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In response to the significant number and severity of work-related back injuries and other musculoskeletal disorders among nurses, the American Nurses Association (ANA) has launched the Handle With Care® campaign*. The campaign seeks to build a health care industry-wide effort to prevent back and other musculoskeletal injuries. This is being done through developing partnerships and coalitions, education and training, increasing use of assistive equipment and patient-handling devices, reshaping nursing education to incorporate safe patient handling, and pursuing federal and state ergonomics policy by highlighting technology-oriented safe-patient handling benefits for patients and nurses. In the absence of ergonomics regulations at national or state levels that protect health care workers, ANA has taken on alternative approaches to encourage a movement to control ergonomic hazards in the health care workplace and prevent back injuries among the nation's nursing workforce.
Key words: back injury, devices, ergonomics, equipment, Handle With Care® , musculoskeletal disorders, patient care ergonomics, safe patient handling, nursing, OSHA, occupational safety, nurse safety
Work-related musculoskeletal disorders are the leading occupational health problem plaguing the nursing workforce. |
Work-related musculoskeletal disorders are the leading occupational health problem plaguing the nursing workforce. Of primary concern are back injuries, which can be severely debilitating for nurses, though other types of musculoskeletal injuries can involve additional body parts such as the neck, shoulders, wrists, and knees. Compared to other occupations, nursing personnel are among the highest at risk for musculoskeletal disorders. Nursing aides, orderlies, and attendants ranked second and registered nurses sixth in a list of at-risk occupations for strains and sprains that included truck drivers (first), laborers (third), and construction workers (seventh) (United States Department of Labor [U.S. DOL], 2002) (see Table 1). Additional estimates for the year 2000 show that the incidence rate for back injuries involving lost work days was 181.6 per 10,000 full-time workers in nursing homes and 90.1 per 10,000 full-time workers in hospitals, whereas comparative incidence rates per 10,000 full-time workers were 98.4 for truck drivers, 70.0 for construction workers, 56.3 for miners, and 47.1 for agriculture workers (U.S.DOL, 2000). In 2001, for cases involving days away from work among registered nurses (total of 24,719), 4,547 were categorized as overexertion in lifting and 14,832 were listed as sprains or strains (U.S. DOL, 2001).
Table 1. Rank Of At-Risk Occupations For Strains And Sprains, 2000 | |
Rank | Occupation |
1 | Truck Drivers |
2 | Nursing Aids, Orderlies & Attendants |
3 | Laborers, Non-Construction |
4 | Assemblers |
5 | Janitors and Cleaners |
6 | Registered Nurses |
7 | Construction Laborers |
8 | Cashiers |
9 | Carpenters |
10 | Stock Handlers and Baggers |
The risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. As such, no nurse is effectively clear from risk. The impact on the nursing workforce may lead to adverse consequences at the organizational level, as well, through increased absenteeism, lost work time, burnout, decreased retention, high turnover, and threatened recruitment. The extent of musculoskeletal disorders among the U.S. nursing workforce is particularly distressing when contemplated in the context of the current nursing shortage. Injuries secondary to patient handling tasks compound factors such as the aging of the nursing workforce, declining retention and recruitment rates, and lowering social value of nursing to worsen the shortage problem.
The Institute of Medicine (IOM) in its report Keeping Patients Safe (IOM, 2003) stated that "[t]he loss of strength and agility that often accompanies aging affects the ease with which nurses can perform patient care activities that require them to turn, lift, or provide weight-bearing support to patients" (p.71). Examples of research that illustrate the impact of musculoskeletal disorders on the nursing shortage report that: 12% of nurses were "leaving for good" because of back pain as a main contributory factor (Stubbs, Buckle, Hudson, Rivers, & Baty, 1986); 20% transferred to a different unit, position, or employment because of low back pain and 12% considered leaving the profession (Owen, 1989); 38% suffered occupational-related back pain severe enough to require leave from work (Owen, 2000); 6%, 8%, and 11% of RNs reported changing jobs for neck, shoulder, and back problems, respectively (Trinkoff, Lipscomb, Geiger-Brown, Storr, & Brady, 2003).
Sources of Injury or Cause
The complexity of patient care encompasses an assortment of variables that place nurses at high risk for injury. The interplay between factors related to the patient, nurse, and physical environment poses a dangerous ergonomic hazard in the health care work setting. Identifying each allows for clearer examination of their association with work-related musculoskeletal disorders.
Unsafe Patient Handling
Nurses suffer a disproportionate amount of musculoskeletal disorders... |
Nurses suffer a disproportionate amount of musculoskeletal disorders consequent to the cumulative effect of repeated patient handling events, often involving unsafe loads (Smedley, Egger, Cooper, & Cogganon, 1995). A variety of patient handling tasks exist within the context of nursing care, such as lifting, transferring, and repositioning patients. Continuous, repeated performance of these activities throughout one's working lifetime results in the development or exacerbation of musculoskeletal disorders. Nurses often lift, transfer, or reposition patients with outstretched arms or bent forward in awkward postures and positions increasing the risk for injury (Nelson, 2003). Because patient handling tasks are conventionally performed manually, nurses are significantly exposed to the ergonomic hazard associated with this high risk duty. Manual patient handling characterizes the lifting, transferring, and repositioning of patients without the use of assistive equipment. Nurses have historically been trained to use "proper" body mechanics to prevent injury from lifting and transferring patients. However, questions arise as to the true value and applicability of body mechanics training to the practice of nursing (Nelson, Fragala, & Menzel, 2003).
Nurses have historically been trained to use "proper" body mechanics to prevent injury...however, questions arise as to the true value of body mechanics training... |
The National Institute for Occupational Safety and Health (NIOSH) offers a "lifting equation" as a tool to determine safe lifting limits (Waters, Putz-Anderson, & Garg, 1994). NIOSH states that the average worker should not lift more than 51 pounds under controlled and limited circumstances. The parameters of this designation, though, cannot be appropriately generalized to nursing practice because it was derived on the basis of defined conditions (e.g., lifting a stable box with handles from ground to waist) that do not translate well to manual patient handling or other ergonomic hazards in the health care workplace. While NIOSH's 51 pounds is typically cited as a conventional reference number, it is important to note that the developers of the lifting equation explicitly recognize the limits of its application and call for the elimination of manual lifting wherever possible through the use of technologic equipment.
Patient Characteristics as a Risk for Injuries to Nurses
Patient characteristics are particularly meaningful when determining the risk of injury associated with manual patient handling. Patient height, weight, body shape, and condition (e.g., contractures, spinal injuries, orthopedic conditions, post-surgical periods, and drains or intravenous line placement) become significant factors in patient handling. Patients are often at some degree of dependence and can offer limited, if any, levels of assistance in moving themselves (Nelson, 2003) or may have limited ability to comprehend instructions and to cooperate. Some may become agitated or combative, commonly because they experience pain while being moved. The changing profile of today's patient population makes patient handling challenging. In-patient care has been largely populated by patients with higher levels of acuity, a growing elderly population, and the rising numbers of bariatric (clinically obese) patients (Thomason, 2003).
Physical Patient Care Environments
The physical environment of care can further pose restrictions on movement and positioning within the specific context of patient handling as well as other nursing tasks. Depending on the care setting (e.g., standard hospital patient room, skilled nursing facility, home care), nursing staff must work within the constraints of the physical area to perform their duties, for example, in lifting patients or reaching for elevated monitors. A personal story of a nurse who suffered a back injury secondary to working in an intensive care setting can be found on the Handle With Care® website (ANA, 2003c). Nurses may be forced into awkward, twisted positions because of limited work space. Hospital furniture and equipment as well as the presence of other hospital staff can create barriers that dictate damaging postures and movements.
Handle With Care® Campaign
Handle With Care® is a national [ANA] campaign...to promote the issue of safe patient handling and the prevention of musculoskeletal disorders... |
Handle With Care® (ANA, 2003b) is a national campaign established in September 2003 by the American Nurses Association (ANA) to develop and implement a proactive, multi-faceted plan to promote the issue of safe patient handling and the prevention of musculoskeletal disorders among nurses in the United States. Through a variety of activities, the campaign seeks to educate, advocate, and facilitate change from traditional practices of manual patient handling to emerging, technology-oriented methods. The campaign seeks to build a health care industry-wide effort to prevent back and other musculoskeletal injuries. This is being done through developing partnerships and coalitions, education and training, increasing use of assistive equipment and patient-handling devices, reshaping nursing education to incorporate safe patient handling, and pursuing federal and state ergonomics policy by highlighting technology-oriented safe-patient handling benefits for patients and nurses.
...The overarching goal...is to motivate the health care industry to take actions that reduce the incidence of musculoskeletal injuries... |
The overarching goal of the Handle With Care® campaign is to motivate the health care industry to take actions that reduce the incidence of musculoskeletal injuries among nurses while improving the quality of nursing care in the context of patient handling.
ANA's Handle With Care® campaign rests on the cornerstone of a position statement titled, "Elimination of Manual Patient Handling to Prevent Work-Related Musculoskeletal Disorders" (ANA, 2003a). This position statement articulates the beliefs and perspectives held by ANA about manual patient handling with the primary interest of nursing in mind. Its principle points are that (a) manual patient handling is unsafe and directly responsible for musculoskeletal disorders among nurses, (b) patient handling can be performed safely with the use of assistive equipment and devices, and (c) there exists a simultaneous reduction of risk for injury among nursing staff and improvement in quality of care for patients. The position statement is intended to be a resource that informs and calls on the health care industry to prevent musculoskeletal disorders among nurses while enhancing patient safety, comfort, and dignity through the use of assistive patient handling equipment and devices. Moreover, this position statement delivers a message to the professional nursing community that ANA maintains its commitment to their health and safety as a core issue (ANA, 2003a).
...ergonomics programs that include the use of assistive patient handling equipment...has essentially rendered "manual" patient handling unnecessary. |
The development of patient care ergonomics programs that include the use of assistive patient handling equipment and devices has essentially rendered "manual" patient handling unnecessary. A growing selection of equipment and devices makes available technology suitable for the variety of patient handling tasks performed by nurses (see Table 2) (Nelson et al, 2003). Level of quality, durability, availability, and the appropriateness/effectiveness for patient conditions does vary across all product lines and manufacturers. Further, facility or unit specific evaluation and selection process that includes front line users is necessary to help ensure proper and diligent use.
To understand the effectiveness of assistive patient handling equipment in reducing the risk of musculoskeletal injury for the nurse worker, this equipment should be viewed as engineering controls. Engineering controls are methods of controlling worker exposures by modifying the source or reducing the amount of agent released (Plog, Niland, & Quinlan, 1996). In patient handling, the agent is the energy/force imposed on the nurse during the act of patient lifting, transferring, or repositioning creating an ergonomic hazard. Assistive patient handling equipment and devices control this hazard by technologically engineering out the energy/force from the job task experienced by the nurse. Application of assistive patient handling technology fulfills an ergonomic approach by designing and fitting the job or workplace to match the capabilities and limitations of the human body.
The use of equipment and devices should not be viewed as the exclusive solution to prevent back injuries and musculoskeletal disorders among nurses, but rather only as a component of a comprehensive safe patient handling or patient care ergonomics program. Essential elements of such a program include a "No (Manual) Lift" policy (that is non-punitive and represents a commitment on behalf of management to provide staff with appropriate measures to avoid manual patient handling), a thorough ergonomic hazard assessment that covers high risk units or areas, investment in equipment, care planning for patient handling and movement, training for staff, and a review and evaluation process. While technologic solutions have been a key and necessary aspect of safe patient handling programs, optimal effectiveness can only be achieved with these complementary pieces. Instituting a safe patient handling program should be systematically and methodologically approached. As an example of a model program, the ANA has incorporated the Patient Care Ergonomics Resource Guide developed by the Tampa VA Patient Safety Center (Patient Safety Center, 2001).
A key to moving forward an initiative such as Handle With Care® is the formation of partnerships. In collaboration with ANA-related groups, state nurses associations, specialty nursing organizations, the research and academic community, and health care systems, ANA facilitates the sharing and dissemination of information with the intent of building a critical mass of momentum to create change. The creation of a network of groups that agree with the fundamental principles of the campaign is essential to put forward a common message that reaches a wide audience. Organizations have begun crafting resolutions, adopting policy stances, providing presentation opportunities, and utilizing channels of communication to their members and other groups.
A principal partner for the campaign is the Tampa Veterans Health Administration Patient Safety Center of Inquiry (www.patientsafetycenter.com). Under the leadership of Audrey Nelson, PhD, RN, FAAN, this research laboratory is the nation's leading center that studies safe patient handling. Through innovative work in investigating the adverse effects of injury of manual patient handling to both patients and nursing personnel, the Center has developed several resources that can be used to support the implementation of a safe patient handling program in health care institutions, including an ergonomic hazard assessment tool for health care settings, safe patient handling algorithms, an evaluation of lifting equipment and devices, and an example of a No Lift policy. All of these and more are contained in the Patient Care Ergonomics Resource Guide that is available on-line at no cost (Patient Safety Center, 2001a; 2001b). Additionally, the ANA, Tampa Veterans Health Administration Patient Safety Center of Inquiry, and the University of South Florida, co-sponsor the Annual Safe Patient Handling and Movement Conference, typically held in Florida in early March every year. This meeting features presentations from national and international experts on health care ergonomic hazards, health care organizations with successful safe patient handling programs, specialists on the economics of safe patient handling, leaders in health policy, evaluators of safe patient handling equipment and devices as well as vendors and manufacturers.
Education and Training
...an important component [of the Handle With Care® campaign] is the education and training of both front-line nurses and health care employers... |
As the Handle With Care® campaign moves forward, an important component is the education and training of both front-line nurses and health care employers (e.g., hospital administrators, chief executive officers). Effective creation of change to value and apply an ergonomic perspective to patient handling is dependent on the knowledge possessed by those in positions to demand and support it. Training workshops geared towards front-line nursing personnel review fundamental topics of safe patient handling, the impact of back injuries on the nursing shortage, the myth of "proper" body mechanics, assessment of ergonomic hazards in the health care work setting, and the use of engineering controls (patient lifting equipment and devices). Front-line staff can take the information to advocate for and work towards improvements in their own work settings (i.e., through health and safety committees, collective bargaining).
Using Assistive Equipment
Because administrators (or executive leadership) within health care organizations possess decision-making authority, the Handle With Care® campaign includes an outreach effort that involves a brochure explaining the economic argument of adopting a safe patient handling program. Amidst concerns rooted in shrinking budgets and financial resources, these decision-makers must be made aware of the cost-savings that can be realized as a function of preventing back and other musculoskeletal injuries by using mechanical equipment, aides, and devices. A common response to the idea of purchasing safe patient handling equipment is that it is cost-prohibitive and that budget constraints cannot accommodate the investment. A programmatic approach, though, that includes the use of patient handling equipment results in a dramatic reduction in costs for treatment and workers' compensation claims as well as other indirect costs related to replacing staff, training new staff, modified duty, and patient injury. Appealing to their interest using an economic argument has been identified as a critical piece to ensure that health care administrators are convinced that the use of patient handling equipment and devices is a sound investment to prevent injuries and reduce injury-related costs.
Reshaping Nursing Education for Safe Patient Handling
A dimension of the Handle With Care® campaign seeks to explore ways to modify how student nurses are taught patient handling. So-called "proper" body mechanics have been historically and continue to be taught in nursing schools as a means to counteract the physical stress of manual patient handling, such as lifting. Traditional body mechanics, though, do not translate well to nursing practice. Early findings of body mechanics studies were based on static loads (i.e., a box with handles) and primarily focused on men. Further, body mechanic methods primarily concentrate on the lower back for lifting and do not account for other vulnerable body parts involved in other types of patient handling tasks, such as lateral transfers from gurney to bed along a horizontal plane.
...methods that make patient handling safe and ergonomically sound are now available. |
Conventional education of patient handling at the training level continues to be based on manual (e.g., "hook and drag") and multi-person techniques (e.g., two-person lift). Persistence of this practice in the education of nursing students perpetuates outdated approaches and contributes to the considerable number of work-related musculoskeletal disorders that continue to occur among newer members of the nursing workforce. Considering emerging scientific research, technologic innovation, and exemplary application in real work settings, methods that make patient handling safe and ergonomically sound are now available. Providing these methods to schools of nursing to incorporate in education and training curriculum is viewed as a critical dimension to preventing the future incidence of musculoskeletal disorders among nurses. By directing efforts during the influential "learning stage" the campaign seeks to catalyze a sorely needed philosophical transformation with respect to patient handling among the prospective nursing workforce. Empowering nursing students with the foundational value and appreciation for the recognition and prevention of ergonomic hazards can have far-reaching effects particularly as they take on leadership roles throughout the variety of health care settings, such as hospitals and nursing homes.
National Policy
...OSHA is barred from pursuing development of another ergomonics standard unless ordered so by Congress... |
On November 14, 2000, the U.S. Department of Labor Occupational Safety and Health Administration (OSHA) issued a final ergonomics rule that would have protected health care workers (OSHA, 2000). Opponents of the rule made claims that ergonomics does not have a scientific basis and employers would incur overwhelming financial costs to ensure compliance with its stipulations. Garnering congressional support and landmark use of the Congressional Review Act, opponents successfully moved forward a resolution (S.J. Res. 6) to repeal the OSHA ergonomics standard (Boehner, 2001a), which was promptly signed by President George W. Bush (Boehner, 2001b). Bush, himself, explained that this Congressional action was used effectively to repeal a costly and overly burdensome regulation that would have cost employers billions while possessing uncertain benefits (Bush signs, 2001). A condition of this repeal is that OSHA is barred from pursuing development of another ergonomics standard unless ordered so by Congress with agreement of the Executive Branch (see Table 3 for a summary timeline of OSHA ergonomics regulation). Absent regulatory activity related to ergonomics, OSHA has published industry-specific ergonomic guidelines, including one specifically for Nursing Home Personnel (OSHA, 2004). These guidelines, in contrast to a standard, are not enforceable, such that employers are not required to comply with them nor can an OSHA citation be issued based on the guidelines.
The international nursing community has long recognized manual patient handling as a true occupational hazard. Several nursing associations across the world have taken initiative, often in response to government regulation, to present positions or policies concerning the act of manual patient handling. At the forefront of the global safe patient handling movement, the United Kingdom and Australia have published official stances on the matter. The United Kingdom's Royal College of Nursing (RCN) issued its Code of Practice for Patient Handling in 1996. The Code offered a framework for implementing a government standard adopted in 1992 (revised in 1998) titled, "Manual Handling Regulations" that covers health care workers (Royal College of Nursing, 2002). The aim of the policy is to eliminate manual handling in all but exceptional or life-threatening situations, orders that manual patient handling may only be done if it does not involve lifting all or most of the patient's weight, and calls for the use of handling aides to reduce the risk for injury. The Australian Nursing Federation (SA Branch) adopted a "No Lift, No Injury" policy in March 1998. Much like the RCN, the central tenet of the policy calls for the elimination of the manual handling of people in all but exceptional or life threatening situations and states that manual assistance may only continue if it does not involve lifting most or all of a client's weight. An additional component of this policy is the establishment of a training program and resource network to disseminate knowledge about safe handling efforts (Australian Nursing Federation, 2004).
The international nursing community has long recognized manual patient handling as a true occupational hazard. |
With the lack of a federal regulation that addresses workplace ergonomic hazards, an alternative approach has been to pursue state-based regulation or legislation. Certain states may be politically amenable to specific mandated worker protections countering resistance to advance national-level regulation or legislation. Establishing momentum for an issue that exhibits support from multiple states serves as a means to build a "ground-swell" up to the federal level and be the impetus for a federal initiative. To illustrate this, the federal Needlestick Safety and Prevention Act of 2000 (PL 106-430, U.S. Congress, 2000) was introduced and passed only after seventeen states, starting with California (California State Legislature, n.d.), had passed their own needlestick safety legislation (ANA, n.d.). Supporting state nurses' associations and state-based coalitions in such efforts was a major component of ANA's Safe Needles Save Lives campaign during the mid- to late-1990s (ANA, 2002).
The Handle With Care® campaign seeks the same strategy for safe patient handling/ergonomics regulations that covers the health care workers. Currently, work to identify and craft model legislative language has been prioritized to assist those organizations and legislators that are interested in pushing forward at the state level. Identifying states primed to take on this pursuit accompanies this effort. Additionally, ANA has provided direct support for state ergonomic regulations. In the state of Washington, the Department of Labor and Industries adopted a rule to reduce work-related musculoskeletal disorders on May 26, 2000 (to be effective on July 1, 2002 with incremental phase-in through 2006) that applied across all industries (Washington State Department of Labor and Industries, 2000). The rule explicitly pointed out "heavy, frequent or awkward lifting" as a criterion for compliance, and nursing and personal care facilities were identified as high risk workplaces for which this rule was intended. A voter initiative I-841 to repeal the rule was spearheaded by the Building Industry Association of Washington which claimed that cost estimates to implement the rule ranged from $80 to $800 million and that jobs would have to be eliminated as a result (Queary, 2003). ANA became heavily involved in supporting the Washington State Nurses Association (WSNA) who advocated against I-841 as part of the Washington State Labor Council to preserve the ergonomics rule. After a media battle for which proponents of I-841 overwhelmingly outspent the Washington State Labor Council, I-841 passed by a 53% to 47% margin on November 4, 2003 eliminating the ergonomics rule (Washington State Department of Labor and Industries, 2003). Further, I-841 contained a stipulation that the state Department of Labor and Industries is disallowed from working on any type of similar rule unless ordered by the state legislature. As other state bills are being introduced and promoted across the country, ANA continually explores ways to offer assistance and content expertise to support such efforts (see California Assembly Bill 2532 on Lift Teams as of 5/5/2004) [www.leginfo.ca.gov/bilinfo.html (choose "Both," enter "2532")].
Reduction in Nurse Injuries
A growing number of health care facilities have incorporated safe patient handling programs with technology solutions and have reported positive results (Evanoff, Wolf, Aton, Canos, & Collins, 2003; Haiduven, 2003; Hefti et al, 2003; Hignett, 2001; Holliday, Fernie, & Plowman, 1994; Mutch, 2004; Owen, Keene, & Olson, 2002; Yassi et al, 2001). Injuries among nursing staff have dramatically declined since incorporating patient handling equipment and devices along with an institutional commitment to the safest available methods. In a work environment that values an ergonomic approach and applies a formal program, nurses are provided a safe workplace in which to practice without the threat of injury. Additional benefits include decreased fatigue, increased job satisfaction, not working in pain, and sustainability of professional careers.
Cost-Savings for Employers
Cost-benefit analyses have shown that assistive patient handling technology successfully reduces workers' compensation and medical treatment costs for musculoskeltal disorders. |
Costs associated with occupational injuries are often more than most realize. As worker injuries decline, both direct and indirect costs associated with these injuries decrease. Cost-benefit analyses have shown that assistive patient handling technology successfully reduces workers' compensation and medical treatment costs for musculoskeletal disorders (Collins & Bell, 2003; Garg, 2003; Nelson et al, 2003; Owen & Fragala, 1999). Savings are viewed as a function of eliminating indirect costs such as time for investigation, lost work days, loss of productivity, modified duty time, replacement of injured employees (turnover), education and training of new hires, liability costs from possible patient injury, overtime pay to those covering shifts and workload, and other operational costs. Case examples have revealed that employers have saved tens to hundreds of thousands of dollars after implementing a safe patient handling program (Collins, Wolf, & Hsiao, 2002; Fragala, 1995; Nelson, Fragala, & Matz, in press).
Quality Patient Care
While the use of assistive patient handling equipment and devices is endorsed as a way to create a safe environment of care for nursing staff, it is necessary to highlight the significant advantage to patients. Patient handling technology has uplifted the level of quality nursing care delivered. Increased safety, comfort, and dignity have been identified as the primary benefits for patients. Assistive equipment and devices provide a more secure process for lifting, transferring, or repositioning tasks reducing the potential for patient injury (i.e., falls, skin tears, shoulder dislocations) as a consequence of a manual patient handling mishap. Patients are less subjected to awkward or forceful handling potentially experienced when lifting, transferring, or repositioning is done manually. Moreover, any anxiety patients may feel with having a person (susceptible to injury) perform the task can be relieved and increase confidence with the use of assistive mechanical equipment. The use of assistive equipment protects patient dignity, especially since a patient's self-esteem and privacy can be compromised during difficult patient handling situations when performed manually. Further safe patient handling equipment can be selected to match a patient's ability to assist in their own movement, thereby promoting the expression of patient autonomy.
Nurses should not have to manually lift, transfer, or reposition patients. |
Nurses should not have to manually lift, transfer, or reposition patients. In reviewing the availability and success of safe patient handling programs that use mechanical equipment and devices, there is no reason for why the American health care industry has not achieved a state in which exposure to ergonomic hazards, particularly with respect to patient handling, is effectively controlled. The benefits of adopting a safe patient handling or patient care ergonomics program for employees, employers, and patients have been clearly demonstrated and are difficult to argue. There continues to be a need to educate all members of the health care industry about innovative programmatic and technologic solutions that effectively reduce the risk of injuries among nurses and other patient care providers. Through the Handle With Care® campaign and its various components, the ANA hopes to help transform current patient handling practices as well as encourage awareness of the dangers of ergonomic hazards in the health care workplace.
Letter to the Editor from Dietrich Mackel .
A.B. de Castro, PhD, MSN, MPH, RN
E-mail: email@example.com
A. B. de Castro, PhD, MSN, MPH, RN. Dr. de Castro is the Senior Staff Specialist for occupational health and safety at the American Nurses Association (ANA). His duties include providing occupational health and safety expertise to ANA and its membership, maintaining relationships with governmental agencies with a focus in work-related injury and illness, and coordinating with other labor organizations to advocate on behalf of workers. Dr. de Castro serves as the primary resource person for the ANA's Handle With Care® campaign. Prior to his current position, Dr. de Castro, earned a doctorate in Occupational and Environmental Health from The Johns Hopkins University School of Public Health, where he also completed the Master of Public Health/Master of Science, Nursing joint-degree program in partnership between the Schools of Nursing and Public Health. He has worked for the national office of the Occupational Safety and Health Administration in its Office of Occupational Health Nursing supporting the development of standards and outreach and training materials, particularly for issues involving special worker populations at risk. In addition to his occupational health policy work and research pursuits, Dr. de Castro draws experience from a variety of nursing practice settings, including acute care, surgery, home health care, and public health making him knowledgeable about the nature of frontline nursing work and hazards in the health care workplace.
*Note: Handle With Care® is a registered trademark. This article was modified to reflect this trademark on 7/20/06.
Article published September 30, 2004
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Owen, B. D. (2000). Preventing injuries using an ergonomic approach. AORN Journal, 72(6), 1031-1036.
Owen, B. D., & Fragala. G. (1999). Reducing perceived physical stress while transferring residents: An ergonomic approach. AAOHN Journal, 47(7), 316-23.
Owen, B. D., Keene, K., & Olson, S. (2002). An ergonomic approach to reducing back/shoulder stress in hospital nursing personnel: A five year follow up. International Journal of Nursing Studies, 39, 295-302.
Patient Safety Center of Inquiry (Tampa, FL), Veterans Health Administration, & Department of Defense. (2001a). Patient care ergonomics resource guide: Safe patient handling and movement (Part I). Retrieved July 31, 2004 from www.patientsafetycenter.com/.
Patient Safety Center of Inquiry (Tampa, FL), Veterans Health Administration, & Department of Defense. (2001b). Patient care ergonomics resource guide: Safe patient handling and movement (Part II). Retrieved July 31, 2004 from www.patientsafetycenter.com/.
Plog, B. A., Niland, J., & Quinlan, P. J. (Eds.) (1996). Fundamentals of industrial hygiene, Fourth edition. National Safety Council: Itasca, IL.
Queary, P. (2003, October 13). Pain, politics converge on ergonomics measure. Seattle Times. Retrieved July 31, 2004 from http://archives.seattletimes.nwsource.com/cgi-bin/texis.cgi/web/vortex/display?slug=ergonomics13&date=20031013.
Royal College of Nursing. (2002). RCN code of practice for patient handling. Retrieved May 5, 2004 from www.rcn.org.uk/publications/pdf/code-practice-patient-handling.pdf.
Smedley J., Egger P., Cooper C., & Coggon D. (1995). Manual handling activities and risk of low back pain in nurses. Journal of Occupational and Environmental Medicine, 52(3), 160-3.
Stubbs, D. A., Buckle, P. W., Hudson, M. P., Rivers, P. M., & Baty, D. (1986). Backing out: Nurse wastage associated with back pain. International Journal of Nursing Studies, 23(4), 325-336.
Thomason, S.S. (2003). Assessment protocol for bariatric patients. Presented May 4, Third Annual Safe Patient Handling and Movement Conference: Clearwater Beach, FL.
Trinkoff, A. M., Lipscomb, J. A., Geiger-Brown, J., Storr, C. L., & Brady, B.A. (2003). Perceived physical demands and reported musculoskeletal problems in registered nurses. American Journal of Preventive Medicine, 24(3), 270-275.
U.S. Congress. (2000). Public Law 106-430. Retrieved July 31, 2004 from http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_public_laws&docid=f:publ430.106.pdf.
U.S. Department of Labor. Bureau of Labor Statistics. (2000). Table R6: Incidence rates for non-fatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by industry and selected parts of body affected by injury or illness 2000. Available at: www.bls.gov/iif/oshwc/osh/case/ostb1039.pdf.
U.S. Department of Labor. Bureau of Labor Statistics. (2001). Nonfatal cases involving days away from work: Selected characteristics (1992-2001). Accessed at: http://data.bls.gov/labjava/outside.jsp?survey=cd.
U.S. Department of Labor. Bureau of Labor Statistics. (2002). Lost-work time injuries and illnesses: Characteristics and resulting time away from work, 2000. April 10, 2002. Retrieved July 31, 2004 from ftp://ftp.bls.gov/pub/news.release/History/osh2.04102002.news.
Washington State Department of Labor and Industries. (2000). Workplace Safety and Health Rules, WAC 296-62-051, Ergonomics.
Washington State Department of Labor and Industries (2003). L&I issues statement on repeal of ergonomics rule. Retrieved May 5, 2004 from www.lni.wa.gov/news/2003/pr031105a.asp.
Waters, T., Putz-Anderson, V., & Garg, A. (1994). Applications manual for the revised NIOSH lifting equation. Retrieved May 5, 2004 from www.cdc.gov/niosh/pdfs/94-110.pdf.
Yassi, A., Cooper, J. E., Tate, R. B., Gerlach, S., Muir, M., Trottier, J., et al. (2001). A randomized controlled trial to prevent patient lift and transfer injuries of health care workers. Spine, 26(16), 1739-1746.


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Welcome to the NKPR Holiday in July 2018 Preview!
The NKPR office got a little chilly last week with our annual Holiday in July preview! We hosted media and influencers in our NKPaRlour to take a look at the exciting new products coming their way this winter. Ok, ready to start your wishlists? Take a look and let us know what you'll be gifting this year 🙂
Nothing says the holidays like a gift guide! The NKPR team put together the best ones for the busy shopper including The Best Beauty and Fashion Gifts Under $100, For The One Who Likes to Splurge, The Best Last-Minute Gifts, and Gifts for an Avid Traveller! An office favourite? Stocking Stuffers (and Hounds Vodka seriously stole the show here)!
Upon entering our winter wonderland, guests peeked under the tree for the winter must-haves from MEC! They also showcased the best picks for an NYE Bucket List and gift guides for the globetrotter, for little explorers, for the coffee lover, and more!
Guests also enjoyed breakfast throughout the day with Tim Hortons' new Breakfast Anytime menu. Have you ever seen a happier face?
Pusateri's also made an appearance and they've exclusively partnered up with celebrity chef Chuck Hughes to develop limited-edition holiday gift baskets with his picks from Pusateri's (including a few products from his own brand)! There are two boxes available in different sizes (with different price points) with custom artisanal offerings like Pusateri's Maple Roasted Pecans and Marcona Almonds (Roasted and Salted), and Chuck Hughes' Balsamic Vinegar and Hot Pepper Spread! These boxes feature some seriously delicious items to keep in your winter pantry, including all the snacks you could ever need for a snow day!
A tea-lightful sight, DAVIDsTEA created their own cosy holiday space in our boardroom (with a tree and fire no less)! Guests were given a sneak peek into their holiday selection, including their ever so popular advent calendar as well as their endless array of warm winter flavours like the classic Sleigh Ride and Santa's Secret. To be honest, nothing gets me in the holiday spirit like warm delicious drinks!
Links of London was a popular destination with their NEW Narrative Collection! Links of London has now introduced new engravable disc charms and necklaces with horizontal bars in Sterling Silver, Rose Gold Vermeil and Yellow Gold Vermeil, all embellished with the collection's iconic bubbled edges. Each beautiful piece can be engraved with a message or memorable date, making it the perfect gift for someone you care about with sentimental meaning! Our showroom also received a new permanent addition- a Links of London telephone booth (which was incredibly popular with our guests).
Lise Watier is introducing a new Holiday collection, "Neiges", inspired by their iconic fragrance! The collection features a highlighting powder, two 5- colour eyeshadow palettes, sparkling lipstick, metallic liquid lipsticks and more! Think of your stocking overflowing with these… yes, please! They are also offering tons of amazing gift sets, great for making gifting a breeze this year.
Flow also debuted their newest flavours (Strawberry and Rose, Watermelon and Lime, Lemon and Ginger, and Cucumber and Mint), offering a point of hydration for guests as they browsed the room.
OGX and Maui Moisture showcased how you could enjoy a spa at home! Maui Moisture's hair masks are incredibly moisturizing, perfect for the dry cold air of winter (and with many options for all hair types and needs). The OGX stylers are perfect to finish off the job and were a huge hit with guests as they enjoyed an on-site touchup throughout the preview.
Swarovski had some simply stunning pieces on display from their Fall/Winter 2018 Collection! Some of the necklaces were so sparkly the guests couldn't put them down- and we can't blame them. Who would you gift a gorgeous Swarovski piece too? Get ready! Winter is closer than you think!


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Pretty Good Year Letterpress Card
A birthday card fitting for this year.
Product Specs
- 4.75" x 4.75" folded card
- Blank inside
- Letterpress printed on luxe soft white cardstock
- Paired with a recycled kraft envelope
Printed by hand on an antique letterpress in Brooklyn, New York. Due to the printing process, which is done entirely by hand, there will be slight variations from print to print, ensuring each card is one-of-a-kind. Like you.
Postage: square envelopes require additional postage
© Kwohtations


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Divine Noise 15ft Black Cable Straight and Right Angle
Every cable is cut, soldered, and assembled by hand in Portland, Oregon using only the highest quality products to ensure that you get the most out of your equipment. Everything from the thick, heavy-duty PVC jacket on these proprietary cables, to the highest quality silver solder to secure components is done to create a reliable, great sounding, high caliber product that you can trust. These cables are made for the tortures of touring with the assurance of performance.
- 20 AWG stranded center conductor, a spiral shield of bare copper providing 95% coverage. Semi-conductive PVC covering reduces Tribo-Electric Noise and provides clean, low-noise performances, without microphonics.
- Low capacitance (30 pF/FT) provide a rich warm tone, not bright, harsh or brittle- the result of overly low capacitance- and not too dull or muddy- caused by too high of a capacitance.
- The oxygen free copper used in our cables delivers the purest sound quality while remaining flexible and noise free
- Thick (.280"), heavy-duty PVC outer jacket designed to withstand the rigors of heavy use while maintaining flexibility.
- Every cable is soldered by hand using the highest quality silver solders
- Completely made by hand in the USA.
- Divine Noise offers a lifetime no hassle warranty on every cable.


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Since late 1999 Amateur Investors (AI) has consistently outperformed the Major Averages using both Long Term and Short Term Investing Strategies.
Investing Strategies
Exchange Traded Funds (ETF) Daily Signals
Using our Market Timing Indicator (MTI) investors are given Daily Signals on when to go Long or Short in the SPY ETF. Click here for results in 2014.
401K/Thrift Saving Plan (TSP) Monthly Signals
Not interested in trading stocks or ETF's but would like to significantly improve the returns on your 401K/Thrift Savings Plan (TSP). Use our Market Timing Signals such as the Mutual Fund Panic Indicator and Mutual Fund Cash Flow Indicator to trade your 401K or Thrift Savings Plan (TSP) on a Monthly basis. Click here for more information on how our Daily Timing Signals can help you significantly improve the returns in your 401K or TSP account.
Click here to Signup for a "Free" 30 Day Trial Membership and have access to these additional Products Daily ETF Buy and Sell Signals 401K/TSP Timing Signals End of Month Strategy Industry Group Performance Market Timing Indicator
Enter your Email Address below to Signup for our Free Amateur Investors Weekly Market Newsletter
Read our latest Articles
"Why Social Security is in Big Trouble" "Bailout America Plan" "Current Bank Texas Ratios" "Mutual Fund Cash Index" "Using the Mutual Fund Panic Index to time Market Bottoms" The Golden Cross: Does it Work "Timing Bottoms in the S&P 500 using Bearish Investment Advisor Sentiment" "Yield on 10 Year Treasury Note versus Dow Performance" "China's Parabolic Move" "Bearish Advisor Sentiment Readings" "Oil Service Sector Exhibiting 5 Wave Pattern"
Why become a Member of Amateur Investors?
Access to many useful Investment Products Check out our Performance Statistics Read some Testimonials from our Members
Disclaimer: The owners of Amateur Investors are not registered investment advisors. The information presented on our site and in our e-mails is not a solicitation to buy or sell any security. Please consult a professional investment advisor before becoming involved in trading stocks.


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AUB University Libraries (UL) Digital Collections
The Digital Collections platform is a gateway to the University Libraries digitized and preserved collections, featuring manuscripts, maps, photos, posters, books, multimedia, and other resources. It provides access to primary source materials and preserves digital resources for the future. It also enables researchers to conduct new types of scholarship. This growing online repository aims to continuously disseminate and provide access to knowledge and valuable historical and cultural material about AUB, Lebanon, and the region for the purpose of advancing the fields of research and education. The platform serves as a hub for collaboration with other AUB departments, faculties, scholars, as well as with external partners in support of digital scholarship initiatives on and off campus.
Who We Are
- Digital Initiatives and Scholarship (UL), contact Kahale, Elie
- Cataloging and Metadata Services (UL), contact Chebani, Basma
- Library Systems and Applications (UL), contact Assi, Mona
- Archives and Special Collections (UL), contact Mikati-Kaissi, Samar
- Research and Academic Collaboration Services (UL), contact Charafeddine, Fatmeh
- Collections (UL), contact Atallah, Mariette
Digitization Standards
We follow FADGI guidelines (Federal Agencies Digitization Guidelines Initiative) for our digitized content. FADGI is a cooperative effort among experts in the field, including Library of Congress, to develop and sustain common digitization guidelines and practices for cultural heritage materials.
We aim, through digitization, to meet the digital projects or the digital collections needs by:
- Providing access copies suitable for the web and by providing digital content that meet specific requirements needed by the digital initiatives.
- Generating high quality digital preservation copies to facilitate long term access.
We focus on providing core descriptive metadata to describe the intellectual entity and to facilitate discovery and access to the digital content. In order to fulfill the project or the digital collection needs, the descriptive metadata core elements is extended to include other information such as provenance and structural metadata.
Also in most of our digital collections especially the one that is unique or deemed to be long term value, we create technical and preservation metadata to ensure long term access. This information is not accessible through the digital collection platform but it is ingested along the digital items into our digital preservation system.
Digital Preservation
The number of digital items in our digital collections or used for supporting different collaborative digital initiatives is increasing tremendously. Given the fragile nature of the digital content along with the continuous evolving hardware, software, standards, and file formats, these digital materials are at a much higher preservation risk than traditional analog materials.
We seek to provide long term access to our digital content though our evolving digital preservation framework which is essential for the Library to carry out its mission of supporting excellence in research, delivering information, and for preserving our cultural heritage.
Full Text search & OCR
We support full text search for different digital collections or whenever it is required by the digital project. The full text search, in addition to the descriptive metadata, improve search results and discovery of the content.
We also perform Optical Character Recognition (OCR) for the digitized content to convert the image of a scanned page into text. We are in the process of adopting new AI (Artificial Intelligence) OCR tools and methodologies to improve our OCR accuracy rate especially for the Arabic content.
Copyright and Term of Use
The AUB University Libraries (AUB UL) aims to make its collection available and easily accessible for research and scholarship. In support of this and to encourage broader discovery, the AUB University Libraries Digital Collections are available under a Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International License. Except where otherwise stated, anyone is free to download and share works under this license as long as they give credit for the original creation, the shared work is not changed and not used for commercial purposes. Attribution should be given to "AUB University Libraries." e.g. "Campus 1967" by AUB University Libraries is licensed under CC BY-NC-ND 4.0
The AUB UL Digital Collections contain, link or refer also to callout content that might be protected by third-party (for which AUB UL has authorization to make available for you). Except where otherwise stated, no part of this content maybe sold, resold, licensed, transferred, copied or reproduced in whole or in part in any manner or in or on any media to any person without the prior written consent of AUB UL and/or the concerned third parties. AUB UL provides access to this content in its digital collections for educational, scholarly and research purposes only.
In addition, the AUB UL Digital Collections contain, link or refer to public domain material or Creative Commons Content. The AUB University Libraries do not warrant that the sharing of content, including public domain or Creative Commons content will not infringe upon the rights of third parties. It is the responsibility of the user to determine and satisfy copyright and other use conditions before copying, transmitting, or making other use of the content.
Takedown Guidelines
AUB UL provides access to content in its digital collections for educational, scholarly and research purposes only. If you are a rights holder and you are concerned that you have found material on this website for which you have not granted permission (or is not covered by a copyright exception under applicable copyright laws), you may request the removal of the material from our site by contacting us through email@example.com. AUB UL will look into the claim and if confirmed the reported content will be removed.
For more information or any questions, please contact us by clicking here


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SE7 DUAL FEEDBACK ACTIVE NOISE CANCELLING BLUETOOTH HEADPHONES. Discover sound quality that brings out the best in your music—including subtle details you may never have noticed.
Cowin SE7 wireless headphones are engineered to sound better, be more comfortable and easier to take with you. Put them on, and suddenly everything changes. Your music is deep, powerful and balanced, and so quiet that every note sounds clearer.
Wearing Bluetooth wireless headphones can provide you with a distraction-free listening experience, especially when you're working out or commuting. SE7 DUAL FEEDBACK ACTIVE NOISE CANCELLING BLUETOOTH HEADPHONES are designed with a 20-hour battery life and built-in mic for hands-free calling and audio control.
Noise cancelling headphones are an excellent way to drown out background noise and enjoy your music in peace. There are many different types of noise cancelling headphones available. Some are designed for travel, others are designed for exercising, and still others are designed for those who want the best sound quality possible. The SE7 DUAL FEEDBACK ACTIVE NOISE CANCELLING BLUETOOTH HEADPHONES are designed for the best sound quality possible. The audio quality is amazing and there are many features that make them a great option for those who want to enjoy their music in peace.
READ MORE 👉 cowinaudio.com
📌 Learn more at: 🔗 zigi.be/CowinAudio


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Formats and Editions
More Info:
�For each of these songs, I just sent over a lead vocal and a piano and Hammock�reinvented these songs in way that only they could do,� explains YELLOWCARD vocalist/guitarist Ryan Key about A Hopeful Sign, the new collaboration with the Nashville-based post-rock duo. Set for release on February 9, 2024 via Equal Vision, the new album revisits some of the alt-rock band�s most memorable tracks and reimagines them in a neo-classical and ambient space, deconstructing the songs and rebuilding them as a whole new aural experience. The first single from the album, �Ocean Avenue,� takes the band�s signature hit and metamorphosing the song from a pop-punk anthem to a contemplative and delicate piano-led ballad. �Yellowcard is in a new place where we are collaborating with other artists more than ever before,� says Key about this new musical partnership. �I have found Hammock in my top three most played artists every year for nearly a decade now. Hammock are one of the defining and most pioneering artists in the post rock and ambient space. We have taken so much inspiration from their work over the years so first becoming friends, and then unexpectedly getting to work together on new music were dreams come true.�
Reflecting on the tracklist on�A Hopeful Sign, he adds, �I still can�t quite believe it�s real, that we were able to create an entire album with a band that has had such a massive influence on us. Whether it is one of our well-known songs or a deeper cut, these versions bring with them completely new interpretations and meanings for listeners who have lived with them for so many years. During the six years that Yellowcard was apart, I was constantly searching for ways to continue my career as a musician and producer. I had the idea to basically do Yellowcard covers featuring friends and artists I�ve had the pleasure of knowing throughout my career. The first artist to reply and complete a collaboration was Hammock with their reworked version of �Empty Street�.�
The nine-track album pulls tracks from 2003�s�Ocean Avenue�(title track, �Only One�), 2006�s�Lights And Sounds�(�Waiting Game�), 2007�s�Paper Walls�(�You And Me And One Spotlight�), 2012�s�Southern Air�(title track, �Telescope�), 2014�s�Lift A Sail�(�Transmission Home�) and 2016�s�Yellowcard�(�Empty Street�, �A Place We Set Fire�).� �It is such an honor to have worked on �A Hopeful Sign� with such talented humans, and this record will be something we cherish forever,� says Ryan.


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About Rob
Rob Olive enlisted in the U.S. Marine Corps fresh out of high school and served four years. He holds a bachelors degree in history from Oregon State University and has operated an insurance agency for over two decades. He lives in Oregon with his wife and three sons.
Read more...
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Latest Blog Posts
- Tolerance on 9/11 Read more →
- So the Left Thinks the United States is "Exceptional" Now? Read more →
- September 11th – A Day to Celebrate Our Exceptionalism! Read more →
- Video of My Appearance on Glenn Beck TV with Dana Loesch Read more →
- Aftermath of Zimmerman Verdict: Shameful Display of Gun & Racial Politics Read more →


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Texting consumers is a very effective means to drive engagement and ultimately sales. Text messages have outpaced emails when looking at conversion and click-thru rates. In fact, 95% of texts are read in ninety seconds or less! While text messages can be a great way to engage with prospects and customers, the FCC's Telephone Consumer Protection Act (TCPA) is a regulation you need to be mindful of. In fact, the average cost of a TCPA settlement is over $6m dollars, which doesn't include legal fees or reputational damage.
Over the past few years, there have been about 4,000 TCPA cases filed annually. Take a look at the growth:
Companies are being targeted for various reasons, but there are a few that I'll cover below along with some advice on how to avoid TCPA suits.
See if you can spot the trend in these cases:
- Papa Johns: $16.5m settlement due to texting pizza specials to consumers without their consent.
- Abercrombie & Fitch: $10m settlement due to texting store promotions to consumers without their consent.
- Rack Room Shoes: $26m settlement for texting their reward program members with various sales without their consent.
Do any of these campaigns sound like something your company is engaged in?
So, you've got someone who has signed up for a rewards program, wants to receive deals, or has provided their number to your company for other purposes, but you are concerned about the TCPA (hopefully). Based on my experience working with hundreds of clients at CompliancePoint, here's where I think you should start. But first…
Quick assumption: Your company is using an automated system to send both informational and promotional texts. Examples include "blast campaigns" (upcoming sale) or "triggered campaigns" (signed up for rewards).
Quick point: Just because the text message says your store is having a sale but doesn't ask the consumer to buy anything on the message, you may think it's not considered "telemarketing". This is wrong. Any plan to sell now or in the future through direct marketing is telemarketing and subject to the TCPA.
Here are my top 5 things to consider:
- Obtain consent. This is not achieved by simply having a number provided by the consumer. Instead, the consumer must affirmatively agree to receive promotional calls/texts by automated means. This is done through a clear disclosure and often accompanied by an unchecked checkbox.
- Honor opt-outs. This seems obvious right? Provide instructions on how to opt-out and look for other phrases like "stop/quit/cancel". Opt-outs should occur immediately with most common texting platforms.
- Keep records. If you receive a complaint, you want to be able to respond confidently and records help you do that. The key records to maintain are your texting records (the phone numbers you texted, the date/time of the text, and the content of the text), your consent opt-in forms, and opt-out requests from consumers with dates. Ask yourself: what records do you need to prove you had consent, and what records prove you didn't text a consumer after they opted out.
- Only text consumers between the hours of 8AM and 9PM according to their time zone. I always recommend going off address and not phone number due to cellphone mobility. If you text a California number at 8PM, but the phone owner lives in New York, you might get a few complaints.
- Monitor compliance with these items. Another one that seems obvious, yet most companies fail to do so, and you see above what happens. I guarantee you'll find issues with most audits.
Bonus – here is a more comprehensive checklist on how to achieve a Safe-Harbor defense.
This article is not intended to be a scare tactic. The TCPA legal landscape is rampant and consumers are more aware now than ever of their rights. A quick Google search of "Cannabis TCPA" helps to illustrate the fact that this industry, like most, is not immune. However, with proper compliance parameters in place, your company can enjoy the benefits of texting with consumers with peace of mind.


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Build and Customize Enterprise-ready Apps Faster
The VMware Workspace ONE platform gives mobile application developers and IT teams the tools to rapidly and cost effectively build, test, deploy and maintain enterprise-ready mobile apps. Whether you're looking for advanced security with app containerization, analytics to measure user adoption, stability and performance, or seeking to improve your user experience with single sign-on, or zero-touch network tunneling, the Workspace ONE development tools are flexible to meet your unique requirements.
In addition to mobile application management, which unifies assignment, policy configuration and distribution of mobile, web and desktop applications to employees, the Workspace ONE mobile app development platform brings together multiple technologies for developers to empower their mobile applications:
- The Workspace ONE Software Development Kit
- Workspace ONE Unified Management following the AppConfig standard
- Workspace ONE Application Wrapping
Arm developers with the tools to roll out secure, enterprise-ready apps faster than ever with the Workspace ONE SDK
- Reduce complexity and time to market by easily satisfying security and privacy requirements including user authentication, app-level passcode, data at rest encryption, network traffic tunneling, data loss prevention policies and more
- Enable IT to remotely manage policies unique to each app or group of users through the Workspace ONE management console
- Improve testability and resolve production issues faster with advanced app analytics, crash analysis and performance metrics in Workspace ONE Intelligence
- Supports apps built on iOS, Android, Cordova, Xamarin and SAP Fiori
Enterprise mobility management (EMM) vendor community standard for developing basic management and security capabilities in enterprise apps
- Leverages native iOS and Android capabilities to configure and secure apps such as per-app VPN and OS managed data loss prevention policies
- Enables developers to enhance their applications with custom policies that may be remotely configured in the Workspace ONE UEM administrative console
- Supports both internally developed and public apps that have added EMM policy support
Add security and management capabilities to already developed applications
- No code approach to adding basic security capabilities to an existing internally built mobile application
- Provides access to a subset of SDK functionality
Why Workspace ONE?
Workspace ONE Unified Endpoint Management (UEM) technology now powers VMware Workspace ONE, an integrated platform for the digital workspace.
Hands-on Lab: Getting Started with Workspace ONE
Explore the features and functionality of our integrated digital workspace platform from the comfort of your browser.
Enterprise mobility management (EMM) is a device- and platform-agnostic solution that centralizes the management, configuration and security of all devices in an organization, both BYO and corporate-owned. EMM goes beyond traditional device management to include the management and configuration of enterprise apps and content.
A comprehensive EMM solution will include MDM , MAM , mobile content management (MCM) , identity management for access control, and productivity apps for easy access to corporate email, calendar, contacts, content repositories and intranet sites. When done right, an EMM solution should supply both the technical capabilities to simplify management and security for IT as well as a pleasant user experience for the employee.
Mobile device management (MDM) is a device lifecycle management technology that enables IT to deploy, configure, manage, support and secure mobile devices through MDM profiles installed on the devices. MDM software provides asset inventory, over-the- air configuration of email, apps and Wi-Fi, remote troubleshooting, and remote lock and wipe capabilities to secure the device and the enterprise data on it. MDM is the foundation of a comprehensive enterprise mobility management (EMM) solution.
Unified endpoint management (UEM) enables IT to stop using separate tools to manage mobile, desktop and now Internet of Things (IoT) devices. UEM solutions provide a holistic and user-centric approach to managing all endpoints by combining traditional client management of desktop and PC systems with a modern enterprise mobility management (EMM) framework. A comprehensive UEM solution will enable IT to manage users and deliver a consistent experience across all endpoints, secure and manage the full device lifecycle, and do it all in a single, comprehensive platform.
Bring your own device (BYOD) is an IT policy that allows employees to use their personal devices for work purposes. EMM platforms enable organizations to implement a BYOD strategy without sacrificing security or employee privacy by providing separation of work and personal data on the device. This separation allows IT to manage and secure only the work data on an employee-owned device. If a device is ever compromised or when an employee leaves the company, IT is able to remove only the work-related data, leaving the personal items on the device intact.


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Includes Audiobook Read by Holter Graham Features an Introduction by Robin Sharma
For more than fifteen years, Robin Sharma has been quietly sharing with Fortune 500 companies and many of the super-rich a success formula that has made him one of the most sought-after leadership advisers in the world. Now, for the first time, Sharma makes his proprietary process available to you, so that you can get to your absolute best while helping your organization break through to a dramatically new level of winning in these wildly uncertain times.
In The Leader Who Had No Title, you will learn:
- How to work with and influence people like a superstar, regardless of your position
- A method to recognize and then seize opportunities in times of deep change
- An instant strategy to build a great team and become a "merchant of wow" with your customers
- The real secrets of intense innovation
- Hard-hitting tactics to become mentally strong and physically tough enough to lead your field
- Real-world ways to defeat stress, build an unbeatable mind-set, unleash energy, and balance your personal life
Regardless of what you do within your organization and the current circumstances of your life, the single most important fact is that you have the power to show leadership. Wherever you are in your career or life, you should always play to your peak abilities. This book shows you how to claim that staggering power, as well as transform your life – and the world around you – in the process.


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Online Public Access Catalogue (OPAC)Library,Documentation and Information Science Division
"A research journal serves that narrow
borderland which separates the known from the unknown"
If you don't have a password yet, stop by the circulation desk the next time you're in the library. We'll happily set one up for you.
If you don't have a library card, stop by your local library to sign up.


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Recommendations for Fully Vaccinated People
COVID-19 Homepage
How to Protect Yourself and Others
COVID-19 Prevention Actions
There are many ways your actions can help protect you, your household, and your community from severe illness from COVID-19. CDC's COVID-19 hospital admission levels provide information about the amount of severe illness in the community where you are located to help you decide when to take action to protect yourself and others.
Prevention Actions to Use at All COVID-19 Community Levels
In addition to basic health and hygiene practices, like handwashing, CDC recommends some prevention actions at all COVID-19 hospital admission levels, which include:
Build Your Personal COVID-19 Plan
Put together your COVID-19 plan so you have all the information you need on hand if you get sick with COVID-19. Download, edit and save, and share your plan with your family, friends, and healthcare provider.
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Staying Up to Date with COVID-19 Vaccines
COVID-19 vaccines help your body develop protection from the virus that causes COVID-19. Although vaccinated people sometimes get infected with the virus that causes COVID-19, staying up to date on COVID-19 vaccines significantly lowers the risk of getting very sick, being hospitalized, or dying from COVID-19. CDC recommends that everyone stay up to date on their COVID-19 vaccines, especially people with weakened immune systems.
To find COVID-19 vaccine locations near you: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233.
Improving Ventilation and Spending Time Outdoors
Improving ventilation (moving air into, out of, or within a room) and filtration (trapping particles on a filter to remove them from the air) can help prevent virus particles from accumulating in indoor air. Improving ventilation and filtration can help protect you from getting infected with and spreading the virus that causes COVID-19. Spending time outside when possible instead of inside can also help: Viral particles spread between people more readily indoors than outdoors.
Actions that can improve ventilation and filtration include:
- Bringing in as much outdoor air as possible—for example, opening windows.
- Increasing air filtration in your heating, ventilation, and air conditioning (HVAC) system, such as by changing filters frequently and using filters that are properly fitted and provide higher filtration.
- Using portable high-efficiency particulate air (HEPA) cleaners.
- Turning on exhaust fans and using other fans to improve air flow.
- Turning your thermostat to the "ON" position instead of "AUTO" to ensure your HVAC system provides continuous airflow and filtration.
CDC's interactive ventilation tools can help you see how much you can improve ventilation in your home or school.
Moving indoor activities outdoors
You are less likely to be infected with COVID-19 during outdoor activities because virus particles do not build up in the air outdoors as much as they do indoors. As the COVID-19 hospital admission level rises, consider increasing the number of group activities you move outside.
Financial support may be available to certain entities, like schools, to make ventilation improvements.
Getting Tested for COVID-19
Get tested if you have COVID-19 symptoms. A viral test tells you if you are infected with the virus that causes COVID-19. If you have COVID-19 symptoms, you should get tested for COVID-19 immediately. If you have been exposed to COVID-19 and do not have symptoms, you should test 5 full days after your exposure. If you do not test at the right time, you are more likely to get an inaccurate test result.
You may choose to get a PCR test at a testing site or healthcare facility. PCR tests are more likely to detect the virus compared to antigen tests. Rapid antigen tests provide results quickly and are available at testing sites or for use at-home. FDA recommends 2 negative antigen tests (if you have symptoms) or 3 negative antigen tests (if you do not have symptoms), performed 2 days (48 hours) apart to be confident that you do not have COVID-19.
Even when you don't have symptoms or a recent exposure to COVID-19, testing may help you make informed decisions about your health and your risk of spreading COVID-19 to others, especially those who are at higher risk of severe illness.
Following Recommendations for What to Do If You Have Been Exposed
If you were exposed to someone with COVID-19, you may have been infected with the virus. Follow CDC's recommendations for what to do if you were exposed. This includes wearing a high-quality mask when indoors around others (including inside your home) for 10 days, testing, and monitoring yourself for symptoms.
Staying Home When You Have Suspected or Confirmed COVID-19
If you have COVID-19, you can spread it to others, even if you do not have symptoms. If you have symptoms, get tested and stay home until you have your results. If you have tested positive (even without symptoms), follow CDC's isolation recommendations. These recommendations include staying home and away from others for at least 5 days (possibly more, depending on how the virus affects you) and wearing a high-quality mask when indoors around others for a period of time.
Seeking Treatment If You Have COVID-19 and Are at High Risk of Getting Very Sick
Effective treatments are now widely available and free, and you may be eligible.
- Contact your healthcare provider, health department, or Community Health Center to learn about treatment options.
- Don't delay! Treatment must be started within a few days after you first develop symptoms to be effective.
- If you don't have timely access to a healthcare provider, check if a Test to Treat location is in your community. You can get tested, receive a prescription from a healthcare provider (either onsite or by telehealth), and have it filled all at one location.
Avoiding Contact with People Who Have Suspected or Confirmed COVID-19
Avoiding contact with people who have COVID-19, whether or not they feel sick, can reduce your risk of catching the virus from them. If possible, avoid being around a person who has COVID-19 until they can safely end home isolation. Sometimes it may not be practical for you to stay away from a person who has COVID-19 or you may want to help take care of them. In those situations, use as many prevention strategies as you can, such as practicing hand hygiene, consistently and correctly wearing a high-quality mask, improving ventilation, and keeping your distance, when possible, from the person who is sick or who tested positive.
Prevention Actions to Add as Needed
There are some additional prevention actions that may be done at any level, but CDC especially recommends considering in certain circumstances or at medium or high COVID-19 hospital admission levels.
Wearing Masks or Respirators
Masks are made to contain droplets and particles that you breathe, cough, or sneeze out. A variety of masks are available. Some masks provide a higher level of protection than others.
Respirators (for example, N95) are made to protect you by fitting closely on the face to filter out particles, including the virus that causes COVID-19. They can also block droplets and particles you breathe, cough, or sneeze out so you do not spread them to others. Respirators (for example, N95) provide higher protection than masks.
When wearing a mask or respirator (for example, N95), it is most important to choose one that you can wear correctly, that fits closely to your face over your mouth and nose, that provides good protection, and that is comfortable for you.
Increasing Space and Distance
Small particles that people breathe out can contain virus particles. The closer you are to a greater number of people, the more likely you are to be exposed to the virus that causes COVID-19. To avoid this possible exposure, you may want to avoid crowded areas, or keep distance between yourself and others. These actions also protect people who are at high risk for getting very sick from COVID-19 in settings where there are multiple risks for exposure.
Additional Resources
- COVID-19 Hospital Admission Levels
- Science Brief: SARS-CoV-2 Transmission
- Science Brief: Indicators for Monitoring COVID-19 Community Levels and Making Public Health Recommendations
- Science Brief: Community Use of Masks to Control the Spread of SARS-CoV-2
- Science Brief: COVID-19 Vaccines and Vaccination


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WAIKIKI is a new DANCING model being offered in 2019. She stands about 31 inches tall with shade. Lampshade sizes 18-20 inch are best suited for this size lamp. this is a more modest lamp with the lei covering the breasts.
E komo mai – welcome – to the home of Hula Lamps Hawaii, where unique design, timeless beauty, graceful functionality, and the aloha spirit meet to create one-of-a-kind treasures from Hawaii that will be kept and cherished for generations.
Hula lamps are artistic lighting sculptures which capture the beauty and grace of this timeless dance, with a base made of cast bronze, Hawaiian wahine or lady in a hula dance pose, and a colorful shade painted with a variety of iconic island motifs. And, many of these lovely ladies actually do dance the hula, thanks to a quiet, internal motor that gyrates their skirts over their swaying hips!
All our hula lamps are classic bronze sculptures, rendered in smooth, warm, glowing brown patina. Each is a custom work of art that is painstakingly cast, painted and signed and numbered—all limited-edition pieces that are really tomorrow's collectible available for you today!
The Hula Lamps Hawaii Story
Hula Lamps Hawaii is the dream and realization of Kona artist Charles Moore, who created his prototypes of the lamp more that 20 years ago. Charles drew his inspiration from the original retro hula lamp styles that were popular in Hawaii back in the 1930s. These lamps were typically of only modest quality and time has taken its toll—they have become increasingly rare and when found, very expensive.
In the past two decades, Charles has put his artistic mark on the art of the hula lamp, skillfully designing and creating his own more detailed and contemporary styled lamps, but still retaining the special vintage look and appeal of the original designs. With each passing year, Charles's creations have become one of the most sought-after treasures by visitors to Hawaii from around the world who wish to take home something truly special from the Islands. This popularity has made Hula Lamps Hawaii the world's premier hula lamp manufacturer, with more than 10,000 pieces sold to date.
Unlike easily-produced and cheaper items appealing to a mass market, each hula lamp created by Hula Lamps Hawaii is painstakingly designed, produced and finished over more than a year's time. The key to the beauty of the hula dancers is the hot bronze casting method Charles uses. This hot bronze or foundry casting method has been used for nearly 2000 years, and involves a lengthy, skilled and complex process. Inexpensive cold cast and alternate methods of casting such as resin are often used instead today by other producers to create a "bronze look," rather than real bronze.
Pick up any of our hula lamps, and you will note they are solid and heavy, a mark of a true bronze sculpture. The hot bronze casting results in a piece that is not only substantial, but—like the true bronze sculptures from the Greco-Roman era still found in museums today—will retain its beauty and value for many, many years.
The hula lamp base consists of the hula dancer—authentically wearing a green, colored or two-tone bronze neck and head lei—as well as a platform on which the dancer stands and which has Hawaiian cultural images attractively sculpted in bas-relief. The dancer also wears a fringe hula skirt, which sways sensually on the motorized models.
The beautiful bronze base of all lamps is crowned with a durable and distinctive shade that has been skillfully hand-painted with flowers such as hibiscus, anthurium, plumeria, heliconia, orchid and bird of paradise, as well as palm trees, seashores, turtles, pineapples, canoes and other Hawaiian motifs. The shades are of semi-translucent construction, which allows for a warm and glowing back-lighting sensually illuminating the island images. Because they are hand done, no two shades are exactly alike.
Choosing Your Custom Hula Lamp
Our hula lamps are all custom, meaning you as the client will choose the particular base you like, which will be either static or motorized. About half our clients choose the motorized version, which turns the hula lamp into "aloha in motion" and is an extraordinary conversation piece. The integrated internal motor was designed by Charles, and the mechanism very quietly creates a fluid and soothing movement of the dancer's skirt over her hips as if she were really dancing the hula. The skirt mechanism is powered by normal AC current and controlled by a separate switch. The motorized models all have popular Hawaiian wahine names, such as Pua Lei, Leilani, Malia, Alana, Maile and others. Many of the static models have well-known Big Island and Hawaiian place names like Mauna Kea, Mauna Loa, Hookena, Waimea, Napali and so on. You will also choose the color for the dancer's skirt for both of the models. Bases range from 12 – 40 inches in height, with the shade.
In addition to the type and size of the base, you'll also choose the lampshade you prefer. Lampshades are sold separately and there are many shades to choose from. While they are the same low-flare style, their size varies from 12 up to 22 inches in height, so they can be matched up with the various sizes of bases. You can also choose the color fringe you'd like on the shade. We find our clients enjoy "mixing and matching" the bases and shades. We ship nearly 95% of our orders and we have special boxes made to protect your hula lamp in shipping so that it arrives in perfect condition. Both the motorized and static versions are limited edition works of art, meaning just that: only so many of each kind are ever produced.
Quite simply, customers who come into our Kona showroom store are usually astounded by the variety and quality of Charles's artistry, which also includes ceramic and brass vases, wall hangings, sculpted dishes and other items.
About the Artist
Like many wonderful ideas, Hula Lamps Hawaii came to be by serendipity—or unexpected good fortune for the founder and creator, Charles Moore. Born in Denver, Colorado, Charles had a worldly childhood, living in a variety of European countries due to his father's career as an engineer for IBM. Post high school, he decided to pursue his interest in art, attending an art and design school near Florence, Italy. This was followed by four years of travel around Europe and India, before he returned to the U.S. to live in Colorado. He married, then relocated with his wife to Kona, Hawaii. In Kona, he bought a boat, doing dive tours and also collecting tropical fish. He might still be doing the dive tours, had not his then-wife one day brought back a vintage hula lamp purchased on a trip to Honolulu. The hula lamp so stirred Charles's latent artistic muse, that he decided it was his life's passion, and in 1995 created the enterprise that is today's Hula Lamps Hawaii. Fast forward seven years to 2002, when—by now divorced from his first wife—on a trip to Suphan Buri, Thailand he met and married a lovely Thai lady by the name of Wanwisa. Soon Wanwisa was helping Charles with the many operation details of Hula Lamps Hawaii and is today the business owner. Charles and Wanwisa have two children, Tyler, 15 and Kaili, 13 years of age.


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ypmap2src(1m) [osx man page]
ypmap2src(1M) System Administration Commands ypmap2src(1M) NAME
ypmap2src - convert NIS maps to NIS source files SYNOPSIS
/usr/lib/netsvc/yp/ypmap2src [-t] [ [-c custom-map-name]...] [-d domain] -o output-directory [ [ source-file]...] DESCRIPTION
Use the ypmap2src utility to convert standard NIS maps to approximations of the equivalent NIS source files. This utility functions like the reverse of ypmake(1M). The primary use for ypmap2src is to convert from a NIS server that uses the NIS to LDAP(N2L) transition mechanism, which does not use NIS source files, to traditional NIS, where source files are required. The ypmap2src utility is also used by NIS administrators who wish to discover the contents of NIS maps for which the sources are not available. Generally, this operation is not necessary. More often, administrators will switch from traditional NIS to N2L in anticipation of the even- tual transition to LDAP naming. When this switch is made, authoritative information is moved into the LDAP DIT, and the NIS sources have no further role. N2L supports NIS clients until such time as they can be converted to LDAP, and the NIS service suspended. The ypmap2src utility does not guarantee that the files that are generated are identical to the original NIS source files. Some information might have been thrown away by ypmake and cannot be recovered. N2L also might have updated the maps to reflect changes made by LDAP clients. It is essential that the sources generated are checked to confirm no problems have occurred. Per entry comment fields, from existing source files, are not merged into source files generated by ypmap2src. If a user wishes N2L to maintain comment information, then the NISLDAPmapping configuration file should be modified so that the comment fields are mapped into LDAP. This will ensure that the comments are visible to native LDAP clients and present in the N2L map files. When ypmap2src is run, it will take up-to-date comments from the map file and insert them into the NIS source file generated. Handling Custom Maps ypmap2src only knows about the standard NIS maps and standard source to map conversion. If an advanced user has changed these, that is, the user has modified the NIS makefile, the equivalent changes must also be made to the ypmap2src script. OPTIONS
ypmap2src supports the following options: -c Specifies that custom-map-name should be converted to a source file by running makedbm -u on it. This is a short cut so that simple custom maps can be handled without editing ypmap2src. -d domain-name Specifies the domain to convert. The domain-name can be a fully qualified file path, such as /var/yp/a.b.c, or just a domain name, a.b.c. In the latter case, ypmaptosrc looks in /var/yp for the domain directory. -o dest Specifies the destination directory for the converted files. A directory other than /etc should be specified. The maps generated are copied to the correct location, /etc, /etc/security or other source directory, as appropriate. -t Specifies that traditional NIS maps, without N2L's LDAP_ prefix, should be converted. By default, maps with the LDAP_ pre- fix are converted. OPERANDS
ypmap2src supports the following operands: source-file Lists the standard source files to convert. If this option is not given, then all the standard source files, plus any cus- tom files pecified by the -c option, are converted. ATTRIBUTES
See attributes(5) for descriptions of the following attributes: +-----------------------------+-----------------------------+ | ATTRIBUTE TYPE | ATTRIBUTE VALUE | +-----------------------------+-----------------------------+ |Availability |SUNWypu | +-----------------------------+-----------------------------+ |Interface Stability |Obsolete | +-----------------------------+-----------------------------+ SEE ALSO
ypmake(1M), ypserv(1M), NISLDAPmapping(4), attributes(5) System Administration Guide: Naming and Directory Services (DNS, NIS, and LDAP) SunOS 5.10 10 Apr 2003 ypmap2src(1M)