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A targeted promotional DVD fails to improve Māori and Pacific participation rates in the New Zealand bowel screening pilot: results from a pseudo-randomised controlled trial
Karen Bartholomew1,
Lifeng Zhou1,
Sue Crengle2,
Elizabeth Buswell1,
Anne Buckley1 &
Peter Sandiford ORCID: orcid.org/0000-0002-1823-24621,3
BMC Public Health volume 19, Article number: 1245 (2019) Cite this article
New Zealand's Bowel Screening Pilot (BSP) used a mailed invitation to return a faecal immunochemical test. As a pilot it offered opportunities to test interventions for reducing ethnic inequities in colorectal cancer screening prior to nationwide programme introduction. Small media interventions (e.g. educational material and DVDs) have been used at both community and participant level to improve uptake. We tested whether a DVD originally produced to raise community awareness among the Māori population would have a positive impact on participation and reduce the proportion of incorrectly performed tests (spoiled kits) if mailed out with the usual reminder letter.
The study was a parallel groups pseudo-randomised controlled trial. Over 12 months, all Māori and Pacific ethnicity non-responders four weeks after being mailed the test kit were allocated on alternate weeks to be sent, or not, the DVD intervention with the usual reminder letter. The objective was to determine changes in participation and spoiled kit rates in each ethnic group, determined three months from the date the reminder letter was sent. Participants and those recording the outcomes (receipt of a spoiled or non-spoiled test kit) were blinded to group assignment.
2333 Māori and 2938 Pacific people participated (11 withdrew). Those who were sent the DVD (1029 Māori and 1359 Pacific) were less likely to participate in screening than those who were not (1304 Māori and 1579 Pacific). Screening participation was reduced by 12.3% (95% CI 9.1–15.5%) in Māori (13.6% versus 25.9%) and 8.3% (95% CI 5.8–10.8%) in Pacific (10.1% versus 18.4%). However, spoiled kit rates (first return) were significantly higher among those not sent the DVD (33.1% versus 12.4% in Māori and 42.1% versus 21.9% in Pacific).
The DVD sent with the reminder letter to BSP non-responders reduced screening participation to an extent that more than offset the lower rate of spoiled kits.
Australia and New Zealand Clinical Trials Registry ACTRN12612001259831. Registered 30 November 2013.
Waitematā District Health Board (DHB) is responsible for a population of approximately 600,000 people in the north and west of Auckland, New Zealand (NZ). Waitematā DHB conducted a pilot of a Bowel Screening programme (BSP) from 2012 to 2017 to inform the potential introduction of an organised colorectal cancer screening programme in NZ [1]. The BSP mailed an immunohistochemical Faecal Occult Blood (iFOBT) self-test kit to all male and female Waitematā residents aged 55–74 years on the BSP population register, which was based on the National Health Index (a unique identifier given to all users of publicly funded health services). The pilot pathway comprised a pre-invitation letter, mailed self-test kit four weeks later, self-test completion, and return of results (via the participant's general practitioner if positive). Non-participation resulted in a reminder letter being sent four weeks after the iFOBT was sent. For Māori, Pacific and Asian ethnicity invitees, a phone call follow-up was made concurrently with the reminder letter.
Strategies to optimise ethnic-specific participation in screening programmes are of international interest. Lessons on successful strategies from well-established screening programmes such as breast and cervical screening have been applied to colorectal cancer screening [2, 3]. A variety of interventions for colorectal cancer screening, in both organised and opportunistic settings, have been examined across patient, provider, organisation and policy intervention levels [4,5,6]. Interventions intended to increase participation at the patient level have emphasised the provision of 'small media' (health education or promotional materials e.g. brochures, booklets, video/DVD) in the context of screening invitation and follow up of non-participation.
The rationale for small media intervention is to act on social cognitive variables such as knowledge or attitude, aiming to reduce barriers such as risk perception or fear of the test [7]. While there is good evidence that small media does improve knowledge and facilitates a more favourable attitude to screening tests, there is equivocal evidence of the link between this and improved screening participation [4]. Many studies have demonstrated that some educational material has a positive impact on screening participation (variable range of effect depending on the kind of intervention and the setting) [2, 3]. There is also evidence that the provision of more detailed risk or test based information reduces screening participation (although informed consent may be increased) [8].
The BSP offered an opportunity to test whether a targeted bowel cancer screening health promotion DVD would raise participation and/or reduce the rate of incorrectly performed tests (referred to henceforth as the spoiled kit rate). The DVD focused on the indigenous Māori population and was developed locally for community awareness raising activities. This study examines its impact on Māori and Pacific screening participation when utilised as an adjunct to the usual non-participation reminder letter.
DVD development
A locally produced six-minute promotional DVD was developed as a tool for Māori community awareness-raising as part of a suite of activities aimed at increasing Māori BSP participation. That is, it was not developed as an adjunct to the bowel screening test kit process. The DVD was intended to be viewed in a range of community settings. A famous Māori rugby player delivered key programme messages aimed at improving knowledge and reducing barriers, including the ease and cleanliness of the test, and key features of invitation and programme participation. The DVD also featured two well-known local Māori elders presenting a narrative description of their programme participation experience. This narrative emphasised the importance of the test, the ease of the test, the nature of return of results and the positive experience of the diagnostic follow-up test. Although the intended audience were Māori, it was felt that many Pacific people would also be able to identify with the experiences portrayed by the protagonists.
Māori and Pacific ethnic group's participation in the first year of the BSP was considerably lower than other ethnic groups (including Asian, NZ European and Other ethnicities) the DVD intervention was tested in both groups. In New Zealand ethnicity is self-identified and respondents may select multiple ethnicities. For both invitation and analysis prioritised ethnicity was used where, in accordance with Ministry of Health Standards, Māori overrides all other ethnicities, Pacific overrides all but Māori and Asian ethnicity is recorded in priority to European [9, 10].
For a 12-month period from 4 January 2013 to 31 December 2013, all Māori and Pacific people who were enrolled in the BSP but did not return a test kit within the usual programme interval of four weeks were classified as non-responders and included in the study.
Intervention and control groups
The intervention consisted of including the promotional DVD with the reminder letter sent out to people who had not responded (non-responders) to the initial screening invitation. The control group was comprised of non-responders who were only sent the usual reminder letter.
Group allocation
Following the pilot programme's existing procedures, reminder letters were generated in batches 3–4 times a week for eligible individuals (Māori and Pacific) once the time from the date of being sent an invitation had exceeded 4 weeks without a test kit being returned to the Coordination Centre. All Māori and Pacific participants were identified for each batch of reminder letters manually. Participants with both Māori and Pacific ethnicity were assigned to the Māori group in accordance with the prioritised ethnicity procedures described above. Study participants were allocated to the DVD plus reminder letter or reminder letter only groups on alternate weeks. DVDs required a slightly larger envelope than the reminder letter alone.
Recruitment monitoring performed approximately halfway through the trial revealed an imbalance in group accrual with more individuals being assigned to the intervention than the control group. This was found to be mainly due to the timing of batches for the reminder letters. To correct the imbalance, the weeks assigned for intervention and control were reversed at week 35 in the study.
There was also some inconsistency in whether the participants were correctly sent DVDs or not according to their DVD/no DVD week allocation according to records kept of who was sent a DVD. This resulted in a slightly lower proportion being sent a DVD than should have been the case if the protocol had been followed correctly (45.3% versus 49.3%). This was mainly due to allocation of patients who became eligible during weekends. To test for any systematic bias a logistic regression model compared those who were misallocated (i.e. incorrectly sent DVDs in a 'non-DVD week' or not sent a DVD in a 'DVD week') with those who were correctly sent DVDs or not according to their allocated week. This found no significant differences between them in ethnicity, gender, age or deprivation quintile. On this basis it was concluded that the misallocation was completely at random and we conducted all analyses on a per protocol basis. The logistic regression results and a separate analysis on an 'intention to randomise' basis is provided as Additional file 1.
There were two pre-specified primary outcomes of interest for the study: the difference in participation and the difference in spoiled kit return associated with being sent the DVD. Participation in the BSP was defined by the return of a test kit regardless of the result (positive, negative or 'spoiled kit'). Participation was censored at three months post reminder letter generation in accordance with BSP standard operating procedure. 'Spoiled' kits are samples which cannot be analysed for one reason or another (e.g. no date on the specimen). A return was considered spoiled if any of the kits returned by that individual were spoiled. Those returning spoiled kits were sent replacement kits with an explanation as to why the previous sample was not usable.
Two non-prespecified secondary outcomes were analysed: the 'Good first kit' return rate (first kit returned was not spoiled hence the number of spoiled kits was zero) and the 'Any good kit' return rate (a good kit was returned at some stage and hence a test result was obtained).
The trial was powered to detect a 5% difference in participation between intervention and control groups in both primary outcomes. Self-identified ethnicity was sourced from the BSP Register (ethnicity as recorded on the National Health Index). Prioritised ethnicity was used in analyses. Area deprivation was determined using the New Zealand Index of Deprivation 2006 (NZDep06) and grouped into quintiles from most deprived (Quintile 5) to least deprived (Quintile 1) [11, 12]. Participants who withdrew from the BSP within 3 months of the DVD/reminder letter were excluded from the analysis.
Wilson 95% confidence limits were calculated for all proportions and differences between proportions by Newcombe's method without continuity correction [13, 14]. Separate pre-specified analyses were performed for Māori and Pacific invitees since it was hypothesised that the DVD might have more impact on Māori than Pacific ethnicity recipients. The Fleiss test of homogeneity of risk differences was used to assess whether a pooled Māori and Pacific analysis would be valid [15]. A log-binomial regression model was fitted to assess whether the impact of the DVD on outcomes changed after controlling for potential confounding by age, sex and deprivation. A separate model was fitted for Māori and Pacific. Data was analysed in Excel®, SAS® 9.4 and Stata® 13.
After 12 months 5271 people (2333 Māori and 2938 Pacific) were randomised (see Consort Diagram in Fig. 1). Of those 2388 were sent a DVD with the reminder letter and 2883 just the usual reminder letter, the difference being attributable to the initial imbalance in group allocation resulting from the pseudo-randomisation process as described above. Table 1 shows that the DVD group did not differ from the no DVD group in demographic characteristics that are known to influence screening participation overall (ethnicity, age, sex and deprivation).
Consort Diagram
Table 1 Demographic characteristics of those who were sent the DVD compared with those who were not
Table 2 presents results from bivariate kit return (participation) analysis. It shows that for Māori, bowel cancer screening participation was 25.9% in the No DVD group and 13.6% in the DVD group. This is a 12.3% absolute reduction in participation and a 48.4% relative reduction in screening participation for Māori who were sent the DVD compared with Māori who did not. For the Pacific ethnicity group participation was 18.4% for the No DVD group and 10.1% for the DVD group, a 8.3% absolute and 45.1% relative reduction in participation. The Fleiss test for homogeneity of the risk difference rejected the null hypothesis (p = 0.043) which demonstrates that there was a significantly stronger absolute reduction in participation associated with being sent a DVD in Māori (compared with Pacific) that was more than should be expected by chance. For this reason, pooled analysis of kit return rates for two ethnic groups is not presented in Table 2. In a non-prespecified analysis it heterogeneity was detected between Māori males and females in kit return rates (p = 0.035); this was of borderline significance for Pacific (p = 0.075), with a stronger negative effect on participation observed in males than females. The table shows that being sent a DVD had a larger negative effect on participation among males than females.
Table 2 Kit return in DVD and No DVD groups by ethnicity and sex
Analysis of the spoiled kit rate is presented in Table 3. The spoiled kit rate for Māori who returned a test kit was 12.4% in the DVD group compared with 33.1% in those who were not sent a DVD, an absolute difference of 20.7% and a relative reduction in kit spoilage associated with being sent a DVD of 62.5%. The corresponding figures for the Pacific group were 21.9% kit spoilage in the DVD group, and 42.1% in the No DVD group with a risk difference of 20.2% and a relative reduction associated with the DVD of 47.9%. In this case the Fleiss test for homogeneity of risk difference was not significant (p = 0.92), suggesting that although Pacific had higher spoiled kit rates, the effect of the DVD on (reducing) the spoiled kit rate was similar for Māori and Pacific, and hence a pooled analysis is presented in Table 2 for this outcome, where the combined risk difference was 20.1%.
Table 3 Comparison of spoiled kit rates between the DVD and the usual participant reminder letter groups by ethnicity
Given that return rates were higher without the DVD, but spoiled kit rates were lower with the DVD, a secondary analysis to test whether there was an offset in benefit was conducted. This secondary analysis compared the proportions in each group where a non-spoiled kit was received on the first return (Additional file 1: Table S2). In Māori these were 11.9% among those sent the DVD and 17.3% among those who were not sent it (difference 5.5%; 95% CI 2.6–8.3%) and in Pacific they were 7.9 and 10.6% respectively (difference 2.7%; 95% CI 0.1–4.8%). These differences are considerably smaller than those based on all kit returns, but remain significant, showing that the DVD was associated with a lower rate of non-spoiled kit return. If subsequent non-spoiled kits are included in the calculation, then the differences widen again as some of those who initially returned a spoiled kit subsequently returned a non-spoiled one. In this case the (any) non-spoiled kit return rates in Māori were 13.4% among those sent the DVD and 22.2% in those not sent it (difference 8.8, 95% CI 5.6–11.8%) and for Pacific 9.6% in the DVD group and 14.5% in the No DVD group (difference 4.9%, CI 2.5–7.2%).
The log-binomial regression analysis (Table 4) established that the significant association between being sent a DVD and lower bowel screening participation was not confounded by gender, age or deprivation for either Māori or Pacific ethnic groups. The reduction in participation associated with the DVD was very similar to that found in the bivariate analysis (46.0% vs 45.6 and 44.9% vs 41.5% respectively for Māori and Pacific). The lower Spoiled kit rate among those sent the DVD was also unaffected by controlling for gender, age and deprivation. In the log-binomial regression model the DVD was associated with 60.0% lower spoiled kit rate for Māori compared with 62.5% in bivariate analysis; for Pacific the corresponding figures were 49.7 and 47.9%.
Table 4 Log-binomial regression models of outcomes
Small media interventions are often developed and delivered in a health setting assuming that they will have a positive impact (or at least do no harm) without any rigorous evaluation of their impact. They may be developed for population-wide application or tailored to a target audience. Tailored approaches relevant to improving ethnic-specific screening participation using small media include: use of culturally informed narratives; promotional messages delivered by group members; messages targeting particular health beliefs; use of culturally appropriate language and visual appeal; or targeted health literacy approaches [16,17,18]. There is some evidence that favours visual or video-based strategies both as a community awareness raising strategy (increased community demand) and a patient focused strategy [19,20,21,22]. The evidence base for tailored approaches suggests they work best as part of a multi-level approach in organised screening programmes, including phone follow-up or navigator-based approaches [23,24,25].
In the Waitematā DHB bowel cancer screening pilot, which used a mailed test kit, people chose to participate at home with little or no interaction with their healthcare provider. An invitee's decision is likely to have been influenced by the written information accompanying the test.
The BSP Steering Group fully expected that the DVD would have a positive impact on screening participation in Māori and possibly Pacific despite being designed for community awareness raising. At worst it was thought the DVD might have no impact on participation. This view was consistent with the evidence base for the impact on participation of small media which supports a positive effect [4, 26], with studies showing either no difference or a positive effect of up to 14% specifically with video/DVD material [19, 20, 27]. The finding that the DVD led to lower participation was therefore disappointing and quite unexpected for the BSP Steering Group (although the result is not inconsistent with previously published research on small media interventions which has highlighted the risks of 'information overload'). It was therefore a salient lesson regarding the importance of rigorous evaluation, even of apparently innocuous interventions, to avoid these becoming an established component of healthcare delivery in the absence of prior evidence for their efficacy.
In retrospect several possible causes for the reduced participation in the DVD group can be identified: potential participants may have found the DVD itself off-putting (with or without viewing it); some may have viewed the DVD and found the content problematic; and others possibly viewed the DVD and made an informed decision not to participate on the basis of their increased knowledge. There is a well-known relationship between the provision of more information and reduced participation in screening [28,29,30,31]. An example of this was the 16% reduction in participation seen in an Australian trial of a colorectal screening decision-aid intervention for socioeconomically disadvantaged populations [8]. However, most reports in the literature of reduced screening participation from small media interventions relate to lengthy educational booklets or intensive decision-aid techniques aimed at improving knowledge and informed consent which were not the focus of this DVD.
Though the content of the DVD may not have been ideal for use as a reminder adjunct, it is difficult to see how it would have led to the observed negative effect on screening participation. It incorporated both narrative and educational components to improve knowledge and reduce barriers to participation. The protagonist in the narrative was a woman, which may have discouraged some men, but the observed reduction in participation was significant for both sexes. This approach was advocated for, and endorsed by Māori health providers at the outset of the BSP [32].
Rather than being due to the content of the DVD, a more plausible reason for lower participation in those sent the DVD could be that some of these individuals felt that it was necessary to watch the DVD before performing the test. If they did not own a DVD player or did not have the time to watch it this would have represented a barrier to participation. No reason for providing the DVD was included with the reminder letter.
The lower rate of spoiled kits in those sent the DVD is difficult to interpret. Whereas it is tempting to attribute this to guidance provided within the DVD on how to perform the test, it is also possible that with a higher kit return rate, the additional participants in the No DVD group were individuals who had (unmeasured) characteristics that made them more likely to return a spoiled kit. Among those who returned kits, the No DVD group had a higher proportion of males than the DVD group (49% vs 39%), but the DVD attributable reduction in rate of spoiled kits was not significantly different between males and females (19.7% vs 19.8%). Other demographic factors did not vary greatly between the groups either. The spoiled kit rate in the BSP was very high initially (and at the time that this study was conducted). Further reductions in the spoiled kit rate were seen after a redesign of the test kit instructions and accompanying materials that was undertaken after this project finished.
The pseudo-randomised trial design was a convenient, efficient and practical approach in the context of an ongoing real-world programme, but in retrospect randomisation at the level of the individual might have avoided some of the problems noted in the methods section such as the unequal accrual rate in the DVD and No DVD group (although we have shown that it is unlikely to have introduced any bias – see Additional file 1 for details).
In this study we were unable to examine the reasons for reduced participation or record which DVD recipients watched the video. The literature suggests that other DVD media have relatively low uptake in terms of audience viewing with reasons provided by patients including lack of time, fear of cancer and not having a DVD player [33]. DVD viewing was found to be higher and related to improved screening participation in physician-based opportunistic colorectal cancer screening settings which is unlikely to be relevant to the BSP [21].
It was anticipated that the targeted nature of the DVD in this study would have no effect or could produce a small marginal gain in screening participation for Māori, and potentially Pacific people in the context of the BSP. It was also hypothesised that it might lead to a reduction in spoiled kits, which at the outset of the BSP was a significant problem. Instead we found that the DVD intervention was associated with lower screening participation in both these priority groups, whose participation was already below the rest of the eligible population. Although the DVD was also associated with a reduced spoiled kit rate, this was not sufficient to offset the lower participation so that even the return rate for non-spoiled kits was lower in the intervention group. This study adds to the literature on the impact of specific types of small media intervention and it provides a reminder that the potential for harm in interventions can easily be overlooked if these are not subject to rigorous assessment prior to introduction as part of routine practice.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Bowel Screening Pilot
DHB:
District Health Board
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The authors would like to acknowledge the support of Gaye Tozer, the Director of the Bowel Screening Pilot and Debbie Holdsworth the Chair of the BSP Steering Committee for their encouragement and support of this research.
The study received no dedicated funding. Costs were covered within the NZ Bowel Screening Pilot which was funded by the NZ Ministry of Health with in-kind contributions from Waitematā District Health Board. The Ministry of Health played no other role in the study.
Waitematā District Health Board, 15 Shea Terrace, Takapuna, Auckland, 0740, New Zealand
Karen Bartholomew, Lifeng Zhou, Elizabeth Buswell, Anne Buckley & Peter Sandiford
Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, 9054, New Zealand
Sue Crengle
School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
Peter Sandiford
Karen Bartholomew
Lifeng Zhou
Elizabeth Buswell
Anne Buckley
KB managed the implementation of the trial, contributed to design, analysis and interpretation, and wrote first draft of the paper; LZ was responsible for statistical analysis and advised on key aspects of design and interpretation of the results; SC provided input into the design, conduct, analysis and interpretation of the trial with specialist knowledge in the area of Māori health; AB was responsible for data management and provided in-depth knowledge of the BSP; EB was responsible for the development of the DVD intervention; PS conceptualised the trial, provided oversight of all aspects and prepared the final draft of the manuscript; all authors reviewed and read, commented on and approved the final manuscript.
Correspondence to Peter Sandiford.
Separate informed consent for this study (additional to the BSP consent) was not sought from participants because the purpose of this health services research was to test uptake, consent would have been impractical and may itself have reduced participation in the screening. Ethical approval with waiver of consent was received from the NZ Health and Disability Ethics Committee (12/NTA/91).
Supplementary material. (DOCX 41 kb)
Bartholomew, K., Zhou, L., Crengle, S. et al. A targeted promotional DVD fails to improve Māori and Pacific participation rates in the New Zealand bowel screening pilot: results from a pseudo-randomised controlled trial. BMC Public Health 19, 1245 (2019). https://doi.org/10.1186/s12889-019-7582-7
Received: 12 January 2019
Bowel cancer screening
Small media interventions
Faecal immunochemical test
Screening participation
Ethnic inequalities
Health behavior, health promotion and society


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Q: How to Define String Writer Length I have a Writline C# code. However each query will bring back a diffrent length (to be populated in a excel database). I can get the length, but I am unsure how to define the n value in the Writline query below (where n will be diffrent each time, I can get the length, but how to define the writeline). Many thanks.
sw.WriteLine(string.Format("\"{0}\",\"{1}\",\"{2}\",\"{3}\......n)

A:
I can get the length

Then you can make a format string:
var fmt = string.Concat(Enumerable.Range(0, theLength).Select(i => "{" + i + "}"));

If theLength is 3, your fmt string ends up as "{0}{1}{2}"

Other helpful factoid. The compiler takes this:
string.Format("....", a, b, c, ...);

And turns it into something like this:
var an_array = new object[]{ a, b, c, ... };
string.Format("...", an_array);

So if you already have an array there's nothing stopping you supplying it:
string.Format(fmt, your_array);

Methods that take a params arg are internally rewritten to take the N number of params as an array; you're always allowed to shortcut that and provide the array

redpajama_set_name: RedPajamaStackExchange


OK I admit it ... I saved some bits of brass from the other projects. Back to the patterns I go to find another project that uses brass and there it is ... The Cider Keg. A really easy project to carve (at least the barrel) and the brass work wasn't bad. Now the spicket was a bit of a challenge as I carved down some dowel pieces. Hand drilled the holes, using an old x-acto knife and a small drill.


text:
Working with vibrant colors, lines, and shapes I build upon the interplay of these elements, either realistic or abstract, which then take on their own life and direction. The experience of the moment directs me to my next step. Building the image on either paper or canvas is never preconceived and I do not know the outcome. Each experience is a delightful journey with the hope that others may enjoy that journey.
Mediums used are pastel, charcoal, colored pencil, acrylic and watercolor.
Artist Sydney Smith holds a Bachelor of Fine Arts degree from The Kansas City Art Institute and a Master of Arts in Printmaking from the University of Iowa under the mentorship of Mario Lasansky.
Ms. Smith taught elementary grades Kindergarten through Grade 2 for twenty years in the Los Angeles Unified School District. There, while teaching the Magnet Kindergarten class, she acted as the Elementary School's Art Show Coordinator for the Visual and Performing Arts Magnet School, an affiliate school of the University of Southern California. There, she wrote art lessons for the elementary grades along with creating a ceramic experience for students at the USC Ceramics Department.
Since retirement, Ms. Smith has relocated to Beverly, Massachusetts and maintains a studio at Porter Mills Studio, 95 Rantoul Street – Studio 2-6. She takes appointments for viewing her work, commissions, and art lessons considerations.

redpajama_set_name: RedPajamaCommonCrawl


text:
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Telehealth Gone Wrong? Not After These Videos
Tom Augello
CRICO Home
Telehealth Lessons Learned
Skip to a section
"I often say to physicians, especially doctors that have been in practice for a while, we have a sixth sense about things—don't ignore that."
In a just-released video series, called "What Not to Do: Telehealth Lessons Learned," David L. Feldman, MD, FACS, speaks to clinicians and administrators delivering telehealth services—an unfamiliar mode of care for some of them before the start of the COVID pandemic. Dr. Feldman is a surgeon in New York who is a telehealth expert and CMO for The Doctors Company and TDC Group, a leading provider of medical professional liability insurance and risk and patient safety services.
Virtual visits can involve patients calling into their video appointment from the supermarket…fuzzy computer screens during examinations…even doctors "visiting" the wrong patient. These challenges and more present additional clinical and liability risks to busy practices delivering telehealth.
The video series was a brainchild of Candello and TDC, a member of Candello's national collaborative of malpractice insurers who pool malpractice data and share expertise. Candello is a division of CRICO with a database representing a third of all open and closed malpractice cases in the U.S..
Although the number of negligence lawsuits based on this mode of care is relatively small, the two companies shared a concern that a push to utilize the technology in new ways, with providers and practices who are unfamiliar with the processes, could lead to a rise in those claims.
"It's fairly new for some providers, and so many places have been fully occupied just standing these services up, that the opportunities for QI education and training to do it well haven't necessarily always been there,"
says Pat Folcarelli, RN, PhD. She is Vice President for Patient Safety at CRICO and a featured speaker in the series.
The videos series has five modules, each focused on a specific area of telehealth care including Clinical, Technical, Legal, and Equity considerations, as well as Managing Unexpected Events. Each of the five "Lessons Learned" videos starts with a 25-second dramatization by actors to provide a typical problem scenario, followed by a brief series of interviews providing expert advice and recommendations to mitigate risk related to the given topic.
Some of the subject matter for the videos was drawn from guidance documents recently published by CRICO's AMC PSO: "Patient Safety Guidance for the Virtual Visit," "Informed Patient Refusal in Virtual Care ," and "National Safe Table Advisory: Detecting and Reporting Patient Safety Risks in Virtual Care Delivery."
Clearly much good has come from the employment of telehealth services, especially providing access to underserved areas or disadvantaged populations. And it is improving some routine care that can be done more safely and better virtually.
Still, there was enough concern about a lack of experience and training about how to handle these scenarios, that these two national medical professional liability insurers—equally committed to improving patient safety—decided a video series on how to do it well is widely needed—and that need will be ongoing.
"I think telehealth has a lot to offer but it's not a panacea, and it shouldn't be the only way we interact with patients,"
says Lee Schwamm, MD, a vascular neurologist and the Director of the MGH Center for TeleHealth at Massachusetts General Hospital in Boston on one of the videos. "It should be complimentary to in-person care and we should use the vehicle best suited to address the medical problem in the most convenient, patient centered, and cost-effective way."
"What NOT to Do: Telehealth Lessons Learned"
Also see Press Release:
Candello and TDC Group Join Forces on Patient Safety Video Series
First Published – October 12, 2022
The SafeCare Study
Results clearly demonstrate a need for better tools, increased measurement of patient harm, and better implementation systems.
Structured Patient Handoffs Can Help Avoid Malpractice Cases
Using Candello data, researchers at Boston Children's Hospital demonstrated a link between patient handoff failures and malpractice cases. Further, they showed that, among cases involving a communication error, 77 percent of them could have been prevented by use of a structured handoff.
2022 CRICO Grant Recipients
More than 57 CRICO-insured researchers will be principal investigators of projects being funded by CRICO in 2022. At the forefront of topics being studied are telemedicine, health care equity, and emergency medicine interventions.
In 2013, the Lahey Hospital and Medical Center Post-Anesthesia Care Unit saw an increase in safety event reporting related to lab specimen labeling errors. As a result of their response, they recently marked 2000 days without this same error.
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METI of Japan Compiles Measures for Homes and Buildings to Achieve Carbon Neutrality by 2050
Publication of "energy conservation measures in homes and buildings for a decarbonized society"
Japan Climate Change Environmental Policies Sustainability Climate Change Environmental Management
Posted on August 27, 2021 by NAKAGAWA Shotaro
On August 23, 2021, the Ministry of Economy, Trade, and Industry (METI) published a report of "energy conservation measures in housing and buildings for a decarbonized society".
The main points of the report
The future vision of housings and buildings to be achieved in 2050 and 2030
Desirable scenario in 2050
Energy-saving performance at the level of ZEH and ZEB standards will be secured in the stock average, and the introduction of renewable energy such as photovoltaic power generation equipment will become common in houses and buildings where it is reasonable.
Newly constructed houses and buildings should have energy-saving performance at the level of ZEH and ZEB standards, and 60% of new detached houses should be equipped with photovoltaic power generation systems.
How to proceed with efforts to achieve carbon neutrality in 2050
Household and business sectors (strengthening of energy conservation measures in homes and buildings)
Mandatory compliance with energy conservation standards, including residential buildings, in FY2025
By 2030 at the latest, when the rate of compliance with the guidance standards exceeds 80%, raise the mandatory energy-saving standards to the energy-saving performance at the level of ZEH and ZEB standards
Energy conversion sector (expansion of introduction of renewable energy)
Expand the use of renewable energy and unused energy according to local conditions, such as photovoltaic power generation, use of solar heat and geothermal heat, and use of biomass.
Absorber measures (expansion of wood use)
Further rationalization of building standards for wooden buildings, etc.
You can find more info about the Carbon neutral of Japan from our website.
Japan sets goal of achieving carbon neutrality by 2050
https://enviliance.com/regions/east-asia/jp/report_2790
METI publishes Green Growth Strategy towards 2050 Carbon Neutrality
The published documents and the related documents can be viewed at the following URLs.
Report (Summary)
https://www.meti.go.jp/press/2021/08/20210823001/20210823001-1.pdf
Report (Full text)
Press release of METI
https://www.meti.go.jp/press/2021/08/20210823001/20210823001.html
Index of Japan EHS
Framework of EHS laws and regulations in Japan.
Japan, Organizations with Governing Environmental Regulations
Overview of Japanese legal system:
What are laws, cabinet orders, ministerial orders, public notifications, and circular notices? How they differ and relate?
Overview of Chemical Substances Control Act (CSCA)
Japan's "PRTR Act"
Act on Confirmation, etc. of Release Amounts of Specific Chemical Substances in the Environment and Promotion of Improvements to the Management Thereof
Climate Change, Environmental Policies, Sustainability
» All posts related to "Climate Change"
» All posts related to "Sustainability"
EHS in Japan
METI releases the Cabinet decision on the 6th Strategic Energy Plan (2021/11/5)
Japan cabinet approves partial revision of PRTR Act (2021/10/26)
Japan, MOE publishes notice on revision of environmental standards for water pollution (2021/10/26)
Japan, MOE revises provisional effluent standard of nitrogen (2021/9/29)
Japan, MOE revises provisional effluent standard of zinc (2021/9/29)
METI of Japan releases interim report on economic approaches to achieve carbon neutrality (2021/9/20)
Japan, Waste management (2021/9/4)
Japan's "PRTR Act" (2021/8/31)
MOEJ unveils outline of draft implementing rules for Act on Plastic Resource Circulation (2021/8/24)
METI releases the Cabinet decision on the 6th Strategic Energy Plan (Draft) (2021/8/14)
» All posts related to EHS in Japan


Nostradamus foresaw a "Man of Blood" who will challenge the two greatest powers of the day. Like with most Nostradamus Prophecies, the term represents a kind of code; an anagram, which hides the identity of this person. Could this man be "THE THIRD ANTICHRIST"; the one said to trigger off the coming World War 3.
One of the two great leaders is certain to be the President of USA; described in this prophecy as the "new land". As pointed out in earlier posts, America as a nation did not exist in the times of Nostradamus, so this is surely a description of USA, like how "new city" represents New York City.
USA has now been at the peak of its powers for a long time now; how long this peak is going to last is not clear. Like with everything else what goes up has to come down; even the greatest of powers.
A generally acceptable interpretation of this prophecy will be that there is a grand alliance between the USA and probably Russia; a kind of pact or treaty. This alliance make the Man of Blood feel severly threatened and hence he is left with no option but to make a preemptive attack.
It is tempting to link this with the North Korean threats; in the wake of the South Korean and US military moves. However it is not wise to jump to conclusions; but one thing appears certain World War 3 will come when you least except it to.


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Community involvement in adapting and testing a prevention program for preschoolers living in urban communities: ParentCorps
Melissa B. Caldwell, Laurie M. Brotman, Stephanie I. Coard, Scyatta A. Wallace, Debra J. Stellabotte, Esther J. Calzada
Strategies to Reduce Inequality
Urban Initiative
We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.
Journal of Child and Family Studies
Conduct problems
ParentCorps
Dive into the research topics of 'Community involvement in adapting and testing a prevention program for preschoolers living in urban communities: ParentCorps'. Together they form a unique fingerprint.
Community Participation Medicine & Life Sciences 100%
social competence Social Sciences 28%
low income Social Sciences 20%
Program Development Medicine & Life Sciences 19%
Social Skills Medicine & Life Sciences 18%
Parenting Medicine & Life Sciences 17%
Feasibility Studies Medicine & Life Sciences 16%
Caldwell, M. B., Brotman, L. M., Coard, S. I., Wallace, S. A., Stellabotte, D. J., & Calzada, E. J. (2005). Community involvement in adapting and testing a prevention program for preschoolers living in urban communities: ParentCorps. Journal of Child and Family Studies, 14(3), 373-386. https://doi.org/10.1007/s10826-005-6850-6
Community involvement in adapting and testing a prevention program for preschoolers living in urban communities : ParentCorps. / Caldwell, Melissa B.; Brotman, Laurie M.; Coard, Stephanie I. et al.
In: Journal of Child and Family Studies, Vol. 14, No. 3, 09.2005, p. 373-386.
Caldwell, MB, Brotman, LM, Coard, SI, Wallace, SA, Stellabotte, DJ & Calzada, EJ 2005, 'Community involvement in adapting and testing a prevention program for preschoolers living in urban communities: ParentCorps', Journal of Child and Family Studies, vol. 14, no. 3, pp. 373-386. https://doi.org/10.1007/s10826-005-6850-6
Caldwell MB, Brotman LM, Coard SI, Wallace SA, Stellabotte DJ, Calzada EJ. Community involvement in adapting and testing a prevention program for preschoolers living in urban communities: ParentCorps. Journal of Child and Family Studies. 2005 Sep;14(3):373-386. doi: 10.1007/s10826-005-6850-6
Caldwell, Melissa B. ; Brotman, Laurie M. ; Coard, Stephanie I. et al. / Community involvement in adapting and testing a prevention program for preschoolers living in urban communities : ParentCorps. In: Journal of Child and Family Studies. 2005 ; Vol. 14, No. 3. pp. 373-386.
@article{ee383309d6224dd884b1b47b58de2fc6,
title = "Community involvement in adapting and testing a prevention program for preschoolers living in urban communities: ParentCorps",
abstract = "We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.",
keywords = "Community, Conduct problems, ParentCorps, Parenting, Prevention",
author = "Caldwell, {Melissa B.} and Brotman, {Laurie M.} and Coard, {Stephanie I.} and Wallace, {Scyatta A.} and Stellabotte, {Debra J.} and Calzada, {Esther J.}",
note = "Funding Information: Stephanie I. Coard, Ph.D. is now at the Center for Child and Family Policy, Duke University. Scyatta A. Wallace, Ph.D. is now an Oak Ridge Institute for Science and Education (ORISE) research fellow at the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. This research was supported by grants to Laurie Miller Brotman, Ph.D. from the U.S. Department of Education, J.P. Morgan Chase, Inc. and Cathy and Stephen Graham, and conducted in collaboration with the Harlem Children{\textquoteright}s Zone (formerly Rheedlen Centers for Children and Families). Very special thanks to our collaborators at the Harlem Children{\textquoteright}s Zone, ParentCorps Community Advisory Board Members, ParentCorps Parent REPs, and NYC Public School 207 for sharing their invaluable community expertise; Rex Forehand, Ph.D. and Mary McKay, Ph.D. for ongoing consultation; and Free Arts.",
journal = "Journal of Child and Family Studies",
T1 - Community involvement in adapting and testing a prevention program for preschoolers living in urban communities
T2 - ParentCorps
AU - Caldwell, Melissa B.
AU - Brotman, Laurie M.
AU - Coard, Stephanie I.
AU - Wallace, Scyatta A.
AU - Stellabotte, Debra J.
AU - Calzada, Esther J.
N1 - Funding Information: Stephanie I. Coard, Ph.D. is now at the Center for Child and Family Policy, Duke University. Scyatta A. Wallace, Ph.D. is now an Oak Ridge Institute for Science and Education (ORISE) research fellow at the Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA. This research was supported by grants to Laurie Miller Brotman, Ph.D. from the U.S. Department of Education, J.P. Morgan Chase, Inc. and Cathy and Stephen Graham, and conducted in collaboration with the Harlem Children's Zone (formerly Rheedlen Centers for Children and Families). Very special thanks to our collaborators at the Harlem Children's Zone, ParentCorps Community Advisory Board Members, ParentCorps Parent REPs, and NYC Public School 207 for sharing their invaluable community expertise; Rex Forehand, Ph.D. and Mary McKay, Ph.D. for ongoing consultation; and Free Arts.
N2 - We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.
AB - We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.
KW - Community
KW - Conduct problems
KW - ParentCorps
KW - Parenting
KW - Prevention
JO - Journal of Child and Family Studies
JF - Journal of Child and Family Studies


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redpajama_set_name: RedPajamaGithub


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Protesters Tell New York Business to Stop Providing Israel's Lethal Tear Gas
TIAA-CREF: Divest from Injustice
Occupied Palestine, October 4th 2010 - The Palestinian Boycott, Divestment and Sanctions National Committee (BNC), on behalf of its constituent organizations and unions representing the majority of Palestinian civil society, calls upon the US non-profit pension fund TIAA-CREF to live up to its motto of providing "Financial Services for the Greater Good" by divesting its funds from companies that profit from Israel's occupation of Palestinian territories and violation of Palestinian rights.
BNC Secretariat
CEO of Israeli Cosmetic Firm Ahava Rattled by Growing Boycott
[CommonDreams.org] In a recent, quietly circulated letter from the desk of Yaacov Ellis, CEO of Ahava Dead Sea Laboratories—a company at the center of a growing international boycott campaign—and directed at the company's retail partners, Ellis
California divestment initiative launched in Los Angeles
http://www.youtube-nocookie.com/v/c4gSLqQW-iI?fs=1&hl=e
Palestinian civil society salutes Olympia Food Co-op's decision to boycott Israeli goods!
Occupied Palestine, 26 July 2010 – Palestinian farmers unions, agricultural organizations and popular committees struggling against Israel's colonial Wall and settlements warmly salute the historic decision taken on July 15th [1] by the Olympia Food Co-op to remove all Israeli products from its shelves. The Olympia Food Co-op has set a historic precedent by becoming the first US grocery store to publicly join the global grassroots campaign for boycott, divestment and sanctions (BDS) against Israel until it ends its human rights violations and oppression of the Palestinian people.
Action Alert: Support the Olympia Food Co-op Now! We Need Your Support Urgently!
Just last week the Board of Directors of the Olympia Food Co-op took thecourageous step of instituting a boycott of Israeli goods, the firstgrocery boycott of Israel in the US. Already, there is a movement afoot tocondemn the Co-op for taking this important stand. Board and staff arereceiving aggressive emails and phone calls, and we need to show them thatthere is local support for the boycott.


It was controversial feminist writer, Maggie Young, who in describing her generation, best captures the DNA of the millennials.
Corporates and governments are tripping over each other trying to understand Young's generation. The manual on millennials has proven to be somewhat elusive with tons of studies on this generational group that despite reporting on some common themes, have not nailed what makes millennials tick.
What we do know is that the term 'millennial' is about as old as the average millennial, coined in 1991 by Neil Howe and William Straus, in their co-authored publication: Generations: The History of America's Future 2584 to 2069. They described millennials as people born between 1980 and 2000. This generation is also commonly referred to as Generation Y.
Millennials matter because they make up the world's largest generational group since the soon-to-retire Baby Boomers. The first cohort of millennials is in their early to mid-30s, at the beginning of their careers, and will become an invaluable engine of the global economy in decades to come.
Millennials matter even more in Africa.
The African Development Bank has reported Africa has more than 200 million people aged between 15 and 24, about 65% of the continent is made up of millennials, making it the youngest continent in the world. Demographic forecasts show that this figure will double by 2045.
In just four years, three out of every four people in Africa will be on average 20 years old in Africa.
While millennials may be dismissed as a generation obsessed with selfies, they also seem to be intent on being part of finding solutions to the world's biggest problems.
The 2015 Deloitte Millennial Survey highlights millennials are tuned into the purpose of a business – what it should do – as much as they are tuned to the impact of the business – what the business is actually doing.
Millennials are increasingly disconnected with traditional approaches to the workplace. They are easily turned off by stiff corporate structures and working within silos. They want dynamic work environments, they are not keen on putting in the slog of years working the corporate ladder, they believe in rapid succession, and they value mobility over the bum-on-seats approach. These insights are pulled from extensive research done through a survey administered to over 4,000 graduates across 75 countries by KPMG to understand what millennials want from the workplace. Although the survey was done in 2011, the insights will continue to shape corporate talent strategies for years still.
What millennials want out of the work of experience is like nothing before that. Top of the list of headaches is that old reward and recognition systems aren't retaining millennials in their positons. Millennials subscribe to "loyalty-lite", happily hopping between employees.
The unparalleled access to the internet and mobile phones is part of the millennial DNA. This generation has no concept of the world before technology. They take as a given that you can have a movie theater, your next taxi ride, and your diet all in your back pocket.
The Wall Street Journal in Millennials: Love Them Or Let Them Go reported millennials don't just view social networks as a communication tool but as a global language that embeds them in various communities. Interestingly, despite the uptake of social media connectedness, millennials still value family and friends even though they will overwhelmingly engage with them on social media platforms.
Millennials value education and are more likely to spend more time investing in their education than the previous generations. The manual on millennials is still missing but if the statistics shared by the World Economic Forum that millennials are increasingly becoming the biggest influencers in the world, that more than 50% of the world's population is under 27 years old and rising to 70% in Africa, it needs to be written. Yesterday.
– The writer, a millennial herself, is a senior anchor on CNBC Africa, and presents the show Young Money on the channel.


Weight: He's heavy! My arms are for sure getting tired hauling him around on my hip all the time.
Health: Healthy! We seem to be between teething and growth spurts, so a nice happy time!
Sleep: It gets lighter here earlier, but he's still sleeping until 6:30am or 7:00am which is nice. Gives me some time to get up with Riley and get things going before he's awake. Still taking 2 naps morning and afternoon. I try to get he and Riley to take their afternoon naps together, but sometimes Charly will take a really long morning nap and isn't ready for his afternoon nap until 2ish.
Nursing: Still keeping up with Pumping. I've been so focused on making it to a year I'm just now starting to realize that we should think more about how weaning may got for both of us. I'm not going to be sad to say goodbye to the pump. But I do like those quite moments when I'm feeding him after he wakes up…although he's super distracted and wiggly so sometimes it's not a relaxing feed. He's drinking from a straw now, which is awesome. And he's sipping water at his meals. I waited until after a year to introduce Cow's Milk to Riley, but I'm tempted to see if Charly likes it now. I'm nervous to wean from the pump, I still feel uncomfortable if I go too long between sessions. Breastfeeding was such a natural stop, I feel like pumping is going to harder in a few ways.
What Charly is up to: Saying "no" "da" "mama" "mmmm" "mah" for more. Still working on waving. He loves to dance and wave his arms around, it's the cutest thing ever. He's a rascal and loves to wrestle and play with Riley, or anyone that will let him climb all over. He's pulling up to stand, but still wobbly. He's got the best belly laugh and the cutest giggle.
PostPartum: I'm looking forward to finding a new exercise routine (well, any routine would be nice!) now that we are in the new house. In a way I'm also looking forward to weaning, and hitting the year mark. I didn't feel like myself again until Riley was a year, and really until we weaned at 15 months. I've been pregnant or nursing for SO long.
Baby Gear: He loves plastic straws. Tonight he pulled one of my socks out of the clean laundry folding pile and it was his new favorite thing. He loves anything that makes noise, and he's drawn to my phone, computer or the iPad screen. Love the Ergo 360.
Thoughts: The year has flown by. With moving and everything else it's been such a whirlwind. I'm so thankful for our little Char, he's such a fun and happy guy. I love that he fits into our family so perfectly. I need to start wrapping my head around the thought of a first birthday, ahhh!


Should pupils start their learning with their teachers giving them a Grade A and, then, be immune from failure? This is what is being proposed by that august institution, the Royal Society of Arts (RSA), of which I am a Fellow. Welcome to the fantasy world of educational 'experts'!
I spent 35 years telling my pupils to be honest with themselves and with others. I now see the opposite, dishonesty, being promoted as a desirable virtue for teachers and by a body that has a royal charter. I doubt if Queen Victoria, who granted that charter, would be amused. And how unkind and unhelpful it is to children.
Sadly, this RSA initiative is grounded in much of what is already happening in schools and has, for long, been promoted by many teacher trainers. This raises the question of what exactly qualifies someone to enter teacher training? It is an important matter since more or less everything in education depends on the quality of our teachers.
Here, then, are the 'Ten Commandments of Teaching'. All new entrants to the profession are expected to embrace them. Commit yourself to these and the door to teacher training will swing open. Question these and you will need to look for another career.
Mastering a body of knowledge is an out-of-date aim since knowledge is easily accessed via the internet. Children need only be taught cross-curricula and utilitarian skills to access and evaluate knowledge, not the knowledge itself.
Teachers are learning facilitators and process managers of the learning process for each individual child. Whole class teaching is undesirable since it is the antithesis of 'personalised', computer-assisted learning.
Central to a pupil's classroom experience, and of paramount importance, is the 'feel-good' factor. Children are not capable of accepting adverse criticisms or judgements and should not be subjected to them.
There is no such thing as 'failure'. To try is to succeed.
All of a pupil's work should be celebrated all of the time.
A principal objective of education is to promote 'value relativism'. There is no such thing as objective truth. All knowledge is provisional.
Teaching is too complicated and sophisticated a process to be understood by anyone outside of the profession, including parents and Government.
Competition in both academic and non-academic areas of school life is divisive. It is inherently bad since it involves 'winners' and 'losers'.
Assessment of pupils and of teachers can only be properly carried out from within the profession.


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Nickthemoviecritic.com
movie reviews, cinema, films, motion pictures, blog, movies, review, film review,
Best Movies Of Each Year By Decade
Meet Nick
WELCOME TO NICKTHEMOVIECRITIC.COM
Jupiter Ascending January 20, 2022
Gamer's Review: The Last Of Us January 20, 2022
The Eyes Of Tammy Faye January 17, 2022
The Tender Bar January 17, 2022
Sharp Objects January 11, 2022
Indie/Independent
Mini-Series
Musical/Music
New Hollywood
Period Piece
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The Golden Age Of Hollywood
Tag: Superheroes
"Hawkeye" is streaming on Disney Plus. It received positive reviews from critics, fans and streamers alike. As you may know, a spin-off with "Echo" is in development streaming soon on Disney Plus. Other upcoming shows like "Moon Knight," "She-Hulk," "Ms. Marvel" & Secret Invasion" will stream this year. Todays review contains no SPOILERS. Feel free […]
Read More Hawkeye
"Spider-Man: No Way Home" is currently out in theaters. The third solo film starring Tom Holland earned positive reviews from critics, fans and movie goers alike. So far, it is making money at the box office. Recently, Tom Holland confirmed he will reprise his role as The Web Slinger in a new trilogy. As you […]
Read More Spider-Man: No Way Home
After Sony's reboot and first installment of "The Amazing Spider-Man" with Andrew Garfield was released in 2012, the company worked on a sequel continuing Peter Parker's adventure as the titular character. This time he squares off against Electro, Rhino & Green Goblin in a botched copy to replicate the Marvel Cinematic Universe or MCU for […]
Read More The Amazing Spider-Man 2
Invincible: Season 1
Hello fellow streamers from around the globe. I've selected an Amazon Prime series as my 700th post. I've been writing articles based on movies, shows, anime, mini-series and video games for the past five years. I'll do a brief history on comic book turned animated series. It's not too long. In 2003, Image Comics (Spawn, […]
Read More Invincible: Season 1
Marvel's What If: Season 1
All episodes of What If's first season are now streaming on Disney Plus. It received positive reviews from critics, fans and streamers. Due to COVID-19, a tenth episode was pushed back leaving only nine episodes completely finished. An upcoming second season will pick up the pieces. As you may know, Disney Plus Day announced a […]
Read More Marvel's What If: Season 1
Eternals is currently out in theaters. It received mixed reviews from critics, fans and movie goers. So far, it's making revenue at the box office. As a Marvel fan, I've never read an Eternals comic. For time I heard of them is when Kevin Feige announced Phase 4's batch of films and shows tied to […]
Read More Eternals
Justice League Dark (2017)
Hello my fellow movie goers from around the globe. It's finally Halloween Month. Meaning, I'll be selecting horror related movies, then post a review if it's good or bad. This time I've decided to pick the eighth installment of the "DC Animated Movie Universe" (not connected to Bruce Timm's Batman) focusing on Batman teaming up […]
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After "Venom" came out in 2018 earning negative reactions from critics, fans and movie goers alike, Sony commenced development of a Venom sequel and their own cinematic universe based on characters from "Spider-Man" such as "Morbius," "Kraven The Hunter," "Nightwatch" & "Madame Web." Both Morbius & "Venom: Let There Be Carnage" were delayed, due to […]
Read More Venom: Let There Be Carnage
Gamer's Review: Lego DC Super-Villains
"Lego DC Super-Villains" was released in 2018 on Xbox One and PlayStation 4. (same year Red Dead Redemption 2 came out) It received positive reviews from critics, fans and gamers alike. The game also sold enough copies worldwide. It's also available on the Nintendo Switch. Rocksteady Games are working on "The Suicide Squad" Kill The […]
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Gamer's Review: Marvel Nemesis: Rise Of The Imperfects
"Marvel Nemesis: Rise Of The Imperfects" was released in 2005 (same year X-Men Legends: Rise Of Apocalypse came out) on PlayStation 2, Xbox and Nintendo GameCube. It received mixed reviews from critics, fans and gamers alike. The game failed to sell enough copies worldwide. Meaning, a sequel never came into fruition. Insomniac Games (the Ratchet […]
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Flashback Review: X-Men: The Last Stand
After "X2: X-Men United" was released in 2003, 20th Century Fox (pre-Disney purchase) commenced development on a third installment. Bryan Singer (back when he had dignity as a respected director) was attached to direct to direct, but he dropped out to make "Superman Returns" The original 1978 "Superman" with Christopher Reeve inspired him to make […]
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Gamer's Review: Marvel Ultimate Alliance
"Marvel Ultimate Alliance" was released in 2006 (same year X-Men: The Last Stand came out) on Xbox/Xbox 360, Nintendo Wii and PS2/PS3. It received praise from critics, gamers and fans alike. In addition to positive reception, the game sold many copies worldwide. Marvel Ultimate Alliance spawned two sequels in 2009 and 2019. The first game […]
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Gamer's Review: X-Men Legends II: Rise Of Apocalypse
After "X-Men Legends" came out in 2004 earning praise from critics, fans and gamers alike. A sequel titled, "X-Men Legends II: Rise Of Apocalypse" was officially released in 2005 (same year the first God Of War came out) on Xbox, Nintendo GameCube and PlayStation 2. The sequel earned more praise, followed by "Marvel Ultimate Alliance" […]
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Gamer's Review: X-Men Legends
"X-Men Legends" was released in 2004 on Xbox, Nintendo GameCube & PlayStation 2. (same year Spider-Man 2 came out) It received positive reviews from critics, fan and gamers alike. Besides praise, the game sold enough copies worldwide. A sequel titled, "X-Men Legends II: Rise Of Apocalypse" came out in 2005 earning critical acclaim. Followed by […]
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Gamer's Review: X2: Wolverine's Revenge
In 2003, "X2: X-Men United" came out. Earning positive reviews from critics, fans and movie goers alike. Prior to the film's release, a video game tie-in with Wolverine was released a month before on Xbox, Nintendo GameCube and PlayStation 2. It received mixed reviews from critics, fans and gamers alike. Insomniac Games (Spider-Man on PS4/PS5, […]
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Flashback Review: X2: X-Men United
After "X-Men" was released in 2000 earning positive reviews and made money at the box office, 20th Century Fox (pre-Disney purchase) began development of a sequel with most of the cast from the first movie reprising their roles. After three years of crafting a cohesive narrative, "X2: X-Men United" disturbed worldwide. X2: X-Men United was […]
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Flashback Review: X-Men
The 1960s introduced iconic comic book superheroes including "Fantastic Four," Hulk," "Iron Man" & "Spider-Man." Fantastic Four are the first superhero team in Marvel Comics. Stan Lee created another superhero team called, "X-Men." Introduced in 1963, the X-Men is a school for kids born with powers as mutants, learn to control their powers instructed by […]
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"Shang-Chi And The Legend Of The Ten Rings" is currently out right now. Critics, fans and movie goers alike praise the latest installment of the Marvel Cinematic Universe or MCU for short. As a Marvel fan, I've never heard of Shang-Chi, until now. He's been around since The 70s. Prior to his cinematic debut, he […]
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James Gunn's "The Suicide Squad" is officially out in theaters and streaming on HBO Max. Unlike the underwhelming 2016 film, the sequel earned positive reception from critics, fans and movie goers alike. So far, it's making money at the box office. I'm gonna come clean, I used to like the first Suicide Squad film. Upon […]
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Loki's first season is streaming on Disney Plus. It received positive reviews from critics, fans and streamers alike. A second season is officially in development with Tom Hiddleston slated to reprise his role as titular character. Loki is my most anticipated Marvel related series on Disney Plus focusing on one of my favorite Marvel villains. […]
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Rajasthan: The Rajasthan NEET PG Medical & Dental Admission / Counseling Board-2019 and Principal & Controller, SMS Medical College has published the merit list of Rajasthan PG Medical Counselling 2019.
Rajasthan NEET PG Medical & Dental Admission / Counseling Board-2019 and Principal & Controller, SMS Medical College is going to conduct counselling for MD/MS/PG Diploma and MDS courses counselling in the category of Government Seats, Management Seats and NRI Seats of above-mentioned Courses in Government and Self-financed Medical and Dental Colleges for the academic year 2019-20.
The merit list includes important details like the name of the candidate, merit rank, NEET PG rank, state merit rank, category, registered domicile etc.


text:
@interface SSPageData : NSObject

@property (strong, nonatomic) NSString* question;
@property (strong, nonatomic) NSDictionary* answers; // Answers -> Value

@end


Home Economical Does the US Target Oil Export In Venezuelan Crisis?
The United States has been trying to cripple the Venezuelan government's ability to secure funds.
However, so called "nuclear option", a full oil embargo, targeting the industry, is not used yet by the US. Industry sector is responsible for more than 90% of the country's revenue.
Despite of the high tensions between the USA and Venezuela, the US refineries are still purchasing Venezuelan petroleum. Moreover, Venezuela owns one of the refineries in Texas through a subsidiary called CITGO.
But as the Washington backs the opposition leader Juan Guaido's claim to the presidency, the crisis escalates more than in the past. In addition, a new round of sanctions is expected in the next few days.
Mike Pompeo, US Secretary of State failed to secure backing from the United Nations Security Council against Venezuela on Sunday, as China and Russia are close Maduro allies.
President Maduro demanded earlier the US diplomats to leave the country. He added that both countries have only 30 days to set new terms of their relationship.
Markets are looking for the US next action. Despite of the failure in the Security Council, US government has been supported by Argentina, Brazil and Colombia.
Finally, there are fears of a global slowdown in the economy and Venezuelan crisis will surely cause this downturn.
Certainly, Venezuela would be the biggest loser of all as the country has the world's largest proven oil reserves – even bigger than Saudi Arabia.
Shock! A nurse raped a patient!