We are live. Okay. Hello everyone. We'll get started in just about a minute. Hello and welcome to our latest expert connect series, the digital supply chain explained. My name is Ira Sager and I'm vice president for learning initiatives for the center for global enterprise. As we've, this is the third session we're doing here and this is something new for us. A 15 minute webinar that we're conducting over the period of five weeks. This is a third, as I mentioned. Our game is to share key management skills for successful digital supply chain transformation. We like to think of this 15 minute session as espresso for the mind brief, but packed with lots and lots of information. And that's thanks to the leader of these sessions and that's Vick Galani, manager of research programs and analytics for the digital supply chain institute, which is also affiliated with the center for global enterprise. We'll have, we hope a few minutes for Q and A at the end of this session. And if you have a question for Vivek, please just post it in the Q and A feature on Zoom. And Vivek, you can take it away now. Thank you, Ira, for introduction. Welcome everyone, good morning, good afternoon or good evening, wherever you are. So for today's session, which is third session in the series, we'll quickly review the digital supply chain and the people aspect of it. We'll see the people side of the DSC. We'll talk about the DSC talent model that we developed earlier this year. And then we'll set the stage for coming weeks of expert connect. So those of you who joined us last week, we talked about the four areas of the digital supply chain, which is demand, people, technology, risk. And those of you who are joining us for the first time over the last two sessions, we talked about digital supply chain and demand. So digital supply chain is a customer-centric platform model which connects the four aspect of the digital supply chain, demand, people, technology, risk. And the digital supply chain institute came up with these ideas of four buckets by talking to 26 different supply chain executives and leaders across the world back in 2016. And I suggest everyone to read Frontside Flip to get more details on the four buckets. And in this four buckets, demand is all about how to calculate the stimulating demand and how to stimulate demand. People is focused on culture and our organizational shift right now in an organization. And I think the pandemic has accelerated those changes right now because of the work from home situation in many of the organizations. Technology is a supportive tool in terms of digital supply chain transformation. And when you are trying to direct to consumer model and going online on the e-commerce platform, I think it enhances your risk and I think managing it makes a really priority. So for today's session, we'll talk about the people aspect of it. So Dell is, let me talk about a quote from Dell for a bit. So Andre Solder from Dell is a member of the institution and also co-chair of the institute. And he mentioned in our latest white paper that digital workforce strategy designed to transform supply chain need to account for people experience skills and not just systems and processes. So most of the companies we have talked or we are talking right now, they are almost the main priority right now is technology, systems and processes always. They do not focus on talent. They do say that talent gap is the main concern for them but they do not have a talent strategy to work on it or to remove that gap. So I think our companies need to make sure that they focus on people experience and skills to make sure they remove the gap, to make sure they can transform to digital supply chain. And doing that research, we did a couple of surveys. So here are a couple of key insights from the survey. So majority of firm that we surveyed reported that there is a concern regarding the current talent pool that is inadequate for the executing the strategy of digital supply chain because they do not have the skills or the talent to go to a data-driven decision-making model instead of just intuition-based decision-making. So I think our companies need to make sure that they train their current people but also hire new talent or digital talent that actually are more focused on data-driven decision-making and they understand the data more than they understand anything else. The second, there is a lack of reported action to develop meaningful digital talent strategy to close the gap. As we talked about, most of the companies don't have a digital talent strategy. Every company has digital demand planning strategy but they don't have digital talent strategy. And talent brands are a meaningful way to attract digital talent must be developed and improved. And we'll talk more about that when we talk about the DSCA talent model. Also firms now see the development of existing talent rather than acquisition as a primary way to close the skills gap. So most companies realize that even if you hire a digital talent, they are, digital talent is lacking a functional expertise that they need to perform, they need to perform their roles and responsibility or better understand the business. So I think it's always better if an individual or an employee has both a digital talent but also a functional expertise or a domain expertise in that area. So what they are trying to do is trying to develop their current employees and make sure that they train them in a digital talent or digital skills to make sure that they can use them at a higher benefit level. And majority of companies do not have supply chain driven digital talent strategy. Some of the companies we talked to, for example, J&J or Colgate or other company, they do have digital talent strategy. But what they lack is supply chain input to those talent strategy. Because if you are using some of those talents for the supply chain, you need to make sure that you have some kind of inputs or requirements that you can put it into the digital talent strategy. And some companies are trying to do that when they hire a new member for the team, trying to put digital skills needed into the roles and responsibilities to make sure that they have those skills when they hire new ones. So by talking to all this company, we found out some of the characteristics of the future talent. So all the supply chain executives that we talked to agree that the new hire should be curious and it should be always about continuing learning. So learning is not an overhead cost or a one-time thing. I think every day in your job, a person has to be curious to learn and learn new stuff every day. And if you do that, you are just stagnant at that level and you won't be able to, you won't be effective to the company in implementing that strategy. And to do that, I think a person always has to have analytical skills, always needs to be flexible and always needs to be data driven. And the last point that I mentioned, it's all about collaborative with a purpose. So I think when we talk to our companies, most of the companies have siloed structure. So different functions don't talk in between. And I think that's the main barrier within the company when they try to do any kind of transformation project. And it doesn't go successful or it doesn't scale up. When you do a profile concept, so I think having those kinds of skills really help a company build a better and scale up a technology or a process that can really increase that revenue. So as you talked about talent, the DCI talent model, we developed this earlier this year with the help of Professor Dave Kerr. So there are three aspects of the DCI talent model. So the first one is about attract and acquire. So when we talk about attract and acquire, companies needs to build a digital supply chain employment brand. I think companies need to pivot that current employment brand to data driven employment brand that developed competency centers in a first location and utilize non-traditional recruitment to get new talent. And so for, and here is a good example. So Wayfair is a good example for this one because if you look at the data science community and how they promote their employment, how they promote some of their employees which are data scientists or data analysts, it really helps them attract and acquire new talent. And I think they are giving right now a really good competition to Amazon in terms of the inventory turnover because of they have a really good talent and they have a really good employment brand to fulfill their digital talent strategy. The second aspect is all about integrating perform. So how, and it's all about enable and drive digital strategies or digital supply chain transformation strategies for that. So how do you pair technologists with domain experts? How do you develop an organization structure that supports exploration and not just to data cleaning or data analyzing? Next we will train for integrated behavior and we'll talk about that model in the next slide. And the third part of the DSPI talent model is all about nurture a data driven culture. So how to create a data science community within your company that talks about different data exploration. If you have a overall community from different function and so data analysts from one function can talk to data analysts or data scientists from other function and talk about different kinds of problems and solutions that companies should be focused on and then start working on it to make it more impactful across functionals. And so commitment to digital community and also support external contributor in that community as well. So as we talked about the integrated behavior here is one of the way companies can, companies are doing an organization structure where they start to put a team for data exploration. And to be part of the team, I think it's not just data scientists can be part of it. It means to have data scientists, data analysts and domain experts. And it's not a hierarchical structure. It's a kind of center of excellence where a part of team member of the team are trying to come up with a non-intuitive insight for by using the unsocial data pattern and finding driven by questions and hypothesis. And sometimes team members are also trying to come up with a business problems that can be solved with the data. So you're not just finding a solution but also finding a business problem that's not has been discovered by senior leadership within the company. So that's part of the data exploration because when we talk to a company, most of the data scientists, they hire, they're 80% of time are spent on data cleansing and that's not a really good use of resources within a company. So companies are now moving away from that structure and make sure they have two different aspects which is function analytics where people can work on data cleansing and data analysis part of it within that function. But then that should be an essential part of the data exploration where people can go and explore insight and data throughout the company and it needs to be cross-functional within the company. So that's all we have. We have more details on each of the three buckets within the talent model and we have more examples and what questions supply chain leaders should ask to make sure that they have a really good demand talent strategy that can implement and stimulating demand, implement the new technologies, scale up a new technology but also managing risk and overall the goal for the digital supply chain is to reduce the cost but also increase the revenue from the supply chain. Thank you everyone to read the latest white paper which is talent and organization of funding guide which is available on DSL website. Thank you everyone to do that and if you have any questions please feel free to reach out to us and happy to have a detailed conversation regarding any of those questions. So back to you either. All right, very good. Thank you Vivek. One quick question before we let people go. I'm curious as you put together a talent or as the company puts together a talent strategy what is the advice for bringing in new talent, new people, new employees versus retraining existing employees and trying to get them to be more data savvy. So how do you strike that balance? Do you strike that balance at all? What is the recommendation? So it's a great question Ida and I think it depends on the company's size and the investment they have right now. So for a small company it's always if they don't have the talent even internally it's always go and get an attract and acquire talent but for big companies they can easily acquire a company to fill that gap immediately but most of those companies are trying to do right now it's train the internal people and trying to move them from intuition to data-driven decision making. And one of the challenges I think they are facing right now because they don't want to hire a new talent in COVID era especially because it's really hard for a new hire to collaborate with team members on a Zoom because they don't know them at all at this point in COVID and they are working from home. So it was attract and acquire before COVID but right now it's all about training and it will change next year and it will change the year after that. I think it's a continuous learning and continuously improving the talent strategy but most companies right now are training internally but then the focus on hiring afterwards if there is a lack of resources within the company then they will go to the second option of attract and acquire. All right, very good. Well, thank you very much. And thank you everyone for joining us and we will see you next week, same time. Thank you everyone and we'll see you next week at the same time.


Alright, I will now take the opportunity to introduce the three speakers we have today. They are presenting on the contribution of the non-physician clinician midwives in improving access to emergency obstetric care to rural communities in Ethiopia. Atela Takele is a senior public health professional in MPH stroke RH and a chief midwifery expert. He has more than 18 years experience in maternal newborn and child health quality improvement in academia, clinical and development activities at different levels. He is currently working at the Ministry of Health as a technical assistant and is leading the second reproductive health strategic plan development 2021 to 2025. Our second speaker will be Beleta Belgu who is a chief midwife and a health monitoring and evaluation expert with over 12 years experience. He has previously worked as an academic dean, clinician, midwife tutor and midwife advisor. He is the monitoring, evaluation, research and learning manager of the Ethiopian Midwives Association. He has managed different project evaluations and researches. Our third presenter for this morning would be Mr. Fecado Alemu who is the public health specialist MPH RH and a registered midwife. He has more than 19 years experience of teaching midwifery and public health in Ethiopia and South Sudan. He's a consultant in management and clinical services, health systems establishment and strengthening, public health initiatives, strategic planning and development of midwifery and nursing. His research interests are in maternal and newborn health, health access and other health related issues like HIV-8 and PMTCT. Currently he's a senior advisor to the Ethiopian Midwife Association and a PhD candidate in MPH RH at Addis Ababa University. Welcome to Kellen. Thank you Katrin and Sylvia as well the audiences across the globe. So I will continue with my presentation and here is outlines and I will start with with the introduction. Maternal mortality is yet unacceptably high in the world and of the 295,000 days, 95% are in low and middle income countries. In Ethiopia there are about 14,000 maternal days every year which is also very unacceptable and again additionally about 2.6 million stillbirths and 2.8 million newborn days occurred per year. So distance from home to health service facility contributed for high maternal mortality rate particularly if the distance from home to institution is you know greater than four hours time. So just do we need really MSc clinical midwives in Ethiopia? So different you know researchers could try to answer all these things. So skill-based attendant with access to cesarean section decreased maternal mortality. Other research indicates that mid-level providers with surgical skill training avert the shortage of obstetric surgeons as task sharing activity. So Nigeria, India, Ethiopia, DRC, Pakistan, Indonesia you know accounts about 50% of all you know all the number of additional cesarean sections planned in a year about 2. I mean 3.2 million cesarean sections in a year. So in 2008 about 278,370 cesarean section need was calculated. However only 1% was achieved as research indicated. There is also high disparity access to cesarean section between rural poor about 0.3% only achieved and versus rural rich which is about almost similar 0.6% and is higher for urban rich community which is about 8.3% have an access for cesarean section. So generally there is less than 10% of facilities provided cesarean section anesthesia and blood transfusion in Ethiopia. Med need for emergency obstetrics is stagnated at 18% despite 100% goal for emergency obstetric and bone care in the world and in Ethiopia as well. Approximately 20% and 1% of the facilities provided cesarean section at urban rural facilities and and respectively as well. So there is a study in southwest Ethiopia. Comprehensive emergency obstetric care service was less than 2% in the remote areas that that there is such you know want to show that remote areas need a trained midwives in cesarean section and 6.6% is in in the in the urban district areas in general. So WHO recommended tasks sharing to address the rural health workforce with surgical gap. So just research you know indicates some some cost benefit analysis when compared to obstetrician and midwives with with surgical skill training. So there is a 30 year cost per major obstetric surgery about 38.9$ for trained midwives and 144$ for you know obstetrics and gynaecology per surgery. So you know trained midwives in surgical skill you know could be cost effective as as the research indicates. In terms of attrition rate of medical doctors about took three bucks after seven years of graduation almost 100% was you know leave their their actual work compared to 12% of of trained midwives and other healthcare providers. Therefore training as a conclusion of these research findings as a literature review training non-physician clinicians is less time consuming and less expensive than physicians do. Employing non-physician clinical costs less than employing physicians which doesn't mean that as as a detailed it says source which doesn't mean that hiring physicians is not recommended but you know hiring midwives in the rural area would be costly you know very interesting for for the community. Crucially non-physician clinicals tend to remain in rural and under-served settings longer in a greater number of than physicians do. So this is taken from a research by Bergsten in 2015. Thank you so much but later we'll continue. Thank you very much. The main objective of this study is to explore the situation of master's clinical training experience and also the current practice and challenges in Ethiopia and the specific objectives are to document the current practice and the related challenges and the second specific objective to examine the situation of the training and competency of clinical midwives in Ethiopia and the third one to identify the training and deployment related challenges of clinical midwives in Ethiopia and the methodology we use exploratory qualitative study with comprised of phenomenological studies and document review. We use this method because most of the clinical midwives were graduated but they are not working as they were trained so we further need to know what was the reason behind their practice or we use this method and the setting Ethiopia is divided into 10 regional state and two city administrations and also the state divided into 68 zones and 900 waradas a total of 4,230 government on health facilities among these 3,980 to our health centers. 52 midwifery teaching institutions are available in Ethiopia. Among these 31 are inverses from the this 31 inverse 6. Six inverses are providing MSc clinical midwife. As of July 2018 the number of midwife graduates in Ethiopia was 20,000 around 20,000 and the study population are all midwife working in the health facility teaching institution government and as well working in NDO and the other senior doctors and gynaecologists were participated and other key improvements from the ministrofiles regional health hospital heads the Dino for schools and the midwifery department heads were involved and the conclusion that I get a midwife participated in FSD were not included in the informant interview and the sample size we use is what sample size and sample techniques purposeful maximum variation sampling technique we are used and the data collection FZD and Ki were conducted from February 1 up to March 2020 and the interview and FGD with audio recorded and digitally transcribed with the consent of participants and Nadish in concurrent field notes were also taken and the meantime taken for the interview was 15 minutes which is ranging from 26 up to 85 minutes like the qualitative data we also assure the qualitative data by assessing the credibility that's whether the findings are plausible and true and also the data triangulation then also dependability and the third one is what transferability was and the findings may be transferred to another setting or context or groups so we check the quality of this qualitative data the data analysis we use at last i version 7.5 use the Ki and FGD data were audio recorded, translated and transcribed verbatism in English and the transcript analyzed using the pre-simple of thematic analysis all careful rate and reread the transcript of the interactive basis and then coding categorized data was done additional codes were created as a team in the coding process and the reporting the report presented uh thematically under each main time septemes brief overview were given and the researcher opinion is provided the discussion part of this research and further direct quotes were used to present the participants voice and the speech and ethical review board of the utopian midwife association grants is the ethical approval and the purpose and objective of the study was well explained to each participant and well informed and also consent for where gain and participation was participatory and the participants were informed so thank you so FGD will continue the result. Head fecado, fecado please unmute yourself and continue. Thank you very much the result was divided into three parts one is a document review and the second is qualitative interview and also on site supervision on document review the program started in University of Gondar in 2000 time after needs assessment done among the stakeholders including the ministrophes um at that time there was a need for to train these midwives to do this procedure as it has been seen by the faculty it appears a very big country with 112 million and with the inaccessible obstetric health service for that we need this mid-level cadres to cover a ruler and under served community so with that this curriculum was started since that the training over 329 clinical midwives were training since 2010 up to the training time up to the data collection time that is 2019 among this 329 clinical midwives master's debuts 30.7 were females this is a distribution with universities as you can see this is the highest number is from University of Gondar and the pink the blue one is male and pink ones are female and in addition the over the six universities which but let I mentioned there are currently 216 students so when we add up the two we have over 550 clinical midwives in the country and again among these one over third are females so among these graduated midwives when we see their status whether they're working actively working or not only 3.6 were providing full CMOC service which means including caesarean section majority of these are working in two out of 10 regions of Ethiopia however when we assess on document review whether they have any significant medical error or not we only found two postpartum wound morbidity but no case fatality and other complications so which means they are practicing safely the procedure safely and we also try to assess whether the students are doing with the standard that is a 15 caesarean section were recommended in the curriculum as the level of competency looking other countries experience so there were 15 css the students achieved more than that the minimum the average number of caesarean section performed during the study time was 25 with a standard division of plus or minus 7.4 the second part of the result was the qualitative finding well these are the distribution of our study participants we interviewed the ministrophiles we interviewed regional health bureau in some country where you are working they may be said state has ministers the others are obstetrician gynecologists who are teachers trainers as well as colleagues school deans clinical midwives the majority of them are males and their ages for most of them is about 15 and 44 team certified to 39 years and have an average of nine years experience so the first thing we were asking were whether this is a program is relevant in Ethiopian setting and can be also duplicated in other countries it has scaled up so almost all our responders to say this program is relevant and the reason they mentioned were that one discovery of a professional they can provide comprehensive care like this is a word from a regional health bureau head who says that in the in that region which have more than six million population the majority of mothers died from obstructive labor and pph so these midwives can provide a comprehensive care that is antenatal care up to preconception care and including post-natal care so in addition to the CS service they can provide quality care in different directions so they prefer these professionals compared to other mid-level providers the other point they mentioned on the relevance of this program was it improved it has impact on quality of reproductive maternal and childhood service by saying this improves the quality of care because this student this level of progress they can supervise and they can train and coach and mentor the junior midwives and bsc midwives and also diploma midwives in in there when they are assigned there with so they can provide the service in general that is another relevance the third one is they provide holistic care to the mothers they provide continuum of care and they provide also non-traumatic delivery like when midwives are doing the the operations they they try to give chance more to non-traumatic interventions like an instrumental delivery spontaneous vaginal delivery before they go to see the reinsection compared to other providers so the this is another quality and relevance the other is in the where these professionals are assigned unnecessary referral to higher centers were reduced so that the mothers and the community are not wasting their time by by by traveling longer distance and by by by traveling to higher centers which are busy and uncomfortable to mothers and like this is a word from a TGD participant they said in their health care capacity they were managing 23 deliveries before the arrival of the clinical midwife but after the arrival of the skin care patient rating 130 per month because the community preferred them and are satisfied with their care service and then the other importance of these professionals they said is timely decision making midwives as they have like accumulated experience in their practice and education they make timely decision especially differentiating normal from abnormal and that is important like when they decide the caesarean section or other interventions they make it timely and they save the baby and the mother the second point next to the relevance where we were as try to assess whether this training is quality up to the standard or not so overall the opening end seems like the medical doctor students and and deans they said that the students are trained in in quality because one of the reason is there is no significant in wound infection and other complications compared to to other providers and in document review we were trying to assess 3100 operations from that document and then from this we only found two complications and it is in an acceptable range and we said the number of professionals which was done by the the midwives in their service area where they are assigned it outnumber the the performance by medical doctors or integrated emergency surgical officers so a minimum of 1000 the minimum caesarean section was seven with the recently assigned clinical midwife to a maximum 1000 was done and then then except to postpartum morbidity no case study was recorded however we found some issues which need to be corrected one is a surgical and theoretical clinical skill needs to be increased to three years in Ethiopia the curriculum is two and a half years but the participants they recommend they it is better to increase two and a half years and sorry half a year a year so that one we can use this the additional half year for internship program in busy hospital this is a word from all the obstetrician and gynecologist in northwest Ethiopia which recommended that this can be used the added half year can be used so that they will develop confidence and then the other is they need more general surgery exposure like they are when the gynecologist and others assess the the the competency of these professionals they say they are very good in obstetric procedures definitely but the abdominal procedures like managing injured bladder managing injured rectum rupture rectum in that case they may need more skill so one they need some surgical exposure in addition to the obstetric one more surgical exposure and the other this can be achieved in busy hospital so if the training can be increased to three years after the basicity the second is in in the visited schools among the six one some have very good skill lab up to the standard the others they they they have no complete instruments like to practice before they go to the actual surgery they they have to practice in a skill lab in a simulated setting so at least it has to be harmonized harmonized among all the schools the other is the student enrollment my my the index where coming from universities but the participants suggested especially this obstetrician and gynecologist from north in Ethiopia he suggested if they come from the practical area they have more like health centers and hospitals they have done universities they have they have more interest more eager for the to learn the skill and also they can go back and serve the community another challenge is the it comes from the professionals themselves they said they even they have agreed to work with with any condition but the minister of health doesn't support them with proper jg and scope of practice so they are they are forced to work under the scope the practice of the license of obstetricians and gynecologists so these were say good morally as well as also professionally hurting them and they are not also getting the benefit why what they have to get and then also the another challenge is organization and health system challenge one there is no proper scope of practice given to these professionals according to their competency in Ethiopia we call it in in some countries it is called job description in Ethiopia we call it jg is not where the formulated and given to this professional and so they have an issue when they go to the practice there so the management the hospital management you have no proper practice you have no proper jg and they are not getting their benefit their professional also responsibility so it is not well understood by the health system both at the at the regional and federal level that is also another challenge in conclusion from our finding we said there is high client satisfaction and the program is highly supported by all stakeholders however even though this there is a consensus that this experience that we drive can be back become imok providers by being taught all the skills needed to undertake advanced obstetric procedures such as the section however lack of policy and regulatory document from ministrophes especially the scope of practice jg job description and proper deployment policy from federal as well as regional levels state level is hindering this professional utilization even the regions which allow them to practice they are not practicing with with jg and they are not even motivated according to the standard or in in comparison with other professional there is a gap in coordination among the ministrophes ministry of science and higher education in curriculum harmonization so that there is some difference in curriculum some mongoose schools and this is not not good to have the same level of training and the same quality of service gap related to availability and adequacy of skill up also well noted especially surgical skill up and the length of practical stay also has to be increased there is a gap uh so we have given this recommendation based on our finding one there is a need to properly recognize clinical midwife with defined scope of practice as imok service providers by the ministrophes there is a need to prepare jg as stipulated in the curriculum and stated competencies there is a need for clear policy document for their recruitment therefore their deployment and have to be motivated and their career paths we have to be clearly stated by the ministry as well as minister of higher education and the region there is a need for collaboration so that a standard training and coordination among the intake and output has to be organized for regional health bureau for state health departments we said the region has to own the program so that they can give proper support especially when these students are going to regional hospitals they will get proper support so the region has to own this program there is a need for pre-regional plan especially a policy document how to recruit and send these students for training and how to recruit them back when they they trained finish their training and their deployment after graduation has to be clearly stated motivation scheme and career and after graduation supervision proper supervision and pull-up and upgrading mechanism has to be needed for training institute for the six universities and additional one which are coming soon so there is a need for curriculum harmonization and standard decision among all training institute so that same output quality assurance scheme such as a skill assessment and deployment in hospitals with client type law is also recommended their entry is mostly from universities has to be revised and more chance has to be given for those coming from service areas why the training institute has to integrate teaching with practical so that the train the trainers has to go to the practical areas and then the practice with their students so with this we are we acknowledge Ethiopia Midway Passive Session who organize and sponsor this training the federal administrators who support us in all process during this training regional health bureau training institute specialist senior obstetrician gynecologist friends and clinical midwives all those give us important training pro first Stefan from Sweden he he gave us an important input and he's also the founder of this program in Mozambique so we want to thank all of you and our our viewers and then the listeners thank you very much thank you very much Fekedu Takele for this wonderful presentation Sylvia you can go on yes another thank you to our presenters Mr. Takele, Mr. Fekadu and Mr. Belete yes indeed your presentation really ties in with this year's theme follow the data investing the midwives with this kind of researchers they give us new evidence that is going to help spearhead the global and regional as well as the national efforts to engage in reproductive maternal and newborn child outcomes worldwide so thank you very much for this very insightful presentation we are now going to allow for some questions from the public if you anybody has questions kindly type them in the public chat alternatively unmute yourself and please ask your question we are reserving merely three minutes for this part of questions while we are waiting for some questions i'm just going to read some of the comments that were said that are posted in the public chat Halima Musa Abdul says great study and presentation and then Getahun says good findings Tena Noiwok, Teneza says great findings good tasks for all the team Gati Lake says well done Feki and the team at all thank you for your nice presentation and Mihiretu Mola and you say salut to Feki and the team interesting findings thank you so much this is from Animo Taghele and then Catherine Shimechero wants to find out how come there are more male midwives training in the universities I think Tefeka too okay thank you very much Catherine for the question generally this is a problem in it's not only in midwifery but in all parts of the training in Ethiopia because you know like in Africa where patriarchal society and more males have access to educations and females so generally the higher education when at the elementary level it's almost the same but reaching at higher in-institute level when you see a degree level and above there more males are represented than females and this is the same for midwifery so but in diploma levels there are more midwives the more diploma middle more females than males but when you see when it go up the more males are represented so that is why there are more males in Ethiopia midwife but in Ethiopian mothers they have no problem with having service with more male and female thank you for the response another question from Jinja another question from Jinja midwife are the men accepted by women giving birth I think this will be our last question okay may I continue yes hello okay uh uh in answering the first question here in Ethiopia there are no the community has no any problem just getting the service from male midwives and males are equally preferred by by neighboring mothers pregnant women and other other part of the community coming for health seeking but even there are other other parts of the like eastern part of of the country uh maybe the community may prefer um female midwives than male midwives and you know the region trained more female midwives than male midwives in that uh in that part of the community otherwise as as a country there is no uh preference of female midwives and uh male midwives okay thank you very much uh that concludes our session on questions


G'day viewers, my name is Oren Thomas. I'm a principal hybrid cloud advocate at Microsoft. In this video, you'll learn about the privileged use category of advanced security auditing for Windows Server. This category of policies allows you to track the use of permissions on computers. This advice is based on the documentation published on learn.microsoft.com at the link in this video's description. This video is part of a series of videos on advanced auditing and related events that you can find in the linked playlist in the description. Some of these topics are a bit dry, but we attempted to make them so you'd be able to review information about advanced auditing in a more digestible format. As a Windows Server administrator, you should have a comprehensive understanding of advanced security auditing in Windows Server and active directory environments. Privileged use security policy settings and audit events allow you to track the use of certain permissions on one or more systems. This category includes the following policies, audit nonsensitive privilege use, audit sensitive privilege use, audit other privilege use events. The audit nonsensitive privilege use policy generates events that show usage of nonsensitive privileges. If you configure this policy setting, an audit event is generated when a nonsensitive privilege is called. Success audits record successful attempts and failure audits record unsuccessful attempts. This is a list of nonsensitive privileges that will trigger events. Access credential manager as a trusted caller, added workstations to domain, adjust memory quotas for a process, bypass traverse checking, change the system time, change the time zone, create a page file, create global objects, create permanent shared objects, create symbolic links, or shut down from a remote system, increase a process working set, increase scheduling priority, lock pages in memory, modify an object label, perform volume maintenance tasks, profile single process, profile system performance, remove computer from docking station, shut down the system, synchronize directory service data. This subcategory also contains informational events from file system transaction manager. The following events will be enabled if you configure auditing through this policy. 4673, a privileged service was called. 4674, an operation was attempted on a privileged object. 4985, the state of a transaction has changed. The audit sensitive privilege use policy generates events that show the usage of sensitive privileges. This is the list of sensitive privileges. Act as part of the operating system. Backup files and directories. Restore files and directories. Create a token object. Debug programs. Enable computer and user accounts to be trusted for delegation. Generate security audits. Impersonate the client after authentication. Load and unload device drivers. Manage auditing and security log. Modify firmware environment values. Replace a process level token. Take ownership of files or other objects. The use of two privileges, backup files and directories, and restore files and directories. Generate events only if the audit audit the use of backup and restore privilege group policy setting is enabled on the computer or device. The following events will be enabled if you configure auditing through this policy. 4673, a privileged service was called. 4674, an operation was attempted on a privileged object. 4985, the state of a transaction has changed. The audit other privilege use events auditing subcategory generates only one event, which is generated by the file system transaction manager. A transaction manager is an instance of a log. 4985, the state of a transaction has changed. This video provided an introduction to Windows Server advanced security object access audit policies. The advice in this video is based on the documentation published on learn.microsoft.com at the link in this video's description. Increasing the security controls applied to Active Directory will improve your overall ADDS security posture, but will not make your systems invulnerable. Security is always a matter of balancing what can be pragmatically accomplished by administrators in day-to-day operations with an assumed breach philosophy. I hope you found this video useful and informative. My name is Oren Thomas. You can find me at aka.ms slash oren. And if you've got any questions or feedback, drop a comment below.


Wrigley's tear mint chewing gum. The refreshing, delicious treat that gives you chewing enjoyment. Present for your listening enjoyment, John Lund as... Johnny Daly. Ben Gordon, Johnny. I've got a strange one for you. Now who's with the cease and where did it happen? It was named Luis Overrado, a $50,000 life dollar. Well, outside of the fact that not too many people own racetracks, what's so strange about it? Well, I guess there's nothing stranger than a winning ticket and a long ticket. The makers of Wrigley's tear mint chewing gum bring you John Lund and another adventure of the man with the action-packed expense account. America's fabulous freelance insurance investigator. Here's to the Johnny Daly. Friends, the makers of Wrigley's tear mint gum present these wicked adventures of Johnny Daly.  That's true of Wrigley's tear mint chewing gum, too. It's an enjoyed by millions, day in and day out. People will find that the chewing on a smooth, delicious piece of Wrigley's tear mint gum somehow will make the time pass more pleasantly. Whether you're working, driving, shopping, or just taking things easy, that good, tasty chewing gives you and Jonathan's satisfaction. So, always keep a package of Wrigley's tear mint chewing gum handy. And whenever you want them for refreshing, it's a delicious treat to you and sick. You'll like it, but it really will. Expense accounts submitted by a special investigator, Johnny Daly, at your home office. Washingtonian life insurance company, Hartford, Connecticut. The following is an accounting of expenditures during my investigation of the temperamental totem board that matters. Expense account item one, $147.35. Airfare between Hartford and San Juan, Puerto Rico. I checked it in at the Cacari of Hilton, and then made my way to police headquarters where I introduced myself to Capriano Cardenas. Captain of the police. It is perhaps unfortunate you did not check with us by telephone before coming down, senor Dalarar, you might have saved yourself the trip. Oh, why is that, Captain? It is a belief that an insurance officer in your suite of Ararado has no bearing whatsoever upon his murder. Well, what does have a... Perhaps you have heard of Anthony Randolph. Randolph? That's the same Tony Randolph who's connected with the Miami Gambling Center? It is. This is here now in San Juan. And for several weeks it has been attempting to persuade the Ararado brothers to sell him an interest in the track. How's he making money now? Two days ago, senor Luis Ararado almost physically threw him out of his office. And now Luis is dead? Yes.  Senor Albarado was last seen by his employees while watching in his office when he tracked the photos of the six of us last night. The death was told by a 38 caliber bullet. And the time of the death was approximately four o'clock last month. Where was Tony Randolph at that time? According to himself and three of his personal friends, he was at a speedpeep in his room at the Sondaro Bee Beach Hotel. So that's the request of senor Luis Ararado. Yes. I understand that Albarado's body he was found under the postboard in the infield. Is that where he was kept? We have no conclusive evidence either way. And what about that winning ticket on a long shot he had in his hand? It was a $15 ticket on Bea Maria, the winner of the fourth race yesterday. The price was $72 to win. Ah, not bad. Any idea what he was doing with the ticket? No, but it would have hardly seemed to have any bearing on the murder. Uh-huh. Of course, it is possible. The citizens are wrong concerning this, Antonio Randolph. However, I still do not believe you will find the insurance to be the result. You seem pretty sure about that, Captain. Fine. Luis and then Jose Albarado were always very close. Not only as partners in the race, but in other business and inventors personally as well. They were brothers. Yeah? So were they came in and able. I sent the car item two to two dollars in advance. Cab had fare out to the Wisconsin so he strapped. I got there between the fifth and sixth races. Made my way to the west wing of the clubhouse, where the Albarado brothers had a private office. Oh, hello. Is the senior Albarado in? Oh, I regret senior, but it is not. I am Maria Roldan, he's confident in his acceptance. Would there be anything I could do for you? Well, why don't you be back, Miss Roldan? Not for several hours in a row. Sounds like you were expecting me. But of course, because they had words that were arriving. Oh, very good. I'm fortunate if his absence makes it necessary for me to work here this afternoon. Oh, but why is that? Because part of my duties consist of asking a hostess when we have a financial day. And that seems to think I may be the right lesson to impression upon them. Yeah, I can see why. Too bad we'll have to postpone it. But perhaps not at any longer than eight o'clock in the season. At Avenida Fiedra, number 49. I see the easy number to remember. Expensive car item three, one dollar and eighty-five cents. Cads there to the condado of the Big Beach Hotel. I caught on Tony Randolph on a private party overlooking the beach. He came completely equipped with swimming trunks, dark glasses, and completely close mouthed bodyguards, hovering obtrusively in the background. Sure, I'd be glad to tell you what I can with the dollar, but I don't figure why you came to see me. Well, you were trying to buy an interest in the Descanso race track from the Alcavorados. Yeah, that's right. I came down here on a little bit of a vacation, saw a lot of the plants, it looked pretty good, so I figured I might invest a few bucks in you. How you making up? Well, I do know how these things are. I take a trip in the sun. Little boys have been playing hard to get, but anyway, it's a surprise. We're getting on okay. Little fuss with Louis Stathorado at the office the other day. Oh, fuss. We're just climbing around, that's all. Just climbing around. Uh-huh. I don't suppose you have any idea who killed him. Me? How could I know anything like that? I just met the guy when I came down here, and all I know is he seemed a nice guy, had a nice plan here, and I wanted to go in with him. How would I have any idea who would want to kill him? Just all I'd ask. Well, that's okay, Mr. Dolly. You got a 50 grand insurance investment.  Well, when you want it, and tell me what I'll do for you. Yeah, what's that? I got a few connections. You know, friends owe me a couple of things, you know? Yeah, I know. Oh, sometimes they get to talking about things like that. Shooting the breeze, nothing better to do. If I hear any, I'll let you know. All right. That'll be just great. Expense account item four, one dollar and eighty-five cents. Cab fare back to the Discanso racetrack. After that rather fruitless interview with Tony Randolph, I was hoping that Jose Alvarado would be back, and I might have better luck with him. Then as I approached Alvarado's office, Captain Cardinals came hurrying up. Oh, it's Mr. Dollar. He was just in time. Yeah, for what? My office just called. There is a shooting for home of Jose Alvarado. The report was phoned in to my office by his son for mass. What did he have to say? He was rather agitated and did not talk long enough to give details. He merely reported that there had been a shooting and requested that an ambulance be sent to the house immediately. Tomas Alvarado was waiting at the house to greet it. And so was the corpse stretched out on the living room floor. A thirty-eight caliber revolver laying beside an outstretched hand. Tomas did the honors. His name was Cuyo Mendoza, the former employee of our district. Why did you should have done such an incident? I do not know. Well, just what did he do, Mr. Alvarado? I don't know what started it. I was in the library, going over the list of four girls for my own concern. Then I heard the angry voices arguing in here. Your father's voice, the Mendoza's? Yes. There was a sound like a blow and I heard my father cry out. I took a gun from the desk and came in here. That forty-five cold automatic on the table over there. Ah, yes. As I kept running in, Mendoza fired a shot at me and I fired one in return and he fell. Then I ran over to my father. He was alive, Mr. Alvarado. He was unconscious. He had a bad heart. Whether it was a blow or the excitement of the argument, I do not know. I was putting the call for an ambulance and I took my father to the hospital and then you were there. You said Mendoza was a former employee. That is correct. He was a thermo-mutual machine operator. He was disturbed yesterday by my uncle Luis Corsteen. Now, obviously there is some connection between that to seeing with my father and possibly my uncle's death. Fortunately, there is no need to speculate when your father regains consciousness. He can tell. Might not hurt to speculate about one thing, Captain. What is that, Sr. Dollar? A bit of pasteboard under Mendoza's arm. Looks like a thermo-mutual ticket to me. At least, Sr. $10 a win ticket in just $4.3 yesterday at number 214, Bella Maria. When the homicide men arrived, Tomas Alvarado dictated the statement to them and then left to the hospital. Captain Cardenas went to headquarters. I went back to the health unit. Expense account item 5, $6.75. Drinks and sandwiches on the Hotel Veranda while waiting for eight o'clock in my rendezvous with Maria Roldan. My peaceful contemplation of the view was interrupted by two phone calls. The first was from Captain Cardenas. Mendoza's cut. The second call was from Tony Randolph. That took a little longer. Where did you hear that, Randolph? Yeah, so you did. What else does the word have to say? Nothing much. You have any suggestions? Yeah, one. No matter what kind of work you do, time to be time and the job seems monotonous. You feel tense and restless and you need something to give you a boost. Will you be surprised how helpful a stick of wriggly spear-made chewing gum can be at times like that? You see, chewing on a smooth piece of wriggly spear-made gum is a natural way to ease tension and relieve that feeling of restlessness. The easy chewing gives you satisfaction. You got a nice little lift out of it. And wriggly spear-made gum tastes good too. Its flavor is lively, refreshing, spearmint of flavor millions enjoy. Try it and see for yourself. You got a few packages of wriggly spear-made chewing gum and chew a stick from time to time while you work. Chewing this delicious gum will make your job seem easier and pleasanter. It really will. And now with our star, John Lund, we bring you the second act of your truly Johnny Dollar. Expensive on item six, one dollar and seventy-five cents. Cab fare to Avenida Pietrus number forty-nine. A swank, ultra-modern apartment building in the New Earth, San Percy section. It's well-money. And so did the lush evening gown Maria was wearing as she greeted me. How nice of you to be so prominent. Aren't you even a bit early? Well, I was hoping you wouldn't mind. Oh, how could I mind? As when a woman is dressed and ready when her escort arrives, it usually indicates she's rather important to her. Yeah. What I'm trying to figure out is, uh, why? Well, I think you should note that already, Thomas. You're always looking for reasons for motivation. Is it not enough that a woman finds you at track, even wishes to send some sign in your company? Well, I suppose it could be. What if it's not? In this case, no. I don't know. I was afraid this evening would not turn out as pleasant as I'd hoped. I'm sorry. There's no need to be. After all, you're down here on business. I can understand. I will answer your questions as best I can. Thanks. Well, suppose we start with Louis Alvarado's murder and those Bea Maria win tickets. Johnny, are you familiar with the operation of a fine mutual strike? As familiar as I want to be. Well, then you know it operates like a complicated adding machine. As each ticket is punched out and sold, the stores appear on the illuminated board in the infield. At the end of this race, the amount of money that has been bet is paid out on the winning horses. It is a foolproof system, entirely automatic. Neither more nor less money than has been bet can be paid out. Well, you've spelled it out pretty clearly. Now, why? Johnny, $21,000 was bet on the fourth race yesterday. As of 6 o'clock this afternoon, more than $26,000 has been paid out on winning tickets. Over $5,000 more than has been bet? Yes. You sure about that? I saw the head book keepers taking fun at this closing time. Was the overage all paid out on $10 win tickets on Bea Maria? Yes, it was. Has this ever happened before? I do not know. Only Jose and Louisa are keeping figures. It is only because I was there alone today that I happened to see them. What does Tom ourselves rather do with the track? Well, he takes much charge of regard and protection, sir. And who we owe Mendoza? He operated a fine mutual machine. At a $10 window? Very interesting. So interesting that it would interfere with how plans would seem. There'll be other likes, Maria. Expensive car items 7, $2.40. Cab fare to police headquarters. Captain Cardenas didn't seem to be too impressed with my latest information. No, Senorita, I do not believe it is possible. I can think of no way in which the party mutual system could be fixed. Well, the extra $5,000 paid out on Bea Maria must mean something. We have only the word of Senorita Roldan that such a sum was paid out. Well, the bookkeeper can verify it. I will check on it, of course, Senor Dala. But this much I can tell you now. It is mechanically impossible to fix the tote board or to punch out any tickets after the race begins. What about forgery? Well, that, too, would be virtually impossible. Each ticket has a special picture code printed upon it and the codes are changed with every race. That sounds pretty foolproof, gentlemen. Believe me, it is, Senor Dala. And even if it was not, what possible connection could all this have with the murder of Luis Salvarado? I wish you hadn't noticed that, Captain. It's been bothering me, too. I borrowed a headquarters car from Cardenas to take the burden off the cab fare items on this expensive account and drove out to the Condado Beach Hotel. Tony Randolph was in the gambling casino. His loan wasn't quite as expensive as it had been earlier that day. Oh, kid, Dala, what's on your mind now? I make it snappy, will you? I've got things to do. You sound like a dice of inviting the hand that rules it. So they're cold. Come on, let's get on with it. Sure. Just tell me who you're gunning for and you can go back to the tables. You better clean up that crack, Dala, and give it to me straight. You're no philanthropist, Randolph. You didn't pass along the word this afternoon out of the kindness of your heart. What's it to you why I'd pass?  It gets you off one, too. That's supposed to mean something? Yeah. If Jose Alvarado is sent up for the murder of his brother, you might have an easier job getting hold of that race track, sir. And you'd save that 50 grand in insurance. So where's your beef, Dala? No beef. If it works out that way. Why don't you make sure it does? Well, maybe I need a little professional advice. Let's take a look outside. Yeah, sure. Okay, Dala, what's that? It's this. Somebody figures a way to beat the Mutuals. Luis Alvarado tumbles to it. So he's kept quiet with a 38 caliber slug. That couldn't make sense. Only they tell me the Mutuals can't be beat. They could be wrong. How wrong? There's no law against counting winning tickets a day or two after the race. Well, you'd have to get the tickets first. Or print them yourself. What's it take to do that? You have to get into the track when it's closed. Get hold of the codes and a roll of ticket paper. And know how to operate one of the machines without flashing a toad board. Takes a lot of doing.  It's practical. Yeah. Anything else on your mind, Dala? Well, no, I don't think so. I do not know, Senor Dala. It is still a theory without proof. Well, the bookkeeper should be able to supply us with some. I'm afraid not. Oh? Why? He was called away from the track after the seventh race from family business. He died in a traffic accident on the way. You're sure it was an accident? Oh, there is no question. An unfortunate occurrence for us. Yeah, even tougher for him. Yes. Of course, we can always check the records of the track, and in that way it's your problem. Sure, go ahead. Captain Cardenas, I think perhaps this is of interest, Senor Dala. What is it? The garden farm beside Mendoza's body. It is registered to Senor Jose Alvarado. Before leaving the office with Captain Cardenas, I found time for one short telephone call. I think I'll be able to drop around in about an hour, Maria. The hospital told us that Jose Alvarado's condition was still too critical to allow questioning. So the captain and I went out to the castle racetrack instead. The full moon was taking a siesta behind a bank of clouds, and the dim, shadowy bulk of the grandstand looked deserted. The watchman at the gate assured us that no one had entered the track since closing time. I think perhaps we are being rather foolish, Senor Dala. This is nothing to be learned out here since this hour of the night. What about the bookkeepers report? We could wait until the morning. Maybe it wouldn't be there by then. However, the hospital assured me that Senor Alvarado could not be released for some time. Well, I won't do any harm to look operating one of the paramutual machines. By hand, there is an entrance to the cages at this time. Not here. What about Format Alvarado? Of course, for an ambulance. I'm hurt. An ambulance. I don't die out here. I don't think your Uncle Louis wanted to either. On the way to the hospital, Tomas Alvarado gave us a confession to the murders of Louis Alvarado and Julio Mendoza. Both were motivated by their separate discoveries of Tomas' little plan for getting rich off his father's racetrack. When the surgeon finally convinced him he wasn't going to die, he decided to retract and left a few details unanswered. But he had told us enough to satisfy Captain Cardenas. So, it was as I told you in the beginning, Senor Dala, the insurance had nothing to do with this matter. Yeah, but you've got to admit Jose Alvarado was involved. Apparently, only to the extent of a blackmail offense by Julio Mendoza. However, that need be no concern of yours. The unfinished business we will take care of in due time. Say, that reminds me. I've got a little unfinished business of my own. Maria was waiting for me as agreed. She's even more lush and lovely than she had earlier. She recommended a nightclub. On our way downtown, I gave her a short regimen of what had happened. So, it was Thomas who was responsible.  Why is that? He could have had everything he wanted. He's only been willing to wait for it. His father's money, you mean? See, it would have come to him in time to do this deliberately or rather murder because he wanted the money now. Well, who knows. Maybe somebody talks him into it. Maybe it's for some reason. Maybe both together. It's a poor thing to do. Oh, well, then why should we concern ourselves about it now? This is our life, John. There will be nothing more to spoil it. Yeah, I think that was probably it. What? A collaboration. Some woman talking into it. He had to be working with somebody. He couldn't have cashed all those extra tickets himself. He had their giveaway. So, somebody else helped him to his spot on our own. Oh, John, you're talking about business again. What did you do with the tickets, Maria? Sell them on a discount to some fence? I'm not being very funny, John. If this is your idea of a pleasant thing... It's not good, Maria. You tipped it when you said you saw the bookkeeper's figures at the end of the racing day. Too bad you didn't know he'd left the track at the end of the seventh race. It was a good try at keeping your own skirts clean. But it didn't work out. He could put it in headquarters. Yeah, let's go in, shall we? Expense account item 8, $38.15. Hotel bill and miscellaneous. Expense account item 9, $152.10. Airfare back to Hartford. Expense account total, $354.95. Remarks? Jose Alvarado was still too ill the next day to have any visitors. So I left Puerto Rico without seeing him. Perhaps it's just as well. How can you give a man $50,000 with one hand and take away his son or the other? Yo, show me Johnny Dollar.


Who is the Tenth Man? The Tenth Man is the one man and ten in your community who needs or will need psychiatric care. He may even spend some part of his life in a mental hospital.  If he's an old man, for example, and feels that life holds nothing more for him. Ladies and gentlemen, this is Ralph Bellamy. Our story is called The Old Folks at Home. It concerns an old gent who felt definitely not at home when he came to live with his granddaughter and her husband in the big city. Strange that Grandpa Barrett should feel ill at ease since Maj really liked the old man and tried hard to make him happy. And when Maj took anyone under her wing, she did a thorough job. Hi. Huh? Where's Grandpa? Grandpa? I don't know, dear. Didn't he go out for a walk a minute ago? Oh, well, how should I know? I've been busy putting the baby to bed. Well, I guess he did go out for a walk. Hank, you really ought to watch him more carefully. Oh, Maj, you worry too much about him. Grandpa won't get into any trouble. He may be old, but he's not senile. Nevertheless, I promised Aunt Edda I'd look after him. She was going to put him in the Old Folks' home. Well, we've saved him from that anyhow. But you know, Maj, we're not doing all we should for him. What do you mean, Hank? Well, we've provided a home for him, but, well, maybe it lacks something. What could it possibly lack? He has his own room, complete privacy. No responsibilities. That's just it. No responsibilities. Nothing to do. Well, you don't even let him help around the house. Help around the house? Why, Hank only last night at the supper table knocked over the water pitcher. So what? I knocked it over last week. Does that make me senile? Oh, you're impossible. I'm only trying to point out that... I think I hear his step in the hall. Have a nice walk, Grandpa. Well, not so nice. Now, it's pretty crowded in this town. Folks don't care if the jostle you're right off the sidewalk. Now, Grandpa, you'll just have to learn to jostle them right back. No. No, I'm too old to pick up any new city ways. We'll have to get you a playmate, someone to talk to. Playmate? Don't talk to me as if I was a child. Oh, I'm sorry, Grandpa. I just meant someone for you to talk to. You know, someone more your own age.  Don't see many old folks around in this neighborhood. I saw in the paper the other day something about the increase in the number of older people on account of improved health conditions, you know, but I never see any of them around here. Maybe they all hang out in the park. Hank. Huh? What park? There's one about 10 blocks south of here. Well, why didn't you tell me? I'll have a stroll down here tomorrow and have a look at it. But it's 10 blocks. Well, 10 blocks ain't far. For gosh's sake, stop treating me as if I was delicate or something. Grandpa, we just don't want you to exert yourself.  Come, Grandpa, you know we want you to be happy in our house. Well, then leave me be, Hank.  Good night. Don't slam the door, Grandpa. You'll wait to... Oh, Hank. We've got to make him happier, but what can we do? You heard what he said, Madge. Leave him be. Hi, Pop. Oh, hello, obviously. Nice day. Yeah. How come you're not at the club? Oh, I don't belong to any clubs. I'm sort of new in this town. Just moved into my granddaughter. I get it. Feeling kind of lonesome too, I guess, huh? Oh, no, no. I'm sort of glad I got a lot of time to myself. I want to read up a bit and I want to think some things out. Yeah. Well, if you get tired of reading and thinking and feel like a bit of socializing, the clubhouse is that big red brick building on Main Street across from the park. Just ask for Miss Lindsay and tell her I sent you. Well, thanks very much, officer, but I don't think... Gray, did you say that place was?  Well, I don't say that it makes much difference, Madge. If he doesn't want to tell us where he goes every day, it's his business, I guess. I wouldn't mind if he just tell me. After all, Hank, anything can happen to a man who's practically 80. Oh, he's a healthy old duck, and wherever he's going, he's having a good time. He's been as happy as a lark all week. Well, I'm not happy as a lark. He was late for supper last night, and from all indications, he's going to be late again tonight. And on top of that, he won't tell you where he spends his time. I think you're smart. Oh, forget it, Madge.  After all, it's what we all want, isn't it? Yes, but... No, I'm not giving up. I'm going to trail him tomorrow. I'll find out what he's up to. Good morning, Mr. Barrett. Good morning, Jake. Where is everybody? Oh, they'll be along soon. Not everybody gets up as early in the morning as you and me. See, Jake, how long has this club been operating? Oh, it's been going on for more than a year now. Sure was a good idea. Who started it? The welfare department. The welfare department? Within this charity? No, not exactly. I look at it this way. They have libraries and parks for people, don't they? So why not a place for us older folks? Yeah, yes, I guess you're right. Why not? Certain years of godsend. I know it was a lucky thing for me. I found out about this place. Having something to do and people to talk to kept me from blowing my top. I don't know when I felt so good. Here I can work all I want to on my painting. Ever in my life did I think I'd make an artist. But look, look here. Yeah. See, gosh, that one of the parks sure is good. How do you like that spot of color right there, the little girl with the balloon? Yeah, just like real. Miss Lindsay showed me how to do that. And next year, I start sculpture. Miss Lindsay sure is a wonderful girl. I love her like she was my own daughter. We couldn't have a better leader. She knows what we like. No fussing, no fretting. But the thing she gets done. Well, she got me interested in working with the jigsaw. You know the electric one? Of course I know it. I made four ship models on it last year. I'm making a hanging sheriff. I saw it. Very nice. Won't manage to be surprised when she sees it. Good morning, Mr. Barrett. Mr. Field. Good morning, Miss Lindsay. Miss Lindsay, is it all right if I start the bandsaw? Of course it is. You know where the switch is. Oh, sure, sure. Well, I'll be getting back to my still life. See you later, Mr. Barrett. Okay, okay. By the way, Mr. Barrett, have you told your granddaughter about the club? Do I have to? No. But I just thought she might be worried. Turn nation, that's her. Man, how did she find out? Grandpa, what is this place? What are you doing here? Hello, mad. Oh, is this your granddaughter? Grandpa, don't you know we've been worried sick not knowing where you've been? What are you doing with that electric saw? You'll cut yourself if you're not careful. Get off at once. Oh, it's quite safe. And he's very efficient with it. Well, sure, Madge. Oh, I don't believe you've met Miss Lindsay, our leader. How do you do? No, I'm so glad to meet you, Mrs. Dobson. I guess you too would have met sooner. But, well, Madge, I didn't want you to find out about the club until I'd finished this. Grandpa, what's that? It's a hanging shelf for knick-knacks. It'll be real nice when it's finished and polished. Well, if you're really interested in this sort of thing, we'll buy you a saw like that and Hank can help you make things with it. Why can't I use this one? Surely you don't expect to come here again. Who would bring you? My own two legs would bring me. Same as they've done for the past two weeks. Well, talk about it at home. Get your hat, Grandpa. You mean I can't come here anymore? That's right. Miss, what's the charge? Oh, there's no charge. This is a municipal community center. Oh, I see. Well, thank you. Come along, Grandpa. Well, Miss Lindsay, I don't want to go. Can't you do something? Well, I really shouldn't interfere. Does this club mean as much to you as all that? Well, it's everything to me. It's home. Well, I'll go and talk to her. Thanks, Miss Lindsay. Uh, Mrs. Dobson. Yes? Mr. Barrett's collecting some things to take home. Would you step into my office for a moment? I'd like to talk with you. Quite very well.  Thank you. Uh, I was so upset at seeing Grandpa with that saw. I'm afraid I didn't catch your name. Miss Lindsay. Oh, Mrs. Dobson, I'd be awfully interested in knowing exactly what you have against this club. Well, I have nothing against the club. It's very nice, I suppose, but it's just that it's not for Grandpa. It's for homeless people and people like that. Oh, this club was intended for lonely people. But Grandpa's not alone. My husband and I are very fond of him. It's possible for a man like Mr. Barrett to be lonely, even among people who love him. And we will get him one of those saws if that's what he wants. Oh, there's no need for him to go to strangers for things his own family can provide. If he likes to keep busy with little tasks like that, I'll let him mind the baby sometimes. Oh, I guess I have coddled him too much, just because he's such a great responsibility. I hope you don't think I'm rude, Mrs. Dobson, but I can't help feeding that you are making too much of the responsibility of Mr. Barrett. But he's so old, does everything have to stop simply because of that? Remember, he's led a very active life. It's difficult for him to sit around and do nothing. Besides, he needs companions of people who are of the same age. Yes, I suppose that's true. You see, one of the advantages of this club is that it gives old people a place where they have a status. Most of our members feel that they really belong here. Won't you let Grandpa Barrett stay with us? Well, I don't know. Oh, he'd think we were trying to get rid of him. Oh, no, he wouldn't. And you needn't feel guilty because you can't relieve grandpa's loneliness. My dear, it's only because you're not 80 years old that you can't understand. What are you going to tell him? I guess it'll be all right. Good. Come in, Mr. Barrett. Well, I... I'm already madge.  You'd rather stay, wouldn't you, Grandpa?  I know it will. But here, I can do things. Here, I've got friends. All right. All right. That's plain enough. You can stay. Can I really? Yippee, wait till I tell Jake. Maybe next year I'll take up painting. Grandpa Barrett and Jake Fields were lucky because they happened to live in a city which supported a community center for the agent. There, they were able to defeat the feelings of loneliness and rejection, which might have led to quick deterioration and a possible mental collapse. But not all of our old folks are so fortunate. Far too many of them are left to their own devices. Is it right to neglect them?  Remember, the old folks enjoy socializing just as much as the young ones do. Nobody likes to be lonely. You have just heard Ralph Bellamy as narrator in The Old Folks at Home, a presentation of the National Mental Health Foundation and other organizations dedicated to the preservation of mental health.


Keeping on our journey here at the Research Symposium, I'm here with my friend Gaby, and we're going to talk a little bit more about your research project and the power of the Healing Touch and Comfort Care. So tell me a little bit about why you chose this project and what the research entailed. Yeah, so I was actually located at a hospice facility called the Fairfield County House in Stanford, and this is something that I never really thought I saw myself doing. The elderly population isn't really what I want to do in nursing, but I was just observing the nurses and the CNAs at the facility and just the way that they interact with their patients. This is actually a picture of the house right now. It's not a hospital at all. It looks like Chip and Joanna Gaines designed the inside of it. It's a six-patient facility, and just the way that the nurses interacted with them woke them up with a kiss on the forehead. I thought that was something so special and not seen as much in the hospital setting, and just like holding their hand while they were feeding them and just as they were giving them medications, just like sitting on the bed next to them, especially with patients that can't hear, speak, or see. It was just, it made such a difference in their care and then their outcomes as well. Absolutely. We were just chatting about this right before our conversation that the end of life is a really tough time for families. So I want to know what you learned during this research. What are your biggest takeaways, and what do you hope to bring with you after graduation? Yeah, so from this project in specific with COVID and everything, there's been such a lack of connection and physical touch, and physical touch promotes the production of hormones such as oxytocin, dopamine, and serotonin, which are the hormones that make you feel warm and fuzzy in your body. So just by producing those hormones, it can actually help you improve your health, your comfort, and actually for the nurse as well, it's really good to prevent burnout and remind you why you chose this vocation as well. Absolutely. So impressive. So you did a lot of this research, of course, independently. You're a one-woman show here, but tell us about your professor's support or faculty staff members that helped you along the way. So I was actually prepared with Dr. Donna Coletti. She's the nurse preceptor at my school, and she actually created the Canary Neck Center for Palliative Care in the Egan School. So she is a doctor in palliative care and is the doctor at this facility. So she was able to have me be a nursing student in the facility. And then I was paired with the RN Doreen Burgos up there as well. She was the one that showed me the ropes of the place in the facility and someone that I actually physically followed around and passed meds with and fed patients with and everything like that. Fantastic. I'm sure it was great to have that mentorship. Yes, for sure. So bringing it here today to the symposium, tell us a little bit about your experience. What has it been like talking to your peers and staff around Fairfield Community? It's really cool. Like, everybody, we're always in scrubs, so I feel like it's different to see nursing students in business casual things, and it's just like a great way to end my time here at Fairfield and just doing research that is really important to each individual nursing student I think is really important. And I've been loving talking to professors and talking with you about my project and everything. So it's just been a great experience. Absolutely. So last but not least, Gabby, what's next for the project and for you? So for me, what's coming next is that I accepted a job at Children's Hospital of Philadelphia. My dream is to be in palliative care for pediatrics. And with this project and this research, I've learned the importance of physical touch and just holding a patient's hand, holding a family member's hand in a tough time, especially at end of life. I think that's really important. And just life in general, I've noticed, like, when my friends and I are talking and it's an emotional conversation, just holding their hand really does make such a difference in my response and in their response as well. So special. Well, thanks for sharing all of your hard work. Thank you so much. Congratulations. Thank you.


In this module, we will talk about microbial growth kinetics. But in this module, we will talk about different methods which are used for the estimation of the growth. As we discussed in previous modules that growth is divided into four different phases lag, log, stationary and decline phase. But these four phases can only be determined if we actually know the growth. How we can estimate the growth of a cell of a microorganism? So in this module, we can see that there are different approaches to estimate the growth. Here you can see there are six different approaches by which we can estimate the microbial growth. The first method is turbidity method and the second is total count, third is the viable count, fourth one is biochemical analysis, fifth that is the physical method which called as graduated capillary tube and the last that is dry or a wet cell mass estimation. So as concerned that turbidity methods, in this method when the growth happen the number of cells increase due to the increase in the number of the cells, cell culture become turbid. So due to the turbidity when we check on the spectrophotometer, basically that measure the cloudiness and spectrophotometers act on the beer-lamored law. As you can see in this slide, this is beer-lamored law which actually measure the amount of light that pass through the suspension of the cell. If there is a more turbidity, then there will be the less light is allowed to pass through the culture. So spectrophotometer give the reading in two terms. One is absorbance and other is the transmittance. In this equation, you can see the relationship between the absorbance as well as the transmittance. So in this picture, you can see that how the spectrophotometer act. In this slide, you can see that this tube is blank, there is no growth and the light is directly pass and then there are 100% transmittance and we can say that absorbance is 0. So on other hand, in the second, you can see here the growth is and the number of cells are in the capillary and then there is a few lights. One beam is only allowed to cross through. So we show that the transmittance decreases as well as the absorbance increases. So this one is the method by which we can estimate the growth in term of number of cells as the cell increase turbidity increase which can be easily measured by the spectrophotometer. But there are some different limitations in this method because sometimes when the medium color is dark by the utilization of the substrate, turbidity also increase. Sometimes that can affect on the estimation of the growth. So we need an alternative method for the microbial growth. So the second method that is the total count. So the total count is basically you can say that cell growth measurement in which we can also count the total cells that include the viable cells as well as the dead cells. So the total count is mostly done with the help of a slide which we called as hemacytometer so this hemacytometer if the culture is very diluted we can directly use that culture. But when the culture is very turbid then we have to first dilute that sample. So in this picture you can see that what is hemacytometer. So here you can see that hemacytometer is basically a glass slide in which there is a standard cavities are formed. You can see in this slide here there are different boxes small box, medium box and large box. And the large box has the diameter you can say the diameter that is the width, length and the depth. Most of the hemacytometers as concerned the large box that is 1 millimeter long 1 millimeter in width and then 0.1 millimeter in its depth. So by counting the cells in different compartment we can estimate that what is the total count in the culture medium. As concerned the viable count viable count is mostly done in the petri plate having some solid media which mostly called as agar medium along with other supplements. So the viable cell is defined at the cell which is able to divide and decrease in the cell number or sorry increase in the cell number. So the viable count the normal way to perform the viable count is to determine the number of cells in the sample which is capable of forming colonies on a suitable medium. So here we can assume those cells which have the ability to grow on the cells then we can count on the plate that is basically the colony count. So as there is the count of the cells we can call as colony forming unit CFU that is mostly done by a simple counting of those all the colonies. So sometimes when we do the viable counting we have to dilute the samples gradually which normally known as the dilution method. In this picture you can see that first of all if we have a sample grown in a flask you take one ml of the sample and we dilute into a specific amount of the volume and then gradually we diluted and we form a different types of dilution and then we take the sample out of each dilution and we culture on the plate and then you can see here the number of colonies decreasing as per the dilution is increased. So by this method we can easily estimate the viable cells present in any culture but as concerned the biochemical analysis it is the direct biochemical measurement of some cellular components such as nitrogen content, total protein, DNA material or any special other compounds which is not the part of the medium. So as concerned the indirect measurement of the chemical activity such as the rate of oxygen consumption or the rate of carbon dioxide production or vice versa. In short the we can use the biochemical analysis by measuring the rate of respiration. So other fifth and sixth method that is the graduated capillary tube that is mostly used in a yeast culture when there is a culture we centrifuge the yeast culture or a bacterial culture in a graduated capillary tube. So when there is a specific volume and then after the centrifugation we estimate the height of the pallet then we can estimate the growth of the culture. And the same way the dry and the wet mass we just centrifuge and then weigh the pallet as a wet mass or then we dry in an oven and then we can estimate the dry weight of the cell. So by these six different methods we can estimate the growth in any fermentation vessel.