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JMIR Formative Research
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Formative Evaluation of Digital Health Interventions (1391) Bipolar Disorders (46) Design and Formative Evaluation of Mobile Apps (554) Mobile Health in Psychiatry (330) Web-based and Mobile Health Interventions (2045) e-Mental Health and Cyberpsychology (889) mHealth for Wellness, Behavior Change and Prevention (2208) Usability of Apps and User Perceptions of mHealth (703)
Published on 13.12.2021 in Vol 5 , No 12 (2021) :December
Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/32450, first published July 30, 2021 .
The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study
Kelly A Ryan 1 ; Shawna N Smith 2 ; Anastasia K Yocum 1 ; Isabel Carley 1 ; Celeste Liebrecht 3, 4 ; Bethany Navis 1 ; Erica Vest 1 ; Holli Bertram 1 ; Melvin G McInnis 1 ; Amy M Kilbourne 3, 4
Kelly A Ryan1*, PhD ;
Shawna N Smith2*, PhD ;
Anastasia K Yocum1*, PhD ;
Isabel Carley1*, BS ;
Celeste Liebrecht3,4*, MSW ;
Bethany Navis1*, BS ;
Erica Vest1*, MSW ;
Holli Bertram1*, MSW ;
Melvin G McInnis1*, MD ;
Amy M Kilbourne3,4*, PhD
1Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
2Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
3VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, United States
4Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
*all authors contributed equally
Kelly A Ryan, PhD
2101 Commonwealth Blvd, Suite C
Fax:1 734 763 9259
Email: karyan@umich.edu
Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app.
Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months.
Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction.
Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being.
Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments.
JMIR Form Res 2021;5(12):e32450
self-management; app; bipolar disorder; symptom management; mental health; feasibility; usability; acceptability; intervention; bipolar; coping; survey; engagement
Bipolar disorder (BD), a serious mental illness, affects at least 2% of the general population. It is the sixth leading cause of disability worldwide affecting the 18- to 44-year-old age group [1], a major risk factor for suicide, and the single most expensive mental health condition [2]. As BD is a chronic condition, individuals with BD often require continuous, long-term monitoring and care. However, 40% to 50% of those with any serious mental illness, including BD, do not receive any mental health treatment [3,4] despite the knowledge that evidenced-based interventions improve engagement with providers [5]. Commonly reported barriers to obtaining adequate care include lack of access, cost, and stigma [6-9]. The vast majority of patients with BD receive care in low-resource settings, which include primary care and community mental health clinics [1,2]. These providers are overburdened and lack the capacity to provide consistent monitoring shown to be effective in the management of individuals with BD [3,10-12]. Mobile health (mHealth) technologies have the potential to overcome these barriers and improve access to care [13]. There are many obstacles to implementing mobile and digital health strategies [14]. Therefore, it is imperative that the field adopts digital health strategies that are grounded in evidenced-based research; offers greater flexibility in terms of treatment options; and accommodates long-term use by heterogeneous patient populations, including varying levels of user engagement or commitment.
Existing or widely available mHealth apps for BD that are readily downloadable on smartphones typically only offer mood tracking or symptom monitoring, do not cover other important areas for individuals with BD (eg, medication adherence, sleep, and intervention), or are not supported by empirical evidence. These include apps such as eMoods Bipolar Mood Tracker, Moodlog, UP! – Depression, Bipolar & Borderline Management, and Bipolar Track. Findings of a systematic review of available apps for BD indicate that the most widely available apps do not reference clinical practice guidelines, standard psychoeducation information, or established self-management tools [15]. Other work on existing BD-related apps found that BD consumer needs were not adequately addressed by the currently available apps [16]. The top features included were mood tracking and journaling [17], and it did not provide adequate educational or other intervention content. Of the 100 top-returned publicly available apps for BD that were reviewed, only 56% mention BD in the content or description, and only 1 app was supported by peer-reviewed research. These findings suggest that mHealth tools for BD have not been widely translated into evidence-based, clinically relevant apps that can be made available to the public.
One specific mHealth tool that is empirically supported—the MONARCA app—uses sensors and self-assessments to gather information about the user's sleep, social activity, and mood, with the goal of providing information to the patients and their providers, but it does not include self-management and educational components [18]. Platforms and databases have been developed to help professionals and consumers access mHealth apps that translate evidenced-based programs and provide guidelines for consumers and help to navigate the mental health app marketplace, including some of the apps listed above [19,20]. However, very few scientifically reviewed apps specifically focus on the needs of individuals with BD, especially beyond mood tracking. One newly developed smartphone-based, self-management intervention for BD (LiveWell) was designed considering empirically supported therapy and included user input in its development, which addresses the need for empirically supported apps to provide self-management components [21]. Therefore, there is a need to focus on the development of other apps to provide options for patients with BD who would like self-management strategies and education, including support with sleep, understanding early warning signs, triggers, and maintaining healthy lifestyles [22,23].
Life Goals Collaborative Care (LGCC) [24] is one such evidence-based intervention based on the chronic collaborative care model that provides proactive care for patients through several components, including patient self-management education; care coordination across providers, predominantly through care manager contacts and improved information systems; and decision support tools for providers. LGCC's central patient-centered tenet focuses on empowering patient-self management skills through the Life Goals program, which is a series of 6 or more self-management sessions customized to individual needs and focused on mental and physical wellness, understanding symptoms, and setting personal goals. Although a component of LGCC, the Life Goals self-management program can serve as a stand-alone, manualized program for individuals with BD [25], and it has been offered via a user-friendly, provider-facing website that guides the Life Goals provider and their patient to customize an LGCC program and a consumer self-directed guidebook [26].
Self-management programs such as those included within the LGCC have been shown to improve medical and psychiatric outcomes for persons with serious mental illness after 6 months [27,28]. Several randomized trials found that LGCC reduced overall affective symptoms and improved overall role function, quality of life, participant satisfaction, and medical outcomes, compared to usual care [24,27].
Self-management programs are patient-centered and encourage regular engagement with the provider. This is challenging and burdensome for providers to implement in low-resource communities. Community-based practices lack the staffing time and capacity (eg, physical space) to offer self-management sessions such as the original LGCC program. They may also face barriers to reimbursement [29]. At the patient level, access to effective, evidence-based self-management programs are also limited outside of in-person care, which may be challenging to access owing to cost, workforce, and stigma. There is a need to develop self-management programs into mHealth technologies, with the hope that such apps will fill this gap by alleviating the burden on the providers and empower those with serious mental illness by providing them with more flexible access to evidence-based treatments.
Barriers regarding access to care and available mHealth platforms were the impetus for the development of a standalone Life Goals self-management mobile app for persons with BD that can be accessed either in a direct-to-consumer format or as an augmentation to in-person care. The aim of this study is to evaluate the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD over a 6-month period. Outcome patterns of key clinical outcomes relating to functioning, disability, and psychiatric symptoms will also be assessed. The Life Goals app adds value to the existing mHealth apps for BD given its evidenced-based content, intervention effectiveness, and functionality of being customizable to the user's need.
Participant Recruitment
For this pre-post-test study, participants were recruited from the Heinz C. Prechter Longitudinal Study of Bipolar Disorder, an observational, naturalistic cohort study gathering phenotypic and biological data, at the University of Michigan [30], or through the UMHealthResearch web-based tool [31]. Individuals were included in the study if they were aged 18 years or older, had any BD diagnosis (ie, Bipolar I, II, or not otherwise specified [NOS], according to the Diagnostic Statistic Manual version IV [DSM-IV] criteria), were community dwelling (ie, not living in a nursing home or other institution), and were current owners and users of a smartphone. Diagnosis was confirmed using medical records or a diagnostic interview using the Diagnostic Interview for Genetics Study [32] or the Mini-International Neuropsychiatric Interview (MINI) [33]. Exclusion criteria were any serious illness precluding participation in Life Goals components as indicated by the provider, or inability to provide informed consent. One participant was excluded because she did not meet the criteria for BD after completing the MINI. Three participants discontinued from the study before completion owing to time constraints (n=2) or because they had difficulty using the app on their phone (n=1). This study was approved by the University of Michigan Internal Review Board, and all participants provided signed informed consent.
The Life Goals app was custom built to use either Apple or Android operating system. Participants were sent invitations to download the app from either Apple App Store or Google Play. Once they logged into the app, they could review the privacy policy (created by University of Michigan's Office of Technology Transfer), which was also saved under the main menu tab for easy access. Participant data were stored securely on University of Michigan's approved servers and protected by the university's security systems. A trained research associate provided training on how to use the app and provided a user manual for troubleshooting. The study team was available to answer questions via phone every business day.
The Life Goals app includes succinct, 5- to 10-minute-long modules that provide self-management activities for managing everyday needs of individuals with BD, including mood symptom coping strategies, stigma concerns, emotional self-awareness and family support, anger and irritability, and preparation for doctor's visits. The content and wording were adapted from the original LGCC program. We encouraged participants to engage with Life Goals modules once a day, but they were ultimately self-guided, interactive modules completed at the user's own pace. Participants could type in free-text personal responses for questions asked by the app. All participants were required to complete the introduction module first, where they learned about self-management, collaborative care, stigma, value, goals, and factors impacting their mental health. Participants were also encouraged to complete the Managing Your Care module at some point, which discusses how to communicate and work with providers. If participants did not engage with the app at all within 7 days, they received one automatic notification as follows: "You haven't logged into the Life Goals app in a while. Tap here to start working on a module." If they left a module incomplete within the past 7 days and did not return to it, they received the following prompt: "You haven't completed your module. Tap here to take you back to where you left off." In all, participants received a total of 3 automated notifications for app inactivity.
Following the mandatory introductory module, the other 13 Life Goals modules covered the following mental health and wellness topics: (1) Managing Your Care; (2) Depression; (3) Mania; (4) Anxiety; (5) Trauma; (6) Thoughts of Hopelessness; (7) Psychosis; (8) Anger/Irritability; (9) Substance Use; (10) Foods and Moods; (11) Move Your Body, Move Your Mood; (12) Managing Tobacco; and (13) Sleep and Mood. Each topic is customizable based on what the participant needs or wants to learn about. Participants were encouraged to complete at least 6 modules in all. See Figure 1 for example screenshots from the Life Goals app.
Figure 1. Life Goals app screenshots: landing page and Identifying Triggers (Depression module).
Feasibility Assessment
Feasibility and patient engagement were assessed through data on the number of times the participants engaged with the Life Goals app and the number of minutes they spent using the Life Goals app during the 6-month study period. A post-study Questionnaire about the user's experiences with the app was used to assess usability and acceptability and collected only at the 6-month interval. The survey contained 7 statements that participants rated their agreement with on a Likert scale, ranging from "Strongly Agree" to "Strongly Disagree." With regard to the usability of the app, participants were asked to rate their agreement with the statements "The material was displayed adequately on my phone screen" and "I had problems accessing the app…because of technical difficulties." Key statements relating to acceptability of the app as a self-management tool were, "The app improved my ability to manage my own health," and "The app helped me make progress on my wellness goals" (see Table 1). Participants were also asked a single open-ended question, in response to which they could provide us with additional free-text feedback on their app use experience.
Table 1. Participant ratings on poststudy evaluation (n=25).
Evaluation question Participants, n (%)
Strongly agree or agree Neutral Strongly disagree or disagree
1. The Life Goals app improved my ability to manage my own health. 9 (36) 10 (40) 6 (24)
2. The Life Goals app material was useful to me. 15 (60) 4 (16) 6 (24)
3. I enjoyed working through the Life Goals app material. 9 (36) 10 (40) 6 (24)
4. The Life Goals app helped me make progress on my wellness goals. 10 (40) 4 (16) 11 (44)
5. The Life Goals app was easy to use. 18 (72) 2 (8) 5 (20)
6. The material was displayed adequately on my phone screen. 22 (88) 1 (4) 2 (8)a
7. I had problems accessing the Life Goals app because of connectivity or other technical difficulties. 3 (12) 3 (12) 19 (76)
aResponse: "Don't know."
Clinical outcomes were self-reported using validated measures of mood, health, and disability at 3 time points: baseline (study entry) and 3 and 6 months postinitiation of Life Goals app. A 6-month time span was chosen, as the original LGCC showed improvements in functioning after this time point [28]; however, in examining the feasibility of a stand-alone self-management app, we added a 3-month assessment period given that many individuals may lose interest after the first few months. A survey of the demographics (ie, age, education, race, and gender), current employment or living status, and insurance coverage was conducted only at study entry. Outcome measures assessed at all 3 waves included health-related quality of life, measured using the 12-item Short Form Health Survey (SF-12) [34]; self-reported health or disability status, measured using World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) [35]; alcohol use, measured using Alcohol Use Disorders Identification Test (AUDIT-C) [36]; drug use, measured using Drug Abuse Screening Test (DAST-10) [37]; and psychiatric symptoms, measured using the Patient Health Questionnaire–9 [38] for depression symptoms and the Internal State Scale [39] for mania or hypomania symptoms. Surveys took approximately 5-10 minutes to complete. All self-report measures were collected digitally using Research Electronic Data Capture (REDCap) tools hosted at University of Michigan [40].
Participants received monetary compensation for their participation in this study and to offset any data usage they may have accrued on their own mobile phones. Participants were offered US $1 for each day they used the app (defined as any interaction within the app), regardless of how many cell phone engagements they chose to use, or up to US $180 for 6 months. They also received US $10 for each survey completed, up to US $30. Maximum compensation for the 6-month study duration was US $210.
Univariate and bivariate statistics were used to examine all feasibility, usability, acceptability, and exploratory clinical outcomes. Feasibility was assessed by examining usage (defined as the number of instances the app was used and the duration while using the app and its modules) across the total 6-month study duration, from baseline to 3 months, and from 3 months to 6 months. For usability and acceptability estimates, frequencies of responses and open-ended qualitative responses were reviewed and summarized to determine common themes. For our exploratory clinical outcomes, paired t-tests were performed to evaluate over-time change. Spearman rho correlations were performed to determine associations between over-time change in outcome measures and app usage.
User Demographics
Of the 496 email invitations sent, 28 (5.6%) participants consented and enrolled in this study. The majority of participants were diagnosed with bipolar type I (n=21, 75%), with a smaller proportion diagnosed with bipolar type II (n=4, 14.3%) and bipolar, NOS (n=3, 10.7%). The average age of participants was 44.7 (range 24-72) years; 68% (19/28) identified as female; 75% (21/28) reported having a college degree; and 10.7% (3/28) identified as racial minorities (Multimedia Appendix 1).
In this pilot study, app use waxed and waned over the course of the study. Of the 28 enrolled participants, 26 (93%) used the app at least once during the study period; 24 (86%) used the app during the first 3 months, and this number decreased to 18 (64%) during the next 3 months.
Over the full study duration, participants engaged with the app for a median of 25 times (IQR 13-65.75) and used the app for an average of 154 (IQR 39-194) minutes. However, this usage was not evenly distributed over time. During the first 3 months, participants engaged with the app for a median of 16.5 (IQR 12.25-41.25) times and for a median of 117 (IQR 22-132) minutes. During the next second 3 months, the median app use had increased to 23 (IQR 6-64.50) times, but the average time spent decreased to 66 minutes (IQR 22, 79) during the second period.
Among the subset of 18 participants who used the app at least once during the first and last 3-month periods, they also showed more app use within the first 3 months (median 11, IQR 7-28 instances) than in the last 3 months (median 8, IQR 5-35 instances), which was a statistically significant reduction (P=.005). This subset also used the app for longer, on average, in the first 3 months of the study (median 7, IQR 1-59 minutes per usage) compared to the last 3 months (median 3.4, IQR 1-31 minutes; P=.006).
Module Completion
Participants were required to complete the introduction module before attempting any other module. Furthermore, they were encouraged to use any or all modules, as deemed interesting, during the 6-month period. Of the 13 modules, excluding the mandatory introduction module, 3 (17%) participants used all 13 modules in the app. Over the course of the study, participants completed a number of modules (mean 8.2, SD 3.3; median 7; mode 5; range 4-13). All participants completed more than 3 Life Goals app modules, and 67% (12/18) of the participants completed 6 or more modules The most frequently assessed modules were the same in both study periods (ie, first 3 months and next 3 months); these included Depression, Anxiety, and Mania (Figure 2).
Figure 2. Number of times the Life Goals app was used at different time points.
Usability and Acceptability of Life Goals App
A total of 25 (89%) participants completed the poststudy survey about acceptability and usability (Table 1). Of these 25 participants, the majority found the material provided by the Life Goals app useful (n=15, 60%); they found the app easy to use (n=18, 72%); and they found the screen display adequate (n=22, 88%). Few participants reported problems accessing the Life Goals app because of connectivity or other technical difficulties (3/25, 12%). However, positive impacts of the app on health management were less widely endorsed: 10 (40%) users reported finding the app helpful in managing their health, and 9 (36%) reported finding it helpful in making progress on their wellness goals.
The open-ended question where participants could provide additional feedback on their app use experience included the following responses:
A lot of the information was obvious to me.
The app is well designed. I can see it being highly beneficial to someone learning how to manage their illness.
I'm pretty stable and didn't really find the app helpful…If I was experiencing symptoms, maybe more so.
I think it will help beginner sufferers more. My habits didn't change a lot, but Life Goals App really got me thinking differently.
Paired sample t-tests did not show significant changes in symptoms or functioning when comparing baseline assessments to 3-month follow-up assessments, or when comparing baseline assessments to 6-month follow-up assessments (Multimedia Appendix 2), likely due to the small sample size. Effect sizes were all small to negligible (Cohen d range –0.372 to 0.183). However, trends for improvements in physical health functioning, mental health functioning, and mania-related well-being were noted. There were no significant relationships between time spent using the app (minutes) or the number of instances using the app within the first 3 months or the last 3 months and changes in outcome measurements during the same periods, except for a positive correlation between change in mania symptoms and Life Goals app duration (see Multimedia Appendix 3).
Principal Results
This pilot study examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD. We found that the median number of times that individuals used this app was 25, for a total of 154 minutes across 6 months. As with usage patterns of other apps, the app was used for a longer time during the first 3 months than the last 3 months of the study period. In a clinical setting, Life Goals participants are expected to complete 6 sessions, or 6 Life Goals modules; completion of 3 sessions is regarded as a clinically significant dose [29,41,42]. As such, all participants completed at least 3 Life Goal app modules, and the majority completed at least 6 Life Goals modules, indicating all received a clinically significant dose comparable to Life Goals in a clinical setting. Furthermore, the number of modules completed (mean 8.2, median 7) indicated reasonable use of the modules. Not counting the introduction module, which was mandatory, the most frequently accessed modules in our sample were Depression, followed by Anxiety and Mania, suggesting that these are areas that appealed to the sample the most or directly addressed self-management needs.
For usability and acceptability, frequencies of responses from participants indicated high usability and satisfaction with the user interface. The majority of participants experienced no difficulties using the app and felt that the material was displayed adequately; however, the results showed low success in the app encouraging self-management of their own health. Only a minority of the participants felt that the app helped them to make progress on their wellness goals and improved their ability to manage their own health. Similarly, when symptoms, health, and functioning were rated over the course of the study using self-report surveys, we found no significant improvements in ratings. However, there were notable trends for mania and mental and physical health functioning over the first 3 months, using this small sample that were pointing in the direction of improved scores. Written responses from participants centered around themes related to liking the app, but the content or self-management pieces were not novel to them, and a few suggested that they felt that the app would be more beneficial to individuals who were newly diagnosed. These findings suggest that targeting the app to those who have received less psychoeducation about BD or were earlier in their illness course may find greater benefit. Future work to understand what individuals with BD look for in similar apps is needed. Only 6% of all those who offered to participate in this study agreed to use the app, suggesting that there may be specific factors that influence the uptake of this type of app. Our future work aims to explore both dissemination via direct-to-consumer and clinically integrated pathways that would address the question about uptake and engagement with self-management apps, such as Life Goals. Recent work suggesting design considerations for development, engagement, and evaluation [43] in apps for BD will be helpful to refine the development and dissemination of this work.
Given our small sample size, our group of participants with BD may not be reflective of the broader, heterogeneous nature of BD. Furthermore, it is possible that a larger sample would have sufficient power to detect changes in clinical outcomes. We did not include a control group, so it was not possible to determine whether clinical changes were related to use of the Life Goals app. Our study design likely resulted in the tendency to include individuals who are more technology oriented and motivated to participate in research, as well as those who are more willing to have an almost daily engagement with the Life Goals app. For example, our sample was already actively engaged in a longitudinal study of BD, so these participants are likely more willing to engage in other research studies and participate in daily activities than are other individuals who are not volunteering their time. Future studies will need to evaluate the use of the Life Goals app in a more rigorous or controlled manner and within a more generalizable population to examine whether use statistics were related to incentivizing participants or whether symptom improvement trends persist over time. Lastly, we compensated our participant's time in this study, which may have increased their interest to participate or their motivation to engage with the Life Goals app.
Overall, these results indicate that the Life Goals app, a smartphone self-management app developed using an evidence-based intervention based on the chronic collaborative care model, is feasible and acceptable for individuals with BD. Individuals using the Life Goals app may use it more frequently at first and may have the greatest interest in mood-related modules rather than other wellness modules. Wider dissemination of the app to individuals in different stages of recovery or earlier in the illness is needed. This app shows potential as an mHealth technology based on evidence-based treatments that can help bridge the gap in access to care and reducing burden on providers. It can also offer greater flexibility in terms of treatment options that accommodates varying levels of user engagement and commitment.
This project was funded by the Michigan Department of Health and Human Services, The Heinz C Prechter Research Program and the Richard Tam Foundation.
MGM has consulted for Otsuka and Janssen Pharmaceuticals and receives research support from Janssen Pharmaceuticals. MGM has also consulted with the Milken Institute for Strategic Philanthropy. AMK and CL are named on the Life Goals app invention disclosure filed with the University of Michigan. AMK is a co-author of a book about Life Goals and receives royalties from New Harbinger publications. SNS, KAR, AKY, HB, IC, BN, and EV has no conflict of interest to declare.
Demographic characteristics of the study participants (N=28).
DOCX File , 19 KB
Self-report clinical outcome data with completion rate, mean score, and SD at each time point.
Correlations between Life Goals app use and outcome measures for time period 1 (ie, baseline to 3-month follow-up) and time period 2 (ie, 3-month to 6-month follow-up).
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Kilbourne AM, Post EP, Nossek A, Sonel E, Drill LJ, Cooley S, et al. Service delivery in older patients with bipolar disorder: a review and development of a medical care model. Bipolar Disord 2008 Sep;10(6):672-683. [CrossRef] [Medline]
Bauer M, Kilbourne A, Greenwald D, Ludman E. Overcoming bipolar disorder: a comprehensive workbook for managing your symptoms and achieving your life goals. Overcoming bipolar disorder: a comprehensive workbook for managing your symptoms and achieving your life goals: New Harbinger Publications; 2009:a.
Kilbourne AM, Post EP, Nossek A, Drill L, Cooley S, Bauer MS. Improving medical and psychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial. Psychiatr Serv 2008 Jul;59(7):760-768. [CrossRef] [Medline]
Kilbourne AM, Goodrich DE, Lai Z, Clogston J, Waxmonsky J, Bauer MS. Life Goals Collaborative Care for Patients With Bipolar Disorder and Cardiovascular Disease Risk. PS 2012 Dec;63(12):1234-1238. [CrossRef]
Kilbourne AM, Almirall D, Eisenberg D, Waxmonsky J, Goodrich DE, Fortney JC, et al. Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program. Implement Sci 2014 Sep 30;9(1):132-114 [FREE Full text] [CrossRef] [Medline]
McInnis M, Assari S, Kamali M, Ryan K, Langenecker S, Saunders E. Cohort Profile: the Heinz C. Prechter longitudinal study of bipolar disorder. International journal of epidemiology. n 2018;47(1):28. [CrossRef]
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Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998:22-33. [CrossRef]
Ware J, Kosinski M, Keller S. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996 Mar;34(3):220-233. [CrossRef]
Chisolm TH, Abrams HB, McArdle R, Wilson RH, Doyle PJ. The WHO-DAS II: psychometric properties in the measurement of functional health status in adults with acquired hearing loss. Trends Amplif 2005 Aug 23;9(3):111-126 [FREE Full text] [CrossRef] [Medline]
Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption--II. Addiction 1993 Jun;88(6):791-804. [CrossRef] [Medline]
Lam LP, Leung WC, Ip P, Chow CB, Chan MF, Ng JWY, et al. Validation of the Drug Abuse Screening Test (DAST-10): a study on illicit drug use among Chinese pregnant women. Sci Rep 2015 Jun 19;5(1):11420-11411 [FREE Full text] [CrossRef] [Medline]
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001 Sep;16(9):606-613 [FREE Full text] [CrossRef] [Medline]
Bauer MS, Vojta C, Kinosian B, Altshuler L, Glick H. The Internal State Scale: replication of its discriminating abilities in a multisite, public sector sample. Bipolar Disord 2000 Dec 24;2(4):340-346. [CrossRef] [Medline]
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Smith SN, Almirall D, Prenovost K, Liebrecht C, Kyle J, Eisenberg D, et al. Change in patient outcomes after augmenting a low-level implementation strategy in community practices that are slow to adopt a collaborative chronic care model: a cluster randomized implementation trial --II. Med Care 2019 Jul;57(7):503-511 [FREE Full text] [CrossRef] [Medline]
Smith SN, Liebrecht CM, Bauer MS, Kilbourne AM. Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res 2020 Dec 30;55(6):954-965. [CrossRef] [Medline]
Morton E, Nicholas J, Lapadat L, O'Brien HL, Barnes SJ, Poh C, et al. Use of smartphone apps in bipolar disorder: an international web-based survey of feature preferences and privacy concerns. J Affect Disord 2021 Dec 01;295:1102-1109. [CrossRef] [Medline]
Audit-C: Alcohol Use Disorders Identification Test
BD: bipolar disorder
DAST-10: Drug Abuse Screening Test
DSM-IV: Diagnostic Statistic Manual version IV
LGCC: Life Goals Collaborative Care
mHealth: mobile health
NOS: not otherwise specified
REDCap: Research Electronic Data Capture
SF-12: 12-item Short Form Health Survey
WHO-DAS: World Health Organization Disability Assessment Schedule 2.0
Edited by G Eysenbach; submitted 30.07.21; peer-reviewed by I Choi; comments to author 26.08.21; revised version received 08.09.21; accepted 05.11.21; published 13.12.21
©Kelly A Ryan, Shawna N Smith, Anastasia K Yocum, Isabel Carley, Celeste Liebrecht, Bethany Navis, Erica Vest, Holli Bertram, Melvin G McInnis, Amy M Kilbourne. Originally published in JMIR Formative Research (https://formative.jmir.org), 13.12.2021.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
Ryan KA, Smith SN, Yocum AK, Carley I, Liebrecht C, Navis B, Vest E, Bertram H, McInnis MG, Kilbourne AM
JMIR Formative Research ISSN 2561-326X


text:
Tag Archives: Gears of War 3
My 2011 Games of the Year.
Everybody's doing it – why shouldn't I?
At Number Five – Bethesda's fantasy co-op adventure, "Hunted – The Demon's Forge".
Not the most polished or original title of the year, but oddly compelling nonetheless. There was something really engaging about the low/gritty fantasy setting, the bickering and mis-matched mercenary duo posh Elven warrior E'lara and gruff barbarian Caddoc (voiced by the always reliable Graham McTavish). This isn't a game which will change your life but it's certainly worth a rental and ends on quite the cliffhanger – which looks unlikely to be resolved in a future release as this title can charitably be described as having 'flown under the radar'.
At Number Four – Epic/EA's sci-fi shooter, "Bulletstorm".
On the face of it, this skill-focussed shooter from Polish developer People Can Fly seemed to operate in the same territory as Epic's other sci-fi first person action series, the always bromantic "Gears of War", but even ten minutes spent in this colourful, gleefully profane, absurdly over the top universe was enough to reassure most players that this game really was its own, ten storey, razor-toothed beast.
There was a little forum chatter about the game's loutish protagonist, disgraced mercenary Grayson Hunt and what a terrible, misogynistic, macho power fantasy he represented – Duke Nukem says hi – but that seemed absurdly overblown to me. This game's nominal hero is clearly the butt of every joke and his belligerence is always his undoing – the female lead in the game, Trishka, is clearly drawn from the same cloth as many female warriors in games (where her clothes are lacking, there's usually an ammo belt or gun to hide her modesty) and gets to save the day and drive the plot at least much as Hunt does.
I'd be absolutely up for a sequel if the numbers justified it to EA.
At Number Three – Epic Games and Microsoft Games Studios' "Gears of War 3".
A surprise to me that this climactic entry in the series landed so comparatively low on my list.
It was in so many ways the most polished and well-made game in the entire series, boasted lots of new and utterly gorgeous environments and introduced characters from the wider "Gears" universe into the game for the first time – hello Jace and Bernie – but still didn't quite click with me. I finished it with little difficulty, didn't look at the multi-player portion of the game and traded it.
I can't say that it was a bad game at all, just one which left me ultimately a bit cold.
At Number Two – THQ and Relic Entertainment's "Warhammer 40K: Space Marine".
This game really managed to scratch the third person action itch that "Gears 3" failed to do. A great and long-established sci-fi universe rendered brilliantly by a developer with lots of experience making PC titles in that world, making their first console action game and getting the awesome Mark Strong to voice the lead and then finding that their publisher released it a couple of weeks before the 800 pound gorilla that is the game at number three on this chart – this game had a lot to recommend it and then was undone by insane marketing decisions.
This game focussed on an admittedly linear game design and compelled the player to play in a specific way which may have annoyed some but I stuck with it and loved the whole campaign. Even delved into the multi-player a bit. Get me, venturing online to have myself struck down by random strangers.
At Number One…
Naughty Dog and Sony Computer Entertainment's "Uncharted 3: Drake's Deception".
I whined a lot about the shooting, complained some more about the enemy artificial intelligence – standing there to present an easy target one second, moments later developing ninja stealth skills by some happenstance to flank you and mercilessly shoot you into the middle of next week – and generally threw my toys out of the pram in response to flaws that I felt made the game artificially difficult and borderline broken in some sections.
A patch did away with the shooting issues in the campaign and the rest of the game was so damned good that it didn't matter that one aspect of the title needed to be worked on post-release, with the assistance of the community and by a developer who acknowledged that the fixes needed to be made (Hi there, Bethesda and "Skyrim").
This game did everything that the landmark second entry delivered so successfully – great storytelling, massive action on a cinematic scale, a gloriously beautiful game world rendered in eye-popping, budget not spared style and technology underpinning everything that you'd give your wisdom teeth to see employed by other devs – and somehow managed to eke a bit more out of the PS3's architecture to make the system's definitive title a cut above the rest.
"Gears 3" on the Xbox 360 approached the beauty of "Uncharted 2" on the PS3 – "Uncharted 3" leaps frogs both platform's new and existing high points and delivers truly beautiful moments and cities that are a pleasure to put the pad down to just look/gasp slack-jawed at for thirty seconds at a time.
It's easy to be blase about Naughty Dog have done with this series – when game two is a massive leap forward from the already accomplished first title, the pressure becomes that bit greater for the developer to move the paradigm on and deliver an interactive entertainment experience which doesn't only improve on their own previous work but which also lives up to the claims that fans have made for it.
I've told people who don't play games that this is a series which underlines why I frequently now go to PS3 and Xbox titles for the thrills that in years gone by I might have found in a Spielberg or Cameron film. Naughty Dog, to me, are the equal of those established film-making icons and regularly deliver titles which surpass any big-budget Hollywood studio film in terms of entertainment and excitement.
I don't believe that this franchise necessarily needs the pseudo validation that a film adaptation allegedly bestows, even though it's apparently going to get one, helmed by the director of this year's "Limitless" – its already more inventive, exhilarating and witty than any comparable film series is and it's the film community which needs to up it's game to catch up with Nathan Drake and co.
Filed under Blogs, Gaming, Geekery
Tagged as Bulletstorm, Gears of War 3, Hunted The Demon's Forge, Uncharted 3, Warhammer 40K - Space Marine
2011 – a completionist's tale
Yep, that's me that they're shooting. Fun times...
"Gears of War 3", "Uncharted 3", "Warhammer 40K: Space Marine", "Singularity", "Bulletstorm" – campaigns done and dusted, multiplayer mostly left untouched (still making progress through "Uncharted 3", really should try out some more "Space Marine").
What have you finished this year – and is finishing games important to you? If you're not enjoying something, do you just put it down or persist with it in the hope that it gets better?
Filed under Gaming
Tagged as Bulletstorm, Gears of War 3, Singularity, Space Marine, Uncharted 3, Warhammer 40K
Charlie Brooker 4, Modern Warfare 3
Fun fact. Charlie Brooker actually looks like this in real life...
Erstwhile screenwriter, telly face and gaming curmudgeon Charlie Brooker is at it again. And as usual, he's got a ruddy good point.
You might remember him from his various BBC series – "How TV Ruined Your Life", "Newswipe" and his one-off special, "Gameswipe", or in his capacity as the creator of Channel Four's ace reality telly/zombie mash-up, "Dead Set". He's also one of the few Guardian columnists whose byline I actively seek in the paper, chiefly as he never loses a chance to integrate games and gaming into the papers' general arts conversation.
His latest column tackles "Call of Duty: Modern Warfare 3" intelligently and asks a simple question that has probably occurred to most games players at one time or another:
"Why am I playing this game, when the protagonist is such a weapons-grade tool?".
Yes, he's got a mohican haircut. In the Military FPS genre, this passes for characterisation...
So often in games, movies and novels set in this genre, we're asked to accept at face value that we should identify with characters whose sole notable feature is an ability to field-strip an assault rifle blindfolded and to p spout inane, frat-boy one-liners largely inspired by the killing of enemy combatants, the inevitable, imminent slaughter of said enemy combatants or the destructive force of the military hardware which will be used to wipe enemy combatants from the very face of the planet.
It's all a bit dull, really – and it's where I can't get excited by the "Battlefield" and "Call of Duty" games. I don't want to be these guys, so the idea of slogging through a five-to-six hour campaign in the company of people who've read too many Jack Ryan novels and taken them far too seriously isn't exactly my mug of Senseo.
I'm not saying that all game protagonists must henceforth be replaced by variations on this guy:
The bard of self-deprecating urbane whimsy
But wouldn't it be more interesting to play one of these games with a protagonist who isn't built like a brick outbuilding and whose sole interaction with the world is to pepper it with bullets, knife slashes and tactical nukes?
I realise the irony of saying this given my preference for the bald-headed, space marine genre of third-person action games but there again, I don't want to be those characters, either.
If games are supposed to be offering me wish-fulfilment and an escape from the pressures of the real world, they're doing a bang-up job on the second point and a piss-poor job on the first part.
Tagged as Battlefield 3, Call of Duty, Charlie Brooker, Gears of War 3, Modern Warfare 3, Space Marine, Warhammer 40K
"Gears of War 3" – second DLC announced.
Got your "Gears of War 3" season pass yet? Me either. I wasn't entirely convinced by the promise of the first "Horde Command" add-on (out in November) but the second one – the just-announced "Raam's Shadow"- seems like it might be more to my liking.
It's the master of disaster, Sera's Reaper, the Locust with the mostest - General Raam!
A three-hour side-story which lets you play as the antagonist and Torque-bow sponge from the first game, "Raam's Shadow" also adds 250 sweet cheevos, new protagonists and – be still your hearts – chocolate weapons.
Chocolate weapons? Toblerone Lancer? Twix Hammerburst? The mind boggles.
It's due out on December 13th, by which time I might have made some actual progress in 'Horde'. Hope springs, and all that.
Filed under Gaming, Geekery
Tagged as Cliffy B, Epic Games, Gears of War 3, Marcus Fenix, Xbox 360
"Gears of War 3" first DLC details.
Beaten "Gears 3" already? Bludgeoned "Horde" and bested "Beast" modes? Merrily chain-sawing a swathe through the multiplayer?
Joystiq has your back.
Hey Bernie? What's up? Other than the body count, that is...
Their post details what to expect from "Horde Command on November 1st, as Epic release the first DLC pack for the game, with video from X-Play.
It's going to cost 800 Microsoft Space Credits or is included as part of the Season Pass, pre-order DLC shenanigans that you can sign up for.
I'm really enjoying "Gears 3" as I plow through it in hour-long increments – though I wasn't expecting THAT major character to pop their proverbial clogs at THAT point in the narrative. I nearly dropped my Cornetto, I'll have you know. I suppose it was inevitable, but that didn't make it any less, well, deflating…
Tagged as DLC, Gears of War 3, Xbox 360
Gears of War 3 – Cliff speaks!
Sir Clifford Bleszinski, architect of active-reloaded mayhem and badassery...
As part of what I may retrospectively title "Gears of War 3" week, here's a link to Aisha Tyler's excellent "Girl on Guy" podcast, which this week features Dude Huge himself, Epic Games design director Cliff Bleszinski.
The "Gears" awesome? It is overflowing. Look at all that juice!
Tagged as Aisha Tyler, Cliffy B, Gears of War 3, Gears Week
"Gears of 3" steelbook unboxing
What's in there, I wonder?
Why, it's one of those new-fangled, "Gears of War 3" steelbooks...
Commando Dom bonus DLC multiplayer character skin
What the inside looks like...
Stickers!
Yep, that's my copy of "Gears 3" alright. Just got to beat "Space Marine" and I'm all over that game…
Tagged as Collector's Edition, Gears of War 3, Xbox 360

redpajama_set_name: RedPajamaCommonCrawl


text:
Topic: Other races
race horse
Triple Crown of Thoroughbred Racing
Thoroughbred horse race
Conditions races
United Kingdom horse racing
National Estimates of Petitioned Status Offense Cases: Race (Site not responding. Last check: 2007-10-30)
Compared with fl youth, white youth and youth of other races had greater proportions of status liquor law violations and smaller proportions of truancy cases (table 78).
Between 1987 and 1996, the number of petitioned status offense cases increased 95% for white youth, 117% for fls, and 164% for youth of other races (table 79).
Increases occurred in all offense categories for all races, with white juveniles having the largest increase in truancy cases, and fl youth and youth of other races the largest increase in liquor law violation cases.
ojjdp.ncjrs.org /pubs/jcs96/pet_7.html (791 words)
National Estimates of Delinquency Cases: Race (Site not responding. Last check: 2007-10-30)
Juveniles of other races accounted for 4% of all delinquency cases in 1996 and comparable proportions of each of the four major offense categories.
Among youth of other races, however, the rate at age 17 was slightly lower than the rate for 16-year-olds (figure 12).
On the other hand, person offense cases accounted for a growing proportion of waived cases between 1987 and 1996, increasing from 22% to 40% for white youth and from 37% to 46% for fl youth.
ojjdp.ncjrs.org /pubs/jcs96/del_8.html (1290 words)
Cormanthyr - Elven Races of Toril
However it was the sun elves own arrogance and contempt of the other races that was the biggest stumbling block to the full realisation of Eltargrim's dream - a city where all goodly races were welcome and all art and lore valued no matter the source.
Silver elves remain a race whose inquisitive nature, curiosity and hunger to see and to know has led them to be wanderers and explorers, and also to be the elves most in contact with the other races.
Other magic is present in the form of druid spells and sorcery rather than the clerical and wizardly magics of scholarship and learning.
myth-drannor.net /DlabraddathNet/z-Cormanthyr/races-Toril.htm (3423 words)
Wacky Races - Wikipedia, the free encyclopedia
Said facilities would sometimes backfire on the other racers---shampoo foam hitting the faces of the other racers, for instance.
The late 1970s series Yogi's Space Race featured Hanna-Barbera stalwards such as Huckleberry Hound, Yogi Bear, and others racing against each other across outer space (and fending off a villain and his canine sidekick).
This is perhaps the most direct homage to Wacky Races, as the episode transforms one of the characters, the mad ace Yazan Gable of Zeta Gundam, into a Muttley-esque character, complete with a dog-like snout and a raspy, hushed laugh.
en.wikipedia.org /wiki/Wacky_Races (1180 words)
[No title] (Site not responding. Last check: 2007-10-30)
It includes people who indicated their race or races by marking this category or writing in their principal or enrolled tribe, such as Rosebud Sioux, Chippewa, or Navajo.
It includes people who indicated their race or races as "Native Hawaiian", "Guamanian or Chamorro", "Samoan", or "Other Pacific Islander", or wrote in entries such as Tahitian, Mariana Islander, or Chuukese.
Some other race was included in 2000 census for respondents who were unable to identify with the five Office of Management and Budget race categories.
www.informationgenius.com /encyclopedia/r/ra/race__us_census_.html (575 words)
EverQuestLive.com - Official EverQuest News
The Frogloks are a race of sentient amphibians.
The fearsome and savage reptilian race on Norrath is known as the Iksar.
Shar Vahl is the majestic den of the Vah Shir.
eqlive.station.sony.com /library/races.jsp (2980 words)
RACE TRAITOR | Other Races
From the first number of Race Traitor, in which we wrote that the only alternative to the white race is the human race, critics have said we oversimplify the race problem.
The situation is still in flux, and it is not yet clear which groups will be admitted to the privileges of the favored race and which will be excluded; the greatest actual beneficiaries of the new ethnic upsurge may be those who have traditionally enjoyed the privileges of whiteness.
We cannot make the point too often: race privilege is for those who have nothing else; its function is not to exempt people from exploitation but to reconcile them to it.
racetraitor.org /otherraces.html (1394 words)
RACE TRAITOR Other Races (Site not responding. Last check: 2007-10-30)
www.postfun.com /racetraitor/features/other.html (1441 words)
Other Races for Dragonstar (Site not responding. Last check: 2007-10-30)
The race would have likely been exterminated if a female silver dragon named Yilamatyl had not intervened by petitioning the Imperial Council to save the bhruu, a creature she claimed was as intelligent as an elf or a human.
The other reason was more to do with the desires of young deepfallen that wished to explore not only other worlds but the stars as well.
Such specimens are few and fare between as the jäger tend to win most battles against other races and go out of their way to either destroy or retrieve the bodies of their dead.
www.geocities.com /rielun/campaigns/dsraces.html (4663 words)
GER - Other races (Site not responding. Last check: 2007-10-30)
The race had a special international feel with the participation of several Dutch runners representing one of the series sponsors Local Heroes and the town of Hof van Twente which were responsible for raising support for the Dutch charity.
Earlier, the race organisers had asked the crowds for a one-minute silence to remember the victims of last August's floods in the town which had claimed more than 250 lives.
Race sponsors ORBIS International which works in trachoma treatment and prevention in this part of Ethiopia, and the Embassy of France, represented by their Ambassador HE Stephane Gompertz, were among the participants as were students from the Wusate Birhan Music School for the Visually Impaired whose members performed traditional music before and after the race.
www.ethiopiarun.org /reports/otherraces.aspx (1407 words)
Off the Kuff: In those other races
Greg has you covered for the local and state races on the slate for 2004 (here and here).
The big news in the state House races is that Rep. Ron "As Bad As I Wanna Be" Wilson has drawn a primary challenger in State Board of Education rep Alma Allen.
If he wins his primary race, it'll be interesting to see if he steps down from the Council or is simply distracted.
www.offthekuff.com /mt/archives/002830.html (602 words)
RACES (Radio Amateur Civil Emergency Service)
RACES is administrated by a local, county, or state civil defense agency responsible for disaster services.
RACES is a function of the agency's Auxiliary Communications Service (ACS), sometimes known as DCS (Disaster Communications Service), ECS (Emergency Communications Service), ARPSC (Amateur Radio Public Service Corps), etc. Many ACS units identify themselves solely as RACES organizations, even though their communications functions and activities typically go beyond the restrictions of RACES operations.
To join ACS or RACES and to be able to participate in RACES and other government emergency communications activities, contact your local, county, or state ACS Officer or RACES Radio Officer or Coordinator.
www.races.net /what.html (658 words)
Other races' hairstyles - The Saga of Ryzom
When you have developers that listen to their customers and make adjustments to the game its important to be responsible about what we ask for.
Lots of things i and many others used to enjoy have been destroyed by ppl complaining they are too hard and the dev's making them easier.
Even 'restricted' to your own races cosmetic merchants now there are a lot of styles available, but would be nice to have the whole range of colors available to all
www.ryzom.com /forum/showthread.php?mode=hybrid&t=15036 (375 words)
Other Races of Caelereth
ACES OF Aside from the main races of the world of Caelereth like humans, elves, dwarves and men, there are also various minor races - the giant, the small races and some races, which don't fit in any of these categories.
Their existence is doubted by many and mostly mentioned in legends and fairytales at the most northern tribes of the ice continent of Cyhalloi, such as the Cyhallrhim elves or the Kasumarii.
Most information concerning this mythical race therefore is gathered through ancient tomes recounting legends of the far north and of narrations of travellers who claim to have met these men-beasts themselves.
www.santharia.com /races/races_other.htm (510 words)
afrol News - South Africans consider other races most racist
Indians, on the other hand, hold that fl and white South Africans are equally racist.
As with national identity, race identity was stronger among Africans than among the other three race groups.
Her study, published earlier this month, was to raise the question of whether strong national identity or patriotism actually matters for the formation of a non-racist and united South African society.
www.afrol.com /articles/16872 (649 words)
Certain races are known to be 'unreadable' to Betazoids, specifically the Ullians, Breen and Ferengi, possibly due to their unique four-lobed brain configurations.
Certain Q are known to tease and torment lesser races for their own pleasure, and as such the Q have been of significant concern to the Federation.
Although the race as a collective whole had suffered from a series of social problems due to their abilities, by the 24th century cases such crimes involving 'mental rape' violations had almost completely disappeared from the general population.
www.trekmania.net /diplomatic/others.htm (4162 words)
Races de chiens - Chien de race
Vous pouvez consulter les standards de plus de 300 races de chiens reconnues.
Chiens courants, chiens de recherche au sang et races apparentées.
Races de chiens et aussi les Races de chiens
www.races-chiens.com (118 words)
On race day, Saturday, July 24, check-in/registration for the 4-mile run/walk will be from 7:00 to 8:00 a.m.
This is a scored race that counts toward the nine races NYRR members need to be eligible for guaranteed entry to the ING New York City Marathon 2005.
You must complete the race with your chip attached to your shoe or your time will not be recorded.
www.nyrrc.org /race/2004/r0724x00.html (583 words)
History of Shan Deral
This webscroll is a collection of historical information relating to the seven known major races and the world of Shan Deral.
Included is a map of the world with notes and and some speculation about what lies beyond the known lands.
There is a complete timeline of Shan Deral history, and much detailed information on the history of each race.
www.clanlord.com /history (118 words)
EverQuest II: The Age of Destiny :: EverQuest 2 News, Information, Articles and Discussion (Site not responding. Last check: 2007-10-30)
The Kerra, who once lived on Odus, were a split race of small tribes.
The Wood Elves, or Fier`Dal, are more accepting of others than their cousins, the High Elves.
Some races can be either good, evil, or neutral based upon their class choice.
www.eqii.com /libraces.php (3230 words)
The Tortoise and the Hare, and Other Races between Unequal Contestants
The Race of the Buffalo and the Hare (Romania, M. Gaster).
The Race of the Buffalo and the Hare.
The race was a five-mile heat, and the ground was measured off, and at the end of every mile a post was stuck up.
www.pitt.edu /~dash/type0275.html (7102 words)
In addition to the races that FLRC sponsors, there are many others in the central and upstate New York area.
Race is in conjunction with the UMC Street Fair featuring live entertainment, karaoke, crafts, great food, baked goods, raffles and lots more.
This race is being offered by the local volunteer fire department to contribute to a building-fund for a new fire house.
www.fingerlakesrunners.org /races/listings (4474 words)
Florida voters to choose nominees to replace Sen. Bob Graham; other races include LePore bid (Site not responding. Last check: 2007-10-30)
Polls showed the Republican race virtually deadlocked as McCollum, a former Orlando-area congressman who lost to Sen. Bill Nelson in 2000, and Martinez, a former Bush Cabinet secretary who was encouraged to run by the White House, sparred over McCollum's support of hate crimes legislation and embryonic stem cell research.
In the Democratic race, Castor, a former state education commissioner and university president, held a double-digit lead over Rep. Peter Deutsch, who hoped to bolster his chances with a large turnout among fl voters.
In other Florida races, six top candidates were battling in a wide-open race to replace Penelas in a nonpartisan primary.
www.sfgate.com /cgi-bin/article.cgi?f=/news/archive/2004/08/31/politics1108EDT0563.DTL (774 words)
Polarized society ignores other races
When two races dominate the limelight and attention, other enthnicities often fail to become noticed by the media and the masses of America
In defense, the white kids would lash back with claims that things were indeed equal between fls and whites and that they were sick of others complaining that things were not.
Other than the descendants of Native Americans, everyone here has an ancestor who came off a boat.
www.usc.edu /student-affairs/dt/V130/N20/01-polarized.20v.html (780 words)
Opinion of Civilization
In other words, culture may be described as the patterned behaviour in which the individual learns, either through instruction or imitation, from other members of his social group.
A race of men now rejected from society for their sable skin and frizzled hair, founded on the study of the laws of nature, those civil and religious systems which still govern the universe.
Certain other tribes as the Nayadi, Kadir, and Benkar are as Negroid as certain of the natives of New Guinea.
www.edensinstitute.com /OpinionofCivilization.htm (7139 words)
Most state Indians also claim other races
That was an increase of 20 percent from the 1990 census.
Many American Indians in Detroit come from Canada or other parts of the United States to work and end up staying and raising families, she said.
Michigan offers tuition waivers to students who can prove they are at least 25-percent American Indian, so young people are drawn to cities with state colleges and universities, she said.
www.freep.com /news/census/cnativ31_20010331.htm (673 words)
Other Races (Site not responding. Last check: 2007-10-30)
Here is some information about some of the major races involved with DS9.
There are many races in Dominion, many of which have not yet been encountered.
The control the drug Ketracel White which the Jem'Hadar need to survive and look after all contact with other races.
members.aol.com /slayersoft/quarks/races.htm (339 words)
Flagler County RACES Net (Site not responding. Last check: 2007-10-30)
The Flagler County RACES Net operates in conjunction with the ARES radio nets on the 147.075 Mhz repeater in Palm Coast.
The RACES Net is supported by amateur radio operators from ARES, REACT, Flagler County Sheriff's Office, American Red Cross, and other recognized organizations under the Communications and Warning Section of the Emergency Management Division of Emergency Services.
Marc Bellefontaine, KA1NJH communicates with other RACES amateur radio operators during the 1998 wildfires.
geocities.com /CapitolHill/Parliament/4013/RACES.html (100 words)
deseretnews.com | Workman woes may spread to other races
Besides losing the mayor's race, the biggest potential implication would be a general indictment of the Republican Party because of the charges against the mayor.
Within the county council races, incumbent Republican Councilman Steve Harmsen is already locked in a tight race with Democratic challenger Jenny Wilson, and he acknowledged that the problems at the county have forced him to do more education about the difference between the council and the mayor.
However, he said that because of his record of strict ethics — for example, he pushed for rules prohibiting gifts or food for elected and appointed officials and openly criticizes fellow county officials for various conflicts of interest — he is not concerned that people will lump him in with the mayor.
deseretnews.com /dn/view/0,1249,595088772,00.html (696 words)
What do you believe about other races? - Stormfront White Nationalist Community (Site not responding. Last check: 2007-10-30)
Their difference cannot be attributed to culture because the difference between them and any other race is so great.
All races have a right to live separately, to govern themselves, to protect and preserve their race.
Their are differences between races however these are merely physical...
www.stormfront.org /forum/showthread.php?p=1672848 (1271 words)
Analyzing Stereotypes And Lightheartedly Poking Fun At Other Races - Beastie Boys Message Board
I mean, Seattle is not known for its progressive race relations, for better or worse it is a super stratified city and occasionally it rears its ugly head (the riots on Mardi Gras a few years back).
Is it really the other way around and people want to go straight to genocide but they can't so they content themselves with stereotyping and discrimination until a hoarde of zombies renders all social structure null and void.
Not just that but being my wife is Chinese, she has and I have alot of friends that are Chinese and they take pride in the fact that they are skilled in mathematics.
www.beastieboys.com /bbs/showthread.php?t=63079&goto=nextoldest (3045 words)


text:
Cast & Crew – Six Stories Tall
Six Stories Tall
Christopher Acevedo (Ensemble) is incredibly thrilled to be working with Adventure Stage Chicago again! Previous credits with ASC include New Kid, and performing "I Am Not Batman" from Six Stories Tall at the International Performing Arts for Youth conference. Other Chicago credits include Winterset (Griffin Theatre), You on the Moors Now (The Hypocrites), Richard III (The Gift), and work with Court, Chicago Dramatists, Tympanic, Mary-Arrchie, Lifeline, Teatro Vista, Strawdog and others. He is the Artistic Director of Tympanic Theatre, is represented by Grossman & Jack Talent, and is a recent graduate of The School at Steppenwolf (Class of 2015). Thanks to Tom, this amazing ensemble, and his wife, Amanda Jane!
Danielle Davis (Ensemble) is thrilled to be back at ASC doing one of her favorite shows! Credits include: Spark and Six Stories Tall (Adventure Stage Chicago, where she is an Associate Artist); The Hundred Dresses (Chicago Children's Theatre); Rent (Theo Ubique); Love, Loss, and What I Wore (First Folio Theatre); Women at War/Tour (Rivendell Theatre Ensemble); Velveteen Rabbit (Lifeline); From Doo Wop to Hip Hop and Aint No Crying the Blues…Howlin' Wolf (Black Ensemble Theater); The Wiz (Theatre at the Center); Chicago PD; and work at Artemisia, TimeLine Theatre, Step Up Productions, and Quest Theatre Ensemble. She holds a BFA in Acting from the Chicago College of Performing Arts at Roosevelt University. Danielle is represented by Paonessa Talent Agency.
DJ LMS (DJ Swing) is a Chicago DJ with passion for turntables and an ear for music. He found his love for music as a hip-hop dancer of many years before he broke into the DJ scene while making mixes for his dance team. LMS has done crowd control from Chicago to Rome, music festivals to college concerts, basement parties to weddings to corporate events. If there's a crowd ready to dance, then DJ LMS is ready to give them a night to remember.
Mikhail Fiksel (DJ/Original Music & Sound Design) has been heard at venues in Chicago, New York, Los Angeles, Brazil, Holland, Japan, China, Russia, and beyond. He is a company member of 2nd Story and Strawdog Theatre Company, and an Artistic Associate with ASC, Albany Park Theatre Project, TimeLine, Teatro Vista, Collaboraction and Redmoon. Theatre credits also include projects with Goodman Theatre, Writers Theatre, Northlight Theatre, Victory Gardens, About Face, The Hypocrites, The House Theatre, The Neo-Futurists, Dallas Theatre Center, Berkeley Repertory Theatre, The Old Globe, St. Louis Repertory, and many others. He was awarded the Lucille Lortel Award for his sound design of the critically acclaimed The Elaborate Entrance of Chad Deity.
Jeffery Freelon (Ensemble) is a Chicago native and graduate of University of Michigan, Music Theatre and Dance School. Jeffery returns to ASC after performing in Theater Unspeakable's The American Revolution. Jeffery was blessed to play an array of different roles at UM, including John Proctor in The Crucible, Nihad Harmanni in Scorched, and Lincoln in Topdog Underdog. Jeffery first made his Chicago debut as the "Bridegroom" in Pursuit Production's Blood Wedding. He has also been fortunate enough to understudy for Othello under the acclaimed director Jonathon Berry .
Alyssa Vera Ramos (Ensemble) is an original cast member of Six Stories Tall and was recently seen in Epic Tales From the Land of Melanin (FEMelanin at Chicago Kids Fringe). As an actor, she has worked with Teatro Vista, First Floor Theater, Chicago Dramatists, and the 1-Minute Play Festival, among others. Alyssa is a Victory Gardens Directors Inclusion Initiative fellow; founding member of women of color performance collective FEMelanin; and company member of For Youth Inquiry (FYI), where she devises participatory experiences, including the upcoming play Expectation. She holds a degree in theatre from Northwestern University. www.alyssaveraramos.com
Nelson Rodriguez (Ensemble) is an Associate Artist of ASC and Artistic Director of Pride Films and Plays, where he appeared in Men on the Verge of a His-Panic Breakdown (2016 Joseph Jefferson Award nomination - Solo Performance). Additional credits include The Compass (Steppenwolf for Young Audiences) and a starring role in the feature film En Algún Lugar. He is a recipient of Windy City Times' 30 Under 30 Award, a member of The Alliance of Latinx Theatre Artsits' playwrights circle, and represented by Gray Talent Group.
Marco Ramirez (Playwright) has had plays produced at The Kennedy Center, The Juilliard School, The Arsht Center, and Actors Theatre of Louisville's Humana Festival of New American Plays (where he's twice received the Heideman Award). TV writing credits include FX's Sons of Anarchy. He trained at both NYU and The Juilliard School. His award-winning play The Royale opened at Lincoln Center in 2016 after a critically-acclaimed premiere production at Chicago's American Theater Company.
Tom Arvetis (Director) is the Founder and Producing Artistic Director of Adventure Stage Chicago. Playwriting credits: Walk Two Moons (Dramatic Publishing; AATE Distinguished Play of 2013), Spark: Chapter One of the Prometheus Project, Sight Unseen: Chapter Two of the Prometheus Project, and I Dream in Blues. Directing credits include: Augusta and Noble, Six Stories Tall, And a Child Shall Lead, 500 Clown: Trapped, Katrina: The Girl Who Wanted Her Name Back, The Blue House. In 2013, Tom received the Orlin Corey Award for Artistic Excellence from AATE. Tom was a member of AATE's first Theater Leadership Institute in 2007, an Ann Shaw Fellow with TYA/USA in 2009 and twice a finalist for a Chicago Community Trust Fellowship. He has served on the AATE board of directors and is an adjunct lecturer at Northwestern University.
Brandon Campbell (Production Stage Manager) happily traveled 2,000 miles back to Chicago to help further the success of this terrific show and tour. Currently, he resides in Seattle, WA with his wife Lacy, and splits his time as a stage technician for Seattle Center, and as a freelance A/V and show director for events throughout the Pacific Northwest. Brandon previously served as Production Manager for ASC between 2007- 2015, and dearly misses the wonderful folks of the Settlement. Past theater work includes production and stage management for Collaboraction, The Neo-Futurists, and Teatro Vista, and puppetry design for Albany Park Theater Project (Gods Work), and here at ASC (The Cay, Sinbad: the Untold Tale, And a Child Shall Lead).
Liviu Pasare (Projection Design) has a Chicago-based practice creating visual experiences using new media and technology. He works as a video designer, cinematographer, editor and animator, and has produced, directed, and performed for live events. He has worked on projects such as inSite, Luminous Field (Luftwerk); Until (Nick Cave); The Dolls (Claudia Hart); The Elephant and The Whale (Chicago Children's Theater/ Redmoon); Mementos Mori (Manual Cinema), Where Did We Sit on the Bus (Teatro Vista); The Making of the Superstrip (Lucky Plush); Piedmont Blues, Douglass(American Vicarious); among many others. He holds MFA degree in Art and Technology from the School of The Art Institute of Chicago and is advancing an academic approach for Video for Performance as faculty at DePaul University. liviu.stoptime.live
Stephanie Paul (Choreographer) is a Resident Director with Albany Park Theater Project, where she has been a director, choreographer, and composer on God's Work, I Will Kiss These Walls, Home/Land, and Feast. Additional credits include: The Royale (American Theater Company – Jeff Award Nomination), Water by the Spoonful (Court Theatre), Six Stories Tall (Adventure Stage Chicago, 2012) and Lookingglass Theatre's LAB program. Stephanie is Founder, Artistic Director and ensemble member of Be the Groove, a Chicago-based rhythmic performance ensemble with performances at the Harris Theater, Jay Pritzker Pavilion, Ravinia, and most notably the Royal Opera House Muscat in Oman. She is an Artistic Associate with Chicago Dance Crash and on staff at Dance Center Evanston. Stephanie has been featured on WTTW's My Chicago and is committed to the exploration of music and movement as integral components of storytelling.
Jessica Kuehnau Wardell (Costume Design) is a freelance scenic/costume designer, teacher and artist in Chicago. As a founding ensemble member of Adventure Stage Chicago, she has been gleefully designing and collaborating with ASC since 2006, creating everything from an island of giant books to a three headed monster on the Red Line. Her Chicago design credits include Hypocrites, Steep, Rivendell Theatre, Griffin Theatre, A Red Orchid, 16th Street Theatre, MPAACT, The Building Stage, Pegasus Players, and Lifeline Theatre. Jessica earned her MFA from Northwestern University and is the Director of Design at University of Chicago. Check out her other designs at jesskdesign.com.
Brandon Wardell (Scenic/Lighting/Properties Design) is a Lighting and Scenic Designer based in Chicago. He is an Ensemble Member with Adventure Stage Chicago as well as an Artistic Associate of Steep Theatre. Recent projects include the critically-acclaimed productions of London Wall, Bat Boy the Musical, Men Should Weep, and Titanic (Griffin); Chicago Voices (Lyric Opera); The Game of Love and Chance (APT); Heathers and Assassins (Kokandy); Wastwater, Brilliant Adventures and The Cheats (Steep); Yankee Tavern (ABT); Bad Jews (Wit); Spark , Six Stories Tall, and Reprise (ASC). Upcoming work Earthquakes in London at Steep. Brandon earned his MFA from Northwestern University and is a Professor at Northern Illinois University. www.brandonwardelldesign.com


Fairy Fencer F is coming out first now.
NIS America has delayed the release of Natural Doctrine one week and pushed Fairy Fencer F forward one week, trading their release dates.
Natural Doctrine, previously set for release on September 16 and 19 in North America and Europe, will now launch on September 23 in North America and September 26 in Europe. It will be available for PlayStation 4, PlayStation 3, and PS Vita.
Fairy Fencer F, previously set for release on September 23 and 26 in North America and Europe, will now launch on September 16 in North America and September 19 in Europe. It will be available for PlayStation 3.


Offer - 20% off any tour!
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text:
« Chapter 29 - Tanzania's Wildebeest Migration in the Serengeti Ecosystem | Main | Chapter 31 - Switzerland - Returning for Mountains & Pretzels »
Toto began an around-the-world trip in Helsinki, Finland, which is way up in Northern Europe. Finland is so far north, half the country is north of the Arctic Circle. The Arctic Circle is the line on your globe or world map that represents 66 degrees latitude. At the center of the Arctic Circle is the North Pole. At least one day per year in the summer, the Arctic Circle has 24 hours of sunlight, and the opposite is true during the winter.
The part of Finland that is above the Arctic Circle is called "Lapland." Do you know what Lapland is famous for (besides being cold and either really dark or really light all t he time)? It is where Santa Claus lives! Can you find the city of Rovaniemi on a map of Finland? It lies right on the Arctic Circle. That is where the people of Finland believe Santa lives. He has a village there with a post office that will answer any letters mailed to Santa Claus there.
It must be really cold in Lapland in the winter, because it was cold at the beginning of May down south in the capital city of Helsinki. The trees had not sprouted leaves yet when I was there, because Finland is so far north on the globe.
In English we refer to this country as Finland and the people "Finns." What would you think the n ame of Finland would be in Finnish? I would think the local name for the country would sound something like the word we use in English, right? Actually, the Finn's name for their country sounds nothing like "Finland." The country's name in the local language is "Suomi" and the people are called "Suomalairen"! I asked a Finnish woman from the tourism office why we use such a different term in English than in the local language and she admitted she had no idea and also found it funny. You'd think we'd call the country "Suomiland" and the people "Suomis," wouldn't you?
While I was visiting, tourists from all over Europe were arriving to Helsinki. This is because Helsinki was hosting the annual Eurovision competition broadcast on TV throughout Europe. Eurovision is like the American TV show "American Idol," except in the Eurovision competition, each country within Europe enters a person or group to represent their country. Then all the countries divide a certain number of votes among their favorite acts (a country cannot vote for itself). There are forty-two countries represented all across the extended European region, from Sweden to Serbia and Ireland to Israel. Each country's fans obviously want their country's act to win, and so it's a bit like a cross between "American Idol" and the World Cup soccer only for Europe. Moreover, the competition occurs once a year.
Last year I was in Slovenia when the Eurovision final was on TV. The whole city was watching, so I did the same at the pizzeria. Last year Finland won with a funny act called Lordi who to me is a cross between the old rock band, KISS, and some monsters from The Lord of the Rings movie! As an honor for winning, Finland got to host the 2007 competition. I met some Spanish students in my hotel elevator with their Spanish flags who came to cheer on Spain in the semi-finals. I wished them luck. Regardless of the ultimate winner, all of Europe gains by learning more about each other's countries every year in the Eurovision competition, which was one of the reasons the broadcasters came up with the idea, I suspect, in the 1950s after the terrible experiences from World War II. The Eurovision competition has been broadcast without interruption every year since 1956. Perhaps we all could benefit if we had a friendly worldwide music competition that welcomed students to meet each other in the spirit of togetherness?
Travel Questions on Finland:
What is unique about the Arctic Circle in the summer?
What is at the center of the Arctic Circle?
What is the name of the province within northern Finland where the Finns believe Santa Claus lives?
What is the name of Finland in their local language?
Where did Toto watch the 2006 Eurovision finals when the Finish group, Lordi, won the competition.
Serbia won the 2007 Eurovision competition days after Toto left Helsinki. In which city will next year's Eurovision competition be held? (Hint: Re-read chapter 6.)
Global Nomad Questions on Finland:
Write a letter or email to Santa Clause in Lapland at his address below. Ask him to write you back. The Finns told me unless he is too busy, he will write back if you ask and that he reads every letter. You can read more about Santa's post office by clicking on this link.
FIN-96930 Arctic Circle
santa.claus@santaclausoffice.fi
Pick one of the 42 countries competing in the Eurovision contest (www.Eurovision.com) and write your own TotoTravels.com chapter about it. Email it to TotoTravels@gmail.com. Toto will select the most interesting chapters to post on www.TotoTravels.com for everyone to read.
Finland actually has a second official language. Do a cybersearch and write what that second language is. (The name of the country in this second official language is "Finland," so my guess is that's why the country's name in English is Finland instead of Suomi.)
In Finland Toto learned something new about the difference between Scandinavia and the Nordic countries. He had mistakenly thought Finland was part of Scandinavia, which is the name of the region made up only of three countries near Finland: Norway, Sweden and Denmark. Finland considers itself as part of the four "Nordic" countries. Do a cybersearch to find out what the other three Nordic countries are.
May 15, 2007 in Europe | Permalink


text:
Q: how make a laravel pagination component? I have a slider component with a back and forward button and I want to get data in sort of pagination how can I do this?
I just want to do this without using Vue.js or livewire just laravel , JS and JQuery.

A: First, why using slider to create a pagination? there are better approach like lazy load, filter column, and simple pagination. lazy load is best for performance i guess.
If you insist to create a slider component, just wondering, how many data that you have? and how many data that you want to retrieve to screen? Imagine, you have more than 1.000.000 rows in your database, you sure wouldn't want to query for them all for real time updates to your screen. Why i tell you 'query them all'?
Let me tell you, if you do a pagination using laravel default pagination (using limit and offset), the flow behind this is like this:

*

*DB will select all of your rows that you have

*DB will limit your row depends on limit parameter

*DB will scan row one-by-one to match the offset that you want

*DB will retrieve the data that you want

With that flow, that's why pagination (limit & offset) is not good enough if you have a lot of data. The solution is change your pagination logic from limit & offset to query like this (case: auto incremental id):
SELECT
    *
FROM
    payments
WHERE
  Id > 15
LIMIT 20

or for descending approach, you can query like this:
SELECT
    *
FROM
    payments
WHERE
  Id < 50
ORDER BY Id DESC
LIMIT 20

Then in laravel, send a json that include a pagination data. So, in javascript you just have to align the pagination data with library or your own pagination logic.

A: Laravel's Query Builder provides a paginate method that gives you a LengthAwarePaginator. Normally, you would render this in a blade view with $items->links(), but instead you can convert its result to JSON (https://laravel.com/docs/8.x/pagination#converting-results-to-json). That way you can use the results in JavaScript any way you'd like.

redpajama_set_name: RedPajamaStackExchange


text:
CALL FOR CONSULTATION 865-522-4964 865-522-4964
James W Justice
David D Noel
Charles C Burks Jr
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A versatile team of attorneys
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From civil litigation, criminal law, and family law, our lawyers supply every case with the knowledge and skill gleaned from their 125 years of combined experience.
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Every individual deserves to have the assistance and support of a knowledgeable attorney when facing the Tennessee legal system. Our attention to detail, thorough investigation, preparation and willingness to take cases to trial help us achieve the best possible results for our clients with respect to their circumstances. We strive to resolve matters outside of court through alternative dispute resolution (ADR) techniques such as mediation and arbitration, but our attorneys are also skilled litigators prepared to handle any contested matter.
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text:
Ao longo de 2 horas vamos aprender sobre controladores, modelos, serviços, templates para fazermos uma app de votação no teu filme favorito do Star Wars em [Angular.JS 1.4](https://angularjs.org/).

1.4? Sim, a força ainda não é suficientemente forte com o 2.0!

## Pré-requisitos:
--------------------------
- Conhecimentos de JavaScript, HTML5, CSS3

Para podes acompanhar o desenvolvimento, necessitas de ter instalado:
- [Git](https://git-scm.com/)
- [Node.js](https://nodejs.org/en/)
- [Bower](http://bower.io/)
- O teu code editor favorito

Podes instalar no teu sistema ou em alternativa, criar uma máquina virtual com o Vagrant.

## Instruções para instalação dos pré-requisitos no teu computador:
--------------------------
- faz download e instala o [Git](https://git-scm.com/downloads) para o teu sistema
- faz download do pacote de instalação do Node.js para o teu sistema em https://nodejs.org/en/
- depois de teres o Node.js instalado, executa 'npm install -g bower' na linha de comandos

## Instruções para criação da máquina virtual com o Vagrant:
--------------------------
- instalar o Virtual Box a partir de https://www.virtualbox.org/
- instalar o Vagrant a partir de https://www.vagrantup.com/
- clonar o repositório a partir de https://github.com/AngularPortugal/script-wars.git
- abrir uma linha de comandos na pasta do projeto
- executar 'vagrant up'
- esperar que a máquina virtual seja inicializada
- o login é feito com o user 'vagrant' e password 'vagrant'

redpajama_set_name: RedPajamaGithub


I'm an Education Coordinator at Spring Creek and a knitter who's recently discovered a passion for knitting lace. Knitting at lunch was fun but time flew by and it was over much too fast. So what started as an enterprise in my own criminal thinking – how can I get away with knitting at work – turned into something entirely different – a daily crochet class for General Population prisoners and conversation about children, respect, food, family, music and more. And like broccoli hidden in the macaroni and cheese, crochet time is also a lesson in anger management and impulse control, in goal setting and delayed gratification, in cross cultural communication and social skills. It's a quietly subversive time with amazing and wonderful results. Hats, scarves, booties and blankets are made and creative muscles flexed as prisoners adapt patterns to their own designs. Correctional Officers do double takes as they walk by the classroom. Everyone knows someone who knows how to crochet, especially in the prisoner population where so many learned how in juvenile detention. And me, the knitter who discovered lace? Now I'm a crocheter too, grateful for the time and space we've created and constantly surprised by what happens.