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An Early Mo(u)rning For Jayhawk Nation

As any student or alum of a blue blood basketball college–Duke, Kentucky, Indiana, North Carolina, Kansas–knows, summer, fall, and winter really serve but one purpose:  to prepare for March Madness, the NCAA Men’s Basketball Tournament.  During this time of year, late March to early April, 68 of the best men’s college basketball teams in the United States punch their cards to the “Big Dance,” in the hope of their one shining moment, a chance to be national champion.

I’m an 8-year Jayhawk, having gone to college and medical school at the University of Kansas.  I was a senior undergraduate when our basketball team–led by Danny Manning–claimed the national title in 1988.  It was truly an unforgettable experience:  the height of uncontrollable joy and complete elation, a party that lasted for three straight days and nights.  Differences and conflicts between people and between groups on campus simply evaporated as hundreds of thousands from Lawrence to Kansas City poured out of their homes, dorms, and workplaces to celebrate together, to hug and high-five perfect strangers, to be in the moment.  For weeks following that win over Billy Tubbs’ Oklahoma Sooners, a collective rapture unified us, making us whole in our exultation and the love for our school.  That intoxicating sensation transcended mere sports:  it was a pure happiness, the way you wanted things to be forever, the way you hoped your life would be like when you grew up, whatever it was your future held.  That feeling is perhaps what I would imagine being jacked up on crack or heroin must be like.  When you’re there, in that moment, you know that it’s unrealistic to expect such ecstasy to be sustainable, it’s so epic and so intense.  But you hope against hope that life could feel this way, if not forever, then at least again.  Some time again.

It is with this hope of recapturing that bliss that every year we Kansas Jayhawks look forward to our autumn ritual, Late Night in the Phog, to usher in the new men’s basketball season and all the hopes and expectations that go with it.  Long after graduation we look forward to watching every game, at Allen Fieldhouse, on television, or online, and cheering on our guys.  We watch the AP and USA Today polls every Monday morning for upward movement in our rankings.  We closely follow our main man, head coach Bill Self, as he clears a path for each year’s kids with grace and confidence.  And as Selection Sunday draws nearer and nearer, our heads fill with a heady mixture of excitement and anxiety, anticipating seeds, matchups, and karma in an annual quest for our holy grail:  the national title.  No matter what your station in life, no matter how happy you might be at home or at work, there is still that other happiness you crave, that sensation more powerful than any street drug.  Your team is the only key that opens the door to that happiness.

It is the proclivity of the Jayhawk to combine hope with expectation, at least an expectation to be a worthy contender, and with class.  But becoming national champion is hard.  Very hard.  And statistically unlikely.  So for us, when it comes to the final result of the national tournament, there are really only two options:  complete elation with a championship or utter devastation when our team falls short.  Since my senior year at KU, that complete elation happened once again, in 2008, thanks to Mario Chalmers and his now-legendary game-tying 3-pointer against the Memphis Tigers:

To witness a true Jayhawk championship court-stormin’, forward to 4:00 in this clip, again taken from Allen Fieldhouse:

And so it was that Jayhawk Nation went into the 2013 national tournament with its usual high hopes, Kansas the #1 seed in the south region.  When we lost in overtime to the Michigan Wolverines 48 hours ago in the Sweet Sixteen, it was full-on, crushing, world-coming-down heartbreak.  Without dwelling on details here, a healthy lead dissipated gradually during the final 3 minutes of regulation play, forcing us into overtime due in part to an incredible Michigan 3-pointer with seconds left, kind of a Mario Miracle in reverse.  We had been winning virtually all game long until the very end of regulation.  It’s tough to take, this idea that just one more point, one less missed opportunity, one more free throw, and the outcome could have been very different.  Jayhawkers around the country reeled in shock.  Only now am I starting to recover from it.

I’ve spent this past weekend nursing my emotional wounds and dealing with another transient but inevitable element of my own special method of mourning:  sleep maintenance insomnia.  I’ve been awakening around 4:30 a.m. for the past 2 days.  Yes, I’ve been following my own advice and getting out of bed to minimize the frustration.  The phenomenon of early-morning awakening is a very common clinical element in situational and characterologic depression.  I know me, and I’ve been through enough NCAA tournaments to know my tendencies:  I’m as blue as can be for 2-3 days after a tournament loss, and then life’s demands and thoughts of next year’s season gradually take over to help me climb out of my funk.  I can already feel that happening today, so I think tomorrow will be a better morning.

One thing’s for sure, a lot of Jayhawks slept poorly this past weekend.  But here’s to a new morning, a new Late Night in the Phog, and a promising 2013-2014 season.  Looks like Kentucky will be the team to beat next year, but we will continue to cultivate our high hopes.  Go get ’em, Hawks!

R.I.P., Phil Ramone

The music world lost a giant today.  Legendary sound engineer and music producer Phil Ramone passed away this morning.  He was 72.

Ramone was born in 1941 in South Africa and raised in Brooklyn, New York.  He became a naturalized American citizen in 1953.  In 1958 he co-founded A & R Recording, a recording studio in New York.  He subsequently became known as an innovative music engineer and producer, and he went on to produce music for dozens of seminal artists from many important genres, from jazz (John Coltrane, Stan Getz) to rock and roll (Elton John, Bob Dylan) to blues (B.B. King) to R&B (Aretha Franklin) to folk rock (James Taylor, Peter Paul and Mary).  He also produced classical music, broadway musicals, large-scale concerts, music for television shows, and movie scores.

I met Mr. Ramone in early 2011 when he dropped by a recording session at Avatar Studios in Manhattan.  He was incredibly warm and welcoming, brimming with soft-spoken humor and wonderful stories.  We took a break for a couple hours and sat in a semi-circle around him in the control room as he regaled us with stories of coming up in New York, gaining prominence in his field, working with Paul McCartney, producing for Billy Joel (coincidentally, the subject of my blog entry from yesterday), and navigating around the music industry.

So much of the music I love exists because of Phil Ramone.  I hope he’s still making music somewhere.

What a Young Billy Joel Fan Can Teach Us

I was the tender age of 12 when Billy Joel released his groundbreaking album, 52nd Street, in 1978. His songs were all over the radio, and I fell in love with them. When his tour stopover in Wichita, Kansas was announced, I begged my parents to go. After some inter-parental discussion and to my great disappointment, it was determined that I was too young to attend the show. As consolation, Mom took me to Musicland in Towne East Square and picked up the 52nd Street LP for me to take home and enjoy. And boy did I enjoy it. I played both sides over and over, memorizing every word. “Zanzibar” remains one of my favorite songs of all time. Imagine my surprise and delight when, upon finally seeing a live Billy Joel concert several years ago here in Seattle, he performed that obscure but wonderful piece from 52nd Street; it felt like he played it just for me.

(In the unlikely event that you’re interested, I eventually wore my parents down, and my very first rock concert ended up being Kiss in 1979, a year after 52nd Street was released.)

I am but one of many millions who have loved Billy Joel’s songs over the years. Recently, during a Q and A with Joel at Vanderbilt University, a freshman named Michael Pollack stood up and asked if he would be willing to be accompanied by him on piano on “New York State of Mind,” his favorite song. Joel granted him his wish, much to everyone’s delight, and the musical result was . . . well . . . incredible. Inspiring. Please click on the video above to witness the performance.

There’s a lesson or two to be learned from this brief event, one which I’m sure Michael will never forget. This world is getting smaller, but the number of people inhabiting it is getting bigger. How are today’s young people to survive and succeed with so much competition surrounding them? It’s no longer sufficient to be good at what you do. You have to have guts now. Billy Joel, in his typical east coast nonchalance, said of Michael, “guy’s got chops!” No disagreement there; he killed it on the piano, as you can see. But another quality Michael possesses is just as crucial, if not more so: guy’s got cajónes too. Big ones.

The favor Michael asked of Joel was asked for honestly and audaciously. No one outside his friends, family, and teachers would know who Michael is today if it weren’t for that moment of boldness and risk. It paid off.

We are at a societal turning point here in the United States. Health care is in a major crisis. Regulations, ever-declining reimbursements, minimal autonomy, increasing overhead and malpractice premium costs, mounting paperwork and administrative hassles: it’s becoming more and more difficult for doctors to find success and happiness in their work. This isn’t a whine or a call for sympathy; it’s just factual. My concern is, in a time in which doctors are retiring early or just plain quitting, who of our young citizens will choose medicine as a career in the future? Why should they go through the hassle and put in all that money, time and effort for so little in return?

I’ve been asked recently by high school and college students if I would recommend medicine as a career. My answer was that it really depended on who they are, based on honest self-assessment. There’s a definite analogy I see between the qualities of a successful and happy future doctor and those of Michael Pollack, the Vanderbilt freshman pianist:

1. You have to have passion. You have to really want it, and for the right reasons.

2. You have to be good.

3. You have to have the audacity to work aggressively to get what you need or want, because in today’s way of the world it’s no longer given to you or made easy.

Seems to me that a young man or woman possessing these three elements should be able to weather the current health care storm and carve out a satisfying, fulfilling career in medicine. If any of the three are missing, however, the happiness factor will plummet, I can promise you. A missing link or two may be why there is so much unhappiness and dissatisfaction among doctors right now.

I want people to go into medicine in part, admittedly, for selfish reasons. I want a quality physician to be willing to care for me when I am old. Doesn’t everybody?

So to those kids and teens considering becoming a doctor: do it if you really want it. If you really want it, and if you know it, and if you know what you’re getting into, then go for it. And go for it hard. Not obnoxiously or unethically, but boldly. It takes audacity now to make it in this world. If you ever want a reminder of what that quality looks and sounds like, click on the video again.

Have a great weekend, everyone!

What About Naps?

Thank you, everybody, for your recent inquiries.  I’m happy to help!

The other day I was asked about daytime naps:  “is it better to take a nap when you are feeling really tired that day or try to go to bed earlier instead and skip the nap?”  In order to best answer the question, it’s important to know what is causing you to want or need the nap in the first place.

The science of sleep regulation is quite complex.  Sleep intensity is mediated by what is called the homeostatic mechanism of sleep, the specifics of which are beyond the scope of this blog entry.  Simply stated, the principles of sleep homeostasis dictate that sleep deprivation results in a compensating increase in intensity and duration of sleep, and excessive sleep (such as related to a daytime nap) reduces the inclination for sleep.  Taking a nap during the day implies daytime sleepiness, so let’s explore why one may be sleepy during the day.

One of the most common causes of daytime sleepiness is simple sleep deprivation.  If you’re getting 5 hours of sleep per night, for example, when your body needs 8, then likely you will not need to take a nap during the day any longer if you then gradually increase your sleep time to 8 hours per night, because by satisfying your body’s natural sleep needs consistently you should eventually feel substantially more awake and alert throughout the day.

Another common cause of daytime sleepiness is insomnia.  If you get less sleep at night because you’re awake a lot in bed, an obvious consequence would be feeling fatigued and drowsy during the day.  The problem is that taking a nap during the day can cause or worsen insomnia, particularly if the nap is prolonged and/or taken in the mid-afternoon to early evening; you tend to get a “second wind” and feel more awake and alert later than what you desire, resulting in further sleeplessness at night.

Finally, you could be sleepy during the day due to a problem with the quality (as opposed to the quantity) of your sleep.  Numerous sleep disorders can cause substantial drowsiness during the day even if you get your 8 hours per night:  obstructive sleep apnea, upper airway resistance syndrome, periodic limb movement disorder, and narcolepsy to name a few.  A good general rule to follow:  if you regularly get 7-8 hours of sleep per night and you’re consistently struggling to stay awake during the day when 7-8 hours per night used to satisfy your sleep need in the past, and if the sleepiness can’t be explained by some other factor (like medications or alcohol), you may want to see a specialist like me.

OK, synthesizing this down, then, here are my personal primary clinical concerns about napping:

1.  If you nap because you’re sleep deprived, there is often residual sleepiness between the time you awaken in the morning and the time your nap starts.

2.  If you nap due to insomnia, a vicious cycle can develop:  the nap can cause or worsen the insomnia, which then reduces your nocturnal total sleep time, which then makes you feel more sleepy during the day, which then makes you want to nap more.  In extreme cases people’s bedtime schedules can be completely turned around due to this problem, such that they become essentially nocturnal, sleeping throughout much of the day and remaining awake all night.

3.  Taking a nap to sustain you for the rest of day may “mask” concerns for an occult sleep disorder.

Bottom line here:  if the nap doesn’t cause difficulties falling or staying asleep at night, and if you don’t have substantial daytime fatigue or sleepiness prior to the nap, and if you’re confident you know the reason why you need the nap in the first place (such as staying up too late the night before), then I think there’s probably not much of a problem with taking that nap.  However, if you find yourself unable to stay awake during much of the day, if you are substantially sleepy during the day despite getting proper amounts of sleep, or if you are having mounting insomnia in this setting, there should be further concern about what is happening.

I’ll add several additional points before Sleep Help Desk closes for today.  First, naps can be intentional (i.e., laying down with the intention of taking a nap) or unintentional (such as falling asleep by accident in front of the television).  Second, if you doze off on the couch at 10 p.m. before you go to bed, that’s still a nap!  That late-night nap can cause difficulties falling back to sleep once you do go to bed, so try to avoid dozing off in the evening until you’re in bed intending to sleep.  Finally, to answer the original question posed to me above, I suggest not going to bed too early if you choose to not take the nap.  If you go to bed way earlier than usual, you can still have insomnia even if you’re sleep deprived, because your body clock “wants” regularity nonetheless.  The idea is to gradually increase your total sleep time such that you reliably get proper amounts of sleep every night.

Trivia question:  who is the famous person napping in the photograph above?  Write me with your answer!

Cheers, everyone!  Keep your questions coming!

“Why Do I Wake Up at the Same Time Every Night?”

I’ve been asked recently by a friend why she finds herself awakening at 2 a.m. virtually every morning.

Many people have experienced this phenomenon, a tendency to awaken at least briefly around the same time every night. There may be many potential reasons for this, ranging from your pet to a need to urinate or a spouse coming to bed for sleep later than you. The expression of certain hormones in your brain throughout the night might play a role.  However, for many people, these brief awakenings may also be related to your brain’s natural rhythms for sleep.

To describe human sleep physiology as simply as I can, human sleep is very dynamic. We sleep in cycles, called ultradian cycles, in which lighter stages of non-REM (called stage N1 and N2) sleep are followed by deeper forms of non-REM (formerly called stage 3 and stage 4 sleep, but now called stage N3, or slow wave) sleep and then, to varying degrees, rapid eye movement (REM, stage R, or dream) sleep. In general, the amount of deep non-REM sleep we have per cycle is highest during the first one-third of the night’s sleep, and the amount of REM sleep we have per cycle gradually increases as the night progresses (which explains why we tend to remember our dreams most around, say, 4-6 a.m.). Exactly how and why we have been designed neurologically to sleep in this way are a mystery. A typical human adult’s ultradian cycle lasts for about 90-110 minutes. Generally it’s most difficult to awaken fully from N3 sleep, and it’s quite easy to awaken fully from REM sleep. This explains why you often feel very groggy if you’re awakened abruptly during the first 2-3 hours of sleep, but may find yourself awakening easily and quickly from a dream later at night.

The primary point I want to make with all this is that between these ultradian cycles, there are normally and naturally periods of arousal from sleep. There can be several of these brief arousals in a typical night.  In children, adolescents, and young adults, these arousals are generally very brief, perhaps lasting for only several seconds; these awakenings are not usually enough to remember, in part because younger people tend to have a lot of slow wave sleep), leaving you with the feeling that you are sleeping uninterrupted all night long, even though you have likely in reality aroused several times. Once you reach middle age, however, such as your 40’s and 50’s, the tendency to recall these arousals from sleep can gradually increase, and the duration of the typical arousal from sleep may gradually increase as well. This may explain why some people remember awakening, say, at 3:30 a.m. on the dot every night. Finally, when you become elderly, in your 70’s and 80’s, say, still more frequent awakenings may occur due to the naturally increased sleep disruption that occurs as your brain becomes more brittle with age.

Why is this all important? Because some people freak out over a spontaneous recalled arousal from sleep in the middle of the night, and this substantial concern or annoyance can generate enough worry or frustration to actually cause persistent wakefulness subsequent to that arousal, potentially triggering chronic insomnia.

Take-home point here: if there is a brief awakening around the same time most nights, and there is no specific symptom or problem that causes the awakening, and if there aren’t substantial problems falling back to sleep, and if there is minimal sleepiness during the day, my sense is that the awakening is probably not much to worry about. If there are substantial problems associated with the awakenings, however, it may be worthwhile to bring that to a doctor’s attention.

Have a great evening, everybody, and sleep well!

Insomnia . . . For Wichita State and Gonzaga

I am and always will be a Kansas Jayhawk.  But my first awareness of college basketball was thanks to Wichita State University, the very school whose team just advanced to the Sweet Sixteen of this year’s NCAA men’s national college basketball tournament by trouncing top-seeded and top-ranked Gonzaga last night.

Wichita State was an integral part of my childhood.  My dad was a professor there for decades, teaching criminology, editing the journal he founded, The International Journal of Comparative and Applied Criminal Justice, and solidifying his legacy in the field of administration of justice.  I also took math, literature, and computer science classes there in the summer while I was in high school.  And, importantly, WSU’s infamous basketball coach, Gene Smithson, lived three doors down from us.  Growing up, we looked up to him and the young men he coached–particularly Antoine Carr and Xavier McDaniel, who subsequently became nationally recognized professional basketball players.  Smithson popularized (and perhaps even invented) the term “MTXE”–“mental toughness, extra effort.”  I live by this phrase every day.

So I have to say I was very pleased with WSU’s win over the Bulldogs last night.  As a Kansas native now living in Washington state, I empathize with both teams and their fans.  Nobody with ties to either school slept very well last night.

Here’s the Wichita State Shocker in bed.  You just watched your team pull down the heretofore #1 ranked college basketball team in the country.  Only now that you’re in bed are you processing what this huge upset means for you and your fellow Wu-Shocks.  It’s pure rapture.  You’re in the Sweet Sixteen in a year of absolute mayhem in men’s college basketball.  There’s no clear, inarguable favorite to take the title like there was last year.  It’s anybody’s tournament; any team can win it all.  This year it might, just might, be the Shockers!  Your head is buzzing from all this emotion and mental racket.  You imagine the improbable run to the championship game, a buzzer-beating final shot that clinches the title, the ticker-tape parade down Douglas Street.  How are you gonna sleep with all that adrenalin running through your brain?

Here’s the Gonzaga Bulldog in bed.  You’ve become tired of the pundits and analysts saying that Gonzaga became #1 by default.  You’ve just heard Dick Vitale on ESPN predicting loudly that “the Shockers are gonna shock the nation.”  Sure, your school is in the West Coast Conference, but you’ve had some wins against quality non-conference teams this season, and going into the Big Dance you know the Bulldogs now have the chance to prove the nay-sayers wrong.  And then . . . crushing, unmitigated defeat–in the third round.  It’s like someone ran over your dog and then sped off.  You feel helpless and in despair, left with the bitter reality of the loss.  You go to bed truly in mourning, knowing the mourning will only continue upon awakening the next day.  How can you hope to sleep tonight, knowing that any temporary rest will bring only minimal reprieve and solace?

Man, I’ve gone to bed both ways every late March and early April for years.  I know exactly how it feels.  And the fact is that all of us have, basketball fan or not, for one reason or another, throughout our lives.  Why?  Because we’re human.  We have emotions, hopes, dreams.  We put ourselves at risk emotionally by daring to hope in the face of adversity or unfavorable statistics.  When the risk pays off, the elation is something you will savor for the rest of your life.  But when you lose, well, that’s also something you remember forever.

It is part of the human condition for these emotional peaks and troughs to affect your sleep.  As such, everybody is susceptible to at least some occasional transient insomnia.  Usually the insomnia burns off as its trigger fades into the background of your life.  However, in some cases the sleeping problem can persist as dysregulation of bedtime schedules and mounting frustration over the insomnia set in and worsen.  It’s at this point that people start to schedule appointments to see guys like me.

Bottom line here:  anything you think about that is of emotional importance–whether good or bad–can cause at least transient insomnia.  Just ask Shocker and Bulldog fans.

I’m hoping that I won’t be going to bed tonight like the Zags did last night.  KU is playing Roy Williams and his Tarheels.  MTXE, baby, and Rock Chalk Jayhawk!

My Recurring Nightmare . . . Read If You Dare

Many people have recurring nightmares, and I’m no exception. The science of this phenomenon is still very young; there is little understood of why dreams recur, or indeed why or how we dream at all. As I mentioned in yesterday’s entry, the prevailing dream research indicates that a majority of dreams have negative or unpleasant content or connotations. As such, unfortunately, having bad dreams over and over is quite common.

I thought I’d indulge a little today and describe my own recurring dream. I’ve had this same dream once or twice per year for the past two decades or so. There’s no monsters, no bad guys, no bogeymen, but it’s absolutely terrifying nonetheless, every single time. Without fail I awaken abruptly at the same point in the dream, drenched in sweat, sometimes literally yelling out in horror. Are you sure you want to join me on my journey back into Hell? Read on.

I’m back in college at the University of Kansas. I’m an underclassman. I’m two-thirds through the fall semester. I’m on an old green and biege campus bus. It’s a bright, beautiful, crisp Kansas autumn morning. The sky is brilliant blue, and white early morning light shines effortlessly through the windows, warming my face. I’m in the back. Nondescript fellow students surround me, sitting and standing silently. I close my eyes, relaxing, taking in the cold smell of diesel and giving in to the comforting, slow side-to-side sway of the bus as it snakes slowly up Naismith Drive into the main body of the campus.

After a couple minutes of reflection, my thoughts turn to the activities of the day. I recognize that I am still enrolled in a course that I need to cancel. It’s an upper-level calculus course, and I haven’t bothered to go to a single class. I haven’t studied a thing for it and I haven’t even shown up for any of the tests. I know, therefore, that I must be failing it. I’m not worried, however: I’ve known all along this semester that I can cancel the class without consequence or penalty, as long as I cancel prior to the deadline. I don’t remember which exact day is the last day I can cancel the class without an “F” showing up in my transcript, but I’m sure the cancellation date is still some time in the future. Or is it?

I wonder now when that deadline is. I’ve got a couple minutes of ride time before the bus drops me off at Hoch Auditorium, so I casually open up my light grey nylon backpack and retrieve my “timetable,” the KU academic semester catalog that describes all the courses and schedules. I look for the deadline to cancel courses. Finally I find the date in bold letters near the bottom of the page. $#!@ me, the deadline was YESTERDAY!

My heart pounds relentlessly now as I take in what this means. I’m on the verge of panic. I’m trying to keep it together, but I can’t see straight. There is an explosion of manic thoughts in my head. I’m going to fail this course now even if I start going to class faithfully and ace every test. An “F” in my undergraduate transcript will immediately put an end to my hopes to go to medical school. I want to scream, but I don’t want to attract attention. I fidget nervously in my seat, wishing the bus would move up the hill a little faster, but it’s crawling. I’m going to have to miss my class now; I have to stop off at Strong Hall, KU’s main administration building, and find some authority in front of which I can plead my case. All the while, I am thinking of what kind of alternative career plan I can come up with that might still provide me a good and happy life. Will an engineering school accept me with an “F?” Pharmacy school? A chemistry post-graduate program, perhaps? These thoughts make the bus feel like it’s going one mile per hour.

Finally I’m dropped off at Strong Hall. My panic and adrenalin send me flying out of the bus and storming down the concrete walk toward the front door of the building. I blast my way inside, unable to think clearly about where to go. I run, out of breath, to a counter built into the wall on the left in the front foyer. There’s an older woman behind the counter; large, imposing gold-colored steel bars separate her from me as I rush over, blustering incoherently that there was some mistake, I need to cancel my calculus course immediately, please please don’t put a failing grade on my transcript. She stares at me, blankly and silently, as I jump up and down like a maniac. I don’t know if she understands what I am saying, but looking at her impassive face one thing is starkly apparent as I blather on: whatever my problem is, she could . . . not . . . care . . . less.

It is at this point in which I awaken suddenly, sitting up bolt upright in bed, sweating and tachycardic, thanking God it was a dream. I’ve had this same dream dozens of times now. Its theme, sequence and outcome are virtually identical each time, but each time it feels new, the horror absolutely fresh.

As you can see, there are no monsters in my nightmare—just me and my own stupidity and foolishness. I feel some vague anxiety even now just thinking about it. The terror and dread come from a place completely different from some rated-R slasher flick: where innocent aspirations and diligent work intersect harshly with reality. This experience never actually happened to me, blowing off a course that I couldn’t get out of. I suppose the recurring nature of the dream exposes some of my deepest personal fears: watching helplessly as the prospects for my future slip through my hands, and loathing myself for getting myself into trouble due to my own irresponsibility. I think it also suggests part of what drives me to be the person who I strive to be every day.

Write me with your recurring dreams. I’m curious to know of them. What are they, and how do they affect you?

Nightmares vs. Night Terrors

Hello everybody!  I’m writing this brief entry tonight to address something a lot of people, particularly parents of young children, can be confused about:  the difference between nightmares and night terrors.  I’ve heard people use these terms interchangeably, but they represent entirely different clinical entities.  Herein I provide a simple distinction between the two.

Night terrors–also known as “sleep terrors” or “pavor nocturnus“–are very memorable for parents.  Here’s a typical scenario.  Your child goes to bed the way she usually does at night.  Later that night, suddenly, from her bedroom comes a loud, blood-curdling scream that scares the hell out of you.  You jump out of bed and run to your daughter’s bedroom.  You find her sitting up in bed, appearing awake and dazed, eyes wide open in fear.  She may or may not respond to you.  She appears distressed and freaked out, sweating and breathing hard; she may move her arms and legs nonspecifically but frenetically as well, compounding your concern as you observe her.  She seems panicked and inconsolable, almost possessed.  After several minutes, though, she calms down, lies down again, and returns to sleep.  The next morning, when you ask her about the event, she tells  you she has no idea what you’re talking about:  she recalls nothing of what happened.

Here’s a nightmare.  You hear your child crying or crying out for you in the middle of the night.  You enter his room.  He’s clearly awake and clear-headed, and answers your questions appropriately and quickly.  He may hug you for comfort.  You ask him what happened.  He tells you he had a terrible dream; a monster was out to get him, for example, or he was about to be pushed off a cliff by someone mean.  He has good recollection of what he was dreaming about.  After some reassurance, he eventually feels comfortable enough to return to bed, and the following morning he may or may not recall the full details of the disturbing dream, but he does remember that he had a terrible dream that caused him substantial distress.

The reason why it’s important to recognize the difference between these two clinical entities is because both can concern and frighten parents, particularly night terrors.  As frightening as they may be to watch, however, they are in and of themselves generally benign in nature and prognosis.

Night terrors represent a type of parasomnia (sleep-related unusual movements or behaviors) typically occurring out of deep non-REM sleep.  As such, dreams are not recalled, and the child is usually completely amnestic of the event.  Though some adults may experience night terrors, they are by far most common in children 3-12 years of age.  As scary as these events are for parents, they are usually not indicative of an underlying abnormality or medical problem, and children with night terrors usually outgrow them over time.  In some children, sleep deprivation or other reasons for going to bed particularly fatigued or sleepy may play a role in the likelihood of night terrors occurring, so make sure that your child gets proper amounts of sleep and sleeps in reasonably predictable, regular schedules night after night.

Nightmares are simply particularly unpleasant and/or frightening dreams.  They occur out of rapid eye movement (REM) sleep, and are usually recalled–and often recalled well–upon abrupt awakening from dream sleep.  For whatever reason, 2/3 – 3/4 of human dreaming is emotionally negative in nature (I had a distinctly negative dream early this morning, for example, though I wouldn’t classify it as a nightmare; hence I’m writing this entry today!).  Most people don’t need specific treatments for nightmares, and how to treat recurring nightmares is controversial.

I think I’ll write a little about recurring nightmares some time soon.  It might be cathartic for me.

Have a good evening, everybody.  I hope your dreams tonight are positive and pleasant.

A St. Patrick’s Day Anecdote

Long ago during my training years, a man in his early sixties—I’ll call him Karl—was admitted to our hospital service one day in mid-March. Karl had metastatic cancer, and he was dying. We on the in-service team liked him very much, remarking quietly to each other how it so often seemed to be the good ones that die early of such tragedies. Despite his terrible prognosis and physical discomfort he was pleasant–jovial, even–during morning rounds, putting everyone at ease with his polite disposition.

One day we walked into his hospital room, and he was having a tough morning, though not for physical reasons. He was really down, uncharacteristically so. We asked him what was troubling him. A little embarrassed at first, he shared that it was St. Patrick’s Day, and true to his Irish roots he normally celebrated that day with a glass (or two) of green beer. Doing so was a custom of his and his family’s for decades. He told us how unfortunate it was that he wouldn’t be able to celebrate this way this time ‘round.

Upon examining him and talking with him further, we took our leave and somberly continued morning rounds. Afterwards I stood at the nurses’ counter with my chief resident. I was post-call and yearning for sleep, so I wasn’t paying much attention to what he was doing; I was hanging around until his exit off the floor, which was tacit permission for me to go home and go to bed. He made a couple brief phone calls and wrote something in a patient chart. He slammed the chart shut, startling me, and grinning widely he proclaimed, “That oughta do it!” And he walked off, swinging his stethoscope in his hand as he disappeared down the hall.

I looked down: it was Karl’s chart. I couldn’t help it, of course. I opened it, flipped to the “orders” section, and read the following in my chief resident’s barely legible scribble:

“Administer 1 glass beer p.o. x 1. Apply green food color prior to ingestion.”

I smiled as I left the hospital that morning.

After awakening from my post-call nap I called the floor and spoke with Karl’s nurse. He had enjoyed his green ale. Several days later he went to hospice a happier man.

That was a couple decades ago. I hear that beer is still available in some hospitals. But I wonder how difficult it would be for a dying person to get it these days. The process of health care is so burdened now with endless complexities—regulations, statutes, administrations, commissions, regulations, third party payers, boards, committees, and did I mention regulations?—it seems hard to believe that underneath all of that still exists the original idea that I went into medicine for in the first place: to actually care for people, to make what is miserable less miserable, to heal, to help make life a little better, maybe lengthen it too. All this sounds so quaint and clichéic now, things one might say in a medical school interview. But isn’t it still true, what we’re all still supposed to be doing in health care? If so, does the administration of health care now really have to be such a struggle, such a fight all the damn time?

To some of those non-clinicians who have their hands in the business of health care, I would ask what they would do if charged directly with the task of making a person’s life better. What rules that they themselves created would they try to bend to grant a dying man a green beer? Or would they? A green beer would be difficult to pre-authorize.

As my life continues on, I am increasingly grateful for what I have, who I have it with, and what I am allowed to do every day for work. I think of Karl every St. Patrick’s Day. To my readers, if you choose to celebrate a little tonight, I’d appreciate your lifting one up to Karl and cheering the greatness of life. We’re lucky to have each day we have.

Happy St. Patrick’s Day, and Happy Selection Sunday!  Lá Fhéile Pádraig Sona Daoibh!

Sleep Song #3: “Shiftwork” by Kenny Chesney and George Strait

One thing I’ve always loved about country music is the recurring theme of hard work. Like sweet tea, personal freedom, trucks and cutoff jeans, getting your hands dirty and proudly carrying out your duties for yourself and your family are major topics in country songs old and new. And boy, can I relate.

I can also relate well to the topic of this little nugget from Kenny Chesney (with a little help from “The King,” the great George Strait). Growing up I worked late washing hundreds of thousands of dishes at a restaurant, and as a medical postgraduate trainee I was expected to work not only night call but also “night float,” in which we worked all night for weeks on end.

According to the Bureau of Labor Statistics, roughly 15 million Americans work permanently at night or regularly rotate in and out of night shifts. That’s a lot of people. People work the night shift for all sorts of reasons: it often pays better, for example, or they may simply prefer the quieter work environment, or their professions or particular stations in life may leave them no choice. Regardless, many or most of these millions of people suffer from sleep problems directly or indirectly related to the timing of their work.

A primary sleep-related problem for shift workers is fatigue. The feeling of tiredness or drowsiness can be pervasive, and when experienced during work can lead to a host of negative consequences, ranging from substantially reduced productivity to major industrial accidents. Working at night can often lead to falling asleep on the job, reduced attention and concentration, and missed time from work.

Why are such problems so prevalent in night shift workers? The answer usually lies in the difference between their weekly activities and the way we are designed to sleep. Days off from work are precious to night shift workers like they are for everybody else. The problem is, on days off, most night shift workers want to be awake during the day, because that’s when family, home, social, and leisure activities take place for everybody else around them. As a result, they end up flipping their sleep schedules around abruptly, such that now they are staying awake during the day instead of sleeping during the day on their non-workdays.

Unfortunately, your brain isn’t quite that flexible. Your body clock “wants” regularity in its sleeping patterns–which the basis for the concept of “jet lag,” for example–and completely changing your bedtime schedules around by reverting suddenly back to a night-time sleep schedule on non-workdays often or even inevitably leads to sleepiness and reduced quantity and quality of sleep.

No matter how many years you’ve put in work at night, your body clock does not biologically adapt or accommodate for your work shifts if you regularly revert back to a night-time sleep schedule when you’re not working. Instead, you adapt subjectively, accepting a certain degree of fatigue as a regular component of your life, and/or inserting a nap here and there to make up for the reduced sleep, or breaking your sleep times up into 2 or 3 separate parts in a day.

There will be more to say about shift work in future posts, because it’s not only a potential medical problem, but also a major public policy issue. Bottom line: fatigue due to irregular sleep schedules stemming from night shift work is potentially dangerous, decreasing safety at work and putting people at risk.

On that grim note, enjoy Kenny’s song! The lyrics don’t delve directly into sleep issues associated with working the night shift, but the fatigue so many shift workers feel can certainly cause “’round-the-clock pain” and make you feel like a big ol’ pile of . . . shift work.

Have a great weekend, No Shoes Nation, shift worker or not!

(written by Troy Jones)

Shift work, hard work, tired body
Blue collar shirt and a baseball cap
Union made

He’s hot, sweat drops, ’round the clock
Door never locks
And the noise never stops
Not all day
Work seven to three
Three to eleven
Eleven to seven

Shift work, tough work for the busy convenience store clerk
Two feet that hurt, going insane
She’s mad at some lad
Drove off and didn’t pay for his gas and he won’t be the last
‘Round-the-clock pain
Work seven to three
Three to eleven
Eleven to seven

I’m talkin’ about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Well I work shift work,
Ten years man, I hated that work
Then I made a break with the money I saved
It took me to the beach
To have a beer by the edge of the sea
And this ’round-the-clock place
I drank my money away
We partied
Seven to three
Three to eleven
Eleven to seven

I’m talkin’ about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Talking about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Seven to three
Three to eleven
Eleven to seven


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Where is your god now? SCORE 27
24hr time makes way more sense prove me wrong. SCORE 23
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Truth. SCORE 222
Villains SCORE 241
Please sir, step aside. SCORE 31
words. SCORE 97
Beware Of The Crocs SCORE 142
So hardcore. SCORE 179
First look at Ben Affleck as Batman SCORE 236
The saddest face swap SCORE 134
Pretty much sums it up... SCORE 21
Math will save you! SCORE 302
A pony we shall have. SCORE 88
Real slick, Ali... SCORE 15
Waking up before the alarm. SCORE 148
Sherlock's only friend. SCORE 218
If you're worse than the devil... SCORE 303
Everyone deserves a second chance SCORE 132
The only thing that'd make Harry Potter better. SCORE 84
Man sits by this gorilla after its mother died SCORE 147
Cats and their naps... SCORE 148
Words. SCORE 156
The Hulk behind the scenes... SCORE 23
When I do dishes. SCORE 103
Selfie level 1995 SCORE 173
Men know this is true SCORE 94
Pug goes bananas in his first ball pit. SCORE 144
La Petite Mort SCORE 100
like that! SCORE 51
Slow Robots do love too!
Snake Humor SCORE 85
I Really Miss Top Gear SCORE 136
Dwayne got no chill SCORE 31
breakfast is served SCORE 26
Pow-pow-powerwheels! SCORE 138
Doritos Roulette. SCORE 189
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-17% Sale!

Mandarina Bavaria Hops – 50g

Pellets - Aroma - (8.5 - 10.5%) - 2019

Mandarina Bavaria hops has an intense tangerine, pineapple, lemon and citrus flavours with a resinous, herbal followup. Sweet and distinctive.

All of our hop packs are vacuum sealed, stored cool and the latest crop.

  • Usage: Aroma
  • Type: Pellets
  • Flavour:Aromas of tangerine, pineapple, lemon and citrus
  • Alpha Acid: 7.9%
  • Year of harvest: 2019
  • Weight: 50 grams
  • Beer Styles:India Pale Ale, Pale Ale, Belgian Ale, French Ale

In stock

Earn 29 Hops Points! towards your next purchase.
SKU: HP-MBH-50 Categories: , Tags: , ,

A tangerine machine when used for late, whirlpool, and dry hop additions,  Intense pineapple, lemon and citrus flavors with a resinous, herbal followup. Sweet and distinctive.

Mandarina Bavaria is great for American IPA and variants, black ales, saisons, Brett fermentations, and other beers where a definite fruity and strongly hoppy character is beneficial.

Year of Harvest 2019
Characteristics Tangerine, Citrus
Purpose Aroma
Alpha Acid Composition 8.5%-10.5%
Beta Acid Composition 5%-6.5%
Co-Humulone Composition 33%
Country Germany
Seasonal Maturity Mid
Total Oil Composition 2.0 mL/100g
Myrcene Oil Composition 70%
Humulene Oil Composition 5%
Caryophyllene Oil 2%
Farnesene Oil 1%
Substitutes Columbus, Nugget, Cascade

1.Boiling gives maximum bitterness. Boil the hops in about 1 litre of water, preferably with about 100 grams of malt extract. Boil for at least 5 minutes. The longer you boil the hops the more bitterness you will impart. Use this hot liquid in place of some of the hot water you use to mix up your other ingredients.

2.Steeping gives some bitterness and some flavour. Let the hops steep in about 500ml of very hot water for about 15 minutes while you prepare the rest of your ingredients. Again use this liquid in place of some of your hot mixing water.

3.Whole hopping gives a bit of everything. Simply add the hops directly to the fermenter when you add the hot water to mix your ingredients. This is the easiest and perhaps the best to try for your first time.

4.Dry or post-fermentation hopping gives aroma to the finished beer. Just add the hops to the fermenter once the peak of fermentation has passed. That is, once the head of foam on the fermenting beer has started to subside and once movement in the airlock has slowed.

Additional information

Weight 0.05 kg
Dimensions 10 × 5 × 3 cm

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Pellets - Aroma - (6.5 - 8.5%) - 2019


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Browse Over 3 Million Questions

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Validity in Quantitative Research Designs

Validity in Quantitative Research Designs

Validity in research refers to the extent researchers can be confident that the cause and effect they identify in their research are in fact causal relationships. If there is low validity in a study, it usually means that the research design is flawed and the results will be of little or no value. Four different aspects of validity should be considered when reviewing a research design: statistical conclusion validity, internal validity, construct validity, and external validity. In this Discussion, you consider the importance of each of these aspects in judging the validity of quantitative research.
To prepare:
Review the information in Chapter 10 of the course text on rigor and validity.
Read the method section of one of the following quasi-experimental studies. Identify at least one potential concern that could be raised about the study’s internal validity.
Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25.
Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 24(4), 325–331.
Yuan, S., Chou, M., Hwu, L., Chang, Y., Hsu, W., & Kuo, H. (2009). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing, 18(10), 1,404–1,411.
Consider strategies that could be used to strengthen the study’s internal validity and how this would impact the three other types of validity.
Think about the consequences of an advanced practice nurse neglecting to consider the validity of a research study when reviewing the research for potential use in developing an evidence-based practice.
Post on or before Day 3 the title of the study that you selected and your analysis of the potential concerns that could be raised about the study’s internal validity. Propose recommendations to strengthen the internal validity and assess the effect your changes could have with regard to the other three types of validity. Discuss the dangers of failing to consider the validity of a research study.
Polit, D. F., & Beck, C. T. (2012).  Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
o    Chapter 10, “Rigor and Validity in Quantitative Research”

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Life Insurance

The Benefits of a Life Insurance

A well-managed life insurance policy is a necessity in modern times. It is a valuable asset that has the ability to protect family and loved ones in the unfortunate event of an untimely death, but there are also other advantages that such coverage can offer. Let us take a quick look at some of the lesser-known aspects of life insurance policies and then determine which are the top companies in the country that have been consistently rated the highest in providing this type of insurance.

The most obvious advantage of a life insurance policy is the fact that upon death a family member or other loved one can access financial benefits to aid in covering any outstanding medical bills as well as to help contribute to any lost income. Most of us are aware that there is the possibility to have multiple beneficiaries, as in the case of a policy directly geared towards a spouse and any children. However, on also has the option to choose a contingent beneficiary. As the name denotes, a contingent beneficiary is next-in-line should an act of god befall the primary recipient(s). So, the three choices one has are;

  • Single Beneficiary
  • Multiple Beneficiaries
  • Contingent Beneficiary

Types of Life Insurance Policies

There are a number of options when choosing a life insurance policy, and these choices are based on the needs of a specific in individual or household.

For instance, a whole-life policy is a type of insurance that provides life insurance with an investment fund. This package will pay a certain amount to the beneficiary parties upon death, while a portion of the premium is also used as an investment vehicle to increase the overall value of the policy. One can then borrow against the accrued cash value without any tax obligations.

Variable life insurance policies are similar in the fact that they also can conglomerate cash value over time, but they do so by utilizing an investment fund whose value depends on the performance of a stock or mutual fund. Thus, returns are not guaranteed.

A fixed-term policy has no investment component, but rather represents a policy that last a certain amount of time as long as monthly premiums are paid. Upon death, a fixed amount of money will be paid to the beneficiaries. To briefly recap, some of the main forms of life insurance policies are:

  • Whole-life policy
  • Variable-life policy
  • Fixed-term policy

Now, let us quickly examine the top three life insurance providers.

Metlife is the single largest life insurance provider in the United States. Notwithstanding that this company has been in operation since 1868, their insurance services are quite popular due to the fact that they offer a variety of packages to choose from while offering flexible payment options and a high level of customer service.

This multinational corporation offers some distinct advantages with their life insurance policies. Known as ProLife 65, it offers standard coverage up until the age of 65, but Prudential also gives the policyholder the ability to obtain waivers for periods of unemployment or disability.

John Hancock

One of the oldest insurance providers in the United States, John Hancock insurance policies are some of the most popular due to their familiarity in the industry. Furthermore, they offer a broad portfolio to meet the specific needs of individual clients and they have received an "A+" rating from A.M. Best, a financial products analysis company.

So, we can easily see the added value that life insurance policies can offer the individual and family in times of duress as well in times of economic hardship. With a bit of research and by comparing the different types of policies and top-rated companies, an educated decision can the be made on which type of coverage represents the most logical choice.


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Nigeria’s Prospa raises record $3.8M in pre-seed investment

Nigeria FinTech startup Prospa is looking to serve the 40 million-plus underserved micro-enterprises across the county. It was only in March when the company qualified as one of the top ten startups in Africa participating in Y Combinator’s winter batch. Few months after graduating, Prospa raised a $3.8 million pre-seed round, a record breaking sum for pre-seed investment in Nigeria and subSaharan Africa. Only Egypt’s Telda has raised a higher amount within that category.

Prospa was founded by Kioma Ugo, Frederik Obagi, and Rodney Jackson Cole. The business pays key focus to freelancers and entrepreneurs acting as the operating system for their businesses. The platform has access to business accounts numbers and other features offered by Prospa.

Registered businesses on the platform can access account numbers and several other features Prospa provides. They are taken through the process of formalizing their businesses and in addition to providing bank accounts.

Speaking to TechCrunch, Obasi pointed out the company’s traction that covers tens of thousands of businesses while keeps growing at 35% month-on-month. He went further to reveal that small businesses have sent out over 360,000 invoices from the platform.

The platforms pricing is dependent on a business’ turnover. Those with turnover’s of below $200 wont pay any subscription fees. Busineses exceeding  ₦100,000 pay between ₦3,000  and ₦5,000  each month.

Source: TechCrunch

The post Nigeria’s Prospa raises record $3.8M in pre-seed investment appeared first on Tech In Africa.

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Where in the World is Reese?

Reese is on the move again. Where in the world is our wonder boy visiting today?

Here’s a hint.

This tree is one of the oldest in the world!

Did you guess the Methuselah Tree? You’re right!

Even though this tree grows high in the White Mountains of Inyo County (eastern California), it’s location is not publicly advertised. Even the tree in Reese’s selfie may not be Methuselah.

Why doesn’t anyone know where this ancient tree stands?

Because there are people who want to cut it down and steal the pieces.

Let’s learn more about the Methuselah Tree

Did you know?

  • The Methuselah Tree is over 4,580 years old!
  • It is a Bristlecone Pine
  • It resides in the “Methuselah Grove” in the Ancient Bristlecone Pine Forest. animated-tree-image-0024
  • This type of tree can grow from 15 to 50 feet tall.
  •  In 2012 the discovery of a nearby tree is estimated to be more than 5,060 years old!
  • There is more than one species of bristlecone pine. The bark of the Great Basin Bristlecone pine is typically orange-yellow to light brown. The Rocky Mountain Bristlecone pine is usually gray-brown.

Thank you, Reese, for showing us the Methuselah Tree.

Where in the world is he off to now? Be sure to join us again when Reese will explore another fun, fact-filled location.

Categories: Where in the World...

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Big Tech Is ‘Stifling’ Free Speech

“Big Tech has a big bias problem. Social media platforms that once facilitated the free exchange of ideas and information are now actively seeking to silence and censor conservative opinions,” proclaimed Brad Parscale in an article for the Washington Examiner. “This new Orwellian impulse that is taking over Big Tech is particularly problematic because social media websites, which are supposed to be safe spaces for all free speech, get special legal perks.”

You can read the full article at the Washington Examiner.

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“People come here with their families to have a picnic because they think it is a park. If I hadn’t told them that it’s a disposal ground on top of an old garbage dump, they would never have guessed!” says Md Forkan Sarder, caretaker of the Faecal Sludge Treatment Plant in Khulna, Bangladesh. The plant is owned by the Khulna City Corporation and its operations are supported by SNV. “I take them around, and explain how the treatment is done. They are surprised that there is no foul stench, you only smell the flowers.” Indeed, the area surrounding the plant is fresh and green, birds are singing and everywhere you look there are fiery red flowers.

No one really wants to discuss faeces. Let alone how it is treated. In Bangladesh, this distaste runs so deep that the faecal sludge from septic tanks is collected unseen by cleaners in the shadow of the night. This is not a small issue because there is no sewage system in Bangladesh, except for a small area in its capital Dhaka.

The city of Khulna has a population of one and a half million inhabitants, of which not a single household is connected to a sewage system. Furthermore, the city is expanding rapidly in an unplanned manner and constructing a sewage system would cost a fortune, and the city authorities have more immediate issues to solve. They need to provide drinking water, end open defecation and the collect huge piles of garbage people produce on a daily basis.

Now that progress has been made in these areas, focus is slowly shifting towards faecal sludge. But over time, people have taken matters into their own hands, installing underground septic tanks to get rid of their faeces. They sporadically call for cleaners to descend into their tanks and scoop out the waste manually, bucket by bucket. Often, these septic tanks are left uncleaned and quietly overflow, letting the problem seep inside the city’s ground water. Either way, the sludge usually ends up in drains not far from people’s houses.

“This dreadful offloading is like a ticking time bomb that can explode any time, especially in the slum areas where the drainage is in poor condition”, says Rajeev Munankami, SNV WASH’s team leader in Bangladesh. This is an environmental and health hazard for the community and do realise even a few drops of sludge can contaminate whole waterways.

"One day I had an accident when I went to clean a septic tank. As soon as I removed the slab from the tank, methane gas was released from the tank and lit up because of the gas lamp I was carrying. I burnt my hand, back and chest," says one cleaner

Many fast-growing cities like Khulna are dumping untreated human waste. Poor sanitation is a leading cause of diseases like diarrhoea, typhoid and cholera. According to the World Health Organisation, over 525,000 children worldwide die because of diarrhoea alone. Due to these diseases, economic losses are profound, and surely higher than investing in decent sanitation. In Bangladesh alone, the economic loss of poor sanitation is US$14 billion annually, which amounts to 6.4% of their GDP.

a vacutug

Scaling up existing sanitation

The problem is huge. To address the lack of Faecal Sludge Management (FSM) SNV started a learning project, Demonstration of pro-poor market-based solutions for faecal sludge management in urban centres of Southern Bangladesh in three cities, including Khulna. The programme is funded by the Bill and Melinda Gates Foundation and United Kingdom’s Department of International Development (DFID).

To prevent high investments in sewage systems, we work our way from the bottom up, taking existing sanitation facilities as a starting point. Big cities in the developing world are chaotic, it’s not like designing your perfect suburbia. Entering a Bangladeshi slum means that you must squeeze yourself into narrow alleyways where bad odours will lead you to the public toilets that are used by 25 families or more. During the monsoon season rising waters will lift up its contents, spilling it out onto the tight alleyways and into the houses.

How are you going to stay healthy? And how will you ever build a citywide sewage system? The answer is - there isn’t one single sewage solution. The only way to get the job done is by starting with what people have built themselves over the years. Basically, we improve existing sanitation by ensuring safe containment, transport and treatment of faecal sludge. This starts with a careful assessment of the entire sanitation service chain (or so called shit flow from consumer demand for sanitation services, to capture, emptying and transport, to ultimately treatment and disposal of reuse). We are determined to remove all hotbeds of disease and contamination, because only by focusing on the entire picture we can sustainably benefit the poor.

Working with city authorities

Growing these safe solutions to realise citywide coverage should be done by involving the city authorities, because they are the ones responsible for proper sanitation, and therefore need to be on board all the way. Ultimately, they are the ones who will organise regular collection.

“It took us a long time to gain the confidence and buy-in of the city authorities and elected councils,” says Rajeev. They saw sewers as the ultimate solution and did not realise the urgency of closing the sanitation loop. To gain much needed government support, we started our project with a knowledge exchange between scientists and city officials to discuss the impact of this unseen problem. Rajeev continues, “We wanted to show them the potential of FSM in a tangible way - by setting up the plant, because the biggest hurdle in FSM is the treatment of sludge. It is sometimes collected and contained, but seldom released properly.” Here, at the edge of the city, we have literally built the capacity to change that.

Bringing about change

Based on the practical knowledge we gathered, we have successfully advocated for changes at policy level; a nationwide Institutional and Regulatory Framework for FSM has been introduced; the national water supply and sanitation strategy of 2014 has a separate FSM related strategy and the Government is actively supporting the manual cleaners for the safe emptying of pits.

There are operational achievements as well. We are introducing mechanical emptying services for septic tanks, using a hose to transfer the sludge into a small vehicle (vacu-tug) or truck that can transport the collected sludge safely to the treatment plant. As mechanisation of the process would mean that traditional cleaners need to invest in equipment, seed capital has been developed to help them with that. Apart from this, we are working on a Geographic Information System (GIS) to support FSM services. This online database will map all roads, drainage systems, houses, septic tanks, pits etc. to provide easy and accessible data for the planning of cleaning services. Put differently, we will know when tanks have been emptied and when it is time to empty them again.

Despite these promising steps, this is just the beginning. Although we are now able to process 15% of Khulna’s faecal sludge, the full capacity of the plant has yet to be realised. In order to establish regular emptying services without losing money, residents must be willing to pay for it. Fortunately, our first market surveys show positive outcomes. Demonstrating the economic potential of sludge management will not only convince city authorities that accelerating the scale of professional sludge management is doable, it is also likely to attract expertise and investments from the private sector.

Creating full consumer demand for proper desludging is tough though, since unlike other waste, sludge has always been taken out of people’s backyard unseen. But we are ready for this challenge. We have developed an action oriented communication campaign on behalf of the city authorities. The message focuses on one clear imperative for its residents; ‘empty your septic tank once every year.’ We want everybody to know this rule, and make it easy for them to act on it; desludging is a one-stop service that is just a phone-call away. Consumers who use the service once, will be reminded every year thereafter, based on the household database (GIS). If the demand is there, we will start replicating our solution with a view to tackling the remaining 85% of Khulna’s sludge that still flows untreated.

More than just the flowers

Let’s go back to the plant and have another look at the fiery red flowers that draw in curious onlookers. Are they just meant to give a nice appearance to a dirty business? No, these flowers are an essential means to decompose the sludge, turning it into soil that can be readily used as fertiliser. Very soon it will be the health benefits rather than the flowers attracting people to our faecal sludge management.


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Youth For Christ does not stand alone. It cannot operate without the rest of the body of Christ. YFC seeks to be in relationship and partnership with local churches and youthworkers. We desire to work together to reach every young person in our area. Without each other, this would be an impossible task. Thus, a non-negotiable component of YFC’s outreach into the teenage world is local church participation.

YFC builds networks to:

  •  Help local church youthworkers gain access to the campus for cooperative outreach to ALL young people.
  •  Provide regular training for church youth workers
  •  Provide consulting for church youth workers
  •  Connect each YFC ministry to one or more local churches

San Bernardino

Chino Valley NetWork
Contact Mike – [email protected] or 909-973-2510

Fontana Area NetWork
Contact Jennifer - [email protected]

Los Angeles County

Pasadena Area NetWork

San Fernando Valley NetWork

San Gabriel Valley NetWork
TBA call or email Casey Cox – 909-731-8300 or [email protected]

Santa Clarity Valley NetWork

Greater Long Beach Area NetWork
3rd Tuesdays @ 9:00 AM…
meets at Denny’s (Carson & 605)
Email Al – [email protected]

La Mirada-Whittier Area NetWork
4th Thursdays @ 11:00 AM
Contact Mike D - [email protected]
Or Mike B - [email protected]

Glendale Project XIX NetWork
Contact Al - [email protected]

Riverside County

San Jacinto Valley NetWork
Meets 1st and 3rd Wednesdays 8:00 AM…
Contact Dan – 951-652-0647 or [email protected]

Orange County

Central Orange County (Irvine, Costa Mesa, Newport, Tustin)
3rd Thursdays @ 9:00 AM
Good Sheperd Lutheran Church
Contact Steven – [email protected]

Huntington Beach/Fountain Valley NetWork

Orange/Santa Ana Area NetWork
3rd Tuesdays @ 1:30 PM
meets FOR PRAYER and SHARE in Starbucks at the Bank in the Circle (Glassell and Chapman) in Old Town Orange
Contact Al – [email protected]

South Orange County NetWork

If you are interested in any of these networks, please contact our office: 562.429.1782


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Major League Soccer’s Week 3 preview: Surprising strugglers, Cali Clasico and more

Darryl Dyck/The Canadian Press via AP

Every team has a bad week and, given the unpredictable nature of Major League Soccer, most teams will experience back-to-back clunkers at some point in a season.

But three? Three usually leads to panic (at least a little).

Several teams with promising offseasons are scratching their heads after two weeks of MLS 2016. As Week 3 takes hold on Friday, which ones might have to worry if their struggles trend into a third week?

[ MORE: Man Utd-Liverpool recap | 3 things | Europa roundup ]

New York Red Bulls, Columbus Crew, Seattle Sounders and Vancouver Whitecaps are all 0-2. All could remain winless after the weekend, though it’d be shocking if the first two fail to get at least a point from their matches.

Two of those teams square off, headlining our Week 3 preview.

Seattle Sounders vs. Vancouver Whitecaps — 10 p.m. ET Saturday

Washington will be the venue for this pair of Cascadia Cup rivals, both hoping to halt tough runs to start the season. While the ‘Caps lost to 3-2 Montreal and 2-1 to Sporting KC, Seattle has scored just one goal in season-opening losses to KC and Real Salt Lake.

It’s been a bit of baptism by fire for Jordan Morris, who is shouldering more responsibility than expected after the departure of Obafemi Martins. He’s looked lively, but has yet to dent the score sheet.

As for Vancouver, they sent mercurial attacker Darren Mattocks packing this week and will hope that’s a bit of addition by subtraction. Both teams know a rivalry win could trigger the good vibes they so badly want to reclaim. The visiting team in this series went 3-0 last year. We’ll be watching to see if that improbable trend continues, or if Carl Robinson will be further vexed by his charges.

Prediction: 2-2.

Los Angeles Galaxy vs. San Jose Earthquakes — 10:30 p.m. ET Saturday

Get multiple screens ready, or at least your recording device, as the California Clasico takes its first strides in 2016. L.A. is smarting after a shocking road defeat to Colorado that set them back to 1-1, while Dominic Kinnear’s Quakes are feeling good with a 2-0 start to the season.

On paper, the Quakes will like their chances after beating the same Rapids team that topped the Galaxy last weekend, but not only does this match carry rivalry stakes, L.A.’s massive star and veteran qualities should have them raring to get back on the home — or any — pitch.

Prediction: Galaxy 2-1

Sporting Kansas City's Matt Besler, left, vies for the ball with Toronto FC's Jozy Altidore as Sporting KC's Jimmy Medranda, right, chases during the first half of an MLS soccer match in Toronto on Saturday, Aug. 8, 2015. (Frank Gunn /The Canadian Press via AP) MANDATORY CREDIT
(Frank Gunn /The Canadian Press via AP)

Sporting KC vs. Toronto FC7 p.m. ET Sunday

Through two weeks, this bad boy looks like an MLS Cup final preview. KC has beaten a pair of decent opponents in Seattle and Vancouver, while TFC cruised past New York Red Bulls before picking up a point at Yankee Stadium.

Both of those came without Jozy Altidore, and Toronto may have to live life without the big USMNT striker again this week (though he’s expected to be named to the U.S. roster for this month’s World Cup qualifiers).

TFC is again dealing with stadium expansion, and this is match three of an eight-match road swing to start the season. This one would have tough night written all over it in the past, but their veteran additions — especially goalkeeper Clint Irwin — could hold sway here.

Prediction: 1-1.

The rest
New York City 2-1 Orlando City
Chicago Fire 0-2 Columbus Crew
New York Red Bulls 2-0 Houston Dynamo
FC Dallas 2-2 Montreal Impact
Portland Timbers 1-0 Real Salt Lake
Philadelphia Union 1-1 New England Revolution
DC United 3-1 Colorado Rapids


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Rapid Slim Review – Is This Product Good For Keto?

Do you want to snap into shape in a matter of days and not months? Do you need a supplement that’ll see you do that smoothly without having to struggle through hurdles of allergies and delayed results? If you do, the answer is right in front of you ~ right inside this article. Just read on.

The review below beings to you a customer endorsed, clinically approved, and expert-certified weight loss supplement. The supplement is known as Rapid Slim. Read through the review to get a more in-depth insight into it below.

What is Rapid Slim?

Without any surgery and/or prescriptions, Rapid Slim is out with a formula that miraculously activates a fat-burning mode in your body. With the formula, all your fat stores will be unlocked.  The scale will then read a figure which balances your BMI, leave alone your body obtaining a leaner, more attractive shape. Rapid Slim is, therefore, merely a solution to your slimming needs.

How Rapid Slim Works

When the body runs short of its primary energy source (carbohydrates), it resorts to its fat stores for energy.  Consequently, the excess weight due to stubborn fat in the body is melted away by metabolism, leaving you lean and healthy.

This is what happens when you take  Rapid Slim, and it can happen in two ways. One can be as a result of the supplement speeding up the process of ketosis in your body, which occurs when you’re already on a low-carbohydrate diet. However, for those whore not on a ketogenic diet, the supplement shifts your body’s attention from burning carbohydrates to burning body fat, naturally. Either way, you’re subject to lose weight via the digestion of fats for energy. Rapid Slim also stabilizes your blood sugar levels, alongside reducing the frequency of your hunger cravings.

One impressive thing about the formula of this supplement is that it consists of all-natural components, which have always been used as weight loss solutions over the years. See who the remedy works for best below.

Who Rapid Slim Works For

Rapid Slim isn’t made to work selectively. It should work for everyone, provided that they all have the weight loss goal. However, the supplement may be unsuitable for a few groups of individuals.

Firstly, due to its natural ingredients, it is a rare thing that Rapid Slim reacts to your system.. So it isn’t like most other formulas that have thousands of records of reacting to users’ bodies. Therefore, Rapid slim works for everyone without any snag except:

× Expectant mothers who may affect their children by consuming the pulls.

× Children under 18 years of age.

Otherwise, everyone else is free to take the supplement. Another thing to take keen note on is that it isn’t safe to take it while taking alcohol. Alcohol is generally unfriendly to all other medications.

Main Ingredients.

You need to set your eyes on some of the individual components that work together to make Rapid Slim effective in its function. The following are the magical ingredients:

a). Hoodia Gordonii.

The Kalahari bushmen know the benefits of this naturally occurring plant so well. The bushmen used to consume it for its appetite suppression effects, back in the days when food was scarce. When taken, the user won’t feel frequent hunger pangs, hence will end up taking in fewer carbohydrates, which will lead the body into digesting stored fats.

b). White Willow.

Who doesn’t know that white willow is used on obese individuals to suppress their hunger, as well as initiate the process of fat burning? That’s the same reason why it is featured in this formula.

c). Garcinia Cambogia.

Garcinia Cambogia has got in it enzymes that digests fats directly. The enzymes also release serotonin that helps to reduce hunger. It has been used for decades for weight loss.

d). Cissus Quadrangularis.

To begin with, for the body to digest fats effectively, its digestive system needs to function correctly. This component of Rapid Slim is known to improve the way your digestive system works. By do doing, the rate of burning fats will elevate. Also, the component is good at helping bodybuilders to build muscles by providing them with more energy.

Your safety comes first. So, you need to know the quality of this supplement before you decide to use it as your weight loss remedy.

The FDA has approved Rapid Slim for sale. This means that it has been evaluated for safety and found fit and effective for use for losing weight.

After the “Benefits” section, you’ll find the “Customers’ Feedback” section that will provide evidence of quality from the real users of this product. To add on top, I’m another user of the product, and that’s what prompts me to share this piece with others ~ I’m my brother’s keeper.

Rapid Slim Benefits

a). Rapid slim speeds up the rate of weight loss. This happens mostly in individuals who are on a low-carb diet. It catalyzes ketosis, which will make your body burn fats in a matter of days.

b). The supplement also helps us to suppress hunger. If you take a keen look at the formula’s main ingredients above, you’ll realize that most of them are added to help you suppress appetite. This is always a significant stage in losing weight.

c). It controls your blood sugar levels, and that’s one very good step. The levels of sugar in the blood need to be stable to avoid further complications that usually come along with overweight.

d). Rapid Slim does not cause reactions to the body’s system. It is comprised of natural components, which have been clinically proven to be very friendly to the body.

e). The supplement is free from GMOs and other cheap fillers.

f). It is a product of a certified company in the United States.

Customers’ Feedback.

On the supplement’s official Facebook page, there are myriads of positive comments left by customers. Most of them seem to be happy with the speed at which the “holy grail” burns down the unwanted weight in you. One of the comments on Facebook goes: “I’m comfortable in my skin after using this artfully made supplement, thanks to the brains behind it, hurray!”

Genuine customer feedbacks are the only verifiable proof of quality, and several of them are available for Rapid Slim.

Rapid Slim indicates that it is going to help you lose weight and stubborn fat. The supplement keeps its promise as it is evident in the feedback given by satisfied customers. The formula’s composition has also been proven to be health-friendly, hence certified by the US FDA.

I highly encourage you to find this product and start your short weight loss journey. Tell me when you need to reward me for this piece of information. I’m gone for now. Best of luck!

We will be happy to hear your thoughts

Leave a reply


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Promoting partnership working in the NHS

Wider Group key comms - 10 July 2018

SPF's Wider Group met on 10 July. Sara Gorton, trade union chair, welcome Caroline Dinenage, minister of state for care and the new ministerial chair of the SPF. The meeting covered a range of issues including: Agenda for Change pay reform, NHS workplace culture, and NHS England's nursing recruitment campaign.

Amanda Oates, executive director of workforce and Mandi Gregory, staff side chair, Mersey Care NHS Foundation Trust joined the meeting to speak about establishing a just and learning culture in their organisation. This initiative won the SPF sponsored 2018 HPMA award for partnership working.

The key communications from the meeting are available on the SPF website.


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transforming organizationS through
the power of process consulting.

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We are a community of consultants in the “helping” business leveraging  humble inquiry and guidance alongside clients to co-create solutions.

What is the society for process consulting?

We are an active group of consultants who believe in the power of process consulting to transform organizations.

Our purpose is to provide a community of practice around the vocation of process consulting and to improve results for organizations, businesses and individual consultants.

Through unique and challenging certifications, courses, and community learning we strive to develop better consultants who put their customers first.

What is process consulting?

Process consulting is an iterative form of humble inquiry and guidance in which the consultant works alongside the client to co-create solutions. A process consultant’s purpose is not to provide ready-made solutions but to advance the client’s growth and learning through an authentic discovery process.

Organizations and businesses dealing with complex change, adaptation or growth benefit from this approach, which includes the social, relational, cultural and psychological dynamics of change, not just the tasks involved.

Process consulting was first described nearly 50 years ago by Dr. Edgar Schein, who is Professor Emeritus at MIT Sloan School of Management.

why do we exist?

  • To provide a space for process consultants to thrive, and to consequently help more organizations thrive!
  • To provide a framework of professional ethics for process consultants.
  • To recognize quality and proficiency among process consultants.

What do we do?

We provide community and standards in the field by offering:

  • Membership to practitioners
  • Courses to practitioners
  • Credentials to practitioners who have exhibited various levels of proficiency
  • Accreditation to third-party course providers that have been vetted and approved by the Standards and Ethics Committee.

Join the community. Sharpen your skills. Build your business.

Member Spotlight

Photo Credit: American Girl

Meet Deanna Singh.

Deanna is an accomplished author, entrepreneur, and champion for marginalized communities. She speaks to tens of thousands of people each year about diversity and inclusion in workshops, seminars, and panels. Learn more about her organization, Flying Elephant.

Check out her recent children's book that she partnered with American Girls to publish:
Smart Girl's Guide to Race & Inclusion

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Etong Car Air Purifier - Portable Air Freshener Ionizer - Cigarette Smoke Odor Smell Eliminator - Remove Dust, Pollen, Pet Smell, Cigarette Smoke, Food Odor - Allergy Relief (Ionic Silver Metallic)

  • NOTE: ThorFire & More IS THE ONLY AUTHORIZED SELLER OF THIS Tsumbay CAR AIR PURIFIER. The most powerful car interior air cleaner which can release 4.8 million negative ions per cm3 in your car for massive odor-fighting power.
  • Actually improve the air quality. By producing negative ions,car air purifier will destroy bad odor-causing particulates from the air,rather than simply covering up the smells like perfume.
  • Cigarette smell killer.With a measurable and controllable quantity of negative oxygen ions, this compact unit destroys bad odor effectively getting rid of smoke smell and other stale odors, neutralizes contaminants like mold, bacteria and viruses purifying the environment helping you breathe easier.
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Iraqi special forces paused their advance in an eastern district of Mosul on Wednesday to clear a neighborhood of any remaining Islamic State militants, killing eight while carrying out house-to-house clearances.

Six of the militants were killed inside a tunnel in the newly-recaptured Gogjali neighborhood, while the other two were shot dead as they advanced on troops, Lt. Col. Muhanad al-Timimi of the Iraqi special forces told The Associated Press. One of the militants was wearing an explosives-laden vest, he added.

Meanwhile, hundreds of civilians cleared out of the adjacent neighborhood of al-Samah, some carrying white flags. All the women were wearing the niqab, a veil that entirely covers the face or only has a small, slit-like opening for the eyes, and all the men had long beards. ISIS strictly enforces an Islamic a dress code in territory it holds.

Throughout the day, special forces could be seen going house to house in Gogjali, Mosul’s easternmost district, while sappers searched the road for explosives and booby traps left behind by the jihadis driven out a day earlier.

Read more- Fox News

Image courtesy of The Associated Press

If you enjoyed this article, please consider supporting our Veteran Editorial by becoming a SOFREP subscriber. Click here to get 3 months of full ad-free access for only $1 $29.97.


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Nausea, Diarrhea, Constipation

Whether it’s an upset stomach, vomiting, diarrhea or constipation, digestive problems can make even a good day crummy. Sometimes they get so intense, they’re downright debilitating.

Here are some simple tips to address these problems and improve your loved one’s quality of life.

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Nausea and vomiting

There are many different causes of nausea. It’s a response to intense pain. It’s side effect of chemo therapy. It can be caused by something as simple as the flu. Or as complex as a blockage in the bowels. Talk to your doctor to learn more about the reason for your nausea. There may be treatments that are specific to the cause. Below are general tips and remedies for calming the stomach.

To ease nausea:

  • Eat smaller meals spread over the day
  • Focus on bland foods
  • Eat slowly
  • Eat food that is cool or room temperature rather than hot or cold.
  • Rest in an upright position, or with the head at least 12″ above the feet. Avoid lying flat when nauseated.

Foods to avoid:

  • Milk or dairy products
  • Fried, greasy or high fat foods
  • Spicy foods
  • Raw vegetables
  • Citrus or other acidic foods

In terms of liquids

  • Avoid alcohol and caffeine
  • Drink liquids between meals rather than during meals
  • Drink only clear liquids (broth, non-caffeinated tea, jello or juices—no citrus)
  • Try ice chips

Other nausea remedies

  • Massage
  • Progressive relaxation
  • Guided imagery
  • Cannabinoids
  • Acupuncture
  • Ginger

If vomiting occurs

  • Let the stomach stay empty for a few hours until the nausea passes
  • Suck on ice chips, or take sips of water ever 15 minutes for 3-4 hours.
  • Add clear liquids (broth, non-caffeinated tea, jello or juices—no citrus)
  • Avoid citrus juices and milk.

As the stomach settles

Start with the “BRAT” diet first,

  • Bananas
  • Rice
  • Apple sauce
  • Toast (no butter) or crackers

If the stomach feels better, graduate to soft solids with little to no spice or fat

  • Cooked cereals
  • Scrambled or soft boiled eggs
  • Chicken
  • Cooked vegetables
  • Stewed fruit
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Constipation is frequent and uncomfortable problem with serious illness.  There are several possible causes.

Pain medicines
Certainly those on pain medicines experience constipation as a side effect. Opioids slow muscle movement, including the muscles of the intestines. Stool sits in the bowel longer, so more water gets absorbed. The stool then gets hard and difficult to pass.

Not eating much
When people don’t feel well, they often lose their appetites. It’s a natural reaction. Without much input, there’s very little output. Going infrequently is not a problem in and of itself. Having a bowel movement once every 1-3 days is still normal. The issue is when there is bloating or discomfort. Or when it’s painful to pass what stool there is. The remedies below will help.

Not enough exercise
The intestines are a muscle with nerves that cause coordinated ripples to push stool towards the rectum. Exercise and movement stimulate those nerves and muscles. Consider walking, or the yoga pose described below. If illness is causing the person you care for to spend a lot of time in bed, then a stimulant might be needed.

A mass or blockage
This could be a tumor in the intestine. In that case, surgery would be in order. The more common physical blockage is a build-up of stool that has become too hard to pass. Sometimes the remedies below can help with impaction. Often an enema will help to soften the stool and provide lubrication for a smoother passage. If that is not successful, the blockage may have to be removed manually.

Here are ways your loved one can avoid or prevent constipation:

  • Drink plenty of fluids. 8-10, eight-ounce glasses of water or nonsugar, noncaffeinated beverages per day.
  • Ask for a stool softener or laxative. Find out what preparation the doctor recommends.
  • Eat high-fiber foods when possible. These include vegetables, uncooked fruits (with the skins), and whole grains.
  • Sprinkle bran on food. Adding 1-2 tablespoons per day (along with drinking lots of liquid) can help keep the bowels moving.
  • Exercise when possible. Walking is the easiest aerobic exercise.
  • Try a simple yoga pose. The “Gas-Releasing Pose” is very effective with constipation. Lie on the bed and bring the knees to the chest. Rotate the knees in a circular fashion. Lift the forehead to the knees if possible and hold for 30 seconds. Any movement that stimulates the abdomen will help.
  • Sit upright to go. People who use a bedpan have more trouble with constipation than those who can walk to the toilet and sit upright. Consider a bedside commode if walking is too difficult.
  • Call the doctor if more than 2-3 days pass without a bowel movement.
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Diarrhea may be caused by the illness. Or it may be a side effect of medication or treatment. Talk with the doctor about appropriate responses. In the meantime, you want to guard against dehydration which can lead to fatigue, confusion, and bed sores. Try the following strategies:

  • Drink plenty of clear liquids (e.g., water, juice, and broth), especially between meals.
  • Eat foods that are low in fiber and high in potassium and protein (e.g., rice, bananas, eggs, toast, crackers, applesauce, mashed potatoes).
  • Avoid spicy or fried foods and most milk products (although some people respond well to yogurt).
  • Reduce or eliminate caffeine (e.g., coffee, black tea, chocolate, and many kinds of sodas).
  • Talk to the doctor about medications that can help firm the stool.
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Saturday, February 11, 2012

The Date is Set!!

Mark your calendar! Solitude Springs Farm is presenting a gardening workshop on Sunday, March 18, from 3pm to about 6pm at the Ken Kunkel Community Center in Goldstream Valley.  We will be constructing a 3 ft by 8 ft raised bed and holding a question and answer session on gardening in the Goldstream Valley area.  The raised bed will be given away at the end of the workshop.  Everyone is welcome!  Tell your neighbors.