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Clinician Survey on Speech Pathology Services for People with Aphasia in Hong Kong
Anthony Pak-Hin Kong1, Christine Wing-Kwan Tse2
1School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
2Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong
Correspondence: Anthony Pak-Hin Kong, School of Communication Sciences and Disorders, University of Central Florida, HPA-2 106, PO Box 162215, Orlando, FL 32816-2215, USA, Tel: +407-823-4791, Fax: +407-823-4816, E-mail: antkong@ucf.edu
This study aims to investigate aphasia practices by speech-language pathologists working with clients suffering from acquired neurogenic communication disorders through an online survey. Questions pertaining to content and intensity of aphasia management, service adequacy, and barriers to effective service provision to persons with aphasia were asked to understand the current service-provision situation in Hong Kong. A web-based questionnaire containing 38 questions was electronically distributed to speech-language pathologists in Hong Kong. A total of 41 respondents (equivalent to about 5% of the body of clinicians) completed and returned the survey. Compared to recommendations in existing best practice guidelines of aphasia from western countries, the results indicated that intensity and frequency of current aphasia services in Hong Kong fell short of expectations. Major challenges perceived by speech-language pathologists that contributed to dissatisfaction of aphasia service included limited manpower, resources, funding, and accessibility. It was also found that barriers to effective services could be related to clinicians' restricted adoption of intervention approaches, lack of active involvement of related healthcare professionals, and insufficient effort of referring persons with aphasia to support or self-help groups. Finally, factors to consider in order to improve existing aphasia management were discussed.
Keywords: Clinician survey; Aphasia; Service adequacy; Intervention approach; Best practice recommendations
Stroke, being the fourth leading cause of death, with 3,259 (or 6.97% of total) registered deaths [1], is a significant disease burden in Hong Kong. Based on a population health survey conducted by the Hong Kong Department of Health [2], the prevalence rates of stroke in the elderly population over 65 years was 5.5%; this was greatly higher than the 0.4% prevalence in those aged between 15 and 64 years. As a rapidly ageing population, it is estimated that by the year 2036, Hong Kong will have 2.3 million people aged over 65 years [3], thus suggesting that the number of people affected by stroke will increase. One of the most common consequence of stroke is aphasia; each year, Hong Kong has over 20,000 new cases of stroke [1,4], of which up to 38% are affected by aphasia [5].
Aphasia affects a person not only in terms of communication, but also social functioning and quality of life, and is considered to be a key predictor of one's post-stroke social outcome. Compared to stroke survivors who are not affected by aphasia, persons with aphasia have been reported to participate less in activities and have a poorer quality of living [6]. Albeit the obvious need of post-stroke services and intervention for persons with aphasia, the focus of existing aphasia management is often placed on fast transitions between care settings or discharge planning because Speech-language pathologists have restricted time for providing aphasia-specific services for stroke survivors [7]. Given that Speech-language pathologists in acute settings tend to focus on dysphagia treatment, persons with aphasia are placed at risk of exploiting neuroplasticity during early onset and thus affect outcome of overall aphasia treatment. Moreover, there is a large array of therapy approaches addressing different aspects of deficits associated with aphasia (such as the functional approach, social/life approach, or neuropsychological approach) that can be mediated in the form of individual or group settings [8]. Choosing the best suited approach and format of intervention for persons with aphasia through individualized planning can facilitate and enhance treatment effects [9].
Speech and language services is one of the important components of stroke rehabilitation. The Hong Kong Hospital Authority has been responsible for managing public hospitals in Hong Kong and delivering services to the community since 1991. There are currently 41 public hospitals and institutions as well as 47 specialist outpatient clinics in Hong Kong managed by Hong Kong Hospital Authority. Post-stroke language therapy for persons with aphasia in the acute phases is mainly provided in government hospitals. Chronic persons with aphasia are often referred to specialist outpatient clinics for follow-up, but most of them self-refer to local university speech-language clinics, community non-profit organizations, and private clinics. In 2008, there were roughly 400 Speech-language pathologists working in Hong Kong [10] but the total number was estimated to have doubled in the past decade. According to the recent report by Hong Kong Association of Speech Therapists [11], approximately 4% of the members were employed under Hong Kong Hospital Authority and 27% registered as working in a private setting.
Speech and language intervention services for persons with aphasia in Hong Kong may be affected by cultural values and beliefs. There is a mismatch between the resources and cultural belief of receiving service among persons with aphasia in eastern and western countries [12]. For example, Asian Americans have been found to be more reticent than Americans about mental distress, thus Asian Americans will be less likely to engage in help-seeking and utilization behaviors. People with Chinese cultural value orientation exert an indirect effect on help-seeking intentions, and respond with more feelings of shame when posed with problems and thus show lower intentions to seek for help [13]. Moreover, it was reported that self-concealment was negatively related to attitude towards counseling and seeking help in the Asian and Asian American populations [14]. In other words, the difference in behavior acculturation between Asian and Western cultures contributes differently to one's willingness to look for assistance regarding personal concerns. A higher degree of public awareness of aphasia services in societies of Asian countries and better education to caregivers of persons with aphasia should, therefore, be emphasized in service delivery to ensure that all persons with aphasia can receive treatment without feeling the need for self-concealment.
In Hong Kong, research on speech and language pathology is limited and its related information is generally less accessible compared to western countries, which are known for their comprehensive and funding-supported provision of education, training, and services for individuals with communication disorders [15]. Kong [16] is one of the very few reports on a family-member survey regarding rehabilitation services for persons with aphasia in Hong Kong. The results revealed that aphasia treatments were insufficient in terms of duration (over 50% of sessions lasted for only 30 minutes or shorter) and frequency (acute persons with aphasia only attended weekly and chronic persons with aphasia attended monthly session), which was below the standards suggested by most existing best practice guidelines (e.g., [17]). A high proportion of respondents (>42%) were dissatisfied with the aphasia services they had received although the content and approaches of treatment utilized had not been specified.
To optimize client care and service delivery for persons with aphasia, knowledge of current practices regarding assessment as well as post-stroke rehabilitation and intervention is required. At present, little information is available regarding the current practice of aphasia therapy in Hong Kong. This study aims to investigate aphasia practices by Speech-language pathologists working with clients suffering from acquired neurogenic communication disorders through an online survey. Specifically, questions pertaining to the content and intensity of aphasia management, adequacy of services, and barriers to effective service provision to persons with aphasia (in the context of best practice guidelines in most western countries) were asked in the clinician survey to understand the current service-provision situation in Hong Kong.
It is anticipated that the results of this study will potentially allow for reallocation of resources by the service providers to facilitate aphasia rehabilitation, and to allow local clinicians to gain a clearer picture of current service provision compared to the ideal management of aphasia, thus to identify how assessment and intervention practices can be modified, and in turn to improve the quality of living for persons with aphasia.
The survey was designed to include major parameters guidelines of service delivery for persons with aphasia to allow for comparison between actual and recommended practice. A pilot survey was completed by five student Speech-language pathologists at The Education University of Hong Kong. With reference to the received feedback regarding the clarity, length, and appropriateness of the questions, the survey was finalized and consisted of 38 items covering the following topics, including (i) Background information, i.e., work setting and clinical experience in aphasia of the SLP respondents, (ii) Aphasia assessment, e.g., assessment tools, outcome measures, and frequency and duration of assessment sessions for persons with aphasia, (iii) Service delivery/Treatment, e.g., frequency of sessions for persons with aphasia, average number of sessions per persons with aphasia, average duration of treatment session, and intervention content utilized, (iv) Aphasia intervention approaches, e.g., clinician's knowledge of different aphasia treatment approaches and their level of confidence and frequency of using these approaches, (v) Client education and counselling, e.g., frequency of client education and counselling, methods of providing client education, and frequency of community education activities, and (vi) Goal setting and discharge, e.g., frequency of collaborating with persons with aphasia and family in goal-setting, reason(s) for discharge, and content of review sessions. Survey Gizmo was used to develop the online questionnaire. Details of the 38 questions, which included answer formats of Yes/No, rating scales, checklists and open-ended text boxes, are listed in Appendix A.
To assess the reliability of self-rating scales pertaining to knowledge, confidence and frequency of using approaches to aphasia rehabilitation, reliability analyses were conducted. The knowledge scale consisted of 11 items (α=0.88), the confidence scale consisted of 11 items (α=0.86), and the frequency scale consisted of 11 items (α=0.6). Knowledge and confidence scales had good internal consistency whilst frequency scales had acceptable internal consistency. The measures also had good face validity.
A web-questionnaire was distributed to practicing Speech-language pathologists in Hong Kong working in hospitals, private settings, university clinics, non-profit organizations, and nursing homes. The questionnaire was electronically released and participants were recruited via email, social media platforms, and through listing on the Monthly Newsletter of the Hong Kong Association of Speech Therapists.
The data from Survey Gizmo was downloaded and collated into an Excel database to ensure valid responses and to rule out duplicate responses. Descriptive statistics and correlational analyses was generated. Anchor points was given to questions utilizing 5-point rating scales. Responses to open-ended questions was downloaded to perform content analysis. Results from the descriptive review of present study were then used to analyze survey results.
A total of 41 Speech-language pathologists in Hong Kong, with an accumulated clinical experience of providing services to persons with aphasia of 7.21 years (s.d.=5.24 years), completed the survey. The distribution of their primary work setting was as follow: Hospitals (39%), Private clinics (24%), University clinics (20%), and non-profit organizations (17%), thus covering a broad spectrum of working environments. Over half of the respondents had 10% to 50% of caseload involving persons with aphasia. However, the dominant caseload of Speech-language pathologists in the hospital setting was reported to be clients with dysphagia.
Concerning assessment of aphasia, most of our respondents reported an average duration of 60 minutes (41.5%) or 30 to 45 minutes (36.6%) per session. Interesting, out of the four clinical settings, only Speech-language pathologists in the hospital group reported providing assessment in 30-minute sessions (21.9%). Information regarding assessment batteries utilized was also sought. A total of 11 assessment/screening tools were reported, such as the Cantonese version of Western Aphasia Battery [18] (50.0%), Cantonese Linguistic Communication Measure [19] (11.8%), Psycholinguistic Assessments of Language Processing (3.9%), Clinical Evaluation of Language Fundamentals (2.6%), or The Multimodal Communication Screening Test for Aphasia (2.6%). Use of informal assessment tools (18.4%) or self-developed items (6.6%) was not uncommon. In addition, 14.6% of the SLP respondents reported to have made revisions to the existing English aphasia screening/assessment tools for their Cantonese-speaking clientele in Hong Kong. Nearly all the tools listed by our Speech-language pathologists were impairment-based assessment batteries and only 1% reported was specific for cognitive-communication disorders (i.e., the Montreal Cognitive Assessment). Interestingly, there were no mentioning of measures that tapped on persons with aphasia's functional communication, language sampling, or quality of life.
As for questions related to aphasia intervention, it was found that the majority of Speech-language pathologists provided treatment once per month (48.8%). Again, hospital-based clinicians tended to provide the shortest treatment sessions of less than 30 minutes at 68.8% of the time. With regards to types of treatment provided, all Speech-language pathologists reported to have included individual therapy in sessions. Communication partner training was the second most included intervention, followed by group aphasia therapy and social community education. None of our respondents reported provision of other types of intervention, such as tele-rehabilitation, computer- or technology-based therapy, in their treatment sessions.
Rehabilitation approaches
The respondents self-rated their knowledge on, confidence with, and frequency of using eleven different approaches in aphasia rehabilitation, including (i) Cognitive Neuropsychological approach, (ii) Functional approach, (iii) Social/life participation, (iv) Discourse-based intervention, (v) Technology-based intervention, (vi) Stimulation, (vii) Group therapy, (viii) Principles of neuroplasticity, (ix) Augmentative and alternative communication, (x) Conversation partner training, and (xi) Training for culturally and linguistically diverse persons with aphasia (see Appendix A for details). Results are displayed in Figure 1.
Percentage of participants' ratings on (A) knowledge, (B) confidence and (C) frequency of use of different approaches to aphasia therapy.
Speech-language pathologists' knowledge on and confidence with 'Functional', 'Social/life participation', and 'Principles of neuroplasticity' were rated the highest. These three approaches were also reported to be the most frequently used. Knowledge and confidence of 'Technology-based', 'Stimulation' and 'Training for culturally and linguistically diverse populations' were rated as 'Limited' or 'Unconfident' by most respondents; they were reported to be used only 'Sometimes' by over half of the respondent, who self-claimed to be 'very knowledgeable' of and 'very confident' on them.
Pearson Correlation test of independence was calculated to determine if the Speech-language pathologists' knowledge of an approach was independent to their confidence level in clinical application. Moderate and positive interactions were found in all approaches with high significant levels. The Pearson Correlation test of independence was also calculated to determine whether clinicians' knowledge of and confidence of different interventions was related to the frequency in implementation. In terms of knowledge and frequency of use, as well as confidence and frequency of use, only weak to moderate interactions were found for cognitive neuropsychological, social/life participation, principles of neuroplasticity, augmentative and alternative communication, conversation partner training, and training for culturally and linguistically diverse populations (Table 1).
Correlational relationships between knowledge on, confidence with, and frequency of using various approaches to aphasia therapy
The respondents were asked about the frequency of and methods used in educating persons with aphasia, their caregivers, and other health practitioners about aphasia as an integral part of clinical responsibility. A relatively small percentage of Speech-language pathologists 'always' provided education, to persons with aphasia (22%) and caregivers (29.2%). In contrast, 63% of respondents reported doing so 'frequently' or 'occasionally' to health practitioners (only 2.4% of them indicated they 'never' provided client education to other health practitioners). Concerning the methods adopted for education, all participants (100%) reported the use of verbal means in giving relevant information or outlining options of aphasia treatment to both caregivers and persons with aphasia. The next two popular methods were through written (63.4%) and web-based materials (48.8%). Only 4.9% (n=4) reported their use of providing demonstrations in the education process.
Goal setting and discharge
The results revealed extensive involvement of persons with aphasia and caregivers when Speech-language pathologists set intervention goals. Specifically, Speech-language pathologists 'always' (24.9%) and 'frequently' (53.7%) collaborated with persons with aphasia when setting goals. This was also the case for involving caregivers: 'always' (22.0%) and on a 'frequent' basis (68.3%),
In regard to discharging persons with aphasia from therapy, the most frequently reported reason was 'poor' or 'plateaued' progress in therapy sessions (18.4%), followed by clients achieving functional communication (14.5%), and poor prognosis of the persons with aphasia (13.2%). Other reasons included client withdrawal or health reasons, low motivation of persons with aphasia, limited financial support, and deficits were minor. Interestingly, 100% of the respondents indicated that they believed their persons with aphasia clients still required language intervention at the time of discharge and, therefore, home-practice was always given (100%). Other common recommendations given by Speech-language pathologists included 'educational materials' (63.4%) and referral to community self-help groups (41.5%) or hospital-/non-profit organizations-based support groups (48.8%).
In addition, 14.6%, 36.6%, and 34.1% of Speech-language pathologists reported they 'frequently', 'occasionally', or 'never', respectively, reviewed their patients after discharge. Only 1% of them reported their persons with aphasia clients were 'always' reviewed. Of the respondents who provided follow-up to their persons with aphasia (n=27), the most frequently reported review-interval was at '6 months' (40.7%), followed by '1 year' (22.2%) and 'over 1 year' (18.5%). Only a small portion of persons with aphasia were reviewed shortly after discharge: 14.8% in '2 to 3 month' and 3.7% in '2 weeks to 1 month' intervals. Concerning the content of the follow-up sessions, it was found that while Speech-language pathologists always reviewed the persons with aphasia's language ability (100%), language training for persons with aphasia and communication partner training was also conducted by 66.7% of Speech-language pathologists.
Challenges and facilitators to service delivery for persons with aphasia
Our participants were asked to rate their overall satisfaction with the current service delivery for persons with aphasia in Hong Kong; 12% indicated 'very unsatisfied', 44% were unsatisfied, and the remaining 44% were neutral. With reference to the open-ended question related to Speech-language pathologists' view on perceived barriers and facilitators to service delivery for persons with aphasia in Hong Kong, the top four listed barriers to effective aphasia services were limited manpower (17.7%), limited resources (15.6%), limited government funding (13.3%), and limited accessibility (13.3%). Other reported barriers included the lack of evidence-based practice for Hong Kong populations (11.1%), limited time for sessions (11.1%), low client motivation (6.7%), limited involvement for persons with aphasia influenced by the culture in Hong Kong (4.4%), and limited support from caregivers (4.4%).
Our Speech-language pathologists specified that increasing the amount of clinical resources or tools tailored for the Hong Kong population (41.7%) would be the top facilitator to enhancing aphasia services. Other suggestions included additional funding to support clinical services (18.8%), employing more Speech-language pathologists (16.7%), enhancing clients' compliance of home practice (8.3%), more frequent treatment to persons with aphasia (4.2%), increasing patient motivation (4.2%) and caregiver support (4.2%), and providing resources for persons with aphasia's vocational training (2.1%).
This study is the first report on current speech pathology practice specific to persons with aphasia in Hong Kong and revealed findings with considerable implications to practice planning and future research in aphasia rehabilitation. It is estimated that our respondents represented 5% of the local Speech-language pathologists body practicing in Hong Kong. In particular, the possible discrepancy in adequacy of service delivery for persons with aphasia between Hong Kong and countries in the West, as we discuss below in detail, would ensure local Speech-language pathologists and Government to better understand the present status of service provision. We hope that this would potentially lead to modification of management programs through comparison to countries that excel.
Unsurprisingly, Speech-language pathologists in Hong Kong faced the same challenge as clinicians in the west, in terms of insufficient clinical resources and materials to support their practice. This can be considered as a major barrier to effective aphasia service delivery. Note that the assessment tools our respondents commonly used were mainly the ones that are impairment-based. This may potentially suggest that other impacting factors on the persons with aphasia's functional communication, such as life activity or social participation, were less holistically considered. In the past few years, a number of newly developed assessment batteries that are linguistically sensitive and culturally suitable have been published; some examples included the Hong Kong version of the Oxford Cognitive Screen [20], Cantonese version of Birmingham Cognitive Screen [21,22], Main Concept Analysis [23,24]. These tools can hopefully broaden the practice scope and widen the resource base of clinical diagnosis of aphasia in Hong Kong.
Given that evidence-based treatment protocols geared for native persons with aphasia in Hong Kong are still lacking, more research is warranted to allow us to better address barriers and gaps of service provision and to enhance the social living and quality of life of persons with aphasia. It has been recommended that aphasia treatment should best be provided five days per week or as intensive as tolerated [25,26]. Our results showed a clear insufficiency in terms of the frequency of aphasia training currently being offered (e.g., once weekly in university and private clinics, which was the closest to recommended level). This may suggest that paid services have potential influence on how often treatment can be provided to clients. Moreover, the result regarding duration of hospital-based aphasia rehabilitation (sessions of 30 minutes) was also found to be below the recommended standard of 45 to 60 minutes [27]. More manpower, resources, and funding, therefore, need to be given to acute/outpatient hospitals to allow service delivery that will be comparable to the international standard. Like treatment for any other speech-language disorder, treatment for aphasia is also individualized. However, it appears that our respondents tended to be restrictive in this aspect and the majority of treatment sessions were conducted through individual training. Finally, more efforts can be paid on targeting the improvement of communication access and reduction of stigma among persons with aphasia, especially because the difference of western and eastern cultures will affect service delivery for persons with aphasia. Kucukarslan [28] has explained why clients would decline treatment due to their perception of language and communication problems as these deficits related to cultural influences on prescribed treatments.
Concerning the caseload of clinicians surveyed, it was found that the dominant caseload in the hospital settings was dysphagia. This is in contrast to the report by Rose et al. [29] in which aphasia dominated the inpatient, outpatient, and community level rehabilitation settings. What also needs to be highlighted is that Speech-language pathologists working in settings of non-profit organizations or private clinics reported a high caseload of pediatric over adult/geriatric cases. This may be reflective of the lower degree of awareness regarding aphasia in the Chinese population and the different cultural values of Chinese who are more reluctant to seek help when posed with problems [13].
The high ratings of knowledge about and confidence in adopting functional and social-life participation approaches of aphasia rehabilitation as well as principles of neuroplasticity reported by clinicians in Hong Kong were similar to reports in Australia [29] and Singapore [30]. This suggests Speech-language pathologists' considerations of life participation under the WHO-ICF model, despite the lack of comprehensiveness in assessment procedures. The positive correlation between the clinicians' knowledge and confidence in using each treatment approach also reflects that continued research and development of related approaches in Hong Kong may facilitate local Speech-language pathologists' ability to extent existing therapy. In addition, our results revealed that the therapeutic approaches rated the highest in terms of knowledge and confidence by the respondents were most frequently used at the same time (despite the lack of significant correlation between knowledge/confidence and frequency of application of approaches to aphasia therapy in general). This seems to suggest that clinicians decide on which approach to utilize based on client's ability rather than their knowledge/confidence in application.
The present finding of Speech-language pathologists' self-rating of knowledge on and level of comfort in applying various clinical approaches of aphasia rehabilitation also sheds some light on direction of continuing education for Speech-language pathologists. It was clear that as compared to impairment-based intervention, local clinicians were less equipped with knowledge base for managing the culturally and linguistically diverse populations. Knowing that 11.9% of the population in Hong Kong do not speak Cantonese as their mother tongue [3], with the percentage excepted to continually increase, local Speech-language pathologists may face more challenges for future serving of this potentially growing caseload. Equally significant will be the expansion of Speech-language pathologists' foundations of knowledge, such as persons with aphasia's social communication [31], discourse training, or group interventions that target social interactions, and their staying up-to-date on new developments, such as tele-rehabilitation to improving accessibility [32,33]. In light of the high penetration and easy access of tablets, smart devices, and internet in Hong Kong [3], technology-based aphasia therapy, e-learning, or i-Rehabilitation will become an important facilitator to service delivery.
One of the keys to successful aphasia management centers around educating persons with aphasia, their families, and related healthcare about aphasia through receive verbal and/or written materials [17,26,34–36]. The results from the survey suggests that there is room for improvement on this aspect where local Speech-language pathologists can strategically collaborate with different professionals when they provide services to persons with aphasia. Moreover, Speech-language pathologists may also consider utilizing a more diverse range of educational materials to persons with aphasia and their caregivers, instead of solely adopting a client-based approach in the process; this can be on top of the component of counselling [37,38].
According to the British Department of Health [39], it is recommended that persons with aphasia be reviewed 6-weeks from discharge. However, our results indicated that this was not the usual practice in Hong Kong (e.g., the majority of persons with aphasia follow-up sessions were provided 6 months to 1 year after discharge). This is worrying because Speech-language pathologists are limited in monitoring maintenance and/or regression of different acquired treatment effects among persons with aphasia, and subsequently cannot provide them with appropriate remediation. The beneficial effects of pairing persons with aphasia with support groups upon discharge have been documented [26,40]. Yet, our current services for persons with aphasia during this transition period seemed to be inadequate because only about 50% of Speech-language pathologists referred their persons with aphasia to self-help or support groups once the therapy is terminated. Moreover, not all persons with aphasia received updated information regarding their functional abilities and/or materials as well as related resources for continuing rehabilitation upon discharge.
There are several limitations of the present study. First, our comparisons of 'best practice' for aphasia versus that of Speech-language pathologists in Hong Kong was based on a small number of countries due to lack of relevant research done on this topic in countries such as Australia [41], USA [42] or United Kingdom [43,44]. The findings may also not be readily generalizable to service delivery in underdeveloped countries. Due to differences in culture beliefs, government funding systems, cultural diversity, and how aphasia intervention is prioritized in Asian countries, one may question how easily applicable our survey results are to other Asian populations. Future directions in extending the current study may include examination of practice for other communication disorders beyond aphasia; this can lead to a clearer idea of how the field of speech and language pathology is developing in Hong Kong. Additionally, clinicians in Hong Kong are most concerned about locally-relevant resources in serving persons with aphasia, which warrants continuing research in developing these said resources for more holistic rehabilitation. With the upcoming trend of applying tele-rehabilitation and advancement of technology in aphasia management in Hong Kong, one may investigate how clinical service for persons with aphasia will improve using technology.
Speech and language services is one of the important components of post-stroke rehabilitation for speakers with aphasia. At present, little information regarding the current practice of aphasia therapy in Hong Kong is available. Being the first clinician survey on current speech pathology services offered specifically to aphasia in Hong Kong. Over half of our respondents (representing 5% of local body of practicing speech and language pathologists) were dissatisfied with the service delivery for speakers with aphasia. Existing practice fell short of most western standards in terms of manpower and financial resources as well as knowledge base of managing aphasia in Chinese. Replication of this study to other Asian countries will allow us to examine the quality of speech and language services in various cultural contexts.
Questions in the clinician survey for examining the current speech pathology practices for persons with aphasia in Hong Kong
Section A: Background Information
1. Are you currently working in the speech-pathology field? [Yes/No]
2. What is your current primary work setting? [Hospital/Private practice/non-profit organizations/Nursing home /University clinic/Other (please state)]
3. What is the dominant caseload in your current work setting? [Dysphagia/Apraxia of Speech or Dysarthria/Aphasia/Cognitive communicative disorders/Other (please state)]
4. In the course of your practice, what is the approximate percentage of caseload that contains people with aphasia? [<10%, 10–25%, 26–50%, 51–75%, >75%]
5. How long is your accumulated clinical experience with aphasia (months/years)? [___years ___months]
Section B: Assessment/Screening
6. Please list the screening/assessment tools you have used for persons with aphasia.
7. What is the average duration of an assessment session you provide to persons with aphasia? [<30 minutes, 30–45 minutes, 1 hour, 1.5 hours, >1.5 hours]
8. Have you made revisions to screening/assessment tools for aphasia? [Yes/No-Go to Q12]
9. How often do you need to reevaluate and/or revise screening/assessment tools of aphasia? [Less frequent than once per 3 year/Once every 3 years/Yearly/Once every 6 months/More frequent than once per 6 months]
10. What screening/assessment tools of aphasia have you reevaluated and/or revised?
11. What revisions did you make (tick all that apply)? [Translation/Omission of items/Adding items/Cueing hierarchy/Changing instructions/Other (please state)]
Section C: Service delivery/Treatment
12. What is the average frequency of treatment sessions you provide to persons with aphasia? [Daily/More than once per week/Weekly/Bi-weekly/Monthly]
13. What is the average duration of a treatment session you provide to persons with aphasia? [<30 minutes, 30–45 minutes, 1 hour, 1.5 hours, >1.5 hours]
14. What intervention do you provide to persons with aphasia (tick all that apply)? [Individual therapy/Group therapy/Communication partner training/Telerehabilitation/Social community education/Other (please state)]
15. Please list any challenges you face in provision of effective aphasia intervention services (For example, limited resources/funding, accessibility, lack of strong scientific evidence, etc.).
16. Please list factors that can facilitate your service provision for persons with aphasia.
17. How satisfied are you with the current service delivery provided for persons with aphasia? [Very dissatisfied/Dissatisfied/Neutral/Satisfied/Very satisfied/]
18. Which of the following areas should be improved for aphasia service delivery (tick all that apply)? [Frequency of sessions/Duration of sessions/Community education/Number of sessions in a block/Communication partner training/Other (please state)]
Section D: Clinical approaches of aphasia rehabilitation
Characteristics of different clinical approaches of aphasia rehabilitation are given below:
19. How would you rate your knowledge in each of the above clinical approaches of aphasia rehabilitation? [Very good/Good/Adequate/Limited/Very limited]
20. How would you rate your current level of confidence in providing service to persons with aphasia using the above clinical approaches of aphasia rehabilitation? [Very confident/Confident/Neutral/Unconfident /Very unconfident]
21. How often do you use the above clinical approaches of aphasia rehabilitation in your practice? [Very frequently /Frequently /Sometimes/Rarely /Very rarely]
Section E: Client education and counselling
22. Do you educate persons with aphasia about aphasia? [Always/Frequently/Occasionally/Rarely/Never]
23. What do you use to educate persons with aphasia (tick all that apply)? [Verbal explanation/Written information/Video resources/Web-based material/Other (please state)]
24. Do you educate the persons with aphasia's family and communication partners about aphasia? [Always/Frequently/Occasionally/Rarely/Never]
25. What do you use to educate the persons with aphasia's family and communication partners about aphasia (tick all that apply)? [Verbal explanation/Written information/Video resources/Web-based material/Other (please state)]
26. Do you provide counselling to persons with aphasia and family regarding the emotional and social changes that may occur with aphasia? [Always/Frequently/Occasionally/Rarely/Never]
27. Do you perceive yourself as competent in providing such counselling? [Yes/No]
Section F: Goal setting and discharge
28. Do you collaborate with the following people in goal setting? (i) persons with aphasia, (ii) Friends/Family of persons with aphasia, (iii) Multidisciplinary team [Always/Frequently/Occasionally/Rarely/Never]
29. What are your three most common reasons for discharging persons with aphasia?
30. Do you review your persons with aphasia client after discharge? [Always/Frequently/Occasionally/Rarely/Never]
31. On average, when do you review your persons with aphasia clients after discharge? [2 weeks–1 month/2–3 months/6 months/1 year/> 1 year]
32. What is done during the review session (tick all that apply)? [Review of language ability/Training of language ability/Communication partner training/Other (please state)]
33. After discharging persons with aphasia, did you think they still required language intervention? [Yes/No]
34. Were recommendations for service given to the persons with aphasia upon discharge? [Yes/No-Go to Q36]
35. What recommendations do you give usually for persons with aphasia upon discharge (tick all that apply)? [Home practice/Other private services/Educational materials/Workshops/Self-help groups/Support groups/Other (please state)]
36. Do you work directly in the community to improve communication access (e.g. educating bank or café staff about communicating with persons with aphasia)? [Always/Frequently/Occasionally/Rarely/Never]
37. Do you provide education to health practitioners regarding how to communicate with persons with aphasia? [Always/Frequently/Occasionally/Rarely/Never]
38. What would you like to see in future research regarding treatments for aphasia?
Declaration of interest statement
The authors report no conflicts of interest. Both authors contributed to the research design, acquisition and interpretation of data, as well as drafting, amending, and critically reviewing this manuscript.
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9. Damasio AR. Aphasia. New England Journal of Medicine 1992;26:531–539.
10. Hong Kong Association of Speech Therapists. Comments on the Healthcare Reform submitted by the Hong Kong Association of Speech Therapists Hong Kong: Available from http://www.fhb.gov.hk/beStrong/files/organizations/O082.pdf. 2017.
11. Hong Kong Association of Speech Therapists. Annual report 2015–2016 Hong Kong: Available from https://speechtherapy.org.hk/Documents.html. 2017.
12. Zhang AY, Snowden LR, Sue S. Differences between Asian and White Americans' help seeking and utilization patterns in the Los Angeles area. Journal of Community Psychology 1998;26:317–326.
13. Lau A, Takeuchi D. Cultural factors in help-seeking for child behavior problems: value orientation, affective responding, and severity appraisals among Chinese-American parents. Journal of Community Psychology 2001;29:675–692.
14. Liao HY, Rounds J, Klein AG. A Test of Cramer's (1999) Help-seeking model and acculturation effects with Asian and Asian American college students. Journal of Counseling Psychology 2005;52:400–411.
15. Cheng LR. Emerging issues in health and education in Asia-Pacific: a focus on speech-language pathology. Folia Phoniatrica et Logopaedica 2010;62:238–245.
16. Kong APH. Family members' report on speech-language pathology and community services for persons with aphasia in Hong Kong. Disability and Rehabilitation 2011;33:2633–2645.
17. Aphasia United. Aphasia United best practice recommendations for aphasia Available from http://www.aphasiaunited.org/best-practice-recommendations/.
18. Yiu EML. Linguistic assessment of Chinese-speaking aphasics: development of a Cantonese aphasia battery. Journal of Neurolinguistics 1992;7:379–424.
19. Kong APH, Law SP. A linguistic communication measure for monitoring changes in Chinese aphasic narrative production. Clinical Linguistics and Phonetics 2009;23:255–269.
20. Kong APH, Lam PHP, Ho DWL, Lau JK, Humphreys G, Riddoch J, et al. The Hong Kong version of the Oxford Cognitive Screen (HK-OCS): Validation study for Cantonese-speaking chronic stroke survivors. Aging, Neuropsychology, and Cognition 2016;23:530–548.
21. Kong APH, Chan J, Lau JKL, Bickerton WL, Weekes B, Humphreys G. Developing a Cantonese version of Birmingham Cognitive Screen for stroke survivors in Hong Kong. Communication Disorders Quarterly 2017;39:387–401.
22. Pan X, Chen H, Bickerton WL, Lau JKL, Kong APH, Rotshtein P, et al. Preliminary findings on the reliability and validity of the Cantonese Birmingham Cognitive Screen in patients with acute ischemic stroke. Neuropsychiatric Disease and Treatment 2015;11:2377–2390.
23. Kong APH. The main concept analysis in Cantonese aphasic oral discourse: external validation and monitoring chronic aphasia. Journal of Speech, Language, and Hearing Research 2011;54:148–159.
24. Kong APH. The Main Concept Analysis (MCA) for oral discourse production Hong Kong: The Commercial Press (H.K.) Limited; 2016.
25. Lindsay P, Bayley M, Hellings C, Hill M, Woodbury E, Phillips S. Canadian best practice recommendations for stroke care (updated 2008). Canadian Medical Association Journal 2008;179:S1–S25.
26. Australian Aphasia Rehabilitation Pathway. Aphasia rehabilitation best practice statement Australia: Queensland; 2014.
27. Godecke E, Ciccone NA, Granger AS, Rai T, West D, Cream A, et al. A comparison of aphasia therapy outcomes before and after a Very Early Rehabilitation programme following stroke. International Journal of Language & Communication Disorders 2014;49:149–161.
28. Kucukarslan SN. A review of published studies of patients' illness perceptions and medication adherence: lessons learned and future directions. Research in Social and Administrative Pharmacy 2012;8:371–382.
29. Rose M, Ferguson A, Power E, Togher L, Worrall L. Aphasia rehabilitation in Australia: current practices, challenges and future directions. International Journal of Speech-Language Pathology 2014;16:169–180.
30. Guo YE, Togher L, Power E. Speech pathology services for people with aphasia: what is the current practice in Singapore? Disability and Rehabilitation 2014;36:691–704.
31. Worrall L, Serrate S, Rogers P, Howe T, Hersh D, Ferguson A, et al. What people with aphasia want: their goals according to the ICF. Aphasiology 2011;25:309–322.
32. Hill AJ, Theodoros DG, Russell TG, Ward EC, Wootton R. The effects of aphasia severity on the ability to assess language disorders via telerehabilitation. Aphasiology 2009;23:627–642.
33. Georgeadis A, Brennan D, Barker L, Baron C. Telerehabilitation and its effect on story retelling by adults with neurogenic communication disorders. Aphasiology 2004;18(5–7):639–52.
34. Canadian Stroke Network. Canadian best practice recommendations for stroke care Canada: Ottawa; 2010.
35. Hebert D, Lindsay MP, McIntyre A, Kirton A, Rumney PG, Bagg S, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. International Journal of Stroke 2016;11:459–484.
36. Simmons-Mackie N, Raymer A, Armstrong E, Holland A, Cherney LR. Communication partner training in aphasia: a systematic review. Archives of Physical Medicine and Rehabilitation 2010;91:1814–1837.
37. Cunningham R. Counselling someone with severe aphasia: and explorative case study. Disability and Rehabilitation 1998;20:346–354.
38. Simmons-Mackie N, Damico JS. Counseling and aphasia treatment: missed opportunities. Topics in Language Disorders 2011;31:336–351.
39. Department of Health. National stroke strategy London: DH; Available from http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Stroke/DH_099065.
40. Lanyon LE, Rose ML, Worrall L. The efficacy of outpatient and community-based aphasia group interventions: a systematic review. International Journal of Speech Language Pathology 2013;15:359–374.
41. Foster A, O'Halloran R, Rose M, Worrall L. Communication is taking a back seat: Speech pathologists' perceptions of aphasia management in acute hospital settings. Aphasiology 2016;30:585–608.
42. Garcia JM, Garrett KL, Pimentel JT, Garcia RG. Clinical services for aphasia: a survey of university clinics. Aphasiology 2002;16:715–726.
43. Code C, Heron C. Services for aphasia, other acquired adult neurogenic communication and swallowing disorders in the United Kingdom, 2000. Disability and Rehabilitation 2003;25:1231–1237.
44. Code C, Petheram B. Delivering for aphasia. International Journal of Speech Language Pathology 2011;13:3–10.
i. Cognitive Neuropsychological approach Addressing language impairment with reference to information processing models of language production and comprehension; e.g., Semantic based treatments, phonological based treatments
ii. Functional approach Focusing on improving performance on everyday communicative tasks such as ordering a meal, asking for help; e.g., Script training
iii. Social/life participation Engaging persons with aphasia in goal setting and focusing on specific social relationships and facilitate persons with aphasia's participation in society; e.g., strengthening daily participation in activities of choice
iv. Discourse-based intervention Use of narrative, expository and conversational discourse; e.g., Main concept analysis; T-units
v. Technology-based intervention Use of telerehabilitation, videos, recordings, computer programs or applications; e.g., AphasiaScripts, ORLA
vi. Stimulation Using intense auditory and visual stimulation and task hierarchies to stimulate language modalities and elicit responses; e.g., Schuell's Stimulation Approach, MIT
vii. Group therapy Conducting therapy with small groups of persons with aphasia
viii. Principles of neuroplasticity Considering principles of neuroplasticity and taking into account of treatment intensity, salience of stimuli, schedule of feedback/practice; e.g., Constraint induced language treatment
ix. Augmentative and alternative communication Providing external support for persons with aphasia who cannot understand/generate messages on their own to maximize functional communication; e.g., communication boards/devices, gesturing, writing
x. Conversation partner training Training persons with aphasia's communication partner(s) with strategies designed to improve communication participation and effectiveness of persons with aphasia; e.g., conversational coaching, SPPARC training
xi. Training for culturally and linguistically diverse persons with aphasia Addressing communication of persons with aphasia who come from different backgrounds or speak languages other than Cantonese
Intervention type/Approach
Pearson's R
Knowledge and confidence of use
Knowledge and frequency of use
Confidence and frequency of use
Cognitive neuropsychological 0.629** 0.456** 0.401*
Functional 0.69** 0.287 0.227
Social/life participation 0.65** 0.437** 0.456**
Discourse-based 0.544** 0.165 0.081
Technology-based 0.539** 0.185 0.075
Stimulation 0.414** 0.064 0.04
Group therapy 0.655** 0.159 0.159
Principles of neuroplasticity 0.649** 0.499*** 0.45**
Augmentative and alternative communication 0.477** 0.397* 0.597***
Conversation partner training 0.639** 0.587*** 0.307*
Training for linguistically and culturally diverse populations 0.643** 0.402* 0.329*
p<0.05;
p<0.005;
p<0.001.


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Thrive Healing Massage
Massage Effects
Massage Techniques
Best Places in Seattle
Live Example of the Benefits of Massage on Mentally Challenged People
Massage therapy is a boon for mentally challenged people who have more challenging behaviours compared to many. However, when massage therapy is applied to such people, both their mind and body undergo relaxation. People with profound intellectual disabilities often fail to express their emotions. As a result, they become victims of depression which further makes them aggressive. To date, many studies have been done to assess the therapeutic value of massage.
To find out how effective is massaging on intellectually disabled persons, several studies were conducted on seven males and thirteen females aged between 5 and 62. Many of them had aggressive or stereotypic self-stimulation behaviour.
Process of Intervention
In hospital wards, residential homes, and in special schools, these studies were carried out. It has been found during the research that almost all the patients suffered from depression and/or anxiety. To compare the effects of different massage techniques, the researchers used multi-sensory rooms. A series of massages were applied to the subjects where each session lasted for between 10 to 45 minutes. Either daily or weekly, these subjects were given massages, with their hands being the frequent location of massage.
Among them Gale and Hegarty in 1996, clients received the treatment over a 3-month period whereas Solomons in 2005 gavethe treatment of longest duration, 8 months. In a certain case, massage was given regularly for 18 months to determine its efficacy.
Most of the times, the researchers preferred not to throw light on the scheduling of the treatment that includes frequency, pressure applied, technique used, duration, and many other such factors. Involvement of acupressure, petrissage, and effleurage is essential to know the overall impact the massage therapy is creating. Assessments made during the pre- and post-treatment sessions showed a remarkable change in their behaviour. On a relaxation level, the psychological data that was presented after the successful completion of the therapy proved that the subjects were transformed to a state of relaxation during the treatment which lasted few hours even when the session is over. Behavioural changes have remained a significant part of the outcome measures.
As soon as the intervention was completed, subjects having severe challenging behaviour started to behave calmly in most of the circumstances. Their self-injuring behaviours were also reduced considerably. Apart from Hegarty and Gale, Dossetor et. al., in 1991 also showed a progressive decrease in his aggressive behaviour. Sadly, two subjects suffering from autism didn't undergo the whole process as they hated all kinds of touch therapies. These studies highlight the fact that a maintenance programme is important in making progress in their behaviour.
From these studies it is clear that massage therapies bring positive emotional and behavioural changes. Using massage, one can make mentally challenged people feel special due to the caring attitude that is shown during the session. Attention and physical touch involved in massage play a significant role in alleviating the depression from intellectually disabled individuals. Moreover, massaging relaxes the muscles which in turn, reduce anxiety and stereotypic self-stimulating behaviour. As restless people cannot experience relaxation, the massage replaces different kinds of maladaptive behaviours in them.
We, at THRIVE HEALING MASSAGE, focus exclusively in refreshing and healing your pains with our latest massage techniques. All our suites are designed to keep in mind the diverse needs of our clients.
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9 mins ago 2 min read
Home > WWE > WWE Battleground Review
WWE Battleground Review
Jeet, 5 years ago 5 min read 45
It was a good event, I will not say that it was worth watching because some of the matches really disappointed when some of the uncountable matches really impressed everyone. Brock Lesnar was rumored to return on this event but no such thing happened. Superstar returns are not taking place at any pay per view events nowadays. I would not say that it was best pay per view event after WrestleMania, that would be very debatable, but I believe everyone should watch this event. Now let us talk about the matches that took place at the event;
The first pre show match between Adam Rose and Fandango was quite a Ridiculous match. Summer Rae and Layla was on Adam Rose's corner who were creating distraction for Fandango, Fandango tried to stop them and they slapped them. The referee saw it but he did not call for disqualification. After getting slapped by Summer Rae and Layla Fandango returned to the ring and Adam Rose pinned him with his finishing maneuver. It might have been a pre show match but still, everybody deserved something better.
Cameron vs. Naomi It was an average match and way better than the previous pre show match. We said it in our predictions section that Cameron would be awarded the victory in this match and that was that actually happened. We also said that Cameron's victory would not be a clean one and it was not. By the victory of Cameron, it is quite obvious that they want this rivalry to get continued for a while more.
The Usos vs. The Wyatt Family was amazing match, and undoubtedly, it was the best match of these individuals. There was no other way to start a pay per view event better than this. We salute the four individuals who performed out of the world in this match. We think this was the best match of the night. Luke Harper and Eric Rowan picked up the first fall, Luke Harper pinned Jey Uso with the Big Boot. Then the Usos won the next two back to back falls consecutively. Well, it might have been a great match, but we still think this feud should come to an end here. This should be the last match of this feud and there is no other way to end a feud in a better than this.
AJ Lee vs. Paige was a good way to start things off for this feud. Both divas performed quite well and it seriously was a good match if you consider it as a diva match. Things that made people more impressed are Paige's survival from the Black Widow submission hold and AJ Lee's kick out from Paige Turner. Indeed, this feud has a great path lying in front, it just needed to be molded in the right pot.
Rusev vs. Jack Swagger was an average match. But it certainly was the best match of Rusev's WWE main stream career till now. The match went on over ten minutes and that is quite exceptional for a mid card match. I would still say, Jack Swagger's performance was better than Rusev. All eyes was at Rusev about he performs. He did perform well but in this occasion his opponent outnumbered him somehow. Since it was a count out victory for Rusev, indeed the feud would go on for a while and it should go on. This is possibly the best feud for Rusev right now.
Expectations were really high from Seth Rollins vs. Dean Ambrose but it seriously disappointed us. The match could never even officially start. We predicted that it was the anticipated match of the night, but it turned out to be an utter disappointment As Seth Rollins was making his entrance, Dean Ambrose attacked him from behind. The fight started before match could officially start. Officials came out to separate the two but they founded it too difficult. Lastly, Triple H came out to prevent them, he somehow took Seth Rollins away. This feud will surely go on for quite a long time. We are eagerly waiting for the next part of this feud. Hope we would get to see them battling each other at Summerslam.
Chris Jericho vs. Bray Wyatt Good match but it was not up to the expectations. A victory for Chris Jericho seriously made things more interesting. It clearly indicates towards a continuation of this feud. As I said, it was good match, but nothing beyond that. It could not come up with the expectations and neither could it fulfill it totally. Bray Wyatt dominated the match for most of the times but Chris Jericho picked up the real thing, the victory.
The Miz won the Intercontinental championship battle royal. The way Miz won the match was a typical heel victory. Rumors suggest that they are planning for Sheamus vs. The Miz storyline next. That means they are planning for another title unification. I would say, that would be a terrible idea. These two titles should never be unified.
And last but not the least, the main event. Not long enough for a pay per view main event but it was quite enjoyable. We think Kane was the best performer of this match and Randy Orton was the worst. It was predictable that Cena would retain the title but a number of sources claimed that Cena was not booked for next couple of Monday Night Raws so he might lose the championship in this event. But we remained still with our prediction that Cena would be victorious. Even we predicted that Cena would pin Kane to win the match and that also came true. Overall, the match was good, and it was worth watching.
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Tahir Ibn Manzoor, 9 mins ago


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Partisan policies didn't raise gas prices, and partisan sniping won't lower them
Hugh Jackson
Digital generated image of oil pump clones (Getty Images illustration)
In 2020 the price of oil crashed, even falling to less than zero one day. Traders actually had to pay buyers to get them to take oil contracts off their hands.
Oil companies would prefer not to sell oil unless they can make money off it. Oil companies are just funny that way. So U.S. producers curtailed production. A lot.
U.S. oil production is still about 12% less than it was pre-pandemic, and isn't projected to get back to pre-pandemic levels until next year. Demand for petroleum products, by contrast, has rebounded to pre-pandemic levels.
Investor pressure did much to stall a rebound in production, and continues to do so. Investors prefer that the oil companies spend their money on dividends and stock buybacks instead of new field development.
In the meantime, OPEC+ is in no rush to bail out the world.
Russia is the world's third largest oil producer, behind the U.S. and Saudi Arabia. Joe Biden warned that sanctions on Russian oil will cause people in the U.S. to pay more for gas. But Russian oil has effectively gone off the market anyway because traders don't want to touch it. "Global financial institutions are doing the heavy lifting and blanket banning anything with Russia written on the documentation," according to an energy analyst with the futures trading firm OANDA. Oil production and sales evidently aren't as accurately reported as in the U.S., but a British firm that watches the industry estimates that nearly 70% of Russian crude has no buyers.
Combine Russia's role as a key oil producer with the anxiety over its invasion of Ukraine, and you get traders worrying that oil supply will be further limited, which in turn increases demand and the price. Bullish traders keep buying, betting the price will go higher still.
Which makes the price go higher now.
And all of that's on top of prices that had already been rising prior to Putin's war, for reasons noted above.
When Republicans aren't blaming Biden instead of Vladimir Putin for Putin's war of aggression, they're blaming Biden "for not reopening America's energy sector," as Adam Laxalt put it the other day.
Laxalt seems to spend most of his time coming up with new and painfully overwrought ways to warn of the existential threat posed by any and all non-Trumpism, so it's hard to know how much bandwidth he has left to review energy market conditions.
But the Republican claim that Biden has "crippled" (another Laxaltism) U.S. energy production is routinely premised on two Biden administration actions: canceling the Keystone XL Pipeline and pausing new oil and gas leasing on public lands.
As I've noted before:
Even if Biden hadn't canceled the Keystone XL and it had proceeded as planned, it would not be delivering any oil to the U.S until 2023 at the earliest. There are a lot of reasons for high gas prices. Biden's decision on that pipeline isn't one of them and has exactly nothing to do with the price of gas today.
The pause on leasing only applies to new leasing and does nothing to prohibit or even limit drilling on millions of acres of public land that, according to the Bureau of Land Management, is currently available for development. Biden isn't responsible for oil company resistance to drill. Investors are.
The main congressional Republican initiative right now to alleviate pain at the pump is to "push for expanded domestic energy production" by reversing those two actions. But neither action is hindering domestic energy production now (and by the way oil flowing through the Keystone XL would not be domestic but Canadian). If anything expands domestic energy production anytime soon, it will be oil selling at (checks Sunday morning price) $115.70 per barrel, not vapid boilerplate Republican talking points.
Many and maybe most voters, perhaps only slightly better informed than Laxalt, don't care about any of the things discussed above. As far as Joe & Jill Voter are concerned, gas prices are high, so it must be the party in power's fault, and that's that.
Republicans know – and love – this. Just as they have no credible policy fixes for today's high prices at the pump, neither do they have any policy for fighting inflation in general. The only solid position the GOP has on rising prices is to hope they stay high enough long enough to assure Democrats lose in November.
The U.S. is the world's largest oil producer, accounting for 20% of global oil production. And the U.S. consumes about 20% of global oil production, also more than any other nation.
The U.S. has about 4% of the world's population.
The U.S. doesn't have an oil production problem. It has an oil consumption problem. (I blame Michele Fiore's F-150.)
A version of this column was originally published in the Daily Current newsletter, which you can subscribe to, for free, here.
Nevada Current is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Nevada Current maintains editorial independence. Contact Editor Hugh Jackson for questions: [email protected] Follow Nevada Current on Facebook and Twitter.
by Hugh Jackson, Wisconsin Examiner
Even if Biden hadn't canceled the Keystone XL and it had proceeded as planned, it would not be delivering any oil to the U.S until 2023 at the earliest. There are a lot of reasons for high gas prices. Biden's decision on that pipeline isn't one of them and has exactly nothing to do with the price of gas today. The pause on leasing only applies to new leasing and does nothing to prohibit or even limit drilling on millions of acres of public land that, according to the Bureau of Land Management, is currently available for development. Biden isn't responsible for oil company resistance to drill. Investors are.
Nevada Current is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Nevada Current maintains editorial independence. Contact Editor Hugh Jackson for questions: info@nevadacurrent.com. Follow Nevada Current on Facebook and Twitter.
Hugh Jackson is the editor of the Nevada Current. He is a former editor of the Las Vegas Business Press, senior editor at the Las Vegas CityLife weekly newspaper, daily political commentator on the Las Vegas NBC affiliate, and wrote the then-groundbreaking Las Vegas Gleaner, which among other things was the only independent political blog from Nevada that was credentialed at the 2008 Democratic National Convention.
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Strong economy, declining gas prices have escaped notice,… by Jacob Fischler July 27, 2022


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Despite that previous statement, I do believe that the travel photography community is stronger than it has ever been. Yes, traditional forms of income-generation are dying, but the evolving world has opened up a thousand different doors for those willing to take the risks to make it in the industry. And, yes, there is a lot of competition out there in the travel photography world, but the community is strong and the amount of camaraderie rather than jealousy in the business absolutely floors me nearly every day.
You have provided a great deal of information on a subject I am really interested in. I will be researching the websites on this list. I have started my own website at http://www.davidhintzphotography.com, I have sold some of my photos on microstock websites and now looking to sell directly from my own website. Thanks for all your work on this topic. I would be interested in your comments on my site if you had the time to look at it.
Whether you're licensing photos through an agency or you're working with local businesses, destination photos sell. If you're just starting out, consider uploading your best work to sites like 500px, where you can offer your images for license quite easily. If you already have a strong portfolio of work, consider applying to Stocksy, the most reputable agency in the stock photo business. Interested in reportage? You can sign up for a Demotix account to get started in travel photojournalism.
Mixing the Hanxiang Water Garden photo shoot and another in the water town of Xinchang, I produced "The Legend of Hua"; a complex photo film meshing the topic of ghosts, opium, Shanghai in its 1930's heyday, traditional Chinese cultural and supernatural elements; all revolving around a plot of betrayal. Its plot is influenced by a 1988 movie by Stanley Kwan (in turn based on a novel by Li Pi-Hua (also known as Lillian Lee), one of the most influential Chinese TV writers, film writers and reporters.
Deep in the Actun Tunichil Muknal, or ATM, cave in Central America, visitors can see where humans were sacrificed. The cave is reached by river, and requires wading upstream for about an hour. Over the centuries, the victims' bones have calcified in place, making them appear to be made of crystal. "You're meeting history first hand," Zackham says. travelbelize.org
Embarking on such photographic projects make me look for relevant snippets of history, social mores and art (for example, the occupation of Shanghai by the Japanese in the thirties, the Chinoiserie fad of the 18th century, fictional stories similar to that of Madam Butterfly et al). I also learned the aesthetic of the cheongsam (aka qi pao) in its various forms, and the beauty of Chinese calligraphy. I also scoured the internet for Chinese legends, poetry and songs/music that inspired the 2-3 minutes plots of my photo films; as I call these audio slideshows.
The setting for the photo shoot which resulted in the slideshow was the beautiful Lin Ben Yuan Family Mansion and Garden (林本源園邸) in the Banqiao District, Taipei. It was a residence built by the Lin Ben Yuan Family, and is the country's most complete surviving example of traditional Chinese garden architecture. It can be traced back to 1847 when it was built for storing of rice crop whose location was more convenient for the increasingly wealthy Lin Ben Yuan family. A few years later, it became the family's main residence.
In March 2018, I traveled to Shanghai to give a lecture and a street workshop at Imaging Group, and recall doing some location scouting in Laoximen with Tamia Tang (my assistant). We met an elderly resident who had lived in her small rooms virtually all her life, and had been told that she would have to vacate them soon. She claimed satisfaction that the city would be offering residents alternative housing or monetary compensation as the weather in Shanghai was too cold for her.


This article is purely academic. The situation I present does not actually exist. I'd just like to discuss how such calculations are made.
Hypothetically, I want to put a bunch of 12/2 NM-B cables through a 2" EMT conduit.
The first question is how many 12/2 cables I'm allowed to put through this 2" EMT.
We head to Chapter 9 of the 2002 NEC for the answer. Table 4 says that a 2" EMT conduit has a total area of 3.356 square inches. Table 1 says that I can only fill this cable to 40% if I have over 2 conductors. Back to Table 4 says that 40% of the conduit is 1.342 square inches.
12/2 NM-B cable is 1/2" wide. Note (9) says I must treat this as a 1/2" round cable. Using pi*r*r, I compute the cable has a cross section of 0.196 square inches. Dividing 1.342 by 0.196 says I can put 6.83 cables in this conduit. Note (7) tells me that since the decimal is above 0.8, I can round this up to 7.
So the answer to the first question is seven. So far so good?
Now the second question is what size breaker I'm allowed to put on these seven 12/2 cables.
So we go to Section 310 of the 2002 NEC.
Table 310.15(B)(2)(a) gives me adjustment factors for more than three current-carrying conductors in a raceway. Since I have seven 12/2 cables, I figure I have 14 current-carrying conductors. The table tells me that for 10 to 20 conductors, I just use only 50% of the ampacity determined by tables 310.16 through 310.19.
So now I head for table 310.16. This table tells me that THHN wire (which is what 12/2 NM-B is made from) has an ampacity of 30 amps when I have not more than three conductors. I will assume an ambient temperature of 86 degrees F so that I need not make an ambient temperature correction. Taking 50% of the 30 amps gives me 15 amps. Since 15 amps is less than the 60 degree rating of 12-gauge copper as per 110.14.C.1.A, I may use the 15 amp rating for my 12/2wGrnd NM-B conductor.
So the answer to the second question is a 15-amp breaker.


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[Kim Seong-kon] Why does socialism persist in capitalist S. Korea?
By Kim Seong-kon
Many foreigners wonder why socialism and Marxism persist and even remain popular in such an affluent capitalist country as South Korea. Perhaps the reason dates back to Korea's liberation from Japanese rule in 1945. Historians argue that at the time, the resistance leaders in the Korean Provisional Government located in China needed a counterideology to fight Japanese right-wing military imperialism. Left-wing ideologies such as socialism and Marxism, which flourished in China at that time, nicely fit their purpose.
When liberation came, therefore, many of Korea's political leaders were socialists already. As a result, the North became a communist regime under the tutelage of the Soviet Union and the South, too, was inclined to socialism due to left-wing leaders who outnumbered right-wing ones. Those left-wing leaders in Korea pursued a unified country and thus opposed the birth of South Korea.
To their disappointment, however, South Korea was born in 1948 and US-educated Dr. Rhee Syngman became the first president due to the support of Washington. Naturally, left-wing leaders were dismayed and infuriated. They thought a right-wing rival from the US had snatched and usurped the throne that was rightfully theirs. From that time on, left-wing activists in South Korea have abhorred America, together with capitalism and liberal democracy, which the US subsequently brought to South Korea.
That resentment persists in today's South Korea. That is why the spiritual descendants of those resentful left-wing leaders still do not want to acknowledge the sovereignty and legitimacy of South Korea. Some of them even assert that North Korea is a more legitimate nation than South Korea because they believe it is the North, not the South, that has inherited the socialist legacy of the exile government.
For that purpose, left-wing radicals have condemned Rhee Syngman as a pro-Japan collaborator. However, experts contend that such an accusation loses validity because during his more than 30 years of exile in the States, Rhee dedicated himself solely to the anti-Japan independence movement. His anti-Japan attitude was also outstanding even after he returned to South Korea as the first president. Indeed, in the 1950s secondary school classrooms in South Korea put up a slogan on Rhee's instructions: "Ban-gong, bang-il!" which means, "Anti-communism! Defend our country from Japan's aggression!"
The second reason why socialism persists in South Korea is the right-wing military dictatorship from the 1960s to the 1980s. In order to fight the right-wing dictatorial regimes, South Korean student leaders subscribed to Marxism and socialism. Hiding underground, they delved into the theories of Marx and Lenin, and Mao and Guevara, and then preached them as if they were gospel.
Persecuted ruthlessly by their own government, the radical student leaders hated South Korea so much that they preferred North Korea. Intoxicated by Marxism, they also detested capitalism and Washington, which they believed was supporting South Korea's military dictators. As a result, Marxism and anti-American sentiment were predominant, especially in the 1980s. Those left-wing radicals preferred China to America and North Korea to South Korea. Therefore, the student leaders' democratization movement in the 1980s inadvertently, but inevitably, turned into a Marxist and socialist movement.
The third reason for the persistence of socialism stems from the ideology-oriented school education of South Korea. From their left-wing teachers and distorted history textbooks, students learn to prefer socialism to capitalism at school. In the 1980s, for example, speaking well of capitalism in class was a taboo in South Korea.
At that time, anti-capitalism was so predominant that if a professor commented on capitalism favorably, he had to bear harsh criticism from students. Even today, a professor who openly praises capitalism in class is likely to lose popularity and become a target of criticism. Of course, it is absurd and paradoxical because South Korea has accomplished spectacular economic success and become an affluent society by taking advantage of what capitalism can offer.
Today, communism has proven itself as a failed project and thus disappeared into history completely, or else hides behind the banner of socialism. One problem of socialist countries is the lack of individuality; the government controls everything and practices surveillance and censorship. People tend to confuse welfare states such as Sweden, Denmark and Norway with socialist nations that were formerly communist countries. In fact, however, they are radically different in every sense.
Although South Korea is not a socialist country, its social welfare system has considerably improved for the past few decades. Its health insurance program, in particular, is definitely one of the best in the world. Therefore, we do not need to become a socialist country in order to make our nation a paradise of social welfare or a unified country. All we have to do is make the original ideal of capitalism fully realized in our country despite its innate problems.
Although socialism persists, South Korea will remain a capitalist country in the years to come.
Kim Seong-kon is a professor emeritus of English at Seoul National University. -- Ed.


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Cobb: I haven't done enough for contract extension
Packers might be waiting for WR to show he's healthy and playing well before offering long-term deal
Cobb: I haven't done enough for contract extension Packers might be waiting for WR to show he's healthy and playing well before offering long-term deal Check out this story on packersnews.com: http://pck.rs/1rJvQAE
Pete Dougherty, USA TODAY NETWORK-Wisconsin Published 2:25 p.m. CT July 27, 2014 | Updated 3:37 p.m. CT July 27, 2014
Green Bay Packers receiver Randall Cobb looks on during training camp practice at Ray Nitschke Field.(Photo: Evan Siegle/Press-Gazette Media)
Randall Cobb strongly suggested that his representatives and the Packers aren't working on a contract extension, at least not yet.
Based on general manager Ted Thompson's history of signing key players to extensions while they're in the last year of their contracts, there's every reason to think Cobb is next in line after fellow receiver Jordy Nelson signed a four-year extension Saturday.
But Cobb today said his agent hasn't had meaningful contract talks with the team.
"There's nothing been said that I know of," Cobb said. "And I've told my agent don't even come to me until he feels that we're at a good spot."
If the sides haven't had serious negotiations, that doesn't mean they won't later in camp or more likely during the season. Cobb is one of the Packers' best offensive players and is unusually young for a fourth-year pro – he turns only 24 in August. He became a key player in his second season, 2012, when he had 80 catches, but then he missed 10 games last year because of a broken leg and finished with only 31 receptions.
The Packers might only making sure Cobb is fully recovered from his injury and performing at a high level before they're willing to offer the kind of money that would entice him to sign long term. Cobb in fact suggested that when asked if he's done enough to warrant an extension.
"I don't believe I've done enough, and I think that's on me," Cobb said. "I can't take last year – I missed 10 weeks, I got injured in a way that there was nothing I could do about it. I think my job is just to come out here every day, do what I'm supposed to, continue to work hard and hopefully my time will come."


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Jewish Thought and Jewish Holidays
Plants, Animals and Landscapes of the Bible
Food in the Bible
BUY THE SCROLL
The Wagtail: a Wintertime Tail…I mean Tale
December 12, 2014 /0 Comments/in Blog, Plants, Animals and Landscapes of the Bible /by Miriam
In the craziness that threatens to engulf us at any given moment, I leave the macro of our political maelstrom to wiser thinkers, and the micro of medical challenges faced by Arik and other loved ones to the experts and to the higher power that guides their hands. For a little peace of mind in the midst of it all, I flee briefly to the natural world no further away than the edges of my Judean Hills hometown. In previous blogs I introduced you to a cucumber that spits to survive and to the symbiotic Atlantic terebinth. This time, I want to tell you about a peripatetic little neighbor of mine that you see in this picture. It's called the white wagtail (Motacilla alba). Read on, there's a legend in it for you, too.
White wagtail
Photo: Miriam Feinberg Vamosh
I found the particular wagtail and his mate darting around the bushes they call home on the edge of my little community of Har Adar, just across from the skating park that overlooks the ancient Canaanite city of Hakfira, the biblical Chephirah (there aren't too many places in the world where a skating park overlooks an ancient Canaanite city, now, are there?). Just beyond Hakfira, by the way, I can see the Ayalon Valley on the edge of which – don't blink, here's the Hanukkah connection – at Emmaus, Judah Maccabee defeated the Syrian Greeks (1 Mac. 4:1-25).
The Canaanite city of Hakfira (at top left of hill in center) with Qatana on the slope and the Ayalon Valley in the distance. In the foreground: Har Adar. Photo: Miriam Feinberg Vamosh
But back to our wagtail. This species is well established around the world and very common in Israel, except in the desert. In fact, Israeli schoolchildren learn to recognize it as one of the signs that winter is here, because these tufted tweeters fly in around November and abide with us until March. And while we're on the subject of their tweet – to me it sounds something like what you get when you let the air out of a balloon by the neck, very, very slowly (which you might do, once, to amuse grandchildren up to a certain age).
Winging their way to us from points north, each wagtail pair picks a territory and guards it zealously. In fact, because they are so fiercely protective of their small dominion, a wagtail can sometimes be seen doing battle against its own reflection in a car or house window.* Yes indeed, we know a lot about that kind of thing in our part of the world.
Of the 227 bird species the experts say nest in Israel, 143 increased their size and distribution in the 20th century. The veteran Israeli ornithologist Dr. Uzi Paz just published a new book in which he focuses on several avian species that seem to be thriving due to human presence. In answer to my email query as to whether the white wagtail was among them, Paz responded that this was not his impression, but it was certainly possible. That's enough for me; I love these little guys.
The wagtail got its name in English because when it's hopping around searching for insects to eat, it bobs its tail up and down like some old-time telegraph operator beating out an urgent message. In Hebrew it's called nahlieli – a name that relates to its habitat rather than its body language. The word nahlieli comes from the word nahal, which means stream. Interestingly, it was the famous Jewish writer Mendele Mocher Sforim, all the way back in 1862, who first named the nahlieli, in his book about nature called Toldot Hateva.
And now for the tale: Nehama and her Mama
A story is told of a little white wagtail named Nehama who lived in Kiryat Ye'arim on the western border of the Tribe of Judah (Josh. 10:9; 1 Sam. 6:21; now Abu Gosh), with her parents and seven brothers and sisters. One day, while Nehama's mama was busy weaving twigs into a new nest for the next round of family, and her father looked the other way for just a second, little Nehama fledged. She flew over Mount Haruah and over the canyon of Nahal Kfira, and landed in Chephirah (Josh. 9:17, Nehemiah 7:29; now Qatana). But right then, clouds blew in from the west, covered the sky and dropped so much rain that before long Nahal Kfira was a ranging stream. Nehama Wagtail, far from the warmth and comfort of her nest, cried out in terror. Her mother heard her, and immediately took off over the narrow, frothing stream. Her tiny wings tired as they beat against the wind and rain, but with the last of her strength she reached the other side, where she was reunited with her daughter. Nehama's mama stayed by her side for as long as it took to teach her daughter everything she needed to know to build her own nest, which she did that very year and for many years thereafter.
This story was told to me by…me. And yes, the similarity to a tale about a certain Willie Wagtail is not coincidental. However, the original ending is rather gruesome and we have enough of those endings around here, so I like my version better and I hope you do, too.
For more of my short stories, all with happy endings and biblical associations, see my book Teach it to Your Children: How Kids Lived in Bible Days.
* www.yardbirds.org.il.
Here's a sprig of pyracantha in its natural setting near my Judean Hills home, together with my wishes for a wonderful holiday to you and yours.
Tags: Holy Land birds, Judean Mountains, Wagtail
The Scroll is a multi-generational historical novel about the survivors of the famous last stand of the Jewish rebels of Masada against the Roman army. Its story line is drawn from a real archaeological find – the divorce document of a real-life woman named Miriam, issued at Masada.
https://miriamfeinbergvamosh.com/wp-content/uploads/2014/12/White-wagtail-use-this-1-300x225-1.jpg 225 300 Miriam https://miriamfeinbergvamosh.com/wp-content/uploads/2019/03/LOGO.png Miriam2014-12-12 16:56:592019-02-02 11:34:04The Wagtail: a Wintertime Tail…I mean Tale
MIRIAM FEINBERG VAMOSH
Author and Israel tour educator
״Discover the hidden lives of biblical women In their stories, you'll find your own״
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U.S. and EU concerned by Turkey's plans to drill off Cyprus
Published: 06:22 EST, 6 May 2019 | Updated: 11:57 EST, 6 May 2019
By Daren Butler
ISTANBUL, May 6 (Reuters) - The United States and European Union have expressed deep concern over Turkey's plans for offshore drilling operations in an area claimed by Cyprus as its exclusive economic zone, adding to tensions between Ankara and its Western allies.
The statements at the weekend came after Turkish Foreign Minister Mevlut Cavusoglu said "we are starting drilling" in the region.
Turkey and the internationally recognised Greek Cypriot government have overlapping claims of jurisdiction for offshore oil and gas research in the eastern Mediterranean, a region thought to be rich in natural gas.
"The United States is deeply concerned by Turkey's announced intentions to begin offshore drilling operations in an area claimed by the Republic of Cyprus as its Exclusive Economic Zone," State Department spokesperson Morgan Ortagus said on Sunday.
"This step is highly provocative and risks raising tensions in the region. We urge Turkish authorities to halt these operations and encourage all parties to act with restraint."
Cavusoglu said that Turkish seismic research vessel Barbaros Hayrettin Pasa was continuing work in the region.
"We will conduct drilling in areas of Turkey's continental shelf and we are starting our drilling work at points identified by Barbaros Hayrettin Pasa," he said in northern Cyprus on Saturday.
The Cyprus foreign ministry said it "strongly condemns" Turkey's drilling operations within its exclusive economic zone.
"This provocative action by Turkey constitutes a flagrant violation of the sovereign rights of the Republic of Cyprus," it said on Saturday.
Speaking at NATO's North Atlantic Council Mediterranean Dialogue meeting in Ankara on Monday, President Tayyip Erdogan said he expected NATO to support Turkey's rights in the Mediterranean.
"The legitimate rights of Turkey and the Northern Cypriot Turks over energy resources in the eastern Mediterranean are not open for argument. Our country is determined to defend its rights and those of Cypriot Turks," he said.
"We expect NATO to respect Turkey's rights in this process and support us in preventing tensions."
URGENT EU CALL
The U.S. statement followed similarly worded comments on Saturday by EU foreign policy chief Federica Mogherini, who expressed "grave concern" about Turkey's intentions.
"We urgently call on Turkey to show restraint, respect the sovereign rights of Cyprus in its exclusive economic zone and refrain from any such illegal action to which the European Union will respond appropriately and in full solidarity with Cyprus."
Any escalation between Turkey and the United States could put more pressure on relations already strained on several fronts, including missile defence and military operations in Syria.
Cavusoglu said in February that Turkey would soon begin drilling for oil and gas near Cyprus. Ankara launched its first drill ship in October off the coast of Turkey's southern Antalya province.
The ship was located 70 km (45 miles) off the west coast of Cyprus on Monday, Refinitiv Eikon shipping data showed.
Breakaway north Cyprus, which is supported by Turkey, says that any offshore wealth also belongs to them, as partners in the establishment of the Republic of Cyprus in 1960.
The island was divided in 1974 after a Turkish invasion triggered by a brief Greek-inspired coup. Countless peacemaking endeavours have failed and offshore resources have increasingly complicated peace negotiations. (Additional reporting by Tuvan Gumrukcu, Can Sezer and Michele Kambas; Writing by Daren Butler; Editing by Dominic Evans, Louise Heavens, David Goodman and Jan Harvey)
U.S. and EU concerned by Turkey's plans to drill off...
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As I write this, we have just celebrated our employees at our Holiday Party – the first in-person in three years! As you'll see on the cover and back page, we recognized our Employees of the Month, named an Employee of the Year, Volunteer of the Year, years of service, and more. Our volunteer Board of Directors also approved an increase in monetary gifts for every employee, regardless of when they joined us, as we know how important it is to extend our appreciation for hard work, dedication, and teamwork.
Here's to 245 Years of Service!
Congratulations and thank you to our 24 service award recipients who marked years of service in 2022 from five to 40 years. They were presented with a total of $7,300 in gift cards to local businesses of their choice, representing funds that go back into our communities.
We also congratulate our 12 Employee of the Month awardees for 2022 who received monetary awards and engraved glass pieces. Thank you all for your commitment to CCCU and members. Check out the back page for more well-deserved recognitions.
Digital Services Upgrade!
As part of our ongoing commitment to providing the latest in technology, we are pleased to announce that Online and Mobile Banking, as well as Voice Banking, will be updated this spring to offer you greater efficiency, convenience, and additional features. In February, we'll move to true Voice Banking, with the ability to talk to the system to obtain account information. In April, we'll upgrade to a new digital platform, with such planned enhancements as the ability to make appointments with our reps within Online and Mobile sessions, block your Visa Credit Card if needed, and more. Prior to the upgrade, we'll provide you with more details on timeframes and what to expect, including the establishment of a page at coastccu.org dedicated to all things Upgrade.
Do's & Don'ts to Help Prevent Fraud
DON'T open emails or click on links from those you don't know
DON'T cash or deposit a check you weren't expecting
DON'T wire, transfer, mail, or give money or gift cards to those you've never met
DON'T assume the person calling or texting is who they say they are. Imposters often state they are from tech support, the IRS, or are a friend
DO switch to e-statements in Online & Mobile Banking. Click on "Estatements & Alerts" on the Menu
DO change your password often and make sure it's strong
DO visit the Federal Trade Commission's official site at ftc.gov to learn more, including the latest scams and how to report fraud
If it seems too good to be true, it probably is. Be skeptical and call Member Support! (707) 445-8801
Financial Sense for Credit Union Members
As Workforce Sentiments Change, Retirement Income Needs Haven't
Hybrid schedules. Mental and physical wellness. Fairness and equity. The US workforce emerged from COVID-19 with very different attitudes toward these needs—and in many ways, public-health uncertainty magnified financial uncertainty. More workers today say they're stressed about money—that anxiety can be a big hit to mental wellness, which can ultimately impair corporate financial health.
Thank you and congratulations to these employees for their exceptional commitment to CCCU and our communities!
Taylor Green – Member Support Center Supervisor
Our members know that phone support that is friendly, efficient, and helpful is invaluable. Our representatives juggle roughly 14,000 calls in an average month and must continuously be fully knowledgeable on all things Coast Central. Supervising the team is a role that requires a strong leader, and Taylor is just that. Although she was newly promoted to the position last year, she provided effective guidance and training, answering questions with expertise, and consistently took initiative to improve service to members and a better work environment for her employees. She also was responsible for the launch of Owlbert the Chatbot and Live Chat, ensuring their success through the entire process and following up to ensure member understanding and utilization. Taylor truly made, and continues to make, a positive difference at CCCU!
Volunteer of the Year & Volunteer of 3rd Quarter
Sarah Hiller – Giuntoli Member Services Manager
Sarah has the distinction of being our most recent Volunteer of the Quarter as well as of 2022! Last year, she volunteered every quarter for a total of 130 hours. But it's not just about the hours. It's also about the 12 local organizations who benefitted from her huge heart: the Walk to End Alzheimer's, Food for People, McKinleyville Little League and Youth Football, Sunrise Rotary Club of Arcata, and more. Sarah inspires her team to also volunteer and instills the concept of giving back to her kids. In her nearby Valley West neighborhood, she has taken the Latino community under her wing and made them feel cared about and supported, assisting with scholarship programs, fundraisers, trash pick-ups, and more. Sarah, you perfectly exemplify our People Helping People approach!
Congrats & Farewell, Carol!
Business Loan Services Underwriter Carol Moorehead will retire next month, after a nearly 60-year career that included a stint with the CIA after college. In addition to her five years at Coast Central, Carol has worked for other local financial institutions for three decades, serving many Humboldt County businesses with their banking needs during that time. CCCU business members continue to tout Carol's expertise and tenacity with their business loans as key contributors to their success. Carol has walked the two-mile journey to and from work for years, and she plans to stay active during her well-deserved retirement. Best wishes from all of us, Carol!
Welcome, Jasmin Gammel!
In November, CCCU welcomed Jasmin Gammel as our new VP Member Digital Services, responsible for our Digital Banking products, Chat, Member Support Center including phone support, check processing, ACH, and our Credit/Debit Card Services Department.
Fortuna Member Services Branch Expansion Planned!
With the closure of the chiropractic office next to our Fortuna location, we jumped at the opportunity to create a larger, updated space for members. Key discussions have been in the works with representatives from CCCU meeting with architects and designers, in conjunction with the City of Fortuna, with a goal of beginning construction this summer. In addition to maintaining the drive-up window and walk-up ATM, the location will feature a new drive-up ATM, expanded new accounts area, an enclosed office for mortgage lending, increased parking, and more. The interior will have natural wood treatments, neutral color schemes, wood look tile flooring, and plants. After completion, expected in early 2024, Manager Laura Morris and the team will officially welcome members and community with an Open House.
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