In 2018, we celebrated the 40th anniversary of the Alma Ata Declaration and confirmed that primary health care at the community level remains the cornerstone of improved population health. To achieve Goal 3 of the Sustainable Development Goals, countries must invest resources in primary health care to advance universal health coverage.
In Zambia, nurses and nurse-midwives still lead over half of rural facilities and guide primary health care delivery in almost all facilities. Nurses ultimately need to manage their own clinical workloads and lead task shifting, task sharing, and delegation of responsibilities among facility staff, community health workers, and community volunteers. Facility staff typically include clinically trained nurses of various levels and community health assistants (CHAs)1—a cadre of community health workers added to the frontline team between 2010 and 2012 who have been trained by the government and put on payroll. They provide households with health sensitization, health promotion and education, counseling, and some primary care, and are supervised by the clinical staff. Community health workers also include community-based volunteers—village members who have had various levels of training, most often from external projects, have varying levels of capacity, and who provide additional support to households, including HIV peer-to-peer counseling, counseling to pregnant mothers, and escorting pregnant mothers to facilities for delivery. Other community volunteers contribute their support through neighborhood health committees.
Head nurses need the ability to assign clinical tasks to the providers best suited to execute them and assess how best to delegate tasks among frontline team members to optimize existing skills. Facility heads must also integrate CHAs into frontline health teams and maximize the impact of CHAs and other community health workers, through guidance and oversight to the full frontline team and by building bridges with the community. This relationship with the community includes engaging with them to solve health challenges, partnering with them to build awareness of disease prevention and encourage healthy lifestyles, and community members working with the facility to improve service quality, reduce morbidity and mortality, and improve population health. Some facility heads also recruit village leaders to endorse or require healthy behaviors among households and mobilize direct assistance of community members for tasks such as building and furnishing maternity homes.
The capacity of nurses to lead community health effectively will determine the quality and safety of the services delivered and returns realized. Yet nurses heading rural facilities have not received updated scopes of practice that reflect leadership activities or additional training to prepare them for the broader responsibilities that come with heading a rural facility. Further, nurses who are deployed to lead these rural facilities have not been awarded updated titles recognizing the significance of their role or commensurate salary increases.
Zambia is striving to optimize investment dollars to meet community health needs and to ensure that its community systems can sustain health initiatives within national budgets and maintain achievements toward reaching the Sustainable Development Goals. The Ministry of Health (MOH) has leveraged development funding from the United States Agency for International Development (USAID), the UK Department for International Development (DFID), the United Nations Children's Fund (UNICEF), and other donors to integrate CHAs into the MOH staff as part of its effort to improve community health and advance universal health coverage. However, the MOH and its partners have faced difficulties in assimilating CHAs with the rest of the community team. They determined that better supervisory support and management from facility heads and district supervisors was needed to maximize the potential of the CHA investment.
Nurses have reported inadequate practical training in supervisory and management skills in their preservice education.
A blended learning program to build leadership and management competencies of rural facility heads was designed and tested in 2016–2017.
Improve the leadership and management competencies of facility heads.
Increase the ability of facility heads to lead frontline teams toward improving quality of care.
Strengthen the skills and confidence of nurses in using technology.
Equip nurses to better lead frontline teams in advancing universal health coverage, measured through improved service quality and access.
A new feature of this training, in the context of nurses working at the community level in Zambia, is its blended learning design. Short-term workshops alone lack the ongoing practice and guidance required to apply learning in context and sustain gains through changed practice. Self-guided or distance in-service programs, even those with intermittent in-person meetings or workshops, are often short-term and lack the oversight of participating supervisors. Finally, most in-service programs train one group of providers without engaging the broader team of staff and volunteers with whom they may need to work to apply new concepts and practices.
Strengthen supervisory and leadership skills among the supervisors while building leadership skills of the facility heads.
Lay the groundwork for sustainability such that both management and frontline team leadership understand the same objectives and develop the same skills.
Strengthen the relationships between the supervisors and the nurses, which are commonly weak in rural settings.
Broaden the understanding and recognition of the potential leadership value that nurses can provide on the frontline if equipped with the training in those capacities.
Further, this joint participation in the program helps to ensure that training aligns with national policies and district guidelines and requirements, strengthening the oversight and accountability mechanisms of the national community health system.
The bulk of the learning in the 12-month program is spent in the workplace and engages community members, volunteers, and facility staff, including any additional clinical staff at the facility, CHAs, and environmental health technicians in a variety of learning exercises. These exercises are integrated with everyday work practices to ease workloads, improve efficiencies, and bring changes that facility heads, their teams, and their clients can see. The length of the program and its integration into service delivery activities allows time for new practices to become habit and perspectives and attitudes to be internalized. Course instructors for the test intervention came from UNZA and other PHC2C partners. This team led delivery of the course with ongoing input from technical advisors from the MOH, the UNZA School of Medicine, the Zambian Union of Nurses Organization (ZUNO), the General Nursing Council, and the Health Professionals Council of Zambia.
The bulk of learning in the 12-month blended learning program is spent in the workplace.
The first 9 months of the course revolve around a community health improvement project, designed so that nurses and their teams can apply knowledge and skills gained through the learning experience to achieve a goal together that improves delivery of a particular service in their community. The project is identified through consultation by the head nurse with facility staff, volunteers, and community members about which service improvement would mean the most to them. Several nurses reported that this exercise offered a fresh introduction to village leaders (e.g., village chief, council headman, council members), who were important later in supporting the work of the frontline team. Examples of projects included increasing enrollment in antenatal care (ANC), improving the quality of services for facility deliveries, and increasing uptake of testing for HIV and other sexually transmitted infections.
The first 9 months of the course revolve around a community health improvement project.
Facility staff of all cadres, including CHAs, as well as volunteers and community members join the facility heads in the development, implementation, and monitoring of the community health improvement project, with ongoing guidance from the district supervisors. These district managers, in turn, learn to provide more hands-on support and to recognize the potential of the head nurses to help them advance service indicators, community health, data management, and evidence building. The last 3 months of the program are devoted to completing the community health improvement project, evaluating the results, and preparing a final presentation for the course graduation event. The community health improvement project demonstrates the results of the training and the capacity of the facility head to build and sustain a cohesive, effective team to deliver high-quality, accessible care. The project also serves as an accountability mechanism, bringing the community and the MOH together as collectively responsible for the performance of their own health system.
The training structure incorporates peer-to-peer learning components and ongoing communication activities, including a WhatsApp discussion group between nurses and managers.
The program also incorporates UNZA Mobile, a mobile application that supplements workbook reading and cross-cadre activities and reinforces learning through audio and visual tools, research links, and review exercises. UNZA Mobile is based on the OppiaMobile application and allows students to access video, audio, and text-based tools without an active network connection. When students join in-person quarterly workshops, the content for the subsequent quarter is downloaded to their UNZA Mobile app because many of the course participants live in rural areas where access to phone connections is poor. As technology and infrastructure continue to improve in Zambia, students will be able to download this content on their own. The mobile application is designed to engage students instantly and add variety to the learning process, accommodating multiple learning modalities while building self-guided research habits. Further, interaction with the mobile application is intended to raise nurses' level of self-assurance in technology use beyond social texting and voice communication.
Twenty facilities (rural health centers and health posts) across 5 districts in 2 provinces were selected to test the course content and delivery approach for viability of operationalization, appropriateness for uptake, and effectiveness in building leadership and management competencies in nurses, as well as to gauge how the program reinforced community and service delivery processes, health system operational mechanisms, and national and district policies. Twenty nurse facility heads (18 of whom completed the course) and 5 district nurse supervisors participated in the test cohort.
One example is the facility head's application of quality improvement practices at the Chibombo District's Mwanjuni health post. With members of her frontline team (and without direct project support), the facility head developed referral cards that CHAs and volunteers use to track the effectiveness of their counseling of women for early ANC enrollment. The CHAs and volunteers give the cards to pregnant women after visiting their homes and tell the women to bring the cards to the facility when they come for their ANC visit. The cards enable the facility head to track how many women the CHAs are visiting, cross-checking with registry information, and how many women referred are coming to the clinic. The nurse uses the cards to document which houses are being visited and which CHAs and volunteers are most effective in applying what they have learned about advocating for early ANC enrollment. It also demonstrates a low-cost solution that was feasible within the health facility's limited budget.
The community health improvement projects showed that nurses were able to build collaboration among the different cadres in the frontline team to identify gaps, prioritize needs, plan and implement strategies to address needs, and improve the quality of care delivered to the community. Through the projects, the head nurses demonstrated their leadership as they were able to articulate their improvement goals, their SMART (specific, measurable, attainable, realistic, and timely) objectives for attaining those goals, and the indicators they defined to monitor and demonstrate improvement. As part of the presentation, the facility heads were able to explain the specific roles and responsibilities of their frontline team members in contributing to the improvement plan, and how tasks had been shifted and responsibilities shared. Facility heads articulated the leadership and management competencies they had applied through the process and how those competencies contributed to the project achievement.
Nurses were able to build collaboration among the different frontline team cadres to identify gaps, prioritize needs, plan and implement strategies, and improve the quality of care.
Less than half of the participants owned a smartphone when they began the program. By the third in-person meeting, 90% of the participants had traded their feature phones to invest in smartphones. All students learned to download applications, access and organize files, and incorporate the WhatsApp social communications tool into work and learning.
The training participants also gained experience and confidence using computer programs. The community health improvement project required that all students develop a PowerPoint presentation to demonstrate their final results. Some nurses developed these presentations on facility or personal computers; others without access to computers wrote up their presentations and used study time allotted during the workshops to transfer their work into PowerPoint on colleagues' computers. Nurses having trouble with their presentations received help from their supervisor and peers. At the outset of the training, only 2 participants were comfortable using PowerPoint. By the third in-person meeting, only 2 were still unable to use the computer programs and functions on their own. The rest of the students, at varying speeds, were able to maneuver through presentation slides and apply shortcuts to update tables and graphs.
All of the students were comfortable using mobile phones to call and text, but initially only a few used their mobile phones to connect with colleagues for support and consultation. However, the nurses soon began to use the WhatsApp community of practice not only to fulfill their course requirement to discuss weekly questions posed by their district managers and socialize with each other but also as a network of support for their work. On at least 2 occasions, a nurse faced a difficult health care challenge while alone in their facility. Without any other support available, the nurse in distress reached out to the community of practice and found technical guidance and moral support to steer through the necessary steps in responding to the critical health need. One of these times, a woman arrived at a facility in the middle of the night with obstructed labor, and the enrolled nurse was the only health care provider immediately available. The second event occurred when a man was brought to a facility unconscious and there was no evidence as to the cause or the needed response. In both cases the patient was successfully treated due to the network of colleagues that were ready to provide their expertise through the community of practice.
Examples of measurable improvements reported for facilities included increasing testing of HIV-exposed infants at 18 months, increasing ANC coverage before 14 weeks, and increasing the number of fully immunized children under age 1.
Efficiency of service delivery is 1 of 6 domains of quality care, as described by the Institute of Medicine.6 Toward efficiency, nurses reported delegation and shifting of tasks as one of their main learnings in describing the competencies they applied in their community health improvement projects. Over and over again, nurses told how the training had empowered them to work better with the members of the team, inside and outside their facility, to divide the work among everyone and to assign roles and responsibilities. Further, the PHC2C team coordinated with the Clinton Health Access Initiative, which had developed a training for CHA supervisors to better guide CHAs on filling out reports and following the government's CHA policies. As the MOH had invested in both programs, PHC2C worked with the MOH and Clinton Health Access Initiative to incorporate elements of the CHA supervisor training into the CLMP to maximize and sustain the benefits of both trainings.
Nurses reported their appreciation of integrating training on reporting skills and CHA policies with training on how to be more effective supervisors through coaching, mentoring, and teaching. As described by the nurses, their improved ability to shift tasks among the team members and provide quality and safety oversight enabled them, as clinically trained providers, to use their time more wisely, see more clients, and achieve population health targets. Community members and facility staff echoed this improvement as a result of the training and noted their own increased motivation and engagement with a clear role that had meaning in contributing to the health of their community.
Timely services is another Institute of Medicine domain of high-quality care. Clients from Mwanjuni, Momboshi, and Chisamba facilities specifically noted shorter wait times and a more effectively run facility due to delegation of duties by the head nurse to the frontline team.
Accessibility to respectful care and high-quality services is increased by shorter wait times, improved services, and greater confidence of the community in the facility. Confidence of clients demonstrates patient-centered care, which translates not only into the care that the community member receives at the point of service but also in the inclusion and engagement of community members in improving the quality of care. Community-based volunteers and neighborhood health committee members described a clear increase in their own collaboration and the nurses' increased outreach to the community, evidenced by the nurses coming into the community physically and inviting community members to share their thoughts and participate in plans to improve services. Staff described that the head nurse shared coaching and mentoring techniques to use with clients and community members and reported that using these techniques had built more trust and confidence in the community to come to them with problems.
During focus group discussions, community members described changes they had seen in the way that nurses and their staff treated clients. For example, a community volunteer from the Kafue Mission Health Center told how the nurse explained to the volunteers that if they wanted to improve care, they needed to listen to the people they were caring for. The nurse wanted to better understand why women were not coming to enroll in antenatal care when they knew they were pregnant. She went into the community and sat with women to listen to their concerns. What she found was that some women were afraid to register with the clinic because the father was not their husband, and they thought they would be required to name the father. The head nurse then instructed all volunteers to be sure to explain to the community members that when they come to enroll in ANC, they do not have to be married or name the father. They can feel safe.
During the formative assessment, some clients had complained that head nurses and staff shouted at patients, treated them with disrespect, and never listened to their problems. In the post-training retrospective assessment, community members noted specifically that they had seen improvements in the way that the head nurse and the other facility providers communicated with clients.
The CLMP program is designed to be sustainable in several aspects. The job requirements of the district supervisor include the supervision and coaching of facility heads and participation in the program, for which they also earn CPD points. The training allows nurses and nurse-midwives to fulfill their relicensure requirements with the council, and to gain the additional title of head nurse in charge. Environmental health technicians and clinical officers are also motivated to pursue the course as their councils recognize it for their CPD units. The MOH recognizes the need and value of improved leadership and management capacity to strengthen primary care delivery and build stronger community systems.
The planning, design, and implementation of this program may offer an example to other countries and global actors of how investments in community systems can be optimized and global goals can be realized in local contexts, and of the commitment and accountability that is required to foster sustainable return on investments. Key factors for success follow.
The intervention met a country need and responded to priorities defined by health authorities and recognized by relevant actors.
Community engagement is an important part of successful health system designs that respond to community needs and advance health-seeking behaviors. A variety of interventions have been implemented to increase and institutionalize community engagement, including social accountability mechanisms, neighborhood committees, quality assurance, and community development groups. We designed this intervention to reflect community voices and engaged community input throughout the process to ensure responsiveness to community needs and community requests for improvement. The program helps to build skills and expectations in the community on how to interact with health facility staff as part of routine work practices and see themselves as part of the frontline team accountable for service quality and health outcomes. It also builds skills and practices among the nurses for collaborating with community leaders and integrating community contributions within the roles and responsibilities of their teams. Further, key stakeholder participation—namely district and provincial management, professional councils, and unions and associations—bridged the gap between community voices and central government awareness.
Inclusive: Key stakeholders, from the community to the government, were engaged from the initial verification of evidence to the interpretation and application of that evidence to recommendations and decision making.
Evidence-based: Evidence-based strategies ensured that the interventions were designed to fit the need and that indicators monitored reflected the expectations of the communities served and quality standards of the health system.
Contextualized: The intervention was shaped to respond to the national infrastructure, health systems mechanisms, and cultural mores of the environment.
Viable: Tools, mechanisms, and training delivery design were all integrated within systems structures, practices, hierarchies, and resources. Succession of program ownership was factored in from the beginning so that removing external support did not end the program.
Flexible: Internal and external partners collaborating on program development remained flexible in applying previous experience and expectations so that individual or even collective agendas would not obstruct needs to adapt the program throughout its initial testing.
At the end of the test intervention in 2017, the MOH approved scaling up the CLMP program, with financial support, and linked CLMP completion and certification to an elevated title for nurses and nurse-midwives. The MOH has also reorganized the establishment of positions and salaries, although the rural facility "in-charge" position is not yet funded by the Public Service Management Division. As of this writing, ZUNO is negotiating for a salary increase upon CLMP completion and assumption of increased leadership responsibilities.
At the end of the test intervention, the MOH approved scaling up the blended learning program.
Based on the learning from this experience, the MOH has encouraged all local institutions to provide in-service leadership training for nurses and midwives working in rural facilities, and it has approved the CLMP as a national CPD program, required for all nurses posted to lead primary health care services at rural health facilities (centers and posts). Institutionalization is being led through UNZA as part of its CPD offerings for relicensure, to be sustained through student payments and annual district budget funds earmarked for CPD. UNZA is also seeking to reduce implementation costs through support from stakeholders such as ZUNO. In January 2019, UNZA will roll out the CLMP to 3 additional provinces—Eastern, Luapula, and North Western—targeting 25 to 30 rural facilities in each where service quality indicators are low. ZUNO has committed financial support to supplement existing provincial support for students who need assistance to take the training.
In addition, the UNZA School of Nursing Sciences has incorporated elements of the CLMP into its updated preservice curriculum for the Bachelor of Science degree program in public health nursing to strengthen the leadership and management component. An updated curriculum, including a community engagement component and community health improvement project model, is planned for implementation by the 2019 academic year. The School of Nursing Sciences hopes to link the improved preservice curricula more closely to CPD with the support of the MOH.
Throughout the planning, development, and implementation of the program, country leadership guided budget decisions so that all program elements would remain financially viable within the national resource structure. The existing management structure provided mentoring and supervision of the nurses during their work, without additional support from the project. Phones and computers were not provided. To make it easier in the future to provide closer supervision of students, preceptors from referral hospitals have been added to the design. The preceptors, students who are completing their degrees during their in-service clinical practice, will receive credit toward the completion of their course by facilitating the online community of practice discussions, participating in the bi-monthly nurse-supervisor calls, and checking workbook exercises. This additional layer of support will not cost the MOH or students, but it will help to give preceptors broader supervisory experience while gaining course credit, and will provide additional on-the-ground mentoring in between the nurses' monthly check-ins with the district managers.
The program was also designed to complement other implementation projects going on in the catchment areas. For example, we aligned training on documentation and reporting with new guidelines on how reporting should be done with CHAs and the greater participation of neighborhood health committees and incorporated the MOH's CHA supervisor training in our supervision, teaching, coaching, and mentoring module. Another key measurement of success was the program's contribution to helping community actors sustain and advance the improvements made in their own communities. For example, nurses applied their skills to advance the MOH program to expand maternity homes as part of Zambia's plan to increase facility deliveries. In one case, the facility head used her negotiation skills to recruit the village leaders' support in galvanizing contributions from community members to complete the facility's maternity home, which had been delayed due to limited resources. In presenting this work in her community health improvement project, the facility head described how she had employed some of the approaches learned through the CLMP for mobilizing resources and combined that skill with some of the tools learned for community engagement to assume responsibility for her own facility and demonstrate some autonomy and leadership in achieving the goal even without the help of external funds or district intervention.
Although this program aims to develop competencies in one cadre—nurses or nurse-midwives leading low-resource facilities—it is also designed to build the skills and knowledge of actors across the frontline team, including community members. Program developers understood that vertical interventions focusing on a specific disease or system can create imbalances in the system. Therefore, the intervention was designed to be holistic and to strengthen the system's capacity horizontally by strengthening roles for nurses in leadership and management.
The small sample size of the test intervention limits the reliable applicability of the results across larger populations, and the scope and 12-month length of the intervention precluded assessment of longer-term quantitative improvements in services. While some community health improvement projects documented measurable improvements in HIV/AIDS, maternal and child health, or sexual and reproductive health services, these cannot be considered significant until continued or stabilized over an additional 12 months.
Designing a fit-for-purpose workforce, meaning a well-integrated team of health workers that is prepared to respond to the needs of the population it serves, requires that countries remain flexible and responsive in education and training. Building capacity stretches far beyond preservice education and in-service training—it is a continuous journey in which various actors in the health system must learn to work together and supervision and management must support professional growth, development, and advancement. Building these skills and attitudes must start in preservice education, by establishing an understanding among clinical professionals of their roles as leaders and managers.
In its approach to community health, Zambia may provide an example for other countries of the region and beyond. When developing strategies to leverage community health workers and strengthen the community health system, it has considered the entire system and how a fit-for-purpose workforce best brings together communities, volunteers, and health facility staff as a cohesive frontline team. Using existing resources and working within national systems and mechanisms, the Zambian government is committed to institutionalizing a program that will continue to strengthen leadership among community providers, build sustainability and resilience within the community system, and improve services toward achieving Sustainable Development Goal 3. Maximizing potential of community-level leadership will go a long way toward realizing people-centered, accountable community health systems that provide access to high-quality care for all.
The authors gratefully acknowledge the numerous contributions of the PHC2C global and national advisory groups. Global Advisory Group members include Michael Bzdak (Johnson & Johnson), Lesley-Anne Long (formerly of mPowering Frontline Health Workers), Gail Tomblin Murphy (Dalhousie University WHO/PAHO Collaborating Center for Health Workforce Planning and Research), Judith Shamian (International Council of Nurses), Laura Hollod (Johnson & Johnson), Carolyn Moore (formerly of mPowering Frontline Health Workers), and Stembile Mugore (IntraHealth International). Zambian Stakeholder Advisory Group members include Mujajati Aaron (Health Professions Council of Zambia); Dorothy Chanda (University of Zambia); Judith Chipili (General Nursing Council); Kanekwa Chisense and Elias Siamatanga (Ministry of Health); Rita Kalomo and Liseli Sitali (Zambia Union of Nurses Organization); Bertha Kaluba (Midwives Association of Zambia); Caroline Phiri (Ministry of Health, formerly with Ministry of Maternal Health and Community Development); and Emily Measures, Salome Temba, and Nikhil Wilmink (Clinton Health Access Initiative). Paul Ngwakum (UNICEF) provided leadership and guidance throughout the development, delivery, and harmonization of the work with broader partners in community systems strengthening and with the Ministry of Health. Maureen Corbett and Rebecca Kohler of the IntraHealth executive team provided leadership and guidance throughout, and have long engaged collaboratively with partners and colleagues in Zambia and globally. Alice Liu, Alex Kellerstrass, and Alex Little of mPowering Frontline Health Workers provided technical assistance in developing workbooks and the UNZA Mobile app, and adapting materials for online access. Nathan Heidt of Positive 6 designed the workbooks. Charity Kapenda and Dorothy Chanda of the University of Zambia provided technical input into the design, implementation, and assessment of the program and remain long-time advocates for supporting the frontline team (Thunder, Thunder, Thunder!). Claire Viadro (previously of IntraHealth) contributed to the research during the formative assessment. Nadia Leveque (previously of IntraHealth) provided invaluable support in program management and logistics.
Zambia's community health assistants (CHAs) background brief. CHW Central website. http://www.chwcentral.org/sites/default/files/Zambia_Community%20Health%20Worker%20Brief.pdf. Published August 2016. Accessed October 26, 2018.
WHO universal health coverage fact sheet. World Health Organization website. http://www.who.int/mediacentre/factsheets/fs395/en. Published September 2014. Accessed January 31, 2018.


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Engaging Communities Around the First 90: Lessons from the AIDSFree Community of Practice
June 26th, 2017 | Viewpoint
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What comes to mind when you hear the phrase "HIV Testing Day" might not reflect today's reality. Since the first National HIV Testing Day was observed on June 27, 1995, a lot has changed:
HIV testing now is routine. Everyone between the ages of 13 and 64 should be tested for HIV at least once, recommends the Centers for Disease Control and Prevention.
HIV testing now offers options. Three different types of tests are available; they help identify an infection at different stages. The test might use blood, urine, or saliva.
HIV testing now can be fast and anonymous. Home test kits can deliver a preliminary result in less than 30 minutes.
What's still true – now more than ever – is that HIV testing remains the key strategy for slowing the spread of HIV and AIDS. About 13 percent of the people with HIV in the United States do not know they have the virus. Worldwide, that number is 40 percent.
And HIV testing is key to the objectives advanced by the Joint United Nations Programme on HIV/AIDS (UNAIDS):
By 2020, 90% of all people living with HIV will know their HIV status.
By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
"It's in all our interests to get to the first 90," says Repsina Chintalova-Dallas, a technical advisor on JSI's AIDSFree Project. She moderates an online HIV Testing Services Community of Practice that brings together more than 700 professionals from 58 countries. The vast majority of members are from outside the United States.
Four times a week, Chintalova-Dallas posts a carefully chosen scientific article, news item, professional tool, or similar resource. The goal is to inform and spark conversation among members.
The strategy works. A recent posting was an article co-authored by JSI colleagues Michael Chanda, Kalasa Mwanda, Wendy Nicodemus, Rebecca Sikaundi, and Andrew Fullem on using peer educators to introduce HIV self-testing. When community members chimed in with questions and comments, they got responses quickly – and from the original authors.
"There's no doubt in my mind this is a valuable resource," says Chintalova-Dallas.
Two rapidly changing issues in the field right now are how to encourage HIV self-testing and how to organize partner notification. Chintalova-Dallas brought colleagues up to date on these topics this month with a JSI in-service.
Getting out that kind of information is at the heart of the community's mission, says Chintalova-Dallas. "If 10 people come in and you're able to do partner notification with only one, that's better than yesterday," she says.
June 27, 2017, is National HIV Testing Day. For more information, join the AIDSFree HIV Testing Community of Practice.
Written by Elizabeth Connor and Repsina Chintalova-Dallas
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redpajama_set_name: RedPajamaCommonCrawl


Explore the following list of BSN programs in Texas. If you would like to pursue your BSN degree at a Texas nursing school, you may consider this page for you. Search for a BSN program in Texas that suits your qualifications and educational needs.


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Barbados Cops Charged with Raping Jamaican Woman
April 11, 2011	0 Comments
The Jamaica Observer reported that they have been identified as Constable Jonathan Barrow, 32, and a Woman Constable, 25-year-old Melanie Denny.
Barrow is charged with serious indecency while Denny is accused of aiding and abetting Barrow to commit an act of serious indecency on the woman.
Both were charged on Thursday (7th April) evening and appeared in District A Magistrate's Court on the following day. They are expected to reappear in court on 1st September. Both were granted bail in the sum of B$5,000.
The complainant in the matter said Denny let two policemen inside the cell she occupied at the Central Police Station in Bridgetown after she was held with marijuana in her luggage at the Grantley Adams International Airport in late February.
She said Barrow forced her to perform oral sex on him while she claims the other male officer, who has not yet been identified, raped her.
Barrow and Denny were pointed out during separate identification parades last week.
The complainant is currently serving a 15-month sentence.
Meanwhile, the 23-year-old Jamaican woman who was allegedly abused by a female immigration officer has been invited by the Barbados Foreign Affairs Minister to visit Barbados to participate in an identification parade to identify the perpetrator.
(This article was written with content incorporated from a Caribbeannewsnow press release)
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Amphora will be hosting a barrel tasting/futures purchasing experience allowing you to taste right out of the barrel and secure "futures" at a great discount. Small groups will be tasted through a variety of 2016 and 2017 vintages led by Amphora's owner/winemaker. You can look forward to an enjoyable and educational experience surrounded by like-minded wine lovers like yourself.
Please note that this is NOT part of the regional Wine Road "Barrel Tasting" event. Groups of 20 will embark on their tasting adventure at 11:00 am, 1:00 pm or 3:00 pm on March 2, 3, 4, 9, 10 and 11. Please allow 1.5 to 2 hours for this experience. This event is by advance reservation only.
To make a reservation, or for more information, please call us at 707-431-7767 or email us at jim@amphorawines.com.
Next Event Listing The Fig Rig at Sonoma Springs Brewing Co.


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Coronavirus, Courage and the Christian Call
Living in a pandemic can be scary. Imagine how much more frightening it is when you struggle to understand the language and culture, when you can only speculate what the continuous updates and warnings are saying.
That's the world where HOPE Literacy students live. But they are not alone. While new restrictions and recommendations may impact classes for the next few weeks, those teachers and administrators who have walked this far with their foreign friends will lift them up in prayer and support them in any way possible.
Society panics in the face of pandemic. There's no more toilet paper at Walmart and the shelves of sanitizers stand empty. You'd think the world was about to end. But as Christians, we should see things differently. And how we live in these trying times sends a message.
In his time, CS Lewis's society faced a similar panic -- not due to pestilence, but due to fear of nuclear holocaust. He wrote, "If we are all going to be destroyed by an atomic bomb, let that bomb when it comes find us doing sensible and human things — praying, working, teaching, reading, listening to music, bathing the children, playing tennis, chatting to our friends over a pint and a game of darts–not huddled together like frightened sheep and thinking about bombs. They may break our bodies (any microbe can do that) but they need not dominate our minds."
Instead of panicking, we need to re-evaluate where our hope lies. If it is truly in Christ, we will exude the peace that passes understanding and be able to reach out with love for others in the face of a sick and dying world.


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De Blasio opened safe injection sites without state permits
Mayor Bill de Blasio is doing an end-run around state laws to open the Big Apple's two supervised shooting galleries, using needle exchange licenses already possessed by the facilities to allow them to provide supervised injection, The Post has learned.
The maneuvering comes three years after Hizzoner's administration authored a letter to state officials asking for licenses under state law for safe injection — arguing that the licenses for needle exchange were not sufficient.
"There is no existing state legislation or approval mechanism for these facilities, and to our knowledge the City of New York did not promulgate regulations or legislation pertaining to these facilities," said State Health Department spokeswoman Jill Montag.
The city's Health Department eventually confirmed the work-around state laws after days of questions from The Post: "These are existing facilities that are operated by organizations regulated by New York State to provide syringe services," said a spokesman.
The questions arose after City Hall refused for days to detail how they gained approval for the two sites in East Harlem and Washington Heights, or which agency was tasked with regulating the facilities, or who would inspect them to ensure they are safe and sanitary.
Bill de Blasio authorized using needle exchange licenses already possessed by the facilities to allow them to provide supervised injection.
Jason Mendez/Getty Images
Those questions remain unanswered.
It's a dramatic about-face from City Hall's 2018 position.
Then-Deputy Mayor Hermine Palacio sent a letter to former state Health Commissioner Howard Zucker requesting that he authorize up to four sites in the five boroughs as one-year pilots.
"As you know, you are authorized to license research studies that may include the possession of controlled substances, as well as studies to deal with controlled substances," Palacio wrote, before acknowledging the needle licenses wouldn't go far enough.
City Hall refused for days to detail how they gained approval for the two injection sites in East Harlem and Washington Heights.
"Precedent for the exercise of your authority to permit these research pilots can be found in the leadership shown by your predecessor in 1992, when he authorized the operation of needle exchange programs in response to the HIV and hepatitis C epidemics," she added.
De Blasio's decision to use the existing needle exchange licenses also runs counter to the findings of a 2017 study — ordered by the City Council and completed by his administration — that evaluated possible avenues for legalizing such sites.
It determined that the best path forward would be for lawmakers in Albany to pass a law allowing the sites to open — or receiving the blessing of the state Health Department.
The 148-page review also found that de Blasio and his Health Department could potentially legalize the operation by declaring a public health emergency, though it said such a move would be legally tenuous.
A 2017 study found that the best path forward would be for lawmakers in Albany to pass a law allowing the safe injection sites to open.
The mayor did not exercise that option in okaying these sites.
"Coordination with the New York State Deparment of Health would be essential so as not to interfere with State health waivers authorizing [needle exchange programs]," the report warned.
And, it added: "As with local legislative efforts, local administrative actions may draw challenges under state law, depending on state prosecutors' enforcement decisions."
The legal maneuvering comes as the city recorded an astounding 2,000 overdose deaths in 2020 — a record high, fueled by rampant contamination of the Big Apple's illicit drug supply by fentanyl, a ultra-lethal synthetic opioid.
New York City recorded 2,000 overdose deaths in 2020.
It also comes as de Blasio prepares to launch a nascent bid for the Democratic Party's 2022 gubernatorial nomination, challenging Gov. Kathy Hochul.
He touted the clinics in a video filmed just outside of City Hall Park and posted on his political operation's Twitter account on Wednesday.
City Hall did not immediately respond to questions or a request for comment.
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Seeing the Door: Is Good Health Truly Enough???
Note to Seeing the Door series: Wherever you go, possibilities surround you! By opening both your eyes and your heart, a door will always appear.
Have you ever noticed how many different types of doors exist in the world? Nearly each and every door leads to an opportunity. Some doors are physical; other doors are metaphoric. All doors lead to opportunity.
What a great question!!! There were many answers from the simple to the more complex; each one thoughtful and each one unique. The one response that left me in a quandary was, "Does anything else matter if you and your loved ones are healthy?" I love when people challenge me; I love when people make me think.
Well my initial response was that good health is not enough. So many people have good health but are crumbling inside. I have seen 'healthy' people hurt. I have had friends who seemed to have it all choose to leave EVERYTHING behind. One of my favorite people committed suicide. So, if I think that way, good health is not enough.
Upon further reflection I realized that in Judaism, we often pray for the healing of body and the healing of soul. So now I am much less conflicted. There are a lot of ways to look at being healthy. Different doorways lead to better understanding; I am really glad I took a few minutes to ruminate on what being healthy means.
May we all be blessed with a healthy spirit and a healthy body.
Seeing the Door: I Can't Believe What I Forgot?
Usually I am so thoughtful. A day doesn't go by when I don't think about where I came from and about the life I lived with my family. I remember the physical environment, the smells, the gifts (believe it or not), and the challenges. I remember the music, the stories, and the tears. Lots of darkness transpired in my childhood, but my father always brought music and stories into my life. Until the day my father died just over 12 years ago, he filled my life with stories and music.
For those of you that know me well, you know that my childhood was scary in nearly every way, but there were moments when a story or music transformed my darkness into light. My father loved both and transferred that love to me. For that I am blessed. After all these years, I am glad that I can find blessings somewhere in all the muck.
At this point, some of you might be wondering why am I bringing this up tonight. Well, it is simply because over the last couple of days, I kept thinking I am missing my dad's yahrzeit, the anniversary of his death. Well today I finally did a double-checked and I realized that his yahrzeit was Thursday night and Friday. Funny, I am a little stunned at the realization. I could make any number of excuses, but perhaps the simple truth is that in this moment, I don't care. Perplexing is the only word that comes to mind.
After a lifetime of letting the memories of my childhood affect me and sometimes torment me for a period of every day, I have now moved forward. While I remember, the memories no longer absorb my daily thoughts. Wow. . . now that is a gift!
So, now that I remember, should I light the yahrzeit candle in memory of my father or should I just let go? While I am not certain what I will decide, I feel some sense of peace knowing that a part of me has truly let go of the intense darkness.
For those of you that know my love of storytelling and music, take a moment and say thank you to Morry Bloomberg. I am so grateful for the gifts he bestowed upon me by example. Just by example, my father opened many doorways within my life. My stories, like his stories have allowed me to interact with people wherever I go; there is no such thing as a stranger.
May Morry's memory be a blessing for good.
Good-bye Abba – I am so sorry I forgot your yahrzeit.
Next Day's Addendum: Tonight I will take a moment and light not a traditional yahrzeit (memorial) candle for my father, but a candle I made . . . . It feels like the right thing to do. A special thanks to those of you that took the time to share your thoughts.
Words can heal; words can hurt. Each of us have experienced the power that can come with words.
Healing with words can be life changing. Healing happens when you sit across from someone who is hurting and you have an open and loving conversation. Listening is a key to moving forward as is really speaking from your heart and saying what needs to be said.
Living honestly and walking gently have an awesome power. As human beings, living in a place of warmth, kindness, and truth creates relationships that fuel our soul. Personally, I try to spread sunshine with words; it really isn't difficult. It just means thinking before you speak and being conscious of the power of both your words and your mood. If you really take the time to think before you speak, positive interactions will happen. No question.
The beauty of my dog Maddie is that always loves with good intentions and never speaks ill of anyone; we could all learn from her.
Over the past months, I have seen the power of words time and time again. What I have learned is intention is a powerful tool. When you share your thoughts about people you know and people you don't know, the words have the capacity to damage others. When you do it with the intention of destruction, that is called lashon hara, otherwise known as the evil tongue or gossip. Chofetz Chaim (a.k.a. Rabbi Yisrael Meir Kagan) describes lashon hara as the potential to be both truth or lies. Words can hurt; words can destroy; it almost doesn't matter if they are truth or not. As time has passed, I am watching lashon hara destroy people and hurt those around them.
The cycle of destruction is demoralizing to everyone that is part of the chain. Those people that speak it, those folks that hear it and those individuals that the gossip is about. Lashon HaRa has the capability of literally bringing down each and every one of those that are part of the chain. Sad and true.
Over the years, I've found myself contemplating how to handle truth that needs to be spoken for whatever reason. What I have come up with is that the key to walking gently is to monitor your intentions. Are your sharing because change needs to occur or are you sharing in order to be hurtful. I often say what is on my mind, but my intentions are rarely to destroy, to hurt, or to create problems. My intention is normally how can we move forward. I really try to walk gently and spread sunshine. And I am not perfect; I can still be better.
Lately I and many that I care for have become the object of manipulative conversations and slander; I am struggling with this reality. Why was the Second Temple destroyed? Because of sinat chinam, senseless hatred of one Jew for another. We haven't changed as much as I would have hoped since the time of the Second Temple. We are still in the midst of baseless hatred. Instead of being reflective and looking at someone's intentions, we tend to slander them and their beliefs or we spread lies and exaggerations. Often there is truth in what is being said, but if you don't look at the complete picture, you begin single handedly hurting communities and people you once valued. We are all human beings.
As we move towards the High Holy Days and as we reflect on how we hold ourselves as human beings, may we remember to walk gently, trust the silence a little more, and let go of anger a bit more quickly. May we remember that most of us have good intentions and do the best we can with the tools we have. Learn to give the benefit of the doubt and believe that most folks have a kindness about them.
What have I learned about how I hold myself as I watch others? I have learned that there is power in silence; I have learned that words complicate truth; and I have learned that I have my own work to do. Each experience I have with others leads to seeing new doors.
May we all learn to be more silent and believe in the good intentions of the people that exist in our lives.
Photo courtesy of Ann Cameron Siegal!
Like the bears above, I love ice cream. Pure and simple. I don't allow myself to eat it often, but I do love it!!! So when I had a craving last night, I decided to share it with my friends on Facebook! So often I am both intense and reflective on Facebook, but last night I just had fun sharing my ice cream journey with others. And people responded.
In a little more than 6 months, one of the holiest days of the year will arrive. The day encompasses intense joy for those that celebrate; the sweetness permeates even the most bitter of moods. And no, I am not talking about Yom Kippur, or Xmas, or Ramadan – the day is International Ice Cream for Breakfast Day. On Saturday, February 1, 2014, those that find ice cream to be an ultimately holy experience, will join together and have ice cream for breakfast; some will even partake in eating ice cream all day!
As for me, I will plan a celebration with lots of ice cream and fair-trade chocolate treats; many flavors and toppings will add to the delight!!!. We will also serve the alternative options for the vegan and allergy sensitive folks among us; did you know that coconut milk ice cream is amazing! We will dance, play music, sing, tell stories, and eat ice cream and then eat more ice cream. For those in need of real food, we will have some of that too. The key is that my family will take time to open our door and flood it with good food, fun company, and a warm environment.
So last night, as I lamented to my Facebook friends and community that I wanted ice cream and I didn't want to leave the house to get it; an idea was formed. The time has come for me to finally have an International Ice Cream for Breakfast Open House.
So, who's coming and what instruments, songs, and ice cream will you bring to share? Time to start planning for some holiness!!!
Our door is always open! C'mon on over! February 1st really isn't so far away!
Know your non-negotiables and honor them.
Over the years I have learned to walk alone. I am not a loner, but I do value following the quiet voice that guides me without the interference of others 'enlightening my sorry soul'. In truth, most of the people I have crossed paths with really do enlighten me and help me gain a better understanding of whatever issue embodies my mind at any given minute. Just the same, I have come to appreciate the learning I do from others while synthesizing the information silently. Ultimately, I have to think for myself and come to my own conclusions.
So much more. . . .
In short, our guts tend to tell us what is right and what isn't as right. When we allow the quiet (and sometimes) loud voice inside of us to guide our actions, we live with integrity. If something doesn't feel 'right' to us, it probably isn't. Listen to that voice as you walk in the world. Over the past few years, I have learned to honor myself by not doing what doesn't feel right. If for some reason, I can't 'get out of something" I am in the middle of, I will as soon as I can.
When injustice surrounds you, it becomes part of you. When you eat food or where clothing that was created by the modern day slave labor chain, you are perpetuating the crime to humanity. The environment matters; living as it doesn't destroys our world. Children are quite literally our future; it doesn't serve us to silently standing allowing things to happen without actively trying to make a difference for good.
Over the years I have found that silence is my friend. I don't like bringing attention to myself all the times, but it is what I do. While it can be difficult to go against 'the norm', it is also an amazing feeling to be able to share the information I have while sometimes inspiring people to learn on their own. Only through gaining knowledge, following up with action, and ultimately sharing what you know/do is it possible to open the door that leads to a little (or a lot) of tikkun olam (repairing the world).
By listening to the quiet voice and living by the values I hold dearly, I am honoring myself. Quite honestly, if I don't live according to my values then I have no way of thriving as a human being. While I accept that sometimes I have to do things I would prefer not to do, I still won't cross the line for big ideological challenges.
May we honor our non-negotiables as we listen to the voice that guides us (especially if that voice is for good).
Most of us have had a broken heart, an intense loss that cripples our soul. Sometimes we heal and sometimes we just move forward; we really don't have a choice.
My heart, for one, has been shattered more times than I'd like to remember. I have lost lovers and friends, family members and loved ones. I have suffered incredible pain at the hands of people that should have loved me differently. And other losses happened because love evolved or death occurred. With each broken heart, I have found a way to mend even though the memories run deep.
With each broken heart, I find a way to ride the waves and emerge a little stronger even if the pain stays with me. Moving through the losses is a non-negotiable. Only when tomorrows stop coming will I stop moving forward. Moving forward is the gift I give myself.
Tonight, as I spoke to my nearly 20 year old, I told him that I felt horrible for a friend of mine going through a broken heart. Without missing a beat, he asked if my friend would need heart surgery. With laughter rippling through me and tears streaming down my face, I couldn't stop laughing at how literal my precious son responded to my friend's broken heart. Wouldn't it be amazing, if all of our broken hearts could mend so easily. Reality doesn't work that way.
The good news is that broken hearts lead to new realizations, infinite possibilities, sweet opportunities. Life continues even after intense loss. If you open your eyes, new horizons will light the morning and evening skies; it might take awhile, but it will happen. One day you will step through the doorway and you will see the light. While the light might be muted, it will still have the ability to usher you into a new horizon.
May each and every one of us find the sparks to move us through the doorways and towards the light.
With the Rosh Chodesh Av (the first day of Av, the new Jewish month) beginning tonight, I have been processing how I can find meaning as we journey towards Tisha B'Av, the 9th of Av? On Tisha B'Av, we mourn the destruction of the both the First and Second Temples as well as many other horrible atrocities that were done to the Jews on this date. Historically, this day is the saddest day in all of the Jewish calendar; on the 9th of Av, we remember, we mourn, and for some of us, we look for ways to make sense of this time.
How can you create an opening or doorway that will allow for new insight when darkness prevails? For me, that means being reflective and finding lessons from the shattered remnants.
While many outdoor spaces offer me the most potent of spiritual places I have ever been, the most spiritual sanctuary and community has easily been Adat Shalom Reconstructionist Congregation in Bethesda, Maryland. There I found peace, spirituality, and community; it was and still is quite beautiful. So when I consider what a Temple could be to in modern terms, I return to Adat Shalom. That doesn't take away what the First and Second Temples mean to the Jewish people, but it does help me find meaning in what the Temples could have meant to those that treasured them and all they stood for. Adat Shalom's beauty quite literally takes my breathe away.
Over the coming days, I will be openly reflecting on what we can learn from the Destruction of the Temples. One way that I gain a little empathy for a time that is somewhat beyond my comprehension is that I want to explore how my body is like a Temple both physically and metaphorically. As sacred beings, we create sacred Temples/sacred spaces by how we choose to walk in the world. Here is a working list of different ways each of us might be like a Temple.
Spirituality doesn't happen without a practice.
In order to grow, I need to take care of myself, my community, and the world.
Nourishing my body with good ingredients will ultimately lead me to be the best I can be.
Surrounding myself with positive energy will create a healthy environment.
Choosing to live with integrity is a way of honoring my essence.
Sometimes what appears to be lifeless, stagnant, or even dead, is actually within a time of rebirth, re-visioning and ultimate growth.
Gaining insight often comes from trusting that the silence will us to the answers.
Taking care of yourself physically leads people to appreciate and take note of your beauty. Similar to the concept of Hiddur Mitzvah.
Taking care of myself leads me and those that work with me to be part of the holy work.nd with this list comes a responsibility to take care of our bodies so we can do the holy work.
All that we do for our bodies makes a difference and ultimately leads to a better makom, a sacred space. And yet it is important to remember that nothing is permanent; impermanence is a reality for all even that which is remembered in our collective memory. While both a sacred being and a sacred place create an imprint and potential impact the world in which they exist, it doesn't mean that it has a permanent place within that existence. Yet each still has the possibility of being impact-ful during and exceeding their time. How each walks in the world matters.
May the sacred beauty we develop within and around ourselves be parallel to how we see the Temple or any of the sacred places in our lives.
Coming soon: Part 2 if 'How is My Body like a Temple?' will explore how can gain insight through Jewish Texts and prayers.


Utilize a timer. If you have problem with focusing on tasks, set a timer for the amount of time that you need for your task. For example, if you're trying to work for two hours, you should set your timer for every thirty minutes. This way you're able to take a break and continue on until the task is done.
TIP! Take the time to properly plan for the upcoming day. Plan as far in advance as you can and work a day or two in advance.
Are you overwhelmed quite a bit? Do you worry that there simply are not enough hours to get all your work done? Are you amazed at other people being able to get so much done in a day? If this sounds like you, perhaps you need to learn better time management skills. Continue on for helpful time management techniques that anyone can use.
A good way to effectively manage your time is through the use of calendars. Lots of folks still like paper calendars on which they can scribble. Other people like using a calendar that's electronic because they can be accessed through their phone or computer. Make sure to have a calendar on hand at all times though.
TIP! Start your day by going over your schedule and filling in any blanks. If you begin your day with the knowledge of what lies ahead, you will be more likely to accomplish your goal.
Calendars are definitely your friend if you want to manage your time wisely! For many people, good old paper calendars are ideal because they can make notes on them. Some people prefer the calendar on their computer or telephone. Make sure to have a calendar on hand at all times though.
Every morning after waking up, take time for planning the day. Make a note of what you plan to accomplish, and allot a time for each task. A day-by-day schedule is very important when planning your time.
TIP! Close the door to your office to work efficiently. An open door tells others to come right in and interrupt you.
If you habitually run late, take special note of deadlines and appointment times. Lack of awareness can have a cascading effect on your schedule. However, staying on track can make a world of difference, causing you to get things done in a responsible way.
Unless you cannot avoid it, refrain from taking a call, responding to a text message or sending an instant message while you are engaged in another task. Every time you are interrupted, it gets harder to refocus on the subject at hand. Get back to the people that want your attention when you complete the task.
TIP! Know that you really can't do everything. It is very difficult to accomplish this.
Begin every day by taking a look at your schedule, making sure it is well organized. If you get a clear picture of what has to happen in any given day, you are much more likely to get everything done. Make sure that you do not overwhelm yourself though.
Be sure to get the hardest tasks out of the way first thing. The tasks that take longer should be done as early as possible. This will release lots of pressure as you continue on to simpler tasks. The remainder of the day will feel very easy.
TIP! Sign up for a time management class offered locally. Your instructor will provide you with some fantastic tips that will help you to make the most of your time.
When scheduling your day, be sure to add in any interruptions. If you schedule your appointments back-to-back and not allow for any unexpected interruptions, your whole schedule may be thrown off. Proper planning will help you to stay focused.
To manage time well, try to determine the effort level required for all of your tasks. Don't waste time trying to do a perfect job on an unimportant task. Devote just enough effort to doing each task on the schedule to reach those immediate goals so you can move to the next item. Keep your hardest work for the important jobs.
TIP! If your space is a mess, organizing it is a smart first step to time management. If you look for things 15 minutes a day, that's almost two hours each week.
Each task you focus on should be the center of your attention. Multitasking is a tough assignment for many people. It can really causes a lot of inaccuracies. Juggling tasks and working quickly often just leaves you stressed out and the work quality end up sub-par. Take your time and get each thing done one by one.
Mentally prepare yourself to really accomplish the tasks ahead of you. Sometimes it can be hard to get started and stay motivated, but practice makes perfect! Set a time for focusing and stick to it.
TIP! Save money, gas and time by doing several errands at once. If you are going to the store, go to the post office too.
Having proper time management gives you more freedom to get all the important things done each day. Read through the tips here to learn how great life is when you have more free time. Practice proper time management, and enjoy a better life.
Take time to consider your life and what you want to achieve during it. Carve out time for those things you deem most important. Cut out tasks that aren't absolutely necessary and then concentrate on the essential ones. Set time for the things you like and you will be a happier person.


text:
import cv2
from PIL import Image, ImageTk
import numpy
from Queue import Queue, Empty
import time
import Tkinter as tk

from Threads import VideoThread
from TelemetryWidget import TelemetryWidget
from ControlWidget import ControlWidget
from img_proc.misc import *
from img_proc.GlobalSurveyor import *
import tkMessageBox

import logging
logger = logging.getLogger('mars_logging')

LEFT_CAM  =  '../gui/left.sdp'
RIGHT_CAM =  '../gui/right.sdp'
CENTER_CAM = '../gui/center.sdp'

CAMERAS = [LEFT_CAM, CENTER_CAM, RIGHT_CAM]

class MainApplication(tk.Frame):
    '''
    Main application handle, contains the frame that contains all other widgets
    '''
    def __init__(self, parent, client_queue_cmd, client_queue_log, client_queue_telem, client_queue_beam, destroy_event, server_ip):
        tk.Frame.__init__(self, parent)
        self.parent = parent
        #this is now depricated, we no longer need the ip, but we may in the future so i'm leaving it here
        self.server_ip = server_ip
        self.client_queue_cmd = client_queue_cmd
        self.client_queue_log = client_queue_log
        self.client_queue_telem = client_queue_telem
        self.client_queue_beam = client_queue_beam

        #fod detection
        self.surveyors = [None, None, None]
        self.call_surveyor = False
        self.fod_enabled = False

        #we found 720/640 to give the most aesthetic view
        self.imageHeight = 720
        self.imageWidth = 640

        self.destroy_event = destroy_event

        #Left Camera, Center Camera, Right Camera
        self.streams = [None, None, None]
        self.displayed_image = numpy.zeros((self.imageHeight,self.imageWidth,3))

        self.init_ui()

        self.runStreams = False

    def image_resize(self, event):
        '''
        Handles the 'OnResize' for the ImageTk window
        '''
        if abs(event.width - self.imageWidth) > 2 or abs(event.height - self.imageHeight) > 2:
            self.imageHeight = event.height
            self.imageWidth = event.width

            self.displayed_image = numpy.zeros((self.imageHeight,self.imageWidth,3))

    def init_ui(self):
        """ Initialize visual elements of widget. """

        logger.info('Appending photo image widget to main app')
        # Image display label
        self.initial_im = tk.PhotoImage()
        self.image_label = tk.Label(self, image=self.initial_im)
        self.image_label.grid(row=0, column=0, rowspan = 2, sticky = 'nsew')
        self.image_label.bind('<Configure>', self.image_resize)

        logger.info('Launching telemetry widget')
        # telemetry display widget
        self.telemetry_w = TelemetryWidget(self)
        self.telemetry_w.grid(row=0, column=1, sticky='nsew')

        logger.info('Launching Control Widget')
        # control and logging widget
        self.command_w = ControlWidget(self, self.client_queue_cmd, self.client_queue_log)
        self.command_w.grid(row=1, column=1, sticky='nsew')

        logger.info('Finalizing frame...')
        # radiobuttons for choosing which stream is in focus
        self.stream_active = tk.IntVar()
        self.focus_center()
        #self.pump = tk.IntVar()
        #tk.Checkbutton(frame, text='Pumpkin', variable=self.pump).grid(row=0, column=4)
        self.grid(row = 0, column=0, sticky="nsew")
        logger.info('Client GUI Initialized')
        self.parent.grid_columnconfigure(0, weight=1)
        self.parent.grid_rowconfigure(0, weight=1)
        for i in range(0,2):
            self.grid_columnconfigure(i, weight=1)
            self.grid_rowconfigure(i, weight=1)

    def define_ideal_images(self):
        self.call_surveyor = True

    def toggle_fod(self):
        self.fod_enabled = not self.fod_enabled

    def get_ideal_images(self, left, center, right):
        logger.warning('Piping ideal images to modules...')
        self.pause_acquisition()
        self.call_surveyor = False
        values = []
        get_thresholds_widget(self.parent, values)
        tkMessageBox.showinfo('Ideal Image Set', 'For each Image do the following:\n\n1) Left click to select a point, continue to left click until you form a simple polygon, these polygons will be highlighted when a fod enters them\n\n2) Repeat this process until the window disappears')
        self.surveyors[0] = GlobalSurveyor(self.parent, left, values[2], (values[0], values[1]))
        self.surveyors[1] = GlobalSurveyor(self.parent, center, values[2], (values[0], values[1]))
        self.surveyors[2] = GlobalSurveyor(self.parent, right, values[2], (values[0], values[1]))
        self.start_acquisition()

    def focus_left(self):
        self.stream_active.set(0)
    def focus_center(self):
        self.stream_active.set(1)
    def focus_right(self):
        self.stream_active.set(2)

    def get_stream_order(self):
        if self.stream_active.get() == 0:
            return (1, 0, 2)
        elif self.stream_active.get() == 1:
            return (0, 1, 2)
        elif self.stream_active.get() == 2:
            return (0, 2, 1)

    def addText(self, big_frame):
        """ Change text on boxes to their designated names """
        font = cv2.FONT_HERSHEY_SIMPLEX
        center = (10, (self.imageHeight - 10))
        topright = ((self.imageWidth / 2) + 10, (self.imageHeight / 3) - 10)
        topleft = (10, (self.imageHeight / 3 - 10))

        def setText(l_text, c_text, r_text):
            cv2.putText(big_frame, l_text, topleft, font, 0.5, (255,0,0), 1)
            cv2.putText(big_frame, c_text, center, font, 0.5, (255,0,0), 1)
            cv2.putText(big_frame, r_text, topright, font, 0.5, (255,0,0), 1)

        if self.stream_active.get() == 0:  # left focus
            setText('Center', 'Left', 'Right')
        #default
        elif self.stream_active.get() == 1:  # center focus
            setText('Left', 'Center', 'Right')
        elif self.stream_active.get() == 2:  # right focus
            setText('Left', 'Right', 'Center')

        return big_frame

    def apply_misc_img_proc(self, image, flip):
        corrected = color_correct(image)
        if flip == True:
            return mirror_vertical(corrected)
        return corrected

    def grab_frames(self, order, blocking):
        if order is None:
            order = [0, 1, 2]

        # Note, we don't do a simple check to see if it's empty because of the non-gaurenteeness of python empty function
        # Our flip flag is order[0] == 1 because if the order is 1 then we are the center image, this is the only
        # camera that is not upside down

        # additionally, we explicitely (without a for loop) do this because of the verboseness, it's better to be overly verbose than a clever programmer
        try:
            l_frame = self.apply_misc_img_proc(self.streams[order[0]]._queue.get(blocking), order[0] != 1)
        except Empty:
            l_frame = None
        try:
            c_frame = self.apply_misc_img_proc(self.streams[order[1]]._queue.get(blocking), order[1] != 1)
        except Empty:
            c_frame = None
        try:
            r_frame = self.apply_misc_img_proc(self.streams[order[2]]._queue.get(blocking), order[2] != 1)
        except Empty:
            r_frame = None

        return (l_frame, c_frame, r_frame)

    def pause_acquisition(self):
        for stream in self.streams:
            stream.disable_display()

    def start_acquisition(self):
        for stream in self.streams:
            stream.enable_display()

    def display_streams(self, delay=0):
        '''
        Where the Image window gets updated.

        Check to see if we're obtaining data
        attempt to grab a non-blocking frame from each camera
        On success, color correct, and pipe into it's designated portion of the image.

        We then have to do some slight manipulation with a matrix to get it to fit
        properly. Then we slam it on the ImageTk window.
        '''
        try:
            if self.destroy_event.isSet() == True:
                self.runStreams = False
                self.parent.displayMarsDisconnected()
                return

            if self.runStreams == False:
                return

            if self.call_surveyor == True:
                logger.warning('Setting Ideal Images...')
                left, center, right = self.grab_frames(None, True)
                self.get_ideal_images(left, center, right)

            frameOrder = self.get_stream_order()

            l_frame, c_frame, r_frame = self.grab_frames(frameOrder, False)

            if self.fod_enabled and self.surveyors[0] is not None:
                l_frame = self.surveyors[frameOrder[0]].run_basic_fod(l_frame)
                c_frame = self.surveyors[frameOrder[1]].run_basic_fod(c_frame)
                r_frame = self.surveyors[frameOrder[2]].run_basic_fod(r_frame)

            thirdHeight = int(self.imageHeight / 3)
            halfWidth = int(self.imageWidth / 2)

            #put images in their correct spot
            if l_frame is not None:
                l_frame = cv2.resize(l_frame, (halfWidth, thirdHeight))
                self.displayed_image[:thirdHeight,:halfWidth,:] = l_frame
            if c_frame is not None:
                c_frame = cv2.resize(c_frame, (self.imageWidth, self.imageHeight - thirdHeight))
                self.displayed_image[thirdHeight:, :,:] = c_frame
            if r_frame is not None:
                r_frame = cv2.resize(r_frame, (self.imageWidth - halfWidth, thirdHeight))
                self.displayed_image[:thirdHeight,halfWidth:self.imageWidth,:] = r_frame

            big_frame = numpy.asarray(self.displayed_image, dtype=numpy.uint8)

            self.addText(big_frame)

            imageFromArray = Image.fromarray(big_frame)
            try:
                tkImage = ImageTk.PhotoImage(image=imageFromArray)
                self.image_label.configure(image=tkImage)

                self.image_label._image_cache = tkImage  # avoid garbage collection

                self.update()
            except RuntimeError:
                logger.warning('Unable to update image frame. Assuming application has been killed unexpectidly.')
                return
            self.after(delay, self.display_streams, delay)
        except KeyboardInterrupt:
            self.close_()

    def start_streams(self):
        '''
        1) If streams are open, close them
        2) Attempt connection to each RTP stream
        '''
        if self.runStreams:
            logger.info('Streams were already open on GUI, releasing and restarting capture')
            self.runStreams = False
            for s in self.streams:
                if s is not None and s._vidcap is not None and s._vidcap.isOpened():
                    s.stop()
                    s.join()
                    s = None
            self.runStreams = True
            self.displayed_image = numpy.zeros((self.imageHeight,self.imageWidth,3))

        for camera in range(0, len(CAMERAS)):
            #logger.info('Attempting to connect to ' + camera + ' on port ' + str(CAMERA_PORT_MAP[camera]))
            captureCv = VideoThread(CAMERAS[camera], CAMERAS[camera], Queue())
            self.streams[camera] = captureCv

        for s in self.streams:
            s.start()

        self.runStreams = True

        self.after(100, self.display_streams)

    def close_(self):
        logger.info('GUI: Stopping all video streams...')
        self.runStreams = False
        #stop the threads
        for stream in self.streams:
            stream.stop()
            if stream.is_alive():
                stream.join()
        logger.info('GUI destroying widgets...')
        #throw widgets in garbage
        self.telemetry_w.destroy()
        self.command_w.quit_()

        logger.info('GUI Destorying main application box...')
        self.destroy()

if __name__ == '__main__':
    root = tk.Tk()   # get root window
    server_ip = 'hyperlooptk1.student.rit.edu'
    in_queue = Queue()
    out_queue = Queue()
    online_queue = Queue()

    # define mainapp instance
    m = MainApplication(root, in_queue, out_queue, online_queue, server_ip)

    # run forever
    root.mainloop()

redpajama_set_name: RedPajamaGithub


text:
Understanding the Tax Deferral Program's Risks and Rewards
If you're still wondering whether or not to defer your employees' Social Security taxes for this fall, you may want to review Connell Foley's latest blog post. Attorney Marianne C. Tolomeo examines the guidance issued by the IRS and the issues employers should consider when deciding.
Connell Foley is NJBIA's Employment Law Resources provider.
The program, created by presidential executive order, allows employers to skip withholding and payment of the Social Security portion of employees' payroll tax from Sept. 1 to Dec. 31, 2020, provided the pay for any two-week period is less than $4,000.
The deferred taxes must be paid back starting the first of the year, from Jan. 1 to April 30, 2021.
"In other words, employees will be subject to double withholdings of Social Security taxes from January to April 2021," Tolomeo writes. "Thus, the sole benefit to employees appears to be the time value of money, that is, having the money in their pockets now and paying the taxes later."
She notes that President Donald Trump would like to excuse this liability altogether, but that would require an act of Congress. That's significant because the IRS guidance makes clear that responsibility to collect and pay the deferred taxes lies with the employer.
"For employees who remain actively employed during early 2021, this should not pose significant problems," Tolomeo says. "If, however, an employee no longer works for the employer in early 2021 (due to voluntary separation, termination, furlough, a leave of absence, etc.), the employer is likely to have difficulty collecting the deferred taxes since there are no wages from which to withhold."


Turbidity meters measure the loss in light beam intensity as it passes through, of a fluid containing suspended particles. Supplying the calculated loss directly related to light particles scattering and absorbing, the tools come in desktop or portable styles. Boasting advanced features, the devices offer a high degree of ease while employed as well as reproducible results. The turbidity meters transport the collected data to other systems for further review.
Description: Ratiometric design in innovative, waterproof, handheld meters.


text:
Exclusive: Airbus puts six jets made for AirAsia up for sale as crisis deepens
By Tim Hepher
PARIS (Reuters) - Airbus AIR.PA has put six jets made for one of its largest customers up for sale after giving up on Malaysia's AirAsia AIRA.KL taking delivery of them, sources familiar with the matter told Reuters.
FILE PHOTO: An AirAsia Airbus A320-200 plane approaches Singapore's Changi Airport January 5, 2016. REUTERS/Edgar Su
The unusual move is a sign of the deepening crisis in the aviation industry caused by the coronavirus pandemic, which some analysts warn could lead to a fire-sale of unwanted planes.
Like other airlines looking to save cash amid lockdowns and travel bans that have crippled their business, AirAsia has said it doesn't need any more aircraft this year.
Manufacturers usually insist an airline takes delivery of jets that have been built, while showing flexibility on delivery dates of planes yet to be produced, especially for top clients.
Although "pop-up" sales of unwanted aircraft are not new, they rarely involve high-profile customers and typically include the manufacturer keeping the deposit, the sources said. Airbus declined to comment on whether it had done so this time.
"It is a harsh step to take," said one source, speaking on condition of anonymity due to the sensitivity of the matter.
An Airbus spokesman said: "We do not disclose or comment on delivery schedules for any customers".
A spokesman for AirAsia, Asia's biggest low-cost carrier, declined to comment.
Airbus has invited bids for four A320neo and two A321neo jets built for AirAsia, according to the sources and a confidential document seen by Reuters.
Buyers can fetch the jets from France or Germany in June, complete with optional onboard equipment ordered by AirAsia.
AirAsia co-founder Tony Fernandes said this month the group had no revenue and 96% of its fleet was grounded. He added that "AirAsia is strong and remains firmly focused on the future".
A senior Malaysian minister told Reuters on Friday that merging AirAsia with loss-making state Malaysia Airlines was one of the options to "save" them.
Airbus said this month it faced many calls from airlines to defer aircraft deliveries, but had not received cancellations directly as a result of the coronavirus epidemic.
A sale would protect Airbus's investment in parts, but comes with greater than usual risk during the industry crisis.
With most airlines struggling financially and reluctant to take deliveries, the move could lead to pressure from other customers to find new homes for aircraft they no longer want, triggering a broader sale of undelivered jets, the sources said.
Airbus has said it has 60 aircraft already built that it is unable to deliver, partly for logistical reasons.
Secondly, Airbus faces a risk that any cut-price deals will set a precedent for future jet sales.
"It's a small community and the result of these tenders often gets out," said a second source familiar with the auction.
Others said Airbus had little choice but to recoup as much as possible from the jets, worth $111-$130 million each at most recent list prices but less than half after typical discounts.
Buyers are currently scarce, but some are ready for bargains. Ryanair RYA.I, a mainly Boeing customer with an Airbus fleet through acquisition, told Reuters last week that now could be a good time to buy jets.
Wizz Air WIZZ.L says it wants to take new planes.
In February, long-haul subsidiary AirAsiaX said it would defer delivery of 78 larger A330neo jets.
Boeing BA.N, meanwhile, faced the latest in a spate of cancellations of its grounded 737 MAX, as China Development Bank said it had agreed with Boeing to cancel 29 jets.
Reporting by Tim Hepher and Liz Lee; Editing by Mark Potter


text:
The Battle for Iran: Policy or Regime Change?
July 5, 2018 A
Iran, in the latest of a series of incidents on its western and south-eastern borders, said it had disbanded a Pakistan-based cell of ant-Shiite militants
Yemen War: The Latest Chapter in Western Effort to Crush Independence
Last month, the long-dreaded invasion of the port city of Hodeidah finally began. Although there is now a "pause" in fighting as UN envoy Martin
Man-Made Drought Threatens to Ravage Iraq
"I once rescued a friend from drowning when he was swept away by the force of the current as we were swimming in the Diyala
Psychoanalysing NATO: Projection
"NATO" can be a rather elusive concept: Libya was a NATO operation, even though Germany kept out of it. Somalia was not a NATO operation even though Germany
Iran's Rhetoric Is Meant to Raise the Oil Price
Iran's ominous rhetoric about making the OPEC+ countries "pay" for their "treachery" to it and hinting at taking action to stop Gulf exports has had
Mongolia's "Third Neighbor" Is Trying to Push both China and Russia Out
Most westerners would typically have a hard time finding Mongolia on the map. Nevertheless, it's a rather unique state that serves as home for well
Don't Get Too Excited About the Mexican Silk Road
There's no better moment than now for Mexico to embrace multipolarity by teaming up with China and possibly constructing a Pacific-Caribbean rail corridor across the
How Israel Upholds 'Security' of Apartheid
Three thousand, seven hundred and four. That's how many live ammunition gunshot injuries were inflicted by Israeli snipers on Palestinian demonstrators inside the Gaza Strip


Hello! Today I want to post this simple video explaining the neurotransmitter Dopamine. By understanding how it works and how to get your body to produce it naturally, you might be able to improve general mood, concentration and productivity. It also explains how addictions are reinforced. It is a good start for a better understanding of our reward systems and ways to improve it. As always, hold on to what is good and leave behind what stops you from evolving.
** If you find yourself in a situation of drug or alcohol addiction or any mental illness please talk to your GP about treatment. This post is informative only and does not substitute a professional health care specialized in treating this issue.
I thought it would be interesting if we started this by learning a bit more about the Myth of Psyche and why it is so significant in today's search for self. Questions like – Who am I? or What am I here for? – can be the hardest ones to answer, yet, so important to our development towards an authentic self. The link bellow is going to take you to a very good explanation of how Psyche's Myth is very present and meaningful when you decide to start your own journey of self discovery.


The Saints keep improving their offensive line with the selection of Peat with the 13th pick.
Peat is huge at 6'7″ and is polished enough to start immediately. He should begin his career at right tackle but could potentially end up at left tackle. The Saints offensive line already ranked 11th last year but with Peat and Max Unger, who came over in a trade for Jimmy Graham, but should be solidified giving Drew Brees and the rest of the offensive time to operate.
This entry was posted in 2015 nfl draft and tagged 2015 nfl draft, andrus peat, new orleans saints. Bookmark the permalink.


TRUTH ABOUT TIBET IN INFORMATION ERA – CELEBRATION OF TIBET MUSEUM ON INTERNATIONAL MUSEUM DAY.
Sharing 'INFORMATION' is the central component of all aspects of social life and national life as people make choices using information. Technology makes it easy to collect and disseminate information to all corners of Earth. Why is it difficult to share information about Tibet? On May 18, in celebration of Tibet Museum on International Museum Day, let us dedicate the use of 'Information' to combat lies and deception used by Red Dragon to create illusion and fantasy.
Truth About Tibet in Information Era. Celebration of Tibet Museum on International Museum Day.
Dharamshala — The Tibet Museum of Department of Information and International Relations, CTA, commenced it's three-day celebration of 39th International Museum Day by launching the museum's exhibition catalog, "A Long Look Homeward" and a promotional video.
Sikyong Dr Lobsang Sangay was the chief-guest and launched the catalog. Mr Sonam N. Dagpo, Secretary of DIIR launched the promotional video of the museum. The Tibet Museum was established in 1998 and graced by His Holiness Dalai Lama, with the purpose to document, preserve, research, exhibit and educate on the matters related to Tibetan history, culture and the present issue.
The event saw Dr Sangay, Mr Tashi Phuntsok, Secretary of DIIR and Mr Tashi Phuntsok Director of the Tibet Museum addressing the audience on the importance and success of the museum in preserving the Tibetan culture, heritage and the stories of undying struggles of Tibetan people under the Chinese oppression. The museum is the proof of China's attempts to create a false image of contentment and prosperity in Tibet.
His message to the current world leaders regarding their passive approach towards the Tibet issue is "What Tibetans are facing and suffering is real so if they see, they must stand for the basic principles of their country which they claim to be democracy and freedom for all".
Every year May 18th is celebrated as International Museum Day with the participation 142 countries and more than 35,000 museums.


text:
La nazionale di calcio della Colombia Under-20 è la rappresentativa calcistica della Colombia composta da giocatori Under-20 ed è affiliata alla CONMEBOL.

Partecipazioni a competizioni internazionali

Mondiali Under-20

Tutte le rose

Campionato mondiale di calcio Under-20

Campionato sudamericano di calcio Under-20

Collegamenti esterni

Colombia
Under-20

redpajama_set_name: RedPajamaWikipedia


text:
Music & Clubs
Review: 'Stan & Ollie'
New biopic on comedy duo Laurel & Hardy is touching, nostalgic
February 13, 2019 by Richard von Busack
Steve Coogan and John C. Reilly play portray the comedy duo Stan Laurel and Oliver Hardy in 'Stan & Ollie.'
John S. Baird's biopic Stan & Ollie has a certain inflationary quality, regarding the appeal of a comedy team in their sunset years. But in lovingly re-creating Laurel and Hardy's mid-1950s tour of Britain, it's a film with lots of charm.
The road is tough on two aging performers. It's bad when no one shows up at the music halls, and it's worse when they're congratulated for surviving their has-been status. At a seaside pavilion, the hostess toasts them: "Still going strong, and still using the same material!"
Stan Laurel (Steve Coogan) is revealed as the sparkplug of the act, the writer who understood the formula. No matter who else was around them, on screen or stage, Laurel and Hardy needed to be the only person in the other's world.
As befitting his massive flesh, Oliver Hardy (John C. Reilly) has trouble with his vices. He accumulates ex-wives and has a taste for gambling that takes whatever money the alimony leaves. New complications come with the arrival in London of the team's wives, who are united in mild detestation of each other. Stan's Russian and haughty Ida (Nina Arianda) is a bit of a princess compared to Oliver's spouse, Lucy (Shirley Henderson, first rate as always). Seeing Ollie and Lucy laying down together in their room at the Savoy, him immense, her tiny, one gets the pleasure of marveling at the way opposites attract.
Performing Laurel and Hardy's cherishable "Trail of the Lonesome Pine," Coogan and Reilly may be even better singers than the originals. They eclipse your memories of their models, with Coogan imitating Stan's monkeyish head scratch and Reilly, through the fat suit and makeup, evincing the beatific side of Ollie.
It doesn't break new ground, this biopic, but it has its stinging moments. When the two get into a fight about an old rift, this time Ollie's slow burn is real, and so is Stan's hesitant peacemaking.
John Paul Kelly's lavish production design drips with nostalgia; it can be a tad too sweet and rich for the times, but it's more evidence that this film was a labor of love.
PG; 98 Mins.
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