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Treating runaway health costs

first_imgThe findings suggest that a global payment model with both financial rewards and penalties, including robust quality incentives, offer a framework for slowing spending growth without sacrificing quality of care, the researchers said.Co-authors included Yunan Ji, a Ph.D. candidate at Harvard’s Graduate School of Arts and Sciences, and Michael Chernew, Leonard D. Schaeffer Professor of Health Care Policy at HMS. Dana Gelb Safran, who is with Haven, an independent organization dedicated to creating better health care outcomes for individuals and families, and Tufts University School of Medicine, and was part of BCBS during the study period, also contributed to the research.This work was supported by a National Institutes of Health Director’s Early Independence Award. Study: Doctor burnout costs health care system $4.6 billion a year Spending dips on health care for the Medicare elderly Related Improvements in cardiovascular area are saving billions in costs, Harvard study finds Work highlights economic cost in lost time, turnover A new study led by Harvard researchers presents a rare long-term examination of a promising payment system for providers that appears to slow galloping health care costs while improving care for chronic diseases like diabetes and high blood pressure and reducing emergency-room visits.Under the current method, insurers pay providers for each service rendered, a practice that critics say can encourage the use of increased treatment even when its benefit is dubious. A so-called global-payment program, on the other hand, gives clinical practices a yearly budget to care for a population of patients, creating an incentive to prioritize preventative care and look for ways to cut unnecessary spending.Evidence from preliminary, and mostly short-term, studies of global-payment experiments has been mixed and has offered a limited snapshot on outcomes. The question remained: Could it work over the longer term once the early changes or investments in care delivery had been made?The likely answer may be yes, according to research published July 18 in The New England Journal of Medicine, which reveals that one of the largest, oldest private insurers that used population-based global budgets achieved sustained success in slowing spending growth while improving care.Over eight years, average spending for patients of an initial cohort of providers covered by an alternative, global-payment contract with a large Massachusetts insurer saved nearly 12 percent ($461 per member, per year) on claims, compared with patients likely in traditional, fee-for-service plans across the Northeast. Subsequent providers with fewer years in the payment model had comparable or smaller savings on claims.The study, led by researchers in the Department of Health Care Policy in the Blavatnik Institute at Harvard Medical School, examined changes in spending on claims, volume of services used, and quality of patient care through eight years of the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC), representing the largest and longest-running global-budget contract offered by a private insurer.“Health care costs are high, and they continue to grow nationwide,” said study author Zirui Song, assistant professor of health care policy and medicine at Harvard Medical School. “The evidence we found suggests that this global payment program has slowed the growth of spending on claims, improved several aspects of quality relative to regional and national averages, and changed some dimensions of provider behavior in a potentially sustainable way.”While incentive payments to providers did offset a significant portion of savings on claims, the overall results nevertheless showed that important changes were made in clinical practice, Song said.“And that is encouraging news,” he said.The analysis found that global-payment patients were less likely than those in a comparison group to visit the ER, receive high-cost specialty drugs, and undergo diagnostic imaging procedures, which research has found are often not optimal and may not provide better outcomes. The study also found that patients received improved preventive care and management of chronic illnesses such as diabetes and high blood pressure.“The idea is not to save money by withholding care but to slow the use of questionable, low-value, or unneeded services in favor of high-value care,” Song said. “This study shows that over the longer term provider organizations can produce meaningful changes in practice and savings for the health care system while improving several aspects of quality of care under incentives that encourage these goals.”The study looked at data from 2006 to 2016 from Blue Cross Blue Shield of Massachusetts (BCBS) and from a database of commercial claims and encounters. The longest-term data are from the first cohort of providers, which joined the AQC in 2009. Over eight years (from 2009 to 2016), average annual medical spending on claims for people in the AQC contract grew at a slower rate.Savings on claims were driven by lower prices in the early years, often due to shifting services from more to less expensive locations or settings, such as switching hospital- or facility-based care to independent- or office-based care. In later years, savings were driven by lower use of services, including laboratory tests, certain imaging tests, and emergency room visits. A number of process and outcome quality measures improved relative to regional and national averages.New provider organizations entered the AQC over the years that the study covered. Savings were generally larger among populations enrolled longer. Patients in organizations that entered the AQC in 2010, 2011, and 2012 had medical claims savings of 12 percent, 7 percent, and 2 percent, respectively, by 2016.The AQC uses what is known as a two-sided risk model: If providers spend less than the target budget, BCBS shares some of the savings with them; if they go over budget, BCBS compensates less than the full amount of the excess so the providers assume some of the cost of overspending. Providers also receive bonuses for meeting quality measures across process, outcome, and patient experience domains.last_img read more

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Nekvasil to announce Saint Mary’s College President-Elect Wednesday, following ten-month nationwide search

first_imgSaint Mary’s Interim President Nancy Nekvasil and other campus dignitaries will announce and introduce the incoming College president at a “special event” for students, faculty and staff Wednesday, according to a media alert. Nekvasil will be joined by Gretchen Flicker, chair of the board of trustees and an alumna from the College’s class of 1993, and Sr. Veronique Wiedower, CSC president of the Sisters of the Holy Cross and an alumna from the College’s class of 1970, in announcing the president-elect.The new president was chosen after a ten-month nationwide search and will be the 14th individual to fill the position since the College was originally founded in 1844. He or she will take office this summer.The search was conducted with assistance from WittKieffer, a national search firm specializing in “presidential and executive searches in higher education,” according to the presidential search webpage. The search committee included trustees, faculty, administrators, students, alumnae and parents.The event will take place on Wednesday at 2 p.m. in the atrium of Spes Unica Hall.Tags: Board of Trustees, Gretchen Flicker, Interim President Nancy Nekvasil, president-elect, SMC presidential search commitee, Spes Unica, Sr. Veronique Wiedowerlast_img read more

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Insectival

first_imgUniversity of GeorgiaYou don’t have to be a contestant on a TV reality show to get upclose and personal with Madagascar hissing cockroaches.All that and more awaits you at the University of Georgia’sannual Insectival Saturday, Sept. 23, from 9:30 a.m. until noonat the Botanical Garden in Athens, Ga.A typical event includes toddlers holding giant millipedes, bugraces and lots of fun, educational events. In keeping with thisyear’s focus on flying insects, the 11th Insectival will includea butterfly release.Entry fees are $2 per person or $8 for a family. Children undertwo years are admitted free.The UGA Insectival is sponsored by the State Botanical Garden ofGeorgia, the UGA Department of Entomology’s H.O. Lund EntomologyClub, the Georgia Museum of Natural History, Athens First Bankand Trust, and Jackson Electric Membership Corporation.last_img read more

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Out to Maximize the Internet’s Vast Space

first_img Mr. Austin Branch, Senior Director, Information Operations: Operating in the information environment no matter what is a critical component of how our Defense Department has to consider operating in the future, the digital age, the ubiquity of information…we have no choice but to be able to compete in this space. Because our adversaries and others are challenging us all the time, so we can’t ignore it. So we have to have the capability to be able to operate in this space and have the capabilities to be effective. The hard part, the challenge is how do you show real value in an enterprise that doesn’t immediately provide opportunities to show direct impact? It takes a lot of time of persistent, sustained engagement to show any kind of measure in change of anything it is we’re trying to shake our strategic objectives on, and particularly for any theater command. Interview with Austin Branch, Senior Director for Information Operations, Office of the Under Secretary of Defense (Policy), Special Operations and Low Intensity Conflict That’s what they have to go back as champions of, and walk away knowing that they’ve got a better network of partners who have similar interests. So when they leave here, they’ll know they have friends not only in the United States, but in Guatemala, in Peru, in Panama. They’ll know who the other people are that have shared challenges. DIÁLOGO: How do you see Information Operations (IO) moving forward in the future? DIÁLOGO: What is the biggest lesson you’d like the partner nations attending the IO SMEE to take back with them regarding IO? DIÁLOGO: What can the U.S. learn from its counterparts regarding IO? Mr. Branch: For operating in the information environment, it’s not just IO. IO is a military term, more importantly all of our colleagues, and all of our friends, and our international partners, they may not have the same idea of what IO is, so I want to set that aside. I want to make sure people are talking about our ability to effectively operate in a complex information environment. So why is that important for our friends and our partners? Because we, the United States, do not have the monopoly on the information space, –in fact, we’re probably one of the most challenged countries in the information space domain¬¬–, because we’re so vulnerable, but at the same time, we need to collaborate with our partners, it’s an all-in proposition. (US + partners)They have as much equity and as much stake as we do in being effective, because it’s a global common, and so we have to be able to do that. They have a stake in this as well. Our ability to make sure that we have some comparable capabilities and understanding is absolutely essential to ensuring security and stability in the various regions where we have common objectives. It’s as simple as that. Mr. Branch: Well, it’s not just an IO mission; it’s a whole mission of engagement. And this exchange of information, transparency, having a general understanding, a common understanding of how we think; this information environment is challenging us, and how might we address it in a common way? It’s not about us empowering them; it’s a mutual empowerment of capabilities. There are a lot of ideas, there’s a lot of development, there’s a lot of experience in our partners that they can share with us, so it’s as rich of an engagement for us, as it might be for them. I am always looking to learn as I go into these types of engagements with our partners in Central and South America, because this information space levels the playing field and we do not have the strategic advantage. We’re all the same. Mr. Austin Branch: Operating in the information environment is very complex and because it’s so difficult to measure in the short term, they have to go back to their own headquarters and be advocates for this. Say, “Listen, no matter what we do, we have to invest in technologies, in methods, in applications; we have to partner with not just the U.S., but others, so we can learn how to operate in this space. This is the information age. We built tanks in the industrial age, we’re building capabilities to operate in the information environment, via the web or other tools like social media, all of that in the electromagnetic environment, the Internet, all those things play huge roles, so how do we ensure that we do it in the most effective and appropriate way? In mid-April, the Information Operations (IO) divisions from U.S. Southern Command and U.S. Northern Command co-hosted an IO Subject Matter Expert Exchange, bringing together military representatives from ten countries from within the Americas to discuss lessons learned, best practices, and the ways ahead on this domain. Austin Branch, Senior Information Operations Director at the Office of the Under Secretary of Defense (Policy) came to Miami to take part of the exchange and urge participants to really work together and convert plans into actions. Mr. Branch also took some time to talk to Diálogo one-to-one on this topic. Mr. Branch: A lot. Well one of the things we really do poorly is we don’t really understand the audiences we wish to engage and shape. We often mirror image, we often presume, and so our colleagues and friends can share with us and get a better understanding of the elements of influence, the elements, the challenge, the interests, attitudes, and behaviors. We often get this wrong, so we can really benefit from their perspectives, from their experiences. It’s more important that we listen rather than talk. We have to go in hat in hand. DIÁLOGO: What is the importance of collaborating with partner nations for IO? They’ve got to go back as champions of that because there’s a general sense from folks that it’s too complex. People just push back and don’t want to get involved because it’s so difficult to understand. They think it’s just dealing with the Internet or just dealing with the media, but it’s more than that, it’s a whole complex layer of things, and you need professionals who understand how to bring those things together to combine hard science: the electronics, the bits, bytes, trons… with the soft science: the behavior, the cognitive piece, because there are people on the other end of those computers. What is it that they think, what do they know? By Dialogo May 01, 2013 DIÁLOGO: What is the value of this exchange for the United States’ IO mission in Latin America? last_img read more

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Good Governance: Understanding the importance of ethics

first_imgFor many years, my focus was on ethics—particularly organizational ethics. As an undergraduate at Georgetown University, I majored in philosophy and minored in psychology. My father thought it was imprudent to follow such a course of study, but I persisted. In doing so, I studied many of history’s greatest thinkers and ethicists.I continued on to law school, immersing myself in the study of law and—ideally—justice. My favorite class was … yes, legal ethics. (Many of my law school colleagues were convinced something was seriously wrong with me.) I then decided to double down and became the first person to receive a master’s in law from Georgetown University Law Center with a concentration in legal ethics and professional responsibility.I went on to found a consulting practice called Ethics Inc. and then served as president of the Ethics Resource Center—the nation’s oldest, independent ethics research organization. I even had a license plate for my car that read “Ethics 1.” It’s safe to say, ethics was a really big part of my personal and professional life! 8SHARESShareShareSharePrintMailGooglePinterestDiggRedditStumbleuponDeliciousBufferTumblr continue reading »last_img read more

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Patti Labelle Wows NYCB Theatre at Westbury With Soulful, Endearing Performance [Review]

first_imgSign up for our COVID-19 newsletter to stay up-to-date on the latest coronavirus news throughout New York The Patti LaBelle show at NYCB Theatre at Westbury on Saturday, Nov. 29, 2014 can be summed up in one word: soulful. Yet of course, a singular adjective could never hope to capture all the passion, all the joy, all the emotional upheaval and celebratory enthusiasm unleashed in the symbiotic love-affair between performer and audience that is a Miss Patti Labelle concert. So I’ll expand.As the audience eagerly awaited the “Queen of Rock ‘n‘ Soul,” the show opened with the acclaimed singer/songwriter Will Downing, who captivated the audience with his rich baritone jazz and R&B vocals. Tearing up about halfway into his set, he looked out at all of the vibrant, happy people enjoying his music, sat back in a mirrored chair, and took a brief moment to reflect, sharing with the audience the story surrounding his last scheduled performance at NYCB. It was back in 2006, Downing said, with R&B singer Stephanie Mills, but he had to cancel because he came down with polymyositis—a rare inflammatory disease of the muscles. To be able to perform at this venue on Saturday—coincidentally, his 51st birthday, he told the packed house—was a dream come true. After a brief intermission, out stepped LaBelle, wearing a simply dazzling dress and absolutely igniting the packed house into a gushing frenzy of applause and cheers. She kicked off the intimate evening with the 1986 synthpop chart-topper “New Attitude” before gliding through an impressive and eclectic array of songs spanning her more than half-century as one of the most entertaining and talented singers of all time. The set included: “New Attitude,” “New Day,” “If You Asked Me To,” “If Only You Knew,” “What Can I do For You,” “If You Don’t Know Me By Now,” “Love Need and Want You,” “Somebody Loves You,” “Stay With Me,” “Right Kind of Lover,” “How Great Art Thou,” “On My Own (with Brandon Winbush),” “You Are My Destiny (with Brandon Winbush),” disco sensation “Lady Marmalade” and “Somewhere Over The Rainbow.” LaBelle hit all the notes with style and ease, belting out the high octaves and injecting each and every number with her signature sass and soul. On the top of the black-baby grand up onstage was a Snow White/Cinderella-esque ensemble that included a handheld mirror and about a half-dozen pairs of illuminated electric-light stilettos, which she changed into throughout the show. LaBelle’s stellar performance left no question as to whether she still possessed the same zest, fire and love for the audience that she had 52 years ago when she first began her legendary career.As Alicia Keys (who was influenced by LaBelle) sings: “That girl is on fire!”LaBelle is a true diva—a legendary singer, talented actress, gifted author and even a talented cook who shares her recipes and has her very own line of BBQ sauces and marinades(!!)—but she’s also a humanitarian, and her support for adoptive services, Big Brothers Big Sisters and the American Diabetes Association, among so many other causes she champions, is well known. Her big heart was on full display at NYCB, too. LaBelle met a couple by the name of Larry and Denise before the show, she told everyone between songs. The singer made sure they had tickets for the performance and even gave them a special shout out during the gig! With not a bad seat in the house, and its amazing sound system, the NYCB Theatre at Westbury proved the perfect venue for such a riveting performance: cozy, intimate and rockin’! “I’ve seen Patti about 40-something times now and throughout the 10 years I have followed her, the one thing that never changes is her spirit,” raved 21-year-old R&B artist, radio show host and longtime LaBelle fan Joey Mannarino, of Philadelphia, afterward. “No matter what songs she sings or where she performs, the love for her fans is what always shines through the most. “Every year she comes to Westbury, her fans travel from all across the country, as they say it’s the best venue in the country to see Patti!” he continued. “As usual, she didn’t disappoint!” For an encore, the sultry songstress let loose an emotionally powerful “You Are My Friend.” The entire house was up on their feet, applauding and shouting praises. What a venue! What a performance! We love you, Patti!!With Zack TiranaFor more amazing gigs and performances at NYCB Theatre at Westbury, check out their page in The Island Ear!NYCB Theatre at Westbury, 960 Brush Hollow Rd., Westbury. venue.thetheatreatwestbury.com Watch Patti LaBelle perform “Somewhere Under The Rainbow” below!last_img read more

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The competition for the selection and appointment of the director of the Tourist Board of the City of Stari Grad has been announced

first_imgA competition has been announced for the selection and appointment of the director of the Tourist Board of the City of Stari Grad.Tourist stories, potentials, resources,…. and challenge as much as we want. The island of Hvar is a UNESCO island. The historical core of the Old Town and the cultural landscape of the Old Town Field were inscribed on the UNESCO World Heritage List in 2008, and there is also the Procession of the Cross, Agave lace, klapa singing and Mediterranean food. And this is just the beginning of the whole tourist story that the whole island of Hvar has.Hvar and the Old Town need a visionary and proactive person, who has practical experience, and the rest is just a form that is less important. However, the conditions of the tender are attached, and the deadline for submission is 15 days from the date of publication (published on November 09.11.2018, XNUMX). Good luck everyone.Priog: Competition for the selection and appointment of the director of the Tourist Board of the City of Stari GradRELATED NEWS:THE OLD TOWN ON HVAR HAS DECIDED TO BAN THE OPENING OF NEW HOSTELSlast_img read more

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Indonesian shuttlers eye group stage wins at Thomas and Uber Cup

first_imgTopics : An official with the Indonesian Badminton Association (PBSI) has said that the Indonesian teams competing in the Thomas and Uber Cup have the advantage over their opponents following the Badminton World Federation’s announcement of the draw results.The Indonesian men’s team will be in Group A of the Thomas Cup with Malaysia, the Netherlands and England while the women’s team will square off against Korea, Malaysia and Australia in Group B of the Uber Cup.“We have been spending the last month competing internally so we can maintain their skills, fighting spirit and also stamina. The coaches have also issued their evaluations for all players so they could improve. Overall, we are in a better condition, [we are] up and ready,” PBSI secretary-general Achmad Budiharto told The Jakarta Post on Monday. However, he said he firmly expected the team would not underestimate its opponents and stay focused on training.“We still have time to practice and improve,” he added.When asked about the current pandemic and how it could pose a problem to the athletes and the tournament, Achmad acknowledged that the PBSI had a big concerns and therefore was doing everything it could to keep its athletes healthy.“There will be tight safety and health protocols to follow during the tournament, including the no-spectators rule. From our side, we have been applying strict protocol, as well maintaining our athletes’ condition,” he said.center_img A total of 16 men’s and 16 women’s teams will compete in the tournament, the world’s most prestigious group badminton tournament. The event will take place at the Ceres Arena in Aarhus, Denmark, from Oct. 3 to 11 without spectators.Head of PBSI development and achievements Susy Susanti concurred with Achmad’s statement on Indonesia’s strong chances, saying both the men’s and women’s team had good shots at winning the group stage.“We are focusing on reaching the quarterfinals first. Our target will be to bring home the Thomas Cup back to Indonesia. The opponent countries are going to be tough but we are optimistic,” Susy, an Indonesian badminton legend, said as reported by badmintonindonesia.org.“The toughest opponent in the group will be Malaysia. We might be in a better position than the Netherlands and England but that does not mean that we should underestimate them.”She said the women’s team might have to work harder than the men to be able to come out as the winners of the group stage. The Korean team, she said, had tough women players and would surely put up a fight.“The Korean team will be the toughest opponent in the women’s group but we still have a chance. However, Malaysia and Australia could be a threat as well. Especially when we are playing in the group category, anything is possible. Being vigilant is a must,” she said.The most important thing, she added, was that all players maintain focus and a fighting spirit while out on the court.Indonesia has won the most Thomas Cup titles of any country with 13 wins, followed by China with nine wins. Indonesia last won the championship in 2002 when it beat Malaysia in the finals. Indonesia’s Uber team has won three cups but faces a title drought, having last won in 1996.last_img read more

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Canadian regulator calls for bids on 18 offshore parcels

first_imgThe Canada-Newfoundland and Labrador Offshore Petroleum Board (C-NLOPB) has issued calls for bids for exploration and production licenses in the Eastern Newfoundland and Jeanne d’Arc regions.The C-NLOPB said last Thursday that the calls involve 17 exploration licenses and one production licenses.Namely, the call for bids NL18-CFB01 consists of 16 parcels while calls for bids NL18-CFB02 and NL18-CFB03 consist of one parcel each.The board added that interested parties must submit sealed bids for the parcels until November 7, 2018.For call for bids NL18-CFB01 and NL18-CFB02, the sole criterion for selecting a winning bid will be the total amount of money the bidder commits to spend on exploration of the parcel during Period I, which is the first period of a nine-year license. The minimum bid for the parcels offered is $10 million in work commitments.As for NL18-CFB03, the sole criterion for selecting a winning bid will be the highest drilling deposit bid with a minimum of $25 million.The calls for bids are included in the 2014 Eastern Newfoundland Strategic Environmental Assessment (SEA). The SEA examines the environmental effects which may be associated with a plan, program or policy proposal and allows for the incorporation of environmental considerations at the earliest stages of program planning.SEA involves a broader-scale environmental assessment (EA) that considers the larger ecological setting and consultation with a wide array of stakeholders.“Assessments of regional and site-specific issues will be completed before any work can begin within the license area. The timing, spatial extent, and nature of proposed oil and gas activities, in addition to mitigations already prescribed by legislation, will determine the level of additional restriction or mitigation that may be required. Any additional measures would be determined during the project-specific environmental assessment and other regulatory approval processes,” C-NLOPB said.last_img read more

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Pellegrini hails four-star Aguero

first_img Press Association Aguero scored all of City’s goals as the champions ran out 4-1 winners over 10-man Spurs in a breathless Barclays Premier League encounter at the Etihad Stadium. The Argentinian also missed a number of other chances, including one of the three penalties he stepped up to take during the game. Pellegrini said: “Joe is the number one keeper of England. He made important saves. “You will all remember the penalty, which was a good save, but he also made a good save early in the first half. “But when we win the game it’s not just because of one of two players. It’s about the whole team performance. “When you score four goals as Kun did or you make so many good saves as Joe did, then of course it’s very important to our team, but it’s not fair if you don’t talk about what James Milner did or (Vincent) Kompany or (Bacary) Sagna.” Spurs boss Mauricio Pochettino had almost pre-empted Aguero’s devastating display by comparing his play to the genius of Mozart in the build-up to the game. It was also a performance that proved fit for a king – with Juan Carlos, Spain’s former monarch, among the VIP guests. Pochettino said: “Kun Aguero had a very good day. He scored it was a very good performance from him. “It was a great game but I’m disappointed with the result. It was tough for us but we need to take the positives and improve. “The third penalty finished the game for us because at the time we had possibilities to score. “But the first key moment of the game was City’s first penalty – for me it wasn’t a penalty. “The next was our penalty miss and the big save from Joe Hart just after. That was a big moment.” Last season Pellegrini suggested Aguero was behind only Lionel Messi and Cristiano Ronaldo among the world’s best players and, now he has apparently overcome the numerous injuries that have plagued him ever since, the City boss is again of similar opinion. Pellegrini said: “It was not easy for Kun last year when he had too many injuries. You can’t put in performances like he did today when you’re not 100 per cent fit. “But now he’s working very well. Maybe he will not score four goals in a game again but he will demonstrate why everyone says he’s one of the best players in the world. “I have said before he could be a Ballon d’Or player. “I have known him a lot of years. I saw his career in Argentina and Spain before he came to England and that’s why I say he’d one of the three or four most important strikers in the world – not (just) because he scored four goals (today).” Aguero’s first goal was cancelled out by a Christian Eriksen strike but he restored City’s advantage from the spot. He then had another penalty saved by Hugo Lloris but made sure with his third attempt from 12 yards after Federico Fazio was sent off. He completed the scoring with a second crisp strike after 75 minutes but City’s performance was not all about the Argentinian. Goalkeeper Joe Hart also had a fine game, making a number of saves in an open encounter, including a penalty stop from Roberto Soldado. Manchester City manager Manuel Pellegrini hailed the performance of Sergio Aguero after the striker’s four-goal demolition of Tottenham.last_img read more