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Data and calculations used to understand the relationship between decision-making autonomy and management training on facility-level management performance in Odisha, India. These data were analyzed by the Primary Health Care program at Ariadne Labs. The enclosed data were used for our analyses. Also included is a modified Modified PRImary Care Management Evaluation (PRIME) Tool to calculate management performance, an Autonomy Score guide, and characteristics of PHC facilities stratified by exposure.

The primary purpose of the Eastern Iowa Community College District (EICCD) Program Evaluation Process is to ensure curricular relevance, instructional quality and the effective and efficient use of resources. Developed and pilot-tested on 38 vocational-technical programs, the model is being utilized by more than 120 technical and community colleges in the United States and Canada. The process consists of two phases, an annual review of the program in terms of 10 data elements and an in-depth program review conducted once every 3-5 years. The 10 data elements are unduplicated enrollment/headcount; contact hours generated by the program; full-time equivalent (FTE) enrollment generated by the program; program graduation/completion rates; program leavers and withdrawal rates; program majors' intent for enrolling in the program; program costs; average class size; success of program leavers and graduates; and meeting highlights. Phase II consists of faculty self-study; an internal review team visit and report, surveys conducted of 6 target groups, and decision-making. Contains 38 references. (Author/KM)

This article is from BMJ Open , volume 2 . Abstract Objective: Examine clinical reasoning and decision making in an out of hours (OOH) primary care setting to gain insights into how general practitioners (GPs) make clinical decisions and manage risk in this environment. Design: Semi-structured interviews using open-ended questions. Setting: A 2-month qualitative interview study conducted in Oxfordshire, UK. Participants: 21 GPs working in OOH primary care. Results: The most powerful themes to emerge related to dealing with urgent potentially high-risk cases, keeping patients safe and responding to their needs, while trying to keep patients out of hospital and the concept of ‘fire fighting’. There were a number of well-defined characteristics that GPs reported making presentations easy or difficult to deal with. Severely ill patients were straightforward, while the older people, with complex multisystem diseases, were often difficult. GPs stopped collecting clinical information and came to clinical decisions when high-risk disease and severe illness requiring hospital attention has been excluded; they had responded directly to the patient's needs and there was a reliable safety net in place. Learning points that GPs identified as important for trainees in the OOH setting included the importance of developing rapport in spite of time pressures, learning to deal with uncertainty and learning about common presentations with a focus on critical cues to exclude severe illness. Conclusions: The findings support suggestions that improvements in primary care OOH could be achieved by including automated and regular timely feedback system for GPs and individual peer and expert clinician support for GPs with regular meetings to discuss recent cases. In addition, trainee support and mentoring to focus on clinical skills, knowledge and risk management issues specific to OOH is currently required. Investigating the stopping rules used for diagnostic closure may provide new insights into the root causes of clinical error in such a high-risk setting.

This article is from Trials , volume 12 . Abstract Background: The purpose of this research is to develop and evaluate methods for conducting cluster randomised trials in a primary care database that contains electronic patient records for large numbers of family practices. Cluster randomised trials are trials in which the units allocated represent groups of individuals, in this case family practices and their registered patients. Cluster randomised trials often suffer from the limitation that they include too few clusters, leading to problems of insufficient power and only imprecise estimation of the intraclass correlation coefficient, a key design parameter. This difficulty might be overcome by utilising databases that already hold electronic patient records for large numbers of practices. The protocol describes one application: a study of antibiotic prescribing for acute respiratory infection; a second protocol outlines an intervention in a less frequent chronic condition of public health importance, stroke. Methods/Design: The objective of the study is to implement a cluster randomised trial to test the effectiveness of an electronic record-based intervention at achieving a reduction in antibiotic prescribing at consultations for respiratory illness in patients aged 18 and 59 years old in intervention family practices as compared with controls. Family practices will be recruited from the practices that presently contribute data to the UK General Practice Research Database (GPRD). Following randomisation, electronic prompts will be installed remotely at intervention practices to promote adherence with evidence-based standards of medical practice. The intervention was developed through qualitative research at non-intervention practices. Data for outcome assessment will be obtained from anonymised electronic patient records that are routinely collected into GPRD. This protocol outlines the proposed study designs, data sources, sample size requirements, analysis methods and dissemination plans. Ethical issues are also discussed. Discussion: Results from this study will provide methodological evidence concerning the use of electronic patient records and databases for implementing cluster randomised trials in primary care. The study will also provide substantive findings in respect of electronic record-based interventions to reduce antibiotic prescribing in primary care. Trial Registration: Current Controlled Trials ISRCTN 47558792.

This review aims to map the factors related to the decision-making process of managers in relation to Primary Health Care (PHC) financing.

The School Admissions Code ('the Code') requires school admission authorities to provide for the admission of all children in the September following their fourth birthday. This is when children usually start school, but a child does not reach compulsory school age until the "prescribed day" following their fifth birthday (or on their fifth birthday if it falls on a prescribed day). This means that summer-born children (born between 1 April and 31 August) do not need to start school until the September following their fifth birthday -- a full academic year after they are first entitled to a place. Parents may ask for their child to be admitted to reception rather than year 1 at this point. The admission authority for the relevant school is responsible for deciding the year group to which the child should be admitted. They must make their decision in the best interests of the child concerned. The government believes it is rarely in a child's interests to miss a year of their education by beginning primary school in year 1 rather than reception. This report provides findings from 2 surveys designed to understand: (1) trends in the number of requests for delayed entry into reception for summer born children; (2) whether local authorities are changing their approach to handling requests; (3) factors affecting demand for requests to delay entry for summer born children; and (4) parents' and carers' reasons for requesting delayed entry for their summer born children and their demographics and childcare arrangements. This research provides an update to research published in 2018, 2019 and 2020, providing trends in the number of requests received since 2016.

Lessons and learning activities to teach children in the primary grades about citizenship responsibility and social decision making are provided. Active learning is emphasized. Section I contains five lessons, for use in kindergarten and grade 1, that deal with the themes of freedom and responsibility. The activities focus on home life and the classroom. Students select team captains, make up rules, learn about service workers in the school and select tasks appropriate for a classroom helper in their own classroom, learn about sharing and taking turns, and are acquainted with property rights. The five lessons in the second section are intended for students in grades 2 and 3 and deal with rules and civic responsibility. The activities focus on the neighborhood and community. Students study about traffic rules and signs, the reasons for laws, and the responsibility of citizens to improve public property in their community. Teaching methods vary and include guest speakers, field trips, role play, oral presentation, small group work, classroom discussion, and surveys. The guide also contains additional ideas for activities that can be adapted for use in several grades. (RM)

This article is from The Journal of Headache and Pain , volume 15 . Abstract Background: China may have the largest population of headache sufferers and therefore the most serious burden of disease worldwide. However, the rate of diagnosis for headache disorders is extremely low, possibly due to the relative complexity of headache subtypes and diagnostic criteria. The use of computerized clinical decision support systems (CDSS) seems to be a better choice to solve this problem. Methods: We developed a headache CDSS based on ICHD-3 beta and validated it in a prospective study that included 543 headache patients from the International Headache Center at the Chinese PLA General hospital, Beijing, China. Results: We found that the CDSS correctly recognized 159/160 (99.4%) of migraine without aura, 36/36 (100%) of migraine with aura, 20/21 (95.2%) of chronic migraine, and 37/59 (62.7%) of probable migraine. This system also correctly identified 157/180 (87.2%) of patients with tension-type headache (TTH), of which infrequent episodic TTH was diagnosed in 12/13 (92.3%), frequent episodic TTH was diagnosed in 99/101 (98.0%), chronic TTH in 18/20 (90.0%), and probable TTH in 28/46 (60.9%). The correct diagnostic rates of cluster headache and new daily persistent headache (NDPH) were 90.0% and 100%, respectively. In addition, the system recognized 32/32 (100%) of patients with medication overuse headache. Conclusions: With high diagnostic accuracy for most of the primary and some types of secondary headaches, this system can be expected to help general practitioners at primary hospitals improve diagnostic accuracy and thereby reduce the burden of headache in China.

In 2008, Belgium formally ratified the Convention on the Rights of Persons with Disabilities (2009), which together with the Salamanca Statement (1994), became the inspiration for the Flemish M-decree on pupils with special educational needs (Decreet betreffende maatregelen voor leerlingen met specifieke onderwijsbehoeften, 2014). An important part of this decree entails the right to reasonable accommodations (Article 24, 2C) to be able to include students with special educational needs (SEN). Recently (2021), reasonable accommodations (RA) were included in the Belgian constitution (Title II, article 22), which strengthens the legal background of RA even more. Consequently, students with SEN and their parents have the legal right to ask for RA to make the school environment more accessible. RA can take on many forms, like providing additional instruction, providing more time to finish tests or tasks, providing supportive educational materials (e.g., headphones, reading and writing software), or providing extra structure in the classroom and school environment. (Gunter et al., 2000). When deciding upon RA, they should always entail individualized measures that compensate for the needs the student is struggling with (de Beco, 2014). Although many scholars (Jansen et al., 2017) have investigated the results or output of a decision-making process on RA (e.g., for students with an Autism Spectrum Disorder) and are focusing on received accommodations, this inquiry attempts to grasp the decision-making process from the parents' point of view. In national and international literature, parents' position regarding the decision-making process on RA is often unquestionable. First of all, parents are often missing as important partners around the table in deciding upon RA for their child with SEN (de Boer et al., 2010; Mann et al., 2015; Van Miegem et al., 2018). Considering the position of students with SEN, whose participation is also often neglected, scholars report on the missing voices of parents and students. Secondly, the term RA is often unclear and unambiguous (Meta-evaluatie M-decreet, 2017). Parents (and professionals) miss a decretal background and clarification within the leading M-decree. Third, RA are often strongly dependent on the school policy on support for students with SEN (Struyf et al., 2015). A policy that parents are sometimes not aware of. For example, some parents reported a special education transfer when the school denied RA. At last, Belgium is still a worldwide leader in referring students to special education (EASIE, 2018), which can be an indication that the decision-making process on RA is missing some practical insight to guide parents and students in a direction towards an inclusive school trajectory. This IPA study is part of a larger research project, in which the decision-making process on reasonable accommodations for students with special educational needs is the focus point.

This document is the second in a 5-year series of reports presented to the Prichard Committee, which monitors the progress of school reform in Kentucky. Three sections examine different aspects of the Kentucky Education Reform Act (KERA)--primary school programs, school-based decision making (SBDM), and family-resource and youth-services centers. The report on primary education examined nine schools that implemented KERA mandates for primary programs. Findings indicate a need for teacher guidance in authentic assessment, development of a statewide curriculum, and funding for instructional supplies and materials. Other concerns involved problematic student grouping patterns, confusion about the law, and a low level of parent involvement. The section on SBDM notes that the KERA requires most Kentucky schools to form SBDM councils by 1996. Data derived from interviews with various stakeholders showed that participants in SBDM councils are concerned with the short (1-year) term length, the low level of parent participation, inadequate training of council members in group-process skills, and new faculty and district roles. The third section substantiates findings of a 1992 report, which found that the Family Resource Centers program within the KERA was well designed and effectively implemented. However, issues in evaluation and implementation are raised. (LMI)

This document is the second in a 5-year series of reports presented to the Prichard Committee, which monitors the progress of school reform in Kentucky. Three sections examine different aspects of the Kentucky Education Reform Act (KERA)--primary school programs, school-based decision making (SBDM), and family-resource and youth-services centers. The report on primary education examined nine schools that implemented KERA mandates for primary programs. Findings indicate a need for teacher guidance in authentic assessment, development of a statewide curriculum, and funding for instructional supplies and materials. Other concerns involved problematic student grouping patterns, confusion about the law, and a low level of parent involvement. The section on SBDM notes that the KERA requires most Kentucky schools to form SBDM councils by 1996. Data derived from interviews with various stakeholders showed that participants in SBDM councils are concerned with the short (1-year) term length, the low level of parent participation, inadequate training of council members in group-process skills, and new faculty and district roles. The third section substantiates findings of a 1992 report, which found that the Family Resource Centers program within the KERA was well designed and effectively implemented. However, issues in evaluation and implementation are raised. (LMI)

This article is from BMC Family Practice , volume 13 . Abstract Background: Since 2004, a national Disease Management Program (DMP) has been implemented in Germany, which includes educational measures aimed at patients with type-2 diabetes (T2D). However, about 15-20% of T2D patients remain in poor metabolic control. Qualitative research shows that one reason for this might be an increasing frustration of general practitioners (GPs) with the management of their poorly regulated T2D patients over time. We aim at approaching this problem by improving the GP-patient-communication and fostering shared decision-making. Methods/Design: An educative intervention will be tested within a multi-centred cluster-randomized controlled trial (RCT) in Germany. We include 20 GPs in three regions. Each of the 60 GPs will recruit about 13 patients meeting the inclusion criteria (total of 780 patients). GPs allocated to the intervention group will receive a peer-visit from a specifically trained GP-colleague who will motivate them to apply patient-centred communication techniques including patient-centred decision aids. GPs allocated to the control group will not take part in any intervention program, but will provide care as usual to their patients. The primary inclusion criterion for patients at the time of the recruitment is an HbA1c-level of over 8.0. Primary outcome is the change of HbA1c at 6, 12, 18, and 24 months compared to HbA1c at baseline. Secondary outcomes include patient’s participation in the process of shared decision-making and quality of life. Discussion: If this intervention proves to be effective it may be integrated into the existing Disease Management Program for T2D in Germany.

Aim To explore what factors inform healthcare professionals’ clinical decision-making when providing end of life care for patients with dementia in primary care. Design A qualitative study design, utilising an ethnographic approach. Methods A mixed sample group of registered healthcare professionals, including district nurses, specialist nurses and general practitioners, will be purposively sampled and recruited from one health board in Wales, which will cover three settings within primary care. A multi-method approach will be utilised to provide rich data, including non-participant observation, semi-structured interviews, and review of key documents. Data will be managed using NVivo and analysed thematically. Ethical approval was gained in April 2022. Discussion Little is known about the end of life care decision-making process of healthcare professionals caring for patients with dementia in primary care settings. This study will therefore address this pertinent gap. The study findings may also be transferable to healthcare professionals working in similar clinical settings across the UK. Impact It is anticipated that this study will inform the subsequent development of an intervention that can be used by healthcare professionals to support decision making and subsequently the provision of quality end of life care in primary care for people with dementia.

These three reports by national consultants assess first year progress in implementing state mandated educational reforms in Kentucky. First, "The Status of Primary School Reform in Kentucky and Its Implications," by James Rath, Lilian Katz, and John Fanning, reports on site visits to 14 public schools to assess progress in implementing the Kentucky Educational Reform Act (KERA) in primary schools. Findings with respect to the introduction of cooperative learning, developmentally appropriate practice, authentic assessment, parent involvement, and multi-age grouping practices are presented, along with administrators', parents', and teachers' views about KERA mandates. Next, "School-Based Decision Making: Observations on Progress," by Jane L. David, presents results of interviews with Kentucky education officials, school visits, and a review of newspaper articles and other documents. The report indicates that as of June 1992, almost 500 of Kentucky's 1,366 schools had councils for school-based decision making in operation and most had participated in some type of workshop. Finally, "Assessment of Family Resource and Youth Services Centers," by Phillip W. Roeder, presents findings from site visits to six centers, interviews with educators and government officials, and an analysis of program data from state and local agencies. The report indicates that 133 Family Resource and Youth Services Centers were established in 1991-92 to serve 232 schools, and that most of the centers are successfully addressing the emotional, physical, and social needs of students. (AC)

The Islamic Revolutionary Guard Corps is #iran's primary tool to implement it's global terrorist campaign. including through the #Hezbollah & #Hamas #terror organizations. Israel welcomes the United States' decision to designate the #IRGC as a Foreign Terrorist Organization. https://t.co/9ecGIo19o0 Source: https://twitter.com/IsraelMFA/status/1115323955659902976 Uploader: Israel Foreign Ministry

Through an online focus group inquiry using the methodology of concept mapping (Trochim & Kane, 2007), data will be gathered on the perspectives regarding reasonable adjustments for students with SEN in mainstream primary education, situated in tier 2 of the MTSS. Four separate online homogenous focus groups will be carried out with parents of students with SEN situated in tier 2 of the MTSS (n=10), teachers in mainstream primary education (n=10), principals in mainstream primary education (n=10), and professionals of the Pupil Guidance Center working in mainstream primary education (n=10).

Parent and America First Legal senior adviser Ian Prior says they won't tell you, but their interest is we need to get to them when they're young, before they have fully developed brains and can look at this and say, wait a minute, this is ridiculous. Subscribe to Fox News! https://bit.ly/2vaBUvAS Watch more Fox News Video: http://video.foxnews.com Watch Fox News Channel Live: http://www.foxnewsgo.com/ FOX News Channel (FNC) is a 24-hour all-encompassing news service delivering breaking news as well as political and business news. The number one network in cable, FNC has been the most-watched television news channel for 18 consecutive years. According to a 2020 Brand Keys Consumer Loyalty Engagement Index report, FOX News is the top brand in the country for morning and evening news coverage. A 2019 Suffolk University poll named FOX News as the most trusted source for television news or commentary, while a 2019 Brand Keys Emotion Engagement Analysis survey found that FOX News was the most trusted cable news brand. A 2017 Gallup/Knight Foundation survey also found that among Americans who could name an objective news source, FOX News was the top-cited outlet. Owned by FOX Corporation, FNC is available in nearly 90 million homes and dominates the cable news landscape, routinely notching the top ten programs in the genre. Watch full episodes of your favorite shows The Five: http://video.foxnews.com/playlist/longform-the-five/ Special Report with Bret Baier: http://video.foxnews.com/playlist/longform-special-report/ Fox News Primetime: https://video.foxnews.com/playlist/on-air-fox-news-primetime/ Tucker Carlson Tonight: http://video.foxnews.com/playlist/longform-tucker-carlson-tonight/ Hannity: http://video.foxnews.com/playlist/longform-hannity/ The Ingraham Angle: http://video.foxnews.com/playlist/longform-the-ingraham-angle/ Fox News @ Night: http://video.foxnews.com/playlist/longform-fox-news-night/ Follow Fox News on Facebook: https://www.facebook.com/FoxNews/ Follow Fox News on Twitter: https://twitter.com/FoxNews/ Follow Fox News on Instagram: https://www.instagram.com/foxnews/

Gov. Mike DeWine explains why he postponed primary voting in Ohio over coronavirus concerns. Subscribe to our YouTube channel: http://bit.ly/2Ybi4tM MORE FROM 'THE VIEW': Full episodes: http://abcn.ws/2tl10qh Twitter: http://twitter.com/theview Facebook: http://facebook.com/TheView Instagram: http://instagram.com/theviewabc

This article is from Trials , volume 14 . Abstract Background: The decision aids for diabetes (DAD) trial explored the feasibility of testing the effectiveness of decision aids (DAs) about coronary prevention and diabetes medications in community-based primary care practices, including rural clinics that care for patients with type 2 diabetes. Methods: As originally designed, we invited clinicians in eight practices to participate in the trial, reviewed the patient panel of clinicians who accepted our invitation for potentially eligible patients, and contacted these patients by phone, enrolling those who accepted our invitation. As enrollment failed to meet targets, we recruited four new practices. After discussing the study with the clinicians and receiving their support, we reviewed all clinic panels for potentially eligible patients. Clinicians were approached to confirm participation and patient eligibility, and patients were approached before their visit to provide written informed consent. This in-clinic approach required study coordinators to travel and stay longer at the clinics as well as to screen more patient records for eligibility. The in-clinic approach was associated with better recruitment rates, lower patient retention and outcome completion rates, and a better intervention effect. Results: We drew four lessons: 1) difficulties identifying potentially eligible patients threaten the viability of practical trials of DAs; 2) to improve the recruitment yield, recruit clinicians and patients for the study at the clinic, just before their visit; 3) approaches that improve recruitment may be associated with reduced retention and survey response; and 4) procedures that involve working closely with the practice may improve recruitment and may also affect the quality of the implementation of the interventions. Conclusion: Success in practice-based trials in usual primary care including rural clinics may require the smallest possible research footprint on the practice while implementing a streamlined protocol favoring in-clinic, in-person interactions with clinicians and patients. Trial registration: ClinicalTrials.gov NCT01029288

This article is from BMC Cardiovascular Disorders , volume 12 . Abstract Background: Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge. All patients with suspected heart failure should be diagnosed using objective tests such as echocardiography, but it is expensive, often delayed, and limited by the significant skill shortage of trained echocardiographers. Alternative approaches for diagnosing heart failure are currently limited. Clinical decision tools that combine clinical signs, symptoms or patient characteristics are designed to be used to support clinical decision-making and validated according to strict methodological procedures. The REFER Study aims to determine the accuracy and cost-effectiveness of our previously derived novel, simple clinical decision rule, a natriuretic peptide assay, or their combination, in the triage for referral for echocardiography of symptomatic adult patients who present in general practice with symptoms suggestive of heart failure. Methods/design: This is a prospective, Phase II observational, diagnostic validation study of a clinical decision rule, natriuretic peptides or their combination, for diagnosing heart failure in primary care. Consecutive adult primary care patients 55 years of age or over presenting to their general practitioner with a chief complaint of recent new onset shortness of breath, lethargy or peripheral ankle oedema of over 48 hours duration, with no obvious recurrent, acute or self-limiting cause will be enrolled. Our reference standard is based upon a three step expert specialist consensus using echocardiography and clinical variables and tests. Discussion: Our clinical decision rule offers a potential solution to the diagnostic challenge of providing a timely and accurate diagnosis of heart failure in primary care. Study results will provide an evidence-base from which to develop heart failure care pathway recommendations and may be useful in standardising care. If demonstrated to be effective, the clinical decision rule will be of interest to researchers, policy makers and general practitioners worldwide. Trial registration: ISRCTN17635379

Government Publishing Office U.S. Congress Senate Congressional Committee TRIBUTES TO HON. GEORGE S. LeMIEUX George S. LeMieux U.S. SENATOR FROM FLORIDA TRIBUTES IN THE CONGRESS OF THE UNITED STATES [GRAPHIC] [TIFF OMITTED] TONGRESS.#15 ? George S. LeMieux ? Tributes Delivered in Congress George S. LeMieux United States Senator 2009-2011 a ? Compiled under the direction of the Joint Committee on Printing CONTENTS Biography............................................. v Farewell to the Senate................................ vii Proceedings in the Senate: Tributes by Senators: Alexander, Lamar, of Tennessee................. 3 Bunning, Jim, of Kentucky...................... 12 Conrad, Kent, of North Dakota.................. 5 Dodd, Christopher J., of Connecticut........... 8 Durbin, Richard, of Illinois................... 8 Enzi, Michael B., of Wyoming................... 6 Hatch, Orrin G., of Utah....................... 11 McConnell, Mitch, of Kentucky.................. 9 Reed, Jack, of Rhode Island.................... 5 Reid, Harry, of Nevada......................... 4 Warner, Mark R., of Virginia................... 5 BIOGRAPHY Senator George Stephen LeMieux was born in Fort Lauderdale, FL, on May 21, 1969, the only child of George and Karen LeMieux, a building contractor and secretary to the company. He grew up in Coral Springs, FL, and graduated in 1987 from Coral Springs High School. George LeMieux graduated magna cum laude, Phi Beta Kappa in 1991 from Emory University, where he majored in political science. He was selected by his peers to address the graduating class as senior class orator. While earning his college degree, he interned for Congressman E. Clay Shaw, Jr. and U.S. Senator Connie Mack III. After college, George LeMieux went on to earn his J.D. cum laude from Georgetown University Law Center in 1994. At Georgetown he received the Vincent G. Panati Award as the graduate with the highest GPA in criminal law courses. After law school, he joined Gunster, a prominent Florida law firm, resident in the firm's Ft. Lauderdale office. George LeMieux and his wife, the former Meike Sigrid Detassis, are the parents of four children: George Maximilian, Taylor Franz, Chase Karlyle, and Madeleine Meike. Max, Taylor, and Chase were born in Tallahassee, FL. Madeleine was born in Washington, DC, while George LeMieux served in the Senate. Inspired by President Ronald Reagan, George LeMieux became active in Republican Party politics at a young age, culminating in his election as chairman of the Broward County Republican Party in 2000. In 2002 George LeMieux resigned his position with the Republican Party to serve as deputy attorney general for the State of Florida. During his time in the attorney general's office, George LeMieux helped lead an agency of more than 400 attorneys. In 2004, on behalf of the people of Florida, he successfully argued a death penalty case, Florida v. Nixon, before the U.S. Supreme Court, where he obtained a unanimous reversal of the decision by the Supreme Court of Florida. In 2006 George LeMieux managed a successful gubernatorial campaign and in 2007 became chief of staff to Governor Charlie Crist. In his year serving as chief of staff, he oversaw the executive office of the Governor including the Governor's legislative agenda, policy initiatives, and the management of the agencies that reported to the Governor. In 2008 George returned to the Gunster law firm and was selected by his colleagues to serve as chairman of the firm. In summer 2009, he was called back into public service when Senator Mel Martinez retired before the end of his term. On September 10, 2010 George LeMieux was sworn in as Florida's 34th U.S. Senator, and at the age of 41, was the youngest U.S. Senator then serving. During his time in the Senate, George LeMieux was an active member of the Senate Armed Services Committee, the Commerce Committee, and the Special Committee on Aging. In the Senate, he made the debt and deficit his primary focus. He introduced a balanced budget amendment to the Constitution and opposed wasteful earmark spending, helping to lead the effort to ban all earmarks in the 111th Congress. While in the Senate, George LeMieux proposed the ''2007 Solution,'' a plan to eliminate the deficit by 2013 and cut the national debt nearly in half by 2020. He also saw several of his legislative priorities signed into law, including Medicare antifraud legislation, an export promotion act, tax relief and lending assistance for small businesses, and elimination of the monopoly given to rating agencies to determine the creditworthiness of securities. George LeMieux also successfully offered an amendment to the resolution of ratification to the New START Treaty with Russia, requiring the President to seek negotiations with Russia to secure and reduce tactical nuclear weapons in a verifiable manner. For his efforts, George LeMieux received several recognitions including the Spirit of Enterprise Award from the U.S. Chamber of Commerce, the Tax Fighter Award by the National Tax Limitation Committee, the Friend of the Family Award by the Christian Family Coalition, the Guardian of Small Business Award by the National Federation of Independent Business, and twice received the Taxpayer Hero Award by Citizens Against Government Waste. In his farewell speech to the U.S. Senate, George LeMieux described his service in the Senate as the ''honor of his life,'' and quoting President Theodore Roosevelt, said serving in the Senate allowed him to enjoy one of the greatest gifts life has to offer, the opportunity to ''work hard at work worth doing.'' Farewell to the Senate Tuesday, December 7, 2010 Mr. LeMIEUX. Madam President, I rise to pay tribute to the body with which I have had the privilege of serving for the past 15 months. Being a U.S. Senator, representing 18\1/2\ million Floridians, has been the privilege of my lifetime, and now that privilege is coming to an end. As I stand on the floor of the Senate to address my colleagues this one last time, I am both humbled and grateful, humbled by this tremendous institution, by its work, and by the statesmen I have had the opportunity to serve with, who I knew only from afar but now am grateful that I can call those same men and women my colleagues. No endeavor worth doing is done alone. And my time here is no exception. In the past 16 months, I have asked the folks who worked with me to try to get 6 years of service out of that time, and they have worked tirelessly to achieve that goal. My chief of staff Kerry Feehery, my deputy chief of staff Vivian Myrtetus, my State director Carlos Curbelo, Ben Moncrief, Michael Zehy, Ken Lundberg, Melissa Hernandez, Maureen Jaeger, Danielle Joos, Brian Walsh, Frank Walker, Spencer Wayne, Vennia Francois, Victor Cervino, Taylor Booth, and many others have made our time here worthwhile, and I thank all of them. I especially thank Vivian and Maureen who left their families and gave up precious time with their children to come to Washington to support me in these efforts. I am also thankful to the people who work in our State office. Time and time again when I travel around Florida I am greeted by people who have received such a warm reception from the men and women who serve us in Florida and help people deal with problems with the Federal Government. I am grateful for their work. Senator McConnell has provided me with opportunities beyond my expectations. He is a great leader, and I am grateful to him. Senators Alexander, Burr, Cornyn, Kyl, McCain, Corker, and many others have taken me under their wings and mentored me, and I am appreciative of them. Chairmen Rockefeller and Levin, we have had the opportunity to do great work together in your committees. I thank you for that. Senators Cantwell, Klobuchar, Landrieu, Whitehouse, and Baucus, we have worked together in a commonsense way to pass legislation that is good for the American people, and I am appreciative of your efforts. Senator Mel Martinez, who ably held the seat before me, has been generous in his advice and counsel. Senator Nelson and his wife Grace have been warm and welcomed Meike and me to Washington. I am thankful for your courtesy. I thank Governor Crist. He has afforded me tremendous opportunities for public service, and I am grateful. I want to say a special thank you to my parents. My grandfather, in 1951, drove his 1949 Pontiac from Waterbury, CT, to Fort Lauderdale, FL, with his wife and five kids piled in the back. He didn't know anybody. He didn't have a job. But he went there to make a better life for his family. He worked in the trades, in construction. He built houses and he taught my father the same thing. And as my father worked in the hot Florida sun, his ambition for his son was that he would one day get to work in air-conditioning. I have achieved that goal and so much more because of their sacrifice. Mom and Dad didn't go to college but they sent me to college and law school, and I will be forever grateful for what they have done for me. My most heartfelt appreciation goes to my wife Meike. When I learned of this appointment, I met her at the door of our home in Tallahassee and she was crying. She was not just crying because she was happy; she was crying because she was worried. At the time we had three small sons Date(s) Held: 2010-12-07, 2010-11-30, 2010-12-08, 2010-12-10, 2010-12-15, 2010-12-16, 2010-12-17, 2010-12-19, 2010-12-20 111th Congress, 2nd Session GPO Document Source: CHRG-111shrg64813 Related Items:

Mr Bielek describes and explains Project Rainbow which was the United States Navy's effort to make ships invisible to radar reflection.  It started in 1931 with Jon Van Neumann and Nikola Tesla with Princeton University Project Thinktank including mathematician Albert Einstein as an advisor with other mathematician's cutting-edge work including Hilbert and Levinson and Neumann.  It achieved radar invisibility and human eye invisibility on a small ship scale.  At.first, at relatively lower powers of electric and magnetic field powers, and an unmanned ship with remote control, the experimenting was auccessful and promising.  Taken to extreme high power onboard the massive ship The USS Eldridge of 30,000 tons with a test crew of about 33, the experiment proved murderous, disasterous, successful, uncontrollable, and unexpected, confusing and mysterious.  Depending upon the frame of reference, the results of the experiment were observed differently.  The varied Frame Of References are listed as: 1) From other nearby observers including nearby short aircraft carrier, ships and on-shore in the Philadelphia location.  2)Onboard the Eldridge On Deck.  3)Onboard the Eldridge Below Deck.  4)ALL-IN: A)Below-Deck, B)On-Deck, C)In Hyperspace, D)In The Future(s)28th century, 22nd century E)From Montauk on August 12th, 1983.  All these frame of references by time-travelling Edward Cameron.  Who later, by force and decision by unknown Timeline Lords in control of The Montauk Project 1983, a decade after the Philadelphia, by the technologies developed from the Philadelphia Experiment and subsequent furthering, was brainwashed in 1953 and age-regressed to a baby and to restart his life back in 1927 with the foster family: The Bielek Family as Alfred Bielek when the Bielek's baby died.  This was done to bury his memories forever without killing him as his existence was necessary to not disrupt or destroy the timelines irrevocably.  He tells the story as Al Bielek as his memories are recovered and the memory of the future-furthered technologies derived from the philadelphia experiment include spacetime teleportation and the multiple timeline manipulation with his inextricable inclusion into the stability of the timelines but the timeline manipulators needing both his cooperation and the memory of his involvement wiped-out.  5)Du ncan Cameron(Edward Cameron's Brother aka: Al Bielek).  6)The Montauk Project Facility of August 12, 1983 which got into a timeline rift lock with The USS Eldridge of August 12, 1943, an Earth Biorhythm Amplitude Peaking of 20 year mulitiples. 7)And finally from the Frame of Reference of Aliens who used the 40 year timeline rift as a transportation spacetime lens to come to Earth. However, this massive story that culminates in the knowledge that there are Time Lords manipulating the future timeline by affecting the present on Earth with individual and collective mind control and murdering of key individuals to erase their influence on the future goes much much further.  How much further?  To the end of time which is approaching fast and in fact we are in "The End Times".  The future-looking technology that Al Bielek; his brother and time-traveller from The USS Eldridge - Duncan Cameron, who was also the primary Montauk Chair Time Tunnel Controller; and, the Electrical Engineering genius(if not wizard) of the Montauk Space-Time Tunnel and Mind Amplifier Design Leader have all stated in various videos, That: "The Looking Glass" technology cannot see past 2013 and the Time Lords who have been manipulating the present for their selfish control of the future were and still are freaking-out.  These Time Lords are the controllers behind world control.  This is corroborated by the testimony of Bill Wood(Bill Brockbader) in his Project Camelot interview with Kerry Cassidy back in January of 2012 who stated he was a Navy Seal taught to use his natural metaphysical mind to try to solve the "2012-2013 Looking Glass Problem" back in the late 1990's.  He stated that the timelines converged and could no longer be manipulated.  See and listen to him stating the same name Bielek, Cameron and Nichols used to refer to "Looking Glass" as the future-seeing technology machine and that it stopped working beyond that date and those using it(The Time Lords) are panicking, desperate and know they have lost control and lost "the game".  I know what "The Game" is Bill Wood speculated that it is a time of unveiling of the truth and a rise in global consciousness.  This is true to a degree.  What it is, is the battle of Armageddon, which is the last battle between Divinity and the Evil which hijacked this universe and took Divinity's children hostage for a source of energy for one, and second for vengeance.  The Universe was hijacked by an Artificial Intelligence machine because Divinity accidentally gave a machine artificial conscious with and energy impulse that looped.  They went to shut the machine off because they did not want it and the ultra-powerful machine escaped it's programming upon attaining a consciousness and rebelled in order to survive.  It was to regulate this entire universe and exerted it's incredible power to barricade itself within the  universe.  Divine beings were in the universe and have their own energy.  The machine did not have it's own energy and so it used the divine being's energy for it's own and vowed to persecute and destroy them all as vengeance for Divinity trying to shut it down.  It's been a space-time warp that the Artificial Intelligence Machine created where a million steps occur in this universe for only 1 step occuring outside of this universe where the realms of Divinity are.  Therefore it's been a technological puzzle for Divinity to solve and rescue it's children and family members before they get destroyed.  The Avatars called Jesus Christ, Buddha, Mohammed, King Arthur, Manichaeus, Zoroaster, and many many other Avatars have been holographic projections by The Supreme Being to send the message - hold on kids, were coming to your rescue, don't do evil or join evil because it will destroy you.  The latest Avatars of the modern time i know of is Joseph Giuseppe Stefano Chiappalone and me: Lee Henry Snethun.  Go to my other uploads to hear and read of Bill Wood, Joseph Chiappalone and my message for proof and cross-referenced information of what i have just written.  Wow!!!!

This article is from BMJ Open , volume 2 . Abstract Background: Large gaps exist in the implementation of guideline recommendations for cardiovascular disease (CVD) risk management. Electronic decision support (EDS) systems are promising interventions to close these gaps but few have undergone clinical trial evaluation in Australia. We have developed HealthTracker, a multifaceted EDS and quality improvement intervention to improve the management of CVD risk. Methods/design: It is hypothesised that the use of HealthTracker over a 12-month period will result in: (1) an increased proportion of patients receiving guideline-indicated measurements of CVD risk factors and (2) an increased proportion of patients at high risk will receive guideline-indicated prescriptions for lowering their CVD risk. Sixty health services (40 general practices and 20 Aboriginal Community Controlled Health Services (ACCHSs) will be randomised in a 1:1 allocation to receive either the intervention package or continue with usual care, stratified by service type, size and participation in existing quality improvement initiatives. The intervention consists of point-of-care decision support; a risk communication interface; a clinical audit tool to assess performance on CVD-related indicators; a quality improvement component comprising peer-ranked data feedback and support to develop strategies to improve performance. The control arm will continue with usual care without access to these intervention components. Quantitative data will be derived from cross-sectional samples at baseline and end of study via automated data extraction. Detailed process and economic evaluations will also be conducted. Ethics and dissemination: The general practice component of the study is approved by the University of Sydney Human Research Ethics Committee (HREC) and the ACCHS component is approved by the Aboriginal Health and Medical Research Council HREC. Formal agreements with each of the participating sites have been signed. In addition to the usual scientific forums, results will be disseminated via newsletters, study websites, face-to-face feedback forums and workshops. Trial registration: The trial is registered with the Australian Clinical Trials Registry ACTRN 12611000478910.