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Home Head Coach Analysis Quique Setien At Real Betis
Head Coach Analysis
Quique Setien At Real Betis
"I understand football through the ball."
If ever a single quote encompasses the footballing identity and philosophy of a coach than the above does for Quique Setien of Real Betis. Setien was clear when delivering that quote that he sees the attacking phase as the most important phase of the game with his sides having a clear emphasis on possessing the ball and dominating the opposition.
Last season, Setien's first in charge of Betis, was extremely impressive as Betis finished in 6th place qualifying for Europe and finishing one place above city rivals Sevilla. Beyond the black and white nature of the league table, however, Betis were one of the most attractive and interesting sides to watch in the whole of Europe. As a coach Setien is very much regarded as a tactician with his love of chess being evident in certain aspects of his preferred style and system of play, from the domination of the centre to the use of discovered attacks in wide areas the level and quality of work on the training field, translated extremely well in to game situations as Betis passed their way through opposition defensive structures time and time again.
With that said however this emphasis on possession and attacking football does come at a price for a Setien side and that price tends to come in the defensive phase where clean sheets were something of a rarity for Betis last season as they scored 60 goals but managed to concede 61.
The main talking point around the squad this pre-season was the loss of the former academy player Fabian who moved across to Italy to join Napoli for a reported €30M. Fabian was the playmaker in the Betis side this season and although he rarely got on the scoresheet or registered an assist his pass was often the one that led to the assist.
With that said the club has moved to strengthen in and add depth to key positions in the squad. We will look in more depth at two particular signings that have been made this summer as well as breaking down some of the attacking patterns that we can expect to see from Setien and Betis as they look to build upon their success of last season.
First, the signings.
The Japanese attacking midfielder was one of the revelations of the 2018 World Cup in Russia with his goals and direct running from the left-hand side causing Japan's opponents problems whenever he was in possession of the ball. With that said the fact that Betis managed to secure the signing of Inui as a free transfer from La Liga rivals Eibar is all the more impressive.
Inui is the type of technically and tactically intelligent player that will thrive for Betis under Setien. Able to play out in the wide areas of even centrally as an '8' he will add a lot to the attacking phase for Betis whilst also working hard in the defensive phase to press or to close down passing lanes in the central areas. It will be equally important this coming season that Inui has the quality to play and combine in tight and compact spaces in the final third of the field, especially as next season we can expect to see more opponents dropping into deeper defensive positions to deny Betis the space to play. In this Inui has the quality on the ball to break down opposition defensive structures.
Here we see Inui in possession of the ball on the left side of the field. The opposition defensive line is relatively stretched but the main striker for Eibar has, somewhat strangely, already moved into an offside position.
Thankfully for Eibar, Inui has the quality on the ball to recognise this and look for a secondary passing option into the final third. His body shape as he looks to strike the ball suggests a lateral pass across the field but Inui uses a disguise in his pass and reads the run made by the far sided player before playing a diagonal pass on the ground through the defensive line and into the run of the attacking player.
As well as being a creative and capable passer on the ball Inui also has the quality to carry the ball and drive through gaps himself in the opposition defensive structure.
Betis under Setien like to play with their wide attackers moving inside into the half spaces or even the central areas as both fullbacks move forward to provide the width. This structured movement will suit Inui well as he will find pockets of space that will allow him to isolate and attack defensive players.
As you can see here at the World Cup we see Inui in possession on the left side, the supporting player moves outside to create space and as he does Inui is able to drive through the gap in the defensive structure before beating the closing defender and looking to curl a shot into the far post.
The Portuguese midfielder has been signed by Betis for a reported €20M having originally looked to cancel his contract at Sporting Lisbon. Given that Carvalho has long been linked to a move to a top European side this can be seen as something of a coup for Betis.
Last season the Spaniard Javi Garcia was the controlling midfielder in the defensive midfield slot, it is likely that given the outlay on Carvalho we will see him start the season in that deep area.
Carvalho is a player with the ability to open up both sides of the field with his range of passing which will be important for Betis under Setien this season.
Here we see Carvalho in possession of the ball against an opponent that is in a deep and compact block ahead of him. Against teams that defend in this manner, and again Betis will face this more this season, there are two options in terms of progressing the ball through in the final third. First of all you can play through the block trying to find spaces inside, Otherwise you can play around the edge of the block to turn the defence and create space that way, this is where Carvalho comes in with his comfort in distributing the ball right or left from his central area he will force the opposition block to move and shift.
As well as being a figure that can add value in the attacking phase Carvalho is also comfortable in defending in open space or covering space in the defensive phase where his athleticism can be hugely beneficial to his team.
Here we see the opposition in possession on the right-hand side with the Portuguese defensive line stretched as the left back presses out to engage the ball and lengthens the space between the central defender and the left back. As the ball is played through this gap for the runner to move in behind however Carvalho reads the danger and moves out to cover the run and win the ball cleanly before moving quickly into the attacking phase for his side.
Attacking Phase
In the attacking phase for Betis, we see Setien impose a number of mechanisms in terms of player movements to both help in the build-up phase for keeping possession of the ball and to help create space further forward into the final third.
The first mechanised movement that Setien likes to see from his players sees the defensive midfielder dropping back into the centre of the defensive line. This immediately creates a back three with the two wide centre-backs splitting out into wide areas forming a chain of three that will allow Betis to circulate the ball quickly and efficiently from one side to the other in order to change the angle of the attack.
This forming of the back three also enables the second mechanised movement to take place as the fullback on the ball side of the field moves into a high position. This movement, in turn, allows the wide attacker on that side to move inside, this in a sense is the discovered attack from chess that we referenced earlier as the wide attacker moves out to empty the space in the wide area that is attacked immediately by the fullback.
On the far side of the field in the attacking phase, the opposite fullback also moves forward but to a deeper line initially in order to provide balance to the attacking movement.
As the attacking phase becomes established and Betis have control of the ball in terms of possession we see the next phase of the attacking plan put into place as Betis move into three distinct blocks.
The first block has the three defensive players who form the base and give options for the ball to be recycled backwards if need be. The second block has the two central midfielders who provide a central option for the pass when the ball is in wide areas and the third block is a block of five with both fullbacks moving high to stretch the width of the field and both wide attackers moving inside to combine with the lone striker.
This established attacking pattern allows Betis to keep possession of the ball and dominate the centre of the field at the edge of the final third.
There is no doubt that this will be a difficult season for Betis under Quique Setien as they look to establish themselves as a top 6 side in La Liga. More clubs will have had time to study the method and style of play of Setien and they will have rehearsed defensive patterns to counter the attacking threat.
With that said however these countermoves will be natural to Setien given his love of Chess, we could well simply see the next evolution in an attacking phase from this exceptionally interesting coach.
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The Premier of the Cabinet (Chosŏn'gŭl: 총리; Hancha: 總理; MR: Chongni) is nominally the non-executive head of government of North Korea. The office is also alternatively known as Prime Minister of North Korea. The current premier is Kim Jae-ryong.
Originally, under the 1948 Constitution of the DPRK, the Premier was a very important post and held actual power over the government. Kim Il-sung himself inaugurated the post, keeping it for 24 years until 1972, while the ceremonial role of the head of State rested in the Chairman of the Standing Committee of the Supreme People's Assembly.
The 1972 Constitution created the post of President of the DPRK for Kim Il-sung, transferring to it all the paramount power. The Premier was now the head of the Administration Council, but most of the powers of the former cabinet were passed to the Central People's Committee, the highest ruling council chaired by the president himself. The first premier after Kim Il-sung was his long-time ally Kim Il. The post was then officially known as Premier of the Administration Council (정무원 총리, jungmuwon chongni).
After Kim Il-sung died, the post of president remained vacant (officially Kim Il-sung was proclaimed Eternal President) as Kim Jong-il planned a new State reorganization. A constitution revision in 1998 abolished both the Central People's Committee and the Administration Council, re-creating the Cabinet.
The Premier represents and oversees the cabinet, which is charged with executing the policies decided by the Central Committee of the Workers' Party of Korea. The office has no policy-making authority of its own.
The Premier is nominally part of a triumvirate overseeing North Korea's executive branch, alongside the President of the Presidium of the Supreme People's Assembly (i.e. the head of State) and the Chairman of the State Affairs Commission (i.e., the commander-in-chief). On paper, each has powers equivalent to one-third of those of a president's powers in most presidential systems. The SPA presidium chairman conducts foreign relations, the premier handles domestic matters and heads the government, and the SAC chairman (known as the chairman of the National Defence Commission before 2016) commands the armed forces. In practice, however, the SAC chairman, which is constitutionally defined as the most pthough it was clear it is the lowest of the three: significantly, Kim Jong-il was NDC Chairman uninterruptedly from 1993 until 2011, and Kim Yong-nam has been President of the SPA Presidium since 1998, while the premiers have often changed.
The following is a list of premiers of North Korea since its founding in 1948.
The Premier is represented by a number of vice premiers, who act as a high-ranking executive assistant to the Premier.
They are: Im Chol-ung, Jon Kwang-ho, Kim Tok-hun, Ko In-ho, Ri Ju-o, Ri Mu-yong, Ri Ryong-nam, Ro Tu-chol, and Tong Jong-ho.
^ "Constitution - The Cabinet". Naenara. Retrieved May 20, 2017.
^ a b c "Chiefs of State and Cabinet Members of Foreign Governments: Korea, North - NDE". Central Intelligence Agency. 21 June 2018. Retrieved 28 August 2018.
^ "N Korea vice-premier 'executed'". 12 August 2015 – via www.bbc.com.
^ (www.dw.com), Deutsche Welle. "North Korea executes vice premier, says Seoul - DW - 31.08.2016". DW.COM.
This page was last edited on 19 April 2019, at 11:41 (UTC).


Th' whisper of the willow wisp.
And the flood goes running.
Along, a little self discovery.
Personal Quote: I am nothing, I wont ever be anything and beside that I carry in me all the dreams of this world.
Please don't send any urgent notes to this page since I don't check this account to often.
And since I already have a hard time keeping my main account (manaxmomo ) up to date, I decided to sort of close down this account.
But not entirely. Some of the more famous pictures will remain, so they can be used in the future, too.
I will still visit this account on and off, so please, keep on crediting me and leaving a link with to your picture underneath the used stock so people can track it down for their use.
I used one of your images. Thank you so much!
Hi there! Ive used your forest stock here [link] ! Thanks!


Temporary Employee salaries at B. Loehr Staffing can range from $9-$14. This estimate is based upon 2 B. Loehr Staffing Temporary Employee salary report(s) provided by employees or estimated based upon statistical methods. See all Temporary Employee salaries to learn how this stacks up in the market.
Looking beyond B. Loehr Staffing?


When it comes to buying a home, one big decision is whether to use a REALTOR® or not. Statistics have found that 88% of buyers polled by the National Association of REALTORS used a real estate agent or broker in 2013. That percentage has gone up steadly since 2001. The reason? REALTORS have a vast wealth of information to help you make a smart, educated decision. We invite you to Take the Buyer's Journey With Us ….KLM Properties knows the way!


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Diphenhydramine Injection
Diphenhydramine injection, Pfizer, 50 mg/mL, 1 mL Carpuject syringe, 10 count, NDC 00409-2290-31
Armas Pharmaceuticals has diphenhydramine injection available.[1]
Fresenius Kabi has diphenhydramine injection available.[2]
Hikma has diphenhydramine injection available.[3]
Mylan has diphenhydramine injection available.[4]
Pfizer has dipehnhydramine injection on shortage due to manufacturing delays.[5]
Diphenhydramine injection, Armas Pharmaceuticals, 50 mg/mL, 1 mL vial, 25 count, NDC 72485-0101-25
Diphenhydramine injection, Fresenius Kabi, 50 mg/mL, 1 mL Simplist syringe, 10 count, NDC 76045-0102-10
Diphenhydramine injection, Fresenius Kabi, 50 mg/mL, 1 mL vial, 25 count, NDC 63323-0664-01
Diphenhydramine injection, Hikma, 50 mg/mL, 1 mL vial, 25 count, NDC 00641-0376-25
Diphenhydramine injection, Mylan Institutional, 50 mg/mL, 10 mL vial, 10 count, NDC 67457-0124-10
Pfizer has diphenhydramine 50 mg/mL 1 mL vials on back order and the company estimates a release date of August 2020.[5]
Alternative Agents & Management
Use oral diphenhydramine tablets and liquid where possible.
Ensure any intravenous diphenhydramine use is appropriate.
Review premedication protocols and remove injectable diphenhydramine whenever feasible. For example, diphenhydramine is not effective for preventing non-hemolytic transfusion reactions.[6]
Oral antihistamines including non-sedating options may be of use in allergic pruritus and urticaria.
Hydroxyzine is another H1 receptor antagonist available for intramuscular injection.
Benztropine injection is an option for patients with acute dystonic reactions.
Low dose nalbuphine or naloxone injection is an option for patients with opioid-induced pruritus.[7-9]
Armas Pharmaceuticals (personal communications). September 18 and October 17, 2019.
Fresenius Kabi (personal communications). August 17 and 29, September 6, 14, 21, and 28, October 5, 12, 20, and 26, November 2, 16, 23, and 29, December 9, 14, and 27, 2018; January 18, February 1, March 1, 15, 21, and 29, April 19 and 26, May 24, June 27, July 18, August 26, September 16, October 7, and December 2 and 20, 2019.
Hikma (personal communications). August 15 and 29, September 5, 19, and 26, October 3, 17, 24, and 31, November 7, 14, 21, and 28, December 5, 12, and 20, 2018; January 23 and 30, February 27, March 13 and 20, April 17 and 24, May 22, June 27, July 17, August 21, September 11, October 2, and December 11 and 18, 2019.
Mylan Institutional (personal communications). August 15, September 19, October 22, November 2 and 8, 2018; January 22, February 19, March 29, April 22 and 30, May 23, June 27, and October 17, 2019.
Pfizer (personal communications). August 17 and 29, September 7 and 17, October 5, 17, and 25, November 8, 23, and 30, December 7, 2018; January 22, March 1 and 14, April 1, 19, and 30, May 24, July 19, August 23, September 17, October 8, and December 13 and 20, 2019.
Mart-Carvajal AJ, Sol I, Gonz¡lez LE, Leon de Gonzalez G, Rodriguez-Malagon N. Pharmacological interventions for the prevention of allergic and febrile non-haemolytic transfusion reactions. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007539. doi: 10.1002/14651858.CD007539.pub2. Review. PubMed PMID: 20556779
Tubog TD, Harenberg JL, Buszta K, Hestand JD. Prophylactic Nalbuphine to Prevent Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Perianesth Nurs. 2018 Oct 30. pii: S1089-9472(18)30278-8. doi: 10.1016/j.jopan.2018.06.098. [Epub ahead of print] PubMed PMID: 30389225.
He F, Jiang Y, Li L. The effect of naloxone treatment on opioid-induced side effects: A meta-analysis of randomized and controlled trails. Medicine (Baltimore). 2016 Sep;95(37):e4729. doi: 10.1097/MD.0000000000004729. Review. PubMed PMID: 27631221; PubMed Central PMCID: PMC5402564.
Liao CC, Chang CS, Tseng CH, Sheen MJ, Tsai SC, Chang YL, Wong SY. Efficacy of intramuscular nalbuphine versus diphenhydramine for the prevention of epidural morphine-induced pruritus after cesarean delivery. Chang Gung Med J. 2011 Mar-Apr;34(2):172-8. PubMed PMID: 21539759.
Updated December 23, 2019 by Michelle Wheeler, PharmD, Drug Information Specialist. Created August 21, 2018 by Michelle Wheeler, PharmD, Drug Information Specialist. © 2019, Drug Information Service, University of Utah, Salt Lake City, UT.

redpajama_set_name: RedPajamaCommonCrawl


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Their new collection is called the Meridian Collection which translate the look of a renegade traveler into a wearable adventure. Perfect for the Summertime! There are three new sunglasses frames that features dramatic details with a good amount of metallic shade. These sunglasses - Flannery, Exley, and Raskin are teardrop-shaped and fashioned from Japanese ion-lated titanium. They're available in Jet Silver and Polished Gold. Both would look great on men and women!
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and yes! we're moving to Seattle!!
Beautiful! :) I love those sunglasses!


You can read more about this type of confusion here.
Here Mr. Khan can be seen holding a makeshift bookmark for his Koran.
So Trump has the black soul, but Brohi is a pure as the driven snow. Once you know Khan, you know you've been conned. The Democrats have an unholy alliance with a totalitarian political movement neatly packaged and marketed as the religion of peace. Sadly, if this country was dumb enough to reelect Barry, then the same challenged electorate is more than capable of electing Hillary. She just another ice cream candidate.
Muslim immigration is my specialty. Check out my website!
It is what the regressive left does so well when it comes to suppressing ideas and arguments that run counter to their agenda.


Take three iron nails and clean them by rubbing with sand paper.
Take two test tubes marked as (A) and (B). In each test tube, take about 10 mL copper sulphate solution.
Tie two iron nails with a thread and immerse them carefully in the copper sulphate solution in test tube B for about 20 minutes [Fig. 1.8 (a)]. Keep one iron nail aside for comparison.
After 20 minutes, take out the iron nails from the copper sulphate solution.
Compare the intensity of the blue colour of copper sulphate solutions in test tubes and (B), [Fig. 1.8 (b)].
Also, compare the colour of the iron nails dipped in the copper sulphate solution with the one kept aside [Fig. 1.8 (b)].
Why does the iron nail become brownish in colour and the blue colour of copper sulphate solution fade?
In this reaction, iron has displaced or removed another element, copper, from copper sulphate solution. This reaction is known as displacement reaction.
Zinc and lead are more reactive elements than copper. They displace copper from its compounds.


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Ancient magnetic fields on the Moon could be protecting precious ice | Science
For years, scientists have believed frigid craters at the Moon's poles hold water ice, which would be both a scientific boon and a potential resource for human missions. Now, researchers have discovered a reason why the ice has persisted on an otherwise bone-dry world: Some polar craters may be protected by ancient magnetic fields.
"It's really exciting," says Jim Green, NASA's former chief scientist, who was not involved with the work. "It makes these areas even more fascinating."
Hundreds of polar craters are in permanent shadow because of the Moon's small tilt to the Sun, 1.5° compared with Earth's 23.4°. The Sun never rises above their rims, keeping temperatures as low as –250°C. In some of the pits, radar instruments on orbiting spacecraft have detected the reflective signature of water ice, perhaps delivered by comet impacts. And in 2018, scientists using an instrument aboard India's Chandrayaan-1 spacecraft reported measurements showing how molecules of polar ice absorbed infrared light—some of the most definitive evidence yet.
Explaining the ice's survival has been a challenge, however. Although sunlight doesn't reach the craters, the solar wind does, and these charged particles can destroy the ice, molecule by molecule, in a process called sputtering. "It's highly erosive," says Paul Lucey, a planetary scientist at the University of Hawaii, Manoa, who was also not involved with the work. "The ice would be gone in a few million years."
Planetary scientist Lon Hood and his colleagues at the University of Arizona now think they know why the ice sticks around. In research presented last week at the Lunar and Planetary Science Conference in Houston, they showed that magnetic anomalies, remnants from the Moon's ancient past, may be protecting some of these craters. "These anomalies can deflect the solar wind," Hood says. "We think they could be quite significant in shielding the permanently shadowed regions."
Researchers have known about the anomalies ever since the Apollo 15 and 16 missions in 1971 and 1972, when astronauts measured regions of unusual magnetic strength on the surface. Some anomalies are now known to be up to hundreds of kilometers across. Although their origin is debated, one possibility is they were created more than 4 billion years ago when the Moon had a magnetic field and iron-rich asteroids crashed into its surface. The resultant molten material may have been permanently magnetized.
Thousands of the anomalies are thought to exist across the lunar surface, but Hood mapped ones at the south pole in detail using data from Japan's Kaguya spacecraft, which orbited the Moon from 2007 to 2009. He found at least two permanently shadowed craters that were overlapped by these anomalies, the Sverdrup and Shoemaker craters, and there are likely more. Although the remnant fields are thousands of times weaker than Earth's, they could be sufficient to deflect the solar wind.
Craters with known anomalies could become prime targets for science and exploration. NASA is already planning to visit the south polar region with a rover due for launch next year, called VIPER, and the agency intends to send humans there later this decade as part of its Artemis program. Studying the ice could reveal how it was delivered, which may in turn shed light on how Earth got its water.
More data are needed to confirm the fields' protective effect. Hood would like to put a solar wind instrument on the surface, which could measure the charged particles that pass the rim of the crater. "You would also need to collect samples and identify what is magnetized," he says.
Currently no such mission is planned. But given the renewed focus on the Moon for many space agencies, Lucey thinks the mystery of the icy craters needs to be studied. "Why are some places icy and some not icy?" Lucey asks. "These magnetic fields need to be investigated as a possible explanation."
Categories Science Tags Ancient, fields, ice, magnetic, moon, precious, protecting, Science Post navigation
Satellite photo shows word 'children' in front of now-destroyed Ukrainian theater
A New Study Has Identified a Dominant Force Driving Evolution on Earth Today


The recruitment of community health volunteers (CHVs) to support the delivery of health programmes is an established approach in underserved areas and in particular where there are health inequalities due to the scarcity of trained human resources. However, there is a dearth of evidence about what works to improve CHVs' performance. This review aimed to synthesise existing literature to explain why, how and under which circumstances intervention approaches to improve the performance of CHVs are more likely to be successful.
We performed a realist synthesis. We identified candidate theories related to our review questions, which then guided the selection, appraisal and analysis of primary studies. Publications of interest dating from 2008 to 2012 were identified by a systematic search in PubMed and IDEAS databases. We considered all study designs that examined the various aspects of CHV performance in the context of formal organisational settings to be eligible and excluded the studies that did not provide explanation about the performance of CHVs neither in the findings nor in the discussion part. Data were arranged according to their reference to context, interventions, outcomes and mechanisms in order to identify the interaction between them. The synthesis of data allowed us to determine explanatory patterns within or across the studies.
We identified broad intervention approaches within the 23 papers included in the review: positioning of the CHV within the community, establishment of clear roles, provision of skill-based and ongoing training, incentives, supervision and logistical support for task distribution and implementation. The findings provided information regarding which mechanisms (self-esteem, sense of duty, self-efficacy, sense of being fairly treated) to target when implementing such approaches, and which contextual factors (stable and supportive cultural, political and social context and intervention closely linked to local health services) create the most favourable conditions for these mechanisms to occur, ultimately contributing to CHVs' better performance. Four main explanatory patterns around these mechanisms emerged as being fundamental to better performance.
The patterns identified, combined with the designers' and other stakeholders' assumptions on how such interventions are expected to work, can be tested by empirical studies in order to provide useful information to be used by programme implementers, policymakers, donors and the community.
Globally, there is a dire shortage of healthcare workers. In many developing countries, the health workforce crisis is a pressing issue that is a major obstacle to achieving the health-related Millennium Development Goals [1, 2]. One of the strategies tried by many countries to address this problem includes task shifting to less qualified health workers. Community health volunteers (CHVs), who are trained lay volunteers and provide health services in their local communities, are an important part of a task shifting strategy and may help address health worker shortages.
Experience has shown that CHVs represent important and unique resources. Trained CHVs can deliver crucial and culturally sensitive health messages, empower individuals to make informed decisions and increase local access to life-saving curative measures [3–7]. However, the performance of CHVs is being questioned by the public health community: high attrition rates and poor quality services have been reported in many programmes involving CHVs [8–11]. Others report how CHVs' ability to deliver is contingent on the scope of their work and workload [12, 13]. In their guidelines on task shifting, the World Health Organization acknowledges the contribution of short-term or part-time volunteers but states that "there is virtually no evidence that volunteerism can be sustained for long periods" [14, 15].
The existing studies on the performance of volunteers highlight the importance of individual motivation [16, 17]. Indeed, performance can be perceived as a behavioural consequence, such as task performance, task persistence, attendance and organisational citizenship behaviour, of the level of motivation, itself influenced by working conditions and other contextual factors [18–20]. These factors include both financial and non-financial incentives, such as training, management practises and community support [7, 9, 21, 22].In general, literature on the performance of volunteers is sparse and the debate surrounding what motivates CHVs to perform well is still salient. One much debated issue concerns the appropriate mix of incentives to motivate volunteers and whether the motivational drivers of non-salaried volunteers differ from those of salaried health workers. Some studies indicate the importance of financial incentives (payment to cover out-of-pocket expenses, micro credit funds) or non-financial incentives with financial value (free health care, bicycles or future job opportunities) as a vital strategy to improve the level of activity of CHVs. Indeed, CHVs are likely to be drawn from poor communities and could see volunteering as income-generating [23, 24]. On the other hand, some authors argue that a number of non-financial incentives (recognition, positive feedback, social prestige) may not only be sufficient but actually be more effective in improving performance [25, 26] and that the evidence used to support the non-sustainability of CHVs' interventions refers to situations where attrition rates are tied to frustration from not receiving promised payment rather than to volunteerism itself .
Systematic reviews on the effectiveness of community health interventions delivered by non-professional health workers underline difficulties in drawing consistent conclusions, and authors raise questions about the applicability of findings to different settings. Little is known about how such interventions bring about change, the role a lay health worker can assume and the reasons behind successes and failures [5, 6, 27–29].
Yet, CHVs' performance and its determinants vary a great deal depending on the context [9, 14, 26, 30], and most of the literature has examined the topic by focusing on barriers or incentives to performance. Since CHV interventions are complex and embedded in complex health and social systems and contexts, a one-size-fits-all scheme for sustaining 'high performance' of CHVs around the world is unlikely to succeed. More research is needed to better understand how different models and combinations of incentives influence CHVs' motivation, retention and performance, and in which particular conditions these happen.
The aim is to synthesise existing literature to explain why, how and under which circumstances intervention to improve CHVs' performance is more likely to be successful.
This review is also part of the International Federation of Red Cross and Red Crescent Societies' (IFRC) research project that aims to better understand how Red Cross and Red Crescent volunteer motivation can be enhanced by appropriate approaches. The IFRC reaches 150 million people annually through 190 member National Societies and 17 million volunteers worldwide. The National Societies implement programmes in order to develop a pool of capable volunteers who can improve health in underserved communities.
For the purpose of this synthesis, we then consider CHVs as health workers who provide services within a formal structure. CHVs often complement professional service delivery but can also be important agents of social change by detecting unmet needs in society. They do not have a formal medical background but are trained and provide health services in their local communities. They do not receive a regular salary but may receive other benefits.
We performed a realist synthesis. Realist synthesis is a theory-driven, qualitative approach to synthesise qualitative, quantitative and mixed methods research evidence . By drawing on broader theoretical insights and using evidence, it offers the potential to develop the intervention theory—hypotheses on how, why and in what circumstances an intervention may be successful—that can be tested in subsequent empirical studies. To uncover such underlying theory (or theories) of intervention, realist synthesis examines the interaction between the intervention, the context (C) within which it is applied, the mechanism (M) that describes how the actors use the resources available to them and the outcome (O) in a sample of primary studies . These interactions are formally articulated as context-mechanism-outcome (CMO) configurations. As CMOs emerge and insights accumulate, the result can attain the level of middle-range theory (MRT). The MRT operates at a slightly higher level of abstraction, being a theory in between grand universal theories and the more specific programme theory that explains the results of a particular intervention.
The key concepts as well as the key terms of the realist approach used for this study are illustrated in Table 1.
Element of the reasoning of the actor facing an intervention (beliefs, values, desires and cognitive processes). A mechanism (1) is generally hidden, (2) is sensitive to context variations and (3) produces outcomes.
Set of hypotheses that explain how and why the intervention is expected to produce outcomes. It can be broken down in the form of one or more CMO configurations.
The choice of the synthesis method was made according to the research questions and the key features of the intervention under study [33, 34]. We consider realist synthesis an appropriate choice as the use of theory and its methodological tools helps to capture the complexity of human resources by including the context in the analysis. The realist perspective allows for a better understanding of how strategies to improve CHVs' performance are supposed to work and what contextual factors affect the outcome . Conventional systematic reviews methodologically limit the development of explanations of the changes brought by an intervention.
This synthesis seeks to identify key mechanisms at play in driving CHVs' performance. These mechanisms are triggered by context-intervention dynamics, and therefore, mechanisms are the result of complex interaction between the intervention approaches and CHVs.
We followed the steps proposed by Pawson in conducting this realist review : (1) identifying potential theories, (2) searching for evidence, (3) appraising primary studies, (4) extracting data, (5) analysing and synthesising evidence. The main differences compared to a traditional systematic review include a purposive and theoretically driven search and appraisal of evidence with the aim of refining theories, the possibility of including multiple types of information and an iterative process. The ultimate goal is to explain why and under which conditions interventions worked [32, 37].
The present article is structured around these five steps and uses the realist and meta-narrative evidence synthesis (RAMESES) publication standards for reporting realist synthesis .
We consulted key experts on volunteering at the IFRC headquarters in Geneva to develop insights on why some approaches improve CHVs' performance more than others. Two meetings were organised, and issues regarding the performance of the Red Cross and Red Crescent volunteers were debated. The key elements of these discussions were then explored through the literature.
We performed a scoping review using a 'snowball' technique in order to map the existing social science theories related to our research objectives. For this, we undertook a review of a wide range of evaluation, management, organisational behaviour and work motivation literature. The theories that were selected are provided in Additional file 1.
In general, performance is influenced by each CHV's individual cognitive (knowledge, skill acquisition) and affective attributes (self-efficacy, ability to master challenges, self-esteem, being close to other people, satisfaction with the work, emotional attachment to the organisation), the intervention approaches and the organisational context in which the CHV operates as well as the broader social, cultural and political context surrounding the CHV.
More specifically, the learning process of the CHV may improve his/her competences. This process is influenced by factors within the organisational environment and, more specifically, related to the content of training, learning methods, feedback from others and the personal experience of the CHVs in dealing with a problem. The CHV's behaviour and work effort is influenced by the degree of motivation and metacognition, which are themselves influenced by the background and past experience of the CHV, the community setting, the social, cultural and political context of the organisational setting and the context of the intervention.
The diverse influences on CHVs' performance, informed by the theoretical landscape, are illustrated in Fig. 1.
Following our scoping review that identified candidate theories, we undertook a search for primary evidence. The search was guided by our research questions and by the candidate theories that were identified in the scoping review. We considered all study designs to be eligible.
The search was made in PubMed and IDEAS databases from 2008 to 2012, and the keywords used were community health volunteers, community health workers, lay health workers, and task shifting. This allowed us to identify a range of primary studies dealing with our initial understanding of how and under what circumstances CHVs may perform well.
We decided to focus our search strategy this way because of the huge number of primary studies and some capacity constraints. Indeed, the process of selecting the number of articles that are potentially eligible for inclusion can only occur as the data sources are analysed in detail. As an example, we initially planned to perform a search in various databases and to review the existing evidence published since 2000. However, to provide an example, a search from 2000 to 2014 in PubMed using community health workers, community health volunteers as keyword provides 3339 items. Some articles can be easily excluded on the title or on the abstract. However, an approximation of 1000 articles remain to be read in order to assess whether they could contribute to find explanation on why and under which conditions the interventions worked.
The relevance of the studies was assessed according to the focus of the review and how each study addressed the research questions. Decisions about whether each study could contribute to identifying CMO configurations and whether the method used to generate these CMO configurations is credible were arrived through discussion in the review group.
The specific inclusion and exclusion criteria that guided the selection and appraisal of documents are presented in Table 2.
The documents included in the review were compiled in Excel. The variables extracted were (1) authors, title of the study and year of publication; (2) study objective and outcomes; (3) intervention characteristics and objectives; (4) prior assumptions reported by the authors; (5) mechanisms gleaned by reader and/or reported by authors; (6) reported/observed actual outcome(s); (7) contextual factors reported by authors to be of influence on CHVs' performance and (8) process of intervention implementation/stakeholder involvement reported by authors to be of influence on CHVs' performance.
For the sake of clarity, we report on the process of analysis and synthesis in two stages, although in practise, this was a reiterative process guided by the review questions. An overview of the activities, the analytical process and the use of candidate theories, is provided in Table 3.
First, using a mix of abductive and retroductive analytical processes, each primary study was examined for evidence based on how it supports, refutes or refines the candidate theories identified in the first step [39, 40]. The candidate theories guided the identification of emerging themes through the process of constant comparative analysis . From the disconnected variables extracted and compiled in Excel, a summary table was developed from each paper under review. The main themes were arranged according to their reference to context, interventions, outcomes and mechanisms in order to identify the interaction between them. The tables were then reviewed by all the authors, and any differences of opinion were resolved by consultation and discussion of the paper. For each paper, we specified CMO configuration(s) and drafted a narrative synthesis.
Secondly, through a process of reasoning, including juxtaposing, reconciling, adjudicating, consolidating and situating all sources of evidence , we synthesised the data from the included papers in order to identify potential patterns. While doing so, insights from substantive social science theories were used to explain at a higher level the explanatory patterns that emerged across the studies. This stage consisted in articulating explanations for intervention and outcomes based on the papers under review. To this end, mechanisms were compared across different contexts to assess if they consistently produced similar outcomes. Moreover, in adjudicating between different sources, we were careful to use the findings of the critical appraisal in relation to the relevant aspects or insights from a study rather than judging the validity of each study as a whole. If our initial critical appraisal was unable to support a judgement about a particular piece of evidence, we returned to the original source so that a bespoke appraisal incorporating rigour and relevance could be made. The research team convened on a regular basis to discuss the patterns that emerged and their degree of fit with candidate theories. Finally, we discussed the findings in view of the larger worker motivation and performance literature and, methodologically, the literature on realist synthesis.
The number of studies retrieved and the steps undertaken are detailed in Fig. 2.
Additional file 2 summarises the studies, the methods used, the context, the intervention, the mechanisms triggered and the outcomes.
Eleven qualitative studies [26, 30, 42–50], one randomised controlled trial (RCT) , one cluster RCT , six cross-sectional studies [53–58], three case-control studies [24, 59, 60] and one cohort study  were reviewed. The studies reported on CHVs' involvement in a wide range of health service delivery. Six studies focused on CHV interventions for promoting health/educational activities that did not specifically involve service delivery at homes of beneficiaries. Ten studies [26, 30, 44, 45, 47, 50, 54–57] reported on CHV interventions for delivering home-based care. Four studies focused on HIV/AIDS management in facilities or HIV counselling centres [48, 52, 58, 61]. All the studies targeted poor communities with unmet health needs (existing physical, financial and educational barriers to health, with no current culturally appropriate health interventions).
In 17 papers, the interventions were implemented by local governmental agencies [26, 30, 42, 43, 46–52, 54–58, 60], and for some of these agencies, local non-governmental organisations (NGOs) provided support [26, 30, 57]. In one study, the intervention was implemented through public-private partnerships . Local NGOs were the main implementing organisation in the other six studies [24, 44, 45, 53, 59, 61].
The studies reported a variety of positive primary outcomes at the level of CHVs, such as satisfactory competence and practises, quality of services, availability, work effort and active participation in the programme, ability to exercise leadership, community engagement and mobilisation, improvement in access to health care, reduction of patient waiting time and the workload of formal health care workers, retention, satisfaction and well-being. Nine studies reported and discussed negative outcomes around dissatisfaction, attrition, reduction of involvement and effort, lack of community mobilisation, poor leadership and sustainability of the programme and inappropriate health practises [30, 44, 45, 48, 50, 53, 54, 57, 60]. Most of the studies included were not set up to assess or explicitly reflect upon the relations between these specific outcomes and the mechanisms gleaned by us as reviewers.
We identified a number of demi-regularities across the studies as being fundamental in generating positive outcomes. They can be structured around four families of mechanisms: (a) positive links between community members and CHVs, (b) mastering new tasks and ability to solve problems (capability), (c) CHVs' feeling of recognition by the organisation for the work done and (d) role identification and recognition across the health system. These demi-regularities are presented below.
In a context where community members value volunteering as a morally good behaviour and when a socially desirable outcome or achievement exists (such as on-the-job certificated training and opportunities for personal growth), an intervention which creates opportunities for developing close, trusting ties between community members and CHVs through providing opportunities to meet this socially desirable outcome or achievement and through clear positioning of the CHVs within the community can produce positive outcomes.
We identified the mechanisms of self-esteem/sense of pride/sense of duty/sense of community recognition as a driver of CHVs. We noticed that success is facilitated if there is a stable and supportive social, material and political context and a strong history of social organisation. Since such interventions operate in a dynamic social system, early visible positive results among community members facilitated positive outcomes through feedback loops.
Negative results also demonstrated the explaining power of this demi-regularity [24, 44, 59, 60]. The volunteers were less likely to be active, remain engaged, take additional responsibilities, exercise leadership or mobilise and organise community responses (outcomes), if there was an unsupportive cultural, social and political context and if the CHVs themselves did not have a prior positive reputation within the local community, particularly among the community's leaders. In such unfavourable contexts, the mechanisms identified did not have sufficient opportunity to fire.
When few educational opportunities exist, a community-based, volunteer-oriented health intervention that provides (1) skill-based and ongoing training, (2) supportive supervision and follow-up and (3) resources adapted to local context and logistical support to perform the work triggered among the CHVs a feeling of their ability to perform the task, a sense of self-efficacy and self-confidence.
It also emerged from the papers that early visible results among community members and positive community feedback reinforces self-efficacy/self-confidence among CHVs; they felt that the health of their community had improved as a result of their activities. The positive experience of the CHVs and the ability to self-organise activities reinforce self-efficacy and ownership over time. These mechanisms contributed to positive outcomes.
In some studies, the mechanisms of self-efficacy and self-confidence were not triggered, and the CHVs had the feeling that they could not live up to the expectations of the communities. This is more likely to happen in remote rural areas requiring long travel time to reach beneficiaries' homes and the health centre if the intervention is implemented without investment in strengthening the health system, if the community expresses an inability to deal with a disease or if the trust by the community in the health services is lost. In such cases, the satisfaction of the CHVs, their involvement and the quality of their services are undermined [30, 48, 54, 57].
We found that providing adequate support to CHVs based on fairness and equity triggered a feeling of being appreciated for the work done and of being valued and thereby contributed to positive outcomes. The kind of incentives adapted or not to the local cultural, social and economic context influenced these outcomes.
More specifically, in the context of poor communities with few opportunities to increase family income and when the involvement of the CHVs in the programme costs them time and money, the provision of incentives with a financial value, such as meals, stipends, free access to health care and micro credit funds meaningfully recognises the CHVs for their efforts and triggers a sense of being fairly treated; this feeling results in a high level of accountability to perform. CHVs feel satisfied with the nature of benefits that they and their immediate family members are receiving, and this contributes to better performance (better retention and active participation in the core activities of the programme).
Furthermore, providing non-monetary incentives (including moral and verbal support, tokens of appreciation, recognition signs and events, on-the-job training, certificates and equipment) as well as a safe- and friendly-working environment triggers the perception of organisational support, recognition for CHVs' contribution and the feeling that their expectations are fulfilled. It also triggers the feeling of being part of the organisation. This contributes to positive outcomes, such as better retention and task performance.
The adaptation of incentives to the local context influences the outcomes. In the context of urban areas where competing opportunities exist, community-based health volunteering interventions that aimed at involving younger, aspirational CHVs resulted in higher attrition rates if they did not help them meet their needs/initial expectations.
According to some studies, financial incentives can undermine other incentives and the moral status of volunteering, especially when volunteering is considered culturally as a morally good behaviour and when paid government workers are not respected [26, 46]. However, in a context of high poverty, where earnings are important for sustaining a family, monetary incentives that are easily distinguishable from a salary triggered a feeling of acknowledgment and recognition for their contribution. In such cases, positive outcomes such as high retention, involvement in the core activities of the intervention and satisfaction among the CHVs were observed [24, 26, 46, 54, 56].
In the context where CHVs are answerable to the health service personnel, a socially desirable community-based health volunteer intervention with (1) specific role definitions, a legal framework and precise procedures for task shifting, (2) support for CHVs in the form of follow-up training and regular supervision from the formal health staff and (3) logistical support can trigger among the trained CHVs a sense of legitimacy, a sense of being valued by health authorities, a deep sense of commitment to their role and a professional identity around this role.
These mechanisms seem to contribute to positive outcomes and were more likely to be triggered when CHVs were well integrated into the operations of their facilities, were acceptable as providers and readily used by clients and when the involvement of the CHVs did not further burden clinical staff.
However, in the context of a weak, dysfunctional and unregulated health system, the involvement of a new cadre of health workers in the public domain, such as CHVs, did not always allow these mechanisms to fire. In that case, it contributed to poor performance, dissatisfaction and high dropout. In the study reported by Schneider , the interventions were implemented through public-private partnerships, and this triggered among the CHVs a feeling of being an exploited labour force and of uncertainty and distrust with regard to the formal health staff. This was mainly due to the lack of integration between governmental and non-governmental agencies and the absence of a broader strategy to strengthen supply, management and deployment of human resource for health. In other studies, intervention approaches that lacked clear role descriptions and career progression triggered among CHVs a sense of difficulty to prove their legitimacy and to develop their identity. Their expectations were not met [48, 59] and distrust with regard to the formal health staff ensued (mechanisms) .
The concepts we identified in the included study map across many different theories (Additional file 1).
A close link between community members and CHVs was identified in this review as being one of the fundamental elements in generating positive outcomes. CHV organisations are embedded in a community context, which is both the target of the organisations and a source of influence on the CHVs' individual motivation and attitudes. As mentioned by Strachan et al. when referring to the social identity approach [62, 63], volunteers' behaviour is subject to perceived group social norms and to what is seen to be in the group's interests. We found furthermore, in line with Hustinx and Lammertyn who studied the nature of volunteering through the lens of sociological modernisation theories , that a stable and supportive social and political context and a strong history of social organisation can be a base for collective volunteerism, in which dedication to the common good is a highly esteemed asset and a sense of duty or responsibility to a local community is a strong motivational driver. Finally, most of the interventions reported in the studies we reviewed operate within the context of community change. According to the existing theories on community change [65, 66], CHVs can exercise leadership, promote critical consciousness and contribute to developing the potential for collective actions. Our synthesis showed that a stable cultural, social and political environment as well as the positive reputation of CHVs within the local community were important contextual factors for these outcomes to be achieved.
CHVs' feeling of self-efficacy and their ability to overcome challenges were keys in determining positive outcomes. As predicted by Bandura's social cognitive theory where self-efficacy is the major concept , we found that CHVs are more likely to mobilise efforts for service delivery if they believe it is attainable through their endeavours. More specifically, the extent to which CHVs feel their service has met community members' expectations as well as fulfilled their personal needs, their perception of their work and their perceptions of other people's reactions to their work are all key factors that can trigger a sense of self-efficacy and self-confidence. This has also been described by Omoto and Snyder in their volunteer process model that focuses, among other things, on how people feel in themselves and how they feel about the organisational context during their initial experiences as a volunteer .
The volunteer work reported by the papers we reviewed is situated in a formal organisational setting. Regarding the delivery of incentives to CHVs, our review confirms that if various forms of volunteering exist in developing countries, individuals are generally interested in both the private and public benefits of volunteering. This is in agreement with the mixed public/private models of volunteering suggested by Schiff and others [69, 70]. We found that the possibility of improving the performance of the CHVs is a function of the degree to which the incentives are perceived to satisfy the CHVs' needs, these needs being themselves influenced by the social or contextual factors. For instance, among the studies reviewed and in the context of high poverty, monetary incentives or non-monetary incentives that have financial consequences contributed to positive outcomes and did not undermine other incentives because they encouraged social recognition, triggered a sense of fair treatment and fulfilment of basic needs. The results are consistent with need satisfaction theories, where the focus has been on finding the right match between incentives, the individuals and their context [26, 71–73]. Responding to volunteers' needs is in accordance with social exchange and equity theories where commitment and good performance occur as individuals and group interests are achieved through reciprocal exchange, fairness and appreciation [74, 75].
Our results are in line with the consistency theory  as well as organisational commitment  and social exchange theory . According to these theories, the culture of an organisation, its structure, leadership, vision and mission and employee management all have a direct influence on the perceptions of organisational support, trust with regard to the organisation, sense of legitimacy and hence on the commitment and motivation of the employees.
Globally, our results showed that the CHVs as human beings have an inherent need for care, respect, trust, recognition and support. When these needs are satisfied, CHVs are often encouraged to work harder and perform better. The mechanisms we identified as being important for CHV performance are also in line with, and build upon, the findings from earlier realist analysis examining the performance of those working closely with communities [78–81]. Therefore, taking a holistic view based on humanistic values in dealing with the CHVs seems relevant. Because of this, the Self Determination Theory (SDT) identified in step 1 (see Additional file 1) could provide an appropriate framework for the study of CHV motivation and behaviour in the context of an organisational setting. According to this framework, humans actively pursue fulfilment of their basic psychological needs , and the degree of satisfaction of these needs supports different forms of motivated or regulated behaviour in a variety of contexts and situations .
The wide range of study designs included in this realist synthesis offered a fair amount of information about CHV-based interventions, contexts and mechanisms through which performance of CHVs can be explained. We reviewed the studies against existing broad theories, identified regular patterns in CHVs' dispositions to performance, and attained the level of MRT. With the identification of mechanisms, the context becomes central in explaining the performance of the CHVs: we know from the literature that CHVs' performance and its determinants (such as initial training, supervision, level of education, types of incentives, etc.) strongly depend on the context. This synthesis suggests that many contextual factors influence outcomes. For example, in the context of high poverty, CHVs cannot feel adequately recognised without monetary incentives, or without non-monetary incentives that have financial value. In the contexts where there are few opportunities for stable social relationships, or supportive norms to develop, CHVs cannot feel sufficiently respected or valued and, as a result, cannot expect to improve their social status by volunteering.
Recommendation for CHV interventions should therefore emphasise the need to take into consideration CHVs' perceptions of these mechanisms and adapt interventions to the local context. The insights from this realist review have implications for policymakers and programmers interested in leveraging the potential of community health volunteers. Based on the evidence reviewed, effective approaches, including approaches which involve clear positioning of the CHV within the community (examples from current evidence include establishment of a local health committee involving CHVs and creating processes for community feedback and for CHVs to play a key role in such processes), approaches which involve explicitly creating opportunities to sign to the volunteers that they are valued and recognised (e.g. through organising felicitation and/or graduation ceremonies…) and approaches which entail clarity of roles, provision of skill-based and ongoing training, incentives adapted to local context, good supervision and logistical support, can trigger mechanisms (sense of self-esteem, sense of duty, sense of self-efficacy, sense of being fairly treated if the organisation is responsive to the local needs, sense of recognition and legitimacy) which are likely to translate into effective, meaningful and sustained volunteer engagement. These intervention approaches can trigger these mechanisms in a stable and supportive cultural, political and social context and where the intervention is closely linked to local health services. That said, these intervention approaches may or may not trigger the said mechanisms in contexts which are unstable and not supportive to the functioning of CVs. More specifically, within the context of the Red Cross Red Crescent Movement, the results of this synthesis informed the development of the programme theory for the volunteers involved in delivering health services in stable and supportive contexts . Indeed, the programme theory that explains how and why the volunteerism intervention is expected to produce outcomes should be developed ideally both from the literature and the voice of the main stakeholders (programme designers, managers and volunteers). Drawing on a programme theory that is sensitive to context and tested by empirical studies is more likely to lead to the development of effective interventions when aiming to improve motivation and performance of CHVs .
This synthesis has some limitations. Since our review was limited to published articles, there was potentially a bias toward including articles that found significant results supporting CHV performance. Studies that found non-significant or negative results of CHV interventions might have provided additional insights regarding mechanisms and contextual factors that hinder CHV performance. The other limitations are inherent to the nature of realist approach. Firstly, the amount of information to be reviewed can be very large and the compilation of the analysis difficult. We attempted to make the findings clearer by presenting them around the main families of mechanisms in the results and discussion sections. Secondly, it is possible that some contextual factors not consistently reported in the evaluations could be relevant. Third, the CMOs and the patterns identified in this review should be considered as provisional and need to be tested in different contexts and in relation to other conditions. Finally, there may have been outcomes that were not sufficiently explored due to methodological constraints. Different performance outcomes were generally reported in the studies reviewed and it was difficult during the analysis to identify the link between more specific outcomes and the mechanisms.
This realist synthesis aimed to explain through which mechanisms and under which contextual factors intervention to improve CHVs' performance is more likely to be successful. The findings provide valuable information regarding which mechanisms to target when implementing the intervention and which contextual factors create the most favourable conditions for these mechanisms to occur, ultimately contributing to CHVs' better performance. We identified four main explanatory patterns around the mechanisms identified that inform future research. These patterns, combined with the stakeholders' assumptions (programme managers, designers and volunteers) on how such interventions are expected to work should be tested by empirical studies in order to provide more detailed, useful information to be used by programme implementers, policymakers, donors and the community.
The authors would like to acknowledge the inputs of key experts at the International Federation of Red Cross and Red Crescent Societies headquarters in Geneva, especially Gabriel Pictet. Finally, they thank Vivienne Seabright for the English language editing of the manuscript.
The study is funded by the International Federation of Red Cross and Red Crescent Societies (Geneva, Switzerland). GV is the recipient of a PhD grant under the IFRC funding that provides a monthly stipend and a bench fee to cover local travel and research expenses.
All authors contributed to conceptualise the study. GV carried out the literature search. GV, JP and SK selected the paper for the review and reviewed the final papers. GV wrote the first draft of the present manuscript. All authors reviewed and provided comments to improve the manuscript. All authors read and approved the final manuscript.
The ethical approval was provided by the Ethical Committee at Rennes University Hospital, France (CHU Rennes Hotel Dieu-Rennes, France—Approval number 14.41).
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Photos private holiday house Villa Karavousi in Kazaviti on Thassos island in Greece.
The Kavanosi family left Kazaviti village in the 1950s. Their historic residence was then purchased and refurbished by a Greek- Swiss lady. Ten years ago we were able to add it to our ensemble of traditional houses at the upper periphery of the village. We carefully restored the original character and acquired also the old wine press opposite and the garden terraces behind.
This cozy family house and gardens suit just right in size and facilities for a holiday of a couple with the option of a third person. It is easily accessible from the village square; we did not want car access, in order to keep a clear distance to any disturbance by traffic. The place preserved its traditional stone walls, vine pergola, fruit trees and an overwhelming abundance of roses, garden and wild flowers, herbs and creepers. The surrounding natural landscape offers an almost exotic wealth of Mediterranean vegetation, even wild orchids and ancient plane trees.
It is in this secluded location that one becomes aware again of the "music of silence", of just pure nature. Up here one gets the sensual feeling of the gentle breeze in the pine trees, the distant bells of goats on the rocky pastures opposite, the calls of ravens and of herring gulls that venture from the sea far into the valley.
When the sun sets behind the Pangeon Mountains on the mainland, flashes of bright colours illuminate the scene. Later in the night the galaxy of countless stars appears against a deep blue sky – what else do you dream of … and for a change, next day the wide sand beach is less than half an hour away.


text:
I'aqui Carnicero Architecture
With rough, sensuous materials and simple geometries, a team charts new courses while employing the basic principles of Modernism.
By David Cohn
House 1+1=1
The building comprises two residences, one for Carnicero himself and the other for a friend, as well as the architect's studio. The house, outside of Madrid in Torrelodones, is raised on an ample podium over a steep slope to take in sweeping views to the south, across the Pardo Nature Reserve to the city skyline beyond. The upper volume of board-formed concrete shades the glazed living areas in the summer. Inside, the double-height living space includes a single piece of built-in furniture incorporating a sofa, bookcase, and kitchen countertop.
Photo courtesy I'aqui Carnicero
Office of the District Attorney
This competition-winning project in Madrid forms part of a campus of 18 round buildings (now on hold), which include designs by Foster + Partners, Zaha Hadid, and Richard Rogers. Working with his former associates, Ignacio Vila and Alejandro V'rseda, Carnicero fit the different elements of the complex program together like 'pieces of a puzzle.'
Watchtower Restoration
For over 1,000 years, this tower in Guadalajara has guarded a strategic mountain pass. Carnicero rebuilt ruined sections of the walls using stone from the site and traditional techniques, separating his intervention with a line of tile markers. Working with the sculptor Eduardo Cajal (creator of the aluminum stair in his own house), he designed a light aluminum footbridge as part of a new approach path that captures the best views over the valley. The railings and arched deck work together to increase the stiffness and strength of the span.
Starting with urban design guidelines that called for a chamfered corner and top-floor setbacks, Carnicero and his associates Alejandro V'rseda and Ignacio Vila decided to transform the beveled edge into a general sculptural strategy. Their aim was to give the small, 29-unit building, which is under construction in Vallecas, Madrid, greater scale and presence. To increase its resemblance to a monolithic crystalline volume, they divided glazed areas into multiple small openings, although the built project incorporates more traditional windows, as demanded by the city housing authority.
Pavilion 16, Old Slaughter Houses
Carnicero's most recently completed project is a renovation of a 50,000-square-foot pavilion in a cultural center being created out of a complex of former slaughterhouses in Madrid. To subdivide the immense space without compromising its flexibility, and to control the entry of daylight from its upper level, the architect inserted continuous rows of steel doors, which hinge and pivot in pairs to create different spatial arrangements. The pavilion is used for exhibition and artists' studios, and can be converted into a theater or an auditorium.
In the house that Iñaqui Carnicero has built for himself in Madrid's rolling northern suburbs, the architect declares allegiance to a classic Modernist discipline, following a Madrid tradition that leads back to one of his influential teachers, Alberto Campo Baeza, and to Alejandro de la Sota and other pioneers of a renewed Spanish Modernism in the 1950s. Carnicero's design reinterprets Corbusian prototypes—the strip window, the crisp rectangular volume raised on pilotis, the double-height interior living space overlooked by balconies and a sculptural stair (made of aluminum and crafted by artist Eduardo Cajal). But he also addresses contemporary concerns, including principles such as thermal inertia and passive airflow.
"It's very simple in section," he explains. "A podium resolves the problem of the steep terrain. The living area opens to the landscape to the south, and the overhanging upper floor keeps out the sun in the summer but not in the winter." The long structure actually comprises two dwellings, with a shared swimming pool on the southern terrace. The architect pooled his savings with a friend, and, with a budget that could have bought only a couple small studios in Madrid, built this elegant formalist statement in board-formed concrete.
Carnicero, 38, recently moved his studio into the house, where he works with three or four collaborators in an ample glazed space under the podium. A large, gentle man and Madrid native, he graduated from the Higher Technical School of Architecture at Madrid's Polytechnic University in 1998, and has taught design there since 2000, working first under Campo Baeza. He won a scholarship to the Spanish Academy in Rome in 2008, where he studied the Roman sojourns of Louis Kahn and Robert Venturi. The influence of Rome on his own work can be found in his interest in rough, sensuous materials and simple, direct geometries. At the same time, he takes a stand against an overly assertive formalism, favoring, in his own words, "works in which the hand of the architect isn't too much in evidence. Instead of the grand statement, architects today must look to more limited interventions, using what's readily available."
Nevertheless, his designs often feature an intriguing complexity, like a three-dimensional puzzle, developed through combinations of simple elements. For an addition to a high school on a tight site in the small southern city of Albacete, for example, each of the three floors has a strikingly different layout, creating a complex weave of open and closed spaces around a central courtyard. And for the competition-winning building for the district attorney's office in Madrid's City of Justice (designed with Ignacio Vila and Alejandro Vírseda before Carnicero established his independent practice), the facade of a round volume is pierced by a series of garden patios that are staggered in position and level to create dynamic diagonal cross-views through the interiors.
In other projects, concepts from Carnicero's house design reappear, as in the proposal for a library and day center for senior citizens in the town of Torrelavega in northern Spain, where the architect raised the pentagonal library volume on columns to create a shaded public plaza below. The elongated, elevated form of the house echoes, at a completely different scale, one of his first commissions for the CEU San Pablo University in Madrid (with Vírseda and Miguel Ángel Cámara): a miniature city of classrooms, offices, laboratories, and public spaces where the linear organization has allowed for the building's expansion in phases over time.
Despite Carnicero's declarations of formal modesty, his work is by no means without a strong architectonic character. Though he has returned to the basic principles of Modernism, he discovers rich new territories to explore using the familiar formulas of structural logic and functional form.
LOCATION: Madrid
DESIGN STAFF: 6
PRINCIPALS: Iñaqui Carnicero
EDUCATION: Higher Technical School of Architecture, Polytechnic University of Madrid, M.Arch., 1998
WORK HISTORY: ICA Arquitectura, with Ignacio Vila and Alejandro Vírseda, 2002–06
KEY COMPLETED PROJECTS: Pavilion 16, Old Slaughter Houses, Madrid, 2011; Social Housing, Vallecas, Madrid, 2011; House 1+1=1, Madrid, 2009; Arab Tower Restoration, Guadalajara, 2004; Don Bosco High School, Albacete, 2003; Polytechnic School, CEU, San Pablo University, Madrid, 2002
KEY CURRENT PROJECTS: Office of the District Attorney, Madrid (suspended); 300 Units of Experimental Housing for VIVA, Madrid (suspended); Garment Museum, Madrid (suspended)
WEB SITE: WWW.INAQUICARNICERO.COM
Grupo Aranea
Iv'n Ju'rez & Patricia Meneses
Atelier Deshaus
Architectural Reboot: Vanguard Firms Take a Fresh Approach to Practice
NOW ON DEMANDCredits: 1 AIA LU/Elective; 1 AIBD P-CE; 0.1 IACET CEU May qualify for learning hours through most Canadian architectural associations Three recipients of RECORD's 2021 Design Vanguard Award discuss how they paved their own paths to starting their practices, through collaborative work, community outreach, a shifting client base, and a focus on sustainability.


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First-of-its-kind 12th Night Kick-Off Festival is Saturday
By beauregarddailynews
Attendees at Saturday's 12th Night Kick-Off Festival will be able to view krewe royalty like this pair from the 2020 12th Night celebration, but krewe royalty won't be the only attraction. (Rick Hickman / Beauregard News Archives)
By Rita LeBleu
Saturday, Jan. 7, marks the first Twelfth Night celebration of its kind in Southwest Louisiana. The opportunity to bid farewell to last year's royalty and see their elaborate costumes and for them to don their finery one last time won't be the only attraction, according to Rebecca Moss, Mardi Gras Southwest.
"Our mission has always been to provide a fun, family-friendly experience," Moss said. "But after the pandemic, we have decided to do a little something to boost participation and economic impact."
From noon to 6 p.m., at the Lake Charles Civic Center's Coliseum, the "12th Night Kick-Off Festival" will feature food trucks, door prizes, fun jumps and live music. The Adam Leger Band, known for its mix of country ballads, rockin' country songs, zydecajun and classic rock takes the stage at 1:30 p.m. At 4 p.m. Dani LaCour – "Keep Your Aim" and "Red Wine" – goes on at 4 p.m.
Admission is $10. Children five and under are free. A cash bar will sell adult beverages for the 21 and over crowd.
"No one is Mardi Gras ready yet," said Moss. "We just finished celebrating Christmas and the New Year. Kids have just gone back to school."
Twelfth Night serves as a sort of dip the toes in the water event before diving into waves of purple, gold and green. Moss expects the festival to grow year after year as she continues to reach out for local entertainment.
Twelfth Night is so named because it is 12 days after Christmas on January 6 and marks the Feast of the Epiphany in the Liturgical calendar.
Mark the calendar for Mardi Gras
Following the new 12th Night Kick-Off Festival will be a totally new event, the Taste of Mardi Gras Cocktail Party to be held Wednesday, Feb. 15. Tickets are $30 and can be ordered by calling (337) 244-1466 or (337) 488-4827.
The Lighted Boat Parade is Feb. 16; Merchant's Parade, Feb. 17, Mardi Gras Gumbo Cookoff, Children's Stroll and Krewe of Omega Parade, Feb. 18; Children's Day Activities, Feb. 19 and the Royal Gala, Feb. 20.
Mardi Gras, Iowa Chicken Run, parade and music, Feb. 21.
For more information on these events, parade routes, additional Mardi Gras activities throughout Southwest Louisiana, and parade entry forms, log onto www.swlamardigras.com.
More Z - News Main
UPDATE: Tornado touches down in Ragley


TABO is a tiny autonomous robot designed for iPad Pro. Ideal for kids to play games or to bring educational content to life, you can enjoy going back and forth between the physical and virtual world. You can program your own TABO too.
TABO's movement- Bluetooth LE: is controlled by Bluetooth LE communication from a external terminal.
3 touch points: By touching the screens with 3 legs, TABO can inform i Pad Pro of its own position and direction.
As combining these two technologies, a screen is changed in accordance with TABO's movement, and TABO is moved in accordance with a change of screen, therefore, various unique content can be realised.
it's more fun and enjoyable learning experience! I think we will all agree with this point !
Are you a developer? You can also Hack the TABO ! It comes with the SDK written in Swift and Objective-C … so you can bring further all TABO's potential with your creative inspiration.


In Piazza Nicola Amore, among the most important places in the historic center of the city, the "Palazzo Nanà" Project is born. Specifically, we offer three-room apartment, located on the fourth floor, composed of functional open space living area with double light and a private sleeping area, where there is a double bedroom with en suite bathroom, bedroom and second service. The apartment stands out for its exceptional finishes, cutting-edge materials, ultramodern home automation systems, following the highest standards of energy efficiency, safety and respect for the environment. It will be delivered finished, complete with plants in accordance with and furnished bathrooms. Available variants for high quality finishes. APE B.


Imagine by Albéric Jouzeau is a photographic project combining travel and decorativeness highlighted by a top-of-the-range photographic picture.
More than photo shots, my art aims to be decorative: colours are just as important as the subjects of the photo. They are timeless shots that will make you travel and add a touch of style to your home interior thanks to their colours, their grains and their frames.
Each photographic picture Imagine by Albéric Jouzeau encourages you to discover a destination.
All is then printed and pasted on plexiglas giving my work a modern and design art feel. The magic of the travel takes place by perfectly being integrated in your interior.
I had the opportunity to go across South Coast of Iceland and to discover breathtaking landscapes. Water, ice, silence… Man seems to be small compared with this bluish tint nature.
I had the opportunity to cross Florida and to discover its various facets : Miami beach, Everglades, Key West. The pinkish tint allows to give a vintage key, like these art deco buildings and these old American cars that we can meet.
It's an amazing place for surfing, these beautiful landscapes of rice fields and the smile of its inhabitants. I wanted to retranscribe in the picture this natural blue/green tint.
This city is unique by its size, its mythical places and its special light represented by this orange tint.
Rio de Janeiro is an overlooked city. But is it a city, a destination of party or a gigant beach ?! I wanted the 3 colors of the Brazilian flag to stand out in this picture.
Welcome to paradise of animals and also of the photographer ! To discover all these species in their natural environment is magic. But don't forget that, behind this warm tint, the animal world is sometimes cruel.
I have gone all over the streets of New York at various seasons. A perfect city for photographers because it's extremely photogenic. Day and night something always happens.
I have travelled all over India from Rajasthan to Chennai. This country with many colours carries you away with its vitality. Women and their nice saris are the perfect symbol.
Among the ten visited islands, I keep in mind the sun, the light, the wind… The tint was well selected because blue and white are everywhere.
I have been there several times for various shootings and mainly during the festival. One moment out of time when we can't make difference between fiction and reality. The black and white tint appeared obvious to me to evoke this cinematic look.
Order also directly on our website under the contact section.
When receiving the payment (Paypal), your order Imagine by Albéric Jouzeau will be directly sent to you within 10 days.


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Insight 24th October 2015
Why does Britain celebrate Bonfire Night?
Cindy Stockman
Ten unusual royal middle names
The Widow of Windsor – A Queen in Mourning
Long Road Photography via Flickr
Every year on 5th November Britain is lit up with fireworks and bonfires with people partaking in the ceremonial effigy-burning of Guy Fawkes. It is a time for people to gather together to share in food, drink and merriment.
The fifth of November,
The Gunpowder treason and plot;
I know of no reason
Why the Gunpowder treason
Should ever be forgot!"
In the year 1605, a man named Guido 'Guy' Fawkes and some angry chaps gather few kegs of gunpowder, and set out to blow up Parliament with the hopes of killing King James I.
5th November was the date fixed for the opening of Parliament. The reason behind this dastardly plan was to cause unrest with the hopes the English Catholics would revolt. The Catholics at the time were upset with the ruthlessness of the severe laws for practising their religion.
The conspiracy would be known as "The Gunpowder Plot."
Parliament: the site of the crime.
In 1604, the collaborators began drawing out their plans. As the group of plotters grew, so did the chance of word getting out.
The 'ringleader' of the group was Robert Catesby. Catesby suggested the plan to blow up the House of Lords and House of Commons as well as assassinate King James I.
Thomas Percy rented a cellar that was beneath the House of Lords. Percy was a solid addition to this band of terrorists as he had connections in King James' Court. The cellars were used to store 36 barrels of gunpowder and firewood.
Best laid plans although do not always come to fruition. A mysterious letter was sent to MP Lord Monteagle 10 days before the opening of Parliament. Monteagle was warned not to be present for the opening of Parliament.
Here is where it gets sketchy. Lord Monteagle was the brother in law of conspirator Francis Tresham. Now it has never been proved that Tresham wrote the letter to Monteagle, but it is certainly suspect that he was warned.
Word got out about the letter got out to the First Earl of Salisbury and other MP's. The MP's sought help to investigate the claims and upon their search discovered the concealed stockpile of explosives.
On 4th November Guy Fawkes, using the alias John Johnson entered the cellar. He was discovered by Sir Thomas Knyvett and Edward Doubleday.
The band of collaborators was arrested as they tried to run. Those able to escape then were captured not too long afterwards. Some were killed on the spot; the rest of the group were imprisoned and later executed.
On 6th November, King James ordered Fawkes to be taken to The Tower of London to be tortured. Fawkes refused to give up the names of those who assisted him.
On 8th November, Fawkes seemed to have signed a confession, but he did not detail everyone who participated in the plot. The next day, after more torture it seemed Fawkes alluded who participated.
As for the conspirators, Tresham died on 23rd December 1605 whilst at the Tower due to natural causes. The eight remaining collaborators were put on trial on 27th January 1606 at Westminster Hall. They were all convicted of treason and sentenced to death.
Robert Winter, Thomas Bates, Sir Everard Digby and John Grant were executed in St Paul's Churchyard on 30th January 1606.
Guy Fawkes, Robert Keyes, Ambrose Rookwood and Thomas Winter were executed the following day at Old Palace Yard, outside of Westminster Hall.
Robert Catesby and Thomas Percy were killed by a single shot on November. The duo was hiding out at Holbeach House in Staffordshire. Both of their heads were set up in front of Parliament House.
5 November was declared by King James I through an Act of Parliament, to be a day of thanks for "the joyful day of deliverance."
To this day, a customary search of the basement of Parliament is conducted by the Yeoman of the Guard at the opening of Parliament.
The cellar that Fawkes and the gunpowder plotters used was damaged in 1834 by fire. When the Palace of Westminster was rebuilt in the 19th Century, the infamous cellar was destroyed.
Photo credit: David Izatt via photopin cc
Related Items5 novembercstockmancstockman3gunpowder treason and plotguy fawkestreason
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Mehsana district (alternate spelling "Mahesana") is one of the 33 districts of Gujarat state in western India. Mehsana city is the administrative headquarters of this district. The district has a population of over 1.8 million and an area of over 4,500  km2. There are over 600 villages in this district with a population of 2,035,064 of which 22.40% were urban as of 2011.

Mehsana district borders with Banaskantha district in the north, Patan and Surendranagar districts in west, Gandhinagar and Ahmedabad districts in south and Sabarkantha district in the east.

Major towns of the district are Mehsana, Vijapur, Bahucharaji, Satlasana, Modhera, Unjha, Vadnagar, Kalol, Kadi, Visnagar, Kherva, Jotana and Kheralu.

History

Mehsaji Chavda, a Rajput and an heir of Chavda dynasty, established Mehsana. He constructed the Toran (arc gate) of city and a temple dedicated to Goddess Toran in Vikram Samvat 1414, Bhadrapad Sud 10 (1358 AD). It is described by Jaisinh Brahmbhatt in poems of 1932 AD. It is also corroborated by Manilal Nyalchand, an author of Pragat Prabhavi Parshvanath of Samvat 1879. He also refers that Mehsaji built the temple dedicated to Chamunda. It inconclusively establishes that the town was founded during Rajput period. Another legend says that Mehsaji established it in Vikram Samvat 1375 (1319 AD).

Gaekwads conquered Baroda and established Baroda State. They expanded their rule in north Gujarat and established Patan as its administrative headquarters. Later the headquarters was moved to Kadi and subsequently to Mehsana in 1902. This northern area under Baroda was divided in 8 mahals. Gaekwad also connected the city by Baroda State railway which was opened on 21 March 1887. Sayajirao Gaekwad III built a palace known as Rajmahal in Vikram Samvat 1956 for his son Fatehsinhrao. It is now used as a district court.

Baroda state was merged with India after independence in 1947. It was included in Bombay state. Later became part of Gujarat in 1960 after partition of Bombay state into Gujarat and Maharashtra. Now Mehsana is a standalone district in north Gujarat.

Divisions
There are 7 Vidhan Sabha constituencies in this district: Kheralu, Unjha, Visnagar, Bechraji, Kadi, Mahesana and Vijapur. Kheralu is part of Patan constituency and rest are part of Mahesana constituency.

Demographics

According to the 2011 census, Mehsana district has a population of 2,035,064, roughly equal to the nation of Slovenia or the US state of New Mexico. This gives it a ranking of 229th in India (out of a total of 640). The district has a population density of . Its population growth rate over the decade 2001-2011 was 9.91%. Mehsana has a sex ratio of 925 females for every 1,000 males, and a literacy rate of 84.26%. 25.27% of the population lived in urban areas. Scheduled Castes and Scheduled Tribes made up 7.97% and 0.46% of the population respectively.

At the time of the 2011 Census of India, 97.58% of the population in the district spoke Gujarati and 1.76% Hindi as their first language.

Mehsana district consists 10 talukas: Becharaji, Kadi, Kheralu, Mahesana, Vadnagar, Vijapur, Visnagar, Satlasana, Jotana, and Unjha. Populations as of 2011 were as follows:

Politics

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Education

Engineering colleges in Mehsana district
Sankalchand Patel College of Engineering, Visnagar, Mehsana
S.P.B. Patel Engineering College, Saffrony Institute of Technology, Linch, Mehsana
U.V. Patel College of Engineering, Ganpat University, Kherva, Mehsana
Unjha Engineering College
L.C.I.T Institute of Technology, Bhandu
Marchant Institute of Technology, Basna, Mehsana
Government Engineering College, Katpur
Sardar Patel Institute of Technology, Piludara, Mehsana
Gujarat Power Energy Institute of Technology, Mevad, Mehsana

Pharmacy and Medical colleges in Mehsana district
S.V. Institute of Management, Kadi, Mehsana
S.K. Pharmaceutical college of education and research, Ganpat University, Kherva, Mehsana (Also has M.Pharma)
Saffrony Institute of Technology, Linch, Mehsana
Pharmacy college in Bechraji, Mehsana
Pharmacy college in Modasa, Dist-Mehsana
GMERS Medical College, Vadnagar

Science colleges in Mehsana district
Mehsana Urban Institute of Sciences, Ganpat University, Kherva (Second largest science college in North Gujarat)
Nootan Sciences College, Sakalchand university, Ganj bazar, Visnagar (first science college in North Gujarat)
Mehsana Urban Science College, Nagalpur, H.N.G.U University
 Smt. R.M. Prajapati Arts College

Teacher colleges in Mehsana district
S.A.Patel B.ed College, Rampura (kukus), Mehsana

See also

References

External links

 Official website
 Mehsana Collectorate

Districts of Gujarat

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