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Dick '70 Presented HWS Service Award
Michael R. Dick '70, P '90 was presented with the Hobart and William Smith Colleges Trustee Community Service Award during an HWS gathering at the Rutland Country Club in Rutland, Vt. on Thursday. This prestigious award is given to members of the HWS family who have shown extraordinary commitment as volunteers, serving their local communities and society as a whole.
Dick graduated from Hobart College with a Bachelor of Arts in political science. As a student, he was a resident adviser, member of the golf team and was elected to Chimera. After graduation, he taught at the Salisbury School in Connecticut for three years. In 1975, he earned his Doctor of Dental Medicine at the University of Connecticut School of Dental Medicine. Dick opened his dental practice in Rutland, Vt., where he resides with his wife Susan and three daughters, one of whom attended William Smith. He has maintained close contact with his alma mater, serving as class agent, admissions volunteer and Alumni Council representative.
Trustee Dr. Richard Wasserman '70 presented Dick with the award at the ceremony; Dick's family and friends joined HWS alums in honoring his dedication and achievement.
"A dentist by trade, Michael recognized early in his life the transformative power of education to sustain communities, provide opportunities, and enrich the lives of society as a whole," Wasserman said of his friend and classmate.
Dick served as a Rutland City School Board member from 1978-1984 and 1990-2006, serving as the board president for 17 of those years. During his tenure as president, he played a role in the construction of the new Rutland High School and the consolidation of the elementary schools. He was given the Martha O'Connor Award by the Vermont State Board of Education for his contributions to public education in the State of Vermont. He was also awarded the Vermont State Dental Society's Citizenship Award for service to the public outside the practice of dentistry.
Wasserman noted, "It is a testament to Michael's leadership in times both good and bad that the School Board unanimously voted to establish a scholarship in honor of him and his wife."
Dick has also been active in a number of community organizations, including as chair of the Dental Division of the American Heart Association, assistant district chair of the Boy Scouts of America, a board member of the Rutland Alcoholic Information and Referral Service and president of Rutland County Dental Society.
Professionally, Dick and his team have been voted Rutland's Best Dentist for the past nine years and his office has been the recipient of the Rutland Herald's Best of the Best Award multiple times. He has served as president of the Rutland County Dental Society and has been active in committee work at the state society level. Dick has achieved Fellowship status in the American Academy of General Dentistry and is also a member of the American Academy of Dental Practice Administration. He has spoken to dental organizations, study clubs, and continuing education forums, throughout the United States and Canada.


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Astrid Maxxim and the Mystery of Dolphin Island – Chapter 10 Excerpt
The storm continued to rage outside the walls of the little house on Dolphin Island. The five young women had to make due with lighting from a single flashlight and several candles. They only ate food that could be eaten cold, and concentrated on that which was in the refrigerator, since without power the food within would eventually go bad.
"I wish I knew which direction the storm is moving," said Penelope, as they sat around the table, eating a dinner of cheese sandwiches and cabbage and fennel salad.
"We had a hand crank radio," said Eleanor, "but I broke the crank off of it."
"Cranked it too hard?" wondered Penelope.
The blonde nodded.
"I can hook up the laptop directly to the internet," said Astrid. "We've got enough battery power to run it for several hours."
Unplugging the now unusable router, the girl inventor connected one MPro 5 notebook to the cable. Loading up the browser, she pulled up the satellite image of the storm.
"It's passing to the north of us," she told the others. "It's not moving very fast though. I would guess we've got another two days of rough weather."
"That's what I figured," said Adeline. "We'd better turn off the computer and conserve the battery."
"First though," said Penelope. "We each need to send a message to our loved ones telling them we're okay."
When it was her turn, Astrid sent the following message, making sure to address it to her mother, father, and to Toby. Power is out here, so no phone, but we are safe and sound. Don't worry. Love to you all. Call you when we get the power back.
"Sending your love to Toby?" asked Penelope, looking over her shoulder.
"No, I'm just… That's just what people say. You don't think he…?"
"Stop worrying about it. He knows how you feel about him and he has since he was old enough to stand."
"Well…" said Astrid, shrugging. "I guess."
That night, the wind rattling loose boards and shingles on the outside of the house, made sleep difficult for Astrid. When she finally dozed off, it was late, and she was awakened at least three times during the night. It was a surprise therefor to find that she had slept late into the morning. All of the other young women were up and dresses and sitting around the table eating bread and jam.
"Why did you let me sleep so late?" asked Astrid, as she wiped the sleep from her eyes.
"There wasn't much point in waking you," said Penelope. "We can't do anything but sit around staring at one another."
"I thought now that it's light outside, I might take a look at the generator," returned Astrid.
"It's light out," said Eleanor, "but it's still too windy to go outside. You would be blown off your feet. I'm a little surprised that we haven't lost the roof."
"The house is sturdy," said Adeline. "We are also protected somewhat by the trees."
"I hope the dolphins are okay," said Astrid.
"They will be fine," assured Océane. "They will swim out to the deep water. The storm won't bother them at all."
There was just enough light coming in through the boarded up windows that they were able to play a French version of Monopoly during mid-day. In the afternoon, the wind seemed to die down a bit, giving Astrid some hope that maybe the storm would soon be over. Then it grew suddenly dark, and minutes later, the island and the little house were deluged by waves of rain. The girls immediately had to scramble to lay out pots and dishes under the sixteen leaks in the ceiling that ranged from a steady drip to a constant stream.
"I feel like we need to look for two of every animal," said Penelope.
It was so dark by five o'clock that it could have been midnight. Astrid peaked out a crack in the boards covering the window. All she could see were bushes being bent by the wind and pelted by the rain.
"Astrid," said Océane, at her elbow. "Will you come help me make dinner?"
The girl inventor followed her to the part of the room that made up the kitchen.
"You seem very nervous," said the French girl.
"Do I? I guess I am. This is the first hurricane that I've ever been in. We don't get a lot of stormy weather in the southwest U.S."
"Everything will be fine."
"Oh, I know it will be," said Astrid. "At least I know that in my head. I guess some other part of me isn't so sure."
"You will feel better after you eat. I'm making sandwiches with the last of the bread and hazel nut spread. I want you to chop of this bag of pistachios and whatever fruit we have left to go on them."
Astrid found a handful of strawberries and two bananas in the no-longer-cold refrigerator, and diced them up fine, along with the pistachios. Océane sprinkled them on the hazel nut spread before placing the two pieces of bread together.
"I have a secret treat," said Océane. "We're all going to have hot cocoa."
"How are we going to do that?" wondered Astrid. "We don't have any heat."
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redpajama_set_name: RedPajamaCommonCrawl


New rates for single-family homeowners with policies under the National Flood Insurance Program will take effect next year, under a new plan announced Monday. But it's unclear what that will mean for policyholders in South Carolina.
Currently, the Federal Emergency Management Agency uses flood zone maps as the primary tool to determine rates. Under the new system, rates will be determined by also factoring in variables such as the distance a building is from the coast or another water source and the cost to rebuild the home or building.
The new rates for single-family homeowners will go into effect Oct. 1, 2020, said David Maurstad, FEMA's deputy associate administrator for insurance and mitigation.
"Yes, some people's rates will increase," Maurstad said Monday during a conference call with reporters. "Other people's rates will decrease. We don't know what that looks like at this time."
Many specifics about the rate system changes were not available.
The adjustment to single-family home policies could impact homeowners in coastal Lowcountry communities, which face flooding risks from the Atlantic Ocean, inland rivers, storm surge, heavy rains and high tides.
Changes to the program, which allows homeowners, business owners and renters in certain areas to buy federally backed flood insurance, have impacted rates for local residents before. In 2013, when a new law related to the insurance program was implemented, rates for many South Carolina policy holders increased.
Nearly 70 percent of the National Flood Insurance Program's 5 million policies were for single-family homes as of November, according to FEMA. South Carolina had more than 200,000 flood insurance policies as of September. Florida, by comparison, had the most in the country with more than 1.7 million.
Maurstad said that the flood insurance program will continue to use flood maps in determining rates. It will also keep using the Community Rating System, which gives policy holders discounts on their rates based on rules set by communities that exceed minimum program requirements. The discounts can add up to as much as 45 percent.
Currently, Charleston city officials are considering whether to require homes built in flood hazard areas be raised 2 feet above FEMA's minimum elevation, which could affect its rating. Charleston County already follows that standard.
FEMA has struggled with keeping the flood insurance program financially sound while also providing affordable rates to policy holders, according to the Government Accountability Office.
The flood insurance program had $20.5 billion in debt as of September, said a GAO report from this month. That comes despite Congress canceling out $16 billion from the program in 2017.
"Without reforms, the financial condition of NFIP could continue to worsen," the report said.


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Tesla delays price hike because of 'unusually high volume' of last-minute orders
The shift to online-only sales results in a traffic jam
By Sean O'Kane@sokane1 Mar 19, 2019, 11:17am EDT
Share All sharing options for: Tesla delays price hike because of 'unusually high volume' of last-minute orders
Photo by Sean O'Kane / The Verge
Tesla has delayed a planned 3 percent price hike on all of its cars until midnight on Wednesday because it had trouble processing a rush of last-minute orders, the company claimed on Twitter on Tuesday morning.
"Due to unusually high volume, Tesla was unable to process all orders by midnight on Monday, so the slight price rise on vehicles is postponed to midnight Wednesday," the company wrote.
On February 28th, Tesla announced that it was lowering prices by 6 percent on all models after deciding to close most of its stores and switch to an online-only sales model. The company said it made these changes in order to cut operating costs, which finally allowed Tesla to start taking orders for the $35,000 version of the Model 3 that it had promised since the car's debut in March 2016.
Prices now go up end of day on Wednesday
The decision angered customers around the world who had recently bought cars at a higher price, and it also caused confusion among employees of many of the company's stores.
Two weeks later, the company reversed course and halted the store closings after "closely evaluating every single Tesla retail location." The decision to keep many of its locations open while keeping sales online meant the company had to raise prices again, this time by 3 percent (except for the $35,000 Model 3). Tesla CEO Elon Musk has spent the last week occasionally reminding his 25 million Twitter followers that the price hike was coming.
"Reminder to buy our S3XY cars before midnight on Monday! Prices rise slightly worldwide on Tuesday," he wrote over the weekend.
Last week, Tesla announced the Model Y compact SUV, a bigger version of the Model 3 that will start at $47,000 when it hits the road in 2020. A $39,000 version will be made in 2021. The company is already taking preorders for the new car, and it says the 3 percent price hikes won't apply to the new vehicle.
Next Up In Transportation


Details: The Junkers Ju-188 was a German WW2 Luftwaffe twin-engine combat aircraft and became one of the most versatile combat aircraft of the war and served as a bomber, night fighter, torpedo bomber and reconnaissance aircraft. The Junker Ju-188 became one of the Luftwaffe's most important aircraft with more than 16,000 built in dozens of variants. This replica is the perfect tribute to an iconic aircraft, accurate down to the smallest detail. The model comes with a display stand.


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Whitaker, Mirren find Oscars glory
Hollywood, February 26
In a glamorous Oscar awards ceremony, Forest Whitaker and Helen Mirren established themselves as Hollywood's biggest talents this year by bagging the Best Actor and the Best Actress trophies, respectively. Whitaker's mesmerising performance as the brutal Ugandan dictator, Idi Amin, in the acclaimed drama "The Last King of Scotland", re-established him as one of Hollywood's biggest talents after he faded from view following a meteoric start to his career.
"My fellow Americans, people all over the world, we need to solve the climate crisis. It's not a political issue, it's a moral issue," — Al Gore after 'An Inconvenient Truth' strikers Oscars gold.
"When I was a kid, the only way that I saw movies was from the backseat of my family's car. At the drive-in," — an emotional Forest Whitaker after winning best actor.
"Ladies and gentlemen, I give you 'The Queen'. Thank you," — Helen Mirren salutes the woman behind her best actress win.
— Reuters photo
Martin's crime thriller triumphs
Al Gore wins
US doing intensive planning to strike Iran: report
Pakistan hopeful of Manmohan visit soon
N-tests not to hinder deal: US
Bodies of 7 victims reach Karachi
India, Pak reaction wins US praise
Pakistan's National Assembly demands joint investigation
India, Bangladesh join hands against terror
Support for Indian doctors gathers steam
US House faults Bush on Iraq
Pak arrests three suicide bombers
Major urban centres in India face quake risk: Study
Deepa Mehta's 'Water' loses
India's hopes of bagging the elusive Oscar were again dashed today as Deepa Mehta's "Water", which was nominated in the Best Foreign Language Film category from Canada, lost the race to "The Lives of Others' from Germany. Dealing with the lives of widows in 1930s India, "Water" was nominated by the Academy last month.
Deepa Mehta, whose film "Water" was nominated in the Best Foreign Language Film category from Canada, poses on the red carpet at the 79th Academy Awards in Hollywood on Sunday. — AFP photo
US to issue 'tough' message to Musharraf
Washington, February 26
US President George W Bush has decided to send an unusually tough message to Pakistan President Pervez Musharraf, a close ally in the war against terror, warning him that the Congress could cut aid to Islamabad unless it is more aggressive in hunting down Al Qaeda militants.
Iraqi Vice-President escapes blast
Baghdad, February 26
A blast at an Iraqi ministry during a ceremony attended by Vice President Adel Abdul-Mahdi killed four people on Monday but the Vice President was unhurt, an employee at the ministry told Reuters.
Nepal Govt to seize King's property
Kathmandu, February 26
The Nepal government today decided to form a committee to seize the property of King Gyanendra and initiate action against the monarch for defending his decision to grab power in 2005.
Indian students hit by new UK law
London, February 26
A large number of Indians studying here, who had converted their student visa into Highly Skilled Migrants Programme (HSMP) category, are now regretting their decision after recent changes in the British immigration laws.
Fire in B'desh highrise, 3 dead
Dhaka, February 26
At least three persons are feared dead and dozens injured here today in a fire that raged through a multi-storeyed building that houses two private television channels and a newspaper office.
City council to set barking dog time limit
Clifton, February 26
The city of Clifton is not going to the dogs. Later this month, the council is expected to introduce an ordinance setting a limit on how long dogs can bark.
In a glamorous Oscar awards ceremony, Forest Whitaker and Helen Mirren established themselves as Hollywood's biggest talents this year by bagging the Best Actor and the Best Actress trophies, respectively.
Whitaker's mesmerising performance as the brutal Ugandan dictator, Idi Amin, in the acclaimed drama "The Last King of Scotland", re-established him as one of Hollywood's biggest talents after he faded from view following a meteoric start to his career.
Whitaker prepared extensively for the part of the ruthless African strongman, learning Swahili and practicing Amin's accent after poring over books and hours of tapes and documentaries.
Helen Mirren, who won her first Oscar for her stoic portrayal of Britain's monarch in "The Queen," began her career as a sex symbol but attracted equal attention playing strong, resilient women.
Long considered the favourite to take home the coveted Oscar statuette, Mirren fought off stiff competition from Penelope Cruz ("Volver"), Meryl Streep ("The Devil Wears Prada") and fellow Britons Judi Dench ("Notes on a Scandal") and Kate Winslet (Little Children").
Though she once dismissed the Oscars as "the creme de la creme of bullshit," Mirren (61) caught the Academy's eye twice before with nods for "The Madness of King George" (1994) and 2001's "Gosford Park." In her award-winning turn, Mirren depicts Queen Elizabeth II as a resolute sovereign, bound by tradition and protocol, who wrestles with public pressure to shed her veneer of propriety and grieves alongside the nation after Princess Diana's death.
Martin Scorsese finally won the Oscar for Best Film Director with the crime thriller, "The Departed", ending one of the highest-profile losing streaks in the event's history. Paradoxically, his victory came for a populist effort that was released with no intentions of seeking awards. Returning to his crime roots, Scorsese gathered an all-star cast, headed by Jack Nicholson, Leonardo DiCaprio and Matt Damon to fashion a story about official corruption in Boston.
''We wanted to make a nice genre movie and look what happened,'' said Scorsese (64) as he arrived at the Oscars with his daughter.
It quickly became the biggest film of his career, selling more than $131 million worth of tickets at the North American box office. — Reuters, AFP
"An Inconvenient Truth," the big-screen adaptation of former US Vice President Al Gore's slide-show lecture about the perils of global warming, won the Academy award for Best Documentary. The award went to director Davis Guggenheim and producers Lawrence Bender and Laurie David.
"I have to thank Al Gore for inspiring us, inspiring me, showing that caring about the Earth is not Republican or Democrat. It's not red or blue, we are all green," – 'An Inconvenient Truth' song-writer Melissa Etheridge.
India's hopes of bagging the elusive Oscar were again dashed today as Deepa Mehta's "Water", which was nominated in the Best Foreign Language Film category from Canada, lost the race to "The Lives of Others' from Germany.
Dealing with the lives of widows in 1930s India, "Water" was nominated by the Academy last month.
The film competed with "Pan's Labyrinth" (Mexico), "After The Wedding" (Denmark), "Days of Glory" and the German Cold War drama, "The Lives of Others".
Present at the Oscars ceremony were the director of the film Deepa Mehta, its Canadian producer David Hamilton, the film's lead actor John Abraham and actor Seema Biswas. — AFP
The decision came after the White House had concluded that Musharraf has failed to live up to the commitments he had made to Bush during a visit here in September last,The New York Times reported.
Musharraf had insisted then that a peace deal he struck with tribal leaders in areas bordering Afghanistan would not diminish the hunt for the leaders of Al Qaeda and the Taliban or their training camps.
Now, American intelligence officials have concluded that the terrorist infrastructure is being rebuilt, and that while Pakistan has attacked some camps, its overall effort has flagged.
"He's made a number of assurances over the past few months, but the bottom line is that what they are doing now is not working," one senior administration official was quoted as saying. "The message we're sending to him now is that the only thing that matters is results." Democrats, who took control of the Congress last month, have urged the White House to put greater pressure on Pakistan because of the statements from American commanders that units based in Pakistan, linked to the Taliban, are increasing their attacks into Afghanistan. — PTI
The employee said it had appeared that a mortar round had hit the Public Works Ministry building.
He said he had thrown himself on top of the minister at the time of the blast.
It was unclear weather the attack was an assassination attempt. — Reuters
A council of ministers met at Prime Minister Girija Prasad Koirala's official residence here and decided to set up a ministerial-level committee to nationalise the property of late King Birendra, late Queen Aishwarya and King Gyanendra.
The committee, headed by minister for Physical Planning and Works Gopal Man Shreshta, includes minister of State for Information and Communication Dilendra Badu and assistant minister for General Administration Dharma Nath Prasad Shah.
The cabinet also officially condemned as "unconstitutional" and "undemocratic" the King's Democracy Day message in which he defended his power grab two years ago.
Badu said the meeting decided to "respect" the interim legislature-parliament's proposal to initiate action against the King for his controversial message.
In his address to the nation on the Nepalese Democracy Day earlier this month, King Gyanendra said he was compelled to seize power because the government had failed to conduct elections and provide public security. — PTI
HSMP holders, who had come to the UK with a promise of visa extensions based on economic activity and permanent residence for four years, have been left vulnerable and devastated due to the new drastic changes, a forum for the affected students said on Sunday.
"The changes, brought in November 2006, did not just affect the HSMP holders but has raised a lot of concern for the future of Indian students who had come to UK for higher education," said Kapadia, director and coordinator of the HSMP forum.
Many of the Indian students, after completing their post-graduation and other courses, had switched to HSMP as in-country applicants, but are now realising that the new changes may not lead them anywhere.
Most of these experienced professionals have spent more than 20,000 pounds on their studies and have switched to HSMP programme after finishing their courses. — PTI
Two of the victims died of burn injuries in a hospital while another died after jumping from the sixth floor of the building, doctors and witnesses said.
More than a hundred persons were rescued, but many are still feared trapped. The cause of the fire and the extent of damage is not known.
Witnesses said fire fighters were still working hard in the afternoon to put out the blaze. The Army, the police and the Rapid Action Force also joined the rescue effort.
The building, in the Kawranbazar business district of Dhaka, houses NTV and RTV stations and the Amar Desh newspaper, all owned by a former member of Parliament.
Survivors said around 2,500 people worked in the building on normal work days. — Reuters
The city of Clifton is not going to the dogs.
Later this month, the council is expected to introduce an ordinance setting a limit on how long dogs can bark.
Noisy canines will be defined as those that bark for more than 30 minutes on two consecutive days.
Getting a summons is rare, because the person who complained must go to court to sign a complaint. Fines for the new ordiance could start at $250. — AP
| Business | Sports | World | Mailbag | Chandigarh | Ludhiana | Delhi |


Banking major Emirates NBD continues to be the most valuable company listed on Dubai Financial Market (DFM), with a market value of nearly AED 47.24 billion, amounting to 14.25% of the total market capitalization of DFM. As per the last week's data of DFM, Emirates NBD added close to AED 18 million in its market valuation last week, followed by another market heavyweight Emaar Properties that emerged as the second most valued company with AED 45.60 market cap, accounting for 13.77% of the total valuation of DFM. Other stocks jockeying for the top of the list included Emaar Malls (AED 35.65 billion valuation, cornering 10.76% of the total market cap) and du (AED 28.47 billion, 8.60%). Dubai Islamic Bank was the fifth most valued company with AED 26.04 billion capitalization, cornering 7.86% of DFM's total valuation.
Overall, the value of shares bought by foreign investors, or non-UAE nationals on DFM during last week reached AED 796.17 million comprising 42.52% of the total value of stocks traded during the period. The value of stocks sold by foreign investors during the same period reached AED 755.31 million comprising 40.34% of the total value of stocks traded during the period. Net foreign investment on the market reached AED 40.86 million during the same period, as aggregate buy, according to DFM data. The value of stocks bought by institutional investors during last week reached AED 573.85 million comprising 30.65% of the total value of stocks traded during the period. The value of stocks sold by institutional investors during the period reached AED 382.72 million which constitutes 20.44% of the total value of stocks traded during the period. Net institutional investment on the market reached AED 191.13 million during the period as aggregate buy.


BIOFACH Japan joins FOOD TABLE in JAPAN 2016 | O.W.N.
Organic Expo / BIOFACH JAPAN are joining forces with other food trade events next year. The food industry in Japan has changed dynamically. It is becoming increasingly important to include food-related trends and needs from other sectors, the show organizers said.
The 15th edition of Organic Expo together with BIOFACH JAPAN will be co-located on 10-12 February with other food shows under the umbrella "FOOD TABLE in JAPAN 2016".
Some organic non-food exhibitors first thought that Organic Expo/ BIOFACH Japan would only focus on "food." However, according to an Organic Expo/BIOFAC Japan representative, buyers looking for organic products for high-end supermarkets and convenience stores, are also interested in adding non-food related goods to their inventory.
The five trade shows Organic Expo/ BIOFACH JAPAN, Supermarket Trade Show, Kodawari Food Fair, Delicatessen Trade Show & Gaishoku FOOD TABLE, will cover all whole food related segments in Japan. The exhibiting area at the Tokyo Big Sight venue – both east and west halls – encompasses a total space of 82,000㎡. The organizers expect an estimated 100,000 visitors.
At the previous show edition held in 2014, Organic Expo – BIOFACH JAPAN hosted 227 exhibitors from 14 countries and welcomed 18,198 visitors. The Organic area had 69 exhibitors.
BIOFACH JAPAN, which is the certified organic area, will display a variety of organic food, beverages, and agricultural supplies and processing services for the organic industry, along with organic cotton, remedies, and aromatherapy products based on organic raw materials. To be part of this exclusive area, exhibitors, and their products have to fulfill the established and strict BIOFACH admission criteria that also apply to BIOFACH in Germany, China, India, and Brazil. The Natural Beauty Care area showcases organic products for beauty, skin and body care as well as fragrances. And the Natural Eco Plaza introduces products serving the natural, sustainable and health-conscious lifestyles.
In 2016 show organizers expect around 20 percent of exhibitors in the Natural Beauty Care section and approximately 30 percent in the Natural Eco Plaza.
According to IFOAM Japan and OMRP (Organic Market Research Project), one percent, an estimated US$1.4 billion, of the Japanese food market comprised organic food sales in 2010. Driven by consumer concerns about food quality, experts forecast an annual growth rate of up to 12%.
Like in 2014, a highlight during Organic Expo/BIOFACH JAPAN will be the presence of European natural cosmetics companies. The only inconvenience will be that Organic Expo/BIOFACH Japan will take place during the same week as BIOFACH in Nuremberg, Germany. European firms will prefer the fair in Germany since it is the largest and most international event in the industry. Japanese companies with a strong emphasis on exports might also prefer to attend the event in Germany next year.
Toshifumi Ayukawa, of the event organizing committee and president of Space Media Japan Company Limited said about last year's event that he was pleased with the wide range of European organic products, in particular, those from Italy. "The selection ranged from chocolate through rice drinks to various superfoods. There is a huge demand for these in Japan," he said.


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Home Small Business Intel Lowers Revenue Outlook
Intel Lowers Revenue Outlook
By Paul Shread | July 17, 2001
A strong day for stocks ended on a modestly weak note when Intel matched earnings expectations, but lowered its revenue outlook.
The ISDEX http://www.wsrn.com/apps/ISDEX/ rose 3 to 215, and the Nasdaq climbed 38 to 2067. The S&P 500 added 11 to 1214, and the Dow surged 134 to 10,606. Volume rose to 1.23 billion shares on the NYSE, and 1.69 billion on the Nasdaq. Advancers led 18 to 12 on the NYSE, and 21 to 15 on the Nasdaq. For earnings reports, visit our earnings calendar at http://www.wsrn.com/apps/earnings/internet.xpl and reported earnings at http://www.wsrn.com/apps/earnings/ireported.xpl. For after hours quotes and news, visit our after hours trading site at http://www.afterhourstrading.com.
After the close, Intel slipped about 2% after matching estimates, but lowering revenue estimates. The company stuck to its contention that business will improve in the second half of the year. Apple Computer lost about 10% after missing revenue estimates and lowering its forward outlook.
Also after the bell, Real Networks dropped 10% after missing estimates by a penny and announcing the resignation of its CFO for personal reasons; Paul Bialek will stay on as a part-time strategic advisor. Veritas plunged on an earnings warning.
During the day, Novellus managed to add 1.64 to 48.01 after topping estimates by a penny at 40 cents a share, but issuing a disappointing forecast.
JDS Uniphase dropped .47 to 10.14 on talk that the company may take a write down of $40 billion - bigger than its $13 billion market cap - for acquisition-related charges.
IBM added .71 to 108.53 ahead of its earnings report tomorrow night. Investors expecting earnings of $1.15 a share, and revenues of about $23 billion.
Some technical comments on the market: Note: We include charts in the technical market commentary. If you can't get the charts via the e-mail newsletter version, try this link: http://www.afterhourstrading.com/column.html
Some mixed signals in the market today. The Dow (first chart) had a strong day, but the buying pressure wasn't confirmed by a sustained move in the TRIN below .80. However, the Dow could be forming an inverse head and shoulders bottom here (unlike at the top, however, where every major index formed a head and shoulders top, only the Dow is showing the bottoming pattern here). If the Dow can take out 10,650, it could be headed north of 11,000. The index is overbought, however, and due for a pullback in the next day or two. The 10,430-10,450 level must hold on any down move to keep that pattern in play. The Nasdaq (second chart) is an interesting study in gaps. Notice how the index bounced today at the mid-point of last week's big gap up, a common support point in gaps. However, the partial fill of that gap increases the odds that it will fill completely in the days or weeks ahead; look at how a partial fill in June of an April gap was followed up by a complete fill last week. Last week's gap up would fill at 1972. Also notice how the Nasdaq was rejected at a downtrend line today. A move above 2071 should take that line out. The S&P 500 (third chart) got rejected at a downtrend line at about 1215 today. 1200 is important support. Tomorrow and Thursday are the last days of an important turn window, but the odds of a crash-like event declined today. The next major turn window is August 5-9, and that one may be good until November.
Special report: For a free introduction to technical chart patterns and an overview of last year's action in the stock market, visit http://www.internetstockreport.com/guest/article/0,1785,2571_500051,00.html.


text: Pull requests welcome!  PSR-2 plus tests please.

redpajama_set_name: RedPajamaGithub


text:
Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study
Nawaraj Upadhaya1,
Mark J. D. Jordans2,3,
Ruja Pokhrel1,
Dristy Gurung1,
Ramesh P. Adhikari1,
Inge Petersen4 &
Ivan H. Komproe2,5
Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements.
In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis.
The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level.
In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.
Governance is a key determinant for economic and social advancement and overall health systems development [1]. As different parts of health systems interact with each other, it is evident that assessing and understanding governance are crucial to improve the performance of health systems [2]. WHO's 2000 World Health Report describes governance as 'stewardship', which was defined as "setting and enforcing the rules of the game and providing strategic direction for all the different actors involved" [3]. In 2007, 'governance and leadership' was included as one of six building blocks of a health system (others included the health workforce, health financing, service delivery, information management and medical products and technology), and was defined as "ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, the provision of appropriate regulations and incentives, attention to system design and accountability" [4].
In the last decade, health governance has received significant academic attention and has been recognized as a critical element of the health systems strengthening agenda [5]. However, globally, governance for mental health systems still remains conceptually underdeveloped despite initiatives taken to improve clinical governance of mental health through an integrated organization-wide (institutional) approach for continuous quality improvement [6]. This issue of mental health systems governance warrants further attention, given that mental health problems account for about 12% of global burden of disease [7].
The little progress that has been made in clinical governance of mental health is associated with the limited capacity to the monitoring and standardization of drug prescription practices [8], leaving out many other aspects of mental health systems governance which play vital roles for strengthening mental health systems. Effective and efficient mental health systems governance is one of the strategies to deal with the high burden of mental illness in low- and middle-income countries. In Nepal, although there is no nationally representative data on disease burden, it can be assumed that, due to lack of resources, expertise and overall governance, both the prevalence and burden of disease for mental health is higher than the global figure. The small-scale studies available have indicated that around 20–25% of all patients visiting primary health care facilities have shown psychiatric morbidity [9], while suicide accounted for 16% of deaths among women of reproductive age [10].
It is increasingly recognized that, in order to achieve the intended results in the overall development of health systems, not only the resources but also the governance and accountability mechanisms need to be in place [11]. The roles of the Ministry of Health, service providers and service users need to be taken into account [12]; for that, governance processes and accountability mechanisms that are responsible for the overall development of the health systems need to be implemented and assessed periodically to identify and address system-level barriers. To do this, better understanding of mental health needs, service availability and utilization, governance procedures and mechanisms, and the interaction between these variables is essential. There are a few studies in Nepal that have touched upon some themes of mental health systems such as policy and legislative frameworks [13, 14], but their focus was mainly on mental health service delivery rather than on mental health governance. Since 2013 mental health systems related studies are conducted as part of the Emerging Mental Health Systems in Low- and Middle-Income Countries (EMERALD) research program which aims to support mental health systems strengthening in six countries (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) [15].
In this paper, we used Siddiqi and colleagues' health system governance assessment framework to report on systems-level constraints and facilitating factors because it provides a set of questions that cover each governance principle at the national, policy formulation and implementation level. This framework has been previously applied in Pakistan, where there are similar health system barriers and opportunities compared to Nepal [1]. The ten governance principles of Siddiqi and colleagues' framework and the themes included in this study are presented in Table 1.
Table 1 Governance principles and associated themes.
The Nepalese health governance context
The unstable political history of Nepal (internal conflicts among the rulers, several political movements against the government and frequent changes of government during the Rana Regime, multiparty democracy, and Maoist insurgency) has resulted in overall poor governance but has particularly affected governance in the health sector. At the same time, there exist quite a few laws and policies aimed at strengthening governance in the health sector. For example, the 2006 Interim Constitution of Nepal, promotes a more decentralized system of governance and guarantees the rights to equality of all citizens regardless of their social, cultural or economic background and physical or mental health status [16]. Similarly, the Local Self-Governance Act of 1999 gives authority to the local bodies to operate and manage health institutions at local level [17]. Following this, the Ministry of Health handed over 1433 health institutions to local health management committees, expecting changes in terms of decision-making power structure and accountability mechanisms. However, no noticeable changes have been observed, and the health system could not ensure the needs and utilization of health services, nor could it involve local people in decisions which have an impact on the health situation of the local community [11].
This study was carried out at two sites in Nepal: (1) the Chitwan district, which included district-level health managers and planners, and (2) Kathmandu, the capital city, which included national-level policymakers and planners. Because context has an effect on governance, these sites were chosen to compare the national urban setting (Kathmandu) with a district rural setting (Chitwan). The Chitwan district has a population of almost 580,000 and is a regional center for business and medical services. Hospital-based mental health services are being provided by government as well as private hospitals based at district headquarters. Mental health services in the community were non-existent until 2011; since then, a pilot community mental health program has been implemented in the health facilities of Chitwan through government-NGO collaboration [18].
Kathmandu city was selected to include national-level policymakers and planners working in the Ministry of Health, Department of Health Services, government hospitals and departments providing mental health services. In Kathmandu valley, both medical and psychosocial support is available through government as well as private sectors. Some NGOs and private groups provide residential treatment services for people with mental illness.
The sampling of respondents for the study was divided into two broad categories namely (a) district-level health care managers and planners, and (b) national-level policymakers. Purposive sampling was used to identify key informants based on their current role and position in mental health care policy development and management, and potential influence for future policy development. Based on the study team's knowledge, possible respondents were identified and approached. At the district level, health staff involved in mental health programs at the District Public Health Office (DPHO), district hospitals and primary health care facilities were approached for an interview. The selected district level participants (n = 11) included health managers such as medical superintendents, health assistants, public health officers and public health inspectors. At the national level, the research team decided to select participants from various professional backgrounds (clinical, human rights, law enforcement, health policy and planning, psychology and mental health research) relevant to mental health policy formulation. The selected national-level participants (n = 17) included: psychiatrists, psychologists, public health officers, under-secretaries from ministries, primary health care in-charges, human rights workers, a police officer, and a research officer who were involved in mental health policy and planning. Table 2 provides the characteristics of the respondents.
Table 2 Characteristics of respondents
A semi-structured interview schedule was developed guided by Siddiqi and colleagues' health system governance framework [1] and adapted to the Nepalese context. For the contextualization process, first the English questionnaire was translated to Nepali by two academic researchers. Then each question of the draft translation was discussed among the research team to determine whether or not the translation captured the real meaning of the question. Once the Nepali textual translation was agreed (consensus), an interview role-play on each question was done to explore the type of responses the question would generate. The validity of the translation was evaluated on two criteria: would the responses make sense in the study locations and were the responses valid for assessing the specific area of the governance framework.
The major areas covered by the interview schedule were: (a) service planning and management for mental health care integration, (b) human resources, (c) equipment and infrastructure for mental health care integration, (d) capacity-building needs, (e) laws and regulations pertaining to mental health, (f) funding, (g) monitoring of mental health policies and services, and (h) quality assurance and ethics.
A team of six experienced researchers (university-level education and average 3 years of research experience) collected data between March and June, 2014. All of them had participated in the translation and validation of the interview checklist and received a 1-week training on qualitative research methods, prior to data collection. In total, 28 interviews (of approximately 45 min to 1 h long) were conducted by visiting the participants at their work places. The interviews were audio-taped, transcribed and then translated into English by bilingual translators. The researchers made check for accuracy of this translation. As many participants made reference to national policies and provisions related to governance but did not know the details of such provisions, additional data was collected by reviewing relevant national-level policy documents. The findings of the document review were charted as per the governance principles and, where relevant, used to substantiate the arguments made by the participants.
Given the descriptive and exploratory nature of the study, we adopted a qualitative research methodology informed by a framework method of data management and analysis [19]. The five stages of framework analysis (familiarization, identifying a thematic framework, indexing, charting and mapping, and interpretation [20]) suited this study as the approach makes use of the priori themes identified by Siddiqi and colleagues' health governance framework.
A random selection of the transcripts were read separately by two researchers (DG and RP) who then generated broad themes and codes within the themes. To incorporate alternative viewpoints, the two sets of 'open codes' developed by the researchers were shared for 'peer-concept' validation with members of the EMERALD project who were involved in research design and data collection. Based on discussion of the preliminary framework, adaptations were made to develop a final analytical framework keeping the categories of Siddiqi and colleagues' framework as parent themes [1]. The transcripts were uploaded in qualitative data analysis software, NVivo-10. The analytical framework was applied to all the uploaded transcripts and, during the coding process, it was further refined. Using the framework matrix option in NVivo, the data were charted and summarized. The framework matrices were exported from NVivo to an Excel Spreadsheet and cross-checked by the researchers who were involved in data collection. When inconsistencies were noted, they were verified with original transcripts. The selection of text under each parent theme mentioned in the results section is based on the data derived from this procedure (Table 3).
Table 3 Mental health systems governance matrix for Nepal
Strategic vision and rule of law
Some respondents had the opinion that existing policies and plans related to mental health were not implemented in practice due to lack of leadership and infrastructure. The example provided by some of these respondents included the mental health policy of 1996 and the Nepal Health Sector Program II (NHSP II), which recommended the integration of mental health into primary health care. However, in almost all districts of Nepal, mental health services are not available from primary health care centers; even district hospitals in large parts of Nepal do not have mental health services. A national-level policymaker said,
"If you see Nepal Health Sector Program II (NHSP II), we have kept Mental Health as an important pillar in the Non-Communicable Disease chapter thinking that it is important component…..but we have not been able to move forward in this process as we had to…." (National Representative 02, Male).
This awareness of the non-implementation of NHSP II was particularly mentioned in relation to the failure to include mental health services within the Essential Health Care Services (EHCS) package, and piloting and scaling up of community-based mental health care. Likewise, a few respondents reported that NHSP II had the provision to appoint a focal point for mental health within the Ministry of Health (MoH), but no such focal point currently exists. Similarly, most of the national-level respondents mentioned that the non-communicable disease Multi-sectoral Action Plan (2014–2020) had the provision for the establishment of a mental health unit, but this also does not yet exist.
Some respondents mentioned that, in the absence of an official mental health act (despite the draft act being revised four times), many people with mental illness are suffering from the discriminatory provisions in other laws and legislation. A respondent from national level said:
"There still exists discriminatory provisions in existing laws such as Civil Code of Conduct, NGOs registration act. The discriminatory laws related to mental health should be removed. State should be playing the role of guardian and ensure the right of all the citizens including people living with mental illness" (National Policymaker 11, Male).
Most of the respondents found the government was not committed to mental health and, as a result, the situation has not much improved since 1996:
"No matter how much it [government] says that it isn't [the situation of mental health services], evidence shows that in 20 years it is still similar. Another thing is, generally, mental health problems are not visible. In our Nepal, they say in the villages that 'Ban dadheko sabaile dekcha, maan dadheko kosaile dekhdaina.' [Everyone will find out if the forest is burning but no one will find out if a heart is burning]" (National Policymaker13, Male).
Most respondents recognized this scenario for mental health as this has not been prioritized in Nepal. For example, respondents reported that there is no functioning unit or regulating mechanism of mental health in the MoH. Some respondents with a human rights background recommended revising the existing policy documents to include human rights perspectives and give priority to all forms of disability, including mental illness, so that mental health services are accessible to all, without discrimination. They stressed the importance of 'equality' in providing treatment and suggested policy provision for a human rights monitor to assess the situation of mental health services throughout Nepal. The policy provisions for psychosocial care for people with mental illness, and focus for gender issues and child mental health, were recommended by all the respondents.
Compared to other governance principles, transparency and accountability were much less discussed by the respondents. They either did not have information on these themes or they did not want to share this. The district-level policymakers did not clearly respond to questions regarding transparency of budget and decision making, and there were mixed responses from the national-level policymakers. A few national-level policymakers thought that there is transparency of the mental health budget since budgeting is done through participatory sharing and discussions, budgets are audited every year, and money is spent as directed by the law. However, other participants were of the view that the mental health budget was not transparent since it has not been allocated systematically and there is no public information on the budgetary decisions.
Some respondents who talked about transparency referred to it mainly in terms of budget allocation, budget expenditure and human resources management. A participant said,
"Since there is no clear budget allocation for mental health, it cannot be said that the programs and budget are transparent." (National Representative 05, Male).
In terms of accountability, this was defined by the participants as responsiveness on the part of policymakers and health care managers to meet the mental health needs of the population.
Monitoring of mental health services and policies
According to some respondents, there was no monitoring conducted and there was a lack of clarity as to who is responsible for this function. Most national-level respondents thought that the MoH was the responsible body for monitoring mental health policies and services. Others thought that monitoring was the duty of the Department of Health Services (DoHS). Some respondents identified a lack of qualified human resources, clarity of roles and tools for monitoring as some of the barriers to effective monitoring:
"We haven't been able to monitor all the organizations fully. This is one weakness. We aren't able to go to the field and do the monitoring. We are working on improving this part." (National Representative 15, Female).
Some of the respondents were of the opinion that if these monitoring and evaluation (M&E) structures could be oriented towards mental health, the monitoring of mental health services could be easily implemented on a regular basis. Respondents also identified factors that could enable monitoring of mental health services in the existing health care system. For example,
"Public Health Administration, Monitoring Evaluation Division under Ministry of Health monitors overall health system" and 'Integrated Supervision Program' does the overall monitoring and supervision of all health services in general." (National Representative 05, Male).
Responsiveness and integration of care
In some respondents' views, both responsiveness to the mental health needs of the population and integration of mental health in primary health care were ignored by the government. There is only one mental hospital at the central level, and respondents found that this was insufficient to cater for the needs of the country. One of the facilitating factors for responsiveness was reported to be the existence of the Good Governance and Management Act 2008, which has mechanisms redressing grievances at the national, regional, zonal and district level. However, some respondents were of the opinion that such mechanisms had not been practiced in the case of mental health. One national-level policymaker said:
"During the monitoring, no such type of mechanism was seen which listened to the complaints or grievances regarding mental health…" (National Representative 11, Male).
In the absence of proper monitoring mechanisms, some respondents found that the health facilities have not been accountable or responsive to the mental health needs of the population.
Participation, coordination and collaboration
Involvement in policy and planning
Respondents reported that, in recent years, the participation in mental health policy and planning of various stakeholders from NGOs, the private sector and the service user community has improved. MoH has been formulating draft policies related to mental health through consultation workshops and meetings. However, some of the respondents expressed that the participation of service users, their caregivers and district-level service providers in policy and planning remained limited.
There were diverging views and opinions about service users' involvement in policymaking. Some respondents found service user and caregiver involvement to be essential. For example,
"Without their involvement, policymaking would be incomplete." (District Representative 09, Male), "Since they are the one[s] who are facing the problem, their input is a must" (District Representative 01, Male), and "'Nothing about us, without us'. So I think participation will come as a first condition." (National Representative 11, Male).
Among those who stressed the need for service user involvement, some said that there should be criteria for selecting service users such that only those individuals who can contribute in policy and planning should be consulted.
There were also views that policymaking was not an ideal platform for service user or caregiver involvement. Some respondents thought that mental health policy development is the domain of mental health experts where service users have no role. A respondent mentioned,
"If we plan to involve them at the initial phase of policy making, then it would sound like, 'Tauko le Puchar hallaune ki puchar le tauko hallaune' [Whether head shakes the tail or tail shakes the head - it is always the head that shakes the tail, so that involvement of service users in policy and planning seem irrelevant]" (National Representative 09, Male).
Involvement in service delivery
Some district-level respondents found that involvement of other government institutions and NGOs in service delivery has improved, especially in programs run by NGOs in collaboration with government agencies:
"Service is delivered in consultation with sectors like VDC [Village Development Committee], police or teacher." (District Representative 09, Male).
However, coordination and collaboration with stakeholders in service delivery and service integration was thought to be insufficient by some of the district-level respondents. They suggested greater coordination and collaboration among schools, VDCs, NGOs and health facilities for integration of mental health services into primary health care.
Human resources capacity
Some respondents identified limited training of health workers in mental health and frequent transfers of health staff trained in mental health as two major problems in human resources for mental health. According to the respondents, the changes in the national government have brought about high staff turnover at district level, even before completing the mandatory 2 years of service in a place.
Lack of awareness and knowledge about mental health issues among health workers was seen by the respondents as another barrier. The respondents acknowledged that most health workers lacked this knowledge because their pre-service training did not cover mental health and even if it did, due to lack of practice, the health workers had mostly forgotten what had they learnt. One strategy suggested by several of the respondents to overcome this problem was task-sharing by mobilizing village-level health workers known as Female Community Health Volunteers (FCHVs). A district-level respondent said:
"Clients do openly share their problem [with FCHVs]… Since they work at community level, they are more aware of peoples who show abnormal activity." (District Representative 03, Male).
Budget allocation and utilization
Most of the national-level respondents said that the proportion of the health budget allocated to mental health has not been publicly stated. In addition, they said that a budget for mental health is allocated only for the mental hospital in Kathmandu and does not go to other hospitals or mental health programs. However, other national-level respondents mentioned that, as part of integrated health care programs, a budget for mental health is allocated to cover the cost of psychiatric wards in regional hospitals. Similarly, a few respondents mentioned that other ministries such as the Ministry of Peace and Reconstruction and the Ministry of Women, Children and Social Welfare are running psychosocial and mental health programs, and said that budgets allocated to these programs have not been accounted for in the total budget allocated to mental health. Still, respondents reported that, even including the budget spent by district and regional health programs and other ministries, the total budget allocated to mental health does not amount to more than 2% of the total health budget. This they found inequitable compared to the disease burden of mental illness in Nepal.
Supply of psychotropic drugs
Some respondents agreed that there was an insufficient and irregular supply of psychotropic drugs at the district level, which was attributed to insufficient budget and lack of prioritization for mental health. Some district-level respondents believed that other health needs, such as maternal and child health, take precedence over mental health and therefore, the purchase of psychotropic drugs are insufficiently prioritized. A district health worker explained:
"There is no provision of supplying additional drugs… It is even difficult to supply adequate amount of [general] medicine within our budget; in this case, if mental health drug is added, then the situation turns worse." (District Representative 01, Male).
Few psychotropic drugs were included in the free drug list, and only two to four drugs were available at the district level. Some district-level respondents criticized that the drugs allocation, coordinated centrally, did not meet the demand. For the effective management of drug supply, respondents recommended that there should be flexible and open policies that allow the districts to purchase the drugs that are needed, even if they are not included in the free drug list.
Equity and inclusiveness
Access to services
Some respondents felt that mental health services were not accessible to all. According to the respondents, services were mostly centered in Kathmandu and some urban areas. In addition, only limited services were available through the government health facilities. Some respondents mentioned that, along with geography and cultural factors, poverty and stigma associated with mental illness are major barriers for access to mental health services. According to these respondents, those who can afford it use modern treatment by traveling far distances, while those who cannot afford to travel 'outside of the community' visit traditional healers in their own community. A participant reported,
"Sakne Raja ko ma janu nasakne deutako ma janu' ['Those who can, they go to the King and those who can't go to God']. While doing the treatment, it is similar thing. Those who can afford, go to medical doctor and those who can't, go to traditional healer." (National Representative 13, Male).
In order to increase access to mental health services in the community, some respondents suggested that the health workers should be provided with training and supervision in mental health and that anti-stigma programs should be implemented in the community. A district-level policymaker said,
"To reduce stigma and discrimination, community-level health workers can be involved because they are directly in touch with the community … They can play a vital role in the rehabilitation process." (District Representative 06, Male).
Some respondents thought that involvement of service users was essential to reduce stigma. According to a district-level policymaker, people, who had mental health problems in the past, but are no longer suffering from mental illness, need to be provided with training on mental health and mobilized as trainers:
"With the known trainer, they develop trust about what s/he just mentioned because they knew s/he had been a sufferer in the past." (District Representative 02, Male).
Respondents were asked whether ethics were applied during mental health research and service delivery. Some of them said that there were no mental-health-specific ethical guidelines; however, general health ethics were applied for both mental health research and treatment provisions. For example, for mental health research, ethical approval must be obtained from the Nepal Health Research Council (NHRC) where proposals are evaluated against general health research ethics. Likewise, the MoH, while regulating health service delivery, also monitors whether or not mental health services are provided in an ethical manner. A few respondents said that if complaints of human rights violation of patients arise, then the MoH addresses such issues. A participant mentioned,
"If any cases regarding violation of rights of the patient comes, then ministry forms a committee to address the issue and based on the report of the committee it takes necessary actions." (National Representative 05, Male).
Mental health information system
The lack of data on the prevalence of mental illness was identified by some respondents as a barrier to prioritizing mental health and allocating necessary resources. A national level representative said:
"As no research [at national level] has been conducted, we do not have background information. So we are not aware of our priority. Government can develop priority area with the help of research of community status." (National Representative 08, Male).
Many respondents lacked knowledge about the types of mental health information available from the Health Management Information Systems (HMIS). Those who were aware raised questions about the quality of record and use of the data gathered. A respondent said,
"I don't think we have good monitoring system… it is haphazard." (National Representative 01, Female). Another participant said, "case incidences and prevalence are never discussed nor are meetings conducted for discussion." (District Representative 03, Male).
Strategies to improve record keeping were suggested by a few of the respondents. They recommended: the development of new mental health indicators similar to the Integrated Management of Childhood Illness (IMCI) indicators and clarity on roles and responsibilities related to record keeping, data analysis and utilization. Another suggestion was to strengthen existing HMIS sections to better manage mental health-related information.
The findings revealed a few enabling factors and many challenges in mental health systems governance in Nepal, as reported by health care policy makers and managers. The enabling policy factors included constitutional provision for health as a human right, inclusion of mental health in the government's 5-year health plan, provisions for mental health care in the recent National Health Policy, and inclusion of mental health care in the Non-Communicable Disease Multisectoral Action Plan. Other facilitating factors came from increasing participation of NGOs and service user organizations in policy forums, and implementation of mental health care projects in Primary Health Care Centers through government-NGO collaboration.
Policy challenges included non-implementation of mental health policy of 1996, lack of a mental health act despite a fourth revision of the draft, and lack of district-level consultation and participation for mental health policy formulation and planning. Other limiting factors included the inadequate mental health care human resources, inequitable allocation of budget to mental health care, lack of mental health services at the district and primary health care level, inadequate supply of psychotropic drugs, poor mental health care recording systems and insufficient infrastructure for delivery of mental health and psychosocial services. The application of Siddiqi and colleagues' health systems governance framework has identified the need for: (1) proper implementation of existing policy provisions by assigning dedicated leadership and ensuring governance procedures and mechanisms at the ministry level; (2) greater coordination and collaboration within and outside the health sector through a systems thinking approach; (3) the restructuring of the current health system to better integrate mental health into primary health care; and (4) development and implementation of accountability and transparency measures both at national and district levels. These four domains of needs will be further explained below.
Implementation of existing mental health policy provisions
Having policies on paper is insufficient; the proper implementation of such policy provisions is needed to ensure access and utilization of mental health services and to reduce the treatment gap. Proper implementation is only possible when governance structures and mechanisms are in place, and there are dedicated people to implement these governance structures. Therefore, good governance is necessary for ensuring effective health care delivery [21] and policy implementation [22].
Good governance is feasible when there is a strong leadership. The absence of such leadership (e.g. through a mental health unit) and lack of clear mental health governance structures in the MoH has prevented the implementation of available provisions in national mental health policy. Greater clarity on mental health governance structures would not only help improve intra-and inter-ministerial coordination but also provide platforms for debate and improvement in mental health provisioning. To achieve this, NGOs and the private sector could play important catalyst and advocacy roles for establishing a central coordination unit for mental health [23]. Many countries affected by conflict and disasters have seized opportunities (during and after the emergency) to make systemic changes in their national mental health systems [24]. The example of Afghanistan shows that NGOs and external development partners played a crucial role in the development of a mental health department there [25].
Coordination and collaboration
The findings of this study suggest that government institutions work in isolation with regard to mental health care, and coordination with other relevant stakeholders within and outside of MoH is very limited. As there are no or few staff assigned to mental health within the MoH, no one appears to assume responsibility or accountability with regard to mental health care.
The study participants identified that, due to the lack of proper policy direction and guidance from policymakers, there are delays in budget release, which affects the timely training of health workers and the distribution of psychotropic medicines to rural areas. Consequently, patients do not receive medicines on time. Impoverished patients then relapse, and while those who can afford to pay (or borrow) for private practices increase their financial burden. Due to these and many other governance-related factors, the patients and their family members lose confidence in the public health system. To change this situation and regain the trust of patients and their family, there is a greater need for intra-and inter-ministerial coordination and collaboration. As mental health care issues are cross-cutting, we argue for a 'systematic' approach for coordination, not only among and across health system building blocks [26] but also beyond the health sector [27], in identifying and addressing barriers to health systems performance in order to improve governance and overall mental health care in Nepal.
Restructuring the current health system to better integrate mental health
Although the mental health policy and Nepal Health Sector Plan-II promote integration of mental health into primary health care [11], policy provisions have not been applied in practice due to the lack of mental health governance mechanisms at the national as well as the district level. Development of district-level mental health governance is needed to bridge policy and practice. For example, one public health officer from the District Public Health Office could be assigned as a mental health focal person to plan and coordinate all district-level mental health activities. Also, a greater emphasis on community mental health programs can help to deinstitutionalize mental health care [28] and increase awareness among community members, thereby helping to reduce stigma related to mental illness.
As there are relatively few psychiatrists in Nepal, it would not be realistic to deploy them in all 75 districts of Nepal. Therefore, while restructuring the current health systems, Nepal needs to adopt a task-sharing approach [29, 30]. This would mean that prescriptions and medications can be managed by primary health care workers, as suggested by the Mental Health Gap Action Program [31], while identification and referral of people with mental illness can be done by Female Community Health Volunteers (FCHVs) [14].
Despite the challenges related to the overburdening of health volunteers and primary health care workers [32], we argue that integration of mental health into primary health care centers is now feasible, because of the enabling factors that are in place. For instance, existing policies promote integration of mental health into primary health care [11], the government has recently included six psychotropic drugs under the free essential drug list, efforts are under way to develop standardized mental health training manuals, and currently the Health Management Information System (HMIS) has procedures to collect mental health data. The additional cost needed for integration is low and may require only a few weeks of mental health training and quarterly supervisions by psychiatrists.
Accountability and transparency for better health system performance
The lack of accountability and transparency measures in place, limited access to health services by poor and marginalized groups, and limited engagement and participation of citizens in health affairs are pertinent health governance issues that contribute to low levels of systems effectiveness [11]. Therefore, improved accountability is an important prerequisite for improved health systems performance [33]. However, study findings suggest that concepts such as transparency, accountability and responsiveness are less developed in the field of mental health in Nepal, and there is lack of clarity as to who is responsible for monitoring mental health services and systems. Hence, there is a need for a structure at each health care level that clarifies roles and responsibilities and to ensure transparency and accountability [12]. Likewise, in order to ensure transparency in budget allocation and decision making, we argue that a system of mental health budget planning needs to be instituted and the capacity of existing HMIS needs to be strengthened. Similarly, grievance redressing mechanisms of the Good Governance and Management Act need to be strictly implemented so that the system becomes accountable and responsive toward the needs of the population.
The results from this study are not easily generalizable to all areas of Nepal; this is because of the presence of a mental health program in the district where interviews were conducted, which is different to many other districts where no mental health services are available. However, the results are indicative of future challenges and solutions that other districts might encounter if mental health programs develop without strengthened governance. Also, in the absence of a mental health policy body at the MoH, and lack of clarity on who are the policymakers for mental health in Nepal, the selection of respondents might have introduced bias. To minimize selection bias, we took a systematic sampling approach in order to represent different stakeholders and institutions potentially involved in mental health policy. Since policymaking is led by government staff, we only included government policymakers currently serving in office. Thus, the results do not capture the views of retired government staff or people from NGOs and the private sector who might have had a significant role in mental health policy making, and we suggest that future studies could assess mental health governance from the perspectives of other stakeholders. One of the limitations of the study is that the inter-rater reliability was not explicitly considered as all the researchers worked on the development, translation, contextualization and pre-testing of the interview checklist. Another limitation of the study is that, due to the small numbers of respondents for the national and district levels, it was not possible to discuss the findings per sub group. As power and prestige play an important role in Nepalese government systems, the power hierarchy between the policy makers and researchers might also have influenced the kind of data being collected and reported.
The findings of this study suggest that, despite having some facilitating factors, there is a lack of legal provisions for mental health as well as non-implementation of existing policies, due to the absence of leadership at the Ministry of Health and lack of governance mechanisms for mental health. Hence, mental health systems governance in Nepal faces many challenges and needs greater resource inputs and leadership to overcome these challenges. Some positive developments are seen in terms of policy recognition for mental health, as well as participation of NGOs, and some service user groups, in mental health policy and planning. However, many governance principles related to transparency, accountability, ethics, responsiveness and equity are still underdeveloped and need greater attention. Likewise, the lack of trained human resources, frequent relocation of trained health workers, inadequate budget allocation, insufficient infrastructure, poor record keeping, and stigma related to mental health are some of the barriers which need to be addressed through proper governance mechanisms at the national and district level.
DOHS:
Department of Health Services
DPHO:
District Public Health Office
EHCS:
Essential Health Care Services
EMERALD:
Emerging Mental Health Systems in Low- and Middle-Income Countries
FCHVs:
Female Community Health Volunteers
HMIS:
Health Management Information Systems
IMCI:
Integrated Management of Childhood Illness
MoH:
NCDs:
NGOs:
NHRC:
Nepal Health Research Council
NHSP:
Nepal Health Sector Program
VDC:
Village Development Committee
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NU participated in study design, supervision of the data collection and data analysis, and drafted the manuscript. MJ and IP designed the study, supervised the whole research process and reviewed the manuscript. RP, DG and RPA were involved in data collection, data analysis and review of the manuscript. IHK reviewed the manuscript. All authors read and approved the final manuscript.
The authors would like to thank Mr. Shree Niwas Khanal, Mr. Nagendra Bhandari and Ms. Jananee Magar for their support in collecting and transcribing the data. We would also like to thank Ms. Helen Fry and Ms. Laura Cole for reviewing the manuscript.
As this paper is based on a study conducted as part of multi-country consortium project, the decision regarding when and where to make the data available has not yet been discussed. Thus, at this moment, we are unable to specify the location where the data supporting our findings can be found.
Ethical approval for this study was received from the Nepal Health Research Council (NHRC) with registration number 175/2013. The transcribed copies and audio tapes were stored in a secured place. Before the analysis, all identifying data were removed. The participants were informed about the nature and objectives of the study, and written consent was obtained from each of them.
The study was funded by the European Union within the Seventh Framework Program (Grant Agreement Number 305968).
Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
Nawaraj Upadhaya, Ruja Pokhrel, Dristy Gurung & Ramesh P. Adhikari
Department of Research and Development, HealthNet TPO, Amsterdam, The Netherlands
Mark J. D. Jordans & Ivan H. Komproe
Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Mark J. D. Jordans
School of Nursing and Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
Inge Petersen
Utrecht University, Utrecht, The Netherlands
Ivan H. Komproe
Nawaraj Upadhaya
Ruja Pokhrel
Dristy Gurung
Ramesh P. Adhikari
Correspondence to Nawaraj Upadhaya.
Upadhaya, N., Jordans, M.J.D., Pokhrel, R. et al. Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study. Int J Ment Health Syst 11, 37 (2017). https://doi.org/10.1186/s13033-017-0145-3
Mental health system
Low- and middle-income countries


Employment Blog - Is obesity on its own, capable of being a disability?
Home / News & Blogs / Employment Blog - Is obesity on its own, capable of being a disability?
2 that obesity is a form of "disability" so that discrimination on the grounds of obesity is prohibited.
The Advocate General found against Mr Kaltoft in respect of point 1. He then went on to consider point 2.
The opinion considered whether obesity, without more, fell within the definition of disability. The outcome of his consideration on the point was that, in certain circumstances, it could.
If an individual has a body mass index of 40 or more and as such classified as "morbidly obese" they may be disabled if obesity has a real impact on their ability to participate in work. Of course, if the obesity does not have a real impact on their ability to participate in work it will not amount to a disability.
So what does this mean for an employer?
If an employee is disabled by reason of obesity then the duty to make reasonable adjustments will arise in the usual way. Reasonable adjustments could include larger seats, parking near to their place of work or roles that require less mobility.
That said it is important to keep the point in perspective. Obesity is not a protected characteristic in itself and accordingly an employee cannot claim they have been discriminated against simply because they are obese. They would need to be disabled by reason of their obesity, and be discriminated against because of that disability, to have grounds to bring a claim.
Further, the employee does need a body mass index of more than 40 before obesity in itself can amount to a disability in itself according to the Attorney General's opinion. Accordingly, there are likely to be fewer people who will fulfil the criteria than it may first appear.
Whilst the point is certainly one to bear in mind, we do not consider that it is likely to have significant or far reaching consequences for the majority of employers.
The ECJ still have to rule on the point. They usually follow the opinion of the Advocate General but not always. We expect judgment in around 4 – 6 months.


text:
Google's Waze acquisition could be in danger because of risky filing tactics
- Jun. 19th 2013 6:57 am PT
The idea that Google could lose ownership of Waze less than ten days after buying it for a rumored billion dollars might sound incredible, but that's the intriguing possibility raised by a law professor from Ohio State University writing in the New York Times.
The law requires companies to make what's known as a Hart-Scott-Rodino filing for any intended acquisition so that the proposed deal can be checked for anti-trust issues before it takes place. Google apparently didn't make this filing.
According to a person close to Google, the company skipped the Hart-Scott-Rodino filing by relying on an exemption. This filing is not required if the acquisition is of a foreign company that has sales and assets in the United States of less than $60.9 million. Waze is an Israeli company with headquarters in Silicon Valley, so it comes under this test.
Waze probably doesn't have $50 million in revenue worldwide, yet the test also looks at assets. Given that Waze is worth $1 billion, it is hard to see that the value of its intellectual property in the United States business doesn't meet the test. And the F.T.C. has previously indicated that companies should include this type of intellectual property in informal guidance …
Professor Steven M. Davidoff at the Michael E. Moritz College of Law at Ohio State University says that as both Facebook and Microsoft were both reportedly in the bidding, Google may have wanted to close the deal as quickly as possible on the 'easier to get forgiveness than permission' principle. Prof Davidoff says this was a risk.
But given the publicity over the acquisition, the government will almost certainly step in to review. Consumer groups are circling, and the Consumer Watchdog Group has written the government to ask for an in-depth review. […] As with previous deals, the government can force Google to sell Waze, or put other restrictions in place, if there is a problem. […]
At the least, this all means that the Waze acquisition is likely to get a thorough review by the government. The battle will now begin. That Google will keep Waze without restrictions is no certainty. But the government faces a challenge. If it does decide to try to unwind this acquisition, Google is going to push the bounds of the law as hard as it can. The future of map search is at stake, and Google may not be evil, but this is business.
Should be an interesting one to watch.
(Via Techmeme.)
Waze is a third-party navigation application that is owned by Google. While using Maps' traffic data, Waze features unique tools that help identify objects in the road, police activity, and more.
Google acquisition of Waze
Google's regulatory challenges


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Firmware is the software that the iMIV and MII devices use to operate. Similar to an operating system such as Windows XP or Mac OSX, but much more simple. This can be changed by uploading different firmware files to the device. This can be done at the time of purchase for a small charge, or by yourself by downloading the firmware for free from our website.


How do they do it — cover entire buildings with bamboo scaffolding, like a network of spiders engulfing a forest, with little to no tools other than thin strips of black plastic to hold it all together, and little to no safety equipment? It always makes me whip out the camera to take a shot of it. No matter how high the building, the bamboo boys can erect that scaffolding — half the time with no shoes on, and a cigarette in their mouths.
So why bamboo? Simple really — it's sturdy, flexible to sway with the wind, lightweight to pass up and down the assembly line of bamboo boys perched on a ladder, and of course cheap and plentiful. Amazingly, the bamboo scaffolding can even be set up outside of just one window of a building!
This is why it's important, when moving in to a new place, to make sure it is not scheduled for any kind of renovation. Because you can end up looking at nets and bamboo for months on end after moving in!
Hi Peter, I don't have any fancy devices to be honest, just regular old point and shoot cameras. Haven't even got a long lens!