The California and Vermont senators have raised more than any other candidate who has thus far divulged fundraising totals. What's still not known is how much these campaigns spent.
Two major Democratic presidential candidates announced their first quarter fundraising hauls this week, setting the bar for their competitors in the process.
Sen. Kamala Harris (D-CA), who announced her candidacy at the end of January, said her campaign raised $12 million from more than 218,000 contributions.
In a news release, Harris said she had received 218,000 individual contributions during the first quarter and 98% percent of those contributions came in amounts smaller than $100. Small-dollar donors could prove crucial in a crowded Democratic primary because they can be tapped repeatedly for contributions before hitting the $2,800 limit on what an individual can donate to a candidate for the primary election.
Harris' aides say that more than 99% of her current donors can contribute again without hitting the limit.
Sen. Bernie Sanders (I-VT), meanwhile, said his campaign raised a whopping $18.2 million in Q1 of 2019. Sanders officially launched his bid in mid-February, giving him about a month and a half to raise these funds. His campaign had previously disclosed that the campaign raised $5.9 million on his first day in the race and more than $10 million within the first week.
Sanders' first-day haul was only eclipsed by one candidate, former Rep. Beto O'Rourke (D-TX), who raised $6.1 million in his first 24 hours. O'Rourke's campaign has not disclosed his Q1 total yet.
South Bend Mayor Pete Buttigieg's (D-IN) campaign said it raised $7 million in the first quarter of the year. While he trails Harris and Sanders, Buttigieg's total is viewed as a strong showing for a little-known Democratic candidate.
Meanwhile, news broke Monday Sen. Elizabeth Warren's (D-MA) finance director quit the campaign after a "heated" argument over fundraising strategy. While that argument took place in February, it's not clear when the finance director quit, but the timing of the news breaking is raising questions about whether Warren's fundraising total will be on part with her fellow candidates.


text:
Q: How do I extract a .tar file on Azure File Share on Ubuntu 18.04? I have a virtual machine in Azure running Ubuntu 18.04. On this machine, I have mounted an Azure File Share as a file share.
Now I'm looking to extract a large file on the mounted drive and it fails. I'm logged in with an admin account.
/mnt/folder/data$ tar xvzf data.tar.gz

The following error is thrown:
tar: Cannot utime: Operation not permitted

How do I change the permissions on Azure File Share to allow .tar files to be extracted when the admin account is logged in?

A: As far as I know, it is not possible to extract files inside a storage account. But you could created a script which extracts the files on you machine and moves them back to the storage account.

redpajama_set_name: RedPajamaStackExchange


Mount an elegant custom laser-engraved wooden nameplate on the boat you've built! Your boat's name will be laser-engraved from 1/16-inch Cherry material.
We have two sizes to choose from. Make your selection from the dropdown.
You can epoxy the nameplate anywhere on the boat you like: on the deck or aft bulkhead of a kayak, or on the inside or outside of the transom of a rowing or sailing boat, for example. The plate will hold up a long time unprotected, but coating it in epoxy and varnish will guarantee it lasts as long as you and your heirs do. The plate may be inlaid if you prefer. It can also be fiberglassed over for additional durability.
When you order, type your boat name in the "Special Instructions or Comments" field on the final checkout screen -- we cannot process your order unless you include this information.
Please keep to about 15 characters for your boat name. And please be absolutely clear about how you would like the text to appear (uppercase, lowercase, spacing, etc.).
Note: This item is drop-shipped, and will arrive separately from other items you order. Your custom nameplate should arrive in 2-3 weeks.


Do you of all time have worry fashioning talk next to others even although you think yourself to be an quick person?
If so, this may brainteaser you. You may reflect on why you are so broke at production speech communication beside others, even yet you are massively smart, and cognize a lot of exciting material possession.
The evidence is that more mediocre citizens near border line ability and mediocre interests are more higher at making elfin speak and have recovered communal skills than race who are markedly quick.
And oodles inhabitants who are extraordinarily natural are utterly poor at production minute discuss voice communication and may have poor municipal skills.
1.) They may be perfectionists. These society may have particularly lofty expectations of themselves nearly everything they do. When they reflect they have substandard at anything, they regard as being themselves deeply harshly. If they construe they are unsuccessful at puny talk, they a moment ago get even more than twitchy and tongue tied. Their unpleasant self judgment makes them so uneasy that they cannot unbend and simply soak up one next to another culture.
2.) People who are especially run may have fatigued supreme of their existence hard to become extremely intellectually developed, but sometimes they failure to come along their universal and heated broadside. They may grain that emergent their municipal and intense on the side is not deeply important, or they may touch that it is too delayed to try revise these new knotty skills.
3.) They may be really critical culture and understand that they should lonesome spend their clip reasoning give or take a few solemn matters and speaking just about real matters. They may imagine that speaking around unessential material possession is a misuse of juncture. This makes them get tired drastically speedily near midget collaborate that doesn't appear to front everywhere.
4.) In both cases, culture who are smarter than intermediate in fact discern top-flight to others and acknowledge they should not have to refuse their occurrence next to mediocre inhabitants having intermediate conversations. They may truly really be snobs at suspicion.
5.) Many extraordinarily innate family see from too much shyness or from penniless same regard. This may origination them to have a feeling that they have cipher absorbing or worthwhile to chip in to a spoken communication.
6.) Some unbelievably agile people, particularly those who are intoxicating in irrefutable and algebraic skills may have a prerequisite titled Asperger's composite. This pattern which is believed to be connate to autism, shows itself in masses nothing like ways. Often, the causal agency who has some scope of Asperger's is extraordinarily bully at concentration on a quantifiable topic, but is inept to think through the kinds of public interactions that maximum other inhabitants yield for acknowledged. People with Asperger's may reach a deal in a rigid, mechanic way, and be uninterested in different people's intense lives.
No substance how intelligent a someone is, a removal of public skills can be full of them backbone in their common go and their career.
So if you are one of those inhabitants who is fairly smart, but has problems next to common skills and beside devising pocketable talk, what should you do?
First, you must ask yourself whether on an upward curve your social skills is something that you genuinely privation to do.
If the response is really no, consequently you don't call for to work on testing to improve this unique endowment.
However, if the response is yes, the redeeming word is that you really can alter your informal skills and your quality to savour miniscule talk, and have enjoyable communal dealings with others.
However, you will entail to kind a indisputable earnestness to up your skills in this area, and you will have to preparation speaking beside others and fashioning friends.


We strive to achieve the highest levels of satisfaction for business partners, customers and employees, create value for customer services, implement state-of-the-art technology, global expertise and efficient resources to build local and global business partnerships and maintain a secure and secure environment.
From the beginning, the Arab Web Academy has built a product that is used by multiple segments of customers. The product support environment of training, technical support, consulting and product development technology has been built on a regular basis while meeting the demands and growth of the labor market and developing the surrounding environment product to enhance its sustainability,.
Build an Arab company working in the field of industry and software development by international standards.
Provide software solutions for various fields and according to the latest technologies used globally.
Development of performance and productivity improvement in various Arab enterprises.
keep up with the constant development of systems to meet the requirements of customers.
To contribute to the promotion of investment and assistance in the training and operation of human resources and linking them to the labor market.
In the Arab Web Academy, We make technology as the origin of the company, facilitating the facilitation and streamlining of business with the highest efficiency and quality, using a harmonious working team that combines two important elements that are vital to the market.
First: Young people who are able to create the best and easiest solutionsSecond: the experienced staff who lead the company to achieve the short and long term goals and also enhance the added values of our customers.
We are keen to grow your business as it leads to the growth of our company. The success and development of our clients' companies and institutions is a measure of our success in our mission.
We work hand in hand to support the growth and development of information technology We are keen to grow your business as it leads to the growth of our company and we work together in a policy to support the growth and development of information technology.
Arab Web Academy is a leading Arab-Egyptian company providing specialized services in the field of information technology, especially the field of designing specialized software development and support, designing, developing and hosting websites - specialized training in technical fields.
In our field especially every second passing means new technology and to keep pace with this development you must have specialized teams of expertise and qualifications that support you in keeping with this development.
Since its inception, Arab Web Academy has been committed to providing solutions and systems in the field of information technology to help its clients to promote their companies and achieve a high return on their investments.
As customers began using our products, the company achieved the confidence of its customers in several sectors as a result of: meeting their commitments, positive interaction with customer and market needs, and flexibility in developing systems continuously .
Our staff is highly skilled , uniquely trained and Cooperate with each other to deliver best service.
we share a mutual passion for technology and doing excellent work for our clients and partners. We pride ourselves on our strategic, integrated approach to public relations and the results it delivers .
We work hard to meet our customers' needs while providing the best service. If you're looking for quality Service made right here in Egypt , you've come to the right place.


The Russian manned transportation spacecraft Soyuz TMA-08M has docked with the International Space Station (ISS).
Approach to the space station, fly-around maneuver, stationkeeping and docking were performed normally, in automatic mode.
The initial contact with the docking port on the research module MRM2 Poisk of the Russian segment of the ISS occurred at 06:28:22 Moscow Time.
After a leak-check of the spacecraft compartments and the docking interface, equalization of pressure between the space station and the spacecraft, the transfer hatches were opened. The spacecraft crew transferred to the Russian segment of the ISS.
A joint international crew of the 35-th Expedition (ISS-35) began its work on-board the space station: cosmonauts Roman Romanenko, Pavel Vinogradov, Alexandr Misurkin (Roskosmos), astronauts Thomas Marshburn and Christopher Cassidy(NASA), Chris Hadfield (Canadian Space Agency).


text:
Q: How to print a double quote using a Zebra printer with EPL? In Java, I want to print a label with a String as the input:
 String command
            = "N\n"
            + "A50,5,0,1,2,2,N,\"" + name + "\"\
            + "P1\n";

But when the input (name) has a double quote character ("), it is blank and prints nothing. I have tried using the replace function:
name.replace('"', '\u0022');

but it doesn't work. I want that double quote printed in label, how can I do this?

A: Sending the " character in the text field of the EPL string makes the EPL code think it is the end of the string you are trying to print.
So, if you want to send(and print) "hello" you have to put a backslash before each " character and send \"hello\"
You also have to do that for backslashes.
So, your (EPL)output to the printer  would have quotes to begin and end the string, and \" to print the quote characters WITHIN the string :
A30,210,0,4,1,1,N,"\"hello\""\n
Also remember you have to escape to characters to build a c# string so in c# it would look like this:
outputEPLStr +=  "A30,210,0,4,1,1,N,\"\\"hello\\"\"\n";
[which contains 6 escaped characters]

A: Couple of points:

*

*replace method returns back string after replacing so you should expect something like:
command = command.replace...

*quote has special meaning and hence needs to be escaped in Java. You need the following:
name = name.replace("\"", "");
String command
    = "N\n"
    + "A50,5,0,1,2,2,N,\"" + name + "\""
    + "P1\n";
System.out.println(command);


This is one of several 1950s era color slides that former mayor, Bruce Gunn gave us in 2015. We revisit this one because we could use a hand with tracking down some more information about the brick building in the background.
Show your age and tell us the name of the building. It sure has changed a lot in 60+ years (haven't we all?).
Quite a few local businesses have set up shop there over the years. Jason Cioci of Riverton Health & Fitness asked if we could tell him more about the history of the building.
So let's crowdsource this project – kinda like GoFundMe, but send information and photos, not money.
What recollection do you have about business from back in the day?
Please add your comments (see the link at the very bottom of this post) or contact us if you have a scan, photo, or document we can post.
Thank you to Christine Jones-Williams, James Lockhart, Bill Moore, Rob Gusky, Jim Lockhart, Cara Vandy, Matt Mlynarczyk, and Christopher Ford who checked in and told about a memory they have of the Collins Building.
We shall add pictures of the Collins Building to our TTATA (things that aren't there anymore) Wish List.
Christine Jones-Williams: I remember Mary Lou's. She sold just about everything, but what she was most famous for was the penny candy.
Christopher Ford: Although I have vague memories of a lumber store in the upstairs (and a lift?) where my father would take me when I was very young, my clearest early memories were of Mary Lou's Shop, where I would go spend my allowance on bowls of candy. I'd then dump the candy on the "counting counter," where Mary Lou would add up the total cost and put it in a small brown paper bag.
After Mary Lou retired and closed her long-running store, I got my first real job at Barbara Drumheiser's Victorian Thymes, where I could still get my candy fix, and where I got my lifelong love of coffee and fine food. During work I'd get my lunch next door at Beverly's D&D Deli.
Mary Lou's Shop sure left an indelible impression on some folks! Also mentioned were Deckards?…Deckers?…and later Bosch's, Freddy's Barber Shop, and my personal favorite – Victorian Thymes. What was that Oscar Wilde quote that owner Barbara Drumheiser displayed over the entrance?
An earlier generation might recall Karl Frank's Meat Store, Hullings & Son Plumbing and Heating, The Jersey Fruit Cooperative, The Riverton Meat Market, The Christian Science Reading Room, or the J.S. Collins & Son Coal and Lumber. What other businesses have resided there over the years?
Whether your "good ol' days" are 25, 50, or 75 years old, it's all still Riverton history.
Thank you for adding your voice to rivertonhistory.com.
Look for more information here as we develop this story on the Collins Building. And don't take any wooden nickels.
My recollection of the _inside_ of the Collins store coincide with Billy Moore's. There was a long counter at the left; and yes, it was a hardware store of sorts, though I think their target customers were tradespeople.
I remember the stores there in the 1980s being (from the left) the barber shop, Christian Science Reading Room, Mary Lou's, Deckard's, and Mr. Bill's Bikes. My mother, Mary Vandy (nee Bishop), remembers it from the 1940s/1950s as the barbershop, the reading room, Mrs. McClellan's Mercantile, Mr. Frank's Grocery, and Collins's lumberyard and hardware.
I remember my folks taking me to Collins around 1970 to buy food for my pet rabbits and ducks, as well as buying candy at Mary Lou's. She sold these little orang flavored jelly candies that were lightly covered powdered sugar to prevent them from sticking together). I also recall Watkin's Furniture that was located on the second floor of the building. You entered a stairwell on Harrison St.to get to the shop. The owner, Ron Watkins, cleaned out a lot of estates (including my grandparents') and sold used furniture and whatever he found in the estates that had value.
Next Next post: Who likes a puzzle?


DALLAS, NOVEMBER 22ND, 1963. Wayne Tedrow Jr has arrived to kill a man. The fee is $6,000. He finds himself instead in the middle of the cover-up following JFK's assassination. There follows a hellish five-year ride through the sordid underbelly of public policy via Las Vegas, Howard Hughes, Vietnam, CIA dope dealing, Cuba, sleazy showbiz, racism and the Klan. This is the 1960s under Ellroy's blistering lens, the icons of the era mingled with cops, killers, hoods, and provocateurs. The Cold Six Thousand is historical confluence as American nightmare. Fierce, epic fiction. A masterpiece.


Sorting names makes customer records easier to find and organize.
The MySQL query language works in that it constructs data records by selecting data from already existing data records. Many people use MySQL databases to power marketing and sales websites, particularly small businesses who need a free and supported database solution. These websites are usually built with a combination of PHP and MySQL. To determine how quickly MySQL queries execute, it is best to open the MySQL command console and test them out.
Enter your MySQL command console.
Jackson, G.S.. "How to Test MySQL Script Speed." Small Business - Chron.com, http://smallbusiness.chron.com/test-mysql-script-speed-46992.html. Accessed 18 April 2019.


We're trying something new at Motor City Soap this holiday season and taking pre-orders leading up to the busiest time of the year!
Collect your soaps and enjoy!
If you'd like to reserve your soaps now, visit our pre-order form at http://bit.ly/motorcitypreorder to get started!
Contact us with any questions at info@motorcitysoap.com or 313-757-2129.


text:
Memo to Members
Senate Banking Committee Holds Hearing on CARES Act Implementation
The Senate Committee on Banking, Housing, and Urban Affairs held a remote hearing regarding "The Quarterly CARES Act Report to Congress" on May 20. Treasury Secretary Steven Mnuchin and Federal Reserve Chairman Jerome Powell offered testimony and answered questions on the efficacy and implementation of financial programs created by the CARES Act in response to the COVID-19 pandemic.
In his opening remarks, Ranking Member Sherrod Brown (D-OH) called for more aid to low-income essential workers and their families. "As essential workers go home to their families after a long, stressful day, they're wondering how they're going to pay the rent, or how they're going to afford another week of groceries," Brown stated. "If Congress does not act now to put money in the hands of the people who actually power our economy – in workers, their families, and Main Street businesses in struggling communities – we risk making the economic crisis worse."
Senator Doug Jones (D-AL) thanked Secretary Mnuchin for Treasury's willingness to begin issuing debit cards to individuals who are otherwise unable to receive economic impact payments. Senator Jones asked the Secretary if he would commit to requiring collection of demographic information for Paycheck Protection Program recipients to increase the program's transparency, after widespread reporting that the loans are being distributed inequitably and locking many minority-owned businesses out of the program. Secretary Mnuchin answered that Treasury has "been advised to make [collection of demographic information] optional and not mandatory, but [they] very much hope people provide that [information]."
Senator Tina Smith (D-MN) highlighted the long-standing challenge of affordable housing supply, questioning Chairman Powell on how this crisis would impact the housing market for both homeowners and renters. Powell expressed serious concerns about the increasing volatility of the housing market in response to this crisis but said the Federal Reserve could do little to address housing affordability.
Watch a recording of the full hearing at: https://bit.ly/36uzcA1
Join NLIHC's National Call on Coronavirus, Disasters, Housing, and Homelessness Today at 2:30 pm ET
Join today's (January 11) national call on coronavirus, disasters, housing, and homelessness at 2:30-4 pm ET. We will hear from Senator Sherrod Brown (D-OH), incoming chairman of the Senate Banking,…
Recording Available of NLIHC's January 4 National Call on "Coronavirus, Disasters, Housing, and Homelessness"
During last week's national call on coronavirus, disasters, housing, and homelessness, we shared insights on the housing provisions included in the recently enacted coronavirus relief bill and…
Additional Coronavirus Updates - January 11, 2021
Updated NLIHC Resources NLIHC FAQ: Emergency Rental Assistance: This FAQ provides additional clarity on duplication of benefits. Individuals living in federally assisted housing, such as households…

redpajama_set_name: RedPajamaCommonCrawl


Christie Dawes scored a breakthrough victory while fellow Australian Kurt Fearnley suffered a rare defeat at the 10km world wheelchair road race championships in the United Arab Emirates.
Four-time Paralympian Dawes (NSW) led home a surging pack to win in 23 minutes and 58 seconds, finishing less than a second ahead of American Shelly Woods and Canada's Diane Roy, securing her first major international title.
"This is just awesome," said Dawes. "I came here feeling strong and looking to contend, but to finish as world champion is something else.
"I've been pushing great the last couple of years and have been getting closer and closer to a big win, so to finally do it is a great relief.
"Hopefully it'll be the first of a few this year."
Fearnley was defeated over the 10km road distance for the first time since 2006 as he finished third in the men's race.
He led for the majority of the race but was pipped by Frenchmen Julien Casoli, the winner, and Denis Lemeunier in a tight finish.
The first four men over the line were all credited with the same time of 20:28.
However the Paralympics star was delighted for Australian teammate Dawes.
"Christie and I spend a lot of time together in training and racing around the world, and she's always the first one there to congratulate me at the end of a race and share a celebratory beer," Fearnley said.
"She's come close so many times and to finally breakthrough is testament to her mental toughness and character and I couldn't be happier for her."


Good News! Toys R' Us has the Legacy Blade Blaster now available for purchase! This is the latest in the Legacy line and is a Toys R Us exclusive. It is highly detailed and has multiple die cast parts, this product also has sounds associated with the original Might Morphin Power Rangers TV Series and can change from blaster mode to blade mode in a few easy steps! The Blade Blaster is still not showing up as available in stores and is limited to 5 per order according to the web site. We have spoken to the Toys R' Us stores in our area and they expect to have this product available in store in the up coming weeks but could not give us a definitive date. We will update you as soon as we have any new information. This Legacy item is priced at $79.99. We have provided a direct link to the www.Toysrus.com product page.
Just PUNCH the button to the right to place your order!


text:
HealthcarePapers 8(Sp) September 2007 : 77-92.doi:10.12927/hcpap.2007.19222
Strategic Purchasing: The Experience in England
Gerry McSorley
Healthcare policy in the United Kingdom (UK) is placing increasing emphasis on the innovation and creativity of healthcare purchasing for health improvement, as well as on the skills and competencies of those charged with its leadership and management. In considering these developments, the current state of healthcare strategic purchasing in the UK must be framed within a number of key contextual issues:
The divergent approaches to health policy and its implementation being taken by each of the four different government departments in England, Wales, Northern Ireland and Scotland (Greer 2004)
The impact of the history of healthcare funding and the current financial climate on the demands placed on those responsible for health purchasing and the relative scope for health improvement that improving or deteriorating levels of funding create (Wanless 2002)
The central government's broader approach to public services and public services management known as the New Public Management, in which government should ''steer" not "row" (Kelman 2005; Pollitt 2002; Osborn and Gaebler 1992)
Health Policy Implementation in the UK
With the advent of increased devolution of power to the devolved administrations of Scotland, Wales and Northern Ireland, the UK has no single unified approach to health policy or its implementation. I have adapted the following descriptions from Greer (2004):
England has opted for markets, hoping that competition between independent trusts (similar to private firms) and between trusts and privately run treatment centres will drive up standards and efficiency. It is hoped that this model will rescue the government from responsibility for every detail of health service delivery.
Scotland has bet on professionalism, reducing layers of management, placing NHS trusts within integrated boards (along with clinical networks) and increasing the role of professionals in rationing and resource allocation.
Wales has relied on a professionalist and localist approach, integrating health and local government to improve the coordination of different forms of care at the local level and to raise standards. It is hoped that this will increase local participation in healthcare.
Northern Ireland has resorted to permissive management, in and out of devolution, concentrating on keeping services going in tough conditions.
The results of such policy divergence among the four UK countries and the relative spend on healthcare might not lead to more activity being delivered, to better population health or to higher levels of public satisfaction. These outcomes might depend more on how resources are deployed and how factors outside the healthcare system influence health (Alvarez-Rosete et al. 2005).
Notwithstanding the nature of this policy divergence, the four countries still share a number of critical challenges:
Demographic changes - in particular the proportional rise of the elderly population
Increasing technological developments and associated costs, both human and financial
Finite resources to fund healthcare
Potentially unlimited demand for healthcare
The prevention of unnecessary hospital admission
Correctly incentivizing the system so as to optimize the chance of achieving the health system's goals
In England, the overall spend on the National Health Service (NHS) has historically been below continental European levels. While many might argue that this comparator is inappropriate given the variations among health systems - some of which are based on social insurance or mixtures of social insurance and private care - the British government committed itself to achieving the target of matching continental European levels of healthcare spending by 2008. This commitment is coupled with the impact of the Treasury forecast of slowing growth in further investment in health services arising from Wanless's Securing Our Future review (2002).
In this paper I place particular emphasis on the situation in England. This is not because that country has the right or wrong solution to strategic purchasing. Rather, given that the majority of the British population lives in England, that is the country in which the greatest impact of health policy reforms will fall.
Background to the Current Situation in England
Since its election to power in 1997, the Labour government's policy for the English NHS has moved through a number of initiatives and positions. On election, the key attribute was fiscal prudence, largely accepting the previous Conservative government's somewhat constraining spending policy. General practice fundholding, a major plank of the Conservative government's reform program, was scrapped. A New Commission for Health Improvement was created to enhance the drive for quality. Many have argued that these early reforms were merely stop-gap measures pending agreement on the future ways forward (Klein 2001).
The first major directional vision was therefore contained in The NHS Plan, which was published with considerable professional support and laid out a 10-year strategy to modernize health services (Department of Health 2000). The key tenets of this plan were as follows:
"Investment accompanied by reform" (the plan's mission phrase)
Extra acute hospital beds
New hospitals funded through the Private Finance Initiative
Extra staff members who were paid more money
Creation of the "earned autonomy" concept for hospitals, which provided those hospitals judged to be successful with greater scope to innovate
Creation of a Modernisation Agency to spread best practices
Bringing together local municipal services and the NHS to pool resources (e.g., creation of care trusts to commission health and social care in a single organization)
Extended roles for nurses and allied health professionals
Creation of patient advocacy and liaison services in each healthcare organization
A national patient survey
Reaching a concordat with private sector providers with a view to ending the historical divide between private and public sector providers
Setting new wait time targets
New investment and service delivery programs in cancer, coronary heart disease and healthcare for older people
Over time, however, the sense at the government level was that, while The NHS Plan had considerable support, the NHS was not moving quickly enough to modernize and meet patients' and the public's expectations of care and access. The NHS Plan was therefore followed up with the NHS Improvement Plan in 2004 (Department of Health 2004), which added new reform components, including the following:
Reforming both the supply side and the demand side
Introducing patient choice of acute sector providers
Revising the role of the New Commission for Health Improvement to an inspectorate role as the Commission for Healthcare Audit and Inspection
Setting challenging new targets for access time for diagnosis and treatment
Advocating the adoption of the triangle of care, with self-management of health by far the most potent proportion of care, followed by disease management (i.e., more proactive support) and, finally, case management for the smallest group of patients with complex needs (i.e., active and specialist care)
The recognition of the divergence between the supply and demand sides embodied by the purchaser-provider split indicated the need for vision and skills on both sides if major progress were to be made in healthcare reform, efficiency and productivity.
The final piece of the reform jigsaw - Creating a Patient-Led NHS (Department of Health 2005) - saw the culmination of growing concerns about the unbalanced nature of the power of the NHS supply side in the absence of assertive and skilled purchasing (or "commissioning," as it will be referred to in the rest of this paper). Creating a Patient-Led NHS sprang from a recognition that the main focus since 1997 had been the acute care sector, incentivizing it to reduce wait times and to improve its services. In doing so, there was a clear risk that a strong, vibrant, incentivized hospital sector would suck all investment into hospital care unless it was balanced by an equally strong and vibrant commissioning function. Creating a Patient-Led NHS focused specifically on the importance of expert, imaginative commissioning. It promoted the belief that a revitalized commissioning function must represent patients, centre on prevention and public health and ensure hospital providers deliver good value for money.
[Figure 1]
Figure 1 captures the resulting model, based on the reforms of 2000, 2004 and 2005. The Organising Framework for NHS Reforms was based on the political need to devolve power at the same time as introducing market-style incentives, which were stimulated by allowing patients to choose which providers to visit (whether not-for-profit or for-profit private hospitals, or public hospitals in the shape of foundation hospitals operating in a quasi-commercial fashion). In order to provide that better balance of skills on the commissioning side of the equation, the Department of Health committed itself to devolving 75% of the NHS budget directly to primary care trusts (PCTs), with a further level of devolution to individual practices in the form of practice-based commissioning (PBC). The unit of currency in this new model was the patient. The method of payment was the tariff: a fixed price for individual procedures based on diagnostic-related groups (DRGs) but adapted to UK clinical practice and renamed healthcare resource groups (HRGs).
This combination of demand- and supply-side reforms has resulted in NHS England in 2007 being in a state of transition from a public monopoly insurer and provider of healthcare, governed from Whitehall, to an insurer with devolved commissioning from a mixed market of providers. The question follows, therefore, as to where on a spectrum of market models NHS England will rest? At one end is a wholly market-based health system in which competition rules and regulation is light; at the other end is a system that is nationally planned, owned, provided and governed from the centre. One way to answer the question would be to consider the following criteria (Lewis and Dixon 2005):
The government's values and ideology
How the existing reform program is led and managed
The level of political support for changes
Public perceptions of the reform program
Evidence of improvements in patient care
Public satisfaction with local health services when compared with other developed countries
In essence, the Labour government's philosophy appears to be "what counts is what works" (Greer 2004: 225). Stevens (2004: 42) offers an alternative perspective on such a multidimensional approach to health policy, describing the need to overcome the inertia inherent in all human systems as "constructive discomfort."
Finally, the Organising Framework for NHS Reforms considered the need for system-management reforms. Organizationally, Creating a Patient-Led NHS required changes to the structures underpinning excellent commissioning and to the mechanism by which the Department of Health devolved market management to the regional level. Figures 2 and 3 illustrate the main functions of the new strategic health authorities (SHAs) - overseeing millions of people - and PCTs - delivering services to hundreds of thousands of people (see Department of Health 2006b).
Definitional clarity is needed in any debate about the value of commissioning. Such clarity requires answering the following three questions:
What is commissioning?
What does it involve?
What does it seek to achieve?
The Department of Health (2006a: 3) defines commissioning as "the means by which we secure the best value for patients and taxpayers." By "best value," the Department of Health means "the best possible health outcomes, including reduced health inequalities" and "the best possible healthcare" delivered "within the resources made available by the taxpayer." In 1995, Øvretveit provided an alternative defi nition of commissioning as a sophisticated and strategic process of assess- ing health needs, developing new services or providers, contracting for services and under- taking a range of strategic efforts to improve population health. Work by Smith and Mays (cited in Wade et al. [2006]) provides a further characterization of commissioning:
It has a conscience, setting out "how things should be" (i.e., what the system aims to achieve and how).
It has eyes and ears, observing and report- ing on "how things are" (i.e., what the system is currently delivering).
It has a brain, processing information from both sources (i.e., identifying and implementing the optimal solutions for delivering stated objectives).
The similarities and differences among these defi nitions underscore the variety of perspectives that characterize the debate about the role and purpose of commissioning. In particular, they question what emphasis ought to be put on each of the elements of successful commissioning. Wade et al. (2006) underscore the visionary and transactional components, while Øvretveit (1995) stresses the health- gain outcomes. Meantime, the Department of Health model adds the concept of value for money, an essential element in a publicly funded system. The criteria for judging what successful commissioning would add to the health of a local population are, however, less clear. This lack of clarity might refl ect the continually changing expectations of healthcare by the public, staff and politicians.
Practice-Based Commissioning
The fi nal act of devolved decision-making within the Organising Framework for NHS Reforms in England was to devolve purchas- ing to the lowest organizational level - indi- vidual general practitioner (GP) practices. PBC involves passing funds from a PCT to individual GP practices so that they can commission services for their populations as they see fi t and within their PCTs' overall strategic aims (Department of Health 2004).1 PBC is aimed at enhancing the prospects of the following (Crisp 2005):
The design of improved patient pathways
A better working partnership with PCTs to create convenient community-based services
GPs taking responsibility for the budg- ets delegated by their PCTs, which cover acute, community and emergency care
More effective budget management
Studies examining the effi cacy of effec- tive commissioning by PCTs indicate that the following factors are important (Smith et al. 2005):
Stability in health organizations
Time for clinical engagement
Policies that support patient choice
Policies to allow shifts of resources both between providers and between different sectors
Incentives for GPs to develop new forms of care
Effective management support and information
Regulations to minimize potential conflicts of interest arising from GPs being both commissioners and providers
While compelling, these factors and the seed of reform and innovation are fraught with the following complexities when considered at the level of implementation:
How to provide stability for healthcare organizations when the prevailing climate has favoured repetitive reconfiguration
How to deliver effective management support when cost constraints are a constant feature of public service management (as part of the implementation of Creating a Patient-Led NHS, management-cost reductions of 15% are required)
How to encourage clinical engagement when demands on GPs are expanded through increasing patient expectations of service alongside a change in culture to a better work/life balance
Smith et al. (2005) further postulate that the greatest challenge facing commissioning will be to create a set of incentives that will engage GPs and enable the development of new forms of seamless services for people with long-term conditions that have eluded previous forms of primary care - led commissioning.
In addition to these organizational factors, there are also profound changes in the skills and competencies required of commissioning leaders and managers, whether clinical or general management. One of the most thoughtful exponents of commissioning skill sets, Simon Stevens, president of United Health in the UK and previously health advisor to the prime minister, has remarked on the need for commissioners to have access to a number of tools, such as the following:
Actuarial design of risk pools and incentives
Utilization and equity auditing
Elective care demand management
Emergency care subsystems redesign (including out-of-hours and community hospital usage)
Primary care performance profiles
Medicines management to ensure appropriate prescribing
Skill-mix redesign, especially at the primary/secondary, health/social care boundary
Patient and public engagement, including self-care
Strategies for changing clinical practice, including clinical decision-support methodologies
The Commissioning Cycle
The Department of Health (2006a) has identified for local commissioners the cycle and descriptors shown in Figure 4 as additional aids for thinking about translating plans into action.
The following sub-sections explain each of the elements presented in Figure 4 (Department of Health 2006a).
Increasingly, assessing needs will be based on more rigorous analytical approaches involving population segmentation and risk stratification. It will involve public health professionals, local authorities, GPs, patients and the local community.
Reviewing Service Provision
Practices should identify gaps and the potential for improvements in existing services. PCTs should utilize the aggregated intelligence of their practices and their local needs assessment to identify gaps or inadequacies in provision as well as broader requirements for service development.
Deciding Priorities
PCTs should produce a strategic plan for the health community based on data on needs assessment collated from practices and on the clear choices patients are making. Practices and PCTs are encouraged to work collectively to reinvest resources that have been released through service redesign where these would achieve greater impact. PCTs should ensure their patients and local communities, as well as municipal authorities and other partners, are properly involved in the process of deciding priorities.
Published Prospectus
Published PCT prospecti will signal the strategic directions for local services, highlighting commissioning priorities, needs and opportunities to service providers. The prospecti offer a focus for discussion with patients and local communities and an opportunity to open dialogues with potential providers.
Practices are expected to work individually, or in groups, to develop strategies and service models to improve healthcare services for the public and to address its priorities.
Shaping the Structure of Supply
PCTs should be clear about the services and service specifications they and their practices and patients want to see developed and give strategic support to proposals where necessary. PCTs have a role in encouraging and supporting practices that offer services locally and attract private sector and third sector (voluntary) providers to offer services in line with identified needs and priorities. Incentives and levers should be used by PCTs to stimulate the supply of services. PCTs will make contracts with local secondary care providers within a new national contracting framework, with the involvement of practice-based commissioners. For a few very specialized services, contracts will be held at the national level. For other specialized services, PCTs should group together to set contracts.
Managing Demand
Practices and PCTs will establish strategies for care and resource utilization to ensure that patients receive the most appropriate care in the right setting. This will guarantee that the benefits of healthcare resources are maximized.
Referrals; Individual Needs Assessment; Advice on Choices; Treatment/Activity
Individual practices and clinicians undertake individual needs assessments, make referrals and advise patients on choices and the treatments available to them - each referral is effectively a micro-commissioning decision. Practices must work with social service and other agencies to facilitate the opportunity for patients to make their choices with the benefit of good advice from their GPs.
Practices will always seek to manage their budgets to maximize the benefits of the resources available to them. To help them, PCTs have a responsibility to provide support programs, including training and development, developing systems to allow practices to monitor the services their patients receive through accurate, relevant and timely data. PCTs remain responsible for the aggregated financial position and for ensuring overall financial balance.
Seeking Public and Patient Views
PCTs will be responsible for measuring and reporting on patients' experiences. Practices will also want to monitor patients' satisfaction. Robust mechanisms for collecting and understanding patients' views will need to be developed by PCTs and made available to practices. Throughout, PCTs must ensure that the public voice is heard in the development of priorities and the shaping of services.
Possible Implications of the Organising Framework for NHS Reforms
No reform program ever has all the facets of its consequences worked out in advance. The Organising Framework raises many questions about the inter-relationship of its components. Work undertaken at the Kings Fund in London, for example, explored a number of key questions about commissioning's ability to effect a shift from secondary to primary care (Palmer 2006):
How will it help cope with potentially unlimited patient demand?
Demand is unlimited because healthcare is free at the point of need. As the public becomes increasingly health-savvy and assertive, there is a greater likelihood that demands will increase. Palmer (2006) argues that commissioning can partly mediate between potential demand and affordability, seeking to obtain the greatest patient benefit with the funds available. Historically, lengthening wait lists/times constituted the pressure valve; however, with the policy drive to reduce wait times this option is no longer available.
In particular, how will PCTs reduce patient demand well below the growth rate seen in recent years - and below the levels required to achieve the access targets - when they have weak levers to manage hospital referrals? The framework says that PCTs and providers should agree on activity levels; however, what happens if they cannot agree or if they do reach agreement but the actual referrals exceed agreed levels? NHS trusts and foundation trusts argue that there is a quasi-market and that they should be free to use available capacity to provide more patient services if patients choose them. They also say they are obliged to make progress toward achieving the access targets. This progress might, however, involve an increase in elective activity that is unaffordable for PCTs and, therefore, inconsistent with PCTs' statutory duty to break even.
How will affordability influence demand?
If PCTs fail to limit demand they will run up deficits. The key question thus becomes what levers and instruments do they have available to control the volume of hospital referrals? In addition to the above considerations, PCTs will require strong leadership to hold their local markets to account because unpalatable decisions might, in some cases, have to be made about removing certain providers or, at least, exposing them to external competition. The degree to which the government would be willing to see such levels of contestability is as yet unclear. SHAs also have a role in moderating between commissioners and providers over these precise points (Smith et al. 2006). This is also particularly important where "stranded capacity" exists in a system. Palmer (2006) argues that the use of the Private Finance Initiative (PFI) to expand secondary provision will lead to a reduction in the need for more new PFI schemes to be approved.
Where stranded capacity exists, hospitals with annual financial balance targets tend to close this down to save costs. In an unfettered market, the price would fall and the utilization rate would rise as demand rose. If this were allowed in the NHS, Palmer (2006) suggests that commissioners would be able to purchase more services for patients, and providers would be able to provide more services, thereby earning more income and reducing deficits. The result would be less stranded capacity and fewer services closed. Arguably, the NHS can work effectively only when downward price flexibility is allowed (Kings Fund 2006).
What are the incentives for hospitals to increase admissions?
Hospital providers receive payment for almost all elective procedures under the fixed tariff within the payment-by-results (PbR) system. It follows, therefore, that in a market system hospitals will seek to expand their revenue base to allow for investment in new services by increasing the numbers of "profitable" patients they can see and treat under PbR. However, a number of key constraints apply:
Because they are required to consult with their PCT before taking any action, it is difficult for a provider simply to drop "unprofitable" services. Each PCT, not the providers, has the statutory right to consult on service alterations, especially when a change is seen as substantial. The PCT, not the provider, consults with the Local Municipal Authority Health Overview and Scrutiny Committee (OSC) on the proposal. If the OSC objects, it can refer the proposed change to central government.
The provider may face relatively long lead-in times to bring on extra capacity, both physical (e.g., beds, operating theatres) and human resource. This step change in capacity is high risk unless it can be shed according to changing circumstances.
PBC encourages GPs to hold funds for close-to-home care and encourages the development of joint protocols with secondary providers to ensure that only those patients who need acute care are referred. Providers are more likely to respond well to sophisticated commissioning if they are confident in the future of strategic planning - even if it does not maximize their income.
The development of a national framework of clinical governance places considerable emphasis on clinical quality and standards. Because providers are subject to independent assessment by the Commission for Healthcare Audit and Inspection, a going-for-everything-you-can-get strategy carries additional risks.
It is important to understand that neither additional nor less work comes at marginal cost. The extra revenue a hospital gains for doing more work - or loses for doing less work - is still paid at the average cost for treating patients. While there will undoubtedly be marginal costs of treating one patient, work on that case will still be paid at the average cost. Expansion and contraction therefore carry the same management issues of complexity. Equally, there might come a point at which a hospital faces expensive step-costs of bringing on new facilities or resources to cope with extra demand. However, each extra case will still be funded at the average cost. Work by Palmer (2006), based on unpublished data, indicates that the typical hospital cost structure is about 10%-15% variable costs, about 60%-75% semi-fixed costs and about 15%-25% fixed costs.
How are PCTs to shift funding from existing hospital providers to support the provision of new services closer to home?
The Organising Framework recognizes the need to fund providers of new services closer to home and, in some cases, to offer them incentives. It does not, however, address the fact that PCTs can do this only if they are sure that spending on hospital care will be reduced. Because PCTs have no effective levers to bring about a reduction of revenue spending on hospital care, they are not in a position to contract with new providers to purchase new services. That is because the new services will be affordable for PCTs only if hospital spending goes down, thereby releasing funds to pay for them. This problem is particularly acute for PCTs that are in deficit and/or under strong financial pressure. PCTs cannot expect any help from hospital trusts to reduce hospital demand because that would make it even more difficult for them to achieve financial balance. This situation results in a vicious circle because if there were alternative cheaper services closer to home to which GPs could refer it would be much easier for GP practices and PCTs to manage hospital referrals. These systems are not yet mature; therefore, elective demand remains difficult to manage. Consequently, a high proportion of PCTs' budgets is spent on hospital care, making it harder for them to afford to commission or provide alternative services closer to home. PBC can - and should - motivate greater and more rapid development in this direction.
How are PCTs to deliver the commissioning priorities they identify in their strategic plans for the medium term?
The description of the commissioning cycle in the framework clearly envisages a strategic commissioning role for PCTs, one that involves deciding priorities in collaboration with local stakeholders and then shaping the structure of supply to ensure that the pattern of expenditure reflects those priorities. A PCT might want to spend more on disease prevention, cancer services or care closer to home; however, if patients exercise choice for more elective hospital care and all the PCT's budget is used to fund this care at full tariff, then there is little the PCT can do about it. This sort of weak commissioning regime leaves the level and pattern of service provision largely to the market. Demand is determined by short-term GP referral practices and supply is determined by the response of existing providers (who are aiming to maximize admissions) to the incentives embedded in the tariffs. Over time, the demand for elective services to hit wait time targets and for technologies is always likely to outstrip available funding - particularly from 2008 when the Wanless effect begins to be felt and funding growth slows sharply.
Some Possible Solutions
There are many possible refinements that can minimize such consequences; e.g., moving from annual to longer-term contracts and paying the full tariff only for contracted volumes of activity and at a standard marginal cost thereafter. Such an approach could have many advantages:
Commissioners would be seen to have real teeth through their ability to shift resources.
Providers would be more likely to support the care-closer-to-home agenda as their ability to expand beyond contracted volumes became more muted. They would also be under a statutory obligation to work in partnership with their PCTs and Health Overview and Scrutiny committees.
Medium-term contracts would provide greater certainty for providers. This might be less destabilizing for both providers and commissioners because marginal costs would be less severe.
The incentives for providers to improve efficiency would be greater because of marginal income derived only from extra work.
Following Palmer (2006), however, I should note that some observers might feel that in a market-based system such matters should be left entirely to the market. These same observers might also argue that lower marginal prices for above-contract volumes would reduce the incentive to expand supply, which is an important characteristic of a system that has lower wait times and relatively robust room for patient choices.
In addition, the whole basis of the tariff requires reworking. Such reworking involves, for example, the treatment of excluded costs, the treatment of "sunk costs," the methodology for allocating costs across HRGs, the finished consultant episode (FCE)/spell conversion and the impact of any market factors to recognize unusual costs (e.g., land values in London).
Understanding the Information Needs of PCT Boards
The issues discussed above illustrate that commissioning - at whatever level - demands strong information in order continually to assess progress. This information can be in many forms and used in many ways, ranging from public health improvement to contract monitoring of providers. This diversity of information and its application suggests the importance of some underpinning principles (Dr Foster 2006):
All information should
be clearly and simply presented;
be forward-looking and present trends;
be updated in a timely manner according to its purpose and potential volatility;
direct the boards' attention to significant risks, issues and expectations; and
provide the level of detail that is appropriate to the boards' roles.
Strategic information should
show trends in health needs, provision and patient satisfaction;
provide forecasts and anticipate future performance issues; and
encourage an external focus and understanding of the context for reform and local action.
Information for performance monitoring should
provide an accurate and balanced picture of current and recent performance, including financial, clinical, regulatory and patient expectations;
focus on the most important measures of performance and highlight exceptions;
be appropriately standardized in order to take account of known factors that affect outcomes, such as the age and deprivation of patients; and
enable comparisons with the performance of similar organizations and health economies.
The key tests of the success of any information resource for boards will be the extent to which it
prompts relevant and constructive challenges;
supports informed decision-making;
provides early warning of potential financial or other problems; and
develops all directors' understanding of the organization, the local health economy and its performance.
The method whereby commissioners acquire this information - given that this responsibility rests with PCTs and is not to be delegated to practice-based commissioners - can be contracted out to third-party agencies, a number of which already exist or might enter the market. Wade et al. (2006: 10) highlight this point using the example of the Greater Manchester Commissioning Business Services:
The Commissioning Business Service (CBS) is a new venture developed by the 14 Greater Manchester primary care trusts (PCTs). The CBS has as its mission the sourcing, procurement and contract-management of the delivery of quality and cost-effective services. It will provide a service to PCTs, practice based commissioners, local authorities, collaborative commissioners, and even providers who sub-contract services. CBS services will include: the provision of off the shelf or bespoke service specifications; a detailed directory of providers and services; public health and comparative clinical data and intelligence; and the full range of operational contract management including contract compliance and resource utilisation analysis. The CBS is planned to become operational in April 2006 and is currently working on business modeling, the development of memoranda of information for each of its business areas, due diligence, the seeking of expressions of interest in providing CBS services, and the detailed design of the organisational model.
Leadership in Commissioning
The agenda mapped above highlights the significant leadership task for commissioners. The complexity of the task, taken together with the prospect of national elections in the near future and the financial position required by Wanless (2002), creates a hothouse climate for accelerating progress. The successful management of change and of harnessing the various interests, both organizational and professional, will be critical. Such leader attributes will require development throughout the organizations, not just at the most senior levels (Wade et al. 2006).
This organization-deep leadership function mimics the move away from the heroic leader model, so prevalent during recent decades, to a more empowering and engaging style of leader behaviour and change leadership (although one that is no less transforming in its ideology) (Smith 2002; Higgs and Rowland 2005). Additional leader behaviours particularly critical in this situation are as follows (Alimo-Metcalfe and Alban-Metcalfe 2003):
Showing genuine concern
Being accessible
Encouraging change
Being honest and consistent and acting with integrity
Being decisive in resolving complex problems
Leading the organization and inspiring others
Focusing effort and supporting a developmental culture
Facilitating change sensitively
The development of clinical leadership and engagement in the new commissioning models at the PCT and PBC levels will be critical to their success. Clinical leaders add knowledge, experience and skills to the commissioning map. Their leadership development must not be left to chance but supported with personal coaching and organizational development nested in a framework of patient and public engagement in the commissioning process and anticipated outcomes.
What if the Model as Conceived Doesn't Deliver?
Speculating about "what if" might seem a little advanced when the reform program is still so young. However, a number of issues remain on which further work will be needed.
To begin with, "choice" implies that there needs to be headroom in system capacity in order to offer real choice to patients. PCTs will have the task of determining the desirable characteristics of their local health markets, one aspect of which will be the extent of "free capacity" and how that capacity can be accessed equitably. Easing market entry will require using new flexibilities to help encourage new entrants where normal market signals might be insufficient (Department of Health 2006a). These flexibilities include payments above tariff, guaranteed income for providers and reduced capital investment for providers through PCT capital grants or joint ventures.
It will also be important to find ways to deal with market exit. Many hospitals are constructed financially and physically on the basis of an historical legacy. They might argue that the volumes of activity are not readily influenced, prices are fixed and wages are set nationally. Hospitals might also contend that they carry significant fixed costs and they must break even each year. Rules for foundation trusts offer greater budgetary flexibility due to their financial framework; however, they still form the minority of hospitals in England. Where a hospital is failing, Palmer (2006) suggests three options:
Restructure the trust on a stand-alone basis. This might involve the closure of certain services for which sufficient demand no longer exists, merging clinical services across trusts under common management where this is cost effective and expanding out-patient services to address the closer-to-home agenda.
Close the trust only when it can be shown that it can be achieved consistent with protecting patients, preserving the concept of patient choice and delivering essential services locally, albeit through a possible alternative supplier.
Transfer the trust to another party, such as another NHS trust or foundation trust, or to an independent provider. In 2007, a foundation trust absorbed a failing NHS trust (Timmins 2007).
Equally, commissioners would need to lead or endorse such activities as those highlighted earlier. This would place PCTs' decision- making very much in the public gaze. PCTs remain largely answerable to the public by proxy rather than directly (although this might change). Work commissioned by the Health Policy Forum has touched on alternative, and perhaps more radical, options, should these be needed (Smith et al. 2006). These include, for example, holding PCTs more accountable to their local populations through quasi-democratic processes by direct elections to PCT boards, or through a stronger mandate on PCTs from municipal authorities. In addition, while providers compete under patient choice, commissioners have locked-in populations - competition among commissioners might therefore be required. It is, however, too early to be judgemental about the rate, pace and success of the current reform program in England.
The new commissioning within the English NHS is still very much in its early days. There are hopes and dangers in equal measure. The divergence of health policy approaches within the UK's four countries will allow important comparisons to be made among them. In addition, the complexity of the reform agenda, the newness of the commissioning organizations and the need to accelerate organizational and personal development to deliver the health gains the public and politicians expect are not risk free. These health gains will require influential and visionary leadership. Likewise, significant organizational development will be needed to secure the potential in the system in which clinical and public engagement is an integral part of that leadership drive.
If it is successful, England's health system reform agenda will deliver benefits to individuals and communities. Looking further into the future, more radical changes might then be required to optimize those benefits.
Gerry McSorley, DBA
Director, Centre for Health Improvement and Leadership, University of Lincoln
Visiting Professor in Healthcare Management and Leadership, University of Lincoln
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1 The English NHS is unusual in its continuing faith in primary care-based organizations to carry out effective purchasing of healthcare services (Smith et al. 2005).


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Selon le Larousse en ligne, la sinologie est l' et le sinologue est un .

On peut considérer le « sinologue » et le « sinisant » comme synonymes. En effet, selon le Littré, le sinologue a pour principal domaine d'étude la langue et l'histoire de la Chine et le sinisant est le spécialiste de la langue et de la civilisation chinoise.

Histoire
Certains estiment que son apparition remonte aussi loin que Marco Polo au . L'étude systématique de la Chine remonte au , quand les missionnaires jésuites, notamment Matteo Ricci, Ferdinand Verbiest, Antoine Thomas et d'autres tentèrent d'introduire le christianisme en Chine. Ainsi, les premières études sinologiques traitent souvent des aspects de la compatibilité du christianisme avec la culture chinoise.

Le Siècle des Lumières est une période de grande curiosité intellectuelle alimentée par les explorations et découvertes de nouveaux mondes. Des récits et des lettres - entre autres celles qui furent rassemblées dans la grande collection des Lettres édifiantes et curieuses -  circulaient et ouvraient l'Europe aux autres cultures. L'immense empire de la Chine fascinait tout particulièrement et des 'sinologues' (un grand mot pour le travail fait à l'époque!) commencèrent à populariser la philosophie, l'éthique, les concepts légaux et l'esthétique chinoise en Occident. Quoique souvent caricaturaux et incomplets, ces travaux ont contribué à un certain intérêt du public vis-a-vis des "chinoiseries", et alimenté des débats comparatifs. À cette époque, la Chine était souvent décrite comme un royaume éclairé.

Voltaire, grand lecteur des Lettres édifiantes..., a manifesté son intérêt pour le pays dans sa pièce, L'Orphelin de la Chine. Leibniz, l'inventeur du calcul différentiel, était très intéressé par la philosophie chinoise et notamment le Yi Jing, où il voyait une démonstration parfaite de la suite des nombres premiers. Il a également puisé dans le chinois l'idéal d'une langue universelle, de nature mathématique - idée immédiatement démentie par une analyse basique de la langue.

En France, Jean-Baptiste Du Halde qui lui-même n'avait jamais visité la Chine, publia en 1735 une Description de la Chine (4 volumes avec cartes) qui était largement fondée sur les lettres reçues de confrères jésuites. Ce livre fit autorité et fut rapidement traduit en quatre langues étrangères.

Aux , d'autres missionnaires tels que James Legge (1815-1897) ont milité pour l'établissement de la sinologie comme discipline universitaire. En 1837, Samuel Kidd (1797-1843) devint le premier professeur de chinois en Angleterre. Les sinologues devinrent progressivement plus nombreux que les missionnaires, et la sinologie s'est établie comme une discipline consistante au . Elle peut avoir une influence politique, avec des sinologues agissant comme conseillers, tels John Fairbank aux États-Unis.

En 1795, l'école des Langues orientales Vivantes fut créée à Paris en 1796 par la Convention.

Jean-Pierre Abel-Rémusat (1788-1832), titulaire de la première chaire d'études chinoises en Occident au Collège de France en 1814, est considéré comme le fondateur de la sinologie ou étude scientifique de la Chine.

Durant la guerre froide, en France, Simon Leys a vivement critiqué les sinologues, dont l'engagement politique - à droite ou à gauche - oblitérait de façon grotesque la validité scientifique de leurs analyses. Il ridiculise ainsi ces spécialistes qui nous expliquent la Chine, notamment Alain Peyrefitte.

Au , la sinologie est une discipline appelée à prendre de plus en plus de poids, étant donné l'importance économique et stratégique croissante du monde chinois.

Sinologues

Allemagne
 Christian Mentzel (1622–1701)
 Andreas Müller (1630-1694)
 Otto Franke (1863-1946)
 Richard Wilhelm (1873-1930)
 Wolfgang Franke (1912-2007)

Belgique
 Charles de Harlez (1832-1899)
 Charles Michel (sinologue) (1853-1920)
 Pierre Ryckmans (pseudonyme Simon Leys) (1935-2014)
 Pascal de Duve (1964-1993)

Espagne
 Juan Cobo (1547-1593) - Auteur de la grammaire Arte de la lengua china (manuscrit, 1592 ou 1593).
 Pedro Chirino (1557-1635) - Auteur du dictionnaire Dictionarium Sino Hispanicum (Manille, 1604).
 Melchor Manzano de Haro (1579?-1630) - Auteur de la grammaire Arte de la lengua chiõ chiu (manuscrit, 1620?).
 Francisco Díaz (1606-1646) - Auteur du dictionnaire Vocabulario de letra china con la explicación castellana (manuscrit, 1643).
 Francisco Varo (1627-1687) - Auteur de la grammaire Arte de la lengua mandarina (manuscrit, entre 1677 et 1682 ; Canton, 1703).

États-Unis
 Herrlee G. Creel (1905-1994)
 John DeFrancis (1911-2009)
 John Fairbank (1907-1991) 費正清
 Ping Ti Ho, Chinois américain
 Immanuel Hsu, Chinois américain
 Ray Huang (1918-2000), 黃仁宇,
 Paul Linebarger (1913-)
 Jonathan Spence 史景遷 (1936-)
 Perry Link
 Peter Lorge
 Thomas Metzger
 Karl A. Wittfogel
 John W. Garver
 Thomas B. Gold

France
 Joseph Henri Marie de Prémare (1666-1736)
 Jean-Baptiste Du Halde (1674-1743) - Auteur du premier grand ouvrage de référence sur la Chine: Description de la Chine''' (4 volumes).[évaluation subjective qui nécessite une citation, en outre il y en a bien d'autres qui le précèdent]
 Arcade Huang (1679-1717) - chinois. Premier sinologue français du fait de ses études passées en Chine. Commence un dictionnaire et une grammaire du chinois.
 Étienne Fourmont (1683-1745) - Élève du précédent. Étend le dictionnaire franco-chinois.
 Joseph-Marie Amiot (1718-1793) prêtre jésuite, missionnaire en Chine, auteur d'une grammaire et dictionnaire mandchou.
 Jean-Pierre-Abel Rémusat (1788-1832)
 Stanislas Julien (1797-1873)
 Léon d'Hervey de Saint-Denys (1822-1892)
 Séraphin Couvreur (1835-1919)
 Henri Cordier (1849-1925)
 Père Louis Gaillard (1850-1900)
 Léon Wieger (1856-1933)
 Arnold Vissière (1858-1930)
 Edouard Chavannes (1865-1918)– Professeur au Collège de France (à partir de 1893)
 Paul Pelliot (1878-1945)
 André d'Hormon (1881-1965)
 Henri Maspero (1883-1945)
 Marcel Granet (1884-1940)
 René Grousset (1885-1952) - Historien orientaliste, plusieurs ouvrages historiques sur la Chine et les empires limitrophes.
 Robert des Rotours (1891-1980)
 Paul Demiéville (1894-1979)
 René Etiemble (1909-2002)
 Rolf Stein (1911-1999) - Professeur au Collège de France
 Robert Ruhlmann (1920-1984)
 Yves Hervouet (1921-1999) - Chercheur et professeur de chinois, Secrétaire général du XXIX Congrès International des Orientalistes
 Jacques Gernet (1921-2018) - Œuvre principale : Le monde chinois.
 André Lévy (sinologue) (1925-2017)
 Léon Vandermeersch (1928-2021)
 François Cheng (n. 1929)
 Isabelle Robinet (1932-2000)
 Michel Cartier (1934-)
 Jacques Pimpaneau (1934-2021)
 Alain Roux (1935-)
 Jacques Dars (1937-2010)
 Jean-Luc Domenach (n. 1945)
 Catherine Despeux (1946?-)
 Jean Levi (1948-)
 Marc Kalinovski (1949-)
 Jean-Philippe Béja (1949-)
 Joel Bellassen (n. 1950)
 Noël Dutrait
 Guilhem Fabre (1951-)
 François Jullien (1951-)
 Pierre Picquart (1951-)
 Marie Holzman (1953-)
 Anne Cheng (1955-)

 Italie
 Michele Ruggieri (1543-1607) - Compilateur, avec Matteo Ricci, d'un dictionnaire portugais-chinois (manuscrit, entre 1583 et 1588).
 Matteo Ricci (1552-1610) - Premier Européen à bien connaitre la langue et culture chinoise.[évaluation subjective qui nécessite une citation]
 Martino Martini (1614-1661) - Auteur de la grammaire Grammatica Sinica (manuscrit, entre 1651 et 1653).
 Basilio Brollo (1648-1704) - Auteur du dictionnaire latin-chinois Hànzì xīyì 漢字西譯 (manuscrit, entre 1694 et 1699) ; plagié par le sinologue français Chrétien-Louis-Joseph de Guignes (publié comme Dictionnaire Chinois-Latin-Français'', Paris, 1813).

Japon
 Shiratori Kurakichi (1865-1942)
 Naitō Konan (1866-1934)
 Takakusu, Junjirō (1866-1945)
 Kuwabara Jitsuzō 桑原隲藏 (1873-1931)
 Ikeuchi Hiroshi (1878-1952)
 Katō Shigeshi (1880-1989)
 Haneda Tōru (1882-1955)
 Ono, Genmyō (1883-1939)
 Kanda Kiichirō (1897-1983)
 Tsukamoto Zenryū (1898-1980)
 Niida Noboru (1904-1966)
 Mori Shikazō (1906-1980)
 Yabuuchi Kiyoshi (1906-2000)
 Mikami Tsugio (1907-1987)
 Nishijima Sadao (1919-1999)
 Ōbi Kōichi 小尾郊一
 Suzuki Torao 鈴木虎雄

Royaume-Uni
 James Legge (1815-1897)
 Thomas Francis Wade (1818-1895)
 Herbert Giles (1845-1935)
 Edward Harper Parker (1849-1926)
 Arthur Waley (1889-1966)
 Joseph Needham (1900-1995)

Russie
 Nikita Yakovlevich Bichurin (1775-1853)
 Pyotr Ivanovich Kafarov (1817-1878)
 Vasiliy Alekseev (1881-1951)

Autres
 Jean François Billeter (1939-), suisse
 Jerome Ch'en (1919-), canadien
 Charles Le Blanc, canadien
 Rafe de Crespigny (1936-), australien
 Jan Julius Lodewijk Duyvendak (1889-1954), néerlandais
 Bernhard Karlgren (1889-1978), suédois
 Erwin Ritter von Zach (1872-1942), autrichien
 Edwin G. Pulleyblank (1922-2013), canadien
 Göran Malmqvist, suédois (1924-2019)
 Wang Gungwu, singapourien
 Jaroslav Prusek, tchèque
 Robert van Gulik (1910-1967), néerlandais
 Étienne Balazs (1905-1963), hongrois
 Ferenc Tőkei, hongrois
 Geremie Barmé (1956-), australien
 Yaroslav Derega (1954-), ukrainien
 Sotiris Chalikias (1947-), grecque

Bibliographie

Notes et références

redpajama_set_name: RedPajamaWikipedia


text:
Kansas City councilwoman trying to evacuate friend from Kabul amid chaos
KANSAS CITY, Mo. — Kansas City 2nd District Councilwoman Teresa Loar has been in near-constant contact with a friend and his family as they try desperately to flee Afghanistan after Thursday's terror attack at Hamid Karzai International Airport.
Loar, who worked for Tetra Tech in support of the USAID Office of Infrastructure in Kabul, said the man is a former co-worker who has seven family members that he is also trying to evacuate.
The man and his family were waiting outside of the airport when they heard the blasts.
"He said everybody's running and screaming, and now they're shooting guns. They don't know what is happening, so they ran to the buses that they got out of and a little later he did text me and let me know that they were at a safe house. His whole family was safe and unharmed," Loar said.
Clay County sheriff recalls work in Afghanistan as terrorist attacks take lives in Kabul
Loar said her friend holds a Special Immigrant Visa and is qualified to be evacuated, but she says after the terror attack by an Islamic State offshoot, things are even more uncertain than they were previously.
She said she's in contact with Congressman Emanuel Cleaver's office and he is also working to resolve the situation.
"He has an SIV visa. They're trying hard to get the families out. At this point in time, we just don't know. I've been in contact with the Congressman all day. We just don't know what's going to happen next."
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Because the man aided in the U.S. mission in Afghanistan he is in danger of being targeted by the Taliban. Like many others, Loar said Afghans who helped the United States went to extraordinary measures to do so.
"The people that came to work every day that were Afghans, they would have to take different routes, would wear different clothes. I mean, they were very nervous about even coming to the building because working for a western company puts you in.. puts a target on you."
Two killed in crash on 69 Highway in Overland Park