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In a year when a sputtering economy might be expected to give him the upper hand in the presidential race, Mitt Romney finds himself on the hot seat on income taxes, fighting perceptions over whether he's paid enough and how much he'd tilt future rates to benefit the rich.
Democrats again hammered the former Massachusetts governor Friday over his steadfast refusal to release more than one completed and one draft tax return. They also hit him over his disclosures that he and his wife, Ann, paid an average 14.6 percent of their $42.5 million in income to the U.S. Treasury in 2010 and 2011.
More than half of Romney's income during that time came from capital gains, which are taxed at a lower rate than income.
Their taxes over the last two years exceed the 12.8 percent tax rate for the average American, as cited in a Congressional Budget Office study.
However, they lag far behind the 24 percent average federal taxes paid in 2009 by others among the 1 percent of Americans with the highest incomes, according to the Internal Revenue Service.
They were also below the 20.5 percent in federal taxes paid in 2011 by President Barack Obama and his wife.
The soon-to-be Republican nominee had attempted to silence critics on Thursday by branding them as "small minded" for fixating on his tax returns at the expense of bigger economic issues. Romney declared that he hasn't paid taxes of less than 13 percent of his income in any year over the last decade and that, "if you add in . . . the amount that goes to charity, why the number gets well above 20 percent."
Those comments quickly boomeranged into front page headlines, emphasizing Romney's inability to shake the issue and raising the specter that his affluence could work against him with middle-income voters in the aftermath of the worst U.S. recession in 80 years.
Joe Rosenberg, a research associate for the Tax Policy Center, sponsored jointly by the Brookings Institution and the Urban Institute, said that "it's not legitimate" for Romney to try to deflect the controversy over his tax rate by counting $7 million in donations to his preferred charities as if they were taxes. Much of that money went to the Mormon church, where he is a member.
"I do think he has sort of painted himself into a corner in terms of what he has promised, which is to further reduce tax rates that disproportionately benefit very high income people," Rosenberg said.
On Friday, Obama campaign manager Jim Messina said in a note to his Romney campaign counterpart, Matt Rhoades, that his side would end its calls for more tax disclosure if the GOP challenger would release returns for five additional years.
"In the governor's case, a five-year release would appropriately span all the years that he has been a candidate for president," Messina wrote. "It would also help answer outstanding questions raised by the one return he has released to date, such as the range in the effective rates paid, the foreign accounts maintained, the foreign investments made and the types of tax shelters used."
A White House spokesman later took a separate jab, asserting that Romney's refusal contrasts with Obama's emphasis on transparency and reflects a broader attitude in which he seeks to "shower benefits on millionaires and billionaires."
"In fact, we're just asking him to live up to the standard of previous major party candidates for president, a standard that was established by his father when he ran for president in 1968," said White House spokesman Josh Earnest, referring to former Michigan Gov. George Romney.
Rhoades, however, quickly extinguished much hope of a further release.
"It is clear that President Obama wants nothing more than to talk about Governor Romney's tax returns instead of the issues that matter to voters, like putting Americans back to work, fixing the economy and reining in spending," he said in a reply to Messina.
The Tax Policy Center has estimated that Romney's proposal to extend Bush-era tax cuts that are scheduled to expire at year's end, and to slash the marginal rate in every tax bracket by 20 percent, would cost the federal treasury $4.8 trillion in the decade beginning in 2015.
Romney has said that he can offset much of those tax reductions by eliminating tax loopholes, credits and exemptions, but he has offered no details of how he'd accomplish that.
"It appears that with everything he's laid out, something will have to give," Rosenberg said. "Either his plan will increase the deficit and he'll need to find more spending cuts to offset it, he will have to not reduce rates as much as he says he will, or he needs to rethink some of the treatment of capital income when he looks to pay for what he has already specified."
A central reason that Romney's personal tax rate has been lower is that much of his income in recent years has come from capital gains – profits on investments on which he's paid a 15 percent tax rate, and from so-called carried interest from his share of the Bain Capital private equity fund. For example, in 2010 he reported capital gains of nearly $12.6 million.
Both Romney and his newly anointed running mate, Wisconsin Rep. Paul Ryan, have advanced policies that would further reduce Romney's tax liabilities.
Romney – as have members of Congress from both parties – has proposed eliminating the Alternative Minimum Tax, a nearly flat tax on higher-income individuals, while Ryan has proposed altogether eliminating the 15 percent tax on capital gains, a change that would have reduced Romney's taxes by more than $3 million over the last two years. Romney says he would leave the 15 percent rate intact.


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|1,432 sq ft
|Property type
|Minimum Stay
|1 - 7 nights
Complimentary Beach Service included March 1 – October 31!
Free Wifi
Tastefully and stylishly decorated, St. Croix 1105 has everything you'll need for your next beach vacation! This Silver Shells St. Croix two bedroom vacation home features beautiful beach views from both bedrooms and the open living area. Enjoy Destin's top resort, loaded with amenities sure to keep the family relaxed and entertained.
Bedding Summary:
Master Bedroom: King Bed
Guest Bedroom : Two Full Beds
Living Room: Queen Sleeper Sofa
Floor-to-ceiling windows and sliding glass doors in the main living area draw in the beauty of the beach and allow the emerald green waters of the Gulf to be seen from the kitchen and dining areas as well. The living area boasts gorgeous, high-end furnishings and includes a flat screen TV, DVD player, and Queen-sized sleeper sofa.
The kitchen is fully equipped with all the cookware and dishware needed to create and enjoy your favorite meals from the comfort of your rental home. The kitchen also includes double sinks, a side-by-side refrigerator, oven, dishwasher, and lots of counter and cabinet space.
Both Bedrooms have large picture windows, stunning beach views, and separate entrances to the Gulf-front Balcony. The Master Bedroom features a King bed, flat screen TV, and walk-in closet. The Master Bathroom has a jetted tub, spacious walk-in shower, two sinks, and ample counter space. The Guest Bedroom has two Full beds, flat screen TV, closet and drawer storage, and its own entrance to the balcony. The Guest Bathroom has a walk-in shower.
Assigned parking is located in the St. Croix garage. St. Croix 1105 is the ideal place to spend time in Destin, Florida, offering all the comforts of home from within one of Destin's premier beach resorts – the Silver Shells Beach Resort and Spa.
Silver Shells Beach Resort & Spa Information:
Bordering the pristine natural setting of Henderson State Park in central Destin, Florida, Silver Shells Beach Resort and Spa is a 31-acre beach resort with every imaginable amenity! The resort is comprised of five condominium towers named after the Virgin Islands, with short-term vacation rentals available in the St. Croix, St. Maarten, and St. Lucia buildings, and monthly rentals offered in the St. Barth building.
An icon resort in Destin, Florida, Silver Shells brings together the essential elements that make for a true landmark beach resort, and lets you enjoy the beautiful white sand beaches and emerald waters of the Gulf of Mexico in luxurious style. A beachside tiki hut serves up frozen cocktails, refreshing beverages, and a menu of delicious grilled fare. In season, service to the pool deck and beach chairs is available. Beach attendants offer beach chairs, umbrellas, and water sports rentals, directly on the beach.
An expansive lagoon pool with a waterfall is located in the center of the resort, which also includes a children's wading pool and community hot tub. The lagoon pool deck offers plenty of chaise loungers and umbrella-shaded tables with chairs. The St. Barth and St. Lucia buildings each have their own private swimming pool as well. Silver Shells also boasts an indoor/outdoor pool, a state-of-the-art fitness center, a large basketball court, and two tennis courts.
Onsite in the Clubhouse building, guests are pampered at The Spa at Silver Shells - a full service spa offering a wide array of services and the latest in today's spa treatments. Ruth's Chris Steakhouse is also onsite in the Club building. Be sure to set aside at least one night for a great dining experience at one of America's leading gourmet steakhouses.
Centrally located and directly on the beach in Destin, Florida, Silver Shells Beach Resort and Spa offers a complete beach resort experience while keeping you close to popular area attractions, shopping, and restaurants.
Destin Area Information:
Destin is well known as the World's Luckiest Fishing Village largely because of its roots as a top fishing destination and quick access to the deep waters of the Gulf of Mexico. Destin boasts the largest charter fishing fleet in the state of Florida. If you have an interest in charter deep sea fishing – Destin is the place.
There is much more to Destin than just charter fishing, Destin has evolved over the years to be a top beach vacation destination. Featuring sugar white sand beaches and emerald colored water, it is an absolutely breath taking area. The town itself offers many upscale shopping, dining, and entertainment opportunities. Much of the development of the area has been done with luxury lifestyles in mind. Destin also has one of the busiest private airports in the country.
The list of things to do in Destin are endless, including water parks, water sport rentals, parasailing, scuba diving, snorkeling, power boating, sailing, fishing, tennis, golfing, shopping, The Gulfarium, goofy golfing, zip lining, bungee jumping, helicopter rides, or simply relaxing on one of the World's most beautiful beaches. Treat yourself to a tranquil vacation in a world renowned beach town, Destin, Florida, located on Florida's Panhandle on the Gulf of Mexico.
Professionally managed by Compass Resorts
This VRBO partner has demonstrated and is committed to fast response times, the best rates, and a great guest experience.
Founded in 2006, Compass Resorts offers travelers a wide variety of vacation rental homes in the greater Destin area. From 1-bedroom condos to 7-bedroom Gulf-front houses, all of our rental homes meet the highest Quality standards. Compass Resorts offers vacation properties in Central Destin, South Walton, Holiday Isle, and Okaloosa Island in sought-after communities like Destiny by the Sea, Dunes of Destin, the Silver Beach Towers Resort, Silver Shells Beach Resort and Spa, Destin Towers, and many more. The Compass Resorts website provides detailed information about all of our communities and vacation homes - as well as local events, area information, and concierge recommendations. Our mission is to deliver the highest quality Vacation Rental Experience as measured by Guest satisfaction. We listen intently to the needs of our Guests, and do business fairly, honestly, and with the highest level of care. Each year, we welcome thousands of families to the Destin area, and we enjoy making them feel right at home. The dedicated staff of Compass Resorts makes the difference!
Property was great, check in and out was seamless and fast, and service was very courteous by staff. Will be back.
Loved it! Didn't want to leave!
Resort has every amenity we needed. Condo was well stocked and super clean. Large floor plan and nicely decorated.
Had a great stay in St Croix 1105. Condo was exactly as pictured, very clean and comfortable. Only 2 other units on the floor so it was very quiet. Easy access to pool and beach. Had a gorgeous view of the pool and the gulf from the patio. Looking forward to our next trip next year. Would highly recommend this unit!
Major issues
1. Carpet was ready for replacement a couple of years ago
2. Mold in both bathrooms
3. Kitchen counters and equipment dirty - What does the cleaning fee pay for?
4. Broken kitchen appliances - Too obvious to be missed but not replaced prior to our arrival
5. Two wall colors in the Master bedroom
6. Lots of damaged walls all over the apartment with some badly patched over with spackle and not even sanded / painted
7. Having to pick up keys at Resort compass location AND bring it back is not convenient
8. Resort itself needs more attention - Dirty/mold on paved areas next to pool, Pool filters/circulation not working (kind of gross), sharp nails/screws not all the way in on board walks (safety issue)
too many more to mention
Silver Shells is a great family friendly resort destination. This was our 9th year staying at this property and it looks the same as when they built it, they keep it up in great shape.

subset: commoncrawl


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Public safety employees make up more than half of the top earners — those earning more than $100,000 a year — in Arroyo Grande, Grover Beach and Pismo Beach, according to a Tribune review of salary information.
About half of each city's top 50 employees work in the police or fire department.
Tribune reporters filed public information requests late last year to obtain salary data for the top 50 earners in each city as part of The Tribune's ongoing effort to review public employee compensation in San Luis Obispo County.
The salary data includes overtime and other forms of compensation, such as vehicle and cell phone allowances, holiday pay and education incentives. It does not include employer-paid contributions to health insurance, Social Security and Medicare.
Other highlights from the data, requested for fiscal years 2008-09 and 2009-10, show:
Of the 14 employees who made more than $100,000 in Arroyo Grande in the 2009-10 fiscal year, 10 worked for the Police or Fire Department. Five were pushed over the $100,000 mark because of overtime pay.
In 2009-10 in Pismo Beach, police employees collectively earned the largest amount of overtime. But the largest individual amounts of overtime went to workers at the city's wastewater treatment plant. Three employees there each earned from about $13,000 to more than $16,000 in overtime that year, pushing their salaries above $70,000 each.
Grover Beach's police chief, Jim Copsey, is the city's highest-compensated employee and makes more — by about $5,000 — than the city manager.
In December, a Tribune report revealed that 85 percent of San Luis Obispo's top 50 paid workers are police and fire employees.
The Tribune's review of the two years' worth of salary information for the smaller cities of Arroyo Grande, Grover Beach and Pismo Beach found that together they spent about $1.1 million on overtime — about half of the $3 million San Luis Obispo spent during the same period.
The Tribune began its focus on public sector compensation after a Los Angeles Times investigation last summer revealed excessive salaries paid to employees and council members in the city of Bell in Los Angeles County. That controversy later prompted State Controller John Chiang to require the salaries of all city and county elected officials and administrators be posted on the state's website.
Since then, several cities in San Luis Obispo County, including Arroyo Grande, Atascadero, Morro Bay and San Luis Obispo, have posted salary information on their websites.
Arroyo Grande
Employee salaries and benefits made up 75.8 percent of Arroyo Grande's $14.1 million general fund budget in 2009-10 and 78.4 percent its $13.7 million budget in 2008-09.
In 2009-10, the salary range of the top 50 earners was $65,981 to $150,791; in 2008-09, the range was $66,449 to $149,732.
An analysis of the salary information requested shows that in both years, eight fire and 23 police employees made the list of the top 50 earners. The fire and police employees also took home the bulk of overtime pay the city spent in both years.
In 2009-10, six fire employees took home a combined $109,055 in overtime — 38 percent of the $282,316 the city spent on overtime that fiscal year. Each of the employees received from $16,190 to $20,570 in overtime.
In the 2008-09 year, the same six fire employees earned a combined $146,484 in overtime. Three employees — two fire captains and a fire engineer — had their salaries pushed over the $100,000 mark because of overtime, each earning from $24,000 to $38,000 in overtime.
The two main reasons for overtime are employees covering shifts when another worker is sick or on vacation, or when firefighters are called to respond to emergencies on countywide strike team assignments, said Fire Chief Mike Hubert.
"I have five people on duty every day," he said. "Any vacation, sick leave or workers compensation (vacancy) creates overtime."
Arroyo Grande firefighters responded on six strike teams to major fires in Southern and Northern California in 2008-09, for which the state reimbursed the city $285,997. In 2009-10, firefighters fought Southern California fires, and the city was reimbursed $168,473.
The formation of the Five Cities Fire Authority, which includes the Arroyo Grande, Grover Beach and Oceano departments, will not change the amount of overtime worked, Hubert said. The way the department is currently operated, he said, "is about the cheapest you can do it unless you go back to volunteers."
The city's police employees, mainly officers and sergeants, also took home overtime pay, but in smaller amounts: 20 people who made the top 50 list received a total of $148,908 in overtime in 2009-10, and $145,184 in 2008-09.
Their individual overtime costs ranged from $1,120 to $12,874 in 2009-10 and $1,530 to $12,437 in 2008-09.
Those overtime costs, police Chief Steve Annibali said, are much lower than four years ago. In fiscal year 2004-05, the city spent $290,000 on police overtime; that dropped to about $161,000 in 2008-09.
Annibali, who became chief in 2008, said he took steps to reduce overtime costs, including changing schedules to give officers the ability to cover shifts without working overtime.
Grover Beach
Grover Beach officials provided a list of salary and overtime costs for its top 50 employees for calendar year 2009. In the 2009-10 fiscal year, 71 percent of the city's $7.4 million general fund budget paid city employees' salaries and benefits.
The city has only 55 employees, so the salaries of the top 50 employees range from $52,980 to $145,067.
Only one of the seven city employees who earned more than $100,000 a year — a police sergeant — had overtime. The $10,380 he received pushed his salary over the $100,000 mark.
Thirty-one of the city's top 50 earners received overtime pay in calendar year 2009, totaling $203,210. Of those, seven fire employees earned a total of $105,817 in overtime; 17 police employees received a total of $74,658.
The police employees — three sergeants, 10 officers and four records technicians or supervisors — received a range of overtime pay, from $298 to $13,294.
The Police Department's overtime budget is among the lowest in the county, said Copsey, the police chief. This year's budget, for example, includes $48,800 in overtime for police officers and dispatchers. (The difference between the calendar year overtime costs and fiscal year costs varied; City Manager Bob Perrault said the difference is likely due to comparing fiscal versus calendar year, but also that costs could have been higher due to vacancies and injuries that prompted a need for overtime.)
The overtime costs for Fire Department employees ranged from $578 (an administrative secretary) to $25,997 (a fire captain).
In the 2009-10 year, the state reimbursed $23,368 to Grover Beach for its response on strike teams to major fires throughout Southern California.
Pismo Beach
Employee salaries and benefits took 54.7 percent of Pismo Beach's $15.4 million general fund budget in 2009-10 and 54.6 percent of its $15.3 million budget in 2008-09.
The city contracts with Cal Fire for fire services, so firefighters are not city employees nor do they appear on the city's list of top 50 earners. In 2009-10, the city spent $1.3 million for Cal Fire to staff its Bello Street and Shell Beach stations.
Of its top 50 earners, nine Pismo Beach employees made more than $100,000 in 2008-09, and 10 hit that mark in 2009-10. In both years, six police employees — the police chief, two commanders and three sergeants — made more than $100,000.
Twenty-three police employees are on the list of top 50 earners for both fiscal years.
Police Department overtime ranged from $1,141 to $10,647 in fiscal year 2009-10 and from $2,133 to $15,788 in 2008-09.
Police officers may have additional overtime requirements because of the size and number of the city's special events, Human Resources Officer Debra Garcia said.
Police Department officials schedule patrol shifts so as to reduce overtime, and preauthorize training and vacations to minimize the impact on minimum staffing requirements, Garcia wrote in an e-mail.
In June 2009, the City Council approved a 20 percent reduction in the Police Department overtime budget, which is $124,002 for fiscal year 2010-11.
But higher individual amounts were earned in those years by workers at the city's wastewater treatment plant.
The plant is operational 24/7, and overtime may result from heavy rainfall, as the plant processes may require monitoring and adjustments, Garcia said.
Reach Cynthia Lambert at 781-7929. Stay updated by following @SouthCountyBeat on Twitter.


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Cultural night in Uppsala Sep.10! (Stockholm)
Uppsala is a beautiful city close to Stockholm Protected content to the North of STKLM, around 1h by train). It's the 4th largest city in Sweden. Only one night Sep.10 Saturday there is going to be a "Cultural Night" with lots of fun live music, dance, yoga, parcour, fire show, exhibitions and many other things during the whole day and night!
Here are the links:
Protected content
Program in Eng: Protected content
If anyone is interested we can form a group of Internations and go by car or train to Uppsala, prepare picnic baskets, get wine and spend a nice day there :)
The sun will not always shine warmly in STKLM!!! :D


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I love hearing stories about how others have applied law of attraction techniques to their lives and had wonderful results. It's inspiring and fun. I started a Pinterest board so I could keep links to these stories when I found them.
The three stories I'm sharing with you here, are recordings from Abraham-Hicks seminars. The clips range in length from 7-12 minutes. They're great mood elevators.
Here are my three favorite LOA success stories:
1. The ease of deliberate creation
In this clip, the woman telling the story sells real estate. She shares two stories about how her efforts to relax and deliberately feel good, led to two unexpected and easy real estate sales.
2. Vortex essay and college entry
A father shares how his daughter's expectations and actions, based on her knowledge of law of attraction, helped her get into the college of her choice.
3. A new 30 day process brings success
A man devised a 30 day process to feel good and thereby created several big changes that transformed his life in wonderful ways.
I hope you enjoy these stories as much as I do!


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Living in Japan, is an amazing experience, that will change you!
What is a Japanese apartment like?
To make living here fun and not unbearable, you need a decent
if not a nice place to live. Where you live of course, makes a huge difference in how you feel about wherever you live, but especially in a foreign country like Japan. Your
Japanese apartment
should be as much of an oasis as you can make it.
A Japanese apartment is different from what you can expect back home. The amenities are few if any. You will need to furnish it from the top down, including the light fixtures!
Dollar Shops and Thrift Stores in Japan
Don`t worry about this too much, as the best dollar shop in the world is Japanese, it is called Daisou. As well there are many thrift shops everywhere, in Japan they are called
(recycle shop said with Japanese pronunciation: "riisaikuru shaapu." I have a fridge and Sanyo TV that we bought from a recycle shop 20 years ago, and they still work! You can buy almost everything cheaply from a recycle shop, then sell it when/if you leave Japan.
As my friend Steve said, "Japan is the best country in the world for buying used things, they are well taken care of and often they are brand new - they are used in name only."
Tokyo Apartment
Many who are planning on living in Japan are concerned about what sort of apartment can they expect to get and how much rent will they have to pay. Learn more about apartments in Japan and other aspects
of your Tokyo apartment.
Lenkowski talks about Teaching & His Life in Japan
Todd Lenkowski is married to a lovely Japanese lady, and talks about living in Japan, teaching, and owning his own English school. He has advice for people who want to
teach in Japan.
I lived here for 6 months when I first came to Japan. Nagoya is a city of wide boulevards and a little bit slower paced than Osaka or Tokyo. I joined an international soccer team and made many friends from not only Japan, but Europe and even Jordan.
Living in Nagoya
Is fun in many ways. You can go out to Inuyama and other places of interest quite easily.
The Japanese Police
While living in Japan you may wonder about the police.
Who are they and what makes them tick? Chris Cutts examines
how the police are organized and how they fight crime.
Japan Heat, Chris Cutts discusses the Japanese police
Whenever you live in another country you have to be concerned about your health and the standard of health care. Japan`s ranks amongst the highest in the world, and the health insurance
program should be trumpeted at the UN. It is a great system
with often 70% of your health care paid for! My wife wants me
to use my health insurance more. Does she want me to get sick? Don`t answer that! But be sure to read up on
Japanese health insurance before you come.
What is the weather like in Japan
My father felt Kanto was like San Francisco without the fog.
Vancouver feels warmer to me than Tokyo in the winter? Or am
I dreaming? Find out at our page about
Japanese weather: what is the climate like here?
Foods of Japan
Japan is famous for many things and one of them is her food! It is good and healthy too! The Japanese in general and the Okinawans in particular are two of the longest lived people in the world. Many medical professionals suspect it has to do with the diet. You will enjoy the
food in Japan.
What of Japanese Religion?
You ask. The traditional religion is Shinto but Buddhism
is popular here. Japanese often have a Shinto wedding
and a Buddhist funeral. They tend to remember their wedding more than their own funeral, and take more pictures of the former
than the latter! What is Buddhism
like in Japan?
The Bosozoku
The Bosozoku of Japan, are the bike gangs that drive around very slowly and rev their engines. Their motorcyles are especially
equipped to make them noisier. As the weather warms up, the riders come out in small groups to ride around the town. Numbers have dwindled of late. In Kaisei Town, a community not
far from my home, a tragedy
Furikome Sagi
Furikome Sagi is the amazing telephone crime that occurs in Japan.
The value in yen that the culprits take every year is truly astounding. It is a shame that such obviously brilliant minds
devote themselves to crime. If only we could channel these
creative yet jaded ones into positive activities
in Japan.
Go back to Japan Living
Read about Travelling Japan
Japanese Lifestyle--Living in Japan
I am often shocked at the news coming from Vancouver. When I left over twenty years ago now, violent crime that made the newspaper anyway, was rare, and shocking the few times it seemed to occur. Now the crimes I read about shock me, not only in terms of how often they happen, but the nature and hideousness of the violence.
I still love Vancouver, it is my hometown, but I am very happy
to be bringing my children up in a comparatively much safer
small city in Japan.
One sunny day (Japan has many of them), I was sitting and thinking
about how my life might have been different had I settled in rainy,
overcast Vancouver as opposed to moving to the sunshine of Kanto.
I wrote this article and it was originally published in The
Vancouver Sun. In Quest for a Better Lifestyle I examine how
much my life is actually like a great
Canadian life.
What to Bring before living in Japan?
This question is often asked at the forum. See what our experts recommend you bring before you start living in Japan.
Tooth brush...check...underwear....check....favorite blanky...check....teddy bear....check
Why did I choose to live in Japan?
My brother was like and English teacher resource for novice
teachers and he encouraged me to go to Japan. I planned
on staying one year, but I have lived almost half my life
here now.
Coming to Japan with Children?
Then you need to check out the stain guide. Or maybe you should anyway as your friend Harvey or Bob may be accident prone as well and it is tough to read the cleaning labels on cleaning products in Japan. The stain guide can help you with your DIY cleaning jobs.
Stain removal advice
for almost every spot known to man! Solutions are offered for clothes, fabrics, carpets and upholstery.
Anderson`s Anecdotes:
A Strange Foreigner`s Take On Life In Japan
A Veteran Teacher`s Advice To Those New To Japan
I have lived in Japan for a long time-almost half my life-and have hopefully gained some insight from my experience working and living in this fascinating country. Here are some ideas which will, hopefully, be useful for those who are new to the
Japan teaching scene.
To Teaching English in Japan - Amazing Experiences
To International Teaching Jobs
To Japan Living 2099
From Living in Japan to How to teach English in Japan (home)
What advice would you give to people who want to make the most of their lives in Japan?
"Make genuine friends, but I guess that's true wherever you go, but particularly so here, I've found. In most areas you will stand out, be objectified and there will likely be a recognizable effort to avoid you for a myriad of reasons (at least that has been my experience). But, when you have true friends, true love about you, the other foolishness sometimes slips beneath your radar."
--Baye McNeil, interviewed by Tokyo Metropolis


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Ancient Egyptian Art and Architecture
October 2014; p ublished online October 2014 .
Book. Subjects: Archaeology; History of Art; Egyptology. 152 pages.
What did Egyptian art and architecture mean to the people who first made and used it—and why has it had such an enduring appeal? Ancient Egyptian Art and Architecture: A Very Short...


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Dear Editor,
I am submitting a letter in response to a recent Jeffrey Hall book review about the Holocaust.
It seems to me that starting the review with a Christian Bible quote and emphasizing in the first paragraph, and later throughout the review, the place of faith and God ("Carrie and her family passed this test of faith with flying colors") places an emphasis on religion which may or may not be germane to the motivation of why humans take great risks to help others who are in danger - thereby causing danger or death to themselves.
When a woman hears the screams of a child in a burning home, rushes in to save the child, is she doing it because of faith in God or because ever so many other human reasons and responses, and it is her immediate human response?
I am reminded of an incident 30 years ago. During lunch break at an office in West Chester dedicated to helping persons with developmental disabilities and getting them out of the Pennhurst Institution and placed in the community, my wife happened to mention during a discussion that she did not believe in God. Another woman said, "Oh, you can't really mean that. How could you do this work if you didn't believe in God?" My wife said she didn't see that there had to be a connection.
To be true to the experiences of the writer, in a book review the voice and the convictions and the experiences of the writer should be the emphasis of the review - not possibly the beliefs of the reviewer.
Reid Warren, Elverson


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A north Northumberland man has hit out at the county's planning department after his plans to provide four homes in his village were turned down.
At last Tuesday's meeting of the north area planning committee, a scheme for three bungalows and a one-bedroom house on a site in Christon Bank were refused by four votes to two.
Jim Little says that one of the properties would be for family use while three would be let as affordable homes.
But north area development manager Peter Rutherford said that the council had no documentation which would guarantee the homes being available through a social housing provider in perpetuity.
He also criticised the design, describing it as 'utlilitarian', and the lack of space on the site.
Coun Anthony Murray was in favour of the application, pointing out that even two affordable homes in a small village 'could be of great value'.
He added that there was support from three neighbours and the parish council, significant in a settlement of this size.
But Coun Trevor Thorne said: "Yes, they are affordable homes, but to let them, we have got to have amenity and space."
After the meeting, Mr Little said: "The county's shouting out for affordable homes and they are stopping it. The planning officer and housing officer contacted me about two years ago to see what we could do.
"It's cost me £2,000. It's money wasted and it's money that comes off the homes."


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USC Caps First Undefeated Season Since 1944, Wins Fourth National Crown
Dec. 8, 2008
By Trevor Freeman
Special to NCAA.com
Winning an NCAA Championship is a heroic achievement that is the culmination of hard work, perseverance and sacrifice. However, when you do it the way the 2008 USC Trojans will be remembered for doing it, immortality is what you have accomplished. With their 7-5 victory over Stanford, the USC Trojans joined a club that includes the likes of the 1972 Miami Dolphins and 1976 Indiana Hoosiers.
Yesterday's 7-5 NCAA Championship win was born a year ago in that same Avery Aquatics Center pool when the USC Trojans were defeated by the California Golden Bears 8-6. Rectifying that loss and winning the NCAA Championship was the mission and USC accomplished that. How a team deals with the adversity of a tough loss is a key factor in determining a team's character. USC's season was a direct response to that loss and it was incredible. From pulling out an opening weekend triple-overtime win over Loyola Marymount to an MPSF Tournament win off a last-second strike from Shea Buckner to falling behind Stanford 2-1 after the first quarter, USC showed the heart of a champion.
The second quarter changed this game. Stanford jumped out at home behind first-quarter strikes by Drac Wigo and Jeffrey Schwimer and clearly had a hop in their step heading into the second stanza. USC's trademark all season long was their smothering defense and they held the Cardinal scoreless in that second frame. Meanwhile, Shea Buckner (who had three goals on the day) found the back of the net for his second goal of the game while Jordan Thompson and Justin Rappel etched their names into history by each scoring their only goal of the game in that period.
Up 4-2 at halftime, USC never looked back. The Trojans moved their lead as high as four goals in the second half and coasted to the finish line. Shea Buckner, Kyle Sterling and J.W. Krumpholz each scored second half goals for the championship Trojans. Perhaps the biggest offseason question that faced USC entering this season was how they would replace the departed Adam Shilling. That question was answered in a big way by Australian freshman Joel Dennerley who was outstanding all season long. In the NCAA Championship game, the Aussie keeper made ten saves.
While this win ensures USC's place in history they have an outstanding chance to touch the rarefied air that a basketball team like the mid-1950s University of San Francisco Dons achieved when they won sixty straight games. While USC is losing three great seniors in Arjan Ligtenberg, Jovan Vranes and backup goalie Ben Weil, they return the vast majority of their offensive core. 2008 United States Olympian and 2008 NCAA Tournament MVP J.W. Krumpholz, Matt Sagehorn, Shea Buckner and Justin Rappel will all be back to trigger the offense next season. USC will also be returning Joel Dennerley in the cage. With those parts in place along with an outstanding coach in Jovan Vavic, one has to believe that USC might be better next season than they were in this year's campaign.
Stanford's shining star in defeat was goalie Jimmie Sandman as he had ten saves for the Cardinal. Stanford will be back next year and perhaps this loss to USC will serve as a motivating tool for the Cardinal as they will possess great talent heading into the 2009 campaign. Sandman, Sage Wright, Janson Wigo and Drac Wigo were all juniors this season and will be looking to end their senior season with a flourish. The Cardinal will have to replace the offensive prowess that Will Hindle-Katel gave to them and that will be no small task.
The Trojans reached the NCAA Championship game by defeating Navy 14-9. USC was down 3-0 early in the first quarter but rallied back for the victory behind four goals from Matt Sagehorn and three from Justin Rappel. Joel Dennerley added thirteen saves in the USC victory. Stanford had to survive a monumental test from a tough Loyola Marymount team in the Final Four. The Cardinal were able to defeat the Lions 6-5 on a Jeffrey Schwimer goal with eighteen seconds left. That game had everything you wanted as it joined last week's USC-Pepperdine MPSF Championship tilt as being one of the two best college water polo games I watched this season. Drac Wigo scored two goals in that victory for Stanford and Jimmie Sandman had ten saves including a huge one on LMU's Brian Beneditti with five seconds left in the game to preserve the victory.
Loyola Marymount finished in third place in this tournament by defeating Navy 11-4. Its NCAA championship window remains open as sophomore Andy Stevens will still have two seasons remaining on campus. The WWPA Player of the Year and 2008 first-team NCAA All-Tournament team selection was once again sensational on the biggest stage. In the 6-5 loss to Stanford, Stevens did everything he could to win that game as he totaled fourteen saves on the evening. One of them was a dramatic stop of a five-meter penalty shot from Drac Wigo with two minutes left in the game that kept the score 5-5. He also had multiple one on one saves and turned in a performance that was better than what he had last year against USC in the Final Four. If there was ever an argument about who is the best goalie in the country, it ended in that game against Stanford. Stevens will enter next season as the best goalie in the country.
It is always tough to prognosticate the 2009 season this early in the going, however there are a few other teams that will be anxious to knock USC off of their perch. California was the former two-time defending NCAA Champion and the Golden Bears will be back with a vengeance next season as they fielded a young squad this year. Spencer Warden was dynamic for California this fall and should only be better in his senior campaign. UC-Santa Barbara is on the verge of having a special season as the Gauchos beat the Stanford Cardinal down the stretch of the season. They will be returning a superstar in 2008 first-team All-MPSF pick Milos Golic along with a budding young prospect in Noah Smith. UCLA is going to be a trendy pick to make the Final Four next season as the Bruins will be returning a number of significant players including goalie Chay Lapin.
Last night and this weekend belongs to a team that chased down history. The last NCAA water polo team to finish the season undefeated was the 1992 California Golden Bears. That was a great Cal team that was coached by a legend in Steve Heaston and possessed such water polo greats as Gavin Arroyo, Sean Nolan and Chris Oeding. This USC team joined them in the history books and what has to be frightening is that this win might only serve as the beginning of what could be a two-year run of greatness.


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|Main » Files » Site Script » Chat
|[ Add new entry ]
* Now allows for the user to leave their name (can be disabled)
* Sample HTML page for how to display the shout script.
* 100% works with tables
* User defined number of comments to show.
1. Make a file called shout.txt and upload it to your server.CHMOD this file to 777
2. Open shout.php with a text editor and change the max length to however many characters you want to limit it to.
3. Use either PHP or SSL to include shout.txt into your page where you want the text to show up.
4. Use the following html to submit text to the shout script. Be sure to change the maxlength to a number less than or equal to the max that you set in the script.
<form method="POST" action="shout.php">
<input size="15" maxlength="10" type="text" name="name">
<input size="15" maxlength="25" type="text" name="c">
<input type="submit" value="Shout">
Once installed you can use test.php as an example of how this works.
I included the name option in this version because some people wanted it, others, however did NOT want it. If you are like me and don't want the name included, the solution is simple. Just don't add it to your submit form. If the script doesn't recieve a name variable, it simply puts >> in front of each message like the old version did.
Cheesehole.net offers no warranty or help whatsoever. Sorry that's what you get with free stuff. Please don't email me asking for help on installing or customizing thi script, as I don't have time for that.
IF you have any suggestions for this script (or others), however, please feel free to visit my site and email me from there. I do listen to and reply to suggestions. --HG
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|ALS Spends 46% for Marketing; 29% for Research
|by Tom McGregor
|Sun, Aug 31, 2014, 10:52 PM
The ALS Association has raised over $100 million in donations from the so-called "ice bucket challenge." Donors intended to give money to help find a cure for Lou Gehrig's disease. Nonetheless, ALS spends more on marketing campaigns than for research activities. Additionally, a team of senior executives earn six-figure incomes.
NewsMax reports that, "The "ice bucket challenge" to raise support for ALS research has gone viral in recent weeks, drawing celebrities, everyday people and even cartoon character . But critics are now saying only a fraction of the money raised is actually going toward research. The ALS Association was founded in 1985 to find a cure for amyotrophic lateral sclerosis, also known as "Lou Gehrig's Disease." So far, almost $100 million has been raised through the ice bucket challenge."
ALS spends 32 percent for public education efforts (marketing); 14 percent for fundraising; and another 7 percent for administration costs, which does not include salaries for senior executives.
"But," according to NewsMax, "critics point to a pie chart on the ALS Association's own website that breaks down how it spends the money it receives. According to the chart, 28 percent is spent on research. Other expenditures include 19 percent for patient and community services, 32 percent for public and professional education, 14 percent on fundraising and seven percent on administration."
CEO Jane H. Gilbert earns an annual salary of $339,475, which does not include added benefits.
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- Research article
- Open Access
- Open Peer Review
Understanding the role of the volunteer in specialist palliative care: a systematic review and thematic synthesis of qualitative studies
- Rachel Burbeck†1,
- Bridget Candy†1Email author,
- Joe Low†1 and
- Rebecca Rees†2
© Burbeck et al.; licensee BioMed Central Ltd. 2014
- Received: 22 October 2013
- Accepted: 4 February 2014
- Published: 10 February 2014
Volunteers make a major contribution to palliative patient care, and qualitative studies have been undertaken to explore their involvement. With the aim of making connections between existing studies to derive enhanced meanings, we undertook a systematic review of these qualitative studies including synthesising the findings. We sought to uncover how the role of volunteers with direct contact with patients in specialist palliative care is understood by volunteers, patients, their families, and staff.
We searched for relevant literature that explored the role of the volunteer including electronic citation databases and reference lists of included studies, and also undertook handsearches of selected journals to find studies which met inclusion criteria. We quality appraised included studies, and synthesised study findings using a novel synthesis method, thematic synthesis.
We found 12 relevant studies undertaken in both inpatient and home-care settings, with volunteers, volunteer coordinators, patients and families. Studies explored the role of general volunteers as opposed to those offering any professional skills. Three theme clusters were found: the distinctness of the volunteer role, the characteristics of the role, and the volunteer experience of the role. The first answers the question, is there a separate volunteer role? We found that to some extent the role was distinctive. The volunteer may act as a mediator between the patient and the staff. However, we also found some contradictions. Volunteers may take on temporary surrogate family-type relationship roles. They may also take on some of the characteristics of a paid professional. The second cluster helps to describe the essence of the role. Here, we found that the dominant feature was that the role is social in nature. The third helps to explain aspects of the role from the point of view of volunteers themselves. It highlighted that the role is seen by volunteers as flexible, informal and sometimes peripheral. These characteristics some volunteers find stressful.
This paper demonstrates how qualitative research can be sythnesised systematically, extending methodological techniques to help answer difficult research questions. It provides information that may help managers and service planners to support volunteers appropriately.
- Palliative care
- Volunteers
- Role
- Systematic review
- Thematic synthesis
- Qualitative studies
Volunteers are integral to the hospice movement in North America [1–3], India [2], Uganda [3], and in several European countries, including the UK [4–7]. Demand for end-of-life care is increasing worldwide with more people dying annually (predicted rise from 2002 is between 14% and 42% by 2030 [8]). Many of these deaths follow a period of chronic illness, such as cancer, heart disease, stroke, and chronic respiratory disease, which may involve palliative care in the advanced stages [9]. In the US there are around 400,000 hospice volunteers [10]. In the UK, where hospice care can include inpatient and day care services (services provided in a hospice building to non-resident patients), and home-based care, there are more than 100,000 volunteers [11], and their contribution reduces hospice costs by an estimated 23% [12]. Volunteers are therefore vital to hospice services.
Whilst we are only beginning to gain a picture of volunteers' activities in relation to tasks undertaken in specialist palliative care, particularly those in patient-facing roles [13, 14], it is clear that volunteer contributions go beyond the purely physical. For instance 86% of hospices involving volunteers in roles with inpatients reported that the volunteers provided emotional care [13]. Although this kind of contribution can be hard to quantify, it appears tangible to those involved [15]. Similarly, whilst a job description lists the activities that someone fulfilling a position is expected to undertake, the actual role is likely to involve other elements which might be harder to describe. This role in the minds of those involved (both those undertaking the role, and others in contact with people undertaking the role) might also be distinct in other ways from other roles within an organisation. Roles can be understood based on three concepts: as a patterned and characteristic social behaviour, as an identity assumed by a social participant, and as a script or expectation for behaviour that is understood by all and adhered to by the performer involved [16].
One aim of qualitative research is to discover what a phenomenon is like from the point of view of those experiencing it, thus providing access to an insider perspective [17]. A narrative review of such studies would bring the research findings together by describing and comparing them. However, more sophisticated techniques are being developed to synthesise this literature. These apply the rigour of systematic reviewing, but at the same time, are sympathetic to qualitative research methods and 'go beyond' a mere description of findings [18]. These methods aim to be interpretative and configurative (i.e., aiming to make new or enhanced meanings by making connections between existing studies) rather than merely adding together or aggregating the qualitative study findings [19, 20]. Reviews using these techniques include topics such as lay understanding of cancer risk [21], and children's and young people's perspectives on body size [22, 23].
We undertook such a review of perspectives on the volunteer role in specialist palliative care, focusing on the role of volunteers with direct patient and family contact, and using thematic synthesis [24]. We aimed to uncover how the volunteer role is understood by those experiencing the role (either as volunteers, volunteer coordinators or patients and family carers), rather than just what volunteers do.
Identifying papers for review
Inclusion criteria
Study inclusion criteria
Inclusion criteria
Study design qualitative study, defined as:
○Data collected by talking to participants, for example, using in-depth or semi-structured interviews and/or focus groups
○Employing a qualitative data analysis method, either mentioned by name, such as grounded theory, discourse analysis, or interpretative phenomenological analysis, or indicated by the use of words associated with such techniques, such as hermeneutic, thematic, or inductive.
○The presence of at least one of the above criteria (data collected or analysis method) should be indicated in the abstract
Study population participants (i.e., people providing the data) should have direct experience of volunteering or of others volunteering in end-of-life care, typically volunteers themselves, patients, patients' (including deceased patients') families/carers, or end-of-life staff. This should be clear from the abstract.
Data #1 there must be extractable data about the role of volunteers in end-of-life care from participants' point of view, for example, but not limited to, what they understand the role of end-of-life volunteers to be, what a volunteer in end-of-life means to them, or what is the contribution of volunteers in end-of-life care. Check full paper.
Data #2 Data relating to volunteers can be extracted separately from that relating to other groups, such as paid staff. Check full paper.
Care focus #1 examines end of life care, defined as care for people at the end-of-life, regardless of age or disease, including palliative care, in any setting (eg hospice, palliative care unit, home care). This should be clear from the abstract, but if in doubt, check full paper.
Care focus # 2 focuses on care given by volunteers in patient/family-facing roles. Should be clear from the abstract, but if in doubt, check full paper. Care defined as activities volunteers perform in relation to patients/families or their implicit role in relation to patients/families.
Reporting language is reported in English. Clear from full reference.
Report format is not a dissertation or thesis or conference abstract. Clear from full reference.
Search process
We searched from inception to May 2013 the following electronic databases: Amed, Cinahl, Embase, Medline, PsycInfo, Science Citation Index Expanded, Social Sciences Citation Index, Conference Proceedings Citation Index – Science, Conference Proceedings Citation Index - Social Sciences & Humanities, IBSS, Campbell Library, and OpenGrey (Sigle). As part of the searches for a wider project on volunteer activity in palliative care (http://www.mariecurie.org.uk/Documents/Research/funding-research/bridget-candy-short-grant-summary.pdf), we searched for all available literature (regardless of research method) reporting empirical research on volunteers in palliative care settings. We developed search strings for 'volunteer' and 'palliative' using both free-text terms and subject headings tailored to each database searched (Additional file 1). In addition, we searched abstracts from relevant conferences and searched all abstracts available online from the Journal of Pain and Symptom Management and Palliative Medicine. We scanned reference lists of studies meeting our inclusion criteria, and undertook forward citation searches of included studies. We identified researchers in the field using a snowball technique, and contacted those found for information on unpublished or soon-to-be-published studies.
Study selection
Two reviewers independently scanned titles and abstracts of downloaded citations to identify papers potentially relevant to our broad topic area of volunteers in palliative care settings (RB, BC). The outputs of the two reviewers were combined, and inconsistencies discussed to resolve differences. From the resulting list, studies were identified for potential inclusion in the present review based on the above inclusion criteria. We retrieved the full papers for citations which appeared to meet our inclusion criteria, and double-checked that the criteria were in fact met.
Quality assessment
For papers that met our inclusion criteria, we undertook two quality assessment procedures since we could find no single tool which both covered practical issues involved in qualitative research (mediated by the quality of reporting rather than necessarily a true reflection of what researchers actually did) and looked at the findings and overall usefulness of potential studies in sufficient detail. First, we applied the Critical Appraisal Skills Programme (CASP) [25] qualitative appraisal tool, which focuses on the rigour, credibility and relevance of research. Second, we used the method developed for another qualitative systematic review [22] which was modified from a set developed for examining the findings of evaluations of intervention processes [26, 27]. This method focuses in more depth on both the reliability and usefulness of a study's findings (available from the authors).
Analysis methods
We used the method for thematic synthesis outlined by Thomas and Harden [24]. This involves three stages: coding the text, developing descriptive themes, and generating analytical themes.
We used EPPI-Reviewer 4 software to organise codes into hierarchical structures, and to keep track of study details and the quality assessment process [28]. The text of each included study was loaded into the software verbatim. One reviewer (RB) developed a set of descriptive codes inductively by coding each line of the findings sections of all the included studies, focusing on those portions of study findings that met our inclusion criteria, categorising meaning and content. Working independently, a second reviewer (BC) using Word software re-applied the codes developed by the first reviewer to the study texts, and, in the process, developed additional codes. The two reviewers discussed the codings, and the first reviewer re-examined the entire set of findings again, paying attention in particular to the new codes identified by the 2nd reviewer, updating the coding frame where they agreed with interpretations.
Initial codes were grouped and regrouped so as to create themes, and then hierarchies. The groupings were then further refined by discussion (RB/BC) and re-checking of the original studies (RB/RR). Successive drafts of a narrative that described the themes seen in the findings were then discussed by the wider study group (RB, BC, JL, RR) and further refined.
Studies found
Included studies
Twelve studies met our inclusion criteria [1, 3, 5, 29–37] involving 294 participants. In three studies respondents had experience of care based in a dedicated hospice building [29, 31, 36], in six respondents had experience of home-care [31, 33–35, 37], and in three respondents had experienced a mix of care settings [1, 30, 32]. In seven studies respondents were volunteers [1, 29–33, 36] (168 participants with ages ranging from 18 to 74), in two they were patients and/or family members of patients who had received volunteer care [5, 37] (38 participants, age range 23-87), and in three respondents came from a mixed population from different care settings or were volunteer coordinators [3, 34, 35] (130 participants, age range 28-65+). The majority of participants in all studies were women. All but three studies [1, 32, 33] were published since 2004. Seven studies were from North America [1, 29, 30, 32–34, 37], four from Europe [5, 31, 35, 36] and one Africa [3]. See Additional file 2 for further details. Comparisons between studies based on setting are drawn where appropriate in the discussion. Other comparisons, for example, between different groups of respondents, have not been made since there were relatively few studies in some categories.
Analysis methods used included thematic analysis [3, 30–32, 35, 36], hermeneutic approaches [29, 37], and grounded theory [1, 34]. Two studies did not state the analysis method used [5, 33].
Quality assessment
Summary of the quality assessment process
Number of CASP criteria met (maximum 9) [25]
Additional assessment criteria [26, 27]: Overall reliability/trustworthiness of the findings
Additional assessment criteria [26, 27]: Overall usefulness of the study
Andersson [29]
Berry [30]
Field-Richards [31]
Finn-Paradis [32]
Guirguis-Younger [1]
Harris [33]
Jack [3]
Luijkx [5]
McKee [34]
Sevigny [35]
Watts [36]
Weeks [37]
Synthesis findings
Theme clusters found in the synthesis
Theme cluster
Sub themes
Distinctness of the volunteer role
Distinct role from that of staff
Specific volunteer roles: professional-like; go-between; advocate/mediator; teamwork; surrogate; relationship roles
Characteristics of the role
Social nature of the role
Providing support
Just being there
Just listening
Keeping patients happy
Volunteer experience of the role
Ambiguity, flexibility and informality
Staff restrict information
Staff control the volunteer role
The distinctness of the volunteer role
Study participants, who included patients and families, as well as volunteers themselves, saw the volunteer role as having an identity separate from the role of paid staff. They also distinguished specific volunteer roles.
Distinct role from that of staff
Respondents made distinctions between staff and volunteer roles by talking in terms of recognised work boundaries [29, 34, 35]. The language used included "not doing someone else's 'paid work', not stepping on the toes of professionals." [34], p.167 and "being afraid to cross over into the domain of the nurses" [29], p.605.
"And I think, for Matthew, the fact of having somebody from outside, not just staff, is important. I think the staff that deal with you all the time, there is some humiliation in your situation that staff has to deal with at another level, his physical needs, so this is strictly someone to talk and be there, a friendly face, a kind face" [37], p.89.
Participants also emphasised the distinctiveness of volunteer roles from those of staff. In one study the volunteer role was summed up as 'complementary, not substitutive' [35], p.743. Another study reported that volunteer coordinators considered that volunteers "provide what no one else on the health care team provides—they are friends and companions to the dying - the possibility of infringing on the roles of others on palliative care team is minimal" [34], p.167.
Specific volunteer roles
Study participants described two categories of volunteer role: one characterised by independence, where volunteers undertook a task that might otherwise not be done by anyone else, and the other characterised in terms of surrogacy.
The first of these included acting as a 'go-between' between patients/family and paid staff [31, 35], or acting as an advocate for the patient and family [33, 35]. One volunteer reported how volunteers "…might notice something that hasn't been picked up by the nurses or something, indeed they might not have said to the nurses, something that they perhaps feel unable to talk about. So you know, we are able to pass stuff on if necessary" [31], p.629.
The role of volunteers in representing patients' interests is explicitly mentioned by volunteer co-ordinators in one study, who said, "They [volunteers] also act as mediators and, at times, advocate for the patient" [35], p.741.
When volunteer roles were talked of in terms of surrogacy, volunteers were seen as becoming, albeit temporarily, an additional or substitute family member or friend [31, 33, 34, 37]. One study reported that participants talked of how "… volunteers will step in …to forge a bond of real friendship so that when the client dies they are 'like family'"[34], p.166.
As one bereaved spouse put it, "Knowing somebody else was aware of what the situation was. I think that was the biggest thing, other than the nurses in the hospital. It was just good. It was a replacement for family, because my family was all away" [37], p.89.
The characteristics of the role
The social nature of the role
The volunteer role was largely characterised in social terms rather than in terms of the specific tasks they undertake [5, 29–32, 34–37]. As one volunteer said, "We encourage the other side of what obviously makes you human not just you know having your physical stuff seen to but just having the social stuff seen to" [31], p.629.
Participants emphasised the importance of relationships, both actual and anticipated. One study reported that volunteers "clearly voiced, that developing genuine and true relationships … constitutes one of their main functions" [35], p.740. For others, experiences of the social side of their work had not always met expectations [29, 32]. A volunteer in one study, for example was reported as saying they had expected "more opportunities to meet them [patients] in some kind of human relationship" [29], p.605.
Providing support
"They [the volunteers] sat and talked to me [bereaved spouse] and just spent time with me, letting me do whatever I wanted to do until I could come to grips with the situation, so it was emotional and mental." [37], p.90.
"Most of the conversations were about everyday things: 'to make things a little positive, it won't be that sad then" [29], p.606.
"All of the coordinators explained that what their volunteers actually "do" is hugely variable and depends completely on what the client and family need and ask for. What does not vary is a fundamental commitment to being there " [emphasis added by review authors] [34], p.166.
Volunteer experience of the role
When volunteers described their experience of their role, their accounts referred to ambiguity, flexibility and informality. Central to their experiences were volunteers' relationships with paid staff, and the control had by paid staff over volunteers' work.
Ambiguity, flexibility and informality
Ambiguity was connected either with uncertainty around the tasks volunteers should undertake [32], or to a lack of clarity about their role on the part of a volunteer in relation to other roles undertaken in their day-to-day life, for example, between being a volunteer and also knowing the patient as a neighbour [34]. This could have negative connotations, for example, "35% (6) of the volunteers interviewed noted that they were not always clear about their role in the organization and, as a result, felt job stress" [32], p.170.
"As long as what I am doing is help to them [staff and clients], I am happy with what I am doing. It does not matter what the job is. ….. and as long as I am of assistance, I am happy . . . ." [1], p.18.
Volunteers referred to the unpaid nature of their role and reported that this led to their perception of the role as informal [31, 35, 36]. A perception of informality was reported in one study to have "attracted them [volunteers] to volunteer initially" [31], p.628.
"It all has got so formal somehow and maybe we matter less because of that" [36], p.112.
Relationship of the volunteer role to that of staff
Some volunteers described aspects of their role that might be considered 'professional-like' [1, 29, 30, 32]. This included using medical terminology [32] and approaching patients in a more formal way than a friend would [29].
Volunteers also emphasised the value of being part of a team with staff [1, 29, 31, 32]. As one put it, "I very much appreciate that we work as a team . . . it takes some time to develop a relationship with the nursing staff, but once you have that, you are definitely a part of a team" [1], p.20.
How staff control the volunteer role
In some studies participants indicated that the volunteer role is controlled by staff in a way which is not always appreciated by volunteers. This included reports of staff not planning in advance the tasks they would like volunteers to undertake, which volunteers found stressful [29]. One study described volunteer frustration with reporting arrangements that acted to limit their role: "Several volunteers wanted to function as counselors [sic] and to communicate directly with the nurse rather than to work with the social worker. They perceived the nurse as having greater authority and power over patient care plans than the social worker" [32], p.171.
"I expect to be on the periphery, but I want to know what ingredients there are in what we are cooking here" [29], p.605.
"As a volunteer I can easily feel left out since I do not understand much of what's going on in the work" [29], p.605.
The potential restriction by staff of volunteer access to patient information was a recurring theme [29, 31, 32]. Participants described concerns about appropriate activities for patients (for example, whether it was appropriate to take patients for a walk [29], p.606), patient confidentiality [32] and safety [31], as well as emphasising the need for information-sharing to improve team-work [29].
"I don't know why they would because I mean we're not professional and you know we're not nurses … I mean we're only here to help you know…we're not looking to take their jobs off them" [31], p.629.
"If there were things that I thought I wanted to do for the clients, staff would say go ahead, as long as it is safe. … It is a very open and supportive environment. If I said I wanted to try something, the staff would go to great lengths to help me get it started" [1], p.18.
In this systematic review of qualitative studies we aimed to uncover how the volunteer role in end-of-life care is understood by those who are closely involved with volunteering, for example, by being a volunteer or receiving volunteer care. Our findings suggest that a volunteer role exists which is largely distinct from that of paid staff, and is broadly social in nature. The findings will now be discussed including some areas of contradiction.
Distinct role versus the professional-like aspects of the role
Although the volunteer role seemed to be distinct from that of paid staff, the synthesis also found that volunteers in some studies appeared to take on a quasi-professional role. It may be that volunteers need to feel that their role is important in order to justify the time and effort they put into it and, therefore, they are keen for it to be seen as a distinct role. However, they may also feel that patients and families (and maybe the researchers) will take them seriously only if they appear to be professional-like. The concept of professionalism involves lay people putting their trust in professionals who in return maintain confidentiality [38]. Therefore, 'professionalising' the volunteer role in this way may be an important part of how patients and volunteers 'negotiate' their interaction. Volunteers' taking on a professional-like role was more common in studies where volunteers were respondents, contrasting with studies where family members were respondents where volunteers were more likely to be cast in a surrogate family role. There was a similar contradiction between the description of the role as 'complementary not substitute' and the finding that volunteers 'do what is needed' (seen in the characteristic 'flexibility'). This could imply that volunteers perform tasks which staff do not have time for, which suggests that the volunteer role may not really be a distinct role, but a way of stretching available funding. It is not clear from the included studies where participants talked about 'doing what is needed' what the tasks involved were, and whether they were part of paid staff's roles or not. Further primary research, such as an ethnographic study following volunteers in relevant settings, could usefully explore all these anomalies.
Types of role
The two types of volunteer role which emerged from the synthesis, independent roles and surrogate family roles, show how the volunteer role may adapt to the care setting in which it is played out. The included studies were undertaken in different settings, including patients' homes and inpatient care facilities. Surrogate family roles arose most frequently in studies of volunteers in homecare or mixed (i.e. both homecare and inpatient) settings. This may be because in inpatient facilities volunteers appear to patients and families to be more like staff in a setting where paid staff were also working. In the home, where patients and families are in a familiar environment, volunteers may feel most comfortable taking on the role of family member or friend. This may be particularly the case where there has been contact over a longer period of time or where only one volunteer has been involved with a family as can be the case when volunteers provide care in patients' homes. On the other hand, patients and families using inpatient facilities are likely to encounter relatively large numbers of staff and volunteers. Again, this contrast between roles could be usefully explored by further primary research, such as a qualitative study comparing relatives' experiences of volunteers in different settings.
Social nature
The dominant characteristic of the volunteer role emerging from the synthesis was its social nature, in particular that respondents characterised the role in social terms rather than in terms of the tasks they undertake. The perceived social aspect of volunteering in a hospice setting has been found to be a motivating factor for volunteers [39, 40]. The social cluster of themes was found in studies interviewing volunteers and in those interviewing family members. It was also found in studies in both home- and hospice-based care, indicating that this is a fundamental aspect of how the volunteer role is understood. Forming relationships with patients and their families are an important and sometimes neglected aspect in palliative care [41], for example, palliative care patients receiving volunteer visits have been shown to live for longer than those not receiving visits [42].
Volunteer experience
The synthesis also identified ambiguity in how the volunteer role is understood. On one hand the role was attractive to volunteers because of its flexibility and informality, qualities which were viewed positively by volunteers (although they are not defined in the studies, so it is unclear to what volunteers were specifically referring). On the other hand, volunteers found it stressful when the tasks to be undertaken were not clearly established, and when this was the case, the role was described as ambiguous. Since a largely quantitative study reports low levels of role ambiguity and role conflict among 97 hospice volunteers in Australia [43] this aspect of our findings would also be worthy of further primary research, such as a qualitative study focusing on volunteers' perceptions of this aspect of the role. Given the increased formalisation of volunteer roles resulting, for example, from legislation around health and safety [44], these aspects may effect volunteers' motivation and satisfaction with the role [45].
The synthesis highlighted the relationship between volunteers and paid staff as important in shaping the volunteer role. This included the way staff 'control' the role, for example, in some studies through restricting access to patient information. It is clearly expected that staff direct the volunteer role, for example, designating the tasks volunteers undertake, since they have overall responsibility for patient care. However, a quotation from a volunteer "in one study I expect to be on the periphery" [29] suggests that this volunteer sees their role as subordinate to that of staff (although the quotation begs the question, periphery of what?). The synthesis also identified issues of staff insecurity, as well as examples where members of staff were supportive of volunteers. All of these findings suggest that power relationships may shape the volunteer role [46], p.154, and further primary research exploring this would be worthwhile, for example, a qualitative study focused on the relationship between volunteers and staff.
In a previous survey, we found that some people volunteered their professional skills, most commonly hairdressers and beauty therapists [13]. In the studies included in the present review, authors did not differentiate between volunteers offering professional skills and others, implying that none of the volunteers were offering professional skills, although this is not explicitly stated. A study specifically of volunteers offering professional skills and comparing their experiences with those of other volunteers might be of value to volunteer coordinators to help manage both groups more effectively.
Implications of the findings
Understanding how a role is conceived by those involved (in the present review mostly volunteers, but also some family members and volunteer managers/coordinators) will help planners and managers of palliative care services to make the most of volunteers' contribution. For example, our findings could help volunteer coordinators present the role as realistically as possible to prospective volunteers. In particular, understanding that the role is not simply a set of tasks to be undertaken and that the role is strongly social in nature is important. Also, an appreciation of how the role is understood will be helpful in training paid staff to work alongside volunteers as effectively as possible. A specific issue which could be addressed includes the contrast between ambiguity in the role, which was stressful for volunteers, and flexibility, which volunteers liked (although this may be being eroded by increasing formalisation of the role due to the introduction of management policies, such as job descriptions [44]). Also, it would be useful to help volunteers understand and deal with any ambiguity they may experience in their role, as well as reducing any ambiguity that may exist by training staff to understand what volunteers can contribute to the patient and family experience of care.
Methodological reflections
The quality assessment process
Three studies contributed very little to the analysis [3, 5, 33]. One of these scored poorly on both quality assessments [33], and one other [5], scored poorly on one set of criteria [22] and lower than most of the other studies on the other [25]. Retaining them in the analysis did not appear to compromise the synthesis since the weaker studies merely contributed to fewer themes rather than changing the themes. The third study [3], although scoring well on both quality assessments, differed in other ways from the other studies. It was the only study not undertaken in a developed country, and volunteers in this study undertook different tasks compared with those in the other studies (for example, providing clinical care). Its focus was also more on what volunteers do rather than on what it was like either to be a volunteer or to receive volunteer care. Furthermore, although this study's authors collected qualitative data, their analyses which used content analysis, were less inductive than most of the techniques used in the other studies. It should also be noted that the CASP criteria rely on quality of reporting which, in turn, is affected by publisher word limits, so not meeting these criteria may have been because of inadequate reporting rather than because these issues were not considered by study authors.
Turning to the second quality assessment tool used [22, 26, 27], which focuses in addition on the usefulness of a study's findings, three studies scored two points out of a maximum of four for 'overall usefulness' [5, 32, 33] which included an assessment of the extent to which the study privileged the role of volunteers. In one of these the focus was on volunteer stress and burnout [32]. In another, which is a comparison of paid and unpaid workers, the findings included little material suitable for synthesis [33]. In the third study the material presented focuses more on descriptive material about families' experiences of the whole care process rather than specifically on experience of volunteer care [5]. This demonstrates the utility of this quality assessment tool and also reflects the experiences of other researchers undertaking qualitative synthesis [47].
Inclusion criteria
The inclusion of one study [3] also raises the question of whether our inclusion criteria should have excluded studies from developing countries, particularly given that the majority of available studies were from the developed world. Given that the synthesis method tends to privilege themes which recur within the available data, any study which stands out from the others is likely not to have much influence on the final themes reported. Although there may be a universal volunteer role common across cultures and healthcare systems, we consider that removing this study would not have benefited our research. An important reason why this study contributed so little was that the data collected by the authors was not analysed using the sophisticated methods employed in other studies rather than simply because it was from a developing country.
In addition, we excluded papers where the primary focus was on topics such as volunteer motivations, stress and burnout, and training, unless findings focused on care given by volunteers in patient/family-facing roles (Table 1). We appreciate that this may have led to our omitting relevant data but we needed to set realistic inclusion criteria because of the time-consuming nature of thematic synthesis. We consider that data saturation was reached since similar themes recurred in the included studies, so additional studies would not necessarily have added relevant new themes [48].
We also included studies with a range of respondents, volunteers, family members and volunteer co-ordinators. This allowed us to gain as wide an understanding as possible of how the volunteer role is conceived, rather than just one respondent group's view, and whether some universal understanding of the role exists. It also acted as a triangulation method. The included studies were also from a variety of countries, just over half from North America and a third from Europe, as well as the one from Africa.
Another strength of our review was that we were able to explore the difference that care setting made on our findings, in particular the finding that our quasi-professional theme came mostly from studies based in inpatient care facilities and the surrogate family member theme from studies in home-based care.
The included studies employed a range of analysis methods which raises the issue of whether it is appropriate to combine data arising from different epistemological approaches. Little research has been undertaken on this issue [47] which largely remains theoretical. We could discern little difference between studies based on analysis method, except that those studies which did not state their analysis method contributed very little to the synthesis [5, 33].
We analysed the questions asked by the researchers in our included studies when collecting their primary data, so far as the information in the published papers would allow. These show a wide range of topics covered, some directly relevant to our research question (for example, 'Participants had the opportunity to share their….understanding of their role…' [1], p.17, and less directly relevant (for example, 'Opening question, "What made you become a volunteer here?". Then the volunteers were asked to describe personal experiences from their voluntary work.' [29]). This demonstrates how a systematic review of qualitative findings can go beyond those findings, and even the original intentions, of individual studies to answer a separate research question.
Thematic synthesis method
An important issue concerns the method of synthesis chosen, thematic synthesis, and how this suited our research question. Our question could be seen as being constructivist in nature, being about how the role of volunteer is understood. This could be construed as similar to how a role is constructed by relevant stakeholders, which is an idea based in an idealist epistemology (where reality is socially constructed [17]). However, our method draws on realist epistemology, where reality is considered knowable, albeit imperfectly [17, 18]. However, methods for qualitative synthesis are underdeveloped and which method to apply in particular situations may become clearer [49].
In using thematic synthesis, we followed the method set out by Harden and Thomas [18]. However, this has previously been used mainly with relatively broad research questions that look at participant views on loosely defined topics (for example, children's views on obesity [22] and barriers to, and facilitators of, healthy eating in children [50]). We, on the other hand, had a research question which was simultaneously less likely to be literally answerable from existing studies (from our searches of the wider literature on volunteers in palliative care settings we were not expecting to find studies which had focused specifically on how the volunteer role was understood) and was relatively tightly defined. Therefore, we kept our research question in mind throughout the synthesis process. This meant, for example, that when coding the studies for themes, we did not code literally every sentence of the findings or results sections as Thomas and Harden did [24]. Instead we coded only those portions of the text which were directly relevant to our research question, omitting sections which were clearly off-topic, such as some text on volunteer motivation [33], p.7].
In this way, the second stage of the thematic synthesis method as outlined by Thomas and Harden [24] was fulfilled, that is, developing descriptive themes. Thomas and Harden then describe using the descriptive themes to answer review questions by inferring answers from the themes, thus generating analytical themes. However, because of our constant mindfulness of our review question, we considered that we had effectively answered our question by the end of the second stage. We had largely focused on our review question when coding, for example, by omitting study findings which were clearly not relevant. Also, when comparing the codes generated in the initial coding and arranging them in a hierarchy we kept our research question in mind, asking ourselves, 'What does this code tell us about the volunteer role?'. We believe that we have 'gone beyond' the original studies to produce a synthesis which does far more than merely describe the findings of the included studies.
Given the aging population and current economic climate, it is likely that specialist palliative care will continue to rely on volunteer support. However, this should not imply that volunteers perform a substitutive role. Indeed, in the studies included in our review, volunteers appear to want to avoid this. As far as we are aware, this is the first systematic review of qualitative evidence to explore the volunteer role. We have shown how the volunteer role is understood, which will be useful for managers and others responsible for volunteer services or who work with volunteers to improve their everyday practice. We have also provided an example of the usefulness of thematic synthesis in synthesising qualitative studies.
The authors thank the Dimbleby Marie Curie Cancer Research Fund for funding the study.
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