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Journal of Medical Internet Research
Published on 05.08.16 in Vol 18, No 8 (2016): August
Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/5712, first published Mar 22, 2016.
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mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study
Angela Pfammatter1, PhD ;
Bonnie Spring1, PhD ;
Nalini Saligram2, PhD ;
Raj Davé3, MBA ;
Arun Gowda4, MD ;
Linelle Blais5, PhD ;
Monika Arora6, PhD ;
Harish Ranjani7, PhD ;
Om Ganda8, MD ;
Donald Hedeker9, PhD ;
Sethu Reddy8, MD ;
Sandhya Ramalingam2, PhD
1Northwestern University Feinberg School of Medicine, Chicago, IL, United States
2Arogya World, Naperville, IL, United States
3Health ARC, Pennington, NJ, United States
4Focus Scientific Research Center, Bengaluru, India
5Emory Centers for Training and Technical Assistance, Behavioral Sciences and Health Education, Emory University, Atlanta, GA, United States
6Public Health Foundation of India, Haryana, India
7Madras Diabetes Research Foundation, Chennai, India
8Joslin Diabetes Center, Boston, MA, United States
9University of Chicago, Chicago, IL, United States
Corresponding Author:
Angela Pfammatter, PhD
Northwestern University Feinberg School of Medicine
680 N Lake Shore Dr, Suite 1400
Fax:1 312 503 0982
Background: In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults.
Objective: A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise.
Methods: Intervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015.
Results: 982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls.
Conclusions: A text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country.
Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF)
J Med Internet Res 2016;18(8):e207
doi:10.2196/jmir.5712
mHealth;
Diabetes is estimated to affect 387 million globally, with disease prevalence expected to increase to 592 million by the year 2035 [1]. Approximately 80% of people with diabetes live in low- and middle-income countries (LMICs) creating a pressing need for prevention and treatment efforts focused on these regions. With 3.6 billion mobile subscriptions worldwide in 2014, mobile phones hold great potential as an intervention delivery channel [2]. Mobile phone uptake is high, even in parts of the globe that lack basic electricity and sanitation infrastructure. Especially since the mobile phone is carried by the user throughout much of the day, mobile health intervention holds the potential to reach and help remote target populations cost-effectively [2,3].
Text messaging interventions could offer a particularly useful health promotion intervention delivery channel for LMICs. Texts can be delivered to the most basic mobile phones and do not require consistent connectivity or Internet capability. Hence, messaging can be delivered inexpensively and automatically to widely geographically dispersed people from different socioeconomic strata [4]. Recent systematic reviews of text messaging health promotion interventions indicate that text messaging has not only proved most efficacious for smoking cessation but also shows some promise for improving other health behaviors, yielding small-to-medium effects comparable with those of print- or computer-delivered interventions [5,6]. However, the vast majority of studies to date have been conducted in high-income countries and in a single language [7]. Since LMICs are disproportionally affected by diabetes as well as underresourced compared with higher income countries, research specifically examining text messaging intervention as part of a public health initiative in LMICs is needed.
India is illustrative of other LMICs, in having a high prevalence of diabetes, poor health care access, and yet a high penetration of mobile device use. Despite its relatively low rates of overweight and obesity, more than 62 million of India's 1.2 billion residents are diagnosed with diabetes [8,9]. The size and heterogeneity of India's population, limited access to health services, and scarcity of quality-controlled clinical laboratory facilities create barriers to intervening preventively on diabetes. Access challenges are particularly acute in India's rural areas, where almost 70% of the population resides [10]. Growing evidence indicates that Indians have heightened genetic risk and a lowered disease threshold in response to diabetes risk factors including age, obesity, abdominal adiposity, and high body fat percentage, resulting in increased risk of diabetes at younger age and lower body mass than other ethnic groups [8]. The elevated and increasing risk of diabetes in the Indian population creates an urgent need for effective interventions that can be scalable to all regions. With its large number of mobile phone subscribers (900 million) [11], India offers a test bed to examine whether an mHealth intervention has the potential to reduce diabetes risk in a LMIC population.
To date, few chronic disease prevention interventions have been tested in the Indian population. Two studies using in-person or telephone counseling showed feasibility, acceptability, and preliminary evidence of efficacious screening and treatment for prediabetic and diabetic patients in rural India. However, these interventions used either individual telephone counseling or a fully equipped mobile van [12,13], requiring extensive personnel and equipment resources that preclude scalability and national implementation in an LMIC. To date, the sole test of a diabetes-related text messaging intervention in India was conducted in men with impaired glucose tolerance, limiting generalizability to the context of prevention in those at risk, rather than population-level prevention [14]. To slow the epidemic of diabetes in India, scalable prevention interventions are needed that can address cultural, geographical, and language barriers across the entire population.
mDiabetes was a text message, public health program developed to address awareness of diabetes and the corresponding risk behaviors. The program was planned to be disseminated through Nokia's mobile platform. The investigators leveraged an opportunity to employ a pre-post evaluation of effectiveness of the messages disseminated. Thus, this study aimed to evaluate whether this 6-month text messaging intervention alone, unaccompanied by costly, burdensome in-person visits or telephone coaching, was acceptable to end users and could improve behavioral risk factors for diabetes in all segments of the Indian population. We hypothesized that those receiving the text messaging intervention, as compared with an untreated comparison group, would show positive changes in 4 health behaviors that lessen diabetes risk: engagement in exercise, avoidance of fat foods, fruit intake of 2 servings a day or more, and vegetable intake of 2 servings a day or more. Furthermore, we explored whether the intervention increased the prevalence of those able to change more than a single health behavior, an important outcome since risk behaviors cluster, and diabetes prevention requires engaging in multiple healthy behaviors [15,16].
Study Design and Participants
Text messages for the mDiabetes program were developed by Emory University and reviewed by a Behavior Change Task Force assembled as part of a 2011 Clinton Global Initiative Commitment by Arogya World. The 56 messages were designed to motivate improvement in diabetes risk behaviors and increase awareness about the causes and complications of diabetes. Based on feedback from Indian consumers, messages were culturally tailored to be more acceptable and actionable by the population. In 2012, Nokia held a 22% marketshare in India, [17] which enabled them to invite one million individuals from all over India to opt in to receive health messages; enrollment was closed once that number was reached. Texts (see Multimedia Appendix 1) were available in one of 12 languages based on participant preference. Texts arrived in a predetermined order and frequency (twice a week) to a dedicated inbox on the Nokia phone. A comparison group was drawn from a database that included all mobile phone users in India, after excluding subscribers to Nokia service.
Ipsos, a global market research company, implemented the evaluation by randomly selecting samples to be interviewed from the Nokia and non-Nokia cohorts and conducting the phone surveys in multiple languages. Intervention participants and controls were recruited in India for a 6-month prospective study. The intervention group of 982 was randomly selected from the one million Nokia phone customers who opted in to receive mDiabetes messages. The control group (n=943) was randomly selected from the database including all non-Nokia mobile phone users in India. The sole eligibility criteria were that participants in both groups be adults aged 18 years and older. The research protocol was approved by an independent ethics review committee of the Centre for Chronic Disease Control of India, New Delhi. The protocol was registered in the Australian New Zealand Clinical Trials Registry, #ACTRN12615000423516.
Between November and December of 2012, Ipsos staff assessed baseline levels of behaviors by interviewing all study participants by mobile telephone in the participant's choice of language. A similar follow-up interview was repeated 6 months later in mid 2013. Interviews were scripted, conducted by personnel who were kept blind to the interviewee's treatment assignment, and lasted approximately 20 minutes. The baseline and 6-month interviews comprised 19 questions asking participants to self-report demographic information, including residential location, age, and health behaviors. To assess physical activity, participants were asked, "Do you exercise currently?" with response options "yes" or "no." Number of fruit and of vegetable servings was assessed with response options of "0 to 1 servings, 2-3 servings, or 4 or more servings." High fat food intake was assessed with the question, "Do you consistently avoid eating high fat food/fried food such as samosas, vadai, bajji, bondas, etc.?" with response options " yes" or "no." Diabetes preventive behaviors were coded as: endorsing exercise, endorsing avoidance of fatty food, endorsing consuming 2 or more servings of fruit, endorsing consuming 2 or more servings of vegetables.
Over 6 months, participants in the active intervention condition were sent 56 unique messages related to diabetes: one message per day for the first 6 days, then 2 messages per week. Participants in the control group received no study contact until the end of the 6-month period.
Data checking, cleaning, and analyses were conducted in 2014 and 2015. The study was designed to detect a 10% difference between groups on change in a composite health behavior score with 80% power and a 2-sided significance level of α=0.05. Power analysis produced a sample size estimate of 384 for each group. Assuming that rural versus urban location would be a meaningful covariate, the objective was to recruit equal numbers in each area. Therefore, with an estimated 15% attrition, target recruitment was 450 participants for intervention and control, stratified by geographic region, resulting in a total sample size of at least 1800.
The match between each individual's postintervention and preintervention survey was confirmed on the basis of phone number and demographic data. Differences between the intervention and control groups in baseline measures and retention were tested by chi-square. All available surveys were included in the baseline analyses, but only matched pairs of surveys were included in the longitudinal analysis. To compare the lifestyle behavior changes over time, a composite healthy behavior change score was constructed. Each instance of pre/postbehavior change from unhealthy status to healthy status was assigned a numeric score of 1; no change was assigned a score of 0; change from healthy to unhealthy was assigned a score of −1. The scores for each of the 4 behaviors were then summed, generating a composite change score that ranged from 4 (when all 4 behaviors moved from unhealthy status in the prephase to healthy status after treatment) to −4 (when all 4 behaviors changed from healthy to unhealthy). Healthful behavior change was operationalized by the composite healthy lifestyle improvement score [18].
Normality of the distribution of the composite score was evaluated before conducting the primary analysis comparing the 2 treatment groups on healthful behavior change. An analysis of covariance was conducted with baseline level of behavior, gender, and urban/rural location included as covariates. Secondary analyses using logistic regression with the same covariates compared the groups on the presence of each of the 4 preventive behaviors at postintervention. All analyses were performed using in IBM SPSS Statistics (version 22) [19].
During the recruitment phase of the study, 982 participants in the intervention group and 943 in the control group consented to take the phone survey (Table 1). A majority of the sample were male (88.52%), lived in an urban location (68.78%), and resided in the North of India (67.06%). At both baseline and 6-month follow-up, the intervention group had fewer males (P<.001) and fewer individuals living in urban locations (P<.001) than the control group. At the end of the 6-month period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey (P=.028).
Overall; n Control; n Experimental; n P value
Baseline 1925 943 (48.99%) 982 (51.01%)
Male 1704 (88.52%) 881 (93.43%) 823 (83.81%) <.001a
Urban 1324 (68.78%) 867 (91.94%) 457 (46.54%) <.001a
North India 1291 (67.06%) 653 (69.25%) 638 (64.97%) .047a
Mean age (SD) 32.2 (10.6) 32.83 (9.39) 31.66 (11.64) .016a
Consumes fruit 46 (2.39%) 31 (3.29%) 15 (1.53%) .033a
Consumes vegetables 75 (3.90%) 53 (5.62%) 22 (2.24%) <.001a
Consumes fat 569 (29.56%) 267 (28.31%) 302 (30.75%) .241
Exercises 1094 (56.83%) 601 (63.73%) 493 (50.20%) <.001a
aIt indicates statistical significance (P<.05).
Table 1. Participant baseline characteristics.
View this table
After controlling for covariates (baseline behavior, gender, urban/rural location), the treatment groups differed significantly in their composite healthy change scores F(1, 1238) = 30.181, P<.001, Bonferroni adjusted 95% CI (0.251-0.531), such that participants in the intervention group reported greater improvement in their aggregated diabetes risk behaviors over time than participants in the control group. Figure 1, demonstrating the distribution of change scores for each group, indicates that 36.55% of participants in the control condition reported a decline in their number of healthy behaviors, as compared with 24.71% of those in the intervention group.
Analyses shown in Table 2 revealed that, as compared with controls, more participants in the experimental group improved their fruit and vegetable intake and reduced their fat intake after intervention. No differential change in exercise was observed between the groups (Figure 2). In addition, 128 (20.95%) of the intervention group compared with 73 (11.55%) of the control group improved 2 or more health behaviors.
Health Behavior Predictor β SE β Wald's χ² dƒ p eβ
Fruit Consumption (n=1243) Constant −0.836 0.098 72.611 1 <.001a 0.434
Baseline 0.543 0.122 19.797 1 <.001a 1.721
Location 0.230 0.141 2.657 1 .103 1.259
Gender −0.132 0.199 0.441 1 .507 0.876
Group 0.549 0.133 17.023 1 <.001a 1.731
Test χ² dƒ P
Overall model evaluation 51.919 4 <.001a
Vegetable Consumption (n=1243) Constant −0.357 0.110 10.452 1 <.001a 0.700
Gender 0.217 0.220 0.972 1 .324 1.242
Fat Consumption (n=1243) Constant 0.465 0.134 12.055 1 .001a 1.593
Baseline 0.463 0.144 10.332 1 .001a 1.589
Location 0.446 0.179 6.215 1 .013a 1.562
Group 0.510 0.156 10.739 1 .001a 1.665
Physical activity (n=1243) Constant −0.163 0.113 2.094 1 .148 0.849
Group 0.094 0.137 0.469 1 .494 1.098
a indicates statistical significance (P<.05).
Table 2. Logistic regression of behaviors at the end of intervention by group with covariates.
Figure 1. Composite behavior change scores by group.
View this figure
Figure 2. Preventive behaviors present at pre and postintervention by group.
This study demonstrated the feasibility and initial evidence of effectiveness of a diabetes prevention text messaging intervention in 12 languages delivered to a sample of nearly 1000 Indian adults, drawn from both rural and urban regions. As compared with those who were not sent diabetes-related messages, those receiving text messages designed to enhance awareness of diabetes risk factors displayed greater improvement in diabetes preventive behaviors over a 6-month period. In addition, the text messaging intervention prevented health behaviors from deteriorating. Importantly, the minimalist and scalable text messaging intervention improved more than one risk behavior simultaneously, an important feature since multiple co-occurring risk behaviors are implicated in the development of diabetes and other chronic diseases. Fat and fruit and vegetable intakes all improved at 6 months in the group receiving messaging, as compared with controls after controlling for baseline differences between the groups. Even though the group receiving text messages reported a small increase in exercise relative to controls, the difference was not significant. Consistent with findings from other studies, a more robust intervention may be needed to produce improvement in physical activity [18]. Overall, results support the feasibility, acceptability, and preliminary effectiveness of a low-cost, low-burden text messaging intervention to prevent degradation of health behaviors over time and to promote the acquisition of diabetes preventive behaviors.
Diabetes imposes a devastating socioeconomic burden globally, especially in the developing world. Although effective diabetes preventive interventions exist, including those evaluated in the Diabetes Prevention Program, the Finnish Diabetes Prevention Study, the Malmo Study of Sweden, and the Da Qinq IGT and Diabetes Study of China, most successful treatments are very burdensome and costly [20-23]. An urgent need exists to develop effective, scalable interventions that are adaptable for different cultures at low per-patient cost. As mobile phone use continues to increase, the use of mHealth interventions to address public health problems grows increasingly feasible and attractive [23]. Results of this study adds to the emerging evidence that population level healthy lifestyle change may be attainable through low-cost mobile health interventions [24].
This study had several limitations that should be considered when interpreting the results. First, the absence of random assignment to treatment groups resulted in some imbalances in the baseline characteristics of the groups. We addressed these by controlling for covariates in the analyses; however, it is possible that inherent differences between the intervention and control populations remained. Second, the selection of participants may have been biased toward those having greater than average interest in health, given that all participants agreed to answer questions about their health. Measurement error and social desirability bias may have been operative since participants' behaviors were self-reported rather than objectively measured. Although these selection biases are of concern, they apply similarly and nondifferentially to participants in both groups. This study was constrained by time and cost of asking multiple questions in multiple languages and as such was unable to use longer, more rigorous assessments of diet quality. Thus, to assess initial feasibility and potential for public health benefit, brief questions were used. Another measurement challenge that affected both groups was that, to avoid appearing rude or insulting, interviewers inferred the participant's gender by listening to his/her voice on the telephone, rather than directly asking. The reliability of interviewers' reports of gender is unknown. Generalizability of these findings beyond the Indian Nokia user context cannot be assumed. However, given high rates of cellphone penetration in other LMICs, we expect that our findings are likely to generalize, particularly if messages are culturally tailored as they were in this study.
The results from this study demonstrate that health promotion text messaging interventions are feasible to implement in 12 languages, across a large LMIC population, and can be effective in improving behaviors that heighten the risk of diabetes and other chronic diseases. With its low cost and burden, text messaging intervention holds the potential to represent sound and effective public health investment. The cost of Arogya World's one million-person program was $0.65 per person, including program development, transmission, and measurement. The current global epidemic of noncommunicable disease creates an urgent need for proven, simple, transportable, readily executable strategies that offer hope for chronic disease prevention at the population level particularly in LMICs. Population-level mobile health promotion interventions like the one described, show promise to meet that need. Additional evaluation using randomized trial design with measurement of objective outcomes will add to the evidence base for the use of mobile technology in chronic disease prevention.
The authors acknowledge study partners Nokia and Emory University and Mallory Stasko and H. Gene McFadden for their expertise, hard work, and support. This study was directed by Arogya World, which received funding from Aetna International, Lifescan Inc. (a Johnson & Johnson company), and MSD India. The funding sources had no involvement in the conduct of the study, writing of the manuscript, or decision to submit for publication. The research protocol was approved by the Centre for Chronic Disease Control of India, New Delhi and registered in the Australian New Zealand Clinical Trials Registry #ACTRN12615000423516. Linelle Blais received compensation to write the text messages used in the current study. Om Ganda has a grant with Amarin Pharma for an ongoing multi-center RCT, receives consulting fees from Amgen and Sanofi, and receives speaker honoraria from Merck and Janssen. S. Sethu Reddy was vice-president of medical affairs at Merck, Sharp, and Dohme until December of 2013 and receives speaker honoraria from Merck, Sharp, and Dohme. No financial disclosures were reported by other authors.
Arogya World (NS, RD, AG, and SR) conceptualized and designed the mDiabetes initiative. NS, BS, and SR, designed the research study. AP, BS, NS, SSR, OG, DH, and SR analyzed and interpreted the data. LB developed the text messages. MA led the Ethics Review. NS, LB, MA, HR, and SR were members of Arogya World's Behavior Change Task Force and commented on the messages and the behavior change data. AP prepared and coordinated the submission of the manuscript. All authors reviewed and approved the final version of the manuscript.
This study was directed by Arogya World, which received funding support from Aetna International, Lifescan Inc. (a Johnson & Johnson company), and MSD India. The funding sources had no involvement in the conduct of the study, writing of the manuscript, or decision to submit for publication. The corresponding author constructed the manuscript, had final responsibility for the decision to submit, and had full access to all the data in the study.
Linelle Blais received compensation as part of a contract with Arogya World to write the text messages used in this study.
Multimedia Appendix 1
mDiabetes text messages sent.
PDF File (Adobe PDF File), 126KB
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LMIC: low/middle income country
Edited by G Eysenbach; submitted 22.03.16; peer-reviewed by S Coughlin, S Bahanshal; comments to author 12.05.16; revised version received 15.06.16; accepted 04.07.16; published 05.08.16
©Angela Pfammatter, Bonnie Spring, Nalini Saligram, Raj Davé, Arun Gowda, Linelle Blais, Monika Arora, Harish Ranjani, Om Ganda, Donald Hedeker, Sethu Reddy, Sandhya Ramalingam. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.08.2016.
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UPDATE: Deal Made for Barnes & Noble to Remain 2 More Years in Bay Plaza
UPDATE: As I predicted, bookstore won't shut down; 2-year deal is made. Go to welcome2thebronx.com for more info.
Headline a bit of a prediction, but quite likely nonetheless. Barnes & Noble in Co-op City was headed for closure because of a rent rivalry with Bay Plaza landlord Prestige Properties and Development. But last night, Borough President Ruben Diaz, Jr. announced a noon press conference today with both bookstore and landlord big-shots present in Bay Plaza at his sides. Bound to be good news, right? We shall see in a couple of hours.
Incidentally, back in 1999, as editor of the Norwood News, I wrote about then-Assemblyman Stephen Kaufman, who successfully hectored Barnes & Noble:
He doesn't represent any of the neighborhoods we serve, but east Bronx Assemblyman Stephen Kaufman deserves credit for shepherding a Barnes & Noble bookstore to the borough. Like many Bronxites, he couldn't fathom how a borough of 1.2 million people had only two small general-interest bookstores. Like few others, however, he did something about it. He bugged, bothered, cajoled and convinced Barnes & Noble officials, making a strong case that a Bronx branch would succeed "beyond their wildest dreams."
And here's my story about the opening 15 years ago.
"…[B]eginning this month, tens of thousands of titles are being pumped into the borough's literary circulatory system, thanks to a new Barnes & Noble superstore that debuted on Dec. 1 in Bay Plaza."
Tags: Barnes & Noble, Bay Plaza, bookstore, Bronx, Co-op City, Prestige Properties and Development, Ruben Diaz Jr., Stephen Kaufman
Categories Bronx Education, Bronx Politics
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No Gas in Bronx Apartments on Strong Street
Phenomenal Bronx Documentary Photo Exhibit in a Muffler Shop. No Kidding.
Care About the Bronx and Beyond? Watch This Brief Video on How a Group of Fake 'Democrats' Has Handed the State Senate Over to Republicans and Learn What You Can Do.
4 Days to Go — Voters on THURSDAY, Sept. 13 Can Put an End to the IDC
A Diner/Restaurant at Former Van Cortlandt Library Site? (Bronx)

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LGBTQ+ Healthcare Equality
All Stony Brook Medicine Hospitals Named National Leaders in LGBTQ+ Healthcare Equality
STONY BROOK, NY, March 28, 2022 – Stony Brook University Hospital (SBUH), which includes Stony Brook Children's Hospital, Stony Brook Southampton Hospital (SBSH) and Stony Brook Eastern Long Island Hospital (SBELIH) have been named "LGBTQ+ Healthcare Equality Leaders" for 2022 in the Human Rights Campaign Foundation's 15th anniversary edition of the Healthcare Equality Index (HEI). All hospitals received the top score of 100 on a survey encompassing non-discrimination and staff training, patient services and support, employee benefits and policies, and patient and community engagement.
"Year after year Stony Brook's LGBTQ+ Committee is committed to providing high quality, equitable care to our LGBTQ+ community in Suffolk County," said Hal Paz, MD, Executive Vice President, Health Sciences, Stony Brook University and Chief Executive Officer, Stony Brook University Medicine. "I am proud of the entire Stony Brook Medicine healthcare system's collective efforts and hard work to achieve this recognition."
Each year SBUH seeks new ways to address and affirm the specific and unique needs of LGBTQ+ individuals. In 2021, Stony Brook Medicine realized there was scarce quantitative information available both nationally and regionally on the healthcare needs of LGBTQ+ persons. As a result, Stony Brook collaborated with more than 30 Long Island-based organizations and community leaders to reach all sectors of the LGBTQ+ community to complete the LGBTQ+ Health Needs Assessment Survey, launched during Pride Month in June 2021. The survey aimed to provide Long Island's LGBTQ+ community with an opportunity to express their healthcare needs so SBM and its partners can better support them and advocate on their behalf. By the end of September 2021, a total of 1,150 participants completed the survey.
Stony Brook Medicine continues to grow its dynamic LGBTQ+ Committee, amongst all of its hospitals, to address the needs of the LGBTQ+ community, including patients, faculty, staff and trainees. The Stony Brook Medicine LGBTQ+ Committee is co-chaired by three SBUH-affiliated colleagues: Rose Cardin, MSN, RN, Director, Patient Education, Stony Brook University Hospital; Allison Eliscu, MD, FAAP, Chief, Adolescent Medicine, Stony Brook Children's Hospital; and Adam Gonzalez, PhD, Director, Behavioral Health, Stony Brook Medicine. The multidisciplinary group is made up of medical and behavioral health providers and trainees, nurses, students, education specialists, and representatives from Human Resources, Information Technology and hospital administration. Its mission is to review, address and affirm the specific and unique needs of LGBTQ+ individuals, as well as promote respectful and culturally sensitive care to the LGBTQ+ community.
"I am incredibly proud of the integral role Stony Brook University Hospital has played in supporting the LGBTQ+ community," said Carol A. Gomes, chief executive officer for Stony Brook University Hospital. "This recognition from the Human Rights Campaign Foundation is a testament to the exemplary work we have been doing, including landmark initiatives such as administering the first LGBTQ+ Community Health Needs Assessment Survey to meet the unique healthcare needs of LGBTQ+ individuals."
In May 2021, SBSH's Edie Windsor Healthcare Center, (formerly the David E. Rogers, MD Center) which has provided care for the LGBTQ+ community and those with HIV since the 1990s, moved to its new location in Hampton Bays to better serve the LGBTQ+ community. The practice, which cares for LGBTQ+ patients and continues to treat HIV patients, has a dedicated, full-time physician, Dr. Eric Lella, and specializes in providing confidential medical services in an accessible and caring environment regardless of sexual orientation or gender identity and expression.
"The Edie Windsor Healthcare Center supports the right of every member of the LGBTQ+ community to receive world-class clinical care in a compassionate environment that is culturally sensitive to the specific needs of the individual," said Robert S. Chaloner, Chief Administrative Officer of Stony Brook Southampton Hospital. "The Center is dedicated to meeting the diverse needs of the LGBTQ+ community."
Stony Brook Southampton's Diversity Leadership Council, a committee of 25 administrators, physicians, nurses, and other staff, actively educates, informs, and provides resources for the wider hospital community about diversity issues while seeking opportunities to build an inclusive and safe environment for all who work in, seek care at, or visit hospital facilities. To foster a sense of inclusion and compassion for all, the hospital has provided training to staff through the Responding to Equity, Diversity and Inclusion (REDI) program and the Greater New York Hospital Association's Cultural Competency and Health Literacy education programs.
Upon reviewing HEI recommendations and criteria to better understand the behavioral health and medical needs of its local LGBTQ+ community, SBELIH revised human resource and hospital wide policies, employee documents, terminology in medical records and facility signage. The changes enhanced SBELIH's already strong focus on providing non-discriminatory and compassionate care. With a long history of serving the LGBTQ+ community, SBELIH continues to add clinicians and other staff members who specialize in LGBTQ+ care. John Batterman, Credentialed Alcoholism and Substance Abuse Counselor, has counseled LGBTQ+ patients in recovery throughout his 27-year tenure. The hospital's history of service contributed to HEI naming SBELIH a Leader in LGBTQ Healthcare Equality.
"Providing gender affirming care is a cultural and organizational shift, and we have made that shift," said Paul Connor, Chief Administrative Officer of Stony Brook Eastern Long Island Hospital. "To create an organization that is truly welcoming to LGBTQ+ patients, we engaged every department, from clinical care to medical records. Steps included ensuring we have inclusive terminology on medical records and forms, as well as boosting cultural sensitivity training for staff to increase awareness of the health needs of LGBTQ+ individuals."
The Human Rights Campaign Foundation is the educational arm of America's largest civil rights organization working to achieve equality for lesbian, gay, bisexual, transgender and queer people. HRC envisions a world where LGBTQ+ people are embraced as full members of society at home, at work and in every community.
To learn more about how Stony Brook Medicine addresses the needs of the LGBTQ+ community, including patients, faculty, staff and trainees, please watch this video.
Stony Brook Medicine offers a range of specialized LGBTQ+ health services including a Talking About Gender (TAG) support group for teens to explore gender identity and expression, and learn ways to deal with stress. For more information on Stony Brook Medicine's LGBTQ+ care, visit: www.stonybrookmedicine.edu/LGBTQ.
Stony Brook University Hospital (SBUH) is Long Island's premier academic medical center. With 624 beds, SBUH serves as the region's only tertiary care center and Regional Trauma Center, and is home to the Stony Brook University Heart Institute, Stony Brook University Cancer Center, Stony Brook Children's Hospital and Stony Brook University Neurosciences Institute. SBUH also encompasses Suffolk County's only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation's first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu/sbuh.
About Stony Brook Eastern Long Island Hospital:
With 70 beds, Stony Brook Eastern Long Island Hospital (SBELIH) is a full-service, community hospital committed to delivering excellence in patient care and meeting all the health needs of the North Fork and Shelter Island. A campus of Stony Brook University Hospital, SBELIH provides regional behavioral health programs serving the greater Suffolk County area. Centers of excellence include Medical-Surgical, Advanced Ambulatory Care, Behavioral Health, Emergency, Geriatric, Diagnostic Services, Physical Therapy and Gastrointestinal Services. To learn more, visit www.elih.stonybrookmedicine.edu.
Photo Caption 1 #656: Stony Brook University Hospital (SBUH), which includes Stony Brook Children's Hospital, Stony Brook Southampton Hospital (SBSH) and Stony Brook Eastern Long Island Hospital (SBELIH) have been named "LGBTQ+ Healthcare Equality Leaders" for 2022 by the Human Rights Campaign Foundation.
Credit: Photo courtesy of the Human Rights Campaign Foundation
Photo Caption 2 Pride: Staff celebrating Pride Month at Stony Brook Southampton Hospital. (Photo taken Pre-COVID)
Credit: Photo courtesy of the Stony Brook Southampton Hospital
Photo Caption 3 SBELIH: Welcoming LGBTQ+ rainbow flags line the walkway to Stony Brook Eastern Long Island Hospital during Pride Month.
Credit: Photo courtesy of Stony Brook Eastern Long Island
Photo Caption 4: PRIDE messages line the sidewalks outside Stony Brook University Hospital.
Credit: Photo courtesy of Stony Brook University Hospital


MCLEAN, Va. - For the third consecutive year, Hilton has been named as one of the World's Best Workplaces recognized by Great Place to Work®. Team Members from the world's most hospitable company say Hilton's culture, benefits and travel perks make it a great place for a career in the hospitality industry. Hilton climbed seven spots to the highly coveted second spot on the list of the top 25 companies and is the highest ranked hospitality company.
Hilton offers programs to help Team Member thrive personally and professionally with global career development opportunities and global training. Industry-leading benefits include: parental leave, adoption assistance, GED support and discounted stays at Hilton properties around the world. Under the Thrive@Hilton framework, the company is designing and creating innovative corporate office space and attire for Team Members working in physically demanding jobs.
Team Members also receive exclusive travel perks, and there are a variety of volunteer programs supporting Hilton's corporate responsibility mission, Travel with Purpose.
With a workforce spanning over 390,000 people across 106 countries and territories, today's recognition is a result of positive feedback from our Team Members. Hilton ranked in 15 different regional best workplace lists, including Australia, Brazil, Chile, China, Colombia, India, Italy, Mexico, Netherlands, Peru, Saudi Arabia, Turkey, the United Kingdom, United Arab Emirates and the United States.


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Big self-storage players muscle out mom-and-pop firms
Major companies buying smaller storage companies for better land values, while real estate investment trusts turn to sector for higher investment yields
Frank O'Brien / Western Investor
Storing stuff is now a near-billion-dollar annual industry in Canada that is attracting big investors, including real estate investment trusts and pension funds. | Submitted
When self-storage giants StorageVault Canada Inc. and Access Self Storage reached a $55 million agreement May 14 for Toronto-based StorageVault to acquire the "asset and business" of an Access store in B.C., it underlined how the self-storage business is changing.
While the industry is still largely the domain of mom-and-pop operations – the Canadian Self Storage Association estimates that at least 80 per cent of operators are independents that manage no more than one storage facility – large U.S. and Canadian portfolio owners are scaling up by swallowing smaller operators.
In the past fiscal year, StorageVault closed on $373 million in acquisitions and it now owns or controls 161 storage locations with six million square feet of rental space across the country.
With 140 Canadian locations, Access is another of the half-dozen major players in self-storage. These include U.S.-based StorageMart, which holds a 4.4 per cent share of the Canadian market; and U-Haul, owned by Amerco, which has about four million square feet of storage space. Edmonton-based Sentinel Storage has a 2.5 per cent slice of the Canadian market, with 24 locations, mostly in B.C. and Alberta.
Smaller operators are being acquired by bigger companies because it is less expensive to buy facilities than to build new ones, due to rising land costs and the uneven development and zoning guidelines in provinces and municipalities. That's according to IBISWorld, which has released an exhaustive study of Canada's self-storage industry.
Some companies are buying existing commercial and industrial property and converting it to storage because the profit margins can be higher. Bluebird Self Storage bought the former National Post building in downtown Toronto for $20 million and spent the same amount converting it to high-end storage lockers.
Phoenix-based U-Haul International Inc., which operates more than 1,300 self-storage locations across North America, has converted the former Zellers department store in Kelowna to self-storage. The 110,000-square-foot facility contains more than 1,000 indoor climate-controlled storage units.
Fuelled largely by demand from the residential sector and small business, the number of self-storage operators in Canada has been expanding at 4.8 per cent annually for the past five years to 1,045 operators, IBISWorld found.
The real estate investment characterized by high capitalization rates, relatively low maintenance costs and rising profits has also attracted other large investors, including real estate investment trusts (REITs) and pension funds. Skyline Commercial REIT, for instance, has bought nine cold-storage facilities so far this year, spending $190 million in a buying binge that included facilities in Calgary, Saskatoon and Winnipeg.
Ivanhoé Cambridge, the real estate arm of the Caisse de dépôt et placement du Québec pension fund, holds a 50 per cent share in Vancouver-based VersaCold, which specializes in cold storage.
Demand for storage units and decreasing vacancy rates helped industry profit margins, measured as earnings before interest and taxes, reach 10.5 per cent in 2019, up from 9.1 per cent in 2014, IBISWorld reports.
Modern storage is becoming expensive, however, due to demand for climate-controlled space and round-the-clock security, according to Cushman & Wakefield, a commercial agency, which has a self-storage division. Also, increasing competition is forecast to drop revenue growth to 1.7 % annually over the next five years, down from 3.1 per cent this year.
Still, a new self-storage facility can churn an ongoing capitalization rate average of 6.27 per cent to 8.7 per cent, which is higher than most commercial real estate, Cushman & Wakefield estimates.
Residential tenants account for the majority of self-storage clients, making up 63.4 per cent of rentals. Commercial tenants rent 25.2 per cent of storage units, with students and military clients making up the rest of the annual $920.9 million annual industry, according to IBISWorld.
Revenue is rising faster from commercial tenants than from the residential sector, however, due to small-business growth. The average commercial tenant rents a storage unit for 22.7 months, considerably longer than the average residential client's rental.
Storage rental prices can reach $3.50 per square foot in Vancouver and Toronto, and are also close to residential apartment rates in other major cities, without the hassle of dealing with residential rental regulations. Since rents are calculated monthly, storage facilities can also often earn more money per square foot than traditional commercial space, where rents are annual.
"Storage lockers are a simple investment – there is often no heat, little maintenance and, if you want to make it a luxury unit, you put in a light bulb," quipped Vancouver real estate consultant Ozzie Jurock.
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Announcements and miscellaneous
Global Sanitation Fund updates
OUmelo
Communications and Documentation Officer with the Water Supply and Sanitation Collaborative Council (WSSCC)
Likes received: 3
Re: New Global Sanitation Fund Progress Report released
29 Jun 2017 10:54 #21915 by OUmelo
WSSCC's new Global Sanitation Fund (GSF) Progress Report shows that GSF's support to governments and partners across 13 countries has enabled 15 million people to end open defecation, since the Fund's launch in 2008. Other cumulative results include 12.8 million people with access to improved toilets, and 20 million with access to handwashing facilities.
As WSSCC's funding arm, GSF strives for universal access to sustainable and equitable sanitation and hygiene, as called for in the Sustainable Development Goals. Read more: bit.ly/2sm9MyG / Download the report in English or French: bit.ly/2t0wcas
Sustaining results:
GSF has placed, and continues to place, considerable efforts on understanding and addressing the conditions that can shape or affect the sustainability of programme results.
In 2016, GSF published a reflection paper on slippage and sustainability , sharing substantial evidence from Madagascar and other supported countries. A paper on catalytic programming for scale and sustainability was also published, which was the result of a global GSF Learning Event and compiled key learning from all GSF-supported programmes. In addition, strategies, approaches and tools have been developed and refined across GSF-supported programmes, to drive scale and sustainability. For example, the Madagascar programme developed Follow-up MANDONA , which helps communities rapidly achieve and sustain ODF status. In Nepal, a sustainability survey was conducted, and building on the study's methodology, GSF began working with the University at Buffalo to develop a standardized outcome survey methodology.
Re: WSSCC Releases New Global Sanitation Fund Equality and Non-Discrimination Study
30 Aug 2017 14:04 #22485 by OUmelo
A new Water Supply and Sanitation Collaborative Council (WSSCC) study assesses its Global Sanitation Fund's (GSF) approach to equality and non-discrimination (EQND).
The study reveals that many people who may be considered disadvantaged have benefited positively from GSF-supported programmes, particularly in open defecation free verified areas. In addition, a range of positive outcomes and impacts related to empowerment, safety, convenience, ease of use, self-esteem, health, dignity, an improved environment and income generation were reported by people who may be considered disadvantaged.
However, the study finds that GSF has not yet systematically integrated EQND throughout the programme cycle. Across all countries, there are people who have either fallen through the net or whose lives have become more difficult after being unduly pressured, or after taking out loans and selling assets to build toilets. More proactive attention is needed throughout the programme cycle to build on current successes and ensure that people are not left behind or harmed through the actions or omissions of supported programmes.
GSF is in the process of putting the study's recommendations into practice through revised guidelines, minimum standards and practical tools.
Download the full study, as well as a summarized version with GSF reflections, and annexes: bit.ly/2v5uZz6
Re: Water Week Blog: Exploring the Circular Economy, CLTS Opportunities & Solutions to Leave No One Behind
06 Sep 2017 13:02 #22576 by OUmelo
Last week, the Water Supply and Sanitation Collaborative Council (WSSCC) was an active participant at the World Water Week in Stockholm. In a new blog on the event, WSSCC's Carolien van der Voorden reflects on conversations around sanitation and the circular economy, the CLTS journey and opportunities ahead, equality and non-discrimination and the role of civil society.
Read her blog here: bit.ly/2f27il0
Re: Equality and Non-Discrimination in Sanitation Programmes: 10 Principles
How can water, sanitation and hygiene (WASH) practitioners ensure that people who may be disadvantaged benefit effectively from sanitation programmes? Ten principles, generated through WSSCC-supported learning and research, can help drive equality and non-discrimination forward.
Recognize differences across all communities and look for those who might be excluded from the programme. Start to wear 'glasses' with lenses that allow you to see people who might be disadvantaged as part of the whole community.
Adhere to the 'do no harm' concept to ensure that people do not become worse off as a result of the programme's actions. Always listen to the voices of disadvantaged people, ensure people's right to privacy, train partners on EQND issues, monitor and evaluate activities, and insure information is accessible to all.
Respect all members of the community and ensure their dignity, even if you don't agree with a person's lifestyle.
Consider the identification of disadvantage as a process rather than a one-off activity – use every contact with the community to consider if some people might be excluded, in what way, and what can be done about it.
Consider how those who are potentially disadvantaged can be actively involved throughout the process (e.g. as Natural Leaders or committee members) and benefit from the outputs (e.g. the use of facilities and skills training).
Encourage people to undertake tasks themselves wherever possible, to boost empowerment and self-confidence; but also recognize where external support is required, whether from the community or external to the community, ensuring that people who are disadvantaged are not put under unnecessary levels of stress and pressure.
Be conscious about the power dynamics between community members and aware that some groups are deliberately excluded and marginalized by communities.
External support should be provided transparently and should identify ways to enable community members to be involved in decision making on how it should be used.
Collaborate with local organizations representing those who are disadvantaged and seek their advice and engagement with the programme.
Continue to learn and build on experiences as to how best to include and benefit from the skills and knowledge of people who may be disadvantaged, and share this knowledge with others.
More information on these and other principles, as well as good EQND practices, can be found in the following publications: Scoping and Diagnosis of the Global Sanitation Fund's Approach to Equality and Non-Discrimination and Equality and non-discrimination (EQND) in sanitation programmes at scale


Google's Chrome browser is one of the most popular in the business, and despite not having been around for as long as the likes of Mozilla's Firefox or Microsoft's Internet Explorer, the continual updates from the GOOG's famously dogmatic development team have made it hard to resist for many Web users. Today, Chrome for Windows has been given an update, bringing forth the improved pop-up notification interface as first previewed in the beta. At this point, only the Windows version sees the updated version, but the search giant has noted that the corresponding Mac iteration is imminent.
Many people tend to operate more than one browser at a time on their computers, and although I do have an affinity to Mozilla's Firefox due in part to its lack of a corporate backing, I have to admit that in terms of features and functionality, Chrome has become my primary Web-surfing client.
The update offers the usual array of bug fixes and performance enhancements, with the clincher being the richer pop-up notifications, which now feature both text and images. Since one can also perform actions within these notification panels, one will not need to jump out of a window in order to respond to a notification; a sure-fire win for productivity.
If you pop off to make a cup of coffee and happen to miss a few notifications, you can readily check them all in one go, so you don't end up with the nasty backlog that can often build up with notifications. And hey, if you don't want to deal with them whatsoever, you can easily disable them from within the settings, meaning you can enjoy uninterrupted concentration on the task in hand.
This latest update is only for users of the Windows variety, but the blog post detailing the update notes that the OS X version will be hitting the download servers "soon." Knowing Google's promptness in delivery, it could well manifest itself in the next day or two, but whatever the case may be, we'll be sure to let you guys know as and when the new Chrome for Mac is dropped.
You can update your Windows version right now by checking for updates within the browser window, or simply heading to google.com/chrome .


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Home inet AI technology: Another competitive "weapon" between the US and China!
AI technology: Another competitive "weapon" between the US and China!
Η Artificial Intelligence AI, which now includes everything from robots to medical diagnostic tools, is a rapidly evolving field that is playing an increasingly critical role in many aspects of our lives. AI is particularly important for both a country and its citizens, and the power of this technology is increasingly escalating in various sectors, such as the economic and military sectors. This is why AI technology has evolved into a competitive "weapon" between countries. A typical example is the USA and China. China seems ready to take the lead in research and use of artificial intelligence, given its national artificial intelligence dominance plan and the billions of dollars the government has invested in it, compared to the US-focused development of the private sector.
Until last year, the two superpowers were largely interdependent on AI technology. It is an area that has attracted the attention and investment of major technology forces on both sides of the Pacific, including Apple, Google and Facebook in the US and SenseTime, Megvii and YITU Technology in China. However, the combination of political tensions and its rapid spread COVID-19 in both nations it furthers the division between them, which will have consequences for both the advancement of technology and the dynamic power of the world for years to come.
Georg Stieler, CEO of Stieler Enterprise Management Consulting China, said that these new technologies will create a new scenario in the next three to five years, and that people who develop them will be able to control different parts of the world.
China's rapid growth in interest in AI technology can be traced back to some key moments that began four years ago.
The first was in March 2016, when AlphaGo, a machine learning system created by DeepMind Google using algorithms and reinforcement learning to train in huge sets data and predict the results, defeated world champion Goe Lee Sedol. This spread throughout China and aroused great interest. Both sides emphasize how quickly technology has advanced and suggest that because the GO includes war-like strategies and tactics, artificial intelligence could possibly be useful in making war decisions.
The second moment came seven months later, when the government of former US President Barack was in power Obama, published three reports on preparing for a future dominated by artificial intelligence, developing a national strategic plan, and describing the potential economic implications. Some Chinese policy makers have taken these reports as an indication that the United States has pursued a more AI strategy than expected.
This culminated in July 2017, when the Chinese government under President Xi Jinping released a development plan aimed at making the nation the world's leader in artificial intelligence by 2030, including investing billions of dollars in start-ups and start-ups.
Lian Jye Su, chief analyst at ABI Research, a global technology consulting firm, said China has noticed that the IT industry comes from the US and has a soft influence around the world through various Silicon Valley innovations. He added that as an economy based solely on its productive potential, China is willing to find a way to diversify its economy and provide more innovative and innovative ways to show its strengths to the world. AI is a good way to do that.
Despite the competition, the two nations have worked together from time to time. China has data masses and much more relaxed regulations on their use, so it can often apply AI tests faster. But the nation still relies heavily on US semiconductors and open source software for AI and mechanical learning algorithms.
And while the United States has the lead in quality research, universities and engineering talent, top AI programs at universities such as Stanford and MIT attract many Chinese students, who later usually continue to work for technology giants such as Google. the Microsoft, Apple and Facebook.
China's fears of a major US artificial intelligence plan have not materialized. In February 2019, US President Donald Trump Trump, issued an executive order of the US AI Initiative, calling on the leading federal agencies to give priority to research and development of artificial intelligence in the 2020 budgets. However, it did not provide new funding to support these measures or further details. of these plans. And since then not much has happened at the federal level.
Meanwhile, China has fallen behind, with AI companies such as SenseTime, Megvii and YITU Technology raising billions. However, AI investment in China fell in 2019 as the US-China trade war escalated and damaged investors' confidence in China. At the time, the Trump administration made it harder for US companies to export certain types of AI software in an effort to curb it. access of the Chinese in American technology.
As part of the COVID-19 pandemic, China turned to some of its artificial intelligence tools and big data in an effort to prevent the virus, such as detecting contacts, diagnostic tools and drones, from boosting social distancing. However, there was a lot of propaganda for all this both in the media and on social media.
The United States and other nations are struggling with the same technologies and at the same time with concerns about privacy, security and surveillance coming with them, as they appear to be more affected than other countries by the virus. The ways in which China is using artificial intelligence to fight COVID-19 is worrying in many ways. The direct impact can be in areas such as the manufacture of pharmaceuticals and medical equipment. But it will ultimately affect artificial intelligence, as a technology that covers so many areas and applications.
Despite the economic effects of the virus, AI's global artificial intelligence investment is projected to increase from $ 22,6 billion in 2019 to $ 25 billion in 2020. The biggest consequence may be the acceleration of the US-China disconnection process. artificial intelligence and everything else.
The US still has advantages in areas such as semiconductors and AI chips. However, in the midst of the trade war, the Chinese government is reducing its dependence on foreign technology, developing domestic start-ups and adopting more open source solutions. Cloud AI giants like Alibaba use open source computer models to develop their own data center chips. Chinese start-up chipset companies such as Cambricon Technologies, Horizon Robotics and Suiyuan Technology have also entered the market in recent years and have raised large sums of money.
But full separation is not expected to happen soon. One of the problems with referring to all of this as an AI gun race is that many of the basic platforms, algorithms and data sources are open source. The vast majority of artificial intelligence developers in China use it Google TensorFlow or Facebook PyTorch, while there is little incentive to participate in domestic options that do not have the same networks.
The United States remains the world's superpower in the AI sector at the moment. But the trade war could ultimately do more harm to American companies related to artificial intelligence than expected, according to experts.
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Q: Forest of the Dead - Vashta Nerada have the knowledge of the Library I went back and watched my favorite two episodes of Doctor Who yesterday (Silence in the Library and Forest of the Dead) and something caught my attention. The Vashta Nerada are intelligent as a swarm in that they can assimilate knowledge from a living being (as when when they take over the consciousness of the expedition team), but at what point were they actually the Library itself?
At the end, the Doctor tells them 'you are the biggest library in the Universe, look me up' (paraphrased) at which point the Vashta Nerada in the suit coming for him stopped and responded "You have one day."
How did they have the ability to look through the knowledge in the books?

*

*I rewatched it to make sure I didn't miss anything, which made about the twentieth time I have seen it, and still couldn't figure it out.

*The only answer I could come up with it the knowledge from the people they "assimilated" allowed them to read, and as a swarm they could read the entire Library in a short amount of time... but that doesn't even make much sense to me.

*Thanks in advance for any insight and sorry if this question is redundant, I looked and couldn't find anything like it.

A: If I do a search in my library's catalogue, I get links to electronic resources (ebooks, databases etc) as well as physical books.  Most (if not all) physical items have a short description, table of contents, chapter headings, or similar.  So even without ebooks I can get an overview of a subject pretty much without opening a physical book.  Obviously if I want proper understanding or in-depth study, I will need to study further, but a quick search is enough to find basic information, and point me in the direction of more sources.
(As for looking in physical books, they are shown as being able to affect physical things - the chicken, the shredded suit, moving the skeletons in the suits.)
I believe the Vashta Nerada could have gleaned enough information about the Doctor to make them at least pause and give him more time - or did they give themselves more time to research him?

A: Though individually relatively harmless, the Vashta Nerada were sentient when sufficient numbers of them were collected together. In the Library, there were thought to be a million million strong and were sentient enough to use the Neural Relay and Data Chip technology in the suits of the explorer/scientists they killed earlier.
Since the technology for the Neural Relay is of a "point and think" variety and was able to be linked up to the library, which was also using a similar technology, it can be presumed the Vashta Nerada used their connection to the library through the Neural Relay and Data Chips to peruse the library and discover any information about the Doctor.

A: According to my closed captioning, the quote is "You're in the biggest library in the world, look me up."
He's assuming that they can access the library's data in the same way that anyone else can. Given that they've been able to communicate with him via the "possessed" humans, and manipulate things like the space suits, I would guess they could use the indices and read books like anyone else.

redpajama_set_name: RedPajamaStackExchange


Job description: My client is currently recruiting a well organised and motivated individual to join the friendly and helpful administration team within NHS and healthcare services in Merseyside. The successful candidate will possess excellent organisational and time keeping skills, and will be comfortable working both as part of a team, and also working individually.
Contract - 3 Months Ongoing.


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Posted on December 24, 2021 by &
Hydrogen Powered Trains in Queensland
Australia's largest rail freight operator, Aurizon and leading global mining company Anglo American have agreed to work together on a feasibility study (the "Feasibility Study") to assess the introduction of hydrogen-powered trains for bulk freight.
Aurizon and Anglo American have entered into an agreement to conduct the Feasibility Study that will explore the application of Anglo American's proprietary hydrogen fuel cell and battery hybrid power units in heavy haul freight rail operations. If the Feasibility Study is successful, the agreement between the two companies could be extended to further phases of collaboration, which could include detailed engineering and the development of a hydrogen fuelled heavy haul locomotive prototype. For further information see the IDTechEx report on The Hydrogen Economy, Fuel Cells and Hydrogen Production Methods.
The Feasibility Study will focus on the potential deployment of Anglo American's hydrogen power technology on Aurizon's Moura rail corridor that operates between Anglo American's Dawson metallurgical coal mine and the Gladstone Port, and the Mount Isa rail corridor that operates between the North West Minerals Province to Townsville Port, via Aurizon's Stuart Terminal.
As part of its commitment to carbon neutral mines by 2040, Anglo American has taken a global lead in the development of green hydrogen solutions for its ultra-class 290 tonne payload mine haul trucking fleet. Anglo American's unique combination of powertrain technologies, designed to operate safely and effectively in real-world mine conditions, will displace the use of the majority of diesel at its mining operations, with an advanced trial of the prototype truck at its Mogalakwena platinum group metals mine in South Africa: Anglo American Hydrogen power.
Aurizon is Australia's largest rail freight company, with the decarbonisation of its supply chains at the centre of its target to reach net zero operational emissions by 2050. Aurizon has also commenced research & development for battery-powered trains with a number of industry parties and Australian universities.
"Hydrogen offers enormous opportunity in decarbonising and continuing to improve the competitiveness of Australia's export supply chains," Aurizon's Managing Director & CEO Andrew Harding said. "This is especially true for bulk products underpinning the Australian economy including minerals, agricultural products and fertilisers, industrials and general freight. Zero-carbon hydrogen-powered trains would also significantly boost the current environmental benefits of transporting more of Australia's bulk freight on rail. Rail freight already produces up to 16 times less carbon pollution per tonne kilometre than road. Aurizon is excited to be teaming up with Anglo American on this project, particularly given their success to date in developing unique technology solutions for use in mine haul fleets," said Mr Harding.
Tyler Mitchelson, CEO of Anglo American in Australia, said, "Anglo American has committed to carbon neutral operations by 2040, and we are aiming to reduce our Scope 3 emissions by 50% in the same timeframe. We know that we cannot achieve all of this alone, so we are working with partners along our value chains and outside our industry to find technical solutions to decarbonise. This collaboration with Aurizon is a great example of the power of partnerships to help address the urgent issue of climate change, while we also look to catalyse new markets to support the development and growth of the hydrogen economy," he said.
Tony O'Neill, Technical Director of Anglo American, added: "Our agreement with Aurizon marks the first time our hydrogen power technology could be tested beyond our existing mine haul truck programme. Displacing our use of diesel is critical to eliminating emissions at our sites and along our value chain. We believe that our innovative hydrogen-led technology provides a versatile solution, whether for trucks or trains or other forms of heavy duty transport."
The North West Mineral Province contains about 75 per cent of the Queensland's base metal and minerals, including copper, lead, zinc, silver, gold, cobalt and phosphate deposits. The province also has the potential to become a globally significant supplier of high-quality vanadium to the energy storage and steel markets with a number of projects under assessment.
The 180-kilometre Moura rail corridor from Dawson to the Gladstone port, and the 977km Mt Isa rail corridor from Mt Isa to Townsville Port both use diesel fuelled locomotives.
Source and top image: Anglo American
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ODI Status: What next?
Published On: March 19, 2018 08:52 AM NPT By: Rajan Shah
Nepali players during the drinks break in its match against the Netherlands in the ICC Cricket World Cup Qualifier 2018 seventh-place playoff at the Kwekwe Sports Club in Zimbabwe on Saturday. Photo: Raman Shiwakoti
KATHMANDU, March 19: Nepal earned the elusive One-Day International (ODI) status after finishing eighth in the ICC World Cup Qualifiers 2018 played at Zimbabwe. This is the first time Nepal is recognized as ODI nation since their inception in International Cricket Council (ICC) as Associate Nation in 1996.
Nepal lost three matches in the group stage against test nations Zimbabwe and Afghanistan as well as fellow associate Scotland. Similarly, the only match it won against Hong Kong seeded Nepal against Papua New Guinea in the cross-over playoff. PNG finished bottom in the opposite group. Nepal won to secure the ODI status. Both teams, Hong Kong and PNG, Nepal defeated in the tournament lost their ODI status and dropped down to Division Two.
The bottom-line is: Nepal now earns the elite status for next four years. The years of hard-work, sacrifices and toil by the Nepali national players paid off. However, it is going to take lot more of hard-work and efficiency to make sure Nepal keeps the ODI status even after the end of the four years.
The status itself won't bring matches or funds for Nepal cricket anyway. To start with how flawed the ICC system is, Nepal won only two matches out of six in the qualifiers and yet ended up with the status granted for four years. An achievement for Nepali cricket, obviously for a team which has worked hard for years with their livelihoods on line without any significant support from the cricket association or the government, but only a consolation from the ICC for an emerging country like Nepal that too taking out the same privilege from fellow associates like Hong Kong and PNG.
Hong Kong and PNG both played 19 ODI games each in four years including ICC/ACC events, none against top eight Test teams. Players representing these teams are going to suffer a significant loss going forward in their future. Hong Kong already faced the agony of not having their best batsmen before the tournament even started. Mark Chapman who is looking for a career with New Zealand and Jamie Atkinson continues to prioritize his school job for living. After the qualifiers, there is no any guarantee that Anshuman Rath might not look for a better career in cricket with Middlesex. The Netherlands lost their ODI status in ICC World Cup Qualifiers held in 2014 before regaining it in two-year long ICC World Cricket League Championship from 2015 to 2017. For some reason, ICC is adamant on limiting the number of ODI teams to 16. Scotland's shrewd preparation before the tournament and drastic improvement in the results is keeping them on hunt to earn the accolades of participating in the World Cup. There will be more 'Scotlands' in four years time. Associates are improving and Nepal's task will get more tedious.
Nepal is in desperate times to have a cricket governing body, more than ever. Either ICC reinstates the suspended old elected body or forms a whole new board with fresh elections and contests. Nepal must find qualified persons selected with proper tests and interviews before appointment of new members in new board is proposed. The later seems a better option given the poor and proven track-record of failure and corruption from current suspended Cricket Association of Nepal (CAN).
With old or new CAN at place, Nepal's first target should be to sort out the domestic calendar.
Everest Premier League (EPL) and Dhangadhi Premier League (DPL) has risen to become sought out ICC approved T20 competitions in associate world. It is no brainer why it can't be done with the 50-over program as well with some help from association or government. The recently held Parliament and House of Representatives elections are set to influx changes in the division of the territorial domestic teams too. The seven provinces shall replace the previous regions. Each province hosting their own championship or selection games before the best players representing the Province's first team in a nationwide apex selection tournament participated by all the seven provinces in all three T20, 50-over and 2/3-day formats.
A settled domestic setup will help producing the new players or allow the forgotten but experienced players like Anil Mandal or Subash Khakurel to stake their claim again for the national team. In the level Nepal national team is going to play batting is going to win you more matches than bowling. Nepal needs to provide players like Rabindra Jung Shahi and Ishan Pandey, both, co-incidentally, opening batsmen winning Best Player of the Tournament awards in respective Khukhuri T20 Challengers Cup and University T20 Cup, with longer format to develop further and make their claims for fragile opening position in the national team. Opening batting has been Nepal's Achilles-heel in international cricket with game of musical chair going on since forever.
At the end of the day, it all boils down to the how players fare on the field in the given day. This gas been Nepal's formula of success all these time, it won't change overnight, amid the lack of support at home from administrative body or government. Nepal is on verge of losing their star players like Shakti Gauchan and Gyanendra Malla for different reasons. Nepal needs to start scouring their gifted talent pool to buckle up before the big games arrive.
Once the above treacherous tasks are sorted; adequate training facilities, international bi-lateral tours and an upgraded coaching and support staff should be the next step in Nepal's next and important mission to salvage the ODI status in four years time.
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