Recipients recognized for efforts in technology, media, chapter excellence, research, education, practice, and leadership.
Baltimore, Md. – Dean Jane M. Kirschling, PhD, RN, FAAN, University of Maryland School of Nursing (UMSON); a faculty member; four alumnae; and the School's local Pi Chapter were honored at Sigma's (also known as Sigma Theta Tau International, the Honor Society for Nursing) 44th Biennial Convention in Indianapolis, Indiana. The awards recognized health care professionals for their contributions to professional excellence.
Kirschling received Sigma's Melanie C. Dreher Outstanding Dean Award for Excellence in Chapter Support, which honors a dean who is an active participant in the chapter and is engaged in supporting Sigma chapter activities. The awardee also provides significant support from the school to the chapter while championing faculty and student involvement in chapter activities and encouraging faculty and student participation in local, regional, and/or global Sigma activities.
Erika Friedmann, PhD, professor and associate dean of research, was named an honorary member of Sigma. The organization bestows honorary membership upon individuals of national or global influence who are not eligible for regular membership but have furthered the course of health care and demonstrate sustained superior achievements that have contributed to the advancement of nursing and health care at the national or global levels.
Sloand earned the Audrey Hepburn Award for Contributions to the Health and Welfare of Children, presented each biennium to a nurse who has made significant contributions to the health and wellbeing of children, and Newhouse earned the Dorothy Garrigus Adams Award for Excellence in Fostering Professional Standards, which recognizes leadership in encouraging the use and promotion of growth of professional standards. Hoffmanand Sullivan received The Capstone International Nursing Book Award for their publication, Medical-Surgical Nursing: Making Connections to Practice.
Additionally, UMSON's local Pi Chapter was recognized through the Showcase of Regional Excellence for its efforts to fulfill Sigma's Presidential Call to Action, which asks chapters to demonstrate influence through advocacy, policy, philanthropy, and/or lifelong learning. Pi Chapter was recognized at the regional level in the lifelong learning category for its partnership with the School's Office of Professional Development to co-sponsor and support the Ann Ottney Cain Lecture in Psychiatric Mental Health Nursing and the Virginia Lee Franklin Lecture, both part of the annual Dean's Lecture Series, and the Summer Institute in Nursing Informatics.
Sigma seeks to advance world health and celebrate nursing excellence in scholarship, leadership, and service. Membership is offered to baccalaureate and graduate nursing students who have demonstrated excellence by scholarship. Nurses who exhibit exceptional achievements in nursing can also be invited to join via the Nurse Leadership option.


text:
package org.wave.populator.setters;

import static org.junit.Assert.assertEquals;
import static org.mockito.Mockito.doNothing;
import static org.mockito.Mockito.mock;

import org.junit.After;
import org.junit.Before;
import org.junit.Test;
import org.wave.populator.core.Filler;
import org.wave.populator.core.examples.ClasseComEnumNaoVazia;
import org.wave.populator.core.examples.ClasseComEnumVazia;
import org.wave.populator.core.examples.EnumNaoVazia;
import org.wave.populator.core.examples.EnumVazia;
import org.wave.populator.enums.ErrorEnum;
import org.wave.populator.exceptions.PopulatorException;
import org.wave.populator.setters.EnumSetter;
import org.wave.populator.setters.Setter;

public class EnumSetterTest {

	private Setter successor;

	private Setter setter;

	@Before
	public void setUp() {
		this.successor = mock(Setter.class);

		Filler filler = mock(Filler.class);
		this.setter = new EnumSetter(filler);
		this.setter.setSuccessor(this.successor);
	}

	@Test(expected = PopulatorException.class)
	public void deveLancarExcecaoQuandoAEnumForVaziaException() throws PopulatorException {
		ClasseComEnumVazia instance = new ClasseComEnumVazia();

		this.setter.set(instance);
	}

	@Test
	public void deveLancarExcecaoQuandoAEnumForVazia() {
		ClasseComEnumVazia instance = new ClasseComEnumVazia();

		try {
			this.setter.set(instance);
		} catch (PopulatorException e) {
			assertEquals(ErrorEnum.EMPTY_ENUM.getMessage(EnumVazia.class.getName()), e.getMessage());
		}
	}

	@Test
	public void devePreencherUmaInstanciaQuandoAEnumForNula() throws PopulatorException {
		ClasseComEnumNaoVazia instance = new ClasseComEnumNaoVazia();

		doNothing().when(this.successor).set(instance);
		this.setter.set(instance);

		assertEquals(EnumNaoVazia.CONSTANTE_01, instance.getEnumNaoVazia());
	}

	@After
	public void tearDown() {
		this.setter = null;
		this.successor = null;
	}

}

redpajama_set_name: RedPajamaGithub


text:
Q: Can I make a VCO full audio range with only one capacitor? I'm trying to make a VCO with a low voltage setup (3.3V), and i 'm using a mcp6002 op-amp. I'm controlling the frequency with an MCP4822 (dac). The problem is that i get a limited range of frequencies.
I'm willing to make it full audio range (20-20000Hz) but till now I am only able to add an offset to the base frequency by using different values for the capacitor or changing resistor values. Is it possible to make it full range and my control signal to modulate the oscillator frequency to a wider range?
I have tried using this circuit but my op-amp does not oscillate with this configuration. How should I proceed to adapt this configuration for my low-voltage op-amps?

A: Yes, you can get 20-20000 Hz with linear control voltage output from something very similar to this circuit with a single capacitor.
Substitute a CMOS-input RRIO op-amp with a low Vos guaranteed to work at 3V (and with GBW of at least 5-10MHz) and substitute a MOSFET such as the DMN5L06K for the BJT + 10K base resistor.
If 3V = 20,000Hz, then 3mV  = 20Hz, so keep the maximum offset spec of the op-amp at maybe a few hundred uV. Microchip probably has an inexpensive part that will suit.
It's a bit easier with a higher supply voltage such as 15V because the offset requirements are less stringent, so the BJT and op-amp offsets don't matter as much.
By the way, rather than coming up with V+/2, simply split the right-hand 51K resistor into two 100K resistors as a voltage divider between V+ and ground.

A: It's possible to design a voltage-controlled oscillator circuit with a range that extends down to zero, up to "infinity" (subject to the limits of the oscillator parts), or both, but such designs are apt to be very touchy when operated anywhere near the ends of their range.  For example, if a circuit charges a cap up to 4 volts and times how long it takes to discharge down to the control voltage, and such a circuit would output 1000.0Hz when given a control voltage of 2.0 volts, then in the absence of noise or device limitations, the voltage required to get any frequency would be 4 volts/2^(1kHz/freq)--a value which will always be in the range 0 to 4 volts for any frequency, but the response would be most helpful near the middle.  Starting at 1kHz and going down, for example:
Freq    1kHz/freq   voltage
1000Hz      1       2.0v
 500Hz      2       1.0v
 250Hz      4       0.25v
 125Hz      8      ~0.0156v
62.5Hz     16      ~0.0000610v

Going up, things would again start nicely but get icky at the top
Freq    1/kHz/freq  voltage
  1000Hz      1       2.0v
  2000Hz     1/2      2.8v
  4000Hz     1/4      3.36v
  8000Hz     1/8      3.67v
 16000Hz     1/16     3.83v
 32000Hz     1/32     3.91v
 64000Hz     1/64     3.957v
128000Hz     1/128    3.978v

If one were to increase the RC time constant of the circuit by about a factor of six, the resulting range might be usable (a range from 0.0156v to 3.978v would handle frequencies from about 20Hz to about 20KHz) but the circuit would be more sensitive than ideal near the edges of its frequency range.

A:
You can remove the series and just use the Log Pot or a 5 turn  pot and get 4 decades. However you compromise sensitivity greatly.
MY DESIGN AND SIMULATOR
To make a quasi Sine, one can use a Decade counter and R DAC  ( Johnson , Gray code or binary)
But to make a 4 decade VCO will have excessive Phase Noise due to high f/V noise.
Varicaps have a limited range even with 0~50V differential to 3 decades.
The most common approach is to use a TIA.

redpajama_set_name: RedPajamaStackExchange


text:
Q: requestHeaders in http-conduit-1.9.4 I'm trying to create http request with custom header (with http-conduit-1.9.4 usage):
req <- parse "https://some_url"
let request = req { requestHeaders = [customHeader] }

And I don't understant what should be customHeader?
I have tried
import Network.HTTP.Headers
let custom_header = mkHeader (HdrCustom "Some-Header") "Some-Value"

but an error occured
Couldn't match expected type `Network.HTTP.Types.Header.Header'
                with actual type `Header'
    In the expression: custom_header
    In the `requestHeaders' field of a record
    In the expression: req {requestHeaders = [custom_header]}

also I have tried just
let custom_header = ("Some-Header", "Some-Value")

and error
Couldn't match expected type `Network.HTTP.Types.Header.HeaderName'
                with actual type `[Char]'
    In the expression: "User-Agent"
    In the expression: ("User-Agent", "erthalion")
    In the `requestHeaders' field of a record

So, anybody knows what should be customHeader?

A: http-conduit does not use the HTTP package at all, they are two different approaches entirely. If you look in the http-types documentation, you'll see that a Header is just a tuple of header name and value.
The only reason your custom_header didn't work is because you need to turn on the OverloadedStrings language extension.


Sweet potatoes with marshmallows not your thing? This easy slow-cooked side is still a sweet and festive addition to your holiday table.
Place sweet potatoes and apples in a 2- to 3-1/2-quart slow cooker. Mix together brown sugar, apple juice, honey, butter, cinnamon and orange peel. Spoon over sweet potatoes. Cover and cook on LOW for 6 to 8 hours or on HIGH for 3 hours or until potatoes and apples are tender.
Meanwhile, cook nuts in an ungreased heavy skillet over medium-low heat 5 to 7 minutes, stirring frequently until browning begins, then stirring constantly until golden brown and fragrant.


Thumb turn sets are most commonly used on bathroom doors. Generally thumb turn sets have privacy locks, meaning that they are a simple and safe way to lock your bathroom door, whilst not requiring a key and also having the benefit of a release in case of emergency, normally in the form of a coin release.
Here at Door Superstore we have a range of thumb turn sets to suit the style of your home. The most popular styles are rose mounted privacy thumb locks, on circular rose mounts and with a range of finishes. From polished chrome and duo chrome finishes to satin nickel, stainless steel and polished brass. The thumb turns also come in a range of designs for you to choose from, depending on the level of finesse and shapes you're looking for. Antique turn and release sets are perfect for traditional homes, period properties and cottages, with traditional oval shaped handles on the outside which retain the style of the home whilst being a practical bathroom lock with a thumb turn on the inside.


text:
Portugal competed at the 2022 Winter Olympics in Beijing, China, from 4 to 20 February 2022.

The Portuguese team consisted of three athletes (two men and one woman) competing in two sports. Ricardo Brancal and Vanina Guerillot were the country's flagbearer during the opening ceremony. Meanwhile a volunteer was the flagbearer during the closing ceremony.

Competitors
The following is the list of number of competitors participating at the Games per sport/discipline.

Alpine skiing

By meeting the basic qualification standards Portugal qualified one male and one female alpine skier.

Cross-country skiing

By meeting the basic qualification standards Portugal qualified one male cross-country skier.

Distance

References

Nations at the 2022 Winter Olympics
2022
Winter Olympics

redpajama_set_name: RedPajamaWikipedia


text:
Stream It Or Skip It: 'Ni no Kuni' on Netflix, in Which a Video Game Becomes an Anime Based on Every Worn-Out Fantasy Trope Ever
By John Serba Twitter @johnserba Jan 17, 2020 at 5:30pm
Netflix's latest anime offering is Ni no Kuni, a video-game adaptation carrying a tenuous association with Studio Ghibli. The renowned animation house contributed character design and other components to the game, but notably is not associated with the movie, despite its similar visual tones and textures. So does the film — which debuted in Japan in 2019 prior to its international Netflix release — survive on its own merits, or exist in the towering shadows of Ghibli and its source material?
NI NO KUNI: STREAM IT OR SKIP IT?
The Gist: It all starts with the thrusting of a pole: An old man stands on a hospital roof, poking his cane into the air. "I'm in the middle of invoking some magic," he explains to a nurse. Is he senile? No way! For soon enough, a trio of high-schoolers will be swept into a parallel world rife with puffy tunics, anthropomorphism, scary monsters and big, glistening-wet heaps of sorcery. Haru (voice of Mackenyu Arata) is a brash basketball star; Yu (Kento Yamazaki) is his relatively timid, wheelchair-bound best pal; and Kotona (Mei Nagano) is Haru's girlfriend, although Yu quietly longs for her.
For reasons yet to be explained (and explained (and explained some more (and then even some more))), Kotona is stabbed in the gut by a red-eyed, black-hooded ninja guy who emanates purple mist. Rushing to save her, Haru and Yu find themselves randomly whisked to Evermore, a place I like to call Middle Blearth. There, Yu can walk, all the better to be a kickass sword-warrior alongside his buddy. Kotona is the princess of the land, ailing from the wound sustained on Regular Blearth. Somehow, Yu summons the courage and wherewithal and whatnot to save the princess from the special effect that's slowly killing her, putting the two boys in good standing with the king and his strange kingdom.
What with one thing and another, Haru and Yu jump back-and-forth between both worlds, learning how one affects the other. Most importantly, if you die in one you die in both, although the method they use to jump realities involves throwing themselves into absolutely fatal situations — leaping off a cliff, for example — which is where I started drowning in the story's convoluted logistics. Inevitably, there's a big battle between good and evil that must be gotten over with, but will all the principal characters survive? I daren't say.
Photo: Netflix
What Movies Will It Remind You Of?: Like I mentioned before, it has a similar look and feel as hand-drawn Ghibli classics such as Spirited Away and Princess Mononoke. And conceptually, there's a wholly derivative Wizard of Oz-via-Tolkien thing happening here.
Performance Worth Watching: Frequently tailing our heroes is a small pink puffball creature with big eyes that seems to be an evolutionary cousin of the soot sprites from My Neighbor Totoro and Spirited Away. Frankly, I'd rather see the story of the Battle of Evermore from its perspective, which would be far more fascinating and original than what we get.
Memorable Dialogue: A prime example of the script's hilariously fatal love affair with exposition follows (spoken by a character who shall remain unidentified to avoid spoilers): "I have returned from death! By using advanced alchemy, I forged a new body from the blood and flesh of magical beasts!"
Sex and Skin: None. Although there's a male-gazey scene where Yu wide-eyes the princess' shadow as she changes into her bathing suit.
Where to Watch 'Horimiya'
'SK8 The Infinity' Release Date and Where to Watch
Where to Watch 'The Promised Neverland' Season 2
Our Take: Disclosure: I've never played the Ni no Kuni games — which originally were about a boy traversing another world on a quest to save his mother — so I watched the film with no baggage, and therefore no context to criticize it for fouling up the concept. I therefore proclaim it to be lousy purely on its own terms as a film. It's stuffed with boilerplate D&D fantasy crapola, generic voicework, nondescript animation and a preoccupation with stilted and stultifying exposition that'll have you battling the Demons of Drowsiness with the Flaming Electrified Sword of Another Cup of Coffee and a Spell of Toothpicks Propping Open Your Eyelids.
The plot is a very loose assemblage of Things That Happen, usually suddenly, with little logic or sense. If an ancient magic weapon is needed to influence the course of a battle, the plot will provide one. If a significant mechanism is needed because it's been too long since the last action sequence, the plot will provide a giant spider. If Haru and Yu need to randomly ascertain without even the tiniest scrap of proof that risking their lives prompts them to warp between worlds, the plot will provide them with an opportunity to throw themselves into a towering flame, and their half-assed lamebrained idea will work. I was bored out of my mind, although my ears perked when the princess reveals that magic does, indeed, have its own distinct smell. That's a new one!
Our Call: SKIP IT. Ni no Kuni is not magical, and therefore smells like something we've all smelled before.
Should you stream or skip the anime #NiNoKuni on @netflix? #SIOSI
— Decider (@decider) January 20, 2020
John Serba is a freelance writer and film critic based in Grand Rapids, Michigan. Read more of his work at johnserbaatlarge.com or follow him on Twitter: @johnserba.
Stream Ni no Kuni on Netflix

redpajama_set_name: RedPajamaCommonCrawl


Each festival includes a specially curated chalk section that allows for professional chalk muralists to compete for awards as well as festival goers to experiment with street chalk. Come and watch the pros as they develop their chalk murals over the three days of the festival and vote for your favorite completed piece. Contestants will vie for 2 top awards: "Best Professional" and "People's Choice". This Spring chalk artists will be scattered throughout the intersections of Mill Avenue. Keep your eye out for them while roaming the festival.
Young artists can try their hand at being a chalk muralist by taking the challenge of interpreting our Spring 2019 theme "Breaking Barriers".
Interested in participating in Chalk-A-Lot Street? Contact Krislyn Powell, Krislyn@downtowntempe.com.


text:
Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia
Suzanne Morony ORCID: orcid.org/0000-0002-4534-08991,
Kristie Weir2,
Gregory Duncan3,
Janice Biggs4,
Don Nutbeam1 &
Kirsten J. Mccaffery5
Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back.
We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a "communication skills" study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses' experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016.
In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back.
Our theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training.
ACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.
The inability of patients to correctly recall information from a healthcare consultation is a well-known problem with significant consequences for treatment adherence. It is estimated that 40–80% of information is forgotten immediately or misremembered [1]. For example, while parents are typically able to remember their child's diagnosis, their memory for a treatment protocol and actions to take remains poor [2]. These problems may be more pronounced for telephone consultations, given that up to 55% of the impact in a face to face consultation can be attributed to visual and non-verbal communication [3], and there is evidence that callers frequently misunderstand health information given by phone [4]. Telehealth consultations involve more frequent patient requests for information to be repeated [5]; however, people with low health literacy are typically less inclined to ask questions and may not indicate if they do not understand [6,7,8]. People experiencing acute stress or anxiety may also suffer temporary cognitive impairments that limit their ability to process information [1, 9, 10]. Telephone-based healthcare is expanding and can improve access, convenience and cost savings for both health care providers and clients [11, 12]; however, it also carries risks [13], and issues of patient safety in telehealth are largely unexplored [14]. The value of a telephone health service is questionable if callers immediately forget or misinterpret the information or instructions they have been given.
There is agreement that telehealth providers require high-level communication skills to compensate for lack of visual cues [13, 15]. There is currently no consensus on what their learning outcomes should be [16, 17], guidance on training methods is lacking [18, 19], and opportunities for further training remain limited [20]. One communication technique that has been recommended for consumer telephone consultations [3, 4] is Teach-Back, also known as the "interactive communication loop". A key feature of Teach-Back is that the onus of ensuring information has been correctly understood rests with the health professional. Teach-Back requires information providers to invite consumers into the conversation, by asking individuals to explain back using their own words the information or action plans discussed. The healthcare provider can then add, clarify, or correct information as required. Teach-Back has been used effectively to improve accuracy of telephone communication between professionals [21] and to support child health outcomes in paediatric settings by improving parents' comprehension of information [22]. It is regarded as an important patient safety practice [23], is widely recommended as a universal precautions approach in healthcare settings [24,25,26,27,28,29] and was recently ranked as the number one health literacy practice by experts [30]. We are not aware of previous efforts to train and evaluate the impact of Teach-Back in a consumer telehealth setting.
Previous research with healthcare providers has identified four key barriers to delivering Teach-Back: perceived time constraints [24, 31,32,33,34], quantity and complexity of information discussed [35], discomfort with phrasing [34, 36] (including consumer-reported discomfort [37]), and divided attention (of parents) [34, 35]. Enablers to the use of Teach-Back include a supportive work environment and practitioner self-reflection [38]. Critical self-reflection is an essential component of self-regulated learning. It is regularly recommended for nursing clinical skill development [39,40,41] and has been used in a number of nursing contexts (see [42] for a recent review) to bridge the gap between theory and practice [39]. Engaging nurses to purposively reflect on their practice while developing new communication skills may both acknowledge their professional competence [43] and encourage them to "test" the efficacy of the new techniques.
This paper describes the development and implementation of a theory-informed 'Teach-Back skills' program delivered to nurses operating a national maternal and child health telephone helpline. It is part of a larger study evaluating the effectiveness of Teach-Back for telehealth. We have previously reported nurse experiences using different Teach-Back phrases and with different kinds of calls at the helpline [44]; in this paper we report their experiences learning to use Teach-Back.
The setting was an Australian national telephone helpline operating from a single call centre. The Pregnancy Birth and Baby (PBB) telephone helpline offers free guidance and reassurance on pregnancy and parenting of children up to 5 years, and is delivered by Healthdirect Australia on behalf of the Australian Government. At the time of the study it was operated by the Royal District Nursing Service (RDNS), a state-funded community nursing organisation in Melbourne, Australia. Calls to the helpline include requests for information (e.g. foods or medicines to avoid during pregnancy), and self-management instructions (e.g. when to seek further assistance). Training opportunities were limited to a maximum of two hours face-to-face in small groups. This study was part of a broader health literacy initiative of Healthdirect Australia.
Intervention development
We were guided by the Theoretical Domains Framework [45] and a model for developing a theory-informed implementation intervention [46], to examine: what (and whose) behaviours need to change; which barriers and enablers need to be addressed; which intervention components could respond to the barriers and enablers, and; how behaviour change can be measured and understood. This is detailed in Table 1 and summarised below.
Table 1 Description of barriers, enablers and intervention components for implementing Teach-Back with reference to the Theoretical Domains Framework
The nurse behaviour we targeted for change was using the Teach-Back method with callers. To confirm that Teach-Back was not already being used at the helpline, JB and DZ audited a selection of helpline calls with reference to a checklist of Teach-Back behaviours and strategies prior to study commencement. To develop knowledge, skills, and beliefs with respect to why, when, and how to use Teach-Back, we conducted small-group workshops illustrating Teach-Back techniques, discussing barriers to using Teach-Back, and role-play practice (see below and Table 2). In order to make training cost-efficient we aimed to maximise nurses' self-directed learning. We did this by encouraging nurses to self-reflect on their communication during each call, both before and after learning Teach Back, using an online survey to facilitate this (see below and Additional file 1).
Table 2 Overview of training materials and activities developed for the 2-h Teach-Back training session
Teach-back workshop
Training in Teach-Back theory and skills was a single 2-h group workshop conducted by 2 facilitators (SM, a research psychologist experienced with call centre operations, and GD, a research pharmacist experienced in Teach-Back training). Training groups (7–8 nurses) were held two weeks apart, and used a collaborative (rather than didactic) approach. Workshop materials were evidence-based Teach-Back training materials developed elsewhere [36] and adapted for the helpline nurses, and consisted of theory, discussion, and practice (Table 2), including barriers to Teach-Back identified from previous research (Table 1). A short video was developed illustrating Teach-Back in a familiar scenario (a caller to the helpline being distracted by her child). Suggested Teach-Back strategies were adapted from an online resource [38]. Group facilitators invited nurses to identify call scenarios that might be suitable for Teach-Back and discover ways of asking for Teach-Back that felt natural. Training discussions acknowledged that not all calls would be amenable to Teach-Back and nurses should use their professional judgement.
Self-reflection surveys
The online self-reflection survey was introduced in a brief video distributed by email, and nurses were advised self-reflection activities could contribute towards their annual continuing professional development (CPD) hours. For the duration of the 7-week study nurses were encouraged to reflect after each call on both the quality of their explanation and their perception of caller comprehension (Additional file 1). Following the Teach-Back workshop (2–4 weeks into the study), additional questions asked which Teach-Back strategies were (and were not) used and why. The surveys also acted as a reminder to use Teach-Back. At the end of each shift, open questions invited nurse comments about their experiences and any communication strategies that worked well (or not) for them. Emails from the research team encouraged participating nurses to complete self-reflections and report any Teach-Back phrases they found helpful. One such technique, "So just to recap, what will you do now? And when do you think you need to take further action?" was added to the online list of Teach-Back strategies at the start of week 4 (one week after the first group had been trained).
All nurses normally working at least 3 h per week at the helpline (n = 18) were invited to participate. Three of these nurses, who worked infrequent shifts or had leave planned during the study period, declined participation. Written informed consent was obtained for all participants, and ethical approval was obtained from the Royal District Nursing Service (150013) and The University of Sydney (2016/083). Consenting nurses were informed via a short online video that this was a research study to test effectiveness of training in new communication skills, and that they had been randomly allocated to one of two groups for training purposes. Group 1 nurses were asked to avoid sharing workshop materials and techniques for the two weeks before the second group was trained, to prevent contamination.
Self-reflection data was collected in real time using an online survey programmed in Qualtrics survey software (Qualtrics, Provo, UT, ©2016) (Additional file 1). Following the trial conclusion we conducted focus groups (onsite, 2 h duration) and interviews (telephone, 15–20 min), with participating nurses and their team leader using a semi-structured topic guide, exploring experiences of the training and of using Teach-Back (Additional file 2). The two focus groups (3–5 nurses per group) were held on the final day of the trial, and nurse attendance was paid. Telephone interviews with nurses unable to attend focus groups (n = 4) and the team leader (n = 1) were conducted by KW (f), a public health researcher, during the following weeks. Field notes were taken (by SM) during focus groups, and both focus groups and interviews were audio recorded and transcribed. The study used a phenomenological methodology.
Transcripts of the interviews and focus groups were analysed using a Framework approach [47], a matrix based method of thematic analysis, with participants as rows and themes as columns. Firstly, one researcher (SM) summarised (and verified with GD) field notes taken during the focus groups (familiarisation) and developed an initial coding framework (identification) guided by the research questions. SM applied an iterative process of coding data using NVivo11 and adding to the coding framework, identifying themes (indexing), then summarising in a thematic matrix (charting). When all of the data was coded, the framework was examined within and across themes and participants by SM and KW (mapping and interpretation) using inductive and deductive methods. Rigour was addressed throughout this process by ensuring a detailed documentation of the analysis process, constant comparison of data and continuous discussion of emerging and final themes. Relevant open-response data collected from the self-reflection surveys was added to the Framework. The Consolidated Criteria for Reporting Qualitative Research (COREQ) [48] were used to ensure quality of the research process. Quantitative data from the self-reflection surveys was examined using descriptive statistics.
Training participants were 16 female maternal and child health nurses, including the team leader who oversaw operations. Focus group (n = 8) and interview (n = 5) participants were 13 nurses (including the team leader) aged 37–61 years (mean 55.1) who had been registered as nurses for 13–41 years (mean 29.5 years) and working in maternal and child health for between 7 months and 33 years (mean 14.2 years). Two had worked on a helpline previously. Number of shifts nurses worked per week ranged from 1 (3–4 h) to full-time (team leader); training groups were balanced by average hours worked per week. Two nurses who attended training declined to be interviewed, saying they had not had much opportunity to use Teach-Back due to rostering and leave. One was on leave and could not be contacted.
All nurses made an effort to engage with the online surveys. Responses were inconsistent however, ranging from 14 to 608 call reflections per nurse as captured in the online survey (0 to 265 reflections following Teach-Back training) and 1 to 20 end-of-shift reflections per nurse. This reflected differences not only in hours worked during the study period but also in interpretation of and engagement with the self-reflection activities. We examined distributions of the quantitative data from the self-reflection surveys (Additional file 1) to identify how frequently nurses reported using Teach-Back (following training). Most nurses (n = 10) most commonly responded that they used Teach-Back "fully"; for two others the mode was "yes-somewhat or partially". This suggests that overall nurses made considerable effort to use Teach-Back strategies. Two nurses most frequently responded that they did not use Teach-Back because they felt it was "inappropriate" for that call.
We explored nurse experiences learning the new skills, what worked, and what could be improved for learning to use Teach-Back (Additional file 2). We identified three key themes in the data: learning to use Teach-Back, using self-reflection for skill development; and suggestions for future. In the nurse quotes reported below, we denote data from focus groups and interviews "N", and comments from the self-reflection surveys "SR".
Changing practice: Learning to use teach-back
Confirming a lack of prior knowledge of Teach-Back, all but one nurse reported she had not learned or used Teach-Back previously.
"It was all teach, not teach-back". (N5).
Prior to the Teach-Back workshop nurses' self-reflections described using communication techniques such as active listening, confirming understanding, and asking for clarification; but some noted they were not always sure if clients understood or will follow through. Following training, nurses reported asking callers what they will do following the call, and indicated they found added value from Teach-Back techniques.
"Clients showed me that they understood my instructions. It helps me feel more confident that the information I am conveying is coming across accurately." (SR).
Several nurses reported speaking to a client who was unable to Teach-Back the information. Nurses commented both on the perceived impact on the client "I think she felt embarrassed and felt like she had been put on the spot" (SR), and expressed interest or surprise that their message had not been received "oh my goodness she could not recall one word I said!" (SR).
A few nurses reported they were comfortable using Teach-Back within one or two shifts, but many struggled to find wording that sounded or felt natural to them, or felt that they were imposing Teach-Back on callers. One nurse reported feeling overwhelmed by numerous possible Teach-Back strategies, saying this interfered with her ability to focus on the call and implement Teach-Back. One technique reported to be effective was to read through the list of suggested phrases, identify a couple that sounded "like me", and restrict Teach-Back to those phrases.
"Well try not to get too bogged down in how to go about it, find something that's natural and easy that will just sort of roll off the tongue. It's going to take time, isn't it …" (N2).
Nurses commented that they enjoyed the approach to training and this was a factor in them embracing it. They made frequent reference to the training video because it highlighted the contextual factors of the unseen caller that may interfere with information transfer. The majority thought the social environment of face to face sessions were important for introducing a new skill such as Teach-Back. One nurse commented that the training had too much theory and not enough role playing. Nurses frequently mentioned that they enjoyed the practical application of skill during role play, because "nurses are such practical people". (N3).
"Yeah, two times was good I think…and the fact that we swapped partners as well, so you didn't just do it with the same person, that seemed to work well.…"(N6).
Comfort with using Teach-Back did not appear to be related to prior experience or the overall number of shifts worked. In the self-reflections nurses commented they were "getting better" or "more comfortable" with using the techniques over time, indicating practice may help overcome some of these barriers. When Teach-Back was not considered appropriate nurses indicated this was because of a distressed child that needed attention, because the caller taught back spontaneously, or the call was a transfer to another service. At the end of the shift some nurses reflected they did not use Teach-Back as often as they thought they "should".
Self-reflection to support skill development
One nurse described the self-reflection that is part of nurse training:
"We are taught to do self-reflection as nurses.. [if].. there was some issue you need to unpack it yourself or improve what actually happened in that call..." (N9).
In focus groups and interviews nurses commented that the self-reflection surveys were helpful initially but became boring and repetitive after a while. Despite this, many nurses commented that this was the first time they had truly reflected on their own calls. One nurse reported she enjoyed the opportunity to reflect on "good" calls, and others described the self-reflections as therapeutic by helping remove any worries about how clients were going to manage the situation or what they would do after hanging up.
"And it produces closure to the day, to the shift, [so you don't] go home worrying that somebody's going to do something at three o'clock in the morning… "(N3).
Some mentioned it was difficult to keep up with self-reflections when multiple calls were coming through in rapid succession. The multiple tasks sometimes resulted in them forgetting to use Teach-Back, self-reflect, and/or recruit the caller for follow-up. Some nurses commented that they tended to self-reflect instinctively, but others mentioned it was helpful to have this focus and think about their own satisfaction with the call.
"I think the reflecting was good to start with, I don't know that we need to do it anymore, but I wonder if you need to revisit it…...every couple of months or twice a year or once a year."(N6).
Suggested improvements
Nurses mentioned that visual reminders such as posters or a field in their computer system that they need to check each time would be helpful to maintain Teach-Back practice. Several mentioned it would be helpful to have a follow-up session with the trainers to monitor progress and to learn from their colleagues. Some thought Teach-Back could be incorporated into their performance management and professional development, or could be part of the initial training they underwent when starting work at the helpline. A few thought training could be conducted via video or podcast but found added value with the group face to face interaction. All nurses commented that learning from colleagues and listening to real examples was very helpful for learning how to apply new communication techniques in different contexts.
"I find just the listening [to other nurses] works really well….because I think you just learn to do it on the run." (N2).
Although there was widespread agreement that they learned the most from each other, nurses noted opportunities to do this were limited because they were rarely together in the same room. Some suggested that the team leader, who routinely reviews calls for quality audits, could identify call recordings in which Teach-Back was used very well (or very poorly) for training purposes; others thought there may be also value in listening to recordings of their own calls:
"Even the times where I thought, I didn't say that correctly, they gave me the responses that I expected and I thought obviously I must have sounded better than what I thought. So if you can reflect on that and listen to yourself, that's a good teaching tool." (N1).
Integration with theoretical domains framework
In Table 1 we presented the barriers and enablers to using Teach-Back identified in the literature, and strategies to manage them informed by the revised Theoretical Domains Framework (TDF). Here we discuss the nurse data with reference to the TDF (domains denoted "x)" corresponding to numbering in [45]). With respect to nurse behaviour change, the primary objectives in this study were to increase nurses' 1) knowledge, 2) skills, and 4) beliefs about capability to use Teach-Back in telephone consultations. In order to embed Teach-Back into professional practice it primarily targeted 14) behavioural regulation (self-monitoring), 3) professional role and identity, and 6) beliefs about consequences. The option to count self-reflection activities towards continuing professional development accreditation also acted as a reward, i.e. 7) reinforcement.
Feedback from nurses suggests the program was largely successful in developing 1) knowledge and 6) beliefs about consequences of Teach-Back; however, nurses reported varying levels of 2) skill, 13) comfort and 4) beliefs about capabilities for using Teach-Back. The wide range of Teach-Back phrases offered as a resource for nurses negatively impacted 10) attention and memory processes for some, a difficulty that may have been compounded by the additional requirement to complete self-reflection surveys. Explicit instructions to focus on only one or two Teach-Back phrases may overcome this. Future implementation may add salient 11) environmental cues such as visual reminders in the workplace like posters or a "did you use Teach-Back" checkbox in the customer relationship management (CRM) software. Future iterations should also facilitate opportunity to learn from colleagues for both 2) skills and 12) social influences. This might include formal training with colleagues by telephone, for example telephone role-play scenarios - although the social impact of a telephone conversation is likely different from a group session.
Our findings indicate that our theory-informed intervention combining ongoing deliberate self-reflection with a single 2-h workshop was largely successful for experienced maternal and child health nurses to develop confidence and skills to use Teach-Back in a telephone helpline for the first time. Nurses perceived they were more effective at ensuring comprehension when using Teach-Back, which may have been enhanced by their deliberative focus on clear explanation and caller understanding with the self-reflection surveys. Nurses reported that the training workshop and self-reflection surveys were helpful for developing Teach-Back skills, and were unanimous in wanting more opportunities to learn from peers on how to use Teach-Back in a range of situations relevant to their specific work environment. This was particularly true for nurses who struggled to use Teach-Back in a way that sounded natural to them. Nurses who reported success with finding their "voice" generally focused on one or two phrases they were comfortable with.
Although the usual target of reflective practice is clinical judgment, this study provides qualitative evidence that a simple online program encouraging self-reflection has value for enhancing communication skill development. This is aligned with current thinking on moving away from a "training mindset" in communication skills development and focusing instead on building on learners' pre-existing knowledge and skills through "reflection, experiential work, and self-directed learning" [43]. We are not aware of any other studies prompting real-time self-assessments for communication skills training or telenursing (although a variation of this technique has previously been used in undergraduate statistics teaching [49]). Most nurses had not engaged in this kind of deliberate self-reflection for their role in delivering telephone advice to consumers, or reflection on what went well. Communication skills training for medical professionals has elsewhere been shown to increase communication self-efficacy [50]. Reflecting only on negative experiences can promote loss of confidence [39], but reflecting on positive experiences may balance this. In this study nurses reported benefits from reflecting on what they did well. The surveys were considered annoying as well as useful, so any future implementation will need to find an appropriate balance. The focus groups were another opportunity for reflection, and nurses appeared to enjoy learning from and with each other, which may have helped consolidate learning.
The organisational context was an important factor in changing behaviour, including implementation momentum from key stakeholders. To reduce time pressure on nurses the management team temporarily relaxed guidelines and consequences for call duration (although nurses still found this a challenge as reported elsewhere [44]). External reinforcement, such as feedback by colleagues or supervisors was not built into this training, and nurses relied on self-reflections and reactions from their clients to monitor their success using Teach-Back. This is consistent with a paradigm of nurse education that harnesses reflective practice to equip learners to develop their own expertise [51].
All data was self-report, which carries an inherent risk of bias. Participants in this study were experienced nurses who were able to engage with self-regulated learning in a workplace supportive of research and innovation. It may be less effective or require more structure for other learners, or in work environments that do not support professional development and standards [39]. Finally, nurses may have been more motivated to participate because this was a research study. A key feature of the self-reflection data collected in this study is that it went directly to the research team and was only reported in summary form, so there was no possibility of evaluation by managers or colleagues. Fear of judgment is one obstacle to encouraging self-reflections [39] and an in-house self-reflection survey may have been less effective. Conversely, it could alert team leaders to staff who may need more help with training. Formative assessment for self-regulated learning typically involves feedback, and this study did not objectively evaluate the calls or deliver any feedback on reflections.
With the increased use of telehealth services it is critical to continue to develop strategies to improve the safety and quality of telephone health advice and embed them into routine clinical governance [52]. In this study, telehealth nurses were able to build the Teach-Back method into their practice, following a theory-informed intervention consisting of a brief training workshop combined with ongoing self-reflection. This intervention may also be adapted for other advanced communication skills and in other telehealth settings.
COREQ:
Consolidated Criteria for Reporting Qualitative Research
CPD:
CRM:
PBB:
Pregnancy Birth and Baby
RDNS:
Royal District Nursing Service
TDF:
Theoretical Domains Framework
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We are grateful to Dianne Zalitis at Healthdirect Australia for logistics support. At the Royal District Nursing Service we would like to thank Elizabeth Bruhn, Maureen Wilkinson, the maternal and child health nurses who participated in this study, and the management who provided operational support. Many thanks to Monique Weir and Olive Dilly for their help developing the training materials, Dr. Lamiae Azizi at The University of Sydney who assisted with the trial design, and Dr. Sunny Naicker who commented on an earlier version of this manuscript.
This study was funded by Healthdirect Australia as part of their broader health literacy initiative. The funder assisted with practical issues concerning study design and did not contribute to data collection or analysis.
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
The University of Sydney, Sydney School of Public Health, Sydney, NSW, Australia
Suzanne Morony
& Don Nutbeam
The University of Sydney, Wiser Healthcare, Sydney School of Public Health, Sydney, NSW, Australia
Kristie Weir
Eastern Health Clinical School, Medicine, Nursing and Health Sciences, Monash University, Box Hill, Melbourne, VIC, Australia
Healthdirect Australia, Sydney, NSW, Australia
Janice Biggs
The University of Sydney, Sydney Health Literacy Lab, Sydney School of Public Health, Sydney, NSW, Australia
Kirsten J. Mccaffery
Search for Suzanne Morony in:
Search for Kristie Weir in:
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SM, JB, KM conceived of the study and its design. SM, KW, GD, KM designed the intervention and evaluation. JB provided logistical support to determine feasibility. SM and GD conducted the training and focus groups. SM and KW analysed the data and DN assisted with interpretation. SM drafted the manuscript with contributions from all authors. All authors read and approved the final manuscript.
Correspondence to Suzanne Morony.
Written informed consent was obtained for all participants, and ethical approval was obtained from the Royal District Nursing Service Human Research Ethics Committee (approval number 150013) and The University of Sydney (2016/083).
Items from online self-reflection survey completed following each call and each shift. (DOCX 15 kb)
Complete interview guide for nurse focus groups and telephone interviews. (DOCX 16 kb)
Morony, S., Weir, K., Duncan, G. et al. Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia. BMC Health Serv Res 18, 162 (2018) doi:10.1186/s12913-018-2956-6
Teach-back communication
Telenursing
Health-line
Teleadvice
Organization, structure and delivery of healthcare


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The Sharing Economy must be supported by the most modern standards of innovation, creativity and competitiveness. This is the reason to believe that a new standard of global economy, more than a possibility, is an individual and collective necessity for all of us, effective global citizens. The difference of this new economy in this new world will be in the exercise of the capacity of the individual participation as the central contribution to the reinvention of the collective society.
The Sharing Economy is not determined by law. It is effectively constructed by all the actors in a free and collaborative strategic interaction. The acceleration of the economy depends largely on its people and institutions. An active commitment, in which the focus in the participation and development of new competences, on a collaborative basis, must be the key of the difference. This is purpose of the E – Economy.
The Sharing Economy must also be developed by a permanent flow of ideas. Ideas demand a permanent collaboration between the different actors, with the strategic challenge of reinforcing the central competences of society and qualifying them as the unique ways of creation of value and modernity. The markets are facing also a unique opportunity. The ideas must be the difference of a proposal we must be aware that is the best key for our ambition of excellence.
The Sharing Economy demands also a commitment of partnership in order to build a real Strategy of Confidence in the implementation of the different policies. The focus on Innovation and Knowledge as the drivers of creating added value with international dissemination is a unique challenge that may be the answer to a new way of interaction between those who have the responsibility of thinking and those that have the responsibility of producing goods and services.
The Sharing Economy demands also a new competitive attitude. We need people to have a new challenge. Society must be able to be the real Platform of a more entrepreneurial attitude, centered in new areas of knowledge and new sectors of value. In a Modern and Active Society, the key word is Co-creation. To promote a dynamic and active creation process involving each citizen is the big challenge for the next years in the future. The future is the right place to say we are in, we want to be in, we want to be the right solution to the global problems we face.


text:
The Black Watch: Fighting in the Frontline 1899-2006 by Victoria Schofield, foreword by HRH The Prince of Wales
The heroic and inspiring story of the fortunes of the Black Watch, whose soldiers have distinguished themselves in theatres of war across the world.
Formed into a regiment in 1739 and named for the dark tartan of its soldiers' kilts, The Black Watch has fought in almost every major conflict of nation and empire between 1745 and the present, and has a reputation second to none. Following on from The Highland Furies, in which she traced the regiment's history to 1899, Victoria Schofield tells the story of The Black Watch in the 20th and 21st centuries. She tracks its fortunes through the 2nd South African War, two World Wars, the 'troubles' in N Ireland and the war in Iraq – up to The Black Watch's merger with five other regiments to form the Royal Regiment of Scotland in 2006.
Drawing on diaries, letters and interviews, Victoria Schofield weaves the many strands of the story into an epic narrative of a heroic body of officers and men. In her sure hands, the story of The Black Watch is no arid recitation of campaigns and battle honours, but a rewarding account of the fortunes of war of a regiment that has played a distinguished role in British, and world, history.
Head of Zeus * Modern History
PRAISE FOR THE HIGHLAND FURIES:
'Schofield's meticulous record of the spirit provides a worthy memorial to the Black Watch' Spectator.
'Rigorously authoritative and detailed... An absorbing book that lives up to its name as the 'Official Regimental History'' Military History Monthly.
'Each campaign, battle and tour of duty [is] allocated its due place... It is lively... recounting the regiment's experiences' TLS
Victoria Schofield
Victoria Schofield is a historian and commentator on international affairs, with special expertise on South Asia. Her published books include Kashmir in Conflict, The Highland Furies, The Black Watch, and The Fragrance of Tears: My Friendship with Benazir Bhutto. She has also contributed to numerous media outlets, including the Sunday Telegraph, The Times, Independent, and Spectator.
ALSO BY Victoria Schofield
The Rebirth of Italy


text:
Tag: lake montebello
Annie Milli Wants You to Live In the City
Elizabeth Heubeck
Earlier this summer, 36-year-old Owings Mills native Annie Milli made the impressive leap from nonprofit Live Baltimore's marketing director to executive director. But when you consider Milli's intense work ethic and fierce love of Baltimore City, the shock of her rapid-fire professional trajectory eases.
Baltimore Women and Allies Band Together for 'A Day Without a Woman'
A poster at Sandy's on The Avenue.
Wednesday won't be business as usual on Hampden's bustling 36th Street, where female business owners plan are displaying vibrant flashes or red in their storefronts and holding events for women to speak out for their rights.
Dreaming of Miami Beach? A Head-Turning Art Moderne House On The Shores Of Lake Montebello
Cynthia McIntyre
Hot House: 2105 Erdman Avenue, Baltimore 21218
Art Deco style house, circa 1949, in painted stucco with rubber roof and enclosed glass porch. Two bedrooms, 1.5 baths, 1,189 sq. ft. on one level. Original curved windows, glass brick, two sided stone fireplace in living room, floor-to-ceiling shelving, plaster walls. Stainless steel GE kitchen unit, eat-in kitchen, hardwood floors, underfloor radiant heating. Landscaped stone patio on double, .2 acre lot: $249,000
OPEN HOUSE: SUNDAY, NOVEMBER 8
Murky Waters Could be Ahead for Lake Montebello
Stephen Babcock
One of the city's drinking water reservoirs may be looking a little cloudy next week. There's no reason to worry, though, city officials say. It's just a routine cleaning.
Baltimore's "Street Corner Astronomer" Encourages You to Stare at the Sun (Through a Special Telescope)
2004's transit
You want to talk about a once-in-a-lifetime opportunity? How about a transit of Venus — when the blue planet takes about six hours to cross in front of the Sun? It's happening on June 5 at 6:04 p.m. And it's not going to happen again until 2117. (Technically, it's more of a twice-in-a-lifetime opportunity, as TOVs occur in pairs eight years apart — so, yeah, there was one in 2004, but whatever, you missed that and now this is your only chance!)
Herman Heyn, Baltimore's "street corner astronomer" occasionally seen in Fells Point or Charles Village offering passersby telescopic glimpses of various celestial sights, will be at the east end of Lake Montebello in northeast Baltimore with a special Sun telescope so anyone who wants to can view the astronomical rarity without causing damage to their eyes.
Heyn encourages spectators to show up early because, according to Heyn's website, "the most exciting part of a TOV is when Venus first appears on the edge of the Sun."
Sailing the Family Car
B. Boyd
We weren't surprised to read about the 14-year-old girl who plunged her aunt's minivan into Lake Montebello last week. In light of the news last month that Maryland drivers scored second to lowest nationally on their written driving test, and considering that most Baltimore motorists seem to consider it their birthright to run reds, and recalling how last December one eager dog owner plowed her SUV straight through Eastern Animal Hospital's wall, we expect local drivers to make, well, not great decisions, like the girl's free-spirited 25-year-old aunt who was giving her young niece an illegal driving lesson when the child accelerated rather than braking, soaring straight for the water. Since everyone's okay, including the aunt's middle-aged mother who rode in back, we can snicker about it, and reminisce about our own driving lesson days.
Back then, every 16-year-old we knew with a freshly laminated driver's license in hand had something to prove, to parents, looking to witness their baby's dedicated road safety, to their rowdy friends, who wanted to hear the brakes squeal a rebel yell as the family wagon hauled the crew out of the high school lot on a Friday, to his or her own young self, who felt a heady rush with each turning of the key—driving equals such wonderful, giddy freedom and, with it, the solemn reminder that your own life, and the lives of others, are in your hands. (Worth noting: Teens make up about 10 percent of the U.S. population, but are responsible statistically for a whopping 12 percent of all fatal car crashes.)
Every 16-year-old we knew caused some minor accident that first year on the road, and one of them an unfortunate car-flipping major accident. My sister sailed my father's sports car into our closed garage door, then left a note of apology and fled. Mysteriously, my best friend parked her mother's extra-wide Buick sideways in the middle of my residential street, and got ticketed and towed. And I barreled downhill backward in a standard transmission Toyota Celica, until I remembered my father's advice, and toward the steep bottom, yanked the emergency brake. That moment scared me enough to master the Celica, and I think because of it, I most always remember to drive with a little fear in my heart, whether or not the wind's whipping through my hair. I sincerely hope the 14-year-old van's captain learns same.
What was your teen driving close call or hard-earned driving lesson, or that of your son or daughter? In the name of road safety, and having a chuckle over the trials and tribulations of teen-dom, please let us hear.


I'm taking a break from our road trip in France to talk about my second favorite season in Warsaw!
Fall has arrived in full force, bringing its colorful leaves and patterns throughout the city. Even if the skies are slightly overcast or gray, you can't help but notice the city's golden yellows, crimson reds, pumpkin-like oranges all around you. And when you get a sunny day like yesterday, the city looks really beautiful!
Warsaw has dozens and dozens of parks. If you remember, I've mentioned before that these plentiful parks are just one of my Top 10 Reasons to Love Living in Warsaw. This past week, I wandered through a few of them to capture the autumnal beauty.
Pretty trees in Pole Mokotowskie Park.
Nearly every Thursday morning, I power walk through Łazienki Park with a group of expat women. This park, with its central location, is one of my favorites and easy to access by public transportation and by bike. The park also is simply splendid during our short fall season.
Then, earlier this week, I ended up down in the Ursynow neighborhood for a doctor's appointment and decided to kill some time strolling through the nearby Dolina Sluzewiecka Park. I couldn't find any information about this park, but I can tell you it's BIG and has a nice stream running through it, walking and bike trails as well as a couple of ponds – currently home to many ducks and a few fishermen.
I always love discovering a new part of Warsaw so this park was a pleasant surprise, especially by the Służewski Dom Kultury w Dzielnicy Mokotów, a community center, I think. I found a wonderful plank walkway and a well-paved path behind the wooden buildings and garden area. When I discover random gems like this, I wish I spoke better Polish so I learn more about these places.
It's not very often that I see a stray cat in Warsaw!
So these 10 photos give you an early snapshot of what fall is like in Warsaw. I'm sure I'll be sharing more fall photos soon!
Warsaw looks so pretty in autumn colours. I'd love to go back and spend more time there although I'm not sure I can drag myself away from Berlin right now.
it looks so similar to here. this is probably why we have so many polish people who settled in this city. it reminded them of home.
@Joyce, You're probably not too far from the truth with that thought!
Beautiful photos, and so glad you shared them!


The search for the truth is individual. Everyone must undertake if for themselves. One woman's search is never the same as another's. One man's experiences will never be another's. That does not mean there are never common elements. Mileposts along the way are common to almost all searches.
Where is the most valuable place to start the search? This question requires us to answer others. For example, was Joseph Smith divinely inspired to translate and publish the Book of Mormon? Were his revelations and translations of other records also divinely inspired?
Since I believe Joseph Smith was divinely inspired, the search for me begins there. It requires me to then proceed in these steps: First, find information about Joseph's teachings, translations, discussions, revelations and beliefs from the most reliable sources. This is not as easy as it once seemed. The materials made available through The Joseph Smith Papers, for example, require some assumptions and conclusions to be revised, discarded, modified or perhaps even noticed for the first time. A great deal of information about Joseph's life, his words, even his revelations has not been accurately transmitted across a mere two centuries. But this is the best and most recent place for the search to begin.
Second, Joseph's paradigm must be adapted, modified and corrected by what the new view of Joseph Smith's ministry reveals and recovers. This is not easy because traditions and presumptions are part of our internal thinking. We hold on to presumptions until forced to abandon them. Even if we think we can begin with a blank slate, we cannot. We do not know what we do not know, and therefore proceed blind to these defects. It requires us to be ever willing to admit we need and must accept correction. This is not easy, but it is necessary.
Third, we must live our lives in conformity with the truth as we understand it so that we gather light and truth from heaven. We cannot live hypocrisy and expect divine aid. We cannot abuse our neighbors and expect divine favor. We are helped by God as we are clean before Him. He (and we) know if we have clean hands and a pure heart.
Fourth, until we have done the work of the first three, there is no justified expectation to discover or have revealed to us something new. Revelation comes at the end of the search, not at the beginning. When, however, the revelation comes, we must be willing to accept it and then reconsider everything in the first three steps in light of what we have gained in the fourth. Even if we think we are living true to the light we had before, once we have more light we must reflect that in our lives. What we did, said, believed or thought before may no longer be consistent with what was just learned.
Likewise, the work of the second step (adaptation, modification and correction) may be wholly inadequate for what new truth has been gained. And finally, the first step (source interpretation and understanding) may change because of the new light.
Every one of us is put through this same process. None of us are spared.
This leads to the question of how to integrate what has been gained in this process with other important information. The best example of a faithful search I can think of is Hugh Nibley. His relentless searching was always informed by the primacy of Joseph Smith and the restoration. He believed in the Book of Mormon even when the LDS Church and its leaders did not. This is discussed in Eighteen Verses. Brother Nibley was himself a restorationist who amplified our understanding of antiquity. However, Hugh Nibley died three years before a single volume of The Joseph Smith Papers was in print. He died five years before the five volumes of The Complete Discourses of Brigham Young were available in print. He never had an opportunity to see or read most of what Brigham Young said. He died before many of the journals of church leaders and apostles were made available. Brother Nibley's work sought to harmonize the restoration with antiquity. He did a great work. But he lived and died without having at his disposal a great body of additional material now accessible to us. It begs the question of whether he would (or should) have reconsidered the content and meaning of the restoration and Joseph's teachings if he learned new information by that process. From all that can be said about Hugh Nibley, it is apparent to me he would have rethought everything he learned if new revelation of the restoration suggested it ought to be done.
There was a prominent anti-Mormon radio preacher named "Dr. Walter Martin." He had a radio call in show I listened to for years. He got most of what he said about Mormonism from dubious source material and he made bombastic claims that were unpersuasive to anyone who had read the widely available book A Marvelous Work and a Wonder, by LeGrand Richards–still a very good book. But Dr. Walter Martin had a constant refrain: "It is the first principle of Biblical hermeneutics that you interpret the old in light of the new." Meaning, you understand the Old Testament by study of the New Testament. It is a sound principle. Of course, he violated this first principle when it came to the Book of Mormon and Joseph's revelations. He discarded the new and judged it only by the old.
This is the one rule Dr. Walter Martin and I agree upon. I apply that across the board with all learning, study and meditation. To recover the past we do not begin the search there, but we begin the search with the latest revelation and attempt to recover truth as we measure it beside what we have received in our day from God.
If the search and accompanying conclusions into Joseph and the restoration are much different now than they were just a few years ago, and the intervening traditions and practices are clearly divergent from Joseph's in just four generations, what does that tell us about caution for antiquity's remaining documents? Even our understanding of New Testament times is only fragmentary. The historian Norman F. Cantor wrote about how little we really understand the middle ages in his book titled, Inventing the Middle Ages. He explains how traditions rather than proof inform much of our re-creation of the period in the relatively recent past. Going back another millennium to the New Testament is even more difficult. And the earliest ages are more challenging still.
The farther back we journey the more we need the restoration to guide, inform and set the framework for the search. This is why Joseph Smith was a necessary figure in this late date in history. We will not get far if we do not accept him as the indispensable milestone marker for the correct path that God would ask us to follow for the walk back to His presence.
I advocate study of the past, including Egypt. What I do not suggest is we measure Joseph Smith by beginning with the New Testament, Old Testament or Egypt. We work backward to test for truth. I think anyone who believes in the restoration would agree with that.


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dpnetadmin
2019 Untitled Artist: Cameron Graves Quartet
A member of the game-changing, genre-blurring Los Angeles collective, the West Coast Get Down, pianist CAMERON GRAVES is taking the modern jazz scene by storm. Graves' style was described by his fellow West Coast Get Down member, Kamasi Washington, as an "almost unbelievable combination of modal jazz, romantic era European classical music, and mathematical death metal." Graves' debut record on Mack Avenue Records, Planetary Prince, which also serves as Graves' pseudonym, comes from The Urantia Book, a spiritual tome that emerged from Chicago in the first half of the 20th century and that purports to reveal the truth of humanity through a combination of spiritual and cosmological ideas, including radical retellings of familiar stories from the Bible. This release marked a seismic shift in the jazz landscape and the game-changing arrival of the genre-blurring Los Angeles collective West Coast Get Down blending elements of Jazz, Classical, Rock and Hip-Hop. The core of the band on Planetary Prince is made up of fellow West Coast Get Down members, whose musical and personal relationships with Graves stretch back to their high school days: tenor saxophonist Kamasi Washington, trombonist Ryan Porter, bassist Stephen "Thundercat" Bruner, and drummer Ronald Bruner Jr. To their ranks are added trumpeter Philip Dizack and bassist Hadrien Feraud, both key members of the groundbreaking modern L.A. jazz scene.
Cameron's soon to be released sophomore album on Mack Avenue, Seven, takes his musical vision to a new height, blending Jazz, Fusion, Rock and Metal. The result is a new and innovative sound that will change the public's view of Jazz. Featuring guest performances by Stanley Clarke, Robben Ford and John "JR" Robinson on the Beatles cover, Getting Better, this Album will firmly establish Graves as a Jazz giant.
Graves was a key member of actress/musician Jada Pinkett Smith's nu-metal band Wicked Wisdom, providing him an entrée into the world of film and television scoring through the Pinkett Smith-directed film The Human Contract and TV series Hawthorne. Through his soundtrack work, Graves connected with legendary bassist and fellow label mate, Stanley Clarke, and is now a member of his latest band, touring internationally. Cameron wrote several songs and performed on Stanley's latest release, The Message, and has performed internationally with the Stanley Clarke Band. Cameron has also performed and recorded on albums for Kamasi Washington, Thundercat, Dr. Dre and Miles Mosley.
September 1, 2019 7:45 pm Sunday, 9/1 | Absopure Water Front Stage


A California joint task force "Drive Sober or Get Pulled Over" campaign started on August 17, and ending Labor Day on Sept. 3. This will create more DUI checkpoints and saturation patrols. Remember that it is always safer, wiser and cheaper to have a designated driver, or call a cab. We at the Law Office of Stephanie M. Arrache would rather people drive safe than get new clients.


Israel Urges Trump, UN To Act Against Iran.
Intelligence Minister Israel Katz told Army Radio on Tuesday that "there is no doubt that further sanctions on Iran are needed," following the ballistic missile test. Katz said that not only Iran's ballistic missile program, but also its entrenchment in Syria and the aid it gives to Hezbollah constitute threats to Israel's security.
The intelligence minister suggested that the Trump administration, and its stance on Iran, offers new opportunities to thwart Iran's hegemonic ambitions in the region that endanger Israel.
According to a US official speaking on condition of anonymity, the medium-range ballistic missile launched by Iran in Sunday's test exploded after 630 miles.
The official said the test was carried out from a site near Semnan, east of Tehran. The official added that the last time this type of missile was test launched was in July 2016.
Senator Bob Corker, chairman of the US Senate Foreign Relations Committee, condemned Iran on Monday and said he would work with other lawmakers and Trump's administration to hold Iran accountable.
On Tuesday, Iran said that the ballistic missile tests carried out by the country were neither part of a nuclear agreement with world powers, or the UN Security Council resolution endorsing the deal.
Neither confirming or denying US accusations that Iran had carried out a missile test on Sunday, Iranian Foreign Minister Mohammad Javad Zarif stated that Iran would never use missiles made in Iran to attack another country.
Zarif also said that such tests were not part of any United Nations resolution ratifying accord.
Ayrault told reporters at the conference that France had made clear its concerns over the Iranian ballistic missile test, adding that it harmed the international community's confidence in Iran and contravened UN Security Council Resolution 2231.


Yesterday we went out shopping to get a few things. Trader Joe's for some Two Buck Chuck, Irish Breakfast Tea and some vanilla beans.The Container Store is almost next door to that Trader Joe's so we went in to check out the Lego storage units. We ended up with one of the Large Boxes and a Large Boy Head.
Then we went to Walmart for some other items and back home until it was time for dinner and Cub Scouts. After Cub Scouts we went to Dairy Queen for a treat.


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Las Vegas Raiders
Smith's World
Storms bring weather show to Las Vegas
Levi Chronister
Just outside The District in Henderson, cars on Green Valley Parkway trudge through minor flooding during storms Monday afternoon.
By Dave Toplikar
Monday, July 14, 2008 | 6:51 p.m.
(First posted at 9:04 a.m.) The Las Vegas Valley was treated to a weather extravaganza this afternoon, featuring a cast of characters that rarely perform in the desert except in monsoon season — hail, heavy downpours and even street flooding.
Storms bringing chance of flooding (7-13-2008)
Valley gets first soaking since May (7-12-2008)
Las Vegas escapes thunderstorms - so far (7-11-2008)
Top 10 tips for flash floods(7-11-2008)
The curtain went up shortly after 1 p.m., when thunderstorms rumbled into the Henderson area, bringing crackling thunder, lightning and strong winds.
Pea-sized hail and pelting rains led to poor visibility on Interstate 215, slowing traffic traveling between McCarran International Airport and Green Valley Drive, according to Sun employees who were traveling along the highway about 1:40 p.m.
Other Sun employees who were out in the soup reported flooding along Green Valley Drive near The District, where cars were splashing through several inches of water. Police scanner traffic also indicated there was street flooding along Horizon Ridge Parkway.
During the brunt of the storm, the National Weather Service issued flash flood advisories and warnings.
The weather service told drivers to be wary of minor flooding in urban areas of Clark County, including Henderson and Green Valley through 3:15 p.m.
At 1:49 p.m., the weather service's Doppler radar and weather spotters indicated that up to a half an inch of rain had fallen since 1 p.m. in the Las Vegas Valley, with more on the way.
Rural areas were also warned about flash flooding in areas frequented by campers and hikers.
Flash flood warnings went out for the Red Rock Canyon National Conservation Area, which had a total of 0.39 of an inch of rain as of 1:55 p.m., according to the Clark County Regional Flood Control District's gauge.
At 2:11 p.m., the weather service's Doppler radar and automated rain gauges indicated two-thirds of an inch of rain had fallen near the Red Rock Canyon Visitors Center.
The weather service issued flood warnings for areas at Red Rock Canyon, Mountain Springs Summit, Calico Basin and the Spring Mountains.
The McCullough Mountains south of Henderson received 0.28 of an inch before 2 p.m. today, according to the Clark County Regional Flood Control District.
A flash flood warning also went up for north central Clark County, which included Hayford Park, Mormon Well Road and Alamo Road, which received between 2 and 3 inches of rain by 2 p.m., according to Doppler radar readings.
By about 3:30 p.m., the curtain fell on most of the desert weather show and all the flash flood advisories and warnings had expired by 4:30 p.m.
Officially, the big storm won't show up in the official readings for the Valley.
That's because McCarran International Airport, which is the official record-keeper for the National Weather Service for Las Vegas, showed only a trace of rain.
McCarran recorded a high today of 97 degrees, with wind gusts during the afternoon between 20 and 22 mph.
Tonight, the chance for precipitation drops to 20 percent, with most of the storm clouds clearing out by 11 p.m. Skies will be partly cloudy, with a low falling to 80 overnight.
Over the weekend, McCarran International Airport reported .04 of an inch of rain, most of which fell late Friday night and early Saturday morning.
The airport also reported traces of rain Saturday morning and Sunday afternoon from storms that passed through the valley.
However, the skies erupted with much more rain Sunday afternoon in some areas of the valley, including Henderson.
On Sunday afternoon, the weather service said that automated Clark County rain gauges reported nearly a half an inch of rain over Henderson. Automated gauges along the Flamingo Wash between Torrey Pines and Decatur measured nearly 0.6 of an inch in less than an hour.
There was also a report of water running nearly a foot deep on the sides of the road near the intersection of Lake Mead Parkway and Water Street in Henderson.
(Sun reporter Mary Manning contributed to this report.)


This high quality, sturdy kitchen unit fits perfectly into a corner.
Featuring a large surface area for a group of children to collaborate and create together! Watch as they slosh, mash and stir their mixtures in the large, removable sink.
Use the chalkboard to encourage mark making. Generous shelving and hooks allow children to self-select their utensils, receptacles, ingredients and more. Use as a mud kitchen, a laboratory or as a role play kitchen. It is a purposely open ended design to enable children to use their imaginations. The wood is FSC Scandinavian Redwood and is guaranteed against rot and insect damage for 10 years. Featuring a large, removable sink for easy cleaning, an oven, 4 x hobs, a large work space, a chalkboard and multiple storage shelves and hooks. Please note accessories not included. Please note that you have two options on delivery. 'Standard' is delivered to your door and 'Assisted' a two person service, positioning your resource where you need it. Once positioned, you will need a few helpers to help you build your resource.


Have you ever wondered about the main microorganisms in our gut microbiota? With this second illustration of our series "Get to know your bacteria", we invite you to discover Lactobacilli.
The Gut Microbiota for Health Publishing Team created this infographic to teach you the benefits of this bacteria and which foods contain it.
Do not hesitate to share this infographic on social media and with your family and friends!


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Clinical patterns of mucormycosis in northwest India
Shockingly, the prevalence of mucormycosis in India (0.14 cases/1000 population) has previously been estimated to be around 70 times that of the worldwide rate.
A new survey was recently published by Dr Jagdish Chander and colleagues at the Government Medical College Hospital (Chandigarh, northwest India). In total 82 patients over 5 years were diagnosed with mucormycosis, of whom 67% were male, 62% were diabetic, and 15% had recently received an intramuscular injection. Presentation was frequently rhino-orbital-cerebral (45%), cutaneous (30%) or pulmonary (17%). The most frequently-isolated agent was Rhizopus.
Despite antifungal therapy (mainly amphotericin B) being commenced for most patients, mortality rates were high: 25 patients (30%) died and a further 8 (10%) were at high risk because they left the hospital against medical advice.
Nip it in the bud. Tissue invasion and mortality are rapid, so if mucormycosis is suspected then commence antifungal therapy and perform surgical debridement without delay.
Watch surgical videos on YouTube of mucormycosis debridement by Dr Murali Chand Nallamothu, Dr Ahilasamy Chennai and Prof Dr Balasubramanian.
Read the paper: Chander et al (2018) Mucormycosis: Battle with the Deadly Enemy over a Five-Year Period in India. Journal of Fungi 4:46.
Proportions of species isolated in mucormycosis cases in Chander et al (2018)


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I expect we have much more in common than you realise.
You want to stop ISIS – So do I.
You are sick of British Youths that commit terrorist attacks – So am I.
You want to DO something about these things – So do I.
But where we differ is on how we plan to prevent these things. Because I'll tell you one thing – Sixteen years of incessant hatred towards Muslims since the suicide mission on the Twin Towers hasn't made it better – It's made it much, much worse.
Look outside your window. Look in the newspapers. Look on social media. All of your hate, your abuse, your EDL marches, your Britain First Mosque invasions – What has it achieved? Has the amount of Islamic Extremism gone up or down?
Your way isn't working. It's clearly not working. You've been calling them "Muzrats" for over a decade and a half and all that's happened is that Islamic Extremism has risen.
And here's the bit you won't like but you need to think really, really hard about if you want it to stop: Hate speech, EDL marches, invading mosques – That's exactly what ISIS want you to do.
Every single time you shout "Send 'em all back home" you are actively recruiting for ISIS.
Because the scumbag who murdered innocent children in Birmingham and the three arseholes who mowed down and stabbed innocent people on London Bridge were all ordinary British men until Islamic Extremists starting dripping poison into their ears.
And what they told them was this: "The West hate you. They bomb innocent children in Syria. They want to wipe Muslims from the face of the earth. They want to deport you from Britain just because you worship in a Mosque instead of a church. Don't believe me? Look around – They are invading mosques, they are nailing bacon to our mosque doors. Look at social media. Can you see the posts calling us 'Musrats"? The posts saying 'Enough is enough – Hang 'em or send 'em back'? Are you just going to let them threaten your family like that?".
And they see what YOU are saying. And the things you are saying are 'proof' that the Extremists are right. So an ordinary British lad straps a bomb to himself and destroys the lives of children because YOU gave him the evidence that convinced him the vile Extremist Recruiter was whispering in his ear was true.
ISIS can't make terrorist attacks without a plentiful supply of people who are willing to die for them. They don't care about these lads, they are just disposable weapons to them.
You want to stop ISIS? Then you have to cut off their supply of young men willing to kill and die.
How do you do that? Two ways.
One is to encourage your Government to stop selling arms to the Saudi's who are funding them but the other, more effective and easier way is to make it impossible for them to convince OUR Young British Muslims that we hate them and they need to hurt us before we hurt them.
How do we do that? Well ask yourself this: Is it easier to believe that the British public hate you if they nail bacon to your mosque door or……. If they politely ask to come to the mosque and find out how we can work together to stop radicalisation?
It's bloody hard to believe someone hates you if he's offering you a cup of tea and asking to listen to you.
Create a world in which the words of ISIS' recruiters look like lies.
Don't hate all Muslims – Befriend them. Have a barbecue and invite them over (beef and lamb only). Organise events bringing your community and theirs together.
If there's nothing but friendship between our communities and theirs how will ISIS recruit the next suicide bomber?
Who is going to want to bomb their friends?
You can end this. The power is in your and my hands.
And I know – You have other issues with Islam. So do I.
For example we can probably both agree that Islam can be very misogynistic (so can Christianity and Buddhism for that matter. I despise pretty much all religions equally) but helping Muslims integrate with our society, instead of pushing them away with hate, gives you a much better chance of changing those ideas.
So please. Just stop helping ISIS yeah?