Hello, everyone. Good morning, good afternoon, or good evening. We're starting at 10 a.m. Depending on where you are joining us from, good morning, good afternoon, or good evening. Welcome to Engineering for Change, or E4C for short. Today, we're very pleased to bring you the latest in E4C's 2016 webinar series on the topic of bringing the infrastructure and planning for the impact. Best Practices and Lessons Learned from VecnaCare. My name is Mariela Matata and I'm Program Manager here at E4C. I will be the moderator for today's webinar. If you're following us on Twitter today, I would also like to invite you to join the conversation with our dedicated hashtag, hashtag E4C webinars. Please feel free to tweet during the webinar or after. I would like now to take a moment now to tell you a bit more about today's webinar. Improving healthcare infrastructure in low-resourced settings requires system solutions that close the information gaps between patients, caregivers, and decision makers. The social enterprise VecnaCare designs and deploys information management and technology solutions which help people live healthier and better lives in environments that have limited access to infrastructure, specifically power or internet access. Today we're joined by Paul Amendola, the Executive Director of VecnaCare's Charitable Trust, who will take us through VecnaCare's eHealth solutions. Key lessons learned and best practices deploying electronic and medical record solutions in low-resourced settings. Welcome and thank you for joining us today. Before we get rolling, I would also like to thank the E4C webinar series team. If anybody out there has questions about the series or would like to make a recommendation for future topics and speakers, we invite you to contact the team via the email address visible on the slide. So the contact will be webinars at engineering4change.org as seen in the slide at the moment. Today's webinar is part of E4C's professional development offerings information on upcoming installments in the series as well as archived videos of past presentations that have been found on the E4C webinar's webpage. Our next webinar will be in January and will be shared details on our site and E4C members will receive an invitation to the webinar directly. So before we move on to our presenter, I would like to tell you a bit more about engineering4change. E4C is a knowledge organization and global community of over one million engineers, designers, development predictions, and social scientists leveraging technology to solve quality of life challenges faced by under safe communities, including access to clean water and sanitation, sustainable energy, improved agriculture, and more. We invite you to join E4C by becoming a member. E4C membership is free and provides access to relevant current news data on hundreds of essential technologies in our solutions library, professional development resources, and opportunities such as jobs and fellowships. E4C members enjoy a unique user experience based on their side behavior and engagement, essentially the more you interact with the E4C site the better we will be able to serve your resources aligned to your interests. We invite you to join E4C's passionate global community and contribute to making people's lives better across the world. Check out our website as seen in the slide, engineering4change.org to learn more and sign up. A few housekeeping items before we get started. Let's see first where everyone is from in the chat window which is located at the bottom right of your screen. Please type your location. If the chat is not open on your screen, you can access it by clicking the icon on the top right corner of the screen. Any technical questions or administrative problems should go into the chat window. Feel free to send a private message to engineering4change.org and if you have any issues. Let's see where everybody is from. Cambridge, Houston, New York, Washington D.C. Florida andapolis in Brazil, welcome. Diego, I see new countries today. Great. So you can also use the chat window to type any remarks you may have. During the webinar please use the Q&A window located below the chat to type in your questions for the presenter that will be doing the Q&A at the end of the session. Again, if you don't see this, you can access it by clicking the Q&A icon on the top right corner. If you're listening to the audio broadcast and you encounter any troubles, try hitting stop and then start. You may also want to try opening WebEx up in a different browser. Again, if you have any problems, please type directly to engineering4changeadmin through the chat. An important information is following the webinar to request a certificate of completion showing one professional development hour for this session. Please follow the instructions on the top of E4C professional development page. Let's just get started. It's now a pleasure for me to introduce our speakers today, Paul Amandora, who is the Executive Director of ECNAC's Shadow Will Trust. He pre-release work at the International Rescue Committee in Health Information Systems. Paul has designed and implemented data collection projects and epidemiology studies in Sub-Saharan Africa and Asia. His work focuses on increasing data quality through data training, reviewing and advising on information systems and database creation. Paul is based in Cambridge, Massachusetts. We also have today Emily Taylor. Welcome, Emily, as well. Emily Taylor has worked in global health for over 10 years focusing on strengthening high quality patient-centered health services. Her areas of expertise in LMICs, her areas of expertise area are in clinical quality improvement, process improvement, and digital health initiatives. She has particular experience in proposal and grant development, business development, project management, strategic planning, and board development. Without further notice, I just want to introduce Emily and Paul so that they start the presentation. We have a brief comment before we get started. They are part of our webinar series of this month, which is based in ICT for Development. They will be talking about one of the tools that is... Well, the good examples of e-health solutions that is being deployed and implemented in the world. Just for... As a general context, e-health is electronic processes and solutions that are being implemented to improve health in the world using ICT or information and communication technologies. Without further to say, I will pass it along to Emily and Paul. Great. Thank you so much. This is Emily Taylor. And this is Paul Amandola. We're really thrilled to be here. We've been fans of Eversy and the Solutions Library and their work for a long time and use the Beta Solutions Library to keep an eye on the landscape. We are here to talk about specifically what Beck and Keras does, our use cases, some of our projects, and we'll also be taking a deeper dive into a couple of our projects and looking at best practices and key lessons learned and how to apply those. I want to say from the beginning that people should feel free to use that Q&A. And I know that we have dedicated time at the end. But if we're ever at a level of detail that is either too microscopic or too broad, please let us know because we can tailor this presentation to the attendees on the call. And we're happy to do that. We want to make it a good use of your time. So we're going to go ahead. Okay. The first thing I wanted to do is say thank you because I have been on the side of Jackie and Sam and wrangling presenters. And it's no easy feat and they did a really nice job and it's great that Eversy is so dedicated to bringing people together and for disseminating content and highlighting various projects and looking at ITT for deep. So thank you to Jackie and Sam and Yana and Mariela for coordinating all of this and her team paths. Do you want to talk a bit about just the overall presentation? Sure. So the structure of the overall presentation we wanted to give an overview of the VECNA CARES technology solution and then a more use case of how it's implemented and what our approach is in the field. The approach meaning or the implementation approach but also the approach as to how the data and the data quality is structured. Great. So just as a quick overview of the flow of the presentation so you know what you're getting into. Great. So this is repetitive. I apologize but we're going to do a brief introduction to VECNA CARES from where we came. Current projects and core use cases. Take a deep dive into the COCMA and TRANSMARA digital district case studies and then talk about best practices and lessons learned. Okay, great. So VECNA CARES is a nonprofit organization. We were started in 2009. We were born of VECNA technologies which is a for-profit privately funded healthcare information technology company started in 1999 by a consortium of MIT engineers. They decided that they wanted to leverage the intellectual property and the free procedures that they had garnered from their time deploying solutions to established markets and figure out how to leverage them and deploy them in lower resource settings. So it started as a sub-initiative of VECNA. We were initially just, we were initially a sub-initiative as I said and had community service hours and then with our success and the uptake of our use case and our solutions, we spun off as an independent 501c3. So in introduction it mentioned that we're a social enterprise. We're actually certified as a, we're registered as a nonprofit organization that we do have a social enterprise-like business model. The great thing about being tied with VECNA CARES, we are physically co-located with them. We are two legally separate organizations but we have a lot of access to their expertise around engineering both hardware and software and robotics and we do a lot of brainstorming with them and also are able to use some of their corporate structure. So we benefit greatly from being with them. Great. So as a quick overview of VECNA CARES mission statement and we've had a couple of mission statements over our eight-year life. This is our most recent and its intent is to be encompassing. VECNA CARES designs and deploys information management and technology solutions to create measurable impact, helping people in low resource settings live healthier and better lives. And I know that the title of this presentation is about, or the series is about eHealth and how ICT for G and how ICT is strengthening eHealth but it's important to note that what we do, we are not preferentially focused on health. We happen to be doing health right now and it's kind of our home base but we have a lot of ideas and some pilots out about how to use this for education and wash initiatives and things like that. So I loved yesterday. This is a great segue to our presentation yesterday. Engineering for Change sent out an email with a lot of great content about ICT and I loved how the tagline was how ICT is improving everything and I think the most important word in the sentence is improving. It can't fix everything and we really have to remember that whenever we look at ICT for development and when we look at eHealth. So the question isn't what could be fixed with ICT because ICT or a technical solution is not a fix. The questions to ask are what current processes could be improved with ICT, what current issues could be mitigated with ICT and what outcomes could be amplified with ICT.  So you have to think about is the process right and then you have to think about how can ICT bolster those processes and improve your outcomes. So our basic theory of change and this is not unique to us, this is sort of the eHealth theory of change and the access to health data theory of change is that with better data, with high quality data, administrators, it allows administrators, it allows clinicians to make better decisions. When they can make better decisions, they can implement better programs because they can better allocate their resources, be it human resources, health commodities, infrastructure resources, et cetera. And with more targeted, better programs that are more tailored and use resources more efficiently and effectively, the idea is that you can improve health outcomes. Okay, so our basic implementation plan at Becna Cares that achieves the theory of change is we do an initial site assessment, we look at community support, we engage community support and local buy-in is so important. We do the installation of our harbor, which I'll get to more in a little bit. We do a central training so that we build capacity at the site. We do a shadowing period. The intent is that we train the trainer and then ultimately we leave and the system stays and continues to serve their needs.  Becna Cares' three core competencies are in hardware, software, and what we call data consultative services. And we really see these things as totally intertwined but also able to be disaggregated from each other. We have hardware solutions, we have software solutions that we've developed in-house, but at the end of the day or actually at the beginning of the day, the most important thing is to find the right solution that works for the setting where we are working. So we can look at hardware, companies hardware, we can look at our software, we can look at other companies' software, but ultimately we're kind of tailor the right solution for the setting. Paul, do you have anything else to say on that? Okay, great. So just to give you a sense of where we came from and where we're going, as I said, we started as Becna Technologies and you'll see some of the Becna products over there which will look familiar to the engineers and any roboticists who are in the crowd. We have drug delivery, you know, physical, they physically move around a ward or a hospital and those are widely used in France and in the U.S. and as I said, in 2009 Becna Care spun off, in 2012 we underwent a huge expansion in Africa. In 2013 we started working with more U.S. clients and then also some medical missions who do pop-up work in either disaster relief settings or in low resource settings. And then from 2014 to 2016 we've experienced really tremendous growth. We went from a staff of about four to a staff of 20. We've had a lot of, you know, our global projects have really expanded and we're scaling up. Our next big step is that we are deploying, we are developing and deploying a version 6.0 of our hardware. So you'll get to know our hardware a little bit better and we'll talk about the size, but just keep in mind that we're also currently working on a bigger or smaller, better, faster, stronger, cheaper version. So as I mentioned, we'll give you a quick overview of our products and services and I still encourage people, you know, if this is becoming too focused on, if we need to take a step back and talk about e-health, we're happy to do that. But this is our flagship product, the Clinapak. It's about the size of a traditional briefcase. You can carry it in a backpack and it was a developed, designed, engineered, manufactured in-house here in Massachusetts. We do all our manufacturing in Uber in Massachusetts. And what is, it is, it's a rugged, easily portable solar powered power management and service. It can be, as I said, it can be solar powered. It can be plugged into AC power. You can plug it into a car battery and when you power it up and literally just press the on button, I am not an engineer, and literally just press the on button, it instantly throws a local Wi-Fi network. You can see the Wi-Fi antenna on the top left there. And what that means, this is intuitive, or you know, obvious to all of you, is that any Wi-Fi enabled device underneath that area, which is about 50 meters in radius, can instantly connect to the Clinapak network, to the local access network that the Clinapak has popped up and any software that is on the Clinapak, that has been loaded on the Clinapak, can instantly be used by all of those tablets. So really here the, to just break it down, the benefit is that in a clinic, in a refugee camp, which is one of our core use cases, patients, consumers will come in, they will get registered, they will, you know, a nurse or an administrator will take information about them, take their birth date, take their name. Then they might send them to a nurse to get their vitals done. Then they might send them over to get some labs done. Then they might send them over to the pharmacy. And previously this involved paper records, this involved, you know, a slip of paper that was easily lost or destroyed. And at the end, they're all stored, you know, in a pile. And it's really hard to parse that sort of collection of data for any meaningful analysis. And of course, if you go back to our theory of change, you can't make better decisions if you don't have access to that data. So what this does is the person registration has a tablet. The person at labs has a tablet. The person at vitals or triage has a tablet. And as soon as the patient is entered at any of those points, that information is instantly synced to the clinic pack and then to all of those tablets. So that as the patient moves through the clinic, their medical record both precedes them and follows them with no actual exchange of paper. It also syncs to a master database that's listed on the clinic pack. And that's a password protected database. And that can produce aggregate level reports, which can be used for looking at resource allocation, looking at, you know, health burden, et cetera. The clinic pack can also power devices. As I said, it's a power management system. So once it has an inverter in it, so once you power it through solar or AC or a car battery, it can then power things over using USB or Ethernet and see what else I want to say about the clinic pack. Great. So I mentioned it throws a local Wi-Fi network. This is just a graphic for those of you who are visual like me. This gives a quick overview of how we were helping in the Ebola response in Sierra Leone. So you'd have one clinic pack and all providers underneath that dome were able to access information. Again, this is up on the ground in Sierra Leone. In addition to our hardware, we have software, which is based on the Vecna patient solution software. The key software functions of the clinic pack software are patient registration and demographics, vitals, capture, diagnosis, treatment support, case review, administrative tax report, pharmacy and inventory distribution and patient flow management. Those are all pretty typical EMR capacities. I want to point out the pharmacy inventory and distribution because it's pretty unique. We're able to manage a dynamic inventory and track prescriptions and dispensation so that people can have a chain of, quote unquote, paper chain of their health commodities. A couple screenshots. We deploy in three different ways and I'll speed this up a bit, sorry. On the bottom here, you have asynchronous, post-it and synchronous. The asynchronous is when we are completely offline and we leverage com carriages and open source platform for conducting surveys. We can also deploy the software as a cloud-based solution, which we do in areas with better connectivity. I'll talk about that with the work we do with Special Olympics. And then clinic pack local, like we were talking about, is where maybe there's no power, there's no connectivity that you have to collect sophisticated information and be able to do analyses in the absence of that infrastructure. And so you would deploy the clinic pack. Two of our major use cases are in refugee camps and disaster relief, e-health, and the clinic pack system in particular and other systems that exist can help with the management of camp health clinics, the administration of them, like we've talked about the resource allocation and then also monitoring and evaluation, both for health burden and also for reporting to funders in different areas. And then we also have a community health use case where we focus on better patient care, surveillance, resource management, and community health work. I want to take a moment and just run through a few of our projects that show the ways that we deploy our different solutions. One is Project I Deliver, which is with Merck for Mothers. And the goal is to develop a digital clinical decision based, clinical decision algorithm and data capture tool for the interpartum period based on the Better Birth Checklist, which was recently released by the WHO. So we work, we are the soccer organization and also the integrator for this with a couple other firms with a prime on it. And the solution that we developed is a customized workflow and data capture tool based on that Better Birth Checklist. And it's being locally hosted on the Clinapak Node Hardware. So that third use case we were talking about where it's locally hosted in areas with no infrastructure. We're piloting it in three clinics in Transmara where we've been working for about five years. So this great work piloting it in clinics that are known to us. And we're currently doing some train-the-trainer sessions and remote support from in-country and then also from second headquarters staff. And then next I just have a quick screenshot of the, a sample screen of the UI of the iDeliver tool. And what this shows is a word dashboard, which, well, it doesn't look super exciting to people who are used to EMRs that are deployed in higher resource settings or established markets.  This is a very simply a task list, but it's a huge improvement for ward management. As I mentioned, we also work with the Special Olympics. Special Olympics is a really great thing that I actually didn't know about before I started here, but at each of their events, and they have hundreds of events around the world every year, they pop up a health screening event where they will have six disciplines. They have about teeth and dental health, eyes, ear health, et cetera, and they have local students and local doctors come and volunteer and do health screenings. In the United States and in Europe, these health screenings are great, not as essential because a lot of these kids are seeing doctors regularly because they have complex special healthcare needs. But the Special Olympics works locally, and these health screenings that are co-located with their events are open to the public. So whenever they do an event, they can come and also have those health screenings, and it's literally sometimes the first time someone's seen a doctor. So we've piloted so far a 15 Special Olympics events globally, and we're getting ready for a big deployment at the World Games in Austria, which we're really excited about. And just to give you a sense, I'm so impressed by the Special Olympics, but if you look at the green box in the lower right, they held almost one short of 900 clinics. They did 134,000 athlete exams in 57 countries last year. So the potential reach there is great, and it's a huge public health database. We also work with AmeriCares, where we do a pharmacy inventory management system. They wanted a way to track the donated inventory and then to track where it's going and also be able to tell the funder, tell the donor, and be able to look from a clinical perspective at what medications were being most prescribed. There are opportunities to scale internationally with that. Some of you may know AmeriCares does a lot of work in many, many countries with drug distribution and essential commodity distribution. Similarly, we work into clinics in Haiti with care to communities where we digitize and standardize the outpatient visit workflows and pharmacy operations. And then I'm going to let Paul talk about the work that we're doing at Kokoma Refugee Camp and Transmara Digital District on a broader level, and then he's going to dive a little bit deeper into the use cases and some best practices and lessons learned. Cool? All right. Thank you, guys. So when you're talking about e-health, a lot of the challenge focuses around that we're talking about aggregated data. Aggregated patient data that's being reported into an information system through paper forms. For instance, you'll know a clinic saw 300 people yesterday, or they saw 2,000 people last month and for which diseases they saw, but it won't break down to a patient level. There's the potential there to use ICT, to use e-health, to use digital technology to get that information down to a patient level to have more of a patient level outcome. So for the next two projects, for the EMR at the Kokoma Refugee Camp and for the Transmara Digital District, our goal was similar for the two projects to design and deploy a patient-centered EMR. As a patient was going through a clinic, either at the refugee camp or through the Transmara Digital District, there would be a longitudinal patient record that would be collected at the point of care. When a patient came in through a registration, their profile would be registered and then the clinician would use a tablet to record their diagnosis, their signs, their symptoms, and then their treatment. Our overall goal for the project, this is basically why we were doing these projects. There's no patient-level digital data. There's a high burden of reporting and poor data quality. So let's think about what this means for all three of these. With no patient-level digital data, as a patient was seen over multiple visits or over multiple facilities, their previous medical history was unknown. Doctors would be relying on patient reporting of their own patient history to make a better diagnosis and to use treatment algorithms. High burden of reporting in some clinics, especially in rural clinics, clinics would be closed for a couple of days a month to collect, to tally reports from paper tally sheets onto monthly reporting forms to then be reported into ministries of health or to UNHCR systems. If clinics are being closed for a couple of days a month, that means patients aren't being seen. There's the potential for digital solutions where if data is being collected in real-time and being reported in real-time, there's the potential to keep the clinics open for additional days per month and more patients being seen. And poor data quality. Honestly, I think that the data quality is so poor in a lot of rural settings that the actual disease burden and health status of a population is mostly unknown. As a patient would come into a clinic, they would be... Their visit is most likely recorded as a tick mark on a tally sheet. That tick mark then at the end of the month is manually calculated and added to a monthly reporting form. There's so much potential for human error both in the diagnosis of the patient, the recording error, the tallying error, that the actual reality between what the information system is saying and what the reality on the ground is can be so far from reality that resources aren't being allocated correctly and patients aren't being treated correctly. This is what we're talking about when we're talking about patient records. These are two different, both from Transmarin and from Kakama, what the patient records look like. Even though the one on the right, this is from a different clinic in the same refugee camp, looks more organized. It would be really difficult to say with any level of precision what the data collected in those paper forms are and what was being aggregated up to the information system. Our outcomes. What are expected outcomes for the project? Increase in data quality, increase in treatment adherence, reduce time for data collection, better use of medication and management, and availability of the data for action. The reality of the ground in both instances, there's unreliable power. So between off-the-grid or off-the-generators, power is not a commodity that can be relied on at either the clinic or the hospital level. The connectivity is very poor. So no reliable internet, no reliable cell signal. And there's a significant problem with human resources, high staff turnover, limited time for training, limited time for supervision and follow-up. This was our plan. A user-centered design process to assess the feasibility of an ICT solution, address the considerations of the solution, and then design and deploy. This is our user-centered, our human-centered design meetings at the beginning of the project when we were looking at what our expected outcomes of the project were, and going through the information system to structure the approach. All ICT projects, especially around health, are going to fall into four different categories. When you're talking about user-centered design, instead of thinking, should we be designing an ICT project, it's better to think of these four categories as possible places for improvement. So data collection and data quality, which is simply digitizing forms. Probably anyone on this call would be in a position to digitize a paper form. It's easy to learn. It's easy to deploy. Increasing provider capacity. So in this setting, it was instituting clinical decision support, so providers would be able to have instant real-time feedback on a patient's diagnosis and treatment. Beneficiary knowledge. There's more of a potential as connectivity and mobile phones are more accessible instead of always thinking about taking data in to start pushing more data out to beneficiaries. And system strengthening. We wanted to use the ICT solution to strengthen the health information system of both the digital district and the refugee camp. Once we outlined with the clinicians, the data clerks, the pharmacy management, what our ideal solutions would look like, we started going through considerations. The considerations listed here are a blueprint for other ICT projects and e-health projects that you might be implementing. The considerations represent lessons learned of dozens and dozens of ICT projects in low resource settings. I'm going to, we'll go through them one by one with some examples. So the most important consideration is the staffing resources. If there is not someone who is owning the project on the ground with the correct ICT or e-health profile, there is going to be a serious constraint of moving the project forward. Out of all the considerations of deploying ICT in low resource settings, the staffing consideration, it's just, it's the most important one. It's sort of the maker break, decision maker for assessing feasibility. It's also unrealistic in most cases to think you can divide the responsibility of the project up over multiple people. So not 20% of someone's time, 30% of someone else's time. This is a specific ICT profile that needs to be filled and needs to have the roles and responsibilities clearly defined. The next consideration, existing technology and literacy. When deploying a surveillance project in two different areas, it was obvious to see that if phones and technology exist in a certain setting, it's a lot easier to deploy. We were deploying a surveillance project in Congo in the DRC and we had to start the training. We had allocated five days for training and ended up being 10 days of training because we needed to go back to a level of this is what a mobile phone does, this is how you turn it on, this is how it's powered. Meanwhile, we did the same exact project in Sierra Leone where the community health workers already had multiple phones and the training took three days. So there needs to be some assessment of the existing technology and the literacy level of the data recorders. Literacy also does not translate into new mercy. So although someone might not be able to read and write, there's still a potential for them to report accurate numbers. Data access and use, it's easy for, it's far easier to collect data on a mobile phone where the challenges is data access. What you don't want to do is implement an ICT project that will only collect data but then make a lot harder for the data to be accessed. If a clinician is already collecting data on paper, that paper is always accessible. If they're not collecting data on a tablet or a mobile phone, if that data isn't as easily as accessible as on paper, you're now withholding data from someone who needs it. It's just another consideration that needs to be addressed. For mobile coverage, gaps that are supplied by most of the network providers are usually inaccurate. There's no substitute for going to the ground to the clinic to see if it's possible to get a signal at the actual reporting site. Logistics, what if a reporting device, if a phone is lost, if a phone is broken? What are your plans for replacement? Data protection, especially if you're collecting individual-level data. What is the plan for confidentiality for privacy? And what are the ethical considerations around collecting the data digitally at all? The ethical considerations are something that's often overlooked but it's something that needs to be essential within the feasibility assessment. And evaluation. How do you determine the difference between evaluating the ICT portion of a project versus the actual health services? If a project is not working, is it because the digital ICT solution wasn't working or was the actual service implementation of the project poorly designed? So within the feasibility, this is the technical assistance and what at BACNA CARES we're structured to provide. The overall solution feasibility, staffing assessment, which hardware and software are most applicable, what's your overall cost and then your cost to sustain the project? What the training looks like, what partners are available, and then how do you structure the evaluation and indicators for both the service provision and the ICT implementation? One of the key lessons learned is to always make sure your data systems are as interoperable both the data structure and the systems as possible. There's an open HIE initiative which outlines the different interoperability levels, the different interoperability service layers needed, but this is another discussion, a more technical discussion. Several technical discussions. But something key to keep in mind as essential in your planning. And then planning for impact, understanding the outcomes and impact. For a lot of projects you're thinking about reducing mortality or having an impact. But the reality of what the routine monitoring data is going to be collecting are just outputs. And then how to structure those outputs to show causality and correlation between collecting your routine outputs and linking them to outcomes for the patient and then impact for the project. Within that evaluation methodology structuring your indicators to track the uptake of the system with usability indicators and how the system is better improving the service provision through efficiency indicators. For example, for usability indicators just tracking the number of users and the number of reports over time will indicate to you the uptake of your system. If the system is well designed as something that's helping the clinicians and the staff it's going to be used. And that's why it's so important to measure because oftentimes clinics or health systems that are they're severely under resourced. So they are low to give not low as I shouldn't say that they may be reluctant to give critical feedback and they may say yes this is a great system because they're getting computers, they're getting attention, they're getting perhaps a cash incentive through a salaried position for that ICT manager. But it's really important to kind of lift a rug on that. And I think a lot of what Paul's talking about is lifting the rug on those design assumptions and the things you hear and looking at the data. There's that great quote like in God we trust all others must bring data. And I think that's really what we're saying is you really do have to as engineers I'm sure you all use data, data, data. You think something? No, show me the data. The usability indicators are really essential for knowing how the system is actually being perceived and used. A quick snapshot of routine evaluation we do around the qualitative attitude about the information system that again just helps track usability. Data quality and results, this is something important to track. Something like this is only possible through collecting data digitally. This is a real-time example of the completeness and quality of different clinics within the digital district. So our key lessons learned. Design with the user, bring the infrastructure, manage expectations both around the data outputs and the data use. Be sure to use data interoperability and structured data standards and understand the best use of data. What data is needed at each level of the information system? A lot of these key lessons learned were based on the principles of digital design which are available online and is a good resource to review. Just to close out the presentation, there are still some ongoing challenges and considerations. Unique patient identification is still a challenge even within using technology. It's still difficult to correct for multiple patient visits to correctly identify a returning patient. There are still security concerns whenever deploying technology to low resource settings. I think there is time now for a question and answer. Thank you so much, Paul and Emily for being here. It was an amazing and insightful analysis of the eHealth challenges, specifically what you have encountered in the field. We have time for Q&A and I will kick it off with the first question. You mentioned that you at VACNA CARE disaggregated hardware, software and consultancy. I'm really curious how you do that and which side is failing in implementation of the project? Can you elaborate a little bit more about how VACNA CARE is handling these issues? It starts with an assessment. Likely an assessment of what the program is really looking to measure. An assessment of what the reality is on the ground and the resources and sort of the consideration slides. But starting with the data and starting with the measurement objectives and then going through there and assessing what's the best software in terms of software we provide or other software available and then a hardware assessment of what the connectivity is in the setting and what's the best solution? In terms of the second part of your question with how we determine if it's the ICT solution or it's the health or it's some combination one of the things you're talking about with the usability indicators is quantitative measures and cross referencing the attitude measures or things like on this slide where you see HR stability and these are anonymous surveys that we give to dappers in the clinics where we're deploying. If they reveal to us an anonymous survey that there's real instability in HR or leadership really isn't engaged you'll see a direct correlation in terms of and so if it's being used very well in areas where staff satisfaction is high and then not well used in areas where staff satisfaction is low let's look at the what's our variable there, it's process and it's staff attitude and leadership attitude. So making sure that we I come from a quality improvement background and the process improvement background and that's what I always say if you digitize a bad system it's still a bad system. What ICT for D one of the things that it can do with health is that it really elucidates those issues and makes them pretty glaring and it can be messy. Things often get worse before they get better in terms of process because you can really pinpoint where the problems are and where the system is failing. And during that assessment it's important to remember that when you're looking at information systems, when you're looking at data flow a lot of times digitizing might not be the solution it's if you're seeing challenges with a difference between with the programs aiming to collect and what they are collecting if their data collection tools aren't correct it's still more appropriate in some cases and in some settings to just use paper to just have a better structured paper system collect the data that the program is aiming for and that's part of the assessment process as well. That's great. Thank you so much for that answer. It's very insightful and of course that's the direction that makes that paper based and digital because we know now after so many years of experience that it's actually the case, but systems don't work as you mentioned before. So you need to fix the system and then digitize them. We have another question and this is very specific. They're asking if electronic medical records or IT systems stand alone or has it been designed to some type of electronic medical record standard or has it been designed to some type of EMR standard? For example, does it dust it or will interface with full functionality to an epic site? So the sort of a two-part question when we are looking at the reality on the ground in the places we work and the level of information that is currently collected. As Paul was saying earlier the data collected at a site might literally just be a number of fevers seen in a month. So going from that to patient level data is a huge improvement. Going from basic patient level data around vitals and diagnoses and a longitudinal patient record about your BMI over time if you're looking at malnutrition it's a huge leap to something like Epic. We are not as complicated as Epic. We are designed to standards since we piggyback on the Vecna systems we are a little different but we have a compliant we can explore in HL7 all those sorts of things but it doesn't interface with an epic system. If I understand the question correctly and then I see part two of that question by Bob are you going to use this as a diagnosis and did you want me to answer that one as well? Yes. This is a great question and the project we are doing with Merck is incredibly facetious about whether or not things are classified as a medical device. Currently it does not provide diagnosis so it's not considered a medical device. There is in the works potentially integrating what we've developed with iDeliver with a predictive algorithm known as Selma which is a simplified electronic simplified effective labor monitoring to actions algorithm that does provide not quite diagnoses but clinical care recommendations at which point the actual software may have to get that classification but currently it does not. Great and if you can address like this next question we have just two minutes left but it's a very good question that Gary put here. What's your approach to updates in hardware and software and on the ground equipment like how do you do to update? Yeah so it's a great question but what we quickly realized was that we have these and I'm going to loop this in with the question right above how technology can be deployed in rural remote areas and how we did it in Kenya because they're really linked. In Kenya we have about 35 clinics right now and since they're all offline you obviously can't do math updates to all of the software and so what we have is we have a field team based in a city in Kenya in Kilgores who does regular visits to the clinics. The hardware itself is really really designed and optimized to be used in rural settings. We actually put it against a wall and put up like a cage around it because if people can access it they try to fix it or they try to like mess with it and really it's just best if left completely all the time it's meant to be hooked into the solar panel or battery and really not be touched. The software is also designed to be really rugged and not require a lot of troubleshooting. So for updates what we do is our software team here will send upgrades to our Kenya team who will then go around and perform the upgrades on the actual hardware so that we can update the software. That's super interesting. Thank you so much. Well the time is up but I just wanted to thank you Emily Paul and everyone who attended. As a last bit of information I posted on the chat the link to the Solutions Library and offering here at Junior Front Change that this product is in so you can take a look at that as well to learn more about this product that the Acnecors offer. I want to thank you for attending and have a great day.


When you check out the main slate for Friday in daily fantasy baseball You're gonna see pretty much right away that Clayton Kershaw and Brandon Woodruff our our top two pitchers of the night on Fandal and I love both those guys look great in their debut is this year generally very good pitchers as well But both of them have one key I would say major flaw in their profile and our job is to decide does that push us off them? How does that alter our ranking of these two guys and where else do we go if we don't want to go Kershaw and Woodruff? We're gonna break down all that also talk about some top stacks And give you some brief thoughts on the early only slate on Fandal for today welcome on into the solo shop That's right here on the Fandal podcast network and Number fire calm. My name is Jim Saunas. I am a senior writer and analyst for a number fire here to break down the main slate over on Fandal with lock set for six 40 p.m. Eastern it is a six game main slate will break down that one here first later on though I also will touch briefly on the early only slate I'll do just one picture and two stacks and that one very quickly if you're tuning in closer to 410 p.m. Eastern you want to get some line ups in for that early only slates I put the time stamp for when that that discussion begins in the episode description on Spotify Apple Podcasts etc etc so you want to jump ahead to that and then come back here for the main slate Feel free to do so but lock for that is at 410 p.m. Eastern the early only slate is a four game slate Whether for the main slate for today there is a chance of rain later in the day for the braves and the Padres I think they should be good to play but it is worth noting there is some rain potentially in the forecast there So check back on the timing of that weather to make sure you will not interrupt the brace and the Padres We'll dive in to the pitching preview on this main slate in just one second But first a reminder to make sure you're subscribed to the number fire daily fantasy podcast feed wherever you get your podcasts NBA DFS via Tom Vecchio for today the daily ISO will still be up I don't believe running during the playoffs, but still a more slate there We've got PGA every week USC for Austin Swain for the big slates. There is one in this weekend So find all those on the number fire daily fantasy podcast feed Wherever you get your podcasts and if you like what you hear leave us a five-star rating grand slams No hitters and double plays are back and there's no better place to get in on the MLB action than Fandall America's number one sportsbook. That's because right now new customers can step up to the plate with a no-sweat first bed up to $1,000 sign up place your first bet and get up to $1,000 back in bonus bets if you don't win So don't miss your chance to get a no-sweat first bet up to $1,000 when you join Fandall today Fandall official partner of major league baseball must be 21 plus and president select states first online real money wager only $10 deposit required refund issued is not with trouble bonus bets that expire in 14 days Restrictions apply see full terms at fandall.com slash sports book Fandals offering online sports wagering in Kansas under an agreement with Kansas Dark Casino LLC gambling problem call 1-800 gambler or visit fandall.com slash RG in Arizona 1-800 next step or text next step to 533 42 in Connecticut 1-888-789-7777 or visit ccpg.org slash chat in Indiana 1-800 9 with it in Wyoming in Kansas 1-800 5 2 2 4700 or in Kansas KS gambling health comm in Louisiana 1-877 770 stop in Maryland MD gambling health org in New York 1-877 8 hope and wire text open Y in West Virginia go to 1-800 gambler net Pitching preview for this Friday main slate Kurt Clayton Kershaw comes in with the highest salary on Fandall He is $10,800 Brandon Woodruff is a 10-5 Look at Jack Flaherty in 9000 Zach efflin 88 and Patrick sandball 86 as the final guy above $8,000 now With Woodruff and Kershaw the two major malfunctions they have today are different for Kershaw It's a repeat matchup for Woodruff. It's a very difficult matchup I like Kershaw a bit more despite the repeat matchup It is not something I love as we'll discuss but I think it does the overall profile does favor Kershaw by a bit Let's talk about him first then we'll dive in to Woodruff later on I don't like repeat matchups because the opposing team is familiar with what that pitcher is doing They prepared for him just a week ago. They know what he's throwing. They saw him in person That's in place here with Kershaw facing Arizona But Kershaw was very good there. He is a good matchup So I'm gonna go back here despite those reservations around that The Diamondbacks aspect of it is pretty big here because they have just a 95 WRC plus against lefties On the current active roster since the start of last year very little power and Kershaw buzzed through them last week He had nine strikeouts and six innings of one run ball He induced a 15.8% swinging strike rate and he needed just 76 pitches to get through six innings. I have Kershaw projected to go up to 88 tonight I had his projection. I think a bit higher than 76 last week So he's more stretched out than what he went last week and 88 may be enough to keep pace with guys like Woodruff The matchup here very good Kershaw has been effective for a pretty long while now He's been throwing more curveballs for his past 16 starts dating back to last year And in that time of 2.87 skill interactive era with a 29% strikeout rate His skill interactive era is best on the slate Very good that a ball dated to So it is suboptimal to have a repeat matchup. I don't like that But I am still fine with it here I think it's good enough where Kershaw will be my top guy the night edging out Brandon Woodruff in number two I think that the reason we can feel good about Kershaw and Woodruff 1-2 despite the fact both have flaws is They are a tier above everybody else from the effectiveness perspective Which is why I'm okay with Woodruff despite a really tough matchup He's facing the Cardinals who have a 120 WRC plus against righties They have a low strikeout rate as well. And that's a big part of why Kershaw is higher for me But Woodruff very very good pitcher. He's been throwing fewer sinkers his past 14 starts His era is 2.38. So good results 2.91 skill interactive era good peripherals 31% strikeout rate that strikeout rate is the highest on the slate for tonight The one issue Woodruff has had is fly balls He's letting up a 42% fly ball rate with a 39% hard hit rate So that's concerning the results have been fine, but my worry is that The batted ball concerns may be more apparent in a tough matchup, which is what he have has I've got Woodruff with the highest strikeout projection on the slate at 7.25 Part of that is pitch count because he's at 97 whereas Kershaw is at 88 So I don't mind if you want to go Woodruff, but just know that it is a tougher matchup for him than Kershaw I think they are a 55-45 kind of split.  I probably go 55 Kershaw 45 Woodruff They're both very close of you have a lean towards one I would say go with it because both those guys to me are very very fun Now for the third slot in the value slot, I think you could go Patrick Sandoval there But he's facing the Jays, which is a very tough matchup despite the changes on their roster so instead I want to go with the other guy in the 8000 range and that's Zac Eflin and We saw a lot of encouraging stuff with Zac Eflin in his first start with the rays And I think it makes him viable here A big part of it is the matchup because Eflin is at home facing off for the A's with a 92 WRC plus on their active roster since the start of last year Minimal walks for the A's that helps keep the pitch count and check which keeps things more efficient And that's good for Eflin Well, I don't think is fully stretched out as of yet Eflin in that debut looked way different than what he did last year He's cut back on his sinker usage, which is always good instead throwing more curveballs and more cutters And he's working in his change up a bit more and that change up was really nasty 83% whiff rate on nine pitches according to baseball savant curveball is good too for Eflin Spin rate for him was up across the board and all this led to A 17.3 percent swing strike rates now that did come against Detroit But the A is not a super stiff matchup either The one concern you could have with Eflin is pitch count because he went 75 in that start I haven't projected for 85 for tonight, which means his strikeout projection pretty modest when he compared to Woodruff and Kershaw but I think that there is upside in that projection because again He did look really good in that first start. He made tangible changes that led to us believing there was an actual change in what he was doing So the projection could be very wrong could be underselling Eflin based on what we saw in that first start So I still like Kershaw and Woodruff more But I will definitively have Eflin in my player pool tonight based on this matchup based on what he did in that first start Because I think there was enough there to believe that it could wind up being legit So to me Zach Eflin the top non-Kershaw or Woodruff starter for tonight As for stacking if you listened to yesterday's slate, I was high in the course field game and It was that as low scoring as could possibly be so that's not ideal And I can understand if you are wary going back there for today, especially because One of the pitchers in this game is better than either pitcher going yesterday I do still think that course field is the top two stacks of today's slate I prefer the Rockies. So let's start there. They're facing Mackenzie Gore and gore had good results in his first game this year He went five and a third innings let up one run that came against the braves and the braves are a very tough team against lefties And also in that game Gore's velocity was up from the end of last year He had good bad at ball suppression and given how talented Mackenzie Gore is that's very noteworthy He could have turned a corner because I wouldn't ease a good pitcher who had a full all season to improve as at a young age But gore did walk four batters there He's that course field for tonight. So it is entirely possible. He's turned things around but I just want to see It happen more than once before avoiding him in dfs, especially when it's that course field So I will be on the Rockies for tonight I think that it's worthwhile to do so despite what gore did despite what happened at course yesterday, but I think it's a good spot to hedge a bit Where you don't go as hard as at course field as you would on a typical slate Still have it as a top stack But maybe not as big of a runaway as it typically would be specifically on the rocky side To account for the fact that gore may be living up to his potential right now This does seem though like a good spot to buy into chris bryant's where bryant basically had a lost year last year But he hit the ball pretty well in the spring With good power numbers. He has run in the past 10 stolen bases back in I think 2021 Not sure if he'll get back to that this year or not, but it could happen We I really want guys who will run this year an mlb dfs because it's a big boost He's facing the lefty So I think it's a good spot to check out chris bryant for tonight, but again, just be cautious I would say in your rocky's exposure because of the changes gore has made Other side of this game is the nationals and I would love to not use them here because they're the nationals I think they're off in stakes But they're facing hosie arania and I feel like that doesn't leave us with much of a choice here arania made his first start this year on the road and Really tough start there four walks no strikeouts two and a third innings He let up four earned runs and all the 12 balls in play. He allowed half of them were hard hits It's the same thing that we saw last year with arania He has made 18 starts since he joined the rocky's rotation back in june His skill interactive era is 5.01. He has a 15 strike area, which is the lowest in the slate and letting up balls and play can be dangerous Anywhere it is especially dangerous at course field arania letting up a 40 hard hit rates on those balls and play across this larger sample and again It was 50 in the game last week. So in an ideal world. I love to not stack the nationals here I think that'd be great. I just don't think I can do that with with the pitcher being arania So the nationals I think we kind of had to go there despite the fact we may not really want to now lefties did hit arania a lot harder than righties last year so That's a good thing here to keep in mind when stacking the nationals Plenty of lefties here a lot of switch hitters kaibara rees one of those switch hitters He had four steals versus righties last year. So he's a catcher who will run He had a 38 fly ball rates minimal strikeouts Didn't hit for a lot of power this spring But he's been fine to open this year. So Ruiz is a guy I'll be high on assuming he does play again with catchers always kind of risky, but With kaibara rees, I think that if he does want to being in there He'll be a guy I'm high on for daily fantasy for today For this third spot for stacking there are a lot of contenders and again, no things to watch for today because Talking about the early only slate later on I will list off the other considerations So should you dislike cores or should you dislike the third stack other contenders? I would consider here for stacking. I like the angels. Uh, chris bassets Really struggled since the start of spring his velocity was way down his first start that puts the angels in play Padres facing jared shoester. It's a decent weather in atlanta. I don't mind that Nick martinez could struggle against the braves. So, uh braves Padres angels and then the rays the rays facing ken walde chuck I think all of those teams are in play, which means you have alternatives if you don't like course field Cool, you can go elsewhere. That's totally fine but You got a lot of alternatives. I used to like course most but if you want to go again Angels pod rays braves rays other alternatives My top alternative though is going to be the dodgers I have a hard time not putting them third against madison bum garter and the big appeal here is the hard contact bum garter Has been allowing mad bum has reduced his cutter usage over his past 16 starts and in that time He's letting up a 40 hard hit rates with a 42 fly ball rate We saw that bite him in the butt last week against the dodgers the same offense Five earned runs in four innings And his velocity in that game was also down from where it was last year. It wasn't like A concerning amount, um, but like it was it was down couldn't think it was cold in la Temperature does impact velocity. So maybe not a huge concern yet, but it was down I think that is at least somewhat noteworthy in that game the dodgers couple barrels against him 5.9 swinging strike rate that's down from 7.4 percent In the other games the fewer cutters towards the end of last year and again the dodgers just saw him last week If i'm gonna be concerned about kershaw in this spot, I should probably be concerned about bum garter as well so I do think the dodgers are number three But again a lot of good options to consider here as far as other stacks on the main slate Within the dodger stacks There are a couple guys here get pretty sizable boosts against lefties JD Martinez I don't tend to use against righties ever at this point in his career Just don't see the appeal a lot of other guys in this lineup. I'd rather use but martinez has a 270 iso versus lefties Since the start of last year that's playable So I can use that trace thompson just more likely to play against the lefty which gives him a boost Obviously does strike out a bunch But really good power numbers both against righties and lefties But should bat sixth or seventh somewhere in there for tonight and that could be high enough For thompson be viable and then also megal vargas hit lefties really well in triple a last year He's missed the past couple of games. So not sure if he'll play But if vargas is in there his salary is $2,500 and I am very into that as a way to Save some salary and make it easier to get to both kershaw and woodruff for tonight Do you want to do some dinger picks here for the main slate only? I'll talk about some for the early only slate too because why not but uh, the boring one and the fun one kind of blend together because Neither of them is like super super super boring, but we're going to go with kairi wies and east side paredes Ruiz aqueous field. So pretty boring there But facing guy lets have a lot of hard contact and fly balls for wies I didn't guess power if not he can steal some bases for us. So good dfs play regardless So kairi wies one of them issa paredes Didn't go yard for us a couple days ago when the rays were very kind to us But i'm back on once again for today. So paredes and ruiz are the two home run calls for the main slate If you're listening after for uh, 10 p.m. Eastern feel free to go on about your way We'll talk to you once again monday, but let's talk a bit now about this early only slate which locks at 4 10 p.m Eastern it is a four game main or a four game slate Pretty limited no big weather concerns for today on this early only slate. So it should be good to go Also temperatures pretty truncated. There's not a huge gap between the highest temperatures and the lowest temperatures My favorite pitcher on the early only slate is going to be lucas geolito I am willing to check out erin savalli Logan gilbert alex cob But coven savalli have pitch count issues and savalli and gilbert are both facing the same teams They faced last week and as discussed with kershaw not a big fan of that gilito Was a guy i was very awful of last year But he looked okay against the astros He now gets the pirates who have a 24 strikeout right against righties So i will go to gilito tonight But again the other guys are at least worth considering here So gilito would be my favorite pitcher on the early only slate The two favorite stacks for me on the early only slate are the white socks and the giants White socks for facing rich hill, which means they get a lefty which is always good for them Maybe not as much as in the past with hosie a brain you've gone But like still a good thing for them to face a lefty We did see Hill get some strikeouts in his first dart But not many withs let up a lot of barrels a lot of hard contact in that game So i think the white socks can handle him the white socks and gilito both to me Good options for this slate the giants other stack I like facing brad keller who i don't mind i think he's okay get some ground balls, but Does let up a lot of hard contact San francisco not as much of a pitchers park this time of year due to cold weather elsewhere The reason that san francisco stinks generally is because it's so much colder than everywhere else But that's not the case on this slate in fact. It's a bit warmer than a couple spots So it's not as big of a pitchers park as it otherwise would be relative to other parks So san francisco the giants. I think that they are in play I also don't mind the twins against hosie or kitty, but I will go at the giants all right above them Dinger calls for the early only slate again just for fun Because it's a small slate But yoan moncada actually hit for a little bit of power against lefties last year and has looked really good to open this year So we'll go moncada against rich hill and then talking about the twins against rickety Let's have a lot of fly balls trevor larnick Hitting the middle part of that order has shown power in the past I'm willing to ride at that so dinger calls for the early only slate yoan moncada and trevor larnick That is all that we have here for today on the solo shot and across this entire week But do want to thank you all for tuning in for today. We are back once again next week with a full week of the solo shot So make sure you are subscribed to the number fire daily fantasy podcast feed wherever you get your podcasts If you have any questions for me if you need Substitute dinger calls if one of my guys isn't in the lineup or you have questions about terminology MLB DFS in general hitting me up on twitter at jim sonnis j i m s a n n e s And you can also follow the fan dual podcast network at fan dual podcast want to thank you all for tuning in for today Good luck to you with your lineups for MLB DFS for today. Have a fantastic and safe holiday weekend for all of you up there Celebrating holidays and we'll talk to you once again on monday. This has been the solo shot right here on the fan dual podcast network


A brand new Terraria to celebrate Valentine's Day has just went live in Pokemon Scarlet and Violet. We're going to cover all of the details for this brand new Terraria event in today's video but before we get into the video please subscribe to the channel remember you can always unsubscribe later if you'd like to. As I said the event itself will be running as of recording this video from the 13th of February until the 14th so not got long to take advantage of this just a couple of days but keep in mind that if you don't go online after downloading this to your game you will be able to keep this event in your game for a lot longer until the next time you go online and then once you do it will remove this event from your Terraria Dens and like we know already these are running from one to five stars and then the five star is going to have a random teratiping but you'll also have a signature teratiping a fairy for this particular event because it is all around Valentine's Day one star raids they're going to be level 12 teratipe is going to be random standard ability on these and the moves are going to be pound baby doll eyes echoed voice and superfang these only going to be available if you are at the start of your playthrough and you haven't got your third gym badge yet one and two star are the ones that you're going to have available item drops for these raid events are pretty good if you're early on in your playthrough in particular for sandwich ingredients and some higher cost items here you can see there's some stardust there but you're going to get candies as well as a bunch of other things that are going to be useful in your playthrough so good event to take part in if you are that early stages now getting on to the three to five star raid events which everyone else if you finish your playthrough will have access to three star raids going to be level 35 hidden ability will be possible on these bullity charm hyper voice superfang other moves and additional move will be player rough and the item drops as you get higher with the star ratings do increase and get a little bit better you're going to get large and medium candies in this one and terror shards are introduced so you're going to get terror shards in this event which is actually quite good a bunch of sandwich ingredients here as well and some higher cost items as well with this rare bone and then moving up to the four star it's going to be level 45 again random terror typing and then hidden ability going to be possible pretty much the same as the three star except the moves do change a little bit bullity charm population bomb introduced with this level 45 tandem house going to be a little bit stronger and on core which can be a little bit annoying to deal with and agility going to be that additional move now again as you imagine with the highest star rating the item drops are going to be a little bit better going to get higher cost items here going to get a big pill as an option coming into these raids but the big juice of this is always going to be these five star rates and they're the ones you want to go after if you're going to want to farm these items level 75 for the five star rates hidden ability possible bulleted on core population bomb and play rough with the additional moves of agility and hyper voice I'm actually quite surprised at how good the item drops are going to be for this event you're going to get large and exhale candies in these drops you're going to get a bunch of the fur as well from the tandem house fur and the terror shards with the relevant terror typing that the den that you've gone in is going to be as well as an enormous amount of sandwich ingredients that are going to be useful for creating sandwiches as well as rare candy's bottle caps and bomb mushrooms and also pp up so you've got a chance of getting those every time you do defeat these terrarium dens and then you're going to have that kind of signature one which is going to be the fairy terror type that will probably appear a little bit more in your map rather than just the random ones that you're going to see for the tandem house so that is all of the details for the event as I say it is only running for a couple of days to make sure you do take the time if you can to get in and take part in this it's going to be a good opportunity to get a bunch of really good item drop and it also gives you the opportunity to get tandem house with a bunch of different terror types which is always going to be good for competitive player getting in with the ghost terror type or fire terror type steel terror type whatever you want you're going to be able to go into this event and make it a lot easier so you can get that mouse hold especially for competitive player like I say with those different terror types so to get this brand new event in your game you're going to need to just come down to your poker portal and as always with these events you're going to need a Nintendo online subscription when you're in your poker portal just come down to mystery gifts and then check poker portal news and this will connect you to the internet this will update all of your dens once you get this message up on your screen you know your dens are updated so you've got this new spotlight terror event to go and enjoy and what you're going to be able to do to identify these dens because the tandem house are going to be an array of different terror types throughout the region you can open your map and you'll be able to easily identify the terror dense by this white glowing aura that you're going to see around here as you can see this one here is a regular one this one will be a spotlight terror this will have the tandem house in it so you want to just identify whichever one you want to go after typewise will go after the fairy one because it is reminiscent of Valentine's Day with the heart terror hat that the fairy types do have and when you've located the terror then they will look like this I'll have an extra glowing aura around them you'll be able to just click in and you'll be able to see here we have a full star terror raid we want to go after a five star though so that's what we're going to look at and let's check this one out and it is the five star dense so once you've found the den that you want to go into either the terror type that you want to have your tandem house turn into whether that be a fairy type or ghost type or whatever you can get them in all different varieties of different terror types you can then go into it I would suggest if you're going after the fairy type specifically for Valentine's Day using this gold ingot build so if any of you are interested the gold ingot build that I am running for this particular raid event I am specifically going to be looking for just the fairy terror type tandem house because it's going to be easy to run through these events with this gold ingot and it is a Pokemon a lot of you probably already have easy to acquire with the steel terror typing we give it the metal coat just to give it an extra bit of output with its damage as well level a hundred of course to give you the maximum output we have EV trained in HP and special attack 250 for both of those and then just throw the remaining four in either defense or special defense we've put ours in defense not that it matters because you're not really going to ever get knocked out by a tandem house no matter even if it is a five star good as gold the ability move set is going to be recovered metal sound nasty plot and make it rain specifically going into these rage is just going to want a nasty plot of three times and then just hit the make it rain button and you should be picking up the knockout on all of the tandem house especially if they are that fairy terror type that you're going up against and of course we have maxed out the IVs on this and hyper trained it already let me go it's always going to be the pre evolution but it shouldn't be that difficult to take down you're probably not going to need any Pokemon that are really dedicated to taking down these terror aides the tandem house because it is a pre evolution to its evolution and the max rate it's going to be is a five star shouldn't be too difficult but if you just want to run through these events and gather a lot of these sandwich ingredients then something like gold ingot is going to be a really easy choice for you to kind of go after and then just run through these events very quickly this event of course is only running for a couple of days like we've mentioned so you've only got a little bit of time to take advantage of this and grab as many of these handy sandwich ingredients as possible but on top of that you're going to be I think the big thing from this event is obviously going to be getting the tandem house so you've got the mouse hold with these different terror types it gives you the opportunity to grab them and get them with the different terror types that are going to be useful for competitive play in particular as a third nasty plot is it going to be enough we should be able to make it rain here and it probably will be enough to take this tandem house down you could go for the metal sounds if you want but yeah we don't don't need to it is that easy and no one's going to have a problem with it it's going to be a nice event to go online with because it's going to be nice and easy to do shouldn't really have too many problems at all and as always since this is a special event I will catch this one and we'll get it in a preemie above all just to kind of recap and then we can have a look at the item drops that we get from this five star rate this is the highest star rate that you're going to be able to go into of course from one to five depending on where you are on your playthrough and what terror dens you've got unlocked and here are the item drops so you can see we do get those XL and large candies get some tandem house fair some very terror shots so it's going to be a really good event for just farming terror shots in general getting eight here and then look at all of these sandwich ingredients plus the red candy and pee pee up as well as a few more sandwich ingredients so like I say some higher cost items here the bomb mushrooms in particular and the red candy as well do make up for quite a good event for item drops in particular so there's a tandem house and like I say Golding are a very good one if you go in specifically after those very type tandem house which is very reminiscent of Valentine's Day so if you are wanting to go and farm these raid events for the item drops after completing one of them just come on to your map and then locate the next one and head to it check it if it's a five star that's particularly what you want to go for more than a lot of star ratings then you can just move on to the next one you can see there are going to be plenty of these spotlighter raids throughout the region and for anyone new if you want to change or just refresh the dens in your area what you can do is just hit your home menu then come down to system settings down into system down into date and time just hit date and time there just click through into okay and then hit your home menu and come back into game and all your dens will refresh as you can see and there we go we've got a nice very one right down here that we can head to and try and farm some of these items while this event is live so happy Valentine's Day have a lot of fun with this event over the next couple of days that is everything that we're going to cover in today's video like I say I hope you have a lot of fun with it and take advantage of these brilliant item drops actually I'm surprised at how good they are in particular and I'm going to be handy for getting all of these sand ingredients as well as the other high cost items that you're going to be able to acquire from just farming these events although it is only a short window that it is available but like I say if you don't go online after you've downloaded it to your game you're going to keep it until the next time you do go online so you're going to have a little bit longer if you decide to stay offline to do these with after the event ends but thank you so much for tuning in I hope you found this video useful like I say have a happy Valentine's Day and I will see you all on another video very soon so until then friends take care of yourselves and bye bye


Hi there, it's me, Monica Wahee, giving you some demonstrations on the use of SAS on-demand for academics, otherwise known as SAS ODA. In this video, I'm going to show you more about automated processing of datasets for ETL into a SAS data warehouse using macros and macro variables. Okay, this video will probably not make much sense to you if you don't watch my previous video, where I demonstrate taking the original dataset named CHAP8 underscore 2 and processing it into 12 different monthly datasets. In that video, I read in a dataset that has multiple states in it. Florida is coded 12, for example, and has multiple months in it, coded 1 through 12. So in that video, I showed you how to split the big dataset into monthly datasets using macros and macro variables, and also the where clause. Now, in this video, I'm going to demonstrate another ETL thing we do with SAS and data warehousing, which is where we read in a file, process it, and then export the processed version, but we do that with a super complicated macro. That way we can shuffle in monthly files one at a time, transform them, and then spit them out. I'm going to show you an example of one of these super complicated macros. First we have a twist in this video. We are going to be importing our dataset from folder X, mapped to libname X, like we did in the last video, but this time we are going to output datasets to a different folder, which is named Y, and we map it in the code to libname Y. Okay, so up here is the simple version of a data step that we are trying to automate. See this code? Let's break it down. DataY.jan2018 underscore FL means we are asking SAS to output a dataset named jan2018 underscore FL into the folder Y, mapped to libname Y. Right. The next line is set X.jan2018, which says, read in the SAS file X.jan2018, that was output from running the code in the last video. Right. And the next line is an if clause, if underscore state equals 12. 12 is Florida. That's why we want to name the output dataset Y.jan2018 underscore FL, so it has a suffix. This is a very normal thing to want to automate. Of course, we want SAS to automatically do this for all 12 months. So that's what we do in this macro code down here. So this is enough code to kill a horse, right? But don't be scared of the code. Here we'll take it line by line. Let's start with the part of the code that tells us we are making a macro. See this code sandwiched between macro and mend is the entire macro, and we see that we are naming the macro keep underscore FL. And at the end, we are running the macro. So that's where we start with the code. Here's me turning off system options in the hopes SAS ODA doesn't complain at me. Okay, here we have the let command. That's a hint, right? That means we are setting a macro variable. The macro variable is being declared as M, and M is set to equal a list of what will turn into prefixes for the names of the data sets that will land in Y. See them? Jan, Feb, Mar, et cetera. Okay, so that's a macro variable. Okay, now here we have a do loop with the N command. We can see that this do loop is setting the value of J to the iteration number. And that number is going to be 1 to 12. Okay, we have three lets inside this loop. These macro variables are inside the loop. So they reevaluate each time we come around. The macro variables they are setting are month, out file, and in file. So you can imagine where this is going. We start with month, and we set this to a value that is, well, it's a substring. See the substring command? You can see the ampersand with M and with J. So that means we are calling up the current value of those variables. Since they were set at the beginning of each loop, the first one is going to have MbJan and Jb1. What this basically does is tells us to read in the three characters in M that pertain to the loop iteration. So if you are going through the loop the seventh time, where J equals seven, the substring code would make month be set to the three characters JUL, read in from the M variable. Once we get month to be the three characters we want, we can set the name of the out files and in files to have the month variable in the name. And also we can add the suffix underscore FL to the out file for Florida. We also can set the lib name so we are outputting to Y and inputting from X. Okay, here we finally get to the code. Recognize this code? This is the macro version of the raw code I showed you above. All right, let's first load this macro into SAS's brain by highlighting macro demand and running. Okay, great. Now let's go back to our code and highlight our macro call and run it. Okay, so here is Y. And here are our automated output data sets with all the right names and the FL suffix. The most important point I want to make is that if you want to run a SAS data warehouse, you are constantly deciding code, especially ETL code, and working on it. You start by crafting efficient data step code, then step by step, you transform it into a macro. I demonstrate this in my book, Mastering SAS Programming for Data Warehousing. Thank you for watching this video. Hopefully, if enough people read my book, we will have some gorgeous data warehouses out there. And I hope you have a gorgeous day.


Hey everybody, welcome back to a week in Geekdom and today we're going to be taking a look at Dance in the Vampire Bund, Age of Scarlet Order Volume 1. So stay tuned. Welcome back to the channel, Geo here and today we're going to be talking vampire manga goodness. Yeah, it's been a while since I've talked about monsters on this channel. I have to give a big shout out to the folks at Seven Seas Entertainment for making this review possible. They sent me a copy of Dance in the Vampire Bund, Age of Scarlet Order Volume 1. The story is written by Nozomu Tamaki. So what exactly is Dance in the Vampire Bund? This book is a sequel to the Dance in the Vampire Bund series. I do believe those came out a while ago in regular editions and like 2-in-1 omnis or something to that effect. But yeah, it is a series that has been around for quite some time now. It deals with the rise of vampires and the character of, and I'm probably going to butcher this name, Mina Tepes. She is the princess ruler of all vampires. She's accompanied by her werewolf companion Akira. And in the original series, if I remember correctly from what I read online, they hoped to establish a society, a kingdom of sorts or a city, a Bund hence the title, where vampire society can live off away from humanity and all that stuff. And of course you've got the eternal struggle between the empiric forces and humans and all that stuff. You want peace and not a lot of people see it that way, so there's going to be conflict involved.  So that was the original series. Every single character in this vampire series learns that supposedly the vampire queen is dead. So at the start of this current manga, Age of Scarlet Order, the sequel, vampires are being hunted all across America. And their remaining hope is about this rumor that there's this escape plan that's being put out and Mina-Tepis is summoning all the vampires to go to the west coast. And they're going to board this secret navy ship or just a regular ship and they're going to escape for the Bund for this, you know, society and stuff. And the problem is, you know, all these vampires are running across America, but the queen is dead. So when you start the series, you're following a couple characters that are facilitating the move for this Muslim family that's trying to escape with their newborn son. I think it was the son, newborn baby. I should say newborn baby instead. And the start of the series is pretty interesting. There's this tension that is very reminiscent of things we've seen in the past in modern situations and unfortunate cases of discrimination and racism. And it's done in a not so tactful manner. It's very in your face, which I know for some people that I really don't mind, but I know for some people it's going to be a bit of a bother. And yeah, it can be a little bit on the nose, but I just found it really hilarious.   But in this series, there's more to that.  So they shouldn't be hated on. But obviously, you know, you're going to have conflicts on both sides.  But at the start of the series, I found it really interesting and it really drove the tension of this pair of mother and daughter as they're trying to escort this family across America, trying to evade the America church order thing, which is a religious fanatic group of people that they want to exterminate all vampires and all that stuff. So that part, I really liked if the story could have, because I had no idea, like I said, I had not read the original source material, the first series, I should say, if the series could have kept that momentum throughout the whole volume, it would have been an awesome read. I really liked it. I haven't said anything yet, but I really did enjoy what I read. It's a very simple, fast paced and interesting read. And I do like the fact that even though you've not, or in my case, I haven't read the original series, the first series, I wasn't lost. I still understood what was happening. I don't know if it's because of clever writing or if it's so used to these types of stories where you can predict where the plot is going. I love the idea of having this super minuscule group of people trying to escape.  So it is relevant. Also I like that it's in the future. By future, I mean September 2020, one of the dates thrown around. So yeah, since the story set, the original set in Tokyo, because they want to build the bond or the society, secret society off the coast of Japan, if I remember correctly. Part of what I liked is that there's this political payoff. The character of Minas Tepes and her family, they got a lot of cash. So they're paying off the national debt so as to gain favor and ease the tension between the two species, I guess. So the transition isn't as rough as, hey, we're vampires, we're settling in here. I don't care what you think. So it's a lot smoother than that. With this series, however, you get the other side of the coin where you are faced with extremist views and the anti-vampire sentiment is spreading across the world because the queen is dead and everything's in disarray and chaos. A couple characters get introduced in Japan that I had no idea who the heck they were. As you read, you start getting to know them and you understand. But the most part, Nozomi does a good job of writing these characters. I really liked, like I said at the beginning, the first half of the book where the tension is on these characters making this pilgrimage of sorts. I thought that was really intense and if the whole series could have been like that, that would have been even cooler to me. Later on, it does go into more manga, anime, trope things about vampires if you know what I mean. So I thought that was pretty interesting. The art is pretty easy to follow, especially the action scenes, they're smooth and you're not going to get lost because sometimes with action manga, they tend to be a little bit too hectic and you get lost in the shuffle. So overall, I thought it was a clean looking series and a very cool way to sort of reinvent the wheel and present a vampire story that's unlike other things we've seen in the past. Even with the original series, I liked the whole idea of involving politics with a radicalization of a group of a minority, in this case vampires, and wanting truce and peace. Obviously it's not going to be as simple as that. There's going to be conflicts and that is carried over into this title, which I believe is like a couple months after the original title. Somebody correct me on that if I'm wrong. But I do like that and there's talks about parliament and, you know, the political side of things of how these groups are not as accepting or should they be as accepting of vampires wanting to isolate themselves, I guess, and live away from humans and still retain an autonomous recognition of nationality of sorts. It's interesting. There's meat in there to get a hold of and do a really interesting thing with it. However, at the end of the book, we do go into the lore of the series with a certain characters past that I don't want to reveal because it's a spoiler for the book. We go into this character's origin and again, I didn't know what was happening, but you figure it out as you're reading and it's not that complicated.  You still have a good time reading the story. I also want to check out the original series so I know about the origin of the plot and seeing like Mina and Akira and all these characters, what their deal was when the story first began. But overall a very fun read. Some of the images invoke certain aspects of society that I wish were eradicated and it goes into very scary territory with extremism and racism and all that stuff. But overall, it's a fun vampire story that I do recommend. Have you read Dance in the Vampire Bund? Let me know in the comment section down below and if you're starting this new book, let me know what you thought of the transition between the two stories and how are you liking this new series, Age of Scarlet Order. Very interested in finding out. Also, if you haven't read it and you want to recommend me some vampire books, more than happy to take those suggestions. Thank you everybody for tuning in. Thank you to Seven Seas Entertainment for making this video possible. They were gracious enough to send me a copy to read and review for you guys, so I'm very excited about that. Thank you. As always you can follow me on your favorite social media platform, Facebook, Twitter, Instagram, all that fun stuff. Share, like, comment, subscribe here on YouTube, hit the little bell icon so you know when new videos pop up. Thank you everybody for being a part of this channel. I've got to go. I will catch all of you on our next video.


The reason why narcissists are so ungrateful. The reason why narcissists are so unappreciative and unthankful. Even when you make a special effort to do something for a narcissist, it's never good enough for them. Even when you inconvenience yourself and do something that you would not ordinarily do, they never appreciate it. Because they have a strong sense of entitlement. They feel like you owe it to them. They feel like they have a right to it. They believe that they are inherently deserving of privileges and special treatment. Even if you took them to a fine dining restaurant, they would pick the place apart. They would make negative comments about the tables or the chairs. They would complain about the food. They would make negative comments about the appearance of the waiter. Rather than appreciating the food or the service. If you went out of your way to drive them to an appointment somewhere, rather than appreciating what you're doing for them, they would complain that you're driving too fast or too slow. They would complain that the car is too small or too old. Or they would make negative comments about the music you're listening to. Most people would never behave like this when someone is going out of their way for them. But the narcissist doesn't even see it as though you're doing them a favor. They expect you to do these things for them. In their minds, that's what you're supposed to do. That's what everyone is supposed to do. If they want something, you're supposed to give it to them. But don't expect the narcissist to be grateful for anything you do for them. They don't understand gratitude. It means nothing to them. They're always scanning the environment for reasons to not be happy about something. Because they're not happy. And they need the environment to reflect how they're feeling inside. Otherwise they would feel like there's something wrong with them. They cannot be grateful about anything you do for them. Because they expect it from you. They feel like they are deserving of whatever they want. So there's no reason for them to feel gratitude. When people feel like they're owed something, they're not going to feel grateful for it. Because they already feel like you owe it to them. They don't see it as something they're supposed to appreciate. Because they don't have to work for it. They don't have to earn it. So it doesn't mean anything to them. They don't value it. But if you had to work for an entire year to save up for a new laptop, you would probably appreciate that laptop a lot more than if someone had bought it for you. Because every time you use that laptop, you would remember all of that time you spent working to save up for it. You are likely to be more grateful for it than someone who didn't have to work for it. Someone who was just giving it like it was nothing. Narcissists expect people to give them whatever they want. They take everyone and everything for granted. Because they believe that something or someone will always be available to serve them. So they don't feel any need to give thanks or recognition. Narcissists are like children. They are emotionally immature. They haven't developed to the point where they are able to meet their own needs or manage their own lives. They haven't developed to the point where they are able to regulate their own emotions. They believe that their feelings and needs are your responsibility. They believe that you are responsible for their lives. If they're not happy or if they need something, you're supposed to do something about it. Narcissists are ungrateful because they believe that everyone and everything is completely worthless. Everyone is inferior to them. They don't appreciate anyone or anything. If you try to show them that they should be grateful about something or if you talk about something that you're grateful for, they're never going to agree with you. They will argue with you that it's not something to feel grateful for. They will make you feel like it's not a good thing. They always have to be in opposition to you because it makes them feel like they are in control. It makes them feel like they have power. But they also want to portray themselves as a victim. So they have to look at everything like it's not good enough for them. They have to act like they're in some undesirable situation. They are very miserable people. They cannot find joy in anything and there is nothing you can do to change that. They hate anything that is good. They hate anything that is positive. They hate to see other people being happy. They just look at them as though they're being fake or as though there is no reason for them to be happy. Narcissists always have to play the victim. They have to see it as though their situation is worse than anyone else's situation. They have to see it as though they're dealing with problems that no one else is dealing with. They never consider that their situation could be a lot worse. They never find anything to be grateful for. They're always negative. They always find a reason to not be happy about something. Even when something good does happen they just see it as though it only happened because of them. So they feel no need to feel grateful for it. Narcissists are completely delusional. They think that everything they need will always be there. They think that even if they spend all of the money more will magically appear somehow. They don't think about the consequences of their actions because they take everything for granted and they believe that everything will eventually work itself out or they believe that you or someone else will solve all of their problems for them. They're like children. They believe that you are responsible for their lives and they expect you to take responsibility for anything that they do wrong. They don't consider the potential negative consequences of their actions so they cannot be grateful when these things do not happen. They just assume that they are superior to people so those kinds of things don't happen to them. There's just no reason for them to feel grateful about anything. They think that people are not grateful for them even though they don't understand what gratitude actually is. In their minds you're either doing something for them or you're not. They don't feel any need to be grateful for anything. They just expect it from you and if you don't do what they want then there's a problem but even if you do it that doesn't mean they're going to be grateful for it. They can pretend to be grateful. They've seen how other people act when they appreciate something but this is just intermittent reinforcement. They're just training you to do what they want. They're not actually grateful for anything you do for them and the best way to expose this is to say no to them the next time that they ask you for something. It will cause a narcissistic injury.  They will say you never do anything for them. They will completely disregard everything you have done for them until that point because they're not grateful for anything. It's just an act and when you say no to them they feel like you're denying them of something that is rightfully theirs. They believe that you owe them something. They have a strong sense of entitlement so they don't feel the need to work for anything or rightfully earn what they want. They just expect it from you like a baby expects milk from its mother and that is the reason why they are so unappreciative. That is why they are so ungrateful. Thank you for watching. I hope this video has made it with you. Please like, comment, share and subscribe. If you would like to donate my PayPal link is in the video description. Coach the Inquires, you can email me at coach.naksafivert.co.uk. Thank you for watching and I'll talk to you soon.