A global shortage of health workers in rural areas increases the salience of motivating and supporting existing health workers. Understandings of motivation may vary in different settings, and it is important to use measurement methods that are contextually appropriate. We identified a measurement tool, previously used in Kenya, and explored its validity and reliability to measure the motivation of auxiliary nurse midwives (ANM) and staff nurses (SN) in rural Nepal.
Qualitative and quantitative methods were used to assess the content validity, the construct validity, the internal consistency and the reliability of the tool. We translated the tool into Nepali and it was administered to 137 ANMs and SNs in three districts. We collected qualitative data from 78 nursing personnel and district- and central-level stakeholders using interviews and focus group discussions. We calculated motivation scores for ANMs and SNs using the quantitative data and conducted statistical tests for validity and reliability. Motivation scores were compared with qualitative data. Descriptive exploratory analysis compared mean motivation scores by ANM and SN sociodemographic characteristics.
The concept of self-efficacy was added to the tool before data collection. Motivation was revealed through conscientiousness. Teamwork and the exertion of extra effort were not adequately captured by the tool, but important in illustrating motivation. The statement on punctuality was problematic in quantitative analysis, and attendance was more expressive of motivation. The calculated motivation scores usually reflected ANM and SN interview data, with some variation in other stakeholder responses. The tool scored within acceptable limits in validity and reliability testing and was able to distinguish motivation of nursing personnel with different sociodemographic characteristics.
We found that with minor modifications, the tool provided valid and internally consistent measures of motivation among ANMs and SNs in this context. We recommend the use of this tool in similar contexts, with the addition of statements about self-efficacy, teamwork and exertion of extra effort. Absenteeism should replace the punctuality statement, and statements should be worded both positively and negatively to mitigate positive response bias. Collection of qualitative data on motivation creates a more nuanced understanding of quantitative scores.
In low-income countries, difficulty in retaining rural health workers has increased the importance of supporting and motivating existing staff, both to maximise their productivity and encourage their retention . Developing appropriate strategies and monitoring progress requires tools to measure and assess the motivation of health workers in low-income settings. Motivation measurement tools have been well developed for use in industrialised countries and usually assess personality-related characteristics and preferences for work conditions. These tools have been used to measure individual differences in values related to the utility of working hard, and the strength of intrinsic motives for performance among different employees . While generic concepts of worker motivation may be relevant in all country situations, the sociocultural context may affect the importance of different determinants and the relationship between them . Therefore, it is important to test and adapt tools to fit with local contexts .
Motivation in the workplace can be defined as "an individual's degree of willingness to exert and maintain an effort towards organisational goals" . Sources of motivation may be intrinsic, whereby an individual is motivated by an internal desire, and extrinsic, whereby rewards or incentives motivate an individual . A less motivated person may perform adequately in minimally demanding conditions, but their willingness to exert extra effort into task completion depends on whether they feel there is personal value in doing so . If organisational and individual goals are similar, then exerting extra effort to complete tasks benefits both the individual and the organisation, which has a positive effect on worker performance.
Contextual or environmental factors also affect motivation. If a workplace does not permit effective working, this might demotivate a health worker. If a worker does not have the knowledge, skills or experience to complete their tasks, this also adversely affects motivation. Worker motivation is thus the ability and willingness to put in the effort required to do the job, which is influenced by individual factors (such as knowledge, skills, experiences, psychological attributes) and organisational factors (such as physical and social environment, policies and practices) (Figure 1) . Organisational factors are more amenable to change than individual personality tendencies, or societal and cultural values. Organisational change may also have bigger effects on motivation and could be used to promote long-term change in personal or cultural values of workers .
The research described in this paper is part of a larger study investigating the effect of organisational change in health facilities in rural Nepal, stimulated by national government recommendations on auxiliary nurse midwife (ANM) and staff nurse (SN) recruitment. In Nepal, maternal health indicators are improving, but the maternal mortality ratio remains high at 281 per 100 000 live births, and newborn mortality is 33 per 1000 live births. Most women deliver at home . In response to these health indicators, the Government of Nepal has made long-term and short-term strategies for maternal and newborn health. The long-term strategy involves starting midwifery training and introducing a midwife cadre to Nepal [8,9]. The short-term strategy has several components: to increase access to maternal health services through establishing 'birthing centres'—enabling existing health institutions to provide delivery care; to develop basic midwifery skills of nurse cadres through a 60-day in-service skilled birth attendant (SBA) training course ; and discontinuing the maternal and child health worker (MCHW) cadre, offering eligible MCHWs to take ANM training. This ANM training for MCHWs has not yet reached all those who are eligible, and some have been upgraded pending receipt of training. Maternal health care in rural areas is usually provided by ANMs who have had at least 18 months training. There are relatively few staff nurse posts in rural areas, and these posts are often unfilled . Table 1 presents levels of training of different nursing personnel in Nepal.
Government guidelines for remote areas also recommend that additional staff be hired on short-term contracts at health facilities that either are upgrading to become birthing centres, are experiencing high absenteeism of staff, or have unfilled posts . Little is known about the effect of this short-term employment (here onward referred to as 'contracting') on health workers, health service performance and provision . We sought to measure the motivation of auxiliary nurse midwives (including MCHWs) and staff nurses in the context of these government recommendations, and therefore, we required locally valid measurement tools.
A review of the literature identified only one survey tool previously used to measure health worker motivation in a low-income setting. That tool was developed for use in district hospitals in Kenya  and subsequently tested in peripheral health facilities in Zambia . It consists of 10 statements relating to three latent factors of motivation: organisational commitment, job satisfaction (including general motivation and burnout) and conscientiousness (including timeliness and attendance). Participants were asked to state the extent to which they agreed or disagreed with each statement. The tool was developed for use among health workers in a low-income setting, but it had only been used by the two studies cited above and had not been validated for use in South Asia. In this study, we explored the extent to which it is valid for use among ANMs and SNs in rural Nepal. We used qualitative and quantitative methods to assess the content validity (the extent to which the tool reflects all the aspects of a concept), the construct validity (the degree to which a tool measures what it claims to be measuring), the internal consistency (the degree to which several items that propose to measure the same general construct produce similar scores) and the reliability of the tool in this context .
We used a reduced form of the COSMIN checklist to establish the local validity of the survey . First, we evaluated content and construct validity by means of a literature review, interviews, focus group discussions and hypothesis testing. Then, we quantitatively tested for the internal consistency and reliability of the tool by calculating inter-item correlation and Cronbach's alpha coefficients. Finally, we conducted a descriptive analysis to understand how motivation may be interpreted between different sub-groups.
Data collection tools were translated from English into Nepali by two trained female Nepali researchers who then collected and entered the quantitative and qualitative data. An additional two researchers translated recorded qualitative data. The tool was piloted with ANMs and SNs working in rural areas to check translation and comprehension. Participants gave written informed consent to participate, and the study was granted ethical approval from the Nepal Health Research Council.
We used data provided by a senior public health nurse in the Family Health Division of the Department of Health Services to purposively sample two districts with high numbers of contract nurses and one with low numbers of contract nurses. We sampled districts in the same geopolitical environment (Western Nepal) to enable comparability of data. One district with high levels of contracting was a remote hill district (Dailekh) with a Human Development Index (HDI) score of 0.422. The other two districts (Banke and Kailali) were in the plains. Banke had an HDI of 0.475, and Kailali had an HDI of 0.467 . Our sampling was driven by practical and theoretical concerns. We used a mixed methods case study design, with the health facility as the case. We sought to compare health facilities with and without contract ANMs and SNs. The potential absence of nursing personnel, and lack of data at the district level about the numbers of nursing personnel on different types of contract, meant that we could not, a priori, design a sampling framework to ensure representation of the population. Therefore, we approached 16 health facilities per district, which had been conducting deliveries for the longest time, and aimed to interview all the nursing personnel in the health facility. Most study participants were ANMs (Table 2). There was variation between ANMs and SNs and their working contexts, which enabled comparative analysis to explore motivation theories. We collected data from health facility management committees (HFMCs), women's groups and the in-charge at each health facility to explore triangulation and meet broader research objectives. Data were collected in sub-health posts (SHPs) (13), health posts (HPs) (29), primary health centres (PHCs) (10), hospitals (4) and district- and central-level stakeholders (12) from April to June 2013. Central-level stakeholders who deal with national-level nurse policy issues were purposively sampled and interviewed.
aIndicates only one observation for this characteristic. As a result, the standard deviation is not calculated.
b96.29 NPR = 1 US dollars.
The 10 statements in the tool were reviewed against the literature on motivation. Our search strategy was focused on studies of motivation of health workers in low-income countries. We used PubMed and reviewed the reference lists of relevant articles. The aims of this process were 1) to test the assertion of Mbindyo et al.  that the statements explore the latent factors of motivation including organisational commitment, job satisfaction and conscientiousness and 2) to identify whether other latent factors exist that were not explored through the 10 statements. This process served as a first check of content validity.
Qualitative data were collected using semi-structured interviews and focus group discussions in one hill district (Dailekh) and one plains district (Banke). We were unable to collect qualitative and quantitative data from 7 in-charges and 51 nursing personnel because they were not at the health facility when we visited. One ANM in a hospital refused to be interviewed. We were unable to contact two HFMCs. Semi-structured interviews were conducted with SNs (13), ANMs (65) and health facility in-charges (25). In each district, semi-structured interviews with the public health nurse (PHN) and the district health officer (DHO) were also conducted. Focus group discussions (FGDs) were conducted with local women's group members (31) and HFMCs (30) at each health facility. There were 6 to 15 people in an FGD, and discussion took up to 2 hours in duration. In nine health facilities in Banke, district women or HFMC participants spoke Abadhi or Hindi. Researchers used an ANM or health volunteer to translate where needed. JM observed a sample of quantitative and qualitative data collection in every district (22 ANMs and SNs, 1 PHN, 2 DHOs, 3 in-charges, 2 women's group members, 3 HFMCs).
ANMs and SNs were asked to comment on their own motivation and the motivation of their work colleagues. We asked them to explain the reasons why they had described their colleagues or themselves as motivated or less motivated. Women's group members, in-charges and HFMCs were asked about the motivation of specific ANMs and SNs and the reasons for this. We asked district- and central-level participants to tell us what type of ANMs and SNs were motivated, why and what motivates them.
Qualitative data were digitally recorded, and researchers translated qualitative data directly into English from the recordings. To check the quality of translation, a researcher back-translated three pages of four randomly selected interviews into Nepali and compared with the recordings. There were few discrepancies.
To explore content validity, JM coded data from all participants according to the domains represented in the tool and domains emergent from the data. To explore construct validity and internal consistency, JM sampled ANMs and SNs on the basis of their qualitative interviews. Twelve ANMs and SNs who appeared motivated and three ANMs or SNs who appeared particularly unmotivated were sampled. Data from ANMs and SNs was compared with data from women's groups, HFMCs and health facility in-charges to triangulate findings. Lastly, ANM and SN motivation scores were examined to understand the extent to which they reflected the qualitative data and to check the reliability of the tool.
Quantitative survey data was collected in all three districts from 137 ANMs and SNs. Seventy-eight of these nursing personnel had also participated in qualitative data collection. Survey responses were recorded by researchers on paper forms and entered into a database at the site of data collection. There were no missing observations and all 137 records were used in the analysis. Quantitative data were analysed independently by NB using STATA version 13.
The motivation tool comprised 11 statements or 'items'. Participants were asked whether they strongly agreed, agreed, disagreed or strongly disagreed with each item. The responses were coded to assign a higher value to those who were motivated and a lower value to those who were not.
We had no a priori reason to give higher weighting to any one item, and previous work in this area treated the items equally . Therefore, the tool was calculated as a simple, equally weighted average.
The first test for internal consistency was conducted by calculating the degree to which the items in the tool were related to each other. If two items are highly correlated, then one of the two items will add little additional information about individual motivation. However, if items are uncorrelated, they measure different traits or dimensions of motivation. We calculated Spearman's rank correlation coefficients for all 11 items to understand how they were related to each other.
We quantitatively measured the reliability of the tool by calculating Cronbach's alpha (α) coefficient of internal consistency [19,20]. Cronbach's alpha assesses the degree to which a set of items measures a single latent dimension. The α value for the motivation index was calculated and compared against acceptability thresholds [21-24].
After testing for internal consistency and reliability, we conducted exploratory descriptive analysis of the data. We first explored the distribution of motivation scores among ANMs and SNs. We then tabulated ANMs' and SNs' average motivation score by sociodemographic characteristics to see how their scores varied.
Literature review: does the tool represent theoretical 'best practice'?
The initial content validation through literature review identified one latent motivation factor: 'self-efficacy' not captured within the existing tool. This was identified as an important concept in the longer Mbindyo tool  and in several other publications [2-4,25-31]. We added a self-efficacy statement to the tool before it was translated into Nepali. In English, this statement reads as: "I am confident about my ability to do my job".
Qualitative results: how is motivation defined in western Nepal?
Most of the characteristics and actions used by participants to define and identify motivation related to conscientiousness: working hard, taking responsibility for work, being energetic, performing or striving towards high performance, being sincere or being determined: "they seem to be doing work actively" (ANM HP). Other related outcomes of motivation were confidence and a lack of carelessness. Careless, unmotivated ANMs and SNs delayed patient treatment unnecessarily, wasted time chatting, took unnecessary, long leave or did personal work during work hours: "there is no-one that makes excuses to get out of work, like they are ill or they have personal work to do. It's not like that here" (ANM HP). Patient care, having good interactions with patients and not keeping them waiting were also emphasised: "Staff are co-operative towards patients. The daily activities of the staff here really has a positive effect on patients" (ANM hospital). Absenteeism was also a strong indication of lack of motivation: "if staff didn't come to the office daily, people wouldn't have been able to get services. Because all the staff come, people have been getting good services, and staff are providing good care" (ANM SHP). Participants did not mention timeliness as an indicator of motivation.
ANMs and SNs who were older or more senior and yet still working hard were exceptional and therefore motivated: "they can manage cases even though they are old, so I think they are motivated and confident about their work" (ANM hospital). But generally, younger ANMs and SNs were described as more motivated than older nursing personnel. A district-level stakeholder told us: "(older nurses) say 'I am over 50 years old now I don't need to work hard anymore'. They look for excuses so that they don't have to work." Another district-level stakeholder told us that this is because: "(younger nurses) want to learn and they want to get more experience…older nurses say you 'are a girl of 20 or 25 years old, you do the work and I will observe.'" Many ANMs and SNs were keen to learn and develop their career within nursing, indicating an alignment of personal and organisational goals: "I am very excited to see the new (abnormal) cases, I feel good about that…I have the opportunity to learn new things" (ANM hospital).
The exertion of extra effort was also seen to define a motivated person and represented any action that went beyond normal expectations. For example, a willingness to transfer knowledge was indicative of motivation in a colleague, as it was not routinely expected: "I think (other nurses) are motivated as they are more experienced than me. They even teach me the things that I don't know" (ANM HP). ANMs and SNs defined enduring personal hardship while working as a sign of motivation, for example being in remote places with few facilities or being away from their families: "She is living alone without her family and providing 24 hour services, that is why I must say that she is motivated" (SN PHC).
Many ANMs and SNs and other participants described motivation as working well together with other colleagues: "they will never say that conducting deliveries is not our responsibility. They all work together" (women's group). Coordination and flexibility is important when providing care in a remote place, and ANMs and SNs felt their colleagues were motivated when they exhibited these characteristics: "While working, the person who has good relations with everyone is motivated and the one who can't cooperate is not motivated" (ANM hospital). Another ANM in a PHC told us: "Everyone is motivated. Everybody helps each other." Although this may be more of a determinant of motivation, in our context it was also an outcome of motivation.
Our analysis shows that the construct validity of the tool is confirmed to a certain extent. All three latent concepts in the tool were also represented in the qualitative data: organisational commitment, job satisfaction and conscientiousness. A statement about absenteeism should replace the statement about timeliness, and indicators of exerting extra effort and being a teamworker should be added to the tool. Some data demonstrated a different understanding of motivation than the definition used in this study . Some participants defined motivation as 'just doing your job', and others defined it in terms of seniority or salary paid: if you were paid more money, you were motivated. This indicates the importance of deconstructing concepts when designing tools.
This section uses survey data and accepted statistical tests to measure the internal consistency and reliability of the tool with nursing personnel in rural Nepal.
The survey was administered to 137 female ANMs and SNs. Most were from Kailali (43%), and the lowest proportions were from Banke (28%). Most were aged between 20 and 29 years (44%). Almost two thirds of the study population belonged to an upper caste group (Table 2), while approximately 25% belonged to Dalit or disadvantaged groups. The majority of the study participants were ANMs (65%), and most worked in health posts (47%). Very few ANMs and SNs worked in district or zonal hospitals (9.5%, respectively). More than half of ANMs and SNs had worked in their current health facility for more than 2 years (54%), and only 9% had worked in their current post for less than 1 month.
We calculated the inter-item correlation coefficients to quantitatively evaluate the internal consistency of the motivation tool. For the tool to be internally consistent, the items in the tool should be moderately correlated with each other [24,32]. Table 3 presents a matrix of the correlation coefficients. Overall, all items are positively and moderately correlated with each other. Some exceptions are the correlations between item 1 and item 2, and item 1 and item 5. Item 1 refers to timeliness. All ANMs and SNs reported being punctual to work.
Note: M1 refers to item 1 in the motivation tool, M2 to item 2 and so on.
The α coefficient of internal consistency was used to measure the reliability of the motivation index constructed from the survey data. The calculated α value was 0.7918. This value was then compared to the acceptability threshold values presented in Table 4. The tool is considered to be internally consistent if α is equal to or bigger than 0.70. As the α value for the motivation tool was above the 0.7 threshold value, the tool can be considered internally consistent in this context.
The high response rates were an indication of the acceptability and comprehensibility of the motivation tool. The results from the internal consistency tests offer encouraging evidence of the reliability of the motivation tool, with both the correlation coefficients and the α value at acceptable levels.
We explored variations in the motivation score by sociodemographic and worker characteristics. The survey enables the calculation of a motivation score between 0 and 5, where a score of 0 denotes no motivation and 5 denotes the highest level of motivation. The mean motivation score in our sample was 4.63 (SD 0.36). The median motivation score was 4.7272 and the mode was 5. The distribution of the motivation score among the nursing personnel is presented in Figure 2. While there were no outliers, the distribution of motivation scores was slightly skewed to the right (skewness = −1.26).
Distribution of motivation score among nurses.
We examined the mean motivation scores by demographic characteristics (Table 2). ANMs and SNs from Dailekh were more motivated (4.74, SD 0.31) than those who worked in the other two districts. Older ANMs and SNs in the 40−49-year age group were more motivated (4.83, SD 0.23) than those who were in other age groups. This is consistent with Mutale et al.'s findings . In addition, nursing personnel belonging to the Dalit Hill ethnic group (4.8, SD 0.30) were more motivated than nursing personnel from other ethnic groups.
Upgraded MCHWs (4.97, SD 0.07) and senior staff nurses (4.91, SD 0.09) were more motivated than nursing personnel working in other posts. Again, this is consistent with Mutale et al.'s study, where senior nurses were more motivated that junior nurses. Those working in sub-health posts also had higher levels of motivation (4.76, SD 0.31). ANMs and SNs who had spent 7 months or more working at the current health facility were more motivated than others. Again, the finding that ANMs and SNs who spent more time in a health post were more motivated than those who had spent less time in a health post was consistent with that of Mutale et al. Finally, ANMs and SNs who earned a higher net income were more motivated. In particular, those earning between 10,000 and 14,999 Nepali rupees (104 and 155 US dollars) per month and between 15,000 and 19,999 Nepali rupees (155 and 208 US dollars) per month were highly motivated, with a mean motivation score of 4.69 (SD 0.28) and 4.69 (SD 0.35), respectively.
Analysis of mean motivation scores of ANMs and SNs with different demographic characteristics indicates that the motivation index could differentiate between high and low levels of motivation among ANMs and SNs. Furthermore, the motivation index was also able to capture variations in the motivation of ANMs and SNs who had different socioeconomic circumstances.
To assess whether the tool accurately captured ANM and SN motivation, we compared semi-structured interview data from 15 nursing personnel, with their motivation scores. ANMs and SNs were purposively sampled from interview data, as they appeared 'clearly motivated' or 'clearly unmotivated'. In addition, we considered data from HFMCs, women's groups and in-charges (Table 5).
Quantitative self-scoring by ANMs and SNs and interview data about how they felt appear to be fairly consistent, apart from participant 1023 and participant 2020. Participant 1023 scored very highly, but her interview and others' perceptions of her indicated she was less motivated. Participant 2020 had a comparatively low score, but qualitative data indicated she was motivated. Triangulation between ANM and SN scores and others' observations of their behaviour were less consistent. Participant 2028 and participant 2006 felt differently from how others perceived them. Although older nursing personnel had higher quantitative motivation scores, this was not always supported by the qualitative data from other participants.
Our research with ANMs and SNs in rural Nepal sought to explore the validity, internal consistency and reliability of an established survey tool developed to measure health worker motivation in Kenya. We have already discussed the validity, internal consistency and reliability of the survey, and therefore in this section, we focus on how the survey could be adapted to improve its appropriateness in the Nepali context. Where appropriate, we also compare our findings to those of Mbindyo et al. .
Motivation, as defined by Franco et al. , was captured to a large extent by the tool. Qualitative and quantitative analysis showed that item 1 on the scale had weaker validity. All ANMs and SNs said that they were punctual when coming to work, and timeliness was not emphasised in the qualitative data. Therefore, this tool item did not help to differentiate levels of motivation. However, in Mbindyo et al.'s study, timeliness was one of the constructs that drove variation in motivation scores. We recommend that the first question on the scale be replaced with a question about attendance or absenteeism when it is used in our context. Qualitative data revealed that exertion of extra effort and teamwork were important components of motivation. These were also other constructs that drove variation in motivation scores in Mbindyo et al.'s study but were not adequately represented in the 11-item tool. These concepts have been measured in other tools measuring the determinants of health worker motivation, but in our study, they were also outcomes of motivation [27,33].
The discrepancy between high quantitative motivation scores of older nursing personnel and qualitative data that younger nursing personnel often work harder emphasises the need for qualitative data to understand these differences. Qualitative data was also useful in revealing the presumption of high motivation among those with better terms and conditions, when we found evidence that often ANMs and SNs with worse terms and conditions were working harder. Therefore, we recommend conducting qualitative research, with a smaller purposive sample, along with the motivation tool where possible.
Most participants had high motivation scores with means of 4.63. This may be because the tool only uses questions that were positively worded. Positive wording may bias participants to rank themselves as more motivated. We recommend changing this tool to have a mix of positively and negatively worded statements to help deal with this bias.
The fact that most ANMs and SNs scored highly on the motivation tool also suggests a potential risk in using this tool to measure change over time or after the implementation of an intervention. If scores are already high, how can they go higher? Qualitative data (not presented here) suggest that there are many factors that demotivate ANMs and SNs in this context, but they were not always reflected in their quantitative scores. This may suggest that the survey is not sensitive to smaller differences in motivation. This study did not set out to assess the sensitivity of the survey, and this is noted both as a limitation of this study and an area for further work.
While we were able to suggest some changes to improve the validity of the tool in this context, this study has a number of limitations. Firstly, qualitative findings suggest that absenteeism was an indicator of lack of motivation and yet we only conducted the quantitative validation survey among nursing personnel who were present in the health facility at the time of data collection. This may explain the high mean motivation scores observed, which may reflect a positive bias in the quantitative data collected. Secondly, our understanding of who is 'unmotivated' in this context may be limited by the fact that when asked directly, nursing personnel and other participants were reluctant to state that a health worker was less motivated. This may be exacerbated by the fact that a few in-charges, women's group members and HFMCs were not well informed about the ANMs and SNs in their health institution (particularly those who were not in regular attendance). This may also have introduced a positive bias. Thirdly, the study included only female nursing personnel. Therefore, the extent to which these findings would also apply to other male health workers is uncertain. Finally, we were unable to test for the criterion validity of the tool, as there is no 'gold standard' tool for the measurement of motivation against which we could compare the calculated motivation scores. We did not re-administer the tool at a second time point, as we did not want to place additional burden on the participants. Therefore, we were unable to test the responsiveness of the tool. Finally, high mean rates observed in the quantitative data may be a result of the positive biases described above, or they may indicate a lack of sensitivity in the tool. This is highlighted as an area for further research.
This study used three sources of data to validate an available survey tool designed to measure health worker motivation. Literature review, primary qualitative and quantitative data were used to explore the content validity, construct validity, internal consistency and reliability of the tool in Nepal. We found that with minor modifications, the tool provides valid and internally consistent measures of motivation among nursing personnel in this context.
The qualitative data suggest that, in this context, motivation is revealed through action. A conscientious approach to work including regular attendance, active participation and high levels of patient care are all seen as signals of high motivation. Conversely, low motivation is indicated by absenteeism, a lack of active engagement in the workplace and poor patient care. The qualitative findings suggest that adding statements about exertion of extra effort and teamwork, and changing the punctuality statement would improve the tool in this context. Quantitative analysis demonstrates that this tool is valid for use among ANMs and SNs and perhaps other health workers in the Nepalese context. We recommend that statements in the tool should be phrased both positively and negatively to help prevent bias. We also recommend the collection of qualitative data to help understand motivation tool scores. To our knowledge, this is the first study validating a survey tool for measuring health worker motivation in this context, and we believe that it constitutes an important start for further work in this area.
We would like to thank all the participants in the study and the District Health Offices of Dailekh, Banke and Kailali who made this study possible. Thanks to Dr Patrick Mbindyo who supplied the original tools and to Ms Rabina Shakya, Ms Indra Rai and Mark Zimmerman from the Nick Simons Institute for their technical advice. The Nick Simons Institute funded the study and JM. NB was funded by a Wellcome Trust Strategic Award, 0936115/Z/10/Z.
JM conceived of and designed the study, oversaw the qualitative and quantitative data collection, completed the qualitative analysis and writing, and was responsible for compiling the first draft of the manuscript. NB completed the quantitative analysis and wrote the quantitative sections of the article. RT and RB contributed to the research design and collected the data. JSW advised on the study design and analysis, and helped to draft the manuscript. All authors read and approved the final manuscript.
JM is a part-time research consultant at the Nick Simons Institute in Nepal and supports research capacity building and research on human resources issues in rural Nepal. She is also a Senior Research Associate at the Institute for Global Health, University College London, working with partners in Asia and Africa on interventions to improve maternal, newborn and child health. RT and RB are experienced in public health research and are consulting at the Nick Simons Institute. NB has a background in health economics and works at University College London. She is interested in researching poverty and inequality, health and nutrition. JSW is a lecturer in the Institute for Global Health, University College London and an experienced health economist. JSW is working on a number of research initiatives, many of which seek to improve the health and nutritional status of women, neonates and children in low-income countries.


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The changing landscape of sexual misconduct in the workplace
Alecsandra Manning-Rees	| 2 September 2019
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Alecsandra Manning-Rees writes an update of the recent case law of sexual misconduct and the attitudinal changes for employers, employees and patients.
The cases discussed below provide an important context for how the High Court now treats so called 'low level' sexual misconduct in clinical practice. There is a clear line being drawn between in what makes a difference between suspension and erasure at sanction stage.
Arunachalam v GMC [2018] EWHC 758 (Admin)
Dr Arunchalam was struck off by a Panel of the Medical Practitioners Tribunal Service (MPTS) in May 2017 following a finding of misconduct in relation to sexually motivated misconduct towards two female trainee doctors. In relation to one of the doctor's Dr Arunachalam sent inappropriate messages and in the case of the other, Dr Arunchalam tickled, hugged and kissed the doctor on the head. At paragraph 34 of the judgement, Mr Justice Kerr stated that "…sexual misconduct is self-evidently always serious and often likely to lead to erasure, even for a first time offender."
Importantly, the learned Judge went on to state as follows at paragraph 61:
"The days are gone when mainstream discourse was in any way split on the issue of sexual misconduct, particularly in the workplace. The mainstream in our society, reflected in our law, is now that there is virtual zero tolerance of such behaviour."
Despite those findings Mr Justice Kerr then went on to find that the Panel of the MPTS had not correctly reasoned their decision in relation to the mitigating factors. This meant that it appeared that the Panel had not properly considered the matter of suspension versus erasure, and therefore they had not correctly demonstrated whether or not they had balanced the mitigating and aggravating factors against each other in determining the appropriate sanction. The Court of Appeal therefore substituted the decision of erasure for a 12-month suspension order from the date of the judgement, something which the GMC had originally supported at the hearing before the MPTS.
Yasin v GMC [2018] – [2018] EWHC 677 (Admin)
In very similar circumstances the case of Dr Yasin also dealt with whether erasure was an appropriate sanction for 'low level' sexual misconduct.
In this case Dr Yasin, within the space of two hours, had separately approached two junior members of staff. In the first instance relating to Ms A he approached the member of staff from behind, pushing his erect penis into her. In the second, Ms B described the registrant doctor hugging her without invitation and moving back and forth such that she could feel his erect penis pushing into her.
Ms B then spoke to Ms A and they decided to report the matter to the senior staff nurse.
The Panel of the MPTS found that the conduct would be regarded as deplorable by fellow practitioners and members of the public, erasing him from the medical register.
Dr Yasin brought the appeal on the basis that the correct sanction to impose would have been one of suspension with a review before the conclusion of the suspension.
On this occasion, rejecting the doctor's appeal, Mrs Justice Yip stated at paragraph 37 in response to the appellant's submission that erasure was wrong:
"I can see that this is a case in which more than one outcome was possible…It may well be that there has been a recent shift in attitudes to sexual misconduct of this nature. It is possible that this sort of low level sexual assault is now regarded more seriously than it once was particularly when committed in a work environment. It would be hard to argue that that is a bad thing.
Certainly, it is right that Dr Yasin's actions did not amount to very serious sexual offending but that is not to minimise what he did. He took advantage of two young women who were at an early stage of their health care careers while they were going about their normal work and rubbed his erect penis up against their bodies".
The General Medical Council v Maher Khetyar [2018] EWHC 813 (Admin)
Finally, the case of GMC and Khetyar demonstrates that again properly reasoned panel decisions can lead to a substantial difference in how sanction is applied upon review.
In this case it was the GMC who brought an appeal against the finding of the MPTS that Dr Khetyar should be suspended from the register. The GMC argued that the correct sanction could only be one of erasure.
Dr Khetyar was found to have committed three separate incidents of sexually motivated misconduct between 2004 and 2013. In the latter two incidents in 2012 and 2013 the Doctor cupped the breasts of two people (one a patient and one a paramedic) without clinical justification. In 2004 he was also found to have pestered and harassed a nurse and this conduct was sexually motivated.
The Panel of the MPTS found that although impaired, the doctor had gained sufficient insight regarding his failure to offer patients chaperones in consultation and had undertaken further training to assist in his explanations of practices during examination.
Unsurprisingly, the High Court found that the Panel had not properly considered the aspect of the sexual assaults in their determination, that Dr Khetyar had demonstrated little remorse or insight into the very serious professional boundaries he had crossed in these incidents. Very much in line with the reasoning in the case of Yasin, the court substituted the sanction of suspension for one of erasure.
It is clear that the cases discussed above, although similar, led to different outcomes even though the doctors were of previous good character and, seemingly no criminal proceedings arose out of the allegations. The wrongdoing is referred to as low level; although in all the circumstances it was found to be deplorable and having caused harm.
What is clear is that had the Panel of the MPTS made clear their reasons for erasure, Dr Arunchalam may not have been so fortunate in having his erasure re-examined and substituted for a suspension order.
Furthermore, in the case of Dr Khetyr had the Panel demonstrated that they had taken due consideration of the element of sexual assault and clearly outlined their reasoning for finding suspension in the present circumstances, the GMC's appeal against sanction may well have not been successful.
As Mrs Justice Yip states, it cannot be argued that taking matters of sexual misconduct more seriously is a bad thing. It reflects a welcome societal change for those who experience harassment, bullying and sexual misconduct in the workplace and reinforces the regulators duty to uphold proper professional standards through the regulatory framework. However in addressing the Panel representatives on behalf of the doctors should take care to ensure that their submissions are tailored to encapsulate all points of the impairment and sanctions guidance, assisting panels as far as possible, to make sufficiently detailed determinations that would not make such easy targets for the High Court.
Alecsandra is an experienced advocate in regulatory and professional discipline cases, crime and general litigation. She also has experience of advising in international policy matters.
Alecsandra Manning-Rees
Rob Howley brings betting into the spotlight: Alecsandra Manning-Rees
Alecsandra Manning-Rees	02/10/2019
Legal 500 Rankings Success: 2020 Edition
Dave Scothern	30/09/2019

redpajama_set_name: RedPajamaCommonCrawl


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Rosie O'Donnell Calls for Trump to 'Rot in Jail' Over National Debt
Image Credit: John Moore/NICHOLAS KAMM/AFP/Getty Images
Rosie O'Donnell Calls for Trump to 'Rot in Jail' Over National Debt
Anger-filled celeb now cares deeply about the country's financial footing
By Tom Joyce | December 6, 2018
Rosie O'Donnell seems to care deeply all of a sudden about the United States' growing national debt.
And she wants to punish President Donald Trump for it.
The leftist comedian and actress reacted angrily to a tweet on Wednesday from Daily Beast reporter Asawin Suebsaeng claiming the president was not focused on curbing the debt.
To this, O'Donnell responded, "Truly a madman — may he rot in jail."
How interesting!
truly a madman – may he rot in jail #trumpepstein #TrumpCrimeFamily #MuellerIsComing https://t.co/QZau6mgRBH
— ROSIE (@Rosie) December 5, 2018
O'Donnell's reaction to a comment about the national debt may appear hypocritical, given her admiration of former President Barack Obama — who was far from fiscally responsible.
When he entered office, the national debt was around $10.6 trillion.
By the time he left office, it had ballooned to around $19.9 trillion — the largest increase from a dollar standpoint in American history.
Despite the massive spending of the Obama administration, O'Donnell was thrilled when Obama was re-elected in 2012.
In response to his victory over Mitt Romney, she tweeted out, "YES WE CAN — YES WE DID — ON WE GROW!!!!!"
YES WE CAN – YES WE DID – ON WE GROW !!!!! #OBAMAUSA
— ROSIE (@Rosie) November 7, 2012
O'Donnell liked Obama so much that she even urged him to declare martial law in 2017 so that he would remain in office longer — and delay the inauguration of the next duly elected president.
I FULLY SUPPORT IMPOSING MARTIAL LAW – DELAYING THE INAUGURATION – UNTIL TRUMP IS "CLEARED" OF ALL CHARGES https://t.co/fUn8FZ8RTj
— ROSIE (@Rosie) January 12, 2017
The double standard should not come as a shock, however, given other comments by Donnell both before and after Trump entered the White House.
O'Donnell and Trump have a longstanding feud that dates back to before he was in the White House.
It started in 2006 when Trump, a co-owner of the Miss USA pageant at the time, allowed 19-year-old Tara Conner to retain her title — despite being caught engaging in underage drinking and using drugs — if she went to rehab.
In response, O'Donnell questioned Trump's "moral compass" and called him a "snake oil salesman" on ABC's "The View."
In response, Trump called her "a loser" and started to poke fun at her on various occasions.
Rosie is crude, rude, obnoxious and dumb – other than that I like her very much!
.@Rosie–If America's Got Talent uses you, the show will fail like all your others!
We finally agree on something Rosie. https://t.co/BSP5F3PgbZ
Since Trump has become president, O'Donnell has not changed her negative attitude toward him.
She has called, for example, for the military to remove him from the White House; she led an anti-Trump tirade outside of the White House over the summer; and she even offered to play Trump's former chief strategist Steve Bannon on "Saturday Night Live" — but they never hired her.
Not to mention that O'Donnell violated campaign finance law this year, using different versions of her name and addresses to donate more than the legally allowed $5,400 — to at least five Democratic candidates.
Tom Joyce is a freelance writer from the South Shore of Massachusetts. He covers sports, pop culture, and politics and has contributed to The Federalist, Newsday, and other outlets.
Fresh Off a Spat with Her Own House Speaker, AOC Viciously Goes After Trump
The Left, Unlike President Donald Trump, Has Forgotten About America's Working Class
by Bryan Crabtree
Rosie O'Donnell Insists There Are Over 100,000 Concentration Camps in America


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Author: Penelope Douglas
Category: Romance | Young Adult
From the New York Times bestselling author of the Fall Away series who never fails to deliver a "powerfully written contemporary love story…"*
Former tennis player Easton Bradbury is trying to be the best teacher she can be, trying to reach her bored students and trying to forget her past. What brought her to this stage in her life isn't important. She can't let it be. But now one parent-teacher meeting may be her undoing…
Meeting Tyler Marek for the first time makes it easy for Easton to see why his son is having trouble in school. The man knows how to manage businesses and wealth, not a teenage boy. Or a young teacher, for that matter, though he tries to. And yet…there is something about him that draws Easton in—a hint of vulnerability, a flash of attraction, a spark that might burn.
Wanting him is taboo. Needing him is undeniable. And his long-awaited touch will weaken Easton's resolve—and reveal what should stay hidden…
(*STANDALONE, NO CLIFFHANGER*)
100. Page 100
The Shy Bride By Lucy Monroe
Deep in You By Penny Wylder
Battle of Britain | World War II
Battle of France | World War II
Operation Weserubung | World War II
Battle of the Atlantic | World War II


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Apr/May 2015 Contributor's Notes
Tom Dooley co-founded Eclectica in 1996 and serves as its Managing Editor. In the twelve years between earning a Bachelor's in English literature from the University of Chicago and a Master's in public administration from the University of Wisconsin-Milwaukee, he taught middle and high school English in Alaska, Arizona, and Wisconsin, amassing fond memories, dubious experiences, and debt. He now works for the government by day, edits Eclectica by night, and feels very grateful for the blessings he has received—chief among them being married to the sweetest gal and the best poet he knows. He and said poet reside in Albuquerque, New Mexico, with eight rescued lapdogs, two cats, and two amazing Haitian-American children.
Jennifer Finstrom has been the Poetry Editor of Eclectica since the fall issue of 2005. A former Spotlight Author, her poetry has appeared in several journals, including RHINO, After Hours, Midwestern Gothic, and NEAT. Originally from Wisconsin, she now lives in Chicago, Illinois. At DePaul University, Jennifer teaches in the First-Year Writing Program and also works as a peer writing tutor and writing group leader for the University Center for Writing-based Learning (UCWbL).
David Ewald is Eclectica's Nonfiction Editor. A previous contributor, his work has also appeared in BULL: Men's Fiction, Spork Press, Metazen, and Halfway Down the Stairs, among other publications. His novella Markson's Pier (written with Stuart Ross) was published in Volume XI of Essays & Fictions.
Anne Leigh Parrish is Eclectica's Fiction Editor. Her debut novel, What Is Found, What Is Lost (She Writes Press, 2014) is a finalist in the Literary Fiction Category of the 2015 International Book Awards. She is also the author of two story collections, Our Love Could Light The World (She Writes Press, 2013), and All The Roads That Lead From Home (Press 53, 2011). She lives in Seattle.
Gilbert Wesley Purdy is Eclectica's Review Editor. In 2013 he took up freelance writing fulltime. His popular Shakespeare authorship book Edward de Vere was Shake-speare: at long last the proof was published as a Kindle Book in late 2013. His monograph Was Shake-speare Gay? (also a Kindle book) was published at the end of February. He has published poetry, prose, and translation in many journals, paper and electronic, including: Jacket Magazine, Poetry International (San Diego State University), The Georgia Review (University of Georgia), Grand Street, SLANT (University of Central Arkansas), The Evansville Review (University of Evansville), Rattle (online), Consciousness Literature and the Arts (University of Wales, Aberystwyth), Orbis (UK), Eclectica, and Valparaiso Poetry Review. He also writes commentary, essays, and reviews at his The Virtual Vanaprastha and Virtual Grub Street blogs. Links to his work online and to a selected bibliography of his work in paper venues appear at his hyperlinked online bibliography.
Greta Bolger is a writer and visual artist who lives in Northern Michigan, a stunning and peaceful place everyone should visit at least once in their lives. She has published poetry and prose in several online and print publications, including The Chimaera; Juice Box; Eclectica; Short, Fast and Deadly; Snakeskin; Contemporary Haibun Online; and others.
Nicole Borg is editor of the Green Blade, magazine of the Rural America Writers Center. Her poetry has appeared in Lake Region Review, The Talking Stick, Lost Lake Folk Opera, and Nodin Poetry Anthology 2015. In 2014, she received an Individual Artist grant from the Southeastern Minnesota Arts Council. She lives in Wabasha, Minnesota, with her husband and two sons.
Rus Bowden is former managing editor for the IBPC, former poetry blogger, former car salesperson, former background artist, father of four grown kids, and a man in love. Since leaving work in 2013, he has taken up photography. His first publication was for National Geographic's news blog. You can find his work at The National Geographic Your Shot site.
Bob Bradshaw is a big fan of the Rolling Stones and easy times. Mick may not be gathering moss, but Bob is. Bob hopes to retire to a hammock soon. His work can be found at Cha, Eclectica, Pedestal, Stirring, Rose and Thorn, and many other publications.
Warren Buchanan is a Bay Area writer with a So Cal bent. He is a freelance writer/editor and part-time lecturer of Screenplay at the college level who writes short fiction, flash, novels and screenplays. He got his MFA from Saint Mary's College and a BA in Screenwriting from Loyola Marymount. His mother is very proud of him. His work has been featured on Stanley the Whale and Hobart Pulp, and he is working on his first novel, Mr. Kamikaze.
Chikodili Emelumadu is a writer, journalist and broadcaster based in London who blogs and is working on her debut novel. Her work has previously appeared in Luna Station Quarterly, Apex magazine, and Omenana. This is her second story for Eclectica.
Noah Engel lives in New York City. He received his BFA from New York University Tisch School of the Arts, in Film and Television Production with a Minor in Performance Studies. He is a young writer, filmmaker, and musician. His poetry has been featured before in Eclectica. More work and info can be found on his website.
Leah Erickson has had work published in many magazines and journals, including The Saint Ann's Review, Eclectica, The Coachella Review, The Fabulist, and Pantheon Magazine. Her first novel The Gilded Lynx will be published in the spring by Kraken Press. She is at work on a second.
John Grabski writes poetry and fiction from a farm in New York. His work is forthcoming at Foliate Oak Literary Magazine and Cyclamens and Swords. He is hard at work on his first collection titled Into the Vertex. You can find him on Twitter at @GrabskiJohn. He says, "I was moved to write 'Lost to Lewy Body' when the world lost Robin Williams. I wanted to shine a light on the viciousness of the disease and perhaps in some small way raise awareness."
Linda Griffin is a lifelong resident of San Diego California and has a B.A. from San Diego State University and an MLS from UCLA. She has retired after a career as a librarian for the San Diego Public Library to spend more time on her writing. She has had fiction published in the San Diego State University literary magazine, The Phoenix, San Diego Writers' Monthly, and Short Story America. "When Carol Left Me" is included in the anthology, Short Story America, Vol. 2, and four stories have received honorable mention in the Short Story America Prize for Short Fiction contests.
Michael R. Hassler is married to his best friend. Of "I Find Myself at 7:00," he writes, "I remember thinking while watching the media's gleeful and exuberant coverage of black people behaving badly, 'Oh my God! The kids are all going to wake up soon and see this stuff... where are the grown-up responsible adults who can explain what this is? Put this into some kind of context? Oh. Wait...'"
Jason Lee Helm hails from Iowa. He has a Masters in Fiction from Sarah Lawrence College and is an Adjunct Assistant Writing Professor at Pratt Institute, where he teaches Junior Studio and a self-designed course called Social Science Fiction. Jason's short stories have been published in Birds of Lace and Lumina Presses, among others. He is querying his first novel, Dictator of the World, a dystopian political satire that takes place on a deadly reality TV show. Jason reads all over NY and lives in Brooklyn with his husband and two cats. "Goodbye, Kate Shelly" is part of a collection of short stories loosely based on experiences that occurred during his childhood in southern Iowa.
Beth Hogan is Communications Director for an education non-profit, and she splits her time between Washington, DC, and Beverly, Massachussets, where she has been a member of a writing group for many years. Beth has been published in Gone Soft Magazine and River Walk Journal, and has been nominated for a storySouth Million Writers Award.
Thomas J. Hubschman is a regular contributor to Eclectica's Salon and is the author of two novels (Look at Me Now and Billy Boy), a short story collection (The Jew's Wife & Other Stories) and two anthologies of writing from the so-called Third World (The Best of Gowanus: New Writing from Africa, Asia and the Caribbean and The Best of Gowanus II: More New Writing from Africa, Asia and the Caribbean). His short stories and non-fiction have been widely published, including on the BBC.
Alex Keegan began writing seriously in 1992, publishing five mystery novels before switching to serious short fiction. He has been published widely in print and on the web and been awarded more than a dozen first prizes for his fiction as well as three Bridport Prizes. Born in Wales with an Irish mother, he now lives and writes in Newbury, England, where he lives with his second wife and two teenage children. These are his 25th and 26th pieces and 14th appearance in Eclectica. He runs a tough internet writing school called "Boot Camp Keegan," many of the alumnus of which have appeared in Eclectica as well, individually and as part of a feature dedicated to raising money for needy children.
Jascha Kessler has published ten books of his poetry and fiction as well as six volumes of translations of poetry and fiction from Hungarian, Persian and Bulgarian, several of which have won major prizes. In 1989, his translation of Sandor Rakos' Catullan Games won the Translation Award from the National Translation Center (Marlboro Press). Siren Songs & Classical Illusions: 63 Fables, revised with a preface was published as an eBook from McPherson & Company in 2013. Also available in 2013, King Solomon's Seal: 75+ Fables. He served as Arts Commissioner for the City of Santa Monica 1990-1996, and he won a Fellowship in Fiction Writing for 1993-1994 from the California Arts Council. His recent works include a translation of King Oedipus, a translator's preface in Sophocles, 2 (Univ. of Pennsylvanis Press, 1999), and King Solomon's Seal: 80 Fables (xLibris, 2013).
Rudy Koshar teaches modern European history at the University of Wisconsin-Madison. His short fiction and nonfiction have appeared in Eclectica, Guernica, Montreal Review, Red Fez, Turk's Head Review, Open Road Review, Black Heart Magazine, Revolution House, and numerous other magazines. He was the second-place winner of the Wisconsin Academy of Sciences, Arts & Letters 2013 Fiction Contest and the recipient of Guggenheim and other fellowships.
Robert Marshall is a writer and a visual artist who has exhibited widely in both Europe and the United States at venues such as Richard Anderson Fine Arts, the Peter Kilchmann Gallerie in Zurich, the K�ln Art Fair, White Columns, and the Brooklyn Museum. He is a recipient of fellowships from MacDowell, Yaddo, and the New York Foundation for the Arts. In 2002, he developed and was for three years the director of Prose in General, a reading series at Art in General that focused on the intersection of fiction and the visual arts. His novel, A Separate Reality, was released in 2006 by Carroll & Graf and was nominated for a Lambda Literary Award for Debut Fiction. In its review of A Separate Reality, The Washington Post called it "as good an encapsulation of adolescence as you�re likely to read." His work has also appeared in Salon, The Michigan Quarterly Review, Ping Pong, The Alembic, apt, Event, DUCTS, Stickman Review, Blithe House Quarterly, The Coe Review, Foliate Oak, and numerous other publications, including the anthologies Queer 13 and Afterwords. In 2007, his investigative feature, "The Dark Legacy of Carlos Castaneda," was chosen for "Best of Salon."
David Mathews�earned his MA in Writing and Publishing at DePaul University. His work has appeared in Eclectica Magazine, After Hours, CHEAP POP, One Sentence Poems, OMNI Reboot, Word Riot, Silver Birch Press, and Midwestern Gothic. His poetry was nominated by Eclectica for The Best of The Net 2014, and he also received first place in the Illinois Women's Press Association's Mate E. Palmer Communications Awards. He is a life-long Chicagoan, and he teaches at Wright College and College of Lake County.
Sarah McPherson�graduated from DePaul University in 2014. She has since moved back to her hometown, where she works in Parks and Recreation. Outside of work she enjoys writing about the facets of small town life along the Miami River.
Marjorie Mir is a member of Poetry Caravan, a group of writers who share poetry with residents of care-giving facilities in Westchester County, New York. The poem, "Passing Odysseus on the Way," was prompted by a recent reading of Why Homer Matters by Adam Nicolson, which, in turn, led her to Robert Fagles' translation of The Odyssey. It interested me to bring forward as narrator a character who is alluded to but doesn't appear in Homer's epic.
Ranjani Murali has an MFA in Poetry from George Mason University, where she taught creative writing workshops, English, and composition. Her poetry, nonfiction, and translations have appeared in Word Riot, Pratilipi, Phoebe, Cricket Online Review, Kartika Review, and elsewhere. She won the 2014 Srinivas Rayaprol Poetry Prize and has received fellowships from the Fine Arts Work Center and the Vermont Studio Center. She works for the Illinois Safe Schools Alliance, a nonprofit that promotes safe schools and learning spaces for LGBTQ and allied students in schools across Illinois.
Veena Muthuraman likes to travel and write the odd short story based in Ayyanarpatti, a place reminiscent of where her roots lie. She lives in Edinburgh, UK.
David Oestreich is the author of the chapbook Cosmophagy, forthcoming from Folded Word. His poems have appeared in various online and print venues, including Ruminate, Chagrin River Review, Lilliput Review, and Eclectica. He lives in Northwest Ohio with his wife and three children.
Kenneth Pobo has two books forthcoming: Bend of Quiet from Blue Light Press and Booking Rooms in the Kuiper Belt from Urban Farmhouse Press. He teaches creative writing and English at Widener University in Pennsylvania. The poems in this issue are from an ekphrastic collection he's working on. His Twitter address is @KenPobo.
Don Pomerantz lives and teaches in New York City. His poems have appeared in Washington Square, Failbetter, Potomac Review, previously in Eclectica, New Plains Review, Euphony, and elsewhere.
Christine Potter is a writer, poet, and internet broadcaster who lives in the lower Hudson River Valley with two spoiled tom cats and her organist/choir director husband. Her two books of poetry are Zero Degrees at First Light (2006) and Sheltering In Place (2013). Area 24 is a free form radio station she runs with a fellow group of music obsessives. About her work, she says, "'Sunset, Far From The City' was written during the unrest in Ferguson, Missouri, and my across-the-street neighbor (who makes really gorgeous contemporary dance) really is named Art. 'Unforgetting' is about my mother, of course, and how hard she works to stay part of the conversation at ninety-one. I started to write fiction as well as poetry a few years ago, and realized the connection between creating narrative and dementia as soon as I thought hard about it."
Jessy Randall is a librarian at Colorado College. Her collection of Mother Goose prose poems, There Was an Old Woman, is forthcoming from Unicorn Press this year. Regarding her poem in this issue, she says, "For the past few summers, my family has gotten together with another family, grownups who have known each other for over 20 years and kids who have known each other since they were born. Last summer, one of us asked this poem's title question as we cleaned up the beach paraphernalia. I no longer remember who it was, but I definitely remember that there were a lot of shovels."
V.K. Reiter has published nine novels, translated French novels for publication in the U.S., including Maryse Cond�'s Tree of Life and five of Daniel Odier's Delacorta series. She has ghost-written three films and served as a freelance editor on several bestselling books. While living in France, she wrote and translated narration for documentary films, wrote English subtitles for French films, was a reader, editor and translator for Les Editions Robert Laffont, and spent five interesting years as editor and consultant to Maurice Girodias, publisher of The Olympia Press both in Paris and New York. She worked as a consultant, script writer, and editor for Michel Thomas, owner of the Michel Thomas Language Centers and publisher of the Michel Thomas Language System. She has a new novel in progress, The Memoirs of Sister Warren Lecroix Falconer, and is also compiling a series of nonfiction pieces, the first of which, "Their Graces," appeared in the Summer 2011 issue of Eclectica Magazine, and the second, "An Afternoon With Salvador Dali," in its Winter 2012 issue. An article, "My Girodias," is available on the SmokeSignalsMag website. Her essay, "Transport," won the X.J. Kennedy Writing Award and was published in the Summer-Autumn issue of Rosebud Magazine. She lives in New York.
Danny Earl Simmons is an Oregonian and a proud graduate of Corvallis High School. He is a friend of the Linn-Benton Community College Poetry Club and enjoys community theater. His poems have appeared in a variety of journals such as The Pedestal Magazine, Prism Review, Eclectica, Off the Coast, IthacaLit, and Fifth Wednesday Journal. He says, "This poem ("A Lovely Emaciation") was inspired by the epigram at the beginning. Mike Hipson is a young man I met at the Linn-Benton Community College poetry club. This line is in a poem he wrote and it stuck with me. I asked him if he'd be OK with me using that line as inspiration for a poem of my own. He said he'd be honored. So this poem came out!"
Ann Skea lives in Australia. She is the author of Ted Hughes: The Poetic Quest (UNE Press, Australia) and has been contributing reviews to Eclectica Magazine since our very first issue back in October of 1996.
Jill Stegman is a retired high school teacher from the Central Coast of California. She has short stories published in such literary journals as Isotope, Literary Mama, North Atlantic Review, RE:AL, South Dakota Review, and Storyglossia. She has an M.F.A. in fiction writing from Pacific University, Oregon. This is her first published piece of nonfiction. She's looking for a publisher for her novel, The Time of Leaving, (find out more on her website). She says, "When I Knew" was written about one year after my husband's suicide, when I had sufficiently digested the impact, but I could still narrate the inconceivable horror of that day. As a writer, I felt that I had casually moved characters around like pawns without really understanding what I was putting them through. Now I have a new perspective. I knew it was pretty raw, but I felt it was destined for publication. I'm very happy Eclectica accepted it."
Heather Steinmann holds an MFA from Minnesota State University Moorhead, and is ABD in the English department at North Dakota State University, where she teaches writing. Her work appears or will appear in Up the Staircase Quarterly, *82 Review, Red Weather, and the Fargo TedX poetry broadside series.
Robert Joe Stout is a former Spotlight Author runner-up. He is a journalist, fiction writer, and poet whose most recent book is Hidden Dangers, Mexico on the Brink of Disaster. His poetry and fiction appear in The Cape Rock, Two-Thirds North, and Prick of the Spindle, among other magazines and journals. He lives in Oaxaca, Mexico.
Ray Templeton is a former Spotlight Author. A Scottish writer and musician, he lives in St. Albans, England. His writing, including poetry and short fiction among other things, has appeared both in print and on the web, and sometimes even other people sing his songs. Recent work can be found in Eclectica, nthposition, Left Hand Waving, and qarrtsiluni. His e-chapbook The Act Of Finding was published in 2009 by Right Hand Pointing, and his collection of prose poems The Skin Still Feels The Stone by White Knuckle Press in 2011. He is a regular contributor to Musical Traditions and a member of the editorial board of Blues & Rhythm magazine.
Melissa Wiley has published lyric essays in Prick of the Spindle, Menacing Hedge, Beetroot Journal, Tin House Open Bar, and elsewhere. Come daylight savings, she falls backward more easily than she springs forward.
Jennifer Van Orman Yurges is a writer and painter. A previous contributor to Eclectica Magazine, she is a graduate of the Stonecoast Creative Writing MFA program in Southern Maine. Her work has been also been published in the Ward 6 Review and The Orange Room Review. She lives in Hallowell, Maine, with her husband and twin daughters. She has a blog that she is not great at updating.


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Whether your website is failing to deliver, or you think it has more potential than it is currently offering up, the tips below can help ensure that your site is fighting fit, and make the most of your B2B website.
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Following our tips can help make your website an important part of your 2018 marketing strategy – to find out more about why a great web presence is so vital, please contact our digital experts on 0191 499 8415 or request a call back.


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Medical marijuana shop shut down
Updated: July 16, 2015 6:01 PM CDT
A day after Winnipeg police told him to shut down, the owner of the city's first medical marijuana dispensary says he wants to meet with the mayor.
But Glenn Price vows he will keep doing what he says is the right thing, dishing out prescription marijuana to Winnipeggers in need, no matter what legal repercussions may be in store for him.
Price said police came to his Your Medical Cannabis Headquarters shop on Main Street on Tuesday and forced him to shut down his operation, which he said provides services to more than 225 patients.
Price said he offers help to people suffering from cancer and post-traumatic stress disorder, among other ailments. He said not offering help to them is akin to a doctor watching a patient die.
"They can make a martyr out of me, they can do whatever they want. I'm just here to bring awareness," Price said.
"… Yes, I have fear of legal backlash. I'm constantly in fear of that, but from what the people in Winnipeg have told me and the people that I've helped and the stories they've told me, I can't stop helping these people."
Price said he provides "one-to-one consultation" to patients and educates them on making sound purchases. He said he's even flagged seven "phony prescriptions" as evidence he's interested in operating in a professional manner.
"I'm doing everything that I can in my power to make sure that there's no one having phony prescriptions or over-prescribing or anything like that," he said.
Last month, Vancouver became the first Canadian city to regulate dispensaries despite pushback from the federal Conservative government.
Now Price said he wants to meet with Mayor Brian Bowman, to hear the stance of the city's leader.
"I want his opinion on it and I want him to hear my views on it," Price said, adding he "reached out" to Bowman to broker a meeting when he opened his operation two weeks ago.
"It would be the same thing as the city of Vancouver standing up to the federal government. The same thing that Vancouver's done could happen here as long as it's handled properly and both parties are open-minded."
Price said he would hold off on resuming operations until after meeting with Bowman, but fully intends to restart his business.
The Sun sent a request for comment to Bowman's communications director on Wednesday.
Winnipeg police said they could not comment on what they referred to as an ongoing investigation.
Price estimates he has spent upwards of $30,000 getting the business started.
david.larkins@sunmedia.ca
Twitter: @LarkinsWSun
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text:
La Superliga Masculina de Voleibol de España 2020-21 (también conocida como SVM o Superliga) es la 57ª edición de la máxima categoría del voleibol español. Esta edición de la Superliga Masculina de Voleibol consta de dos fases: la liga regular y los Play Offs por el título. El torneo lo organiza la Real Federación Española de Voleibol (RFEVb).

Sistema de competición

A diferencia de temporadas anteriores, consta de un grupo único integrado por catorce clubes de toda la geografía española, dos más que en la anterior edición. Primero, siguiendo un sistema de liga regular, los catorce equipos se enfrentan todos contra todos en dos ocasiones, una en campo propio y otra en campo contrario, sumando un total de 26 jornadas. El orden de los encuentros se decide por sorteo antes de empezar la competición. La clasificación final se establece teniendo en cuenta los puntos obtenidos en cada enfrentamiento, a razón de tres por partido ganado con un resultado de 3-1 o 3-0, dos por partido ganado por 3-2, uno por partido perdido por 2-3 y ninguno en caso de perder por 1-3 o 0-3.

Como medida excepcional y para devolver a la competición a su capacidad normal en los últimos años, la Real Federación Española de Voleibol (RFEVb) estipuló una cantidad mayor de descensos para esta campaña. Los equipos que perderían la categoría son los cuatro últimos, es decir, los que estén entre la undécima y decimocuarta posición. Estos equipos, competirían el año siguiente en Superliga 2.

Clasificación para la XLVI Copa del Rey
La RFEVB da la posibilidad de clasificarse para la Copa del Rey de Voleibol a los equipos que ocupan las 7 primeras plazas de la clasificación al finalizar la primera vuelta (13 partidos) y al equipo organizador, o en el caso de que no haya a los 8 primeros en la primera vuelta, de participar en la Copa del Rey de Voleibol 2021.

Clasificación para competiciones continentales
La CEV otorga a la Superliga española 2 plazas de clasificación para competiciones continentales, que se distribuyen de la siguiente forma:
 El campeón de los Play Offs y por lo tanto de la Superliga acceden a disputar la tercera ronda de clasificación a CEV Champions League. En caso de perder, jugaría los 64º de final de la CEV Cup.
 El subcampeón de la Superliga accede a disputar los treintaidosavos de final de la Challenge Cup.

Nota: Estas reglas solo son aplicables a la temporada actual, ya que pueden variar de un año a otro. Por lo tanto, no se deben tener en cuenta los casos de temporadas anteriores ni posteriores.

Equipos participantes

Equipos por comunidad autónoma

Ascensos y descensos
Un total de 14 equipos disputan la Superliga: los 12 clasificados de la Superliga masculina de voleibol de España 2019-20 y los primeros clasificados de la Superliga 2 Masculina de Voleibol de España 2019-20.

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Información de los equipos

Clasificación

Evolución de la clasificación

 Con partidos aplazados por motivos relacionados con Covid-19

Play-off

Los Play Offs de la Superliga Masculina de Voleibol 2020-21 se disputan en tres fases de cuartos de final hasta la gran final entre los 8 primeros clasificados en la fase regular. Así mismo, se enfrentan el primero clasificado contra el octavo, el segundo contra el séptimo, el tercero contra el sexto y el cuarto contra el quinto, todas estas eliminatorias al mejor de tres partidos. Quienes consigan dos victorias, se enfrentarán en una ronda de semifinales hasta alcanzar otras dos victorias, es decir, al mejor de tres partidos. La distribución sería entre el ganador del primer partido contra el de la tercera eliminatoria; además del ganador del segundo contra el del cuarto. Los equipos que sobrevivan a ambas eliminatorias, serán los que jueguen entre ellos la final para alzarse con el título.

Esta fase del K.O se disputará en un periodo comprendido entre el 28 de febrero y el 10 de mayo de 2021, dependiendo de cuanto se alargue cada eliminatoria.
 Los partidos deberán disputarse en días consecutivos salvo acuerdo de ambos equipos.
 En todo caso entre el inicio de cada encuentro deberá transcurrir un mínimo de 18 horas, salvo acuerdo mutuo o por TV. En caso de que no se juegue el 5º partido del play-off de semifinales, se habilitará también el viernes para disputar el primer partido.

Estadísticas

Mejor Jugador de la Jornada (MVP)
La Real Federación Española de Voleibol entrega unos premios cada jornada al mejor jugador, a los mejores de la jornada y al mejor entrenador.

Referencias

2020
Voleibol
Voleibol
Voleibol en 2020
Voleibol en 2021

redpajama_set_name: RedPajamaWikipedia