The sound of your own voice is always jarring, isn't it? Even without worrying about the science behind it, the fact of the matter is you never sound the way you think you do.
This goes for everybody. Thanks to countless hours of creating and editing my own podcasts, I've gotten over the shock (and disgust) at how I sound. Every once in awhile I'll listen to an old clip and shake my head. The more I do, I think I've been able to balance out the sound to be more authentic with how I talk on a day to day basis.
It's one thing to do it when you're the host, but being a guest always throws me off my game. Or at least, it used to. When Ian Ryan of Golden Habits reached out to me, I took this as an opportunity to see how far I've come in presenting my ideas and thoughts on communication.


Shubhra Gupta, The Indian Express 1.5 Out of 5 The sequel to 'Singham' is chock-full of the usual car-on-jeep action. Explosions go off at regular intervals. Shoot-outs—one really well-shot-- occur frequently.
Saibal Chaterjee, NDTV 2 Out of 5 Singham Returns has a fair sprinkling of angry wisecracks that might draw spontaneous whistles and loud claps from those that love violent fights to the finish.
One can only hope that this is indeed the end, and another sequel isn't lurking in the future.
Manjusha RadhaKrishnan, Gulfnews 2.5 Out of 5 The action is there, but is not so violent, and you don't feel overwhelmed. The language is clean with punchy one-liners from various characters, written by Sajid-Farhad, and makes the film watchable with family.
Mohar Basu, Koimoi 2.5 Out of 5 Singham Returns doesn't match up to Singham and that is the failure of this franchise venture. It is definitely a very watchable film with Ajay putting in his best foot forward in a role that brings out his caliber to the fullest but for those who are expecting a Rohit Shetty fun watch, this film is neither immensely entertaining or superbly enjoyable. The action doesn't offer anything new and the drama is too superficial for my taste. It is just about average and that too only for its lead man whose swagger rules the show in this one.
Rohit Khilnani, Headlines Today 3 Out of 5 The dream team of Rohit Shetty and Ajay Devgn delivers a good entertainer. It's for fans of brand Singham and I'm sure they are all out there in large numbers.
Shubha Shetty Saha, Mid Day 3 Out of 5 Rohit Shetty's cleverest moment comes when his hero after having witnessed the most expensive SUVs turn to ashes, has a humble, kind of apologetic tiny personal car, thus subtly highlighting his clean conscience. The rest of the film is not so subtle.
Sukanya Verma, Rediff 3 Out of 5 Returns offers quite a bit to whistle about with its steady supply of straightforward action and a hot-headed hero who delivers a punch with a fist and a line.
Taran Adarsh, Bollywood Hungama 4 Out of 5 SINGHAM RETURNS is a complete mass entertainer with power-packed drama, hi-intensity dialogue and towering performances as its aces. The brand value attached to it coupled with a long weekend will help the film reap a harvest and rule the box-office in days to come. A sure-shot WINNER!


text:
Q: how do i create a directory in perl which includes current timestamp as EPOCH The direcrory structure that i am creating is thus:

my $startTime = `date +%s`;
my $startTime2 = $startTime + 10;
chomp($startTime2);
print "startTime2: " . "$startTime2";
my $pwd = getcwd();

#my $PWD=system("pwd");
print "Current Working Directory: " . "$pwd\n";
my $logdir = "$pwd" . "/load-logs";
print "Log Directory: " . "$logdir\n";
#chmod( 755, $logdir ) or die "Couldn't chmod $logdir: $!";

mkdir("$logdir/$startTime2", 777) || print $!;
#print "start Time in epoc : "."$startTime";
#mkdir("$startTime3", 777) || print $!;
#system("mkdir \$logdir/$startTime");

my $reqlogfile  = "$logdir/$startTime2/req.log";
print "reqlogfile: " . "$reqlogfile\n";
my $resplogfile = "$logdir/$startTime2/resp.log";
print "resplogfile: " . "$resplogfile\n";

now, mkdir("$logdir/$startTime2", 777) || print $!;
does not create a directory which has the current value of $startTime2 under $logdir

A: A problem may be that your $logdir wasn't created, so it's best to ensure it is created.
Also, it's best to make sure the umask is reset so that if you chmod to 0777, the parent shell's umask doesn't interfere with the umask in the script.
Perl's mkdir doesn't work as the shell's mkdir -p (which creates intermediate directories if they do not exist). One could use mkpath from File::Path, or simply ensure the intermediate path is created, as I show below:
use strict;
use warnings;
use Cwd;

my $start_time   = time;   # equivalent to `date +%s`, less a shell out ;)
my $start_time_2 = $start_time + 10;

umask 000; # ensure the permissions you set are the ones you get

my $pwd = getcwd();
print "Current Working Directory: $pwd\n";

my $logdir = "$pwd/load-logs";
print "Log Directory: $logdir\n";

mkdir $logdir
    or die "Cannot mkdir $logdir: $!"
    unless -d $logdir ;
chmod 0755, $logdir or die "Cannot chmod 0755 $logdir: $!";

mkdir("$logdir/$start_time_2", 0777)
    or die "Cannot mkdir $logdir/$start_time_2: $!"
    unless -d "$logdir/$start_time_2";

my $reqlogfile  = "$logdir/$start_time_2/req.log";
print "reqlogfile: $reqlogfile\n";
my $resplogfile = "$logdir/$start_time_2/resp.log";
print "resplogfile: $resplogfile\n";

The above (with strict, warnings, etc) works for me:
~/t$ perl t.pl
Current Working Directory: /home/mf/t
Log Directory: /home/mf/t/load-logs
reqlogfile: /home/mf/t/load-logs/1293636556/req.log
resplogfile: /home/mf/t/load-logs/1293636556/resp.log

Launching it multiple times doesn't die, and creates the directories (and chmods them) if needed. You can check that via ls -la load-logs/.

redpajama_set_name: RedPajamaStackExchange


text:
Jacinda Ardern reacts to hen's party gift on live TV: 'This will never see the light of day'
By Lucia Hawley| 1 month ago
Jacinda Ardern had a hilarious reaction to a hen's party gift given to her by breakfast show hosts ahead of her wedding this summer.
During an appearance on TVNZ's breakfast show, host John Campbell handed the New Zealand Prime Minister a present for her pre-wedding celebrations.
Before Ardern accepted the gift, she remarked, "Wow, this could be any manner of distasteful gifts."
READ MORE: Waitress fired for not sharing $4,400 tip
Jacinda Ardern accepted a hilarious hen's party gift from breakfast show hosts. (TVNZ)
As she opened up the present on air, she revealed the contents — a sparkly headband covered in diamantes spelling the word "Bride," a bridal sash and a bottle of wine.
Ardern's hysterical reaction of disappointment was captured on camera, as she joked, "I can promise you, this will never see the light of day."
This summer, the politician is set to marry her long-term partner, TV presenter Clarke Gayford, in Gisborne, New Zealand.
The pair began dating in 2013 and got engaged in 2019. (AP)
READ MORE: Kim Cattrall's subtle response to SATC fans
The pair began dating in 2013 and got engaged in 2019, and share three-year-old daughter Neve.
Earlier this month, ZM reporters asked the Prime Minister how her wedding planning was going, to which she replied, "You'd have to ask Clarke, he's in charge".
"I said to someone I do really think I'm the least-engaged bride. I know the big stuff, but he's really doing the lot."
For a daily dose of 9Honey, subscribe to our newsletter here
All the times Jacinda Ardern has made the world love her
Grace Tame announces engagement to Max Heerey
Louis Vuitton unveils late artistic director's stunning final collection
Netflix confirms 'Squid Game' will get a second season

redpajama_set_name: RedPajamaCommonCrawl


text:
Die Raiffeisenbank Plankstetten AG ist ein Kreditinstitut in der Rechtsform einer Aktiengesellschaft innerhalb der genossenschaftlichen Finanzgruppe der Volksbanken Raiffeisenbanken. Die Bank mit Sitz im Ortsteil Plankstetten der Stadt Berching (Landkreis Neumarkt in der Oberpfalz in Bayern) wurde im Jahr 1896 in der Rechtsform einer Genossenschaft gegründet und im Jahr 2010 in eine Aktiengesellschaft umgewandelt.

Geschichte

1896 wurde die Raiffeisenbank gegründet. Die erste Geschäftsstelle war im unteren Teil des Ortes an der Bahnstrecke Neumarkt–Dietfurt. Später zog die Bank in das ehemalige Schulhauses des Ortes Plankstetten um.

1999 war die Bank finanziell fast am Ende und der Genossenschaftsverband war für die Ablösung des Vorstandes mit einer hohen Abfindung, welche auch vom Genossenschaftsverband finanziert worden wäre. Die Ablösung fand dann kurz danach ohne Abfindung statt, der Zwist hielt aber an, da die Fusion mit der Raiffeisenbank Berching ausblieb. In den Jahren 2005 bis 2010 herrschte ein heftiger Zwist mit dem Genossenschaftsverband Bayern. Dieser versuchte, mehrmalig mit kostspieligen Zwangsprüfungen, die Bank zur Fusion zu zwingen. Im Verlauf wurde die Raiffeisenbank Plankstetten im Jahr 2007 als erste Bank überhaupt aus dem Genossenschaftsverband Bayern ausgeschlossen und schloss sich dem Genossenschaftlichen Prüfungsverband Mecklenburg-Vorpommern an. Der einzige Weg zur langfristigen Sicherung der Eigen- und Selbstständigkeit der Bank war die Umwandlung in eine Aktiengesellschaft. Die Umwandlung wurde von den Mitgliedern nahezu einstimmig beschlossen, welche am 30. August 2010 rechtskräftig vollzogen wurde.

Erste Kritiken dazu verstummten schnell, als die ersten Geschäftsergebnisse nach der Umwandlung bekannt gegeben wurden. Seither erzielt die Bank jährlich neue Rekordgewinne und weist Ergebnisse weit über denen anderer Genossenschaftsbanken aus; die Bilanzsumme konnte mehr als verdreifacht werden, die Betriebsergebnisse und Gewinnrücklagen bestätigen, dass die langfristige Eigenständigkeit gesichert ist. Die Mitarbeiterzahl konnte mehr als verdoppelt werden und die Hauptstelle der Bank in Plankstetten wurde in den Jahren 2016 bis 2018 umfassend renoviert.

Unternehmensstruktur
Die Raiffeisenbank Plankstetten betreibt als Bank das Universalbankgeschäft und hat Kunden im gesamten Bundesgebiet. Die Bank verfügt über zwei Filialen, die Hauptstelle in Plankstetten und eine Zweigstelle in Kevenhüll. Die Raiffeisenbank Plankstetten AG ist der amtlich anerkannten BVR Institutssicherung GmbH und der zusätzlichen freiwilligen Sicherungseinrichtung des Bundesverbandes der Deutschen Volksbanken und Raiffeisenbanken e.V. angeschlossen.

Weblinks

 Offizielle Webseite der Raiffeisenbank Plankstetten

Einzelnachweise

Berching
Plankstetten
Unternehmen (Landkreis Neumarkt in der Oberpfalz)
Gegründet 1896

redpajama_set_name: RedPajamaWikipedia


Dropbox recently deprecated their original (v1) API, which is still used inside of Ensembles, and they have announced it will stop working in around a year from now. Where does this leave Ensembles?
For now, apps will continue to work fine, so there is no immediate rush. But within the next few months, we need to start taking steps. We will be moving the Dropbox backend in Ensembles to the v2 API, either using the REST API, or perhaps using an as yet unreleased Objective-C API. We expect to begin that work in August, and it should be ready a month or two after that.
Older PostCloudKit Data Sharing in Ensembles?


Polbase - Reference: Association of Epstein-Barr virus early antigen diffuse component and virus-specified DNA polymerase activity.
Association of Epstein-Barr virus early antigen diffuse component and virus-specified DNA polymerase activity.
The role of Epstein-Barr virus (EBV) early antigen diffuse component (EA-D) and its relationship with EBV DNA polymerase in EBV genome-carrying cells are unclear, EBV-specified DNA polymerase was purified in a sequential manner from Raji cells treated with phorbol-12,13-dibutyrate and n-butyrate by phosphocellulose, DEAE-cellulose, double-stranded DNA-cellulose, and blue Sepharose column chromatography. Four polypeptides with molecular masses of 110,000, 100,000, 55,000, and 49,000 daltons were found to be associated with EBV-specified DNA polymerase activity. A monoclonal antibody which could neutralize the EBV DNA polymerase activity was prepared and found to recognize 55,000- and 49,000-dalton polypeptides. An EA-D monoclonal antibody, R3 (G. R. Pearson, V. Vorman, B. Chase, T. Sculley, M. Hummel, and E. Kieff, J. Virol. 47:183-201, 1983), was also able to recognize these same two polypeptides associated with EBV DNA polymerase activity. It was concluded that EBV EA-D polypeptides, as identified by R3 monoclonal antibody, are critical components of EBV DNA polymerase.


No matter what holidays you celebrate at this time of year you can pretty much count on seeing relatives that you otherwise don't spend a lot of time with. As a result, you might get a few raised eyebrows when you give your child chicken nuggets at a big family dinner or Aunt Dotty tells your child to stop rocking in his chair. Maybe your child doesn't like hugs or family photos. And your child might rip open a present from their grandparents only to show disinterest and move on to something else. There are any number of your child's behaviors that will get scrutinized and perhaps silently (or not so silently) met with disapproval.
Extended family members that you don't see regularly often don't understand your child's diagnoses and resulting social and behavioral difficulties. Complex Learners can't flip a switch just because family from out of town or grandparents they rarely see come to visit. Some of your family members may have expectations of your child that won't be met. You may feel pressure about this and even embarrassment at times, especially if you feel that your parenting skills are also under the microscope.
Here are a few tips to help make these situations easier – for both you and your child.
Family gatherings are exciting but also a landmine for your child to have difficulty regulating emotions and behaviors. A major reason for this is the fact that Complex Learners just don't know what to do in these social situations. The more information and strategies you can provide, the more likely things will go more smoothly for your child. Maybe he can show your relatives how to fist bump instead of getting a bear hug. If you're going to another home, let her know the scene, like how many people will be there, the layout of the house, what time dinner starts or when you are exchanging gifts. Check out this post that gives you tips for previewing and practicing with your child – it can definitely make holiday gatherings easier.
Why can't you make him sit still? She's not very friendly, is she? Does he always run around and interrupt people? Is she acting silly and talking so loud just to get attention?
You may hear these and other questions or comments, most likely directed at you but possibly directed towards your child as well. At these times you will need to let relatives know a little about your child's diagnoses without providing a complete evaluation! Explaining that his brain is wired differently or that crowds are difficult for children with sensory issues might be enough. But you also might have to explain that it doesn't help to talk critically or forcefully to your child. You may have to pull the relative aside and explain things more in depth. And sometimes it might work best to recruit another family member who understands and can validate that your child's issues stem from complex learning and attention differences, not because you let her do whatever she wants.
Your child may need a space and some quiet activities to focus on if a family gathering gets overwhelming, but you may need your own space as well. Find a favorite cousin or aunt and go into an unoccupied room or step outside with a hot beverage. Reconnecting with someone who understands your parenting challenges can be validating and relieve some of your stress. You might need a moment to yourself as well. Breath, stretch, walk around the block – these same strategies you encourage for your child may be helpful for you as well.
And don't feel bad about leaving early. You might wish your child could hang in longer so you'd have more time with relatives, but it's better to respect your child's limits, and your own, so that fatigue and family dynamics don't ruin the evening. If your child has trouble with transitions and leaving places without a meltdown, you can plan an abbreviated visit ahead of time, preparing your child with the time and plan for leaving. A few quick goodbyes may be all you need. Or if your family insists you take home half the leftovers, get those things ready ahead of time and have everything near the door before you escape.
Family can be a joyful and yet sometimes a frustrating part of the holidays for parents with Complex Learners. Remember, it may take a while for some people to understand that your child's difficulties are related to the way his brain is wired. With good strategies, understanding and a positive attitude, family members can be a support and not an added stress at the holidays.


text:
/StarWars
Rogue One Prequel Series
Star Wars: Forest Whitaker Teases Saw Gerrera Embraces the Dark Side of the Force
By Patrick Cavanaugh - July 26, 2018 04:14 pm EDT
Of the many compelling elements of Rogue One: A Star Wars Story, one of the most fascinating was the depiction of characters who were neither Jedi nor Sith, but who were only slightly attuned to the ways of the Force. Forest Whitaker starred as Saw Gerrera in the film, a character whose devotion to the Rebellion sometimes took deadly turns. The actor recently confirmed that, while he supported the Rebel Alliance, his beliefs led towards to the darker corners of the Force.
"I liked playing that character. He's amazing because in this movie, the director put more gray into Star Wars stories than normal," Whitaker shared with People. "He's a character who was fighting against oppression and those dark forces that were trying to harm humanity, but yet decided to take on some of their practices in order to be able to win, because he thought the final result was more important. That's a big question, by any means necessary, that we have to look at and see, what is necessary?"
Saw wasn't the only character to be only slightly attuned to the Force, with Donnie Yen's Chirrut Îmwe also being familiar with teachings of the Jedi Order without actually being a master. The blind Chirrut regularly used the Force to engage in hand-to-hand combat, yet viewers didn't get to see Saw fully tap into those dark teachings mentioned by Whitaker.
Whitaker continued, "I love that concept of people looking inside themselves — as they say, the Force being with you — or being able to find your eternal power and allowing it to manifest in the world, and recognize the miraculous is possible at any moment."
The actor not only performed the character in Rogue One, but also lent his vocal talents to the character's portrayal in Star Wars Rebels. In that series, the character also demonstrated his devotion to the Rebel Alliance, even though he ultimately turned on the series' hero Ezra to accomplish an objective for the Rebellion that delved deeper into those darker deeds.
Saw debuted in Star Wars: The Clone Wars, though that series didn't fully depict the lengths he was willing to go and darkness he was willing to embrace, with the events of that war and growing ruthlessness of the Galactic Empire seemingly pushing him to a breaking point.
With Star Wars: The Clone Wars getting a final season next year, we look forward to another possible appearance from Saw.
What do you think about Whitaker's remarks? Let us know in the comments below or hit up @TheWolfman on Twitter to talk all things Star Wars and horror!
[H/T PeopleTV]
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Use this guide to replace a head light in your '98-'02 Honda Accord.
Turn the head light bulb counterclockwise and pull it straight back to remove it.
This site has helped me soooo very much!! I can't thank you enough!!!!
Nobody can replace the headlight for my 1999 Honda Accord (low beam). Everyone says the 9006 is supposed to fit the socket. The socket is fine; the connector for the new bulb is covered by a plastic sheath, which the old bulb doesn't have. Should I go to a dealer for this part?


text:
<component name="libraryTable">
  <library name="support-fragment-25.0.0">
    <CLASSES>
      <root url="file://$USER_HOME$/.android/build-cache/326b96decba72db50651f4774fe770d188df2767/output/res" />
      <root url="jar://$USER_HOME$/.android/build-cache/326b96decba72db50651f4774fe770d188df2767/output/jars/classes.jar!/" />
      <root url="jar://$USER_HOME$/.android/build-cache/326b96decba72db50651f4774fe770d188df2767/output/jars/libs/internal_impl-25.0.0.jar!/" />
    </CLASSES>
    <JAVADOC />
    <SOURCES>
      <root url="jar://$USER_HOME$/AppData/Local/Android/Sdk/extras/android/m2repository/com/android/support/support-fragment/25.0.0/support-fragment-25.0.0-sources.jar!/" />
    </SOURCES>
  </library>
</component>

redpajama_set_name: RedPajamaGithub


when starting treadmill it starts up and runs extremely fast then shuts itself down..it does not respond to any buttons being pushed in the few seconds it is on..what is the problem?? thank you!!
sounds like your motor controller went bad.
ok is this an easy fix? can I do it myself?
is motor controller the same as the motor control board?
A worn out walking belt can make a motor controller go bad because of the high friction.


text:
Enhancing Mental Health Care Transitions Reduces Unnecessary Costly Readmissions
Posted in Clinical Quality Analytics, Financial Empowerment
Nationally, hospitalization for persons with mental health disorders has increased faster than hospitalization for any other condition. Of concern is the lack of bed space to intake these patients on a timely basis. In Minnesota, for example, more than 50 percent of available state psychiatric beds were closed between 2005 and 2010. Furthermore, readmission rates for patients with mood disorders is higher than any other mental health condition, with 15 percent readmitted within 30 days of hospital discharge and up to 22.4 percent of patients with schizophrenia being readmitted. While the average cost of a readmission in the U.S. is approximately $7,200, of greater concern is hospital readmission represents poor patient outcomes related to lack of adequate access to community mental health resources and challenges with adherence to care plans needed to prevent chronic relapse.
In response to these challenges, Allina Health put a new care transition process in place, redesigned workflow, and added key patient support roles. To measure the effectiveness of new interventions, Allina relied on the Health Catalyst Analytics Platform, which includes the Late-Binding™ Enterprise Data Warehouse and a broad suite of analytics applications.
• 27 percent relative reduction in potentially preventable readmission rate.
• 80 percent patient retention rate in established outpatient mental health services.
HIGHER READMISSION RATES FOR PATIENTS WITH MENTAL HEALTH ISSUES
STRETCHED RESOURCES PREVENT PATIENTS FROM RECEIVING CONTINUED TREATMENT
ENHANCING MENTAL HEALTH CARE TRANSITIONS
Enhancing Mental Health Care Transitions Reduces Unnecessary Costly ReadmissionsDownload
Driving Strategic Advantage Through Widespread Analytics Adoption
27 percent relative reduction in potentially preventable readmission rate.
80 percent patient retention rate in established outpatient mental health services.
Nationally, hundreds of thousands of people in need of mental health care seek help from local hospitals. In 2012, inpatient admissions for mood disorders reached 847,000, with inpatient stays for schizophrenia, one of the most acute mental illnesses, reaching 383,000. In 2011, it was estimated that 37 percent of individuals with disabilities and on Medicare had a serious mental disorder.1
Both mood disorders and schizophrenia are associated with relatively high readmission rates, further taxing the already limited availability of inpatient mental health treatment. Within 30 days, 15 percent of patients with mood disorders are readmitted nationally, while 22.4 percent of patients with schizophrenia are readmitted. Across the U.S., the average cost for the repeated hospital stay is approximately $7,200.2 Key factors influencing the rate of readmission include issues with medication management, poor outpatient follow-up and/or treatment, and comorbid substance use disorders.3,4
Allina Health, an integrated delivery system in Minnesota, provides inpatient and outpatient mental health care to communities throughout Minnesota and western Wisconsin. Recognizing that patients with mood and mental health disorders are particularly vulnerable to readmission, Allina committed to improving outcomes for mental health patients.
At Allina, mental health patient acuities have been worsening, while inpatient and outpatient services are stretched ever thinner. Statewide in Minnesota, between 2005 and 2010 more than 50 percent of available state psychiatric beds were closed. Moreover, Minnesota has fewer psychiatrists than any other state and access to outpatient resources like crisis stabilization and rehabilitation services is increasingly more challenging.
This lack of sufficient inpatient and outpatient mental health services has resulted in an influx of patients coming to the emergency department (ED) to receive mental health care, with many boarded in the ED for extended periods of time while they wait for an available inpatient bed or outpatient service. Post discharge, many patients have no contact with their outpatient mental health provider until weeks or months after discharge. Establishing case management services for patients with complex mental health needs can take up to 60 or even 90 days as the referrals for services make their way through the approval process.
With these challenges as the backdrop, Allina Health was determined to improve outcomes for patients with mental illness, including reducing their rate of readmission and improving their access to community supports. Abbott Northwestern Hospital (ANW), part of Allina Health, embarked on a mission to maximize the effectiveness of care planning in the inpatient mental health units and ensure both a smooth transition and successful treatment in the outpatient setting.
To achieve the above objectives, Allina knew it would need to enhance partnerships with other organizations in the community while introducing new roles and interventions internally. The latter would require a redesign in workflow, aided by data and analytics to evaluate the effectiveness of new measures.
Piloting a new transition process. Allina received a grant to pilot an enhanced care transitions project at ANW in partnership with the Minnesota Community Healthcare Network (MCHN), supporting patients from seven different counties.
MCHN includes five outpatient mental health agencies that provide for an integrated healthcare approach and comprehensive treatment for individuals living with serious, persistent mental illness and other complex conditions, such as chemical dependency, chronic health conditions, and socioeconomic challenges.
The aim of the project was to increase access to community support for ANW adult mental health inpatients at the highest risk for readmission by developing and implementing a collaborative discharge and transition pilot. A primary goal of the project was to reduce readmissions by at least 10 percent. To support this goal, the team worked to:
Develop mental health interventions that enhance chances of successful recovery in the outpatient setting and subsequently reduce readmissions.
Improve access to community mental health resources while a patient is still hospitalized.
Create a patient-centered recovery model that promotes early patient and family engagement in discharge planning.
Improve patient advocacy in treatment and demonstrate improvements in patient experience.
Improve communication between inpatient and outpatient resources to ensure best care transitions and follow-up.
In addition to monitoring process measures related to the recovery plan and outreach, the readmission rate was established as the key performance indicator.
Optimizing the EHR for better documentation and analytics. Allina revised its EHR to support documentation of community care coordination, transition meetings, follow-up appointments, transmission of discharge records, and goal setting meetings with the patient and families.
Allina then utilized the Health Catalyst Analytics Platform, which includes the Late-Binding™ Enterprise Data Warehouse and broad suite of analytics applications, to aggregate data from the EHR. Using the platform, Allina can monitor and evaluate both process of care and outcome measures.
Engaging patients and building trust. Allina introduced two new roles at ANW that have been instrumental in supporting a successful transition and activation of outpatient resources: a mental health navigator and a peer support specialist.
The mental health navigator is a mental health professional who partners directly with the patient and care team to establish essential outpatient services, enhance discharge planning, support patient-centered recovery initiatives, and conduct routine outpatient follow-up with MCHN contacts and patients.
The peer support specialist is an individual with a mental health diagnosis who has been in recovery for a minimum of one year and has completed peer support specialist certification. As the patient's advocate, the peer support specialist fosters a trusting relationship with the patient, participates in or runs recovery groups, encourages patients to engage and participate more deeply in care planning, and provides outpatient follow-up to maintain recovery and prevent crisis as needed.
Proactive patient engagement. With these new roles in place, Allina redesigned the inpatient workflow. Following admission, the social worker completes a diagnostic assessment, and the mental health navigator reviews every adult patient to identify if they meet inclusion criteria for the pilot. Pilot inclusion critieria includes the following: lives in the metro area; has a diagnosis with a high risk of readmission; was previously hospitalized or visited the emergency department for mental health concerns, and lacks available outpatient services. If the patient meets these criteria, the mental health navigator invites the patient to participate in the program. If the patient declines, the peer support specialist is engaged to meet with the patient and help encourage participation in the program. Very few patients declined participation in the program throughout the course of the pilot.
Patients who agree to participate in the program sign a release of information form that lasts for five years from the date of signature, allowing easy and ongoing bilateral exchange of patient information between Allina and the five participating MCHN agencies. This ensures that communication between the mental health experts at the hospital and in the in the community does not end when the patient is discharged from the hospital.
Effective care coordination. Unique patient needs are identified by the mental health navigator and referrals to community services are sent to the MCHN community hub via a service request. The MCHN community coordinator reviews the service request and shares it with the five outpatient mental health agencies. The MCHN agencies review the patient's needs and respond within 4-6 hours or faster with the resources they are able to provide. The mental health navigator reviews the options with the patient and together with the MCHN community coordinator identifies which agency is best able to meet the patient's needs.
Prior to discharge, some key actions take place. Firstly, the selected MCHN agency is contacted to initiate an onsite assessment and to establish a proactive outpatient plan while the patient is still hospitalized. This early engagement helps bypass delays in establishing timely and effective outpatient care and enhances relationship building that increases likelihood for continued patient participation in services once discharged. For many patients, the MCHN contacts will come onsite for multiple visits with the patients, especially if their care is highly complex. Secondly, prescriptions needed after discharge are filled at the hospital to increase chances of medication adherence in the outpatient setting. Pharmacy educators offer group education opportunities to review the importance of medications, review potential side effects, and answer any patient questions. Thirdly, the patient participates in transition meetings, plans for discharge, establishing goals, and their recovery plan. The Recovery Plan is developed with the patient early in admission process and is written in patient-centered, easy to understand language (see Figure 1).
Figure 1. Sample patient-centered recovery plan
Upon discharge, records regarding the patient's inpatient stay and discharge needs are sent to the next level of care within 24 hours. The MCHN agency contacts the patient no later than 48 hours after discharge, and in many cases, will make immediate contact or even come to the hospital to visit with the patient on day of discharge.
Both the mental health navigator and the peer support specialist follow-up after discharge. A follow-up phone call is set up with the MCHN agency contact and the patient between 30-45 days post-discharge to review recovery status and help identify opportunities to improve outpatient care.
A team approach keeps patients out of crisis. Should challenges arise while the patient is receiving care in the outpatient setting, the MCHN agencies can contact the mental health navigator and mental health experts at ANW for assistance.
In one compelling example, a patient receiving care in the outpatient setting was robbed, and the patient's medications were stolen. Since the prescription had already been filled within a 30-day period, insurance would not cover the cost of a refill. The MCHN agency contacted the mental health navigator, who subsequently collaborated with the inpatient mental health prescribers and pharmacy staff. Ultimately, the team contacted the insurance company and were successful in getting coverage for the refills. This ensured the patient could take their medication as prescribed, avoiding an unnecessary readmission.
Another patient was discharged to a chemical dependency treatment program. Unfortunately, she was exited from the program, which meant she was no longer compliant with the terms of her probation and was at risk of being jailed. The patient reached out to the navigator, who helped the patient find a crisis residence, maintaining compliance with her terms of probation and keeping her out of jail.
In yet another example, a 22-year-old man who was homeless had been admitted multiple times for chemical dependency and a suicide attempt. He began working with the peer specialist and was discharged to a chemical dependency treatment facility for a one-year outpatient treatment. It was important to the patient to be admitted to a faith-based treatment facility, which the team supported him in doing. The peer specialist met with the patient frequently, establishing a relationship and supporting the patient in his recovery. Today, the patient is working to become a peer support specialist, completing the training that will allow him to help others facing similar challenges in the future.
The enhanced care transitions program at Allina is improving care transitions for patients, and decreasing mental health readmission rates.
27 percent relative reduction in potentially preventable readmission rate. When compared to a control group, those who received enhanced care transitions had a much lower rate of readmission. Nationally, the 30-day readmission rate for patients with mood disorders is 15 percent. The 30-day readmission rate for patients with schizophrenia is 22.4 percent. The enhanced care transitions program is achieving a readmission rate far below the national average, with only 4.6 percent of the enhanced care transitions program patients readmitted within 30 days.
97 percent relative improvement in the transmission of records within 24 hours of discharge.
Multiple processes of care improved.
95 percent of patients have a recovery plan.
90 percent of patients are successfully established with a MCHN agency before discharge.
88 percent of patients receive a MCHN agency onsite visit prior to discharge. If an onsite visit was not possible due to fast discharge timelines, all efforts to have a conference call with the patient was made.
94 percent of patients have a follow-up appointment prior to discharge.
100 percent of patients receive a closed-loop call within 45 days of discharge.
92 percent of patients successfully arrived at their follow-up appointment.
Two patients were incarcerated, and unable to go to their follow-up appointment. One patient preferred a different psychiatrist and was subsequently rescheduled.
More than 80 percent patient retention. Importantly, the enhanced care transitions program is successfully retaining over 80 percent of patients in the established outpatient services at 30-days post-discharge, far surpassing national retention rates.
"Tracking key outcome metrics really show us what we're successful at so we can modify our interventions and the program design."
– Heather Sievers
Performance Improvement Advisor
Allina has created a blueprint for other provider organizations to study to solve the problems that hinder some of our most vulnerable patients from receiving the compassionate care they deserve. Having demonstrated success and identified more patients who could benefit from the enhanced care transitions program, Allina is working to secure the funding required for program expansion.
1, 2, 3. Heslin, K. C. & Weiss, A. J. (2015). Hospital readmissions involving psychiatric disorders, 2012, HCUP statistical brief #189. Agency for Healthcare Research and Quality.
4. Finnerty, M. (2012, June 21). The quality concern: Behavioral health inpatient readmissions.


The phrase, "The more things change, the more they stay the same," describes the difficult situation President Jacob Zuma finds himself entangled in, as a social grant crisis unfolds, much to the panic of 17 million recipients as to whether they would get paid come 1 April.
Zuma has to choose whether to fire or keep a minister whose support he needs for his survivalist political strategy.
In January 2012, as the ANC prepared for an elective conference wherein Zuma vied for a second term, a major crisis of non- and late-delivery of textbooks to schools in Limpopo hit the country. As it emerged, Basic Education Minister Angie Motshekga knew about the looming crisis four months before the government had placed the provincial education department under national administration.
Expectedly, Zuma stood by her, despite a growing chorus of calls to fire her. He could not afford to fire her. As then ANC Women League (ANCWL) president, she carried the weight of the league's support for his re-election as ANC president. At the conference, the ANCWL carries the same weight as a province.
Perhaps, it was Zuma's turn to return the favour to Motshekga. In the latter stage of his protracted corruption case, Motshekga stood by him. In 2009, then as MEC for Education in Gauteng, she chose to go to Bloemfontein – where the Supreme Court of Appeal (SCA) set aside Judge Chris Nicholson's judgment that Thabo Mbeki and his cabinet had influenced the NPA's decision to reinstate the corruption charges against Zuma – over a meeting of the Council of Education Ministries (CEM) in Pretoria. As if that was not enough to lay bare how she undervalued her portfolio, Motshekga said one does not need an educational qualification to become a president, referring to Zuma.
Once more, Zuma cannot afford to fire Social Development Minister and ANCWL President Bathabile Dlamini over the social grant crisis in a run-up to the ANC's elective conference in December. She is running Nkosazana Dlamini-Zuma's campaign to become the next ANC president. As I explain in the article, "President Zuma has Proven to Be a Law unto Himself," Zuma would not only run the country from the grave, but also pull the strings within the NPA to avoid prosecution with Dlamini-Zuma as the number one citizen. She would just be a ceremonial president.
By firing Dlamini, Zuma would tilt the balance of power to Cyril Ramaphosa's faction, comprising Finance Minister Pravin Gordhan, Tourism Minister Derek Hanekom, and Chief Whip Jackson Mthembu, to name but a few. In contrast, his faction, which includes the Dlamini, Water and Sanitation Minister Nomvula Mokonyane, and State Security Minister David Mahlobo, to name but a few, as well as the ANCWL and the ANC Youth League (ANCYL), wants him to fire Gordhan. Therefore, by firing Dlamini and leaving Gordhan, Zuma would sow seeds of disunity within his faction. He cannot afford to turn his faction against him at this crucial time.
Similarly, he cannot afford to fire Gordhan and leave Dlamini. This would also tilt the balance of power to Ramaphosa's faction and intensify calls for his resignation and/or the ANC to recall him. The once mighty Zuma is not anymore. More so, given that the Ramaphosa faction, led by Hanekom, has already tabled a motion of no confidence in him. The motion failed, but further weakened him to the core following Nenegate.
Before 9 December 2015 — the day Zuma fired Nhlanhla Nene as finance minister and replaced him with an economic nonentity in Des Van Rooyen, a blunder that plummeted the rand against the U.S. dollar and other major currencies — he could fire and appoint both ministers and deputy ministers willy-nilly, but not anymore. He is skating on thin ice.
In December 2016, delivering an ANCYL lecture on economic freedom, Zuma laid bare a failure by his faction to support him following Nenegate. "I can tell you sitting on my own being pushed to reverse the decision," he said. He asked the members whether they would defend him if he "takes another decision". Clearly, Zuma would have to think twice before he fires Gordhan.
In all fairness to Dlamini, her firing or resignation would not address the incompetence of the current administration, as the fish rots from the head. I have lost count of how many commissions of inquiry and ministerial and/or presidential task teams Zuma has appointed since taking over the reins in 2009, not to mention how long it takes to 'apply his mind' on their findings and implement their recommendations.
Simply put, Zuma is running the country with incessant commissions of inquiry and ministerial and/or presidential task teams to investigate the incompetence of the current administration and corruption. No wonder, while the commission of inquiry into university fees is underway, there are calls to institute commissions of inquiry into maladministration and corruption at Eskom, the SABC, and the South African Security Service Agency (SASSA), to name but a few public institutions embroiled in maladministration and corruption. Incidentally, the commission of inquiry into state capture is still on the way.
The social grant crisis has brought four issues to the fore. First, the ANC's failure to establish a central tender board, as promised in its 2014 election manifesto. Perhaps, the centralised system would have spared the 17 million social grant recipients from Dlamini's incompetence.
Second, an interregnum has crept in as degenerative factionalism within the ANC deepens in the run-up to the forthcoming elective conference. Dlamini had over two years to address the social grant crisis. Instead, she focused on factional interests so much that she forgot the Cash Paymaster Services (CPS) contract, which the ConCourt nullified it in 2014, expires on 31 March this year.
The ANC is in the latter phase, namely degenerative factionalism, with factional interests at the centre of it all, from clientelism to privatised incentives. The outcomes of it are manifestly playing themselves out in the public, from decisional stalemate to instability and from political corruption to grotesque usage of state resources, all of which impinge on the party's reputation.
Third, the state lacks capacity to provide public services. As a result, ropes in private service providers to provide them. This sows a seed of private-public sector corruption. One has to give it to the EFF in this regard. As one of its seven non-negotiable cardinals, the EFF wants to build a state capacity for government to provide public services in order to end the private-public sector corruption.
Four, the ANC's hypocritical scrimmage on the white monopoly capital and the so-called radical socio-economic transformation have once more come to the bare. It talks left, but walks right. The CPS is the subsidiary of U.S.-based Net1 UEPS. It is not a black-owned company, not even Gupta-owned. Yet Dlamini fights tooth and nail to continue enrichment of the same white monopoly capital. Talk of hypocrisy at its best.
Molifi Tshabalala is an independent political commentator.


The real estate industry in India is quite changed than what it used to be yesterday. We have flashy real estate developers who spend lavishly on full-page ads, we have acres of unused land ready for development and we have seen hamlets turning to developed cities too quickly than anticipated. The overall growth was really outstanding, but then are we still missing out on something? Is India's real estate industry has not received its due growth? If it is so, why? We take a look at different aspects of India's real estate industry. Read on!
According to some research done on property trends, and India's evolving reality, we are facing 22.7 million housing shortage and to count on the claims the shortage can be overcome as quickly by 2022.
Although the aim is quite rational and there's no reason denying it, the sector has not matured yet to fully take on the ambition and cater to everyone's housing goals too quickly, despite government's regular developmental steps aimed at simplifying property buying process.
Reasons are no surprises. India is developing. And it is giving rise to a set of issues by the way. The rise in nuclear families, migration of people from villages to urban localities, need for corporate settlement as companies are evolving and rising income level – but despite the positive factors which positively work as growth deciders, the country is still facing a great number of issues for the growth of reality.
People are not keen to buy new properties, people are not interested in reduced interest rates on home loans, and they are not showing too much of inclination to give the real estate sector a definite push – which is why we have unoccupied flats, unused inventories and pending invoices left from the part of real estate developers. They are even not keen to stay on new projects because of the time, effort and money required to begin a new project.
But, why? Why are Indian consumers not being so interested despite so many developmental efforts from the government are done to simplify the real estate sector?
We have REIT to regulate property decisions, reduced home loans, buyer protection system, improved range of scrutinized property developmental system and governing bodies taking the sides of buyers. Despite, why India's real estate industry is making a sluggish growth?
People are trying to get in new flats on a rented basis than to opt for new flats. It is because people are not investing a good amount of money on the new property purchase.
People are now picky about choosing real estate developers. Some incidents of property frauds and delayed property developments even from established players are negating the impression of established developers. This is, in turn, creating a bad impact of the real estate industry.
As mentioned, property developers are trying to lure in more customers to overcome the sluggish growth of property purchase process. But people are demanding. They need more rewards. A lucky draw does not work the purpose.
Real estate developers need more innovative means and innovative techniques to tell consumers that they should come forward to invest money. But the rising cost of operational complexities and rise in spending has made developers to limit their offline branding.
These are some of the reasons why Indian consumers are not buying property in bulk and despite there is a growth indicator people are preferring to wait. Having said that it does not mean that people are actually refraining from buying the new property.
Some cities are reported to get hiked demands from consumers and some cities are getting an increased set of queries. It is positively contributing to the growth factor; but when we talk about the overall growth of the real estate industry in India, the sector is still struggling to get in new consumers.
Property purchase processes are not complicated in India, and with the government taking developmental steps to uncomplicate the process, people are coming forward but there is a pause in growth; which when overcome; will result in a bubble burst for the real estate industry.
In gist, we can say that real estate industry in India is enough developed to scale on growth, and as consumers build trust and get more affordable options to invest in it, the sector will positively rise to a new level of growth. Till then, the sluggish growth will be in practice, but it will overcome soon.
How Real Estate Websites are Changing The Way Consumers Choose To Buy Property?


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Ottawa Times: Kinzinger hopes House passes bill to 'fully fund' the border
Congressman speaks with president during roundtable
President Donald Trump speaks about immigration and family separation during a meeting with the members of Congress, including U.S. Rep. Adam Kinzinger, R-Channahon (second from the top on right) in the Cabinet Room of the White House on Wednesday in Washington.
President Donald Trump signed an executive order Wednesday halting his administration's policy of separating children from their parents when they are detained illegally crossing the U.S. border.
Prior to Trump signing the order, U.S. Rep. Adam Kinzinger, R-Channahon, along with Congressional colleagues, met with the president during a roundtable discussion at the White House.
Kinzinger credited the president for boosting the morale of the military by investing in defense, and said the border wall between the U.S. and Mexico plays a role in international security. Kinzinger has supported increased border security.
"It's a bill we're going to bring up and hopefully pass in the House this week fully funds the border and takes care of these issues," Kinzinger told Trump. "And I hope the House can pass it, and I wish Democrats will join us, because there's a lot of stuff in there they'd like, because it's an 80 percent issue, but unfortunately I think they like the politics of this a little better."
Trump's order does not end the "zero-tolerance" policy that criminally prosecutes all adults caught crossing the border illegally, according to the Associated Press. But it would keep families together while they are in custody, expedite their cases and ask the Defense Department to help house them. It also doesn't change anything yet for the some 2,300 children taken from their families since the policy was put into place.
Prior to Trump's announcement Wednesday, Kinzinger had issued a statement reiterating he was against the practice of separating children from their parents at the border, saying it "must end" and "it should have ended long ago."
"I am alarmed by the recent reports coming from the U.S.-Mexico border and urge the administration to take swift action," Kinzinger said in that statement.
He said he would support a standalone resolution to fix the issue, in addition to working with Congressional colleagues on a broader immigration plan.
"I hope my colleagues, on both sides of the aisle, will support the compromised package that increases border security, provides a permanent solution for the Dreamers, and makes the necessary immigration reforms that will reduce the high number of illegal border crossings," Kinzinger said in the statement.
"In my Air National Guard service, I have worked along the border in patrol and other missions, and I know firsthand that it is not secure nor entirely safe," he added.
The congressman said he is not supportive of parents putting their children in danger by illegally crossing the border, saying "these parents are putting their children at risk for human trafficking, amongst other dangers."
His political opponent Sara Dady, an immigration attorney from Rockford, has been critical of Kinzinger and Congress for not passing the Dream Act. She said it is lawful for refugees to seek asylum in the United States.
"Trump says he will undo his policy of family separation at the border. Lessons learned 1) there is no law required government sanctioned child abuse and 2) there should never be a policy requiring government sanctioned child abuse. Let's see if he keeps his word," Dady tweeted Wednesday.
Until Wednesday, the president, Homeland Security Secretary Kirstjen Nielsen and other officials had repeatedly argued the only way to end the practice was for Congress to pass new legislation, while Democrats said Trump could do it with his signature alone.
"We're going to have strong, very strong borders, but we're going to keep the families together," said Trump, who added that he didn't like the "sight" or "feeling" of children separated from their parents.
Trump's order may create a fresh set of problems and may well spark a new court fight, according to the Associated Press. It's unclear what happens if no changes to law or the settlement take place by the time families reach the detainment deadline. The language also leaves room to separate children from parents if it's best for the child's welfare.
It's also unclear what will happen to the children already separated. Health and Human Services Secretary Alex Azar said his department will start reuniting detained immigrant children with their parents — but he made no specific commitment on how quickly that can be accomplished. And officials said the cases of the children already separated and turned over to their custody would proceed as usual, according to the Associated Press.
The "zero tolerance" policy put into place last month moves adults to the custody of the U.S. Marshals Service and sends many children to facilities run by the Department of Health and Human Services.
The policy had led to a spike in family separations in recent weeks, with more than 2,300 minors separated from their families at the border from May 5 through June 9, according to Homeland Security.
The original article, which was contributed to by the Associated Press, can be found on the Ottawa Times website, MyWebTimes, here.
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Adam Kinzinger is a member of the Air National Guard. Use of his military rank, job titles, and photographs in uniform does not imply endorsement by the Department of the Air Force or the Department of Defense.
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