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Prevalence and...
Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers
CCBYNC Open access
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2939 (Published 11 August 2009) Cite this as: BMJ 2009;339:b2939
Kate Shannon, assistant professor12,
T Kerr, assistant professor12,
S A Strathdee, professor and chair3,
J Shoveller, professor2,
J S Montaner, professor and director12,
M W Tyndall, associate professor12
1British Columbia Centre for Excellence in HIV/AIDS St Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
2Faculty of Medicine, University of British Columbia Vancouver, BC V6T 1Z3, Canada
3Division of Global Public Health, University of California San Diego School of Medicine, La Jolla, CA 92093-0507, USA
Correspondence to: K Shannon kshannon{at}cfenet.ubc.ca
Accepted 8 March 2009
Objective To examine the prevalence and structural correlates of gender based violence against female sex workers in an environment of criminalised prostitution.
Setting Vancouver, Canada during 2006-8.
Participants Female sex workers 14 years of age or older (inclusive of transgender women) who used illicit drugs (excluding marijuana) and engaged in street level sex work.
Main outcome measure Self reported gender based violence.
Results Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). Analyses were based on 237 female sex workers who completed a baseline visit and at least one follow-up visit. Of these 237 female sex workers, 57% experienced gender based violence over an 18 month follow-up period. In multivariate models adjusted for individual and interpersonal risk practices, the following structural factors were independently correlated with violence against female sex workers: homelessness (adjusted odds ratio for physical violence (aORphysicalviolence) 2.14, 95% confidence interval 1.34 to 3.43; adjusted odds ratio for rape (aORrape) 1.73, 1.09 to 3.12); inability to access drug treatment (adjusted odds ratio for client violence (aORclientviolence) 2.13, 1.26 to 3.62; aORphysicalviolence 1.96, 1.03 to 3.43); servicing clients in cars or public spaces (aORclientviolence 1.50, 1.08 to 2.57); prior assault by police (aORclientviolence 3.45, 1.98 to 6.02; aORrape 2.61, 1.32 to 5.16); confiscation of drug use paraphernalia by police without arrest (aORphysicalviolence 1.50, 1.02 to 2.41); and moving working areas away from main streets owing to policing (aORclientviolence 2.13, 1.26 to 3.62).
Conclusions Our results demonstrate an alarming prevalence of gender based violence against female sex workers. The structural factors of criminalisation, homelessness, and poor availability of drug treatment independently correlated with gender based violence against street based female sex workers. Socio-legal policy reforms, improved access to housing and drug treatment, and scale up of violence prevention efforts, including police-sex worker partnerships, will be crucial to stemming violence against female sex workers.
Rights violations and abuses experienced by female sex workers are seldom considered in discussions of violence against women, as shown by a review of the global scope and magnitude of gender based violence.1 The United Nations Convention on the Elimination of All Forms of Discrimination against Women defined the term "gender based abuse" as "any act of gender based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or in private life."2 This definition encompasses rape, torture, mutilation, sexual slavery, forced impregnation, and murder, and distinguishes male perpetrated violence against women from other non-gender based forms of violence. Gender based violence has been recognised as a global public health and human rights problem that leads to high rates of morbidity and mortality, including gynaecological problems, sexually transmitted infections, depression, post-traumatic stress disorder, substance dependence, suicide, and mortality.3 4 5
Despite extensive evidence documenting the severe adverse health outcomes associated with gender based violence, our understanding of the magnitude of violence against women has been largely drawn from data on partner violence.1 4 5 Additionally, although individual and interpersonal correlates of gender based violence have been well described, there are no empirical models that account for larger structural inequities that could promote gender based violence.
Of particular concern is the fact that gender based violence and gender inequity have increasingly been cited as important determinants of a woman's risk of HIV infection.4 6 7 Among drug involved and sex work populations, violence has been associated with an elevated likelihood of acquiring sexually transmitted infections or HIV through unprotected sex, the exchange of sex for drugs or money, multiple concurrent sex partnerships, and sex with a risky partner (for example, a partner positive for antibodies to HIV or a partner who has multiple sex partners).8 9 Furthermore, the synergistic relationship between crack cocaine smoking and survival sex among female sex workers has been shown to exacerbate violence and exploitation against women and increase the risk of acquiring sexually transmitted infections or HIV, resulting in reduced control of female sex workers over the negotiation of HIV risk reduction practices with clients.10
In 2002, the Joint United Nations Programme on HIV/AIDS (UNAIDS) called for the decriminalisation of sex work, recognising the longstanding promotion by public health advocates and sex workers of safer working conditions and protection from violence.11 Although UNAIDS retreated from this endorsement in 2007,12 the UN secretary general, Ban Ki-moon, reconfirmed the organisation's position against punitive sanctions targeting sex workers at the UN High-level Meeting on HIV/AIDS in June 2008. Despite these policy statements, many countries, including Canada and the UK, continue to promote conflicting sex work regulations that maintain the buying and selling of sexual services as legal but criminalise soliciting for sexual services in public spaces, living off the benefits of prostitution, and working indoors in managed or cooperative settings (for example, brothels).13 14 15 16 Enforcement of these criminal sanctions has been shown to create "tolerance zones" in outlying and isolated public spaces that are then subject to police crackdowns and unwritten rules of engagement between police, clients, and sex workers. Importantly, a growing body of qualitative evidence has documented the adverse impact of street policing strategies on the health and safety of female sex workers17 18 19 20 21; and yet, there has been no empirical investigation to date evaluating the relationship of criminalisation and enforcement based policing strategies with the likelihood of violence against female sex workers.
In Canada over the past two decades, urban centres have experienced epidemics of violence against street based female sex workers that have been posited to coincide with prohibitive policy changes and enforcement based strategies, such as police crackdowns.13 14 15 A study in Vancouver, British Columbia, of women who used injection drugs between 1996 and 2002, the majority of whom were in street based work, showed a 47-fold higher likelihood of mortality in this group compared with an age matched sample of the general population, with homicide being the most common cause of death.22 Widespread scrutiny over the delayed response by police and the judicial system to the deaths of female sex workers led to an extensive police investigation of over 69 women missing from the streets of Vancouver and the inception of the Missing Women's Task Force in 1999, which was estimated to have cost more than $C116 million (£65 million; €75 million; $107 million) by the end of 2007.23
This study aims to identify the prevalence and structural correlates of violence against female sex workers by using longitudinal data derived from a prospective cohort of street based female sex workers in Vancouver, Canada. Given that sexual and physical violence have been shown to be conceptually different,6 we further hypothesised that client perpetrated violence would be conceptually unique owing to the specific context of a sexual transaction; therefore, three separate violence experiences—physical, sexual, and client perpetrated—were modelled separately.
The Maka Project is a community based HIV prevention research partnership that has been described in detail elsewhere.24 Briefly, between 2006 and 2008, street based female sex workers were enrolled in an open prospective cohort and participated in baseline and six monthly follow-up visits that included an interview questionnaire and voluntary screening for HIV. On the basis of previous research that identified 100% substance use among street based female sex workers in Vancouver,25 eligibility criteria were defined as being a woman aged 14 years or older who used illicit drugs (excluding marijuana) and engaged in street level sex work. Determining a representative sample of female sex workers is difficult owing to the unknown size and boundaries of this population; therefore, we mapped areas with over 60 female sex workers and identified solicitation spaces for targeted outreach and recruitment. Time space sampling was used to systematically sample all women (inclusive of transgender women) at staggered times and locations along these strolls.26
At baseline and follow-up visits, trained peer researchers (that is, former and current female sex workers) administered a detailed semistructured questionnaire with questions related to demographics, health service use, working conditions, violence, and sexual and drug risk practices. In addition, voluntary HIV screening using the new point of care rapid INSTI test (bioLytical Laboratories, Richmond, BC, Canada; specificity 99.3%, sensitivity 99.6%) was conducted by the project nurse, supported by pre-test and post-test counselling. Tests positive for HIV antibodies were confirmed by Western blot. Detailed health and violence questions were then asked by the nurse in order to facilitate counselling and referral to support services.
Dependent variables
Given that serial measures over three follow-up visits were available, we were able to analyse the data longitudinally. The following three categories of violence experiences perpetrated by men were considered at each six month interval and modelled separately: (a) physical violence ("Have you been physically abused by someone (excluding clients) in the last six months? This may include partner, pimp, dealer, police, security guard, stranger, or other"); (b) rape ("Have you been forced to have sex (penetrative) against your will (excluding clients) in the last six months?"); and (c) client perpetrated violence ("Have you experienced a 'bad date' in the last six months?"). Respondents who answered "yes" to having experienced a "bad date" in the past six months were asked to classify the incident(s) of violence into the following categories: verbal harassment; abduction or kidnap; sexual assault; rape; strangling; physical assault or beating; assault with a weapon; being thrown out of moving car; or other.
Independent variables
Specific environmental and structural factors collected at baseline and follow-up visits were considered on the basis of evidence in the literature and relationships hypothesised a priori. These factors were: homelessness; having tried but been unable to access drug treatment; place of servicing client (car or outdoor public space compared with indoor settings (for example, hourly room, sauna)); and current and historical street policing strategies. Current policing variables (reported at baseline and at each six monthly follow-up visit) included confiscation of drug use paraphernalia without arrest and moving working areas away from main streets as a result of policing. Historical police assault was recorded as self reported police assault before first baseline visit (defined as self reported physical assault and/or having been forced to provide sexual favours to police). Although the majority of police officers in Canada are male, the interactions could have involved female police officers.
Individual variables considered as potential confounders owing to their known or hypothesised relationship with gender based violence and one or more independent variable(s) included age (defined as ≤24 years v >24 years of age); ethnicity; HIV antibody status; and drug use patterns. Aboriginal ethnicity (for example, First Nation, Méti, Inuit) compared with non-Aboriginal ethnicity was considered owing to evidence of an elevated prevalence of trauma among Aboriginal people. HIV antibody status was based on HIV screening results at each study visit. Similar to previous analyses,25 drug use patterns included any cocaine or heroin injection, crystal methamphetamine use (injection or non-injection), or crack cocaine smoking.
Five risky interpersonal practices were also considered as potential confounders owing to their known or hypothesised relationship with gender based violence and one or more independent variable(s): (a) having a male sex partner who injects drugs; (b) exchanging sex while high on injection or non-injection drugs; (c) having unprotected sex; (d) being pressured into sex (vaginal or anal) without a condom; and (e) having a male intimate partner who procures drugs for use by the sex worker. Consensual unprotected sex was reported as inconsistent condom use for vaginal, anal, or oral sex with regular clients ("regulars"), one time clients ("johns"), and primary partners. Given the different risks associated with penetrative sex compared with oral sex, only unprotected vaginal and anal sex were considered in our analyses. The micro level practice of relying on a male intimate partner to procure drugs was considered on the basis of our qualitative research documenting female sex workers' experiences of having a primary partner limit their ability to negotiate violence prevention strategies through reducing access to material resources.18 All models were adjusted for childhood sexual abuse owing to its known confounding relationship with experiences of violence in adulthood, criminal behaviour, and negotiation of sexual risk reduction.
Analyses were restricted to female sex workers who attended a baseline visit and at least one follow-up visit. The baseline variables considered were demographic variables, childhood sexual abuse, and historical assault by police. All other variables were treated as time updated covariates that referred to experiences occurring during the previous six month period.
We examined bivariate associations and tested for potential collinearity or effect modification of individual, interpersonal, and environmental and structural variables with experiences of each type of violence by using generalised estimating equations and a working correlation matrix. Fisher's test of exact probability was also used to compute P values when one or more of the observations was less than or equal to five. We used generalised estimating equations for binary outcomes, with logit link for the analyses of correlated data because the factors potentially associated with violence during follow-up were serial (time dependent) measures. In addition, models generated from generalised estimating equations take into account the correlation between repeated measures for each subject. Data from every participant follow-up visit was considered in the analyses. Given the conceptual differences in the types of violence episodes, we then fitted separate multivariate logistic generalised estimating equation models for each of the three violence outcomes (physical violence, rape, and client perpetrated violence), adjusting for known or potential individual and interpersonal confounders and variables that retained significance with violence in bivariate analyses at P<0.10. Variables were considered significant in multivariate analyses if they retained significance at P<0.05. All reported P values are two sided with 95% confidence intervals. Given that each violence outcome was modelled separately, unadjusted and adjusted odds ratios of associations between independent variables and outcome measures are reported separately for each specific violence outcome.
Of 267 female sex workers invited to participate, 251 women returned to the study office and consented to participate (response rate of 94%). A total of 237 women completed a baseline visit and at least one follow-up visit, with a total of 575 observations available over three visits (median visits 2, interquartile range (IQR) 2-3). Approximately half (113/237 (48%)) of the women self identified as Aboriginal and 43% (102/237) as white. The median age at baseline was 36 years (25-41 years) and the median age of sex work initiation was 15 years (13-21 years). Twenty per cent (47/237) were young women aged less than 24 years. The prevalence of HIV infection was 23% (55/237). The majority of women (206/237 (87%)) reported "absolute homelessness" (living on the street) at least once in their lifetime, with approximately half (104/237 (48%)) reporting homelessness over the 18 months of follow-up. One fifth (47/237) reported having tried but been unable to access drug treatment, with long waiting lists being the primary reason for inability to access drug treatment (45/47 (96%)). One fifth (48/237) reported one or more dependent children (median 2, IQR 1-3), with 32% (76/237) reporting having had at least one child apprehended by social welfare services (median 3, IQR 1-4).
A total of 57% (136/237) of women experienced violence at least once over the 18 month follow-up period, with 38% (90/237) reporting physical violence, 25% (60/237) rape, and 30% (70/237) client perpetrated violence. Table 1⇓ describes the specific incidents of client perpetrated violence reported by female sex workers.
Type of client perpetrated violence reported by the 70 (30%) street based female sex workers who experienced client perpetrated violence over 18 months of follow-up
Tables 2⇓, 3⇓, and 4⇓ show the unadjusted and adjusted associations in the multivariate models for each violence outcome (physical violence, rape, and client perpetrated violence). In multivariate models that adjusted for individual and interpersonal risk practices, the environmental and structural factors independently associated with violence against female sex workers were homelessness (adjusted odds ratio for physical violence (aORphysicalviolence) 2.14, 95% CI 1.34 to 3.43; adjusted odds ratio for rape (aORrape) 1.73, 1.09 to 3.12), inability to access drug treatment (aORphysicalviolence 1.96, 1.03 to 3.43; adjusted odds ratio for client perpetrated violence (aORclientviolence) 2.13, 1.26 to 3.62), servicing clients in cars or public spaces (aORclientviolence 1.50, 1.08 to 2.57), prior assault by police (aORrape 2.61, 1.32 to 5.16; aORclientviolence 3.45, 1.98 to 6.02), confiscation of drug use paraphernalia by police without arrest (aORphysicalviolence 1.50, 1.02 to 2.41), and moving working areas away from main streets owing to policing (aORclientviolence 2.13, 1.26 to 3.62).
Bivariate and multivariate models for individual, interpersonal (partner level), and environmental and structural factors correlated with physical violence against street based female sex workers
Bivariate and multivariate models for individual, interpersonal (partner level), and environmental and structural factors correlated with rape experienced by street based female sex workers
Bivariate and multivariate models for individual, interpersonal (partner level), and environmental and structural factors correlated with client perpetrated violence against street based female sex workers
Our results demonstrate an alarming prevalence of gender based violence among a sample of street based female sex workers. Furthermore, we found that the environmental and structural factors of homelessness, inability to access drug treatment, servicing clients in cars or public spaces, and enforcement based policing strategies were independently associated with gender based violence, even after adjustment for the potential confounding effects of individual and interpersonal risk practices. Although previous research samples suggest that the lifetime prevalence of violence among female sex workers is between 50% and 100%,27 28 many such estimates have been based solely on reports of client violence.29 30 In comparison, over half of the women in this sample experienced physical and/or sexual violence over an 18 month period.
Comparison with other studies
The persistent relationship between enforcement, both of policies on prostitution and those on drug use (for example, confiscation of drug use paraphernalia without arrest and enforced displacement of sex workers to outlying areas), and violence against female sex workers points to the role of criminalisation in enhancing the likelihood of violence against street based female sex workers. Of particular concern, prior assault by police had the strongest correlation with both sexual and client perpetrated violence against female sex workers. In 2000, the World Health Organization classified police officers' excessive use of force as a form of violence,31 and yet there is scant empirical evidence with which to characterise the public health impact of police violence.30 32 Police contact with street involved populations can be pervasive, and evidence suggests that excessive use of force, including violence, can be a characteristic of "police crackdowns" that target street populations.32 33
A growing body of qualitative evidence documents the multitude of negative outcomes of street policing strategies for female sex workers, including displacement of street based sex markets, disruption of peer networks and informal safety structures, and increased risk of violence and sexually transmitted infections.17 18 19 20 21 Police violence against female sex workers has been reported to include excessive use of physical force, forced removal and subsequent abandonment in outlying areas, and coerced sex provided to police in exchange for freedom from detainment, fine, or arrest.16 17 18 19 20 21 32 Qualitative evidence suggests that prior police perpetrated assault could increase fear of violence among female sex workers and reduce the likelihood that female sex workers will access police and judicial support as a means of averting future violence by partners, clients, or other third parties.20 Epidemiological analyses among street based injecting drug users have consistently linked enforcement strategies with adverse health outcomes, including an elevated likelihood of practices that increase the risk of HIV infection, such as syringe borrowing.34 35 36 Taken together with recent findings from our study mapping geographical "hot spots" in which female sex workers working in outlying and industrial areas are pressured into unprotected sex by clients,37 this study demonstrates the potential unintended adverse consequences of enforcement based approaches to sex work. The findings provide new evidence to support global calls for the removal of criminal sanctions targeting sex workers, including statements by UNAIDS, and further support the need for systematic evaluations of the effects of legal strategies on health outcomes among female sex workers and clients.
Of major concern, and to our knowledge not previously documented, is the fact that an inability to access drug treatment was associated with a twofold increase in the odds of both physical and client perpetrated violence. A review of Canada's drug strategy showed that of the $C368 million targeted at illicit drug use, 73% were spent on enforcement based initiatives and only 14% spent on addiction treatment.38 Accordingly, the demand for addiction treatment far outweighs availability.39 As of 2008, an estimated 176 detoxification beds and 326 long term treatment beds were available in the province of British Columbia (12.11 beds per 100 000 population), with a wait time of four to 12 weeks and only 14 beds allocated for mothers with children.40 Canada's policy makers have been slow to respond to the shortage of beds in drug treatment facilities. In addition, evidence of the harms of enforcement based strategies is mounting both locally and internationally.41 42 This research suggests that the failure of the current drug strategy to support women's ability to access treatment may compound experiences of violence among female sex workers. The observational nature of this study precludes determining causality. Nevertheless, qualitative accounts document the role of binge drug use and drug withdrawal in reducing female sex workers' ability to negotiate HIV risk reduction practices with primary partners and clients, which supports our evidence of the potential enhanced vulnerability to violence that results from an unsuccessful attempt to access drug treatment.18 19 This research underscores the urgent need to improve and scale up access to and availability of drug treatment facilities for female sex workers, including programmes that support pregnant and parenting mothers.
Furthermore, the extremely high prevalence of rape experienced by female sex workers over the 18 month follow-up period points to the immediate need to scale up violence prevention strategies, including increasing support for female sex workers accessing legal and victim services and improving the monitoring of and legal responses to violence against female sex workers. The 63% elevated likelihood of rape among women who reported reliance on a male partner to procure drugs supports evidence elsewhere of the adverse impact of gender inequities in access to economic or material resources on women's health outcomes.6 Rape has been associated with an increased likelihood of acquiring sexually transmitted infections and/or HIV owing to the high likelihood of vaginal and/or rectal trauma;5 therefore, the prevention of sexual violence against female sex workers needs to be integrated into HIV prevention efforts. In addition, the independent correlation between rape and consensual unprotected sex with a primary partner highlights the risk of sexual transmission of HIV infection and the need for gender transformative and couple focused prevention efforts that target partner violence and sexual decision making.43
Finally, the observed relationship between living on the street and the enhanced likelihood of both rape and physical violence highlights the need for structural level responses that focus on poverty and housing, including innovative models of supportive housing that have a harm reduction perspective. Our findings are consistent with previous studies demonstrating an increased likelihood of physical violence among homeless women in substance using populations.44 In one study, homeless female sex workers in the United States were more likely than non-homeless female sex workers to report servicing clients who refused to use condoms.45 In addition, poverty and drug dependency have been associated with both clients offering and female sex workers accepting more money for unprotected sex.25 46 47
Several potential limitations of our analyses should be considered. Although the observational nature of this research precludes determining causality, our longitudinal analyses using generalised estimating equations and accounting for repeated responses by the same respondent may have reduced some potential temporal bias. Additionally, the use of self reports to measure violence episodes could subject the data to social desirability or response bias. Given the highly stigmatised and criminalised nature of sex work and our qualitative work to date, however, under-reporting of violence episodes would be more likely than over-reporting and thus any misclassification would have attenuated estimates towards the null. Furthermore, the use of direct wording in questions on experiences of violence—for example, "have you been physically assaulted in the last 6 months?"—has been shown to underestimate the incidence of violence against women by failing to account for more ubiquitous episodes of violence, such as slapping.3 Similarly, in qualitative work on client perpetrated violence, we have shown that physical violence perpetrated by clients is so commonplace that many women only define "bad dates" as episodes of extreme violence, such as rape. However, we cannot discount the possibility that some variables could be over-reported. In addition, there are always limitations to measuring police violence as it is not possible to distinguish between excessive use of force and legitimate use of force. Finally, given the multiple types of both indoor and outdoor sex work environments—such as establishment sex work venues (for example, bars and massage parlours) or escort agencies—and the differing legal frameworks of prostitution around the world, it might not be possible to generalise our results to other sex work environments or countries.
Conclusions and policy implications
Our findings document an extremely high prevalence of both sexual and physical violence against female sex workers that persists because of large scale structural inequities. This research provides important empirical evidence demonstrating the adverse public health effects of enforcement based policing approaches to sex work and drug use, and supports global calls to remove criminal sanctions targeting sex workers. Furthermore, our findings suggest that evidence based structural interventions that promote improved access to housing and increased availability of drug treatment will be crucial to stemming the epidemic of violence against street based female sex workers.
Gender based violence has been identified as a global public health and human rights priority, and leads to high morbidity and mortality
A recent review of gender based violence highlighted how rights violations and abuses against female sex workers are seldom considered in discussions of violence against women
There is a growing body of qualitative evidence documenting the adverse effects of street policing strategies on the health and safety of sex workers
Homelessness and inability to access drug treatment were independently correlated with gender based violence against female sex workers, even after adjustment for potential confounding individual and interpersonal risk factors
This study is among the first epidemiological investigations to demonstrate an independent association between criminalisation of and enforcement based approaches to sex work and raised odds of both physical and sexual violence against female sex workers
Our findings support global dialogues on preventative approaches to sex work, including removing criminal sanctions that target female sex workers
Cite this as: BMJ 2009;339:b2939
Acknowledgements: We thank our community partner, the WISH Drop-In Centre Society, and other community collaborators, research staff, and co-investigators of the Maka Project Partnership. We acknowledge the statistical and data management support provided by Calvin Lai and Ruth Zhang.
Contributors: KS conceptualised the study, developed the data analysis plan, and wrote the original draft of the manuscript. TK, SAS, JS, JSM, and MWT provided content expertise and critical feedback on the analyses and interpretation, and read and approved the final version for submission.
Funding: This research was primarily funded through an operating grant from the HIV/AIDS Community-Based Research Program of the Canadian Institutes of Health Research. KS, TK, and JS are supported by the Canadian Institutes of Health Research. TK and MWT are supported by the Michael Smith Foundation for Health Research. JSM is supported through an Avant-Garde Award from the National Institute on Drug Abuse of the National Institutes of Health. The funders had no role in study design, data collection, or in analysis and interpretation of the results, and this paper does not necessarily reflect views or opinions of the funders.
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Surratt H, Inciardi JA, Kurtz SP, Kiley MC. Sex work and drug use in a subculture of violence. Crime Delinq 2004;50:43-59.
Ntumbanzonda M, Dubrow R, Niccolai LM, Mwandagalirwa K, Merson MH. Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo. AIDS Care2006;18:777-85.
Strathdee SA, Semple SJ, Pu M, Orozovich P, Martinez G, Lozada R, et al. Correlates of injection drug use among female sex workers in two Mexico-U.S. border cities. Drug Alcohol Depend2008;92:132-40.
See other articles in issue 7718
Kate Shannon, T Kerr, S A Strathdee, J Shoveller, J S Montaner, M W Tyndall et al
Shannon K, Kerr T, Strathdee S A, Shoveller J, Montaner J S, Tyndall M W et al.
Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers BMJ 2009; 339 :b2939 doi:10.1136/bmj.b2939
Articles by Kate Shannon
Articles by T Kerr
Articles by S A Strathdee
Articles by J Shoveller
Articles by J S Montaner
Articles by M W Tyndall
You are going to email the following Prevalence and structural correlates of gender based violence among a prospective cohort of female sex workers
Housing and health
Epidemiologic studies


Becks bottle 3D illustration rendered in metal ray.
Heres a couple of test characters ive been working on.
Heres a couple of retouching illustrations for the Daily Mail newspaper.
This was an event concept to be created at Westfield shopping mall.
Heres a selection of press ads painted in the style of the old masters.
This is a 3d illustration i created for a website design for KJA artists.
Heres a selection of frames from a Kelloggs pitch for Special k cereal created for RM2 London.
Keyframes for Morrisons supermarket featuring the loveable geordie duo of Ant and Dec.
These were key frames for the Argos christmas campaign featuring an adopted penguin.
This is a book cover i created for Matt Piggott.The book is available on Amazon.
This is a selection of storyboard frames i did for Freeview tv. Created using 3d and photocomps for RM2 London.Below is the finished commercial.
These are a couple of test characters ive been working on for a friends book.
Here are a selection of storyboard frames from Oreo i did last summer for RM2. Below is the finished tv commercial.
This is an illustration i did for KJA artists using photoshop and 3d packages.


text:
Unity's impressive Megacity tech demo is available now
By Fraser Brown 19 March 2019
Where we're going, we don't need roads.
Megacity is a very flashy tech demo designed by Unity to show off the engine's entity component system and burst compiler. It's mostly just pertinent if you're a developer, but the product of these tools is certainly enjoyable to watch, even if you're a layman. It's available for download now, and you can see it in action in the above video from last year.
"In Los Angeles, there was a lot of interest in ECS and the Burst Compiler," says Unity. "Building on the Nordeus demo from Unite Austin, our Game Code and FPS Sample teams produced Megacity, a dynamic futuristic cityscape. Megacity exploits our Data-Oriented Technology Stack (DOTS), the name for all projects under the Performance by Default banner, including ECS, Native Collections, C# Job System, and the Burst Compiler."
The city took two artists only two months to create, complete with flying vehicles, hundreds and thousands of objects and countless audio sources. Other teams did assist, however, providing other upcoming Unity features due out this year. Here are a few of them:
Workflows for (very) large scenes
C# audio system
HLOD system
ECS culling system
Asynchronous scene streaming
Asynchronous entity instantiation
Improvements to ECS tooling and debugging features
As someone whose development experience doesn't go beyond putting an adventure game script into Articy Draft, a lot of this is going right over my head, but the city is tantalising nonetheless. Futuristic megacities seem like brilliant video game fodder, but they're rare. I've been waiting for a recreation of Judge Dredd's Mega-City One or The Fifth Element's New York for years, but neither city has been given the attention they deserve.
Presumably the scale is a bit off-putting, but Unity's Megacity is apparently evidence that something that massive and complicated can be built on a small budget. Unity explains how it was built below, and there are several other videos that go into greater detail about the specifics.
You can download Megacity here, giving you access to the full source files and assets. Now, who's going to build Mega-City One for me? Maybe Rebellion could pause one of the many Sniper Elite games in development and give Dredd some love.
Fraser Brown
Fraser is the sole inhabitant of PC Gamer's mythical Scottish office, conveniently located in his flat. He spends most of his time wrangling the news, but sometimes he sneaks off to write lots of words about strategy games.

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: NuGet restore issue when downloading solutions from github I have a project on Github which I have made on my laptop https://github.com/Mech0z/Foosball9000
However now I am on my desktop and I have trouble getting the solution to compile and I am not sure why NuGet do not want to restore my packages?
Its packages like System.Web.Http and Castle Windsor, stuff that should get restored if I look in my packages.config
I am running VS 2015 Enterprice RC, but I have seen the same issue in VS 2013

A: Okay, so grabbed the project from GitHub and attempted to build (but failed as you did). Your build status in your README is saying it can't get a build up either.
Did some digging though, it appears your FoosballOld.csproj has a lot of broken references (based on its location being so deep in the project). Keep in mind that NuGet's default behavior is to restore packages to "packages" along side your .sln file. So, given your FoodBalOld.csproj is in src/FoosballOld/FoosballOld, referencing ../packages isn't going to work:
<Reference Include="System.Net.Http.Formatting, Version=5.2.3.0, Culture=neutral, PublicKeyToken=31bf3856ad364e35, processorArchitecture=MSIL">
  <HintPath>..\packages\Microsoft.AspNet.WebApi.Client.5.2.3\lib\net45\System.Net.Http.Formatting.dll</HintPath>
  <Private>True</Private>
</Reference>

With that said, I would advise you update these references (if you're intending to keep this file structure, changing them to ..\..\..\packages should work).
Once I changed that:
Build Summary
-------------
00:02.670 - Success - Debug Any CPU - src\FoosballOld\FoosballOld\FoosballOld.csproj
00:00.527 - Success - Debug Any CPU - http://localhost:2521
00:00.005 - Success - Debug Any CPU - Models\Models.csproj
00:00.003 - Success - Debug Any CPU - MongoDBRepository\MongoDBRepository.csproj
00:00.002 - Success - Debug Any CPU - Logic\Logic.csproj

Total build time: 00:02.856

========== Build: 5 succeeded or up-to-date, 0 failed, 0 skipped, Completed at 5/3/2015 9:42:20 AM ==========

To the original point, I have NuGet package restore set on build:

If you don't have this defined, you'll probably have to right-click your project individually and open "Manage Nuget Packages...". In that window, you should see an alert at the top to restore packages.
This is all assuming you have NuGet installed within visual studio. If you don't, you'll need to "Enable NuGet package restore" at the solution level I believe.

redpajama_set_name: RedPajamaStackExchange


text:
In association with Mayo Clinic
K-D Balance
Sideline Assessment
Head Games Film
Reading Solutions
King-Devick Monitoring
Neurological Function
Home > Research > Reading Solutions
The Effect of the King-Devick Reading Acceleration Program on Reading Fluency and Comprehension: A Summary of Randomized Clinical Trials
Authors: Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Halker-Singh RB, Bogle JM, Mandrekar J, Talaber A, Leong D
Publication: Vis Dev Rehabil. 2017;3(4)
Background: Reading performance is essential to a child's academic success. Reading is a complex task involving the integration of language, attention, information processing including eye movements. Efficient eye movements provide a physical foundation for proficient reading and these skills can be improved as multiple studies have reported successful outcomes following training. Data from these studies are summarized and presented to examine the effect of the training program across a wide demographic and large student population. Subgroup analyses further lend insight to ideal timing and length of training.
Methods: Data from five investigations of in-school training programs were combined and analyzed. Study participants were randomized into treatment or control groups. Students 1st through 4th grade (n=611, 7.0 ± 0.8 years) underwent eighteen, 20-minute sessions utilizing King-Devick (K-D) Reading Acceleration Program (RAP). Reading fluency and comprehension was assessed pre- and post-treatment.
Results: The treatment group had significantly greater improvement compared to the control group in fluency (8.9% vs. 5.9%, p<0.001) and comprehension (9.1% vs. 3.1%, p<0.001). A separate group of high-needs students (n=111) also improved significantly in fluency (p<0.001) and comprehension (p<0.001). An extra-training group, who received an average of 11 additional treatment sessions, improved significantly in fluency and comprehension following extra-training (p=0.003, p=0.013). There was a greater improvement in reading comprehension for students receiving intervention in the fall as compared to the spring (10.9% vs 8.1%, p<0.001).
Conclusions: Improving reading skills in youth is essential to building foundations for future academic success. Efficient eye movements are one necessary component of proficient reading that integrate with visual processing, word decoding and attention span. K-D RAP improves aspects of reading that are not currently addressed in schools. Based on the positive reading outcomes there is increasing evidence supporting the inclusion of teaching the physical act of reading in the early education curriculum nation-wide.
Summary Points:
The treatment group had significantly greater improvement compared to the control group in fluency (8.9% vs. 5.9%, p<0.001) and comprehension (9.1% vs. 3.1%, p<0.001).
A separate group of high-needs students (n=111) also improved significantly in fluency (p<0.001) and comprehension (p<0.001).
An extra-training group, who received an average of 11 additional treatment sessions, improved significantly in fluency and comprehension following extra-training (p=0.003, p=0.013).
There was a greater improvement in reading comprehension for students receiving intervention in the fall as compared to the spring (10.9% vs 8.1%, p<0.001).
During the training, out of 611 students, 97.6% improved in reading fluency and 90.2% improved in reading comprehension.
Slowing of Number Naming Speed by King-Devick Test in Parkinson's Disease
Authors: Lin TP, Adler, CH, Hentz JG, Balcer LJ, Galetta SL, Devick S
Publication: Parkinsonism & Related Disorders. 2014; 20(2):226-9.
BACKGROUND: The King-Devick (KD) test measures the speed of rapid number naming, and is postulated to require fast eye movements, attention, language, and possibly other aspects of cognitive functions. While used in multiple sports concussion studies, it has not been applied to the field of movement disorders.
METHODS: Forty-five Parkinson's disease (PD), 23 essential tremor (ET), and 65 control subjects were studied. Subjects performed two trials of reading out loud single-digit numbers separated by varying spacing on three test cards that were of different formats. The sum time of the faster trial was designated the KD score and compared across the three groups.
RESULTS: PD patients had higher (worse) KD scores, with longer reading times compared to ET and control subjects (66 seconds vs. 49 sec. vs. 52 sec., p < 0.001, adjusting for age and gender). No significant difference was found between ET and control (Δ = -3 seconds, 95% CI: -10 to 4).
CONCLUSIONS: This is the first study of the King-Devick Test in Parkinson's disease. PD patients were found to have a slower rapid number naming speed compared to controls. This test may be a simple and rapid bedside tool for quantifying correlates of visual and cognitive function in Parkinson's disease.
Two trials of the K-D Test were administered to individuals with Parkinson's Disease (PD) and essential tremor (ET) and compared with controls.
Those with PD scored significantly worse on the K-D Test compared to those with ET and the control group (adjusting for age and gender).
There was no significant difference in scores in the ET group verses control group.
The K-D Test may be an effective bedside tool for quantifying aspects of visual and cognitive function in patients with PD.
The Effect of In-School Saccadic Training on Reading Fluency and Comprehension in First and Second Grade Students: A Randomized Controlled Trial
Authors: Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker-Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D
Publication: J Child Neurol 2017;32(1)
Date: October 2016
Efficient eye movements provide a physical foundation for proficient reading skills. We investigated the effect of in-school saccadic training on reading performance. In this cross-over design, study participants (n=327, 165 males; mean age (SD): 7yrs-6mos (1yr-1mo)) were randomized into treatment and control groups then underwent eighteen, 20-minute training sessions over five weeks utilizing King-Devick Reading Acceleration Program Software. Pre- and post-treatment reading assessments included: fluency, comprehension, and rapid number naming performance. The treatment group had significantly greater improvement compared to the control group in fluency (6.2% vs. 3.6%, p=0.0277) and comprehension (7.5% vs. 1.5%, p=0.0002). The high-needs student group significantly improved in fluency (p<0.001) and comprehension (p<0.001). We hypothesize these improvements to be attributed to the repetitive practice of reading-related eye movements, shifting visuospatial attention, and visual processing. Consideration should be given to teaching the physical act of reading within the early education curriculum.
Students in 1st and 2nd grade were enrolled in 6 weeks of the King-Devick Reading Acceleration Program.
The treatment group had significantly greater improvement compared to the control group in fluency and comprehension.
A subgroup analysis was performed on high needs students, who were students with an active IEP or in reading recovery Overall, high needs students went from 26th to 40th national percentile rank in reading fluency and from 40th to 56th in comprehension after RAP.
The King-Devick Test, an eye movement test used for reading screening, may be used to predict below-average reading
The Effect of Saccadic Training on Early Reading Fluency
Authors: Leong DF, Master CL, Messner LV, PangY, Smith C, Starling AJ
Publication: Clin Pediatr 2014;53(9)
Background: Eye movements are necessary for the physical act of reading and have been shown to relate to underlying cognitive and visuoattentional processes during reading. The purpose of this study was to determine the effect of saccadic training using the King-Devick remediation software on reading fluency.
Methods: In this prospective, single-blinded, randomized, crossover trial, a cohort of elementary students received standardized reading fluency testing pre- and posttreatment. Treatment consisted of in-school training 20 minutes per day, 3 days per week for 6 weeks.
Results: The treatment group had significantly higher reading fluency scores after treatment (P < .001), and posttreatment scores were significantly higher than the control group (P < .005).
Conclusions: Saccadic training can significantly improve reading fluency. We hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.
Students in grades 1st through 3rd enrolled in a 6-week long Reading Remediation program to train reading-related eye
King-Devick Reading Remediation significantly improved reading
At the 1-year follow-up reading fluency scores remained significantly higher than before K-D
K-D Remediation shows promising results in improving early reading
King-Devick Computerized Neurocognitive Test Scores in Professional Football Players with Learning and Attentional Disabilities
Authors: Mrazik M, Naudi D, Borza C, Kobitowich T, Simran S
Publication: Journal of Neurological Sciences. 2019
Tags: Football,Learning Disability,Professional Athletes,
Objective: This study examined outcomes from the King Devick (K-D) in athletes with Learning Disabilities (LD) and attention disorders (ADHD). Methods: A total of 574 professional football players from the Canadian Football League (CFL) completed baseline evaluations with computerized neurocognitive testing (CNT) prior to the 2016 competitive season. Player age, education, history of concussion, LD, and ADHD were analyzed for K-D and Immediate Post Concussion Assessment and Cognitive Testing (ImPACT) performance. A series of analyses of co-variance (ANCOVA's) were used to compare participants with a history of LD and ADHD with history of concussion as a co-variate. Results: Approximately 5% of participants reported a diagnosed history of LD and 13% with ADHD. Performance on the K-D test was not significantly correlated with age, education, or history of concussion but was significantly correlated with history of LD and ADHD. Participants with LD performed approximately 6.9 seconds slower on the K-D test (t[563] = 4.70, p. = 0.0003) and participants with ADHD were approximately 2 seconds slower (t[572] = 2.04, p. = 0.04). Conclusions: Results indicated that players with a history of diagnosed LD and ADHD performed slower on the K-D test in comparison to athletes with no history of diagnoses. The results of this study underscore the importance of recognizing individualized outcomes when using the K-D.
Performance on the K-D test was significantly correlated with history of LD and ADHD.
Participants with a history of LD performed approximately 6.9 seconds slower on the K-D test, a result consistent with findings of slower K-D scores in LD samples.
Players with a history of ADHD presented with statistically significant slower performance (1.9 seconds slower) when compared to the non-ADHD group.
There was no significant effect for history of concussion on K-D baseline score.
The K-D Test was significantly correlated with Visual Motor Processing, Visual Memory, and Reaction Time, however R-squared values were low suggesting little overlap between the cognitive abilities suggesting that the K-D Test adds unique information to the clinical outcomes associated with concussion.
Impact of Factors that Affect Reading Skill Level on King–Devick Baseline Performance Time
Authors: Chrisman SPD, Harmon KG, Schmidt JD, Kaminski TW, Buckley TA, Kontos AP, Clugston JR, McCrea M, McAllister T, Broglio SP, Ortega J
Publication: Annals of Biomedical Engineering. 2018.
Tags: Collegiate Athletes,Language,Learning Disabilities,Learning Disability,Reading,Sports-Related Concussion,
The King–Devick (K–D) test is often used as part of a multimodal assessment to screen for sport-related concussion. However, the test involves reading numbers, and little is known about variation in baseline performance on the K–D by reading skill level. We conducted a cross-sectional study analyzing data from the Concussion Assessment, Research and Education (CARE) Consortium to assess differences in baseline performance on the K–D associated with factors that impact reading skill level (learning disorder [LD] and primary home language other than English [PHLOTE]), while controlling for covariates (gender, type of sport, attentional issues, history of concussion and modality of administration). We had a sample of 2311 student-athletes (47% female), and multivariate regression indicated an average K–D performance time of 40.4 s. Presence of LD was associated with a 3.3 s slower K–D time (95% CI 1.9–4.7, p < 0.001), and PHLOTE was associated with a 2.6 s slower K–D time (95% CI 1.2–4.0, p < 0.001), after controlling for other covariates. These results suggest caution in the use of normative data with the K–D. Future studies should explore the impact of factors associated with reading skill level on sensitivity of the K–D in detecting concussion.
The King–Devick (K–D) test has been used as a rapid sideline screening test, since it evaluates complex cognitive function including visual-motor coordination, language function and attention, and thus sensitive to concussion and other brain injury.
Multiple regions of the brain are necessary to complete the K–D test. Motor function is involved, particularly saccades (scanning from left to right across the page in a coordinated fashion) and accommodation (contracting the eye muscles in order to focus on and read the numbers). The amplitude of saccadic eye movement is associated with the oculomotor nuclei, whereas the direction of these eye movements is associated with the reticular formation. Individuals completing the K–D must also recognize single digit numbers, a function that has been localized to the inferior temporal gyrus. They must then associate each number with the English word for that number and contract the oral musculature to say the word for each number aloud, which involves both language comprehension (Wernicke's area) and language production (Broca's area).
Multiple regression analysis including presence of LD and PHLOTE (primary home language other than English) in addition to other covariates had the best model fit, and indicated a 3.3 s longer K–D performance time for those with LD (95% CI 1.9–4.7, p < 0.001) and 2.6 s longer K–D time (95% CI 1.2–4.0, p < 0.001) for those with PHLOTE.
These results suggest caution in using normative data with the K–D test, as these factors may result in false positive findings in the absence of concussion.
Pre-season Concussion Testing in High School Students with Academic Difficulties or Attention Deficit Hyperactivity Disorder
Authors: Herceg M, Wojtowicz M, Iverson G
Publication: Br J Sports Med. 2017; 51(11):A81-82
Tags: ADHD,Learning Disability,
Objective: Learning disabilities and/or ADHD are considered to be important risk factors or modifiers for concussion assessment and management. The purpose of this study was to examine cognition and symptom reporting in high school students with academic difficulties or ADHD and compare to those without at baseline.
Design: Retrospective analysis of three measures routinely given as part of a high school yearly concussion baseline protocol. Setting: The library of a high school in Westchester County, NY.
Participants: A sample of 143 high school students who participate in collision/contact sports [Age M (SD)=15.4 (1.2); Boys=78, 54.5%] completed baseline testing.
Main results: Non-parametric tests were used because of violations of normality. High school students with academic difficulties or ADHD (n=21) were compared to controls (n=122) on King- Devick, SAC, ImPACT Cognitive Composite scores, and Total Symptom ratings. Students with LD or ADHD performed significantly more poorly on King-Devick (p=0.003; d=0.79), Visual Motor Speed Composite of ImPACT (p=0.007; d=0.79), and reported more symptoms at baseline on the Post-Concussion Scale (p=0.005; d=0.59). No significant differences found between groups on SAC (p=0.11; d=0.36) or ImPACT Verbal Memory (p=0.54; d=0.16), Visual Memory (p=0.20; d=0.26), or Reaction Time (p=0.14; d=0.55) Composites.
Conclusions To our knowledge this is the first study to examine performance on three different baseline measures. High school students with academic difficulties or ADHD performed more poorly on King-Devick, the Visual Motor Speed Composite of ImPACT, and reported more symptoms at baseline. Findings suggest these students need to be monitored for specific post injury changes.
High school athletes with learning disability and/or ADHD performed worse on K-D Test at baseline compared to controls.
This highlights the importance of establishing an individual pre-injury baseline for comparison during concussion screening and recovery monitoring.
Additionally, the study supports a prior study demonstrating the eye movements may be impacted by neurological changes associated with ADHD.
Visual Performance Testing in Children and Adolescents with ADHD
Authors: Karbinovskaya Y, Mueller B, Wells J, Baner N, Davies K, Moehringer N, Hasanj L, Leong D, Galetta SL, Jacobs B, Balcer LJ
Publication: Presentation at the American Medical Society for Sports Medicine 2017 Annual Meeting
Tags: ADHD,
Purpose: In the United States, ADHD is estimated to affect 5.4 million children between 6-17 years old. It is the most prevalent pediatric neurodevelopmental disorder. The King-Devick (K-D) test is a vision-based assessment of rapid number naming that requires saccades and visual processing. In sideline testing of young athletes with concussions, the K-D test demonstrated higher score times after a concussive injury as compared to the baseline pre-season scores. ADHD, like concussion and mild TBI, has been linked with visual pathway dysfunction. Our investigation looked at whether children with ADHD scored worse or similar to age-matched controls.
Methods and Study Design: Our prospective study looked at children with ADHD and their age-matched controls in patients diagnosed with ADHD between ages 5-21. Analysis compared K-D scores of patients with ADHD to those scores of student-athlete controls matched for age and gender. Data analysis was done with logistic regression, ROC curves and t-test.
Results: Among 134 participants in this study, ADHD vs. control was significantly associated with higher K-D scores (p<0.001). K-D showed a greater capacity to distinguish ADHD in participants older than 11 years of age when compared to controls. Participants with a diagnosis of ADHD required an average of 14 seconds longer to complete the K-D test compared to controls. Stimulant medication use was not associated with differences in K-D scores within the ADHD group.
Conclusions: This study illustrates that visual pathways might be utilized differently in children and young adults with ADHD compared to controls.
Significance of Findings: Given the difference in baseline K-D scores of patients with ADHD, this study can have implications for assessing concussions. Different baseline norms may be needed in the management of concussions in athletes with ADHD.
Visual pathways might be utilized differently in children and young adults with ADHD compared to controls.
Norms should not be used for sideline concussion screening as variables such as age and ADHD diagnosis can affect performance. Comparison against individual baseline should be used and is supported by the literature.
Caution should be used when considering used of baseline norms in the clinical management of concussion.
Reading Fluency Measures with Single Word Presentation Verses Left-to-Right Reading in Third Grade Students
Authors: Wethe J, Leong D, Talaber A
Publication: Presented at the American Academy of Optometry 2016 Annual Meeting
Objective: Accurate and efficient eye movements are an important aspect to a child's reading performance. Poor readers demonstrate higher rates of eye movement disorders, which may negatively impact reading. Saccadic eye movements direct the eyes to the next word while reading. Single word presentation reading presents each word centered in the screen. The purpose of this study was to measure reading fluency for students using single word presentation reading and traditional left-to-right reading. Methods: In this randomized study, participants (n=22) read 3rd Grade Scholastic Reading Fluency Passages using single word presentation and left-to-right reading. Left-to-right reading was measured by adding the total number of words read correctly in one minute (WCPM). Reading fluency was measured using single word presentation by adjusting the speed of presentation to the maximum speed the student stated words clearly without errors for one minute (WCPM). Students answered three reading comprehension questions following each reading passage. Results: Students achieved significantly higher reading fluency scores when reading with single word presentation compared with left-to-right reading (mean (SD), 154 (47) WCPM vs 125 (46) WCPM, p<0.001, Wilcoxon signed-rank test). Reading comprehension scores were slightly higher when reading with single word presentation verses left-to-right reading (92% (18) vs 88% (17)), however this was not statistically significant (p=0.335). On average, students read 28.8 more words per minute while reading with single word presentation compared with left-to-right reading. Conclusion: This study found that single word presentation reading may be a more efficient method of reading and maintain or improve reading comprehension. Single word presentation technology should be considered as an addition to current reading methods.
Single word presentation reading may be a more efficient method of reading and maintain or improve reading comprehension.
The Effect of the King-Devick Reading Acceleration Program on Reading Fluency and Comprehension in Grade School Students: A Randomized Controlled Trial
Authors: Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D
Objective. The King-Devick Reading Acceleration Program (RAP) is an eye movement training program aimed at improving reading performance for grade school students. King-Devick RAP was implemented in the fall season in the first grade curriculum in order to evaluate its effectiveness on reading performance.
Methods. In this randomized, controlled, cross-over design, study participants (n=134, 76 males) were allocated into treatment and control groups in a two-to-one ratio and underwent eighteen, 20-minute training sessions over six weeks utilizing King-Devick Reading Acceleration Program Software. The treatment group read aloud single, randomized numerical targets zero through nine that were presented in a left to right direction. The control group read aloud single, randomized numeric targets, positioned in the center of the screen which did not change position. The speed of presentation was gradually increased over time as the subject progressed through training. Pre- and post-treatment reading assessments were performed, including the Wechsler Individual Achievement Test Third Edition (WIAT) Reading Fluency and Comprehension Tests and the King-Devick Test.
Results. The treatment group improved significantly compared with the control group in reading fluency (14% vs 11%, p=0.015) and reading comprehension (12% vs 5%, p<0.001). The high needs student subgroup was analyzed as a separate group and consisted of students with an Individualized Educational Plan, enrolled in reading assistance programs, or were English-Language Learners. The high-needs student group (n=25) significantly improved in pre- to post-treatment assessments in both reading fluency (14%, p<0.001) and comprehension (10%, p<0.001).
Conclusion. The K-D RAP program significantly improved reading fluency and comprehension over the course of six weeks of in-school training. This study further supports teaching the physical act of reading in the early education curriculum.
The King-Devick Reading Acceleration Program significantly improved reading fluency and comprehension over the course of 6 weeks (6 hours) of in-school training, which was flexibly incorporated into the daily classroom schedule.
Efficient eye movements are one necessary component of proficient reading that integrate with visual processing, word decoding, and attention span; cognitive processing also contributes to successful reading.
The King-Devick Reading Acceleration Program improves aspects of reading that are not currently addressed in schools.
Based on the positive reading outcomes found in this study and prior studies, there is increasing evidence to support the inclusion of teaching the physical act of reading in the early education curriculum.
Oculomotor Training using King-Devick Remediation Elementary School Reading Fluency Outcomes
Authors: Wethe J, Leong D, PangY, Weil R
Publication: Vis Dev Rehabil. 2015;1(2):130-134
Oculomotor training has been associated with improvements in reading fluency, but the physical act of reading is not typically taught in schools. The purpose of this retrospective study was to examine reading fluency outcomes in elementary students following oculomotor training. Methods: Pre- and post-training Scholastic Reading fluency benchmarks were reviewed for nine students (Grade1 through 4) who had undergone 6-week in-school training using King-Devick (K-D) Remediation software. Results: All students demonstrated improvement in reading fluency scores following training and this was statistically significant (p=0.008, Wilcoxon signed-rank). Conclusion: Findings support prior research that oculomotor training results in improved reading fluency.
Students, grades 1st through 4th participated in 6 weeks of the King-Devick Reading Acceleration Program and underwent pre- and post- standardized reading fluency testing in this pilot
All students improved in reading fluency after the course of the training.
The improvement in reading fluency may be attributed to the rigorous practice of eye movements (saccades) and shifts in visuospatial attention, which are necessary for proficient
Visual Performance Testing in Children with Attention Deficit Hyperactivity Disorder
Authors: Mueller B, Wells J, Baner N, Davies K, Moehringer N, Hasanj L, Leong D, Galetta SL, Balcer LJ
Publication: Neurology Apr 2015, 84 (14 Supplement) P1.330
Tags: ADHD,Youth Athletes,
BACKGROUND: ADHD is the most prevalent pediatric neurodevelopment disorder. In the United States, it is estimated that 5.4 million children 6 and 17 years of age (or 9.5% of U.S. children) have received an ADHD diagnosis. The King-Devick (K-D) test is a vision-based test of rapid number naming that requires saccades and visual processing. In sideline studies of youth and collegiate athletes with concussion, the K-D test consistently demonstrates higher (worse) time scores post-injury compared to pre-season baseline scores. There is growing evidence that, like concussion and mild traumatic brain injury, ADHD may be associated with visual pathway dysfunction.
PURPOSE: Using the King-Devick (K-D) test, a vision-based test of rapid number naming that requires saccades and visual processing. We investigated whether children with ADHD has worse scores compared to similar aged controls.
METHODS: Design: Prospective study of children with ADHD (diagnosed by Conners Scale and NYU pediatric neurologist) and age-matched controls. Participants: Patients diagnosed with ADHD (5-21 years of age) seeking care from the NYU Neurology Faculty Group Practice and Child Study Center. Analyses compared K-D scores of patients with ADHD to those of pre-season baseline scores for student-athletes controls category matched for age and gender. King-Devick Test: a vision-based measure of rapid number naming that varies the spacing between numbers on successive cards.
RESULTS: Among 134 participants in this study, ADHD vs. control status was significantly associated with higher K-D test time scores (p<0.001, logistic regression models, accounting for age). K-D showed a greater capacity to distinguish ADHD vs. control groups in youths older than 11 years of age (ROC curve areas from logistic regression models was, 0.55 for youths ≤11 years of age and 0.79 for youths ≥11 years of age). Patients with ADHD took an average of 14 seconds longer to complete the K-D test, compared to control youth (p<0.001, two-sample t-test). Use of stimulant medications was not associated with differences in K-D time scores within the cohort of patients with ADHD (p > 0.05, best KD trial of ADHD on Rx vs. best KD trial of ADHD off Rx).
CONCLUSIONS: Visual pathways may perform or be utilized differently in youths with ADHD compared to controls. This alteration in visual performance on the K-D test in youths with ADHD is likely due to the widespread distribution of brain pathways devoted to vision (approximately 50% of the brain's circuits). The limited capacity of the K-D to distinguish ADHD in youths younger than 11 years of age may be due to variations in reading ability in this age group. Use of stimulant medication was not associated with altered K-D test performance.
Investigated if there was a difference in the King-Devick Test of rapid number naming in subjects (ages 5-21) with ADHD verses those without.
Subjects with ADHD showed significantly worse K-D scores compared to the controls.
The K-D Test demonstrated a greater capacity to distinguish ADHD vs. control groups in youths older than 11 years of age (ROC curve areas from logistic regression models was, 0.55 for youths ≤11 years of age and 0.79 for youths ≥11 years of age).
Patients with ADHD took an average of 14 seconds longer to complete the K-D test, compared to control youth (p<0.001, two-sample t-test).
ADHD medication was not associated with differences in K-D scores within the cohort.
Since ADHD is a neuro-development disorder and more than 50% of the brain is devoted to vision, the K-D Test highlights aspects of vision which may be affected by ADHD.
Oculomotor Training using KD Remediation Improves Reading Fluency
Authors: Winters B
Publication: Presentation at College of Optometrists in Vision Development 2014 Annual Meeting
The purpose of this study was to determine if adding oculomotor training, using King-Devick (K-D) Remediation software, to an existing high school reading program would improve reading fluency outcomes. In this prospective, single-blinded, cross-over trial, of high school students (n=53) in grades 9 and 10 enrolled in the school's 12-week supplemental reading course, all students received reading intervention using Scholastic's Reading 180 system (New York, NY). Students were randomized by classroom into 3 groups based on their initial training condition (K-D Remediation, Placebo & Scholastic Only) and pre- and post-remediation measures were performed using the K-D Test and Reading Curriculum-Based Measurement (RCBM) reading fluency test. There was a significantly greater percentage improvement in reading fluency scores (WCPM) with combined K-D Remediation compared to reading intervention with Scholastic Only (7.54% vs. 3.59%, p = 0.03). Over the entire training period there was an average increase of 9.88 WCPM during sessions with K-D Remediation, 4.7 WCPM with Scholastic Only and 2.78 WCPM during Placebo. Expected improvement of a successful reading program is an increase of 5 WCPM. In this study, reading intervention coupled with oculomotor training using K-D Remediation, resulted in nearly double the expected reading fluency improvement.
This investigation examined the effect of adding the K-D Reading Acceleration Program (RAP) to the Scholastic Reading 180 reading course for students in grades 9 and 10 receiving supplemental reading
Students who had the addition of K-D RAP to their existing reading intervention saw nearly twice the improvement in reading fluency compared with reading intervention alone.
The greatest improvement occurred in the placebo group after crossing over to K-D RAP
The King-Devick Test as a Reading Fluency Training Program For Students in Elementary Schools
Authors: Allen M, Beatty R, Blanco S, Devick S, Kattouf V, Messner L, Messner S, Pang Y, Tennant A, Richardson LD
Publication: Presented at the American Optometric Association 2012 Annual Meeting
The King-Devick Test is an established eye movement test that has been used historically to detect reading disorders related to poor visual-motor skills. Seventeen students in grades 2-4 from the St. Elizabeth School in Chicago Illinois, a predominantly African American K-8 school, were screened for reading inefficiency using the King-Devick Test (K-D Test) and assessed in reading fluency using the Scholastic Fluency Test pre- and post-treatment. The control group had a mean-word improvement of 13.11 words as compared to a 30.02 mean word improvement in the treatment group (p = 0.0413). A Sub-group analysis of grades 2 and 3 showed a mean word improvement of 31.94 among the treatment group as compared to 13.11 for the placebo group (p = 0.0267). Reading fluency measures significantly improved following eye movement training.
Reading fluency significantly improved following 6 weeks of the King-Devick Reading Acceleration Program for 2nd and 3rd grade
Fourth grade student reading performance improved somewhat, however the improvement was not as drastic as seen for 2nd and 3rd grade students, indicating there is likely an optimal time frame to implement the eye movement training.
Eye movement training programs should be considered as a part of reading curricula in
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Triple-A Scranton snowed out. Game will be made up as part of a May 15th doubleheader.
Double-A Trenton scheduled off day.
High-A Tampa scheduled off day. Apparently that's the only thing that can stop Jose Tabata.
Man, Alex is simply scorchin' the ball this year. After games like that, you wonder how pitchers ever get that guy out.
Bobby [Abreu] taught me so much in big-league camp, that really helped a young kid like me adjust from A-ball, to big-league pitching and just being in that kind of environment.
He's supposedly had some maturity issues in the past, hopefully Bobby knocked some sense into him. How crazy is it to think that of all the great players in big league camp with the Yanks this year, A-Rod was probably the only guy with more physical talent than Tabata.
In other new, it looks like Phil Hughes' site has been shut down; now there's just a message board.
Seriously, check out the box score.
Man, I don't think I've ever seen a line drive homer like the one Elijah Dukes hit. Talk about a laser.
Anyways, in honor of Opening Day, here's the full lineups for all four squads.


One of the crown jewels of the Del Webb communities Sun City Summerlin lies on the foothills of the Spring Mountains above Las Vegas. From its beginning on the plane to the last phase with the panoramic views Sun City Summerlin has something to offer to almost everyone. For the active mature adult it is a singular opportunity. Enjoy your passions...or simply enjoy the surrounds. You can't go wrong in Sun City Summerlin.
The 7800 dwellings are home to more than 15,000 people. Sun City homes range in size from 1000 square feet to more the 3,000. Prices start at $160,000 for the small Sun City condos and go to over $1,000,000 for the largest Sun City homes on premium lots.
Hot, sunny days most of the year ...all you could want. You get to the point where a stormy or cold day is a welcome change. But back to the sun and heat before the bad weather becomes a nuisance. Occasionally cool but pleasant winters to offset the summer heat. Yes it does snow and we do have a freeze...but only in the rare and special years. Winter starts in December and Spring comes in mid February. The rest of the year is mostly summer.
Golf, swimming, dancing, physical fitness facilities, clubs, games, social life and ties to the multiple resources of Las Vegas.
Golf is one of the linchpins of the community. The three courses are well maintained and available to the residents at very low prices. You can get a feel for this by visiting the Sun City Summerlin Community Association Golf site.
There is a chartered club for most things that one could desire. Dance, bridge, mah jongg, chess, tennis, wood working, computers...there is a club for each and every need. Well equipped shops support many hobby groups. See the Sun City Charter Clubs for examples. For the computer nerds try the Sun City Summerlin Computer Club.


Every member of our specialist team is trained to the highest standards, including NVQ Level 2, and registered with CSCS. As such, you can rest assured that our guaranteed roofing services are among the most attentive, comprehensive and robust across the West Midlands and beyond.
To view some of our finished projects for yourself, simply browse our portfolio. We have experience working on both traditional renovation and modern roofing projects throughout Coventry, Warwick, Birmingham and across the UK. Contact our friendly team today to find out more.


Did you ever ask yourself what the results of skin damage are? Well, if you are still young, the damaged inflicted by the sun's rays might not yet be that visible. The reason for this is the gradual manifestation of the accumulated effects of the sun to our skin. For this reason, people only get to be exposed to these terrifying effects for real if they are already forty years old and above. So, even at an early age, gather information on how you will be able to competently defend your skin from the sun.
Let us then take account of these detrimental effects. The most widespread of them all is sunburn. However, other than being extremely uncomfortable and painful for most people, having a sunburn is actually a great risk for having the most malignant type of skin cancer – melanoma. Another negative result is premature aging wherein symptoms accompanying old age occur even before reaching the aforementioned stage. The sun's ultraviolet rays contain free radicals which cause wrinkles, age spots, pigmentation and other signs that make people appear older than they actually are. In addition to this, the skin's dryness and thickening is swiftly becoming obvious. The next negative outcome of the sun, which you might not be familiar with is the immune system's deteriorating function. Without a reliable immune system, we are highly prone to developing various diseases such as skin cancer. And the most feared skin condition brought about by the sun is cancer of the skin which also happens to become the cancer type that has the highest prevalence. Basal cell carcinoma, squamous cell carcinoma and malignant melanoma are its three kinds. The type of skin cancer that most individuals suffer from is basal cell carcinoma. The type of skin cancer that forms from actinic keratosis and is the next most common skin cancer type is the squamous cell carcinoma. Lastly, the most threatening of them all, is the malignant melanoma. It is therefore very important to go to a doctor immediately if unusual skin changes begin to appear.
Therefore, in order avoid this list of negative occurrences, you must know how to protect your skin as early as you can. If you know someone from the younger age brackets, encourage them to do the same.
Always wear sunscreen whether you are outside or you are just staying inside your home. Sunscreens are given a certain score to represent their sun protection factor. A milder sunscreen is available for use when you will not be going outside your house. However, a sunscreen designated with a sun protection factor of fifteen and above is what you will need once you opt to go outside. Do not also fail to remember to choose a sunscreen that protects you from the dangers of both the ultraviolet rays A and B. You will distinguish that it is a broad-spectrum type of sunscreen if the label on the sunscreen reports it protects from both UVA and UVB or if the label indicates titanium oxide or zinc oxide as one of its ingredients. When utilizing sunscreens, apply as much as you can and do not think you are being wasteful because this just might cost you your skin in the end. During the time at which the sun's rays are most damaging – from ten in the morning until three in the afternoon – minimize your activity under the sun. Lastly, wear additional protective clothing such as pants, clothes with sleeves, hats or caps and sunglasses.


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Late Detroit artist featured at BBAC
By: Tiffany Esshaki | Birmingham - Bloomfield Eagle | Published March 5, 2019
Mary Ann Aitken, an artist with roots in the Cass Corridor of Detroit, created this untitled piece that will be featured in her posthumous solo exhibition at the Birmingham Bloomfield Art Center.
Image provided by Hope Brown, PublicCity Public Relations
BIRMINGHAM — Nothing could ever keep artist Mary Ann Aitken from sharing her observant, unique soul with the world, and helping others to do the same. Not even death.
Her spirit is indomitable.
Guests can see for themselves through April 18 at the Birmingham Bloomfield Art Center during a special exhibition of the Detroit native's work. "Mary Ann Aitken: Indomitable Spirit" opens this Friday, featuring her signature impasto-style paintings and drawings.
Aitken was a major figure in the Cass Corridor art scene in the 1980s, and she shared her talent through art therapy in the decades that followed. She exhibited her work around the state, as well as in New York and Berlin. She died in Brooklyn in 2012.
"We are so excited to showcase this important body of work by a Cass Corridor artist," Annie VanGelderen, BBAC president and CEO said in a press release. "Aitken's work demonstrates the rawness and emotional underpinnings of a lifelong artist and art therapist."
Local artist Ed Fraga, winner of the 2009 Kresge Arts in Detroit fellowship for visual arts, was a longtime friend of Aitken's. He said that she asked him to manage the collection of her art when she was gone.
"Mary Ann's art reflects the honesty by which she lived. She painted her surroundings with a depth of feeling rarely seen, and will be remembered for her art as she will for the generosity of her spirit," Fraga said in an email.
Aitken's work is included in the collections of Wayne State University, the Grand Rapids Art Museum, the Flint Institute of Arts and the Detroit Institute of Arts.
"For Mary Ann, painting was her expression, her therapy and her joy. I know she would be thrilled to see people coming to view her work, especially those from her favorite city," her sister, author Maureen Aitken, said in an email.
"Indomitable Spirit" is free and open to the public during the BBAC's regular operating hours. For more information, visit BBArt Center.org.
The Birmingham Bloomfield Art Center is located at 1516 S. Cranbrook Road in Birmingham.
Fillies and films: Museum presents leisure lecture series
Birmingham police to host first-ever kids Bike Rodeo
Residents report Nazi flyers in neighborhoods
Oakland County committee adopts Fair Chance Hiring Policy
Four dead in two Bloomfield Township car accidents
Menards opens in Village at Bloomfield
Birmingham to host master plan drop-in clinic


In his books and speeches, President Trump has often promoted the power of walking away from a deal. And that is what he did in Vietnam today, ending a summit early with the leader of North Korea.
President Trump will hold off raising tariffs on hundreds of billions of dollars in Chinese imports, after what he called "very productive" trade talks in Washington this weekend.
Tariffs had been scheduled to jump from 10 to 25 percent next Saturday. But Trump agreed to postpone that increase in hopes of negotiating a more comprehensive trade agreement.
President Trump declared a national emergency. Then he headed to Florida to spend the weekend at his Mar-a-Lago resort.


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Post-Match Report
Match report: Arsenal 4-0 Chelsea
Josh James 24 Jul 2022
Chelsea -
Sun Jul 24 - 1:00
Camping World Stadium
Florida Cup
Odegaard (36)
Saka (65)
Lokonga (90)
A thoroughly deserved win over Chelsea was the perfect way to round off a successful pre-season tour to the USA.
We looked to take charge of this Florida Cup match from the first whistle, and unsurprisingly it was Gabriel Jesus who put us ahead with his fourth goal of pre-season.
Martin Odegaard and Bukayo Saka added further goals either side of the interval, before Sambi Lokonga ensured we had a scoreline befitting of our performance, with a late fourth.
Playing the third and final game of tour, we looked sharp from the off, creating the first clear chance after just five minutes.
Defending a corner, Gabriel Martinelli nicked the ball on the edge of his own box and sprinted forward on the counter-attack, in a move very reminiscent of his famous goal at Stamford Bridge in January 2020.
This time however he elected to pass to Saka on the overlap, and his shot was saved by Edouard Mendy.
We continued to look the more likely scorers in the opening exchanges. Oleksandr Zinchenko – on his first appearance for us – was getting forward well on the left and had a shot charged down when he found space inside the box.
Shortly afterwards though we did get the goal our pressure merited, and what a finish it was. Granit Xhaka fired a first-time pass into the path of Jesus, who advanced on the keeper and casually dinked the ball over him for the opener.
The second was another well-worked goal. Martinelli held onto possession just long enough for Odegaard to make his run into the box, before slipping the ball into his path. The captain did the rest, sliding his shot low into the corner.
It was one-way traffic in the first half. Thomas Partey was the next to go close, shooting just over from 20 yards out.
Odegaard, Saka and Jesus were beginning to enjoy themselves, with some wonderful one-touch passing and flicks – much to the delight of the vocal Arsenal support in the sell-out 63,000 capacity Camping World Stadium in Florida - a new attendance record for the venue.
Despite our dominance in the opening 45 minutes, Chelsea so nearly pulled one back before the break, but Mason Mount's effort struck the upright.
We kept up the tempo in the second half, and shortly after the hour mark we made it 3-0.
Martinelli drew a diving stop from Mendy on the volley, it fell to Granit Xhaka who flicked the ball up before firing another shot at the Chelsea keeper. But it was third time lucky as Saka thumped home the rebound into the roof of the net.
Mikel Arteta sent on several players to give minutes to the squad late on, and one of those subs, Sambi Lokonga, got in the act in the closing stages with a composed header at the far post, putting the seal on a comfortable win.
At the final whistle we were presented with the Florida Cup, ensuring a memorable 10-day trip to America ended on a high.
The big news before kick-off was the inclusion of Oleksandr Zinchenko, just a day after he completed his transfer from Manchester City. He lined up at left-back, in a strong-looking side for this final game of our USA Tour.
Gabriel Jesus was the other summer signing to start, with Gabriel Martinelli, Martin Odegaard and Bukayo Saka supporting him up front.
Thomas Partey and Granit Xhaka were paired in midfield, Ben White started at right back with William Saliba and Gabriel in the heart of the back four. Aaron Ramsdale started in goal.
The team have flown back home straight after the final whistle, for another week of pre-season training at London Colney before the Emirates Cup against Sevilla next Saturday.
That match kicks off at 12.30pm, and is our last friendly before the Premier League campaign gets underway on Friday, August 5 away to Crystal Palace.


The talk is aimed at introducing Spark from near-low-level details of RDD and jobs that are triggered by actions. It's a deep dive into what happens after a simple spark-shell execution and how Spark distributes tasks amongst executors. It is also going to demonstrate the difference between Spark's local mode and clusters, how stages are created given a Spark user program with Spark shell and UI. It should be as useful for developers as administrators who would like to dig deeper into Apache Spark under the surface of RDD API. The approach is to demonstrate what is behind a simple "spark-shell -master", and learning Spark from another non-API perspective. The talk is a sort of a summary of what I learnt about the architecture of Apache Spark from reviewing Spark's source code and writing the notes at https://jaceklaskowski.gitbooks.io/mastering-apache-spark/.
Jacek is an independent consultant who offers development and training services for Apache Spark (and Scala, sbt with a bit of Hadoop YARN, Apache Kafka, Apache Hive, Apache Mesos, Akka Actors/Stream/HTTP, and Docker). He leads Warsaw Scala Enthusiasts and Warsaw Spark meetups. The latest project is to get in-depth understanding of Apache Spark in https://jaceklaskowski.gitbooks.io/mastering-apache-spark/.


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Merck releases data for three oncology drugs at ESMO Virtual Congress
Mateen Dalal September 21, 2020 Science and Environment
Merck, a renowned pharmaceutical company, also known as MSD except in Canada and the United States, has reportedly unveiled new data regarding three investigational medicines from its expansive and diverse oncology pipeline. The data about the three medicines, MK-6482, which is an oral HIF-2α inhibitor, MK-4830, the first-in-class anti-IL T4 treatment, and MK-7684 (vibostolimab), an anti TIGIT therapy, was presented during the ESMO Virtual Congress 2020.
The data obtained from cohort expansions of the company's Phase 1b trial assessing vibostolimab, as monotherapy as well as in combination with its anti-PD-1 treatment, KEYTRUDA, in patients suffering from metastatic NSCLC (non-small cell lung cancer) as well as Phase 1 trial data for anti-IL therapy MK-4830 for patients diagnosed with solid advanced tumors, showed acceptable safety profiles for both investigational medicines as well as early signs of the anti-tumor activity.
In addition, the Phase 2 late-breaking MK-6482 trial data demonstrated anti-tumor responses for patients with VHL (von Hippel-Lindau) disease with clear cell RCC (renal cell carcinoma) as well as other tumors.
Senior Vice President of early stage development in clinical oncology at Merck Research Laboratories, Dr. Eric H. Rubin stated that the newly released data for all three investigational medicines is promising. The data also signifies continued momentum in the company's consistently expanding oncology pipeline.
Dr. Rubin further added that through the last five years, KEYTRUDA has become fundamental for treating several advanced cancers. The company's extensive oncology portfolio as well as promising pipeline candidates highlight its commitment to bring in new, innovative and effective medicines to the healthcare industry to tackle the unmet medical demand for cancer care.
The company also announced that it would start the Phase 3 trial of Vibostolimab in the patients suffering from NSCLC (Non-Small Cell Lung Cancer) during the first half of 2021.
Source credit: https://www.merck.com/news/merck-presents-promising-new-data-for-three-investigational-medicines-from-diverse-and-expansive-oncology-pipeline-at-esmo-virtual-congress-2020/
Australian telescope maps around 3 million galaxies in record time
Mateen Dalal December 3, 2020
Greenbacker purchases 5.9 MW solar portfolio developed by Ameresco
ISRO confirms GSAT-29 satellite launch in GSLV Mark-Three rocket
Nokia, Vivacom partner to deploy XGS-PON and GPON networks in Bulgaria
Mateen Dalal October 14, 2020