The, the system is also set up for you to be able to make key data important and visible to the user. So for example, if you would like the gestational age of the woman to be present that can be in a top patient bar that can be on the right side in a widget. You can have key conditions for example their HIV status, so that it doesn't need to be a part of just the data elements in the entry form but you're actually highlighting and raising the visibility for that data. Relationships between tracked entities so that you can know for example the mother of these two children, you could follow the thread from the mother to the children's records. We'll be building out much more in terms of analytics with relationships in the future, but the links between them already exist which can be very useful for example for the healthcare provider to be able to pull up a family and go through their records when they're doing a village visit. Notifications, a very powerful tool you can set rules that will trigger the notifications based on some conditions that you've determined. Those notifications can go to the tracked entity themselves to their phone number as an SMS it can go inside the system to other users. You could be alerting for example the the birth registrar that a birth has taken place and give them the link to the individuals data about their name, their mother's name their their birth date, etc. And many other user tools that we have which again are not on the analytics side they're much more about facilitating work processes and allowing for the users to, to replace many of the tools that they've been using on paper, giving them access to referring scheduling taking notes, assigning events to other users for example. And of course we do a lot with security and privacy and have a focus on analytics. Within kind of this set of functionality there are many many different ways to use it, but hopefully what you're seeing is that there is a wide array of possibilities and ways that again tracker has been designed generically to be customizable to fit your use cases and the way that you want to use it. No system has to use every one of these different functionalities. But you may want to consider adding some functionality to try to make the tracker implementation that you have better suit the users or better suit your data needs, or be easier to use in general. So there are many different ways that you can customize the system to fit your needs. So just giving you a quick look at some of the screenshots here showing you over on the right that all of this is present in Android as well. You can have a single tracker implementation that's running both in the browser and on Android depending on who your user is where they have access to hardware or network. You can set up things like the program notification that you see where it's just a library of possible notifications that go out to the right people depending on the conditions that you set, etc. And again just giving you a quick look at how all of that data that's coming through an individual records can be aggregated upwards it can be used in maps it can be used in various different types of charts. What I'm showing you here are some of the examples for the standard covid vaccine registry that have been set up. But all of the tools that you may be familiar with in the DHS to analytics suite, through the data visualization or other data apps are available to be used with tracker as well. And in fact the data can live side by side you can have a version of the data that is represented via tracker and that by HMS or aggregate data, living in the same dashboard. One point to make is that tracker is both a front end and a back end. And again this isn't a developers Academy we don't need to spend a lot of time thinking about what that means for front end and back end but the idea is that you don't just have to use the tracker app. There are many different ways that we have tried to enable tracker to be useful for you if you have an existing individual data system if you have an EMR if you're using something like ODK or com care. All of that can be fed into tracker back end for taking advantage of the analytics and the visualization or for combining that data and sharing it with the aggregate side. You can also use the tools that we have available to build your own apps that are custom and serving a specific purpose that you have. So I'm showing a couple of examples here that we may hear a bit more about in just a moment. On the right we have allow who's created an ICD 11 app using the tracker data model. On the left we have Rwanda, which is created a COVID vaccination portal, where they're able to generate the unique ID from the individual and use that to lead the individual to a COVID vaccine certificate with a QR code. So again, don't feel like if you don't see what is in the tracker app, if the tracker app is either too much it has too much functionality for your use case, or it's not specifically meeting the needs of your use case. That doesn't mean you can't use tracker. Tracker can be integrated with your other system. You can build your own simple app on top of it that removes functionality or add some key functionality. So there are many different ways that your system can can make use of tracker. I wanted to speak just for a moment about why we think tracker is valuable and why the university has spent time and effort on building out this suite of capabilities. I'm just referencing here the first guidelines that WHO put out about digital interventions for health system strengthening. These were published just a couple of years ago. You can see from the introduction that the World Health Organization is thinking along the same lines that we are that many of the functionalities we're describing, they're not a luxury, they're a necessity. If we're going to achieve the Millennium Development Goals, the Sustainable Development Goals, if we're going to achieve the kinds of eradication of diseases that we like, if we weren't going to achieve coverage of things like COVID vaccine, then there are many digital tools that are a necessity. We simply couldn't get there without it. And they listed in this same document 10 different specific recommendations for any digital health system strengthening tool. This was based on a systematic review that they conducted that looked at all of the published literature about digital health interventions and grouped them based on their efficacy and their impact. And you can see that the DHS II Tracker system in specific is able to cover seven or eight of these specific recommendations. And so we see that the tracker system is a vital and necessary part, a tool of what many countries can use to achieve their goals, and that these interventions are endorsed by the literature by the World Health Organization by the best scientific practice. So for these reasons, we spend a lot of time trying to make sure that tracker fits your needs, that it can be used for the purposes that you would like, and that it can have the maximum impact on the health outcomes that you're trying to achieve. But we also know tracker is difficult. So this is at least my way of thinking about tracker. This would be a picture of the blocks that I had as a kid to build with. You have a massive set of possibilities. But your ability to turn this into something beautiful is based on how skilled you are, which can be quite complicated. And we also know that the kinds of systems that you would like to have in many countries are complicated. You would like to have a system that links both the health services and the lab system that is able to do referral referrals and fine loss to follow up you want to send notifications. You want to be able to have all of this data be comparable across sites and with the HMIS system. So there are many different pieces and when you're staring at tracker as a pile of possible functionalities, it can be quite daunting. One of the things that we work with and spend a lot of time on are these WHO health data toolkit packages. So the University of Oslo is a collaborating center with the World Health Organization. For the last four or five years we've started to put together pre built configurations of DHS to for various health areas. And the way this process works is that we partner with health experts who know the global recommendations, the necessary guidelines, the data requirements, the key indicators. And we spend time with them configuring a version of DHS to which can be shared with the world that meets those requirements that covers the global recommendations that produces the key indicators. This is made available through the WHO website through the DHS to website. You can see some of the categories that we're working on some of these are works in progress, some of them are already completed and being used by many countries. The packages come with not only the metadata for you to add to your system, but they also come with system design documents, guidance for the installation. Sometimes we even have included with them training materials. So the idea is to make it easier for you to approach DHS to and be able to use it. It's there for both aggregate and tracker, we're of course focusing in this academy on the tracker use. And quite honestly tracker is the one that maybe benefits the most from these kinds of packages because tracker is such a complex system to put together well. I think of these packages more like this, rather than that box of parts that you can put together into whatever form you wish. A package actually comes with a goal in mind it has all of the pieces that you need. If you follow the instructions you can build it exactly out to be the thing that you want. But you also have the opportunity to leave off parts that you don't want or to add in a different component that would be useful for your situation. It's still adaptable still flexible but it's meant to make it a little bit easier for you to achieve your goals with tracker. Just to give you a sense right as of our last counting we knew of at least 46 different countries that we're using at least one of those packages. Many of the countries that you represent are probably here on the board. Many of you may have even worked with some of these packages. But you haven't worked with the packages and you see your country here you should probably be reaching out to whoever was responsible for using the package and learn from them about the possibilities for tracker packages. The packages include HIV case surveillance TB case surveillance malaria elimination vaccine registries, many different COVID packages. So there are all kinds of pre built and ready to go tracker packages that you could take advantage of that footprint of 46. At tracker worldwide there's there's even more countries that are just using tracker in some fashion they've built their own programs they've linked it to other systems they've built their own applications. So at this point we have over 75 countries that are using tracker on a national scaled approach. As you can see from kind of the growth chart at the bottom this has been a massive growth since 2015 2016 to get to this scale. It means that in the last four or five years we've learned a lot about how to implement. Many of these countries have gone through the growing pains of trying to make tracker work of figuring out the complexities of supporting it through the implementation side. And so that's a lot of what we hope to share with you today and in the coming two weeks to make sure that we're giving the best practices and the best examples about how to implement tracker. We've widely implemented use cases just putting a list up here you'll probably see one of the health areas that you're working on or interested in. These I would say again are not theoretical so much at this point these are these are mostly use cases that have been implemented over and over in various different ways and many different countries. Many of those listed on this slide also have an associated WHO package with them. So you would have an easy starting point. If there isn't a published a package associated with the health area you're interested in. You can always go to the community of practice and ask if anybody has covered the health area that you're interested in their their implementation may be a starting point for you. It may be something to learn from see how they've decided to design their system, see what the resource requirements and support infrastructure have looked like. So really engaging with the community of practice is a good idea, especially if you're starting out now a tracker, but even if you're already running tracker you may be able to learn substantially from from some of the other countries and the use cases that have been carried out. So I was just going to show you a quick map for example of immunization data and what a difference this has made. We started taking a look at those countries that were collecting immunization data in 2018 and are able to compare that with January 2021. I think that we've gone to the point where we have a fully integrated and parallel systems stopped for for immunization data 31 by January 2021, meaning that the DHSU system has been able to be fully integrated, any parallel system that they were running, whether electronic or on paper they were able to stop using, and they were able to adopt tracker for all of those purposes. I'm sharing these examples because I do want you to know that it's, it's proven and very possible to run these kind of large scale implementations at this point. You can make use of tracker to cover many of your existing needs, and that usually the difference between those countries that are successful or those health programs that are successful and those that are not is implementation and the management of the implementation. So this is about how you conduct your trainings, how you provide capacity building over time, how you build your IT support team, how you source the, the, the Android devices that you're going to use. So these key considerations will be discussing this week will make the difference between whether you're able to make that jump into a fully realized tracker system or whether it ends up just being a pilot that doesn't go very far. So in closing here there were a lot of questions about this. The word of the day today is immunization campaign, which is also why I showed the immunization slide just before this. As a reminder, you can find the attendance link in the slack channel, and you'll be able to fill it out today and use immunization campaign for your word of the day. At this point, I am actually going to stop speaking so much and give you a chance to hear from a number of the countries that are participating in this academy about how they are using the tracker application. So I was going to turn it over now to colleagues from Ethiopia to talk us about their laboratory reception tracker app. Do you want to share your own screen or would you like me to walk through your slides. Hello. Thank you. I will stop sharing on my side and you can share your screen. So is it still loading? Is it feasible? No. Oh yeah, now it comes. Thanks. My name is Malakasarit and I'm from Ethiopia. Currently we are using the tracker to collect the COVID test results and starting from the collection, specimen collection up to the point where we track each individual suspect from cases, treatments and up to the discharge stage. So before we started the COVID pandemic started, the HS2 was being used for aggregate reporting. But when COVID started and the release of the WHO package by Oslo, we were able to interpret the WHO package, the whole COVID package in Japan, and of course made some customizations. So there was, once the development was started and once specimen was coming in, then there came, there was a month long test campaign in the country that we wanted to collect around some months. So this became very large for the both the HS2 system and also for the laboratories. So tracker capture was a bit cumbersome for us so that the data collectors were not able to, we were not able to use data collectors up to their full potentials because it was a bit too much work. So we, in addition to this, there was this high load for specific labs. So one lab, when it receives a large batch of specimens, it dispatches it to another lab. So we had to come up with a solution and what we did was we developed the HS2 app, a tracker app to act as one stop place for approving specimens, distributing those specimens to specific laboratories, and also record the test results. So this is the basic screenshot of the app. What is being done is, first we select the organic and then we select the program, and then we have two states that is in concern. The first is the laboratory request stage, and the second is the result stage. So once for the laboratory request stage, this is the approving stage. We select the laboratory that we want to dispatch the specific specimen to, and then we select the number of days that we want to load, and we will load it. We added the days because most of the labs might not have very fast internet connection, so it will just load it once and cash it there. So using that, we, as you can see, there is this basic fields that we can use to search with, but we mostly use the specimen ID. So the specimen ID is read through a barcode. So once the specimen ID is read, the only thing to do is approve or we have an error. The view error is added here because some of the mandatory fields might not be collected by the specimen collectors who use Android phone to collect the basic information about the specimen. So, in order to send it to an actual lab, they need to up to fulfill every mandatory data, and once it is approved, it will be dispatched to the laboratory. So this is the very simple form that we have developed for them, and in order to provide the results, we just go to this result, to this page. So this page, as you can see, the stage is changed from laboratory request to laboratory result. So the result, we just change the approve button to a drop down button where a user can select the results that he wants. So once the user selects or clicks on the result, that result is saved. So by doing this we have tried to facilitate for the data encoders the input of laboratory results for them. So by doing this, we were able to buy now we have about 1.7 million specimens collected in the HS2 for the COVID, and it is being used by almost all laboratory reception clerks and result encoders across the country. And despite its objective of course to facilitate the distribution of parts and also to handle the large load of data being come we also added, we also have seen additional advantage like it's now being the main portal to capture the results and even additional laboratory requests are coming to us, so that we can implement this for COVID which has gone for COVID to other lab tests as well. So first specimen collection type and the laboratory reception time and result issue time is collected, because we collect what time is the specimen was collected from the collector, and also we will collect what time the result was approved that means when it reached to the specific laboratory. And also the result that the result issue time, we were able to calculate a accurate indicators for T80 or thermal round type. This also ensured the app also ensured for us that a completeness because no specimen goes to any lab without being approved first. So in order to approve that specimen or that specific request. It needs to have a complete that before the approval stage was was found because we were not able to communicate to them because the result collectors might not feel all the necessary data. They might feel that they might not feel the phone numbers and things like that. And in addition to that, it takes less than 10 seconds for data encoders to enter the lab because they just need to scan the output, click on the results and within a set of two clicks, they will have entered a specific result. So this was the additional advantage that we have by developing the app on top of the tractor capture that is already existing in VHS. This is from my side, if there are any questions I will answer them all. Thank you Mike. Thank you so much. So again, if you have questions, feel free to put them into the Slack. We'll have people monitoring and they can go ahead and answer. If, yeah, we just have a link now, Martin has put into the chat that will take you to the questions channel so feel free to put them there. This one was a great example of being able to build the app that works exactly the way that you want it to for Ethiopia. So thank you for sharing that experience and then hopefully you can monitor the Slack for for any questions. Okay, with that, I think we will switch over now to Lao. I'm not sure that John will be presenting or another. Hi all, can you see my screen. Yes, thanks John. You can see a presentation. So I'm just going to talk about DHS to tracker use cases in law. Just want to just a quick presentation. There's a brief idea about how we are using tracker program in law and what it took to use DHS tracker in in law. PDR is, we've been working with with them from quite some time, both you Mr. Foster and his Vietnam and supporting a lot. We started with as normal DHS to starts we started with aggregate, and then we work on the event and then in two, two years back, three years back we started with with the tracker program. These are the different tracker programs what we try to use. We started with malaria case investigation program. And then the foci, and then the TV, and then the TV contact examination and tracking. So HIV, ERT treatment. And now when COVID started it was a COVID surveillance contact tracing code of entry and vaccine registration. So these are all the programs what we started with. But now the one good advantage about law was DHS to was was made as a national system, and everyone agreed that like the DHS to system will be the official source for for all the data. So we had put a lot of buy-in from the ministry itself. And also we did lots of work with the WHO and other development partners to bring them together and see more than their only program but also the whole health system strengthening. So what we learned from the this years of law tracker implementation is we need a health system strengthening approach even for tracker, even for when we want to implement a simple like say malaria program or COVID or anything. We need to make sure that like everyone understand it is not like one tracker program it is like you have many other tracker program will come out. So we talked with all the health program people and this get a common agreement, just even for patient demographic.  So we want to synchronize all the things so that like we don't duplicate. All the time what we just seen many, many places that we have occupation for HIV, which is different occupation for malaria is different. And also we try to combine all the things and to say we are, we have key common patient demographic details which every health program should collect. They can also collect additional attributes patient attributes that's not a problem but at least these five key program demographic because they have to collect each and every tracker program. That was something common agreement we tried to deal with, and also support mechanism for some national core team group of 11 people at the national level, combining from different programs WTO, law team, Ministry of Health, the Department of Planning and Finance, and also help program people so they allocated a couple of members to be a part of core team will be trained in in tracker and also in DHS to try to manage and maintain. We also did lots of coordination collaboration with all the relevant partners and national stakeholders. It's because as and when things happen people want to introduce many new programs and other things, but they first need to understand what can factor do and what cannot do. That's one of the main things sometimes people just come down can you please include this particular logistic thing into your system we just say no sorry, you have M supply you have other things please use that one. And what DHS tracker can do is tracking a particular patient or lab sample or things or period of time and produce health program analytics. It is not a hospital management system it is not a complete patient record, even we collect patient details but that is specific for that particular Other thing what we learned is we require quite a lot of server support and access, because like as and when things are operating and changes we also need to monitor quite a lot on the server, the logs and other things. That was the few things which we looked after. For this session I will try to present is few things one thing is on the COVID self registration vaccine and the screening and I see the app which has already been presented so I won't going to do the demo but I will just like talk about it. Just to talk about the COVID self registration right now Laplau has been doing all the COVID vaccination but there have been an enormous workload at the health side so people have to enter all the different details the patient demographic details and also few medical things so what we tried to do was to create a website external app which enters all the different data but stores the data in DHS to program itself directly. And then it also allows public to check whether the health authority have accepted the status whether it is pending or approved. It's also reduces the data work in data work data workload on the health worker side so that like they can just like do the screening not deal with all entering all the patient demographic details and other things and then provide vaccination report. We don't say vaccination certificate because we'll work with Diwork and other people and with Units to foster to make the vaccination certificate but we are still just producing a simple vaccination report with QR code where they can try to find other things. The solution basically exist in external website which I'll just show you very shortly and then public can just like enter the check the status and everything. And after that when health official they just like log in to DHS to as they normal do and then like say how many people have been self registered and then they enter and all the different things. This is actually it's not a generic app because it's been customized quite a lot for law itself because not all the health facilities are providing the vaccination and not all the health facility will allow self registration. So there are few health facilities and also only on few particular days and timing the allow the vaccine registration. Just to quickly to show you on that you can all see my screen. So this is the law version of self registration. So where people just like fill in all the different details the first name last name and all different things select the province where they have been answer some of the things and plus select the site. So when they select the site only allocated date will be shown. This is May 27 and when they select that one the slot will be shown on which what kind of slot are available at what dates. Based on that one they can just select and register it once they register SMS is sent to their phone with their ID and all and then they can check their their status. I'll just like show few things on that. This is some is again it's all demo and test site. So it's not a real data. So this one is is checking for the site and just like gets the status. So this particular person has been approved from the system and then they can do the all the data. That's the that's for the public and I'm just like trying to show how what happens in DHS to so in DHS to what we have done is to create a simple app which is basically DHS to itself. But just to make sure like we have them self registration things done. So every time when the self registered is there so it will show around here list of all the registered people. We will not give any kind of code number because that's the workflow so self registration will not get any number. They will do the check and screening they will ask where they are what kind of things are or the phone or things only when they approve they will select which team is going to vaccinate and what is the the number what they are allocated. Once they are given then this number is allocated to a particular person and then they can do the screening and vaccination and also give the same date whether they can come to the same date what they have suggested to or if they want to reschedule they can just do that from based on the available needs. That's basically how the system works so that health worker don't have to enter any of these details and nor we need to maintain separate system for COVID registration because when they do all the data entry. It's directly going into DHS to tracker program and storing all the data and the rest all the different stages like screening and the vaccination stages is filled by health worker. This is the one of the use cases what we've been trying to add up as Mike mentioned, you don't really have to use all these things but when we have different cases so you can try to modify also try to use to satisfy your own needs. Just going back, we also try to, this is another custom app for ICD-11 for cost of death. We've been working with the WHO HQ and with UNICEF first to try to make sure when they install many countries are trying to use the ICD app. We want to try to give a more customizable solution where country can install the ICD-11 app based on their country settings and country DHS configuration. And then like it will also use analysis tool like export to Anacor or built in dashboard which is basically few additional source which we've been working with the WHO on grouping the data based on ICD-11 chapters. Yeah, that's basically all from me. If you have any question, please write in the slacker or things. I would be happy to respond. Thanks Mike. My name is Oswald Dachaga. I work with the Ghana Health Service and I'm a member of the Institute on Equality, making this presentation alongside Kwame who's also on the call. So for Ghana, we have been doing trucker implementation in the early parts of 2016 after now. As far as DHS is concerned, we have been a team that have started using it really much early from 2012. And largely our deployment objective, especially for the trucker system have largely been based on trying to reduce errors and omissions during data collation and entries by health facilities and sort of trying to be able to automate our data gathering system for health facilities and move gradually towards a paperless system. And so the trucker system came in handy for us and it's been doing so well for us for some specific programs for now. But as I've mentioned, our main system actually using the aggregate system that teams do and all these fall in line with our strategy as a country of ensuring that there is universal access to healthcare services and also improving on the efficiency of the services that we provide across the country. Now there are three major areas that we have implemented trucker in Ghana and the first one had to do with maternal and child health where we are tracking antenatal care delivery post-natal and then child welfare as well as growth promotion services and this is being implemented about a number of regions in country. We also have the TB surveillance and case management model which is also on trucker and it's also able to help us track all susceptible TB cases and also track their treatment as well as outcomes. And the third one has to do with HIV, which we have also implemented for ART sites. This also helps us to do trucker clients, track all clients that are on treatment and are assessing their medications at our various ART sites. There is also a plan to of course track all clients that are on the HIV testing and counseling session. So as I mentioned our scope have largely been for MCH HIV and then TB and for MCH currently five regions out of the system in Ghana. I am implementing it using it for client management and tracking as well as being able to generate service reports in aggregate form that then allows us to be able to move that into our main repository which is the aggregate system. HIV is implemented in about 586 ART sites and as I mentioned is also used for client management and able to schedule appointments for ART clients to come for their medication and able to also track misopportunities to then allow care providers to do default at tracing and be sure that everybody that is supposed to take their medications are able to get them on a timely manner. We also are able to generate some useful response including clients currently on treatment and all that and those are great outputs for our HIV program. For ATC clients we are yet to fully deploy that and the target is around a little short of 5000 health facilities and we are currently initiating processes towards deploying that functionality and area. For TB we are implementing in about 348 facilities and those include hospitals and district hospitals as well. It tracks all TB clients that are on treatment and also generate outcome reports as well. This again we are able to generate all our aggregate reports, our TB08 and TB07 reports that then feeds into DIMMS2. Now running and using tracker for us have come with a lot of sources but it also comes with its own challenges. On the side of logistics one of the key challenges we've largely faced have to do with the acquisition of these electronic devices that is Android tablets that you'll be able to use to do a full nationwide deployment and that has to come with a lot of funding and even their management. Then the funding for training of healthcare providers is also another critical area that you need to look at. Then of course change management, the fact that people are used to capturing their data manually and then now you are asking them to capture data using an Android device and all that comes with its own challenges. Then of course the stability of the tracker app for offline data capture. This I must say have improved largely with the recent releases of the Android app but it's still a challenge for facilities that are not able to acquire tablets that meets a certain minimum standard. Then they have functionality challenges. Then abuse of devices by end users because we do know that once you are not able to control and manage these devices while using MDMs, then end users install all sort of apps on it. Then tablets begin to run slow and that affects the functionality of the device and MDMs also do not come cheap. So it's one area that we think that if the UIO is a lot more involved, we should be able to solve that problem so that we at least restrict a lot of the unauthorized apps that get into the tablets and affect the functionality of the Android app. Now, one of some of the ways we have largely tried to use to improve and overcome these challenges had to do with engagement with partners to support us in the acquisition of the tablets and all the deployments we have done currently for NCA, TB and HIV have largely been from the support of partners for the acquisition of the Android devices. Progressive deployment instead of a one-time deployment. In Ghana we say we do not do pilot, we do progressive deployment because piloting usually will come with these own challenges. So what we do is to plan a move, a region at the time or a district at the time and cover the entire country somewhere in the resources are available. Another critical thing we have done is to design and deploy in such a way that it meets the needs of the service providers and communicate exactly the importance of how it can help them to enhance their service provision. And once you do that and do that very well, all stakeholders are able to get the buy-in and the interest is brought up and they are able to help you implement successfully. As I indicated, recently the latest version of the Android have been largely successful and we are currently using it for some implementations and it's so far stable than the previous ones. We have also initiated some integrating efforts and in one of our regions we have been able to successfully integrate the HIV E-Tracker with a PCR machine for viral load tests. And so once a test request is done by the health facilities is transmitted directly to the health facilities that have the capacity to run these tests using the PCR machines. And once the results are made available from the PCR machine it is then posted directly onto the tracker without a health service provider intervention. And for us that is something quite great to share and currently there are plans to expand into other regions and gradually make it available to the entire country. So to conclude what I would like to say is that the electronic systems in themselves do not improve your course because they are good tools that helps you to improve your health service delivery and data capture. But what is critical is the human being that run the system. And for that we always say that you need champions especially among the end users who will own the system and run it as if they have started it. So this is some reference point where other service providers then learn from and indicate that well if my colleague is using it and it's producing results why not I can also use it and it largely improves and aid other people together by supporting your implementation. I think towards the system is critical and what say that the quality of data from any information management system largely depends on the interest of the leadership as well if you have a national leadership that are interested in output in the data in the best of quality then of course you have to and they are able to communicate a lot more in the advocacy areas as far as getting people to accept the use of tracker and all other systems that we are deploying this concern so for us in Ghana this is what we are doing for now and we are always available to share these experiences. Thank you very much. Great. Thank you so much as well. So we've had a number of questions coming in through slack and maybe we can we can take a moment to address some of those I there will be a few for you and Kwame about the Ghana one but maybe first if John Lewis is still on. There was a question about how you were able to publicize the availability of the self registration tool. How did how was it made known to the people that they could use that for self registration.  Alright, maybe he's. Yeah, don't set me an answer actually. So I posted that on the slack. Okay, great. In the question from Abdul Rahman. All right I'm pulling it up and how so john says about the self registration app we still use the WHO COVID vaccination package. A few things are customized for loud. What we try to do is to remove loud specific details and share. We also work with the Oslo team and how best we can release it. Okay. So that was speaking more specifically to maybe how to share the self registration app that you have in terms of being others being able to make use of it and maybe adapted for their own use. So if you're still with us and are able to answer at some point the question about how do you make it aware to the general public that they can use self registration. But then otherwise, maybe we'll go on to some of the questions that have come up for Ghana. One of the questions from Peter Ricketts was about Ghana, how are you managing your data dictionary. How do you create a team and tool that is being used how do you ensure that the metadata kind of across these different tracker packages is standardized. So Oswalder Kwame I don't know if you have anything you'd like to say there. So, for Ghana, what we are doing is that as I mentioned, teams to which is our main repository for aggregate system is our master instance that has all unit structure and a lot of metadata that we then use on other tracker instances. We run separately HIV and TB tracker run on the same instance, the maternal and child health also runs on a separate instance. Then we have the teams to which runs also on a separate instance, but largely all the tracker instances borrow their metadata and resources. As in all units and other structures from the main one, then it becomes a lot more easier to integrate and then transmit data across these systems, but we do not. For instance, currently, if you have a pregnant mother on the MCH system who is HIV positive, currently the two are not linked so you have to register this pregnant mother on the HIV instance as well to be able to provide HIV care. Thank you. So that was a bit of a response to both of those questions that had come up about whether the attractant these are shared across the instances and where you keep your terminology service. These are, these are both again very important implementation questions when you're deciding to set up your first tracker implementation, it would be useful to think of a data dictionary approach, where you try to standardize the formatting to set up your data elements, your analytics, your program indicators. And then as you continue to add on more tracker instances or you're sharing this data with the HMS. Again, having someone whose responsibility is to keep terminology synced to do your best to reuse the metadata that you can. Things get really messy very quickly Ghana is of course had a lot of experience using tracker, but even so I'm sure that this has been part of the challenge is to try to make sure that the data terminology is staying in sync and is making sense across systems. And the other decision about sharing of tracked entities. So it's very common for a set of services to have a natural link where a woman is being targeted and you would like her to be able to receive services in a single instance that combines, perhaps the ANC care HIV care, but there's also considerations of access control and wanting to ensure that for example something like the HIV data perhaps should be on a separate instance depending on what your legislation is depending on who the users are. So again, many of these are our implementation considerations that they don't have to be the technology consideration so much. And the technology is there to share these tracked entities across programs, but it's more of a question about what you want to achieve, and who should have access. Okay, so maybe at this point, Sakebo, if you're willing and ready to share I think you were going to share your own screen. So is it possible to see my screen. Yes, we can see your screen it's in the kind of notes view but we can still see the slides. Okay, so maybe what I can do just one minute to do it again. Okay, fine. I think now it's just fine. Yes. Yes. Okay, so thank you everyone. So my name is Sakebo working for his for was in Central Africa. So we were working on what we call the DC's surveillance tracker for packaging and we start to do in some channel for two countries, Mali and actually. So, basically, in most of times for DC surveillance reporting. It is the same in several countries. The best thing is for them is to make identification of the cases after to make notification. But only after the notification they can do the sample collection going to the lab side and to have a result. And they finally get a declassification, but there is something important for them it is they have to submit those information to the ratio. So for Africa side, it will be double a two or four. So something we learned from them here is those countries are still working on our paper form. And most of them, after the paper form of submitting data in IPM for for electronic data, but usually they don't do it at the end level side, but they are doing it at the central level, because a lot of people, a lot of end users doesn't have been trained on that. But something we will also found is that even the notify information into APM for the data from laboratories have their own database. So if you go to the country now you can find the one database where you have the notification information and directly the information based on laboratory results. So, actually, what that is a one of their form, and the reform based on APM for it is based on each decision is you can find the APM for form for managers and another APM for form for AFP and results and so forth. And the symptoms for the lab information also. So what we decided to do and based on our WHO recommendation is to have what we call the PG packages and actually we have until nine diseases inside many HICS, measles, proto virus and so forth. And actually we have only one tracker dealing with those nine diseases. And as you can see here you will have a way to register a person. And now we have also the way to really manage the PM for not automatically better. We design what we call the program holds for validation pattern to be sure that the actual countries will have the same way to deal with for the AP number since so we will have to send them to the WHO site so this is something we call standards now so we need we are working on that. But for the formula side, you will have the way now to off submitting digital for the clinical information that also the lab information also so now based on the tracker abilities that we can have those information in the same form in the same database. So, and what you have or we have already a demo instance for that so if you want to, you can go there and test by yourself for what we already done based on this PG package. So what is the plan for to go now so for to go in the first time they are thinking to still sending the platform from the facilities at the district. But the district now will have this ability to enter a data based on the SS to at the district level, not in the past at the central level, but they want something we call the remote management. This way, it will allow population themselves if they found something based on surveillance to send SMS and this SMS will be go to the DHS to and this will have some machine based on events. Based on what we can send notification to some medical person that you know some kind of population found a surveillance issue somewhere. So we have already that designed into our system not include the packages that for to go initially we have actually that's for them. And they are discussion with WHO will start the end users training among next month. I guess that's for money money actually have had in the past something based on CBS but they were like some kind of one form pair of diseases that actually they decided to use these packages because they have all in all in one place. And since there are those packages is coming from with dashboard also so everything is designed actually for them. And the next step for them is to train and uses and you can start submitting data with that. But we're still in discussion with coming home coming home we start with this package in July. And I know that there is a discussion actually for one day also to start using those packages. So for the specific next plan for our side is to help them to train user. But also we found that since laboratory have their own application we are thinking about to do what we call the ability way for their own system and the DHS to be PG packages. So if they don't want to go to the DHS to end the field results, they can still working with for their own database and based on their own technologies aspects so we can send those information directly to the PG forms. And so what they are doing in the past all the countries after some period they have to send the MPM for data to the data wise data afro wirewise. So what we decide now to do is we are implementing some kind of data push up this way will allow countries they are self so based on those apple based on the SS to of course to send their data they'll collect for the PG directly to the regional afro wirewise. That is what I decided to share with you guys and thank you. Okay, thank you very much, so people just in the in the interest of time I'm going to move on to the next country quickly but again please do continue to put questions into the slack will will answer there and if we have time will also bring up some more of the questions for the participants to speak to So keep both you can also keep your eye on the chat see if any questions come up for you. And then we were going to do Rwanda next if I believe Adolf is going to do the presentation. Okay, thank you very much. Good afternoon. Good morning to everyone. This is Adolf Kamugonga working with the history wonder. So I'm going to take you through about the Rwanda use case, implementing a DHS tracker. So allow me to, to share my screen for a jump to what I prepared for you. So do you all see my my screen. Yes. Okay, so as I saw, what I have prepared for the audience today is Rwanda has been implementing a DHS tracker or experience in DHS tracker up since 2014. Whereby I started implementing the TB tracker and the API tracker. So for the sake of this experience sharing. I have prepared to share the COVID surveillance whereby we adopted and consider the WHO package developed to support countries to monitor cases COVID cases. So this is what I'm going to share with you now, showing and them showing how Rwanda went to paper is using the choice to manage COVID cases. So as you can see, from this slide. So, when COVID came out, as we are aware, the WHO and the University of Oslo developed and and shared a package to support COVID case management, helping countries to to see to register cases to record lab requests, whether by then it was a PCR test and also be able to capture results. And Rwanda went ahead and also configured SMS and emails as a notifications for for every single case identified in the country. So as we are aware, DHS to have access to DHS, you need to have logins username and password. So we start with any collaboration with the coordination team in Rwanda, the task force in charge of managing case management, COVID case management. So we came up with an idea of having a self registration interface, whereby any single traveler willing to come to, to go to Rwanda can have an interface to register him or he or herself. So that directly demography information and information related to price details, hotel reservations are directly shared with the country DHS instance, so that as soon as a passenger or a visitor reaches to the airport is directly found into the DHS package in the DHS instance, managing COVID cases. So whether you are a case, whether you are not a case so whoever was willing to travel to Rwanda since then have to pass through this travel allocator form, which is a self registration form. So we share the demographic information, and by then, all those information are automatically pushed to DHS instance through DHS APIs for agents at the airport and entry points to directly fill the rest of information including related to COVID case management. So when after piloting that Dabrature package, I'm sure maybe most of you are aware of that package. So people has to know the outcome of the sample assessment, the specimen assessment. So since to facilitate the client or the passengers to see the outcome or for the tests. So we have developed together with the guy who have developed the platform, the portal whereby a passenger can the passenger can have without having a username and password to DHS instance, can use the unique identifier provided by the DHS instance, and the phone number provided during the registration can go to that portal to see the test results without visiting or going back to to rub facilities. Also, from that DHS instance for COVID case management, when passengers arrives in the country, they have to be kept for 74 hours to a current identified quarantine hotels. And also we found that it's more relevant to have a hotel dashboard, because we the country didn't want to share to give access to national DHS instance for hotels managers to always go and see the COVID test results. So we also a portal has been customized to for the hotel and also for the hotel tenants to for themselves to to assess and see the results when the outs. And also the hotel managers to see how many hotel residents the results are out and if they're out what are the status if they are positive so they are depending on the the period. So nowadays, the COVID treatment is home is for the serious sick people who are kept at the clinics but if there are no major symptoms, people are allowed to be self content in their home until they are cured and follow the instructions given to by the Rwanda Biomedical Center. Also from that COVID management tracker. We had, you know, Rwanda is a landlocked country. So, whereby most of the goods shipping coming through roads. So truck drivers have to get a travel pass. And to get the travel pass. So they have to to share that formation with the, the regional East Africa platform for every truck driver tested in Rwanda from the organized the RAB facilities and when the PCR test comes out negative. So that person can get a pass in the form of certificates in the form of certificates for for for that driver to to transit from a from Rwanda to any neighboring a country towards to Mombasa or Dar es Salaam ports. So they also the the DHS COVID registry also help to support a number of social activities, including the indicating whereby any, any organizer or any provider who is planning to to to offer auto to to run any social event needs to have like the indicating. system to buy tickets and in order to get tickets to the system consult the national COVID 19 registry for for for the status. We saw for the started to ensure that this person purchasing the ticket is is not posted. So it was a quick overview of how far the implementation is for now. And what makes this implementation the most successful. There is a national coordination mechanisms put in place by the government, whereby there is a national joint task force that has multiple departments, among the others there is a data science unit in charge of coordinating this. So the system has been rolled out to base case management the COVID case management system. So the system has been rolled out. Over 550 public facilities and private clinics have access. So, initially, the private the private clinics were not in the list but as we the government initiated the rapid test for COVID 19. That's when the, the private facility just came in to facilitate rapid tests across in country but as we are aware they for the external international travelers so they are supposed to do PCR tests and it's only done in eight PCR testing sites, also integrated into the So we did so as we implement the this COVID 19 case management package. People, even though we have been using the HR structure since 2014. So we had to pass through a number of online sessions to make sure that all information is aware captured into the system, and also reliable results, reliable information are complete, the system for the system to generate certificate. So we also leverage on the existing e-learning platform of the Minister of Health to make sure every data corrector and every system user from whether from lab pass the e-learning course to make sure that understand the basics to use the system to use and capture COVID case information into the system. At this moment, with regard to this COVID case management, over 700 handsets are being used to capture information. So we understand the workload and the synchronization difficulties when it comes to to synchronize outreach or to synchronize at the end of the day, all tested individuals. As I said, the package also is SMS and email notification levels, especially this SMS certification are mostly attached to any registration and results. This means for if you are registered by a data collector at any facility, or if you are using this passenger form as a self-registered person, you automatically get an SMS and an email notifying you with your unique identification code provided by the HHS package, and also an SMS with that code, but also on your phone number shared. So you can get that SMS on your phone or on email. Sorry to interrupt. We're running a little low on time at this point. We have one more country. Do you think you can jump maybe to some of your lessons and challenges just for a minute or two? And then of course, we'll be sharing your slides and this is I really appreciate it. This is a great example from Alwanda of a very integrated kind of system. So please do ask questions for Alwanda in the Slack and Adolf if you can follow up there and we'll of course share the slides. But yes, if you can just take a moment or two and we'll have time for Mozambique. So as a lesson learned and what maybe you can take and share with the audience is we found that the use of the unique identifier help us to especially to trace the specimen across, especially because they were having people being tested from different facilities. So the unique identifier help us to to use the system whether from the point of collection of specimens and also at the tracking the specimen at the lab facilities. Of course the use of this package help us to improve the management of cases and also provision and sharing information to whoever needs information, whether for certificates is sharing and also to any person who needs COVID test results. Of course, we realize that the interdisciplinary team managing the COVID cases is also very key if you want to be more successful. Of course, we found that even though this package has been developed, you know, the technology can solve or can solve everything so there's sometimes you need to change a little bit to the existing workflow to make sure that the technology is is is fits into the existing workflow. So as the challenge that we can share with the audience. As a start you we struggled with the server settings and the specifications that has been improved as we move forward and also maybe the big thing is as we're using the handsets synchronization wasn't really a straightforward process especially when we are tracking where we want to capture photos for for registered cases and also with the internet connectivity that is not really so stable in developing countries. The other challenge that maybe you can share with you is the use of the limited you will find where we've been synchronizing with the lab information systems, whereby you'll find it has its own requirements for example, to quite a few digits as a unique ID and as we are when they're using tablets, some of the tablets kept like depending on how you set it, number of UIDs for a very specific tablets so when you have let's say, 700 tablets across. So you may easily run out of course that sometimes you have to synchronize do sync data sync and configuration sync. So I can say summary that what I can say as some of the challenges we face in Rwanda with regards to implementation of this COVID package, COVID, the COVID management package developed in collaboration with the WHO and the University of Oslo. Over. Thank you. Have questions, maybe you can get them in Slack on chat. Yes, thank you. Thank you so much. Yeah, that's fantastic. It's always great to see what's going on in Rwanda so yes please do put questions into into the Slack channel again we will continue to answer questions even after the session ends. We, we don't have a lot of time left but we do have one more country that we wanted to hear from the lessons and the way that they're using tracker. I think Emilio is going to share with us from Mozambique. Good morning, everybody. Can you hear me. Yes. Thank you. And I will, if you allow me I will share the presentation. I hope you can see it. Yes, we can see it. Yeah, thank you. Yes. My name is Emilio Moss and I'm part of the group that is based in Mozambique. I should say also that Mozambique is responsible, the team in Mozambique is responsible for the Zofani countries. I mean, Cab Verde, Sampo-Meg, Gineb Sao, and so on. So we've been doing a lot of work in this different place, but in this case I will be sharing examples from modern. So DHS systems here will provide overview. The Minister of Health has adopted official, the DHS in 2015. So one year later the ministry start to engage in DHS track implementation, CCTV for tracking pass. Also, there was a development on the hospital for hospital inpatient and death registration. I should say that this project here, it was interoperated with the Ministry of Justice database. During the COVID was also assist COVID for COVID-19 surveillance and vaccine delivery. It integrated disease surveillance and response, lepros, patient tracking. All this implementation took place during the last few years after the adoption of the DHS. So that the men of this implementation that are taking place and apps have been developed to support users in Mozambique. For example, Epo, in Gineb Sao and Gambia, for example, for COVID surveillance, Cab Verde, COVID surveillance and stock management of vaccine. In Angola, we are using a community health information system interoperability with Kobo Collette, that is a system that exists in Angola. So Mayor, where we are currently based now, I should think that the connection today is quite okay because this is one of the challenges that we're talking about. We also developed the COVID-19 surveillance system and hospital management system. I would say that in these different countries, they are kind of a pressure to provide, to include more application using a tracker. Even yesterday, we had a meeting here in Sonto Mayor that is asking for to include more areas of health within the hospital to be a tracker. In terms of objective, while some has target specific area, this track implementation, most of them has been implemented national and aim a string in case based reporting system like managing clients of different services, tracking of patients in order to improve adherence and reduce loss of follow-ups. For example, most of these TB patients, HIV patients, should be recorded, should be remembered or reminded to come to hospital to take a medication, check client mitigation, assess monitor patient treatment process, history and his related data, improve the quality of data being reported. So this is very important issue here because there's a team who is really working in terms of to provide the quality of data that has been circulating through this record system. To speed also access to data, for instance, host system currently sending data to the Ministry of Justice, system for death notification and certificate issue. So this is what we can consider as one of the smart project within Mozambique. Patient information sharing also among different programs, health programs. So the second objective here is to relate individual level data with aggregate data being reported from same facility. This is also very interesting work that we have been doing because most of the program, they want a checkup, but if you go to the management of the hospital or the program, they want these to be tracked. It's very special now that we have this immunization. So jumping to lesson, I think that's because we are dealing with many, many, many program in different countries. So we come up really to observe that the project should be led by Minister of Health with clear objectives, clear objectives, plan and available resource. Most of the countries, I mean the team is there, but some of the countries, some of the project, they don't have enough resources. They don't have human resources that can really provide with a good plan and with clear objectives. So I think that this is one of the big challenge that we face among our implementation should also allow engagement of partner and be support to project objectives in terms of coordination and collaboration, creating task forces. Most of the health programs in different in our countries are supported by different partners. In some cases, it's very easy for program to ask for any support, but in other countries, the support is really take time to come. And we see that in the countries or in the programs, the partners are more flexible, things are really working. So this is very important to engage the partner in order to support these different objectives to make the project working. Capacity building is a key, as we said before, it's being supportive and available whenever support is required. So, I mean, we, the team of Mozambique is responsive to support the different countries. What we're doing is really to create different teams in these different countries. But here we're really finding a very, very serious, really this team in order to take over the health information system. So we think that this capacity building is really a key issue that should be addressed during implementation of trackers. So developing DHS to custom apps to respond to specific user needs that are not not even responded by DHS tracker. Like for example, sitemap in echo and Excel spot in TB, they are as I mean, one thing is that the, the, the core DHS tracker is responding for for some kind of a specific issue, but when we go to to different organization, they really want something very specific that the DHS core tracker should be adapt for these specific needs. So, I'm going to translate the COVID-19 as well as Basin delivered the Minister of Health was waiting for Internet from this from its partner. But this, this waiting was was really very long. So in that in this case is the the universal force. We managed to secure to secure Internet to get things moving so with the partner with our big partner like universal force we managed really to implement the checker surveillance system in Mozambique. So here in order of adding most of the presentation that came up before our presentation really express a lot of applications that is taking places in different in their own category. But here we focus on the on Mozambique, but there is one also very interesting application apps that I would like really to emphasize that we need to put here on this slide. This application that it was developed in an episode that gives, for example, a patient when one is aiming to travel for them has to go and go the test. The test is sent on SMS, telling the test and say that your result is it's available. It gives a link that you can go and see and what kind of action you should take. I think that it's a very, very important application. But before that it was in terms of concentration on mean when the test is started, it was free of charge in Universal, but now the people who are testing they have to pay. And then new challenger has come up that for example, some of that that should be moving different server and he also we find a different problem in terms of capacity of these different servers. We don't put things in cloud things work proper without any problem with support of South Asia or sometimes with different partners, but the country they want to be on physical servers, and sometimes this service, they don't have enough capacity to deal with this kind of mega circulating within trucker. I think this is the challenge that we're facing and probably with this Academy probably will find some of the result. Thank you very much for listening to us. Thank you so much, Emilio. And that was, I think a perfect kind of setup for us to end the day on and leading into our first session tomorrow so just a reminder to everybody we will start again at the same time tomorrow using the same zoom link the same password to get in. And some of those things that Emilio, you were just pointing out and actually auto that you were as well about the key challenges and and lessons learned those are exactly the topics were introducing for the first session tomorrow, looking at the key considerations for tracker planning. And then we'll spend the second session tomorrow looking into the readiness assessment and introducing the tool that we'll be using for planning for the rest of the week so very big thank you to all of the countries that shared in this last session their use cases. It really helps to see how trackers being used in action. We hope all of you feel like you can use the slack and ask additional questions and we are happy to try to follow up and appreciate your time today we will do our best to stay on time with the sessions. But of course, this is something that we're still working on the format but thank you for staying with us today and we'll look forward to seeing you again tomorrow. So thank you very much.


When I first saw the building, it was like, well, compared to what a different college I've been to, it's like, it's been massive. It's a big wow where you go into it. To see the first group of students walk through this door in September was absolutely amazing. They were taking photographs of the building. They were texting their friends. I think a new college like this one is better because for one thing, it looks good and if places look good, people want to go there every day and they want to study there. I strongly believe that a building can change students' attitudes. I've noticed the big difference in the way they are together. There's more self-confidence. The main changes are of course related to the teaching itself, having wonderful resources, wonderful equipment, industry standard, which is superb for the learners and staff to utilise, but also the environment in the building is completely different. This is a very light and airy building. It's got lots of communal spaces, which really lifts the motivation and enthusiasm of the staff and the students. IT is very important. It's a very forthcoming technology, it's changing all the time and Colin Morgana have responded to this and we've got some excellent IT suites now. Every room, not including the non-IT suites, have smart boards now and we're all trained up to use these effectively, which encourages the learners then to start embracing this a bit more, coming up to the front and using it and certainly more interactive learning takes place. The students think it's amazing here. They love the architecture, the facilities. There's a gym and a library here and you can get something to eat and have a coffee. Everyone knows it's a new building. They don't want to damage it. They don't want to be graffiti. The capital investment here for the students in particular has created an opportunity for them in local business as well and I think that's really good. The main benefits of having a big facility like this is just you get plenty of options to do. They run extra programmes, so if you're interested you can learn animation or music or go to the gym. There's lots of other stuff to do around you. The environment I think motivates not only the learners but also the lecturers as well. You know, fantastic. We've moved from Rivellin, which I think needed a good old look of paint but we're moving here, you know, it's really motivated us in terms of teaching and the facilities that we have available, not only within the classroom but also outside the classroom as well. By opening this building we were able to bring in the public library from Taftswells. So again we have community groups used in the building for the first time. The community benefits have been quite significant. If you look around the locality of the college you'll see other businesses investing in expanding for their own businesses which can only be good for the long term future of this community as well. This building has a biomass boiler. It has the ability to regenerate rain, harvest rain. We have voltaic cells. We have a green roof. And so all of the technologies that were available to us have been incorporated. I think the Welsh Government should invest more money in colleges like this, yeah, definitely. This has been a success because more people have turned up than they thought they would be and I love it and I think this should be shared with more people, yeah, definitely. The learners experience has been perhaps brought into the 21st century from what they've experienced and I think that's quite important and quite a large statement not just for the community but for Wales as well.


What's up guys Michael here with Jaspie's doing a quick recap for 2023 tops chrome jumbo eight bucks case break Pick your team number one was done on fanatics live. Here's the list if you forgot Can pause and take a look there But uh, yeah Start off with some color rookies and fractors and such Some Acunia base MVP buyback and show haze Can't forget the show haze Stowers Got a gold engine with kutchin gold wave out of 50 and a nice show a refractor Acunia prism refractor Another Acunia refractor Corbin Carroll refractor All right Getting into the autos now. I'm gonna jazz Chizum ultraviolet for the Marlins Spencer steer auto crochet ends purple James Alvin auto Some color colos to 199 Ruiz to 299 tovar nice color maps there to 50 No, we got a authentic relics and autograph of Tory Hunter that one is out of 99 We've got a one-soto technicolor auto out of 25 How about a red Matthew batten five of five rookie auto for the Padres and Adley-Ruchman refractor auto out of 499 All right, that does it for the recap. Thank you to everyone who bought into the break Thank you guys for watching and I'll see you guys the next one. Bye guys


Wonderful, wonderful. Okay, let's just, Nancy, we'll start right at the beginning. Okay. Tell us a little bit about your early life, because your father and your grandparents have a very interesting history. Yes. Um, is this on? Can you hear me? I guess you can hear me. Yes. Um, my father and his parents, um, fled Nazi Germany. And at the beginning of September 1939, now if any of you are World War II officials, you will well know that on September 1st, 1959, you know that on September 1st, 1939, it were invaded Poland, instantly creating World War II. Um, the ship that my father and his parents were destined to fly to this country on was, it was either Norwegian or Swedish, I don't remember at the moment. But they had to take a tugboat out of the harbor in England to their ship. Of course, because both Norwegian, Norway, and Sweden are generally neutral countries, so the ships flew without a strike for war pay. And would not bring the ship into the harbor. So my father and his parents made it here by that much. What shaped you as a child? Shaped me as a child. My battle with my parents. That's quite, it's very deep. My continuous battle with my parents. Yeah. Um, that really was about it. Tell us more about that, when we were preparing for the city of Euboe. You have some extraordinary history there. Um, my father was not a bad man. He had a fuse about as long as from here to there. But once you reached there, look out. He also was not unreasonable. There were a number of times that he said things or did things that I said they were some of the smartest things he ever did in his life.  So that was always a battle because my father basically, God love him, did not understand psychology. So that was not until almost the end of his life when we had some conversations that he had actually understood. A little bit of my mother and myself. I'm my mom's daughter. Yeah.  Um, when my mother going through my death course, um, came upon a pack of cigarettes. Of course she had a cow and three more. And, uh, my father, God love him, put that pack of cigarettes. He was a smoker. I remember, I remember when my father went to cigar and pipe rather than cigarettes. Because cigarettes went up to 50 cents a pack. And she used to make them out of cigarettes. Well. So that's a while back. Um, but there was a drawer in the kitchen. A bottom drawer that he kept his pipe tobacco on the cigars and whatnot. And one night I don't know my mother. She transferred a TV or whatever. I happened to be in the kitchen and he happened to be in the kitchen. And he took me aside and he said to me, well, he said, I can tell you why you shouldn't smoke. I can tell you this. I can tell you that. I can tell you the next thing. I can tell you because I had chronic bronchitis as a child. You shouldn't smoke. He said, I also know that I can't make you not smoke. He said, but do me a favor. Do us both a favor.  And then he pulled out that pack of cigarettes because she found it in my desk drawer. And he said, if you want your cigarettes, here's where they are. That's just one of the numerous occasions that he showed that he was pretty, oh, what a beautiful puppy.  But your father called you many sticks of dynamite put together. What does that mean? My father was a short man. He came up to about here on me. I was the tall one in the family. I might say still the next tall. And he always said that with his long temper and when you get to the end of it, that he was many sticks of dynamite put together. And one day in the kitchen again, we were having a little confrontation. And he reminded me of that phrase that he was many sticks of dynamite put together. And I just looked at him. I was in my mid teens probably and I just looked at him and I said, yeah. So what am I? And he looked me up and he looked me down. And then he said, you're a lot of sticks of dynamite put together. And I've always said that was one of the smartest things my father ever said. He realized at that moment that if he wasn't real careful, I was going to take this off. As a child, you said you tried to actually control your parents. What was going on there? Well, it was a battle for control. I didn't realize that until I saw my first psychologist. But it was a battle for control between me and my parents. My first real psychologist that I saw, he told me at one point, he said, I don't understand, Nancy, what hold do your parents have over you? As former children, we all know what kind of hold our parents have over us. And I was completely confused. I was like 19 at the time.  And this is after he had met my parents. And he said, your parents are so clumsy and they just don't have it. They aren't there. And I don't understand what control they have over you. It took me about another five, ten years before I really figured out what to keep on by that. But I finally did and that was a good thing. But I and my parents were a constant battle for supremacy. And we were that. I'll try to make it a real short story. My sister and I, my sister is six years older than me. I don't ever remember playing with my sister. So I must have been pretty young. And my mother told this tale and my sister remembered the rest of it.  And my sister said, I was a beautiful princess. And I just sat there and I kind of started smirking. I was like, let me guess, I was the handsome prince. And my mother just kind of looked at me and she was like, yes, I think that's what you were. And relating to that point, one time my sister and I were playing teams in Queens or whatever and my mother said to me and I was prancing around the house with my blankie, my robe.  Girls can't be kings because I was the king. And I looked at her and I said, I'm the king.   And I guess I never learned that lesson because I kept saying I'm the king and my parents never quite understood that whole kind of stuff somehow. But as a child, you were also exploring a lot of sadistic activity. Tell us about that. Well, amongst, yeah, making my parents gray. I always said I was proud of the gray hair my father ever got. Yeah, I had an interesting relationship with flies. Now I can't even imagine being able to grab a fly out of the air on the table or wherever anymore. But when I was probably four, five years old, I used to manage to nail flies. And I didn't flatten them. There was no fun in that. Some of them, I pulled their wings off. I watched them spin around. I found that quite fascinating. And some of them, I pulled their legs off and watched them. Well, the ones about the wings walked around. The ones without the legs spun around. And then I planted them in the tea plant, which was a plant there in the front of the house. Yeah, and all of them. That later on I tried, I put a pebble way and grabbed a fly. And I put a pebble over there that were gray. And then later on I tried to dig them up and I never could find them and I never could figure out why I couldn't find them.  But yeah, I was sadistic after her early age. Well, your first partner, Denise, really encouraged you to explore SM. Please tell us about that. What was going on there? Well, she was a bottom. She was in the SM. There was no question about that. And my follower said she saw what she liked and what she saw. And she took me in hand and she basically gave me the basics. So this is how you do it. This is what you don't want to do. And we learn a lot from each other. Such as? Well, I learn pretty much everything from her. What are some of the main things that she taught you?  I'm proud of you. Was there anything that you found just mind-boggling or was there anything that really excited you as you were learning this process? Well, it all excited me. Mind-boggling? No, because I was already, when I used to go to Carroll Street with you, down an old town. There used to be, every Sunday evening, a couple of guys in leather fan-dancing. Fan-dancing has always fascinated me. That's what fascinated me. But intrinsically, I understood what they were about. I understood what the leather meant. Nobody had to tell me that. I had a real basic understanding of that. From where or came from. How did that evolve for you? Well, just watching people, learning from people, by watching them. I mean, I never, Denise was my own mentor if I could say that I had a mentor. Other than that, I've been my own mentor of other people's mentors. Because it's just, it's very natural for me. It just, has always been that. How many people would you say you've mentored over the years? Oh, thank God. There was probably more than I know. But if you said that, yeah. Sky, you. At least. There's a fair amount of people, but I've mentored in one way or another. Is there any recurrent bit that you've shared with every single one of those people or has it varied person by person? Well, it always varies depending on the person, depending on the situation. But the basic is don't do anything to somebody else that you really want them to yourself. Or at least be willing to try. Okay. You came out very young. You came out at age 17. Tell us about the gay community that you experienced at that time. Oh my God. That was just prior to the AIDS crisis starting. It was in 1977, 78, 79. It was Sunday afternoon movies at Carol Speakeys in Holtown. Cheeks, Cherries, Broadway Review. I'm sorry, Broadway Limited. All the bars you can imagine. It was play and be playing. That's what the guys were looking for. That's what they got. So for example, what sort of things did you experience in that situation? Was there anything new and wonderful for you there? Well, I was a dancer. I loved to dance. So if anything, that was the joy of it. But sometimes... There were a couple of John Waters movies that they showed it to me. There were a few scenes that I remember that I was just cracking up at all. I was the only woman there and the guys were going... I was just cracking up. Things like that. The Chicago's double A meat market was your home bar back in those days. That bar and some of the other bars are sort of the thing of legend nowadays. Tell us about the old days. Yes. Tell us about those places. What did you experience there? Camaraderie, neighborhood, friendship.   No matter where you are. Leather, non-leather. Any particular feelings that come to mind or emotions that come to mind? I mean, I'm not... I love Chuck of Tuchets. But the new Tuchets, he's not the old Tuchets and every time that I go in there, I want to cry. Because those are the numbers I have. The old Tuchets on Clark Street and Carol Speakeasy, double A meat market. A few other places. You're giving me the impression that that was very precious to you that those places were almost magical. Yes. What... Can you give us an example or two of why you feel so strongly about them? It was just the memories made, the people met, the friendships made, the events sometimes. I mean, it's like GLLA. I love GLLA. I missed GLLA last year. I hated this much. Back this year, and I feel just like I'm home again. So I love GLLA. Why do I love GLLA? Because it is opening and welcoming to everyone. And there are not many events in this country or abroad that I'm aware of that are that. I mean, what... When Mother United Chicago, which was the club that I was a founding member of, first came out in 1981, Mr. Ellis was nodding his head. We told people they'd say, well, what are you about? And we told people we were pansexual. Well, most people at that time had no idea what pansexual meant. They assumed it meant bisexual. Not even bisexual as in sex, but that we had men and women in the same club, which we were the first real out club to do that in Chicago.  What are your thoughts or what were you feeling about being a woman in the leather bars at that time? You were probably one of the only ones. Well, one of a few. And I respected the fact, understood and respected the fact that I was in a man's space. And I tried not to turn on their toes if somebody didn't want to deal with me. I didn't push myself in their face. I didn't push anybody's face. Most of the time, they introduced themselves to me. That was their business. Otherwise, I wouldn't go about their way.  I had a sense, experiences in vanilla bars, so no big deal there. That's really, I mean, well, their bars are it. But you had an altercation in the old touche bar. You really, when we were preparing for this, it's quite a story. You really established yourself as one of the guys, so please share that. It must have been some holiday weekend, as I recall. And it was at the old touche, and we were upstairs, and there was a bunch of our old group of our friends, and I was sitting on a bar stool, and one of my friends, he was a pretty slight man. I had my leg up on the stool rail, and he was kind of sitting on my knee, which was not uncommon.  And there was this very, very drunk guy who shouldn't have even been there, and he certainly wasn't in code. And he was kind of wandering around, and he kept wandering closer and closer and closer.  And so my friend shoved him in, all himself on the stool, and he came back again. And my bird, putting my cigarette out on his arm, did not face him. So I realized that this was a real good one. And he came at my friend again, and I don't know what I said to him or whatever, but it wound up with him throwing his drink at me.  I was like, I'm fine, I'm fine, I'm fine.  And I kept my eye on him after that because he still didn't have the brains to go downstairs. And I kept my eye on him after that, but I also realized very quickly that every guy back there was watching him. And if it was circling maneuver, he came a little too close, there would be somebody stepping in between us or somebody bumping into him or whatever. So I was like, okay, I guess I made my name tonight here. They understand that I really can take care of myself here. They don't need any big, broad, new hands to do it. So the next weekend, what really told me that something had changed was the next weekend. There was this gentleman, and we always called him S&M for stand-up modeling. I don't know if he actually played or if he really was stand-up model. He was very good looking stand-up model. Head-to-foot leather sunglasses. I've never understood dark sunglasses in a dark bar.  But dark sunglasses, the whole nine yards. And he always stood in the same corner or two shape. And I have to have him when I'm walking through a bar or first walk in, and I kind of look around and see who's there, whatever, most of us do that, I think. And the next weekend after this altercation, walked in, walked past him, looked at him and say a word. We never had anything he never admitted that I existed, so I just left him to me.  And I must have had my jaw to the floor because very soon his friend of mine asked me what was wrong, you know? So I told him when I was like, you're kidding, and I was like, no. And that was when I realized that I really, I had made my name for myself, so. Wonderful. What's your favorite kink? These days, unfortunately, it's watching other people. Unfortunately. Amen. Better than nothing, yeah. And the red ones are better than some. But plugging, I would say. What about it, do you like so much? I just, I like to throw, I like to snap. Oh, sorry. I like to throw, I like to snap, I like reaction. Okay. What challenges do you see for the letter BDSM LGBTQ community? Oh my God, what challenges aren't there? For example. I'm sure most of us have been seeing it lately, especially that there's a lot of not so nice words, not so nice actions, not so nice whatever going on.  We're not going to have what it takes to stand up for ourselves and really get what we deserve and what we have earned. Well said. Well said. How would you like to be remembered by the community? Oh my God. Well, I'm sitting here, so. There's how I want to be remembered. She made it out the stairs. Get that down. I wasn't afraid to step up for somebody that needed help to step down when it was time to rearrange some brain cells. Well, I know in preparation for this chat a lot of people were very pleased that you were coming to the interview. That's quite an honor for you. How do you feel about that? I don't feel any different today than I did 30-ish years ago. 30-ish years ago when Leather, United, and Chicago I first really started and our name had been going from coast to coast. People started hearing about us with members going to different runs and events, people seeing who we were. I started at Double Amy Market which was our home bar. I started having people that I had no clue who they were giving in mind that I am not a naturally gregarious person. You have no idea what it takes for me to sit up here and talk to y'all. I'm very shy and retiring by nature unless I need to stand up and open up my mouth for some reason. So I would start having, oh, and another thing, a horrible number of names. I'd be absolutely horrible. I just, after 15, nearly 20 years, I just now have remembered the name of my doctor's nurse. That's pretty bad. She's one of the exceptions. I don't know why I could remember her name. But it's pretty bad. So when people would come up to me from a person's country at Double A and introduce themselves and say I'm so-and-so and blah-blah-blah from Seattle or San Francisco or Nebraska or wherever the hell. And I'd start introducing myself. Hello, I'm Nancy Weinberg. I'm President of the World Bank. Like, a lot of title holders have their schtick. That's what enables them to do what they're doing as title holders. That was my title. That was my schtick. Hello, I'm Nancy Weinberg and I'm the President of the United States of Chicago. And before I got halfway through my schtick, they'd say, I know who you are. Blah-blah-blah. I'm assuming it never showed. I must be a pretty good actor. I was just standing there. I didn't know if I was paying attention to what they said after that because I was standing there going, how the hell do you know who I am? I've never met you before in my life! So that's it in the nutshell. That really is. And I'm very honored to be here. I'm very honored for the trust and the respect that so many people have given me over the years. It means more to you, to me, than you can ever know. Thank you. So one question I'd like to ask each of my subjects. What's the biggest misconception about you? I really don't know. Because people who really don't walk up to me and abuse themselves and be my friend have the puts before they do it and the people who don't, I really don't know what they think.  Sitting or standing, I can't be. It just depends on the situation. But I'm not necessarily a very nice person. I can take a lot more crap from people than most people realize or take themselves. That all depends on what I see on them. Well, Nancy Lee, I would like to thank you very much. Thank you.


The Qing Haidebetten Plateau has experienced significant changes in its frozen ground over the last few decades due to rising temperatures and increasing precipitation. These changes have been reflected in the air-freezing and thawing indices, which have decreased significantly by 71 degrees C.d.d.c. and 48.13 degrees C.d.d.c. respectively. Additionally, the ground-freezing and thawing indices have also decreased by 34.33 degrees C.d.d.c. and 40.37 degrees C.d.d.c. respectively. This decrease in freezing and thawing indices is likely due to the effects of rising temperatures and increasing precipitation on the plateau. This article was authored by Xu Weifeng, An Qiwong, Shouhua Liu, and others.


Hi friends, how are you guys? I hope you're enjoying mathematics now Continuing with our problem solving sessions. This is another session in which we are going to discuss These two questions. So it's given that x and y are positive real numbers Then you have to simplify under root x to the power of minus 4 y to the power of 5 This is one and the second one is this looks too intimidating, isn't it? But don't worry, you'll be able to solve it using the laws of exponent. So how to solve both of them Let's start with the first one first one says x to the power minus 4 and y to the power of 5.  Okay. So hence How do I go about it? So I'll use the laws of exponent. So under root anything is nothing but x to the power of minus 4 y to the power of 5 and this whole to the power half, isn't it? Which law did I use? nth root of anything is Equal to a to the power of 1 by n. Now why a has been given as positive is we really don't want to take chances Where we have to find out that I say square root of a negative number. So hence to Avoid such situations. It is already given that x and y are positive. So no problems with negative Square, you know Let's say square rooting that number. Okay. Now, what is the next step?  This is a product Okay, so hence here What is next step next step is x to the power minus 4 into 1 by 2 Into y to the power 5 into 1 by 2. So what rule again? So a to the power m Whole to the power n is equal to a to the power m times n Okay, so please I'm writing these rules again and again. That's such that it gets Uh reinforced and you know, uh, it gets permanently set in your mind Now x to the power minus 4 into half no brainer It is x to the power of minus 2 and it is simply y to the power 5 by 2. Isn't it? So hence I can now write it as y to the power 5 by 2 Divide by x squared y Because a to the power minus n is equal to 8 1. Sorry not a 1 upon a to the power n So these are the rules which we used And now you see you cannot really reduce it further Okay, so hence this should be the final Answer now, let's take the Next question So here is the next question guys. So looks a little intimidating. It's complex looking question, but trust me While you do three fourth of such types and you'll be very very comfortable solving all these questions now Let us see how to let us see how to Solve this so hence the the step is nothing very very simple You take each terms separately and simplify to the maximum possible extent Now let us say First term root x right so hence I can write this as x to the power minus 2 by 3 whole to the power half right next y to the power 4 by 2 and then This divided by x y to the power minus half Whole to the power half. Isn't it? This is what it is right now. Okay. So next is Again, this will be nothing but x to the power minus 2 by 3 into 1 by 2 and the rule I'm writing here a to the power m to the power n is equal to a to the power mn Isn't it now? This is nothing but y to the power 2 simple arithmetic and then divided by divided by x to the power half and y to the power minus half to the power half Okay, now let's again keep simplifying. So it is x to the power minus 1 by 3 Why this 2 and this 2 will go? times y square divided by x to the power 1 by 2 And then it is y to the power minus 1 by 4. Isn't it?  So this will be y square divided by x to the power 1 by 3 And if you see this is nothing but into 1 upon so since it's a division so it is x to the power 1 by 2 and y to the power minus 1 by 4 Isn't it? Since it's division it will go into the denominator Now, let us simplify further. So if you see it is y square into y to the power 1 by 4 why because a to the power minus n Is equal to y to the power a sorry a to the power n Right, so hence or vice versa. You can say a to the power n is equal to 1 upon a to the power minus n So I adopted this rule to get y to the power 1 minus 1 4 1 by 4 in the numerator, okay Now divided by what is left for x x to the power 1 by 3 into x to the power 1 by 2 now Right. So what is this now simple y is the common base. So hence it will be 2 plus 1 by 4 divided by x to the power 1 by 3 plus 1 by 2 which rule did I use again a to the power m into a to the power m is equal to a to the power m plus n is it it so hence final answer y to the power take lcm so it is 8 plus 1 by 4 and here take lcm it is 2 plus 3 by 2 So hence finally you will get y to the power 9 upon 4 And 9 9 upon 4 divide by x to the power 5 by 5 by sorry, this will not be 2. This would be 6 here So 5 upon 6 right. So y to the power 9 by 4 divided by x to the power 5 by 6 This is the final answer. So again, please remember how to utilize the laws of exponents to solve such problems


Hi, I'm Dr. Sunil Kini working as a concerted orthopedic surgeon at Manipal Hospital's Bangalore. To start with age is one of the non-modifiable causes of arthritis. Earlier it was thought that arthritis mainly affects people over the age of 60 or 65 years, but it's not true because of changing lifestyle habits and obesity. We see that arthritis in a much younger population now say in the late 40s or the early 50s. The arthritis is mainly caused in this age group by the wear and tear of the cartilage and after which there's an appearance of bone to bone. So for the elderly population it's very important to keep fit and modify their lifestyle accordingly, do exercises so that they can keep the joints in place for a longer time.