Business Needs Fractal Indicators- Why and How?
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The human body is fractal and so are the emotions. The presentation suggests the use of fractal indicators to deal with complex system and to keep the consistency of fractal systems.
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Twelve tips to get your IR and PR teams working together.
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Burton Lee - European SpaceTech Startups Ecosystem - Intro w Thank You's - Ma...
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Recognizing contributions from Burak Cetin (Course Support Assistant), Barbara Pivnicka, Richard Pivnicka, Gerald Brantner, Andrus Viirg (Enterprise Estonia). Recognition of contributions of members of Burton Lee family: Alma Lehtinen Lerum (Godmother), Frank Freeman Lee (Father), Louise Freeman Lee (Grandmother), Burton James Lee Sr (Grandfather).
Website: http://www.StanfordEuropreneurs.org
YouTube Channel: https://www.youtube.com/user/StanfordEuropreneurs
Twitter: @Europreneurs
HACK IT! Urgent versus Important...
The classic Eisenhower matrix for deciding what's urgent and what's important and how it can help you be more productive.
Elements of the Smart Office
Over the last few years, the term โsmartโ has been used more and more frequently to describe the technology that has become integrated in our daily lives. Now, smartphones and smartwatches are practically ubiquitous, smart cars are starting to hit the pavement and smart homes are becoming the norm.
The โsmartโ trend is becoming equally as present in our workplaces as well. Smart technology is making the transition from our personal lives to our workplace, and in doing so, this technology is reshaping the modern office.
It is not only changing the way we meet, present and collaborate, it is changing the physical environment in which we work as well.
And because of this rapid infiltration of smart technology, it is important to be up to date on this rapidly evolving technologyโ a seemingly daunting task. But donโt fear! PGi is here to present you with the elements that are beginning to integrate together to build one incredibly smart office of the future.
The Global Landscape of Digital Finance Innovations
More than half of the worldโs adult population, nearly 2.5 billion people, remain unbanked. Technology โ particularly the mobile phone โ has been used in recent years to extend financial services past the limits of bank branches and reach new consumers in traditionally underserved segments. Initial efforts focused on payments but have now grown to include savings, insurance and credit products delivered by digital channels, known as โproducts beyond payments.โ Despite a dramatic expansion in the number of digital financial service deployments, the offering of these financial services are not new services. Rather, they are existing services migrated to a lower-cost digital channel, therefore offering greater scale potential. And even then, use of these channels currently remain low.
This research seeks to accomplish four objectives:
Catalog the ways in which technology, especially mobile, can enhance access or use of financial services
Provide a comprehensive landscape of the latest innovations in digital finance
Consider the current and potential impact of these innovations on financial inclusion
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1. How well did digital P2G payment solutions reach and address the needs of the financially excluded?
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ALARM FATIGUE in Nursing UniversityInformatics.docx
ALARM FATIGUE in Nursing
University
Informatics
Why is this important to me?
I am completely numb to most alarms after working in acute care medical surgical. It is scary! I would like to understand more about what can be done since technology will only increase.
What is Alarm Fatigue?
Defined as a Desensitized response to medical alert equipment and technologies due to the frequency
Sensory Overload
Too many phones, pagers and overhead announcements
Missed critical events
Patient safety concerns
Over stimulated staff
Outline
Define Alarm Fatigue
How Alarm Fatigue effects Healthcare
Share the Evidenced Based Data
Explore the Adverse Events
Discover a solution
What are the challenges and benefits
Can a solution be implemented?
Potential References
Citing reports of alarm-related deaths, the Joint Commission issues a sentinel event alert for hospitals to improve medical device alarm safety.
ECRI Institute. Strategies to improve monitor alarm safety.
Alarm fatigue sets off bells. Modern Healthcare
Alarm fatigue a top patient safety hazard.ย Canadian Medical Association Journal
Over-monitoring and alarm fatigue: For whom do the bells toll? Heart and Lung.
There are so many good sources!!!
5
Why are these Relevant?
These sources are directly relevant to why alarm fatigue is a problem that is only getting worse.
How and why it effects healthcare.
Joint Commission reporting of such incidents that have been directly related to alarm fatigue.
How to change the course of alarm fatigue.
Evidence based reporting and studies for reference support.
What is Alarm Fatigue?
Alarm Fatigue is care givers desensitized do to overwhelming amounts of alarms.
The many โbeeps, chimes and bellsโ are the reason for delayed care and even death.
A 12 day study at John Hopkins determined over 350 alarms per bed.
Over 80% are false alarms.
No standardization of alarm technology
The more false alarms the less likely someone responds.
(Jones, 2014)
Where do We begin?
Review the Joint Commission Reports
Speak to Safety Experts in Other Fields
Create a Culture of Safety
Leadership Buy In
Staff Buy In
Redefine the Framework
Trust, Report and Improve- Concepts
Have accountability for safety protocols
(Chassin & Loeb, 2013)
Joint Commission Reports
-566 Alarm Related Deaths Between 1/2005-6/2010
-Most Often Reported in ER
-85-95% Alarms are false
-The Many False alarms desensitize Staff
(Ed Manag., 2013)
Summary
The amounts of research and data available for alarm fatigue is overwhelming. The data supports a overhaul of the technology systems to become integrated with All of the vital sign alarms. Also to have standards in place for baseline alarm settings. Alarms should also be in reference to baseline health status of patient to prevent false alarms. I still have a lot of work to complete and will be ready to present next week!
Annotated Bibliography
Citing reports of alarm related deaths, the.
Basic AccountingPart A Answer each of the following questions.docx
Basic Accounting
Part A: Answer each of the following questions in one or two paragraphs. Each answer is 20 worth 20 points.
Explain what a balance sheet is, and how itโs different from the income statement, the statement of the changes I ownerโs equity, and the statement of cash flows.
What is a return on equity? How is it calculated? And why is it significant?
List four examples of timing differences, and explain why theyโre significant.
Part: B Answer each of the following questions in one to four sentences. Each answer is worth 4 points.
Determine which classification of accounting is most concerned with the use of economic and financial information to plan and control many of the activities of the entity.
How the return on investment measure of performance calculated?
Is financial accounting historical scorekeeping or is it future oriented?
What does the bookkeeping/accounting process begin with?
Explain the significance of the allowance for Bad debts account.
In Financial accounting, what is one application of the matching concept?
Explain what a callable bond is?
What is the slate voting?
Who are the ultimate owners of a corporation?
What is the term used to describe the revenues of the firms that sell purchased or manufactured products?
Anatomy and Physiology I
Part A: Answer each of the following question in short paragraph. Each answer is worth 20 points.
An 80- year old woman is having trouble walking without falling down. Explain how disorders of many organs may contribute to her problem.
At a routine heath screening, a 54 year old man is found to have an elevated blood glucose kevel.
The test is repeated several times on separate occasions but yields the same results. If his condition isnโt treated adequately, what complication might develop and in which organ systems? What type if counseling does this man need?
Describe in detail the pathway for a signal traveling from one neuron to another. Start from the dendrites of one neuron to the dendrites of an adjacent neuron. What aspect of the neuron helps speed up signal transmission?
Part: B Answer each of the following questions in one to three sentences. Each answer is worth 4 points.
After you donate blood, what cellular process is responsible for regenerating a fresh supply of blood cells in your body? Where does this process occur?
Which specialized cells in the eye are responsible for sensing dim light, bright light, and color vision?
A 60- year old woman reports pain her knees that started during a rigorous hiking trip. She had no pain before the hiking trip. Her knees and distal thigh are swollen and tender. She can no longer walk on that leg. Which conditions of the muscular and skeletal systems might this woman have?
Identify the portions of the integumentary system that do and donโt have nerves.
A 25 โyear old man spends much of his time outdoors without using any type of protection from the sun. Which two conditions should this man be concerned a.
Qest4 energetic testing language and practice
This presentation describes the approach to health and the understanding of communication that applies to all forms of energetic testing.
Directions Please provide detailed and elaborate responses to the.docx
Directions: Please provide detailed and elaborate responses to the following questions. Your responses should include examples from the reading assignments, if possible. For each question, your response must be at least 100 words in length and utilize APA guidelines.
1. What is a prefix? What is an example of a prefix? Give at least three examples of different medical terms that share that same prefix. Give an example of medical terms that share the same root but have different prefixes.
2. What is an ectopic pregnancy? Where does implantation of the fertilized egg usually occur? Where does the remainder of ectopic pregnancies occur? What are the treatment options for ectopic pregnancies?
3. Describe the training process that physicians experience. Why is it important for physicians to undergo such a rigorous training process before they are allowed to practice medicine? Explain your reasoning.
4. Explain residency training and indicate the significance of it. List 3 examples of residency training and specify the differences among the selected examples.
5. Select 3 medical specialists and identify their respective specialties. Conduct a word analysis of each medical specialist term by dividing the medical specialist term into word parts and specifying the meaning of each. For example, cardiologist can be broken down into cardi/o (heart) and โist (specialist).
6. Choose one of the case reports on pages 176-187 in your textbook. Indicate the medical specialty and any term that is related to that specific medical specialty. Then, specify the meanings of all related terms by breaking the terms into word parts.
7. Write your own case report using the medical terminology you have just learned in this module. Begin by selecting a medical specialist and identifying the specialty. Then use the appropriate word parts to form terminology that describes a medical situation of your choosing.
8. Describe the educational process that is necessary to become a doctor. How does a doctor become a specialist?
9. Describe the cardiovascular system. Begin by first identifying significant anatomical parts and explaining what role each organ plays in the overall system. Then, name important pathology that afflicts those particular anatomical parts just named. Also, choose which laboratory tests and diagnostic procedures would be used in compliance with that specific pathology.
10. Explain the workings of the digestive system. First, begin by identifying important anatomical parts and indicating what each organ is responsible for in the entire system. Next, specify any diseases or pathology that afflicts those specific anatomical parts just named. Then, select the laboratory tests and diagnostic procedures that would be used in compliance with that particular disease or pathology.
11. Examine the endocrine system. Start by identifying endocrine glands and explaining where each gland is located in the body system. Then, indicate any disease.
What These 5 Systems Of The Body Can Tell Us About Organizations
Trying to understand how organizations work is a topic of many books and articles. As these authors point out, each organization has distinct strengths, limitations, and unique processes for providing products, technology, and services. An organization may be defined as two or more people focused toward common goals. Yet as organizations become larger, the focus toward the common organizational goals becomes more departmentalized and less organizationally focused. To lose sight of the organizational goals in favor of day-to-day performance and money is a predicament for leaders. The lack of common direction causes organizations to lose time, money and customers.
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Weโre entering a new era of digital government that could transform how citizens feel about their state. Hereโs what research needs to do, to make it happen.
New insights on human behavor
This compilation of few of my buzzes is to me is like drops of water collected together. A buzz is a drop of water and collecting drops of water together may generate new insights. A separate drop of water has no other water to adhere to or cause the formation of a surface tension. If a drop of water is frozen it doesn't produce ice flakes; drops of water do. I want to say that you may enjoy the flakes as this is my driving desire to compile several buzzes into an eBook.
An individual buzz is like a tree and the collection of buzzes in an eBook is the forest. A single tree may not form a canopy; in contrast, many trees may form one. I hope that you see the canopy and enjoy the comfort it offers you.
Scattered roses may produce tiny fragrance. A bundle of roses may produce far greater stronger fragrance. I hope you enjoy the fragrance and to stay away from the thorns.
Digital Finance Plus Readiness in Tanzania: Summary
CGAP and McKinsey assessed Tanzania's readiness for digital finance applications in five sectors.
8am - 8pm your timetable for remote working
With remote working becoming increasingly commonplace, this slide presentation shows how todayโs remote and flexible employee can add value every hour.
Remote working, flexible working, working-from-home and out-of-office. All common demands from todayโs workers - and not just Millennials. But when working takes place outside the four walls of your office, how can todayโs organisation aim for sky-high productivity?
The answer can be found in two words: working day. Dawn to dusk doesnโt specify a location. And todayโs collaborative work methods can keep people happy and productive, wherever they work from. Find out what productivity means today, then check out this hour-by-hour planning guide to remote working nirvana.
Burton Lee - European SpaceTech Startups Ecosystem - Intro w Thank You's - Ma...
Introduction by Burton Lee, Lecturer, European Entrepreneurship & Innovation, Stanford Engineering, at Stanford on March 7 2016, in our final session: 'From Comets to Startups :: Building Europe's SpaceTech Entrepreneurship Ecosystem'.
Recognizing contributions from Burak Cetin (Course Support Assistant), Barbara Pivnicka, Richard Pivnicka, Gerald Brantner, Andrus Viirg (Enterprise Estonia). Recognition of contributions of members of Burton Lee family: Alma Lehtinen Lerum (Godmother), Frank Freeman Lee (Father), Louise Freeman Lee (Grandmother), Burton James Lee Sr (Grandfather).
Website: http://www.StanfordEuropreneurs.org
YouTube Channel: https://www.youtube.com/user/StanfordEuropreneurs
Twitter: @Europreneurs
HACK IT! Urgent versus Important...
The classic Eisenhower matrix for deciding what's urgent and what's important and how it can help you be more productive.
Elements of the Smart Office
Over the last few years, the term โsmartโ has been used more and more frequently to describe the technology that has become integrated in our daily lives. Now, smartphones and smartwatches are practically ubiquitous, smart cars are starting to hit the pavement and smart homes are becoming the norm.
The โsmartโ trend is becoming equally as present in our workplaces as well. Smart technology is making the transition from our personal lives to our workplace, and in doing so, this technology is reshaping the modern office.
It is not only changing the way we meet, present and collaborate, it is changing the physical environment in which we work as well.
And because of this rapid infiltration of smart technology, it is important to be up to date on this rapidly evolving technologyโ a seemingly daunting task. But donโt fear! PGi is here to present you with the elements that are beginning to integrate together to build one incredibly smart office of the future.
The Global Landscape of Digital Finance Innovations
More than half of the worldโs adult population, nearly 2.5 billion people, remain unbanked. Technology โ particularly the mobile phone โ has been used in recent years to extend financial services past the limits of bank branches and reach new consumers in traditionally underserved segments. Initial efforts focused on payments but have now grown to include savings, insurance and credit products delivered by digital channels, known as โproducts beyond payments.โ Despite a dramatic expansion in the number of digital financial service deployments, the offering of these financial services are not new services. Rather, they are existing services migrated to a lower-cost digital channel, therefore offering greater scale potential. And even then, use of these channels currently remain low.
This research seeks to accomplish four objectives:
Catalog the ways in which technology, especially mobile, can enhance access or use of financial services
Provide a comprehensive landscape of the latest innovations in digital finance
Consider the current and potential impact of these innovations on financial inclusion
Identify enabling conditions and investments needed to unlock the potential of the sector
Global Landscape Study on P2G Payments: Summary of in-country consumer resear...
For this study on P2G (Person-to-government) payments, Rwanda was selected as a focus country given the potential reach and varied nature of two key initiatives: the IREMBO e-government platform and the Tap&Go smartcard for public bus transport. Digital payments for school fees and utility payments were also studied. Tap&Go is privately managed but offers P2G learnings for other countries where public transport is government-run.
The research sought to answer questions across three key areas:
1. How well did digital P2G payment solutions reach and address the needs of the financially excluded?
2. What were effective and sustainable business models between actors, and how were they set up?
3. How do current and planned solutions support and work with the evolving digital payments ecosystem in Rwanda?
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ALARM FATIGUE in Nursing UniversityInformatics.docx
ALARM FATIGUE in Nursing
University
Informatics
Why is this important to me?
I am completely numb to most alarms after working in acute care medical surgical. It is scary! I would like to understand more about what can be done since technology will only increase.
What is Alarm Fatigue?
Defined as a Desensitized response to medical alert equipment and technologies due to the frequency
Sensory Overload
Too many phones, pagers and overhead announcements
Missed critical events
Patient safety concerns
Over stimulated staff
Outline
Define Alarm Fatigue
How Alarm Fatigue effects Healthcare
Share the Evidenced Based Data
Explore the Adverse Events
Discover a solution
What are the challenges and benefits
Can a solution be implemented?
Potential References
Citing reports of alarm-related deaths, the Joint Commission issues a sentinel event alert for hospitals to improve medical device alarm safety.
ECRI Institute. Strategies to improve monitor alarm safety.
Alarm fatigue sets off bells. Modern Healthcare
Alarm fatigue a top patient safety hazard.ย Canadian Medical Association Journal
Over-monitoring and alarm fatigue: For whom do the bells toll? Heart and Lung.
There are so many good sources!!!
5
Why are these Relevant?
These sources are directly relevant to why alarm fatigue is a problem that is only getting worse.
How and why it effects healthcare.
Joint Commission reporting of such incidents that have been directly related to alarm fatigue.
How to change the course of alarm fatigue.
Evidence based reporting and studies for reference support.
What is Alarm Fatigue?
Alarm Fatigue is care givers desensitized do to overwhelming amounts of alarms.
The many โbeeps, chimes and bellsโ are the reason for delayed care and even death.
A 12 day study at John Hopkins determined over 350 alarms per bed.
Over 80% are false alarms.
No standardization of alarm technology
The more false alarms the less likely someone responds.
(Jones, 2014)
Where do We begin?
Review the Joint Commission Reports
Speak to Safety Experts in Other Fields
Create a Culture of Safety
Leadership Buy In
Staff Buy In
Redefine the Framework
Trust, Report and Improve- Concepts
Have accountability for safety protocols
(Chassin & Loeb, 2013)
Joint Commission Reports
-566 Alarm Related Deaths Between 1/2005-6/2010
-Most Often Reported in ER
-85-95% Alarms are false
-The Many False alarms desensitize Staff
(Ed Manag., 2013)
Summary
The amounts of research and data available for alarm fatigue is overwhelming. The data supports a overhaul of the technology systems to become integrated with All of the vital sign alarms. Also to have standards in place for baseline alarm settings. Alarms should also be in reference to baseline health status of patient to prevent false alarms. I still have a lot of work to complete and will be ready to present next week!
Annotated Bibliography
Citing reports of alarm related deaths, the.
Basic AccountingPart A Answer each of the following questions.docx
Basic Accounting
Part A: Answer each of the following questions in one or two paragraphs. Each answer is 20 worth 20 points.
Explain what a balance sheet is, and how itโs different from the income statement, the statement of the changes I ownerโs equity, and the statement of cash flows.
What is a return on equity? How is it calculated? And why is it significant?
List four examples of timing differences, and explain why theyโre significant.
Part: B Answer each of the following questions in one to four sentences. Each answer is worth 4 points.
Determine which classification of accounting is most concerned with the use of economic and financial information to plan and control many of the activities of the entity.
How the return on investment measure of performance calculated?
Is financial accounting historical scorekeeping or is it future oriented?
What does the bookkeeping/accounting process begin with?
Explain the significance of the allowance for Bad debts account.
In Financial accounting, what is one application of the matching concept?
Explain what a callable bond is?
What is the slate voting?
Who are the ultimate owners of a corporation?
What is the term used to describe the revenues of the firms that sell purchased or manufactured products?
Anatomy and Physiology I
Part A: Answer each of the following question in short paragraph. Each answer is worth 20 points.
An 80- year old woman is having trouble walking without falling down. Explain how disorders of many organs may contribute to her problem.
At a routine heath screening, a 54 year old man is found to have an elevated blood glucose kevel.
The test is repeated several times on separate occasions but yields the same results. If his condition isnโt treated adequately, what complication might develop and in which organ systems? What type if counseling does this man need?
Describe in detail the pathway for a signal traveling from one neuron to another. Start from the dendrites of one neuron to the dendrites of an adjacent neuron. What aspect of the neuron helps speed up signal transmission?
Part: B Answer each of the following questions in one to three sentences. Each answer is worth 4 points.
After you donate blood, what cellular process is responsible for regenerating a fresh supply of blood cells in your body? Where does this process occur?
Which specialized cells in the eye are responsible for sensing dim light, bright light, and color vision?
A 60- year old woman reports pain her knees that started during a rigorous hiking trip. She had no pain before the hiking trip. Her knees and distal thigh are swollen and tender. She can no longer walk on that leg. Which conditions of the muscular and skeletal systems might this woman have?
Identify the portions of the integumentary system that do and donโt have nerves.
A 25 โyear old man spends much of his time outdoors without using any type of protection from the sun. Which two conditions should this man be concerned a.
Qest4 energetic testing language and practice
This presentation describes the approach to health and the understanding of communication that applies to all forms of energetic testing.
Directions Please provide detailed and elaborate responses to the.docx
Directions: Please provide detailed and elaborate responses to the following questions. Your responses should include examples from the reading assignments, if possible. For each question, your response must be at least 100 words in length and utilize APA guidelines.
1. What is a prefix? What is an example of a prefix? Give at least three examples of different medical terms that share that same prefix. Give an example of medical terms that share the same root but have different prefixes.
2. What is an ectopic pregnancy? Where does implantation of the fertilized egg usually occur? Where does the remainder of ectopic pregnancies occur? What are the treatment options for ectopic pregnancies?
3. Describe the training process that physicians experience. Why is it important for physicians to undergo such a rigorous training process before they are allowed to practice medicine? Explain your reasoning.
4. Explain residency training and indicate the significance of it. List 3 examples of residency training and specify the differences among the selected examples.
5. Select 3 medical specialists and identify their respective specialties. Conduct a word analysis of each medical specialist term by dividing the medical specialist term into word parts and specifying the meaning of each. For example, cardiologist can be broken down into cardi/o (heart) and โist (specialist).
6. Choose one of the case reports on pages 176-187 in your textbook. Indicate the medical specialty and any term that is related to that specific medical specialty. Then, specify the meanings of all related terms by breaking the terms into word parts.
7. Write your own case report using the medical terminology you have just learned in this module. Begin by selecting a medical specialist and identifying the specialty. Then use the appropriate word parts to form terminology that describes a medical situation of your choosing.
8. Describe the educational process that is necessary to become a doctor. How does a doctor become a specialist?
9. Describe the cardiovascular system. Begin by first identifying significant anatomical parts and explaining what role each organ plays in the overall system. Then, name important pathology that afflicts those particular anatomical parts just named. Also, choose which laboratory tests and diagnostic procedures would be used in compliance with that specific pathology.
10. Explain the workings of the digestive system. First, begin by identifying important anatomical parts and indicating what each organ is responsible for in the entire system. Next, specify any diseases or pathology that afflicts those specific anatomical parts just named. Then, select the laboratory tests and diagnostic procedures that would be used in compliance with that particular disease or pathology.
11. Examine the endocrine system. Start by identifying endocrine glands and explaining where each gland is located in the body system. Then, indicate any disease.
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Vital monitoring
Vital signs provide important information about patientsโ clinical condition and inform any required interventions
Inadequate response to deterioration is the most common cause of reported critical incidents
Nursesโ compliance with observation protocols can be poor, particularly at night
Peaks in observation frequency suggests the timing of observation is often driven by ward routines
Electronic vital signs devices and early warning score charts may increase vital signs measurements, butย further research is needed
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Business Needs Fractal Indicators- Why and How?
- 1. Business Needs Fractal Indicators- Why and How? Ali Anani, PhD
- 2. I dedicate this presentation to a great human and researcher on complexity To: Dr.Vincenzo De Florio
- 3. Complex systems have repeating patterns that make them look simple, but not Simple enough
- 4. The more complex the system is, the simpler the KPIs should be This is amazing!
- 5. Like a flock of birds If one birds violates it can be easily found out
- 6. Mostly, Key performance Indicators (KPIs) are of questionable value Complex systems are not subject to linearity
- 7. Complex systems result from simple interactions that feedback to each other Beware of disturbing the system with interfering measurements
- 8. Interesting to note that the human body is a highly complex system Yet; very simple indicators reveal its healthiness
- 9. Organizations are complex bodies with repeated patterns and they need simple indicators repeating in a pattern all overย
- 10. In emulation of the human body temperature, repiration rate and pulse rate are key indicators
- 11. These 3 indicators give us the ... Vital Sign if the body is healthy or not
- 12. Next comes the Differential Diagnois and is followed by the Final Testing
- 13. These indicators are easy to monitor And they may be arranged as a fractal triangle
- 14. The body temperature, respiration rate and pulse rate Are quite telling if somebody is sick or not
- 15. I suggest the use of indicators That have fractal structure
- 16. A fractal arrangement similar to the Sierpinski Triangle
- 17. Something like this repeating fractal triangle A repeating structure
- 18. The indicators may be scaled from the section to the department to the division, to the organization and so on....
- 19. The equivalent to blood circulation is the circulation of information
- 20. Is there high tate of information flow? or, information clotting
- 21. Is there information "anemia"? or, information toxicity?
- 22. Information with high "Octane Number"
- 23. Likewise, is there over-sweating of employees? Heated anger?
- 24. We need to detect first the Vital Signs of the Organization Body
- 25. If we treat organizations as living bodies we need to adopt procedures adopted by MDs
- 26. Before leaning heavily on a bundle of indicators
- 27. We need first to select the vital few