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anything 6 hours ago
Bilan 2015 et perspectives 2016

BAIE COMEAU, le 6 janv. 2016 /CNW Telbec/ lutte l'aust du gouvernement Couillard, la n du secteur public et la fin du r Harper ont marqu l'ann cartier replica necklace love 2015 sur le front social et politique et au niveau des relations de travail. Et celle qui commence ne sera pas de tout repos pour pr des acquis sociaux. De nombreux travailleurs et travailleuses auront renouveler leurs conventions collectives et devront n l'am de leurs conditions de travail.

2015 une mobilisation sans pr cours de la derni ann partout dans notre r aux c de leurs alli des autres organisations progressistes, les membres de la CSN ont sur la ligne de front contre les politiques d'aust mobilisation, qui avait commenc en septembre 2014, s'est poursuivie jusqu' la fin de l'ann 2015. En toile de fond, la n du Front commun pour le renouvellement des conventions collectives des 540 travailleuses et travailleurs du secteur public qu Ici, sur la C ce sont plus de 7000 personnes qui sont touch Il faut rappeler que le plus gros employeur sur la C c'est le gouvernement du gold love replica necklace Qu d le pr du Conseil central C CSN, Guillaume Tremblay.

Parmi les moments phares de la derni ann notons la mobilisation du 1er mai 2015 contre les politiques d'aust dans tout le Qu la manifestation du 3 octobre qui a rassembl plus de 150 000 personnes dans les rues de Montr dont trois autobus de manifestants de la C les quatre jours de gr rotative du secteur public durant les mois de novembre et de d et qui furent historiques.

Le gouvernement Couillard doit retenir des le de 2015. La formidable mobilisation des travailleuses et travailleurs du secteur public a mis en lumi les impacts n des mesures d'aust sur les programmes sociaux et les services la population. Les lib n'avaient pas de mandat sur ces questions et la population a clairement d cette op de sabotage de l' social qui nous caract comme soci qu D'ailleurs, les sondages d'opinion publique tr clairs ce sujet.

La lutte devra se poursuivre, car le d social va continuer de se creuser et la qualit de vie des citoyens, des familles, des r en sera grandement affect Le rapport de Luc Godbout sur la fiscalit et celui de Lucienne Robillard sur la privatisation de nos soci d' vont venir nous hanter. Projet de loi 20, frais accessoires, r du panier de services m sous financement en et en sant projet de loi 70 pour les prestataires d'aide sociale visant encore une fois les plus d voil autant de raisons pour lesquelles nous devrons nous mobiliser. Aucune raison ne justifie ces choix, car le gouvernement dispose d'un surplus budg de 2,6 milliards de dollars, avant le versement au Fonds des g contre 650 millions de dollars en 2013.

Changement de garde OttawaL'une des bonnes nouvelles de 2015, qui nous permet d'esp est sans aucun love necklace replica cartier doute l' d'un gouvernement lib ce titre, nous souhaitons que le premier ministre Justin Trudeau respecte ses nombreux engagements Nous avons d des points positifs souligner le retrait de deux projets de loi antisyndicaux (le C 525 et le C 373), l'annonce d'une enqu publique sur la disparation des 1200 femmes autochtones, l'implication du Canada la derni conf climatique Paris. allons surveiller de pr son engagement r le financement de Radio Canada et d'annuler la r sur l'assurance emploi, un dossier primordial pour la C ajoute Guillaume Tremblay.

localement, plusieurs de nos syndicats de tous les horizons auront renouveler leurs conventions collectives. Nous en ferons une priorit Le conflit de travail l'H La Caravelle de Baie Comeau vient en t de liste. Pensons aussi aux travailleuses des Caisses Desjardins de la C aux employ d'Autobus Boulay et Manic dans le transport scolaire, nos deux syndicats des p de Sept et de Baie Comeau, aux travailleurs de la ZEC de Forestville et des Silos de Port Cartier, aux personnes oeuvrant dans le secteur pr Le projet pilote annonc par le ministre responsable de notre r Pierre Arcand, pour prioriser la main d' locale dans l'industrie de la construction sera surveiller indique Guillaume Tremblay.

Du c des centres de la petite enfance (CPE), nous avons de grandes inqui par rapport aux compressions qui leur sont impos chaque ann Plusieurs sur la C ont de la difficult couvrir leurs cartier love replica pendant frais et ce, apr avoir fait des miracles dans certains cas. Ce service essentiel pour nos enfants doit une priorit pour le gouvernement lib Malheureusement, de nouvelles places octroy dans des CPE ont retir De plus, les doivent avoir des conditions de travail la hauteur de leurs responsabilit L'ann 2016 sera elle aussi fort charg non seulement sur le plan des relations de travail, mais aussi sur le plan social et entra ainsi des impacts sur le d de notre r La C qui a toujours compt sur la pr de usines et une stabilit d'emploi gr nos richesses naturelles, doit se remettre en question.

La crise foresti le faible prix du minerai de fer qui a notamment entra une fermeture temporaire de la mine de Rio Tinto Havre Saint Pierre, le retrait du projet FerroQu Port Cartier et l'absence des investisseurs pour l'apatite de Mine Arnaud ne sont l que de tristes exemples pour d qu'une diversit s'impose et que celle ci ne peut se faire sans l'appui du gouvernement du Qu

Le gouvernement du Qu doit agir quand ces transformations surviennent et avoir une vision long terme d de certains minist mise en place d'infrastructures (gaz naturel, routes). Nos instances politiques r doivent se concerter et avoir une vision r de notre d avec tous les acteurs locaux.

Conseil central C CSN sera encore au rendez vous en 2016 et jouera son r sur le front des relations de travail pour bien repr ses travailleuses et travailleurs. Plus largement, nous continuerons de d les int de la C conclut Guillaume Tremblay.
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  • LLLOO6 6 hours ago
    Sister Act a heavenly treat

    What takes this show to heavenly heights is not divine intervention, it sage directing by Max Reimer and divine casting, starting with Aurianna Angelique in the lead role of Van Cartier, the character created by Whoopi Goldberg in the movie of the same name upon which the musical is based.

    Van Cartier, a self absorbed nightclub singer obsessed with becoming a star, witnesses a murder by her gangster boyfriend, Curtis, a nightclub owner who won cartier love replica pendant even hire her.

    The singer flees to a police station where an officer, Eddy, puts her in protective custody at a convent in Queen of Angels Cathedral, where she assumes the identity of Sister Mary Clarence.

    There she meets the Mother Superior, played by stage veteran Susan Gilmour, who reluctantly agrees to accept Van Cartier after being told by Monsignor O (Larry Mannell, in a deliciously lighthearted counterpoint to Gilmour) the facility is in financial peril and could soon be sold to developers.

    The singer cum nun meets the convent collection of oddball nuns, whose vocal efforts are an irritation to the Mother Superior.

    Van Cartier takes over as choir director, inspiring the nuns to find their voices with R and disco like hymns that cause a sensation, drawing large crowds of new parishioners and saving the parish from closure.

    The media catches on and it not long before her gangster boyfriend and his pals discover Van Cartier new identity.

    Angelique brash, sassy, egotistical and fast talking Van Cartier is perfect, her vocals and acting outstanding, second only to the superb replica cartier pendant necklace performance of Gilmour as the strict, no nonsense, straight laced Mother Superior.

    The rest of this large cast also deliver great performances, bringing their characters to life, among them Laura Mae Nason as the shy, quiet Sister Mary Robert whose vocal powers are a Rebecca Poff as the unsmiling Sister Mary Lazarus, Lorraine Foreman as the ancient Sister Mary Theresa, Susan Johnston Collins as the fun and friendly Sister Mary Patrick and Amanda Leigh as the vision obsessed Sister Mary Martin of Tours.

    Matthew G. Brown as the cop, Eddie, who still has a crush cartier necklace replica love on Van Cartier from their high school days, gives a lovely, understated performance that is a convincing contrast to Angelique Van Cartier.

    Lee Siegel, renown for his powerful pipes, plays the gangster boyfriend, Curtis. His blundering thugs provide much of the comedy, led by David Lopez in the role of Curtis nephew, TJ, Gerrad Everard as Joey and London native Oscar Moreno as the Spanish speaking Pablo.

    The gang is love replica cartier necklace hilarious at times, their performance of Lady in the Long Black Dress igniting several belly laughs.

    Choreographer Lisa Stevens keeps most of the moves simple, but fluid, interesting and fun. Kevin Fraser lighting design is flawless and the music inspiring, led by musical director Paul De Gurse on keyboard.

    Reimer harnesses the immense talent of this show to ensure the story is clearly told, but let them run with their characters and creativity, some pushing the envelope toward silly caricatures that are necessary to make this show so much fun.

    What: Sister Act, a musical written by Bill and Cheri Steinkellner with additional book material by Douglas Carter Beane, lyrics by Glenn Slater and music by Alan Menken. presented by Drayton Enter tainment, directed by Max Reimer.
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  • LLLOO6 6 hours ago
    As Jordans 2017 pays tribute to MJ's alma mater with the "UNC" release, they'll also be releasing the Jordan Trainer 2 Flyknit Michigan as a nod to their partnership with the school. Labeled with "Go Blue" at the heel stripe and the tongue, Jordan Trainer 2 Flyknit is a good choice for both Michigan fans and those who want to have a good performance on the court. Constructed with air mesh, the sneaker is full of air permeability. Following we have a Nike Air sole that offers dynamic cushioning. Together with the Flyknit and Nike's most innovative technologies, Jordan Trainer 2 Flyknit is absolutely a perfect training sneaker with durability and flexibility. In addition, the school's signature navy and yellow color theme allows it to shift the public’s obsession with sneakers.
    New Jordans 2016, Still remember a few months ago launched a variety of university color Air Jordan 31 Low, then also caused a wave of small waves, mainly to blue and yellow color of the University of Michigan is one of them, The theme of this color is Jordan Brand sponsored by the University of Michigan color, shoes with Michigan iconic naval blue and yellow color composition, shoes are Michigan slogan "GO BLUE" words. this 'Michigan' in the deep blue part of the toe, there are faint mixed with yellow lines. In addition, the strap for this pair of shoes is not just the stability of the role of training, editor I think this is half of the material before and after the high contrast color of the important bridge, so that the whole pair of shoes more coherent.
    New Jordans 2018 has been marketing their Trainer 2 silhouette in hopes of gaining traction in their new athletic department of footwear created for runners and cross-trainers. Dressed in the classic Michigan colors with a mix of College Navy and Amarillo. Built with an all-new Flyknit pattern that includes a lock-down supportive mid-foot strap. Completing the design are Dynamic Flywire cables, faded soles with "Michigan" branding on the tongues and "Go Blue" on the back tabs. Inspired by the University of Michigan Wolverines, the Trainer 2 wears a two tone upper featuring Michigan's bold college navy and amarillo colors. Following the pattern of the Trainer 2's knit upper, its outsole displays a navy gradient that transitions to yellow towards the back heel of the sneaker.
    jordan 7 hours ago
    what to see and do in winter

    Madridis the highest capital city in Europe (2,178ft/664m), which means crisp, cold weather in winter. The sky is usually still startlingly blue, however, and you can sit at a pavement caf in the imitation Bvlgari bracelet serpenti white gold bright sunshine in the afternoon after visiting the Prado. If you need another nudge, I'll just mention that hotel rates serpenti bracelet replica are at their lowest in January and the sales are on too.

    Don't miss.

    The 200th anniversary of the Teatro Real, which has already begun commemorating its foundation in 1818 by extending its repertoire and working with opera houses around the world.

    Sorolla in Paris, Sorolla Museum

    This major exhibition of the work of Joaqun Sorolla, one of the great Spanish artists of the 20th century, charts the Valencian painter's international development from his first visit to Paris in 1885, at the age of 23, high imitation bvlgari serpenti bracelet when he came into contact with the Impressionists. This evocative Madrid museum was originally the home of Sorolla and his family.

    Bulgari and Rome at the Thyssen Bornemisza Museum

    My favourite winter hotel

    The new Ttem hotel in the smart Salamanca Bvlgari bracelet yellow gold replica neighbourhood is a good place to recover after a day shopping in the surrounding streets. The bar and restaurant are called Hermosos Malditos, which is the Spanish translation of the F. Scott Fitzgerald novel The Beautiful and The Damned. I usually collapse onto one of the midnight blue sofas in the decadent bar for a restorative cocktail or two I find the Sherry Mary does the trick. From 104 a night; read a full review and check availability.
    sefien 7 hours ago
    find a new way to maintain the Colosseum

    This is a fact now readily acknowledged by the country's political hierarchy, with new methods to pay for the upkeep of these magnificent structures being sought."To me, this belongs to the entire mankind," Rome mayor Ignazio Marino told CNN as he looked out copy bvlgari snake bracelet over the Italian capital from a balcony at City Hall."We have to share projects and ideas but we have to the share responsibility to maintain these for the generations to come," he added.The Colosseum brings in nearly $50 million every year but much of this money now goes to pay for the upkeep of less visited treasures across the city.Problems regarding funding started during the global financial crisis a little over five years ago.In 2014 alone, the city of Rome ran a deficit of over $1 billion dollars and required a federal decree to bail it out.These budgetary issues are complicated further by social and professional movements pressuring their representatives elected representatives on a number of issues such as pay and public services.On high imitation bvlgari serpenti bracelet the sprightly spring Bvlgari snake bracelet gold copy day that CNN visited the Eternal City, junior doctors were on the streets seeking a pay hike.There are some, however, who say that if there is any hope of bringing replica bvlgari bracelet price back the days of "La Dolce Vita," Italy needs to bundle its history with what the world sees as the Italian lifestyle.It is here that the private sector has begun to play its part.According to Diego Della Valle, owner of high end shoemaker, Tod's, the nation's biggest companies have a responsibility to maintain Italian monuments as they are all part of the same brand experience.DDV, as he is known, is spending $34 million on a five year scrubbing of the travertine marble front of the Colosseum.
    sefien 7 hours ago
    Jonathan Demme's Musical Moments Made Sense

    We'd known each other glancingly since the 1980s, thanks to a shared life in downtown NYC, seeing bands in clubs and going to screenings. As it happened, I was on my way to a film festival showing of a movie I'd made. And there was Demme, in town with his Neil Young Trunk Show, a follow up to the seminal doc Heart of Gold (2006), ambling down the street by himself, looking around quizzically in the bright autumn sunlight, because that was one of his main modes: quizzical.

    The Two Way

    We said hi, chatted a bit, and the twinkle in his eye told me he appreciated the fact that I happened to be carrying in my arms a large and fairly heavy potted plant, which I had just purchased for $3 at a church rummage sale, partly to calm my nerves. Something about that gesture was very Demme meaning wholly available to the vagaries of the moment. But what was even more Demme was the nature of the music I'd used in the movie I was about to show, which ranged from Pylon to Santigold to Syd Straw. It was a soundtrack as mixtape approach that I now realize, in the wake of his horribly sad passing, was almost entirely indebted to Demme's influence in general, and to Something Wild in particular. Demme entered my cinematic consciousness at a time when female avatars were few and far between, and somehow I sensed (even though I didn't know it at the time) that he completely supported women who wanted to make movies, and was to become an increasingly tireless booster of the creative impulse in others across both race and gender lines. Back then I simply yearned to try to do what Van Cleef & Arpels replicas he did unite words and pictures to tell stories on a screen, with a propensity for humanism and a well curated soundtrack. The breadth of his practice, shifting from dramas to comedies to documentariess, from Hollywood backed fare to tiny indies, was an inspirational add on.

    Part of Demme's genius was to present moviemaking as a prime locus for avidity, open to all. His core energy, including when I saw him on the sidewalk that day, was both available and excitable. As has been widely remarked at this point, that aspect of his personality found perhaps its most enduring expression in his approach to and enthusiasm for music. He deployed it in his work in ways that surged across genres, slyly making pluralistic points while avoiding being merely cool or touristic, and always emphasizing fun.

    Early on, Demme, who wrote rock criticism in his youth, had the Velvet Underground's John Cale score his Roger Corman produced chicks behind bars debut flick, Caged Heat (1974). That was merely the beginning in a long career of inspired, and often repeat, sonic fake Van Cleef & Arpels Perlee bracelet cheap collaborations, in which David Byrne occupies a particular place of privilege and really, one can never praise enough the molecular understanding of shooting and cutting live performance that is Stop Making Sense (1984). Think of the scene in Rachel Getting Married (2008) in which Tunde Adebimpe performs an a cappella version of Neil Young's "Unknown Legend." It's so very Demme in its casual championing of a mixed universe and affirmation of what it means to be a dimensional being.

    But it was Something Wild (1986) that most brilliantly telescoped Demme's gleeful fusion of song and subject matter, and provided, for me and I suspect many others, a guide to how one could deploy one's personal playlist in the service of broader narrative interests. (I have to add that the renegade Nickelodeon series on which I was originating director, The Adventures of Pete Pete, never could have boasted a soundtrack featuring Yo La Tengo and Magnetic Fields were it not for Demme's influence, not to mention cameos from Iggy Pop and LL Cool J.) Something Wild is at once exuberant and edgy, as much of an identity shape shifter as its heroine, indelibly embodied by Melanie Griffith. There's something so particularly evocative about the way Something Wild operates it's partly generational, but it's also dispositional. The movie feels born of a time when you could stroll into a record store and flip through bins of vinyl, or buy a used album off a dirty blanket on the sidewalk for a buck, or hook into a track as you heard it float past you on a boombox. Life at that time invited you to find songs in public if you wanted to find them, and those songs were an invitation to a certain way of Van Cleef & Arpels Perle bracelet gold replica living. Demme optimized that feeling; it was integral to his enterprise. Music was tactile, there to be discovered, then shared, and not in the way we tend to use the word "sharing" now.

    Consider the opening to Something Wild, the camera gliding across the Hudson River to open up and probe the world of lower Manhattan, the twin towers still standing. David Byrne and Celia Cruz's "Loco De Amor (Crazy for Love)" percolates and then blasts its brassy horns, a heady fusion of downtown art pop and salsa queen styling. It's a song that takes us by the hand, promising something dedicated to fluidity and then the movie delivers it. Later on, The Feelies that shambling band whose carefully calibrated tracks shift from muted emotion to frantically strummed bursts of energy, and much beloved by Demme turn up to perform a cover of Bowie's "Fame" in a high school reunion scene. It's a deadpan cameo, a private homage, but in every way it also serves the dominant narrative interests, and it feels like a gift. At the end, reggae singer Sister Carol literally steps out of her cameo as a waitress into performer mode with her iteration of "Wild Thing." Clad in Jamaica hued garb, standing in the doorway of a downtown building now no doubt long lost to gentrification, Sister Carol frankly engages Demme's lens as the closing credits roll, returning the movie from its more harrowing aspects to the sheer necessity of everyday joy.

    All of these musical moments gave the feeling that Demme was something of a low key conjurer, but of course there was a major focus and rigor behind his approach in Something Wild, and in everything else that he did. He just chose to never show his seams. And only now is it fully evident what a great, extended, cinematic party he threw for anyone who cared to join it, so that his heartfelt, generous example might be their example, too.

    Katherine Dieckmann's film Strange Weather, starring Holly Hunter and Carrie Coon, with music by Sharon Van Etten and songs ranging from Interpol to Cassandra Wilson, opens theatrically on July 28.
    eiiuse 7 hours ago
    Michael van Gerwen beats Phil Taylor to claim Premier League title

    Van Gerwen defeated Adrian Lewis in the semi final before seeing off Taylor

    World number one Van Gerwen was barely troubled throughout Finals Night, seeing off Adrian Lewis in his semi final to set up a date with 'The Power' who beat defending champion Gary Anderson in their last four encounter.

    Playing in his fourth consecutive Premier League final, MVG wasted little time in getting out of the traps, racing into a 7 3 lead at the interval and it was the tenth leg just before the break that proved so crucial.

    With Taylor needing tops, MVG took out 100 with two double tops of his own and that seemed to suck the life out of Taylor, who had fake Van Cleef & Arpels clover bracelet rose gold led 2 1.

    Van Gerwen claimed his second Premier League title with a dominant victory over Taylor

    As he had done earlier in the night, Van Gerwen returned with ruthless efficiency, taking out four unanswered legs to claim a comprehensive victory over Taylor, who remains without a major title since the 2014 Grand Slam of Darts.

    For Van Gerwen, it is a second Premier League title and a first since 2013 and after topping the regular standings for a fourth straight year as well as setting a new world record TV average during Week Four, he appears an unstoppable force.

    Premier League Finals Van Cleef & Arpels fake gold bracelet Night recap A dramatic night at the O2 as it happened

    "There were two moments for me the sixth leg and that 100 finish in leg 10," Wayne Mardle told Sky Sports.

    "Instead of going 6 4, it went 7 3 and that absolutely devastated Phil Taylor and he was a spent force. Phil was finding it hard to best imitation Van Cleef & Arpels bracelet keep tabs with Michael anyway and at that point, that 100 finish was just what he did not need.

    "He [Taylor] came back from the break and he looked beaten. He had a couple of legs, but Michael quelled his enthusiasm and he couldn't get up and running again."

    Phil Taylor returned to Finals Night but had to settle for runners up spot

    Van Gerwen has now won the Masters, the Dutch and German Masters as well as the UK Open this season and will have his sights fixed on the rest of the majors after a stunning start to the year.

    However, Mardle says it will be difficult for the Dutchman to secure a clean sweep, he missed out on the Premier League and World Championship last year despite a fantastic season.

    "It will be tough to win everything," explained Mardle, "because last year he was as dominant as we have seen anyone, apart from Phil Taylor.

    Losing finalist Taylor says Van Gerwen put him under extreme pressure during his Premier League final and he could not match the Dutchman

    "But he [MVG] couldn't win the world title that went to Gary Anderson and he couldn't win this [Premier League]. He has put this right tonight. but to win it all, I am not sure."

    Earlier in the night, Van Gerwen had beaten an out of sorts Lewis with a blistering display after the interval.

    'Jackpot' had mounted a comeback to close to within two legs at the break but a trademark surge through the gears from van Gerwen left Lewis trailing and four straight legs was enough to seal a 10 4 victory and a place in the final.

    In the other semi final, Anderson had matched Taylor to trail 5 4, but 'The Power' registered a crucial break at the interval which turned the game in his favour.

    Defending Premier League champion Gary Anderson was beaten at The O2

    Anderson could not get going and despite a late rally from the 'Flying Scotsman', Taylor held on to claim a 10 7 victory and a place in the final although it was to be Van Gerwen who had the final say.
    eiiuse 7 hours ago
    Patient reported outcome measures in practice

    Scores of tools to measure outcomes that matter to patients have been developed over the past 30 years but few are used routinely at the point of care. Nelson and colleagues describe examples where they are used in primary and secondary care and argue for their wider uptake to improve quality of careClinicians' understanding of the effect of disease and treatment on patients' daily lives is poor.1 In response to this problem, over the past three decades, hundreds of standardised measures have been developed to capture patient reported outcomes, including symptom status, physical function, mental health, social function, and wellbeing. However, the patient reported outcome measures (PROMs) movement has largely been driven by the agenda of researchers or service payers and has failed to focus effectively on improving the quality of care from the patient's perspective (box 1). We use two examples to show how the use of PROMs in everyday practice has the potential to narrow the gap between the clinician's and patient's view of clinical reality and help tailor treatment plans to meet the patient's preferences and needs.2Box 1: Uses of PROMsHealth systemPerformance assessmentValue for moneyInformation for patients or cliniciansChoice of providerChoice of treatmentBarriers to routine use Hermes bag knock off Evidence shows that the systematic use of information from PROMs leads to better communication and decision making between doctors and patients and improves patient satisfaction with care.3 4 5 6 7 There is also evidence that patients report better outcomes for example, improvement in depression.8 However, research on attempts to embed measurement of patient reported outcomes into routine practice has revealed many technical, social, cultural, legal, and logistical barriers to successful adoption.9 10 11 12 13Clinicians are often reluctant to use PROMs routinely because they fear it will add to their workload rather than make them more efficient and effective. Furthermore, many clinicians who do spend time talking to patients contend that they already understand their patients' problems and do not need additional information from them.Patients generally welcome systems that routinely use PROMs. However, they say that patient reporting systems must be used well and not misdirect the focus of the clinical encounter, burden patients, or focus only on factors that have value to clinicians (box 2).Box 2: Views of patient advocatesFor most patients there is no systematic or effective method for communicating what happens outside the clinical encounter, such as perceived needs, symptoms, response to treatment, undesirable side effects, effect on function, and what matters to patients and their families. Like clinicians, patients want better outcomes for individuals and communities, and better professional development and system performance, although we might not use those same words to describe them.PROM systems have the potential to enable improvement by providing information that can bridge the gap between the clinical reality and the patient world, triggering learning as well as the right next action.PROM systems must be codeveloped by patients, the public, and professionals to obtain maximum value. They should be integrated with the rest of the patients' healthcare information and patients should be able to use the information when and where they choose, including for research to benefit others with their condition.Any system designed to assess and respond to patient reported outcomes must include relevant and validated Hermes handbag copy measures. These must be analysed and reported appropriately and the response to them made explicit in the notes. Identifying the best way to incorporate PROMs in pre existing medical record systems while safeguarding privacy is challenging. The best design will vary for different patient populations, practice types, and clinical settings.Below we present two cases from Sweden and the United States that show routine use of PROMs in primary and secondary care. Both systems were developed by experienced, practising physicians and share similar objectives but the design differs.Swedish rheumatology quality registryThe Swedish rheumatology quality registry was established in 1995 and contains data on over 66000 patients, about 85% of people in Sweden Hermes handbag knock off with rheumatoid arthritis.14 Data generated by patients is fed into a user friendly "dashboard" and used to support care. Patient reported outcome measures are tracked over time in relation to ongoing treatment. Patients input information on both disease specific and general measures of function and health, helping clinicians to provide more appropriate and patient centred care. The dashboard displays trends and is used to guide treatment, shared decision making, and self management. Experience suggests that the registry dashboard helps necklace Hermes replica engage and empower patients and increases their confidence that they can manage and control their condition.14Karin A, who has rheumatoid arthritis, says: "Nowadays I work together with my doctor and the computer for every change in my treatment. I can check my disease at home between visits. Before I go to see my doctor I report on and measure my own health. It's easy; I just click on the screen and enter how I feel now."Clinical outcome measures seem to improve after patients start measuring, reporting, and sharing responsibility for the management of their condition with their physician. Patients in one region (Gvle County) that implemented routine use of PROMs in clinic visits had less disease activity, as measured by C reactive protein, than patients in regions where structured communication with doctors was not necessarily part of routine care.15Patients have a personal identifier to access the registry, and the system is easy for patients to use and input information. The system also contains all the usual data used by medical staff to track outcomes (blood test results, inflamed joint counts, etc) so staff do not need to spend extra time inputting data or to move from one screen to another. Because patients track their outcomes between office visits and can communicate electronically when there is a change, the timing of appointments (urgent care for flare up or routine follow up) and their duration and content can be preplanned by the office staff and guided by patients' needs and priorities. Registry data can also be aggregated to examine population health, improve quality of care and provide transparent public reports on patient outcomes at the county level. For practice improvement the system also provides a summary of all patient data (with national benchmarks) and a secure registry to target interventions at groups of patients with similar needs (such as those with diabetes, emotional problems, or low confidence to self manage health problems). The system is used by hundreds of practices in the United States and Canada, and initiatives to increase uptake are under way in Iowa, Massachusetts, and British Columbia. The system is endorsed by several medical specialty organisations.Patients usually access HowsYourHealth from home or within the doctor's office. They have the opportunity to share their "check up" data with the office staff, receive information tailored to their needs, and create a personal health plan for tracking and sharing their health status and behaviours. They can also access tools to help build confidence and skill in self management and better understand the risks and benefits of treatment. The system collects generic patient reported outcomes, including COOP/WONCA measures on pain, mobility, mental health, age and sex specific preventive health needs, and self management capacity for common risks and conditions. Patients control their HowsYourHealth information and its security, and it doesn't require a personal identifier or password.A controlled trial involving 45 primary care physicians and 1651 patients aged 70 years found that the HowsYourHealth system significantly improved patient ratings of overall care quality and their understanding of important risks (such as falls and advance planning of care). Patients also reported that it helped with daily activities, emotional issues, and social support.7 Another controlled trial involving 47 primary care physicians and 644 adults with pain and emotional problems showed sustained improvement when HowsYourHealth was combined with a problem solving intervention supported by a nurse educator.8Practices typically build HowsYourHealth into the routine "annual check up," and patients are usually happy to use it once they understand how it helps their care and improve the practice. James Bloomer, a family practitioner, describes his practice's approach:
    PM 'Will Force Europe To Vote On Juncker'

    The Prime Minister, who sees the controversial candidate as a symbol of Europe's past and a potential obstacle to reform, is expected to set out his concerns when he meets Herman Van Rompuy, president of the European Council. Mr Juncker is forced through as the council's nomination, Mr Cameron will call a vote at a meeting of the 28 member bloc on Friday, requiring each country to set out their position clearly.

    A Downing Street source told Sky News the vote would be handbag Hermes copy "unprecedented" and a "break away" from the traditional approach of the European Council, which has always managed to find a consensual candidate.

    "British officials have been clear . that if there was the political will to find consensus, then the decision on Commission President could and should be delayed," the source said.

    "But if leaders aren't even willing to consider alternative names, despite their widely expressed misgivings, then a vote should take place."

    Despite Hermes Kelly bag replica opposition from Mr Cameron, Mr Juncker enjoys support from many European leaders, including French president Francois Hollande and Italy's Matteo Renzi.

    However, in an interview with Hermes Birkin bag replica Sky's Murnaghan programme, Poland's foreign minister Radoslaw Sikorski said the process for nominating Mr Juncker necklace Hermes fake was democratic because he was the choice of the centre right European People's Party, the largest group in the European Parliament.

    "In Dublin a couple of months ago, we agreed that this time it would be more democratic, not just national leaders meeting in a room overnight and coming out with a solution," he said.

    "This time we decided to nominate a candidate ahead of the election.

    "The candidates of the socialists, the liberals and the centre right were plastered all over Europe, so those who bothered to take an interest knew that if they voted for us, Mr Juncker would be the candidate.
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