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Article Policy| Volume 61, ISSUE 2, P85-92, March 2013
Global health diplomacy: An integrative review of the literature and implications for nursing
Anita Hunter, APRN, PhD, FAAN
Anita Hunter
Corresponding author: Dr. Anita Hunter, Dominican University, 50 Acacia Ave., San Rafael, CA 94901.
Department of Nursing, Dominican University of California, San Rafael, CA; Board Member Holy Innocents Children's Hospital Uganda, Inc, San Diego, CA
Lynda Wilson, RN, PhD, FAAN
Lynda Wilson
School of Nursing, University of Alabama at Birmingham, Birmingham, AL; Co-Chair, American Academy of Nursing Expert Panel on Global Health and Nursing, Washington, DC (2010-2012)
Marcia Stanhope, RN, DSN, FAAN
Marcia Stanhope
College of Nursing, University of Kentucky, Lexington, KY
Barbara Hatcher, RN, PhD, MPH, FAAN
Barbara Hatcher
Marianne Hattar, RN, DNSc, FAAN
Marianne Hattar
Nursing Department, California State University Northridge, Northridge, CA
DeAnne K. Hilfinger Messias, RN, PhD, FAAN
DeAnne K. Hilfinger Messias
College of Nursing and Women's and Gender Studies Program, University of South Carolina, Columbia, SC
Dorothy Powell, RN, EdD, FAAN
Dorothy Powell
Community Health Initiatives, School of Nursing, Duke University, Durham, NC
Published:September 21, 2012DOI:https://doi.org/10.1016/j.outlook.2012.07.013
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The increasing interconnectedness of the world and the factors that affect health lay the foundation for the evolving practice of global health diplomacy. There has been limited discussion in the nursing literature about the concept of global health diplomacy or the role of nurses in such initiatives. A discussion of this concept is presented here by the members of a Task Force on Global Health Diplomacy of the American Academy of Nursing Expert Panel on Global Nursing and Health (AAN EPGNH). The purpose of this article is to present an integrative review of literature on the concept of global health diplomacy and to identify implications of this emerging field for nursing education, practice, and research. The steps proposed by Whittemore and Knafl (2005) were adapted and applied to the integrative review of theoretical and descriptive articles about the concept of global health diplomacy. This review included an analysis of the historical background, definition, and challenges of global health diplomacy and suggestions about the preparation of global health diplomats. The article concludes with a discussion of implications for nursing practice, education, and research. The Task Force endorses the definition of global health diplomacy proposed by Adams, Novotny, and Leslie (2008) but recommends that further dialogue and research is necessary to identify opportunities and educational requirements for nurses to contribute to the emerging field of global health diplomacy.
The increasing interconnectedness in the world that has resulted from globalization has significant implications for nursing and healthcare. The American Academy of Nursing Expert Panel on Global Nursing and Health (AAN EPGNH), whose members are active participants in the global arena, recognize that health problems transcend national borders and that all nurses must be prepared to address global health challenges. Since 2007, global health has become the top foreign policy issue of our times (
Labonté and Gagnon, 2010
Labonté R.
Gagnon M.L.
Framing health and foreign policy: Lessons for global health diplomacy.
Global Health. 2010; 6: 14
), encouraging the interaction of state and nonstate participants to position health issues more prominently in foreign policy decision-making. This process and the engagement of all key stakeholders are parts of a new approach to global health called "global health diplomacy" (
). Nurses who work in the global health arena need to be aware of this new emphasis and identify their responsibilities as global health diplomats.
Novotny and Adams (
Novotny and Adams, 2007
Novotny, T. E., & Adams, V. (2007). Global health diplomacy: A global health sciences working paper. University of California San Francisco Global Health Sciences. Retrieved from http://igcc.ucsd.edu/pdf/GH_Diplomacy.pdf.
) defined global health diplomacy as "a political change activity that meets the dual goals of improving global health while maintaining and strengthening international relations abroad, particularly in conflict areas and resource-poor environments [and that] health diplomacy is not only the job of diplomats or health leaders in government structures, it is a professional practice that should inform any group or individual with responsibility to conduct research, service, programs, or direct international health assistance between donor and recipient institutions" (p. 1-2). To better inform nurses about the concept of global health diplomacy, this paper presents an integrative review of literature on the concept of global health diplomacy and identifies implications of this emerging field for nursing education, practice, and research.
Whittemore and Knafl, 2005
Whittemore R.
Knafl K.
The integrative review: updated methodology.
Journal of Advanced Nursing. 2005; 52: 546-553
described an integrative review of the literature as the broadest type of research review, combining data from both empirical and theoretical literature to define concepts, review evidence, review theories, and analyze methodological issues. Those authors modified the original framework for literature reviews proposed by
Cooper, 1998
Cooper H.
Synthesizing research: A guide for literature reviews.
3rd edition. Sage, Thousand Oaks, California1998
and suggested that an integrative review should include: (a) a clear statement identifying the problem or purpose of the review; (b) identification of the strategies used to search and identify relevant literature; (c) evaluation of the quality of the data; (d) analysis of the data; and (e) final synthesis and presentation of the data.
acknowledged that many strategies can be used for each of these stages. The purpose of this review was to analyze the concept of global health diplomacy and identify implications of global health diplomacy for nursing practice, education, and research. The framework proposed by
was used to organize the review. We did not find reports of empirical research other than descriptions of existing health-diplomacy programs, so our review focused on theoretical articles and empirical descriptions of global health initiatives. The articles included in this review were identified by searching the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases using the search term "global health diplomacy," without specifying any date restrictions. Additional articles were identified by reviewing reference lists of the original papers, and by searching Google Scholar using the keywords "global health diplomacy." Empirical or theoretical articles were included in the review if they addressed the historical development of global health diplomacy, defined the components and challenges of health diplomacy, proposed future development of global health diplomacy, and/or discussed strategies for preparing global health diplomats.
To evaluate the quality of the articles that were included in the review, the authors adopted one of the strategies proposed by
, which was to consider authenticity, informational value, representativeness of sources, and methodological quality of each document that was included in the review. To analyze and synthesize the data from these diverse sources, the authors reviewed all papers, wrote annotated summaries of each paper, and then developed a system for classifying the articles, displaying the data, comparing the themes that emerged from each paper, and drawing inferences and conclusions, using the methods proposed by
. The review is organized according to the main themes that emerged from analysis of the papers: historical development of global health diplomacy, definition and components of global health diplomacy, challenges in global health diplomacy, and preparation of global health diplomats. The review concludes with the authors' recommendations and implications for nursing practice, education, and research.
What Is Global Health and Global Health Diplomacy?
The term global health refers to "an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasizes transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and [it] is a synthesis of population based prevention with individual-level clinical care" (
Koplan et al., 2009
Koplan J.B.
Bond T.C.
Merson M.H.
Reddy K.S.
Rodriguez M.H.
Sewankambo N.K.
Wasserheit J.N.
Towards a common definition of global health.
Lancet. 2009; 373: 1993-1995
, p. 1995).
Adams et al., 2008
Adams V.
Novotny T.E.
Global health diplomacy.
Medical Anthropology. 2008; 27: 315-323
defined global health diplomacy as "an emerging field that addresses the dual goals of improving global health and bettering international relations, particularly in conflict areas and in resource-poor environments" (p. 316).
Katz et al., 2011
Katz R.
Kornblet S.
Arnold G.
Lief E.
Fischer J.E.
Defining health diplomacy: Changing demands in the era of globalization.
Milbank Quarterly. 2011; 89: 503-523
proposed that the varying definitions of global health diplomacy fall into three different categories (1) core diplomacy or formal negotiations between and among nations; (2) multi-stakeholder diplomacy or negotiations that are not necessarily intended to lead to binding agreements; and (3) informal diplomacy or interactions between international public health actors and their counterparts in the field, including host country officials, nongovernmental organizations (NGOs), private-sector companies, and the public. Identifying these different categories of global health diplomacy may be important to clarify services/resources that may be offered, especially when governments argue for incorporating health issues into their foreign-policy debates (
Kaufmann and Feldbaum, 2009
Kaufmann J.R.
Feldbaum H.
Diplomacy and the polio immunization boycott in Northern Nigeria.
Health Affairs. 2009; 28: 1091-1101
Global health diplomacy combines the art of diplomacy with the science of public health; it balances concrete national interest with the abstract collective concern of the larger international community's health; it reduces health inequities; it secures human rights; and it recognizes that effective international health interventions are ethical and sensitive to historical, political, social, economic, and cultural differences (
Schrecker et al., 2008
Schrecker T.
De Vogli R.
Globalisation and health: The need for a global vision.
World Health Organization, 2012
World Health Organization. What is health as a bridge for peace? Retrieved March 12, 2012, from http://www.who.int/hac/techguidance/hbp/about/en/index.html.
The plethora of definitions supports the basic premise that global health diplomacy encompasses a political change activity and requires both the art of diplomacy and the science of public health to promote formal negotiations between and among nations and international public health actors and their counterparts in the field to address security, development, global public goods, trade, human rights and ethical/moral reasoning.
Historical Background of Global Health Diplomacy
There is growing recognition of the importance of promoting global health. The United States (U.S.)
Institute of Medicine, 2009b
Institute of Medicine. (2009b). U.S. commitment to global health: Recommendations for the public and private sectors I. In N. A. Press (Series Ed.). Retrieved from http://books.nap.edu/catalog.php?record_id=12642.
Institute of Medicine and Press, 2009a
Institute of Medicine. (2009a). The U.S. commitment to global health: Recommendations for the new administration. In N. A. Press (Ed.) (pp. 52). Retrieved from http://www.nap.edu/catalog.php?record_id=12506 doi:0-309-12767-X.
published two reports outlining recommendations to enhance the U.S. commitment to global health. A consortium of Universities for Global Health (CUGH) was developed in 2009 with a mission to define the field of global health, standardize curricula, expand research, and coordinate projects in low-resource countries (
Consortium of Universisties for Global Health, 2009
Consortium of Universities for Global Health. (2009). Saving lives: Universities transforming global health. In Consortium of Universities for Global Health (Ed.). Retrieved from http://globalhealthsciences.ucsf.edu/sites/default/files/content/cci/muhas-universities-transforming-global-health.pdf.
Center for Strategic and International Studies Commission on Smart Global Health Policy, 2010
Center for Strategic and International Studies Commission on Smart Global Health Policy
A healthier, safer, and more prosperous world: Report of the CSIS Commission on Smart Global Health Policy.
in: Center for Strategic and International Studies. Center for Strategic and International Studies, Washington, D. C.2010
was also commissioned to identify recommendations for smart global health policy in the United States, and for the first time, the
National Institutes of Health, 2010
National Institutes of Health, N. H., Blood, and Lung Advisory Council
Advisory Council Minutes.
National Institutes of Health, Nationl Heart, Blood, and Lung Advisory Council, Bethesda, Maryland2010
made global health one of its top five priorities.
The U.S. government document Healthy People 2020 (
United States Department of Health and Human Services, 2011
United States Department of Health and Human Services. (2011). Healthy People 2020.
) included a new global health goal for the first time in the history of the Healthy People series: to improve public health and strengthen U.S. national security through global disease detection, response, prevention, and control strategies. The Healthy People 2020 document outlines the U.S. objectives for meeting this new global health goal to address continuing emerging disease threats: promote health abroad, prevent the international spread of disease, and protect the health of the U.S. population.
Badeau, 1970
Badeau J.S.
Diplomacy and medicine.
Bulletin of the New York Academy of Medicine. 1970; 46: 303-312
described the historical evolution of the concept of "medical diplomacy," noting that centuries ago physician-priests sometimes accompanied Egyptian missions to neighboring countries and acted as ambassadors. He also noted that the nature of diplomacy changed following World War I and that diplomacy is no longer the purview of only a small elite corps of professional diplomats. Factors such as improved communication, educational levels, an end to colonial rule in many parts of the world, and increased public demand for civic participation has resulted in changes in the face of diplomacy.
Fidler, 2001
Fidler D.P.
The globalization of public health: The first 100 years of international health diplomacy.
Bulletin of the World Health Organization. 2001; 79: 842-849
suggested that health diplomacy emerged because of global threats to public health in the 19th century. The Marshall Plan, the end of the Cold War era, and the medical assistance provided by the U.S. military in Europe and Japan following World War II signaled increased emphasis on the importance of foreign aid and "persuasion" as a key component of foreign diplomatic initiatives in both the U.S. and in other countries (
Feldbaum et al., 2010
Lee K.
Michaud J.
Global health and foreign policy.
Epidemiology Review. 2010; 32: 82-92
noted that global health has historically been of importance in foreign policy as evidenced by the international sanitary conventions that began in 1851. These international sanitary conventions subsequently evolved into the International Health Regulations (IHR), focused on enforcing disease control with minimum interference with international trade (
World Health Organization. (2005). International health regulations, 2nd edition. In World Health Organization (Ed.). Geneva.
suggested that although the World Health Organization (WHO) has had problems enforcing IHRs in the past, the 2003–2004 outbreak of the Severe Acute Respiratory Syndrome (SARS) resulted in revision of IHRs and granted the WHO authority to supersede interests of member states using surveillance data for purposes of infectious disease control. Those authors further described the historical link between international aid and foreign policy interests, which was a key factor in the 1961 establishment of the U.S. Agency for International Development (USAID).
Addressing health without addressing the causative factors for illnesses has contributed to the failure of many well-intentioned global health programs.
Cahill, 1974
Cahill K.M.
Editorial: Medicine and diplomacy.
Preventive Medicine. 1974; 3: 187-192
called for "the diplomatic potential of medicine as a vehicle for international goodwill" (p. 190). Subsequently,
Health and foreign policy: An American view.
Annals of Tropical Medicine and Parasitology. 1997; 91: 735-741
introduced the term "preventive diplomacy," noting that diplomats and politicians frequently lack an understanding of the health and humanitarian issues that they address and challenged health professionals to become active in addressing global health and human rights issues to offer innovative approaches to health and human rights issues that may be more effective than the methods used in the past.
noted that the concept of medical diplomacy was first introduced in the Carter administration in 1978, as a "vehicle by which channels of communication can be established between nations when international relations are strained or severed" (p. 121).
noted three recent trends in international aid to address health issues: (a) dramatic increase in funding for health; (b) increased number of organizations involved; and (c) a tendency to focus on HIV/AIDS as a single health problem. Others have also noted the increase in health-related aid and the increased international focus on HIV/AIDS (
Ravishankar et al., 2009
Ravishankar N.
Gubbins P.
Cooley R.J.
Leach-Kemon K.
Michaud C.M.
Jamison D.T.
Murray C.J.L.
Financing of global health: Tracking development assistance for health from 1990 to 2007.
Lancet. 2009; 373 ([Article]): 2113-2124
Shiffman et al., 2009
Shiffman J.
Berlan D.
Hafner T.
Has aid for AIDS raised all health funding boats?.
JAIDS: Journal of Acquired Immune Deficiency Syndromes. 2009; 52: S45-S48
). Other factors that have contributed to the growing interest in global health diplomacy include the growth of NGOs participating in international health programs, the increasing globalization of science and of pharmaceutical research, and growing concerns about biosecurity (
, p. 315).
A major impetus to the development of global health diplomacy is the concern about threats to global health security. The 2007 WHO annual report focused on threats to global public health security, such as epidemic diseases, food-borne diseases, accidental or deliberate outbreaks (e.g., nuclear accidents, toxic spills), environmental disasters, and the identification of strategies to minimize and address those threats (
World Health Organization and Organization, 2007a
World Health Organization. (2007a). The World Health Report 2007: A Safer Future: Global Public Health Security in the 21st Century In W. H. Organization (Ed.). Geneva.
). Chan, Director General of the WHO, argued for "….inputs from policy analysis and research; … [and] improved training opportunities for both diplomats and public health specialists in the interface between health and foreign policy" (
Chan et al., 2008
Chan M.
Store J.G.
Kouchner B.
Foreign policy and global public health: Working together towards common goals.
Bulletin of the World Health Organization. 2008; 86 (498-498)
Kickbusch and Buss, 2011
Kickbusch I.
Buss P.
Global health diplomacy and peace.
Infectious Disease Clinics. 2011; 25: 601-610
described the use of health diplomacy to promote peace and to encourage the evolving global partnerships of countries across hemispheres to address global health issues. The authors cited several examples of global health leadership roles and emphasized the importance of the WHO in providing global coordination for the multiple initiatives in the often-overcrowded global health landscape. For example, in 2011 Brazil hosted the "Global Conference on Social Determinants of Health," and in May 1998, the World Health Assembly formally accepted the "Health as a Bridge for Peace" initiative as a feature of the "Health for All in the 21st Century" strategy (World Health Organization).
WHO launched the "Health as a Bridge for Peace Initiative," promoting cease-fires during times of conflict to permit health projects, such as vaccination campaigns, and promoting collaboration in training initiatives among countries that were previous enemies (
Rodriguez-Garcia et al., 2001
Rodriguez-Garcia, R., Schlesser, M., & Bernstein, R. (2001). CERTI: Crisis and Transition Toolkit: How can health serve as a bridge to peace? Policy Brief; George Washington University School of Public Health and Health Services; GWU Media Center. Retrieved from: http://www.certi.org/publications/policy/gwc-12a-brief.pdf.
). Further, the foreign ministers of Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand issued the Oslo Declaration and Agenda for Action to increase the priority of global health issues in foreign policy (
Amorim et al., 2007
Amorim, C., P., Douste-Blazy, H., Wirayuda, J. G., Støre, C. T., Gadio, N., Dlamini-Zuma, N. (2007). Oslo Ministerial Declaration—Global health: A pressing foreign policy issue of our time. The Lancet, 369(9570), 1373–1378.
Barber et al., 2011
Barber J.L.
Cohen B.A.
Rockswold P.D.
Global health diplomacy: A call to action.
Military Medicine. 2011; 176: 481-483
noted that in the United States, the field of global health diplomacy has been bolstered by the $63 billion U.S. Global Health Initiative that was launched in 2005 to address HIV/AIDS, growing challenges posed by chronic diseases, and to strengthen health systems.
reviewed the literature published from 2000 to 2009 to identify arguments that governments have used to incorporate health issues into their foreign policy deliberations. The literature revealed six policy frames: security, development, global public goods, trade, human rights and ethical/moral reasoning, noting that arguments within the different frames are sometimes contradictory. The most frequently mentioned argument was concern for national and economic security, followed by the use of health to stimulate development and promotion of the public good (by preventing pandemics, addressing problems related to climate change, or regulating health-damaging products such as tobacco).
In summary, the notion of incorporating medical or health care in foreign policy or international aid programs is not new; however, there has been limited discussion about this concept in the nursing literature.
Challenges in Global Health Diplomacy
described a key challenge related to health diplomacy initiatives, noting that "the use of aid for political ends is always resented by those who receive it, but it is particularly resented when that aid deals with basic human needs such as food or health" (pp. 310-311). Other authors have also identified this challenge, particularly when aid that is tied to political ends addresses basic human needs such as food or health. In addition, focusing on health as a political instrument often limits the ability of global health initiatives to address priority health problems in a sustainable way (
Kickbusch et al., 2007
Silberschmidt G.
Global health diplomacy: The need for new perspectives, strategic approaches and skills in global health.
Ingram, 2005
Ingram A.
The New Geopolitics of Disease: Between Global Health and Global Security.
Geopolitics. 2005; 10 ([Article]): 522-545https://doi.org/10.1080/14650040591003516
identified three potential problems with the use of health as a foreign policy tool: (a) decreasing the credibility of health workers who have previously been viewed as neutral and not involved with state politics; (b) giving priority to narrow state interests over the interests of alliances needed to address global health issues; and (c) focusing on health as a political instrument rather than a human rights issue.
To address the potential challenges associated with linking healthcare assistance to foreign policy goals,
advocated separating U.S. foreign aid that addresses basic human needs for food, health, and education from other technical assistance programs and placing the responsibility for such programs with a private organization that receives U.S. governmental funding (similar to the model of the British Council in the United Kingdom).
noted that some have recommended explicit ethical principles to guide policy decisions to prevent the "high politics" of foreign policy from consistently overriding the "low politics" of global health (p. 13).
Lemery, 2010
Lemery J.
A case for white coat diplomacy.
Journal of the American Medical Association. 2010; 303: 1307-1308
suggested that the U.S. State Department engage physicians in "white coat diplomacy" to address humanitarian needs and foster "good will," but noted the concern of academic skeptics who fear that linking healthcare services to diplomatic goals might invite "manipulation."
Novotny, 2006
US Department of Health and Human Services: A need for global health leadership in preparedness and health diplomacy.
American Journal of Public Health. 2006; 96: 11-13
noted the instances of interference by federal agencies into the scientific independence of global health programs, such as restrictions on travel, scientific input, and collaboration.
Other challenges for global health diplomacy relate to confusion and failure to develop a common definition of the concept of global health security, the conflict between the rights of individual nations versus the need for international health regulations (
Aldis, 2008
Aldis W.
Health security as a public health concept: A critical analysis.
Health Policy and Planning. 2008; 23: 369-375
), and the increasing number of stakeholders interested in global health issues and the potential problems resulting from failure to coordinate global health initiatives (
). An example of this conflict was Indonesia's refusal in 2006 to share influenza virus samples with the WHO Collaborating Centers on influenza that traditionally receive samples from around the world for analyses to be used in development of new vaccines. Indonesia's refusal was based on the perception that the vaccines would be used to benefit only wealthier nations and would not benefit Indonesia (
). Many writers have emphasized the importance of coordination of global health initiatives by groups such as the World Health Assembly (
It is important for nurses to be aware of the potential ethical issues that arise when healthcare that is provided as a foreign-policy tool decreases the credibility of health workers who have previously been viewed as neutral and have not been involved with state politics; when it gives priority to narrow state interests over the interests of alliances needed to address global health issues; and when it focuses on health as a political instrument rather than a human rights issue.
Preparing Future Global Health Diplomats
There is growing recognition of the need to develop educational programs to prepare global health diplomats. U.S. Secretary of State Hillary Rodham Clinton called for the creation of a corps of civilian health diplomats who could contribute to the joint goals of diplomacy and international development by addressing problems related to health, food insecurity, environmental challenges, and challenges related to global warming (
Clinton, 2010
Clinton H.R.
Leading Through Civilian Power.
Foreign Affairs. 2010; 89 ([Article]): 13-24
Hotez, 2011
Hotez P.J.
Unleashing ''Civilian Power'': A new American diplomacy through neglected tropical disease control, elimination, research, and development.
PLoS Neglected Tropical Diseases. 2011; 5https://doi.org/10.1371/journal.pntd.0001134
suggested that the core of health diplomats proposed by Secretary Clinton could make significant contributions to addressing the global health challenges posed by neglected tropical diseases that affect nearly all of the world's "bottom billion" citizens who live on less than $1 per day.
Kerry et al., 2010
Kerry V.B.
Auld S.
Farmer P.
An international service corps for health–An unconventional prescription for diplomacy.
New England Journal of Medicine. 2010; 363: 1199-1201
described a specific proposal for an International Health Service Corps (IHSC) to enhance local health capacity, similar to the health outreach programs that have been provided by Cuba.
Interdisciplinary programs to prepare future global health diplomats should involve experts in fields such as foreign policy, academia, global health, epidemiology, health policy, economics, law, environmental science, and bioethics (
Kickbush et al., 2007
Kickbush I.
Drager N.
Alcazar S.
Global health diplomacy: Training across disciplines.
also recommended training U.S. military personnel in strategies for collaboration with humanitarian organizations and local governments, strategies to promote sustainability, cross-cultural and historical sensitivity, and disaster response.
summarized the goals of health diplomacy training programs, noting that "successful health development efforts have depended on functional and respectful relations among all the stakeholders, including donor and recipient governments, health care providers, local political leaders, and field-based NGOs. A capable health diplomat must have a sophisticated understanding of the structures, programs, approaches, and pitfalls surrounding these relationships to achieve success, whether working in the clinical setting or at the policymaking table" (p. 319).
Although no articles were identified specifically discussing global diplomacy content in nursing curricula, there are references related to addressing the general topic of global health in nursing curricula.
Bradbury-Jones, 2009
Bradbury-Jones C.
Globalisation and its implications for health care and nursing practice.
Nursing Standard. 2009; 23: 43-47
suggested that nurses have a global responsibility to address non-communicable diseases, as the leading cause of death worldwide, through work in health policy, research, education, and individual practice.
Archambault, 2010
Archambault N.
Incorporating global health into undergraduate nursing education.
MSN, University of British Columbia, Vancouver, British Columbia2010
recommended that undergraduate nursing programs address the key global health concepts of global citizenship, social justice, health equity, and the determinants of health, and suggested that content should include: introduction to global health, global health goals, determinants of health, healthcare systems policy and politics, primary health care, global nursing issues, culture and, healthcare, epidemics, communicable and non-communicable diseases, epidemiology and health outcomes, and humanitarian emergencies.
The Association of Faculties of Medicine of Canada (AFMC) Resource Group on Global Health and the Global Health Education Consortium (GHEC) proposed a set of global health competencies for medical students (
Association of Faculties of Medicine of Canada Reference Group on Global Health and Global Health Education Consortium, 2009
Association of Faculties of Medicine of Canada Reference Group on Global Health and Global Health Education Consortium. (2009). Global health essential core competencies Retrieved February 22, 2011, from http://globalhealthcompetencies.wikispaces.com/.
Wilson et al., 2012
Wilson L.
Harper D.
Tami I.
Mendes I.
Ventura C.
Zarate R.
Warren N.
Global health competencies for nurses in the Americas.
Journal of Professional Nursing. 2012; 28: 213-222
Wilson et al., 2010, 2012
Wilson, L., Harper, D., Tami, I., Mendes, I., Ventura, C., Zarate, R., & Warren, N. (2010). Global health competencies for nurses in the Americas. Paper presented at the Global Health Education Consortium, Cuerna Vaca, Mexico.
adapted these competencies for nurses, and surveyed nursing faculty in the U.S., Canada, and Latin America to identify their perceptions about whether the adapted competencies were appropriate for nurses. The competencies are divided into six broad categories: (a) global burden of disease; (b) health implications of travel, migration, and displacement; (c) social and environmental determinants of health; (d) globalization of health and healthcare; (e) healthcare in low resource settings; and (f) health as a human right and development resource. Survey responses were received from 561 nursing faculty members in the U.S. and Canada and from 56 nursing faculty in Latin America, indicating general agreement that the 30 competencies identified in these categories were important and appropriate for inclusion in nursing curricula. Although there is a need for further research to refine and validate these competencies, the survey results can be used to guide development of curricula to prepare nurses to contribute to addressing global health problems.
Finally, the Association for Prevention Teaching and Research convened a Healthy People Curriculum Task Force consisting of representatives from eight health professional educational associations in order to promote achievement of Healthy People 2010 objectives by integrating more content related to health promotion and disease prevention in curricula of the various health professions. The task force identified specific content related to global health that should be integrated into the curriculum (
Association for Prevention Teaching and Research Healthy People Curriculum Task Force, 2009
Association for Prevention Teaching and Research Healthy People Curriculum Task Force. (2009). Clinical prevention and population health curriculum framework. Retrieved from http://www.aacom.org/InfoFor/educators/Documents/Revised_CPPH_Framework_2009.pdf.
The literature reviewed provides important guidance that can be used to develop interdisciplinary curricula to prepare nurses and other healthcare providers to develop competencies in global health and global health diplomacy.
Implications for Nursing Practice, Education, and Research
The estimated 35 million nurses and midwives in the world make up the greatest proportion of the global health workforce (
World Health Organization and Organization, 2007b
World Health Organization. (2007b). World health statistics 2007. In W. H. Organization (Ed.). Geneva, Switzerland.
), and thus nurses could play a critical role in global health diplomacy initiatives if they were properly educated and prepared to be global healthcare providers and diplomats. Since the time of Florence Nightingale, nurses have provided culturally appropriate healthcare in diverse global settings. They have been key participants in addressing global natural disasters such as the 2004 tsunami in Thailand or the 2009 earthquake in Haiti. Global health diplomacy is an interdisciplinary academic field. Global health diplomacy is guided by wisdom gained through experience and the ability to find mutually acceptable solutions to global health challenges. Preparing nurses to contribute to global health diplomacy initiatives begins with the preparation of nurses as global citizens who are morally and ethically bound to understand and help individuals and groups at local, national, and global levels.
In addition to building on initial efforts to identify global health competencies for nurses, research is needed to identify additional competencies necessary to prepare nurses as global health diplomats. There is a need for dialogue and discussion among leaders in diverse disciplines such as nursing, medicine, political sciences, social sciences, law, business, and economics to further define these competencies and develop curricula that will prepare future leaders both in global health and in global health diplomacy (
Before nursing can support the concept of global health diplomacy as a dimension of this profession's global work, it is important to have a critical dialogue about the ethical and moral conflicts inherent in this concept – providing healthcare as a humanitarian responsibility versus using healthcare as an instrument of political activity. To begin such dialogue and promote further research to evaluate and refine the concept of global health diplomacy as a nursing phenomenon, the members of the AAN EPGNH Task Force on Global Health Diplomacy in Nursing endorse the definition of global health diplomacy proposed by
as "an emerging field that addresses the dual goals of improving global health and bettering international relations, particularly in conflict areas and in resource-poor environments" (p. 316). Further, the Task Force members believe that health diplomacy "is not only the job of diplomats or health leaders in government structures, it is a professional practice that should inform any group or individual with responsibility to conduct research, service, programs, or direct international health assistance between donor and recipient institutions" (
, p. 2).
If healthcare and healthcare providers truly wish to make a difference in the health of the people of the world, then identifying the causes of health problems, finding solutions, and implementing interventions are required steps. Global health diplomats must be prepared academically and experientially with astute negotiation skills; with collaboration skills to work with nations to protect health interests; with economic development acumen; epidemiological and research skills; and with diplomatic, economic, political, legal, medical, cultural, and conflict-resolution skills. There is need for further dialogue in the professional nursing community to identify nursing's role in global health diplomacy and identify competencies that should be incorporated in basic and advanced nursing educational programs to prepare students to contribute to health diplomacy initiatives.
Accepted: July 29, 2012
Received in revised form: June 13, 2012
Received: April 8, 2011
DOI: https://doi.org/10.1016/j.outlook.2012.07.013
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.


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CityU awards scholarships to outstanding PCLL applicants
The City University of Hong Kong invites interested individuals to apply for a spot in the Postgraduate Certificate in Laws (PCLL) programme by sending in their applications to earn the opportunity to be granted a scholarship.
Rewarding remarkable individuals
Earning a PCLL degree in Hong Kong at one of Asia's top law schools is a privilege that not many will have. But, CityU is giving the opportunity to earn a Postgraduate certificate in laws to applicants that have performed beyond expectations as proven in their applications. Scholarships are granted to PCLL applicants whose records have shown that they are capable of bringing the CityU name to glory.
To be accepted into the CityU School of Law is deemed with high regard. Being awarded one of the very limited number of scholarships by CityU, is of even higher esteem. The CityU School of Law awards a maximum of ten outstanding applicants with scholarships every year and each of the successful applicants will be given a HK$50,000 scholarship. Both local and non-local PCLL applicants are invited to submit their applications for the once in a lifetime opportunity to study at CityU.
It is important to note that there are no additional steps in applying to be awarded with a scholarship. Submitting an application to the CityU School of Law will automatically include you in the scholarship selection process.
Studying at CityU School of Law
Whether you receive the scholaraship or are simply accepted into the Postgraduate certificate in laws programme, one can expect to receive the best that CityU has to offer when it comes to law studies. The CityU School of Law prides itself in being among the top law universities in all of Asia. It has made its mark in law studies history and continues to build on a legacy of excellent law education. Without a doubt, earning your PCLL in Hong Kong is best done at none other than the prestigious City University.
Globally competent graduates
The School of Law trains its PCLL students to be competent trainee solicitors and exemplary pupil barristers. They are taught by no less then experts in their respective fields of study. The City University of Hong Kong has done much to stay true to its commitment to becoming the leader in law education in Asia by inviting law professionals from all over the world to provide instruction to Hong Kong's future lawyers.
The goal of CityU School of Law is to produce graduates that posses the following qualities: Well-rounded and client-centered, highly knowledgeable, adept to problem-solving, competent in advocacies, and capable in drafting processes
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CityU seeks to become more than just Hong Kong's top law school. It works tirelessly to be internationally known as Asia's top school for law studies. To achieve that objective, the university must be vigilant and ever-accepting of constructive criticism. To maintain and elevate the quality of education at which classes are administered at the CityU School of Law, Postgraduate certificate in laws classes are conducted in intimate settings. This means that small group instructions and discussions are the common mode of learning for PCLL students. Emphasis is placed on the quality of knowledge transfer hence the implementation of this method.
Community of law professionals and institutions
The results of the method speak volumes, gaining CityU valuable recognition from the law community. The Hong Kong legal community praises the PCLLprogramme of the CityU School of Law and works on collaborative efforts to foster the growing community of law students and law professionals, in turn raising the bar for the law community in Hong Kong.
School of Law Admission Scholarship for the Full-time PCLL Programme
Purpose of the Scholarship
To reward outstanding applicants to the School of Law's Postgraduate Certificate in Laws (PCLL) Programme who fulfill the criteria for the award.
Number and Value of Award
A maximum of 10 scholarships will be awarded to the PCLL students in each academic year. The value of each scholarship will be HK$50,000. The number of scholarships and allocation of scholarships each year are left entirely at the discretion of the School, and the decision is final.
The Scholarship is payable directly to a successful applicant. .
All PCLL students (local and non-local) are eligible for the Scholarship.
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Selection of recipients will be based on a consideration of relevant factors, primarily their academic merits.
The Scholarship will be paid to the recipients after their completion of studies of Semester A in their PCLL study. To receive the Scholarship, a recipient must:
accept an admission offer, enrol in the PCLL programme by paying all required fees and commence his/her study in Semester A of the given academic year; and
undertake all the required credit units in each of the two semesters of his/her study and complete the study within one academic year.
Failure by any student to comply with any condition specified above will result in forfeiture of the Scholarship. The School of Law may also require a recipient in breach of the above to repay the money to the School.
Application Procedure and Deadline
All PCLL programme applicants will enter the application for the scholarship automatically.
For enquiries about PCLL Admission Scholarship, please email to lwpcll@cityu.edu.hk.
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BCCI ombudsman fines Pandya, Rahul for Koffee fiasco
Last Updated : 20 Apr 2019 01:43:12 PM IST
BCCI ombudsman fines Pandya, Rahul for Koffee fiasco (File photo)
BCCI Ombudsman D.K. Jain has asked all-rounder Hardik Pandya and opener K.L. Rahul to pay a sum of Rs 1 lakh each, to widows of 10 constables in paramilitary forces who have lost their lives on duty.
They have also been asked to deposit Rs 10 lakh each in the fund created for promotion of cricket for the blind as fine for their misconduct in chat show.
In a report, accessed by IANS, the ombudsman has also said that if both the players fail to do so within four weeks from the date of the receipt of the order, the Board of Control for Cricket in India might deduct the said amount from the match fees payable to the players.
The ombudsman noted that the players had already missed out on earning of about Rs 30 lakh as they had been sent back from the tour of Australia. But he also noted that cricketers in the country are role models and their act should be befitting the status they have acquired.
But he also noted that since both the players apologised and did not contest the action initiated against them, it is unnecessary to return a categorical finding as to whether the remarks made during the course of the chat show constitutes as an act of indiscipline or misconduct or violation of any of Rules and Regulations on part of players as contemplated under Rule 41 (1) (c) of the rules.
Clearly, the matter ends with this and the two cricketers can now look forward to representing the country with aplomb in the upcoming World Cup in England and Wales as the national selectors have picked the duo in the 15-member squad.


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If you're not a huge fan of leather, perhaps a fabric chesterfield sofa is for you? Seen here in premium duck egg blue linen, this gorgeous fabric chesterfield has proved a big hit with our customers.
Available with a choice of luxury upgrades including Chrome Studs, this piece features a standard serpentine base and chrome stud finishing. This is an extremely comfortable sofa that offers style and elegance for any home.
If you're not quite sure on the fabric or the shade, don't forget to ask us about our bespoke upholstery service, which aims to meet your exacting requirements.
Crafted here in our Honley (West Yorkshire) workshop, your British-made piece is manufactured by time-served, talented craftsmen. What's more; your chosen piece will not leave our workshop before being thoroughly inspected by our workshop manager and Distinctive Chesterfields' MD, Steve Laidlaw. Giving you the peace of mind you're looking for that ours are quality pieces of furniture, this inspection ensures your piece won't arrive at your home anything less than perfect.


Discover Young's rich gold heritage and Chinese history, and why the region was once known as the 'El Dorado' of NSW.
Known as Lambing Flat until 1861, Young has a fascinating and at times volatile history steeped in gold. After the precious metal was first discovered in the area in 1860, Lambing Flat became known as the 'El Dorado' of NSW, with over 14,600kg of mainly alluvial gold extracted from its goldfields.
As is to be expected in the discovery of a rich goldfield, the Burrangong field drew in thousands of miners and prospectors from both near and far. This was a rich and vast area that could be worked easily with limited capital, equipment or manpower, making it every unlucky miner's dream. By the 1860s, such places were rare as gold was proving harder to find, and competition for the good ground was immense.
Among the new arrivals were 1500 Chinese miners, who staked their claim on the Lambing Flat filed from its earliest days. The Chinese were organised labourers, arriving in NSW in groups of around 100 people, complete with a leader. This approach allowed them to undertake mining in a vastly more systematic way than European miners, who worked alone or in small groups.
Chinese teams were prepared to invest time and labour in building infrastructure, such as water races and dams, to underpin their mining efforts. Water was typically a very scarce resource on the diggings, so the way the Chinese were able to provide for their own needs was a major point of difference.
The success of the Chinese miners in re-working ground that Europeans had abandoned as no longer payable led to palpable jealousy and resentment, with Europeans accusing the Chinese of 'taking their gold'.
While anti-Chinese sentiment was widespread, the highly dispersed nature and small number of miners on many of the NSW diggings had usually acted to prevent major confrontation. Many predicted that it needed only a rush to a goldfield rich enough to attract a large concentration of European and Chinese miners for an explosive situation to develop. Thus, with 9000 miners on the Burrangong and Lambing Flat goldfields by 1861, the stage was set for confrontation.
In late 1860 and early 1861 there were several attacks on Chinese miners. On 30 June 1861, some 3000 Europeans marched against Chinese miners on Lambing Flat goldfields, attacking their two main camps at Blackguard Gully and Back Creek. The Europeans were mainly armed with pick handles and carried a flag emblazoned with the words, 'Roll-up Roll-up No Chinese', which is on display today in the Lambing Flat Folk Museum. In a brutal expulsion that included scalping some 'Celestials' as their pigtails were cut off, the Chinese were banished on a cold midwinter night, with no equipment or provisions.
After the riot, 1276 fearful Chinese took shelter at local landowner James Roberts' property at 'Currawong', 20km away near Murrumburrah. Roberts, his wife Elizabeth and their employees fed and sheltered the Chinese for two weeks.
Police reinforcements arrived on the field a week later, with three of the ringleaders arrested on 14 July. That night, 1000 miners attacked the police lock-up to free the men, resulting in one death when the police fired and charged the crowd. The next day the men were released.
The riot led the assistant gold commissioner to read the British Parliament's Riot Act of 1714, which gave local authorities the power to declare a group of twelve or more people to be an unlawful assembly, and order them to disperse or face punishment.
Such a blatant uprising against law and order shocked the colony, with popular opinion blaming it on the presence of the Chinese. Parliament passed an anti-Chinese immigration bill and restricted where the Chinese could mine. This is regarded as the beginning of the 'White Australia Policy', restricting non-European immigration, which ended with the abolition of the Immigration Restriction Act in 1973.
This highly discriminatory legislation did help reduce tensions, creating a gradual status quo of resentful co-existence. As the alluvial gold reserves dwindled, most Chinese miners returned home, while those who stayed often drifted into new occupations. To diminish the memory of the riots, the name Lambing Flat was changed to Young, after the governor Sir John Young. Today, all citizens are respected and welcome in Young.
Those interested is discovering more about this significant period of Australian history can visit many of these sites along the Gold Trails of Young and Harden, many of which are still in a similar condition to how they were in the mid-19th century. Those eager to try their hand at fossicking are also encouraged to do so, with gold pans are available for hire from the Lambing Flat Folk Museum.


Ensuring Success for Employers, Investors and Immigrants.
Our clients are the foundation of our Firm. We put you first. We use our decades of direct experience in Immigration Law to work on each case in a collaborative, team approach. We ensure that our case preparation, process and even our communications with our clients are focused on ensuring that you know and understand what we are doing for you, why we are doing it, and when it will be done.
The exceptional team of immigration attorneys at Kuck | Baxter Immigration Partners provides detailed and accurate advice and legal representation in all aspects of immigration law. Our expertise encompasses all types of Business immigration matters for large and small businesses and investors, as well as inventors, students, doctors, employees, families, asylum seekers and those seeking to stay in the United States.
Every case that we take will benefit from our decades of legal experience. Our case preparation methods, collaborative approach, and standards of client communications were developed with the wisdom that comes from years of experience and dedication.
Our practice revolves around you, the client; your priorities are our priorities. Our office staff and deportation attorneys respond to emails and phone calls on the same day they are received, because that is the level of service that our clients deserve.
My husband and I are both immigrants so we went to see many immigration lawyers and worked with some of them. No one was as good as Kuck and his team. They are very accurate and fast responding. We were extremely pleased with their work and highly recommend them.
My wife was arrested by ICE because she was under exclusion orders from the immigration in Atlanta. She was picked up by ICE from my home. It is amazing what this immigration attorney can do. He got my wife's charges dismissed and got her a green card. I had visited about three attorneys who could not help. If you have an immigration or deportation problem I would advice you to go see this guy. He is really amazing.


Big News from the smalles electronic art gallery in the nordic countries (that I've visited so far). Jacob Remin, a media artist that have been part of events like electrolobby06 (Ars Electronica), Halfmachine, running the website campingsex.org and one of the initiators of the danish 8-bitklubben is also behind mikrogalleriet.
The fact is that Jacob was one of my students at K3 during one term as part of an exchange with DTU (Danish Technical University) where he was taking part in the engineering education. Since then he has been using Arduino in many projects and has helped quite a lot to warm up the hardware electronic art scene in Denmark.
At some point he found a small space in Norrebro, Copenhagen and decided to transform it into an art space. One of the most active until today. I guess I will be blogging more about the Danish art scene and its relationship to Arduino and other open source hardware projects (believe me, there is more). Just as reference you should check Lab, and Komponent, two of the historical groups in Copenhagen doing quite a lot of events.
The video within this post shows an Arduino-hacked football stadium LED screen that somehow ended up in the hands of these people … who said Danes didn't know how to party?


With golfing, nature trails, a clubhouse facility loaded with activities and a pier with gazebo nearby, The St. Augustine Shores has something for all lifestyles! Why not enjoy life in this 2 bedroom, 2 bath Conquistador Condo home. Thanks to a maintenance-free exterior, all you need to do is add your personal touches to make this home yours. Don't delay, your Intracoastal sunrises await!


I'm so happy to share with all of you the great news that Elegant Interior Designs was chosen by the design site Freshome as one of the Best Interior Designers in Philadelphia!
Elegant Interior Designs was one of 20 selected out of more than a hundred interior design firms in the city, and we're thrilled to be in such great company.
"Elegant Interior Designs, LLC, an award-winning interior design firm, has served the Greater Philadelphia area and beyond since 2003. The company, based in Ambler, provides residential and commercial clients with unique, warm, inviting living spaces that reflect their personal taste and lifestyle….
It's about you, not us!
We're obviously honored to be recognized by the site, but we'd be remiss if we didn't use this opportunity to thank all of our valued clients and referral partners. Your testimonials, your feedback, and your support clearly played a vital role. This recognition is as much about you as it is us!
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TIP! You never want to leave the cords of your drapes dangling down. Cats should not be allowed to play with these cords, as they can get parts of their body stuck in the cord loops.
A cat is a very complex creature. From the moment they prance into your house, cats can be indecipherable. Being informed on cats can make the cat care process easier. You should keep reading for some useful tips that will help you become a better pet owner.
It is a good idea to microchip your cat. Even cats who live completely indoors may someday decide to bolt out the door or escape out of a window. Tags and collars may be able to help you get your cat back, but cats can sometimes take these things off or they could get hung up on a tree or something. You can use a microchip instead; you can store your contact information in the chip and it will not bother your cat. The chip will never be lost because it is under the skin and it can easily be read by any shelter or vet.
If your cat is male, understand that he could develop crystals inside his urine, which can be very painful to him. Therefore, prevent this issue from occurring in the first place by feeding your cat the right type of food. The cat is in pain passing the crystals, and the correction for this is costly. Keep your cat's diet low in levels of magnesium. Always read labels. Fish products are usually higher in magnesium.
TIP! Regular visits to the vet will preserve your cat's health. A yearly visit for a regular check-up is important, with more frequent visits for shots as required.
Create a tablecloth for the feline. Some cats prefer removing their food from the bowl and eating it on the side. Sometimes this will make the area around the bowl messy, and you'll have to clean it. To make clean up a breeze, use a place mat underneath the bowl or a piece of fabric. You'll be able to pick it up easily and shake the excess food into the trash.
TIP! It is likely that your feline friend enjoys grooming his fur. However, if it has a lot of hair, hairballs can occur.
If you get a cat for your kids, make sure to set clear boundaries in advance. You can then teach your kids which areas your cat can go into. Advise your children not to let the cat out if it is to be an indoor cat. Make sure your children understand the rules from the get go.
TIP! Prevent crystals from forming in the urine of male cats with the right diet. Your cat will experience considerable pain when he has to pass these crystals, and it's not an easy (or cheap) problem for your veterinarian to fix.
You should try your hardest to figure out the reason that you are hearing your cat meow. Learning about your cat's meows will be easier the longer you know her. She could be signaling that she is hungry, or she might want to go outside. Pay attention to her cues, and you can understand your cat that much more.
TIP! Put a cloth down in your cat's eating area. Often, a cat will remove food from his bowl to eat on the side.
Don't let your cat outside. Being outside all the time is not safe for a cat. Cats can become infected with fleas, ticks and ringworm. Your cat could be injured by other animals, people and vehicles. When your cats go outside, keep an eye out to make sure they do not wander too far away.
Do you own a dog and cat? Dogs are known for eating other pet's food. Try locating your cat's food in an area where the dog cannot go. This is a good way to keep your pets from fighting over food and water.
TIP! Cats enjoy climbing on things. To keep your cat happy, offer him a spot of his own up high where he can survey his kingdom.
Make sure you are cautious about leaving a young child alone with a small kitten. If children are younger than five years old, pets ought not be left with them. Most of them simply aren't mature enough to grasp the concept of danger to themselves or the animal. Once the child is older and more mature, decide if they are ready for the responsibility of handling animals.
TIP! Never try to teach a cat how to work a litter box. This comes quite naturally to them and is not something that is learned.
You should talk to other pet owners if you have an issue with yours. You won't have the knowledge to handle every cat issue properly, so take advantage of the experiences of others. There are also forums on the Internet which cater to cat parents.
TIP! Brush your cat's fur regularly. This will spread a cat's oils from their fur and help blood flow from within their skin.
You may not be able to impress your cat, but proper care will certainly not go unnoticed. Use this article to ensure that you are fulfilling your cat's most basic needs, as well as its need for love. Your cat just might start playing nice! Follow these tips for your best chance of success.
Most people are interested in learning about additional reading, however, they are not always aware of how to do so on their own. Fortunately for you, this article has given you the information that you need to get started doing just that. Now put what you have read in this article to use.


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Your password needs to be at least 6 characters. (ex: Z2PxmeO!S+A1)
Your password needs to be at least 6 characters. (ex: s7B3vJVnXzd@)
5 Times J.K. Rowling Got Real About Depression
J.K. Rowling is best known for her beloved Harry Potter series, but there's a side to her that some Muggles might not know about. Rowling, then in her 20s, wrote the first book in the series while caring for her newborn daughter and dealing with the aftermath of her recent divorce. She also dealt with depression during this time and experienced suicidal thoughts. It was difficult for Rowling to adjust to her worldwide attention, but she's since told The Guardian that she's now disengaged from the pressure.
Rowling has been vocal about her mental illness. In May, the author responded to a tweet from a fan about failure. "This may get lost in the noise…" the fan's tweet read. "But what wold you say to someone who has failed to find meaning and wants to finally give up?" Rowling first responded with a few photos:
.@BrocaesarTV I would say: look at this. pic.twitter.com/2N0FUgh1On
— J.K. Rowling (@jk_rowling) May 4, 2015
.@BrocaesarTV And this. pic.twitter.com/YA2MRoGK7g
.@BrocaesarTV And even this. pic.twitter.com/Fpx6HYGRaz
Then Rowling really opened up, writing: "And I'd say, the world is full of wonderful things you haven't seen yet. Don't ever give up on the chance of seeing them."
.@BrocaesarTV And I'd say, the world is full of wonderful things you haven't seen yet. Don't ever give up on the chance of seeing them.
We're always grateful when people in the spotlight don't shy away from discussing difficult issues. Below are four other times Rowling was candid about her depression. We hope, if anything, her words can help someone struggling realize they are not alone.
1. "It's so difficult to describe depression to someone who's never been there, because it's not sadness. I know sadness. Sadness is to cry and to feel. But it's that cold absence of felling — that really hollowed-out feeling." — J.K. Rowling
2. "Depression is the most unpleasant thing I have ever experienced… Sad hurts, but it's a healthy feeling. It is a necessary thing to feel. Depression is very different." — J.K. Rowling
3. "[My depression] was characterized by a numbness, a coldness and an inability to believe you will feel happy again. All the color drained out of life." — J.K. Rowling
4. "I have never been remotely ashamed of having been depressed. Never. What's there to be ashamed of? I went through a really tough time and I am quite proud that I got out of that." — J.K. Rowling
If you or someone you know needs help, see our suicide prevention resources.
If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.
Image via Wikimedia Commons/S.macken6
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Google adds two-factor authentication option to Google Apps
Google beefing up its mobile apps
The smart paranoid's guide to using Google
Ring! It's Gmail's new voice feature calling
Google rolls out 2-step verification for Apps users
New sign-in feature unveiled at Google Atmosphere aims to boost cloud security
By Sharon Gaudin
Google today moved to boost security for users of its hosted Google Apps tools by adding a new two-step verification process.
Google announced the new sign-in feature Monday morning at its Google Atmosphere conference in Paris.
"Cloud computing is about making your information easily accessible from anywhere, on any device," Eran Feigenbaum, director of security for Google Apps, said in a blog post. "Until today, organizations looking to secure their information beyond a password have faced costs and complexities that prevented many of them from using stronger security technologies. Today, we are changing that with the introduction of a more secure sign-in capability for Google Apps accounts that significantly increases the security of the cloud: Two-step verification."
The feature, which must be enabled by an administrator, requires that users have two means of identification - something they know (a password), and something they have (a cell phone).
Feigenbaum explained that after a user plugs in her password, a verification code will then be sent to her cell phone.
"This makes it much more likely that you're the only one accessing your data," he said. "Even if someone has stolen your password, they'll need more than that to access your account. You can also indicate when you're using a computer you trust and don't want to be asked for a verification code from that machine in the future."
While this new capability is just for Google Apps business users today, Feigenbaum said it will be rolled out to all individual Google users "in the coming months."
Google apps include Gmail, Google Docs and Calendar.
Sharon Gaudin covers the Internet and Web 2.0, emerging technologies, and desktop and laptop chips for Computerworld. Follow Sharon on Twitter at @sgaudin, or subscribe to Sharon's RSS feed . Her e-mail address is sgaudin@computerworld.com.
Sharon Gaudin is an experienced technology and science reporter.


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HomeBlogWhat is CTR in Google Adsense : 5 Tips to Increase the Adsense CTR
What is CTR in Google Adsense : 5 Tips to Increase the Adsense CTR
Kalpesh Meniya January 07, 2021
Google AdSense is the best Ad network to monetize any blog but you can make money only if you can increase the CTR but what is CTR in Google Adsense and how to Increase CTR?
In brief, CTR stands for the Click Through Rate, which is the percentage of users click to the Ads displayed on your website based on the total number of Ads displayed on your site.
The definition of CTR can be finished in two sentences but there are a lot of efforts needed to increase the CTR of any website for Google Adsense earning.
The primary source of monetization for any blogger is Google Adsense and there are two very important ways to make more money using Google Adsense.
Driving the unlimited traffic to the website.
Increasing the CTR of Ads on the website.
This guide will explain to you all about What is CTR in Google Adsense, how to increase CTR of the website, and how to check CTR in Google Adsense, we will also focus on differences in between impressions CTR and page CTR.
Must Read: How to start a successful blog
How much money does Google Adsense pay for the Ads and brief summary of relative terms like what is Google Adsense, What is RPM, what is page views and CPC?
We will also focus on what is the maximum CTR allowed in GoogleAdsense, how to increase the CTR of Adsense?
Let us first discuss, what is CTR in Google Adsense?
What is CTR in Google Adsense?
Google Adsense is the Google-owned Ad network, which was started back in the year 2003. If your site is approved with Google Adsense, then by placing Ads you can make money.
Google Adsense pays money to the publisher like us based on the two ways.
Ads impression
Ads clicks
Ads impression is known as the number of times Ads displayed on your website whenever any visitor visiting your site and you will be paid for that Ad impression and this will be counted as RPM which means revenue per mile or 1000 impressions.
However, Ads click is the major source of revenue, which will be counted only if any visitor clicks to the Ads displayed on your website and the revenue earned per click will be known as cost per click or CPC in Google Adsense
While comparing the earning using both ways, Ad clicks have more potential to make a minimum of $0.01 to $100 per clicks and that is why click is an important factor of Google Adsense CTR.
If your website is hosted on WordPress then don't miss to connect or verify WordPress site with Google Adsense else you won't receive any ads on the site.
CPC of the keywords depends on the niche and keyword selection here is the collective list of highest paying keywords or niche you can use for your references.
If you have understood the above two terms then it will be easy to understand what is CTR in Google Adsense.
CTR stands for the click-through rate or in other terms, the percentage of ads clicked based on their total number of impressions.
Let me simplify, this to you using an example.
Imagine you have a website that has daily 100 visitors, which means, you will have at least 100 page views.
Am I, right?
If your blog is approved with Google Adsense, then on an average with 1500 words content you can place at max 5 Ads at different places of the website such as:
One Ad before the content
One Ad after the content
One Ad on the sidebar of the page.
Two Ad in the middle of the content
Which means if 100 visitors, then an average there will be 100*5=500 impressions on the website, well this number can vary due to certain reasons like
Few users might be using an Adblocker.
Few user's internet speed is very slow which causes, ads will be not loading properly.
Few users visited your site but bounced back after reading the first few paragraphs, so no impressions for the lower side of the page
Like that, there could be various reasons but here in our case, we can consider all 100 page views with a total of 500 impressions.
When it comes to calculating the CTR in Google Adsense, for which we have two types.
What is Impressions CTR?
Impression CTR will be calculated based on the total number of Ad clicks divided by the total number of impressions on your website. As in the above example.
If out of 100 users, if 10 users have clicked to an average of 2 ads on the page, which means now we have 20 clicks out of total 500 impressions, then the Impression CTR will be:
CTR = (20/500)*100 = 4%
This means the Impressions CTR for the above scenario will be 4% and the impression CTR in the google AdSense dashboard is known as the CTR or click-through rate which calculates the percentage-based on the total site impression.
If we will create a mathematical formula then:
CTR = (Total number of clicks on Ads /Total number of Ads impressions)*100
If I summarize once again, then CTR in Google AdSense will define how many ad clicks have been received on the total number of ad impressions, if any reader is visiting your website.
Similarly, we have another CTR which is page-level CTR.
What is Page CTR?
Like impression CTR, page CTR will be calculated based on the average individual pages instead of taking the reference of complete site impressions.
In the above example, if we have a total of 100 page views and every page has a total of 5 ads displayed with 2 Ad clicks by 10 users then a total of 20 clicks, and the Page CTR would be.
Page CTR=(20/100) *100=20%
In the mathematical formula, we can calculate it as:
Page CTR = (Total number of clicks on Ads/total number of page views)*100
These major difference in between Impression CTR vs Page CTR is a hidden truth behind the overall concept of what is CTR in Google Adsense.
In Google Adsense, the earning will totally depend on the high Adsense CTR. But do you know how much should be the max CTR for a particular page? If not then keep reading.
We will discuss that later but first, focus on how to check the CTR of the Google Adsense account.
How to Check CTR in Adsense?
Click through rate is a factor to check the clicks on the ads impressions and in this case, the only way to validate is from the Google Adsense account.
If your blog or site is approved with Adsense then you can navigate through the below steps.
Login to Google Adsense account.
Click on the homepage of the Adsense account.
Place the filter for the date range as here I selected for the last 7 Days.
A matrix with different details will be shown as below.
In the above Adsense dashboard, you can see the total number of ad impressions is 25k, the total number of Page Views is 89.1K however, the number of clicks received is 2.65k.
If we put all numbers in the mathematical formula then the end results for the Page CTR will be.
Page CTR=(2650/89100)*100 =>2.97 which is approx 2.98%
But how to check the exact Impression CTR or exact page CTR, in this case, clicks to the Reports on the left-hand side below the home and it will navigate to the Default report.
Click to Custom fields and place some additional filers in it.
Set filter like Page views, impressions, clicks, Page CTR and CTR
A new window with exact impressions and clicks will be displayed as you can see below.
If we will use the mathematical formula to calculate the impressions CTR then we have.
Impressions CTR= (2655/24,992)*100=10.62%
Page CTR= (2655/89,137)*100=2.98%
From the above two matrices, you can see the impression CTR will be always higher as compared to page CTR because it calculates the ad clicks from the overall site impressions.
Let discuss on what is the good CTR for an Adsense which ensures your account is safe.
What is Good CTR for Adsense?
Having a higher CTR in result more earning but it should not be higher as Google will disable your account. Yes, there have been a number of cases reported by people.
Due to the higher page CTR, as a result, their AdSense account was banned and was never active even after appealing a number of times to Adsense, as it against the Google Adsense policy.
If taking the reference of the ideal Page CTR then, it ranges in between 1-3% and if your site is also having the same CTR then you are almost in the safe zone and this is what AdSense is expecting.
Click through rate of the Adsense depends on various factors such as the selection of the niche if you are in health and fitness or tech niche then the chances are higher that you may get more ad clicks as compare to any informative guide niche.
But anyhow, if you have crossed the benchmark of 10% and CTR is close to 15% then you need immediate attention for your site as in ideal scenario it looks higher then what google is expecting.
With my personal experience, I have tested my site with 8% CTR and it was perfectly fine but I am also familiar with the site which has CTR of close to 18% and was banned by Google Adsense.
Practically, it is impossible to have a CTR which is close to 20%, no user on your site is landed to click the ads but there to explore the content you have written.
Sometimes, people use shady techniques to increase CTR like:
Placing the Google AdSense ads in parallel with images.
Placing the page layover AdSense ads to maximize the ad clicks.
Maybe clocking or redirecting the users from invalid site to Adsense approved site.
There could be multiple ways through which publishers try to manipulate the CTR of the AdSense and now I hope you got a good idea on what is CTR in Google Adsense.
Before ending this guide let me give you some ideas or genuine tips on how to increase the Adsense CTR?
How to increase the CTR in Google Adsense?
An increase in the CTR means placing the ads on the right places of the page, but only placing ads does not increase the CTR, as a user only clicks ad if they found relevant to their interest.
Thanks to Adsense personalized ads placement feature which, observes the cookies of the visitor and based on his past search or history will place respective ads on the site.
Now next is our job to highlight those ads to the users by placing them to the right position on the page, which I suggest as explained below.
Place the Link ads just below the title of the page or above the first paragraph, which increases the chances of clicks as link ads look like as an anchor text and the text color would be blue.
Place 300*250 square box display ads on the top side of the sidebar which attracts the user's attention and grabs the highest CTR.
Place the mixture of display or link ads two times in the middle of the content ideally after 30 and 50 paragraphs.
Place a sidebar sky scrapper long verticle ads of 300*600 (responsive ads) to cover the half of the sidebar page.
Place a long horizontal ad of size 720*90, just after the content of the ads to grab the user attention, if he scrolled till the end of your website
Use the Google Auto Adsense feature, which will place the ads on different places to the middle of the content based on user engagement.
Here is the list of 10 high performing ad units shared by WpBeginner, which you can use to maximize the AdSense revenue
Above are a few 5 spots that are very well suggested to every website owner to place the Adsense ads, so they can maximize the CTR and can increase the Adsense revenue.
But the layout of every website is different, hence you can opt any one pattern as suggested below which fits best.
Make sure, do not over-optimize the post with the AdSense ads else the bounce rate or exit rate of the site will get increase and you may start losing the user engagement and the google ranking.
I hope you are clear with the concept of, What is Impression CTR and what is Page CTR in Google AdSense and how to check and increase the CTR but always try to focus that the Page CTR should not be more than 8%.
Wrap Up on What is CTR in Google Adsense
CTR is the primary factor to judge how much revenue you are making based on the number of ads impressions and pageviews on your site, if it is less than 1% then you definitely need attention to optimize ad placement.
If Adsense CTR is more than 8% then focus on minimizing the risk of disabling the Adsense account, but you can not fully control CTR as it mostly depends on the niche if you have an entertainment site then it may be higher than what you have expected.
What are your site CTR and your Adsense account is banned or disable anytime before?
Let me know in the comment box, so we can figure out up to what level you can maximize the CTR for that particular niche?
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In a very large stock pot over medium-high heat, add the water, lemon, salt, and Old Bay Seasoning and Tony Chachere's; bring to a boil.
When the seasoned water comes to a boil, add redskin potatoes, onions and garlic and boil for 20 minutes. When done, the potatoes should be easily pierced with a knife but not mushy.
Add corn and cook and continue cooking an additional 5 minutes (begin timing immediately, don't wait until water is boiling).
Add shrimp and crab and cook an additional 3 to 5 minutes longer. Don't overcook the shrimp. Remove from heat and drain immediately.
Serve with lots of paper towels or napkins, plus melted butter for the corn, cocktail sauce for the shrimp, and sour cream or ketchup for the potatoes. This is a messy dish; you'll need a whole handful of napkins or paper towels.


Nigeria's Finance Minister, Kemi Adeosun, has resigned sources close to her told Daily Trust.
It is not clear when she submitted her resignation letter.According to our source, the resignation followed the allegation of not serving the compulsory National Youth Service Corps, NYSC, and obtaining a certificate that the NYSC have disowned.
The Minister of State for Budget and National Planning Hajia Zainab Ahmed, another northerner, has been tipped to replace Mrs Kemi Adeosun, the Finance Minister, who reportedly resigned his position Friday.
Sources disclosed that Hajia Ahmed will not need to undergo Senate screening for confirmation as she is already a serving Minister.


text:
Diageo tentatively tests a return to YouTube after its brand safety scare
By Rebecca Stewart-30 April 2019 13:38pm
The Guinness and Gordon's owner is running a series of "scaled trials" in the US, India and Europe
Diageo is toying with a return to YouTube after concerns around the efficiency of the platform's brand safety measures triggered a two-year hiatus.
The Guinness owner is running a series of "scaled trials" in the US, India and select countries in Europe to test the effectiveness of YouTube's latest brand safety updates. The tests are being supported using third-party brand safety technology and reporting tools.
"They've been going well so far," Isabel Massey, global digital director at Diageo, told The Drum. "But we're monitoring them really closely, so we will certainly continue to test and learn and make sure we're doing the right thing."
The business has made it clear it will only consider a full return to YouTube if its experiment confirms that the Google-owned platform meets the standards outlined in Diageo's Trusted Marketplace programme, introduced in 2017 to make sure the brand gets the best value from its media buys.
Massey explained: "What we've been doing is working with YouTube to make sure that the changes they've made themselves, and the changes we've made as part of our own progress uphold the standards we believe are important."
Diageo will only consider a full return to YouTube once the business has run a full series of trials and is satisfied they meet Diageo's high standards.
Google itself has admitted that the "dark pockets" lurking on the internet mean YouTube may never be 100% brand safe. Since 2017, the platform has faced unrelenting questions from advertisers over ad misplacement – its 'mea culpa' moment coming in the wake of an investigation from The Sunday Times which detailed how household brands were inadvertently funding extremist and violent content through ads.
In the wake of the furore some brands, including Adidas, froze spend for a matter of days. Diageo, however, has been uniquely consistent in voting with its wallet. Even now it is tentative about a wholesale return to YouTube and members of its marketing team previously admitted that the freeze hadn't necessarily impacted brand performance.
For YouTube's part, it has developed a suite of internal tools to alleviate brands' concerns. These include strict new criteria for content monetisation and greater controls for advertisers on what they perceive as 'appropriate content'.
In response to recent fears around child safety, the site upped its use of machine learning, which has helped it to double the speed at which it is able to take down any content that violates rules.
Misplacement fears aside, brands are facing a fresh call from the World Federation of Advertisers (WFA) to consider their "moral responsibility" when spending with tech giants who host extremist content, whether it's monetised or not.
Following on from a month in which YouTube faced questions over paedophilic comments and Facebook was used to live-stream a New Zealand terror attack, the trade body stopped short of encouraging brands to freeze spending, urging them instead to put pressure on social media platforms to do better.
When asked if these events made her nervous about a potential return to YouTube, where excerpts of the Christchurch shooting video wound up, Massie said that "combatting walled garden issues" was something she was "passionate" about.
"We'll do that in the right way for Diageo," she said.
As well as taking ownership of Diageo's brand safety strategy, Massey has also been figuring out how to bring creative and media closer together within the business, something the likes of Renault and O2 have also been testing.
"We want to make sure that we're integrating the teams. So breaking down the borders between our own businesses and theirs, and also between disciplines, like media and creative."
The brand has already tested this with Smirnoff in North America, where it got creative and planning teams to sit in the same room and collaborate on a big campaign. Though she declined to name the work, Massey noted that the setup sent "effectiveness levels through the roof".
"That's a model we're now rolling out globally and we're really delighted," she added.
Where fellow FMCG marketer Keith Weed has pointed out the difficulty in getting different P&Ls and egos under the same roof, Massey said the Smirnoff experiment hadn't brought about the same challenges.
"Everyone was focused on the outcome, and what we were all aiming to do together. If everyone is clear on that and has joint goals and knows that the success is dependent on us going after that together then the egos come second to that."
This article is about: World, Diageo, Youtube, Marketing, Brand


Join the Center for Biological Diversity, Friends of the Tampa Bay National Wildlife Refuges and The Ale and the Witch for environmental education, conversation and beer!
We'll be in the plaza, and this month's event will feature a presentation by Davey Connor with the Suncoast Rise Above Plastics Coalition. The Rise Above Plastics Coalition started small and rapidly grew to include a dozen organizations dedicated to ending our dependence on single-use plastics. Davey will talk about the coalition's #BanTheBag campaign, what an Ocean Friendly Business is, and how you can make a positive impact.
Davey Connor currently chairs the Rise Above Plastics Coalition. His background is in media relations and communications. He realized his passion for advocacy when he moved to St. Petersburg and learned about the mission of Rise Above Plastics.


text:
June 2022 was the hottest June in Houston history
A high-pressure ridge, effects of climate change and a lack of rain caused last month to break the record set in 2011 as Houston's hottest June.
Duaa Faquih
| Posted on July 1, 2022, 3:33 PM
Allison Lee/Houston Public Media
A view of Buffalo Bayou and the Houston skyline.
June didn't just seem hotter than usual – it was. In fact, it was Houston's hottest June on record.
The average temperature in June was 86.7℉, a number that accounted for the daily highs and lows. That broke the existing record set in 2011 by half a degree.
"In meteorological and climatological terms, that's really a significant breakage of the record," Space City Weather meteorologist Eric Berger said.
So why was it so hot?
"We were basically sitting beneath a ridge of high pressure for much of the month," Berger said, explaining that the sunny days and light winds that persisted throughout June were a recipe for very hot days.
Rising temperatures can also be attributed to the effects of climate change, Berger said. Galveston Island broke its own record for the average temperature in June by more than a degree, indicating the Gulf of Mexico's rising temperatures.
In terms of the weather in July and August, Berger admitted that, when comparing this year's June to 2011, "it's a little bit scary."
After its record-breaking June, the summer of 2011 was the hottest ever recorded in Houston and the city suffered its worst drought on record.
However, Berger explained that research does not necessarily display a strong correlation between a hot June and a hot July and August.
"Just for the fact that we were so hot in June does not necessarily mean that July and August are going to be hot this summer," Berger said.
With that said, next week will warm up again as a high-pressure ridge moves back into Texas. Berger predicted temperatures in the Houston area will be in the mid-90s with lots of sunshine.
Energy & Environment Houston Local Weatherclimate change drought june summer
The cybersecurity threat of TikTok (Jan. 23, 2023)
Posted on January 23, 2023 · On Monday's show: Now that TikTok has been banned from government-issued devices in Texas, we discuss what sort of threat the social media app may pose.
Tags bbc Chris Bronk climate change cybersecurity Dwight Silverman Jeff Balke nfl NLF playoffs sports technology The End of the World Has Already Happened TikTok Timothy Morton
Harris County adopts plan to slash greenhouse gas emissions on county operations 40% by 2030
Andrew Schneider, Politics & Government Reporter
Posted on January 10, 2023 · The climate action plan, which passed 3-1 on a party-line vote, aims to reduce emissions compared to a base year of 2021.
Tags climate change greenhouse-gas emissions Harris County Commissioner Adrian Garcia Harris County Commissioner Lesley Briones Harris County Commissioner Rodney Ellis Harris County Commissioner Tom Ramsey Harris County Commissioners Court
Fentanyl vaccine, and climate refugees (Dec. 2, 2022)
Posted on December 2, 2022 · On Friday's show: A new vaccine developed in Houston targeting the dangerous synthetic drug fentanyl could be a gamechanger in the opioid epidemic. And we learn how climate change could exacerbate the world's refugee crisis.
Tags Cat Daddies Cats climate change climate refugees documentary environment fentanyl fentanyl vaccine Mye Hoang pets refugees The Good The Bad and The Ugly
Boil water notice lifted (Nov. 29, 2022)
Posted on November 29, 2022 · On Tuesday's show: We bring you the latest on the fallout and the effects of the city-wide boil water notice. And we learn how a local researcher is using a telenovela to help Latinos dealing with Alzheimer's disease.
Tags (w)Hole Alzheimer's Disease climate change dementia entrepreneurs entrepreneurship Greentown Labs grief Jung Center latinos Luis Medina mark jones politics rice university telenovelas TEX-E Texas Legislature visual art
Your July 4th cookout will be pricier this year
Flooding, pollution more likely to occur in Houston minority communities
LIST: Houston 4th of July events


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