Lisa Wehr's Public Health Blog

Lisa is originally from Sigourney, Iowa. She attended Iowa State University and received her bachelor’s degree in Music in 2010. She is currently a first year Master’s of Public Health (MPH) student in community and behavioral health (CBH). Lisa works on the medicine-psychiatry unit at the University of Iowa Hospitals and Clinics (UIHC). Through this blog Lisa hopes to let people learn about the CBH department.

This student blog is unedited and does not necessarily reflect the views of the College of Public Health or the University of Iowa.

26 December 2011

Happy Holidays

Since I never get my snail mail cards out on time (as most of my family/friends will attest to)....why should anyone expect me to get blog cards out on time?

But here they are:

Courtesy of the CDC:
Deck Yourself for Flu
12 Ways to Health

14 December 2011

Correlation Does Not Equal Causation

I've been posting a lot recently...must be a finals week phenomenon.

But a few weeks ago I was watching an old Frontline episode about the conflict over vaccines and autism. (you can watch it here)

The biggest take home message is something most scholars are familiar with: "Correlation does not equal causation." And funnily enough, today I came across this from business week. It amused me. (click on the picture to see all six graphs in full size)

And in 14 hours I'll be starting my environmental health final! And in 16 hours I'll be done with the semester!


13 December 2011

Mobile Health

After writing my post about twitter I got to thinking about other ways mobile devices (namely a smartphone and ipad) had changed how I consume information...particularly in the realm of health.

A smartphone really was the turning point in my twitter usage. Following a significant number of feeds while only checking on it once or twice a day in a browser is not pleasant and I definitely don't have the attention span to read several hundred tweets (honestly, I don't even have the attention span to write an entire blog post). However, on my phone one touch, a couple swipes, and I've read my tweets. The time required is minimal and my phone is always with me so I check it multiple times a day.

But twitter isn't all that my phone/ipad have changed. I have become somewhat of a blog fanatic because now I no longer have to go to a zillion different blog sites, or even to google reader. I pull up the app on my phone and everything is right there whether I have time to read one post or twenty. (I think I will dedicate a different post to the public health blogs I watch)

And there are several dedicated apps that are amazing for public health. Harvard School of Public Health has an incredible app. It combines official news stories, tweets, videos, podcasts, pictures, an events calendar, a community section where app users can post and interact with each other, links, and more!

The apps have grown more slowly than twitter accounts or blogs, and are dominated by the medical field (although as I said before, don't rule out anything because it's not strictly public health). I'm sure much of this is because of the time and effort required to make a functional app. But there are a couple.

  • HealthMap: Outbreaks Near Me--the mobile extension of
  • Government Health News--news from U.S. government agencies related to health
  • This Is Public Health--just fun. Take photos with your phone and virtually add the "this is public health" sticker to them. 
Some that are in the medical realm but could easily be used with a public health bend are ones that illustrate surgical procedures, give vaccination schedules, provide disease/medication information, and assist with medical Spanish.

And there are countless apps for the health consumer. Ones for weight loss, exercise, medications, medical records, disease management.

Mobile devices could be the next rising face of public health.

11 December 2011


How do I keep up with public health news?  The number one way for me is through twitter. I have become increasingly more fascinated with twitter recently and particular it's role in health/medicine/public health.

Somewhat recently (as in October...time goes fast) Mayo Clinic in Rochester held their 3rd annual social media summit. Being a social media summit, the event was heavily tweeted and blogged. There is a catalog of blog posts from the event available on this blog. However, it also brought up many ideas of social media in health and questioned many commonly held notions. Shortly thereafter, was APHA. Perhaps because I had just "watched" the entire MayoRagan summit through twitter, I was a little disappointed in the number of tweets that came out of APHA. There wasn't much.

Some other things that have come up regarding health and social media is the use of Twitter to follow health trends (there is also a service on google that tracks this) and a more recent story from NPR about agencies using twitter to track health misconceptions. Both really interesting concepts that I'm sure will see growth and innovation in the near future.

So want to get your news watching up to speed?
Here are the list of health-related twitter users I follow:

  • APHA (@PublicHealth)
  • Iowa Department of Public Health (@IAPublicHealth)
  • Health Corps (@HealthCorps)
  • SAMHSA (@samhsagov)
  • Iowa Primary Care Association (@iowapca)
  • Wendy Swanson-an MD interested in social media use in health (@SeattleMamaDoc)
  • John Hopkins School of Public Health (@JohnsHopkinsSPH)
  • Harvard School of Public Health (@HarvardHSPH)
  • Robert Wood Johnson Foundation-Public Health (@RWJF_PubHealth)
  • UI Health Care (@uihealthcare)
  • APHA Annual Meeting (@APHAAnnualMtg)
  • American Academy of Family Physicians (@aafp)
  • American Medical Association (@AmerMedicalAssn)
  • Journal of the American Medical Association (@Jama_current)
  • Yale Medicine (@yalemedicine)
  • Virtual Mentor-a medical ethics journal (@VMethics)

One thing I can say is to not write off any one user because they are more medically related (like the American Medical Association). There is some really great research that comes through these organizations and is extremely applicable to public health.

A great way to start off your list simply googling a phrase like "public health twitter users." Here's a site to start you off: 50 Public Health twitter users to follow. As you continue to use twitter your list will continue to grow. I have added a lot of users because one of their tweets was retweeted by someone else I follow. It's like visible virtual networking :)

Give it a try!

25 November 2011

Environmental Disparities

As I was driving this week I caught up on some of my NPR podcasts. One just blew me away. It was about the community, environmental pollution, and resulting health issues around the Tonawanda Coke factory [read/listen here]. For years the factory was emitting toxic substances way above the levels reported to the EPA. Through years of concerted effort by the citizens and the help of an insider at the factory. The state environmental agency refused to test for many of the chemicals for years because of the cost. The citizens started their case with a air sample device made out of a bucket and other supplies from a hardware stare.

It makes one wonder (and even the reporter mentions this) how much earlier would this have been stopped if the factory was in an affluent community?

Why should people be testing their air with homemade bucket devices? Why were plant inspections scheduled, giving the factory a chance to change the settings on devices that routinely emitted toxins like benzene?

And upon coming home and looking up the article again I discovered this is part of a series called Poisoned Places: Toxic Air, Neglected Communities. If you have any interest in health disparities or environmental health I would suggest check out the series' page as it has links to all of the stories and a map of the government's watch list for certain non-compliant facilities (and an explanation for which non-compliant companies wind up on the watch list), including 3 in the Iowa City/Coralville area.

Oh, and a happy belated Thanksgiving!

08 November 2011


I painstaking typed out a post on my iPad the last day of APHA. And as I was saving it the app crashed. I was irritated to say the least. Too irritated to retype it and between the flight home and catching up on laundry and work, I no longer remember what I had even written.

APHA was crazy! Tons of people and tons of exhibits and tons of sessions. I'm planning to watch the keynote speeches I missed on the APHAs youtube soon as I finish my focus group paper. I definitely heard some interesting speakers and some not-so-interesting speakers. Went to a really great session on social marketing and mass media.

Here are a few pictures from the trip...

First up is all the CBH students in attendance, with the lovely Dr. Parker.

And the Library of Congress. I squealed inside when I got my reader ID and was able to go in the reading room.

14 October 2011

Environment and Health

This is an extremely random post of only slightly related thoughts. My only excuse is that it's a Friday.

The environment plays an interesting role in my life. I could go on for hours about the topic. My interest in the environment really enhanced (maybe even resulted in) my interest in food, environmenalt health, and other public health topics. This video isn't related to health, but it's about the environment and definitely one of my absolute favorites. You should all watch it. Right now. Seriously.

Mr. W

heehee. It never fails to make me laugh. And to think that Germans are unfairly accused of being humorless.

Also...the topic of environment constitutes my first academic "contact" with public health (and specifically public health at the University of Iowa). I attended the Environmental Health Sciences Institute for Rural Health (EHSI) from the Environmental Health Sciences Research Center (EHSRC) in 2004. The two people I distinctly remember from that are David Osterberg and Peter Thorne (two college of public health faculty). And my final project was on antibiotic use in animals. I wish I could say it was a defining moment in my public health interest, but I honestly have no memory of any defining moments in my public health interest.

And if you really want to see another video only marginally related to health (via my convoluted logic) watch this parody of all the communication campaigns.

The first minute never fails to make me laugh. After that I just lack Star Wars knowledge. (In full disclosure the only Star Wars I have ever watched is the Family Guy version.)

And one final bit of random:
Is there a standard height for couches and other furniture? Every couch I have ever owned has been just high enough for tennis balls to slip under. Like this.
Every week or so I have to do a dog toy "rescue mission." This was last night's haul (with the accompanying dust bunnies)
And in case you were wondering, those really are paint rollers in the picture. What can I say? Zef's a cheap date. And literally 5 minutes after I took this picture another tennis ball succumbed to the couch.

12 October 2011


In the professional sense, that is.

I have heard for years how important relationships/networking/who you know are in life. But since starting college, and particularly since starting graduate school, that point has finally started to hit home.

When I started college as a music major I naively thought that I was going into a field where success was based purely on performance and relationships only mattered once you had the job. I learned very quickly that it was no different than anywhere else. Yes, the ultimate job offer was based purely on performance (in professional orchestras this is achieved by screened auditions, where the auditioners cannot see or speak with the auditionee...they only hear their playing). However, it took some serious networking to be invited to those screened auditions. This was achieved through conferences, masterclasses, lessons with professionals, competitions, and other such activities.

These relationships are just as important in public health. That didn't surprise me as much as the helpfulness of everyone I have worked with in public health. I am currently looking at various ideas for my practicum. I'm not planning on completing it until summer, but I figured an early start gives me more opportunities to find something I am really interested in and more time to figure out the little details. I have done some "cold call" type looking, but the best results have come from asking people I know. Randomly contacting AHECs, researchers, and others often results in somewhat uninspiring responses. Not because they don't want to help, but because you are just one person among many who are probably contacting them and they don't have a personal connection with them.

The best talks/leads I've had so far come directly from people I know. It started by talking with residents on the unit I work in at UIHC. I started here because the integration of psychiatry and primary care is what I'm interested in and many of our residents come from combined internal medicine/psychiatry and family practice/psychiatry programs. This led to mention of a staff doctor who does research and is known to be extremely helpful to interested students. In talking with this doctor we determined that his current work might not be the best fit for what I want to do, but here comes the better part. He knows someone who is currently working on something that appears to be precisely what I'm interested in and he introduced me to her. And the best part? He offered that if things didn't work out with this other researcher he would be willing to carve out something within his research. Wow. I also have some conversations in the works with my nurse manager and the nurse educator for the behavioral health services at the hospital.

My suggestion: ask.

I know it's not easy, and I am one of the worst offenders. I hate asking people for help. I'm always afraid of being a nuisance, getting rejected, or other awful things. But the truth is, most people aren't like that. In fact, I have yet to come across someone who has told me or acted as if any of those things are true. I had trouble asking around about practicums, but the world has not stopped turning, and no one has chewed me out yet. I was afraid to ask a physician if I could interview him for a class project, but when I did he was not just willing, but excited to. And he led me to another physician, saving me from having to make a cold call.

There are never shortages of opportunities to talk and meet new people. Speakers are constantly coming through the college and university, there is a plethora of conferences in the field, and we have an amazing faculty available to us. Make use of it while you're still here.

And don't forget that tomorrow I'm attending the Iowa Rural Health Association Annual meeting and will be tweeting at with hashtag #IRHA11

10 October 2011

Social Media

In a discussion with other members of the CBH student association we have decided that specific social media accounts for CBHSA are not necessarily practical or more useful than what we already have. I already use quite a bit of social media so I have opened up my personal accounts and use them for a lot of public health related links and thoughts.

My tumblr blog is a collection of all the interesting links I come across in my days. The reason for a separate blog is that there is such a large number of them and I don't write full blog posts. It also serves as an archive for myself so I can easily find links I know I've seen before. Not all relate to public health, but a great number do (because that's what I'm interested in). And quite a few include brief comments by yours truly ;) The link for that is

I also have a twitter account. The twitter account links to both this blog and my tumblr blog. I also use twitter as a quick and easy way to write real-time updates on conferences I attend. I'll make sure to announce it on this blog when I'm at a conference and tweeting (if you're impatient the next one I'm attending is the Iowa Rural Health Conference on October 13 and I will be using the hashtag #IRHA11). My twitter name is lwehr. You can see it here or follow it on your favorite platform (I personally like tweetdeck).

I have also dabbled in Digg, LinkedIn, StumbleUpon, but don't use them very much. Are there any sites I'm missing?

Also, the APHA hashtag is starting to see some activity as the annual meeting moves closer. Check out #APHA11

October 10-16

CBH Events
Oct 12, 11 a.m., Faculty cadidate seminar, 283 EMRB
Oct 12, 11:30-1, PATTC Webinar (presented by one of our own students, Bob Rohret!), register here

CPH Events
Oct 11, 12 noon, MPH Seminar. B111 Med Labs
Oct 12, 11-1, CPH Info fair, EMRB Atrium (Be like me a recruit all your friends to public health)
Oct 13, 11-1, CPH Info fair, 2600 University Capitol Centre
Oct 14, 10:30 a.m., CPHSA meeting, BSB 1-107

Other Public Health related events
Oct 13, all day, Iowa Rural Health Association Annual Meeting, Johnston, IA (I will be attending this)
Oct 13, 3:30-6 p.m., UI Sustainability Rally, Kinnick Stadium, register here
Oct 14, 1 p.m., ECO Hawk Waste Audit of Burge/Daum Residence Halls, basketball courts behind Burge (U of I)

07 October 2011

Cheap Food

When we discuss the challenges of healthy eating one popular argument is the high cost of healthy foods. Recently I came across this article by a dietitian with a meal plan to eat healthy for one week for $36 (for one person). That works out to just over $5/day, or about the cost of a single McDonalds combo meal. Take a look at the article, meal plan, and shopping list and see what you think. Does this seem like a viable solution? One thing that could be an issue would be prep time and knowledge.

As an aside regarding homemade vs fast food check out this article. I think my favorite argument is the one regarding the time cost of fast-food:
Others will argue that the McDonald’s version is more “convenient.” This is nonsense; in the time it takes to go into a McDonald’s, stand in line, order, wait, pay and leave, you could make oatmeal for four while taking your vitamins, brushing your teeth and half-unloading the dishwasher. (If you’re too busy to eat it before you leave the house, you could throw it in a container and microwave it at work.
The original article on cheap healthy eating also doesn't address food deserts. (Speaking of which did you know that the Economic Research Service within the USDA actually has an interactive map of food deserts in the United States. Cool, huh?)

 I don't think there will ever be a simple "one-option" solution to better nutrition for everyone. However I do think that ideas and articles like this one, which offer alternatives to common arguments and get us thinking outside the salad bowl are a good start.

05 October 2011


Another typical day at school.

Environmental Health lecture about workplace health.

Then it was Designing and Implementing Interventions. We discussed the application of theory in designing health interventions and then each student discussed the theory/theories they intended to use for the intervention that is our semester project.

The more I write the more I wish I had taken a technical writing course at some point. Don't get me wrong, I manage, but having more background experience would be nice at times. I've been browsing the open courseware at MIT and found the materials for both a general scientific/technical writing class and one specifically focused on medicine and public health. When I get some time I'm going to look into what's available on them. But unfortunately I know that looking through online class materials will never be as good as getting critique from an instructor.

Tomorrow we have an early journal club and then I'm headed down to Sigourney for the afternoon. As part of my Communicating with the Community class I have to interview "key stakeholders" for my project. Tomorrow I'm interviewing a primary care provider. Tonight was spent revising my interview guide in preparation.

And on a side note: I made my own butter! It's pretty easy and it tastes absolutely heavenly. This plays into my mild obsession with "real food" Real food is a term coined by Michael Pollan. Here is a brief article explaining it, if you want something more in depth I would suggest reading his book In Defense of Food.

03 October 2011

Fat Tax

Denmark's new "fat tax" on food containing more than 2.3% saturated fax has caused an explosion of news stories.

This is the latest attempt to reduce obesity, the public health concern of the century.

My question is what happens with the income generated from the tax? Will it be used to fund more obesity treatment/interventions? That would seem a logical choice and probably the one to make the most health difference.

This BBC story is brief but brings up some interesting questions.

Similar ideas have been discussed for soda and the like in the United States. With this move by Denmark perhaps we will get actual evidence on the efficacy of such interventions.

02 October 2011

October 3-9

CBH Activities/Meetings
Oct 6, 8:30 a.m. Journal Club W421 GH
Oct 6, 11 a.m., CBH Seminar-Julie Ansager, 283 EMRB

CPH Activities/Meetings
Oct 5, 7 p.m., ECO Hawk meeting, IMU Purdue Room
Oct 7, 3:45 p.m., CPH Open Forum, 1117 MERF
Oct 7, noon, Start Somewhere Walk (link)

Other Events related to public health
Oct 5, 1 p.m. CDT, Policy Webinar (using policy as a tool to improve population health), link
Oct 6, 10 a.m., Webinar on Final Review of Healthy People 2010, link
Oct 7, (all day) HIV/AIDS Conference @ hotelVetro, Iowa City

18 September 2011

Week of September 19th

I'm trying something new. I get massive numbers of emails with different events on different days. Sometimes I get them 1 week ahead, sometimes I get them 4 weeks ahead. They all too easily fall to the bottom of my inbox and the date passes. a service to everyone I am attempting to compile these emails as they come into my inbox. Then, every Sunday I will send out an email with events for the next 7 days.

The next few weeks I will try different formats. I would love to get feedback on what people think of this (e.g. more events? less events? different events?) This week I am organizing everything by day. Next week I will try organizing them by event type.

Monday Sept 19
5:30-7:30 p.m. Free CPR/AED Certification and Alcohol Bystander Training. Brochure

Tuesday Sept 20
APHA Get Ready Day
CBH Picnic! (You should have already signed up for this one...)

Wednesday Sept 21
ECO Hawk meeting, 7 pm, IMU Purdue Room
Thursday Sept 22
Fall Job & Internship Fair, 11 am to 4 pm: IMU Main Lounge website

Lecture-Memories of Oakdale Sanitorium, 5:30-6:30 pm: UI Main Library, Room 2032

Friday Sept 23
Child and Adolescent Mental Health Conference brochure

08 September 2011

I'm still here at this lovely conference. Unfortunately I don't have a great tool for in depth updates (aka something with an actual keyboard- I left my iPad keyboard at home). But if you want brief immediate updates check out my twitter feed ( I'm tweeting the conference with the hashtag #ehconference ~L - Posted using BlogPress from my iPad


Today I'm attending the "Engaging Communities to Advance Environmental Health Policy" conference here in Iowa City. I'll have updates later tonight or tomorrow. ~L - Posted using BlogPress from my iPad

02 September 2011

Here we go again!

The University is back in full swing. I have finally gotten my work switched to the right schedule and am getting settled into the routine of classes again. Even though I took classes over the summer I also worked full-time. Inverting the balance to full-time classes and part-time work definitely gives it a different feel.

We have some great new students joining the department this year. I have one picture from the various orientation activities we had. There was also a digital photo scavenger hunt, but unfortunately none of the students participating have sent me those pictures yet (hint hint).

This semester the classes I'm taking are Environmental Health, Designing and Implementing Interventions, and Communicating with the Community. So far it's turning out to be a great lineup. And I only have class 2 days/week, so I can't really complain.

My summer was full of traveling to see friends, visiting my boyfriend and family, and doing all those great things that only happen in the summer (the state fair!) Shortly before school started I went out to Denver, CO to visit a friend who had just moved out there to start graduate school. I had never been to Colorado so it was a lot of fun. My friend is also in a health science field, so I had a chance to look at the facilities the University of Colorado School of Public Health has. I also got some great pictures in the mountains and Denver Botanic Gardens.

I also hit up the Des Moines Zoo (a little lacking as far as zoos go, but I love zoos so it doesn't really matter)
And now I'm off to do some studying. Enjoy the upcoming weekend!


02 August 2011

Time slips away

It's been a busy summer for me. I didn't realize I hadn't written in so long.

I finished up health communication and enjoyed it immensly.

I turned 22!

I worked...a lot. And then switched work titles. And soon will be switching work hours.

My brother got married.
It's been pretty hot here...hence the lovely humor spotted on a hospital office door.

Matt and I went to the Science Center in Des Moines. I LOVE the science center! Right now they have a plasticized body exhibit. I also have a fascination with bodies and plasticized bodies are amazing. This particular exhibit is called "Body Worlds Vital" (By Gunther von Hagens). A few years ago I saw a similar exhibit called "Bodies Revealed."  They both are pretty amazing exhibits, but I preferred the Bodies Revealed exhibit. Body Worlds Vital has fewer full bodies and many more individual body parts. They also try to do some "artistic" things to the full bodies they have which is just downright creepy sometimes. Bodies Revealed has a huge number of full bodies, in action poses, and not "artistically" presented. If you have an option between the two Bodies Revealed is my suggestion. I also think Bodies Revealed would be better for children because Body Worlds Vital requires a lot of reading and is much more adult oriented. But even if you don't have an option I'd say at least go to one because bodies are so freaking cool.

The science center also has some pretty neat stuff for kids (because really, I'm just an oversized kid...and a slightly hyperactive one). The picture above is the rocket I made and shot out of an air launcher. And there was this really cool vacuum tube setup to shoot balls through. And a ginormous domino setup (I knocked over my dominos just as I was no video). And lego race cars, and caternary arch building blocks, and a place to build the most efficient water turbine, and native Iowa animals, and a whole bunch of time-lapse photos.

And I got an iphone.

And I'm really excited for the fall semester to start.

26 May 2011

Say What?

That's the first thought that comes to my mind when I see this picture. 
Want another perspective on the first year of graduate school? I have included all my facebook statuses from the past year, because what better way to remember life than through facebook?

And before you freak out: this post looks inanely long, but there's not much actual content in it.

The boring "I'm in school" statuses:
I piece of my soul died last week when I realized that I was officially a student at the University of Iowa....and I almost cried.
First week of graduate the books.
Yes, I wore my ISU stuff to work (at the U of I) yesterday/last night. Yes, I got some strange looks from all the hawk fans as I was leaving work at 7:30 a.m. Yes, I will be wearing it again when I work tomorrow. No, I don't give a hoot about football, but I still want to say...Go State!
 I still prefer Iowa State
Done with my first semester of graduate school! I still managed to make today's one to one at work was incredibly productive, sans homework: My unread posts in Google Reader went from 463 to 358!
I ♥ Chobani. I do not ♥ Biostatistics.
WebCT (ISU) has a far superior histogram function that ICON (UofI). I could spend hours on WebCT splitting the sections into smaller and smaller ranges. Icon has lame, boring, permanent ranges.
There are papers:
Yay! My paper was moved back a week. Now I have all of next week to continue procrastinating on my assessment of adequate pre-natal care...
A random Disney song popping up in my itunes playlist while I'm writing a "serious" paper...makes me happy.
One presentation down. To go: a paper, another presentation, another paper, and a test. All done by Dec 8 and then I'm free!!!!
 Fv\ #${EFCC43 <----Zephyr's kindly contribution to my research paper. I think it means that he knows a lot more about the subject than I do and that I should just turn it in like that and play frisbee instead.
Social stigma and health. 3 pages. Go. 
 I have determined-through a purely random and unscientific study-that the Iowa State Daily is much better than the Daily Iowan. However, the Daily Iowan contains a New York Times crossword which slightly lessons the enormous gap between the papers. 
And other homework:
I shall be productive, I shall be productive, I shall be productive [taps pens together 3 times]....yeah, it's not working
Got a lot of cleaning done today. Yes kids,sometimes avoiding homework has good outcomes.
Actually reading my textbook. And taking notes. I'm pretty much an outstanding student.....for tonight anyway.
I just pulled out my biostats notes from this morning. The only thing I wrote: "probabilities suck."
Am I the only one that thinks it's a little strange when professors assign journal articles they authored as required reading?
Note to self: studying in a hospital stairwell results in too many doctors stopping to ask if I'm okay. Apparently "normal" people don't sit in stairwells.
I just want to read something that I do not have to discuss in class, cite in a paper, or otherwise mentally manipulate. And please please please let me have just one week where I am not required to look at a single journal article.
Just think...if I had a snuggie I wouldn't have to take my arms out from under my blanket to turn the pages on my book. But alas, i have no snuggie. 
I've learned the importance of sleep and food:
Dear brain and body: For the past week you haven't been getting along...I can't sleep and then I'm exhausted and then I still can't sleep. I can't form coherent comments for school anymore and I hardly have the energy to stand up. But can we please please please call a truce for a few hours so I can finish this paper? I promise that as soon as I am done the battle may resume in full force.
All my appreciation
Thought I had myself sorted out...but I just woke up from a 2 hour nap that I initially fought quite heavily. I suppose I needed it? I am probably still a couple nights short on my sleep...
Apparently I was more tired than I thought after work this morning. Since I slept through a couple alarms....and subsequently missed class. 
 So much for the claims on my electric blanket that it wouldn't wear out like "other" ones. Only one year old and there's just one corner that really heats up well. Although, I do put my blankets through a lot of wear.
I have spent over half of 2011 asleep. I think I'm off to a good start. 
This morning I awoke to find Zephyr sleeping on two of my pillows and a pile of blankets...while I had a sheet, and no pillows.
I do love sleeping on couches. Kind of makes me question why I spent money on a bed. 
Likes Hummus. A lot. A whole whole lot. An entire metric ton of love for hummus.
I was walking through the produce section and saw a sign for pink lady apples next to a sign for gala apples. For a moment I was really excited thinking that there was a lady gaga variety of apples... 
 Somewhere along the line I missed the lesson that a toaster oven will burn me just as easily as a real oven...ouch!
It's relieving to know that my 100% apple juice is both lactose AND gluten free. 
Having an adventure attempting to make my own pumpkin puree from a fresh pumpkin. What have I learned so far? It's really easy...except for the cutting part. I don't have a single knife suitable for cutting a pumpkin in half. 
 There is my dog (Zephyr/Zefir depending on what I feel like typing that day):
I don't think Zefir realizes what a delicate flower I am.
I'm sick of Zefir walking all over me....and my homework, laptop, bed, cell phone, journal articles, backpack, couches, and every other delicate thing I own.
Once again I have Zefir's immense help on a paper. I'm beginning to think that he should be the one in grad school and that I should be the one playing with tennis balls and squeaky toys all day long. 
 I think my parents have implanted something in Zephyr's brain. He barks at family guy but not any other tv shows. He insists on lying between me and matt when we're together. Wonder what other moral guidelines in me he's keeping in check?
On Monday Zephyr popped my stability ball. Today I bought a new stability ball...and Zephyr just popped it.
 There has been a lot of work:
 I love that the hospital's electronic charting system is called EPIC. I get to say EPIC a lot every day.....really, I say the word EPIC an EPIC amount!
Work work workity work 
What to do with myself before work? Surely one shouldn't be productive...
  Busy night. Among other things...One patient tried to kiss me. Another tried a few pickup lines. The third called me a heifer.
Just paid all my bills for the month. A little depressing to do all at once, but rather relieving in the sense that I don't have to think about any of them for another month! 
I make somewhat of an irresponsible adult.
 And there are the random, rambling thoughts from Lisa's brain (hold onto your hats ladies and gents):
 Of the 99 counties in Iowa, Keokuk County ranks 3rd from the end with percentage of adults (25 and older) with a bachelor's degree. Is it people not getting degrees or higher educated people moving away? 
I officially hate the word "jegging"
  Please excuse me while I go bang my head on the sidewalk until I forget all the results of the election.
What the hell have I been doing to myself the past few years??!? World, take heed, the old Lisa has returned!! 
Visitors: Please do not feed the ego. 
I'm a bitch. 
‎...yes, I expect to live forever, but I just don't have time to wait! 
Highlight of my day: I was looking at the clock at 1:11 on 1/11 
‎"just last week I was sitting on my couch and now I'm here." Me too! Well said reality tv contestant. Well said. 
Apparently I forgot to put my last name on a rebate form because the rebate card was sent to "Lisa No Name"
 Flipping through a Better Homes and Gardens magazine I read this: "Experts agree that the toughest school transitions are from elementary to middle school, middle to high school, and high school to college." ....and what other school transitions are there...???
Just signed up for netflix. This will either be a brilliant move or a disastrous mistake 
 My facebook wall is filled with posts by me. I am either a friendless jerk or...well, a friendless jerk?

Have a lovely Thursday, all!

18 May 2011

Never Fear

I am still here. And alive. And an mph student.

I've had an interesting 3 months. I had some time away from school and the month since then has been filled with catching up from that. But I've completed my first year! It feels good. I honestly can say that every day I study public health I love it even more.

And now it's summer! Sort of. I am currently taking a 3-week class. It goes from 9-12:40 Monday-Thursday for 3 weeks. Intense, for sure, but I have actually been enjoying fully immersing myself in one topic. The class is Health Communication, which I have always found fascinating. I love human relationships. It's definitely what I want to do with my life--work with people.

Aren't they just the most adorable little cacti you've ever seen?

I am continuing to work. Zephyr has an unprecedented amount of energy (I took him for a run today and since we returned 2 hours ago he has continued to sprint through the house, throw toys in my face, and jump on my laptop). The weather has been to die for. I have planted my garden. I have finally seen the light in regards to my inability to properly water house plants and switched to succulents. I went to the NAMI (National Alliance of the Mentally Ill) Walk with my coworkers. I went to Ames and sent my boyfriend Matt off to Europe (what a loser, who goes to Europe when there are awesome 3-week classes to go to back here???) I found out I'm lactose intolerant (this really sucks since I LOVE milk products....except milk...I really don't like milk). Realized just how much of a genius my little brother is (seriously....check out his website and remember that he's a sophomore in high school). And two of my best friends got engaged!

I'm sure there's so much more that has happened, but I'll leave it at that since I have a lot of reading to do for class tomorrow morning. Hope everyone's having a great summer!

23 February 2011


And after my last post about my decision to write a paper on eating disorder relapse I remembered that it's National Eating Disorder Awareness Week!

National Eating Disorders Association

Today I Woke Up...

...with a dog on my head.
Okay, that has nothing to do with the rest of this post, but it was a strange way to wake up.

Actually I wanted to write about writing papers. Yay! (I just finished my first paper of the semester this morning)

I believe a couple weeks ago I wrote a post about how I was graded in classes. In case you didn't notice, papers are highly prominent. Particularly long, involved, research papers. Or a series of smaller papers that all add up into one long, involved, research paper. Key words there: long, involved, research. Meaning I can't just sit down a couple days before the due date a whip something out.

So how do I start? And how do I keep from getting buried in the work?
Tiny steps. I always start work on the paper on the day it's assigned. This doesn't mean I start research and writing on the first day of classes (blasphemy!). It typically involves something benign like narrowing down and/or choosing a topic. I am terrible at choosing topics; probably because I am terrible at making decisions. So starting early gives me plenty of time to suck it up and decide. I don't really have a system for topic decisions. I usually look at the professor's directions ("a health related behavior?"....there's a lot of those) and think about what I am interested in researching. I write down those areas. For example:

  • Mental Health
  • Rural Health
  • Primary Care
Then I go through and brainstorm topics within those larger areas that fit the required paper topic:

  • Sleep and mental health
  • Nutrition and mental health
  • Exercise and mental health
  • Mental health in rural areas (two areas of interest!!)
  • Preventing eating disorder relapse
  • Nutrition
As you can see, some are narrower than others, some have a specific health-related behavior, others will take some more brainstorming. Eventually I force myself to choose one from the list. Sometimes I'm smart and think to look at the available literature before getting myself too deep and finding out that no one has really studied the topic. For this paper I chose eating disorder relapse prevention. A couple reasons preventing relapse narrows my target population, it has more defined behaviors (as opposed to primary prevention of eating disorders), and I'm interested in it.

Then comes the research....

21 February 2011


It's so easy to bash big companies like google and claim they're ruining our privacy, and maybe they are. But I'll be completely honest: I love Google. And this is not an exaggeration. Sometimes it's a little disconcerting, but it's so darn convenient. One username, one password.
A quick breakdown of the Google services I use:
  • Google (the search engine): the most obvious service, but so useful. It creeps me out when it remembers my past searches and become ever more talented at predicting my next search, but it's still amazing. 
  • Google Scholar: great for research. And the best part is I can access essentially all the full-text results for free because of my affiliation with the university. 
  • Google Chrome: It's fast and a beautifully minimal browser. When I open a new tab it pops up icons of my most frequented web pages that I can simply click on. It also syncs my chrome browsers, setting, and bookmarks across my computers (desktop and laptop) so they're both exactly how I want them without much work. My biggest problem is that I like to keep a lot of tabs open (at least 10 at a time) and chrome slows down when I get to about 12 or more. It does remind me to keep my tab appetite in check though. And I am still puzzling about why Google Bookmarks doesn't automatically sync with the bookmarks in chrome, hence the reason I don't use google would be a lot of work. 
  • Gmail: Amazing simple and brilliant.
  • Google Translate: ok, rarely do I actually need to translate webpages, but it's still a lot of fun to play with. (and I waste way more time than I should on it)
  • Google Trends: Another amazing time sink. Although I have found a couple legitimate uses when researching blog posts and being able to see the rise in searches about obesity, for example.
  • Google Reader: An outstanding RSS reader. It consolidates all my blogs, lets me star and tag them, email them and more. (You could even add this blog's RSS feed! *wink*wink*nudge*nudge*)
  • Google Calendar: Another simple, elegant service. I can have multiple color-coded calendars (e.g. work, school, personal). I can set up email, text, or pop-up alerts for 5 minutes before to weeks ahead of time (great for reminding myself to start work on a paper). 
  • Google Voice: I don't know about anyone else, but I hate listening to voicemails. Google voice lets me avoid that. When I don't answer my phone it forwards to my google voice account which then transcribes the voicemail and sends it to my email. The transcribing is a little buggy, but it's usually decipherable, and it's improving, and the actual audio is still available to listen to. 
  • Blogger: Ok, so this is one google service I don't particularly like. I use it for this blog out of necessity, but my personal blog is on Wordpress (a far superior platform). And it really irritates me that every time I put pictures in my posts blogger refuses to format them correctly. I have to view and preview the pages multiple times and make a hundred tiny edits to just make things line up correctly. 
  • Google Maps: this always gives me better directions than mapquest, it might be because I grew up in a rural area and mapquest is terrible in rural areas. I also love that it now provides walking and biking directions with consideration to bike lanes and wide sidewalks (public health, eh? eh?)
  • And then there's Google Earth, YouTube, Google Body, Google Books, Google Docs, Picasa (I find the face recognition in Picasa to be endlessly fascinating). 
But the one that trumps them all is Android. I can't live without my android phone (and the little green guy is kinda cute). Everything is interconnected: I can post articles from the NYTimes app directly to my facebook, I can open up twitter links in my browser and save them to my ReadItLater account. And since I use such a large number of Google services, they are automatically set to work with my phone...brilliant!

Seeing all these written out makes me realize just how much I depend on Google. It would be a very rough day for me if Google disappeared. Maybe I'll consider changing some...on second thought, that would be an awful lot of work. I'll continue as a diehard Google groupie for a while longer. 

18 February 2011

Grammar and Writing

My younger brother calls me a grammar snob. I'm not. Really. I mean, I listen the the GrammarGirl podcasts, and I own Grammar Girl's books, as well as a couple of Diana Hacker's books, and I have a slew of grammar bookmarks in my browser. But I equate being a grammar snob with having perfect grammar/writing. At this I surely fail. Yes, mistakes bother me. Yes, I point out other people's mistakes. But I know that I have plenty of my own mistakes. Despite my attempts to edit I would venture a pretty large bet that several slip through. And there are probably grammar errors that I make that I don't even know I'm making (ignorance is bliss?). In most of my writing (formal and informal) I try to write things as concisely as possible. I also fail at this quite often.

I can be pretty hard on myself about grammar, which is why blogging can sometimes be such a relief. It gives me a legitimate outlet for a more informal writing style. I can pull out my favorite [often questionable] writing vices.

  • I like to ask questions and then answer them (check out a couple paragraphs down). I'm sure there are times that I overuse that technique (probably every blog post). 
  • I like to use ellipses (...) although I do my best to restrain myself since there are very, very few uses in formal writing and it is oh so easy to overuse them and drive people nuts. Extreme use of the ellipses bothers me too.
  • And my use of sentence fragments? (see that one there!) I like to tell myself it is "stylistic" and not just plain wrong. Mostly I use them for my question asking, but I occasionally use them for emphasis (such as right after the first sentence in this post. 
  • I also have a love affair with parenthetical remarks. This is because my brain thinks like that. Severe caffeine use makes it worse. Sometimes to the point where what I write is almost impossible to follow. The majority of my editing involves removing my tangential thoughts, or at the very least making them less obtrusive. I attempt to spare you all the torture of my mind. I live with it 24 hours a shouldn't have to. 

  • Not as easy to spot, but I can get rather verbose at times. I forget that writing "I think" or "every single" or "so amazing" is redundant. The remainder of my editing revolves around removing those.
I'm positive there are many many more. But the beauty of blogging is that I can use them. I can evaluate where they work and how many is too many. I can edit. And none of it is graded!

    16 February 2011

    That's great! So what do

    Anyone currently in public health knows where this comes from.
    It starts with an innocuous "So what are you doing these days?"
    And the answer, "I'm in grad school in public health." (note: Avoid simply saying "I'm getting my MPH" It generally causes more trouble than it's worth)

    Then comes the awkward moment where they start to sound happy for you but then they just wonder what on earth public health is.

    And the next awkward moment where you know that they don't want a long answer, but it's nearly impossible to explain in just a single sentence. (Unless, of course, you use a run-on sentence).

    Because, really, does anyone actually know what public health is? Maybe on some level people in the field have a sense of how broad it is, but I think it would take a lifetime to know everything it possibly encompasses. (Seriously, at least once a week I ask myself "What is public health?" I still don't have a good, succinct answer.)

    To begin with, there are the 5 main areas: community and behavioral health, epidemiology, environmental health, health policy, and biostatistics Though many schools use various titles, they all have the same basic ones. But even that doesn't tell most of the story. So much in public health is collaboration between the departments and collaboration with other professions.

    Sometimes I consider giving a quick example of public health that people might easily relate to, but there are so many! It's completely overwhelming.

    A sampling:
    community clinics, food safety, community planning, policies for insurance companies, vaccination programs, sanitation, health education, disease prevention, infectious disease, farm safety, workplace injuries, promoting seat belts and responsible drinking and exercise condoms nutrition birth control sunscreen sleep habits medication adherence, studying trends in diseases injuries food poisoning risks and social trends, emergency response, professional licensing, air quality, food quality, water quality, household safety (radon, lead, etc), number crunching (determining the deaths from gunshots or diabetes), prenatal care, childhood care, environmental testing. And not just in the US, but all of this happens globally, too!

    I could sound pretentious and cite a dictionary definition: "Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals"

    I could be a jerk and tell them to look it up themselves (this is what I did to my little brother growing up when he asked the meaning of a word).

    I usually give in to brevity and simply say "I'm in community and behavioral health, and I focus a lot of disease prevention, and health education, and interventions that impact communities."

    Is it the actual definition of public health? No. Is it all those people really care about? Usually.

    15 February 2011

    Another Week

    How did I miss my Monday blogging date? My sincerest apologies. 

    My weekend was fairly uneventful. I did homework, slept, visited my parents/little brother, slept some more, went to a meeting for my homeowner's association (somehow got elected to the board of directors?!), returned to sleeping, and did a little more homework. 

    And I enjoyed the weather. It's been above freezing for a few days now! The snow is melting, which does make mornings slightly difficult as it all refreezes into ice. I made the "mistake" of taking Zephyr on a long walk on Sunday. Walks energize him and I had to suffer through the rest of the day as he obnoxiously stared at me and barked, threw toys in my face, dropped toys on my laptop, dropped tennis balls off the couch, squeaked squeakers next to my ears, and chewed bones on my lap. 

    I worked yesterday; I work again today; I work overnights this weekend. 

    That pretty much sums up my life: school, sleep, Zephyr, work, repeat.

    You should also check me out in the CPH news digest.

    My favorite part of this article is that the writer uses the word gander in the intro paragraph. I'm a sucker for vocabulary.

    Some of it is stuff you could glean from my blog, but there's some unique stuff as well.


    11 February 2011


    I have been restraining my excitement and motivation regarding the blog. I have so many great thoughts I want to share with you all. And when I take a day to sit down and draft a bunch I can hardly keep from posting them all at once. Although it's slightly frustrating, it's even more exciting because I look forward to every Monday, Wednesday, and Friday and choosing which post I get to put up that day!

    My current queue is dwindling (down to like 5ish random posts), but never fear because I have a word document listing all the new ones I still want to write and this is my catching up weekend....which was (is) the intended topic of this post.

    As much as I attempt to stay organized and on top of things, life still gets in the way from time to time and my system falls behind. This was one of those weeks. I worked this past weekend and had a hellish time. This included exhausting patients, a couple attempted punches, and getting off 2 hours late. Thus I didn't get much of a chance to do my typical weekend work. I didn't read my textbooks, I didn't get all my assigned articles read, and I didn't get to clean my house and backpack. I had Monday off and spent part of it catching up on sleep and baking for journal club. Tuesday I had class, meetings, and work from 9:30 a.m. until 11:30 p.m.--with no break. So I got nothing done there. Wednesday had some appointments and class and Thursday had class, some breaks to play catch-up, and band rehearsal. And somewhere along the way I started to come down with another illness (I spent the first week of classes this semester incredibly sick).

    So where do I stand overall? I have 3 chapters to read in one textbook, 4 in another, I need to go through my biostats notes (completely lost on a couple things), do my biostats homework, start writing a paper (apparently the middle of February snuck up on me!), and write a few more blog posts. This is in addition to my sadly neglected house, dog, and flute. I have the weekend off. I had to decline a visit to Ames to play catch up :( and I am gearing up to tackle it. I did pick up a few hours at work today, but not a whole shift.

    In these times it is always tempting to start at the beginning and work until I'm up to what needs to be done for the coming week. But I've discovered that isn't always the smartest idea. As great as my intentions and motivation are I don't always get through everything on my list. Sometimes a life event happens, other times I just get burnt out. The best thing for me is to do the upcoming work first and then go back to the stuff I am behind on. If I start at the beginning of my list and don't get through it all I finish the marathon weekend still behind and my stress levels never change. If I at least have this week's work done then I don't spend the week stressing about where to fit it in before class, I just look for spaces to catch up on the back stuff.

    And I try to keep it fresh throughout the weekend as well. Here's what helps me.

    • I work in shorter chunks and in different places (coffee shops, Hardin, nooks in the hospital). 
    • Lots of diet coke and coffee (deserving of their own food group)
    • Breaks with some fun things like a run with the dog
    And what do I avoid?

    • TV. Seriously, who can watch just one episode of Family Guy?
    • Naps. They're addictive.
    • Spending all day in my pajamas. It makes it really hard to seriously work. 
    • Starting without a plan. If I finish one item and don't have the next one planned, it becomes really easy to while away an hour or two.
    • Internet surfing. We all know this one.
    Wish me luck and I'll be back on Monday!

    09 February 2011

    From the Old to the Young

    In a similar vein as my recent post about the 91-year-old athlete and the benefits of more intensive exercise for the elderly, I saw this article looking at the benefits of weight training for children. It is generally recommended that children and adolescents don't participate in weight-training. The initial reasoning was that child-laborers in Japan had stunted growth and it was assumed that heavy lifting was the cause, but new research suggests that this may not be the case. In fact, new studies show that weight-lifting can be incredibly beneficial for youth. Unlike adults, who generally gain muscle with strength training, children reap neurological advantages. Their muscles and neurons begin to interact much more efficiently.

    In the distant past children had built-in weight training with farm chores, but very few children these days have that option. (I was fortunate to grow up carrying 5-gallon buckets filled with feed and water and wrestling lambs)

    Should we change our recommendations?

    07 February 2011

    Scientific support for the love of my life

    ...the furry, four-legged one that is.

    If you've read many of my posts and noticed my [mild] obsession with my dog, Zephyr, you probably expect that I get really excited when I come across scientific studies regarding the benefits of pets!

    On a purely anecdotal level, my dog has huge benefits for me. He forces me to get out and exercise every day;  not just moderate exercise, either. To control his energy level I get the full-out very vigorous label. And to keep up with all his exercise needs I have to keep myself well-nourished. I can't spend all day asleep in bed, Zef is bouncing atop me by 10 a.m. (it used to be 6, so we're making progress).

    And it's hard to have a bad mood around him. He loves life from the moment he wakes up; everything (even nail trimming) is turned into some type of game. Making a bed? He hides under blankets. Drying his feet? the towel become a tug rope. Throwing anything in the air? It's a game of fetch! (true story, one time I was tossing a rolled-up pair of socks and he caught them and swallowed them). I've also learned to "go with the flow" and that most "emergencies" aren't really things to get stressed about. In addition to the socks he has eaten a bar of soap, a highlighter, hairties, a sharpie, a plastic frisbee (yep, actually swallowed the pieces), he licked a razor blade, sliced his foot on a piece of tin roofing, and has broken a front tooth.

    To get an idea of what his personality is like, check out the video below. 

    Of course, he's no therapist. And it's not to say he's without stresses (finding a place for him to stay when I travel, food, vet bills [fortunately my mother's a vet], training, and other time/financial investments). Many people told me I should wait to get a dog. Do I wish I had paid more attention to their advice? Some days. Would it change my decision? No. I'm not saying that everyone should get a dog. I really think each individual needs to closely examine how much effort and stress they're willing to take for a pet, but in my case I can never be fully happy without a dog. And there is no way in the world I would give me dog up.

    And I try not to get too freaked out by studies that show therapy dogs may spread MRSA and CDiff. Or the medical and training controversies fueled by pets sleeping in the bed (you better believe that Zephyr owns my queen-size bed). Or the ridiculous amount of vacuuming I do every week. Or the amount of money I spend on tennis balls and frisbees.

    But how can you look at this face and continue to worry about all that?
    Or even just see that silly little bob-tail.


    04 February 2011

    The "D" word


    What is it? Is it something you do for a couple weeks or a month to "get healthy"? Or is it a way of eating over a lifetime?

    I always use it with the second definition. Mostly because there's no other word to use that easily describes what a person eats day in and day out. Vegetarians/Vegans have it easy: I'm a vegetarian, I eat a vegan diet. But what about the majority of the population? "I eat mostly foods based on plant leaves and lean meats, trying to minimize my intake of cereal grains and saturated fats." That just sounds pompous.

    And I think that it was originally intended for such purpose. It is only recently that we have begun to try all sorts of strange, short-lived methods to lose weight. The atkins diet, south beach diet, cabbage soup diet, weight watchers diet, cottage cheese diet are all recent inventions. Although I suppose something similar to the cabbage soup diet could have occurred in history during famines, I'm guessing weight loss was not the reason. ["I've got it; we'll kill off our corn plants and eat cabbage soup for the winter! Think how great we'll all look for planting in the spring!]

    I think it's ridiculous that people honestly believe they can eat differently for two weeks, lose weight, go back to the way they had been eating, and not gain the weight. And if I run an ultramarathon tomorrow do I not need any more exercise this month? Any pattern of eating that a person cannot sustain over a long period of time is counterproductive.

    I could continue this rant for a few more paragraphs, but I'll stop here. (though I might mention that any "diet" that doesn't include rice krispy bars of epic proportions like in my previous post is not a diet worth eating). 

    And it's time for the weekend! (one filled with work for me) and the Super Bowl (I really hope the packers win simply for my boyfriend's sanity), and some warmer days ahead. Other than that I will be filling my time with homework, reading, cleaning, running, flute practice, and probably some yoga too because my hamstrings are killing me. 


    02 February 2011


    13 inches of it! It is rare that a university has a snow day, but we did today. As an undergrad we always referred to them as "once in a lifetime" events. But I have now had a snow day for two consecutive years. [can you say global weirding?]

    I wish I could tell people considering Iowa that this is very unusual, but it seems to be happening more and more often (please refer to global weirding comment above). I will say that one (sort of) nice thing about Iowa is that the snow typically melts on and off during the winter. It's not like more northern states where it just piles on top of itself until Minnesota just disappears. It snows, then melts down a few inches, then gets cold and freezes again, then snows (repeat ad nauseum). And snow is manageable. Unfortunately Iowa also gets ice from time to time. Ice is tricky stuff: impossible to drive on and nearly impossible to remove from the roads. It also brings down power lines and trees.

    It does end, though, and summer comes. Eventually.

    But back to today. I did what any self-respecting college student does with some free time:

    Sleep! (Yes, I really do wear a hat in the house. For me to be warm the thermostat has to be set at least at 80, and there is no way I am paying that much for heat. And yes, Zephyr insists on sleeping on top of me quite frequently.)

    I also played in the snow with Zef

    And I watched the Biggest Loser and Cupcake Wars, read the latest Runner's World, painted a closet, put up double-track shelving in the closet, and pestered the dog.

    Elsewhere in recent news...I chopped off my hair.

    And ate an enormously large rice krispy bar. The picture below is after I had devoured half of it. (I might also add that I was in class designing an obesity intervention with a group....oh the irony)

    Hope everyone was able to enjoy the snow in some small way, even if you're like me and hate everything related to winter.

    So this post basically mirrors my day: random, fun, and full of photos.

    Have a great evening all! I'll leave you with a nice reminder that sunny days are ahead....even if it is still a long way off.