Past Spotlight


Ms. Basta  has over 20 years of experience as a Nurse Practitioner, the past 10 of which have been providing care to the population of the Upper Valley in New Hampshire, first as an integral part of the Inpatient Diabetes Management team at DHMC and presently, as a primary care provider caring for the DHMC employee population.

In her role on the Inpatient Diabetes Management Team, a program she helped to develop in 2007, she  managed hospitalized patients with challenging diabetes concerns ensuring seamless discharge to their medical homes across Northern New England.  She played a key role in educating medical residents in diabetes care and co-authored several papers with her partners in Endocrinology at DHMC in the Journal of Hospital Medicine and the Journal on Quality and Patient Safety with respect to diabetes management on inpatient services.

In 2013, she became one of three founding members of a newly formed primary care practice established through the DHMC Employee Wellness department designed to care for DHMC employees while also being a living laboratory for innovation in the delivery of healthcare services. As one of the founders, she was instrumental in creating a culture of honesty, humor, and service that now cares for over 2,000 patients. Her embodiment of the vision for our clinic helped to attract additional team members and her reputation as a compassionate and knowledgeable provider has attracted many patients to our service.

In addition to her commitment to clinical care, her colleagues, and her profession, she exemplifies the values of scholarship and lifelong learning.  She is enrolled a Master’s in Public Health program at The Dartmouth Institute to further pursue her passion as a patient advocate in the study of Population Health. She is currently working on developing a project that will continue her service to patients with chronic conditions while also improving practice. 



Richard Young, APRN, came to NH when HealthFirst Family Care Center in Franklin New Hampshire first opened.  He was instrumental in developing the center in Franklin then helped opened the new office in Laconia, NH.    He helped to develop chronic care management systems and programs and developed quality metrics.


“Rich brings a true dedication to his work, he engages patients thoroughly in a discussion about their health and how they can make a difference in what they do on a day-to-day basis. He has always been a great advocate for the clients and helps them to understand how their daily activities of eating and exercise and choices make great differences in their health outcomes. Riches has always been extremely conscious of the importance of documenting both the individual issues of the clients and of the clients as a group using clinical metrics to look at how practice patterns, procedures and programs can be changed and modified for the larger public's health.”


The challenges of working with an underserved population can be many.  Richard is a mentor both to his colleagues and to his patients. He is an active listener and uses his skills, holistic approach and integrates interdisciplinary modalities to  care for his patient population.


In addition to improving the health of his patients and the community, he is raising 3 children.  He continues his caring work, outside of the office through his work with Circle Camps for grieving children.  Richard is described as “a noble man...who goes about his daily worth without accolades.”


Please join me in thanking Richard Young for contributions to health care in the Lakes Region of NH.  



Kathleen Broglio, DNP, ANP-BC, ACHPN, CPE, FPCN

In this time of the opioid crisis, Dr. Broglio's work is especially important. She has changed the lives of patients, colleagues and the world of palliative care. She has piloted a palliative care clinic specifically for patients with prior or current opioid use disorder and concurrent cancer-related pain. She educated our region’s palliative care and hospice providers in the use buprenorphine for pain. She spearheaded collaboration with a local methadone clinic to improve the coordination and overall quality of care for patients with OUD being treated with methadone who also need management of cancer-related pain.

Dr. Broglio is committed to education as evidenced by leading educational sessions for Dartmouth’s palliative medicine fellows, presenting across the country including 2018 American Academy of Hospice and Palliative Medicine Annual Assembly, the American Association of Nurse Practitioners (AANP) and The American Society for Pain Management Nursing. She recently taught pain and symptom management to nurses in India at the Indian National Palliative Care conference. As part of the faculty for AANP, she presents on safe opioid prescribing. She has published articles and book chapters in the area of pain and palliative care.

She received a grant to develop, implement, and study an inter-professional curriculum to educate the healthcare, maintenance, and administrative staff at the new Jack Byrne Center for Palliative & Hospice Care (JBC) at Dartmouth-Hitchcock Medical Center (DHMC). Kathleen also won a DHMC Department of Medicine grant to develop and implement a curriculum to teach oncology clinicians about safe opioid prescribing and implement a system for universal precautions in opioid management for cancer-related pain. She is the 2018 recipient of the AANP, National Institute of Drug Abuse, Substance Use Training Award to improve screening and referral in the oncology setting. Kathleen is a scholar at the Dartmouth Collaboratory for Implementation Sciences which provides support and mentorship for research efforts.

Kathleen has served on the board of the National Hospice and Palliative Credentialing Center, as Vice-President and Steering Committee member for the Metro New York Chapter of the Hospice and Palliative Nursing Association (HPNA), and as Secretary for the American Society for Pain Management Nursing.

“Kathleen’s contributions are broad and deep. She provides expert patient care and tireless advocacy, serves her profession through leadership, nurtures colleagues through mentorship and collaboration, and brings her whole heart to everyone around her. She embodies Brene Brown’s calling to live with a soft front, strong back, and wild heart. She is the rare combination of intellect, humility, skill, leadership, drive, and caring emanating from an incredible human being.”

Remarks by Ginny Wright 2017 NH NP of the Year

This year the NP of the Year is a wonderful patient advocate, active in Healthcare policy, innovative in her practice, a faculty member and a mother. She works hard with and for her patients, students, family and organization.

 She is the Clinical Director of the Cardiomyopathy Clinic, a clinic that serves approximately 700 individuals with complex medical problems. She has been responsible for a myriad of policies and procedures that guide the care of these medically fragile patients in the clinic and other satellite offices. Her doctoral research on the treatment of patients with decompensated heart failure using IV Lasix in an outpatient setting resulted in a change in practice. The protocol she wrote for her doctoral study is now utilized by the Home Health and Hospice VNA allowing patients to avoid hospitalization.  This change in practice also resulted in significant cost saving in the health care system. She is an expert practitioner and has “written the book” for the care of persons whose lives depend on their implanted Ventricular Assist Device (VAD).  She has presented at numerous national and international conferences on the care of patients with heart failure. She is. an expert clinician that is “well loved” by her patients.

She has also been a member and Chair of the Advanced Practice Committee at her hospital. She worked tirelessly to get Advanced Practice a voting membership on the Medical Executive Committee. She currently serves as that member.  

She is a full time faculty member in the DNP Program. In this role she has endeavored to broaden her students' perspectives by organizing programs in which students will have hands on experience in the delivery of health care outside of the USA in both Costa Rica, this year, and Belize in 2019. She also is a member of the steering committee working to provide healthcare to an underserved population in the city of Nashua through the deployment of a mobile health van.    

She has been involved in forwarding the profession of Advanced Practice Nursing since serving on the NHNPA as the Recording Secretary when she was a student in her Nurse Practitioner program over 20 years ago. In the succeeding 20 years she been a tireless volunteer serving in a number of capacities within the NHNPA structure.  She has most recently traveled to Washington DC as member of the New Hampshire Delegation at  the AANPHPC.

The above litany of her accomplishments pale when we reflect on how much she has contributed, on a daily basis, not only to the care of her patients but to the advancement of Advanced Practice Nursing.

I know of no one more deserving of this award, Dr. Marilyn Daley! Congratulations

Susan Feeney DNP, ARNP, FNP

Susan Feeney is this year’s recipient of the Lifetime of Service award professional career spans over 30 years of providing primary healthcare care. Her first position after she graduated from Texas Women’s University was in orthopedics as a staff nurse. Returning to New England she provided care for the next 10 years to woman and infants in a variety of maternal-child positions. In 1996, she received her MSN from UNH beginning her distinguished 22-year career as a family nurse practitioner.

This year’s recipient has not only had a successful clinical practice but has been the knowledgeable teacher and wise mentor to many NPs as she led the FNP program at Rivier for over a decade. Many of us in NH were saddened to see her leave NH two years ago to teach at the Graduate School of Nursing at UMass Medical School in Worcester. Committed to excellence in graduate education she pursued her DNP at UMass Boston and was awarded her Doctorate in 2016.

She is known nationally as an expert lecturer on a wide variety of clinical practice topics and her international work includes outreach in both Senegal and the Dominican Republic. I am sure she would say she would not have been able to accomplish all of this without the loving support of her husband and children.

During the past 4 years she has lead the NHNPA as vice president and president. Her ability to see the big picture balanced by her clear analysis of issues and positive, inclusive leadership style have been an asset to our association. She understands our dual responsibility of financial viability and mission impact. NHNPA has matured during her tenure and is well positioned for sustainability and mission impact. Truly a NH jewel whose career will continue to shine in Massachusetts, we wish you the best.

Congratulations to this year’s Lifetime of Service Award winner, Susan Feeney

Jennifer Thompson, 2018 NHNPA Advocate of the Year

The following letter was written by Bob Dunn, the NHNPA's Lobbyist and previous Advocate of the Year:

Over the course of the years that I have had the privilege of representing NHNPA in Concord, I have developed a theory that there is a correspondence between the skill of nursing and the skill of lawmaking. Nurses in the legislature invariably make excellent legislators, so it is obvious that if you are a good nurse you are going to be a good legislator, too.

My theory in this regard has expanded a bit, though. Over the years of working with the members of the NHNPA government affairs team, I have come to the conclusion that the same skills that make a person a good nurse also make that person a good advocate in working with the legislature. This year’s award recipient has reinforced my confidence in the truth of that theory.

The recipient of this year’s Advocate of the Year Award has been a member of the NHNPA Board for several years and has put a tremendous amount of time and effort into NHNPA’s government relations efforts. As a measure of her dedication, I need only cite the fact that I frequently see emails from her that she has sent out on weekends or evenings, and in particular I see emails that are sent out at horrifying times of the day (here is a random sample of some of those: 5:16 a.m; 5:02 a.m; 4:54 a.m; 4:49 a.m; 4:45 a.m).

She has been tireless in her work at reviewing bills and drafting testimony for NHNPA to submit to legislative committees. She has maintained her commitment to NHNPA’s advocacy efforts even after she spent an entire day with me at the State House in January. Her work on behalf of APRNs in New Hampshire has been invaluable.

So it is a great honor for me to announce that the recipient of this year’s NHNPA Advocate of the Year Award is the Chair of the NHNPA Government Affairs Committee, Jen Thompson.

Alison Davis

Alison Davis is an Acute Care Nurse Practitioner serving as lead nurse practitioner for the inpatient and outpatient heart failure programs. She is part of a highly specialized team caring for advanced heart failure patients including post-transplant and LVAD patients. Alison has been integral in starting the first CardioMEMS program in northern New England. She serves as the Cardiovascular Team representative for the Northern New England Chapter of the American College of Cardiology since. She has recently published data on the CardioMEMS Sensor and presented her work at the Heart Failure Society of America 21st Annual meeting in Texas.

Kerry Nolte, PhD, FNP-C

Kerry Nolte is an assistant professor of nursing at the University of New Hampshire and continues her clinical practice as a Family Nurse Practitioner at Families First, a Federally Qualified Community Health Center. In her clinical work, Kerry is particularly concerned with engagement in care and supporting people who use drugs. She received her MS in nursing from UNH and her PhD in nursing from Northeastern University. Her international experience includes serving on Project Hope in the South Pacific and leading global education programs for UNH in Ghana. Kerry’s research interests focus on communication and reducing harms associated with using drugs. Her previous inquiry has focused on HIV prevention in vulnerable population. Kerry serves the NHNPA working on policy and represents NHNPA on the Governor’s Commission on AOD Healthcare Task Force. NHNPA congratulates Kerry as one of the authors of,Have Yhe Conversation: Caring for People Who Inject Drugs, A Guide for NH HealthCare Providers.





Dorothy Mullaney

This year’s lifetime of service award was given to Dorothy Mullaney. She is the director of associate providers at Dartmouth Hitchcock Medical Center. She is an instructor in pediatrics at Geisel Medical School of Medicine. She joined Dartmouth Hitchcock Medical Center in 1999. Dorothy received her Master’s in Health Sciences from McMaster University in Hamilton, Ontario, after receiving her baccalaureate from Saint Anselm College. In 2013 she was awarded her DNP from Northeastern University. During the last 20 years, Dorothy has served the New Hampshire Nurse Practitioner Association and NH NP’s in various leadership roles. On the board of nursing, she has been a member of the liaison committee and prior to full scope authority, she served on the prescriptive practice committee. Dorothy is committed to the role of the nurse practitioner. She has unified her team at DHMC as the “go to” person. Her selection as the first director of associate providers speaks volumes as to the esteem she is held in. Dorothy is a tremendous treasure to all of us. But most importantly to the tiny babies and families she cares for. At the the community hospitals throughout NH, the sound of the helicopter or ambulance siren alerted us that help was on the way. But it was Dorothy’s calm and confident voice that put us at ease.

Ginny Wright

This week's spotlight is Ginny Wright. Ginny was recently awards the NP of the Year, 2017, by the NHNPA. Ginny Wright work at Crossroads Family Practice in Concord. Ginny was honored at the Northeast Regional Annual Conference in Newton, Ma in May. Her family surprised her by joining her at the ceremony. Ginny was recognized with this honor for her successes in practice, for mentoring students and for helping to advance independent practice of NP's through her service to the NHNPA.

Ginny has been successful in blending an understanding of medicine with good nursing care focusing on keeping patients and staff laughing by being a positive role model. One of her coworkers said, she makes "any bad day into a great day at work." Her patient panel consists of multi-generational families. She has mentored many students, some of whom have continued to work at Crossroads. Due to her service to patients, students and NHNPA, Ginny has been recognized as the 2017 NP of the Year. Congratulations

Legal medical marijuana reaches milestone in NH

Lisa Withrow, APRN, owner of Palliativity Medical Group in Bedford, has certified hundreds of patients for therapeutic cannabis. (Allegra Boverman/Union Leader) 

It's been one year since New Hampshire's first therapeutic cannabis dispensary opened, and more than 3,000 Granite Staters are now registered with the state as patients.

But some doctors reportedly are still reluctant to participate in the state-run program. A recent report to lawmakers by the program administrator identified "patient access due to lack of provider participation" as an ongoing challenge.

As of April 7, 722 medical providers have certified patients for the program, according to the state Department of Health and Human Services.

Bedford family nurse practitioner Lisa Withrow, who said she has certified hundreds of patients for the program, said many of them have told her they can't find another provider willing to certify them for medical marijuana. She said one concern among providers is the Drug Enforcement Administration's listing of cannabis as a Schedule I drug, meaning it has a high potential for abuse and no accepted medical use.

Two years ago, Withrow, an advanced practice registered nurse (APRN) started Palliativity Medical Group, an outpatient palliative care center. Formerly the director of palliative care services for Elliot Health System, she also has worked as a home-care nurse, hospice visiting nurse and hospital oncology nurse.

Palliative care, Withrow said, "is a medical specialty that focuses on the patient and how they're feeling as they're living with chronic and serious illness or illnesses." She said cannabis can improve the quality of life for such patients.

"I'm not saying it's a wonder drug, but for the right person, for the right condition, it can really bring some benefit," she said.

Most of her patients don't want to smoke cannabis; they rely on edibles, tinctures and salves to relieve their symptoms, Withrow said.

New Hampshire's therapeutic cannabis law specifically states that providers are not required to participate. It also says those who do cannot be subject to arrest or prosecution by state or local law enforcement.

For a patient to obtain medical marijuana here, a doctor or advanced practice registered nurse (APRN) must certify that the patient has both a "qualifying medical condition" (such as cancer, glaucoma, HIV or Parkinson's disease) and one of the symptoms specified in the law (such as severe nausea, vomiting, seizures or chemotherapy-induced anorexia).

Providers must have a relationship with patients for at least three months before they can certify them for the program. They don't write prescriptions for cannabis; they only certify that their patients have qualifying conditions and symptoms. Patients then send that certification with their applications to DHHS, which issues patient registry cards.

Michael Holt, therapeutic cannabis program policy administrator at DHHS, said he hears anecdotally from patients that physicians are either unwilling to sign the certification papers "or are prohibited by their practice or hospital group from participating in the program."

But officials at Dartmouth-Hitchcock, Elliot Health System, Catholic Medical Center and Lakes Region General Hospital in Laconia all said they have no such prohibition. And a spokesperson for the New Hampshire Hospital Association said she knows of no hospital here with such a policy.

"We leave it to the individual physician's discretion to determine the most appropriate treatment for the patient," said Clarence Adams, spokesman for Dartmouth-Hitchcock.

Greg Baxter, chief medical officer for Elliot Health System, also said it's up to physicians to decide whether to certify certain patients for the program. "I neither direct them to nor prohibit them from doing so."

Baxter said he regularly interacts with other chief medical officers and is unaware of any that have such policies either.

When New Hampshire was first creating its medical marijuana program, Baxter attended a medical conference where he and his peers were discussing how they were going to handle the issue. And the answer was simple, he said: "We're not. The doctors are going to decide whether they're going to access this regimen, and that's how we're going to handle it."

When patients say their doctors won't certify their medical conditions or symptoms, Holt said he recommends that they check with their other medical providers. But he said, "If all their doctors say no, it is up to the patient to identify a provider who will certify them, and perhaps switch their medical care."

That's not ideal, Holt acknowledged, which is why he cited the lack of providers as an ongoing challenge in his recent report on the program for a House oversight committee. "I want to make sure that the Legislature knows this is one of the issues that patients are facing," he said.

Brett Sicklick is chief operating officer for Prime Alternative Treatment Center in Merrimack, the last of the four state-licensed ATCs to open last year. As of last week, there were 938 patients registered with his facility.

Sicklick said he hears from his patients all the time that their doctors are unwilling to certify them for medical marijuana. "It's unfortunate, because that patient then has to start a relationship with a new provider, really just for the purpose of certifying them for the program," he said. "It's sad, but it's one of those realities."

Lawmakers this session have passed similar versions of House and Senate bills to add chronic or severe pain to the list of qualifying conditions. But they rejected proposals to add opioid addiction and post-traumatic stress disorder (PTSD) to that list.

APRN Withrow testified at legislative hearings in favor of adding chronic pain and PTSD to the list of qualifying medical conditions.

Withrow said 90 to 95 percent of the patients she has certified have chronic pain. "All of them have shown significant reduction" in the amount of opioids, muscle relaxers and psychotropic drugs they take, she said, and many have gotten off those medications altogether.

"That's what the patients want," she said. "They don't want to be on these things."

David Landry of Hillsborough took painkillers for 15 years after he injured his back while working for a moving company. Along the way, he realized he was addicted, and he got into a methadone program.

After Landry underwent lung surgery recently, his doctor at Catholic Medical Center suggested cannabis could alleviate both his chronic pain and his dependence on opiates. He began using cannabis edibles, tinctures and oils, weaning himself off the other drugs.

And now, for the first time in 15 years, he said, "A little over five weeks, I've been clean."

Landry, who is married and has four children, said his health is improving and he's trying to get back into the workforce.

"I'm proud of where I am now," he said. "I need to get back into the real world."

He credits his doctor for suggesting cannabis. "I was actually surprised with her bringing it up to me," he said. "I'm also really grateful that she did, because I wouldn't be where I am today without her."

The state's therapeutic cannabis program may be gaining acceptance, but the Legislature continues to oppose recreational marijuana use.

While voters in Massachusetts and Maine legalized marijuana last year, Senate lawmakers here last month killed a bill to do. The House did pass a bill to decriminalize possession of small amounts of marijuana; it is currently before the Senate Judiciary Committee.

Sicklick from Prime ATC contends cannabis is safer than "a lot of the medications that are being prescribed all day every day without much regard."

"This was used for medicinal purposes for thousands of years, and it's only within the past 70 years or so that it hasn't been deemed to have medicinal purposes," he said.

"If we found this plant in the Amazon today," he said, "it would be hailed as the greatest miracle for health care that we've come across."

[email protected]

Marilyn Daley DNP, APRN

Dr. Daley is a family nurse practitioner and a Doctor of Nursing Practice serving as Clinical Director of the New England Heart & Vascular Institute Cardiomyopathy Clinic at Catholic Medical Center. She has been a co-author on numerous publications, most recently in the American Journal of Cardiology in 2015. She is the Chair of the Advanced Practice Provider committee at CMC and recently played an integral part in the granting of a seat on the Medical Executive Committee with voting rights for Advanced Practice Providers. Dr. Daley is also full-time faculty in the DNP program at Rivier University.

Charlotte Houde Quimby, CNM.

Charlotte passed away unexpectedly at age 78 earlier this month, and she will be sorely missed by her family and friends, her community, and the legion of families who benefited from her passion, intelligence, energy, boundless love, and unfailing efforts to promote health and wellness among women and children in New Hampshire and around the globe. She graduated from St. Anselm College cum laude in 1960 with a BS in Nursing, among the first generation of university educated nurses. She married Robert Joseph Houde, St. Anselm 1960, and began her personal and professional life in the age of Kennedy’s Camelot. She became a maternity nurse at the Central Maine Medical Center. After having six children of her own, she committed herself to ensuring that pregnant women had the most satisfying experience possible when delivering their babies. She made this her life’s mission. She was accepted to the Yale School of Nursing and earned her Master of Science in Nursing degree and Certified Nurse Midwife (CNM) designation in 1972. At the time, Yale did not offer clinical privileges to CNM’s. Undeterred, Charlotte packed up her six children, the youngest still in diapers, and they all spent the summer in a tent in Stone Mountain Park in Georgia so that she could complete her residency at Grace Hospital. Back in New Haven, the burgeoning women’s rights movement was reflected in Charlotte’s life and work, as women were demanding more input into the decisions around their own deliveries. Charlotte was eager to represent and advocate for women and families and chose midwifery as her path to do so. Charlotte improved care for underserved women throughout New Haven, developing a prenatal program within the Fair Haven Health Clinic as a volunteer. She delivered hundreds of babies at Yale-New Haven Hospital and helped to educate the next generation of nurse midwifes, serving as an Assistant Professor at the Yale School of Nursing from 1973-1978 and chairing the Maternal-Newborn Program for three years. In 1977 she was awarded the Yale University School of Nursing Distinguished Alumna Award for her pioneering work. Her first husband’s untimely death in 1978 left her as a single mom of six children aged 9 to 17. The bonds of friendship and support that were forged during that difficult time will never be broken. Charlotte’s home in North Branford also became a safe haven for adolescents who forever benefited from her wise counsel on their often-questionable decision-making skills. No topic was off limits at Charlotte’s home, and given that she was a midwife, you can imagine the breadth of discussions that took place! Despite her long work weeks and full schedule with her own six children, “Ms. Houde” served as a second mom and mentor to dozens more. In 1983 Charlotte was hired by DHMC in Hanover, NH, to build its new midwifery program from the ground up. In addition to building the DHMC midwifery program and delivering hundreds of Upper Valley children at DHMC, Charlotte was privileged to witness the births of many of her own grandchildren, a special gift for all involved. After her “retirement” from DHMC in 1990, she still had plenty to give. She spent the next 10 years building programs supporting prenatal care and safe midwifery practices to reduce infant mortality in Senegal, Uganda, Vietnam, and Indonesia. She settled back down in Meriden and decided to pursue change through political means. She was elected to the Plainfield School Board and, later, to two terms as Plainfield’s Representative to the NH State House. Charlotte worked tirelessly for women and families throughout her life. Poignantly, her final achievement in the field was published just last week: “The CenteringPregnancy® Model.” This book represents a fitting capstone to an incredible life story and groundbreaking career. Despite the fact that Charlotte spent an inordinate amount of time caring for women’s bodies, she never lost track of the fact that the key to everything was each person’s heart and soul. She poured her whole self into her family, friends, and work. We are all the better for it.


Ms. Wright is certified as both a family and adult nurse practitioner and is the owner of two nurse practitioner operated clinics within New Hampshire called Wright and Associates Family Healthcare. She is also the founder of the NH Chamber of Entrepreneurial Nurse Practitioners, an organization designed to assist nurse practitioners with independent practice issues. We recognize her this week as we celebrate her most recent publication in Nursing Administration Quarterly. Her article titled “New Hampshire nurse practitioners take the lead in forming an accountable care organization” highlights the quality and cost effective care that nurse practitioners provide in this state.

New Hampshire NPs Take the Lead in Forming an Accountable Care Organization

Margaret Frankhauser

The New Hampshire Nurse Practitioner Association is excited to announce a new opportunity we have created to recognize the wonderful work our friends and colleagues are doing to promote our profession and wellbeing of our patients. If you know of someone who deserves recognition for the work they do, please let us know by clicking on the link below!

Margaret Frankhauser has been working as the Executive Director of Central NH VNA and Hospice. She has also worked in the National Health Service Corps, with the NH Department of HHS, and as a Program Chief with the Bureau of Disease Control. She was named to the Robert Wood Johnson Foundation Executive Nurse Leader Fellowship. She has served on numerous national and state task forces and worked tirelessly with the NH Board of Nursing representing APRNs. Her tireless work ethic, passion for leadership, and support has shaped our profession since 1985. We wish her luck as she transitions to Colorado to work as the CEO of the Next Fifty Initiative.