Hello, and welcome to Adventures in Small Business. The program is a collaborative effort by the Hawaii, the US Small Business Administration, Hawaii District Office, the Hawaii Small Business Development Center, the MINK Center for Business and Leadership, and the Veterans Business Outreach Center of the Pacific. The program is to showcase local entrepreneurs and other small businesses and their starts and to hear about their adventures. I am Laurie Hiromatsu from the Hawaii Small Business Development Center and today we're fortunate to have two entrepreneurs, Nicholas Comfort and then beyond Dablan, correct? Founders and owners of Pervet Donut Stop on Kona Street. Welcome, and thank you for being here. Thank you. Could you please share with us your story? We can start off with your backgrounds, how you started and a little bit about each other. Okay, I'm Nicholas Comfort. I'm originally from Oregon. I've been out here about 11, actually a little over 11 years now. Pretty much the whole time I've been here and then even back home was in the service industry in one form or another, from serving coffee houses, from actually serving tables to bartending. Yeah, and that's, we actually met through bartending. Hey, Oregon? Hi here. Yeah. He doesn't make it off the island. Yeah. My name is Breon Zablan, born and raised here. Same thing, work in the food and beverage for 15 years. And everything from dishwasher to manage. Bartending most of my time. Then at that point, I worked at the hotel and that's how I met Nick. So where did you first meet? And how did you come up with this idea of a donut stop? We originally met at the Modern Honolulu, where we both worked, bartending. And then, I mean, we were there working together for four years or so like that. And the idea kind of got sparked by starting a bar, kind of getting out of working for someone else and starting a bar. And then as we dove into that more, it just kind of became obvious to both of us that we didn't want to get further into the nightlife. It was a thing to try to get out of. He's got kids, he's married, those types of things. I'm coming home at six in the morning type of thing. It's just not real fun. And you can only do it for so long. And so that kind of slowly transformed into a coffee venture. And then that slowly transformed into a donut venture, which we still sell coffee as well. So it started off where you first was talking about having, being entrepreneurs, having your own business, and then it went from a coffee shop all the way to a donut stop, right? Yes. So how did it morph into that? And then how did the name purvey? What does it mean or did you come across that? Yeah, so we, like you said, we started off as a coffee venture. Couldn't find the real estate to do what we wanted to do. Being Hawaii, you know, there's only so much land. Yes. We're lucky enough to meet up with Yolani Center and they wanted some kind of food slash coffee or a shot in there or business. And at that point, we're kind of going over donuts and seeing what else can we do besides everybody's coffee. And we had this great idea that we're gonna make donuts. We've never made a donut before in our life, but we're gonna do it. How did you learn? Okay, we're going from a bartender skill set to now a baker, donut maker skill. So how did you learn and what was the process? How long did it take? Part of it was funny because I brought up the coffee idea because I have history working with coffee and those types of things and trying to convince him, say, hey, you know what? I like the idea of going to business. I like this, but we're not doing the bar thing. All right, let's do this coffee. He says, I don't even drink coffee. I don't know anything about coffee. It's the same thing as bartending. It's just a different product. You don't deal with angry drunks. You're dealing with people in the morning and trying to make them happy. It's just a different atmosphere. And then transforming into the donut thing, it was seeing the niche that something, like a product that's been around for hundreds of years, it's proven itself to last. And there's a lot of opportunities with making unique experiences through it, not just the product, but really making a one-of-kind experience that no other donut shop, we believe, has done what we do. So then at that point, we pretty much committed to it and started researching everything. We could watch every YouTube video and we actually linked up with a pastry chef in San Francisco, flew over there. They kind of taught us the basics of at least how to make somewhat of a donut. And then from there, it was more focused on the business side of things and figuring out how to get doors open and all the hurdles that came with that. And then testing things in our machine because it was completely different. So there was a lot of, yeah, a lot of trial and error. So this donut chef or pastry, how did you connect with the person? Just cold called him or somebody introduced you to them? We had a mutual friend, our mutual friend kind of put us in contact. We were up there and we basically had about two days. We stayed there three days and we went through different mixes, different recipes. It's kind of a funny story, but we've made about 200 plus donuts and we're in San Francisco, going to the hotel we're staying at and saying, I just don't want it. To anybody, you just walk in there and asking people to try the donuts. Essentially, pretty much, yeah. Especially the hotel, like anyone, they knew us so we'd take them in and just drop them off the whole staff and get their opinion on them. The feedback, you can change the recipe according to that. So this recipe is now your recipe? Yes. Nice. How did you come up with the name? So the name, we wanted something that's catchy. People don't forget it. Lengthwise, there's a lot that went into thinking of how many letters, how many things you want to do. We really want to build a brand, not just have a name that goes like any other business and stands alone. Pervade, there's a lot of meanings to it to us. There's purveyor, which obviously you're making and selling goods. To purvey is to express a message or a view. So for us, this is our way to purvey ourselves and different things that we say messages or views. And to us, it's just like an environment and kind of a culture we're trying to create. We wanted to purvey aloha as well. Like it's one of our biggest things. Purveying that message of just love and having fun, enjoying life. Enjoying the product, enjoying what you're doing. Exactly, the experience. That was something really big for us. It's important for you both. And then the logo, your unicorn. Did you, how did that come about, idea, and what does it represent? It honestly started from a Dr. Pepper bottle that came in one time and it had a unicorn on it. And we're like, you know, that is really funny. It wasn't this one, but then we just started playing with the idea because we had been working on a logo for quite some time and just trying to find something that fit. Something that tied into Hawaii, all these things.  Nothing fit what we were looking to do. And so this concept really came from, hey, here's something that has nothing to do with donuts, but it makes people smile. And that's the biggest thing. They walk in and this is the first thing they see. That's, it automatically makes them smile or laugh. So that was kind of the idea behind it. And then it just kind of growing from there. It just caught on to all ages, across all different divides. Everybody likes to recognize it's a unicorn. Yeah, yeah. And it's an interesting market that we didn't know the existence of people love unicorns.  The selfies, huh? Yeah, yeah. Self pictures. So what has your experience been working with Hawaii Small Business Development Center and how did you register? Can you just kind of walk some of some people who are looking to start a business? What are your experience from? Startup, registering, all the way through. Share some insights and maybe stage advice of what you went through. I would say sort of like starting up, there's, I mean, there's a lot of unknowns. There's a lot of questions. There's a lot of hurdles that you see in front of you where when we got connected with the Small Business Development Center, it just opened doors and put us in connection with people. It's a reliable source that you can trust where if say I need to try to find a banker or a lawyer, I can cold call 100 lawyers, but I don't know which one has a reliable reputation and with the Small Business Center, that's one thing that we were able to get. We went in and said, hey, you need to trademark. Here's three lawyers that we suggest or recommend and from that to funding, putting us in connection with different banks and people higher up in the banks that can help us try to build those relationships. Yeah, I mean, working with you guys has been awesome. You guys, any question we have, you guys are quick to answer, quick to help. And you guys are knowledgeable on it. Us being entrepreneurs and new to this whole thing. I mean, like you said, we worked in bars. Totally different from running our own business. So it was just the resources that you guys provided for us and helped us. Well, I'd say that other big thing. So obviously the grant side of things that you've kind of put, I mean, those are a lot of things that I think they're out there for people to find if you're searching for them, but as you're building a business, you don't really put time into doing those things. So having you come and contact us and say, hey, you know, this grant is available and this is something that you guys could qualify for. And things like that, I think are huge too. I'm glad. I'm glad that the Small Business Development Center is able to assist you and we'll also be here wherever you need it for your journey. Thank you. As you build your business and continue to grow.  Multiple. Okay, what is the biggest one you could think of? Top two maybe. I would say trying to get our doors open. We had so many roadblocks in the fact of getting it open and we know there's times that we look at each other and we're like, we're all in. And it's a scary feeling, but it's a leap of faith you gotta take. At that point, every day it's a new, we're learning something new. It may be a new problem. It may be something that we dealt with before, our machine, anything of that sort.  Not getting afraid of it, realizing, hey, let's fix this, let's get this going again. What has made you overcome it? What element do you think made you be able to push beyond and go over that hurdle? Just kind of having, I think for us, it's having a bigger vision and having a goal from starting the donut thing, you know, it's all of our friends that are in the bar industry and us telling them, hey, we're gonna open a donut shop.  Yeah, yeah, and then I think the other thing is just realizing through the process that people that you always think know everything, don't know everything, and they've been where you're at, asking for help, finding those people that have done things in business and not being afraid to ask them because most of those people are more than willing to give you advice or help you in any way they can because they've been there. That's important, right? Seeking out assistance early on before it becomes a really big issue. How about passion for your business? Is that something that, you know, is underlying all of that that helps you because you love what you're doing, you have a vision and you're committed to doing it? Is that? Definitely, I think passion is one of the biggest keys in, you know, running a business. If you have passion for it, you know, you're not working, it's not work. It's something that you love doing. We love pervading our message of who we are, bringing forth, you know, happiness, aloha. When people come into the shop and their smiles, working at a bar, you don't give somebody a drink, they get mad.  Isn't it funny? Yeah. Well, we're gonna be coming up with our short break, but just to work quickly, you know, so passion, understanding, I guess being able to reach out for assistance and understanding how to break it down piece by piece, is that the way to give the subscribers? Everybody's been there. Anyone that you look forward to or look up to has been there at one point or another, so realize that not everybody knows everything. Yeah, that's a good realization, right? And then so you have other mentors besides SBDC who help you, is that another? Yeah, I mean if we have lots of mentors through, I mean even books and things like that, I consider those mentors. We've had a lot of people that have helped us in one way or another that are mentors. Yeah, we've taken on as many as we can. Always learning, always learning. Gonna go do a break now, thank you. Thank you. Aloha, my name is Duretian. You are watching Think Tech Hawaii. I will be hosting a show here every other Wednesday at 1 p.m. and we will be talking to a lot of experts and guests around sustainability, social justice, the future here in Hawaii, progressive politics, and a whole lot more, so please tune in and thank you for watching Think Tech Hawaii. Aloha, my name is Mark Shklav. I am the host of Think Tech Hawaii's Law Across the Sea program. My program airs every other Monday at one o'clock on Think Tech Hawaii. Most of my programs deal with my own life and law experience. Recently, I interviewed Alex Jampel, who I have known for over 30 years, about his voyage across the sea as a lawyer from Tokyo to Hawaii. Those are the type of stories that I like to bring and like to talk about. Human stories about law and life. Aloha. Hi, welcome back to Adventures in Small Business. Today, we have our guests as Nicholas Comfort and Bjorn Zablan from Prevey Donut Stop. Can you share with us what kind of advice would you give to people who are just starting out or considering opening a business, whether it's a donut shop or a clothing store or whatever it may be? Don't open a donut shop, yeah? No. Just keep on going, don't give up.  Seek help, you know, all the way to the business center and just keep up the drive. So if you had to do something differently, what would you have done differently? Looking back to your start. I don't think there's enough time, huh? Yeah. What jumps out at you the most that I wish I had done this a little bit differently and I think maybe we have avoided or helped us financially or why? Honestly, we had huge problems with construction, but I mean that's... That's very common. And that's also what got us to the brink of, hey, we have to open doors tomorrow or we're like, we have no money. Yeah. Yeah, I think a little more due diligence on that side of things could prevent that. Yeah, off the top of my head, that's definitely... That's one of the things, the biggest thing has been the construction understanding, giving us a little more time. Is that what you think people would know or just better understanding of the process? I think a little bit, well, I mean, a little bit of everything, but more so just a little bit more due diligence on the people you bring on to do these and how credible it is and those types of things. That's good to know, so a licensed contractor using all those people. Right, because if your budget is only X amount of money and they say it's gonna be three months and ends up being six months, well, that button, your reserve cash is now gone and so those are the things that disappear pretty quick. So having a cushion is important when you start out, right? A cushion off of a cushion. Yeah, three cushions. Two cushions, so construction period delays and ramp up period for your business as well as additional unexpected delays. Yes, absolutely. What was the pivotal moment in your business that you felt like, oh, this is... We're now getting traction and we're feeling more comfortable about the decision you made to become a doughnut shop owner? I think for me, it was probably when we met the Cal Commies with the Yolani Center.  When you have no experience, nothing proven, so it's really selling yourself as an entrepreneur and an idea and saying, you know, we're gonna do this. So for them to give us the chance, that was when it was like, okay, now focus four, we've got a lease, now it's, how do we do this? That's what it was. And then the accounting system, we always talk about as business advisors, we always talk about an accounting software system. You folks have one, you folks have been using one? Yeah, at first we were using, we actually did have a bookkeeper when we first got started just for the fact that you're trying to do so many things at that point. It's the last thing I wanted to try to do. We did take our own books over and we just use a QuickBooks online software which is so convenient and very easy to do. And quick. And I noticed whenever we meet and we talk about, okay, how are you doing? You first really understand your financial statements. How critical is that, do you think, for your business? Very critical, I mean, learning every aspect of your business is critical. From day to day, day to day agendas of what you have to get done to, I mean, even, you know, making sure the donuts are coming out a certain way, the glaze is a certain color, everything is critical, and the financials is one of the most critical things out there. Yeah, I think with the financials, it's understanding percentages of where, you know, your employee cost should be, your product cost, and at the end of the day, your bottom number, what margin are you trying to make and what's realistic, and monitoring those on a regular basis to know if your product cost is a little high, why is it high, you know, your employee cost, things like that, just trying to figure out how to get those numbers and having goals of what numbers you want and how to get there. When you started, did you have a business plan? Projections, right? We did. And it helped you as a road map?  We can get some back. Yeah, we can get, I guess, is the word. Yeah. With the numbers originally, but we did have people on Eolani's side looking at it that, you know, what they're doing, and they know numbers, and that gave us a very quick sense of how to get, you know, what are we looking for, and it's like, this number's too high, it should be around 25%, this needs to be here, and so just that little mentorship right there gave us a knowledge of, okay, this is where they should be, and how to get there, and yeah. But it is good to have that business plan as a road map, because it is like your blueprint for your business, right? I mean, it's evolving, or it's a changing document, living document, so you can change it up, like with a lender, you change it up accordingly, and then the projections help you budget yourself for the change of time as you launched it. Did that help as you launched your business, the projections and all of that? Yeah, it just gives you, I guess, the ability to grade yourself on how you're doing it, and if you're getting close to there, or if you're not, and then it gives an idea of the potential growth you have, because if you hit your number the first year, then it's like, okay, what's our goal the next year? How do we keep growing without just staying stagnant? You know, many times, having a partnership is good, and has its pros and cons, right? You know, having somebody go along the journey with you, and encountering somebody, be able to overcome some of those in a difficult, but it also presents its own challenges, right? So, would you kind of share a little bit about your partnership, how do you first handle it when you come to a moment of, you know, in-pass? What do you first do, and what kind of advice do you have between keeping your partnership going well? With us, I mean, we've worked together before. I mean, that's a plus. I mean, I know how you work, he knows how I work. And especially behind the bars, one of those unspoken things like, I kind of know what his next step is, he kind of knows what might be. So. And on. Next step. Next step. This is our partnership right here. No, but it, you know, I have full trust in this guy. I trust him with myself, my family, you know, everything. I know he does the same thing for me, he's better. So, how do you keep it, you know, if you have different philosophies or there's a difference in, we should make this type of donate, but under the person's hands, no, it's not gonna pair well with our, you know, line up. What do you first do? How do you first? I think it's just having the conversation and talking through it, understanding each other's views of why I feel one way and why he feels another way. And going from there and trying to figure out, you know, what is the best solution to this? And luckily, we really haven't came across too much to disagreements. It's usually if he feels one way and he's pretty strong about it, then it's like, you know, I trust your opinion on this. And I'm like, it comes with even hiring, you know, there's people that we brought on and said, if you trust him, then I trust him. Like, I don't need anything else besides that. So it's having that trust, I guess, in each other to make the right decision for not only the business, but each other. That is really good because, you know, managing a partnership in itself is as critical and as challenging as managing a business, right? Because it's something in addition to managing your business. Yeah, I think that one thing that I would like to say is that it's also, it could have a lot of downfalls because I think a lot of people find the wrong partners. But if the advantage of having a partner is especially through that initial stage, there's a lot of times that you probably just want to be done with it, where if you have a partner that you can just kind of push each other, it's like, you know, you don't want to wake up, it's like, hey, you know, let's meet, let's go do this, like, okay. Set to wake up. Yeah, if there wasn't that phone call, hey, let's go grab coffee and figure this out. Like, I would maybe just stay in bed. So there's that aspect of it too. I think there's a lot of good things that come if you find the right partnership. Yes, definitely. Interesting partner. That's really, really good. And it's really nice to see how your partnership has really, and I see how you interact with each other. And it's really, really encouraging because you both have a respect and you both understand each other's nuances and inner strengths and weaknesses. So I think you both make a really, really good partnership. I guess what would you share with the audiences as would be the top, would be two, three or five, I guess, behaviors or skill sets that is really important to an entrepreneur that you have learned to rely on? I would say the first things that just realizing that an entrepreneur, all you are is a problem solver. Like, you're gonna have a problem almost every single day, one way or another. Whether it's going through the process of opening the business or once the business is opened, the machine's down, employee calls out, something's wrong. You got an unhappy customer. No matter what, every single day, there's gonna be something to fix. We're gonna figure out how and how do we overcome this. So I think that's the biggest thing is going into the mindset and knowing that that's your job. If something may go wrong, so prepare for it. It will go wrong. Yes, it will go wrong. Two more times, two more times. Really? Yeah, I mean, like I said before, being driven and not letting it get the best of you. A few days after we signed our lease, Duncan Donut did a press release that they're gonna open back in Hawaii. And both of us were just kind of like, ooh. Well, at least we knew that there was a market for it. There's times that when we first open, they can hire in the shop and one person come to the door and they're just like, but don't let it hinder you. Just continue to push on, figure it out. Positiveness. Exactly. Your shop, survey, Donut Stop is number one in Yelp. Congratulations, that was really nice. If you could share with us some of your products here and what is in the future, what is in Horizon for a purvey? Okay, we'll start. This is gonna be our weekly Donut. So it's actually a butter glaze with graham cracker, brown sugar toasted or cream belated on a fresh pineapple.  It's our best seller, everybody loves those. And I see like a, like a, like a lihing, lihing going popular. This is the sunburned holly. We got it from my business partner over here, Nick. He went to the beach and didn't put SPF a million on. And it's gonna be lemon with lihing going on top of it. Yeah, it's another two super popular. They're all popular, but the Hulk smash is gonna be our house mint glaze with Oreo on top of it. So it's like a mint chocolate-ship ice cream flavor or a Girl Scout cookie. Yeah. And then the Killin' Me Smalls, which is your classic kind of s'mores taste that everybody really loves. That's my favorite. That's like a lemon glaze, right? Yes, lemon glaze. We have a graham cracker and then we have a homemade vanilla cream cheese drizzle on top of there. And a lot of people like pink cats, right? Yes. That's gonna be our matcha glaze with cake pat on there. That's our maple peanut butter glaze with a raspberry-preserved drizzle on it. That's a big seller. People love peanut butter, love that one. So your donuts are made to order. So when you go there, it's not like pre-made.  You have to pick what you want and then you actually make it there for the customers to pick. Right. Yeah, everything's made fresh. It is, I want to scare you, it's not a long process. Usually throughout the day, we're just constantly running donuts, so it's not a, hey, wait for 30 minutes while it gets built. It's really fast. It's in the process. So it makes it unique. We've kind of hit that market where it's a unique flavor profile, but also made fresh to order. There's people that do it fresh, but it's just very basic stuff. There's people that do the very unique flavors, but they're sitting in the case all day. So it's trying to blend the two together and find a way to make that work. Greatest about closing up, but I wanted to share with you what's on the horizon from Purvey and then there's an event coming up, right? That you folks are very proud of, it's gonna be featured. Yes, so Children's Youth Day, we're teaming up with Hoi News now and we're basically giving donuts away for the children. I believe it's October 6th. 6th. We'll be at the 10th at the State Capitol and we're just gonna be handing out donuts for Purvey comes by. All right, great. Well, thank you very much, everybody, for joining us. Thank you, Nick and Rion, for being here with us and we wish everybody, check out their donuts on Kona Street. Have a great day, everybody. Thank you.


things I wonder when I see people making content like Star Wars is doomed Ahsoka Smirk Ahsoka Smirk fold arms probably ranks above Boba Fett and Kenobi but that's not an achievement of any kind it's mostly boring I don't even know about that it doesn't damage Star Wars anyone near as much as Kenobi and Boba Fett was like with all of this crazy like Night Sister and Mortis and all of this stuff yeah it definitely made me more angry in the other shows I think the zombies are retarded but it doesn't like they've got their own magic system they're introducing with a bunch of creatures that were apparently very distant from the primary galaxy you can do all of this it's incredibly ill advised I think it's hyper cringe but like it's not quite the same as destroying the connections and understanding of the timeline between Obi-Wan and Vader possibly one of the most foundational relationships of all of Star Wars and IP that's true that's true especially considering this concerns people that I barely consider canon like who the fuck are all of you people very easy to sort of memory hole like it doesn't exist Kenobi's a bit harder yeah watching fucking Ewan McGregor tearing up as he's seeing Hayden Christensen through the broken mask of Vader it's just like how dare you well fuck the show let's get out of here shitty show bye bye goodbye everyone bye bye now terrible show bye


So in this video we are going to talk about tables. In the earlier days of web design tables were mostly used for laying out even the whole page web experience but as we've always known tables are just supposed to be used for tabular information let's say if you're listing users of a particular something and you want to table form so you can use the table block so if we quickly search for table by clicking the plus button and typing table we're able to find it here or if we are not going to use that and we're used to the shortcut of being the slash you can slash table enter and you'll see that it gives you a form that a dialogue box that allows you to add and say maybe I want to have six columns that's the vertical form and then I want to have about 10 rows so when I hit create you have your six columns then you have your 10 rows now you can still edit this if you need be the later versions of GWTN but you can actually strive this out and say I want you to have alternate colors here and table block allows us to also make it fully recognizable or wide or even just centered so we'll just go for the wide width for now and we have the options of either deleting columns and we can also let's say delete rows and reduce maybe we've done too many rows so we can reduce that we can change it back to this so that we can easily see how that's being affected so now we have four columns and we're going to delete another row so it's shorter for us now there are more table options right here in the right hand side and you can say I want to have a fixed table width for the cells or you can add a header section and you can add even a footer section for you so you have a footer you have a header and that can be seen so I'm just going to change the formatting here to allow us to see that so we have our head we have our foot footer there and we can change also the color settings let's say we want it to be a little blue or just a little bit of that need and then we can also add other classes that we can always use CSS to affect our table so we'll have information here for example I want to have a first name once I type and tab then I am able to get the option and then I'll do the last name I'll do the edge I'll do the class let's say maybe this is school students and then I can say maybe the stream they are in so that will make it available for me and then yeah so I'll just align this to the center so you're able to align in the latest version of our Gutenberg you're able to align this wherever you want to you can do individual alignment and that will work out so we have here a left align and then we have centers for both of these so as you add information you can have john door and then john door is 34 and he's in blue the blue stream so this this is all available for us you can try the styles that available you can add your own but this is how you use the table um the table block so for then Chris uh Chris is 23 he's in the red stream and that's the table block for you uh if you serve it and then just upload and reload here you'll see that we have our table here so the more content we add the better it will look so enjoy using the table block uh in the next video we shall be looking at something different and we shall be looking at the blocks that go into the layout element so we shall look at the columns we shall look at buttons we shall look at the media text and so on so thank you for watching uh keep looking out for the channel and bye bye


So I really was privileged to have this meeting with the PM. The PM was kind enough to give me quite a lot of time and to talk a lot about his way of thinking about India, which was quite unique because, you know, one hears about policies but one rarely hears about the thinking behind it. He talked about the way he sees governance in particular and why sometimes the, maybe the mistrust of the people on the ground colors our governance and how it therefore creates structures of kind of elite control over the governance process, not a responsive government. And in that process he also, I think very nicely explained how he's trying to reform the bureaucracy to make it more responsive to understand the ways in which people's views need to be taken into account to expose them more to the reality on the ground. And that I thought was, I think it's a very important point for India to have, create a bureaucracy that actually lives on the ground and gets its stimulus from how life is on the ground. And without that we get an unresponsive government. So thank you PM, that was a unique experience for me.


Okay thank you. At first I'd like to thank all of the cooperating agencies. This has been a big event with a lot of people involved, a lot of mutual aid within the state of California. First the city of Ridgecrest was a lead on this incident. We were in unified command with Kern County Fire. OES director Gillarducci, Cal Fire director Tom Porter, Major General David Baldwin with the California National Guard. CHP Deputy Commissioner Scott Sillsby, U.S. Congressman Kevin McCarthy's office, Shannon Grove's office, Mick Gleason's office, Public Health, Environmental Works, Human Services, and Southern California Edison Red Cross. And so as you can see there's a lot of people involved with this. At 10 30 this morning we had an earthquake in Ridgecrest and with that we started a large number of resources and it was for not only the earthquake but we were assured that there would be aftershocks and we've had over a hundred aftershocks after the main earthquake and we have resources from all over the state of California. We have resources from Rialto, Chino Valley, San Manuel, Redlands, Colton, all formed through the Office of Emergency Services with a strike team leader. You saw our equipment from Los Angeles County and we appreciate our partners and it's important to recognize them. We've had minor to moderate injuries in Ridgecrest a few but with the magnitude we were very grateful that there was such a limited amount of injuries and damage. There's minor and moderate damages to various structures out in Ridgecrest. We have two facilities open. One is at the Fairgrounds and Kern McGee Center for cooling centers. We know with the power being out that is an important component that we need to look at and it's important for the community to know that you're safe. We have a lot of resources as you can see behind me. The magnitude of people that would be involved in an incident like this or bigger that we're prepared to act. Let's see our radio communications is open 9-1-1 system. We had over 163 calls out in the Ridgecrest area emergencies. That's a large number and so there was a extreme backlog but we were able to catch up to that because of master mutual aid. One structure fire. The airport wasn't affected and also the Army Corps has inspected the dam and the dam is secure. LaLake Isabella Dam and we feel comfortable with that situation. With that I'll hand it over to Director Gilarducci with OES and then I'll follow up with questions after this. Good afternoon. Thanks Chief Witt and Mark Gilarducci, Director of Governor Newsom's Office of Emergency Services. First of all let me just convey our thoughts and concerns to all those who've been packed by today's earthquake. You know certainly not a small earthquake and you know there was enough damage and people you know on a day where we were together with our families celebrating the nation's holiday having to deal with this earthquake. We are of course as the Chief mentioned happy to see that the number of injuries was relatively minimal and really no report of fatalities. Definitely want to highlight the exceptional response by both the City of Ridgecrest and Ridgecrest and Kern County fire and sheriff and all the other emergency services rapidly responding to the event and obviously the Chief mentioned but the state agencies are standing behind me the leaders of those organizations immediately engaged with the county shortly after the quake occurred providing assets from all of the various agencies that are represented here the Cal Guard, the CHP, Cal Fire and then of course through OES a mutual aid from a number of Southern California departments including urban search and rescue resources and fire strike teams. Also shortly within hours really of the earthquake Governor Newsom did proclaim a state of emergency that was very important because it ensured that all resources that could be made available were being made available and all state agencies were focused on supporting the county in the city. It also opened up key programs that will be necessary for recovery over the long term. Clearly this was a very large quake in its size and could have been much more injuries and damage but we do feel lucky and now we're going to focus on completing the damage assessment working with both the city and the county on really refining both damage assessment to critical infrastructure as well as working to support the county as they work with the community members doing an assessment and it's important to do a good assessment after earthquake. Sometimes earthquake damage is hidden and it takes a little bit to make sure that we're determining the quantity and the magnitude of the damage. Keep in mind it's important that people understand that there are going to be aftershocks in fact there have been a number of them but there could be aftershocks and there could be even a quake as large as the initial quake in the next 24 hours so it's important that people secure any non-structural items in their home that could fall over that haven't fall over in the initial quake. Be safe have a family plan and make sure that you're you're thinking through that and I know that they're working hard to reestablish the power in the area and in cases where there are any other lifelines that are necessary working through that. We're also making sure that you know as individuals to listen to local authorities in the event that they issue any a new or additional alert and warnings throughout the night and into tomorrow so that you are as informed and empowered to respond accordingly. We'll continue to stay very much engaged through my office the Office of Emergency Services. Governor Newsom has been briefed each each hour we've been making sure that he is up to speed in fact we just got off a phone briefing his office and throughout the remainder of this particular incident we'll be working closely with the local authorities to make sure that all the resources are met and so with that I'll be turned it back over to Chief Witt and we're happy to answer any questions. Okay I'll open it up for questions at this time from anybody for myself or anybody behind me? So in terms of the source of where it took place or USGS going to be out there they concern that any surrounding areas where there may be other faults like San Andreas fault may be a concern for the community? Well as Director Gillarducci stated we're concerned about aftershocks because we know that in the next 24 hours there could be more and they are monitoring the situation currently the others? In terms of the app with I heard that there was also an issue with the app the shake alert app and so if ready current did set out alert today who would have got it and didn't go there? Brandon you want to talk about that? Yeah so we did not put out a ready current on this this was the city of Ridgecrest and they were handling this scenario so at that point it was just a notification door-to-door as they were going and assessing. So if you were to send out a ready current it be everyone here? Everybody who is signed up within the area that's affected that's where ready current will reach out to you. So absolutely we we've actually been on conference calls with with the USGS and the seismic with the state and that's exactly part of the warnings I mean it's an earthquake it's unpredictable and we do expect to have more aftershocks and yes that could happen. Northridge is a good example three years later they did have another major earthquake and so it's definitely something that's a concern. So I've been out to Ridgecrest probably several other report reporters have as well given the fact that Kern County has a lot more structures a lot more of a bigger sized community if we were to experience that type of magnitude here what would the devastation look like would it be as light? I wouldn't even want to take a guess at that but I think the most important part is that people are prepared as as the director had said we people need to be prepared expect to have no power for 72 hours and have a plan in place and that's the best way to mitigate it we'll get out notifications that we can but as you see just this earthquake took place in Ridgecrest and it's it's extremely draining to get a lot of resources there quickly to assess it and get action taken place and so that's where we're bringing in more to be able to handle that but it does take some time.  We'll be continuing to monitor the situation I'll let Chief Whit answer that. Tomorrow we're going to have the same number of resources out tomorrow you know during this next 24 hours OES will let us use the OES equipment throughout the day on the incident and throughout the night and so we're going to have the same number of people ready and prepared to protect not only Ridgecrest but the County of Kern. Any other questions? Power you mentioned a little bit about the issue of power so. Power should be on tomorrow by tomorrow we should have most of the power on I have to defer to Southern California Edison but from what I'm told from a person that I talked to with Southern California Edison that we should have a lot of the power on by tomorrow. In the latest sorry the yeah so Southern California Edison was estimated around 7,000 and that was earlier at the impact and now we're down to roughly around 1300 without power. Gas issues. There are some gas issues but they're being addressed. There's nothing significant right now being reported. How many total structure fires can you touch on that one more time? So we want we had one active structure fire but numerous calls for structures and those could be from gas leaks and multiple other things but the only one active structure fire. Any other questions? Okay, thank you very much and we will be sitting out more information as it comes in and if you have any questions contact our local PAO. Displaced. Is there anyone displaced? I know that we just talked about injuries but people who are displaced. So we have no reports of any major displacement of residents and we do have Red Cross who will be supporting that and establishing different centers as needed. Are there gonna be extra patrols besides just you guys like anyone else that's gonna be coming that you guys haven't I know pretty much everybody's within that mutual aid system coming in have most most have actually made it here and we're just gonna continue working on the scenario that we have ahead of us. Two cooling centers as I mentioned.


So, without much ado, I'd like us to go into our presentation for the day. Please welcome Leah, join me in welcoming Leah Brigante. Leah Brigante is a midwife with a decade of experience. She has been working in a series of roles including clinical leadership, research, policy, and advisory. Leah joined the Royal College of Midwives in 2017, contributing to improvement of maternity policy and midwifery practices across the UK and internationally, working with the European Midwifery Association and the European Forum for Nursing and Midwifery, and representing ICM on WHO guidance development groups. In her development role as consultant, midwife in public health, at Guise and St. Thomas NHS Foundation Trust in London, Leah led the Lambeth Early Action Partnership mid-maternity portfolio and developed an innovative social prescribing service for the prenatal period. Leah is part of the RCM expert clinical advisory group and has led a number of resources to support the pandemic response, including authoring the joint RCM-RCOG guidance on provision of midwifery lead settings during the pandemic. Leah has conducted research on midwife lead settings provisioned, the role of consultant midwives, and higher risk women's experiences of midwifery continuity of care as core investigator of the Popeye trial at King College London, as part of her MSc in implementation science, and Leah holds an affiliate research contract with King's College London and is a guest researcher for MSc programs in global and public health at King's College London and City University of London. Leah, over to you and welcome. So I'll give you presentation status, then we can continue from there. So welcome, Leah. Thank you. Thank you so much, Carol. It's great to be here and I'm delighted to start my IDM 2023 with you all. So for all of you that are midwives or aspiring midwives at the International Day of the Midwife. So I'm going to give you a bit of an overview of what I'm going to cover in this presentation. So we're going to talk a little bit about midwifery continuity of care models. Then we're going to move into the study ID as part of my MSc. So we're going to be looking at the aims and the methodology that he was used. I hope that's not the most boring part of this presentation. And then we will move on to the findings, the conclusion and hopefully recommendation that people can take on from this study. So what we know at the moment is that a lot of women and girls across the world don't have the right access to the right care when it comes to sexual and reproductive health as well as newborn and maternal health. And although there are international goals to reach universal cover, we know that it's very slow and midwives have been identified as a solution because midwives are incredibly cost effective and could meet the need of women and girls and babies by 90%. So we know that we can use this publication like the world's midwifery report in 2021 to make a case for midwifery globally. So some of the data from that report, they look at how midwifery could affect over 56 maternal neonatal outcomes. And those outcomes are improved by midwifery philosophy and practice, but also how almost 83% of all maternal deaths, silver, and also newborn deaths could be averted with high quality midwifery care. So I was very proud to co-author the position statement on midwifery-led continuity of care with Lise Lotte quickly from the Royal Dutch College of Midwives and also Sarah from the UNFPA we submitted a statement to the ICM Council and it was approved and published not very long ago. And the International Confederation of Midwives has this statement that basically encourages all country to advocate for the development of models of midwifery care, but also where those models don't exist to implement them, but where they exist to scale up and maintain such models and had an element of continuity. So what is the continuity of care? Because there have been a lot of definition and people seem to still be a bit confused of what he actually means. So we know midwifery on its own, so care provided in a midwifery model by a midwife will improve outcomes for women and babies. But those outcomes are particularly improved when there is a non-midwife caring for the woman and the baby across the pregnancy, birth and postnatal period. So what continuity of care is, is care provided by a non-midwife and a small team to support as a backup or often this is provided with a body or a partner midwife. And those midwives work in partnership with the women and they are able to lead care provision and care planning for these women as well as providing and delivering care. Obviously, those midwives don't work on their own. They are part of a wider, bigger network of multidisciplinary team and they are able to refer to specialists as necessary and make sure women receive the right care, the right time. And this data is based on the Cochrane Review that Jane Sandel and the team led. So I'm not going to go into all of the outcomes from the Cochrane Review but if you're not familiar with the Cochrane Review I would invite you to go and have a look because every time I look at it as a midwife I'm very proud that midwifery can make such a difference. So most of the outcomes that have been shown to be affected in the Cochrane Review have to do with baby loss. So there is a reduction in gestational loss by 19% before 24 weeks and 16% in general. Women are 16% less likely to lose their baby. They also have a reduction in preterm birth by 24%. And there are some outcomes that apply to intervention during labor so women are less likely to have an epidural or they're less likely to have an instrumental birth or an episiotomy. And they are a little 5% more likely to have a spontaneous vaginal birth and no difference in cesarean was identified by the review nor differences in adverse outcomes. So what we know about continuity is that it's a meaningful relationship that is formed over a period of time sometimes over location and over pregnancies because some women are looked after by the same team and by the same midwife across even pregnancies. And there is an opportunity for the midwife and the woman to form a reciprocal relationship. This relationship often extends to the family because women are often seen in their own homes and there is opportunity to involve siblings, partners and extended family. Obviously this is a complex intervention because it's a model of care that has a number of intervention offered within this model and we're going to go and look a little bit into the details of those. So we don't really understand what the mechanism is. Possibly there is an opportunity to pick up when things go wrong much sooner because of the relationship and because knowing the person in front of us. But also it could be that the relationship is therapeutic and allows also improve that advocacy and improve the care planning and navigation of systems. So I'm just going to set up the context for the puppy trial which is the context in which my study took place. So the puppy trial was a pilot study of midwifery practice in preterm birth including women experiences and it was a trial, a feasibility trial. So it was looking at whether a model of continuity of midwifery care with access to a specialist obstetric clinic. So those are not women that were low risk. Those are women with mixed risk and increased preterm birth risk. So women that were considered to have this increased risk would receive this model of care within an inner city UK teaching hospital. And obviously this was looking at pregnancy outcomes and women experiences but mostly looking at feasibility as it was in a feasibility trial. So a total of 334 participants were recruited in the trial. 169 were allocated to the puppy intervention group which is where my part of the study took place and I will go into the details of that and 165 received the standard care. So women were identified before 24 weeks and if they had increased risk of preterm birth they were randomized into the two trial groups. So the women in the trial intervention group they had anti-natal intrapartum and post-natal continuity from a primary midwife and they also were referred to an obstetric or other consultation, other specialists if needed, if they developed complication during pregnancy and if they needed any additional care. Also they received labor and birth care in their chosen place of birth. So they had an option of giving birth in a hospital setting in a midwifery unit setting or a home. Always provided, this care was always provided by the puppy midwives and they were also then seen by the primary midwife and the puppy team at home following discharge from hospital or after a home birth. The care was received mostly by this named midwife that each woman was allocated at the start of her pregnancy at the start of the journey but every named midwife also had a partner midwife so each woman was given a primary and a partner and also a small team of six was backing up 24 hours, 24-7, providing 24-7 cover seven days a week so that obviously those midwives could have some time off and the team was composed by six full-time midwives including a team leader and they were working very closely with the obstetric clinic as again those women allocated to the trial had some level of complexities and in order to maximize continuity and making sure that the women they were cared by the puppy team were also familiar with the six midwives in the team. The team was providing antenatal education classes and also monthly group session where women could drop in and meet the rest of the team and the rest of the midwives. I've put the puppy protocol there if anyone is interested in going and looking into the detailed kind of intervention description. So the aim of my part of the study which was set within the trial by was a small study was to look at the views and experience of women in the midwifery continuity of care intervention group and try to identify core aspects of continuity from the women perspective and possibly to use some of these findings on the core aspect to inform development of continuity of care in this specific setting but also more generally because some of these could be transferable. So the methods I used were qualitative interviews those were semi-structured in-depth interviews after the women had their babies so in the early postnatal period I had a topic guide so I had a bit of a set of questions I wanted to ask but it was more of a flowy conversation. All interviews happened in the women's home they were audio recorded they were then transcribed anonymized and uploaded on MVV12 which is just a software for analysis. The sampling was purposive it was the same criteria that applied to the trial participation applied to my study so obviously all the women I interviewed they matched one or multiple risk factor for freedom birth. I ended up contacting 20 women and 16 agreed to be interviewed and although there was an attempt to seek variation in socio-economic group ethnicity parity and obstetric history you will see my sample was diverse but not super diverse. So the data analysis was using Brown and Brown and Clark the sixth stage is described so it was all about familiarizing with the data generating codes then searching for teams reviewing those teams and then doing all the writing up. We were I had a team I had a supervisor because of my master and obviously the wider POPP trial investigators some of them were were involved with this part of the study supporting me so some of the interviews were double coded and although the analysis was inductive we then were kind of going back and making sure that the teams applied to the whole data set and they were not very dissonant teams and the recruitment kind of continued until we achieved the data that they were satisfying but also within the project timeline because they didn't have a lot of time for this study. So in terms of participants most women that were part of the study lived in a deprived urban area although the household incomes was above the median average UK income. Obviously we were in London so London also has a slightly different median income compared to the UK household. So in terms of demographic of the participants I had you can see here I had a good split in terms of age in terms of education it was a well educated group more than half were educated at a degree level of higher degree leg level. I had the ethnicity split the European kind of included UK and Eastern European or you know outside of the UK European and then I had two women from Africa or Afro-Caribbean ethnicity and one mixed and one Asian. So in terms of parity I had an equal split between Premiers and New Liberals women and I had one woman they had a previous freedom but and four they had a previous miscarriage or loss before 24 weeks. So in terms of birth outcomes this was quite an interesting sample because a majority majority of the women planned to give birth in a midwifery led settings and these included the option available to them as alongside and home births but as you can see from the birth outcomes table actually not all of them ended up in their favorite place of birth and two participants experienced preterm birth although their babies were alive and healthy at the time of data collection and yeah as you can see we had a split in vaginal birth 10 out of 16 and then one elective cesarean and four emergency cesarean. So this is the most interesting part and those are the teams that emerged from the interviews and I've linked that the full paper if you're interested into into reading about it so those are the five teams and now I'm going to go through each of them and give you some details and some quotes. So the first team was accessibility so this was described as women really enjoyed having this direct access to a name midwife and a team this this meant they had a mobile number they could call this number was obviously a 247 number that was split between the team in terms of covering those 247 hours but what it meant in practice is that women didn't have to call the hospital switchboard introduce themselves give their data they they had a real responsiveness but also somebody that knew them was picking up the phone and they didn't need to repeat their medical or obstetric history. So one of the quote here is this woman say if I needed anything she was there I could text her you know I could speak to her it was completely different she was there all the time this is where I actually took the title of my paper because it was this idea of this woman had a baby before and she didn't have the kind of constant presence in the background of this midwife that she knew. The second team was time and this might be a concept that seems a bit odd but often in very busy maternity services and midwifery clinic women don't really have much time with their midwives and they come with a lot of questions with a lot of things they would like answered but they don't necessarily have the time and the space and this was very different in the poppy team care because women said the midwives were extremely generous with their time they never felt they were rushed they never felt the midwife had somewhere else to go or something else to do they just felt the midwife was there for as long as they needed it. The midwives were providing antenatal and postnatal home visits and they also had they also had the clinic and providing antenatal care for example in the women's home as well as postnatal meant that often the partner or older siblings could get involved with the care and that kind of gave a different dimension of this appointment with the midwife. The third team was building relationship and I found a beautiful description in the data of the women describing their midwives as being like a friend, being like a mother, being like a sister you know this kind of really emotional connection and relationship with the midwives. They also spoke about knowing them and of them so it wasn't just about I know the name of the midwife I really got to know the midwife I really understand her as a person and they received social and emotional support in fact I think a couple of women saying how it was then difficult to say goodbye at the end of the care when you know they've been in these close relationship with this person for nine months plus and then you know the discharge they arrived and this person that they'd seen so regularly was kind of walking out and again this this is a very nice quote of a woman that described them as friends with lots of skills. Advocacy was another team that was identified and kind of it was it took place across three main streams so there was they advocate I do in the advocacy for women autonomy and I will go into that with some of the stories he also meant supporting free choice including women making the so-called outside guidance choice and also he meant navigating complex healthcare systems for the women and making sure that women were not lost or falling through the gaps so those are two very different stories but I just wanted to go into into them given that we have time and so there was the first one is the pink quote at the top I'm not going to read it out but this was a woman that had a very traumatic first experience with a with a forceps birth and a long induction of labor and she was told that she couldn't give birth in the midwifery led unit this time because she had a complication and the midwife the puppy midwife attended the appointment with a consultant obstetrician to make sure she had this personalized birth plan and she didn't need to go to the labor ward you know the obstetric unit but she could go in a midwifery unit and and this is exactly what happened she then ended up having a beautiful water bird and I will pick up a quote from her laser on his presentation which is I think one of the most powerful quotes I've got and the and the other quote here in in the green this is a different you know a different story this is a woman that had an emergency cesarean but she really wanted an elective cesarean this time and she you know I don't know if you are aware but there have been kind of national drivers to reduce the unnecessary cesarean so obviously she wasn't offered an elective cesarean she was encouraged to look at her option including a v-buck heavy virginal birth after cesarean but for this woman this really was not what she wanted and the midwife did the advocacy for her to make sure she had the elective cesarean and this kind of removed all the anxiety that she had in the pregnancies and she felt very confident about it and about the midwives and the midwives really respecting her choices another team was trust and trust obviously developed as alongside their relationship and women you know it was having the time having the advocacy all of those things then led to a relationship of trust so women felt they could speak to their midwives they felt respected they did not feel scared and this improved disclosure especially in one case of of a woman they had some social complexities and you know there was involvement of other agencies and she was confident that the midwives would support her despite all the social complexities this also enabled the midwives sometimes to take a a role a birth there was almost letting women do their things and just giving them the confidence and this was described by a few of the women as this feeling when their midwife walked in the room as they were in labor or they were in second stage that you know the middle midwife didn't do anything she just walked in and sat next to them and just said hi i'm here and this kind of made a big difference for them and this quote at the top is exactly the quote i was saying earlier about this woman they had such an healing birth experience with the second time because the midwife advocated for her to give birth in the every unit and and for her to use the pool that she said my my view on birth was completely changed and now i'm able to pass a positive message about birth to friends and to my daughter you know this this daughter that she had birthed six weeks i think before i interviewed her the last team was the emerge from this present from from my study was the reduction of stress and anxiety and this this is quite an interesting team because women felt they were in control of the whole process and knowing how the care was going to be organized and delivered and having been planning the care alongside the midwives meant there was no uncertainty and this applied to all sort of things even things that i've never really thought about as a midwife myself having been providing continuity for years in my own midwifery experience and it was things like being very clear of you know the midwives is coming to me so i don't have to get into the car and drive in traffic you know i don't have to look for parking i don't have to you know it was this kind of being clear on what to expect how how to expect it when to expect it it was it was a very interesting findings and also they had this kind of almost background presence of the midwives 24 7 this was a real big difference because they sometimes were not even calling the midwives out of hours sometimes they were emailing the midwives or texting the midwives but they were not texting a hospital you know hoping someone would pick it up they were texting this particular person and this person would get back to them with blood results chasing appointments so they felt they had this kind of you know they were in this bubble they were being held someone was held in their pregnancy and their space and this applied to postnatal care and two of these women had pre-term births and those babies were in Nico and and and the midwives did step in and support them even when they were discharged from the hospital and the babies were in Nico and you know really going the extra mile and making sure they were not being they were not losing any kind of postnatal care because their babies were in hospital and this is such a beautiful quote there as well it was this this woman say as soon as midwife be arrived I stopped feeling fear and the body obviously relaxes so in terms of this is just to say that because the context of this trial was looking at the feasibility of implementing such a model for women with obstetric complexities and the higher risk of preterm birth in the in the in my interviews I was trying to look at you know if there is anything that we could identify that would have made a difference in terms of preterm birth but you know this is a very small study there is no causation there is some literature out there that if you are more calm and confident and there is less stress and anxiety and and this is provided by having a social support this can buffer the mechanisms to stress but obviously and there is some some evidence out there the stress can be a predictor for preterm birth but really I can I can only say I can only conclude from this study that because they had continuity they had management and relational and information continuity they had accessibility to the team they were they described as you know those are the things that made us feel safe and in control and obviously because they were in a continuity model they had very consistent care they didn't miss appointments they had very prompt referral things were spot very quickly and they had the the referral that they needed but there is no kind of causation or or association either I don't think so the key conclusion I draw from the study is that recognizing that if women are cared by non-midwives and those midwives are accessible all the time these support women feeling listened to but also to be actively involved in clinical decision-making and obviously these also then contributes to to women feeling less stressed and anxious during pregnancy and birth but also during the early parenthood so I think it's very important when we look at implementation of development of midwifery continuity models of care for women with obstetric complexities that we look at those teams and make sure that we have access in place and when I mean when I say access is this 24-7 access to advocacy to have time built in so it doesn't matter if you see the same midwife but for 10 minutes you know it needs to be within a model of care that has all those core elements and those core components that will allow the relationship to flourish and to build so then trust and advocacy and all those other things can develop from their relationship so this is very important because it will improve outcomes it will improve women experience of care but also it will reduce anxiety levels so those are all the co-investigator and the people that have been part of the puppy trial journey as well as the funders and I wanted to acknowledge them all my co-investigator but also the Royal College of Midwives that supported me to do my master and King's College London my university and the NIHR that funded the trial and obviously a very heartfelt thank to all the women that let me in their homes and told me their stories you know very emotional at times and as the midwives had been generous with their time towards the women the women were very generous with their time towards me giving me their whole although they all had you know small babies and more important things to do then talk to me so thank you so much those are my contacts if you want to get in touch and I will link the full paper if anyone is interested and wants to go in and find out more and I'm obviously here to take questions now thank you very much Leah very interesting presentation very engaging and I especially like the quotes from the women it felt like you know very personal you got really relational with the women and which was a good thing they developed confidence with you and indeed I love the quotes from that that came from the women makes it so real and very engaging thank you very much there's a comment here in the public chat the 24-7 can be overwhelming for the midwives it's great for the women to have access at any time but does this not sometimes push reasonable boundaries of a valid relationship and then there's also another comment thank you Leah wonderful work and we have just a few minutes to take in a couple of questions and yeah the presentation did very well so I don't know whether you would want to respond to the comments and thank you Leah will you take this forward and make this a permanent feature of care in terms of scaling this what sort of case load would be carried by a midwife so kindly respond to those questions and comments Sheila that's a great question so maybe I wasn't very clear but the 24-7 was not provided by a single midwife it was provided by the 24-7 team backup so the midwives were never working you know here in the UK we still follow the european directive when it comes to working hours so the midwives cannot exceed a certain number of hours per day or per week so that the in the same way you would roster you know if you're working on a shift pattern so you would cover a shift a road that we shift they were covering on calls so yes the the women get these 24-7 access but it's not to a single individual it's to a team of six to a team of six that is splitting their availability across the week and the months so they can all go on holiday they can all take study days they you know obviously they can go off sick if something happens so it's not as overwhelming as in my sound because they're not working in an independent midwifery models they're not on call 24-7 themselves is the team that is sharing this this this load so often you know the midwife would do seven and a half hours or 12 hours a day as she would do on a normal shift based on how the road that was organized for that week and the women you know this is provided within the national health care system so they know they have access to midwives but they were they are explained very clearly from the beginning that the the continuity is provided by a team of six and they have one in six chances of getting their midwife and that kind of doubles to one in three because they are given two midwives so they have a partner and a primary midwife so yeah I agree the model needs to work for for midwives as well as he has to work for women and that's why it's a team based model rather than a one person doing doing it all I think Linda is asking if these should be a permanent feature of care so this team is still going on they still exist they were set up as a team for the trial in a hospital that didn't have any continuity of care at all and everything was made in place so those midwives didn't get a temporary contract they got a permanent contract and they are they are staying on and working in this model although obviously I know that every team has been moved around and restructured because of the pandemic but it's still going strong and as you know I'm sure you know Linda but there is a commitment to scale up those models but obviously we need to have the right resources the right number of midwives you know and all of the things to take this forward and what sort of caseload so yeah so I guess the caseload varies of based on the complexities of the women so those women here in the trial they had some complexities in terms of they had a high risk of freedom but a lot of them were in MDT care so they were cared by a specialist clinic for Prid and Bert as well as the midwife so the midwife carried and reduced the caseload they had I think 24 women a month so it was it was a small caseload but I know it has been done in when I definitely did the caseload it was between 30 and then 32 women a month so it really depends of your population where you are and everything else so I hope that answer well so we got Carol in terms of question oh joy joy camp is my lovely colleague at the Royal College I hope she says how do you hope your finding will change practice well I really hope that because we have all the quantitative data and we know how it changes those are kind of obstetric outcomes and you know and and and women outcomes and intervention but I really hope that when the the Coggin review has been taken and implemented without sometimes looking at those things that you know we have the numbers but do we know what the women say about those models and I hope you know my side is just one but there are so many others the kind of say this advocacy and the relationship and the trust but also the time and the access so I hope that when people look at implementing a continuity model they they look at those core aspects and don't dilute the model you know I shouldn't be a tick box yes you have the same midwife but this midwife has a caseload of 50 because that's not never gonna work I hope that it will affect practice as in people will look at making sure those elements are in those models as they get implemented and scaled up and thank you Magda for your thank you and Linda and Sonya so she says I was about to ask how would you manage if there is more than one client who refers to a specific midwife based on her comfortability with a specific midwife yeah so I mean that's I have to say that kind of happens sometimes that women prefer one midwife maybe because they've been cared by the person before in the past or maybe because they're not happy with a midwife and usually you know with a team of six those teams are usually between six seven sometimes even eight midwives if they are part time it can be accommodated and you know people can move around they still it's not a private service so you know if someone doesn't like seven midwives it's we can't find new ones but you know within a team I'm sure it can be accommodated and people can be moved around but I have to say it does happen rarely it happens but rarely and yeah thank you Leticia thank you so thank you thank you very much Leah thank you audience for the many questions and she has given her contacts there maybe this conversation can continue offline after this and Leah once again thank you very much for your presentation very enlightening a lot of learning it's been great thank you


Numerous studies have pointed to the health benefits of coffee, but there are still lingering questions about just how much you should be drinking and the type of coffee you should be using. Now, a new human study is giving us some answers. Drawing on data from UK Biobank, scientists have once again confirmed the association between coffee and better health outcomes with ground coffee emerging as the healthiest type. Coffee was once considered rather unhealthy. One study from 1988 found that 80% of physicians recommended avoiding coffee to their patients with cardiovascular problems, which may be because coffee may transiently elevate blood pressure. However, in recent decades, evidence to the contrary has been steadily accumulating. Now the European Society of Cardiology considers drinking 3-4 cups of coffee a day to be moderately beneficial and the American Heart Association notes that the evidence for coffee's health benefits stacks up quickly. Coffee is also associated with a lower risk of type 2 diabetes and Parkinson's disease. Caffeine is by far the most well-known ingredient in coffee. Coffee contains more than 100 biologically active chemicals, including polyphenols, which are potent antioxidants. Like many recent studies, this new study published in the European Journal of Preventive Cardiology makes use of UK Biobank, a huge open repository of various health data on around half a million British citizens. The size of UK Biobank enables researchers to control for many variables. In this case, covariates included age, gender, ethnicity, BMI, comorbidities such as hypertension and type 2 diabetes, and lifestyle risk factors of smoking, tea consumption, and alcohol consumption. Participants with a cardiovascular diagnosis at baseline work excluded in the median age was 58 years. Importantly, the study considered three popular types of coffee, ground, instant, and decaf. Participants were only able to select one type of coffee and then were grouped into six intake categories ranging from zero cups to more than five cups. In line with most existing studies, coffee consumption was shown to be generally beneficial. Coffee intake of up to five cups per day was associated with significant reductions in the risks of cardiovascular disease, congestive cardiac failure, coronary heart disease, stroke, and various arrhythmias. The biggest risk reduction was detected in the two to three cups per day group. Ground coffee consistently outperformed the other two types, including arrhythmias, cardiovascular mortality, and all-cause mortality. The ideal dose of ground coffee appears to be two to three cups per day. People who drank this amount were a full 27% less likely to die from all causes than non-drinkers during the follow-up period. Despite the inherent limitations of this study, the results are compelling and in line with previous research. It appears that moderate coffee consumption may confer some protection against cardiovascular disease and all-cause mortality. So will this study change how you view coffee or how much you drink? Let us know in the comments. When there's more to share, we'll have it for you here, so please subscribe so you don't miss out. I'm Ryan O'Shea and we'll see you next time on Lifespan News.


What is up my fellow drone nerds summer is right around the corner Know what that means there's gonna be a ton of things to do water parks firework shows picnics and of course Drone events if you didn't know that was the thing It's totally a thing and they are an absolute blast I think some of you guys might have gotten into FPV a little bit more recently Maybe you've never been to a drone event before because there hasn't really been one in a while But certainly things are looking better and we are starting to see drone events scheduled again In fact, we have an event of our own coming up called a rotor riot rampage And it is going down in just over a week from now We wanted to make this video to go through the five things that you need to keep in mind when you're going to an FPV event starting off number one probably the most Important one. We're not saving it to the end. We want to make sure you hear it pay attention to this one number one is You need to know how your video system works and how to use it how to change your channel and your power levels something That's very unique to flying FPV versus other types of RC is that your video Transmitting system operates on a limited number of channels and you need to share this limited number of channels with the other Pilots around you something about an FPV event is you're gonna have a bunch of people together You can only fly so many pilots at once in a given area without video Interfering with each other, so you need to share those available channels accordingly So what that means is you need to first off know how to change the channel of your video System you do not want to show up to an FPV event and When you go to get in line see that this line is for race band 3 and have no idea What any of that means be familiar with the fact that your video? Transmitter on the drone is going to be set to a certain channel and your goggles are also going to be set to a certain Channel those need to match up and those need to be on The channel that you are either assigned or in line for or however the event works So for example at rotor at rampage the channels are divided up among different Adjacent flight lines so that the two flight lines don't interfere with each other So for example channels that are close together like channel one and channel two will be split between two flight lines We're trying to space it up. Essentially, we'll have it divided up so that at one flight line You'll be flying race band channels two four six and eight and at another flight line You'll be flying race band channels one three five and seven some of these systems like the DJI system it works together and you just need to set the channel in your goggles and the drone and The goggles will match each other and be on the channel that you put them on And I think there are even some analog systems that do something similar like the TBS fusion system But if you don't have one of those systems Keep in mind that you'll have to set your drone to a channel and your goggles to a channel The other thing that you need to keep in mind with regards to your video system is the power level There's going to be a limit to how powerful you can set your video transmitter to because airwaves can get pretty messy So we want to keep power as low as possible the less gain on your video system Means there's going to be less noise now if you go to a drone race They're probably going to require you to drop your power all the way down to 25 mW and for most drone race courses That's all you're really going to need you're going to be standing there flying some gates big open grassy area of a rampage That's not exactly the case the whole point of rampage is Freestyling around a really exciting freestyle environment. So we're going to be flying around concrete buildings metal Structures trees you name it We're going to be freestyling it at rampage and that means we need a little bit more power than 25 milliwatts So we are allowing all the pilots to go up to 200 milliwatts So here's what you need to do if you are coming to rampage set your transmitter to 200 milliwatts Set your transmitter to a channel that you plan on using set your goggles to a matching channel and know how to Change that channel because if you go from one flight line to another you might need to move from say race band 3 To race band 4 and that's going to make sure that you are able to fly with clear video and more importantly That's your fellow FPV pilots also have clear video You don't want to be that guy messing up Everybody's video number two the next thing that you need to know before coming to a drone event is how to pass a fail Safe test. This is a very common thing that you will see at drone events whether it's the famous Multi GP international open the West Coast throw down or of course rode a right rampage You're probably going to be asked to have your drones pass a fail-safe test So what that means is you need to show that when your drones fail safe the props stop That is the safest configuration Especially if you're going to be flying an event where there's other people if you have some sort of connectivity issue and you lose Control of your drone. We want to see that drone Just fall, you know it's a bummer to see your drone Just fall out of the sky but better that than have it fly away at an event You're going to be flying in a given area whether it's a race course or a rampage flight line You're going to be flying in an area where people are prevented from just walking out into so if you're flying in That area and you fail safe and the drone just drops is not going to hurt anyone It just might hurt your drone, but that's better than it flying off into an area where it shouldn't be and Potentially causing a bigger problem than just having your drone fall out of the sky So you need to have your drone set up so that if it fail saves meaning it loses connection to your controller Prop stop and it falls the way that's going to be checked is that a tech check where you are going to bring your drone with the props off Props off you're going to plug in your drone You are going to then arm your drone the motors will be spinning and then you're gonna do something that feels very unnatural and you're gonna turn off your radio and what the inspector is looking for is for those spinning motors to Stop turning off your radio while the drone is armed simulate to you losing connection while flying It's what we want to see happen. There is for the motors to just stop. We don't want to see him spool up We don't want to see GPS kick in try to fly home We don't want to see any that we just want to see the motors stop And if that's what happens with your quad you will get a sticker of approval on your drone And then you will be able to fly that checked drone at any of the events flying Locations next up guys. Let's talk about batteries your drones are not going to fly without a fully charged lithium polymer Batteries strapped to their backs. So you want to make sure that one you've got a healthy amount of batteries and two You know how to charge them because even if you bring 20 of them hopefully you get lots of flying and burn through them all and get to recharge them and keep on Rippin if you need to get stocked up on batteries right now We're going to be having a sale on China hobby line batteries as they are the official battery sponsor of rotor riot rampage Even if you do completely forget your batteries China hobby line is providing every pilot at rampage with a free Battery so even if you miss this video and forget all of your batteries at least At least you'll have one but regardless of whether you are flying a China hobby line battery or a different brand of battery Just make sure you have a fuse that when you finish one pack you can get back in line and hopefully rip again real soon But even if you bring six or ten or even twenty batteries, you're probably gonna burn through them at some point So you need to know how you're going to recharge them now at rampage We're gonna have some charging areas so that if you forgot your charger Don't want to go back to your campsite to get it or just want to use one of our ultra-fast toolkit RC chargers You can do so we're gonna have a charging area set up in the build room where you can charge your batteries While you're working on repairing your quad But what if you need to charge your lipos and you're all the way out at one of the far away flight lines You don't want to deal with going all the way back because you just want to keep on flying Well in that case you might want to consider having a portable power station Maybe this is a generator if the event you're going to allows it or maybe this is some really big Battery pack maybe it's the rely on outlaw at rampage We are taking care of this for you and supplying rely on outlaw power stations at all of the flight lines The rely on outlaw is essentially a big old battery It's got an AC inverter built in so you can run anything from laptops to TVs to even refrigerators But it can also output DC voltage directly which is perfect for powering you guessed it drone battery chargers So don't worry about heading all the way back. We got you covered with the rely on outlaw You can get charged up right then in there and get back to shredding So you got your lipo packs you know how to juice them up Now the next thing that you want to think about are your props and your tools If you're pushing yourself at a race event trying to get your lap times down You're pushing yourself at a freestyle event trying to get some perfect dives through teeny gaps You're going to be crashing you're definitely going to be breaking and bending props And you may even be breaking some other things on your drone you're going to need to do some repairs So definitely get stocked up on props you're going to be going through a lot of those And definitely bring some spare arms or motors and the tools that you need to do those repairs You know bring all your heck strivers bring your soldering iron We've all been there having to do some field repairs to get the drone back up in the air after you totally biffed it Don't be embarrassed if you've been flying for any length of time then you are no stranger to the field repair Speaking of props I definitely have to shout out both HQ and Gemfan for supporting Rampage Every pilot coming to Rampage is getting some props both free when they walk through the door So again if you forgot your batteries and your props we got you that battery And we got you a couple of props to at least get you in the air and then again Maybe head over to the store booth and pick up a couple extra sets So guys number five on this list is a new one for drone events and that is know what the events COVID procedures are this is a new challenge for putting on an event And so understand that any organization putting on event wants it to be safe and wants you to have a good time Hopefully as the world continues to improve things can slowly get back to normal But for now there's going to be some amount of thinking about Keeping everyone safe and healthy that you're going to have to do when going to an event at Rampage We are so psyched to announce that FPV exchange has sponsored free COVID screening for everyone at the event We've also got free masks and we are going to be following CDC guidelines for wearing masks Bottom line is we want everyone to be safe and healthy I want to ask you guys to respect and care for your fellow FPV pilots and see past the Differences that you guys might have on this issue So if you see the value in these type of precautions and believe that it helps make everyone safe great And if you don't see the value in these precautions I'd ask for you to see the value and at least making your fellow FPV pilots feel more safe and comfortable Isn't that worth it? We all just want to go fly our drones and have a good time So let's do whatever it takes to make that happen And guys that leads us to our number six bonus item for that list and that is to bring a good Attitudes no, I'm not talking about attitude FPV goggles I'm talking about bring a smile on your face Everyone is there to have a good time and enjoy this crazy hobby that we all share together The best part of going to events is seeing people help each other fix their quads after a crash Help them dial in their tune share knowledge share your time and help everyone enjoy themselves And that's one of the most rewarding things about being in this community All right guys, whether i'm going to be seeing you at rampage in a week or you're prepping for another drone event this summer I hope this list helps you guys prepare for an awesome time at a drone event It is an absolute blast getting together with other FPV pilots and tearing up the skies Leave a comment down below with your best tip for going to a drone event and how to have the best time possible If you enjoyed this video found it helpful Hit that thumbs up button if you're new to all this hit the subscribe button It's free it costs you nothing you can even click that bell so we can send you a notification Every time we post a video so you don't miss a single one i'm lidgerid and i'll see you guys next time on rotor riot I want to play a game I want to fly a quad and ready


What's up everybody, Jason here for jasperyscasewrakes.com, 22-23 top CWA football club competitions, Merlin's chrome soccer just sold out. This is a three box break, random teams number one guys, and again really really beautiful stuff here with Merlin. It's 25 total spots. There is a all other teams not listed combo spot, which is right here, all these teams here. But everybody else of course, we get a straight up random team in there and against three boxes from a case, all card ship, so we can run this back at least like four more times. So let's dice roll it. And there's a one and a six, sorry seven times, one, two, three, four, five, six, and seven. Yeah, Rosario down to Tyrone, seven times, one, two, three, four, five, six, and seven. Liverpool down to Inter Milan. Hi, so Rosario Liverpool, Diego with AC Milan, Victor with Barcelona and Chelsea, Craig with the combo spot, Kev with Bear Munich, Sporting Club for Alex, Joe with Real Madrid, Fernar Basse, I think it's called, for Christopher, I'm not sure, I mean I'm not a big star guy. Lebsic for Joe, Brian Kay with PSV, Kevin Dixon with PSG, Joe Estad, Kev Dixon with Salzburg, Aaron Bilinsi with Manchester City, Kev with Dortmund, Brian with Rangers, Victor with Benfica, Joe with Manchester United, Jared with Celtic or Celtic, Jonathan with Tottenham and Copenhagen, Joe with Juventus, Joe and Dresen, sorry, then Joe Cooke, you have Arsenal, then Tyrone with Inter Milan. So I'll give you guys a quick minute to see your teams and if you guys want to potentially trade. Okay, maybe Joe left, J-Mac, I don't know what's going on, so let's just close it then I guess. All right, here we go guys, so boxes per break, so this is how we would separate them right here. I'm going to keep that one standing up, but basically it's one, two, three and then there's a fourth one over here, right over here, this hand right here. So I'm going to just quickly do a quick little dice roll or something like that, and if it lands on a five or six, we'll just redo it until it lands one through four. Four, there you go, so it's going to be the one that's standing up, so one, two, three, we're going to take these ones out of the way. The ones that are standing up there would be that box. Next year's product, you're probably not going to have them anymore there. Three boxes and then we'll go through them. All right, here we go guys. All right, we got a Gabriel Martinelli there, it's for Arsenal, Jude Bellingham, that's the refractor there for Dortmund, Mo Salaf or Liverpool, it's a 150, that is a Merlin Sorcerer's Auto, that's Frank Ricard, and that's for AC Milan, that's pretty nice, probably old school legend, right, AC Milan going to Diego, there you go, you got a nice Roberto Carlos, insert, you got Noni for Chelsea, to $199, you have this Frankie Dijon for FC Barcelona, I forget what this is called, but it's kind of like a little Merlin print, which is pretty awesome, and we got Fabio Carvalho for Liverpool, out of 75, Enzo Fernandez, Neymar for PSG to 350, PSG is going to Kevin Dixon, Gavi and killing him, Bapé refractor, you got a Divin Mumba, or a Obama for West Ham United, you autograph Sanjo Tonali, another one for AC Milan, go to Diego, man, back to back, KDV, you got Issa, Alfonso Devis, Darwin Nunez for Liverpool, going to Rosario to $99, you got Mohamed Ali Cho for Sociedad, we should be going to the combo spot, we will, and Garnaccio, refractor rookie, Cody Gacpo, Garnaccio base, nice one there for Olympic to $50, Issa, no those two autos, it was both for AC Milan, Sanjo Tonali and then you had the sorcerers, this would be box three, Gabriel for the ageless insert, we got the 250, Noni, I want a more sleeves, Modric, Joel Filesh, you got Divin for West Ham, $299, the autograph should be somewhere right here, Enzo Fernandez, or maybe it's literally the last part, yes it is, Warren, Zaire Emery, which I believe someone said this guy's pretty good, I got an orange out of 25 autographs yesterday, that's good, PSG, it's going to Kevin Dixon, which is a quick little three boxer, AC Milan to get the first two autos, and you got PSG there with the third one, and then obviously I'm sleeping up a lot of the inserts because they look really nice, refractors, all the colors, stuff like that, so there you go guys, another three boxer though is in the store if you guys want to run it back, JaspiesCaseBricks.com


Hi, I'm Eddie Gruten and Ben and I are driving the little 911 Porsche 978. The camaraderie and the friendship that we've had over the years and the laughter and the challenges of all the different stages has just been really good for a get up a decent heartbeat and we've just gone through a major dead spy rebranding exercise and you see a change in colors from the from the green to the blue and the boys came on board in the company and they they said to me that we don't have a real retail brand and as we've been a long-term supplier to BP while being a nationwide for a long long time it was never really advertised as dead spies and quite obviously they are the main sponsor of this of our event anyway over here is a lot of fun and it's always good to finish the day because every day is different and we we like the competition too it's some great guys in the whole team and everybody likes to do it better than the other