What I've been reading

The Hound of the Baskervilles
by Sir Arthur Conan Doyle

narrated by Simon Vance

"Sir Charles Baskerville has been found dead. There are no signs of violence, but his face is hideously distorted with terror. Years earlier, a hound-like beast with blazing eyes and dripping jaws was reported to have torn out the throat of Hugo Baskerville. Has the spectral destroyer struck again?"

A good story - obviously I've read it before, but it must have been a long time ago because I barely remembered any details, let alone whodunnit. This Sherlock Holmes anthology is certainly living up to its promise so far.

The Man Who Was Thursday: A Nightmare
by G. K. Chesterton

narrated by Simon Vance

"Gabriel Syme is a poet of law. Lucian Gregory is a poetic anarchist. As the poets protest their respective philosophies, they strike a challenge. In the ruckus that ensues, the Central European Council of Anarchists elects Syme to the post of Thursday, one of their seven chief council positions."

This started badly and ended badly, but the middle was quite good. I didn't think I would relate to a story about anarchists, but I just substituted the word 'baddies', which worked well enough. The identity of the anarchist known as Sunday was revealed towards the end (it wasn't really a surprise), but after that the whole thing stopped making any sense at all. I got the impression that the author didn't really know himself how to finish it.

The Goshawk
by T. H. White

"This is the record of an intense clash of wills during the training of a great, beautiful hawk, in which the pride and endurance of the wild raptor are worn down and broken by the almost insane willpower of the schoolmaster falconer."

This is referenced extensively in Helen Macdonald's recent bestseller 'H is for Hawk', and having read that and unearthed this from my shelves it was obvious that I needed to read it. It's not quite as brutal as Macdonald makes out - she seemed to quote the worst bits, but even so, White has a tough time with his hawk and the hawk has a worse time with him. A classic for the aspiring austringer or falconer or someone like me who is a little bit obsessed with these birds; I don't think normal people would find much of interest other than to consider how things have changed since those difficult postwar years.

Guns, Germs and Steel
by Jared Diamond

"Since 1500, Europeans have, for better and worse, called the tune that the world has danced to. This book tries to explain why, and suggests that the geography of Eurasia was best suited to farming, the domestication of animals and the free flow of information. The more populous cultures that developed as a result had more complex forms of government and communication, and increased resistance to disease. Finally, fragmented Europe harnessed the power of competitive innovation in ways that China did not."

This was recommended ever so long ago, when I started my degree in 2007 and I've been looking out for it ever since. One of the lecturers was encouraging us to read around our subject, which is what I do quite a lot, so in return for this recommendation I provided him with a whole load of suggestions of other interesting books about science. In comparison with the books I recommended, this one is a dud as far as I'm concerned. The question the author sets out to answer is why Europeans tended to dominate the societies they met rather than being assimilated or even dominated by them, the simple answer being the title of the book. The discussion then becomes exceedingly anthropological, and I am not particularly keen on lengthy discussion about the development of farming and pottery or the spread of language throughout Austronesia. So read 'The Goshawk' if you are interested in birds of prey and read this if you are interested in anthropology, and avoid them both if you're not.

DESMOND

Peckover House, August 2014

"Another blog post so soon after the last?" I hear you cry. Well, I've been working on this one and another as yet unpublished post for ages, and I'm a bit busy for the rest of the week and the weekend, so here goes.

I have had a look back at the blog, and I can hardly believe that I haven't really explained what DESMOND is. Given that it has formed a large part of what I've been doing over the past 9 months or so, I'm surprised I haven't described the programme.

DESMOND is a nationally delivered structured education programme, designed to meet the criteria within the NICE guidelines for Type 2 diabetes, which has quite a lot to say about patient education:

1.1 Patient education

1.1.1 Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review. Inform people and their carers that structured education is an integral part of diabetes care.

1.1.2 Select a patient-education programme that meets the criteria laid down by the Department of Health and Diabetes UK Patient Education Working Group.

• Any programme should be evidence-based and suit the needs of the individual. The programme should have specific aims and learning objectives, and should support development of self-management attitudes, beliefs, knowledge and skills for the learner, their family and carers. 
• The programme should have a structured curriculum that is theory driven and evidence-based, resource-effective, has supporting materials, and is written down. 
• The programme should be delivered by trained educators who have an understanding of education theory appropriate to the age and needs of the programme learners, and are trained and competent in delivery of the principles and content of the programme they are offering. 
• The programme itself should be quality assured, and be reviewed by trained, competent, independent assessors who assess it against key criteria to ensure sustained consistency. 
• The outcomes from the programme should be regularly audited. 

1.1.3 Ensure the patient-education programme provides the necessary resources to support the educators, and that educators are properly trained and given time to develop and maintain their skills.

1.1.4 Offer group education programmes as the preferred option. Provide an alternative of equal standard for a person unable or unwilling to participate in group education.

1.1.5 Ensure the patient-education programmes available meet the cultural, linguistic, cognitive and literacy needs in the locality.

1.1.6 Ensure all members of the diabetes healthcare team are familiar with the programmes of patient education available locally, that these programmes are integrated with the rest of the care pathway, and that people with diabetes and their carers have the opportunity to contribute to the design and provision of local programmes.

So we offer group education delivered by trained and quality assessed educators with a curriculum that is written down. The only part that deviates slightly from the guideline is that I don't believe we are meeting the cultural and linguistic needs in the locality, but we're working on it.

The name DESMOND stands for Diabetes Education for Self-Management of Ongoing and Newly-Diagnosed. The syllabus content is prescribed, as are the Educator Behaviours in delivering the content. Educators are assessed on the manner of their delivery as well as including the messages that need to be delivered, because there is also a philosophy behind the curriculum. I do agree with this approach but I sometimes find it difficult to educate in the approved manner without sounding patronising.

During our delivery we are supposed to give as few direct answers to participants' questions as possible, because the emphasis is on self-management - if they have questions after the course we want them to be able to work out how to find the answers when we're not around. Of course, if nobody knows what is represented by the two numbers in a blood pressure measurement or how sulphonylurea medications work then we're going to tell them. But if someone asks "Is [food x] good for you?" as they often do, we are supposed to first throw the question back to the group, and encourage them to use the principles they've learned in order to work it out for themselves.

The course is delivered by two DESMOND educators either in one full day or two half days a week apart. After introductions and housekeeping, sessions include information about what diabetes is, causes, medications, monitoring, carbohydrates, calories, long-term effects and how to avoid them, other aspects of health associated with diabetes (cholesterol, blood pressure, smoking, depression), the annual review, physical activity, fats and overall food choices. Participants are encouraged and supported in recording their own results in a 'Health Profile', and at the end they are expected to create an Action Plan containing one thing that they are going to try to change or achieve as a result of the course, and how they will go about doing it.

My journey as a DESMOND educator started in October last year, when I attended the two-day course in London. The next stage is for educators to go away and practise educating, and within six months they are supposed to arrange a session when they are observed for half a day by a mentor and given feedback, and then the final quality assessment of a whole day's course, of which you deliver about half, alongside your co-educator.

There are some interesting assessment tools, including a 'beep score'. The assessor listens to a track in one ear that beeps every ten seconds, and marks down who is talking at the point of the beep - is it the educator, the participants, or is something else happening (an activity, or silence, or laughter)? A percentage score is calculated to represent the proportion of time that the educator is speaking, which needs to be less than the particular percentage threshold set for that session. Other assessment is more conventional - is all the content delivered, are the educator behaviours as they should be, are the learning objectives met?

I had my mentor visit in February, and my final assessment in June. Thankfully I passed, so I am now DESMOND accredited, but it's lucky that the assessors have some leeway in their assessment. My Physical Activity session has never been great, but it was dismal on this occasion - I think it has since improved a little. We are expected to devise our own action plan along the same lines as the participants, and I really should have a look at mine soon. Accreditation is periodically re-assessed, and you have to deliver a certain number of courses a year in order to remain accredited.

I do enjoy delivering DESMOND, and of course every group is different. I haven't had anything very difficult to deal with - the most challenging was probably one participant with mental health issues who spent some of the time asleep, and walked in and out of the room at random. He wasn't very disruptive though, as we could ignore him or include him as appropriate. Every now and then a participant tells us that they don't know why they have been invited to the group because they don't actually have diabetes - of course we have checked beforehand and they do have diabetes, but the way the programme is delivered means that they usually work this out for themselves as we go along. The most negative comments we get are generally those that say they wish they had been given the information earlier.

We were given extra funding for a year because we got very behind with our courses and waiting times became unacceptable, so I have been employed one day a week to help catch up. We have caught up and that funding ends in September, and I will actually be glad to go back to four days employment a week. In order to keep up my DESMOND accreditation I do need to deliver a few courses, which will be on top of my four days a week.

So from October I hope to have an extra day in the week for all the jobs that are hanging over me - much work around the house and garden, buying a new car, a dress for Sister D (the fabric has now been bought!) Or, more likely, I'll doss about as usual and nothing will get done. Place your bets.

Travel and work and badminton and running and shopping and cooking

Courmayear, February 2015

There's been another trip south, which is why there hasn't been much blogging action recently. I've been fully occupied all of one weekend on family stuff, and during the week there's been work and badminton and running and shopping and cooking, and the sole TV programme that I actually watch (The Great British Bake-Off) has started a new series. And I went out with work colleagues to celebrate my birthday, and met a friend while I was in London that I hadn't seen for more than 25 years. So blogging has had to take a back seat.

Lola II and Mr M and I ate well as usual during my visit. We decided to try somewhere we hadn't been before that offered Caribbean food from Trinidad. It was a fairly new restaurant and they were very keen to tell us all about the food, which had a more Indian influence than the Jamaican style food that's more commonly found. I had mutton, Lola II had chicken and Mr M had salt cod, and it was all very good indeed. Next day I wore my newly made dress for the Family Birthday Celebration (and I wore it the week before for the Works Night Out), and it looks so good and I was complimented so much that it all went to my head and I offered to make another one for Sister D. Using stretchy material it shouldn't take too long...

Badminton - the good news is that following rest and changing my mouse to the other side, my racquet arm is as good as new, possibly better. Running - I'm getting along OK, I'm nearly half way through a training plan leading up to this pesky 10k plus obstacle course that I've signed up to, but I have a feeling that the race will arrive before the end of the training plan... not that it matters that much.

Work - lots of interesting things and still many frustrations. We tried to entice as many 16 to 21 year-olds as we could onto a specially designed education course for Type 1 diabetes, but out of the thirteen or so who had verbally agreed to come, only two turned up (and for a period of about 15 minutes we thought it would only be one). One of the meter manufacturers has offered to sponsor a course that would include go-karting so as to attract the target audience, but I'm not sure if we'll take them up on it because we don't actually like their meter very much. The company that makes the meter we do like hasn't provided us with a rep since last December, otherwise I'd be very keen to put a bit of pressure on them to help us out.

Solitary holiday #3

Harrogate, July 2015

I liked Harrogate, despite the rain. The town was accessible and attractive, as were the people. Maybe I'll go again next year.

Monday

Despite the forecast it didn't rain all morning, and I ventured out to have a look round. The town is larger than I was expecting and I wandered about fairly randomly, just getting oriented. My first impressions were that the architecture is lovely, there's quite a lot of history reflected in the buildings, and there is no shortage of places to eat, often advertising local produce that looks rather tasty. And lots and lots of shops that I didn't go into. Maybe later in the week.

Like my Solitary Holiday two years ago, I thought I'd like to make another dress, but this time for me rather than for Lola II. My inadequate preparations for this holiday (as usual) meant I hadn't bought any fabric in advance, but I did do a bit of Internet research and discovered that there are two fabric shops within walking distance of my apartment. Two! The first was very small, very crowded, the member of staff I found was rather unhelpful and they didn't seem to have the range I wanted. The other one, however, was bright and airy and despite having less stock overall, they had more than one design in the jersey fabric I was looking for. And I got a whole lot of invaluable advice and information about sewing with stretchy fabric, using a fancy double needle, tips for putting in the zip, and an offer to help me get the hem straight if I couldn't do it on my own.

'Kursaal' or Royal Hall, 1902

Tuesday

Looking into the hall from a box

The rain held off for my outing today, which was to the Royal Hall. This glorious building was built at the turn of the 19th century as an entertainment venue for those coming to Harrogate to take the waters. At the time it was named the Kursaal, but was renamed after the First World War due to anti-German sentiment. At the turn of the 20th century it had deteriorated to the point of demolition, but was saved and restored to its former glory.

'Ambulatory' circuit, Royal Hall, showing doors to boxes

There happened to be an Open Day on Tuesday including a tour of the building. Apart from the wonderful decor, stained glass windows, interesting private boxes and the provision of a walkway all around the outside of the inner hall, the part of the tour that made the greatest impression on me was when we were shown where the rear balcony was. In its heyday, the smart folk of the time would have looked out over a rose garden, a tennis court, statuary and parkland leading up to the grounds of the Majestic Hotel. Now you can see only concrete yards, the bins, and the back of some of the halls belonging to the International Conference Centre.

Wednesday

Today's cultural outing was a tour of the Turkish Baths. Unlike the single spring in Tunbridge or the few in Leamington (now reduced to just the one there too), there are many sources of spa water in Harrogate, and with varying composition including waters containing sulphur, iron and magnesium. The first spring was discovered in 1571, well before Leamington's or Tunbridge's.

The Pump Room (which I visited after the Baths) was built on top of four of these springs, and the Turkish Baths was built just up the road in an absolutely enormous heavy-looking building that now houses the Tourist Information office, a large Wetherspoons pub, a nightclub and a Chinese restaurant as well as the Baths, which have been restored to nearly how they would have been originally but taking account of modern sanitary requirements.

Frigidarium, Turkish Baths

The fixtures and fittings are wood, tile, terrazzo and mosaic floors and glorious walls painted in the Turkish style. Heat is provided by a boiler in the basement, and we were taken through successive rooms from the 'cold' room, the plunge pool through three stages of heat including the steam room. It is still owned by the Council and in use today (although obviously not during the tour) and also offers other 'treatments'.

As the popularity of spas declined in England, lots of buildings were repurposed. The Victoria Baths became Council offices, a building originally built as a theatre or assembly room is now an Art Gallery. In more recent times the town reinvented itself as a conference destination and even hosted the Eurovision Song Contest in 1982 and the end of the first stage of the Tour de France last year. There are still quite a few reminders of Le Tour around town in cycle logos, small sculptures or features on buildings.

The original Pump Rooms, now split into several separate establishments

Thursday

This was supposed to be a mostly fine day so I planned to go to Harlow Carr, a Royal Horticultural Society garden. It can be reached on foot through the municipal Valley Gardens and Pinewoods, so that's what I did. I'm sure the gardens are very lovely and probably comparable with many other gardens I've visited and enjoyed. The main problem was the rain, which took much of the pleasure out of seeing plants and landscape, and then the battery on my camera ran out. Eventually I got so fed up of getting rained on that I gave it up and walked back, at which point the sun came out. Not for long, though.

Dinner was at a Turkish restaurant, where the lentil soup was particularly delicious.

Friday

Throughout the week at odd times here and there I've been working on the dress. Today I haven't planned anything else, so I had a good run up at the most difficult bit - putting the zip in. After two or three attempts I finally decided that the fabric is so stretchy that I don't actually need the zip, which made the business a whole lot easier and could have saved me three hours. I did some cooking, some reading, and I watched a film on DVD. Outside, it rained.

One of the reminders of the Yorkshire Tour de France

Saturday

There's a Parkrun in Harrogate just a few minutes walk from where I'm staying, so I did that. Compared with the lovely Leamington route around the golf course with its monster hill in the second kilometer, Harrogate's course is almost completely flat and just three straightforward laps around a field. It was gloriously sunny and I felt optimistic for better weather at last.

The dress is almost finished, but the final hem went very wrong when I kept running out of thread. The fancy twin needle works surprisingly well at producing a stretchy seam, but is fairly hungry for thread and misbehaves badly when deprived. I had to unpick the whole seam, and it was lunchtime, and I wanted to go to a particular pub for lunch which was near the fabric shop. So I put on the dress with its slightly unfinished seam to show the lovely ladies in the shop, and the moment I stepped out of the door it started to rain.

The pub was a good choice for lunch and the lady in the fabric shop was pleased that I'd come to show her the almost-finished dress. I finished it in the afternoon and then finished up my holiday with a performance of The Gondoliers in the evening, the first event of the Gilbert and Sullivan Festival being held in Harrogate through August. Lovely.

Sunday

More rain, obviously, but sunshine as soon as I got home and went indoors to unpack. That's life.

Waterlogged roses