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HomeJuly 2015News from around your health services
News from around your health services
Pancreatic transplants to move to St. Vincent's
Awards For New Day Hospital
Mallow Memory Research Unit
New cancer strategy
Teens births decrease
HIQA Unannounced Inspections
New Forensic Hospital
Dormant Accounts Funding
CEO for Our Lady's Hospice & Care Services
€45 million reform fund
Air ambulance to be permanent
Elder Abuse Referrals Increase
Suicide Prevention Strategy
Minister launches North Cork Infant Mental Health Network Model
New maternity hospitals sites
New EU logo for medicine websites
Twenty six terminations carried out in 2014
European Court rules on NCHDs
No Change In Fair Deal Funding
New Ambulance Headquarters
Arts For Health
Navan Road Primary Care Centre
Targeted intervention in mental health services
New Medical Council CEO
Pancreatic transplants are to move from Beaumont Hospital, Dublin to St. Vincent's University Hospital, Dublin, Health Minister, Dr. Leo Varadkar has announced.
The Minister said that the consultant who undertook pancreas transplants at Beaumont Hospital took early retirement at the end of 2014.
" Given the limited number of surgeons who specialise in transplantation, the filling of such vacancies poses a challenge. While Beaumont Hospital is making every effort to recruit a suitable replacement, the hospital is also collaborating with St Vincent's University Hospital on a combined approach to kidney/pancreas transplants. It is proposed that pancreatic transplants, of which six were performed in 2014, will move to St Vincent's University Hospital.
"The two hospitals, together with Organ Donation and Transplant Ireland (ODTI), which is part of the HSE and my Department, are working to make arrangements to facilitate the commencement of this work as soon as possible.
"Most pancreas transplants are combined with a kidney transplant. Such cases will involve transplant surgeons from St Vincent's University Hospital and Beaumont Hospital working together on the St Vincent's campus.
"In addition to working with St Vincent's Hospital in a combined approach to kidney/pancreas transplants, Beaumont is also collaborating with that hospital on the development of an intra-abdominal organ retrieval service that will facilitate a more effective and cohesive overall procurement and transplant service.
"Beaumont Hospital wrote in May to all patients who have received a pancreas transplant, as well as to patients who are on the transplant waiting list. They have also written to all referring consultants. At this point, all pancreas transplant recipients have been seen by clinicians in Beaumont or have appointments in place. Future pathways of care are being discussed with all patients at these meetings. "
A joint assessment clinic for the eight patients who are waiting for a pancreas transplant, involving consultants and nurses from both Beaumont and St. Vincent's, was held at the end of July.
The Minister said that management and clinical staff at the hospitals were committed to ensuring that an optimal service would be put in place to the long-term benefit of those in need of pancreas transplants. As St Vincent's was already established as the National Liver Transplant Centre, and was a designated centre for pancreas cancer services, it was well placed to undertake pancreas transplants.
Every effort was being made to have all the necessary arrangements and protocols in place to facilitate St. Vincent's being in a position to undertake pancreas transplants from mid-September, should a suitable donor/recipient match occur.
The Minister added that additional funding of almost €3m had been provided to facilitate the development of the most appropriate infrastructure to support organ donation and transplantation. This would facilitate the appointment of 19 whole-time-equivalent staff dedicated to organ donation and transplantation across the country. Included in this are five Organ Procurement Coordinators, who have been appointed, and six Organ Donation Nurse Managers who would be in post in each of the hospital groups by the end of August.
In July 2014, An Taoiseach, Enda Kenny, opened the new Day Hospital for Care of the Elderly at St. Joseph's Hospital, Raheny which is under the management of Beaumont Hospital.
The capital project was fully funded by Beaumont Hospital Foundation through public donations totalling €2.1m. It was made possible through income donated by one major donor (€1.5 M) and €600K made up of sales of raffle tickets and funds generated from cake sales, head shaves and much more. Its completion was a crowning moment for the work of Beaumont Hospital Foundation.
The Day Hospital now provides specialist care for the elderly living in Beaumont Hospital's catchment area in a purpose designed and built setting.
It will assist in detecting early-stage health issues in older patients, preventing them from needing hospitalisation for acute treatment at a later stage. The services of the new Day Hospital will also allow patients who have been hospitalised to be discharged to their own home earlier from where they can complete their care programme by accessing the services of the Day Hospital rather than remaining as inpatients.
The 7,000 sq ft unit, includes a fully equipped, six bed medical assessment ward, physiotherapy gym, occupational therapy activities of daily living suite, speech & language therapy room, family and social work consultation rooms and a dining/social room for patients.
Speaking at the event, An Taoiseach said, "The new healthcare facility will provide North Dublin's elderly community with a state-of-the-art service which will relieve the pressure on the main hospital and create a gentle and respectful, caring environment for older people to complete their care and rehabilitation. It is a fabulous contribution to community healthcare services in North Dublin and I would like to congratulate the many supporters of Beaumont Hospital Foundation for their part in making this new facility a reality".
Since opening the building has now received four awards over 2014 and 2015. They are:
Construction Industry Awards 2014
Overall Excellence in Construction and
Health Project of the Year 2014.
Irish Healthcare Centre Awards 2015
'Healthcare Building Project of the Year' for a building design that best enhanced the staff service and patient experience.
Irish Building & Design Awards 2015
'Healthcare Building Project of the Year'
Mallow Primary Healthcare Centre (MPHC) is to become the site for the first satellite NEIL Memory Research Unit, joining forces with Trinity College Dublin engage older adults in brain health research.
Failing cognitive function prevents millions of older adults from living independently. The goal of the Neuro Enhancement for Independent Lives (NEIL) Programme at Trinity College Dublin is to enable independent living and improve quality of life by conducting research and developing interventions aimed at dementia prevention.
In November 2011, NEIL established a Memory Research Unit at Trinity College Dublin, under the direction of Professors Sabina Brennan, Brian Lawlor and Ian Robertson. The purpose of this unit is to collect rich and comprehensive data from 1000 healthy adults aged 50+, with the aim of furthering understanding of memory and related processes, and the aspects of our lives that influence these processes as we age.
The NEIL programme is also committed to empowering older adults through outreach and education. The NEIL Memory Research Unit, coordinated by Caoimhe Hannigan, has already collected baseline data from 860 participants. MPHC has become the first satellite site for the memory research unit.
Prof. Brennan says that "we place great importance on building long-term relationships with our research participants inviting them to take part in follow-up assessments on an on-going basis. Our research volunteers are very important to us, because without them we cannot further our understanding of memory and ageing. We really look forward to this new collaboration which will allow us to engage with many more members of the general public"
Yvonne Finn Orde, General Manager, HSE North Cork said "It is hoped that through this innovative partnership with TCD, Mallow will be not only be a satellite site for NEIL, but also be a test site for the educational resources being developed by NEIL, and help develop new and innovative services for the people of North Cork".
Dr. Cormac Sheehan of the HSE and The Department of General Practice UCC, who is overseeing for the running of the Memory Research Unit Mallow said: "This study will provide an accurate baseline of the cognitive functions of healthy adults over the age of 50. We also hope that this will open exciting opportunities for more research at MPHC and lead to experience and employment opportunities of young graduates of UCC and our other national universities."
"Anybody interested in hearing more about taking part in our study can contact us and leave your name, phone number and address by calling 0864128797 or by email mrumallow@gmail.com, or the Memory Research Unit Mallow, MPHC, Mallow, Co. Cork."
Minister for Health, Dr. Leo Varadkar has set up a National Cancer Strategy Steering Group to advise the Department of Health on developing a new National Cancer Strategy for 2016-2025.
The Group is chaired by Professor John Kennedy, Consultant Medical Oncologist, St. James's Hospital, Dublin and brings together a range of experts in cancer control. It will report later this year.
Minister Varadkar has also set up a Cancer Patient Forum to facilitate a patient input to the development of a National Cancer Strategy for 2016-2025. Members of the public and other organisations will also be able to have their say on the new Cancer Strategy.
Dr. Varadkar said: "Following the last two cancer strategies, the majority of people now survive cancer and survival rates continue to improve. The objective of the third strategy should be to bring Ireland in to the top tier of countries when it comes to cancer care. The number of people surviving cancer is likely to increase significantly in the years to come. However, Ireland's growing and ageing population also means that cancer incidence is expected to double between now and 2040. We are only now seeing the full benefits from setting up the Centres of Excellence and still face many challenges. I want to thank Prof. Kennedy and the members for offering their expertise to the Group and helping us to steer a course in cancer treatment over the next nine years."
Some of the issues which the new Strategy will address include:
Minimising the rate of increase in cancer numbers through prevention measures, including initiatives promoted by Healthy Ireland aimed at keeping people healthier for longer.
Ensuring that services for cancer treatment are on a par with the top international performers.
Improving the quality of life of people recovering from cancer.
The announcement of the Steering Group coincides with the publication of a peer review analysis of the previous strategy, 'A Strategy for Cancer Control in Ireland'. The review was led by Professor Pádraig Warde of the Princess Margaret Cancer Centre, Toronto and is available on the Department of Health's website http://health.gov.ie/blog/publications/national-cancer-strategy-2006.
The number of births to teenagers in Ireland has decreased from 1,381 in 2013 to 1,253 in 2014, according to figures from the Central Statistics Office.
This is a 60% decline in the number of births to teenagers over the last 13 years.
This equates to a decrease in the teenage birth rate from 20 per 1000 women aged 15-19 in Ireland in 2001 to 9.3 per 1000 in 2014.
Welcoming today's figures, Ms Helen Deely, Head of the HSE Crisis Pregnancy Programme, said "There has been a significant shift in our society over the last 14 years. Increasing numbers of young people are receiving good quality Relationships and Sexuality Education (RSE) in schools and in youth groups. Relationships and Sexuality Education in schools and youth groups has a huge part to play in the figures outlined today with research showing that those who received sex education were 1.5 times more likely to have used contraception the first time they had sex compared to those who did not receive sex education.'
HIQA has just published a revised guide to the monitoring programme for unannounced inspections undertaken against the National Standards for the Prevention and Control of Healthcare Associated Infections.
This guide focuses on the key elements of the 2015 monitoring programme and replaces the guide issued in March 2014.
In May 2009, HIQA produced the National Standards for the Prevention and Control of Healthcare Associated Infections to reduce risk and improve patient safety. The monitoring programme allows for unannounced inspections to take place in acute hospitals to monitor compliance with these Standards.
The monitoring programme during 2015 will predominantly focus on the following three areas:
Hand hygiene compliance.
Cleanliness of the environment and equipment.
Effectiveness in implementation and monitoring of infection prevention care bundles.
HIQA's Director of Regulation, Ms. Mary Dunnion, said: "HIQA will continue to monitor the cleanliness of the hospital environment and the effectiveness of the measures to promote hand hygiene performance as before. In addition, the Authority's unannounced inspections will now monitor hospitals' effectiveness in implementing infection prevention care bundles."
She said care bundles, a structured collection of evidence-based measures, could reduce the chances of infection occurring from a number of healthcare interventions when used reliably and consistently. Infection care bundles had been recommended in national guidelines to reduce the risk of infection that might occur in patients who had an intravenous line or urinary catheter in place to aid in their overall treatment.
"Healthcare Associated Infections are not an inevitable consequence of healthcare. The 12 Standards, produced by HIQA with the assistance of an external expert advisory group, are designed to encompass all of the key elements that a healthcare provider should have in place to protect patients against the risk of Healthcare Associated Infections," she said.
"Every patient has the right to high-quality healthcare in a safe environment. Our inspections will assess each hospital to see that the recommendations in the national guidelines are met in order to reduce the risk of infection for patients. Each hospital is responsible for developing a quality improvement response to identify and address improvements where there is a non-compliance. Re-inspections may be carried out within six weeks of the first inspection if performance is deemed to be sufficiently poor during inspection. Re-inspection aims to rapidly drive improvements."
The guide is available on the HIQA website and the findings of all inspections will be made publicly available and published on the HIQA website.
An Bord Pleanála has granted permission for a new forensic hospital at Portrane, Co. Dublin. This will replace the existing Central Mental Hospital in Dundrum.
The development will consist of:
A 120 bed National Forensic Hospital which will replace the Central Mental Hospital
A new 10-bed Mental Health Intellectual Disability Forensic Unit.
A new 10-bed Child and Adolescent Mental Health Forensic Unit.
The new facility should become operational in 2018. As part of this project the design work will be progressed for three 30 bed Intensive Care Rehabilitation Units (ICRU) in Cork, Galway and Portrane. A fourth ICRU is planned for an existing facility in Mullingar.
A new €2.7 million round of funding to support people with disabilities and for substance misuse prevention initiatives is being made available under the Dormant Accounts Fund.
The Department of Health is sponsoring five measures, which will be co-ordinated on the Department's behalf by the Health Service Executive (HSE):
Local area co-ordination in disability services.
Advancing best practice in meeting National Standards for Residential Services for People with Disabilities – minor capital and training initiatives.
Health-related supports to assist young people with disabilities and autism to make the transition from second level education to further education, training, employment.
Person-centred innovations in the delivery of non-centre based respite services for people with disabilities.
Substance misuse prevention initiatives.
Ms Audrey Houlihan
Ms. Audrey Houlihan has been appointed Chief Executive Officer of Our Lady's Hospice & Care Services, Harold's Cross and Blackrock, Dublin.
She was Head of HR & Organisation Development at Our Lady's Hospice & Care Services for four years. She joined the organisation in 2001 and has held a number of different roles including Business Manager.
She has a HR and Finance background and has experience in both the private and public sectors. She has also worked in the retail and wholesale industries in Ireland and the UK.
Ms. Houlihan holds a BA in HR from the National College of Ireland and an MA from the Institute of Public Administration.
As vice chair of the National Voluntary Hospitals HR Manager group she played an integral role with a range of employee relations issues.
She is currently a member of the Board at Caritas Convalescent Centre and of the Management Committee of the All Ireland Institute of Hospice and Palliative Care.
Our Lady's Hospice & Care Services is a 228-bed specialist facility that cares for people in its Harold's Cross and Blackrock facilities and in the community.
There are three elements to its services:
Palliative care: Over 800 seriously ill patients are admitted annually. It also provides over 11,000 home care visits for those who prefer to stay at home as long as possible.
Rheumatology & Musculoskeletal Disease Unit (RMDU): It works with more than 800 patients annually to assess, diagnose and treat a range of conditions. These include rehabilitation and on-going disease management.
The care of older people services are provided in Anna Gaynor House, a 100-bed residential care unit in Harold's Cross.
The Minister for Primary and Social Care, Ms. Kathleen Lynch TD has welcomed the establishment of a fund to support the implementation of reforms in disability and mental health services.
The Service Reform Fund is supported by The Atlantic Philanthropies, the Department of Health, the Health Service Executive and Genio.
The Minister said "The Atlantic Philanthropies has been a valued supporter and enabler of person-centred services. Refocusing services by putting the person at the heart of the delivery of care takes investment as well as behavioural change. The Service Reform Fund will provide financial support towards this change, in line with the Government's policies for these sectors."
The Service Reform Fund represents a total combined investment of €45m by the funding partners from 2015 to 2017, of which The Atlantic Philanthropies will invest €15 million and the Department of Health, €30m.
The pilot Emergency Aeromedical Support Service (EAS), which provides dedicated aeromedical support to the National Ambulance Service (NAS), is to be made permanent.
It is particularly important for patients in the west where land ambulance transit times would not be clinically appropriate.
The service is currently operated jointly by the Irish Air Corps and the National Ambulance Service, with back-up provided by the Irish Coast Guard. It was set up on a pilot basis, to see if there was a need for a dedicated emergency aeromedical service on a permanent basis. It operates alongside the Air Corps' inter-hospital transfer service which was introduced in 1964 and carries out approximately 100 missions each year.
A working group was established to look at options for the future delivery of the service. The Group has recommended that a service be made permanent. Both Minister for Health, Leo Varadkar and Minister for Defence, Simon Coveney have agreed to seek the endorsement of Government for this proposal and commit to an ongoing review of the operation, so as to sustain a quality service into the future.
Both Ministers marked the 1,000th 'air ambulance' mission with a special event at Casement Aerodrome, Baldonnel.
Minister Varadkar said: "I congratulate the staff of the Irish Air Corps, the National Ambulance Service, and the Irish Coast Guard for completing 1,000 missions on the 26th May last. This is a great example of what can be achieved by Government Departments working in partnership. This service has been a great step forward in providing access to specialised emergency treatment for patients living in remoter areas. It is also of significance that one third of the missions have been in response to STEMI heart attacks, and have allowed these patients to be treated in a specialist setting within 90 minutes of diagnosis."
Welcoming the fact that a Department of Health led Working Group, provided a positive assessment of the quality of the service that has been provided by the Air Corps, Minister Coveney commented, "Whilst the Air Corps has certainly set the benchmark during the pilot phase, and will continue to provide the service at its current level, as would be expected in implementing the report we must and indeed are obliged to keep an open mind as to the many different ways of providing the service and to keep all options under consideration in the context of ensuring a sustainable long term arrangement."
The role of the Emergency Aeromedical Support Service is to deliver advanced life support patients at the scene by the Advanced Paramedic and attending NAS ground crew. It also provides rapid transport for patients to the most appropriate hospital that meets the clinical need of the patient.
The Air Corps provide the crews from 'Number 3 Operations Wing' to fly and maintain an Agusta Westland AW139 helicopter, which is based at Custume Barracks in Athlone. The National Ambulance Service provides the onboard Advanced Paramedic.
The Emergency Service is tasked by the National Aeromedical Coordination Centre which is based in the National Emergency Operation Centre in Tallaght. The NAS operates a permanent support team for the EAS including a dedicated air medical liaison officer, education and training officer and a number of aeromedical advanced paramedics who crew the aircraft on a rotation basis.
A total of 2,592 referrals were made to the HSE Elder Abuse service in 2014, which is an increase of 5% on the previous year, according to annual figures produced by the service.
This represents the largest number of referrals received in any year since the service was established.
Psychological abuse was the most frequently reported form of abuse at 29%, followed by financial abuse (21%), self-neglect (21%), neglect (15%), and physical abuse (12%).
Sixty six per cent of referrals related to females and, of these, the majority (54%) were in the over 80s age group.
Applying the referral rates/1000 population across all HSE areas, the referral rate is between three and a half and four times greater in the over 80s when compared to the 65-79 year age group.
Public Health Nursing Service continues to be the main referral source despite a 4% drop from 2013 to (29%), followed by hospital (14%), and family (13%)
There was a significant increase in the number of concerns that first originated from older people themselves, from 19% in 2013 to 26% in 2014. As has been characteristic of previous years, the alleged perpetrators are adult children in 49% of cases, partner/husband wife (19%) and "other relative" (15%).
Additionally there were 5% of cases classified as "other" that when further explored, predominantly related to Landlord/Lodger related concerns which was evident for both male and female clients.
The new National Strategy for Suicide Prevention in Ireland 2015-2020, 'Connecting for Life,' sets out a vision of an Ireland where fewer lives are lost through suicide, and where communities and individuals are empowered to improve their mental health and wellbeing.
It aims to reduce suicide and self-harm by 10% over the next five years.
Central Statistics Office (CSO) data has shown that between 2007 and 2011 there was an increase in the suicide rate in Ireland, specifically among men.
However, recent figures have pointed to a reduction in the rate of suicide. CSO confirmed figures for 2012 indicated that 541 people lost their lives by suicide. Provisional figures for 2013 (475 deaths) and 2014 (459 deaths) have indicated a decrease in the numbers of deaths by suicide.
The National Registry of Deliberate Self-Harm has indicated that in 2013 there were 11,061 presentations to hospital due to deliberate self-harm. International evidence confirmed the presence of mental health issues; particularly depression and anxiety and also co-morbidity with drugs and alcohol were factors which significantly increased the risk of suicidal behaviour amongst individuals.
'Connecting for Life' has seven goals:
Better understanding of suicidal behaviour.
Supporting communities to prevent and respond to suicide behaviour.
Targeted approaches for those vulnerable to suicide.
Improved access, consistency and integration of services.
Safe and high-quality services.
Reduce access to means.
Better data and research.
It sets out sixty-nine actions agreed by ten Government Departments, twenty-one State Agencies, NGO, Community and Voluntary sector partners to achieve the seven goals.
Director of the National Office for Suicide Prevention (NOSP) Mr. Gerry Raleigh said, "Our focus is to reduce suicide. 'Connecting for Life' provides clear direction. We have developed the strategy by following a collaborative, inclusive and evidence informed pathway. We must now move into focused action and be accountable for what we do to reduce suicide in Ireland. We recognise that we cannot do this alone, no single agency, no single Government Department, no single individual can reduce suicide on their own. Therefore, we must ensure that we work together to achieve our shared and attainable goal for our nation."
A copy of 'Connecting for Life' can be found here
The North Cork Infant Mental Health Network Model at the Mallow Primary Healthcare Centre has been officially launched by Minister of State, Ms. Kathleen Lynch.
Over the past number of years, Primary Care Psychology services in Cork North have received significant referrals pertaining to infants and toddlers who have problems with sleeping and feeding or situations where parents find it very difficult to soothe them. If persistent, these stressful and upsetting problems can place considerable strain on the relationship between parents / carers and young children.
Ms. Catherine Maguire, Senior Clinical Psychologist and Infant Mental Health Specialist said "Early experiences for infants and toddlers matter and the role of the caregiver relationship is critical in supporting early development. What happens during the infant stage of development lays the foundation for future psychological social and emotional functioning, health and wellbeing. Infant Mental Health provides a unique opportunity to ensure the interactions that occur between the infant-parent/caregiver relationship are promoted and supported. Adverse early childhood experiences impacts on the young child's social and emotional development. Untreated, their effects will continue to impact negatively on physical, social, emotional health".
The North Cork Child and Family Psychology service developed the Infant Mental Health (IMH) model to meet the needs of these young children and their families. Master classes were devised and delivered by them to frontline professionals who come into contact with young children and families to increase their knowledge and skills in this area with the aim of ensuring that young children have their needs met at the earliest possible contact.
During the next stage of the model, the HSE primary care psychology service enlisted the support and collaboration of the Cork North Community Work Department which led to the development of Infant Mental Health Network Groups in the community. These groups are made up of a wide range of professionals who have contact with young children and families such as staff from HSE and Tusla , family resource centres, community childcare projects, ethnic minority services and others. The purpose of these groups who meet regularly is to expand and consolidate clinical knowledge and to support its integration into their work with families. The North Cork Infant Mental Health Network Groups are believed to be the first of their kind internationally.
Yvonne Finn Orde, General Manager Cork North said "The Infant Mental Health practice in North Cork was led by the pioneering work of Catherine Maguire and Rochelle Matacz, Senior Clinical Psychologists and Infant Mental Health Specialists, HSE Cork North Child and Family Psychology Services. The HSE has been pleased to support and fund the training for this innovative work. It is now very rewarding to see their work and expertise being rolled out across North Cork and in other parts of the country where North Cork Primary care has facilitated the training of staff in this model and has worked collaboratively with both HSE and Voluntary Sector partners in educating interdisciplinary groups of professionals, voluntary groups and, in turn, the public, regarding Infant Mental Health principles and practices and integrating them into service across the community – making infant and toddler mental health everybody's business.
Brendan Scahill, Community Worker said, "We are glad that our Department has had this opportunity to work in collaboration with our colleagues in the Psychology Department, HSE, to develop the model so that together a rich learning environment has been created and continues to thrive in North Cork".
The Coombe Women's & Infants University Hospital, Dublin will be relocated to St. James's Hospital and the Rotunda Hospital will move to the Connolly Hospital Blanchardstown site, Health Minister, Dr. Leo Varadkar has announced.
These decisions means that all three Dublin maternity hospitals will at a future stage be located alongside major adult teaching hospitals, following the earlier decision to move the National Maternity Hospital from Holles Street to the campus at St. Vincent's University Hospital.
The Minister said that while the Rotunda and the Coombe had served Dublin and the country well as standalone hospitals, current best practice was to co-locate maternity hospitals with adult acute hospitals. Both hospitals needed significant capital investment, particularly the Rotunda, which was more than a century old in parts.
A review of the proposed sites for the development of maternity hospitals in Dublin was carried out following the Government's decision to develop the new children's hospital at the St. James's campus, and the need to develop a maternity hospital on that site.
The Department said it consulted widely to take account not only of the current attendance patterns at the hospitals but also at how access for patients could be improved. Those consulted included HSE Estates Division, HSE Intelligence, Health and Wellbeing Division, the Clinical Programme for Obstetrics and Gynaecology and the Masters of the two maternity hospitals. It looked at planning risks, site capacity, demographics and a range of clinical criteria. The review considered the composition of Hospital Groups, and attempted to best align the hospitals within the relevant Hospital Group.
Welcoming the announcement, Dr. Sharon Sheehan, Master of the Coombe said "The tri-location model of maternity, paediatric, and adult services, will, I believe, enhance the quality of care provided to women and children across the country, and as such, we fully endorse the development of the new children's hospital at St. James's, and we welcome the opportunity to be the maternity hospital within this tri-located model."
Dr. Sam Coulter-Smith, Master of the Rotunda Hospital said that "the hospital is delighted to welcome the announcement, noting that co-location of the Rotunda with a significant acute adult partner has been the Rotunda's strategic ambition for some time. The Master and the Board welcome the announcement by the Minister and look forward to development of a new world class Rotunda on a redeveloped Connolly site".
The announcement was welcomed by Ms. Eilísh Hardiman, CEO, Children's Hospital Group, Dr. Sean Walsh, Interim CEO, Our Lady's Children's Hospital, Crumlin, Ms. Mona Baker, CEO, Temple Street Children's University Hospital, Mr. David Slevin, CEO, Tallaght Hospital, Dr. Susan O'Reilly, CEO of Dublin Midlands Hospital Group, Mr. Lorcan Birthistle, CEO, St. James's Hospital, Mr. Bill Maher, CEO of the RCSI Hospitals Group and Ms. Shona Schneemann, Interim CEO Connolly Hospital.
Approximately 40% of babies born in Irish hospitals are born at the Coombe, Holles St. or the Rotunda hospitals. The Department said the proposed move of the National Maternity Hospital at Holles St. to the campus of St. Vincent's University Hospital was progressing. A Design Team was in place and it was anticipated that a planning application would be submitted later this year.
A planning application for the new children's hospital at the St. James's campus will be made within the coming weeks.
A new EU logo has been introduced to signify the legitimacy of a website. Minister for Primary and Social Care. Ms. Kathleen Lynch, said members of the public were advised to look for the logo which would appear on websites of all registered EU pharmacies and medicines retailers.
She said members of the public were strongly advised not to purchase medicines from an internet site which did not have the EU internet logo.
"Falsified (fake) medicines are a significant health risk to patients. A total of 10.1million counterfeit and illicit pills were confiscated in 10 days in June 2013. Fifty per cent of the medicine sold by unregulated online retailers is estimated by the World Health Organisation to be unreliable and potentially harmful. Often the fake medicine doesn't contain the active ingredient that is needed to make the medicine work, or it contains the wrong dose. The substances that are used to bulk up the medicine can also be harmful."
She said that to tackle the growing problem of fake medicines the EU adopted the Falsified Medicines Directive in 2011. The objective of the Directive was to strengthen the EU legal framework which regulated medicines to prevent falsified medicines being supplied to patients through the legal supply chain.
One of the features of the Directive was the introduction of EU wide controls on supply of medicines by the internet. In Ireland these controls applied to pharmacies/retailers involved in the internet supply of non-prescription medicines. The internet supply of prescription medicines would continue to remain prohibited in Ireland on grounds of public health protection.
"With effect from June 24, 2015, all legally-operating pharmacies/retailers established in the EU will display the new EU internet logo. Members of the public should click the logo to ensure that the website is registered on one of the national lists of legally-operating pharmacies/retailers. This will ensure that the non-prescription medicines you purchase are safe and effective", said a statement from the Department of Health.
"To stay safe when buying from a website, first look for the logo. Do not continue if the website does not contain the logo.
"Secondly click on the logo which will take you to the website of the national regulatory authority corresponding to the flag displayed on the logo. The flag corresponds to the country where the pharmacy/retailer is established. Once there, check that the pharmacy/retailer is listed. Then continue with your purchase.
"In Ireland the Pharmaceutical Society of Ireland is the body responsible for maintaining the list of Irish registered retailers. However Irish consumers may also purchase non-prescription medicines from a website registered in another EU member state. The important thing is to check that the pharmacy/retailer is registered in the member state in question before making a purchase."
Twenty six terminations were carried out in Ireland in 2014, under the Protection of Life During Pregnancy Act.
The first annual report on the Protection Act which was laid before the Houses of the Oireachtas revealed that fourteen of these terminations arose from a risk to the life of the mother arising from physical illness, three arose from a risk to the life of the mother from suicide, and nine from a risk to the life of the mother from emergencies arising from physical illness.
Health Minister, Dr. Leo Varadkar said the total number of terminations was in line with annual estimates presented to the Joint Oireachtas Committee hearings on the General Scheme of the Bill in January 2013.
Minister Varadkar said that on the basis of the notifications received by the Department, the evidence indicates that the Act was working and that the hospitals were compliant with the notifications requirement under the Act. He said the information published on these procedures was restricted in order to limit the risk of identification in what was a private confidential matter between patients and their doctors.
The HSE has also submitted a report as required under Section 15 of the Act on Reviews carried out in 2014. This report has also been laid before the Houses of the Oireachtas.
The HSE's report shows that one application for review was made to the Executive, one review was carried out under Section 7 of the Act, and the Review Committee found that this application did not meet the criteria for a termination of pregnancy under the Act.
Dr. Varadkar said "We are satisfied that the legislation in working in the way it was intended to. I know the figure of 26 may seem high but bear in mind it is three on the grounds of suicide and 23 on the grounds of physical illness where there is a threat to the life of the mother.
"If you read back on the evidence given by obstetricians to the Joint Oireachtas committee, the figures they used were in the region of 20 or 30 cases a year where a termination is necessary to protect the life of the mother."
The HSE's report also shows that one application for review was made to the executive and the Review Committee found this application did not meet the criteria for a termination of pregnancy under the Act.
Mr Varadkar said this was a personal and private matter for the women concerned and her doctors. He said it was not for politicians or other third parties to be investigating or getting involved in.
The Act requires that the Minister for Health be notified of each termination of pregnancy no later than 28 days after it has taken place, without disclosing the name of the woman.
The Protection of Life During Pregnancy Act 2013 was enacted on July 30th, 2013 and came into force on January 1, 2014. It allows for a termination of pregnancy where there is a real and substantial risk to a woman's life from a physical illness, when there is an immediate risk to the life of the woman arising from a physical illness or when there is a real and substantial risk to the life of the woman arising from suicide intent.
The European Court of Justice has recognised that protected training time, where NCHDs are engaged in educational and training activities and are not available to their employers for work purposes, does not constitute working time.
The Department of Health said that this part of the judgment would support the achievement of EWTD compliance.
"It will be incorporated into the detailed implementation plan, currently being prepared by the HSE, for achievement of compliance with the 48 hour maximum average working week requirement, said the Department.
"The Department is pleased that the Court did not accept that the duration of the reference period used in Ireland for the purposes of calculating the average working week infringes the Directive. Pursuant to the Collective Agreement made between the HSE and the IMO in January 2010, this period may extend to 12 months in certain circumstances.
"The Department is also pleased that the Court recognised that the legal framework in Ireland, resulting from the legislation transposing the Working Time Directive for Doctors in Training (the 2004 Regulations), is clear and applicable and that this legislation has to be taken into account when assessing the provisions relating to 'hours of work' in the employment contracts of NCHDs.
"The Government, the Department and the HSE are committed to achieving full compliance with the 48 hour requirement as soon as possible. Attainment of full EWTD compliance will require reconfiguration of some services across hospitals groups and the completion of the capital projects in train relating to paediatrics and maternity. Notwithstanding the recruitment of nearly 750 additional NCHDs over the past four years, there are difficulties in recruiting and retaining certain categories of NCHDs and in attracting them to smaller hospitals where the nature of the work does not support a sufficient number of training posts.
"The HSE has been focused on progressing compliance and substantial progress has been achieved. In the latter half of 2014 and the first quarter of 2015 Ireland has consistently recorded compliance levels in excess of 95% for many of the requirements of the Directive including the granting of daily breaks and daily, weekly and fortnightly rest periods. There has also been significant improvement in relation to the 48 hour maximum average working week requirement. Compliance has improved from 33% in 2011 to 69% in the first quarter of 2015 and the most recent monthly data for May shows compliance above 70%. Consistent with this improvement, data from the HSE also shows that average working hours for NCHDs have reduced considerably, falling from 60 hours a week in 2009 to 54 hours per week in 2012 and to 51 hours at the end of 2014.
"While the judgment followed a referral by the Commission, there is ongoing positive engagement with the Commission on the matter. This engagement and the progress made to date were acknowledged by the Commission when it presented its case to the Court of Justice. There will be further engagement between the Irish authorities and the Commission in the autumn when the details of the judgment have been worked into the HSE's plans for achieving full compliance.
"There is also ongoing engagement between health service management and the IMO following the agreement reached at the LRC in 2013 that provided for a National Verification and Implementation Group to monitor progress and to implement measures to achieve compliance."
The Government has decided to make no change in the area of funding or eligibility for the Fair Deal scheme according to the Department of Health. The Department Statement followed the Review of the Nursing Homes Support Scheme which suggested that those with higher incomes could be asked to contribute an increased amount. It suggested this could rise from an existing 80 per cent to 85 per cent. It also suggested that as some residents have refused to pay their contributions, the Government could consider changing the law to allow for attachment orders to be secured to permit the cost to be deducted from their earnings or pension or placed against their property.
The approved budget for Fair Deal this year is €993 million which will support 23,960 people in nursing home care by the end of 2015. The Government increased this budget by €54 million this year, allowing the waiting time following approval to be brought down to four weeks. By 2018 it is projected that the number of people benefiting from the Scheme will grow by up to 1,126, at an additional Exchequer cost of €49 million over the three year period. It is forecast this number could rise to 33,070 by the end of 2024.
The Review was carried out by the Department in collaboration with the HSE with input from Deloitte and Touche as external consultants. Specific recommendations are to:
Standardise or centralise certain administrative processes.
Develop the use of information technology and web-based systems.
Enhance application materials and make these easier to understand.
Improve procedures used in the validation of financial information submitted by applicants and in the recovery of deferred contributions.
Develop new approaches to setting nursing home prices to ensure that value, adequate capacity, and transparency are achieved.
Minister of State at the Department of Health, Ms. Kathleen Lynch said the review had identified some things that required attention and adjustment. She said this was to be expected and work would commence immediately on the areas identified, particularly those that could be addressed quickly on an administrative basis. The Government has decided to establish a Working Group composed of representatives of a number of Departments, the HSE and the National Treatment Purchase Fund (where relevant) to oversee implementation of these recommendations.
"Other issues, such as further emphasis on community care and the development of new models of residential care, will take longer but are also very important," she added.
Under Fair Deal residents also contribute to the cost of their care. Resident contributions amounted to approximately €293 million in 2014. At end 2014 the average weekly contribution from residents in a public unit was €285 and in a private unit was €294.
The review said that an analysis of scheme participants identified:
Average cash assets of scheme participants: €49,590.
Average value per participant of other relevant assets (including principal private residence and other property): €88,941.
18% of scheme participants had no declared cash assets.
15% of participants had no declared cash or other relevant assets.
Just over 9% of applicants opted to defer the portion of their contribution that was based on other relevant assets including property.
15% of applicants had no declared income other than the Non-Contributory Old Age Pension.
The average declared income for applicants assessed on a single basis was €281 per week.
The average declared income for applicants assessed jointly (as part of a couple) was €562 per week.
It found the average weekly cost of care in a public facility was €1,390 and in a private or voluntary facility was €893 at end 2014. Based on the end 2014 data from HIQA, there were 450 private and voluntary (Section 39) nursing home operators. These facilities could provide accommodation for 22,232 residents.
The review also found that approximately, 104,500 or 17.8% of older people were in receipt of some kind of service for older people in 2014, including residential care, home care and day care. While initiatives to increase healthy life expectancy would have some impact on utilisation of services, if services were to continue to be provided to the same proportion of older people as in 2014, by 2016 approximately 111,000 older people would be receiving these services. This would increase to 130,000 by 2021 and to 143,000 by 2024 and the increase could be even higher if informal carers were unable to provide the same rate of care that they currently provided.
The report sets out options for the future financing of the scheme including reducing the level of assets – currently set at €36,000 for an individual or €72,000 for a couple – which were not taken into account during the financial assessment for the scheme. It said another option would be to increase the contribution an individual was obliged to make from their assets which was currently set at 7.5 per cent.
The review is available on the Department's website.
Minister for Health Dr. Leo Varadkar T.D. has officially opened the new HSE National Ambulance Service (NAS) headquarters, in the Rivers Building, Tallaght, Dublin 24.
Ms. Laverne McGuinness, Chief Operations Officer, HSE, Mr. Martin Dunne, Director of the National Ambulance Service, Mr. Gavin Doyle Control Supervisor, Health Minister, Dr. Leo Varadkar and Mr. Paul McMahon, Emergency Medical Dispatcher
This building houses the National Emergency Operations Centre (NEOC) where 999/112 calls are received and emergency paramedic teams are dispatched.
The Department of Health said that this new state of the art facility enables the NAS to see all available paramedic teams and vehicles in real time, ensuring that the closest available resource is dispatched to an emergency within moments of the call being received.
"The NEOC operates over two sites, on a singular ICT platform, one in the Rivers Building and the other in Ballyshannon, Co Donegal. The NEOC also houses the aeromedical coordination centre for all emergency aeromedical requests and dispatches the emergency aeromedical service. In January of this year the NAS through the NEOC received an accreditation from the International Academies of Emergency Dispatch. This accreditation places the NEOC as one of only seven centres with this accreditation, within the UK and Europe.
"The Rivers Building also houses the National Ambulance Service College where all NAS Emergency Medical Technicians, Paramedics and Advanced Paramedics receive training and ongoing revalidation. This college has the latest training aids and simulators within the building ensuring comprehensive training in a consistent manner for all staff. The college also trains all the call taking and dispatch staff for the NEOC.
Mr. Damien McCallion, HSE National Director for National Ambulance Service, said; "The opening of the Rivers Building today is the result of the vision and hard work of the staff in the National Ambulance Service who have worked hard to deliver the modern facility that we have here. This will provide enormous benefits to patients, in terms of the co-ordination of a national fleet with the nearest available team responding, and to the staff who work here."
Mr. Martin Dunne, Director of the National Ambulance Service, said; "I want to thank all who were involved in the move of our services to our new headquarters here in Tallaght. This is the result of the commitment, dedication, hard work and co-ordination of all involved to realise an infrastructure of sophistication. We can see the benefits already for patients, with the integrated platform for resource deployment which enables the closest available resource to be dispatched to the call within minutes of receipt of the call."
President Michael D. Higgins opened Uilinn: the West Cork Arts Centre in Skibbereen.
The President commended the Arts for Health programme that is run with the HSE and its importance to patients in long stay residential facilities and those who attend day centres. In conjunction with the HSE and Cork County Council, Uilinn organises an exceptional Arts for Health programme for older people in healthcare settings.
Arts for Health runs all year round and is delivered by team of professional artists from different disciplines.
It takes place in five community hospitals (Skibbereen, Schull, Dunmanway, Clonakilty and Castletownbere) and Bantry General Hospital Care of the Elderly Unit and five Day Care Units. Partners comprise West Cork Arts Centre, Cork County Council, Cork Education & Training Board and the HSE. The HSE is represented through the Cork Arts + Health Programme, the Communications Department, Health Promotion Department, the Nursing Directors of Community Hospitals and the Day Care Centres, West Cork.
The works produced from their time at the hospitals is on www.westcorkartscentre.com/ and see "arts and health".
The Centric Health Medical & Dental Practice and the HSE's Navan Road Primary Care Centre has been officially opened by the Minister for Health, Dr. Leo Varadkar.
Speaking at the official opening Dr. Varadkar said: "The Navan Road primary care centre is the second provided by the Government in Dublin West, after the Blanchardstown Primary Centre which opened last year. It's a fantastic facility for local residents, offering GP surgeries, physiotherapy, occupational and speech and language therapy, social work, psychology and mental health teams. A third centre in Dublin West is now under construction in Corduff and will open next year.
"These new primary care centres join over 40 locations already across the country opened since 2011, with another 30 underway. Of these, 14 will be delivered by PPP and will receive funding from the European Investment Bank, the first time the Bank has invested in health care infrastructure in Ireland."
The development, which is a newly constructed large bespoke facility, is located on the corner of Cabra Road and the Navan Road in Dublin 7. The facility provides 3,252 sq m/ 35,000 sq ft of space over four stories to accommodate a wide range of health services in one campus.
The Centric Health Navan Road Medical & Dental practice consists of a team of 10 professionals including three GPs, Dr. Roisin Lyons, Dr. Shane Quigley and Dr. Michael Hayes.
The Centric Health practice operates offers a wide range of services including Antenatal Care, Blood Tests, Under 6 GP Care including Child Vaccinations, Health Screening, Physiotherapy, STI Screening and 24 Hour Blood Pressure Monitoring. The practice provides for both medical and non-medical card patients. The practice will also be joined by Dr. Irene Lavin and Dr. Ciaran O'Driscoll from the Navan Road dental practice.
Also attending the opening were the retired GPs who built up the Navan Road practice over many years – Dr. Owen Carey, Dr. Maurice Brennan and Dr. Dympna Frawley.
Centric Health's primary care mission is to keep people healthy in their own communities. Its model is based on working in partnership with established colleagues to deliver multidisciplinary care in modern bespoke premises. This is the third centre Centric Health has delivered in partnership with the HSE as part of the national primary care strategy.
There are also two HSE community mental health teams based at the primary care centre who provide services for the entire Dublin 7 area. The community mental health teams are consultant led and included a social worker, psychologist, community psychiatric nurses and occupational therapists. There is also a Community Mental Health Day Hospital accommodated within the primary care centre.
Speaking at the event, Des O' Flynn, HSE Area Manager Dublin North City said: "The co-location of primary care services in the new Centric Health and Navan Road Primary Care facility has enabled the HSE to significantly increase the range and type of health care we can provide locally to the community and has facilitated the enhanced integration between health services in our community. This will result in increased patient centered care being delivered locally to a model of best practice."
The Minister for Primary Care, Social Care and Mental Health, Ms. Kathleen Lynch has welcomed the publication of the Mental Health Commission's report into the targeted intervention into services in Carlow/Kilkenny/South Tipperary by the Inspector of Mental Health Services.
The report makes nineteen recommendations. These are aimed at improving assessment, risk and incident management, clinical assessment processes, service team staffing and composition, team governance and review processes, timely communications with families and the filling of certain gaps in the Child and Adolescent Mental Health Services in South Tipperary, in particular.
"I'm satisfied that the specific HSE implementation plan, which was agreed with the Commission, has delivered or is delivering on these important recommendations. In addition, I'm satisfied that the HSE is addressing any outstanding issues in consultation with the Commission", the Minister said.
"I have been aware, for some time, of concerns around the issue of suicide or other incidents in the area. I supported the original decision to make this targeted intervention and I wholeheartedly support objective measures which promote quality and safety for service users who are at the centre of everything we do", she continued
"The targeted intervention team found no basis to suggest that the rate of suicide in the area was anomalous. Nor was there a common causal factor for the incidents and deaths examined. However, the intervention did identify specific improvements and they are being implemented. Most importantly, the lessons learned will be shared with other services across the country, as appropriate", she said.
"The Government will continue to invest in the modernisation of our mental health services. Since 2012, an additional €125 million and 1,100 posts have been approved. But it's not just a question of resources. We need to continue to change cultures and behaviours and this requires full engagement by all concerned, not just in Carlow/Kilkenny/South Tipperary, but nationwide.", she concluded.
I would like to thank the Mental Health Commission for the consistently diligent and constructive efforts which contribute greatly to improvements in the provision of mental health services."
Mr. Bill Prasifka has been appointed as Chief Executive of the Medical Council. He was previously Financial Services Ombudsman, Chairman of the Competition Authority and Commissioner of Aviation Regulation.
Announcing the appointment, President of the Medical Council, Prof. Freddie Wood said: "We are delighted to announce Bill's appointment as Chief Executive. Bill brings significant experience in regulation across a number of sectors, and we look forward to working with him to further our work in providing a strong regulatory framework for the benefit of patients and doctors."
Mr Prasifka said: "The remit of the Medical Council is exceptionally important in providing an environment which enhances good professional practice among doctors, and I am really looking forward to building on the work of the Council for the benefit of patients in Ireland."
Mr. Prasifka will take up his new post in October. Ms. Catherine Whelan, the former Chief Executive of the Independent Hospitals Association of Ireland and former Medical Council member, is the Interim Chief Executive.
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text:
package org.apereo.cas.support.saml.authentication.principal;

import com.fasterxml.jackson.annotation.JsonCreator;
import com.fasterxml.jackson.annotation.JsonProperty;
import org.apache.commons.lang3.builder.EqualsBuilder;
import org.apache.commons.lang3.builder.HashCodeBuilder;
import org.apereo.cas.authentication.principal.AbstractWebApplicationService;

import javax.persistence.Column;
import javax.persistence.DiscriminatorValue;
import javax.persistence.Entity;

/**
 * Implementation of a Service that supports Google Accounts (eventually a more
 * generic SAML2 support will come).
 *
 * @author Scott Battaglia
 * @since 3.1
 */
@Entity
@DiscriminatorValue("google")
public class GoogleAccountsService extends AbstractWebApplicationService {

    private static final long serialVersionUID = 6678711809842282833L;

    @Column(length = 255, updatable = true, insertable = true)
    private String relayState;

    @Column(length = 255, updatable = true, insertable = true)
    private String requestId;

    private GoogleAccountsService() {}

    /**
     * Instantiates a new google accounts service.
     *
     * @param id         the id
     * @param relayState the relay state
     * @param requestId  the request id
     */
    protected GoogleAccountsService(final String id, final String relayState, final String requestId) {
        super(id, id, null);
        this.relayState = relayState;
        this.requestId = requestId;
    }

    @JsonCreator
    public GoogleAccountsService(@JsonProperty("id") final String id,
                                 @JsonProperty("originalUrl") final String originalUrl,
                                 @JsonProperty("artifactId") final String artifactId,
                                 @JsonProperty("relayState") final String relayState,
                                 @JsonProperty("requestId") final String requestId) {
        super(id, originalUrl, artifactId);
        this.relayState = relayState;
        this.requestId = requestId;
    }

    public String getRelayState() {
        return this.relayState;
    }

    public String getRequestId() {
        return this.requestId;
    }

    @Override
    public boolean equals(final Object obj) {
        if (obj == null) {
            return false;
        }
        if (obj == this) {
            return true;
        }
        if (obj.getClass() != getClass()) {
            return false;
        }
        final GoogleAccountsService rhs = (GoogleAccountsService) obj;
        return new EqualsBuilder()
                .appendSuper(super.equals(obj))
                .append(this.relayState, rhs.relayState)
                .append(this.requestId, rhs.requestId)
                .isEquals();
    }

    @Override
    public int hashCode() {
        return new HashCodeBuilder()
                .appendSuper(super.hashCode())
                .append(relayState)
                .append(requestId)
                .toHashCode();
    }
}

redpajama_set_name: RedPajamaGithub


Emergency Medicine operates early in the course of disease when uncertainty is high and information light. We need to do things that help us cognitively offload in the care of critically ill patients. In how many specialties would you be expected to acutely manage (and possibly resuscitate) anyone who comes to you for care – young or old, surgical or medical, sick or not sick with limited time and information. We are constantly having to think outside the box. Consider these 4 topics when thinking outside of the box: Bougie 1st Intubation, Mechanical CPR in OHCA, HD-Guided Epinephrine Drips in OHCA, and Stroke Ambulances. What side of the discussion do you fall on in these controversial areas?


If God's Conservative, is CNN doomed?
One, In the United States, Conservatives continue to outnumber moderates and liberals in the American populace in 2009, confirming a finding that Gallup first noted in June. Forty percent of Americans describe their political views as conservative, 36% as moderate, and 20% as liberal. This marks a shift from 2005 through 2008, when moderates were tied with conservatives as the most prevalent group.
Two, CNN, which invented the cable news network more than two decades ago, will hit a new competitive low with its prime-time programs in October, finishing fourth – and last – among the cable news networks with the audience that all the networks rely on for their advertising.
Now, who are the leading news guys on TV? Bill O'Reilly tops at 881,000 viewers and Sean Hannity rakes in 659,000 viewers . Liberal news analysis is way behind.
Consider the first snippets' implication on the second. Conservatives outnumber Liberals, 2 to 1. On TV, Fox's viewers outnumber their liberal counterparts, almost 3 to 1. Which means in addition to conservatives glued to O'Reilly and Hannity, moderates too seem to be joining in.
Where does that leave liberal news media? Of course, as a viewer segment liberal numbers are big enough to be catered to. But the question is, how many channels can profitably operate, pandering to bleeding liberals? Not many. And that's why CNN's going down.
What choices does CNN have? Reinvent and go the Conservative way. Its a good idea, considering there aren't any other strong conservative networks jostling with Fox for conservative eyeballs. But, that isn't going to happen any time soon, considering the fact that liberals can't and won't see business sense anytime in the near future. Isn't that why they see Obama as the Socialist saviour? Which means the choice CNN has is to ratchet up its liberal propaganda to the level of Chris Mathews, Keith Olbermann and Rachel Maddow, that may give them a chance. To stay afloat. But then again, CNN already has its opinionated sister network in HLN.
I say, it will be tough going for CNN.
Brands that see their segments dying, have three stark choices. Either abandon the segment to move to a growing one (reinvention becomes a must), or fight hard to eat into competitor share (added investment becomes imperative), or to go on their knees and pray hard (humility is non-negotiable) that their segment numbers grow.
For CNN, I recommend prayer. But then I realise, isn't God conservative?


text:
Jose Mourinho Stands by Victor Lindelof After Tough Pre-Season for New Man Utd Signing
Manchester United manager Jose Mourinho has backed defender Victor Lindelof to succeed at the club following his £30m from Benfica, despite a tough start to life in a United shirt for the young Swede during the summer tour so far.
Lindelof's unofficial debut against LA Galaxy was marred when he skied the ball in front of an open net, while he also drew criticism on social media when he clumsily clattered Theo Hernandez to give away a penalty against Real Madrid, and then poorly missed in the penalty shootout himself.
BRENDAN SMIALOWSKI/GettyImages
He's looked nervous and doesn't quite appear to be up to speed with his new teammates, but Mourinho insists that his progress has been good and the club will give him time to settle.
"Step by step. Benfica is a giant club, I always think that players coming from Benfica come mentally ready because it is a big club and the responsibility to play for them makes players ready," Mourinho commented after Sunday night's 3-0 win over Valerenga (ManUtd.com).
"But the Portuguese league is different and has different qualities. Benfica is one of the dominant teams, so he's more used to playing with the ball than without the ball, so he needs his time and we are going to give him his time to develop," the boss added.
Nils Petter Nilsson/Ombrello/GettyImages
"Such a young player needs time. Manchester United is a huge club with huge responsibility; the Premier League is the same. So let's give him time, but we're happy with what he is doing, step by step."
Lindelof played another half of football against Valerenge, while Marouane Fellaini, Romelu Lukaku and youngster Scott McTominay scored the goals on the night.
For McTominay, who was handed a surprise debut by Mourinho towards the end of last season, it was a special moment after an impressive summer so far.
"Coming over with the first team for a start and just playing games with them in pre-season and then obviously to get my first senior goal - it's the best feeling in the world," he told MUTV.
"It's the best moment of my life so you just want more and more of this. This is what you work for every single day in training, dedicating yourself. I'm just going to enjoy it now and push forward to do my best."

redpajama_set_name: RedPajamaCommonCrawl


A detailed look at Carlisle United's latest accounts, which cover the 2017/18 season.
United suffered an overall loss of £121,000.
This is less than the previous campaign, when they lost £209,000.
They got through much more than this, though, in a 2017/18 season where they finished 10th in League Two under Keith Curle.
Bearing in mind that £860,000 was loaned to the club during the season by Edinburgh Woollen Mill - the same amount converted into shares by chairman Andrew Jenkins from his own existing debt - it means that, in reality, Carlisle spent just short of £1m (£981,000) more than they could themselves afford in 2017/18.
You will not find the words 'Edinburgh', 'Woollen' and 'Mill' anywhere in the accounts. This is consistent with both United and EWM's policy of saying very little about the firm's involvement with the Blues.
Nonetheless, their financial part in the club is clear enough when looking at these new figures.
They indicate that Philip Day's firm loaned Carlisle United another £860,000 in the 2017/18 campaign - taking the club's overall debt to EWM to £1.31m.
EWM are the only creditor whose loans are secured in this way – the charge, in fact, covering all the club's assets.
The fact their £860,000 of new loans is the same figure Jenkins wiped from his own debt appears to support what the chairman has previously said: that he would remove £1 of his debt for every £1 of new money that came into the club.
The chairman and his fellow owners, meanwhile, continue to supply personal guarantees over the EWM debt.
The 2017/18 season is the first full campaign in which EWM have been financially involved with the Blues in this way.
There remains persistent speculation about whether Day's firm could step up their involvement and, eventually, take over the club.
United, though, remain reluctant to be drawn on such a possibility, while EWM continue not to comment.
The above figures indicate United's increased reliance on EWM.
Indeed, loans from Day's firm now account for more than half of the club's overall debt – a significant shift from the period when Jenkins, along with his firm Pioneer, was the Blues' major creditor.
By the end of the 2017/18 accounting period, United's total debt stood at £2.26m – an increase of £245,000 from £2.01m.
That figure is largely comprised of loans from EWM, Jenkins, the chairman's firm Pioneer, and bank debt.
The Blues have said they have been striving to keep their overall debt at a similar level.
Asked for the reasons for the £245,000 increase, United said: "The total debt includes all bank finance, such as overdrafts and finance lease, which changes day to day and month to month with the normal trading circumstances, and this affects the reported figures."
Jenkins, meanwhile, loaned the Blues more cash last season - even as a significant part of his debt was removed.
The accounts show he put a further £260,000 into the club during 2017/18.
Taking into account his conversion of £860,000 into equity, this means United's overall debt to Jenkins fell by £600,000 during the year.
As of June, they owed the chairman £135,000.
The accounts also show that debt from "other related parties" – understood mostly to refer to Pioneer – went down by £85,000 in 2017/18. As of June, that debt stood at £493,000.
The question of why some of the existing debt has been converted to shares by directors, as opposed to having it written off, receives this answer by United: "The loan providers offered to convert, and the board decided they wished to agree to it."
The shares received by those directors are non-voting 'B' shares in United's holding company.
A confirmation statement from CUFC Holdings, filed in January, showed Jenkins' allocation of such shares to have increased from 400,000 to 1,198,000.
John Nixon's B shares also significantly increased - from 20,000 to 132,000.
The News & Star has asked United to clarify these figures.
Carlisle's spending on the team in an attempt to get out of League Two went down in the 2017/18 season – but only slightly.
Their total football expenditure was £2.6m, having spent £2.76m in their play-off campaign of 2016/17.
These figures include players' wages, bonuses, agents' fees, football staff salaries and costs, and spending on such things as travel and accommodation for away games.
The small reduction, United say, is simply as a result of fewer bonuses being paid in a less successful term.
Otherwise, the club say the largely similar amount shows they maintained their spending levels in a bid to back another promotion attempt.
Indeed, they note in the accounts that their spending on the team remained "significantly in excess of what the club could afford without external funding support" – which is where EWM and Jenkins' loans came in.
They remained, too, at the upper end of their spending limit under League salary cost management protocol rules – 96 per cent in 2017/18, as opposed to 99 per cent the previous year.
Where did the club rank for player spending?
The accounts appear to shed some definitive light on how Carlisle measured up to their League Two rivals in terms of spending.
They suggest that, although United finished in mid-table, they were a play-off side in terms of budget.
"According to EFL independent benchmark data, our spending was in the top six of League Two in 2017/18," a note in the accounts states.
United remain at pains to point out that the amount a club spends on the team does not automatically equate to improved league position.
They say that the focus of that spending, and aspects like the quality of coaching and recruitment, is also crucial.
Another striking revelation connected to this area is mentioned later in the accounts.
It observes that, while Carlisle finished 10th in both the 2015/16 and 2017/18 seasons, they spent £575,000 more to do so in the latter campaign.
On these figures in general, Nigel Clibbens said: "We reported similar information in the previous year too, and we have continued to do that again in the 2017/18 accounts.
"Firstly, it gives some wider context to the level of the club's total spending on football.
"More importantly, it also helps bring together information about the spending decisions made by the board, the financial consequences and the numbers we report in accounts."
The effect of an underwhelming season and falling crowds is reflected starkly in these areas.
United's headline turnover figure went down – from £4.27m to £3.99m.
This figure covers all club activities, including money from cup runs and player sales.
With average home attendances down by more than 500, the club's business turnover also fell to £1.97m from £2.28m.
This, United say, was the "understandable" result of those lower gates - with income falling in certain specific areas.
Ticket income, for instance, dropped by £204,000. Retail income took a £30,000 hit, and commercial income was down £74,000.
The accounts further note that "commercial activities had a difficult year", adding that "sponsorship and matchday hospitality were particularly challenging" in 2017/18.
This period included the departure of former sales and marketing director Phil King, who left the club in March and was not directly replaced.
Certain areas of the club's income, though, did go up.
Season-tickets, for example, provided a boost, United making £374,000 from these as opposed to £327,000 the previous year.
This reflected the sale of 2,236 season tickets, up from 1,858.
This helped offset very slightly the damaging £250,000 loss in matchday ticket income.
The fall in ticket sales and sponsorship also affected United's "underlying contribution".
This refers to the money Carlisle were able to put towards their football spending before receiving outside help from the likes of EWM and Jenkins.
In 2017/18 this fell by £260,000, to £1.39m.
United's income from the Premier League and EFL, meanwhile, went up to £960,000 from £919,000.
Academy grant money from the EFL also increased, to £466,000 from £424,000.
The amount United raked in from "football fortune" – player sales and cup runs – also suffered a small reduction.
In 2017/18 the accounts show they made £449,000 from these areas, as opposed to £484,000 in 2016/17.
This reflected, in part, a season of modest cup runs, including second-round exits in the Checkatrade Trophy and Carabao Cup, and a third-round departure from the FA Cup at the hands of Sheffield Wednesday.
They did earn more from player trading, though, than in 2016/17.
The rise to £223,000 from the previous year's £209,000 is down in part to the January sale of striker Sam Cosgrove to Aberdeen.
The figures are also believed to include further instalments from the departures of Brad Potts and Kyle Dempsey to Blackpool and Huddersfield respectively in 2015.
They do not, though, include any money from the January 2017 sale of Charlie Wyke to Bradford, all of which United say was included in last year's accounts.
Asked whether there could be any further instalments in the future from some of the above, United said these were only "hypothetical" and depended on a host of different factors.
As such, these are estimated at £nil for the purposes of the accounts.
These increased from £424,000 to £482,000.
The explanation given for this is the extra cost of running the club day-to-day, plus the retail cost of sales for purchases, as well as matchday staff and stewarding. Costs from minimum wage and holiday pay legislation regarding matchday staff are also cited.
United, though, say they reduced certain overheads in order to help balance the books.
Overall, total business costs and overheads went down from £1.525m to £1.44m.
United have conceded that the sceptical feeling among many supporters inevitably took its toll last season, with a change of financial approach having been made since then.
Nigel Clibbens said: "If you aren't getting as many supporters through the turnstiles and commercially, it starts to make an impact very quickly in many areas.
"In the second half of the season in particular, from Christmas onwards, it was a difficult time with off-the-field issues like manager and player contracts to be decided, and we were firmly fixed in the table just above halfway, unable to mount a challenge and struggling at home.
"At the same time we had to deliver some difficult messages about the future direction of the club.
"Andrew Jenkins has commented on this being a 'difficult but necessary transformation' and I would certainly endorse that."
This became a briefly hot topic this year when a football finance expert suggested there was a director at United earning about £174,000.
This was not the case, as that figure in the accounts covered expenditure on all three salaried directors at Brunton Park, not just one.
In other words – Clibbens, King and finance director Suzanne Kidd.
That overall amount in the 2017/18 accounts fell slightly – to £168,000.
That small drop reflects sales and marketing director King's departure in the latter stages of the accounting period, in March.
As well as salaries, the figure is believed to cover pension and national insurance contributions, plus other costs.
It does not, though, cover David Holdsworth coming onto the books as director of football. That was not confirmed until later in the summer and will be included in next year's accounts.
Carlisle have, meanwhile, said that these accounts do not include the payment of any expenses incurred by co-owner and "director of external affairs" John Nixon whilst carrying out his various EFL and FA duties.
"That is not the case," Nigel Clibbens said. "Only bona-fide club-related expenses wholly, necessarily and exclusively incurred on CUFC business and authorised in advance are reimbursed.
"This simply policy applies to everyone, regardless of who they are, including John."
Clibbens added: "The expenses of all the Holdings directors together are almost nil over all my time here."
In terms of the club's overall staffing, the accounts show Carlisle hired extra football employees, but reduced staff in other areas.
On the football side of the business, numbers grew from 46 to 54. Admin staff, by contrast, went down by 15, from 177 to 162.
Asked to explain these changes, United said the numbers reported in each area are the "average monthly number".
Admin staff, they said, "mainly comprise stewards", meaning that attendances, opposition and cup games affect matchday staffing numbers.
"Football staff includes players and support staff - again this is an average rather than being specific individuals," the club add.
Overall, United's wage bill came down slightly. By the end of the season, wages and salaries stood at £2.96m, down from £3.14m. Overall remuneration, which also includes social security and pension costs, dropped to £3.25m from £3.43m.
United's community work is once more highlighted in the accounts as a source of positivity.
One aspect clearly growing is their community ticket scheme, which saw 2,585 complimentary tickets issued to groups over the season.
This was an increase of 22 per cent, up from 2,119 in 2016/17.
Nigel Clibbens said: "It's something that is going from strength to strength.
"Our long-standing support from the Cumberland Building Society is fantastic and makes a real difference to that.
"With the young fans we have coming to games, both in our community stand and those playing on the pitch, it all helps create the next generation of fans, which is something we have been focusing on."
United did, though, see a decrease in player appearances in the community in 2017/8.
Some 368 appearances were made, down from 430 the previous campaign.
Asked about this, Nigel Clibbens said: "The 2016/17 season was exceptionally high due to more events which featured a larger number of players all together.
"Our players are hugely supportive and you can see from the club reports and social media we are active most days, and that really makes the difference."
In Clibbens' notes to the accounts, the chief executive sounds a warning.
This, in simple terms, means that, if attendances continue to slide, either the funding provided by such as EWM and Jenkins must go up, or spending on the team must come down.
Clibbens added: "We have to operate in a prudent and financially sustainable way that doesn't risk putting the club at risk.
"We have to spend what we can afford. By growing our income and controlling our costs, that makes us more able to invest in the team and the club.
"That's why #8kforMK was important in showcasing the potential of the club."
What could next year's accounts look like?
For some time now United have talked about making "difficult decisions" in a bid to better balance their spending.
It is likely, then, that a significant reduction in football outlay, for instance, will be shown in the 2018/19 figures, as well as in other areas of the club.
How heavily they have relied this season on EWM and Jenkins, in light of this spending policy but often lower crowds again, will be interesting.
Jenkins, at least, believes United have emerged "stronger, more resilient and better prepared for the future" as a result of their changed approach, which includes the appointment of DOF Holdsworth, a restructure of the commercial team, managerial changes and, he says, "a number of strategic signings", as well as a better campaign in League Two so far.
In the meantime, Nigel Clibbens said: "The club has had some hard decisions to make and that continues, but the decisions are for the good of the club, with the aim to have a club that is stronger and successful.
"Crucially this must come without making it fragile.
"We are starting to see the benefits and improvements on and off the field, and the future accounts will reflect that."
In a more strict, short-term basis, there is no immediate threat to the viability of the club according to auditors MHA Moore and Smalley.
The Preston-based firm say there is nothing in the accounts that casts significant doubt over United's ability to continue as a going concern for the following 12 months.
The club's directors later in the accounts concede this remains dependent on the "ongoing support of its directors and financiers".
Over a broader period, it can also be noted that these are the 10th accounts to be filed by United under their current "custodian" owners, who took control of the club in the summer of 2008.
The past decade has seen the regime report a loss on six occasions and a profit four times. Over 10 years, United have suffered a total loss of £1.19m.
United are again filing their annual accounts at a relatively late stage before the April deadline.
This renders the figures increasingly historic, with shareholders and fans having to wait nine months in order to get a full financial picture of the most recent season at Brunton Park.
Asked if they could not file their figures sooner, United said: "The board contains the majority of shareholders, and they approve the timing.
"The practicalities of the preparation and normal audit process takes at least six months for us, given the club and finance business we have to deal with.
"We are then into January when the transfer window takes priority.
"Once that is complete, we are planning for the AGM with the notice period and filing - that means February/March."
That AGM, which offers shareholders the chance to question directors on the 2017/18 accounts, is being held next Thursday, March 21, in Foxy's Restaurant.
As well as the financial figures, the 37-page accounts contain detailed comments about the state of the Blues.
Indeed, the accounts open with a 12-page strategic report by Clibbens. This, he says, is provided because the board believe "all supporters and stakeholders have clarity on the direction and progression of the club".
It states United's "key priority" is to rise up the pyramid, starting with promotion to League One, while the club's "overall objective" is to "work together, building a sustainable and successful club that we can take pride in".
The report is divided into sections, one of which highlights fan relations with bodies such as the Carlisle United Supporters' Group (CUSG).
Clibbens adds that the club's relationship with supporters' trust CUOSC "remains good – [their] appointed director continues to play his part in holding the executive directors to account and providing oversight".
He added: "We hope it [CUOSC] can grow and have stronger links to all fans. This inevitably will need new fans to join to shape its approach".
Under a section entitled "pride", Clibbens says United aim to be "open, honest and straight-talking", saying the club make decisions for the right reasons.
He reiterates that the 2017/18 season was disappointing, with poor home form, while he calls for "improvement" in recruitment and player development.
As he did last year, Clibbens conducts a statistical review of the season in the accounts document.
He states that United began the 2017/18 season having added to their strike force (the £50,000 signing of Richie Bennett from Barrow) and with a number of targets for the campaign ahead.
This included: conceding fewer goals, achieving more clean sheets, scoring first in more games, converting more leads into wins, improving home results, becoming stronger against the best teams in the division, maintaining their habit of coming from behind to gain points and, overall, finding greater consistency.
All laudable targets. Reality, though, was different.
The chief executive notes that United's points-per-game average went backwards and, despite three January loan signings and the permanent additions that month of Cole Stockton and Jamal Campbell-Ryce, a better second half of the campaign did not deliver enough victories.
"We failed to win any of the last five home games, all of which cast a cloud," Clibbens adds.
He notes that United were only in a top seven place for seven days of the entire season - and only in the top half of the table for 43 per cent of the campaign.
Just seven points, meanwhile, were taken from 14 games against the top seven sides.
"We showed no ability to beat the top 10 in the division either, winning only one game out of 20," Clibbens adds.
While United's record of points after scoring first in games actually improved, "too often winning positions became frustrating draws," Clibbens says.
Their record of conceding equalisers (16 times) was the worst in League Two for a second consecutive season.
This, the director says, was "a fundamental, long-standing, recurring weakness," which United failed to address. A failure to get two goals ahead in enough games is also cited.
Only twice, Clibbens adds, did Keith Curle's team gain extra points "late in games" (ie the last 10 minutes), both times against relegated Barnet.
Goals conceded in this late period of matches accounted for 23 per cent of those United shipped, Clibbens says.
This cost them 11 points from five games.
Against this, Carlisle's overall clean sheet and defensive records improved. They were fifth best in the division with a "very creditable" 15 shut-outs.
Home and away form also differed. United were only the 16th best home side in League Two in 2017/18, but the fourth best on their travels.
United had 28 contracted players over the campaign, down from 34 in 2016/17. They used more loan players (five, up from three).
The Blues, Clibbens says, made 15 signings overall in 2017/18, yet these played on average fewer minutes than those who had already been on the books.
He does note, though, that there was "more consistent selection of starters" than before.
United, meanwhile, fielded an older team in 2017/18, with an average age of 28.3.
This was an increase of more than a year, making them the fourth oldest side in League Two. Clint Hill's involvement, aged 39, helps account for this.
Excluding loan players, only four of the Blues' 23 contracted players were aged under 25.
Elsewhere, Carlisle's injury record went up, with injured players missing the equivalent of 150 games (up from 92). The long-term loss of Jason Kennedy helps to explain a rise like this.
Suspension levels were broadly the same, while in terms of substitutions, Clibbens notes that Curle used all three subs in 43 of United's 46 games.
More often, too, did the manager make a change at half-time than in the previous season: 12 times, as opposed to nine.
The chief executive also devotes a section to United's academy, noting that an extra £119,000 was directed to the club's youth department: partly from EFL grant income, and partly from the club.
There were few grounds for celebration, though, in terms of the path from youth to first-team in 2017/18.
"For the second year in a row no academy player received an opportunity to start a first-team League Two game," Clibbens writes.
The need for the academy and senior department to work with a "shared vision, common purpose and proactive desire to provide opportunities" is described as a "priority area for cultural change within the club".
The EFL Futures scheme – which rewards clubs for introducing young English players into their line-ups – was not particularly lucrative as a result of the above.
United earned £10,900 from this, ranking them 18th in League Two. The first-placed club, not identified here, made £50,000.
Noting the "difficult" year in the commercial department, Clibbens observes that last summer's major concert at Brunton Park - Lionel Richie - was a success. But it was "not as lucrative" as previous gigs at the ground.
Clibbens further says that changes have since made to reorganise this department, seeing the departed Phil King's duties allocated to other staff.
The club, he adds, are also now receiving "additional external support" in this area of the club – a likely reference to individuals such as Kevin Dobinson, a Carlisle businessman close to EWM's Philip Day.
Sales and profits from the matchday programme were "poor", continuing a wider trend of falling demand, United having since changed to a smaller publication.
Lotteries and promotions remained "stable" but "discretionary spending" on matchdays was reduced.
The ongoing issue of Carlisle's stadium is mentioned.
Addressing the stadium issue, he adds, is a "top priority" for the club's owners, including CUOSC.
He reiterates that United are unable to self-fund a new ground and, while the matter remains under review, it will require a "united and community-based approach, with fans and public and private sector working together".
Looking ahead on a financial footing, Clibbens talks again about efforts made last summer to "restore the viability of the club" by bringing down football spending "to affordable levels".
He notes that the number of senior and "high-earning" player contracts that expired last summer "gave an opportunity and flexibility to improve and reshape the squad, and achieve a more effective use or our playing budget".
Alongside this, he says the managerial change, plus the extra "football expertise" brought by Holdsworth, were necessary parts of this new approach.
"We expect 2018/19 to be even more challenging, commercially and in terms of ticket income and attendances with a further resultant fall in underlying contribution," Clibbens concludes.
"The general upward trend in attendances and total ticket income reversed in 2017/18, and this is the major business issue facing the club.


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text:
Q: How to express $\operatorname{adj}A$ as a linear combination of $A^{n-1}, A^{n-2}\dots A,I$. If $A$ is an $n×n$ non-singular matrix?
How to express $\operatorname{adj}A$ as a linear combination of $A^{n-1}, A^{n-2}\dots A,I$, if $A$ is an $n×n$ non-singular matrix?

I am not looking for a long proof or solution. However, I don't even know where to start.

A: Here is  starting point:
Let $p_A(t)$ be the characteristic polynomial of $A$.  By Cayley-Hamilton, $p_A(A)=0$.  Additionally, $adj(A)A=\det(A)I$.If $A$ is invertible, this lets you solve for $adj(A)$.

redpajama_set_name: RedPajamaStackExchange


text:
Miejscowości w USA:
 Reyno – miejscowość w stanie Arkansas, w hrabstwie Randolph
Gminy w USA:
 Reyno (ang. Reyno Township) – gmina w stanie Arkansas, w hrabstwie Randolph

redpajama_set_name: RedPajamaWikipedia


Following the loss of a loved one, there are many options available to a family to help create a lasting memory of a treasured loved one. There are traditional options and many new ideas. This includes creating items that can hold a physical memory for eternity.
Following a funeral, there are options to create a memorial, as in a headstone. This provides a place that family, or friends can visit. This option can be restrictive depending on the local authority or church, that controls the cemetery. A memorial can be arranged following a burial or after a cremation where the cremated remains, or ashes, are buried.
In the modern society that we live, funeral options are modernising also. This means that there are many new options available during the whole process, but with regard to creating a lasting physical memory, there are several options also. Here are a few options available.
Prior to the funeral, Sims and Jones Funeral Directors, Swansea can take a fingerprint from your loved one with a few simple steps. This can be kept for a period of time until the family are ready to use the print. This then can be transferred into an item of jewellery to the families own choice. This will create a lifelong physical memory. There are many choices available from a necklace, cuff links, to a key ring.
There are many ways to remember a loved one and Sims and Jones Funeral Directors, Swansea are happy to discuss any options with you further to ensure you are making the correct decision.
Please feel free to call us for any advice on 01792 700501.


text:
Jarmila Gajdošová was the defending champion, but lost to Magdaléna Rybáriková in the quarterfinals.

Chanelle Scheepers won her first WTA singles title, defeating Rybáriková 6–2, 6–2 in the final.

Seeds

  Maria Kirilenko (semifinals)
  Jarmila Gajdošová (quarterfinals)
  Ksenia Pervak (first round, retired due to left shoulder injury)
  Petra Martić (quarterfinals)
  Bojana Jovanovski (first round)
  Alberta Brianti (first round)
  Chanelle Scheepers (champion)
  Magdaléna Rybáriková (final)

Qualifying

Main draw

Finals

Top half

Bottom half

External links
 Main draw

Guangzhou International Women's Open - Singles
Guangzhou International Women's Open