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African Journal of Primary Health Care and Family Medicine
African Journal of Primary Health Care and Family Medicine - latest Issue
Volume 11 Number 1, January 2019
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A description of community-based participatory research of hypertension awareness, prevention and treatment in a district of Matabeleland South Province, Zimbabwe
Authors: Pugie T. Chimberengwa and Mergan Naidoo
Source: African Journal of Primary Health Care and Family Medicine 11, pp 1 –9 (2019) http://dx.doi.org/10.4102/phcfm.v11i1.1839
Background: Hypertension is an important worldwide public health challenge because of its high prevalence and concomitant risks of cardiovascular and kidney diseases. The risk factors for hypertension are well known, and screening, diagnosis and treatment of hypertension have been well researched. However, this knowledge has not been translated into community practice as there remains a huge knowledge gap between the academics, health workers and the communities. There is need for community participation in developing and implementation of health interventions among marginalised communities.
Aim: The aim of this project was to improve the community's knowledge about hypertension by positively influencing beliefs and behaviours, leading to improved community hypertension outcomes.
Setting: The study was undertaken in Ward 14, a rural area situated south-west of Gwanda District, Matebeleland South Province in Zimbabwe.
Methods: We conducted a health services research utilising qualitative methods by using a community-based participatory approach using a cooperative inquiry group.
Results: There was improvement in knowledge about awareness and primary prevention of hypertension. Community hypertension care was established through competence training of village health workers (VHWs) and more persons living with hypertension were enrolled into care. Pill pickup rate and treatment compliance improved and the community's confidence in VHWs was restored. Community hypertension screening, treatment registers and health facility referrals were established.
Conclusion: The community was empowered; the VHW was established as a key link between the community and the formal health delivery. This was a sustainable form of improving community hypertension health outcomes.
Accessible continued professional development for maternal mental health
Authors: Sally Field, Zulfa Abrahams, David L. Woods, Roseanne Turner, Michael N. Onah, Doreen K. Kaura and Simone Honikman
Background: Changing global health and development trends have resulted in a need for continued professional development (CPD) within the health and development sectors. In low-resource settings, where the need for training and CPD may be highest, there are significant challenges for disseminating information and skills. There is a need to improve mental health literacy and reduce levels of stigma about maternal mental illness. The Bettercare series of distance learning books provides a peer-based format for CPD. We aimed to evaluate the Bettercare Maternal Mental Health book as a format for CPD.
Aim: The aim of this study was to determine whether the Bettercare Maternal Mental Health book significantly improves knowledge and decreases stigma around mental health for care providers from the health and social development sectors.
Setting: One hundred and forty-one participants (social workers, nursing students and health professionals) were provided with the Bettercare Maternal Mental Health book to study.
Methods: Before and after studying the book, the same multiple-choice knowledge test and the Mental Illness Clinicians' Attitude Scale were used to assess cognitive knowledge and mental health stigma, respectively.
Results: Participants' knowledge showed a statistically significant (p < 0.001) improvement between the pre- and post-test results, for all six chapters of the book. However, participants' attitudes towards mental illness did not show a statistically significant change between the pre- and post-test results.
Conclusion: We found that this method of learning elicited significant improvement in mental health knowledge for care providers. Continued professional development policy planners and curriculum developers may be interested in these findings.
Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa
Authors: Delarise M. Mulqueeny and Myra Taylor
Source: African Journal of Primary Health Care and Family Medicine 11, pp 1 –11 (2019) http://dx.doi.org/10.4102/phcfm.v11i1.1824
Background: Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care.
Aim: This study investigated whether patients' needs were being met, described which needs were met, which were not and how such needs could be met.
Setting: The study took place at four ART clinics in eThekwini district public hospitals.
Methods: This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients' needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers' observations.
Results: All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution.
Conclusion: To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes 'patients' needs'. The results reflect patients' willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs.
A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV
Authors: Antonia L. Wadley, Tamar Pincus and Michael Evangeli
Background: Stigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.
Aim: The goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.
Setting: The study took place at an HIV clinic in Johannesburg, South Africa.
Methods: Mediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.
Results: In all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman's r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).
Conclusion: Whilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.
Lifestyle, cardiovascular risk knowledge and patient counselling among selected sub-Saharan African family physicians and trainees
Authors: Pius O. Ameh, Kenneth Yakubu, Miriam Miima, Olugbemi Popoola, Gulnaz Mohamoud and Klaus B. von Pressentin
Background: Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies.
Aim: The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA.
Setting: FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA.
Methods: A web-based cross-sectional analytical study was conducted using validated, selfadministered questionnaires. Following collation of responses, the relationship between the participants' CVD prevention knowledge, lifestyle practices and CVD counselling rates was assessed.
Results: Of the 174 participants (53% response rate), 83% were married, 51% were females and the mean age was 39.2 (standard deviation [SD] 7.6) years. Most of the participants responded accurately to the CVD prevention knowledge items, but few had accurate responses on prioritising care by 10-year risk. Most participants had less than optimal lifestyle practices except for smoking, vegetable or fruit ingestion and sleep habits. Most participants (65%) usually counselled patients on nutrition, but less frequently on weight management, exercise, smoking and alcohol. The region of practice and physicians with poor lifestyle were predictive of patient counselling rates.
Conclusion: Training on patient counselling and self-awareness for CVD prevention may influence patient counselling practice. Promoting quality training on patient counselling among FPs as well as a healthy self-awareness for CVD prevention is thus needed. The complex relationship between physician lifestyle and patient counselling warrants further study.
Reasons why insured consumers co-pay for medicines at retail pharmacies in Pretoria, South Africa
Authors: Ntobeko M. Mpanza, Hazel Bradley and Richard Laing
Background: Costly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance.
Aim: This study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments.
Setting: The study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa.
Methods: An exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators – one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes.
Results: Co-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes' function.
Conclusion: Unavailability of lowest-priced medicines at pharmacies contributes to copayments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments.
Descriptive epidemiology of anaemia among pregnant women initiating antenatal care in rural Northern Ghana
Authors: Engelbert A. Nonterah, Emmanuella Adomolga, Adadow Yidana, Juliana Kagura, Isaiah Agorinya, Emmanuel Y. Ayamba, Solomon Atindama, Michael B. Kaburise and Majeed Alhassan
Background: Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana.
Aim: The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits.
Setting: The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana.
Methods: A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC.
Results: We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31–13.8). The median gestational age at booking was 14 weeks (5–36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4–47.1], and was high among teenage mothers (52% [34.9–67.8]), mothers who booked in the third trimester (55% [33.6–74.7]) and grand multiparous women (58% [30.7–81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58–2.46]), booking during the third trimester (OR = 2.06 [1.78–2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19–8.32]).
Conclusion: Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery.
A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province
Authors: Esther N. Hlongwa and Maureen N. Sibiya
Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy.
Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN).
Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu.
Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN.
Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases.
Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science.
Social and economic barriers to adherence among patients at Livingstone General Hospital in Zambia
Authors: Kaala Moomba and Brian van Wyk
Background: Zambia is one of the countries hardest hit by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic with a national HIV prevalence estimated at 14% among those aged 15–49 years in 2012. Antiretroviral therapy (ART) has been available in public health facilities in Zambia since 2003. By early 2016, 65% of the 1.2 million Zambians living with HIV were accessing ART. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally.
Aim: This article reports on social and economic barriers to ART adherence among HIV patients being attended to at Livingstone General Hospital in Zambia.
Setting: Livingstone General Hospital is located in the Southern province of Zambia, and had over 7000 patients enrolled for HIV care of whom 3880 patients were on ART.
Methods: An explorative, qualitative study was conducted with 42 patients on ART where data were collected through six focus group discussions (3 male and 3 female groups) and seven in-depth interviews. Data were audio-recorded and transcribed verbatim and subjected to thematic content analysis.
Results: Economic factors such as poverty and unemployment and the lack of food were reported as major barriers to adherence. Furthermore, social factors such as traditional medicine, religion, lack of family and partner support, and disclosure were also reported as critical barriers to adherence to ART.
Conclusion: Interventions to improve adherence among ART patients should aim to redress the socio-economic challenges at community and individual levels.
Knowledge and home treatment of measles infection by caregivers of children under five in a low-income urban community, Nigeria
Authors: Obioma Uchendu, Olusimbo Ige and Oluwapelumi Adeyera
Background: Despite the availability of a safe and effective vaccine for over 50 years, measles remains a leading cause of death among young children in developing countries.
Aim: This study assessed the knowledge and home treatment of measles by caregivers of children under 5 years.
Setting: Abebi community, Ibadan, Oyo State, Nigeria.
Methods: A descriptive cross-sectional study of 509 caregivers of children aged 6 months to 5 years in a semi-urban community in Ibadan was conducted using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect information on socio-demographic characteristics, knowledge of aetiology, main symptoms and signs, and home treatment of measles. Chi-square test and logistic regression were used to explore associations at 5% level of significance.
Results: Most of the caregivers were females (96.3%), married (86.1%) and were the biological parents of the children (90.9%). More than half had good knowledge of the cause (59.7%) and main symptoms and signs (52.8%) of measles. However, the composite knowledge was good in 57.6% of caregivers. Over half (54.4%) of the caregivers reported that their children ever had measles. Majority (91.3%) of caregivers whose children had measles gave home treatment, while 24 (8.7%) sought treatment from health facilities alone. There was a significant association between caregivers' educational status, age, tribe and marital status and their knowledge of measles; however, tribe was the only significant predictor of knowledge after regression analysis. Caregivers from other tribes were 3.3 times more likely to have good knowledge of measles than Yoruba caregivers. Caregivers who were 35 years and older compared to those younger than 35 years (OR: 0.625; 95% CI: 0.425–0.921) and those who were not currently married compared to those married (OR: 0.455; 95% CI: 0.273–0.758) had lower odds of having good knowledge of measles, respectively.
Conclusion: Home treatment by caregivers of children with measles is high. Health education on the cause, prevention and treatment of measles should be provided for caregivers.
Low back pain among primary school teachers in rural Kenya : prevalence and contributing factors
Authors: Hussein E. Elias, Raymond Downing and Ann Mwangi
Background: Low back pain (LBP) has been recognised as a common occupational problem with a high prevalence among work-related musculoskeletal disorders. Although there appears to be a high prevalence of LBP among school teachers, there is inadequate information on the prevalence and predisposing factors of LBP among primary school teachers in rural Western Kenya.
Aim: To determine the prevalence, factors associated with LBP and physical disability caused by LBP.
Setting: The setting was public schools in rural Western Kenya selected by simple random sampling method.
Methods: A cross-sectional study was conducted among primary teachers from public schools using a self-administered questionnaire. The questionnaire included information on LBP, demographic data, occupational and psychosocial factors and disability score. The 12-month prevalence, associated factors and LBP disability were analysed.
Results: The 12-month self-reported prevalence of LBP among primary teachers was 64.98%, with close to 70% of them reporting minimal disability. The logistic regression analysis showed that female gender (odds ratio [OR]: 1.692, p < 0.02) was associated with LBP and high supervisor support (OR: 0.46, p < 0.003) was negatively associated with LBP.
Conclusion: The prevalence of LBP among primary school teachers in rural Western Kenya is 64.98%, with the majority of them reporting minimal disability. The identified risk factors were female gender and low supervisor support. The presence of work-related psychosocial risk factors in this study suggests a comprehensive approach in evaluation and management of LBP. Preventive measures should be in place to prevent and reduce the progression of LBP disability.
World Family Doctors Day 2019 : reflections from an African perspective
Author Robert Mash
May 19th is World Family Doctors Day (WFDD), and this year the theme is 'Family doctors – Caring for you for the whole of your life'.1 This editorial reflects on the relevance and meaning of this day and this year's theme from an African perspective. In sub-Saharan Africa, family doctors are scarce, mostly working in the private sector and without any postgraduate training in family medicine. Primary care in the public sector is mostly offered by nurses and mid-level doctors, known as clinical officers or clinical associates. Family physicians, doctors with postgraduate training in family medicine are even rarer, and in many countries nonexistent or counted on the fingers of two hands. In this context, the concept of medical generalism may be more appropriate, as it potentially encompasses all the different health professionals delivering primary care. 'Medical generalism is an approach to the delivery of healthcare that routinely applies a broad and holistic perspective to the patient's problems'…and involves 'being able to deal with undifferentiated illness and the widest range of patients and conditions' as well as taking 'continuity of responsibility for people's care across many disease episodes and over time'.2 Medical generalism, therefore, includes the principles of comprehensive and continuous care over the life course and embraces the theme of this year's WFDD.
A declaration for all?
Author Ian Couper
The year 2018 marked the 40th anniversary of the Alma Ata Declaration on Primary Health Care (PHC), adopted at Almaty, Kazakhstan, in September 1978. Primary Health Care comprises of three aspects that focus on improving the health of individuals and communities, namely, empowering people, multisectoral policy and action, and integrated health services built around primary care and public health. Many different events took place during 2018 in preparation for a Global Conference on Primary Health Care, held on 25–26 October 2018, arranged by the World Health Organization (WHO) and UNICEF (United Nations Children's Fund) in Astana, Kazakhstan, where various world governments renewed their commitment to PHC in order to achieve universal health coverage and the 2030 Sustainable Development Goals.
Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal
Authors: Desiree Govender, Saloshni Naidoo and Myra Taylor
Background: Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.
Aim: The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children.
Setting: The study was conducted in a local district hospital in Ugu, KwaZulu-Natal.
Methods: An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis.
Results: Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.
Conclusion: In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.
Contribution of the Nelson R. Mandela School of Medicine to a socially accountable health workforce
Authors: Amy Clithero-Eridon, Danielle Albright, Cameron Crandall and Andrew Ross
Background: A socially accountable health professional education curriculum aims to produce fit-for-purpose graduates to work in areas of need. 'Fit-for-purpose' can be assessed by monitoring graduate practice attributes.
Aim: The aim of this article was to identify whether graduates of 'fit-for-purpose' programmes are socially accountable.
Setting: The setting for this project was all 37 district hospitals in the KwaZulu-Natal province in Durban, South Africa.
Methods: We surveyed healthcare professionals working at district hospitals in the KwaZulu- Natal province. We compared four social accountability indicators identified by the Training for Health Network Framework, comparing medical doctors educated at the Nelson R. Mandela School of Medicine (NRMSM) with medical doctors educated at other South African and non-South African medical schools. In addition, we explored medical doctors' characteristics and reasons for leaving or staying at district hospitals.
Results: The pursuit of specialisation or skills development were identified as reasons for leaving in the next 5 years. Although one-third of all medical doctors reported an intention to stay, graduates from non-South African schools remained working at a district hospital longer than graduates of NRMSM or other South African schools and they held a majority of leadership positions. Across all schools, graduates who worked at the district hospital longer than 5 years cited remaining close to family and enjoyment of the work and lifestyle as motivating factors.
Conclusion: Using a social accountability approach, this research assists in identifying areas of improvement in workforce development. Tracking what medical doctors do and where they work after graduation is important to ensure that medical schools are meeting their social accountability mandate to meet community needs.
'No one prepared me to go home' : cerebrovascular accident survivors' experiences of community reintegration in a peri-urban context
Authors: Pragashnie Govender, Deshini Naidoo, Kiara Bricknell, Zainab Ayob, Holly Message and Sibongiseni Njoko
Background: The South African health system has policies and strategies to ensure effective rehabilitation and reintegration of individuals who have survived a cerebrovascular accident into their respective communities. However, implementation of such guidelines remains an issue.
Aim: This study sought to explore cerebrovascular accident (CVA) survivors' experiences of community integration.
Setting: The study was located in a peri-urban community within the KwaZulu-Natal Province, South Africa.
Methods: An explorative qualitative study with eight purposively selected CVA survivors was conducted via semi-structured individual interviews. Data were audio-recorded and manually transcribed prior to thematic analysis. Trustworthiness of the study was maintained by strategies such as analyst triangulation, an audit trail and use of thick descriptions. Ethical principles of autonomy, informed consent, confidentiality and privacy were also maintained in the study.
Results: Six themes emerged that highlighted (1) loss of autonomy and roles, (2) barriers to community reintegration, (3) social isolation of participants, (4) finding internal strength, (5) enablers of community reintegration including the positive influence of support and the benefits derived from rehabilitation and (6) recommendations for rehabilitation.
Conclusion: The study revealed both positive and negative influences that impact CVA survivors' ability to effectively reintegrate into their respective communities following a CVA. Recommendations include the need for education and awareness around access to rehabilitation services for CVA survivors, advice on how to improve CVA survivors' ability to mobilise in the community and make environmental adaption to facilitate universal access, provision of home programmes and caregiver training for continuity of care and for inclusion of home-based rehabilitation into current models of care.
Development of a Sesotho health literacy test in a South African context
Authors: Marianne Reid, Ega Janse van Rensburg-Bonthuyzen and Mariette Nel
Background: Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests.
Aim: The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language.
Setting: The test was developed in the Free State Province of South Africa, for use among Sesotho speakers.
Methods: Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps.
Results: The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman–Liau Index score. A context-suitable and comprehensive SHLT ensued from this work.
Conclusion: The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries.
Implementation of postnatal care for HIV-positive mothers in the Free State : nurses' perspectives
Authors: Lumka Mangoejane and Mokholelana M. Ramukumba
Background: Postnatal care (PNC) provides the opportunity for protecting the lives of women infected with human immune deficiency virus (HIV) and their babies. The prevention of mother-to-child transmission of HIV (PMTCT) guidelines provide a framework for implementation of PNC. There has been no empirical evidence on how the nurses at the clinic level implement these guidelines. In addition, there are reports that PNC has been neglected in South Africa.
Aim: The study aimed to explore the implementation of PNC for HIV-positive women, by explicating nurses' views regarding their practices. Setting: The study was conducted in 2015 at three clinics at Mangaung Metro Municipality in the Free State.
Methods: A qualitative, evaluative case study was conducted to provide a detailed account of the implementation of PNC, using 2015 PMTCT guidelines as a framework for evaluation. Eighteen key informants participated in three focus groups. Data were reviewed through direct thematic analysis.
Results: Four themes emerged from data analysis, namely, guidelines as an empowering tool, implementation of HIV guidelines, perceived successes and challenges of postnatal HIV care, and measures to strengthen postnatal HIV care services. The study found that nurses interpreted and used guidelines to direct their practice. However, there were challenges and some successes.
Conclusion: It was concluded that nurses had a good understanding of the guidelines provided for their practices and implemented them with various levels of success. Effective management of HIV-infected women during the postnatal period requires well-designed multidisciplinary collaborations, adequate resources, continuous professional development programmes, a high level of competence and confidence.
Nutrition knowledge, attitudes and practices of primary school children in Tshwane Metropole, South Africa
Authors: Nomsa P.S. Mamba, Lizeka Napoles and Nelly M. Mwaka
Background: The increasing prevalence of being overweight and obesity in South African school children requires interventions that are evidence based. Nutrition knowledge, attitudes and practices (KAP) studies are thus needed to provide evidence for the planning of interventions that address and prevent nutrition problems in school children.
Aim: The aim of the study on which this article is based was to assess nutrition knowledge, attitudes and practices of grade 4–6 learners from three primary schools in a South African township. The article seeks to highlight the key results of this quantitative study.
Setting: The study took place in three primary schools in Mamelodi township, Pretoria, South Africa.
Methods: Data were collected from grade 4–6 learners using self-administered questionnaires. After coding and collating data using Epi infoTM, STATA was then used for analysis. A description of KAP results was carried out using simple descriptive statistics, while the associations were tested using a chi-square test.
Results: Learners displayed inadequate knowledge of a balanced diet (23%) as well as low knowledge of food groups. With regard to attitudes, the most liked food group was the drinks and snacks (72.9%), while the least liked food group was the fruits and vegetables (8.11%). With regard to practices, the most frequently consumed food group was the drinks and snacks (72.6%), while fruits and vegetables were the least consumed. However, 78.91% of the learners displayed very good nutrition-related practices, such as making their own breakfast and eating breakfast.
Conclusion: The inadequate knowledge displayed by learners indicates a gap with nutrition education in the curriculum. There is a need to explore innovative and novel approaches to improve nutrition knowledge of school children. Parents also need to be targeted to ensure better outcomes.
Factors that impact the timely treatment of obstetric fistulas in Malawi : the perspective of health care providers
Authors: Mwawi S. Gondwe and Pranitha Maharaj
Background: In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition.
Aim: The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals.
Setting: The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi.
Methods: An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi.
Results: The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals.
Conclusion: The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care.
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forward in time you must use both P and T together--i.e., C symmetry.
JS: This is important. Also we need to be clear how the closed loop Feynman diagrams are needed for unitarity. Is it only for scalar Higgs diagrams or more general?
R-bar L)] as per the Weyl form of the Dirac Lagrangian.
I haven't fully checked the algebra, but I think it is right.
translators as back up. They settled on Latin.
Feconey Cuzzin let out a laugh, then covered his mouth, and apologized.
First mate also whipered head to head.
"Port of Amalfi," said Lazzaro.
"Are you near Amalfi now?" asked Assebraker.
Syria, in order to buy the Byzantine silks that it resold in the West.
"More like Mathematics," said Assebraker. Then she spoke to Gage.
thing up on the hills," and he pointed at Dinny.
"Or demon!" said Manuel Psaila.
"Or the Questing Beast," said Benedict Bonacci.
""D, none of the above," said Assebraker. "It is called a dinosaur.
nowhere near Amalfi, according to their mariner's compass.
"The Crusaders interrupted. "I'll get back to all that," said Gage.
time) a serious science factual description of a spacetime wormhole.
is from the fiction and towards the fact. Old favorites, such as H. G.
without producing problems such as the notorious grandfather paradox.
movies, which Nahin comments on while missing their point entirely.
coconut, radiation-preserved salad vegetables, and wine.
2) nonunitary entanglement signals with non-orthogonal Glauber macro-quantum coherent states at the transmitter entangled with single qubits at the receiver.
"Here's to the success of our mission," said Gage, while a grad student handed out bottles of champagne.
"We got our dinosaur, and transported her to this desert island," said Assebraker.
He did the saber/bottle maneuever. The top of the bottle, still corked, flew in a parabola, landing neatly on a campfire. Everybody laughed.
Assebraker noted Feconey Cuzzin's tiny facial expression changes when Gage said "'steal' the time machine." She was even more sure that the pirates had a dastardly plan.
"Few of the writers of Dr. Who have had the imagination actually to use his time machine in this kind of way." Said Gage, still quoting Gribbin.
"The TARDIS guy," said Scatty Vickerman.
"Which led where? Or When?" said the pirate captain.
"Channel Tunnel?" said Feconey Cuzzin.
"The English Civil War?" said Feconey Cuzzin.
"Hard to believe," said Feconey Cuzzin.
"Then what happened?" said Scatty Vickerman.
"Negative energy? Hang on there," said Scatty Vickerman.
"Is time an illusion?" asked Feconey Cuzzin.
I think he was quoting someone else - not his calculation?
the effects of the displacement of the GPS during the time of flight of the neutrinos.
when you plug in the numbers you get 2 x 30 ns = 60 ns.
You could add Doppler effects, etc if you wish. It is the same idea.
Why the three Arrows of Time march together in lock-step.
Think of the Three Musketeers "All for one, one for all."- the Fourth is the Psychological Arrow of Consciousness.
2010, 46 pp., 10,850 words.
"I'm the practical one on the team, as number two," said Dr. Assebraker.
"Universe expands and collapses?" said Scatty Vickerman.
Sarfatti Comment: In the hologram theory the alignment of these two arrows is trivial. Also the special initial condition of the universe is trivial as well. We have both a past and future boundary hologram screen (2D surrounding surfaces - us at center) as given by Tamara Davis - the pixelated computing past particle and the future event horizons respectively.
We are the interior bulk 3D hologram image projections clashing both past and future in the here-now in sense of Yakir Aharonov's overlap of history and destiny state vectors. However we also need macro-quantum coherent signal nonlocality beyond orthodox quantum theory for the whole madcap idea to work. Crazy indeed. Crazy enough to be true?
condition and backward from the future boundary condition." If you believe that, then conventional use of tense is indeed obsolete and distracting, and using the subjunctive mood in counterfactual statements becomes problematic."
Obviously Mermin does not take this way of thinking seriously. Pity. Modern cosmology shows our past particle horizon must have a boundary condition as well as our future event horizon. If they are fractal, then all scales from Planck to Hubble are involved. Indeed, the physics on both of these 2D hologram screens is Bohm's Implicate Order with us as hologram images in the bulk 3D interior's explicate order. Seth Lloyd also thinks these observer-dependent pixelated surface horizons are computers - presumably quantum and possibly conscious?
Aharonov wrote: "However, as Mermin certainly knows, analyzing sentences in isolation without the many clues found in context doesn't do them justice. The initial setup is indeed elementary, and we put in all the details, so it is hard to see how it could be misinterpreted. The situation becomes far more interesting and surprising, though, when weak measurements are taken into account; to ignore them, as Michael Nauenberg and Art Hobson did, is to completely miss the point. We believe that no true understanding of quantum mechanics can be obtained without taking weak measurements seriously."
"Television, and it didn't use vacuum tubes since before I was born.
"Yes, you know how a bursting shell flings shapnel in all directions.
"Oddly enough," she said, "The Bible was right about that.
Literary Magazine, 1838, which sends the narrator back a millennium.
And these used fictional Time Machines?" said Scatty Vickerman.
considering a hypothetical method to determine the mass of a star.
"Projectiles fired upward from the Earth," said Feconey Cuzzin.
"Michell asked himself how large this effect could be," said Dr.
certain critical speed to escape from a star's gravitational embrace.
This 'escape velocity' depends only on the size and mass of the star.
"You wouldn't happen to have a copy?" said Feconey Cuzzin.
who have seriously studied Einstein's equations were less dismissive.
"Dr. Who?" said Feconey Cuzzin.
[end chapter; use the following in an another chapter. Too much talk.
N.D. Mermin wrote: "Why has the Aharonov group been confusing some of us in this way for two decades? There is a clue in the final section of the authors' PHYSICS TODAY article, where they talk about the flow of time. There they suggest taking seriously the idea that time "propagates forward from the past boundary condition and backward from the future boundary condition." If you believe that, then conventional use of tense is indeed obsolete and distracting, and using the subjunctive mood in counterfactual statements becomes problematic."
I don't know what you think you looked at. Again if you really want to know the relevant vetted literature I am sure that Puthoff, Maccabee, Brandenburg, Vallee and Friedman, for a start can guide you. So can Eric Davis who worked for Robert Bigelow at NIDS on UFOs and who currently works for Puthoff. Davis's reaction at Orlando 100 year Star Ship was obviously political in some way - he did not want to discuss what he really knows.
Your logic below is most peculiar Jim. It seems to my way of thinking that if we see warp-wormhole technology in the skies from an advanced intelligence intruder that can knock our air force out of the sky and disable our nuclear missiles that is the most important fact we can have! It tells us that Hawking's chronology protection conjecture and other no-can-do arguments are wrong. Furthermore, I think the paper I gave at Orlando shows how they work. Of course, I can be wrong, but I am not even wrong. In any case, it's our best shot in my opinion. I am again attaching the final draft of my Orlando paper.
You want disclosure? - the attached pdf is my best shot at that to date.
From Government secret files...The report that shocked the Congress!
The shattering report that stunned the world's top leaders now available to the public!
Well, I looked at that "literature" many years ago. While some of it is entertaining, only one case was attended by information that might have some physics relevance -- the so-called RB-47 case (where passive monitoring electronics was present and recorded a strong 3 GHz signal). I see nothing in your conjecture that would relate to the signal detected in that case. The rest of the reports -- even if you take them as legitimate -- at most can be taken as evidence that someone has figured out how to do warp/wormhole tech. So what? That's not the question.
Of course it is the question in my way of thinking.
The question is: can we figure out how to do the tech?
Of course we can. I think I have, though I may be wrong - that remains to be seen.
You don't need to talk about UFOs to answer that question.
Of course, we do. It's the 800 lb gorilla in the room to my way of thinking and to Brandenburg's and others.
They are a needless distraction that debase a serious discussion of how to do the tech.
Dead wrong in my way of thinking. Totally antithetical to my judgement here.
Rogue physicist Dr. Jack Sarfatti crashes the UFO topic into DARPA's 100 Year Starship Symposium. Are there any clues left smoldering in the debris field? | STARstream Research | STARpod.org | News, Feature Stories, and more.
Jack Sarfatti "A century can fundamentally change our understanding of our universe and reality," proclaims the DARPA website, "Man's desire to explore space and achieve the seemingly impossible is at the center of the 100 Year Starship Study Symposium. The Defense Advanced Research Projects Agency (DARPA) and NASA Ames Research Center (serving as execution agent), are working together to convene thought leaders dealing with the practical and fantastic issues man needs to address to achieve interstellar flight one hundred years from now."
Jack Sarfatti The transmitter can send the message retrocausally after the message is received. The signal nonlocality is metric independent not restricted by the causal light cone. The choice of where and when to transmit and where and when to receive is completely contingent on the free will of Alice and Bob for the same entangled pair. For example, Alice may be on a Starship many light years from Bob who stays on Earth. The coherent state is stored on the Starship whilst the specific qubit it is entangled with is stored in Bob's receiver. Bob can receive future messages from Alice. Indeed, both of them can communicate with each other, each in their own real time, no matter what their global space-time separation is – if this general quantum theory with signal nonlocality proves correct.


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Minnesota author Alison McGhee tells a 'Tattoo…
OUR PICKS:
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Summer books to try
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That's one wacky shed
Minnesota author Alison McGhee tells a 'Tattoo Story' in new picture book
By Mary Ann Grossmann | mgrossmann@pioneerpress.com | Pioneer Press
Couple indicted in fatal shooting of 18-year-old blocking them in at Minneapolis gas station
Minnesota DHS deputy commissioners rescind their resignations
22-year-old on trial for causing traumatic brain injury in fight outside State Fair
Wisconsin congressman calls 4 minority congresswomen 'anti-American'
Head spinning over Minnesota DHS drama? Here's a timeline and cast of characters.
St. Paul man accuses deputies of rape, is charged with false reporting
Alison McGhee isn't resting on her laurels. This popular Minnesota writer shows her many talents in two new books unique for her — "Firefly Hollow" and "Tell Me a Tattoo Story."
"Firefly Hollow" (Atheneum, $16.99), designed for middle-grade readers, is her first with animals as characters. "Tell Me a Tattoo Story" (Chronicle Books, $16.99) is applauded by critics and booksellers for being the first to treat a tattooed character with respect as a loving dad who explains his elaborate body art to his little boy.
McGhee, an associate professor at Metropolitan State University, has written five adult novels, two young-adult novels, 12 picture books and three children's chapter books in her Julia Gillian series. She has won four Minnesota Book Awards in adult fiction and children's fiction categories. The Bink & Gollie books she writes with fellow Minnesotan Kate DiCamillo won the American Library Association's Theodor Seuss Geisel Award.
"Firefly Hollow" came first. The story of a friendship between a boy cricket and girl firefly who follow their dreams, a vole who is the last of his kind and a human boy who misses his deceased friend won a Christopher Award this spring for "affirming the highest values of the human spirit."
It started about eight years ago, when McGhee was mailed a package of colored sketches and watercolor paintings from artist Christopher Denise, with whom she shared an agent.
"There was a cricket and a vole on a dock where a little boat was tied up," she recalled. "It was so endearing, the tenderness of those illustrations; the look in Cricket's eyes. Vole was some sort of sailor. Christopher sent the artwork to see if I would like to do a picture book. His work was so beautiful I said 'yes' without thinking about it."
McGhee never dreamed writing about animals would take several failed attempts and the temptation to quit before she found her story of creatures from different worlds coming together and overcoming fears.
TATTOO TALE
"Tell Me a Tattoo Story," illustrated by Wisconsin native Eliza Wheeler, is so different from "Firefly Hollow" it's hard to believe the books came from the same author.
"This is the first picture book about tattoos, and it's getting so much love. It's one that's near and dear to my heart," McGhee says. "So many young parents wanted me to write this book for them. Tattoos have been considered low class, but the fact is 39 to 40 percent of Americans under age 35 have at least one tattoo. I want to be an artist of the time in which I live. It's time to stop shuddering at tattoos and start viewing them as an art form."
In the book, Dad tells his little boy the origin of each tattoo. One is his dad's admonition to "be kind." Another pays tribute to "the longest trip I ever took," which shows Dad in military uniform, leading a long line of soldiers through sandy terrain. The last tattoo is the boy's favorite. It's a small heart with his birth date.
McGhee got the idea from her agent, whose friend wished one of her authors would write a book with tattoos.
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"My agent brought it to me, and instantly I said, 'Oh, my gosh, what a great idea. It will honor my children and all tattooed parents.' I wrote it quite quickly. It formed itself and came out."
The story is personal to McGhee, because her son and youngest daughter are multiply tattooed, although their mom is not. "I'm in my 50s, and I don't mess up my skin any more than it is," McGhee jokes.
She recalls when her son, Luke O'Brien, was 18 and texted, "Mom, would you kill me if I got a tattoo?" McGhee responded, "Well, honey, not if it's a heart on your bicep with 'MOM' in the middle."
She needn't have worried. Her son's first tattoo, in the middle of his back, was of Ferdinand the Bull, his first picture book. "That melted my heart," his mom admits.
McGhee became so intrigued with the tattoo culture she featured real people's tattoo stories on her blog, alisonmcghee.com/blog.
There isn't much personal information in McGhee's published bios, confirming her assertion that "I am pretty private." She admits that despite all her books and presence in social media, she's "reserved."
McGhee grew up in the Adirondack Mountains of upstate New York and attended college in Vermont. She moved to Minneapolis to be with her husband. They raised three children in Minneapolis' Uptown neighborhood, and she incorporates details from that area and the schools they attended in some of her books.
Now that the kids are out of the nest and she is divorced, McGhee says she's "a little bit of a nomad," living part time in Southern California, in a shack in Vermont and in Minneapolis. She continues teaching at "my beloved Metro State" but considers herself a writer first and prof second.
Alison McGhee seems to be sharing a joke with a camel in Sharjah, United Arab Emirates, when she attended the International Reading Festival there in late April. (Courtesy photo)
That spirit of adventure led her in April to the International Reading Festival in Sharjah, one of the United Arab Emirates, where she was on a panel, gave "a bunch of interviews" and presentations at two schools as well as visiting the library, museums and other cultural sites.
"This was a mind-blowing experience. It will take me awhile to fully absorb it," McGhee recalled the day after she returned to Minnesota. "It was my first time in a truly Arab country, and I made it my goal to have as many deep conversations as
I could with cabdrivers and authors from Pakistan, Iraq, Egypt.
"I went with shame and guilt in the back of my mind and decided to be the anti-Trump ambassador without mentioning his name. Without exception, people shook their heads, rolled their eyes. The common feeling was that we are all just people and forces like Trump are beyond our control."
This summer is full of more travel for the author, visiting parents, children and her boyfriend and "write, write, write before beginning teaching in August." She hopes to finish a picture book and rewrite an adult novel.
"I've been working on this one for quite a long time," she says of the adult novel. "I hope it turns into a good book. I haven't published one since 'Falling Boy' in 2007. I can't believe these years are gone. My head has been completely in the world of children's books. It's lovely to write again for adults."
Mary Ann Grossmann
Mary Ann joined the Dispatch-Pioneer Press in 1961 when there were two papers. She has been a fashion writer, a women's columnist and the women's department editor who brought "society" pages into the 20th century. She was named book editor in 1983, just when the local literary community exploded. She has won the Minnesota Book Awards Kay Sexton Award, a Page One Award and YWCA Leader Lunch Award. She retired in 2001 and works part time. A graduate of Macalester College, she lives on St. Paul's West Side in a money-sucking Victorian house with assorted old animals.
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Bell Museum celebrates 50th anniversary of Apollo 11 with public viewing of moon rocks
The public viewings began Tuesday to coincide with the half-century anniversary of the launch of Apollo 11.
Stillwater Lumberjack Days ready to kickoff
Stillwater's annual Lumberjack Days celebration will begin its 5-day run on Wednesday. From a boat cuise on Wednesday to the big parade on Sunday, each of the five days will have unique activities. The market and food vendors, as well as a number of other activities, will run Friday through Sunday on the festival grounds downtown Stillwater. Main stage music...
Winding Trail Books, St. Paul's newest independent bookstore, will celebrate its grand opening weekend beginning Thursday in the St. Anthony Park neighborhood. Located in Milton Square at Como and Carter avenues, near the space that formerly housed Micawber's Books, Winding Trail is co-owned by Sue Costello and her fiance, Rick Gahm. The couple, who live in Vadnias Heights, are lifelong...
LOS ANGELES (AP) — HBO's "Game of Thrones" slashed its way to a record-setting 32 Emmy nominations Tuesday for its eighth and final season, leading HBO back to dominance over Netflix, the streaming service that bumped it last year from atop the increasingly crowded television heap.
Minnesota United-branded futsal court replaces basketball at West 7th park
Minnesota United and the U.S. Soccer Foundation have unveiled the first in a series of "mini-pitches" in St. Paul -- hard-surface play areas installed over underused outdoor basketball and tennis courts or other lots. Representatives of the Major League Soccer team, the soccer foundation and MLS Works joined St. Paul Parks and Rec officials on Friday at St. Clair Park-West...
Registration details announced for St. Croix Crossing Half Marathon
There is still time for runners to sign up for the July 27 St. Croix Crossing Half Marathon and 5 kilometer run. It will cost you more, though, the longer you wait to register.

redpajama_set_name: RedPajamaCommonCrawl


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West Lake Landfill activists join forces with Flint water protestors to pressure EPA
Chuck Raasch, St. Louis Post-Dispatch
Activists working with CHEJ around the West Lake Landfill controversy in St. Louis and in Flint, Mich., have joined forces to put pressure on the federal Environmental Protection Agency to respond more forcefully to both environmental crises. An article in the St. Louis Post-Dispatch covers a joint press conference between Flint activists and JUST MOMS stl, a group organized to force the EPA to reduce the threat of radioactive waste at West Lake Landfill.
At the press conference, about a dozen representatives said they will picket EPA headquarters because of EPA administrator Gina McCarthy's unwillingness to meet with them or to act more urgently.
That standoff with the EPA is not new, and McCarthy has previously refused to meet with representatives. What is new is the linkage between West Lake and Flint, where the EPA and other local, state and federal authorities have been under fire for allowing lead exposure in water there to persist, endangering the health of families in that community.
Flint activists say recalcitrance and stonewalling from government agencies, and especially the EPA, have left residents exposed to cancer-causing lead and other health problems.
The two groups will share share health and other information, and continue to join forces to pressure the EPA.
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By Sharon Franklin. Emily Beament published an article on January 16, 2023, on The Ecologist, a news and analysis website that focuses on environmental, social
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No, I don't mean the catwalk type!
This topic has been brewing in my mind for over a year, and when WordPress so kindly provided me with my handy dandy annual round up, it showed me that the most popular posts I've written are those on writing or publishing – as if there aren't enough of those out there already – so I reckoned it was about time for another.
Anyway, back to topic. 'Modelling', in this case, is something I use every day in my work, both equestrian and writing. It actually refers to a concept used by NLP practitioners (that's Neuro Linguistic Programming).
Well, it is. It's used extensively in business training, sports psychology at the highest levels, and teacher training, or indeed any form of coaching. Other aspects of NLP involve the study of communication, which is why the relevance to teaching and coaching, and it can also be described as 'the science of communication'.
We can apply both these aspects to our writing, because what is writing (fiction or non-fiction), but the ability to clearly communicate our knowledge, or our characters, or our plot, to the reader.
It's quite a large subject, so today I'm focussing on one 'small' area: that of story construction.
This is the most important starting point: read. Read widely, and read books of acknowledged excellence. If you want to analyse them afterward, for style, content, how they create believable characters, tension, etcetera, fine. But you don't have to. Just read lots of excellent work and allow it to sink into your subconscious.
When you read something that's less than stellar, you might want to try making a comparison: what was it that didn't work, that was disappointing compared to those excellent books you've been submerging yourself in? Again, this is more about concept than detail – think on a broad scale.
If you really allow the great writing to sink in, when you start writing your own work, you should find yourself 'modelling' your structures (plot line, character, scene) on the excellence that has lodged in your subconscious. This doesn't mean you copy shamelessly – but you should start to know what 'feels' right, (or wrong), in comparison to the excellent examples that you've read.
Do you realise how much excellence there is out there, amongst screen writers?
You may not be overly-enamoured of someone's film or TV adaptation of your favourite novel, but believe me, those who don't know the novel will love the show. A great example would be the recent series of films based on 'The Hobbit'. Many aficionados of Tolkein's work were scandalised by the Hollywood-style treatment, creating new characters (a female elf for a love interest, for goodness sake!) and new climaxes, while missing out some stuff altogether. But did it hurt the box office takings? Nope. Because it was excellently structured and scripted for the target audience.
Script writers know all about construction – things like story beats, character arcs, plot arcs and the like. They have to, otherwise viewers would lost interest, and a film (or TV show) would flop, which costs MONEY!
Again, you can study their excellent use of structure in a formal way, by analysing, or taking classes (and I'm not for one minute suggesting you ignore such options), but if you, once again, watch and absorb, allow the structure to seep into your consciousness and lodge there, when you begin to write, you will find yourself copying, or modelling the structures that keep millions of people glued to big (and small) screens.
For myself, I realised a while ago, that I've learned an incredible amount by watching TV soap operas. They aren't my favourite shows, but I've gone through periods of being a devotee to one or another, and when I questioned why, I realised it was the structure that the writer has used, that kept me coming back. Not on an intellectual or analytical level, but on that gut 'I need to find out what happens next' level.
Watch how they structure relationships in these shows – how, as the audience, you really want a character to spill the beans, or share their troubles, or something along those lines, but events always prevents them from doing so at the very last moment, and the outcome is bound to lead to disaster further down the line.
That, my friend, is awesome story construction. How to structure your plot – every scene, every relationship, every event – to keep your reader turning the pages and coming back, panting to buy your next book.
No, I'm not, as those of you that have been around here for a while, advocating ending your book on a cliff hanger (see my post: Please don't leave me hanging), but if you use this absorbed knowledge, that should eventually feel like instinct, to write such exciting or absorbing books that keep the reader up late at night, or missing meals, you will create fans ready and eager for your next tome.
Neither am I suggesting that modelling take the place of editing, especially if you are in the earlier stages of your writing career, but as is so often cited, the better your work when you send it to an editor, the less needs fixing, and the less expensive the experience will be.
So how about all you writers out there, can you think of instances when you've used modelling, now you can recognise what it is you were doing? What have you learned from excellent books, films or TV shows? I'd love to know – it's all a positive learning experience.
Great guidance from an expert writer.
Absolutely! It would be like being a chef, if you didn't like tasting the food.


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'Parenthood' Cry of the Week: Fight for Your Marriage, Damn It!
Is there any movie or television show in the history of moving images that does not benefit from a momentous dinner scene that forces the characters to confront their lingering issues? There's a reason the dinner trope is so prevalent. It always works, and this week's Parenthood is no exception. The entire clan assembled at the grandparents' house, and each of the siblings aired a grievance. Parenthood is finding a unique comedic rhythm, though thankfully that is not at the expense of the tears.
Prepare the tissues, because you'll be furious and sad
Crosby and Jasmine's daughter's baptism occurred this week, which meant every character was saying the baby's name over and over. Aida. That's her name. Aida, as in the opera. Aida, as in there is no explanation for why they would pick such a bad name. Jasmine suggested it with no primer on why, and Crosby accepted. What a horrible name. Perhaps the writers said, "We imagine this fake child having a name that was never popular but reached an extremely modest peak in the 1960s. I suppose now that Haddie has been banished, another weirdo name had to be introduced." This episode served as a reminder that for all its strengths, the Parenthood writing staff cannot be trusted to name children.
Prepare the tissues, because you'll be overwhelmed with happiness
Erstwhile Parenthood fan David Jacoby recently pointed out that there has been a marked difference in Drew's appearance. When did this guy develop such defined cheekbones? Now that he is armed with a less-Bieberesque haircut, Drew is suddenly the hot, comic relief of Parenthood, paired with an increasingly valuable roommate. Berto (the roommate) slept with Drew's former flame Natalie, rightfully assuming that Drew had no claim since he had spent the last month engaged in a final dalliance with Amy. Perhaps guy code would dictate that Natalie was off limits to Berto, but he can't be bound by rules. The Natalie situation led to a dispute between Drew and Berto over ownership of Gatorade and almond butter. In Berto's defense, who hasn't sneaked a few schmears of his or her's roommates nut butter? Nick Krause was essentially playing his Descendants character, but what a delightful character that is. Ultimately, the roommate tension drives Drew to Amber's apartment, where they get drunk and high together. Everyone wins, including us viewers.
Cry Moment of the Week runner-up
Jason Katims says there are no rules in his writers' room, but it does know when certain plotlines are more emotional. Last night, Zeek drops in on his estranged son-in-law, Joel, and it's hard to imagine that the writers didn't count on this provoking a few tears. Following Aida's (ugh) pre-baptism dinner, Zeek shows up at Joel's apartment to deliver a speech about how Joel was still part of the family. (The unannounced pop-in seems to be a Braverman special. Crosby did the same thing earlier in the episode, and Amber popped in on Drew last week.) Sam Jaeger recently spoke about how much he enjoys working with Craig T. Nelson, and he was probably alluding to this scene, though he couldn't say so at the time. The Braverman patriarch adds gravitas to every scene he's in, save for the scenes where he's intentionally going for humor. We've only seen Joel interact with Julia and his kids over the few episodes, so I welcomed Joel's tête-à-tête with Zeek. Yet for all the power he brings, Zeek Braverman is more of a caricature than any other member of the family. He often delivers a soliloquy that leaves the other characters speechless, or he swoops in to save the day, but his relationships are relatively shallow. We accept his marriage as fact, which is why Camille's disengagement from it is jarring. He's more of a constant deus ex machina than a fully developed character.
Cry Moment of the Week kill shot
While we wait for the explanation of why Joel moved out, Julia begs him to fight for their marriage. I feel like she is acting as a mouthpiece for the rest of the us. Why isn't Joel fighting for the marriage? WHAT HAPPENED? With five episodes to go in Season 5, we haven't seen Sonya Walger in awhile. Joel sits in his trailer-office, listening to Julia's pleas over the phone. As the camera pulls out and we can see the entire office, I waited for Pete to show up. An affair for Joel may be too simple of an explanation, but the frame, with him sitting in the dark office, seemed incomplete. There is something missing, and it's the void that makes Julia's phone call all the sadder. Her turmoil is senseless.
Filed Under: TV, Parenthood, NBC
'The Good Wife' Resets and Refocuses for Season 7 October 6, 2015
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2018 KHEL End of Year Video
By Urban|2019-02-24T12:51:48-05:0012:47 pm|General|
KHEL ANNUAL REPORT 2018
Every year, the community around Lakshmi Devi Academy (LDA), KHEL's school for underserved children in Dehradun, India, grows and changes. What remains constant is the need for education. Thirty-five years ago, we asked questions like, 'how do we get our kids to sit still long enough to drink a cup of milk?' Now we ask, 'how do we give our kids an education that supports them academically, socially, and personally?' And at the end of every year we ask, 'what was our biggest challenge? Where did we succeed?' Our biggest challenge was tracking what happens to students who leave LDA. In 2018, 12 students dropped out of school. Our community used to be mostly people who had been ostracised from their villages and were searching for a new home. Now, migrant families are usually looking for work and don't intend to stay. They don't have cell phones or addresses. They leave because they couldn't find work, they found work somewhere else, someone died, got sick or married, they owe someone money, they ran out of money, it's harvesting (or planting) season so they went back to their village, or any number of other reasons that we don't know, and which they're not obligated to tell us. It wasn't too long ago that migrant families' children worked, so it's encouraging that while they're in the community, they send their kids to LDA. Our greatest achievement was hiring Nikita. This doesn't seem like such a big deal, she's just another young woman working at her first job while studying for her B.Sc. Here's what we did right: many years ago, we educated Devender, Nikita's father. At the time, LDA only went up to 5th grade so he [...]
By Urban|2019-02-24T12:43:55-05:0011:39 am|General|
Building Education One Brick at a Time
Report on Construction at Lakshmi Devi Academy A Project of KHEL Total Cost for Stage One of LDA construction project: INR28,00,000 (USD40,000/€35,000) After more than three years of planning, construction work at Lakshmi Devi Academy (LDA), KHEL's school for underserved children in Dehradun, India, began in March 2017. The reason we are releasing this report now is that we wanted to see how well the construction worked for our kids. It takes some time to understand crowd flow and movement, and what we've learned this past year will impact future construction. In India, it's normal to wait through a monsoon season to see how construction holds up. Overall, this construction has performed admirably and has met our expectations. We invited the community and some of our students to a ground-breaking ceremony. Representing KHEL were Co-Founder Lalita Arya (fondly known as Ammaji), Executive Director Stomya Arya Persaud, Board Member Mr. Ahluwalia, and Beni Bhatt, KHEL's General Manager. Of course, all of KHEL's staff and teachers joined us. From Dhyana Mandiram Trust (DMT), which funded a large portion of this effort, we welcomed Tejas Chandaria, Narinder Pushkarna and Dr. Upreti. Also present were City Councillor Kamli Bhatt, and members of LDA's Volleyball team. In addition, we were happy to welcome both of our contractors, Jakir Ansari and Rajender Chauhan, and Mr. Maindola, our architect. KHEL serves a diverse community. In keeping with our policy of inclusion, we asked representatives from the 4 major religions of our community to take part in the ground-breaking ceremony. Ammaji began the proceedings with a prayer and blessing. Pandit Harshanand performed a short Hindu ceremony, Iliyaas Ansari gave a Muslim blessing, Mr. Ahluwalia said a Sikh prayer and Prakash Goel offered a [...]
Happy Diwali Video
Lakshmi Devi Academy (LDA) Adolescent Resource Center (ARC) Report
India is home to more than 225 million children ages 10 to 19 years. At Lakshmi Devi Academy (LDA), KHEL's school for underserved youth in Dehradun, India, we provide a comprehensive education designed to give our children the tools to reach their full potential as individuals and leaders. Helping our kids become productive adults requires collective action on education, health, employment, personal development and interpersonal relationships. The Adolescent Resource Centre (ARC), instituted at LDA several years ago, gives our children the tools they need for their lives outside the classroom. ARC covers many overlapping areas of development. We discuss life skills and livelihood. The children learn decision making and relationship skills, and they spend time in personal contemplation. We share with them what kinds of changes to expect during adolescence, how our social attitudes might change during this time, and crucial information on reproductive health. We talk about nutrition, health, hygiene, what constitutes a balanced diet, and common and infectious diseases including HIV/AIDS and other sexually transmitted diseases. Throughout this year long process, we encourage curiosity, open discussion and problem solving. The ARC councilors, Madhavi and Karishma, stress that confidentiality is a critically important part of ARC. Our kids and staff all live in the same community. The advantage to this is that everyone looks after everyone else. The disadvantage is that everyone knows everyone else's business, and gossip among or about teenagers can be devastating. Many of our kids don't have access to personal space in their homes; sometimes a living room doubles as a family bedroom, and in that same space there may be a small area in one corner for cooking. This makes confidentiality vital to building trust with our children because [...]
Swami Veda Bharati at LDASwami Veda Bharati, formerly known as Dr. Usharbudh Arya, together with Mrs. Arya (Ammaji) founded KHEL and transformed a community. When he passed away, what Ammaji wrote isn't so much an obituary as a celebration of his life that included the mission of KHEL to bring kindness, health, education and laughter to the impoverished children of his home town, Dehradun.Thou hast made me known to friends whom I knew notRabindrath TagoreSwami Veda Bharati1933-2015©Lalita Arya 2015Swami Veda loved languages. He knew so many I cannot count and among them is the sweet lilt of Bangla. He loved Tagore's poems and this quote from Tagore's Gitanjali was one of his favorites. This poem fully illustrates the kind of life he lived, and seems most suitable for the occasion to celebrate his life with the world he created. He was given seats in homes not his own, not as an invited guest, but as an honored and loving teacher. He traveled far and wide into unknown lands and found kinship among strangers. He treasured the old and found it still abiding in the new. He had that ability to go back into time, pull out the relevant from the archaic and adapt it to contemporary life. His family saw this in everything he did – his three daughters, his son, their spouses, their mother, and grandchildren. Sometimes he went so far back we would sit agape, listening, lost in time and space.Before taking sanyaasa he had already adopted a larger family than his own, prompting a few old family friends to say to his children after his Mahasamadhi – Thank you for sharing your father with us. This was the swami he was that [...]
By Stomya Persaud|2017-12-19T08:55:41-05:003:18 am|General|
'You don't have to be privileged to have potential'Shivani, KHEL VolunteerHow many children have amazing potential and no means to develop it because of simple, solvable challenges? In some parts of the world, kids are being bombed or kidnapped because they and their families believe in education. At KHEL the threats are, thankfully, less life threatening. But it's no less devastating to a child who wants to get an education and can't because she's menstruating and has no sanitary napkins, or because he has to get a job at 9 years old because his parents are too sick to work. For some children it's as simple a problem as they don't have shoes.How do we help kids to achieve their potential? Education is the primary means to self improvement and is the most basic service we offer. But, there's no point providing children an education if they're too sick or malnourished to focus on their studies so we also organise health camps, vaccinations and other forms of medical and nutritional support for the kids and their families. Education isn't just about academics. Through our volunteers and the many visitors to KHEL our kids get the benefit of meeting people from all over the world. In 2014, through the Adolescent Resource Centre, we introduced innovative programs to provide our kids with education for life such as career planning, relationship advice and health and hygiene lessons. Lakshmi Devi Academy (LDA), KHEL's school for underserved children in Dehradun, India, is more than just a school. It is a gathering space that fosters relationships among diverse groups in a small and densely populated community. Programs like the Buddy Project help the kids to develop empathy for each other from [...]
Rest in Peace, Munni Devi
From Stomy and Ammaji - With sorrow in our hearts, we share the tragic news of the untimely death of one of our devoted staff members. Munni Devi worked for KHEL for over 20 years, helping to look after not only our school but our students as well. She was only 46 years old and is survived by three grown daughters, Seema, Rekha and Chanda, and her husband, Puran, as well as many other family members. A few days ago Munni fell in her home and hit her head. She lost consciousness and her family had to break down a door to reach her. She was taken to a hospital and was seen by two neurosurgeons. It was apparent that her prognosis wasn't good but we immediately put together funds for surgery, just in case the doctors gave the go ahead (thank you, Swami Veda, for offering to cover a large portion of the cost). With her family around her, she was in and out of consciousness for less than a day. Non-relatives weren't allowed in the ICU but Beni, KHEL's General Manager, went anyway to lend his support to the family. In India, you must deposit money with the hospital before they'll treat you. We gave her family the required deposit. During the night she slipped into unconsciousness and didn't wake up again. She passed away peacefully surrounded by her loving family. Beni stayed with them during the day of her passing, helping to arrange for transportation to Haridwar, a Hindu holy city near Dehradun. In one of her moments of consciousness, Munni had asked to be taken there. We joined the family and friends at the 'ghats', a place on the Ganga's banks [...]
LDA Buddies
In September 2014, KHEL started a new program to foster good relationships between the younger and older students at LDA. Once a week, our 5-8th grade students meet with a 1-4th grade student to work on a project together, share a snack, help with homework or just chat about their lives and their families. Recently the Buddies got together to make thank you cards for KHEL's friends and donors. Shalini, a long time KHEL volunteer, designed this program by drawing on her experience as a mentor to under served middle school students in New Orleans when she was a college student at Tulane University. The program has been running for several months and the kids look forward to the days when they get to hang out with their Buddies. LDA is more than just a school. It is a gathering space that fosters good relationships among diverse groups in a small and densely populated community. Programs like the Buddy Project help the kids to develop empathy for each other from a young age and teach them much needed mentoring skills for adulthood. They learn that, no matter how poor they are, they have something of value to share with someone else.
By Stomya Persaud|2017-12-19T08:55:41-05:0011:58 pm|General|
The Peoplr of KHEL's Adolescent Resource Centre (ARC)
At Lakshmi Devi Academy (LDA), KHEL's school for under served children, we've been running the ARC Program for a few months. The kids look forward to the days when they get to stay after school to take part. The program is designed to be fun so they have a great time with their friends while learning about health, hygiene, relationships and other topics relevant to 7th and 8th graders. There weren't any sessions in January since classes didn't resume after the winter break until January 14. Then the weather became challenging and the state government mandated that schools close for a short period. Many people, including one of the ARC trainers, were sick with seasonal colds and flu. More than one organisation made ARC at LDA possible. RDI - HIHT (Rural Development Institute - Himalayan Institute Hospital Trust) provided the staff to survey LDA's students as well as two trainers who work directly with the children. Bhola Shankar Dabral, representing Dhyana Mandiram Trust (DMT), worked hard with other DMT members and donors to raise the necessary funds, while also liaising with KHEL staff to get the program up and running at LDA. Without the dedicated people who run RDI and DMT, ARC at LDA wouldn't be possible.Before the ARC inauguration two young women, Karishma and Ankita, came to LDA to talk to the kids. They asked what problems the kids had, what sort of programmes would be helpful to them, what did they know about health and hygiene, what their living conditions were at home, and many other questions. This information was then evaluated by the two trainers so that the sessions are tailored to the needs of LDA's children. For Karishma and Ankita this [...]
By Stomya Persaud|2017-12-19T08:55:41-05:0012:29 am|General|
Exam results! All our 8th class students passed. Transfer certificates are issued in May, so that's when we'll find… twitter.com/i/web/status/1…
On #WorldHealthDay, we recognise the Indian government's ASHA Program that comes to LDA every month. This program s… twitter.com/i/web/status/1…
There were a few tears shed as the 8th class students said goodbye to their friends and teachers. But in the end, t… twitter.com/i/web/status/1…
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Home / 1-year-old Ghanaian tech whiz who's coded for Instagram and Snapchat / News / THE YCEO: 21-year-old Ghanaian tech whiz who's coded for Instagram and Snapchat
THE YCEO: 21-year-old Ghanaian tech whiz who's coded for Instagram and Snapchat
THE YCEO March 26, 2019 0
1-year-old Ghanaian tech whiz who's coded for Instagram and Snapchat
Besides creating algorithms for Instagram and Snapchat and consulting for Twitter, he's now working with Kanye West and Jaden Smith to create augmented-reality experiences around music and politics for the tech festival ComplexCon next year in Chicago.
"With Jaden, we are getting more young people to vote and creating experiences around that," Sandu told CNN about his work with the musician and actor who is the son of Hollywood stars Jada Pinkett Smith and Will Smith.
Born in Accra, Ghana, Sandu's parents came to the United States when he was 3. He learned to code when he was just 13, during a work experience at Google eight months after the tech giant moved into Frank Gehry's "Binoculars Building" in Venice, California.
For Sandu, it was a life-changing experience that cemented his meteoric rise in the American tech industry. In 2019, he plans to go back to Africa to help students envision social platforms of their own.
1-year-old Ghanaian tech whiz who's coded for Instagram and Snapchat News


Famously known for its gorgeous beaches, unique wildlife and "the Outback," Australia is truly one-of-a kind. As TransAct's vice president of global gaming in Asia Pacific, I recently had the chance to visit the land of the Down Under for the 2018 Australasian Gaming Expo (AGE). Held from August 14 to 16 at the ICC Sydney Darling Harbour NSW, the gaming team and I displayed TransAct's premium casino printers and software solution to approximately 6,000 attendees.
AGE is the world's third largest hospitality and gaming tradeshow and the biggest event of its type in Australia. At the show, we displayed the Epic 950, which is the industry standard in ticket-in/ ticket out (TITO) printing and currently installed in over 750,000 slots throughout hundreds of casinos and gaming operations worldwide. We also displayed the Epic Edge™ TITO printer, which is built on the proven long-term performance of the Epic 950. The Epic Edge is the next-generation casino ticket printer that offers operators an enhanced 300 DPI print resolution, delivering a 50 percent improvement over current printers. Attendees at the show also learned about the latest iteration of Epicentral, which is the gaming industry's only enterprise-level promotion and bonusing software suite that can target customers in real-time while they play their favorite slot machine or electronic table game.
At TransAct, I'm responsible for building customer relationships and driving gaming sales across the Asia Pacific region. As such, I'm pleased to say that Australia has proven to be a great market for the Epic 430 and Ithaca 9000 printers, which are our robust, high-end point of sale printers used in electronic betting terminals. Additionally, since the Pub and Club market is still relatively new to TITO printers in some states of Australia, we predict major growth opportunities as new regulations develop and operators see the benefits of these printers. To increase our presence in Australia, we recently appointed The Bright Group (TBG) to serve as our regional sales partners to help us focus on the country's local market and give customers the best possible sales and support experience. We have found that working with local partners who know their customers' needs is much more efficient than having one sole global partner.
In addition to exhibiting at the show, we also had the opportunity to venture out and reconnect with our customers in Sydney's beautiful Darling Harbour. We couldn't be more excited for our future in Australia and we look forward to supporting the show once again next year.
Pictured (L to R) are Armando Flores, Director of Marketing; Rashid Suliman, VP of Global Gaming in Asia Pacific; Russ Wige, Technical Sales Director; and Tracey Chernay, Senior Vice President of Global Casino, Gaming and Lottery.