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Article Text
Objective We aimed to assess the nature of association between job stress and occupational injuries among firefighters in Korea.
Design Cross-sectional study.
Setting We conducted a nationwide survey using self-reported questionnaires in South Korea.
Participants A survey was conducted among 30 630 firefighters; 25 616 (83.6%) responded. Our study included firefighters who were 20–59 years old. Individuals with <12 months of current job experience and those with missing data were excluded; ultimately, 14 991 firefighters were analysed.
Results Among fire suppression personnel, high job demands (OR=1.49, 95% CI 1.25 to 1.77), high interpersonal conflicts (OR=1.18, 95% CI 1.02 to 1.37), a poor organisational system (OR=1.33, 95% CI 1.14 to 1.55), and a negative workplace environment (OR=1.41, 95% CI 1.21 to 1.64) were associated with the occurrence of occupational injury; high job demands (OR=1.22, 95% CI 1.01 to 1.47) were also associated with the frequency of injuries. Among emergency medical services personnel, high job demands (OR=1.26, 95% CI 1.03 to 1.54), high interpersonal conflicts (OR=1.40, 95% CI 1.19 to 1.66), a poor organisational system (OR=1.55, 95% CI 1.30 to 1.85), lack of reward (OR=1.43, 95% CI 1.21 to 1.69) and a negative workplace environment (OR=1.30, 95% CI 1.10 to 1.54) were associated with the occurrence of occupational injury; low job control (OR=1.20, 95% CI 1.04 to 1.38), high interpersonal conflicts (OR=1.18, 95% CI 1.03 to 1.36), lack of reward (OR=1.17, 95% CI 1.02 to 1.35) and a negative workplace climate (OR=1.16, 95% CI 1.01 to 1.34) were also associated with a greater number of injuries. Among officers, high job demands (OR=1.96, 95% CI 1.35 to 2.85) and a negative workplace environment (OR=1.54, 95% CI 1.13 to 2.10) were associated with the occurrence of occupational injuries; however, there was no significant correlation between job stress and the number of injuries.
Conclusions High job stress among firefighters was associated with both the occurrence of occupational injury, and also with an increased frequency of injuries. Therefore, job stress should be addressed to prevent occupational injuries among firefighters.
- firefighters
- job stress
- nationwide study
- occupational injuries
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Strengths and limitations of this study
This is a nationwide study including a large number of firefighters of Korea.
There have been only a few systematic studies of the association between job stress and occupational injury among firefighters. This study showed that high job stress is related to both the occurrence of occupational injury, and to the frequency of occupational injuries in Korean firefighters.
Owing to cross-sectional design, this study could not establish a causal relationship, and were only able to identify the association between job stress and occupational injuries.
There was possibility that the result was biased by using self-reported questionnaires and missing some potential confounders.
Firefighters are responsible for the safety of citizens, and perform functions that include fire suppression and emergency medical services (EMS). As such, they are exposed to physical or chemical hazards that lead to high rates of occupational injuries.1–3 According to a report by the National Fire Protection Association, 18 500 cases of exposure to hazards were reported and 63 350 injuries occurred in the line of duty, in the USA in 2014.4 According to another report, firefighters responsible for fire suppression had a 1.4–7.4-fold higher risk of non-fatal injuries than did workers in other industries.5
Factors that affect occupational injury among firefighters have been investigated. A study by Fabio et al6 showed that such injuries were influenced by work environments such as the number of alarms, grades of fire, number of structural floors at the scene, work intensity, civilian injury, time of incident and number of pumpers. Other studies reported that obesity was associated with increased injuries among firefighters.7 ,8
Various factors affecting occupational injury have been reported for other occupations, including long working hours9 and shift work.10 ,11 Individual characteristics such as obesity8 ,12 ,13 and moderate or heavy alcohol consumption14 ,15 also play a role. Separately, other researchers also examined whether psychological factors such as negative affectivity,16 depression symptoms17 and mental illness18 were risk factors for occupational injuries. In terms of job stress. Recent studies have shown that occupational injury is associated with excessive workload, high cognitive demands and low job satisfaction, high intragroup conflict, job insecurity,19 low decision latitude, conflicts with the supervisor or colleagues,20 lack of organisational support,21 poor physical environment, unfair reward and treatment,22 verbal abuse and low predictability,23 and organisational injustice.24
Despite a plethora of studies, there have been only a few systematic investigations to identify factors influencing occupational injuries among firefighters. In this study, which is based on a survey of all Korean firefighters, we aimed to investigate the existence of a correlation between job stress and occupational injury among firefighters.
Study participants and methods
This cross-sectional study was conducted via a survey targeting firefighters in South Korea between July and November 2007. To explain the questionnaire and increase the response rate, the survey was conducted in coordination with the health managers at each fire station. A questionnaire was mailed to 30 630 firefighters; 25 615 (83.6%) responded. The self-reporting structured questionnaires were used to investigate the characteristics of participants, frequency of occupational injury during the previous 12 months and job stress at the current place of employment. Hence, 5165 respondents who had <12 months' experience in the current task job were excluded. We also excluded 5310 firefighters with missing basic data (sex, age, marital status, smoking status, alcohol consumption, frequency of exercise, education, current job category, current job experience, occupational exposures or job stress). Ultimately, data of 14 991 firefighters who were 20–59 years old were analysed. All participants provided written informed consent for their participation.
Occupational characteristics and injury
In the survey, participants were asked to reply to the question; "How many times have you experienced injury in the workplace that required medical care during the past 12 months?" Hence, occupational injuries in this study were restricted only to events related to the firefighters' duties. Furthermore, minor injuries that is, those that did not require medical care, were excluded. Occupational injuries within the previous 12 months were recorded because only a few such injuries occurred within shorted durations. Firefighters included all workers employed at a fire department and its related services, including: fire suppression (extinguishing a fire), paramedics (providing emergency medical care), rescue workers (rescuing people who are trapped or in medical emergencies), special investigators (investigating a cause of fire), informatics training officers (training other firefighters) and others.25 These jobs were categorised into fire suppression, EMS (includes paramedics and rescue), and officers (including administrators, special investigators, and communicational and informational system operators).
Job stress
Job stress was identified according to the short form of the Korean Occupational Stress Scale (KOSS-SF), which was a structured questionnaire to estimate the job stress of Korean employees.26 KOSS-SF was based on the most commonly used job stress questionnaires such as the Job Content Questionnaire, National Institute of Occupational Safety and Health job stress questionnaire and Occupational Stress Index. This scale is comprised of 7 subscales and 24 items: job demands (4 items), job control (4 items), interpersonal conflict (3 items), job insecurity (2 items), organisational system (4 items), lack of reward (3 items) and workplace environment (4 items). Each item allowed four possible responses: 'strongly disagree', 'disagree', 'agree' or 'strongly agree'. Subscale scores were the sum of each item, which was then converted into 100 points. Cronbach's α coefficient for each subscale was calculated to evaluate the internal reliability of the KOSS-SF, which ranged between 0.51 and 0.82. In this study, Cronbach's α coefficient for subscales of job stress ranged from 0.55 to 0.77. The KOSS-SF also showed acceptable validity by analysing internal consistency and factor analysis;26 it also recommended using scores dichotomised around the median for the total study population. Therefore, the scores of each job stress were dichotomised at the median of the total firefighters (table 1).26
Occupational exposure
Firefighters have been exposed to various hazards that are directly linked to occupational injury. To clarify the effects of numerous such exposures, participants were asked whether or not they have experienced the following 12 hazardous conditions and/or exposure to materials in the workplace at least once: overload (lifting a heavy object repetitively), inadequate posture (working in an uncomfortable posture for a long time), lack of lighting (working in darkness), excessive heat or cold (working in an excessively hot or cold environment), noise (exposed to loud noise at work), vibration (exposed to vibration at work), dust (exposed to metallic dust, welding fume, grain dust, asbestos or other agents at work), organic solvents (exposed to organic solvents such as thinner, gasoline, light oil, kerosene oil, normal hexane, benzene, trichloroethylene and unknown organic solvents at work), other chemical agents (exposed to chemical agents such as chloroform, carbon tetrachloride, dimethylformamide, carbon disulfide, pesticide, urethane, epoxy resin and other unknown chemical agents at work), metals (exposed to metals such as lead, chrome, nickel, mercury, cadmium, aluminium and other unknown metals at work), biological agents (exposed to biological agents such as blood and other droplets or fluids at work) and radiation (exposed to non-destructive radiation at work).
Other confounding variables
Smokers were categorised as current smokers, ex-smokers and never smokers. The Alcohol Use Disorders Identification Test (AUDIT)27 was used to identify hazardous drinkers among firefighters. Participants were categorised into hazardous drinkers (AUDIT score ≥8) versus non-hazardous drinkers (AUDIT score <8).28 Regular physical activity was divided into exercising either <3 times or ≥3 times per week. Education levels were categorised into <12 years of schooling versus ≥12 years (high school or above). Marital status was categorised as married and living with a spouse versus other (never married, divorced, etc).
Statistical methods
All study participants were divided into two groups: those who had experienced occupational injury during the previous 12 months and those who had not. Injuries according to occupational and demographic characteristics were compared by using the χ2 test and Cochran-Armitage trend test. Distribution of the numbers of injuries during the previous 12 months according to current job was also analysed. Job demands and job control were examined for analysing job stress; this analysis was conducted by stratifying the duties of firefighters into fire suppression, EMS and officers as mentioned above.
Association between job stress and occurrence of occupational injury was identified through a multivariate logistic regression model with adjustment for potential confounders that affect occupational injury on univariate analysis, including sex, age group, marital status, smoking status, hazardous drinking and occupational exposures. Some workers had one or more occupational injuries during the previous 12 months; hence, we tested whether job stress is related to the number of occupational injuries as well. The number of occupational injuries is counted variables that were commonly analysed by Poisson regression model, negative binomial regression model. In this study, the distribution of the number of injuries was overdispersed and zero-inflated. Thus, we selected a zero-inflated negative binomial regression model to handle the distribution.29 ,30 The model was used to analyse the association between job stress and the number of occupational injuries; using this method, the incidence rate ratios (IRRs) and 95% CIs were calculated by adjusting all confounding variables. In this study, p values below 0.05 were considered statistically significant. Statistical analysis was performed using the SAS V.9.2 software (SAS Institute, Cary, North Carolina, USA.)
General characteristics
Over a period of 12 months 1757 participants comprising 14 349 men and 642 women experienced occupational injury (11.72%). There were significant differences between injured versus not injured personnel with respect to sex, age, marriage status, smoking status, hazardous drinking, current job and occupational exposures (table 2).
Distribution of the number of injuries by current job
The number of firefighters who experienced injuries in the previous 12 months included 840 fire suppression personnel, 723 EMS workers and 194 officers (table 3). As some firefighters were injured more than once, there were 5580 injury incidents; 2691 among fire suppression personnel, 2226 in EMS workers and 663 among officers. Including firefighters who never experienced injuries, the mean number of injuries was highest among EMS workers and lowest among officers; however, after excluding non-injured firefighters, that order was reversed (table 4).
Analysis of occupational injury according to job stress
ORs were calculated using a multivariate logistic regression model to identify the association between job stress and the occurrence of occupational injury. Among fire suppression personnel, high job demands, high interpersonal conflicts, a poor organisational system and a negative workplace environment were related to the occurrence of injury. Among EMS personnel, high job demands, high interpersonal conflicts, a poor organisational system, low rewards and a negative workplace environment were related to injury incidents. Among officers, high job demands and a negative workplace environment were associated with injury (table 4).
The IRRs of the number of occupational injuries were calculated by a zero-inflated negative binomial regression model comparing participants with high job stress to low job stress. Among fire suppression personnel, high job demands were associated with an increased number of injuries. Among EMS personnel, low job control, high interpersonal conflicts, low rewards and a negative workplace environment were related to an increased number of injuries. There were no correlations between the factors investigated and injury among officers (table 4).
This study showed that excessive job stress is related to the occurrence and the frequency of occupational injuries in Korean firefighters. Many recent studies have investigated occupational injury due to physical and chemical exposure, as well as psychological factors including job stress. However, the association between job stress and occupational injuries among firefighters has rarely been examined. Our study is meaningful because it is a nationwide survey involving the entire firefighter force of Korea; moreover, it reveals an association between job stress and the frequency of occupational injuries in Korean firefighters after adjusting for confounding variables.
In this study, high job demands were associated with the occurrence of occupational injury regardless of the nature of the current job. In a study of small-to-medium sized Korean manufacturing enterprises, workers with highly demanding jobs had a greater risk of occupational injury.31 A study from Japan also showed that high quantitative workloads, high variance in workload and high cognitive demands were associated with occupational injury in men working in small-to-medium sized manufacturing enterprises. Among female workers, high quantitative workloads and high cognitive demands correlated with a greater risk of occupational workplace injury.19 The results of our study suggest that firefighters, who have high-risk jobs, also experience a greater risk of occupational injury corresponding to higher job demands.
Low job control (ie, the ability to make decisions) was found not to be significantly associated with occupational injury among firefighters. Murata et al32 showed no statistically significant effects of job control on occupational injury among blue-collar workers. Nakata et al19 showed that female workers in small-to-medium sized manufacturing enterprises had a higher risk of occupational injury when they had less job control. Although low job control was associated with the number of occupational injuries among EMS personnel in our study, it was not associated with the occurrence of occupational injury in either sex.
High interpersonal conflicts were associated with the occurrence of occupational injury in fire suppression and EMS personnel. A study of Finish hospital personnel showed that problems in interpersonal relationships and conflicts during collaborations at work were related to occupational injury.33 Another study of Japanese small-to-medium sized manufacturing enterprises workers showed that female employees with high intragroup conflicts at the workplace had a higher risk of occupational injury.19 In both our previous and current studies, high interpersonal conflicts appear to be an important factor contributing to occupational injury, although the nature of the job was different.
In this study, high job insecurity was associated with a lower occurrence of occupational injury among fire suppression personnel. There were 47 deaths of firefighters actively on the job between 1998 and 2007, which constituted 22% of all causes of death among firefighters. Additionally, the average age of death of retired firefighters was 58.8 years during the same period.34 Therefore, our reported rate of occupational injury could be underestimated if certain firefighters were unable to respond to our questionnaires because of disabilities or other medical reasons. Since we had no information on non-respondents, we could not assess the presence of the bias. However, considering the dangers of fire suppression, it is possible that the occurrences of injuries were underestimated in our study. Probst and Brubaker35 reported that workers in insecure jobs underwent more occupational injuries than those in secure jobs. Nakata et al19 showed that high job insecurity was associated with an increased risk of occupational injury among male workers in small-to-medium sized manufacturing enterprises. To clarify the association between job insecurity and the occurrence of occupational injury among firefighters, further studies that consider biases inherent in their designs are necessary.
A poor organisational system was associated with the occurrence of occupational injury in fire suppression and EMS personnel. Recently, a 1-year follow-up prospective study in Spain was conducted to investigate any association between job stress related to organisational support and occupational injuries.21 Lack of organisational support was evaluated by questionnaires and then estimated by index, severity and frequency; all were positively correlated with the risk of occupational injury. In the same context, our current results show that lack of organisational support in firefighters was also related to occupational injury.
A study in Hong Kong revealed that injuries among construction workers were influenced by emotional stress, which included unfair rewarding policies.22 In our study, the lack of a reward was also associated with the occurrence of occupational injury among fire suppression and EMS personnel. Rewards were an important factor for predicting workers' safety and health with respect to the effort-reward model. In a cross-sectional survey of 11 636 Dutch workers, participants with high efforts and low rewards had a significantly higher risk of emotional exhaustion, psychosomatic symptoms, physical symptoms and job dissatisfaction (OR 3.23 to 15.43).36 Although jobs vary by nature, the lack of rewards ought to be considered a factor affecting occupational injury.
A national representative survey in France reported that various adverse workplace practices such as verbal abuse, physical violence, low predictability and bullying, as well as psychological demands and low decision latitude, were related to occupational injuries.23 Furthermore, an important study revealed that organisational injustices such as supervisors' abuse of power can affect both workers' rights as well as their health and safety.24 That study also revealed qualitative data regarding the association between the level of power abuse and risk of occupational injuries. Such aspects can equally apply to the firefighting profession in terms of workplace climate.
The association between job stress scales and the number of occupational injuries using the zero-inflated negative binomial model significantly differed by current job duties. For fire suppression, only high job demands were associated with an increased number of occupational injuries. Among EMS personnel, low job control, high interpersonal conflict, lack of reward and a negative workplace environment were related to the number of occupational injuries. However, there were no statistically significant results for officers. Since the association between job stress and the number of occupational injuries has rarely been researched, there are few published data to compare our results to. Nevertheless, considering the different results according to job duties, our statistical method may be useful to estimate the differences in associations between job stress and occupational injuries in various jobs.
Our study had some limitations. First, because the study was conducted using a self-reported survey, recall or reporting bias may have occurred. However, because severe cases of injuries are more easily remembered, the fact that our study design surveyed only injuries that required medical care may have minimised recall bias. Self-reported surveys also carry a bias resulting from the lack of incorporation of non-respondents' data. Moreover, since workers who are hospitalised, retired or deceased cannot respond to the survey, a bias towards healthier workers may have occurred. If we were able to incorporate the data of non-respondents somehow, it is possible that our final results would be different. Second, confounding variables such as working patterns, hours of duty, sleep patterns and types of injury were not included, although these may have an influence on the relationship between job stress and occupational injuries. Third, because the study design was cross-sectional, we could not establish a causal relationship and were only able to identify the association between job stress and occupational injuries. For example, the results of our study could be interpreted as the number of occupational injuries themselves having an impact on job stress. Thus, careful interpretation of our data is required. However, the advantage of this study is that it was based on a nationwide survey that included the entire firefighter force in Korea.
In summary, our study revealed increased occurrence and frequency rates of occupational injuries due to job stress among firefighters. Although there were differences in injury rates according to current job duties, we found that high job demands, high interpersonal conflicts, a poor organisational system, lack of rewards and a negative workplace environment were factors associated with the occurrence of occupational injuries. As for the frequency of occupational injuries, fire suppression personnel with high job demands experienced a greater number of occupational injuries. In EMS workers, low job control, high interpersonal conflicts, lack of rewards and a negative workplace environment were associated with an increased number of occupational injuries. This study exposes the job stress factors that should be ameliorated to prevent occupational injuries among firefighters. Our results can be used to better address job stress and hence to minimise occupational injuries among firefighters.
Contributors Y-KK designed the study, analysed and interpreted the data, and drafted and revised the manuscript. Y-SA interpreted the data and revised the manuscript. KK suggested the study design and revised the manuscript. J-HY suggested the study design, interpreted the data and reviewed the manuscript. JR analysed and interpreted the data, revised the manuscript.
Funding This research was supported by the Next Generation Fire Protection and Safety Core Technology Development Programme funded by the National Emergency Management Agency (NEMA-Chasedae-2014-44).
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Institutional Review Board (IRB) of Dongguk University Ilsan Hospital approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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Queuing to pass through the stringent security of Jerusalem's central bus station, it is important to keep your end destination in mind so as not to lose all hope and give up.
By British standards, people in Israel are rude.
The transition from the orderly queues and lack of eye contact usually found on public transport in the UK to the forthrightness of the Middle East is a difficult one, and one which takes some getting used to. Call it refreshing, call it repulsive – Israelis will push past unsuspecting and helpless tourist prey like myself, walk over young children and trample senior citizens if they think it will buy them an extra half a minute. The concept of personal space goes out the window. I quickly learnt that in this situation, the only answer is to give as good as you get and to have no mercy on anyone who stands in your path. Bags on belt, coins on side, body through scanner – the young man on the other side checks my backpack. His body language is apathetic and his eyes are full of ennui as he pretends to check its contents.
The next stage of the journey consists of dodging the throngs of passengers inside the station, darting in all different directions. Some stand idly admiring the piles of 'kippot' being sold on impromptu stalls, others sit and socialise in generic chain cafés drinking overpriced coffee. They are good places to rest and people-watch. Orthodox Jewish families pass by clad in black clothing. The fathers don black 'huckel' hats and the mothers, in long skirts and with covered hair, push prams crammed with multiple children.
Add to the recipe posses of young IDF recruits in transit to and from base, sporting khaki uniforms. Most of them are carrying bags larger than their torsos, their attention flitting between looking where they are going and texting on their smartphones, which seem as important to them as the huge machine guns casually flung over their shoulders. Sights such as these, combined with the forever-repeating and clashing playlists of chart hits which emanate from the different shops of the bus station give the place a uniquely bizarre atmosphere. After buying my ticket, I boarded Egged bus no. 960 to Haifa.
Before visiting the city itself, I had arranged to visit a nearby kibbutz. The first Israeli 'halutzim' – the pioneers – had envisioned the kibbutzim as utopian communities, founded on a combination of socialist and Zionist ideals and were traditionally based on agriculture. However, in recent decades emphasis has shifted from agriculture to areas such as industry and high-tech enterprise, with many being privatised.
This particular kibbutz, called 'Eshbal', is located just east of Haifa and overlooks the Israeli-Arab city of Sakhnin. It is unique on the kibbutz scene, part of it being a boarding school for Ethiopian youths who need a 'second chance' in Israeli society, which often ostracises them. I get off the bus at a designated junction where Alon Dror, Eshbal's director, is waiting for me in his car. As we snake through the hills, the landscape is stunning.
"Coexistence is possible"
Alon's office in Kibbutz Eshbal is small, strip-lit and there is a year planner shabbily blue-tacked to the wall, reminiscent of a school staff room. With time against us, we set straight to talking. "Our main mission here is to educate equality based on human rights", he says. "Our role is supposed to be philanthropic, while remaining a kind of 'exchange' – without any kind of condescension or arrogance in approaching Arabs. We hope this means that they will realise coexistence is possible and then mutual respect will be achieved".
He seems to have recited these words on more than one occasion. He goes on to tell of the multiple schemes and projects which Eshbal engages in, and it becomes clear that he isn't merely paying lip-service. There are Arabic lessons for adult Jews every week. They work with local Arab teachers and youth leaders to run exchanges for both Arab and Jewish youth – together. "We do this because there is no mixed [Arab-Jewish] education here in Israel. True, most people want it that way and are happy with the system as it is, but it also means the two groups never meet. These separate systems, combined with religious difference and the obvious discrimination which is present brings with it a lot of racism and fear". I ask him whether he thinks the exchange projects are successful in their aims. "They're not going to solve the conflict" he said, "but I can tell you that after these mixed projects, Arabs definitely see themselves more as part of a community. They arrive here and meet the Jewish youth. At first there is naturally a huge amount of mistrust … and often a language barrier as not all Arabs speak good Hebrew and very few Jews speak any Arabic at all. But after they begin totalk, they see that the 'others' are human just as they are and … it goes from there."
Alon's rhetoric is definitely inspiring. I wonder to myself why there aren't more places like this. He continues, "as for national identity, our goal is to teach Jews not to neglect their Jewish culture but to revive it, and exactly the same goes for the Arabs. The biggest reason for Arab extremism is the Israeli government – it suppresses Arab culture. So we want to nurture these two unique identities, as well as promote our one, common identity."
"Taught to fear each other"
I ask him what he believes are the main reasons for the huge mistrust between the two populations. "Unfortunately, all the parties in the Knesset currently, both the Jewish onesand the Arab ones, are nationalist" he said, somehow managing to frown with his whole face. "They go from extreme to extreme." He brings up the Israeli government's controversial proposals in 2009 to require all new citizens of Israel to pledge allegiance to a 'Jewish and democratic state'. "It was obviously a bad law, but was completely blown up by the media as it doesn't really affect anyone non-Jewish – it was a provocation. But what we saw were extreme responses from the Arab side, and further to this came extreme Jewish responses. It's a vicious circle.
The two 'nations' – the Arabs and the Jews – meet on the news and in the newspapers. They stand apart from one another at the gas station when hitchhiking… they are taught to fear each other. What we aim to do is 'vaccinate' society against the political game and focus on what Arabs and Jews have in common." Alon seemed to like this analogy. He spoke of 'vaccination' again on more than two occasions, after which we ran out of time.
On the bus to Haifa, I replayed our conversation in my head – in particular his words on society's 'fear'. It became clear in my mind that the media was not the only platform by which Israelis are taught to fear. I thought back to the hellish bus station – the adolescent gun-wielding school leavers in uniform are also part of this agenda. And it's not just in bus stations where you come across them. They march around in the Old City of Jerusalem, the sound of the hard soles of their boots hitting the cobbled paving attracts the attention of everyone they pass. They flock around shopping malls and guard train stations. Young Israelis buy IDF memorabilia and wear it as any Brit would wear Jack Wills. Even small children can be seen flying F16-shaped kites on the beach in Tel Aviv, a 'bubble' city where life usually carries on as normal during military conflicts. It's probably impossible to go a day without seeing anything army-related in this country. Little wonder then, that people are so scared.
I wondered how Haifa would fair compared to the things I'd read and heard about it. Most sources give the indication that it is a surprisingly tolerant city in a country where segregation and racism are sadly a daily norm. Lonely Planet describes its population as a 'famously tolerant, intercultural mix' and tells of its 'Christmukkah' festival – a combination of Christmas, Muslim Eid-ul-Fitr and Jewish Hanukkah. Haifa's University is the only in the country with an enforced 50/50 Arab-Jewish student ratio.
Indeed, returning back at the city's main bus station I was struck by the presence of the many Arab customers using bus companies which I assumed had almost exclusively Jewish patronage. I boarded a local bus to take us to where I was staying. Standing in the packed vehicle, we were surrounded by an array of languages. Hefty Jewish construction workers sat next to scantily-clad and heavily made-up Russian women. They chatted and laughed, the Arab women in hijabs next to them not battering an eyelid. It appears the travel books weren't lying – this really is normal for Haifa.
Beautiful Haifa
The next morning I went to investigate the city properly. Relatively similar to Tel Aviv in that it is relatively removed from the focus of political struggle, Haifa's proximity to the Galilee's high Arab population makes it an obvious place for local Israeli-Arab citizens to relocate to. It is easy to sense this, as here Arabic is heard in the street much more than in other Israeli cities. It isn't hard to picture veiled women in Jerusalem out shopping, timidly walking by IDF soldiers stationed on street corners, careful not to cause any trouble, quick to return home.
"The bilingual city"
In Haifa it is a different story: Arabs of all ages proudly and happily walk through the streets, not confined to 'their' neighbourhoods or constantly thinking where they 'should' be. Outside the city hall, there are only Arab teenagers to be seen, enjoying the last days of the summer holiday. At least from the outside, you get the sense that they also feel this is their city. One interesting thing about Haifa is that its residents are not really confined to different neighbourhoods according to their ethnic background.
Anton Shammas, the Israeli-Arab writer, dubbed Haifa 'the bilingual city'. Yet as time went on I couldn't help but feel it should be called the 'trilingual city', because of the high Russian representation in shop signs and adverts. This is apparently due to the large amount of Russian Christians who come to Israel, following (usually distantly) Jewish relatives in search of a better lifestyle. Their weak or altogether absent Jewish identity means they have little will to learn Hebrew and so signage in their mother tongue is catered to them.
Tired from the heat and humidity, I stop for a drink in an Arab-run café on the chic Allenby Avenue. Looking around, I see mainly Arab customers wearing expensive suits and designer labels. On the table next to me there is a group of blonde, very western-looking women, one of them has a tattoo or two – they are speaking Arabic. From here I went further up Mount Carmel to the renowned Bahá'í Gardens.
The stunning Bahá'í Gardens
The Bahá'í faith was founded by a man called 'Bahá'u'lláh' (lit. 'glory of God') in 19th-century Persia and emphasises the spiritual unity of all humankind. In this faith, religious history is seen to have unfolded through a series of divine messengers, each of whom established a religion that was suited to the needs of the time and the capacity of the people. These messengers have included Abraham, the Buddha, Jesus, Muhammad and most recently the 'Báb' and Bahá'u'lláh himself. The faith's presence in Haifa came as a result of multiple banishments of Bahá'u'lláh from Persia and Ottoman Baghdad, after which he came to the area surrounding Acre, where he stayed till his death in 1892. And so it was decided that the international headquarters of the Bahá'í faith would be established in nearby Haifa – certainly an apt decision for such a pluralistic religion.
Later, I visited the well-known Masada Street. Despite taking its name from a Jewish historical site near the Dead Sea, the street is in fact a haven of Arab and Russian cafés and shisha bars. Somewhat tucked away between tall apartment buildings and sheltered by leafy trees, the establishments lining its pavements easily go unnoticed in the daytime. After nightfall however, they change form completely and bathe themselves in countless fairy lights and play loud Arabic music, which makes the place feel more like Cairo or Beirut than a sleepy city in northern Israel. After a little deliberation I settled for a small shisha café.
"We are not allowed to have an identity"
Just inside the door is a picture showing two interlocking hands – one black, one white; the word 'Coexistence' written underneath in capital letters. The owner of the café sees me taking a photo of it, and we get talking. Hamdi is an Arab Christian whose family has always been in Haifa. I ask him if he feels happy to be Israeli.
"Well" he said, "the problem is we are not allowed to have an identity in this country. Sure, I am happy enough living in Haifa, running this café… just because at the end of the day we all just want to live our own lives in peace and make money, you know?" He seems keen to talk. "But neither I nor my family can, or are allowed to feel like we belong here. I would even serve in the army if it meant I could have this … but we would still be second class citizens here. Someday I want to take my children away and move to Canada" he said, his eyes widening with excitement. "At least there, they can be part of society." Despite Hamdi's dejection, I ended my trip to Haifa in a positive mood. As predicted, Haifa had shattered many of my own ideas about the conflict. Now I had to see how Hebron compared.
Cosmopolitan Masada Street at night
On the Hebron-Jerusalem bus I get talking to Abdallah, an Arab youth who feels the need to warn me about the situation there. "Hebron is not at all like Ramallah or Bethlehem. The situation there is different, there are many problems between Jews and Arabs. It is a very harsh conflict".
Upon arrival it is clear that Hebron, both the second-holiest city in Judaism and one of the 'four holy cities' of Islam, is in deep trouble. Before I have the chance to see anything there are clashes erupting around the centre of the town. The furry of activity makes it impossible to know what is going on and I am quickly pointed in the direction of the old city. Although quieter here, the conflict is no less seething.
"I have strong hatred for the Jews"
Towering above the narrow market streets is an ugly, fortress-like structure, enclosed in barbed-wire fencing. Peering down from a raised platform are two orthodox Jews and a heavily-armed IDF soldier. It seems that I am the only one looking up, the only one in the whole street who finds this sight unusual. Arab traders haul their carts full of produce and mothers pass by with their children completely unfazed, obviously aware of exactly what lurks in eyeshot above us. Going further into the souq, the traders I pass are friendly and interested in where I am from. Up for grabs on their stalls are antique coins dating from the British Mandate which are inscribed with 'Palestine Pound' in English, Arabic and Hebrew.
Suspended above the narrow lanes is a series of wire and fabric nets, the need for them quickly becoming apparent. Caught in the nets is a large amount of rubbish; empty packaging, plastic bottles and even rocks, hanging precariously and blocking much-needed sunlight from the tiny streets. Israeli settlers who live in the houses above the souq show their distaste towards Palestinian presence in Hebron by throwing these objects down in a violent and aggressive attempt to crush the Arab morale.
Flying high above, attached to the exterior walls of the houses, are countless Israeli flags. The message here is clear: the settlers not only do not wish for coexistence in any shape or form, rather they want Hebron's Arab population to leave altogether. This feels like real apartheid.
I talk to Ishaq, one of the shop owners, and ask him how the people of Hebron react to the aggression of the settlers. "There is no point in saying anything", he says. "After all, there is nothing to say! There is no point in doing anything to the Jews. After 15 years in prison I know that it is better to keep our heads down and walk against the walls." His head lowers and he appears deep in thought. "When I see checkpoints many things run through my mind. I am not happy that we have to live with this daily. It not fair because this is a holy place for Muslims. I have strong hatred for the Jews."
"Free Israel"
Many of the 30,000 Palestinian residents of the Israeli-controlled area (dubbed 'H2') have left due to extended curfews, movement-restricting checkpoints, the closure of Palestinian commercial activities near settler areas and relentless settler harassment. Evidence of the halting of Palestinian trade can be witnessed on Shuhada' (Martyrs) Street, a former principle thoroughfare and shopping area. It was closed to Palestinian traffic following Baruch Goldstein's 1994 massacre of 29 Palestinians who were praying in the Ibrahimi Mosque. Today it remains eerily similar to how it must have looked fifteen years ago.
The shutters on shopfronts are all firmly locked, but the signs above shopfronts all remain, albeit covered in a thick layer of dust. Traffic signs are still in place, but no cars have passed them in years. Israeli guard towers dominate the modest skyline, looking down onto the lifeless streets. There is a definite post-apocalyptic atmosphere which is almost frightening. A few graffiti tags are dotted around, one rallies the Jews to 'keep smiling' while another demands 'Free Israel'. Sounds can be heard coming from the Jewish settlement not far from here.
The scenes on this street evoke the sinister images of WWII and the ghettos of eastern Europe. This ghetto however, seems entirely self-imposed.


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Photo by Theo Tate
Photo by Theo Tate
Photo by Theo Tate
Photo by Theo Tate
EDWARDSVILLE – Even the cold and rainy conditions couldn't prevent the Edwardsville boys track team from celebrating another Southwestern Illinois Relays championship on Friday.
The Tigers won their second straight SWIL Relays title after edging the East St. Louis Flyers 97-95 in the boys division of the 11-team meet at Winston Brown Track and Field Complex at EHS. Last year, they won the Edwardsville meet by 41 points.
The defending Class 3A state champions won titles in three events. Max Hartmann earned the team's athlete of the meet honors after winning the 1,600-meter run with a 4:43.23. Cameron Kirkpatrick came out on top in the discus with a throw of 132 feet, 7 inches. The 3,200-meter relay team of Francesco Romano, Roland Prenzler, Zach Walters and Jack Pifer won with an 8:20.43.
The Tigers and Flyers were tied at 84-84 going into the final two events, the 4,000-meter distance medley relay and 1,600-meter relay. Edwardsville outscored East St. Louis 13-11 in those events.
The rest of the field on the boys division behind the Tigers and Flyers rounded out with Rockwood Summit, O'Fallon, Belleville West, Collinsville, Alton, Mascoutah, Belleville East, Granite City and Althoff.
In the girls division the Alton Redbirds finished third with 96 points, trailing only champion O'Fallon (108) and Belleville West (101).
The Alton girls placed first in four events. Jeanea Epps won the 100-meter dash in 12.68 seconds and helped the sprint medley team – which also included Rashia Johnson, Daysha Lacey and Kellie Mans – win with a 1:53.58. Laila McNeal won the high jump in 4-10 and the long jump in 17-6.75.
Also, Edwardsvile finished fourth on the girls side with 94 points. The Tigers placed first in four events, three of them were relays.Katelyn Singh won the 1,600 with a 5:31.22. She also anchored the distance medley relay team – which included Kaitlyn Loyet, Haley Allard and Melissa Spencer – to a first-place finish with a 13:40.44. The 3,200-meter relay team of Loyet, Spencer, Lorie Cashdollar and Abby Korak placed first with a 9:48.23 and the 1,600-meter relay team of Cashdollar, Elise Krone, Jaydi Swanson and Rachel Kubichek won with a 4:15.55.
The rest of the girls field was Belleville East, Rock Island, Collinsville and Granite City.
Alton was in a tie for sixth with Collinsville with 44 points in the boys division.
Ja'quez Roberson was the lone Alton athlete with a championship for the boys, placing first in the shot put in 46-11.
The Granite City Warriors placed eighth with 16 points in the girls division and 10th with 12.5 points in the boys division.
The Warriors' best finish came in the girls meet, where the sprint medley team of Ty'tiana Hall, Rickenzie Williams, LaTorria Deal and Brianna Snead finish second with a 1:56.39.
Chad Lakatos 3 23 18
Edwardsville boys track coach Chad Lakatos discusses his team winning the Southwestern Illinois Relays for the second year in a row on Friday.
Katelyn Singh 3 23 18
Edwardsville senior Katelyn Singh discusses on winning two events in the girls division of the Southwestern Illinois Relays on Friday.
Jeanea Epps 3 23 18
Alton junior Jeanea Epps discusses on winning a pair of events in the girls division of the Southwestern Illinois Relays on Friday at Edwardsville.
Tom Miller 3 23 18
Granite City boys and girls track coach Tom Miller discusses his teams' performances at the Southwestern Illinois Relays on Friday at Edwardsville.


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tv [untitled] September 8, 2010 12:30pm-1:00pm PST
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that went from the wall, the rod, and then the block of concrete. if the wall tried to move, it would engage the rod, which would engage the block of concrete. these were built as gravity walls. they're very, very wide at the base. gosh, some of them are six, eight, 10 feet wide, and they are like dams. they are faced with basalt blocks that came from the quarries in marin county. they have performed very well. the classic gravity wall. there is enough friction along the base, and there is a slope on the backside, so there is enough weight pushing down on the wall that keeps it from moving. >> this is on broadway, along
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rage and russian hill. >> that is a completely different design. this is truly what is called a cantilever retaining wall. it is designed to rotate and move. you can see the quality of construction. probably what they did in those days, they would take the rock that was present in the vicinity and mix it with the cement and create concrete. so there is no quality control. the strength of that wall various props -- varies from batch to batch, but it is safe. that is a gatt -- that is a gravity wall with a buttress in it. the diagonal strokes are buttressedes to keep the wall from moving. the wall is actually providing support to the house is above. you cannot tolerate any movement.
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so they put these angles of concrete called buttresses. >> what would be under that? >> that is the cathedral at the corner of california and taylor. the rock under here is franciscan. it is sandstone. it is probably the hardest rock in san francisco at this location. we have just recently completed an investigation for the expansion of cathedral school, and they chose to go down 20 feet below the surface of the street, and it was incredibly hard. it was harder than the concrete that was placed as a foundation. the rock beneath the concrete was 10 times stronger than the concrete that is used to support the building. >> okay, moving to another part
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of the city, this is the eastern side. >> this is on army street? >> yes, this is army st., se. look at all that stuff. it is an active city. >> a lot of the old industrial, the american can co., goodman lumber. all that good stuff. >> wow. >> and this building is one of the examples of remaining 1906 earthquake damage. it has been repaired above, and that is where they repaired the damage. what did they found these buildings on, back in the early days? >> those days, remember i mentioned early on, it would use of redwood grillage and they
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would extend the grillage up far enough so it would spread out the load. today, one would know when to evaluate a building like this, we say to ourselves, there is no way this building can be standing. the bearing pressures that are being posed on the soil far exceed the strength of the materials present, yet it works. it could be such a phenomenon as arching and other things to keep the building standing. typically, today, we would support this building on pilings. we would support this going down to more confident material. within this is phil, bay mud, shall mud, and then down sand. re tom hill, at one time second street ended at howard. at that point, there was a large hill. the wealthy people of san
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francisco lived on top of the hill, and churches were built along howard. then the city fathers in the 1920's let us knock down the hill, let us extend second street, and it finishes at the ballpark now. as you move south along second, that whole area, you get into rock. many of these old warehouse buildings, as you approach rincon hill, are sitting on rock. if you go down to king street, which is the street that fronts the ballpark, if you cross the street from the ballpark and the look on the sidewalk, there is actually a little brass plates that depict the location of the bluff that existed, the
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transition from the beach to the vertical cliffs that existed at second street. at second and king. all of that was taken down, and they have built warehouses. now at his condominium developments. and portions of mission bay. the first building of mission bay, third and townsend -- i am sorry, third and king, it is a rock site. if you go further into mission bay, it goes from rock to week bay mud. -- weak bay mud. this is on the folsom? >> the old wonder bread bakery. a little bit higher up.
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>> that particular building, if you look closely, the rock has actually receded back because of rockfalls. it was too expensive to put in foundations, so the foundation for that building is right on the surface. over the years, the rock face has receded to the point now where the flooding in the face of the bluff come together -- the footing and the face of the building and the bloc come together and are exposed. >> the confidence in the building is starting to be undermined. down at the bottom of the hill, out towards the bed, there are all kinds of uses there. what on earth would they be doing? >> what you are looking at here, two things occur along the south waterfront. one, sand that is dredged from
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the sacramento river is actually put on barges and brought down into the bag at pier 80 and 92, and then they stockpiled the sand and wash it and tip it over to the concrete producers, bodhi, central, and others, rose and jensen, hanson, and the sand is coming down the sacramento river to mix with the aggregate to make concrete. the other thing that happens down in this area of san francisco, we are becoming more and more green at society. we are taking the asphalt and recycling it, and then we take concrete and put it through -- they will put it through a grinder and grind it to
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different rock sizes and use that as the aggregate for asphalt or concrete. i am not sure if this is a sand pile for the concrete or if this is a recycle plant. but it is one of them. the city has opened up the large piers that unfortunately are not being used. we don't have the commerce we had in the old days. it has gone to oakland. we don't have the real site on the side of the bay. >> south of market has very unusual conditions, settlement. >> south of market, that particular fixture is at sixth street, which is right in the heart of this.
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some of the largest magnitudes of movement during the 1906 earthquake occurred in this area of what is called sullivans march, which it sullivans march, just south of market. not only did it solidify and saddle, but when the ground slopes, and actually flows and moves latterly. some areas of mission creek and sullivan's marsh, that was on the order of 15 feet. it was significant. everything you see south of market was built after the 1906 earthquake. the longer the time between the 1906 earthquake and the time of construction, the more likely people forgot about all the
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damage that occurred in 1906. so they were not as sensitive and perhaps cautious as they should be. many of these buildings that we see south of market, while they appear to be in excellent shape and are performing well, have not been either seismically strengthened or had at the subsurface conditions improved, so they are waiting. there could be significant damage during the next major earthquake. >> that reminds me of one of the central questions i wanted to ask you. which is this example relief focuses on the point. that is, what would you recommend for someone who is considering purchasing a building in the way of a consultation with geotechnical
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engineers such as yourself, just to get a little heads up on what they might be facing in the lifetime of their ownership of the building? >> i believe it is in a prospective buyer's best interest, if they're buying an existing building and commercial area, that they consult with a structural engineer to make sure the building is structurally adequate and that to consult with a geotechnical engineer. dewitt least point out to them whether the building their purchasing -- to at least point out to them whether the building their purchasing is in a potential hazard zone. it not only has liquefaction, but it also has a hillside stability issues. while it may be stable sporadically, when the
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earthquake comes, the slopes may fail. as a minimum, they should retain the services of a geotechnical and structural engineer, and there are well qualified people who come out. i am not just talking about and inspection service, i'm talking that licensed engineer, geotechnical, to look around, look at the maps available, and write an opinion letter as to the adequacy of the structure or the soil. there is another thing to consider when you are buying and building to the east of the van ness ave. a third map. this map depicts the area of the fire that followed the 1906 earthquake.
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the blue is where all the buildings were destroyed or badly damaged by the fire. as a result, the ashes from those fires remained on site. in those days, lead paint was used to paint the sides of buildings. it is a known carcinogen. it is a hazardous material. what they did was after the earthquake, they took these mounds of sand, the valencia st. hill, if you go up market street, you know how it starts to climb? imagine that was a much larger hill. they mined 26 million cubic yards of sand out of theire, and they mixed it with the debris from the fire and they used it to fill basements. so you have sand, ash, pieces of
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wood, brick. well, the ash is a hazardous material. you come along and used to buy a site at sixth and mission, with the understanding you will demolish the building and build a 50 story building. and you thought you were just going to dig out the sand, the film, and haul it to another site. now you come to find out the material you were going to move at $8 per ton is now going to cost anywhere from $40 to $78 per ton. the has a significant impact -- and has a significant impact on the cost of your project. if you are out on the sunset and vine a single-family home, just have the geotechnical engineer come out and say it is on earth quicksand, the building will
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probably settle three-quarters of an inch. have the structural engineer look at the frame and say, you have a serious soft story here. lawrence, expected that. you might want to put in some clips and fasteners and sheer walls to stiffen it out. as you move east, you have not only the soft issues, the structural issues, but you have the hazardous-waste. if you recall as a kid, every intersection had for gas stations? now you cannot find a gas station anywhere? those four gas stations had leaky tanks. now we also have to look at the presence of hydrocarbons in the soil. >> moving along, the perfect setup for the next question. >> when we went out on our long
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walk together, we talked about the relationship between the nature of a building, primarily its height, and the soil on which it sits. the slide is a good reminder of that. >> the ground has a natural period. the denser the material, the harder the material, the shorter the period of the ground. bay mud, which is present close to the shoreline, and the green area, the crown has a very long period. when the earthquake comes, there is a link of time that it takes the ground to go from one, slosh back and forth, measured in seconds. the deeper the bay mud deposits, the greater the length of time it takes for the motion to go one direction and back. so as you approach soft sites, loose sand sites, bay mud sites, the period of the site is long.
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if you come along and build a tall building, and the ground is going like this, we know that tall buildings, the taller the building, the longer the period, the longer the time it takes to go from one side and back. iand the rule of thumb, every story that you add, it adds a 10th of a second to the period. if you have a 40 story building, you have a building that takes four seconds to go from one side to the other and back. now, that for second building is sitting on 100 feet of bay mud that also has a period of four seconds. the combination of those and harmony, what happens is they amplify the motion and the
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building will collapse. example, the infamous bridge. in that case, the wind got in harmony with itself and it collapsed. what you try to do is you try to put a building on a site so that if the ground it is a long period, you want the building to be short. if the ground is short period, you want the building to be long. that is what happens when you get into the financial district. quite often, they will go down through the bay mud, put the structure on dense sand that has a very short period, and building is at 40 stories high with a very long period. even though the ground is doing this, the building is slowly moving. so there is damage, but there is less risk of damage. alternatively would have done is
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layers and we've springs and all kinds of different -- and leaf springs and all kinds of different tools that can take the structure and put them on face. -- on phase. so when you look at a building like this, 10 stories, the period of that is about one second, 1.5 seconds. that is probably sitting on that sand or rock and that is about a quarter cent. so it is ideal. the ground is going like this, the building does not feel it. you feel it, but the building, it is not doing damage to the structure. >> the building next to it, let's say it is wood frame. what are thoseeperiods? >> there are less than a second. the beauty of a wood frame building, it is probably the most forgiving construction. it squeaks, the plaster will crack, and if you don't have the soft story to deal with, you
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just have your cup of coffee and the one with your life. >> i guess this is turtle bill. >> grandview, turtle hill, san the mountain, -- sand mound, depending on how long you have been living there. >> this is northwest, of golden gate park. the nearest background, sunset and the richmond district? >> way out to the end, that is for smiley, the veterans hospital. this is for smiley. rock, rock, rock, rock, rock. here is hunters point. that rock is called serpent tonight. -- serpentinite. along this zone, there is another rock type, volcanic
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rock. it is serpentinite. it is a very treacherous rock. if you go up market, you will see it where the met -- barack is exposed in that cut. -- for rock that is exposed in that it is cut. it can be hard work and have the consistency of soap and just slides. why is it like that? it is an intrusion. it is like toothpaste that was extruded through a crack in the earth. that means it was a sheer zone or fault, hundreds of millions of years ago, where it actually came up through and bubbled out and formed this band of serpentinite. adjacent to that is this wonderful rock. what is the other thin that is bad about serpentineite?
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it contains naturally occurring asbestos, which is a carcinogen, known carcinogen. if you go to where st. mary's cathedral is, cathedral hill, that is one of the outcrops. there is a high percentage of serpentinite in the rock. in the old days, the 1930's, 1920's, san franciscans to not bother to deal with the disposal companies. they would take their garbage out the other side of twin peaks, bump their garbage, and shovel sand on top of it. so in the old days, you could go out there and build your home and be surprised that you would find sanitary landfill or construction debris landfills. they were prevalent out there. >> this is twin peaks? >> going up to twin peaks.
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>> one form does not change much. >> eucalyptus trees have got much taller. that is not halt leading up to predict that is the hill leading up to there. fifth avenue, that area of san francisco. ucsf. that is this area right here. >> it is an earthquake hazard micro zone. >> again, another example of the wpa. the streets, they wanted to get to the top of the hill, said the duties beautiful walls and stairways. they are doing well. >> all of these hillsides have catalyzed the design and construction of the interesting foundations and sub framing. >> up there, you'll find quite
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often, because it is rock, they have dug holes, filled it with concrete, put pulls up, and built their buildings. they have been there actually now 67 years. >> some of these are significant earthquake hazard? >> many of them, because they're not properly braced, because the foundations are not deep enough. the consequences could be significant during an earthquake. >> the tunnel opened that whole section up to development. did that lead to park side? >> west portal is right here. it this slope. westport open up this whole area down here, with the reservoir. the tunnel was built and two different ways. one of them was cut and cover, the other was a tunneling machine. as they came close to the side
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of the hill, they dug down vertically, took out the dirt. they took the dart -- they took the dirt and replaced it as phil -- fill all along the lower part of market street. they filled in the ravine. >> thank you all very much. that was a heck of a tort of san francisco. thank you for your attendance. we hope to see you every third thursday right here.
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Lilly looks to leave behind animal health business
Eli Lilly released its Q3 financials and the major talking point was the announcement that the business was reviewing "strategic alternatives" for its Elanco Animal Health unit.
The company said it would provide an update on its decision by mid-2018, and this could involve spinning out the business or looking at selling the division entirely.
The decision only comes a few years after Lilly had acted to bolster the unit, by purchasing Novartis' animal health unit back in 2015 and not long after it had closed a deal with Boehringer Ingelheim to take over its animal vaccines division.
However, with the business having grown to become one of the largest in the animal health business, the possibility of it becoming a standalone company could tempt Lilly. It generated global sales of $740.6 million in the quarter but its growth has been sluggish compared with the pharmaceutical side of the business.
It is also worth noting that Lilly has made concerted efforts to slim its operations globally of late; it revealed that it would cut 3,500 jobs just last month in order to save itself $500 million in annual costs.
David A. Ricks, Lilly's chairman and CEO, commented on the Elanco strategic review: "Today, we are also announcing a strategic review of our Elanco Animal Health business. Elanco has developed into a premier animal health company, and has been an important growth driver and source of revenue diversification for Lilly. Through acquisitions and organic growth, we've grown Elanco to a size and scale that now allows us to consider a variety of options to maximize future value."
The move is part of a larger industry-wide trend towards focusing on the pharmaceutical angle, by looking at shedding units that provide slower growth. With Novartis's departing Jimenez discussing options to sell on its Alcon unit in its own Q3 results and, prior to this, Pfizer's own mooted divestiture of its healthcare unit.
Other than the potential sale of animal health unit, Lilly announced that it had beaten analysts' expectations by revenue growing across its business by 9%. It noted particular successes in growing its diabetes business, with Trulicity's sales growing to $528 million and Humalog beating expectations to bring in $696 million.
Ben Hargreaves
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text: Looking for a little more physical energy and a little more self confidence or wanting to be physically healthier then this 3rd Chakra Solar Plexus Energy Healing CD is just what the Midwife orders. Again I will say this is an exceptional powerful, deeply relaxing Solar Plexus Chakra balancing, chakra meditation. It works on your aura strengthening its color and vibration. It works very well not because I have made it but because it is channeled by spirit through me to help you be more confident during this unbalanced uneasy time on the planet we are all experiencing. Investing in ourselves is critical to maintain balance as we walk forward It helps us as humans gather lost parts of ourselves to integrate wholeness. It's simple, just click on the add to cart button and get the head sets ready and reclaim and experience self power.


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Active ingredients of a person-centred intervention for people on HIV treatment: analysis of mixed methods trial data.
Lowther, K
Harding, R
Simms, V
Ahmed, A
Ali, Z
Gikaara, N
Sherr, L
Kariuki, H
Higginson, I
Selman, LE
MetadataShow full item record
BACKGROUND: A new model of care is required to meet the changing needs of people living with HIV (PLWH), particularly in low and middle-income countries, where prevalence is highest. We evaluated a palliative care intervention for PLWH in Mombasa, Kenya. Although we found no effect on pain (primary outcome), there was a positive effect on mental health (secondary outcome) in the intervention group. To inform replication and implementation, we have determined the active ingredients of the intervention and their mechanisms of action. METHODS: We conducted a randomised controlled trial (RCT) with qualitative exit interviews in HIV clinic attenders. The intervention was delivered over 5 months, with a minimum of 7 clinical contacts. Longitudinal quantitative data on components of care received were analysed using area under the curve and logistic regression. Qualitative data were analysed using inductive and deductive thematic analysis. RESULTS: Quantitative data analysis identified that intervention patients received more weak opioid, laxatives, discussion about spiritual worries, emotional support from staff for themselves and their families, time to talk about worries, discussion about future and planning ahead. Qualitative data analysis found that patients reported that having time to talk, appropriate pain medication and effective health education was of therapeutic value for their psychological well-being. Integration of mixed method findings suggest that positive effect in quantitative measures of mental health and well-being are attributable to the active ingredients of: appropriate medication, effective health education and counselling, and having time to talk in clinical encounters. Mechanisms of action include symptom relief, improved understanding of illness and treatment, and support focused on articulated concerns. CONCLUSIONS: Routine care must provide opportunities and means for existing clinical staff to make routine appointments more person-centred. This approach enabled staff to identify and manage multidimensional problems and provide tailored health education and counselling.
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Cassie Zuri
Marie likens her friend Cassie to a dark faerie. Once, while the friends were walking to work, the shadows moved and the setting sun so dazzled Marie's eyes that Cassie, walking in front of her, became a dark phoenix rising out of the sun rays. Shortly after that, Marie started calling her friend "Faer Cassie" for the stunning visual trickery she had experienced that had made her friend seem quite ethereal and capable of flight.
In addition, her friend has the short stature and slender body of a faerie without wings. Her friend moves with the kind of quick fluidity that Marie imagines faeries use too. At The Stiff Drink Cassie would handle trays of interestingly shaped glasses often without accident. The only times her physical grace was compromised was when she was really drained, either because she wasn't eating or sleeping enough. Cassie doesn't need much of either though, especially sleep. Marie often wonders if Cassie has a permanent energy providing alchemy circle somewhere on her person, but Marie has never seen it.
While Marie looks out for her friend with an open face, Cassie prefers to observe her friend and the world from behind a long, dark sheet of hair. Cassie does not wholly obstruct her dark, bullet-hole eyes, but she tends to use her hair like a curtain to sharpen her focus and lessen attention paid to her. Despite her tendency to veil herself behind her hair, Marie has never known a Cassie without deft although dark makeup.
Although Cassie applies lots of makeup, Marie does not think the makeup is to attract a mate, which is a quirk that baffles Marie since she adores doting on her boyfriend. Regardless of Marie's gentle suggestions, Cassie has never taken a date to a social function. However, Marie has recently noticed Cassie get dreamy eyed occasionally although Marie has never determined who has caught Cassie's attention.


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Freelance Service Designer / Facilitation Toolkit Designer
Gear Stream, Inc.
Headquarters: Raleigh, NC
View all Gear Stream, Inc. jobs
We are an Enterprise Digital Transformation firm that has developed novel Human Centered Design methods and intervention techniques that radically foster corporate transformation and reinvention. We have a number of proven frameworks that we use for helping facilitate companies for digital that focus on a variety or core themes including: agile structure, adaptive leadership, agile performance management, and product / customer experience innovation.
Our Need
We need to productize our intellectual property so that we can more rapidly on-board practitioners seeking to master and employ our methods and tools. These practitioners could be future employees of our firm, 3rd party partners, as well as transformational change agents that work inside large companies.
Our Context
The work of a Service Designer / Method Toolkit Designer will be to synthesize our current assets and help us to polish, integrate, and package these assets for use in a variety of contexts including: Marketing / Sales Engagement, Client Engagement / Facilitation, Practitioner On-boarding and Training.
The Work - Deliverable's (examples)
Deliverable's will cover a range of service design / method toolkit themes including:
- Overview of High Level Frameworks suitable for marketing and/or client communications
- Detailed Faciltiator Guidebooks and Templates
- Detailed Method Guidebook(s)
- Infographics
- Tool Kits for: CX Research, CX Design, and Product Design
- Tactical Thinking Tools including: Templates and Canvases
- Design Guidance for Software Tools that Support and Facilitate our Organizational Intervention / Transformation Work
Ideal Candidate
We seek a freelancer who can work with and for us from anywhere in the world, however impeccable written and oral English skills required.
Freelancer will be flexible to work part-time, with a schedule that can accommodate the need to scale up and down as our needs change over time.
MUST be passionate about digital transformation and organizational / behavioral change management.
Skills and Experience required will include:
- Service Design - NOT just UX Design
- HCD Design, particularly related to Organizational Process and Structures
- Digital Product Design involving complex, long-running Customer touchpoints
- CX Research
- UX Design
- Graphic Design
- Intimate Knowledge of Modern Agile Product Development Methods and Techniques
- Persuasion and Behavioral Design
Help us maintain the quality of jobs posted on We Work Remotely. Let us know if this job isn't really remote.
Please ensure you meet geographic and skills requirements before applying.


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Dear Samsung,
I just finished watching your latest commercial with superstar Gabriel Medina riding one of your new Galalxy walkie-talkie surfboards. Wow. So much innovation you packed into a mere three minutes. Forgive me for my scattered thoughts, my head is still spinning.
What your advertisement inflicted on me (besides a burning impatience for the day I can send pictures of my genitalia to my friends while they're in the middle of a cutback) was an empowering burst of inspiration to chase down a few ideas of my own that, until now, I've been too timid to pursue. So please, Samsung, submit any/all ideas to your obviously thriving ideas department so they can be brought to fruition ASAP.
– Wine bed: Just like a waterbed, but with wine. Get thirsty for some Pinot in the middle of the night? Problem solved.
– Chip gloves: Say goodbye to flaming hot cheeto stained fingers. Say hello to a better world.
– The questamation mark: Can I patent this


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Bajet $25-50 USD / jam
I have an export company. I need a business assistant to handle daily activities. To check you ability I will test you through skype. If your opinions and views are well then i will select you.
This job includes writing business plans
making business analysis
should have knowledge about export and importing goods
Thank you.
26 pekerja bebas membida secara purata $31/jam untuk pekerjaan ini
Hi, I could help you on this. please read email for clarifications.
Hi, I have thoroughly read your offer and I'm interested in this project as I have much previous experience in the similar jobs. All the best, Milan
Greetings, Sir i am interested in providing my professional service to [login to view URL] check my PM. Regards
Dear Employer, I have an experience of 13 years in the same area.
Dear Hiring Manager, I specialize in IT, Internet, and Computer Law; and also, Intellectual Property Law (Copyright, Patent and Trademarks). With over seven years of experience researching and constructing high qualit Lagi
Experienced business consultant ready to assist you making your business a successful one. See pm for more information.
Hello Sir, I am interested to work with you on this project.
Yes, I am interested to work with you for this kind of projects specially Business Analysis as well as Business risks and Financial Analysis. for sure you can discuss the details with me on Skype or through mail.
I am very well versed with the requirement. Im a financial advisor and also having clients having the field preferred by [login to view URL] in accounts MIS, financial planner and advisory services.
I M fully qualified to handle your work . i know all the accounting skills needed to handle your work i will give you the best
Hello Sir, I can dedicate one person who is having more than 8 years experience in Managerial level in Sri Lanka. If you like to have an interview with him, please let me know the time. Thanks..
Hi Please pm me the details will ensure quality of service and ontime.


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Today I wanted to write a post about two people who are my biggest inspirations (obviously apart from my family who inspire me everyday!) I think it's really important to have an inspiration and someone to admire and I wanted to share with you mine.
The first person is someone who I have admired for a long time, but particularly in the last few years when I found out more and more about them. That person is Walt Disney. A lot of people laugh when I say Walt Disney and say they love Disney. I don't doubt their love for Disney because I think you'd have to be crazy not to but when I say Disney I mean the man himself.
He came from such a humble background and created and built things and places which make millions of people happy. His animations and movies are so well known and Mickey Mouse is probably the most recognised cartoon in the world.
The reason why I admire him so much is his philosophy. He never lost sight of what he was trying to achieve: to make a place for the whole family to have fun together. He encourages people to believe in their dreams and have such high aspirations. For me, this is so important and inspires me so much.
Last year she started her YouTube channel called Klossy. It takes no time at all when watching one of these videos to see why she is one of my two biggest inspirations. She is so positive, happy and genuine. She seems like she is comfortable to go with the flow (something which I can only aspire to) and it's no wonder she is so popular! Karlie is such a hugely successful model but she still is so humble which is why I have so much admiration for her.
I wanted to write this post because I am so motivated for 2016 and excited about what is to come! Being inspired by people is what keeps me motivated and I'm sure you all have your own inspirations who you love to follow on social media or maybe it's one of your closest friends or family members. Either way I hope you have had a great start to the new year so far and wish you all the best!
This is one of my favourite Walt Disney quotes I wanted to leave you with:
'All of our dreams can come true, if we have the courage to pursue them'
Let me know who your biggest inspirations are in the comments below!


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The Men Who Would Be Kings use the same rule engine as in Lion Rampant and Dragon Rampant but with some twists to give a better Colonial wargaming flawour.
I have participated in the playtest and i like the rules even if Colonial wargaming is not my major era. I also manged to get two pictures in the book:)
Now I will start working on my new force, some Zanzibar slavers...
Info about the book.
The Men Who Would Be Kings
Author: Daniel Mersey
Illustrator: Peter Dennis
Short code: OWG 16
Publication Date: 22 Sep 2016
"The Men Who Would Be Kings is a set of rules designed for fighting historical or Hollywood colonial battles in the mid to late 19th Century, from the Indian Mutiny to the Boxer Rebellion. Large scale colonial clashes tended to be one-sided affairs, but there are countless reports of brief, frantic skirmishes in every colonial war, where either side could be victorious, and these are the battles that The Men Who Would Be Kings seeks to recreate. Although focusing on the British colonial wars against the Zulus, Maoris and others, these rules will also permit players to explore the empires of France, Germany, and other nations, as well as allowing for battles between rival native factions. Gameplay is very simple, and is driven by the quality of the officers leading your units, in the true spirit of Victorian derring-do and adventure, where larger than life characters such as the (real) Fred Burnaby and the (fictional) Harry Flashman led their troops to glory and medals or a horrible end at the point of a spear tip."
|A last look at my mock-up cover of the rules:)