text:
Safety culture in the primary health care settings based on workers with a leadership role: the psychometric properties of the Slovenian-language version of the safety attitudes questionnaire – short form
Zalika Klemenc-Ketis1, 2, 3Email authorView ORCID ID profile,
Irena Makivić1 and
Antonija Poplas-Susič1
Accepted: 2 October 2018
Safety culture describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation. With this study, we aimed to determine the psychometric properties of the Slovenian-language version of the Safety Attitudes Questionnaire (SAQ) – Short Form in primary health care settings.
This was a cross-sectional study in the largest primary health care in Slovenia. We invited all employees with a leadership role to participate in the study (N = 211). We used the Slovenian-language version of the SAQ – Short Form.
There were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. The mean age of the sample was 46.2 ± 10.0 years. Exploratory factor analysis put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. This model explained 61.7% of the variance of the safety culture in the primary health care setting. The reliability of the whole scale and of the six factors, assessed using Cronbach's alpha, was all above 0.78.
The results of our study suggests that the Slovenian-language version of the SAQ – Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role In Slovenia. The Slovenian version differed from the original SAQ – Short Form and the majority of other translated versions. Also, the data was from one health centre only and therefore we cannot draw strong conclusions on its external validity.
Patient safety is an increasingly important part of quality assurance in health care. Within patient safety, a concept of a safety culture has developed which describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation [1]. As safety culture is a group, and mainly an organisational phenomenon, it differs across the different levels and organisations of health care [2, 3], so appropriate tools should be employed in order to capture the true state of affairs. Safety culture differs from safety climate the latter referring to the measurable components of safety culture, a kind of a snapshot of safety culture at the given moment in time [4].
Several tools have been developed to measure the safety attitudes of healthcare providers [5–7]. Recent reviews of the Safety Climate Surveys in health care settings showed up to 17 [7, 8] available surveys, however only three were developed for a primary health care settings [7, 8]. Another systematic review on tools for safety culture in primary care [6] put forward the Safety Attitudes Questionnaire (SAQ) [9] as one of the widely used and also one of the most appropriate instruments for assessing patient safety culture. In 2007, the SAQ was adapted to outpatient (primary healthcare) settings [5]. This adapted version, the SAQ – Ambulatory Version (SAQ-AV), was found to be a reliable tool for comparing attitudes across different professional groups of healthcare providers outside hospitals [5, 10, 11]. Its shorter version, the SAO Short Form is being increasingly used in many countries [9, 12–18].
In Slovenia, quality and safety at the primary health care level have been the focus of study over the past several years [19–22]. Patient safety features in primary healthcare have been investigated through a study on the Quality and Costs of Primary Care in Europe (QUALICOPC), dealing with the organisation and accessibility of primary healthcare services [23]. In addition, safety culture has been measured by the Slovenian-language version of the SAQ-AV in out-of-hours primary health care settings [24–26]. Out-of-hours settings in Slovenia differ from primary healthcare centres in terms of organisation, location, and staff. Out-of-hours health services are combined with emergency medical services and are available both at the same place and time. Sometimes, they are located in hospitals and sometimes in the healthcare centres. Professionals that work in OOHC are family physicians, emergency physicians, and emergency nurses. Sometimes, there are also laboratory technicians and radiology technicians. Usually, emergency nurses work only in OOHC settings while family physicians work in their practice and in OOHC on the basis of rotation. An out-of-hours health centre has thus a unified leadership and can be seen as a "natural social unit"; which is a validation criteria for organizational climate measurements [27].
To date, the safety culture in primary health care settings such as primary health care centres has not been measured in Slovenia. Also, the SAQ – Short Form has not yet been validated in the Slovenian language.
Within this study we wanted to fulfil the following aims: 1) to test the reliability and validity of the Slovenian-language version of SAQ – Short Form in primary health care settings, and 2) to determine the factor structure of the Slovenian-language version of SAQ– Short Form in primary health care settings.
Research design and setting
We performed a cross-sectional study in the largest community health centre in Slovenia. This health centre provides healthcare services for the municipality of Ljubljana, which comprises around 280,000 people. It is divided into eight units, which are located in separate buildings in different parts of Ljubljana. It employs around 1500 employees of different medical and non-medical backgrounds.
We invited all the employees with a leadership role to participate in the study (N = 211). Employees with a leadership role come from different professional backgrounds (i.e. physicians, dentists, registered nurses, nurse assistants, administrative staff etc.). They are appointed to be leaders of different units within the health centre, such as chief of nurses, chief of physicians, chief of whole units, director of health centre etc. They work mostly within their professional fields, but have a certain amount of their working time dedicated to their leadership tasks. We thought that a homogenous group such as workers with a leadership role would be appropriate for a validation study as they are the ones responsible for the safety culture and their role in creating a proper safety environment is crucial.
We used the SAQ – Short Form [9] which consists of 36 items. Each item of the questionnaire is answered on a 5-point Likert scale by which the respondents indicate their level of agreement with the statement ranging from "disagree strongly" to "agree strongly"). In the analysis, the scores of negatively worded items were reversed so that higher scores always indicated a more positive evaluation of the safety culture. There are six factors in the original SAQ – Short Form: Teamwork Climate (items 1–6), Safety Climate (items 7–13), Job Satisfaction (items 15–19) Stress Recognition (items 20–23), Perceptions of Management (items 24–28), and Working Conditions (items 29–32). Items 14 and 33–36 are not included in any of the factors.
We were granted permission to use this questionnaire by the University of Texas at Houston-Memorial Hermann, Center for Health care Quality and Safety. The permission was given on June 3, 2016.
We also collected data on demographic characteristics (gender, age, role, work experience, working hours, and location of work).
The data was collected through an electronic survey. The link to the survey was sent to the email addresses of the participants in February 2017. The first reminder was sent after two weeks, and the second two weeks after the first. Participation was confidential, possible identifiers such as e-mail and IP addresses were removed by the administrative coordinator in the project. It was not possible for the researchers to link the participants to their responses.
Variability of the data set
We determined the skewness and kurtosis of the data set. Skewness was 0.210 and kurtosis was 0.332. We concluded that for a given sample size, the measures of the variability indicated a normal distribution of the data [28].
Confirmatory factor analysis
We performed a confirmatory factor analysis (CFA) of the SAQ – Short Form. We used the items that were part of the original factors (31 items). The following indices for the good CFA model fit were considered: 1) the chi-square goodness-of-fit: the model is acceptable if the p-value of chi-square is not significant, 2) relative chi-square, which is the chi-square divided by degrees of freedom (df), should range up to 3 [29]; 3) Comparative Fit Index (CFI) should lie within 0.90–1.00 for a fit model; 4) the Normed Fit Index (NFI) should range between 0 and 1 with a value of 0.90 or greater indicating of a good model fit; and 5) Root Mean Square Error of Approximation (RMSEA): a value of about 0.05 or less would indicate a close fit of the model in relation to df [30].
Our CFA model did not provide a good fit and therefore the explorative factor analysis (EFA) was carried out with an Oblimin rotation (with Kaiser normalisation) on 31 items as in the original factor model [9]. As the results was not acceptable, we decided to perform the EFA on all 36 items in the questionnaire. This yielded an acceptable result with good share of explained variance. A cut-off point for factors loadings was 0.300. We also performed a Kaiser-Meyer-Olkin analysis and a Bartlett test (both measures test how suited is the data for factor analysis). We determined that the Kaiser-Meyer-Olkin measure should be < 0.8 and that the Bartlett test should be < 0.001 [31]. For each of the six factors, the scale scores were calculated by obtaining the mean of the item scores within one factor. Next, correlations between the scale scores were calculated to determine construct validity. Reliability (internal consistency) was assessed using the Cronbach's alpha. Values of Cronbach's alpha over 0.7 are considered acceptable, over 0.8 good, and over 0.9 excellent [32].
Sample characteristics
There were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. Most of the sample consisted of physicians and registere nurses. All health centres' units were represented in the sample (Table 1). The mean age of the sample was 46.2 ± 10.0 years; the mean time in current post was 13.6 ± 10.0 years, and the mean number of weekly working hours was 36.2 ± 10.4. The mean number of years of clinical experiences participants was 21.9 ± 10.1 years.
Demographic characteristics of the participants
Number (%)
136 (88.3)18 (11.7)
Physician, dentist
Nurse assistant
Other clinical staff
Community Health Centre unit
CFA model on the original six factors with the appropriate items (see Methods section) did not provide a good model fit on all test. P value was < 0.001, the relative chi-square was 1.636, CFI was 0.874, NFI was 0.737, and RMSEA was 0.064.
Factor structure
The on 36 items put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction (Table 2). This model explained 61.7% of the variance. The Kaiser-Meyer-Olkin measure was 0.824 and the Bartlett test was significant (p < 0.001).
Factor model and reliability
Factor loading
Cronbach's alpha
Cronbach's alpha if item deleted
Factor 1: Perception of Management
Management is doing a good job.
Management doesn't knowingly compromise patient safety.
Management supports my daily efforts.
I get adequate and timely information about events that might affect my work.
All the necessary information for diagnostic and therapeutic decisions is routinely available to me.
Nurse input is well received in this clinical area.
My suggestions about safety would be acted upon if I expressed them to management.
Problem personnel are dealt with constructively.
I know the proper channels to direct questions regarding patient safety in this clinical area.
I am encouraged by my colleagues to report any patient safety concerns I may have.
The culture in this clinical area makes it easy to learn from the errors of others.
The levels of staffing in this clinical area are sufficient to handle the number of patients.
Factor 2: Stress Recognition
I am less effective at work when fatigued.
I am more likely to make errors in tense or hostile situations.
When my workload becomes excessive, my performance is impaired.
Fatigue impairs my performance during emergency situations (e.g. emergency resuscitation, seizure).
Factor 3: Teamwork Climate
I experience good collaboration with staff physicians in this clinical area.
−0.825
I experience good collaboration with nurses in this clinical area.
I experience good collaboration with pharmacists in this clinical area.
The physicians and nurses here work together as a well-coordinated team.
Factor 4: Communication
In this clinical area it is difficult to discuss errors.
Communication breakdowns that lead to delays in delivery of care are common.
Disagreements in this clinical area are resolved appropriately.
In this clinical area it is difficult to speak up if I perceive a problem with patient care.
I have the support I need from other personnel to care for patients.
This hospital does a good job of training new personnel.
Factor 5: Safety Climate
Medical errors are handled appropriately in this clinical area.
I receive appropriate feedback about my performance.
I would feel safe being treated here as a patient.
It is easy for personnel here to ask questions when there is something that they do not understand.
Factor 6: Working Conditions and Satisfaction
This is a good place to work.
I am proud to work in this clinical area.
Working here is like being part of a large family.
Morale in this clinical area is high.
I like my job.
Trainees in my discipline are adequately supervised.
There was a significant difference in items belonging to the factors of the original scale and of our scale. Except for the factor Stress Recognition, all factors in our factor model had partially or completely different items (Table 3).
The distribution of items within factors on the original SAQ – Short Form scale and on our SAQ – Short Form scale
Perceptions of Management
Stress Recognition
Teamwork Climate
Safety Climate
Working conditions and Satisfaction
SAQ – Short Form (original)
Items 24–28
Items 7–13
SAQ – Short Form (our study)
1, 9, 12–14, 24–29, 31
Items 6, 33–35
Items 5, 7, 8, 10
Items 15–19, 32
Reliability of the SAQ – Short form and its factors
The reliability of the whole scale, through Cronbach's alpha, was 0.963 and the reliability of the individual factors was also good (Table 2).
Construct validity
All the factors except Stress recognition were significantly correlated with each other (Table 4), while Stress recognition was correlated just with the Communication.
Mean scores, standard deviations and intercorrelations of the five factors
Perceptions of Management (F1)
Stress recognition (F2)
Teamwork Climate (F3)
0.572a
Communication (F4)
−0.238b
Safety Climate (F5)
Working Conditions and Satisfaction (F6)
aCorrelation is significant at the 0.01 level
bCorrelation is significant at the 0.05 level
The Slovenian-language version of the SAQ – Short Form used with the employees of the largest primary health care centre in Slovenia did not fit perfectly to the original factor structure [9]. Our new factor model revealed six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. Cronbach's alphas of the factors were good, indicating no problems with the factors. The six-factor model of the Slovenian SAQ – Short Form covered 36 items.
Our factor structure differs from the original one [9] in the context of some factors. Factors Teamwork Climate, Perceptions of Management, Working Conditions, Safety Climate, and Stress Recognition are the same as in the original factor structure [9]. However, the items belonging to these factors differ (see Table 3). Our model also revealed one new factor (Communication) and one partly new factor (Working Conditions and Satisfaction). The latter is actually a combination of two factors from the original SAQ – Short Form scale. The factor Communication has not been revealed within the original scale but has already been revealed as an individual factor of the Slovenian-language version of the SAQ-AV [25]. Communication has also been recognised in other safety culture measurement tools as an important domain within the safety climate or culture [7, 10, 33].
Some items have negative loadings (all items in factors Teamwork Climate and Working Conditions and Satisfaction). This indicates that these factors are negatively correlated to the construct. It is a general agreement that the strength of a loading needs to be measured by its absolute value with the possibility that preconceptions about appropriate reverse coding might need modification based on the signs of factor loadings [34]. Therefore, we decided to keep the original wording of the items.
All the factors measured the same construct except for Stress Recognition. This could be due to the fact that other factors related more to work and the working environment, and Stress Recognition more to personality traits. Stress Recognition was weakly correlated with Communication, which indicates that if the working environment stimulates communication about safety issues, the workers feel that they manage stress better.
The validation studies on SAQ – Short Form in Norwegian ([35], Italian [13], Portuguese [14], Chinese [15], Swedish [16, 17], and German [18] language confirmed the original factor structure. However, they were carried out in the secondary health care level which makes it difficult to compare the results of our study to them as our study was done in primary health care settings. Our result of a CFA not perfectly fitting to the original factor model indicates that there are differences in the safety culture between primary and secondary health care levels which has already been pointed out elsewhere [6, 33]. Namely, primary health care differs from hospitals in terms of organisational structure, administrative and clinical processes and the reasons for encounters [36]. However, it could also indicate that the tool used (the SAQ – Short Form) was not specific enough for the primary health care settings and another tool could be used.
The safety climate and culture research in health care in general has been predominately conducted within acute care settings and hospital settings [7] therefore the existing measurements in primary health care settings are relatively new which makes our study an important one for this field of research.
The differences in factor structures between countries make cross-country comparisons of patient safety culture challenging. The structural differences may reflect cross-national variation in the nature and structure of primary care, or it may mean that item wordings trigger different connotations in different languages. For these reasons a wise option might be to compare countries at the item level rather than at the factor level [10].
The differences in the safety culture between the different levels of health care require different tools for measurements that would be developed for primary care or hospital safety culture measurement tools adapted for the use at the primary health care level. Since there is currently no consensus on which tool is the best to use [7], further research should focus on performing the \adaptations and validations of the existing tools for use at the primary health care level, with special emphasis on establishing the construct and criterion validity [7]. Another option would also be a development of a new scale which would be based on the theoretical model of the safety culture at the primary health care level.
Our study has some limitations that have to be mentioned. We are aware of the fact that an EFA always produces a solution, but does not assess the risk that the EFA solution only describes the data set, and it may not be possible to generalise. Due to this fact, the results of our study may not be generalised to the whole population. The sample size in our study was limited to employees with a leadership role, which could produce a selection bias and therefore limits the validity of our results. However, the results were very similar to our previous study [25] and also to the Dutch study [10] (both performed at the primary health care level) and this gives us confidence in the validity of our results. Although the response rate was high, there is no information on the characteristics of the non-respondents, so this could also be a source of bias.
We used the SAQ – Short Form for the primary health care settings despite the fact that there are other specific primary health care tools available [6, 7] and might have been a better tool for our study. This is another limitation of our study.
The results of our study suggests that the Slovenian-language version of the SAQ – Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role. The factors and item loadings in our study differed from the original SAQ – Short Form and the majority of other translated versions.
Further studies should explore the safety culture of other primary health care organisations, and perhaps also use other tools for measuring it in order to recognise other factors that are also important. Possibly, another tool for a more comprehensive measurement of safety culture that would be based in the theoretical frameworks should be developed.
CFA:
CFI:
Comparative Fit Index
Degree of freedom
NFI:
The Normed Fit Index
QUALICOPC:
Quality and Costs of Primary Care in Europe
RMSEA:
Root Mean Square Error of Approximation
SAQ:
Safety Attitudes Questionnaire
SAQ-AV:
Safety Attitudes Questionnaire-ambulatory version
We would like to thank all the participants in the study.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
ZKK conceived the study prepared a research protocol, supervised the data collection, interpreted the results and wrote the first draft of the manuscript. IM prepared the research protocol, analysed and interpreted the data. TPS supervised the study, interpreted the data and revised the first draft of the manuscript. All authors read and approved the final manuscript.
The study was approved by the National Ethics Committee (No. 107/07/16). Participants gave a verbal informed consent to participate in the study. As this was an electronic survey, a written consent was not applicable. The method of acquiring the consent was approved by the ethics committee.
The authors declare they have no competing interests.
Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
Department of Family Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
Deilkas ET. Patient safety culture - opportunities for healthcare management. Oslo: University of Oslo, Norway; 2010.Google Scholar
Guldenmund FW. The nature of safety culture: a review of theory and research. Safety Sci. 2000;34(1–3):215–57.View ArticleGoogle Scholar
Tomolo AM, Lawrence RH, Watts B, Augustine S, Aron DC, Singh MK. Pilot study evaluating a practice-based learning and improvement curriculum focusing on the development of system- level quality improvement skills. J Grad Med Educ. 2011;3(1):49–58.View ArticleGoogle Scholar
Hann M, Bower P, Campbell S, Marshall M, Reeves D. The association between culture, climate and quality of care in primary health care teams. Fam Pract. 2007;24(4):323–9.View ArticleGoogle Scholar
Modak I, Sexton JB, Lux TR, Helmreich RL, Thomas EJ. Measuring safety culture in the ambulatory setting: the safety attitudes questionnaire - ambulatory version. J Gen Intern Med. 2007;22:1–5.View ArticleGoogle Scholar
Parker D, Wensing M, Esmail A, Valderas JM. Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. Eur J Gen Pract. 2015;21:26–30.View ArticleGoogle Scholar
Curran C, Lydon S, Kelly M, Murphy A, Walsh C, O'Connor P. A systematic review of primary care safety climate survey instruments: their origins, psychometric properties, quality, and usage. J Patent Saf. 2018;14(2):e9–e18.View ArticleGoogle Scholar
Vasconcelos PF, Arruda LP, Sousa Freire VEC, Carvalho R. Instruments for evaluation of safety culture in primary health care: integrative review of the literature. Public Health. 2018;156:147–51.View ArticleGoogle Scholar
Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ. The safety attitudes questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;3:44.View ArticleGoogle Scholar
Smits M, Keizer E, Giesen P, Deilkas EC, Hofoss D, Bondevik GT. The psychometric properties of the 'safety attitudes questionnaire' in out-of-hours primary care services in the Netherlands. PLoS One. 2017;12(2):e0172390.View ArticleGoogle Scholar
Bondevik GT, Hofoss D, Hansen EH, Deilkas EC. The safety attitudes questionnaire - ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting. BMC Health Serv Res. 2014;14:139.View ArticleGoogle Scholar
Bulajic M, Bezic H, Plavec D. Factors associated with the differences in the safety attitudes questionnaire 2006 short form assessment of the management of Croatioan hospitals. Hrčak. 2017;11(2):9–20.Google Scholar
Nguyen G, Gambashidze N, Ilyas SA, Pascu D. Validation of the safety attitudes questionnaire (short form 2006) in Italian in hospitals in the northeast of Italy. BMC Health Serv Res. 2015;15:284.View ArticleGoogle Scholar
Saraiva D, De Almeida A. Validation of the safety attitudes questionnaire - short form 2006 to Portugal. Int J Nurs. 2015;2(1):103–12.Google Scholar
Lee WC, Wung HY, Liao HH, Lo CM, Chang FL, Wang PC, Fan A, Chen HH, Yang HC, Hou SM. Hospital safety culture in Taiwan: a nationwide survey using Chinese version safety attitude questionnaire. BMC Health Serv Res. 2010;10:234.View ArticleGoogle Scholar
Goras C, Wallentin FY, Nilsson U, Ehrenberg A. Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version). BMC Health Serv Res. 2013;13:104.View ArticleGoogle Scholar
Norden-Hagg A, Sexton JB, Kalvemark-Sporrong S, Ring L, Kettis-Lindblad A. Assessing safety culture in pharmacies: the psychometric validation of the safety attitudes questionnaire (SAQ) in a national sample of community pharmacies in Sweden. BMC Clin Pharmacol. 2010;10:8.View ArticleGoogle Scholar
Zimmermann N, Kung K, Sereika SM, Engberg S, Sexton B, Schwendimann R. Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals--a validation study. BMC Health Serv Res. 2013;13:347.View ArticleGoogle Scholar
Klemenc-Ketis Z, Svab I, Poplas Susic A. Implementing quality indicators for diabetes and hypertension in family medicine in Slovenia. Zdr Varst. 2017;56(4):211–9.PubMedPubMed CentralGoogle Scholar
Petek D, Mlakar M. Quality of care for patients with diabetes mellitus type 2 in 'model practices' in Slovenia – first results. Zdr Varst. 2016;55(3):179–84.PubMedPubMed CentralGoogle Scholar
Zelko E, Svab I. Overcoming cultural cleavages: results from a health promotion intervention among Roma. Acta Medico-Biotechnica. 2016;9(1):33–41.Google Scholar
Ivetic V, Poplas-Susic T, Pašić K, Selič P. Beliefs and viewpoints of family medicine physicians on approaches to identify and treat medically unexplained symptoms. Acta Medico-Biotechnica. 2016;9(2):47–57.Google Scholar
Pavlic DR, Sever M, Klemenc-Ketis Z, Svab I. Process quality indicators in family medicine: results of an international comparison. BMC Fam Pract. 2015;16(1):172.View ArticleGoogle Scholar
Klemenc-Ketis Z, Deilkas ET, Hofoss D, Bondevik GT. Patient safety culture in Slovenian out-of-hours primary care clinics. Zdr Varst. 2017;56(4):203–10.PubMedPubMed CentralGoogle Scholar
Klemenc-Ketis Z, Maletic M, Stropnik V, Deilkås ET, Hoffos D, Bondevik GT. The safety attitudes questionnaire – ambulatory version: psychometric properties of the Slovenian version for the out-of-hours primary care setting. BMC Health Serv Res. 2017;17:36.View ArticleGoogle Scholar
Klemenc-Ketis Z, Deilkas ET, Hofoss D, Bondevik GT. Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care. J Multidiscip Healthc. 2017;10:417–23.View ArticleGoogle Scholar
Zohar D. Safety climate: conceptual and measurement issues. In: Campbell Quick J, Tetrick L, editors. Handbook of occupational Health Psychology. Washington, D. C: American Psychological Association; 2003. p. 123–42.View ArticleGoogle Scholar
Kim HY. Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod. 2013;38(1):52–4.View ArticleGoogle Scholar
Carmines E, McIver J. Analysing models with unobserved variables: analysis of covariance structures. Beverly Hills, CA: Sage Publications; 1981.Google Scholar
Hooper D, Coughlan J, Mullen M. Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods. 2008;6:53–60.Google Scholar
Field A. Discovering statistics using IBM SPSS statistics. London: Sage Publication; 2013.Google Scholar
Gliem JA, Gliem RR. Calculating, interpreting, and reporting Cronbach's alpha reliability coefficient for Likert-type scales. Ohio: Ohio State University; 2003.Google Scholar
Kirk S, Parker D, Claridge T, Esmail A, Marshall M. Patient safety culture in primary care: developing a theoretical framework for practical use. Qual Saf Health Care. 2007;16(4):313–20.View ArticleGoogle Scholar
Knafl GJ, Grey M. Factor analysis model evaluation through likelihood cross-validation. Stat Methods Med Res. 2007;16(2):77–102.View ArticleGoogle Scholar
Deilkas ET, Hofoss D. Psychometric properties of the Norwegian version of the safety attitudes questionnaire (SAQ), generic version (short form 2006). BMC Health Serv Res. 2008;8:191.View ArticleGoogle Scholar
Palacios-Derflingher L, O'Beirne M, Sterling P, Zwicker K, Harding BK, Casebeer A. Dimensions of patient safety culture in family practice. Healthc Q (Toronto, Ont). 2010;13:121–7.View ArticleGoogle Scholar


Bangalore, July 22: A three-year-old girl was sexually assaulted by a juvenile in a village 30 km from here while her parents were away from home, police said Tuesday.
"The incident occurred late Friday when the 16-year-old accused sexually assaulted the child, taking advantage of her parents' absence from home at Thatteguppe village," Ramanagara district police superintendent Anupam Agarwal told over phone.
Police registered a case against the accused, who is absconding, under the Protection of Children from Sexual Offences Act (POCSO) Act, on a complaint filed by the girl's mother.
"We have rushed police teams to surrounding villages to hunt for the accused, who stays near the girl's home," Agarwal said.
Her mother lodged the complaint Tuesday after she got the child examined by a local doctor who found her sexually abused.
"We have admitted the child at St. John's hospital in Bangalore as she is in a serious condition. We will conduct a medical test to check if she was sexually assaulted only after she recovers from illness, as she had recently undergone heart surgery," Agarwal said.
The accused was identified as the son of a Thalgatpura gram panchayat member.
When the girl's parents returned home and asked the accused why he was there and what was he doing, he told them he was helping their child pass urine and fled the spot.
The latest heinous crime has outraged the villagers, coming as it does within three weeks after a six-year-old student was allegedly raped by a skating coach in an elite school in the city's eastern suburb.


Discussion in 'HardForum Tech News' started by AlphaAtlas, Nov 8, 2018.
GPUs are already being deployed to track people outside of Teslas and on the streets, but apparently, the algorithms those GPUs run are limited to relatively low resolutions of about 608x608 pixels. To keep up with improving camera technology, researchers have come up with a new algorithm that can handle higher resolution video. "YOLO v2" downscales the large video frames first, and "performs a fast object detection" that it uses to intelligently crop the full resolution frame and send the pieces to multiple GPUs. This yields much better results than just downscaling a feed before processing, and is faster than processing the full frame.
Check out a video of the algorithm in action here.
"Our method reduced the time necessary to process high-resolution images by approximately 20 percent, compared to processing every part of the original image under high resolution," Růžička said. "The practical implication of this is that near real-time 4K video processing is feasible. Our method also requires a lower number of server workers to complete this task."
The eyes of skynet are getting upgrades.
trandoanhung1991, Viper16, mynamehere and 3 others like this.
trandoanhung1991, scojer, mynamehere and 2 others like this.
I predict a major research effort into masking your face without actually using a (visible) mask.
DoubleTap, mynamehere, Willypants and 2 others like this.
There is absolutely nothing revolutionary here.
It's the same "Fuzz" input. See what the angle of difference is to the trained vector to develop a normalized value between 0 and 1 (1 being 100% match) for potential tracking targets. Determine inter-frame velocity and direction based on traied patterns. (Similar to mpeg encoding) Refine if close, and reanalyze on a higher detail level. This is a big old DUH.
Reminded me of Phantom 2040.
scojer and Aioeyu like this.
clockdogg and scojer like this.
Targets detected, charging phased plasma rifle, selecting full auto.


Farm Tours at 10:30, 12, 1:30 and 4 pm! Pick apples and press cider on a century-old cider press. Visit the farmstand to pick out wonderful produce and a favorite pumpkin! Make a felted pin, enjoy tasty goodies and have fun with this free event. Fun for the whole family!


Keep up to date with all the news regarding Dart Products Europe. From what we are up to in the trade press, to breaking news and press releases, you will find all of our up to date information right here on our news page.
Can't find what you're looking for? Please feel free to contact us at any time.
According to Footprint News, 73% of survey respondents among the FSM leaders (Foodservice Management) named healthier eating as a key trend. 55% of respondents mentioned meat free eating increasing from just 10% in 2017.
Our wide range of containers and lids cater for your everyday needs. Whether you are looking for a secure lid fit, excellent clarity or portion control your choices are endless. Catering for your clients' needs; grabbing something on the way to the gym or for snacking in-between meal times, we have the perfect on-the-go solution for you.


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Posted inArts and Entertainment
Full Speed or No Speed: Striker stays true to their metal motto
by Lexi Wright September 29, 2017 September 4, 2020
On Monday, Sept 25th, Striker floored the crowd at Dickens Pub with the energy of their live performance.
Currently on tour with their fifth, self-titled album, the Edmonton-based band has grown immensely throughout their years in the industry. It doesn't hurt that the band has a truly metal work ethic.
"The tour has been amazing for us. It's 32 shows in 33 days. We have one day off, apart from the hurricane the day we were in Florida, but most of the shows still went on," says Tim Brown, Striker's lead guitar player.
You know you're a true metal band when you still decide to play a gig, even with a hurricane warning in effect. That's what Striker found themselves doing when they drove 50 hours from Edmonton to Miami during Hurricane Irma.
"We were the only car on the road driving into the city because everyone else was leaving, yet we played the show and the turnout was surprisingly good, considering everyone was gone," says Dan Cleary, lead vocalist.
Striker's sound is a mix of heavy metal, hard rock, and of course, 80's hair metal
During the show, the band was shredding like nobody's business – their hair was everywhere, swishing back and forth like a violent cracking whip and although it was still attached to their heads, I wouldn't have been surprised if their hair had fallen out. For the next interview, I need to determine Striker's shampoo secrets.
Dickens Pub was packed full and Striker was playing so loud you could even hear them playing from outside the building. Photo by Lexi Wright
The band's popularity is also highly credited to their powerful vocals, crisp harmonies, catchy lyrics and impressive guitar leads. Needless to say, I was expecting quite the performance at Dickens and I was not disappointed.
Neither was Brett Morrison, a Striker fan who attended the Dickens show.
"They have that old-school, heavy metal sound to them, it's quite reminiscent of Judas Priest and old Megadeth," he said. "This album is amazing, but their older stuff really hits home for me. Their songs have a very nostalgic feeling."
Rav Abernader, a promoter and childhood friend of the band members, seconds that opinion.
"It's great to see a natural progression for Canadian heavy metal bands. Regardless of what people see in Canada, because our metal scene is severely lacking, when you witness bands like Striker, it revives the scene and make you proud to be Canadian."
Striker is appealing to a new generation of metalheads, while maintaining their old-school metal identity. Their live shows are truly something you won't want to pass up.
These guys are staying true to the metal motto: Full speed or no speed.
lwright@cjournal.ca
Editor: Jamie McNamara | jmcnamara@cjournal.ca
How winning The Launch brought a Calgary based rock band nationwide
Local cover band Back in the Day have been performing together since they were teenagers

redpajama_set_name: RedPajamaCommonCrawl


The Kobe Harborland New Otani Hotel is located in the middle of the Kobe's new downtown area. The Kobe Harbor land New Otani Hotel responds to and meets the needs of business travelers with convenient services and hotel facilities. The Kobe Harbor land New Otani Hotel provides for easy access to all parts of Kobe and is only a short stroll from the JR Kobe train station. With an impressive range of business, recreational and dining facilities, coupled with impeccable service, the Kobe Harbor land New Otani Hotel perfectly combines the traditional elements of Japan's rich and vibrant culture with the latest in hotel accommodation facilities. The well-appointed rooms at the Kobe Harbor land New Otani Hotel are equipped to meet the exacting criteria of today's traveler whether they be on business or simply enjoying the delights of Kobe. Five restaurants and bars offer a wide variety of cuisine and drink. In Kobe Harborland New Otani Hotel , there are fourteen banquet halls available for meetings, receptions and other special occasions.


I wanted to study abroad because I wanted to know more about the world I lived in. I wanted to challenge my comfort zone and push myself to become a citizen of the world. I studied in Spain with UA for a month in the summer and followed it with a semester traveling with Semester at Sea. I've never learned more about humanity and culture than I had in that year. There so much that goes on every single day that we are completely unaware of and it was eye opening to see the lifestyles of people from various countries across the globe.
I took "Camel Trek" while I was visiting Morocco during the second week of October in 2016. I had joined some friends for a camel trek into the Sahara desert to camp for a night. After that night on the dunes watching the constellations move across the sky, I arose at daybreak for the trek back into civilization. I took the photo specifically as I waited on my camel at dawn and watched the others ride up and over the dunes, disappearing into the horizon.
I took the picture because I couldn't believe I was seeing such a scene with my own eyes. The whole experience seemed unreal, intangible. I couldn't stop thinking, "How did I ever get so lucky to live this life?" I had to capture the moment. I had to share my experience and the best way I knew how was through photography.
After traveling across 11 countries with Semester at Sea, this particular photograph continued to be my favorite amongst hundred others. The experience was so unique and I treasured it dearly. Also, as a photography fan, the composition of the photo excites me. The shadows on the dunes and the string of camels dipping into the horizon… it's as if I'm still there every time I see it.
My (study abroad) experience was beyond words. There's no way to describe the change that happens within you while you dive into a foreign place. It enhances your global perspective. There's no way to communicate the difference it makes in your mind and heart and soul. So I just say: try it yourself if you can, and you'll never regret it.


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Truckee improving online mapping system
Local | September 13, 2019
hjones@sierrasun.com
New additions have been added to Truckee's Geographic Information System, an online mapping system, that gives users more insight into ongoing construction projects around town and emergency preparedness.
The map allows users to view all projects that are active in the town and see whether they are under construction or still in the planning process. Users can input an address and locate the desired parcel on a map and zoom in on that parcel, a feature that gives users more concise images and information than a typical PDF map.
"If you're curious about what's going on around you, you can type in an address and you'll be able to see all the projects around you," said Drew Jack, Truckee's information technology specialist.
When the project is selected, it will display the name, description, the planner assigned to the project and a link to more information. The map also gives users information on road construction throughout the town and is updated daily directly from the Public Works Department.
… you can type in an address and it you'll be able to see all the projects around you." — Drew Jack, Truckee information technology specialist
"It gives you an idea of where they've been and where they're going," said Jack.
A second feature of the map gives an updated evacuation guide and highlights main evacuation routes in neighborhoods. When a user types in an address, arrows will show up on the map directing drivers to the appropriate route.
"This is still a map that should be used to prepare for evacuations not during an event," said Jack.
A third addition, meant mainly for the police department and public works, gives officials information on where cones and traffic enforcement is needed around town.
"It allows quick action and resource deployment," said Jack. "It's really simple and that's the idea."
IMPROVEMENTS TO INCREASE EFFICIENCY
The town has been making improvements to the program for the past few years.
Past developments with the program allow the public to display their land parcel information and sketch out a potential modification. Users can then use a function to print out a standard PDF template that the town has set up to proceed with an application for the modification. This way communication is consistent between the town staff and the public because they're all working off the same data.
The map can also be used to locate trails in the area, the trails length, whether it's an asphalt or dirt trail and the last time it was updated in a maintenance database.
"We're constantly l developing these maps hoping that the public will use them and hoping that staff is using them, too, to increase efficiency," said Jack.
Hannah Jones is a reporter for the Sierra Sun. She can be reached at 530-550-2652 or hjones@sierrasun.com.
Lake Tahoe Basin and El Dorado County roadwork schedule: Jan. 19-25, 2020
Tahoe National Forest to hold meetings on natural fire
Film by Truckee local to be featured at Wild & Scenic Film Festival in Nevada City
Tahoe Forest Health System welcomes first baby born in 2020


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Монте-Оливето-Маджоре (Monte Oliveto Maggiore) — первый и самый главный монастырь католического ордена оливетов. Основан на холме в 10 км от тосканского города Ашано в 1313 году сиенским юристом Бернардо Толомеи. Название получил в честь Масличной горы в Иерусалиме.

В Средние века монастырь был одним из главных землевладельцев на территории Сиенской республики. Строительные работы в Монте-Оливето-Маджоре шли почти непрерывно с 1393 по 1526 годы. Монастырские здания сложены из красного кирпича. Попасть в обитель можно по подъёмному мосту, пройдя по аллее чёрных кипарисов. Над монастырским комплексом парит готическая колокольня.

Большой клуатр монастыря, возведённый в эпоху кватроченто, украшен стенописью Луки Синьорелли и Содомы на темы из жизни святого Бенедикта. П. П. Муратов определяет её как «один из грандиознейших фресковых циклов Италии». Подробнее о содержании фресок см. статью Содома.

Из монастырской церкви св. Варфоломея происходит большое «Благовещение», с 1867 г. висящее в Уффици и единодушно атрибутируемое Леонардо да Винчи.

Ссылки
 Официальный сайт аббатства

Появились в 1313 году
Аббатства Италии
Бенедиктинские монастыри Италии
Монастыри, основанные в XIV веке
Культовые сооружения провинции Сиена
1313 год в Италии

redpajama_set_name: RedPajamaWikipedia


text:
Q: Execute cucumber scenarios containing given step I modified a step definition. How do I tell cucumber to run all but only those scenarios containing this step?

A: Put a tag on the relevant scenario(s) like this
@tagname
Scenario: scenarioname
Given some stuff...

and run it with
    cucumber --tag @tagname

redpajama_set_name: RedPajamaStackExchange


That would equal a total of $665, offering a savings of $365!!
The question I would then ask you is," What do you do with those pictures?" Do you ever compile and print them? Do you make a book of them? Where will they end up? Will they forever stay on your phone or computer? Isn't it nicer to sit down and look at a book than look at a computer?
The following are the pages from a Baby's First Year Book that I just created. This book will be a treasure that this family will have to look back on for years to come. What a lovely tribute to this child!
These are screen captures of the book, so are not indicative of the quality of the book. You will notice that we also did a maternity session for this book and I can do the same for you.
Give me a call if you are interested in this package or if you know someone who might be.
It's the end of Dylan's First Year. It's been wonderful to see Dylan grow from a tiny newborn into a fun and lively one year old. Babies change so quickly in that first year of life. It's like no other year of a person's life. I just finished making up the book that Dylan's parents will receive of her first year and I wanted to share it. Copy and paste the following link to see the first 15 pages of it.
Dylan's parents bought the First Year Club plan for their newborn. When you purchase The First Year Club, you receive 4 shoots in your baby's first year for the price of $200. As well you receive an 8×10 book of that year. There are a number of advantages to this plan, besides the savings in session fees. The important thing, I think is that you will be sure to have a visual record of that first year. I will remind you of when it is time for your next shoot. You won't be putting it off and then wishing you had pictures later. It's also a great gift idea for anyone that you know who is having a baby.
Let me know if you have any questions about The First Year Club. Have a look at Dylan's book. I am also making a video of Dylan's pictures. Watch for it in my next post.


One of the most popular thing for some people for past-time activities is to play sport games at all. In line with that many sports can also be found nowadays, May it be ball games and even sports where you can play even if you are just sitting. Golf is one of the most popular sport you can play nowadays. being not simple to play is one the characteristics of this game golf at all. Playing this sports might be difficult at all and aside from that almost not everyone can play it at all since it would require some resources just to be able to play it. The training and equipment's for this golf sport might be quite high at all that is why some people might not be able to play at all.
Your needs must be the first to be consider at all. Suiting your needs for the specific variety of golf clubs you might like is the first thing you must consider at all. The quality of the golf clubs you will be choosing must be consider at all. For every player and consumer the most important thing at all is the quality which would last longer at all.
Your budget for this golf clubs must be consider at all. Choosing one of the golf clubs with is not popular brand at all but with good quality is a good thing you may consider at all. Before buying one of these golf clubs the need to compare the prices from different store is really needed. purchasing it in lower price is one good thing you can get from it.


text:
package core;

import org.bukkit.Server;
import org.bukkit.entity.Player;
import org.bukkit.command.CommandSender;

public abstract class CommandListener {
	private Kikkit kikkitPlugin = null;

	public CommandListener(Kikkit plugin){
		kikkitPlugin = plugin;
	}

	//public abstract boolean onCommand(PlayerChatEvent event, String[] cmdData, Player sourcePlayer);
	public abstract boolean onCommand(CommandWrapper command);

	protected Kikkit getPlugin(){
		return kikkitPlugin;
	}

	protected boolean canUseCommand(CommandSender sender, String command){
		return kikkitPlugin.canUseCommand(sender, command);
	}

	protected boolean canUseCommand(Player player, String command){
		return kikkitPlugin.canUseCommand(player, command);
	}

	protected Server getServer(){
		return kikkitPlugin.getServer();
	}

	protected void setCommandHandled(CommandWrapper command, boolean wasCommandHandled){
		if(wasCommandHandled){
			//event.setCancelled(true);
			command.IsCancelled = true;
		}
	}

	protected String getLastFromIndex(String[] data, int startIndex){
		if(startIndex > data.length - 1) return "";

		String returnString = "";
		for(int k = startIndex; k < data.length; k++){
			returnString += data[k];

			if(k < data.length - 1) returnString += " ";
		}

		return returnString;
	}
}

redpajama_set_name: RedPajamaGithub


One of the many challenges Procurement & Supply Chain people struggle with is mastering how to grow their careers successfully. So this article is the first of a number of planned 'clinics' from Sigi Osagie and Peter Smith to help supply management and procurement folk by addressing specific questions we've been asked on the broad themes of career and performance.
I've got many years' experience working in Procurement roles in different companies, and I consider myself to be a good Procurement Manager. But I still haven't been able to step up to a senior or executive-level role as I would like. What do you see as the most important skill I need to make that move up?
This is a question many people ponder but never really take action to address. Sometimes people don't feel confident enough to ask; or they may have no one – a mentor, coach, shaman or whatever – to explore the question with and get the developmental help they need. Or, worse still, some people just bumble along without any thought given to their career growth and direction.
I presume that you're currently in a middle level role. This clarification is important, as the skills needed in middle management can be quite different from those required to step up to an executive role.
I hope your "many years' experience" means several years spent in different roles building a broad knowledge base and multiple perspectives. This distinction is also important – you should always grow your experience from different stints of work, rather than doing the same thing time and again. Some people have "10 years' experience," for example, but it's actually 1 year's experience times 10. This is not growth.
Being "good" may not be adequate to make the step up. Good often means average or the same as most people. What you want is not to be "good" but to be outstanding – you'll find it easier to make the step up compared to many others who are good or average.
There isn't really one "most important skill" required to move up to a senior role, other than your personal effectiveness. This is the single trait or competence that affects everything else.
For example, your personal effectiveness shows in your ability to think clearly about your intents: you must be clear on your career goal(s). Do you want to step up into an Operations, Supply Chain or General Management senior leadership role, for example, or to become a CPO?
Each of these (and other executive roles) may require different routes. You may need to get some exposure to other functional areas beyond Procurement. You could do this in any number of ways, for example: getting a secondment to another area; learning from colleagues in other functions; making a deliberate job change, and so on. Consider any such job move as a stepping stone towards your ultimate career goal.
Broadening your experience base will give you a more rounded understanding of business and the wider organisation, and a better grasp of the implications of each function's actions on other functional areas, which will help develop your strategic thinking and awareness. This is always advantageous in executive roles, even if you remain in Procurement.
I've deliberately drawn on your own words to give you some pointers. So I hope you can see that your ability to step up to a senior role starts with your own perspectives – how you see yourself and your worldview.
People with poor soft skills typically have stunted careers. The higher up you climb, the more vital your soft skills become. And you're more likely to grow wings and fly if you get yourself a mentor or coach to help you sharpen those abilities.
Self-leadership. You must be adept at managing yourself – how you think, what you focus on, how you act, and so on.
People management. In a line management role you must be effective at getting the best out of your people. Aligning people effectively is also important to get results through others who don't report to you.
Results-orientation. Focus on delivering results; that's what you're paid for. If you work for a lousy boss who hasn't given you SMART objectives, set yourself some. Then deliver.
Persuasive communication and influence. Sharpen your abilities to win people over. This isn't just about using hard facts and technical lingo; get savvy at 'connecting' with folks emotionally and empathetic listening.
Interpersonal relationships. Immerse yourself in appropriate networks of people who will have positive impacts on your growth. Always remember The Golden Rule, and help others when you can. Manage your 'personal brand' sensibly – learn how to build rapport, communicate your achievements and aspirations, and market yourself -- in the right way, to the right audience and with the right message.
Self-belief. Above all else, believe in yourself. You have what it takes to achieve what you want. Don't let anyone tell you differently; not even yourself.


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OHIC trims health insurer rate increases for 2022, citing affordability
Prompted in part by public comment, an intervention by RI Attorney General Neronha, and his own agency's analysis, Commissioner Patrick Tigue reduced proposed rate increases by some $41.6 million
Photo by Richard Asinof
Patrick Tigue, R.I. Health Insurance Commissioner, in his office.
Why is this story important?
Efforts to control rising medical costs have become front-and-center as Rhode Island's health care delivery system confronts the challenges of a proposed hospital consolidation, the stresses on the system from the ongoing coronavirus pandemic, and questions about the long-term sustainability of the business models for the health care industry. The recent decision by OHIC on 2022 rates for commercial health insurers reflects those challenges.
The questions that need to be asked
Will housing be seen as being connected at the hip to health care when the Rhode Island Foundation announces its suggested investments in four or five big transformative ideas? How do pharmacy benefit managers become part of the conversation around commercial insurance rates, given that the cost of prescription drugs has been identified in OHIC's analysis as the highest trend in medical costs? When will the R.I. General Assembly conduct a comprehensive audit of the managed care organizations' performance as private contractors for R.I. Medicaid? Does the state of Rhode Island need to seek greater regulation of self-insured companies when it comes to health insurance, which fall outside the jurisdiction of OHIC? In his role as public health advocate, will R.I. Attorney General Peter Neronha pursue legal remedies to the low reimbursement rates paid to providers of behavioral health services, which has created a barrier to access during a time of increased needs?
Under the radar screen
Given the recent decision by the U.S. Supreme Court not to intervene over the Texas law that seeks to ban abortions after six weeks and authorizes bounties to be paid to citizen vigilantes to help enforce that law, women's health – and a women's right to make her own decisions about her own body – promise to be key issues in the 2022 midterm elections.
Most women – and most men – know women who have had an abortion, which is a common, safe and important health care procedure. But it is often not a topic of conversation, much like miscarriages, which are also common occurrences.
In the coming months, men as well as women need to be able to become fully engaged in the public conversation around the dire threats to women's health created by the new Texas law.
PROVIDENCE – We hold these truths to be self-evident: that all health care is personal, that health care delivery is complex and expensive, that place-based health initiatives can create better outcomes than just those to be found in a doctor's or nurse's office, and that the increasing medical costs in Rhode Island are a result not of utilization but from escalating drug prices, often driven by profit motive.
Here in Rhode Island, one of the major "hurricane" barriers erected to protect against the increasing costs of health insurance is the Office of the Health Insurance Commissioner, which reviews, modifies and then authorizes annual rate increases for commercial health insurance plans in the individual, small group, and large group categories.
On Wednesday, Sept. 2, R.I. Health Insurance Commissioner Patrick Tigue announced his decision on the proposed 2022 rate increases sought by commercial health insurers. In the news release accompanying his decision, Tigue said that he had "rejected all charges for profit and contributions to reserves in the 2022 rates that were filed with OHIC in May 2021 for review."
In addition, Tigue said that several insurers were required to modify the actuarial assumptions set forth in their filings, which will produce additional savings for consumers.
As a result of these changes, Tigue continued, "Rhode Islanders will save [more than] $41.6 million in 2022 compared to what the commercial health insurers requested."
Here are the rate increases that were approved by OHIC:
• In the individual market: Blue Cross and Blue Shield of RI, with 17,159 members, asked for a 3.1 percent increase, but was approved for a 0.1 percent increase. Neighborhood Health Plan of RI, with 24,866 members, asked for an 8.5 percent increase, but was approved for only a 3.5 percent increase.
• In the small group market, Blue Cross and Blue Shield of RI, with 40,255 members, requested a 2.9 percent increase, but received a minus 0.3 percent decrease. Neighborhood Health Plan of RI, with 1,730 members, requested a 6.5 percent increase, but only received a 1.5 percent increase. Tufts Health Plan, for its HMO plan, with 1,879 members, requested a 5.2 percent increase, but only received a 4.7 percent increase; Tufts Health Plan, for its PPO plan, with 946 members, requested a 5.1 percent increase, but only received a 4.6 percent increase. UnitedHealthcare, for its HMO plan, with 906 members, requested a rate increase of 17.5 percent but only received a 7.8 percent increase; UnitedHealthcare, for its PPO plan, with 2,220 members, requested a 10.7 percent increase, but received only a 1.3 percent increase.
• In the large group market, Blue Cross and Blue Shield of RI, with 68,936 members, requested a 7.4 percent increase, but received only a 4.6 percent increase. UnitedHealthcare, with 15,461 members, requested a 14.1 percent increase, but receively only a 7.7 percent increase. Tufts Health Plan, with 3,430 members in its HMO plans, and another 3,159 members in its PPO plan, requested 9.1 percent increases for both plans, but received only a 7.7 increase for both plans.
One factor clearly identified in the medical trend assumptions were rise in the costs of prescription drugs, which were the highest-cost trend across all three markets.
• In the individual market, prescription drugs received a 9.2 percent increase in 2022 rates; in the small group market, prescription drugs received a 10.1 percent increase in 2022 rates, and in the large group market, prescription drugs received a 7.5 percent increase in 2022 rates.
Translated, the high cost of prescription drugs is still the biggest cost factor that is driving medical costs higher in the commercial insurance market.
The state's public health advocate weighs in
In response to Commissioner Tigue's decision, R.I. Attorney General Peter Neronha issued the following statement:
"Several weeks ago, my Office objected – across the board – to requests by insurers to raise health insurance rates for Rhode Islanders, citing serious concerns about affordability in the context of the ongoing COVID-19 pandemic, the frequency of substantial annual rate increases, and adverse impact on minority communities already suffering from economic and health inequities."
Neronha continued: "While I firmly believe that no rate increases are justified, I am encouraged to see that the Office of the Health Insurance Commissioner took into account affordability as a factor in denying requested rate increases from insurers."
Tigue offers insights into his decision
ConvergenceRI asked R.I. Health Insurance Commissioner Patrick Tigue some questions, following up on his ruling on the proposed commercial insurance rates for 2022. Here are his responses:
ConvergenceRI: What is the message that you are sending with these rate decisions?
TIGUE: My message is two-fold: First, given the strong financial positions of the health insurers participating in the Rhode Island market and the hardships faced by many Rhode Islanders and small businesses in the state due to the pandemic, I did not agree that charges for profit or contributions to reserves should be built into premiums in 2022, so I rejected those charges, which substantially reduced the proposed rate increases.
Second, the cost of health care remains a core concern of mine. Expected medical trends for 2022, which ranged from 5.7 percent to 7.1 percent across different markets, drove the overall premiums that were ultimately approved by OHIC. This is a critical point.
Medical trend reflects the amount and types of services that consumers use, and the prices paid for those services. Through rate review we scrutinize the methods used to project these expenses and the influence of different factors, whether they be pharmaceutical prices or use of expensive inpatient services, etc.
We work hard to arrive at a medical trend that is reasonable, and which will support an actuarially sound premium. But more has to be done outside of rate review. Over time, we will not reduce premiums or materially reduce medical [cost] trends unless we support people and communities to live healthy lives and we reduce sources of inefficiency in health care delivery, while maintaining scrutiny over insurer administrative costs and profits.
ConvergenceRI: How important was the intervention by RI Attorney General Neronha?
TIGUE: OHIC has a good working relationship with the Attorney General's Office and we value their input. I considered all of the public comments submitted by Rhode Islanders.
This year OHIC received the most substantial public comment that we have in recent years and this is a credit to those who organized so many people to make their voices heard.
I want to say a few things about how we use the public comments. Rhode Island law requires that the health insurance premiums set forth by the insurers for my review and prior approval be "consistent with proper business conduct" and "consistent with the interests of the public."
These two standards can be mutually reinforcing and, at times, in tension with one another. Each standard comprises several elements, but here are the most salient ones.
• "Proper business conduct" means that the premiums are actuarially sound, support solvency, etc.
• The "public interest" includes supporting access to care, quality, and importantly, affordability. In addition to the "Affordability Standards" that are promulgated in regulation and include such policies as the cap on hospital price inflation and mandated investments in primary care, I can consider affordability in the context of rate review.
The public comments thoughtfully articulating the challenges facing Rhode Islanders during this difficult time are essentially evidence that I drew upon in rendering my decision.
My decision must be rational and based on evidence, not arbitrary and capricious. I must identify specific components of premium for modification and substantiate why the given components should be modified.
As a matter of administrative process, my decision to modify the rates proposed by the insurers can be appealed by the insurers, first in an administrative hearing, and ultimately in the courts.
It is important to have this strong evidence basis should those appeals be sought. This year the public comments, combined with my review of the insurers' financial performance, were particularly helpful in substantiating my rationale for stripping charges for profits and contributions to reserves from the 2022 premiums.
I want to thank everyone who took the time to comment – including the Attorney General, who submitted actuarial analysis on the individual market filings as well.
ConvergenceRI: What is the current status of the proposed new affordability standards?
TIGUE: The new Affordability Standards are still under development. OHIC continues to meet with stakeholders to review the policy concepts and solicit feedback. This feedback will be considered as we develop changes over the next few months.
ConvergenceRI: In a recent story, I reported on the financial conundrum facing Women & Infants Hospital regarding what they say are flat or decreasing rates of reimbursements for births and deliveries. Is that an area worthy of investigation by OHIC regarding investments in maintaining access to quality health care?
TIGUE: I'm happy to speak with management at Care New England and Women & Infants hospital any time to discuss the issues brought to light in your article.
Ensuring affordability, access and quality


Audio reflections on the theme of prayer, taken from the writings of those who have walked the path of devotion to God. These timeless quotes are accompanied by moving, instrumental music.Thirty minutes of quotes as well as 30 additional minutes of inspirational music only. Jewel case.


February 10 Covenant Presbyterian Ash Wednesday Service 2618 New Albany Road, Cinnaminson Rev. Dr. Debra Cerra "Resistance"
February 17 Sacred Heart R.C. Church 103 4th Street, Riverton Rev. Tristan Shin "Responsibility"
February 24 Bethany Lutheran Church 617 Morgan Avenue, Palmyra Pastor Wesley Allen "Trust"
March 2 Asbury United Methodist 2492 Andover Rd, Riverton, NJ 08077 Rev. Joel Buckwalter "Repentance"
March 9 Central Baptist Church 514 Maple Avenue, Palmyra Rev. John Doll "Forgiveness"
March 16 Calvary Presbyterian 300 4th Street, Riverton Deacon Joseph Donadieu "Faithfulness"


July | 2016 | The Jamestown Comet.
Support your local county fair.
Photo courtesy Jack Delano, a county fair in Georgia Taken in October 1941.
As summer winds down, county fairs are an institution prominent since the middle 19th Century. For some families, the county fair is the highlight of the summer. It represents the culmination of the agricultural year in crops, livestock, and education.
As I was growing up, the fair signaled the end of summer and provided what was, for lack of a better description, my vacation. I spent my summers in 4-H, working on every type of project from beef cattle and bicycle rodeos to first aid and rocketry. The weeks leading up to the fair were always packed with activity for me and the benefits are farther reaching than just the immediate event.
Most regional organizations exhibit at the fair including Boy and Girl Scouts, Rotary and Grange, and, most notably for youth, 4-H and Future Farmers of America (FFA). The junior fair events were designed to showcase these organizations and meet the needs of farm families to help provide educational opportunities.
What most children love is the opportunity to get close to live farm animals. Youth exhibitors have their livestock boarded at the fair through the week either awaiting show times or auction. During that time, visitors can see and often pet the animals, with the permission of the owners, and ask questions about them.
While strongly focused on rural interests, the fair isn't only about farming. Music and variety entertainment is in no short supply on the fairground. Multiple stages and grandstand events offer everything from local garage bands to big-name entertainers. And those with an artistic eye have plenty to see as well!
While some people might believe that the only artwork to be seen at a county fair consists of macaroni pictures, they'd be incredibly wrong. If it's art you're interested in, some of the most amazing hand crafted artwork hangs on the display walls at the fair. Fine art buildings on the fairground become temporary museums to local artisanship.
Anyone may submit for judging hand artwork, needlepoint, quilting, photography, pottery and a myriad of other artistic work. Contestants need not be part of the 4-H, FFA or other organized groups, in order to enter. The resulting exhibits are diverse and eye-catching, on display from hobbyist and professional alike, judged equally.
Those familiar with the PBS series, "Antiques Roadshow," might enjoy a tour of the antiques exhibit. Each year, the fair hosts a contest of antiques from every category, including glass, metals, wood and rare items. As with art, the exhibitors are local residents, hoping for a little notoriety out of a family heirloom or favorite antique or collectable – all on display for the enjoyment of the patrons.
Strolling through all of these exhibits, visitors may notice colored ribbons. Each one represents the achievement level of the participant in his or her category of judging. The awards may not be the ultimate goal, but for someone who plans on a career in livestock demonstrating an award-winning history can go a long way towards securing a professional establishment later.
But the fair is certainly not just for the exhibitors. What good is all this effort if no one comes to visit? Offering everything from food and rides to shows and educational opportunities, the family entertainment value of the county fair is tough to beat.
Generally, admission runs under $10 for adults, less for kids, seniors and veterans, and weekly passes are often available at a discounted rate. Often, the gate ticket allows access to everything on the grounds, although there is generally an additional fee for high-profile grandstand events.
My home fair in Greene County, Ohio, opens July 31 this year and runs until the following Saturday. Having started in 1839, it is has moved locations several times, but remains the longest running county fair west of the Alleghenies. If you're in the area, check it out. You can learn more at greenecountyfairgrounds.com.
If you have a county fair near you, take the time to spend the afternoon there this year. In addition to getting a great day of family-oriented fun, you are supporting the local community. Get out and enjoy the fair.


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ViewRay, Inc: Revolutionizing Radiation Therapy with Innovative Solutions to Conquer Cancer
Article Updated:	January 7, 2022
Comments Off on ViewRay, Inc: Revolutionizing Radiation Therapy with Innovative Solutions to Conquer Cancer
ViewRay was founded in 2004 by Dr. James Dempsey and since then, it has been a leading innovator in MRI-guided radiation therapy. At ViewRay, patients come first and are at the center of everything. The company's vision is to "Conquer cancer by re-envisioning radiation therapy." Most of the cancer patients who undergo radiation therapy require daily treatments that last over several weeks. For example, a standard radiation treatment course for prostate cancer patients can last 9 weeks and go up to 45 treatments. With conventional treatment, radiation is delivered in lower doses over dozens of treatments, called fractions, to minimize the impact of the radiation on healthy tissues.
In addition to that, ViewRay's mission is, "To treat and prove what others can't." This can be supported by the ever-growing clinical evidence published by MRIdian clinicians, demonstrating a positive impact to patients who were treated for various hard-to-treat cancers including pancreas, prostate, central lung, liver, kidney, and breast cancer. The impact of MRIdian was most notable in patients with inoperable tumors that were previously deemed untreatable due to their location in and around healthy organs or critical structures.
Meaningful Patient Impact
The most compelling stories are the patient experiences reported by MRIdian centers. For example, there are cases where patients with inoperable pancreatic sought out second opinions at hospitals with MRIdian MRI-guided radiation therapy technology after they were told they had cancer with no treatment options. After completing treatment on MRIdian, some patients were reclassified as surgical candidates because their tumor had reduced in size and was no longer near critical structures. As demonstrated in clinical studies, other patients experienced prolonged survival compared to patients not treated on MRIdian.
The Big Four Guiding Principles
Scott Drake is the CEO of ViewRay. He joined over three years ago and brought to the company a management approach that he is deeply passionate about. He believes in the big four guiding principles when leading a high-performance team and company. The first and most important is "ARD" which stands for attract, retain, and develop the best talent on the planet. Scott believes it to be the highest priority for leaders to build a high-performing team. At ViewRay, colleagues are deliberately referred to as "teammates" to make it clear that everyone remains focused on achieving the same goals and objectives.
The second principle is to "Operate with wicked strategic clarity." Scott clarifies, "I include 'wicked' as a tribute to my hometown, Boston, but more importantly, because "wicked" is a memorable word and implies an extra level of intensity to focus on the most important activities that are going to "radically delight" our customers. To establish and maintain wicked operational clarity, ViewRay conducts strategy meetings twice a year to review feedback from teammates, customers, and shareholders and identify the most important projects that will continue the success and growth of the organization. The third of the big four guiding principles is "Execute as if lives depend on it," because in this business, indeed they do. The fourth guiding principle is to "Live our Culture."
A crucial part of ViewRay's culture is to "show up" for teammates when "life happens." Scott describes this as… teammates get married, divorced, have children, become ill, and face the passing of a loved one. And hence, showing up for each other in these difficult times strengthens the bonds between teammates at ViewRay.
Leveraging Innovation through Disruptive Technologies
In 2014, ViewRay launched the world's first radiation therapy system which integrated a high-performance with low-field strength MRI system which enables on-table adaptive planning and real-time tissue tracking and radiation beam control. In 2016, Dr. Dempsey and the ViewRay team commercialized the first ever MRI-guided radiation therapy system with an integrated linear accelerator (LINAC). This innovation includes the patented radiofrequency (RF)- "cloaking" technology to prevent RF emitted by the LINAC from impacting the MRI image quality, as well as magnetic shielding technology to ensure accurate delivery of radiation.
This approach to radiation therapy is called MRIdian SMART (Stereotactic MRI-guided, adaptive radiotherapy). After treating nearly 16,000 patients, MRIdian clinical teams are now defining treatment success by using a five-point criteria; the ability to deliver an ablative radiation dose; treating with tight margins, eliminating the use of markers or implants, and completing treatments in five or fewer fractions, with patients experiencing no to low grade 3 or higher toxicities. ViewRay refers to these criteria as the MRIdian 5.
Developing Innovative Solutions to Conquer Cancer
Innovation is at the core of ViewRay's quest to conquer cancer. The company strives to solve impossible problems to help clinicians better fight this deadly disease and to provide patients with new hope and a better quality of life. The result was the invention of the MRIdian MRI-guided radiation therapy technology. MRIdian is the first radiation therapy system that implements vision guided control by capturing real-time MRI images eight times a second, faster than human reaction time, to track the tumor as it moves and stop the radiation beam when the tumor moves out of position.
When tumors or nearby critical structures abruptly change position, MRIdian's real-time tracking and automated radiation beam control instantly reacts and automatically turns the radiation beam off. Likewise, when the tumor returns to the correct position, the radiation beam is automatically turned back on. The integration of on-table adaptive planning, real-time imaging, tracking of the tumor, and automated radiation beam control is the key to the precision radiation delivery of MRIdian and the personalized treatment it offers to patients.
Conquering the Clinical Challenges
Over the past 30 years, conventional radiation therapy has introduced many lifesaving developments, however, poor soft tissue visualization and no real-time imaging during beam-on has limited its clinical potential. ViewRay has overcome these clinical challenges faced by conventional radiation therapy and confronted them all with its innovation. The traditional imaging technology associated with radiation delivery systems is based on x-rays, which provides good visualization of bone, but limited visualization of soft tissue. This leads to clinical challenges such as the inability to accurately see a tumor for treatment alignment. "Because it is difficult to differentiate between the cancer and nearby soft tissues with CT x-ray images, clinicians often have to implant surrogate registration markers or fiducials. During this invasive procedure, several markers are placed in the area of the tumor to allow the imaging system to see where the radiation treatment should be delivered." says Mr. Drake when asked to describe the clinical challenges facing radiation oncology. In addition, there exists the inability to revise the treatment while the patient is being treated "on-table." Between fractions, tumors often change in size, orientation, or shape, and patient anatomy can change for reasons such as weight loss or gain. Mr. Drake continued by stating "The greatest challenge faced by radiation oncology is the inability to accurately track the tumor and nearby critical structures directly during the treatment and to account for this movement in real-time. This requires physicians to expand the targeted region thus exposing healthy tissue to unnecessary radiation and limiting the intended dose that is delivered to the tumor. By not being able to overcome these challenges, patients may suffer from radiation side-effects, referred to as toxicities, due to unwanted dose to healthy tissues."
ViewRay not only focuses on improving clinical outcomes but also on shortening treatment time and improving quality of life. Today, because of these limitations of conventional radiation therapy, only 14% of patients are treated within 5 or fewer fractions despite decades of innovation in radiation oncology. In contrast, about 80% of MRIdian patients are treated with 5 or fewer fractions. Mr. Drake emphasizes, "The dramatic difference in the patient experience must be considered. That is 5 separate visits to the hospital versus 45 visits. The difference in time, energy, life and career disruption, and financial burden is profound. This is priceless time given back to patients and their families, allowing for a faster return to normal life."
Mr. Drake concludes, "We believe everything begins and ends with the patient. Our quality policy sums it up nicely, 'We make medical products that we would be proud to have used on our loved ones.' Our mission and our culture compel us to develop innovative solutions to conquer cancer and positively change the lives of cancer patients around the world."
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Is the Buildup to World War I Being Repeated for WWIII?
Eric Zuesse
© Photo: Public domain
The great scholar of Turkish history, Taner Akçam, has described today's geopolitics — the alliances and hostilities toward possibly another World War — as being not ideologically based like WWII, but instead greed-based (empire-grabbing) like WWI:
These are wars of power, influence, and control over the use of Middle Eastern energy resources and the "security issues" related to it. It is quite obvious that the sides in this war are not "those who want democracy and human rights" versus "those in favor of evil dictatorships."
The axes that are now starting to take shape are proof of this: Saudi Arabia and Israel – openly supported by the United States (and likely Egypt over time) – are forming one alliance; Russia, Iran, and Turkey are establishing another.
A tableau reminiscent of 1918 power blocs.
Today's alliances are modernized versions of WWI.
World War I was a mess of alliances on each of its two sides, the Central Powers, versus the Entente Powers. The aristocracies that were on the side of the Central Powers included (among others) the following: Jabal Shammar (Saudi Arabia allied with Turkey); Germany; Austria (including Croatia & Bosnia); Ukraine; Poland; Lithuania; Georgia; Turkey; Italy.
The aristocracies that were on the side of the Entente Powers included: China; Japan; Czechoslovakia; Russia; Serbia; UK; Canada; US.
Today, we instead have the West: US; UK; Saudi Arabia (UK-allied 'Arab Revolt' that ended in 1925 with Ibn Saud's victory); Israel; EU led by Germany; Ukraine; Japan; South Korea; versus the East: Russia; Iran; Turkey; China.
An odd-man-out is North Korea, which will be supported by China if it stops developing its nuclear program beyond what's needed for its self-protection (protection against repeating what had happened to Saddam Hussein and Muammar Gaddafi), but which will be opposed by China if it develops an aggressive, conquest-oriented, imperialistic, nuclear capability (which would reduce security not only for Japan and South Korea, but also for China).
In WWI, there was a long list of neutral countries (including Switzerland, and all of Scandinavia, plus the Western Hemisphere south of the US); and, in a prospective WWIII, there would also be many such countries on the sidelines. (All of them, however, would become subject to the intense nuclear radiation after the War, and would therefore likewise become unlivable — neutrality wouldn't save any country from destruction.)
But, after the war was done, what did the world gain and lose from it?
And what would the world gain and lose from a prospective WWIII?
So: how sane was WWI?
And how sane would be a WWIII?
Why, then, was WWI even waged, at all? And what does that history teach us about what seems to be happening today?
I think that it teaches us a lot. It teaches us that mistakes can happen. Signals and intentions can be misread. The priorities of leaders can be misunderstood (such as were the priorities of Kaiser Wilhelm II — that he placed the divine right of kings as being the supreme obligation of any king to protect and defend in order to keep his personal honor — misread, until too late and the Archduke Ferdinand of Austria became assassinated on 28 June 1914 by the well-intentioned naive anti-imperialist Gavrilo Princip, who couldn't have cared less about whether the assassination, which he was planning, would violate what the German Emperor felt to constitute the ultimate moral principle).
History during the past century has definitely taught us (though humans seem not to have learned it) that humans have now (with nuclear weapons, and also with human-caused global warming) acquired, by means of the fruits of our technological ingenuity, far more power, on a far bigger scale, than humans possess the intelligence and character to be able to control, and that we are thus becoming increasingly dangerous and destructive to the entire planet, like we never have been before, throughout all of human history. We're now, tragically, clearly out of our depth. Surely, this will end in WWIII, unless something else ends us even sooner. Humans seem to be destroying the planet, by a final War, if not by a global burnout. A WWIII would bring the end much sooner than global burnout would, and now seems likely to occur.
All sane bets are thus off. All that remains now is just bad gambles. Anyone who thinks otherwise needs to tell everybody else why optimism isn't stupid, under the present (and past) circumstances — in other words, in the light of history.
I agree with Akçam's analogy between the buildup toward WWI, and today's buildup toward WWIII. Kaiser Wilhelm II felt to be the ultimate moral principle the divine right of kings; and America's ruling aristocracy today feel that the ultimate moral principle is that, as US President Barack Obama expressed more frequently than any other US President has, the US is the only "indispensable" country — that all other nations are either vassals or else enemies of the US, but are, in either case, "dispensable." Obama's successor, Donald Trump, has still not condemned and disowned that fascist view. Consequently, any US-allied country needs to accept that not only are the US aristocracy's enemies "dispensable" to the US aristocracy, but that the US aristocracy's allies are, likewise, "dispensable" to America's Government. It's an "Either you're with us, or else you are against us" situation, for any currently US-allied country — no current US ally will be allowed to become neutral. This places an incentive upon Turkey to outright withdraw from NATO, and even for Germany perhaps to do so; but, for some reason, the opposing alliance, of Russia, China, and Iran, are not as yet forming themselves in any official way as constituting an alliance, such that Turkey or maybe even Germany would withdraw from NATO and join "the opposite side."
It's not yet clear that there yet is an opposite side. (Maybe that will be coming soon.) The more that the US regime blocks peaceful and mutually advantageous paths forward, as it has been doing since 2013, the more likely that its competitors will announce that the US and its allies are "enemies," and are not merely "competitors." America can't continue much longer to proclaim itself to be the only indispensable country, before everything starts going onto a war-footing; and the step from that situation to a nuclear armageddon could turn out to be surprisingly short.
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At last! After decades of campaigning, years of mass mobilisations, the careful deliberations of the Citizens Assembly and the recommendations of the Oireachtas Committee, we have our chance.
Now, finally, the people of Ireland and especially the women of Ireland have a historic opportunity to break with the dark past and take a major step towards choice and real equality.
But to do this the referendum in the Summer has to be won. Socialist Worker would have preferred a simple vote on Repeal, with no replacement, as the Oireachtas Committee proposed. But the limited enabling phrase proposed by the Government doesn't change the essence of the matter. This will be a big step forward.
We very much hope the referendum will be at the end of May to facilitate the voting of young people who will be most affected by this crucial change.
But whenever it is the key task is to win it. There must be NO COMPLACENCY.
The opinion polls are favourable but the gap may narrow as Anti -Choicers engage in well funded emotive campaigning, backed by virtually every Catholic Church in the state.
That means we need a MASS CAMPAIGN from below – a real movement of people power. There are some on 'our side' , like Micheál Martin who might prefer a low-key, passive campaign dominated by 'moderate' politicians resulting in a narrow win, and followed by legislation embodying a disappointing and limited compromise. In truth they wouldn't care much if we lost.
Mná na hÉireann,the women of Ireland, and all who want Ireland to really move forward , need better than this.
We need a mass campaign on the streets – for example the largest possible demonstration on International Women's Day, March 8.
We need mass canvassing teams going door to door in every town and county. We need to get out the vote in working class areas which voted so heavily YES on marriage equality. We need as big a win as possible to send a clear message to the politicians that people want real change and real choice.
NO GOING BACK! IT'S TIME TO TRUST WOMEN!
See article on Repeal by Bríd Smith TD on page 3.