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5:50 pm
Tue August 12, 2014
Despite Neighbors' Concerns, Ice Rink 'A Go' In Portsmouth
By Emily Corwin
It may seem warm out for talk of winter sports, but come December, ice skaters in Portsmouth will have a new outdoor rink for skating and ice hockey.
That's the word from the Strawbery Banke Museum, which announced Tuesday it had surpassed its fundraising goal, bringing in almost $500,000 for the project.
Sixteen neighbors of the museum fought the ice rink in court, citing concerns of noise and traffic. A county judge dismissed the case in January.
Notable donors behind the new ice rink include the New Hampshire Charitable Foundation, Paul Holloway, and Senator Martha Fuller-Clark.
Construction begins in autumn for the rink, which will be a temporary structure erected and disassembled annually.
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Our special coverage of the closest race for years
Explore the personal stories of Syrian refugees in Lebanon
20 Sep 2007 11:03 GMT
Tackling poverty
Incumbent Jettou was a former businessman with no political affiliation and democracy activists had called for his replacement to be chosen from among the parties which emerged with the most seats in the election.
The king said he had chosen El Fassi after taking into account the vote results.
He called El Fassi "a man of state with great experience, who has always shown a sincere political commitment and a great sense of responsibility in the different positions and missions he has carried out."
Mohammed said the new government must work for democratisation and development.
Elections 2007
A series of special reports
El Fassi's party played a central role in the fight for independence from France and has a conservative, nationalist agenda that includes staunch support for Morocco's presence in the disputed territory of Western Sahara.
The new government will have to tackle both widespread poverty and a rise in politically motivated violence.
Seven bombers blew themselves up in the economic capital Casablanca in March and April, killing themselves and a police officer, while al-Qaeda's North African wing has threatened more attacks across the region.
Cabinet consultation
Several parties besides Istiqlal could win ministerial posts in the new government, including the Islamist Justice and Development party which came second in the polls which were marked by a low turnout.
El Fassi said the king had asked him to consult with political parties to come up with a cabinet.
He said: "His majesty gave me advice and guidance, which I will respect down to the letter, so that Morocco has a government that lives up to its challenges, and so the kingdom can address questions, notably on social policy."
He said he would begin the consultation process on Thursday.
The outgoing government includes conservatives, socialists and technocrats appointed directly by the monarch, including the powerful interior minister.
Modernising monarch
Ultimate power remains with Mohammed VI, 44, who is the country's executive head of state, military chief and religious leader.
El Fassi is the third prime minister to serve under the king, who took the throne in 1999.
Mohammed has been praised as a modernising monarch, granting more power to women and founding the Equity and Reconciliation Commission, which exposed abuses committed against Moroccans under the 38-year rule of his father, King Hassan II.
However, human rights activists say that the king's regime still carries out crackdowns on press freedom, and that hundreds of innocent people have been arrested and tortured in so-called anti-terror sweeps by Moroccan police.
Source: Agencies
Appeals court slightly reduces jail terms for journalists held for a July 14 report.
Istiqlal, a member of the outgoing government, dashes Islamic party's ambitions.
Activists in the Czech Republic demand that a pig farm built over a former Nazi concentration camp be shut down.
Politics, War & Conflict, Human Rights
In religiously conservative Brazil, women risk jail time and their lives to undergo the procedure that is illegal but commonplace.
Health, Human Rights, Latin America
Trash is a fast-growing import in the Scandinavian country, which turns it into heat for people's homes.
Environment, Europe, Sweden
Critics say the UK's home secretary is using Muslims as a 'political punchbag' in a bid to shore up right-wing support.
Human Rights, Politics, Racism
It is a source of sustenance but also of tension and new political realities are now increasing uncertainty.
Egypt, Sudan, Middle East
A media post-mortem into the UK's surveillance report. Plus, why five years on in Argentina the media looks so familiar.
Media, Edward Snowden, Security
The untold story of how the Lebanese community overcame the odds and found their place in multicultural Australia.
Asia Pacific, Australia, Lebanon
How to keep a telenovela profitable and demanding sponsors happy while inspiring the production team to stay passionate.
Arts & Culture, Mexico, Latin America

subset: commoncrawl


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V3 headed into the Atlantic Ocean on Wednesday morning to witness one of the more challenging parts of BT's Superfast Cornwall project, bringing fibre to the Isles of Scilly. Situated miles off the shore of Cornwall, the islands needed an undersea cable to provide fibre internet.
The cable marks the first time fixed internet will be available on the islands, having relied on a radio link access service for many years, which offered just 2-3Mbps speeds. Once the fibre is up and running – likely before the end of the year – speeds of 60-80Mbps should be available.
While watching the deployment in progress, we snapped some pics as it unfolded, as the £3.7m project reached a milestone moment.
The deployment meant Porthcressa Beach was closed, but no doubt those on the islands were happy to forgo one day of sunbathing to let the internet come ashore.
Once the cable is on the beach it will be hooked into the network that is being built around the islands and then buried underground, to keep it safe and secure.
The Dibble & Grub café on the seafront of Porthcressa Beach is just one of many businesses to welcome the arrival of the fibre services. Gaz O'Neill, owner and vice chair of the Isles of Scilly council, said it would transform the lives of residents, and improve things for visitors, by finally offering fast, reliable internet access.
The deployment even drew a small crowd of onlookers, who watched the operation to bring fibre broadband to their island unfold.
For BT the rollout marked a major moment in its multi-year project to bring fibre to 95 percent of Cornwall and the Isles of Scilly, having spent three years planning the deployment, which involved dodging numerous shipwrecks around the islands.
Services should be online before the end of the year, as the residents of the five islands that make up the remote archipelago – St Mary's, St Agnes, Tresco, St Martin's and Bryher – can enjoy fixed internet access for the first time.
23 Jul 2014
Who would have thought that both mobile and internet services are now considered essential by UK consumers?
While Ofcom drew the line at revealing that grass is indeed green, the organisation did disclose that its latest study shows UK consumers believe they can't forgo the comforts of the web or a shiny smartphone.
The study is part of Ofcom's continued work to ensure that consumers receive good value for money from various communications services.
While the term 'essential' is banded around a fair amount – describing anything from desserts to hair products – the study reached a consensus that essential refers to the need to contact the emergency services, or just keep in touch with family and friends.
More than 60 percent of consumers rated voice services as the most essential, while 59 percent said mobile voice or text services were just as important. Fifty-seven percent of consumers claimed internet access was their most important communication service.
Ofcom also explored the adoption of essential communications services. Unsurprisingly, the research found that 95 percent of UK households have at least one mobile phone, while more than 80 percent have a landline and internet access.
Given that these communications services are considered essential, it is reasonably positive that only 14 percent of consumers claim to have difficulties paying for them. Although 45 percent of the people surveyed have admitted to cutting back on luxuries to ensure they can afford mobile and internet payments.
Claudio Pollack, Ofcom's Consumer Group director, declared that it was encouraging that the majority of people do not struggle to pay for various communications services. But added: "It's important that help is available for those who do."
While the US is benefitting from Google's 1Gbps fibre service, called Fiber, UK citizens will sadly be left behind as the search giant confirms that it has no serious plans to bring its Fiber service to British shores.
Last week, a (clearly unreliable) source informed The Telegraph that Google was in talks with British fibre specialist CityFibre, with the intention of extending the Google Fiber project beyond the US and over to Blighty.
Unfortunately, this discussion broke down as concerns were voiced that CityFibre's existing partnership with BSkyB would be threatened. Despite this curveball, optimistic fibre fans held out hope that Google would lavish the UK with its full-fibre network.
Rumours remained in circulation until a Google spokesperson shot them down telling Engadget: "We have informal conversations with other telecom companies all the time. But we've never had any serious planning discussions about bringing Google Fiber to Britain."
This is a shame as Google Fiber, currently operating in four US cities and with plans to extended it to cover another 34, is a service that could well appeal to those stuck with slow broadband.
What makes the Google Fiber networks so coveted is that they use fibre-optic cabling for the entire network to deliver speeds of 1000Mbps. Comparatively, most of BT's fibre network delivers a 'mere' 76Mbps and rely on old copper wires to connect homes to the street-based cabinets.
Nevertheless there are some fibre projects in the works. In a bid to reduce their dependency on BT Openreach networks, a joint venture between BSkyB, TalkTalk and CityFibre aims to establish a 1Gbps city-wide fibre networking in York.
While the three companies have a vision to roll out the service to other UK cities, for the immediate future Britain has no alternative except to mourn the lack of Google Fiber.
While Germany's stupefying 7-1 destruction of Brazil in the World Cup semi-final in their own back yard sent footballing records tumbling, it also helped break two fairly notable Twitter records, which show how big the social network has now become.
As users around the world watched agog as the goals flew in, Twitter exploded. A truly staggering 35.6 million tweets about the company were posted, making it the single most discussed sporting event of all time on the platform.
With 35.6 million Tweets, #BRA v #GER is the most-discussed single sports game ever on Twitter. #WorldCup pic.twitter.com/pRjssAZmhg
— Twitter Data (@TwitterData) July 9, 2014
This easily beat the 24.9m tweets sent about the Super Bowl earlier in 2014. Not only that, but the moment the fifth goal nestled in the back of the net Twitter exploded once again, helping smash the tweet per minute (TPM) record with more than half a million posts.
The #BRA v #GER match also set a TPM record: Khedira's 29' goal (0-5) saw 580,166 TPM. #WorldCup pic.twitter.com/188YGgrgZg
— Twitter Data (@TwitterData) July 9, 2014
As the Guardian notes this is by far and away the largest ever number of tweets about one event to be sent in a minute, surpassing numerous events such as Usain Bolt's gold-medal 200m sprint peaked at 80,000 tweets per minute, and Beyoncé's Super Bowl half-time show in 2013 at 268,000 tweets per minute.
A real-time map of messages on Twitter as they were posted also gives some indication of where in the world the result left the biggest impact: unsurprisingly Brazilians were rather vocal about the result.
A sophisticated gang of criminals have taken around $36m worth of hardware, smartphones and other devices from Samsung in Brazil.
Samsung confirmed the theft in a statement to V3 and reported that there were no casualties. "It is regrettable the incident took place," it said. "However, it is fortunate that there were no casualties. The police are currently investigating the incident, and we will fully co-operate with the police authorities and will make utmost efforts to resolve this issue."
According to a detailed report from Reuters, a group of around twenty people took part in a sophisticated armed robbery that began with the criminals the taking over a staff bus. Hostages were taken and around 100 or so workers were restrained while a group of people drove vans onto the Samsung site, filled them with hardware and then drove off. Around 40,000 Samsung products were taken away in seven trucks.
Reuters said that the police report reads like the plot of a Hollywood movie. Local media has CCTV that shows people in dark clothing and balaclavas moving the stolen hardware into trucks.
"After stopping the shuttle on its way to the factory, seven armed assailants took over the vehicle while colleagues took all but two of the eight employees originally on board to a remote location, where they were set free," it reports.
"With the coast clear, the attackers then allowed 13 other culprits, driving the getaway trucks, into the factory. The robbers, communicating with one another by radio and cell phones, then proceeded to load the vehicles with the loot."
Samsung hardware includes a Find my Mobile feature, but we do not yet know if the firm will use it itself.
Technology hardware robberies are increasing, as are the scale and scope of virtual robberies and data heists. Virtual assaults affected 552 million web users in 2013, including 40 million at retailer Target alone.
The moment the European Court of Justice ruled that the people of Europe do have a right to be forgotten, the warning bells sounded. What on earth would such a woolly, hard-to-define ruling actually mean in the digital age?
It turns out, as many warned, it's effectively creating a strange, quasi-censorship system that is forcing Google to remove links to news articles that almost certainly deserve to be in the public domain.
Google protested hard against the ruling but ultimately it must comply with the law. So it has chosen to start removing articles from its indexes, and letting the firms involved know. So far the BBC and The Guardian have reported that pieces have been removed from Google, such as a column by Robert Peston commenting on bankers' woes during the 2007 financial crisis.
It is not clear who made the requests, or why, but Google has decided that it must remove them. It could have possibly deferred the decisions to a legal authority, but instead has chosen to become the judge and jury of the requests it receives.
In many ways this isn't Google's fault. With over 50,000 requests piling up, it probably felt compelled to start making some decisions. However, the precedent is worrying.
Like it or loathe it, Google's reach is huge, and removing a result from the index is a very good way of ensuring bad news is hidden away. While for some there may well be a legitimate reason to want a result removed, for most cases the motives could well be more questionable.
It's already been reported that some have asked for links regarding stories of tax dodgers, paedophiles and dodgy doctors to be removed from the Google search index. Again, the motives for this could come from an honest, understandable stance, but the outcome is worrying.
In effect, the European courts seem to have ended up creating a system of censorship, but rather than being the state that controls it, it is the people that have the right to try and hide themselves, with Google seemingly happy to process requests without question.
There are two points to consider though: firstly, the pressure this situation is creating for the EU could force it to amend its ruling. Secondly, with so many online outlets writing about the articles that are taken down, we could well see the Streisand effect come into play.
Perhaps Google is hoping for both outcomes, in order to show the EU courts how absurd the decision is proving.
26 Jun 2014
Mobile phone users can expect a little more privacy, perhaps, thanks to legal moves in the US and UK.
Across the Atlantic the Supreme Court has found that an automatic search of an arrested person's mobile phone is against the Fourth Amendment. It said, rather than search a phone like they would a pocket, the authorities should apply for a warrant [PDF].
Chief Justice John Roberts Jr said the arguments put forward by the US government in favour of warrantless searches could not match the right to privacy.
"The US asserts that a search of all data stored on a cellphone is 'materially indistinguishable' from searches of these sorts of physical items," he wrote.
"That is like saying a ride on horseback is materially indistinguishable from a flight to the moon. Both are ways of getting from point A to point B, but little else justifies lumping them together."
Meanwhile former News of the World editor Andy Coulson has been found guilty of conspiracy to hack phones in court. While his predecessor Rebekah Brooks was spared a guilty verdict, Coulson, who was a close advisor to the prime minister, could receive a prison sentence of two years.
Coulson was found guilty of a charge of conspiracy to intercept voicemails. News UK, part of Rupert Murdoch's News Corp, apologised in a statement.
"We said long ago, and repeat today, that wrongdoing occurred, and we apologised for it. We have been paying compensation to those affected and have co-operated with investigations," it said in a statement. "We made changes in the way we do business to help ensure wrongdoing like this does not occur again."
The move is good news for privacy this side of the pond, as a message has been sent out that accessing private phone records and data is not acceptable.
A short train ride from London lies the commuter town of Borehamwood. Tucked away among the numerous trading estates, high-streets shops and Wetherspoons pubs that are worryingly busy for a Thursday morning, lies a nondescript building with no outwardly obvious role.
But step inside and the familiar aqua and yellow branding of operator EE is immediately visible, for this is one of the firm's two network service delivery department (NSDD) testing labs (the other is in Bristol).
V3 joined a small gathering at the facility on Thursday in a rare chance to peek inside such an environment and to hear from EE about what goes on behind such innocuous-looking doors.
The labs are where EE carries out much of the testing on its network and the devices and services that it will host, to ensure everything is hunky dory before it goes live. This means manufacturers are often to be found lurking inside with never-before-seen devices, as they work with EE to ensure the phone and its components will work on the EE network when its released to the public.
Sadly we didn't see any iPhone 6 devices lying around, but we did spot a few other interesting things that we snapped as we had a look around.
Blast from the past
As you may expect, testing labs are not the sexiest of places, with most of the floors covered in various boxes filled with kit from firms ranging from Sun Microsystems to Nokia and Huawei. However, the below box from long-defunct Canadian telecoms firm Nortel did catch our eye.
EE explained that it has to keep such old kit around to test devices and services on all possible technology that they could come into contact with, as while they may be old they still serve their purpose.
A waterfall of wires
Another common sight at any testing facility, or data centre, is wires. Lots of them. Even so, V3 was quite impressed to see a waterfall of wires running through the facility. Quite beautiful in a way.
Moore's law in the base station
One other thing that caught our eye was just how much the telecoms kit that powers the mobile world has changed over the past 20 years. We all know that phones have reduced from great bricks to svelte, pocket-sized things, but the same is true of base stations.
The image below shows the unbelievable size that base stations used to be, and getting them installed to deliver nothing more than a 2G services was no easy task, as EE director of Network Services Tom Bennett explained. "You used to have to close the roads and get cranes in and hoist them into position, it was fairly demanding stuff," he explained.
Now, as the Huawei base stations below demonstrate, far smaller units that provide both 2G and 4G coverage, are available. "These are light enough for engineers to carry up onto the roof themselves for installation," added Bennett.
About The Frontline
Insight into the latest tech news from V3.co.uk's team of reporters


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Annual Salary: $120,037
Constitutional officer reporting to the Chief Justice and Supreme Court, exercising administrative responsibility for the Office of the Appellate Clerk. Responsible for planning and supervising the work of a staff of approximately 15 engaged in varied clerical and administrative duties of the appellate courts and for performing specialized duties requiring considerable knowledge of procedures, regulations, and laws governing the appellate courts.
Minimum qualifications: Graduation from an accredited four year college or university and an accredited law school; licensed to practice law in one of the states or territories of the United States or the District of Columbia, or in the United States federal courts; and a minimum of 10 years of legal experience, with significant experience in appellate law, court administration, or similar legal and management experience.
For more information about the position and the application process, see http://www.kscourts.org/Court-Administration/Job-Opportunities/job-opportunities.asp.
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4/1/2015Diversity Committee Meeting
4/1/2015Brown Bag Ethics: The Bermuda Triangle of Law: Ethics, Advertising, and Social Media Use
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4/10/20152015 Bankruptcy & Insolvency CLE


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Godspeed to our Olympians
Thursday, January 30, 2014
Ordinarily, with the Winter Olympics in Sochi, Russia, we would simply wish our athletes — especially those with ties to our region — all the best as they seek gold, silver and bronze on behalf of the United States.
Several European news outlets are also reporting a hunt for "black widows" — believed to be the wives of Islamic militants killed by Russian authorities. Police are said to be distributing photos of one black widow and seeking information about two other black widows who may be suicide bombers.
Under normal circumstances, competing for Olympic honors is no easy task. It takes a unique kind of athlete willing to make a unique and long-term commitment to their sport. This time around, however, competing in Sochi will take something extra.


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Cleveland Sculptra Doctors and Reviews
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Cleveland Sculptra cost
Average cost in US: $1,775
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Cleveland Sculptra reviews
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Newbie to art of slowing the effects of aging through cosmetic procedures. I am a young-looking 57 year old who stays out of the sun, works out and fuels my body with healthy foods. I chose Sculptra after researching the options available and amount of time it should last. Arrived early for my appointment and spent time with the nurse having special high res pictures taken and numbing... more


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Cremesheen GlassMAC
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Northern District of California Real Property Cases
Torts to Land Cases, Dockets and Filings
Cases filed
Cases 1 - 10 of 104
Willams v. Quality Loan Services Corp. et al
as 3:2014cv02228
Defendant: Federal National Mortgage Association, Chase Bank/JP Morgan, N.A., Quality Loan Services Corp.
Plaintiff: Stephen C. Willams
Cause Of Action: Foreclosure
Nationstar Mortgage L.L.C. v. Segelstrom et al
as 1:2014cv01776
Defendant: Erik David Segelstrom, Cathie M. Hamer
Plaintiff: Nationstar Mortgage L.L.C.
Cause Of Action: Petition for Removal
Sepehry-Fard v. GreenPoint Mortgage Fundiing, Inc., et al
as 5:2013cv04535
Defendant: Marin Conveyancing Corp. , California Reconveyance Company , U. S. Bank National Association and others
Plaintiff: Fareed Sepehry-Fard
Cause Of Action: (a) Fed. Question: Real Property
Caballero v. Doan et al
as 5:2013cv04482
Defendant: Does 1 through 10, inclusive, Thanh Doan
Plaintiff: Amadeo Caballero
Cause Of Action: Declaratory Judgement
RILEY et al v. RICHARDSON et al
as 4:2013cv04364
Defendant: Siskiyou County Sheriff's Department, JON E. LOPEY, RICHARD SONTAG and others
Plaintiff: GLENN MICHAEL KUDER, PHILIP JUSTIN RILEY
Cause Of Action: Declaratory Judgement
Schaeffer et al v. Piccolo Properties, L.P. et al
as 3:2013cv04358
Defendant: Piccolo Properties, L.P. , Gregory Village Partners, L.P. , Central Contra Costa Sanitary District and others
Plaintiff: Ryan Schaeffer , Anne Schaeffer , R.S.
Cause Of Action: CERCLA
Perla v. DMG Asset Management
as 3:2013cv02034
Plaintiff: Alcides Valladares Perla
Defendant: DMG Asset Management
Cause Of Action: Fed. Question
Amador v. TT Investment Properties, LLC
as 5:2013cv01939
Defendant: TT Investment Properties, LLC
Plaintiff: Rene G. Amador
Cause Of Action: Fed. Question: Tort Action
Caballero v. Doan
as 5:2013cv01594
Plaintiff: Amadeo Caballero
Defendant: Thanh Doan
Cause Of Action: Fed. Question: Tort Action
Barbieri v. PWFG Reo Owner, LLC et al
as 3:2012cv05252
Plaintiff: Ronald James Barbieri
Defendant: PWFG Reo Owner, LLC , Philip Zampiello, McGarrigle, Kenny & Zampiello, APC and others
Cause Of Action: Fed. Question


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I use Rockcastle for any of my arrangements in Rochester.Using the online ordering (or by phone sometimes) I expected a bit more than I saw in their retail location on Long Pond. The last time I…
I was borna dn raised in Rochester. i've recently moved West. Everyone in the city knew that Rockcastle was 'the best' though my personal relationship with Fabulous Flowers kept me going there. recently a dear friend had a death in the family, and I needed to order onle for next day (which was a Sunday). FF could not do it, so, I went to 'the best'. Rockcastle's website is misleading, and...
Rockcastle Florist, Inc is located at 870 Long Pond Rd in Rochester and has been in the business of Flowers, Fresh since 1974.
Established in 1951, Rockcastle florist is family owned and operated. With two locations in Greece and Canandaigua, we serve all of Monroe, Ontario and Wayne counties daily. Through our wire service, Teleflora, we deliver around the world!


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Tie leg to tail, and skewer wing fiat against body.
Place, skin side up, on rack in roasting pan.
Completely cover with cheesecloth dipped in melted fat, or rub bird with fat and cover loosely with foil.
Roast at 325 °F., allowing 3 1/2-4 hours for 5â€â€8 pounds.
Dressing may be cooked under bird if foil is placed over rack; or bake it separately in greased casserole.


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Home Concert Tickets Alternative and Indie VV Brown
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Find the VV Brown tickets you're looking for on NME ticket exchange, the world's largest ticket marketplace. Select an event to view the range of tickets available or view the VV Brown tour on a map to find an event near you. You can also sell your spare VV Brown Concert Tickets on NME ticket exchange, and listing tickets is free. All VV Brown tickets are covered by the NME ticket exchange Ticket guarantee!


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Colossal Cupcakes
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Those of us with hearty appetites should take note of the Colossal Cupcake from Crumbs Bake Shop; an impressive 6 1/2″ tall, it'll feed you and 6 other friends, if you're feeling generous. (Thanks Laura!)
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LONG-TERM SURVIVOR PROGRAMS A PARADIGM FOR THE ADVANCED PRACTICE NURSE The Role of the Pediatric Nurse Practitioner in Follow-up Care of Children, Adolescents, and Young Adults Cured of Childhood Cancer The increasing cure rate for childhood cancers increases the numbers of children, adolescents, and young adults who are survivors. Follow-up care for these survivors goes far beyond the former 5-year plateau. The care necessary for the long-term survivor is more than just a history and physical examination. Pediatric cancer survivors require specific screening and assessment. Today, we recognize that care for this population must be lifelong. The trauma of cancer is not over just because the treatment phase has ended. Cancer is a "permanent life experience" as described in 1980 by Shanfield. However, today resources in healthcare are stretched even to provide the care for patients who are actively being treated for their cancer. The increasing population of cancer survivors creates a further stress on health care professionals. It becomes increasingly difficult to follow long-term survivors with the number of medical professionals available today and the myriad problems these survivors face. Childhood cancer survivors have expressed that they do not wish to burden physicians and loved ones with their issues that may seem insignificant compared to the life-threatening events of the treatment phase. (Leigh) The following is a review of some of the phases described from the perspective of childhood cancer survivors. • Diagnosis This is the period of time when the diagnosis is made. Tests, scans, laboratory studies, invasive and non-invasive procedures are performed. The patient and family are given extensive information. There is usually input from many sources. The family is asked to give consent for treatment. • Treatment During this phase, the actual treatment occurs and may include surgery, radiation therapy, chemotherapy, immunotherapy, and any other therapy. Supportive care measures may be given. Acute side effects and toxicities occur during this treatment phase. • Intermediate survival "When an individual completes initial cancer therapy, he or she enters an intermediate phase of survival where survivors walk a fine line between the land of the sick and well." (Leigh, p 194.) They are in a type of limbo when all signs of disease are gone. Although the actual treatments have been completed, there may be some lasting effects that make the survivor physiologically different, challenging other aspects of their lives. Psychologically, the patient (if old enough) and the family experience the stress of potential recurrence. Although there is a sense of relief that there are no further treatments, the anxiety and fear of the return of the disease can be overwhelming. Socially, the intermediate phase may be the hardest of all for the survivor and family. The supportive persons surrounding the family, as well as the healthcare providers, expect that all is normal and the child and family should return to life as it was before cancer. It is during Long-term Survivor Programs 2 A Paradigm for the APN this phase that the child and family may find it difficult to speak with physicians for fear that they will be considered ungrateful, complaining, or difficult. • Long-term phase During this time, the child and family begin to realize that cure may actually be a reality, as things really do return to a "normal" state. However, during this phase, long-term (chronic) and/or late (delayed) physiologic effects may occur. In addition, psychosocial issues may include issues surrounding reentry into the job market, school, peer friendships, and/or post traumatic stress disorder. (Hobbie, etal, 2000) The transition from being ill to being completely well is considered one of the stressful challenges that evoke anxiety. (MacLean, etal.) This transition must be acknowledged by caregivers, long-term survivors, and their families. It is important that there is ample time to help with the necessary adjustment. "All survivors need follow-up care that is organized, systematic, and comprehensive, including physiologic and psychosocial components." (Hobbie, etal, 2002, p 426) The authors note that the goals of off-therapy programs include: • Assessment of risk factors based on preexisting disease, the diagnosis, treatment, and acute effects; • Obtaining a careful history, including psychosocial issues and well-being; • Providing a thorough physical examination; • Teaching health promotion and disease prevention strategies; • Developing a specific plan for lifelong follow-up care that can be shared with other health care professionals. THE HEALTHCARE ENVIRONMENT The changes in the healthcare industry are very complex and are intertwined with providers, agencies, government, and society. The medical model which includes diagnosis, treatment, and cure is no longer a viable paradigm for today's society. Today, chronic disease, lifestyle-induced illness, and health and wellness issues have made it nearly impossible for cure to be the outcome of the medical model. There is a new paradigm for healthcare delivery, which is more holistic. Disease and its associated symptoms are merely the information for healthcare providers rather than the focus. The patient, family, and society are all partners with the healthcare provider to ensure that self- care, self-reliance, and self-responsibility are part of the care emphasizing human values, cooperation, and mutuality. (DeBack & Cohen) THE NURSE IN PEDIATRIC ONCOLOGY The pediatric oncology nurse emerged in the late 1940s when children with cancer were diagnosed and soon succumbed to their disease. Nursing care consisted of "keeping the child clean, comfortable, and out of pain." (Foley & Fergusson, p.10). When chemotherapy was initiated as a treatment modality, the nurse developed into the tumor therapy nurse. Jean Fergusson was an early pioneer in oncology nursing. She worked with Dr. Sydney Farber and Long-term Survivor Programs 3 A Paradigm for the APN others at Children's Hospital in Boston, helping to develop one of the first tumor therapy clinics in the United States for children with cancer. (Foley & Fergusson). Pediatric oncology nurses were the unsung heroes in the 1950s. Their role was primarily to administer chemotherapy. There were stringent hospital rules preventing family visitation, except during limited, prescribed times. By the 1960s, improvements in outcome for the child with cancer became a reality with the use of improved therapeutic treatment strategies and supportive care methods. Family-centered care became important and pediatric oncology nurses became the link between the patient, parent and family, and the physician. The nurse provided clinical care, education, and support. The nurse was educated and mentored by the physicians with whom she worked. Eventually continuing education programs were developed to provide the pediatric nurse with information and peer support. As progress in treatment improved through clinical trials' research, the pediatric oncologist needed a nurse to assist with data collection and patient evaluation. Dr. Henry Silver, a pediatrician, and Dr. Loretta Ford, a nurse educator, envisioned the original role of the pediatric nurse practitioner (PNP) in 1967. They developed a continuing education program for nurses at the University of Colorado in Denver, CO, to provide health care screening, education, and common illness management to healthy children in areas with limited access to physicians. In the early 1970s, Dr. Donald Pinkel, the first medical director of St. Jude Children's Research Hospital in Memphis, TN, and his colleagues, adapted the Colorado model to train selected nurses to perform physical assessment and advanced technical skills. At the completion of their training, they were awarded a certificate from St. Jude and were called nurse practitioners in pediatric oncology. (Foley & Fergussen) At that time, there was a shortage of primary care physicians, which provided an impetus for the nurse practitioner to provide direct patient care to patients with increasing complexity of health care problems. When childhood cancer cure rates began to increase in the mid-1970s, a need arose for a new healthcare provider who would specialize in childhood cancer. Nurses recognized that this would be an innovative role for the nurse. In 1976, Jean Fergusson, RN, DEd, at Children's Hospital of Philadelphia (CHOP) designed a two-semester educational program to train nurses as pediatric nurse practitioners with a specialty in pediatric oncology. In order to meet the qualification for certification, it was necessary for the program to provide designated didactic information and clinical practice in the area of pediatric primary care. These nurses were eligible to sit for the certification examination as PNPs. Subsequently, as the nursing profession recommended that the PNP have an advanced nursing degree, the CHOP program developed a relationship with Widener College and later with University of Pennsylvania, to provide courses leading to a Master of Science in Nursing (MSN) degree. Many of the early graduates continued their education and to received a Master's degree. Presently, all states require that PNPs receive an advanced degree. In 1987, the Association of Faculties of Pediatric Nurse Practitioner/Associate Programs delineated the scope of practice for the PNP: "wellness, prevention, and health promotion. Long-term Survivor Programs 4 A Paradigm for the APN PNP/As perform physical examinations and developmental assessment, treat common childhood illnesses, coordinate care of common chronic illness in children, and help families meet their health needs." Since that time the role of the PNP has evolved at a rapid pace forging new trails in health care delivery. The PNP can be found in such settings as intensive care units, inpatient units, schools, surgical centers, emergency rooms, and specialty outpatient clinics, to name a few. (Tobias & Klemt) Many PNP graduates are certified by the National Board of Pediatric Nurse Practitioners/Associates and others are certified by the American Nurses Association (ANA). The name "advanced practice nurse" (APN) is used today to describe the combined and /or blended role of clinical nurse specialist (CNS), which traditionally was that of educator in a specialty area, and nurse practitioner (NP), as described above. Each state has different licensure requirements for APNs. Many states recognize APNs as a separate and distinct entity for licensure. In many states, the APN may have prescriptive privileges if they are certified and meet the pharmacology requirements of that state's board of nursing. In some states, the APN has prescriptive privileges that may include controlled substances. After meeting the states' qualifications, the APN must maintain the privilege by meeting certain ongoing educational requirements. Today, the APN in pediatric oncology is a licensed, registered nurse prepared with a minimum of a master's degree. This nurse has acquired advanced knowledge in pediatric oncology nursing with demonstrated competencies in all areas of basic practice in addition to the APN standards. Although there is no specific certification for the APN in pediatric oncology there is certification in primary care and advanced oncology nursing. The APN in pediatric oncology (APN/PO) should also be certified by the Oncology Nurses Certification Corporation (ONCC) as a Certified Pediatric Oncology Nurse (CPON). This certification test measures basic knowledge and requires that the nurse have clinical practice experience in pediatrics and pediatric oncology. The role of the PNP is ever evolving. With the changes in health care delivery and the demonstrated ability of APNs to provide high-quality care, they are providing care to patients who are well, as well as those with complex health care needs. This new environment requires more APNs who can coordinate care, case manage, advise and council, triage and monitor, advocate, evaluate outcomes, utilize evidence-based care, and add to the body of knowledge through research. There is no end to the continuum of care services that can be provided by the APN. These changes call for adjustments in relationships with other healthcare professionals. Further interactions with all members of the healthcare team will facilitate these relationships. SCOPE AND STANDARDS OF PEDIATRIC ONCOLOGY NURSING The Scope and Practice of the APN in pediatric oncology was traditionally delineated on an individual basis. The APN and the collaborating physician(s) would develop standards for collaborative practice and write this as well as the job description under which the APN would function. The pediatric oncology nursing Standards of Nursing Practice was developed by the Association of Pediatric Oncology Nurses (APON) in 1978 and revised in 1987 to reflect nursing process and outcome standards. In 2000, APON developed a new Scope of Practice and Long-term Survivor Programs 5 A Paradigm for the APN Outcome Standard of Practice for Pediatric Oncology Nurses in accordance with the American Nurses Association (ANA) standards. It was published by the ANA and includes the scope and standard for practice of the APN. It provides the guidelines under which an APN in pediatric oncology should practice. It is used to formulate the job description for the APN and provides a standard by which the APN can be evaluated. The Advanced Practice Nurse in pediatric oncology nursing (APN/PO) is expected to practice according to the Scope and Standards of Pediatric Oncology Nursing Practice, 2000. The qualities of the nurse, the standards of care, and the performance standards are abstracted below. Qualities for the APN/PO Self-directed in the development and maintenance of competency: The APN/PO seeks educational opportunities whenever possible. It is essential for the APN/PO to continue to learn and grow in all aspects of pediatric oncology care, as well as pediatric primary care. This includes knowledge about clinical trials, treatments, side effects, potential long-term effects, and much more. It is essential that the APN/PO attend continuing education programs, professional meetings, and conferences. Member of professional organizations: The APN/PO should be a member of appropriate professional organizations, such as the Association of Pediatric Oncology Nurses (APON), Oncology Nursing Society (ONS). This provides an avenue for interaction with colleagues and an opportunity to grow and develop in the professional aspects of the profession. Certified in relevant areas: It is essential for the APN/PO to be certified in the area of practice. The Oncology Nursing Certification Corporation (ONCC) offers certification as a. Oncology Certified Nurse (OCN), a Certified Pediatric Oncology Nurse (CPON), and Advanced Oncology Certified Nurse (AOCN). The National Board of Pediatric Nurse Practitioners and Associates (NBPNP/A) also offers certification as a Certified Pediatric Nurse Practitioner (CPNP). Role model for clinical nurses and other healthcare professionals: The APN/PO serves as a role model for other nurses and for healthcare professionals within an inpatient and outpatient setting. It is part of the professional commitment of the APN/PO to educate the public sector, as well. Standards of Care for the APN/PO Assessment is the first standard of care for all healthcare professionals and includes data collection to determine physical, emotional, cultural, and social needs, as well as the well being of the child and family. Diagnosis is the next standard of care and it involves the systematic analysis of the assessment data to identify actual and potential diagnoses. Outcome Identification occurs when the APN/PO identifies expected outcomes based on the assessment and diagnoses of the patient and family, in collaboration with the multidisciplinary team when appropriate. Planning based on the diagnoses, involves the formulation and implementation of a plan of treatment, and interventions to achieve the desired outcomes. Implementation includes case management, consultation, health promotion, education, prescriptive authority, referral, and research to implement the appropriate plan of care. Evaluation is the last step that is an expected standard of care. It is essential that the APN/PO monitor and evaluate the response to the plan and the interventions provided. Long-term Survivor Programs 6 A Paradigm for the APN Standards of Professional Performance for the APN/PO Quality is the basis for all of the care given by the APN/PO. The APN/PO develops criteria and evaluation for quality clinical outcomes and effectiveness. Self-Evaluation by the APN/PO is vital to continually assess one's own clinical practice in order to maintain competent care. Continuing education and integration of new knowledge and advances into their practice is required of all oncology APNs. (ONS Position Statement, The Role of the Advanced Practice Nursed in Oncology Care, 12/97.) Leadership roles by the APN/PO include functioning as a leader, role model, and mentor for the professional development of peers, colleagues, staff, and students. In addition, The American Academy of Nurse Practitioners notes that an important leadership function is participation in legislative and professional activities to promote professional advancement and health related social policies. (Nurse Practitioner as an Advanced Practice Nurse Position Statement, American Academy of Nurse Practitioners.) Ethical practice includes advocacy for the patient and family, including their rights, access to care, informed decision-making, autonomy, and developmentally appropriate information. The complexity of pediatric oncology care requires coordination and on-going interaction among the multidisciplinary team. The team includes other disciplines, as well as the patient and family. Research and evidence-based practice are incorporated into research activities and clinical practice. BARRIERS TO EDUCATION AND TRAINING FOR THE APN/PO Several issues provide barriers for nurses to enter the APN arena. There is still a lack of definition of advanced practice nursing, variability in educational preparation, and lack of agreement among state boards of nursing related to privileges for APNs. However, more importantly, there is a critical shortage of nurses. Presently, hospitals are coping with a shortage of 126,000 registered nurses (RNs), and it is predicted that this will increase to more than 400,000 by 2020. (Maes, 2002). The number of APNs is estimated to be 196,279, or 7% of the total RN population. Nurse Practitioners comprise 53% of this population, or 102,829 nurses. (O'Grady) It is believed that a majority of pediatric oncology nurses are members of the Association of Pediatric Oncology Nurses (APON), as it is the only professional organization for pediatric oncology nurses. The statistics available from APON membership demographics indicate that of the 2000 members, there are 457 members with a Master's Degree; 192 indicate that they are nurse practitioners; 162 indicate that they are clinical nurse specialists. There are 865 members with Baccalaureate Degrees and 225 with Associate Degrees. It is possible that some of these nurses will further their education and become APNs in the future. There are 29 masters' programs listed on the Oncology Nursing Society's (ONS) Website to educate the nurse as an APN with a specialty in adult oncology. (www.ons.org) However, there are relatively few programs for the nurse who wants to become an APN in pediatric oncology. In fact, careful review of the curricula of the colleges and universities that offer a Master's Degree in Nursing with a specialty in oncology reveal that some may outline that there is a pediatric advanced practice curricula, but in actuality there are no scheduled courses. There may be some Long-term Survivor Programs 7 A Paradigm for the APN integrated lecture material or an adjunct lecture that is included in the course, but there are no programs with formal, full-time curricula in pediatric oncology. Emory University and the University of Pennsylvania and others may offer courses taught by an APN/PO experienced with long-term survivors, but these are usually on an adjunct basis. St. Jude Children's Research Hospital offers a distance learning program for pediatric oncology. Therefore, the pediatric nurse may have to enroll in a program that will provide a degree in pediatric primary care or adult oncology. Many programs offer clinical experiences in areas of desired future work, such as pediatric oncology. A student may contact a pediatric oncology program where there is a willing physician or ANP to function as preceptor. Occasionally a student may have the opportunity to see patients who have completed therapy and are followed in a late effects clinical setting. This is usually on a "hit-or-miss" basis. At the successful completion of these programs, a master's degree is bestowed and the nurse may sit for a certification examination. Jackson, etal (2001) described the characteristics of employment, the children served, and the role functions of recent graduates of PNP programs. Of the 137 surveys returned (52% return rate) indicated that 70% of the respondents indicated they "often" or "sometimes" provided care to children with acute/critical conditions, and 77% reported caring for children with chronic conditions. This data suggests that PNPs function beyond the traditional areas required for the pediatric primary care education they may have received. The authors conclude that educational programs should address the changes in the care continuum provided by PNP graduates. It is necessary for more programs to provide curricula and clinical practice situations in keeping with these changes. A survey was undertaken by the Advanced Practice Nurse Survey Team formed by the Oncology Nursing Society (ONS) Steering Council in May 2000 to ascertain critical issues inherent in advanced practice roles. (Lynch, etal.) A sample of 1000 APNs from the ONS membership received surveys with 368 surveys being returned (37% response rate). Fifty-eight percent of the respondents had not graduated from an oncology-specific graduate program. There are several negative aspects of this scenario. First, in order to learn the basics of pediatric oncology, the nurse must glean information from preceptors. Formal classes are rare. Nurses are resourceful and should be able to garner necessary learning from preceptors and extrapolate data from adult to pediatric care. Nevertheless, this is a failing in the educational system. There is a need for more programs to train nurses to become APNs/PO. It is possible with the myriad information a nurse needs to learn in masters' programs that there may never be time to see patients who are survivors of childhood cancer. In fact, it probably is not a priority for the student. It is crucial for the student to gain skills in history-taking and physical assessment and this is best accomplished during the general on-therapy clinic setting. Unless there is an integrated long-term survivor program, the student may not see patients who are off therapy. Recently there has been increasing literature about long-term effects and childhood cancer survivors. This is a means for nurses to study and learn about the problems of survivors and their families. However, this too is not a formal method for learning. The nurse must obtain the information on an independent basis. Long-term Survivor Programs 8 A Paradigm for the APN Nurses must be lifelong learners in order to give the best care to their patients, whether acute or follow-up care. Nurses have been instrumental in the research focused on various aspects of survivorship, including insurance and employment, marriage and relationships, fatigue, and post- traumatic stress disorder, as well as many others areas. However, constraints on healthcare dollars may effect the ability of the APN/PO to participate and attend continuing education programs. Organizations such as the International Society of Pediatric Oncology (SIOP), American Society of Pediatric Hematology-Oncology (ASPHO), Association of Pediatric Oncology Nurses (APON), Oncology Nursing Society (ONS), as well as the Children's Oncology Group (COG) offer conferences and educational seminars directed toward nurses and/or physicians specializing in pediatric hematology-oncology. There may be one or two sessions included in these conferences about long term survivors of childhood cancer. Often this is the only information nurses can obtain on the subject. There is only one pediatric oncology nursing textbook: Nursing Care of the Child and Adolescent with Cancer (Baggott, etal.) Included in the book is a fine overview of survivorship, covering physiologic and psychosocial issues. It speaks to many issues, but is by no means complete. Principles and Practice of Pediatric Oncology, (Pizzo and Poplack), is the foremost text directed toward pediatric oncology physicians. It includes chapters on physiologic late effects and on psychosocial issues including the late effects of childhood cancer, educational and financial issues in pediatric cancer, advocacy, insurance, education, and employment issues. There is literature emerging on the topic of long-term survivors. An Internet search of literature using the description "childhood cancer survivors" found on "PubMed" shows 161 articles from 1998 to 2002. In fact, the literature has changed from general topics to specific issues of survivorship ranging from the physiologic to the psychosocial. Networking with nurses from other comprehensive follow-up programs will help with mutual problem solving and in collaborating for the development of nursing research studies and educational materials. Through oncology nursing organizations such as the Association of Pediatric Oncology Nurses (APON), and Oncology Nursing Society (ONS), as well as the Children's Oncology Group (COG), there is a method to further collaboration that can assist in following long-term survivors throughout their lifespan. Although this is not a formal educational methodology, it provides nurses with an arena for discussion, mentorship, informal education, and collaboration. LONG-TERM SURVIVORS' CLINICS Three major pediatric medical organizations, International Society of Pediatric Oncology (SIOP), American Society of Pediatric Hematology-Oncology (ASPHO), and American Academy of Pediatrics (AAP) endorsed standards for long-term follow-up care for childhood cancer survivors. They advocated for the establishment of specialty clinics oriented to the preventive care that not only focused on maintaining an absence of disease or dysfunction, but also psychosocial and socioeconomic health and productivity. Survivors must be evaluated in a systematic manner to determine the full impact of cancer and its treatment. Long-term Survivor Programs 9 A Paradigm for the APN Models for Long-term Survivors' Programs There is no real knowledge of the number of programs that exist today to follow long-term survivors throughout the United States. However, it is estimated from a 1998 article by Oeffinger, etal, in a survey of the Children's Cancer Group and the Pediatric Oncology Group (now merged to form the Children's Oncology Group) that 96 institutions had some form of long-term survivor follow-up program. Harvey, etal pointed out that it is essential that all of the team members involved in long-term survivor programs be "committed to the program and understand the unique issues of long-term survivors of childhood cancer." (p. 120). This provides an atmosphere that is safe for the survivor who may have medical and psychosocial concerns and fears. Understanding the developmental issues facing the adolescent and young adult is a very important. Blending the normal developmental issues with those of the long-term survivor may be a daunting responsibility for caregivers. The size of the follow-up program usually dictates the type of program and the staffing requirements. Small-sized programs often are not able to have dedicated staff for the long-term survivor program. Financial and personnel constraints determine the organization of the program. Most importantly, it is imperative that the caregivers involved are familiar with the potential adverse effects of treatment. Several program models exist for the follow-up care of long-term survivors. Regardless of the type of program utilized, the basic principle is to provide multidisciplinary care to the survivor and the family. This team should include the APN/PO, social worker and/or psychologist, and pediatric oncologist. Subspecialty caregivers from radiation oncology, endocrinology, gynecology, cardiology, neurology, and genetics, to name a few, may be present in the clinic or called on a referral basis. (Harvey, etal.) Shared Programs When long-term survivors are integrated with patients in all phases of the health/illness continuum, it is known as a shared program. Many programs, especially small and medium-sized programs use this model. The shared program offers many positive features. For instance, patients who are undergoing therapy have the opportunity to see and speak with patients and their families who have survived the ordeal. It demonstrates to the on-therapy patient that there really are long-term survivors and that this can be a reality for them as well. In addition, the caregiver may appreciate having long-term survivors integrated into the daily routine as it gives a hopeful perspective, especially during times of stress. A shared program can give an opportunity for a mentorship program between survivors and newly diagnosed patients and their families. This type of program assists the new patient with knowledge about what to expect, and, in turn, it provides the survivor an opportunity to "give back" to those who helped. There are some negative aspects of this type of program. The caregiver may not have enough time to spend with the patient and family during the busy clinic when patients are receiving treatment and protocol/treatment decisions must be made. Many topics must be covered beyond the history and physical examination for the long-term survivor. The caregiver many not have the proper mind-set for the myriad issues facing the off-therapy patients, if patients on and off Long-term Survivor Programs 10 A Paradigm for the APN therapy must be seen at the same time. For the patient, interactions between survivors and on- therapy patients may perpetuate feelings of survivor's guilt. Also, caring for survivors in a pediatric setting may make the older patient feel uncomfortable among youngsters going through treatment. These older teens and young adults may become noncompliant in their follow-up visits. Stand-alone Programs The stand-alone program usually has dedicated time and/or space for the long-term survivor program. In this type of program, patients have the opportunity to interact with one another and share experiences. The caregiver can set the time and mood of the clinic and spend as much time as necessary without taking away from patients who are receiving treatments. Program planning, evaluation, and research efforts are made easier by amassing patients with common needs. (Hollen & Hobbie) However, in this type of program the patient and family lose the opportunity to act as a role model for others. Large programs can support a stand-alone program. With many survivors and personnel to care for them, there are enough resources to provide appropriate follow-up. Insurance carriers may not reimburse for the specialized evaluation by many caregivers, counseling, and coordination of service that is part of the follow-up for long-term survivors. Interdisciplinary Programs In the interdisciplinary model for the long-term survivor program, caregivers from all disciplines are present to see patients and their families. These may include social worker, psychologist, neurologist, radiation oncologist, physical and/or occupational therapist, and others. This type of program offers the patient and family the opportunity to see all of the needed specialists with one visit, rather than going to many different appointments. Careful coordination and scheduling is required to provide continuity of care for the patient, family, and all of the needed specialists. It may also be necessary for the program coordinator to plan for the required tests, x-rays, and follow-up studies prior to the actual patient visit so the team members can discuss results and plan for the impending visit. Transition Programs Transition programs may include adult healthcare providers—internist, medical oncologist, family practitioner, and/or an adult/family nurse practitioner who specializes in oncology. This model helps the survivor and family become familiar with specialists who care for adults and who are familiar with oncology. Ideally, for a period of time, in this program, the APN/PO would continue to be involved in the care of the survivor as it relates to issues that pertain to the past history of the pediatric cancer. Through education and mentorship, the adult/family nurse practitioner would learn about the late effects of the childhood cancer and begin to establish a rapport with the patient and family. This model presents the concept of an interdisciplinary transition program based in an adult- oriented ambulatory care setting that links the expertise of the pediatric oncology team, with the necessary pediatric and adult subspecialists. (Oeffinger, etal 2000) Underscoring this model is Long-term Survivor Programs 11 A Paradigm for the APN the opportunity to have the patient followed for all of their adult years as new issues and problems arise that are outside the expertise of the pediatric team. This transition model provides survivors with freedom to move away from their parents and treating institutions. Good communication between pediatric and adult APNs can provide continuing care at any site as long as the patient is considered at risk for potential future physiologic and psychosocial problems. Other benefits of transition have been noted by Rosen. • A sense of future: Pediatric-centered care may give a subtle message that adulthood may be an unrealistic expectation. Transition to adult-centered care suggests an ongoing future. • A valued member of society: The move to adult health care gives a signal that the survivor is indeed a valued member of society. It may serve to emancipate the survivor, to be more self- reliant, and to decrease emotional regression and risk-taking behaviors. • Age-appropriate health care: The transition to adult-centered care assures that the overall health care needs of the survivor will be provided. • Ongoing medical surveillance: Continuity of care is maintained through linkages between the pediatric and adult providers. The transition program is an ideal rather than a reality. Logistically it is very difficult to have the healthcare providers from both pediatrics and adult medicine (or adult oncology) to maintain a joint venture. Financially, it is unlikely that insurance companies would provide reimbursement to all involved healthcare providers. Another barrier to a transition program is the lack of education of healthcare providers. The future of these programs rests with the appropriate education of community-based practitioners. It is important that all survivors be provided with the essential information about their disease and treatment. Regardless of the type of follow-up care the survivor receives, having complete information empowers survivors to advocate for themselves. (Hobbie & Ogle) A multidisciplinary team approach is the standard for pediatric oncology programs. It should provide the model for adult follow-up programs. The APN/PO in Long-term Survivors' Programs The nurse is in a very special position because of the basic nursing education and the experience in the practice of holistic care to the patient and family. The APN nursing education includes physical assessment, pharmacology, interpretation of laboratory findings, pathophysiology, disease management, critical thinking, and specific issues in pediatric oncology. The nurse's education provides a focus on developmental issues. In fact, because the nurse is educated and trained to care for persons of all ages as part of basic nursing training, the APN/PO can recognize appropriate behaviors, as well as deviations through the lifespan. Other important topics usually incorporated in the APNs education include reimbursement and health care financing, outcomes' management, administrative issues, and research skills. This education, as well as the years of experience in the field of pediatric oncology, are the prerequisites for the PNP to become involved in the care of long-term survivors. The APN has developed roles that encompass clinical care, patient/family education (including development of websites and other media), professional and public education, consulting, community relations, Long-term Survivor Programs 12 A Paradigm for the APN advocacy, program development, and fund-raising. This background, experience, and education make it a logical choice that the APN/PO has become the leader of the team in caring for long- term survivors. Oeffinger, etal (1998) noted that the APN/PO is most appropriate to be included in long-term survivors' programs and to lead the team caring for the long-term survivor. Traditionally, programs in pediatric oncology include the APN. Depending upon the size of the program, this nurse may practice either in- or outpatient or both. The APN is often the closest caregiver to the family from diagnosis to off-therapy. The APN begins the relationship with the family at the time of the initial diagnosis. Traditionally, the APN is involved in the initial discussion meeting with the parents. "The PNP plays an invaluable role at this point in the family's lives." (Christensen and Akcasu, p. 60) The APN is often the primary source of information and assurances, thus establishing a rapport which sets the tone for the potentially long, positive relationship with the child and family. The PNP is consistently available to provide comprehensive management across the inpatient and outpatient continuum and is the consistent person upon whom the family can rely. This provides a holistic approach to care and allows the APN to better care for and advocate for patients. This role enhances communication with the healthcare team across settings and provides seamless health care. APN/POs traditionally have taken the lead in the care of long-term survivors of childhood cancer. The increased intensity and complexity of cancer care requires more rigorous monitoring, coordination of services, ongoing communication between the patient, family, the community, school, employer, etc, and the healthcare professional. Pediatric oncology nurses are in an essential position to continually measure and improve the outcomes of pediatric oncology nursing care. Central to the team is the APN/PO who can carry out myriad responsibilities for the long-term survivor program and functions in many different roles during each clinic session. In pediatric oncology, the care needs of the child and family drive role definition for the APN. (Baggott & Kelly). The APN/PO provides clinical case management for survivors and their families through coordination of services among disciplines, monitoring for actual and potential late effects, and taking a leadership role in assisting with navigation through the healthcare system. (Hobbie & Hollen) • The APN/PO acts as facilitator of the long-term survivor program and reviews charts before patients are seen. It is especially important to have the medical record organized in order to determine what treatments were given, what side effects and complications the patient had, and what complications might be expected. A review of past visits is essential as long-term survivors usually only come for annual visits. • The APN/PO provides the history and physical examination at the time of the visit. • The APN/PO functions as an educator for the patient, family, as well as other healthcare professionals. • As case manager, the APN/PO can provide the recommended follow-up care, summarize the visit, and assure that there is a letter to the primary care physician and the patient. (Harvey, etal). • The APN/PO is also a researcher, identifying research questions and assisting with all aspects of research to help understand the biopsychosocial needs and long-term effects of childhood cancer and its treatment. Long-term Survivor Programs 13 A Paradigm for the APN Therefore, the APN is a resource and problem solver allowing for collaborative management as the patient and family move through the healthcare continuum. In pediatric oncology, APN roles are diverse and vary greatly between institutions. The focus is usually on clinical practice, consultation, education, leadership, theory, and research. CONCLUSION The APN as a facilitator in long-term follow-up care can be instrumental in overcoming the barriers to care that face the childhood cancer survivor. As a patient advocate, consultant, educator, and leader, the APN can focus on the psychosocial, financial, and medical needs of their patients and families. In many programs, the same nurse has been involved in the assessments and treatments of the patient during the treatment phase. This nurse is in the unique position to have gained the trust of the child and family for the years of treatment. It is very beneficial if that same nurse is involved in the care of the child and family as they transition to the status of long-term survivor. At the very least, the nurse should introduce the family to the new healthcare professionals who will continue their follow-up care. At best, the APN should continue to follow these families in a transition program that coordinates efforts of the pediatric and adult teams. A barrier to providing nurse-driven follow-up care to pediatric cancer survivors is a lack of formal educational opportunities. Research and articles on issues of long-term survivorship is increasing and there are continuing education programs on the topic. These provide a means of education for nurses. It is suggested by MacLean, etal, that the American Cancer Society takes a leadership role in the development of workshops and other educational activities for the primary healthcare provider. Lastly, the nursing shortage is predicted to continue since fewer nurses enter the profession and more nurses reach retirement age. There will be a shortage in all nursing specialties, but as cancer statistics increase, there will be fewer oncology nurses available to care for the adult patients and even less in pediatric oncology nursing. With fewer nurses in the workforce, there will be fewer APNs who will specialize in pediatric oncology and therefore fewer APN/POs able to care for long-term survivors. Long-term Survivor Programs 14 A Paradigm for the APN Bibliography American Academy of Nurse Practitioners. Nurse practitioner as an advanced practice nurse: Role position statement. http://www.aanp.org/np_advanced_practice.htm, 2002. American Academy of Pediatrics, Section on Hematology Oncology. Guidelines for the pediatric cancer center and role of such centers in diagnosis and treatment. Pediatrics, 99(1), 1997: 139- 141. Arceci RJ, Reaman GH, Cohen AR, Lampkin BC. Position Statement for the need to define pediatric hematology/Oncology programs: A model of subspecialty care for chronic childhood diseases. J Pediatr Hematology Oncol, 20(2), 1998: 98-103. Association of Pediatric Oncology Nurses, American Nurses Association. Scope and Standards of Pediatric Oncology Nursing Practice, American Nurses Publishing, Washington, DC: 2000. Baggott CR, Kelly KP. Interdisciplinary collaboration. In Baggott, etal, (Eds) Nursing Care of Children and Adolescents with Cancer, (3rd Ed), W.B. Saunders Company, 2002: 626-639. Christensen J, Akcasu N. The role of the pediatric nurse practitioner in the comprehensive management of pediatric oncology patients in the inpatient setting. J Pediatr Oncol Nurs, 16(2), 1999: 58-65. DeBack V, Cohen E. The new practice environment. In Elaine L. Cohen (Ed.), Nursing Case Management in the 21st Century, St. Louis: Mosby-Year Book, Inc., 1996. Foley GV, Fergusson JH. History, issues, and trends. In In Baggott, etal, (Eds) Nursing Care of Children and Adolescents with Cancer, (3rd Ed), W.B. Saunders Company, 2002: 2-23. Harvey J, Hobbie WL, Shaw S, Bottomley S. Providing quality care in childhood cancer survivorship: Learning from the past, looking to the future. J Pediatr Oncol Nurs, 16(3), 1999: 117-125. Hobbie WL, Hollen PJ. Pediatric nurse practitioners specializing with survivors of childhood cancer. J Pediar Health Care, 7, 1993: 24-30. Hobbie WL, Ogle S. Transitional care for young adult survivors of childhood cancer. Seminars in Oncol Nurs, 17(4) 2001: 268-273. Hobbie WL, Ruccione K, Harvey J, Moore IM. Care of survivors. In Baggott, etal, (Eds) Nursing Care of Children and Adolescents with Cancer, (3rd Ed), Philadelphia: W.B. Saunders Company, 2002: 426-464. Hobbie, WL, Stuber M, Meeske K, etal. Symptoms of Posttraumatic stress in young adult survivors of childhood cancer. J Clin Oncol, 18(24), 2000: 4060-4066. Long-term Survivor Programs 15 A Paradigm for the APN Hollen PJ, Hobbie WL. Establishing comprehensive specialty follow-up clinics for long-term survivors of cancer: Providing systematic physiological and psychosocial support. Support Care Cancer, 8, 1995: 1-6. Jackson PL, Kennedy C, Sadler LS, etal. Professional practice of pediatric nurse practitioners: Implications for education and training of PNPs. J Pediatr Health Care, 15, 2000: 291-298. Leigh SA. The long-term cancer survivor: A challenge for nurse practitioners. Nurse Practitioner Forum, 9(3), 1998: 192-196. Lynch MP, Cope DG, Murphy-Ende K. Advanced practice issues: Results of the ONS advanced practice nursing survey. Oncol Nurs Forum, 28(10) 2001: 1521-1544. MacLean WE, Foley GV, Ruccione K, Sklar C. Transitions in the care of Adolescent and young adult survivors of childhood cancer.Cancer, 78(6), 1996:1340-1344. Maes, S. The Nursing Shortage: Part I. Healthcare Community Tries Innovative Approaches to Solving a National Crisis. ONS News. 17(5) 2002:1, 4-6. O'Grady, ET. The nursing shortage: Why nurse practitioners should embrace the problem. Am J for Nurs Practitioners, April 2002: 31-36. Oeffinger KC, Eshelman DA, Tomlinson GE, Buchanan GR. Programs for adult survivors of childhood cancer, J Clin Oncol, 16(8), 1998: 2864-2867. Oeffinger KC, Eshelman DA, Tomlinson GE, etal. Grading of late effects in young adult survivors of childhood cancer followed in an ambulatory adult setting. Cancer, 88(7), 2000: 1687-1695. Oncology Nursing Society. The role of the advanced practice nurse in oncology care. http://www.ons.org, 1997. Pizzo, PA, Poplack, DG (Eds). Principles and Practice of Pediatric Oncology. Philadelphia: Lippincott Williams & Wilkins, 2002. Rosen DS. Transition to adult health care for adolescents and young adults with cancer. Cancer Supplement, 71(10), 1993: 3411-3414. Shanfield SB: On surviving cancer: Psychological considerations. Comprehensive Psychiatry, 21, 1980:128-34. Tobias NE, Klemt CS. Pediatric advanced practice nursing. Nursing Clinics of North America, 35(1), 2000: 1-169.
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Virginia Fly Fishing & Wine Festival
Over 50 onsite exhibitors will have the latest in fly fishing equipment, fly tying and guide services. Beginner to expert anglers will enjoy nonstop lectures on where, when and how to fly fish in the Mid-Atlantic and beyond. Virginia wine tastings, microbreweries, local food and live music will also be featured. Event Details.


text: HomeFilmNews Crime pays for Di Bonaventura Email Print +Talk +G+ +Tweets October 11, 2010 | 05:00AM PT Producer has full plate of projects ahead Lauren Zima Di Bonaventura on a bonny venture | Crime pays for Di Bonaventura | Di Bonaventura seeks sweet spot in marketing | 'Red' tries to answer the age-old question | Are studio execs merely producers-in-training? | At work with Lorenzo Di Bonaventura Lorenzo di Bonaventura has about 10 films in development, including several sequels and bigscreen adaptations. Notable projects include the Antoine Fuqua-directed "Consent to Kill." The film centers on Mitch Rapp, a CIA counterterrorism agent featured in several novels by author Vince Flynn. Gerard Butler, Matthew Fox and Colin Farrell have reportedly been up for the role. "The Associate" will also bring a character from book to box office; it's an adaptation of the John Grisham novel. Shia LaBeouf is signed on to star. But di Bonaventura also has some fun and fantastical tricks up his sleeve: He's working on "Moscow" (which brings back classic character Jack Ryan to the screen), a "G.I. Joe" sequel, "Beverly Hills Cop IV," "Asteroids" (based on the Atari videogame) and a live-action version of "The Hunchback of Notre Dame." Want Entertainment News First? Sign up for Variety Alerts and Newsletters! Post A Comment 0 Most Popular 1 TV 6:03PM PT 'Daily Show': Trevor Noah 2 Film 4:46PM PT Watch the First Trailer for 3 Film 1:25PM PT Paramount Expanding 4 TV 12:38PM PT Masi Oka Returning for NBC's 5 TV 11:59AM PT 'The Walking Dead' Spinoff Variety Jobs Senior Licensing & Royalties Administrator Entertainment One, Los Angeles, California Account/Project Coordinator (Ad Agency) Petrol Advertising, Burbank, California Directing / Cinematography Instructor The Los Angeles Film School, Los Angeles CA Assistant Director of Loyalty Marketing Lincoln Center for the Performing Arts, Inc., New York, New York Accounting Supervisor MPCA, Los Angeles, California See More Jobs Marketplace Leave a Reply No Comments Cancel reply Comments are moderated. They may be edited for clarity and reprinting in whole or in part in Variety publications. Enter your comment here... Fill in your details below or click an icon to log in: Email (required) (Address never made public) Name (required) Website You are commenting using your WordPress.com account. ( Log Out / Change ) You are commenting using your Twitter account. ( Log Out / Change ) You are commenting using your Facebook account. ( Log Out / Change ) You are commenting using your Google+ account. ( Log Out / Change ) Cancel Connecting to %s Notify me of new comments via email. Notify me of new posts via email.


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Book your room at Aparthotel Hispanos 7 Suiza
Apartment (2 people)Max Occupancy: 2 guests (up to 1 child, 1 infant)
Apartment (3 people)Max Occupancy: 3 guests (up to 2 children, 2 infants)
Apartment (4 people)Max Occupancy: 4 guests (up to 3 children, 3 infants)
Apartment (5 people)Max Occupancy: 5 guests (up to 4 children, 4 infants)
4-star family-friendly apartment in Barcelona (Eixample) near Sagrada Familia
A stay at Aparthotel Hispanos 7 Suiza places you in the heart of Barcelona, minutes from Sagrada Familia and close to Casa Batllo.
This 4-star apartment is within close proximity of Plaza de Toros Monumental and Fundacio Joan Brossa.
Make yourself at home in one of the 20 air-conditioned rooms featuring kitchens with refrigerators and stovetops. Rooms have private balconies. Wired and wireless Internet access is complimentary, and flat-screen televisions with satellite programming provide entertainment. Private bathrooms with shower/tub combinations feature deep soaking bathtubs and complimentary toiletries.
Enjoy recreation amenities such as a sauna or take in the view from a rooftop terrace. Additional amenities include complimentary wireless Internet access, babysitting/childcare (surcharge), and tour/ticket assistance. Guests can catch a ride to nearby destinations on the area shuttle (surcharge).
You can enjoy a meal at a restaurant serving the guests of Aparthotel Hispanos 7 Suiza, or find a snack in a coffee shop/café.
Featured amenities include complimentary high-speed (wired) Internet access, express check-in, and express check-out. For a surcharge, guests may use a roundtrip airport shuttle (available 24 hours) and a cruise ship terminal shuttle.Information missing or incorrect? Tell us!
Hotel Amenities
Hotel Amenities
The apartment offers a restaurant and a coffee shop/café. Public areas are equipped with complimentary high-speed wired and wireless Internet access. For a surcharge, the property provides a roundtrip airport shuttle (available 24 hours), a theme park shuttle, and a cruise ship terminal shuttle. This family-friendly apartment also offers a sauna, a rooftop terrace, and tour/ticket assistance. Parking is available onsite for a surcharge. Guests can use the indoor pool at a partner hotel.
Aparthotel Hispanos 7 Suiza is a smoke-free property.
- 24-hour front desk
- Babysitting or childcare (surcharge)
- Airport transportation (surcharge)
- Total number of rooms - 20
- Number of floors - 5
- Coffee shop or café
- Elevator/lift
- Express check-out
- Casino shuttle (surcharge)
- Cruise terminal shuttle (surcharge)
- Ferry terminal shuttle (surcharge)
- Shopping center shuttle (surcharge)
- Theme park shuttle (surcharge)
- Tours/ticket assistance
- Free WiFi
- Free wired high-speed Internet
- Designated smoking areas
- Express check-in
- Dry cleaning/laundry service
- Rooftop terrace
- Luggage storage
- Laundry facilities
- Multilingual staff
- Restaurant
- Safe-deposit box at front desk
- Self parking (surcharge)
- Train station pickup (surcharge)
- Year Built 2001
- Area shuttle (surcharge)
- Sauna
- Smoke-free property
- Number of buildings/towers - 1
- Free use of nearby fitness center
Available in all rooms: Free WiFi , Free wired high-speed Internet
Available in some public areas: Free WiFi , Free wired high-speed Internet
Self parking (surcharge)
Room Amenities
- Premium bedding
- Balcony
- Air conditioning
- Soundproofed rooms
- Climate control
- Phone
- Refrigerator
- Minibar
- Coffee/tea maker
- Microwave
- Kitchen
- Daily housekeeping
- Turndown service
- Second bathroom
- Private bathroom
- Free toiletries
- Hair dryer
- In-room massage available
- Shower/tub combination
- Bidet
- Deep soaking bathtub
- In-room childcare (surcharge)
- In-room safe
- Iron/ironing board (on request)
- Rollaway/extra beds available
- Cookware, dishware, and utensils
- Washer/dryer
- Separate dining area
- Dishwasher
- Stovetop
- Satellite TV service
- Flat-panel TV
- Free WiFi
- Free wired high-speed Internet
- Separate living room
- Room service
- Pillow menu
- Day bed
- Free cribs/infant beds
- Espresso maker
Where to Eat
Aparthotel Hispanos 7 Suiza has a restaurant on site.
Room service is available.
Nearby Things to Do
The recreational activities listed below are available either on site or nearby; fees may apply.
- Bicycle rentals nearby
- Scooter/moped rentals on site
To make requests for specific accessibility needs, complete the "Special or Accessibility Requests" section of "Trip Preferences" when you book your hotel.
- Accessible bathroom
- Accessible parking
- In-room accessibility
- Roll-in shower
Hotel Policies
Check-in time starts at noon
Check-out time is noon
Payment types
You need to know
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
No pets or service animals allowed
- A tax is imposed by the city: EUR 0.72 per person, per night, up to 7 nights. This tax does not apply to children under 18 years of age.
- Resort fee
- Airport shuttle fee: EUR 65 per vehicle (one way)
- Rollaway bed fee: EUR 30 per night
We should mention
Cash transactions at this property cannot exceed EUR 2500, due to national regulations. For further details, please contact the property using information in the booking confirmation. This property offers transfers from the cruise terminal, ferry terminal, airport, and train station (surcharges may apply). Guests must contact the property with arrival details before travel, using the contact information on the booking confirmation. A resort fee is included in the total price displayed. One child 2 years old or younger stays free when occupying the parent or guardian's room, using existing bedding. Only registered guests are allowed in the guestrooms. No pets and no service animals are allowed at this property.