In the run up to the Diabetes Professional Care Conference (Nov 14-15), I had the privilege of gaining insight from one of their esteemed speakers, Anne Cooper, on the importance of Language in diabetes. I hope you enjoy the piece.
When we talk to people with diabetes, language matters. It really matters.
When we talk to people with diabetes, language matters. It really matters. "We" is anybody around those who live with the condition: GPs, nurses, dieticians, employers, family, friends. Language can make us feel great or make us feel worthless; our choice of words might heal old wounds or open fresh ones. Caryn's son knows that from experience, and so too do millions of other people with diabetes around the globe.
"Language creates an environment where people can be more or less resilient," says Anne Cooper, a founding member of the NHS-backed Language Matters working group, who has Type 1 diabetes and helped to develop a new set of recommendations on how to talk to people with the condition. "Labelling influences how you behave – if you're cared for with positive use of language, you can better self manage.
Yet for people with Type 2 diabetes, who make up around 90% of all people with diabetes in the UK and 40% of whom have at least three comorbid chronic diseases, framing the conversation correctly can be a serious force for good in empowering people to make healthy lifestyle changes.
Indeed, as a survey study asking patients about their experience with health care providers at the time of diabetes diagnosis n = 172) showed, reassuring messages from healthcare providers are associated with less diabetes distress and better self-management at 1 to 5 years after diagnosis.
Small changes in the way we talk to or about people with diabetes can have big implications for their health.
It's a curious paradox that as the Western world becomes more prosperous and its population lives longer, some of the most preventable health crises are rapidly escalating. One of the first and foremost among them: childhood obesity.
The stats make for alarming reading: one in three UK children are overweight or obese before they finish primary school. Of these, 40% will become obese adolescents. The vast majority of whom – 75-80% – will become obese adults at severely heightened risk of developing Type 2 diabetes and other health issues.
The causes of child obesity aren't homogenous; hereditary, physiological, social and environmental factors can all play a role. But there's no doubt that ever since the end of WWII in the West, and more recently in developing countries, there's been a surplus of calories in the food we consume. As Susan Jebb, professor of Diet and Population Health at the University of Oxford put it this week, the situation in which food is readily available for most people has arrived in the blink of an eye in evolutionary terms.
Industry appears indifferent. Take Starbucks, for example, which pledged to slash added sugar in its drinks in alignment with the Government's Childhood Obesity Plan. That didn't stop them marketing a "short-sized" hot chocolate for kids with a whopping 20.1g of added sugar – more than the entire recommended daily limit for 4-6 year olds. Starbucks is by no means alone.
So how can we address the problem? If the corporate world is unable or unwilling to step up to the task, we're left with two options: 'hard' measures (regulation), or 'soft' measures (promoting, assisting and allowing healthier choices).
Even the subtlest of nudges can be highly effective in facilitating positive behaviour change. In New Mexico, USA, a simple change in the design of a shopping trolley was shown to help people make better decisions about the food they buy. Researchers marked a line with yellow duct tape across the width of the trolley, and added a sign asking shoppers to place fruit and vegetables in front of the line and everything else behind it. The result was a 102% increase in sales of fruit & vegetables (at no loss of profitability to the retailer).
In Iceland, LazyTown, a popular childrens' TV show, features a healthy superhero motivating children to eat healthily and be active. In partnership with the Icelandic Government, children aged 4-7 were sent a LazyTown "energy contract", signed with their parents, in which they were rewarded for eating healthily, going to bed early and being active. One supermarket chain rebranded all its fruit and vegetables "Sports Candy" – LazyTown's name for healthy food – and saw a consequent 22% increase in sales. Since LazyTown hit the airwaves in 1996, Iceland has become one of the only countries in the world in which child obesity levels have fallen.
There's promise closer to home too. A partnership between LazyTown and the UK Nudge Unit led to the launch of the Change4Life programme, Public Health England's flagship initiative for preventing childhood obesity. This year's Change4Life campaign, encouraging parents to look for '100 calorie snacks, 2 a day max' provides parents with money-off vouchers for healthier snack options including malt loaf, lower-sugar fromage frais, and drinks with no added sugar. A survey of 1001 mums who used the Change4Life Sugar Smart app found 96% of those with children aged 5-11 had reduced their families' sugar intake.
Tesco, the chain which first embraced the behavioural insights approach by removing sweets and chocolate from its checkout aisles, has this month devised another way to nudge people into making healthier choices. Its 'little swaps' basket comparison will be displayed at the front of stores to highlight lower sat fat, salt and sugar alternatives to the most popular childrens' products. The comparison busts the myth that healthier choices cost more too.
In a world in which the next generation is set, for the first time, to be less healthy than the last, that understanding can't come soon enough.
The way we're supported to manage our health is changing, fast. That much was made clear in the NHS Long Term Plan, published last month, which set out a blueprint to make the health service "fit for the future" by combining the latest tech. with a renewed focus on prevention to save an additional half a million lives.
One of the most welcome elements of the Long Term Plan is a pledge to make a comprehensive model of personalised care "business as usual" across the NHS. One-size-fits-all approaches are rarely the most effective when it comes to population health – and will no longer be the norm as health professionals prioritise what matters most to each person when making care decisions, allowing individuals to play a more active role in managing their own health.
The rationale for greater personalisation is clear: more than 40% of people want to be more involved in decisions about their care. Only around half (55%) of adults who live with long term conditions such as diabetes feel they have the knowledge, skills and confidence to manage their own health and wellbeing on a daily basis.
Giving people more of the knowledge, skills and confidence they need to manage their health improves their "patient activation". Individuals with a higher level of activation, typically gauged by Patient Activation Measure (PAM) scores, are more likely to benefit from health interventions, adopt healthy behaviours, and see positive health outcomes and lower costs to their health economies.
Research by the University of Oregon suggests the annual cost differential between a patient who stays high in activation and one who stays low in activation over a 12 month period, once demographics and health status are accounted for, totals $2,000. That's a 31% difference.
For our part, we've learnt at Changing Health that what's absolutely fundamental to improving our service users' activation, shaping healthy lifestyle behaviours and ultimately, preventing Type 2 diabetes at scale, is to make it simple. That means guiding people to fit positive changes – such as aiming for 10,000 steps a day, reducing carbohydrate intake, whatever they need to do – into their own existing routine.
But of course, everyone's routine is different. That's where the psychology is crucial; to facilitate change, you first need to understand which behaviours you're trying to change and what kind of behaviours they are. Helping somebody to avoid an intentional unhealthy behaviour, underpinned by a certain attitude – "I know I shouldn't have that cake at the coffee shop, but I'll burn it off later!" – requires a different approach to helping them break out of a habit – eating lunch on the go each day – because the two behaviours are undertaken at different levels of awareness.
Gaining a thorough understanding of each Changing Health user's own individual behaviours, then offering personalised lifestyle recommendations, is how we make long-term behaviour change sustainable for each person.
The outcomes speak for themselves. In a trial of digital behaviour change programmes for Type 2 diabetes management conducted by the North West London Collaboration of CCGs, a personalised approach increased Changing Health users' PAM scores by an average of 10 points. That equates to a 20% lower risk of hospitalisation and 20% greater medication adherence, alleviating the strain on scarce healthcare resources in an area of the UK with a diabetes population of around 130,000.
As the NHS rolls out this new model of care across the health system, millions of people stand to benefit. Individuals will enjoy a more positive experience with their healthcare provider and improved quality of life. Clinicians will, research suggests, see improved job satisfaction. Health inequalities, meanwhile, are likely to fall as people in areas with greater socioeconomic challenges, who are more likely to live with long term conditions and stand to benefit the most from improving their activation, gain a better understanding of their health. These are exciting times.
Meet the author John Grumitt, Changing Health Chief Executive, on our team page. Attending Diabetes UK Professional Conference 2019? Come and say hello at stand F42, and pick up a white paper on the psychology of lifestyle interventions, personalisation and Type 2 diabetes.
Changing Health lifestyle coach and resident vegan Jadine answers your questions on how to live a healthy, happy lifestyle, free from animal products.
Vegans don't eat any kind of produce that comes from an animal. That includes the obvious ones: meat, fish, poultry, dairy, eggs and honey – and the not so obvious ones: gelatine, milk powder (found in some pizza bases), gummy sweets, some kinds of crisps and vegetable stock contain animal products too.
Instead, vegans live on a plant-based diet, made up of grains (like bread and pasta) pulses (like beans and chickpeas), vegetables, fruit, and nuts. Vegans eat the same kinds of meals as everyone else – from curries and chillis to pizza and pasta – but with a few substitutions in the ingredients.
What kind of benefits will I see?
Weight loss, which decreases your risk of developing cardiovascular disease, high blood pressure or fatty-liver disease too.
Better glycaemic control or in other words, maintaining normal blood sugar levels for more of the time.
Being more aware of what you're eating – If you're working towards cutting out animal products, you usually need to plan ahead, or take a closer look at what's in your food. This is a really important skill to have when you're making lifestyle changes.
So far, so good. But I have Type 2 diabetes. Is it suitable for me?
Yes! In fact, it might even help you manage your diabetes better than any other approach. Clinical trials have shown a low-fat, plant-based diet keeps your blood glucose more balanced than any other diet usually recommended for people with Type 2 diabetes(1).
There's also evidence that compared to meat eaters, vegans have a lower BMI and less fat on the body and around internal organs; they're all factors that help your body regulate its blood glucose properly(2).
Can I eat what I want, as long as it's plant-based?
And remember: being vegan means avoiding animal products as far it's practical to do so. Your health comes first. So never skip meals!
Instead, plan ahead. When you already know what you'll be eating in the week ahead – and with so many places on the high street offering tasty, plant-based meals these days, being avoiding animal products is easy as (plant-based) pie.
Here's one of my favourite vegan recipes – it's healthy, budget-friendly and packed with good stuff.
Serve into bowls, top with avocado & tortilla chips, chilli and coriander – et voila!
The best approach to reversing Type 2 diabetes is a hotly contested subject. While experts agree that sustained weight loss is a fundamental part of the process, the diet a person should adopt to achieve that weight loss, and improve their glycaemic control, is less commonly agreed upon. Some studies have shown promising results for the very-low-calorie-diet approach, while others suggest the Mediterranean diet holds the key to success. What Dr David Unwin discovered in 2013 was that for certain diabetes care patients, a low carb diet may trump all others.
Conventional wisdom at the time was to medicate rather than prevent, with prescribing budgets eaten up by diabetes drugs as diagnoses soared across the UK. Dr Unwin had spent a quarter of a century recommending traditional drug treatment for diabetes care, in line with NHS treatment guidelines.
Then he stumbled upon the low-carb approach. Championed by prominent advocates diabetes.co.uk and others, the diet showed serious promise in improving glycaemic control for people with diabetes. He began recommending it to his patients as an alternative to medication and, so as to fully understand the difficulties his patients may face in sticking to low-carb, also adopted the diet himself.
"Back in 2013, our GP practice had a very 'drug centred' approach to Type 2 diabetes," he says. "Lifestyle medicine was almost unheard of. The partners felt that rather than going on about dietary carbs I should concentrate on seeing properly sick people. This meant the only way forward was to work for free in my own time on a Monday evening. My wife came in to help me staff the surgery.
"After six months, the partners could see my results were beating what they could do with drugs, particularly when the first few patients managed to come off medication. Initially I was unsure about the low carb approach so I joined my patients on the diet and we learnt together, trialling recipes we found on the internet. We even arranged practice based cooking demos.
Diabetes Care That Could Potentially Save NHS Millions!
In 2015/16, Dr Unwin's practice saved £40,000 on drugs. To put that in perspective, if every one of the UK's 7,435 practices were to make an equal saving, the NHS would be £297 million better off each year. So the practice partners were, by then, firmly on side – but challenging official treatment advice across the whole of the health service was another matter entirely.
Dr Unwin was very vocal about his patients' successes with low-carb online and in the press, publishing extensive research into the approach as an alternative to drug therapy. He also developed a peer-reviewed e-learning module for GPs explaining the science behind the low carb approach, its impact on glycaemic control and how to discuss it with patients, which won him the prestigious accolade of NHS Innovator of the Year. Last week, it was chosen by the Royal College of General Practitioners as its Course of the Month for November.
"My generation of doctors was brought up with a deep distrust of 'the media'," he says. "My partners were worried the first time I appeared in The Daily Mail. Despite the risks I feel the internet is democratising medicine – making relevant information so available.
For the next three years, David plans to continue encouraging doctors to promote lifestyle change over medication. "I think the idea of reversing type 2 diabetes or more properly putting it into remission without drugs is probably a valid goal for about 50% of people with diabetes.
"The longest remission in my practice is 9 years. I feel this is such a hopeful message, that there is so much people can do themselves to make a difference by cutting back on the dietary sources of glucose.
Changing Health's behaviour change programme is now available to provide 150,000 people living in Greater Manchester Type 2 diabetes support, as part of a suite of digital resources to help them better manage their condition and live healthier lives.
The NHS England and Innovate UK funded initiative makes diabetes support available from a range of providers any time, anywhere via a one-stop shop web platform, Greater Manchester Diabetes My Way. Users will benefit from digital education on lifestyle and personalised, one-to-one behaviour coaching, delivered by Changing Health, alongside tools for easier sharing of glucose monitoring data and care records with healthcare professionals.
The scheme was launched with the aim of giving people with diabetes all the skills and knowledge they need to play a more active role in managing their condition, by adopting positive diet and exercise habits and learning how to maintain lifestyle changes over the long term.
Type 2 diabetes support in Greater Manchester has in the past been limited to classroom education programmes, which are often inaccessible for those unable to travel or take time off work, or who have learning difficulties. Digital tools overcome these challenges, and in some cases, have been shown to improve uptake of diabetes support by more than 500%.
In addition to improving the support on offer for people with diabetes, the initiative is also likely to deliver significant cost savings for healthcare delivery in Greater Manchester, with fewer complications arising from the condition, fewer hospitalisations and fewer A&E attendances.
John Grumitt, Changing Health Chief Executive, said: "It's great to be selected as one of the Greater Manchester Diabetes My Way providers and build on the evidence that with access to the right support, people with diabetes can make big changes in their lives and manage their condition more effectively.
"Health Secretary Matt Hancock shared his vision last week of delivering more patient-centric care, facilitated by digital tools. Greater Manchester Diabetes My Way will play a key role in making that vision a reality.
"We know that a large proportion of people with Type 2 diabetes want to make a change in their lives – but often, they simply aren't sure how best to go about it. This initiative aims to change that.
Wave 2 of the Innovate UK Test Bed funding programme has agreed a grant of £975,000 towards the £1.2m project cost, with the remainder contributed by the industry partners involved.
Case studies of people who have achieved diabetes remission using digital tools are available.
People with diabetes can't always tell fact from fiction. And with the internet awash with conflicting sources of information on diet, exercise and glycaemic control, it's easy to see why. In the space of just two weeks, the Daily Express alone published or republished 17 clickbait headlines on diabetes, often misleading, and designed to appeal to readers' fears about their health.
Of course, that's not to understate the public health crisis currently facing the nation – a recent estimate by Diabetes UK suggested a record 12.3 million people are now at elevated risk of developing Type 2. But we urgently need to stem this flow of misinformation.
Even the broadsheets can be prone to misrepresenting scientific evidence. The Guardian, for example, ran in August with the headline "No healthy level of alcohol consumption, says major study". That referred to a major mata-analysis of 694 studies to work out how common drinking was, and a further 592 that assessed the health risks, accounting for a total 28 million people and published in The Lancet.
The researchers found that for each extra drink consumed in a day, the harm increased, and that the lowest level of harm was zero drinks – the basis of the Guardian's headline. It isn't, however, that simple.
The study showed that 918 in 100,000 people who consume one drink a day can expect to experience an alcohol-related health issue. Yet 914 of those people will experience such a health issue no matter what, meaning only four in 100,000 do so as a direct result of consuming one drink a day(1). The study also did not account for other factors that may have been the actual cause of harm – drinkers are more likely be poorer and to smoke, for example.
Again, this is not to understate the risks; it's beyond doubt that drinking is detrimental to health. The point, however, is that misleading headlines create a widespread lack of understanding what constitutes an achievable, healthy lifestyle – with significant implications for public health.
Many people are unaware, for example, that consuming carbs, not fats, is what typically leads to weight gain. Another common misconception is that Type 2 diabetes is a sign of having eaten too many sweets, rather than too much bread and pasta.
Peer support groups for diabetes can be tenuous in reliability too. A 2011 study of health social networks, published in the Journal of the American Medical Infomatics Association, found that only 50% were aligned with clinical practice recommendations (n=10).
Users of Changing Health's programme for diabetes management, which combines evidence-based education on diabetes with behaviour change support, consistently tell us they were overwhelmed by the sheer volume of conflicting viewpoints on diet they had found online. Their GPs typically only have the time to hand them a stack of leaflets, and while the NHS website goes some way to helping, there's more that could be done.
We must counter this deluge of misinformation by providing more people with clear, evidence-based guidance and support. If we don't, there's only one likely outcome: incidences of diabetes will continue to rise and with them, the strain on health economies across the nation.
Knowledge and confidence are a potent mix. That much has been made clear this morning, as new research from the Health Foundation shows that if people with long-term conditions were provided personalised support, a staggering 436,000 emergency hospital admissions and 690,000 A&E attendances could be avoided entirely.
The findings confirm the conclusion I reached with Professor Mike Trenell of Newcastle University in 2015: that when people know what to do and they feel they can do it, they can achieve incredible things. It was on that basis that we founded Changing Health, delivering behaviour change programmes for people with Type 2 diabetes.
Many people with Type 2 don't know how to properly manage their condition. There's a wealth of information to take in, with too much misinformation online, and GPs rarely have enough time to give their patients much further guidance than a stack of leaflets.
But if we could give everybody with Type 2 diabetes a comprehensive understanding of diet, exercise and how lifestyle impacts on the condition – and then empower them to act on that understanding – the implications for public health are enormous.
How Would Personalised Support Work?
The Health Foundation report makes a number of recommendations on how to achieve this: primarily health coaching, peer support and greater access to apps. All have been shown to improve patients' PAM (Patient Activation Measure) scores, which predict an individual's engagement with their health and healthcare based on over 400 peer-reviewed studies.
Indeed, a trial of Changing Health's programme in the North West London Collaboration of CCGs found that personalised support for diabetes, including lifestyle coaching and digital education, results in a 10-point PAM increase – enough to boost patients' score by one level (out of a total four).
According to the Health Foundation, if we can give just the lowest ability patients (level 1) the knowledge and the confidence to manage long-term conditions as well as those at level 2, we could prevent 504,000 A&E attendances, and 333,000 emergency admissions per year. That equates to 5% of all emergency attendances, and 6% of all emergency admissions in England each year.
On an individual level, we see this science in action every week as more people with Type 2 diabetes put their condition into remission. Once people know how, for example, complex carbohydrates affect their blood sugars, and they're given a motivational boost on a regular basis, they're often able to cut out the bread and the pasta – and begin reducing their HbA1c. It's simply a matter of providing that support in the first place.
Fortunately, we're seeing increasing recognition among healthcare providers that, as the Health Foundation points out, there's a very broad spectrum of ability and confidence among people to manage long term conditions, and different approaches are needed accordingly. At the same time, technology is enabling the delivery of more personalised support for such conditions, improving patients' self-efficacy in managing them and, as a result, living happier, healthier lives.
For Type 2 diabetes the outlook does, then, look promising. But diagnoses are still rising, and the clock is ticking. We must act fast.
Author Holly Hart, MSc, is a qualified Health Psychologist and one of Changing Health's lifestyle coaches. This article is based on real life case studies, including two users who achieved Type 2 diabetes reversal in 10 weeks between April to June, 2018..
People with Type 2 diabetes usually know they need to make a change, and they have the motivation to do so. But their self-efficacy – that is, their beliefs about their capabilities to succeed – is often low; they perceive significant barriers preventing them from sustaining a healthier lifestyle.
There are, however, some useful techniques to help people with diabetes overcome the barriers to change and translate their motivation into action.
Many people think fresh, "healthy food" is more expensive (it doesn't have to be!), while others may be hampered by a lack of social support – often key to success. Some may worry that eating as a family may require the entire family to change their diet, and some may have been disillusioned by a lack of success when trying to make lifestyle changes in the past.
People with diabetes report that one of their biggest barriers to making the changes they need to is a lack of access to education and information. Those who do receive guidance from their healthcare provider often tell us that there was too much to take in, too quickly, and they ended up with only a limited understanding of how their condition affects them. We tend to provide links to websites and tell people what to search for online instead, so they can learn at their own pace in their own time.
A common misconception we find among people with diabetes is the idea that following a diet means cutting out your favourite food and getting up at 4am for an exercise class. In fact, the simplest lifestyle changes are typically the key to successful management or even remission of diabetes. The inspirational success stories you get to hear as a coach are testament to this approach, and communicating to patients that their lifestyle changes don't need to be radical can transform their outcome expectations.
Debra, a Changing Health user who recently achieved Type 2 diabetes reversal in 10 weeks, did so by making only "little swaps", like pasta for cauliflower rice, so a healthier diet didn't feel like a chore to maintain. It's also important to avoid warning people with diabetes about what will happen if they don't make a change; research has shown this doesn't work.
Instead, we find that listing the benefits of a healthier lifestyle can be much more effective, particularly those which impact the most on everyday life: improved cognition and memory, better concentration, reduced tiredness and feeling less out of breath when walking the dog or taking the children to the park. focusing on past successes (identifying and emphasising previous, successful attempts to initiate lifestyle change) has been linked to optimal care consultations and better clinical outcomes.
Pairing this with discussions about how to overcome barriers that have occurred in the past, or might come up in the future, enables the patient to think more positively about making a change and this positivity is key.
Healthcare providers can also support patients on their journey towards a healthier lifestyle by encouraging them to set clear short, medium and long-term goals. SMART goals – specific, measurable, achievable, realistic and timely – keep patients focussed every step of the way and have been proven to be effective in improving outcomes.
If patients write these goals down, the chances of success are even higher – up to 42%, according to new research. Changing Health coaches suggest users write down their progress so far on post-it notes and leave them in prominent places around the house, boosting their motivation to keep going when times are tough.
Every individual is at a different stage in their behaviour change journey and so it's important to take their unique circumstances into account. Ultimately, it's about re-framing the conversation to focus on their own possibilities of success, rather than the consequences of failure, at every point of contact.
The biggest lesson I've learnt, though, is that while people with diabetes don't often realise that transforming their health can be a straightforward process – once they do, they're bound to surprise you.
Type 2 Diabetes Reversal | How Did She Do It?
Meet Sheinaz. She's a GP Practice Manager in Gateshead, Newcastle, and she was largely sceptical of the power of digital interventions to help people Type 2 diabetes change their lifestyle and better manage their condition. Until she tried one out for herself.
On 13 January 2018, Sheinaz was diagnosed with diabetes. Her GP told her that her HbA1c level, an indicator of blood glucose control, was at 52. That meant her condition was under control – but only just. It was enough to motivate Sheinaz to begin making some big lifestyle changes, and when her GP offered to refer onto the Changing Health programme to help her do so, she accepted – albeit with some reservations about whether it would be of much use.
The programme comprises a course of digital education on diabetes to improve participants' understanding of how diet impacts on their condition, combined with one-to-one lifestyle change coaching from an expert in health psychology and behavioural science.
"I was devastated to hear the diagnosis, absolutely devastated" she says. "I just thought, 'I have a healthy diet, I do all the things I could possibly do, what more can I do?' Going to a group session wasn't really sustainable for me, and the other option was having a health app.
It was a complete change of mindset for Sheinaz – and it paid off. In just ten weeks she had lost 18lb, or a little over 8kg. Then came more good news.
Sheinaz was ecstactic. And six months on from the original diagnosis, she's living a whole new life. "In myself I feel better, my memory's much better… I'm sleeping really really well, bouncing with energy, and bouncing with confidence. I love the diet and I've got so much energy as a result, and I'm still losing up to half a pound per week but I never feel like I'm on a diet.
The Changing Health programme was designed to empower users not only to adopt healthier habits, but crucially, to keep them up – for good. That looks promising for Sheinaz. As of mid-July, she's now lost a total of 24lb and dropped two dress sizes.
In July 2017, Tina C, a Fire Prevention Officer from Northamptonshire, achieved something incredible. She had been diagnosed with Type 2 diabetes two years earlier and needed medications to keep her blood sugars in check day by day. She was feeling lost, was struggling to keep a check on her diet, and things were getting worse.
Then came the call from the BBC. A second series of the hit documentary How to Stay Young was on the cards, and Tina had been selected to participate. If she was up for it, she would embark on a strict, 12-week diet and exercise plan supervised by Changing Health's Professor Mike Trenell, with the aim of reducing her "real body age". She would undergo extensive testing at four, eight and twelve weeks to assess everything from her weight and blood glucose levels to quality of sleep and cognitive function.
Tina accepted. The diet took some serious willpower; calories were reduced to just 800 per day, with each meal logged in the Changing Health app alongside Tina's daily physical activity levels for her lifestyle coach to feed back on. It was a dramatic shift from Tina's normal habits, but she kept it up.
Fast-forward 12 challenging weeks, and there was big news. Watched by millions across the UK on BBC1, Professor Trenell gave Tina the results from her final round of tests. Had she walked in and there and then, Professor Trenell told her, he wouldn't say she has diabetes. He'd say she haddiabetes.
She was gobsmacked. She had taken control of her health and transformed her life. And a year on, she's kept it up. "It's been a difficult year with some big challenges," she says. "Sometimes your mind gets unfocussed, you end up comfort eating – in April I lost my way. It was the first time I'd felt like that, and it disappointed me.
Perhaps the most drastic change in Tina's lifestyle over the past year has been her meal choices. "I used to just load up on carbs, thinking they would fill me up – not realising that carbs actually turn to sugar in your blood! Now I'm eating a lot of vegan meals and plant-based foods… and sugar-free baking has changed my life! I use a lot a cacao in my cake recipes; it's just a matter of getting your taste buds used to it.
"The recipes in the Changing Health app have been really useful too. All kinds of foods I didn't even know about have become staples… Chia seeds, for one, have become a massive part of my life. I have to think of unhealthy foods as evil. I'll allow myself a treat on very special occasions, for example I baked a normal cake for a 40th birthday, and I'm going to have a slice!
Diabetes Professional Care 2017 brought record numbers of delegates to London's Olympia conference venue, with over 3,000 healthcare professionals involved in the prevention, treatment and management of diabetes attending to learn about the latest developments in this area of care.
This November's event looks certain to be an even bigger hit, and Changing Health is for the first time to become an event sponsor as well as an exhibitor. The sponsorship is another major milestone for Changing Health in what will be the company's most eventful 12 months to date.
Changing Health will be presenting new data to inspire healthcare providers and commissioners, showing how personalised support for behaviour change can be highly effective in diabetes prevention and management, helping patients lose weight, lower their HbA1c and significantly reduce complications. The data supports the need for a new, highly personalised approach to diabetes care outlined in the company's first White Paper, published in May.
Now in its fourth year, DPC quickly became a key diary entry for those looking to find new perspectives on diabetes care, according to Event Director Toby Baker. "We were acutely aware at the time that there wasn't an accessible forum which provided free, high-quality, relevant information education to all those who come into contact with people with diabetes and related conditions, not just the specialists.
With almost two thirds of the UK adult population now either overweight or obese, there's universal recognition that something must be done to avert a full-blown public health emergency. Many policymakers, on the recommendation of leading public health experts, are looking first to junk food marketing for dealing with the obesity epidemic.
It's clear that marketing has played a central role in our steady weight gain over the years; Public Health England estimates 40% of food bought in the UK is done so at a discount, increasing overall consumption by 22%. That's more than anywhere else in Europe. Viewers of family TV shows like The Voice see 12 adverts for junk food within an hour.
The Government's role in averting the obesity epidemic, however, is subject to dispute. A number of measures have been floated; alongside the sugar levy, which came into force last month, a cross-party proposal to ban "buy one get one free" offers on junk food is gaining momentum, as is a plan to curb junk food TV advertising before 9pm, while a mandatory traffic light labelling system appears to be almost certain. London mayor Sadiq Khan last week opened consultations on a ban on junk food advertising on London's public transport network.
But free marketeers argue that such "nannying" by the state restricts consumer choice with no benefit to public health. Some even suggest that the rising figures of the obesity epidemic are artificially inflated to justify these "intrusive" policies. "Who benefits from over-egging childhood obesity rates? As usual, powerful people with killjoy aspirations are the most likely to spread bad data far and wide," wrote Kate Andrews of the strongly free-market Institute of Economic Affairs (IEA) in City A.M earlier this month.
Is The Obesity Epidemic Fabricated?
Who are these 'powerful people with killjoy aspirations'? Have Jamie Oliver, Sadiq Khan et al fabricated the obesity epidemic just to spoil the party? Meanwhile, who benefits from suggestions that controlling the marketing of harmful products is detrimental to consumers? For a start, many of the conglomerates that fund the IEA, including, British American Tobacco, Philip Morris and Japan Tobacco International, amongst others, although the organisation is notoriously opaque in this regard. Perhaps understandably.
"Such policy proposals make it harder for adults to live their lives freely," Ms. Andrews continues. Again – questionable. If we can't make 'free choices' without the influence of a marketing campaign, rather than a rational assessment of the facts, aren't they actually quite the opposite?
Controlling junk food marketing more tightly is about limiting the number of times we're prompted (be that a supermarket offer, a daytime TV ad, or a billboard on the tube) to buy unhealthy food we don't need on a whim. The odds of being obese are more than twice as high for young people who report seeing junk food advertising every day. These policy proposals will restrict exposure to such advertising, but they don't curtail our freedom to buy what we want to.
The sugar tax doesn't prevent us from buying six-packs of Coca Cola, but it's shown promise elsewhere in reducing overall sugar consumption; in Mexico, where 70% of the population is overweight or obese, it's already driven a 7.6% fall in sales of sugary drinks. If the trend is replicated in the UK, that's a clear win for public health at very little expense to the everyday consumer.
The obesity epidemic is a multidimensional issue and so must be the approach to reversing current trends. As I argued in a previous Linkedin post, mandating alone will not change behaviour at a national level. A combination of 'hard' legislation, 'soft' nudges and individual and group interventions are all needed to encourage people to make healthier choices.
What's certain is this: we've been bombarded with junk food promotions for decades. We're consuming more calories than ever before, with disastrous results. The only real opposition to the proposed regulations comes from those who stand to lose out on profit. Government should boldly ignore the protests of the corporate lobby and curb the constant and ever-present influences to buy high-calorie, sugary foods. To the benefit of us all.
Personalised care may be the solution, considering that most of us can't exactly make rational decisions about what we eat. We, as a nation, know full well that consuming too much sugar and fat, and too few vegetables and fruit, is detrimental to our wellbeing and longevity. Yet the vast majority of us do it anyway.
The National Diet and Nutrition Survey (NDNS) published by Public Health England in March showed that in 2014-16, adults consumed on average 4.2 portions of fruit & vegetables per day, fewer than PHE's recommendation of 5 per day – to which just 31% of adults adhere. As a result, only one third of the UK population is not overweight.
So why do we make these choices? Information and guidance on nutrition is widely available. The argument that "not everybody can afford to eat healthily" is – at least in 2018 – a myth, as was recently evidenced by Changing Health lifestyle coach Holly Hart in her mission to document an entire week's worth of healthy, tasty cooking for just £20.76.
The answer lies in behavioural psychology. We often make rapid decisions on what to eat based on habitual, social and environmental factors – "it's takeaway Friday"; "everyone's heading to a steakhouse", "I'm hungry, and I'm drive past McDonalds on my way home from work".
Overcoming these psychological factors is not easy. Many people need support to do so. Some face-to-face interventions, such as WeightWatchers and Slimming World, can give people a better understanding of how they could eat more healthily and assist in weight loss, but don't equip people with the repertoire of psychological tools needed to sustain such a change over the long term.
More personalised care, however, can be highly effective in translating motivation into new behaviours that become firmly established over time. Changing Health's team of expert lifestyle coaches, trained in health psychology techniques, help programme users to make this happen.
Coaches devise a unique programme to each user's individual needs, which requires a thorough understanding of that user's current lifestyle habits to identify barriers to change. Open-ended questions and active listening are therefore crucial from the outset.
Setting SMART (Specific, Measurable, Achievable, Relevant, Timely) goals, from skipping takeaway fridays to walking home from work, is key to success. For example, research shows that those who write their goals down, share them with a mentor or friend, and provide regular updates on progress are 33% more likely to achieve them.
Reflecting on and summarising interactions shows users their coach has listened to them and understood, while feedback on performance, social support and prompts and cues are all important for continued motivation.
Personalised interventions have been proven effective in better engaging people with their health and healthcare, and facilitating long-term behavioural change. If they can be adopted at scale, the implications for public health are boundless.
Changing Health's behavioural science white paper will be published on 16 May 2018 at the Primary Care Conference, NEC Birmingham. Meet the author Mark Williams on our About Us page.
Sleep duration and quality are now widely accepted as important factors in the prevention and management of mental health7, cardiovascular,and metabolic conditions including type 2 diabetes1.
Normal sleep is characterised by reduced consciousness, little or no nervous activity and inactivity of nearly all voluntary muscles1. Sleeping for too long, or not enough, poses potential risks of obesity and Type 2 diabetes; optimum sleep should be seven to eight hours each night. There is a 9% relative risk of developing type 2 diabetes for each hour of shorter sleep, and a relative risk of 14% for each hour of longer sleep4.
So do people with Type 2 diabetes get the right amount? Taking a generalised view from available research, the simple answer would be: absolutely not. Sleep impairment is more common in females, but is prevalent among both genders7.
Societal/economic pressures: Shift work, unemployment, etc5.
Master your body and consult a dietician or nutritionist to help guide you through food choices and meal times that match your body clock.
Speak to your employers about your condition and try to work out productive working times that would not impact on your health negatively.
Stick to a sleep schedule as this can help regulate your body clock. There are medications like exogenous melatonin that help in the management of circadian rhythm disorders6. Speak to a sleep specialist if you have problems sticking to a particular bedtime.
Ensure you sleep in a comfortable room (with appropriate bed, pillows and mattress) devoid of distractions.
Brady, E. M. and Hall, A. P. (2016) 'Sleep and type 2 diabetes mellitus', Practical Diabetes, 33(1), pp. 23–26. doi: 10.1002/pdi.1993.
Guest, J. F., Panca, M., Sladkevicius, E., Taheri, S. and Stradling, J. (2014) 'Clinical outcomes and cost-effectiveness of continuous positive airway pressure to manage obstructive sleep apnea in patients with type 2 diabetes in the U.K.', Diabetes Care, 37(5), pp. 1263–1271. doi: 10.2337/dc13-2539.
Merikanto, I., Lahti, T., Puolijoki, H., Vanhala, M., Peltonen, M., Laatikainen, T., Vartiainen, E., Salomaa, V., Kronholm, E. and Partonen, T. (2013) 'Associations of chronotype and sleep with cardiovascular diseases and type 2 diabetes', Chronobiology International, 30(4), pp. 470–477. doi: 10.3109/07420528.2012.741171.
Shan, Z., Ma, H., Xie, M., Yan, P., Guo, Y., Bao, W., Rong, Y., Jackson, C. L., Hu, F. B. and Liu, L. (2015) 'Sleep duration and risk of type 2 diabetes: A meta-analysis of prospective studies', Diabetes Care, 38(3), pp. 529–537. doi: 10.2337/dc14-2073.
Vetter, C., Devore, E. E., Ramin, C. A., Speizer, F. E., Willett, W. C. and Schernhammer, E. S. (2015) 'Mismatch of sleep and work timing and risk of type 2 diabetes', Diabetes Care, 38(9), pp. 1707–1713. doi: 10.2337/dc15-0302.
Wilson, S., Nutt, D., Alford, C., Argyropoulos, S., Baldwin, D., Bateson, A., Britton, T., Crowe, C., Dijk, D.-J., Espie, C., Gringras, P., Hajak, G., Idzikowski, C., Krystal, A., Nash, J., Selsick, H., Sharpley, A. and Wade, A. (2010) 'British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders', Journal of Psychopharmacology, 24(11), pp. 1577–1601. doi: 10.1177/0269881110379307.
Zhu, B., Quinn, L. and Fritschi, C. (2017) 'Relationship and variation of diabetes related symptoms, sleep disturbance and sleep-related impairment in adults with type 2 diabetes', Journal of Advanced Nursing, (October), pp. 689–697. doi: 10.1111/jan.13482.


text:
Canada's allies racing ahead on boosting cybersecurity, PM told
By Alex BoutilierOttawa Bureau Reporter
Fri., Jan. 27, 2017timer3 min. read
OTTAWA—Canada's closest allies are pumping billions into new cybersecurity plans as Ottawa ponders a new approach to defending the country's vital cyber systems and networks.
A 2016 briefing note prepared for Prime Minister Justin Trudeau noted the U.S., U.K., Australia and New Zealand have all updated their cybersecurity strategies, with the U.S. planning to spend $24 billion to bolster the country's defences.
Canada is still operating under a cybersecurity plan devised in 2010. And compared with the updated plans of the other "Five Eyes" countries, Ottawa spends comparatively little to protect the public and private systems that underpin everything from online banking to the government's top-secret network.
The briefing note was prepared by Canada's most senior public servant, Michael Wernick, and obtained under access to information law. In it, Wernick stated that these "allied strategies reflect a fundamental enlargement of cybersecurity issues into policy areas" including research and development, trade and market development, and international relations.
They also emphasize cybersecurity needs to be addressed across all government departments, Wernick wrote.
The Liberals have pledged to revamp Canada's approach to cyberdefence, and recently completed months of public consultations on the issue. The results of that survey have not been made public, but are expected to be released by Public Safety Minister Ralph Goodale sometime this spring.
Scott Bardsley, a spokesperson for Goodale, said that it would premature to talk about what the Liberals' approach to cybersecurity will be.
"When Canada's current cybersecurity strategy was launched over seven years ago, there was no Instagram and Netflix had just launched in Canada," Bardsley noted.
"A lot has changed since then, which is why the prime minister mandated a review of measures to protect Canadians and our critical infrastructure from cyber threats."
Bardsley pointed to $77.4 million committed in the Liberal's first budget to improve the "security of government networks and information technology systems." But that money is spread out over five years, and only $27 million is expected to be spent before 2019.
Australia, Wernick's briefing note states, has committed $227 million for cybersecurity over the next five years. Australian Prime Minister Malcolm Turnbull also appointed a new minister of cybersecurity, as well as an adviser and "cyber ambassador"
In a statement earlier this week, Turnbull called cybersecurity the "new frontier of warfare."
"This is the new frontier of warfare, the new frontier of espionage, it's the new frontier of many threats to Australian families, to governments, to businesses," Turnbull said in a statement.
Turnbull connected the threat directly to allegations that Russia interfered with the 2016 U.S. presidential election. American intelligence officials allege Moscow hacked the emails of several prominent Democratic Party officials and released them through Wikileaks.
In an unclassified report, U.S. spies alleged Russian President Vladimir Putin was personally involved in the hacking campaign, a claim Moscow denies.
The U.S. has proposed $24 billion in spending to enhance their government's cybersecurity, as well as to help private businesses and individuals to protect themselves, the briefing note states. President Donald Trump, who dismissed the recent allegations of Russian hacking as a "witch hunt" and who has professed an admiration for Putin, has said that he will appoint a team within the coming months to "aggressively combat and stop cyberattacks."
Canada spent $780 million between 2001 and 2012 on various cybersecurity initiatives, according to an October 2012 report from the auditor general's office. That same month, the previous Conservative government committed an additional $155 million over five years for the Canadian Cyber Incident Reponse Centre, which assists other levels of government and the private sector in securing their networks.
But it's difficult to say just how much money the federal government spends on cyber defence. Several departments have a mandate to protect Canadian government networks, including the Communications Security Establishment and Shared Services Canada.

redpajama_set_name: RedPajamaCommonCrawl


text:
Pubdate: Mon, 20 Nov 2000
Source: Anchorage Daily News (AK)
Copyright: 2000 The Anchorage Daily News
Contact:  http://www.adn.com/
Author: Mike G. Breaux
MONEY TOPS MORALS IN DRUG WAR
I must respond to Jena-Lee Wright's question ("Are morals worth money?"
Letters, Nov. 17): "Exactly when did we decide to lose our morals in order
to save money?" That's a no-brainer. This country not only lost its morals
to save money, it lost them to make money. Yes, that's why we continue to
spend $15 billion a year to fight the war on drugs. Not only is it immoral
for a government to wage war against its own people, it's immoral to make
money and build our economy on the backs of people who are suffering from
an addiction.
I am not pro-legalization, but I am for decriminalization. I feel people
should not go to jail for simply using drugs. If they commit a real crime
like driving under the influence, robbing to support their habit, etc.,
then by all means they should pay their debt to society. Our criminal
justice system -- oxymoron in itself -- is fair only if you're able to
afford proper defense. In fact, you can get away with murder if you have
enough money. Our political system has become one of the most shameful
losses of morals because of the very same reason: money.
To Jena-Lee Wright, in the immortal words of a certain PTA president of a
local elementary school: Welcome to America.
- -- Mike G. Breaux
MAP posted-by: Keith Brilhart


At this year's National Association of Tower Erector's conference, we were asked to pull out a crystal ball and talk about the future of the wireless industry. Bob Paige, Senior VP of M&A at Vertical Bridge and Clayton Funk, Senior Director at Media Venture Partners and I were led by Craig Lekutis of Wireless Estimator in a wide ranging conversation. Small cell and tower infrastructure deployments, carrier CAPEX spending, FirstNet and its RFP for development of a nationwide public safety network, regulatory headwinds and development of 5G and IoT technologies were all part of the discussion. A link to RCR's video coverage of the panel is included below with these and other insights for 2016.


Does 'The man with the withered hand' (Mk 3:1-6) discuss the issue of warfare on the Sabbath?
In verse Contra Apionem I:212 Josephus confirms Agatharchides's statement, speaking of his Jewish compatriots as 'men who consistently care more for the observance of their laws and for their religion than for their own lives and their country's fate'.
I believe there is a story in the Synoptic gospels that – in its clearest form in Mark – discusses this subject at the beginning of the rebellion against the Romans in 66 CE. It is the story of the man with the withered hand, Mark 3:1-6, Matthew 12:9-14, Luke 6:6-11.
(1) Again he went into the synagogue, and a man was there who had a dry hand. [(2) And they watched him, to see whether he would heal him on the Sabbath, so that they might accuse him.] (3) And he said to the man with the dry hand, "Come into the middle." (4) And he said to them, "Is it permitted on the Sabbath to do good or to injure, to save life or to kill?" But they kept silent. (5) And he looked around at them with anger, grieved at the inflexibility of their heart, and said to the man, "Stretch out your hand." He stretched it out, and his hand was restored. (6) The Pharisees went out, and immediately held counsel with the Herodians against him, how to destroy him.
This translation is based on Nestle-Aland, with some slight changes, for example 'dry' instead of 'withered'. I will discuss below why I have put verse two between square brackets.
At first sight this is a miraculous healing study, but at closer view the central element of the story is the fundamental Sabbath question raised in verse 4: Is it permitted on the Sabbath to do good things or to injure, to save life or to kill? We can reformulate the question as follows: Are we allowed to wound and kill on the Sabbath? Or: Are we allowed to take part in military activity on the Sabbath? These questions necessarily belong to an era with military activity, which in this age is inevitably the war against the Romans (66-70 CE). In contrast to the Maccabean story, this time the issue was raised and settled timely, not after a major bloodshed.
In these circumstances it is not difficult to recognize the man with the withered hand. This man doesn't have a physical problem, but his hand remains dry because it doesn't want to spill blood with the sword it holds – at least not during the Sabbath. This makes Jesus, one of the most prominent rebellion leaders in Galilee, angry because this opinion jeopardizes the military ambitions of the revolutionaries. The 'hardness of heart' of verse 5 in this context is probably better translated as 'inflexibility of heart', because the persons concerned can't give up their Sabbath principles in a war situation of life or death. If the hand was restored to its 'humid' condition after stretching it out, this is simply because the person involved was given a sword again. That the 'hand' problem disappeared at once means that the person involved accepted the sword, that way solving the 'war on Sabbath' problem amongst the Galilean revolutionaries at the beginning of the war against the Romans. This dryness problem was not the problem of a single man but of one of the revolutionary factions, as the plurals (αὐτοῖς/οἱ/αὐτοὺς/αὐτῶν) in verse 3 to 5 indicate. Maybe this story describes the confrontation of Jesus, the most prominent leader of the Galilean rebels, with a strict revolutionary faction that had a negative view on Sabbath warfare. It is their leader whom Jesus urges to come forward to the center of the synagogue (verse 3).
Verse 6 supports this thesis. Would the Pharisees and the Herodians look for a way to destroy Jesus if he had wrought a healing miracle to one pitiable disabled person? I don't think so. The reaction of both groups is political. The Herodian party surely was opposed to the rebellion, and here the Pharisees are mentioned as anti-war in the same breath. The '7/7-war' decision of the revolutionaries was bad news for the anti-war parties and an element of further political polarization. This is why the other parties wanted to eliminate Jesus.
Without verse 2 this pericope is a consistent rebellion story. Verse 2 tries to distract attention away from the original war content of this passage. It changes the political 'warfare on the Sabbath and subsequent deadly opposition' focus to a 'Jesus healing on the Sabbath and his subsequent accusation' focus, putting aside the political/military subject of the story. The accusation theme is introduced prematurely in verse 2, while in my military interpretation (without verse 2) the murderous intentions of the opposing parties naturally appear at the end. The flow of the text is also more natural without verse 2.
Re: Does 'The man with the withered hand' (Mk 3:1-6) discuss the issue of warfare on the Sabbath?
Mark 3.1-6: 1 He entered again into a synagogue; and a man was there whose hand was withered [ἐξηραμμένην]. 2 They were watching Him to see if He would heal him on the Sabbath, so that they might accuse Him. 3 He says to the man with the withered hand, "Get up and come forward!" 4 And He says to them, "Is it lawful to do good or to do harm on the Sabbath, to save a life or to kill?" But they kept silent. 5 After looking around at them with anger, grieved at their hardness of heart, He says to the man, "Stretch out your hand." And he stretched it out, and his hand was restored. 6 The Pharisees went out and immediately began conspiring with the Herodians against Him, as to how they might destroy Him.
1 Kings 13.1-10: 1 Now behold, there came a man of God from Judah to Bethel by the word of Yahweh, while Jeroboam was standing by the altar to burn incense. 2 He cried against the altar by the word of Yahweh, and said, "O altar, altar, thus says Yahweh, 'Behold, a son shall be born to the house of David, Josiah by name; and on you he shall sacrifice the priests of the high places who burn incense on you, and human bones shall be burned on you.'" 3 Then he gave a sign the same day, saying, "This is the sign which Yahweh has spoken, 'Behold, the altar shall be split apart and the ashes which are on it shall be poured out.'" 4 Now when the king heard the saying of the man of God, which he cried against the altar in Bethel, Jeroboam stretched out his hand from the altar, saying, "Seize him." But his hand which he stretched out against him withered up [ἐξηράνθη], so that he could not draw it back to himself. 5 The altar also was split apart and the ashes were poured out from the altar, according to the sign which the man of God had given by the word of Yahweh. 6 The king said to the man of God, "Please entreat Yahweh your God, and pray for me, that my hand may be restored to me." So the man of God entreated Yahweh, and the king's hand was restored to him, and it became as it was before. 7 Then the king said to the man of God, "Come home with me and refresh yourself, and I will give you a reward." 8 But the man of God said to the king, "If you were to give me half your house I would not go with you, nor would I eat bread or drink water in this place. 9 For so it was commanded me by the word of Yahweh, saying, 'You shall eat no bread, nor drink water, nor return by the way which you came.'" 10 So he went another way and did not return by the way which he came to Bethel.
How does this possible link play into your idea, if at all?
I see a similar incapacity of the hand in an atmosphere of violence.
I don't believe that the 'withered hand' pericope in the synoptics is a fulfillment story of 1 Kings 1-10. The elements of the two stories are too different.


You must MAKE, BAKE or CREATE what you sell. You can not be a reseller of goods not produced by you.
Spaces for December are 5' deep x 6' wide.
Tables/Chairs not provided. Space can be set up how you wish.
Table Rental is available at $10 per show. Please specify 6 ft or 4 ft. Limited quantities available.
This application does not guarantee you a spot as all shows are juried. You will be sent an invoice upon your confirmation. Payments can be made via email money transfer or by Visa or Mastercard.
All payments are not refundable unless OTS can not deliver a show date due to unforeseen circumstances. If you can not make a date chosen, you may be able to transfer to another date at the discretion of OTS.
How did you hear about On the Spot Mercer Collective?
If you were referred by a friend, please leave their name in the"Other" box so we can reward them.


Has no minimum for private clients.
Has no minimum for institutional clients.
Wealhouse is a Toronto based global investment firm. We comb the globe for businesses with great long-term growth potential in earnings and free cash flow. We only invest in businesses where we have the opportunity to meet management to discuss some of our checklist questions that we feel are most relevant to our mutual success as potential long-term shareholders. We look for management teams that have the ability to build businesses with loyal customers, employees and shareholders.


text:
Otiocephalus är ett släkte av skalbaggar. Otiocephalus ingår i familjen vivlar.

Kladogram enligt Catalogue of Life:

Källor

Vivlar
Otiocephalus

redpajama_set_name: RedPajamaWikipedia


Love is powerful. You needn't look any further than a mother for proof. This gift book lets a Mama Bear in your life know she's a special breed—the perfect mix of strength and tenderness, tenacity and nurturing.
Hallmark simply knows how to manufacture the best, most heartfelt products. This book is hands down the most wonderful book to share with a sister, a friend, a daughter who also is a Momma Bear for Mother's day or anytime. It's delightful... and so true.
This was a gift for my cousin who has a two year old son.She loved the book and will enjoy sharing it with him. Hallmark books make great gifts!


The Ministry of Industry and Trade has urged Vietnamese firms to verify information of Thai business partners carefully to avoid being swindled.
The ministry said that recently the Trade Counsellor in Thailand received a number of requests from Vietnamese firms asking for assistance in handling frauds they faced when doing business with Thai companies.
Many Vietnamese firms were looking for business partners from Thailand via the Internet and decided to do business and pay deposits without adequately verifying information about them.
After that, they did not receive their ordered products or failed to contact their partners and lost the deposits.
The trade counsellor urged Vietnamese firms to verify information of their Thai partners carefully, especially those with whom they are doing business for the first time.
The information should be verified on official channels or via the trade counsellor.
All Thai businesses must register their information with the Department of Business Department, which is published on the portal: www.dbd.go.th/Applications/cds/.
While negotiating contracts and transactions, Vietnamese firms should ask partners to provide adequate information for verification as well as choose safe payment methods. The contracts must clarify terms for compensation and agencies to resolve any possible dispute that may arise.


text:
California inmates study at first college that is based behind bars
Eric Risberg/AP
Instructor Douglas Arnwine hands back papers with comments to his incarcerated students during a Mount Tamalpais College English class called Cosmopolitan Fictions at San Quentin State Prison on April 12, 2022, in San Quentin, Calif. (AP Photo/Eric Risberg)
Behind a fortress wall and razor wire and a few feet away from California's death row, students at one of the country's most unique colleges discuss the 9/11 attacks and issues of morality, identity and nationalism.
They are students at Mount Tamalpais College at San Quentin State Prison, the first junior college in the country based behind bars. The college was accredited in January by the Western Association of Schools and Colleges after a 19-member commission determined a college program held at San Quentin for more than two decades was providing quality education to its students.
Ted Mitchell, president of the American Council on Education, the umbrella organization for all U.S. higher education institutions said, "This is a profound step forward in prison education."
The college has a $5 million yearly budget and is funded by private donations. The staff is paid and there are also volunteers.
49-year-old Derry Brown said of his English 101 class, "I wish I had learned this way coming up; instead I was in special ed my whole life."
Brown said, "There is joy in learning, that's why I want to continue," he said. "Even when I get out, I'm going back to college."


We are delighted to offer for sale this three bedroomed property located within the popular Tulloch area of Perth, close to many local amenities including schools, shops and leisure facilities. The city centre is only a short bus journey away.
This immaculate property is extremely spacious throughout and the accommodation is over two levels comprising 3 spacious bedrooms with wardrobes, a large lounge, a very large dining kitchen and a stylish modern shower room suite.
Externally there is a fully enclosed garden to the rear with lawn and patio area. To the front is a monoblocked driveway providing off-street parking and a detached garage.
The property benefits from electric central heating, double glazing and fresh, tasteful decoration throughout. There is currently gas supplying the fire in the lounge and the hob in the kitchen.
Living Room13'9" x 13'5" (4.2m x 4.1m).
Kitchen / Dining20'8" x 8'10" (6.3m x 2.7m).
Bedroom 113'7" x 12'2" (4.14m x 3.7m).
Bedroom 212'2" x 8'10" (3.7m x 2.7m).
Bedroom 310'7" x 10'5" (3.23m x 3.18m).
Shower Room6'5" x 5'6" (1.96m x 1.68m).
Garage19'8" x 13'1" (6m x 3.99m).
Property reference PRH180264. The information displayed about this property comprises a property advertisement. OnTheMarket.com makes no warranty as to the accuracy or completeness of the advertisement or any linked or associated information, and OnTheMarket.com has no control over the content. This property advertisement does not constitute property particulars. The information is provided and maintained by Aberdein Considine - Perth. Please contact the selling agent directly to obtain any information which may be available under the terms of The Energy Performance of Buildings (Certificates and Inspections) (England and Wales) Regulations 2007 or the Home Report if in relation to a residential property in Scotland.
We are delighted to bring to the market this well presented 3 BEDROOM SEMI DETACHED VILLA situated in a popular residential area in the village of Almondbank.
Next Home are delighted to bring to the market this deceptively spacious 3 BEDROOM SEMI-DETACHED VILLA quietly tucked away at the end of a cul-de-sac in the popular village of Bridge of Earn.


text:
School threats bill passes Senate 41-0
Thursday, March 22nd 2001, 12:00 am
OKLAHOMA CITY - The state Senate voted unanimously Wednesday for a bill that would allow schools to suspend students for a year for threatening to kill or seriously harming classmates or teachers.
Sen. Kathleen Wilcoxson, a former teacher, is the author of House Bill 1092, which now goes back to the state House for consideration of Senate amendments.
She said some parents and others might think the punishment allowed in the bill is harsh, but that such threats should be taken seriously, just like how airports handle bomb threats.
``I cannot begin to tell you the number of calls I've gotten from school administrators, educators and parents who are concerned about this problem. The fact is it happens more often than we hear about, and students need to know this simply won't be tolerated,'' Wilcoxson, R-Oklahoma City, said.
Current law allows suspension of a student for violation of a school regulation, immorality, possession of an intoxicating beverage or a dangerous weapon or a controlled dangerous substance.
OKLAHOMA CITY - The state Senate voted unanimously Wednesday for a bill that would allow schools to suspend students for a year for threatening to kill or seriously harming classmates


Endeavoring to learn more about who Harkat truly is, Darren and Harkat journey to the Lake of Souls. Facing unending twists, turns, and trials, the two eventually find themselves at the edge of a lake teeming with souls.
With the whole town on their tail, not to mention the vampaneze, Darren, Mr. Crepsley, and Vancha flee. Realizing that they cannot outrun their pursuers, the vampires instead brace themselves for the onslaught and prepare for a deadly battle. Lady Evanna predicted that only one of the hunters would live if they missed their opportunity to kill the Vampaneze Lord. Has their time already run out?
Darren once again struggles against the urge to feed upon the human blood hishealth requires.
Living once again in the human world, Darren is forced to attend high school--despite being 20 years old. On his first day, Darren is shocked to see Debbie, his girlfriend from all those years ago, who is grown up and teaching English. Young adult.
Dead if he loses - damned if he wins. The time has finally come for Darren to face his archenemy, Steve Leopard. One of them will die. The other will become the Lord of the Shadows - and destroy the world.
The amazing manga retelling of Darren Shan's international best-selling vampire saga, with illustrations by Japanese artist Takahiro Arai.


With six star-fighter designs, create a fleet of 30 full-colors and ready to fly starfighters. These starfighters look as great as they fly because of the full-colored, custom-design paper used to create them.
Please note that we were not paid or asked to promote this book. This is a book we purchased for my son and he liked making the flyers! We do however get a commission on the sale if you purchase the product with the link below.
Click to watch the Star Wars Folded Flyers video in Youtube.
Star Wars Folded Flyers is a 60 page instructional book with fun facts about each starship, complete step-by-step folding instructions and six foldable display stands.
Six-Starfighter designs look as great as they fly because they're made from full-color custom-designed paper.


text:
Resort 2018A.L.C.
NEW YORK,June 6, 2017
by Emily Farra
Walking into A.L.C.'s showroom on Madison Square Park, you already know you're not going to see anything fussy. But it's still refreshing to discover a pleated dress that's legitimately cool—not sweet—or a floaty palm-printed skirt effortlessly styled with Nike sneakers. Both pieces speak to the brand's special sauce; Andrea Lieberman's vision is of truly relaxed luxury, clothing that's grown-up but also throw-on-and-go easy.
As a mother of two in Los Angeles, Lieberman knows a thing or two about laid-back style. "Everyone in L.A. always looks like they're going to the gym!" she joked. Her version of athleisure is actually tempting, though, such as Resort's puff-sleeved sweatshirts and a drapey silk tracksuit with gold palm trees embroidered on the back. Lieberman said the '70s was a big influence, specifically "the '70s in Miami," which explained the warm palette, palms, and mesh-like knits. "There's a little Lauryn Hill, too, who has always been a big inspiration for me," she added.
Much of A.L.C.'s appeal does come down to the way Lieberman puts it all together; a mustard turtleneck looked even better with "honey" gauchos, and many looks featured ribbed knits cleverly layered underneath (a smart solution for bone-chilling offices). But her pieces can stand alone, too. The aforementioned pleated frock, which came in a surprising red, green, and black combo, had everything you want in a dress: It was flattering, sexy, and practical for day or night.
A.L.C. Pre-Fall 2020
A.L.C. Spring 2020 Ready-to-Wear
A.L.C. Resort 2020
A.L.C. Fall 2019 Ready-to-Wear
A.L.C. Resort 2019 New York


This is a delicious recipe. Even my 12 year old son liked it.
This soup is good, but it tasted more like carrot soup than potato leek soup. Next time I will use fewer carrots.
Thanks for your comment. And I agree with you – it needs less carrots. I must have been using small carrots when I wrote up the recipe! I have since changed the recipe to 2 carrots, which I think works much better. Thanks again!
Made this tonight. Even my 5 year old ate and loved it. Thanks for sharing!
Used left-over baked potatoes and threw in some fresh chopped parsley.
What if you don't have an immersion blender? Can you let cool slightly and transfer to a traditional blender?
Yes, I would recommend cooling it near completely before transferring the soup to a blender, especially if you're blender container is made of plastic – as I'm sure you've heard how plastics & heat don't mix. Even though the blender container may be BPA free, there are other BP's out there. But if it is a glass blender container, you should only need to cool is part way in order to blend safely.
I have made several vegan leek soups and they always lack something. This was a simple and delicious soup. I think the carrots gave it a better depth of flavour and pulled it away from being too savoury. Even the neighbour child loved tonight's family meal. I'll be passing it on. Thank you!
This is a nice basic recipe thats easy to be creative with. I made a double recipe and added a 1/2 TBS of minced fresh ginger and a clove of garlic while sauteeing the veggies. After cooking I added a few handfulls of fresh baby spinach then hit it with the immersion blender. It became a beautiful green color and at the same time my 87 year old Mom who loved it, had the benefit of barely cooked spinach without much effort on her part. I added some carrots and potatoes in a very small dice that I cooked separately to give it some texture. Thanks so much for posting this recipe.
Wonder how this would be if the leeks were added after the immersion blending to give it a little contrastive color and a bit of standout flavor. Anybody tried it like that?
I bet that would work really nicely, especially in giving some texture to an otherwise puréed soup. Give it a try & let us know!
Great to hear! Mmm fresh parsley would be a great addition. And bean sprouts would add a nice crunchy texture – good thinking!
Going to make this for dinner.. Doesn't mention what to do with the dill!
Onions + garlic = a tasty way to flavour soup AND support your immune system!
hi, i made the soup last night and it was amazing. only one suggestion: if you are using veggie stock, it tends to have a lot of salt in it so don't add salt until after the soup is ready. i had to add more potatoes in order for them to soak up the additional salt. enjoy!
That's a good point! We'll adjust the recipe to make that clear. Thank you!
I'm making this for the second time tonight. Great recipe! Sautéing isn't necessary though. I skipped that step and it turned out fabulous still.
Great! We love hearing how the recipes turned out for people. This would be great for retaining the flavours & textures of the veggies.
Forgot to mention that this is so much better with about a full bulb of garlic.
Wow – all that garlic will surely cure what ails you!
i'm about to make this and I'm not sure when to at the Dill… It's in the list of ingredients but not in the preparation.
Thank you for bringing that to our attention. I updated the recipe with dill included.
Making a double batch of this right now!
Great! We hope you enjoy!
I just made this soup today. I have to admit that it looks good, but I didn't like the flavour. I think it lacks something. I modified the recipe a little bit. I added onions, garlic, celery and fresh parsley and a little more thyme. I felt like it needs something else.
I agree that sometimes I make this soup & it needs additional seasoning. I think it has to do with the type of potatoes used. We tend not to add "enough" onions and garlic because our kids don't really enjoy those flavours, but it sounds like you added some really nice herbs & flavours to make a delicious soup!
Just made this, really yummy! I added the juice of a large lemon, and a bit more fresh sage than the recipe calls for. Delicious. Thanks!
Blending potatoes often turns them into glue – I am surprised no one else has had this problem?
You're right – at certain times of the year (in the fall especially), some varieties are gluey/sticky when you boil them. I remember my grandmother saying that she didn't like making potato salad with some fall potatoes, for this reason.
You can ask your farmer or grocery store clerk if the potatoes you're buying are ok when boiled (I think they are better for roasting if they are the gluey variety of potatoes). This can help avoid the gluey texture in your soup. However, we just add more water when this happens and don't really mind the thickness.
Thanks for bringing this up, as I'm sure that other people have had this issue!
I loved this recipe! I did add bay leaves because I like the flavour in soups, but it was amazing.
Awesome! I agree with you about the bay leaves. Maybe I'll have to add that to the recipe!
Did anybody try to add coconut milk? To make it a bit more creamier? Any other suggestions?
Hi Tanya, adding some of the coconut water should help thin it out a little. As well, when you are mixing the coconut cream & coconut water together, the heat created by mixing should help make the yogurt more smooth & creamy.


text:
Zimbabwe Observer
We tell the Zimbabwe story as it is…
Current struggle has outgrown political parties, Sikhala
5 months ago Editor
Zengeza MP, Honourable Job Sikhala also spokesman of J31M
A top MDC Alliance executive yesterday ruled out the possibility of entering into another South Africa-mediated government of national unity (GNU) and threatened to scale up mass protests to force out President Emmerson Mnangagwa's "corrupt government".
Speaking to NewsDay from his hideout, MDC Alliance vice-chairperson Job Sikhala said: "There are moments and times we must put a stop to all the evil around us. Zimbabwe cannot continue on this self-destructive path imposed on the nation by Mnangagwa's rogue regime."
Sikhala said although the Nelson Chamisa-led MDC Alliance welcomed South African President Cyril Ramaphosa's decision to send envoys to cool down political tension in Zimbabwe, they would resist attempts to force them into a unity government with Zanu PF.
This was in reference to the 2009-13 GNU between Zanu PF and the two MDCs which was facilitated by former South African President Thabo Mbeki on behalf of Sadc.
The opposition claims Zanu PF emerged the main beneficiary of the unity government, although it had lost the presidential race to the late MDC leader Morgan Tsvangirai.
"Any attempt to seek an elite political settlement where the usual political suspects will get into an incestuous political relationship will be totally rejected.
"The current struggle of the masses has outgrown individual and political organisations' narrow interests. People want to be the main stakeholders to the state of affairs. They want a raft of institutional and governance reforms to entrench public interest.
"As long as the attendant issues of the masses are not attended to, democratic expression will be action without end. We have now resolved that the democratic struggle must now be without end until all issues are attended to.
"We are now not going to announce our next move. We will just act without announcement until people's victory. It's now action without ceasing," said Sikhala, who was recently forced into hiding by State security agents who stormed his Chitungwiza home ahead of protests planned for July 31.
He added: "How would a normal government call its citizens terrorists simply because they have called on it to put an end to looting and corruption? Such an arrogant and heartless response requires a response in equal measure from all of us. This is our country and we cannot continue to allow perverse and intolerable behaviour to go unchallenged.
"In terms of Zimbabwe's Constitution, all Executive, Legislative and Judiciary authority is derived from the people. Terrorists and dark forces can only be agents of the rogue regime that are abducting, torturing, sexually assaulting and murdering Zimbabweans who are targeted only for political reasons.
"Rather than for Mnangagwa to end the scourge of corruption and looting, he has unleashed State security elements to abduct, torture, maim and intensify human rights abuses," Sikhala said.
Sikhala's call for mass protests came as South Africa's opposition Economic Freedom Fighters (EFF) leader Julius Malema urged Zimbabweans to stop social media campaigns and confront Mnangagwa's government head-on on the streets.
Speaking at an EFF women's rally yesterday, Malema said Zimbabwean youths should stop fighting from South Africa and London, where most economic and political refugees fled to.
"Why is the youth of Zimbabwe not rising in Zimbabwe and facing death because they are already dead? Our own comrades must stop the hashtag revolution and engage in the real revolution. They supported us during our struggle (against apartheid) and we must support them now," he said.
"Zimbabweans are not cowards, Zimbabweans have fought before. Why is the youth of Zimbabwe fighting through hashtags? Why is the youth of Zimbabwe fighting from South Africa and London? Why are they not occupying borders in Musina? We will support them."
Added Malema: "Mnangagwa has become a pig and he is eating his own children in Zimbabwe. He is no different to (Cyril) Ramaphosa. When they came in, we had hope for change, but things have become worse.
"We are here at mama (Winnie Mandela)'s grave to talk about the rights of women because she was the champion of that. Yet, next door in Zimbabwe, the rights of the people of Zimbabwe are being violated, particularly the rights of women."
Mnangagwa recently ruthlessly clamped down on dissent by arresting political activists and journalists, a move that has received global condemnation, with the United Nations (UN) secretary-general Antonio Guterres warning last week that he was "following developments in Zimbabwe with concern".
The UN boss urged Mnangagwa to protect fundamental rights, particularly the freedoms of opinion and expression and the right to freedom of peaceful assembly and association.
The United Nations Human Rights Commission also slammed increasing cases of human rights abuses in Zimbabwe, with its spokesperson Liz Throssell saying citizens should not be persecuted for protesting peacefully.
But police yesterday said they would not allow any form of protests during the COVID-19 lockdown period.
"Our duty is to maintain peace. Any attempts to incite people to engage in protests during the COVID-19 restriction period will be foiled. People must know that we are in COVID-19 restriction period and we will arrest people for breaching those restrictions.
"People must protect their life from this virus. If they try to grandstand, they will be affected by coronavirus. This disease is real," national police spokesperson Assistant Commissioner Paul Nyathi said.
Zanu PF acting spokesperson Patrick Chinamasa said he would only respond to Malema and Sikhala's threats after reading their statements.
United Kingdom-based political analyst Wilbert Mukori said the opposition should not expect Ramaphosa to talk tough on Mnangagwa as they were fellow comrades.
"President Ramaphosa and Sadc will not talk Mnangagwa and Zanu PF to step down since they have already endorsed the Zanu PF regime as legitimate. Once again, we are where we are. What can be done to move forward? South Africa and Sadc must swallow their pride and acknowledge that the 2009-2013 GNU failed to deliver the desired democratic reforms and to stop Zanu PF rigging elections," Mukori said.
"They must also acknowledge that their endorsement of Zanu PF as the winner of the July 2018 election has left them with no political leverage to force Mnangagwa to step down, a prerequisite for getting the reforms finally implemented.
"President Ramaphosa and Sadc must approach the UN or some such other nation that is not compromised to chart a roadmap to get Zanu PF to step down and then appoint a competent body to implement the reforms."
— News Day
editor@zimbabweobserver.co.za
http://zimbabweobserver.co.za
Tags: MDC A, Sikhala, Wiwa
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