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Greetings friends and colleagues,
Welcome to the fall edition of the CHW SPIG newsletter. I hope you find this newsletter exciting and informative.
The past year has been extraordinarily exciting and busy for CHWs in the United States and throughout the world. As the CHW model continues to gain recognition and application throughout the world (particularly in the areas of community organizing, HIV/AIDS, maternal and child health, and chronic disease prevention, management, and treatment), community health workers are becoming more involved in policy and practice issues relevant to our field. Recent interest in CHWs' ability to help people embrace healthier lifestyle choices and behaviors has powered this growing interest, as the field of public health as a whole ponders its own future and the future of health in general.
In this newsletter, we hope to provide an overview of our more recent developments, particularly in our group's development and relevant national campaigns. This edition also contains an article written by Anne Willaert describing our program at the upcoming Annual meeting; another by Maria Alvarez deLopez on the very first Michigan CHW conference recently held in Grand Rapids Michigan; a report written by Susan Mayfield-Johnson on the 2008 Unity Conference in Albuquerque, New Mexico; and an article from Newsletter Editor, Gail Hirsch, on the extraordinary Lisa Renee Holderby, an accomplished and visionary CHW leader from Massachusetts who is the recipient of the 2008 Helen Rodriguez-Trias Social Justice Award and will be honored at the Annual Meeting.
APHA Annual Meeting Program
Firstly, I want to thank Anne Willaert and the program planning committee she chairs, for the exciting and innovative program they have created for the upcoming 136th Annual Meeting of APHA in San Diego, California. My thanks also to those who volunteered to review and evaluate the many abstracts we received. Our program this year includes scientific sessions, poster sessions, business meetings and a roundtable discussion on CHWs as agents of change, in addition to a CHW leadership workshop organized by Lisa Renee Holderby and Carl Rush – the first time the SPIG has sponsored such an activity. We will also host a wonderful social reception on Monday evening, October 27th, which has been arranged by Susan Mayfield-Johnson, our Treasurer. Our reception has always provided a wonderful opportunity for meeting with new and older colleagues and introducing our SPIG to the larger APHA community. Our general business meeting is scheduled (as usual) at the stimulating hour of 6:30 AM Wednesday morning. Our Liaison Committee to other Sections, SPIGs and Caucuses has also been very active this year. The committee reviewed most abstracts to be presented at the Annual Meeting this year and selected appropriate sessions for us to co-sponsor. I thank Tori Booker, who chairs that committee, for these efforts.
Our new Committee on CHW Education y Capacitación will also meet during the upcoming Annual Meeting. As interest in CHWs grows, so does interest in certification, training and remuneration. It is important that such considerations recognize the large body of work already published on appropriate training for CHWs in both college and non-academic settings and that the voice of CHWs lead the discussion. It is equally important that any credentialing process be developed in a way that supports inclusion rather than limiting participation in the field. Training and certification are both issues with potential to significantly alter our character, membership and how we are viewed in our communities. These issues also present significant challenges to employers and funders of CHW programs, in that incorporating our role(s) in the healthcare system requires significant understanding on the part of individuals and organizations, to embrace our wisdom and approaches to working with community. CHWs must speak to these issues in order to maintain our character and the trust we enjoy within our communities. And healthcare systems must resist the urge to "Make them like us."
CHW Section Application
I am very excited to announce that the CHW SPIG has submitted an application for "Section" status to APHA Intersectional Committee for Governing Council consideration at the Annual Meeting this year. This is a huge accomplishment for us and is a direct result of efforts on the part of our SPIG leadership to develop our own internal organizational structure and our involvement in APHA governance for several years in preparation for this application, but we need your help. Although the SPIG continues to enjoy increased visibility within APHA and our sessions at the Annual Meeting continue to gain in attendance, we still face challenges increasing our membership numbers to meet the required minimum of 250 members. We ask for the support of all our advocates, supporters, allies and stakeholders to select the CHW SPIG as your affiliation on your APHA membership form to help us achieve this important goal. Towards this end, we have also engaged in a membership drive through an email campaign and through participation in local APHA affiliates.
CHW SPIG Elections
This year, the SPIG held official APHA-sanctioned elections for our leadership positions, including Chair, Chair-elect and Secretary. Lisa Renee Holderby from Massachusetts has been elected to succeed me as the Chair. Maria Alvarez deLopez, another dedicated and inventive CHW from Michigan, has been elected Chair-elect, and Carl Rush continues to serve as our Secretary. Now that we have established this formal process, we will continue to implement it in the future. Our other SPIG Councilors continue to be elected at the general business meeting during the Annual Meeting.
Policy Resolution Supporting CHWs
Also on the policy front, the CHW SPIG Policy Committee worked very hard this year to develop and submit a policy brief titled, "Integrating Community Health Workers to Improve Access and Reduce Health Disparities," for APHA Governing Council consideration. This resolution highlights the finding of the Health Resources Services Administration (HRSA) that there are over 120,000 CHWs working in the United States and that CHWs have been identified as a strategy to reduce and eliminate health disparities. The Institute of Medicine (IOM) report, "Unequal Treatment: Confronting Racial and Ethnic Disparities," states that CHWs "offer promise as a community-based resource to increase racial and ethnic minorities' access to health care and to serve as a liaison between healthcare providers and the communities they serve." This resolution builds on a previous one (APHA policy statement 2001-15) written by the SPIG and passed by APHA Governing Council in 2001 titled, "Recognition and Support for CHW's Contribution to Meeting Our Nation's Health Care Needs." I want to thank Maria Alvarez deLopez, the policy committee chair, and all members of that committee for their outstanding work and commitment to this important effort.
Bureau of Labor Statistics
On the national scene, I am happy to report progress on several important initiatives. Last year the CHW SPIG responded to a request from the US Department of Labor Bureau of Labor Statistics (BLS) for comment on possible new Standard Occupational Categories for the 2010 census. Both HRSA and the CHW SPIG submitted comments to the policy committee of BLS to consider CHWs as a unique standard occupation category (SOC). We are proud to report that BLS accepted our comments and made a recommendation that CHWs be recognized as a SOC. That is great news. Unfortunately, BLS decided to combine CHWs with health educators in a compound category with a shared SOC code. In response to this recommendation from the BLS policy committee the SPIG mobilized a national campaign to submit comments to the policy committee requesting a separate and independent SOC for CHWs. The campaign generated hundreds of comments from CHWs, CHW-led organizations, and CHW stakeholders from around the country. The response was much larger than the policy committee expected so it is taking them a while to review them all. We expect to hear from BLS on their decision in the very near future. It is important to mention that this initiative, like many other emerging CHW policies, have broad local and national significance for our identity and our practice. It is increasingly evident that CHWs must come together in local and national organizations to develop a collective voice and inform these decisions. Without the efforts of the CHW SPIG and other local and regional CHW organizations, these important decisions would be made without our voices potentially leading to a loss of identity and severe limitations on who may practice our field.
American Association of CHWs
AACHW continues to develop as an independent national association. Over the past year AACHW has concentrated on developing our own organizational structure and strategic plan. The Association has produced a CHW Code of Ethics and a set of Core Values that help describe our practice. AACHW and the CHW SPIG have worked together to create a definition of CHWs that is self-descriptive and endorsed by CHW practitioners from around the country. Our definition is the following.
A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.
I applaud the work the CHW SPIG and AACHW in helping local CHW leaders organize independent professional associations and supporting their development. It is vital that we continue supporting emerging local organizations and their members. CHWs everywhere share concern that the growing interest in our work may lead to credentialing criteria that could alter our very identity and limit membership in our practice. This possibility is particularly alarming in the case of government and hospital-based programs which often establish exclusionary employment practices.
So, please let me thank you for visiting our web location and for your interest in the CHW field. I hope you find this newsletter informative and useful. Please remember to select the CHW SPIG as your primary or alternate affiliation on your APHA membership profile. Your support will help us achieve Section status. We hope to see you at the Annual Meeting. For comments, please contact me at firstname.lastname@example.com or our newsletter editor, Gail Hirsch, at gail.hirsch@.massmail.state.ma.us.
Sergio Matos
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by Anne Willaert
The Community Health Worker Special Primary Interest Group has planned an interesting and interactive program for the APHA 2008 Annual Meeting in San Diego. This is an exciting year for the CHW SPIG as we move toward becoming a Section, providing an opportunity to promote CHWs and their profession throughout the world and in our own country, states and communities. The program this year consists of four Scientific Oral Sessions, one Roundtable Session, four Business Meetings, two Poster Sessions, and a Social Hour Reception.
We are also planning something new this year -- the planning committee felt strongly about providing interactive sessions that would inspire and provide valuable information for CHWs and their supporters. In this year's program we are sponsoring a three hour leadership workshop for Community Health Workers. This workshop is replacing two oral session slots, and is scheduled for Wednesday morning, October 29th.
A social hour reception on Monday evening from 6:30 – 8:00 pm will be filled with wonderful announcements and opportunities for everyone to meet, mingle and network. We will also have an delicious menu of fun treats!!
To register for the APHA conference and to view the CHW SPIG program and speakers go to http://www.apha.org/meetings/highlights/. When you register make sure you name the CHW SPIG as your affiliation. See you soon in beautiful San Diego!!
by Gail Hirsch
Lisa Renee Holderby, stepping into the Chair of the CHW SPIG this fall, will be awarded with the 2008 Helen Rodriguez-Trias Social Justice Award at the APHA 136th Annual Meeting in San Diego. This award honors public health workers who dedicate themselves toward social justice for underserved and disadvantaged populations.
Ms. Holderby is being honored as a public health leader for her "courageous and innovative leadership in statewide as well as national efforts to improve the health of under-served communities through promoting the unique, essential and often under-recognized contributions of community health workers." Holderby, with nearly 20 years experience as a CHW and currently executive director of the Massachusetts Association of Community Health Workers (MACHW), was nominated by Gail Hirsch, MEd, Coordinator of Workforce Initiatives for the Massachusetts Department of Public Health's Division of Primary Care and Health Access and editor of this newsletter.
Ms. Holderby has played a leadership role in ground-breaking state and national efforts to promote the contributions of CHWs to public health. In APHA, she has served as both leader of the Policy Committee of the CHW SPIG, as well as a governing councilor. She is a founding member of both the Massachusetts Association of Community Health Workers (MACHW) and the American Association of Community Health Workers (AACHW). Her vision has inspired CHWs across the country to better advocate for the needs of the communities they serve. Ms. Hirsch credits Ms. Holderby for contributing to the inclusion of community health workers in Massachusetts' 2006 landmark health care reform legislation.
As Ms. Holderby prepares to assume leadership of the CHW SPIG, the SPIG invites all APHA members to join us in honoring her at the Public Health Awards Reception and Ceremony, scheduled for 6:30 p.m. on Tuesday, October 28th at the San Diego Convention Center. The recognition of Ms. Holderby's unique vision, dedication and leadership serves as an inspiration to CHWs and CHW advocates across the country.
by Maria Lemus
Vision y Compromiso a 501(c)3 organization and its Promotora/Community Health Worker Network are committed to creating and sustaining a statewide, consumer-driven approach to promoting the health of Latina/os by supporting and integrating the work of and Promotoras and Community Health Workers (P/CHW's).
It is because of this reason that we are convening 1000 Promotoras and Community Health Workers from throughout the 10 regions that the Network serves, delegations from other states, and Mexico at the Sixth Annual Hacia Una Vida Digna y Sana Promotora/Community Health Worker Conference. This convening will provide P/CHW's with the opportunity to continue developing their leadership skills, build their capacity as critical resources to the communities that they serve and provide them the opportunity to network and share best practices. This convening will take place December 5-6, 2008 in Los Angeles.
Last year's conference convened nearly 1000 P/CHW's from throughout the state of California, Arizona, Texas, New Jersey, Florida, Massachusetts, New York and Baja California. For many, this was the first time that they had the opportunity to network and share their work with their peers and to take part of the larger community of Promotoras. Through plenaries and workshops, the participants of this conference learned new skills and knowledge that strengthened their capacity to continue serving the tens of thousands of individuals and families throughout the United States, Latin America and beyond.
For more information, call/Para mas información comuníquese con:
Isalia Zumaya (213) 202-5359
by Rebekah Gowler, MSW
The Massachusetts Department of Public Health (MDPH) has made great strides in promoting a sustainable community health worker (CHW) program in the state through its implementation of Section 110 of Chapter 58 of the Acts of 2006 (health care reform). Section 110 requires MDPH to convene a statewide advisory council comprised of 14 named organizations to conduct an investigation of the CHW workforce in Massachusetts and develop recommendations related to CHW training and certification and expanded financing options for CHW positions. The investigation findings and recommendations are being written into a legislative report, which is being submitted to the House and Senate Committees on Ways and Means and the Joint Committee on Health Care Financing.
To date, the MDPH and its advisory council have completed the investigation of the CHW workforce, finalized its recommendations, and are nearing completion of the full legislative report. The investigation included an online survey of CHW employers across the state, an internal survey of MDPH programs that support CHWs, a literature review of CHW research, key informant interviews with CHW leaders and best practice programs from across the country, MDPH-sponsored regional focus groups of CHWs, and supplemental information from regional town meetings on CHW training and certification conducted by the Massachusetts Association of Community Health Workers (MACHW). Recommendations for a sustainable CHW program are made in four areas: 1) a statewide identity campaign for the profession of community health worker; 2) stronger workforce development, including a statewide training infrastructure and certification; 3) expanded financing options through public and private funds; and 4) an administrative infrastructure to ensure implementation of the recommendations.
Section 110 is one of a number of provisions in Massachusetts' landmark health care reform legislations that aim to address racial and ethnic health disparities in the state's health care system. Evidence supporting CHWs' efficacy in reducing health disparities, as well as promoting health reform's goal of increasing access to care for all residents, is central to the MDPH report. In addition to this evidence, the report defines and describes the workforce, presents outcome, effectiveness and cost data from the investigation, details challenges to workforce development, and outlines its recommendations for a sustainable CHW program. MDPH plans to release the report to the legislature in fall of 2008 and will continue to work closely with key stakeholders to support and advance the CHW workforce throughout the health and human service systems in Massachusetts.
by Maria Alvarez deLopez
"I am proud to be a CHW" exclaimed Yvonne Neal, CHW from Grand Rapids, Michigan.
The first Community Health Worker Conference: "Reflections and Strategies for Your Future" was hosted by Spectrum Health Healthier Communities in Grand Rapids Michigan. More than 100 participants attended the conference, most from various cities in Michigan which include; Ann Arbor, Detroit, Bangor, Redford, Lansing, Holland and Muskegon. Others came as far as Chicago and Minnesota.
Sergio Matos CHW from New York presented an awe-inspiring keynote address. Sergio asked members of the audience to help with a skit which illustrated the rich history of Community Health Workers.
Samirz Hernandez, Sonia Rivera Ramos, Jo Carnavale
CHWs were awed when they heard the powerful narratives of the CHW's who came before them.
Roshawnda Thompson, CHW II from Grand Rapids, Michigan read the Proclamation which was signed from George Heartwell, Mayor of Grand Rapids, Michigan. A proclamation is a formal public announcement. Mayor Heartwell, signed the proclamation recognizing CHW's contribution and declaring the 2nd week of June as CHW appreciation. Roshawnda encouraged CHWs to go back to their cities and create a proclamation which would recognize CHWs.
The conference offered an opportunity for participants to understand the roles, responsibilities and unique contributions of CHW's; and also provided a platform for networking and professional development. Conference participants were eagerly asking organizers about details for CHW Conference 2009. A special thanks to Michigan Public Health Training Center and Grand Rapids Community College for supporting the Community Health Worker conference.
by Lisa Renee Holderby and Cindy Marti, MPH
SHREWSBURY , MA – On Wednesday, September 10, 2008, community health workers and their allies took part in the Massachusetts Association of Community Health Workers' (MACHW) Second Annual Meeting. The theme of the meeting focused on the critical role that community health workers play in eliminating health disparities. Governor Deval Patrick issued a proclamation declaring a second Community Health Worker Day in Massachusetts, coinciding with the annual meeting. Governor Patrick acknowledged that community health workers are public health professionals who serve a unique role in improving access to health care and reducing health disparities. Additionally the proclamation urged all Massachusetts residents to acknowledge the work of CHWs and our dedication to the neighborhoods and communities we serve.
The MACHW annual meeting was titled, "Eliminating Health Disparities From Pittsfield to Provincetown." Pittsfield is in the western region of the state and Provincetown is located on the most eastern tip of Cape Cod. It is extremely timely, as the Massachusetts Department of Public Health Community Health Worker Advisory Council has completed a report highlighting the role of CHWs in the effort to eliminate health disparities. The report was mandated in the MA health care reform law passed in 2006 and contains recommendations to sustain the CHW workforce in Massachusetts. MACHW is hopeful the Governor will see the report and its recommendations favorably, in light of his proclamation.
The meeting program consisted of speakers and presenters on the topic. Judith Kurland, Chief of Staff to Boston Mayor Thomas M. Menino, served as the keynote speaker. She reminded participants about the vital role community health workers (CHWs) play in the health care system and in the elimination of health disparities. Ms. Kurland acknowledged that the contributions of CHWs to the public's health often go unrecognized. To gain recognition, efforts must be made to improve documentation of the work of CHWs to prove to funders that CHWs are effective and contain costs. Ms. Kurland is one of the original founders of Healthy Cities/Healthy Communities in the United States. Her career in both government and the not-for-profit sector has sought to promote social and economic justice through community development. She formerly was the Regional Director for the United States Department of Health and Human Services during the second Clinton administration.
Luci Leonard and Octavio Hernandez, a team of community health workers at Community Health Programs in the Berkshires, were the CHW featured speakers. They reiterated the vital role CHWs play in eliminating health disparities and improving the health of communities. The CHW team highlighted some of their outreach strategies including being persistent and consistent with community members, staying up to date on changes in health reform regulations, utilizing technology to maximize efficiency, and collaborating with other agencies to create innovative solutions to help their clients. Ms. Leonard explained that their team approach of pairing an RN with a CHW improves their outreach efforts. In addition to presenting, the CHW team was also acknowledged as recipients of the Community Health Worker Leadership Award.
In addition, other community health worker champions were honored for their tireless efforts to advance the field. Senator Dianne Wilkerson and Representative Byron Rushing each received awards as Legislative Champions for their leadership in promoting the role of community health workers in the elimination of health disparities. Furthermore, a teen empowerment organization based in Lowell, the United Teen Equality Center (UTEC), received the CHW Outstanding Employer award for their outstanding support of community health worker staff by supporting their professional development, developing opportunities for career pathways, and empowering their CHW staff to influence the direction and governance of the organization. Finally, Suzanne Baroni, of Signature Health-Brockton Hospital, received the CHW Supervisor Award for her supportive commitment as a supervisor to CHWs by understanding the role and importance of her CHW staff, working to integrate CHWs into the health delivery team, and being supportive of her CHWs accessing trainings and classes that enhance their work.
When asked about the significance of the day, Lisa Renee Holderby, Executive Director of MACHW, said, "This has been an amazing day. Community health workers from all corners of the Commonwealth came together to share experiences, resources and be acknowledged for their unique role in promoting health equity. We look forward to the continued integration of CHWs in efforts to eliminate health disparities across the Commonwealth. Congratulations to the award recipients who have made such strong contributions in this area of public health."
by Susan Mayfield-Johnson
Community health workers from 28 states, the District of Columbia, and seven Native American Nations/Tribes attended The Center for Sustainable Health Outreach's annual Unity Conference June 16-19, 2008 at the Hotel Albuquerque at Old Town in Albuquerque, New Mexico. The conference attracted more than 225 participants, the majority of whom were Community Health Workers (CHWs).
The Unity 2008 Conference theme, "Community Health Workers: The Winds of Change—From Grass Roots to Ground Breaking Public Health Professionals" noted the necessity of a professionally recognized and respected field for community health workers, especially as they strive to meet the demands of a changing health care system, decreased funding, and increasingly diverse populations.
On the first day, Unity 2008 opened with a breathtaking cultural prayer and dance performed by Jackie Bird and her two sons, Gordon and Sheldon, of the Dakota-Hidatsa Tribe of Sioux Falls, South Dakota. Co-Directors, Jackie Scott and Susan Mayfield-Johnson, then welcomed participants to Unity 2008 and emphasized that Community Health Workers must realize that there is power in unity. In her opening welcome greeting, Jackie Scott discussed how we could learn some important lessons from geese (excerpted from Angeles Arrien).
Fact 1 – As each goose flaps its wings, it creates "uplift" for the birds that follow. By flying in a "V" formation, the whole flock adds 71% greater flying range than if each bird flew alone.
Lesson: People who share a common direction and a sense of community can get where they are going quicker and easier if they are traveling on the thrust of one another.
Fact 2 – When a goose falls out of formation, it suddenly feels the drag and resistance of flying alone. It quickly moves to the back of the formation to take advantage of the lifting power of the bird immediately in front of it.
Lesson: If we have as much sense as a goose, we stay in formation with those headed where we want to go. We are willing to accept their help and give our help to others.
Fact 3 – When the lead goose is tired, it rotates back into the formation, and another goose flies to the point position.
Lesson: It pays to take turns doing the hard tasks and sharing leadership. As with geese, people are interdependent on each others' skills, capabilities, and unique arrangements of gifts, talents, and resources.
Fact 4 – The geese flying in formation honk to encourage those up front to keep their speed.
Lesson: We need to make sure our honking is encouraging. In groups where there is encouragement, the production is much greater. The power of encouragement (to stand by one's own heart or core values and encourage the heart and core of others) is the quality of honking we seek.
Fact 5 – When a goose gets sick, wounded, or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it dies or is able to fly again. Then they launch out with another formation or catch up to the flock.
Lesson: If we have as much sense as geese, we will stand by each other in difficult times as well as when we are strong.
The first plenary session highlighted at least ten different local, state, and national Community Health Worker networks and coalitions. The American Association of Community Health Workers then shared their progress, including the formal and official adoption of the mission, vision, bylaws, and code of ethics. The final plenary session had Community Health Workers and supporters engaging in a lively discussion around CHW credentialing and legislation.
Day Two consisted of several skill-building and breakout workshops. The Centers for Disease Control and Prevention offered an 8-hour intensive skill-building workshop on Using a Training-of-Trainers Model to Prepare Community Health Workers/Promoters to Use the Road to Health Toolkit on Primary Prevention of Type II Diabetes. Participants received preliminary copies of the toolkit to take back to their communities. Also offered was a 6-hour intensive Krav Maga self-defense workshop. Krav Maga (Hebrew for "contact combat") has been recognized as the most efficient self-defense system for real-life situations, emphasizing practical defenses against real attacks. Based on simple principles and instinctive movements, this reality-based system is designed to teach real self-defense in the shortest possible time. Participants learned to defend against common chokes and grabs from all angles, punches and kicks, and weapons such as guns, knives, and sticks. Also emphasized is how to function under the stress, shock and adrenaline rush of a sudden, violent encounter.
Breakout sessions on advocacy and training were presented, and skill-building sessions on understanding PowerPoint, how people realistically change, and incorporating health messages through song and dance were also offered. Poster presentations were tendered, followed by two introductory dance sessions, Latin Dance and Samoan Dance.
The evening reception was set outside in the courtyard, against the backdrop of the setting sun on the Sandia Mountains. After Milta Franco was honored with the Esther M. Holderby Dedicated CHW Award, dancing and karaoke broke out under the evening stars.
The final day of Unity 2008 consisted of several skill-building sessions. All day intensive sessions on Using a Training-of-Trainers Model to Prepare Community Health Workers/Promoters to Use the Road to Health Toolkit on Primary Prevention of Type II Diabetes and Krav Maga were repeated, and four ½ day skill building sessions, the Power of Learning: Gain the Skills to Really Go Red, Incorporating Basic Sign Language Vocabulary for Your Clients, Basic Tobacco Cessation Intervention Certification, Presentation and Facilitation Skills, and Creating A Code of Ethics for CHWs: Policy and Practice were offered.
Conference evaluations noted excellent speakers and sessions. Conference participants appreciated the change of location to the western side of the United States, and many reflected on the diversity of the conference participants. While many did not feel that there were enough out-of-conference activities, several conference participants snuck in hot air balloon rides and sessions of white water rafting in nearby Taos to end their New Mexican Unity experience. Announcements for Unity 2009 are forthcoming. Look for the Mark Your Calendar Postcards and Call for Abstracts as we celebrate Unity's 10th Year Anniversary.
by J. Nell Brownstein, Ph.D.
Good news: a new resource will be soon be available to you on CDC's website: http://www.cdc.gov/dhdsp. In the United States, community health workers (CHWs) help us meet our national Healthy People goals by conducting community-level activities and interventions that promote health and prevent diseases and disability. CHWs are trusted, respected members of the community who serve as a bridge between their community members and professionals in the field of health and human services. They provide an important service by establishing and improving relationships between these professionals and members of the community. As lay community health educators and role models, CHWs promote, encourage, and support positive, healthful self-management behaviors among their peers. As community advocates, CHWs help people get the services and follow-up care they need. CHWs serve as patient and community advocates, as "coaches" for disease management, and as patient "navigators," guiding patients through the health care system. They also strengthen their community's understanding and acceptance of medical care. The recognition of their successes, by the Institute of Medicine and others, has led to recommendations that CHWs be included as members of health care teams to help eliminate racial and ethnic disparities in health care.
"The Community Health Workers Sourcebook: a Training Manual for Heart Disease and Stroke Prevention" is the first comprehensive cardiovascular training curriculum for community health workers (CHWs) and other lay people. The sourcebook offers basic information and activities to increase CHW skills in preventing heart disease and stroke. The sourcebook covers topics across the spectrum of heart disease and stroke that are essential for the education and promotion of disease self-management for community members.
The sourcebook is a resource that builds on strong partnerships between the National Center for Chronic Disease Prevention and Promotion at the Centers for Disease Control and Prevention (CDC) and other agencies and organizations. The sourcebook reflects the latest research and national guidelines on heart disease and stroke and their prevention.
This resource will be helpful to you in many ways, including training staff at your agency and in partnership with other agencies and organizations. We hope that your will introduce the Sourcebook to your partners. We thank you for your interest in this new resource and we welcome feedback on your experiences in putting it to use.
We have a very limited number of hard copies of the sourcebook, but we plan to make English language version available on CDC's Heart Disease and Stroke Prevention Health Web site in the near future. We are in the process of translating the Sourcebook into Spanish and pilot-testing it. Then we will place the Spanish version on our website.
Please send your comments and questions on this sourcebook to:
J. Nell Brownstein, Ph.D.
Division for Heart Disease and Stroke Prevention
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
770 488-2570
Dr. Brownstein's e-mail address is email@example.com. Visit our Web site at www.cdc.gov/dhdsp.
Across the country, at all levels (statewide, locally and nationally), CHWs are organizing professional associations or networks. CHW associations advocate for CHWs and the communities they serve. They give CHWs a means of gaining additional skills, accessing support and recognition, and sharing resources and strategies with peers.
This regular newsletter feature highlights the ongoing organizing efforts of CHWs across the country. We urge CHWs to contact their local networks and get involved! If there is no network in your area, think about starting one. Contact the network nearest you for information and strategies about organizing.
We recognize the enormous energy and commitment of CHWs as they organize.
We also know that this is only a partial list of CHW associations. If you know of others, please let us know! Contact Newsletter Editor Gail Hirsch at: firstname.lastname@example.com or (617) 624-6016.
State and National CHW Associations and Networks
For more information or to join, please contact Co-Chairs Durrell Fox and
Pam Chapman (firstname.lastname@example.com or email@example.com )
Staff contacts at the Harrison Institute for Public Law at the Georgetown
University Law Center are Jackie Scott, (202) 662-4229,
email@example.com or Sara Hoverter, (202) 662-4233,
firstname.lastname@example.com .
Wandy Hernandez, Chair, Chicago Health Connection, 957 W. Washington
Boulevard, Chicago, IL 60607; (312) 243-4772; Zeida Estrada, Secretary;
Gateway to Care, Harris County CAP 6201 Bonhomme #243-S, Houston, TX
77036, (713) 783-4616;
Arizona Community Health Outreach Workers Network (AzCHOW), Of, By, and
For Community Health Outreach Workers;
http://www.publichealth.arizona.edu/azchow/; Lourdes Fernandez, Co-Chair
firstname.lastname@example.com ; Flor Redondo, Co-Chair, email@example.com ; Belen
Feather, Secretary.
The Community Health Worker/Promotoras Network, Maria Lemus, Executive
Director, Vision Y Compromiso, 2536 Edwards Ave., El Cerrito, CA 94530;
(510) 232-7869; (510) 231-9954 fax; e-mail: email@example.com , or
Maria at: email@example.com
Orange County CAA (Certified Application Assistor) Task Force, a
non-profit professional association for Care Coordinators, Health
Advocates, Promotoras etc. They meet once a month for program updates,
training and to share best practices as well as to network. Contact:
Maria Wahab, Chair, Children's Hospital of Orange County, 455 S. Main St.,
Orange, CA, 92868-3874; Office: (714) 516-4334; Fax: (714) 532-8785;
E-mail: firstname.lastname@example.com .
REACH-Workers – the Community Health Workers of Tampa Bay. Please contact
Michelle Dublin, Chairperson of the network, at (727) 588-4018 or
Community Outreach Workers Association of Maryland, INC. (COWAM), 259
North Lanvale Street, Baltimore, Md. 21217, (410) 664-6949 or (410)
669-7960, Carol Payne, (410) 962-2520 (ext. 3062).
Massachusetts Association of Community Health Workers (MACHW), Lisa Renee
Holderby, Executive Director, email@example.com, (617)524-6696 x102.
Michigan Community Advocate Association (MICAA), Contact: Maria Alvarez
deLopez, email@example.com ; President-Roshawnda S.
Thompson - firstname.lastname@example.com ; (616) 356-6205 or (616) 827-2094 or (616)
Minnesota CHW Peer Network out of the Minnesota International Health
Volunteers, 122 W. Franklin Ave. #522, Minneapolis, MN 55404, Contacts:
LuAnn Werner (612) 230-3255 email@example.com, Andrea Leinberger (612)
230-3254 firstname.lastname@example.com . Chair - Grace Anderson,
email@example.com ; Co-Chair -- Anita Buel -
Community Health Worker Institute, NJ AHEC/ UMDNJ-SOM, 42 Laurel Road E., STE. 3200 Stratford, NJ 08084. Contact: Carol Wolff, (856) 963-2432 ext. 202. The New Jersey Community Health Worker Institute is NOT considered a Network or an Association but, it supports and sponsors the NJ CHW Clusters that are now meeting to discuss the strategy for building into a statewide network or association. NJCHWI provide the clusters technical assistants, resources such as coordinating meeting locations, materials and social items and events and trainings for the CHWs.
New Mexico Community Health Workers Association (NMCHWA), P.O. Box 81433,
Albuquerque, New Mexico 87198, firstname.lastname@example.com. Web page can be accessed
at www.nmchwa.com . Telephone number is (505) 255-1227 and fax (505)
873-5317; or contact BJ Ciesielski, firstname.lastname@example.com , (505)
272-4741; fax (505) 272-5944.
NEW YORK CITY -Community Health Worker Network of NYC; 425 E. 25 Street,
Box 616; New York, NY 10010; (212) 304-6415; Sergio Matos, Romy
Corvacho; http://chwnetwork.org/ ; email@example.com .
ROCHESTER - Rochester Outreach Workers Association (ROWA), Latisha
Williams, Chair, 585-274-8490; email@example.com ; Lucinda
Colindres, (585) 244-9000, ex. 454.
Ohio Community Health Workers Association, Vivian Anderson, President, (616) 466-2247, email@example.com
Oregon Community Health Workers Association, 9000 N. Lombard Street--2nd
Floor, Portland, OR 97203, 503-988-3366 x28686, Teresa Ríos,
firstname.lastname@example.com, or Veronica Lopez Ericksen,
firstname.lastname@example.com, or Noelia Wiggins, Director Community
Capacitation Center - (503) 988-3366.
Washington Community Health Worker Network
Lilia Gomez - (360) 786-9722 (ext 230) - firstname.lastname@example.com
Seth Doyle - (206) 783-3004 (ext 16) - firstname.lastname@example.com
For those of you who are not members of the CHW Special Primary Interest Group or APHA itself, please consider joining us! If you are a member of APHA, the SPIG also welcomes you to join us as a primary member.
If you are unable to select CHW SPIG as your primary affiliation in APHA, please consider electing the CHW SPIG as a secondary section, and you will receive our CHW newsletter!
For those of you who are not yet members of APHA, there are many options for membership.
· A Special Community Health Worker subsidized membership ($65 annually for those whose income is under $30,000 annually).
· A consumer subsidized membership ($65 annually for those who do not derive income from health related activities).
· A Student/Trainee subsidized membership ($50 annually for those enrolled in a college or university or occupied in a formal training program).
· Regular membership is $160 annually.
Memberships include all benefits such as the American Journal of Public Health and The Nation's Health. For details on how to become a member of APHA and how to designate the CHW SPIG as your Section/SPIG, please call (202) 777-APHA. You can also check out APHA's Web site at
http://www.apha.org or e-mail firstname.lastname@example.com.
In the event you cannot become an official member of APHA, we still need your wisdom, support, knowledge and power. Please feel free to contact any of the officers listed in this newsletter about the CHW SPIG and how you can be involved.
Sergio Matos
Community Health Worker Network of NYC
(212) 304-6415
Chair-Elect/Governing Council Representative
Lisa Renee Holderby
Massachusetts Association of Community Health Workers
(617) 524-6696 x102
Immediate Past Chair/Governing Council Representative
Durrell Fox
New England HIV Education Consortium
23 Miner Street
Boston, MA 02215
(617) 262-5657
Carl Rush
(210) 745-0560
Treasurer and Co-Program Planner
Susan Mayfield-Johnson
University of Southern Mississippi
(601) 266-6266
Program Planner 2008
Anne Willaert
Minnesota State University
4 Myers Field House
Mankato, MN 56001
(507) 389-2590
Policy Committee Chair
Maria Alvarez deLopez, CHW
MOMS - Mothers Offering Mothers Support
Spectrum Health Hospital
75 Sheldon SE, Suite 203
Grand Rapids, Mi. 49503
Phone: (616) 391-6052
Chairperson, Committee on Education y Capacitación
Romelia Corvacho
Community Premier Plus
384 E. 149th Street Suite 504
Bronx, NY 10455
(718) 630-3201
Liaison to Other APHA Sections, SPIGs and Caucuses
Tori Booker
Migrant Health Promotion
224 W. Michigan Ave.
Saline, MI 48176
(734) 944-0244
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Nell Brownstein
Centers for Disease Control and Prevention (CDC)
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(770) 488-2570
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Gail Hirsch
Massachusetts Department of Public Health
Boston, MA 02108
Phone: (617) 624-6016
Membership and Recruitment
Dwyan Monroe
Special Advisor
E. Lee Rosenthal
(915) 747-8233
Privacy Policy | Site Map | A-Z Health Topics | Social Media | E-Mail-A-Friend | Careers
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"We learn when we squirm."
That's a saying Kim McCully-Mobley has been dishing out to her students, interns and friends for well over 30 years. And, she's been squirming herself for 50 years.
"In fact, I was born squirming!" She laughs.
"Some of the best things in life happen to us when we get outside our comfort zones. Too often, we bail on things that cause us much consternation or discomfort. I learned some valuable life lessons by pushing past those moments to see what was on the other side. I encourage my students to do the same. Once they trust me, I watch them grow," she stated.
Self-described as a cowgirl/gypsy/historian/storyteller, McCully-Mobley has been an employee of Drury University since the spring of 1992. She spent the first 11 years running the Aurora Satellite campus (which closed in 2003) and serving as an adjunct faculty member in the English and communications departments. She began teaching online courses about 11 years ago and has worked as an online mentor, teaching blended and seated courses on campus, in Lebanon and Monett.
"I believe in the Drury Difference. Drury has been like a second home to me through the years. I love the people who work here, the students and the value system that seems to be in place here. Everyone matters. Every idea is important," she explained.
McCully-Mobley holds an associate's degree in journalism from Missouri Southern State University in Joplin, where she worked on the award-winning newspaper: The Chart. She holds a bachelor's degree in English from Drury University and a master's from Drury in education/human services. She is currently working on additional graduate work in literacy and special reading.
She also piloted a dual credit program at the high school level this past year whereby students were exposed to an online component as part of the course. She has presented her research and findings on digital storytelling, technology in the classroom and social media at conferences for Morenet, Missouri Distance Learning and Write to Learn.
She has a 30+ year career in journalism, having served as a newspaper editor in Monett and Aurora for over 20 years. She has earned international, national, state and regional awards for her writing and has covered tragedies, murder trials, Presidential visits, big turnips, white squirrels and Pulitzer Prize winners. She served as president of the Southwest Missouri Society of Professional Journalists, the Aurora Rotary Club, the Ozark Press Association and the Aurora Education Association.
A longtime member of the International Society of Weekly Newspaper Editors and the Aurora Chamber of Commerce, she is currently the president of Main Street Aurora and has been a 20-year board of director member. In 2004, she earned distinctions as the Loyd R. Ellis Community Service Award winner from the Aurora Chamber of Commerce. She was also named the 2007 Teacher of the Year at Aurora High School through the local education association.
Her passions include her faith, her family and friends, community service, literacy, Ozark folklore, storytelling, photography and writing. She has been a part of the Ozark Writing Project/Digital Storytelling Institute at Southwest Missouri State University and has participated in work at the Ozark Writers' Colony in Eureka Springs in 2010 and 2011. She has already booked her stay for 2012 and plans to help the colony with fundraising and publicity efforts. She makes her home on a small farm in Barry County with her husband, Al, of seven years, and her 21-year-old son, Jake, who is a senior at Drury.
McCully-Mobley has taught in the communication arts department at Aurora High School for the past seven years. She is also the yearbook advisor and the co-sponsor for Student Council. A 1979 graduate of AHS, she is an outspoken Houn' Dawg who takes the time to make sure students know the town's history and the colorful history of its mascot.
She heads a family publishing business known in the area as Spirit Publishing. The company is devoted to promoting the region's history, culture and stories through a variety of methods. She is currently tying up loose ends on a memoir/coffee table book called: The Road Home: A Seasonal Journey. She will also be traveling to Southern Illinois University in July as part of a Civil War research grant funded through the National Endowment for the Arts and Humanities.
"We can only know where we're going when we know where we've been," she stated.
Steven Bryant has over 35 years of experience in management, including 28 as the CEO of a not-for-profit corporation, with a wholly-owned, for-profit subsidiary, and a stint as a U.S. Air Force officer during the Vietnam conflict. He served as Executive Director and CEO of the National Board for Respiratory Care (NBRC) from 1974-2002. The NBRC is the occupational certification and licensure agency for respiratory therapists and pulmonary function technologists in the United States. Mr. Bryant was the organization's first full-time staff member and during his time with the company the numbers of credentials awarded grew from about 2,400 to more than 250,000 and all 48 of the states that regulate the practice of respiratory care contracted with the NBRC for use of its examinations for licensure. They also encouraged the international growth of respiratory care by working with the Consejo Mexicano de Inhaloterapia, AC to conduct job analysis research and develop examinations now offered for credentialing in more than 10 countries by the Latin American Board for Professional Certification in Respiratory Care.
In 1982, a subsidiary corporation was formed, Applied Measurement Professionals, Inc. (AMP) to vertically integrate the NBRC's test development and administration functions and gain independence from Educational Testing Service (ETS), author of the College Board exams. Mr. Bryant was AMP's first President and CEO (1982-2002). The company has grown from only doing work for the NBRC to developing and administering examinations for over 100 other occupations, including real estate salespersons and brokers in 12 states. In addition, AMP has a Management Services Division responsible for association management for 17 national organizations, as well as a technology division, known as Logic eXtension Resources (LXR), developers of test software which has over 30,000 users worldwide. AMP now has a staff of 168 and a national network of more than 200 computerized assessment centers offering examinations six days a week to about 500,000 candidates annually. The consolidated NBRC/AMP entity has gone from an annual budget of $125,000 during my first year in 1974 to over $30 million today.
Part of AMP's profitable growth was fueled by acquisitions that he accomplished, purchasing and merging a defunct printing company into our operation in 1987, purchasing the real estate testing program from American College Testing (ACT) in 1991 and acquiring computerized testing capability through acquisition of LXR in 1996. In 1996, the company developed a four-year plan to convert AMP from pencil/paper testing to computerized testing, highlighted by negotiation of an agreement with H & R Block, the world's largest tax preparer, to install and operate a national network of computerized AMP Assessment Centers within Block offices across the United States. The network opened in 2000 and has now successfully given over 2,000,000 examinations. For more about the capabilities of the two organizations where Mr. Bryant spent most of his professional career, visit their websites www.nbrc.org and www.goAMP.com.
Educationally, Steven Bryant's undergraduate degree is in Business Administration, with a major in Industrial Management, from the University of Arkansas at Fayetteville (1971). He completed the MBA program at Rockhurst University in Kansas City in 1982, including the "Executive Semester" program. Mr. Bryant graduated with honors from both schools and maintained a 4.0 grade point average during his MBA studies, which he completed at nights and on weekends while working full time.
Steve Bryant has been "semi-retired" since 2002 (at age 52), and has continued to work part-time for the NBRC and AMP, writing most of their marketing materials, annual report, newsletters and assisting his successor as CEO. Steven Bryant and his wife Jill have three children; Jackie, 30, Ross and Claire, twins who are 19, three dogs, two cats and two horses. He enjoys boating at Table Rock Lake, old cars, especially of the 60's muscle car variety and playing with his grandson, Jacob, who is now six. Jacob loves model trains and calls himself a "train driving man", so they spend a lot of time in the basement "playing trains."
David Ulbrich teaches History at the CCPS campus in St. Robert. Mr. Ulbrich is a historian at the U.S. Army Engineer School at Ft. Leonard Wood. He received the 2003-2004 General Lemuel Sheppard Dissertation Fellowship from the Marine Corps Heritage Foundation. Mr. Ulbrich earned his doctorate in history from Temple University.
In April 2011 he published his first book: David J. Ulbrich, Preparing for Victory: Thomas Holcomb and the Making of the Modern Marine Corps, 1936-1943.Annapolis, Maryland: Naval Institute Press, 2011.

subset: commoncrawl


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Need a better – or different – place to work? Check out the newest coworking space at NASA Johnson Space Center.
Coworking spaces are shared working environments that encourage collaboration. They focus not only on the physical space, but also about the development of a dynamic, interactive community. You can find other creative spaces at JSC here.
"Coworking hinges on the belief that innovation and inspiration come from cross pollination of different people in different fields or specializations. Random opportunities and discoveries that arise from interactions with others – also dubbed 'accelerated serendipity' – play a large role in coworking." (Working in the UnOffice, Night Owls Press)
1958 is a unique workscape experiment at the Johnson Space Center. Located in B35 adjacent to JSC's Acceleration Center, it was inspired by Chicago's 1871 co-working center for digital startups. 1958 provides multi-purpose, reconfigurable rooms to support conversations, quiet work, team meetings, small retreats, and free flowing ideas.
As part of the Agency's Open Government Plan, NASA is committed to standing up more collaborative environments in physical spaces across the agency. The 1958 space helps meet this goal and fosters a culture of collaboration at Johnson Space Center. The space demonstrates how physical assets can enable communities to engage with each other in the ways they prefer, while experimenting with new tools and techniques not normally provided by the traditional NASA workplace. Providing innovative spaces at and across centers offers alternative workspace for personnel, creative collaboration options for distributed teams, and actual equipment for modern techniques such as fast prototyping of hardware.
Envisioned by Center Operations as part of the Creative Spaces project, and part of the Acceleration Center, 1958 gives the Johnson Space Center a forum for that "accelerated serendipity" the NASA is so well-known for.
One Giant Leap
The largest space in 1958, this enormous room is subdivided into smaller nooks and team "pods" complete with rolling white boards as well as an area for classes or larger meetings.
Store House
The Storehouse includes a free use printer and copier as well as general use supplies. The library is also located in this room, ideal for pulling up a beanbag and checking out some books.
Chromatic Room
The bright and colorful Chromatic Room includes 2 standing desks and supports 6 to 8 person meetings.
Ernest Tubb Room
The Ernest Tubb Room is designed for teleconferences, features Polycom capability and seats 3.
Maker Room
The "hackerspace" of 1958, the Maker Room is the place to take things apart or figure out how to put them together. The 3D printer and other tools are located here.
Self serve and self cleanup. Food and drink often fuels collaboration!
White Room
This space and the white room inside with expansive writable surfaces is ideal for small retreats or extended meetings. It includes 2 standing desks as well as a number of other clusters for small groups to work.
Cube Garden
The Cube Garden is filled with free cubicles for when you need a little solitude or heads-down space to focus.
Be friendly. Since there is no receptionist, it's up to you to welcome new guests.
Be responsible. Clean up after yourself. If you use a whiteboard, wipe it down before you leave. If you pulled out a chair, put it back. If you created a mess, clean it up.
Be open-minded. Learn from the fellow coworkers. Networking, idea sharing, socializing, cross pollinating, group problem solving, and partnering are all encouraged!
Be independent, or collaborative. If you are working independently, use headphones, and respect other's right to collaborate. If you are working in a group, respect others right to work independently. If someone is wearing headphones, do not disturb them.
Be understanding. Remember that your coworkers are people first, and coworkers second. They all have their own pressures, challenges and goals.
Be part of the solution. Could something here be improved? Contribute to making this a great space to work. Consider donating something!
Pass it forward. Once you get the hang of something (the coffee, 3D printer, etc.), help someone else learn what you know.
Take a break! We all tend to get hyperfocused on our work sometimes and forget to stop to take a break. Use the opportunity to meet someone new.
Ask: If you have a question, please ask for help. Please keep in mind that this is actually the working office space of a team at NASA. Contact Leah Galindo, Nicholas Skytland, Chris Gerty or Ali Llewellyn and we'll do our best to help however we can.
Who can use 1958?
1958 is a co-working space available free to use for any NASA employee or contractor.
Is 1958 open to the public?
1958 is located onsite at NASA Johnson Space Center and requires that you be badged to access the facility.
Is there wifi and how do I connect?
Yes, the 1958 network has the standard "nasa" and "nasa-guest" networks and you connect as you would on any other facility on site. If you are a guest badged for day access, you will have to contact your NASA POC and ask them to request access to the "nasa-guest" network.
Is there any association with the Houston Technology Center?
The Houston Technology Center has a satellite office at NASA Johnson Space Center, located in Building 35 on the second floor (above the 1958 space). 1958 is open to all members and guests of HTC – in fact we encourage everyone to use it and hope that the close proximity to HTC will catalyze even more innovation at NASA.
Do you have a project and screen we can use for our meeting?
We do have a portable project (contact Leah Galindo to use it) but do not have a screen at this moment – but it's almost better to simply project on the wall.
Do you have an audio system to support my talk?
Yes, we have a Bose microphone and speaker system that we can make available upon request.
Do you have a laptop or computer that I can use?
No. TBD answer.
Can I re-arrange the furniture?
Yes, the 1958 space is completely reconfigurable and all furntire is portable. However, we ask that you let us know in advance if you plan on a major reconfiguration and you are required and responsible for putting the space back as you found (if not better).
Stop in and say hello!
The 1958 Co-working space is location in building 35 at NASA Johnson Space Center.
Are you interested in reserving the 1958 co-working space for a meeting or an event? If so, please email Leah Galindo (email@example.com) or Eric Elizondo (email@example.com) regarding your request.
Please note that 1958 is a co-working space open to all employees at NASA Johnson Space Center and although we do allow reservations, we do not allow you to close the space off from others. There may be others who are sharing the room with you.
If you require a private space for a closed meeting, please request room 235 and 237 in Building 29 across the street are available.
If you have questions please contact us using the form below. You can also contact Leah Galindo, Nicholas Skytland, Chris Gerty or Ali Llewellyn and we'll do our best to respond as soon as we can.


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Guide to the diagnosis, treatment and prevention of conditions from A to Z.
Consider the following statistics related to breast cancer:
Excluding cancers of the skin, breast cancer is the most frequently diagnosed cancer in women.
The American Cancer Society (ACS) estimates for 2013 that about 232,340 new cases of invasive breast cancer are being diagnosed in women in the U.S. In addition, during 2013, 64,640 new cases of carcinoma in situ (cancer that has not spread beyond the original site) will be diagnosed, primarily (about 85%) ductal carcinoma in situ.
In 2013, it is estimated that 2,240 men will be diagnosed with breast cancer.
Year 2013 estimates include 40,030 deaths occurring from breast cancer in the U.S. alone. This includes approximately 39,620 women and 410 men.
According to ACS, the breast cancer death rate in women age 50 and older in the U.S. has been falling by about 2% per year, since 1990.
Breast cancer ranks second among cancer deaths in women after lung cancer.
"As a two-time breast cancer survivor, the Director of the Breast Center...
"Director of the Breast Center tells her story of her diagnosis and her...
"One woman visited Hopkins in desperation after her breast cancer...
Find a Doctor at Another Johns Hopkins Medicine Member:
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Fish Rite Boats River Jet 20 Outboard - Multi-Species Fishing Boat
2014 Fish Rite Boats River Jet 20 Outboard Description
River Jet 20 Outboard
With its low sides, center console and vee hull, the River Jet was built for fishing the upper Sacramento River, where the salmon, stripers, steelhead and sturgeon run. The River Jet has become so popular that guides all over the U.S. are using it for all types of fishing.
With all of the comfort, convenience and durability features that Fish-Rite has become renowned for, the River Jet is bound to please the guides and their clients as well as the serious and casual angler. Feel confident and secure in reaching the most remote parts of the river or lake with power you can feel.
Fish-Rite has redesigned the River Jet with an all welded aluminum hull, built tough to last a lifetime. Professional guides prefer this Fish-Rite boat over all others because of the endless options and attention to quality and detail. The River Jet has a built-in fish box in the bow that will accommodate your day's catch. The River Jet is available as an inboard or outboard and in prop or jet models.
2014 Fish Rite Boats River Jet 20 Outboard Specifications
- Length Over All: 20 Feet
- Beam: 8 Feet
- Max Load: 1750
- Dry Weight: 1200
2014 Fish Rite Boats River Jet 20 Outboard Standard Features
Be the first to write a review for this boat!


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Everybody is always searching for The One. As a toddler, you look for your favorite pacifier; as a child it is your favorite toy. You look for The One in adolescence as you fall in and out of puppy love. Now you are an adult and still you want The One, the only - the best damn exhaust system out there for your car.
Turbo aims to help you in this department by tracking down twelve (count 'em buddy) exhaust systems for the very popular Subaru WRX. All WRX aftermarket exhaust manufacturers were invited to participate in this shootout and the dozen you see below obliged.
They witnessed firsthand their products being put to the test under controlled conditions to see which one would claim top honors; the summa cum laude of exhaust.
As with our last exhaust shootout (September 2002), we've compiled for you several different attributes of each exhaust system: price tag, weight, size, horsepower, torque and sound.
This time we added a few other variables to the mix, including highest horsepower and torque gain at any given rpm and piping diameter. Depending upon which characteristic you value most, you can decide for yourself which system is going to be The One for your ride. Some like 'em loud, some are horsepower whores, others like the biggest pipe (compensation issues? I wonder) and some are on a budget.
Four pizzas, eleven hours straight of dynoing, and twelve exhaust systems later, what you see below are the vital stats we came up with. The search is now over...and The One waits to be crowned.


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Powerful music production, now with downloadable updates, 50 new features, and 1GB of new samples.
Native Instruments MASCHINE Groove Production Studio
Create tight rhythms, harmonies, and melodies in moments with MASCHINE - the highly enjoyable instrument that combines a pattern-based sequencer, professional sampler, multi-effect unit, and VST/AU plug-in host. Everything is intuitively controllable via the fully integrated hardware - once you touch the tactile controller the fun and intuitive workflow takes over, allowing you to stay focused on what matters - the music.MASCHINE is constantly evolving; the latest 1.8 free update makes it possible to do offline time stretching and pitch shifting, host transport control, pre-listen to samples from hardware browser, and muc more. There are even new effects like Transient Master and Tape/Tube Saturators all for a free update.Studio PowerhouseMASCHINE integrates easily into your computer-based studio setup. Use the hardware controller to find, load, and play sounds, automate parameters, and arrange patterns on the fly. Combine this with the ability to control and sequence all of your external hardware instruments, or switch to MIDI mode to control other software.After quickly and intuitively developing your ideas, drag and drop your patterns as MIDI or audio files directly into your DAW to finalize and mix your production. You'll soon realize MASCHINE is a powerhouse capable of revolutionizing the way you make music.Creative Performance ToolMASCHINE is fast becoming the ultimate performance tool for creative musicians. The MASCHINE controller is super-sturdy, yet easily portable. The highly responsive pads and endless rotary knobs are addictively playable, while the two backlit displays keep you informed of what's going on - perfect for any club or stage.Use MASCHINE as an instrument for performing your own tracks, or sync it with other gear like TRAKTOR PRO 2 (sold separately) to add more dynamics to your live set.Supreme Sounds ModeMASCHINE comes with over 6GB of ready-to-use, professional and inspiring sounds. Create rhythms and melodies right away with the included drum kits, one-shot samples, basses, synths, and acoustic instruments - all fully tagged for easy browsing.MASCHINE now also includes KOMPLETE ELEMENTS (worth $59 / 49 €), providing more than 1,000 stunning sounds drawn from the flagship KOMPLETE 7, opening a world of styles and flavors ready for use in your productions. And now, you can add extra fuel to your MASCHINE with the new range of MASCHINE EXPANSIONS - premium sample kits created by renowned sound designers and artists.What's New in MASCHINE 1.6Plug-In HostingUse any Native Instruments or 3rd-party VST or Audio Units plug-ins directly inside MASCHINE. You can even hook up combinations: e.g. load MASSIVE (sold separately) to Slot 1 and GUITAR RIG (sold separately) to Slot 2 – and tweak them both from the hardware controller - the parameters are automatically mapped to the knobs on the MASCHINE hardware.KOMPLETE ELEMENTS IncludedTo get you started using plug-ins inside MASCHINE a free copy of KOMPLETE ELEMENTS is included with this update. KOMPLETE ELEMENTS comprises over 1,000 stunning sounds drawn from the flagship KOMPLETE software bundle, including KONTAKT's vintage ABBEY ROAD drum kit and Vienna Symphonic orchestral instruments, six REAKTOR synthesizers and 35 GUITAR RIG amps and effects.Workflow EnhancementsIn addition to plug-in hosting, many other new improvements have been made. These include pad-link, swing per sound, internal drag-and-drop of audio, renaming of clips, duplication improvements, and 16 stereo outputs.Pad-LinkAny pads in the same link group can trigger each other – play multiple sounds such as two snares and a clap by hitting just one pad. Select one or more pads to be the master, and others in the group to follow as the slaves - perfect for musicians using MASCHINE in a live context.Swing Per SoundSwing allows for rhythmic shifting of a pattern, creating a shuffled, live feel. Swing can now also be applied to individual sounds in MASCHINE 1.6, rather than just at the Group or Master level.Module SlotsThe architecture of MASCHINE's module slots have been modified to allow great freedom and flexibility, with instrument and effect plug-ins now selectable in the first module position - select either Sampler, Input, MIDI Out or Plug-ins for the first module slot and use the remaining slots to host any combination of effects, external or internal.Enhanced Drag-and-DropNow you can drag-and-drop single or multiple files into MASCHINE directly from your operating system, and build up your own customized library of samples. Plus it's now easy to move audio within MASCHINE from one location to another - great for converting a Group to audio to free up resources in MASCHINE.
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is PAN's Organizing and Media Director. Follow @PaulAtPan
Last Friday, three global pesticide corporations threw the legal equivalent of the kitchen sink at the island of Kaua'i. The suit filed in federal court is the latest in a long stream of corporate bullying that has become commonplace on the island and around the world.
For years, the Hawaiian islands have been a global epicenter of testing genetically engineered (GE) seeds. This means big money for pesticide and biotech corporations. And as momentum grows to restrict GE testing and pesticide use thoughout the islands, corporate bully tactics are becoming increasingly agressive. And desperate.
Like many, I was lucky enough to spend the holidays surrounded by family and food. So I was especially unnerved by new evidence, released just before the holidays, that bee-harming pesticides have been linked to impaired brain development and function in children.
The science showing that neonicotinoid pesticides (or neonics) harm bees is clear. New evidence highlighting impacts on children's health is also disturbing, especially as a father. And while other countries are stepping up to protect bees and kids from neonics, policymakers here in the U.S. are still seemingly stuck. My New Year's resolution: This year we keep high heat on EPA and insist regulators take meaningful action on pesticides that harm bees and kids.
Inaction? Intransigence? Negligence? Whatever the right word, we're reminded that the U.S. is behind the curve when it comes to protecting bees. Yesterday, Europe's restrictions on bee-harming pesticides went into effect.
Today, in a full-page advertisement in the New York Times and six other major papers, PAN and over 60 food, farm, faith and investor groups are calling on the Environmental Protection Agency (EPA) to take action. Quickly.
On Saturday, the small island of Kaua'i prevailed over the world's largest pesticide and genetically engineered (GE) seed corporations.
In the face of fierce industry opposition and political drama — including a mayoral veto, secret text messages, intimidation from the State and switched votes — the people demanding better protection from pesticides prevailed. The County Council voted once to pass Bill 2491, and then — to overide the mayor's veto — they did it again. Kudos to all who made this victory possible!
This is NOT what democracy looks like. In a replay of California's narrowly defeated labeling initiative last fall, a handful of corporations effectively bought Washington state's election to label genetically engineered (GE) foods.
In the face of impressive grassroots support and fundraising, pesticide and Big Food corporations spent $22 million to defeat I-522 — more than any campaign in the state's history and the equivalent of $30 per voter. As the largest single contributor, Monsanto led the charge. Yet despite being heavily outspent, the initiative was defeated by a small margin.
Pesticide Action Network North America
Main Office: 1611 Telegraph Ave, Suite 1200, Oakland, CA 94612
Midwest Office: 3438 Snelling Ave, Upper Level, Minneapolis, MN 55406
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As an Argentina fan, I really do not care about Euro 2012. But when I have a big tournament to watch like this, although there is no my favourite team, I have to watch. I like to watch football match. For me, Euro MATCH is a kind of Champions League match, which will involve most of the great players in Europe.
Anyway although there will be no my favorite team to play, I just hope Netherlands to qualify for the finals and win. Perhaps because Dennis Bergkamp's goal against Argentina in 1998 which although made me disappointed, yet the goal was beautiful, so I RESPECT Holland. Or perhaps the main rival for Holland is Germany, because I do not like Germany since 1990 - where Rudi Voeller's diving brought Germany to glory against Argentina.
Anyway, that's all insignificant actually. More important for me is Euro tournament will not take place peacefully. Yesterday, most people in UK tweeted about a documentary on BBC - Stadium of Hate. This documentary is about strong Racism and anti-semitism occur in Eastern Europe. Poland and Ukraine will be the host for this year - so I think better you watch this Euro.
Oh before that, sacrebleu Patrice Evra! Having been disheartened by Luis Suarez last season, I think he will not be able to face the Racism that will happen in his games
As a conclusion, Racism is everywhere. Even though many organizations tried to combat this problem, try to exterminate this, but it will still be there. To quote George Carlin, "in World War 2, Nazi Germany lost in war, but fascism wins".
If Evra play well, what can I say, bonne chance.
From Balotelli Statement
"If someone make a racist statement with me, I will kill him"


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2009 Nissan Murano
Nissan's alt-crossover gets a new look and new powertrain.
Note: The 2005 Nissan Murano SE 2WD pictured below is representative of the 2005 Nissan Murano S 2WD.
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2005 Nissan Murano
Nissan labels the Murano an urban SUV and describes its shapely sport utility as sculpture in motion.
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The redesigned 2009 Murano debuts in LA.


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Attend an Information Session on Tuesday, October 7, 6:30-7:30 p.m. at Arcadia's Glenside Campus. REGISTER NOW. Questions about the session or prefer not to register online? Contact Christine Litwin at 267-620-4832 or by e-mail, email@example.com.
Arcadia is ranked a national leader for study abroad, and Arcadia's graduate business students don't just talk about the global marketplace—they take two one-week international business trips, meeting with executives of global companies.
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Camp 1 Sunset - Aconcagua Dec 2008
© Axel Smeets, Dec 2008
Camera used: Canon PowerShot A470


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Mom to Stepmom: 'Don't Dress My Kid'
No I dnot see the big deal. As long as she's dressed properly I don't see what the mom is making a fuss about. Seems like she's just jealous. What does her father say about this? Maybe you might want to explain to your stepdaughter that her mom doesn't feel comfortable with her wearing your clothes so it might be best to keep it worn at your house. Just to be spiteful you can do the same to whatever clothing she's bought for her and return it to her in a bag as well. Lol that mom is being immature. Again, as long as it's decent and not over the age appropriate clothes, what's the problem!
I would allow her to wear your clothes but just ask that she give them back to you before going back to her mom's so that they don't get lost.
I have two teen daughters. When they go to their dad's they wear the clothes on their back and come home in the same ones. Since I am the one who purchases everything for them, I want to keep it all at my house. But, they live with me also so it is a different side of the story. If they came home in their "father's house clothes" I would fold them and send them back the next time just out of respect because I would expect the same treatment.
I expected this article to be about the stepmom loaning or buying the step-daughter age inappropriate clothes & the mom disliking it. But it's not at all. It's about the daughter borrowing t-shirts and, for the love of pete, sweatshirts & her mom having a problem just because the clothes belong to the step-mom. For God's sake, woman, grow up! The mom is being childish & spiteful, and I think the step-mom is handling it just right. Don't feed into the immature behavior of the mom just to keep her happy. It's not your job to keep her happy. She can get over it.
What's amazing here is the mother was also sending back clothes that were bought for the daughter. How does she know that the step-mother bought them, verses dad buying them for her.
Sometimes people can be so petty. It's not like the child chose to get divorced.
It's not a great position to be in but, yes, you stop letting your stepdaughter borrow the clothing. Right or wrong, the mother of the child in question has made a decision and a stepparent does not have the right to over-rule.
Additionally I would not tell the stepdaughter that her mother banned the borrowing/buying of clothing. I would just make like it was your decision and then drop it. If you say it was her mother you're automatically making mom out to be the bad guy and you don't want to start that.
It's time for the bioMom to sleep with the fishes. You must really love that guy!!!
I think you should talk to your husband about this, so that he knows what is going on. Then talk to your step-daughter. You need to set some ground rules for wearing your clothes with her. Let her know that it is upsetting to her mother if she wears your clothes to her house, and that, as her mother, her feelings need to be respected. So she can borrow your clothes, but cannot wear them or take them over to her mother's house.
The mom should get a life!
I totally disagree with Leah, especially about acting like it was your decision not to let sd borrow your clothes. Why should you take the blame (and seem totally selfish too,when your not) just because the bio. mom can't grow up and put her own daughters feelings above her childish pettiness doesn't mean you should take the blame. You should worry about your sd happiness more than the bio. moms, the adult is not your responsibility.
Teenagers can also be a little manipulative, playing both sides against the other for attention. I would caution you because that could be some of this too. The clothes you mentioned are name brand and pricey, another issue might be that now that mom's single, trying to support her daughters, she cannot afford those types of clothes for them and takes offense. I would let her wear whatever is appropriate and just let her know she changes back into her clothes before she leaves so your clothes stay at your house. There is no need to take the bait and discuss it further with the teen or have a war with mom.
Stop letting her borrow your clothing, but don't stop buying clothing.
Hubby needs to have a convo with ex-wife
Does dad do ANY actual parenting at all?
You can say, "I'm buying my stepdaughter clothes because I lovvvve her," or, "He's working all the time and I have free time so I buy her things," or, "My husband just doesn't have the time or interest," and it all boils down to—
Dad just doesn't have the time or interest in parenting his kid.
If dad stepped up and started actively parenting, and buying clothes for his own daughter instead of foisting it on you, I can't picture mom sending bags of clothing back home.
Does dad do ANY actual parenting at all?
You can say, "I'm buying my stepdaughter clothes because I lovvvve her," or, "He's working all the time and I have free time so I buy her things," or, "My husband just doesn't have the time or interest," and it all boils down to—
Dad just doesn't have the time or interest in parenting his kid.
If dad stepped up and started actively parenting, and buying clothes for his own daughter instead of foisting it on you, I can't picture mom sending bags of clothing back home.
"Or do I ignore her mother's message and let my stepdaughter borrow away because it makes her happy?"
Well, giving kids a diet of nothing but chocolate makes them "happy," but our job as adults is to raise children, not give them their every hearts' desire.
It's a stretch to assume a mom would be cool with their precious child traipsing around their home, their sanctuary, with clothes from The Other Woman on their back. I'd actually go so far as to say it's childishly naive.
You know mom doesn't like it, so you can either continue to buy and lend the kid inappropriate clothes (Abercrombie and Fitch for a pre-teen? What's next, playing wounded because mom mean old mom doesn't approve of you dressing her in Frederick's of Hollywood?) or you can grow up and let the kids' mother parent them the way she sees fit.
But by all means, if you care more about proving a point than raising kids, and parenting them, continue buying and lending them clothes and letting them know how unreasonable and mean their mom is.
Why are you buying clothes for your stepdaughter? The more you write, the more I understand why the mom feels like you are trying to replace her. Mom and dad need to work out who pays for the kid's clothing and who buys it. It has NOTHING to do with you. You are not one of the parents. The mom is still alive and active in her kid's lives. (What is this "bio mom" stuff in the comments? The kids is not adopted.)
Your conversation with your stepdaughter was just setting her up to have a conflict with her mother. Now you've made it clear to your stepdaughter that you are willing to go against her mother's wishes. You have put the kid right smack in the middle - what kid wouldn't want lots of cool clothes? I think a better thing to say would have been something along the lines of "I didn't know that, I'll talk to your parents." Then let them work out what they want to do. Follow their wishes just as you would do if it your neighbor's kid.
And yes, I do wonder why you are lending clothes to your stepdaughters. It could look to other people like you are trying to win them over and make them like you, especially if the clothes are expensive or cool. I can easily imagine feeling jealous of a stepmom who did something like that and wondering about her motives. (I like to think I'd be too smart to say anything though. Not because I'm a nicer person who only wants the best for her kids, I just think mom's strategy is going to backfire.) Given a mom who is already suspicious of you, I think you might have forseen this.
Anyhow, I think you really do need to sit down and think about two things:
1. Are you trying to be a second mother? The kids have a mother who is alive and taking care of them. They don't need another one. Their dad is their other parent. You're his wife, but not their mother. When they are your house, he should take care of them. Sometimes you should go away and leave them alone. If there are problems, he should deal with them, especially anything involving his ex-wife. I don't think you are doing this to steal her kids, I think you are trying to be a good stepmother, but you seem to be stepping over the line into trying to be a good mother sometimes.
2. Are you getting to the point where you are so mad at the kids' mom that you are giving out negative messages about her to the kids? It sounds to me like you are doing some of what you accuse her of and letting your feelings (insulted that she gives back your clothes) affect your actions.
It is CLOTHES people, grow up, get over it and have a parenting meeting. All 3 parents need to step up and have a conversation.
Remember best interest of the child, keep your pettiness to yourself and don't put the child in the middle. She deserves the right to bond with her stepmom (she lives with her part of the time) and if that is through borrowing clothes so be it. Mom wake up to the fact that you are creating a problem where there shouldn't be.
I agree that someone's creating a problem where there shouldn't be one. But it's the stepmother, not the mom.
Let the dad parent his kid.
Let the mom parent her kid.
Stop trying to be the cool best friend who lends inappropriate, too-old clothing to the kid and talks smack about mom.
Why are you buying clothes for your stepdaughter? Why doesn't dad buy her clothes?
Did anyone miss that this is a teenage girl? I don't know of a single teenage girl growing up who went shopping with their dad. We either went shopping with our mom our shopping together. If I got clothes, my mom was the one who bought them even if it had my dad's name on the tag.
She should be able to shop with her stepmom or get clothing from her stepmom. She shouldn't be forced not to have the relationship she wants with her stepmom just because the bio mom is jealous.
If Stepbomb wasn't there, don't you think dad would have to spend time with his pre- teenage daughter, no matter how uncool or unhip the girl might think that is?
And from her other posts, it seems to be a pre-teen, not a teen. And other way, totally inappropriate of a grown woman to dress another woman's little girls in Abercrombie and Fitch, a hypersexualized brand.
When you married your SD father she became your step DAUGHTER and when she is with you you and her father take care of her (a marriage is a partnership) If she is your spouses responsibility it makes her your responsibility to. You have every right to have a close relationship with her despite what other people say or the bio-mom you are her step MOM which makes you a motherly figure in her life, if the bio mom has a problem with that it just means she's insecure in her own relationship with her child she should be close enough with her daughter to know no one can replace her. And as for the clothes there is Absolutely nothing wrong with you buying your SD clothes thats just immature for anyone to say you are overstepping your boundries by buying your SD clothes, just continue to be a good SMOM, and don't let the BM get to you, your SD is old enough to decide for her self what type of relationship she wants to have with you and if your both are happy and your not disrespecting her mom to hell with everything else. Buying or lending clothes is not disrespectful or wrong . Good Luck


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Rates/Status/Due Dates
Student(s), if you ever want to check your "Prority Registration" date to register for an upcoming semester you can simply go to www.cpcc.edu and select "CPCC Login" in the yellow box to the left of the page. Then under CPCC Login Start Section, select manage account (3rd option), Login with your username/password and select the last option "Priority Registration - View priority registration information", listed will be your upcoming registration date. Usually Registration dates are undated at the end of each previous Semester.


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flat-rolled steel,
integrated steel mill
Chris Prentice
NEW YORK The new owners of the former RG Steel LLC steelmaking complex in Sparrows Point, Md., have put....
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Are you stocking more inventory today than 18 months ago?
We actually don't know who his investors are. At the point when we are ready, we will investigate further. There are just so many things to handle and there are a lot of items to be considered with the project."
-- Charles C. Mitchell, Barstow city manager


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Foaming Hand Soap - 1000mL - 6 pk.
by Touch Free Solutions | Item #: 748252 |
This solution works with the Touch-Free Foam Dispenser. This antibacterial foam soap keeps your hands clean and smells great. Each case has six sealed bottles, each producing 2,500 applications for 15,000 applications per case. The entire bottle goes into the dispenser for easy refill.
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This was the wine I picked out to go with the rabbit stewed in a bacon/garlic/sage sauce that I made on the weekend.
13% alc. Translucent medium clear-ruby colour. Very shy nose; rather non-descript, though some brothy/earthy notes did come through; the fruit component was next to absent, however. Fantastic acidity and structure, though; the wine is 100% Nebbiolo aged for 18 months in large wooden casks and 6 months in steel tanks. Excellent tannin on the midpalate; lithe structure with an overall light-bodied impression, but with good grip and firmness. Aromatically non-descript, but well structured. Mildly bitter on the finish.
The wine was actually a superb match for the rabbit, as it was awfully gentle aromatically, but had really good structure and a savoury flavour profile that worked well with the sauce.


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This item is discontinued.
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The Cost of Raising a Child
A child born in 2013 will cost nearly a quarter of a million dollars to raise to age 18, with food making up about 1/6th of that. Wow!
Healthy Eating on a Budget
Eating healthy doesn't have to be expensive. See our tips and materials to make healthy, budget-conscious choices.
My Recipe
Use My Recipe to build, save, and analyze your favorite recipes. My Recipe is just ONE part of the SuperTracker!
Summer time is a great time to eat healthy
Follow MyPlate on Facebook for tips, Foodie Friday, and fun!
MyPlate Kids' Place
A brand new resource for kids (and parents/ educators too). Games, videos, songs, and much more.
What's New?
- Tip of the Day –
- Happy Earth Day! – (April 22, 2013) Experience Earth Day by doing outdoor activities you enjoy.
- USDA/White House Video Challenges – Check out the winners of the First Lady's Let's Move! Initiative's Communities on the Move Video Challenge and the MyPlate Fruits and Veggies Video Challenge. Download the MyPlate Community Toolkit.
- Ten Tips Nutrition Education Series – Print them, post them, follow them.
- Kids' State Dinner – (July 23, 2014) The First Lady hosted a lunch for the winners of the 2014 Healthy Lunchtime Challenge. Download the cookbook and watch the video. (The 2013 and 2012 cookbooks are also available.)
- Healthy Eating on a Budget – (May 22, 2014) Think eating healthy has to be expensive? Healthy Eating on a Budget provides advice and tips for the budget-conscious consumer.
- MyPlate Kids' Place – (May 30, 2013) MyPlate Kids' Place has online resources and tools to help kids make wise choices in a fun and appealing way.


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The antitransmedia arguments
On March 23, 2011 By Haritz Rodriguez
In recent days is growing a sort of controversy surrounding the term transmedia. I can even say that there is a new movement under the label antitransmedia.
It's a very positive discussion, since it allows to exchange views and define a concept that seems quite abstract.
Any label or new term is in [...]Continue Reading →