text:
Study protocol
A comparative effectiveness study of two culturally competent models of diabetes self-management programming for Latinos from low-income households
Janet Page-Reeves ORCID: orcid.org/0000-0001-9401-32481,
Lidia Regino1,
Cristina Murray-Krezan1,
Molly Bleecker1,
Erik Erhardt1,
Mark Burge1,
Elaine Bearer1 &
Shiraz Mishra1
Diabetes risk is extremely high for Latinos from low-income households. Health guidelines recommend that individuals learn strategies to self-manage their diabetes, but getting people to adopt required lifestyle changes is challenging and many people are not able to prevent their pre-diabetes from escalating or effectively control their diabetes. Systematic reviews show that culturally competent self-management programs can significantly improve diabetes outcomes and different models for culturally competent programming have been developed.
This patient-engaged study will compare the effectiveness of two distinct evidence-based models for culturally competent diabetes health promotion at two sites that serve a large Latino patient population from low-income households: 1) The Diabetes Self-Management Support Empowerment Model, an educational session approach, and 2) The Chronic Care Model, a holistic community-based program. Data collection will involve interviews, focus groups, surveys and assessments of each program; and testing of patient participants for A1c, depression, Body Mass Index (BMI), and chronic stress with hair cortisol levels. We will recruit a total of 240 patient-social support pairs: Patients will be adults (men and women over the age of 18) who: 1.) Enter one of the two diabetes programs during the study; 2.) Self-identify as "Latino;" 3.) Are able to identify a social support person or key member of their social network who also agrees to participate with them; 4.) Are not pregnant (participants who become pregnant during the study will be excluded); and 5.) Have household income 250% of the Federal Poverty Level (FPL) or below. Social supports will be adults who are identified by the patient participants. PRIMARY OUTCOME: Improved capacity for diabetes self-management measured through improvements in diabetes knowledge and diabetes-related patient activation. SECONDARY OUTCOME: Successful diabetes self-management as measured by improvements in A1c, depression scale scores, BMI, and circulating levels of cortisol to determine chronic stress.
Our hypothesis is that the program model that interfaces most synergistically with patients' culture and everyday life circumstances will have the best diabetes health outcomes.
This study was registered with ClinicalTrials.gov on December 16, 2016 (Registration #NCT03004664).
Although diabetes is a national health crisis, risk is not the same for everybody. Individuals from minority and ethnic populations and those with low-income status are at significantly higher risk [1]. Health guidelines emphasize the importance of patient self-care over narrow reliance on medical treatments for reducing the health impact of diabetes and improving diabetes health outcomes. However, systematic reviews have repeatedly demonstrated that culturally competent health promotion approaches that account for culture and the social context of poverty can be key to improving health outcomes [2,3,4,5,6,7,8,9,11]. In particular, culturally competent self-management interventions have been shown to significantly improve both glycemic control and behaviors related to diet and physical activity, and also to increase diabetes-related knowledge. A variety of different models have been developed to create "culturally competent" diabetes self-management programs [2,3,4,5,6,7,8,9,11]. Yet, there is no agreement on what cultural competence specifically means or entails, and, because of a continued emphasis on individual behavior in approaches to diabetes health promotion, the design of self-management programs does not always create cultural competence in a way that makes sense in relation to patients' lives or improve their health.
Methods/Design
This patient-engaged project compares the effectiveness of two distinct evidence-based models for culturally competent diabetes self-management health promotion currently being implemented by programs available to Latino patients from low-income households in Albuquerque, New Mexico. We hypothesize that the program model that interfaces most synergistically with patient's culture and everyday life circumstances will have the better diabetes health outcomes (See Fig. 1: Conceptual Model).
Conceptual model
Aim #1 : Characterize the ways that two distinct culturally competent diabetes self-management programs interface with patient culture and socioeconomic context.
Aim #2 : Measure and compare improvement in patient capacity for diabetes self-management.
Aim #3 : Measure and compare patient success at diabetes self-management.
Data will be gathered at baseline, three, six and 12 months by community data collectors who will be members of the research team. Each of the comparator sites is implementing a program in a "real life" setting, thus providing the opportunity for a pragmatic assessment of the comparative effectiveness of the program models under externally valid and generalizable conditions.
Study population demographics
New Mexico, one of four majority minority states, has the largest percentage of Latinos in the United States (46.3% of the state's population) [12]. Of New Mexico's nearly one million Latino residents, most are of Mexican ancestry (62%) [13]. In Albuquerque, 47% of the population is Latino [14]. In New Mexico, 18.9% of Latinos live in households below the poverty level and 12.4% of Latinos have diabetes [15]. Census data reveal that Mexican-heritage Latinos tend to self-identify as racially "white" (53%) or as "some other race" (37%) [16]. This fact and the specific racial make-up of the New Mexico population influence our anticipated enrollment.
Source of Recruitment, Including the Volume of Eligible Patients Available and Expected Participation Rate. We will recruit 240 patient participants from the two programs through our site partner institutions. Estimates of current clinical use suggest that we will be able to successfully recruit participants to meet our target enrollment (See Table 1).
Table 1 Target Enrollment
Comparator #1. The Diabetes Self-Management Support Empowerment Model (DSMS) [17]. The DSMS is a patient-centered, theoretically based educational framework. It combines a series of clinically informed group didactic sessions that use a patient self-determination approach to empower patients to take control of their own diabetes health with follow-up supports to sustain self-management gains achieved during the sessions. The DSMS requires that educators acquire proficiency in culturally competent supportive care across the lifespan as one of five domains for certification. Educators are expected to be informed about, anticipate, and be aware of specific challenges that might accrue in the patient's diabetes self-management experience.
Comparator #2. The Chronic Care Model (CCM) [11, 18]. The CCM involves six synergistic domains: 1.) Improved access to care, 2.) Patient self-management support, 3.) Patient decision support, 4.) Care coordination, 5.) Integrated health information systems, and 6.) Access to community resources. To create a holistic care regime, the CCM focuses on addressing social determinants of health by meeting the medical, cultural, and linguistic needs of patients through integration of cultural norms and social relationships from the patient population into the program design.
Participant characteristics
This project will enroll three types of participants for different components of the study:
Social supports
Program staff and providers
Patient (n = 240) & social support (n = 240) participants
Participants for this study will be enrolled as patient-social support dyads. One hundred twenty patients and their corresponding social supports will be enrolled at each site. All patient participants will be adults (men and women over age 18) who: 1.) have been identified by a provider as having pre-diabetes (A1c between 5.7–6.4%) or diabetes (A1c ≥6.5%) and enter one of the two diabetes programs during the study; 2.) self-identify as "Latino" or "Hispanic;" 3.) are able to identify a social support person or key member of their social network who also agrees to participate with them; 4.) are not pregnant (participants who become pregnant during the study will be excluded); and 5.) have household income 250% of the FPL or below. Social support participants will be adult individuals who are identified by the patient participants.
Subset of patient and social support participants for interviews (72) and focus groups (72)
At each of the sites, we will identify a purposive sample of interviewees and focus group participants from those already recruited to be in the study and invite them to participate.
Staff & providers (n = 36)
As part of our program assessment, we will identify up to 6 key program staff and/or providers per site each year.
Description of processes
We will use a variety of data sources to compare the effectiveness of the two models including program inventories, surveys, interviews, focus groups, and patient physical measures (A1c, BMI, PHQ-9, and hair cortisol). Domains of inquiry include: a.) program accommodation of patients' language preference, cultural values, and socio-economic limitations, b.) program-related interpersonal interaction and communication, c.) program design to encourage social support among participants, d.) social "fit" with and social support from program peers, e.) social support from program staff, f.) diabetes health knowledge, g.) diabetes self-activation, h.) stress management, i.) A1c control, and j.) lifestyle changes to support diabetes health. Program assessment data will allow us to characterize the nature of each program and its approach to cultural competence. Survey responses and clinical test results from a large sample at each site will yield empirical (quantitative) data on patient-reported outcomes. Interviews and focus groups with a subset of participants will provide rich, in-depth, contextually meaningful (qualitative) data regarding the domains of inquiry from the perspective of patients, social supports, and program staff/providers.
All study activities will be conducted in English or Spanish, depending on the language preference of the participant. For each component of the study, the participant will receive a $50 merchandise card.
Programmatic assessment
We will inventory each program regarding program design, size, structure, operation, and theoretical/philosophical orientation; professional qualifications/training of program providers; activities or resources available through the programs; strategies in place for Spanish language use or acceptance, inclusion of social supports and family, accommodation of challenges created by patients' limited socioeconomic circumstances, and the inclusion of stress management techniques; and data on referrals to the program, sign-ups, participation, no-shows, and attrition. To gather qualitative information, we will conduct interviews with providers and staff at each site. We will assess patient and social support participants' perceptions of the program interface using a cultural competence survey [19, 20] that asks about physician bias, inter-cultural understanding, respectful interactions, language barriers, experiences of discrimination, and issues of trust. To gather qualitative information about cultural competence, we will include questions on programmatic interface in interviews and focus groups with patients and social supports (described below).
We will hire four individuals from the population of study to work as Data Collectors. The Data Collectors will administer the survey orally to all patient and social support participants at baseline (when they enter the study), with follow-up at three, six, and 12 months. All participants will be asked to provide: 1.) Contact information to be used for follow-up, notification of high A1c results, and to invite the participant to the end-of-project presentation of data to study participants; and 2.) Demographic information to be used to characterize the participant and to be used as covariates in the proposed analyses. The survey will consist of questions from or modified from four tools validated and found to be reliable in our population:
1.) The Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC) [19, 20] [used as part of the programmatic assessment discussed in the preceding paragraph—will be administered at 3, 6 and 12 months only].
2.) The Diabetes Knowledge Questionnaire (DKQ) [21,22,23].
3.) The Patient Activation Measure (PAM-13) [24,25,26,27,28,29,30,31,32].
4.) The Patient Health Questionnaire 9 (PHQ-9) [33,34,35,36].
We will conduct 72 interviews with patients and social supports (12 per year × 2 sites × 3 years). We believe that data from 12 interviews per site per year will capture a sufficient range of responses to achieve thematic saturation [37]. Interviews will last one to 2 h and will be semi-structured. We will audio-record interview sessions and recordings will be transcribed and translated if necessary.
We will conduct 12 focus groups (2 per year × 2 sites × 3 years). Focus group participants will be distinct from those recruited to participate in the interviews described in the preceding paragraph. Focus groups will include six distinct participants each. Focus groups will last one to 2 h and will follow a semi-structured focus group guide. We will audio-record focus group sessions and recordings will be transcribed and translated if necessary.
Physical measures
We will obtain the following measures from patients at baseline, 3, 6, and 12 months:
The phlebotomy-trained Data Collector will draw blood samples at the same time they administer the survey. A1c will be tested on whole blood using the DCA Vantage 2000 analyzer.
Patient participants' BMI will be calculated using height and weight measurements obtained by the data collectors. Height and weight measurements will be taken using a standardized protocol. Two measurements will be taken for height and two for weight for each participant at each data collection point. An average of the two measures of height and an average of the two measures of weight will be used in the BMI calculation. The calculation will be done automatically in the database.
Hair cortisol
To obtain objective information about the biological level of chronic stress, we will measure cortisol in hair. Hair cortisol is emerging as a reliable test for circulating levels of cortisol, which is an indication of chronic stress [38,39,40]. Hair will be gathered from patients only and not from social supports, and will only be gathered at two time points: baseline and 6 months (note: hair samples will only be gathered at baseline and 6 months).
The data just described will be managed using REDCap software [41] which includes data capture, storage, and reporting capabilities. Surveys will be designed in REDCap to capture study participants' contact information, demographic information, and responses to the survey questions. The physical measures of patient participants will also be stored in the REDCap database, and recruitment, data collection appointments, and participation in qualitative data gathering activities will also be tracked using the software.
Hypothesized effect sizes and sample size requirements for outcomes
We hypothesize that the CCM model will be superior to the DSMS in its ability to increase diabetes knowledge and patient activation, lower A1c, and improve depression scale scores, BMI, and levels of stress among participants. Our hypothesized effect sizes and measures of variability are based on previously reported improvements as measured by the various instruments (cited for each measure in Table 2).
Table 2 Hypothesized effect sizes and measures of variability
Sample size and power calculations
We will recruit N = 240 patient-social support pairs (n = 120 per site) with anticipated 20% attrition to obtain complete data on at least n = 96 pairs per site. Table 2 describes power for hypothesized effect sizes between the CCM and DSMS between the change scores from baseline to 6 months on the DKQ, and PAM-13. Similarly, we report power for the secondary measures (A1c, BMI, and PHQ-9), as well. We assumed a two-sided type I error rate and adjusted for the number of comparisons made (two comparisons for the co-primary outcomes; three for the co-secondary outcomes) using a Bonferroni correction (α = 0.025, α = 0.017, respectively). The power analyses for detecting site differences among change scores were based on multiple linear regression models including demographic characteristics, participants' perceived cultural competence of providers (CAHPS-CC), and social supports' change scores on the DKQ, PAM-13, and PHQ-9 as covariates. We report Cohen's f effect sizes based on the regression method [42, 43].
We will use descriptive statistics to summarize patient and social support characteristics. We will calculate means and standard deviations or medians and quartiles for continuous variables and will compare them across sites by t test or Wilcoxon rank sum test, depending on the distribution of the data. We will calculate frequencies and percentages for categorical variables and will compare them with the chi-square test or Fisher's exact test, as appropriate. To assess how the primary and secondary outcome measures change over time, we will fit linear mixed models to each outcome with the primary independent variable in each model being treatment site. The models will include covariates including participant characteristics, measures of social support, and exploratory measure of hair cortisol. Interactions between time and model will be included in each mixed model to determine whether measures change differentially between the sites over time. To address potential heterogeneity of treatment effects for poverty status (less than FPL versus between FPL and 250% FPL), we will also include an interaction term between poverty status and site. We will report adjusted least-squares mean difference estimates and appropriate confidence intervals of the outcome measures.
We will complement our quantitative analyses by conducting analyses of data from key staff/provider interviews (Aim #1), and patient/social support interviews and focus groups (Aims #1 & 2). We will follow criteria for a theory-driven qualitative content analysis [43]. We will identify themes, and code and subcode transcripts to explore interconnections between theme categories and to develop a holistic interpretation of the data.
It is common in studies of diabetes to have the primary outcome be A1c levels. But in this patient-engaged study, patients wanted us to take a different approach. We know how to get people to lower their A1c; the issue is getting them to do those things. Patients told us that you have to understand your diabetes, have the capacity to make changes in your life, and know how to control your stress before you can even think about lowering your A1c. Therefore, we said that "capacity" is measured by our two primary outcomes (diabetes knowledge and diabetes-related patient activation) and the success of the capacity is measured by the biological measures of A1c, BMI, depression, and cortisol. We hypothesize that the program that is most culturally and contextually situated will do the best job educating people about their diabetes in a meaningful, lasting way, helping them to become empowered (activated), and helping them or giving them strategies to deal with stress in their lives. Therefore the most culturally and contextually situated program will be the most "culturally competent" and will have the best impact on capacity for diabetes self-management (as measured by diabetes knowledge and patient activation in relation to diabetes health). We also expect to see primary, secondary, and exploratory outcomes to be correlated--e.g., patients with better knowledge and activation are likely to have lower A1c levels, lower BMI, improved depression scores, and lowered cortisol levels.
In addition, patients told us that the common approach to measuring diabetes control at the individual patient level fails to appreciate the cultural and social context of people's lives, which they believe is essential for understanding diabetes self-management for Latinos. To attempt to capture this social dimension of people's lives, we are recruiting patients and social supports as dyads. Patient outcomes will be measured and information we gather from social supports will inform our understanding of those results.
Obstacles we anticipate include confounders that may influence statistical analyses, attrition in participation that may make data collection difficult, and identification of A1c and depression levels that could require that we refer patients for further care. At the end of this 3-year study we expect to be able to identify the characteristics of diabetes self-management programs that make them culturally competent.
A1c:
HbA1c blood test for glycated hemoglobin or glycosylated hemoglobin to measure blood sugar level
CAHPS-CC:
The Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set
CCM:
The chronic care model
DKQ:
The diabetes knowledge questionnaire
DSMS:
The Diabetes Self-Management Support Empowerment Model (DSMS)
FPL:
Federal poverty level
PAM-13:
The patient activation measure (PAM-13
PCP:
pg/mg:
Picogram of cortisol per milligram of hair
PHQ-9:
The patient health questionnaire 9
REDCap:
Research Electronic Data Capture - a browser-based clinical and translational research database software program
Beckles G, Zhu J, Moonesinghe R. Diabetes - United States, 2004 and 2008. Morb Mortal Wkly Rep. 2011;60(Suppl 1):90–3.
Barrera M, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: A progress report. J Consult Clin Psychol. 2013;81(2):196–205. doi:10.1037/a0027085.
Hawthorne K, Robles Y, Cannings-John R, Edwards AGK. Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med J Br Diabet Assoc. 2010;27(6):613–23. doi:10.1111/j.1464-5491.2010.02954.x.
Kong A, Tussing-Humphreys LM, Odoms-Young AM, Stolley MR, Fitzgibbon ML. Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obes Rev Off J Int Assoc Study Obes. 2014;15(Suppl 4):62–92. doi:10.1111/obr.12203.
Lie DA, Lee-Rey E, Gomez A, Bereknyei S, Braddock CH. Does cultural competency training of health professionals improve patient outcomes? A systematic review and proposed algorithm for future research. J Gen Intern Med. 2011;26(3):317–25. doi:10.1007/s11606-010-1529-0.
Nam S, Janson SL, Stotts NA, Chesla C, Kroon L. Effect of culturally tailored diabetes education in ethnic minorities with type 2 diabetes: a meta-analysis. J Cardiovasc Nurs. 2012;27(6):505–18. doi:10.1097/JCN.0b013e31822375a5.
Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabet Med J Br Diabet Assoc. 2013;30(9):1017–25. doi:10.1111/dme.12188.
Ricci-Cabello I, Ruiz-Pérez I, Rojas-García A, Pastor G, Rodríguez-Barranco M, Gonçalves DC. Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression. BMC Endocr Disord. 2014;14:60. doi:10.1186/1472-6823-14-60.
Whittemore R. Culturally competent interventions for Hispanic adults with type 2 diabetes: a systematic review. J Transcult Nurs Off J Transcult Nurs Soc Transcult Nurs Soc. 2007;18(2):157–66. doi:10.1177/1043659606298615.
Zeh P, Sandhu HK, Cannaby AM, Sturt JA. The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review. Diabet Med J Br Diabet Assoc. 2012;29(10):1237–52. doi:10.1111/j.1464-5491.2012.03701.x.
Dauvrin M, Lorant V, d'Hoore W. Is the chronic care model integrated into research examining culturally competent interventions for ethnically diverse adults with Type 2 diabetes mellitus? A review. Eval Health Prof. 2015. doi:10.1177/0163278715571004.
Brown A, Lopez MH. Ranking Latino Populations in the States. Pew Res Cent Hisp Trends Proj. August 2013. http://www.pewhispanic.org/2013/08/29/ii-ranking-latino-populations-in-the-states/. Accessed 2 Feb 2016.
United States Census Bureau. American Community Survey Demographics and Housing Estimates 2012. American Fact Finder. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed 1 Sept 2014.
The Heller School for Social Policy and Management. Albuquerque, NM. diversitydata.org. http://www.diversitydata.org/Data/Profiles/Show.aspx?loc=68. Accessed 4 Feb 2016.
New Mexico Department of Health. New Mexico's Indicator-Based Information System. https://ibis.health.state.nm.us/. Accessed 4 Feb 2016.
Ennis SR, Rios-Vargas M, Albert NG. The Hispanic Population: 2010. United States Census Bureau; 2011. http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf. Accessed 2 Feb 2016.
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National Standards for diabetes self-management education. Diabetes Care. 2011;34(Suppl 1):S89–96. doi:10.2337/dc11-S089.
Stellefson M, Dipnarine K, Stopka C. The chronic care model and diabetes management in US primary care settings: a systematic review. Prev Chronic Dis. 2013;10:E26. doi:10.5888/pcd10.120180.
Agency for Healthcare Research and Quality. CAHPS: Assessing Health Care Quality From the Patient's Perspective. US Department of Health and Human Services; 2014. https://www.ahrq.gov/cahps/about-cahps/cahps-program/cahps_brief.html. Accessed 10 Nov 2015.
Agency for Healthcare Research and Quality. About the CAHPS Cultural Competence Item Set. https://cahps.ahrq.gov/surveys-guidance/survey4.0-docs/2312_about_cultural_comp.pdf. Accessed 10 Nov 2015.
Sixta CS, Ostwald S. Texas-Mexico border intervention by promotores for patients with type 2 diabetes. Diabetes Educ. 2008;34(2):299–309. doi:10.1177/0145721708314490.
Mauldon M, Melkus GD, Cagganello M. Tomando Control: a culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes mellitus--evaluation of a pilot project. Diabetes Educ. 2006;32(5):751–60. doi:10.1177/0145721706291999.
Garcia AA, Villagomez ET, Brown SA, Kouzekanani K, Hanis CL. The Starr County Diabetes Education Study: development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001;24(1):16–21.
Schiøtz ML, Bøgelund M, Almdal T, Jensen BB, Willaing I. Social support and self-management behaviour among patients with Type 2 diabetes. Diabet Med J Br Diabet Assoc. 2012;29(5):654–61. doi:10.1111/j.1464-5491.2011.03485.x.
Rygg LØ, Rise MB, Grønning K, Steinsbekk A. Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial. Patient Educ Couns. 2012;86(1):98–105. doi:10.1016/j.pec.2011.04.008.
Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med. 2010;8(5):410–7. doi:10.1370/afm.1161.
Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42(4):1443–63. doi:10.1111/j.1475-6773.2006.00669.x.
Hibbard JH, Mahoney E. Toward a theory of patient and consumer activation. Patient Educ Couns. 2010;78(3):377–81. doi:10.1016/j.pec.2009.12.015.
Hibbard JH. Community-based participation approaches and individual health activation. J Ambulatory Care Manage. 2009;32(4):275–7. doi:10.1097/JAC.0b013e3181ba6f63.
Hendriks M, Rademakers J. Relationships between patient activation, disease-specific knowledge and health outcomes among people with diabetes; a survey study. BMC Health Serv Res. 2014;14:393. doi:10.1186/1472-6963-14-393.
Dixon A, Hibbard J, Tusler M. How do People with Different Levels of Activation Self-Manage their Chronic Conditions? The Patient. 2009;2(4):257–68. doi:10.2165/11313790-000000000-00000.
Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–26. doi:10.1111/j.1475-6773.2004.00269.x.
Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21(6):547–52. doi:10.1111/j.1525-1497.2006.00409.x.
Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602. doi:10.1007/s11606-007-0333-y.
Reuland DS, Cherrington A, Watkins GS, Bradford DW, Blanco RA, Gaynes BN. Diagnostic accuracy of Spanish language depression-screening instruments. Ann Fam Med. 2009;7(5):455–62. doi:10.1370/afm.981.
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a Brief Depression Severity Measure. J Gen Intern Med. 2001;16(9):606–13. doi:10.1046/j.1525-1497.2001.016009606.x.
Yamada J, Stevens B, de Silva N, Gibbins S, Beyene J, Taddio A, Newman C, Koren G. Hair cortisol as a potential biologic marker of chronic stress in hospitalized neonates. Neonatology. 2007;92(1):42–9. doi:10.1159/000100085.
Guest G, Bunce A, Johnson L. How Many Interviews Are Enough? Field Methods. 2006;18(1):59–82.
Lehrer HM, Dubois SK, Maslowsky J, Laudenslager ML, Steinhardt MA. Hair cortisol concentration and glycated hemoglobin in African American adults. Psychoneuroendocrinology. 2016;72:212–8. doi:10.1016/j.psyneuen.2016.06.018.
Larsen SC, Fahrenkrug J, Olsen NJ, Heitmann BL. Association between Hair Cortisol Concentration and Adiposity Measures among Children and Parents from the "Healthy Start" Study. PLoS One. 2016;11(9):e0163639. doi:10.1371/journal.pone.0163639.
Kim S, Love F, Quistberg DA, Shea JA. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care. 2004;27(12):2980–2.
Selya AS, Rose JS, Dierker LC, Hedeker D, Mermelstein RJ. A Practical Guide to Calculating Cohen's f(2), a Measure of Local Effect Size, from PROC MIXED. Front Psychol. 2012;3:111. doi:10.3389/fpsyg.2012.00111.
Gläser J, Laudel G. Life with and without coding: Two methods for early-stage data analysis in qualitative research aiming at causal explanations. Forum Qual Sozialforschung. 2013;14(2). http://www.qualitative-research.net/index.php/fqs/article/view/1886.
Wolever RQ, Dreusicke M, Fikkan J, Hawkins TV, Yeung S, Wakefield J, Duda L, Flowers P, Cook C, Skinner E. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010;36(4):629–39. doi:10.1177/0145721710371523.
Druss BG, Zhao L, von Esenwein SA, Bona JR, Fricks L, Jenkins-Tucker S, Sterling E, DiClemente R, Lorig K. The Health and Recovery Peer (HARP) Program: A peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res. 2010;118(1–3):264–70. doi:10.1016/j.schres.2010.01.026.
Grønning K, Rannestad T, Skomsvoll JF, Rygg LØ, Steinsbekk A. Long-term effects of a nurse-led group and individual patient education programme for patients with chronic inflammatory polyarthritis - a randomised controlled trial. J Clin Nurs. 2014;23(7–8):1005–17. doi:10.1111/jocn.12353.
Lorig K, Ritter PL, Villa FJ, Armas J. Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educ. 2009;35(4):641–51. doi:10.1177/0145721709335006.
Looker HC, Knowler WC, Hanson RL. Changes in BMI and weight before and after the development of type 2 diabetes. Diabetes Care. 2001;24(11):1917–22.
Avery L, Flynn D, van Wersch A, Sniehotta FF, Trenell MI. Changing physical activity behavior in type 2 diabetes: a systematic review and meta-analysis of behavioral interventions. Diabetes Care. 2012;35(12):2681–9. doi:10.2337/dc11-2452.
Bogner HR, Morales KH, de Vries HF, Cappola AR. Integrated management of type 2 diabetes mellitus and depression treatment to improve medication adherence: a randomized controlled trial. Ann Fam Med. 2012;10(1):15–22. doi:10.1370/afm.1344.
Lorig K, Ritter PL, Laurent DD, Plant K, Green M, Jernigan VBB, Case S. Online diabetes self-management program: a randomized study. Diabetes Care. 2010;33(6):1275–81. doi:10.2337/dc09-2153.
Sauvé B, Koren G, Walsh G, Tokmakejian S, Van Uum SH. Measurement of cortisol in human hair as a biomarker of systemic exposure. Clin Invest Med. 2007;30(5):E183–91. PMID: 17892760
Russell E, Kirschbaum C, Laudenslager ML, Stalder T, de Rijke Y, van Rossum EF, Van Uum S, Koren G. Toward standardization of hair cortisol measurement: results of the first international interlaboratory round robin. Ther Drug Monit. 2015;37(1):71–5. doi:10.1097/FTD.0000000000000148. PMID: 253872
Staufenbiel SM, Penninx BW, de Rijke YB, van den Akker EL, van Rossum EF. Determinants of hair cortisol and hair cortisone concentrations in adults. Psychoneuroendocrinology. 2015;60:182–94. doi:10.1016/j.psyneuen.2015.06.011. PMID: 26176863
Short SJ, Stalder T, Marceau K, Entringer S, Moog NK, Shirtcliff EA, Wadhwa PD, Buss C. Correspondence between hair cortisol concentrations and 30-day integrated daily salivary and weekly urinary cortisol measures. Psychoneuroendocrinology. 2016;71:12–8. doi:10.1016/j.psyneuen.2016.05.007.
Ursache A, Merz EC, Melvin S, Meyer J, Noble KG. Socioeconomic status, hair cortisol and internalizing symptoms in parents and children. Psychoneuroendocrinology. 2017;78:142–50. doi:10.1016/j.psyneuen.2017.01.020. [Epub ahead of print]. PMID: 28199857
Aguiló J, Ferrer-Salvans P, García-Rozo A, Armario A, Corbí Á, Cambra FJ, Bailón R, González-Marcos A, Caja G, Aguiló S, López-Antón R, Arza-Valdés A, Garzón-Rey JM. Project ES3: attempting to quantify and measure the level of stress. Rev Neurol. 2015;61(9):405–15. PMID: 26503316
Cohen JE. Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates, Inc: Hillsdale; 1988.
We would like to recognize the contribution of our Patient Advisory Board members who met monthly over a period of 2 years to provide substantial input for the design of this patient-engaged study. We would also like to acknowledge Mary Lynn Johnston at the UNM Hospital Center for Diabetes Education, and Blanca Pedigo and John Bulten at One Hope Centro de Vida Health Center/East Central Ministries, who are our site partners. Hannah Cole-McGrew joined our team after the project was funded and is now providing significant support for implementation of the study, and Maria Tellez has been our patient engagement coordinator and now manages the activities of community data collectors, Virginia Sandoval, Denisse Guerrero, and Loida Varela.
The research described in this protocol has been funded through a peer review process by the Patient-Centered Outcomes Research Institute (PCORI) under # CER-1511-32,910 and is currently in progress. The production of this article was supported in part by PCORI Awards (Tier I-#7,738,704, Tier II-#7,738,704, & #CER-1511-32,910). The views presented in this work are solely the responsibility of the authors and do not necessarily represent the views of the PCORI and its Board of Governors or Methodology Committee. Additional personnel training and clinical laboratory expertise was provided by the University of New Mexico Clinical and Translational Research Center (NCATS #8UL1TR000041).
As this study just began to enroll participants in February 2017, no data is currently available to be shared. Following the end of the study, the de-identified datasets generated and/or analysed will be stored in the UNM data repository, LoboVault, a designated long-term digital archive resource maintained by the UNM Libraries. Quantitative data will be available from the corresponding author on reasonable request. Qualitative data (interview and focus group transcripts) will not be shared because this data will have been gathered from a small sample and will contain a large amount of personal information that would identify the participant.
University of New Mexico Health Sciences Center, Albuquerque, USA
Janet Page-Reeves, Lidia Regino, Cristina Murray-Krezan, Molly Bleecker, Erik Erhardt, Mark Burge, Elaine Bearer & Shiraz Mishra
Janet Page-Reeves
Lidia Regino
Cristina Murray-Krezan
Molly Bleecker
Erik Erhardt
Mark Burge
Elaine Bearer
Shiraz Mishra
JPR, the PI, brought together the team, conceptualized the study design, worked closely with the patient partner (Co-PI) to engage patient stakeholders to develop the research question and patient-identified outcome measures, was the lead writer, and wrote sections on program inventory, interviews, focus groups, qualitative analysis and patient characteristics. LR, the patient partner Co-PI, convened a Patient Advisory Board, worked closely with the PI to engage patient stakeholders as indicated above, and provided input to ensure the cultural appropriateness of the project design and data collection techniques. CMK was the principal designer of the quantitative data analysis plan and primary author of sections regarding power, sample size, and analysis of outcome data. MB identified the database software and the instruments and wrote sections describing the survey psychometrics and use, wrote sections describing data management and storage, and assisted with bibliographic materials. EE was a major contributor in the design and writing of the quantitative data analysis plan. MRB designed the component of the study involving analysis of patient A1c data and advised on study design related to participant eligibility, crisis management planning for patients found to have high A1c, and all aspects of diabetes health that needed to be considered in the design and implementation of this study. ELB designed the component of the study involving analysis of patient hair samples for circulating levels of cortisol as a biomarker for chronic stress. She provided language regarding hair collection, analysis, and storage procedures. She reviewed and edited the MS and drafted the discussion. SIM provided guidance for incorporating patient-identified outcome measures into the study design and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.
Correspondence to Janet Page-Reeves.
This study was approved by the Human Research Protections Office (HRPO) which is the ethnics committee for the University of New Mexico (UNM) on October 7, 2016 (HRPO study approval #16–303). The study began recruiting in February 2017. All participants will provide written informed consent.
Page-Reeves, J., Regino, L., Murray-Krezan, C. et al. A comparative effectiveness study of two culturally competent models of diabetes self-management programming for Latinos from low-income households. BMC Endocr Disord 17, 46 (2017). https://doi.org/10.1186/s12902-017-0192-4
Hispanic Americans


text:
Q: How to nest button style element within app theme in Android Studio project I am trying to define the Material Button background colour as a theme in my Android App, so that all buttons get the style from the app theme. I have the following style defined in my Android app.
I have the following in my theme/style xml file
<style name="Theme.SimpleTheme" parent="Theme.MaterialComponents.DayNight.DarkActionBar">
    <!-- Some theming -->
</style>

<style name="SimpleButton" parent="Widget.MaterialComponents.Button">
    <item name="colorPrimary">@color/blue_grey_800</item>
    <item name="colorOnPrimary">@color/white</item>
</style>

Then in the layout file, I have:
<com.google.android.material.button.MaterialButton
    android:theme="@style/SimpleButton" />

Now, this works to get a particular button have my desired background colour, but I have to set the Style attribute in all the material button elements in all the layout files.
Is there any way I can nest the styles so that I do not need to explicitly mention the style in all the buttons?

A: Yes, there is a way to do that.
First, create a theme for your button, and make it inherit AppCompat Button (although it's a material button).
for example:
<style name="bTheme" parent="Widget.AppCompat.Button">
        <item name="android:backgroundTint">@color/black</item>
        <item name="android:textColor">@color/white</item>
</style>

Then, on the main app's theme, add the following line:
<item name="materialButtonStyle"> @style/bTheme</item>

This should do the trick :)

redpajama_set_name: RedPajamaStackExchange


The commissioning of the new Blue Gene/Q petaflop supercomputer JUQUEEN marks another quantum leap in supercomputer performance at JSC. At the same time, it is recognized that special efforts by the users are necessary in order to get the most out of this unique research tool.
The aim of this hands-on workshop is to support current users of JUQUEEN in porting their software, in analyzing its performance, and in improving its efficiency. It is highly recommended that project PIs send at least one expert on their code to this workshop.
This course is a PATC course (PRACE Advanced Training Centres).


text:
Q: ES6 Filter/reduce an Object from an array Given
commentIdList = [2,3]
comments = { 1 : "a", 2: "b", 3: "c", 4: "d" }

Output needed
filteredComments = [ {2:"b"} , {3:"c"} ]

My Unsuccessful try
const filteredComments = comments.filter((c)=> commentsIdList.map(comment=>c.id === comment))

A: Use Array.map() to iterate commentIdList. Get the value from comments by the key (id), and create a new object using computed property names:

const commentIdList = [2,3];
const comments = { 1 : "a", 2: "b", 3: "c", 4: "d" }
const filteredComments = commentIdList.map((id) => ({
  [id]: comments[id]
}));

console.log(filteredComments);

A: This is one way
commentIdList.map(commentId => ({ [commentId]: comments[commentId] })


Red Tapered Triangle Pendant - 18"
This red cuboid triangle pendant is ruby red with chunky glitter suspended in it. This pendant comes with a 18" stainless steel ball chain.
Red Tapered Triangle Pendant - 16"


Of course, I'm talking about the dreaded teen years. But, you know, they don't have to be that way: dreaded, that is. There are things you can start doing NOW to lay a foundation for a fruitful and yes, even enjoyable, stage in the parenting journey.
At first glance, this simple art may not seem like a big deal, but taking the time to actively listen and engage in conversations with your little ones is definitely laying the foundation for future conversations. If you've found their chatter irrelevant for the first 11 years of their life (and, believe me, they can tell!), it's going to be a whole lot tougher getting them to open up when the stuff starts gettin' deep just because you've decided that dialogue is now important.
Spend time doing things your kids enjoy. Building Lego forts and having tea parties may not be your idea of a good time, but those simple acts go a long way to show your little ones that they're valued. Include them in doing things that you enjoy…baking, crocheting, going for walks, etc. Sure, it'll slow you down a little, but you're building a foundation for your future relationship. It's worth it.
While rescuing our children from unpleasant consequences might seem that we're doing them a favor, in the long run, we're seriously short-changing them. Kids need to understand that we're not always going to be there to save the day. And what better time to learn that than when they're young and the consequences are likely to be far less reaching and detrimental.
In all our getting obedience from our kids we have to very careful to ensure that we don't lose their hearts. Outward obedience is nice, but if we've alienated their hearts, we've failed. Discipline and correction can be handled without shaming and belittling. And, if you mess it up, a sincere apology (without excusing their actions) will go a long way in showing your child that you value them.
Sure, we've mentioned understanding the "actions=consequences," aspect of responsibility, but it's equally important that our kids understand that they have a responsibility to their families. Households don't run themselves, but kids won't know that unless we take the time to teach them that everyone pitches in to do their part. Even toddlers are capable of helping put away their toys. Preschoolers can empty small trash cans and put away folded clothes. You can decide what responsibilities are age appropriate, but have them doing something! Talk to your kids about the roles that the adults play in keeping things going in your house. They need to know that responsibility requires things being done whether we feel like it or not. Parents go to work even when they're tired. Meals are prepared and clothes are washed even when we'd rather sit on our bums and watch TV. This ongoing conversation does a lot to help the kids understand the important part they play in the family dynamics, paves the way to transition into more responsibility as a teenager, and will eventually be a huge blessing to their future spouse, kids, and employers/employees.
Of course, instilling these principles in your child's heart does not guarantee a life of making smart decisions on their part, or a close relationship between you both. But it does lay a solid foundation from which they are better prepared to face life well-equipped. And it also makes it more likely that you can both enjoy the teen years…together.
You'll be able to sleep soundly, knowing that you did ~ and are doing ~ the best you can in the most important role you'll ever have!
Are you a parent of teens? Or are you on "the other side" of parenting, with adult children? What else would you add to this list? Share your wisdom with us!
How true. Maybe I'm more acutely aware of the link between toddlers and teenagers because we spend time with a teen-aged aunt regularly, and I've watched her grow since she was 4. I definitely see the link between how she was parented as a small child and how she acts now. And I see how she acts now affects my toddler! Sadly, I think this awareness has made me too tight on the reigns….Pray that I find the right balance!
I have a preteen and a 6 year at home plus 3 teenage and 2 adult step children who visit often. I have let them all know growing up that it matters most that they are whole heartedly good people to themselves and others and never stop trying to succeed in whatever they want to be or do. 15-16 seems to be the hardest to deal with just because they always seem to think its just them and nobody understands but as they get older, if you reassure them they aren't alone and can talk to you it gets much better.
Excellent advice, Kristina! 15-16 is a tough time for some. My oldest son really struggled during those years. Thankfully, my 2nd didn't and my 3rd, who is smack dab in the middle at 15 1/2, seems to be doing well. Praying that my preteen will do well. My husband and I are definitely laying the best foundation we can, but sometimes we fall short. And, of course, ultimately the kids make their choices.
Honestly, Brittany, you'd have to work pretty hard to do that! LOL But seriously, those years will FLY by (and yes, I know you've heard that before, probably ad nauseum!) Keep your "end game" always in the forefront!! Thanks for stopping by!
Good words, Candy. With two 11 year olds I feel like we're seeing what we "should have" done better and are more on top of relationship building now that we realize how short our time with them really is! I appreciate your balanced perspective on obedience and relationship. There is no benefit to sacrificing either in favor of the other.
Thanks, Abi! And, you're right, our time with them certainly is short. So glad that you've made changes that will build relationship. Oh, how I wish I'd figured that out sooner with my oldest. But, God is merciful and knows our hearts even when we fall short and I'm thankful to say that things turned out fine and we have a great relationship now.
Our children are 16, 14, 12, 7, 5, 2 and a new baby and you have written a wonderful post! What you say is true about spending time and listening to what they have to say as well as teaching them to work along side of you will mean that as they grow you'll have created a respectful and loving bond. We have found that we feel more like guides now with our older children and have the greatest times together of prayer and fellowship in the Lord. Praise God for His wisdom and goodness and ask Him every day as you parent for it. Thanks for the encouraging post!
I love this, Jeannie! What a wonderful testimony you have. 🙂 "We have found that we feel more like guides now with our older children…" Exactly! I'd never thought to word it that way, but you definitely hit the nail on the head. I hope you'll continue to join us here as we share the insight that God has, through time (ok, AND age), given us. I'm certain that you'll have wisdom to share and that your comments will be a blessing and encouragement to many.
Thanks for the advice – something I need to think about! We now we need to think about the future, but sometimes it's so much easier just to deal with the now. Thanks for sharing with the #BlogFair, hope you can visit again this week.
Totally agree…Much easier to deal with the now! 🙂 Unfortunately, the "now" becomes the past much too quickly, doesn't it?
The active listening part is really hard for me. I have an 11 year old that loves to talk and two little toddler boys who love to get into trouble. I've started planning dates just for us and taking her to run errands with me. I still need to make time to just sit and talk with her about whatever she wants. Today is the best time to start, right?! Thank you for sharing!
Girl, I know! Active listening is so hard some days. The dates are an excellent idea! Pat does that with her kids. I wake one of mine early every morning so we can have one-on-one time and always spend intentional time with another just before bed. And then, of course, we do need to teach them that it's not all about them and sometimes conversation has to wait. Parenting is like this super crazy balancing act. Sometimes we'll get it right and sometimes we won't, but at the end of the day if they know we love them and we're doing our best, I think we can call it a success. Blessings to you on your mama-ing journey!
Here via the Learning Kid Linkup.
We're still awhile away from the teen years, but this is great advice.


In the Milwich Parish Survey of 2010, All Saints Church was considered "important" to the community by the majority of parishioners, as a building, place of worship and for major life events such as Baptisms, Funerals and Weddings.
Maintaining All Saints historic building, the churchyard and supporting ministry in the Parish costs Milwich Church approximately £1,200 a month and presently we are falling somewhat short of this. These monies have to be found locally from the congregation, supporters and reserves, which are being used up very quickly.
The repairs to the building as identified in the quinqennial inspection have been delayed for the last three years but an additional £4,000 will have to be found for this, during the latter part of this year and early next.
If you are one of those who consider the Church to be an "important" part of the village then we ask you to please help us as much as you feel able.
This can be done in a number of different ways. Please support the fund raising events we hold each year or consider helping us with a donation.
Whilst we will always be pleased to see you at our Sunday services, we accept that it may not be your wish to attend church every week but we invite you to support us and become a friend of the Church by making a weekly, monthly or annual donation. If you are a tax payer, we can recover a further 25% from the Revenue if you sign a gift aid form. Ring Paul on 505099 for details.
All Saints Village Hall is vested in Milwich Church and the Church also have to underwrite the running costs but thankfully the hall is presently breaking even.
We know times are presently difficult for many but any help you can give will be very much appreciated.


Nanda Bhauju Saurya Urjah was established to help community households by providing light to increase the working hours of women and the study hours of children.
Tulasa and Om Kumari have known each other for 25 years, and they aspired to work together like sisters helping the community to brighten their households.
Tulasa Pathak got married at the age of 20 and though her family members were not supportive when she involved herself in work, her husband was her inspiration.
She began her journey into business so that she could help her husband financially and help her son complete his engineering degree while simultaneously contributing to her community.
Om Kumari Mahato aims to grow her business throughout the district. A single mother and a teacher by profession, she desires to commit her life for the good of her community and create a positive impact through solar products.


text:
declare module api {

  interface IStep {
    order: number;
    picture: string;
    text: string;
  }

  interface IIngredient {
    order: number;
    quantity: number;
    food: IFood;
  }

  interface IRecipe {
    id: number;
    name: string;
    description: string;
    picture: IPicture;
    cooking_time: number;
    preparation_time: number;
    number_servings: number;
    steps: IStep[];
    ingredients: IIngredient[];

    // not implemented yet
    tags: string[];
    suggestions: string[];
  }

}

redpajama_set_name: RedPajamaGithub


Filled with marshmallow vodka, hot cocoa and graham cracker crumbs, this s'mores-inspired cocktail has all the goodness of the campfire classic with a soul-warming boozy kick. Garnish with toasted marshmallows and chocolate-dipped graham crackers for a tasty finishing touch.
Bourbon, chocolate ganache and marshmallow meringue? Yes, please. A splash of booze gives this pie its bold flavor, but feel free to leave it out since it doesn't change the consistency of the ganache.
Perfect for apartment dwellers or indoor theme parties, this portable s'mores centerpiece pulls double duty as decor and marshmallow roasting station. Your buffet will never be the same!
Transform your favorite fireside treat into an easy-grab brownie bar you can bake in the oven. Pro tip? Double the recipe. These delicious bites go fast!
Surprise an outdoorsy friend with everything they need to make their own ooey-gooey s'mores. Hand-make the cookies, marshmallows and chocolate squares so they're especially tasty, then package the goodies "hobo-style" for a gift that's ready to travel.
Looking for a creative, grab-n-go dessert for your next party? Skip the campfire and pre-make s'mores by holding skewers of marshmallows over a flame, then dipping them in chocolate and graham cracker crumbs.
Served in a Mason jar and topped with torched marshmallow fluff, this s'mores-pumpkin pie mashup is all of our dreams come true.
For your next fireside gathering, set up a mobile outdoor s'mores station by outfitting a serving tray with all the necessities. Keep marshmallows in a tall vase and arrange graham crackers and chocolate on a platter. Mix things up a bit by adding extra options like pretzels or peanut butter cups!
Throw together the delicious flavors of marshmallow, graham cracker and rich, semi-sweet chocolate to make this yummy, giftable bark perfect for stocking stuffers or holiday parties!
Yes, marshmallows are cheap and easy to buy, but it's so much more rewarding to make your own!
Is it possible to improve on the classic? Maybe if your love for pie crust outweighs your love for graham crackers. This simple recipe gives s'mores a crispy, flaky base that will leave your guests asking for, well, s'more.
Take your patio party to the next level with these marshmallows-turned-edible shot glasses overflowing with chocolate, booze and s'more booze.
No place for a real firepit? Turn any outdoor surface into the perfect gathering spot with this tabletop fire bowl made from a ceramic planter.
Are you and your S.O. stuck in a date-night rut? Pack a picnic basket full of nibbles you can cook over a fire, head out to the backyard and cozy up in the great outdoors for an evening. Cap it all off with after-dinner drinks and s'mores for dessert!
Help guests have "s'more" fun after the party ends by sending them home with one of these sweet snack boxes.


text:
Making Speedbumps 4 Eels
Like a synchronized school of fish, a group of Glass students in RISD's Hot Shop circle around the casting furnace to check on a collection of newly formed bell-shaped jars.
Like a synchronized school of fish, a group of Glass students in RISD's Hot Shop circle around the casting furnace to check on a collection of newly formed bell-shaped jars. Ever so careful not to bump into each other – or the molten hot tools strewn about – they inspect pieces being made for Speedbumps 4 Eels and Other Intelligent Creatures. "We're making aquatic habitats that will attract marine animals indigenous to local rivers," explains Cydney Ferguson-Brey MFA 14 GL. "The glass biospheres will float close to the surface of the water so people can see wildlife in their natural habitats."
The project is the latest in a series of artistic experiments led by Natalie Jeremijenko, an Australian-born professor of art and education who currently teaches at New York University (NYU) and is serving as a visiting artist in Glass this semester. The engineer and biophysicist expresses her environmental activism through site-specific installations that facilitate whimsical, slightly off-kilter interactions between humans and "non-humans."
For instance, a couple years ago Jeremijenko installed a piece off the bank of Manhattan's East River called Mussel Choir, a "glee club" of bivalves hooked up to sensors and audio sensors that "sang" about the quality of water as they filtered it. She has also created seaweed bars containing chemical agents that rid organisms of heavy metals. The idea is that people can experience joy in feeding the fish knowing that they're also ridding their scaly bodies of poisonous mercury. And if they grow hungry themselves, they can taste the leafy bars, too. "A lot of my work attempts to motivate people to challenge our relationship to natural systems," she notes.
In the Glass studios, both undergraduate and graduate students are creating two types of lovely devices that will be incorporated into Speedbumps 4 Eels and another related project Jeremijenko envisions. One design is the bulbous jars, which will be partially submerged so that the water they capture will be heated up through solar energy – and attract aquatic creatures seeking warmth and the algae that will grow inside the glass space. Another design is rectangular, but also acts as an aquatic looking glass.
"Instead of taking dead – or at best, incarcerated – organisms out of their environment and putting them on display in a museum or under a transparent encasement, these installations allow viewers to see the behavioral patterns of eels in the wild," Jeremijenko explained to a small group of students who came to a presentation she made at RISD at the end of October. "The goal is to reveal what happens just underneath the water's surface. It's a fascinating thing to see."
Professor Rachel Berwick 84 GL, head of the Glass department, first became acquainted with Jeremijenko's socially-charged work in the early 1990s when they were both teaching at Yale. "I'm really excited that students got the chance to see the way Natalie works," notes Berwick. "She's a really ambitious artist who knows how to effectively execute an idea – even when there are a million infinitesimal decisions that have to be made before a vision becomes reality. Plus, she's an incredibly open and generous person."
In the spring, Jeremijenko will return to RISD to spark more eco-friendly installations and see how they fare in the waters of downtown Providence. She's excited to continue her work with the diverse students who navigate RISD's ever-shifting channels of exploration.
"This place is full of the wildest hutzpah and most valuable experimentation I've ever seen," Jeremijenko notes. "I've had more rewarding technical conversations with the RISD artists than with most of my science and engineering students. They're figuring out wondrous and meaningful things to do with these incredible materials, and their knowledge is both deeply technical and deeply engaged with cultural questions."
-Abigail Crocker

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: Insert row below a specific text (text occurrence times) vba-excel This code searches all "-" in column A and when it finds that character in a cell, adds a new row below:
    Sub insertRow()
      Dim c As Range
      For Each c In Range("A:A")
        If c.Value Like "*-*" Then
            c.Offset(1, 0).EntireRow.Insert
        End If
      Next c
    End Sub

I want to insert a row below every "-". If there are three "-" in a cell, I want to add three rows below that row and put in the text after every "-". How can I do that?
e.g.:
        column A:
        str1-str2-str3-str4
        str5
        str6-str7
        str8-str9-str10
        str11-
and the result like this:
        column A:
        str1
        str2
        str3
        str4
        str5
        str6
        str7
        str8
        str9
        str10
        str11
Can anyone help me? Thanks!

A: Something like the below should work - it relies on the array base 0 default indexing. If execution time is a concern, there may be ways to optimize though
Sub t_exe566965()
    Dim r As Range
    Dim a As Variant
    For Each r In Range("A:A")
        If r.Value Like "*-*" Then
            Debug.Print True
            a = Split(r.Value, "-")
            r.Offset(1, 0).Resize(UBound(a)).EntireRow.Insert Shift:=xlDown
            For i = LBound(a) To UBound(a)
                r.Offset(i, 0).Value = a(i)
            Next i
        End If
    Next r

End Sub


text:
Q: C# draw curve and polygon with mouse events I am a beginner in C#, so be gentle.
In C#, I want draw curves and polygons like in Paint; where you hold the left mouse button to draw. Can you give some advice or code on how to do that?
Thank you.

A: For the beginning, try just tracing the mouse with Graphics.LineTo() - then start to play with mouse down and up events, then go from there.  There is much to explore in the graphics area, and it should be lots of fun!
As for the array:
List<Point> points=new List<Point>();

later, on mouse move:
points.Add(new Point(mouse.X,mouse.Y));

and much later, if you need real point array
Point[] pa=points.ToArray();

A: You need to handle the mouse down, move and mouse up events while persisting some data which is then drawn on the Paint event of whatever control you are painting into.
Take a look at this CodeProject article for a good example of what you need to do.
For connecting points with a curve you should look at this article for drawing Bezier curves from a set of points. Here's another one that does spline interpolation.

A: The CodeProject article referenced by Paul Sasik is an excellent starting point.  For drawing curved lines, you might want to try using Graphics.DrawBezier(...), which takes an array of points as a parameter, and renders a curved line through the points.  This will have some complexity issues, though, as you need to decide how many consecutive points to use for each segment, and how to handle the running overlaps.


text:
Dodgers minor league news
Landon Knack tosses six innings, strikes out 10 for Tulsa
First career 10-strikeout game for the right-hander
By Ryan Walton@RyanCPWalton Jun 27, 2022, 6:01am PDT
Share All sharing options for: Landon Knack tosses six innings, strikes out 10 for Tulsa
Photo by John E. Moore III/Getty Images
Sunday in the Dodgers minors saw a mixed bag of results with some good pitching on display and a homer from a two top prospects.
Player of the day
Tulsa starting pitcher Landon Knack struck out a career-high 10 batters with no walks in six solid innings for the Drillers Sunday afternoon. The right-hander scattered nine hits and allowed just two runs to have his team in the lead when his day was done.
Knack was drafted in the second round (60th overall) by the Dodgers in 2020 out of East Tennessee State and is 9-5 with a 3.39 ERA in 25 career games (20 starts).
The 24-year-old has a brother-in-law named Will Craig who was drafted by the Pirates in the first round back in 2016. Craig is the first baseman in this play from last year with Javier Báez.
Triple-A Oklahoma City
Miguel Vargas hit his fifth homer of June (12th of the season) to give the Dodgers a 2-1 lead that six different pitchers made stand up in a win to close out the series with Round Rock (Rangers).
Gettin' Miggy with it for the lead!
Vargas hit his 12th homer of the season to put the Dodgers in front at 2-1! pic.twitter.com/wv3zhNKFM6
— Oklahoma City Dodgers (@okc_dodgers) June 26, 2022
It was an exciting finish after the Express put runners on first and second with two outs. A ground ball up the middle was fielded by shortstop Jake Amaya and he stepped on second for the force.
The umpire called safe as the runner reached at the same time but instead of bases loaded, the runner was sent from third on the play. Amaya fired it home to record the out and end the game.
One of the more unique endings to a game you'll ever see!
Dodgers hang on for a 2-1 win and take the series from Round Rock! pic.twitter.com/Ko00N8sf15
Ryan Noda drove in the other run on a single for OKC that tied the game in the second inning at the time. The 26-year-old third baseman finished the game 3-for-4 and went 7-for-19 overall in the series against Round Rock.
Double-A Tulsa
A three-run eighth for Midland (Athletics) erased an outstanding effort from Knack, sending Tulsa to a 5-3 loss to close out the final game of the series and the first half.
The Drillers led 3-2 after Knack's day was done heading into the seventh inning. Tulsa had a one-run advantage thanks to a solo home run for Andy Pages in the fourth and a two-run blast for James Outman in the sixth. It was number 12 on the season for Pages and number 16 for Outman.
Reliever Nick Robertson needed to get four outs in a scoreless seventh after his second strikeout of the inning reached on a wild pitch. The eighth inning wouldn't go as smoothly for the right-hander.
Brett Harris tied the game for the RockHounds with a solo homer and two batters later, William Simoneit launched a two-run homer to put Midland on top for good.
High-A Great Lakes
The Loons stayed hot Sunday with 15 hits and 11 runs to win their 15th game in the last 17 games, defeating Fort Wayne (Padres) 11-3 in the series finale. Great Lakes has pounded out at least 12 hits in three straight games, 41 in total, as they finished off the six-game series with five wins.
Six of the nine hitters in the lineup had at least two hits for the Loons Sunday and only one batter failed to record one.
Already on top 1-0 heading to the fourth, Great Lakes strung three straight RBI-doubles together from Jose Ramos, Imanol Vargas and Jonny DeLuca to complete one of the three innings with at least three runs scored.
Eddys Leonard doubled in a run in the eighth and came home on a Ramos two-run homer to lengthen the lead to 7-1. The four runs Great Lakes scored in the top of the ninth made the three runs the TinCaps scored in the final three innings a footnote.
Ramos finished the game 2-for-5 with four RBI and his third homer in the last four games, going 6-for-17 with 10 RBI to pace the offense.
Low-A Rancho Cucamonga
A five-run inning proved to be the undoing for Rancho on Sunday as they dropped the fourth game of the six-game set to Lake Elsinore (Padres) by the score of 8-7.
The two clubs traded two-run homers in the first inning off the bat of Luis Diaz and James Wood and the Quakes had a 3-2 lead in the second on a Yunior Garcia solo shot.
Lake Elsinore doubled four times in the bottom of the third to hang a five spot on the scoreboard and take control of the game. Rancho pulled within one with a two-run triple from Austin Gauthier and a RBI-groundout in the fifth but they wouldn't get any closer to taking the lead back.
Each team would score one more before it was all said and done, with Rancho having the opportunity to take the lead in the ninth. Two walks and a single loaded the bases with one out in the top of the ninth for the Quakes but the final two hitters of the game struck out to end the threat.
Triple-A: OKC placed pitcher Robbie Erlin on the 7-day injured list retroactive to June 25, 2022. Pitcher Kevin Malisheski assigned to Oklahoma City Dodgers from Great Lakes Loons. Pitcher Jose Adames assigned to Oklahoma City Dodgers from Tulsa Drillers.
Sunday scores
Oklahoma City 2, Round Rock 1
Midland 5, Tulsa 3
Great Lakes 11, Fort Wayne 3
Lake Elsinore 8, Rancho Cucamonga 7
4:05 p.m. PT: Great Lakes vs. Dayton [Reds]
5:05 p.m.: Tulsa vs. Arkansas [Mariners]
5:35 p.m.: Oklahoma City at El Paso [Padres]
6:30 p.m.: Rancho Cucamonga vs. Visalia [Diamondbacks]
The top four affiliates are off Monday.
Dodgers sign Matt Andriese to minor league deal The Dodgers signed seven-year major league veteran pitcher Matt Andriese to a minor league contract.
What could Will Smith's contract extension look like? Plus, early predictions on the Dodgers' 2023 lineup and farm system impact.
Updated Dodgers 40-man roster A full list of every Dodgers transaction from the end of the 2022 World Series through the start of 2023 spring training.


text:
8748 8161 for a trial lesson
bukit timah & clementi
H2 Math
IP/ O Level A Math
Timothy Gan
Fong Ching
O Level E. Math
Sam Yap
O Level/ IP Level A.Math
tim gan
● Bachelor of Engineering (Mechanical, Honours), NUS
● NIE, PGDE
● Curently pursuing Master of Science, Mathematics of Educators, NIE NTU
● STEM trained by instructors from the USA (Research for Better Teaching)
● Ex-MOE teacher (Ministry of Education)
● A decade worth of teaching experience, including both private and public practice.
In his 5 years as an MOE teacher in Singapore, Tim Gan believes strongly in keeping explanations simple and to involve layman terms during lessons to make it more relatable to students and reaffirm his students' basic knowledge of O Level and A Level Mathematics. Thus, he is able to teach students of varying academic abilities and help them achieve their fullest potential. He has 9 years of tutoring experience in A Level Mathematics and O Level Mathematics. 2 years ago, he was also asked to help students in IB Mathematics.
During his time as an MOE teacher, Tim Gan was the overall teacher-in-charge of the Math Talent Management Programme in his school, a programme which provides students the opportunities to take part in various Mathematics competitions, namely, Singapore Mathematics Olympiad (SMO), Singapore and Asian Schools Math Olympiad (SASMO), Australian Mathematics Competition (AMC) and UNSW Math Competition. Apart from that, Tim Gan was also given the role of mentorship for beginning teachers. Through years of his experience in teaching and fine-tuning of his practices, he was able to develop a strong pedagogy in teaching which enables him to push his students to their maximum potential. All the classes taught by Tim Gan were able to exceed their expected grades (expected MSG) predetermined by MOE.
Because every misconception is addressed
Through his numerous years of teaching experience, he feels that the poor understanding of concepts is one of the key factors that severely hindered students from having consistent and effective practice with Mathematics questions. Therefore, he believes that everyone can excel in Mathematics, and excellent grades are possible to achieve in the O Level and A Level Examinations. As school curriculum can be demanding, what students need to excel in Mathematics is structured guidance and practices in place to help them make effective use of their time. Hence, he uses his lessons to first shore up his students' foundations and conceptual understanding before moving on to more rigorous practice questions and conceptual tests.
He groups his resources and questions according to increasing level of difficulty so that both weak and stronger students are able to pace themselves within the same class. Group tuition provides a competitive element towards learning, which is a great motivating factor for students to strive harder and learn from one another about how to avoid making common errors. Higher-order thinking questions will also be given at the end of each topic complemented with thorough explanations during lessons and also online, thereby allowing students to learn at their own pace.
Mr Gan is a teacher who is full of passion to teach and is always willing to help his students. Even though I've only joined Tim Gan Math in Semester 1 of JC2, personally, I am very grateful to have him as my math tuition teacher as he helped me understand mathematical concepts a lot better an...
Mr Gan is a teacher who is full of passion to teach and is always willing to help his students. Even though I've only joined Tim Gan Math in Semester 1 of JC2, personally, I am very grateful to have him as my math tuition teacher as he helped me understand mathematical concepts a lot better and slowly regain my confidence back in math. I used to be a student who detest math due to the complexity of the subject but Mr Gan made them easier for us by using simplified methods to allow his students to understand better. He is a great source of motivation, especially during the stressful A Level period and he does his best to answer every query of his students and push them further in the very last lap — A levels. He also welcomes questions even out of class through WhatsApp, which is really useful for us students as we get to clarify our doubts as soon as possible. I am blessed to have Mr Gan as my math tutor and I'm extremely thankful for all the help he has given me throughout the whole A levels.
, Anderson Junior College
Cliché to say, joining Mr Gan's classes was one of the best decisions I've made in my JC life. I have never once felt that his lessons were boring because Mr Gan always makes an effort to joke around in class and lighten the atmosphere. And needless to say, the sole reason I stayed was because...
Cliché to say, joining Mr Gan's classes was one of the best decisions I've made in my JC life. I have never once felt that his lessons were boring because Mr Gan always makes an effort to joke around in class and lighten the atmosphere. And needless to say, the sole reason I stayed was because I could learn new and easier methods to approach math questions and subsequently get better at math with Mr Gan's new techniques and skills, along with questions in practice sets and worksheets that are organized neatly according to a particular section of each topic. Each lesson Mr Gan goes "Understand? Ok or not?" to make sure we follow through and are able to understand clearly what he has taught us which I honestly really appreciate as I have never seen this amount of dedication in other tuition centres I have joined. I am filled with gratitude for having such a great tutor and friend and I sincerely recommend joining Mr Gan's classes!
Xiao Shuo
Mr Gan explains the concepts very clearly and his notes are well organised according to the type of questions for each chapter. His classes are lively and it makes learning maths more enjoyable. He does not hesitate to stay back after class to explain other doubts or questions that we might ha...
Mr Gan explains the concepts very clearly and his notes are well organised according to the type of questions for each chapter. His classes are lively and it makes learning maths more enjoyable. He does not hesitate to stay back after class to explain other doubts or questions that we might have. I have definitely seen an improvement in my school work in just a month of joining the tuition. I would highly recommend Mr Gan to anyone who is looking to join a math tuition!
Abirami
, Raffles Institution
● Bachelor of Science (Education), NTU
Fong Ching is an NIE trained teacher with 6 years of teaching experience. While teaching, she has worked with the Mathematics Curriculum Planning & Development Division (CPDD) to design lesson packages for both scaffolding Mathematics concepts for low progress learners and stretching higher ability students. Apart from that, Fong Ching was also a mentor for beginning teachers and interns.
Her students range from varying levels, allowing her to understand the difficulties that students face when learning Mathematics. Her knowledge of their struggles has allowed her to plan lessons and develop resources to cater to the students' needs.
I am thankful to have Ms Fong as my maths tutor. She is very patient in her approach while teaching, clarifying my doubts along the way, allowing me to better understand certain key concepts and solutions better. When I was unable to understand a particular working, she would use other methods...
I am thankful to have Ms Fong as my maths tutor. She is very patient in her approach while teaching, clarifying my doubts along the way, allowing me to better understand certain key concepts and solutions better. When I was unable to understand a particular working, she would use other methods to allow me to understand better. Through her guidance, I was able to better understand what was being taught in school and it gave me an edge over my peers. Ultimately, from struggling to pass E Maths at the Secondary 3 end-of-year exams, I was able to obtain an A1 for prelims the following year. Thank you, Ms Fong!
, Ahmad Ibrahim Sec
Miss Fong is a patient and thoughtful teacher. She helped me tackle both Paper 1 and 2 questions that I initially have troubles with through the practices in class. When I doubt, I would never hesitate to ask her to help and she would clear my doubts on the spot. During my five months with her...
Miss Fong is a patient and thoughtful teacher. She helped me tackle both Paper 1 and 2 questions that I initially have troubles with through the practices in class. When I doubt, I would never hesitate to ask her to help and she would clear my doubts on the spot. During my five months with her, my E. math had definitely improved and I gained confidence in tackling various E.math questions.
Clementene Wong
, New Town Sec
Miss Fong is a very friendly teacher who allows students to feel comfortable and not be scared to ask her when in need of help. She ensures that her students understand how to answer the questions even if it means repeating an explanation a few times. With her help in these five months, I have...
Miss Fong is a very friendly teacher who allows students to feel comfortable and not be scared to ask her when in need of help. She ensures that her students understand how to answer the questions even if it means repeating an explanation a few times. With her help in these five months, I have improved and is able to be confident and do well in my E.math. As a student with many careless mistakes, she never fails to point it out. Overall, Miss Fong is a very easy-going teacher who does her best to help students when they are in need.
Kai Xuan
● A decade worth of teaching experience in private practice.
● Experienced in research and development in the engineering field.
● ASEAN Scholar.
Mr. Sam is a Mechanical Engineer by training, actively applying his mathematical and physics knowledge for Research and Development in the Precision Engineering industry. In his decade of experience, he has designed and produced machines that are marketed globally today. Being an avid educator, over the years, Sam has tutored students in primary school Mathematics, secondary school Additional Mathematics and polytechnic Mechanical Engineering subjects.
In teaching, Sam's philosophy is that students require the correct understanding of mathematical concepts through concise explanations, targeted practice with mathematical questions and most importantly timely feedback. He believes that every student with the right understanding can excel in Mathematics and achieve excellent grades in the O Level Examinations. Thus, he engages his students individually, keeping each student up to pace and ready to tackle harder problems.
At Tim Gan Math, structured guidance and practices are put in place to help students make effective use of their time. Lessons are used to first shore up the students' foundations and conceptual understanding before moving on to more rigorous practice questions, higher-order thinking questions and conceptual tests.
Resources and questions are grouped according to increasing levels of difficulty, so that students at various proficiency levels can pace themselves within the same class. The group tuition environment also exposes the students to fair and healthy competition in their learning, which serves as a great motivating factor for students to strive harder and to learn from one another on how to avoid making common errors.
In the third quarter of the year, Sam administers mock tests to students which sums up the topics covered in the year. The emphasis of these tests is not the score, but rather for the students to apply their conceptual understanding of the topics, to understand their strengths and weaknesses better, and to condition themselves for the exam setting. Each test paper is then meticulously marked and reviewed in detail.
Samuel is very sincere, patient, encouraging and engaging. He often goes the extra mile, staying back late to provide 1-1 consultations for students. He exhibits the important dispositions required of an educator and mentor. We also regard his domain knowledge in A.Math as strong and clear, th...
Samuel is very sincere, patient, encouraging and engaging. He often goes the extra mile, staying back late to provide 1-1 consultations for students. He exhibits the important dispositions required of an educator and mentor. We also regard his domain knowledge in A.Math as strong and clear, this is often demonstrated by his ability to explain how a question can be tackled in a very clear manner. Lessons are also very structured. These are the aspects which Adelle appreciates and likes about the lessons with Samuel. Adelle also finds the drills via the structured listing of questions in the customised topical worksheets very helpful. They kind of made her acquire enough practices in a progressive and systematic manner.
Adelle Chan's Parent
, Bedok South Sec
Before joining the tuition, I was struggling a lot with amath and was constantly failing in every test iI had, scoring many F9s. However, after joining the tuition, after my common test 2, with the patient guidance of Mr Sam, I had a deeper understanding in the topics that Ii was tested on and...
Before joining the tuition, I was struggling a lot with amath and was constantly failing in every test iI had, scoring many F9s. However, after joining the tuition, after my common test 2, with the patient guidance of Mr Sam, I had a deeper understanding in the topics that Ii was tested on and passed my amath paper for my end-of-year examinations, scoring a C5!
Megan Yeoh
, Nan Hua High School
Copyright 2020 © Tim Gan Math Learning Centre | MOE Registered


text:
Rio de Janeiro clashes mar Flamengo homecoming after Libertadores win
Soccer Football - Copa Libertadores - Flamengo Victory Parade - Rio de Janeiro, Brazil - November 24, 2019 General view as Rio de Janeiro police clash with fans during the parade REUTERS/Ricardo Moraes
RIO DE JANEIRO (Reuters) - Clashes broke out in the streets of Rio de Janeiro on Sunday, as a group of fans of hometown soccer team Flamengo, who had gathered in the city center to welcome back players after they won the Copa Libertadores, battled with police.
Tens of thousands of Flamengo fans had flocked to the open-top bus victory parade, thrilled by Flamengo's first title in 38 years in South America's biggest club competition. But towards the end of Sunday afternoon, fights broke out between police and red-and-black-clad fans, TV images showed.
The cause of the clashes was not immediately clear. Fans, buoyed by a day of drinking, hurled rocks and bottles at police, who responded with tear gas and rubber bullets.
The incident marked an unfortunate end to a largely peaceful and joyful event. Flamengo's 2-1 victory against Argentine club River Plate in Lima on Saturday lifted sprits in Rio and Brazil, hit by years of crime, corruption and unemployment.
Reporting by Gabriel Stargardter; Editing by Peter Cooney


text:
NGC 5979 es una nebulosa planetaria en la constelación de Triangulum Australe cerca del límite con la constelación de Norma. Fue descubierta el 24 de abril de 1835 por John Herschel.

De apariencia ligeramente elíptica, la distancia estimada de NGC 5979 a la Tierra, basada en emisiones metálicas, es de cerca de 11 700 años luz. Las estrellas como el Sol pasan la mayor parte de sus vidas convirtiendo el hidrógeno en helio. Cuando se agota el hidrógeno en su núcleo, se expanden y enfrían, transformándose en gigantes rojas y comienzan a desprenderse de grandes cantidades de gas y polvo a través de un suave viento estelar. Cuando la estrella se ha desprendido de la mayor parte de su masa, la estrella se calienta de nuevo iluminando el material expulsado, a la vez que un viento estelar mucho más fuerte barre el capullo de material oscuro y nace la nebulosa planetaria.

Véase también
 Lista de nebulosas planetarias
 Lista de objetos NGC

Enlaces externos
Catálogo SEDS

Referencias

Nebulosas planetarias
5979
Constelación de Triangulum Australe
Objetos astronómicos descubiertos en 1835

redpajama_set_name: RedPajamaWikipedia


Romana Guillotte is a terribly average cellist, but pretty good at bar trivia. Occasionally, she shakes off the sand and glitter of Las Vegas to be a Film Festival gypsy, working such places as Sundance, TriBeCa, and LA Film Festival. She has an MFA in Writing for Dramatic Media, and a BA in Film Studies from UNLV. She's had pieces appear in "Plasma Frequency Magazine", "Slink Chunk Press", and "The J.J. Outré Review".


Guide athletes to develop the understanding and value of hard work with a process over outcome mentality by safely developing athletes to reduce injury and improve performance.
Ground-based movements that require work done by the entire body. The demands required from most all sports involve the kinetic chain working efficiently and explosively.
I will train athletes to become more efficient in their movements and teach them how to create power from those movements.
The way that is accomplished is by focusing intently on the technique of each movement prescribed. Anyone can write a good program, but if it is not executed as intended, the work is useless.
Training to develop more efficient athletic movement and improved strength should be treated as seriously as a sports practice.
If you don't practice as hard as you play, the benefits of your training will not be there when you need it the most.


, selects the top choices along with best resolution only for you all, and this images is actually among photographs choices in your finest photographs gallery in relation to Personal Cash Flow forecast. I'm hoping you might think it's great.
posted by means of Sandra Fuller from 2018-09-13 10:37:00. To view almost all photos inside Personal Cash Flow forecast images gallery remember to adhere to this kind of hyperlink.


text:
1And Isaac called Jacob, and blessed him, and charged him, and said to him, Thou shalt not take a wife of the daughters of Canaan. 2Arise, go to Padan-Aram, to the house of Bethuel thy mother's father, and take a wife thence of the daughters of Laban thy mother's brother. 3And the Almighty ·God#GodHebrew: El bless thee, and make thee fruitful and multiply thee, that thou mayest become a company of peoples. 4And may he give thee the blessing of Abraham, to thee and to thy seed with thee, in order that thou mayest possess the land of thy sojourning, which God#GodHebrew: Elohim gave to Abraham! 5And Isaac sent away Jacob; and he went to Padan-Aram, to Laban the son of Bethuel the Syrian, the brother of Rebecca, Jacob's and Esau's mother.
6And Esau saw that Isaac had blessed Jacob, and sent him away to Padan-Aram, to take a wife thence, blessing him, and giving him a charge saying, Thou shalt not take a wife of the daughters of Canaan; 7and that Jacob had obeyed his father and his mother, and was gone to Padan-Aram. 8And Esau saw that the daughters of Canaan were evil in the sight of Isaac his father. 9And Esau went to Ishmael, and took, besides the wives that he had, Mahalath the daughter of Ishmael Abraham's son, the sister of Nebaioth, to be his wife.
10And Jacob went out from Beer-sheba, and went towards Haran. 11And he lighted on a certain place, and lodged there, because the sun had set. And he took one of the stones of the place, and made it his pillow, and lay down in that place. 12And he dreamed, and behold, a ladder was set up on the earth, and the top of it reached to the heavens. And behold, angels of God#GodHebrew: Elohim ascended and descended upon it. 13And behold, Jehovah stood above it. And he said, I am Jehovah, the God#GodHebrew: Elohim of Abraham, thy father, and the God#GodHebrew: Elohim of Isaac: the land on which thou liest, to thee will I give it, and to thy seed. 14And thy seed shall be as the dust of the earth, and thou shalt spread abroad to the west, and to the east, and to the north, and to the south; and in thee and in thy seed shall all the families of the earth be blessed. 15And behold, I am with thee, and will keep thee in all places to which thou goest, and will bring thee again into this land; for I will not leave thee until I have done what I have spoken to thee of.
16And Jacob awoke from his sleep, and said, Surely Jehovah is in this place, and I knew it not. 17And he was afraid, and said, How dreadful is this place! this is none other but the house of God#GodHebrew: Elohim and this is the gate of heaven. 18And Jacob rose early in the morning, and took the stone that he had made his pillow, and set it up for a pillar, and poured oil on the top of it. 19And he called the name of that place Beth-el; but the name of that city was Luz at the first. 20And Jacob vowed a vow, saying, If God#GodHebrew: Elohim will be with me, and keep me on this road that I go, and will give me bread to eat, and a garment to put on, 21and I come again to my father's house in peace — then shall Jehovah be my God#GodHebrew: Elohim 22And this stone, which I have set up for a pillar, shall be God's#GodHebrew: Elohim house; and of all that thou wilt give me I will without fail give the tenth to thee.
First published in 1890. This edition is maintained by the British and Foreign Bible Society.
1So Isaac summoned Jacob, blessed him, and gave him these orders: "Don't marry a Canaanite woman. 2Get up and go to Paddan-aram, to the household of Bethuel, your mother's father, and once there, marry one of the daughters of Laban, your mother's brother. 3God Almighty#28.3 Heb El Shaddai or God of the Mountain will bless you, make you fertile, and give you many descendants so that you will become a large group of peoples. 4He will give you and your descendants Abraham's blessing so that you will own the land in which you are now immigrants, the land God gave to Abraham." 5So Isaac sent Jacob off, and he traveled to Paddan-aram, to Laban son of Bethuel the Aramean and brother of Rebekah, Jacob and Esau's mother.
6Esau understood that Isaac had blessed Jacob and sent him to Paddan-aram to marry a woman from there. He recognized that, when Isaac blessed Jacob, he had ordered him, "Don't marry a Canaanite woman," 7and that Jacob had listened to his father and mother and gone to Paddan-aram. 8Esau realized that his father Isaac considered Canaanite women unacceptable. 9So he went to Ishmael and married Mahalath daughter of Abraham's son Ishmael and sister of Nebaioth, in addition to his other wives.
Jacob's dream at Bethel
10Jacob left Beer-sheba and set out for Haran. 11He reached a certain place and spent the night there. When the sun had set, he took one of the stones at that place and put it near his head. Then he lay down there. 12He dreamed and saw a raised staircase, its foundation on earth and its top touching the sky, and God's messengers were ascending and descending on it. 13Suddenly the LORD was standing on it#28.13 Or beside it or beside him and saying, "I am the LORD, the God of your father Abraham and the God of Isaac. I will give you and your descendants the land on which you are lying. 14Your descendants will become like the dust of the earth; you will spread out to the west, east, north, and south. Every family of earth will be blessed because of you and your descendants. 15I am with you now, I will protect you everywhere you go, and I will bring you back to this land. I will not leave you until I have done everything that I have promised you."
16When Jacob woke from his sleep, he thought to himself, The LORD is definitely in this place, but I didn't know it. 17He was terrified and thought, This sacred place is awesome. It's none other than God's house and the entrance to heaven. 18After Jacob got up early in the morning, he took the stone that he had put near his head, set it up as a sacred pillar, and poured oil on the top of it. 19He named that sacred place Bethel,#28.19 Or God's house though Luz was the city's original name. 20Jacob made a solemn promise: "If God is with me and protects me on this trip I'm taking, and gives me bread to eat and clothes to wear, 21and I return safely to my father's household, then the LORD will be my God. 22This stone that I've set up as a sacred pillar will be God's house, and of everything you give me I will give a tenth back to you."
2011 Common English Bible. All rights reserved.


The period before Christmas has been quite hectic for me. If you work in the retail business, you know what I mean. This is the toughest time of year for us. Luckily, I didn't have to work on the 24th this time … so first thing in the morning I prepared my favourite soup, beef broth, the way my Mom taught me. For that, I use the usual veggies, but the most important ingredients are beef bones with marrow and turkey/goose/duck neck. These together make a really rich and golden soup. So, the Sunday menu looked like this: soup with noodles, bone marrow with toast and a bit later salade de boeuf. As for sweets, we had homemade cookies, cheese chips and the famous Hungarian beigli (nut rolls). We spent the day lounging around, taking a long walk and when being at home, we were watching TV and trying out all kinds of drinks: a good red wine, eggnogg, thanks to a good friend and Valhalla bitter from Denmark, a treat from my daughter. Wow, that one is fantastic. It helps to digest the huge amount of food one usually has during Christmas.


Learn from entrepreneurs that have been there and done that, through our podcast interviews with Australian and OS entrepreneurs, blog articles, or book tickets now to be part of the studio audience for "The Startup Lounge Live".
Chris Rolls is a serial entrepreneur, educator and investor. He has built from scratch four businesses in four different industries over the last 20 years, 3 of which have become amongst the largest of their type in Australia.
Chris talks about extreme leadership with US NAVY Seal Jocko Willink.
Who Is Chris Rolls? An interview with Startup Lounge host Chris Rolls.


text:
BlackBerry Is Reportedly Launching A New Water-Resistant Smartphone, Will Ditch The Physical Keyboard
BlackBerry has been quite aggressive with their smartphone launches lately. Recently, the company launched the new KeyOne smartphone, which was rather well received in the market, at least compared to their other offerings. However, now, it looks like the company is all set to launch a new device and this time around, it is expected that we will be getting something different from the company.
Apparently, TCL, the Chinese smartphone manufacturer who is manufacturing the hardware for BlackBerry, has revealed to the source that the company is planning on launching a new smartphone. This new smartphone will be launched under the BlackBerry brand and it looks like it will land somewhere around the month of October. While not a lot is known about this alleged new smartphone, the source did manage to pull out a few useful info.
Firstly, it has been reported that this smartphone will have no physical keyboard. This means that it will be a touchscreen offering just like some of the previously launched smartphones like DTek50 & DTek60, etc. Yes, this is not really surprising right. However, it has also been reported that the smartphone will come with IP67 certification for water and dust-proofing. Well, if you have used some of the Samsung offerings like Galaxy S8, etc. then this certainly might not be as appealing, however, this is first of its kind for BlackBerry.
One of the TCL's official said that they believe this new smartphone will stand out in the market. He also believes that this offering is planned to lure people away from the typical Samsung and Apple's offerings. Apart from being IP67 certified, he also revealed that this smartphone will have a huge battery which is rated to last for more than 26 hours of mixed use. With this, it certainly looks like BlackBerry is going for durability and longevity as their unique selling point.
And on top of all this, this new device is again expected to bring in all the new security features with it as well. Remember the DTEK 50 smartphone? It was said to be the most secure smartphone and it looks like this new one will also be on the same lines. However, as far as the specs of this smartphone are concerned, there is not a lot of info available. But some of the previous rumors say that this could be a mid-ranged offering powered by a Snapdragon 626 processor. If this is true, then it would be a hard sell to make people switch from Galaxy and iPhones. With that said, we would like to know your thoughts on this. Would you be interested in picking up a blackberry smartphone over the Galaxy offering from Samsung or iPhone? Be sure to let us know by dropping a comment down below.
Note – The Featured image display is of DTEK 60.
Xiaomi Mi Mix 2 Smartphone Is Confirmed To Launch On September 11th
Lenovo to Launch K8 Note Lite & K8 Plus Smartphones in India in September