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Volume 10, Issue 3 – June 2017
Clinician Connect
ACI Board Chair Comment
Chief Executive Comment
ACI Update
Aged Health Network Update
Burn Injury Network Update
Centre for Healthcare Redesign Update
HARC Scholarship
Intensive Care NSW Update
Intellectual Disability Network Update
Institute of Trauma and Injury Management Update
Ophthalmology Network Update
Pain Management Network update
PEXS2017
Primary and Chronic Care Team Update
Sax Institute
Transition Care Network Update
Deputy Secretary, Strategy and Resources
In the delivery of a patient centred healthcare system, it is important to focus on what matters to patients. As clinicians we are quick to ask 'What is the matter?' but in seeking to determine the best course of treatment for the patient, we can be slow to ask 'What matters to you?'. By understanding what matters to patients we can start to develop a shared understanding and commitment to a treatment plan.
Health care is changing and so are the needs and expectations of communities, patients and carers. Increased demand, an ageing population and the higher prevalence of chronic disease provide challenges for the planning, delivery and evaluation of health services. The key focus of the NSW health system is to provide health services which are patient focussed, evidence based, safe and of high quality, effective and efficient.
Value in health care is a comprehensive approach that includes the Institute of Healthcare Improvement (IHI) triple aim1 of; improving the health of the public (health outcomes), providing efficient and effective care and improving the experience of care relative to cost. In this context, health outcomes are the results that matter most to patients2 .
NSW Health is refocusing the health system to focus on the delivery of value based care. To achieve this, NSW Health has initiated the Leading Better Value Care (LBVC) program. This program has created shared priorities for initiatives identified for implementation across the NSW health system. This involves clinicians, pillars, local health districts, specialty networks and the NSW Ministry of Health working together to improve the health of the public, improve the patient's experience and to provide efficient and effective care.
Leading Better Value Care supports the concept of shared system priorities and forms part of NSW Health's strategic initiatives.
The LBVC program is being conducted in tranches to optimise the benefits of a strategic approach, alongside learning and the flexibility of incorporating new and innovative initiatives.
The key goals of the program are:
Focussing on patients through adopting a patient experience and health outcomes approach
Focussing on value across the triple aim to support moving away from volume
Addressing future demand and fiscal pressures by creating future system capacity through efficient and effective care and services
From 1 July 2017, with implementation to be completed by 30 June 2018, Leading Better Value Care initiatives will impact clinical teams across NSW who are caring for people:
with osteoarthritis
at risk of osteoporotic refracture
with chronic heart failure (CHF)
with chronic obstructive pulmonary disease (COPD)
at risk of diabetes related foot complications
at high risk of falls in hospital
with end stage renal disease.
All of NSW shared services and pillar agencies are part of the support network for the implementation of the Leading Better Value Care initiatives.
You might well ask why is this program necessary. NSW Health must act now to capitalise on current opportunities:
Accelerate implementation of key strategies which have demonstrated benefits for patients and the system.
Establish shared priorities across the system (LHDs, Pillars, Clinicians, MoH).
Focus on getting the clinical processes right – resulting in efficient care, enhanced capacity and avoided costs.
Understand variation and address any unwarranted clinical variation.
Consolidate projects to improve patient experience and reported outcomes and to enable more effective and efficient healthcare.
Reframe the NSW Health system as a world leading, sustainable, patient centred health system.
There are considerable challenges in implementing a program such as Leading Better Value care. Such a long term program requires strategic vision, commitment to and investment in, analytics that support informed decision making. As well, appropriate drivers such as purchasing, evaluating, monitoring, and incentivising quality need to be aligned. Considerable work is underway to streamline the process of collection, analysis and reporting by leveraging existing infrastructure and capability.
In many cases though, changes in the longer term are also required in care settings outside NSW Health. Our relationships with Primary Health Networks will be critical to the work of providing better value healthcare.
Leading Better Value Care initiatives are designed and led by clinicians, working in collaboration with statewide clinical networks providing significant clinical engagement, and in conjunction with the Agency for Clinical Innovation and the Clinical Excellence Commission.
For more information please check website www.eih.health.nsw.gov.au/bvh
Osteoarthritis Chronic Care Program
Osteoporosis Refracture Prevention
Robyn Speerin
Network Manager, ACI Musculoskeletal Network
robyn.speerin@health.nsw.gov.au
Diabetes High Risk Foot Services
Marina Davis
Diabetes Lead, ACI
marina.davis@health.nsw.gov.au
Michelle Frawley
UCV Program Lead, ACI
michelle.frawley@health.nsw.gov.au
Olivia Hibbitt
olivia.hibbitt@health.nsw.gov.au
Renal Supportive Care
Kate Lloyd
A/Director, Acute Care, ACI
Kate.lloyd@health.nsw.gov.au
Falls in Hospital
Lorraine Lovitt
Lead NSW Falls Prevention Program, CEC
lorraine.lovitt@health.nsw.gov.au
Institute for Healthcare Improvement
ICHOM 2016
by Prof. Brian McCaughan Chair, ACI Board
It is appropriate at this time of change that we recognise the tremendous volume of work initiated, co-ordinated and implemented by the various Clinical Networks, Taskforces and Institutes which are the core of what is the ACI. Great credit to all our staff who have maintained the momentum initiated by Nigel Lyons and sustained so capably by Donald MacLellan over the last nine months in his role as the acting Chief Executive. The Board and I personally have appreciated the role Donald has played in extending the twilight of his very successful career in surgery and management.
We now look forward to a new era in ACI as we focus on Elizabeth Koff's vision of 'Value, not Volume' in her role as Secretary of the Ministry of NSW Health. As many of you are aware we have been recruiting staff for the Leading Better Value Care program.
We welcome our new Chief Executive, Dr Jean-Frédéric Levesque, to harness the ACI's enthusiasm for better care for all our patients and carers in New South Wales. Jean-Frédéric is known to many of us in ACI and he has worked extremely closely with many of the Clinical Networks and the Unwarranted Clinical Variation Taskforce in his role as CE of the Bureau of Health Information (BHI). Jean-Frédéric's medical training in Canada and subsequent role in addressing health system issues both in Canada and Australia position him ideally for leading the ACI into its next phase.
Over the next two years we will continue the increasing collaboration with CEC and both Carrie Marr and Jean-Frédéric will be instrumental in this phase as we head towards co-location on the new St Leonard's site later this decade. There are some roles and functions of CEC and ACI that are quite unique to each of those organisations but we share so much in common in terms of patient care that our work must continue in a mutually strong and collaborative fashion.
With the appointment of Jean-Frédéric, we also look forward to filling the senior vacant positions and bringing even greater stability to the workforce at ACI. I would like to thank all of those people who have stood up and accepted acting roles whilst we have had vacancies, as well as staff seconded to the Ministry.
Critical to the success of ACI has always been the clinical involvement in all our processes and this is certainly a point that is to continue unabated. I am delighted as part of that process to be able to announce that Dr Sarah Dalton, our Clinical Lead at the ACI, will be increasing her commitment to the organisation and moving to a 0.8 position once her secondment at the Ministry is complete.
It is certainly an exciting time ahead and I look forward to discussing any these issues with all of you at the ACI.
by Prof. Donald MacLellan Outgoing A/Chief Executive, ACI
After four years as the ACI Director of Surgery, Anaesthesia and Critical Care (SACC) and then the last eight months as Acting Chief Executive (a wee surprise), the time has come for me to finally bask in the pleasures of retirement!
It has been a great privilege to have worked in this unique organisation. The ACI is an indisputable leader in healthcare improvements and benefits from the extraordinary commitment of large teams of clinicians and managers who freely give their time to improve patient care. ACI continues to embrace change as it now enters a new and exciting phase with major programs, including Better Value Patient Care and Patient Recorded Outcomes Measures, and led by a new Chief Executive.
I wish to thank my colleagues in SACC for their support and congratulate them for their tremendous achievements over the last four years. I have appreciated the support and advice of Professor Brian McCaughan during my time at the ACI, and in particular over the last eight months in his role as Board Chairman. Finally, thank you to all ACI staff who I have had the pleasure to work with and I wish them well in their continuous endeavours to improve patient care across NSW.
Best of luck to Dr Jean-Frédéric Levesque as he steps in to this role, I will continue watch with interest as the ACI continues to deliver innovation to the system.
by Dr Jean-Frédéric Levesque Incoming A/Chief Executive, ACI
Dr Jean-Frédéric Levesque
Acting Chief Executive, ACI
JeanFrederic.Levesque@health.nsw.gov.au
Change is opportunity. Change is challenging. In the healthcare sector, change is also constant, sometimes planned through explicit policies and programs, sometimes emergent through innovations led by clinicians and local champions. The NSW Agency for Clinical Innovation (ACI), through its various programs proactively seeking to spur change, and through its expertise responding to requests to support innovations, has a crucial role to play in the improvement of healthcare.
It is with great excitement that I start acting in the role of Chief Executive of the ACI. The mandate is clear: build on the foundations of the organisation to ensure the continuation of activities that make change feasible in clinical settings and improve alignment of our efforts to ensure that system priorities are better addressed. The end goal: the population of NSW receives better access, better care, and better outcomes.
From a personal perspective, I arrive with great enthusiasm and a desire to bring evidence-based innovation to the core of the organisation's activities through the clinical networks, taskforces and institutes. To support the advancement of a learning healthcare system, the ACI has to model change and be a learning organisation. This means that clinical information will be both a material we will work with to support local change, as much as it will be an input to our work to identify where we are needed. It also means that the evidence we will provide to the system to support the implementation of policies and redesign programs, as well as the emerging innovations, has to come both from what is recognised as best practice and leading ways to organise care, as well as from what we measure empirically about how care is actually provided. I will strive to promote a culture of measurement and evaluation as a key component to our work.
From an organisational perspective, the ACI is at a crossroads. The scope of work of the organisation has expanded in recent years and a variety of programs have been implemented. Clinical networks, taskforces and institutes are active and facilitate discussions around clinical improvements. I feel privileged to have the opportunity to lead the organisation at a time when so much has been established and the potential for innovation is so great. This great juxtaposition of expertise, ranging from change management, organisational design, implementation science, and clinical leadership, represents an amazing opportunity to integrate our activities around poles of innovation, to create bridges and foster a team approach to ensure the integration of our work and enhanced synergies between our change management expertise and our clinical leadership.
From a system perspective, the expertise of the ACI is key to achieving the goals and aims of the healthcare system in NSW and instrumental to the success of many priorities and policies. Working in synergy with the Ministry of Health, local health districts, and other pillars will be key to our work. Finding a balance between investing in programs aimed at supporting innovation across the entire healthcare system and aligning our organisational priorities with broader system priorities - to make a difference on those difficult problems that require a concerted effort - will be required. I will work with our executive leadership team and our clinical leads to ensure that we find the right equilibrium between supporting both planned policies and emergent change.
According to some definitions, agency is the capacity of an organisation to act in a specific environment, clinical relates to the diagnosis, treatment and care of patients, innovation is the process of introducing new ideas, procedures, or methods. I invite you to work with me and the leadership team and clinical leads to work towards the mission that is embedded in our name - acting to introduce new ways to organise care to produce better outcomes for patients in NSW. You have my entire commitment.
The ACI held a forum for all ACI staff on 25th of May. The theme was 'Our story', which embodies a number of concepts; it recognises that the ACI is made up of a large number of individuals, each with their own story. It also reflects ACI's story as an organisation, acknowledging where we have come from and where we are going. Finally, it introduces the concept of storytelling to assist us to learn and share ideas, and translate complex data and information using creative ways to drive change.
Ian and Anna from Limelight Creative Media provided an overview of the considerations needed when communicating complex information to drive change, particularly via visual mediums such as film.
Updates were given on a number of previous key priority pieces for the ACI, including cultural competency, the ACI - LHD operating model, and the NSW Government 2016 People Matters Survey results.
A fantastic keynote session was also provided by Annabel Crabb. Annabel is a writer, and broadcaster with the ABC. She is a regular guest on ABC News 24's 6pm current affairs show The Drum, and on ABC TV's Sunday morning politics programme Insiders. Annabel also hosts her own ABC1 political cooking show, Kitchen Cabinet, in which she invites herself around to the homes of federal MPs in search of food and conversation. Annabel wowed the crowd with her entertaining and informative session on finding and shaping the story.
View image slideshow
Values and Behaviour Award
Congratulations to Rhiannon Beck, Primary and Chronic Care Project Officer, who was presented with the ACI Award for Values and Behaviours at the recent ACI Staff Forum.
Promoting and recognising our shared values though the workplace is important in continuing to create a positive and supportive working environment. The ACI Values and Behaviours Awards provide an opportunity to recognise staff who consistently demonstrate our shared values and behaviours.
Nominations for the award are open to all ACI staff. People working within the organisation are given the opportunity to highlight individuals in recognition of their achievements in the demonstration of the ACI values and behaviours charter each quarter.
Rhiannon was awarded the honour after being nominated for the third time, due to her outstanding and consistent collaboration, respect, professionalism, and achievements, in particular with the Navigating Healthcare Neighbourhoods project. Congratulations Rhiannon!
Aged Health Network Update Co-Chairs: Bill Thoo, Kelli Flowers
Aged Health Network
Kelli Flowers
Kelli.Flowers@health.nsw.gov.au
New Network Manager
Welcome to Kelli Flowers, who will be Acting as Manager of the ACI Aged Health Network while Glen Pang is on secondment to the Knowledge Manager role. Kelli comes from Liverpool Hospital where she is the Aged Care Clinical Nurse Consultant. She has been part of the Aged Health Executive for the past six years and is Co-Chair of the Nurses Subgroup.
Kelli brings a wealth of knowledge and experience to the role and will be a valuable driving force in continuing to meet the goals of the Network. Welcome Kelli.
Burn Injury Network update Co-Chairs: John Harvey, Diane Elfleet
Burn Injury Network Manager
Anne Darton
anne.darton@health.nsw.gov.au
Burn Injury Network
Taking the heat off burn prevention
The ACI Statewide Burn Injury Service (SBIS) continues to work on the preventing frequently occurring burns with the release of the revised Burn Injury Prevention and First Aid brochure and magnet.
Designed to help NSW families understand how to prevent and treat common burns that can occur around the home, the factsheet and magnet will be distributed free at events such as Bandaged Bear Day and the Pregnancy Baby & Child Expo. It is also distributed by Kidsafe NSW, as well as to GP offices, early childhood centres and community health centres across NSW.
SBIS Chair John Harvey emphasised the practical advice provided by the pack in helping to reduce the risk of burns around the home through simple, clear first aid advice.
"Around 87 per cent of the burn injuries we see result from avoidable accidents. By highlighting some of the common risks we hope to provide information to help people reduce the possibility of burns at home," he said.
"For example, many people don't realise that water from a standard household hot water system can reach up to 75°C. At that temperature you can sustain a serious burn in under one second. By installing a hot water temperature valve or mixer, you can greatly reduce the risk of getting burnt."
Tips to help prevent burns occurring in the home include.
Be careful when drinking hot drinks such as tea and coffee, or eating foods such as two minute noodles as these can easily fall into the lap causing painful burns.
Keep children away from objects such as irons, heaters, BBQs, oven doors and exhaust pipes and monitor their use when children are about.
Take care when removing food and liquids from the microwave after heating.
Keep an eye on small children around home fitness equipment – the rotating belts of treadmills and stationary bikes can cause serious friction burns.
Manager, Centre for Healthcare Redesign Update
Lea Kirkwood
Lea.Kirkwood@health.nsw.gov.au
Redesign Program Building Capability in LHDs
Twenty six participants from 11 Local Health Districts (LHDs) and Specialty Health Networks (SHNs) across NSW were awarded a Graduate Certificate in Clinical Redesign at the most recent NSW Agency for Clinical Innovation's (ACI) Centre for Healthcare Redesign (CHR) graduation ceremony in April.
Participants were recognised at the ceremony for their project to improve care in their Iocal health services.
Through the Redesign Program, the ACI is investing in the people working across NSW Health, building capability and capacity across the districts, and ensuring that the innovations being developed at the heart of our services are able to be effectively implemented.
The ACI Centre for Healthcare Redesign Graduate Certificate Program is an intensive 20 week course which provides the latest knowledge and training in project management, clinical redesign and change management to build the capability of healthcare staff in NSW. Graduates of the program are awarded an accredited Graduate Certificate in Clinical Redesign through a partnership with the University of Tasmania.
The CHR School supports local healthcare staff to identify, design and implement innovative improvements for patients and carers. Networking, shared learning and working collaboratively with patients, clinicians and management to improve healthcare are a strong focus of the course.
During the program, healthcare staff are supported with comprehensive training from the ACI CHR team, workplace mentoring by local healthcare redesign managers, and sponsorship from a local senior executive.
To date, the program has seen more than 650 improvement leaders developed across a range of metropolitan, rural and statewide health services from NSW and interstate.
For more information on the ACI Centre for Healthcare Graduate Certificate Program webpage
For information and posters from the initiatives in this graduation, visit the ACI Innovation Exchange.
HARC scholars focus on challenge of reducing clinical variation in healthcare
Five future healthcare leaders, including one ACI staff member, are set to embark on research in areas ranging from responding to the threat of antimicrobial resistance to tackling clinical variation in cancer care after being awarded 2017 HARC scholarships.
HARC (Hospital Alliance for Research Collaboration) is a collaboration between the ACI, Sax Institute, the Clinical Excellence Commission (CEC), the Cancer Institute NSW and the Bureau of Health Information (BHI). It aims to build the NSW health system's capacity to close evidence-practice gaps by fostering the use of research evidence in policies and programs.
The Collaboration's focus for 2016-17 is to better understand the role of clinical leadership in effecting change in the health system to address unwarranted clinical variation. The scholars were invited to apply to conduct projects either on this theme, or on closing evidence-practice gaps.
The 2017 HARC Scholars are:
TARA DIMOPOULOS-BICK, MANAGER OF PATIENT EXPERIENCE AND CONSUMER ENGAGEMENT AT ACI
Tara Dimopoulos-Bick is looking at what can be learnt from international evidence and experiences to improve the uptake of shared decision making within NSW health services.
She said Australia was behind other countries in using shared decision making processes and decision aids, and the project would help to connect ACI to experts in countries that had progressed further in the field, including the US, England, France, Germany, Netherlands and Canada.
AMY BISSON, PROJECT OFFICER, HEALTHCARE ASSOCIATED INFECTIONS AT THE CEC
HARC scholar Amy Bisson from the CEC will study multi-drug resistant organisms.
Amy is set to investigate ways of reducing unwarranted clinical variation and harm from multi-drug resistant organisms for NSW patients, with a particular focus on the emerging threat posed by carbapenemase-producing Enterobaceriaceae (CPE).
Having previously worked as a nurse, Amy said she was well aware of the frontline impact of the spread of multi-drug resistant bacteria. While Australia had not seen the same numbers of CPE infections as some other countries, it was recognised as a public health priority, with the first Australian hospital outbreak documented in 2012 and cases rising since.
"It is the last line of antibiotic treatment after other options have failed, and that is why it is so critical," she said. "Infections are often in very sick patients, and the mortality rate is very high."
Amy will use the scholarship to travel to Melbourne, Switzerland and the UK to study strategies that had been proven to bring about change in practice improvements, communication, education and quality improvement.
She said she hoped the information she gathered would help inform the CEC 's development of guidelines, outbreak plans and tools to reduce unwarranted clinical variation and patient harm when responding to multi-drug resistant organisms such as CPE.
TINA CHEN, MEDICAL AND SCIENTIFIC ADVISOR AT THE CANCER INSTITUTE NSW
Dr Tina Chen will use her scholarship to investigate how point-of-care, patient-reported outcome and experience measures can be used to achieve more effective, patient-centred care.
Dr Chen will look at what patient-reported data is most pertinent and how to best obtain that data at the point of care, as well as how to appropriately analyse such data to form pragmatic measures and linked clinical endpoints that will enable evaluation and comparisons of treatment effectiveness.
LILIAN DALY, LEAD RESEARCHER AT BHI
Lilian Daly will visit Canada and England to build her knowledge and skills in the development of patient safety measures to assess hospital performance.
She said she would investigate the relative merits of composite measures such as harm-free care and risk-adjusted measures that were focused on particular complications in specific patient groups – such as joint surgery – to help build internal BHI capacity.
RUYAMURO KWEDZA, MANAGER, QUALITY AND SYSTEM PERFORMANCE AT THE CANCER INSTITUTE NSW
Dr Ruyamuro Kwedza will use the HARC scholarship to investigate ways to strengthen approaches to collaboratively understanding and addressing clinical variation in cancer care across NSW.
In her application, Dr Kwedza said the process of moving from identifying variations in care – such as cancer care – to determining if variation is unwarranted and then to reducing undesirable variation remained a challenge for health systems. The project will enable her to visit international agencies with expertise in this area, as well as to conduct a literature review, to help inform future approaches for the Cancer Institute.
For more information on the 2017 HARC Scholarship Program, visit www.saxinstitute.org.au/news/introducing-the-2017-harc-scholars/.
IC NSW Manager
Kelly Cridland
kelly.cridland@health.nsw.gov.au
Intensive Care NSW
Launch of Intensive Care NSW
In May 2017, the ACI's Intensive Care Coordination and Monitoring Unit (ICCMU) and the Intensive Care Service Network (ICSN) relaunched as Intensive Care NSW (ICNSW) at the Critical Care at the Vineyards Conference.
This change has occurred as a result of evolved roles and functions for both ICCMU and the ICSN, with a merge established as the most effective way forward for the previously individual functions.
ICCMU was first established on a recommendation in the 2001 New South Wales (NSW) Intensive Care Plan. Its work was centred on knowledge management, quality and safety, data integration, and analysis. ICCMU achieved a significant amount in these areas, supporting clinicians in improving delivery of intensive care services on many fronts, including a significant contribution to quality and safety research.
In November 2016, representatives of the Intensive Care Service Network (ICSN), ICCMU and other key stakeholders attended an Intensive Care Planning Workshop to reassess the future purpose and function of the ICSN and ICCMU, and to determine how to best support clinicians working in the 45 public Intensive Care Units across NSW. This is an exciting time for the ACI, SACC and Intensive Care NSW in determining the new direction to support safe quality Intensive Care for the people of NSW.
As part of this process, the ACI website has been revised, including the new Intensive Care NSW logo and strategic direction. For more information on ICNSW, please don't hesitate to contact the Manager. More information on the roles and functions of ICNSW can be found onICNSW Website.
Intellectual Disability Network Update Co-Chairs: Maria Heaton, Jenny Martin and Less White
Intellectual Disability Network Manager
Tracey Szanto
tracey.szanto@health.nsw.gov.au
Building Capability in NSW Health services for People with Intellectual Disability: The Essentials Launch
The ACI Intellectual Disability Network will launch a resource and website which guides LHDs in the way they deliver health services for people with intellectual disability at an event on Thursday, 27 July 2017. The Essentials initiative includes a self-assessment checklist for LHDs to help identify areas of strength and need. The half day event will include showcasing LHD projects aligned with The Essentials to generate interest and possibilities for action from mainstream health services.
Please contact the Manager for more information.
Ryde Hospital developing pathways and partnerships
Leah Whitton – lead clinician in Hospitalisation project at Ryde Hospital.
Photographer: B Bonham
Ryde Hospital is working on two collaborative projects to improve health services for people with intellectual disability. These projects align with actions identified in The Essentials package.
Northern Region ADHC has partnered with Ryde hospital, the ACI, Lifestart and Sydney Children's Hospital Network (SCHN) to adapt the visuals and training resources Say Less Show More for adults.
Ryde Hospital is also leading another collaborative project with partners from NSW Ambulance, primary health networks (PHNs), non-government organisations (NGOs), Ageing, Disability and Home Care (ADHC), and the ACI on hospitalisation, in order to improve staff awareness, pathways, and prevent unnecessary presentations. Links to the project resources will link to The Essentials website alongside other practical tools like Daniel's story, guidance from clinicians and people with ID and A2D.
Christine Lassen
christine.lassen@health.nsw.gov.au
Trauma 2017 Research Workshop
The ACI Institute of Trauma and Injury Management (ITIM) team presented the The epidemiology and predictors of post-injury multiple organ failure in New South Wales study at the Research Workshop of the Trauma2017 Conference in Melbourne in April.
Post-injury multiple organ failure (MOF) is the primary cause of late trauma death and has a significant impact on resource utilisation after blunt multisystem trauma. Patients who develop MOF not only have a higher mortality rate among major trauma patients (25% versus 3%) admitted to the intensive care unit (ICU), but are at greater risk of poor long term functional outcomes. In addition, patients with MOF stay longer in the ICU and use more significant resources.
There is no specific treatment for MOF; prevention through timely care, control of bleeding, resuscitation, and organ support are the key elements of today's practice. In order to focus preventive efforts against this deadly and debilitating syndrome, it is essential to describe its epidemiology and identify the predictors.
photographer: Christine Lassen
This is the first time in Australia that MOF will be evaluated by a multi-centre prospective study.
This project is funded and supported by ITIM and will be undertaken at all major trauma services in NSW.
For more information on this or other research projects please visit the ITIM Research page.
Ophthalmology Network Update Co-Chairs: Michael Hennessy, Julie Heraghty and Andrew White
Sarah-Jane Waller
SarahJane.Waller@health.nsw.gov.au
Ophthalmology Network
Vision Defect in Stroke Tool
The Vision Defect in Stroke Tool has been endorsed by the State Forms Management Committee and is available for use in NSW public hospitals.
The vision screening tool was developed to be used by non‐eye care practitioners to assist in the identification of pre‐existing and recently acquired vision problems in patients who had had a stroke. The need for such a tool had been previously identified, with many patients failing to have eye conditions detected and therefore managed during the early stages of their recovery.
The tool, developed and tested by the ACI Orthoptic Standing Committee, was validated in a further study conducted in conjunction with the University of Technology and Northern Sydney Local Health District.
The tool comprises a mini questionnaire with a vision screening test designed to be conducted at the bedside. The questionnaire determines current and newly acquired ocular conditions in response to straightforward questions and guided observations by non‐eyecare practitioners.
An eLearning module to support the implementation of the tool is currently under development and is due for completion at the end of June. The training module will be hosted on the Health Education and Training Institute (HETI) professional development platform.
On behalf of the Ophthalmology Network Executive, a huge congratulations to the Orthoptic Standing Committee who championed the tools development, refinement and advocacy.
New Co-Chair
We are pleased to welcome Andrew White, Associate Clinical Professor and Head of Ophthalmology at Westmead hospital as the new Co-Chair of the ACI Ophthalmology Network. Andrew steps in to the role vacated by Ross Ferrier, who stood down in February 2017.
Andrew has a subspecialty interest is glaucoma and brings a wealth of international and local experience in Ophthalmology. He is also a member of the Association for Research in Vision and Ophthalmology (ARVO), sits on the Executive of the Australian Society of Ophthalmologists, and is a member of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) NSW State Branch Committee. He is an author of the Asia Pacific Glaucoma Society Guidelines on the management of glaucoma (to be published this year), as well as the lead author on the RANZCO endorsed Guidelines for collaborative management of glaucoma.
Andrew has been the chair of the NSW Community Eye Care project since its inception in 2015 and is the lead clinician in the implementation for the glaucoma and diabetic retinopathy arms of the project at Westmead.
Welcome Andrew.
Pain Management Network Update Co-Chairs: Sheree Smith, Jimmy Chien
Pain Management Network
Jenni Johnson
jenni.johnson@health.nsw.gov.au
Pain management program for CALD community
The NSW Pain Plan 2012-2016 has now been widely implemented across NSW. Service capacity has been significantly enhanced as a result, with waiting lists reduced to 63 days on average across the state.
It has become evident, particularly for some areas of NSW where culturally and linguistically diverse (CALD) populations are prevalent, that adaptation of existing materials and service models is necessary to breach cultural barriers around understanding and uptake of these services. Materials require translation and cultural adaptation in order to optimise learning of the self-management approaches known to be the most effective strategy in managing chronic pain
Pain management program and a complete toolkit have been developed, translated and adapted for the top four language groups identified; Chinese (traditional and simplified), Arabic, Vietnamese and Greek. Pain management education and self-management program for people with chronic pain from the four cultural backgrounds will be implemented through multicultural health services in the following Local Health Districts, commencing in mid-May 2017:
Sydney LHD
South Eastern Sydney LHD
South Western Sydney LHD
Western Sydney LHD
Illawarra Shoalhaven LHD
Hunter New England (HNE) LHD
The programme runs in the community once per week for six weeks. People with chronic pain will learn skills to manage their pain in a group setting with others from their cultural background.
For more information about the program and resources, visit the ACI Pain Management Network webpage or contact the Network Manager.
Patient Experience Symposium 2017
The 2017 Patient Experience Symposium was held on 2 – 3 May 2017 at the Sydney Masonic Centre, with the theme Communication and Connecting People.
The Symposium is organised by a network of NSW Health organisations, with the ACI and Clinical Excellence Commission (CEC) as lead co-sponsors.
The 2017 Symposium was extremely successful, with 596 people attending the event, including 91 identifying as consumers. Attendees mainly included managers, clinicians and consumers from NSW Health, however also included interstate colleagues, primary healthcare and international guests working in patient experience.
Keynote sessions by Jason A. Wolf, President, The Beryl Institute, USA, which organises the international Patient Experience Week, and Tim Blake, Engaged Patient and Carer, Managing Director, Semantic Consulting, were well received, as well as several consumer panel sessions across the two days.
The annual Patient Experience Symposium aims to bring people together to improve the experiences of care for people from NSW. The Symposium provided the opportunity for people to network, learn, and share their ideas, work and projects with each other, cooperatively building our knowledge of this evolving aspect of patient care.
Participants were encouraged to follow along through social media using the event hashtags #PExS2017. The conference program, presentations, and the plenary livestreamed sessions are now available on the event website.
Evaluation of the 2017 Symposium is underway, and planning has commenced for the 2018 event.
If you would like any further information please contact: Melissa Tinsley Melissa.tinsley@health.nsw.gov.au.
Manager, Primary and Chronic Care Team
Regina Osten
regina.osten@health.nsw.gov.au
Primary and Chronic Care Team
Drug and Alcohol, Mental Health and Primary Care: Working Towards Integration event
On Friday, 28 April 2017, the ACI Primary Care and Chronic Care team hosted a Drug and Alcohol, Mental Health and Primary Care: Working Towards Integration event.
Keynote speaker Kirsten Meisinger MD discussed the patient centred medical home model and how it has been used in the United States to integrate mental health and drug and alcohol services with general practice. Kirsten is the Medical Staff President and Primary Care Physician at Cambridge Health Alliance, Boston, USA.
Local speakers at the event included Hester Wilson, Charlotte Hespe and Sandra O'Brien.
Recordings of the event can be found on the Navigating the Healthcare Neighbourhood website on the videos page.
Photographer Rhiannon Beck
New approaches to suicide prevention are under the spotlight in the latest issue of Public Health Research & Practice (PHRP), which includes an article on a decision-support tool for policy makers and communities.
The Guest Editor for Issue 2 (2017) is Professor Ian Hickie, Co-Director, Health and Policy, at the Brain and Mind Centre in Sydney. Themed articles include an 'In practice' paper on how system dynamics modelling ‒ a "what if" tool to test the likely impact of different interventions ‒ has found that increasing general practitioner training could have the biggest impact on preventing suicides in Australia. A perspective article describes a 'systems' approach to suicide prevention, which is now being trialled in New South Wales, and another proposes new 'transdiagnostic' models of stepped care for mental health, arguing that the current stepped-care models of service delivery do not cater well for comorbidities or complexity in real-world clinical practice. In a consumer's perspective, National Mental Health Commissioner Jackie Crowe describes how Australia's mental health sector is nearing a tipping point for transformation.
Other articles discuss the development of an online alcohol-related health promotion animation aimed at Baby Boomers; and review the evidence available on disability income support design and mental illness.
A non-themed article in the issue questions whether tobacco and alcohol companies should be allowed to influence the Australian National Drug Strategy. Other non-themed articles include research into identifying adverse drug reactions in hospital ICD-coded data; and explore the challenges of integrating evidence into health policy and planning.
PHRP is Australia's first online-only open access peer-reviewed public health journal, published by the Sax Institute with a strong focus on the connection between research, policy and practice.
You can subscribe to receive quarterly e-alerts when the journal is published, make suggestions about themes or topics for future issues, submit papers and follow us on Twitter @phrpjournal.
Transition Care Network Update Susan Towns, Mae Rafraf
Manager, Transition Care Network
Lynne Brodie
lynne.brodie@health.nsw.gov.au
Transition Care Network
Youth Week commenced in 1989 as an initiative by the NSW government and is now celebrated across every state and territory as a mass recognition of younger people. ACI Transition Care Coordinators and Support Workers joined youth health teams at Royal Prince Alfred (RPA), Westmead, Children's Hospital Westmead, and John Hunter Hospitals to promote health related youth activities, including transition care.
ACI, Canteen and RPAH youth team sharing a stall to celebrate and promote youth week at RPAH.
Transition care support worker Amanda Loughmann joining in the inspiration art project as part of youth week at RPAH
Visit by Sandy Whitehouse
Members of the ACI Transition Network Executive were provided with a wonderful insight into transition care services in British Columbia, Canada when visiting doctor Sandy Whitehouse presented on Maintaining connections for youth as they transition from Pediatric to Adult Care at the Network's Executive Meeting on Monday, 8 May 2017.
Sandy is Founder, Medical Director, Clinical Associate Professor, Dept. of Paediatrics, University of British Columbia, Canada. The primary differences between BC and NSW relates to the systems to engage young people with primary care in BC. This engagement includes providing a medical home through community general practice, and their focus on supporting young people to become more health literate and engaged in their transition through resources such as TickIT and the TRAC toolkit, which help young people with their transition planning.
For more information visit website.
Inaugural Transition Graduation in the Hunter
The inaugural ceremony for young people graduating from John Hunter Children's Hospital to adult health services was held on Wednesday, 14 June 2017 at thee Hunter Medical Research Institute (HMRI). Congratulations and good luck to all of the young people involved.
For enquiries please contact ACI Transition Coordinator Angie Myles at Angela.Myles@hnehealth.nsw.gov.au
Sarah Cullen – Consumer Champion
Sarah and her mum Emilia on a beach in southern India in December last year
This year marks the 10th year that Sarah has been involved as a consumer representative with the ACI Transition Care Network. The occasion was marked late last year at the November Executive Meeting. Sarah also partners with the ACI Nutrition and Stroke Networks. She is well qualified to represent young people with a chronic condition / disability as during her adolescent years she survived two strokes. She has since completed a degree at Macquarie University and currently works at Mary Mackillop Outreach. Sarah was awarded the National Disability Award in 2008 for Services to Stroke NSW, launch of different strokes for young stroke survivors and their carers and her work with the ACI Transition Care Network. She has spoken at numerous forums and her ongoing involvement and support of the Network is greatly appreciated.
Burn Rehabilitation Management Course – 2 Days
BMT Master Class - July
Spinal Cord Injury Core Course
BMT Senior Nurses Forum
Brain Injury Rehabilitation Case Management Education Day
ACI Mental Health Innovation Showcase
Please visit our Events Calendar for program details and information on how to register.
Tweets by @nswaci


Short's Brewing Co. Pub in Bellaire is a fully functioning brewery. There is a gourmet deli in the pub as well, featuring an array of artisan sandwiches, wraps, soups, appetizers and pizzas. The Short's production facility is in Elk Rapids.


SAP C4C Assessment Test to validate C4C skills of candidate.
SAP C4C (Cloud for Customer) is used to deliver usable, extensible and productive designs for the customers which works on the detail part of customer requirement by providing various solutions through the SAP software.
SAP C4C test is been designed to assess the candidate in the area of advance functional and configuration support of SAP C4C, Cloud, CRM Modules, CRM Implementation, ERP Operations, ERP Consulting and Payroll Management, SAP C4C Development, etc.
Using powerful reporting, you will have detailed analysis of test results to help you make better decisions and predict candidate and employee success. The test enables employers and recruiters to identify potential hires by evaluating working skills and job readiness. For this reason, emphasis is laid upon evaluating the knowledge of applied skills gained through real work experience, rather than theoretical knowledge.
SAP C4C test may contain MCQ's (Multiple Choice Questions), MAQ's (Multiple Answer Questions), Fill in the Blanks, Descriptive, Whiteboard Questions, Audio/Video Questions, LogicBox (AI-based evaluation), Job-based Simulations, True or False Questions, etc.
Q 1. The Library allows you to store documents. You can track the history of the document, then the version is managed by which of the following?
You have to upload the certificate of the trusted Certification Authority (CA) that has also issued the employee's certificate.


CITY OF INDUSTRY, Calif., June 20, 2011 – Utility Trailer Manufacturing Company, the industry's largest manufacturer of refrigerated trailers and a leading manufacturer of dry freight vans, flatbeds, and Tautliner® curtainsided trailers is pleased to announce that it has received the largest single order for the 4000D-X Composite™ dry van from Ryder System, Inc.
Utility Trailer Manufacturing is America's oldest privately owned, family-operated trailer manufacturer. Founded in 1914, the company designs and manufactures dry freight vans, flatbeds, refrigerated vans, curtain-sided trailers, and side skirts. Utility currently operates five trailer manufacturing facilities across the United States. Utility's 3000R® and the 3000R® multi-temp refrigerated trailers are manufactured at the Marion, Virginia and Clearfield, Utah plants. The 4000D® and 4000D-X Composite™ dry vans are manufactured at the Glade Spring, Virginia and Paragould, Arkansas plants. The 4000A®, 4000S®, drop deck and double flatbeds as well as the Tautliner® are all manufactured at the Enterprise, Alabama facility. Utility also has an extensive independent dealer network with 105 locations throughout the United States, Canada, Mexico, and South America.
CEVA Logistics, one of the world's leading supply chain companies, designs and implements industry leading solutions for large and medium-size national and multinational companies. Approximately 50,000 employees are dedicated to delivering effective and robust supply chain solutions across a variety of sectors and CEVA applies its operational expertise to provide best-in-class services across its integrated network, with a presence in over 170 countries. For the year ending 31 December 2010, the Group reported revenues of €6.8 billion. For more information, please visit www.cevalogistics.com.
Ryder is a FORTUNE 500® commercial transportation, logistics and supply chain management solutions company. Ryder's stock (NYSE: R) is a component of the Dow Jones Transportation Average and the Standard & Poor's 500 Index. Inbound Logistics magazine has recognized Ryder as the top third party logistics provider and Security magazine has named Ryder one of the top companies for security practices in the transportation, logistics, supply chain, and warehousing sector. Ryder is a proud member of the American Red Cross Annual Disaster Giving Program, supporting national and local disaster preparedness and response efforts. For more information on Ryder System, Inc., visit www.ryder.com.
This news release may contain forward-looking statements. These statements include, but are not limited to, discussions regarding industry outlook, the Company's expectations regarding the performance of its business, its liquidity and capital resources, its guidance for 2011 and the other non-historical statements. These statements can be identified by the use of words such as "believes" "anticipates," "expects," "intends," "plans," "continues," "estimates," "predicts," "projects," "forecasts," and similar expressions. All forward-looking statements are based on management's current expectations and beliefs only as of the date of this press release and, in addition to the assumptions specifically mentioned in the above paragraphs, there are a number of factors that could cause actual results and developments to differ materially from those expressed or implied by these forward-looking statements, including the effect of local and national economic, credit and capital market conditions, a downturn in the industries in which we operate (including the automotive industry and the airfreight business), risks associated with the Company's global operations, fluctuations and increases in fuel prices, the Company's substantial indebtedness, restrictions contained in its debt agreements and risks that it will be unable to compete effectively. Further information concerning the Company and its business, including factors that potentially could materially affect the Company's financial results, is contained in the Company's annual and quarterly reports, available on the Company's website, which investors are strongly encouraged to review. Should one or more of these risks or uncertainties materialize or the consequences of such a development worsen, or should underlying assumptions prove incorrect, actual outcomes may vary materially from those forecasted or expected. CEVA disclaims any intention or obligation to update publicly or revise such statements, whether as a result of new information, future events or otherwise.


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2020 - 2021 Charity
Charity Selections
2018 Fashion Show
Getting about with Gadabouts
Officers 2021 - 2022
New Member Information Form
Bethlehem House
As a faith-based organization, Bethlehem House does not pursue state or federal funding. Because we desire to include God in all we do, we rely on the support of our community to sustain the mission. Funding comes from individuals, families, churches, organizations, grants, businesses, and community and faith groups. Additional funds are raised through events sponsored by Bethlehem House and fundraisers organized by community members. We have an unrestricted budget, meaning we can allocate money to where it is needed most.
On campus housing and structured support for adult women who are pregnant and lack safe housing options. Incorporating staff knowledge of nursing, social work, and mental health - there programs provide pathways for healthy pregnancies, compassion, parenting skills and early stages of self-sufficiency through job preparation and education.
Women range from 19 to 30 years of age and can stay 18 months.
In a loving, nurturing home, Bethlehem House presents a woman who is pregnant and homeless with the option of living at Bethlehem House throughout her pregnancy and up to 15 weeks after the birth of her child. Upon settling into her new environment, each expecting mom is challenged to create a new life plan for herself and her child. A life plan is as unique and individual as the woman creating it. Each woman works daily with family life director Gina Tomes and other staff to put her life plan into action by working toward educational goals; saving for a car; searching for affordable housing; engaging in parenting classes, financial planning, spiritual development and other classes; and additional activities that present opportunities to work toward self-sufficiency and community development. By following her life plan, a woman can fulfill her hopes and dreams and create a promising future with her child.
A check for $10,500 was presented to Bethlehem House from Metro Women's Club
Metro Women's Club
metrowomensclub.org

redpajama_set_name: RedPajamaCommonCrawl


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The Science Survey • May 25, 2018 • https://thesciencesurvey.com/news/2018/05/25/born-to-fight-the-march-for-babies/
Born to Fight: The March for Babies
Anthony Guan
Bronx Science Key Club members, along with members from other Key Clubs around the city, gather for a group photo after the walk.
Aaron Wu, Staff Reporter
Usually, it takes an infant around thirty-seven weeks to mature. However, in rare cases, birth happens much sooner than it should. As a result, premature babies are born, some suffering from debilitating conditions such as dysfunctional lungs, irregular body proportions, a poor ability to feed, slow weight gain, and difficulties in regulating body temperature. Premature births occur more often than one might think, and they are now ranked as one of the leading causes of death for babies. In addition, researchers lack the resource and knowledge to completely resolve this problem. In response, the March of Dimes was created to combat premature births by raising awareness and by fundraising for research.
Formerly known as the National Foundation for Infantile Paralysis (NFIP), founder Franklin D. Roosevelt helped those with polio, attempting to explore the mysteries behind it. Later on, the president of the organization, Basil O'Connor, was able to diversify the focus more towards birth defects and premature births, which led to the development of March of Dimes in 1958.
The name itself actually came from the comedian Eddie Cantor. To honor FDR's birthday, fundraising parties called 'Birthday Balls' are held annually on January 30th. When Cantor was organizing the event in 1937, he pitched in the name as a pun on the famous newspaper 'The March of Time,' in the hopes of increasing its appeal towards the public. The name would also grow to be an optimist slogan for Cantor, for if a million people donate a dime, it would add up to a total of $100,000. These two factors, and the collaboration with NFIP, contributed to the eventual widespread fame that the organization has now.
"We march to show our support for better programs and to provide healthcare for pregnant mothers and babies," Noshin Shakawat '19 of Key Club said.
By 2016, March of Dimes was worldwide, supporting over four million babies and their families across the globe. To give the public a voice in this cause, an annual walk is hosted to raise awareness and fund research for premature babies. The 2018 March for Babies walk took place in Lincoln Center on April 29th, 2018. Nearly 5,000 families, friends, and other organizations were invited, clad in purple to support the cause by marching down the roads of Columbus Avenue.
Through this event, students from different schools across the city also had the opportunity to attend the march, including Bronx Science students. Some students chose to volunteer as course marshals who guide and cheer on people as they walk pass, while others decided to participate in the walk itself. The Bronx Science Key Club was present at the walk as a supportive volunteering organization. With their high spirits and colorful posters, members of the club were also able to voice their support for the march. "We march to show our support for better programs and to provide healthcare for pregnant mothers and babies. We believe that all newborns deserve the chance to grow up and live in our world as healthy as possible," Noshin Shakawat '19 of Key Club said.
As New Yorkers marched down the streets, the purple garments reflects their spirit and compassion for those with birth defects, and the need to better our environment for the newborn infants. At the end of the day, New York City raised approximately $77,000 for the March of Dimes. Whether we personally experienced a similar situation, or are just simply enthusiastic advocates, we came together in purple.


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Beyond the Footsie: Monday close
SMALLER company shares closed in the red, mirroring the muted performance of blue-chips despite a busy day for corporate news among the minnows. The FTSE SmallCap index finished off 6.1 points at 2529.2, its lowest point of the session.
OneMonday Group, the public relations outfit, was given an unexpected boost by news that the consultancy arm of PricewaterhouseCoopers is to acquire rights relating to the 'ONEMONDAY' trade mark for $5m (£3.5m) in light of the unit's name change to 'Monday'. OneMonday shares gained 3p to at 32 1/2p, with the group now requiring a name change.
Consolidation hopes lifted ebookers 32 1/2p to 337 1/2p after fellow internet travel group Lastminute.com, up 3 3/4p at 81 3/4p said it is seeking more acquisitions to boost its presence in Europe. Lastminute.com also announced a strategic partnership in Germany with LCC24, Lufthansa's new online travel agency.
Applied Optical Technologies, the supplier of anti-counterfeiting technologies, rose 4 1/2p to 52 1/2p after winning an order to supply security foil for Euro banknotes.
Biotech minnows also advanced. Fulcrum Pharma rose 1 3/4p to 14p on news of a deal with The Medicines for Malaria Venture (MMV) to provide drug development management services for a new class of anti-malarial drugs.
Ten Alps Communications - the events organiser and media group in which Bob Geldof has a significant stake - gained 3 1/2p to 17p after posting a sharp hike in pre-tax profits.
A similarly strong full-year performance buoyed Belhaven Brewery, up 25 1/2p to 330p, Bizspace, 2 1/2p to 22 1/2p and Burndene Investments, 6p at 49p.
But T Chapman, the computer consultancy firm, shed 6p to 16 1/2p, undermined by a full-year profits warning.


Marie Mawad & Amy Thomson -- "Europe's wireless carriers are falling behind their U.S. rivals in efforts to boost tariffs as they introduce faster service, with price cuts in France and Britain indicating phone bills will shrink further.
EE, the U.K. mobile-phone company owned by Deutsche Telekom AG (DTE) and France Telecom SA (FTE), last month reduced rates for its fastest fourth-generation services, and Vivendi SA (VIV)'s SFR unit slashed prices in France by as much as 25 percent on packages built around quicker data transfers. In Germany, the first major western European market with 4G, Vodafone Group Plc (VOD) has cut the cost of its most expensive plans."


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Së pari i falënderohem Allahut i cili më mundësoi ta rishikoj përkthimin e Kurani në gjuhën shqipe, të cilin e kam përkthyer dhe e kam botuar gati para. Home · Objectives · About Us · Contact Us · Guest Book · Facebook · Twitter · YouTube · Dailymotion · Scribd · Calameo · Slideshare · Issuu · Pinterest · Google . Kurani ne gjuhen shqipe added a new photo. November 11, ·. No automatic alt text available. LikeComment. Eduart Haka, Erduan Salihi, Feride Cikaj and.
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Now the Fun Starts
Well, I was right about the Devil Rays series. The A's swept, but all three games were squeakers.
Next up: the White Sox. Their lineup seems a lot less menacing without Magglio Ordonez and Frank Thomas. The first game pitching matchup looks to favor the A's, but all four starters in the last two games have reputations for Jekyll-and-Hyde performances. What kind of games we get depends entirely on which pitchers decide to show up:
Tuesday, 5:05pm (FSN): Rich Harden (8-5, 3.80) vs. Jason Grilli (0-1, 9.00)
Wednesday, 5:05pm (FSN+): Barry Zito (10-9, 4.54) vs. Freddy Garcia (10-10, 3.84)
Thursday, 11:05am (ESPN2): Mark Redman (9-10, 4.59) vs. Jose Contreras (12-6, 5.04)
Meanwhile, this streak where all the contenders win every day is about to end. Tomorrow, the Boston Red Sox begin a stretch of nine games where they play the Angels, Rangers, and A's. These series will be crucial in determining if the wild card will go to Boston, or to the AL West runner-up. A sweep here or there, and somebody could quickly fall out of the race.
UPDATE: Freddy Garcia is going to miss his start with a sore forearm. Grilli will pitch Wednesday, and Felix Diaz will be called up from AAA to pitch Tuesday's game. Diaz is 10-2 with a 2.97 ERA in Charlotte this year.
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A's-Rays Phase
The A's have gone 9-1 in their last 10 games, and gained no ground at all on the Angels and Red Sox. Poor Texas "only" went 7-3, and lost two games in the standings.
Nobody is letting up, so the A's need to keep winning this weekend. In theory, Tampa Bay should yield to the A's playoff steamroller, but this weekend's pitching matchups look surprisingly even:
Friday, 7:05 PM (KICU): Mark Hendrickson (8-12, 4.63) vs. Mark Redman (9-10, 4.30)
Saturday, 6:05 PM (FSN): Dewon Brazelton (6-4, 3.31) vs. Tim Hudson (9-4, 2.85)
Sunday, 1:05 PM (FSN): Scott Kazmir (1-0, 0.00) vs. Mark Mulder (17-4, 3.72)
Hendrickson and Redman are lefties of similar quality, Brazelton shut down the A's last Sunday, and Kazmir is the hot prospect that the Mets inexplicably gave away. The Devil Rays won't be pushovers.
An empty stomach? OK, these ridiculous Barry Zito excuses have to stop.
Really, I've heard them all now, and I've been watching, and I'm convinced now that there's only one thing wrong with Barry Zito: in each game, he needs to establish early on the ability to throw the curveball for strikes. If he does, he dominates. If he doesn't, he sucks. The curve sets up everything else for him. It's that simple.
Today, Zito didn't throw a curveball for a strike until the fourth inning. In the third inning, he yielded four runs. After that first good curveball, the Orioles got nothing else. The only thing stopping Zito after that was his pitch count.
Let's not confuse the issue. It's not about empty stomachs or his lack of zen mentality or his declining strikeout rate or bad DIPS numbers or listening to too many people. It's all about the curve.
My Kind of Game
I went to the game last night, and it was exactly the kind of game I love to watch: a pitchers' duel that the A's win dramatically.
Bruce Chen (!) was doing his best Barry Zito imitation, mixing high-80s fastballs, a changeup, and a big-bending curveball to confound the A's hitters. Like Zito when he's at his best, Chen had the A's either striking out or popping up.
But Rich Harden matched Chen pitch for pitch. He threw a lot of pitches in the first inning, but then he settled down, and got through eight innings without yielding a run.
Marco Scutaro sent us all home happy by hitting a two-out, three-run homer in the bottom of the ninth of B.J. Ryan. It doesn't get much better than that.
I'll be at the game today, too. Hopefully, Zito will continue his recent run of good pitching.
Mulder Wins Ugly Again
Mark Mulder won his 17th game last night, but he didn't look good doing it. Mulder dominated from April through June 24th, but since then he's been inconsistent. The only pitch he seems to have had good control with recently has been his fastball, and last night he had trouble that, too.
It's a testament to his talent (and run support), that he can keep winning even if he's not pitching sharply. Mulder said after yesterday's game that his mechanics are off. I hope that's all it is.
Billy Beane says he's not worried about Mulder, but I can't help myself. The last time Mulder went a month without being his usual dominant self, it turned out he was pitching with a broken leg bone near his hip.
Uff då. But this time, it's just mechanics, yeah, that's right, ya sure, oh yeah, he'll fix everything next time out, yabetcha, so dat Cy Young will go backta Oakland, instead of, ya know, heading off to dat land of Scandihoovians and fellas out dere named Olaf and Sven and Lars and Johan.
Hey, folks, Ken Arneson here. I'm stepping over from the Will Carroll Weblog for awhile to fill in while Mark takes some time off. Why anyone would go on vacation during a pennant race, I don't know. He's got some wimpy excuse, I forget what it is. Getting married or something.
So about them A's: I was watching the A's game on TV tonight, and tearing my hair out for the first five innings watching the A's fill the bases over and over again without scoring. Mercifully, Jermaine Dye, bad thumb and all, finally came through with a clutch hit, and the A's held on to win.
Miguel Tejada, as expected, got a nice ovation in his first at-bat. But the rest of the game was ugly. A lot of the ugliness came from the fact that the Raiders played at the Coliseum on Saturday night, and the field was horrible. There were bad hops all over the place. Hopefully, A's groundskeeper Clay Wood can take the next 24 hours and smooth out the field.
I was checking out the A's and Raiders schedules, and there are two more instances where the A's have to open a homestand after a Raider home game. The first game will be four days after a Raider game. The Raiders play on September 2, and the A's start a series against Boston on September 6. That gives Wood four days to clean things up, which isn't so bad, I guess.
The last homestand, however, starts the day after a Raider game. The Raiders play on Sunday, September 26, and the A's host the Mariners on September 27. It's hard enough to get Ichiro out without giving him a bumpy infield to hit through.
Raiders are also scheduled for home games on October 17th and 24th. In case of playoffs, break glass.
If the MLB championship ends up being decided by a bad hop caused by the NFL, it would truly be a shame.


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Mercedes EQC range, battery and charging
Four years since it launched, the Mercedes EQC has lost its competitive edge; many rivals will now go further on a charge
by Richard Ingram
Range, battery & charging - currently reading
Running costs & insurance
Performance, engine & drive
Interior, dashboard & comfort
Boot space, seating & practicality
Reliability & safety rating
Mercedes EQC: Living with it
Range, battery & charging rating
Buy used for less at BuyacarPrice & Specification
Wallbox charging time
Rapid charge time
245 miles 12hrs 45mins (0-100%, 7.4kW) 35 mins (10-80%, 112kW)
The Mercedes EQC's official driving range of around 250 miles was competitive when it launched back in 2019, but technology has progressed and rivals now manage more miles on a charge. The recently-updated Audi Q8 e-tron, for example, claims a range of up to 330 miles, while the bigger-battery BMW iX xDrive50 can do up to 380 miles before needing to be plugged in. Furthermore, when the time does come to top up, those competitors will charge faster, too.
After driving the EQC ourselves we expect you'll get just over 200 miles to a charge in mixed driving, or a little less in cold weather. It's disappointing that the EQC's fastest rapid charge rate is just 112kW – the updated Audi can accept up to 170kW, while the new Polestar 3 can reach 250kW if you find the right ultra-rapid charger.
Mercedes EQC range
The EQC has a claimed range of up to 245 miles from its 80kWh battery, which is lagging a little behind rivals like the above-mentioned Audi Q8 e-tron and BMW iX, as well as the Tesla Model X, and even the ageing Jaguar I-Pace. Technology in this area of the market has progressed rapidly over the past few years, and Mercedes has been left behind.
Adding salt to the wounds, when testing the EQC in the UK to see what it was like to live with, during the colder months we were only seeing around 180 miles on a charge. But if you do a lot of trundling about town and make good use of the regenerative braking (which, unusually, you must turn on using steering-wheel paddles), the range will increase.
Charge time
The EQC gets Type 2 and CCS sockets, which gives it access to the vast majority of public chargers. If you can find a public rapid charger capable of delivering upwards of 112kW (the Merc's maximum charging speed), then you can get a 10-80% charge in around 35 minutes.
While that might sound competitive, rivals now offer much faster charging. Despite the Audi Q8 55 e-tron's bigger battery (114kWh vs 80kWh in the EQC) it'll perform a 10-80% in just 31 minutes, thanks to its 170kW peak charging speed. A BMW iX's 200kW maximum is faster still.
However, if you only ever charge at home, that's unlikely to be a dealbreaker. Plug into a dedicated 7.4kW home wallbox and you can expect a full charge of the Mercedes EQC's battery in around 13 hours.
The Mercedes has a water-cooled on-board charger and thermal battery management, which pre-heats the batteries in advance of charging (as long as the system knows a charge is imminent). It then keeps the batteries cool while charging takes place, which promises good things for the longevity of the battery.
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In This Review
VerdictA decent all-round premium electric SUV, the Mercedes EQC has become overshadowed by more up-to-date arrivals in the class
Range, battery & charging - currently readingFour years since it launched, the Mercedes EQC has lost its competitive edge; many rivals will now go further on a charge
Running costs & insuranceMercedes has dropped the entry-level Sport trim, and while that means every model gets extra kit, starting prices are high
Performance, engine & driveThe Mercedes EQC has a different character to any of its rivals: it majors on comfort more than fun
Interior, dashboard & comfortThe Mercedes EQC has a striking interior focused on an impressive infotainment system, plus generous standard equipment
Boot space, seating & practicalityThe Mercedes EQC is a satisfactory family car, but isn't as roomy as the larger Audi Q8 e-tron or Tesla Model X
Reliability & safety ratingThe Mercedes EQC did very well in independent Euro NCAP crash-testing, scoring the maximum five-star result
Mercedes EQC: Living with itWe spend a couple of months living with the Mercedes EQC to find out of the world's oldest carmaker's first serious electric effort can justify its hefty price tag


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Our Blogs > Quality Legal Services for the Low-Income LGBT Community
Quality Legal Services for the Low-Income LGBT Community
By Cathy Sakimura, Esq., NCLR Family Law Director
Recently, a colleague at a legal aid organization told me about a client who came in for help because he had quit his job. It wasn't until the attorney gave the client an overview of their legal programs, including their LGBT work, that the client opened up and said he had quit because he was being harassed at work for being gay. Without this kind of information, they would have never had a case.
This story reinforced what we, at the National Center for Lesbian Rights, had known—that even a small change in how providers talk to clients can make LGBT people feel safe enough to share their experiences and seek help. This is also the reason why I traveled to Tennessee a couple of weeks ago, to train advocates representing low-income people in how to competently and respectfully serve low-income LGBT clients. Together with Lisa Cisneros, LGBT Program Director at the California Rural Legal Assistance (CRLA), we trained representatives from all of the state's legal aid organizations serving low-income individuals. Our work is part of NCLR and CRLA's joint project to improve these type of legal services across the country.
Unfortunately, there are thousands of low-income LGBT people in need of legal services but most local legal aid groups are not trained in serving LGBT clients. As a result, many LGBT people often feel discouraged from seeking legal advice and many lose their ability to enforce their rights. Our project provides the tools these groups need in order to provide respectful services to low-income LGBT clients and to create a welcoming environment for them in every office.
NCLR and CRLA have done similar trainings in Georgia, California, and Texas. One of our goals is to reach offices serving rural communities. We are pleased that in these states, the project has led to widespread changes that has help LGBT people access quality legal services, including:
Rewriting procedures to show support for the LGBT community by never assuming clients are not LGBT and asking gender-neutral questions about family relationships
Organizing legal trainings to ensure that legal representatives know how to effectively advocate for LGBT clients and their families
Changing bathroom policies to allow everyone to use a safe and appropriate bathroom
Changing how case information is recorded so that transgender clients are always referred to by their lived names, even if they have a different legal name
Creating an LGBT task force to improve services for LGBT clients in all areas of the organization
We are proud that our work have been met with a lot of excitement. Legal advocates are eager for this type of training and want to provide the best possible representation to their LGBT clients.
Our goal is to spark a nationwide change in all legal services programs, so that every person can have equal access to justice.
Select an Issue... Asylum & Immigration Elders Employment Family & Relationships Marriage Parenting Relationship Recognition Federal Legislation & Policy Healthcare Housing Low Income & Poverty Prisons Rural Communities Proyecto Poderoso Sports State Legislation & Policy Transgender Law Transgender Parents Transgender Youth Youth Additional Civil Rights


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Home / Entertainment / freeSAT: AXN Program will be available to all customers in November
freeSAT: AXN Program will be available to all customers in November
The freeSAT satellite operator temporarily accesses all three AXN channels in standard definition (SD / MPEG-2) temporarily to their customers. As part of the promotional action, all operator clients AXN, AXN Black and AXN White will be able to look regardless of the prepaid package. The trials will take place from 1 November to 30, 2018.
During November, viewers will be able to see some of the premiere sections of popular crimes or science fiction series
. Maritime Intelligence Agents are the classic TV screens. Special team investigates interesting crimes around the world. The twelve series will take them to Russia, where they will face the killers and lives of their lives. AXN presents the 12th NCIS series: Los Angeles every Thursday at 21:00, also in two episodes in a row
Laurent Combalbert and his elite team return to TV screens in the premiere of the second series of the Ransom series. Although they are going deeper into the world of organized crime, they try to balance their personal lives with these professions.
Customers with providers receive AXN programs at positions 120 (AXN), 121 (AXN White) and 122 (AXN Black). Users can customize their own devices using the following parameters
Full list of stations, both with operator offer and technical parameters, can be found under the Frequency
] FEC
Norms / Modifications
AXN CZ (MPEG2) 12092 MHz S / QPSK 0B1C (Conax), 0B02 (Conax), 1815 (Nagravision ), 0D97 (Crypto Works), 1882 (Nagravision), 0653 (Irdeto) 7/8 28000 DVB-S / QPSK 0B02 (Conax), 1815 (Nagravision), 0653 7/8 28000 1815 (Nagravision), 0D97 (Crypto Works), 1802 (Nagravision), 19909013] on PID
AXN 5206 Beat (Mpeg), 5306 Eng (Mpeg) AXN White / MPEG2) MPE G2) 5102 11002 5102 5002 5202 hon (Mpeg), 5302 ron (Mpeg) (Mpeg), 5403 (Mpeg), 5403 ron (Mpeg), 5503 cze Mpeg) 5103 11003 5103 5003 19659059]


Project Size | 110,000 s.f.
Restore exterior of the 1903 National Historic Landmark Jordan Hall building.
Restoration of exterior masonry included limestone repair and replacement, repointing mortar joints with historically appropriate mortars, and delicately performed masonry cleaning.
Replaced damaged portions of the original African marble columns and rosettes on the façade which required diligent research and selection of a close match from Italy.
Original windows on the public facades were carefully removed, restored and reinstalled.
All of the restoration work was performed in strict accordance with the Secretary of the Interior Standards for Historic Preservation and reviewed by the Massachusetts Historical Commission to assure the long term integrity of this National Landmark.


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Does springtime make anyone else want to start decluttering and organizing every single room and drawer in your home, or is it just me? This winter was long and grueling, piles of snow and bitterly cold temperatures, let's say she more than outwore her welcome! All the days we spent watching the snow fall I was slowly making a list of ways to refresh and switch up our living spaces! I am pretty sure that I have been in decorating mode since about January. I am ready for spring.
Since welcoming baby Leo, we have been spending more time than ever at home. It's been special to be a family of three snuggled up inside together these past few months. Making memories and John and I are both savoring these precious times as much as we can. To say I am a big old sponge lately would be an understatement. Time feels like it is flying by faster than ever before.
But with a new baby comes all the clutter and unwanted mess. After nine months of being pregnant, our home was spotless (hello nesting) to only be destroyed for about four months while we were figuring out how to survive life with a newborn! Fast forward a few more months, and now we are settling into more of a routine and moving out of the insanity into a different one that feels a little more organized.
Our Master bedroom has been one area that we needed to get under control! This room tends to act as a catch-all for all the things from baby stuff to the dog toys, to John and I, not hanging our clothes up as we should! You know that one chair in the corner that seems to act as a second closet for all the things you don't have time to deal with and keep piling and piling until you forget there is a chair hidden under the mess? Yes, we too know all about this! I have finally moved the chair so it could not function like this anymore!
We are slowly working on getting more and more accomplished around here. However; please do not open my dresser drawer or my closet, Marie Kondo would not be impressed!
Simply rearranging your existing furniture, art, shelves, and pictures can make a huge impact and is one of the most affordable ways to refresh your space. I tend to have similar styles flowing throughout the house so what works in one room can easily be swapped out and placed in another.
For a money saving tip pick one consistent look and feel, and make it a common thread throughout your home, so there is continuity. Items in our dining or living room could easily be swapped out for decor and furniture in our master and vice versa.
Add personal touches and print your photos! We have been the absolute worst about this, but it makes your house feel like a home with pictures on the wall. I couldn't be happier with our newest prints. You might have noticed these hanging in our master bedroom! More details below.
I could not be more in love with our Fracture glass prints. These images are the first thing I see when I wake up in the morning and the last when I go to bed. We recently took family photos on one of our trips, and I was beyond excited to print these. Yes, I said print because I want to treasure these moments forever.
These prints are a piece of art. You know how picky I am with our walls. I do not hang anything unless I know it is staying (thank you, Command Hooks)!
Fracture takes your digital images and prints them directly on glass. No framing headaches! They are modern and clean, and they match our home so beautifully. There will be more of these to come, and I have a feeling this is going to be a new gift to give everyone in my family. Everyone asks me for pictures of Leo, and I can't think of a better way to provide them with something they will treasure forever.
Fracture is offering a special spring sale from March 20 through April 4th use my code TAMARA20 for 20% off all prints and stands on Fractureme.com. Perfect for Mother's or Father's day, and what a unique way to keep all your most valued moments close by every single day. I hope you will check them out because they are doing big things and I love supporting a business who care about our planet and also help make treasuring moments a priority!


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Development Jan 06, 2023 2 min read
The Hour-Long SQL Query, 2023 Edition
Back in May of 2015, I found an odd performance issue in the SQL libraries for .NET Framework. I blogged about it at the time, but essentially, reading data from a SQL column by calling IDataReader.GetChars(...) gave us O(N²) performance. This means that as the data grows, the time it takes to read the data grows exponentially.
The other night I decided to give it another shot. Fortunately, past me left just about all the code I needed in the original blog post (linked above), so I only had a few tweaks to make to get the original test up and running.
Yet at the same time, the code was running on a very different system. Back in 2015 I was on .NET Framework, but since then Microsoft have copied, ported, and refactored code as they brought features to .NET Core and then delivered performance improvement after performance improvement after performance improvement after performance improvement after performance improvement.
(If you have a spare few days I recommend reading those very long posts, there is some very interesting low-level performance stuff in there.)
They also discontinued the old System.Data.SqlClient libraries and introduced the newer Microsoft.Data.SqlClient libraries (also on GitHub), so although I expect that Microsoft mostly renamed the old code, we could be in for something completely different.
The other thing that has changed in all this time is that the .NET Framework bugtracker on Microsoft Connect - and indeed, all of Microsoft Connect - has been shut down and wiped from the internet, so there is no trace left of my original bug report. Fortunately Microsoft now operate on GitHub Issues, so at least it's not like they don't have a bug tracker at all.
I updated the original sample code to reproduce this so that I could now run it on .NET Framework or .NET Core, and so that I could choose whether to run it agains the older System.Data.SqlClient libraries or the newer Microsoft.Data.SqlClient libraries.
Armed with this, I set up a brand new Windows Server 2022 VM, installed SQL Server 2022 Developer Edition, and ran the tool in all four configurations.
I have never seen such a perfect O(N²) example before in my life.
In all four configurations, the sample application showed a very clear O(N²) performance characteristic - such a perfect representation that I don't even think I need to graph it this time. On this particular VM, the amount of time it takes to read N megabytes of XML is almost exactly N² seconds.
The original workarounds from 2015 all still work, and I have now escalated this as a new GitHub Issue.
Back in 2015, I concluded with:
Hopefully this will be fixed in a future .NET Framework release.
Unfortunately for my hopes, Microsoft announced in 2019 that "future investments in .NET will happen" for .NET Core, and that .NET Framework will basically only get "bug-, reliability- and security fixes" so there is now almost no chance of that happening.
Hopefully though this will at least get fixed in Microsoft.Data.SqlClient for all platforms that it supports. Perhaps. One day.
Tag: Development, SQL, .NET
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