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Great frame for their position!
LWVLMR President Henrietta Saunders and member Suzanne Dixon of LWV Holland, MI took some time out from the Great Lakes Restoration Conference in Grand Rapids for a fun display of their love of Lake Michigan.
The Conference was organized by the Healing Our Waters - Great Lakes Coalition. This year was a special celebration of a decade of the coalition's Great Lakes advocacy and of founder Peter Wege.


Thompson, R.C.A. and Smith, A. (2011) Zoonotic enteric protozoa. Veterinary Parasitology, 182 (1). pp. 70-78.
A growing number of enteric protozoan species are considered to have zoonotic potential. Their clinical impact varies and in many cases is poorly defined. Similarly, the epidemiology of infections, particularly the role of non-human hosts, requires further study. In this review, new information on the life cycles and transmission of Giardia, Cryptosporidium, Entamoeba, Blastocystis and Balantidium are examined in the context of zoonotic potential, as well as polyparasitism and clinical significance.


Tanzania is experiencing acute shortages of Health Workers (HWs), a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers' shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting.
We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants' practical experiences of implementing task shifting in their respective health facilities (district level) and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted.
Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy infrastructures are not in place before formalising tasks shifting. There was also a perception that implementation of task shifting has ensured access to services especially in underserved remote areas. Professional discontent and challenges related to the management of health personnel policies were also perceived as important issues to consider when implementing task shifting practices. Additional resources for additional training and supervisory tasks were also considered important in the implementation of task shifting in order to make it deliver much the same way as it is for conventional modalities of delivering care.
Task shifting implementation occurs as an ad hoc coping mechanism to the existing shortages of health workers in many undeserved areas of the country, not just in the study site whose findings are reported in this paper. It is recommended that the most important thing to do now is not to determine whether task shifting is possible or effective but to define the limits of task shifting so as to reach a consensus on where it can have the strongest and most sustainable impact in the delivery of quality health services. Any action towards this end needs to be evidence-based.
Like many countries in the world, Tanzania is experiencing acute shortages of health workers, a situation which has forced health managers, especially in the underserved districts, to hastily cope with such problem by adopting task shifting. However, this has been due to limited options to deal with health personnel shortages. Moreover, there have been on-going discussions at various decision making levels in Tanzania regarding the most favourable and convenient ways of implementing the strategy, albeit as a short term solution. However, these discussions are not backed up by rigorous scientific evidence. It is thus crucial to generate such evidence in order to inform policy and practice. The aim of this paper is two-fold. Firstly, to describe the current status of implementing task shifting in the context of acute shortage of health workers. Secondly; the paper attempts to provide a descriptive account of the potential opportunities, benefits and the likely challenges which might ensue as a result of implementing task shifting.
In the literature, task shifting has been defined in different ways depending on various circumstances of health care settings. Almost unanimously, the literature consider task shifting as the process of delegation of tasks from skilled to low or unskilled health workers [1, 2].The World Health Organization (WHO) defines task shifting as "the 'rational' re-distribution of tasks among health workforce teams" [3, 4]. "Specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of available human resources for health" [3, 4]. Delegation of tasks to community lay workers has also been prevalent in many sub-Saharan African countries [4, 5].
In almost all of its typologies, task shifting is not a new concept. In the last few years, this concept and its practice had re-emerged to be at the centre stage of global debates and had now been considered to be one of the potential strategies to address acute shortages and unmet needs for health workers in the health care systems of many countries. Task shifting has seen a welcome re-emphasis by the World Health Organization (WHO) whereby in 2010 it had issued global recommendations (see Task shifting pre-conditions section below) on how to design, manage, monitor and evaluate task shifting practices . The main perceived aim of task shifting is to improve access to health care services in places with acute shortages of health personnel without compromising its quality .
Task-shifting has been shown to be effective in high-income countries whereby appropriately trained and well supervised lower-level cadres perform delegated tasks well or better than the trained ones [1, 6, 7]. Promising successes had been documented especially in relation to delivery of the HIV/AIDS interventions [5, 8, 9]. Despite evidence of task shifting's cost effectiveness from other countries, there is little documented information in Tanzania regarding implementation of task shifting, notwithstanding the fact that it has been in practice for many years in the country. In addition, there is virtually no evidence on the potential benefits, opportunities and challenges which may be associated with implementing task shifting in the country. The World Health Organization has recently engaged a 'speed' gear towards advising countries to consider scaling up task shifting practices by offering a range of recommendations regarding optimal ways for its effective implementation. In many instances, emphasis has been placed on quality assurance issues as they are related to health services delivery in the context of task shifting [3, 5].
To outline key steps for developing and implementing a national task shifting action plan (using WHO generic guidelines adapted to suite the Tanzanian context.
Among the resolutions reached in this meeting were a) to undertake a stakeholders' analysis by focusing on the implementation of task shifting in Tanzania; b) to identify priority programmesa, which currently implement task shifting in response to shortage of health personnel required to implement their programme activities and c) to undertake a desk review in order to document and analyse task shifting experiences as implemented by different disease programmes. Up to the time of writing this paper, there was no documented evidence on how far the above recommendations were implemented. The findings reported in this paper provide one of those few resources given a weak knowledge base on the subject. This information is quite crucial for informing policy makers and programme planners about the current situation of task shifting implementation in the country's public health care system. The findings will also add to the existing (albeit, weak) evidence base which is needed to back-up the on-going discussions about whether formalised task shifting in Tanzania is needed and whether it is feasible to ultimately deliver what is meant to deliver without compromising access and quality of health care services.
Against this background, the rest of the paper is organised as follows. The following section presents the context by describing the Tanzanian socioeconomic, health and demographic indicators, organization of the country's health care system and health workforce situation and; reflects this with the need to implement task-shifting. This is followed by a description of the methodological approach. Subsequent sections present findings, discussion of the main findings and methodological limitations. Conclusions and recommendations are presented at the end of the paper.
Tanzania is one of the poorest countries in the world characterised by enormous shortage of health workers. The World Health Organization reports that the country has 0.02 physicians per 1000 population, the lowest in the world . A recent analysis of the HRH situation indicated that there are 46,896 total health workers in Tanzania and are distributed as shown in Table 1 below . On average, there are 1.4 total health workers per 1000 people ranging from 0.3 per 1000 people in a typical remote district to 12.4 per 1000 population in a relatively urban district. Medical attendants, the highly unskilled cadre of health workers, constitute the largest proportion (40.2%) of the country's total health workforce. Nurses form the largest proportion (27.8%) of the total skilled health workforce in Tanzania. The few health workers available are unequally distributed and many of them are concentrated in urban areas . This mal-distribution is indicative of disproportionate access to quality health care services with rural populations being highly disadvantaged.
Albeit informally, task shifting in Tanzania is taking place in all health facility levels and it is practised both within cadres (medical officers, assistant medical offices and clinical officers) and between cadres (for example between clinical officers and nurses). Up to the time of writing this paper there was no rigorous scientific evidence permitting any conclusion regarding which tasks can easily be shifted from one cadre of health worker to another. Note that, there are many cadres of health workers in Tanzania and their tasks are described in detail in each cadre's job description. It is thus difficult to present all tasks of all cadres in this single paper.
Many of the country's health status indicators are not promising with HIV/AIDS and the fast re-merging non-communicable diseases posing as an additional burden to the already resource-constrained health care system. Task shifting practices in Tanzania are on-going and had been in place for many years . To date, it is not surprising, for instance, to find an Assistant Medical Officer (AMO) working as a District Medical Officer (DMO), a post which is supposed to be held by a fully trained Medical Doctor (MD).
Geographically, Kongwa district (6°12′00″S 36°25′01″E6.200°S 36.417°E) where this study was conducted is one of the 5 districts constituting Dodoma Region. It is bordered to the North by Manyara Region, to the East by Morogoro Region, to the South by Mpwapwa District and to the West, by Dodoma Rural District. According to the 2002 Tanzania's population and housing, the district has a population of about 249,760 inhabitants. We calculated the number of health workers per 1000 population based on the country's HRH census of 2001/2002 and the 2002 population and housing census. We found that the district has 0.001 total health workers per 1000 population . The district is among ten districts in the country with the lowest number of health workers per capita. In Tanzania, the legal framework and existing national health policies and regulations do not recognise task shifting (except for AMOs who are officially recognised to perform some of the MOs duties ) as an official strategy for addressing the health personnel crisis. However, there has been ongoing discussions and frequent stakeholder's consultations focussing on how to adapt the WHO's global recommendations which provide a recipe to be adhered before attempting to scale up task shifting.
In order to collect data needed to address our research questions and objectives, a qualitative study design was employed. We relied largely on information from Key Informant Interviews (KII) at the district level. Additional interviews were done with informants at the national level.
Key informants at national and district levels were purposely selected on the basis of their strategic positions in policy and decision making processes related to HRH issues in Tanzania. Additionally, they were recruited based on their experience and their knowledge in specific policies and regulations regarding training, health worker carrier path (re)structuring and development. At the district level, five key informants were involved. They included such officials as the District Health Officer (DHO), the District Medical Officer (DMO), the District Nursing Officer (DNO), the District hospital Medical Officer in-charge and the District Human Resources Officer (DHRO). The initial plan was to include such informants as focal persons of the national disease programmes such as the District HIV/AIDS Coordinator (DAC), the district focal person for Malaria, Tuberculosis and Leprosy, and the in-charge of Reproductive and Child Health (DRCHC). However, after experiencing data saturation, the remaining interviews were discontinued. At the national level on the other hand, interviews were held with ten key informants, four of them were from the Ministry of Health and Social Welfare. The rest were from the following organisations with one informant each: Christian Social Service Commission, Ifakara Health Institute, World Health Organization, Medical Association of Tanzania, national AIDS Control Programme and the national Malaria Control Programme.
At the beginning of interviewing, a broad question capturing the study's major issues was asked to each informant. This was followed by questions which sought clarifications on specific issues on task shifting. An interview guide with open-ended questions was used for this purpose. New issues relevant for the study were added to the interview guide and were further explored in the subsequent interviews. All the interviews were face to face and in Swahili which is the official language in Tanzania. However, in cases where the informant was not conversant with Swahili language, an English version of the interview guide was used. All the information collected through interviews was tape-recorded. The main topics in all interview sessions at the district level focused on district officials' practical knowledge and experiences of the existing task shifting practices. Particularly, the interviews dwelt on district officials' insights reflecting the actual implementation of task shifting and its implications for quality of services, work relationships between and within cadres of health workers, motivation, health worker productivity, coverage and its retention potentials. Additionally, interviews inquired on the prevalence of the practice and whether it happens as a deliberate policy strategy to counter the effect of shortage of health workers or it happens as an adhoc response to the crisis of health personnel due to limited options and resources. In addition to topics which guided interviews at the district level, national level interviews dwelt on policy issues related to long term strategies of dealing with the shortage of health workers. These policy issues included: implications of task shifting for the existing human resources policies related to remuneration, promotion, supervision, motivation, productivity assessment and training.
All information collected through in-depth interviews was subjected to thematic content analysis. The process of analysing data was iterative and was concurrently done with data collection. The recorded data were transcribed and translated verbatim. The transcribed notes were combined with notes that were hand-written during data collection. Initial familiarization with the data was done at this stage. The research team used multiple-coding which involved the cross-checking of coding strategies and interpretation of data by different researchers. Four researchers were involved in this process. Multiple coding was done to create coding categories which were capable of reflecting the content of the data and concepts used by the informants rather than the questions or concepts predetermined in the interview guide. The coding categories extracted from the transcripts were used to systematically analyse commonalities and apparent contradictions reflected in the data by focusing on issues which were repeatedly mentioned or strongly emphasized by the informants. However, we did not observe any obvious and significant contradictions between views expressed by the national and district level informants.
This was a non-intrusive study. However, ethics clearance was requested from and was issued by the Medical Research Coordinating Committee (MRCC) of the National Institute for Medical Research (NIMR) prior to actual data collection. Informed consent was sought from the study informants after having explained the aims of the study and assuring them that their participation was voluntary and no personal identifiers will be made available to anyone outside the research team.
In this section, we start by providing a description of informants' awareness, acceptability and the extent to which task shifting is implemented as a strategy to deal with acute shortages of health personnel. We then present informants' perceptions on the potential benefits, opportunities and challenges associated with implementation of task shifting.
Both at national and district levels, informants registered broad consensus regarding their awareness of the on-going task shifting practices in the country. In relation to this common understanding among informants, informants at the national level warned that task shifting is not mandated by laws governing medical practice in Tanzania and hence not fully realized. They pointed out that informal task shifting is more prevalent in rural areas than in urban areas where for example Assistant Medical Officers (AMOs) perform many clinical tasks that would otherwise be performed by Medical Officers.
"Task shifting in Tanzania is prevalent in health care delivery. In most cases medical attendants are doing tasks of nursing officers much as clinical officers perform medical officers' tasks (National level informant).
"In fact, Tanzania is one of the pioneers of task shifting whereby the cadre called Assistant Medical Officer (AMO) had been officially recognized by the ministry of health for quite long time now. In this country, about 80% of all caesarean sections are being performed by AMOs, the tasks which should otherwise be performed by Medical Doctors or specialists (National level informant).
Based on their experiences, respondents were asked to air their opinions on the feasibility of task shifting. Majority of informants both at the national and district levels conceded that task shifting is feasible but any decision to scale it up has to seriously consider issues of quality of services and other associated challenges of implementing this initiative. They pointed out that with simple and standardised procedures for managing simple clinical procedures, and strong supervision and mentoring, task shifting can produce some good results. However, designing long term and sustainable intervention to address the health personnel crisis, was widely emphasised.
"If we are to take a pragmatic approach, then our focus should be on producing more nurses and clinical officers and the associated mid-level cadres because these are the types of cadres who are more likely or more willing to work and accept to stay in underserved areas and the cost of producing these cadres is relatively cheaper than that of producing higher level cadres such as medical doctors and specialist" (National level informant).
Regarding types of task shifting, Manongi et al. had coined 'vertical' and 'horizontal' task shifting as most common concepts associated with task shifting in Tanzania . Analysis of our data presented in this paper provides a confirmation to these concepts, though from a different study site. The above authors had further sub-divided 'vertical' task shifting into 'upward' and 'downward acting' to reflect how it is actually practised. Our 'Upward' acting is a scenario whereby for whatever reasons, lowly trained health personnel (or untrained ones) take the duties of properly trained health personnel or higher cadre health workers. Downward acting on the other hand involves a scenario whereby, for whatever reasons, a highly trained health worker takes the duties of a lower level cadre or unskilled health worker. 'Horizontal' task shifting is also practised, although is more widespread than 'vertical' task shifting. It involves a situation whereby in the context of shortage of appropriate personnel, physician's clinical tasks are delegated to non-physicians, for example from clinical officers to nurses or laboratory personnel. This was also reported to be prevalent in our study site. The quotes below confirm the earlier finding and attest that upward and downward acting were also prevalent in our study setting.
"We have a 40% shortage of clinical officers in our district. According to the government regulations, every government owned dispensary is supposed to be led by a clinical officer who is the in-charge of clinical and administrative tasks at this level. But due to this shortage, many dispensaries are manned by medical attendants, with very limited medical skills (District level informant).
By implications, the responses from almost all our informants at national and district levels indicated that there are no policies or regulations to guide implementation, monitoring and evaluation of task shifting practices in Tanzania. This is regardless of the fact that all cadres have clear job descriptions. However, due to acute shortages of qualified health workers' job descriptions are not adhered to.
"I am not sure about the existence of regulatory policies, but what I know is that AMOs can perform gynaecological operations although they are not supposed to do so but due to shortage of workers with such specialised qualifications, they always perform such procedures. For instance in Muhimbili National Hospital, medical attendants are not allowed to offer injections. We know they are not allowed, but what else can you do if you were in such a situation? let people die?" (National levelinformant).
" In circumstances where a seriously sick patient come to a dispensary, the only health worker who is present at that facility at that time cannot just let the patient die. He or she must do something even if there is no doctor to attend him. This is really challenging, especially in relation to the quality of services expected by clients and that which is predetermined by national policies and guidelines" (National level informant).
While almost all informants at the district and national level were seriously worried about the potential negative effect on quality of services as a result of implementing task shifting, few others were concerned about the limits for which workers are supposed operate. That is which tasks can be delegated and be implemented effectively.
Further to the above contentions, bold recommendations were consistently provided by our informants pointing to policy makers and planners to make sufficient preparations before considering to up-scale task shifting.
"No I do not think that we should rush to scale up task shifting before working on establishing a strong foundation for its implementation. I personally think that this is a short term remedy. Long term and sustainable strategies should consider expanding training capacity of our training institutions and ensure that only the skilled staffs come into service. Lower level cadres will also need to gradually upgrade their professional skills through the implementation of effective carrier advancement programmes and policies which support continuing education and on-the-job training" (National level informant).
'If we are not careful, task shifting will relax our efforts to design effective interventions that are needed to offer long-lasting solution to the current health personnel crisis (District level informant).
Almost all informants at the national level and majority at the district level conceded that the historical context of Tanzania provides an opportunity that task shifting is feasible. In this regard, they directly made reference to the experience of using AMOs to perform tasks which would otherwise be performed by MOs. The following subsections describe other perceived opportunities and benefits of implementing task shifting in the context of health personnel crisis in Tanzania.
"It (task shifting) motivates and create challenging environment especially if high level tasks are delegated to lower level cadres. It creates excitement in the case of the job well done among those to whom tasks are delegated." (National level informant).
"It may de-motivate the cadre or health worker, from whom the tasks are shifted from, making them feeling useless or disregarded. Additionally, health workers may feel undermined upon receiving advice from a lower cadres, for instance a nurse advising a clinical officer on how to manage a certain clinical procedure-that will definitely annoy the latter" (National level informant).
Increased retention of health workers especially in remote areas was perceived by the majority of as one of the potential benefits to be accrued out of implementing task shifting strategy. Informants had a consistent perception that it is easier to maintain a lower cadre health worker who is already working in the remote health facility than deploying qualified personnel from somewhere else, particularly in urban areas. This was perceived to be true both from the point of view related to recruitment costs and the fact that the existing health workers (lower cadre) are already used and immersed in the life conditions of remote areas.
"Skills of lower cadre health workers and especially community health workers are hardly portable both nationally and internationally. Lower cadre health workers can also be easily and cheaply recruited from within areas where they live and where they are supposed to be working. It is thus easy to retain these workers as they are already used to the living conditions of their localities" (District level informant).
Increased coverage and access to health services was perceived by majority of informants both at the national and district level as one of the potential benefits of implementing task shifting in a resource constrained settings like Tanzania.
"Consider a situation of a typical remote dispensary where you only have one medical attendant doing everything- medical examination, drug prescription to managing injections and drug dispensing! His absence implies that even small procedures such as managing simple interventions would not have happened and many people would have been denied access to services, notwithstanding considerations of quality. I must assure you that, in most of remote villages, services such as family planning are managed by lower cadre health workers such as medical attendants and community health workers" (District level informant).
Almost all Informants at district and national levels indicated that in most cases, tasks are delegated without any special or additional training to those who are supposed to implement them. However, there are sporadic trainings given to some health workers especially by disease-specific programmes such as those addressing HIV/AIDS, Malaria and Tuberculosis. These types of trainings only happen when these programmes have some skills they want to impart to health workers to perform specific tasks, for example general HIV/AIDS counselling training given to nurses. In most cases, delegation of tasks is done based on health workers' experience in the absence of clear policy guidelines. In terms of supervision, it was learnt that implementing task shifting may not only be costly but also time consuming.
This study is one of few attempts in Tanzania describing the current situation of task shifting in the health sector. It has especially focused on task shifting's inevitability due to serious shortages of health workers in remote and mostly underserved areas. It has highlighted some of the potential opportunities offered by task shifting in terms of improving coverage of health services and rural retention of health workers. It also brought forward the discussion on possible challenges that may come with implementation of task shifting in relation to quality of health care, management of human resources policies as they relate to training and development, the need for additional incentives, motivation and staff promotion. Hereunder, are sub-sections discussing the main findings and methodological limitations.
This study has provided confirmation of two types of task shifting namely; 'horizontal' and 'vertical' task shifting as coined and interpreted by different authors [3, 5, 13]. Comparably, vertical task shifting has been perceived by majority of our informants as easier to be implemented in the Tanzanian context than horizontal task shifting. The main reason for this perception is that it is easier to train a cadre of health workers who belong to the same 'family' of professional practice, for example physician-clinicians. Meaning that, it is easier to delegate task from higher level physician-clinicians to lower level physician-clinician than to delegate the same tasks to non-physician clinicians. The logic of this perception lies in the level of effort and resources needed to train and supervise those to whom new tasks and responsibilities have been delegated. The fact that delegating tasks and responsibilities of specialists to non-specialists requires additional training and supervision has been acknowledged by previous reports [3, 5, 13]. However, there is virually no published scientific evidence on the costs and cost- effectiveness of task shifting implementation in resource limited settings such as Tanzania. Future studies should thus focus on addressing this evidence gap.
This study has demonstrated that task shifting has a potential for increasing coverage and access to health services especially in rural and remote areas which faces a disproportionally huge shortages of health workers. Similar findings have been documented elsewhere [5, 14]. In the context of offering caesarean section services, Friedman had argued that task shifting to less trained health workers can contribute to substantial increase in access to services and reduction of maternal mortality . In Tanzania and especially in the delivery of simple health care interventions, many health workers with lower skills have been performing tasks way out of their professional training and job descriptions .Community drug distributors have been recommended and successfully been used in different health care settings to manage simple health service interventions [3, 5, 14]. Similarly, the use non-physician clinicians in Malawi had significantly contributed to the successful roll-out of the Malawian national ART plan [16, 17]. From the above discussions, it is noteworthy that task shifting seems to be feasible and effective only in the delivery of 'simple' health interventions which logically require less additional training and efforts needed for additional supervision.
Retention of health workers in remote and underserved areas is a critical policy issue for Tanzania as it is for many low and middle income countries. This study indicated that task shifting has the potential for improving the retention of health workers in remote areas where the needs for health care services are higher than the available health personnel. With some optimism, respondents emphasised that in order to exploit task shifting as a positive incentive for rural retention of health workers, its implementation should be accompanied or rather reinforced by additional incentives and effective supportive supervision. If the above mentioned prerequisites can be realised (given the fact that many countries are resource-constrained) it is then likely that remote-specific cadres of health workers can be established and retained in remote areas. Note that, the qualifications of the said remote-specific cadres are not easily portable and thus it is somewhat difficult for them to opt out for rural–urban or international migration. A report by Zachariah et al. had highlighted similar observations by arguing further that, task shifting can be expected to support the retention of existing health workers by reducing burnout and increasing morale through more efficient team management of patient case-loads . A follow up study of a task shifting programme conducted in Mozambique by Pereira et al. had found that after 7 years of engaging non-physician clinicians in the provision of obstetric care, about 90% of non-physicians were still working in the district while almost all of the medical doctors available had left . Our findings and observations from the literature might have two policy implications. Firstly, in order to have an effective task shifting programme, policy makers should consider paying health workers decent salaries which constitute living wages and which are commensurate with their responsibilities. This payment which should be linked to expanded responsibilities must also be associated with healthy working environments which may include additional incentives such as provision of a reasonably decent housing, provision of opportunities for educational and professional development and sustained supportive supervision programmes. Secondly and most importantly, is the consideration by all stakeholders that planning for effective task shifting strategy which is expected to lead to improved retention of health workers should be comprehensive and multi-sectoral. Task shifting as an innovation to improve retention of health workers is recommended to be comprehensive and multi-sectoral because oftentimes, ineffective retention strategies characterising many health systems in low and middle income countries are not due to malfunctioning of the ministries or departments of health alone, many stakeholders out of the health sector have important stakes too in the affairs of health sector [3, 19, 20].
Findings from this study demonstrate that relinquishing tasks which involve complex procedures to completely unskilled or lower cadre personnel may be counterproductive not only to the patients' general health conditions but also may threaten their lives. Our informants recommended that, in order to ensure that implementation of task shifting does not compromise quality of health care services which is already very poor; there is a need to have clear and acceptable job descriptions which will guide on how to define task limits. Clear job descriptions alone are not enough to effectively delegate tasks from more skilled to less skilled health workers. They should be accompanied by adequate financial and non-financial incentives. Note that, financial and non-financial incentives can be used as a means for retaining and enhancing productivity of health workers with new or additional responsibilities [3, 5, 21]. However, the need for additional incentives as a prerequisite to effectively implement task shifting is quite an obvious challenge especially in a country experiencing serious crisis of shortage of economic and financial resources such as Tanzania.
Other findings from the literature had originally presented a more or less similar picture as presented by our study regarding the implications of implementing task shifting for quality of health services. Chu et al. have contended that shifting clinical responsibilities from higher to lower cadres raises ethical concerns of lowering standards of care .In the current study, this ethical concern featured very explicitly as most of our informants consistently associated the practice of task shifting with declining quality of services might. It has been recommended that, in order to ensure that task shifting deliver quality health care services, its implementation must be aligned with the broader health systems strengthening [8, 21, 22]. This is due to the fact that task shifting practice is indeed not a solution to a weak health system. Other long term and sustainable strategies should be implemented in line with task shifting [8, 21, 22]. That is, health systems must assure a number of functions such as clinical care, uninterrupted supply, training and supervision, improved remuneration to health workers are effectively implemented before considering to scale up task shifting [8, 21, 22].
Absence of regulatory frameworks to suit the demands of monitoring quality aspects associated with the implementation of task shifting practices was also mentioned by our informants as one of the possible reasons which may compromise quality of health care. This finding confirms what has already being reported [3, 5]. In Tanzania for example, there are known professional and ethical regulations which guide the practice of such cadres as MOs and nurses. Other cadres' professional and ethical conducts are regulated or managed by the existing rules and regulations of the establishment and those issued by the Ministry of Health and Social Welfare. This implies that, regulations (from professional organisations, mainly covering nurses and doctors) may not be meaningful or satisfactory for monitoring quality of a health services provided by other health workers who are outside the two cadres (doctors and nurses). This further means that, if there will be a reason to scale up task shifting given accumulated evidence on its feasibility and cost-effectiveness, then the existing professional and ethical regulations need to be intensively reviewed to give room for the new demands associated with the implementation of task shifting.
It has been shown that when properly managed, task shifting, and could act as an incentive for motivating health workers to exert more effort in delivering services to their clients. Results have indicated that if superior tasks are delegated to a lower skilled health worker, there is potential for increased motivation as those to whom tasks are delegated will feel a sense of pride and recognition. The literature is however a little bit vigilant on suggesting a direct and clear link between task delegation and increased motivation. In the context of task shifting, motivation is expected to happen only when the increased tasks are accompanied with additional incentives, supportive supervision and good working environment [3, 5, 6, 21, 23]. One randomised study has indicated that supportive supervision (not just that pertaining to task shifting) can increase health worker productivity at least in the short term. It has also been argued that, if properly done, supervision can act as a mechanism for providing professional development (for both supervisors and supervisees), improving health workers' job satisfaction and ultimately increasing motivation and thus, productivity [24, 25]. On the contrary, task delegation may at times be a de-motivating factor. Our informants have indicated that additional supervisory roles to the fewer skilled and experienced health workers available may act as a disincentive if there are no supportive working environments. The literature suggest that too often, supervisors lack useful skills, working tools and transportation; and are usually overburdened by a number of administrative duties [26, 27]. Thus, it is unnatural to expect that health worker motivation and productivity will increase only because tasks are decentralised. Good working environment is an equally important input for increasing performance, with or without task shifting.
This study was purely qualitative and exploratory in nature and thus unable to provide conclusive policy recommendations. However, the study has provided a strong research foundation whereby appropriate research questions can be formulated and followed up by using well designed experimental studies to verify some of the important findings reported in this and other studies. For example, in the context of differing levels of financial resources between HIV/AIDS care and overall health care delivery system, quality aspects can be assessed using the same cadres of health workers (for example nurses performing tasks which would otherwise be performed by clinicians) by comparing them when they operate in the HIV/AIDS specific care and when they are offering other health services. Findings from such studies might increase analysts' confidence in their conclusions as regards to whether task shifting compromises or improves quality of health care services. Thus, this somewhat lustrous task-shifting's picture seen in the HIV/AIDS care should be re-examined so as to see whether the same picture can be painted in the delivery of other non-HIV/AIDS services.
As a first step, future research should focus on gathering and synthesising enough evidence in order to ascertain the optimal ways of task shifting implementation and provide a framework for monitoring and evaluation its effectiveness, its impact on quality and costs. In addition, future research should focus on quantifying the extent to which task shifting is practiced in health care systems by analysing the gaps between what is prescribed in health workers' job descriptions and what they actually do.
The second step should require health managers and policy analysts to not only determine whether task shifting is cost effective, but also define the limits of task shifting and determine where it can have the strongest and most sustainable impact in the delivery of quality health services.
Finally, health managers should mobilise important stakeholders and resources and engage them in broader, evidence-based- discussions on pertinent issues regarding the best ways to employ task shifting (albeit as a short term solution to the existing health personnel crisis) while at the same time ponder on the longer term and sustainable interventions needed to alleviate the health workers' crisis.
We would like to thank all our informants who offered their valuable time to share their wealth of knowledge and experiences. This work was carried out with support from Global Health Research Initiative (GHRI), a collaborative research funding partnership of the Canadian institutes of health research, the Canadian International Development Agency, Health Canada, the International Development Research Centre and the Public Health Agency of Canada. And also, the work was carried out with the aid of a grant from the International Development Research Centre, Ottawa Canada and with the financial support of the Government of Canada provided through the Canadian International Development Agency (CIDA). The views expressed in here are solely those of the authors. They do not represent anybody or institution (s) mentioned in the paper nor do they represent the position of institution for which authors are affiliated to.
Michael Aloyce Munga conceived the idea, prepared the proposal and submitted it for funding, participated in data collection and analysis and had the sole responsibility of preparing the first drafts of this paper. Other authors have equally participated in data collection, analysis and critically commented on the manuscript. All authors have read and agreed the manuscript to be submitted as it is.


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Parathelges piriformis is een pissebed uit de familie Bopyridae. De wetenschappelijke naam van de soort is voor het eerst geldig gepubliceerd in 1972 door Clements Robert Markham.

Bopyridae

redpajama_set_name: RedPajamaWikipedia


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One of the most important reference tools that companies use to establish and evaluate their internal controls is the Committee of Sponsoring Organizations' (COSO) Internal Control - Integrated Framework. Initially published in 1992 (the 1992 Framework), the COSO framework has been the most widely used model for internal control for the past 20 years.
2015 will be an exciting year for the payments industry, especially for merchants that now have a number of new payment technologies at their disposal. Emerging payment technologies such as Point-to-Point-Encryption (P2PE), Tokenization, EMV/Chip and Signature and Mobile Payment Acceptance are hitting the market globally and all of them can help reduce the risk of cardholder data compromise as well as potentially impact the compliance posture of merchants that choose to adopt them.
Several weeks ago I had the opportunity to speak on a panel at a healthcare conference. In attendance were CIOs, CISOs, VPs of IT, and members of legal counsel. The individuals attending the session represented organizations ranging from small- to medium-sized business associates all the way up to large, multi-networked hospitals defined as covered entities under the Health Insurance Portability and Accountability Act (HIPAA).


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U.S. Mayors, Governors and Business Leaders Commit to Climate Action through America's Pledge
Bloomberg PhilanthropiesPublished on Apr 22, 2018
Mayors, governors and business leaders from across the United States reaffirm their support for America's Pledge to meet the Paris Agreement on climate change, with or without leadership from Washington. https://www.americaspledgeonclimate.com/
Mike Bloomberg provides funding for UN Climate Change Secretariat
U.S. Mayors, Governors and Business Leaders Commit to
Climate Action through America's Pledge
Bloomberg Philanthropies Published on Apr 22, 2018
http://www.ecoethics.net/CSOLI/BHS-2018/Audio/20180422-Newshour-Bloomberg-paying-for-US-delegation.mp3
NEW YORK, NY – Today, Michael R. Bloomberg, the United Nations Secretary-General's Special Envoy for Climate Action, announced a contribution to support the operations of the UN Climate Change Secretariat, including its work to help countries implement their commitments under the 2015 Paris Agreement. The contribution realizes Bloomberg's promise from June 2017 to fill a significant funding gap that comes as a result of President Donald Trump's intention to withdraw from the Paris Agreement and proposed steep budget cuts for international programs, including those on climate.
Bloomberg's contribution of $4.5 million provides the UN Climate Change Secretariat with sixty percent of the anticipated U.S. government support this year. On March 23, the U.S. Congress passed an omnibus spending bill for fiscal year 2018, allocating $3 million to the UN agency, down from approximately $7.5 million provided annually in prior years. Bloomberg will make additional funds available to the UN Climate Change Secretariat should the U.S. government continue to fail to pay its share of the UN climate budget in 2019. Bloomberg Philanthropies' funding will strengthen the UN Climate Change Secretariat's capacity to support developing countries, carry out strategic outreach to promote climate action among stakeholders such as cities, regions, business and civil society, and address institutional needs in areas such as information technology and communications.
Following President Donald Trump's announced withdrawal from the Paris Agreement and proposed funding cuts for domestic and international climate programs, Mike Bloomberg launched the "We Are Still In" declaration and created America's Pledge on climate change with California Governor Jerry Brown in the summer of 2017. These efforts aim to demonstrate that the U.S. can meet its pledge under the Paris Agreement regardless of federal inaction, while spurring additional climate and clean energy commitments from U.S. cities, states, businesses and other "non-federal actors."
Michael R. Bloomberg, UN Secretary-General's Special Envoy for Climate Action, founder of Bloomberg LP and Bloomberg Philanthropies, and three-term mayor of New York City, said, "The U.S. pledged to work with the rest of the world to fight climate change under the Paris Agreement, and that includes providing our fair share of the funding to help countries reach their goals. Our foundation will uphold our promise to cover any cuts to UN climate funding by the Federal government – and the American people will uphold our end of the Paris Agreement, with or without Washington."
Patricia Espinosa, the Executive Secretary of the UN Climate Change Secretariat, said, "When countries adopted the historic Paris Agreement to limit global temperature rise, they also recognized that achieving that goal would take broad-based global climate action in all sectors, public and private. I welcome this generous contribution from Bloomberg Philanthropies as an important, practical recognition of our need to work together, and to step up our response to climate change."
Bloomberg also provided the majority of funding for the U.S. Climate Action pavilion in Bonn, Germany at COP23 when the federal government failed to provide the traditional exhibition space for American climate leadership. At COP 23, Bloomberg and Governor Brown launched the phase 1 America's Pledge report – a footprint analysis of GHG emissions in the United States – and formally submitted it to the UN in place of the federal NDC. They plan to release the phase 2 later this year and formally submit it, as well
From 2014 to 2016, Bloomberg Philanthropies supported the UN Climate Change Secretariat – the climate negotiating body of the UN – for its work with cities, states and businesses. Bloomberg Philanthropies' funding to the UN Climate Change Secretariat will cover costs associated with international climate negotiations formerly paid for by the U.S. government, including financing the participation of delegations from the world's least developed countries at COP 24, this year's climate conference to be held in Katowice, Poland.
To learn more about America's Pledge please visit www.americaspledge.com or watch this video.
Only the Super-Rich Can Save Us!: Ralph Nader
"In the cozy den of the large but modest house in Omaha where he has lived since he started on his first billion, Warren Buffett watched the horrors of Hurricane Katrina unfold on television in early September 2005. . . . On the fourth day, he beheld in disbelief the paralysis of local, state, and federal authorities unable to commence basic operations of rescue and sustenance, not just in New Orleans, but in towns and villages all along the Gulf Coast. . . He knew exactly what he had to do. . ."
So begins the vivid fictional account by political activist and bestselling author Ralph Nader that answers the question, "What if?" What if a cadre of superrich individuals tried to become a driving force in America to organize and institutionalize the interests of the citizens of this troubled nation? What if some of America's most powerful individuals decided it was time to fix our government and return the power to the people? What if they focused their power on unionizing Wal-Mart? What if a national political party were formed with the sole purpose of advancing clean elections? What if these seventeen superrich individuals decided to galvanize a movement for alternative forms of energy that will effectively clean up the environment? What if together they took on corporate goliaths and Congress to provide the necessities of life and advance the solutions so long left on the shelf by an avaricious oligarchy? What could happen?
This extraordinary story, written by the author who knows the most about citizen action, returns us to the literature of American social movements—to Edward Bellamy, to Upton Sinclair, to John Steinbeck, to Stephen Crane—reminding us in the process that changing the body politic of America starts with imagination.
How Clean Is Our Air? | On Point
https://dts.podtrac.com/redirect.mp3/traffic.megaphone.fm/BUR8493577470.mp3
With Meghna Chakrabarti
Two big reports on air pollution. One looks at the world and the other zeroes in on California. We'll look at the big takeaways, and more.
Ledge King, USA Today reporter covering the EPA. (@LedgeKing)
Daniel Greenbaum, President of the Health Effects Institute.
Janice Nolen, American Lung Association's Assistant Vice President of National Policy.
Mayor Robert Garcia, Mayor of Long Beach, California. (@RobertGarciaLB)
Highlights (lightly edited):
On the global picture of our air
Greenbaum: "When you look at what the levels of air pollution are in every country across the world and where the people are… you see that 95 percent of the population of the earth is living in places with air above those safe standards.
There's extensive evidence that air pollution can affect both respiratory health, it can exacerbate asthma, but of more concern is it can really exacerbate and cause premature death from things like stroke, heart attack, and even lung cancer."
On burning fuels indoors
Greenbaum: "There is improvement. What we see is that as countries improve their economic status, more and more of the households shift to cleaner and cleaner fuels. They might shift to LPG (Liquefied petroleum gas) eventually they might shift to electricity. So we are seeing an improvement, but it still means there is something like 800,000 people dying prematurely from indoor air in India."
"We do still have far too many people who live in areas that literally can shorten their life, where the air quality is a health risk and even a life risk."
Daniel Greenbaum
Colin Kaepernick Wins Amnesty's Ambassador of Conscience Award
And former San Francisco 49ers quarterback Colin Kaepernick has accepted Amnesty International's highest prize, the Ambassador of Conscience Award. In 2016, Kaepernick sparked a movement against racism and police brutality at sporting events across the U.S. by refusing to stand for the playing of the national anthem ahead of NFL games. This is Colin Kaepernick speaking Saturday night at an Amnesty awards ceremony in Amsterdam.
Colin Kaepernick: "It was James Baldwin who said, 'To be black in America and to be relatively conscious is to be in a rage almost all the time.' My question is: Why aren't all people? How can you stand for the national anthem of a nation that preaches and propagates freedom and justice for all, that is so unjust to so many of the people living there? How can you not be in a rage when you know that you are always at risk of death in the streets or enslavement in the prison system? How can you willingly be blind to the truth of systemic racialized injustice?"
Women Claim 5 of 6 Goldman Environmental Prizes for 2018
The winners of the 2018 prestigious Goldman Environmental Prize have been announced, with women claiming five of the six prizes. Among this year's winners are anti-nuclear activists Liz McDaid and Makoma Lekalakala, who led a successful campaign against South Africa's bid to purchase as many as 10 nuclear power plants from Russia. In Latin America, Francia Márquez wins a prize for her campaign against illegal mining in the Amazon, which led Colombia's government to crack down on cyanide and mercury pollution. And in the U.S., LeeAnne Walters wins a Goldman Prize for uncovering the crisis of toxic lead in Flint, Michigan's water supply, after she commissioned a test of her home's tap water and found it was so contaminated it qualified as hazardous waste.
HSBC Pledges to Roll Back Financing of Fossil Fuel Projects
In a major victory for environmentalists, banking giant HSBC said Friday it will no longer finance the development of tar sands oil extraction, most coal fired power plants, and oil and gas drilling in the Arctic. HSBC says its new policy, which will also end financing to hydroelectric and nuclear power projects that don't meet certain requirements, is targeted at helping keep greenhouse gas emissions below targets set in the landmark 2015 Paris climate accord. In a statement, the Sierra Club's Kelly Martin welcomed the policy, calling it "yet another signal to Donald Trump and the rest of the world that, despite their worst laid plans, the era of fossil fuels is coming to a close."

redpajama_set_name: RedPajamaCommonCrawl


I decided to pursue a career in medicine to better the lives of others. I have always loved to work with children and chose a career as a pediatrician. I was particularly intrigued by the unmet needs in treating pediatric headaches, as well as developmental disabilities, attention deficit hyperactivity disorder (ADHD), learning disabilities, and autism spectrum disorders, and ultimately I specialized in child neurology.
I care for children with a variety of conditions, including ADHD, tics, Tourette disorder, learning disabilities, and autism spectrum disorder. I am experienced in all types of pediatric headaches, including migraine, tension and chronic headaches. I also treat patients with concussions and post-traumatic headaches, as well as seizures and epilepsy. I am a strong advocate for children who may require special education services to address developmental delays, attention disorders, and learning disabilities.
Our pediatric neurology practice utilizes the most sophisticated diagnostic and treatment technology available. Additionally, we have access to consultants for all specialties of pediatric medicine.
I treat every person and family with compassion and develop strong patient–doctor relationships. I take the time to listen to each patient's concerns and history to assure an accurate diagnosis. I am committed to educating patients to enable them to confidently make decisions about their healthcare.
My research has focused on ADHD and epilepsy medications. I am a member of the American Headache Society.


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Эухе́нио Александрино Гонсалес Дербес (; род. 2 сентября 1961) — мексиканский актёр, режиссёр, сценарист и продюсер.

Ранние годы
Эухенио Дербес родился в семье известной мексиканской актрисы Сильвии Дербес и писателя-публициста Эухенио Гонсалеса Саласа. В раннем детстве мальчик познакомился с творческой богемой, коротал часы за кулисами театров и на съёмочных площадках, а в 12 лет и сам засветился на телевидении — подростку дали роль второго плана в теленовелле. Затем последовал ряд незначительных работ на телевидении.

В школьные годы занимался танцами, музыкой и вокалом; всё это пригодилось ему в будущем: в 19 лет юноша окончательно определился с профессией и поступил на курсы актёрского мастерства, после окончания которых стал театральным актёром.

Карьера

Личная жизнь
Первой супругой Эухенио Дербеса стала коллега по цеху — актриса Виктория Руффо, сыгравшая главную роль в сериале «Просто Мария». Они поженились в 1992 году. Брак, в котором родился сын Хосе Эдуардо Дербес, распался, продержавшись менее пяти лет.

В 2012 году актёр сочетался браком с Алессандрой Роcальдо — моделью и актрисой, бывшей солисткой группы Sentidos Opuestos. Молодожёны сыграли пышную свадьбу, на которую было приглашено 700 гостей; трансляцию мероприятия можно было наблюдать в Интернете. В этом союзе появилась дочь Айтана. Семья живет в Лос-Анджелесе.

У актёра также есть два внебрачных, но признанных им наследника — сын Вадир и дочь Айслин. Хосе Эдуардо, Вадир и Айслин пошли по стопам отца и делают успехи в кино.

Дербес активно занимается благотворительностью. Эухенио следит за здоровьем, несколько лет назад влился в ряды вегетарианцев.

Избранная фильмография

Примечания

Ссылки

Киноактёры Мексики
Лауреаты премии Гильдии киноактёров США за лучший актёрский состав в игровом кино


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By trustee in International Public Notice Legal Notices Softening up the enemy January 11, 2020
Muslim Woman Seeks Election To Colorado House Of Representatives
Iman Jodeh (Democrat) is running for Colorado House of Representatives, District 41 in the 2020 election.
Jodehis the daughter of muslim Palestinian refugees. Her father, a faith leader and mother, a former Sunday school teacher for over 30 years.
According to reports, Jodeh operates the educational nonprofit Meet the Middle East and serves as the first female spokesperson for the Colorado Muslim Society and as the deputy policy adviser for the Interfaith Alliance of Colorado.
When asked why she is running for office, Jodeh replied:
It's time. There are 75,000 Muslims in Colorado, and that number is growing. Islam is slated to be the second largest religion in the United States by 2040. We have an obligation as Americans and Coloradans to get to know our neighbors. In this instance, we have an obligation to ensure equal representation. And I'm a person who can represent a large portion of this growing community.
READ MORE: CLICK HERE!
Softening Up The Enemy! Part 9: Corrupt the influential


An individual stage of the token parser.
This routine does the majority of Syslogd's work.
This class can parse grok pattern strings to create a parser that can assign parsed values to a syslog message object.
This class is used to construct a sequence of ParserStage objects that can parse ByteBuffer objects into tokens.
The state of the entire parse operation.
This class uses a RadixTree to store a tree of parser stages.
This parser reads a set of grok patterns that are stored in the grok-patterns.txt classpath resource and uses the patterns to construct a syslog message parser.
A parser that handles the new Syslog standard (as defined in RFC5424).
This class uses a single ParserStage sequence to parse an incoming ByteBuffer message.
This is a bean container that can be used as a SyslogdConfig service.
The received messages are converted into XML and sent to eventd.
A stricter variant of the CustomSyslogParser which parses Syslog-NG's default format.
The TimestampFormat class implements the code necessary to format and parse syslog timestamps, which come in the flavor of 'Sep 14 15:43:06'.
This enum contains all well-known syslog message fields.


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Game Reviews, Role-Playing GameLeave a comment
August 26, 2019 August 26, 2019 Sam Lilly
Final Fantasy is a role-playing game by Square Soft for the Nintendo Entertainment System. The basic plot is that the world's elements have been thrown into chaos. In order to restore peace to the land as the prophecy foretold, four Light Warriors carrying darkened orbs of the elements must come together and fight to restore the light in each orb. This is where you come in. Continue reading "Final Fantasy"
2D Shooter, Game ReviewsLeave a comment
Jetpac is an arcade-style shooter made by Ultimate Play the Game for the ZX Spectrum and the VIC-20. Ultimate Play the Game later became known as Rare, a company responsible for a number of hits. One of those hits was Donkey Kong 64 for the Nintendo 64. As an unlockable bonus minigame on DK64 you could play Jetpac. This is the version I've played and will be the basis for this little review. Continue reading "Jetpac"
2D Platformer, Game ReviewsLeave a comment
Donkey Kong (NES & N64)
The arcade hit Donkey Kong famously had its first true appearance unaltered for home consoles on the Nintendo Switch, but there have been a number of ports attempting to replicate the experience between these two releases. Today I'd just like to talk about two of them. Continue reading "Donkey Kong (NES & N64)"
2D Platformer, Adventure, Game ReviewsLeave a comment
Shantae: Half-Genie Hero (Jammies Mode)
Jammies Mode is yet another DLC pack for Shantae: Half-Genie Hero. Unlike the other packs, this one was added as a free update along with a new bonus transformation dance available later in the main game which turns you into the tank from the new Blaster Master Zero game. Continue reading "Shantae: Half-Genie Hero (Jammies Mode)"


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FAME - the Federation of Australasian Mandolin Ensembles
About FAME
About FAME >
Mandolin Orchestras
FAME's Committee of Management
Meetings of FAME Inc
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Perth FAME Festival January 2023
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The Perth FAME Festival held from January 8th t0 15th, 2023
This will be held at St Catherine's College, 2 Park Rd, Crawley WA 6009. Information about the College is available HERE.
The conductor for the FAME Festival Orchestra was Werner Ruecker, currently conductor of the Sydney Mandolin Orchestra, and previously conductor of the Melbourne Mandolin Orchestra and the Warrnambool Symphony Orchestra.
Here are some more detailed notes on how the FAME Perth Mandolin and Guitar Festival 2023 went.
Having been left dormant for the last two years waiting for travel to once again become an option, the Perth FAME Festival program contained one new work (a World premiere) and one Australian premiere.
Werner Ruecker's new work "Covid Times" is an acknowledgement of the mood purveying the continent over the last few years.
Robert Schulz' "Symphonic Fantasy in E minor" , a truly ambitious title, was premiered in Japan in 2015, so its been sitting on the sidelines waiting for its Aussie premiere. It is scored for Mandolin Orchestra, timpani, percussion and flute. One long movement and depending on the tempo about 25 playing minutes.
Yasua Kuwahara's "Outside of Forest" is typical of his understanding of what mandolins can do. This composer is also renowned for his avant garde writings, but you will be pleased to know this is not one of them.
From the original guitar solo, we will be exploring the rhythms of South American composer Maximo Diego Pujol in a re-working of his 'Trez Piezas Rioplatenses', a three movement work with some exciting challenges but some beautiful melodic interest especially in the slow movement.
To compliment the above we will also be performing Valentin Roesser's "Sonata No 2", a well written baroque work in four movements.
The music for Festival registrants was made available for download from a Secure password protected Music Library in this website.
The rehearsal room was fully air-conditioned with space just outside for cases and bags.
One important new idea for our time together was to make all Orchestra rehearsals take place during the day. So by 4 PM we were able to sit back a bit and recover from the 4 hours of hard yakka. there was a midweek break for players to relax and see a bit of Perth on the Wednesday afternoon and evening.
As in years before the FAME Annual General Meeting took place on the Monday evening and we held a wonderful in-house concert on Friday evening with players performing in small groups or as soloists with comedy and some amazing playing!
Festival Concert
The Festival Concert was held at the Perth Modern School Auditorium. This was a venue for our end of week concert which was held on the Saturday afternoon from 3 PM and left the Saturday evening to wind back and relax. The following Sunday we all said our farewells and left to go home but we're all looking forward to the next FAME Festival in Brisbane from 3oth of June 2024!


The Twin Cities transit system changed dramatically between 2000 and 2010: service improvements included the launch of light-rail transit and a high-frequency bus network. "The changes were implemented in response to growing demand and to provide long-term, high-quality service, increasing accessibility and mobility in the growing region," says Jonathan Ehrlich, planning analyst with the Metropolitan Council.
The study, led by Humphrey School associate professor Yingling Fan, found that service expansions have yielded increased transit use. Within the area of the Twin Cities region served by transit, the researchers found that residents were significantly more likely to use transit in 2010 compared with 2000—either for a particular trip or at any point during the day.
Researchers came to this conclusion after analyzing the relationship between transit service and transit use at both the trip and person level. In both cases, they measured transit service in terms of accessibility to jobs within 30 minutes of travel time.
Researchers made additional important findings on personal characteristics and transit use. For example, they found a changing relationship between vehicle access and transit use. While access to a car did make an individual less likely to use transit for a trip in both 2000 and 2010, the effect was less pronounced in 2010—meaning transit is successfully attracting more choice riders.
This research is part of an extensive five-part report sponsored by the Metropolitan Council and the Minnesota Department of Transportation based on the rich set of data produced by the council's Travel Behavior Inventory household travel survey. David Levinson, RP Braun/CTS Chair in the Department of Civil, Environmental, and Geo- Engineering, is the project's principal investigator.
For more information, read the full article in the October issue of Catalyst or visit the research project page.


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Home › Sport › Football
De Bruyne ruled out of Manchester City's clash with Dinamo Zagreb
The Belgium playmaker has a groin injury.
Manchester City's Kevin De Bruyne, right, will not play against Dinamo Zagreb (Peter Byrne/PA)
By Andy Hampson, PA
Kevin De Bruyne has been ruled out of Manchester City's Champions League clash against Dinamo Zagreb on Tuesday with a groin injury, the club have announced.
https://www.belfasttelegraph.co.uk/sport/football/de-bruyne-ruled-out-of-manchester-citys-clash-with-dinamo-zagreb-38552636.html
https://www.belfasttelegraph.co.uk/sport/football/49d25/38552635.ece/AUTOCROP/h342/bpanews_e32cdc55-1b16-4ca1-83ab-21ec89019e90_1
The Belgium playmaker missed a training session on Monday, fuelling speculation he had suffered an injury before being substituted late in Saturday's Premier League game at Everton.
The club have not put a timeframe on how long the 28-year-old will be out of action but he is now doubtful for Sunday's clash with Wolves.
De Bruyne had been in fine form in the opening weeks of the season after an injury-ravaged 2018-19 campaign.
Guardiola said after the Dinamo game, which City won 2-0, that De Bruyne had not yet been ruled out for the weekend.
He said: "It's not serious but today he could not play. We'll see for Sunday. Right now I don't know, we are going to see. Maybe he can get fit and we can take a risk but (if not) I think after the international break he'll be fit."
By Ian Parkes, PA Leicester boss Brendan Rodgers believes his side proved they are not a one-man band after watching a crushing 4-1 victory over West Ham at the King Power Stadium.
By Simon Peach, PA Chief Football Writer Ole Gunnar Solskjaer admits Manchester United supporters had every right to feel "disillusioned" on a night when anti-Glazer chants provided the backdrop to an embarrassing home defeat to Burnley.
By Jonathan Veal, PA Tottenham will be hoping for good news on Harry Winks' ankle injury after boss Jose Mourinho said the midfielder would be out for "weeks not months".
Ole Gunnar Solskjaer concedes Manchester United fans have every right to feel...
By Simon Peach, PA Chief Football Writer Ole Gunnar Solskjaer believes Manchester United supporters had every right to feel "disillusioned" on a night when anti-Glazer chants provided the backdrop to an embarrassing home loss to Burnley.


From the DVD Lab: New, special edition 2-disc DVD releaseDARK DAYS hits the streets today!
Rolling Stone calls it "A film of staggering force" and Ebert &Roeper give it "Two Thumbs Up".
From the DVD Lab: New, special edition 2-disc DVD release DARK DAYS hits the streets today!
FROM THE DVD LAB:COMPASSION IN EMPTINESS!ON DVD TODAY!!
A 4 DVD Set of the Dalai Lama's teachings ofA Commentary on Bodhicittaby Nagarjuna andA Guide to the Bodhisattvas Way of Lifeby Shantidevaat Radio City Music Hall, NY 2010. All proceeds will benefit the Tibet Center. Featuring an amazing cover by the wonderful Shepard Fairey!
FROM THE DVD LAB: COMPASSION IN EMPTINESS! ON DVD TODAY!!
A 4 DVD Set of the Dalai Lama's teachings of A Commentary on Bodhicitta by Nagarjuna and A Guide to the Bodhisattva's Way of Life by Shantideva at Radio City Music Hall, NY 2010. All proceeds will benefit the Tibet Center. Featuring an amazing cover by the wonderful Shepard Fairey!
FROM THE DVD LAB: Samantha Morton's directorial debut, THE UNLOVED, streets on DVD today!Check out a clip from her interview here. Full interview and deleted scenes on the DVD!
FROM THE DVD LAB: Samantha Morton's directorial debut, THE UNLOVED, streets on DVD today! Check out a clip from her interview here. Full interview and deleted scenes on the DVD!
BANANAS!* streets on DVD today! Check out this excerpt with Director Fredrik Gertten from a sweet extra feature, part of our new series FROM THE LAB.


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Police: Ulster man killed father in response to sexual abuse
Nicholas Pascarella Jr. used a baseball bat to beat his father to death, state police testified Monday
Police: Ulster man killed father in response to sexual abuse Nicholas Pascarella Jr. used a baseball bat to beat his father to death, state police testified Monday Check out this story on poughkeepsiejournal.com: http://pojonews.co/1B0lgs7
John Ferro, Poughkeepsie Journal Published 5:58 p.m. ET Dec. 29, 2014 | Updated 3:21 p.m. ET Dec. 30, 2014
Nicholas Pascarella Sr., left, as seen in a photo posted to Facebook, was killed on Saturday. His son, right, as seen in a photo provided by State Police, was arrested and charged with second-degree murder and fourth-degree criminal possession of a weapon.(Photo: Left, photo from Facebook.com; Right, photo courtesy of State Police)
MARLBORO – The 39-year-old Clintondale man accused of murdering his father stated he did so because his father sexually abused other family members including himself, a state police investigator testified in Marlborough town court Monday.
During a preliminary hearing before Judge Michael Kraiza, state police Inv. Timothy Jordan testified he took those statements from Nicholas Pascarella Jr. shortly after Pascarella turned himself in to Marlborough town police on Saturday.
Pascarella is charged with second-degree murder in connection with the death of his father, Nicholas Pascarella Sr., 67, at his parents' home on Felicello Drive Saturday. He is also charged with fourth-degree criminal possession of a weapon.
Under questioning from Michael Kavanagh of the Ulster County District Attorney's Office, Jordan, the state police investigator, gave the following testimony:
"I am here to kill you. I am going to kill you with this bat."
State police Inv. Timothy Jordan, recounting Nicholas Pascarella's Jr.'s statement
Jordan said he encountered Pascarella Jr. at the police station, where he allegedly had turned himself in.
Jordan said Pascarella Jr. gave statements indicating he went to his parents' home with the intent to kill his father, that he waited outside the home for his father to emerge and then, using a baseball bat he had picked up outside the home, hit his father in the head several times.
Pascarella Jr. said he waited to make sure his father knew he was approaching, Jordan testified, and that his father asked him what he was doing at the house.
According to Jordan's account of Pascarella Jr.'s statements, the son said he told his father, "I am here to kill you. I am going to kill you with this bat."
Jordan said Pascarella Jr. said he estimated he hit his father five or six times, then took the bat with him and drove straight to the Marlborough police department.
Pascarella Jr. gave statements that his father had sexually abused his young grandson — Pascarella Jr.'s son — as well has Pascarella Jr.'s brother, who committed suicide approximately 11 years ago, Jordan said.
Pascarella Jr. said he had also been abused by his father, Jordan testified.
Under questioning from MariAnne Connolly of the Ulster County Public Defender's Office, Jordan testified that Pascarella Jr. stated he told his father, "I am here to kill you for what you did to me, my son and my brother."
Jordan testified that one of the first comments Pascarella Jr. made to Jordan was "Is he dead?"
Jordan said that upon learning that his father had died after being transported to MidHudson Regional Hospital in Poughkeepsie, Pascarella Jr. said, "Thank God."
Jordan also said that Pascarella Jr. said his mother witnessed the attack from the window of her home, and that she screamed.
"(Pascarella Jr.) articulated that it was good for her to watch," Jordan testified.
Pascarella Jr. wiped tears from his eyes as the state police investigator gave his testimony.
His wife, Michelle Pascarella, sat behind him during the proceeding. She declined to comment.
In other testimony, Marlborough police Officer Eric Masten said he arrived at the home on Felicello Drive shortly after noon on Saturday.
He said he found Pascarella Sr. lying in the driveway with severe head trauma. Masten said he assisted paramedics and escorted the ambulance to MidHudson Regional Hospital.
Kraiza ruled there was sufficient evidence to warrant a grand jury investigation and remanded Pascarella Jr. to Ulster County Jail without bail.
John Ferro: 845-437-4816; jferro@poughkeepsiejournal.com; Twitter: @PoJoEnviro
Read or Share this story: http://pojonews.co/1B0lgs7
Without permit, delayed for years, Sports Kingdome project at crossroads


John Oyegun Cry Out after APC Governors dump him for Buhari. Read more..
The All Progressives Congress (APC) National Chairman , John Oyegun, has revealed that the party has resolved the issues dividing it.
John Oyegun revealed this at the party headquarters in Abuja on Wednesday, after meeting with five state governors from the ruling party.
The Governors are Abdulaziz Yari of Zamfara, Simon Lalong of Plateau, Rochas Okorocha of Imo, Abdullahi Ganduje of Kano and Ibikunle Amosun of Ogun.
The governors were earlier with President Muhammadu Buhari, where they made known their decision of supporting the president against the extension of Oyegun's tenure .
"Today the governors, NWC decided to sit and look at the issues seemingly dividing us. All the issues you have been completely and totally resolved. We are back in business as one united and happy family.
"I want to say that NEC setup a technical committee. From the minute we called them into session they have worked non-stop with virtually no sleep," Oyegun said.
Oyegun also confirmed the national executive committee (NEC) meeting of the party will hold on Monday.
"NEC will hold on Monday. The chairman of the committee said his report will be ready by evening it will be placed at NEC for appropriate actions.
"The APC leadership is back as one united and focused party. Strongly behind the president and executives in the states," he added.
The PDP Group Led By Senator Sheriff is Preparing To Celebrate APC in Edo. Read details..


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I'm a Connecticut native. I was born and went to school (both St. Mary's grammar and high school) in New Haven. I graduated from the University of Connecticut and then went on for my masters in education at Central Ct.
My husband and I moved to Cheshire in 1978, and raised a family here. We were drawn to Cheshire by it's suburban yet somewhat rural flavor, and it's great school system. It turned out to be a great place to settle.
My favorite locals spot isn't a restaurant or a bar... it's a vegetable stand! I love stopping at any one of the farm stands throughout town and picking up local produce from one of our farms.
Fall... It's beautiful here when the leaves turn.
Just spend a day casually visiting and driving around the area. You will quickly see how pretty and pleasant the town is, and how easy it is to get to New Haven, Hartford, or even go in to New York on the train.
My family, my friends, my career, good weather, good health... when Uconn wins both NCAA basketball championships in the same year... lots of things.
I spent my childhood wandering around the neighborhood on the Yale Campus up at the Divinity School and the Botanical Gardens, where we lived. We had much more unstructured time than kids do today, and I spent my after school time climbing trees, playing ball, hide and seek, kick the can, etc, with friends. Growing up in New Haven in the late 50's and 60's was an adventure. Just think about history for a moment and you can get the picture.
All of my photos and memorabilia from family and friends.
My first career was as a classroom teacher. I left education to become a realtor, and I have been a realtor with Calcagni since 1989.