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The Desert Sun www.phoenix.va.gov Phoenix VA Health Care System May/June 2010 Vol 32 • Issue 3 Safety program helps nurses avoid injuries Nurses and nursing care staff rank in 8-hour shift. A nurse's lifting environment is the top 10 most hazardous occupations for not a controlled space and that means it is often musculoskeletal injuries. According to the limited space, resulting in awkward positions." Bureau of Labor Statistics, the number one Wyatt explained that back injuries are cause of these injuries relates to patient handling cumulative. "As nurses lift, turn and provide and movement. care for patients, they may exceed the The effects of these injuries are far reaching. biomechanical limits of their backs. Since In fact, 12 percent of nurses leaving the field each many injuries relate to patient handling and year do so because of back pain, according to a movement, the VA is making sure patient report from the American Nurses Association. safety always comes first. We cannot ignore the The report also states that 38 percent of RNs caregivers' health and safety." have suffered occupational-related back pain The Safe Patient Handling Program is in full severe enough to require taking leave from work. force at the Phoenix VA, with almost 200 lifts So, what is the Phoenix VA Health Care set for facility-wide installation. Multiple training System doing to protect our nurse's health? events continuously improve communication of The PVAHCS offers a Safe Patient Handling the transfer needs of the patients we serve. Program to build a "culture of safety" to "Today, we have more than 60 Unit Safety educate staff in the latest ways to provide safe Peer Leaders representing each area and shift," patient care and safe working environments. said Wyatt. "These strong, caring leaders are Safe Patient Handling Programs began in all VA actively working to make a difference in the lives facilities in 2009. The program is supported by of their coworkers and our patients." a three year, multimillion dollar funding project. As a part of the National Patient Safety Susan Wyatt, an RN and PVAHCS Patient Awareness Campaign, the Phoenix VA is Photo: Paul Coupaud Sheila Girard, CNA, moves Jamie Powers, a Veteran living Safety Manager said, "Research has shown the reminding all nursing staff to use lifts and help in the PVAHCS Community Living Center, into her bed using average nurse lifts 1.8 tons of weight every others safely make the change. a patient lift system. L I F T S A F E LY ! INSIDE DO: Director's Corner .............2 • Tuck in the chin to keep the back as straight as possible while lifting. News ...........................3 • Lift with the strong leg muscles. • Ask for help with the heavy, awkward items. CLC Transforms ...............6 • When possible, use mechanical equipment to move heavy items. Nursing Week .................8 DON'T: • Use your back muscles to do lifting. Recognition ................. 10 • Try to lift an item that is too heavy of awkward. Highlights .................... 13 • Twist your body while carrying an object. • Attempt team lifting without proper coordination. Literature ................... 15 VHA Mission: Honor America's Veterans by providing exceptional health care that improves their health and well-being. Directors Corner PVAHCS doing great, 'Go team Phoenix!' By Gabriel Peréz exceeding these to give "the best Health Care to our Veterans" in our Health Care System Administrator / Medical Center Director delivery of health care. "GO TEAM!" We had great participation on the all-employee survey Areas we have to work on include: by our Phoenix VA Health Care System team. A special "thank you" to • Suicide Evaluations everyone who participated. • Inpatient and Outpatient satisfaction We had an all-time high for participation and led the VISN for the first • Processing of 1358s time in a long time with an 88 percent In the area of patient satisfaction, our scores dropped for the first half of response rate. We could not have the year. This is our Veterans' perception on how we satisfy our Veterans. accomplished this without your input. Here are a few ways we can improve our Veterans' satisfaction: It really demonstrates the kind of spirit • At every level, we need improved communication with our patients and teamwork we can be proud of. about their care process, what to expect, and to make sure we are Our mid-year evaluation revealed keeping them informed about what is next. This knowledge can we are at 81 percent in our rating reduce anxiety in patients. for the facility. This is a big increase • Treat our customers with the highest dignity and respect. How we over last year's 64 percent. Our expect our own providers to treat us is exactly how we should treat goal is to be at 100 percent and our Veteran customers. lead the nation in VA facilities for • Look around your environment, if it is not a welcoming space that our delivery and quality of health instills confidence in our Veterans, think about what you can do to care. Each of us has to do our part support change and/or make suggestions for change. Little things to deliver the best customer service can make a big difference (magazines in a waiting room, soothing and the "Best Health Care to our music, signage, etc.). Veterans." All of us working together can make the Phoenix VA Health Care Many areas are meeting quality System the place where each of us delivers the "Best Health Care to our Gabriel Peréz delivery goals and we should be Veterans." Social workers: Helping homeless Veterans find a way By Robin Bernier, LCSW apartments in the community by helping to pay the a will, there's a way and HUD/VASH is the way." Social Worker rent and providing supportive services. Acceptance "I will have a roof over my head and not have While on a trip, a person asked me what I did into the HUD/VASH program is based on a need to worry about where I'm going to stay. I will be for a living. My response was "I help Veterans for subsidized housing, meeting of certain eligibility around people my own age and be able to make find homes." requirements and the ability of the VA staff to new friends, fit into my new environment, to be Being a social worker at the VA is a rewarding effectively work with a particular Veteran. clean and take a shower and bath, wash clothes career in itself, but I work as a Housing and In my job I hear many stories. Here are a few and cook meals." Urban Development/VA Supportive Housing quotes I've heard: "It will help me get my life back together. If program social worker. The program is an "I'm homeless." you have your own place, you have your own initiative to end homelessness among Veterans. "Because I have a disability and I get a fixed sense of security ... it stabilizes me and provides HUD/VASH is a joint project between the income, I really can't afford an apartment ... I me a foundation." Department of Veterans Affairs and the local really need the help." I am privileged to be able to serve the men and housing authorities. The goal of the program "To advance my horizons, I want to use this as women who have served our country by helping is for homeless Veterans to secure independent a stepping stone to a brighter future. Where there's them find a place to call home. The The Desert Sun is a bimonthly printed publication for VA staff, volunteers, our Congressional members, Veterans Service Organizations and the Phoenix community. Desert sun | May/June 2010 This publication is supported by: Desert Gabriel Peréz .....................................................................Medical Center Director & Health Care System Administrator Chris Bacorn, FACHE.....................................................................Associate Director Dr. Raymond Chung ............................................................................... Chief of Staff Cynthia McCormack Ph.D. ......................... Associate Director Patient Care Services Sun Paula L. Pedene, APR..................................Public Affairs Officer & Managing Editor Medical Media ........................................................... Graphic Design & Photography and the Desert Sun Editorial Board If you would like to submit an article, that falls within medical center and appropriated funding guidelines, please contact PVAHCS PAO Paula L. Pedene, APR at (602) 222-2667 or via e-mail at firstname.lastname@example.com. We are not authorized to accept any advertising, political or editorial content. 2 Periodontal team dispels myths, warns of risks By Debby Kurtz-Weidinger, RDH, M.Ed. Myth #1: Bleeding gums aren't a Staff Dental Hygienist big deal If a person decided to make a list of the top Red, swollen and bleeding gums ten things they'd like to do in their lifetime, it's are an important sign of periodontal a good bet that gum surgery, better known as disease. If you notice your gums periodontal surgery, wouldn't make the cut. bleeding when you brush your teeth Unless, of course, they've had the or when you are cleaning in between opportunity to have their gums examined and your teeth, this could be a sign of treated at the VA periodontal disease. Gum disease by the dynamic can lead to tooth loss, and may also periodontal team contribute to the progression of other of Dr. Laurence diseases, including heart disease and Ambrose and diabetes, so it is important to begin his assistant, treating periodontal disease as soon as Kristina. Together, possible. This includes dental hygiene they have been treatment to remove hard and soft helping maintain deposits from your teeth. the periodontal Myth #2: Daily flossing isn't health of qualifying necessary Phoenix Veterans Dr. Laurence Ambrose Routine oral care, which includes for nearly 12 years. brushing daily to remove bacterial Ambrose is a board-certified periodontist, deposits (commonly referred to as a dentist who specializes in the prevention, "plaque"), and using dental floss (or diagnosis, and treatment of periodontal disease, any other type of adaptation that and in the placement of dental implants. goes in between your teeth), is the Courtesy photo Dr. Lawrence Ambrose, VA periodontist, works on a Veteran with his Periodontists receive extensive training in best way to prevent gum disease. dental assistant, Kristina. these areas, including three additional years of However, it is estimated that only 14 education beyond dental school and they are percent of Americans clean in between their presence of sufficient supporting bone and a familiar with the latest techniques for diagnosing teeth on a daily basis. It is vital that you keep healthy mouth that will support the implant. and treating periodontal disease. In certain up with your daily oral care, and see a dental Myth #4: Poor oral hygiene is the only way instances, periodontists can also perform professional for a thorough check-up and dental to develop gum disease. cosmetic periodontal procedures to help a hygiene treatment. If gum disease is detected, a Failure to include optimal oral hygiene in person achieve an aesthetically-pleasing smile. consultation with a periodontist your daily routine can certainly Approximately 75 percent of Americans may be indicated. contribute to the progression of suffer from some form of gum disease — from Myth #3: A tooth lost to gum gum disease, but there are a variety mild cases of gingivitis, or gum inflammation, to disease is a tooth lost forever of other factors that can also the more severe form known as periodontitis, Gum disease is a major impact your risk. For instance, which includes loss of the supporting bone cause of tooth loss in adults. tobacco use has been shown to around the tooth. With increasingly more However, in addition to treating greatly increase your chance of research indicating that gum disease may be gum disease, periodontists are developing gum disease. Stress, linked to several other diseases, including also experts in placing dental poor diet, and even genetics can diabetes and heart disease, maintaining healthy implants — a convenient also play a role in the health of teeth and gums has become more important and comfortable way to your gums. than ever. permanently replace missing "Your oral health is It is felt that the discrepancy between the teeth. A dental implant is an invaluable," Ambrose prevalence of gum disease and the lack of artificial tooth root that is said. "While quick fixes Desert sun | May/June 2010 treatment can likely be blamed on a lack of placed into the jaw to hold for periodontal disease understanding of the effect periodontal disease a replacement tooth. Dental may seem like a good may have on overall health. Patients don't always implants have a fairly high option, it's a better idea seek the periodontal care they need because they success rate, and with proper to research treatment are not aware of the long-term and potentially care, allow you to speak, eat options and discuss them dangerous implications of untreated gum and smile with confidence. It with a periodontist first. We disease. Unfortunately, a variety of myths exist is important to note, though, that in order for can evaluate your unique condition, and offer surrounding periodontal disease and the effects it an implant to be successfully placed in patient, the treatment that is best for you — one that is can have on overall health, these include: specific criteria must be met, including the supported by both science and experience." 3 By Frances Hamumaiah promote healing, and decrease the Clinical Nurse Specialist burden of post-operative pain. The There is a growing body of We recently submitted a proposal evidence that enforces the beliefs on describing the benefits of massage the benefits of music and massage therapy and other complementary and pain therapy improving a patient's surgical alternative therapies and were fortunate experience. Listening to music before, to have received grant funding to include corner: during and after surgery can lessen massage therapy to our patients following anxiety, and is a distraction from the major surgery. ambient noise and flurry of activity We are still planning the program, necessary to make sure the patient's recruiting staff and ordering equipment so Innovation surgical experience is safe and effective. With suggestions from our this benefit will be available to Veteran's during their hospitalization for surgery. in patient- surgical patients, nursing staff, and We will keep you updated on our generous support from our Volunteer progress via bulletins and posters located department, we are in the process throughout the facility. centered of developing our Perioperative (Editor's note: This is the first in a series Patient Music Library and purchasing of informal communications regarding the equipment (iPods, CD players, introduction of complementary and alternative care headphones) to meet patients' music preferences and delivery needs. therapies to our Veterans scheduled for surgery. Additional information will be provided as Therapeutic touch, such as massage progress on this project is made. Please watch for therapy, helps to decrease anxiety, bulletins as the program comes full circle.) VA training requirements still transforming By Joan Etzenhouser Changes include the annual • New supervisors must Training Training Specialist education requirement being complete a pre-test and the Portal. There have been significant reduced from 40 to 20 hours. 14 modules of "Nuts and In the changes recently in the VA Also, the VA has eliminated the Bolts of Supervision" in LMS. future, education training requirements. 20-hour annual safety education There is also a post-test after they requirement. the modules are complete. will be In addition to these changes, • Most of the all-employee available there are other helpful LMS tips mandatory annual reviews only on to help VA staff members get the are now on LMS. The only LMS. most of the educational time: course currently remaining • To be a • VA staff should call their local on the VISN 18 Training mentor for the VISN & facility LMS administrator when they Portal is "Prevention of leadership programs (LDI, need assistance. Please do not Health Care Associated LITE, & SAW), employees call the VA LMS Help Desk. Infections." must attend an 8-hour core • Existing supervisory staff • For the time being, most mentor training course. need to have 20 hours clinical staff and critical care For more information, call the of education containing nursing staff MARs will be education department at extensions supervisory content each year. available on the VISN 18 5785, 6369 or 6423. VAEA Membership in the VA Employee Association is only $5 per coupons for Sea World, Catalina Island, and free or reduced price site where you can look at the discounts we have. They Desert sun | May/June 2010 year and offers many discounts to tickets for the annual Home and range from mortgages, banks, provides members. People who are members are added to the e-mail group and Garden Show and the Men's Luxury Toy show. We also have a chiropractors, leisure time activities (i.e. Dolly Steamboat, will receive announcements about Halloween party with costume and Verde Canyon Railroad and discounts, discounts and events. Some of the attractions we pumpkin decorating contests. The vendors for the discount more), books, candles, camping, white water rafting, and more. benefits discount tickets we for include programs hold a fair during these People interested in joining the Castles and Coasters, all three parties and bring lots of door VAEA can call Michelle Roberts water parks, and Legoland. We get prizes. There is a VAEA web at extension 6442. 4 VA diabetes researcher earns prestigious award The Phoenix VA Health Care System's director of diabetes research, Dr. William Duckworth, was honored for Outstanding Achievement in Clinical Science with the first ever presentation of the John Blair Barnwell Award. The Barnwell Award recognizes leading VHA investigators who have Dr. William Duckworth Research staff celebrates successes, achieved international acclaim for outstanding scientific achievements in clinical research that announces upcoming projects advance the diagnosis and treatment of diseases By Angela Boyd, RT, MHA, CCRC Jeanne Attrep, M.D., Registry study and disorders in the Veteran population. Clinical Research Senior Clinical Coordinator to determine incidence of hypocalcemia research recognized by the Barnwell Award The Department of Veteran Affairs post reclast with Paget's disease, funded reflect efforts leading to clinical implementation celebrated 85 years of research during National by Novartis. The study will investigate of new diagnostic or treatment strategies. Research Week, April 26-30. The PVAHCS has the effectiveness of physician and patient This award recognizes Duckworth's lifelong 84 research investigators conducting 110 studies. education strategies about calcium and contributions to advancing diabetes care in The majority of investigators are clinicians) vitamin D supplementation by assessing patients with this devastating disease, and who get their ideas from their daily work with the incidence of hypocalcemia in patients comes with a three-year, $50,000 stipend to patients. Some investigators work in research with Paget's disease of bone ten days after the PVAHCS which will continue to help fund laboratories on projects that ultimately lead treatment with Reclast 5mq IV. future diabetes research studies. to patient-centered studies. Investigators are James Felicetta, M.D., Impact of non- "We are incredibly proud of Dr. supported by staff who coordinate studies and severe hypoglycemia on attitudes, decision Duckworth's achievements," says Dr. Raymond maintain regulatory documents. making, and glycemic control in type 2 Chung, Phoenix VA's Chief of Staff. "However, Some of the successes include: diabetes, funded by Eli Lily in conjunction we are mostly grateful for his work in improving April 27: with Albuquerque. The study objectives the treatment of type 2 diabetes." • 250 poster presentation viewers are to determine the prevalence of non- In earlier work, Duckworth has also been • 227 "permission to be contacted" forms severe hypoglycemia in patients on medical instrumental in studying the use and value of April 28: therapy for type 2 diabetes, describe patient implantable insulin pumps in patients with type 2 • 61 visitors to the poster presentations and provider attitudes about hypoglycemia, diabetes and has developed programs to increase • 30 R&D office tour visitors describe how hypoglycemia affects patient the use of insulin pumps and the management of • 46 laboratory tour visitors and provider management of diabetes, and patients with diabetes. • 50 evaluations completed describe the effect of hypoglycemia on Although most of his work has been done in the VA, but this work is applicable to all patients April 29: glycemic control. with diabetes. His most recent accomplishment • 282 visitors to the poster presentations Paska Permana, Ph.D., Madres para la Desert sun | May/June 2010 was as the initiator and co-chairman of the VA • 39 R&D office tour visitors Salud, funded by the National Institute of Diabetes Trial, along with Dr. Carlos Abraira • 93 laboratory tour visitors Nursing Research. The project examines the at the Miami VA. This seven-and-a-half-year, • 22 "permission to be contacted" forms relationship between moderate increases in 1,800-patient study was directed at examining • 192 evaluations completed physical activity and body fat loss in sedentary the major cause of mortality in patients with • 500 people ate at the BBQ Hispanic women during the postpartum diabetes, namely, cardiovascular disease, and period, and to explore the relationship determining whether intensive glucose control Upcoming studies between postpartum depression symptoms, reduced heart attacks, strokes, death from Some newly approved research studies physical activity and inflammatory processes cardiovascular disease, and other diabetes starting in the spring include: in body fat tissue. complications. 5 CLC transformation continues at PVAHCS By Michelle Roberts the Voc Rehab program, we were PVAHCS Community Living Center offered his services as part of his As part of the Community Living training to change careers. Center's cultural transformation Bryant has been working with to provide a more homelike residents for the past five months in atmosphere, organizers continue the recreation therapy program. He to strive to add more activities for organizes domino games, evening patient residents. movies, one-to-one exercises, and card To help achieve this measure, the games, and generally helps wherever Community Living Center staff has he's needed. He also started a extended recreation therapy services program that allows a Veteran resident to include evening activities. This is to present another resident with a Courtesy photo the result of the CLC's association certificate that thanks that person for a Michael Bryant, a Community Living Center volunteer, helps CLC patient residents through with the Vocational Rehabilitation Random Act of Kindness. a series of fitness exercises. Service. Michael Bryant, a volunteer The "act" could involve someone have been two recipients so far. in more meaningful uses of their who provided exercise classes observing a Veteran helping Both gentlemen were extremely time in the CLC. twice a week for residents, had another Veteran or a Veteran just surprised and grateful for the Bryant has accepted a position been working as a physical trainer helping another Veteran through recognition. All of these activities at the Regional Office Wellness for some years. When he entered an emotionally tough patch. There help to keep the residents involved Center. Plant life thriving thanks to CLC gardening table project By Ruby Sheffer and Julie Effron There is some of (Navajo crew who set up two of • Our local administration for PVAHCS Community Living Center code-talker) Edward Anderson's the planters and made one their support. It started with a very special corn in the east side planters. It's of them into a wonderful • A special thanks to the table made by an Eagle Scout there because when he asked what sensory garden. grounds crew here, many named Carter we were going • Candace and Nick Martinez who are also gardners, that Doyle. to grow in the who help with plant care. set the planters into place. The table planters and was designed was told that to hold potted it was for CLC Good 'Karma' comes to CLC residents plants and Veterans to By Emily Waldron Effron said when helped those grow whatever PVAHCS Community Living Center Parker passed away, his who could not they wanted, It might take the family allowed Karma to bend down he raised an average person a little continue to bring love to garden. eyebrow, more sniffing around and hope to patients The table is grinned, and to learn about a recent here. Jack Doherty, a still in the said, "Corn." addition to the Phoenix medical center patient, Karma Community And so there VA team. said he takes delight Living Center it is, all three Karma, a German Shepherd in Karma. "Karma is very easy Wander varieties, service dog, is thriving in the going and laid back," he said. Garden and is including blue. confines of the medical center "She even has a nicer room full of potted A lot of and she's a hit with patients, than I do!" Doherty explains plants. Only people made doctors and nurses. he often becomes bored, but now, thanks Photo: Bill Pedene the CLC garden Karma has had a background with Karma his boredom is no to the help possible. The of bringing love and hope to longer an issue. "I spend a lot of Desert sun | May/June 2010 Navajo code talker Edward Anderson grows of a lot of corn in the CLC planters CLC staff members of the community. time patting her and rubbing her good people, would like to According to Julie Effron, a belly," he said. it has been joined by two new thank: recreational therapist, Karma Karma provides love and wheelchair accessible planters. • The volunteers of worked as a service dog for the entertainment to employees In addition, on the east side Honeywell, in conjunction visually impaired. She found her and patients alike. Any medical of the CLC, there are three with Rebuilding Together – way into the medical center while center guests that meet up with similar planters. They exist for who built the planters. working for Robert Parker, a Karma will definitely get a smile wheelchair-bound Veterans to • Kaitlin Smith and her World War II Army Veteran who from this beloved German grow what they wish. hardworking Venture Scout spent the last year of his life here. Shepherd. 6 Miracle on the Mountain Clinic assisted by his coach, Eva Blind Veteran challenges Gergely, who is an Orientation and slopes, achieves dreams Mobility Specialist working for the Phoenix VA at winter sports clinic Advanced Low Vision Clinic. By Eva Gergely won a gold dollar for hitting the pin To be Blindness Rehabilitation Specialist in the target. considered for When Veterans conquer the "There were a lot of events selection, Gorski mountain, at the National Disabled to choose from and they were had to apply for Veterans Winter Sports Clinic, it professionally handled, the most an opportunity proves to all that a disability need memorable event was the trout to participate in not be an obstacle to an active, fishing" he said. the 2010 Winter rewarding life. "The hospitality at the clinic and Sports Clinic "It's very important because all of volunteers really assisted in by completing Veterans with disabilities have making this clinic run so well," he an extensive a feeling of frustration, fear and said. "From the Elks to the DAV, application and anxiety that they can't perform at there were groups to meet and body conditioning the level they were accustomed to escort everyone at the different gates program to Courtesy photos before their disability, said Andrew at the Denver airport." prepare him Andrew Gorski, a blind Veteran, learns self defense techniques Gorski, a blind Veteran. "At the Gorski added "The volunteers for the physical at the 24th National Disabled Veterans Winter Sports Clinic in clinic these barriers are broken were most impressive and very activities. Once Snowmass, Colo. down, making us feel whole again." upbeat." He had a great week his application was In late March, the Phoenix interacting with other visually approved, he received an orientation VA National Recreation Events impaired veterans from Reno, Nev., and mobility lesson from his coach Committee and the Disabled and Michigan. to assist him in navigating unfamiliar American Veterans sponsored This year many Veterans were areas, such as the airport, without Gorski to attend the 24th National able to interacted with a few Para- the benefit of vision. Disabled Veterans Winter Sports Olympians and Olympians, including At the Phoenix VA Health Care Clinic in Snowmass, Colo. Gorski downhill skiers Bode Miller and Casey System, a team of blind rehabilitation was one of 352 Veterans ranging Puckett, along with snow boarders specialists start with a patient-centered in age from 19 to 86 from across Gretchen Bleiler and Andy Finch. approach that includes primary the nation that went to learn and Veterans experienced the slopes care, ophthalmology, low-vision improve their skills in winter sports. with the Olympians along with a optometry, social work, audiology and The clinic promotes rehabilitation celebratory "Night of Champions" to other services. This interdisciplinary by teaching Veterans with significant meet and greet the athletes. approach helps visually impaired disabilities and visual impairments Before attending the clinic, Veterans get on track to rehabilitation how to participate in downhill and Gorski said he wasn't familiar with and greater independence. The cross-country skiing. Alternative the services offered the VA offered PVAHCS also has an Advanced Low activities are available that allow for blinded Veterans. He said Vision Clinic that serves Veterans who Veterans to experience other he contacted Visual Impairment still have some sight, but who struggle adventures such as scuba diving, Services Team Coordinator with reading and mobility. This Gorski poses on the slopes during the first pistol shooting, snow shoeing, Tom Hicks, and Hicks referred clinic teaches them about their eye day of the clinic. snowmobiling, fly fishing, sled Gorski to a six-week inpatient conditions and provides them with hockey, self defense and curling. comprehensive blind rehabilitation low vision tools to help them remain nearly 50,000 Veterans nationwide On his first day at the clinic training program at the Tucson independent. These tools include who are visually impaired are Desert sun | May/June 2010 Gorski broke his right hand while VA's Southwestern Blind magnifiers, talking clocks, closed those age 55 and older who downhill skiing with his instructor. Rehabilitation Center. At the center circuit video magnifiers and special have lost their eyesight due to Despite his injury he persevered he learned skills to improve his sunglasses. diseases like macular degeneration and said he had an overall incredible personal safety and independence, The programs also include and diabetic retinopathy. Blind experience. He also participated such as working with a white cane, outpatient rehabilitation services in or visually impaired Veterans in trout fishing and snowmobiling, sighted guide techniques, and other Veterans' homes, as well as referrals interested in referral to any of where he won the sprint with a adaptive techniques and tools. to a world-class VA inpatient rehab the aforementioned programs sighted guide amongst his sighted Gorski said he took his new center located at the Tucson Southern should contact Tom Hicks, VIST peers. He also curled, sponsored by adaptive knowledge and skills and Arizona VA Health Care system. coordinator, at 602-277-5551, the Colorado Curling Team, were he put them to use at the Winter Sports The largest portion of the extension 7236. 7 VA nurses have you covered The Phoenix VA Health Care System celebrated Nurses' Week from May 6 to 12 Events were organized by the Nursing Recruitment and Retention Committee and focused on fostering nurses caring today for healthier a tomorrow. Four PVAHCS nurses — Sheila Girard, Jane Grover, Anne Glynn- Baldwin, and Jolyn Moeller — earned the Secretary of Veteran Affairs Award for Excellence in Nursing. Photos: Bruce Bowens Gathered for Nurses' Week events are, back row from left to right, Dr. Cynthia McCormack, Dr. Keith Piatt, Gail Smith, Stephanie Bowles, Ann Sena, Kim Atwood, Rosemary Vogel, Judith Jungbluth, and Charles Olsen; In the second row from right to left are Tom Burns, Joan Malone, Loretta Chase, Angie Otradovec, Maribel Luna, Joselyn Dimeco, Linda Jones, and Cindy Dewaters. Front row from left is Marietta Stites, Sharon Navratil, Sharon Navratil, Michaela Arnaudova, and Gabriel Peréz has seen more than 350 patients in the RN Diabetes Case Manager clinic in the nine months the clinic has been open full time. With an intensive focus on this population, A1C rates have shown a reduction in more than 85 percent of the Veterans who participate in the Case Management Moeller serves on the Phoenix VA chapter of the Prevention of Amputation Care and Treatment committee, with the goal of improving diabetic foot care within primary care and appropriate referral to podiatry. She also participates in the Diabetes Redesign committee, a multidisciplinary committee seeking to improve patient outcomes in diabetes and compliance with clinical reminders in diabetes. She provided input to the Diabetes Flow Chart, an algorithm for diabetes care within primary care. Using current evidenced-based Desert sun | May/June 2010 community practices and research, she also helped to create the insulin adjustment patient instruction sheet, widely used in primary care to assist JOLYN MOELLER, RN, BSN CDE Veterans in managing their insulin use. She ensures all changes in practice Jolyn Moeller applies advanced nursing skills in the assessment, treatment and process are shared with her nursing peers and providers in the in- and nursing care of patients with diabetes across ambulatory care. She is a full house primary care clinics and the community-based outpatient clinics. time RN diabetes case manager and an expert in diabetes care. Moeller does Moeller represents the spirit of collegiality among VA nurses and is a model assessments of diet, exercise, medications, sleep, lifestyle and home blood VA ambassador in her community activities. She focuses her growth on the sugar readings, and makes recommendations to the patient and provider for on the improvement of the care and the health, safety and rights of the patient. improvements in blood pressure, lipids and A1C. Moeller has fully embraced her clinical role in Diabetes Case Management and She coordinates with dieticians in the care of patients with diabetes. She is currently completing the last semester of her master's degree. 8 JANE GROVER, LPN Jane Grover exhibits strong nursing traits: communication, SHEILA GIRARD, NA accountability, and professionalism. Grover is a dependable, Sheila Girard is a nursing assistant who consistently performs at a compassionate, knowledgeable, and dedicated member of the Ward 2C high skill level, and takes pride in providing Veterans with excellent health care team. She has excellent organizational skills and is always patient care. Because of her strong knowledge base, she is able to there to assist team members. identify abnormal levels and vital sign readings and promptly informs She completes patient care needs in a positive manner. Grover is her team leader of these changes for resolution. Girard enjoys learning a wonderful person to work with and is well-liked by her peers. She's new skills and offers a positive approach whenever she is floated to currently taking pre-requisites classes with the goal of becoming a different departments. registered nurse. Girard received training on safe patient handling and is involved in the Grover often takes the lead in preventing and treating skin continuous staff training in proper usage of the equipment. She's taken breakdown. Because of her interest in skin care, she is now a the lead in completing required paperwork for the program and works to member of the Skin Care Committee. prevent injuries by educating others on lift and transfer equipment. She is conscientious and proficient in medication administration. Girard is sensitive to the needs of the different groups of Veteran She demonstrates excellent knowledge and skill in navigating the patients, including the World War II, Korean War, Gulf War and BCMA, consistently placing in the "top performer" bracket each Iraq War Veterans. She spends extra time learning about each month for the documentation of PRN Effectiveness within one- patient's history and their special needs. She routinely goes the extra hour campaign. mile to provide her patients with a more comfortable hospital stay. element for each patient, assisting them in any way needed to reduce additional stress. Glynn-Baldwin finished the BSN program at Grand Canyon University and plans to begin her masters program in the fall. She is a member of Sigma Theta Tau, the National Honor Society for Nursing. Glynn-Baldwin is passionate with oncology nursing and her goal is to advance her skills in chemotherapy administration. The completion of the Oncology Nursing Society's class, Biotherapy and Chemotherapy Certification, helped her become proficient in the complex medication administration. In spite of knowledge in medication compatibility and usual chemotherapy routines, she consistently collaborates with the Desert sun | May/June 2010 multidisciplinary team when administering chemotherapy to ensure high level of patient safety. She is a role model and an excellent preceptor. When ANNE GLYNN-BALDWIN, RN, BSN orienting new employees, she emphasizes that lifestyle choices Anne Glynn-Baldwin shares the charge nurse role in 2C. should never be considered when providing a high level of health Glynn-Baldwin consistently provides the highest level of care for our Veteran patients. care possible for our veteran patients. She has an excellent She consistently promotes the positive nursing image by her organizational skill, and has the ability to utilize staff to meet dedication in providing excellent care to her patients and their each patient's needs. family. She ensures that quality care is provided at all times, and She prepares assignments according to patient acuity, and time reflects the qualities of a true VA nurse. 9 GLBT month features celebration events The Phoenix VA Health Care System kicks off gay, lesbian, bisexual and transgender month at 8 a.m., June 1 with a presentation by Assistant Mayor of Phoenix Tom Simplot. Simplot has been instrumental Tom Simplot in the face lift of the Melrose Place District of Phoenix. He represents a widely diverse district in the heart of central Phoenix, stretching from 51st Avenue to 24th Street, and Bethany Home Road to Van Buren Street. Courtesy photo Dr. Becky Allison, a local cardiologist It's a wrap! and president of the Arizona Senator John McCain and Phoenix VA Health Care System Administrator Gabriel Peréz display a patriotic Gay and Lesbian quilt. Senator McCain, an ex-prisoner of war from the Vietnam War, visited May 1 with Veterans here. During his visit Medical Association, the senator donated the quilt to the patients in the Community Living Center. The patients visited with the senator will speak at 2 p.m., listened as he shared his thanks for their service to our country. The senator also thanked the staff for their support of June 8. Allison has had many of our patients. Senator McCain took photos with patients and staff during the visit. our Cardiology Fellows under her PVAHCS salutes volunteer contributions tutelage. Allison and her partner host Becky Allison By Sheila Beran-Parker the Transgender Day of Remembrance in Voluntary Specialist November each year at the Arizona state capitol. If you have ever put together Finally, Allison a jigsaw puzzle, you know how Sinclair will hold important it is for each piece to an in-service connect and fit properly in order for and educational the "big picture" to come together. presentation at 9 a.m., But more importantly, the puzzle June 29. In addition symbolizes interchanging pieces to her duties here, of various shapes and designs she serves on the interlocking with each other to board of directors serve a purpose and to complete a of 1 Voice GLBT Allison Sinclair mission. Community Center and was instrumental in the More than 260 volunteers, guests, Photos: Bruce Bowens construction phase of getting the Center open. The More than 260 volunteers, guests and staff joined together March 30 for the and staff joined together March Center is at 725 W. Indian School Rd., Suite 125. Desert sun | May/June 2010 annual PVAHCS Volunteer Recognition Awards Ceremony. 30 for the Volunteer Recognition She will show the documentary "Trinidad," Awards Ceremony: "Volunteers - A which features Dr. Stanley Biber and his Perfect Fit." predecessor Dr. Marci Bowers, who brought Thank you goes out to all the changes to the town of Trinidad, Colo., and the staff in assisting with the Volunteer reactions of the townspeople of this small town. Recognition Ceremony, and huge GLBT month originated in the United States thank you to the staff who served and was first celebrated in 1994. The month- the lunches to the volunteers. Our long annual event focuses on gay, lesbian, volunteers were truly touched by bisexual and transgender history, the gay rights your overwhelming presence. Volunteer awards movement and related civil rights movements. 10 Sisters share PVAHCS volunteer recognition By Paula L. Pedene, APR Veterans Program includes Public Affairs Officer monthly check-ins, gift baskets Sisters Kathy Laurier and and additional support to new Barb Shaw are responsible for moms and their infants. "The the creation of the Maternity calls from Kathy and Barb are Support Program for new moms often the only connections these and their children at the Phoenix Veterans have with the VA VA Health Care System. Thanks during their pregnancy," says KJ to their diligence and the support Sloan, Women Veterans Program they offer new moms, the sisters Manager. "Kathy and Barb are can now add the title of VA the face and voice of our VA. Volunteers of the Year to their Through their regular interaction accomplishments. with the Veterans, women's needs Sisters Kathy Laurier "These two women have are identified and addressed, and Barb Shaw earned 2010 Volunteer gone above and beyond as while a rapport and trust is of the Year recognition volunteers. Their dedication, established and maintained." at the Phoenix VA compassion and spirit of Through donations to the Health Care System excellence are very apparent," Phoenix VA Health Care System's for the creation and said Maternity Program Veteran Women Veterans Program, operation of the PVAHCS Maternity Kori Kirkpatrick. "As a first- Laurier and Shaw regularly create Support Program. time mother, I appreciated having giant gift baskets for Women Photo: Bruce Bowens someone to trust with personal Veterans who are expecting and are identified and referred to demonstrated what excellence in issues and concerns. At the they conduct "house visits" before appropriate providers," says KJ health care can look like." Phoenix VA, we are honored or after the babies are born. Sloan. "The women Veterans also According to PVAHCS leaders, to have people of this caliber "Our women Veterans are are given a gift (the baskets) that Laurier and Shaw have made the volunteering." no longer disconnected from says 'The VA cares about you and Maternity Support Program such The compassion they show the system, so issues that once this new life you have brought into a success that it has become the in their work with the Women would have gone unaddressed the world.' Kathy and Barb have national model for other VAMCs. Public Affairs recognizes PVAHCS staff PR contributions Paula L. Pedene, APR Public Affairs Officer T H A N K Y O U ! When staff members assist our VA Thanks to Scott McRoberts, Anna Ivey, who were trying to film the VA Medical with media and other PR requests, their Bobbi Larson, Tina Simmons, Michele Center to the public affairs office. efforts help us respond to media queries Laib, Michelle Bagford, Geri Ryan, To Scott Timiney and the Outpatient Caroline Rosemond, Manny Moneda, Pharmacy staff for their support in the and other public relations requests in Desert sun | May/June 2010 Karen Walenga, Betty Beason, Bonnie ABC 15 filming of the pharmacy. a positive and timely manner. These Conrad, Judy Cosby and Jeff Bagford for To the CLC recreation therapists "PR Providers" earn recognition in this their help with the Doctor's Day event and and others for the support of the "Veteran column and receive a special token of activities. Walking" and Senator John McCain visit. appreciation for their PR efforts. Thanks to Dr. Vivienne Halpern To the VA Police for their support for the DVT series to be placed on the during the Senator McCain visit. social media sites. We received numerous To Kathy Laurier, Barb Shaw and compliments on the information she shared. Sheila Beran-Parker for their support with Rebecca "Becky" Munoz for following the Maternity and Newborn Program media policy and sending the ASU students to the requests. 11 APRIL By Vic Nickson Patient Services Assistant roster to those who require it. Leslie respects our Veterans and consuming project, requiring patients be seen within 30 days, which she Leslie Johnson was selected as the in turn is respected by them. She is handles like a "maestro." Employee of the Month for April. so calming and reassuring to others, Leslie Johnson is committed Johnson has gained the trust and it endears a loyalty from them to 120% to the Veterans and to VA respect of all those with whom she her, seldom seen or experienced at mission accomplishment. For comes in contact, and exhibits the her level. For example, cardiology example, as alluded to earlier, she qualities of excellence, commitment, patients continue to seek her out stays late, comes in early, and has and compassion. even though she has not worked come in on weekends to get the job Those who know her describe there for over a year. Likewise, file done. She is the type of unsung her as trusted, highly reliable and room employees search out her hero, little notice, but who keep as the glue who holds the office expertise, even though she has not organizations humming along at together. As an example, Johnson is worked there in almost three years. maximum efficiency. responsible for the Internal Medicine She is not only excellent in She is compassionate. She spends House-Staff Roster. This roster is every way, but is an outstanding time with patients; follows-up to time consuming to prepare and very employee already strategically ensure they have what they need Leslie Johnson difficult to maintain with not only thinking organizationally at the next to get the best care possible. In daily but sometimes hourly changes. level. Leslie is always seeking higher addition, she does tremendous work It must be updated, clear and 100 education and self-improvement. for the Phoenix VA Health Care percent accurate at all times. She takes pride in her work and System's blood drive. she writes She not only accomplishes this goes the extra mile. As an example, and coordinates the advertisements during normal duty hours, but has she volunteers for many projects, for the Drive; secures prizes and been known to give up her personal including preparing the clinic access incentives; makes a big Hollywood time and come into the office while spreadsheets for the Medicine production out of it to get volunteers on scheduled annual leave to get this Service. This is another time to give blood to help the Veterans. MAY By Vic Nickson Patient Services Assistant George excels at building and sustaining relationships with all Service redesign team as well. She is sensitive, compassionate, San Juanita George is the Program customers. She respects others; and has excellent rapport with all Support Assistant for Human conducts courteous interactions customers. She cares and helps Resources Management Services, and with customers; handles conflict in everyone. She has her own customer is congratulated as the Employee of a professional manner; builds and satisfaction survey system, utilizing the Month for May. sustains trust and respect and is open customer feedback to bring in better The superlatives for San Juanita to ideas from other people. valued items available for the Pride George roll down like a mighty She has earned many compliments; Award program. In addition, George river. She has been described as the Pride Awards and is respected among improved PVAHCS morale which has pulse, the catalyst, the heart and soul, peers, customers and supervisors. had the side benefit of contributing the single most valuable member Additionally and importantly, she to the hospital's reputation within the of HRMS; the behind the scenes supports the chain of command, outside community. mover responsible for much of the whereas others may not even grasp She is excellent in every sense of organization's success; and excelling at the concept of the chain of command. the word and is a 2009 graduate of all facets of her duties, responsibilities George is not only a multi- the LITE program. In addition, she and VA core values. task person, but a versatile multi- is a certified mentor for PVAHCS Desert sun | May/June 2010 San Juanita George She is knowledgeable, skillful, talented one as well. She honors virtual training in mediation. Lastly, in performs without supervision, and commitments to all, wears many hats a final burst of whirlwind of activity, exceeds all expected functional and and completes all assigned tasks. she attends annual dispute resolution technical literacy skills required for For example, she not only installed conferences; prepared a booth and her duties. The acting HRO trusted a new system for tracking advanced entered an education board at the her to assist with the end of year and voluntary leave; is responsible 2009 VA Quality Expo Pride Award budget reporting and allotments. for timekeeping, purchasing, HRMS Program resulting in a 95 percent Also, she not only managed the leave intranet vacancy announcements; turnover rate of Pride Award items administration program, but improved and the Pride Award program; but (an unusually high rate); and has also it as well. is on the Facility Systems Customer had time for personal development. 12 ]Dr. Marciella Moffitt recently Transplantation and the third ]Ben Mormino, psychiatrist, will become a U.S. received two prestigious awards will be published in June in the a six-year citizen in June. Geete moved from the College of Medicine Journal of American Society of veteran of the from Bombay (also known as Faculty at the awards banquet Echocardiography. United States Mumbai), India to Chicago, Ill., held at the Virginia G. Piper Department in 1996 on an Exchange Visitor Auditorium. One recognized her ]Congratulations to Christian of Veterans Visa. efforts as a teacher for the class Meyer, M.D., the 2010 American Affairs Police He moved to Arizona in 2005 of 2013 and the other was for her Diabetes Association Cure Award was promoted after receiving his green card efforts in teaching doctoring. winner. He received his award to the rank of and accepted a position with the April 24 at the Diabetes Update lieutenant/ PVAHCS last August. Awards Luncheon at the Phoenix criminal Ben Mormino He said the best part of his Convention Center. investigator job is listening to Veterans talk The Phoenix VA also had April 25. In this capacity he about their combat experience. an exhibit booth and provided is responsible for sharing in "Learning from them helps me to information about diabetes the duties, responsibilities understand other people, and stay programs. Patty Hamm and authorities of the chief of connected to the next Veteran" coordinated volunteers from the police for the management and he said. PVAHCS Community Relations operations of criminal and other Geete will be completing his Committee for the effort. investigations. citizenship in June and is looking David Simper Prior to his promotion, forward to his interview. He ]April 21 was National Mormino served as a detective says it's a "special privilege being ]Dr. David Simper recently Administrative Professionals with the Department of Veterans an American," and that "It is an had two articles published Day — the Endocrinology Affairs, New York Harbor Health honor and privilege not everyone on PubMed.gov and in the Department thanks Becky Miller Care System. He is also a retired is blessed to get." American Heart Association for all she does to help Veterans, detective sergeant from the New Journal. The first was on the endocrinology staff, and the York City Police Department ]Karen Cizek, MSN, RN; acute coronary syndromes, Diabetes Program. Her hard and served honorably as an Nicolette Estrada, PhD, such as unstable angina, acute work, dedication, compassion investigator with the U.S. Coast MAOM, RN, FNP; Jan Allen, myocardial infarction, and sudden and expertise (especially this past Guard Reserves. MSN, RN, CIC, CPHQ; and cardiac death, and how they are year when she was often the only Teresa Elsholz, MSN, RN commonly associated with the administrative professional in ]Danny Franco, Ph.D., won the were recently published in the presence of vulnerable plaques Endocrinology) were the glue best poster contest at the VISN May edition of the Nursing in coronary arteries. The second that held the department and the 18 Research Forum. The project 2010 Journal. Their article was was on proteomics profiling Diabetes Program together. works to uncover the function of titled "A Crystal-Clear Call reveals role of smooth muscle a protein called Clusterin in tumor to Standardize Color-Coded progenitors in extra cellular ]Welcome aboard to Mehr cell, chemo-drug resistance. Wristbands". matrix production. Ahmed, M.D. Ahmed did his residency trainings in physical ]Dr. James Felicetta, chief of ]Several PVAHCS staff members ]Dr. Brian Boudi had two papers medicine and rehabilitation at medicine was a lead investigator are participating in Project H3 published in eMedicine World University of Illinois at Chicago on the Accord Study, designed orientation and training to better Medical Library Specialties from 1991 to 1995, and is to look at the diabetic population assist homeless Veterans. Cardiology Section found on the board certified in that field and lipid control. The report, Team U is Michael Leon, VA Allecat. The first was on since 1996. He has worked in published in the Journal of Anthony Irby and Robin Desert sun | May/June 2010 risk factors for coronary artery the VA system for more than American Medical Association, Bernier; and Team T is Michelle disease. The second paper was 13 years. He joined the OEF/ found that aggressive lipid, Cook, Esther Thomas and on atherosclerosis causes, signs OIF program and team at hypertension targeting yields no Chris Hughes. and history. PVAHCS last October. He is benefit for some with diabetes. More than 58 representatives the OEF/OIF physiatrist and The findings were presented attended the orientation to learn ]Dr. Raymond Migrino was his practice involves seeing at the American College of the history of how survey data was recently published in American OEF/OIF patients with spine Cardiology's Annual Scientific developed in New York and how Journal of Physiology. He will pain, musculoskeletal pain Session here in March. this evidence- and community- have two other publications and polytrauma-related special based practice is ending soon at the Journal Heart Lung rehabilitation needs. ]Dr. Jayant Geete, a PVAHCS homelessness across the country. 13 PVAHCS staff gain Veteran insight through discussion program Richard C. Katz VA has always recognized the need program's founders is Dr. Timothy by two professionals who studied Chief, Audiology and Speech Pathology for training regarding the technical Richardson, chief of staff at the literature and its effect on the way Stories are unique to human and interpersonal aspects of our jobs. Augusta, Maine VAMC and himself a people perceive the world. Elizabeth beings. Stories are powerful because Literature & Medicine: Humanities Vietnam Veteran. A VA psychiatrist Larson-Keagy, Ph.D., a lecturer they involve not just facts but at the Heart of Health Care is a from the Boston, Mass., Dr. Jonathan at ASU in Cultural Geography, emotions, too, and provide listeners national award-winning reading Shay, has worked with Vietnam and Erica Kinias, M.A., Arizona with a deeper understanding of others and discussion program for health Veterans for more than 20 years, Humanities Council Grant Manager, and, upon reflection, themselves. care professionals that, as one and won a McArthur Foundation facilitated the first group discussion I have worked for the VA for participant wrote, "renews the heart Genius grant for his books, "Achilles series (Oct. 2009 to March 2010) at more than 35 years and still remember and soul of health care." Literature in Vietnam," which describes the this medical center and have lead the first time a Veteran told me a story & Medicine discussions help health lasting effect of combat on soldiers, groups at other hospitals in the during his examination for speech and care professionals improve their and "Odysseus in America," which Phoenix area. They will return in hearing problems. communication and interpersonal describes the barriers challenging June with a new series of books and He was a navigator during World skills while increasing their cultural returning Veterans. films for the second series. War II, shot down over Germany awareness, Many Veterans Because the first series of and captured by civilians who empathy for themselves Literature & Medicine discussion group tortured him until he was rescued by patients, have written sessions at our medical center was so German soldiers. In order to survive and job books successful, the Literature & Medicine as a prisoner of war, who were fed that Program and the Arizona Humanities only a watery potato soup, he learned Council agreed to fund a second to suppress his natural instinct to series of six discussion sessions at gag so he could eat insects – catch our medical center on the following them, put them in his mouth, chew dates (all Mondays): June 7, July 12, them, then swallow them – until he Aug. 2, Sept. 13, Oct. 4 and Nov. 8. was liberated at the end of the war. Each session is from 4 to 5 p.m. and He told me his life now was good: meets in a quad meeting room in the He enjoyed his job, was happily ACC basement. The grant will buy married, and had four children, but satisfaction. First created by the describe their experiences overseas all materials so there are no out-of- he had one complaint: Whenever Maine Humanities Council in 1997 and at home. By reading their books pocket expenses. he heard or saw someone cough or for Maine health care professionals, and discussing what we read with In order to facilitate discussion, gag, even his dog, he himself would Literature & Medicine groups have met other employees, we gain insight into the group will have a maximum of 25 immediately vomit. in more than 130 health care facilities the lives of the men and women who participants. Materials are selected to I referred him to Psychology in 25 states, and more than 15 VA served and sacrificed for our country, focus on different populations and Service and they found his reaction medical centers. better preparing us for the needs of issues, but ultimately the emphasis was caused by his POW experiences. Literature & Medicine provides Veterans who come to our hospital is on patients, health care providers, After a few weeks of therapy, a mechanism for VA employees for help. and Veterans. In addition, an author he no longer suffered from this to gain more insight into the Reading and discussing written (a Vietnam War combat Veteran) will reaction. Fortunately, his outcome needs of Veteran patients and the accounts of illness, death, and attend and participate in discussions was successful, but the lesson that experiences of our fellow health care human relationships in other places when the group talks about his stayed with me was time did not heal workers. Literature & Medicine builds and times helps us see the world book, "Recondo: LRRPs in the 101st all wounds. People could survive community within the medical center from the perspectives of others. Airborne." terrible experiences and upon and helps easy feelings of futility and This is crucially important for In addition to books, DVDs and returning home, still suffer for the isolation. One participant wrote, "It health care professionals who treat other materials provided by the grant, rest of their lives. I think about this feels wonderful to come back to why patients and work with others from Dr. Raymond Chung, the PVAHCS man every time I meet a new patient I was attracted to medicine in the religious, socioeconomic, or cultural chief of staff, will buy pizza for and that memory causes me to listen beginning and to share dialog with backgrounds different from our discussion session members. Desert sun | May/June 2010 and watch and act with more care others who care." Participants report own. Discussing shared readings To participate in the group, you than I might otherwise. an increase in empathy for patients with fellow workers deepens our can pre-register through TEMPO As people responsible for (79 percent), interpersonal skills (64 understanding of each other's work (under "Literature & Medicine providing health care to Veterans – percent), communication skills (58 and enriches our relationships with program") or, space-providing, and that includes us all, whether we percent), job satisfaction (62 percent), patients and each other. register at the first session at 4 p.m., work directly with patients or support and cultural awareness (67 percent). Literature & Medicine is the only June 7 in the ACC basement. those that do – we are obligated to Veterans and VA staff are leaders national program that engages a cross (Editor's note: Contact Rich Katz do whatever we can to improve the in this effort to strengthen delivery section of experienced health care by e-mail at email@example.com or state of health and quality of life of of health care with experiences professionals with the humanities. call him at extension 7043 for additional the Veterans entrusted to our care. represented in literature. One of the Our first discussion series was lead information) 14 Disabled Veterans Walk across America raises awareness His smile is big, his heart is huge and his feet were made for walking to help our nation's Veterans. On Nov. 11, 2009, U.S. Marine Corps Veteran Richard Hunsucker embarked on a journey to walk across America from Jacksonville, Fla., to San Diego, Calif. His quest was to make it to San Diego by Memorial Day and participate in ceremonies there. Hunsucker includes VA clinic and hospital stops along the way. On Saturday, April 24 he met with patients in the PVAHCS Community Living Center in the dining room for coffee talk. "The first Veteran I met on my journey was a World War II Veteran. He was a Marine in uniform and we talked for 20 minutes. When you meet someone of that stature, I knew right then my walk across America would US Marine Corps Veteran Richard Hunsucker stops at Phoenix VA Courtesy photo be outstanding. I think about that Veteran every day," says returned as many phone calls and build better lives. At last count he personally decorated by Hunsucker Hunsucker. e-mails as he could when he was had more than $630,000 pledged. with white paint markers, stickers Hunsucker walked about 17 resting at night and prepping for Along his journey Hunsucker and thousands of signatures from miles or more each day. He would the next day. The purpose for was accompanied by fellow Army Veterans and others along the way. then sit down at his computer and the walk was to raise awareness of Veteran Vince Strickland, who You can read more about his blog about the day's journey. He disabled Veterans and to help them drives the pace car which was journey at www.vetwalking.org. Buckeye VA community clinic gets new location, provider The Phoenix VA Health Care health education programs, System is committed to the health screening programs, and women's and well-being of Veterans. health services. The clinic's highest To better meet the needs of priority is to provide personalized, local Veterans, the Buckeye VA world-class health care services to Health Care Clinic moved to a Veterans. For more information, different location with a new please call the Buckeye VA Health provider in early May. The new Care Clinic at 623-386-6093. clinic is located in the office of Dr. VA Health Care Clinics provide Desert sun | May/June 2010 Rohita Malhotra, 213 E. Monroe ease of access for appointments Ave., Buckeye, Ariz. 85326. for patients rather than driving The Buckeye VA Health Care to the main hospital. Each clinic Clinic provides comprehensive provide primary health care services primary and preventive health to Veterans within 30 miles or 30 care services, as well as other minutes of a Veteran's home, reduces specialized services such as travel time and shortens waiting times chronic disease management, for Veterans needing outpatient care. 15 Eyes also need protection from solar rays Extended exposure to the sun's UV rays has been linked to eye damage, including cataracts, macular degeneration, and photokeratitis that can cause temporary vision loss. In order to protect your eyes in the sunlight, your sunglasses should: • block out 99 to 100 percent of both UV-A and UV-B radiation • screen out 75 to 90 percent of visible light • be perfectly matched in color and free of distortion and imperfection • have lenses that are gray for proper color recognition. If you spend a lot of time in bright sunlight, wrap- around frames can provide Photo: nasa.gov additional protection from The risks of sun exposure and its relationship to skin cancer have been well documented. Regular sunscreen use seems to help limit these harmful effects. Sunscreen use is recommended in all individuals exposed to the sun. harmful UV radiation by keeping UV rays from Sunscreen helps protect from sun's harmful rays reaching the eyes. Frames with a close-fitting, wrap- As the late Nat "King" Cole that taking precautions against 15 or higher around style provide the sang, it's almost time to "roll out sunburn is only necessary when • SPF 15 filters out over 90% of best protection because those lazy, hazy, crazy days of they're at pool side or on the golf the sun's harmful UV-B rays they limit how much stray summer." course. However, as ACS officials • SPF 30 - 96 percent sunlight reaches your eyes But there's more to summer warn: "Sun exposure adds up day • SPF 45 - 98 percent from above and beyond the than just "soda, pretzels and beer." after day, and it happens every time • Waterproof if sweating or periphery of your sunglass Summer also means long, hot days you are in the sun." swimming lenses. of sunshine and, if we're not careful, The ACS offers a simple • Made specifically for use on Also, remember UV eye painful and often dangerous over- reminder about the four key your face protection for children and exposure to the sun. ways to protect yourself from the • PABA (para-aminobenzoic teenagers. They typically According to the American dangerous UV radiation: "Slip! acid) free if you're sensitive to that spend more time in the sun Cancer Society, "It isn't possible Slop! Slap! and Wrap!" It stands for chemical than adults. or practical to completely avoid "Slip on a shirt, slop on sunscreen, • Water-based if you have acne Finally, even if you are Desert sun | May/June 2010 sunlight, and it would be unwise to slap on a hat, and wrap on or oily skin. wearing contact lenses that reduce your level of activity to avoid sunglasses to protect the eyes and Apply sunscreen about 20-30 have UV protection, you the outdoors. Time in sunlight also sensitive skin around them from minutes before going out in the still need to wear sunglasses. helps your body make vitamin D, ultraviolet light." Not all sunscreens sun, plus every two hours when UV rays will likely affect which can be important for good offer adequate protection, so it's outdoors, after swimming or the eye tissue that is not health. But too much sunlight can important to choose the right one. sweating, and even if wearing hats covered by the contacts. be harmful. There are some steps Look for one that is: and protective clothing. Your eyes will be more you can take to limit your amount of • Broad Spectrum - protects Finally, remember that no comfortable, too, with most exposure to UV rays." against both UV-A and UV-B rays sunscreen offers one hundred of the bright light blocked. Some people mistakenly believe • SPF (sun protection factor) of percent protection. 16
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By Catholic Online (NEWS CONSORTIUM)
6/11/2012 (2 years ago)
Catholic Online (www.catholic.org)
Just because it's summer vacation, a child's brain doesn't stop developing. Kids need to keep their minds active. That's why most schools have adopted summer reading programs to keep kids learning over the summer months. But what if you child doesn't have a summer reading program? Never fear, Catholic Online is here!
By Catholic Online (NEWS CONSORTIUM)
Catholic Online (www.catholic.org)
6/11/2012 (2 years ago)
Published in Living Faith
Keywords: Summer reading, summer vacation, activities, homeschooling
LOS ANGELES, CA (Catholic Online) - Summer reading is a great activity and can be a lot of fun for both parents and adults. In addition to exercising the mind, summer reading is also a good way to buy some quiet time at home or to keep a child occupied on a trip or during a wait.
How to use this list
Catholic Online has collected a list of summer reading books from various sources covering a variety of subjects for kids. The books are classified by grade level, but your child's reading level should be taken into account. Even within some of the grades, particularly towards the end of the list, the reading becomes more rigorous and college preparatory in style.
There's no need to make your child read every book on the list, unless they really enjoy reading. In that case, you may find the list too brief!
Each book on the list has been vetted for appropriateness, however you get the final say. In all cases, read the dust jacket or back of the book, or find the synopsis online and decide for yourself. It also doesn't hurt to read the book and quiz your child on what they read. Even better, make time to share and discuss the reading every day. The books and the events between their pages make great starting material for discussions!
Set a daily schedule for reading. Determine the number of chapters your child should read in advance and approximately how much time that should take. Keep an eye on your child and see that they're awake and making progress. Be alert for any signs of frustration. A child who finds the material frustrating to follow will soon learn to dislike reading. In that case, choose a different book with a lower reading level.
Each book on this list can be found in your public library and online. Most should be inexpensive and can be rapidly shipped to your home.
We hope you have a great time getting lost in the pages of these books!
COL summer reading list
1st Grade
Any of the BOB books
Dr. Seuss books
If You Take a Mouse to School, to the Movies books
If You Give a Mouse a Cookie, Laura NumeroffIf You Give a Pig a Pancake, Laura Numeroff
Guess How Much I Love You? S. McBratney
Goodnight Moon, Runaway Bunny, BrownLittle Red Hen, Cardone
Sammy the Seal, Hoff
Danny & The Dinosaur Books, Hoff
Jump, Frog, Jump, Kalan
2nd Grade
Berenstein Bears stories, Stan and Jan Berenstein
Frog and Toad stories, Arnold Lobel
Arthur stories, Marc Brown
Magic Tree House series, Mary Pope Osborne
Henry and Mudge series, Cynthia Rylant
Boxcar Children series, Gertrude Chandler Warner
Amelia Bedelia stories, Peggy Parish
3rd Grade
Ramoni Quimby, Age 8, Beverly Cleary
Mr. Popper's Penguins, Richard Atwater
Encyclopedia Brown, Boy Detective, Donald Sobol
Little House series, Laura Ingalls Wilder (this is a series that increases reading level per each book, perfect for 3rd through 6th grade)
The Giving Tree, Shel Silverstein
Good Grief...Third Grade, Colleen O'Shaughnessy McKenna
Magic Tree House series, Mary Pope Osborne
Stuart Little, E.B. White
Charlotte's Web, E.B. White
Secret Garden, Frances Hodgson Burnett
Black Stallion, Walter Farley
Anne of Green Gables, L.M. Montgomery
4th Grade
The Secret History of Tom Trueheart, Ian Beck
The Penderwicks series, Jeanne Birdsall
5th Grade
Alice's Adventures in Wonderland, Lewis Caroll
Number the Stars, Lois Lowry
The Time Machine, H.G. Wells
Oliver Twist and or A Christmas Carol, Charles Dickens
Adventures of Tom Sawyer, Mark Twain
Black Beauty, Anna Sewell
Treasure Island, Robert Louis Stevenson
Holes, Louis Sachar
A Series of Unfortunate Events, Lemony Snickett
6th grade
Island of the Blue Dolphins -- Scott O'Dell
Education of Little Tree, Asa Earl (Forrest) Carter
The Island on Bird Street, Uri Orlev
7th and 8th grades
Treasure Island, Robert Louis Stevenson
The Call of the Wild, Jack London
The Count of Monte Cristo, Alexandre Dumas
The Eagle of the Ninth (also published as The Eagle)
The Hound of the Baskervilles, Arthur Conan Doyle
Kidnapped, Robert Louis Stevenson
Life As We Knew It, Susan Beth Pfeffer
Little Women, Louisa May Alcott
9th grade
Of Mice and Men - Steinbeck
Oliver Twist - Dickens
The Pearl - Steinbeck
Flowers for Algernon - Keyes
Midsummer Night's Dream - Shakespeare
The Monkey's Paw - Jacobs
Romeo and Juliet - Shakespeare
The Little Prince - St. Exupery
To Kill a Mockingbird - Lee
The Good Earth - Buck
West Side Story - Shulman
Cheaper by the Dozen - Gilbrath/Carey
The Odyssey - Homer
Bullfinch's - Mythology
Great Expectations - Dickens
10th grade
Hiroshima - Hersey
Black Like Me - Griffin
Fiddler on the Roof - Stein
Antigone - Sophocles
Shoeless Joe - Kinselle
Deliverance - Dickey
Julius Caesar - Shakespeare
Animal Farm - Orwell
Merchant of Venice - Shakespeare
1984 - Orwell
Lord of the Flies - Golding
Brave New World - Huxley
Catcher in the Rye - Salinger
Alive - Read
Death Be Not Proud - Gunther
Silas Marner - Eliott
Separate Peace - Knowles
Les Miserables - Hugo
Connecticut Yankee in Les Miserables King Arthur's Court - Twain
Summer of '49 - Halberstam
11th grade
Red Badge of Courage - Crane
An American Tragedy - Dreiser
The Crucible - Miller
Our Town - Wilder
Grapes of Wrath - Steinbeck
As I Lay Dying - Faulkner
Winesburg, Ohio - Anderson
For Whom the Bell Tolls - Hemingway
The Scarlet Letter - Hawthorne
Old Man and the Sea - Hemingway
Ethan Frome - Wharton
Death of a Salesman - Miller
The Awakening - Cather
Raisin in the Sun - Hamsberry
Moby Dick - Melville
Walden/Civil Disobedience - Thoreau
Billy Budd - Melville
12th grade
Oedipus Rex, Antigone - Sophocles
Gulliver's Travels - Swift
A Man for All Seasons - Bolt
Pygmalion - Shaw
Murder in the Cathedral - Eliot
Women of Troy - Euripides
Becket - Anouilh
The Plague - Camus
Hamlet, Macbeth, King Lear - Shakespeare
Pride and Prejudice - Austen
Beowulf - NA
Sons and Lovers - Lawrence
Heart of Darkness - Conrad
Glass Menagerie - William
Dubliners - Joyce
Portrait of an Artist - Joyce
Waiting for Godot - Beckett
St. Jude
St. John the Baptist
St. Matthew
St. Francis of Assisi
St. Barbara
St. Benedict
St. Joseph of Cupertino
St. Christopher
St. George
St. Isidore the Farmer
St. Brigid of Ireland
St. Ann
St. Gerard
St. Anthony
St. Joseph
St. Florian
By Hannah Raissa Marfil (NEWS CONSORTIUM)
Disney movies are a well-known and well-loved part of most people's childhood. These stories talk and teach us things, like believing in ourselves and follow our dreams. Recently, the stories inspire courage and kindness, as well as forms of "true love." But viewers ... continue reading
By Hannah Raissa Marfil (NEWS CONSORTIUM)
The Bible is one of the most popular published books ever written in the history of life, but also one of the hardest to read and understand. Unlike most books published today, the Bible contains a lot of statements that are full of dates, metaphors and written to ... continue reading
By Tony Magliano
As the minds and hearts of Christians throughout the world focus on the suffering, death and resurrection of our Lord Jesus, we naturally think of the Holy Land. Throughout much of history, in the land where the world's savior taught human beings to love one another as ... continue reading
By Catholic Online (NEWS CONSORTIUM)
A Rhode Island school district is being sued over the claim that 200 Christian teachers were denied requests to take Good Friday off from work. The teacher's union claims that the decision denies educators the two religious days that they are afforded in their ... continue reading
By Catholic Online (NEWS CONSORTIUM)
For the first time in over 150 years, the blood of St. Januarius liquefied in the presence of a pope this past weekend. The phenomenon occurred when Pope Francis visited Naples this past weekend. It was the first time the blood liquefied in the presence of a ... continue reading
By Deacon Keith Fournier
Louis and Zelie married in France in 1858. They had nine children. Five entered a consecrated or religious life in the Church. We have 218 letters which were written by Zelie. They record the naturally supernatural pattern of a very real, human and devout ... continue reading
By Deacon Keith Fournier
James was the son of Zebedee and brother of John. From faithful stock, we see in this encounter that some forms of zeal may indeed be genetic. In fact, the zeal in both of these brothers caused the Lord to name them the Sons of Thunder.(Mk 3:14-17) However, human ... continue reading
By Hannah Raissa Marfil (NEWS CONSORTIUM)
Disheartening isn't it? But it has been observed that Christians are divided among themselves. This is not what God wanted, as expressed by the writings in the Scriptures. However, there are some issues between the believers that makes them not united as they should ... continue reading
By Deacon Keith Fournier
In an age that has lost its way, because it has succumbed to the selfish pursuit of illusory pleasure, Joseph needs to be lifted up as a model for men who truly want to follow Jesus Christ. It is time for Christian men to follow his example, and become men again. ... continue reading
By Catholic Online (NEWS CONSORTIUM)
As the emerging African economic powerhouse of Nigeria takes to the polls, Pope Francis, in a stirring message, has urged the country's bishops to build a united front against the Boko Haram terrorist group. Pope Francis' comments came in a letter to the ... continue reading

subset: commoncrawl


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I'm getting an error message when I try to get to Gartner. What does this mean?
An error occured during Federation with Gartner. Please contact your administrator.
I set up alerts in the old Gartner portal. How do I manage them now?
I'm an IT staff member so I go directly to GTP when I enter the Gartner portal. Can I still see the old Gartner Core interface?
I'm an IT staff member and I've signed up for "tracks". I'm getting email notifying me that there are documents available but I can't click through to see them. How do I see them?


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Type: Online
The 100% online MSCE degree prepares professionals with a bachelor's in civil engineering for career advancements.
Ohio University's online Master of Science in Civil Engineering (MSCE)program from the Russ College of Engineering and
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LeTourneau University offers a 30-credit online master's degree designed to help mid-career engineers meet this rising demand
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About this Vendor
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Contact Info
1609 E. Main St., Freeland, WA


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ULTIMATE ANAL - Lex The Impaler 7 - Lela Star
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(Problems with magnets links are fixed by upgrading your torrent client!)
This is scene from my ULTIMATE ANAL collection. Check out other videos from my collection here: http://www.kat.ph/user/Bagadasha/uploads/ VIDEO PARAMETERS: Size: 375 MB Play time: 00:38:51 h Frame width: 640 Frame height: 360 Resolution: 640x360 Bitrate: 1021 kb/s Frame rate: 29 f/s AUDIO PARAMETERS: Bitrate: 324 kb/s Channels: 2 (stereo) Sample frequency: 48 kHz CATEGORIES: ULTIMATE ANAL, big dick, big tits, anal, cowgirl, hardcore FEATURED PERFORMER: Lela Star SCENE DISCRIPTION: Lela Star, the lean young brunette featured on the lower right hand corner of the front cover, was up first and given the status of her previous projects, it could be argued that she was the biggest "name†of the ladies in the entire cast (at least a few years ago). She wore a blindfold and sexy lingerie as some music played, her tease session hampered a bit by some artistic looking visuals. Thankfully, the arty farty stuff one might expect at a particular contract laden company elsewhere was turned off when Lexington Steele entered the picture. He savored her body orally and soon placed his pecker by her mouth, Lela's instincts honing in on it to start blowing him, her lithe young form poetry in motion as she continued to engage his boner orally as deeply as she could (both with and without her hand). The sheer girth of it spread her mouth in erotic fashion, Lex rewarding her efforts but stuffing his face between her ass cheeks to satiate his love of her great ass. Their personal chemistry was solid and she really threw herself into the action, the vaginal pounding simply awesome and even the anal better than ever expected for her first time with the guy. She even rode actively with him tearing up her ass once up for it, the ending wad of splooge gracing her face showing she was content at a job well done (Lela cleaning him off and smiling). SCREENSHOTS: http://bayimg.com/HaMPNAAdL http://bayimg.com/haMpoaaDl
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Stephanie Paige Ogburn has been reporting from Colorado for over five years, primarily from the Western Slope.
She was previously a reporter at ClimateWire, an editor at High Country News and a reporter at the Cortez Journal. Now based in Denver, Stephanie is enjoying the many amenities of city life, and getting used to traffic. When not reporting, she enjoys backpacking, mountain biking, growing food, cooking, and spending time with her family.
Originally published on Thu June 26, 2014 11:41 am
Parts of Southeast Colorado are experiencing a longer period of drought than the dry times that occurred during the Dust Bowl.
According to Nolan Doesken, the state climatologist, the past three years and eight months have been the driest stretch ever recorded for some parts of the state, including Rocky Ford, La Junta and Ordway.
"It was drier than the worst consecutive drought period of the 30s and of the 50s," said Doesken.


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As some of you may know, today is the 30th Anniversary of Knott's Montezooma's Revenge. It is an awesome classic thrill ride that blasts from 0-60mph in three seconds. What makes it so fun and exciting is the lack of over-the-shoulder harness so that you can go through the loop without obstructions. I wish California Screamin' would get rid of their harnesses. Anyway, I hope some people on here managed to get some rides in, I know I did, even with the dozens of schools that came (mostly middle schools, which means lots of bad mouthing, and I heard lots of it today)
Anyway, Happy 30th!


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Barrow man died at sea - inquest
Last updated at 17:48, Sunday, 11 May 2014
A BARROW businessman who drowned at sea may have died because brain surgery left him "unable to recognise danger", an inquest heard.
The body of ex-Barrow Raiders commercial director, Peter Millican, 46, of Abbey Road, was recovered from the sea off Askam pier on February 5.
The inquest, at Barrow Town Hall yesterday, heard Mr Millican had been recovering from a rare condition called Type 2 Arnold-Chiari malformation, in which the lower part of the brain is pushed downwards towards the spinal cord.
Mr Millican's partner of 11 years, Jane O'Hare, told the coroner's court his condition had been misdiagnosed by doctors for two years.
She said if the condition had been spotted sooner, at Type 1 stage, a simple procedure could have corrected it.
Instead on May 26 last year Mr Millican underwent a seven-hour operation which wiped three years of his memory and left him with brain damage and agoraphobia (fear of going outside).
He was left unable to remember his mother's birthday party three months before the operation or the previous three Christmases.
Mr Millican was also unable to perform tasks such as operating a remote control or working a toaster – but Ms O'Hare said he had been making steady improvements in the months before his death.
"Peter realised he wasn't the same person anymore," she said.
Ms O'Hare spoke of setting her partner "little goals" and said he had been in better spirits before his death.
"We had a party at my house and he was the life and soul," she said.
Ms O'Hare told the court: "We came to realise after the operation Pete did not click where there was danger."
She said he had once tried to remove a chicken from the oven with his bare hands before he was stopped.
He had also been picked up after previous walks on Askam beach "soaking wet" because he could not recognise bad weather would present a danger.
The court heard CCTV cameras at the family home showed the last images of Mr Millican alive getting into a taxi – probably to visit his mother.
Ms O'Hare said: "You could see he was happy, he was walking tall and he was smiling."
Summing up, coroner Mr Ian Smith described Mr Millican as a man with a "very nasty" condition who underwent "very severe" surgery.
He said: "Where some people just lay down and accept it he fought back to regain the skills he lost through the operation, making good progress.
"This was a man who recognised he had a problem but knew how to deal with it."
Mr Smith said the most likely scenario was that Mr Millican fell into the water and was unable to get out. He recorded a verdict of accidental death.
Ms O'Hare told the Evening Mail: "We are relieved about the verdict but the family is still heartbroken. He really did fight to get better."
First published at 14:32, Sunday, 11 May 2014
Published by http://www.nwemail.co.uk
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Please rate, share and subscribe. Thank you! -------------------------------------------------------------- Barstow Factory Merchants Outlet Mall - Ghost Mall (aka "Dead" Mall) Originally opened for business in 1988, the mall seemed to be at its peak in the early 90's. In 1992 the mall boasted over two million visitors. Now it's just a "Ghost Mall" also known as a "Dead Mall". There were once hundreds of stores at this thriving desert mall. the Gap, Lenox China, Guess, Ralph Lauren Polo, Coach, Izod, Monet, Jones New York, Royal Doulton, Bugle Boy, Van Heusen, Gloria Vanderbilt, Fieldcrest Cannon and Sony, just to name a few. In the late 80's and early 90's this was the place to stop when traveling back and forth to and from Las Vegas from Southern California and the desert communities. It was convenient to stop, stretch your legs and get a cold drink. Then spend a couple of hours browsing through the stores. The overhead speakers still pipe music through the closed off sections of the mall. The perky prerecorded announcement entices visitors to stop at the food court for a refreshing soda or an ice cream. The food court is closed. The mall is starting to show signs of neglect and vandalism. The only public restroom remaining open has seen better days. There was a time when the parking lot was packed. Buses brought groups to the mall and hoards of commuters would circle, searching for a parking spot. Now, it's not unusual to see only one or two lone cars in the parking lot. The last few to visit as this mall takes is last gasp. Once, there were hundreds of shops in this 330,310 square foot mall, now according to the sign, as of June, 2013, there are only seven merchants remaining. I've seen this place open, watched as it boomed and now it's decline. It's just sad to see this once vibrant place evolve into a ghost town. Hopefully the future will bring some life back into this place in the desert. Photography by Jay Scott Wood Fine Photography ©2013 all rights reserved. Soundtrack "Oceanic Dawn" by DJ Masque http://sampleswap.org/profile.php?mode=viewprofile&u=47067