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text:
Rooster Teeth Celebrates Five Years Of RWBY
Five years ago on July 18, 2013, the late Monty Oum and the folks at Rooster Teeth launched its hit web-series RWBY. The show tells the story of half-sisters Ruby Rose and Yang Xiao Long as they form a team of "huntresses" with their respective partners Weiss Schnee and Blake Belladonna (the titular Team RWBY) to fight the monstrous Grimm and conspiring evildoers intent on disrupting global peace. With its anime-inspired visual style and character designs, Oum's top notch combat choreography, an ever-growing all-star cast of voice actors and some of the most diverse and catchiest songs to ever grace a series soundtrack, RWBY has become a hit all across the globe.
I'm not going to argue over which of the show's four main protagonists are the best, as the answer is Yang and Weiss by a country mile, but one of the particularly fun things about RWBY is how its cast of characters are all inspired by various sources of fairy tales, mythology, history and even the occasional Internet meme. As a result, many a fan has debated over who *Insert New Character Here* is based on and what their source of inspiration may loosely entail for future plot developments.
That said, the franchise has endured tragic developments along the way. As previously stated, series creator and original director Monty Oum passed away on February 1, 2015 due to medical complications only two volumes into what Rooster Teeth has teased will be a rather long story. Following this heavy loss, current director Kerry Shawcross and co-writer Miles Luna stepped up to continue the show's ongoing development.
Speaking personally, I can't deny that I have my personal quibbles and frustrations with RWBY. As a fan, it's always easy to get caught up in the quality of the storytelling and fandom drama. But all of that aside, I think it's important to look back on what the team behind RWBY has accomplished over the past five years and appreciate the wonderful things that have come out of the show's fandom. Fans have written their own original song or two and the franchise is a goldmine for cosplayers, fan artists and fan-fic writers. Creativity begets more creativity and I think that's something Mr. Oum- a lifetime fan of all sorts of other franchises of anime and video games- would be happy to see continuing to bubble throughout the fandom of RWBY.
Happy Birthday, RWBY. Here's to many more for you all.

redpajama_set_name: RedPajamaCommonCrawl


BSM South is a community of students in and around Abilene, TX.
Here's my definition of worship: acknowledging God's presence by expressing great love, high respect, and deep gratitude towards Him. I've learned that this is the truest way to describe in easy terms what God desires to receive from us. He didn't appear to Moses as a burning bush and ask him to sing a song for Him. No! God asked Moses to take off his sandals. Why did God ask Moses to take off his sandals? Seems weird, right? He asked him to take them off because He wanted Moses to acknowledge with his physical body that He was standing before the presence of God Himself. How was taking off his shoes going to signify that he was honoring God's presence?


text:
Q: Wrong portlet version and deploy problems with Maven I created a new portlet plugin (build based on Maven) by using Liferay IDE.
If I launch a mvn liferay:deploy, deploy process ends successfully. But if run the same process (deploy) another time, the deploy fails.
Updating my-portlet from version 6.2.5 to version 0.1
Not updating my-portlet because version 6.2.5 is newer than version 0.1

I declared <version>0.1-SNAPSHOT</version> in my pom.xml file, but Liferay tells me (also in control panel) that plugin installed version is 6.2.5.
I'm using Liferay CE 6.2 (ga6), and following settings:
<liferay.version>6.2.5</liferay.version>
<liferay.maven.plugin.version>6.2.5</liferay.maven.plugin.version>

That are used (excluding portal dependecies) only in the following lines:
        <plugin>
            <groupId>com.liferay.maven.plugins</groupId>
            <artifactId>liferay-maven-plugin</artifactId>
            <version>${liferay.maven.plugin.version}</version>
            <executions>...</executions>
            <configuration>
                <liferayVersion>${liferay.version}</liferayVersion>
                ...

Do you have any idea about my problem?
Thank you.
EDIT
The problem is the same (portlet version 6.2.5) also by setting liferay.version and/or liferay.maven.plugin.version to 6.2.4...

A: and thanks for comments and reply.
I think I found a solution, and I would like to share it for future readers... because I didn't find it on the web... or better, it is on the web, but isn't related to this issue.
My original (Maven) module name was (due to project original specifications): client-external-customer-portlet, so resulting WAR was client-external-customer-portlet-0.1-SNAPSHOT.war
Someone on the web suggested to remove dashes from portlet name - in order to avoid a well-known Spring-mvc-portlet error.
I resolved my issue just applying the same suggestion to my portlet name: now it is clientExternalCustomerPortlet and resulting WAR is clientExternalCustomerPortlet-0.1-SNAPSHOT.war. In this way everything works fine.
My 5 cents are that LR deploy system uses dashes as special separators also in the deploy process.
By the way I get this idea when, deploying client-external-theme-0.1-SNAPSHOT.war, logs said that the context name was only client-ext.
I hope it can be useful.

A: The problem is that liferay starts with version 6.2.5 in your case, and you are trying to deploy a 0.1 version that is older than by default on Liferay.
I would try to deploy the portlet without version, just delete from name-portlet forward.
Portletname-portlet.war

In that case, liferay takes the version 6.2.5 like portlet version and deploy it succesfully.

redpajama_set_name: RedPajamaStackExchange


text:
Testing feedback message framing and comparators to address prescribing of high-risk medications in nursing homes: protocol for a pragmatic, factorial, cluster-randomized trial
Implementation Science > Ausgabe 1/2017
Noah M. Ivers, Laura Desveaux, Justin Presseau, Catherine Reis, Holly O. Witteman, Monica K. Taljaard, Nicola McCleary, Kednapa Thavorn, Jeremy M. Grimshaw
Audit and feedback
Analysis of covariance
Antipsychotic medication
Behaviour change technique
Continuing Care Reporting System
CIHI
Canadian Institute for Health Information
CPSO
College of Physician and Surgeons of Ontario
HQO
Health Quality Ontario
Institute for Clinical Evaluative Sciences
Ontario drug benefits
OHIP
Ontario health insurance program
Resident Assessment Instrument
RPDB
Registered persons database
Tricyclic antidepressants
There is evidence that how audit and feedback (AF) is designed and delivered may impact the effectiveness of the intervention [ 1 ]. However, little attention has been paid towards identifying the best way to design AF to encourage changes in clinical practice, in order to resolve discrepancies between actual and desired performance [ 1 ]. Brehaut and colleagues identified 15 suggestions for improving the effectiveness of AF but highlighted numerous areas requiring further empirical research to address outstanding uncertainty [ 2 ].
One area of uncertainty relates to the choice of the comparator that reflects desirable practice in a feedback report. Most often, the recipients' performance is compared against the average performance achieved by those practicing in the region. However, a higher benchmark more closely representing desired care would more clearly demonstrate the discrepancy between actual and desired performance for the majority of feedback recipients. A large randomized trial demonstrated greater improvements when feedback recipients were compared to an 'achievable benchmark', operationalized as the median score achieved by the top 10% of peers [ 3 ], versus those compared to the median [ 4 ]. To our knowledge, as is the case with many implementation science results [ 5 ], this has never been replicated.
Another area of uncertainty relates to the 'framing' of feedback content [ 6 ]. For a given quality indicator, it is possible to describe performance in multiple ways. For instance, a metric may be described as the proportion of patients for whom a desirable or guideline-concordant task was achieved (e.g. patients in whom high-risk medications were avoided). Alternatively, it may be described as the proportion of patients receiving care that is generally undesirable or not concordant with guidelines (e.g. patients inappropriately prescribed a high-risk medication). To our knowledge, despite extensive literature about how framing influences health-related decisions and behaviour in other contexts [ 7 – 12 ], the impact of different approaches to framing performance feedback provided to clinicians has never been tested.
We have previously argued that the science of AF is 'stagnant' [ 13 ] and that further trials testing AF against a usual care control group will not add new knowledge to the field [ 1 ]. Further, we have proposed that implementation scientists can partner with health systems or organizations already conducting interventions such as AF to create 'implementation science laboratories' in which various approaches to optimize such interventions can be tested [ 14 ]. In the present article, we describe a trial testing different AF designs, embedded within an implementation science laboratory.
This is a pragmatic, 2 × 2 factorial, cluster-randomized trial testing variations in the comparator and in framing on the effectiveness of AF to change prescribing, in the context of an existing province-wide AF intervention. An embedded mixed-methods process evaluation will explore potential mechanisms underlying the observed effects. The protocol received ethics approval from the Research Ethics Boards at the University of Toronto and Women's College Hospital. The Ottawa Health Science Network Research Ethics Board approved the process evaluation and the economic evaluation. The trial is registered on ClinicalTrials.gov (NLM identifier: NCT02979964).
In the province of Ontario, Canada, medically necessary services, including a broad formulary of prescription medications for those living in nursing homes, are covered under the government-run, publicly funded health plan. Health Quality Ontario (HQO) is the provincial advisor on quality in healthcare and, as such, supports ways to improve healthcare quality through quality improvement initiatives. One such initiative is HQO's 'Practice Reports', whereby confidential, aggregate feedback is offered to physicians across the province about their own practice. The reports for physicians working in nursing homes are known as the Long-Term Care Practice Reports (http://www.hqontario.ca/Quality-Improvement/Practice-Reports/Long-Term-Care). The HQO reports are generated by a multidisciplinary team, including clinicians, epidemiologists, and quality improvement experts, supported by input from front-line clinicians, health services researchers, sector organizations and associations, and policy makers. HQO relies on best evidence, advice from the groups listed above, and established methods (e.g. modified Delphi process) to select and develop indicators, and generate suggested action plans to support quality improvement for the Report.
In 2015, we developed an implementation science laboratory to support the optimization of HQO's AF initiatives. This involves a concerted effort between implementation scientists and HQO to conduct applied research that will optimize the impact of HQO's ongoing initiatives, while simultaneously contributing novel, generalizable findings that add to the scientific literature [ 14 ].
Intervention design: long-term care practice reports
Details on the history of the long-term care practice reports and its re-design in preparation for this study can be found in Additional file 1.
Two members of the team (LD and JP) reviewed the content of the re-designed report to identify evidence-based behaviour change techniques (BCTs) [ 15 ] that were likely to contribute to behaviour change (i.e. the 'active content'). This process was undertaken to ensure a standardized description of the report content with the goal of contributing to the broader understanding of how to design effective AF interventions [ 1 ]. The re-designed reports included a total of five BCTs that were operationalized throughout (summarized in Table 1).
Behaviour change techniques included in re-designed reports across all trial arms
Example of operationalization
Feedback on behaviour
Monitor and provide informative or evaluative feedback on performance of the behaviour (e.g. form, frequency, duration, intensity)
7/72 of my residents were prescribed a benzodiazepine
Social comparison AND Discrepancy between goal and behaviour
Draw attention to others' performance to allow comparison with own performance AND Draw attention to discrepancies between a person's current behaviour (in terms of the form, frequency, duration, or intensity of that behaviour) and the person's previously set outcome goals, behavioural goals or action plans (goes beyond self-monitoring of behaviour)
7 additional residents in my practice may be at increased risk associated with benzodiazepines (compared to Ontario long-term care physicians with lower prescribing rates)
Information about health consequences
Provide information (e.g. written, verbal, visual) about health consequences of performing the behaviour
How many of my residents are exposed to risks (e.g. falls) related to benzodiazepines?
Analyse, or prompt the person to analyse, factors influencing the behaviour and generate or select strategies that include overcoming barriers and/or increasing facilitators
Change ideas, worksheets and resources regarding how to implement best practices for prescribing
Definitions taken directly from Michie et. al. [ 15 ]
Program theory and logic model
We developed the program theory [ 16 ] for the AF intervention in a manner consistent with the hypotheses proposed, and the theory and evidence underlying these (refer to Additional file 2). We defined the intervention according to the BCTs used to target hypothesized constructs, using terminology described by the Behaviour Change Technique Taxonomy v1 [ 15 ] and informed by techniques described by goal-setting theory [ 17 ], Social Cognitive Theory [ 18 , 19 ], and nascent theory characterizing the role of competing priorities in healthcare professional behaviour change [ 20 – 22 ]. We then summarized the program theory as a path analytical model to inform the mechanistic theory-based process evaluation (Fig. 1).
Theory-informed logic model. APM antipsychotic medication, BCT behaviour change technique, BZD benzodiazepine, CNS central nervous system
Experimental conditions
All participants will be sent a version of the HQO Practice Reports (Additional file 3) which include the BCTs outlined above. For the study, we manipulated two features of the feedback which may be thought of as experimental factors: (1) the comparator (average vs top quartile) and (2) the framing of the feedback content (patients at risk vs patients safe from risk). Thus, we created four versions of the HQO Practice Reports (Table 2).
Factorial 2 × 2 diagram of trial arms
Factor 1: Comparator
[Top quartile/average]
Factor 2: framing
[Benefit framing/risk framing]
75th percentile/benefit framing
Average/benefit framing
25th percentile/risk framing
Average/risk framing
Factor 1: benchmark/comparator in feedback reports
Participants' prescribing rates will be compared to either the provincial average or top performing peers (top quartile). Prior to this trial, HQO practice profiles compared performance of the recipient to provincial averages on a summary page and both provincial and regional averages on the detailed indicator pages. One of the recently published suggestions for practice feedback design is to use 'a single comparator that effectively communicates the key message' [ 2 ]. Comparing recipients to the top 10% of their peers is more likely to achieve this aim than comparing to the average score of all their peers [ 4 ]. However, HQO felt that a benchmark of the top 10% may risk unintended discontinuation of medications that may be actually be appropriate, rather than a careful review of medication use. The top quartile was decided to be acceptable for the purposes of the trial while maintaining the essential needs of the HQO program that avoids unnecessary harms to residents in LTC.
Factor 2: framing of performance in feedback reports
Factor 2 tests the framing of the feedback reports to be either 'risk-framed' (e.g. emphasizing patients at risk of harms) or 'benefit-framed' (e.g. emphasizing patients safe from risk of harms) without changing the underlying data. Decision-making is affected by the way a problem (or in this case, feedback) is framed [ 11 , 23 ]. Framing has been shown to affect clinical decision-making of physicians in prior studies [ 24 ], with the perceived level of risk involved in the decision posited as a mediating factor [ 25 ]. Prospect theory describes how people may differentially weigh the potential gains and potential losses, emphasizing the importance of risk aversion in decision-making [ 26 ].
We operationalized risk framing by providing feedback on the proportion of patients receiving high-risk medications and describing this as patients at risk of harm from those medications. This framing was designed to be presented in two ways: visually using the line graph with percentage of patients at risk on the y-axis and red colour emphasis in the graph and in text form with the statement 'Nn additional/fewer resident(s) in my practice may be/are at increased risk associated with benzodiazepines' (see Additional file 4). We operationalized benefit framing by providing feedback on the (1-X)% of patients in whom high-risk medications were avoided and described this as patients safe from the risks of harm associated with those medications. This framing was designed to be presented in two ways: using a line graph with percentage of patients safe from risk on the y-axis and green colour emphasis in the graph and in text form with the summary statement 'No additional/fewer resident(s) in my practice may be/are safe from risks associated with benzodiazepines' (see Additional file 4).
We refined the language for risk framing and the associated colour changes iteratively through a user-testing process (Additional file 1) to ensure that the emotional responses invoked would encourage action rather than distract from the task of improvement [ 6 ].
Physicians who (1) voluntarily signed up to receive an HQO Practice Report prior to randomization and (2) consistently have >5 residents that they care for in the nursing home setting (to allow for adequate data capture) will be included in the trial. We will include data from nursing home residents if the residents' most responsible physician is eligible.
Cluster randomization is necessary because the intervention is delivered to physicians who may work collaboratively with other health care professionals. To prevent contamination that could occur when physicians work in multiple nursing homes, we have grouped homes that share physicians into clusters. Thus, the unit of randomization will be groups of one or more nursing homes sharing physicians. An independent statistician will randomize these clusters independently by the two factors (resulting in four experimental conditions), stratifying by total number of beds in the cluster [ 27 ], using a randomly permuted block design of length four. Physicians who sign up for the report after randomization and who belong to a cluster already assigned will be provided the same allocation as others in their group to avoid contamination.
Participants in this study (i.e. physicians) are not explicitly blinded, but the risks in this instance are felt to be minimal, as they will not be aware of the variations being tested nor the outcome measures and analytical approach. Further, the trial occurs in the context of a newly designed report that incorporates new quality indicators. The analysts will be blind to allocation status.
Quality indicators collected for use in the feedback reports and related clinical measures are derived from routinely collected administrative data, linked using unique encoded identifiers at the Institute for Clinical Evaluative Sciences (ICES).
Data will be compiled from the following databases: (1) the Ontario Drug Benefits (ODB) database, covering nearly all prescriptions in nursing homes; (2) the Canadian Institute for Health Information (CIHI) databases covering all inpatient hospitalizations and emergency department visits; (3) the Ontario Health Insurance Plan (OHIP) database, covering physician billings; (4) the Registered Persons Database (RPDB) covering demographic information including date of death; and (5) the Continuing Care Reporting System (CCRS) database for clinical and demographic information on nursing home residents collected using the Resident Assessment Instrument (RAI). The RAI is legislatively required for each nursing home resident in the province within 2 weeks of admission date and then every 92 days, or any other time when the clinical condition of a resident considerably changes. The RAI captures a range of data such as functional and cognitive performance scales and can be used to determine date of admission and discharge from each nursing home [ 28 ].
HQO will track the unique College of Physician and Surgeons of Ontario (CPSO) numbers for those physicians who signed up for the reports. This will be encrypted and linked to the ICES Physician Database to assess physician characteristics, including age, sex, and whether they graduated from Canada or an international school. For each physician who signs up for the Practice Reports, HQO will also keep a file to track the number of times they downloaded the report at each quarterly release. This data will be confidentially shared with ICES analysts (keeping investigators blind), and the coded data will be used to conduct a sensitivity analysis to examine how intensity of exposure relates to effect size.
All primary and secondary outcomes of interest are summarized in Table 3 and are defined at the individual resident level. The primary outcome is the monthly number of CNS-active medications per resident, as determined from the ODB database. 'CNS-active' medications will be defined in a manner consistent with the HQO quality indicator used in the Practice Reports, covering the medication classes of antipsychotics, opioids, benzodiazepines, and antidepressants (including tricyclic antidepressants and trazodone). This was chosen as a way of capturing any change to prescribing that was directly influenced by the measures provided in the Practice Reports. Secondary prescribing outcomes will include additional measures of prescribing that might be directly influenced by the Practice Reports: proportion of days supplied benzodiazepines, any prescription of benzodiazepines, mean daily benzodiazepine dose, dose equivalent of benzodiazepine dispensed, proportion of days supplied antipsychotics, any prescription of antipsychotics, mean daily antipsychotic dose, dose equivalent of antipsychotic dispensed, and presence of three or more CNS-active medications. We will also assess statin prescriptions as a non-targeted control or 'tracer outcome' [ 29 ]. These are not expected to be affected by the intervention and will be used to identify secular trends in prescribing in the homes.
Primary and secondary outcomes—all defined at the level of the individual resident
Number of repeated measurements
Primary outcome measure
Number of CNS-active medications (antipsychotics, opioids, benzodiazepines, or antidepressants (including tricyclic antidepressants (TCAs) and trazodone))
Benzodiazepine (or z-drug) prescription
Proportion of days supplied
Over the 6-month interval
Any prescription of
Mean dose dispensed
Antipsychotic prescription
Presence of 3+ CNS-active medications: antipsychotics, opioids, benzodiazepines, or antidepressants (including TCAs and trazodone)
Statin—tracer outcome
RAI data will be used to identify dates of admission and discharge to define the appropriate set of residents contributing to each time period. We will also use RAI data to summarize relevant demographic and clinical characteristics of the cohort of nursing home residents cared for the participating physicians. We will use an open cohort design; all eligible residents present in the home at any observation time will be included in the analysis. To be eligible for analysis, the most responsible physician of the nursing home resident must have signed up to receive the report.
All primary analyses will be by intention-to-treat. The primary outcome (monthly number of CNS-active medications over 6 months pre- and post-intervention) will be analysed using a general linear mixed effects regression model; time will be specified as a continuous variable and a common secular trend will be imposed across all study arms with the effect of the intervention modelled as a slope deviation from the secular trend. The analysis will adjust for the size of each home as a fixed effect. Random intercepts and slopes for time will be specified for the unit of randomization (group of homes) and for the individual resident to account for cluster and individual autocorrelation. The primary comparison between the arms' 6-month post-intervention will be estimated using least square mean differences, together with 95% confidence intervals. Because the traditional two-stage testing approach (i.e. an interaction test followed by dropping the interaction term if non-significant) can lead to bias in factorial trials [ 30 ], we will present both four-arm and factorial analyses.
We will examine whether the language in the key message in the report (i.e. the bolded statement declaring the number of additional/fewer patients are at risk from (or safe from risks of) benzodiazepines) is differentially associated with changes in prescribing. This is an uncontrolled element of the intervention, dependent on the observed distribution of performance of physicians relative to their peers. The relative performance of the physician compared to the comparator may act as an effect modifier because having additional patients at risk of harm or fewer patients safe from harm may invoke different responses than having fewer patients at risk or more patients safe. Additionally, it is plausible that recipients may respond more actively to simpler language (e.g. '7 additional residents in my practice may be at increased risk of harm' may be easier to interpret than '7 fewer residents in my practice are safe from risk of harm') because the simpler wording may make it easier for recipients to evaluate their performance relative to the comparator and respond accordingly. Thus, we will adjust for relative performance (i.e. better, same, or worse than comparator) and clarity of the statement (i.e. additional versus fewer) as a covariate and then conduct planned subgroup analyses to examine differential effects of the intervention across these subgroups (while acknowledging unmeasured confounding and uncertain power in these subgroup analyses).
We will also explore potential effect modification by baseline prescription rate, ownership status of nursing home, beds in the home, location (urban/rural), specialist utilization (proportion of patients with geriatrician or psychiatrist consultation within 6 months), plus primary physician characteristics (sex, years' experience), as well as patient characteristics (age, sex, time at facility, levels of function and cognition). A planned sensitivity analysis will examine effects by extent of exposure to the intervention (i.e. fidelity of receipt, which assesses whether physicians downloaded their report).
The secondary outcomes, measured as proportion of days supplied with each prescription over the 6-month interval post-intervention, will be analysed using a general linear mixed effects regression with baseline proportion as a covariate. Random intercepts will be specified for the unit of randomization and for the individual resident. Monthly mean dose dispensed will be analysed as described for the primary outcome. Secondary outcomes measured as repeated binary proportions will be analysed as described for the primary outcome but using mixed effects logistic regression.
The RAI is needed to have accurate dates of admission and discharge from nursing homes, but linking data with the RAI can involve substantial delays. A planned interim analysis will be conducted using ODB data only to be used for HQO's internal purposes.
In head-to-head trials where small changes to existing initiatives are tested and where each sequential change in the process of optimization is expected to offer cumulative benefit, it is necessary to power for small changes. In this pragmatic trial, the sample size is dependent on the number of providers who sign up for the reports. At the time of study launch, there will be physicians working in over 200 nursing homes who have signed up to receive the HQO Practice Reports. After grouping homes sharing providers together, we anticipate having approximately 160 clusters, with an average of 350 beds per cluster. In a 2 × 2 factorial design assuming no interaction and similar effects for each intervention, a test of each intervention at 6 months in an ANCOVA design will achieve 90% power to detect an absolute mean difference of 0.3 in the primary outcome (i.e. a reduction across arms in the mean number of CNS-active medications from 3 to 2.7). Based on previous data, we have assumed a standard deviation of 4, an intracluster correlation coefficient of 0.05, a cluster autocorrelation of 0.8, and an individual autocorrelation of 0.9 [ 31 ]. In the presence of an interaction effect, switching to a 4-arm comparison would require a slightly larger difference of 0.4 in the mean number of medications.
For our secondary outcome (any monthly prescription of antipsychotics), our sample size will achieve 90% power to detect an absolute difference of 1.2% (or a relative difference of 6%) from a reference arm proportion of 20% using six monthly pre- and post-intervention measurements, with an intracluster correlation coefficient of 0.05, a cluster autocorrelation of 0.8, and an individual autocorrelation of 0.9. In the presence of an interaction effect, switching to a 4-arm comparison would require a larger relative difference of 8.5%.
We will conduct a cost-effectiveness analysis from the perspective of the publicly funded health care system. Total costs include costs associated with designing and delivering interventions and health care costs incurred by nursing home residents. We will use a micro-costing technique [ 32 ] to identify, measure, and value resources required for the interventions. HQO staff will provide the number and type of resources used for designing and delivering interventions. We will multiply the quantity of each type of resource required by its unit costs to obtain component-specific costs and overall costs for the interventions. Health care costs incurred by nursing home residents will be derived using the costing methodology developed at ICES [ 33 ].
We will estimate the incremental cost per unit change in monthly number of CNS-active medications as well as the incremental net benefit of the interventions using a general linear mixed effects regression model. A series of sensitivity analysis will be undertaken to examine the effect of conducting a complete case only analysis and of varying input parameters. Uncertainty in the analysis will be addressed by estimating 95% CIs using a non-parametric bootstrapping method. Results from the bootstrapping exercise will also be used to depict cost-effectiveness acceptability curves, which represent the probabilities that interventions being cost-effective over a range of potential threshold values that the health system may be willing to pay for an additional unit of effect.
Embedded theory-based process evaluation
The process evaluation involves a mixed-methods approach informed by the UK Medical Research Council's Guidelines [ 34 ] to examine whether the intervention targets the intended constructs outlined in the program theory (Fig. 1) and understand the contextual factors that shape how the intervention works in practice.
To assess fidelity of receipt, we will examine the extent of exposure (i.e. timing and frequency of Practice Report downloads). We propose that exposure (fidelity of receipt) will be a key effect modifier of the intervention.
The intervention's mechanism of action will be assessed via surveys of participating physicians across all four arms to measure theoretical constructs targeted by the intervention. Targeted constructs include intention, self-efficacy, outcome expectations, descriptive norms, and goal prioritization. To minimize response burden, a single validated question was included to measure each construct for the prescription of targeted medication classes (benzodiazepines, antipsychotics, and CNS-active medications), in addition to medications that the intervention does not directly target (e.g. statins). These will therefore provide the capacity to conduct a multiple-behaviour process evaluation [ 35 ] that will examine the presumed mechanisms underlying any changes observed in prescribing and whether these vary by experimental condition. Prospect theory suggests that when physicians make a decision, they consider risky (i.e. the decision to start/stop benzodiazepines), loss-framed messages may have a larger impact on their behaviour than gain-framed messages [ 19 , 36 ]. At the same time, the importance of coherence between framing and how the recipient is oriented towards promoting gains or preventing harm is emphasized in Regulatory Fit Theory [ 37 ]. We assume that most physicians are focused on preventing harm when thinking about high-risk medications. We will include a questionnaire designed to assess whether individuals are promotion- or prevention-focused which has been validated in patient population [ 38 ]; we have adapted this tool to focus on healthcare professional behaviour. Responses will we be used to assess whether respondents' regulatory focus moderates the effect of the feedback framing intervention.
To gain a more nuanced understanding of how and why the intervention worked as observed, we will conduct qualitative interviews with interested participants. We will examine whether participants view changes in prescribing as a risky behaviour, as assumed, or if they endorse generally positive experiences with prescribing these medications, and perceive their ongoing use as generally safe. We will also probe the underlying mechanisms through which the interventions may influence prescribing behaviour (Fig. 1). The constructs measured in the theory-based questionnaire will be represented within the interview topic guide. Interviews will focus on gaining additional insight into quantitative responses to the constructs assessed in the questionnaire while providing an opportunity for respondents to clarify any additional factors relevant to their experience of using the feedback report allocated to them.
Recruitment and data collection
Working with HQO, we will send an invitation to all report recipients who download their report to complete a survey about the reports. We will follow an adapted Dillman protocol with a series of weekly reminders to optimize response rate [ 39 ]. Respondents will also be incentivized through a $25 raffle prize [ 40 ] provided by the research team (HQO, as a provincial agency, is prohibited from offering such incentives). Interview participants will be recruited using self-identification during the web-based surveys. Interested respondents will be contacted via e-mail to confirm interest and schedule a one-on-one, semi-structured telephone interview. An interview guide will focus on report use and ideas for improvement, prioritization of prescribing behaviour change in relation to the three prescribing indicators summarized in the report, and questions to probe the hypothesized mechanisms of action underlying the interventions (summarized in Fig. 1). It is expected interviews will last between 30 and 45 min. As interviews will focus on the experience of healthcare professionals in using feedback on aggregate data, there is very little risk of any patient-identifiable data being discussed. Nevertheless, all names and locations will be removed from transcripts to ensure that respondents are anonymous for the purposes of any reporting of results (presentations, manuscripts).
Items in the web-based survey used to measure constructs which are hypothesized antecedents of behaviour (Fig. 1) will be scored by participants using a 5-point Likert scale and described using mean and standard deviations (median and interquartile ranges in the case of skewed distributions). The survey also contains 11 items assessing regulatory focus, scored using a 9-point Likert scale, with high scores representing agreement and low scores disagreement. Six items assessed the extent of promotion focus, and five assessed the extent of prevention focus. We will assess the internal reliability of the items measuring each of the focus types (promotion/prevention) using Cronbach's alpha. If internal consistency is <0.7, we will explore whether we can improve this by omitting individual items. We will then use the mean of the items measuring each focus type to create a composite score ranging from 1 to 9 for each focus type. The prevention focus composite score will then be subtracted from the promotion focus composite score. The resulting score will be used to classify the physicians as primarily prevention- or promotion-focused: physicians with positive scores will be classified as promotion-focused and physicians with negative scores as prevention-focused.
We will use multiple regression to explore the relationships between hypothesized predictor constructs (Fig. 1) and the dependent variable (intention to appropriately adjust prescribing) controlling for group allocation. We will then compare the post-intervention scores for the constructs across the intervention groups using independent samples t tests, conducting separate comparisons for each of the two main effects (message framing and professional comparator). We anticipate that approximately 250 providers will be allocated in the trial and that approximately 40% will download the Practice Reports. With an anticipated survey response rate of 40%, we expect to have 40 questionnaires available for analysis, evenly distributed between arms. With 20 survey responses in each group (presence or absence of each main intervention effect), we will have 80% power to detect a difference of 0.9 standard deviation units in any of the constructs between the two intervention arms using a two-sided t test at the 5% level of significance. We will use hierarchical mediation and moderation models to determine whether interventions work through hypothesized pathways to aid interpretations for generalization in various contexts. We will also conduct additional exploratory analyses to assess the impact of measurable provider, patient, and contextual characteristics on the outcomes.
The analytical method for the interviews will involve an iterative process of data collection and analysis using qualitative software NVIVO 10. Interviews will be analysed by two independent researchers using the framework method [ 41 , 42 ]. This method of analysis involves six key steps: familiarization with the data, coding the data, indexing (applying the analytical framework), charting (summarizing the data from each transcript by category), and interpretation. A coding framework will be developed, with the key psychological constructs (Fig. 1) serving as overall themes. Open coding will be applied as required by the data to allow for the emergence of themes not captured within the constructs. The researchers will meet to discuss and refine the coding framework and themes. Throughout the indexing period, refinement will involve discussion with a third researcher and the wider study team as necessary, for example, to reach consensus on discrepancies and include the clinical perspective. At the charting stage, data will be re-arranged into tables and summarized according to the analytical framework. We will then re-examine the data to develop our interpretation of the mechanisms of effect of the interventions.
The framework approach ensures a systematic approach to summarizing and classifying the data, facilitating a comprehensive review of participant narratives while encouraging a higher-level conceptual analysis [ 42 ]. Using an interconnected analytic strategy allows for the constant refinement of themes while progressing towards the development of an overarching conceptual framework of how the intervention works and why. Recruitment will continue until saturation is reached; however, we anticipate conducting ~15–20 interviews based on similar studies [ 43 ]. We will employ a 10 + 3 rule, whereby at least 13 interviews will be conducted; if no additional themes are generated in the last three consecutive interviews, this will serve as evidence of data saturation. If not, interviews will continue until at least three consecutive interviews do not raise new themes. If less than 15 physicians consent to be contacted, we will contact them all for interview. Snowball sampling will be used to seek out contrasting cases, if possible.
Ethical considerations
This trial meets all ethical principles for a deviation from the general principles of research consent [ 44 ]. Specifically, the study intervention and data collection procedures pose no more than minimal risk for participating physicians and are unlikely to adversely affect their welfare. This is because these physicians already voluntarily signed up for the Practice Reports; HQO can design them in any reasonable fashion and evaluate the effects of their initiative so long as confidentiality is respected. Furthermore, the experiment would not be feasible without a waiver of consent [ 45 ]. Typical consent procedures would likely create selection bias (i.e. physicians likely to consent may systematically differ in the way they respond to framing). Therefore, the participating research ethics boards approved waiver of consent with provision of opt-out opportunities and a debrief at the time of outcome assessment (refer to Additional file 5).
This trial demonstrates how partnerships with health system organizations can create opportunities to advance implementation science [ 14 ]. We envision this trial as the first in a series of studies in our implementation science laboratory with HQO that test AF variations. The collaborative process described herein may offer lessons for others working in implementation science laboratories and illustrate how appropriate compromises can be reached in this context to achieve both scientific objectives and health system improvement goals.
Numerous components within AF may play a role in the effectiveness of the intervention; no single trial can answer all the remaining questions about how to optimize design and delivery. Further work will be needed both to optimize these aspects of AF and to test additional features. This is especially true because this trial is not without its limitations. The re-design process (see Additional file 1) was abridged to accommodate project deadlines. In addition, framing was difficult to operationalize in a clear manner because the data lacked clinical granularity; prescribing high-risk medications more often than the comparator may sometimes be appropriate, depending on the patient characteristics, and the feedback required carefully crafted content to acknowledge this issue. We cannot be certain that our elaboration of risk framing and benefit framing will be equally clear/understandable to recipients. Further, our hypothesis related to framing assumes that recipients of AF reliably perceive the decision to change (i.e. start or stop) benzodiazepine prescriptions to be a risky behaviour; this will be explored in the process evaluation. We also acknowledge that Regulatory Focus Theory [ 36 ] posits that the alignment between message delivery and the way in which a person perceives that task plays a role in how persuasive the message will be and its effect on performance. We emphasized preventing risks in the report because we felt this fit both the overall goal of the initiative (i.e. to limit high-risk prescribing) and the widely held medical dictum to 'first do no harm' [ 46 ]. We will assess participants' regulatory focus in the process evaluation to help interpret the results. In general, other design aspects beyond those manipulated in this trial may create noise that drowns out any signal we may hope to find; we will explore the role of these aspects where possible to inform future research.
Learning about how physicians respond to positively versus negatively framed clinical performance feedback may have implications for a wider field of continuing professional education [ 47 , 48 ]. This protocol demonstrates how one can manipulate theoretically informed components in a process that can both improve a specific intervention and provide generalizable insights. The general approach may be used to inform approaches to additional head-to-head trials and to generate new knowledge regarding how best to design and deliver implementation interventions.
The trial began December 2016, with 267 physicians from 160 clusters of nursing homes allocated to the four experimental conditions. The intervention period is ongoing.
The authors would like to acknowledge the staff at Health Quality Ontario for their help in the development and implementation of the intervention.
This study is funded by the Canadian Institutes for Health Research and the Ontario Ministry of Health and Long-Term Care through the Ontario SPOR SUPPORT Unit. The funder was not involved in the design of the study or the writing of this manuscript. JG holds a Tier 1 Canada Research Chair in Health Knowledge Transfer and Uptake and a CIHR Foundation grant for related work. NMI holds New Investigator Awards from the Canadian Institutes of Health Research and the Department of Family and Community Medicine, University of Toronto.
Ethics approval has been received from the University of Toronto and Women's College Hospital Research Ethics Boards (#2016-0122-E). The Ottawa Health Science Network Research Ethics Board approved the process evaluation and the economic evaluation (#20160934-01H).
All authors have read and approved the final manuscript.
JP is an associate editor of implementation science. JG and NMI are members of the editorial board of implementation science.
Additional file 1: Details of the re-design of the intervention in preparation for this trial. (DOCX 28 kb)
13012_2017_615_MOESM1_ESM.docx
Additional file 2: Hypothesized mechanism of action for each factor being manipulated in the trial. (DOCX 18 kb)
Additional file 3: Screenshot of the first page of the Practice Reports used prior to this trial. (DOCX 167 kb)
Additional file 4: Screenshots of the first page of the four versions of the Practice Reports tested in this trial. (DOCX 504 kb)
Additional file 5: Waiver of consent documents: letter of information and debrief to participants in the trial. (DOCX 28 kb)
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Presseau J, Francis JJ, Campbell NC, Sniehotta FF. Goal conflict, goal facilitation, and health professionals' provision of physical activity advice in primary care: an exploratory prospective study. Implement Sci. 2011;6:73. CrossRefPubMedPubMedCentral
Presseau J, Johnston M, Francis JJ, Hrisos S, Stamp E, Steen N, Hawthorne G, Grimshaw JM, Elovainio M, Hunter M, Eccles MP. Theory-based predictors of multiple clinician behaviors in the management of diabetes. J Behav Med. 2014;37:607–20. CrossRefPubMed
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Noah M. Ivers
Laura Desveaux
Justin Presseau
Catherine Reis
Holly O. Witteman
Monica K. Taljaard
Nicola McCleary
Kednapa Thavorn
Jeremy M. Grimshaw
Evaluation of the Tsima community mobilization intervention to improve engagement in HIV testing and care in South Africa: study protocol for a cluster randomized trial
Barriers and facilitators to reducing frequent laboratory testing for patients who are stable on warfarin: a mixed methods study of de-implementation in five anticoagulation clinics
General practitioners' views and preferences about quality improvement feedback in preventive care: a cross-sectional study in Switzerland and France
Data for Improvement and Clinical Excellence: a report of an interrupted time series trial of feedback in home care
Competing for space in an already crowded market: a mixed methods study of why an online community of practice (CoP) for alcohol harm reduction failed to generate interest amongst the group of public health professionals at which it was aimed
Beyond "implementation strategies": classifying the full range of strategies used in implementation science and practice


This morning, Morgan Stanley's top equity strategist Adam Parker was on CNBC explaining his bearish outlook on stocks.
Sam Ro summarized Adam Parker's beliefs in a post at the end of March.
"Lower forecast earnings growth and more concentrated earnings among S&P stocks."
"Non-normalized interest rates and a vastly expanded Fed balance sheet."
"Much higher commodity prices, particularly oil."
"Index rebalancing has contributed to performance: 125 new firms have $82 billion more market cap than the outgoing companies had in 2006; also, 25% of income growth is from Apple."
"Don't pay a higher multiple for today's corporate earnings!"


Friday Finds 3 | One quality, the finest.
Picnic in Provence: A Memoir with Recipes, by Elizabeth Bard – This is the follow-up to Bard's best-selling memoir Lunch in Paris and I liked it even more than the first book. Bard talks with raw honesty about the strain her book caused in her relationship with her mother-in-law who felt that Bard had disclosed too much that was private. She lays bare her feelings of inadequacy as a parent of a young son who clearly prefers his daddy. But the book is really about finding her place in France, but in Provence instead of in Paris. Bard and her husband move to the Cereste in the south of France where they decide to break with their prior careers in order to open an artisanal ice cream shop, Scaramouche. I'm not a big ice cream person, but Bard's description of how they sourced the best local ingredients and experimented to create the most luscious combinations made me want to try a scoop of everything. If you'd rather eat ice cream than read about it, Scaramouche has now opened a second shop in Paris (22 rue la Vieuville, in the 18th). It's closed for the winter, but I definitely want to check it out this summer.
Chef's Table: France – This Netflix Original series explores the stories of four very different Michelin starred chefs. Each chef is completely different in the style of cuisine and back story, but each clearly infuses each dish with love as well as skill. It's an enchanting short series – and I'm not even a foodie!
TripFiction – I've always loved to prepare for a trip by reading about my destination beforehand, whether it be a travelog, history, memoir, or historical fiction. And when I come home, reading about places I have discovered helps prolong the pleasure of the trip. I just discovered Trip Fiction, a website dedicated to this proposition. Search your destination and tailored recommendations pop up that you can purchase through the site. I checked their recommendations for France, and they are goodies. Even if your travels are only of the armchair variety, you will find plenty to enjoy here. Bon voyage!
This entry was posted in Cuisine, Literature, Media, Travel and tagged Chef's Table: France, Elizabeth Bard, Picnic in Provence, Trip Fiction. Bookmark the permalink.
I hope you find the perfect read!
I second your enthusiasm for Chef's Table: France. The episode about Alain Passard of L'Arpège was fascinating.
Wasn't it? His passion for vegetables was amazing.
I love Trip Fiction. I found a bunch of books set in Quebec before we went there this summer. Then, when I was in Chicago and finished a book that I hadn't expected to, I went to a little used bookstore. I pulled up tripfiction to find books set in Chicago. So fun!
Got Chef's table on my list now!
Looks like I've come late to the Trip Fiction party!


text:
Sandip Das
Non-Executive And Independent Director
Sandip Das is one of Asia's most respected telecommunications professionals and an acclaimed Chief Executive. He is on the Advisory Board of a UK-based investment company, reputation-management firm Astrum and Exhibitions India, besides consulting for international banks and investment companies. He was formerly the MD & CEO of Reliance Jio, Group CEO and Executive Director of Maxis Communications Berhad, Malaysia and CEO and Board Director of Hutchison Essar Telecom (later Vodafone), India. He holds BE (Mechanical Engineering) and MBA degrees, and is an alumnus of Advanced Management Program (AMP 188) from Harvard Business School, Boston. For four years, he appeared on the Global List of Most Powerful People in Telecom published by Global Telecoms magazine. He has been awarded the Lifetime Achievement Award for his contribution to Indian Telecom by Voice & Data magazine, Cyber Media Publications.


Thank you for Celebrating Women, Transforming Lives with Bridge!
On April 22, more than 300 supporters of Bridge families attended an unforgettable Celebrating Women, Transforming Lives Spring Luncheon at Danada House. Together, we celebrated our shared commitment to the betterment of women and children in our community, and notably, our two outstanding honorees: The Hinsdale Junior Woman's Club, with the Transforming Lives Award; and, Bridge graduate Lisa McNeeley, with the Life Transformed Award. Thank you for joining us for this special day!
Bridge has many people to thank for making this event a success: our outstanding emcee, ABC7's Judy Hsu, for sharing her warmth and shining personality at the luncheon; our speaker, Sally Miller, for telling her touching stories; to our luncheon committee, for all your hard work behind the scenes.
A big thank-you also goes out to our amazing sponsors for helping make Celebrating Women, Transforming Lives possible: DuPage Medial Group Charitable Fund; Assurance; Coldwell Banker Charitable Foundation; Glen Ellyn Bank & Trust; Naperville Bank & Trust; Wheaton Bank & Trust: My Chef Catering; BMO Harris Bank; BeaksCo; Digital Benefit Advisors; Career Vision; Catcon, Inc; Neil Gates Photography; Nicor Gas; and Yorke Printe Shoppe.
Thanks again–your support means more Bridge families will have their lives transformed. We look forward to seeing you next year!


text:
package brooklyn.entity.container.docker;

import java.util.Collection;

import org.slf4j.Logger;
import org.slf4j.LoggerFactory;

import com.google.common.base.Predicates;
import com.google.common.base.Throwables;
import com.google.common.collect.ImmutableList;
import com.google.common.collect.Iterables;

import org.apache.brooklyn.api.entity.ImplementedBy;
import org.apache.brooklyn.api.location.Location;
import org.apache.brooklyn.api.location.MachineLocation;
import org.apache.brooklyn.api.location.MachineProvisioningLocation;
import org.apache.brooklyn.api.location.NoMachinesAvailableException;
import org.apache.brooklyn.core.entity.lifecycle.Lifecycle;
import org.apache.brooklyn.core.entity.lifecycle.ServiceStateLogic;
import org.apache.brooklyn.core.test.entity.TestEntity;
import org.apache.brooklyn.core.test.entity.TestEntityImpl;

import brooklyn.location.docker.DockerLocation;

@ImplementedBy(LiveTestEntity.LiveTestEntityImpl.class)
public interface LiveTestEntity extends TestEntity {

    MachineProvisioningLocation getProvisioningLocation();
    MachineLocation getObtainedLocation();

    public static class LiveTestEntityImpl extends TestEntityImpl implements LiveTestEntity {

        private static final Logger LOG = LoggerFactory.getLogger(LiveTestEntity.class);
        private DockerLocation provisioningLocation;
        private MachineLocation obtainedLocation;

        @Override
        public void start(final Collection<? extends Location> locs) {
            LOG.trace("Starting {}", this);
            callHistory.add("start");
            ServiceStateLogic.setExpectedState(this, Lifecycle.STARTING);
            counter.incrementAndGet();
            addLocations(locs);
            provisioningLocation = (DockerLocation) Iterables.find(locs, Predicates.instanceOf(DockerLocation.class));
            try {
                obtainedLocation = provisioningLocation.obtain(provisioningLocation.getAllConfig(true));
            } catch (NoMachinesAvailableException e) {
                throw Throwables.propagate(e);
            }
            addLocations(ImmutableList.of(obtainedLocation));
            ServiceStateLogic.setExpectedState(this, Lifecycle.RUNNING);
        }

        @Override
        public void stop() {
            LOG.trace("Stopping {}", this);
            callHistory.add("stop");
            ServiceStateLogic.setExpectedState(this, Lifecycle.STOPPING);
            counter.decrementAndGet();
            if (provisioningLocation != null && obtainedLocation != null) {
                provisioningLocation.release(obtainedLocation);
            }
            ServiceStateLogic.setExpectedState(this, Lifecycle.STOPPED);
        }

        public MachineProvisioningLocation getProvisioningLocation() {
            return provisioningLocation;
        }

        public MachineLocation getObtainedLocation() {
            return obtainedLocation;
        }
    }

}

redpajama_set_name: RedPajamaGithub


Silvine Twin Wire Carbonless Triplicate Memo Books.
Manufactured from quality paper with durable laminated covers and perforated for easy tear.
Features white pages numbered from 1 to 50 with an index sheet.


Parkers Leading Berkshire, Wiltshire, Gloucestershire and Oxfordshire estate agent providing the best service whether you are looking to buy, sell or rent.
... in our services is our ambition. Our office Directors and staff offer unrivalled knowledge of the area with over 160 years combined experience of which is unmatched by any other local estate agent.


text:
Enjin (ENJ) Allies with Miss Bitcoin to Launch the First NFT Project in Japan
Reading Time: 2 minutes by Dalmas Ngetich on January 18, 2021 Altcoins
Gracone Inc, an educational platform highlighting the use of blockchain and non-fungible tokens, particularly in charity, is partnering with Enjin to launch the first Japanese NFT charity project via Kizuna, a hub that aims to change the society through sustainable development goals by leveraging on the blockchain, an announcement on Jan 18 reveals.
Tokenizing Art on Enjin
Through the Kizuna platform, the project's objective will be to raise funds for supporting teenagers affected by the coronavirus pandemic. Kizuna launched in 2017 as a cryptocurrency donating platform. Its CEO is Mai Fujimoto, popularly known as Miss Bitcoin.
In their first campaign, the Enjin platform will be used to mint non-fungible tokens (NFTs) of art created by Japanese celebrities to raise funds for an Osaka-based non-profit called DxP. The goal is to raise over $20,000 by selling tokenized NFT art created by Japanese celebrities.
Currently, the non-profit is the home for over 3,000 drop-out students who receive food and financial support following the effects of the coronavirus pandemic. However, this is the first time they are integrating NFTs in their fundraising mission, applying blockchain for a noble cause, Noriaki Imai, the Founder, reveals.
"This is my first time being involved in an NFT program. I strongly believe in the potential of cryptocurrency to change people's lives, and I feel very honored for DxP to be part of this initiative and benefit from the application of blockchain technology."
The "Sanpo Yoshi" Concept
The mission blends well with the Japanese "Sanpo Yoshi" concept that calls for sustainable and symbiotic commerce, benefiting the transactors and the community. In Miss Bitcoin's view, the NFT charity project describes this concept well.
By purchasing tokenized art, people not only enjoy their pieces but end up directly contributing to those in need, affected by the novel coronavirus.
"When fans purchase NFTs drawn by artists and celebrities, they can not only enjoy the art but also directly contribute to those in need. I believe this NFT campaign will bring joy to many people, and I'd like to thank the Enjin team and artists who have agreed to join the initiative."
NFTs are tokens that cannot be copied or used interchangeably, like Bitcoin. Instead, these tokens have unique properties, each with distinguishable characteristics and traceable in the blockchain. It is because of this feature that NFTs are finding application in digital art. Witek Radomski, the CTO of Enjin, is behind the EIP-1155 standard.
Democratizing Art and Benefiting the Society
According to Maxim Blagov of Enjin, tokenization of art presents efficiency and speed at unprecedented levels. Due to the digital nature of pieces, it is possible to securely and transparently distribute valuables via the blockchain, a perfect use highlighting the benefits of distributed ledger technology and its application in improving societal causes.
"Art tokenization is another great example of how blockchain can automate the sale and fulfillment of high-value assets. While traditional art can take years to sell, it can be minted, listed, sold, and distributed within minutes via the blockchain."
Unlike traditional models requiring third-party auditors to check and verify the flow of funds, the blockchain is a self-auditing system that rids intermediaries.
Exclusively digital, donations can be tracked from sources to recipients in real-time, helping slash the need for extra costs. The DxP fundraising might be the first of the many.
Already, Kizuna has revealed plans to explore and identify more opportunities where NFTs can be used as a means of responding to other critical issues like addressing poverty, environmental conservation, global pandemics, and others.
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altcoin cryptocurrency ENJ Enjin miss bitcoin


There are many people out there with very busy and high profile lives who are unable to come to me. After having several requests for me to travel for private sessions I thought I would make it available to anyone needing that consideration. There is special pricing for this personal service and all travel and lodging expenses must be paid by the client.


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Home » Letters » Screwtape Letters Audio John Cleese
Screwtape Letters Audio John Cleese
1 Screwtape Letters Audio John Cleese
2 The Screwtape Letters Study Guide: A Bible Study On The C.s. Lewis Book The Screwtape Letters
2.1 Free Audiobooks Of Popular Books Narrated On Youtube
3 Audio/videos (dvds, Cds)
Screwtape Letters Audio John Cleese – "My dear wormwood" is a phrase that many readers will immediately recognize as the opening to the classic work of C.S. Lewis
. The book features a series of letters from Screwtape, a senior devil, to his cousin Wormwood who is just learning how to most effectively seduce his first human (aka "patient"). While the book itself is well known and widely read, the background to its genesis is a fascinating story. In this post we will not only write
, but also list adaptations of the book over the years, study resources, and highlight our Lenten Reflection series on the book beginning at the Wade Center on February 21, 2018.
The Screwtape Letters Study Guide: A Bible Study On The C.s. Lewis Book The Screwtape Letters
In a letter dated July 20, 1940 to his brother Warren, who had returned to active service during World War II as a major in the Army. Lewis was attending a worship service at his church, Holy Trinity in Headington Quarry, when a thought occurred to him. As he explained to his brother:
"Before the shift was over…I got an idea for a book [which] I think could be both useful and entertaining. It [would] be called As one Devil to Another and would consist of letters from an elderly, retired devil to a young devil just getting started on his first "patient." The idea [would] be to give all the psychology of seduction from the other point of view."
, HarperSanFrancisco, 1996 p. 268) The actual writing process was tedious for Lewis because of the mindset he had to adopt while writing in a devilish guise:
"Although I had never written so easily, I never wrote with less pleasure. …While it was easy to twist your mind into the devilish pose, it wasn't fun, if not for long. The tension caused a kind of mental spasm. The work I had to project myself into as I spoke through Screwtape was all dust, grit, thirst and itching. Every trace of beauty, freshness and conviviality had to be excluded. It almost choked me before I was done." (Lewis's 1961 preface to The Screwtape Letters and Screwtape Proposes a Toast)
See Also Words With A S E Five Letters
Free Audiobooks Of Popular Books Narrated On Youtube
, a weekly Anglican newspaper, had published Lewis's articles titled "The Dangers of National Repentance" (March 15) and "Two Ways with the Self" (May 3). When Lewis offered
They agreed to serialize all 31 letters running in weekly installments from May 2 to November 28, 1941. The letters proved to be very popular and were later collected and published as a book the following year. Lewis dedicated the book to his friend and colleague Inkling J.R.R. Tolkien, but Tolkien was surprised at the gesture (see
, draft letter to Michael Tolkien No. 252, November or December 1963). And, as Humphrey Carpenter reports, not entirely satisfied with the book itself: "for one who believed deeply in the power of evil [Tolkien] thought it foolish to play with such things rather jokingly." (
Typescript at his London publisher could be destroyed in a German bombing raid (a justified fear in WWII in Britain), Lewis sent his handwritten manuscript for safekeeping to his friend Sister Penelope, an Anglican nun at the Convent of the Community of St Mary the Virgin at Wantage. When she later tried to return it to Lewis, he told her to sell it. This handwritten manuscript is now in the Berg Collection of the New York Public Library. The typescript is kept at the Wade Center under the number CSL/MS-107 in our C.S. Lewis Manuscript Collection. The Wade's typescript also includes a handwritten preface researched by Lewis scholar Brenton Dickieson. You can read Brenton's findings in "The Unpublished Preface to C.S. Lewis's"
The Screwtape Letters: Lewis, C S: 9781444424096: Amazon.com: Books
, along with his BBC Radio speeches in the 1940s (later published in book form as
), combined to give Lewis greater recognition as a Christian spokesperson. An example of this was the September 8, 1947, cover of Time magazine featuring an image of Lewis with the caption "Oxford's C.S. Lewis: His heresy: Christianity." As a result of this increased profile, Lewis's fan mail also grew significantly during this time, requiring him to spend hours each day writing responses to his correspondents.
"The book is sparkling yet truly reverent, a perfect joy in fact, and should become a classic." (Manchester Guardian, Feb. 24, 1942) "Mr. Lewis possesses the rare gift of making justice legible, and has produced a fine piece of sermon illuminated by flashes of insight" (New Statesman and Nation, May 16, 1942). Charles Williams, co-author of Inkling and Wade, wrote two glowing reviews of The Screwtape Letters in The Dublin Review (July 1942) and Time and Tide (March 21, 1942). His Time and Tide review entitled "Letters in Hell" was written as a parody Screwtape letter addressed to "My Dear Scorpuscle."
See Also Dead Letters Midsomer Murders
Not everyone was equally receptive or grateful to Lewis's efforts in this book. In his 1961 preface to
The Screwtape Letters And Screwtape Proposes A Toast: C. S. Lewis: Amazon.com: Books
Lewis reports a humorous case in which a rural clergyman, failing to understand that the letters were meant to be read from an opposing point of view, withdrew his subscription from
In which he stated that "much of the advice given in these letters seemed to him not only incorrect but also diabolical."
Despite requests to write additional Screwtape letters, Lewis's only subsequent Screwtape offer was prompted by an invitation from
That he said he "pulled the trigger". (1961 preface) Published on December 19, 1959 as "Screwtape Proposes a Toast," Lewis moved from a letter approach to having a lecture by Screwtape at the Tempters' Training College's annual dinner for young devils. This fictitious address later appeared in a new edition of
Audio/videos (dvds, Cds)
Has undergone various treatments over the years through audiobooks, dramatizations, adaptations, and so on. The non-exhaustive list below contains some examples of these screw tape variants.
TagsArtifact of the Month Art Barbara Reynolds BBC Bill Gresham Books Bordighera C.S. Lewis Catalog Change-Ringing Charles Williams Chris Mitchell Cinema Clyde S. Kilby Dante Display Dorothy L. Sayers Douglas Gresham Easter Elaine Hooker Santa Claus Letters Featured Artifact Frodo Baggins G.K. Chesterton George MacDonald Imagination Italy J.R.R. Tolkien Joy Davidman Letters from Father Christmas Lord Peter Wimsey Man Born to be King Christianity Only Most Reluctant Convert Northern Polar Bear Owen Barfield Perelandra Pilgrim's Regress Planet Narnia Poetry Publications Ransom Trilogy Reading Religious Maps Religious Drama Sheldon Vanauken Space Trilogy Subcreation That Hideous Strength Theater The Hobbit The Nine Tailors The Screwtape Letters Translations VII Wade Center – 50th Anniversary Wade Center – Events Wade Center – General Wade Center – Hansen Lectureship Wade Center – Muriel Fuller Endowment Wade Center – Zeal of Thy House Museum Promoting the gospel around the world. Help strengthen the worldwide Church with gospel-centered resources. Our campaign ends in . . .
See Also Twinkle Twinkle Little Star Sheet Music With Letters
On the advice of C.S. Lewis, we want to help our readers "breathe the clean sea breeze of the ages through our minds," which, as he argued, "can only be done by reading old books." Continuing our Rediscovering Forgotten Classics series, we want to explore some forgotten Christian classics that remain relevant and serve the church today.
C. S. Lewis would be alarmed to see The Screwtape Letters in a series on the benefits of reading old books. He would say his book is not old enough. When he spoke of old books, he meant:
Character Development, Critical Thinking And Screwtape Letters
Books – works of Plato, Athanasius or Aquinas. But I find that the gap between his writing in the 1940s and my rereading today is long enough to qualify it as "tried against the multitude of Christian thought through the ages" (
, I thought it would be funny. How could a fictional series of letters from a senior demon to a young intern not be hilarious? (If you ever want to feel the full power of his humor, look up the audio version read by John Cleese.)
Your patient has become humble; did you draw his attention to the fact? All virtues are less formidable to us when the man is aware that he has them, but this is especially true of humility. Catch him the moment he's really poor in spirit and smuggle his mind into the gleeful reflection, "Great! I am humble, 'and almost immediately pride – proud of his own humility – will appear.
If he goes that way, let him write a book about it; that is often an excellent way of sterilizing the seeds that the Enemy plants in a human soul.
Surprising Celebrity Audiobook Narrators
But I soon found the book to be far more compelling than entertaining. Lewis shines the light of Christian reflection on sin and temptation in revealing and disturbing ways. He does make me chuckle, but that only makes me lower my guard long enough to feel conviction and repent. I look more honestly at myself and turn away from sin more determinedly after overhearing this diabolical dialogue.
This profound and striking story takes the form of a series of letters from Screwtape, a devil high in the Infernal Civil Service, to his cousin Wormwood, a junior colleague engaged in his first mission on Earth, attempting the damnation of to secure a young man
Halo, Saya adalah penulis artikel dengan judul Screwtape Letters Audio John Cleese yang dipublish pada September 15, 2022 di website Caipm
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Hurricane Irene Destroys 90% Of Homes On One Bahamas Island … Now It's Headed For US (Video)
August 26, 2011 by Infinite
– Irene destroys 90% of homes on one Bahamas island… now it's headed for US (Telegraph, Aug 25, 2011):
Hurricane Irene has destroyed 90 per cent of the homes on one remote Bahamas island – a brutal demonstration of the storm's power as it roars towards America's densely populatd north-east coast.
On the remote Acklins Island, where Irene's eye passed over Wednesday, nearly every home in the Lovely Bay settlement were destroyed, the National Emergency Management Agency said. Several were literally blown away.
The storm is raking slowly through the Atlantic archipelago on a track that will see it barrel up the US East Coast over the next few days. It is predicted to make landfall by Saturday somewhere near North Carolina, where evacuations are already taking place.
On Thursday New York Mayor Michael Bloomberg revealed how seriously American officials are taking the threat as he warned city residents in low-lying areas to make for higher ground.
Irene is currently a Category 3 storm – the same strength as Hurricane Katrina was when it destroyed much of New Orleans in 2005.
However forecasters are predicting that, once it moves past the Bahamas into the warm waters off Florida, Irene will strengthen even more into a lethal Category 4 storm.
As of noon GMT, Irene was packing winds of 115 miles per hour and was located about 65 miles east northeast of Nassau. Once it becomes a Category 4 its wind speed will have increased to 135 miles per hour.
Tourists have been fleeing from the storm's path through the Caribbean in recent days as Irene gained in strength. Now America is bracing for the storm's fury.
Officials in towns up and down the coast are scrambling to inspect bridges, sending naval ships away, dusting off evacuation plans and getting sandbags ready for potential floods.
They are also considering where and when to move people out of harm's way.
President Barack Obama, holidaying on Martha's Vineyard off the East Coast, may also have to face evacuation depending on the storm's path.
The US Navy on Thursday ordered all its ships in the huge port of Hampton Roads, Virginia, out to sea to weather the storm.
On Thursday the NHC issued an alert for the entire US East Coast.
Forecasters said they expected the eye to come close to Cape Hatteras, North Carolina early Saturday, then continue north over water toward the eastern edge of New York's Long Island on Sunday.
It's then predicted to chug up the East Coast, dumping rain from Virginia to New York City before a much-weakened form reaches land in Connecticut. Finally, it should peter out in Maine by Monday afternoon.
"This could be a very large storm, so we are taking it very seriously," said North Carolina Governor Bev Perdue.
Bill Read, director of NHC, said the track remains uncertain but that "the exact center of the storm may stay close to the coast on Saturday and perhaps become a big threat to New England and Long Island."
He said the storm had become "very well organized overnight" and was growing in size.
"It is in the warmest water and a favorable environment so it could actually get stronger," he told reporters in a conference call.
The NHC said that "interests in eastern North Carolina and the mid-Atlantic states should monitor the progress of Irene."
Insurers kept a nervous watch in case Irene threatened wealthy enclaves such as the Hamptons, an eastern Long Island playground for New York's rich.
Forecasters warned that even if the centre of the hurricane stays offshore as it tracks up the mid-Atlantic coast, its wide, swirling bands could lash cities including Washington and New York with winds and rain, knock out power, trigger coastal storm surges and cause flooding.
"We're not paying attention just to the eye of the storm. We're looking at how wide it is, how large it is," Virginia Emergency Management Department spokeswoman Laura Southard said.
Craig Fugate, the head of the US Federal Emergency Management Agency, said emergency personnel were preparing from impact from the Carolinas to New England.
"This is going to be a big storm. Just because it hits one area doesn't mean its not going to cause damage further up the coast," he said.
"The most important thing for people to do right now is to listen to and follow the instructions of their local officials. If you are told to evacuate, evacuate."
If Irene makes a direct landfall in the continental United States, it will be the first hurricane to hit there since Ike pounded Texas in 2008.
Meanwhile, a new tropical depression formed far out over the Atlantic early Thursday, with the National Hurricane Center saying it would likely become a tropical storm later in the day.
Categories Environment, Global News Tags Bahamas, Environment, Global News, Hurricane, U.S. Post navigation
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Trendy gyms and fitness clubs have been popping up like food trucks all around the country, and we all know at least one friend or couple who work out religiously. The routine is almost always the same, you pay your monthly fee, change into your workout garb and head into a gym full of sweaty strangers and overzealous bodybuilders grunting madly during their deadlifts.
Take careful consideration of where any workout equipment is going to be placed and ensure that it isn't near the garage door or other obstruction. Maybe you need more lighting to see safely, so wiring up new overhead lights could be in the works. That said, you're in the garage, so there's a particularly large obstacle you have to contend with, the garage door.
That is probably the largest piece of your garage so it shouldn't ignore. Most garage doors are just aluminum or wood panels with little to no insulation which can be bad in deep winter or the middle of summer with the AC going.
You can buy insulation yourself or replace your door with an insulated steel door to keep the elements at bay. Where you live will obviously be the biggest deciding factor as to what you do with the Garage Door, but something you may want to modify no matter where you are at the door height.
Most garage doors, especially automatic garage doors, roll up and toward the ceiling leaving you with considerably less space to work with if you plan on doing any overhead workouts. You should think about getting a high lift conversion so that your door's tracks will be placed closer to the ceiling than standard installations.
One or two extra feet of space can be a boon if you're holding free weights over your head or doing stretches, plus today's openers can come with many modern security features like app control and monitoring.
Obviously, efficient storage and layout options are a must when converting a confined space like the garage. You'll want to maximize your floor space for your primary workouts so installing some shelving along the outer walls is a good investment. For heavy duty storage, think of installing anchored hooks for weights and racks for bikes and bags.
A garage gym conversion wouldn't be complete without upgrading your cold, barren concrete floor. There is any number of Epoxy and Urethane coatings you can choose from to seal your floor, not to mention rubberized exercise mats to keep your equipment from damaging your newly treated floor.
That is what you walk on after all, so treating the floor properly will help prevent slips or trips. If you spill some of your sports drink, it'll be a quick wipe down, and you're back to making lunges in no time.


Our client is seeking a UX/UI Designer Contractor for 24 months! Immediate interviews!
The Senior UI/UX Designer will be responsible for crafting the future of our products and applications. We strive towards providing engaging consumer-grade mobile and web experiences for the financial industry. We are looking for a designer who is hands-on and passionate about the native all environment (iOS and Android) with strong UX Skills. In this senior role, seeking After Effect and motion graphic skills to bring innovation to create amazing experiences for our customers.
• Five or more years of design user experience, UI design and visual design.
• After Effect and motion graphic skills. Native all environment (iOS and Android).
• Development of complex user interface design solutions of industry-leading grade.
• Large corporate environment experience.
• Ability to design in part of agile and Waterfall software development workflow.
• Experience in agile and waterfall software development processes.
• Ability to work under minimal supervision as a self-starter.
• Problem solving skills with intelligence under ambiguous situations and requirement changes.
• Standard design tools experience.
Execute and develop complex customer experience solutions for web, mobile and desktop industry leading applications.
• Utilize a broad array of user centered design tools including: wireframes, visual mockups, site layouts, taxonomies, navigation schematics, user flows, templates, prototypes.
• Work on multiple projects simultaneously.
• Navigate and assess business, user and technical requirements. Analyze related internal and external sites and align guidelines and standards to policies of best practices.
• User testing arranging, conducting and analyzing.
• Create product usability evaluations and product development teams support.
• Present and defend designs and relevant milestone deliverables to peers, direct managers, and executive stakeholders.
• Develop innovative research and tests theories that lead to alternatives, leading edge design solutions.
Are you available? Please send your most current resume to Angelee at resumes@mbg.com and reference 15630.