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Plan C: Meeting Survivorship Needs in a Changing Health Care Landscapeboth nationally and internationally. As a pandemic, there continues to exist great unknowns and uncertainty which has resulted in fear, anxiety, depression and in some cases heightened risk of suicide. The encouragement of social isolation has further complicated the mental health impact of the virus., further highlighting health disparities in the U.S (SAMSHA, 2020). The University of Washington forecasts that the impact will last between 12- 14 months, and may be further complicated by potential COVID spikes (Univ. WA, 2020).f 5,000 U.S. adults in June suggested thatID-19 (CDC, 2020). Another study conducted by the Commonwealth Fund suggests that Americans are doing worse psychologically due to COVID-19 compared to other high income countries (Williams, et al, 2020). Rates of depression are forecast to be much higher in the general population (30-60%) due to the chronic and ongoing social and economic disruption as a result of COVID-19. Additionally, suicide rates are influenced by unemployment rates (Phillips, 2014). According to the University of Washington's Forecast, the "disillusionment phase" is anticipated to peak in the Fall of 2020 and Winter of 2021. It is described as the "trauma cascade" which results inse. Cancer patients are also affected by the pandemic. Many hospitals and treatment settings have modified their operations and/or postponed treatment as a result of COVID-19 (NCCN,2020) Some patients indicate that they are fearful about coming for care and risk being exposed to COVID-19 (JCO, 2020). Some have indicated that they would rather risk dying of cancer than of COVID. Health care workers and First Responders are at particular risk for experiencing stress, PTSD, and other psychological symptoms (Annals, 2020, CDC,2020). Understanding the phases of adaptation and recognizing populations at risk may help social workers and mental health providers anticipate and plan for intervention strategies. This presentation will address the emerging behavioral health impacts of COVID-19. The impact of the pandemic on cancer care as well as identifying populations at risk for greater distress will be considered as well as proactive intervention strategies. Resilience and strategies to improve coping will be will be outlined. Psychological First Aid, Brief Supportive Therapy, the cultivation of resilience and meaning will be included in this presentation.
1. Discuss the mental/behavioral health impacts of the Coronavirus Pandemic for both those with the infection and those affected.
2. Describe best practices for clinical interventions and strategies to proactively assist vulnerable and at risk people, especially those affected by cancer.
3. Integrate established and valid clinical and concrete disaster responses for COVID patients, caregivers, and at risk health care workers.
As primary providers of psychosocial care, oncology social workers can benefit from a tracking system that monitors the services they provide. In January 2019, the Mount Sinai Downtown Oncology Social Workers began implementing the OSWiiPV. one oncology social work department (five distinct locations) which has used the OSWiiPV for over a year. The presentation covers our decision-making about implementation, adapting the instrument to the setting, problems experienced and barriers overcome. We also describe how we used the data, and the benefits to the department from doing so. Finally, the next steps for broader implementation, research, and comparison of results with other departments are discussed.
1. State the three reasons why implementing OSWiiPV is useful in practice sessions.
2. Identify how to use data collected to monitor social work productivity, determining appropriate staffing levels, and submitting reports to administration.
3. State three ways in which the use of tracking software, like OSWiiPV can enhance oncology social work practice.
The issue of brain death has been increasingly in the spotlight after recent high profile cases have called into question how it is determined, and then handled, by hospitals. LThis presentation follows a process taken on by a hospital palliative care social worker who recognized the need for consistent and thoughtful practice beyond just determination of brain death, to family communication, education, support and ancillary staff involvement. Beginning with two challenging cases in the ICU, and substantial moral distress among the bedside staff, this social worker built an interdisciplinary task force to create policy that guides medical teams in involving appropriate ancillary support, clear and direct communication, education of families, and establishing expectations for the process of withdrawal when brain death is determined. Educational materials were also created out of this process and are now available in the ICUs and provided to families as early in the process as is feasible. This presentation will provide guidance for others who are interested in policy and effecting change in our day to day practice in critical patient situations.
1. Describe the key elements of building a coalition or task force to produce policy and practice change that is most likely to secure buy-in from necessary stakeholders.
2. Produce policy where it is needed, and identifying necessary support to make it successful.
3. Summarize the definition of death by neurological criteria, and express understanding of the supports necessary for families to find acceptance of the diagnosis and appropriate next steps.
Ever since Dr. Harold Freemanm in 1990, patient navigation programs have been evolvingand patient navigation is no different. Prior to everyone’s “normal” changing with the COVID-19 pandemic, the Commission on Cancer (CoC) revised their Cancer Care Standards. Although patient navigation is no longer identified as a requirement to achieve CoC certification, navigation continues to be recognized as an essential element in achieving and documenting patient-focused quality cancer care. Navigation programs embrace duties that support key priorities for cancer care programs and healthcare systems as a whole. Ten years has passed since the  joint position paper on the role of patient navigation and is still relevant today: Patient navigation processes “are essential components of cancer care services”, “Patient outcomes are optimal when a social worker, nurse, and lay navigator function as a multidisciplinary team”, and “Patient navigation programs must lay the groundwork for sustainability” We will discuss the changes in the CoC’s standards and identify efficient ways AOSW members can support each other and easily access resources that may be available to our patients to address their barriers to care.
1. Discern between the 2016 and the current 2020 CoC standards affecting patient navigation.
2. Identify a system for providing patient-focused assessments to identify both patient- and system-related barriers to care and make appropriate utilization of resources.
3. Utilize an AOSW- member directory of referral resources.
1. Identify three ways that oncology social workers adapted care during the pandemic.
2. Utilize one skill from adapted care that they can use in their own setting.
3. Identify interventions that were successful during the global pandemic with oncology patients and caregivers.
Lung cancer stigma is high, with 48% of patients reporting stigma attributable to interactions with cancer care providers. Stigma can result in multiple negative psychological outcomes such as misreporting and underreporting of symptoms and smoking behaviors and avoidance of help seeking. Oncology social workers can be instrumental in mitigating these negative consequences through normalizing concerns about discussing smoking history and helping patients cope with their reactions to stigmatizing conversations with other treatment team members. Can improving the empathic communication skills of thoracic oncologyimprove the patient experience and decrease the stigma lung cancer patients feel? To find out, the Empathic Communication Skills Training Module to Reduce Lung Cancer Stigma in Patients Undergoing Treatment for Lung Cancer was developed and evaluated. Participating cancer care providers learned specific communication skills such as providing a rationale for tobacco use discussions; normalizing, acknowledging and preparing patients for recurring smoking questions; and encouraging expression of feelings. Preliminary efficacy of the empathic communication module was examined by assessing participating clinicians’ evaluation of the training module as well as perceived self-efficacy before and after the training. Overall, clinicians favorably reviewed the training and perceived self-efficacy to communicate empathically with lung cancer patients increased significantly. Examination of patient outcomes is pending but these preliminary results indicate this promising empathic training module may be worthy of being replicable to other cancer care settings to decrease the stigma-related distress that lung cancer patients experience during interactions with treatment team members.
3. Distinguish discussions with healthcare providers people with lung cancer might find helpful versus those that are not.
Up to half of (Guan et al., 2016). Cpromisemanaging cancer (Abad, Bakhtiari, Kashani, & Habibi, 2016). ACT encourages psychological flexibility and CBT helps patients with cancer learn how to recognize and reframe maladaptive thoughts (Low et al., 2016). Mind-body techniques give participants another tool to increase self-efficacy as well as influence the physiological effects of the chronic stress response (Kwekkeboom, Cherwin, Lee & Wanta, 2010). This presentation offers the week-by-week agenda for the Mind Over Matter (MOM) intervention, as well as opportunities to participate in experiential exercises including meditation, leading diaphragmatic breath, and participating/leading small group processes geared to support attendees feeling empowered to offer MOM. This novel, 5-week, group intervention aims to increase emotional coping and reconnect the participant with a sense of control. MOM is based on the foundations of CBT, ACT, and introduces mind-body techniques. Results from a pilot sts and a decrease in depression symptoms following participation in the MOM program.
1. Review founding theories and concepts of the intervenstress response.
2. Summarize the Mind Over Matter program, offering the agenda of five week intervention, an opportunity to experience exercises that are part of the intervention, and an opportunity to practice facilitating aspects of the intervention.
3. Discuss implementation and evaluation of Mind Over Matter in its current setting and explore potential settings. Review Mind Over Matter data regarding emotional and physical symptoms.
This paper explores an understudied area in oncology social work, with increasing relevance to an aging and sandwich generation workforce, namely, how might (and how are) personal experiences with as a cancer patient or caregiver influence the ways in which oncology social work services are delivered? This question becomes increasingly salient as the psychosocial oncology workforce ages and is increasingly diagnosed with or caring for loved ones with cancer while working simultaneously in oncology care settings. In this exploratory study, the primary researcher used intensive, in-depth interviews with social workers who specialize in oncology, and who have had a cancer diagnosis and / or who have been a cancer caregiver, employing the constant comparative method of simultaneous data collection and analysis to optimize interpretation. Participants made explicit and implicit reference to evolving philosophies that guided self-disclosure in their practice, and recommendations for its judicious use in practice. These recommendations identified the critical need for self-disclosure only when clinically appropriate, to advance the therapeutic relationship, support client coping and adaptation to a diagnosis or treatment, and/or prepare clients and families for end of life decisions.
1. Define therapist self-disclosure and synthesize definitions from a review of the literature and empirical findings from the study data.
2. Distinguish ethical and appropriate self disclosure from disclosure motivated by the workers needs.
3. Consider mechanism for ensuring appropriate, ethical, and judicious use of self-disclosure.
One of the core values of social work practice is the importance of human relationships. When providing care to patients and their families, our work is centered around connection, sharing, trust, vulnerability and honesty. These relationships enhance the well-being of those we work with. Maintaining clarity about the nature, functions and goals of the relationship is fundamental to ethically sound social work practice. Our Code of Ethics provides an essential framework to guide these relationships and avoid boundary and role violations that can cloud the work and the relationship. When a member of our healthcare team—a part of our “work family”—is the patient, the relationship is automatically dual in nature. This duality is necessary and unavoidable. Duality in a relationship exists on a continuum. It can have positive aspects and, it also can provoke tension. Unanticipated challenges can arise. When providing care to a member of our team, we must be keenly aware of our sense of and use of self. We need to be aware of our own abilities, functions, and biases to provide optimal psycho-oncology support to our patients and our teams. This presentation will focus on four key areas: (1) clinical and interprofessional team practice skills, (2) policy development and administrative management, (3) navigating ethical gray space and (4) self-preservation/self-care. Through the use of case presentations, personal experiences, and theoretical examination we will attempt to navigate these stormy waters with an ethical lens. Our goal: improving delivery of care to all patients and supporting our interprofessional teams.
1. Identify three key ethical tension points that arise when working with members of our team who are also our patients.
2. Discuss administrative and policy recommendations to employ best practices at our own treatment centers.
3. Recognize the impact of the work on our use of self in clinical practice, self-regulation, self-preservation and in navigating our space within our interprofessional teiginally was developed as a psychotherapyr and has shown efficacy in the treatment of cancer symptoms and side effects. Research studies show evidence that EMDR, an evidence-informed treatment that targets emotional distress and associated physical symptoms, can reduce the physical and emotional distress of cancer and side effects successfully. This presentation will consider the development of EMDR and its use in the psychological support of people with trauma and with cancer. It will review the basic EMDR trauma protocol and eight phases of treatment. Additionally, it will outline other EMDR protocols used with cancer patients. EMDR demonstration with a mock patient will provide an opportunity to observe EMDR in context. Information about basic and advancwill be provided.
1. Consider the development of treatment approach for cancer trauma.
2. Describe the original 8-Phase model and other protocols for EMDR therapy with cancer patients.
3. Identify EMDR training requirements, continuing education opportunities, and professional support.
Although many cancer survivors adjust very well post-treatment, a significant number still experience fear of recurrence, anxiety, and depression lasting for months or years (Yi & Syrjala, 2017). Survivorship distress decreases quality of life and increases risk for full-blown anxiety and depressive disorders. Distress may also be associated with inefficient utilization of medical care and negative health behaviors (Otto, Soriano, Siegel, LoSavio & Laurenceau, 2018; Fisher, Beeken, Heinrich, Williams & Wardle, 2016). To better serve distressed cancer survivors, we developed a group intervention, “Valued Living for Survivors”herapeutic approach well-suited for people living in the shadow of cancer because it promotes acceptance, mindfulness, cognitive defusion, and value-based behavioral change, while at the same time allowing space for challenging thoughts and emotions reflective of the reality of survivors (Harris, 2008; Hayes & Smith, 2005). In a 2016 pilot study of 42 participants we compared participation in “Valued Living” to change in time alone and showed beneficial outcomes with regard to anxiety, depressive symptoms, fear of recurrence, vitality, and sense of life meaning (Arch & Mitchell, 2016). In 2019 we completed a larger,139 anxious post-treatment survivors (Arch et al., 2019). This presentation will inform about key concepts in ACT and its relevance to work with cancer survivors. In addition, we will share the results of the recently completed Valued Living RCT, and will give an experiential overview of techniques used in the intervention.
1. Discussits relevance for cancer survivors.
2. Discuss the impact of an ACT-based intervention (“Valued Living”) for anxious post-treatment survivors.
3. Describe specific strategies and tools used in the "Valued Living" intervention and offer participants an opportunity to directly experience some of the tools.
This skill building, two-part practice intensive is an orientation to the field of psychosocial oncology and oncology social work career development. The target audience for this session are oncology social workers with three years or less in this niche field. Participants may be new graduates or practitioners shifting from another area of social work. The goals for this session are to provide a brief introduction to current trends and significant tasks in oncology social work, connect with oncology social workers in similar areas of practice for ongoing networking, and identify opportunities for self-care and career growthunderserved populations and the transference of prior experience and skills into oncology social work.
1. Recognize the history of oncology social work in diverse settings and anticipate potential career paths.
2. Identify the importance of use of self, self-care, and the development of a professional skill set, network, and mentorship in growth as oncology social worker.
3. Discuss the influence of models of care; specifically, patient-and-family-centered care and values based care, on the practice of oncology social work.
We will explore what Advance Care Planning encompasses, the documents often involved in these conversations, how legacy planning plays a role in the process, and how to engage staff in a daylong training curriculum. Trainees will learn to better address advance care planning needs and how to have a richer more comprehensive conversation with their patients about these very important issues. Presenters have many years of experience addressing advance care planning with patients, teaching these skills to their colleagues, and supervising other social workers as they learn to better address these needs. Target audience will be any social workers and/or supervisors who work with oncology patients in a healthcare setting.
1. Explain the Advance Care Planning process throughout the oncology patient’s disease cycle (new diagnosis, disease progression, remission, end of life and legacy planning).
2. Discuss their beliefs about Advance Care Planning, and ethical implications when teaching others Advance Care Planning techniques.
3. Design a similar Advance Care Planning educational program for their departments.
This interactive seminar will explore how the core principles of primary palliative care lay the foundation for the delivery of quality oncology service. Using the Fourth Eas our framework, we will consider how addressing patients’ quality of life domains can enhance collaborative practice. We’ll conclude with an exploration of leadership and advocacy opportunities that enhance our provision of person-centered, family-focused, culturally-congruent care.
1. Identify core palliative care principles applicable to oncology social work practice.
2. Recognize how addressing patients' quality of life domains provides a framework to enhance collaborative practice.
3. DiscussPalliative Care improves quality of life for patients/ng. Sexuality is a key component for quality of life and an essential form of expression capable of relieving suffering, offering meaning, and maintaining connection with others. Though palliative care is supposed to be holistic in focus, sexuality is often overlooked and avoided during assessment. Between 10-100% of their cancer diagnosis/tretermined that a core competency of Palliative Care social workers should be assessing sexuality in patients. Though patients want healthcare professionals to ask and discuss sexual health, multiple barriers have been identified as to why healthcare professionals do not and when discussions do occur are kept "medicalized". Due to the clinical skill set, social workers are perfectly poised to lead teams in discussing sexual health with patients and partners. Many models exist to assist healthcare professionals in starting sexual health conversations and assessments, including ALARM, PLISSIT (ex-PLISSIT), BETTER, and CARESS. Research is limited on how these models are applied to diverse patient populations and the unique cultural considerations that exist when discussing sexuality, such as past discrimination, distrust of the medical system, health inequality, and language barriers. This presentation will review research regarding beliefs around sexuality from diverse perspectives, cancer, and palliative care.
1. Identify the impacts of cancer on sexuality for patients/partners and differentiate between assessment models.
2. Recognize the barriers to communicating about sex, sexuality and intimacy with diverse palliative care patient populations from both provider and patient perspectives.
3. Apply knowledge of assessment models andBlack, Latino/a, Asian and LGBTQ communities.
Eancer patients and survivors varies from 30% to 80% (Horneber et al., 2011; Judson et al., 2017; Sanford et al., 2019). While some well-researched integrative modalities have been proven safe to use in concert with traditional cancer treatments, others modalities are ineffective or have been shown to interact with medical treatments and/or cause harm (National Cancer Institute, 2019). Therefore, patients must be empowered to make wise selections regarding integrative therapies and collaborate with their oncology team when making these decisions. Given that 30-40% of cancer patients do not disclose use of integrative modalities to their oncology provider, social workers are needed and uniquely suited to bridge this g integrative therapies for common cancer side-effects and provide social workers resources for cancer survivors to gain information about reputable and evidenced-based integrative cancer care modalities.
1. Discuss the importance of communicating integrative modality use with medical providers.
2. Describe a variety of integrative modalities and their application in cancer treatment, prevention, and side-effect management.
3. Utilize select resources to facilitate safe and effective patient decision making around the use of integrative modalities.
This one hour paper presentation will focus on one institution's tiered response to the COVID-19 pandemic to create supportive and educational programs geared towards patients and families impacted by cancer and healthcare professionals on the frontline. This workshop will provide tangible steps and strategies to provide exceptional patient and staff programming. Using measurable tools and outcomes, tto implement, execute and evaluate effective virtual programming to support patients in the time of a pandemic.
1. Use practical skills to effectively coordinate, execute and evaluate meaningful programs to support those impacted by cancer during a pandemic.
2. Identify effective techniques to minimize barriers impacting access to healthcare while maximizing their reach to patients through use of resources within their own institution. (eg. EHR, Newsletters, cancer registrar).
3. Apply evidence based interventions to differentiate your cancer center as a leader in providing supportive care to staff during a crisis.
Chinese A have high rates of a variety of cancers. There is a growing need for culturally-tailored cancer support services for Chinese-speaking patients. However, this type of service is limited. In response to the needs of the Chinese-speaking cancer patients, oncology social workers at Mount Sinai The Blavatnik Family – Chelsea Medical Center started building a comprehensive cancer support program in February 2019. In this presentation, the development of the program will be reviewed, specifically, lessons learned and challenges overcome. The presentation will cover conducting biopsychosocial-cultural-spiritual assessment in a culturally sensitive way, identifying individual Chinese-speaking patients’ psychosocial needs and providing support throughout cancer treatment, initiating and maintaining discussion about advance care planning, strategies for outreach and recruitment, and program monitoring. Through patient encounter aggregate data collected, participants will better understand the needs and concerns of this patient population.
1. Identify at least 3 barriers for Chinese-speaking cancer patients to access psychosocial support services.
2. Identify questions that should be included in a biopsychosocial-cultural-spiritual assessment with Chinese-speaking cancer patients and providing education on completing Advanced Care Planning documents.
3. Identify strategies for recruitment of Chinese-speaking cancer patients to a support program.
The leading cause of death for women in 2015, between the ages of 25-54, was cancer (Park et al., 2016). Many of these women were raising children at the time of their deaths. Coping with an advanced cancer diagnosis and single parenthood brings about complex challenges and uniquely specialized needs. It is particularly complex for single parents with dependent children, inadequate support systems and life-limiting illness, who confront complicated legal, pragmatic, emotional, financial and/or spiritual/existential issues whenupon their death. These decisions must be made hurriedly while enduring intense physical, emotional and/or existential suffering. Historically, health professionals have not consistently addressed parenting concerns as part of end of life care (Park et at., 2016), nor have best practices been established. As the disease burden intensifies, the family unit is at a heightened risk for destabilization, which could lead to a traumatic death ild. The foundation of this paper presentation is a case study involving a 53-year-old single female who was diagnosed with a life-limiting gynecological cancer. The patient needed to complete custody planning on behalf of her 10-year-old daughter who had previously experienced several foster care placements before being permanently placed with the patient. The presentation will include intervention strategies focused on the implementation of an interprofessional team approach which was enhanced by a partnership between the palliative care team and an outside adoption agency.
1. Describe custody planning in the context of life-limiting illness.
2. Demonstrate the practical and clinical benefits of a partnership between the adoption and oncology social worker in the context of custody planning during end of life care.
Trauma-Informed Care (TIC) is increasing in prominence in a variety of social work fields of practice. This presentation offers an overview of TIC and its application to oncology social work. Included is a rationale for TIC model in inter-professional oncology teams, an overview of trauma-related symptomology, an overview of TIC evidenced based modalities, Adverse Childhood Experiences (ACES) and the relationship to healthcare utilization, and the impact of a healthcare trauma on the individual and family system.
1. Apply principles of trauma-informed care to oncology settings, includingin our interactions with healthcare team members.
2. Summarize trauma informed modalities useful in oncology social work practice.
3. Integrate trauma-informed assessment in distress identification and management in order to optimize trauma-informed care for patients, survivors, and caregivers.
1. Review background of healthcare disparities in the US and explore the cancer experience as an intersection with these issues.
2. Describe the use of resilience -based clinical supervision, to help staff better work with and witnessing the many stressors in patients’ lives.
Title: In 2020, the COC revised its Survivorship Standard to focus more on quality programming and less on the quantity of Survivorship Care Plans delivered. The new standards left many cancer programs scrambling for fresh ideas to meet the new standard, which requires a Survivorship Program Team be established and the documentation of three services focused on survivors. Our Cancer Network was on the way to creating a new menu of meaningful programming when COVID-19 interrupted the way healthcare services were being delivered. Brainstorming new ways of delivering Survivorship programming suddenly became imperative. Not only were there new requirements to meet the needs of survivors, but there were a variety of parameters in which these programs would need to function. The decision was made to take our Survivorship Goals to a digital platform, specifically using Facebook as a medium. While initially skeptical of an online community, research quickly showed us that even “lurking” behaviors can be beneficial for patients. This enabled us to extend our reach to patients who may otherwise not engage in Survivorship Programming, including those with late treatment effects. Creating novel digital programming with multi-disciplinary support developed cohesion, and made Survivorship Care a more intentional process. It forced innovation and creative thinking, strengthening our team’s sense of ownership of the content. This presentation will explore the twists and turns of Survivorship Program planning during COVID-19 and the journey to make digital programming that is meaningful, feasible, relevant, and according to our health network’s standards.
1. Identify ways patients benefit from virtual Survivorship Programs.
2. Differentiate between types of interaction available through online platforms.
3. Summarize steps to create meaningful interdisciplinary online Survivorship content.
In this pilot study, as and other disciplines, including cancer support program leadership and public health researchers, developed a patient-centered intervention for providing financial navigation to patients with cancer and their families. Cancer-specific financial distress screening, psychosocial assessment and ongoing check-ins formed the basis of this intervention, in which patients were assisted to apply to programs across the spectrum of government, non-profit organizations, local grant foundations, and in-hospital programs. Pinancial toxicity, as measured by the COST, and in their search for financial assistance programs. Participants reported that the program had given them “piece of mind,” let them “know that doctors, nurses, social workers and everyone really cared,” enabled them to feel “less afraid of having cancer,” and ultimately became “a huge factor in treating my cancer.” Patients whose illness and/or financial situation deteriorated during their participation in the program still overwhelmingly reported the benefits of this model that involved frequent visits with social workers and that focused on their unique cancer treatment experience. We will discuss the skillset unique to social workers that facilitates the negotiation of complex, disjointed health care systems and financial assistance programs in the service of helping patients with cancer to proactively address the problem of financial toxicity, so that they can better adhere to treatment, experience higher quality of life and improved survival.
A qualitativenderstanding and knowledge of diversity for 10 healthcare professionals and leaders at UPMC Magee-Womens Hospital. This understanding was achieved by exploring how healthcare professionals conceptualize diversity, including race and gender differences, and about their participation in diversity training, resources, policies, and initiatives. The study conceptualized diversity through Madeline Leininger’s cultural care diversity theory and Kimberlé Crenshaw’s coined term of Intersectionality. This framework stressed  to remain competent in understanding the multiple identities experienced by Women of Color and how this can impact their overall care.
Family conferences are a setting forRecognition that high quality oncology care is patient-centered, family-focused and culturally congruent has heightened the importance of skilled communication with families. Family conferences allow for information exchange and clarification, observation of dynamics, emotional expression and sharing, and shared decision making. Given the changing environment of health care in which traditional in-person communication may shift to video-based remote communication or a combination of the two modalities, oncology social workers need to apply their skills in these varied configurations. Social work leadership in family conference organization and implementation, regardless of who specifically runs the meeting, is an opportunity to apply and illustrate this expertise. Evidence informed elements and processes of family conferences will be reviewed and connected with oncology social work roles. An experiential approach in the session will allow participants to explore and apply social work practices across contemporary health care configurations of family conferences.
3. Identify content areas, as well as structural and process elements, of family conferences for oncology, palliative and end of life care.
3. Develop psychosocial care approaches that are responsive to the informative, supportive, and practical needs of young women with breast cancer and their romantic partners.
In recent years, awareness has been raised regarding the unique physical and psychosocial needs of young adult (YA) cancer patients (Knox et al. 2017). While more focus has been on the YA population, little research or clinical focus has been on YAs with advanced disease (Knox et al., 2017). Young adults with advanced cancers continue to describe feeling alone and forgotten, and with unmet and unrecognized needs (Lundquist & Berry, 2019). Even though many YAs experience disruption of developmental milestones, those diagnosed with metastatic cancer are faced with the reality that they may never attain these milestones (Zebrack & Isaacson, as cited in Lundquist & Berry, 2012), and grief adds a unique challenge to their cancer journey compared to other YAs (Lundquist & Berry, 2019). As a young adult, accepting the reality of a metastatic diagnosis is very difficult; “having a supportive space to process these challenges…allow(s) them to further explore their experience and come to terms with their personal reality” (Paul, 2018). As Oncology Social Workers we are perfectly suited to recognize, address, and educate other providers regarding the unique needs of this niche population of cancer patients. Iof YAs with advanced disease differ from those without advanced cancers; the distress that providers tend to feel about young adults with metastatic disease; and how we can help these young patients process such a heavy diagnosis, including addressing mental health needs, relationships, developmental milestones, grief, legacy building, and end of life.
2. Utilize this presentation to improve practitioner knowledge, young adult patient-provider communication, as well as, young adult patient quality of life by integrating best-practices and resources available.
3. Demonstrate knowledge in regards to psychosocial needs and specific resources for young adults diagnosed with metastatic disease.
Although underutilized in the past, the practice of neuro-palliative care is on the rise, especially in European countries, corresponding with an escalating number of trained facilitators (Vierhout, et. al, 2017). We know that palliative care, in general, is especially effective when introduced early to patients and their caregivers. Due to the depth of care needs - this is even truer brain tumor. As an Oncology Social Worker with the Brain Tumor Network, a  navigational services, free of cost, to patients and caregivers across the United States - I field many requests for patient education specific to helping families understand and overcome misperceptions regarding palliative care. A common theme which has arisen within these conversations is lack of early education regarding the value of neuro-palliative care, as well as how palliative care services can be received in conjunction with active treatment. Recognizing that the integration of these services early on may feel like a careful dance between hope and the realities of a brain tumor diagnosis; there is an opportunity for team collaboration to make that careful dance more of a steady walk together. Paying attention to what our teams, patients, and caregivers ag, education, and advocacy dedicated to early neuro-palliative interventions for patients and caregivers impacted by a brain tumor.
1. Express the ways in which Oncology Social Workers can lead early discussions that educate our patients, caregivers, and team members on the value of neuro-palliative care.
2. Describe how early conversations help facilitate open communication, quality of life, a better understanding of perceived goals of care, and ultimately hope.
3. Evaluate current barriers to early neuro-palliative care interventions through case analysis and group discussion.
As part of the cancer care workforce, oncology social workers are the primary providers of psychosocial services and interventions. While we can acknowledge variations in what oncology social workers do and how they work across different settings, AOSW’s Standards of Practice suggest that there exists a core or universal set of activities and tasks that are grounded in the values and principles of Social Work and apply across all settings. The purpose of the AOSW CORE study is to identify a range of activities that distinguish and delineate the oncology social worker role. Conducted in two phases, the study first engaged an expert panel of 35 AOSW members in the derivation of a set of 91 tasks across six domains that distinguish the scope of oncology social work practice: (1) Clinical Assessment and Intervention; (2) Care Coordination; (3) Professional Advocacy and Political Action; (4) Patient Education and Advocacy; (5) Organizational Support and Service; and (6) Professional Education. A national survey then evaluated the extent to which an estimated 1,000 oncology social workers acknowledged the relevance of these tasks to their own practice. Achieving the highest levels of quality and equity in cancer care depends upon how well comprehensive oncology social work services, as identified in this study, are integrated into medical care systems, enhance patient outcomes, and achieve operational efficiencies and cost-offsets. Findings from the AOSW CORE survey may be used to inform initiatives related to social work education and training, credentialing and certification, health policy, and research.
1. Summarize the multiple and varied activities in which oncology social worker engage across different cancer care settings.
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GPICS-1D12U-SCA-S
Singlemode breakout with SC/APC connectors chassis we can place up to 4 drawer devices in 1U.
GPICS-1D12U-SCA-S Breakout allows on connection of two separate locations using single MPO 12F cable with A polarization. Device has built-in single MPO port and 12 SC/APC. To connect two breakouts you need to use one singlemode 12F MPO cable.
1 singlemode MPO port, 12 SC/APC ports


Here, Shri Krishna gives us a formula, a technique to remove errors and defects in saattvic actions. This purifier is the combination of three words – Om, Tat and Sat. All three words are indicators of the eternal essence, of brahman. In fact, each of these words has been used in the Vedas to refer to the eternal essence. Om comes up in the Rig Veda. Tat and Sat come up in the Chhaandogya Upanishad. The word Sat is also used in the second chapter of the Gita to refer to the eternal essence. Note that the eternal essence is beyond name and form. These words are only pointers.
Next, Shri Krishna gives us the heritage of this purifier. Prajaapati, Lord Brahma, created the universe along with the sacrifice and the Vedas, as we have seen in the third chapter. He also created braahmanaas, who performed rituals and sacrifices with faith in the Vedas. These braahmanaas would always use Om Tat Sat to purify their sacrifices, to remove any defects in the rituals. Now, per the teaching of karma yoga, whenever we perform saattvic actions, they automatically become a sacrifice. Therefore, even we can use Om Tat Sat to purify our saattvic actions.


work@Vifor Pharma
My initial motivation was after my studies in biochemistry at ETH Zürich. As a medium-sized specialty pharmaceutical company and global leader in iron supplementation products, Vifor Pharma has an outstanding culture of fostering the entrepreneurial spirit of its employees.
What are the main challenges you have in your current position?


Hi, I love hot naked fun and am keen to know what you enjoy and explore that?.... or maybe there is something you want explore with a hot older sensual lady? Would you like a dinner companion the next time your in town... who can hold a conversation... and has a quirky sense of humor? That you can also take back to your hotel room and have some hot naked fun with? I'm just as comfortable in either situation? I enjoy sex... as much as you, its second nature to me ... and my curves are just what you need to hang onto. I love to be pleased and be please even more.. my sense of fun and openness will make your time with me memorable... so you'll want more and more. I’m a kiwi girl of European decent. Please be respectful and take time to write something in your msg to me - a "Hi" or "Hey" kind of message I may overlook, I won’t take calls from private numbers. I'm into most things... so we can discuss what you'd like? A GFE? Maybe some fantasy play? Maybe some role play? And yes... the bust is real I do this part time... so will only be able to reply and play on that basis. Please send a text as an into, as Im not keen on answering calls from unknown numbers, no caller ID or Blocked numbers. I've had to deal with some not nice people... so... please respect that... and we will get on great. I believe in treating others well... so please do the same for me?


The Best Sad Anime Quotes About Love That You Need Know Update 05/2022
Short sad anime quotes
Do you know any heartbreaking quotes? The best anime quotes are the ones that are relatable since they are short and to the point.
Regardless of how badly someone has been harmed, they are intended to attempt and move forward. – Mirajane Strauss’s work
That’s exactly what I was going to say. The world we live in is full of cruelty. It dawned on me that life was a gift. – Mikasa Ackerman
I’ve done nothing thus far. Depressed and lacking self-confidence is narcissistic to the point of insanity. In the words of Sorata Kanda
The pain of forgetting is similar to a cut. Even if the wound heals, there will still be a scar. In this case, it’s Monkey D. Luffy.
To truly understand another person, you must experience their suffering alongside them. – Mr. Nagato
You can die at any time, but to actually live requires a great deal of courage. The character of Kenshin Himura
Even the nicest people can be a little sour. You can’t battle a bully with a bully. Keep your chin up and your shoulders back. In other words, Hinata Miyake
Sad anime quotes about life
It’s normal to experience low moods. Overcoming obstacles takes time. Once you’ve taken the time to pause, you’ll be able to get back on your feet again. That’s what we do as humans, after all. In other words, “Mondo Oowda”
Some people in this society don’t realize that what they think is a lighthearted joke can cause significant harm to another person’s life and well-being. – Mio Nishizono / Mio Nishizono
Take your mind off of it. Those who want vengeance will meet a tragic end. It’s heartbreaking, and you’ll only inflict more pain and suffering on yourself. Even if you are successful in your quest for vengeance, you will still be left with an empty feeling. In the words of Hatake Kakashi;
What did you say before? Who knows what an ordinary gun owner can achieve when given the opportunity? There is no one on this planet who can fully escape the grip of violence. Anyone can get their hands on a gun these days. Our faith is placed in firearms rather than human compassion. – Koko Hekmatyar
Weep if you’re feeling down. Laugh if you’re feeling good. Anger is a natural reaction to disliking something. When you’re depressed, rely on someone else for support. Prioritize your own well-being over the well-being of others. Don’t harbor animosity toward anyone. Take a moment to celebrate your accomplishments. When you fall in love, stick with your partner. The name of Maria Otonashi
Changes in currency and passports are akin to this. At first, it may be difficult to get used to, but you will get used to it. After all, the passage of time is depressing… As time goes on, both joy and sorrow fade away. – Conan the Barbarian
Consider making changes if you’re dissatisfied with the outcome. If things don’t work out, you may become depressed as a result. in the words of Nanana Ryugajou
EIt’s important to remember that love isn’t always a bed of roses. These love quotes from various anime characters can teach you more about love.
You’re a fool. Surely you’d had enough of the romantic craze by now? The “love” you think you’re experiencing is merely a delusion. That kind of love isn’t worth getting down over. The writer’s name is Kyouya Sata
I long to be in your companyly you, from here on out. – Naruto Uzumaki’s character name is
Love is like a mirror, reflecting your ugliest aspects back to you. Envy, jealousy, bigotry and anger are common reactions to unrequited love. There’s no reason to be embarrassed about having to face a wide range of emotions. — Margery Daw
Only the days that I spent with you are genuine to me. The following is an interview with Vincent Volaju:
I’d been pondering whether or not a broken heart has a deeper significance. Is it the same ast’s good to know that now. Clearly, this had some deeper significance. Because, despite the pain, I’m pleased I fell in love with you in the first place. In this case, it’s Takemoto Yuuta.
I’m not sure why people fall in love at all. Is there a better way to deal with these feelings? – Nejima Yukari
Sharing a route isn’t enough to make someone fall in love with you. Khamsin: –
I’m not going to despise that individual. Even if he doesn’t feel my love for him. As long as they’re still mine, they’ll always be precious. The author, Ninako Kinoshita
Anime quotes about pain
My entire family was shattered by the one thing I had prayed for. A wish I made without realizing what he really wanted from me caused all this pain for my family. in the words of Kyoko Sakura
Anxiety and discomfort are a part of everyday life. It’s a continual process of contemplation and decision-making. – Alcor is the name of the company.
W painful memories. The Scarlet Erza
Is it torturous to have to wait? Is it worse to be the one who has to wait on others? There is no longer any need to wait. That is the most upsetting part. TAKADA, Hiro
When someone you hold in high regard disappoints you, it hurts. In the words of Misaki Ayuzawa
Even if it’s difficult, try to smile while you’re feeling down… When something hurts, crying will only make it worse. In the words of Chie
I’d like it if physical discomfort outweighed emotional discomfort. I could focus on it if I inflicted just enough pain on myself. The author, Kusunoki
Anime quotes about death
Death is an inevitable part of life. Animals succumb to natural causes. Plants succumb to the elements. Even the soul reapers die. You may call it the apex of the cosmos. In the end, all that is created vanishes into oblivion. – Baraggan Louisenbairn
It doesn’t matter if you have power or not, you will all perish at some point. Think about what your life will be like while you’re still here. – Macbeth’s witch
Someone should kill themselves before they say, “I’d rather die.” I wish that was the case with everyone who says that. To let them know what I’m going through. – Subaru Natsuki
Death isn’t nice. As far as you can see, it’s pitch black. You’re the only one out there. No one else is around to help you. MEI MISAKI, author
I’m willing to bet that those who have passed on are a lot more tolerable. In the words of Crona
Do not try to end your own life. However, there is no need to be alarmed. Death is an inevitable part of life, and it cannot be avoided. – Keisei Tagami’s name
Death, in my opinion, is a dreadful thing  decent or terrible; everyone is the same. It treats people fairly. It’s frightening because there’s no such thing as a truly horrible death. – Sunako translates.
Sad anime quotes about loneliness
We all feel lonely at some point in our lives. It impacts a person’s entire health. Loneliness is a complex feeling, and anime characters that have experienced it have shared their insights.
The sweetest individuals are the most isolated. The brightest smiles can be found on the saddest faces. The smartest individuals are those who have been hurt the greatest. They’re doing it beey went through. JELLAL FERNANDES
Because someone is significant to you, it doesn’t mean they’re a nice person. Even if you were aware of their terrible intentions. Loneliness is a force that cannot be overcome. – Gaara’s name is mentioned.
We are all alone, no matter how many relationships we appear to have. The name of Mei Misaki
One of the most common causes of death is loneliness. the wise wolf holo
Loneliness is something everyone should go through at least twice in their lifetime. No, you have to see it for yourself.. The thought of being tethered to another person odisturbing. Loneliness is a subject that must be learned. Some things, I’m sure, can’t be fully appreciated without it. The name of Hachiman Hikigaya
As a prisoner, I had experienced the solitary confinement. I understand the rush of adrenaline you get when your friends come to your aid, as well as the worry that they might be hurt or even killed. The writer, Rukia Kuchiki
For a long time, I genuinely believed that dying alone was preferable that living life on your own. It’s Kirito’s turn
Although alone is calming, there is no one with whom to share joy. The name of Ayumu Aikawa


0, NR08136, the Center for Women's Health and Gender Research, NR040M01-RR-00037.
American Academy of Sleep Medicine Task Force Report. Sleep-related breathing disorders in adults: F(1999) 22:667–689.[Web of Science][Medline]. Sleep (1992) 15:173–184.[Medline]
Arthritis Foundation. (2007) Retrieved June 4, 2007. from.
Bloom BJ, Owens JA, McGuinn M, Nobile C, Schaeffer L, Alario AJ.  (2002) 29:169–73.
Carskadon MA, Keenan S, Dement WC. Nighttime sleep and daytime sleep tendency in preadolescents. In: Sleep and its disorders in children.—Guilleminault C, ed. (1987) New York, NY: Raven Press. 42–53.
Dahl RE. The regulation of sleep and arousal. Developmental & Psychopathology (1996) 8:3–27.[CrossRef][Web of Science]
Gaudreau H, Carrier J, Montplaisir J. A (2001) 10:165–172.[CrossRef][Web of Science][Medline]
Hinds PS, Hockenberry M. Developing a research program on fatigu (2001) 18:3–12.[Medline]
Hockenberry-Eaton M, Hinds PS, Alcoser P, ONeill Brace J, Euell K, Howard V1998) 15:172–182.y (2004) 31:390–392.
Labyak S, Stein L, Bloom B, Owens JA, Lunsford V. Sleep in children with juvenile rheumatoid arthritis [abstract]. Sleep (2001) 24(suppl):A15.
Lewin DS, Dahl RE. I9) 20:244–252.[Web of Science][Medline]
Owens J, S Behavior Pediatrics


Did Bolton'a?
VOA reported that the president added that knowledge of the responsible party or parties of the drone attack will be made public "for certain over the next pretty short period."
Speaking to reporters on the South Lawn on Monday afternoon, Trump, asked about Secretary of State Mike Pompeo directly blaming Iran for the attack on the Saudi installations, replied: "I think we'e."


causes of testicular cancer anddisease.
Find out more about the risks and possible causes of testicular cancer.


- C </s> Front
From McKeesport? You and your mate can listen to TL and "Music for Young Lovers" while enjoying a hot toddy from this "Mighty 1360" mug!
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JacksonvilleWatts' Envoys Ready for Sri Lanka
It was to be the field trip of their dreams, but things didn't come together in December for a small group of Watts high school students.
Initially, Sri Lanka was the destination of choice because, with the help of a Sri Lankan Buddhist stationed in Los Angeles, the students were going to study the Sarvodaya movement of conflict resolution and social commitment.
The tsunami makes the mission more intense.
The students will be delivering more than $200,000 worth of medical supplies -- much of it donated by AmeriCares and Adventure Medical Kits -- to hospitals and clinics.
Belson visited Nepal several years ago and was struck by the custom of Western travelers giving candy and gum to residents of a country with a healthcare crisis. She started the nonprofit Medicines Global and began urging travelers to carry medicine instead of M&Ms.
Belson wanted to offer opportunities to students who don't have many. She approached Anne Lamont, who runs Jordan's magnet program, and came up with a contest to determine which students would travel abroad. </s>  vs. Crime Inc. (1941) More at IMDbPro »
Trivia:The scene where Tracy uses the infrared light bulb to reveal the presence of the Ghost was accomplished simply by printing the film in negative form. more
Quotes:Lucifer: I begin to see your plan. By creating a reign of terror, you can force the city to accept any demands you make! more
Movie Connections:Referenced in Body Fever (196


14-Year-Old Who Attacked a Woman on a Bike Is Arrested for Attempted Rape, LAPD Says
Dennis Romero | December 18, 2014 | 9:28am
Here's what the LAPD says happened:
The victim was knocked off her bicycle by the male who then attempted to sexually assault her. As the attacker began to hit the victim, she fought back and screamed for help. The suspect ran away and the victimattacker.
The attack was reported at 9:40 p.m. Sunday, the department said.
Anyone who might have witnessed the attack or anything else suspicious in the area was asked to call detectives at 818-756-4820.


Our brand new Figures & Portrait Artists’ Retreat offers artists a unique opportunity to work closely with models without instruction. A male and a female model will work with artists each day. There will be opportunities to work on various draped, costumed, and nude poses both in the studio and plein air. Artists can work on both short and long projects.
The idea behind this workshop is to explore the freedom of working with models in a more relaxed setting, allowing artists to achieve their goals at their own pace. It will be facilitated by our experienced male model, Rudy Vavra. Rudy has worked many artist workshops and, as an artist himself, relates well with the needs of other artists.
If you’re self-motivated and could use time to concentrate without instruction, or if you have a friend you want to spend time with, or you just want a relaxing art vacation, the Artists’ Retreat is for you. Take advantage of the spring blooms of upstate New York, or work indoors in the climate controlled Carriage House Art Studio. We offer a 6-night or 3-night option.
While artists interested in all subject matter and mediums are welcome to attend this retreat, please note there is a model fee included in the enrollment rate.


I think your last paragraph captures very well the attitudes of perhaps 50% of Singaporeans towards religion — that one must believe, because there's something deficient in failing to believe. You might say, too, that these people are hedging their bets, following Pascal's Wager. "God or gods may not exist, but one can never be too sure…don't risk attracting their hypothetical wrath."
I used to hedge my bets too. On official forms asking for my religion, I'd put "Free Thinker" (one of those New Age phrases that don't mean anything — is one 'free' to believe in Satanism or Zeus or the Flying Spaghetti Monster?
Sometimes in the religion column, I'd put "Atheist."
Eh?When did I mention that atheism is a religious belief?
Email me if you wanna join!
Thanks so much about the information. I've got quite a busy schedule lately, so I'll hold off joining it for now, but will follow your blog as frequently as I can. All the best for the Freethought network!


under Sugnu Assembly Constituency where 40 Acres of land are under watermelon plantation. Ibethoi’s brother Khunbakchou was the pioneer of watermelon plantation in Kakching Khunou. Ibethoi has been planting watermelon in his farm since three years.
By January or February the farmers are busy planting watermelon. They have harvested their paddy and had stored enough grain. Instead of leaving the open field the farmers grew watermelon which needs lots of water to grow. The farmers dug up ponds and store water for the farm. The fruits are reap during April / May month.
A watermelon weigh around 3 to 5 kg. The standard rate in the market is Rs 10 per Kilogram. Ibethoi was carrying Rs 20 thousand worth watermelon in a Tata DI. She says the bigger watermelon are already sold out from her farm and she was carrying the smaller ones.
1000 pieces of watermelon is an easy sell for a day expressed a happy Ibethoi. She wishes that the government opens a cold storage at Kakching Khunou to store the watermelon after harvesting as the production is increasing every year in the area. </s> Factory Method n, which is used in project to centralize creation of similar family object in application. It's part of creation design patterns as it helps to create objects in application.
Why to Centralize Object creation with Facotry?
To create object at run-time which serves purpose, based on requirement (i.e. based on input parameters).
Below is class diagram and code implementation of Factory pattern.
Code below creates different command to perform task such as addemployee, editemployee etc.
CommandFactory, GetCommand can only return ICommand. If developer added new property/method let's say xyz which is specific to command ex. AddEmployee, then developer cannot access it like addCommandObj.xyz as return Command is of type ICommand and it doesnt has that property.
It doesn't violate open close principle as object get created using reflection and using Generics Template type T in CommandFacoty class - GetCommand method. Check CommandFacotry Class in above code.
Factory pattern is one of the highly used deign pattern which used in most of the application to create and centralize object creation. So when it written not strongly type based way can lead to problem. So it's better to implement it strongly type based way (Generics implementation) to avoid issues and it helps to stick your code with SOLID principle. </s> In a deal that expands its presence in the aerospace aftermarket, Timken Co. (NYSE: TKR) has acquired Turbo Engines, Inc., a provider of aircraft engine overhaul and repair services. J. Ron Menning, Timken vice president - aerospace, consumer and super precision, said the combination "of new engine overhaul capabilities with Timken's existing replacement parts and service operations opens up powerful opportunities to provide complete fleet support for our growing aviation customer base." " We intend to expand our aerospace portfolio by making strategic investments that help us improve customers' performance," Mr. Menning said. Timken plans to run the former Turbo Engines operations with existing management at its current location in Tucson, Ariz. Timken said the staff at the 42,000-square-foot Tucson plant consists of 35 people, primarily airframe and powerplant technical specialistsththththRT'S BACK!!! Stunning Saussy Burbank home w/cozy front porch, open floor plan w/ immaculate hardwood floors on main, spacious dining room w/tray ceilings, double french doors open to quaint study/office, beautiful kitchen w/granite countertops, SS appliances w/center island & breakfast area, open to the great room w/custom built-in cabinetry on each side of the gas log fireplace w/ lots of natural lighting throughout. Cozy, fenced in backyard, features a brick paver patio, tiered landscaping to showcase the dwarf flowering cherry trees, knockout roses, and dwarf Laceleaf Japanese maples...a place to read, relax, entertain, & play! Upstairs features a generous master bedroom en-suite w/double vanity, garden tub, tile shower & custom walk-in closet, plus three additional, spacious bedrooms, large laundry room, full bath & 15x19 bonus room. Large 2 car garage w/shelving & utility sink. Great community, enjoy a walk, ride your bike or take a dip in the pool! </s> BERLIN – Cognitive behavioral therapy carries the best evidence to treat MS-related fatigue.
BERLIN – In addition to the pain, motor and sensory impairments, and cognitive dysfunction that can stalk multiple sclerosis (MS) patients, for many, there’s also the challenge of an invisible, tough-to-quantify entity: fatigue.
“Approximately 80% of patients suffer from fatigue, so it’s an immense problem in MS. There’s no real clear relationship with disease


This Orcas Island Wedding was a very special wedding for me to shoot because Hailey and I have been friends since we were, what? 15 or so?! Together we spent many high school memories together – from dance-partying at our favorite lake, TPing all the boys in our class, being on homecoming court, and going to camps together. We also both went to the University of Washington, and graduated a year early together! Her and Brett met while working in the San Juan Islands (Brett is native to the islands!) one summer, and the rest is history. Their love is tender, goofy, and contagious. And it only made sense that they get married on one of the islands! It was a weekend I won’t forget.
Hailey and Brett effortlessly made all of their wedding dreams come true by inviting many of their friends to play important roles on their day. Family and friends came together to arrange florals, bartend, cook, bake, and set tables. It was truly a family and friend affair at this Orcas Island Wedding at Oddfellow’s Hall.
Book out a few airbnbs ahead of time. These will be helpful for the wedding party getting ready, family from out of town, and providing housing for vendors.
Have a welcome dinner at one of the airbnbs! The best part about these types of weddings is that most people make the trek up early, which means you get more time with your people! Host a bbq the night before, or even a morning-after brunch as people start hitting the road.
Stay a while! You’re in a beautiful place, and if you don’t feel like making an early drive to the airport to immediately go on your honeymoon, take a day or two to enjoy the vacay spot just the two of you, after the guests have gone.
For another summertime, WA-based destination wedding, check out Alice and Evan’s wedding in Lake Chelan.


From the Art of Balancing Soil Nutrients.
This adjustment by weight is really only practical for crops planted on an individual basis like corn. Wheat could be done, but it would be very time consuming. For turfgrass, tissue numbers could be adjusted by clipping weight. It would not be very practical to collect whole fields, but collecting sample areas and calculating that to the whole field, green or tee could be done without too much problem.
Why sample this early in the crop maturity anyway? Grass crops such as corn and wheat determine some of their yield very early. Corn, for instance, is determining the number of ear kernel rows around the 6-leaf collar stage. It would also be good to sample corn at the tassling stage—another critical time in which ear length is being determined.
Ultimately all crop production issues can come back to nutritional problems. Unfortunately these crop production problems, whether quality or quantity issues, are not always related to the level of nutrients in a soil. Diseases or root pruning caused by insects can easily restrict nutrient uptake too. Also remember that compaction is still the top reason for limiting nutrient uptake.
Figure 88 shows a seed treatment test that I was working on in 2007. Although there were large differences in weights and nutrient levels at 6-leaf collar stage, the yields were essentially the same at harvest with the exception of the outside 6 rows. The outside 6 rows received limited compaction. I have in the past tested the soil in the outside 15 feet and found it to have poorer fertility than the center of the field. The compaction, along with fertility shortages in the center of the field, neutralized the gains set up by the seed treatment. Many of the disease issues in crops are nutritionally related. I am certainly not qualified to discuss this topic in much depth, but the book Mineral Nutrition and Plant Disease written by a number of authors and edited by Datnoff, Elmer and Huber is certainly a book that should be in everyone’s personal library.
Personally I have seen that fungicide applications on soybeans have not yielded much response, especially where a foliar application of manganese was applied to improve plant nutrition.


"I feel as excited about this team as I did about last year," said St. John's head basketball coach Mike Jarvis before a contingent of reporters in the press room at Alumni Hall Friday night. "The kids believe they can compete and beat anybody."
The men's sojourn through the 1998-99 campaign is well documented; a surprising run through the regular season, culminating with an appearance in the Elite Eight before bowing out to Ohio State. The women's program also had its share of successes, improving on seasons of sub-par play to a level of respectability. Both Jarvis and new women's coach Darcel Estep are hoping to continue the trend set last year. "These kids know how to win," Jarvis said of his 10-man roster, which can certainly prove dangerous if the team gets bitten by the injury bug or gets into frequent foul trouble. I'm excited that these kids are here. We could've filled positions. We could have put people in uniform, but that's not how you build a program. You play the guys you want."
Jarvis' roster this season is without three key players from last year, Tyrone Grant, Ron Artest and Collin Charles. Grant graduated, Artest opted for the NBA and Charles, the team's back-up point guard, transfered. Forward/center Albert Richardson is also gone, losing his bid for another year of eligibility. In their place will be former Rice High School star Anthony Glover, 6-foot-11 swingman Jack Wolfinger and long-range shooting sensation Heath Orvis. They will join returnees Barkley, Donald Emanuel, Chudney Gray, Reggie Jessie, Lavor Postell, Kareem Syed and Bootsy Thornton. Though the team seems lean on interior players, Jarvis and his players seem confident that they can succeed against the best teams in the Big East. "We have a lot of guys who can score a lot," said Thornton. "I'. I just want to win."
"We may not be better, but we'll be good," said Barkley. " It's going to take a lot of hard work."
"I'm staying in school to get my degree," he said is response to the first question asked of him by a reporter. He later added , "It's possible, but I'm concentrating on academics and this year [with the team]."
"He's an ox," Thornton said. "It's a struggle just trying to screen him. There's not a muscle on his body that's not cut. I don't know how anyone wouldn't be intimidated by him."
Wolfinger reminds Barkley of former Rhode Island star and Queens native Lamar Odom, the fourth overall selection in the most recent NBA draft, in that he is a tall and lanky ball handler who plays his best basketball on the perimeter. "He's not Lamar yet," Barkley said. "But he can take you down low or take you outside."
The men's team will makes its competitive debut on Tuesday, Nov. 2 in an exhibition match-up against Marathon Basketball. "I won't know what I have until we have a couple of tough losses," Jarvis said. Health is the key. If we're healthy we will compete with anyone."


A workshop for Local Authority officials with responsibility for event safety, particularly those with a lead role on their event Safety Advisory Group. The purpose of the workshop is to review the approach being taken in different Local Authority areas, to share best practice from across the country and to progress a consistency of approach in dealing with event safety in Scotland. The workshop is coordinated by COSLA and Police Scotland, in partnership with EventScotland.


Last Sunday seen the Seniors and Reserves travelling to Edendork for their second league game. Unfortunately they were unable to get a win. With it all level at half time with 4-4 each Paul Rafferty and Darren McCurry gaining points for each team. After the break Declan Murphy secured points for Galbally putting them in front, however Edendork fought on and finished the game two points ahead with a score line of 10-8. The reserves put on a brave fight in the second half with the game ending with a score line of Galbally 5-6 to Edendork 2-15.
This Saturday Seniors and Reserves are at home to Gortin with a throw in time of 4:30 and 6pm. All Support is Welcome. Wishing all the Players and management good luck.
This Friday night sees the start of the Senior league when our Ladies play Beragh in Pearse Park @7pm. We wish all the ladies and management the best of luck in fourth coming season. All Support Welcome for the ladies.
Our Minor boys had a good win against Cappagh with a scoreline 2:13 to 1:14 on Tuesday night.
Minors play Dromore in the championship at home in Pearse Park next Tuesday night. All Support welcome for the minor boys.
U6 & U8 Boys and Girls and U10 Boys training will take place every Wednesday 7-8.
Gaelic for girls continues on monday 6.30-7.30.
We have had a great response to our Path of the Pearses cycle with over 130 people signed up, with over 50 of these people having never cycled before, all cycling abilities are welcome to join. Our next registration date is this Monday 27th April 8-9 in the Galbally community centre. For anyone who is unsure what way the registration works, only £40 has to be paid upfront when registering we take all your details including the size of your cycling tops, there is tops available to try on for sizing when you register this is to insure you get the correct size. Once you sign up you will receive an Information Pack- within this pack there is a sponsor sheet where you will be able to fundraise the rest of the £110. There is also a leaflet about Cycling Ireland, we would strongly advise all our cyclist to get insurance with cycling Ireland. Our6th May at 6:30pm, everyone to meet at the Galbally Community Centre.
It is COMPULSORY everyone wears a Helmet. We would suggest everyone gets their bicycles checked making sure they are ready for the road. We would also recommend the following: Water, Jacket, Cycling Shorts, Tubes and Pump.
Congratulations to Sharon McKeown on winning the Jackpot of £5400 with the winning numbers 8, 5, 3, 11. The jackpot will start again at £1000, next draw will take place on 28th April.
Congratulations to the Tyrone U21 squad and management especially our own club men Fearghal McGarrity and Ronan McGeary on reaching the All Ireland Final. Best wishes for the final!


was on January 22, 2014 (1,302 days ago) and it was 85,073. And this is the worst position that urlspion.nl ever had in Alexa.
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Inline HTML </s> Romance realize the power of the time capsule to heal broken hearts and inspire newfound relationships..
When Gema gets roped into meeting her fiancé’e’s been keeping from them.!
’s wedding.. </s> .ur first performance went down really well, with some lovely audience members staying behind afterwards to tell us how much they enjoyed it and congratulating the actors on their fantastic performances. I can honestly say that the show went from strength to strength from there on out, with each performance getting stronger and with continued positive audience reactions. I think personally that we hit our stride on our first Saturday performance, halfway through the run, and that each performance during the second week was as solid and polished as I could have hoped for.
Aside from our own run, the shows I and others saw during our time at the Fringe were incredibly inspiring and I would say personally that I feel like my eyes have been opened to many new and different styles and types of theatre which I found to be one of the most valuable aspects of my visit to Edinburgh. Some personal highlights for me would have to be Terra Incognita, a physical theatre piece about climate change, The Marked, a tale of homelessness and alcoholism told using puppetry and physical theatre, and Yeti’s Demon Dive Bar, a ridiculous cabaret show.
The experiences that I and others had over the course of the month were tiring, stressful, inspiring, brilliant and so much fun, and I cannot emphasise enough how much I enjoyed my time there. If theatre at all interests you, or you want your mind to be opened to new experiences, the Fringe is definitely one for the bucket list.
“I was given the opportunity to be in the cast of ‘Death and The Human’ to perform at the Edinburgh Fringe Festival this August. I’d never even seen the festival let alone performed at it. So that was something I never thought I’d do, and I was very excited if a bit nervous. It didn’t disappoint.
“We spent three weeks as a cast and crew together: one week of rehearsals, and two performing at the Fringe. Honestlyharing a flat for two weeks with the cast and crew. You make friends in every production at the guild, but spending so much time together and working through the challenges of a new production means you get to know each other a lot more. When I realised we were doing 12 performances, I was quite daunted as I’d already felt well out of my depth. However, the opportunity to constantly improve and tweak things proved to be really rewarding, especially given how new this style of performance was to me. Sadly, potential audience members apparently don’t just fall from the sky and land perfectly in the seats of your venue at the exact time you happen to be performing (shocking, I know). So, I got my first taste of ‘Flyering’. (Microsoft says that’s not a word but I heard it often enough so it must be). Whilst I was initially too embarrassed to approach strangers and offer them flyers, the atmosphere on The Mile was unforgettable and made it all really fun.
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Belt stripes brown beige 115cm


How to look for a job in DenmarkIf you are thinking of looking for a job in Denmark, you can find vacant posts here on Øresunddirekt, check company websites or send a "spontaneous application." You can find more tips on how to find your dream job in Denmark here.
- Send unsolicited applications (more common in Denmark) - a so called "uopfordret ansøgning". Applications are sometimes saved for future needs.
- Trade unions/a-kasser (unemployment insurance fund) can also inform you about new jobs.
- Register with some recruitment agencies.
Jobcenter - the Danish public employment service
Work and residence permits for foreign nationals be granted a residence permit and work permit in Denmark. You can read more about the rules on nyidanmark.dk.


Tops has the store under contract and is expecting to have its due diligence completed by the end of the month. It hopes to close on the deal during the first week of June, it said.
Tops declined to offer other details about the store, including any planned changes, when it hopes to open, or even whether it will open at that location at all.
The Amherst-based grocer took over a family-owned supermarket in Sanborn in November 2015 and closed it to complete $1 million in renovations before celebrating a grand opening the following April.
Shurfine Markets is a retailer cooperative made of of independent stores in Western New York, Pennsylvania, Maine and Maryland.


I was disappointed that Kellogg's new mystery leaves Lilly and her new husband Richard to enjoy in their honeymoon in peace. But in her new novel, Insatiable, set in glamorous playgrounds around the world, she introduces a new character, Jacqueline du Fidelio. Jackie . She is a fine artist, but has lousy taste in men -- except for her wonderful, amoral gay butler and closest friend, Nigel, who is the narrator of the story. The story begins in prison, where Jackie is scheduled to be executed for murder and Nigel is saying good-by to her for the last time. Then Nigel tells the story and what a story it is. In a personal note, Kellogg says, "Nigel is the biggest, most neurotic sissy on the planet."
Sorry. Gotta go. I have to find out what happens to Dr. Kay Scarpetta in Patricia Cornwell's newest, "The Last Precinct."


Who doesn't love them some Girl Scout cookies?! I do, I do! My faves are no doubt the Samoas aka Caramel deLites, as they're sometimes called, so when I found out that my favorite local baker, Lisa B of The Chocolate Swirl was making them into cupcakes and cake pops, I nearly lost my cookies so to speak. The idea is totally rad and so wonderfully nostalgic, that I can't wait to see how its executed.
You can get your delicious Girl Scout treats starting this weekend, as Lisa will be selling them at the upcoming Queens County market at Sac's Place. Come by from 12 p.m. - 4 p.m. and bring your sweet tooth.
Sunday, February 24th from 12:00 p.m. - 4:00 p.m.


By far the most complicated action sequence I’ve ever been part of, and if it wasn’t “oner” — almost 12 minutes long and it’ks!
Are you excited to see the scene unfold on screen?


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Try 250-plus varieties of cheeses at artisan creameries across the Golden State
This two-star Michelin restaurant has perfected the culinary concept of simple elegance
Fro’s a... </s> Photo Credit: Marietta House Museum
DescriptionFederal-style home of Supreme Court Justice Gabriel Duvall, who owned slaves but often leaned towards abolitionist ideals. The museum is furnished to interpret 19th century living.
Weddings </s> .
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10K Yellow Gold 0.05 ct. Diamond Cushion Emerald Ring$150.99
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14k Yellow Gold Pink Ruby Ring Earrings Necklace Set$152.99 </s> How to get customers to try (and love) your products
As a small business owner, you no doubt put great care into ensuring your products and services are up to a high standard – perhaps even exceeding customers’ expectations. However, exceeding expectations proves difficult if you can’t get people to try out what you have to offer.
While promoting your products’ unique qualities through marketing can sell them as an idea, actually getting them into people’s hands (or mouths!) so they can experience them for real is even more powerful.
The challenge is how do you get prospective customers to sample your products? Here are a few tactics that can help:
Brighten people’s day with a free treat
As well as timing, keep the weather in mind too. Free refreshments on an unexpectedly hot day or a nourishing snack in the cold can be a welcome indulgence as people go about the town. And it’s not just the sensory enjoyment that counts, the emotional uplift goes a long way too. Just as a kind gesture from a stranger can make your day, handing out free trial products at the right moment can be incredibly effective as it creates a happy feeling – and subsequently, a positive association with your brand.
Create a pop-up shop or attend an event
In contrast to the surprise approach of stopping – and hopefully delighting – people in their tracks, organized events are great opportunities to appeal to people when they’re already in the mindset of discovering something new. Look for events in your area, such as farmers’ markets, and consider booking a spot where you can offer the chance to try different product flavors or scents. Hopefully some people will make a purchase there, but even if they don’t, you can give them a sample to take away, together with a calling card so they know where to find you.
Pop-up shops are another great way to help people discover your products. A pop-up shop is essentially a temporary retail space that appears for a limited amount of time only. Do a little online research for temporary spaces available in your area – whether in a mall or a street level location – thinking of course about your target customers and where they’re most likely to be. The great thing about pop-up shops is that they create a sense of excitement and one-off opportunity, perfect for getting people to try – and buy – your products.
There’s nothing like a perfect match to please the palette – or any of the senses for that matter, depending on your product. If you run a deli that sells artisan cheese, why not team up with your local wine shop to offer free tasting – perhaps with some ready-made gift hampers nearby in case it’s love at first sip/bite? If you’re in the business of bathing products, there’s


Tech	Wednesday, May 04, 2016
Samsung Galaxy Note 3 to Feature an Octa-Core CPU and GPU
Picture: MyDrives
May 3, 2013|11:38 am
The Samsung Galaxy Note 3 will feature both an Octa-core CPU and GPU.
The latest rumors point to the new phablet coming with an 8-core Mali 450 GPU which will work well for graphic-intensive activities such as mobile gaming. The device will also pack Samsung's Exynos 5 Octa processor, making it even more powerful. Other rumored specs include 3GB RAM, a 6-inch full HD display, and a 13-megapixel camera.
The image was leaked by a site known as Mydrt., 3-to-feature-an-octa-core-cpu-and-gpu-95223/


We were panting and sweating during the initial encounter. Actually, he made it look effortless. I, on the other hand, was hard at work. I couldn't keep going for more than 20 or 30 minutes. Those elliptical machines are tough! In parallel fashion with a hottie, though, I was on fire.
By the third workout, Basil asked me out. I immediately agreed, attempting to hide my excitement beneath my panting, heavy breathing, and constant flow of perspiration. Basil would be my first, my first date since marital breakdown. He would leave an impression for other reasons, though.
"Meet me at Cali's Pub 'N Grub. I've started a tab." He texted. I was on my way, and my panting ceased upon reading the message. I'm no drinker. Still, the guy was cute, and a good 10 years younger. Thoughts of cougardom propelled me to the Pub 'N Grub in a flash.
The movie was great too. Sean Penn was phenomenal as Harvey Milk. It's a must-see. Basil, not so much. The dude didn't make a move during the movie, except to grab his coffee and motion for the few pieces of chocolate that I hadn't devoured.
We strolled afterward, as he expelled stories of intoxication (his). There were parties, and a time when he got lost because he had too much to drink, and so on.
Three days later, Basil was on the elliptical machine when I entered the gym. This time, I chose the treadmill across the way, with my backside facing him. In my black tights and cropped T-shirt, I gave the guy a view of what he was missing - were he sober enough to see it.
I never saw him again. I'm guessing he's working up a tab right now. After all, it's 5pm or 8am or 12 noon somewhere.
I wonder what made him think you'd be a good drinking buddy. If someone forced me to guess, I would say it was your bosom. So it's a good thing no one is forcing me.
Robyn, that was pretty damn funny...and entertaining. Glad you at least got some chocolate and a movie...he paid right?
I love me some coffee. I love me some alcohol. It's a shame I can't afford both. So I drink the free coffee at work.
Ugh...they're clueless. I have absolutely no desire to date. none...zipo..ziltch...for that exact reason.
 I'm glad he didn't latch on to you!!
giggle...the priorities were all taken care of....chocolate....and yogurt....
We should have a power ring or something to make it official!!
Paprika, girl your so funny!
Sorry he was such a boozer lozer!
Your blog has got it going on, ah ha ha!
I'm with pat on this one!
and yeah, i like Harvey Milk too. the man and the movie...
It's a good thing you flushed him--celibacy is still way better.  Some guys, really...
Ya know, if you think about this, it's actually quite sad. You, my dear, are the smart one. No fried brain cells or pickled liver.
Smart girl! And you were able to look on the bring side and have your chocolate, too!


- from Blue Mars by Kim Stanley Robinson
They were specks in this universe, specks! But what ideas they had. People would do anything for the sake of an idea, anything.
It's pointless to achieve a red Mars by pouring blood over the planet. We have to find another way. We can't do it by killing people. Not even by killing animals or plants, or blowing up machines. It won't work. It's destructive. It doesn't appeal to people, do you understand? No one is won over. In fact they're put off. The more we do things like that, the more green they become. So we defeat our purpose. If we know that and do it anyway, then we're betraying the purpose. Do you understand? We aren't doing it for anything but our own feelings. Because we're angry. Or for thrills. We have to find another way.
- from "The Body-Snatcher" by Robert Louis Stevenson


Reduced Sickness Absence after a Physical Activity Intervention among Health
Care Workers: One-Year Follow-Up of a Randomised Controlled Trial


For most sex related things, the rules are clear and simple, such as wear a condom and/or take birth control if you’re going to engage in sexual intercourse. For other things, the rules are undefined and still developing. Sexting falls under the latter category.
Even the judiciary has not set forth a clear precedence on the legality of sexting. In recent years, the courts have been divided over the issue, with some courts stating that sexting between minors constitutes child pornography while others include it among a wide range of obscenity charges.
While the courts have primarily exercised jurisdiction over cell phone sexting, I consider all explicit messages or pictures sent via text message or over the internet to be sexting. Sexting can occur through countless mediums, including but not limited to Chatroulette, Skype, Second Life and Facebook.
Easy, quick and sometimes anonymous access to these mediums makes sexting incredibly tempting to try. For some people, the internet is the site of their first exploration of sex because it is impersonal and seemingly private. People are more likely to do and try things they wouldn’t normally do or say in real life, face to face interactions.
As more and more young people gain access to better, faster technology, the number of people sexting is likely to increase. An Associated Press MTV poll reported that approximately 30 percent of 14 to 24 year oldsOf course, open and free access to these things also makes sexting quite risky and dangerous. While the legal ramifications on the issue remain unclear, the consequences of sexting are not. Sending explicitly sexual messages or nude pictures often involves emotional harm, especially if the messages or images spread among peers or becomes viral on the internet.
“Textual harassment” and “cyberbullying” have become increasingly common, causing parents and activist groups to raise awareness about it.
For example, MTV recently developed “A Thin Line” campaign designed “to stop the spread of digital abuse” and “build on the understanding that there’s a ‘thin line’e.”
Despite generally understanding the possible consequences, many young people still engage in sexual interactions on the internet and via cell phone—just as many people engage in sexual intercourse with the understanding that they could possibly get pregnant or transmit STDs. Just like when having sex, safety and prevention are important to remember and thoroughly consider before sexting.
You should take into account all consequences of sending sexual images or messages before sexting. There is a good chance that the image or message will be passed on to other people. Once you send something of sexual nature, you usually lose control over who sees it.
Given that you accept the above ramifications, I highly recommend taking precautions if you insist on sexting: Like most things, the best way to prevent digital abuse is to not post or pass on explicit messages or photos; however, I understand the notion that sexting can be a momentary thrill.
Perhaps you see it as a means of connecting or becoming closer with someone. In this age of instant gratification, it couldn’t be easier to obtain the brief excitement of sending or receiving nude pictures.
I don’t want to be a “Debbie-downer,” but the problem is that the thrill of sexting is almost always shortlived.
The bottom line is that a sext message or photo could be used against you and distributed to other people at a later date. If you do decide to sext, always take a caution and thoroughly consider the long-term ramifications before sending an explicitly sexual message.
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Design for Large Living Room with Kitchen: Photo 2016
Large Palette for Kitchen-Living Room Design
The white kitchen furniture set makes it unobtrusive as if it is almost not there. The tasteful brown colour palette embodied by the milk chocolate sofa, wooden wall panels and coffee curtains confers to the living room an atmosphere of peace and comfort, while the yellow chairs not only brighten up the interior as intended by the design project, but they also delimit space.
Light in Large Living Room Design
Each area of this multifunctional living room has its own lighting. LED lighting is used in the kitchen around the furniture set to highlight it and the work surface. Pendant lights are used in the dining room and the angle of the lighting fixtures in the corridor can be changed. The designers have chosen to insert spotlights into a narrow slit in the living room ceiling (as seen on the photo). Such modern ideas were very popular in living room designs in 2016. A floor lamp with a chocolate brown lampshade was also added in the sitting room not only for convenience, but also to create a romantic feel....


Armenia and Artsakh are once again the subjects of Azerbaijan’s unprovoked aggression. With an endless supply of the most advanced military technology and supported by an army of mercenaries, the Azeri army is ruthlessly attacking the peaceful Armenian population, which has no choice but to heroically repel the aggressor with the great sacrifice of the most precious of its society; its youth.
We salute our employees from Armenia International Airports, Converse Bank, Karas Wines and Zvartnots Handling, who have left their families behind and volunteered to join the defense of our homeland.
We are eternally grateful. Their sacrifice will not be in vain.
We pray for an expeditious end to the military activities and return to peace.
We pray for everyone’s safe return home.


International Health Specialist Program
FALLS CHURCH, Va. -- Over the past 20 years, the U.S. Air Force’s International Health Specialist program has played a key role in transforming global health engagement, giving it a new structure and purpose. As the program has matured, its impact on global health engagement has grown.
Prior to the program’s launch, global health engagement consisted of large humanitarian assistance events where U.S. military medics delivered care to populations of partner nations.
“These specialists would be able to lead engagements that not only influence the entire world medically, but also support National Defense Strategy objectives within regions around the globe,” said Carlton. “The mutual benefit to the United States and its partners and allies persuaded the Department of Defense to invest in this program.”
One of the strategic advantages of global health engagement is it creates space for cooperation where there otherwise may not be one. It serves as an initial platform for combatant commanders to establish a new partnership. Because of this, International Health Specialists are often at the helm of enabling military-to-military relationships.
“The program helps medics sharpen their strategic outlook,” said Hogg. “Air Force medicine is more than just clinical care; it is bigger than that. International Health Specialists working side-by-side with other countries, including our joint partners, opens their eyes to the many ways military medicine supports the broader Department of Defense mission. The skillset of International Health Specialists adds to the capability of our medics."
“The future of the International Health Specialist program will continue to evolve by developingthreats, shaping global health engagement through the professionalization of the role, and working with partners to support ol. Wesley Palmer, current International Health Specialist program director.
engagement anniversary international health specialist IHS 20th anniversary Air Force Medical Service AFMS GHE Global Health Engagement of the International Health Specialist Program