text:
James McAvoy at 5'7″: 'I sometimes get told I'm too short for a role'
I love tall men. I want to climb them. There's nothing better than a lanky-yet-muscular guy above 6'4" who carries himself well. But there's also something to be said for normal-sized dudes and short dudes too. James McAvoy isn't really what I would consider short – he's shorter than average, if "average" is six feet tall, give or take two inches. James is 5'7". He's well built, well proportioned and he's also really handsome and talented. Which makes him just… hot. But Hollywood has given him a little bit of a complex about his height because other people are so obsessed with it. Come on, peeps. We don't want shorter dudes wearing lifts all the time now! James chatted about his height in an interview to promote his latest play – he's starring in Cyrano de Bergerac at the Playhouse Theatre.
James McAvoy revealed he's been turned down for a number of movie roles because of his height. The "X-Men" and "Split" actor, who is 5'7″, told The Telegraph, "As a shorter man, I sometimes get told I'm too short for a role. Or even when I get a role, I'm made to feel like, well, of course, we're going to have to do something about that," the 40-year-old added in reference to an unnamed female co-star who said their on-screen relationship seemed unlikely because of their height difference.
She reportedly questioned McAvoy's casting "because nobody would believe [the character] would be with someone like her."
"That was a kick in the nuts," he admitted "I was like, 'All right, now I've got to pretend that I really like you for eight more weeks. This is going to be really tough, because you're so far up yourself.' It got really interesting, that relationship," McAvoy continued said. "Sometimes you're made to feel like you're not good-looking enough to get a role."
[From Fox News]
I will seriously fight anyone who suggests that this wee Scottish angel is not good looking enough. He's absolutely beautiful! Great face, great smile, gorgeous blue eyes. But I could see how Hollywood – and even British film/TV productions – would still try to "fix" his height. It's a thing – they'll make actors stand on boxes so they'll look slightly taller than their female costars, that kind of thing. And I've heard various tall actresses talk about how important it is for them to have tall costars too. I don't know. I feel like some of it is just standard industry crap, but some of it is just people being mean to James for no reason. Also: interesting blind item about the female costar who bitched about his height. I would say Charlize Theron, but I think she hand-picked James for Atomic Blonde. Angelina Jolie in Wanted? Hm. Jessica Chastain? No, I think she's kind of short too. Anne Hathaway in Becoming Jane? Keira Knightley in Atonement? I NEED TO KNOW.
Photos courtesy of WENN.
84 Responses to "James McAvoy at 5'7″: 'I sometimes get told I'm too short for a role'"
Slowsnow says:
And I love your first two sentences.
Signed: married to a tall man I want to climb.
Ps/ also need to know who the sh*tty actress was. James is a delight in every sense!!!
Please tell me it's not Angeline.
Also, shorter people get less job offers in general than taller folks.
Sucks that things having nothing to do with ability affect that.
BellaBella says:
Not in the movie world tho. Short people rule! Most actors are short.
MariaS says:
Nah, he's been really positive about working with Angelina Jolie. Talked about how understanding she was about how much he farted in the car scenes with her because of all the protein shakes they made him drink.
trace_smiles says:
Well, I got told I was too short for basketball when I was younger and it bummed me out so, I feel his pain 🤷🏻♀
Oh, please. He's too good for anyone who suggests his height is a flaw!
I'm also not even quite 5'2″. 5'7″ still has 5″ on me. I'm a big fan of the shorter guys – my husband is about 5'7″ – 5'8″.
Short people can rest easy because we tend to live longer, so there's at least a trade off, I guess.
runcmc says:
That is SO crappy, I feel awful for him! Both my fiancé and I are 5'7" and I remember when we first met, I thought I didn't like men shorter than 6 ft (since I'm tall-Ish for a woman, and super tall for a woman from my country) but his confidence blew me away.
All that to say: I really hope the movie industry doesn't beat the confidence out of James McAvoy because that's the most attractive trait of all, beyond height or anything else IMO.
Same here! I'm 5'7′ and my husband is 5'8′ (and a half so he claims lol) and I used to only like guys over 6 foot till I met him. I didn't even think twice about his height.
I am 5'7.5 and my boyfriend is like just 5'4….. definitely had to get used to it!
He certainly has every right to feel aggrieved and annoyed, but I do wonder if he knows that's how women are treated, not just in his industry, but in everyday life – about every part of their bodies and personalities.
Too big, too loud, annoying laugh, shouldn't wear that, etc.
Of course, McAvoy is so damn pretty.
Zapp Brannigan says:
Exactly he is employed in an industry where a 29 year old Angelina Jolie played the role of the mother to a 28 year old Colin Farrell, (In Alexander the great) and in "Kinsey," where 59-year-old John Lithgow plays the father of 52-year-old Liam Neeson, Hollywood is about as deep as a puddle.
lucy2 says:
Very good point, and he's done quite well regardless.
Me thinks Christina Ricci (Penelope). I think he got along well with Angelina Jolie.
toro says:
c ricci is shorter than him
Livvers says:
This was my guess. Supposedly she does not have a reputation as a kind person, shall we say. And McAvoy says nothing about his costar being literally taller then him, more that she thought herself 'above' him.
Polly says:
But Penelope literally has a pig snout for a nose. I don't think she would consider that character too good looking to be with someone like him?
I love Penelope. Such a weird, great movie. Bonus Peter Dinklage and Reese Witherspoon.
bub244 says:
Whoever said he isn't good-looking enough for a role needs their eyesight sighted. I'm a few inches taller than him and I think he's very sexy.
He. Is. So. Hot.
I'd hit that all over town, and twice on Sunday.
He's one of my favorite actors! Had no idea he was short, and don't care. I'm 6ft1, hell he can climb me! LOL
I can't remember when I first heard this, but I always thought the reason there were so many men in the 5'6″ to 5'10" range in Hollywood was because it is easier to frame shots between them and their woman costars. I remember seeing behind-the-scenes photos of a Ben Affleck film once and his costar was standing on an applebox just to get her head in frame with him. When McAvoy said this I realized it must have been an erroneous assumption on my part (even thought it seems practical to me!).
Algernon says:
No, you're right. When we shoot commercials, we prefer to match heights of everyone on camera because it's quicker and easier than dealing with a super tall person who sticks out like a sore thumb. I think James's comment is more about this particular costar who made him feel bad, because in general he's a great height for camera.
Ahh I love him!! Atonement is one of his best movies. Love. I'll watch him in anything.
Who is this co-star? How nice he didn't disclose that.
I doubt it is Jessica Chastain. The two of them are good friends. (
Allie says:
I'm not even 5 feet and was always very happy to meet guys who were shorter than 6 feet. I don't want to climb anyone. I want to be able to have conversations with someone without getting neckpain from looking up all the time. Also, a huge difference in height looks just super weird as if you're out with daddy.
This. Neck strain from kissing, heavier weight on top etc.
My husbands my height give or take an inch and he is still heavier weight on top lol
Astrid says:
Yup, totally agree. Neck pain from always looking up. I like men to be nearer to my height
Oh, I want to know. Was he ever in a movie with Kidman? It probably is not Theron, she did want his specifically for Atomic Blonde. Keira loves his ass and is petite herself, so who? Maybe Angelina, thought is she really that much bigger than him?
Valiantly Varnished says:
Keira is the same height as Charlize (5'9"). And Angelina is 5'7". It may not be any of them.
Heh! That's the average height of American leading men. Korean leads are taller than their British and American counterparts. Majority of the Avengers heroes have that height. Add most Star Wars men to that. Tom Cruise, ahem. Jason Statham, Mark Mark. A lot of these Hollywood actors are surprisingly tiny in real life. The thing with McAvoy is that he has such small frame. He is built like a boy. Diego Luna is around 5'10" but he seemed smaller because he has narrow shoulders and a twinky body.
Your cousin Vinny says:
Add to that George Clooney. I once found myself standing next to him and he was suprisingly petite
I was thinking this too – a LOT of Hollywood leading men are considered "short". RDJ is another one, and Sylvester Stallone too.
IMUCU says:
James is one of my favorites…I'm 5'4, my husband is 5'7 and he seems tall enough to me (-:!
SJR says:
McAvoy is Hot! No need to worry about height, he has talent. One of those actors I will watch almost anything because they are in lead role. I first noticed him in Shameless and he really did burst off the screen, right from the start.
I am 5′ 6″ and I admit I have a "type"… 5'9" or taller, dark hair, soft brown eyes, fit, easy going, funny, must have 40 hour a week employment, a kind way to others.
Basically, Keanu Reeves. 🙂
Texas says:
I love shorter men. 5' 10" (which is not short actually, is perfect). But 5' 7" would work to.
Omg James is my forever crush! Also, I love short men. 💁🏻♀
For the actress, Im gonna go out on a limb and suggest Kerry Washington from Last King of Scotland. Apparently it was a tough shoot all around, and very tough subject matter so who knows what went down. I'm not saying Kerry isn't awesome (she is!) but maybe she was suggesting that this woman isn't going to throw her life away for someome so tiny?? Lol Who knows!
Kerry is 5'4″, so I don't know that she'd complain about it?
I'm thinking Savannah is right and it's Anne Hathaway. She's 5′-8″.
(all heights according to google)
Trillian says:
I think that's short. But then, I am from Germany, men tend to be taller here. Living in the US I was often the tallest person in a checkout line (and I am 5'9) and if I had a dollar for every time some guy said "Oh, you're soo tall" ….
Yes. I'm 5'6" and all I get are the "YOURE SO TALL" comments. I'm the literal shortest in my entire extended family- My mom's family immigrated from Austria and she was 5'11". I can't imagine all the comments she got If I get it so much at my height. My poor mom always wore flats and walked hunched over 🙁 my husband is 5'10" by the way, which is the American male average exactly. And he's the shortest of the men when we gather for family events for my side.
Moneypenny says:
You just have to go to the Midwest where everyone is of German, Dutch and Scandinavian descent :). Growing up there at 5'11, I was always a tall woman, but most men were my height or taller!
Turtledove says:
He is one of a handful of actors that I will watch in *anything*. Talented, charismatic and pretty as hell. Who cares how TALL he is? We are talking about movies, actors have been standing on apple crates for as long as film was rolling.
He's great as Lord Asriel in the new adaptation of His Dark Materials.
Yea…but he's about 7'0″ tall….When he stands on his talent….so…there's that!
Lena says:
My vote is Charlize who said that. I saw a promo interview for her new movie bombshell with the other actresses and I was kind of taken aback how kind of aggressively blunt and profane she was. I think she might be socially awkward enough to be the type to say something mean and blunt like that. I know people say she said she picked him but don't they always say how they always wanted to work with such and such and actor once they are doing publicity for the film?
Jadedone says:
Was he a love interest in Atomic blonde? Sorry never saw it.
I could see her saying it, she is pretty blunt, but she was a producer on Atomic Blonde and involved in the casting, it wasn't just promotional talk.
He lives in my neighborhood in London, and when I first moved here and didn't know my way around, I was navigating with my head in my phone. Ran smack into him. He is so damn handsome, who cares about the height?
Lucky you!! I bet his eyes are even bluer in person! Haha
TheRickestRick says:
As I'm 5'8 you'd think I'd like only tall men but I've discovered over the years that there's something about being able to stand eye to eye and chest to chest. I find it so erotic, much more than craning my neck back for eye contact or kissing. So I'm all in for "short" guys, therefore James McAvoy = perfectly delicious!
I'm too short for anything. I wish I had height. Taller people are deemed more attractive (even tho they look average) and tend to have higher salaries too.
anneliser says:
I usually prefer taller guys even though I'm on the short side myself … but JM I would hit like Cyber Monday.
Mee says:
Yeah he's short. YEAH MOST MALE ACTORS ARE SHORT. A friend of mine is an actress, she's 5'7 and often lies about her height…says 5'6 because if the guy is short she gets auto eliminated before she even auditions.
I am 5'7″ and I find that I am taller than a lot of people even though I'm not that tall. I personally prefer men to be taller than me. It's not them, it's me, for real. I am big boned woman with big boobs and broad shoulders. I want a bigger partner. I've been with shorter dudes and very thin dudes and it just makes me too self conscious because of my own size insecurities. Those personal issues simply aren't there with a big tall man.
I would of course make some hypothetical exceptions, including James McAvoy and this gorgeous doctor I work with who happens to be a Marine vet, a successful GI surgeon, and is roughly 5'5″. Hot is hot in the abstract.
I'm big boned w big boobs as well but I'm 5 ft 6 in. My 6 ft tall 240 lbs husband makes me feel petite and has no problem with my build. After dating guys who wanted me to be so thin, it is a pleasant change.
10KTurtle says:
I'm obsessed with IMDB trivia, and based on the heights listed in all their pages almost everyone in Hollywood is under 6ft. My friend and I joke that we could totally "Godzilla the red carpet" because I'm 5'10" and she's 6'0".
Side note: I hate being taller than everyone all the time, but at the same time I get a weird anxiety when I am around people taller than me because it happens so seldom. I would love to meet a guy the same height as me or a little shorter who likes me, but men don't like taller women (no matter what they all say).
megs283 says:
I'm 5'11" and my husband is slightly shorter than me. In my single days, I used to get SSOOOOO MADDDD seeing a short woman with a tall man. Glad those rage-filled moments are over!
I dated two guys who were taller than me. They were tall, but they certainly weren't right for me…
I wouldn't say I get mad, because personal preference is personal preference and I was never particularly looking for a tall person myself. I'd settle for a nonsmoker who graduated from high school and doesn't send me unsolicited d*ck pics at this point… I think anybody is lucky these days to find someone you like who likes you back at the same time.
What is it w tall guys being w short women? Very rarely do you see a tall man with a tall woman!
I'm sorry that's been your experience, Turtle. I'm 5'10" and as a teenager found it absolutely mortifying. Then I came to terms with it, and now I actually really like it – to the point i'll happily wear heels, even if they put me higher than my 6'0" boyfriend! I totally get the feeling though, I spent so many years slouching so as not to tower over boys. The ones who make you feel bad for it aren't worth it, and my boyfriend now loves my long legs 😉
YES to tall men. I often say I want to climb tall men too lol! I am 5'7" so I an not short for a woman but I am not supermodel height either. I don't think I could date someone my height or shorter. I enjoy tall men.
Note: When I was in NYC last month to see Tom Hiddleston in Betrayal, Alexander Skarsgard walked past me on the street. First off – my GOD that man is beautiful in person. And second he is a GIANT. 6'4" tall Swede. And then later that night I saw another tall drink of water – Tom Hiddleston- who is tall and lovely and was super nice and gave me an autograph and picture. And also very handsome. It was a good day.
5'7″ too, and I too like tall guys, but I wouldn't be opposed to dating someone my height or slightly shorter, if I liked them.
I am SOOOOO jealous you saw Alexander in person.
Wow, I'm so jealous
bekindbekindbekind says:
A friend filmed scenes with Tom Cruise while standing in a trench so TC would be taller.
It all depends on your value to Hollywood. If they want you, they'll do anything to make you look any number of ways. If they don't, they'll find an excuse to reject you.
ETA – This is no disrespect to McAvoy. Hollywood has many levels of "want." McAvoy is a respected talent. TC is an A++++ superstar. God knows why at this point.
msd says:
Exactly. Hollywood is full of short movie stars. Most of the male ones are shorter than they look and the film business is kinder to short men than tall women, or women in general. It's a business built on looks but you can be sure McAvoy gets nowhere near the amount of judgment on height/weight/looks than his female co-stars.
Went to see this beauty of a man last week at the Playhouse Theatre in London and he is absolutely gorgeous, ladies. Also, got a chance to compare our height after the play as he was signing posters and taking selfies with the fans outside the theatre – what can I say, his 5'7″ match mine 5'5″ quite perfectly :-)))
Eugh says:
Lol anytime I read an IMDb height I also subtract 2 inches for reality. Glad this scientific observation backs up my logic!
No Doubt says:
I'm tall for a woman…5'8″ to be exact so I need a tall man. The taller the better! I would happily make an exception for him and Shia Lebeouf though haha!
I actually prefer men close to my height, but as I'm 5'11" that means they're pretty tall anyway. I once dated a guy who was 6'6″ and it was too big of a difference, I felt like a child around him and I did not find it sexy at all. One – three inches taller is the sweet spot. Never understood the desire to feel dainty or delicate around a guy, but I was lucky enough to grow up in a place (Hawaii) where both men and women are pretty tall and there were always a lot of guys who were much bigger than me so I was never made to feel insecure about my height.
Ignoto says:
The first person that came to mind was Rebecca Hall. She's 5' 10". They were in the film "Starter for 10" and their height difference was noticeable.
Normades says:
I think this is the best guess. Anne is a try hard but she seems pretty professional and her colleagues all seem to like her. Also her husband isn't very tall Charlize picked him for the role and the other actresses are all on the shorter side.
So I'm voting for Rebecca too.
I'm starting to think it was Anne Hathaway
Sloth says:
I have been reading this blog for years, and have come close to cracking and commenting, but this is the article I could not resist! I'm a sucker for James McAvoy and love a good mystery. Becoming Jane was filmed in the aforementioned 8 weeks, which to me is a bit of an Easter egg. There seems to be no documented interaction between the two aside from in the film. When asked about working with each other, their responses seem careful and sometimes tepid from a few interviews I've skimmed – James admitted in one that they clashed 'creatively', whereas hers were characteristically grandiose although she said when she first met him she minimized him as just 'a lovely young man' (despite him being older, thus kinda coming across as patronizing). She's 5″8, so at least marginally taller. At that time she was also in the midst of what I consider to be her slightly smug – and affected saccharine – phase…
Whereas Charlize is indeed taller and notoriously does not mince her words, she presumably had veto power as the driving star and co-producer of Atomic Blonde, and her relationship with James seems more in line to the relationship he presents with Jennifer Lawrence.
And that concludes my 15-minute investigation/15-minute exercise in procrastination 😛
Jesma says:
I wonder is Anne usually has taller costars than James. IMHO he is better looking than Anne anyways.
Xpresson says:
I read something about this years ago. It is Anne Hathaway. They didn't get on that well on set. The article mentioned something about him not being tall etc. James was not that well known yet so I'm not surprised that Anne wasn't too keen on him. Anyway…. yeah it was Hathaway
I'm 5'1 and my man is 6'1. I usually preferred shorter guys but you can't fight love.
I'd tap McAvoy in a second. That actress is crazy.
Highland Fashionista says:
Well, I'm 5'11, so from where I'm sitting you ARE too short for the role. LOVE YOU.
They could just cast short actresses with him. Someone like Emilia Clarke, maybe.
I'm with you on the height thing. I can accurately recognize 6'4 from 2 blocks away. And I've only once ever dated below 6'2 but ever since Wanted I've said James could sooo get it. Also, is that Fassbender with him?
Perthgirl says:
Rebecca Hall from Starter for Ten is very tall. The one who Sam Mended had an affair with. Would make sense as her and McAvoy were both starting out then.
Alaska says:
Why would women be interested in big guys? Hmm, I wonder.


Technology Time: What is Linux?
• The table of processes.
• The management of the multitasking- and multi-user capability.
• The management of the mass-storage systems.
• The hardware-drivers for printers, modems, etc.
However, Linux is far more than only the Kernel. Linux is a complete operating system that was developed over the years by many people. This is completed by applications like the XFree86™, the X Windows System for PC based computers, the word processing and layout application TEX or the StarOffice™, and (of course) games. The development of the Kernel is still coordinated by Linus Torvalds. He implements every change of the Kernel by himself. The special quality of Linux is the fact, that Linux basically is a free system. Therefore, many developers that were keen about the idea of free software, worked on Linux over the years for free.
The name "Linux" comes from the Linux kernel, originally written in 1991 by Linus Torvalds. The rest of the system, including utilities and libraries, usually comes from the GNU operating system announced in 1983 by Richard Stallman. The GNU contribution is the basis for the alternative name GNU/Linux.
"home directory" with his files; no user could access files of other users. That was elementary for a multi-user operating system. Multi- user operating systems were needed urgently because many people had to share one mainframe computer. Ken Thompson developed the UNIX system for his employer, the Bell Laboratories. Bell Laboratories is a 100% subsidiary company of AT&T. The Bell Laboratories gave the documentation for UNIX and the source code for nearly the cost price to universities. Besides, AT&T was doomed in an Antitrust-procedure in 1956 to give away licenses on all his patents. Therefore, many different UNIX systems came into being. These systems are all UNIX-systems but differ in details.
The Common UNIX Printing System ("CUPS") is a portable printing system for UNIX-Systems. It is developed by Easy Software Products. It is going to replace the old Line printer daemon ("LPD") and to become the new standard printing system on Linux/UNIX. CUPS is based on IPP (Internet Printing Protocol), an extension of the Hyper Text Transfer Protocol (HTTP), and gives you the opportunity of the full control over every printer in your network. IPP is designed to provide remote printing services and is very close to become the standard network printing system on all operating systems. Also, Windows 2000 is going to support IPP as network printing protocol.
Besides IPP, smb, socket, serial, parallel and USB (Universal Serial Bus), CUPS also supports the old LPD/LPR system, wherefore you can use the LPR/LPD command set to work with your printers, if you have to. CUPS is designed to be compatible with it but some tools like Berkeleys lpc can be used for system control only. The CUPS software can be used either as server (in most cases) or as client, so there is no need to have different software for each purpose.
CUPS is designed to use PPD files (PostScript Printer Description) to make printers work with UNIX. The server generates its own driver for each printer from a given PPD file to make it available in your network. No additional driver for your clients is needed. In most cases, PPD files designed for Windows NT will work fine without any changes. CUPS is provided under the GNU GPL (General Public License) and the CUPS API's (Application Programming Interface) are provided under the GNU LGPL, so it may be used in commercial applications.
You can use a variety of tools to administer printers in CUPS. Some are special to your distribution, some are free and some are commercial. We tested CUPS mostly on a PC running SuSE Linux.We cannot say much about the use of CUPS with any other Linux distribution like RedHat or Linux Mandrake, but it should be very similar on any other system.
AS mentioned before, the ESP web interface is included in any CUPS version. You can use it for printer administration and job management. To show this example, we used the web interface provided by CUPS. It is accessible via Port 631, the standard port for IPP and CUPS. It is no problem if you have CUPS and other servers on the same machine while using this port.
If your printer does not appear in this list, please make sure that there is a PPD file for it in this location. If it is not, get one and just copy it to this location.
The last one does not work on every system, but in SuSE Linux it does. You need to be logged in as root to do that (or use the "Speruser" command SU).


A new report from CBN reveals that an al-Qaida publication is advising would-be terrorists how best to start forest fires to burn America.
It includes pictures, diagrams, explanations on how to start fires to obtain the most damage.
The report noted fire Battalion Chief Jane Hutchinson said the ideas were not farfetched.
The article also provides information on how to use guns.
Wrote Stakelbeck, "Al-Qaida loves publicity of any kind, and the fact that Inspire is in the news and making headlines surely galvanizes them and makes them think they are having an impact. In a perfect world, I and others would just ignore Inspire," he wrote.


text:
Q: Converting an LWP::UserAgent from Perl to Ruby I am trying to add a User-Agent to the header in my HTTP request (in Ruby), but am unsure of the format of the user-agent string. here is how it is defined in Perl:
use LWP::UserAgent;
my $ua = new LWP::UserAgent(keep_alive=>1);
$ua->credentials($netloc, '', "$user", "$pwd");

If I try to print $ua;, I get a hash which changes every time. I believe that in Ruby I should have the credentials embedded into a single string. How can I know how to format this string? Or, How can I successfully print the contents of $ua in Perl?
Ruby code:
http = Net::HTTP.new("your.site.com", 80)
req = Net::HTTP::Get.new("/path/to/the/page.html", {'User-Agent' => 'your_agent_here'})
response = http.request(req)

A: Your Perl example does not show you setting the User-Agent header (using the agent method). That's the header that identifies the software performing the transaction. You are adding Basic Auth credentials in the Perl example, which is how the user demonstrates they are allowed to access the resource. They are completely different things.
When you print $ua, you are seeing the memory address of the object, like LWP::UserAgent=HASH(0x7fa9db00b1b0).
If you want to set the User-Agent string in the Ruby example, fill in the string you want.
If you want to supply the username and password for Basic Authorization, see the example in the Net::HTTP docs:
uri = URI('http://example.com/index.html?key=value')

req = Net::HTTP::Get.new(uri)
req.basic_auth 'user', 'pass'

res = Net::HTTP.start(uri.hostname, uri.port) {|http|
  http.request(req)
}
puts res.body

redpajama_set_name: RedPajamaStackExchange


Hotel Gregory is located at a quiet street of a residential Vinohrady-district just about 10 minutes walk far from Wenceslsas square. The underground station is Dejvicka in the line A until the station Namesti Miru.
Hotel Gregory capacity is 24 beds in the apartments with three or four beds in each apartment. Spacious two-room apartments have their own bathroom with bath and separate toilet, television set with satelite programs, tea and coffee making facilities, safe and kitchenette.
The hotel offers rich buffet style breakfast.
Hotel Gregory provides the reception area, with 24-hour service, offers drinks, toilet articles, exchange services, sales of coach tours and trips, taxi orders, free safe deposit storage, Wi-Fi and other services.
Hotel Gregory offers fax and photocopy services to its business guests.


Nurses work hard in an extensive variety of capacities, and the work of nursing can be taxing – both physically and mentally. As a nurse, you have the right (some may even say the responsibility) to look after yourself and take your self-care to the next level in order to provide care for others.
Read on to see how mindfulness can positively affect how you feel and how you cope with the pressures at work, allowing you to improve your nurse-service user relationship and take better care of yourself.
Self-care is a primary part of any nurse's mental wellbeing, because it sets the stage for mindfulness. However, self-care can mean very different things from individual to individual; for some nurses, some time at the church is a balm for the soul, whilst others enjoy hiking or some fresh air in the countryside.
Generally, self-care means seeing to your own needs, taking care of your issues, making sure that you're eating properly, and so on. In other words, self-care means taking time out for yourself to make sure that you're healthy – and it's important because nurses must first look after themselves before they can look after others.
Mindfulness is a way of living with greater attention and intention. Nurses can find themselves living on 'autopilot' mode, meaning their bodies operate in a routine pattern whilst their minds go about the job at hand. This 'mindless' way of living can limit how they experience life, affecting the choices they make, the chances they take, and exacerbating stress.
The mind of a nurse is busy. It's constantly processing memories and care plans and rehashing past events. At the same time, it must also respond to all the challenges that the work environment poses – an endless stream of information that increases distraction and stress. That's why nurses are advised to practice mindfulness to help them feel calm and clear-headed, and bring their awareness to the present.
How Can It Benefit Your Nurse-Service User Relationship?
Firstly, greater awareness and less susceptibility to distractions will improve your assessment skills and reduce the risk of errors when carrying out technical procedures. In addition, mindfulness can also enhance your communication with service users and fellow healthcare professionals by ensuring you listen and respond with greater attention.
For you to start looking after yourself as a nurse, you need to first recognise that there's a deficit – then formulate a self-care plan, and take action in the interest of your health and wellbeing. Just don't forget to evaluate and adjust your plan on an ongoing basis – like how you would for your service users!
A job in nursing is hard enough without a self-care deficit, so start practicing mindfulness and put your own health and wellbeing on the top of your priority list – you've earned it! If you need more tips on making the most of your nursing experience, take a look at these time-saving tips for nurses.


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Employers struggle with absence levels due to 'secret' carers
More than one in three employers report that absence levels have increased because their staff are struggling to cope with their caring responsibilities outside of work. But, new figures from the CIPD, the professional body for HR and people development, show that just one in six organisations have policies in place to help achieve a better balance between their home and working lives.
The annual CIPD/Simplyhealth Absence Management survey shows that savvy employers put policies in place to help staff fulfil their caring responsibilities outside of work while continuing to meet the demands of their job. Flexible working arrangements are by far the most common type of support (68%), followed by compassionate leave (53%) and (paid or unpaid) carers' leave (48%). Two-fifths (42%) offer access to counselling services and three in ten offer career breaks and sabbaticals. One in six organisations offer access to financial services (17%) or options to purchase additional annual leave days (15%). Although only one in six employers say they have organisation wide policies or guidelines in place for carers, an additional two fifths report that they do offer support to individuals on an ad hoc basis. The CIPD is now calling on more businesses to adopt a formal policy to support workers, and ultimately benefit business.
Supporting those with caring responsibilities to balance their work and home lives, and therefore retaining our talent, is a key issue. Recent UKCES research has predicted that there will be four generations working side-by-side by 2030. With this 4G UK workforce, employers are having to manage an increasingly diverse range of employee needs. We're seeing intergenerational issues coming to the fore; and in particular, a rise in the number of people with caring responsibilities. And this is an issue that is set to increase for the growing 'sandwich generation.' As people have children later, and are looking after parents in the ageing baby boomer generation, they find themselves caring for both their children and their older relatives.
"It's therefore absolutely vital that employers have strong wellbeing policies in place, and communicate the benefits of flexible working to their employees, who all have the right to request to work flexibly under new legislation. But most importantly, line managers need to receive adequate training on how to have constructive discussions with their staff about the various benefits available to them. And it's proven that flexible working can improve engagement and productivity within the workforce. With this in mind, hopefully in the future more workers will be able to handle the demands of caring.
Dr. Jill Miller, CIPD Research Adviser
Other findings from the survey show that overall absence levels have dropped from 7.6 days per year to 6.6 (public sector: 7.9, private sector: 5.5, voluntary sector: 7.4). However, findings also show that there has been a significant rise in the number of employees still attending work whilst sick, a trend called 'presenteeism,' with a third of employers revealing employees have been struggling in to work whilst sick. Stress and mental health problems in the workplace also remain high, with over 40% of employers citing an increase, despite signs of economic recovery. 70% also stated that they believe absence levels can be reduced further, signalling a need for an overhaul of wellbeing policies.
On the face of it these figures look positive as overall absence levels have dropped by a whole day. Yet it's clear that there are underlying deeper issues, with many employers telling us that employees are still struggling into work whilst sick, whilst others are struggling to manage work with home responsibilities. These pressures can have an extremely negative impact on the workforce. It's important that employers address this presenteeism, in particular looking at managing workloads, so that when people are off sick they feel they can stay at home and recuperate before coming back to work.
Dr. Jill Miller
Adapting both working practices and health and wellbeing initiatives to support the changing needs of today's modern workforce is a must for organisations. The expectation that employees conform to rigid working patterns is becoming a thing of the past as demands on an individual's time continue to increase. This 'sandwich' generation are operating at capacity and it's essential that they receive as much support as possible to help them meet their commitments at home as well as at work. Although it's great to see that this year a fifth of organisations have increased their wellbeing spend, it needn't cost the earth. Understanding the issues affecting your employees and equipping line management with the tools they need to help support them is key to a healthy, happy workforce.
Corinne Williams, Head of HR at Simplyhealth
3 million people are juggling work with caring for an older or disabled loved one. Without the right policies in the workplace and the support of good quality, flexible and affordable care services, these employees often feel unable to juggle it all, with millions feeling they have no alternative but to give up work to care. We estimate this costs business £3.5 billion a year, with extra costs to the economy and to the families themselves in lost earnings and pensions.
Emily Holzhausen, Director of Policy at Carers UK
CIPD/Simplyhealth Absence Management Survey 2014
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From the first class that began studying in the annex of the First Christian Reformed Church in Waupun to the current students attending CWC, all of you have shared in the CWC Experience. As alumni of Central Wisconsin Christian, our goal is to continue to stay in touch with you during your journey through life after CWC. Whether it's planning for a reunion, spreading the news about your latest job promotion, giving you a tour of "your school", connecting you to alumni in your area, or whatever else your needs may be, the Advancement Office is here to partner with and serve you.
Please use the links provided to update your contact information, submit alumni news, find out about upcoming class reunions, and request transcripts.


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HomeImproving procedure efficiency with the Waqar-Malosa Intravitreal Injection Guide
Oral Presentation at EuRetina Annual Congress 2020
Can use of an intravitreal injection guide improve procedure efficiency compared to standard technique of injection delivery?
Various intravitreal injection devices are available commercially. Data has been published previously on safety profiles and patient comfort, but none to date on their effect on procedure efficiency and patient pathway. This study is a time and motion analysis on the use of an injection guide by an experienced ophthalmic nurse practitioner.
In this prospective single-centre study, 43 consecutive patients received an intravitreal injection first by standard injection technique, with next injection delivered using an Intravitreal Injection Guide. All injections were performed by same experienced ophthalmic nurse practitioner. Primary outcomes were total patient time in procedure room and total procedure time. Data was also collected on complication rates, medication used, laterality and patient demographics.
Use of the injection guide showed a statistically significant decrease in mean total time in procedure room of 41.7 seconds (P < 0.001, 95% CI 19.7;63.8), and in mean procedure time of 55.9 seconds (P < 0.001, 95% CI 45.3;66.2). The median total time spent in the procedure room and procedure time were lower with pre-filled Lucentis (Ranibizumab) compared to Eylea (Aflibercept) (P < 0.05). No complications were reported.
Use of an intravitreal injection guide can provide a cost-neutral and safe method of enhancing efficiency on an ophthalmic nurse practitioner led list, with a safety profile similar to standard technique.
The use of intravitreal injections in treatment of a wide variety of retinal conditions such as neovascular age-related macular degeneration (nAMD), diabetic retinopathy and vein occlusions is well established,[1-3]. Millions of injections are delivered worldwide per annum and on a background of an expanding elderly population, their use is set to increase exponentially over the next decade,[4]. In the United Kingdom alone, the Royal College of Ophthalmologists has predicted an increase in nAMD cases of 53 percent between 2015 to 2035,[5]. To cater for this growing demand, nurse practitioners, hospital optometrists and orthoptists are increasingly training to deliver injections,[6]. From a patient perspective, provision of therapy has vastly improved visual outcomes,[7], but at the expense of undergoing invasive treatment once a month or bi-monthly for many years.
Various teams globally have developed innovative intravitreal injection devices,[8-11]. Published evidence has shown improvement in pain scores, enhanced operator preference and patient satisfaction. However, to date there has been no published data from a time and motion study to ascertain improvement in procedure efficiency. We present results from a locally developed intravitreal injection guide to assist in developing such evidence.
MATERIALS AND METHODS:
The study was performed between November 2019 and February 2020 at the Royal Eye Infirmary, Plymouth, U.K. A single experienced advanced nurse practitioner (AT) performed all injections (experience of 8000 injections with standard technique and 1000 with Waqar-Malosa Intravitreal Injection Guide). As injection delivery by either standard technique or injection guide are both considered standard of care in our department (dependent on operator or patient preference), ethics approval was not required. Local Clinical Effectiveness Group approval for use of the guide was obtained, and it is also both CE marked and FDA approved (510 (k) Exempt). All patients were seen by the medical retina team and informed decision on treatment made with consent form completed as per routine. The study included both treatment naïve and previously treated patients.
43 consecutive patients received an intravitreal injection with the standard technique, followed by injection delivery with the Malosa Intravitreal Injection Guide when next injection clinically indicated.
For both visits, the same assistant called the patient in and asked them to sit on the procedure bed. As soon as the patient entered the room, stopwatch A was started and stopped when they left the room at the end (to record total time spent by patient in procedure room). Whilst the nurse practitioner completed the safety checks with the patient and case notes (confirming name and date of birth, checking and marking which eye to be injected and with which medication, confirming any changes to recent health that may be a contraindication and marking the relevant eye), the AHP placed the injection pack on a trolley. The patient was then asked to lie down on the bed. The nurse opened and set up the injection pack, whilst the AHP instilled 0.5% Proxymetacaine Hydrochloride eye drops followed by 1.5 ml of 5% povidone-iodine solution on patient's lid margins and into the lower fornix. The AHP then opened, using a non-touch technique, a pre-filled Lucentis injection or helped draw up an Eylea injection into a 1 ml syringe. The nurse practitioner instilled 0.5% proxymetacaine hydrochloride eye drops and cleaned the lids with 5% povidone-iodine, ensuring some entered again into the fornices.
Stop watch B was now started on both visits to document time taken for the injection itself. It was stopped when the patient's vision was checked (ability to count fingers) at end of the procedure.
For the standard technique (Basic IVT Pack MMK470/1, Malosa Medical), a drape was placed followed by a guarded lid speculum. The patient was asked to look inferonasally and a drop of 0.5% proxymetacaine hydrochloride was instilled in the superotemporal quadrant followed by one drop of 5% povidone-iodine. A calliper was used to indicate site of injection (3.5 mm for pseudophakic and 4 mm for phakic eyes). The injection was delivered (0.05 ml of medication) in the super-temporal quadrant using a 30 gauge needle (two-thirds of needle length entry). A cotton bud was used to check for vitreous wicks and Minims Chloramphenicol 0.5% eye drops instilled on injection site. The speculum and drape were removed, lids cleaned with normal saline and dried, and vision checked.
For the Intravitreal Injection Guide (Core IVT Pack MMK877, Malosa Medical), the upper lid was hooked with the lash guard and patient asked to look inferonasally. A drop of 0.5% proxymetacaine hydrochloride was instilled in the superotemporal quadrant followed by one drop of 5% povidone-iodine. As per manufacturers recommendations, the triangular footplate was placed on the sclera with the apex at the limbus. The injection (0.05 ml of medication) was delivered through the central chamber (4 mm from limbus with 7 mm needle length entry) using a 30-gauge needle and sustained plunger pressure for 5 seconds to minimise reflux. The guide was removed, a cotton bud used to check for vitreous wicks and Minims Chloramphenicol 0.5% eye drops administered onto injection site. Lids were cleaned with normal saline and dried, and vision checked.
For both visits, the post injection steps were the same. The patient was sat up in the bed and given both verbal instructions and a leaflet on symptoms of complications and point of contact in the department should there be any concern. They were then stood up and escorted out of the room by the assistant. All patients were also given an Outcome Form which they handed in to the reception to allow the administrative team to book their next appointment.
Statistical analysis was performed using R 3.6.2. Counts and percentages were used to summarize categorical variables. Continuous variables were summarized using mean ± standard deviation (SD) or median and interquartile range (IQR) for normal and non-normal variables, respectively. Wilcoxon rank sum or signed rank test was used to test the null hypothesis of no difference between groups for non-normal data and t-test was for normally distributed variables. The unadjusted average difference and 95% confidence interval were calculated when t-test was used. The difference in time was calculated for each patient. Linear regression used to assess factors associated with the difference in time. Hypothesis testing was performed at 5% level of significance.
The study sample included 43 patients. The average age of the included patients was 76.9 ± 12.8 years (Table 1). Males and females represented 32.6% and 67.4% of the included patients, respectively. The median number of pre-study injections was 11 (IQR 5; 22.5). Indications for treatment included diabetic retinopathy (9.3%), vein occlusions (18.6%) and wet age-related macular degeneration (72.1%). No complications were reported with either technique. The average total time and procedure time were lower with the use of Intravitreal Injection Guide compared to when the standard technique was used.
Age 76.9 ± 12.8
F 29 (67.4%)
M 14 (32.6%)
No of pre-study injections 11.0 [5.00;22.5]
Laterality:
Bilateral 3 (6.98%)
Left 26 (60.5%)
Right 14 (32.6%)
Indications for treatment:
Diabetic Retinopathy (DR) 4 (9.30%)
Vein Occlusions (VO) 8 (18.6%)
Wet Age-Related Macular Degeneration (wAMD) 31 (72.1%)
Drug:
Eylea 13 (30.2%)
Bilateral Eylea 3 (6.98%)
Lucentis 26 (60.5%)
Bilateral Lucentis 1 (2.33%)
Standard technique (Total Time in Procedure Room) 373 ± 92.2
Standard technique (Procedure Time) 262 ± 88.0
Intravitreal injection guide (Total Time in Procedure Room) RoomRoom) 331 ± 87.0
Intravitreal injection guide (Procedure Time) 206 ± 66.3
Continuous data was presented as mean ± SD or median (IQR). Categorical data was presented as count and %. Time is presented as seconds
Signed rank test showed that there was a statistically significant difference in total time spent in procedure room (P < 0.001) and procedure time (P < 0.001) between both techniques (Table 2). The median total time in the procedure room was lower when the injection guide was used compared to the standard technique. The median procedure time was also lower with the injection guide. The unadjusted average difference in the total time spent in procedure room was 41.7 seconds while the unadjusted average difference in procedure time was 55.9 seconds.
Standard technique Intravitreal Injection Guide Δ 95% CI P
Total Time in Procedure Room 373 ± 92.2 331 ± 87.0 41.7 (19.7; 63.8) < 0.001
Procedure Time 262 ± 88.0 206 ± 66.3 55.9 (45.3; 66.2) < 0.001
Data was presented as mean and standard deviation Statistical analysis was performed using unpaired t-test Δ Standard technique – Intravitreal injection guide
Overall, the median total time spent in the procedure room and procedure time were lower with Lucentis compared to Eylea (P < 0.05 for all comparisons). Density plots for both primary outcomes showed a left-shit with the injection guide.
Linear regression was also used to assess factors associated with procedure time. Results showed laterality and drug used were significantly associated with the procedure time for both techniques. For the standard technique, the average procedure time was higher by 300 seconds for bilateral injections compared to unilateral left injections (B = 301, P < 0.001). The average time was not different between injections with right and left laterality. The average procedure time was lower by 48 seconds in injections when Lucentis was administered compared to when Eylea was administered (B = -48.41, P = 0.007).
Similar results were observed with the Intravitreal Injection Guide. However, an interesting finding was that the average increase in procedure time was higher by only 200 seconds in bilateral injections compared to unilateral injections (B = 203, P < 0.001). This indicates that the use of the guide saves approximately 100 seconds in bilateral injections.
Provision of intravitreal injections has improved tremendously over the last decade. Many patients have now had dozens of injections over the years, and expectations understandably have heightened. Of all the steps in the procedure, patients mostly find the drape and speculum most uncomfortable,[11,12]. Many physicians do not routinely use a drape, and indeed the recent European Retina Society guidance does not consider a drape necessary,[13]. It is important however to ensure lashes do not touch the needle to prevent endophthalmitis, such as with a guarded lid speculum.
To meet growing demand, allied health professionals are increasingly playing a central role in service provision. Pioneered in the United Kingdom, nurse practitioner led injections have been found to be safe and the concept is gaining traction worldwide,[14-16]. As an expansion of the idea, the Royal College of Ophthalmologists have also supported involvement of suitable trained hospital optometrists and orthoptists in this specialist role. Ensuring high-quality training and standardised completion of procedure are essential to maintain best practice. The current COVID-19 pandemic will cause expanding waiting lists, and maintaining multi-disciplinary teams will be crucial.
Delay in treatment can result in permanent visual damage and is a challenge for most health-care systems,[17]. It is therefore desirable to increase list efficiency, allowing health services to deliver treatment to more patients per annum whilst maintaining patient comfort and procedure safety. Intravitreal Injection Devices have been developed by different teams internationally to help meet this objective. Of varying designs, they allow injection delivery without a drape or speculum and with safety profiles comparable to standard techniques,[8,9,10,18,19].
The Waqar-Malosa Intravitreal Injection Guide consists of a triangular base plate which is curved to follow the contour of the eye and has three studs at the corners for stabilisation of the eye. Its apex has an arrow to indicate placement at the limbus. The base plate is connected to a cylindrical chamber, which in turn is connected to a handle and a lash guard. The lash guard is able to effectively splay the lashes away from the site of the injection and the injection needle (thus obviating the need for a speculum/drape whilst also reducing the risk of infection) and the cylindrical chamber allows 7 mm of a 13 mm/30 gauge needle to enter the eye (thus eliminating the risk of over-insertion). Once the base plate is firmly placed on the surface of the eye, the chamber will only allow the injection to be delivered 4 mm from the limbus, and perpendicular to the sclera, thereby ensuring precise delivery through the pars plana and avoiding lenticular/retinal damage. An incorporated metal swage tube in the chamber prevents intra-ocular plastic particulate entry.
Whilst the various devices positive impacts on pain scores and patient satisfaction are documented, no evidence exists to quantify efficiency gains. Previous studies have made mention of decreased procedure time, however evidence has not been presented to support this thought,[20].
This study demonstrates a statistically significant reduction in both Total Time in Procedure Room and Procedure Time with use of an intravitreal injection guide on an Ophthalmic Nurse Practitioner list. The recent Getting It Right First Time (GIRFT) report has suggested 16 injections as standard in a four hour session for the NHS,[21]. It is estimated that 388 031 intravitreal injections were performed across the NHS in 2015,[22], and currently in our unit 6000 injections are delivered per annum. Based on these figures, use of the guide increases capacity by one injection per list, 375 injections per annum for a unit our size, and 25000 injections per annum for the NHS. GIRFT also highlighted some units perform up to 30 injections per four hour session. In this instance capacity gains will be higher at two injections per list, 750 per annum for a unit our size and 50,000 injections per annum for the NHS. If the cost of an injection guide pack remains similar to a standard pack (this is feasible as the guide replaces material costs for a drape, caliper and speculum), the outcome is a significant cost-neutral increase in delivery capacity for the health service.
In keeping with previously published data, we have found use of pre-filled Lucentis syringes to be more efficient than drawing up an Eylea injection,[23]. Reassuringly, Eylea will also soon be available as a pre-filled formulation. As more anti-VEGF agents undergo development, our data supports the use of pre-filled syringes not only for safety but also for procedure efficiency. Although the sample size is small, it has been interesting to note reduction in time for bilateral injections with both the guide and pre-filled Lucentis. This can be attributed to ease of set-up of new sterile kit between eyes, but a larger sample size is required to draw more concrete conclusions.
Strength of the study is comparison of both techniques between the same patients to minimise the effect of poor mobility, difficult communication and patient positioning on measured outcomes. In addition, standardisation has been achieved by using the same nurse injector and assistant for all cases, and data has been collected not only for the procedure time, but also total time spent by patient in the procedure room. This methodology provides a more accurate understanding of the true impact of efficiency gains for service delivery planning, as any patient related factors (e.g. poor mobility) that could off-set stand alone gains during the procedure are also considered.
Areas for further work include comparing similar outcomes between different types of intravitreal injection devices, across injectors of varying experiences and professional backgrounds (i.e. doctors, nurses, orthoptists, optometrists), and to explore the effect of injection devices on learning curves for injectors in training. A larger sample size would also be required for more accurate confidence intervals.
In conclusion, use of an intravitreal injection guide results in a statistically significant reduction in both time spent by patient in the procedure room, and the procedure itself. This can support a cost neutral and exponential increase in service delivery for the NHS, whilst enhancing the patient experience.
CATT Research Group, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364(20):1897‐1908. doi:10.1056/NEJMoa1102673.
Hykin P, Prevost AT, Vasconcelos JC, et al. Clinical Effectiveness of Intravitreal Therapy With Ranibizumab vs Aflibercept vs Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion: A Randomized Clinical Trial [published online ahead of print, 2019 Aug 29]. JAMA Ophthalmol. 2019;137(11):1256‐1264. doi:10.1001/jamaophthalmol.2019.3305
Prünte C, Fajnkuchen F, Mahmood S, et al. Ranibizumab 0.5 mg treat-and-extend regimen for diabetic macular oedema: the RETAIN study. Br J Ophthalmol. 2016;100(6):787‐795. doi:10.1136/bjophthalmol-2015-307249
Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(2):e106‐e116. doi:10.1016/S2214-109X(13)70145-1
The Way Forward Report: Age related macular degeneration and diabetic retinopathy. The Royal College of Ophthalmologists. 2015.
Ophthalmic Service Guidance – Intravitreal Injection Therapy. The Royal College of Ophthalmologists. August 2018.
Mehta H, Tufail A, Daien V, et al. Real-world outcomes in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor inhibitors. Prog Retin Eye Res. 2018;65:127‐146. doi:10.1016/j.preteyeres.2017.12.002
Ratnarajan G, Nath R, Appaswamy S, et al. Intravitreal injections using a novel conjunctival mould: a comparison with a conventional technique. Br J Ophthalmol. 2013;97(4):395‐397. doi:10.1136/bjophthalmol-2012-302155
Han DP, McKenney KC, Kim JE, et al. CLINICAL EVALUATION OF THE RAPID ACCESS VITREAL INJECTION GUIDE: A Handheld Instrument for Assisting Intravitreal Injections. Retina. 2017;37(4):778‐781. doi:10.1097/IAE.0000000000001229
Watanabe K, Masafumi U, Mohamed Y, et al. Safety of Intravitreal Injection Guide. Journal of VitreoRetinal Diseases. 2018;2(1), 26–31. https://doi.org/10.1177/2474126417728622
Tailor R, Beasley R, Yang Y, et al. Evaluation of patients' experiences at different stages of the intravitreal injection procedure – what can be improved?. Clin Ophthalmol. 2011;5:1499‐1502. doi:10.2147/OPTH.S24358
Sanabria MR, Montero JA, Losada MV, et al. Ocular pain after intravitreal injection. Curr Eye Res. 2013;38(2):278‐282. doi:10.3109/02713683.2012.758290
Grzybowski A, Told R, Sacu S, et al. 2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations. Ophthalmologica. 2018;239(4):181‐193. doi:10.1159/000486145
The Royal College of Ophthalmologists. College Statement on intra-ocular injections by non-medical health care professionals (HCPs). April 2013.
Simcock P, Kingett B, Mann N, et al. A safety audit of the first 10 000 intravitreal ranibizumab injections performed by nurse practitioners. Eye (Lond). 2014;28(10):1161‐1164. doi:10.1038/eye.2014.153
Rasul A, Subhi Y, Sørensen TL, et al. Non-physician delivered intravitreal injection service is feasible and safe – a systematic review. Dan Med J. 2016;63(5):A5229.
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Waqar S, Ayaz A, Karamat I, et al. A novel device for rapid, safe and precise delivery of intravitreal injections. BMJ Innovations 2019;5:8-12.
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National Institute for Health Research. https://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=22013015682&ID=22013015682. Accessed 6/5/2020
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Subhi Y, Kjer B, Munch IC. Prefilled syringes for intravitreal injection reduce preparation time. Dan Med J. 2016;63(4):A5214.


Like many transitioning corporate executives who come to FranNet for guidance, Chris wanted to attempt starting and scaling his own business from scratch, something he'd never done. At the time however, the economy was becoming "a little too dicey," as he described it, so he looked for help in determining if it was the right time. If so, was he as well suited for business ownership as he thought?
Working with Chris reminded me of when I left a marketing executive role at 3M to venture out on my own. It was both exciting and terrifying at the same time. For Chris to be successful, we needed to develop a personalized business model to address the goals and attributes he most desired such as a high growth potential, simplicity, recurring/contractual revenue and a predictable future exit strategy for when he'd be ready to retire. When we identified an opportunity in master franchising for a start-up commercial cleaning franchise company, Chris was immediately interested.
Master franchising (or regional development) is a much larger way to grow a franchise business throughout a territory or region. With a typical franchise agreement, the franchisee is offering services or products directly to the end user. A master franchise agreement includes the rights to an exclusive geographic market, which allows for multiple ways to generate income including sharing in the royalties from the locations operating in the region you're in charge of developing. I've often called it the sweet spot of franchising.
Sounds like a dream, right? Realize though, prime territory for established brands like Subway were scooped up years ago when those companies were much younger and relatively unknown. The opportunity for substantial growth through master franchising exists predominantly with emerging brands. To succeed as a master franchisor, you must relish the idea of helping mold a younger, growing company versus having a finely tuned business system handed to you. And you must be comfortable leading in multiple business functions including sales, marketing, finance and operations while being committed to developing an entire territory.
Fast forward and Chris White has discovered he is indeed well suited for business ownership as President and Master Franchise Owner of Mint Condition of Georgia, providing commercial cleaning and floor care services. As the master franchisee with ownership rights to the state of Georgia, he's taken Mint Condition from 0 to 30 franchises and is enjoying being part of the $100 billion annual commercial cleaning industry.
Chris answered some questions for the benefit of anyone looking for their next chapter through business and franchise ownership.
I thought my general management background was well suited to assume the challenges of a startup business. I wanted to start from scratch and develop it to a point where it is an attractive company for someone else to acquire and continue scaling when I'm ready to retire. We also knew there were tremendous growth opportunities in the Atlanta market and across Georgia.
How would you summarize your business ownership journey?
Knowing I've started a business from scratch and built it into a successful enterprise is extremely rewarding. We've worked to put together a solid foundation, one that is set up for another individual or company to take it to the next level as I approach retirement. This company has a bright future and I'm proud to have had a hand in creating our success.
What challenges have you encountered as an entrepreneur?
When you start a business, you learn everything and that nothing can be skipped or missed. In the corporate world, if I had an IT problem I just called the IT department. In my own business, I do a little bit of everything and have learned self reliance. When I go to bed each night, I know I'll face new challenges the next day, but I've gained a whole new level of confidence to get the job done.
I'm approaching 70 years old and my wife and I are looking forward to spending more time with our children. We are exploring some strategic options to free up some personal time as we go on to the next chapter in our lives.
Understand how to apply the skills you have and learn or hire the skills you don't.
Trust the advice of your franchise consultant and choose a business for the right reasons.
Utilize the support network of the franchisor and fellow franchisees.
For Chris, taking on a new challenge after a successful corporate career meant taking risks at a time when the economy was struggling and corporate layoffs were commonplace. Through research, introspection, determination and a belief in himself, he shed the corporate suit for a master franchise that suited him perfectly.
Considering your next chapter? Click here to get started or sign up for one of local events. Phil can be reached at pkuban@frannet.com.


After graduating from Minot State University, Roxanne married Al Keller. Together they owned and operated a business until 1980, when they accepted the pastorate in Brookings, SD and later in Minot, ND. Al and Roxanne pastored for 12 years and then did church planting for nine years. Al and Roxanne also raised three children.
Roxanne later returned to school earning her master's degree in counseling psychology, and went on to own a private counseling office.
In 2000, Pastor Al and Roxanne moved to Minneapolis, became members of Living Word, and began volunteering in Pastoral Care. They joined Living Word as staff in 2003 and as pastors in 2005.
In September of 2007, Pastor Al went home to be with the Lord. Since then Roxanne has stepped up to the position of pastor in Pastoral Care and does benevolence, spiritual guidance for individuals and married couples, as well as hospital visitation, and other pastoral duties.


text:
The Illogic of Opposing Obama's Nuclear Deal
June 3, 2015 Guest Contributor 3 Comments
by Henry Johnson
A new report by the Iran Project elaborates on the basic reasons for supporting the comprehensive nuclear deal being negotiated between Iran and the U.S. The report, authored by distinguished former diplomats including Ambassador Thomas Pickering and Paul Pillar (whose National Interest blog posts LobeLog frequently features), demonstrates why Iran's current leadership is unlikely to violate a final deal. The report uses as its premise the assertion by the U.S. intelligence community that Iran has not decided whether to acquire nuclear weapons. This question, and the logic that follows, is central to understanding the disputes over whether President Obama is pursuing the correct policy vis-à-vis Iran.
Perhaps the chief concern among detractors of the president's diplomacy is that it does not go far enough in slashing and constraining Iran's enrichment program. Many of the deal's opponents, for whom Israeli Prime Minister Benjamin Netanyahu speaks most forcefully, share the belief that the U.S. objective should be to eliminate Iran's enrichment capability altogether. This all-or-nothing objective flows from the premise that Iran is actually deceiving the U.S. and is committed to obtaining at least a threshold weapons capability. Iran's putative agreement to a deal, they worry, is nothing but a ploy to unravel the sanctions regime before bolstering its enrichment program and pinning all the blame on the U.S. In order to rationalize Obama's failure to recognize this grandiose subterfuge, some commentators and political leaders have attempted to paint Iranians as untrustworthy and even dishonorable. Senator Tom Cotton, for example, libeled Iran's foreign minister as a coward and a draft evader. Senator Lindsey Graham called Iranians liars and cheaters, and Netanyahu regularly draws parallels between present-day Iran and genocidal threats to the Jewish people throughout history.
The Iran Project's new report argues that these concerns are unfounded. The U.S. government's highest intelligence authority on questions regarding the military intentions of foreign nations has and still does contradict the belief that Iran harbors a secret long-term plan to acquire nuclear weapons. The Director of National Intelligence (DNI) has repeatedly testified in open session before Congress that Iran halted its weapons program in 2003 and has not made a decision to acquire nuclear weapons. Aside from the DNI's "high-confidence" assessment, the report also outlines the difficulty that Iran would indefinitely face in trying to pursue a "sneak-out"—the use of undeclared facilities to enrich enough uranium for one bomb. This includes the contention that "Iran is the most watched country in the world," and that "the unprecedented extension of inspections…will make it even more difficult for Iran to conceal a new facility." The authors also point out that the U.S. intelligence community "has concluded that the IAEA would detect in a timely manner any direct violation of the agreement" and that it itself is capable of detecting undeclared facilities, "as it has done the two previous times Iran failed to declare in a timely manner its nuclear-related sites."
The assumption that Iran is pursuing a bomb and a nuclear accord at the same time is simply illogical. Why would a country that is the closest it has ever been to a weapons capability forfeit its best "breakout" option, unless it did not ultimately want a bomb? Prior to the Joint Plan of Action, Iran had enjoyed the option of enriching enough uranium for one bomb in less than three months. A final deal will effectively push this window of time to at least one year. Iran presumably could have rejected substantive talks from the outset and in so doing inched closer toward a weapons capability. It is not in Iran's interest to do this now, and it will be less in its interest to do so in the future, when the inspections regime is tougher and the length of its breakout time greater. The same basic cost-benefit analysis—weighing the risk of U.S. or Israeli strikes and isolation from Western economies—will apply 15 years from now, except that Iran would then be precluded, due to a permanent inspections regime, from a sneak-out option. As the report's authors put it, "One must question why a country that could have developed a nuclear weapon any time over the last decade would now agree to restraints with unprecedented verification and then cheat."
Even if a new geopolitical fact were to persuade Iran's leadership into considering anew pathways to the bomb, the weight and seriousness of this fact would have to supersede several political interests in Tehran. Elites in the Islamic Republic have for the most part reached a consensus to support President Rouhani's handling of the nuclear file. A successful deal would reinvigorate the economy and act as a pressure valve for the simmering discontent that boiled over once not too long ago. As noted in the report, "In recent months the IRGC and other institutional conservatives in Iran have refrained from public attacks on the agreement, and recently given it support, suggesting that they are falling in line with Khamenei, who appears increasingly supportive." A major breach, furthermore, would "destroy the large investment Iran's leaders have committed politically and economically in reaching the agreement in the first place." It would "entail re-imposition of U.S. sanctions with a consequent impact on third states dealing or trading with Iran…even if the full international sanctions regime is not restored." These consequences would enrage some key voter demographics, not only for triggering economic fallout, but also for returning Iran to a detested pariah status. The consequences would doom President Rouhani's reelection campaign and possibly lead to a repeat of the 2009 protests and the prospect of popular revolt.
If Iran did wish to acquire nuclear weapons, it would not agree to the parameters set by the Obama administration—and no policy other than war could commit it to a zero-enrichment capability, according to the report. Fortunately, though not for the sake of clarity, international politics is scarcely characterized by such extremes. States usually prefer making a bargain that ends in peace to imposing their will by war. The environments in which diplomatic bargains can grow and ripen, however, are prone to outside interference, both from within the state and without. Internal political opponents may prize the scuttling of their adversary's legacy over progress in the name of international peace. Foreign interlopers may, in pursuit of narrow self-interests, attempt to goad a superpower into taking actions that they themselves balk at. So far, Obama has deftly fended off these outside pressures. The survival of his foreign policy legacy will be decided by the strategy he devises to placate restless allies and protect his deal from whatever hawkish tendencies the next U.S. administration might exhibit.
Photo: DNI James Clapper
Analysis, Iran Benjamin Netanyahu, breakout, DNI, Hassan Rouhani, Henry Johnson, Iran, Iran Project, Khamenei, Lindsey Graham, nuclear deal, Paul Pillar, sneakout, Thomas Pickering, Tom Cotton
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Don Bacon
The Iran Project Report is about what might expect from a select group of US establishment foreign policy operatives, quite insular and without any consideration of not only the views of the other five US confederate nations in this matter but also (especially) a lack of understanding of Iran and of Iran's positions especially its sovereignty concerns and its past experiences with US perfidy including cyberattacks, assassinations and unwarranted sanctions as well as the torpedoing of the previous Brazil/Turkey nuclear agreement in 2010.
Examples from the study:
–President Hassan Rouhani and Foreign Minister Mohammad Javad Zari have led the government…The Iranian Revolutionary Guard Corps (IRGC) plays a particularly important policy role in Iran's neighborhood and is directly responsible to the Supreme Leader, Ayatollah Ali Khamenei. — Actually Khamenei is chief of state
–Granting sanctions relief in exchange for severe restrictions on Iran's nuclear program will mean that sanctions have served their purpose. –Actually Iran greatly expanded its peaceful nuclear program under sanctions, and the talks were the US idea
There are other obvious errors.
–The report quotes "U.S. Director of National Intelligence (DNI) has repeatedly testified…."..becomes…WHAT ARE THE IMPLICATIONS OF THESE FINDINGS…becomes…The intelligence community's ?ndings on Iran could be mistaken…and then….The intelligence community learned from its past mistakes, and has new and powerful tools. –Sure.
–that factors into: [The intelligence community] was aware of the Iranian undeclared facilities before they were publicly disclosed, and of?cials have often characterized their conclusions about Iran as "high con?dence" assessments. –what undeclared facilities? If this is a reference to Fordow it is incorrect.
–There are many other questionable assumptions and "facts" in the report. I could spend a week on it.
MostafaviHassan
Thank you Mr.Henry Johnson. While endorsing some of Don Bacon's valid comment, I welcome a move by learned experienced people to prevent a great disaster before it happens- a disaster far greater than what happened and is happening in Iraq, If that can be called a disaster which is not by people like Netanyahu's value system.
Netanyahu and his administrations' character and policies are well known to journalists,political analysts,intelligence agencies of western countries and even heads of states like Obama,Sarkosy,Putin….their comments on this man outside diplomatic protocol are known to everyone.He and his administration are irresponsibly playing dangerous political games that would undoubtedly have adverse consequences on,not only Israeli interests,but also on American and Western interests in total and could push the world to the brink of a disastrous situation with the possibility of irreversibility. The fact that all countries in the world,with the exception of a few,recognised Palestine as an independent state,the unpopularity of Israel among the ordinary people of the world,rise of anti-Jewish and even greater than that anti-zionists sentiments in the west are but a few examples of Netanyahu's anti-Israeli behaviour and policies. We must not forget Israeli role in the creation of Iraq invasion catastrophe,which is considered by Netanyahu 's administration a great success !! They are thinking of Iran in a similar terms and system of value that led to the invasion of Iraq. Iran is feared and quite unpopular among Arab poppet regime of the area.This is not new but the previous regime enjoyed a good relationship with the west and Arabs did not enjoy so much atrocious and false confidence to openly express their animosity towards Iran.Incidentally, a main reason for Arabs' unfriendly feelings towards Iran was Iran's open good relations with Israel !! Netanyahu is trying to take advantage of the circumstances to hit Iran with the approval and help of poppet rootless Arab countries and total active participation of the US, to score a positive political point for himself and Israel.This is all childish dreams as some other of Netanyahu's policies. You don't know Iran and Iranians Mr.Netanyahu. If you enter a war with Iran you will find Iranian Jews on the Iranian side fighting Israel.
Iran is feared and quite unpopular among Arab rootless poppet regime of the area.This is not new but the previous regime enjoyed a good relationship with the west and Arabs did not enjoy so much atrocious and false confidence to openly express their animosity towards Iran. The main reason for Arabs' unfriendly feelings towards Iran was Iran's open good relations with Israel !!This bring us to the next point which Mr.Netanyahu atrociously ,ungratefully and deliberately lied about the historical relationship between Iranians and the Jews.
"…. Iran's historical genocidal threats to the Jewish people throughout the history….." Not a normal person of moderate dignity,integrity,fairness and justice could ever make such a statement. As said by Mr.Don Bacon, I could talk about it weeks !! I INVITE IRANIAN JEWS IN IRAN OR ABROAD,INCLUDING THOSE IN ISRAEL AND AIPAC TO FURNISH MR.NETANYAHU WITH A SUITABLE ANSWER OF THEIR OWN.
Exactly contrary to Mr.Netanyahu's statement, Iran has always been the only,yes the only, sure and safe haven for Jewish people in the world throughout the history.They always lived In Iran as equals and enjoyed very high positions in the government and hierarchy of the Iranian power pyramid.True, in the IR of Iran minorities cannot occupy certain positions,as it is for Arabs and Muslims in Israel.However there is a difference. In Iran Jewish people are not marked as Jewish in anyway and are not distinguishable from muslims in anyway- name,appearance,birth certificates,identity cards…. unless they deliberately want to be distinguished.Consequently many people of Jewish background are occupying high government positions without being known as Jewish. Most recent example was Mr.Ahmadi-Nejad, the previous president who was from a Jewish family. The 25,000 self declared Jews in Iran have their own elected member in the National Assembly ( just like Arab members in the Knesset ) and enjoy life without any prejudice , are well integrated with the rest of the people ,Iranian culture ,customs and live as one of several ethnic groups ( Kords, Lors, Azaris,Rashtis …). Thus, majority of Iranian Jews refused to go to Israel despite incentives offered by Israeli government or if some did,most came back via third countries after utilising and saving all the advantages handed out by the Israeli Government. The old Iranian Jews in Israel or other countries consider Iran as their home and every year celebrate Norooz(the Iranian New Year) and wish to return home before they die. Thus the biggest Jewish population in the ME outside Israel live in Iran by their own choice.The 25,000 official figures of Iranian jews is the figure for self declared Iranian Jews. According to some Iranian Jewish sources, if we take the undeclared Iranian Jews into account,which we should really do, about 10 % of the population of Iran are from jewish backgrounds !! Yes,Mr.Netanyahu !! I expect Iranian jews' testimony .
I advise Mr.Netanyahu and his gang to read their Tore properly. Who is Cyrus The Great,as mentioned in Tore,and what did he do for the Jews and how do the Jews revere him even today? You don't know your history and your Tore Mr. Netanyahu ,because you are not Jewish,by religion or by race .
As for Iran Talks, the west,specially the US,better cease the opportunity for a respectable peaceful settlement to the dispute. The other side of the coin is not advantageous to either-side of the negotiations and both are capable of throwing all the achievements away and enter a new phase of animosity, which would be a humanitarian catastrophe.Feel responsible and put unnecessary doubts aside.
ruven golan
Mr. Johnson, why is a "moral" US negotiating with a Iran who holds US citizens, and threatens to annihilate Israel? Why does the POTUS say he will not demand from the Iranians to destroy Israel? Isn't that tolerating terrorism? Why do the Iranians continue to enrich weapon grade uranium when they have enormous proven oil reserves? Do you not believe that their form of religion is to subjugate or kill all opponents? What is the difference between the Ayatolas and Hitler?
Can The Iran Crisis Be A Blessing in Disguise for Europe?
Iran Isn't A 'Unitary State,' Domestic Politics Play A Role In Its Foreign Policy


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text:
Q: Where can I add the FindViewById() and the listeners in a fragment? I created a Fragment and called it Kabar and I can see that the Button and the TextView appears as expected.
Here is my Fragment:
public class Kabar extends Fragment   {
    private Button button;
    private TextView text;

    public Kabar() {
        // Required empty public constructor
    }

    @Override
    public View onCreateView(LayoutInflater inflater, ViewGroup container,
                             Bundle savedInstanceState) {
        // Inflate the layout for this fragment
        View v= inflater.inflate(R.layout.fragment_kabar , container, false);
        return v;
    }
}

This is my fragment_kabar layout:
 <FrameLayout
 xmlns:android="http://schemas.android.com/apk/res/android"
     xmlns:tools="http://schemas.android.com/tools"
     android:layout_width="match_parent"
     android:layout_height="match_parent"
     tools:context="com.examplee.my.Kabar">

     <!-- TODO: Update blank fragment layout -->
     <RelativeLayout
         android:layout_width="match_parent"
         android:layout_height="match_parent">
         <TextView
             android:id="@+id/tt1"
             android:layout_width="wrap_content"
             android:layout_height="wrap_content"
             android:text="mohsen kabar" />

         <Button
             android:id="@+id/tt2"
             android:layout_width="wrap_content"
             android:layout_height="wrap_content"
             android:layout_marginTop="113dp"
             android:text="Button"
             android:layout_below="@+id/mohsenkabar"
             android:layout_alignParentRight="true"
             android:layout_alignParentEnd="true"
             android:layout_marginRight="93dp"
             android:layout_marginEnd="93dp" />
     </RelativeLayout>

I need to use the Button and the TextView.
Where can I place this code?
text=(TextView) text.findViewById(R.id.tt1);
button=(Button) button.findViewById(R.id.tt2);
button.setOnClickListener(new View.OnClickListener() {

    @Override
    public void onClick(View v) {
        tt1.setText("kkk mmm bbb ddd");
    }
});

A: There's two options onCreateView and onViewCreated (preferred) methods.
void onViewCreated (View view,
                Bundle savedInstanceState)

Called immediately after onCreateView(LayoutInflater, ViewGroup,
  Bundle) has returned, but before any saved state has been restored in
  to the view. This gives subclasses a chance to initialize themselves
  once they know their view hierarchy has been completely created. The
  fragment's view hierarchy is not however attached to its parent at
  this point.

A: try this add this code in your kabar fragment
  @Override
public View onCreateView(LayoutInflater inflater, ViewGroup container,
                         Bundle savedInstanceState) {
    // Inflate the layout for this fragment
    View v= inflater.inflate(R.layout.fragment_kabar , container, false);

      TextView  text=(TextView) v.findViewById(R.id.tt1);
      TextView  button=(TextView) v.findViewById(R.id.tt2);

      button.setOnClickListener(new View.OnClickListener() {
      @Override
      public void onClick(View v) {
      text.setText("kkk mmm bbb ddd");
       }
   });
    return v;
}

A: Replace your code with folowing in onCreateView
text  =(TextView) v.findViewById(R.id.tt1);
button=(Button) v.findViewById(R.id.tt2);
button.setOnClickListener(new View.OnClickListener() {

    @Override
    public void onClick(View v) {
        text.setText("kkk mmmm bbbb ddd");
    }
});

A: make this change in your code
text=(TextView) v.findViewById(R.id.tt1);
button=(Button) v.findViewById(R.id.tt2);
button.setOnClickListener(new View.OnClickListener() {

    @Override
    public void onClick(View v) {
        text.setText("kkk 'mmm' 'bbb' 'ddd'");
    }
});

A: You should Add your code in the OnCreateView in your Kabar Fragment:
public class Kabar extends Fragment {

    private Button button;
    private TextView text;

    public Kabar() {
        // Required empty public constructor
    }

    @Override
    public View onCreateView(LayoutInflater inflater, ViewGroup container,
                     Bundle savedInstanceState) {
        // Inflate the layout for this fragment
        View v = inflater.inflate(R.layout.fragment_kabar , container, false);

        TextView  text = (TextView) v.findViewById(R.id.tt1);
        Button button = (Button) v.findViewById(R.id.tt2);

        button.setOnClickListener(new View.OnClickListener() {
            @Override
            public void onClick(View v) {
                text.setText("kkk mmm bbb ddd");
            }
        });
        return v;
    }
}