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What does Ignacio Isusi offer?
When you have achieved success and still ask yourself what is missing, coaching may be the answer.
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Managing your own life is not easy in those circumstances, especially if they happen suddenly or when you are very young.
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Reach out to me and we will start your process of personal and professional transformation. Welcome to your new life.


text:
Public Defender's Office employee arrested for OVI, drug possession on I-275
Administrators confirmed she is not an attorney, but a supervisor for guardians ad litem
Updated: 12:00 AM EDT Sep 19, 2018
Dan Griffin
WEBVTT WOMAN WAS DRIVING UP THEN -- CALLERS SAY THE WOMAN WAS DRIVING AT THEM HEAD-ON. >> YOU JUST LIKE, OH MY GOSH, I'M GOING TO DIE AND YOU HAVE TO GET OFF THE ROAD REAL QUICK. DAN: JOHN ELLINGHAUSEN IS GLAD TO BE ALIVE, AFTER NEARLY BEIN HIT HEAD-ON AT ABOUT 1:00 A.M. MONDAY. >> I WENT OVER INTO THE RIGHT LANE, LUCKILY THERE WAS NO OTHER TRAFFIC, JUST THIS CAR AND ME, WENT OVER INTO THAT LANE AND SURE ENOUGH, I SAW THAT CAR COMING OVER TOO, THEY CROSSED THE LINE, LIKE THEY'RE GOING T HIT ME HEAD ON. DAN: HE WAS ON HIS WAY TO WORK. HE WAS ALSO ONE OF SEVERAL WHO CALLED 911 AFTER COLERAIN TOWNSHIP POLICE SAY SUSAN ZILLICK, WAS SPOTTED DRIVING WESTBOUND IN THE EASTBOUND LANES OF I-275 NEAR COLERAIN AVENUE. >> HE HAS HIS EMERGENCY FLASHERS GOING. HE WAS GOING SO FAST, I COULDN'T EVEN SEE WHAT COLOR THE CAR WAS. >> IT'S A RED SUV, BUT THEY'VE BEEN DRIVING ON THAT SIDE OF THE STREET FOR LIKE 10 MINUTES. >> HE WAS IN THE CENTER LANE AND WE WERE IN THE CENTER LANE AND HE WAS NOT MOVING. SO WE GOT OVER REAL QUICK AND HE WAS GONE. DAN: TONIGHT, WLWT UNCOVERED ZILLICK IS AN EMPLOYEE OF THE HAMILTON COUNTY PUBLIC DEFENDER'S OFFICE. SEEN HERE ON THEIR WEBSITE. ADMINISTRATORS CONFIRM SHE IS NOT AN ATTORNEY, BUT A SUPERVISOR FOR GUARDIAN AD LITEMS, EMPLOYEES WHO REPRESENT CHILDREN IN JUVENILE COURT. THEY SAY SHE IS ON PAID ADMINISTRATIVE LEAVE. POLICE SAY WHEN THEY FINALLY STOPPED ZILLICK, SHE SMELLED OF BOOZE, WAS UNAWARE OF WHAT WAS GOING ON AND HAD URINATED HERSELF. OFFICERS ALSO FOUND PILLS AND NOTICED HER JEEP HAD DAMAGE DOWN THE SIDE. ELLINGHAUSEN IS GRATEFUL HE'S HERE TO TALK ABOUT IT. >> THEY WERE GOING TO CRASH, THERE WAS NO SLOWING DOWN, THEY WERE GOING TO HIT SOMETHING OR SOMEBODY. DAN: ZILLICK'S BOSSES TELL ME THEY'VE HAD NO ISSUES BEFORE THIS. THEY SAY IF CONVICTED, THEY'D HAVE TO MAKE A DECISION ABOUT HER JOB. I ALSO TRIED TO TALK TO ZILLICK, BUT SHE HUNG UP ON ME. LIVE DOWNTOWN, DAN GRIFFIN, WLWT NEWS
A supervisor with the Hamilton County Public Defender's Office was arrested and charged with OVI and drug possession after driving the wrong way on I-275 on Monday.Several scared people called 911.Callers described a car coming at them head-on, and some said the driver had no lights on and was flying."You're just like, 'Oh my gosh, I'm going to die' and you have to get off that road real quick," John Ellinghausen said.Ellinghausen is glad to be alive after nearly being hit head-on at about 1 a.m. Monday."I went over into the right lane. Luckily there was no other traffic, just this car and me. Went over into that lane and sure enough, I saw that car coming over too. They crossed the line, like they're going to hit me head-on," Ellinghausen said.He was on his way to work during the frightening situation.Ellinghausen was one of several people who called 911.Colerain Township police said Susan Zillick, 48, was spotted driving westbound in the eastbound lanes of I-275 near Colerain Avenue."He has his emergency flashers going. He was going so fast, I couldn't even see what color the car was," Ellinghausen told a dispatcher.Other people gave descriptions of the situation from their point of view."It's a red SUV, but they've been driving on that side of the street for like 10 minutes," another caller told dispatchers.Another woman told a dispatcher of a quick maneuver to avoid being hit."He was in the center lane and we were in the center lane and he wasn't moving, and Chuck, my husband, was like, 'What the hell?', so we got over real quick and 'Boom!' He was gone," she said.WLWT uncovered that Zillick is an employee of the Hamilton County Public Defender's Office.She still had a profile on the organization's website as of Wednesday.Administrators confirmed she is not an attorney, but a supervisor for guardians ad litem, who represent children in juvenile court.They told WLWT Zillick is on paid administrative leave pending further investigation.Police said when they finally stopped Zillick, she smelled of alcohol, was unaware of what was going on and had urinated on herself.Officers also found pills and noticed her Jeep had damage down the side.Court records show Zillick refused to take any sobriety tests.Ellinghausen is grateful he's here to talk about it."They were going to crash. There was no slowing down. They were going to hit something or somebody," he said.Zillick's bosses said they've had no issues before this incident.They said if convicted, they'd have to make a decision about her job.WLWT also tried to talk with Zillick, but she hung up the phone.She is set to be back in court next month.Arrest records show she is charged with drug possession, OVI, operating with no headlights and driving the wrong way on a one way street.
COLERAIN TOWNSHIP, Ohio —
A supervisor with the Hamilton County Public Defender's Office was arrested and charged with OVI and drug possession after driving the wrong way on I-275 on Monday.
Several scared people called 911.
Callers described a car coming at them head-on, and some said the driver had no lights on and was flying.
"You're just like, 'Oh my gosh, I'm going to die' and you have to get off that road real quick," John Ellinghausen said.
Ellinghausen is glad to be alive after nearly being hit head-on at about 1 a.m. Monday.
"I went over into the right lane. Luckily there was no other traffic, just this car and me. Went over into that lane and sure enough, I saw that car coming over too. They crossed the line, like they're going to hit me head-on," Ellinghausen said.
He was on his way to work during the frightening situation.
Ellinghausen was one of several people who called 911.
Colerain Township police said Susan Zillick, 48, was spotted driving westbound in the eastbound lanes of I-275 near Colerain Avenue.
"He has his emergency flashers going. He was going so fast, I couldn't even see what color the car was," Ellinghausen told a dispatcher.
Other people gave descriptions of the situation from their point of view.
"It's a red SUV, but they've been driving on that side of the street for like 10 minutes," another caller told dispatchers.
Another woman told a dispatcher of a quick maneuver to avoid being hit.
"He was in the center lane and we were in the center lane and he wasn't moving, and Chuck, my husband, was like, 'What the hell?', so we got over real quick and 'Boom!' He was gone," she said.
WLWT uncovered that Zillick is an employee of the Hamilton County Public Defender's Office.
She still had a profile on the organization's website as of Wednesday.
Administrators confirmed she is not an attorney, but a supervisor for guardians ad litem, who represent children in juvenile court.
They told WLWT Zillick is on paid administrative leave pending further investigation.
Police said when they finally stopped Zillick, she smelled of alcohol, was unaware of what was going on and had urinated on herself.
Officers also found pills and noticed her Jeep had damage down the side.
Court records show Zillick refused to take any sobriety tests.
Ellinghausen is grateful he's here to talk about it.
"They were going to crash. There was no slowing down. They were going to hit something or somebody," he said.
Zillick's bosses said they've had no issues before this incident.
They said if convicted, they'd have to make a decision about her job.
WLWT also tried to talk with Zillick, but she hung up the phone.
She is set to be back in court next month.
Arrest records show she is charged with drug possession, OVI, operating with no headlights and driving the wrong way on a one way street.

redpajama_set_name: RedPajamaCommonCrawl


My MacBook has become very slow recently and not because of any software update. But it just became suddenly slow. Logging in to my account takes 2 minutes and even opening a …... Every device sooner or later begins to run slower and slower. Even the Mac, which is a highly-efficient Apple product, starts to slow down and becomes a real pain to use over time.
Like all electronics, after time, MacBooks begin to run much slower than they did when they were originally purchased. One of the most common questions at any Apple store is, "Why is my Mac so slow?" how to get gems fast in dragon city on facebook Troubleshoot a Slow Running Mac. Whether you have an old Mac or a brand new one, they will eventually slow down and you might spend a significant amount of time on load screens or waiting for apps to start responding.
Troubleshoot a Slow Running Mac. Whether you have an old Mac or a brand new one, they will eventually slow down and you might spend a significant amount of time on load screens or waiting for apps to start responding.


text:
France protecting data rights as it forges new cybersecurity cooperation with India
Home News / Blog France protecting data rights as it forges new cybersecurity cooperation with India
France is taking a proactive role in strengthening its cybersecurity cooperation with India, signing a new agreement to combat cybercrime to protect its citizens and business sectors.
Over the past year since GDPR was introduced in the European Union, France has been keen to work with international partners on data rights and data security as a whole.
AI, 5G and digital commerce were among the key topics at a summit in New Delhi between France and India in October, attended by France's National Cybersecurity Agency along with 130 delegates from both countries.
As technology starts to become a bigger part of our lives, France and India have been looking at ways in making sure data transference between states is safe, and that the laws which govern people's data, are replicated between friendly nations. This goes without saying that people's individual rights as data subjects is becoming a key topic of discussion, particularly as there remain considerable cybercrime threats for citizens around the world.
Companies and governments have also been seeking ways to improve data architecture, data security and network security as a whole in their discussions, keeping in mind the ever evolving landscape, and how data is being used, stored and processed in different countries - often by multinationals, but increasingly by small businesses and tech startups.
At the GITEX Technology Week in Dubai back in October, multinational companies gathered to display the latest innovations in tech, including advancements in AI and IoT devices - laying the foundation for a new era of technological innovation and inter-connected systems where digital citizen rights will take centre stage.
Verity Systems, a manufacturer providing data security solutions for governments, businesses and medical institutions, has been working behind-the-scenes to develop new tools that can securely erase data records from different types of media. And with the evolving data landscape, legacy network systems and hard drives are being retired with a stronger emphasis being placed on secure data erasure of personal information that is no longer in use.
With the risks associated in improperly handling data disposal, and the very nature of data rights and people's personal information, businesses and governments are taking note of the evolving landscape of technology, and how to deal with the careful disposal of older systems which will be made redundant by newer innovations and technological breakthroughs.
In our ever evolving digital landscape, we are only seeing the beginning of what will be a transformation of the digital ecosystem we see today, and when it becomes more closely integrated, across borders, digital citizen rights will be a key priority for countries moving forward.
To find out more about degaussing, and how data can be securely removed from hard drives, explore some of the links below. You can also speak to one of our technical advisors by contacting [email protected]
The Crunch 250 Hard Drive Destroyer
Degaussing hard drives with the DataGauss Max
What is hard drive degaussing?


I bought a new laptop that has Windows 7 Pro on it.
I tried installing LMDE2 and when it finally loaded and I input my settings, I just had to edit the partitions and let it finish.
Unfortunately, my laptop had all 4 primary partitions used up.
I'm afraid to move HP_Tools because I know some tools are used during the login and it has directories called BIOS, BIOS UPDATE, and other important directories.
But, I'm sure someone must have a dual-boot HP laptop. I've got the ProBook G2. Can someone give me some suggestions how I can make this dual boot?
Last edited by webtarget on Sun Feb 07, 2016 11:52 am, edited 2 times in total.
You can remove the sda3 Recovery partition. BUT, first you have to back it up. Do NOT remove any of the other partitions.
You should find an option in either Windows or HP Assistant to create system recovery DVD's. You may also be able to save it on a portable hard drive. Once you have created the backup, HP Assistant will remove the Recovery partition.
Note, you can only do this ONCE. Make sure your backup was successful before you proceed with the deletion.
You will lose the ability to do a factory reset, because the partition is gone. If you need to reinstall Windows, you do it from the DVD's you made or the portable hard drive.
I have a HP dv7 laptop and had to do this just so I could make an extended partition for Windows D: and E: volumes. I suggest you invest in some imaging software such as Acronis to make regular backups of your laptop. Acronis will backup both Windows and Linux.
Using Acronis, I have always kept regular system images, and restored from earlier backups when things broke. I have never needed to use the recovery DVD's.
Edit: Just saw your posts number. Assumed you were a newbie. So I guess you already know how to do system images. But the info on the Recovery partition will help other HP users.
Delete HP_TOOLS (sda4). That particular partition just contains some useless HP tools which you won't miss. Don't delete HP_Recovery (sda3): you might need that at some point (for example when selling your laptop to a Windows user).
I've owned several HP laptops in the (recent) past, and that's what I always did.
I recently had this problem when I installed Mint on my brother's laptop. I used Clonezilla to back up all 4 partitions, then partitioned the drive the way I wanted it with gparted. I made the 4th partition an extended partition, and put the HPTools and Mint in the extended partition. Don't know if this is the easiest way, but it worked.
This example shows a GPT disk. If the response line read "msdos," that would indicate an MBR disk.
Thanks, didn't try your suggestion yet, but, I doubt it's GPT, the installer (GParted at that point in time) said I can't create a new partition. But, you got me thinking of converting this laptop to GPT. The only thing is that it seems like a lot of work because I'll have to make 4 images and I only use Windows on my laptop for 2 applications: My scanning software, and tax software, which only happens once a year.
I'm thinking the easiest and most efficient suggestion is removing the HP_Tools and putting linux there.
Pjotr wrote: Don't delete HP_Recovery (sda3): you might need that at some point (for example when selling your laptop to a Windows user).
Good point. I have no intention of selling my laptop, so opted for removing the huge recovery partition instead.
Interesting you said the Tools partition is not needed. Gives me another one I can delete if I ever needed to. My laptop can hold two HDD's, so Mint is on one and Windows on the original.
webtarget wrote: I only use Windows on my laptop for 2 applications: My scanning software, and tax software, which only happens once a year.
In that case, forget dualboot, install windows in VirtualBox.
to include partition sizes, as well ?.
actually did help another user to dual_boot, after deleting that recovery partition - sda3.
- use the inbuilt tool to make some recovery disks, first.
it's usually a win boot disk & three system disks, for a total of four dvd's.
webtarget wrote: you got me thinking of converting this laptop to GPT.
Converting to GPT is possible, but also requires installing the EFI-mode Windows boot loader. This procedure is a little obscure, but is documented at various sites, such as this one. It's probably not worth the hassle in your case, unless you want to investigate EFI-mode booting or have a compelling reason to boot in that way.
This suggestion is well worth considering. Using VirtualBox to run Windows enables you to run it side-by-side with Linux and avoids all manner of dual-boot complications. The main drawback to this approach is that you'll need to re-install Windows, and possibly deal with licensing hassles. Depending on the software, you might be able to run it under WINE, which is another method of running Windows programs under Linux.
Regarding Virtualbox, if I install it and install Windows in there, can Windows be saved on a separate drive or partition?
The reason I ask is that in case I want to re-install Linux, I don't want it to blow away my Windows too, which takes way longer to install.
webtarget wrote: Regarding Virtualbox, if I install it and install Windows in there, can Windows be saved on a separate drive or partition?
The normal configuration for VirtualBox is to use files as virtual disks for the virtual machines. Thus, you can back up Windows just by copying one file. (The machine configuration is elsewhere, so you'd need to copy a directory tree to back up the machine configuration as well as the Windows installation.) If you like, you could devote a separate partition to VirtualBox to help separate it from Linux; or use a separate /home partition and keep the VirtualBox files there, which will also keep VirtualBox separate from the OS. If you really want to do so, you can set up VirtualBox to use dedicated partitions directly, but that's a more advanced configuration. I've seen documentation for doing this, but I haven't saved any URLs. I'm sure a Web search will turn it up.
Sorry for the delay. I've updated the first post with the partition sizes, if you're still interested. If I can just eliminate 1 partition, I'll be able to resize sda2 and create a new one for LMDE. I'm thinking sda3 is the best bet without having any effect on Windows. I'll just offload it to an old usb 2.0 stick I don't need anymore.
which is is a bit small - but this depend on what you intend to do with the Mint system.
- you may have to shrink the C: drive - sda2 - back a bit as well.
then the linux installer will detect that & place it into the linux boot menu.
For that reason i wanted to install the linux on a partition on the harddisk, next to my WINDOWS7. But .. my pc has already the 4 partitions in use.
Anyone has any idea why my USB stick seem to fail me very often ?? Would already resolve my worries.
And has someone the correct answer which partition i can delete safely ? Would not want to kill my complete Windows 7..
I have an HP Mini 110 with Windows 7 Starter 32 bit, and all 4 primary partitions were used. After a bit of scouring the web, I found that the partition that the Windows OS is in does not actually need to be a primary partition. I used Partition Wizard (I think - it was about 2 years ago) to change that partition to an extended partition. My Windows 7 Starter works perfectly fine (for Windows) and I am dual booting to Mint Mate 17.3. I don't know if this will work with Windows 7 Pro. The info that I read did state that this will not work with XP.


DICKSON, TN – For the Dickson County Cougars boys' and girls' basketball teams, it was good to be back home for the first time in the 2018 season on Tuesday night. It was short lived, however, as the Lady Cougars started the night with a 55-44 loss to the Brentwood Lady Bruins.
The Lady Cougars shot 31 percent from the floor on Tuesday, and 25 percent from beyond the arc. It was not enough to beat a Brentwood team that was led by sophomore guard Amelia Osgood with 28 points.
Osgood, and twin sisters Emily and Delaney Trushel combined for all 55 of Brentwood's points. It was a back and forth game the whole way, until Brentwood pulled away in the final period, outscoring Dickson County 17-8.
The loss drops Dickson County to 4-3 overall, and evens things up at 1-1 in District 11 play, while Brentwood improved to 7-1 overall and 2-0 in the district.
The boys' teams followed the girls' game, and it was a similar result. Dickson County could not overcome a slow start, and the defending district champions led the whole way to win 49-40.
"I'm proud of the effort in the second half" said Dickson County coach Jason Tigert, "the guys never laid down.
Brentwood held a 23-8 lead at halftime, and at one point led by 23 in the third quarter, however the Cougars kept fighting to cut the lead to 6 with under three minutes to play.
However, the slow start caught up to them, to hand Dickson County its first district loss of the season.
Kody Pardue led the Cougars in scoring with 12, while Brentwood leading scorer Jack Thurman put up 22 points.
That loss brings Dickson County to 4-4 overall, and 1-1 in District 11. Brentwood improved to 7-2 overall and got its first district win to get to 1-1.
Both Brentwood teams return home to play Spring Hill next, while Dickson County hits the road to face Ravenwood on Friday.


I've been thinking a lot lately about a funny biblical word. A word that sounds positively quaint to our ears, so little does anyone use it these days. In fact, I suspect the only time most of us ever hear it is when we're actually reading the Ten Commandments as we've done this morning. There it is, in #10. "You shall not… covet." To covet meaning simply to desire, to wish for something enviously.
On one hand the old fashioned language lends it a certain weight – the sin of covetousness – but I wonder how many of us actually take this commandment seriously?
But even when we make the connection, it's hard not to be dismissive – after all, we're bombarded with hundreds if not thousands of messages every single day designed (let's face it) to encourage coveting! If not our neighbors' slave or ox or donkey, then certainly his home theater system, her smartphone, or their car.
Not all of the Ten Commandments seem equally to inspire us to brag about breaking them – though the Sabbath one certainly does, in this fast-paced, 24/7 culture. (Rest? Who has time to rest? We're all so busy!) I think this one, about coveting, is considered to be decidedly outdated too. In a culture so driven by advertising, in an economy that relies so heavily on convincing us we must have things we don't really need, is it even possible to take the 10th commandment seriously?
And just how serious is it, anyway? I mean, sitting in a list alongside murder, theft, and adultery, why does coveting even rate a mention? How could simply wanting something (not taking it, mind you – that's commandment # 8… or distorting the truth to get it, which would have us in #9) why would just plain wanting it be so bad? What's the big deal?
Maybe the big deal is what coveting isn't.
For coveting is the opposite of contentment.
And "I want what he's got" prevents us from recognizing God's amazing gifts that already surround us.
Just listen for a moment and try to guess what this next quote refers to: "You want it. You want it bad. Sometimes so much it hurts. You can taste it. You feel like you would do anything to get it. Go further than they'd suspect. Twist your soul and crush what's in your way. Then you get it. And something happens. You become the object of your desire. And it feels incredible." Would you believe you've been listening to an actual perfume ad?
If you were with us a couple of months ago you'll remember reading Jesus' words in the Sermon on the Mount, where he reminded us that it isn't just what we do, but what's in our hearts that counts? So that not just murder, but hatred, is a problem; not just adultery, but lustful thoughts? I'm reminded of that gospel teaching when I read this tenth commandment. Because apparently, it's not just lying and stealing that can be destructive. It's also our desire for more.
OK, so coveting is really bad – it made the top ten list of things we oughtn't do, even –yet we live in a society designed precisely to make us covet. The advertising industry isn't likely to slow down anytime soon. So it sounds like a Catch-22 to me. It makes me wonder if there's any way out.
There is, but it turns out we need to revisit that other most neglected commandment to find it. Would you believe we already have in our hands a secret antidote formula to help us avoid the sin of coveting, of wanting more? And it sits right there disguised as… Sabbath.
What's the connection? Sabbath, one day each week to step away from the rat race, to step away from keeping up with the Jones's, to take a break from working and rushing and shopping till we drop.
I'm sure many of my teenage daughters' friends would be dismayed to hear me say this, but a day at the mall probably isn't the best way to spend a Sabbath, in order to take full advantage of its life-giving benefits. The purpose of Sabbath, after all, is to step away from the pressures of the world in order to reconnect with ourselves, with our loved ones, and with God. One of those worldly pressures is the pressure to acquire the newest and best, the latest and greatest.
This isn't a guilt trip, honest – it's an invitation. And I'm preaching to myself as much as I am to anyone else. But to regain our sense of perspective and our priorities, we do need to step away once in awhile.
For each of us I imagine it could look a bit different, what any one of us would most benefit from stepping away from. When it comes to allowing the Sabbath to help us avoid the sin of coveting, we might hear an invitation like: Put down the catalogs. Step away from the home shopping network. Or just plain unplug – literally, as well as metaphorically. Step away for an hour or two. Better yet, the Scriptures tell us, step away for a whole day. Leave the whole advertising-dependent economy behind, stop comparing your life to others' lives on social media, and do something else entirely. Then sit back and watch your priorities begin to fall back into place. The promise is that when we claim that time away, we'll discover ourselves wanting less, because we'll remember how much we've already been given.
Not that our priorities will magically stay in place – that's why we're invited to do this every single week. Otherwise even Sabbath couldn't compete with the other messages we hear.
Bottom line: coveting has been an issue for God's human creatures from day one. Adam and Eve wanted more fruit than was good for them. The children of Israel, wandering through the wilderness, wanted to hoard more manna than they really needed. The fact that coveting made it into the Ten Commandments only further emphasizes that it has been an issue all along. But –here's the good news – our tendency to violate that pesky tenth commandment can at least begin to be countered by the gift of the fourth. Remember the Sabbath Day. Step away from the rat race. Step away from consumerism. Regain your perspective. Reclaim your life.
Obviously the danger is we'll continue to ignore both commandments and become entirely swallowed up by the culture – we're exposed to vastly more "buy me" messages than any prior generation. It'll take some doing not to be brainwashed into believing what we're told about what we must have. Interestingly we are also, in this culture, very likely to forget to slow down, rest, step away and regain our perspective through the gift of Sabbath.
Think of the most memorable, amazing moments in your life. How many of them required a shopping trip? How many of them were affected by anything a neighbor had or wore or drove? I'll wager not a one. The best things in life are unattached to anything the advertisers can sell us. Because as hard as they try, they can't package love. For that matter they also can't sell awe, or mystery, or holiness, or peace. But these things are already there, absolutely free, if we'll just stop long enough to notice them. Grace upon grace upon grace.
"Thou shalt not covet." It's a hard word. But God in his infinite wisdom also offers us this complementary commandment that helps us keep it. Thank God one of the things we most need to avoid breaking the tenth commandment is already given us in the fourth. Let's claim the antidote formula! Step away, for a time, from all that's out there trying to convince us the key to the good life is more stuff. Step away, and watch the transformation in our hearts from coveting to appreciating, from wanting to celebrating.
Sabbath can be hard to come by in our go-go-go culture, where as often as not when we ask each other "How are you?" we get answers about being so busy we can't keep up. Sabbath rest, for some of you, may at this moment feel utterly out of reach.
But how might it transform your life to remember that God not only invites you, but commands you, to stop, catch your breath, and rest? What small changes could you make– even this week – to make it possible for you to keep this commandment in some way, rather than assuming it's utterly impossible, and ignoring it completely?
I imagine summer's as good a time as any to give it a try.
Maybe you haven't been thinking about that funny old biblical word, specifically. But if, like me, it concerns you that our society encourages us to covet, I urge you over the next few months to step away for a Sabbath, as long as you can, as often as you can. And watch your "I want's" begin to morph into "thank you's" and your "I need's" into stories of amazing grace. Amen.


text:
The Government requests State units to find measures to boost export of agricultural products
The resolution of the regular Government meeting in March 2018 has just been promulgated by the Government to direct many ministries and sectors to urgently carry out many tasks in order to meet the objectives
The resolution stated that the Government agreed on a target of economic growth in 2018 of at least 6.7% and determined to strive to achieve higher levels in order to create momentum for 2019, while improving the quality of growth. The Government requests the ministries, agencies and localities to continue their efforts and take initiative in carrying out drastic, synchronous, and effective tasks and solutions according to the resolutions of the Party, the National Assembly and the Government.
Accordingly, the Ministry of Planning and Investment regularly monitors the socio-economic situation and the implementation of the growth scenarios of each sector and the whole country, and produces quarterly reports to the Government and the Prime Minister. Assuming prime responsibility and coordinating with the Ministry of Science and Technology in studying and evaluating the impact and formulation of the national strategy on the industrial revolution 4.0.
The ministries and agencies managing the prices of essential commodities and services shall take the initiative in closely coordinating with the Ministry of Finance in order to propose the roadmap for price readjustment at the appropriate levels and report them to the Prime Minister, ensuring the target of controlling inflation.
Timely response to changes in trade policies of other countries
Ministries, agencies and localities shall continue to take drastic and synchronous measures to speed up the economic restructuring together with renewing the growth model and raising the labor productivity, quality, quantity, efficiency and competitiveness. Focusing on the task of equitizing state-owned enterprises, divesting state capital, ensuring the completion of the plan in 2018 which has been approved by the Prime Minister. Intensifying the work of inter-branch coordination in removing difficulties and solving problems in the implementation of projects, especially the infrastructure works, energy and key industrial production to open resources, improve production and business efficiency.
The Ministry of Industry and Trade shall assume the prime responsibility and coordinate with concerned ministries and agencies in settling and responding promptly to changes in trade policies of countries which affect export. Studying and taking defensive measures in accordance with international commitments signed by Vietnam in order to protect domestic production and consumption. Adopting solutions and policies to step up the development and strictly control the domestic market, the retail distribution system and new forms of business and e-commerce.
The Ministry of Agriculture and Rural Development shall increase forecasts and recommendations on agricultural production, ensure the balance between supply and demand, and review the plannings of each branch. Coordinating with localities in propagating and raising awareness and mobilizing farmers. Assuming the prime responsibility and coordinating with the Ministry of Industry and Trade, the Ministry for Foreign Affairs, the Ministry of Finance (the General Department of Vietnam Customs) in working out measures to boost the export of main agricultural products.
The Government requires the ministries and agencies to strictly implement the recommendations of the Task Force to inspect the implementation of the Government's tasks, which will focus on reviewing the list of products, goods, specialized inspection procedures and business conditions in the fields in charge of simplifying, reducing or abolishing business conditions, to promptly formulate and report to the Government a draft decree amending many decrees on business conditions and specialized inspection procedures under its management.
Concentrate on handling establishments which pollute the residential environment
Also in this Resolution, the Government requested the Ministry of Natural Resources and Environment to intensify the inspection, examination and handling of violations and prevent and control projects and works which cause environmental pollution. Coordinating with localities in settling establishments which pollute the environment of residential areas. Assuming the prime responsibility and coordinating with the Ministry of Agriculture and Rural Development for organizing conferences on land-use mechanisms and policies, raising land-use efficiency and conferences on strengthening land management in State owned agro-forestry farms.
The Ministry of Transport shall expeditiously work out plans on accelerating the construction of important traffic infrastructures which have been promulgated. Attention should be paid to speeding up the construction of Trung Luong - My Thuan and My Thuan - Can Tho expressways.
Praise 7 Ministries announcing plans to cut specialized inspection procedures
The Government praised the Ministry of Justice, the Ministry of Industry and Trade, the Ministry of Transport, the Ministry of Health, the Ministry of Construction, the Ministry of Agriculture and Rural Development, the Ministry of Labor, War Invalids and Social Affairs which have simplified 50% of the list of goods, products and procedures of specialized inspection and business conditions. Requesting ministries and agencies according to their functions and tasks to be promptly promulgate according to their competence or submit to the Government for consideration and promulgation of the decrees on the reduction of business conditions and specialized examination procedures.
The Ministry of Foreign Affairs shall study the dynamics and change of policies of other countries, promptly advise and propose to the Government and the Prime Minister about the appropriate solutions. The Ministry of Public Security shall direct competent forces to intensify the inspection in apartment buildings; organizing fire prevention and fighting exercises for the people, to promptly arrange and consolidate the fire prevention and fighting forces, ensuringefficient operation.
Improve the contents of specific mechanisms and policies to support Ninh Thuan province
Regarding the draft resolution of the Government on specific mechanisms and policies to support Ninh Thuan province in socio-economic development and stabilization of production and people's life in the period 2018-2023, the Government requested the Ministry of Planning and Investment to assume the prime responsibility and coordinate with the relevant ministries and branches and the People's Committee of Ninh Thuan province in absorbing opinions of the Government members and finalizing the contents of specific mechanisms and policies to support Ninh Thuan province to develop its economy, socio-economic development, production stabilization and people's life in the period 2018-2023; to send to the Ministry of Justice opinions on contents and forms of documents, ensuring compliance with the provisions of the Law. On that basis, completing the document submitted to the Prime Minister for signing in May 2018.
The Government has recognized the proposal of the People's Committee of Ninh Thuan province, continued to pay attention and facilitate the development of Ninh Thuan province. Assigning the relevant ministries and branches according to their assigned functions and tasks, study and handle them according to regulations. With regard to matters under the competence of the Standing Committee of the National Assembly and the National Assembly, the Ministry of Planning and Investment shall assume the prime responsibility and coordinate with the relevant ministries and agencies in reporting to the National Assembly's Standing Committee for consideration and decision.


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On our show this week Mark Graban, an internationally-recognized expert in the world of lean healthcare, in a discussion on lean hospitals and ways to reduce healthcare costs. Lean hospitals aim to reduce healthcare costs by eliminating wasted funds, increasing patient care, and keeping hospitals profitable.
Be sure to share any of our shows with friends and family you think may find them interesting or helpful! You may read a complete transcript of the show below.
Carmela J: Hello and welcome! It's now 5:06 and it's time to get some good tips on The Conversation on News Talk WOKV where health and wellness are explained. I'm your host Carmela J. and of course I'm here with our weekend expert Dr. Ali Kasraeian. Hello sir, how are you doing this evening?
Dr. Ali Kasraeian: I am good!
Carmela J: Are you enjoying this dreary weather?
Dr. Ali Kasraeian: It is very rainy outside but I'll tell you, I love rainy weather. I'll tell you one thing that it does on Saturdays. It doesn't make me feel guilty for prepping for the show.
Carmela J: Oh, there you go!
Dr. Ali Kasraeian: Because I'm sitting like a student reading. Thank you everyone! Thank you for joining us on The Conversation today. We have a lot of exciting things to talk about. We have a guest Mark Graban joining us from Texas to discuss this very interesting concept of lean hospitals. I'm very excited to talk about that and I'll introduce him in a second. One very exciting thing I noticed today while I was opening up the paper – have you heard about the idea of bioengineering organs and kind of all that?
Dr. Ali Kasraeian: So far to date, in actually a pediatric urologist in North Carolina bioengineered bladders that were implanted in children with dysfunctional bladders. They've done noses. They've bioengineered arteries to use in people.
Dr. Ali Kasraeian: They are close to what some call the Holy Grail of bioengineering, the human heart.
Dr. Ali Kasraeian: A group out of Spain led by Dr. Fernandez Viaz has gone to the concept of a very elegant way of working towards hopefully in the near future creating a bio-engineered human heart, which will revolutionize the idea of transplant. For two factors, there's a limit in terms of donors available. But two, when people have transplants they have to be on immunosuppressive medications for their life, and that is a challenging thing to do because it increases your risk of infection, it suppresses your immune system. With this idea, what they've done is take cadaver hearts and they put them in this potentially a bio-detergent, which washes away all the cells within three to four days. After that, you have this scaffolding of collagen. So basically this matrix that sits there and they expose it to the patient's own stem cells.
Dr. Ali Kasraeian: Stem cells are basically cells at the beginning of development. So these cells can become anything. When they place them on this collagen in the right environment, and they're basically right now waiting for this thing called a bioreactor to finally become perfect for use, which recreates the environment of the human womb so it facilitates what's called organogenesis or the creation of organs. So these stem cells now become the heart so you can transplant essentially a donation of the patient's own heart cells formed in the heart to do that. The reason why this is so incredibly elegant is that the heart has multiple different types of cells. You need an electrical circuitry to create that pulse that you have and how it beats in a coordinated manner. And also the amount of blood that goes through the heart during a minute is incredible. This is for me at least mindboggling in terms of the amazing things science is doing.
Dr. Ali Kasraeian: Now that we spoke about that, we can get to our exciting show today everyone. Mark Graban is an internationally recognized expert in the field of lean healthcare. This idea of lean, which he will expand on hopefully for today it's very elegant and it's application to the healthcare field I think is very elegant. And he describes it in a number of different things. He blogs. You can go to markgraban.com to hear of some elegant discussions in terms of things that we can apply to individual healthcare from the office space, the hospitals. Kind of applying it to the global healthcare environment if you think a little bit through rose-colored lenses. He's got an award-winning book that I tried to read through as fast as I could over the past couple days. Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement. The idea of being more efficient. He's got a very interesting background of how he arrived at this and I will not delay the introduction anymore. So Mark, thank you for joining us today!
Carmela J: Hello Mark! How are you?
Mark Graban: I'm doing great, thanks!
Carmela J: So great to have you. Thank you!
Dr. Ali Kasraeian: To start with, I guess ultimately we want to move towards an explanation of what this lean idea is and how it applies to the hospital, but how did you become involved and interested in this idea?
Mark Graban: My own career kind of shadowed the adoption of practices from engineering and manufacturing, called lean, into healthcare. I'm an industrial engineer. Started my career working; I grew up in the Detroit area. I started working right out of college at General Motors in the mid-90's. We were very much trying to basically catch up to Toyota in terms of their quality and productivity. I worked in an engine plant. I learned very early on in my career, I was fortunate to work under a plant manager who had been one of the first GM people to work with Toyota in California at a plant that GM and Toyota ran together starting in the early 80's. I learned that lean, as a quality improvement methodology and a management system, first off it's about people. It's not rocket science or brain surgery, it's certainly not as complicated as creating an artificial heart that you were talking about. But it's this distinctly different approach to managing organizations and managing people. I had the chance back in 2005 to join a consulting group that was part of a division of Johnson & Johnson that was doing consulting work with medical laboratories and hospitals and health systems, and that is really where I got my first start in applying these ideas in healthcare. I'm certainly not the first one to have done this. There are cases in Michigan, in Seattle, dating back the latest the late 1990's of people learning from the auto industry, learning from companies like Boeing and bringing some of these kind of proven management and system improvement practices into healthcare.
Dr. Ali Kasraeian: What are some of the basic initial concepts of lean that you found intriguing not only as a general concept, basically with the Toyota concept from what I learned, they tried to be very efficient in minimizing what is, and I use this term all the time, but they specifically use the idea of waste which is any movement or effect or any kind of effort that you undertake that doesn't provide any value to that effort is eliminated to make you more efficient. Through that, they've created this increased productivity by reducing costs and being more efficient. Is that seemingly accurate in terms of the general concept of the beginnings of the lean concept?
Mark Graban: Yeah, I think that's a good start. We talk about, as you described it, waste is any work or time or activity that doesn't provide value to the patient. In a healthcare setting, value would be things like diagnosis, treatment, education, being comforted in the emergency department before you're diagnosed. Those really key steps that get us healthy or help keep us healthy as a patient. So lean is a very customer-driven philosophy and methodology, which is one reason it translates very well into healthcare. Physicians, nurses, other people working in healthcare are already incredibly patient-focused and compassionate and really concerned about their patients. Lean then gives them methodologies and a management system to help eliminate that waste so we that can focus more time on patients and more time on their care. A classic example of waste that a patient sees is time in a waiting room. There's actually some very innovative work. There has been a lot of great lean work in Jacksonville out of Medtronic and some other really innovative companies. In fact, in Jacksonville I had the chance to visit his clinic, there's a dentist named Sami Bahri who has essentially eliminated waiting room time for his patients. He's improved his own efficiency, he's improved his own outcomes for the patients and a really high level lean is really about both quality and efficiency. They go hand in hand as opposed to viewing those as some sort of trade off.
Dr. Ali Kasraeian: When you look at that in terms of the trade off concept with healthcare, one of the big things and a couple weeks ago we discussed the article out of Time Magazine, which talked about the excessive costs in the delivery of healthcare in the United States and how some of that may not have been necessarily essentially. I mean, it's a vastly complicated discussion but in terms of looking at the concept of lean, it's essentially trying to make more efficient and eliminate overhead.
Mark Graban: Well, you're trying to eliminate unnecessary costs. And you're right, the discussion in Time Magazine kind of goes to show healthcare is a very screwy market. It's a very complicated market. Where in the lean philosophy we say value is something the customer is willing to pay for. Now if we put ourselves in the shoes of being let's say a car buyer, it's very easy for us to evaluate the cost of different cars. We don't have to buy the car to then find out what they're going to bill us for after we've taken that car home. There's a lot of really great publicly available data on the quality of different cars and one thing that really hampers healthcare consumers or patients if somebody's proposing that you should probably have surgery, it's really hard to find data on infection rates at different hospitals to find out what the cost is going to be at different hospitals if you were to even try to call and find out I need to get a head and neck MRI, how much is that going to cost?
Dr. Ali Kasraeian: The problem with that a lot of times comes up with like you mentioned in terms of systems and a process issue is that the cost is very much dependent on so many factors, like your coverage whether it's Medicare, whether it's Medicaid, whether it's a private payer and things of that nature. And whether you're in that work, whether or out. You're very much right. The process itself inherently seems to create complicated conversations between patients and providers and patients and hospitals. The lean system, do they approach the concept of that aspect of healthcare in terms of the layers of complication that goes into even before you get to the bedside?
Mark Graban: Well, it's hard to think of cases where people have used lean principles to help simply that interaction between the payer and the provider and the hospital and the patient. There are some organizations that are doing some really innovative work where they have the advantage of being both the health insurer and the health provider. There's an organization in Washington State called Group Health Cooperative, which has done things to really break down some of the communication barriers between let's say the insurance arm of their organization and the primary care groups. But they have the advantage of being part of the same non-profit corporate structure as opposed to the barriers and different incentives that a separate insurance company and the hospital and then let's say the physician who's part of a stand alone physician group, they're part of different organizations with their own financial drivers. A lot of that is really inherent in our American system and lean is really more effective at the process level of somebody getting scheduled for a procedure. Using lean practices for example to make sure that all the insurance approvals have been done properly and all the lab testing is done properly before the patient arrives so you don't have to cancel or delay or reschedule your procedure. Lean tends to be really affective at addressing some of those things that people might run into.
Dr. Ali Kasraeian: I tell you, one of the things from my reading over the past week over the lean concept was, and we mentioned it on the show where we discussed the Time article. One of the frustrations that physicians and healthcare providers have, I think that we through our training and our inherent beliefs of what we do, we expect that if we do the right thing at the bedside, everything else would kind of take care of itself. Some of the things that the lean concept and some of your writings bring up is those efficiencies in the delivery in that process in the system make that a big source of frustration, not just for the physicians and the people in the healthcare delivery side of things, but also for the patients. Some of the concepts here look towards making that interaction a little bit stressful for everyone involved, and in turn being more efficient with better outcomes and having a little bit better decrease in that cost that seems to plague our healthcare system.
Mark Graban: Yeah, there's often times very mutual benefit to be had for, let's say surgeons and patients. Doing everything we can to have good systems and processes, that sets things up so that the surgeon has everything they need when they need it in the OR to help minimize the length of time a patient is under anesthesia to improve the efficiency of the OR, not by working faster but by eliminating problems and eliminating delays. The hospital is providing better service to the surgeon for all the support departments and support staff. Everything that has to happen to line things up for the patient and surgeon to be there and ready to go. That's also a great benefit for the patients in terms of not having to wait as long for surgeries or not have to wait as long in the waiting room or the pre-op area.
Dr. Ali Kasraeian: I'll tell you, the importance of that concept is very understated because it sets up that whole process of that day for someone being in the operating room both in terms of the patient, their family, and the surgeon. We're going to take a little break I hear?
Carmela J: Yep, that's right. It's 5:20. Today we will be talking about this concept of lean hospitals with our guest Mark Graban on The Conversation. Don't forget to call us at 340-0690. Stick around on News Talk WOKV.
Carmela J: Welcome back! This is Carmela J. and you are listening to The Conversation on News Talk WOKV. Thank you for staying with us! Tonight we've been talking about the concept of lean hospitals, and remember we want to hear from you. You can call us at 340-0690.
Dr. Ali Kasraeian: Welcome everyone and thank you for joining us on The Conversation! We are here on a Sunday. It's rainy outside and the lights are flickering in here. I feel like we're on like a 1920's radio show. We're joined today by our guest Mark Graban, an international expert on the concept of lean hospitals. Thank you Mark for joining us! Again, we're talking about this idea of lean and it comes from the way the Toyota Company looked at being more productive, more efficient, and thereby reducing costs. What Mark, what you have done with a number of different colleagues that you've worked with through the years has come up with the application of this concept and the understanding of that application to the healthcare system. On thing I was looking at that I think is very elegant in terms of running any kind of system, the lean concept is not really looking at fixing a big picture, but it's looking within the system to find a number of problems that are discovered, and teaching people how to problem solve. By the accumulation of multiple small problems solved, you create a more profitable and efficient, and by profit I mean better outcomes for patient care. You get a system that is more successful in doing that and thereby having a decrease in costs of delivery of healthcare within that system.
Mark Graban: Right, and what we tend to see are better results in terms of patient's safety and quality. We see reductions in waiting times. We see reductions in costs. Now a lot of times that doesn't directly translate to lower costs for the patient, but that results in lower costs for that might be captured by the hospital or health system, or the payer, the insurance company, or Medicare, Medicaid because even non-profit hospital systems still need to have a positive financial line so they can continue investing in new technologies and by improving processes. There are huge opportunities to reduce costs and improve quality. For example, looking at all of the little things that lead to patients acquiring what we call bedsores or pressure ulcers in a hospital. A lot of times this happens because nurses and other staff are just stretched really thin. Again, it comes back to waste. There's too much waste in the process. They're running around searching for medications. They're trying to find IV poles when they need them. When you start fixing all of those little things, it's not just one big fix but it's all of these little things that contribute to the waste. You can be more attentive to the patients at the bedside and reducing those pressure ulcers can be worth millions and millions of dollars to a hospital because Medicare, Medicaid, and insurance companies are basically not wanting to reimburse the hospital for problems that are increasingly proven preventable, like certain types of infections, patient falls, things that are really egregious. Let's say wrong side surgery, operating on the right knee instead of the left knee. There's some of those financial drivers that are leading hospitals to pay even closer attention to quality and improvement.
Dr. Ali Kasraeian: That's a great place to stop and we'll come back in the next half hour and we'll invest a little bit more of that discussion.
Carmela J: That's right! Stay with us on News Talk WOKV.
Carmela J: Welcome back! You're listening to the second half hour of The Conversation on News Talk WOKV. I'm your host Carmela J. I'm here with our weekend expert Dr. Ali Kasraeian and our special guest Mark Graban is on the phone with us. Thank you for staying with us as we continue our discussion. Remember you can call us at 340-0690.
Dr. Ali Kasraeian: So everyone, thank you for joining us again! Hopefully everyone is safe in the weather out there. Mark, thank you for joining us. We've been talking about the concept of lean hospitals and making our healthcare system a little bit more efficient at the ground level where we're delivering care in the clinics and the hospital system. One question I had for you Mark, looking at the concept of lean vs. what seems to be going on with our healthcare system. Our healthcare system is kind of looking at decreasing this dilemma of high costs in healthcare by trying to decrease and cut reimbursements, which in turn puts the hospitals in a difficult place in terms of their profit margin to, like you said invest in growth and invest in technology and things of that nature. Also, it creates a fairly low morale within the people delivering healthcare as we saw approaching January. When people were worried about the fiscal cliff and the 30% decrease in Medicare, about 30% of physicians opted out of covering patients with Medicare in an AMA study. What lean tries to do is look at reducing the costs of delivery of healthcare thereby sustaining that profit margin for the hospitals by doing that. One question I have is if there a finite limit to where you can decrease that cost of spending, where do you negotiate the rest of the costs to be more efficient in the delivery of healthcare for everyone?
Mark Graban: Right. I share your concern with the pretty dramatic slashing of reimbursement. We're trying to I think as a country give more people access to care. Then when the government does things that leads physicians to not want to take new Medicare and Medicaid patients, it goes against that goal. I think the lean management philosophy gives us a really clear comparison between just slashing price and actually improving the system that truly takes cost out of the system. I'll go back to the auto industry again on a comparison of the way Detroit automakers treated their suppliers as opposed to the way Toyota partners to their suppliers. General Motors, and Ford, and Chrysler were notorious for just basically bullying their suppliers and slashing the price that they paid every year, which lead to really combative relationships. It led to people having to cut corners on quality. It was a really dysfunctional relationship. Toyota has always had a much more cooperative approach with their suppliers. To work together to collaboratively find ways to reduce costs and then share that savings. So I don't like seeing in the healthcare where we have one large party kind of bullying another. Reducing the price we pay doesn't mean cost is actually getting taken out. We see dysfunctions in a number of countries. In the UK, the NHS has had some fairly recent scandals where, even though they don't spend as much on healthcare as the US, their costs have been increasing. No country has unlimited budget for healthcare so there's been a lot of cost cutting pressure. So you've had hospitals that are short staffed, and there's been a lot of quality problems and patient harm that has resulted from just slashing what's paid. That's why we need to work together to actually improve processes, to improve efficiency, reduce costs in a way that improves quality rather than harming quality.
Dr. Ali Kasraeian: I'll tell you, one of the parts of the delivery of healthcare for all of us who are the physicians and nurses, the people that run our clinics, the people that work in our clinics, and the hospital; everyone wants to do a good job of delivering the best care for their patients. What the processes that you're talking about in terms of decreasing the nurse to patient ratio and delay in delivery of things, that puts an undue stress on everyone at every aspect of the process, which makes those outcome measures which are becoming ever more important in the US healthcare system and the reimbursement picture that will emerge in the next few years, it's making that very challenging if we don't pay attention to it now proactively.
Mark Graban: Yeah, I agree and I would certainly agree with the statement that individuals in healthcare are incredibly committed and well educated. There's a growing number of people I think in the healthcare quality movements and healthcare patient safety movements that realize you can have a lot of really talented, wonderful individuals and still have a really broken system. I think one of the other ways that comes up is I think unfortunate things that occur when there's a medication error or some sort of harm that is done to a patient. These are more often than not very system related issues and healthcare is still trying to get away from the traditional culture of blaming an individual instead of looking more systemically at how and why that problem occurred. Punishing an individual leaves a lot of dysfunctions. Instead of preventing future problems, it leads people to cover up and hide problems. That's a core part of that Toyota kind of lean-based management system. Instead of having people hide and cover up problems, we need to be open about risks and things that could go wrong. So that we can fix the system before somebody is harmed instead of just punishing somebody after the fact.
Dr. Ali Kasraeian: You know it's a very interesting thing. Of the things in one of your books I was looking at, there was a quote that you mentioned hospitals do many wonderful things but if we have world-class doctors, we have world-class treatments, and a completely broken process. That's really not going to translate well for maximizing, optimizing those world-class doctors and world-class treatments to maximize their efficiency of delivering world-class outcomes. That's an important thing for us to consider as we proactively think of ways to increase and improve our outcomes by decreasing, and decreasing costs in the long run. One thing that in a lot of the writings you mentioned in one place that we have to decrease cost and add value to our services so as the market increases, it will increase what it's willing to pay for those optimized and better outcomes. Do you think that's something we can see in the foreseeable future?
Mark Graban: Well, I think in terms of the idea of increasing value and people being willing to pay more, I think there's an interesting dynamic. If you look at the types of healthcare that people tend to pay for out of pocket. For example, laser eye surgery. The cost has gone down and the quality has improved over the last 20 years. There's different market dynamics than there are for other types of less elective procedures that are covered by insurance. I think that's one thing that makes healthcare very, very different than the car business is that this connects between what I want as a customer vs. what I'm willing to pay for. In a lot of cases, personally speaking, I have health insurance through my wife, through her employment. I pay something but I'm certainly not having to do, there's nothing driving me to do any sort of cost comparisons. Like I mentioned earlier, there's very little data available and this varies state by state, to find out which healthcare organizations are less likely to give me an infection or give me a medication error. You're kind of taking your chances based on the reputation of an organization. There's been a lot of quality studies and as this data comes out, some of the really big brand name high profile healthcare organizations don't always deliver the best quality to patients, and I think that's going to be a real wake up call for a lot of the really nationally known medical centers. They can do amazing things like developing new types of transplants, back to your discussion again of these artificial hearts, but if you go in for a relatively knee replacement surgery, are they really the best at making sure you don't get an infection?
Dr. Ali Kasraeian: It's very interesting, the last two points you bring up. The American College of Surgeons is trying to be very preemptive and proactive in trying to create transparency and then creating that no blame look at outcomes within hospital systems to compare outcomes within their peers. If something seems to be an outlier within any of those systems within the region, they in a non-blame fashion are trying to set up systems where people can discuss what may be going on. For example, if one hospital has a high risk of blood clots, deep vein thrombosis, or pulmonary emboli, or things of that nature, or infections, they all work together to see what that challenge may be to see if they can improve that. They've got a number of studies that look by doing that preemptively, that they can improve outcomes all across the board. That's one thing that the American College of Surgeons is trying to do. A lot of it is driven by the fact that a lot of the payers, whether it's the government or private insurance payers, are being to look at better reimbursement for better outcomes.
Mark Graban: Yeah, and I think that's a very important trend. Some of the best lean healthcare organizations are participating in experiments. There's another new approach called the Accountable Care Organizations, or ACOs, where again you have these different organizations but let's say a hospital system and the surgeons and the medical device maker are trying to figure out different ways of sharing the reimbursement that gets people aligned to work together on efficiency improvement and quality improvement. Some of these experiments are taking place through the Affordable Care Act. I think some of it's encouraging but it's sometimes easier to say at a real high level conceptually, we're going to pay for quality and better outcomes. The devil is in the details of, well how do you really precisely and scientifically determine how we should be reimbursing exactly how many dollars for X? How do we pay doctors and health organizations to keep patients healthy instead of treating them once their chronic condition has gotten to a point where they have to be hospitalized? There's so much change going on in healthcare right now. It's both I think really scary and really promising.
Dr. Ali Kasraeian: I'll tell you the scary thing about the outcomes measure reimbursement concept that I brought up at conferences and we don't really have much of an idea how it's going to play out is that are these types of changes going to keep physicians and hospitals and departments from taking care really sick patients? That's something that we've seen before. The cardiothoracic group up north, which was very well known for taking care of the sickest of cardiac patients and doing the most complex redo bypass graphs and things of that nature, but they also had a high mortality rate. Thereby whenever they got kind of dinged for reimbursement and people were looking at them, hey your rates are too high. They're like you know, we'll just do what everyone else does. And they went back to doing the regular stuff and the regular operations that had less risk, and their outcomes became fantastic and their reimbursements went up. That's one thing that I look at and I worry that if it isn't done smartly, and asking the right questions you may set up a situation where people are going to take care of healthy people and then the sick people are going to be out on the ledge and we're going to recreate the same problem in a different formulation.
Mark Graban: I very much share that concern and I think there's a general management principle of having to be careful with incentives and measures. When we try to impose I think overly simplistic incentives in really complex systems, you get a lot of dysfunction and unintended consequences. I think that's true. I saw a lot of that back when I worked in manufacturing, and I certainly see that in healthcare. We have to be really careful about that. I think that's where lean, the promise of lean is improving the system very locally. Each doctor. Each nurse. Each health system. Rather than trying to come up with a single solution out of Washington D.C. and even Dr. Don Berwick who was running Medicare and Medicaid services said that the solutions for healthcare problems are not going to come from D.C., we need everybody working together on quality and efficiency improvement.
Dr. Ali Kasraeian: And that's a tall undertaking. That's one of those things that we don't understand. The people that are trying to do these things it's kind of like an everyday education in terms of trying to recreate something and also change something that's been going on for decades. That's quite a challenge. Especially since you bring up the car industry. The car industry, people go do comparisons. You look at and you have a price that you pay for something, and you get what you pay for. I'm not going to go out and buy a Bentley because I can't afford it. But with healthcare, everyone wants to have Bentley level service, and all of us that are practicing medicine want to deliver that. However, the cost constraints of the system make that very challenging to do.
Mark Graban: I think some of this comes back to the different definitions of quality. Bringing it back to more practical cars maybe, the difference between a Lexus and Toyota. There's one aspect of quality that says the Lexus has maybe nicer seats and certain features and better engine. But then there's a different definition of quality that says basically the absence of problems. Whether I buy a $12,000 Toyota or a $80,000 Lexus, I still have a similar expectation that engine is not going to break down and stop working in the first year. I think when we look in healthcare, the parallel I would draw is that there may be some aspects of healthcare quality, certain exotic types of procedures or medications that some people are going to have access to that some people won't. But then there's that other definition of quality that says regardless of what's happening, don't harm me in the process. I think that's one of the main things that people are really working on today that's really important.
Dr. Ali Kasraeian: And it's interesting to find out who is going define those outcomes, and we'll talk about that a little bit more. Are we up for our next break?
Carmela J: Yes, we have to take another break, but we still have a few minutes left to finish our discussion on the concept on lean hospitals. Stay with us on News Talk WOKV.
Male: You're listening to The Conversation with Dr. Ali Kasraeian and Carmela J. on News Talk WOKV. To join The Conversation call 340-0690.
Carmela J: We're wrapping up on The Conversation on News Talk WOKV. Thank you again for listening. Dr. Kasraeian, what are we closing with tonight?
Dr. Ali Kasraeian: Today we've been talking about the concept of lean hospitals, which I find very intriguing and I'm going to look at our own clinic and try to apply some of these principles. I think we're already starting to do some of this stuff, but may bug Mark to help me. Mark, anything to leave our audience with? Both with physicians listening, patients listening, anyone that isn't seeing doctors right now, what are some closing thoughts for them to leave with this concept of lean healthcare as it's applying to us here in the United States?
Mark Graban: Well, one of the things I always like to emphasize with the lean improvement methodology, whether it's for you and your clinic or people working in a hospital, or even patients who might be able to apply this in their own workplaces. Lean improvement doesn't come from an expert coming in and telling people what the answers are. Lean is being taught a methodology that you can use to identify problems and frustrations and opportunities in your own work, and then have ways of learning how to do problem solving, how to do continuous improvements. That's the focus of my most recent book called Healthcare Kaizen. It's really about how do you engage everybody in improvement, lots of small improvements adding up to a big difference. Making things better for your customers and your patients. Having it be a more rewarding and enriching workplace and then leading to better results for the organization that you work for. It doesn't require a lot of complicated methodologies and lots of Japanese terms, even though kaizen is a Japanese word. It's pretty simple, it just takes a different style of leadership that's willing to listen to people, to engage people, and work together in improvement.
Dr. Ali Kasraeian: I think that's the key of this concept and I think that's, in my opinion, the key of leadership is engaging people into what they're doing. If people are engaged, I think they will go above and beyond their own expectations of what they want to do. One of the goals of this show is to engage people in their own healthcare. To think about and ask questions that they might not otherwise think of because it's not something that we readily walk around thinking about. That engagement concept of the lean concept for me is the most, for the lack of a better word, engaging. Because I think that's the way we get things done. If people don't want to do something or if people are being told to do something, and they're negatively reinforced to do something, I think we lose them somewhere along the line. I think the positive reinforcement in engaging people to do better or seeing things and identifying things they can do better is the way that this would make us all do better I think.
Mark Graban: Yeah, and I think lean at it's core is a very positive, optimistic methodology that assumes things can always be better instead of feeling shamed that we have problems, it focuses instead on the positive. Let's look at how to make things better and how to do so often in creative ways. One example even for a patient, if somebody has a lot of medications that they have to take on a certain schedule, maybe they forget, maybe they missed some meds, or if they forget if they've taken them. That problem could be solved through technology or a simple plastic pillbox and I encourage people to look for simple, elegant solutions to the problems that they're facing in managing their own health rather than looking for big expensive technology.
Dr. Ali Kasraeian: Thank you very much, Mark!
Carmela J: Okay. Thank you so much, Mark! Thank you for being with us. Thank you everyone for listening. Please join us again next week on The Conversation on News Talk WOKV. I'm Carmela J. We'll see you next Saturday at 5pm for more talk on your health and wellness.


text:
New Men's Alliance Structure
Home/Information/Here Are 11 Simple Rules to Be Male Feminist
Here Are 11 Simple Rules to Be Male Feminist
Redaksi ALB 4 November 2014 Information Leave a comment 1,583 Views
Transforming Patriarchal Masculinity for Gender Justice in East and Southeast Asia: Learning form the Past for Future Activism
Open Letter to Australia Awards Scholarships, DFAT and the University of Melbourne
State of the World's Fathers: Time for Action
These are but a few of numerous male celebrities, among others, who have recently come out as feminists. Emma Watson's high-profile #HeForShe campaign and the White House's launch of #ItsOnUs against sexual violence have encouraged many more men to think critically about feminism. More importantly, we're talking about why it's necessary affirm and practice gender equality, given the many ways institutional sexism and patriarchy have created environments where conventionally white, masculine, cisgender men have power and privilege.
But men saying they support feminism is just one small, albeit important, step in breaking down these disparities. Going forward, men need to take the next step, challenging and dismantling their preconceived notions and stereotypes relating to women and gender identity. This can and should be done while also affirming the leadership of the many women who have paved the way.
Keep in mind that a feminist, as defined by Nigerian author Chimamanda Ngozi Adichie, is a person who believes in the social, political and economic equality of the sexes (and various gender identities). Although some believe that men have no place in the movement, other ague that strategic social movements should build bridges of solidarity. It's not about focusing or coddling men, but instead recognizing that people who have privilege can operate with respect and understanding by taking the leads from those who have been marginalized.
For men who wish to truly engage in the struggle for gender equality, here's some ways they can help do the work while being cognizant of how their identities may limit their understanding of women's struggles:
1. Allow women to lead the way and affirm their capable leadership. Don't assert yourself at the forefront.
Feminism has primarily been a movement for women, led by women. Although bell hooks wrote the iconic Feminism Is for Everybody to encourage all people to become invested in the struggle for gender equality, maleness is still privileged in a society that promotes male perspectives and experiences at the expense of women's.
For men to insist on positioning themselves and their maleness ahead of women's voices is to ignore that a man's voice will, on the whole, be perceived as more legitimate, even when he's not speaking with any authority or accuracy on issues pertaining to women.
2. When it comes to issues that directly pertain to women's bodies and experiences, be quiet and listen.
For people who have penises and a male reproductive system, they will never know what it's like to have a period, go through menopause or bear children. If a man is conventionally masculine, straight and not transgender, he is much less likely to encounter street harassment and sexual assault or be told that his gender innately makes him unfit to fully participate in various aspects of the workplace. And should he dare to speak up in favor of gender equality, he likely won't face online harassment, including death and rape threats, as was recently the case for feminist gaming critic Anita Sarkeesian.
Instead of talking over women or worse, making unfounded assumptions about what they experience on a daily basis, be quiet and listen to what women have to say, and redirect other men to their voices.
3. Men don't get to determine if they are "allies" to the feminist movement. Women do.
As men, being a feminist isn't some special badge earned after going to a rally, speaking out for gender equality or holding another man accountable for sexist behavior. It's not about getting "ally cookies" or a pat on the back every time you do something that's considered pro-feminism. Instead, making sure your actions aren't sexist, transphobic or reinforcing gender-based bigotry should be the minimum. It is not going above and beyond to act respectfully and in solidarity with women working towards gender equality.
4. Take responsibility for addressing men's issues with other men, rather than expecting women in feminism to do all of the work.
Men who are ignorant about feminism — and even so-called men's rights activists — often critique feminists for not addressing what they describe as men's struggles. Some of these issues include the disproportionately high male suicide rate, how the court system regards fathers in custody battles and the perceived abandonment of survivors of sexual violence.
On the one hand, these criticisms miss a pretty large point: Feminism can, and already has, helped men as well as women.
Additionally, men, especially white men, are already positioned to work towards resolutions, since institutional sexism gives them a disproportionate hold on the levers of power. Instead of railing against the women in feminism, it's important that men take steps to work with each other, as well as with feminist leaders, recognizing how the struggle for gender equality actually plays a key role in many of these efforts.
5. Use your male privilege to encourage other men to work towards gender equality, under women's leadership.
Once you feel that you have a stable understanding of what it means to be a feminist, play a role in motivating other men you know to join you in pushing for gender equality. Being a feminist shouldn't be seen as a chore, a job or a simple label, but rather as a lifelong commitment to ensuring that institutional sexism comes to an end.
But, as the CEO of Microsoft recently learned, that commitment should run deeper than tokenization, ot telling women, from a position of privilege, how they should approach key issues such as the gender pay gap.
6. Don't use the label of "feminist" as a way to try to get women to like you — that's disingenuous and counterproductive.
We've all heard the horror stories of men using feminism to try to get dates or new female friends, thinking the label may prove they are somehow "softer" and not as ignorant as more conventionally masculine "bro" types.
However, this "nice guy" approach can backfire. Beware the male feminist who behaves as though his feminist sympathizing makes him more entitled to female sexual attention, even when he shows little to no understanding of his privilege. Instead, this logic objectifies and belittles women, with the assumption that they can be manipulated into liking someone who really doesn't care about their position in society.
7. When given opportunities to perform professional work related to feminist issues, consider referring other women instead.
Women have been at the forefront of feminism and civil rights efforts for more than 100 years. But by and large, institutional sexism often renders women and their experiences invisible, because male needs, thoughts and opinions are usually elevated above their female counterparts.
So when organizations or news outlets ask for a "male perspective" on issues such as feminism and gender equality, ask what the needs and goals of the conversation are, in order to discern whether or not you can truly speak from a place of experience, education and expertise, especially if the topics are related to issues that mostly affect women. Don't be afraid to suggest a female peer if you're not the best suited for the event or discourse.
8. Educate yourself about the history of feminism and how women of different backgrounds have approached the movement.
Feminism means different things depending on the country, its laws, racial and ethnic groups, class stratification and the prevailing world religion, among other factors. In the United States, feminism encompasses enslaved women writing about their struggle for both their womanhood and for their full humanity to be recognized and respected. It includes the fight for suffrage, reproductive justice, access to education and equal employment opportunities.
Often, those struggles have privileged the perspectives of mainstream white women, at the expense of women of color who endure universal but differing struggles, given disparities along the lines of race and class. It's all the more important, especially in a "post-racial" society, to make sure the history of feminism isn't whitewashed.
9. Ensure your feminism is intersectional.
Before diving into feminism, men should remember that what's often heard in the mainstream doesn't provide a complete snapshot of the movement.
Many women in feminism have long rallied to ensure that the fight for gender equality is inclusive and cognizant of everyone, including people of color, queer, trans and gender nonconforming people, people with disabilities, differences in class and ability, various faiths and non-faiths and other identities and situations. That's because intersectionality ensures that various goals and needs are addressed to truly elevate everyone, rather than focusing on the experiences of those who have relatively more privilege.
It's a critique against mainstream, white-centered feminism levied by Mikki Kendall and feminists around the world in August 2013 with the viral hashtag #SolidarityIsForWhiteWomen:
10. Acknowledge that sometimes, women need opportunities to discuss feminist issues without the presence of men. And that's okay.
When hashing out difficult conversations, ideas and questions about women's issues and the direction of the movement, it can be challenging to deal with interjections from men who derail the conversation due to their relative lack of understanding.
In addition, some women may feel more comfortable discussing their bodies and their experiences absent the gaze and presence of men, whose thoughts, needs and desires are privileged in virtually all sectors of society. Instead of taking offense, practice respect and compassion by minimizing yourself in the situation, and simply asking if there's any way you can be helpful outside of the closed dialogue.
11. When women criticize your involvement in feminism, don't talk over them or talk down to them. Actively listen and be accountable.
Sometimes, in doing the work or attempting to be helpful, people make mistakes, and that's a human thing to do. But listening to constructive criticism and being accountable for missteps is what separates a responsible ally from someone who is clueless about their privilege.
Instead of talking over women or talking down to them, ask questions about how you can be most helpful. And, given institutionalized sexism and male privilege, figure out how you can work with women in leadership to remedy any damage done. Because that's what true allyship and solidarity look like in feminism.
Source: Mic
About Redaksi ALB
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Stephen Suleeman: This is very important becauae we cannot ctmreate equality between men and women...
nur iman subono: Luar biasa....saya bisa belajar dari negara dan pakar mengenai pelibatan laki2.....
Masculinity Violence against Women Islam Terrorist Australia Parenting Domestic Chores Family Men Involvement Relationship domestic violence Domestic Chore Home Philipines Economic Oppurtunities #KitaMulaiSekarang Gender Norm Movement Fundamentalism Politic Gender Equality Epistemology Knowledge Care giver Feminism


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I am full of energy i like big tasks. I am a very hard working person and i really need a job as i feel like im wasting my holiday going out with friends rather than get saving up for things such as provisional and driving lessons.


18 kt., one pair composed of delicate discs of overlapping petals applied with bluish-green plique-à-jour enamel accented by round diamonds, and one pair of openwork discs applied with colorful floral enamel, both signed Masriera, approximately 14 dwts. With two signed boxes.
Enamel cufflinks: enamel nicely applied, good condition.
Diamond and enamel cufflinks: enamel in good condition. 3/4 x 11/16 inch.


text:
Дефере́нт (лат. deferens — несущий) — понятие, используемое в геоцентрической модели Птолемея. Согласно этой модели, всякая планета равномерно движется по кругу (эпициклу), центр которого, в свою очередь, движется по другому кругу, который и называется деферентом.

Основанием для такой искусственной конструкции послужила необходимость моделировать неравномерное движение планет, в частности попятное движение, а также объяснить изменение их видимой яркости, связанное с изменением расстояния от Земли.

См. подробнее Эпицикл.

Литература

 Еремеева А. И., Цицин Ф. А. История астрономии: Основные этапы развития астрономической картины мира. — М.: Изд-во МГУ, 1989. — 350 с.

История астрономии

redpajama_set_name: RedPajamaWikipedia


text:
Union claims victory in fight against Alcoa
The Australian Workers' Union has been campaigning for two-and-a-half years to protect the wages and conditions of its 1600 members employed at Alcoa smelters and mines across Western Australia.
The Australian Workers' Union (AWU) claimed an important victory on June 7 after the Fair Work Commission (FWC) upheld its appeal against a previous ruling allowing US aluminium giant Alcoa to terminate its enterprise bargaining agreement (EBA) with the union. Had Alcoa been allowed to go ahead with the termination, workers' wages would have been slashed by as much as 50% and jobs threatened by casualisation.
The AWU has been campaigning for two-and-a-half years to protect the wages and conditions of its 1600 members employed at Alcoa smelters and mines across Western Australia.
As part of the dispute, workers went on strike for 52 days at company sites in Kwinana, Pinjarra, Willowdale, Huntley and Wagerup. The strike ended on September 28 after the AWU secured a guarantee that no current worker would be replaced by casual employees or labour hire contractors.
Since then, Alcoa has attempted to get AWU members to vote for inferior EBAs on three occasions. Each time, workers have voted its offers down, with 61% of members voting "No" in the latest vote in March.
The union labelled the FWC's December ruling to allow Alcoa to terminate the EBA as "not just erroneous, but heartless". While the company argued that the EBA restricted its ability to operate effectively, efficiently and profitably, the AWU noted that financial audits showed the company had made almost $2 billion in profits in 2017.
AWU state secretary Brad Gandy hailed the decision to uphold their appeal, saying: "The AWU will continue strongly opposing Alcoa's attempts to terminate the current agreement and remains focused on negotiating a new, fair and reasonable agreement as soon as possible. This is an important win for all union members, as we are all in this together."
Gandy added: "If the company fixed and addressed the job security element of the agreement, then we would be almost over the line. We've always seen job security as key in these negotiations. This could be resolved by the company being sensible and offering something fair and reasonable, or rolling over the current agreement."
workers' rights and unions
Australian Workers Union (AWU)
Green Left is driven by community concerns, not commercial interest.
GLW stands defiant in the Australian media landscape that's dominated by two multi-national corporations.
GLW offers a reliable voice of reason for all unionists, activists and socialists.
MUA Qld Assistant Branch Secretary


text:
Q: jQuery code to Ajax convert I want to convert the below jQuery code to Ajax is it possible ?
<script type="text/javascript">
    $j(document).ready(function () {
        $j("#co-shipping-method-form .buttons-set button.button").click(function () {
            var shippingSelectedValue = $j("input[name='shipping_method']:checked").val();
            if(shippingSelectedValue == 'freeshipping_freeshipping' ){
           $j("#customtest_modal_id").show();
            }
        });
        $j("a.reset-customtest").click(function () {
            $j("#customtest_modal_id, #checkout-step-shipping_method").show();
            $j("#checkout-step-payment").hide();
        });

    });

</script>

A: I think you misunderstand concept of AJAX.
Here are things AJAX can do for you:
- Read data from a web server - after the page has loaded
- Update a web page without reloading the page
- Send data to a web server - in the background
In short, AJAX is a way to transport data via XML

A: Oh I got it.
First, you need to define a function with your logic, like
function clickButtonSet() {
  //you code here
}

Then, in your html, you add an action onclick into .button-set
<button class="button-set" onclick="clickButtonSet()"> Click Me </button>

The same with button .reset-customerset
Try it :)

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Take the first steps for building your own business and gain financial independence.
This initiative represents another step in reaching the objectives of "Partnership for Employment in Bucharest-Ilfov, South – West and South Muntenia" project that HRS is implementing along with its partners.
At the end of the training (60 hours), participants will receive official recognition through ANC Certification.