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MIRECC / CoE
Education Mission
The mission of the VISN 2 South MIRECC Education unit is to develop programs that help change provider behavior and that improve the use of evidence based effective practices in psychopharmacologic, psychotherapeutic, and psychosocial programs. In addition, the Education unit collaborates closely with other parts of our MIRECC, the Mental Health Executive Board (MHEB), the Veteran's Advisory Council of VISN 2 South, and other MIRECCs to bring these programs to the network. Our newest effort involves assisting VISN 2 South in implementing recovery throughout its mental health programs.
VISN 2 South MIRECC Psychiatry Fellowship Advertisement
Start dates are flexible. Those wishing to start at the beginning of the academic year 2019 should complete their applications by December 1, 2018.
VISN 2 South MIRECC Psychiatry Fellowship
Overview: The Mental Illness Research, Education and Clinical Center (MIRECC) of the New York/New Jersey Veterans Healthcare Network is accepting applications from physicians for a 2-year Post-Doctoral Advanced Fellowship Program in Mental Health Research and Treatment. The primary goal of the fellowship program is to train psychiatrists to become leading clinical recovery-oriented physician-scientists with a focus on serious mental illness in veterans. Our mission is to pursue a discovery-to-recovery approach for serious mental illness by determining causes, identifying predictors, and developing treatments that overcome barriers and enable recovery.
Application Due Date: Applications will be accepted on a rolling basis until the position is filled.
Eligibility Requirements: Applicants must have completed ACGME-accredited residency training, be board eligible or board certified, and have an active, unrestricted U.S. license to practice medicine. International medical graduates must also have a current visa and an ECFMG certificate that is valid indefinitely. Applicants on a J-1 visa must have current ECFMG sponsorship as well.
How to Apply: Interested candidates who meet eligibility requirements should submit: (1) Cover Letter (including the reasons for your interest in this particular fellowship training program, a brief overview of your previous clinical research experiences, how you see this program promoting your professional and career goals, possible projects/research initiatives, and fit with mentors at the MIRECC); (2) Curriculum Vitae; (3) 3 letters of recommendation; (4) Graduate school transcripts; (5) Writing sample of your choice. Please email all application materials directly to the Fellowship Director, Dr. Yulia Landa at firstname.lastname@example.com.
Please feel free to contact the Fellowship Director, Dr. Yulia.Landa with any additional questions at firstname.lastname@example.com, or by phone at 212-659-8732.
VISN 2 South MIRECC Psychology Fellowship Advertisement
Start dates are flexible. Those wishing to start at the beginning of the academic year 2018 should complete their applications by December 1, 2018.
VISN 2 South MIRECC Psychology Fellowship
Overview: The Mental Illness Research, Education and Clinical Center (MIRECC) of the New York/New Jersey Veterans Healthcare Network is accepting applications from psychologists for a 2-year Post-Doctoral Advanced Fellowship Program in Mental Health Research and Treatment. The primary goal of the fellowship program is to train psychologists to become leading clinical recovery-oriented physician-scientists with a focus on serious mental illness in veterans. Our mission is to pursue a discovery-to-recovery approach for serious mental illness by determining causes, identifying predictors, and developing treatments that overcome barriers and enable recovery.
Application Due Date: December 1, 2018
How to Apply: Interested candidates who meet eligibility requirements should submit: (1) Cover Letter (including the reasons for your interest in this particular fellowship training program, a brief overview of your previous clinical and research experiences, how you see this program promoting your professional and career goals, possible projects/research initiatives, and fit with mentors at the MIRECC); (2) Curriculum Vitae; (3) 3 letters of recommendation; (4) Graduate school transcripts; (5) Writing sample of your choice. The program is using the APPA CAS (APPIC Psychology Postdoctoral Application) online system. For more information about the application process please go to http://www.appic.org/AAPI-APPA/APPA-Postdoc-Application-Information.
Please feel free to contact the Fellowship Director, Dr. Yulia Landa with any additional questions at email@example.com, or by phone at 212- 659-8732.
Additional Information
CBT for Psychosis Clinicians Manual - Yulia Landa, PsyDGrand Rounds Presentation 9-9-11 (Presentor: Bruce M. Levine, MD)
Table of Contents
- Problem Solving for Veterans with Serious Mental Illness (SMI) (Bruce Levine, MD)
- Studies in Multifamily Group (MFG) Treatment for Veterans with Traumatic Brain Injury (TBI) (Deborah Perlick, PhD)
- Family-focused treatment for caregivers of patients with Bipolar Disorder (Deborah Perlick, PhD)
- Reducing self-stigma of family members of persons with Serious Mental Illness (SMI) (Deborah Perlick, PhD)
- Veterans' satisfaction with Dialectical Behavioral Therapy (DBT): An ongoing qualitative evaluation (Deborah Perlick, PhD)
- MyHealtheVet Focus Groups(Bruce M. Levine, MD)
- Suicide Risk Assessment and Prevention(Bruce M. Levine, MD)
- Clozapine Education and Consultation Program(Bruce M. Levine, MD)
- Experimental Education and Recovery Implementation (Bruce M. Levine, MD)
- Additional Efforts
- Educational Pilots
- Conferences
Completed Projects
- Veterans with Intractable Discharge Issues (VIDI)
- Cultural Competency(Juan Mezzich, MD, PhD)
- MIRECC Clinical Practice Guidelines/NJ Algorithm(David Smelson, PsyD, Miklos Losonczy, MD, PhD, Bruce Levine, MD)
Problem Solving for Veterans with Serious Mental Illness (SMI)
Bruce Levine, MD
The study's purpose is to determine whether a small group of Veterans with Schizophrenia will complete a 4-session Problem Solving Training, and whether they will find it engaging and helpful. While lengthy interventions used in other studies of SMI patients have included training in problem solving, brief training has not previously been tried with this group. Participating Veterans will be asked to complete several brief self-report questionnaires on problem-solving skills and psychiatric symptoms, and the data will be analyzed to determine whether there have been changes on these measures during the study period.
Studies of Multifamily Group (MFG) Treatment for Veterans with Traumatic Brain Injury (TBI)
Deborah Perlick, PhD
TBI-related deficits in memory and executive functioning, if not understood and addressed, can lead to friction among family members. To begin to address this problem, a pilot study was recently conducted with funding from the Department of Defense (#W81XWH-08-0054) and the MIRECCs for VISNs 3 and 6. The study evaluated the feasibility, acceptability, and initial efficacy of implementing a novel adaptation of the multifamily group (MFG) treatment model developed for persons with Serious Mental Illness and members of their families to facilitate coping with the problems associated with mental illness. While the original MFG model teaches problem-solving skills, the adapted model also incorporates skills training from other evidence-based treatments (e.g., emotion regulation from Dialectical Behavior Therapy and communication training from Behavioral Family Therapy). Compensatory strategies for TBI-related deficits and education about TBI and comorbid disorders are included as well.
The study included 14 OEF/OIF Veterans and a spouse, partner or other family member for each. The intervention consisted of 2-3 initial "joining" sessions for individual families, a 2-session educational workshop, and 12 bimonthly MFG sessions. Participating Veterans reported significant positive outcomes, including improvements in anger control, use of social supports and occupational activity. Family members reported reduced burden and increased empowerment.
After the end of the treatment, MFG participants who took part in focus groups identified treatment benefits in four areas: 1) exploring common struggles and reducing isolation; 2) building skills to cope with TBI and related problems; 3) increasing understanding of the interconnection between TBI and PTSD; 4) rebuilding relationships through communication and understanding. Participating Veterans and family members also offered recommendations to improve and increase access to the program. Overall, they found MFG-TBI highly acceptable.
On the basis of these promising findings, Dr. Perlick received a Merit award from VA ORD to conduct a 3-site, 4-year randomized clinical trial of MFG for Veterans with mTBI and their spouses or partners (#1 IO1 RX0011 06). Participant enrollment is to start in June, 2014.
Family-focused treatment for caregivers of patients with Bipolar Disorder
Deborah Perlick, PhD
Coping with Bipolar Disorder can be challenging not only for persons with the illness but also for members of their families. The burden on family members puts them at risk for depression and other adverse health outcomes. To address this problem, this study (NIMH R34 MH071396) evaluated a family-focused cognitive behavioral intervention, delivered in 12-15 sessions, that was designed to promote the adoption of constructive coping strategies and increase self-care skills. The participants in this study were the primary caregivers of 46 individuals (a mix of Veterans and non-Veterans) diagnosed with Bipolar Disorder I or II. The caregivers were assigned at random either to receive the study intervention or to view health education videotapes. Reductions in caregiver depression, caregiver burden and health risk behavior were significantly greater for those who received the study intervention than for those who received health education only. These effects were found immediately after treatment and also at 6-month follow-up. Mood improvement was greatest for the caregivers who had reduced their use of emotion-focused coping styles and adopted more functional coping skills. Reductions in symptoms of Bipolar Disorder were greater for the individuals whose caregivers received the study intervention than for those whose caregivers who received health education only. Change in Bipolar Disorder symptoms was mediated by change in caregivers' symptoms; in other words, the individuals with Bipolar Disorder whose symptoms decreased most were those whose caregivers felt less depressed. This finding suggests that, even when an individual with Bipolar Disorder is not available for treatment, working with a family member alone (i.e., to increase coping skills and reduce depression) can be beneficial, both for the family member and for the person with the illness.
Reducing self-stigma of family members of persons with Serious Mental Illness (SMI)
Deborah Perlick, PhD
Discriminatory practices and negative stereotypes are often directed at persons diagnosed with SMI. The resulting self-stigma – the internalization of the devaluing views of others - affects not only those who are mentally ill but members of their families as well. Studies have found associations between self-stigma and low self-esteem, social withdrawal (in response to anticipated rejection), psychological distress, and subjective burden. To reduce self-stigma, several studies have evaluated interventions targeting persons diagnosed with SMI; however, this pilot study was the first to evaluate a brief (1-session) intervention targeting family members. The study was done with the support of NIMH (R01 MH077168), in collaboration with the National Alliance on Mental Illness. The participants were assigned at random either to attend a formal presentation by a clinician on the subject of mental illness, or to receive the study intervention, which included a videotape showing family members describing their experiences of coping with stigma, and a discussion facilitated by two family peers who modeled and encouraged sharing within the group. Among participants with low-to-moderate anxiety prior to treatment, reductions in self-stigma were significantly greater for those receiving the study intervention than for those who attended the clinician's presentation, suggesting that peer-led interventions deserve further study.
Veterans' satisfaction with Dialectical Behavioral Therapy (DBT): An ongoing qualitative evaluation
Deborah Perlick, PhD
DBT is a manualized treatment that helps individuals to manage turbulent emotions. Veterans who received newly implemented DBT services at facilities in the metropolitan New York-New Jersey area (VISN 3) received questionnaires asking how they benefited. So far, 39 Veterans have returned completed questionnaires. Of these, 74% reported that DBT helped them to control their emotions and 72% reported that it helped them control their behavior. While most (54%) preferred family participation in some but not all skills training groups, 90% were open to the idea of involving family members in DBT. The Veterans anticipated that family member acquisition of DBT skills might increase the familial support available to them and improve family relations overall.
MyHealtheVet Focus Groups
Bruce M. Levine, MD
In January 2004, the Under Secretary for Health endorsed the Action Agenda "Achieving the Promise: Transforming Mental Health Care in VA". One of the action steps it contains is to "develop MyHealtheVet to better serve the needs of veterans with mental illnesses". MyHealtheVet provides web based information on VA benefits, special programs, health information and services to veterans who have access to the Internet. It is now being piloted at nine facilities which has generated much positive feedback as well as recommendations for improvement. The ultimate version of My HealtheVet will contain a fully functional secure personal health record system including e-prescription refills, messaging, copies of the veterans health record and self-care tracking and management tools.
My HealtheVet is intended to promote greater participation of veterans in their own health choices and care. In order to fully develop a Mental Health portal for My HealtheVet, it was critical to involve veterans and families in the needs assessment/requirements phase. An effective needs assessment tool included conducting Focus Groups with veterans and their families so they could identify what they need to better understand their own behavioral health concerns and/or diagnoses and treatment.
Eight MIRECCs (including VISN3 MIRECC) held a total of 14 focus group discussions and distributed needs assessment questionnaires to determine the types of health information that veterans are interested in, how they stay aware of their health information and needs, and what their thoughts are about using an internet-based personal health record and informational website. Two of the focus groups assessed veterans with psychotic diagnoses, two assessed only women, two involved those with PTSD, two groups evaluated veterans with anxiety and depression, two were held for veterans with substance use disorders, one group involved OEF/OIF returnees, one was held for veterans from primary care, one examined the views of veterans who do not receive VA care, and one group assessed family members of veterans. The outcome of the Focus Groups will be used to refine and improve the My HealtheVet Mental Health portal.
Suicide Risk Assessment and Prevention
Bruce M. Levine, MD
The Suicide Risk Assessment and Prevention Initiative (SAP) was established in an effort to further enhance the lives of discharged SMI patients. The program achieves this goal by educating clinicians, increasing sensitivity to suicide risk, improving recognition of veterans with high risk of suicide, improving documentation of risk to enhance communication with non-mental health clinicians, and decreasing malpractice risk.
Since its first meeting in 2001, SAP's suicide workgroup has produced the following:
- Members devised an evidence based suicide risk assessment that is currently being piloted. This instrument is being programmed as a dialogue box/clinical reminder for the Computerized Patient Record System (CPRS) and is tied to the alerts section as well. The goal is to implement this assessment throughout VISN 3. It is tied to a number of psychiatric diagnoses and all Mental Health Stop codes, and will come up in CPRS with variable frequency depending on the patients' assessed level of risk. The instrument is designed so that explanatory material (definitions, how to score the assessment, background and evidence base for each item), as well as sample questions to ask a patient to evaluate the presence or absence of each item, are available to clinicians as they work through the assessment (this material is all available).
- Evaluation:
We will be looking at the rates of usage, quality of treatment plans generated by doing the assessment, satisfaction of users of the instrument, rates of suicidal ideation, as well as attempts and suicides in the Mental Health population in the VISN. We are also doing interrater reliability evaluations on the suicide assessment tool, and are looking at the sensitivity and specificity as it is implemented.
- Findings:
Because one concern of the staff is being able to intervene when suicide risk is determined to be present, future training will involve more about suicide intervention. In the early usage, clinicians have found the tool useful in generating higher quality treatment plans for the factors contributing to suicidality. There has been some concern about the perceived workload, as well as medical and legal ramifications of having a suicide assessment in the record. In the few pilots done thus far using a handwritten version of the instrument, the additional workload for interviewing the veteran and recording the results has varied from five to fourteen minutes.
- Recommendations for System Wide Application:
This is a risk assessment as opposed to a screening tool, and therefore has limited use for the entire system. First, it fits best within a Mental Health Setting. Second, while it has significant face validity, it has not yet been adequately tested to determine its true utility. We have never answered the question about whether improved assessment leads to improved prevention, and it will be a long time before we can answer that question. We expect that in the first year we will identify more suicides than in previous years, simply because assessing all mental health patients for suicide risk will increase our awareness about potential suicides, and may change how we categorize some deaths that occur.
- Evaluation:
- Conferences: Evidence Based Practices for Suicidal Persons
- June 2006: Cosponsored with V4 and V19 MIRECC
- Partnered with AFSP, AAS
- Psychopharmacology, Current Research, NIMH Center Reports, OEF/OIF issues, Best Practice Research
- Breakouts: CBT, DBT, IPT, Family, Web Based, Community Based Interventions
- February 2007: Reprise in Denver
- New Topics to include Gender, Cross Cultural (e.g. Native American), OEF/OIF Panel
- Breakouts to focus on training and skill acquisition
- February 5, 2003, the workgroup held a 6-hour Suicide Assessment and Prevention Conference that was attended by 430 VISN 3 mental health staff, with the didactic portion being teleconferenced to V2. The first two hours of the program consisted of four half-hour talks: Maria Oquendo, MD presented "A Model for understanding Suicidal Behavior", Gretchen Haas, PhD discussed "Suicide Risk Identification and Prevention", James Stinnett, MD presented "Managing Risk Factors in Suicidal Patients", and Bruce Levine, MD discussed "Psychological and Social Interventions for Suicidal Individuals". The didactic session was followed by two workshops: the first on reviewing the assessment of suicidal patients, either from the attendees experience or from case vignettes culled form RCAs in V3; the second being a review of the proposed Suicide Risk Assessment with opportunities for feedback on the instrument. The V3 Suicide workgroup trained 40 facilitators throughout the VISN to lead these breakout sessions. Subsequently we have held a VTEL meeting with the facilitators, refined the risk assessment, are piloting it, and are moving towards implementation over the next few months, with further training scheduled for the rollout. With the cooperation of our HSRD group we will also be doing an evaluation of the effectiveness of this effort.
This project involved significant collaboration with the V4 MIRECC with Gretchen Haas (VISN 4 MIRECC co-director) serving on the V3 Workgroup and Katy Ruckdeschel making available the materials and strategies used in the suicide initiative in V4. This allowed for our efforts to be consistent with and complimentary to each other.
- June 2006: Cosponsored with V4 and V19 MIRECC
- Suicide Prevention: Next Steps
- Evaluate Instrument
- Treatment Plans with Assessment vs. TAU
- Mirror image study within VISN 3
- Prospective comparison with another VISN
- Over longer term evaluate case finding and impact on Suicide rates
- Treatment Plans with Assessment vs. TAU
- Use improved case finding to collaborate with Brain Bank
- Telephone Operator and Clerk/Secretary Guideline
- Physical Plant
- Road Shows
- Primary Care Education facility by facility
- Develop screening program for PC
- Suicide Education for MH and SAS, another round
- Expand assessment to all outpatients
- Develop Local Computer Module for Suicide Risk Assessment
- Web Based Interactive Training (national)
- Assessment, treatment, service Coordination
- Collaboration with EES, VISN 4, 19 and others
- Modular training, Case Based
- Continued Collaboration with VISN 1
- Evaluate Instrument
- Template
- Hand Template
- Template Explanations
- Sample Questions
- CPRS Suicide Template demonstration
- Presentation on Suicide Prevention Day
Clozapine Education and Consultation Program
Bruce M. Levine, MD
Despite remaining the gold standard for the treatment of treatment refractory schizophrenia, Clozapine has remained underutilized, and is the slowest step to be adopted in the various psychopharmacology algorithms. The VA has had an historically low use of Clozapine for seriously mentally ill veterans, and VISN 3 has had a low usage for the VA. In order to increase usage in VISN 3, the MIRECC developed a Clozapine education and consultation program. To date, the program has resulted in a 80 percent increase in Clozapine utilization, and in 37 additional Clozapine trials at the Montrose VA. Of particular import is that a 35 percent response rate, vigorous enough to lead to discharge, was achieved with severe nonresponders (VIDI patients).
- Education: The educational piece of this program consists of a series of Video teleconferences outlining the use of psychopharmacology guidelines, the evidence base for 2nd generation antipsychotics, the evidence base for Clozapine, and day-to-day use of Clozapine. We also collected a series of "Essential Papers on Clozapine" and have made them available to VISN 3 practitioners. The MIRECC Education Director and Coordinator of this program visited each VISN 3 facility to discuss clinicians' experiences with Clozapine and usage issues at each facility.
- Consultation: Because of Clozapine's unique side effect profile, a consultation program was devised for physician use. This program enables psychiatrists considering a switch to Clozapine, and those managing patients on Clozapine, to call the MIRECC and receive a real-time consultation from a clinician experienced in the use of the medication. We have also made a number of visits to facilities within the VISN to offer live consultation of difficult clinical situations.
- Results: These initiatives have led to an average increase of 80% in the usage of Clozapine across the VISN, but without further increase in 2 years. In addition, they have been exported to MH QUERI and adapted for trials in other Networks, have contributed to White Paper on change in VHA Clozapine Policy, and we have re-surveyed VISN 3 providers on Clozapine prescribing.
- New Initiatives: The following list outlines current and upcoming additions to this project:
- Case Finder
- Pilot in Bronx with Chart Reviews
- Automate follow-up and outcome of identified cases
- Education Program for Veterans with SMI
- VISN 3 Clozapine Responders
- Participate in above program
- Characterize subgroup that develops weight loss and improved metabolic profile after stabilization on CLZ
- Academic detailing using findings of CATIE re Clozapine
- Continue work nationally to improve Clozapine access and use in VHA
More >>
- Case Finder
Experimental Education and Recovery Implementation
Bruce M. Levine, MD
After a VISN wide conference: "Recovery in Action" which introduced VISN 3's recovery implementation initiative, the MIRECC organized veteran and staff focus groups about the barriers to recovery and needs of staff and veterans for implementation. The experience was so powerful that the recommendation was to do this at each facility for all staff and as many veterans as possible. We have trained 65 leaders across all facilities in the network, half staff and half veterans. The "Recovery Discussions" have begun at 1 facilitiy, is awaiting IRB approval at the other facilities within the VISN and the rollout will be administered by the VISN 3 LRCs. We plan to evaluate the efficacy of this modality for implementation of recovery transformation in the VA.
Additional Efforts
Clinical Consultations/MIRECC VTELS
- MIRECC Consultation Service
- The MIRECC provides expert second opinion conferences both live and via video teleconference on a regular basis (twice monthly at Hudson Valley, monthly at Northport, eight per year at NY Harbor, monthly inpatient and bimonthly outpatient at JJP, one-to-two times per year at NJ) for veterans who are not succeeding with their current treatment regiments. These conferences reach staff as well as trainees in all disciplines and help disseminate rigorous psychopharmacologic practices, evidence based psychotherapeutic, rehabilitative and psychosocial treatments, and recovery oriented practice.
- Bibliotherapy Resource List
- MIRECCs from VISN 1, 3, 16, 19, and 21 have created a list of educational resources pertaining to PTSD, schizophrenia, substance abuse, depression, bipolar disorder, generalized anxiety, health/wellness, sexual trauma, and traumatic brain injury that can serve as self-help guides or supplements to treatment. Resources will include books, pamphlets, and websites with information on the title, author, publisher/source, date, and approximate cost. Relevant empirical findings and article citations will also be included. This resource will be disseminated through the OMHS Office of Psychotherapy Programs and the national MIRECC website.
- This list can assist clinicians, peer technicians, and veterans to incorporate psychoeducational materials into their current practice/treatment. Providing information about self-help resources is consistent with the VA's recovery philosophy.
- Bibliotherapy Resource Guide
- Implementation Science Group
- In 2007, the MIRECC & COE Education Group formed an Implementation Science interest group to teach ourselves more about implementation strategies and how to apply these techniques to different educational initiatives. The group meets monthly to review articles and discuss implementation issues and research. Experts are invited to present to the group. These ongoing discussions will enhance education efforts by promoting effective strategies for putting innovative knowledge and skills into routine practice.
- MIRECC Recovery Interest Group
- Since July, 2006, a MIRECC Recovery Interest Group has met monthly to share information about how each Center is attempting to implement recovery. The group discusses common problems and look for ways to collaborate. Recent topics have included educating local recovery coordinators, teaching about leadership, disability and recovery, using recovery toolkits, training peer technicians, and examples of effective Consumer Councils. This group will further disseminate information about recovery implementation across MIRECCs and COEs.
- Suicide Pocket Card, Revised Version and Resource Guide
- With increased emphasis on suicide prevention, a new pocket guide accompanied by a brief manual containing expanded explanations and descriptions was needed to offer guidance to the field. This need was accelerated following the release of the JCAHO safety goals. Evaluating potentially suicidal veterans in non-Mental Health settings was emphasized in the new pocket card, although issues of risk assessment were addressed in the resource guide. The guide is consistent with the evidence-based efforts toward suicide screening and assessment taking place at the VA. The card and guide is expected to facilitate rapid dissemination of knowledge to the field about effective suicide screening, risk assessment and offer guidance on acute management. It will provide a basis from which to develop more complete prevention efforts.
Educational Pilots
A Dialectical Behavior Therapy (DBT) Clinic is being piloted at the Bronx VA to treat Self-Destructive Personality Disordered veterans. This project, led by Dr. Marianne Goodman, uses a manualized cognitive behavioral treatment approach that was developed to treat chronically suicidal individuals, many of whom met criteria for Borderline Personality Disorder (BPD). The approach combines behavioral interventions including skills training, exposure, problem solving with cognitive techniques of mindfulness, and stresses the importance of client-therapist connection. The DBT approach has also been successfully adapted to inpatient settings, criminal justice settings, outpatient populations of BPD substance abusers, depressed and suicidal adolescents with BPD or BPD traits, and binge-eating disordered individuals.
Despite the pronounced difficulties in interpersonal relationships inherent in BPD, minimal attention has been paid to couples and family treatment in the literature. We are currently treating subjects with Borderline Personality Disorder and their family memberswith a seven-session course of familyDialectical Behavioral Therapy to examine the impact of family DBTon measures of mood and emotion, aggression, family function, intrafamily conflict tactics and violence, relationship quality and adjustment, and communication patterns. Preliminary data will be available after January 2005.
Family Interventions for Serious Psychiatric Disorders in VA: Implementing a Continuum of Services
This September, 2009, conference will provide VISN 3 Mental Health staff with increased knowledge and skills to deal with family psychoeducation, which includes Behavioral Family Therapy and Family Focused Therapy and family consultation. It is the VISN 3 expectation that all attendees will identify three (3) families, apply one of the interventions learned in the conference and participate in the post-conference bi-monthly 60 minute family intervention consultation sessions for approximately 6-9 months following the training. These will occur either in person or via telephone and might run for up to 75 minutes, depending on the number of participants.
VISN 3 Peer Technician Retreat
MIRECC, MHCL, and LRCs collaborated on this one day conference for Peer Technicians hired in recent enhancements. This conference focused on professional identity and development. Dan O'Brien-Mazza was the keynote speaker. The curriculum included roles within the VISN with an outline of the mental health care system structure in VISN 3 and the VA, as a whole, followed by talks on ethics, professional development, and breakout sessions, which featured role plays and discussions of a variety of clinical/professional situations that Peer Technicians would encounter.
Implementation Science
As a result of growing interest among the MIRECC & COE Education Group in implementation science, we have collaborated with EES, the GRECCs, and Ken Shay, Director of VA Geriatric Programs, to develop a workshop focused on implementation science theory and its application. The multi-day meeting during the fall of 2008 was a small skill-based workshop to meet the needs of our two groups. QUERI, HSR&D staff, and other implementation experts with successful projects served as faculty.
Planning Committees for Continuing the Transformation of VA Mental Health Services: Bridging the Gaps
This, 740 person, conference combined the national MIRECC conference and the Best Practices conference into one comprehensive meeting. Additional partners included NEPEC, SMITRC, PERC, Mental Health (MH) and Substance Abuse Disorder (SUD), QUERIs, NCPTSD, CESATE, VISN 2 Center for Integrated Healthcare, and Vet Centers. The conference focused on progress toward implementing the VA MH Strategic plan and its goals. MIRECC directors agreed to support needed training initiatives for local recovery coordinators.
VHA Local Recovery Coordinator Training
The MIRECCs spearheaded efforts to develop the first national training for the Local Recovery Coordinators (LRCs). The LRCs are given the task of facilitating the implementation of recovery-oriented mental health programs at their respective sites. This training served to communicate a common philosophy and policy to LRCs and assisted them in assessing their needs for program development. By the close of training, the LRCs had set two short-term and one long-term goal for program change and drafted an Action Plan for meeting their goals.
National Suicide Prevention Coordinators Training
The VA hired Suicide Prevention Coordinators at each Medical Center facility during the spring and summer of 2007. An initial face-to-face training for coordinators was held in Atlanta, in August, 2007. This meeting, attended by 175 Suicide Prevention Coordinators and other key mental health officials, was designed to alert everyone to best practices in suicide prevention strategies, as well as help newly hired coordinators understand their role and the expectations of their position. Monthly and as-needed audio-conferences are held to continue providing on-going education and direction. Continual support is provided by the CoE, the VISN 3 & 19 MIRECCs, the Office of Mental Health, and the National Center for Patient Safety. Attendance at the conference exceeded expectations and attendee evaluations of the conference were excellent. Suicide Prevention Coordinators have already begun to implement selected strategies in the area of suicide prevention.
Evidence-Based Interventions for Suicidal Persons
This was a regional conference in collaboration with VISN 4 MIRECC and VISN 19 MIRECC, which was held in Atlantic City, NJ from June 13th to June 14th of 2006, and repeated, with some modifications, in February, 2007, in Denver, CO. The conference focused on educating providers on the state-of-the-art evidence-based interventions for persons at risk for suicide. These included psychopharmacological as well as psychosocial interventions such as CBT, DBT, IPT, family and web-based treatments. There were also programs focused on research and evaluation issues, and the implementation of these interventions within the VA.
Recently Completed Projects
Veterans with Intractable Discharge Issues (VIDI)
This project involved review of every longstay patient remaining in VISN 3. A team of clinicians co-chaired by the MIRECC Education Director and MHEB Business Manager reviewed and discussed each patient in terms of diagnostic assessment, psychopharmacologic treatment, psychosocial and rehabilitation interventions, as well as behavioral, family, community and financial discharge impediments. Some of these patients have made progress through recommended interventions, and a white paper is being prepared which characterizes the population and makes recommendations for enhancing recovery.
Cultural Competency
Juan Mezzich, MD, PhD
The goal of cultural competency training at the Bronx VA was to enhance clinical and cultural competence through the DSM-IV cultural formulation. This involved a specially prepared guidebook to the culturally competent assessment and a reader of important papers on cross-cultural psychiatry. The course was delivered to one team at the Bronx VA through 10 weekly sessions. Data was collected on the impact of the course upon the trained mental health professionals, and subsequent steps include evaluation of impact on patient care and outcomes, as well as offering the course to other facilities in the network.
MIRECC Clinical Practice Guidelines/NJ Algorithm
David Smelson, PsyD, Miklos Losonczy, MD, PhD, Bruce Levine, MD
This implementation pilot study examined the effect of clinical monitoring and feedback on physicians' level of clinical practice guideline adherence. In addition, researchers investigated the effect of guideline adherence on clinical outcomes, such as community tenure and hospitalization frequency. Results revealed that monitoring had weak effects on guideline adherence, and no effect was found on mental health service utilization. Thus, researchers concluded that labor-intensive use of clinical monitors might not be justified.
The project involved formation of Internal and External Advisory Boards that assisted with rolling out of staff training on the algorithm and instruments, development of a side effect and co-existing symptom algorithm, development of a fidelity measure, and development of a consumer satisfaction measure. Two groups of physicians were analyzed from VA facilities in East Orange and Lyons, NJ, and 51 patients were followed for one year after being placed into the treatment algorithms. Below is a brief explanation of the algorithm's development, instruments used, assessment measures, and possible future directions.
A review of existing algorithms, including VA National Guidelines, APA, the Texas Medication Algorithm Project (TMAP), and PORT was conducted. After careful consideration, a modified version of TMAP was selected, and named the New Jersey Algorithm.
The sequence includes two trials of atypical antipsychotics followed by a Clozaril trial. If no favorable response is observed, a third atypical neuroleptic is tried, followed by a typical neuroleptic, followed by a combination of antipsychotic medications. The consensus of the internal advisory committee was to provide a flexible algorithm that will allow for minor modifications as new research is disseminated. Though a positive outcome has not been observed with the NJ Algorithm to date, researchers suspect that a larger sample size might generate significant findings in the future.
Assessment Measures:
A modified set of TMAP assessment measures was used to evaluate patient progress and algorithm effectiveness, a fidelity measure was developed to ensure physician compliance with prescription guidelines, and a survey was administered to assess patient concerns.
Pre-Study Survey:
A pre-study survey was distributed to evaluate physician background knowledge and needs. Results indicated that physicians were familiar with clinical practice guidelines, believed guidelines would be beneficial based on expert consensus, and expressed eagerness to learn more about the use of algorithms.
Training experiences from the project led investigators to begin developing a clinical practice guidelines exportable educational curriculum. This curriculum could be used for implementing clinical practice guidelines at both VA and non-VA sites. The internal advisory committee agreed on the ten topics listed below, and plans to partner with the NY State Office of Mental Health in developing this curriculum. This curriculum program will be recorded on audiotapes, and will have accompanying continuing education credit to facilitate participation.
Core Curriculum Topics:
- Psychopharmacology Review
- Increasing Medication Compliance
- The Use of Adjunctive Psychopharmacological Agents in Psychosis
- Management of Impulsivity and Aggression
- Psychopharmacology in Acute Psychiatry
- Psychopharmacology in Symptomatically Persistent Patients
- Management of Patients with Psychosis and Concurrent Substance Dependence
- Special Considerations in Geropsychiatric Patients
- Pharmacoeconomics
- Effective Non-pharmacological Treatment Modalities for Schizophrenia
Members also recognized the need to develop a dual-diagnosis clinical practice guideline, and put together a workgroup comprised of local and national experts in this area. Depending on the study results, we also want to explore the use of computerized clinical reminders as a more cost effective method for doing monitoring and guideline adherence.


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The news is filled with optimistic messages about the improving economy. The stock market is up. Gas prices are down. The real estate market is holding its own.
Maybe, in other places, it's improving. Maybe it's improving here, but we're just slow to get the memo way up here at the tip of the country. I don't know.
What I do know is that more Americans are on food stamps than ever. The food pantries have more customers than they can serve. In spite of the mandatory insurance provision, people still can't afford to go to the doctor, and insurance companies are still wont to approve some treatment options - even when those treatments are prescribed by the physician who sees that individual. Almost half of the residents here in Maine are receiving some sort of Federal aid. Every time Deus Ex Machina and I go to the grocery store we're sideswiped by the increasingly higher cost of feeding our family. More than ever, I'm seeing charities in need. Everyone wants, but no one can give, because no one has anything.
Maybe it's just Maine. Maybe it's just my family. But I just don't see any improvement in the economy here - not in the overall economy, nor in our personal economy. Things are tight, and what I keep hearing - from everyone and everywhere - is that Christmas giving may be more lean than usual.
There was a time when making homemade Christmas gifts was simply not an option for me. I'm not terribly creative or very talented (I'm no Martha Stewart - and that's for sure!), and the kinds of things I could imagine making didn't seem to be very useful, actually. Further, the ideas for gifts to give were a long the lines of reusing baby food jars to make snow globes, which are fun, but not very useful.
Over the years, I've started saving websites that show ideas for gifts to make. Some of my favorite ideas are on Martha Stewart's website, but I've also been saving articles, like this one, that lists 25 Handmade Gifts Under $5. I won't, necessarily, choose to make any of the gifts listed, but it gives me some ideas, and at a time when I can feel overwhelmed, these kinds of very specific gift options help to focus me.
I love giving (and receiving) handmade gifts. It's fun, for me, to think about the people to whom I wish to give, and to think about what they might like, and then, to figure out a way to create that gift. It's even more fun when I can create that gift from things I have here at my house.
And as a hoarder, the kinds of things I have available for giving are pretty impressive.
We also have some very cool tools, like a bottle cutter so that we can make some upcycled gifts out of used wine bottles (the ones we don't refill with our homemade wine, that is :)). Or I might be able to spare one or two of my beloved canning jars to make one of the ideas on this list.
We will give a combination of bought things and homemade things this year, as usual. What I realized, though, is that too many of the things I've purchased over the years are things that I could have made - with a bit of imagination.
Things may be a little tight, but that doesn't have to mean that we can't enjoy the holiday season. In fact, since all of us are in the same boat, seems to me that it could be even more fun to see how creative we can all be.
Sneak preview:
There is always a lot of painting of wooden things here at this time of year ;).
Monday, December 8, 2014
1 comment:
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subset: commoncrawl


text:
SiMn1. SiMn a kind of universal deoxidize agent for steelmaking industry , is a kind of application widely, larger output of ferroalloys. The consumption of electric furnace ferroalloy products. 2. Silicon in Siliconmanganese has strong affinity with manganese and oxygen. Deoxidation products MnSiO...Read More
Silicon Manganese 6014SiMn a kind of universal deoxidize agent for steelmaking industry. 1.Average granularity,feeding accurately 2.Deosidizing takes less time,and high effect 3.Reducing the consumption of raw and auxiliary materials and saving energy. 4.Promoting melt fast and can reduce the power consumption...Read More
Silicon Manganese AlloySilicon Magnesium Alloy (Nodularizer) is remelting alloy composed of rare earth, magnesium, silicon and calcium.Read More


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I've wanted to try Makeup Revolution products for the longest time so when I had some Christmas money, I decided straight away to get some items. At the time there was a Christmas promotion whereby if you spent £25 or more on items then you got a free gift with your order. After seeing what you would get, I took full advantage of the offer.
Makeup Revolution was launched in London in March 2014 and in that time has gained fast popularity. Their products range from as little as £1 and I have heard fantastic comments about the pigmentation of the makeup. New products are launching all the time and I already want/ need the I love Makeup Blushing Hearts (I adore the heart shaped packaging,) the Naked Chocolate Palette and the new Lip Lava's. Anything with cute packaging and I neeeeed it!
I decided on three eye shadow palettes these being;
Iconic 1 - I chose this one as it had lots of shimmer shades and I love nudes as they make my blue eyes stand out more. I loved the look of the golds in particular and can't wait to see if they are buttery and pigmented.
Iconic 3 Again this has a great mix of shimmers and mattes and what I love about this one is the more pink/ gold shades. These really remind me of the Urban Decay Palettes but for a much smaller price tag of £4 compared to £37.
Mermaids vs Unicorns When I heard the name of this palette, it made me want it even more! I love mermaids and I love Unicorns so great name choice. I've only actually started wearing nude colours recently whereas this palette is definitely my go to. I like wearing blues and greens so I'm leaning towards a Mermaid already.
I got the blush palette in All About The Pink for £6 and it has a mixture of shimmer, matte and baked blushers. I love pink blushers and these six shades look fabulous.
I love lipsticks and so I decided to choose six different ones as they were an amazing £1 each.
The colours I chose were;
Mostly pink shades with a purple too as I loved the look of this shade.
This is the free gift that I got with my order. I wanted one of these palettes as soon as I saw them, yes purely for the pink gem heart on the front! This is the I Heart Passion palette and it will look beautiful on my dressing.
Also included with the gift were these three lipglosses. The vibrant pink shade looks an absolute beaut.
I also got this vivid blush lacquer too which is not a shade I would necessarily choose myself but it will be great to try it out and see if I suit it or not.
What do you recommend from Makeup Revolution? Have you tried this brand before?
Love Laura xoxo


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Sunday, August 7, 2016
Pawlympics Event Silly Sleeping Furries And DIGGING
Click HERE to get to their Blog...
AND our CUSSIN..... SARGE is Hosting DIGGING
Click HERE to get to His Blog
THIS is Ernie's entry..
16 comments:
- Ann Adamus said...
Hi there Frankie and Ernie! Well, guess it's getting-up time ... and time to go out and do the digging! Thanks for joining our event, we were really glad to have you be part of it ... oh, and if you dig up any bones over at Sarge's, Dougie Dog wants to know if you'll share; he's not much of a digger ...
Happy Sunday! Woof, woof.
- August 07, 2016
- Sarge said...
Hey FnE!
Wow, the games are off to a great start! I know fur sure that you two can do all kinds of sleeping. BOL. Thanks for digging with me.
Grr and a Sporting Woof,
Sarge, Athlete
- August 07, 2016
- Madi and Mom said...
FnE love you silly sleeping and Ernie OMCs how appropriate you are wearing a pirate bandanna for the digging event!!!
Hugs Madi your bfff
- August 07, 2016
- The Army of Four said...
Do you guys know this posted twice?
- August 07, 2016
- Yamini MacLean said...
Hari OM
uuugggghhhh - I'sa not slept since Friday cuz of the Os and the Ps... so much to see and STILL not enough hours... and now I'sa getting double vision!!! hugs and wags, YAM-aunty xxx
- August 07, 2016
- Hailey and Zaphod and their Lady said...
All your training has really paid off guys!
- August 07, 2016
- Kismet said...
You're not gonna get many style points. Your sleeping isn't synchronized very well. You need a choreographer.
- August 07, 2016
- Murphy said...
You two set the bar high for these events fur sure!
Your Pals,
Murphy & Stanley
- August 07, 2016
- Angel Ludo van Doggy said...
The pawlympic games are really heating up now. I don't know whether I should be watching the blogs or the TV. I think the blogs!
-Wiggles, Arran
- August 07, 2016
- Bouncing Bertie said...
You guys are going to have so many medals I'm thinking the world gold price might shift.
Toodle pip!
- August 07, 2016
- The Adventures of The Bell Fur Zoo said...
So many pawtastic athletes in both events!!
Matt & Matilda
- August 07, 2016
- LBJ said...
You did a great job - you're going to win so many medals!
Smoochies to my Frankie
Abby Lab
- August 07, 2016
- Dory and the Mama said...
Looking great guys!!!
Dory, Jakey, Arty & Bilbo
- August 07, 2016
- Mary Ann said...
I saw the comment about the hummingbirds feeders at Calamity Acres! Good advice! I actually had one of those feeders but it got just a little bit warped and would not keep from dripping. I need to get another. Those holes were actually harder for me to keep clean, but I am cleaning them daily now. I had five zipping across my deck tonight! Thanks for the advice about the vinegar, I'll do it.
- August 07, 2016
- Dennis the Vizsla said...
hello ernie its dennis the vizsla dog hay that is sum awsum digging for shoor!!! if yoo do not git a medal i am totaly going to blaym the eest german judges!!! we do stil hav thoze rite??? ok bye
- August 08, 2016
They say that Olympic stars practice practically their whole lives. Yup. It looks like you guys have has LOTS of practice napping and digging... Well done. Medal winners for sure!
Love and licks,
- August 08, 2016


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Since 1994, there have been no [abortion] providers in the state. Planned Parenthood flies a doctor in from out-of-state once a week to see patients at a Sioux Falls clinic. Women from the more remote parts of the large, rural state drive up to six hours to reach this lone clinic. And under state law women are then required to receive counseling and wait 24 hours before undergoing the procedure.
Before performing an abortion, a South Dakota doctor must offer the woman the opportunity to view a sonogram. And under a law passed in 2005, doctors are required to read a script meant to discourage women from proceeding with the abortion: "The abortion will terminate the life of a whole, separate, unique, living human being." Until recently, doctors also had to tell a woman seeking an abortion that she had "an existing relationship with that unborn human being" that was protected under the Constitution and state law and that abortion poses a "known medical risk" and "increased risk of suicide ideation and suicide." In August 2009, a US District Court Judge threw out those portions of the script, finding them "untruthful and misleading." The state has appealed the decision.So abortion is legal, but so inaccessible that it might be impossible for some. I hadn't realized that could be the case, so I found the report very disturbing.
Speaking of Planned Parenthood, the House of Representatives wants to block their federal aid. It will probably fail in the Senate, so "thanks" for wasting everyone's time. This bill is absurd to me, because Planned Parenthood doesn't just provide abortions (which, as we've noted, are not illegal). They provide birth control, STD/HIV testing, and perhaps most importantly, information. While I may be indifferent about sex, I am NOT indifferent about reproductive rights and sex education. If that education is withheld, people won't suddenly become celibate, which seems to be a common misconception held by Republican politicians. While I'm asexual, I feel like I understand the nature of sexuality better than these presumably sexual politicians do. People will still have sex, they'll always have sex. Without good information, they'll just be less likely to make safe choices.


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Welcome to Used-Laptops.co.uk, the home of buying used laptops on the internet.
We sell a vast range of used laptops at the very best prices available online in the UK. Here at Used-Laptops.co.uk, we pride ourselves on being the one-stop-shop for all your used laptop needs. Basically, if you are reading this and you are thinking about buying a used laptop, then you are in absolutely the right place. In fact, there is no need whatsoever to look anywhere else.


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I was talking last time (Part 1) about my immediate reactions to the State of the Union Address, particularly from a political lense. Now I'd like to focus on the major problems the President wishes to tackle and the strength of his domestic policy recommendations, in order as they come up in the address (though, because of the length of the address, I won't be hitting every point).
Obama is right to place heavy emphasis on equality of opportunity. Unlike the concept of income inequality, an opportunity agenda is something that has broad support across the political spectrum and is a shared value nation-wide. One of his best recommendations is an overhaul of the tax code, whose loopholes cause precious time and resources to be diverted away from productive activities as individuals and companies seek to minimize their burdens. Running at an estimated cost of at least $250 billion/year in lost economic output and at least $1 trillion/year in lost revenues, the tax code is an abomination. This lost output translates into lost job opportunities and slower job creation. If the President fails to reform it (e.g. by cutting loopholes and lowering marginal rates), it will assume the title of Obamination. His proposal to use some of the savings to help rebuild the nation's infrastructure is also not a bad proposition, as the American Society of Civil Engineer's 2013 Infrastructure Report Card estimates that America would need to allocate an extra $1.6 Trillion just to upgrade our infrastructure to a state of "good repair". If we continue to fail to maintain the nation's physical capital, our competitiveness will deteriorate and the sluggishness in productivity growth that has been the norm since the 70's will drag on. Additionally, his idea of further connecting businesses and universities via regional hubs is also laudable. Universities are a critical source of research and discovery; connecting them with businesses can help transform those ideas and discoveries into useful, productivity-enhancing goods and services. All of these ideas will bolster American opportunity.
From there, his message starts to deteriorate a bit. He mentions that his administration has made more loans to small businesses than any other, and wants to do still more. Is this really a good thing? State-directed lending (à la China) has had mixed results both in the past and present. Although sometimes successful, loans tend to be politically driven and may not exhibit much, if any, return on investment. As such, they tend to distort the market and allocate resources inefficiently, propping up businesses, ideas, and methods that aren't economically viable in the long-run.
The address then turns back to embracing the market with his sound advocation of patent-reform and the ongoing natural gas/fracking boom. Indeed, both are important issues; litigation has gotten out of control in many parts of the country, adding needless transactions burdens on thousands of businesses; a sounder process that reduces frivolous litigation would be welcome. Streamlining the permitting process and reducing red tape for natural gas is also a long-needed reform; it's good that the administration is finally realizing that fossil fuels still hold massive potential in both creating jobs and lowering American energy costs (which have dramatically increased our competitiveness relative to other developed nations, such as those in Europe). At the same time, his mentioning of reducing fossil fuel subsidies is good as it produces problems similar to the problems small business loans produce. Republicans would be smart to firmly stand with the President on this issue and work to get rid of the subsidies once and for all. Corporate welfare almost never works – we have far better uses for our money.
After talking about the usual climate change mantra, he then shifts to immigration. Personally, my views contain a mix of both Republican and Democratic thinking. I agree with the Republicans that "blanket amnesty" would have some serious harmful effects on the country. Specifically, I think granting illegal immigrants citizenship status who broke the law without penalty would undermine the rule of law, something that has already been undermined during this administration (think federal drug enforcement). Not only that, it isn't really fair to those who took the time and effort to come here illegally. At the same time, Democrats are right in that deporting millions of illegal immigrants isn't practical (or smart policy) either. Not only is it extremely costly in fiscal terms, but it is damaging economically. Like it or not, immigrants add to our GDP, lower costs for businesses and allow other citizens to specialize in higher value-added jobs. Deporting them would raise costs, disrupt economic activity and ultimately slow growth. Additionally, many illegal immigrants now have children – the so-called "Dreamers" – who came to this country through no fault of their own. Deporting them or, worse, splitting up families via deportation is emotionally traumatizing and morally questionable. As such, I think the best solution is to grant them citizenship status only after a) thorough background checks have been conducted b) high penalties (for breaking the law) have been applied, including perhaps putting them at the end of the line behind other immigrants that are attempting to get naturalized status. Also good would be to streamline the naturalization system in a way that maintains our national security. The President didn't lay out the terms of his desired reform package in his address, though I'm sure that whatever he supports will contain lots of needed naturalization and far too little penalization.
The President then moves on to the importance of education, especially pre-K education. It is true that early childhood education can improve cognitive development and boost achievement in a child's academic career (and even later on in life), and is something the country needs to consider to bolster its human capital and even total factor productivity (the level of efficiency in turning capital and labor into economic output). However, his advocation of "invest(ing) in new partnerships with states and communities across the country" to boost pre-K education should be approached with caution. I believe that states and localities know best how to create competitive, high-quality educational programs. Getting the federal government involved, even if it is "just" via funding, might not be a good idea. Federal involvement can hinder local innovation and can make localities far too reliant on federal aid (something that can make states puppets of whatever the federal government wants – think Medicaid). Increasing federal involvement since the 1970s, especially since the creation of the Department of Education by the Carter Administration hasn't noticeably boosted educational access or progress; indeed, since the 1970s, progress on indicators ranging from reading and math proficiency to graduation rates have stagnated. Let the states and localities do it on their own; no federal involvement is necessary.
Obama's policy proposals then turn outright populist with his insistence that Congress raise the minimum wage, and lended support to Senator Tom Harkin and Representative George Miller's proposal to raise the federal minimum from $7.25/hour to $10.10/hour. On net, I think this is a very bad idea. Let's start with the usual neoclassical argument: assuming that the current minimum wage right now is at the "equilibrium" wage (which likely is not true), a raise in the price floor would lower business demand for labor while simultaneously increasing the supply of people willing to work. This creates a labor surplus that would translate into unemployment. Indeed, a Congressional Budget Office estimate of the proposal's effect on employment projected that enacting the Harkin/Miller bill would reduce employment on net, with its central estimate at about a 500,000 decrease in employed workers. Then we hear the counterargument by left-leaning economists, such as those at the Economic Policy Institute. They argue that an increase in the minimum wage could actually increase economic growth and job creation, counteracting any job losses. This would be due to the "multiplier" effect of raising the wage of millions of low-income citizens, whose marginal propensity to consume (according to Keynesian theory and many studies) is high. In other words, the newfound income these people would have would be spent almost immediately, increasing aggregate demand and generating economic activity. That is a possibility I suppose. However, we must remember that the equilibrium wage is vastly different across the nation – different states have different price levels and levels of competitiveness; for some, raising the minimum wage could theoretically increase job creation; in others, however, raising the minimum would place it far above the current equilibrium, increasing unemployment. As The Economist has noted, places like Puerto Rico are already suffering from high labor costs due to the current minimum wage, and economists in general have long recognized the high minimum wages of many European countries as contributing to their high long-term unemployment rates. In places like these, the costs of further increases would far outweigh the economic "benefits". Additionally (as The Economist also mentioned), let's face it: many of the jobs minimum wage workers currently perform could easily and efficiently be done by technology and automation. I believe that the only reason many of these jobs still exist is due to cultural norms, which have a tendency to get in the way of rational economic thinking. Raising the minimum wage could accelerate the shift towards these technologies substituting for low & medium-skilled workers, hurting them in the short term. No matter what, the minimum wage is a command-and-control solution to tackling the problem of poverty and low-wage work that will cause more harm than good. Other ideas (such as an increase in the earned income tax credit that the President mentioned) that reward workers without distorting the market and disincentivizing them from working (or employers from hiring) are needed. Additionally, wages are partially a result of overall cultural norms – change the norms, and perhaps we can change the wage.
The last big thing I wanted to address from Obama's speech is a commendable proposal, the MyRA. Partially due to record-low interest rates, savings rates for Americans are at an all-time low. This is very worrying. Savings are crucial for a good retirement (which Social Security was originally meant to compliment, not substitute) and for consumption smoothing (look up the Modgliani life cycle hypothesis). A lack of them can put further liabilities and pressures on entitlements. Additionally, savings help the economy to grow by boosting available financial capital for investment. Without them, long-term economic growth is put into jeopardy. Helping workers to put away reliable savings, especially at a time when defined-benefit pensions are dissapearing in favor of less stable 401Ks is potentially a good idea for governmental involvement. My only caveat: should it be federal?
Overall, the speech was good, with a mixture of good and bad proposals. The nation now needs to prioritize and, when that is done, begin to have thorough debates on these critical issues. Forget midterms; this is among the administration's last good chances to finally leave a positive mark on American history.


text:
All items > Shop by Brand > Olight
- Modes:5
- Max Output:550 Lumens
- Max Runtime:600 Hours
- Peak Beam Intensity:3500 Candela
- Beam Distance:118 Meters
- Impact Resistance:2 Meters
- Water Resistance:IPX-8
- LED Type:CREE XM-L2
- Battery Type:CR123, 18650
- Batteries Included:No
- Length:4.188"
- Head Diameter:0.875"
- Body Diameter:0.88"
- Material:Aluminum
- Color:Black
- Weight:1.80 oz.
- Brand:Olight
- Model:S20
- Model Number:OLS20-L2
- Country of Origin:China
- Best Use:Everyday Carry
- Product Type:Flashlight
Olight manufactures premium flashlights like this S20 Baton. It has a powerful Cree XM-L emitter that puts out 550 lumens from two CR123A or one 18650 battery. The S20-L2 has a black hard anodized aluminum body with a thumb push-button switch, a removable steel pocket clip and lanyard. The tail end of the light has a strong magnet, a great bonus. There are four adjustable brightness levels and two types of strobe. The Olight S20-L2 features a low-voltage indication (the bottom side switch will shine red when the power is low). Water Resistant down to 2 meters.
- Multi-function side switch with four brightness levels from 0.5 to 550 lumens, plus a strobe mode
- Power indicator built in to side switch, letting you know when your battery is getting low
- Memory function to remember the last power setting used, along with quick access directly to the brightest level and a lock-out mode to prevent accidental activation
- Latest top-of-the-line, highest-performing, single-die CREE XM-L2 LED
- Aircraft-grade aluminum body with anti-scratch type III hard anodizing and stainless steel head ring
- Two-position U-shaped pocket clip
- Flat tail cap with strong magnet to secure to ferrous surfaces
- Reverse polarity protection to prevent improper battery installation and thermal management to avoid overheating
- High: 550 lumens / 2 hours
- Mid: 120 lumens / 9 hours
- Low: 5 lumens / 120 hours
- Lower: 0.5 lumens / 600 hours


text:
This content has been marked as final. Show 2 replies
1. Re: Selection on BLE dongleuser_1377889 Jan 30, 2016 3:55 AM (in response to madhusudan.sangam)
A comparison of the two devices show that the cy5677 is confirm to the latest BLE 4.2 standard whilst the cy5670 is not.
Depending on the capabilities of the device you want to connect to you may use the (older) cy5670 which seems to be on stock.
2. Re: Selection on BLE donglemadhusudan.sangam Jan 30, 2016 4:10 AM (in response to madhusudan.sangam)
Hi bob,
Thanks for the reply, a small query,
1. does it have BLE 4.1 stack.
2. and does it support 250 MTU change.
Waiting for reply,
thank you.


text:
I must confess, I have a bit of a teensy obsession with Kimono's, I have about 5 or 6 now and I just love them all. They are the easiest thing to just throw on over a simple tee and a pair of jeans like what I have done above. I just think they make you look all fancy and are just so pretty.
This is the newest one in my collection, I got it last week. Its from Monki on ASOS. I had wanted a long kimono like this for so long and it's just perfect. Seriously I have been swishing around the place like I'm Penny Lane, it literally makes you feel like you are such a hippy, I kinda feel like I'm wearing a dressing up costume or something when I have it on as it's kind of dramatic with the length but I just love it.
I think it's going to be great when the weather starts to heat up and it will solve that whole in between summer stage when you need to wear a cover up but you don't want it to be to heavy and warm.
Also how crazy light is my hair getting at the ends? I couldn't believe it when I was looking through these photos and saw it, which reminded me that I need to do my brunette to blonde to brunette again post in case any of you are currently on a hair colouring 'journey', then hopefully my tips and tricks that I've learned so far from changing my hair colour so much might help, so keep an eye out for that soon!
You can buy the Kimono HERE for £18


text:
Kermesse Oecuménique de Monaco (Monte Carlo)
The Kermesse Oecumenique de Monaco Saturday December 6, Protected content at Le Chapiteau Espace Fontvieille is a wonderful event with plenty to interest the whole family and a great sense of community! Under the High Patronage of HRH the Princess of Hanover, this is the place where Monaco's fans of second hand treasures go to find a bargain. A silver tray? A gently used Gucci purse? Designer clothes? How about some books for your vacation or some toys for the kids? There are always fantastic Tombola prizes to win, a popular snack bar, and food stalls. Fun for everyone!
The Kermesse Œcuménique de Monaco raises funds for the charitable activities of St. Vincent de Paul, The British Association of Monaco, St Paul's Anglican Church Monaco, the Église Reformee de Monaco, L'Église Grecque Orthodoxe St. Spyridon de Nice, and La Communauté Espagnole. It is a great opportunity to clear out cupboards, closets, attics to donate to a worthy cause!
The Tombola ticket sales are a key part of the 45th Kermesse Œcuménique de Monaco fundraising efforts. There are great prizes to be won. Tickets are on sale now. Tickets are 2 Euros each or a carnet of 20 for 40 Euros. The draw on December 6th Protected content conducted by the Huissier, Maître Escaut-Marquet, and results are published in NiceMatin. Winners not present at the draw will be contacted to arrange collection of the prizes.
If anyone would wish to buy Tombola tickets, please contact Kristi Prenn If anyone would be prepared to join the team of volunteers selling tombola tickets, please contact Kristi Prenn.
There is a Facebook site 'Kermesse Oecumenique de Monaco' , featuring most of the fantastic prizes to be won during the tombola, and an Events page '45e Kermesse Oecumenique de Monaco'. It would be much appreciated if InterNations members on Facebook could 'LIKE' and 'Share' the pages with Facebook friends. It would be terrific if it was possible to create a link to the 45e Kermesse Oecumenique de Monaco Event page to further spread the word.


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Secret Clearance Shopping Tips!
Published on 1/21/2016 by The Melea Show
Want to know my Secret Clearance Shopping Tips?? Sometimes Clearance Prices will take advantage of you! This video will show you how to know where to find secret clearance items and how to really find some amazing clearance deals! And show you how to use a special app to ↓↓↓↓ CLICK SHOW MORE ↓↓↓↓ actually help you know if a deal really is a good deal.
You can use a number of "Price-Scanning Apps", but the one I used in this video is called RedLaser and you can find it in the Apple Store or the Google Play Store. Download it (it's FREE) and use it to help you scan and save in-store shopping clearance items!
And on a side note.... who is excited for SUPERBOWL Recipes that are easy?? Sharing some of my favorites on the next episode!! Hit the like button if you're excited to watch! XOXO
Want to "Live the Ultimate Life for Less"?? Don't forget to SUBSCRIBE to my channel here: http://www.youtube.com/user/Freebies2Deals?sub_confirmation=1 That way, YouTube will let you know when my next video goes up live!
For more deals & money-saving tips and tricks, visit my full site at http://www.Freebies2Deals.com. No matter WHEN you visit, you will find crazy deals and freebies available for THAT day. It's the easiest way to always save money. :)
FOLLOW ME: Instagram: http://www.Instagram.com/melea_johnson Periscope for LIVE Videos: @Freebies2Deals Facebook: http://www.Facebook.com/Freebies2Deals Pinterest: http://www.Pinterest.com/Freebies2Deals Twitter: http://www.Twitter.com/Freebies2Deals
XO, Melea


text: I've been wanting to try DR strings for quite a while. They seem to get great reviews for brightness and longevity. My gas got out of hand yesterday and I bought a couple of 4 string sets, probably below cost , and I'm looking to purchase at least one .135 b string. Can anyone point me toward and online source? TIA


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Welcome to Beading Daily!
I'll admit, I've been experiencing just a bit of what one of my friends calls PPA—Pre-Party Anxiety. It always happens to me sometime between the time I invite people to a party and the first time the doorbell rings. Do I have enough chairs? Is it too late to change the curtains? What if no one likes the onion dip? What if no one shows up?
But pretty quickly, I realized that even if everything wasn't perfect (those curtains really must go!), it would all be OK—because of YOU. This is your community and together we're going to create something wonderful! I'm going to do my part—provide great free projects each week, plus beading tips, techniques, interviews, and more. But I'm going to depend upon you to say, "Michelle, why don't you talk about crimping?" Or to chime in and agree with my latest post—or disagree ("Actually, the best way to crimp is to twirl on one foot, hum 'Lara's Theme', and bite down on the crimp with your left molar.")
In the kitchen, cooking up some beading fun.
(Yes, those are tubes of seed beads in the saucepan!)
While I have been beading for a number of years, I do not promise to know everything—when I say we can all learn from each other, I'm including myself in that group! What I can promise you is that if you want to know something about beading that I don't know, I will find out for you! The editors of Beadwork, Step by Step Wire Jewelry, Step by Step Beads, and Stringing, not to mention all our terrific Interweave Press book authors, are eager to answer your questions, share tips and techniques, and offer free projects of all types. And we're not limited to the Interweave universe. If the best book that's ever been written on the left molar crimping technique is published by Dental Beading, Inc., then that's the book we're going to talk about.
On Wednesday, I'll tell you all about the first Beading Daily challenge and the stories behind the two projects below. In the meantime, turn up the music and let's get this party started!


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Sorry for the delay in posts. I've been busy being wrong.
As we know, one of the first tenets of "good" science is reproducibility. If I follow someone else's protocol, using the same starting material, I should get the same results. But if you do that, and you get a different result, how do you know whether the alternate result is because you didn't quite replicate the protocol, or because the original conclusions were wrong? Or what if you interpreted the same results differently?
I can imagine this is an especially large problem when you are new to a protocol (or at least that is my excuse), as you lack a sense of the range of possible outcomes. For example, a labmate was trying to interpret a catalase test earlier, and would have said that all our results were negative compared to the plate of mixed soil bacteria I had, where adding a drop of hydrogen peroxide caused a baking soda and vinegar type volcano effect. Two of the bacteria were supposed to be catalase positive, and if we added tons of hydrogen peroxide directly to a plate with a high density of bacteria and looked really really close for a few minutes and imagined a positive result, we got one or two small bubbles. This is exactly the same as if I drop a drop of the hydrogen peroxide on uninoculated media. So did the authors who stated these organisms were catalase positive actually mean it, or did some nervous inexperienced student who was told to look for any sign of bubbling squirt a bubble onto the slide and say there was a positive result? Who decides where the boundaries of a positive or a negative result are - would it not depend on "how" positive or negative your control organisms are? Do people publish the organisms they used as controls alongside their determination of whether something shows a positive or a negative result? No evidence for these yet.
Maybe we should just mandate that all standards in genomics tables be replaced by full-colour pictures. Voluptuously bubbling hydrogen peroxide. Stunning Gram stains. Replace someone else's interpretation of ambiguous data with informative eye candy.
In another instance, I have been working (a bit too long) on trying to get well-published qpcr primers to work, and finding that the conditions as close to the original ones I can reproduce in my lab just don't work. I was afraid I had contaminated the freezer stock of my organism, or put too much or too little template, or used the wrong temperature...something that was my fault. I tried to come up with an answer and a solution for my PI for when I told her that things weren't really working. But apparently, however, what I thought was close enough to the original conditions probably is not; the primers were tested against a sequence placed in a purified plasmid, and I am using genomic DNA.
Which brings us to another class of issues with reproducing an experiment - what if you purposefully are not exactly reproducing an experiment, because you don't believe the methods used are valid and/or reliable and/or result in biologically meaningful conclusions? Why waste time and money trying to reproduce an experiment that was invalid when it was made, and still invalid now, just to try and compare your results to ones you cannot trust? At my stage, I think it is so you can fit in; the ability to reproduce something invalid is a valuable skill for perpetuating some of the falsehoods of science, which you have to be able to do in order to prove your worth in breaking the (methodological) status quo.
So why use a plasmid template for qPCR, even if it does a poor job representing the kinds of templates you will be comparing with from the environment? Because it is one of the standards for this kind of data collection; we can hide behind completely non-reproducible data, uncertain whether it is due to the methods, or because we are dealing with "complex" environmental samples that nobody else is likely to exactly mimic.
But no matter what I may do to try and convince myself I wasn't wrong, I was. I tried to reproduce results under the conditions I thought they should be done, not those in which they were intended.
So if you are wrong, either make sure you do it reproducibly so you can challenge what is deemed right, or do so using conditions nobody expects ever to exactly reproduce. But know when to accept that it is you, not science, not the protocol, that is wrong.


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Sale Date Ended
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The workshop will be conducted by Chirag Thakkar, an MBA from Management development Institute, Gurgaon with 98.38 percentile in CAT. He trains the mid and higher management of various companies on Leadership and Time Management.. He has trained more than 10000 students in Engineering and MBA colleges on Aptitude, Interviews and Group Discussions. He is now also expanding to train school students on realizing that the right time to develop Leadership traits is when the students are young and receptive.
The Workshop is for 7th, 8th & 9th standard school students
Workshop takeaway and Module Information
1.Ensuring that the student automatically emerges as a leader in the group
2.Group Discussions, just the way we train MBA students(But with different, simpler topics catered to the student age group)
3.Making the student take initiatives in group activities
4.Strategy and Logic building sessions through Management puzzles
5.Ensuring confidence to communicate
6.Tasks involving convincing skills to ensure clarity of thought processess
7.Story building IMPROV sessions to increase spontaneity and humour
8.Effective presentation skills
9.Effective time management
10.Understanding group dynamics
11.Speaking one's way to impress
12.In short, development of Leadership traits
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RAMEN.Co was first opened after the extreme success following the Ramen Burger craze at Smorgasburg. Eventually, a shop dedicated to the culinary beast was opened here in FiDi, and it's serving up serious ramen bowls alongside non-Ramen Burger options. But fret not, it'll always be the home of the Ramen Burger, which you should get, immediately.
- New York
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Discover Bars & Restaurants


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Monday, August 8, 2016
The Last One by Alexandra Oliva
Summary on Goodreads.
"It begins with a reality TV show. Twelve contestants are sent into the woods to face challenges that will test the limits of their endurance. While they are out there, something terrible happens—but how widespread is the destruction, and has it occurred naturally or is it man-made? Cut off from society, the contestants know nothing of it. When one of them—a young woman the show's producers call Zoo—stumbles across the devastation, she can imagine only that it is part of the game ..." [+ more]
This book just reminded me of the movie "The Condemned" where a bunch of prisoners were thrown on an island to fight for survival against each other while everything is transmitted live online.
I can't even produce a reasonable explanation why I didn't like this book. I just couldn't connect.
Thank you Netgalley for providing me with a free copy of this title.
The Last One by Alexandra Oliva
Lectus Read
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The Byrd Theatre
A compelling and clear strategy that moves the Byrd Theatre forward, allowing it to better market itself to move-goers and donors.
Develop a compelling and clear brand that moves the Byrd Theatre forward, allowing it to better market itself to move-goers and donors.
Key findings/ Opportunities
- Richmond people love a lot about the Byrd and its experience - but they can't quite define that experience.
- The essence and history of the Byrd are rooted in the Golden Age of cinema. (1928)
- The theatre has very good relationship with its community. Especially, most of donors have supported the Byrd are local business owner.
"Carytown is Richmond's Jewel, and the Byrd Theatre is the gem that created this jewel" - A Richmonder.
Opportunity: Leverages its relationship with the community and positioning the Byrd as "Carytown's homage to the golden age of film".
1. Renamed the theatre to "The Byrd: Carytown's Movie Palace"
2. Developed supporting tactical recommendations to embrace the unique film experience.
New philanthropic ticket option
Golden-Age-inspired movie poster and uniform : Work with VCU Communication Artsto use this idea as a school project if there isn't a budget.
Programming: LESS "Dumb & Dumber" movies, MORE"Inception" films or second run independent films, OCCASIONAL Golden-Age films.
Local business partnership:
- Donation boxes in partner stores
- Sales of Golden-Age-inspired movie posters + merchandise (Film-centric gift shop at local businesses.
- Concession items showcasing wares of other Carytown businesses (Donated by partners + branded for exposure)
Team members
Khuyen Le, Luisa Contaifer, Daren Lifferth, Perry Lowder, Emily Smith


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Newcastle United are set for another busy week of comings and goings as Rafa Benitez looks to add a midfielder and at least one defender before the Bohemians game on Saturday.
And after the high-profile departure of Papiss Cisse, United are braced for further exits of some of the squad's established players. Interest has been shown in Cheick Tiote, Tim Krul and Daryl Janmaat – while the completion of Euro 2016 brings Moussa Sissoko's future into sharper focus.
But first United will confirm the signing of Isaac Hayden from Arsenal on Monday, with the former Hull City loanee set to join on a long-term contract with Newcastle hoping to help him develop into a first-team player next season.
They see him as a midfielder rather than a defender, and are keen to address that area with a move for Grant Hanley. Two bids – the second at £4.5million – have been rejected by Blackburn, and Newcastle do have other targets that they could move quickly on if Rovers continue to resist their offers.
Owen Coyle said: "Number one, I don't want to be selling Grant Hanley. I'll say that openly.
"But obviously we can't stop clubs from admiring our players. It's the same with me. I admire players at other clubs and go after them. But what I would also say is about Grant Hanley's valuation as a player. I hold him in very high esteem. I think he's a very, very good player.
"And I think it's fair to say, in my own opinion, they are nowhere near the valuation of Grant Hanley. I don't want to lose him."
Benitez's desire to move quickly to bring in new recruits has seen them sign four players already in this window, with high-profile exits for Fabricio Coloccini, Cisse and Andros Townsend.
This will be an almost unprecedented summer of change at St James' Park and Benitez would like a high-profile signings to add to Matz Sels, Matt Ritchie, Dwight Gayle and Jesus Gamez. That may depend on whether Newcastle can hold onto Sissoko and Georginio Wijnaldum, who is rated at £30million by the club and has attracted interest from Spurs, Liverpool and Everton.
We can also expect some clarity on Remy Cabella's situation in the next few days, while Florian Thauvin – who is interesting Lazio – is another whose future may be resolved soon.
Newcastle are also looking to add players to their under-21 squad and Peter Beardsley's young side had three trialists as they defeated Bradford Park Avenue 3-0. Flavio Da Silva – a Portuguese under-19 international – scored and Tyler Harvey, who has played for Plymouth as a midfielder and forward.
Da Silva was released by Benfica in February and holds a Portuguese passport. Newcastle are hoping to bring in more players for the development squad in the coming weeks.


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The Rio Grande Herald (Rio Grande City, Tex.), No. 13, Ed. 1 Thursday, February 4, 1988
Description: Weekly newspaper from Rio Grande City, Texas that includes local, state and national news along with extensive advertising.
Date: February 4, 1988
Creator: Roberts, Kenneth
Item Type: Refine your search to only Newspaper


text: Ahh, thank heaven for spring and these one-shot pilots, which may never make it on the fall schedule, but are worth checking out nonetheless. Here's the latest one: NBC's Our Planet Tonight (8 p.m., WPTV-Ch. 5, WSVN-Ch. 7). Those Airplane! maniacs, producers David and Jerry Zucker, created this spoof of TV newsmagazines, and somehow found John Houseman in a sufficiently receptive mood to play the anchor. His distinguished co-host is Morgan Fairchild, one of network television's premier bleached blondes. Among the hour's exclusive reports is something called The Mystery of Geraldo Rivera's Secret Vault (in which a crew invades Rivera's home and finds a sealed room in his basement). I think this show's a great idea, but I'm willing to bet that if it aired every week, enough viewers would think it's a real news show, and not a spoof, to cause problems.


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Separate names with a comma.
Discussion in 'Growing and Managing a Business' started by Kay, Sep 22, 2010.
This change is still a week or two away, but it's a good one.
You can download Microsoft Security Essentials from here. I use ESET Smart Security which is not free, so I just might switch to this free Microsoft product when my ESET licence expires.
I've always found it fairly alarming the number of SMEs/SMBs that don't consider the licensing of the software they use. They see "Free download" and don't think/care to check if the free use is limited, which it is in many cases, to home users only.
Thanks for sharing Kay. I've not actually used MSE yet, but having read many reviews of it in recent time it's one I've been meaning to try and I'll certainly consider it even more for the future in light of this change.