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This was undertaken at a large district general hospital in the south of England which had been granted NHS Foundation Trust status. It provided a full range of services in addition to being a regional centre for three specialties.
Those participating were the radiology specialty manager, the directorate manager and the consultant radiographer. Three interviews were conducted; two were conducted face-to-face but because of a difficulty of arranging a suitable time for the third, the interviewee completed the question template on-line.
Radiography Profile
There is one consultant radiographer in post who specialises in gastrointestinal imaging (GI). The consultant had been in post for two years and was appointed on Agenda for Change (AfC) band 8b which remained unchanged at the time of interviews.
The 'four tier system' Career Progression Framework began to be implemented pre-2005 and became fully implemented on the appointment of the consultant radiographer in 2008.
There are 12 advanced practitioners in post whose specialities comprise barium enemas, ultrasound, urodynamics and skeletal reporting and nuclear medicine reporting. The introduction of these posts began before 2005. The advanced practitioners are banded at AfC band 7.
There are four assistant practitioners in post but one assistant is studying to become a radiographer. Posts were introduced about 10 years ago and those currently employed are employed at AfC band 4. The assistants' fields of practice are general radiography, trauma, dentals, DEXA and screening (general not interventional). Shortly their scope of practice will be extended to include theatre radiography.
Rationale for adopting the CPF
The main rationale for adopting the CPF was as a service improvement to reduce waiting times and increase flexibility of the service.
The introduction of assistant practitioners, although meeting a service need, was also seen to be important as a way of introducing career progression for helpers. Increasing their scope of practice would be beneficial to the department by contributing to spreading the radiography workload as well as providing a financial benefit. Some years ago, before accredited training was introduced, it was felt that that as the overcouch imaging of barium enema patients was very repetitive, the 'helper' working in screening could probably be trained to carry out this activity under supervision. A risk assessment was undertaken and the helper was trained to carry out this task. This then meant that there was increased job satisfaction for the helper and patient lists could be managed with fewer staff, with those not required being deployed to areas where there was a shortage. This proved to be very successful and when a foundation degree started, the helper was one of the first to register for the programme, having already gained an NVQ level 3 in the interim.
Currently there are three assistants at AfC band 4. There have been as many as five but one retired, another took a post in another hospital and a third is undertaking a radiography degree.
Practice areas are general radiography, trauma, dentals, DEXA and screening (general, not interventional) and shortly to be in-theatre.
The case for more assistants was made by the consultant who was of the view that:
"It is the way that the staffing of departments has to go in the present financial climate. We need a lot more assistant practitioners as there is scope to use them in many more areas in the department. With appropriate training there is a role in ultrasound, mammography, theatre, nuclear medicine, CT and MRI."
Training is provided by a local university to provide an academic content but the trust trains assistants on the job to carry out particular screening procedures that run strictly to protocol; this is felt to have obvious benefits to theatre and the department.
Advanced practitioner posts were introduced to bring about service improvement by reducing waiting times and increasing flexibility of the service.
The advanced practitioner as a title has not been introduced but radiographers in particular areas with an interest in a speciality were encouraged to develop so that they could take on some of the work carried out by radiologists (eg barium enemas, skeletal reporting). Some universities offered courses that gave academic support to their clinical training. This gave the role development process credibility to sceptical radiologists and to the risk management team.
This was straightforward in ultrasound because of the many precedents elsewhere. With regard to skeletal reporting a business case had to be made.
Consultant post
The rationale for seeking to appoint the consultant posts was service need. At times there was not full radiological cover, especially for lower GI imaging and radiographers were already working at an advanced level in that field at the trust. There was a recognition that this approach to appointing a consultant radiographer had taken place elsewhere in the UK and it was seen as a logical progression to pursue in the trust. The role was included in the departmental strategic plan but the case for the role had to be put to the Directorate Management Team.
In addition to the service need there were issues of professional leadership and educational development on which it was considered important for the consultant to take the lead.
The development of the consultant post was led by the radiology speciality manager and the clinical director. The first step was to review the service need and once this had been established the strategy was to look at consultant appointments elsewhere in the UK. The precedents from other trusts provided for a process of cross-fertilisation in coming up initially with several job plans. There were a number of consultations within radiology and with consultants outside radiology in the trust. The development team emphasised that the necessity was to provide evidence to justify the post and ensure it was not viewed as simply a job that was being designed for a specific individual. Therefore the post had to reflect a role that would meet the needs of the service.
When the post was approved it was advertised both within the trust and externally. There was an external enquiry but this did not lead to an application. There was, however, an internal candidate who applied and was successful.
Role Content
The job description was put together after studying similar posts in other trusts and by taking advice from sources within and external to the hospital. It was agreed by the speciality manager, the lead radiologist and the directorate management. The core elements were agreed as primarily GI radiography/radiology with responsibility for leading on barium enemas; other elements included membership of the multidisciplinary team (MDT); CT colonography; professional lead in radiography; membership of the departmental management team and educational lead including responsibility for ensuring staff CPD needs are met.
Post appointment negotiations took place between the speciality manager and the consultant radiographer as it was recognised that the role would develop. The consultant explained that:
'These [requirements] have changed as the job has evolved. When the job description was written, the emphasis was very much on the clinical side: professional lead, education, clinical governance and audit. Now I am very involved in all of the above plus service improvement and skill mix within the department.'
Although the consultant cannot quantify the percentage of time spent on each element as they are continually in flux, four clinical sessions are routinely undertaken per week plus the reporting requirements arising from those. However if there are radiologists away who have GI lists the consultant covers those in order that the waiting times remain on target.
The initial job description reflected the clinical need but the managerial and leadership roles have developed subsequently. The consultant and managers agreed that the benefits have been greater than anticipated.
Criteria adopted for assessing and selecting applicants for the consultant post were based around qualifications and experience relative to the job description. The applicant was marked against a scoring grid matched to the job description.
The panel was the speciality manager, the lead radiologist and an external member who was a consultant radiographer.
The consultant has two lines of accountability; on a non-clinical basis to the speciality manager and clinically to the lead radiologist in the same way as other radiologists.
CPD arrangements are in place for the consultants and for advanced practitioners. This is based around a performance management programme using a dial system where performance is scored on a scale 1-10 with 5 being the optimum score, less than 5 demonstrates an underperformance and over 5 an over performance on a particular task type.
Impact and benefits
There have been a number of impacts on the clinical side including freeing-up radiologists' time from some specific types of examination, improving the use of their training time and enabling increased demands elsewhere to be met. For example, prior to the consultant radiographer appointment, the need for barium enemas was not being met to the required level. The radiographer-led barium enema service and radiographer involvement in CT colonography has had a positive impact on service capacity in these areas. The trust is very satisfied in the way the service is run. In particular, the importance of the professional lead role was emphasised which included developing the work force and undertaking a training needs analysis for radiographic staff.
The anticipated benefits of the appointment have been realised but the overall effect is one which is different to what was expected in that there have been advances in areas other than those planned. These have been improvements in clinical governance within radiology which is now much better organised; improvements to staff development and training and improvements in planning and recording. Clinically, there has been an impact on service capacity since introduction of the consultant post.
It was difficult to determine whether there had been any direct impact on proportion of patients meeting 18 weeks targets pre-and post-implementation of the consultant post as there have been so many modernising projects. But it was clear that if the consultant radiographer had not been appointed the department would have to have done things differently. However, the patient waiting-list length pre- and post-implementation has reduced. The trust meets its 6 week target for imaging and 2 weeks for cancer. Overall, there was a strong view that the key benefits are around patient care and timely radiology. Lists are no longer cancelled because of holidays or sickness and, if required, the capacity is increased by extending lists or running extra lists.
As radiologists are normally involved in a range of modalities, they are therefore not always readily available. Because of this, the consultant radiographer is now the named person for contact by referrers on aspects of GI imaging and plays a key role within the multi-disciplinary team.
"I have a part to play within the multidisciplinary team and as such can communicate findings straight to referrers and also arrange any examinations that they may require at short notice. We also discuss service provision, patient information etc."
Likewise in the case of advanced practitioners, their involvement in ultrasound, urodynamics and with referrers and multi-disciplinary teams has produced similar benefits.
For assistant practitioners, their benefit is exemplified by operating the DEXA service under the responsibility of a band 6 radiographer. The manager recommended that the SCoR extend the scope of practice of assistant practitioners.
In summing up the benefits of the consultant post, the speciality manager stated:
"There have been clinical benefits, certainly, but with the development of the managerial and leadership roles, the benefits have been better than planned."
The consultant radiographer identified the benefits as:
"Service improvement and programme leadership. A flexible, patient centred GI service. A robust Clinical Governance Agenda. High level of student support. The introduction of induction and preceptorship programmes together with work experience book and engaging with schools to organise visits as part of their science programme. I do not think that we envisaged that the role would evolve in the way that it has and for that reason the benefits are different. We had thought that they would be mainly to the clinical side of things but the other parts of my role have made a bigger impact on the department".
Monitoring the service
Activity is measured on a monthly basis and waiting times on a weekly basis for both financial and service planning reasons. In 2006 there were 125,304 examinations and in 2008 it was 147,866. For fluoroscopy following the appointment of the consultant radiographer in the first year there was a 24.8% increase in activity; in the second year it was a 7.8% increase but activity is continuing at this higher level.
Figures are reported internally to the directorate management. They are used to measure performance, comparison with previous returns and are used for strategic planning. Year on year comparisons are made and are noted at Board level. This does impact on departmental income as money is transferred into the budget based on activity.
The figures are also reported externally to the primary care trust and they are compared against national tariffs in relation to funding.
With regard to complaints, the department would investigate any against the consultant if any had been made but to date there have not been any. Where complaints are made against the department the consultant radiographer investigates these. There has been no change in the number of complaints overall since the year in which the consultant the post was introduced.
Consultant costs
Overall, the cost to introduce the consultant post has been salary (Band 8b) plus development and training. There was no additional funding to resource the post; the start-up costs had to be found from within the department's budget. Now the post is established it sits within the department's budget on a recurrent basis. There is no data that directly demonstrates the cost-benefits or could be used to calculate cost savings except the self- evident difference in salary between a consultant radiographer and consultant radiologist. These were produced when 'selling' the concept to the directorate management and featured as part of the ongoing discussions.
There are no robust succession plans in place should the consultant move on. However, the future of barium enemas are under discussion but the consultant radiographer also performs CT colonography and the role would develop to meet new requirements.
If the consultant did leave, following the initial panic, the trust would seek to reappoint as the post is valued but a new person would have to have the same clinical skills and be at the appropriate level.
The department is now discussing a consultant radiographer post in nuclear medicine and has identified potential for introducing radiographer consultants in ultrasound and breast imaging.
The trust fully endorses the CPF but the development and implementation process has to be rigorous; there are a lot of key people to persuade in radiology as well as the wider trust.
This was undertaken at a large trust in the north of England.
The hospital was a large trust formed from the merger of three hospitals in the north of England. Imaging services are provided across the three sites.
Interviews were undertaken with four individuals: the director of clinical services (a radiologist), two consultant radiographers (one of whom had been involved in writing the original proposal to introduce consultant posts and the other having come through the trainee consultant route) and a radiologist.
The CPF had been in place for around three years by the time at which the interviews were conducted, in late 2009.
There are two consultant radiographers and two trainee consultants at the hospital, along with an extensive cohort of advanced practice radiographers and sonographers. If the scope for and justification (through a business case) for a consultant post is established, a post will be developed and the trainee is eligible to apply, but the posts must be nationally advertised as per Department of Health guidance. Consultant radiographers are employed on AfC band 8b and the trainees are on 8a.
A considerable number of advanced practitioners were in post: two in breast imaging, 20 in ultrasound, two in CT reporting, 9 in film reporting, one GI practitioner, and four in barium studies. Advanced practice radiographers are employed on AfC band 7.
In addition, six assistant practitioners were employed.
There had been a radiographer clinical specialist role within the hospital since 2002 and this was seen as a precursor to the consultant role: the roles were 50 per cent clinical and 50 per cent non-clinical and had been introduced with the aim of developing advanced practice. This had led into discussions about advanced/consultant practice and the possibility of a radiography role in leading on service development rather than simply leading advanced practice within a focused area.
One key driver had been discussions around the emergency care and critical care agendas which were at the forefront of NHS policy at that time; a further factor was the need to meet the four hour target in Emergency Departments/A&Ea. Considerations regarding service cover and service development also played a part.
There was some existing history of extended practice: radiographers had been reporting on plain films in the hospital for over 12 years. However, this had been a somewhat ad hoc arrangement, with some appropriately qualified radiographers not reporting at all. Introduction of the consultant post to lead on service development was therefore seen as an opportunity to extend and formalise the role extension that already existed.
Given that much of the role was envisaged as focusing on leading and changing practice, a significant additional factor in the decision to take forward the proposal for consultant radiographers was the fact that the managers also felt that they had in post an individual who not only had the required talent, drive and ability to do the job but also – and more importantly at the planning stage - to lead on gaining approval for the consultant posts.
Two consultant posts were originally planned: one in the ED and one in GI. Planning for the GI post was largely prompted by screening requirements aligned with the cancer service agenda and largely focused on addressing key clinical service needs for which there was not necessarily any radiologist leadership. Rather than the focus for the changes being on issues that needed to be tackled and which radiologists were not or could not tackle, it was about changing how the imaging services department looked at things in total and in particular worked across disciplines.
Regarding introduction of the advanced practice radiographers, while the intention was for these individuals to take on some of the radiologists' role this was seen as potentially filling a gap in service provision and releasing some of the radiologists' time for other activities rather than being about cutting costs.
Therefore, there had been a combination of factors. "It wasn't just a cynical move to plug holes, [and] it wasn't singularly because we thought it was a good idea; it was multi factorial".
One comment is worth noting. The clinical service director stated:
"My view is that for the extreme role extension [ie to consultant level] in radiography you need to have suitable people in post before you plan it. And there are not huge [numbers] of people out there. I think that's one of the constraining factors [and] the most interesting bit."
There are six assistant practitioners in general radiography and one assistant in a partner managed MRI service, with that development being supported by the trust. The trust had recently recruited one person to start as a trainee assistant practitioner for mammography but the individual had then decided against continuing in this post, so there was no assistant in mammography at the moment but it is planned to appoint an assistant practitioner in this area at some point in the future.
The trust first developed just one assistant practitioner; this individual was already a very experienced clinical support worker. A second assistant practitioner was appointed two years later. A further four had been trained in the last year in plain film radiography. The trainee assistant practitioners undertake the first year of the radiography degree to qualify for the role.
These last four posts had been planned with a view to providing the additional staff that would be required when the department moved into new premises in the near future. A key factor influencing this decision had been the fact that the SHA still provides backfill funding, which enabled the department to recruit two trainee assistant practitioners internally and two externally. The trust was looking at introducing assistant practitioners in a number of other areas, mainly in radiographic practice, with some discussion regarding the possibility of their introduction into CT, too.
The assistant practitioners work the same extended days as other staff and the same rotations too. They work as part of the team, under direct supervision, but as integrated, flexible, members of the team. Their work is varied, although for the majority of their time they may take x-rays under supervision; at other times of the day they will work as a support worker.
The general radiography posts had been developed and reconfigured by the consultant to make best use of their time. Radiographers in plain film were now being used as reporters the majority of the time; previously these radiographers had only been plain film reporting for one or two sessions a week and yet often had been employed in a band 7 post. Following the role reconfiguration 60 per cent of their time is dedicated to advanced practice, clinically, and the remainder of their time is clinical, so that now they are involved in work that is appropriate to their banding all the time. The change had also meant that radiographers were now providing services 12 hours a day and at weekends on one site and 9-5 at the other two sites and at the same time radiographers had taken on a large proportion of the radiologists' reporting workload.
The advanced practitioners are clinically accountable to the Consultant but are line managed by the radiography manager. All advanced practitioners are expected to hold a postgraduate certificate and be working towards a master's degree. All of the sonographers are advanced practitioners.
One of the consultants (one of the case study interviewees) had been employed within the trust prior to introduction of the consultant posts. They had been tasked with writing the proposal for the introduction of the consultant posts and then subsequently had been appointed (following an open recruitment process) as a consultant, at band 8b, in 2004. The second consultant had been appointed initially to a trainee post at band 8a and then, once qualified and following advertising and open competition for the post, was appointed consultant at band 8b in 2006. It should be noted that the original proposal had proposed two posts, with one being in GI imaging. However, a failure to recruit had meant that this post was effectively frozen and the second consultant post had arisen from a subsequent proposal for service support in breast imagingb.
There were several reasons for seeking to appoint the consultant posts. One was service need. On occasions there was not full radiological cover, especially for lower GI imaging. There was also an acute shortage of suitable consultant radiologists making recruitment challenging and the desire of incoming radiology consultants to focus on their chosen area of subject specialisation meant that a lot of bread and butter radiology work was not being done; as the consultant radiologist stated:
"There was no space in people's work plans, so things like plain film reporting, ultrasound, etc. were being left by the wayside, and there was a need to get it reported and sorted".
At the same time, several radiographers were already working at an advanced level in the trust when discussions first took place. There was a recognition that the appointment of consultant radiographers to improve imaging services had already taken place elsewhere in the UK and it was seen as a logical progression to pursue within the trust. In addition to addressing the service delivery needs, appointment of a consultant was also expected to provide professional and educational development and leadership.
The development of the consultant post was led by the radiology speciality manager and the clinical director. The first step was to review the service need and once this had been established the strategy was to look at consultant appointments elsewhere in the UK. The precedents from other trusts provided for a process of cross fertilisation in coming up initially with several job plans. There were a number of consultations within radiology and with consultants outside radiology in the trust. The development team emphasised the necessity of providing evidence to justify the post and not a job that was being designed for a specific individual. Therefore the post had to reflect a role that would meet the needs of the service.
The job description had been written to fit the framework that would get approval. However, the head of service had had a significant say in making sure that the balance was right. The basic structure for the consultant post was around six-tenths clinical, three tenths development support of others and leadership and one tenth research. However, the ED role had changed since the consultant had been appointed and it was now felt to be closer to a quarter research, a quarter service leadership and development and slightly less clinical. It was felt that over time the role would become less clinical as that individual moved into more of a leadership role alongside the Clinical Director and the radiography manager.
There are indications that, in the case of the two successful appointments, the role had been developed with the strengths of the eventual appointee in mind. The priorities within the two posts allowed the consultants to play to their strengths.
Regarding the consultant post based in ED, while the post is employed through imaging services, the role sits within ED; this post is therefore involved in implementing change more widely within the trust, rather than being constrained to implementing change within imaging services. The consultant had looked at how imaging services integrated with other areas and at how pathways could be changed and new pathways introduced, in collaboration with the management team.
The consultant post in the breast imaging service was also largely focussed on service development. While the role was being defined, the eventual appointee was seen as the person most likely to be appointed to the post. Although this individual has a clinical role, they also enjoy implementing systems and have a strong network of contacts externally. The role now requires this individual to collaborate with outside services across directorates.
Research has been a central part of the role. For example, in the breast imaging service, the referral pathway for mammographic surveillance had been changed based on a study undertaken by the consultant (while in the trainee consultant post) which culminated in the recognition that patients should be stratified according to risk and their surveillance regime determined from that.
There is also evidence of changes to patient pathways. In the ED, direct access for trauma patients through GPs and through the walk-in centre had been introduced. The big issue had not been access to imaging but access to report. Now, radiographers not only report but can also give the patient advice and instruction regarding their injury, which normally the GPs would do. The immediate availability of reporting means that patients can now also be referred directly into the appointments system, whereas before they would have had to wait for a referral from their GP. This means that patients are managed better and it has increased capacity in the ED.
The key issues for the posts were seen as being able to work autonomously and confidently and being able to drive their own agenda, to drive change and challenge practice both within the department and across boundaries.
The criteria used for assessing and selecting applicants for the two consultant posts were based around qualifications and experience related to the job description. However, the two trainee consultant posts had not been advertised externally; they had been given to people who were viewed as particularly appropriate because of their previous experience, as the consultant radiologist indicated:
"The trainee posts are only secondments at the end of the day. If they don't prove that they've got potential for a consultant post in their area then they'll go back to their old job."
The trainee consultants are required to go through a Masters' programme and to prove during the secondment that they have the potential to take on a consultant post in their area: if they do not, then they return to their old job. Where the business case for the post is justified, the post is advertised nationally and the trainee will be eligible to apply for the post at that point.
A number of clinical and capacity benefits were identified:
At various points in time, the trust had found themselves with gaps in the service; this was attributed largely to the rapid development of complex imaging, with, as a result, the more basic and routine imaging being left behind. There had also been problems with reporting in ED, with radiologists sometimes not reporting for up to 14 or 15 days after the patient attended. The developments in radiography had meant that they now had a 12 hour radiographer-led hot reporting service for the ED which was likely to be extended to a twelve hours seven days a week service in the near future. Recently this had been extended to include radiographer discharge of patients from ED under protocol and these innovations around discharge have freed up clinical time.
Across the imaging service, the consultant and advanced practitioner posts were seen as having plugged gaps, supported service delivery and innovation and/or freed up radiologists' time. Introduction of these grades had also allowed for double reporting of barium enemas and, in the breast scanning service, introduction of the consultant post has allowed the double reporting of mammograms. The interviewees believed this would not have been feasible before the introduction of the advanced practice posts. Although the actual throughput of patients remained the same the trust had been able to bring the added benefit to the patient of double reporting, which is the 'gold standard' for mammography.
Having the consultant radiographer permanently based in the department meant that the timings for stereotactic core biopsies could be more flexible, which in turn meant that they have been able to reduce the waiting times for patients for that procedure. The consultant radiographer had been responsible for stereotactic core biopsies since 2004 (when they were an advanced practice radiographer prior to being appointed to the consultant post); previously it had only been radiologists who undertook this job and they did just one session per week. The trust did not hold records on this, but the interviewee believed that previously they were doing "probably two stereo cores a week". Now they could accommodate eight a week.
"It's been a godsend. It has freed up consultant radiologist time to do more intricate cross sectional imaging. In my world of breast work it's made up for the fact that we haven't been able to recruit to posts. It's provided additional hands in one-stop clinics and in the second reporting of films. And certainly for A&E and for the outpatient, hospital based stuff, that's been expanded; it's definitely taken a huge load off the consultant radiologists to allow them to develop additional services."
The radiologist confirmed this point, saying that they felt that there had been improvements across the board: introduction of the consultant posts had enabled the trust to adhere to the RCR guidance that everything should be reported and to meet the radiology 6-week (and soon to be two-week) targets for the breast service.
The breast service had one consultant radiographer and one and a half whole time equivalent advanced practitioners in place and this had allowed the service to increase the numbers seen in clinic. The radiologist in charge of the service was unable to provide figures relating to the increase but commented:
"We lost one consultant radiologist, were unable to secure a locum and could not re-recruit. We had [these advanced personnel] in place and training up when the crunch came. We had this 'before' scenario, and then we put them in place, and immediately after, we had a service that was ticking along and it would have fallen apart had they not been there, so it's not really that easy to quantify [but] the clinic numbers and smooth running of clinics have been down to having these multi-skilled people, including the consultant and advanced practitioner, able to work with a minimum of supervision."
One of the biggest impacts of introduction of the consultant role has been the introduction of hard evidence-based practice and change in systems. The change to the referral pathway for mammographic surveillance was reported in an earlier section. There had also been changes made to the referral pathway because previous research had revealed extensive slippage in patients and that some were not getting mammograms until nearly nine months after they should have. In the breast service, then, there is evidence that the consultant has been able to put research into practice, "to implement it, put the systems in place so we can improve the patient pathways".
When the department moves to new premises it will be possible to have two simultaneous symptomatic one-stop clinic lists running. The proposal on the table at the time of the interview was for the consultant radiologist and the consultant radiographer each to have their own list within that clinic. This would increase the patient throughput significantly. With their present arrangements they have only 16 patients per clinic. With the new arrangements they will increase to 24 patients per clinic, with five clinics per week. In addition, the consultant radiographer was able to undertake interventional guided ultrasound; previously it was only the radiologists that could do this procedure. Although the service was not yet at a point where they could really increase the patient numbers (because they were constrained by the existing site and were waiting to move to the new premises), those patients who were seen in the clinic at present did not have to wait so long to be seen because of the additional personnel available.
More widely there were felt to have been benefits for referrers with a more responsive service and better access. There were also thought to be benefits arising from the improved relationship with a number of areas, primarily the emergency department, GI practice, ultrasound, breast and neurological (because of the CT reporting). In ED, as was reported earlier, the consultant radiographer had worked with colleagues to change and improve patient pathways. A large part of these improvements had arisen from their being able to offer immediate reporting – delays in reporting had been a particular weakness previously.
Introduction of the advanced and assistant practitioners in imaging services meant that virtually all patients were now being imaged within two weeks. On a typical day the department conducts a thousand examinations with around half being radiographic and the other half requiring more complex imaging. Looking at the extent of change by modality, radiology is the area in which radiographers have had the biggest single impact by their contribution to reporting. Virtually all images were being reported within five days.
While there had been improvements to capacity arising from introduction of the ED consultant post, the increase in capacity did not relate to the imaging service more generally but to ED itself and, indirectly, with other hospital departments (eg through the new referral processes). Introduction of the consultant had helped the service meet the four hour target. In terms of actual throughput of patients, there was negligible impact because by nature of its role an ED department sees everybody presenting on a day. However, in a report published in 2004c on the impact of this site's introduction of the ED consultant post, it was reported that journey times through the ED had been cut (although no data/figures were provided) while ED recalls because of misinterpretation had decreased by approximately 50 per cent.
A complication in demonstrating the cost benefits of introduction of such roles is that they do not occur in a vacuum; neither does the department remain unchanged around the new posts. One of the consultant radiographers stated:
''It's very difficult [trying to] tie it down to [the impact of] one person because it's more that it's been a gradual change, although some have been quicker than others. It's very difficult to pin down specific cost-benefits. I've looked to see if historically we can and it's very difficult to say 'we saved that money'….[and there is] research income both in terms of through backfill or additional money. The secondments of the two trainee consultants are being funded out of backfill research money, which in turn is funded by a backfill component of a DH research grant that funds my time. And the best way for them to backfill me is for other people to take on some of the strategic things that I do.''
The research is conducted through patient recruitment to trials, so that brings in direct organisational income and although this does not necessarily come in to radiology it is one of the areas where the money can be positively identified. Some of the cost savings may arise through release of workforce (primarily the more expensive radiologists). But this can be difficult to estimate in the ED. Looking at reporting, cost-benefits may centre on the fact that the trust is are gaining more complex work from radiographers than they had been previously, so that is more about value for money than savings per se.
The trust had not attempted to calculate the savings made, or other cost-benefits (e.g as in value for money) arising from the changes made.
The department had developed a report tracker and that allows the managers to see activity levels for all the modalities of reporting. They monitored and had graphs giving historical data on total activity, but had now moved to this system which allowed active management of each individual modality. In general their level of activity had grown by 5 - 8 per cent each year for the last 8 – 10 years, with faster growth in areas such as MR and CT but this was not entirely attributable to the introduction of the new posts. Performance data are reported to the SHA and at national level and the Service Board receives a report internally. Figures are recorded internally for the number of complaints, but these are not recorded against individual members of staff.
A record of the number of reports that are made is compiled every month, categorised by reporter and an annual report is produced. While it would be possible to calculate an overall departmental report rate before and after the introduction of these posts, this had not been done.
Overall, the main costs in introducing the consultant posts had been their salary plus the cost of training (for those who had come through the trainee consultant route). Very little cost was involved. This was partly because they had vacancies at the time. For the ED consultant, the only cost was advertising and selection, plus the cost of the upgrade of the appointee's post to 8b. If the selection process had resulted in an external recruitment, then the trust would have used money saved from existing vacancies. The trust will not allow departments to advertise a job unless they have the money available to recruit to it. Funding for the first consultant posts came from money that had originally been intended for radiologists. In addition, they had not directly replaced the post of the radiographer that was upgraded to consultant. The same situation pertained when they appointed the consultant radiographer for the breast service. However, interviewees – including one of the radiologists - were keen to emphasise that the developments had not been planned and had not been intended as a way of getting 'a radiologist on the cheap':
"They [consultant radiographers] can hold their own with any consultant radiologist quite happily and should be allowed to. They are not a replacement or a threat but a…just another colleague. I wouldn't want trust finance people to see it as a radiologist on the cheap."
Part of the training process requires the trainee consultant to justify their employment by demonstrating cost-efficiencies. The interviewee who had been through the consultant training process had identified new funding streams as part of the training and had looked at the current systems and how these could be made more efficient. In addition, by enabling double reporting, introduction of the consultant radiographers has reduced the chance of litigation; this may feed through into cost savings.
The trust does not have a succession plan as such but is trying to develop more of these specialist roles and to grow the service. Another person in a similar role to the clinical specialist had now become a trainee consultant. Regarding succession planning in ultrasound and breast imaging they had a clinical specialist team that works alongside the consultant, so in terms of succession planning they would expect someone from that cohort of people to be appropriate for development.
By the time that the current two trainee consultants finish their training, the department aims to be considering their next steps: whether to look at recruiting two more trainees in other areas, that's for discussion. Although they recognised that finances were likely to be challenging in the future, they did not anticipate remaining with just five consultants in post. Increasing the number of consultant radiographers was part of their substantive workforce plan at the time of the interview.
Whilst costs were not seen as a real constraint on developing the consultant radiographer posts, one limitation however is finding the time to provide the training and mentoring needed. With limited numbers and limited staff, it is difficult for the radiologists to spare the time to train up consultant radiographers because of the lack of available time in the working day. This could constitute a barrier to the introduction of further posts.
a. A four-hour target in emergency departments was introduced by the Department of Health for National Health Service acute hospitals in England that required trusts to ensure that, by 2004, at least 98% of patients attending an A&E department must be seen, treated, admitted or discharged in under four hours.
b. Trainee consultants for GI and fluoroscopy were subsequently appointed following the original case study interviews.
c. NHS Modernisation Agency (2004) Radiology: Supporting the Delivery of Emergency Care
References Appendix 2 - Discussion Guides


text:
US Air Force Grants Exemption for Norse Heathen Beard
The Air Force Times reports on Air Force SSgt Garrett Sopchak, who just became the first US Air Force Airman to be allowed to wear a beard — because he adheres to Norse Heathen religious beliefs.
The Army granted a similar waiver last year, and beard exemptions have been granted for a growing number of Sikhs and Muslims — though not atheists.
Sopchak, a 28-year-old aerospace ground equipment craftsman at Hill Air Force Base in Utah, on July 8 become the first airman to get approval to wear a beard in accordance with his Heathen faith.
Sopchak said in a Tuesday interview that in the old sagas, a beard was a sign someone was a respected member of the community who could be trusted to help others. Central figures in Norse mythology such as Odin and Thor are commonly depicted as wearing beards.
With that as the justification, how long will it be before the first Christian asks for an exemption, given that "central figures" in Christianity are "commonly depicted" having beards…?
Incidentally, has anyone noticed that all these military religious freedom issues are being resolved without anyone calling Michael "Mikey" Weinstein? Seems he's not as important as he might think.
tagged with atheism, beard, christian, garrett sopchak, heathen, hill afb, Islam, mikey weinstein, Military, military religious freedom foundation, MRFF, norse, odin, Religion, religious freedom, Sikh, thor

redpajama_set_name: RedPajamaCommonCrawl


The content is placed at a fixed address that does not change after linking.
The content does not depend on any fixed address and might be moved after linking without any extra processing.
The content depends on fixed addresses, relocation information is output to enable the content to be moved to another location by another tool.
You cannot explicitly use this attribute for an execution region.
The content is placed at a fixed address that does not change after linking. The content might overlap with other regions designated as OVERLAY regions.
A load region can be explicitly set with the ABSOLUTE, PI, RELOC, or OVERLAY attributes.
An execution region can be explicitly set with the ABSOLUTE, PI, or OVERLAY attributes. An execution region can only inherit the RELOC attribute from the parent load region.
The OVERLAY attribute cannot be inherited. A region with the OVERLAY attribute cannot inherit.
A base address load or execution region always defaults to ABSOLUTE.
A +offset load region inherits the address attribute from the previous load region or ABSOLUTE if no previous load region exists.
A +offset execution region inherits the address attribute from the previous execution region or parent load region if no previous execution region exists.
Placement of sections with overlays.


Goals: People with Progressive Supranuclear Palsy and related disorders like Multiple System Atrophy and Corticobasal Syndrome may have trouble accessing the healthcare that they need, which may affect their quality of life and that of their caregivers. This may be due to many reasons. To ensure our patients receive all the care they need to stay healthy, we are interested in understanding how and why people with Progressive Supranuclear Palsy and related disorders use various health services.
Benefits: Your involvement will provide no direct benefit to you, but will contribute to scientific knowledge about Progressive Supranuclear Palsy and related disorders. Your participation will help us identify the unmet needs of people with these disorders, and potentially shape future research into treatments.
Participants: People with Progressive supranuclear palsy and related disorders who are 40 years of age or older, speak and read English fluently, live in the United States, have the capacity to use and navigate an online portal to complete a survey, and can provide informed consent.
Details: Subjects will participate in an online survey, which will include questions about their medical history, healthcare use, unmet needs, quality of life, and caregiver strain. Subjects will be contacted 12 months following the initial survey to complete a follow-up survey.


A Winnipeg tech company is the first to access the federal government's much-debated and controversial worker training program.
Winnipeg-based information technology service provider Oxygen Technical Services Limited is the first recipient of the Canada Job Grant, which helps Canadians obtain job training by providing up to $15,000 per person for related costs. When fully implemented, a total of $300 million will be invested in the effort on a national basis.
Oxygen, which has 20 employees, provides clients including Cisco Systems and Dell with procurement, project management and managed services. Funds from the Canada Job Grant will now allow the company to invest more than $56,000 to support skills training and certification for 15 current employees. Those funds include more than $18,000 from Oxygen's own coffers.
The firm was selected as the grant's first recipient for several reasons: the training will lead to certification, which in turn supports job creation; the training is linked to company growth; and Oxygen is a small business in a vital economic sector. Oxygen was an early applicant for the Canada Job Grant and met basic selection criteria by providing eligible training costs, employer contributions, a third-party trainer and an available job at the end of training.
Deal reached on Canada job grant?


Screening of Upwardly Mobile at the African Americans in WNC Conference.
Filmmaking in general, and documentary filmmaking in particular, is a multi-layered process. While most people are familiar with the activities surrounding the release and promotion of a finished film, few are aware of the tremendous amount of effort that comes in the years leading up to that time. In our case, the process of filming is only one of three key areas of activity related to making Beneath The Veneer. strong>Two other critical functions involve raising money and building an audience. We can achieve this by screening Upwardly Mobile.
Earlier this month, we kicked off the first in what will be a series of events, locally and nationwide, to address both of those critical areas. Using the short film Upwardly Mobile, which we produced last fall, we've been hosting public and private screenings with various communities to introduce the people, places and issues to be featured in Beneath The Veneer. This has allowed us to engage others in conversations about opportunity, success and inequity as it relates to youth growing up in historically marginalized and disenfranchised communities.
While some of these events will allow us to appeal for financial and volunteer support of the film, all of them will raise awareness of the numerous ways that youth are impacted by systemic inequity. Since Upwardly Mobile shows not only the conditions that are faced by youth in historically marginalized and disenfranchised communities, but also the ways in which dedicated members of those communities are working to address those conditions, the film serves as a powerful tool for audience engagement.
So far, we've had overwhelmingly positive feedback from these events. Whether the audience has consisted of wealthy, white, privileged allies or people of color working to better their lives and communities, we continue to be encouraged and inspired by the ways that Upwardly Mobile challenges viewers to see the world around them in new ways. This work has allowed us to meet new friends, supporters and collaborators, and has greatly informed us as we progress with the filming of Beneath The Veneer.
We look forward to future events like this and encourage you to check back often for news of upcoming screenings, or to contact us if you're interested in bringing Upwardly Mobile to your community.
Welcome Aboard! You are now on the film mailing list.


text:
 package org.castafiore.ui.engine.context;

import java.io.Serializable;

import javax.servlet.http.HttpServletRequest;

/**
 * This interface acts as a Filter to be used exclusively in Castafiore framework.
 *
 * It is configured inside a spring application context.
 *
 * The order in which Filters are executed are not granteed. But depends on how the spring application context serves the implementations of this interface
 * @author kureem
 *
 */
public interface CastafioreFilter extends Serializable{

	/**
	 * executed upon begining of request before application is loaded
	 * @param request
	 * @throws Exception
	 */
	public  void doStart(HttpServletRequest request)throws Exception;

	/**
	 * executed at the end of the request. After event is executed
	 * @param request
	 * @throws Exception
	 */
	public void doEnd(HttpServletRequest request)throws Exception;

	/**
	 * executed whenever any exception is caught
	 * @param request
	 * @param e
	 */
	public void onException(HttpServletRequest request, Exception e);

}

redpajama_set_name: RedPajamaGithub


We're glad you've chosen the Village of Brown Deer as your home. Our Village offers a cozy, friendly community with hometown values while also offering the accessibility to the urban-chic Milwaukee atmosphere. Brown Deer has a population of around 12,000, a nationally recognized library, and a community where everyone knows your name. The website was intended to provide some information about the village and to help you become more acclimated to our community and what it has to offer. Check out our website at www.browndeerwi.org. For more information, give us a call at (414) 371-3000.
Thanks Again and Welcome to Brown Deer!


text:
Jordan doubts gender of Iranian women's football player
by DAILY SABAH WITH AGENCIES
ISTANBUL Nov 15, 2021 - 10:08 am GMT+3
Iranian women's national team players participate in a training session, in Tehran, Iran, July 12, 2021. (GETTY IMAGES)
by DAILY SABAH WITH AGENCIES Nov 15, 2021 10:08 am
Lethal Valencia fires haul past Kasımpaşa in Fenerbahçe's 5-1 rout
SÜPER-LİG
For Iran's coach, it is a matter of "inability to accept defeat," but the Jordan Football Federation is insistent that one player in Iran's women's national football team may not be female at all. The Federation formally submitted a complaint to the Asian Football Confederation (AFC) to "verify" the gender of a player from a rival team who played in a Sept. 25 Women's Asia Cup qualifier.
Ali Bin al-Hussein, the president of the Jordan Football Association (JFA), shared the letter Sunday on Twitter. "Considering the evidence submitted by JFA and given the importance of this competition, we request the AFC to initiate a transparent and clear investigation by a panel of independent medical experts to investigate the eligibility of the player in question and others on the team, particularly (given) that the Iranian Women's Football Team has a history with gender and doping issues," the letter said.
After the match ended with a 0-0 score, Iran defeated Jordan 4-2 in a penalty shootout in the Group G clash held in Tajikistan to earn a spot in the 2022 AFC Women's Asia Cup.
The player's identity questioned by Jordan is not disclosed, but Iran quickly responded to allegations. Iranian team's coach Maryam Irandoost was quoted by media outlets that Jordan's complaint to AFC was "an excuse not to accept the defeat." She was quoted as saying that each member of the team was carefully examined by medical staff in hormone and testosterone tests.
Last Update: Nov 15, 2021 12:37 pm
iran jordan womens football gender
From viruses to whales: Scientists study climate change at 'end of the world'


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I have created this profile for my daughter. She has done her master's degree and is searching for a suitable job. We come from an upper middle class, nuclear family with moderate values, currently settled in Agra.
My daughter has a Master's degree and she is employed in private Sector as a supervisor currently based in Agra. We belong to a middle class, nuclear family with moderate values.
She's is M.A in Hindi.She's private teacher.she have join family.She's hobby like singing ,dacing.
My name is Priya K. I have completed my M.A.. I grew up in a Upper Middle Class, Joint family with Moderate.
My name is Neha and I am working as a Doctor in the Private sector. I have completed my Other Bachelor Degree in Arts / Science / Commerce. I grew up in a Rich / Affluent class, Joint family with Moderate values.
My daughter has a Bachelor's degree and she is employed in Private Sector as an Executive currently based in Agra. We come from a Middle class, Nuclear family background with Liberal values.
I have completed my Bachelor's degree. I am currently not working and I live in Agra. I come from a middle class, nuclear family background with traditional values.
My son name is GAURAV KAPOOR, working as a Software Professional in the Private sector. He has completed B.Tech from Bangalore and working in a multi national company there.. He grew up in a Middle Class class, Nuclear family with Moderate values.
I have a Bachelor's degree and I am currently stationed in Agra working in Defence sector (army). I belong to an upper middle class, nuclear family with moderate values.
My name is VIVEK TANDON. I come from a Middle Class, Nuclear Family with Traditional Values. I have completed my MBA and currently work in the Private Sector as a Banking Service Professional.
My name is Manoj khatri and I am working as a Executive in the Private sector. I have completed my B.Tech.. I grew up in a Middle Class class, Nuclear family with Moderate values.
I have a Bachelor's degree and I am employed in psu company of delhi as an private employee (Assistant Engineer) currently based in Agra circle ( u.p. west). I belong to a upper middle class, joint family with liberal values.
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My name is Rahul Taneja and I am working as a Engineer - Non IT in the Private sector. I have completed my B.Tech.. I grew up in a Upper Middle Class class, Nuclear family with Moderate values.


text:
Rappler Team Wins 2 Awards For Drug War Story
CMFR
Screenshot from Rappler.com
ONLINE NEWS site Rappler's investigative team won the Society of Publishers in Asia's (SOPA) Excellence in Human Rights Reporting Award and Excellence in Investigative Reporting Award for a 2018 series on the Duterte administration's so-called drug war.
On May 29, SOPA announced that Rappler's seven-part investigative story, "Murder in Manila," won two awards: the Group B Excellence in Human Rights Reporting Award, and the Group B Excellence in Investigative Reporting Award.
In a November 2018 monitor, CMFR cheered the series for finding "strong indications" of police-vigilante link, while much of the media had reduced the Duterte "drug war" narrative to mere crime reports. As CMFR noted in its study on media's coverage of the drug war, "it is not too late to update coverage of the continuing war on drugs and to raise questions about what it has gained and what has been lost."
The story was written and investigated by Patricia Evangelista, photographed by Magnum fellow Carlo Gabuco, with reports by justice beat reporter Lian Buan and police reporter Rambo Talabong, with design by Dominic Go. Rappler's investigative team, Newsbreak, is headed by editor and Rappler founder Chay Hofilena.
The series was published daily for a week beginning October 4, 2018, with the story "Some People Need Killing." It investigates the local chapter of a vigilante gang in Tondo, Manila, whose members had been arrested for murdering drug suspects and small-time criminals, including a 16-year old boy.
A judge in the Investigative Reporting category described the Rappler piece as "brave, tenacious and granular investigative reporting into how Philippines President Duterte's war on drugs was carried out, through the eyes of those who pulled the trigger on addicts, while getting backroom bribes from dealers."
"This is the kind of reporting that reminds a reader why the free press is vital to a democracy," the judge said.
ABS-CBN News Digital's Stories From Under The Rubble: Inside The Battle Of Marawi and GMA News Online's Tiempo Muerto | Hope Springs in the Season of Death received honorable mentions in the Excellence in Journalistic Innovation and Excellence in Feature Writing categories, respectively.
See the links below for Rappler's series.
Part 1 | 'Some people need killing'
Part 2 | 'The cops were showing off'
Part 3 | 'Get it from the chief'
Part 4 | 'What did the CSG do wrong?'
Part 5 | 'I finish the job'
Part 6 | 'There are snakes everywhere'
Part 7 | 'It's war'


text:
Most of the stars that populate the galaxy are in the prime of life. It's a phase that can last anywhere from a few million years to a trillion years or longer.
In astronomical jargon, that phase of life is known as the main sequence. And a prime example of a star that's on the main sequence is Altair, the leading light of Aquila, the eagle. The star is high in the southeast at nightfall, at one corner of the bright Summer Triangle.
The main sequence is named for a relationship between a star's brightness and its surface temperature or color. More than a century ago, two astronomers noticed that if you plotted those two characteristics on a graph, most stars lie along a narrow line — the main sequence. And it's all because of what's going on inside those stars.
Altair is bigger and brighter than the Sun, for example, and its surface is thousands of degrees hotter. Yet both are on the main sequence because they're both "fusing" the hydrogen fuel in their cores to make helium. That keeps both of them shining steadily.
A star's time on the main sequence depends on its mass. The Sun, for example, will spend about 10 billion years in that phase. But Altair is almost twice the Sun's mass, so it "burns" through the hydrogen much more quickly. As a result, it'll spend just a quarter as much time on the main sequence. After that, it'll puff up and enter the next phase of life: a red giant.
We'll have more about Altair tomorrow.
Lifecycle of Stars


text:
Qatar has had:
How Prepared Is Qatar?
Qatar has work to do to prepare for the next epidemic. They are committed to improving preparedness, but an outbreak today could cause deaths and cross borders.
Qatar has finished their National Action Plan and is working on improving epidemic preparedness in one or more gap areas.
What Are Qatar's Strengths & Gaps?
Biosafety and Biosecurity
Epidemic preparedness is not just about your country; it's a global issue. Right now Qatar is not ready for an epidemic. What happens when an epidemic breaks out in Bahrain, Iran (Islamic Republic of), Saudi Arabia and United Arab Emirates?
Better Prepared
neighbor Share Qatar and neighbor's status via Facebook
See Qatar's Data
Take Action in Qatar


text:
WDRV (97.1 The Drive)/Chicago Honored With Two 'Silver Dome' Awards
by Charese Frugé
Two 'Silver Dome' Awards
HUBBARD RADIO Classic Rock WDRV (97.1 THE DRIVE)/CHICAGO was honored by the ILLINOIS BROADCASTERS ASSOCIATION with two SILVER DOME Awards.
The first: The "Best Radio Station Community Service" trophy was presented for THE DRIVE's "Friday Night Singalong" series in which the City of CHICAGO partnered with THE DRIVE and lit the Downtown CHICAGO Skyline in red, white and blue during a surge in the pandemic. Thousands of Classic Rock fans took to their porches, patios and balconies every FRIDAY night to sing along with some of the greatest and most inspirational songs of all time.
The second: The "Behind The Song" podcast series, hosted by JANDA LANE. Now entering its fifth year in production, "Behind The Song" dives deep into the lyrics of some of Classic Rock's most legendary titles with details and perspective on the singers, songwriters and inspirations that provided the foundation for each song.
WDRV PD/Brand Manager ROB CRESSMAN ROB CRESSMAN said, "We are so very proud to have been considered for this high honor from The ILLINOIS BROADCASTERS ASSOCIATION. Our team at THE DRIVE is second to none and I am fortunate to be associated with such a talented group. To see such hard work and perseverance recognized is highly rewarding. It fuels our collective determination to perpetually strive for excellence in all that we do. Accepting these awards in the midst of the ongoing pandemic furthers our resolve to reach higher heights in spite of the associated obstacles and challenges."


text:
Tag Archives: Online Tutoring Website
Online Marketplace for Tutors
August 8, 2018 Online Learning, Python ProgrammingMarketplace for Tutors, Online Tutor Finder, Online Tutor Website, Online Tutoring Website, Website to find TutorsMainak Mittra
Mike was famous for his out-of-the-box career choices, something that earned him the tag of a rebel among his friends. So, it was not a surprise when, in spite to scoring the highest in subjects like economics and algebra, he choose to drop out, and pursue music as a career. His parents were as much disappointed as they were concerned about his future.
The Travails
Having set out to carve a career in the field of his choice, Mike quickly realized that making a living out of his passion would not be an easy job. He could bag a few gigs and call-shows to begin with using his contacts, but that was surely not enough to sustain a reasonable lifestyle. To add up to his net income, he started offering music lessons, mainly vocal and classical guitar classes to teenagers. That too did not assure a steady inflow of cash. Firstly, because the number of students turned out to be only a few. And secondly, because teenagers were fickle minded, they would pick up the guitar one day and get bored with it right after a week and drop out. Mike started wondering how far could he carry on like this.
One day, his best friend from school, Paula dropped in for a surprise visit. At that time, Mike was giving guitar lessons to his students, a group of three boys. They were just about to leave when Paula rung the bell.
"Hey, what's up"? Paula's enthusiasm was met with a feeble smile on Mike's face. "Hey. Wow! Come in!"
"What's wrong with you?" Paula was anxious, seeing that the signs of struggle were everywhere in his rented place, now more conspicuous than ever.
"Nothing, it's just been a little tough these days. That's it" Mike tried but couldn't hide the tone of despair.
"Care to explain?" Paula tried to be of help.
"Actually, I'm getting tired of this now. My students, all three of them, are going to withdraw by this month-end. In every two months, I'm giving lessons to a completely new set of people. They 're just coming in and going by, frustrating me at its worst", Mike never sounded this helpless as far as Paula could remember.
"Listen", Paula said "I have good news. There's a cousin of mine, she wants to take vocal classes, and she has heard about you. But, the only catch is that her place is at Hancock, nearly two hour's journey from here. Would you be able to take this up?"
"I'm afraid I can't. That will be too much of traveling. I can refer my friends who live near Hancock, they can help her out".
"Wow, you have musician friends there as well?" Paula didn't expect that.
"Ah, my network is quite large you see. I have my folks everywhere, just like me", Mike sighed, "struggling and trying to make both ends meet. And for us artists, tuition is one of the few sources of regular income that we have".
"Wait a second! Why not take this entire thing up to another level?", Paula quipped. She was always the ingenious one in their group. "What do you mean?" remarked Mike.
"Simple. You have your fellow mates, a network of artists in South California who provide tuitions and do it seriously. I know a lot of people who offer subject-specific classes. Even I would love to give French lessons to young learners. So, what we all need, is students who are serious about learning what they desire to. On the other hand, there are folks like my cousin, and I believe a lot of others too, who need dedicated teachers"
"Yeah, so what'll we do? Organise a meet-and-greet?" Mike quipped.
"Yes, but in a way that makes it fruitful for all", Paula didn't care for the tinge of sarcasm in his voice, "Not face-to-face, but in cyberspace"
"Woah, that escalated quickly! Now, who will take up the tech bits? That's not my cup of tea, and you're no better"
"Listen, I'm serious. I'll set up an appointment with a tech solution provider that my brother recently worked with for a venture of his own. They can help us out to get things off the ground"
"Hey, are you serious?"
"Very much I am! Wait for my call, once they confirm, I'll tell you when and where to drop by"
Paula left that day, keeping her promise. After a week, they were at the office of that tech company. They discussed the proposition with the representative, who created the blueprint of an online portal where students could reach out to the best teachers/mentors in areas of academics, language and of course, music. Both the parties could set their priorities straight, with respect to the location, the level of expertise, and the price point. They could also come to mutual terms, regarding the time and place of the classes, in the portal itself.
Interested to get a more detailed account of the solution, Download the Case Study;
No Email Ids/Contact Numbers needed.
"Also, if you ask me, there's another excellent addition that has a lot of potential," Emily from the Tech company was keen to help. You could also offer online tutoring, for cases where taking physical classes is not possible. That way, you're spreading the geographical boundaries of your business "
In that case, Mike said "We'll also have to think of something through which we can transfer large audio/video files because the instructor has to send samples, notations etc. The student should also be able to bounce off similar stuff with the teacher."
"Not an issue, we'll be in talks with our development team to streamline the portal with fast file uploading system", Emily assured him, "This will be one of its kind. What have you thought of naming the portal?"
"Yikes! We haven't thought of any", Paula admitted.
"Let's call it an online marketplace for tutors, as for the type. You can name it anything you want, after all, it's your idea", Emily smiled.
The idea was executed with flying colors, and today, Mike has stopped spending sleepless nights overpaying his next month's bills. The portal, has enabled him to have a steady source of income courtesy his pool of geographically dispersed and enthusiastic students who share his passion towards music. Besides, it has also helped him garner a reputation for himself in his field of work.
Talk to Mindfire Solutions, and we'll help you push your idea to the real world!


← OPINION: Could England 'Pass The Torch' For Pakistan T20s?
Driving through Eastbourne on Monday on the way to see Sussex play Kent, I remembered the last time I had been there, almost two years ago. I remembered knocking on a door in a sunny street, and my knock being answered by a white-haired old lady.
Her name was Ruth Prideaux.
I was there to interview her as part of my PhD – to hear her memories of her time playing and coaching England. Of the many interviews I conducted, they sometimes went well, sometimes not quite so well. And some stick in the memory more than others.
This one? One of the most enjoyable, most memorable, of all. It was impossible not to warm to Ruth in the two hours or so that I spent with her, drinking tea and listening to her memories of playing and coaching the sport she loved. It was also impossible – even at the age of 83 – not to feel slightly in awe of her; and to get a sense of why the players she coached were in awe of her, too.
Ruth sadly passed away last month. I am thankful I was able to meet her before she died. She deserves all the plaudits in the world.
Ruth Prideaux (nee Westbrook) was a formidable lady because she had had to be. Born in Greenhithe, Kent in 1930, she learned cricket at Gravesend Grammar School, before attending Anstey College of Physical Education to train as a PE teacher. All this came after an early battle of wills with her father about the sport she loved. "My father was not pleased," she told me. "I had three brothers at that time, and he thought they should be playing cricket and not me. He didn't like the idea of his daughter playing cricket. And I was the only one that really wanted to!" What happened in the end? "He had to put up with it," she recalled, her blue eyes twinkling.
By the time she was selected for England, to tour Australia and New Zealand in 1957/8, he had come round to her way of thinking! She described that tour as "wonderful" – but it was yet another struggle, both to gain leave from her teaching job, and then suffering the financial burden of having to forfeit six months of her salary (the length of Australasian tours in those days, thanks partly to the month-long boat ride there and back).
Contrary to her own expectations, she did indeed get the job.
That was not the end of the battle, though. By the time of her appointment, Ruth was working as a lecturer in the Sports Science department of Chelsea College of Physical Education, with radical new ideas about the way she wanted the England team to progress. She secured funding from the National Coaching Foundation for a five-year intensive training programme from 1989 to 1993, which incorporated both sport psychology and physiological testing.
Steve Bull, a colleague at Chelsea, became the team's official sport psychologist, and worked closely with Ruth to plan the programme, which aimed to increase confidence, develop positive thinking skills, and provide team cohesiveness. There was also an intensive focus on both nutrition and physical fitness.
Ruth's coaching programme was years ahead of its time; no other sport, including men's cricket, had utilised sports psychology before. And much of Ruth's work in these years now serves as the foundation for the elite coaching techniques which are used within both men's and women's cricket.
Fast forward five years to Lord's, August 1st 1993. Jan Brittin takes the winning catch, New Zealand are all out for 128, and Karen Smithies and her team lift the World Cup, hugging each other and shedding tears of joy.
That white-haired figure looks on from the balcony, quietly satisfied at what she has achieved with her team. She knew they could do it before they could.
Sure enough, England were actually left needing to beat their old enemy, Australia, in order to reach the final – and they did so in spectacular fashion, thanks to a wonderful innings from Carole Hodges, who finished on 105*.
Ultimately, England's World Cup victory in August 1993 was largely the fruit of Ruth's labour. Steve Bull reported that, by the time he concluded his work with the squad, "a feeling existed [among players] that success would not have been achieved without the provision of sport psychology support".
Her pride at the achievement was still evident in our interview, 20 years after the event, as she recalled the tournament, eyes shining. It is an achievement made all the more impressive by the fact that in all her years working with the England team, she was never paid a penny.
There were awards, of course – the National Coaching Foundation's England Coach of the Year in 1993 being just one – and yet somehow I wonder if Ruth ever quite got the recognition she so deserved. Had she been a man – had she won a men's World Cup – the whole world would know her name. Did anyone realise, I wondered as I left her house after our interview, that one of cricket's greatest ever coaches was at that moment living in a little corner of sunny Eastbourne?
It is just one more reflection of the battle Ruth fought her whole life – the battle against being told she couldn't do it because she was a woman.
Not any longer. And as Ruth herself recognised, she is partly responsible for that transformation.
That is quite some legacy, I told her. "Yes," she agreed.
Thanks – A very interesting and informative read!


text:
by Crystal Boutiette
Megan Alexander to Emcee NY HOBY GALA
"INSIDE EDITION" Correspondent and HOBY Alumna, Megan Alexander (Washington, '97) will be the Master of Ceremonies for the Annual Albert Schweitzer Leadership Awards Dinner on May 5th, 2014 at The Plaza in New York City.
Megan is one of the youngest rising stars in the television news industry. At a young age she is already on the national show "Inside Edition" and frequently appears on CNN's Showbiz Tonight" and also CMT, TBN, FOX and CBS. She has covered high profile events such as the most recent presidential election, the crisis on Wall Street, major awards shows and interviewed celebrities such as Anthony Hopkins, Robert Redford, Hugh Jackman and Madonna among many others.
Born and raised in Seattle, WA, she attended King's High School and graduated from Westmont College with a degree in Political Science. Megan debuted on television as part of the cast of "Tennessee Mornings on Fox 17." She worked as a traffic reporter for MetroNetworks. While in Nashville, Megan hosted a teen show for LifeWay Christian Resources called "Fuel." She also worked as a reporter/anchor for KENS5, the CBS station in San Antonio, TX, and co-hosted the show "Great Day San Antonio" She appears in country music artist Josh Turner's music video "What it Ain't" on CMT, Her film credits include the independent film "Something to Prove.", and she wrote the theme song for the film "Heaven Cent". Megan hosts the Inspirational Country Music Awards each year from Nashville. She is a member of the CMA (Country Music Association).
Megan offers media consulting for a variety of clients, including preparing up and coming artists for press. She emcees countless charity events around the country for organizations like Girls Quest, Girls Inc and HOBY. Megan loves working out, traveling and is always up for the next adventure. She and her husband are the proud parents of a baby boy, and a Golden Spaniel named Indiana.
This year's Albert Schweitzer Leadership Awards will honor Governor Haley Barbour, former Governor of Mississippi and Founding partner of the BGR Group; Rodney O'Neal, President and CEO of Delphi Automotive and Sheila T. Smith, Deloitte CRG, US Corporate Restructuring Services Group Co Leader and Americas Region Restructuring Services Leader. Other honorees include the HOBY Outstanding Young Alumni Award recipients, Virginia Newsome (Kentucky, '11) and Sara Surani (Texas, '12).
The evening's purpose is one of celebration, but, it also serves as HOBY's greatest fundraiser. Without it, our programs would not reach the 10,000 students it does annually; our young people wouldn't learn the impact they have on our world and our communities wouldn't benefit from the amazing service our alumni do when they learn that they CAN.
Please visit our events page for an easy calendar link to SAVE THE DATE! For more information on this year's honorees, check our website and "like us on Facebook" . You can also contact BHS at (646) 559-9943 or via e-mail at jennifer@bhsstrategiesllc.com.
Volunteers & Alumni: There will be volunteer opportunities for local alumni as well as a need for choir singers. Watch your email and Facebook for updates on ways you can help
Supporters: We can't do this without you. Please check out the the ways you can sponsor HERE.
http://www.hoby.org/new-york-awards-dinner
Tags: Albert Schweitzer, Albert Schweitzer Leadership Awards, BGR Group, Deloitte CRG, Delphi Automotive, Gala, Givernor Haley Barbour, Governor of Mississippi, HOBY, Hugh O'Brian, Hugh O'Brian Youth Leadership, Inside Edition, Master of Ceremonies, Megan Alexander, New York City, NYHOBYGALA, Rodney O'Neal, Sara Surani, Sheila Smith, The Plaza, Virginia Newsome
About Crystal Boutiette
View all posts by Crystal Boutiette →
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VOLUNTEER SPOTLIGHT– This is Matthew


The latest bugfix release of the Python 2.7.13 series is now available for download. Enjoy!
3.6.0 final release will be the same code base as this 3.6.0rc1.
intervals starting in the first quarter of 2017.
Python 3.6.0a3 has been released. 3.6.0a3 is the third of four planned alpha pre-releases of Python 3.6, the next major release of Python. During the alpha phase, Python 3.6 remains under heavy development: additional features will be added and existing features may be modified or deleted. Please keep in mind that this is a preview release and its use is not recommended for production environments. Python 3.6.0 is planned to be released by the end of 2016. The next alpha, 3.6.0a4, is planned for 2016-08-15.
Python 3.5.2 and Python 3.4.5 are now available for download.
You can download Python 3.5.2 here, and you can download Python 3.4.5 here.
Python 3.6.0a2 has been released. 3.6.0a2 is the second of four planned alpha releases of Python 3.6, the next major release of Python. During the alpha phase, Python 3.6 remains under heavy development: additional features will be added and existing features may be modified or deleted. Please keep in mind that this is a preview release and its use is not recommended for production environments. Python 3.6.0 is planned to be released by the end of 2016. The next alpha, 3.6.0a3, is planned for 2016-07-11.
Python 3.5.2rc1 and Python 3.4.5rc1 are now available for download.
You can download Python 3.5.2rc1 here, and you can download Python 3.4.5rc1 here.
Python 3.6.0a1 has been released. 3.6.0a1 is the first of four planned alpha releases of Python 3.6, the next major release of Python. During the alpha phase, Python 3.6 remains under heavy development: additional features will be added and existing features may be modified or deleted. Please keep in mind that this is a preview release and its use is not recommended for production environments. Python 3.6.0 is planned to be released by the end of 2016. The next alpha, 3.6.0a2, is planned for 2016-06-13.


, we all selects the very best selections having ideal resolution simply for you all, and now this pictures is usually among photos libraries in our greatest photographs gallery regarding Beautiful Hiline Homes Roseburg. I am hoping you can like it.
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Wow, I can't believe that we are done with the musical. It was fun! I'm kinda happy that it's over. I can now concentrate on school. But I'm going to miss being with everyone. Well at least we are going to see each other a couple of more times that I know of for now. It was an amazing experience and I'm glad that I did the musical. The last show went extremely well and we had a fairly good sized crowd. Oh, and I feel sooo terrible about kneeing poor David in the mouth. He did such a wonderful job of acting and singing throughout the pain. I hope you'll forgive me David.
I too am sad about the show being over, but I'm glad the last show went so well. Are you kidding? Our last audience was a full house, practically! :) A big audience really helps the performers. I wish I could thank everyone who came!!! I am sad that we won't see all our lovely friends as often.
Oh, and don't feel terrible about the result of your skills as a captive. :) I'm sure it was a mistake. And I'm sure he's already forgiven you, haven't you, David?
Yes the show was lots of fun. And yes, it was almost a full house for 111 Evelyn. I did notice that everyone was really doing there best on the last night, not that they weren't on the other night, it just really showed on the last night. I know I have loved getting to know everyone in the show. This always happens to us Tianna, we are always doing things together then they come to an end and we don't know when we are going to see eachother again. I'm going to miss you at my party but at least I'll see you at the cast party. Oh I hope he has forgiven me. I feel sooo bad about hurting him.


Penguin Book Phone Cover: Best penguin books by harland miller images on.
Summary : Best awesome literary iphone cases mostly for plus. Head case kawaii christmas penguins leather book for. Personalized penguin book cover case for iphone. Iphone plus go away i m reading penguin book.


The Independent Filmmaker/Producer/Investor must be aware of Set and Location Security because any shoot is a magnet for people, especially in this day of cell phones and text messaging.
Security should be vigilant all the time because he equipment for a Project shoot is expensive and portable. Innocent look-ee-loos will spoil a scene quickly not to mention intentional nuisances.
This Agreement between the independent Security Company/Personnel and the Producer is drafted in plain English that is easy to read and comprehend. This is a five page, eleven clause legal Agreement. The Agreement may be filled in on your computer or printed out and filled in later.
2. The Distributor and the Producer have entered into a Distribution Agreement dated as of ____________________, 20___, regarding among other things, the assignment by Producer to Distributor of certain exclusive rights of distribution and exploitation in the above named Project in designated media and non-exclusive incidental rights necessary to exploit the Project (collectively such rights are referred to hereinafter as the "Rights"), all as more fully set forth in the Distribution Agreement.
3. The Distributor and the Producer desire to secure the right of Producer to the Rights upon the terms and conditions of this Security Agreement.
(i) Intangibles: All of the Distributor's right, title and interest in and to the Rights in the Project as more fully set forth in the Distribution Agreement dated as of __________________, 20___.


text:
package biweekly.property;

import java.util.Date;

import biweekly.util.ICalDate;

/**
 * Represents a property whose value is a date or a date-time.
 * @author Michael Angstadt
 */
public class DateOrDateTimeProperty extends ValuedProperty<ICalDate> {
	/**
	 * Creates a new property.
	 * @param value the date-time value
	 */
	public DateOrDateTimeProperty(ICalDate value) {
		super(value);
	}

	/**
	 * Creates a new property.
	 * @param value the date-time value
	 */
	public DateOrDateTimeProperty(Date value) {
		this(value, true);
	}

	/**
	 * Creates a new property.
	 * @param value the date-time value
	 * @param hasTime true if the value has a time component, false if it is
	 * strictly a date
	 */
	public DateOrDateTimeProperty(Date value, boolean hasTime) {
		this(createICalDate(value, hasTime));
	}

	/**
	 * Copy constructor.
	 * @param original the property to make a copy of
	 */
	public DateOrDateTimeProperty(DateOrDateTimeProperty original) {
		super(original);
		value = (original.value == null) ? null : new ICalDate(original.value);
	}

	/**
	 * Sets the date-time value.
	 * @param value the date-time value
	 * @param hasTime true if the value has a time component, false if it is
	 * strictly a date
	 */
	public void setValue(Date value, boolean hasTime) {
		setValue((value == null) ? null : new ICalDate(value, hasTime));
	}

	private static ICalDate createICalDate(Date value, boolean hasTime) {
		if (value == null) {
			return null;
		}
		return (value instanceof ICalDate) ? (ICalDate) value : new ICalDate(value, hasTime);
	}
}


text:
Phenagoniates is a genus of fish in the family Characidae. It contains the single species Phenagoniates macrolepis, which is found in Colombia, Panama and Venezuela.  It is sometimes kept as an aquarium fish.

References

Characidae
Monotypic freshwater fish genera
Freshwater fish of Colombia
Fish of Panama
Fish of Venezuela
Fish described in 1913

redpajama_set_name: RedPajamaWikipedia


text:
ADCA > About > Australian Blockchain Sector Welcomes Formation of Parliamentary Friendship Group
Australian Blockchain Sector Welcomes Formation of Parliamentary Friendship Group
The Australian blockchain sector received a boost today with news of the formation of the Australian Parliamentary Friends of Blockchain.
Formation of the bipartisan group was announced by co-convenors, Senator Jane Hume (Lib, VIC) and Senator Sam Dastyari (Lab, NSW) at an event held in Parliament House and attended by more than 100 industry stakeholders.
Senator Hume noted that "the opportunities for government, academia and the private sector are enormous". Senator Dastyari stated that the "question for Australia is are we going to follow or are we going to lead?"
Nick Giurietto, Chief Executive of the Australian Digital Commerce Association (ADCA), which is the industry body for Australian businesses investing in blockchain, also addressed the meeting.
He noted that "smart countries will take advantage of blockchain technology to renew and strengthen their economies and cement their place among a small group of global economic leaders".
Giurietto called for ongoing close co-operation between government, regulators and industry in advancing the adoption of blockchain technology in Australia.
"Commercialisation of blockchain solutions almost always requires a rethinking not just of existing processes but of the architecture of existing systems. This requires deliberate collaboration between policy-makers and industry."
Reflecting the diversity of interest in blockchain technology from sectors right across the economy, Giurietto noted that both leading corporates and small entrepreneurial start-ups attended the launch event.
Giurietto welcomed the formation of the Parliamentary Friends of Blockchain group as a significant opportunity to enhance dialogue between policymakers and industry.
"I hope that the formation of the Parliamentary Friends of Blockchain comes to be seen as a key moment when Australian business and government came together to press the accelerator pedal on blockchain adoption."


FInd your name in a Blank Excel Sheet? How?
Microsoft has announced a very good deal to all the users of Excel. Few names are listed in Excel application. Who ever find their names in Excel are awarded lifetime free Office pack with all latest versions released in future. This sounds good right. Then why are you waiting check yours. Here are the Names Dump which was released recently and I am lucky to announce "Hey! my name is there!!!!"
Did you find your name in the Names Dump. No! then proceed how to find your name. If yes, then enjoy your day!!! I will tell you how to claim this offer in the end of the post. Keep reading...!
To find your name in Excel is a trick, column names are arranged in an alphabetical order right? so, we will hide the unwanted letters and keep the letters which comes in our name and that is why you can see most of the columns hidden and few of them are displayed in the Names Dump.
Nice trick right?. From now, If you want to present any information to your boss, use this trick and make your boss wow!.
Note: There is no offer as such. It is just to create hype.
If you like this tip, please do share it on your social networking sites by clicking on the icons placed around the blog. If you want to support me for maintaining this blog REGISTER here for free.


text:
Home > Books > The Soulkeepers
Author: G.P. Ching
Series: The Soulkeepers, Book 1
Genres: Science Fiction and Fantasy, Young Adult
ASIN: B004RR1NZI
Sometimes the end is just the beginning!
Book 1 of 6 in the bestselling Soulkeepers Series
Over 5,000 five star reviews.
Downloaded over 1.5 million times.
When fifteen-year-old Jacob Lau is pulled from the crumpled remains of his mother's car, no one can explain why he was driving or why the police can't find his mother's body. Made a ward of his uncle and thousands of miles from home, Jacob meets a beautiful and mysterious neighbor, Dr. Abigail Silva, who offers to use her unique abilities to help him find his mom.
In exchange, she requires Jacob to train as a Soulkeeper, a gifted warrior charged with protecting human souls. He agrees to her demands, desperate for any clue to the mystery of his mother's disappearance. But soon Jacob finds himself trapped in a web of half-truths, and questions Dr. Silva's motives for helping him.
"One of those rare stories that seizes your attention from the start and never lets it go. I would highly recommend The Soulkeepers. It has everything a reader could ever want." ★★★★★
– That Bookish Girl
"An astounding book. The concept of the storyline was genius. Every line, every word felt well-thought out and meaningful. The Soulkeepers never felt like an outright horror book to me, no slashing or blood-letting, but I was completely creeped out (in a good way)." ★★★★★
– Andrea Thompson
"5 stars. An utterly spellbinding, elaborate and spectacularly written adventure. From its very first words - "Death lived up to Jacob's expectations" - the story will pull readers in and take them on an adventure as Jacob discovers abilities he never knew he had and tries to uncover the truth about his mother's whereabouts." ★★★★★
– Fiktshun Reviews
Other Books in "The Soulkeepers"


text:
var natural = require("natural");
var wordnet = new natural.WordNet();
var async = require("async");
var _ = require("lodash");

exports.define = function (word, cb) {
  wordnet.lookup(word, function (results) {
    if (!_.isEmpty(results)) {
      cb(null, results[0].def);
    } else {
      cb("no results");
    }
  });
};

// Does a word lookup
// @word can be a word or a word/pos to filter out unwanted types
var wdlookup = exports.lookup = function (word, pointerSymbol, cb) {

  var match;
  var pos = null;

  pointerSymbol = pointerSymbol || "~";
  match = word.match(/~(\w)$/);
  if (match) {
    pos = match[1];
    word = word.replace(match[0], "");
  }

  var itor = function (word1, next) {
    wordnet.get(word1.synsetOffset, word1.pos, function (sub) {
      next(null, sub.lemma);
    });
  };

  var synets = [];

  wordnet.lookup(word, function (results) {
    results.forEach(function (result) {
      result.ptrs.forEach(function (part) {
        if (pos !== null && part.pos === pos && part.pointerSymbol === pointerSymbol) {
          synets.push(part);
        } else if (pos === null && part.pointerSymbol === pointerSymbol) {
          synets.push(part);
        }
      });
    });

    async.map(synets, itor,
      function (err, items) {
        items = _.uniq(items);
        items = items.map(function (x) {
          return x.replace(/_/g, " ");
        });
        cb(err, items);
      }
    );
  });
};

// Used to explore a word or concept
// Spits out lots of info on the word
exports.explore = function (word, cb) {
  var ptrs = [];

  wordnet.lookup(word, function (results) {

    for (var i = 0; i < results.length; i++) {
      ptrs.push(results[i].ptrs);
    }

    ptrs = _.uniq(_.flatten(ptrs));
    ptrs = _.map(ptrs, function (item) {
      return { pos: item.pos, sym: item.pointerSymbol };
    });

    ptrs = _.chain(ptrs)
    .groupBy("pos")
    .map(function (value, key) {
      return {
        pos: key,
        ptr: _.uniq(_.pluck(value, "sym"))
      };
    })
    .value();

    var itor = function (item, next) {
      var itor2 = function (ptr, next2) {
        wdlookup(word + "~" + item.pos, ptr, function (err, res) {
          console.log(err);
          console.log(word, item.pos, ":", ptr, res.join(", "));
          // console.log(res);
          next2();
        });
      };
      async.map(item.ptr, itor2, next);
    };
    async.each(ptrs, itor, function () {
      cb();
    });
  });
};


Dr Pachauri, the head of the UN's IPCC, as financially profiting from the global warming "crisis".
The inadequately supported and false IPCC report on disappearing Himalayan glaciers (Glaciergate).
The inadequately supported and false IPCC claim that vanishing tropical forests will result from "climate change". As North reported, Simon Lewis, a Royal Society research fellow at Leeds University who specialises in tropical forest ecology, called the IPCC report "a mess" that lacks substance and primary research (Amazongate).
The manipulation of climate data at the East Anglia Climate Station (Climategate).
The £4 billion in 'climate change' investments by the BBC's pension fund investor - investments which may have influenced BBC reporting and which suggest that, like Caesar's wife, the BBC is not above suspicion (Beebgate).
How the IPCC and the media manufactured a climate change "crisis" with false data is a shocking story. Slowly but surely, with the persistence and courage of a few writers such as North, the falsehoods are being stripped away.