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The Best Writing on Mathematics 2016

Best Writing on Mathematics 2016The Best Writing on Mathematics 2016 is out. I am happy that my paper The Pioneering Role of the Sierpinski Gasket is included. The paper is written jointly with my high-school students Eric Nie and Alok Puranik as our PRIMES-2014 project.

At the end of the book there is a short list of notable writings that were considered but didn’t make it. The “short” list is actually a dozen pages long. And it includes two more papers of mine:

To continue bragging, I want to mention that my paper A Line of Sages was on the short list for 2015 volume. And my paper Conway’s Wizards was included in the 2014 volume.

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2013 Deck – Week 08

Most of my photographs from the recent Mashramani parade for Georgetown were of one particular style, but somewhere in the middle of all the fast flying shots that I took I managed to capture one that was quite different from the wide shots of the floats or the half-body close-ups of the revellers

I don’t know if it’s the photography book I have been going through, but for some reason this image stands out from the plethora of photographs that I took on Mash Day.

The book is “Through the Lens – National Geographic Greatest Photographs”, and it contains some truly amazing photographs.  I am certainly not claiming that any of mine can class with anything from National Geographic, far from it, but the “feeling” that I got from this one was different from the rest, and I think that it is a better photo for that.

You have to see it large, please click on the image to see it in the Gallery.

For me, this shows a woman lost in the moment; it’s just her, the music, the rhythm, the motion…  alone in a crowd, part of the band bu apart from the band all at once.  This is “the moment” for Mashramani 2013.  I hope you like it.

Mashramani 2013

I know that most people’s Mashramani photos are already out there, and I have to say that this year saw a large increase in not only the amount of photos out there but also an increase in the quality of the photography of the event.

In trying to “cover” the event I take a lot of photos, which means I then have to process those photos.  This year I used two cameras, I had a wide-telephoto Sigma 17-50mm on the Canon Rebel T1i body and the slightly longer telephoto Canon 18-135mm kit lens on the Canon 60D body (my favourite lens for the event, the Tamron 18-270mm, has an issue I cannot resolve as yet, it’s slow to focus, which is not good for moving subjects).  My favourites from these events have always been close shots rather than wide, but I decided to try to get a variety anyway.

As I expected, my favourites are still the close-up shots  🙂

Click on the Image above for the full Gallery

For a hand-picked selection, click on this Link, I selected my favourites, not necessarily the best ones, just the ones I like  🙂

Mashramani.  A Guyanese Celebration that has taken on the overtones of Carnival.  The name, derived from an Amerindian word (Arawak) meaning “Celebration after hard work” has been synonymous with Guyana’s Republic Day celebrations for many many years.  Although the original activity began in the mining town of Linden (known as Mackenzie back in those days), it spread quickly around the country.

It is probably hard to have grown up in Guyana (or at least one of the towns in Guyana) and not have attended and have memories of Mashramani celebrations, especially the “Float Parade”.  But after reading Krysta’s blog post “Mash in Guyana, People going crazy”, my mind did that funny thing where it takes you back to remembering what it was like when you were a child.

Just for the record, her title was a reflection of a popular song for the Mashramani celebrations going back many years, it was written and performed by Rudy Grant and is yet to be replaced as “The” song for Mashramani.

So, back to my memories of Mash (faulty though they may be)!

I won’t go into any detail (since that is very much lacking in my memory) but I’ll tell you what I miss… the Low-bed trailers.  I remember there being two very distinct types of “Floats”, one was the very mobile (often times extravagant) personal Float Costume, handled by one man or woman, who expertly maneuvered it down the streets, spinning and dancing and giving a very exuberant display, the second was the low-bed display, a very low (two or three feet of the ground low) trailer with an extravagant display on it, these were usually pulled by a tractor (I even remember a Tapir pulling one once).

These days I see the larger trucks which make seeing all the components of a well-detailed display hard to see.  So, I miss the low-bed trucks or trailers that were used back then.

As a photographer on Mash Day, it’s a nightmare, the police have no control over the crowds, who fill up the street where the bands are supposed to pass, and when the Bands\Floats are passing they also walk alongside, in-front and behind, and sometimes even within!  In doing so they obscure others from seeing and enjoying the beautiful costumes and other design works in the Floats and trucks.  Of course, that also makes it really hard for a photographer to get “easy” shots, but we persevere and press on to get what we can 🙂

I’ve put aside (with Nikhil’s help) a Select set which is about a quarter of the whole gamut, you can click HERE for that, but I do encourage you to check out the whole Gallery by clicking the image below.

This photo for me is very much “Mashramani”, this is Slingshot, a Guyanese singer / Calypsonian, a few years ago he fell of the horse-cart and was injured, this year he was back, undaunted, and back on the horse-cart!  Hats off to you Slingshot!

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We're Not Making A TV Show

By Biz Stone

Just to be clear, Twitter is not making a television show. Some Hollywood folks are developing something that leverages Twitter and they are extremely enthusiastic as evidenced by all the media hubbub yesterday and today. We have little to do with their efforts but we wish them success.

Like the thousands of apps being built around Twitter, there is a growing interest from the entertainment and news industry. We see these projects and others as yet another way the ecosystem is enriched for everyone who uses Twitter.


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Twitter’s mobile web app delivers performance

By Revenue Platform
Wednesday, 14 September 2011

As the number of people using Twitter has grown, we’ve wanted to make sure that we deliver the best possible experience to users, regardless of platform or device. Since is not optimized for smaller screens or touch interactions familiar to many smart phones, we decided to build a cross-platform web application that felt native in its responsiveness and speed for those who prefer accessing Twitter on their phone’s or the tablet’s browser.

A better mobile user experience

When building as a web client, we used many of the tools offered in HTML5, CSS3, and JavaScript to develop an application that has the same look, feel, and performance of a native mobile application. This post focuses on four primary areas of the mobile app architecture that enabled us to meet our performance and usability goals:

  • event listeners
  • scroll views
  • templates
  • storage

Twitter’s mobile web app delivers performance Twitter’s mobile app architecture

Event listener

For the Twitter application to feel native, responses have to be immediate. The web application delivers this experience by using event listeners in its code.

Traditionally, Javascript uses DOM-only events such as onclick, mouseover, mouseout, focus, and blur to render a page. However, because Twitter has so many unique points of interaction, we decided to optimize the resources presented to us with mobile devices. The web application we developed uses event listeners throughout the code. These syntactic events, loaded with the JavaScript on the client, listen for unique triggers that are fired, following the users’ interactions. When users retweet or favorite Tweets, the JavaScript listens for those events and responds accordingly throughout the application, updating screen views where necessary.

The client-side JavaScript on the mobile application handles communication with Twitter through the Twitter API. To illustrate the use of event listeners, let’s look at how a Retweet works. When a user clicks the Retweet button on the UI, the system fires a click event that fires a Retweet request through the API.

The web client application listens for an event like a Retweet and updates the rest of the application when it receives it.

When that Retweet event is successful, a return event fires off a signal and the web app listens for a successful Retweet notification. When it receives the notification, the rest of the application updates appropriately.

The web app’s architecture ensures that while the user-facing layer for the various web apps may differ, the app reuses the custom event listeners throughout, thus making it possible to scale across all devices. For instance, both the iPhone and the iPad use the same views and modules, but in different navigation contexts, while the event architecture drives the rest of the application.

Mobile browsers use a viewport on top of the browser’s window to allow the user to zoom and scroll the content of an entire page. As helpful as this is, the viewport prevents the web pages from using fixed positioned elements and scrolling gestures. Both of these provide a better user experience because the app header is fixed and you can fit more content in a smaller area.

We worked around the limitations of native scrolling by writing a ScrollView component that allows users to scroll the content using JavaScript and CSS Transforms and Transitions. The CSS Transforms uses the device’s GPU to mimic the browser’s viewport.

ScrollView adds a scrolling element and a wrapper container to the element that you wish to scroll. The wrapper container has a fixed width and height so that the inner contents can overflow. The JavaScript calculates the amount of pixels that overflow and moves the scroll element, using CSS Transforms.

ScrollView listens for three events, onTouchStart, onTouchMove, and onTouchEnd to render a smooth animation:

The mobile site stores the initial touch position, timestamp and other variables that it will use later to calculate the distance and velocity of the scroll.

Next, the web app simply moves the scroll element by the delta between the start and the current positions.

Finally, the web app confirms if the scroll element has moved. If there was no movement, the application fires a click event that stops the scrolling action. If the scroll element moved, it calculates the distance and the speed to generate inertial scrolling, which fires a timer.

When the timer fires, the application uses CSS Transforms to move the scroll element to the new position while it decreases the velocity logarithmically. Once the velocity reaches a minimum speed, the application cancels the timer and completes the animation. During this process, it takes into account important coordinates to calculate the elasticity when the user scrolls past the lower or the upper boundary of the scroll element.

ScrollView is used to specify which content is scrollable. It can also be used to fix the navigation header to the top of the window to implement Pull-To-Refresh and infinite Tweet timelines.

One of the many customized solutions unique to Twitter and its user experience is a templating system. Templating is a two-pass process. During the first pass, the app expands the templates and marks the places in those resulting strings where dynamic data needs to go. The app then caches the results of the first pass. When it does a second pass to add dynamic data, the app references the cache, delivering a substantial performance benefit.

Efficient storage

In addition to custom events, we reexamined the use of storage available to the web app from the native browser. Since 15 percent of all mobile applications are launched when the device is offline, the solution needed to cover both online and offline instances. Twitter’s new mobile web app makes use of the HTML5’s app cache, which allows you to specify which files the browser should cache and make available to offline users. Using app cache also helps limit the amount of network activity. You can specify in your manifest file what to store; these include items such as the master index file, sprites, and other assets. When a user loads a page, the web app shows the assets from app cache; it stores the new assets when the manifest gets updated. This ensures the web app can be used even when it is offline, since an updated manifest is always waiting in the cache.

The web app also uses local storage for simple items, such as user settings, user information, and strings, that are persistent throughout the application for immediate access. It uses a SQL database to handle Tweets and Profiles. Within the schema, each storage database gets a name based on the user, allowing for very quick joins between tables. Separate user tables allow for encapsulation and provide the ability to bundle data securely, by user. Given the growing use cases for devices like an iPad, especially in a multilingual setting, this innovation allows for two people using separate languages to receive all the translated strings cached per user on the same device.

In addition to using storage elements of the HTML5 spec, Twitter’s mobile application also makes use of some of the best tools of CSS3. This list includes

  • Flex box model
  • Gradients
  • Shadows
  • 3D transforms
  • Transitions
  • Animations

Future direction

The event framework gives us a scalable way to grow this product over time. Our goal is to add support for new devices as well as build new user-facing features and elements. We will invest in both native applications and the web. In cases where we can or should go native, we will, but in many cases we believe our web app provides an optimal approach for serving a broad set of users.

Twitter’s HTML5 mobile application was developed by Manuel Deschamps (@manuel) and designed by Bryan Haggerty (@bhaggs). Mark Percival (@mdp) contributed to the coding of the mobile architecture.


text: Press Release# 35: Zone Offroad, 2011 Ultimate Adventure Official Suspension Coldwater, MI— May 25, 2011— Zone Offroad Products is proud to announce securing the official suspension sponsor position for the 2011 Ultimate Adventure. Hosted by Petersen’s 4Wheel & Off-Road Magazine, this annual event challenges teams as they take on the ultimate road trip from state to state and trail to trail with nothing more than their rigs and teamwork. No trailers and no whining, the Ultimate Adventure 2011 joins teams from across the country to compete in this grueling competition of will and skill. Teams for the 2011 Ultimate Adventure


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Skip to main content

Post Editor Problems, In The Singapore Region, Continue

Now into its second month, we are getting reports of improperly loading post editor sessions, from bloggers in Singapore.
My edit/newpost page is screwed up, with buttons everywhere, and the button for posting pictures and videos's missing too ... I'm a Singapore user using SingNet.

This problem, apparently being related to your Internet service, can't be seen by Blogger, or by anybody but you (and your neighbours). If you don't report your problem, don't expect for it to go away. And possibly, you should be reporting the problem to your ISP too. And please, when reporting the problem at this end (either in Blogger Help Forum, or comments here), state explicitly whether you are in Singapore or the vicinity, and whether your ISP is SingNet (and neither implies the other, so answer both please).

Be part of The Solution, not of The Problem! First, check to ensure that you have selected the correct version of the post editor. Then, proceed to my private forum, The N Zone, where we may try to work on this problem ourselves.

>> Top

Layfon Lin said…
Hi, I too also a Singaporean using Singtel ISP user.. Like all others, my post page and everything in the settings page and the rest are all screwed.. My main problem is the settings page under 'Permissions' which i cant locate the save author button and the links to the individual pages are one liners and doesn't have the blogger background as what i have started blogging from the start..

Please please help to resolve the case as it is VERY irritating and annoyed by the problems everyday occurs and like there is no improvement to it..

Hope to see your reply soon.. Thanks..
disberg said…
Just found your Blog looking for information on Blogs Site Feed Urls.

Your site explicitly laid out what is was and also how to use it.

Just wanted to say thank you. I have bookmarked your blog and will give it a good read later on.

I have just started 2 Blogs, one on FreePress-Google and the other on Blogger dot com. Drop by if you have a moment.

Popular posts from this blog

What's The URL Of My Blog?

We see the plea for help, periodically I need the URL of my blog, so I can give it to my friends. Help! Who's buried in Grant's Tomb, after all? No Chuck, be polite. OK, OK. The title of this blog is "The Real Blogger Status", and the title of this post is "What's The URL Of My Blog?".

Where's The Dashboard?

We see this confusion, a couple times a week, in Blogger Help Forum: How Do I? . Where is the dashboard? In the Classic Blogger GUI, the display which contained the "Blog List" (at the top), and the "Reading List" (at the bottom) was labeled "Dashboard". Many people also called the "Settings" / "Template" screens for the various blogs, linked from the Blog List, the dashboard. The New Blogger GUI has no page with the label - and no links "To The Dashboard". The Navbar (another unlabeled feature) has two links - "Design" and "New Post" - which lead to different dashboard sections, when you are appropriately logged in to Blogger . And, the "B" logo at the far left of the navbar will, similarly, take you to the Blog List / Reading List.


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Bill Hentschell

Global Director of Intent Based Networking

Global Partner Organization

Bill Hentschell has been with Cisco over 20 years now. He has held various leadership roles, is involved Cisco’s M&A activity, and is a strategic advisor to several ISV partners. Leveraging his background in programming, operating systems, and networking he has been a frequent speaker at many industry events including RSA, Cisco’s Global Sales Experience, Cisco Live (Americas, LATAM, EMEAR, and APJC), Enterprise Connect, and a featured speaker for The Department of Homeland Security. Bill currently serves as the Global Director of Intent Based Networking for the Global Partner Organization at Cisco Systems, Inc. Mr. Hentschell is responsible for driving global GTM strategy for Intent Based Networking across all RTMs including distribution, resale, and managed services. He is focused on partners profitability and Cisco brand preference through enablement, programs, incentives, offers, launches, acquisitions, and thought leadership. Mr. Hentschell attained his MBA and piloted the first Cisco MBA cohort with University of Phoenix. Additionally, he has degree in Management and Leadership from the MIT Sloan School of Business and his B.S. in Criminology and Criminal Law from the University of Missouri. Currently he lives in St. Louis Missouri with two young children and spends his free time as an amateur photographer and beginner hockey player.

November 18, 2016

Okay, but what are you trying to do?

Going Digital, Digitization, The Digital Experience are all terms being thrown around these days and I am often asked “what does that really mean?”.  While the industry has done an amazing job of creating new buzz words, it is hard for the everyday technologist to link them to anything practical.  We can put together the […]


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There have been a plethora of articles written on how this pandemic has transformed the way people go about their daily lives. And if there is one thing which everyone agrees is that the role of the Service Provider’s telecommunications network has never been more critical than it has been since the turn of the decade. The need for connecting more devices to the network, the insatiable demand for bandwidth, and the criticality of network reliability have created more expectations and also newer revenue opportunities for Service Providers. This requires Service Provider to re-look at their current network and transform them to provide a reliable and consistent user experience. The access and aggregation network of the service providers are at the cusp of this transformation and are challenged by increased capacity, low latency, ultra-reliability requirements driven by the transition from 1G to 10/25/100G. At Cisco, we have been relentlessly working on transforming the economics of moving the bits to build and run the infrastructure, in a secure and simplified way.

NCS 540 portfolio helps the customer in their transformation journey, with a myriad range of products meeting different capacity and interface requirements all the way ranging from 1G to 100G. As of writing this content in 2021, Cisco has sold over 100,000 devices in a short period of time. To recap the benefits of the NCS540 product family which has seen product launches in each of the years 2018/2019/2020/2021 :

  • Hardened and ruggedized with transformed economics to move the bits
  • Large number of interface port options from 100Mbps to 100G
  • Stringent Timing and latency capabilities
  • Secure, Reliable, and Carrier-Grade Operating System (IOS-XR)
  • Application-aware network with Segment Routing
  • Simplified Automation capability with Telemetry/Netconf Yang.

We are now accelerating the success of NCS 540, by introducing 400G to the access network with NCS 540 Large Density Router

Currently, there is a paradigm shift happening, with the convergence of IP and optical layer, which helps reducing complexity, allows operators to maximize the current fiber capacity, and offer more CAPEX and OPEX savings. The new architecture allows us to put the onus back on the router which helps in simplifying the management of the network. The density and form factor of optics have greatly reduced over time and with the evolution of digital coherent solution, a 400G optics can now directly reside in a router with zero density trade-off. So why does 400G be an option only for Core Networks even though we are seeing the router capacity increasing multifold at the access layer? Why not extend the benefit of the technology innovation all the way to access networks? Our new NCS 540 Large Density router has been designed keeping these innovations in mind.

Cisco has recently published a detailed whitepaper on the Economic Benefits of using Converged 400G IP Transport. With the launch of the NCS 540 Large Density router, we are extending the capability to scale to 400G.

So, what is so unique about our Large Density Router? Built on merchant silicon ASIC, the large density router is now able to extend the 400G coherent technology all the way to the access network. The NCS 540 large density aligns with Cisco Routed Optical Networking Architecture, which relies on a single control plane based on IP/MPLS in a converged hop-to-hop IP and optical network. It is not just about 400G, the large density router also supports SFP56, which offers backward compatibility with SFP28/SFP+/SFP, using the same PAM4 technology used in 400G. All these technological innovations are offered in a 1RU temperature hardened form factor, and 299mm in depth, making it suitable for deployment as a cell-site router, pre-aggregation, or an aggregation router. The platform also offers tighter time and phase synchronization and high-accuracy clocking along with GNSS (Global Navigation Satellite System) capabilities needed for 5G networks.

Powered with Cisco IOS XR software, the NCS 540 Large Density router offers customers an end-to-end SDN-based solution that will enable a programmable network coupled with Cisco’s automation platform that utilizes real-time network telemetry for advanced traffic engineering and control. As operators are looking to upgrade their network for 5G and Broadband deployments, why not future proof it so that you can scale well beyond today’s capacity, performance requirement and offer lower TCO. NCS 540 Large Density router will help in this transition offering better simplification and operational efficiencies.

To know more about NCS 540 Large Density Routers, click here:
Cisco Network Convergence System 540 Series
Converged 5G xHaul Transport Whitepaper
5G Transport Technical Case Study
Sprint Strengthens Its IP Mobile Network for 5G with Cisco
Indosat Brings Converged SDN Transport Network to Indonesia


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Kidney Diet Tips

The health and safety of our patients and teammates is our top priority. We are keeping a close eye on this situation and reinforcing the extensive infection control practices already in place to protect them. Click here to find videos and additional resources.

Vitamin D in Chronic Kidney Disease

Vitamin D is a well-known vitamin that some of us may think of as the “sunshine” vitamin. In your health classes growing up, you were likely taught the role of vitamin D in maintaining healthy bones.

While vitamin D is vital to bone health, it also has a key relationship with the kidneys. In this article, we will take a look at how kidneys and vitamin D interact, the types of vitamin D and food and supplement sources for vitamin D.

Types of Vitamin D

While there are many forms of vitamin D, the two major types are:

Cholecalciferol, vitamin D3

Ergocalciferol, vitamin D2

Vitamins D3 and D2 can be retrieved from sunlight or food. They are both considered nutritional vitamin D and are inactive in the body. Once absorbed, the liver changes it to a different form called calcifediol. Calcifediol is further transformed to the active form, calcitriol, in the kidneys.

Calcitriol is the active form of vitamin D. At this point, vitamin D now acts as a hormone, or messenger, to complete important roles in the body. These important roles involve bone health, cell growth, immune function and reduction of inflammation.

Kidney Disease and Vitamin D

Research shows that the majority of individuals with chronic kidney disease (CKD) are deficient in inactive vitamin D (2).

Researchers have found an association between low inactive vitamin D levels and the occurrence of a condition called secondary hyperparathyroidism (SHPT) in people with CKD (2).

SHPT is common among CKD patients, especially as kidney disease progresses. It occurs when the parathyroid gland becomes enlarged and releases too much parathyroid hormone (PTH). High levels of PTH lead the body to pull out calcium from the bones.

Overtime, this causes bones to weaken and calcium deposits to build up in tissues and organs, including the heart. If the heart becomes calcified, blood flow is reduced which may lead to a heart attack. Therefore, preventing or treating SHPT is important. Vitamin D is a big component of both treatment and prevention.

In studying individuals with CKD, researchers found a positive relationship between inactive vitamin D levels and active vitamin D levels (2). Therefore, if an individual has a low level of inactive vitamin D, correcting it may improve active vitamin D levels. In turn, this can help prevent hyperparathyroidism or serve as a treatment if already diagnosed.

Food Sources of Vitamin D

Only a handful of foods are naturally good sources of vitamin D. Fortunately, some common foods are also fortified with vitamin D.

Fish liver oils and flesh of fatty fish like tuna, mackerel and salmon contain the best sources of vitamin D. Smaller amounts of vitamin D can be found in beef liver, cheese, egg yolk and some types of mushrooms.

In the United States, most milk is fortified with vitamin D. Some brands of ready-to-eat cereal, orange juice, margarine and yogurt are also fortified with vitamin D.

Vitamin D Supplements

Recommendations for vitamin D supplements should be made by a physician. Recommendations by a doctor are based on current vitamin D levels along with sun exposure, diet and stage of CKD.

Types of Nutritional Vitamin D Supplements:

  • Ergocalciferol (Vitamin D2)
  • Cholecalciferol (Vitamin D3)
  • Calcifediol

Vitamin D plays an important role in preventing and treating secondary hyperparathyroidism among CKD patients. If uncontrolled, weak bones and calcium build-up in tissues and organs is possible. If you are not on a vitamin D supplement, you may choose to discuss options with a doctor to get your vitamin D levels checked and see if supplementation would be appropriate.

For more information read our past post “Vitamin D Basics“.

Additional Kidney Diet Resources

Visit and explore these diet and nutrition resources:

DaVita Diet Helper online meal planner and tracker

DaVita Kidney-Friendly recipes

Today’s Kidney Diet cookbooks

Diet and Nutrition articles

Kidney Smart® Classes taught by kidney experts in your area

This article is for informational purposes only and is not a substitute for medical advice or treatment. Consult your physician and dietitian regarding your specific diagnosis, treatment, diet and health questions.

Samantha Carter MS, RD, LD

Samantha Carter MS, RD, LD

Samantha Carter, MS, RD, LD has been a registered dietitian since 2012 and a DaVita dietitian since 2017. She has previous experience in acute-care hospitals and long-term nursing facilities. Samantha finds her previous work has given her a passion for kidney disease and an understanding in complications associated with the disease. Besides nutrition, Samantha also has a passion for the outdoors, traveling to adventurous places, and playing sports (especially tennis and volleyball).


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Is Victoria’s Constitution Invalid? Rutledge v Victoria

By Dr John Waugh

So you don’t want to pay your council rates, or your parking fines? If you live in Victoria, a bit of searching on the internet will provide you with what looks like a great solution: you don’t need to pay, because the Victorian Constitution is invalid. Anything that local councils do under its authority is invalid too. These arguments recently came before the High Court, not for the first time, in Rutledge v Victoria [2013] HCATrans 294 (Hayne J).

Mr Rutledge claimed that he wasn’t bound to pay his rates to the Greater Bendigo City Council, because the creation of the Council wasn’t properly authorised. In effect, the argument was that the Victorian Parliament couldn’t validly establish the Council, because the power it relied on was given by the Constitution Act 1975 (Vic), and that Act was invalid.

Law and mystery
Mr Rutledge had earlier made the same claims in the Victorian Supreme Court, without success. Now he took his case against the State of Victoria and the Greater Bendigo City Council to the High Court. They applied for judgment against him, on the ground that his action was bound to fail.

It’s not hard to see the appeal of arguments like these, at least until you look at the details. Arguments about constitutional validity turn up routinely in the news, and occasionally the courts do indeed overturn Acts of Parliament or government decisions on constitutional grounds. To the ordinary ratepayer, it’s not immediately apparent what the difference is between, on the one hand, arguments that the High Court has accepted in such cases as South Australia v Totani [2010] HCA 39 (the Finks Motorcycle Club case) and Williams v Commonwealth [2012] HCA 23 (the school chaplains case) and, on the other, the arguments put forward in Rutledge and similar cases.

From the outside, constitutional law is often mysterious. The subtle and complex grounds on which challenges succeeded in Totani and Williams seem to hold out the promise that similarly arcane reasoning might succeed in other situations. True, the consequences of accepting the arguments for Mr Rutledge would be sweeping, entailing the invalidity of Victoria’s constitution, but it’s possible to find comparable examples by reaching further back into history. Continue reading

Fly-In Fly-Out Workers Entitled to Accommodation while on Strike: Construction Forestry Mining and Energy Union v Mammoet Australia Pty Ltd

By Adriana Orifici

CFMEU v Mammoet Australia Pty Ltd Case Page

The High Court’s final decision before the 2013 federal election concerned the highly political area of industrial relations law. The case, Construction Forestry Mining and Energy Union v Mammoet Australia Pty Ltd [2013] HCA 36, resulted in a win for the union and striking construction workers. While the then opposition leader was determined to not raise the prospect of industrial reforms during the election campaign, the new Coalition government has since sought to undo industrial initiatives of the past government. This might mean that the High Court’s decision is exposed to legislative reform, with mining lobbyists agitating for the government to bring legislation before parliament to overturn the decision.

In Mammoet the High Court unanimously decided that providing accommodation to striking employees is not a ‘payment’ that is prohibited by s 470(1) of the Fair Work Act 2009 (Cth) (Fair Work Act). This decision is significant because it confines the meaning of s 470(1), which prohibits an employer from making ‘a payment’ to an employee taking protected industrial action in relation to the ‘total duration’ of the action on that day. Moreover the effect of the decision is that if an employer fails to provide a striking employee with non-monetary benefits during a period of protected industrial action, this may constitute adverse action under the Fair Work Act or breach of the terms of a relevant industrial instrument. Continue reading

News: The High Court blurs the moment

Today’s High Court announcements on same-sex marriage, immigration detention and consumer law were doubtless disappointments for some. However, the one body that may be especially disappointed is the Court itself. The Canberra Times reports:

The court handed down its findings in the landmark case about 12.15pm, although a statement announcing the decision was accidentally published on the court’s website about 20 minutes earlier.

While French CJ’s announcement in Courtroom 2, reportedly greeted by silence and sobs, was anticipated by many legal observers, others knew exactly what the Chief Justice would announce. Continue reading

Australian Competition and Consumer Commission v TPG Internet Pty Ltd

Jeannie Marie Paterson and Veronica Wong, ‘Fine Print Disclaimers May Not Protect Advertising from being Misleading: Australian Competition and Consumer Commission v TPG Internet Pty Ltd‘ (6 January 2014).

Continue reading

Commonwealth v Australian Capital Territory (‘Same-Sex Marriage Case’)

Continue reading

News: The High Court sets a time and venue

You are cordially invited…:

Please be advised that the High Court will deliver the following judgments in the next week:

Thursday, 12 December 2013 at 12:15 pm in Court No.2 Parkes Place, Canberra

Plaintiff M76/2013 v Minister for Immigration Multicultural Affairs and Citizenship & Ors(M76/2013)

Australian Competition and Consumer Commission v TPG Internet Pty Ltd(M98/2013)

The Commonwealth of Australia v. The Australian Capital Territory(C13/2013)

The third case is the same-sex marriage case. This announcement (from the High Court’s Judgment Delivery Notification alert service) confirms the ‘hopes’ that French CJ expressed at the end of Tuesday’s hearings. Barring an unlikely retraction, the validity of the ACT’s marriage law will be known on December 12. Indeed, it will be known not too long after 12.15pm that day. The announcement also reveals two further details: the venue and who else is in the order of ceremonies. Continue reading

News: The High Court sets a date

Yesterday’s hearing in the same-sex marriage case concluded with the following words (at 4:40:15 on the video) from French CJ:

The Court will reserve its decision. The Court hopes to be in a position to announce a decision on 12 December.

The first sentence means that the Court will not decide the case right away. That is typical in final hearings, although there are exceptions (see here and here.) However, the second sentence is not at all typical. In most cases, no indication is given and the judgment comes when it comes.  For example, there was no indication at the May hearing that today’s decision on patents would be the Court’s slowest judgment this year. The Court makes exceptions, though, if knowledge of the timing of the judgment would make a significant difference to someone. For example, at the conclusion of the 2010 hearings on the validity of laws on electoral enrolments, French CJ announced that he hoped that the Court would be in a position to announce a decision the next day, presumably saving the Commonwealth Electoral Commission a lot of money in planning for the contingency of a judgment of invalidity after the rolls had closed.

It is easy to see why the High Court announced a (tentative (UPDATE: see second comment below)) date for judgment in Cth v ACT. As has been widely reported, the announcement immediately resolved whether or not this weekend’s planned weddings in the national capital can go ahead (subject to the distant possibility of a speedier Court decision or the less distant possibility of a Commonwealth application for an injunction.) However, the particular date the Court set is a genuine surprise Continue reading

Bank fees back in court again

The class action involving bank fees is back in court again. Last year, the class action against banks was uplifted to the High Court in Andrews v Australia and New Zealand Banking Group Limited [2012] HCA 3. It was remitted back down to the Federal Court for decision in light of the High Court’s decision last year and is presently being heard. The case involved the rule against penalties in contract. The essence of the rule is that parties may stipulate the amount payable for certain breaches of contract (known as ‘liquidated damages’), but if the amount payable is not a genuine pre-estimate of loss and is instead in terrorem of the other contracting party (i.e. designed to scare them into performance rather than compensate for loss) then the clause may be struck down by the law against penalties: see Ringrow Pty Ltd v BP Australia Pty Ltd [2005] HCA 71; (2005) 224 CLR 656, affirming Dunlop Pneumatic Tyre Co Ltd v New Garage and Motor Co Ltd [1915] AC 79.

There has been intense media interest in the case (see here and here) and indeed, I was contacted by a number of outlets when the case went back to the Federal Court (for example, here and here) . As noted on Monday, there is a great deal of money at stake for both the banks and the customers. The present class action involves a $57 million claim, but other planned class actions are estimated to be worth $243 million, and more may be in the pipeline, depending on the success of this claim. Continue reading

News: Same-sex marriage hearing ins and outs

Today was to be the first of two days of hearings of Commonwealth v ACT, the High Court’s first foray into the issue of same-sex marriage. The dispute has been the subject of a number of excellent media pieces explaining the legal issues, most recently a preview on The Conversation by Sydney Law School’s Professor Anne Twomey, including a link to a paper she presented last week on the key statutory provision in the dispute, s. 28 of the ACT (Self-Government) Act 1988. This blog’s case page provides links to coverage  of the case on Opinions on High, the transcripts of hearings to date, the Commonwealth’s writ of summons and the High Court’ s own archive of orders and written submissions. Following a recent innovation, the Court will post videos of the hearings on its webpage.

The breaking news today is that the Court has reportedly reserved its judgment after just a single day. While we wait for the transcript of the proceedings, the other news at this stage is about who is involved in the hearing and who isn’t: who is on the bench? who is at the bar? and who is absent? Continue reading

Beyond Male and Female: Time for a Non-Specific Sex Category

By Anna Chapman

Earlier this month the High Court indicated it was prepared to hear a legal case that tests the ability of intersex Australians to be legally recognised as being neither male or female.

The High Court hearing will be the final decision in a claim initiated in 2010 by NSW resident Norrie, who had applied to the NSW Registry of Births, Deaths and Marriages for a certificate to register a change of sex from male to ‘non-specific’.

The evidence before the hearing was that Norrie (who does not use a last name) did not identify as either male or female. Although at birth Norrie’s sex had been recorded as male, as an adult Norrie had undergone medical procedures, and now self-identified — and was identified in the community — as androgynous.

Statutory declarations from Norrie’s doctors supported the registration of a change in sex to ‘non-specific’. The NSW Registrar initially granted Norrie’s application, but this was later revoked.

Norrie appears to be the first person in Australia to litigate for the right to be identified as being of ‘non-specific’ sex. This ground-breaking litigation squarely challenges the capacity of law to countenance sex and gender diversity. Continue reading


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I found Ally on the side of the street she was starving and flea influenced and abused I got her back to health she was funny loving and caring I’m so glad she came into my life I only had har for a year it hurt me so very bad when she passed away I love and miss her so very much its been three years ago and I still cry a lot for her my baby girl R.I.P. ALLY MAY

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You can view status and manage services running on the BPF server by choosing System > Administration > Services from the menu.   One service that is vital for BPF is CUPS (the printing system).  Without it, no printing will be accomplished.  You can check the status of CUPS using either the CUPS Printer Page (described elsewhere in this document) or simply access the console and see if there is a ‘green light’ next to the CUPS service.


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Blue Sky Network Launches SkyRouter 2, Advanced Web Portal for Comprehensive Tracking of Air, Land and Marine Assets

Blue Sky Network Launches SkyRouter 2, Advanced Web Portal for Comprehensive Tracking of Air, Land and Marine Assets

La Jolla, Calif. — March 7, 2011 — Blue Sky Network, a leading, global provider of satellite tracking and communication solutions for land, sea, and aviation, today introduced SkyRouter 2. This web portal’s detailed global mapping solution and unrivaled user interface allow administrators to more easily view, track, and communicate with every aircraft, vehicle, ship, and person in their organization.

The new features build upon Blue Sky Network’s global web portal that supports remote monitoring of globally dispersed and critical assets. Users can track assets, communicate via simple text messaging, and receive and update trip plans. Key new features for SkyRouter 2 include:

Customized Compound Rules: Administrators can also create custom rules and alerts based on specific events or combinations of events, such as customizing notifications based on business specific data points. For example, managers can know when a vehicle is started after hours, when a vehicle is speeding, stopped, “out of bounds,” or driving erratically.

Same Page, Multiple Maps: All assets can be tracked on one map, or each geographic area can be viewed on separate maps. Both street and aerial (image) views are available for any area in the world. Users of Blue Sky Network’s HawkEye 5300 dual-mode tracking devices can also see which network—GSM or Iridium—provided position and event data, which allows a seamless view of network coverage for planning purposes.

Ease of Use: SkyRouter’s point-and-click interface makes tracking, creating reports, and every aspect of fleet management easy to execute, understand, and share.

The playback feature of SkyRouter 2 offers additional visibility and accountability. The playback system is unlimited and recording begins upon installation. It incorporates onboard diagnostic tools recording the routes and activities of all assets, which gives administrators the data required to better manage their transportation assets.

“With the launch of SkyRouter in 2003, Blue Sky Network pioneered using a web portal for asset tracking,” said Jon Gilbert, founder and CEO of Blue Sky Network. “This important upgrade is the result of extensive market research and feedback from Blue Sky Network’s thousands of users. With cutting-edge features such geo-fencing and street-level mapping, we are proud to offer SkyRouter2 to our customers. ”

Demos of SkyRouter 2 will be available at the 2011 HeliExpo March 5-8 in Orlando, Florida. For more information on Blue Sky Network and SkyRouter 2, please visit:

About Blue Sky Network
Blue Sky Network is a leading global provider of voice and data services via the Iridium satellite network. Our aviation, marine and vehicle products for GPS tracking, real time flight tracking and fleet management provide reliable fleet tracking and communication services. Blue Sky Network’s solutions serve the Aviation, Oil and Gas, Government, Forestry, Mining, Supply Chain Management and Intermodal Transportation markets. Founded in 2001, Blue Sky Network is headquartered in La Jolla, California with customers and distributors worldwide. For more information about our company and solutions, visit the Blue Sky Network website at

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Blue Sky Network Receives STC on the Versatile C1000A – Fixed-Installation Satellite Voice And Data Solution

Blue Sky Network Receives STC on the Versatile C1000A – Fixed-Installation Satellite Voice And Data Solution

The Sky Is No Longer the Limit

La Jolla, CA – September 16, 2003 – Blue Sky Network, a pioneer in satellite communications for the aviation industry, has received an STC for the C1000A; its newest Iridium based global satellite fixed-installation voice/data solution. The unit will be formally introduced at the HeliTech 2003 show in Duxford, U.K., on September 23. Blue Sky Network began shipping units this month.

The flexible new product, a fixed-installation Iridium satellite telephone system, uses an analog signal to provide crew and passengers access to voice and data connections from as many locations in the aircraft as desired, using a variety of communication hardware. In addition, the C1000A can be interfaced to many existing, but more expensive, airborne telephone systems allowing customers significantly lower communication costs. Blue Sky Network is an Iridium Service Partner and provides service plans that are very competitive, easy to understand, and strategic for corporate owners and operators.

The C1000A system includes a feature rich modem unit, which is typically installed remotely, most often in an avionics bay. In the cockpit, an interface to an optional standard telephone dialer in the audio panel would allow pilot and crew to make and receive calls through headsets, while continually monitoring air traffic control. In the cabin, standard RJ-11 connectors can be installed in as many locations as desired and/or analog handsets can be permanently installed. The C1000A can be configured to accommodate any one of several FAA certified cordless phones currently on the market.

With the additional installation of DB-9 connectors, crew and passengers can enjoy data dial-up connections for laptops from multiple locations in the aircraft, benefiting from Iridium Direct Internet data at up to 10 Kbps.

The modem unit can be coupled with Blue Sky Network’s fixed-installation cabin console unit, which features an included Motorola Digital handset, an RJ-11 connector for analog phones, and a DB-9 connector for data dial-up. Equipped with a SIM card reader for easily insertable cards, the cabin console unit allows crewmembers and passengers to use individualized SIM cards, for separate service plans and billing accounts.

C1000A units are sold in pre-packaged kits, complete with FAA TSO’d antennas tuned for Iridium, and all required installation hardware. Kits can be upgraded to include the Motorola Satellite Series 9505 portable phone and the unique Blue Sky Network FAA TSO’d dual-channel antenna, allowing for two simultaneous connections while in-flight, as well as global connectivity off the aircraft. C1000A kits are priced as low as $10,995.

About Blue Sky Network
Blue Sky Network is pioneering affordable, global satellite flight following and communications for the aviation industry, from full-featured asset tracking solutions to entry-level SATCOM voice solutions. Our aviation installation ready equipment kit prices begin at $1,695 for an entry-level SATCOM package, and range to $13,995 for a full-featured fixed and portable SATCOM solution. Kits for our D1000 asset tracking solution begin at $5,995, increasing to $11,995 for full-service fixed voice and data communications. Blue Sky Network provides global coverage through the Iridium Satellite System, including monthly per minute voice and data plans, pre-paid calling cards, individual monthly SkyRouter packet data plans, and fleet plans for SkyRouter packet data. The company is dedicated to unsurpassed customer service, including technical support 24-hours-per-day. Blue Sky Network is a member of aviation associations HAI, NBAA, AOPA, EAA, and AEA, and is headquartered in La Jolla, California. For more information, please visit

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Blue Whale Poke Bar & Grill puts a new spin on the ol’ poke place.  We are a couple of local guys serving up what we cook in our homes.  We are bringing our tables to yours with dishes to excite everyone in the family.  We draw influences from home cooking in the Philippines, Korea, Hong Kong, and China – all places where Blue Whales travel.  We like to think of our Blue Whale, Bailey, traveling all over the world and bringing back cuisine to share.  Our dishes are sustainably sourced and freshly prepared just for you.

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What do multiple sclerosis patients and their caregivers perceive as unmet needs?

Multiple sclerosis (MS) has a major impact on the physical, psychological and social life of patients and their families. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients.

We evaluated what MS patients and caregivers perceive as unmet needs and compared patients’ opinions with caregivers’ opinions using a multidimensional questionnaire. The questionnaire was specifically designed for the study, taking into account different aspects of the global care perceived by patients and care givers, such as information about MS, medical treatment and rehabilitation, patients’ relationships with medical staff and their psychological and social life.

We administered the questionnaire to 497 patients and 206 caregivers. Results showed that the majority of participants were satisfied with medical staff but expressed a desire that staff be more forthcoming with information about MS. As for medical treatment concerns, more patients found there to be useful a multidisciplinary approach than caregivers did. Both required psychological support for patients but patients felt a greater need for it at the time of diagnosis, whereas caregivers felt it was required post-diagnosis. Both reported significant strains on patient relationships at work but no effect on other social interactions.

A better understanding of MS patient needs, starting from the point of view of patients and caregivers, could have a great impact on quality of life and on management of the disease.

Peer Review reports

MS is a chronic, non-traumatic neurological disease afflicting more than 2.1 million people worldwide [1]; in most cases, MS affects young people of productive age and significantly affects the rest of their lives [2]. MS symptoms may include impaired mobility with limb weakness, poor coordination, sensory problems, vision and hearing loss, cognitive impairment and sphincteric dysfunction. Additional symptoms arise from neuropsychiatric complications [3] with substantial consequences on psychosocial, emotional and working domains [4]. Patients and medical professionals often disagree on issues surrounding health and disease [5]; the concept of “unmet need” is still ambiguous [6]. Several Quality of Life (QoL) studies for MS have shown that patients underscore the emotional problems and burden put on their mental health more than clinicians do [4]. People now acknowledge that psychological, social and psychiatric issues play a major role in health-related QoL [7]. A questionnaire aimed at evaluating caregivers’ QoL has also been proposed recently [8]. Family and caregivers are deeply involved in helping patients cope with the physical and psychosocial effects of the disease. There are some studies that have evaluated the unmet needs of disabled subjects and caregivers, but no tool exists for comparing both patients and caregivers point of view in relation to the same issues, so existing questionnaires were not suitable for the aim of our study. Understanding the needs of patients and what their caregivers perceive to be the unmet needs of patients will increase patient-caregiver satisfaction on a global scale and improve the quality of care [9]. The aim of this study was to evaluate the different perceptions of patients and caregivers about management of MS, particularly about the same items, to gather information to ameliorate the care of patients. Our intention was not to evaluate the impact of the disease on patients’ and caregivers’ QoL by using common instruments, because this could condition our analysis, influencing the answer to the questionnaire subject of the study.

The study group comprised consecutive participants who attended the MS Centre of the University of Cagliari between October 2010 and July 2011; patients attended the Centre for scheduled visits, to undergo to infusion therapy and to access the rehabilitation service.

Also included in the study are the caregivers. The rationale for including these subjects was to obtain a highly representative sample of MS patients and caregivers regularly attending the clinic. Caregivers were defined as those individuals, connected in various ways to the patients (partners, parents, brothers/sisters, sons, other relatives, professional caregivers and friends), who were dedicated to providing an appropriate and global support of MS patients (physical and psychological).

The exclusion criteria were a refusal to participate, the presence of severe cognitive impairment, [10] vision/hearing disability. The rationale for excluding patients with severe cognitive and/or vision/hearing impairment was that a disability of this nature could influence perceptions of need in a major way. Severe cognitive impairment was evaluated using Rao’s Battery. Only 14 patients were excluded from participation on this basis.

All patients had sufficient vision, hearing and cognitive functioning to complete the survey. The patients with severe motor disability completed the questionnaire with the assistance of a relative (not included in the study). Members of the medical staff approached patients and took informed consent. Patients had needed time to consider to take part to the study. The questionnaire was self-administered, voluntary and filed. We preferred to use an anonymous questionnaire because it included a section regarding satisfaction about medical staff.

All participants completed the questionnaire at the time of inclusion in the study. Patients and caregivers were allowed as much time as needed to complete the questionnaire in a quiet, private and comfortable setting inside the MS clinic.

Questionnaire design

A multidisciplinary team composed of neurologists, psychiatrists and public health experts developed the questionnaire specifically for the study. In designing the questionnaire, we took into account the opinions of those persons most involved in MS management in our clinic, including therapists, psychologists and nurses. The questionnaire was designed to take into account different aspects of the global care perceived by patients and caregivers.

The questionnaire for patients focused on their level of satisfaction regarding the explanations of current, alternative and future therapies provided by neurologists at the time of diagnosis and afterwards. The second part of the questionnaire focused on patients’ relationships with the neurologists and medical staff, paying particular attention to the requirements of other specialists; this is a very important item because it represents an indirect expression of unmet needs that may be modifiable [11].

The final section asked patients and caregivers to discuss how the disease had affected patients’ personal relationships (with family, friends, partner and colleagues), as well as their psychological state at the time of diagnosis and afterwards.

The items on the questionnaire for patients and caregivers were the same and both focused entirely on the patients’ needs. This was because we wanted to explore the degree of concordance between them.

All items on the questionnaire were multiple-choice questions

Unmet needs were deduced indirectly, as clearly apparent in the questionnaire. We did not use the expression ‘unmet needs’ in the questionnaire because we suspected that the use of explicit questions could influence the results.

As a preliminary, the two questionnaires were administered to 10 patients and 10 caregivers. Items considered ambiguous, misunderstood or rarely answered were deleted or reworded, while other missing items were added. The preliminary questionnaires were excluded from the analysis.

Data analysis

Collected data were summarized through descriptive analysis expressing results as percentages and 95% confidence intervals. Differences in perception between patients and caregivers were analyzed with a chi-squared test.

Each participant gave their informed consent for the use of anonymous data for the study. The study was approved by the ethics committee of the University of Cagliari. Data were not nominal at the source and each participant was identified by a code number.

The questionnaire was administered at the MS Centre of the University of Cagliari, between October 2010 and July 2011, to 497 MS patients and 206 caregivers. Approximately 200 patients and 100 caregivers did not participate in the study; the principal reason was refusal to participate because of personal organizational problems. Demographic and clinical characteristics were not significantly different between those patients who participated and those who did not. We cannot rule out the possibility that participants attending the clinic may have different needs from those who do not attend, but the aim of the study was to explore different aspects of the global care perceived by patients and caregivers attending the clinic, with the final objective being to support their needs.

The clinical and demographic characteristics of the patient population are summarized in Table 1.

Table 1 Patient demographics

The group of caregivers (206) consists of 35% (72) partners, 28% (58) parents, 17% (35) brothers/sisters, 10% (21) sons, 5% (10) other relatives, 3% (6) professional caregivers and 2% (4) friends; 62% (127) were female and 38% (79) male. There was no difference in caregiver presence on the basis of neurological disability of patients.

Questionnaire results

Diagnosis and conduct of medical staff

Approximately 90% of patients were diagnosed at our Center. We noted that the level of satisfaction regarding diagnosis was high and nearly the same for patients and caregivers. The majority of patients (67%) and caregivers (68%) were completely satisfied. A quarter considered this moment to be lacking in some respects (patients 24%, caregivers 23%) and a minority (patients 9%, caregivers 9%) found it unsatisfactory. As for medical staff conduct, both patients and caregivers considered it kind (patients 64%, caregivers 58%) and attentive (patients 30%, caregivers 34%) (Table 2).

Table 2 Satisfaction with diagnosis and medical staff conduct

Source of information

Despite overall satisfaction with how they were diagnosed, the majority of patients (76%) and caregivers (78%) sought more information about the disease, mainly by consulting the Internet (patients 54%, caregivers 53%), media (patients 17%, caregivers 17%) or their personal neurologist (patients 23%, caregivers 25%).

Both patients and caregivers judged the information provided by the doctor about available therapies for MS (patients 79%, caregivers 60%) and therapeutic choices (patients 83%, caregivers 69%) to be exhaustive; a significantly higher degree of patients (p = 0.001) found this to be the case. Patients (53%) and caregivers (52%) were equally satisfied with the information provided by the neurologist about future therapy options (Table 3).

Table 3 Sources of information and satisfaction with current, future and changes to MS treatment

Participation in the choice of medical and rehabilitation treatment

More than half of patients and caregivers expressed trust in the therapy (patients 66%, caregivers 55%). It is interesting to note that the majority of caregivers (80%) believed patients were fully involved in therapeutic choices, which was not the case for patients. In fact, about half of the patients (44%) (p = 0.001) believed they were not completely invited to participate in choosing a therapy (Table 4).

Table 4 Confidence in future therapies and patients participation in choice of treatment

Multidisciplinary approach to MS

The second part of the questionnaire focused on consulting other specialists (particularly physiatrists, psychiatrists and urologists). Patients (30%) reported a desire for a multidisciplinary approach (seeing more than one MS specialist), a significantly higher percentage than for caregivers (0) (p = 0.001) (Table 5).

Table 5 Need to consult other MS specialists l

Social impact of the disease

The last section of the questionnaire, which focused on the disease’s impact (modification over time) on patients’ personal relationships and social interactions, was designed in four parts and based on the different kinds of relationship: with relatives, friends, partners and work colleagues. Patients and caregivers did not significantly differ in their opinions of relationships with friends (patients 74%, caregivers 62%) and family (patients 64%; caregivers 57%), which they generally report to be unchanged. They did have a different perception of the effect on relationships with partners, however; the majority of patients considered it to be unchanged (59%), compared with 42% of caregivers (p = 0.001). However, patients (50%) reported a negative effect on their relationships with work colleagues more frequently than caregivers did (43%) (p = 0.001) (Table 6).

Table 6 MS impact (modification over time) on personal relationships

Psychological support

The questionnaire distinguished the need for psychological support at diagnosis and later, over the course of the disease. At diagnosis, both patients (70%) and caregivers (85%) affirmed in equal measure the patients’ need for psychological support, especially from family (patients 21%, caregivers 22%). After diagnosis, however, patients (65%) and caregivers (45%) disagreed about the need for psychological support. Patients (19%) considered familial support less necessary than caregivers (49%) did (p = 0.001) (Table 7).

Table 7 Need for psychological support at time of diagnosis and post diagnosis

MS and its treatment significantly affect all aspects of life for individuals at every stage of the disease, regardless of the level of disability, as well as the lives of caregivers. As is widely known, the support of caregivers is very important for MS patients to lead a normal life [12]. Both patients’ and caregivers’ opinions are relevant to understanding which of the patients’ needs are not being met and what can be done to enhance the quality of care. An open dialogue between physician, patients and caregivers can establish a relationship to improve patients’ wellbeing indirectly. Recent findings suggest that some factors, such as acquiring information on MS and communicating with medical staff, can compensate for the worsening of QOL [11]. Acquiring information on MS is useful for psychological adjustment in MS patients since awareness and coping may be associated with this improvement [13].

The increased availability of sources of disease information arise the important issue of quality–not quantity–of information on the disease for MS patients. Nowadays patients may have easily access to unfiltered information on the internet regarding MS, not always being able to interpret them. Therefore the consequences of searching for health information can be both positive and negative [14].

However, a clear discussion with their own neurologists may be more effective in order to obtain a deeper knowledge [15].

The present study is the first step toward a larger project to assess the perspectives of both patients and caregivers. For this purpose, we first ideated a questionnaire that gathers evidence of how patients and caregivers regard the amount of information they receive about MS, the viability of a multidisciplinary approach, their relationships with medical staff, the impact of the disease on patients’ social life and the patients’ need for psychological support. The items on the questionnaires for patients and caregivers were the same and focused entirely on patients’ needs, so that the questionnaires could be useful for us to explore the concordance between them.

Very few research studies about MS patients take into account both patients’ and caregivers’ points of view. Koopman et al. [16] conducted an analogous study with a quantitative questionnaire administered to 353 MS patients and 240 significant others. Despite different styles, questions, items and participating demographics, our questionnaires yielded similar results. This study identified the 10 most important needs for both groups, but there was also a high demand for information regarding MS and psychosocial support (i.e. good relationships with physicians, MS healthcare team, family and friends). Our questionnaire was ideated to reflect the points of view of patients and caregivers about unmet needs related to the disease; no studies are available that evaluate and compare opinions of both. Although it is not a validated tool, it could be useful to obtain patients’ and caregivers’ opinions about the level of satisfaction of our MS management and to explore unmet needs in a clinical practice setting. The questionnaire, which includes a section regarding satisfaction with medical staff, was ideated to be anonymous so as not to affect the answers of participants completing it in the same clinic where the medical staff worked. Results showed a particularly high level of satisfaction on the part of both patients and caregivers regarding neurologists and their way of providing information about diagnoses and treatments. Given that approximately 90% of the patients interviewed were diagnosed at our Center, and because our facility is dedicated exclusively to the diagnosis and care of this disease, it is crucial to understand where we excel (in terms of patient satisfaction) and areas in which we could improve (responding to their expressed dissatisfaction).

In order to achieve a good therapeutic relationship is essential to build a good relationship between the physician and the patient and to listen carefully to patients' descriptions [15]. This explains why we chose to include queries about the staff's aptitude and how they behaved towards patients.

Both patients and caregivers considered our medical staff to be attentive and kind. Both patients and caregivers deemed exhaustive the information provided at the time of diagnosis and afterwards by the neurologists to patients about available therapies for MS and the therapeutic choices. However, it was interesting to note that caregivers believed patients were more involved in choosing their therapy than patients did. In fact, about half of the patients complained about not being completely invited to participate in such decisions. Patients’ desire to play a more active role in their therapy is probably due to their greater emotional involvement.

Despite the fact that patients and caregivers considered the information given by neurologists to be exhaustive, both sought further information, primarily consulting media and Internet sources. This datum, analogous to those found in several other studies, seems to be ‘universal’ [1720] and points to the gap between MS patients’ perceived need for information and the information they are actually given by key professionals. Moreover, similar findings have been detected in studies on other severe chronic diseases, demonstrating how much patients desire to find understandable information [21]. The unpredictable, variable nature of MS and the possibility of increasing disabilities mean that from the time of diagnosis onward, patients may suffer severe psychological problems.

MS may cause several problems, both visible and invisible. Patients with MS can display multiple objective symptoms related to different systems or less visible problems related to the autonomic nervous system, cognition, mood, pain and fatigue [16]. Symptoms vary between MS patients, and caregivers may only be able to observe them partially. Optimal management of MS symptoms requires a comprehensive multimodal and case-by-case approach [17]. MS patients preferred to see several specialists to treat the disease (in particular physiatrists, psychiatrists and urologists), while caregivers seemed to consider such an approach less important because of their partial understanding of the various aspects of the disease and their focus on contingent problems.

Patients and caregivers agreed upon the need for psychological support, especially from the patients’ families, but patients stressed the importance of such support at the time of diagnosis, whereas caregivers found it was useful at a later stage in the therapy. This finding underscores the sensibility of caregivers regarding the changes in patients’ relationships over the course of the disease. Caregivers’ opinions about the quality of patients’ personal relationships has been found to have an impact on clinical outcome, suggesting that caregivers should be involved in more aspects of patient care [22]. Our study did not take into account the need for psychological support on the part of caregivers, although such a study could be very interesting. Considering treatment for caregivers may be useful to improve overall satisfaction for all parties [23].

Given the complex physical, psychological and personal impact of MS on patients’ and caregivers’ lives, it is very useful to identify what patients and caregivers perceive to be unmet needs and to compare their opinions. This kind of approach could give us important feedback concerning the quality of care provided and allow us gather information to improve the management of MS.

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Correspondence to Lorena Lorefice.

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LL, MGM and EC participated in the design and coordination of the study and the acquisition and analysis of the data, and drafted the manuscript. GF and GC participated in the acquisition and analysis of the data and drafted the manuscript. CS and GM participated in the analysis of the data and drafted the manuscript. JF, GC and MM drafted the manuscript. All authors read and approved the final manuscript.

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Lorefice, L., Mura, G., Coni, G. et al. What do multiple sclerosis patients and their caregivers perceive as unmet needs?. BMC Neurol 13, 177 (2013).

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  • Multiple Sclerosis
  • Multiple Sclerosis Patient
  • Medical Staff
  • Psychological Support
  • Therapeutic Choice


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