to target. Results from the Delphi study confirmed that the core attitudes, social norms, barriers and facilitating factors of responding to the prescribing feedback were consistent. For this reason, the research team chose to design a behaviour change intervention for each of the four psychology constructs within the two models: attitudes (TPB), subjective norms (TPB), perceived behavioural control (TPB) and action planning (HAPA). The results from the email Delphi questionnaire were used to inform the content and design of each of the four A4 page interventions. The psychology-informed interventions are available to view as Additional file 3: Psychology-informed interventions.
Participating practices in arm three would receive interventions targeting (in order of receipt): action planning (HAPA), perceived behavioural control (TPB), attitude (TPB), subjective norms (TPB) and a repeat of the action planning intervention in the fifth round of feedback. The intervention appears as page two in the feedback document. An example of the feedback document is available to view as Additional file 4: Example feedback intervention.
The aim of this paper was to describe in detail the design and development of a feedback intervention for a cluster randomised trial evaluating the impact on high-risk prescribing of two different designs of feedback compared to a simple educational message. The results of the previous clinical audit feedback trials have been mixed [11], and in terms of evaluation, a major criticism has been that most have not been informed by theory or been explicit in their approach [12].
This study provides an unusual opportunity to provide a practical demonstration of how one might use theory to inform an intervention, given real-life constraints, and rigorously test the intervention in a health-care setting. This was a pragmatic trial, which was intended to be feasible to implement at a large scale by virtue of being embedded in NHS data systems from the outset, and was therefore limited by time, cost and practical constraints. While we acknowledge that a more sophisticated and costly psychology-informed intervention might plausibly produce a larger effect size, we sought to test whether investing in a `real-world' feasible resource, to develop a theory-informed intervention, improved prescribing more than the development of a current `best practice' form of feedback. Drawing on the behaviour change literature, we selected evidence-based theories to inform our intervention for changing prescribing behaviour. The development of our elicitation study and Delphi questionnaire was informed by TPB where we referred to the TPB manual, designed specifically to help health services researchers, use behaviour change theory to design and develop questionnaires, the results of which can then be used to help inform targeted interventions. In terms of reporting, we have been guided by the Consolidated Standards of Reporting Trials (CONSORT) group [27] and the recommendations of Michie et al. [28] and the recent introduction of the Workgroup for Intervention Development and Evaluation Research (WIDER) [29].
A criticism of previous published behaviour change intervention studies has been that they have lacked explicit detail in their approach and therefore hinder their reproducibility [30]. Our aims in this paper were to describe in detail the design and development of our feedback intervention and to provide a pragmatic `real-life' example of implementing a theory-informed intervention. We believe that documenting the intervention in detail is important in supporting the interpretation of the findings of the main trial and will make a useful contribution to the literature on intervention development, particularly for researchers or health service improvement professionals working within the constraints of a real-life health-care setting.
BG and MB conceived the original study and developed the protocol with ST, DP, CR and LR. The intervention components were designed and developed by BG (educational newsletter and support for searching); BG, MB, ST and CR (feedback on targeted indicators) and KB (psychology-informed intervention). KB led the writing of the first draft of the paper, with contribution from BG. All authors commented on the first draft and contributed to the editing and redrafting. All authors read and approved the final manuscript.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM: Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ. 2004, 329: 15-19. 10.1136/bmj.329.7456.15.
Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, Elliott RA, Howard R, Kendrick D, Morris CJ, Prescott RJ, Swanwick G, Franklin M, Putman K, Boyd M, Sheikh A: A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet. 2012, 379: 1310-1319. 10.1016/S0140-6736(11)61817-5.
Howard RL, Avery AJ, Slavenburg S, Royal S, Pipe G, Lucassen P, Pirmohamed M: Which drugs cause preventable admissions to hospital? A systematic review. Br J Clin Pharmacol. 2007, 63: 136-147. 10.1111/j.1365-2125.2006.02698.x.
Higashi T, Shekelle PG, Solomon DH, Knight EL, Roth C, Chang JT, Kamberg CJ, MacLean CH, Young RT, Adams J, Reuben DB, Avorn J, Wenger NS: The quality of pharmacologic care for vulnerable older patients. Ann Intern Med. 2004, 140: 714-720. 10.7326/0003-4819-140-9-200405040-00011.
Fick D, Semla T, Beizer J, Brandt N, Dombrowski R, DuBeau CE, Flanigan N, Hanlon J, Hollman P, Linnebur S, Nau D, Rehm B, Sandhu S, Steinman M: American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012, 60: 616-631. 10.1111/j.1532-5415.2012.03923.x.
Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH: Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003, 163: 2716-2724. 10.1001/archinte.163.22.2716.
Gallagher P, O'Mahony D: STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Age & Ageing. 2008, 37: 673-679. 10.1093/ageing/afn197.
Avery AJ, Dex GM, Mulvaney C, Serumaga B, Spencer R, Lester HE, Campbell SM: Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method. Br J Gen Pract. 2011, 61: e526-e536. 10.3399/bjgp11X588501.
Dreischulte T, Grant AM, McCowan C, McAnaw JJ, Guthrie B: Quality and safety of medication use in primary care: consensus validation of a new set of explicit medication assessment criteria and prioritisation of topics for improvement. BMC Clin Pharmacol. 2012, 12: 5-10.1186/1472-6904-12-5.
Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K: High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. BMJ (Clinical research ed). 2011, 342: d3514-10.1136/bmj.d3514.
Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD: Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006, 2: CD000259-
Foy R, Eccles MP, Jamtvedt G, Young J, Grimshaw JM, Baker R: What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC Health Serv Res. 2005, 5: 50-10.1186/1472-6963-5-50.
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD: Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012, 6: CD000259-
Excellence. NIfHaC: Behaviour change at population, community and individual levels (Public Health Guidance 6). London: NICE; 2007. from http://www.nice.org.uk/guidance/ph6.
French SD, Green SE, O'Connor DA, McKenzie JE, Francis JJ, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw JM: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012, 7: 38-54. 10.1186/1748-5908-7-38.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005, 14: 26-33. 10.1136/qshc.2004.011155.
Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology-an International Review-Psychologie Appliquee-Revue Internationale. 2008, 57: 660-680. 10.1111/j.1464-0597.2008.00341.x.
Guthrie B, Treweek S, Petrie D, Barnett K, Ritchie LD, Robertson C, Bennie M: Protocol for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study: a cluster randomised controlled trial using ePrescribing data. BMJ Open. 2012, 2: 1-10. 10.1136/bmjopen-2012-002359.
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Hausenblas HA, Carron AV, Mack DE: Application of the theories of reasoned action and planned behavior to exercise behavior: a meta-analysis. J Sport Exerc Psychol. 1997, 19: 36-51.
Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, Kaner EFS, Smith L, Bonetti D: Constructing questionnaires based on the theory of planned behaviour. Man Health Serv Res. 2004, 2010: 2-12.
Sheeran P, Orbell S: Do intentions predict condom use? Meta-analysis and examination of six moderator variables. Br J Soc Psychol. 1998, 37 (Pt 2): 231-250. 10.1111/j.2044-8309.1998.tb01167.x.
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Dreischulte T, Grant A, Donnan P, McCowan C, Davey P, Petrie D, Treweek S, Guthrie B: A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: The DQIP study protocol. Implement Sci. 2012, 7: 1-13. 10.1186/1748-5908-7-24.
Schulz KF, Altman DG, Moher D, Grp C: CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010, 63: 834-840. 10.1016/j.jclinepi.2010.02.005.
Michie S, Fixsen D, Grimshaw JM, Eccles MP: Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009, 4: 1-6. 10.1186/1748-5908-4-40.
Albrecht L, Archibald M, Arseneau D, Scott SD: Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations. Implement Sci. 2013, 8: 1-5. 10.1186/1748-5908-8-52.
Davies P, Walker AE, Grimshaw JM: A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implementation Sci. 2010, 5: 14-10.1186/1748-5908-5-14.
The authors would like to thank all the members of the EFIPPS Advisory Group for their valuable input into the study design and conduct and in particular, Jackie Caldwell (project manager), Iain Bishop (pharmacist supporting intervention development and implementation) and Grant Wyper (data analyst implementing the measures in routine data) at ISD Scotland. The Health Services Research Unit, University of Aberdeen, is core funded by the Chief Scientist Office of the Scottish Government Health Directorates.
This work was supported by the Chief Scientist Office of Scottish Government Health Directorates research grant CZH/3/17. The funder has no role in the study design, data collection, data analysis or the decision to publish and other dissemination.
Centre of Population Health Sciences, University of Edinburgh Medical Quad, Teviot Place, EH8 9AG, Edinburgh, UK
Karen N Barnett
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, The John Arbuthnott Building, 161 Cathedral Street, Glasgow, G4 ORE, UK
Marion Bennie
Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, AB25 2ZD, Aberdeen, UK
Shaun Treweek
Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower 26 Richmond Street, Glasgow, G1 1XH, UK
Christopher Robertson
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010, Australia
Dennis J Petrie
Centre of Academic Primary Care, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, AB25 2ZD, Aberdeen, UK
Lewis D Ritchie
Quality, Safety and Informatics Research Group, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK
Correspondence to Karen N Barnett.
Additional file 1: Short two-page educational material. This file contains the education material that was delivered to all three arms of the trial. (PDF 196 KB)
Additional file 2: Supplementary educational material available on the website. This file contains the supplementary educational information that was available to all three arms of the trial via the website. Practices were directed to the website, and the supplementary information, in the short educational material that was delivered to all practices. (DOC 214 KB)
Additional file 3: Psychology-informed interventions. This file contains each of the four one-page psychology informed interventions that were embedded in each of the five quarterly rounds of feedback. Action planning was repeated in the fifth round of feedback. (PDF 629 KB)
Additional file 4: Example feedback intervention (arm three). This file contains an example of one round of quarterly feedback delivered to a practice in arm three of the trial. (PDF 250 KB)
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Barnett, K.N., Bennie, M., Treweek, S. et al. Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705). Implementation Sci 9, 133 (2014). https://doi.org/10.1186/s13012-014-0133-9
Medication review
Inappropriate medication
Intervention development
ePrescribing

redpajama_set_name: RedPajamaCommonCrawl


text:
Forticrete's Hardrow Slates provides Eighteenth Century Charm for Taylor Wimpey Development
Highly durable Hardrow Slates from Forticrete have been specified by Taylor Wimpey Homes (East Midlands) for its stunning collection of one, three, four and five-bedroom properties in the historic town of Stamford.
With Stamford steeped in historic charm, built around picturesque seventeenth and eighteenth century buildings which offer an attractive setting, Taylor Wimpey Homes (East Midlands) specified Forticrete's Hardrow Slates in diminishing courses in Barley for an authentic traditional appearance.
Kevin Bendall, Design and Planning Executive at Taylor Wimpey Homes (East Midlands), commented: "With Stamford steeped in historic charm, built around picturesque seventeenth and eighteenth century buildings which offer an attractive setting, it was vital that we found a tile that provided an authentic traditional appearance.
"It was clear that Forticrete's Hardrow Slates in diminishing courses provided the ideal solution. The Barley colour was chosen as it ensured the stimulating finish both ourselves and the local vernacular required."
Suitable for use in regions where a natural stone slate appearance is required, Forticrete's Hardrow roof slates are manufactured with a slight variation in dimensional tolerance, adding to the product's character when laid.
The range, which is extremely durable and mellows with age, can be laid in either random widths or diminishing courses for an authentic traditional appearance. The slates are available in a variety of sizes, for both roofing and vertical cladding. The sizes range from 457mm x 305mm (min. pitch 25o), right up to the imposing 610mm x 457mm which can be laid confidently at pitches as low as 17.5o, creating a bold appearance.


text:
KC leaders condemn recent violence in metro, around the country
Speakers called on audience members to contact their representatives
Updated: 9:50 PM CDT Aug 7, 2019
KMBC 9 News Staff
WITH GUN VIOLENCE FILLED PENN VALLEY EDUCATION CENTER TO DEMAND ACTION. >> ARE YOU DISGUSTED? YES. BUT JUST BEING DISGUSTED IS NOT ENOUGH. BRIAN: SEVERAL SPEAKERS ASKED EVERYONE TO CALL AND WRITE CONGRESSIONAL LEADERS IN DC AND STATE LEADERS IN JEFFERSON CITY. >> WHILE MASS SHOOTINGS DO GET A LOT OF ATTENTION, AS THEY SHOULD, KANSAS CITY IS EXPERIENCING MASS SHOOTINGS. BRIAN: 87 WERE MURDERED, 309 SHOT SO FAR THIS YEAR IN KANSAS CITY. >> THOSE ARE PRETTY SOBERING FACTS. >> WHY IS IT THAT EVERY YEAR N IN KANSAS CITY WE'RE TALKING ABOUT SETTING OR MATCHING OLD HOMICIDE RECORDS BRIAN: THE SPEAKERS SAY IT'S NOT A COINCIDENCE. SAINT LOUIS, KANSAS CITY, AND SPRINGFIELD ARE ALL AMONG THE MOST VIOLENT CITIES IN AMERICA. >> IT IS NOT AN ACCIDENT. IT IS BECAUSE WE HAVE DEREGULATED WEAPONS TO A POINT THAT IS IS DANGEROUS HERE. IT'S DANGEROUS. YOU DESERVE BETTER. >> WE'RE NOT GOING TO STOP TILL WE HAVE MADE A DIFFERENCE FOR EVERYONE IN KANSAS CITY. BRIAN: MAYOR LUCAS SAYS NOTHING SHOULD BE MORE IMPORTANT THAN FIXING VIOLENT CRIME IN OUR
Community leaders and more than half a dozen organizations condemned violence in Kansas City and recent mass shootings in Texas and Ohio.People upset with gun violence filled Penn Valley Education Center to demand action."Are you disgusted? Yes. But just being disgusted is not enough," U.S. Rep. Emanuel Cleaver II said.Several speakers asked everyone to call and write congressional leaders in Washington, D.C., and state leaders in Jefferson City."While mass shootings do get a lot of attention, as they should, Kansas City is experiencing mass shootings," Jackson County Prosecutor Jean Peters Baker said.So far this year in Kansas City, 87 people have been murdered and a total of 309 shot."Those are pretty sobering facts," Kansas City police Chief Rick Smith said."Why is it that every year now in Kansas City, we're talking about setting or matching old homicide records?" Mayor Quinton Lucas said.St. Louis, Kansas City and Springfield are among the most violent cities in America. "It is not an accident. It is because we have deregulated weapons to a point that it is dangerous here. It's dangerous. You deserve better," Peters Baker said."We're not going to stop until we have made a difference for everyone in Kansas City," Lucas said.
Community leaders and more than half a dozen organizations condemned violence in Kansas City and recent mass shootings in Texas and Ohio.
People upset with gun violence filled Penn Valley Education Center to demand action.
"Are you disgusted? Yes. But just being disgusted is not enough," U.S. Rep. Emanuel Cleaver II said.
Several speakers asked everyone to call and write congressional leaders in Washington, D.C., and state leaders in Jefferson City.
"While mass shootings do get a lot of attention, as they should, Kansas City is experiencing mass shootings," Jackson County Prosecutor Jean Peters Baker said.
So far this year in Kansas City, 87 people have been murdered and a total of 309 shot.
"Those are pretty sobering facts," Kansas City police Chief Rick Smith said.
"Why is it that every year now in Kansas City, we're talking about setting or matching old homicide records?" Mayor Quinton Lucas said.
St. Louis, Kansas City and Springfield are among the most violent cities in America.
"It is not an accident. It is because we have deregulated weapons to a point that it is dangerous here. It's dangerous. You deserve better," Peters Baker said.
"We're not going to stop until we have made a difference for everyone in Kansas City," Lucas said.


text:
Orange allies sign Ukraine accord
Pro-Western parties with slim majority agree to form coalition government.
The agreement was signed on Monday after the official election results were announced [AFP]
They hold 228 seats in the 450-member legislature - two more than needed to win most votes.
As head of the larger group, Tymoshenko is almost certain to be restored to her former job.
"Let me just say that the election has led to a change in parliament. Power has changed hands in Ukraine and we have achieved the result we had hoped for," Tymoshenko told reporters after the brief signing ceremony.
"The parliament is new, those in power are new. The democratic team has all grounds to reform all sectors of life so that people feel tangible changes in the country."
Tymoshenko was President Viktor Yushchenko's first prime minister after weeks of mass rallies in 2004, which came to be known as the Orange Revolution, swept him to power.
But the two fell out and Tymoshenko was sacked within eight months after her team was hit by infighting, relations with Russia soured and investors took fright at her calls for a broad review of "dubious" privatisations.
First task
The coalition's first tasks after forming the government are aimed at ending a year of political deadlock and include carrying out a pledge to remove privileges from members of parliament and alter a law which substantially reduced the president's powers.
Tymoshenko is set to assume the
premiership again [AFP]
Vyacheslav Kyrylenko, head of the pro-presidential Our Ukraine party, also initialled the agreement - to be formally signed at the new parliament's first sitting.
Their accession to power would turf out of office the president's rival, Viktor Yanukovich - who lost the 2004 election to Yushchenko but bounced back last year to become prime minister.
Yanukovich's Regions party, with its power base in eastern Ukraine, remains the largest single group. But, together with its Communist allies, it commands only 202 seats in the chamber.
Tymoshenko said an "Orange" government would give wide powers to the opposition in parliament and would sponsor a law outlining its role.
In the run-up to the accord, she agreed to a call from the president to give some leading jobs to his rivals.


text:
Points of Light Seeks the Most Community-Minded Companies in the United States
Points of Light has opened The Civic 50 survey, an annual initiative that recognizes the 50 most community-minded companies in the United States. Now in its seventh year, The Civic 50 serves to recognize stronger corporate commitment to community through engagement, volunteerism, and social impact strategies.
Participation in The Civic 50 survey is open to companies with revenue of $1 billion or higher, that are prioritizing community-building, enhancing corporate citizenship, and delivering innovative employee volunteer programs.
"Points of Light recognizes the key role that businesses play as leaders in their communities and stewards of resources," said Natalye Paquin, president and CEO, Points of Light. "We're proud to continue working with leading companies in understanding how they continue to prioritize their impact on doing social good through their investments. As we see each year, the momentum is growing for more and more companies to focus on this work."
The Civic 50 serves as a roadmap, to view trends over time, and help see changes and leaders in corporate service. Honorees from The Civic 50 in 2018 are leading in prioritizing community-building and corporate citizenship. Findings from last year's survey show:
70% have taken national leadership positions on public education or policy efforts, while employees have volunteered more than 13 million hours.
Employee volunteer program participation is increasing, with 100% supporting individual and group volunteer recognition.
60% measure employee engagement as a business outcome.
A technical assistance webinar will be held on the survey launch day, Thursday, Dec. 13, at 12 p.m. Applications will be accepted Dec. 13, 2018, through March 15, 2019. Results will be announced at the Points of Light Conference in June. Visit Civic50.org to register for the technical assistance webinar and participate in the survey.
The Civic 50 survey is an initiative of Points of Light and is powered by True Impact, a web-based measurement tool and benchmarking network for the charitable sector.
For more information, visit Civic50.org or email civic50@pointsoflight.org.
NewsPoints of Light, The Civic 50 survey
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January 6, 2020 Stuart Mitchell 0
Points of Light Launches The Civic 50 Survey to Recognize Nation's Top Corporate Citizens for 2020
Points of Light, a global nonprofit dedicated to accelerating people-powered change, today launched The Civic 50 survey for 2020....
Points of Light and The Starbucks Foundation Expand Innovative Service Model in 20 Cities Across the United States
Points of Light, the world's largest organization dedicated to volunteer service, and The Starbucks Foundation announce...
May 4, 2018 Stuart Mitchell 0
Scooby-Doo and the Mystery Inc. Gang Inspire More Meddling Kids and Their Parents to "DOO GOOD" in Their Communities with a New Social Responsibility Initiative
Today's parents are more aware than ever that inspiring the next generation to engage in social...


text:
@midnight
SN 4 | EP 4141 | August 4, 2017 - The 600th and Final Episode
@midnight celebrates its 600th and final episode with Ron Funches, Paul F. Tompkins, Wil Wheaton, Steve Agee, "Weird Al" Yankovic, Marcella Arugello and many more.
Available: Comedy Central, Amazon.com, Google Play, iTunes Store, YouTube
"RENO 911!" alumni Thomas Lennon and Robert Ben Garant -- and the popular website Funny or Die -- are among the responsible parties for the daily, late-night comedy competition "At Midnight." Hosted by Chris Hardwick, the series welcomes a rotating lineup of top comics for a battle to determine who has the funniest take on the day's social media and pop culture happenings. Using social media as the catalyst and a fake game show as the setting, "At Midnight" challenges comics to turn the most absurd news and posts that social media has to offer into hilarious bits worthy of a stand-up act. The winner is crowned the funniest person on Earth -- at least until the next "At Midnight" airing.
Chris Hardwick,
Season 4 Season 2 Season 1 Season 2017 Season 2016 Season 2015 Season 2014
Robert Ben Garant
Mike Farah


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Bruce Conner: It's All True (2016)
10 February 2019, dusan
Filed under book | Tags: · art, catalogue, collage, conceptual art, experimental film, painting, photography, punk
"Realist. Surrealist. Hippie. Punk. Bruce Conner (1933-2008) was all of these and more. A pioneer in experimental film, collage, photography, conceptual works, and paintings, he challenged the limitations of medium, genre, and style, constantly breaking new ground. Both of and ahead of his time, Conner continues to exert influence over artists working today. Bruce Conner: It's All True was the first comprehensive retrospective of this pivotal American artist's output, bringing together over 250 objects in various media, including film and video, works on paper, assemblages, photographs and photograms, performance, and more. Spanning his five-decade career, the exhibition presents aspects of Conner's work that have rarely been seen before, from paintings he made in the 1950s to photos from the Bay Area punk scene in the 1970s to video work from the 2000s, as well as numerous works produced in the last decade of his life."
With texts by Rachel Federman, Laura Hoptman, Kellie Jones, Michelle Barger, Roger Griffith and Megan Randall, Rachel Federman, Kristine Stiles, Rudolf Frieling, Gary Garrels, Diedrich Diederichsen, Stuart Comer, Johanna Gosse, a.o.
Edited by Rudolf Frieling and Gary Garrels
Publisher San Francisco Museum of Modern Art, in association with University of California Press, 2016
ISBN 9780520290563, 0520290569
Review: Hugo Daniel (Critique d'art, 2017, FR).
Exh. reviews: Roberta Smith (New York Times), Andrea K. Scott (New Yorker), J. Hoberman (New York Review of Books), Matthew Biro (Brooklyn Rail), Maika Pollack (Aperture), Kristin M. Jones (Wall Street Journal), Kimberly Connerton (Aesthetica), Thomas Gladysz (Huff Post).
Exhibition (MoMA)
Exhibition (SFMOMA)
Exhibition (Reina Sofia)
Love Forever: Yayoi Kusama, 1958-1968 (1998) [EN, JP]
17 December 2017, dusan
Filed under catalogue | Tags: · art, collage, installation art, minimal art, painting, performance art, pop art
Yayoi Kusama's work combines elements of expressionism, minimalism, surrealism and pop art.
"Although an active experimental artist throughout her time in New York during the '50s and '60s, Kusama had been largely forgotten by the United States public after her return to Japan in the '70s. That is, until her artwork began circulating across the US and globe again in the mid-'90s. One of these major retrospectives, Love Forever: Yayoi Kusama, 1958-1968, was co-organized by the Los Angeles Museum of Art and The Japan Foundation, and travelled from Los Angeles to New York City and to Minneapolis.
Kusama described this moment in her autobiography Infinity Net: "My exhibition at Robert Miller Gallery that year… won an AICA award. A review in Time Out said that 'Kusama has kept out of sight, ensconcsed in her own infinite world, but now she's back to reclaim her rightful place in the history of postmodernism…' But the biggest highlight came in March 1998 when Love Forever opened at the Los Angeles Museum of Art. This grand retrospective cemented the reassessment of Kusama as a major avant-garde artist. It included some eighty pieces and had taken five years to compile.""
With essays by Lynn Zelevansky, Laura Hoptman, Akira Tatehata, and Alexandra Munroe.
Publisher Los Angeles County Museum of Art, Los Angeles, 1998
Online companion to exhibition (MoMA)
PDF (English, 1998)
PDF (Japanese, 1999)
Jindřich Štyrský: Emilie Comes to Me in a Dream (1933/1997)
10 October 2017, dusan
Filed under artists book | Tags: · collage, dreams, eroticism, sexuality, surrealism
Jindřich Štyrský (1899–1942) was a painter, poet, photographer, collage artist and editor. A founding member of The Surrealist Group of Czechoslovakia he edited Erotická revue that included illustrations by well-known Czech artists and had an imprint called Edice 69 (Edition 69) where Emilie přichází ke mně ve snu, a portfolio of 10 erotic surrealist photo-collages, appeared in 1933 as its sixth and final volume. Štyrský believed that in pornography he had found a destabilizing medium that could be used to subvert established social and artistic norms. Bohuslav Brouk, a psychoanalyst affiliated with the Czech surrealists, contributed an afterword in which he commented forcefully on the subject of pornography as art. Despite its small run of 69 copies, the book is now considered a masterpiece of Czech Surrealism.
This new edition contains 12 collages, two of which were edited out from the original.
With an afterword by Bohuslav Brouk
Publisher Ubu Gallery, New York, 1997
via Oh Top Book Photobooks
PDF (low res, 5 MB)
See also collection of 21 collages in Centre Pompidou


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YANKEES 2, MARINERS 1 (10): N.Y. beats M's at their own game
By Kirby Arnold, For The Sun — May 20th, 2001
(Clemens 4-0) at Seattle
(Sele 5-0)
KIRO-710
SEATTLE - In the land of pitching, defense and technically sound baseball, the Seattle Mariners saw their own reflection Saturday.
The team that stared back at them was the New York Yankees, whose near-flawless execution in the field, at the plate and on the basepaths produced a 2-1 victory over the Mariners in 10 innings at Safeco Field.
How perfect were the Yankees?
Three of their pitchers held the Mariners' Ichiro Suzuki hitless for only the third time this season, ending his hitting streak at 23 games, one short of Joey Cora's team record in 1997. Yankees starting pitcher Orlando Hernandez, who allowed just four hits in eight innings, got Suzuki out on two groundouts and a strikeout, then planted a first-pitch fastball in his back in the ninth inning.
"The young man had a 23-game hitting streak. He's entitled to an 0-fer every once in a while," Mariners manager Lou Piniella said.
The bigger picture was what the Yankees did to pull off their second straight victory and become only the second team to win a series from the Mariners this season.
Derek Jeter, down to the Yankees' last strike in the ninth inning of a 1-0 game, poked a score-tying RBI single off Mariners closer Kazuhiro Sasaki, and Jorge Posada produced the game-winner in the 10th with a ground ball to second base that scored Tino Martinez.
"We're capable of hitting home runs, but we're not a home run-hitting team," Jeter said. "It's the little things that allow you to win, especially when you get to the postseason."
Alfonso Soriano, a 23-year-old rookie second baseman, almost single-handedly putting himself into scoring position for the tying run in the ninth inning against Sasaki. Soriano dug a split-finger pitch from Sasaki for a one-out single and, after Chuck Knoblauch flied out to deep center field, stole both second and third base. He scored easily on Jeter's single to center.
In the 10th, Bernie Williams led off with a double and went to third when Martinez grounded out to second base. Sasaki intentionally walked David Justice to set up a double play situation.
The Mariners got that grounder from Posada, a high-hopper to Bret Boone at second. Justice was running with the pitch, however, and Boone went for the sure out at first even though it led to the winning run.
With M's starter Jamie Moyer mastering his breaking pitch and hitting every edge of the strike zone, it looked like one run would be plenty. Jeter's fourth-inning single wasn't just the only hit off Moyer, it was the Yankees' only baserunner against him.
All it got Moyer was a no-decision. He'd thrown only 88 pitches through seven innings, but Piniella opted for the power left arm of Arthur Rhodes in the eighth, and he responded with a groundout to Tino Martinez and two called third strikes to Justice and Posada.
Sasaki, who hadn't pitched in six days, took over in the ninth and allowed as many baserunners as he got outs. As a result, he suffered his second blown save and the Mariners lost for the first time in the 31 games they had led after eight innings.
The long layoff was no factor, Price said.
"Not at all," he said. "He's been up throwing during two of those days. Kaz is 17 of 19 (in save situations). I'll take that."
MARINERS 6, YANKEES 2: Sele stops Yanks
The Seattle starter outpitches a strangely out of control Roger Clemens and Bret Boone drives in three more runs as the M's avoid a sweep. TUESDAY Seattle (Abbott 2-1) at Minnesota (Radke 7-1) 5:05 p.m. KIRO-710 FSN INSIDE/C5 Tomko sent down, and ... [Read More...]
MARINERS 5, ROYALS 4 (11): Road-killer M's sac K.C.
SUNDAY Seattle 5, K.C. 4 TODAY Seattle (Abbott 2-2) at Kan.City (Durbin 3-2) 11:05 a.m. KIRO-710 Ch. 7 * Mike Cameron' sacrifice fly scores the winning run after a blown save by Kazuhiro Sasaki as Seattle ups road record to 21-5. KANSAS CITY, Mo. - ... [Read More...]
SEATTLE 1, NEW YORK 0: One-hit wonders: M's foil Lilly
SATURDAY Seattle 1, New York 0 TODAY New York (Hernandez, 2-1, 1.29) at Seattle (Moyer, 3-1, 4.20) 1:35 p.m. KIRO-710 FSN M's FACT The last time the M's were no-hit was by the Yankees' Dwight Gooden on May 14, 1995. * The Yankees' Ted Lilly takes a no-hitter into the ... [Read More...]
MARINERS: One more late-game collapse
* The Mariners come back to take the lead in New York, then lose in the 10th innings when Bobby Ayala gets himself in trouble. By Gordon Wittenmyer For The Sun NEW YORK -- Alex Rodriguez spoke so quietly he was barely audible in ... [Read More...]
THE MAJORS: M's break out Bronx brooms
THURSDAY Seattle 7, New York 3 TODAY Seattle (Sele, 3-0) at Chicago (Baldwin, 0-0) 5:05 p.m. KIRO-710 Ch. 7 * Seattle sweeps the Yankees for the first time since 1997 and ups its record to 18-4, the best in the majors. NEW YORK - The Seattle Mariners are ... [Read More...]


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Climate change: island life in a volatile world
4.3 Dilemmas of climate change
1 Dividing the planet
2 Island territories, ocean flows
2.1 Issues of responsibility
2.2 Climate change in a globalised world
2.3 Divisions that matter: thinking through territories
2.4 Worlds in motion: the importance of flows
3 Settling islands
3.1 Voyages of discovery and settlement
3.2 Migrations of life
4 Volatile worlds
4.1 When climate changes
4.2 Shifting ground
Reading 1a File
Reading 1b File
Reading 1c File
Reading 1d File
Figures 3a and 3b File
Level 2: Intermediate
BSc (Honours) Geography and Environmental Science
Science: the weather
In Section 4.1, we looked at claims that climatic change thousands of years ago triggered the movement of people into the ocean, eventually leading to the settling of islands like Tuvalu. We have also seen that these islands only rose out of the ocean because of dynamic geological processes coupled with dramatic changes in climate and sea level.
Take a moment to consider how an understanding of the formation of oceanic islands like Tuvalu makes you feel about the current predicament of the Tuvaluans. Has it changed the way you think about human-induced global climate change and the responses or responsibilities this might entail?
The people of Tuvalu claim that carbon emissions are changing global climate. In particular, they point to the unwillingness of nation states like the USA and Australia to support the Kyoto Protocol, which seeks to reduce these emissions. The idea that the earth's natural greenhouse effect is being enhanced by a build-up in carbon and other greenhouse gases because of non-renewable energy use is fully supported by many environmental campaigners around the world, such as Molly Conisbee and Andrew Simms, the authors of Environmental Refugees (2003; see Reading 1B). This notion is also supported by the huge international consortium of climate scientists that comprises the IPCC. Similarly, for Nunn (2003), and many other geographers who have made a study of oceanic islands, the inherent changeability and precariousness of island life is reason not to discount human-induced climate change, but to take it very seriously indeed.
Nonetheless, perhaps unsurprisingly, there are others who see this differently. Some commentators have used the idea of the constant motion of the earth's crust to counter the argument that greenhouse gas emissions are having a significant impact on sea levels. In this regard, US climate negotiator Harlan Watson has noted the particular instability of the Pacific: 'The South Pacific is very volcanically unstable on the sea floor … so you have some natural subsidence occurring anyway. Islands are appearing and disappearing all the time' (cited in Kriner, 2002, p. 2). Other voices in the climate change debate have argued that because global climate fluctuates constantly, current warming is nothing out of the ordinary. Danish statistician Bjorn Lomborg, for example, has suggested that as the planet is still coming out of the Little Ice Age, a gradual warming and attendant rise of sea level is to be expected (Lomborg, 2001, p. 263). Similarly, Bill Mitchell of the Australian Tidal Facility claims that there is little evidence in the Pacific of sea level changing more rapidly than that which would be expected from gradual natural warming (Field, 2002).
It would be an oversimplification, however, to suggest that the climate change debate neatly divides itself into two opposing factions. Researchers and campaigners of all persuasions have taken the possibility of human-induced changes into account as well as the many physical variations that are not reducible to human activity, and this leaves room for very different weightings to be applied to the many variables involved.
Thinking through territories and flows does not offer any easy answers to, or any direct route out of, the dilemmas posed by the prospect of a human contribution to global environmental change. Yet it can offer a versatile way to approach any such issue that brings together human and non-human forces. Furthermore, with the kind of issues that present themselves in the contemporary world, the need to address human and non-human processes together seems to be more the rule than the exception.
There is evidence that natural fluctuations of climate may have induced the earliest human settlers of oceanic islands to head out into the ocean, and may have put later island territories under severe stress.
Islands are both created and destroyed by shifts and flows of the earth's crust, forces that are largely beyond human influence.
The difficulty of disentangling human impacts on global climate from natural fluctuations means that working out the human contribution to these environmental changes is a complex and contested process.
While territories may appear stable or fixed, our planet is constantly in the making, all the way down to the earth's crust and the molten rock beneath it.
Previous 4.2 Shifting ground
Next 5 Conclusion


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Shannon Boxx to Lead Walk to End Lupus Now™ in Naperville Aug 10
Chicago Red Stars Will Wear Lupus Awareness T-Shirts During Warm-Ups Saturday
Chicago, Il. – Chicago Red Stars midfielder, and Lupus Foundation of America, Illinois Chapter advocate, Shannon Boxx will be leading the Walk to End Lupus Now™ event in Chicago's Western suburbs on Saturday, August 10. The walk features 1 and 3 mile routes along the Naperville Riverwalk and begins at 9am.
The Chicago Red Stars have partnered with the Lupus Foundation of America, Illinois Chapter to raise awareness for the event. The Foundation and lupus supporters will attend the Red Stars match this Saturday, August 3, when Chicago takes on Seattle Reign FC at 6 p.m. at Village of Lisle – Benedictine University Sports Complex. All Red Stars players and select staff will wear lupus awareness t-shirts during team warm-ups that day to further bring awareness to the cause.
Boxx, a veteran of the U.S. Women's National Team and three-time Olympic gold-medalist, revealed publicly in 2012 that she was living with lupus. Since then she has become an avid spokesperson for the cause and has worked nationally to raise awareness for the mysterious disease.
Funds raised at the Walk to End Lupus Now event will benefit the Lupus Foundation of America, Illinois Chapter's mission to improve the diagnosis and treatment of lupus, support individuals and families affected by the disease, increase awareness of lupus among health professionals and the public, and find the causes and cures and the Chicago Red Stars are proud to partner in this mission.
Learn more about the walk at www.lupuswalkil.org or visit the Lupus Foundation of America, Illinios Chapter's website at www.lupusil.org.
Stay tuned to www.chicagoredstars.com for further details or follow the team on twitter @chicagoredstars and on facebook.com/chicagoredstars.


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OBITUARY: Fred Silverman, a Palisadian and a Legendary Television Executive at Three Networks
Posted on January 31, 2020 by Sue
September 13, 1937 – January 30, 2020
Riviera resident Fred Silverman, 82, died from cancer at his home on January 30. He was a legendary and influential programming executive, who worked for CBS, ABC and NBC.
Raised in Rego Park, Queens, New York, he was the only child of a Jewish father, TV and radio repairman for Sears, and a Roman Catholic mom, a housewife.
Silverman graduated from Forest Hills High School and Syracuse University, then earned his master's degree at Ohio State.
According to the Hollywood Reporter, Silverman wanted to be a director, but an advisor suggested that he "really ought to consider programming," Silverman recalled in a TV Archive interview. "It requires a real knowledge of the business, and it is kind of creative, because you're picking the shows."
His 600-page master's thesis was an analysis of ABC programming practices from 1953, when the network had few hits, until 1959, when programs like "The Untouchables" and "77 Sunset Strip" were popular. He said he tried to analyze what the factors were for the meteoric rise of the network.
Silverman's first job was editing commercials at Tribune's WGN-TV in Chicago in 1961. Two years later he moved to WPIX in New York and oversaw "Bozo's Circus," a live program. In the afternoon he aired films for kids under Family Classics.
At age 25, Silverman became the director of daytime programs for CBS, and in 1970, he was put in charge of everything on air for CBS. He convinced CBS President Bob Wood to run "All in the Family" and "The Mary Tyler Moore Show" on Saturdays. "Mash" was moved to Tuesdays and "Beverly Hillbillies," "Green Acres" and "Petticoat Junction" replaced.
During Silverman's tenure, "Maude," "The Jeffersons," "Good Times," "One Day at a Time" "The Bob Newhart Show," "Rhoda, "Kojak and "The Waltons" pushed CBS into first place.
In 1975, Silverman left to become president of ABC Entertainment and took it to number one in primetime with shows such as "Charlie's Angels," "The Love Boat," "Family," "Donny & Marie," "Three's Company," Eight Is Enough," "The Bionic Woman," "Mork and Mindy" and "Good Morning America."
Silverman is credited with reinventing the television miniseries with "Roots," which won Peabody and Emmy awards.
In 1978, Silverman went to NBC as president and CEO. Although he was responsible for hits such as "Diff'rent Strokes," "The Facts of Life," "Cheers" and "Hill Street Blues," he exited that company in 1981 because NBC finished with its worst season in history.
He formed The Fred Silverman Company to produce shows to sell to television, including "Perry Mason TV," "Matlock," Jake and the Fatman," "In the Heat of the Night," "Father Dowling Mysteries" and "Diagnosis Murder."
He received the Women in Film Lucy Award in 1995 for excellence and innovation in works that enhance the perception of women in TV. Silverman was inducted into the Academy of Television Arts & Sciences Hall of Fame in 1999.
He is survived by his wife, Catherine Ann Kihn; two children, Melissa and Billy, and daughter-in-law Anna.
A private service will be held for immediate family and a celebration of his life will follow. In lieu of flowers, the family requests contributions be made in his name to the Motion Picture & Television fund for emergency medical assistance.
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Putin Invites Erdogan, Rohani, Abbas to Opening of Largest Mosque in Europe
MOSCOW – The presidents of Iran, Hassan Rohani, and Turkey, Recep Tayyip Erdogan, with Palestinian leader Mahmoud Abbas have been invited by Russian president Vladimir Putin to attend the opening of the largest mosque in Europe on Sept. 23 in Moscow.
The Kremlin said on Friday that Putin has personally invited them to the ceremony to be held in the Russian capital, after which they are going to hold bilateral meetings.
The Council of Muftis of Russia told EFE that Putin will chair the Wednesday opening of the Grand Mosque in Moscow, which will accommodate more than 10,000 worshipers.
The mosque, which will have a space of more than 18,000 square meters and a height comparable to that of a six-story building, will open its doors on the occasion of the Islamic Feast of Sacrifice (Eid-al Adha).
The mosque was constructed on the remains of one built in 1904.
Moscow is the second city with the most Muslims in Europe after Paris, with a million and a half, between residents and migrants from the Caucasus and Central Asia.
Russia is home to about 23 million Muslims, according to the Council of Muftis, mostly in Moscow, the North Caucasus and the republics of Tatarstan and Bashkiria.
However, Putin, an avowed Orthodox Christian, has made it clear that Russia is a secular country and has stopped any attempt, for example, for Muslim girls to wear headscarves in schools.


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Vibra Continente – The official Copa America song 2019
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Adam Levine stopped working as judge of The Voice America after 16 seasons
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How does SeungRi's scandal affect other YG artists?
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After divorce, Adele announced a new album that will pursue exciting music
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The famous singer-player love in the world
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Being criticized for losing substance after 6 years of operation, how did BTS respond to their music products?
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Justin Bieber announced a break from music
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Music interests of the world's top 5 soccer stars
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The talents of the world's top stars like Marco Reus, Wayne Rooney, Lionel Messi or Cristiano Ronaldo,… all fans have been admired, but also about their personal interests outside the yard perhaps it's a secret. Let's learn about the music…
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