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Saturday, 30 June 2012
Case discussion on Twitter: how can we make best practice explicit?
Image by quinn.anya
It's great to see the growth of discussion in medical education on Twitter. Recently I have seen a few really interesting cases being discussed (and a lot being learned), but there have also been some questions about how we together can think about what is best practice in leading these discussions.
Case discussions have always been a very important way of learning in medicine. And as one doctor said, junior staff are still encouraged to submit cases to journals, but it can take many months for a case submitted to a journal to reach publication. In the meantime, social media removes those barriers to publication. We can all self-publish. But we have to be responsible too. I think that all of the people currently involved in leading discussions are being responsible, but how do we make clear to others what best practices we are following? I think that it is important to consider this for a few reasons. First, we have an obligation to all patients to make these discussions safe. Second, we are modelling how to share these cases to other students and professionals.
We also need to think about whether the existing guidance, which in the UK is from the GMC, is sufficient to guide us.
So a few questions....
What should we tell patients about sharing their story? Do we need their consent if the story is not recognisable to others?
When the GMC discuss confidentiality the emphasis is on not sharing information (without consent) that would allow another to recognise a patient or someone close to them. In the new draft guidance on social media the only additional emphasis is on the impact of embedded information such as GPS co-ordinates that would allow us to know from where a tweet was made, or an image taken.
My own practice is that if I want to share a story about a patient that might allow them to recognise themselves then I ask permission, and I record that when sharing the story. So far this has only happened once and it was in a blog post. How could it be conveyed that a patient was aware and happy that their story was being shared on Twitter? If this is done in a separate tweet then those following the tweets may miss it and wonder if permission has been given. Is this something we need to be concerned about?
What about sharing images routinely made as part of care?
In 2011 the GMC gave additional guidance on the audio-visual recordings. For some images made as part of routine care, such as pathology slides, internal images of organs, and xrays, then no specific consent to take the images is needed. It is presumed that if the patient gives consent to the procedure then they give consent to the image being recorded. The guidances says that attempts should be made to make patients aware that they may be shared in an anonymised form, but there is no need to ask permission before doing this. This includes for publication in widely-accessible media such as press, print and internet. We can presume this includes Twitter!
The draft social media guidance makes no additional comment on this so sharing an anonymised image on Twitter for teaching purposes seems acceptable. But images are rarely of much value without an accompanying story. So we are back to the situation above. How much permission is it good practice to obtain before sharing a story? And we have to remember that the real-time nature of social media means that a story about a patient might be shared as it is happening, rather than six months later, so that it is more likely that people may recognise themselves or others.
Other images that are made as part of routine care, but are not part of a procedure, such as an image of the outside of the body, do need specific consent to be given. And again patients should be made aware that these images may be used for teaching or research, but specific consent does not have to be given for them to be shared for this purpose as long as they are anonymised and all identifying details are removed. However, the guidance states that if the image is to be shared in widely accessible media (eg Twitter or a blog) then if the image is identifiable consent must be obtained. If the image has been anonymised then good practice is that consent should also be obtained but," if it is not practicable to do so, you may publish the recording, bearing in mind that it may be difficult to ensure that all features of a recording that could identify the patient to any member of the public have been removed."
What about recording an image to share in an educational discussion on social media?
The GMC guidance which applies here is the section on "recordings for use in widely accessible public media". Here, even if the patient is not identifiable, and has been anonymised, consent must be given explicitly. Paragraph 37 states:
"You must get the patient's consent, which should usually be in writing, to make a recording that will be used in widely accessible public media, whether or not you consider the patient will be identifiable from the recording"
We are also obliged to check with our employers what their policies are. Some trusts prohibit the use of mobile phone cameras by staff to protect patient confidentiality.
If consent has been obtained from patients to share their non-identifiable images online, how can we share that information in a tweet? Can we presume that if we see an image shared on Twitter then the person sharing it has followed the correct policies, just as when we see an image in a journal we might presume that the correct policies have been followed? Should those leading case discussions develop their own policies and make these accessible from their Twitter profile?
Medical education on Twitter is fantastic. There are no professional or geopgraphic boundaries to discussions. And no boundaries to patients participating either! I want to see all that is happening already continue and also for more people to get involved. I think that by considering these issues and showing how we can be safe and transparent we can take these discussions to a new level of participation.
32 comments:
Hi Anne Marie,ReplyDelete
I'm glad you wrote this post, because watching one of the streams on Twitter had made me think about some of these questions.
First of all, I think having these discussions in a public forum is excellent; open practice can help clear up a lot of mis-understandings between those in various professions and those outside, but obviously sensitive information needs to be carefully treated. GMC guidelines and the Data Protection Act help remind people of this, but more importantly, it is just plain and simple common decency to make sure you aren't discussing someone else's personal details.
The possibility of someone missing context applies to missing some parts of the conversation on Twitter, not just missing whether permission has been sought and given. I wouldn't worry too much about this one - it could, potentially, have an impact on reputation, but in general I think the profession is well enough respected that normally it is assumed that consent has been given. As long as you can demonstrate clearly that it has been if challenged, that should be OK.
Of course, if the patient changes their mind, having had the conversation on a public forum makes things trickier. And for that reason, I think I would always argue on the side of caution.
The tweets which caught my attention earlier did not identify the individual, but if I knew they doctor and was involved in their community, I am pretty sure that, if this was a live 'case', or a recent one, I would be able to identify the patient. Perhaps a little too much detail was given? On the other hand, if this was brought up by one practitioner on behalf of another, it would be very hard to identify the patient. As you suggest, there is more to being able to identify someone than just 'hard' details - the context includes your location, description of the circumstances, whether your account is anonymous (unknown by your community), the timing of the discussion in relation to the event...
And yet, quickly cross-checking with other people's opinions via tools such as Twitter could improve clinical outcomes (multiple second opinions, if you can tweet sufficient facts and enough people are responsive). If it isn't a real-time issue, perhaps leaving the debate until a (randomised) time later might be best, just to minimise the risk of connections being made?Replies
Thanks Pat. Your point that the profession is trusted so doesn't need to be so explicit publicly is a good one. It's interesting that often the questions about consent here are being asked by other doctors rather than the public! For me a big part of this is about showing those with less experience what is a good way of doing things. It's about teaching. If we presume that everyone knows what the rules are and that we are following them, then it can be harder for someone more junior to know what those rules actually are!Delete
I've started talking here about the use of twitter for education. I think there would be a different set of issues if thinking about using social media to discuss a problem and get help making clinical decisions. That would certainly deserve its own blog post.
I am glad you started the ball rolling. Here are some quick general comments.ReplyDelete
This is going to be a moving target. I can see explicit patient consent for SoMe regulations, SoMe IRBs etc in the future. We will probably have content specific for SoMe in human research subject protection training.
Some considerations for best practices -
1. The tone of the tweet/post - what impression will it create about the patient (intentional or not) in the readers' minds.
2. If you were the patient and this was tweeted about you, what would be your reaction? Even if it was anonymous and only you could identify yourself?
3. Comments generated by the tweet/post - in a post you can remove/moderate then but you cannot control much on Twitter.
4. The author should think about the point s/he is trying to make. Where appropriate, use a minimal necessary standard - fudge/add other details so it really becomes a hypothetical case while preserving the essential message. Should clearly then not call this a real case but use appropriate disclaimers to explain that the facts were changed to preserve the message but protect the pt.
5. Consider the public health impact - e.g. a blog/tweet about the first case of a dangerous communicable infection seen in a geographic area...Replies
Some interesting points there. Where do you stand on consent to discuss cases? Do you think that is something we can skirt around by 'fudging'?Delete
The informed consent for social media is tricky.Delete
Since many patients probably don't intuitively understand the various aspects of Social Media and they may feel a bit vulnerable declining consent when asked by their health care provider, it may not really be a true willing informed consent. That I why I mention that we may end up with special regulations for informed consent for this and even oversight bodies like Institutional review boards. Pending that, we need some standards which set the bar pretty high.
This is a very interesting debate that you have opened up ... In my experience in facilitating twitter discussions via #NurChat I have found that we do not discuss specific patients - nurses participating seem to grasp the nature of social media in that it is very public and remain cautious. What tends to happen in #NurChat debates is that nursing will be discussed in generic forms without mention of specific cases or healthcare settings ... This still proves to be worthwhile debate but sits nicely within the boundaries of public discussion. However I do think that more consideration needs to be given to debating specifics within social media because there can be so many benefits to an open debate and as this way of developing professionally grows we need to have the mechanisms in place (and known) in order to have more complex discussions.ReplyDelete
I have the idea that twitter its maybe nice to show and image or study but not to discuss clinical cases. In that setting we have been using Google Plus and the feature of circles or a group (Close or even open but specific to that issue) in Facebook. I agree with your points and previous commentary.ReplyDeleteReplies
How often is their value in sharing a clinical image without the accompanying story? And in the UK, if the image has been made for the purposes of sharing on social media then explicit consent should be gained for this. I think that we would have to presume that even though Facebook and Google + can be 'closed' they are widely accessible media.Delete
Have you ever had patients participate in discussions about their cases in social media? I think that could be a really rich learning experience for all involved!
New England Journal of Medicine uses photos with a very short history and they are very popular in Facebook. http://www.facebook.com/TheNewEnglandJournalofMedicine/photos so an image could be enough in some settings.Delete
I really have not considered to discuss clinical cases in an open way with patients in social media more than some advice. Use to only with other colleagues and my students. I think we have to be cautious about it and feel comfortable.
- Chris Tiplady30 June 2012 at 17:26
I'm keenly watching this debate on Twitter and am grateful for a reminder of the rules. I want to start a haematological education account but keep thinking of the problems. I see a simple idea of sharing a blood film - utterly anonymous. But then I need the story next to it. If I say this is the blood film of a three year old girl presenting with petechiae etc. then it is very very easy for someone who knows my name, my hospital or my region to identify the story. The story has to be close to the truth to be educational but sufficiently different to be anonymous. I can't say it's a 47year old business man to start the same discussion. Using opposites is too obvious so I am left puzzling over what to do. My feeling is to use the oldest blood films I can find and entirely make up a story. I bet someone ends up thinking its about them thoughReplyDeleteReplies
Chris this is a wonderful example which gets at the point I was trying to make much more clearly than I managed I think!Delete
There are (at least) two solutions.
1. Ask the family of the three year old for permission to share the story. Even tell them when it is happening and get them to join in. In some ways that seems less risky, but it would still take a very careful discussion to make sure that consent was 'informed'.
2. Make the story up. This is going to be less rich because made-up stories are less likely to be as complex and bring up the same learning points as real ones. But it would still be useful I'd think.
And then I think that you would need some kind of statement making clear that anything you discussed was either with consent, or was made up.
What do you think? Thanks again for sharing?
- Chris Tiplady30 June 2012 at 18:22
Excellent advice. Will do your second point along with the disclaimer when I get this going. I reckon there would be problems only in malignant diagnoses involving some patients and also think its appropriate to get your Trusts permission. That would be best practice. Thanks againReplyDelete
A topic which is rich in the complexities of morals and ethics.ReplyDelete
The following is case reads in rather a strange way but it is to give whole background in short as possible time:
11 week old infant feels warm to her mother who has noted decreased feeding and increased sleep duration during the day. Takes temperature and 38.1 goes to GP who records a temp 38.9 and although not noting signs of serious concern refers to Paediatricians.
Paediatric SpR reviews and notes febrile, quiet child, not quite right in their or mums eyes and performs full septic screen (CRP 11, WCC 11.4) and commences broad spectrum antibiotics.
Consultant reviews and knowing father, who is in medical profession, fails to introduce themselves (while mother in room), doesn't wash hands and makes clear point of discovering occipital node (when SpR had not noted this) in front of parents.
Lets just say someone (lets call them John Smith a Paediatric SHO) decides to tweet about this. The following could be tweeted
@John_Smith: 11 week old presents with fever of 38.9 of uncertain source - what is the best antibiotic cover?
@John_Smith: 11 week old with confirmed fever over 38.5 has no abnormal findings apart from an occipital node. Does this increase the chance of the cause being viral?
@John_Smith 11 week old with fever presented with CRP 11 and WCC 11.4. Would you proceed to full septic screen?
@John_Smith: 11 week old daughter of a doctor presents with a fever of uncertain source - are you more likely to do a full septic screen?
@John_Smith: 11 week old presented today with fever and consultant didn't introduce himself or wash his hands. Should I have said something?
John_Smith uses the following profile "Trainee Paediatrician. Lives in beautiful Newton. Loves reading and tweeting." He also contributes to a twitter feed called @MeduuEduu which presents cases for discussion and tweets
@MeduuEduu Case 23: 11 week old with confirmed fever over 38.5 has no abnormal findings apart from an occipital node. Does this increase the chance of the cause being viral?
Questions from this
i) which if any or all of the tweets breech confidentiality
ii) is @MeduuEduu safer than @John_Smiths tweet because no locality is mentioned at all
Are the following of similar education value?
@John_Smith: 8 week old presents with fever of 38.7 of uncertain source - what is the best antibiotic cover?
[clinical knowledge test no different from original case]
@John_Smith: 10 week old with confirmed fever over 38.5 has no abnormal findings apart from a femoral node. Does this increase the chance of the cause being viral?
[Clinical conundrum probably no different from original but specific clinical feature hidden]
@John_Smith 9 week old with fever presented with CRP 12 and WCC 11.7. Would you proceed to full septic screen?
[unlikely parents would know actual results but hides this possibility without changing ethos of question]
@John_Smith: 9 week old boy whose mother is a paediatrician presents with a fever of uncertain source - are you more likely to do a full septic screen?
[Similar dilemma, and potentially plausible situation, which would not reveal original case]
@John_Smith: 5 year old came in with a seizure and the consultant didn't wash their hands before examining him. Should I have said something?
[Again dilemma maintained as well as confidentiality]
I am sure there are some very specific cases that can't always be altered but I throw this out there to create debate...Replies
I guess this gets to the heart of why we share cases. Surely the closer it is to the real life situation (or interpretations of it) the the more the learning. Where do you stand on patient consent? Would it be very awkward to say to that parent that you would like to discuss this case on twitter as you thought it produced useful learning points? Is it unfair to burden patients in this way? How likely are they to be interested in joining in the conversation? Is it us doctors who feel uncomfortable in disclosing our uncertainty?Delete
I really like the idea of involving patients; there does need to be a good discussion with the parties involved but I think that more often than not people are more willing to participate in educational initiatives than the governance police might think and we should credit them with the good sense most people have. If you are familiar with HealthTalk online, this kind of additional material would be an excellent addition.ReplyDeleteReplies
I really like the idea of involving patients too. I am sure that it will be the way forward. Who do you think the 'governance police' are and why do you think that they consider that people are not willing to participate in educational initiatives?Delete
You don't need patient permission to write them up in an article, although you do to share photographs of them. However I consider social media far diffent than the Lancet! I generally will be very non-specific when discussing medical stuff online - and if specific cases are mentioned they are usually common enough that I'm talking generalities.ReplyDelete
I do case-based teaching sessions on twitter, and the cases are basically fabricated on the spot but may be inspired by recent or past memorable cases. My twitter feed is public, I am easily identifiable, and I've been a patient myself so the last thing I want is for someone to be embarrassed or offended by what I've said about them! So I don't say it...Replies
You don't need patient permission to write them up in an article? Are you sure? The Lancet states: " Ifthere is an unavoidable risk of breach of privacy—eg, in a clinicalDelete
photograph or in case details—the patient's written consent to
publication, orthat ofthe next of kin, must be obtained
• To respect your patient's privacy, please do not send the
consentformto us. Instead,we require you to send a statement
signed by yourself confirming that you have obtained consent
from the patient using The Lancet patient consent form"
And here is the patient consent http://download.thelancet.com/flatcontentassets/authors/lancet-consent-form.pdf
I think that the #micro140 cases are super. (Are they being archived?) But I'm wondering if a statement from you about the steps you take to protect patients might not be a useful addition. You could link to it at the start of discussions or from your Twitter profile. Just a thought:)
Thanks for posting ++
As a patient I am more than happy to give permission for my case to be discussed in social media but would be a bit uneasy if I recognised myself explicitly - especially with a picture - because I would nt rant details of my condition being known to all without my knowledge - thinking of mental health issues and employers reading about them etcReplyDeleteReplies
Thanks Julie. I haven't seen any case discussions in mental health/psychiatry yet. I can understand that thinking mental health is being discussed without your consent would be much more distressing than seeing a picture of your ingrown toenail taken and shared without your permission. Good distinction:)Delete
Its hard to generalise about social media- in a way twitter is like a discussion over coffee in hospital cafe- lively but very public and crucially hard for people to make mistakes or admit ignorance without loading face. Google groups may be more like a discussion in a seminar room- more private but can lack energy and not everyone shows up. So as well as confidentiality we need to pay attention to the dynamics between learners.ReplyDeleteReplies
Your point about the fact that some people feel uncomfortable making mistakes and admitting ignorance on Twitter is a good one. I make mistakes and I admit it. I don't think I lose face. In fact I think in this day and age being seen to admit to mistakes adds to credibility. How can we get this message spread more widely?Delete
Do you think that if people were more comfortable in this then there would be greater participation in case discussions?
- Lisa Nolan25 July 2012 at 20:18
Anne Marie, Re: Spreading the message...I think that the healthcare professionals who are already using Twitter & Social Media are blazing a trail and the message will spread itself. Seeing comments about everything from clinical observations to venting about a rough day to enthusiasm about their hobbies and interests - really humanises people and I have no doubt it makes newbies to Twitter feel more comfortable about sharing their own successes and mistakes - especially when the mistakes are clearly being used as lessons for the future. And anyone who is reluctant can always use an avatar and a non-identifiable bio!ReplyDelete
Re: how to convey that consent has been obtained, perhaps a simple hashtag or acronym like CG+ (Consent Given) could be used with each tweet and that would be similar to the Lancet asking an author to declare that consent was obtained. Owner of Twitter account/person tweeting would then be accountable?Replies
CG+ <- I like it! We still need to figure out what the nature of the consent should be though. I didn't even broach that here, but Mark Ryan makes a good start on some of the questions over here http://smhcop.wordpress.com/2012/07/03/what-are-the-ethics-of-crowdsourcing-a-diagnosis/ - although his account is about consent for sharing which will be beneficial directly to the patient- one hopes. Although, hopefully participating in education should also be beneficial to patients too.Delete
Thanks for replying ++
Hi, I read your blogpost with interest and I am curious to know your opinion on case discussion on other platforms like e.g. Google+ Circles discussion or other types of semi-closed (not public) case discussion, what are your considerations on that?ReplyDelete
G+style (more alike forummembers discussing in threads visible (members-only) as a whole instead of loose parts like tweets). So Google+ has other characteristics then Twitter. Because like Facebook or a forum discussions are so to say nested (i.e. all comments are presented together in one thread) the disadvantage of loose parts like loose tweets can be taken away, especially when in the openingspost of a thread the topicstarter adds comments on patient' s consent and regarding the professional responsibility of any colleague doctor involved in the discussion. Also by using Circles comments are only shared with a Circle of people you now and not visible to the outside world, so they are semi-private nd not public and visable by anyone browsing by. So in Google+ one can better take care of which audience can and which audinece can not view and/or take part of case discussions. (a VERY important additional remark on this specifically for Google+ Circles is that the topic starter should ALWAYS choose to lock the message before posting. Locking a message prevents the messages to be (accidentally) re-shared by Circle-members outside of that specific Circle. Locking a message is not the same as closing it for comments, these are seperate settings for each Google+ posting and can be chosen (also afterwards when already posted) by clicking the circle with an arrow in it at the top tight corner of the posting). In Twitter there are only two modes: public or closed/locked, but in the latter case one should be VERY aware of ones followers on Twitter that gave acces to ones locked tweets. Most people have a lot of followers that are not professional colleagues but frineds, or enthusiasiasts sharing hobbies or whatever). Also on twitter seperate tweets can be retweeted and, as you correctly state, the erst of the story pieces are not necessarily retweeted in combination with one piece. Personally I do not feel that I need to have patients consents in ANY case I discuss online as long as it is fully anonymised, and as long as I feel I can take the professional responsibility (primum non nocere) for the group of people I exclusively (!) choose to share a case with, with the main purpose of finding a solution for that case (in the interest of my patient being discussed) and a secondary aim to become better doctors by learning from each other from anonymised cases of daily clinical practice. Ethically it may even be favourable for doctors to crowdsource rather then to be too much of a solo-player and dive into textbooks to solve things on ones own. The crucial consideration for me is too maximally rule out that any of the group members I discuss a case with could end up (via-via) harming my patient. Chances that the latter happens are fairly reduced when I discuss cases online woth colleagues from all over the world and actually so far without a single colleague from my own country discussing along. But one should always (again) be aware and cautious, that is your professional task.
To conclude: looking forward on how you regard the use of e.g. Google+ (closed) Circles for case discussions. For me it is obvious Twitter is not the platform that most ideally suits that purpose for reasons you summarise very nciely in the above blogpost.
Greetings from the Netherlands,
Michiel M Zandbelt, MD, PhD, rheumatologist
Thanks Michiel,ReplyDelete
I don't think that a public conversation is a risk, but I think not involving a patient in a conversation about their care is. Just as we believe in giving patients access to their records I believe that they should be able to participate or have access to discussions which are about them.
I don't believe that there is much benefit from discussing anonymised cases. If you do then I suspect it is because we disagree on the meaning of anonymised.
The benefit of social media is that it allows multiple voices to participate. This can lead to messy conversation but I believe that ultimately more will be learnt. Hiving of conversations to what fees like a closed spaces might make for an easier conversation and that may be legitimate. But we should be explicit about why we are doing this. If we are going to excluded patients from learning from these conversations we need to have a very good explanation.
Thanks again,
Anne Marie
Hi Anne Marie,ReplyDelete
funny to notice how we approach the same phenomenon from quite dfferent "flying routes" (dutch metaphor for judging a situation from different points of view/perspectives). Had to re-read and re-think a bit to find words for a reply ;-)
It could be that the crux is in the perhaps grey -and not so strictly bordered- area between shared decision making versus learning/education.
The first is about persons (the same situation could end up in different made shared decision on which way to go in patients with different characteristics or different own views or preferences) whilst the latter is un-personalised and about cases (of course behind each case from real life an unique person is hidden, but learning from a case is reduced to a technical discussion putting facts together rather then involving the dinividual patient characteristics in a decision).
I personally regard myself a very "2.0" doctor in putting effort in playing a role as a professional advicer for the patient in my outpatient clinic and make shared decision with a particular patient. Just pressing patients into one or another corner, telling them waht to do and prescribing stuff without some level of agreement and informed conent with the person that is going to take that medication is not my way of being a doctor. With regard to patient empowerment and shared decision making I think we have two minds one thought so to say.
But as learning from each other and medical education concerns (the actual topic of this blogpost, I did notice you mention in a reply to one of the earlier comments above that you considered writing a separate blogpost on shared decision making and social media, so I assume you see some differences here as well, although in general this is a somewhat overlapping issue) I like to teach patients, like to teach students, and like to be teached by them myself as well. But, having said that, although in a modern health 2.0 era patients and doctors are considered equivalent they are of course not identical in knowledge, vocabulary used etcetc...
==end of part one===
===start of part two===ReplyDelete
Like my colleague Carlo V Caballero-Uribe in a comment above I have actually never considered involving patients in the technical part of the discussion (so it is a good thing you raise this question!), sometimes indeed a conversation may be easier with people with the same educational background and jargon. That is not to say that transparency isn' t important.
For now I prefer the patient' s personal doctor to report to the patient what was the result of crowdsourcing his online colleagues and then -giving this additional information- decide together with that patient which way to go (shared decision making), but if a patient would specifically ask me of course I would provide him or her access to that conversation, there is nothing secret or whatsoever. However I would not take the initiative. Although a patient wants to be his/her own co-pilot (co-doctor) why should every patient join converstions between doctors apart from what is relevant for his/her own health? I do not assume every patient wants or thinks to become a doctor and know everything about his/her own health and also other ones health without a medical education. And if a patient would want that she or he is smart enough to know she/he should start a medical education as a basis first and then build from there.
Although equivalence is important doctors should so to say (I am sorry I can not find the proper words but from a doctor's pont of view you can also take patient empowerment and emancipation too far) not have to apologise being different then patients in having had a longterm medical education and training and wanting to discuss cases (not persons!) in their own circles just too (technically) learn from within their own professional circles next to what they learn by practising their job in everydays contact with and from patients.
Also of importance in discriminating between learning and (shared) decision making is that a case discussion does NOT result in a decision being made, it only results in building a (differential) diagnosis and gaining other ones experiences in how certain treatments turned out succesfull or not.
A decision on the other hand, I fully agree with you, should always be made together and with informed consent of the individual and unique patient involved.
So, whilst equivalent in my opinion it is allright to acknowledge their is a difference between doctors and patients, and doctors wanting to (technically) discuss cases (not persons) with each other, in my opinion nothing wrong with that.
Quote: "I don't believe that there is much benefit from discussing anonymised cases. If you do then I suspect it is because we disagree on the meaning of anonymised."
That is also where I came from in terms of anonymising (for the technical discussion -that is NOT for the decision making part- between doctor' s from a doctor' s point of view it is vice versa: there is no benefit of knowing the name of the patient or knowing the patient.
I guess you came from the patient (learning) point of view on anonymising, otherwise I o not really understand what you meant with the above quote on anonymised case discussion.
I will leave it with this, however looking forward to your response on this part of the discussion,
bye from the Netherlands,
Great post and Great Comments. Thank you.ReplyDelete
I am reintroducing word verification to cut back on spam posts. I'm sorry if you find it frustrating,


text:
CM@Risk Projects
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|CSU Architect/Engineer Agreement for CM@Risk Projects
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Typically not appropriate for use on minor capital projects or supporting design services due to extensive deliverables defined in agreement.
|A complete agreement includes the Agreement,
Rider A, and Exhibits A, B, C, and D.
|CSU Project Architect/Engineer Agreement
(For CM@Risk)
|MS Word file
(rev date: 2-12-18)
|Rider A - General Provisions
(For CM@Risk)
|MS Word file
(rev date: 1-14-14)
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Provided as a suggestion for format and outline of content. Each Scope of Work must be written to reflect the specifics of an individual project.
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subset: commoncrawl


text:
Marc Emery Prison Blog Post Number Thirty Three
Marijuana Activist Marc Emery Update
Marc at D Ray James, March 2011March 9-15: This past Wednesday was extremely odd because I didn't get a single ordinary sized letter. Odder yet when I didn't get any letters on Thursday. Or Friday. Normally I get 8 to 10 letters a day. So today, Monday, March 7, I discovered that SIS (Security), led by Mr. Lindsay, is taking my mail from the mailroom after it has all been inspected and cleared of contraband, and then taking my letters to their office and reading each one.
I wouldn't mind that so much but they are holding letters up to 5 days so they can read them, then I finally get them. None of my incoming letters are a security risk, threat or concern, so it can only be for titillation purposes, although I have never, alas, received a single letter I would consider licentious.
So letters I would have received last Wednesday, I'm receiving 5 days later. My outgoing mail, which in a low security facility is sealed by the inmate and is generally not opened by the facility, is taking a longer time to reach their destinations, so I can only assume security is going the same with my outgoing mail and reading it also, and delaying its posting. I find it remarkable that GEO Group never has enough money to provide fresh vegetables or fruit in our diet, or extra soccer or volleyballs or guitars, but can pay the security men here to read hours of my mail, and to no particular end that I can determine other than to upset me.
I was put on the CIM list two weeks ago, Controlled Inmate Monitoring. I did not realize that meant all my mail was now going to be detained, delayed and read. Since I have posed no threat to this facility, and in all valid assessments am a model prisoner, I find this 'special' treatment aggravating. I was able to pose this situation to the Acting Warden Mr. Zenk today. While he casually acknowledged I'm on CIM and my mail is being monitored, he said he would talk to security and see if the turnaround time could be lessened. I will be asking Security what they expect to find in my incoming or outgoing mail that justifies their time, effort and blatant interference in my correspondence.
Newsletter #7 was discussed with me line by line by Security when I issued it 10 days ago, which I did not mind. I was happy to have their input. I gave #8 to Security as soon as the final version was off the photocopier. I have obviously nothing to hide and consider my newsletter a window on the world of DRJ from the perspective of an inmate. In many ways, I do this facility a favor, at no cost to them, of telegraphing the problems of inmates before the problems become critical mass/crises. Many of the staff, families of inmates, and certainly SIS read this newsletter. The B.O.P. liaisons here read it. They have used my comments in their interactions with the GEO Group/D. Ray James staff.
Marc at D Ray James, March 2011Reading my mail and holding it up several days I regard as a betrayal of trust. I'm living up to my obligations to report fairly, truthfully and behave in a polite manner. What happens to me, matters to hundreds of thousands, perhaps millions of people to in North America and the world. I don't exploit that in any way. I don't tell people to bombard DRJ or GEO Group in protest at the inadequacies here I have regarded of egregious. But there is a quid pro quo at work whether DRJ acknowledges it or not. If I am going to be targeted for harassment, which is what I consider this mail screening and delay to be, then I am being disrespected. Mail in the United States takes only 2 or 3 days at most to get here normally, so when I see letters today that are postmarked Feb. 28th and March 1st, I know my mail is being detained unreasonably for no purpose related to the security of this facility.
Along with DRJ's perfidious blockade of my incoming mail and the snooping of my outbound mail for obscure purposes, I have discovered a systemic error in the Keefe Commissary computer that is ripping me off as well as every inmate here. As an inmate, I have a limit on spending on commissary of $320 a month. I buy a lot of my food I eat from commissary as the food served by DRJ is monotonous, lacking in Vitamin A, B, C, calcium, potassium, essential fatty acids, Omega 3 and 6, and is really just a regurgitation of carbs, fats, sugars and protein day after boring, tasteless day. I spend my limit usually the third week of the month, so for the last 7 to 10 days I have next to no food items to eat. I couldn't figure out why this was so. Postage stamps and health items are supposed to be exempt from the $320 monthly limit. But I've checked my commissary records and that of numerous other inmates and found that I and all other inmates are having stamps deducted from our $320 monthly limit!
For me this has been devastating, as I buy $21 to $26 in stamps each week (the weekly limit is $26.20). The net result of this admitted error is that I am cheated out of being able to buy $100 worth of food a month, because my postage stamps are being subtracted from the $320 spending limit. This is cruel punishment that is inexcusable. In the DRJ Inmate Handbook it clearly states that the $100+ limit on postage stamps is above the $320 monthly limit. So over 4 months I've been cheated of $400 on my spending limits. This has affected hundreds and hundreds of inmates as running shoes were also erroneously debited from the $320 spending limit, messing with inmate spending budgets, along with postage stamps. This is unforgivable but I have the statements from Keefe to show they are deducting expenditures on postage stamps from the $320 monthly limit, so we shall see how long it takes this crooked outfit to rectify their previous errors (if they ever will) and stop ripping us off week after week.
Marc and Peter at D Ray James, March 2011So much mail sent to me here has never gotten to me, and numerous letters sent by me here are interfered with and do not arrive. Along with hijacking photographs and letters I send out, they cheat me of photographs that are taken that they don't give me. My hand is on my wife's buttock, so they say in denying me the last photo; before that it was a similar complaint. But they don't show you the photo nor do they refund your $1, so you have to believe their warped interpretation of things, which, considering my experience here, they are completely unbelievable. Hopefully one day you will be able to see my photographs I've paid for and had taken of me at DRJ but I have my doubts. [Note from Jodie: The only photographs that had failed to arrive in the mail from Marc when he wrote this finally showed up in my mail on April 1. The photos were taken February 12 and 13.]
I've taken to listening in on Randy and Jon's guitar sessions. Randy is from New Westminster, BC, vocalist of the Mojo Stars, and Jon is from South Africa. I sit in on their 90 minute sessions where they play about 20 songs, from Eagle's Hotel California to Helplessly Hoping by Crosby, Stills & Nash, Helpless by Neil Young, Under the Boardwalk (Drifters), Brown Eyed Girl (Van Morrison), House of the Rising Sun, the parody of life here 'Folkston Prison Blues' (the Johnny Cash song Folson Prison Blues reworked) and a few beautifully done original tunes as well. I've taken to sitting in and throwing requests at them, and filling in a few blanks in their recollection of lyrics. I did a rock and roll trivia board game in 1987 with 6,000 questions and answers, and from 1989 to 1991 had a Billboard Top 40 retrospective show on radio playing songs from 1955 to 1973 with history of the artists and the song.
While there are now up to 6 guitars for inmates to play available there is no sheet music, songbook or access to lyrics. So I asked Jodie to send me some songbooks I could lend the musicians, and she obliged by sending me sheet music of The Eagles, Sting, Tom Petty, and Neil Young. I mail her a letter asking her to look up the lyrics of about 30 songs, including American Pie and Vincent by Don MacLean, The Wreck of Edmund Fitzgerald by Gordon Lightfoot — as ubiquitous a Canadian song as you'll ever hear, though it is about an American freighter ship plying Lake Superior ("the big lake they call Gitchee Gumee"), numerous Dylan songs, Joni Mitchell, and Cat Stevens.
Marc and Jodie, March 12, 2011If any one of my readers has any extra guitar songbooks lying about their homes or studios that you could part with, it would be greatly appreciated here. [Note from Jodie: mail cannot be sent to D. Ray James from this point on, as Marc is being transferred.] There are some songbooks that have an assortment of classic songs in them, with titles like 200 Classic Songs of the 60's and 70's, and that sort of thing, that would be of tremendous use here. Beatles, Bob Dylan, Talking Heads, Crosby, Stills & Nash, Neil Young (Harvest, After the Gold Rush, etc.), Arlo Guthrie, Woody Guthrie, Robert Johnson, Muddy Waters, Hank Williams, Sr., Merle Haggard, any blues, western, pop and rock classics in guitar playing notation and lyrics (songbooks) would be appreciated.
Adam at the BCMP Vapour Lounge will be recording 'Folkston Prison Blues' next week, live, before an audience, and then it will be put on YouTube shortly afterward and linked to these newsletters. [Note from Jodie: The video and lyrics can be seen in Marc's blog #8, posted here.] Our next parody song, "It's D. Ray James As We Know It (and we're doing time)" — REM song 'It's the End of the World As We Know It' being the source song, is being worked on now for Adam to record after we perform it here. I'll be part of the vocal chorus in our performance of 'It's D. Ray James As We Know It.'
I was pleased to hear that Tommy Chong was in Vancouver at the Rio Theatre doing a fundraiser for my best friend Dana Larsen who is seeking the leadership of the New Democratic Party of British Columbia, the party currently the opposition to the governing Liberal Party. The fundraiser was Monday, March 7, and the next night Tommy jammed with the house band at the BC Marijuana Party Vapour Lounge, helping raise another $1,500 toward Dana's leadership race. The entry fee to run for the leadership was $15,000 into the party coffers, and Dana was accredited as a bona fide contender. The voting for NDP members to choose the leader of the BC provincial party is April 17. Follow Dana's leadership campaign at www.VoteDana.ca. Naturally, repealing the prohibition of cannabis is central to Dana's platform.
Thursday, March 10:
Marc and Jodie, March 12, 2011The D. Ray James business office spoke to me today to acknowledge that they have been improperly including postage stamps and health products in the $320 inmate monthly spending limit. The result of this for me is that I order $90-$100 in postage stamps monthly, these are supposed to be exempt from the $320 monthly spending limit; that has, in fact, been debited from my spending limit each month so far. So I've only been able to order $220 worth of food, which only lasts me 20 days of each month. I should be able to order $320 worth of food AND $100 in health care (ibuprofen, antibiotic ointment, etc.) and postage stamps per month. So for four months I've been cheated out of my full spending limit.
From the point of view of Keefe Commissary, they too have ripped themselves off of tens of thousands of dollars because inmates have been unable to spend their full limits. With 2,000 inmates, it could be hundreds of thousands of dollars of purchasing power negated all due to a computer inputting error! You'd think one of the Keefe or D. Ray James paid staff would have caught on before I had to alert them into making the correction. There will be no credit or compensation for our/my lost purchasing power, but at least I can take credit for correcting an egregious flaw here. The Business Office assures me that this has now been rectified for all future inmate purchases.
My spider bite on my left buttock is still getting a daily medical department look, and both I and they are pleased it is healing rapidly now, the draining having stopped three days ago after about ten days of blood and pus weeping out of the wound.
Monday, March 14 marks 365 days — one year — in prison so far on my sentence, including all of the time that I spent in North Fraser Pretrial Centre up in Canada before being extradited. My treaty transfer application has been in DC for two months, the decision is due to be made in the next 4 to 6 weeks.
Peter Maverick has appointed himself as a one-man books-for-prisoners resource. Peter has sent over 50 books in Spanish including a 25-volume history of each state in Mexico. I have discovered that my Mexican colleagues relate to the state they are from in a strong way, so these books about each state are read voraciously. The books are ordered through Amazon, and Peter has spent well over $750 on these books and postage to send them to me over the last 3 weeks, over 125 books. My personal collection of books, including my law & prison books, number less than 20; the vast bulk of books I have received are loaned to other inmates, and are read studiously and passed on when they are done reading it.
I just finished Michael Pollan's beautifully written book 'The Botany of Desire' and I endorse this 250 page book to anyone who wants to be enthralled by every page while learning so many marvelous details and history about the apple, the tulip, the potato, and marijuana, and the co-evolution of these plants with humankind. Simply terrific book. I understand he has a contemporary bestseller on the NY Times Lists. I'd love that book.
Marc and Jodie, March 13, 2011In a triumph of anti-intellectualism here at D. Ray James Correctional Institution, I am on the bring-5-books, receive-5-books regime with the mail room here once again. Thus I must advise anyone sending me books to now only send books I have specifically requested. Recently, I have received perhaps 150 books in the last month which I have by and large lent out to other inmates, which they are devouring in a satisfying manner, satisfying to anyone interested in knowledge, literacy and disseminating knowledge. That, alas, excludes the decision makers here at D. Ray James. This decision would have come from Warden Zenk himself, with input from Security. I am reminded of that Who song 'Won't Get Fooled Again', "meet the new boss, same as the old boss".
Books sent to me for the benefit of the Spanish-Language inmates have been extremely useful and well-received but will now have to stop. If I can't store them and send them out once every two weeks, I'll have to have the 5 I return destroyed each time because I can't buy enough postage stamps to ship the 5-returnees to my friend Catharine Leach, or my supplier-in-chief Peter Maverick. But I'll try to return to Peter the books I'm going to inevitably receive that I can no longer take possession of.
Sigh. Mail room nonsense has returned once more. Of course, in any sane place, I could donate them directly to the inmate library, where virtually no relevant books have been purchased and added to the reading library in 5 months since this concentration camp for foreigners opened — 5 months ago! That is why the books I've lent around are so welcome: the library is deliberately kept as useless as possible by management here.
I got my pay for February. I'm here every morning, afternoon, and evening shift, 7 hours a day. I missed a day and a half for lockdown, and a few hours in medical getting my infection dealt with, and I don't get 'paid' for Presidents' Day (February 21). Total pay for the month: $5.10. Yes, you read correctly, five dollars and ten cents. That was 12 cents an hour, and my official reinstatement wasn't until February 10, but I've been here three shifts a day, every day, since December. My pay grade has been raised to 29 cents an hour. Ah, there's no labor like slave labor. The GEO Group Inc. motto is "GEO Group: World-class employee, performance, behavior."
IMPORTANT NOTE: On Friday, April 1st, Marc was informed that he will be shipped out to a new prison on Monday, April 4th. Federal inmates can be shipped anywhere in the USA, and are never told where they are going.
Marc will not be able to write newsletters while being transferred, or until he is settled into his new prison and able to get commissary funds for buying stamps to send out mail. There is still a Newsletter #10 to be posted, and two more significant articles by Marc.
Please stay tuned to his progress here and at www.Facebook.com/PrinceOfPot and www.Facebook.com/JodieEmery where updates are posted right away.


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Blinded by the Light
Blinded by the Light is a manic black comedy, a madcap farce of drinking, smoking, Mormons, Catholics, transvestites and a saint all crammed into the tiny bedsit of the hapless Mick.
Mick's priorities in life are finding new ways to call in sick for work, getting hold of some roach paper, and seeing Siobhan again: he needs nothing else to make him happy. But in a moment of idleness he lets a couple of evangelical Mormons into his bedsit; they are so delighted to have found a friendly ear, it seems unlikely they'll ever leave. Despite Mick's increasingly desperate attempts to shock them out of all hope of converting him, soon they are visiting three times a week – prompting his landlord to invite over Lily and Jack from the Legion of Mary, to bring him back into the Catholic fold. Mick can just about juggle his schedule of visiting evangelicals, until the moment that the petty criminals from upstairs present him with the preserved head of Saint Oliver Plunkett.
Bolger's increasingly surreal comedy is a triumph of riotous humour and sharp observation. It was first produced in 1990 by the Abbey Theatre, Dublin.


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Unschooling is based on the belief that children learn best when they are internally motivated. Unlike homeschooling which is essentially doing school (following a curriculum) at home, unschooling allows children to explore their interests and learn without the restrictions of a curriculum.
Teacher and author John Holt — one of the founders of the modern homeschooling movement — coined the word "unschooling" in 1977 to mean "learning that does not look like school learning, and learning that does not have to take place at home." He believed, "there is no difference between living and learning…it is impossible and misleading and harmful to think of them as being separate."
Pam Sorooshian explains unschooling like this:
"Unschoolers simply do not think there are times for learning and times for not learning. They don't divide life into school time or lesson time versus play time or recreation time. There is no such thing as 'extracurricular' to an unschooler – all of life, every minute of every day, counts as learning time, and there is no separate time set aside for 'education.'"
There are many other names for unschooling including "natural learning," "life learning," "experience-based learning," "delight-driven learning," and "independent learning," and there are a ton of resources available online to learn more about it. Here are just a few:
- Joyfully Rejoicing: Joyce Fetteroll
- The Natural Child Project: Jan Hunt
- Exploring Unschooling email series: Pam Laricchia
- Radical Unschooling: Sandra Dodd
- Radical Unschooling: Dayna Martin
Over the past couple years we started our own unschooling journey, which I plan to write a lot about in the future – including how we began on this path. However, I first wanted to provide a little bit of a background information to explain some of the ideas behind unschooling.
I welcome your questions. I absolutely won't have all of the answers, but I enjoy a challenge and the opportunity to think about why I'm doing what I'm doing.
Don't miss a single CDG post, subscribe to my blog.


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GCH CH Fuzzy Farm Twist and Shout
Down my way we are fond of saying we will be there, "God willing and the creek don't rise." As we told you here the Greenwich Kennel Club did not open their show grounds in Norwalk CT until Saturday, the morning of their show because of high tides.
GCH CH De Lamer Point Break
(Photo by Angela Stein)
Once underway it was the usual heated competition. Judge Lydia Coleman Hutchinson seven finalists were the Irish Setter, GCH CH Evergreen Good Intentions, the Afghan Hound, GCH CH Exlysta Aries Ciel Noir, the Portuguese Water Dog, GCH CH Cnsand Ardanwood Whitewash The Fence For Me, the Norfolk Terrier, GCH CH Yarrow Venerie Ticket To Ride, the Toy Poodle, GCH CH Smash Jp Sakura, the Schipperke, GCH CH De Lamer Point Break, and the Puli, GCH CH Fuzzy Farm Twist and Shout.
Her Best was the Puli, Twister, and her Reserve was the Schipperke, Surfer. It's the first of the year for Twister and breeder/owner/handler Alice Lawrence. Twister and Alice were the winners of the AKC 2012 Owner/Handler series while collecting 21 Herding Groups. Congratulations to Alice, co-breeder Sherry Harman, and owner Steve Lawrence.


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Empire 3-Piece Bath Set
View Selection
Empire is a traditional style of tap given an unconventional Art Deco twist in the form of hexagonal design detailing. The collection consists of taps, basin mixers, bath-shower mixer, concealed wall valves/bath spout, and a matching heated towel rail.
Delivery & Returns
For Online Orders
or return your order.
on price
any competitor quote
(on a like for like basis)


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Climate change
Directory of resources
The directory provides links to web-accessible resources in categories of relevance to policymaking. Links to climate change portals of UNEP/WHO and other UN agencies are in Section 9. Selected links to other organizations, e.g. academic/research institutes, government and civil society are in Section 10.
Policy brief
Since 1988, the United Nations Intergovernmental Panel on Climate Change (IPCC) has reviewed scientific research, and provided governments with summaries and advice on climate problems. In its most recent report, the IPCC concludes that the average temperature of the earth's surface has risen by 0.6 °C since the late 1800s. It is expected to increase by another 1.4–5.8 °C by the year 2100 – a rapid and profound change. Even if the minimum predicted increase takes place, it will be larger than any century-long trend in the last 10 000 years. The principal reason for the global increase in temperatures is a century and a half of industrialization, with the burning of ever-greater quantities of oil, gasoline, and coal; the cutting of forests; and use of certain farming methods.
Climatic changes already are estimated to cause over 150,000 deaths annually.
That estimate includes deaths as a result of extreme weather conditions, which may be occurring with increased frequency. Changes in temperature and rainfall conditions also may influence transmission patterns for many diseases, including water-related diseases, such as diarrhoea, and vector-borne infections, including malaria. Finally, climate change may affect patterns of food production, which in turn can have health impacts in terms of rates of malnutrition. There is further evidence that unmitigated greenhouse gas emissions would increase disease burdens in the coming decades. The risks are concentrated in the poorest populations, who have contributed the least to the problem of greenhouse gas emissions.
Over a decade ago, most countries joined an international treaty – the United Nations Framework Convention on Climate Change – to begin to consider what can be done to reduce global warming and to cope with whatever temperature increases are inevitable.
In 1997, the Kyoto Protocol, which has more powerful (and legally binding) measures, was developed by governments as an addition to the treaty. This protocol came into force on 16 February 2005. The Kyoto Protocol is signed by 128 nations, and commits the participating industrialized countries to cut emissions of greenhouse gases by over 5% below 1990 levels by the period 2008-2012.
In addition to addressing the root causes of climate change, it is also important to take action to adapt to a changing climate. This includes actions that immediately improve the health of the poorest communities and also to reduce their vulnerability to climate change effects in the future.


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June 2, 1992
Release # 92-093
PRODUCT: 4,700 "Bunny on a Stick" items sold from February 1 to April 15, 1992 by Wal-Mart stores.
PROBLEM: The item failed the CPSC rattle test because the handle may cause a small child to choke and/or suffocate. In addition, the wooden balls attached to the item came off during testing and also present a choking hazard.
WHAT TO DO: Return to place of purchase for a refund.
WASHINGTON, DC -- In cooperation with the U.S. Consumer Product Safety Commission (CPSC), Wal-Mart Stores, Inc. of Bentonville, Arkansas is voluntarily recalling approximately 4,700 "Bunny On A Stick" Easter rattles, item number 100660. The item failed the CPSC rattle test because the four-inch long by half-inch diameter wooden handle represents a choking hazard. In addition, two one-half inch diameter wooden balls attached to the item came off during testing, also presenting a choking hazard.
The item is constructed of wood and consists of a handle attached to a body with a bunny head and two balls representing its paws. The balls strike the hollow bunny head producing a sound when the item is shaken. The item is painted in pastel colors and was imported from Taiwan by Wal-Mart.
Bunny On A Stick items, were sold nationwide from February 1, 1992 to April 15, 1992, for approximately $2.00 each.
Wal-Mart Stores, Inc. reported to CPSC that they received a report of a child who nearly choked on one of the small wooden balls. Neither CPSC nor the company is aware of any other safety complaints or injuries involving this product. This voluntary recall is being conducted to prevent the possibility of injury.
Consumers are urged to take the Bunny On A Stick item away from young children immediately and return it to the store where purchased for a refund. Consumers with questions about this recall may contact the company at 1-501-273-4314.
The U.S. Consumer Product Safety Commission is announcing this recall as part of its mission to protect the public from unreasonable risks of injury and death associated with consumer products. The Commission's objective is to reduce the estimated 28.5 million injuries and 21,600 deaths associated each year with the 15,000 different types of consumer products under CPSC's jurisdiction.
The U.S. Consumer Product Safety Commission is charged with protecting the public from unreasonable risks of injury or death associated with the use of thousands of types of consumer products under the agency's jurisdiction. Deaths, injuries, and property damage from consumer product incidents cost the nation more than $1 trillion annually. CPSC is committed to protecting consumers and families from products that pose a fire, electrical, chemical or mechanical hazard. CPSC's work to help ensure the safety of consumer products - such as toys, cribs, power tools, cigarette lighters and household chemicals -– contributed to a decline in the rate of deaths and injuries associated with consumer products over the past 40 years.
Federal law bars any person from selling products subject to a publicly-announced voluntary recall by a manufacturer or a mandatory recall ordered by the Commission.
To report a dangerous product or a product-related injury go online to www.SaferProducts.gov or call CPSC's Hotline at 800-638-2772 or teletypewriter at 301-595-7054 for the hearing impaired. Consumers can obtain news release and recall information at www.cpsc.gov, on Twitter @USCPSC or by subscribing to CPSC's free e-mail newsletters.
Please use the below phone number for all media requests.
Phone: (301) 504-7908
Spanish: (301) 504-7800


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Cinedigm To Release Irish/Scottish Horror Film In Theatres; New Video To Release Across Digital, On-Demand and DVD
(Los Angeles, CA, March 22, 2012) – Cinedigm Entertainment Group, a division of Cinedigm Digital Cinema Corp. (NASDAQ: CIDM) and entertainment distributor New Video have jointly acquired the U.S. distribution rights to Citadel, Ciaràn Foy's Irish-set horror film whose world premiere recently won the "Midnighter Audience Award" at the 2012 SXSW Film Festival. Cinedigm's theatrical distribution will commence this fall, with New Video's roll out across on-demand, digital and DVD/Blu-ray beginning in early 2013. Citadel is the first scripted acquisition under the recently announced partnership between veteran distributors Cinedigm and New Video to acquire and distribute independent films theatrically in North America and across on-demand and digital platforms and DVD/Blu-ray.
In Citadel, Foy's writing and directing debut, young father Tommy Cowley is afflicted with chronic agoraphobia after his wife is brutally killed by a gang of twisted feral children. Trapped in the dilapidated suburbia of Edenstown, he finds himself terrorized by the same gang, now intent on taking his baby daughter. Torn between the advice of an understanding nurse and a vigilante priest, Tommy sets out to learn the nightmarish truth surrounding these hooded children. He also discovers that to be free of his terror, he must finally face the demons of his past and enter the one place that he fears the most – the abandoned tower block known as the Citadel.
Citadel is an Irish / Scottish co production by Blinder Films and Sigma Films, and is funded by the Bord Scannán na hÉireann/Irish Film Board, Creative Scotland, Section 481 and UK Tax Credit
Citadel was produced by Katie Holly of Blinder Films and Brian Coffey fromScotland's Sigma Films. Executive Producers are Gillian Berrie, Kieron J. Walsh and David Mackenzie; the film stars Aneurin Barnard, James Cosmo, Wunmi Mosaku, Jake Wilson, and Amy Shiels.
"Citadel is a disturbing, powerful and altogether original psychological horror film," said Bob Fiorella, COO of Cinedigm Entertainment Group. "Garnering remarkable reviews for first-time writer/director Ciaràn Foy, we believe Citadel is poised to find a wideU.S. audience and we are unbelievably proud to make it the first scripted acquisition in our new joint venture."
"Ciaràn Foy clearly made his mark at SXSW as a rising star with incredible talent," said Susan Margolin, Co-President of New Video. "Citadel is a cinematic achievement supported by a stellar cast, and a real treat for horror fans. We're excited to bring Ciaràn's exceptional debut to market."
Writer / Director Ciaran Foy: "I'm absolutely thrilled that will have U.S distribution with Cinedigm and New Video. I have always had the audience in mind when creating this feral little movie, and to have the opportunity for it to play on such a vast stage is exhilarating"
Producers Katie Holly and Brian Coffey: "We are thrilled that Cinedigm/New Video have picked up Citadel for theUS. They have such a vastly experienced team and their enthusiasm for the film was evident from the get-go, we can't wait to work with them on theUS release"
Commenting on the news James Hickey, Chief Executive of the Irish Film Board: "This is great news for Citadel which is Ciarán Foy's directorial debut. Following on from its successful world premiere at SXSW where it picked up an Audience Award and garnered critical acclaim, we are delighted that Cinedigm Entertainment Group and New Video have acquired U.S. distribution rights and that Citadel will now have the opportunity to be seen theatrically by American audiences."
Robbie Allen, Portfolio Manager for Film at Creative Scotland: "We are delighted that the successful launch of Citadel at SXSW has resulted in this distribution deal. It's great that audiences in the US will get to see this film, which is a wonderful example of what can be achieved when Irish and Scottish talent work in partnership. The results really are impressive and we hope this will be the first of many such deals that will see Citadel enjoyed by audiences around the world."
The filmmakers were represented in the negotiation by Nate Bolotin of XYZ Films and the UTA Independent Film Group.
About Cinedigm Entertainment Group:
Cinedigm Entertainment Group is a state of the art digital distributor of award-winning independent films and alternative content guided by CEO and Chairman Chris McGurk, an industry leader with over 20 years of distribution experience. CEG has released close to 200 independent films and alternative content events over the last few years, with past releases ranging up to 1,000 screens based on content and audience footprint. Films released by Cinedigm include: "Life In A Day" directed by Kevin McDonald, produced by Ridley Scott and released in association with National Geographic Entertainment and YouTube; "The Ward" directed by John Carpenter; "Smell of Success" featuring Billy Bob Thornton, Téa Leoni and Ed Helms; "Back & Forth," a Foo Fighters documentary directed by Oscar® winner James Moll; and Peter Bogdanovich's "Runnin' Down A Dream" with Tom Petty and the Heartbreakers.
Current and upcoming CEG films include filmmaker Parris Patton's "No Room For Rockstars," the much-anticipated documentary chronicling the Vans Warped Tour which premiered at Sundance in January, 2012; "Like Water" about UFC champion Anderson Silva which premiered at the 2011 Tribeca Film Festival where it won the "Best New Documentary Director"
award for first-time filmmaker Pablo Croce and "The Invisible War," the groundbreaking documentary investigating the rape epidemic within the U.S.military from Oscar®- and Emmy®-nominated filmmaker Kirby Dick and winner of the Audience Award at the 2012 Sundance Film Festival. www.cinedigm.com
About New Video:
New Video is a leading entertainment distributor and the largest aggregator of independent digital content worldwide. Headquartered in New York City, with an international presence in 45 territories, the company delivers feature films, TV programs and web originals via digital download, streaming, video-on-demand, Blu-ray, DVD, and theatrical release. In 2011, New Video bowed Oscar®-nominated Hell and Back Again and South American blockbuster Elite Squad: The Enemy Within in US theaters. Through a new partnership with digital exhibitor Cinedigm Entertainment Group, New Video is poised to bring more independent films to theaters nationwide. New Video streamlines distribution and marketing for filmmakers and partners, bringing a wide variety of fresh content to new audiences. The company's library includes original TV series and movies from A+E® Home Entertainment, HISTORY™, and Lifetime®, unforgettable games and trophy sets from Major League Baseball®, storybook treasures from Scholastic®, award-winning documentaries from Docurama Films®, next-gen indies from Flatiron Film Company®, and acclaimed independent films and festival picks through partnerships with the Sundance Institute and Tribeca Film. New Video is proud to distribute many Oscar®-nominated documentaries including GasLand, Waste Land, Paradise Lost 3: Purgatory and Hell and Back Again.
Citadel trailer:
For more information:
Cinedigm Public Relations:
Maggie Begley
President, MBC
firstname.lastname@example.com; 310-301-1785
Cinedigm Investor Relations:
Kimberly Esterkin
firstname.lastname@example.com; 310-829-5400
New Video:
Sommer Hixson
firstname.lastname@example.com; 646-259-4138


text: In celebration of Blacktip Reef's first anniversary (this Friday, August 8th!) , we're highlighting some of the awesome animals that call our newest exhibit home! Blacktip Reef Sharks Take one look at our colorful reef and you're sure to spot our sleek school of blacktip reef sharks, the exhibit's namesakes! Commonly found in the reefs and shallow, inshore waters of the Indo-Pacific, the blacktip reef shark are known for their sleek build and the black "tips" on its dorsal and caudal fins. Blacktip reef sharks can grow to be up to six feet in length. The typical diet of a blacktip reef shark includes small fishes, invertebrates (mostly octopus) and shrimp. Here at the Aquarium, our sharks are scatter fed a nice mixture of restaurant-quality fish and squid! Zebra Sharks Joining our school of blacktip reef sharks in this exhibit is our pair of zebra sharks, Zeke and Zoe! Did you know? These zebras lose their stripes! As juveniles, zebra sharks have dark bodies with yellowish stripes. As they mature, their pattern changes to small dark spots. Zebra sharks can be found in the western Pacific Ocean (from Japan to Australia), the Indian Ocean and the Red Sea. Wobbegong Sharks Wobbegong sharks are proof that sharks come in all shapes and sizes! Wobbegongs have wide, flat bodies that are covered in darker lines and splotches that help them perfectly conceal themselves within their reef homes. Also known as "carpet sharks," there are 12 species of wobbegongs found worldwide. Blacktip Reef is home to two species: the tasselled wobbegong and the ornate wobbegong! Check back all week as we continue to celebrate the one-year anniversary of Blacktip Reef! Tags: animals, blacktip-reef, species-spotlight, blacktip-reef-sharks, zebra-sharks, wobbegong-sharks Categories: Animals Previous Post Next Post


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Will Arnett and my birthplace
Will Arnett hosted the first annual Laughter Is The Best Medicine Gala in support of Toronto East General Hospital last night. I was born at Toronto East General! And my cousin Cat and I worked there for a summer as kitchen staff. They always say hospital food sucks. I put on 10 lbs working there because it didn't. Will's father was chair of the hospital board for two years. Several of his family members also received care there. So he came home and brought along Jerry Seinfeld who performed at the event.
Will was joined by wife Amy Poehler and God I love her so much for being there with him and God I love them so much for being so great together. They posed on the press line for a while and then, as Will was being interviewed, Amy apparently went off to go hang out with his family. Also, yes, Arrested Development is on. Will confirmed this week on several talk shows and to reporters last night that they start shooting the miniseries in the next couple of months and then straight through to the movie this summer.
Click here for more about Toronto East General Hospital and to make a gift.
John R. Kennedy/Splash


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Activities for Clients
Here at Oakleaf we have various different activities, groups and workshops that you might like to get involved with. It might be to learn new skills, find a new hobby, or just to meet new people and get out and about. Have a look at the schedule of events below to see what is going on this month.
We currently host activities in Guildford Town Centre, North Guildford, Waverley and Surrey Heath.
You can download the October to December 2019 calendar here
If you would like to come along to Job Club, please contact Katie Dewick on 01483 303649 or firstname.lastname@example.com
If you are interested in any of the activities and would like to book a spot or need more information, please contact Annalise Baker on 01483 303649 or email firstname.lastname@example.com.
What's on this Month?
March 20, 2020
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11:30 am Fitness Class
Fitness Class
Mar 20 @ 11:30 am – 12:30 pm
Get healthy with beginner keep-fit classes at Oakleaf! Aimed to get you fitter, feel healthier and have some fun too! Sessions cost £2 each week. [...]
12:45 pm Karate in QE Park
Karate in QE Park
Mar 20 @ 12:45 pm – 1:45 pm
12 weeks plan: General knowledge about Karate (history, purpose, methodology) Physical training with use of Karate techniques from Kata (form) called Pina Kata Partner work [...]


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Fun, Fast & Easy, No-Soldering, No-Circuit-Board Electronic Projects!
You are invited to receive this fun little 10-in-1 project kit FREE with your self-addressed stamped envelope! Just follow the instructions on our "How Can I Get It?" page, but don't send money, just include a small note with the words ""Free Kit Offer for Elektor readers" written on it. Please allow us 4 weeks for delivery (we have a lot of these to make!).
And when you're done, skip over to our forum to let us know how it turned out!
~ From your friends at PAiA.
We're going to show you how to make the world's most bare-bones electronic music instrument – and a bunch of other things, as well.
This instrument is called a 'ribbon controller', but it's also known after its inventor, Paul Tanner, as a 'tannerin'. He called this instrument an 'Electro-Theremin'. That name didn't catch on because this is not a Theremin (the musical instrument you control by moving your hands in the air) even though it sounds like one. You are going to build a sound generator that changes pitch as you slide wires back and forth on a conductive "ribbon" we will make as part of this project..
We also discuss how you can take this same circuit and do many other experiments with things you have around your home.
Brian Wilson and the Beach Boys' song "Good Vibrations" used the magic of Paul Tanner's ribbon controller to make its distinctive sweeping wee-oo-wee sound. Wikipedia has a great page on the history of the ribbon controller: http://en.wikipedia.org/wiki/Electro-theremin
If you aren't holding one of our "2-Transistor Ribbon Kits" in your hand, keep reading. We'll explain how to make your own kit, or how to get one from us for about the cost of a can of soda.
If you do have the kit, this page will teach you about your kit, show you how to hook it up and talk about several experiments you can do with parts around the house.
EDUCATORS: Click this link for background about using this kit if you're a teacher or group leader. This is a fun & cheap group project.
Briefly, the circuit (called a relaxation oscillator) measures resistance and creates an audio tone to match. The value of the resistance determines how fast a capacitor charges. Once the capacitor gets enough charge, the transistors turn on. This causes the speaker to 'pop' and it also forces the transistors to turn off (relax!). The capacitor then starts to charge up again, repeating the cycle all over again (oscillation).
Enough theory? >>Let's make it!


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As COVID-19 reshapes our economy, our newsletter will help you unpack the news from the day.
Quarterly earnings reports out this week from the major banks including JPMorgan Chase, Goldman Sachs and Bank of America show very, very strong gains. Many companies are benefiting from the changed tax code, but banks are a special case.
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Our daily newsletter unpacks what's happening in the COVID-19 economy and what it means for you.


text: You may or may not have seen our annual offer to do with replacing your shocks and struts for a special offer price during the two months of September and October. But what exactly are shocks and struts? And how do they help with your vehicle? And when should I be looking to replace them? Hopefully, this little piece will answer all your questions or at least educate you on the importance of this car maintenance issue. Lets start with the "WHAT" part. To put things in the simplest terms possible, shocks and struts help keep your vehicles tires in contact with the road. That sounds pretty important, right? They help make your ride more comfortable so there is less jumping around when travelling on these bumpy Arizona back roads and your ride is as smooth as possible. They are also key components in the safe handling of your vehicle. They maintain the vertical loads placed upon the tires that ensure the tires stay in constant contact with the road while helping to maintain a balanced ride. They play an absolute vital role in helping your vehicle with stopping, its stability and the vehicles steering. They prevent excessive tire and body movement, reduce vehicle "bounce", help with the vehicles handling and braking. It is also key with regards to your wheel alignment and finally, they help to keep the tires from wearing too quickly. Now we will move quickly onto how your shocks and struts can wear out. Damaged Bushings – This is the part that contributes to premature wear on your tires and could also lead to other suspension issues. Deteriorated components – This is the part mentioned above that will lead to excessive body and tire movement. Worn internal Oil – Could affect the vehicles ability to handle road impacts. Overall, the rate of wear on your shocks and struts is dependent on a number of different variables including' Road conditions Environment conditions Driving style Vehicle load. Here in Arizona, if you are constantly driving lots of back roads with potholes that challenge your suspension, this may have an impact. Also, one other thing to consider locally is the almost constant heat and the affect that can have on this vehicle maintenance issue. We will finish off with the why we may need to replace them. Like all maintenance issues, you can easily overlook the importance of these so it's important to find out your vehicles history. Discuss its repair history with your auto shop and find out when this was last taken care of. Usually the recommended period can be anywhere around the 50,000 mile mark (depending on the variables mentioned above). Ask yourself questions like, are your tires wearing quicker than usual? Do you have a lot of problems with your brakes? Is your ride quality still as good as it used to be or have you noticed the standard of drive diminish?  Take advantage of the great SHOCKTOBER offer for September and October where all seven of our valley locations have partnered with Monroe to offer you 4 shocks and strut replacements for the price of 3.  More details can be found in store if you call and request an appointment and as always, any questions, please call in and ask our expert service advisors or visit the Monroe website for more details. http://www.monroe.com/en-US/