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Home Reviews King's Bounty: Review of The Legend
King's Bounty: Review of The Legend
loothunter
Original King's Bounty, released in 1990, was one of the most influential games for the whole strategy genre. And a direct precursor to the infamous Heroes of Might and Magic series.
However, Heroes games are mostly focused on "global" strategy level with managing many heroes, gathering resources, and actually building stuff in your castles. While in KB the whole game was set around a single hero and you, embark on the quest on the behalf of the King.
And developers of King's Bounty: The Legend decided to return to the roots.
The Legend Returns
Still, the new game became much more resembling of typical RPGs. There is a deliberate progression system with experience points, leveling up and acquiring new skills. There are many NPCs ready to chat and give you a quest or two. Sometimes those quests involve more than just fighting and carrying packages. They can even branch – allowing different solutions or rewards.
There is no more time limit. But there is still a day-night cycle, with some creatures becoming stronger at night. And there is no more way to capture castles for weekly income. Though you can still put creatures into a garrison of friendly castles if you need to replace them with another type of troops, but don't want to disband creatures completely. At least, you don't need to pay a salary to your soldiers too.
Probably, the most radical change is that traveling on a global map became real-time. While riding through the woods (or roaming across the sea, when you get the boat) you can avoid some wondering creatures if reacting fast enough. You can even make them chase you and lure away from their post by passing just at the sight range – a useful trick to get some treasure if your army is under-powered.
And treasures are lying practically everywhere! Chests with gold and magic scrolls, flags that increase your character's leadership, altars that grant experience, or permanently raise some stats. The latter looks more like a feature from Heroes, but such "reference" is only welcome. And the most valuable artifacts are guarded by powerful armies, which you must fight.
Turn-based combat in details
The tactical battlefield also came a long way from a simple 6×5 plane. Now it's hexagonal and varies in shape and sizes. In addition to ordinary obstacles, there can be special items affecting the course of the battle. A hive of bees, who attack random squad each turn, a totem that buffs (or curses) anyone near it, a chest with some gold. There can even be a potential ally – destroy a coffin at the cemetery, for example, and you'll get a squad of skeletons or vampires to fight on your side during the rest of the battle.
Battlefield type and layout actually depend on the terrain, you start a fight. A neat detail that you can also use to your advantage by luring some creatures to the ground type where your troops become stronger.
Yes, the strength of some creatures depends on where or when they fight. And there are many other nuances. Floating creatures can fly over some obstacles. Archers can fire special freezing or flaming arrows once per battle. Snakes can attack over one hex remaining out of range for retaliation, though such attack takes a turn to recharge. Druids can summon bears. Bears raise their attack when taking damage. Practically every type of creature, even the most basic peasant, has some special attributes or abilities.
Choosing creatures who have synergy for your army provides an enormous range of tactical options. But you can gain even more advantages if you develop a hero accordingly. Obviously, attack and defense stats will boost the same parameter of your army. And high leadership will allow hiring more creatures of each type. But there are even special skills that grant your units additional abilities. Or boost existing ones.
And don't forget the trickiest option of all – magic.
Spells, Artifacts, and… Wives
As in Heroes series, you can cast spells either by using scrolls or reading them from the spellbook. The latter requires mana and the spell itself to be actually added in the book. Oh, and your hero must have a skill in one of three schools of magic – Order, Chaos, and Distortion.
Those skills can be upgraded to level 2 or 3, which will allow you to cast an advanced spell version that deals more damage, lasts longer, or affects more units. And if you don't need that, you can always press Ctrl and use basic spell version that costs less mana. Neat!
Spells themselves come in all shapes and sizes. From basic fireballs and healing to teleportation, creating copies, summoning special creatures and placing traps with different effects. But that's nothing compared to a variety of items that can rival full-fledged RPGs!
Check this – some artifacts are living things and have own Morale level! If you fight dragons with Dragon Slayer sword, it will be glad and become even more effective. If you won't kill dragons but have them in your army instead, the sword will become angry. And eventually will teleport you to a special arena where you have to defeat gremlin guardians to restore the balance.
Another interesting feature is the opportunity to get married. First, of course, you need to complete a quest – defeat a monster, lift a curse (or not if you want a zombie wife), or something else your future wife desire. Then you propose, and voila! Not only your wife provides some stat boost for you or your troops, but also she can hold four additional artifacts. Or children – they basically replace wife's item slots and also provide bonuses. Too bad that birth order is random and is set at the start of the game.
Spirits of Rage
The last, but definitely not the least, is The Chest of Rage. It contains four powerful creatures from across dimensions. Sleem the Lizard Prince, Lina the Technomage, Reaper from the Temple of Time, and Zerok – each is basically an NPC with its own backstory, dialog options, and a quest that you need to take before being getting access to their abilities.
After that, you can summon them on the battlefield to attack enemies, protect your army, or do some other special trick. It's like being able to cast an additional spell each turn. And they even gain experience, leveling up their abilities. Though there are still some restrictions, including the use of Rage.
Essentially, Rage is an additional resource similar to Mana. Except out of combat it doesn't restore but in fact, dissipates over time. You need to deal (or receive) damage in combat to gain Rage. Or use spells and artifacts to get more. Managing your "rage level" becomes an additional layer in tactics, especially since filling the Rage bar also increases damage from Critical Attacks of your units.
It's Like in Fairy Tales
Honestly, it's rather hard for me to find any imperfections in this game that is rightfully called a cult classic. Yes, the story is rather straightforward and at times campy. But it totally fits the world that is well-crafted to remind you of old times when there was no need for everything to be grim-dark.
I can also nitpick the interface. Nowhere you're actually told how Rage impacts Critical Attack – that's info that I got from "extended" manual, that doesn't even exist in English. Also, you can't look up your stats during the battle, so if you use the "Sacrifice" spell to increase the number of creatures in the stack you can outdo the leadership limit and they turn on you. Yeah, that last one went pretty specific.
One of a few "Slayers" references. Developers clearly like that anime series.
As I've said – it's all just nitpicks. Beyond them, King's Bounty: The Legend is a true unaging masterpiece. One of the few examples of "spiritual successor" done right. It doesn't follow the original game formula exactly but borrows enough core features to recreate the feel and experience. It introduced a few new (for its time) ideas and mixed modern conventions with the old in just the right proportion. So a new generation of gamers wouldn't be bored or frustrated and fans of "old school" wouldn't feel cheated of what they think makes King's Bounty King's Bounty.
Tactical battles that offer a variety of challenges. Including arena-sized bosses.
You can win battles by using different strategies, depending on the abilities of units, magic spells, Spirits of Rage, and hero skills at your disposal.
The beautiful magical world that is inhabited by colorful NPCs that you can chat with or take a quest.
The relative freedom of traveling. On arriving in a new area you choose where to go, what monsters to fight, and how to get treasures lying around.
Randomization of treasure types, artifacts, troops for hire, and monsters allow greater replayability.
The interface doesn't show some things like leadership cap during the battle.
Basic story.
Some jokes are based on Russian and even Soviet culture and will miss most people.
King's Bounty: The Legend
Kings Bounty
Previous articleOn The Radar -September 2020
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kings-bounty-review-of-the-legend
Good

Tactical battles that offer a variety of challenges. Including arena-sized bosses.

You can win battles by using different strategies, depending on the abilities of units, magic spells, Spirits of Rage, and hero skills at your disposal.

The beautiful magical world that is inhabited by colorful NPCs that you can chat with or take a quest.

The relative freedom of traveling. On arriving in a new area you choose where to go, what monsters to fight, and how to get treasures lying around.

Randomization of treasure types, artifacts, troops for hire, and monsters allow greater replayability.

Bad

The interface doesn't show some things like leadership cap during the battle.

Basic story.

Some jokes are based on Russian and even Soviet culture and will miss most people.

Sid Meier's Alpha Centauri – Review
Yggdra Union: The GBA Classic Strategy Game Heads on PC
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Home | Louis Botha… first leg in the changing face of Joburg
One of the most discussed topics among Johannesburg Jewry over the past year has been the construction on the very busy Louis Botha Avenue artery. "What's going on?" is frequently asked and "Why is it taking so long?" Read the answers in the first of a multi-part series of articles, see the pictures and the complete PDF document the City has approved – find out how the six-fold population densification by introducing low- and middle-income residents will affect you…
Lifestyle/Community
ANT KATZ
What the Louis Botha corridor will look like in a few years, above, and see many more pictures and documents in and below the story
The Louis Botha Avenue hustle and bustle is not just building a Bus Rapid Transport (BRT) from Alexandra township to Johannesburg's CBD; it is the first stage of a major redevelopment in the coming two decades that will herald a complete transformation of the city.
By the time all is said and done, there will be six BRT stations between Orange Grove and the Wynberg industrial area, with six times the present population density. It will also see the automatic rezoning by the City Council of all land several blocks deep alongside Louis Botha with developments ranging between two and eight storeys, with business rights near the stations.
SEE PICS WITH EXTENDED CAPTIONS BELOW
Taxis will not be allowed to travel on the road, but will have much more profitable "last mile" passenger loads from the stations to their destinations. Originally there were only going to be three east/west crossings in this area but community complaints have led to the Council agreeing to five crossing points
The City aims to have at least four development corridors – two running north/south and two east/west. The latter ones will cross the north/south version down George Avenue, past the Chevrah Kadisha, over the N3 and all the way to Kempton Park (if Ekurhuleni buys in).
Click to find the complete 145-PAGE PDF DOCUMENT (cover illustrated right) that the City has approved and the seven previous STORIES AND LETTERS on JR-Online on the subject
To facilitate a programme of such massive proportions, Johannesburg has to build the requisite infrastructure first – and that is what is happening now. For example, what used to be commonly known as "death bend" (the stretch of Louis Botha Avenue between Houghton Drive and Yoeville), has seen the hillside demolished and the road straightened out.
So, readers, while it may seem to be taking forever, think of it as the pilot project for the Johannesburg of 2050 and be patient. Once one has read what will be taking place, one will be surprised that it has been managed with so little disruption to the lives those who are touched so regularly by Louis Botha Avenue.
STORY CONTINUES AFTER PICTURE…
Johannesburg Jewry are severely affected by scenes such as this one near Balfour Park this week where workmen are active on both sides of the road and, in the distance, all the way to Gresswold as well. Read why, and see the pictures below to understand what is happening, why, and how it will affect you!
The reticulation of power and water to service six times as many residents, and the removal of sewage and storm-water pipes and drains, all have to be put in place.
Follow the story, join the conversation…
Over this week and next – and maybe more if required – Jewish Report will try and answer our readers' questions. Feel free to join the conversation and let's hear what you think in our comments section below.
Jewish Report has also have placed a link to the 145-page "Strategic Framework" document in a PDF format for readers to see, download, print or share – to understand what is happening and why.
This major undertaking is bound to be a challenge to commuters and residents for quite a number of years to come.
Some of the motivation for the redevelopment, according to the City, is to address the problems of past spatial planning practices which have left Johannesburg with "sprawling low-density areas of settlement, lacking viable public transport systems."
The majority of working-class and poor citizens are still living on the fringes of the city, commuting daily often at considerable cost, and face long distances to access work and economic opportunities. Also, private car and taxi use is a significant driver of energy consumption and greenhouse gas emissions.
Follow this fascinating series in our print edition and on the web (which, as you can see below, has the space to carry many more illustrations to see how it will affect your own quality of life and business and housing investments in the area.
And remember, this is an interactive website. Join the conversation and have your say by posting comments below – either in your own name or anonymously.
Illustrated above is a visualisation of what the future holds showing a small bus stop on the Louis Botha Avenue "Development Corridor" – around all bus stations will be six to eight storey developments and business rezoning. They will also have facilities for mini-bus taxis to take passengers from the bus stop closer to their homes
At left is a bulk services trench near Balfour Park which has already had some infrastructure buried, filled with soil and compacted for further service to be added. This exercise is happening on both sides of the road in some places.
The bus stations will be situated at Orange Grove, Raedene (which will in time link up to the East/West corridor down Scott Street), Balfour Park, Corlett Drive, Wynberg and Marlborough. This map has a colour-coded key which illustrates the future population density plans
This pictograph illustrates the envisaged densification of population as envisaged in the council's plan. The red focus area is that directly along Louis Botha Avenue. This has been subjected to an intensive study and is expected to grow six-fold. This will, however, obviously be driven by demand (for accommodation) and supply (by developers or landlords)
Illustrated above is a larger bus station, this one in Wynberg, which will also intersect the the Alexandra to Sandton route also currently under construction, has additional facilities and parking to support the higher traffic convergence and mini-bus taxi usage
Follow Jewish Report in the coming weeks to find out how the changes may affect your property values, what opportunities they may offer and how the lifestyle of both observant and secular Jewry may be impacted
Related Topics:Ant KatzJohannesburgLouis Botha AvenueRea Vaya
Chutzpah
'and chazas will fly'
'The biggest problem NOW is that the constr people are incredibly slow and disorganized.After all this time not ONE single block is complete. Why not do a block at a time, finish ALL the pavements and road surfacing, street lights and storm-water drains before going to the next one. most NEW street lights are still not working. why?? The mess and chaos they have left behind in most places is totally unacceptable. is this a proper construction company, it doesn't look like it. Also, this company should not have been allowed to control the traffic, as their expertise is obviously zero.'
Israel Rugby 7s to camp with the Blitzbokke
Rav Ilan Herrmann
The thrill-a-minute Rugby 7s have captured the hearts of fans around the world. The Blitzbokke, South Africa's national Rugby 7s team, ranks second in the world, and is among the most exciting, formidable, and feared of 7s teams.
Exactly 9 191 km away are the Israelis, an emerging rugby nation that has talent, determination, and a world-class coach in South African Kevin Musikanth. Now, these two squads will meet. The Israeli 7s side will be travelling to the SAS Rugby Academy in Stellenbosch to train with the Blitzbokke.
The Blitzbokke will have the opportunity to prepare for the coming 7s rugby season by measuring their skills of play against the Israelis. And the Israelis, well, they will be rubbing shoulders with, and learning from the best in the world and honing their skills for their coming European Rugby season.
"It's an opportunity for our boys to learn from the world's best," says Musikanth. The SAS Rugby Academy is run by the legendary Frankie Horn, a technical expert whose coaching guidelines and methods are second to none in World Rugby 7s.
Musikanth took over as Rugby 15s head coach in Israel in 2018, and in October 2019, he became director of rugby for the Israeli Rugby Union and head coach for the national programmes of both the 15s and the 7s.
Horn visited Israel last December at the behest of Rugby Israel and its supporting Olympic body and since then, the partnership has continued to grow. The upcoming training camp will begin in Israel, where Horn, together with Phil Snyman, the former Blitzbok captain and multiple world champion winner, will spend a week with the players and coaching staff at Wingate, Netanya, the home base of Rugby Israel. They will then all travel to Stellenbosch for a week's camp with the Blitzbokke.
"We've already seen the difference through our partnership with Frankie. Two of our players were spotted by him on his previous trip to Israel, and have been training at SAS on the off-season," says Musikanth. The two players are Omer Levinson (scrum half) and Yotam Shulman (lock).
Horn, technical advisor to Rugby Israel's 7s, says "It is a great opportunity for both teams to derive positive benefit from the camp."
Israel Rugby has been making considerable professional strides since Musikanth took over the reins. Israel 15s played their 100th test match against Cyprus and celebrated with a 34-22 victory.
"We're in the top 25 in Europe in 15s and in the top 16 in 7s, the toughest, most competitive continent in world rugby," says Musikanth, "and I can realistically see us setting our sights on the Top 15 and Top 12 respectively in the future."
Currently, there are three eligible South Africans who are on the Israeli national squad: Jayson Ferera as flanker (Pirates Rugby Club), Daniel Stein as fly half (studying in Israel), and Jared Sichel as prop (Hamilton's Rugby Club, Cape Town). Eligibility to play for a national team in rugby is stricter than in other sports. One does not qualify just because one has a passport. One has to have had a parent or grandparent that was born in that country or one has to have lived in the country for at least three years.
"With so much Jewish rugby talent around the world, we would be able to put a world-class Israeli national team together if not for the measures that restrict eligibility to national call ups," says Musikanth.
The Israel Rugby development project was accelerated thanks to Musikanth initiating Bridges through Rugby. This project is the collective effort of a few South African Jewish businessmen who appreciate the long-term vision of Israel becoming a stronger rugby nation. They have come on board to assist with this most opportune tour. National financial support is fixed and, as such, is limited. While the strong players and national coaches will be attending the training camp in Stellenbosch, there will be some that will, unfortunately, have to stay behind.
"This is a once-in-a-lifetime opportunity for our players and coaches. To get to see the best upfront and feed off their knowledge is going to be incredible," says Musikanth. "Everyone is eager to go, of course, but there is a cap to the support we have in place. We would like to take a development u20 squad as well as coaching staff who would carry the benefits of this into the future. A rugby visit to Stellenbosch can change rugby lives in many respects. Stellenbosch is rugby utopia!"
Rugby aside, with the Israelis and South Africans camping together, the question of what will be for dinner after a gruelling day's training may be a matter of contention. A tussle for whether to serve boerewors or shwarma may result in a scrum in the SAS dining hall to determine the outcome.
SA teen curates LA Holocaust exhibition
Julie Leibowitz
Youngsters who have seen David Labkovski's paintings of the Holocaust say the artworks are much more raw and emotional than the black and white images we have come to know so well.
"It really hits home. You get the feeling of what these people went through," says a student commenting on the artist's work.
Now, Labkovski's works have been combined with the stories of famed Yiddish writer Sholem Aleichem in a new online exhibition titled "Recalling a Lost World – David Labkovski brings Sholem Aleichem stories to life", hosted by the Holocaust Museum Los Angeles. One of the curators of the exhibition, which opened on 28 October, is 14-year-old Eva Trope in Grade 9 at Yeshiva College in Johannesburg.
In the exhibition of about 30 artworks, Labkovski's depiction of the world of Eastern European Jews prior to, during, and after the Holocaust, is combined with the writing of Aleichem, who Labkovski thought of as his muse. Though Aleichem's characters were created decades earlier, they are so true to life, he could have been describing the people of Vilnius – or Vilna as it was then known – in Lithuania, Labkovski's childhood home.
For Labkovski, reading Aleichem's stories brought him back to his childhood. He wanted to commemorate the Jewish world that was, not just how the Jewish people died, but how they lived for centuries before the Holocaust.
The exhibition has a dark side, moving from paintings with bright colours and Aleichem's fairytale-like settings to increasing scenes of destitution. Some place their subjects in the Vilna ghetto with Jewish stars on their clothing, and the exhibition culminates with an image of the destroyed Great Synagogue of Vilna after the war.
The exhibit includes audio tours which share Labkovski's illustrations of Aleichem's stories with the audience along with teacher educational lesson plans combining the art and literature.
The combination is a powerful way to educate viewers, particularly youngsters. "I could stare at the works for hours," Trope says of the exhibition. "The placing of the people, buildings, the colour of the sky … many of the Holocaust stories I found unrelatable before have come to life."
Trope, who "loves art in all its forms", got involved in the exhibition through a poetry competition organised by the David Labkovski Project (DLP) earlier this year. The DLP uses Labkovski's art to improve youngsters' understanding of the Holocaust and promote tolerance and acceptance.
The competition brought her in touch with Stephanie Wolfson, director of education at the DLP, and Trope joined the DLP's six-months-long International Student Docent Programme with students (Grades 8 to 12 ) from around the world who learn how to educate others about Labkovski's art. From this, she was asked to join the team curating the current exhibition.
Curating is a "big job", she says. She worked on the layout, narratives, translations of interviews and story summaries, among other things. Trope was even required to attend meetings at 01:00 at times because her co-workers in the United States were nine hours behind her. "It was a bit stressful with school work and exams," she admits, but it was worth it.
At 14, she was the youngest member of the team by far, "but we had sophisticated discussions, and listened to each other", Trope says.
Michele Gold, the president of the Holocaust Museum Los Angeles, describes Trope's involvement as "remarkable".
"Eva is wise and professional beyond her years," says Leora Raikin, the founder and executive director of the DLP. "She has shown dedication not only towards the creation of the virtual exhibit, but the translation of movie footage. She was also part of the official speaking panel for the launch of the international exhibit along with the Israel consul general to Los Angeles, Dr Hillel Newman."
What's next for this budding art historian? She aims to get involved in other exhibitions, and to help expand this project by, among other things, assisting in bringing the exhibition to South Africa.
Falling in love with the world's hottest real estate
Jordan Moshe
Falling in love with Jerusalem was the last thing Sarah Tuttle-Singer could have imagined. However, the love story that would unfold between this American-born writer and the ancient Jewish city proves that their match was ordained from the start.
A journalist and the author of Jerusalem Drawn and Quartered, Tuttle-Singer shared her story at eLimmud2 this past Sunday, 25 October. It began in the first summer she spent in Israel at the age of 16 in 1997. Raised in Venice Beach, California, today she lives in Israel with her two children and has made it her mission to come to grips with what it really means to live in the Jewish capital.
"Going to Israel was the last thing I wanted to do," she said. "I wanted to hang out at the pool, go to the movies, and to the mall. But my parents had another idea, and I remember the afternoon my mother called me into her office.
"I walked in and saw her sitting at her old library desk, drinking her coffee, and smoking a cigarette. She said, 'Sarah. Sit down.' I wondered what sin of mine she'd found out about, but then she said, 'I've decided it's time for you to go to Israel, experience your roots, and meet the people who are your family.'"
Such a trip wasn't a priority for her daughter, in spite of having grown up on stories of her mother's travels in Israel in 1967, involving camels walking through Damascus Gate and the smell of rose water and the peals of church bells in the Jerusalem markets. But her mother remained adamant.
Her intuition proved right.
"I fell in love," said Tuttle-Singer. "For the first time in my life, I didn't have to explain why I kissed a mezuzah on the side of the door or explain why I didn't eat shrimp tempura. It was the first time all the pieces of my identity came together, and it all made sense. I stood on a rooftop overlooking the Old City, and I fell in love. I felt at home."
Tuttle-Singer swore she would return on aliyah, knowing that Israel was where she belonged and that the root of her belonging was in Jerusalem. She returned for brief subsequent visits, feeling connected to Jerusalem and its people, believing this was where she ultimately belonged. However, it didn't occur to her that things weren't as positive as they appeared.
"One night, I took a walk in the Old City, and ended up at the Damascus Gate," she recalled. "I was standing there having a fantasy moment, and I suddenly felt a searing pain in my head and neck. I touched my head and my hand was sticky with blood. The pain hit, and I realised that someone had been throwing stones at me. I was terrified.
"I was standing there covered in my own blood. I ran headlong into the Muslim Quarter, and found myself surrounded by loud and scary Arabic, jarring sounds, and my senses were bouncing. I found two border police officers, they walked me out, and I sat at Jaffa Road and cried.
"I thought I'd never go back again."
In spite of returning to America, Tuttle-Singer married an Israeli, and while they led comfortable lives in Los Angeles, they resolved to make aliyah. Plagued by fear and doubt, however, she was reluctant to leave the safety of home and return to Israel with her husband and two children. Still, she resolved to rediscover her love for Israel but chose to stay away from the Old City.
Reeling from a breakdown in her marriage and subsequent divorce, it wasn't until colleague and journalist Avi Issacharoff convinced Tuttle-Singer to venture back into the ancient quarters that she slowly reignited the passion of her youth.
"My heart was in my throat, and I felt sick to my stomach," she recalled. "It was my first time back in 15 years, and the last time I had been there was I hurt." Tuttle-Singer gradually overcame her trauma, and with the help and care of local residents, rediscovered her love of Jerusalem.
"I slowly realised that I wanted to live in the Old City, to go into it as deeply as I could and be part of it," she said. "I divided the year into four parts, just like Jerusalem is divided into four, and I wanted to be part of each community."
Over time, Tuttle-Singer engaged with people across the Jewish, Muslim, Christian, and Armenian quarters, and came to a realisation.
"This is the hottest piece of spiritual real estate in the world," she said, "and we're afraid to look each other in the eye in spite of being in love with the same space. I resolved to go into the city again to see beyond the borders and the fear that divides us."
While her experience has blended uplifting spiritual moments with physically frightening ones, Tuttle-Singer said that she learned the importance of connecting with others based on a shared love of the ancient city.
"I learned that you can have a treaty between governments, but unless people live by the treaty, it's meaningless. We won't live by it unless we know each other, unless we take steps to begin having conversations, it will never happen.
"One conversation may not change the world, but if it leads to more conversation, you have a friendship, and that can become a basis for positive change."
Farewell to an architectural giant
Voices6 days ago
A December of COVID-19, paranoia and cancelled plans

redpajama_set_name: RedPajamaCommonCrawl


text:
Q: How to render twitter feeds in Angular Application? In my project, twitter feeds not rendering, I have tried debugging still not able to find, so I need help.
I have also tried some other stackoverflow answers, which was not working for me.
here is my code,
index.html

app.component.html
Tweets by {{ twitterurl }}

app.component.ts
twitterurl: SafeResourceUrl = '';

constructor(public sanitizer: DomSanitizer){}

ngOnInit(){
let twitterurl = //will come from server
this.twitterurl = this.sanitizer.bypassSecurityTrustResourceUrl(twitterurl);
}

Thanks

redpajama_set_name: RedPajamaStackExchange


Cream three of the eggs with the caster sugar until pale and thick, then add the water and fold in the flour. Spoon into two greased 20 cm/8 in round cake tins (pans) and bake in a preheated oven at 180�C/350�F/gas mark 4 for 12 minutes until springy to the touch. Turn out on to a wire rack and leave to cool.
Whisk the remaining eggs and the egg yolk with the icing sugar until frothy. Soften the gelatin in the lemon juice in a small bowl. Stand the bowl in a pan of hot water and leave until dissolved. Whisk the cream until stiff. Stir the gelatin and lemon rind into the egg mixture, then fold in the whipped cream. Return one of the sponge cakes to its tin, then spoon the cream mixture over the top. Cover with the other cake and chill before serving.


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How to Prep for Race Day with Laurenne Ross
12.05.2018 | Ski Racing Staff
Laurenne Ross has ten years of experience on the U.S. Ski Team, she's appeared in two Olympics, and she consistently finishes in the top 15 on the World Cup circuit. This year, we're lucky enough to have her setting pace as our newest NASTAR National Pacesetter. One might assume that with all that experience and success, she feels comfortable before the start of a race, yet even she still finds herself tensing up.
While physical preparation the night before and the morning of a big race is important, keeping your nerves in check is equally as, if not more, influential when it comes to skiing your best race. If Ross has learned anything on the circuit, it's how to dial herself in to get ready to kick out of the start gate in the best headspace possible.
"All in all what I've learned over the years is how to maintain my focus and how to stay where I am, rather than think about results because the fear of failure is so difficult to get past" she says. "'You know, 'what if I fail, or what if I win?' Those are the thoughts that can really destroy a day of racing."
Ross recently shared with us the unique things she does in order to remain present before, during, and after big race days.
Veteran Laurenne Ross limbers up at the start. Photo: SRM
Typically, Ross will spend the afternoon before a race doing some sort of recovery and physical preparation. This involves a bit of spinning on the bike, some core workouts, and a short session of strength and power to get her muscles activated and engaged. After that, she'll watch some video with her team, especially if it's a downhill race. They run through the course, analyze training runs, and use this knowledge to figure out exactly where and when they need to execute on the track the next day. When it comes to food, Ross does whatever she can to make sure her meals are healthy and green, with a bit of protein.
"I typically bring some green powder on the road, so I have it if I don't feel like I'm getting enough vegetables in my diet" she says, especially since her and the team depend on their hotels for food, which sometimes may not meet expectations.
When it comes to falling asleep the night before a race, Ross struggles since she isn't a "huge sleeper." While she aims to get a full eight hours, she knows that won't always happen because it's at night when her nerves hit. She tries to make the best of that nervous energy by channeling it into creative, distracting alternatives.
"I like to keep my mind off the stress and do something else. I'll play my guitar, I'll try and hang out with my teammates, I'll read, or draw, or write in my journal. Or I'll go out and walk around and take photos and just kind of try and maintain a calm state of mind."
On the guitar, she loves to delve into more complicated pieces of music, or work on chord combinations she's written herself so that it's easy to get consumed in song. Her reading recommendations include self-help favorites such "The Art of Fear" by Kristen Ulmer or "The Mindful Athlete" by George Mumford, and her new found love, a graphic novel series called "Saga."
The morning of…
Ross gets up early to meditate for at least a half hour before diving into warm ups. She'll spend another half hour on the bike in addition to an extra warm-up routine to activate her core and key leg muscles. After breakfast, when the team heads up to the hill, there isn't much prep work left. It's time to focus on skiing and inspection.
"I go over the course in my head after inspection multiple times. I review it at the bottom section, right when I get to the finish I'll go over it, I review it in the lodge, on my way up to the run…even when I'm at the start I'll continue to do so until I feel really comfortable and feel like I don't have to think about where to go anymore."
At the start…
In addition to visualization, Ross takes time to hop into another warm-up routine, the same one she performs every race. Core warm-up, leg swings, anything to get her heart rate up. After imagining her run and getting her body moving, the most important thing Ross does is remember to breathe. It's also the key piece of advice she would offer to a young racer who is still trying to find their rhythm on race day.
"Trying to maintain presence and trying to be really aware of your breath and how your body's feeling and just being aware is really important, and that helps a lot with the stress and not being overwhelmed. Remembering to take a deep breath is something that's really simple but it's easy to forget, and that's something I still work on constantly," she says.
After her run…
In an attempt to not be focused on her time, Ross goes back over her run in her head after going through the finish, remembering what felt good even if her time wasn't what she wanted.
"I try and remember moments of brightness or moments where I may have made a mistake and regained my composure and not base my day off of what my time was" she explains. "That's become really important because if you just base your day off of how good your skiing all the time, then if you're not skiing great it can really put you in a rut."
After coming back from an injury, Ross admits she is still trying to get past the initial fear that coincides with making a comeback. What she relies on to keep her grounded outside of the support of family, friends, and coaches is the fundamentals – the skills she knows will help her out of a pinch when the skiing gets scary.
"I'm really working on just getting more comfortable in my skiing and just learning how to push myself again" she notes. "I just have to stay really present and stay with my breathing and also remember why I'm doing it and that's because it's so much fun and there is nothing else that's like it."
Take it from Ross, race day tends be stressful. But no matter what kind of racer you are, with a solid pre-race routine and practiced mental focus, that stress can be subdued until you return to the present and remember why you came to race in the first place – because it's fun.
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Author: Ski Racing Staff
Location: Park City, UT
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This is a second part of the amazing Egypt trip. My trip to Alexandria Egypt was back in 2008. In the second half of the trip we went to Cairo Egypt, as well as Siwa Oasis. The impressions are unforgettable! Everybody should see the desert at night – so many stars! The Giza Pyramids are a true wonder of engineering and a must see, too. The best thing is it only takes 3 hours to drive from Alexandria to Cairo Egypt (compared to 6 hours from Red Sea resorts Sharm el Sheikh or Hurghada).
Really early wake up call (4:17 am). The drive went really smoothly, although the traffic was hardly any better than in Alexandria. Cairo is huge! Our first stop was at the famous Giza pyramids. Impressive sight, however, we had to fight off greedy Bedouins begging for money and demanding fee for photos with them (or their camels). Some fellow travelers told us tales how they invite you to sit on a camel and then demand money to help you down from the animal.
At some point a police officer called us to a nice spot and agreed to take some pictures. OF course, he asked for a tip, too! Our next stop was another tourist trap – perfume and papyrus shop. Nothing much to tell about these – either you pay or you stay out.
As requested, our guide took us to the famous Khan el-Khalili – the oldest bazaar in Cairo Egypt, famous for merchants selling souvenirs, antiques and jewelry. A great place for people who know how to haggle. Skilled salesmen will get you to buy trash if you are not careful! For me – I just enjoyed the scene and didn't bother buying anything there. The feeling of constantly being watched from all sides is quite frightening and uncomfortable. It's in their culture and I understand that now. But back then it really seemed like invasion of privacy. I wouldn't have liked to be there alone.
Our last stop was Egyptian museum – another must see in Cairo Egypt! This outstanding museum has a rich collection of Egyptian antiques. Among the most important artifacts, without doubt, is the famous Gold Mask of Tutankhamun, composed of 11 kg of solid gold.
Although I spent almost a whole day in Cairo, I can't say I've seen it. These are just little fractions of the most important sightseeing's. The city is full of little gems and you need to spend there some time to really understand it.
Another early morning wake up call due to a really long bus ride – 480km and 5 hours drive. That's five hours through the desert with nothing much to see. When we finally arrived at our destination, it seemed almost unreal – huge green oasis in the middle of sandy dunes. And even better – there is a whole town! Water (hot springs) coming from the ground created a perfect setting for plants and trees. Siwa Oasis is one of Egypt's most isolated settlements, with 23,000 people (mostly Berbers). The place is mostly known due to its ancient role as the home to an oracle of Ammon. The remains of the temple are a popular tourist attraction.
Siwa Oasis is an interesting place to visit due to it's culture and relatively isolated community. Additionally to already mentioned Oracle temple, there are some other great attractions, such as the Gebel al Mawta (the Mountain of the Dead), a Roman-era necropolis featuring dozens of rock-cut tombs and "Cleopatra's Bath", an antique natural spring.
The highlight of our trip was an adventurous sand dune jeep safari. Locals are particularly proud of this entertainment and gladly take you on a wild ride. The emotions are hard to describe – one should try it at least once!
On our way back it got dark quickly and suddenly millions of stars were showing the way! I have literally never seen a sky so clear and bright with stars. There is zero light pollution for hundreds of kilometers. I wish we stayed in the desert and watched the skies. The memory of it is still haunting me!
As I mentioned before, this trip was my first ever solo trip and my first trip to a relatively remote destination. Although it was fully organized, it gave me a feeling of freedom and curiosity to keep going. It was like nothing I have seen before. I got bitten by a travel bug and came back with just one wish – get on another flight and explore the world! Egypt is amazing, despite all the negativity written about it in the papers. People are hospitable, although their culture needs some getting used to. Some day I hope I will board on a river cruise to check out famous Luxor temples and all other treasures along the Nile.
Wow, you have such wonderful photos! I love your open and positive attitude and I can't wait to see where your next trip takes you!
Wow..Congrats! It's really great thing!! That you covered your second part of Egypt trip. After reading your blog, I also remembering those days, I had gone there for holiday's tour. It was really wonderful trip forever. Siwa is a historic site and an important point on an old commercial route famous for its relatively mild climate. It is a good place to spend holidays. I had gone with my friends to enjoy New Year with the help of the best travel agency (askaladdin.com). We visited many famous places of Egypt. Among all, Egyptian pyramid is the most famous spot of the Egypt. It such a wonderful place. The whole trip was amazing!


text:
BMC Family Practice
Research article | Open | Open Peer Review | Published: 17 February 2011
Genetic educational needs and the role of genetics in primary care: a focus group study with multiple perspectives
Elisa JF Houwink1,3,
Scheltus J van Luijk2,
Lidewij Henneman1,
Cees van der Vleuten4,
Geert Jan Dinant3 &
Martina C Cornel1
BMC Family Practicevolume 12, Article number: 5 (2011) | Download Citation
Available evidence suggests that improvements in genetics education are needed to prepare primary care providers for the impact of ongoing rapid advances in genomics. Postgraduate (physician training) and master (midwifery training) programmes in primary care and public health are failing to meet these perceived educational needs. The aim of this study was to explore the role of genetics in primary care (i.e. family medicine and midwifery care) and the need for education in this area as perceived by primary care providers, patient advocacy groups and clinical genetics professionals.
Forty-four participants took part in three types of focus groups: mono-disciplinary groups of general practitioners and midwives, respectively and multidisciplinary groups composed of a diverse set of experts. The focus group sessions were audio-taped, transcribed verbatim and analysed using content analysis. Recurrent themes were identified.
Four themes emerged regarding the educational needs and the role of genetics in primary care: (1) genetics knowledge, (2) family history, (3) ethical dilemmas and psychosocial effects in relation to genetics and (4) insight into the organisation and role of clinical genetics services. These themes reflect a shift in the role of genetics in primary care with implications for education. Although all focus group participants acknowledged the importance of genetics education, general practitioners felt this need more urgently than midwives and more strongly emphasized their perceived knowledge deficiencies.
The responsibilities of primary care providers with regard to genetics require further study. The results of this study will help to develop effective genetics education strategies to improve primary care providers' competencies in this area. More research into the educational priorities in genetics is needed to design courses that are suitable for postgraduate and master programmes for general practitioners and midwives.
In the age of genomics, the genetics of common chronic disorders, pharmacogenetics and large-scale applications in screening are becoming increasingly important. Primary care providers (e.g. general practitioners and midwives) will have to discuss these issues with their patients, who are becoming increasingly aware of genetic contributions to disease and also have high expectations of genetic testing [1]. Consequently, primary care providers need to be educated to meet the needs of their patients that are created by rapid advances in genomics [2]. Genetics literacy among primary care providers needs to be improved to enable their participation in the debate on the hopes and hypes of genomic medicine and to distinguish between useful and useless practical applications in health care [3]. Currently, genetics and genomics are rather underrepresented in postgraduate (physician) training programmes in general practice (here, the terms general practice and family medicine (commonly used terms in the Dutch health care system) are considered synonymous to the more commonly used term family practice in the U.S. healthcare system) as well as in master programmes in midwifery and public health [4, 5]. It is widely recognised that medical professionals and medical students should be educated about genetics [2, 5–7].
Research into the perspectives of general practitioners and midwives on the educational priorities and attitudes in relation to genetics [8–16] revealed a need for genetics education for primary care providers in areas like psychosocial issues and screening, assessment of the risk of genetic malformations and basic genetics. However, the educational needs of primary care providers and their views on the role of genetics in family practice are still under investigation, and international efforts to translate these needs into education programmes are still in their early stages [17, 18].
Primary care providers have a unique role in the Dutch health care system and general practitioners are easily accessible to all patients for any complaint, request or question. Midwives provide obstetric and perinatal care and give advice and guidance to patients on pregnancy and childbirth. Genetics could have an effect on daily primary care practice if basic and clinical science advances in genomics of common chronic diseases in practice and midwifery care are successfully translated [2, 3, 19]. Changes will only be effective, however, if they fit well into practice routines. It is therefore important to understand how these key professional groups conceive of their responsibilities and experiences in relation to genetics. For the implementation of genetics training in daily practice to be successful, it is important to identify factors that can enhance or inhibit effective genetic primary care.
Up till now, most studies of educational needs concerning genetics have been limited to the perspectives of target groups [1, 4–14]. Professional training needs can be derived from those studies and from challenges posed by new applications as foreseen by experts. This study explored the views of general practitioners, midwives, patient advocacy groups and others involved in genetics in health care and education regarding their need for genetics education and the role of genetics in primary care. This information was collected to help develop effective genetics education and training as well as effective integration of genetics in primary care.
We used a qualitative study design with focus groups because this enables the exploration of the meaning and significance of the role of genetics and the need for education in that area as perceived by different stakeholders. A discussion with members of the research team and primary care providers revealed that general practitioners and midwives were the primary care providers most likely to be confronted with issues of genetics and genomics in their practices.
We used purposive sampling to recruit specific groups of professionals for focus group interviews in order to obtain rich, relevant and diverse data.
The participants were expected to provide complete and possibly complementary perspectives on genetics in primary care practice and education. Potential participants were named by key persons and network contacts at academic departments of general practice and the midwifery academies at Amsterdam and Maastricht, the Netherlands.
We convened three types of focus groups, (1) two groups of general practitioners, (2) two groups of midwives, and (3) three multidisciplinary groups composed of clinical genetics professionals (clinical geneticists or genetic counsellors), primary care educators, and representatives of patient advocacy groups. The participants in the multidisciplinary groups were considered experts who were expected to have a broad view of the role of genetics in primary care and the need for genetics education i.e. what is needed, what works and what does not work.
For each focus group, ten to fifteen professionals from one region were invited by email or telephone. Those who responded positively received an invitational letter, informing them that the purpose of the study was to explore their perceptions of the role of genetics and genomics in primary care and the related education needs. The term 'genetics' was commonly used during the focus group discussions, and the term 'genomics' was used to denote a broad definition (e.g. common complex disorders and rapid technological developments).
Additional file 1 provides an overview of the participants. The interviews lasted approximately two hours and were held between March and August 2009. The discussions were facilitated by an independent and experienced moderator (SL), who encouraged the participants to participate actively and to openly state their viewpoints and engage in discussion. An assistant (IH) took notes and all the sessions were attended by one observer (LH). Participation was voluntary and participants received €100 plus travel expenses.
The study was approved by the Medical Ethics Committee of VU University Medical Center, Amsterdam and Maastricht University. All participants gave informed consent at the start of their focus group session.
Interview guide
An interview guide with open-ended questions was developed to ensure coverage of the major topics (Additional file 2). The moderator opened each focus group interview with an introduction and a round-robin open question: "What are your experiences with genetics/genomics in primary care?" Further probing by the moderator was rarely required, since each group spontaneously talked about genetics education needs and the role of genetics in primary care. When needed, asking for clarification of the answers was sufficient to elicit ample additional information.
The focus groups were audio recorded and transcribed verbatim. Member checking entailed sending a summary of the sessions to all participants and inviting their comments, which were then incorporated in the transcripts. Using Atlas.ti5.2 for data analysis, two of the researchers (IH and LH) independently coded the themes that emerged from the transcripts. They compared their coding for reliability and reached consensus on differences through discussion. Through a process of discussion and deliberation, connections between the codes were identified and categories and themes developed. The transcripts were read repeatedly to check the accuracy and completeness of the themes and subthemes. In the results section, representative quotes from the focus groups, translated from the Dutch, are presented to illustrate the themes.
All participants acknowledged the importance of genetics education for primary care providers. A need for education was expressed more urgently by the general practitioners than by the midwives, while members of the multidisciplinary group generally indicated that both groups were deficient in genetics knowledge and skills. The extent and focus of the discussions differed between the general practitioners and the midwives, because the general practitioners saw themselves as generalists while perinatal care was the primary focus for the midwives. This difference was reflected in their priorities for education.
Four distinct themes emerged: (1) the need for genetics knowledge, (2) taking a family history, (3) ethical dilemmas and psychosocial effects related to genetics, and (4) insight into the organisation and role of clinical genetics services (Additional file 3).
The need for genetics knowledge
General practitioners perceived deficiencies in their basic understanding of genetics, since they had never been taught this or because their knowledge had faded. They experienced their lack of knowledge as a barrier to the use of genetics in diagnosis, treatment and in consulting clinical geneticists, and they expressed a strong need for this knowledge, as reflected in the words of one general practitioner (male, 37 years):
"I think it's essential to know the basics [of genetics].... You should know what a gene is, that there are deviant genes and that genes can be turned on and off... These are basics that clarify genetics and make it understandable so that it can be translated to patients in relation to diagnosis or treatment or to advise them to refrain from something, smoking, for example."
Other participants acknowledged this need and argued that general practitioners should have more knowledge in order to provide general genetic information. Primary care providers wondered how much they really needed to know about such a complex field. All groups shared the view that primary care providers cannot be expected to know everything. Since many genetic diseases are rarely seen in primary care, there is no urgent need for them to be included in training programmes.
General practitioners appeared to be generally aware of their lack of knowledge, which made them ill equipped to identify genetic problems in their patients. In response to the question about experiences with genetics/genomics, one general practitioner (male, 52 years) said:
"I desperately hope the midwife or obstetrician will think of [prenatal diagnosis for women of advanced maternal age], because I don't always think of bringing it up. Also, I tend to think the specialist will consider all the genetic aspects of a clinical problem, but this often is not the case."
Midwives did not perceive a lack of genetics knowledge and said the midwifery master programme provided sufficient education on this topic. Multidisciplinary group members, however, said that both general practitioners and midwives needed education to increase their knowledge, as they observed a lack of knowledge in both groups.
There was a discrepancy in the content of the required knowledge as perceived by the participants. General practitioners mentioned a need for knowledge about prevention of common genetic diseases, whereas the midwives were primarily interested in prevention of perinatal diseases. To meet these educational needs, general practitioners and multidisciplinary experts believed that genetics education should address family history and inheritance patterns.
Both general practitioners and midwives were interested to know where they could find more genetic information. There appeared to be a general need for easily accessible sources of information such as web-based education or websites with short and easy to understand information that could be applied in daily practice.
Taking a family history
Primary care providers believed that taking a family history was extremely important as it allows for familial risk stratification and identification of hereditary conditions. For midwives the importance of family history was limited to perinatal disease. The need to increase awareness of familial diseases in primary care was discussed by a midwifery educator (female, medical doctor, 56 years):
"We agree on when to think of some familial diseases. I mean, it's clear when speaking of colon carcinoma or breast cancer that you realise [as a general practitioner] that it can be inherited. There should be a clinical guideline to help one decide when to consult a clinical geneticist for further diagnosis. Today, more general practitioners should realise this [colon carcinoma or breast cancer] could be familial."
An educator, allied to a postgraduate general practice programme, thought that taking a family history was well covered during postgraduate training, but the general practitioners were not quite so sure. Although family history was part of some consultations, most general practitioners said that family history and pedigree drawing were not part of their daily routine. The midwives said that family history was something they did every day, but they lacked the skills for pedigree drawing. They thought this was not important, however, because they did not do it often enough to maintain this skill. They thought the main thing was to be able to recognise high-risk factors in a family history
"Midwives generally lack sufficient knowledge to draw a pedigree. I think the same applies for general practitioners, but it is more important for them [general practitioners] to detect high-risk family history criteria. How and when is something important? The signalling function, that is important and it should be taught. Counselling is important for both general practitioners and midwives. But above all it is important to be clear on when something is important, how important it is for you, what you want to do about it, and once this is clear you can take the next step" (a female GP and midwifery educator, 39 years).
General practitioners were uncertain about recording information from family history in the electronic patient record. Participants said that measures should be taken to improve the electronic patient record to include information from family history.
Ethical dilemmas and psychosocial effects related to genetics
Most primary care providers expressed concern about the surge of genetic testing which confronted them with ethical dilemmas and more profound psychosocial effects of genetics in their daily practice. One participant said he was faced with "an increasing amount of vague, worrying and inexplicable genetic information". He referred to information about genetic risks provided to consumers by commercially available Personal Genome Services. Primary care providers felt unqualified to deal with these issues and thought that genetic ethical dilemmas should be part of genetics education.
General practitioners also wondered whether it was beneficial to their patients and themselves to know everything about a patient's genetic background. They voiced concern about the possibility of unauthorised dissemination of genetic information and related privacy issues if it were to become obligatory for them to take a family history and record the information derived from it. They asked: "Who should you inform about genetic information and who should you not inform if you want to keep your patient's best interest at heart, for example when a patient wants to take out life insurance or needs a mortgage to buy a new house?"
Midwives thought that developments in genetics were moving at a very rapid pace, giving rise to feelings of insecurity both in midwives and their patients. They discussed whether following the protocol for perinatal screening might be inappropriate and therefore not uniformly applicable. They preferred to adapt the application of genetic protocols to individual patients, because test results could have important genetic and personal consequences. One midwife, (female, 40 years) explained:
"Surely because this child is already in the uterus, the basic question is rather what do you really want to know? Because what are you going to do with this [genetic] information?"
Clear guidelines as to when a general practitioner should be proactive and bring up the subject of familial disease to patients and their families were non-existent but considered necessary. General practitioners were unclear about how to guide patients in their decisions around prenatal and genetic testing. As a result they perceived non-directive counselling as difficult because it was influenced by their personal opinions and sense of urgency. One general practitioner (male, 52 years) explained:
"I used to discuss prenatal screening with patients at first when it was a hot item. Everybody wanted the triple test, but this seems to change when you explain that it gives a probability that doesn't offer any certainty and things can also happen after the baby is born or you cannot always see things on the outside and people then pull back automatically. I try to counsel nondirectively, because it promotes shared responsibility. I like to hold on to this nice shared responsibility, because it doesn't make me feel that I am solely accountable."
General practitioners and midwives alike mentioned consanguinity as a complex issue to discuss with patients and they raised the problem of how to deal with a potentially increased risk of congenital disease. One general practitioner (female, 52 years) said:
"When cousins get married, they are blissfully happy when presenting this news to their doctor. As a general practitioner I find it complicated, when there is a disease in the family, to confront these people with this problem in today's society."
Inter-cultural differences were considered a source of difficulties in discussing prenatal or preconceptional screening. Midwives sensed urgency early on in pregnancy when recommending this type of screening to members of ethnic minorities in order to prevent congenital disease. This feeling of urgency was sometimes enhanced by language barriers and time constraints.
Insight into the organisation and role of clinical genetics services
General practitioners expressed a need for education with regard to indications for referral to clinical genetics services. Some general practitioners preferred to first gather information from other sources (such as online websites) before turning to a clinical geneticist. Other general practitioners said it was better to refer than to do it all yourself. Midwives, on the other hand, said it was easy for them to consult clinical geneticists, whom they regularly telephoned for advice.
Some general practitioners and midwives said it was not clear to them what clinical geneticists do and what the clinical trajectory would be once a patient was referred to such a service. General practitioners mentioned their lack of familiarity with this type of service as a cause of inappropriate consultation strategies, which could result in untimely referrals. Geneticists argued that general practitioners should consult them more often, and that this should be stimulated by education.
"The relation between primary and secondary care is sometimes difficult. Once the clinical geneticist has diagnosed a certain genetic disease, which means more specialised information, the patient's family members find themselves in a pickle together with the GP and then the whole process (of consulting) starts all over again. [...] I hope education of primary care providers will result in accessible consultation services. Because I don't think the general practitioner should know everything about everything ... but they should at least know that help is easily available." (Clinical geneticist, female, 45 years).
The role of genetics in primary care
The role of genetics in primary care was perceived to be unduly limited as a result of care providers' inadequate genetics knowledge and skills. Although care providers might show some interest in improving their knowledge, representatives of patient advocacy groups indicated that primary care providers were "not sufficiently proactive" in this area. They perceived an urgent need for inclusion of genetics in primary care guidelines in order to make genetics a "hot item". General practitioners and midwives said they were unsure about their responsibilities in relation to genetics, perhaps because they lacked insight into the genetic background of diseases and its possible consequences. A representative of a patient advocacy group (male, 59 years) said:
"No knowledge (of genetics) and no interest (in genetics). It's not a hot item. It seems as if general practitioners are not interested in identifying patients with familial hypercholesterolemia (FH). We have an excellent screening programme for this in the Netherlands, which threatens to go under because too few index patients are put forward by general practitioners. General practitioners do not alert patients that they might have FH when there is a positive family history and high cholesterol levels, and patients are not advised to take part in a brief screening programme [...]. General practitioners often say they don't have the time or they're not interested or they see no benefit."
Primary care providers noticed a change in their experiences with and views of the role of genetics in primary care, which led to an increased need for basic knowledge of genetics and family history taking. General practitioners felt their current knowledge was insufficient to meet these needs. Participants also said they noticed an increase in patients' questions about genetic issues. They perceived a change in the responsibilities of primary care providers that prompted increased attention for genetics. They also saw an urgent need for a description of the responsibilities of different disciplines in relation to genetic issues. A clinical geneticist (female, 40 years) put it as follows:
"When I think of genetics I think of monogenetic disorders, but of course disorders (seen in primary care) are often complex disorders or multigene or gene environment interaction disorders. Of course, clinical genetics cannot deal with all those problems, it's simply impossible. [...] I think it is the task of the general practitioner, but I find this difficult... is it really the task of the general practitioner to deal with such complicated problems?"
Overall, participants were positive about the changed role of genetics in primary care. They said this change emphasised their role as an easily accessible source of information. However, there was also some criticism. General practitioners saw even more work coming their way, which caused some concern. Taking a family history, non-directive counselling, and unfamiliarity with recording information from family history in their electronic patient record were said to take up a great deal of time.
General practitioners indicated that they were aware of rapid developments in genetics and the subsequent lag in its application in primary care. They regarded this as important and pointed to two aspects of this change. Firstly, they said it was urgent for limits to be set in relation to required genetics-related knowledge and responsibilities in primary care. Secondly, education should include the clinical application of genetic developments and ways to communicate genetic information. A midwifery educator (female, medical doctor, 56 years) clarified these aspects:
"Highly educated people develop national genetics guidelines. Even the ethical issues involved in these problems and how to deal with them are prescribed. In primary care you are in close contact with patients and it can be difficult sometimes to apply theory-based guidelines in a way that can be understood by patients, it is difficult to do this appropriately."
Suggestions for strategies for effective genetic education
At the end of each focus group interview, the participants were asked to briefly consider effective strategies for teaching genetics in primary care education (Additional file 4).
The following general considerations emerged: programmes should be relevant to primary care practice, participants in the multidisciplinary group emphasised the importance of assuring the quality of educational strategies and suggested that programmes should range in duration from brief sessions to ten-day programmes. Finally, strategies should be added to existing programmes or could be integrated with other topics, such as cardiovascular risk management or familial breast cancer as examples of common diseases.
The results of this study indicate that Dutch primary care providers need, and would welcome, more extensive education in genetics. Four major themes emerged in relation to the role of genetics in primary care and the related educational needs: lack of basic knowledge, need for education on family history taking and the potential clinical consequences, ethical dilemmas and psychosocial effects related to genetics and insight into the organisation of regional genetics services and the referral system. There was general agreement that increased genetics knowledge and family history taking by primary care providers would require a better understanding of the organisation of genetics services in order to promote more appropriate and timely referrals. In summary, the results point to a need for courses in genetics for master programmes in midwifery and postgraduate programmes in family medicine.
A similar need for genetics education in primary care was also found in other studies. The identified needs are in line with the learning outcomes and core competencies in genetics proposed by genetics experts for non-genetic health care professionals [17, 18]. Since there is little published research on the extent to which the need for genetics education matches the core competencies, we used a qualitative approach to explore the views of the target group. In this way we gained insight into the educational needs of this group with regard to genetics; general practitioners indicated that a paucity of knowledge can lead to poor recognition of and unresponsivess to genetic problems in daily patient care.
The results of this study are in line with some studies and differ from others with regard to the need for increased genetics knowledge among midwives [8, 13] and general practitioners [5, 10, 12, 14, 16, 19, 20]. The midwives in our study seemed more confident of their basic knowledge and did not perceive as strong a need to adapt existing educational programmes as was expressed by midwives in studies by Benjamin et al. and Metcalfe et al. [8, 13]. This difference may be due to differences between master programmes in midwifery or between health care systems.
Our results support the outcomes of the afore mentioned studies regarding deficiency in skills (e.g. taking a family history, referral to appropriate regional genetics services and non-directive counselling) [8, 13]. It may be problematic for primary care providers to take appropriate steps in response to the perceived shift in the importance of genetics in primary care, such as taking enough time to discuss the family history or non-directive counselling. Another step to take would be to improve the electronic patient record in order to achieve accurate documentation of family history information.
Martin and Wilikofsky reported on general practitioners' perceptions of their role in genetic counselling and their unwillingness to accept this role due to time and organisational constraints [21]. Representatives of patient advocacy groups and genetic counsellors in our study emphasised the need to increase acceptance of the importance of genetics and genetic counselling in primary care. The responsibility, on the part of the patient or the doctor, to report data from the family history remains a topic of debate, however, even though the importance is clear and primary care seems well suited to include this role in daily practice routines[22]. Perhaps a joint effort by all stakeholders would be realistic and useful.
General practitioners and other participants in our focus groups recognised the important role of genetics in primary care. This is in contrast to a study conducted by Fetters et al. in 1999 [12], which found general practitioners reluctant to invest in self-education in genetics, because they felt genetic problems were not clinically relevant. Our study suggests that today's primary care providers are aware of a progressive impact of genetics on primary care and therefore increasingly conscious of what they don't know. They recognise the need for attention to genetics in educational programmes. Perhaps this is a reflection of family medicine finally becoming aware that genetics and genomics are an integral part of primary care.
Clinicians were seen to be uncomfortable in applying genetics in their daily practice, which resulted in difficulties in referring adult patients for genetic counselling[7]. Our study showed similar results. Some general practitioners were reluctant to consult a clinical geneticist, whereas midwives seemed to be more comfortable with this. Representatives from patient organisations were also aware of this barrier and urged more genetic education for primary care providers, general practitioners in particular. Taylor et al. also suggested that insurance coverage of genetic consultation can be a problem. There is currently a paucity of published research on the clinical value of genetic evaluation in primary care [23–25]. Genetic counselling could be of greater value and might be integrated in periodical check-ups more often if its results had greater practical applicability.
The educational strategies suggested by general practitioners and midwives in this study appear to be supported by Gaff et al. [26], who concluded that "Program logic, adult learning theory, and evaluation theory together provide a useful and relevant theoretic framework for the development of genetics education programs for health professionals."
The use of focus groups has engaged primary care providers of a potential genetics education programme in the Netherlands. A variation in concepts is possible, because it is unknown how far the themes reach in their contribution and interaction in real practice. The aim of this study was intended to yield results regarding the participants' particular views on knowledge, skills and attitudes in relation to genetics education in primary care. Apart from homogenous groups of general practitioners and midwives, we included participants from a variety of backgrounds to obtain input on broader and future developments in genetics in primary care. However, it remains to be investigated if the results have relevance beyond the Dutch health care system, since the nature of the sample was drawn from this particular health care system.
Together with previously published studies on various aspects of genetics in primary care education, our study offers a broad perspective on genetics education. We believe this information can be used to develop genetics education programmes in the near future. The inclusion of multidisciplinary focus groups which could provide meta views can be considered a strength but also a weakness of this study because of the unequal representation of different fields of expertise in these groups. Another limitation is that purposive sampling can result in self-selection, which can introduce bias. Our study revealed four major themes concerning the role of genetics in primary care. In order to ensure that our picture is complete and usable for educational purposes, and possibly for policy makers as well, consensus has to be sought, for example by means of a Delphi procedure.
The results of this study suggest that postgraduate training in primary care could be enhanced by incorporating additional training in basic clinical genetics. For midwives and general practitioners there should be more emphasis on counselling using strategies that are clinically feasible and on ethical issues relating to genetic conditions. Insight into the organisation of regional genetics services and the referral system should be enhanced to promote interdisciplinary collaboration. There is an urgent need for a clear description of responsibilities and guidelines to enable effective use of developments in genetics in primary care. Especially descriptions of the genetic responsibilities of primary care providers and their specific role in this area will have to be addressed by future research. Useful and effective application of genetics knowledge can only become a reality when genetics education is improved.
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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2296/12/5/prepub
The study is part of the research programme of the Centre for Society and Genomics & Centre for Medical Systems Biology, and is financially supported by the Netherlands Genomics Initiative. We thank all focus group participants for their contribution.
Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
Elisa JF Houwink
, Lidewij Henneman
& Martina C Cornel
Institute for Medical Education, VU University Medical Center, Amsterdam, The Netherlands
Scheltus J van Luijk
School for Public Health and Primary Care, Department of General Practice, Maastricht University, Maastricht, The Netherlands
& Geert Jan Dinant
Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands
Cees van der Vleuten
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Correspondence to Elisa JF Houwink.
All authors made a substantial contribution to the concept and design of the study. IH organised and attended all the focus groups, wrote the summaries for member checking, carried out the analysis together with LH and wrote the first draft of the paper. SJvL was moderator of the focus groups. LH attended the focus groups to take notes and observe. SJvL and LH participated in the design of the study and the development of the focus group scenario. CvdV, GJD and MC were involved in coordination of the study and design.
Electronic supplementary material
Additional file 1: Table 1 Characteristics of the participants in the focus groups. (DOC 50 KB)
Additional file 2: Table 2 Interview guide for the focus group discussions. (DOC 29 KB)
Additional file 3: Table 3 Themes and subthemes identified regarding the genetic educational needs of general practitioners and midwives. (DOC 30 KB)
Additional file 4: Table 4 Suggested strategies, including details, for effective ways to incorporate genetics into primary care education. CME continuing medical education. (DOC 33 KB)
https://doi.org/10.1186/1471-2296-12-5
Primary Care Provider
Familial Hypercholesterolemia


As the World Cup champion United States women's national soccer team brushes the confetti off of its shoulders and polishes its coveted trophy in preparation to parade it across the nation, the San Diego State women's soccer team is polishing its cleats and dusting off its kits for the 2015 campaign.
Coming off a 2014 season in which SDSU finished 15-5-2 and won a third straight Mountain West regular-season and tournament title, the Aztecs are looking to take the next step: a deep run in the NCAA tournament.
The past two seasons have seen the Aztecs eliminated from the NCAA Women's College Cup in just the first round. In 2013, they fell 3-0 to No. 2 UCLA and in 2014, they lost to California 3-2 in extra time.
But a new year and a fresh start are on the horizon.
After spending the summer watching stars like Alex Morgan, Carli Lloyd, and Abby Wambach reach the top of their mountain, SDSU is looking to do the same. Head coach Mike Friesen, who served as a World Cup analyst over the summer at Fox 5 San Diego, spoke about how the mentality of the USWNT has inspired his players.
Fans got to see the first glimpse of the 2015 squad under the lights last Friday when SDSU took the pitch for a friendly against Long Beach State University. The Aztecs won 1-0.
Junior midfielder Victoria Barba netted the lone goal of the match on a penalty kick in the 60th minute. It was her first appearance since suffering a torn labrum in her hip early last season.
Following the match, Barba had a hard time describing her feelings of playing again.
"Honestly, I don't have any words for it because I'm just glad I'm able to play again," Barba said.
The friendly gave Friesen an opportunity to pinpoint the team's strengths, as well as the areas it needs to improve upon.
"We feel really good about where we're at. This is a very, very talented team with a lot of new pieces, especially in the midfield," Friesen said.
The new faces include transfers Hedda Regefalk from Cal State Bakersfield, and Gemma Craine from Monroe College in New York.
Friesen was also excited about two new freshmen: forward Leah Pruitt, who was all over the pitch Friday, and utility player Milan Moses.
The friendly also brought out a few concerns for SDSU heading into the season. Friesen pointed out how the team needs to improve on the defensive side of the ball.
As far as taking the next step in the national tournament, Friesen believes the Aztecs will have to perform well in the early stages of the season.
The Aztecs will face University of Kentucky, Arizona State University and the team that ended their national title dream last season, Cal, all on the road.
Friesen believes that his team will have to win these key non-conference games, as well as games within the conference, in order to propel themselves to the next level.
"We've got a very difficult schedule, a lot of games on the road, but if we can get victories out of some of those games, and do very well in conference, it's going to put us in a position where we can … not have an early game in the NCAA tournament against an extremely difficult opponent," Friesen said.
The Aztecs will kick off their regular season against Utah Valley University at the SDSU Sports Desk on Aug. 21 at 7 p.m.


On the western side of Arusha, at the foot of the magnificent Mount Meru, lies east African luxury which can only be experienced at Legendary Lodge.
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Fountain of Youth: Michael Kelly's Work Will Grant Longer Life to the Upgraded APS Electron Beam
Particle accelerators are complicated machines. They are often enormous – the Advanced Photon Source (APS) at the U.S. Department of Energy's (DOE's) Argonne National Laboratory, for instance, is large enough to fit a major-league baseball stadium inside its circumference – and their job is to set tiny, invisible particles racing up to very nearly the speed of light. They do this using a complex system of magnets and electrical systems, all designed to extraordinary tolerances and operating with mathematical precision.
In short, accelerator systems can be difficult things to understand, but after more than 20 years at Argonne, Michael Kelly is an expert in them. Kelly is a group leader in the Lab Physics Division, and he has extensive experience designing components for accelerators. So when the people behind the upgrade of the APS – a DOE Office of Science User Facility – were looking for someone with just that kind of experience to help them build the state-of-the-art electron storage ring that will be at the heart of the new facility, they knew where to find him.
"My involvement with the APS began in earnest with the APS Upgrade in 2014," Kelly said. "The Upgrade Project managers came to the Physics Division when I was not yet a group leader, and my boss told them I had the relevant experience they were looking for."
Physics may be a precise science, but Kelly's path to his current role wasn't quite as planned out. He obtained his undergraduate degree at the University of Virginia and his degree in nuclear physics from the University of Washington in Seattle, but never intended to work on accelerators.
"When I came to Argonne in 1999 as a postdoctoral researcher, I intended to do nuclear physics," he said. "But there were no open positions, except in accelerator physics. So it was a lot of luck. I have always liked physics and engineering, but the details have been luck."
Kelly spent his years at Argonne building up experience in designing superconducting cavities – essentially very cold electro-magnetic systems that accelerate particles while losing very little energy. The current APS uses a copper-based system operating at room temperature that is less efficient, and the upgrade team needed accelerator physicists to help them design cavities that are more state-of-the-art. In particular, the upgrade team assigned Kelly to work on a single superconducting component that will have a major impact on the operational efficiency of the upgraded APS.
It's called the bunch lengthening system, and Kelly's answer to the question of what it does sounds simple: "It increases the lifetime of the electron beam in the storage ring," he said. But like most physics machines, the full answer is a little more complicated.
Before the electrons reach the storage ring, three other accelerators have sped them up to nearly the speed of light. The storage ring keeps them at that speed for as long as it can, and at each bend in the track, the electrons release radiation in the form of very bright x-ray light. This is the light scientists use for research. But over time, the beam loses electrons due to scattering, and the denser the beam, the more likely the electrons will scatter.
So when scientists talk about the lifetime of an electron beam in a storage ring like the APS, what they mean is how long the beam can circulate in that ring without losing so many electrons that it can no longer produce enough of the high-brightness x-rays needed for research.
The current APS electron beam has a lifetime of about 12 hours, after which the electrons must be topped off with an injection of freshly accelerated ones. The upgraded APS will need this a lot more frequently, due to the higher density of the beam.
"Instead of the 12-hour lifetime we get now, we'll get one that lasts one to two hours," Kelly said. "So the system we have designed will increase the beam lifetime. It won't get back to the current level, but it will extend it by two to four times. It's a disruption to scientists using the APS when we have to inject beam, and to the extent we can avoid that, we want to."
While it's referred to as an electron beam, the electrons actually circulate the ring in smaller bunches. The upgraded APS will also forego top-off replenishment of electrons in favor of a system that swaps out older bunches with freshly accelerated ones. The bunch lengthening system Kelly and his team have designed stretches out the shape of those bunches, which ensures that they will last longer inside the storage ring.
"The beauty of it is that it's one device, a single two-meter-long cryomodule," Kelly said. "It's a unique device, no one has built one exactly like it."
The bunch lengthening system is mostly built, and Kelly and his team are in the process of assembling it. They'll have a couple more chances to test it before it is fitted into in the new storage ring, which will be installed during a year-long shutdown of the APS beginning in April 2023.
Though Kelly has been concentrating on just one part of the upgraded machine, he keeps the big picture in mind. That's easier for him to do, he said, since his wife, Shelly, has been a longtime user of the APS – she conducted research for years as an Argonne research physicist and was recently hired to lead the APS Spectroscopy Group.
"Most of us leading major pieces of the upgrade think a lot about the lasting impression it will make on science and technology, in a wide range of areas," Kelly said. "The equipment often outlasts the people who build it. The upgraded APS is expected to still be running 20 to 30 years from now, and that's satisfying. They don't have to know my name, as long as they're using my work." ― Andre Salles
The Advanced Photon Source is a U.S. DOE Office of Science User Facility operated for the DOE Office of Science by Argonne National Laboratory under Contract No. DE-AC02-06CH11357.
The U.S. Department of Energy's APS is one of the world's most productive x-ray light source facilities. Each year, the APS provides high-brightness x-ray beams to a diverse community of more than 5,000 researchers in materials science, chemistry, condensed matter physics, the life and environmental sciences, and applied research. Researchers using the APS produce over 2,000 publications each year detailing impactful discoveries, and solve more vital biological protein structures than users of any other x-ray light source research facility. APS x-rays are ideally suited for explorations of materials and biological structures; elemental distribution; chemical, magnetic, electronic states; and a wide range of technologically important engineering systems from batteries to fuel injector sprays, all of which are the foundations of our nation's economic, technological, and physical well-being.
Argonne National Laboratory seeks solutions to pressing national problems in science and technology. The nation's first national laboratory, Argonne conducts leading-edge basic and applied scientific research in virtually every scientific discipline. Argonne researchers work closely with researchers from hundreds of companies, universities, and federal, state and municipal agencies to help them solve their specific problems, advance America's scientific leadership and prepare the nation for a better future. With employees from more than 60 nations, Argonne is managed by UChicago Argonne, LLC, for the U.S. DOE Office of Science.
The U.S. Department of Energy's Office of Science is the single largest supporter of basic research in the physical sciences in the United States and is working to address some of the most pressing challenges of our time. For more information, visit the Office of Science website.