Welcome back. Glad to have you all with us. Just a little fun fact that I noticed from yesterday. The latest time zone that was joining us was Papua New Guinea, which is I think 6pm. And then the earliest time zone that I saw was from the US with 4am. So we have quite a range of times here. I realized yesterday we went a little bit over the schedule time. Apologies for that. We really wanted to make sure that we had time for each of the countries that was presenting and time got a little bit away from us. We will do our best to stay on the schedule time slots going forward. We also promise you that the word of the day will come up before we run over time. So if you need to drop off at the exact time and we are running over, you still can get your attendance points for the day. So at least for that you should be fine to get your certificate. So the other thing I just wanted to go through before we start the presentations is to show you again the two sessions that we have today. So I'll speak a bit at the beginning, going over some of the maturity model and key planning considerations, and we'll also introduce the planning template, which we mentioned yesterday. The planning template has now been shared with you fully. I believe that many of you received it before the academy that started with the readiness assessment. We've received from those of you that filled out your readiness assessment, we've already received those for the for the rest of you if you look in the project planning template channel, or in the announcements channel on Slack. We've also got a link for the project planning template, and we'll talk a bit more about that after the main topic of the first session. That template just so you know is a document that we're hoping you can use throughout the academy for the two weeks and that will become a useful product for you in your own tracker implementation. So please do take a look at that download it and feel free to be using it throughout the academy. I think we're ready to jump over to the initial presentation here. As usual, please be on Slack, ask questions in the Slack channel will do our best during and after the presentations to look at the questions and try to share the any answers with the full group will also be writing answers in Slack so you can see those answers and they'll be served there. But if you haven't yet open Slack or signed back in today, please do so. I'm actually going to post a couple of questions in the Slack channel, after I do a few of these slides, so that you can be thinking of the answers to these and we'll read some of your responses out towards the end of my first session here. So please do sign into Slack. The first thing that we wanted to do was just give a little bit of our considerations around tracker maturity and scale. This is something that it's becoming a much more understood topic in the realm of health informatics and digital health implementation. For those of you that have been working in digital health for for 10 years, you know that this is a topic that has always been discussed what is a mature digital health system. What does it mean to have scale. How do you know your system is sustainable. And we went through an era where there was a lot of discussion about pilots there's too many pilots, small scale projects or are a waste. They take up too much time. And that was kind of an in our opinion I think a very early way of discussing digital health implementation. The fact of the matter is that the digital health implementation at this point we recognize should be implemented at the level that is appropriate, and that level of which it is appropriate depends very much on what you're trying to achieve. There's nothing that says that having a more complex system or having a system that covers every health facility in your country makes it a better or more worthy implementation. It really should be the input implementation should be suited to your public health need, and it should be suited to your users and it should be suited to the hardware you have available and the network connectivity that you have. You can always think of kind of a two by two graph here that is giving you a sense of the complexity the coverage the scale of your system. And this is actually a useful way to visualize it for yourself and for your team as you're doing your your planning for your implementation, and you're thinking about the various systems that you have in country. I'm showing you an example here of how at least at one point we thought of the Ghana implementations. This is a couple of years old so they may have a different understanding of where their separate tracker systems fall on this graph. But just showing you on the left on the y axis we would have what we call coverage coverage doesn't mean every person in your health system it doesn't mean every patient it doesn't mean every health worker. What it means is out of your desired population. How far have you reached. And so we could see that the Ghana TV system at in in this graph was almost at the end it had achieved what coverage it had intended to achieve. Whereas the ART system at the time had not gone very far with its coverage they intended to cover more ART sites they wanted to get more of their patient population into the system. But meanwhile, the complexity on the bottom the x axis was very different between them. So we would have a system like the maternal health system which was a fairly straightforward system for entering in the basic key data that were captured during a maternal health visit. It was not something as complex as the ART system. It didn't include, perhaps, notifications or it didn't have the strong link to the desired analytics. So it had less complexity in the configuration, but a higher coverage rate. Whereas the TV system would have been somewhere in between it was a little more complex than the mch system, not as complex as the RT system, but with a very high coverage rate. And the utility of thinking about it this way is helping you to better understand some of the underlying requirements of your system, who is your population, who is your user population, what level of data are you trying to access. How complex is the system how much it support is it likely to need. How important is it for this system to maintain constant uptime versus how big of a challenge would it be if you were needed to do an update and the system was down for two days or something. So just being able to think about your system in these terms kind of helps you to have a more sophisticated understanding of the support requirements and the goals that you're trying to achieve. So we wanted to spend a little bit of time today talking about why you're using tracker, and what are the benefits of capturing individual level data, what are the benefits of capturing individual individual level data at the point of care. So you can see from the top triangle in blue, we've listed out some of the things that you can expect improvements on this can lead to better data use or more data use. For example, if you're providing data back to the healthcare provider, giving them information on which children are missing vaccine doses, or which ART patients are lost to follow up. So this can help them actually use the data to improve the clinical outcomes. These benefits can be given to patients and health workers. So again, in many aggregate kind of systems, the data is really going one way, it's going up, and it's not being used to give benefits back to the clinic or the patients. But with a individual level system, you can do things like send SMS notifications to the patients, letting them know when their visit is or which medication they should be using or what are some possible complications to look out for. For the health worker themselves, again, it can give them planning tools that can provide them with decision support. It can give them, you know, an improved set of tools for actually carrying out their job rather than just reporting. Operational clinical performance improvements. So you can create, for example, dashboards that are clinic facing, giving them information on how well they are performing at managing hypertension. And maybe some links to resources to remind them of the clinical workflow that they should be following or how to improve. You can give them the opportunity to send messages and notifications about needing resupply of a given medication. And the data for individual level systems also in the last one can have a strong impact on health policy and research. You don't need to know ahead of time all of the indicators you will ever want to calculate, because you have the individual granular level data, meaning that you're essentially creating a registry that can last over time. And you could learn a year from now. Actually, we need to understand better the link between malaria and COVID. We didn't ask for that as an indicator that was nothing that we thought of. But we do have individual level data on all of the patients that had malaria, all of the patients that had COVID, and we can design new indicators that recombine that individual level data and give us a better understanding of whether or not there is a link. So these are fairly strong benefits to trying to get down to an individual level system. In the public health world, I would argue that we always have wanted individual level data and that the reason that we have aggregate data is because that was what we could achieve at the time. But in the future and going forward, we expect there to be a stronger and stronger desire to collect individual level data. On the downside of having this kind of a tracker system, it is a much more complex configuration. There's a lot more to take into consideration about how the data entry should look, adding in those kinds of tools like decision support or notifications. It adds a degree of complexity. You may need to think about dealing with your SMS service provider and setting up a gateway. You want to consider every possible reason that you would want to send a notification and work on the language of sending those and agree with the care workers that this is the right information to send. So there's there's a lot of different things that come up in tracker that make it more complicated. From your IT support system, you're expecting a lot higher number of users, whereas in the past, your DHS2 system might only reach to a district level or even a regional level. And you would have a handful of users in each district or region. Instead, you're pushing down to facility level, you're pushing down to community health worker level. And this can be the difference between having 200 DHS2 users and 10,000 DHS2 users, which is in order of magnitude higher and brings a lot of additional challenges with IT support with, you know, complaints with trying to handle turnover. You're also a much larger amount of data. You're simply collecting more information and this brings in additional challenges around performance, around data storage, around data management, data cleaning, duplication. So any number of challenges associated with the data management. And by its nature, individual level data is typically more sensitive. All of the healthcare data has always been considered to be something sensitive, but when you're dealing with personally identifiable information, you're looking at you have somebody's name and their HIV status, for example. This typically in the legal realm really brings up added burdens or added requirements when it comes to keeping that data safe, having strong data access policies informing the population of any breaches. So there's much more to consider when you're trying to implement an individual level data system. So what we would go through and are going to be talking a lot about through the course of the next two weeks is how to mitigate those challenging aspects of having an individual level system so that you can end up achieving the benefits that you see on the top. And so the way that we at least graphically have thought about this is we're creating a house, and we have these five kind of infrastructure prerequisites for DHS to tracker system at the bottom. These are the horizontal bars we think of these as prerequisites. And then we have these eight boxes that we think of as the key considerations. And this really represents the bulk of the topics that we will cover in this academy. These are all of the parts that if you are responsible for an implementation, you will want to have standard operating procedures named staff job descriptions budget lines, all that correspond with these different key issues. And so we'll talk a little bit in the second session about doing a readiness assessment where you're looking at, for example, these five horizontal bars and and determining whether you are ready for this kind of an implementation. And we'll talk throughout the week about these eight boxes, trying to understand the different implementation considerations that are involved with ensuring that you have proper hosting and security, for example. So this is what we'll start to give a little bit of an overview for during this presentation. And at this point I'm actually going to pause the presentation for a moment, and I'm going to put a couple of questions into the slack channel that would be things that I hope that you can consider while we discuss. So give me just a moment to stop sharing one screen, and I'm going to jump over to another. Okay, if you are in slack right now you'll start to see that I'm going to post three different questions into the questions channel, and I'll read them to you in just a moment. We'll go back to sharing my screen now. Okay, so the three questions that I have shared the first is after we have discussed all of these different challenges. Why have you decided to use tracker, and what benefits are you planning to get from adopting tracker for your program. The second question would be if you could start over with your implementation what would you do differently. So there are many of you in the in the academy that are already running tracker what would you, what would you try to do differently if you could. So something that you would tell us not to do what would that be. So throughout this presentation as I discuss a few of these different key considerations try to be thinking of some answers to these questions. Please post those answers under the individual questions in slack and towards the end of the presentation will bring up some of what each of you have to say. I want to make sure from Anna or Martin, are you seeing now my slide that says real time versus second entry. Good to go. Okay, so this is the first key consideration. This is something that you would want to be thinking about as you're doing the design of your tracker system. If you are trying to have the people who generate the data also be the ones that do the data entry, or is the data entry going to be done secondarily it would be first captured on paper, but you would have a data clerk, or even that same individual who would later in time go into the system and enter the data from paper into the system. So this, this is a key thought that you would have when doing the design because if you are doing real time data entry, you can add in things like decision support. You would want to make sure to highlight some key information that perhaps you're going to generate a notification to the care provider, for example, if they're doing an ANC visit, you want them to immediately get a response that based on this would make sure the patient likely as hypertension. Right, so this is the kind of information you would, you would have to plan for and put into the system if it were real time. If it's secondary data entry, rather than optimizing decision support, you would focus instead on data entry, a data entry clerk has a lot of data to get through they want to do it very quickly you want to make it as easy as possible for them to navigate the form and capture the data. You may also include different data items, the healthcare worker may need to capture more information than you're planning to analyze. And there's no reason to for the data clerk to enter all of that information, the data clerk rather is creating more of a reporting form. So this is again something that you would really want to know about and think about ahead of time. It would also have an impact perhaps on how many people you're going to train, how many devices you need to make sure are available. These things would impact your budget they would impact the IP support structure that you have. So it's definitely something to think about and to know. We generally believe that doing real time data entry brings the most benefits from an individual level system, but that doesn't mean you should do it. If it's not possible if you don't have the resources for training if you don't think that you can provide the hardware. If the users that you're aiming at don't have a reliable network connectivity, then you could probably decide that now is not the time. You could also decide there are different parts of the country where it makes sense to do real time and where it makes sense to do secondary data entry, and it's completely fine to have a mixed system. You want to make sure that as far as the reporting goes that the information that they're all sending up is standardized, but you may determine that in a given level of your health system or in a given region of your health system. And yet to do real time data entry, perhaps it will be time next year, perhaps after you show the benefits and impacts in one area, then you would be willing and ready to roll it out to another area. So these are things that will impact your planning of training your planning of how many resources you need etc. Another key consideration is how your tracker program is going to live in the ecosystem of your HMIS.  And there's already a process with people that are trained that are used to doing the HMIS reporting on the ministry side or the program manager side there's already a routine for assessing the data that comes through the HMIS. In other words, they are expected dashboards they know what analytics they're looking for. And so if you're introducing tracker, you need to know how tracker fits into that same ecosystem. Are you going to have the same people looking at data from tracker that would be looking at the HMIS. Are there going to be additional people. Are you now going to start providing dashboards at the district level or at the health facility level whereas previously you only had dashboards for higher level users. Is it your collecting. Is it going to be able to calculate the same indicators that would come through the HMIS. If it is calculating the same indicators as the HMIS. Would you want to replace some of the aggregate reporting, or are you going to have two different sources of information. If you do have two sources of information, how will you reconcile them. What do you do if the tracker system is telling you something different than the HMIS. There's a lot to consider here. We have a session later in the week that talks about linking tracker to aggregate and thinking some of those through. But this is something that also would just feed into your design overall about who your users are and what they're going to be using tracker for another key consideration would be whether your users are going to be on Android or the web. So the web is easier interface for many users because they have a full keyboard they have a nice big screen. The web is also persistently online. The data as you enter it is being sent to the server so it's being safely stored somewhere outside of the facilities location. And it gives them the opportunity to have a computer at their site that they're using for other purposes as well. And many of the kinds of users that were targeting were actually giving them their first health data system. They don't have a computer at their location they don't have wired internet. They often have only an intermittent mobile connection. And so there's no chance for them to be using the web they actually would need to be on an Android application. Android is the intermittent connectivity solution. They can collect data on Android it's stored locally and they can sync that data later when they do have a connection when they go to the district for their monthly meeting or when they check in at a different site once a week. And so for those kinds of users Android is the solution but that brings with it again a host of implementation considerations. How are you going to provide everybody with an Android device. How are you going to ensure that those Android devices are updated regularly. How are you going to make sure that the Android device has airtime. What are you going to do to troubleshoot when somebody loses an Android device how would you replace it or if the device gets broken. So many of these are key considerations again you might determine that there's a part of your country or a part of a region that can be on the web and another part that should be on Android. And those can live side by side they're reporting data to the same place, but you would want to have kind of a sophisticated rollout plan to make sure that you're serving the needs of both users that they both have it support solutions. To manage the main complications that come with either of the different modalities hosting and security again we've talked a little bit about this I think we've emphasized the point that tracker information is often more private and more sensitive. In many countries they're passing legislation about data privacy. We of course in Norway are dealing with the GDPR legislation that came in effect a couple of years ago. I can say for sure that we, the tracker can comply with this very rigorous legislation because it is being used in Norway for the coven tracking and coven surveillance. But it also depends very much on how you use tracker. The tracker itself has many, many different tools and ways of being configured, and it could be configured to be completely open where you've given no thought to who has access or what type of user should be able to see individual level data. And this would be the implementation failing at sensitive data, not the software. So it's very important for you to know what the regulations are in your country and in the project in the area that you're working. It may also be important for you to establish your own policies. Many countries don't yet have appropriate regulation or legislation, but that doesn't mean that we don't have a responsibility to try to protect this data.   So there's many different considerations for implementation that are about trying to ensure the most secure system possible. When it comes to hosting, again, this is something where many of you may already have a DHS to hosted environment. But you would want to do a second assessment on that environment if you're going to start including tracker data to see if it has the appropriate level of security, who has access to that aggregate data. Would you need to keep your tracker in a separate instance would you want to keep it on separate hardware. Are there requirements in the country that would actually require you to have the tracker data on a separate server than the aggregate data. So again, a lot of kind of legwork to be done at the beginning of your implementation to understand what the key considerations are for your country. And perhaps develop policies that you want to have signed off on by the leads in the Ministry of Health. This is something that we've done in a couple of countries, where they didn't have the legislation that you would expect. And so instead we drafted policies that were signed off by the director of the Ministry of Health, and they would include some kind of training for every user that they would have to also sign in agree to the designing process. This essentially we're just saying here that this depends again on understanding very much your use case. What are you trying to achieve what is the data that you may need to make sure to collect how does that does that align with the indicators that you're going to be responsive to what work processes are you supporting and can you map out those processes, to ensure that the system you have come up with is matching what the user wants to use it for. Probably kind of the at the lower end of tracker configurations we see a country simply redesigning their paper form and putting it into tracker. This usually leads to some frustration because there are already things on the paper form that people are used to skipping through there are things that are easy for them to ignore. There are things that are unnecessary and everybody knows that, but if they get re implemented into tracker it can lead to a lot of frustration. So when you're going through the design and configuration process, you probably want to take time to reassess your paper forms and to think through which of the aspects of the form are not being used, which of them should be improved. Are there key data elements that are missing from the paper form, but then take it a step further and think about who is your user. And what is their role, how do they actually enter this data, are they a data clerk or are they a clinical health worker, are there additional tools that you would provide to them because you can in tracker. This is a process. This process should usually be done working with users, try to do some level of user acceptance, some, perhaps some level of user design, visit the sites that are using the system once it's introduced. See if they have any recommendations on how to improve the use of the system, what aspects of it are the most frustrating. So this can be something that again happens before the system is introduced during kind of the beginning piloting phase after the system has been in place for a while. And making sure that you are trying to constantly improve on this, the tool that is being provided to your users scale. This takes us a little bit back to that first slide, just thinking in what is the impact of introducing such a system. What we've really seen over the last year with the introduction of so many of the COVID surveillance and COVID testing programs and now the COVID vaccine programs is that this in many countries has become their largest IT implementation ever with the highest number of users, the highest number of people or patients that are being entered into the system. And this is means there's a lot of learning to be done about how to manage that volume of data, how to how long will training take how many trainers do you need. What is the cost associated with all of these things. So again, before the implementation begins having some discussion around the cost associated with it understanding what scale you're trying to achieve. Perhaps you'll do a phased roll out. Ghana talked a little bit yesterday about doing kind of a continuous progressive roll out where they rolled out the system two years ago but there's still a portion of the country that they're training even now and getting them to adopt the system. So that is something that doesn't all need to be done at the same time but it's something that you can think about and plan for in the implementation process. Training we've mentioned several times. But again, we I think are all very familiar with a training of trainers kind of approach, but you may find that you need to do even another tier of training, where you have trainers at the national level that go and train district level users who will then go and train facility level users, for example. The time that it takes to train 10,000 users is massively different than training 200 users and the number of teams that you might want to have involved with the training changes as well. Also the types of training that you're offering. Much of the training now may revolve around the device itself. You're introducing an Android device and you want to teach them about how to keep it charged and how to make sure that a pen is used for security purposes. You'll have to train users about whether or not they're able to load additional apps on the phone or what to do if they run out of airtime. So there are more topics to be introduced when you're rolling this out to the lower kind of parts of the health system in terms of training. So any of them, these topics may have nothing to do with the HS to or the health program they may actually be about maintaining devices or or how to, who do they call when they have an it question, which takes us to the it support unit. I think if Ghana were speaking right now they would, they would have a lot to say about how their it support unit structure has had to change over time. They went from having a very successful aggregate system with a dedicated unit at Ghana health services providing all the it support to having multiple national scale tracker implementations with many more thousands of users and many more thousands of devices. It support starts to need to devolve down again in the ecosystem. Perhaps when you're training the district level users on the system, you also need to train them to provide frontline it support. They can perhaps answer the most basic questions when a user is struggling because they have locked himself out of the system, or because they have, you know, run out of airtime or because the battery is not charging and how do they get a new device. Usually the team that you have at the national level won't have enough staff to be able to field all of these questions. But that means thinking through is there are there more people that we need to hire is there more of an infrastructure that we need to put in place at the lower levels. Are we going to change some people's job descriptions are they going to be providing more it support along with the typical kind of supervision that they used to do from the regional or the district level. At the central IT support unit, you may also want to staff up as well around managing 100% uptime for your tracker system. If the tracker system is a part of your clinic clinical care process. It has a really negative impact when the system goes down for a day or two days in your aggregate system you maybe could live with that. It's nobody's ideal but if the system goes down for three or four days, the health care still is provided there there are not as many negative impacts. But if your ART system goes down and there's no way to bring that system up for the next two days that can have a very significant problem for the people that are trying to receive and provide care. So thinking about how to have round the clock over the weekend support for a system failure is really important. If it's because I've come to the end here that I'm. Okay. So, again, this, this was a brief overview of these key considerations we have more to say on every one of these topics but we wanted to start getting you thinking about some of the challenges associated with this in order to help you plan in order to help you. So please ask for the appropriate level of resources from the groups that are supporting your tracker implementation. Many of these topics again will have their own dedicated tab and the project planning template and I'll spend a moment on that. Now, so I'm clicking over to the project planning template. Again, this document has been made available to you in Slack. It is in the announcements channel it's also in the project planning template channel. You can download it and use it for yourself throughout the week. I'm just showing you a little bit of what is in here in the next session will be taking a look at this first tab the readiness assessment. The readiness assessment is really trying to answer some of those basic questions that I was just raising about the scale that you will go to what is your end goal your support structure connectivity and hardware, trying to give you a set of questions that you should be able to answer as you're dealing with stakeholders as you're working with your national programs as you're thinking through the timelines associated with your system. We have a process matrix here which again will spend more time on later but just giving you helping you to map out what are the processes that you're trying to support throughout the life of your tracker implementation. You can go through your objectives what any inputs and outputs would be how you could use this kind of information to design your tracker implementation. We have a roles and responsibility tab, where you can think through who the governance team is the management team the development team deployment operations. So this is helping you think through what their responsibility is, who the named individuals can be, who are their supporting staff. We have a privacy and security tab that will again walk you through more that is providing you the opportunity to think through all of the different aspects of how to keep your system private and secure, including the processes that you would put in place and who the responsible people would be for those. You keep going over, don't get lost in the first few tabs there are more tabs to help you set up a monitoring plan and an evaluation plan for your system. And when you have come up with all of that information, you would then have the opportunity to think through a work plan about how you would roll out your system, what are all of the different activities that need to come into place, what are the new documents job descriptions so P's that you would need to have and how long it would take for you to get to the appropriate scale that you are wanting to achieve. And then finally we have a budget tab, which would help you to map out what are the resources that you need for your system. We have some plug figures here, but again we'll have a dedicated session to helping you think through and fill this out. So our hope is that by the end of the Academy, you will have filled out all of these different tabs, and you will have at least a very strong starting point for the planning for your system. For those of you that already have a system in place. This is also an opportunity to document some of these things that may just exist in theory or in practice right now. So helping you to write out who is responsible and how things are working. I see Martin you ever raised him. Yes, like, there was a question about after they filled it out, do they share it with us in some way by email or. At the end of the week actually are at the end of the Academy, our last day will be an opportunity for some to share their project planning and for us to discuss. And so that's the main point of sharing the project planning template that the full project planning template is for you. It's not going to be graded on our side. It's not going to be where your team to have and to fill out and to be able to use going forward. So it won't be used to give you a grade or something instead it's meant to be a very practical exercise for you to be able to document and plan around your own implementation. Right, so, like practically how do they shared with us. I guess we'll make some decisions and give some more information about that the very last sessions is about sharing and we'll we'll probably ask you to create some slides for your different implementations that answer at least parts of these and that will share them together during that final day. I'm going to give you some more information about that for now, using the tool as we go through each of the sessions so if you take a look back at the agenda, you'll see today will do the readiness assessment review conversation, and you can be filling out then this first tab today while we're talking and after the session has ended. So I'm going to continue to have then questions about key Android considerations in a session about how you do program design. So again, this will give you an opportunity to start planning out some of those parts of it. We have sessions on data access management that would fit into your security profile, for example, we have this scaling, linking our data tracker budgeting monitoring and evaluating. If you have any sessions you will have your version of this document open, you would be able to fill it out throughout the session, put in some thoughts and and and the information into the document and and again follow up even after the session is over. Yeah, I know I just want to add to that that there are sessions almost every day where we put aside time that the facilitators are ready to discuss after the after the normal sort of course sessions, so where you can work on your assessments and you can and you can post questions to us and we will, we can help you to fill it out and to discuss with you. It's also noted in the agenda. Okay, the last thing that I was going to do for this session before we take a break was take a look now at our slack and see some of the things that people have entered for responses. So our first question here after seeing all the reasons trackers difficult. Why have you decided to use it what benefits are you playing to get from adopting track. So let's take a look. From Abdul having timely data and be able to make decisions based on facts. So this is one of the things that tracker is really good at. It's a good reason to be adopting an individual level system tracker data is immediately available. So if you have depending on where you're doing the data entry but if you do it at the point of data generation, then you can have updated indicators and dashboards immediate. You can have them updated nightly, rather than going through a monthly process where it's first on paper, it's then entered into a reporting form at the clinic, the clinic sends that to the district the district aggregates that information, enter enters it into the aggregate system. So it really speeds up the process to being able to make decisions and to react quickly. If you see a stock out at a facility then you immediately respond rather than waiting for a monthly report that shows the stock out. If you see a spike in fevers in a given location, then you can have an epidemiology team looking into what's going on and react more quickly with a disease surveillance approach, for example. Abdul Rahman shares the envisaged benefits will consist of reducing dropouts in the API program and to be able to track women and children enrolled in the API program. So again, this is a another clear benefit to the individual data, rather than reporting higher level aggregate numbers of who, how many children are lost. You can be producing daily a list for the healthcare worker that shows which children have not received their second dose and giving them that child's contact information their mother's contact information a phone number to follow up with. So allowing them to really have a working tool to address the problem of dropouts rather than reporting on dropouts and trying at a national level to make a difference. Okay, let's take a look at some of the other responses here. If you could start over with your implementation, what would you do different. All right, Anna, it looks like you had a response, do you want to share your response. Sure. So I've been working on a project. I've been working on a COVID contact tracing tracker project here in Norway where we're making a system to track the infected person a surveillance and then who has been in close contact with them to enable to put them into quarantine and keep track of how many close contacts as a positive case have etc etc. And this is being used by contact tracers all over the country. I think one reflection I have had after working on that project is the complexity of the of the workflows. It's very specific how each different office working with contact tracing works and they find their own little routines to make this run smoothly and if I would do this again I would involve healthcare personnel or the contact tracers in this case at an earlier stage in the design process. And I would also involve the people requesting and data and dashboards at an earlier stage to even better understand what their needs for data is so that we can provide that in an easier way without manual work for example. Over. Thanks. Abdul I see that you again responded having a view of the reports that the system will have to answer. Yes. So this often is something that I've run into when we've worked on systems where we are told from the beginning Oh here is the paper report implement this and tracker. And then we find out after that is done that that paper report didn't answer all of the analytics needs, and that it never has that there's just been a lot of people skipping some of the required indicators, and that the ministry really wants to have a different set of analytics than they used to have. So knowing ahead of time okay what are the analytical outputs what kind of reports need to be provided and rethinking some of the, the ways that you are designing the tracker would be really useful and important. So having DHS to aggregate for HMS and some health facilities Abdul Ramon says, making sure that these health facility staff and provincial project supervisors are involved in the design of the tracker framework from the beginning. So I guess I'll make some guesses here as to why this would be useful to you but I think it's, it's great advice if you already have people that are used to DHS to or to the aggregate, and now you're introducing something new. And of course to let those same people have a say in how the new system is going to be, whether it's going to be replacing parts of it or not. How do they use the systems together. Who are the users that are entering data making sure that it's very clear to everybody involved what this new system is and what they should use it for. And it also lets them give you very useful advice designing with the user is always going to be better than making kind of assumptions or guesses at the national level. Okay, and last thing that we'll just take a look at before the break. If there was one thing in to tell the room not to do what would it be Abdul says never start without training the people involved very well. One point training can make the all of the difference about whether or not your system is a success. Do not get web hosting services from general service providers rather search for providers who are familiar with the HS to this I think is something that is really a learning point for every country is to figure out what the best approach is for hosting services. So they're often requirements for hosting locally there often is some kind of infrastructure in place. You can use the requirements for tracker to reconsider any of those policies and to think about what would it mean if you had downtime how would you get a response who would be responsible. What are the privacy requirements and that those kinds of answers should really drive your selection of hosting process, whether it's on the web or it's done locally. And there are quite a few as Abdul Rahman points out there are quite a few groups NGOs companies that specifically provide DHS to hosting services. And so they may be worth considering depending on what resources you have and what policies to provide. One of this says starting without a clear idea what the data will be used for what kind of decisions will be made based on the tracker data. So this is something you would definitely not do. And again so doing like an early data mapping process as you're designing your tracker thinking through each data element you're going to craft what should be the limits on those data elements should you have program rules that hide or show the different ones. What are the decisions that you want to make. Why are you collecting the data. Are you doing it just because it's always been done that way or is there an actual clear purpose for that data. So many of those things that really you should do in an early process of design before you have put additional burdens on all of your users out there. Okay, I think with that will will stop those questions will remain in the slack channel. Feel free to continue adding some thoughts there that you'd like to share with the group. Of course use the slack channel to ask additional questions and we'll continue to fill those out. But at this point I think we're ready to take a 15 minute break. And schedule 30 minute break. Okay, we can do that a 30 minute break. So we will do a 30 minute break which means that we would be coming back here in Oslo at 1125. So 30 minutes from now we'll be coming back and this is where we'll dive into the ready assessment review. We've had several participant volunteers who are going to join on for that session to talk through their readiness assessment. And we look forward to having the rest of that conversation. So we will see you back here in 30 minutes. Thank you.


Okay, I hope you're doing well. It is Thursday, 3rd of February, and of course I had to jump on and say a quick word about Metta or Facebook after their shares got absolutely slammed in aftermarket trade yesterday. So there's plenty of memes going round about Zuckerberg at the moment, but I wanted to get up to speed on some of the main numbers and why there's been such a dramatic drop in their shares. So let's take a look at this. This is the aftermarket session last night when their numbers hit the tape. In fact, I couldn't do it quick enough to capture really the bottom, where they were down as much as 23%. I must also say that in pre-market trade now, some early indications would say they're off these worse levels, but only by a couple of percentage points. So still looking for a deep negative open for Facebook on the street later on today. So you can see here the stock price trading close proximity to 250 bucks, having traded 3.25 prior to the earnings coming out last night. So what exactly was the rationale here? What were the numbers and what is it that investors are so worried about with Facebook? So a couple of things, looking at the actual quarter and how they performed. First off, their revenues actually came in just slightly above expectations. In fact, at 33.67 against 33.43 billion, their EPS though was amiss at 367 against $3.84. Those numbers not so much to focus though. What the market was really concentrating on are metrics such as DAUs and MAUs, which is daily and monthly active user numbers. Because of course then, this is where they derive most of their incomes from advertising and active users are absolutely critical for them to continue to make money. And the daily figure came in below expectations of 1.95 billion at 1.93. We'll look at those and we'll circle back to that in a moment. The other thing is obviously there's a lot of conversation of course brought about by the shift from Facebook to Metta. Of course, as they positioned themselves for web three and so forth. And their reality labs operating loss was a pretty sizable 3.3 billion dollars. And actually, I saw some interesting comments that the new disclosure of reality labs segments operating loss as overall was 10.2 billion for 2021. And analysts on the tech side are suggesting that that's gonna point to at least a 10 percentage point drag on overall operating margin, which could obviously get worse than near to medium term. Because as we're gonna look at, as the demographics are shifting quite violently against Facebook and there's multiple other challenges that they're facing through pandemic currency headwinds, through the regulatory environment, through Apple's operating software and the ability for them to be able to target through the advertising model. There's gonna be a massive emphasis for them to try and really push in to get ahead first to market advantage if you like in some ways, given the user size of the user base for this positioning of the Metaverse. The problem is that's super expensive. And as then just mentioned there, what it is gonna lead to most likely is that overall operating margins are gonna change quite dramatically. So it's another burden pressure point for the company going forward. The outlook was pretty disastrous. They see Q1 revenues at 27 to 29 billion. The street was looking for over 30. And they see year on year growth in Q1 to be impacted by headwinds, both to impression and price growth. So double whammy. Now, one of the key interesting metrics that obviously a lot of people look at are daily active users that I mentioned. And this is a super interesting graphic because it starts to break down by geographic area. So not only can we see the total number, which as you can see here has definitely plateaued at 1.93 billion. What you can see is the rest of the world and also US and Canada, those numbers, albeit to a small degree, have declined. But important is they've declined here for the first time in those key regions. And that's what makes people particularly nervous. So we've actually declined in some of their key areas. And looking at this on a different basis, this goes back to the last 10-year performance of, I was looking at last night, monthly active users on Facebook. And you can see here, there is the context of course as well that competition is another major challenge that the company needs to confront, which we'll get to in a moment. And obviously as the market starts to become saturated of users who have access to mobile applications and so forth and internet connection, obviously this number will start to slow. But you can see here, these numbers have been declining quite rapidly, continuously for a long period of time. And the other thing, of course, that's really challenging for them at the moment is teen and young adults daily active users. They've actually, if you look at that demographic segment of the DAUs or MAUs, they've been declining pretty much for a decade. I mean, we all know, right? I mean, who uses Facebook apart from your uncle and your auntie and maybe your grandma. So this is a big problem for them. And hence a lot of rationale with the pivot, particularly coming on the back of all that negative press last year about how that algorithm specifically targets and can create mental harm to young individuals. So this is really where it gets interesting because the CFO on the conference call covered a number of points, challenges that the company faces. On the impression side, he said that they continue to face headwinds of growth, increased competition for people's time and a shift of engagement within their apps to things that are more akin to what young people use, like TikTok. So moving away from those more traditional news-based type feeds into something more short and snappy in the form in which they're delivered. Apple's iOS changes were not in effect. And so the company, according to the CFO, anticipate modestly increasing act targeting and measurement headwinds from platform and regulatory changes. So they're still to come. And then they're hearing from advertisers, this is what the CFO said, that macroeconomic challenges like cost inflation and supply chain disruptions, they're continuing to have an impact on companies' abilities to advertise. So advertiser budgets are being pressured at the same time as well. And then there's the foreign currency headwind to year over year growth. So as you can see here, there's a whole list of things that have really contributed to why there's been such a bearish reaction to their shares. I think Mark Zuckerberg was also on the conference call last night and he really summed it up. He said, people have a lot of choices on how they want to spend their time. And apps like TikTok are growing very quickly as everyone knows. And he warned on the call that competition would put short-term pressure on metas advertising business. And remember that comes, as I said, as operating margins are gonna be pressured as they try to really hyperspeed because out of necessity, they push into their reality labs division and some of those other areas that would be facilitating the structure around their web three and metaverse idea. Quite hilariously, the calls on Wall Street, you can see here, there's a lot of jokes going around last night. This is all of the major analyst teams from across the street. And when they're asked about what their current rating is, buy, hold, so forth. Nearly every analyst on the street has a buy rating on Facebook at the moment. And yeah, it just goes to show you shouldn't put all of your trust in what these analysts say because it doesn't always materialize. But yeah, on that point, I hope that was useful. Just a super quick update. And yeah, remember to subscribe to the channel. If you like what you hear, we've got more things coming out. In fact, I'm gonna jump on later and do a Bank of England one on the macro front as well. So I'll see you then. Thanks very much.


Hello aces, welcome back to module 5, lesson number 3, training your staff with ease. In this lesson, you're going to learn how to train your staff with ease through an employee handbook. Why is that essential for your restaurant's success? Because not only does it increase productivity for your staff, but also increases retention and decreases the turnover of your staff. It gives you clarity on the business as a whole as you define this whole handbook, but then it also gives clarity for your staff.  Everything that you understand, you've been working on, you've been consuming these ideas and thoughts and you take this for granted if you don't put them down in a handbook which you can share and train your staff with. We need to get them up to speed with the values, we need to get them up to speed with everything that you believe in and making sure that you don't leave anything through the cracks and that's the reason why having this handbook allows you to align with them with your stated culture and making them much more fulfilled when they understand what is it that you're trying to do. Now creating this ultimate training handbook, don't take this lightly, you should start this right from the get go because it's all about documentation and that's the reason why in module one we start off with starting with your why's, your mission and we have a ton of different exercise for you guys to fill in and then that way now you can compile everything and put it into this training handbook. It's how you standardize excellence and ensure everyone is on the same page. There is a tremendous power when everyone in your team is rolling and sink towards this one common vision, common goal, working in your set of beliefs. Tremendous power in doing that. This is also how you can create a business that don't rely on you. So many nightmares happening out there of restaurant nightmares where the owners and the founders need to work in the restaurant business for 12, 14 hours because they feel like they need to be there all the time to turn, to put down fires to fix employee relation, to customer problems, chef problems, all these crazy things are happening. But if you have this training handbook, you're going to be able to empower your staff to work in your favor. It's a business that gives you flexibility and location freedom when you're able to create this but also to be able to actually preach and exercise this handbook. Your ultimate training handbook should include informed all your employees of the rules, the values, the cultures, mission and goals, everything that you have defined in Module 1. Employment standards. Basically, within your city, what are the standards for employment? Ensure that people follow rules and streamline process. Within your organization, what are the different types of tasks that needs to be done? How is it that you want things to be done? Do you want your staff to come in? First thing is to check in and punch in or do you want them to just work on an integrity basis that they don't need to sign in? Identify each of these tasks and making sure that it's in this handbook and making sure that they sign to it allows everyone to be on the same page. So in the future, when they come in late for 15 minutes, you won't have arguments because you never gave them the rule. You guys never had that alignment whereas if in the handbook, it's stated that once you come in, you log in right away, you punch your card and they don't do that, then it's a very simple black and white who's right, who's wrong. Next up, it also acts as a great incentive for your staff because when they know that, hey, they follow these different principles and these rules, they know that these are the values and mission and statement. It also incentivize them to do better and incentivize them to follow it and access a structure for them to work with. Next up is also a way to protect your restaurant because you have identified everything in there, you've identified what causes for termination and all these types of rules in the future when there are disputes with your potential employees, then this also acts as a way to bring it up to court whatsoever because there are signatures that you need your staff to sign. So creating your own ultimate training handbook because once again, you invested in this course. In the link below, there are templates you can follow a step by step process in creating your own training handbook. Some of the common pitfalls when creating your handbook is misalignment. Once again, just like how a great culture is all about alignment with the stated culture versus what people preach, same thing with your handbook. The stated way and the stated things that you put in your handbook needs to be carried out and lived throughout your shop. So whatever you say within it, you need to make sure that you practice it. So for example, if you tell people to come in and punch in the card and you play favorites, your manager doesn't need to punch in or the cashier doesn't need to punch in because you know what, you guys know each other so well, then your staff, other employees would feel that, hey, you know what, if my manager is not doing it, then why should I do it? Because of this lack of consistency and alignment, make sure the alignment exists, make sure that whatever you say you do. Treating the handbook like a self learning manual, never ever have this giant binder. And when you're on board someone just giving it to your staff, it defeats the whole purpose of this handbook. This handbook as as a reference guide doesn't take the responsibility of you or your manager to train your staff accordingly. Never just throw it to your staff without going over with them. Make sure that you are able to explain to them, show them the vision. The handbook acts as a reference guide only. Make sure it's integrated with their job, go through it with them, guided tour and on hands training with the staff, invest in the training, invest in the time for them to really understand what is it that you guys do. In this lesson, you've learned how to train your staff by ease by creating an employee handbook. Make sure that you guys download in the link below the employee handbook and start creating it for your dream restaurant. In the next lesson, we're going to be talking about the six steps to keep your best staff from leaving and to reduce turnover. I'll see you guys in the next lesson.


President of the United States, accompanied by Senator Jim Abner. My campaign, that means so very much to me, but most of the United States. Thank you very much. Thank you all very much. Thank you. Jim, thank you for that most generous introduction. My thanks also to some bands that have been making beautiful music. The Central High Band, the Douglas High Band, and the Stevens High Band. It's an honor to be here today in Rapid City, not so far from the places that President Theodore Roosevelt used to visit back around the turn of the century. Teddy told me how grateful he was that I'd suggested he come here. But it's an honor also to share this platform with so many of South Dakota's finest. Your Governor Bill Janklow, your next Governor George Mickelson, your Senior Senator Larry Pressler, your former Congressman Clint Roberts, and the next Congressman from this great state, my friend Dale Bell. And the man South Dakota is about to re-elect the United States Senate, Jim Abner. And would you forgive me if I say a special word to a young man seated out there in the audience? Not long ago, a third grader at the Clegghorn School mailed me a letter asking me to visit his class for show and tell. Well, time wouldn't permit I wasn't able to go to the class, so the class came here. And greetings then to my young friend Kent Powell and to the entire third grade class from the Clegghorn School. And to all the young people here in the audience, I have a special message to you from my roommate. When it comes to drugs, she's asked me to please tell you for yourselves, for your families, for your future and your country, just say no. Well, it's wonderful to be here in Rapid City, and you know, as I often say to my staff, when we're getting into Air Force One and taking off in Washington, it's great to get out of Washington and get back to where the real people are. You probably know I couldn't do this much traveling when Congress was in session. As Jim Abner will tell you, that's because some of those folks need watching. Now, I'm not complaining about the institution of the Congress, that I respect very much, but it's just some individuals there. There's some of them that, in their approach to doing government business, remind me of the three fellows that came out of a building and found they'd locked themselves out of their car. And one of them said, get me a wire coat hanger. I can straighten that out and I can get in and trip the handle and get the door open. The second one says, you can't do that. Somebody will think we're stealing the car. And the third one said, well, we'd better think of something fast because it's starting to rain and the top's down. But that story says so much about how the tax and tax and spend and spend policies left our country just a few short years ago. Negative growth, double digit inflation, the highest rates since, and get ready, the highest rates since the Civil War. And so as part of that 1980 cleanup crew for the worst economic mess since the Great Depression, Jim and I headed for Washington. We cut government growth, slashed regulations and cut income taxes almost 25 percent. And today we're enjoying one of the longest economic expansions in our history. The prime interest rate has fallen by two-thirds. Mortgage and auto loan rates are down. Inflation has plummeted from more than 12 percent to 1.8 percent. And we've created over 11.5 million new jobs in a little less than four years. More jobs than Western Europe and Japan combined have created in the past 10 years. And you know, when we started that economic plan for recovery and expansion, there were a lot of people critical of it back there and making fun of it and so forth. And I could tell that the plan was working when those people stopped calling it Reaganomics. Just days ago we learned that the figure that represents the country's economic growth, the gross national product, GNP, and some other indicators show our economy is gathering momentum for even more growth, higher take-home pay, and more new jobs. In short, we're headed for prosperity. And I'm determined to see that those who still are not sharing fully in our nation's prosperity do so. And I give you my pledge that neither Jim nor I will be satisfied until this expansion reaches every sector of our economy and every home in America and until every American who wants a job has a job. To broaden our expansion, I signed into law last week the most sweeping reform of the tax code in our nation's history. For more than 80 percent of Americans, it means a top tax rate of 15 percent or less, and that's why I call it tax cut tube. But wouldn't you know it even before this fair share tax plan reached my desk? The Democratic leadership in Congress was saying that they wanted to break faith with the American people and turn tax reform into a tax hike. You know, the truth is those people have never met a tax they didn't like. And when it comes to spending your hard-earned money, they act like they've got your credit card in their pocket. And believe me, they never leave home without it. The American people know the truth. We don't have a deficit because we're taxed too little. We have a deficit because the Congress spends too much. Now, isn't it about time they started protecting the family budget instead of fattening the federal budget? The contrast between us and the leaders of the other party is just as apparent when it comes to judicial appointments. Now, you know, the president appoints the federal judges, but they can't be a judge until they've been approved by the United States Senate. I began appointing federal judges to be approved by people like Jim Abner and the Republican Senate. The federal judiciary has become tougher, much tougher on criminals. Criminals are going to jail more often and receiving longer sentences when they get there. And over and over, the Democratic leadership has tried in the Senate to torpedo our choice for judges. And that's where Jim can make all the difference. Without him and the Republican majority in the Senate, we'll find liberals like a certain fellow from Massachusetts deciding who our judges will be.  Thinking of those things and those types, there was a Democratic fundraiser at a downtown hotel. And when the people were coming out of the fundraiser, there was a kid with some puppy dogs. And he was holding them up for sale. And he was saying, buy a Democrat puppy, buy a Democrat pup. Two weeks later, the Republicans held a fundraiser in the same place. People were coming out and there was the same kid with the puppies saying, buy a Republican pup, buy a Republican puppy. And a newspaper man that had seen him there two weeks before said, hey kid, wait a minute. Two weeks ago, you were trying to sell those pups as Democrats. Now you're selling them as Republicans. How come? The kid says now they got their eyes open. But ladies and gentlemen, we've come now to an issue that transcends in importance, even all the other crucial matters that I've mentioned. My most solemn duty as president, the safety of the American people and the security of these United States. Here too, because of the support of men like Jim Abner, we've been able to restore America's strength. There's nothing I'm prouder of than the two million young men and women in our military service. And there are some people whose the only savings they would ever recognize is to try to reduce the spending with the Defense Department. Well, let me tell you, if we ever have to ask those young men and women to put their lives on the line for the United States of America, then they deserve to have the finest weapons and equipment that we can produce. And with Jim Abner's help, we're going to see that they get it. Because of our young men and women in uniform, things have changed a little around the world. You know, America used to wear a kick me sign around its neck. We threw that sign away and now it reads, Don't tread on me. And today, today every nickel and dime dictator around the world knows that if he tangles with the United States of America, he'll have a price to pay. And one other thing I'm especially proud of, after six years of this administration, not one square inch of territory in the world has been lost to communism and one small country, Grenada, has been set free. And finally, there's another special accomplishment. We remain committed to our decision to move ahead with our strategic defense initiative against ballistic missiles, the SDI. Today, we're dealing with the Soviet Union from a position of strength. And it was SDI that brought the Soviet Union to the bargaining table. And let me pledge to you, I pledge to you our goal is to keep America strong, to save the West from nuclear terror, to make ballistic missiles obsolete, and ultimately to eliminate them from the face of the earth. SDI is America's insurance policy to protect us from accidents or just in case, well, or any madman who might come along, like a Hitler or a Gaddafi, or just in case the Soviets don't keep their side of a bargain. The record on Soviet treaty violations is clear. We can either bet on American technology to keep us safe or on Soviet promises, and each has its own track record. I'll bet on American technology anytime. I knew that there were those who had their doubts, but flying back from Iceland, I knew the American people would support firmness with the Soviet Union, so I couldn't come here today without thanking each of you for that support. And I also want to make an announcement. Secretary Schultz and Foreign Minister Shevronadze will meet next week in Vienna. And these meetings will be a follow-up to the discussions Mr. Gorbachev and I had at Reykjavik, Iceland, two weeks ago. I have directed Secretary Schultz to tell Mr. Shevronadze that the proposals we put on the table in Iceland remain on the table, and we're ready to take up where we left off in Reykjavik. We want to confirm and build on the agreements reached there. We hope the Soviets are prepared to join us to reduce the threat of nuclear weapons. And I believe this is a unique opportunity for progress if the Soviets are willing to move forward. Now I know in a crowd like this there have to be some of you who are Democrats. And I want you to know, yes, yes there are. I've been all across this country, and I know that there are millions of patriotic Democrats who are totally out of step with the leadership of their own party. And I want you to know that during these past six years as President, I've relied again and again upon the support of Democrats like those who would be present here. I thank you. And as you may know, I used to be a Democrat myself until I learned that the liberal leadership of that party had become completely out of step with the hardworking and patriotic men and women who make up the Democratic Party. Now I know how tough it can be to break with tradition, but I remember what Winston Churchill said when he changed parties. He was a member of the British Parliament, and he changed parties and was criticized for doing so. And Winston Churchill said, some men change principle for party, and others change party for principle. Here in South Dakota, the choice couldn't be any clearer. Jim Abner has voted to cut your taxes and keep America strong. He's a man who stands where he says he stands. And then there's Jim's opponent, who talks moderate at home but votes liberal in Washington. Whether the issue is national defense or highway funding, the people of South Dakota deserve better than a man who votes against the views and interests of his constituents and then tries to alibi his way out of it. Jim Abner is one of the most effective members of the entire Senate, the original sponsor of seven bills that have become law, the author of more than 50 amendments. The list of his legislative achievements goes on. Just today, Air Force One landed on a new runway at Ellsworth Air Force Base. It was built to accommodate the B-1s. Jim has worked so hard to bring here. B-1s, the Jim's opponent, voted to cripple by cutting their funding. And in coming days, I'll be signing into law Jim's water development bill, a bill that breaks a more than decade-long stalemate in water development projects built by the Corps of Engineers. Well, this, then, is what it comes down to. In Jim's opponent, you have a man who would vote to raise your taxes, vote to weaken our defenses, and vote to take us back to the grim days of the 70s. But in Jim Abner, you have a senator with six years of experience in the Senate at getting things done for the people of South Dakota. He is a senator who believes in peace through strength, a senator who led the fight to cut your taxes and create new jobs, and a senator who believes in the goodness and decency of the American people, and just as you heard up here in the greatness of this nation. My friends, let's come together to see to it that this once, this, just this once, the nice guy finishes first.  Will you choose your Democrat or the Democratic leaders who in 1980 weakened our nation and nearly brought our economy to its knees, who raised your taxes and have announced their plans to do so again? Now, just to be sure where you stand, I thought I'd conduct an informal poll. Speak up loudly so that all America can hear you. Do you want to go back to the days of big spending, high taxes, and runaway inflation? Do you want Ted Kennedy controlling the confirmation of federal court judges? Do you want to return to policies that gave us a week in vacillating America? That's good to hear. Now, would you rather have low taxes, low inflation, and low interest rates? Would you rather have an America that is strong and proud and free? Do you want Jim Abner as your senator from the great state of South Dakota? Thank you, thank you. You just made my day and you didn't hurt Jim Abner's feelings a bit. You know, my name, my name will never appear on a ballot again, but if you'd like to vote for me one more time, you can do so by voting for Jim. Important, important as this election will be to me, it'll be even more important to you and especially to all you young people for it'll shape our nation's future. Now, every poll shows that the age group between 18 and 24 has the highest percentage in support of us in what we're doing. But now I want you to listen. Every poll also shows just as clearly that in that same age group there is the lowest voter turnout. So do you young people, exercise your sacred right as an American, participate in shaping history itself by going to the polls and casting your vote and when you leave here, not only are you going to vote but buttonhole your friends and neighbors in your age group and tell them they have to vote too. You know at the beginning of World War II and we were going into that terrible war, General George Marshall, who is the Chief of Staff of the United States Army was asked if the United States had a secret weapon and if so what was it? And he said yes, we do have a secret weapon. It's just the best blankety-blank kids in the world. I've been around this country and on campuses and I've been in schools and I've seen our young people in the military and all I can tell you if George Marshall were around today he would say you are the best blankety-blank kids in the world. But it's time to go now, but before leaving, I'm doing Colorado. But before leaving, I'd just like to say that people my age really believe that it's our duty to turn over to you young Americans a country with the same freedom and opportunity that our parents and grandparents handed to us. And every generation between mine and yours in this room we all have the same pledge. That's what we're going to do to give you the kind of America. Sometimes we've slipped a little over the years when some of those people I've talked about before had their way. But we always come back and right now here again it is that kind of a country and when it's your turn to take charge that's what we're going to turn over to you. When we look at you, we see your openness, your enthusiasm for America and for life itself and it gives us heart. My friends in casting your vote for Jim Abner you will be winning one for yourselves, for South Dakota winning one for America. And yeah, you'll be winning one for the Gipper. Thank you all. Thank you all and God bless you. With Mr. Dennis Martin the American Federation of Police has a unique presentation to make to Senator Abner on behalf of those ladies and gentlemen who spend their days laying their lives on the line to make sure that you and I are safe within our civil jurisdictions 24 hours a day. Dennis Martin. Thank you, Governor Danklow, Mr. President. Honored guests, ladies and gentlemen, the 68,000 member American Federation of Police is very pleased and proud to present the Covenant Golden Eagle Award for 1986 to Senator James Abner. Senator Abner has led the fight in Washington, D.C. against one of our nation's most serious problems, that being drug abuse. Senator Abner who chairs the Senate Appropriation Committee on Treasury was responsible for reinforcing our U.S. Secret Service Department, thus creating tremendous support for law enforcement nationwide. Senator Abner was an influential force in the establishment of the Glencoe Law Enforcement Training Center located in Georgia. Yes, it is obvious that Senator James Abner's name is synonymous with hard work and the American way of life. And now it is with great honor that I present Senator James Abner with the Covenant Golden Eagle Award for 1986 for outstanding support to law enforcement. President Martin, I do get left without words once in a while, believe me. And nice things like this happen to me. This is one of my prouder moments in my life, coming from the American Federation of Police. That means something to me. As Mr. Martin said, I do have a number of law enforcement agencies under me and my part of the appropriations that I chair. Mr. President, sometimes I cheated on the other agencies to get money to put into these agencies because I believe so strongly in them. And nothing would make me happier to know that our local police have this kind of a feeling about this. And I'm very grateful and I do thank you. I have another little pleasure here. I don't mean to duck behind you, but I want to call on our good president, Mr. President. I know on your journeys across America, I'm sure you have received many interesting gifts. Well, we in Western South Dakota, and particularly the Rapid City Chamber of Commerce, also want to provide you with a momentum of this visit, and we wanted to give you something that was different. And believe me, we have. You know, Mr. President, in South Dakota we occasionally have some cold weather and getting around in a blizzard can really be very difficult for our wildlife. Now, our gift to you is a result of some confusion in one of those blizzards. It seems that a jackrabbit and an antelope got together in an effort to keep warm, and the result was a whole new breed roaming our badlands and the Black Hills and the prairies. Well, Mr. President, we wish to present you with your own trophy of one of these rare animals, a South Dakota jackalope. So, at this time, would all of you please join Senator Abner, all of these candidates, yours, my, and our president in singing America the Beautiful.


So you have a test coming up. You have to put those long hours in, but how do you do it without losing focus? That's exactly what we'll talk about in this video. Let's get into it. Hey guys, what's going on? In today's episode, we're going to talk about how to study longer hours without losing focus. Now, if you're on your medical journey, you are no stranger to putting in long hours. And while on this channel, we are trying to focus on how to minimize those hours. Sometimes you just have to put them in, but how do you do that effectively without losing that concentration, that focus and keeping yourself affected throughout the entire process? Now, the first tip that I absolutely love is to sandwich your strategies. Now, when you're going to grind out a long day of 10 to 12 hours of coming quiz, of coming test, whatever it may be, there's going to be a combination of things that are going to be very effective as well as things that are low yield, but you just feel like you have to do. So for example, maybe you're a little bit behind or you need to review some review slides or watch a lecture or read a syllabus. Those are going to take some time, but they're probably not going to give you the biggest pain for your buck. On the flip side, time that you can be spending doing flash prides, practice questions and just reviewing your material and assessing how much do you know versus not know is really where you're going to get the most quality of that 10 to 12 hours of studying. And so a lot of times when I'm working with students, there seems to be a difficulty of like, well, I need to do this, but I also know this works for me. How can I make sure that I do this throughout a day that way that 10 to 12 hours is truly effective. And one of the best things that I found that works really well is to sandwich those strategies. So for example, if you know, flashcards really work for me or practice questions really work for me, but I also have to do like X, Y and Z. Maybe you have to watch a video, which is not super high yield, but I want to make sure I don't miss something. Then go ahead and start your day where you're likely going to be the most focused and focus on an hour, two hours, hour and a half of that high yield activity. So maybe you want to do flashcards for an hour and a half and you're going to take the 10 of a break and then maybe you do need to watch videos so you can transition your studying to now going to videos for an hour or whatever it may be. And then you can transition back either into the flashcards or another element of high yield studying for you.  You can essentially have a flashcard session, a video session followed by a whiteboard session. That way, when you're studying for that first half of the day, even if it's four to six hours, you feel like at least two thirds of that was spent on high quality forms of studying. This is also a good way of keeping that motivation in as well as keeping things fresh. So if you're creating a study schedule for a weekend before a quiz, I encourage you to use a sticky note or whatever you may be using to create your calendar and essentially alternate by things that are really high effective, or if there's things that you need and kind of putting them in the middle. So a lot of times when I'm working on non-studying related things, I kind of do the same. I may be making a video and then maybe doing some boring chores and then doing something more effective for residency. But that way, I also feel like the things that I need to get done that I don't really want to are a part of my life and then studying it's the same exact way. Before we get on to the rest of the strategies, if you're watching this video or listening to it on a podcast, then you're likely studying what's studying in general. If so, I encourage you guys to check out the free study resources that we have, including our study rehab course and our eight step study program that basically are the same things that I either use to coach students or something that I use in medical school. Again, those are absolutely free. Those will be linked down below. The tip number two is to have an absolutely, like absolutely amazing midway reward. A lot of times when I look at my longer study sessions in medical school, for example, when I was studying for board exams, they step one or step two, the best way I could grind out a 10 to 12 hour day and really keep concentration all the way through was one, doing the stacking as we talked about earlier, but also midway, would just have something I'd be really looking forward to. And that way, I could grind out a good study session, have that midway reward and feel like, dang, today's already been an amazing day. And often that would be in the form of a workout because I just enjoyed working out or watching a TV show that I caught up on or maybe something as simple as having lunch with a loved one or friend or colleague, somebody who you just need to catch up on regardless of what you choose for that midday reward to be. I really encourage you to schedule that in. So maybe you're 12 to one, 12 to 130 slot, but not specifically dedicated to studying. And instead of feeling guilty, understand that if I actually use this time, focus on me, when I come back to study, I'm gonna come in fresh, I'm gonna come in motivated. Most importantly, you can look at your day and say, not only have I studied how I focus on the academic self, but I focus on my personal self. And I know how to balance these. So regardless of how busy I am, I know I can combine these and still get good results in both personal as well as academic career. Now, tip number three is to really focus and be mindful of what you put into your body and specifically what you eat. I learned this the hard way in college medical school, but really my lack of focus on what nutrition was truly affecting those midday kind of grinds where my energy would just drop between the hours of one to four p.m. I was usually a combination of my lack of eating anything for breakfast or being really hungry and then eating something that was probably not the most smartest thing to do for lunch, like a pizza, pasta, really carb-heavy foods that just make you wanna take a really long nap. Now, everybody's body is different and I'm not encouraging you to stick to a specific kind of diet, but I do encourage you to focus on the foods. They really give you the energy versus the foods that bring you down 30 to 40 minutes after eating them and then try to make sure that either you're eating smaller meals, maybe you may be snacking more around the times you really wanna be focused. So if you're studying on a Saturday for a test on a Monday, the worst thing you can do is have a really big lunch around 12 p.m. So if you're studying on the weekends for an upcoming test and maybe smarter to focus on smaller meals for breakfast and a midday snack and a lunch versus doing your typical three meals a day kind of thing, that way you can have that constant form of energy throughout. On the flipside, while it's important to focus on what you should need, it's also equally important to focus on those foods that really do give you that extra boost of energy. So when I was studying for board exams, it was very natural for me to have a bowl of almonds, a bowl of nuts, a bowl of grapes or fruits and just kind of snack on those because I never really felt hungry while studying but did feel like my energy would go up not eating those versus eating something else. Now, the next tip to really make the most out of a long study day is to really focus on front loading, the thing that you really have to do. It's very easy for us to have 10 hours and kind of split, okay, saying, oh, I need to do this and also do this. And these are both equally important, but for some reason, one of those tasks end up being at the start of our day and the other tasks end up being in the latter half. And I found more and more as I worked with the students that they tend to not really get to that second task. That's also really important. So when I'm studying or when I'm working on something I tend to focus on getting both of those my first half of the day. So if I had a research project and I had to prepare for an exam, I would try to do both of those before the hours of 12 p.m. That way even if I chose to be lazy and procrastinate the rest of the day, those things were done. I would use a combination of stacking my study strategies and work strategies. So maybe I studied a little bit, did something that was a little ineffective like watching a video or highlighting notes and then came back to working on my research notes that by the time from nine to 12, I would be able to get done with all of those. So whenever you're planning a long day of study strategy, it's really important to one, just kind of plan out all of your tasks that you want to get done and prioritize them and on which ones you want to get done the most. That way if you were to only work half the time, the most important things were done. And then two, try to use a sandwich technique that we talked about earlier where you can still keep that focus on those really high important tasks. The very worst case scenario, if you decided to take a nap that ended up being a little bit too long, we've all been there, then at least the most important tasks of your day are out of the way. And my next favorite tip is to really make sure that you use your breaks effectively. Now a lot of you guys have probably heard about the Pomodoro technique which is basically where you alternate between 25 minutes of work, all by five minutes of breath time. And then once you get to 50 minutes of work, you've asked for 10 minutes. It's found to be super effective for students on a medical journey because that 50 minute window is just about right where you are still focused a little bit more and the focus will go down. So any more setting you'll do probably won't be that helpful anyways. So regardless of you use the Pomodoro technique and their timers, you can Google some of them that you can use as you're studying or using your own time intervals. The main thing I would recommend is to look at your to-do list that you created, again, something that you've ideally prioritized. And then if there's going to be a task that is going to be extensively long, so let's say you are going to work on watching the lectures from Monday to Wednesday, that's not gonna only take you an hour. You can say, well, this is roughly going to take me four Pomodoro, or four 25 minute sessions followed by a five minute break. Then you can put that on your Google calendar or your calendar and you can actually be able to see when you take a break and when you should be working and ideally how much time it should take you to finish that individual task. This is a great way to be able to split something that may be a little bit demoralizing when you say, gosh, man, I have to study for like two and a half hours for this one task. You may say, okay, well actually I only have to study for 25 minutes and then I can take a break and still move on to the next part. So if you're reading a syllabus chapter, I would recommend finishing that page before you officially take a break. If you're doing questions, I would recommend finishing the question that you're on before moving on to your break time. However, when you come back and refresh, you don't have to feel like you're catching up with what you just learned. You're easily able to transition to the next part of that learning. And then finally, something that I've started to do more as I've become a resident is to use power naps effectively. If you want to learn more about power naps or effectively how to use it in things like medical school, I'll link down below one of the videos that I've made on YouTube, but basically it involves finding your favorite source of energy, usually caffeine such as coffee and tea and then immediately drinking it and combining that with a 20 to 30 minute nap. It's found to be effective getting some of that adenosine out, which is known to give that kind of groggyness feeling that most of us have around a two to four p.m. slot. I've had to be really effective more so than studying during that one to three slot of saying maybe I'll just take a nap between one to two and then I can use that time slot between two and four where normally what I've been focused to use that power nap to really then be able to get another solid study session. And then final tip on a long day of studying to remain that focused, to really have a cutoff time. This is super important. A lot of you guys that are familiar with this channel know this is something I really recommend. But if you have a 10 hour day easily go to 12 p.m. It's super easy to lose focus at forward p.5 because you have just so many more hours to go. But if instead you say I'm gonna cut off the studying today at 8 p.m. or 9 p.m. or 10 p.m. you pick a time then you know at least there is a finish line that you're going to and then you can focus on how can I make each of those chunks whether it's using pomodoro technique or the stacking techniques that we talked about in this video to really get the most focus of those last few hours. So having a cutoff time saying after this absolutely no more studying. It's been so much more advantageous and on the flip side, if you're saying I would feel guilty lush if I stopped studying at 9 p.m. knowing that I could have studied till 12. A really a good test to really show that you're overblowing the situation is to focus on your last exam or last quiz and ask yourself did that actually 30 minutes or an hour or two hours or three hours of extra studying would that really have impacted your grades? Because most likely you would have been spending that time that you're tired by the way doing things that are probably not effective. So that three hours could have been spent doing something more effective such as sleeping or enjoying time for yourself. That way when you come back to studying you're coming back motivated and focus on high yield studying techniques. So if you think that more hours will get you better grades you probably know from your personal experience and if don't rely on my own at least to say that absolutely does not. And if anything those last few hours are not going to be the most effective. So have a cutoff time that we can truly say there's my finish line and two I have a little bit of time before I go to bed to really enjoy it in the last bit of the day. Those guys are some of my favorite tips on how to study a long day and still keep that focus. If you guys did enjoy this episode go ahead and let me know down in the comment section down below. If you're watching this on YouTube go ahead and hit that like and subscribe button to get more content just like this one. Also just tells me you should make more videos like that. I enjoy that kind of content. So that like would really be appreciative and having that comment down below just helps me engage with you guys and make sure that I'm making videos that are really relevant to you. If you're listening to this as an audio form through podcasts and yes, if you're not familiar you can check out the TMJ show podcast through your favorite podcast lesson platform. Whenever you do consider hitting that follow and subscribe function to be notified when new episodes go out. That'd be super helpful if you could leave an honest review on iTunes. With that being said guys if you did enjoy this episode then check out some of our free resources like our study rehab course which is basically the same strategies I teach my coaching students as well as eight step study program which is the same strategy I use in medical school and those will be linked down below for free. And if you're interested in getting more one-on-one personalized help then definitely consider checking out the medic night program to also see what kind of results our students are getting after just one week. With that being said guys thank you so much for watching our listening. Super appreciative of all your support. Hopefully as always I've been able to help you guys on your journey. As always thank you so much for joining me online. If you did enjoy this video then definitely check out this video right here on how you can use Anki like a pro as well as this video on how to study in medical school step by step. But until then guys I will see you guys in the next one. Peace.