· Web viewend. Our lives are still on track. We are still parts of families and communities and we still want to find ways to be meaningful. One of the ways I have been able to

Transcript: MD SupportThe Eyes of the Macular Degeneration Community

HadleyMD SupportThe Eyes of the Macular Degeneration CommunityPresented by Dan RobertsDate January 19th, 2017

Ed HainesLet me formally welcome you to Seminars@Hadley. My name is Ed Haines. I am an Instructor at the Hadley Institute and a member of the Seminars@Hadley Team. Today’s seminar is entitle MD Support: The Eyes of the Macular Degeneration Community. This is a terrific organization. I am going to quote from their mission statement, “Macular degeneration support is a worldwide non-profit, public service organization founded by retired educator Dan Roberts. Its mission since 1995 has been to provide information and support for people who are affected by macular

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degeneration and similar retinal disease know more simply as MD support, it is based on the internet and also offers a public awareness program designed to reach people who are without internet access. The founder and most of the organizations volunteers are visually impaired themselves.”

I think this is a fantastic organization and it has really so much to offer, which is why I am very, very pleased that the founder of MD Support, Dan Roberts, has agreed to speak to us today. MD Support reaches out monthly to over three thousand people with macular degeneration and low vision. I know after listening to him today, you will want to be part of that community. I will go ahead now and turn the mic over to Dan Roberts.

Dan RobertsThank you, Ed for making this opportunity available to us. Our members and our affiliates have been listening this month to your presentation on Hadley’s new Low Vision Focus Initiative. I hope you will receive a lot of requests for those audio recordings. Your offer to mail out free informational


CDs to those who don’t have internet access is a step beyond what our organization can offer and it is an excellent addendum to the kind of work we are doing. I hope our efforts are proving to be as beneficial to Hadley, because working together like this strengthens both of our missions and allows us to be that much more effective for the people that we serve.

My presentation will be under thirty minutes which will leave plenty of time for a Q&A afterward. Also, I turned seventy last year, so my train of thought tends to derail easily. I appreciate your holding questions, therefore, until the end to help me stay on track. You could probably go in and type in the questions as they come to you because I do have a lot to talk about and you might forget it if you wait. I am sure that Ed can collect them as we go along.

My life took and unexpected detour in 1994 when I was diagnose with a chronic retinal disease that threatened to put the brakes on a future I had carefully laid out for myself and my family, my three children; but instead, because of that detour, I discovered the joy of helping thousands of others to understand that visual impairment is not a dead


end. Our lives are still on track. We are still parts of families and communities and we still want to find ways to be meaningful.

One of the ways I have been able to give my experience meaning was to form the non-profit organization called macular degeneration support which has been providing information and support since 1998 as an official organization, non-profit, to people with vision loss. Even with the immediacy of the internet, millions of elder seniors are still unconnected to the information and support that could literally save their lives. Recent polls show that 40% of seniors are not familiar with internet technology. My experience has shown that more than half of that 40% cannot or will not take advantage of it. So, they still need intermediaries to pull them into the circle. That means continuing to reach out through clinics and schools, libraries, retirement centers, educational seminars, kiosks in shopping malls, television, radio, and hopefully through their younger family members who are familiar with the internet. That is where organizations like MD Support and the Hadley Institute come in.


You may have listened to a podcast I did for Hadley a few years ago in which I talked about the history of my organization and introduced some of our outreach efforts at that time. I will review some of those initiatives briefly, but I would also like to take this opportunity to update you on some exciting new developments.

MD Support is based on the internet with a large informational website, about a thousand pages now, a telephone helpline, an email discussion group, and a web message board. All of which serves more than 25,000 people monthly. I, and most of our volunteers, as Ed said, are visually impaired people who have learned that the best way to help ourselves is to help others. Our work is supported and guided by a seventeen member advisory board made up of leading professionals in the field. That is who keeps me honest.

Since I last spoke with you, MD Support has joined with Prevent Blindness, a Chicago based service organization with whom we are now sharing all of our resources. With the additional reinforcement they have been able to offer, we have launched


several strategies to help make living with low vision easier. I would like you to know about those.

First, we have a searchable transportation database where people can find paratransit services and helpful information about the services each of them offers. It is unique in that it not only provides contact information, but it lists up to fourteen accommodations that have been established for optimum service to the visually impaired such as verbal identification of stops, assistance in boarding, adequate hours of operation, and whether the service is door to door or curb to curb.

Our second initiative is a library of free informational publications available in large print and online. We have titles such as “A Self-Help Guide to Non-Visual Skills” which is essentially a book on low vision rehabilitation self-help for those people who are not near a rehabilitation institute or a clinic, let’s say out in the nether lands of the country where they are not near a large city that may be better equipped for that kind of help. This is a way they can get started with that and find


references and resources. That is an important one. Remember, these books are all free.

We have one called “Caring for the Visually Impaired” which is to help families and friends understand our situations and our challenges. We have a visual skills workbook. We have one that is just a collection of writings from people from our community over the past two decades: poetry and essays. Things like that that they just put down on paper and they are no collected in this book which is quite a read. It makes you feel much less alone to reach the personal thoughts of these folks.

A third initiative is a new idea – I am very excited about this one – an interactive publication wherein a person can, by filling out a brief questionnaire, create a free personalized book about dealing with their own unique experiences with low vision, specifically macular degeneration. Our first book has been successful. We are now working on a second book about diabetic retinopathy. These books are accessible online or they may be printed out. They are also updatable by the user by simply returning to the site and resubmitting the questionnaire. It is like having a book written just


for you. It is an interesting model that I am hoping other organizations will pick up on: an interactive book.

Finally, this sister site that we have called Prevent Blindness features a news blog that I maintain as Editor in Chief. By entering your email address at the bottom of any article on there, you could receive notices of latest developments in treatment and research for all low vision conditions. It is a good resource, again. All four of these resources may be found at the low vision website. That is at www.lowvision.preventblindness.org. You will find all of these right there on the front page.

MD Support also provides programs for over three thousand people who are without personal access to the internet or live support groups. This, we call the International Low Vision Support Group, or LIVSG. This provides free information and support through audiovisual presentations to groups of senior adults around the world. New presentations are recorded and uploaded to our website each month, year round. They are played our facilitators at almost one hundred and seventy retirement


centers, organizations, clinics, senior centers, and libraries in thirty-seven states in fifteen countries.

The programs include audio visual talks by motivational speakers and leading experts in the fields of low vision care research, low vision products, and rehabilitation. Much like Hadley has on their site with the webcasts. We also pass along web presentations to our groups that are provided online by Hadley and other highly respected organizations. Our group facilitators might be retirement community activity directors or they might be staff nurses or community volunteers or even low vision people themselves. They each received an online facilitator’s kit with step by step instructions for organizing and running a successful support group. They receive access to more than one hundred and twenty past and present presentations for viewing or listening either on our offline. They receive immediate answers to their questions through personal email and contact with me. They also get monthly planning materials including descriptions of upcoming sessions, meeting reminders, handouts, and a large print monthly newsletter with special features and updates on research and developments.


This is because I want people to be encouraged not wary of starting a support group. It doesn’t have to be difficult. We help them in every way possible, especially by helping them with programs, because that is the hardest part of running support groups is coming up with programs. Well, now there are plenty of them online that are available for absolutely nothing to the general public. Those may be accessed.

In spite of the success of that group, the International Low Vision Support Group, I was frustrated that we were still not reaching a large segment of the low vision community that is unconnected due to physical and geographical or technological limitations, so it made sense to incorporate telephone conferencing technology into our outreach. That used to be high tech and it is still around and everybody can get to a telephone. That led to an extension of the ILVSG, what we call Telesupport. It is a free year round program of monthly support group sessions held over the telephone. This has served to connect more than 250 people since it began in 2008. Each forty-five minute session typically includes a brief


update on research and developments followed by listening to and discussing the current month’s recorded ILVSG presentation. The members all receive through postal mail the same newsletters and handouts that are sent to our ILVSG facilitators. An additional perk of telesupport is that the members who wish to do so may share their phone numbers with one another for personal communication between the monthly meetings. This “phone pal” you might call it aspect of the program is optional with phone numbers, otherwise, remaining totally private.

Now, why are we doing this? Well, personal reason for one. I am trying to be the person who I wish was standing outside of the clinic door when I was diagnosed back in 1994. I needed answers to my questions, I needed help I needed to know where to go. The doctor didn’t have the time because there were a lot more people like me sitting it the waiting room. Being a former teacher, I just decided to go ahead and just change my subject matter from Choir Directing, which is what I did as a high school teacher, and I now am focused on low vision and helping to maintain quality of life for people who are dealing with low vision. I have used


a lot of those people as my…I guess you could call them “missionaries” in the field. They go out. They spread the information around, they get it out, they help me with the databases, and we all now have a sense of purpose that I think everybody needs when they are subjected to this kind of a challenge in their life.

Due to disability, lack of transportation, or lack of internet access a large number of low vision people, as I said, are being left out. This is our way of reaching those people with the same resources and support that we have been sharing with millions of others over the two decades of MD Support and Living Well with Low Vision websites. Again, I appreciate Hadley doing the very same thing and joining us in the effort and us joining them. We will definitely continue to work together to get the word out to those folks.

Then, in 2014, just as I was thinking we were filling the gaps in the information in the support network provided by not only us, but by many other similar organizations. My friend Liz Troynik who is Director of MD Foundation called me. She had just come back from the National Convention of the American


Council for the Blind in Las Vegas, Nevada. There she saw a definite need for guided assistance programs at Low Vision conferences. She asked me if there wasn’t anything we could do technologically to help solve the problem of people just being totally lost in these large areas.

I accepted the challenge and after several weeks of research, decided that the new Bluetooth low energy way finding technology was the answer. I contracted Indoo.rs, that is actually their website. It is a way finding technology company based in Vienna. I contacted them to design an app that would not only audibly describe the unique indoor environments of low vision conferences, but would help the attendees navigate to each point of interest with ease and accuracy.

I called the app Low Vis Guide. Unlike portable GPS devices that use satellite technology, it is usable indoors where access to satellites is not available. Using a smartphone or tablet with voiceover, the users can audibly look around the venue no matter where he or she is standing and then call up directions and routing assistance to any point of interest. We launched it in May 2015 at the


National ADA Symposium in Atlanta where a man name Bill DeMaio was the first person to use it. For those four days, Bill could see through walls; which is really saying something considering he had zero eye sight.

For years, bill could find his way around an unfamiliar building, only by either asking people for directions or hoping to find Braille signs. But then, on that day in May when I met Bill, he was given an extraordinary gift of sight with this new app. Let me read an excerpt from an article that we published about his experience. It is brief. “He stood with his guide dog, Isaac, in the middle of the Hyatt Regency Atlanta hotel’s pre-conference area. Neither of them had ever set foot, or paw, in that room before, but after simply listening to his iPhone for a minute or so, Bill was amazed to be able to describe and give directions to meeting room, restrooms, vendor booths, and other points of interest in the entire conference area, even those that were beyond normal site. Once he realized that he was now on equal or better par with his fully sited counterparts, he decided to sign in. Turning toward the registration table fifty feet away and around the corner, he guided Isaac to


the exact location. That is right, Bill guided Isaac.” Isaac was his guide dog. “Whose look of canine bewilderment was matched only by the big smile on his owner’s face.”

Since Bill’s experience two years ago, we have provided the service for more than twenty events including national and state conventions at the American Council of the Blind, state conventions for the National Federation of the Blind, the Blinded Veteran’s Association, Guide Dogs for the Blind, and the Alliance for Equality of Blind Canadians.

How does that work? Location information is transmitted by small electronic beacons placed about sixty feet apart throughout the venue. Concession areas, meeting rooms, exhibit areas, registration tables, restrooms, you name it, they are all customized to the organizations specifications and mapped out in advance. The app then identifies the locations both visually and vocally through the users Apple iPhone or iPad bundled with Bluetooth 4 capability and with voiceover turned on.


Anybody with a current Apply iDevice can independently navigate these large and often confusing venues. We are hoping that Low Vis Guide will provide a safer and more enjoyable experience for all who attend these functions. Low Vis Guide is unique, so you won’t – unfortunately – find it duplicated anywhere else. We have refined the technology of indoor mapping to specifically assist blind and low vision users at temporary events like conventions and conferences.

In addition to visual mapping, it uses voiceover and audible tone routing and it is customized to the particular layout, features, and time frame of the event. Those functions are too precise and short-term to be useful in more general environments. What you do is when you walk in the front door, you pick up your iPhone. My system isn’t available for Android. It is available, at this point, for iPhone users who know how to use voice over.

What they do, the minute they walk in the door, they open the app and it immediately starts talking to them. It starts telling them what is around then for up to as many feet as they set it for. That is called the “Look around” feature. If they want to go


someplace, if they hear something about, say there is a coffee bar, they hear that is fifty feet to their left. Well, that might be through a wall, so they do have to be careful not to turn left as start walking because it would be on the other side of that wall. Like I said, Bill DeMaio said he could see through walls. That is what I was talking about.

So, they turn on the navigation tone. There is a way to do that and this tone will then sound if they are going the wrong way. I like to compare it to my wife who when I used to drive, if I could hear her, I knew I was going the wrong way. If she was quiet, I was going the right way. That is how the app works. She loves it when I mention that. The tone, as long as you keep it quiet, you are going the right way. It will take you around pillars, it will take you around furniture or through doorways and take you to within three meters of that coffee shop. That is how it works.

It has been amazing to these folks, unfortunately a lot of these people don’t yet have iPhones who attend these conventions. Now a lot of them are buying iPhones because they want to come back next year and be able to use this app. It is going to


be available lots of places, but not my app. It is specifically for low vision conferences. It is donated. It is supported by grants. This doesn’t cost the organizations anything, but people who are low vision and visually impaired and blind will be able to start seeing these in stores and shopping malls and amusement parks, hospitals, just about anywhere the public gathers, we are going to start seeing these commercially placed in these areas so that we will be able to find our way around.

Our challenge is to make sure that they are not just visual maps on an iPhone. Mine is audio as well as visual. It tells you what is around you. We are hoping that in the future… and I implore you, if you go to a place that has this available and it doesn’t have audio, please don’t be quiet about it, you know it is possible. It should have audio for us and many people like us. Help spread the word. It is coming. It is going to be in many, many places and we are going to be able to take advantage of that. It is called Indoor Way Finding. It is also called Indoor GPS. It is not really GPS, because it is not satellite. It strictly works on beacons that act like little cell towers around the building.


Enough of that. I could go on and on about that. I probably already have too much. I want to end with that. Then, if anybody has any questions about that or any of the other projects that we are involved in or has any suggestions about what gaps we need to fill next, please use the Q&A time to do that. I want to thank, again, the Hadley Institute for the excellent service it is providing to the blind and the visually impaired and for its willingness to work in tandem with organizations such as MD Support for the benefit of everybody. For more information about MD Support and all of our outreach efforts, you can find us on the internet at www.MDSupport.org. Ed, I will turn it back over to you.

Ed HainesThanks, Dan. That is a lot of information. I had several thoughts that made me excited when I was listening to your presentation. I think I will wait for questions first before I chime in with what I was thinking about. We do have a listener who texted in two questions, specifically. Number one, he is curious about exactly what macular degeneration is and secondly, he wants to know if there is


http://www.MDSupport.org/

actually a telephone number that he can call to be part of your community?

Dan RobertsYes, that is Dale I think that asked that questions, if I am correct or at least that is the screen name. Macular degeneration is a disease of the central area of the retina, the back of the eyeball. It is kind of the opposite of retinitis pigmentosa. RP affects the peripheral vision. Macular degeneration affects the central vision because it is the macula that is affected. It is thought to be caused by poor nutrition of the cells or aging. Mostly aging is to blame. We are just outliving our eyes is the problem. We are not supposed to be living as long as we are nowadays.

The eyes, the retina, is a very delicate tissue. It is affected by inflammation and by simply aging of the cells so that we gradually lose our central vision over a period of months and years. It is a very slowly progressing disease. If you have to have a disease of the retina, this is probably the most generous one because it gives us plenty of time to adapt and to learn about new techniques


and technology that can help us live with a loss of central vision where we can’t see people’s faces or read or see details. There are ways to work around it. Actually, 99% of everything we do during the day, we can do if we were totally blind. I am not talking about going to work and doing that kind of task, but normal daily living activities, we can perform 99% of those with loss of total vision.

Macular degeneration doesn’t make us blind. Retinitis pigmentosa doesn’t make us blind. There are blinding diseases. There is glaucoma. There is diabetic retinopathy that can do that. But, we make sure that everybody knows that they can work around the problems by using their other senses. I hope that answers your questions. I probably got a little bit preachy there, but that is what it is. If didn’t explain it well enough, Dale, go ahead and ask me again.

The number of the helpline where you can reach us is toll free 888-866-6148. That is 888-866-6148. Thank you, Ed. He put that number up on the chat. Give us a call. You can also go to www.MDSupport.org, that is our homepage. My phone number is also there and my email address.



You are free to write to me at [email protected].

Ed HainesDo we have any other questions?

UnknownYou mentioned something about the support groups. Tell me more about being able to get speakers for those.

Dan RobertsThe speakers that we provide are all recorded ahead of time. They will either do a specific recording for us like Ed has done for us this month. We are also using one of his recordings, one of his webcasts, in March. These are not live speakers, I want you to understand that. The way this operates is we have, as I said, about a hundred and seventy affiliates. Each affiliate has a person who is, say, the Health Director of a care center or of a retirement home. We are in touch with those people monthly, by email. They receive presentations from us that have been done for that


mailto:[email protected]

month which are playable over the internet and they can then play those for their support groups. They are also visual. We format them as PowerPoint presentations with slides and talking points along with the audio for people who do have some functional vision who do like to be entertained a little bit visually.

That is how they receive these and you could, if you have internet access, you can see the same programs on our website at www.MDSupport.org. You go to the Audio Visual Library and you will find about a hundred of them that are right there for you to look at any time you want or play it for support groups. Did that answer your question?

UnknownYes, it answered my question. Thank you.

Ed HainesDan, this is Ed. I just had a couple of comments and then a question. First comment is, I don’t know if you know this, but the founder of Hadley, William Hadley, was also a retired teacher. Of course, we



are almost a hundred years old, so it is interesting to note how two retired educators have built these great institutions and programs. I thought that was great.

Also, the indoor way finding, I just had a comment. I wish I had listened to this presentation a week ago because I was asked by the Transportation Security Administration to give a talk about low vision and the difficulties people with low vision encounter when they are negotiating the TSA process. I gave it actually to the TSA personnel and they have got that archived. I can think of now immediately a hundred applications in an airport where the wayfinding technology would be appropriate. It was interesting to hear about it.

Now, my question is about affiliation with your organization, if you are a support group leader are there restrictions or specific requirements to be an affiliate? In other words, if I ran a support group and I wanted to use my own presenter sometimes, but on those times when I didn’t have a presenter, I would like to use your material. Is there a requirement that the group leaders use your offerings monthly faithfully or can they kind of


intersperse your programming with what they are already doing? I don’t know if that is a really clear question, but I wonder if you could answer that for me.

Dan RobertsThat is an excellent question. I should have covered that. No, there is no requirement that they must use our programs. As I was a support group leader myself before I decided to make this worldwide and do it the easy way, do it on the internet instead of running all over town to support groups. One of my biggest problems was “What material can I do next month that is going to keep these people interested in coming back and socializing with each other and forming, really, a successful group. Programming is the hardest thing there was. Sometimes it wasn’t. Sometimes I would get people right away, but there was a gap there. I am kind of a gap filler. That is what this is. It is there if they need it.

For example, sometimes they can’t get through the whole summer and find doctors and people like that who are willing to come and do presentations.


Well, some of these are excellent for that kind of thing, just for filling in when you can’t get somebody. I always recommend that they find a live person whenever possible, just like I always recommend that people find live support groups whenever possible, as opposed to, say, our telephone group. But, you need to have backups and that is what we are trying to provide here.

Ed HainesThat sounds fantastic. It reminds me that there are other organizations now establishing support groups for seniors on the telephone. One is called Senior Center Without Walls out in California that is doing some fantastic work bringing seniors together in virtual support groups by using just basic telephone technology. They also have low vision groups. I am sure they would be interested in what you have to offer, as well. I think it is a really valuable resource. I have spoken to a number of these virtual telephone support groups and they obviously give a great deal of meaning and interaction to individuals who otherwise might not have it.


Dan RobertsYes, I have been in touch with the Seniors Without Walls support center out in California. As a matter of fact, one of their members stays in touch with our telesupport group to get the programs. One disadvantage they have is they don’t necessarily have… The leaders of the groups are the ones who need the information and that kind of thing. A lot of times they have had trouble finding the information that they need. That is one place where we can help them, because we do have the resources to help them to help others.

When I first started this, there were no other support groups like this. I am so happy to see that these folks are taking this over and spreading this. We, ourselves, are going to be working with Prevent Blindness during this next year to increase this as much as possible. A hundred and seventy sounds like a lot of groups, but we are talking about thirty-six states in seventeen countries. That just barely scratches the surface. We still have a lot of people out there who need to be able to get this kind of information.


Ed HainesI completely agree. I think the National Eye Institute is estimating that by 2030, there will be six million seniors with low vision in the United States alone. There is a huge population out there that we are not yet reaching and that we will need to reach. Does anyone else have any other questions?

MargaretYes, Hi. This is Margaret. Wonderful presentation. My husband and I are about to move into a retirement community. I was wondering about the efficacy of inquiring whether people there who organize speaking events and similar types of things were aware of your organization and maybe making them aware of it if they weren’t. Do you have any thoughts on that? Thank you.

Dan RobertsHi, Margaret. Yes, definitely, let them know. If they haven’t heard about it, I am surprised. If they haven’t heard about it, we need people like you to let them know that we are here. We can take as many… We can go to infinity with the help of the


internet and broadcast emails. We can help an uncontrolled number of people to start groups like that. If you are moving in there, you sound like an excellent resource from them and I would love to work with you on maybe starting a group if they don’t have one. You might want to give that some thought.

MargaretThank you. I will. It was just kind of an impulsive question, but yes, I will be happy to consider that.

Dan RobertsMy whole life has been based upon impulse. That is why I got myself into this. It never hurts to jump in as long as you know how to get out if you have to.

Ed HainesAny other questions? Well, for those of you who are not reading a text box, Julie did write in and ask if we are going to be archiving this presentation because she has some friends who would definitely benefit from the webinar. Yes, indeed, we will archive it, as we do with all of our webinars. I will


mention to you, Dan, that I think we have had about ten participants today. Normally, within about six months or so of our low vision focus webinars, we have had five to six hundred individuals who have listened to the archived version. So, this has a pretty broad outreach. Those of you who have asked questions today, you can know that your questions will be heard by a lot of people.

Any further questions? Hearing none, let me officially close this webinar. I have some housekeeping to go through. As I just mentioned, this seminar recording will be archived on the Low Vison Focus website at www.LowVisionFocus.org. As well as the Hadley Institute website www.Hadley.edu. The recordings are available, of course, 24/7. Each of the recordings is now also available as a podcast. You can download it and listen to it on your computer or mobile device. For those of you on Twitter, Hadley’s Twitter hashtag is #SeminarsAtHadley.

Thank you everyone for participating today. I really appreciate it. We do, of course, value your feedback as I mentioned earlier. Please let us know


http://www.Hadley.edu/

http://www.LowVisionFocus.org/

what you thought of this webinar and we are always looking for suggestions for future webinar topics by sending an email to [email protected] and by completing the short survey as we conclude today. I am now going to hand the microphone back over to Dan for him to give a final goodbye and then he can sign out. Go ahead, Dan.

Dan RobertsI have greatly enjoyed meeting you. I know ten people doesn’t sound like a lot, but I have been all day on telephone conferencing with my telesupport groups and out of sixty people today, I think they only had about twenty. So, I think it is the time of year, but having it archived is a great idea because then people can tune in at their leisure. I will also send people to your site there. I hope, Ed, that you are starting to get phone calls from our folks from today, because every one of them was excited about the Low Vision Focus Initiative on the CDs and cassettes. I hope you continue with that and add even more information to that because it is going to be a very popular topic in our community.


mailto:[email protected]

Ed HainesDan, thank you so much and thank you for presenting today. You have got a fantastic program and you have done so much. I know I need to talk with you more about some…just to tap your brain and all of your expertise because you have such a wide outreach. Thank you for your time today. Now, I understand why your voice is hoarse, you have been talking all day long. Thanks for soldiering on. Diane Tex, thanks so much for the wonderful information and Julie says, “Thank you so much, Dan.” She will be visiting your website. Sue also says, “Thank you, Dan. Great topic.” Thank so much.

For more from the iFocus Series, including many other topics of interest to individuals with vision loss, visit the Videos@Hadley page on the Hadley Institute website at www.hadley.edu.


Documents

· Web viewend. Our lives are still on track. We are still parts of families and communities and we still want to find ways to be meaningful. One of the ways I have been able to