text:
Games Radar
SFX The world's number one sci-fi, fantasy and horror magazine
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SFX Issue 194
By Dave Golder
Supernatural 's resident angel fights the apocalypse on TV while commanding an army of Minions in real life…
"This is definitely the coldest interview I've ever done," complains a shivering Misha Collins as he warms his hands on a nice cup of tea. We're sitting in a huge bare-brick room in North London and the heaters are losing their battle with the winter chill. Collins is still perky despite the cold, however, having warmed up (mentally at least) while conducting interview after interview all morning to promote Supernatural 's debut on Living. Which is pretty "cool" in itself – if you pardon the pun – because how many other series suddenly pick up viewers and critical acclaim after four years on the air, and then find their fifth season launched with such a fanfare on UK telly?
Collins, who joined the show at the start of season four as the angel Castiel, has his own theory for the show's long-awaited success. "I shouldn't be saying this, but it's entirely due to me," he deadpans. "It's because I'm amazing." Then he laughs and continues more seriously, "I did a decent job, yeah, props where props are due, but the fact is that the introduction of my character coincided with the introduction of the mythology of angels. Suddenly for the writers there was a whole new wealth of material to mine, and it gave them a lot of stuff to work with."
Castiel certainly had a lot to do last year: after pulling Dean Winchester out of Hell, he spent the rest of the season trying to decide whose side he wanted to be on. "Castiel intermittently protected and then ultimately misled Sam and Dean," the actor explains. "He was following the orders of Heaven throughout season four, but at the end he disobeyed and became a rebellious angel. And now, at the start of season five, he's a renegade and is hunted by both Heaven and Hell, and working with Sam and Dean trying to head off the apocalyptic confrontation between Lucifer and the archangel Michael."
The angel had to overcome another hurdle before embarking upon his new mission, however, seeing as he was smited (er, smitten? Smote?) by an archangel in the season four finale. Thankfully he was brought back to life, but we point out that it can't have been easy to reassemble him after he exploded into a million pieces. "I've been thinking about that recently," Collins declares with a grin. "Somebody had to actually collect all the bits and fragments and molars and pieces of hair and blood that were scattered around from Castiel's body and reconstitute him. Can you imagine that assignment? 'Where is that toe?' Maybe it got pushed under the sofa in Chuck's living room…"
With Castiel sticking around to help the Winchesters fight the apocalypse, does Collins think he's eventually going to become part of the family? "I think he is working his way into the family somewhat. At times it seems he's a bit disconnected from Sam and Dean, and I think that their triggering of the apocalypse also put a little distance between him and them. He definitely began the season feeling angry and disappointed at them. Justly or unjustly!"
An instant success on the show, Castiel isn't the only one who's been popular with the fans. Collins himself, helped by convention appearances and a rather unusual Twitter account, has attracted a lot of attention. "It's a bit strange and a great stroking of the ego," he laughs. "It's always nice to have people fawning over you." As he speaks, a heater rumbles into life a few feet away (better late than never), and so we have to clarify whether he just said "fawning" or "fondling". "No, I said 'fawning'," he nods sagely, "but the fondling is also nice."
Which brings us to that bizarre Twitter account with its tens of thousands of followers, on which Collins has claimed to have eaten a pony in an underground bunker, been imprisoned by the Queen in Buckingham Palace and declared his intention to take over the world. "I don't really know what my Twitter persona is," he muses. "It's a strange phenomenon and I'm having some fun with it. Apparently I'm an Overlord of sorts who has lots of Minions, which are handy. But I've not actually put them to any productive use whatsoever, so it's kind of wasteful." [Not any more: since we chatted with him, Collins has set his Minions to work and so far raised over $30,000 for Haiti relief.]
So he's been a busy chap over the last year and a half. What would he cite as the highlight? "Sitting in this frigid room," he says ruefully, over the roar of the useless heater. "And it's really nice having a job for a long period of time. I've always wondered, 'Why would you want that?' But now I see!" And the fact that Supernatural is such an interesting show helps, too. "A lot of procedural cop shows would be dull to be stuck on every week. Interviewing the perp in witness room number two over and over again. On Supernatural there's always something new going on. We get to play different characters or travel through time – there's always an adventure!"
Dave Golder
Dave is a TV and film journalist who specializes in the science fiction and fantasy genres. He's written books about film posters and post-apocalypses, alongside writing for SFX Magazine for many years.


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Advantages of using Microsoft Access
by Ethan
in Tech
Microsoft access is a super powerful tool meant for building massive databases for use in the business. There is a fundamental difference between access and other Offices programs like Word and Microsoft Excel. First, it is not beginner-friendly; it's impossible to use it properly without proper knowledge of the database theory.
To make a proper useful Access database, you need to experience writing queries in SQL. Access is the easiest tool to use a simple database, and it's an excellent starting point for the very interested user. So, let's discuss the advantages of Microsoft Access in this article. Also, get the basic information about the Microsoft access cloud further:
Database Systems are quick and easily created
Microsoft Access produce a user-friendly application
MS Access provides flexible database systems
Well, Popular and you can get help and support easily
Microsoft Access is quite old, and its expertise is not going to disappear
Prevents the Human Mistakes
Helps in creating User Interfaces
Share your Findings
Microsoft Access is the best tool for creating bespoke systems which have a database. It mainly consists of the wizards to enhance the process of forming a database application. In addition, it consists of a vast array of functionality that is readily available.
For the programmer who is an expert specializing in MS Access, you can also find the development time, which is approximately half what is required to create the same system using the variable pattern. Therefore, it can prove to be a huge advantage as it translates directly into a cost-saving for you.
You can produce an extremely basic database in access. But with a little bit of magic from the professional expert, you can convert the database into a well-formed application. Here are the various examples that can be used in the clients' system's programming code to give rise to user-friendly and automated processes. The final result is the method of the easy-to-use system, which fits around the method that your business operates.
With the help of Microsoft Access, it creates systems in the first place, and it is much quicker to amend things like in other packages. You must add new bits into the system, which can be integrated quickly. Access is perfect for the real-life business world, and it can change the system. It might cost you the earth and without the long-time delays. Check out the Microsoft access cloud computing information and get the appropriate information regarding it.
The access and the VBA programming language is well recognized by most developers, programmers, and software companies. It means that you need to create a system by making use of Microsoft Access. It will not get interconnected with the individual who created it for you. One of the most important points to note is that you must have the source files. A well-known developer will make sure that you consist of the source files.
Microsoft Access has been for quite a long time. There have been creation systems in Microsoft Access from 1994, and access has been before then basically. There are not many businesses that can deliver the same criteria. If you wish for a system that has good longevity, then Microsoft Access is the best choice.
If you have an excel spreadsheet, Microsoft Access helps catch up on the inconsistencies caused by human error.
The user interface is the screen that your employees observe when they enter or edit the data. In access, you can create forms that only show the employees' fields to do the jobs. It also gives the company better knowledge of security. The employees do not have full access to the company records. Thus, Microsoft access helps in creating the user interfaces.
Some data can help make business decisions moving ahead. For example, you might want to see how many leads are in the marketing campaign. So one of the major benefits of Microsoft Access is that it is extremely simple to share the findings with others.
Are you interested in relational database theory? Then, you can surely create the appropriate Microsoft Access Database by connecting with a professional expert for greater information. Access Experts is the one stop solution to know everything about Ms Access.
Tags: Microsoft Access
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redpajama_set_name: RedPajamaCommonCrawl


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Astros Promote Owner's Son Jared Crane To Executive Team
By TC Zencka | November 9, 2019 at 10:22am CDT
The Astros moved some pieces around in their front office recently, per Chandler Rome of the Houston Chronicle. With an eye towards succession, Astros owner Jim Crane has moved his son Jared Crane into a position to oversee the club's business operations.
Longtime team president Reid Ryan has been moved out of the role and into a different position within the organization as Executive Advisor of Business Relations. The organization says Ryan will remain "an important part of the Astros organization," though they've also said that he will have more time to explore other opportunities. All in all, the shift from Ryan to Crane seems a significant change for both parties.
Ryan, of course, is the son of Hall of Famer Nolan Ryan. The elder Ryan has been an advisor to the team for the past six seasons, but his role has expired and he is not expected to continue on with the team.
This all comes on the heels of an unfortunate situation surrounding former assistant GM Brandon Taubman, but the team insists this shakeup has nothing to do with the handling of Taubman's situation. Instead, the move is part of a long-term plan by owner and chairman Jim Crane to move his son into an increased role with the team.
Payroll Notes: Diamondbacks, Cubs, Mariners
Trevor Bauer Explores Different Agency Experience, Becomes First Client Of Luba Sports
SoxPow
Executive team what?
how nice! why did my father always insisted my separation from his vast wealth?
MaybeYouShouldDrive
It was probably due to your poor command of the English language.
clepto
Great rip. Always hammer inferior posters.
forwhomjoshbelltolls
It's good to see that Jared Crane was able to overcome all of the obstacles in his way in order to prove that he is the most qualified person for this job.
A modern day Horatio Alger story.
jleve618
The glass floor catches another!
paddyo875
In privately-owned companies and other places like the WH, it seems that nepotism is the unfortunate norm.
kripes-brewers
Zing! Good one paddy…
Mo4ever
I'm assuming this is tongue in cheek, so I up-rated it. Apparently you can accurately predict a person's future level of success by certain qualities in kindergarten: IQ, home background, social awareness and persistence. Pretty much none of which anyone earns, good or bad. All you have to do is wake up and be yourself each day, the one you were destined to be as a kindergartner. Jared was probably predictable the day he was born and given his silver spoon.
charles stevens
Well the Astros might as well start looking for new homes for their AA and AAA teams. It's pretty sad that Nolan is now at odds with the Astros and Rangers.
GeoKaplan
Time for Ryan to come home to the Angels…He's a crusty old man, but just speaking with the pitchers every Spring would leave them inspired and star-struck.
Ryan is not still at odds with the Rangers. He threw the first pitch in the finale at old Globe Life last season and is having his steak line sold at the new park. AAA and AA leases do not come up annually either.
nstale
except for the Astros bought the AA team from Ryan Sanders baseball a few years ago…
digimike
Life is a modified meritocracy. Recognize, adjust and move on.
ChiSoxCity
Meritocracy? Hardly. Nepotism is the exact opposite of a meritocracy, though I have no qualms with it.
Why wouldn't you have qualms with it? I worked in a company riddled with nepotism and even though I was somewhat shielded as an executive it was pretty awful the way decisions were made and people were treated. I only stayed fifteen months.
I guess I can see it in a very small, private company, but in a larger one or a public company it's difficult to tolerate.
Succession of progeny is one of the prime directives in nature. No owner of a privately owned company willfully passes over children/family to "others". Would you? Now if the kid is a dirtbag, perhaps not, but you get my meaning.
In a small, private company I would not "pass over" my kid, assuming s/he had the talent and right attitude. In a larger company it would be all about merit. I would not risk the income of 100's of employees on someone just because they're my kid.
MODIFIED meritoracy.
mlb fan
You don't fire Superman, Batman or Nolan Ryan……..
Tom E. Snyder
Nolan Ryan was not fired. He quit.
AlvaroEspinoza
In the book The Iowa Baseball Confederacy, the father is killed by a line drive and the son receives all of his baseball knowledge when he passes. Could be the same theory here
At least he spells Jared the correct way.
Baseballfreak
Steinbrenner 3.0!
Well, he is going to be the owner one day. Why couldn't they just promote Jared to "VP of assistant
ownership?" Of course the recent brouhaha had nothing to do with pushing Reid Ryan out of the way!
retire21
Assistant TO the Regional Manager.
America in a nutshell smh
CrikesAlready
The beginning of the Spanos-equivalent in MLB. Years of mediocrity in spite of the talent to follow.
RunDMC
I'm interested to know the name of the job Jared Crane is assuming the role of, but we all know it's Assistant to the Regional Manager.
takeitback
I think it's funny that people have a problem with this. If Crane plans on passing the team down to his son, I would prefer his son have some experience within the organization first. It's Crane's organization, that he paid a ton of money for, why shouldn't he be able to hire his son if he wants to prepare him to take over one day?
Maybe because lots of people depend on the organization for their income, and an entire fandom of loyal people invest in it for their loyal enjoyment. I would never hand over a company with this market value to someone just because they're my son. Never. That would have to be about merit. Anything else is just bad faith to everyone else involved with the company.
This is not some mom and pop.
hiflew
In fairness, you don't really know that he is NOT a qualified candidate for the job. Assuming someone got his job based only on nepotism is almost as bad as nepotism itself. Everyone deserves a chance to prove their worth.
Now you may not make your kid GM, and that I get, but team ownership is not about merit. It's about being wealthy or having a wealthy family.
Jonthunder
The Astros front office is exploring every avenue of toxicity lol.
dynamite drop in monty
Gin and tonics for all
rxbrgr
Nice. I bet Crane Jr. will get paid $50,000 per month for his vast experience and business acumen in this advisory role.
thomasg2018
Sad star of affairs
Cole is gone as well. The Astros will low ball him and say they tried just like Morton last year.
I believe Morton took less at TB because he wanted to play at home.
Orioles, Austin Voth Avoid Arbitration


text:
Events Press Statements
Young Fine Gael call on Minister Coveney to expel Russian Ambassador to Ireland
Young Fine Gael have written an open to the Minister for Foreign Affairs and Defence, Simon Coveney, requesting that the Russian Ambassador to Ireland be expelled. This request comes following the Russian Federation's illegal invasion of Ukraine's eastern border and its decision to no longer recognise Ukraine's sovereign claim over Donetsk and Luhansk.
In the letter, Art O'Mahony, President of Young Fine Gael said: "As a nation which has experienced the trauma of imperial aggression, Ireland has an obligation to defend the principles of democracy and self-determination. Russia's recognition of Donetsk and Luhansk as independent states is in violation of international law and its military incursion is an assault on our liberal western values."
Young Fine Gael have asked the government to action five points as a retaliation to Russia's invasion of Ukraine. These are:
Expel the Russian Ambassador to Ireland
Support severe economic sanctions on Moscow through the European Union
Condemn Russia's actions at the United Nations Security Council
Express Ireland's unequivocal support for NATO in the region and desire for peace
Amend the Defence Act 1954 to remove Russia's veto over the deployment of troops
"We believe that these actions will send a strong message to Moscow that Ireland unequivocally supports Ukraine at this difficult time and that military neutrality does not mean political neutrality."
"Young Fine Gael will work with our colleagues in the Youth of the European People's Party (YEPP) to ensure that the governments of Europe unite in their resolve to defend Ukraine."
YFG is the first Irish youth wing to call for the expulsion of the Russian Ambassador to Ireland.
Along with fellow sister parties in the Youth of the European People's Party (YEPP), Young Fine Gael will be using the #StandWithUkraine hashtag to show solidarity with the people of Ukraine.
51 Upper Mount Street, Dublin 2
yfg@yfg.ie


text:
$LOAD_PATH.unshift(File.join(File.dirname(__FILE__), '..', 'lib'))
$LOAD_PATH.unshift(File.dirname(__FILE__))
require 'rspec'
require 'zappos'
require 'net/http'

API_KEY = '190a7d0566b7abba2e041db5e751b1251e593aa2'

# Requires supporting files with custom matchers and macros, etc,
# in ./support/ and its subdirectories.
Dir["#{File.dirname(__FILE__)}/support/**/*.rb"].each {|f| require f }

def file_fixture(filename)
  open(File.join(File.dirname(__FILE__), 'fixtures', "#{filename.to_s}")).read
end

def stub_http_response_with(filename,code=200)
  format = filename.split('.').last.intern
  data = file_fixture(filename)
  response = Net::HTTPResponse.new( '1.1', code, '' )
  response.stub!(:body).and_return(data)
  response
end

def stub_client_response_with( zappos, filename )
  response = stub_http_response_with( filename )
  zappos.stub!( :execute ).and_return(
    Zappos::Response.new( zappos, nil, response )
  )
end

RSpec.configure do |config|

end

redpajama_set_name: RedPajamaGithub


text:
Solidarity to the prosecuted comrade Matheus Machado
Support the brazilian comrade who is facing up to 10 years in jail for protesting against Bolsonaro's government.
Instagram: @machado.ttt
Telegram: @CamaradaCamarada
About the mobilization for Machado's freedom
Interview with Machado's mother
Interview with Machado
About his prison
Matheus Machado is a brazilian tattoo artist, anarcho-communist and revolutionary militant, that took part in the recent protests against Bolsonaro in the city of São Paulo, Brazil. Actively participating in the first line of protestors, he got arrested in the third round of street manifestations after being identified and snatched by infiltrated police officers, known in. Brazil as 'P2'.
In his backpack, the police only found a police helmet. But prosecutors are pushing forward, without any proof, four crimes against Matheus: physical assault, property damage, arson and theft. He is being accused of setting a bank on fire, destroying a metro station, assaulting a metro security guard and stolen his helmet.
The protest, that happened in 3 of July past year (also known as the "3J'), was the most agressive against Bolsonaro's government since the beginning of the manifestations. Matheus took part in the bloc that became known as "Bloco Combativo", gathering the most radical militants. This bloc was responsible for the destruction of banks and police vehicles, for erecting barricades in the main streets of São Paulo and engaging with police and security guards.
Comrade Machado remained 11 days arrested, in the Belém II prison facility, under severe conditions. A giant campaign emerged from his prison, demanding imediate freedom and labeling his prison as a political one.
He also got arrested 5 years ago, in 2016, at another protest in São Paulo, but this time against the rise in bus fares. For this reason, he remained imprisioned for 3 days. Since then, Matheus got recognized and organized part of the the radical wing of the antifascist scene in São Paulo, bringing together a significant group of black bloc adepts around him. And because of this, and mainly because of his underground activities with this group, he got identified and informally labeled as a "leader".
In a free pending trial, he is now prohibited from attending political events, obeying curfew and other restrictions, facing criminal charges that can put him in jail for 10 years or more, for physical assault (3 months to 1 year), theft (2 to 4 years), arson (3 to 6 years), public and private property damage (4 months to 8 years). Besides the possible fines and the risk of going to jail, there is also another investigation going on, to find and prosecute other militants from the Bloco Combativo that participated in the direct actions in São Paulo. With the help from ABIN (the Brazilian Intelligence Agency) and the PF (Federal Police), the president is measuring no efforts to catch and punish the tougher part of the resistance against him.
The results from this investigation could perfectly fit the Bolsonaro's objective to create a boogyeman, a scapegoat for him in order to remain in power.
This year, the most important election of the history of Brazil will take place in October. The risk of more prisons or investigations against the radical wing of the Bolsonaro's oppostition is growing bigger each and every day.
For this reason, we need to be prepared to face any circumstances, and to be fully prepared, we need money.
The funds from this campaign will be used to:
Covering of attorney and other legal/procedural expenses.
Covering of possible fines or prison support in a conviction case scenario.
Financial support for the activities of the Bloco Combativo and the anarchist/communist militants aligned with comrade Machado.
And also, financial support for the antifascist movement in São Paulo for this year activities, that is an election year, and very likely a violent year in the streets.
You can see some of his work in his Instagram profile @machado.ttt. Among other reasons, comrade Machado became recognized by mixing radical art with radical politics, delivering pieces like these:
To support the brazilian prosecuted revolutionaries is support the Brazilian Revolution!


Survival, instinct, brains. How do we eat them? How do we use them?
In the wake of the zombie apocalypse innovative ideas have become more important than ever. Watch and take note on how to survive the "human apocalypse" in a special DED Talk presented by a zombie who has seen it all.


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In our Fairfax Dental Clinic, we make sure that you receive the highest level of preventative services including routine cleanings or periodontal maintenance. Our ultimate goal is to help you maintain great oral health throughout your lifetime!
Your teeth are not the only important part of your oral health. Your gum and bone health are also an essential component of your overall oral health. The gum and bony structure surrounding your teeth act as the foundation to a healthy smile.
Gingivitis is an inflammatory condition of the gum tissue caused by the accumulation of food particles, plaque and bacteria onto the tooth surface. If allowed to remain on the surface of the tooth the bacteria will cause inflammation of the gum tissues. Since gingivitis is a painless condition most patient won't ever realize that they have it. Some additional symptoms of this condition in the advanced stages are bleeding gums, tenderness or sensitivity when brushing. If left untreated gingivitis can progress to a more aggressive form of gum disease called Periodontitis which can start to destroy the bone support around your teeth.
In our Fairfax Clinic we can provide comprehensive periodontal cleanings and help you establish a dental hygiene routine to keep this vital component healthy for many years to come! If you have any questions about your current hygiene plan please ask us.


text:
Home Mobile Integrated Healthcare Ada County PET Tackles Mental Health Cases Head-On
Mobile Integrated Healthcare
Ada County PET Tackles Mental Health Cases Head-On
Dawn Rae, BS, NREMT-P -
Emergency responders in EMS and law enforcement have been the front line for mental health crises throughout history. Agencies have responded to this role in a variety of ways–all of which have helped provide a more sensitive response to these vulnerable individuals, and spawned myriad deployment models across the nation.
Whether agencies increase mental health training for responders or create nontraditional response teams, communities are bettered by collaboration. That's why community paramedics in Ada County, Idaho, created a program that brings EMS, law enforcement and mental health clinicians together to serve its residents. In doing so, the program has saved healthcare dollars, decreased time to definitive treatment for persons in crisis, and reduced preventable hospitalizations.
Law enforcement agencies in Ada County respond daily to an ever-increasing number of calls involving persons with mental health issues. In the state of Idaho, a sworn police officer is one of two individuals authorized to place a person on an involuntary mental commitment hold. Officers may take a person into custody whom they determine meets Idaho Code 66—326 of being "gravely disabled," or their "continued liberty poses an imminent danger to that person or others." Once placed on this hold, an officer within Ada County is required to transport the individual to an ED or call for EMS to do so. EDs medically screen the patient and arrange for placement at one of the local inpatient psychiatric hospitals.
This process is commonly called a "24-hour hold," but this nomenclature is misleading. An individual will be hospitalized for more than 24 hours, possibly up to 72 hours, before they're evaluated by an examiner.
The Mobile Crisis Unit (MCU) consists of state-appointed, designated examiners for individuals placed on the 24-hour hold. Designated examiners meet with individuals after their detainment and determine whether they continue to meet the criteria for involuntary hospitalization. If the patient no longer satisfies the requirements, the designated examiner releases the hold. If the patient continues to meet the criteria, the hold will continue and a second designated examiner will evaluate the patient after a few more days. If the criterion is met for more than 5—7 days, the individual is afforded a sealed, civil court hearing wherein a judge will rule regarding continued hospitalization and commitment. The designated examiners testify as expert witnesses in these hearings and are responsible for directing treatment for committed clients.
The MCU also provides mental health crisis screening and intervention for the Psychiatric Evaluation Team (PET), a 24/7 crisis hotline and in-person crisis service in the community. The PET serves the courts by conducting mental health assessments as ordered.
The concept for PET was first proposed in the summer of 2013 by Jeremiah Wickham, an Ada County community paramedic, after he recognized the potential cost savings in diverting involuntary mental holds. After convening a stakeholder group that included representatives from local hospital systems and inpatient psychiatric facilities, all Ada County law enforcement agencies, Idaho Department of Health and Welfare's MCU, and others to discuss the issue, a final consensus was reached. Under the guidance of the stakeholders, community paramedics would pilot a screening process to medically evaluate individuals placed on an involuntary mental hold by law enforcement. The medical screening criterion was based on physiological standards that are intended to determine an individual's medical stability. Community paramedics would also obtain a thorough history of the present event, as well as any medical history that would warrant a more thorough evaluation by a physician.
From Nov. 1, 2013, to Feb. 28, 2014, community paramedics screened 56 individuals using the elected criteria. Twenty-nine (52%) people passed the screening and were considered a positive evaluation. During this pilot, community paramedics responded to any 9-1-1 call where a person was being placed on an involuntary mental hold, without regard for presenting a complaint. This method ensured that the screening tool was utilized on a variety of patient presentations, thereby collating the best data available. No person was diverted during this pilot phase, and once it was completed the screening data was compared to ED medical evaluations. The in-field medical evaluation was validated, as no medically compromised individuals passed the screening tool. (See Figure 1, below.)
PROGRAM EVOLUTION
In September 2014, under the guidance of Ada County paramedics' medical directors and inpatient psychiatric facilities, we began a beta phase to implement screening and diversion. The phase lasted six months, with goals that included collating sufficient data to prove cost savings, ensuring law enforcement support, and determining any logistical barriers to the program.
A significant program change was the addition of a dedicated MCU clinician to work alongside community paramedics and officers, providing expert mental health assessments and resources. The clinician also coordinated the direct admission of a patient to an inpatient psychiatric facility after they had been medically evaluated. We held informational staff meetings at all involved locations, and our paramedics attended shift briefings that educated law enforcement officers on the new processes.
Paramedics were available in the field seven days per week from 4 p.m. to 12 a.m. These hours were selected based on data collated by the MCU, which plotted the time of day of all involuntary holds enacted by officers. The clinician was available to respond in person during these hours, and remained available as a resource for officers 24/7. Throughout the shift, paramedics monitored the computer aided dispatch (CAD) system for both EMS and police, screening for call types that involved a mental health component. They contacted the officers and/or EMS crews by mobile data terminal, phone or radio to advise the PET's availability and response time. Officers and EMS crews were also encouraged to request the PET as necessary, which grew popular as personnel became more familiar with the team and the assistance it could provide. MCU clinicians could also initiate help from the PET for calls received by their crisis line from individuals who were in need of involuntary hospitalization.
At the end of the six months, leadership within Ada County and the MCUs decided to continue the project, though the hours and days were changed to Monday through Friday, 2—10 p.m. Officer feedback greatly influenced the decision to continue, as the PET became known as a valued resource. Discussions with the psychiatric facilities involved also yielded support for continuation. They reported no negative outcomes and patient experience was believed to have improved from immediate hospitalization.
The PET serves the courts by conducting mental health assessments as ordered.
After 14 months of the program, the PET had responded to 329 calls and evaluated 120 individuals who were placed on involuntary holds. Of these, 38 were diverted from EDs at a cost savings estimate of $2,400 per diversion. (See Figure 2, below.) In addition, the PET completed a total of 33 hospitalization diversions, bypassing the involuntary mental hold process completely by establishing an immediate safety plan and subsequent follow-up with individuals, as deemed appropriate. Utilizing the MCU's expertise in evaluating individuals in crisis, and furthering the World Health Organization's principle of utilizing the "least restrictive treatment," the 33 diversions saved an estimated $165,000. This figure represents an ED evaluation and a three-day average length of stay for an individual with a first negative designated exam. What this figure doesn't include are the associated court costs or the cost of involuntary hospitalization to an individual, such as the loss of income, insurance co-pays, etc.
After contact with the PET, 50 individuals opted to admit themselves voluntarily to an ED for psychiatric evaluations and five were accepted by inpatient psychiatric facilities on a voluntary basis. Due to insurance regulations, voluntary direct admissions are difficult to coordinate without an ED evaluation. We're continuing to work on ways to enable this option for those seeking treatment.
Calls continue to be identified through CAD as well as through police officer requests. This method isn't perfect, however, as the PET wasn't involved in 124 mental holds that were initiated by officers for unknown reasons. Improved dispatch methods and furthering officers' understanding of the process will likely decrease this number as the program progresses.
Teresa Shackleford, clinical supervisor of the MCU, said this protocol has proven to be effective in the field.
"When we began the PET project, we had one rather modest goal in mind–medically clear involuntary psychiatric patients in the field whenever possible, thereby bypassing the ED, resulting in direct psych admit. Since the project went live, the PET team has not only prevented unnecessary ED visits, but we have also prevented many unnecessary hospital admissions."
By working with officers on scene, MCU clinicians can implement safety planning, resource referrals and follow-up services. When appropriate, an involuntary hold and subsequent hospitalization may be avoided altogether, an outcome that's only possible with the collaboration of the PET.
Shackleford said she's seen other unanticipated outcomes as well. "In addition to those exciting results, Mobile Crisis has noticed a significant jump in calls from law enforcement officers seeking consultation on cases outside of the hours of the PET team project. Overall, collaboration between our local agencies has increased dramatically, which helps us to serve the community more effectively and helps our mutual clients have a better experience when they find themselves needing our assistance."
In response to the increasing number of calls involving mental health issues, the Boise Police Department hired a mental health coordinator to assist officers in both a proactive and reactive manner.
LAW ENFORCEMENT'S PERSPECTIVE
The PET team has established itself as a valued co-responder to Ada County law enforcement agencies, acting as an in-field resource not only for mental health issues, but also for individuals with dementia and developmental disabilities. What began as a project to save healthcare dollars has become a valued resource for patrol officers during a variety of emergency calls. This collaboration provides officers with better tools to respond to calls involving medical and mental health issues, and gives individuals experiencing mental health crises appropriate, timely treatment and resources.
"The PET has greatly helped our patrol deputies in the field," Ada County Sheriff Department Patrol Supervisor Sgt. Ron Santucci said. "They simply have the knowledge that the average patrol deputy does not when it comes to dealing with people in crisis. The service this segment of people is now getting is much better. After having been a police officer for 25 years, I can tell you that deputies will not call for a service unless it works! "
"Partnering with the PET provides responding law enforcement officers the capability to assess and divert citizens in crisis to much needed resources. The knowledge and skillset of PET members is a valuable resource and appears to decrease the workload of emergency services by handling calls for service properly and safely the first time," Boise Police Officer Zach Powell said.
THE PROGRAM'S FUTURE
As the PET continues to establish itself, the need for outcome data from across the treatment spectrum becomes increasingly necessary. Obtaining patient information from the systems involved has proved to be difficult, but it's a high priority of the program. The team continues to track response outcomes and works to consistently provide a timely service to the community.
One of the program's main goals is establishing a reproducible model for law enforcement, EMS and MCUs across the state. As community paramedicine in Idaho continues to grow, more of these collaborative relationships will likely prove effective–both in healthcare dollars and patient experience.
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Dawn Rae, BS, NREMT-P
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PhD Material Science and Engineering,Shanghai Jiaotong University.Shanghai, China.
Ph.D Mechatronics Engineering,International Islamic University Malaysia.
Prof of Magadh UniversityPh.D Information Technologies.
PhD in Robotics and AutomationUniversity of Rousse, BG.
Doctor of Technology (Mech. Eng.)Cape Peninsula University of Technology, Cape Town.


Read on for detailed information about countries in Europe, including best times to visit, special events, and maps.
Europe is the cradle of Western culture. Its countries are littered with the ancient ruins, medieval castles, art museums, and glorious cathedrals that make up the bulk of most people's sightseeing agendas. Europe is also a continent of idyllic farmscapes and natural beauty, of ancient forests and glacier-clad Alps, of sparkling coastlines and time-stoppered villages.


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