The opioid case.
Several counties in our area, including Westchester and Nassau, they're suing or planning to sue
the major drug companies.
They want to hold those Big Pharmas liable for the opioid epidemic.
My next guest representing some counties in that drug case, Mike Papantonio, he's a prominent
nationally known attorney and syndicated radio talk show host as well.
He's also a author of a new book called Law and Vengeance.
Well, I sat down with him recently to discuss some big cases, his unique insight into.
The Times editorial piece recently where they pointed out that sure we hear all the language
about the war on addictive drugs here and how we can all cooperatively work together.
Some of these Big Pharma companies obviously knew the products they were making were highly
addictive.
They knew about the tragedies unfolding in every single corner of this country and now
possibly in the case of Purdue, for example, that we're going to give them taxpayer dollars
to come up with non-addictive drugs.
It seems like we're actually profiting the bad actors.
Well, it's worse than that.
At full disclosure, I'm handling those cases for Kentucky, and Ohio, and West Virginia.
I'm handling those cases for counties and cities who've lost billions of dollars because
of the opioid crisis.
But the real problem comes down to the fact the company not only knew about it, they built
it into their business plan.
They built what we call drug diversion into their business plan.
You would have pill mills doing business on 3rd Street in some town called Somewhere America.
Then you would have the distributor, the sales person from, say, McKesson or one of the other
companies that drive by that pill mill everyday.
They're well aware of the addiction problem.
What's so interesting about this, Richard, is under the law they have a duty not to only
report that something is going horribly wrong in this community wherever it may be, but
they have a duty to actually correct the problem.
The way I'll be trying this case is to say that they had direct notice.
They clearly knew that the drug addiction was taking place.
The geometric addiction was just growing leaps and bounds.
But at the end of all this, we have to understand we look at these people different because
they dress different, Richard.
They wear Armani suits.
They have Rolex watches.
They drive around in Bentleys.
That is nothing less than drug cartel.
Until the American public can understand simply because somebody doesn't look like a criminal,
they don't look like a street thug, they have an office on Wall Street, until we can get
past that and understand that the criminal activity took place here.
Unfortunately nobody has gone to prison.
My goal is I try these cases across the country will be obviously to be able to recover money
for these counties that have lost billions of dollars but to also call enough attention
to where we have a Department of Justice that has the courage to say, "Why do we treat this
Armani suit character different than we treat a child out on the corner with a hoodie on
who's selling two ounces of marijuana so he can have something to eat the at the end of
the day?"
This division of how we have in our justice system, this division is killing democracy
and the opioid crisis is a great example of it.
Again, the book is called Law and Vengeance.
Mike Papantonio, I really appreciate the time.
Thank you so much.
Well, thank you.
For more infomation >> Wall Street Opioid Drug-Pushers Are Responsible For Thousands Of Deaths: PROSECUTE NOW! - Duration: 3:26.-------------------------------------------
Technique for Increasing Intention that will ACCELERATE the Law of Attraction Process - Duration: 8:47.
now in this video I'm gonna share with you the most powerful technique that
I've ever found for increasing in tension and how when we do this we
actually accelerate the process of attracting what we want and we make it
something that's much more probable
welcome back to another video my name is Aaron and I help people to expand their
consciousness now in this video I'm gonna be sharing with you a powerful
technique that we can use to amplify the intentions that we have towards
attracting what we want now this is a technique that I've used this is a
technique that I read in a book called peek which is all about understanding
how we can have peak performance in what we're doing how we can really become the
best version of ourselves it kind of shows a new process for the whole 10,000
hour rule the idea that if you do anything for 10,000 hours you become a
master at it in reality its if we do 10,000 hours and we always have the
intention of improving of having what's called a strong mental representation of
what we're trying to do and how when we do that over time we get better and
better so it could actually be less than 10,000 hours if we go about it with the
right practice now in the same way this is going to use a technique from that
book so that you can apply in your own life towards really getting what you
want and understanding how this correlates with the law of attraction
process now realize that for the law of attraction process the important parts
of it are the emotion that we feel towards our desire the action that we're
taking towards our desire the thoughts that we're having towards our desire how
our beliefs are creating our reality now an easy way to amplify all of these is
to simply have an intention for an outcome having a mental picture in our
mind of what we want to experience and to have this outcome be something that
we're constantly working towards something that we're constantly starting
to become more up because we're more focused on it so it's the idea that
sometimes we might be focused on not necessarily what we do want but
sometimes we get focused on what we don't want now this could mean and the
best analogy I heard for this is that somebody that is a leading golfer was
talking about how and what the process is for becoming an amazing golfer and he
says it's 90% mental 10% skill or 10% not a skill but 10% of
the physical part of it and what he means is every time that he goes to hit
the ball he's not so much focused on all the little details as he is is he's
focused on the outcome of where he wants the ball to go what kind of technique
that he wants and as he has that outcome that makes it so he moves towards it in
a much more powerful way now this is something that they've shown a lot when
it comes to sports is when they're focused whatever you focused on you move
towards so if you are for example maybe a NASCAR driver and if you are driving
around the track the idea is that if you start to skid off and you're focused on
a pillar or you're focused on into the side of a wall if your eyes go there
they'll tell you that that's where your body will follow now in the same way
wherever your mental picture is in your mind goes is where your body will follow
and as well your intentions will follow so be focused on the exact picture of
what you want to experience and not even just the picture but focus on who you
would have to become to have the kind of experiences that you want and as you do
this you set yourself up for success now I do this by always having an intention
before I come into these videos I have an intention to create an awesome piece
of content that reaches thousands of people that people can really feel like
they got value from that's my intention before I go into every single video and
because of that it's like my body just naturally follows it's like I naturally
kind of fall into a flow State I don't have to think very much because you know
I create my 2 or 3 videos a day and that would normally be something hard to do
but I believe because I have such a strong mental representation of why I do
what I do because I I patterned my body into doing this every single day no
matter what it makes it easier and easier for me to do it so have a
powerful intention have a powerful why and then underneath that why give
yourself a powerful reason why you're doing it in the sense of a larger vision
maybe it's to add value to other people maybe it's because it's just a part of
who you are whatever it is be consciously aware of what that is now
another part I want to talk about with this is something called segments
intending which is something I've talked about a lot I've been doing it more and
more recently and I just get amazing results with it so I wanted to share it
to you and it's a book that I actually got from the law of attraction by
Abraham Hicks or Esther Hicks but channeled by Abraham and it's all about
understanding how when what we do is before we go into any little segment of
our day a segment could be you are gonna get in your car and go drive the segment
could be you're gonna go prepare your lunch a segment could be you're gonna go
brush your teeth and take a shower all of these things are segments and what we
can start to pattern ourselves to do is to have a powerful intention before we
go into each one before you get into your car have an intention to drive
safely to the next place for you you to just flow in traffic very smoothly have
an attention when you're creating your lunch that it's going to be something
healthy you're gonna create it with good energy you're gonna feel good about
doing it here to feel good while you're eating it if you have any intention of
cleaning the house everything's gonna go smooth everything's gonna happen the
right way you're gonna get everything clean and it's gonna here feel good
about it afterwards all of these things are little many segments of our day and
if we have intention as we go into it we start to pattern ourselves for having
that kind of intention and to become something that's very powerful for us so
the idea is to have a strong mental representation of what that is and to
set these little intentions throughout the day now the funny thing is that the
more you do this the easier it becomes it gives to the point to where
eventually you just naturally subconsciously on autopilot have the
intentions before you go into certain things you know sometimes as I get into
my car I'm naturally just thinking about driving safe and going through traffic
in a very smooth way and it happens very smooth because I patterned myself
through repetition to have this kind of perspective now what you can do is also
have the same perspective have the same kind of way you go about it before you
go into certain parts of your day now another tip I want to suggest with you
or really encourage you to use is have something where you have an intention to
do something and possibly think about how things could happen in a different
way and kind of pattern yourself towards getting back on track now this happens
when in time we have a habit maybe were like oh I'm gonna eat healthy now
imagine have that intention and the outcome of eating healthy and of making
those right food choices but imagine what you would do if you are at a
restaurant and a friend asked you and said hey let's get the cheesecake or hey
let's get that or hey let's get this what you do is you look at yourself and
you think well this what would I do in that
situation and you see yourself saying you know what I'm actually gonna get
this or actually I may not even go out and go to that restaurant
everyone's gonna stay home and eat and eat something healthy the idea is that
you start to patter yourself of what you would do if what you would do if and
then you start to set yourself a trigger so that you are able to fall back into
place now this is powerful for understanding intention because with
intention every choice we make is adding onto a certain type of experience on to
a certain kind of outcome and if we align our choices to that outcome we are
much more likely to experience so this is all about understanding focus how
powerful it is remember at the same time our subconscious mind runs over 90% of
our life so what we must do is take conscious control of what our repetition
is so make those choices understand that we must align our beliefs to who we
prefer to be and that's not something I created if you push the link below that
is a free meditation hypnosis that you can listen to right before you go to bed
you can listen to out throughout your day it's something that you can use to
really tap into the feeling of how you prefer to be is something that changed
my life you know I listen to it every day to something I believe and give a
lot of credit to because ivory pattered my thoughts to really become the kind of
person I prefer so remember all you have to do is have a strong mental
representation of how you prefer to be as you have this mental representation
you'll start to see things differently you'll start to move towards things in a
very powerful way set yourself these little triggers towards remembering that
you can what if this happens how will i act and you start to repattern yourself
towards going on the direction that you want set little segments intention start
your day as you get into your car as you're making your lunch as you're going
to work as you're going throughout your day set these little intentions and over
time they will build up and it'll become easier to do so with that being said I
hope you guys enjoyed this video feel free to like this video if you liked it
subscribe if you haven't already also education here so that you're able to
see the daily vids that I do and other than that I will see you guys in the
next video please much love namaste
-------------------------------------------
Thanksgiving leftovers for breakfast? Stuffed turkey French toast - Duration: 4:05.
For more infomation >> Thanksgiving leftovers for breakfast? Stuffed turkey French toast - Duration: 4:05. -------------------------------------------
Plain Language - Writing for the Web - Duration: 1:05:03.
What we are going to do today is give you an update on plain writing principles on the
lot.
If you write for the web, Internet, blog, newsletters, social media anything involving
the web this class will allow you to use plain language so I -- readers can actually read
your contents and get the information you need.
Help your readers complete their top tasks if you are familiar with the top task very.
Understand how the plain writing act of 2010 affects you and your job or whether it does
not.
Sometimes it is an unpleasant surprise to find out it doesn't.
Find out where to get more training in plain language and joined the federal plain language
community.
Lots of possibilities here.
>> What I'm going to talk about now is what is plain language.
There is a lot of debate about it and some working definitions.
But the most consistent definition that we have found internationally as well as nationally
is that plain language is a style of communication that allows readers and hearers to quickly
find what they need, understand what they read or hear, and use what they read or hear
to fulfill their needs the first time they read or hear it.
That's important.
Eat it won't be in plain language of your 3 to 36 times.
That's not going to work.
If it's in the foot but -- footnote on page 72 on hundred 40 page PDF that something language
must not helping.
You may find different terms and some people say plain language and some say playwriting
as in the law and some people say clear communications or plain English.
But mostly these are all meaning the same thing.
And it's particularly important on the web because people move fast on the web and you
don't have a great deal of time to get their attention and clarity of language and clarity
of message is going to be very helpful.
>> The slide came up from a number of classes that I've had with people kept saying people
-- that plain language is this or that my start listing them because I thought was rather
interesting.
Plain language is not writing in baby talk.
It's not trying to be folksy, colloquial, playful, or politically correct perfect --. None
of those have anything to do with plain language nothing has -- plain language has nothing
to do with stripping out necessary technical and legal information.
Notice the word necessary.
Sprinkling legal terms into your writing does not make it legal writing it just makes it
confusing and hard to understand.
It's not a final step.
Although I will tell you I have been given things as the last up saying hey make this
plain language.
After a short discussion we see what we can do to improve it.
It's not something you do at the end.
It's not a style guide issue.
Plain language is not writing imprecisely.
In fact I would say it's more precise.
It's not just one step.
Like using pronouns in a Q&A format that may be a tool you use to reach plain language
but not the only thing.
There's not only one step.
It's not something the lawyers, Federal Register, or OMB will never go for.
Actually we have huge numbers of supporters and all of those areas.
Many lawyers and international organizations for lawyers to talk about plain language.
And see about how they can do it.
Most of our more powerful supporters are in fact writing from legal.
And it's also not easy.
Lane language is not easy.
I wish it were.
A colleague of mine used to say that it would be so nice if we had a plain language button
on her keyboard and I live for that.
I think I would be great.
You just hit the button and at plaintiff eyes or whatever it does.
But I haven't seen it and I haven't seen any more than the easy button.
But I would love to as a set.
Are these things in mind when we discuss plain language and see where plain language fits
for you.
>> Big question is always what governs plain language?
And that is the plain writing act of 2010.
Which said that all new government documents and there is no grandfathered and you don't
have to go back and fix all documents, but all new government documents that meet the
following criteria must be written in plain language and the deadline for that was October
13, 2011.
And that was a couple years ago.
We are past that deadline right now.
If you have documents that are necessary to get government benefits or services or for
filing taxes.
Plain language.
Documents that provide information about federal benefits or services or go plain language.
Arguments that explain to the public had to comply with a federal requirement.
Plain language.
If you are working with citizens working with the public or if you're working with everybody
outside of your own agency, plain language is required.
Paper, electronic letters, publications, forms, notices, is an instructive -- instructions
any government document.
>> OMB come -- provided final guidance on April 13, 2011 and another supporter of this
government death -- government -- governance is the plain link which action information
network and it was founded in the mid-1990s with the goal of using plain language for
all government communications.
And they are responsible for two things.
Essentially making sure that we offer free half-day trading to federal agencies for plain
language and maintaining the federal plain language guidelines.
I have a link further down on this but that is the main to purposes of plain.
And they worked on that final guidance for OMB.
>> So what are the benefits and why are you being asked to write things in plain link
which?
>> It's an essential part of open government.
We are also seeing that creating documents using plain writing or plain language and
reduce agency costs.
It shows the customer focus, increasingly important element in government communications,
it helps you communicate effectively because your organizing your orchid -- information
for the reader.
That is possibly the most important part of plain land which.
A breakdowns barriers and one of the things as a cochair I get is a lot of the emails
to plain and a lot of them are, I can't understand Medicaid or Veterans Affairs or my letters
I received from the taxes.
Can you help us?
And unfortunately we can't.
Plain can't and we have to say here are the plain contacts for the agencies and maybe
they can help you or get you to someone.
But we really get a sense that people are getting information they can't understand.
And the dangers of that are they don't comply with it.
They don't understand it or they do something wrong.
And that sets up a whole sequence of events because you have more letters and telephone
calls and face-to-face meetings.
And those really do take up a lot of time, staff resources one if you could just nip
it in the butt and get it right the first time people would do what you need them to
do.
>> There is also as I said there's customer service.
Executive Order 13571 streamlining service delivery and improving customer service.
Government managers must learn what is working in the private sector, and a lot of working
in the slapdash private sector self-service.
The more the government and the more the companies can put on the web for self-service the cheaper
it is.
So if they can make it available to you on the web you do not have to email or call.
That is another reason for plain language writing on government websites is to make
it clear what people can do.
>> So what are the ways we can go about this?
We don't have time in an hour's webinar to talk about all of the plain language techniques
on the list.
And these aren't even all of them that there are a few that are particularly important
to writing on the web.
>> Most important and the most stash absolutely most important is identify your audience and
organize content for them.
What do your readers want to do?
For example, in where I work in GSA and technology division we sell IT to the rest of the federal
government.
We have two main audiences.
We have business partners or industry partners that are vendors who want to work with us
and we have our customers which is other federal agencies.
Those are two really distinct agencies.
They don't want the same information.
You have to make sure you've organize content for the right audience.
And that one is their.
As on any website using design features to make it easy to scan.
People scam on the web and a lot of that scanning is coming off-line and is happening with magazines,
newspapers, things like that.'s off-line behaviors are starting -- online behaviors are starting
to drive online as well.
Keep your sentences and paragraphs short.
Don't get people confuse with what's going on.
Use pronouns, active voice, and verbs.
That's another good technique for web writing.
Choose simple, everyday words so people don't stop when they are reading and say I wonder
what that means.
I don't know what that means.
In my own right page?
And of course trim excess content.
All of these are what will really help your web writing, allow people to do what they've
come to your pages to do.
Except for maybe two agencies, none of us have fan clubs.
And people come to government websites to do things.
Now the two fan clubs I can think of our national parks.
People want to see the pictures and NASA.
People want to read about go the rest of us, people are coming to do stuff.
>> As I said people don't really read on the web.
They scan.
They scan to see is this the right page, is this where I'm going to get the information?
And you've got a couple of different things working here.
One of the things you have to make sure is that your titles echo what's on the page and
as you are linking and using descriptive link language.
I think I have more amount later on.
People don't read but they scan so used to make things short and distinctive.
For that you would use identify your audience and organize content but you'd also use design
features, and short content.
>> People will rarely read dense text anywhere.
I have a couple of slides that are essentially what I call the wall of words.
People take one look at that and think there's not enough coffee in the world for me to look
at this page.
It's too confusing.
So they've done some eye tracking research to see how people deal with dense pages and
they use the usual F pattern and some may have used crazy eight or or if you Google
page analytics so you can see where people are going and what are they looking at.
Generally, classic eMac, generally people are going down the left-hand side and maybe
a little and the middle.
I've notice that on the heatmaps I've run we have anytime this is the next one, anytime
we have a bulleted list people gravitate to that.
People's eyes look at that.
We might also have headers or any big links like if we are linking to a PDF but what you
really have is that left-hand side and then a little dab in the middle.
Sometimes you have things over on the right but generally the right-hand zone is the dead
zone and you put stuff there because it has to be up there but I'll put it on the right-hand
side.
>> Is so some sobering facts, this is some research from Nielsoen and people read an
average of 18% of what's on the page.
That's not a lot.
So those of you who devote a lot of time to content at your desk, the more words you have
on the page the less the percentage that gets red.
This is a paradox.
To get people to read half your words you need to limit your pages.
If people are saying oh this page is going on forever and it's scrolling they are going
to get lost and lose interest.
One of the things is you have to make sure people know what's going to be on the page
and they have to see the limits of the page.
What can they do with that information?
>> The biggest question is who is your audience?
That's always the biggest question in plain language and web writing.
Big surprise, your audience is not your supervisor or coworkers.
It's always a huge surprise for some people.
But what can you do to identify your audience?
Well check your Anil -- analytics.
Huge important step on this.
We use Google analytics at GSA and what we did with our analytics is we look at what
pages they are going to.
How long are people staying on this pages?
Can you find out what they're doing on the pages to Mark are they emailing are they clicking
on a link are they downloading a link?
We went through an entire file download -- download report and looked at what was not getting
downloaded six times in the month or so and asked does this need to be here?
Is it earning it keep?
Is it worth the space of taking up?
And those are the questions you have to ask.
A webpage or website is not a billboard.
You do not throw everything up there you have a purpose, you have a business goal for each
piece of content.
And if it does not meet that goal it is off the island.
Check your analytics and look where people are going, have your business goals, right
for the audience and find out who's reading your content.
I have the example and we have customers and other federal agencies and also people may
industry the -- they are entirely different audiences in different goals.
And why are they coming to your page what do they need to know?
What are they trying to do?
Another helpful thing is to check your search terms log just to find out is new stuff at
the top or do you have the consistent things that people are looking for?
If they're still looking for it maybe you need to make it easier to find.
These are the things that are always worth doing with web content particularly in plain
language.
People say they are looking for cars and on your website you are describing them as vehicles
you have a terminology problem.
>> What do customers want?
What do your customers want?
What do your readers want?
People come to your site to perform a task and get something done.
They come because they hope to get it done by themselves.
One of the questions you might want to test, and this is an excellent opportunity to consider
usability testing, where you have coworkers out of your division come over and say we
are just trying this can you see if people and you can do these tasks on the website
because we're trying to improve it.
There is a whole methodology of course with digital cup University is covering but that's
really another way to find out.
It's hard to look at your website clearly when you've been working on it forever.
Your mind fills in the blanks and it's very easy to lose -- lose perspective.
If people can't complete their tasks or what they need to do on their website they will
leave.
One of the very useful things that we've done is we have a huge spreadsheet of all of our
webpages and we say what is the business goal of this page?
How will we measure that this page is successful?
And that's not really a plain language issue but it does help us focus the page to the
audience which is a plain language technique.
>> Content your customers probably do not want.
Think about this.
When your office was formed, why would they care?
Who is the head?
People probably don't care about that.
What the headset the day he was sworn in?
What had looks like?
You'd be amazed what your annual report from three years ago look like.
How the bureaus organize?
And that may be more appropriate for the intranet.
What you did for customers five years ago?
No.
Content.
The text of the law that authorizes your office.
Really this is the sort of thing you have to say would want this?
If we have this on now are people going to that page?
Are people finding this information useful?
How does this help them do anything unless it's of course a research project?
>> Another thing to consider on websites is what kind of page is it?
And that is a really important question.
Part of that is the difference between print and web.
And print tells a story, is when you're, you generally have a beginning middle and end,
you can take it on the Metro, you can take it to coffee shops, you can take to the park,
you can read in sunlight, all of this mostly written in complete sentences.
The web is a lot chop your.
It also tells the story but it's easy to scan story, it's quick, uses minimal text, user-friendly,
users can be stressed, it impatient, skeptical, disoriented and all of those things may work.
It requires a certain interaction from the user web has to compensate for a lot more
than print as.
>> These are the steps with to take to make it work.
One of those things is to figure out what kind of page type.
There are three main types of pages.
There are portals or homepages.
Connector or pathway pages.
I always think of them as [ Indiscernible ] pages.
If you want this go there and if you're looking for something to go -- do something else go
there.
And the content pages themselves.
The content pages are going to be the heaviest with content.
The first two are really identifying.
The first is here's a page here we are in here are the things you can do.
If you want to do these things and then down to the meat.
Think of these sorts of things.
Think of topics.
Were our people wanting to go do not make people read from the beginning of the page
down to the end.
Give them the way to scan.
Give them headers.
Give them sections.
Have a conversation.
Make it possible to engage with your reader.
If you are -- very few content pages may contain more information and have more what I call
files or attachments.
They might have been ordering guide.
They may have instructions.
It may have things that people want to open up.
>> You will also want to foreground your content.
Those of you who took journalism this is the information you are looking for.
The inverted pyramid.
Start with the shortest and clearest statement about your topic.
Conclusions and key info first then the background.
I cannot tell you that there been too many times I've gotten emails from various divisions
that say we conducted a pilot study to find out what kind of training you should have
and this is how many people participated this with the range of the survey, and this is
the information we got.
And honestly, I looked at that whole email that was one big block of text and said all
I care about is what I have to take.
That's all I care about.
I don't care about your pilot study.
I don't care about the details.
I assume you did one but I don't care about the details.
What I want to know is classes I have to take this year by the end of the fiscal year and
the classes I've to take next year.
Battle.
So this -- that's all.
So this requires a real effort to put yourself in your readers shoes and what do they need
to know?
Not what do I want to tell them?
>> These are some of the sample pages about well organized content.
Had to get through the Lancaster?
I'm going over is -- how to get through the line faster?
I'm going overseas next week and I like the how to pack and now -- how not to pack.
It gives me a visual.
I know I'm been have to look up the 3 ounce rule and this is a page that says this is
what it will help you do, get through the line faster.
Not comply with TSA, safety, security, airline restrictions.
I don't care about that.
Care backing through the line faster.
And they help me do that.
That is my tech -- task.
>> Second.
First 11 characters of the page is the most important people decide and five seconds or
less if your site is useful.
Make sure if you put headers with your sections.
It helps people follow along.
It's a really quick way of organizing material to get people to what they want.
>> Here's another one.
Not a perfect example or a perfect screenshot by any means I can tell about us and what
we do.
There's probably some other things that that's at least before things here.
>> This is one of the wall of words that I've seen.
This is just one big paragraph.
And I can't tell what they do.
I can't tell what they are going to help me do.
This would be, there are guide words in here if you read through, there's in addition and
furthermore but what would really help is what it would help me do?
What task are they going to help me?
Is this just about an organization it needs to be in sections.
And needs to be in different parts.
Over sees it another -- overseas high-profile projects and functions doesn't tell me a great
deal.
In needs to in shorter paragraphs and be a lot more specific.
>> So Heather -- headers, lists commas and tables are good ways to design the content
to make it easier to understand.
Use headers or headings because they increase white space.
They -- it doesn't help if you have a big wall of words because people stop reading.
It's too difficult and it's fatiguing to the eye.
>> Using lists make it easier to -- for the reader to see everything in a process.
It adds blank space because you can add space between items in a list.
Helps also if you use numbers for steps in a process and bullets for everything else.
You have to think about how your ordering material and have to make it explicit.
Of a big list of customer service managers and I looked at the list and said how is this
organized?
Because it seemed to be all jumbled together.
It was last names up-and-down, date name of the agency contact was an ordered and it was
ordered by the key number.
And I said that's great because I'm glad there's organization but can you add a line saying
it's an order by key number.
Because people might know that right offhand.
But as I said when you've been working on something it's very difficult to see the faults
and it because you are used to working with it and you know all of the back stuff.
>> So for example here's one of those wall of words.
It's just hard to read.
It doesn't help that all of the material seems to be the same.
Form I 800 a supplement one supplement to, it's just awful.
>> Too long and didn't read.
I would really have to be desperate to know that information.
>> Putting it in a list makes it a lot easier.
>> Putting it in a table makes it even better.
Although I know that our friends in mobile first would not be so happy because smart
phones do display less conveniently as laptops.
So tables help save words and they make it easy to locate specific provisions and you
can take and complex material at a glance.
They are particularly good if you have if/then for those of you who do estimated payments.
The IRS always has something that if you have descended a quarterly payment if you live
in and then they have a whole table of states.
If you live in wherever, senders to Pittsburgh.
I don't have to try and follow along with a ruler to make sense I can just look for
my state.
And where they want the money sent to.
>> Keeping things short is also a key point in web writing.
No one wants to read stuff like this.
I mean this is just scary.
You can look at it and say you could probably divided here in the middle with regard and
you've got some numbers here.
So maybe you could move those out but that's still really horrible.
And in the context all it needed was this.
Instead of this, this two lines with links.
One of the biggest aggregators of information on the web is links.
Please use them and use descriptive link language so people know what's going to happen when
they click on them.
You don't have to repeat everything on your page particularly if the belong somewhere
else.
>> How would you shorten this?
There is no escaping the fact that is considered very important to note that a number of various
available applicable studies ipso facto, they are sprinkling in legal terms again, have
generally identified the fact that additional appropriate nocturnal employment could usually
keep juvenile adolescence off their affairs in the night hours, including but not limited
to the time prior to midnight on weeknights and/or 2 AM on weekends.
That was 62 words of gibberish.
And a perfectly appropriate more night job to keep use off the streets.
This doesn't impress anybody it just confuses them.
>> Using short paragraphs.
Limit your paragraph to one subject or step.
Smaller bites or sections are easier to digest mentally.
If you like a number but I swear I'm not coming over to your agencies and counting paragraphs.
Seven lines per paragraph.
Eyeball it.
Are your paragraph more or less the same size or do you have a couple really long ones and
then some teeny tiny short once.
>> Similarly with sentences.
One subject presentence.
Don't make it confusing or complex.
I've seen sentences and sentence length recommendations of 20 words or fewer in printed documents
and 15 or fewer on the web.
Again if you like the comfort of having a number.
>> Pronounce.
There's already a rate barrier between citizens and the government.
I once got a call from the IRS pre-email days and it was a voicemail on my machine from
the IRS and they started with don't worry.
It was like checkers guide to the galaxy where they say don't panic.
You really should not have government communications starting with don't worry this is just a routine
call.
Of course I was panicking for the rest of nine.
It turned out my bank can sent in my mortgage statement.
Silly stuff.
How awful that they have to start their messages with don't worry or don't panic.
If we can help right now Matt barrier -- break down that barrier we are more likely to help
them.
If we use language they are used to seeing it is more likely they will understand what
we want them to do.
You don't like your audience having to translate terms like I refinance last year and I was
reading through the huge amount of paperwork and kept thinking which one am I, I finally
put it on Post-it notes.
I'm not used to these terms and my reading level which is very high, completely drops
in a field I'm not familiar with.
You might have people who are very smart in their own fields coming to something they
are unfamiliar with and a process they don't know and I'll tell you they have to ask the
stupid questions and ask the obvious questions because they don't understand.
>> Using pronouns to speak directly to your readers and if you are writing relevant it
requires a lot less work and help you eliminate words.
Is a sneaky way of having shorter sentences and paragraphs.
>> Writing directly.
It's another very powerful thing.
Passive verbs, verbs, and complex verb forms can make your writing week and confusing.
And unfortunately it's notoriously a part of government writing.
One of the biggest things is mistakes were made.
Passive voice.
Made the mistakes?
Nobody they just happens and no one is to blame or at fault.
They just somehow got through security and mistakes.
What you want to make sure you are doing is writing an active voice.
So in passive voice the person doing the action follows the verb.
So Arlene was promoted by her boss.
To make that active voice it would be Arlene's boss promoted her.
You have very clearly in English subject verb object.
Someone is doing something.
That is the sort of thing you need to look for.
This is definitely something to improve because this helps people understand who is doing
what and what are they responsible for doing?
>> This merely repeats all that information about active voice.
>> Use your customers language.
Use your readers language.
Avoid bureaucratic and legal language because they can really lead people astray.
Limit your jargon and acronyms.
When I was helping with a program that did usability testing for government agency websites,
there was always a top 10 and often these three were in the top five too much text,
too many words appear in, too much jargon and acronyms, insider terms, acronyms that
more than one agency can use and just using the words that people didn't understand.
Ways to avoid that to make your avoid -- writing more useful.
Is avoiding the foreign and Latin names.
Avoid abbreviations use contractions, use everyday words, use descriptive link language.
It makes it easier to understand what you are trying to convey.
I often get emails as I said from plane and I get the admin emails and people say that
letters from the government have all kinds of typos they capitalize federal, S government.
And we know that's not strictly speaking a typo but a style guide issue the two people
who do not work in the government they say what a typo or when ego and these are things
you have to think about when you are appealing or communicating with a non-federal government.
>> So the bureaucratic and legalistic language.
I'm sure you've seen things like this integrating quality solutions, strategically engaging,
hereby, things like that.
Along with prepositional phrases those can always be Titans.
That's one step that can help your writing.
One final editing's that.
>> Use contractions.
Instead of the needs of the customers use the customers needs.
Instead of the Mission of agency use agency's mission it's grammatically correct and works
on the web.
>> Descriptive link language is important information particularly on the web because
linking is so important.
Make your links distinctive and consistent and don't just say click here.
Give them language that lets them though instead of download the guidelines work download this
report say download the Alliant to ordering guidelines.
Then they will know exactly what they're getting and if they are downloading a lot of stuff
or using assistive technology and used click here or download this or view this report,
what they will end up as a whole stack of links that all say click here, click here,
click here.
If you can say download the set, ordering guidelines or industry partner lists it will
know exactly what's in the download.
>> That's a very important point for web writing to make sure you are using descriptive link
language.
Some of the things you can do with your web content, as I said look at your analytics
for whatever your most frequently big visited pages are and most frequently downloaded documents.
What are your audiences?
What type of people coming use your website?
Have you scrubbed your pages for jargon?
That includes program names, acronyms, technical words, or speak.
Trying get people outside your organization help you with that.
Have you looked for out-of-state contact?
Make sure none of it needs to be there.
Are you making sure you have goals for all of your pages?
So people can complete whatever task is available to them?
Are your pages still useful?
We were redoing some pages for cyber security and we found out they had for welcome pages
and we said pick one.
You not have four pages.
You can only have one.
People off the street websites as billboards and pen stuff I.
Than they have to say we do have for welcome pages and I'll wonder how that happened.
People just put pages up.
Sometimes if this step up and say what -- why do we have this here?
You need something about program history?
Does that belong somewhere else?
These are the questions you need to ask of your content.
>> Some of the things you can do is work on your key content and public facing documents.
The plane writing act of 2010 does not apply to the Internet.
Or two emails which I think is so unfair.
You can apply the plain language guidelines on plain language.gov and I will make sure
they're in the email we send out you.
You can join the plain language action and information network if you would like to know
more about that.
And you can take more classes from Digital God University.
And look at some of the material they are a have recorded on those pages.
Here you have some online training and NIH as one and it's plain language.NIH.gov and
if medical stuff doesn't make you horribly queasy as it does me it's a really good course
that you may need to know about that ends there's a volume 2 of lingo the words writing
web content that works it's a good way to get introduced web content and Janel do we
have any questions?
>> We do we have several questions.
As a reminder if you have a questions type them in the checkbox will get to as many questions
as we can.
Inks Repacked a lot in 45 minutes.
Very helpful tips.'s let's start blog -- broadly, if an agency is starting out with a plain
language program and review their content to make sure it's in plain language water
your top three tips or had you get started on that because it can seem overwhelming
>> I think the most important step is to look at where are people going.
Look at your analytics.
Don't go after the page that 20 people go to, that's not owing to give you big bang
for your buck.
Look at your analytics and see what your most visited pages are.
See the pages that have a big steak.
Depending on what your agency is.
We always want to make sure that our contract pages, that people can order from us.
That is an absolute business goal right there.
People have to be able to order.
You might also, depending on your agency, you might want to look at your call center
or see what kind of emails you are getting.
We have one of those rate this page surveys on our site and it says did this page copy
make acquisition?
And we don't actually get a lot of good information about that but we we do get is I was expecting
something else from this page.
It reports every page.
I was really surprised not to have that.
And that's useful to now as we look at the language were using and the terms we are using.
>> Thank you that's helpful.
It can be overwhelming if you focus on those key pages to go
>> Focus on the top 10.
Start their and then look through the next 10.
>> You talked about writing for your audience in identifying that.
Can you talk about some tips and techniques for writing for science-based audience?
>> That question comes up all the time and one of the things and techniques I've heard
other agencies use because this does come up a lot is having plain language summaries
or abstracts of their information and that's a huge step because what I think some of the
stage and sees found his people were not going to the full report and they wanted to know
is this the report I want?
And one of the steps was simply standardized format where you have a website and you have
the title in the category any of the names and then you have a plain language abstract
or summary statement that explains what it was about and what people would learn if they
looked into it.
I think that's a good interim step and I know there are a lot of people working with scientists
and researchers.
And there's various degrees of resistance.
Like lawyers there's various degrees of resistance to plain language but that is an excellent
step at least to start with.
At least, it's like the descriptive link language.
Where people say oh it's about that.
I thought it was about this.
I don't need to open the report.
And be confused but you can tell what this is about.
That I think is the best up to do first.
In the case of clarity.
The next steps are continuing to work and negotiate and if you can work with friendly
people.
Focus on your best writers and keep working your way.
One of the things that might be helpful for working with that is get a few head people
who are willing to work with you on that and have them brownbag have a webinar.
Make a case study or paper out of it.
How we did this.
Talk to me about hosting a plain language meeting.
Groups everyone can see my calendar.
How can this happen?
>> Good luck with that project.
And speaking of writing for an audience and that one was more about the scientific albeit
-- audience I've heard the question come up about writing an eighth grade level can you
speak to that?
>> I think a lot of this happens first in newspapers and magazines and journals where
they say they are measuring literacy from a profit mode.
Which is fine.
But government agencies really can't say that we are writing to a certain grade level because
readability they don't guarantee plain language.
They can guarantee, they are generally factors about how many words with Tony's obeys you
have.
How many long words to have?
How long are your senses?
It's a factor of that.
If you'd change that you can bring your score down.
However there are many short words that are just as confusing.
It's an important indicator and at a previous agency we had one group that just refused
to write to what we were using at the time which was a sixth to eighth grade level.
Just as a ballpark.
And we use that as an indicator of more work needed to be done on these pages rather than
we want them specifically to this grade level.
These people and the groups materials coming in at 24 or 26 and that's all we needed.
We set the rest of the website is written at this level with this kind of material and
yours is coming in at 24.
We can't guarantee that only the people who will understand your content are coming to
it.
This is what we used.
And it still wasn't fantastic content but it was at least more in line with the rest
of the site.
And if you're taking a look at it from the enterprise-level uke really have to say no
you don't get to go play by yourself.
You have to play in the big sandbox with everybody.
>> And attendee put in a tip more than a question she found that the Hemenway actual can be
helpful.
Re: familiar with that?
>> I've heard of it but we cannot recommend any software or app over another but I'm very
glad people are finding things that are useful.
>> That makes perfect sense.
Can you talk about who the plain language act applies to?
A question came in asking if it applies to the local government or if it's just federal?
>> Plane focuses and when I say plane I mean the plain group focuses on the federal level.
Plain language in itself is an international movement and there are many states that are
now signing plain language into law.
I'm going to completely miss these up because I haven't been keeping track but I think it's
Minnesota, California just did something with ballots, and a couple of months ago I spoke
to someone in Oregon that healthcare had done a plain language lot in Oregon and they were
trying to figure out how to go about it.
Local governments can pass whatever laws they like as far as I know.
I don't know how much support is out there for them for that.
Will often ask if you can teach us that the state local level in the cities and we are
like now but we do have some information available because we share the videos in the digital
got University stuff we've done already.
>> And just a reminder to everyone that we did record today's presentation or are recording
and we will send you the link to the recording and also post it on our digital got that you
-- video library because of your colleagues were unable to join us will send you that
link.
Also a lot of people are asking if they can get copies of the slides.
Be Mac absolutely.
If you want to send them out -- >> Absolutely if you want to spend them out
with the survey would be fine.
>> Definitely so look out for those slides as well because there are a lot of good resources
and examples in their.
Lets go through more questions.
Do you have any advice how to convince management it's worth investing the time in promoting
plain language in an agency's writing?
>> Ice cream always helps.
[ Laughter ] chocolate cookies.
Donuts.
I think that appealing to them for the sake of language itself is not really going to
work.
As a strategy.
You might get it lucky with people who are interested in it already but I think that
what you have to appeal to is this solves a problem.
And it's even better if you can say the solves a big problem.
That's why say take a look at your analytics and where people going.
Is that where you want them to go?
Check with your call center and water people calling about?
Is there easy fix you can do on the web that would make some of those calls go away?
So there will always be calls and if you can make them not always be the same call that
a big help for your coworkers and managers.
I think it starts pulling -- boiling down to can you get people to have business goals
for their webpages.
And that's a big concept.
That they big leap for a lot of people.
Barrier are still billboard mentality and if you put it on the web people find it.
And we know that doesn't work.
One thing I've done is there was some content I wasn't particularly happy about and I gave
it six months and then I ran six months worth of data and analytics and send it to the owner
and said this is where people are going on your micro-site or your webpages is this where
you want them to go?
And he said no I want them to be doing other things.
So I said let's talk about that.
Lets set up a meeting.
Lets see where I think people are going astray.
This is what might be confusing people and they don't need that information.
And seeing that information, spreadsheets, is screenshots meant that he sat down and
really looked at the content and thought this is not what I wanted to be.
I want people to do something else.
That was really remarkably effective.
Just appealing to people's sense of language, now.
Put it as part and an important part of customer service though or the customer experience
or however you want to phrase it.
And you might get a better response.
Also if they are moving to self service on the web.
They actually have to put in plain language for it to work.
You can say this will solve your problem.
And make sure what problem you're been a figure out plain language will solve.
>> Thanks Mac -- thanks Catherine and I'm been a combine a couple questions.
This is talking about subject matter experts and can be very dense content and just resistant
to when you change the content for fear of change obtain -- changing the intent or meeting
and how do you deal with that because another person asked that they have a coworker that
insists including the minutia and the content but how do you convince your coworkers who
are set in their ways?
>> It's not easy.
As I've said on slide five or slide seven plain language is not easy.
I think that one of the things I've tried to keep in mind for myself, barring the instant
plain language is that there is a continuing.
And maybe with one of your coworkers they've written something and it's very dense and
you say I want to show you something and you just schedule and Adobe connect or sit down
together and these paragraphs really feel too long and there's too much going on and
you've got so much important information, I want people to be able to see all of it.
And then maybe what you do is break apart long paragraphs into shorter.
Maybe you add some section headers.
Maybe you add some bulleted list.
But you say I haven't actually changed any of your writing.
And then the next time you start changing some of the writing but you say look this
is all I'm doing to make it a little bit more digestible.
If they are open to food motifs use those.
It's really hard to get all of your information because they're so much of it.
I'm trying to put some space in so that people can see how it relates to one or another part.
>> So it's start off small.
>> Start off small, and I've been biting my nails over some things but I'm waiting for
the six months to pay off so I can run analytics and save this is what people are doing and
that is this what you want them to do?
>> So we are about at noon and we can take a couple other questions and if we didn't
get your questions was an Catherine the questions and she can get back to you.
We talked about tips for science writers, do you have any tips for easily displaying
foreign language?
You talked about tables in this question came in during that time.
>> I'm not sure about plain language because I can really only talk about plain English
as it were because so much of the plain language part like active voice, that the features
it English.
There are other language -- linkages that rely on passive voice, I don't know because
I intake that many foreign languages.
I think however, your basics would apply.
Like having shorter paragraphs, and striving for shorter sentences, if that's possible,
making sure yet headers.
And then I'd have to know a lot more about the language before I could speak anymore
that.
I'm sorry I don't know.
>> Thanks Kathryn.
We talked about making information more concise and applying the plain language principles.
This comes up a lot in our webinars about 508 compliance.
Can you provide an example of a time you have run into this issue specifically related to
writing and plain language and making sure it's 508 compliant.
Are those married or?
>> I think they are married because I'm thinking in terms of people using assistive technology
and if the text is clear people can find in tab through the different sections.
They can find areas that they want.
The biggest 508+ is the using descriptive link language.
I talked to a guy in our 508 office because people kept sending me stuff with click here
and I'd make a steady note motion and say what do we say?
And I checked out the 508 office and he said I use assistive technology and if all you
put his click here then that's all I see.
If you write something that says read the 2015 report on kumquats then I know I'm going
to get that.
If we don't want to read that particular reports and I won't reserve that for later.
I think the descriptive link language is the biggest point about 508 if you will.
There's the other element of if it's easy for everyone it really is easier for everyone
that the screenwriter -- screen reader is reading more clearly.
The screen reader is reading and getting to the point faster.
What benefits everyone also benefits people using assistive technology.
>> That's a great example and even for people who don't need assistive technologies at his
much easier to scan when you know where the link points to.
We will take one more question and it's exactly related to descriptive link language.
This question is do use the entire link if it's only going to view the link on the web?
I'm assuming that means would you use a portion or use it long.
>> Like use an entire sentence?
I see.
One of the information -- these were the different options and I didn't
make this very clear.
The links would be bringing your new patient -- the description would be bring your new
information packet your first appointment and one choice was download the packet.
Another length choice was get started with your own copy.
And the last option was don't -- download it now so you don't forget it.
I don't remember offhand which one they chose but what I might have done myself is simply
link new patient information packet.
Don't link a whole sentence.
And I'm going to interject now unsafe you are on the web don't underline anything unless
it's a link.
I had the big fight yesterday.
Don't underline it unless it's a link.
Because people will be saying they're trying to click.
And you are laughing but seriously I've been there.
When I'm trying to click and it's just . >> It's frustrating.
>> It's extremely frustrating because the web has certain -- set certain expectations.
I can do this and get things done and I find when I'm on a website and I can't do it it's
really frustrating.
Wanted to go someplace over the weekends and was trying to find the location, no location
listed.
Don't even get me started on restaurant websites because it would be another hour but people
have expectations from their experience and it's our job as the government to not say
were not going to do that but to meet them where they are.
You can say were not going to do that.
You have to.
You have to play in the web sandbox.
You don't get to take your toys and stop somewhere else.
It's a good -- >> That's a good point about expectations
that have Ari Ben sent -- set.
-- That have already been sent.
Organ ask one more question I wanted to let attendees know we've put the evaluation link
in the checkbox.
And will also send the slides and Catherine's resources.
A question came in about writing for social media and Catherine actually did a webinar
a year or so ago about writing in plainly which for social media and we will include
that and other digital God resources that we've done in the past and how to sign up
for future plain language classes.
Catherine and closing if you could have our attendees come away with one thing from today
what would you tell them.
Or something they can implement in the writing wake -- right away?
>> A few weeks ago I was teaching some GSA people about the principles of plain language
and it was an editing class and we went through all the principles and we started with some
of their own work.
At the end of the four sessions someone said, you know every time I send out a letter or
email to someone I ask myself if I'd want to receive it.
And if I wouldn't I don't send it out until it is.
And I thought I'm taking the rest of the day off because that is really at.
When you send out something would you be happy to receive it?
Would you know what you're supposed to do with it?
Or would you sit there as I frequently do and think why did I get this?
What am I supposed to do to Mark --? Maybe any another cup of coffee.
Would you be happy to receive what you are sending out?
The golden rule of plain language.
>> That's a great tip to close with.
Thanks so much Catherine and thanks everyone for attending and have a great afternoon.
>> And Mac --[ Event Concluded ]
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Fun Care - Princess Gloria Makeover Kids Games for Girls - Duration: 2:19.
Fun Care - Princess Gloria Makeover Kids Games for Girls
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Homos No Match for Jewish Mom Body Shaming at Circuit Party - Duration: 4:24.
I haven't been to a warehouse party like this in ages.
Me neither.
But I remember what to do...
Shirts...
Off...
Shirts off! Shirts off! Shirts off!
This is so freeing!
We can just be ourselves and uninhibited.
(Benito cont.) It's like, no judgements!
Hey how are those Weight Watchers classes your mom got you working out?
Terrible!
I'm just like, "Mom, you are literally the only one who cares!"
OK, well, I'm gonna go get us some drinks...
I'll scope us some hot guys.
Dude!
You must give zero fucks...Good for you!
Um, thank you!
Hey sexy.
Do a lap in the dark...
Oh my god no!
Hey, can I get a photo with you?
Uh, yeah!
No one is gonna believe that I saw Rosie O-fuckin'-'Donnell at this party.
What?! Where?!
Hey sexy. What's---
*Rodrick vomits*
I'm so sorry.
Mom?
Mom: I was scrolling through photos of Rosie O'Donnell on Instagram...
And YOU came up! Without a shirt! You're brave!
I have to go!
I'm blind! Oh my God!
Oh my god I'm blind!
Make it stop.
He's so fucking gross.
You too Mrs. Goldberg...OK. Happy Hanukkah to you and Morty...OK.
Benito it's your mom.
I know your belly and chest are flabby...
You've got that disgusting patchy back hair...
But I am so proud of you, Benito.
Fuck this. I'm leaving!
But we just got here.
Mom: Guys! Guys! Guys!
Tyty: Hi Mrs. Goldberg-Lopez!
Mom: Hi Tyler...
Mom: I am so sorry to interrupt your debauchery
But I just want to give a round of applause to my son Benito...
Benito: Oh my God...
Mom: Who took his shirt off.
*Crowd applauds tentatively*
Mom: Yes! He's doing a very brave thing. A very brave thing.
He's the one over there with the dinner plate nipples!
Yes!
*More enthusiastic applause*
Sure. He's no Ted Schmidt from Queer as Folk...
Hell, his last boyfriend made him fuck in Spanx!
*Crowd laughs*
Benito: Mom! I told you that in confidence!
Benito: That was only one time!
Mom: But he's doing a very brave thing...A very brave thing.
Yes! He's got that patchy back hair and he's still here shirtless!
Benito: Stop clapping! Why is everyone clapping?!
Mom: Yes! Give it up for him!
Quentin: I can see!
Benito: Don't clap at that, Tyty!
Quentin: I can see!!!
Mom: He's got those fat fucking nipples and he's still here.
*Thunderous applause*
*Benito cries*
Tyty: What is his problem?
Mom: He's just insecure about his body.
*Crowd giggles*
Mom: Hey...Share a dark room glory hole boys?
Crowd: YEAHHH! LET'S GO! ALRIGHT!!!
Tyty: You are so supportive.
Mom: Thanks Tyler.
-------------------------------------------
"Clinical Pearls: Tracheostomy Care for the Acute Care Nurse" by Janelle Nobrega for OPENPediatrics - Duration: 7:22.
Clinical Pearls: Tracheostomy Care for the Acute Care Nurse,
by Janelle Nobrega.
Hello, my name is Janelle Nobrega,
I am a Clinical Nurse Specialist at Boston Children's Hospital.
This presentation is designed to give
a broad overview of the care considerations for a patient
with a tracheostomy.
I will review safety checks, suctioning, humidification,
site care, and emergency response.
Safety Checks.
All supplies that may be needed to change a tracheostomy tube
should be readily available at the bedside or within reach.
Your bedside safety checks should include a pulse oximetry
monitor, a cardiac monitor if clinically indicated
for your patient, a spare tracheostomy tube
the same size currently in place, a spare tracheostomy
tube one size smaller than currently
in place, water-soluble lubricant and a syringe
for cuffed tubes, humidification,
oxygen setup if clinically indicated,
suction equipment and supplies, bandage scissors,
and a self-inflating ambu bag with a pop-off valve.
An easy way to remember these items is the acronym MASHTT.
M stands for monitor: cardiac and pulse oximeter.
A stands for ambu bag with pop-off.
S stands for suction.
H stands for humidity.
And the two T's at the end stand for your spare
trach the same size and your spare trach one size smaller.
Suctioning.
Suctioning a tracheostomy should be
done at a minimum of every 8 hours,
and as needed when clinically indicated
by clinical assessment to ensure patency
of the artificial airway.
Depth of suction is determined by adding the shaft
length of the tracheostomy tube to the adapter/flextend length,
and then adding one centimeter so
that you can suction just below the end
of the tracheostomy tube.
Apply suction while withdrawing the catheter
for no more than five to ten seconds per pass.
Instillation of saline is not routine practice
and should only be utilized for thick secretions.
Here at Boston Children's Hospital,
we use clean technique for suctioning
a tracheostomy in the inpatient areas,
and sterile technique for suctioning a tracheostomy
in the intensive care units.
This is because patients with a fresh tracheostomy
are at greater risk of infection than patients
with mature stomas.
Your institution may have different guidelines.
Humidification.
Our institutional policy at Boston Children's requires
that all patients with a tracheostomy tube
have either an active or a passive humidification device.
All patients use an active humidification device
while sleeping.
Do not use a passive device when the patient
is unattended or unable to remove
the device him or herself.
An example of an active humidification device
that we use here at Boston Children's Hospital
is a large volume nebulizer.
If no supplemental oxygen is required
and optimal aerosol output is desired,
a large volume nebulizer can be operated utilizing a wall air
flow meter.
Set the dial to 0.35 to 0.40 to activate the Venturi effect.
An example of a passive humidification device
is a heat moisture exchange or an HME device.
When utilizing an HME, check periodically and assure
that it is clear of secretions.
Replace the HME if secretions are visualized.
After applying an HME, assess for changes
in respiratory status, including work
of breathing and tachypnea.
Consider decreasing the use of an HME
or changing to an active humidification device
if there is an increase in the viscosity of airway secretions.
If supplemental oxygen is required
you may utilize a large volume nebulizer or an HME.
When utilizing a large volume nebulizer
ensure use of an oxygen flow meter
and adjust the FDO2 dial accordingly
to maintain acceptable oxygen saturations for your patient
per prescriber order.
Note that if a FDO2 of greater than 50% is required,
consult respiratory therapy to ensure proper oxygen delivery
setup.
If supplemental oxygen is required with an HME
you must utilize an HME with an oxygen adapter.
Connect the side port via oxygen tubing to a wall oxygen flow
meter.
Adjust the flow accordingly to the patient's oxygen
requirement per prescriber orders.
Consult your institutions HME device manual
to review the appropriate adjustment range of oxygen flow
through an HME as this may vary according to the manufacturer
of the device.
Site Care.
Tracheostomy site care should be performed daily at a minimum,
and tracheostomy ties should be changed daily
to allow for assessment of the tracheostomy stoma
and the peristomal skin as well as the surrounding
skin of the neck.
Tracheostomy site care can be performed with sterile saline.
Consider quarter strength hydrogen peroxide
for sites with drainage and consult
your institutional experts for assessment as needed.
Neck care can be performed with mild soap and water.
Removing tracheostomy ties is always a two person procedure.
This procedure can be performed by any combination of nurses,
respiratory therapists, or caregivers.
Ensure that only one small finger thickness
can be inserted between the neck and the tracheostomy ties
in the sitting or side lying position.
The inner cannula of a double lumen tracheostomy tube
is cleaned or replaced at least once a day and as needed.
A nurse, respiratory therapist, or caregiver
can change the inner cannula.
Note that the first tracheostomy change is often
done by the surgeon, a physician assistant, or a nurse
practitioner.
Routine tracheostomy change frequency
is determined by the patient's surgeon.
That procedure will not be demonstrated in this video.
Emergency Response.
In the event of an unplanned decannulation,
a tracheostomy obstruction, or if the patient
is in any distress, call for help immediately
and activate the emergency response
per your institutional policy.
Attempt to replace the tracheostomy tube one time
if you are comfortable.
Direct responders to your safety supplies,
including the spare tracheostomy tubes present at the bedside.
If the patient has a critical airway
you may need to page advanced providers for assistance.
Thank you very much for watching this video
on care considerations for a patient with a tracheostomy.
Please help us improve the content by providing us
with some feedback.
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Man Utd star Romelu Lukaku won't be banned for kick at Brighton star - ex-Prem referee - Duration: 1:20.
Man Utd star Romelu Lukaku won't be banned for kick at Brighton star - ex-Prem referee
Lukaku is facing an FA wrap for allegedly kicking Brighton defender Gaetan Bong in Saturday's 1-0 win at Old Trafford. It was missed by referee Neil Swarbrick at the time but the games authorities are looking at the incident.
The striker will miss Manchester United's key clashes against Watford, Arsenal and Manchester City if he is slapped with a three-match ban. But Gallagher isn't expecting Lukaku to be banned. "There's always that option (of retrospective action)," he said on Sky Sports.
"It has to be violent or brutality and it's not really either to me" Dermot Gallagher on Romelu Lukaku "The FA have got options to have a look at anything they see like this.
"I would be surprised, I think it would be more petulant than violent. "It has to be violent or brutality and it's not really either to me.
"It's just an act of petulance and they will get told to be careful." Lukaku is out of form at Old Trafford having scored just once in his last 10 games for United.
Zlatan Ibrahimovic could replace the Belgian if he is suspended. The Swede is fit again after recovering from the knee injury which prematurely ended his first campaign with the club.
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Cartoons for Children😃Irregular Plural Nouns for Kids First Grade. Education Videos for Children - Duration: 3:22.
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5 Health Benefits Of Eating Eggs For Breakfast – Eating Eggs Regularly - Duration: 3:02.
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No plans for Bank Holiday on Prince Harry and Meghan Markle's wedding day - Duration: 3:38.
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Halloween Makeup Tutorial Compilation 2017 | Easy Makeup Tutorial for Beginners - Duration: 10:06.
-------------------------------------------
Date A Live Rinne Utopia (PS4) - What They Can Do For Yoshinon: Epilogue (English Subtitled) - Duration: 5:40.
Are you ready?
P-Please...wait a little longer...
Roger that.
...Um, are you ready now?
N-No...not yet...Sh-Shido-san...
...P-Please help me...
...W-What happened!?
...A-Au...
I'm coming in, okay Yoshino?
Are you okay...? Wait...H-hey, what's with the outfit...?
I-I'm sorry...
...I-I couldn't...put it on by myself...
Yahaa~ Shido-kun, you lucky dog~!
You can't take it easy for a second, can you~?
Hey hey...
This could really be taken in the wrong way.
Um...can I ask you...
...to help me get dressed...?
N-No, but...
Is that a no...?
Uh...Ahh...I got it.
It's quite the mess, so we can't really do anything about it~
...I-I get it already! Here, give me your hand...
It must be pretty tough for Yoshino to put on clothes for herself...
But...if they want to look cute, I can't really say no...Well, I guess that's just an excuse. I want to see them when they're like that too, obviously.
Yoshino, you were thinking that you should be pulling yourself together, weren't you?
W-Well...I couldn't count on you...before, you know...?
Yeah yeah, that's right.
But when that happened you got really close to Shido-kun, didn't you~?
Shido-san's...special!
...R-Really?
Yes!
Good grief, you two are so lovey dovey~
H...Hau...
...Well, stuff like this isn't so bad, right~?
...Sheesh, you just say whatever you want, don't you...?
...There, done.
...H-How do I look?
...Eh? Uh, yeah! I-It...really suits you, Yoshino!
Ehehe...
Yahaa~ Shido-kun.
You're looking a little embarrassed~
You're so cute~
What a cute couple you two have become~
Phew phew~!
Quit teasing so much, Yoshinon!
...Shido-san.
...Hm?
I'm...really happy...
Mm, aah...
Yoshino is here, and Yoshinon too...We'll laugh together just like this. I'll make sure moments like this keep going. I'll do whatever I can so that I never have to let them go. Ever.
I'm feeling pretty happy too.
Yeah!
-------------------------------------------
Little Known Cure For Erectile Dysfunction (ED Impotence) - Duration: 4:15.
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Horrific Warning Just Issued For US Women After Muslim Men Start SICK New Trend To Take In Sex Slave - Duration: 7:29.
As people all around the world continue to be victimized by the practitioners of Islam,
liberals keep idiotically arguing to bring more third-world migrants to America.
Places where Muslim migrants have allowed to invade bear little resemblance to the all-American
neighborhoods they once were, where locations like Minnesota and Michigan are constantly
making headlines for the barbarism that refugees are carrying out on the "infidel" populace.
With Sharia Patrols, female genital mutilation, and even the rape and murder of whites becoming
increasingly more common as Muslims try to take over our country, an urgent warning is
now being issued to women all across America, after the disturbing new trend of crime is
popping up in our country's biggest metropolitan cities.
Utilizing Uber services is becoming a common way for people to travel, as it's much more
economical than calling a taxi.
But leave it to Muslims to find a new way to exploit American women and our way of life.
According to reports, a Muslim driver sexually assaulted a woman on American University campus
in Washington DC last week, but chillingly, a new pattern is emerging of Muslim drivers
sexually assaulting their women passengers, as these women make incredibly easy prey.
According to Breitbart:
Authorities arrested El Houcine Jourhdaly, 36, of Springfield, Virginia, and charged
him with felony first-degree sexual abuse, WTOP reports.
D.C.'s Metropolitan Police said that the incident took place Sunday morning between
3:20 a.m. and 3:50 a.m. at a building near the center of campus.
"At approximately 3:23 a.m., the victim received a ride, in what she believed was
a vehicle for hire, from the suspect.
When the suspect arrived at the listed location, he ordered the victim to exit the vehicle
and then sexually assaulted her," D.C.'s Metropolitan Police said in a statement.
Police say the 21-year-old victim got into an argument with her boyfriend after a night
of drinking when Jourhdaly booted the boyfriend from his vehicle and raped the victim "with
an unknown body part."
Uber told WUSA that the suspect used to work for the ride-sharing company, but Uber permanently
banned him from driving for the app two years ago.
Police say that, although Jourhdaly was not authorized to drive for Uber, he kept an Uber
sticker on his Honda Civic.
Authorities do not believe that the suspect and the victim knew each other.
Other Uber drivers, and people who have posed as Uber drivers, have allegedly committed
sex crimes against passengers.
An Uber driver from Massachusetts, who was in the country illegally, skipped town in
May after he allegedly raped a female college student on three occasions.
In that same month, a man in Rhode Island allegedly posed as an Uber driver to sexually
assault a 15-year-old girl.
In August, a Chicago Uber driver was arrested after he allegedly locked his 19-year-old
victim in his car and demanded sex from her in lieu of payment for the ride
This disturbing trend comes mere weeks after what's believed to be Muslim-led human trafficking
rings are popping up across our country.
In the Muslim-infested city of Minneapolis, women and children are disappearing off the
streets at an unprecedented rate.
74 abduction cases were reported in that city just this year, leaving the FBI and local
authorities completely frazzled.
The Quran is very explicit to its followers on what they're expected to do to the infidel.
Rape and taking women as slaves are both tenants of Islam, so it should come as no surprise
that Muslims would continue to practice this aspect of their religion after arriving to
America, while using the sob story of "escaping their war torn countries" to guilt Americans
into opening their communities to them.
According to The Religion of Peace:
"Islam neither ignores nor condemns slavery.
In fact, a large part of the Sharia is dedicated to the practice."
"Muslims are encouraged to live in the way of Muhammad, who was a slave owner and trader.
He captured slaves in battle; he had sex with his slaves; and he instructed his men to do
the same.
The Quran actually devotes more verses to making sure that Muslim men know they can
keep women as sex slaves (4) than it does to telling them to pray five times a day (zero)."
Abducting women, as in the case of this Uber driver and with the current human trafficking
epidemic, fall in line directly with Mohammed's teachings.
In fact, acts like these are actively encouraged throughout the Quran.
Quran (33:50) – "O Prophet!
We have made lawful to thee thy wives to whom thou hast paid their dowers; and those (slaves)
whom thy right hand possesses out of the prisoners of war whom Allah has assigned to thee"
This is one of several personal-sounding verses "from Allah" narrated by Muhammad – in
this case allowing a virtually unlimited supply of sex partners.
Other Muslims are restricted to four wives, but they may also have sex with any number
of slaves, following the example of their prophet.
Quran (23:5-6) – "..who abstain from sex, except with those joined to them in the marriage
bond, or (the captives) whom their right hands possess…"
This verse permits the slave-owner to have sex with his slaves.
See also Quran (70:29-30).
The Quran is a small book, so if Allah used valuable space to repeat the same point four
times, sex slavery must be very important to him.
He was relatively reticent on matters of human compassion and love.
Quran (4:24) – "And all married women (are forbidden unto you) save those (captives)
whom your right hands possess."
Even sex with married slaves is permissible.
Quran (8:69) – "But (now) enjoy what ye took in war, lawful and good" A reference
to war booty, of which slaves were a part.
The Muslim slave master may enjoy his "catch" because (according to verse 71) "Allah gave
you mastery over them."
Quran (24:32) – "And marry those among you who are single and those who are fit among
your male slaves and your female slaves…"
Breeding slaves based on fitness.
Quran (2:178) – "O ye who believe!
Retaliation is prescribed for you in the matter of the murdered; the freeman for the freeman,
and the slave for the slave, and the female for the female."
The message of this verse, which prescribes the rules of retaliation for murder, is that
all humans are not created equal.
The human value of a slave is less than that of a free person (and a woman's worth is
also distinguished from that of a man).
Quran (16:75) – "Allah sets forth the Parable (of two men: one) a slave under the
dominion of another; He has no power of any sort; and (the other) a man on whom We have
bestowed goodly favours from Ourselves, and he spends thereof (freely), privately and
publicly: are the two equal?
(By no means;)
praise be to Allah.'
Yet another confirmation that the slave is is not equal to the master.
In this case, it is plain that the slave owes his status to Allah's will.
(According to 16:71, the owner should be careful about insulting Allah by bestowing Allah's
gifts on slaves – those whom the god of Islam has not favored).
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Healthy for Life 20 by 20: Year Two - Duration: 5:56.
In 2015, the American Heart Association and Aramark
came together to form an innovative health impact movement
designed to help millions of Americans lead healthier lives.
Recognizing that more than 70% of Americans
had a poor diet, and nearly as many were overweight,
our two organizations decided to work
closely together to achieve a bold goal.
To improve the health of Americans
by 20% over the next five years.
"Healthy for Life 20 by 20" was born.
This was a new and innovative model,
a multi-year collaboration that takes
a comprehensive approach, taking aim across
four different health-impact areas,
each one essential to making a difference.
Working together we are impacting the food environment
through healthy menu innovation,
reaching millions of consumers through
health awareness and engagement programs,
supporting underserved communities
through outreach and education,
and improving employee health and well-being.
Results to date show that this innovative approach
is having a real impact across all
four of the areas we've targeted.
Job number one was to establish
industry-leading, healthy-menu commitments.
Aramark committed to the bold goal
of reducing calories, saturated fat, and sodium by 20%
and increasing fruits, vegetables,
and whole grains by the same amount.
Aramark shops, and many developers,
have embraced the challenge.
We're bringing health-inspired innovation
to hundred of recipes each year.
While there's more work to be done
we're well on our way to reaching our goal.
In the first two years alone, we've achieved
a 13% average reduction in calories, saturated fat,
and sodium, across key menus.
30% of choices on the menu are now vegetarian or vegan
and almost 15% of menu selections
are now made with whole grains.
We're taking a holistic approach.
We're introducing new plant-based choices
that our consumers love, and we're bringing
healthier, ethnic, and multi-cultural cuisines to the menu.
We're partnering with celebrity chefs
that specialize in healthier cuisines
and we're adding whole grains across the menu.
And we're finding ways to create lighter classics,
better-for-you comfort foods and
other new health-inspired favorites.
Aramark and the American Heart Association
are also working together to inspire
consumers to make healthy choices
part of their everyday lives.
We're proactively engaging millions of consumers
to help them discover what healthy food can do.
Our new "Feed Your Potential" health engagement campaign
has been launched in more than a thousand
locations around the country.
Aramark chefs and dieticians,
along with experts from the AHA,
are sharing their insights and ideas
to help people live healthier lives.
Healthy recipes and cooking tips
are reaching millions of people.
From college students just learning how to cook
to busy professionals looking for healthy, time-saving tips.
Newsletters, blogs, emails, and social media
are all being used to bring nutrition
and wellness information to consumers,
at the time and at the place that best fits their needs.
And health promotions and sampling programs
are encouraging people to try new foods and new flavors.
The AHA and Aramark are committed
to supporting those who live in underserved communities,
where learning how to access, choose, and prepare
healthy foods is more important than ever.
Guided by AHA experts, we've created
an innovative suite of health-education
experiences that are building food literacy,
teaching new skills, and giving moms
and other caregivers the confidence
they need to prepare healthy home-cooked meals.
More than a dozen Healthy for Life
educational experiences have been created
as part of a new community-engagement curriculum.
After piloting the new program in three cities
it is now expanded to over 25 cities
and is continuing to expand to
community centers nationwide.
Through healthy food tastings, cooking classes,
grocery store field trips, and community meal experiences,
participants are changing their attitudes and behaviors.
On average, participants report a 28% increase
in fruit and vegetable consumption
and significant increases in whole grains in their diets.
We're helping to create healthier communities
and healthier consumers, but we also believe
that a healthier America starts with each of us.
So, with the support of the AHA, Aramark has expanded
our already robust employee health program.
The goal, to enable our 250,000 employees
and their families to live healthier lives.
Here too, we're having an impact.
This year, Aramark was recognized
as a Best Employer for Healthy Lifestyles,
receiving the highest level, Platinum Award,
from the National Business Group on Health.
This honor reflects the many ways
Aramark is helping to improve the health
and well-being of its associates
through resources and programs such as health assessments,
online coaching, well-being challenges, and more.
It also highlights the value of deep collaboration
as the American Heart Association and Aramark
work so closely together to achieve a shared goal.
Inspired by the collaboration with the AHA
many Aramark employees in turn develop
a passion for well-being that they
bring to their families and to the
local communities where they live and work.
It truly takes a team to tackle big challenges
but as part of this unique health-impact initiative
we have the team.
A team of chefs, of dieticians, of menu developers,
of community health experts, and of public health leaders
all working together to achieve a shared goal.
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