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Pigs, Pain Management & Palliative Care
In this episode of 4x4 Health, we talk with Krista Dobbie M.D., a palliative medicine physician for the Taussig Cancer Institute- Palliative Medicine Program at the Cleveland Clinic. Dr. Dobbie is a longtime leader in the field of palliative care and, at the Cleveland Clinic, has been on the cutting edge of integrating palliative medicine into other medical specialties. Her humor, empathy, and desire to educate are all present in this exceptional episode. If you were as impressed with Dr. Dobbie as we were, we highly recommend you check out her award winning essay "Zumi the Palliative Pig". Check out some pictures of Zumi below!
Dr. Dave Levin: Welcome to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I'm your host Dr. Dave Levin. Today I'm talking with Krista Dobbie, a palliative medicine physician with the Taussig Cancer Institute, had a medicine program at the Cleveland Clinic. Dr. Dobbie has been a leader in palliative medicine for many years. In addition to providing exceptional care for patients and families facing serious or life-threating illness, she is a bridge builder and educator. Consider her work at Cleveland Clinic. She co-chaired the End-of-life committee leading culture change for better End-of-life care for patients and their families. She founded the first outpatient palliative heart failure clinic and participates in the integration of palliative medicine with other medical specialties. Her contributions to education were recognized by the palliative medicine fellows when they chose her as the 2016-2017 Teacher of the year. Prior to joining Cleveland Clinic, Dr. Dobbie was instrumental in establishing and overseeing an integrated system of clinical palliative medicine throughout Southeastern Virginia. In 2008, that program received a Citation of Merit, Circle of Life award from the American Hospital Association. When Dr. Dobbie isn't seeing patients, she can be found at home with her various pets including her pet pigs. She's also a writer. I highly recommend her essays, Patients, Providers and Pets, One Health for All and my favorite, Zoomy the Palliative Pig. We will be sure to provide links to those on our website. I'm proud to call Krista a friend and colleague. She is one of my healthcare heroes and by the end of this podcast, I fully expect she'll be one of yours as well. Krista, welcome to 4 x 4 health.
Dr. Krista Dobbie: Thank you.
Dr. Dave Levin: I'm gonna ask you a series of four questions today and you have up to about four minutes to answer each one. Let's start by having you tell us a bit more about yourself and your organization.
Krista: Well, I originally started out pursuing a career in Oncology and after one year of doing an Oncology Fellowship, I realized that I was probably better at helping patients have conversations about what their goals were and how they wanted their care to be directed and I actually pursued a career in palliative care. I started out as a Hospice Medical Director. Back then in those days it was volunteer work 17 years ago. So, I volunteered part-time as a Hospice Medical Director and participated in outpatient home visits and then have the opportunity to help, begin and start an inpatient palliative care unit back in 2005 and that was such a tremendous opportunity to be part of that moment that was changing healthcare and during those days I remember, half the time we had to explain what palliative care was and how it wasn't just hospice care but it's been so important in my life to continue that work.
Dr. Dave Levin: So, I wanna go deeper on this question and part of my motive and asking you to come on the show today was to help spread the word about what palliative care is and one of the things that you taught me very early on and our work together is that while it certainly has a major role to play in End-of-life care out of medicine offers much, much more that it's really for anyone who is facing a serious or life-threatening illness. Can you talk a little bit more about that, about those concepts and how you've seen it play out in real life with patients and families?
Krista: Sure. Palliative care is really an all-encompassing field, in that you wanna look at the patient as the total patient and you look at what that patient is going through and what does that mean, I mean, palliative care is care for seriously ill or patients dealing with life-threating illness but what is it on a day-to-day basis, it's talking to patients, talking to families, addressing their symptoms and attempting to improve their quality of life while they are living with that illness and that maybe pain management for some, that maybe spiritual support as they struggle with why they are dealing with the illness, that maybe support to the care giver, to the family who's frustrated or feeling burned out and that's why true palliative care requires a multidisciplinary team, it requires physicians, it requires nurses or extended care providers like, physician's assistants or nurse practitioners and also social work and we often times neglect to uplift and support our social workers in healthcare but they are the folks that can really meet with these families and offer counseling. So, palliative care is not just End-of-life care, it's important care and I teach my fellow that sometimes it's just walking through the door and saying, hey, how are you, I'm Dr. Dobbie, let me know how things are going and I tell them to get comfortable with the hi, how are you consult because when you sit down and when you really start to listen to what the patient is going through, you really start to find out what's important to that patient and oftentimes what we as physicians worry about may not be what the patient is worried about and especially today medicine has become so technical, so many different physician teams are required to deliver good care and sometimes you need just that one person that can sit down and say, how are things going.
Dr. Dave Levin: There's a lot in what you just said. I'd like to drill a little deeper on two ideas here. The first is this notion of in healthcare, we can't cure everybody but we can heal everybody and as you point to there are many things that go into healing people, that go beyond the purely technical pathophysiology of their disease are the treatment plans and a part of what I have found so inspiring about this and frankly also helpful to me in my own journey through life is this idea is there's always something that we can be doing to help and comfort and to heal those who are sick even if a cure, an outright cure is not possible but this is critically important and it often aligns better with what patients want than what we might be thinking about from a purely medical standpoint. The other thing that I learned from working with you and others in palliative medicine is that very often the first thing to do is to treat the symptoms just as you alluded to and that there's two benefits to that. There's the obvious benefit of it's part of the healing process, it makes people feel better and alleviate suffering but the other is that very often these patients are facing really critical difficult decisions about their care, about their lives, about their families and a part of the purpose in treating the symptoms is to get them into a state where they can more readily and easily deal with those. If you're suffering great pain or nausea or in great distress, you're not in any condition really to deal with these more challenging kinds of questions. So, I apologize, I know I got up there, just gave a speech about all this.
Krista: Ha, ha [Laughing], I love it.
Dr. Dave Levin: So, correct me where you need to but also if you could share some examples from your own work that kind of illustrate this, I think it would be helpful.
Krista: Well, I totally agree. I think you need to control pain, you need to control very distressing symptoms like, shortness of breath, nausea vomiting because you can't have meaningful conversations if the patient can't participate because of those distressing symptoms but I'll give you a recent example that I love. I had a lady who had advanced Metastatic Pancreatic Cancer and she had been ill for quite some time and I sat at her bedside, this was after her pain was controlled and we started to begin to discuss where she was with the dying process and we had started to talk about the fact that she knew that her disease was not being able to be cured and that she was tired and that she was at the end of her treatment options and I said, what is the most pressing thing right now, what are you fearful of most about dying? Are you worried you're gonna be in pain, are you worried about your daughters and her answer surprised me and it reminded me that it's always so important because each patient is different. She said, Dr. Dobbie, I'm worried about my two little dogs and where are they going to go when I die. I think a good example of palliative care as we talked about that, we worked out a plan so that her family was aware of that fear and her family joined together and we ended up placing the dogs and she went home and I know she was at such peace and her anxiety was gone and had I just given her Ativan, that wasn't gonna fix her anxiety but addressing what she was really fearful of and it's different for every patient. I had a recent patient with Pulmonary Fibrosis, very short of breath and he asked me, he said, I need to know how I'm gonna die because I am scared each day, my oxygen requirements are going up and we had a really good conversation about how we could alleviate his shortness of breath. Sometimes what patients think is distressful, it's different for each one of them and I think good palliative care gets to the root of that issue. Taking a time to listen and formulate a care plan that's individual. Often times I've had several young mothers that want to go home to be with their children but they don't want to die in the home that their kids are gonna grow up in. So, we address that and as they get more ill, we may move them to an inpatient hospice facility. So, those are some examples that I can think of that are different for each patient but meaningful to each patient.
Dr. Dave Levin: Alright, now I'll promise myself I was not gonna get tearful during this podcast. You are challenging me Krista. I want to go, before we leave this, part of what I've learned from studying this area from working with great physicians like, you. Again, is this issue of, it's not just for patients that are facing death. I wanna press you a little more on this. The story that I remember from my working with you was a gentleman who had suffered a pretty severe leg injury and it was not gonna kill him but it was dramatically altering his life and the future. Do you recall the patient I'm talking about and would you mind sharing a little bit of that story?
Krista: I believe so. I think this is a gentleman that, if I'm remembering correctly, it may have been someone who had sustained a traumatic injury from a fall that palliative medicine was consulted for to help with his pain management. His quality of life, he was unable to work and actually what he ended up having was a complex regional pain syndrome and had continued swelling even after the leg had healed and we were able to temporize his pain and actually refer him for a spinal cord stimulator for one of our anesthesia team and it changed his life because he was then able to be out of pain and go back to work and in fact, I just saw a gentleman last week in clinic who had survived a very large resection for a spinal cord tumor and fortunately he was not paralyzed but he had some residual nerve damage and was dealing with a lot of significant nerve pain and I think he just anticipated that this would be his new normal and his life and the neurosurgeon referred him to my outpatient palliative care practice and we were able to change his medicines around and they sent me the most wonderful message about how he was actually participating with the family again and living his life in his greatest success was he was able to sleep through the night without waking up in pain and I think those are the patient examples that get me up in the morning and keep me doing this job 17 years later.
Dr. Dave Levin: If I recall correctly, the first gentleman that we were talking about was also a surfer. Maybe I'm conflating.
Krista: Oh yes, yes.
Dr. Dave Levin: And, what I remember about when you shared this story was that he was in two kinds of pain. He was in the pain that you described from his injury but he was also in a kind of psychic pain grieving about surfing and also about how this was gonna affect his relationship with one of his children. Am I recalling this correctly?
Krista: Yes, I had forgotten. That was so long ago. I had forgotten, that was a severe Orthopedic injury and we spent a lot of time with him doing his post-op pain management, counseling him, getting him also some professional, I don't profess to be a professional counselor but getting him some professional counseling to accept that injury and to be able to recover from that, that was very significant orthopedic injury. That's a great example of palliative care and it can help so many people and so I tell my colleagues, if you even remotely thought of me, get me involved, it won't hurt, maybe more than likely we can help.
Dr. Dave Levin: Part of why I remember that story is because it made a profound impression on me. If I have not made this blatantly obvious to our listeners today, part of the message here is that palliative medicine applies to a wide range of conditions and I would echo your advice to your colleagues in speaking to just the community to say, if you are a loved one or facing a life-threatening over a very serious injury, you should consider getting palliative medicine involved. These stories illustrate to me the profound impact and I'll make one last observation about it. I don't wanna leave people with the impression that palliative medicine is lightweight if you will when it comes to medicine. In fact, as you described, you deal with some very difficult and complex clinical situations, like advanced pain management, complex injuries and the like but you also are looking at, as you said, the whole patient and their other needs and what are their goals. So again, I apologize I know I just gave a speech there, got up on the soapbox but as I am known to do but it should be obvious that this is a passion for something that's very important.
Krista: One thing I do wanna say, our organization has really transformed in support of palliative care and now any person that is placed on ECMO which is a machine that helps oxygenate the lungs when the lungs are failing, these are usually people that maybe listed for lung transplant. Any patient that is placed on ECMO, automatically gets a palliative care consult and that's really that hi, how are you consult for the family because oftentimes the patient is sedated but we know that we may have to make some difficult goals and care decisions down the road if the patient doesn't get a transplant or if they get sicker but it's so nice to know and tell families, this is automatic. I mean, everybody that gets put on this machine and we're here to help you and so I think we've come a long way in 20 years, that was never happened in the past but it's much more common now.
Dr. Dave Levin: It goes to another really important issue here and we don't want to spend too much time on this today but acceptance by other physicians, nurses and other members of the care team has been an important issue as well and it always fascinated me when I was in Cleveland Clinic to watch this interaction because on one hand you've got a group of clinicians that are dedicated to providing absolutely cutting-edge medical care and do it exceptionally well and there's at least the possibility of the temptation to view palliative care is kind of throwing in the towel. Well, we're done now, there's nothing else we can do, let's call a palliative medicine or to view it almost as a kind of professional thread in a way and part of the journey that I've seen you and others on in palliative medicine over the years is essentially to deliver the same message we've been talking about for the last 15 minutes or so but no, this is actually in support of your goals, this is helpful to you, it can enhance the work that the rest of the team is doing and I'd like to believe that we've made good progress on that cultural front. No doubt it's an ongoing effort though.
Krista: We've made incredible progress and one of my very favorite consults, I got called by a thoracic surgeon for a lady who had nausea and they had tried everything and Krista, can your team help us and I thought, this is great! Ha, ha [Laughing].
Dr. Dave Levin: Exactly.
Krista: I've arrived!
Dr. Dave Levin: If you've just joined us, you're listening to 4 x 4 Health and we're talking with Dr. Krista Dobbie, palliative medicine physician at the Cleveland Clinic. Krista, I know you've got your hands on a lot of different things, so this may be a tough question for you but what's the most important or interesting thing that you're working on right now?
Krista: I've made it my mission in 2019 to improve palliative medicine for our heart failure population. So, we had started an outpatient palliative medicine heart failure clinic here at the Cleveland Clinic. I think we're about at least ten years behind dealing with this population. Studies show that they suffer just as much if not more symptoms than Cancer Patients and I really want to focus on improving hospice care for this population and so we're coming together here at the Cleveland Clinic with multiple teams to say, how can we make the hospice care for our heart failure patients. The best we can, the smoothest transition from the inpatient setting to the outpatient setting and how can we think outside the box to deliver therapies to these patients that help them remain comfortable and spend the remaining days that they have at home enjoying their loved ones and family.
Dr. Dave Levin: So, there's literally a million different areas that you could focus on, I think palliative medicine. Why did you gravitate to this particular population in a setting?
Krista: I think because palliative medicine is well entrenched now in cancer care and it's not as entrenched in heart failure care and there's lots of reasons for that and it's no one's fault but this is a neglected patient population that I think heart disease is still the number one killer in our country and a lot of these patients, they need help, they need help with, when do they not wanna come back for more IV Lasix to the hospital, when would they wanna consider an advanced therapy like a left ventricular assist device or potentially a heart transplant or maybe they don't want those things. How do you help them be comfortable, we still need a lot of research in this area because a lot of the therapeutic interventions we borrow from the cancer population but yet we don't have good clinical based evidence that using some of these modalities is as beneficial in heart failure.
Dr. Dave Levin: Yeah, I would, as someone who's also been an administrator and responsible for cost of care, I would add, this is a patient population where not only is there a big opportunity to improve the quality of their care, there's a cost issue here as well whether it's the total cost of care or the data that suggests there's substantial number of unnecessary hospital admissions or readmissions, there's cost associated with that, there's actual penalties, let's save that from some tears and so I don't mean to play down the clinical or other importance of this but I think it's one of those happy coincidences where there's a real opportunity improved care, there's a group of clinicians that can come together as stakeholders and subject mater experts and there's a business case that aligns too, that makes this not just feasible but sustainable over time. Is that a fair summary as well?
Krista: Yeah, sure. I think the most important thing for me is you really want to stay home but you want your IV Lasix to try to help get the fluid off, we can do that at home and you can be comfortable, why not and it decreases your chance of hospital acquired infections and it also allows you to be comfortable, so that patients do have quality of life rather than feeling, we would overload it in short a breath.
Dr. Dave Levin: For the next question, I always remind my guests that this show is PG-13. So, with that in mind, we're family-friendly here but what's your favorite pet-peeve or rant these days?
Krista: Well, and this happens less and less but I still go a little crazy every time I get the 4:30 consult on Friday for the patient that's had a 40+ day hospital admission and now all of a sudden, the ICU team wants you to come do goals of care and so I always have to check myself a little bit, like gosh, there's been so many missed opportunities to discuss goals of care. Did the patient want to be intubated, did the patient want the trach and the feeding tube, does the patient want to be committed to be living in a long-term healthcare facility now and yet maybe all of those things have already occurred but you're getting called in to have that conversation. So, while we've made many advances, unfortunately some of those patients still slipped through the cracks and I get quite passionate about those missed opportunities. So, I have to always remind myself before I call my consultant back not to give them an earful on Friday afternoon and why are you calling me now but sometimes it flips out.
Dr. Dave Levin: Right. Well, it's certainly a reasonable pet peeve to have. What hopeful signs do you see to address this and improve over time?
Krista: Well, I think we have started more projects with our ICU team to prevent that from happening. So, I do see that happening less and less frequently, also any family members that are listening today, when you're being faced with difficult decisions for our loved ones, you too, you could always request that the palliative care team meet with you and we certainly had families request that when maybe physicians forgot that they could call our services or didn't think to place that consult. So, I would encourage family members, you know, you have a voice in this too and you have a right to request that the palliative care team be a part of your care team.
Dr. Dave Levin: Well, I think that's an extremely important point that patients and their families have every right to expect this kind of care and they should inform themselves and they should advocate for themselves and if you get pushback on that then you should push back as well.
Krista: Yeah.
Dr. Dave Levin: So, the other thing that I've seen as things like, multidisciplinary rounds in the ICU setting, things like that, that can help kind of broaden the perspective for the care team and sometimes identify opportunities for palliative medicine to get involved sooner. It's my podcast, so I get to do what I want and even though I'm only supposed to ask you four questions, I'm asking you five today. So, my extra question today is, what's up with the pigs?
Krista: Ha, ha [Laughing]. I'm so glad you asked. So, I have three pet pigs. I only ever set out to have one. I always say my heart is bigger than my head because I took in two rescues and I got my pet pig six years ago. I think because I was feeling a little burnt out and I needed something that was bringing joy in my life, something that was different. I've always had dogs or cats. So, I got Zoomy and what I started to do is make videos of the pigs and I started to share those with my patients. It happened quite by accident. One day I had one of my most favorite patients get a terrible diagnosis and when she wasn't doing well and I turned to her and I said, I'm not going to let you leave here sad, let me show you my pet pig and we both kind of laughed through our tears and it was such a powerful moment and I realized that this was an incredible tool. It was a virtual pet therapy, I like to call it. I started to send it to patients when they were nervous about chemo, here have this will help you smile and get through your day, you got this. I would use it for fellow colleagues. We'd come out of a family meeting and I'd text, that was really rough, I'm glad we're in this together, here's a video of my pig to cheer you up and it taught me that if you share something personal of yourself with your patients, with your colleagues, you know, you no longer this white coat and we ask people when they're their most vulnerable to have very personal discussions with us and I'm not saying a pig helps that go easier but I think when people feel a connection to you, like you're a true human being and not just these white coat, those discussions happen more organically and there is more of a trust in having those discussions. So, I always say, my pigs have made me a better physician, haha [Laughing].
Dr. Dave Levin: It's probably true and what you are describing is something very dear to my heart which is this idea of being an authentic leader and an important part of being an authentic leader is to show your personal side to be willing to be vulnerable in front of others because the truth is we're all vulnerable, we just tied it to different degrees and the other thing I think that's, I love this idea of virtual pet therapy and again, this is something I've learned from working with folks like you and your colleagues is there's all kinds of other therapies out there. Again, they may not cure the underlying disease but they heal, they provide comfort and so aromatherapy and massage therapy and pet therapy and all these other things, these are real and have real value and it feels like sometimes we've lost some of that in our very westernized scientific approach to medicine and we need to bring some of that back into, to humanize this and what is a very humanistic activity. I love the pigs and the other thing you said today that strikes very deeply with me is this is for you and it's for your colleagues and to our listeners, I highly recommend that you follow Dr. Dobie on Twitter on a regular basis. She posts something that just makes my day, that just makes me smile and very often, it involves one of the pigs as well, [Laugh]. So, I just love this part of your story for so many different reasons and thank you for sharing all of that. For our last question today, you've offered an awful lot of sage advice but I'm gonna ask you to wrap today by offering your most sage advice.
Krista: I think my most sage advice is in healthcare be you. I think there was a time that we talked about professionalism and maintaining boundaries and while I think all of that is important to prevent burnout and moral distress at times, I think remembering to be you, to share something personal with your patients, that makes that connection, it builds those meaningful relationships and I think when you have meaningful patient interactions on a day-to-day basis, that builds resilience and it actually fights against burnout because you feel like, you've made a difference in someone's life and so I think that happens by sharing something of yourself.
Dr. Dave Levin: Well, that's sage advice not just for practicing medicine, that's sage advice for leading your life. To me is resonates very deeply for myself and for others when I sort of find myself blue and down and cynical, very often the curious to connect with others to help to give and you feel better and it helps you appreciate what you have. So, that's truly sage advice indeed. We've been talking with Dr. Krista Dobbie, palliative medicine physician and obviously one of my personal heroes from the Cleveland Clinic. Krista, thanks for joining us today.
Krista: Thank you so much for having me.
Dr. Dave Levin: You've been listening to 4 x 4 Health, sponsored by Sansoro Health. Sansoro health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I hope you'll join us next time for another 4 x 4 discussion with healthcare innovators. Until then, I'm your host Dr. Dave Levin, thanks for listening.


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Agency profile
Name: WaterAid
Address: WaterAid, 47-49 Durham Street, London, SE11 5JD, UK
Email: email@example.com
Website: www.wateraid.org/uk
Year founded: 1981
Chief executive: Barbara Frost
No. HQ staff: 289
No. staff worldwide: 1151
ENN interviewed Dan Jones and Megan Wilson-Jones from WaterAid for the Field Exchange agency profile slot. Megan is the Policy Analyst for health and hygiene in the global policy team, while Dan (no relation) is Advocacy Coordinator for Healthy Start, WaterAid's current global advocacy priority to improve child health and nutrition by integrating water, sanitation and hygiene into health policies and programmes worldwide. Both used to work for RESULTS UK (which advocates for building the public and political will to end poverty) and, since they are relatively new to the organisation, checked in with some longer-serving colleagues to answer some of our questions. The answers were very interesting.
WaterAid was set up in 1981 by the UK water industry following a Thirsty Third World conference, which was prompted by the industry's desire to respond to the UN Decade on Water. The UK water industry raised £25,000 and WaterAid was born, starting with projects in Zambia and Sri Lanka. Fast forward to 2016 and WaterAid has just celebrated its 35th anniversary. Its growth has been truly phenomenal: in the six years from 2009 to 2015, it provided 9.6 million people with clean water and a further 13 million with sanitation facilities. It also expanded its country programmes in that time from 22 to 37, including countries in Asia, Africa and the Americas. This year, WaterAid India became the first country programme to become a member of the WaterAid International Federation. The secretariat for the Federation is based in the UK and all members (Australia, Canada, India, Japan, Sweden, United Kingdom and United States of America) are involved in advocacy and fund-raising in respective countries.
Dan explained that WaterAid's general operational model is to work with local partners to target the most marginalised communities. It is best known for its 'taps and toilets' programmes; a reflection of its founding by a group of water engineers. Over the years, the organisation has evolved into using a 'transformation and sustainability advocacy-based model', working closely with national governments, who are encouraged to take ownership of scaling up and delivering sustainable water, sanitation and hygiene (WASH) services for the whole population. This new strategy is much more about advocacy and exercising influence; WaterAid still supports on-the-ground programmes, but increasingly uses them to demonstrate what can be done to local, district and national decision-makers in order to provide evidence and support the government in scaling up and 'owning' the provision of national services. WaterAid also invests in work to enable citizens to claim their rights. As it looks to influence governments on how much and how they spend on WASH, it supports them in budget planning and tracking. It also looks at international institutions and donor agencies and how WASH needs to be integrated into health, nutrition and education, because WASH underpins many of the Sustainable Development Goals – as Megan puts it simply: "They all need WASH for success". The ultimate aim is national-led plans that donors coordinate and harmonise funding streams behind; an ambition that explains WaterAid's engagement with mechanisms such as the Sanitation and Water for All global partnership (SWA)1; similar to the SUN Movement in the WASH world.
Megan explained that nutrition is a relatively new area of interest for WaterAid, as part of its expanding work on health. The growing evidence of links between WASH and nutrition, as well as critical work on environmental enteric dysfunction (EED), has helped promote greater focus on nutrition within the organisation. The World Health Organisation (WHO) estimates that half of all undernutrition is linked to infections caused by unsafe water, lack of sanitation and poor hygiene. Most member countries now have health advisors that cover nutrition, and country programmes are increasingly employing health and nutrition staff. Megan mentioned two recent WaterAid nutrition-sensitive WASH programmes. One is in Bangladesh, where the WASH programme has an element specifically to improve access to water for food production. The second, in Nepal, is collaboration with the Ministry of Health and builds hygiene and nutrition behaviour-change into the routine immunisation of rotavirus. WaterAid has just developed internal guidance material on how to improve the nutrition-sensitivity of WASH programmes.
Dan explained that the organisation still sees itself very much as a development agency with a focus on long-term sustainable programming, although emergencies do occur where they operate in fragile contexts. For example, in Nepal recently, WaterAid found itself working as part of the WASH cluster, contributing hygiene expertise to programming. The organisation has also been involved in the Ebola crisis in West Africa, as well as engaging in policy dialogues on anti-microbial resistance. Megan described how these experiences reinforced the vital importance and major gaps in provision of clean water, sanitation and good hygiene in hospitals and health clinics. (WHO estimates that, for example, 38% of healthcare facilities in low and middle-income countries lack access to clean water, making preventing and controlling infections impossible).
WaterAid is increasingly collaborating with the SUN Movement at global and national levels. The SUN Movement Secretariat has contributed greatly to WASH policy development at national level, with country staff becoming members of the national Civil Society Alliance. WaterAid has also recently become part of the new BabyWASH coalition, working closely with World Vision (lead) and others. This coalition is bringing together actors from Early Childhood Development, Nutrition, Health and WASH, and was launched at this year's UN General Assembly.
WaterAid believes that multi-sector programming is essential to ending malnutrition. However, its recent Missing Ingredients report (summarised in this edition of Field Exchange), which analysed national nutrition action plans, found that apart from Timor Leste and Nepal, very few countries are comprehensively embedding and integrating WASH into these plans. Furthermore, very few WASH plans make reference to nutrition. Megan reflected that designing WASH programmes through a nutrition or health lens can lead to better quality programmes; for example by targeting programmes based on nutrition vulnerability. With regard to behaviour change, there is a real opportunity to come together and combine efforts – taking breastfeeding and food hygiene as examples, both involve changing behaviours, which is challenging. However, through utilising multiple delivery channels and delivering joint messaging, especially if one reinforces the other, this could lead to more effective and sustained behaviour change.
WaterAid is not a research-organisation and does not engage in randomised controlled trials, however it is well placed to contribute to the learning and evidence around delivering coordinated and integrated programmes, often described as operational research. Although the nutrition focus of its work has so far been on stunting (where there is the strongest evidence of a link between WASH and nutrition), it is likely that, given the increasing evidence of overlapping pathways for wasting and stunting, the attention of WASH actors like WaterAid may start to include a focus on wasting.
Our last question concerned the major challenges for scaling up nutrition-sensitive WASH programming. Dan reflected that, in order for WASH services to lead to nutrition outcomes, the services must be utilised, and changing behaviours is very challenging. It requires understanding the specific context (knowing what motivates behaviours and what the barriers are), which is informed through rigorous, formative research. The typical time-frame of WASH programmes can also be problematic, as they are often too short to report nutrition impact unless followed for a number of years. Finally, stakeholders need to stop thinking in silos. Dan suggested that this occurs on multiple levels – programme silos, sector silos, divided ministerial responsibility in governments, and even silos within donors (humanitarian and development). This, he argues, needs to change.
WaterAid is a large and highly respected WASH agency that is starting to look at how policy and programming can best support nutrition. ENN greatly looks forward to including WaterAid learning in this relatively new area in future issues of Field Exchange.
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By Monsurul Hoq and John Brogan Monsurul Hoq was working as a Statistician Epidemiologist during the study. He has experience in monitoring and evaluation of community-based...
FEX: The Ethiopian Orthodox Church Development and Inter-Church Aid Commission
By Gebreselassie Atsbahha Gebreselassie Atsbahha is Emergency Relief Officer with the EOCDICAC. He has over 20 years of experience in humanitarian, social protection and...
FEX: WASHplus in Mali: integrating WASH and nutrition for healthy communities
By Renuka Bery, Sahada Traore and Lonna Shafritz Lisez cet article en français ici Renuka Bery is the Integration Manager of the WASHplus project managed by FHI 360....
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Essential Job Duties/Scope of Work: International Medical Corps is leading a consortium with Action Against Hunger (ACF) and Save the Children UK (SC UK) to provide technical...
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15-812: Technical Surge Advisor- SBC Country: Global Department: Nutrition and Food Security Essential Job Duties/Scope of Work: International Medical Corps is...
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Summary of research1 Background ENN produced a report, through the MQSUN+ programme, that synthesises existing evidence and stakeholder opinion on what works to prevent...
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15-812: Technical Surge Advisor- SBC BACKGROUND International Medical Corps, a global humanitarian nonprofit organization dedicated to saving lives and relieving suffering...
FEX: The cost of a knowledge silo: A systematic re-review of water, sanitation and hygiene interventions
Summary of research1 By Michael Loevinsohn Michael Loevinsohn is a research fellow at the Institute of Development Studies, UK. An ecologist and epidemiologist, he has worked...
Combining WASH and nutrition activities within a multisectoral package to improve young children's diets and reduce child stunting in Sindh province, Pakistan
View this article as a pdf Dr Sahib Jan Badar is the Programme Coordinator of the Accelerated Action Plan, Department of Health, Government of Sindh province. Eric Alain...
FEX: Reflections on 30 years of nutrition-sensitive agriculture
By Heather Danton Heather Danton is the food security and nutrition director with JSI Research and Training Institute Inc. for USAID's global nutrition project, SPRING. She...
FEX: Nutrition funding: The missing piece of the puzzle
News Summary of report* A recent report by Generation Nutrition, a coalition of 85 civil society organisations, describes both why funding matters to nutrition and the...
FEX: Complementary food hygiene: An overlooked opportunity in the WASH, nutrition and health sectors
Summary of research1 Location: Global What we know: Poor food hygiene may account for a substantial proportion of diarrhoeal diseases and contribute to malnutrition among...
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FEX: Impact evaluation of WASH in nutrition intervention on morbidity and acute malnutrition in Niger
View this article as a pdf Lisez cet article en français ici By SaïdouTamboura, Dr Moussa IssaLende and Lucia Pantella Tamboura Saïdou has worked in...
Reference this page
ENN (2016). WaterAid. Field Exchange 53, November 2016. p72. www.ennonline.net/fex/53/wateraid

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Tag Archive for: Volunteering
Nurturing God's Creation/0 Comments/in Biblical, Breaking the Cycle of Poverty, Street Outreach /by admin
Each spring, my wife and I find joy in feeding the birds that frequent our large rural Ottawa backyard. Together we peer out at our many-winged visitors through the kitchen window or separately through the patio doors. Species include beloved cardinals, chickadees, doves and nuthatches. Uninvited, yet equally welcome, guests are feisty red squirrels and their companion, more docile black squirrels.
Our love of nurturing nature in this simple way brings great joy.
While most of us understand the need to nurture God's creation, helping people living on the margins may not always come so naturally. Judgement, criticism and stereotypes sometimes precludes caring for people in need.
Street outreach organizations like Ottawa Innercity Ministries, however, look beyond 'first impressions,' scratching below the surface to the person underneath. They do so by sustaining life on the streets of our fair city and bring great joy to those in need.
Each day of the week, volunteers generously donate a couple of hours of their time to provide food, clothing and words of affirmation to our street friends. The outpouring of Jesus' love and warmth during this brief interaction offers hope, which can enable the escape from the prison that is street life.
OIM conducts drop-ins, a youth art program and advocacy to those who grasp at this hope and seek a better life.
We know that these interventions bring with them joy through faith in a better future.
Isaiah 43 v 1: "Do not be afraid, for I have ransomed you. I have called you by name, you are mine."
-Peter, Street Outreach Volunteer
Ottawa Emergency Services – Thank You!/0 Comments/in About OIM, Street Outreach /by admin
You never know what to expect on street outreach. Some days are uneventful; others are not.
One chilly Sunday afternoon early in April our team crossed Dalhousie Street at Rideau. There in front of a popular cafe, amidst the hustle and bustle of shoppers, lay a big man.
No one else seemed to notice him.
It was disturbing to see someone seemingly asleep like this, especially for our two new team members. We knew he was in very bad shape. Under-dressed, unconscious and helpless on the cold floor of our concrete jungle, we weren't sure of the cause.
However, our team leader took charge and tried to wake him, as OIM has trained us to do. With few signs of life, his first thought was that the man had over-dosed and was dying. To administer Naloxone or not?
Weighing the odds, our quick thinker dialed 911 for medical assistance. Coincidentally a police cruiser stopped at the intersection and was approached by another member of our team.
The police promptly took over, checked the prostrate young man for vital signs and called for an ambulance.
Once the man was in the ambulance, when asked, one of the paramedics said Naloxone was not warranted in this situation as an (opioid) overdose did not seem to be the issue. We were thankful for their timely response and expert care.
Just as the ambulance arrived, a fire truck pulled up to offer assistance and another could be heard approaching rapidly.
All of this happened within ten minutes. Needless to say, we were impressed with our Ottawa emergency services and thankful that our friend had been well taken care of so quickly.
-Peter, Street Outreach Volunteer
This story is part of A Special Series this month in honour of OIM's 30th Anniversary. We hope to raise awareness, challenge misconceptions, and honestly reflect the lives of those who call the streets their home. As you reflect on these stories, please take a moment to PRAY EACH DAY – just 30 seconds – for our ministry's needs including a permanent location for our OIM Office as of Aug 1 .
Thanks and God Bless.
What does volunteering at OIM look like?/0 Comments/in About OIM, Dignity, Homelessness, Respect /by admin
When people ask about what volunteering among the poor looks like, I tell them about Beth:
Beth comes every Wednesday all the way from the outskirts of Ottawa to the downtown core, where she has been volunteering at the Office "Stop In" for 7 years. Our guests from the streets can always expect her to be here each week where she greets them with a ready smile, a cup of coffee, and a chat. It's encouraging to meet people who find the time to share a part of their busy lives with our guests with the only objective being to give love and support to the most needed here in downtown Ottawa.
It's not what she does that matters, it's that she shows up and let's them know someone cares.
– Gaby, Staff
30 Days of Prayer, 30 Seconds a Day, Celebrating 30 Years of Service
This story is part of A Special Series this month in honour of OIM's 30th Anniversary. We hope to raise awareness, challenge misconceptions, and honestly reflect the lives of those who call the streets their home. As you reflect on these stories, please take a moment to PRAY EACH DAY – just 30 seconds, in fact – for our ministry's needs.
Thank you and God bless.
A Passion To Serve/0 Comments/in Volunteer Homelessness, Volunteer Ottawa, Volunteering /by admin
Why do you volunteer at OIM?
It's a question that I have been asking our volunteers lately. The answers that have come back have had one thing in common: a big passion for serving.
Working with OIM volunteers has been a privilege for me. It's encouraging to meet people that find the time to share a part of their busy lives with our guests with the only objective being to give love and support to the most needed here in downtown Ottawa.
Let me tell you about a few of our wonderful volunteers:
Beth comes every Wednesday all the way from the outskirts of Ottawa to the downtown core, where she has been volunteering at the Office "Stop In" for 7 years. Our guests can always expect her to be here each week where she greets people with a ready smile, a cup of coffee, and a chat.
Sacha is a busy university student, but she comes every Thursday to the Office "Stop In." She's always ready to play a game of "spit" with Harold or learn from the guys how to play bridge.
Kirk and Hamish go on Street Outreach every Wednesday morning. Kirk comes early to get coffee going and when Hamish comes with special sandwiches that he made especially for the regulars they see that morning, they hit the roads ready to serve!
Our volunteers are loving, passionate servers with big compassionate hearts. It's amazing to see a community that really cares about one another.
In spite of all the difficulties that individuals struggle with all around us, I am so encouraged by the people I know who are out there really trying to make a difference.
Gaby, OIM Staff
Making a Difference In The Midst of Adversity – Is It Possible?/0 Comments/in Biblical, Homelessness, Personal Experiences, Poverty, Reflection, Stories from the Street, Street Outreach, Volunteer Homelessness, Volunteering /by admin
Every time I do street outreach in downtown Ottawa, I can't help but notice the constants. Like the difference between those who are blessed with "enough" and those who aren't.
I see it each Sunday night in the stylish clothes some people wear or the cars others don't have. It's visible in their health or sickness. It's in their expectant or distant gaze.
Affluence in Ottawa abounds. We work hard and from a "world" perspective, deserve this. It is apparent in the streetscapes of the neighbourhoods we visit in the downtown core. Walking purposefully north from the office on Bank Street to Sparks Street, over to the Market and then back along Elgin we see the imposing, manmade landmarks; great buildings old and new. Our parks are pleasant places to rest and take in the abundant fresh air. In the evenings at least, the streets are quiet and clean. Ottawa is a world class city. It abounds with hope and a prosperity.
But from a spiritual perspective, things are not always so positive.
There is much strife on our streets and we see it every week. It, too, is world class…
In spite of this, I love going downtown in the fall. We start before the sun sets and end after dark. The vibe doesn't change; just the ratio of 'haves' and 'have nots' alter as the night marches on.
The trendy restaurants are full during the dinner hour but afterwards, while the bright lights still shine throughout the downtown core, people begin to flee open air events like the light shows and canal cruises. Stores close and tired workers escape to the relief of their homes.
But the homeless have no home other than the streets we find them in. Our street community is diverse and reflect a variety of circumstances. There are two happy and informed 62 year olds who I have come to know separately, who never complain and are joyful in our conversations. We frequently meet youth on Rideau Street who are similarly outgoing, but often in various states of sobriety. Then there are the despondent who can't seem to grasp the severity of their situation nor seek adjustment to it. The more difficult ones are those who suffer from the unkind effects of psychological disorders. They share a common home and often a similar future.
Last Sunday night my young colleague and I sat down beside a woman seated on a curb in an Elgin Street parking lot. She was obviously in a saddened state, bent over crying. She had two plastic bags on the ground beside her, stuffed with clothes that she may have had to rescue in an attempt to escape an unfortunate social situation.
We spoke to her compassionately, telling her we were "outreach", asking how we could help but to no avail. She wouldn't lift her head from within her cupped hands nor acknowledge our extended hearts. All we could do was leave her a sandwich and a bottle of water with the good news that "Jesus loves you".
My accomplice and I are both blessed with happy, healthy homes to go back to at the end of our short shift on the streets. But as we hang up our red vests we are easily reminded that our friends are not as fortunate.
However, we believe that, through our small effort, we leave them in the love of Jesus Christ and continue in the hope that there be a positive change in their lives.
Peter, Street Outreach Volunteer
One evening, while on street outreach…/0 Comments/in Homelessness, Miracles on the Streets, Personal Experiences, Stories from the Street, Street Outreach, Street Youth, Street Youth Ottawa, Volunteer Homelessness, Volunteer Ottawa /by admin
Earlier in the day at church I prayed for increased spiritual closeness to our street friends. Wow, was I rewarded!
Later that evening, my young street outreach partner and I met 52 street friends. They represented all facets of this diverse culture; those just trying to get by, those seeking secure and comfortable housing, those on disability and those suffering with addictions.
A former "hooker" hugged me while we were ministering to someone and told us both how OIM has positively influenced her life.
Later, a middle aged unmarried couple asked for prayers for themselves and also for the man's son who was also present. The couple expressed their love for one another and inquired as to how they could be married by a minister.
We had several open and friendly lifestyle conversations with young adults living on the edge and the fringes of society. One young woman confided the food we provided her that night would preclude her from shoplifting and its inherent dangers!
We prayed with others and were both inspired by the rewards of our work for The Kingdom that night as never before. In fact, I believe my outreach partner, who is new to the city and looking for meaningful ways to help the under privileged, felt the Holy Spirit's presence that night and was re-invigorated by the experience.
Peter T, Volunteer
A Humbling Experience/0 Comments/in About OIM, Christmas, Drop In Services, Homelessness, Mental Illness, Personal Experiences, Volunteer Homelessness, Volunteer Ottawa /by admin
Recently, a few of us were talking about people we had met through the drop in and where they were. I talked about John, a man that I had met over 15 years ago when we ran our drop in out of another location downtown. John was a homeless man who had his challenges being homeless with mental illness issues. He was a flamboyant individual, colourful, always had an opinion and was willing to discuss any current topic and extremely political. (If he could have found a way to control his mental illness, I do believe he would have made an attempt to become a politician. But that is another story.)
John's colourful dress reflected his mood and his outlook. I had once told him he reminded me of a peacock because he always had feathers in his hat and he was brightly dressed. I didn't mean it as an insult and he didn't take it that way. It sparked a friendship that has lasted many years…
During Christmas of 2005 my father died, predeceased by mother in 1994 and both in the month of December which makes the period of Christmas hard for me.
In May 2006 I am outside the drop in and in a real depressed mood. We had just put dad in the ground and I am dealing with a lot of emotions; guilt, everything associated with the loss of your last parent. With no close family nearby to talk to I am isolated, with my only siblings in British Columbia. John comes up to me pushing his grocery cart filled with his worldly possessions and sees that I am depressed and asks me what is wrong and I tell him. No one else has picked up on this, or if they have they haven't asked.
He leans over and very quietly says to me, "I have been there brother. I know exactly what you are going through. I am here for you if you need to talk." He reaches out, squeezes my shoulder, looks me in the eye and something passes between us that can't be expressed in words. Tears flow and I mumble 'thanks.'
Every week I give up my time for the homeless, the marginalized, to support them. And, here, it took a homeless man to recognize my pain and hurt and to provide me the one thing I needed: unconditional love. I was humbled, I was loved and I learned a lesson that I have never forgotten.
Love comes in all sizes, shapes and forms. We just need to learn to recognize it and accept it.
Ken B, Volunteer
Contact Info
- Phone: 613.237.6031
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The New Jersey Devils have released the schedule for the events between Saturday, February 6 and Tuesday, February 9 that will comprise the celebration of legendary goaltender Martin Brodeur's No. 30 jersey retirement.
The "Martin Brodeur Jersey Retirement presented by Prudential" will culminate with a special on-ice ceremony starting at 6:15 p.m. on Tuesday, February 9 when the iconic No. 30 will be raised to the Prudential Center rafters. The Devils-Oilers game will follow the ceremony with a start time of 8:08 p.m., and doors will open at 4:30 p.m.
Hosted by "The Voice of Hockey," Mike "Doc" Emrick, the ceremony will feature Brodeur surrounded by his family, as a number of special guests pay tribute to his illustrious career in New Jersey. Among those scheduled to be in attendance include: the Devils' legendary trio of retired numbers, Ken Daneyko (No. 3), Scott Stevens (No. 4) and Scott Niedermayer (No. 27); Devils Stanley Cup-winning coaches Jacques Caron, Jacques Lemaire and Larry Robinson; the widow of Pat Burns, Line; and NHL Commissioner Gary Bettman.
On Monday, February 8, Prudential Center will host "An Evening With Marty" as the Devils face the Rangers at Madison Square Garden. The event will include the unveiling of "The Salute," the statue created by sculptor and New Jersey native Jon Krawczyk and commissioned by the Devils to honor Brodeur forever at Prudential Center. The evening will also include a special Q&A with Brodeur and a viewing party of the game on the center-hung scoreboard at the arena. A limited number of tickets are available to the public for purchase for this exclusive event. To purchase tickets, visit NewJerseyDevils.com/Brodeur.
Earlier in the day at 1:30 p.m., the Devils and Brodeur will launch the Denis Brodeur Sports Photography Program at Henry Snyder High School in Jersey City in honor of Brodeur's late father, an acclaimed photographer for the Montreal Canadiens. Local dignitaries, Devils' alumni and community members will be on hand to help dedicate the program. The event, which will take place at the Charlie Heger Ice Rink in Jersey City, will be followed by a Learn to Skate clinic for local youth hockey players at the rink.
On Saturday, February 6 at 11 a.m., the Devils and Brodeur will host a youth hockey clinic at the Devils' practice facility at Prudential Center, where approximately 20 local skaters and goalies will get personal instruction from one of the best in the sport. Brodeur will then participate in a ceremonial puck drop as the Devils take on the Capitals at 1 p.m. at Prudential Center. To purchase tickets, please visit NewJerseyDevils.com/tickets.
Saturday, February 6
11 a.m. Marty Brodeur Hockey Clinic (Devils' Practice Facility, Prudential Center)
*Private Event
1 p.m. Devils vs. Capitals (Prudential Center)
- Marty to participate in ceremonial puck drop
Monday, February 8
1:30 p.m. Denis Brodeur Sports Photography Program Launch (Charlie Heger Ice Rink, Jersey City) *Private Event
- Dedication of a sports photography class at Henry Snyder HS in honor of Marty's dad, Denis
2:30 p.m. Hockey in New Jersey Clinic (Charlie Heger Ice Rink, Jersey City) *Private Event
- Learn to Skate clinic with Marty
6:30 p.m. "An Evening With Marty" (Prudential Center, Main Ice)
- Unveiling of "The Salute" statue
- Q&A with Marty
- Devils-Rangers viewing party
- Limited public tickets available at com/Brodeur
Tuesday, February 9
TBD Marty Media Availability (Prudential Center)
4:30 p.m. Doors Open
6:15 p.m. Start of On-Ice Jersey Retirement Ceremony
8:08 p.m. Devils vs. Oilers
For more information, please visit NewJerseyDevils.com/Brodeur.


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Opposition Leader Mahinda Rajapaksa said he did not think President Maithripala Sirisena would seek an extension of his tenure because he vowed to serve only one term.
Mr. Rajapaksa said this when responding to journalists after visiting several schools in Colombo yesterday.
When asked about his comments on President Sirisena's alleged attempts to seek an extension in office, he said, "I don't think he will do that. He came only for one term. I believe he is not a President who will postpone elections," he said.
This came amid reports that President Sirisena was planing to seek an advisory opinion from the Supreme Court under Article 129 whether he could serve in office till June 20, 2020, thereby postponing the presidential election otherwise scheduled for later this year.


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ROANOKE (WSLS 10) - More storms Friday morning are causing school delays and road closures.
Alleghany County is on a 2-hour delay. Pocahontas County schools are closed as they are dealing with flood warnings.
More than 400 Appalachian Power customers were without power as of 7:30 a.m. in Bedford County and more than 100 customers in Botetourt County. Those numbers have been increasing slightly over the morning hours.
More than a dozen roads were closed early Friday morning due to flooding and trees down. You can check the latest closures on our traffic section.
This comes as southwest and central Virginia deal with heavy rain and high winds for the third day in a row this week.


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TV czarina Ekta Kapoor recently became a mother and we are really happy for her. She also hosted naming ceremony for her newborn son Ravie Kapoor in and the who's who of the film and TV industries graced the event to give their blessing to the new born.
Here's sneak peak of who all made it to the party:
Karan Johar and Ekta Kapoor have been known to be great friends for a long time and he took time out of his busy schedule to bless the little Ravie
The Bachchan's in the house. Shweta Nanda and Abhishek Kapoor were also seen at Ekta Kapoor's baby christening. The duo had also made an appearance together in the talk show Koffee With Karan.
One of the most loved television couple Divyanka Tripathi Dahiya and Vivek Dahiya too made it to the party. While Divyanka was looking every bit stylish, Vivek was rocking the casual look. Divyanka Tripathi is currently busy shooting Yeh Hai Mohabbatein while Vivek is seen in Qayamat Ki Raat. The actor recently posted on his social media that the show Qayamat Ki Raat will be going off air soon
Once the most loved bahu of the Indian television and today one of the cabinet holder, Smriti Irani too was present for this occasion.
From Tulsi to Parvati. Sakshi Tanwar too also present for this occasion.
Ekta Kapoor's old friend and producer Nivedita Basu was seen getting into the party bearing gifts.
Another cute couple Anita Hassanandani and Rohit Reddy too were a part of Ekta's special moment. While Rohit kept it traditional, Anita opted for a stylish blue dress. The duo were also recently seen in a music album that is doing well.
Shabbir Ahluwalia and Kanchi Kaul too were at the party looking adorable as ever.
Krystal D'Souza opted for an Indian attire for the occasion and she was looking drop dead gorgeous.
The Naagin 3 star Pearl V Puri along with Mushtaq Sheikh, Anita Hassanandani, Vikas Gupta and Additi Gupta also posed for a selfie with Ekta Kapoor.
Actress Surbhi Jyoti too took a click or two with Producer Ekta Kapoor. Currently Surbhi stars in Ekta Kapoor's Naagin 3.


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Maryland Sea Grant seeks to hire a Legal Fellow and a Graduate Assistant. More details.
Bio-optical model for Chesapeake Bay and the Middle Atlantic Bight.
Magnuson, A; Harding, LW; Mallonee, ME; Adolf, JE
Retrievals of bio-optical properties from satellite measurements in Case 2 waters depend on algorithms that account for multiple constituents affecting spectral quality of the upwelling light flux. Semi-analytical (SA) models are suitable for this purpose, but must be parameterized with in situ data, particularly in estuarine and coastal waters. We examined spatial and temporal variability of bio-optical properties in Chesapeake Bay and the adjacent Middle Atlantic Bight (CB/MAB) to parameterize and validate the Garver/ Siegel/Maritorena (GSM01) model. Several years (1996-2002) of data on inherent and apparent optical properties confirmed high scattering and strong absorption by dissolved and particulate components that did not co-vary. These data, consisting of the chlorophyll (chl a)-normalized phytoplankton absorption coefficient, a(ph)(*)(lambda) and the spectral slope of absorption due to dissolved p and detrital materials, S-cdm: were used to optimize model parameters of GSM01 and produce a version of the model tuned for CB/ MAB we have designated GSM01-CB. Performance of GSM01-CB was measured against the globally optimized version of GSM01 and the empirical algorithm, OC4v.4, using both in situ and satellite-derived radiances from the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) as inputs to the model. GSM01-CB outperformed OC4v.4 in retrieving chl a in CB, and both SA models outperformed OC4v.4 in MAB. GSM01 and GSM01-CB also returned reasonable estimates of other bio-optical products, including the absorption coefficient for dissolved and detrital materials, acd(cdm)(443), and the particulate backscatter coefficient, b(bp)(443). We present alternatives to the parameterization of GSM01-CB to account for interannual variability of a(ph)(*)(lambda) in CB using empirical relationships with key variables that regulate phytoplankton dynamics in the estuary (i.e., freshwater flow and nutrient loading), and to include regional gradients of S-cdm in MAB.
'Related Research Project(s)' link to details about research projects funded by Maryland Sea Grant that led to this publication. These details may include other impacts and accomplishments resulting from the research.
'Maryland Sea Grant Topic(s)' links to related pages on the Maryland Sea Grant website.


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One who sees or observes keenly. That's the dictionary definition of eagle eye. It helps explain my experience being the subject of such observation. It also provided a reminder of the power of nature.
Our house outside of Eagle River was near Rice Lake on Highway G. The houses behind us had lake access and one of our neighbors let us use their pier. They were often not there since this was a vacation home; that provided a perfect vantage point for enjoying the beautiful north woods sunsets.
That's how we first spotted the eagle's nest in a large tree on the south end of the lake. The pair would arrive each spring and put on a show of flying around high and low and swooping for food then returning to the nest. Binoculars gave us an almost video-cam view of their domestic activities.
One year, we noticed babies in the nest. It was a pleasure to watch these eaglets being fed, along with all the other nest maintenance that was going on. The adult pair took turns heading out for food. That was their main job and it kept them pretty busy throughout the day.
We were entertained, seeing the eaglets many attempts to launch from the nest. On their first tries, they'd take off and then swoop so low we thought they'd land in the lake. But they soon got their footing, venturing out just a short distance before returning home; as time passed, their forays out into the world grew longer and longer.
One day as we were doing our usual watch, one of the adult eagles left the nest and made his rounds of the lake. I don't know how to determine an eagle's gender but for this story I've decided it's a him. Much to our surprise, he made sweeps near us a couple of times and then perched in a tree about twenty feet directly above us.
We're looking up. He's glaring down. I suddenly fully understood the term, eagle eye. His eyes were piercing. We wondered what he was thinking and if he would attack us. Maybe we were the food source he was looking for. It was kind of scary. We sat quietly, maintained eye contact and waited him out. He then began to flap his wings, getting ready to take off. Luckily, he headed out instead of down.
The last year I lived in this house, the eagles didn't return to the nest. We worried and weighed the possibilities. The fact that eagles usually return year after year to the same nest made their absence less than hopeful. We'll never know. Such is life.


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Selena Gomez & Zedd: Hot Couple Parties At Vanity Fair Bash After Song Release
YES! Zeddlena hit up the A-list Vanity Fair post-Oscars party on Feb. 22 right after their new song dropped. Talk about ending the night off right!
Selena Gomez, 22, and Zedd, 25, just had to finish off Hollywood's biggest night together! The hot new couple attended the Vanity Fair party together to hang with their celeb friends. While Zedd didn't take Selena along for the actual Oscars, they continued their cute after party streak as a couple!
Zedd & Selena Gomez At Oscars Party: Rock Vanity Fair Bash As Couple
Zedd was never far from Selena's side at the Vanity Fair event in Los Angeles. How could he resist? Selena looked absolutely sexy from head to toe. From her sultry eye makeup to her sexy black dress, she was flawless!
The couple posed for pics with Justin Theroux and Hailee Steinfeld. Zedd and Selena looked so cute. The "Stars Dance" singer sweetly leaned her head into her beau for the photo op. Selena also found her pal Jennifer Aniston for a quick picture. The shared an adorable hug with Zedd's standing close by.
As HollywoodLife.com has told you before, Jennifer more than approves of Selena's new romance with Zedd. "When Jen met Zedd at the Globes, she was really impressed with him and mentioned to Selena during the night that she was happy to see her in such a good mood and that Zedd was a great guy. Selena definitely took that as Jen giving her blessing, which is huge for her," a source told HollywoodLife.com EXCLUSIVELY.
In case you forgot, a Golden Globes after party was the very first time Selena and Zedd attended anything together. Now we just need them to walk a red carpet as a couple!
HollywoodLife.com told you first that Selena and Zedd would be attending Oscar after parties if Selena wanted him to. Aw! We love how devoted Zedd is to Selena!
Selena Gomez Declares Her Love For Zedd In 'I Want You To Know'
In addition to the Oscars, Selena and Zedd were celebrating the release of their highly-anticipated new song. "I Want You To Know" leaked early on Feb. 22, and the song is everything and more.
Coupling Selena's fantastic vocals and Zedd's DJ artistry, "I Want You To Know" is already one of our favorite new songs of the year. How could it not be? It's the love ballad of our dreams!
In the song, Selena all but says, "I love you." She sings, "I want you to know that it's our time / You and me bleed the same light / I want you to know that I'm all yours / You and me run the same course."
OMG. Well, Selena certainly proved that she's all Zedd's at the Vanity Fair Oscar party!
HollywoodLifers, are you glad Selena and Zedd attended the party together? Didn't Selena look great? Let us know!
— Avery Thompson


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Another exhausting, yet fun day out this afternoon.
Hanging Rock State Park
Way too many stairs at this point.
Looking up!
A pretty view.
Taking a much needed break because I didn't bring water this time.
New walking stick. From Amazon.
He's taking his break in front of a cave.
This cave is where the Tories hid after the Partiots took over their land.
She loved how this cave felt as if it had air conditioning.
Time to enter.
On top of the cave.
Daughter and I.
Small water falls
Very cool tree roots!
A different smaller cave.
Under a bridge there was a very pretty creek with Cinnabar mushrooms scattered about.
She had so much energy and said that she can do this everyday, all day! Lol
I am not sure what kind of mushrooms these next few are. Not 'magic' though. 😉
A lot of mold!
These ones looked very meaty?!


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Don't just watch shooting stars. Wear them! Authentic meteorite jewelry for Christmas is now available in the SpaceWeather Store.
COMET LOVEJOY IN THE MORNING: Noted astronomer John Bortle urges observers (especially in the southern hemisphere) to "begin searching for Comet Lovejoy's bright tail projecting up out of the morning twilight beginning at dawn. The tails of some of the major sungrazing comets have been extraordinarily bright. Comet Lovejoy's apparition has been so bizarre up to this point that it is difficult to anticipate just what might happen next ... [including] the exact sort of tail it might unfurl in the morning sky."
This just in! The ghostly tail of Comet Lovejoy was sighted this morning shining through the twilight glow of dawn over Australia. Peter Sayers sends this picture from Devonport, Tasmania:
"I was surprised to be able to see Comet Lovejoy in our Tasmanian summer early morning twilight with the waning Moon," says Sayers. "The comet's tail was just barely naked eye and perhaps a degree long."
The visibility of the tail could improve in the days ahead as the comet moves away from the sun and the background sky darkens accordingly. Early rising sky watchers should be alert for this rare apparition. [finder chart]
SPIRAL COMET TAIL: As Comet Lovejoy recedes intact from its Dec. 16th close encounter with the sun, researchers are pondering a mystery: What made the comet's tail wiggle so wildly in transit through the sun's atmosphere? The effect is clear in this sequence of extreme UV images recorded by NASA's STEREO-B spacecraft:
"Why the wiggles?" wonders Karl Battams of the Naval Research Lab. "We're not sure. There might be some kind of helical motion going on. Perhaps we're seeing material in the tail magnetically 'clinging' to coronal loops and moving with them. [Coronal loops are huge loops of magnetism that emerge from the sun's surface and thread the sun's atmosphere.] There are other possibilities too, and we will certainly investigate those!"
Battams notes that these images can be combined with similar images from STEREO-A on the other side of the sun to produce a three dimensional picture. "When we pair these together, and throw in the SDO images too, we should be able to get an incredibly unique 3-D picture of how this comet is reacting the the intense coronal heat and magnetic loops. We are going to learn a lot."
TIANGONG 1 AND MARS: This week, China's new space station, Tiangong 1, is making a series of bright passes through the morning skies of North America. On Dec. 18th, Kevin Fetter of Brockville, Canada, caught the 8.5-metric-ton spaceship flying past the planet Mars (video):
Tiangong 1 is unoccupied now, but China is planning to send Taikonauts to visit the experimental station at least once and possibly twice in 2012. To prepare for their arrival, last Thursday automated systems onboard Tiangong 1 began a series of air quality checks inside the station's 15-cubic meter pressurized volume.
Tiangong 1 is currently about as bright as the stars of the Big Dipper (a value that will approximately double when future spacecraft dock with it). To see it, check Spaceweather's Simple Satellite Tracker or your cell phone for local flyby times.
Dec. 10th Total Lunar Eclipse Gallery
October 2011 Aurora Gallery [previous Octobers: 2010, 2009, 2008, 2007, 2006, 2004, 2003, 2002]


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The day will come that you will be looking for a baby pushchair and that you will soon discover that there is a wide range as well as variety of baby pushchair that is available in the market. This might seem a little bit confusing to you as well as overwhelming and you will end up at the loss when you are going to buy it. The very first thing that you have to do is to narrow down your choices by simply understanding the many categories that is available in the market such as Britax car seat. Baby stroller, baby pushchairs,, baby buggies, baby prams are often the common terms that are used and they may be or may not be referring to the same thing. For you to better understand the names and terms, a more concise description will be given to you in this article.
Strollers vs Pushchairs vs Buggies
Both the stroller and Pushchairs are chairs with wheels and it can often be folded for easy transportation and storage. The primary function of the strollers and pushchairs is to transport infants from one location to the next. The only difference between the two is the term and description due to the geographic and cultural influence. Stroller is often used in the US while pushchair is used in the UK. Now that the buggy is more compact and has become a trend in the UK, the pushchair on the other hand has been slowly replaced by the buggy. Buggy on the American English is synonymous to baby carriages and prams which also transport babies in a lying position and this are often used for new born babies. Whether it is a stroller, buggy or pushchair it is a form of transportation for the child whether they are sitting or lying down and it is often forward facing direction instead of facing the person who is doing the pushing.
Pushchair comes in different forms and configurations, it also have different models that provides different degrees of adjustments for you to recline the child or baby. There are some that is best suited for newborns while some pushchairs are more appropriate for older babies who can sit upright. The most common pushchair today is the buggy and it is for single baby, there are also available for twin or double pushchairs and this type comes in side by side and tandem configuration. It was only in recent years that there is an increase of multiple births such as triplets and that they also have created triple pushchairs.


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Throughout his life, Arthur Conan Doyle, creator of Sherlock Holmes was an ardent supporter of the spiritualist point of view. He had many debates (arguments) with eminent critics of spiritualist ideas, in particular, Harry Houdini, illusionist, escape artist and an ardent debunker of spiritualist beliefs, often catching false mediums in the act.
Conan Doyle's son was killed in the First World War and some have suggested that the father's desire to contact his son overrode all other considerations. However, Doyle's beliefs were not fleeting. He wrote what is probably the greatest history of the spiritualist movement ever penned. Highly readable even today and available on Amazon.com. This book is a skilled and serious attempt to clarify spiritualism. I highly recommend it to anyone interested in this subject.
Photo courtesy of http://www.flickr.com/photos/peterdenton/2051118628
Doyle attended many seances and saw and heard the greatest mediums of his day. Perhaps the ultrarational Mr. Holmes was simply a compensating mechanism for the author, a personification of any doubts Conan Doyle may have felt.
In the twenty-first century, few people still believe in spirtualist ideas, though there are pockets even today in places like Lily Dale, New York, a town in upstate New York, where Conan Doyal visited and whose chief qualification for permanent residence is proving that one is a capable medium.
The crossroads of a belief in the spirit world lay in the Victorian era when Darwin published his book "On the origin of the species"in 1859. After publication public opinion shifted very quickly to a rationalist point of view regarding anything spiritual. It also changed the form of many Christian beliefs.
My own thought is that faith is one of the most personal choices we make. To anyone who has read Autobiography of a Yogi by Paramahansa Yogananda, disbelief in the world of spirit seems equally impossible. Another important source of pro spiritualist writers is to be found among professional exorcists, many of whom make Hollywood's portrayal of demons and spirits seem tame. For instance, how about a possessed doll that comes alive and causes catastrophic events in someone's life? Farther out than a Stephen King novel, yet attested to by an exorcist who was tested, utilized, even famed among those who know the back streets of the human soul. Even today we are fascinated with paranormal subjects, as evidenced by such movies as Paranormal Activity 3.


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DoD Aircraft Rental: Stick Time Not IncludedBy Scott Spangler on March 25th, 2019
Anyone who has investigated becoming a pilot knows that aviation is sold by the flight hour. Anyone who's ever rented one should find this interesting: the Fiscal Year 2019 Department of Defense Fixed-Wing and Helicopter Reimbursement Rates for the Air Force, Army, and Navy.
"When determining the hourly rate, agencies should utilize the appropriate rate category." They are, Other DoD, Other Federal, Foreign Military Sales, and All Other. Civilian use, such as movie making and the like, would be All Other. Unfortunately, the document makes no mention of stick time, but I imagine that's not the case for Foreign Military Sales, where the hourly rate would be for demo flights?
Like all rentable aircraft, I'm sure the DoD computed the hourly fees by summing the airplane's operating and fixed costs such as fuel, scheduled maintenance, and engine and system overhaul funds, added the cost of human resources, the people who fly and maintain the aircraft, and divided that number by however many hours they expected to rent each aircraft every year.
What's interesting in paging through the document is guessing at the contribution of each factor for the (All Other User) hourly rate. Among Air Force bombers, the B-2 goes for $62,012 an hour. That's roughly $10K more than the B-1 ($51,475) and nearly double the B-52's $33,919. This explains why the B-52 continues to serve, and it makes one wonder what the hourly rate will be for the B-2's replacement, assuming there is a B-21.
A good guess would be that it is nowhere close to the hourly difference for the Navy's long serving patrol plane, the Lockheed Electra-based P-3 Orion, which rents for (All Other Users) $9,015 an hour, and its replacement, the Boeing 737-based Poseidon, which goes for $9,928 an hour.
There seems to be only one aircraft, the Beech Super King Air-based C-12 Huron, in service with all four branches of the U.S. Military. (Given their special relationship, Marine aircraft, like the AV-8 Harrier, $13,768 an hour, are listed with the Navy's birds.) The Army rents its C-12 to All Other Users for $2,226 an hour. The Navy/Marines rents their UC-12-Ws for $2,497 an hour. The Air Force rents its C-12C for $3,341, its C-12F and C-12J for $$3,350.
The cheapest aircraft on the list is the T-6 Texan, the winged classroom used in Air Force and Navy primary flight training. The Air Force rents its T-6A for $917 an hour. The Navy rents its T-6A for $1,877 and its T-6B for $1,839. It's interesting that the B-model with its glass, HUD, and Hands on Throttle and Stick cockpit rents for the lower amounts. Another question is why the Navy's T-6's rent for almost double the rate of the Air Force. Is it because the Air Force flairs to land and the Navy planes, given their carrier heritage, arrive?
The document's final tables may provide a clue. They subdivide the total hourly rental into O&M (Operations and Maintenance), MilPers (military personnel involved with operations and maintenance), and Utl (asset utilization fee). It costs the Navy $1,621 an hour to operate and maintain its T-6A; it costs the Air Force just $794. The Air Force also charges a lower utilization fee, $34 per hour to the Navy's $72. Finally, it seems that either the Air Force pays its personnel less, or there are fewer personnel involved. The Air Force charge is $88 an hour to the Navy's $184.
With a small loan and not going out to dinner for the rest of my life, it might be nice to rent one or two of the military's fleet for an hour, if only the rental came with some stick time. – Scott Spangler, Editor
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text: Anthony Jackson A graduate of the University of the Pacific and a 16th round pick of the Colorado Rockies in the 2006 MLB Draft. He spent time in the Rockies and Dodgers organizations from 2006-2012 as a middle infielder and outfielder. Anthony is currently a varsity coach at Carlsbad High. 5 Tool Hitting Center is Blessed to have him on the staff. He works with all levels.