text:
Queer Walking Tour
Trans Oral History Project Collective Organizers
Michelle Esther O'Brien is NYC TOHP's part-time staff working with the NYPL. She brings years of community organizing, including in labor unions, HIV and AIDS services, and trans movements. She is currently a grad student researching the class politics of NYC's LGBTQ movements.
AJ Lewis co-organizes the NYC TOHP. He is a postdoctoral fellow in gender, women's, and sexuality studies at Grinnell College and is interested in how LGBT communities have historically drawn from nontraditional organizing tactics such as magic as alternatives to state-sanctioned reform structures.
Jamie Magyar is a member of the NYC TOHP collective with particular interests in transcripts, archives, and events. He works in the publishing industry and lives in Brooklyn.
Aviva Silverman is an artist and a triple Aries living in Chinatown, New York, who works in sculpture and performance. Their practice engages with religion, gender nonconformity, and nonhuman actors to revisit existing forms, in particular, technologies of spiritual and political surveillance. They do organizing work with prison-abolition and Palestinian-solidarity groups in New York City, and are interested broadly in community-based healing through narrative, diasporic Judaism and mysticism, and science fiction.
Jeanne Vaccaro co-organizes the NYC TOHP. She is a Mellon fellow in feminist arts & sciences at UC Davis and the curator of Bring Your Own Body: transgender between archives and aesthetics, organized for the Cooper Union.
Sebastián Castro Niculescu is a former intern turned collective member with the NYC TOHP. She is a trans Latina writer, artist, organizer/curator and performer originally from the NYC metropolitan area. Sebastián is currently a Mellon fellow studying Ethnic Studies at Brown University and Sculpture at RISD. Her research lies between Latinx Studies, Trans Studies, Critical Race Theory, and Performance Studies.
Jaime Shearn Coan is a writer and PhD Candidate in English at The Graduate Center, CUNY. He currently serves as a Mellon Digital Publics Fellow at The Center for the Humanities, and lectures in the Department of Drama, Theatre, and Dance at Queens College. He has written and published widely.
Former Collective Members and Interns
Adelaide/Matthew Dicken is a non-binary Pisces transwoman theatre-maker and resource-mover of European descent living in a collective home in Flatbush, Brooklyn. She organizes in grassroots abolitionist movements committed to mutual aid for incarcerated queer and trans people of color, freeing criminalized survivors, and building support structures towards economic self-determination for people working for trans & disability justice.
Jay Toole is an activist and storyteller with over fifteen years of experience organizing around LGBT homelessness issues, and forty years of experience navigating homelessness herself in NYC. From 2002-2012, Jay was a co-founder and Shelter Director at Queers for Economic Justice (QEJ), which became the first LGBT organization to facilitate support groups for queer individuals within the NYC shelter system.
Elliott Maya was a community outreach intern for the NYC TOHP. They are a black nonbinary writer who graduated from Grinnell College with an undergraduate degree in English; gender, women's, and sexuality studies; and American studies. Their research focuses on the lives and well-being of black trans women, black butch women, and black non-binary individuals.
Kamryn Wolf is a queer and nonbinary activist, artist and graduate student at Union Theological Seminary in NYC, where they are studying chaplaincy and spiritual care with transgender and gender nonconforming people. They bring to NYC TOHP a concern with care work, spirituality, racial and economic justice, and collective action.
Aoife interned for the TOHP over the summer of 2019. They are a member of Smith College's class of 2022 and they are a Study of Women and Gender and Anthropology double major. Aoife is active in organizing for first generation, low income and transgender students on campus.
Ric interned with the NYC TOHP. She graduated from Grinnell College and currently works for a queer youth advocacy nonprofit in Iowa.


Everyone, thank you very much for your help and support for Tina. We all recognize her as a wonderful, smart, and caring person who has given very much to the people she has been serving. Please keep her in your thoughts and prayers as we being this journey.
Tina has had a very grave accident - she fell off of a golf cart on Monday, Sept 7 2015. She was meeting the family of her new boyfriend and they went for a ride around the development after dinner. She was brought to Bayonet Point Trauma center.
That evening she had 2 surgeries on her head. The first was considered relatively minor injury of the left side of her brain. However, because of the massive internal bleeding and swelling it quickly became a fight for her life.
The second surgery that night consisted of a "craniotomy" (https://en.wikipedia.org/wiki/Craniotomy) . To stop the bleeding and brain swelling the doctor had to remove a portion of her left frontal lobe as well as address several other areas that were bleeding profusely. Her brain swelled to a pressure of 80, which the doctor said by all rights she should not have survived.
However she lived through the night. Early Tuesday morning she moved her right hand and leg, and so the doctor ordered another CAT scan, and Wednesday morning went in and operated a third time to remove the damaged/dead tissue and reposition the pressure sensors in her brain.
Tina is still considered in a "coma" - her initial "Glasgow Coma Scale" (GCS - https://en.wikipedia.org/wiki/Glasgow_Coma_Scale ) was a "3" (the lowest) on Monday night. Today, she is considered to be a "7" or "8" - with the Doctors telling us "3-8" is generally considered a coma.
About 20% of her frontal left lobe was lost/removed, as well as a portion of her temporal lobe. Her vital signs look in acceptable ranges and she is moving her left arm and leg both spontaneously. Her right side is still very little movement but is responding to pain. It is still to early to tell if she is going to survive, however she has beaten the odds so far - The next 1-2 weeks will be telling. Her current cranial pressure is in the 20-23 range today, a bit high, but is without sedation or pain medication. If it goes higher the surgeon will add sedation.
Finally if we survive the next 2-3 weeks he will have her moved to a long term care facility who can better help with the care. If all goes well with that he expects to be able to re-attach her skull in 3-4 months.
Long term we can expect to have speech and cognitive rehabilitation as well as physical training to overcome the right side weakness.
I will post updates here as they come in, please check back here for her status.
We really do appreciate all the prayers and support for her - she would not have made it this far without them! Thank you!
To interact with Tina's website, sign in or register today.


In this lovely video, harpsichordist Julian Perkins performs Frescobaldi's 'Toccata Decima' from Toccate e Partite, Libro Primo (Rome, 1615) on a 1622 harpsichord in the Cobbe Collection at Hatchlands Park. The harpsichord is attributed to the Italian maker Girolamo Zenti, it has two 8-foot registers with a four-octave compass from C/E (short octave) to c3. Despite its modest size, it has a strikingly resonant quality that is ideally suited to the lyrical qualities of Frescobaldi's music.


TORONTO, ON – Mill Street Brewery has released a new edition in their Mini Brew Pub series of sampler six packs for Winter 2010.
This edition includes bottles of Tankhouse Ale, Stock Ale, Organic Lager, Coffee Porter and Betelgeuse Belgian-Style Tripel, as well as a 473 ml can of Lemon Tea Ale.
The pack is available now at LCBO outlets throughout Ontario for $12.95.
Also out now is the 2010 vintage of Mill Street Barley Wine. Packaged in a unique 500 ml ceramic bottle, it is available at the LCBO for $11.95.


Make your own Netherlands antilles room with full control over it.
It was, is, and always will be free for Netherlands antilles . Thanks!
Want to meet attractive singles in Netherlands antilles ? Join FarjiChat.com today and start browsing fun-seeking men and women for FREE. There are singles from all over Netherlands antilles online waiting to meet you and chat today! No tricks or gimmicks, here! FarjiChat.com is one of the top free online dating services in Netherlands antilles .
Netherlands antilles online chatting rooms without registration in farjichat.com you can find new friends and make new friends internationally in our chat rooms with no registration. our farjichat.com website chatrooms works without registration, every one can meet their local friends, families and loved ones at farjichat.com and much more here having to fun with farjichat.com without registration one & only online chat rooms across the worlds without download and no setup required to stay connected with your friends online.


We are a small-batch coffee roastery and tasting room in Ithaca, NY, specializing in fantastic fresh crop specialty coffees from around the world. Our coffees are sourced through transparent and sustainable partnerships with coffee farmers, exporters, and importers. Then, the coffees are meticulously roasted to highlight the inherent nuances within each bean including their variety, process, density and terroir.
Roasting coffee is part art and part science. We stay focused in method and creative in our approach. Oh and love - there's lots and lots of love. Our coffees are roasted in 10-20 pound batches, hand-sorted before and after roasting, and hand-packaged in hand-stamped bags.
We want to share the simple fun of our good coffee with you, and we hope you'll share it with your family and friends. A little sharing goes a long way - and like the namesake copper horse weathervane, it never goes out of style.


Tennis courts are readily available throughout Charles County. Courts are located at Southern Park and White Plains Park and are open to the public year round.
White Plains Park: This facility is open seven (7) days per week. All courts are available on a first come, first served basis between 8:00 a.m. and 10:00 p.m. Tennis court lighting is available weekdays only until 10:00 p.m. from April 1st through November 30th.


The library is open daily from 7:00 a.m. until 2:30 p.m.
Students may come to the library with a teacher or with a signed agenda.
Students may check out two books for two weeks. Books may be renewed for an additional two weeks.


text:
A scoping review examining the integration of exercise services in clinical oncology settings
Elochukwu F. Ezenwankwo1,2,
Daniel A. Nnate3,4,
Godspower D. Usoro5,
Chimdimma P. Onyeso5,
Ijeoma B. Anieto5,
Sam C. Ibeneme5,6,7,
Yumna Albertus1,
Victoria E Lambert1,
Antoninus O. Ezeukwu5,
Ukachukwu O. Abaraogu5,8 &
Delva Shamley1,9
Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations.
Four thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis.
Service implementation was relatively modest across the included studies. Exercise services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events.
Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise-based rehabilitation for individuals on cancer treatment. While this model appears feasible for patients/clinicians, efforts are required to optimize service integration both in the short and long term. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding the patient core management team to include staff from the exercise rehabilitation unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating oncologists and nurses) in the referral process. Future research should consider effective strategies to promote patients' sense of self-efficacy and behavioral control and, further, the place of audit and feedback in improving exercise service delivery and overall service implementation.
From in vitro models, early preclinical studies, and large population-based observational studies to high-quality clinical exercise efficacy trials and behavior change studies involving 'real world' scenarios, the cancer exercise literature abounds with clear and profound evidence of the mitigating effects and health benefits of exercise in the trajectory of cancer care [1,2,3,4,5,6,7]. Engaging in regular exercise program not only is safe and feasible for cancer patients but can also improve treatment tolerance [8,9,10], facilitate early recovery [8,9,10], and reduce the length of hospital stay [11, 12]. There is also evidence that exercise can slow cancer progression [13], lower the risk of recurrence, readmission, and mortality [13, 14]. An improved exercise lifestyle has also shown great promise for a better quality of life [10, 15], particularly early return to work and other day-to-day activities [10]. Recent reports suggest that only about 30% to 47% of cancer patients are meeting current global exercise recommendations [16, 17]. While many factors preclude cancer patients from engaging in regular exercise, lack of access to exercise-based rehabilitation as part of routine care in treatment settings has remained a major barrier [10, 18].
Calls to make exercise-based rehabilitation an integral component of routine oncology care are gaining more traction globally as the World Health Organization moves to increase global access to high-quality rehabilitation as an essential healthcare service for individuals with chronic disease [10]. Many stakeholders are increasingly acknowledging a foremost implication of this 'call to action' to include embedding exercise services in cancer treatment settings [14]. Oncology care models that foster integrative exercise-cancer care units may provide a more pragmatic approach for delivering access to timely, flexible, and high-quality exercise-based rehabilitation to cancer patients. When patients are offered early access to individualized and supervised exercise programs, they are well-positioned to develop the physical, mental and psychosocial capacities to confront the challenges associated with cancer treatment even before they set in. Providing access to exercise-based rehabilitation within a cancer care setting is likely to encourage integrated and multidisciplinary oversight, creating opportunities for routine joint patient evaluation, shared decision making, and triage. A key benefit of this approach is that oncology clinicians, including doctors, nurses, and exercise specialists, can recognize any potential risks/threats and intervene more holistically and timeously. This approach is likely to increase patients' confidence and satisfaction in their care. As exercise adoption and maintenance are particularly challenging in posttreatment populations, an integrated exercise-oncology care model may be the greatest leverage available to healthcare providers to intervene most critically within the window of time when patients are more amenable to behavior change [19].
Embedding an exercise service unit in a typical cancer treatment setting may present some challenges to patients, clinicians, and the health service system. First, the actual process of installing an exercise unit within existing treatment settings may require slight to huge (infra)structural (re)adjustments. The likely potential for disruption in workflow could come at a risk to patients as they may be unable to access routine care more efficiently during such time. Second, many health systems are currently grappling with underfunding globally. Hence even where integrative exercise-oncology models are less resource-intensive, health services may find it challenging to hire exercise specialists with the right credentials and experience for handling the peculiar exercise needs and challenges of cancer patients. Another critical factor is the capacity for patient screening, triage, and referral. As this is a relatively new frontier, the present clinical oncology workforce may lack the clarity, culture, and the will to assess, advise, and rightly refer patients for exercise medicine [14]. Many facilities lack robust guideline-concordant care with well-defined and streamlined patient screening/evaluation algorithms and referral pathways [8]. Together, these concerns raise a question about the feasibility, including the cost implications and sustainability of implementing an exercise service unit in a standard oncology clinical setting.
Research objective
We aim to provide a comprehensive summary of peer-reviewed literature on the feasibility of implementing an exercise service unit within a cancer treatment setting. To achieve this, we performed a scoping review of the literature using the modified framework of Levac and colleagues [20]. The current review does not warrant consent to participate or institutional ethics approval as only publicly available peer-reviewed literature was utilized, with no primary data collection [20]. However, we reported our findings using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [21].
Study eligibility
We included studies that evaluated the implementation of exercise service units within cancer care settings in this review. To be eligible, service units were to have a well-defined structure and be located in a clinical setting (e.g., inpatient or outpatient services, public and private practice). Essentially, studies must report data for one of the following implementation outcomes: acceptability, adoption, appropriateness, practicality (including cost), feasibility, fidelity, penetration, sustainability, and quality assessment. As such, studies including trials evaluating exercise benefits in cancer populations were excluded. We also included studies providing stakeholder perspectives on the co-location of exercise service and cancer care units. No restrictions were placed on study design or publication date. Non-primary research, including reviews, commentaries, and viewpoint articles, including non-English studies were further excluded.
Information sources and search
EE and DN conducted a comprehensive literature search on Embase via Ovid, CINAHL via EBSCOhost, MEDLINE via Ovid, Web of Science Core Collection via Clarivate Analytics, and ProQuest (Health and Medicine) independently. In developing the search strategy, relevant search terms and medical subject headings (MeSH) were identified by exploring the National Library of Medicine Database [22] and, further, by reviewing a recent review of exercise interventions for cancer survivors [23]. Specific keywords and MeSH terms applied in the search include (but are not limited to) cancer, neoplasm, exercise, feasibility, etc., and implementation outcomes such as acceptability, adoption, appropriateness, practicality, etc (See Additional File 1). Additionally, recent systematic and meta-analytic reviews of cancer exercise literature were scanned for relevant citations.
Article screening and selection
Identified records were exported to RefWorks software for de-duplication and then Microsoft Excel Spreadsheet for screening. EE and DN independently screened the titles and abstracts of all retrieved citations and, further, the full texts of the remaining articles using the review's eligibility criteria. Differences in opinions during the screening process were resolved by discussion in consultation with GU.
Data extraction and analysis
A data extraction form was developed and tested to guide data extraction. First, we reviewed varieties of constructs as considered in the Implementation Outcome Framework of Proctor and Colleagues [24], Bowen's framework [25], and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework of Glasgow and colleagues [26], Next, we adapted a list of priority outcomes drawing on recent evidence and our experience in implementation research (Table 1). Data on study characteristics, cancer care setting, nature/components of exercise services, and implementation outcomes were extracted. This review focused on the following key implementation outcomes: implementation, cost, reach/penetration, service uptake/adoption, acceptability, patient satisfaction, fidelity, and sustainability. Quantitative and qualitative results were extracted, analyzed, and integrated to produce the final synthesis.
Table 1 Operationalization of implementation outcomes
Six studies providing data from over 30 exercise programs were included in this review [27,28,29,30,31,32]. Details of the screening and selection process are provided in Fig. 1. One of the studies was conducted in Canada [31] and the rest were carried out in Australia [27,28,29,30, 32]. Included studies were largely prospective, involving varying cancer types and patient demographics except for Dennett et al., [28]— a qualitative report on clinicians' perspectives. Patients were generally above 50 years and on active treatment with either chemotherapy, radiation therapy, or immunotherapy. Of the oncology services, two were publicly funded [27, 31], one was privately funded [29, 30], and another involved both public and private hospitals/cancer centers [32]. Exercise services were individualized and group-based and largely featured a combination of aerobic and resistance exercise [27, 29,30,31,32]. More details on the included studies are provided in Table 2.
PRISMA flow diagram of the study selection procedure
Table 2 Description of included studies
Summary of implementation
A summary of the implementation outcomes is provided in Table 3.
Table 3 Summary of implementation outcomes
Service implementation
Exercise services were largely operated independently of the housing treatment settings, and program staff was generally not part of the patient core care team [27, 29, 31, 32]. Exercise programs were delivered by physiotherapists [27, 31, 32], exercise physiologists [29, 32], and kinesiologists [31] experienced in oncology settings. One study reported a clinician-to-patient ratio of 1:4 [27]. Access to exercise services varied across the included studies. In one study, exercise sessions were available every Monday to Thursday, and participants had access to a one-hour gym session once or twice a week [27]. In another study, participants had access to three exercise sessions per week, with each session lasting two hours [29]. In Dennett et al., [32] outpatients accessed programs twice a week for eight weeks while inpatients attended up to two sessions per day for the entire duration of their hospital stay. Early morning sessions and lack of coordination between treatment and gym times were reported as key barriers to program access [29, 32]. Structured patient referral mechanism was generally lacking except for one study that showed evidence of a well-designed patient triage and referral pathways [31]. Referrals were largely verbal, from the oncologist and other healthcare providers directly to the exercise programs [27, 29, 32]. Self-referrals were also reported in all the included studies [27, 29, 31, 32]. One study reported using an email system to create a central access point for the clinicians [27]. Exercise programs were promoted differently across the included studies. Strategies such as flyers [27, 32], posters [27], newsletters [27], letters to general practitioners [32], community awareness [32], and in-hospital presentations [31] were adopted to promote the programs within and outside the health facilities. At program completion, patients were largely recommended for home-based exercise programs [27, 31, 32], a hospital-based multidisciplinary rehabilitation program [27] or community-based rehabilitation programs [27, 31, 32].
Exercise programs were delivered at no cost to the patients; however, operational costs were largely covered with public funds, including grants [27, 29] and private donations [31]. Staff salaries accrued a greater part of the operational cost [27, 29]. In one study, the per-patient cost to the health service within the evaluation period was AUD $1,104 [29].
Service reach
Program reach as reported in two studies was 10% [27] and 12% [29], with Kennedy et al. [29] reporting an annual reach of 10% to 14% over a 50-month evaluation period. In one study,(31) 1635 patients were evaluated in 5 years with an average of 5.8 follow-up visits. Another study identified only 31 programs from 85 public and private hospitals/cancer centers in 6 out of 8 states/territories in Australia [32].
Service uptake
Individual referral data were generally lacking. In one study, 46 staff made 148 referrals over a 6-month evaluation period [27]. In another study, all the oncologists (n = 11) consulting in the cancer center had at least one patient under their management attending exercise clinic within the 50-month evaluation period [29]. Referrals were largely from doctors, nurses, and allied health staff [27, 29, 31, 32]. Referrals from nurses were around 20% [29] and 36% [27, 31] of the total referrals. Referrals from doctors were generally poor —i.e., 21%–22% [27, 29] and 35% [31]. Factors that improved service uptake among clinicians were patient feedback, regular service promotion, enhanced visibility, convenience, building rapport among the clinicians (treating oncologists, nurses and exercise specialists), accessibility, good timing, and staff experience [27, 28, 32]. Poor knowledge among doctors on the role of exercise in cancer management was reported as a major barrier to service uptake [32].
Acceptability
Two studies reported 27% [27] and 44% [29] acceptance rates. One study reported 71% compliance in a sample of 41 patients over three years [31]. In another study, 56% of the participants who elected for three weekly exercise sessions attended 7 out of 16 sessions [27]. In the same study, 40% of the participants electing for once per week exercise sessions attended only 3 out of 8 sessions [27]. A different study reported 10% to 70% annual enrolment per program (n = 31 programs), averaging 2000 cancer survivors per year across Australia [32]. Common reasons for non-utilization, missed sessions, and dropout were COVID-19 restrictions [27], hospital readmission [27], disease progression [27], lack of awareness of service availability [29], adverse skeletal events,[31] unwellness due to treatment [27], and patient refusal [27].
Patient satisfaction was high amid varying cancer types and patient demographics. In one study, 81% of the total responders (n = 46) were satisfied with the facility, location, and timing of the program, and all the responders (n = 57) reported their willingness to refer other patients to the program during treatment [27]. Key drivers of patient satisfaction were improved wellbeing and overall treatment experience [27, 29], staff experience and professionalism [29], social value [27, 29, 32], feeling of empowerment [29], and patient-centered service [32]. Wrong program timing [32], lack of coordination between gym and treatment times [29], parking issues [27, 29, 32], travel distance [32], and lack of transition plan [29] were frequently mentioned as major causes of dissatisfaction.
None of the studies provided reports on service fidelity. However, to ensure a high standard of care, service implementation was largely led by clinicians with experience in oncology settings [27, 29, 31, 32]. In one study, this was further ensured by a steering committee comprising a patient, clinical directors, physiotherapy manager, and a community partner [27]. Other approaches maintained to ensure a high-quality service delivery include regular updates [27] and continuous staff mentoring and education [31].
To sustain exercise services beyond the evaluation period, philanthropic funds were sought to pay staff salaries in one study [27]. In another study [29], program duration was reduced to three months besides partnering with the cancer care center to cover operational costs and scaling down the operational hours to two days per week (one hour per session). Eligibility was further rescinded for patients receiving chemotherapy alone in the same study [29]. Reported lack of a financial model and effective communication between partnering organizations were the major threats to the program's sustainability [29].
The impetus for the current review stems primarily from the growing need to close the research-practice gap that has long existed in the field of exercise oncology. Even with the overwhelming evidence on the feasibility, safety, and clinical benefits of exercise in cancer patients, exercise-based rehabilitation is still generally considered an adjunct instead of an integral component of care during treatment. The result of this evidence-practice gap is that most patients do not have access to exercise services while receiving cancer treatment, a period when the debilitating effects of cancer treatments are at their peak and can best be mitigated or ameliorated with exercise-based rehabilitation [8, 14, 33]. Despite a limited number of studies, implementing exercise services in [proximity to] a cancer unit appears to be an effective approach for increasing access to exercise-based rehabilitation for individuals on active treatment [27,28,29,30,31,32]. While this approach seems to be feasible for both the clinicians (the referring clinicians and those delivering the programs) and patients, the current evidence is not a confirmation of the overall feasibility of exercise service integration in oncology care settings. The lack of a clear implementation plan was evident across the included studies [27,28,29,30,31,32]. As critical to a successful service implementation as this may be, issues relating to funding and organizational buy-in hold even far greater implications for effective service integration and long-term sustainability.
Overall, service implementation was modest even though fidelity to any pre-implementation plan was not demonstrated. As a direct consequence of this downside, capacity for patient screening and risk stratification, effective patient triage, and structured referral mechanisms were generally lacking. Exercise services were largely operated independently of the clinical settings in which they were embedded, and staff leading these programs were also not part of patient core management team [29, 32]. This compromised the potential for shared decision-making in most programs and enabled communication gaps between the clinical staff and exercise service providers [29, 32]. Lack of an implementation plan was implicated in the poor coordination between exercise sessions and treatment time. In one study, patients reported that they could not attend exercise sessions because they constantly clashed with their treatment times [29]. As co-location does not automatically translate to successful service integration, a detailed implementation plan ensures that structures and strategies that reflect the changing dynamics of the clinical environment housing an exercise service unit are put in place to drive effective and sustainable integration.
Access to exercise programs was relatively feasible and similar across the included studies. Most programs were open to participants two to three times a week [27, 29, 31, 32]. In one study, for example, exercise services were available from Monday to Thursday during the six months evaluation period [27]. In another study, patients on admission had daily access to exercise programs throughout their inpatient stay [32]. Another consistent finding across the included studies was the simplified and convenient nature of the referral process [27, 29, 31, 32]. Although well-defined referral pathways were generally lacking, patient referrals were simple and convenient. Exercise referrals were mostly verbal, directly from the referring clinicians (the oncologists, nurses, and other allied health staff) to the exercise programs [27, 29, 32]. One study reported an additional use of a central access point (email referral) to facilitate patient referrals further [27]. Another major facilitator of referrals was patient feedback [27, 28, 32]. One study reported that doctors who received positive feedback directly from their patients were more inclined to refer more patients to the exercise program [28]. By encouraging patients to feedback to their clinicians on their thoughts, experiences, and concerns with the exercise program, exercise service providers can motivate doctors [and nurses] to engage more fully and proactively with the referral process. Barriers to patient referrals were recorded at both individual and health service levels. At the individual level, while most doctors were aware of exercise benefits, particularly during cancer treatment, many lacked the will to refer patients to exercise programs. In one study, doctors reported referring patients to the exercise program only when they remembered and had the time to do so [29]. At the health service level, low organizational buy-in, even with the reported evidence of adequate service promotion, was a major finding [27, 29, 31, 32].
Lack of organizational buy-in may be responsible for the overall low service penetration and utilization among the clinicians. For example, two studies reported overall service reach ranging between 10% and 12% [27, 29], with Kennedy et al. [29] reporting an annual reach of 10% to 14% over a 50-month evaluation period. One study identified only 31 exercise service programs in the whole of 6 out of 8 states/territories in Australia [32]. Successful integration of exercise services in routine oncology care demands a concerted effort to develop and identify the right implementation strategies to provoke a cultural shift in the host organization, which is critical for increasing organizational buy-in. One way to achieve this is by providing education to the healthcare providers working in oncology settings. Healthcare providers can only refer patients to exercise service programs if they know how, when, and where patients can be referred for such services [8]. To refer patients for exercise services, doctors and nurses, for example, should understand and appreciate the rehabilitation dimensions of their patient care and effectively and proactively screen patients for exercise interventions [8, 33]. As this is a relatively new frontier in cancer care, many healthcare providers in oncology settings may need to be trained on how to use exercise screening algorithms and referral guidelines to adopt these tools [8, 33]. Tools such as electronic medical records and integrated/central referral systems can improve service ease and efficiency, and ultimately utilization [8, 33].
Organizational buy-in can also be improved by enhancing the visibility of the service units. In one study, the referring clinicians were pleased with the value created by the frequent presence of physiotherapists in the cancer unit as they actively featured in ward rounds, offered clinical insights even during informal discussions, and took part in patient assessment and decision making [28]. Another strategy to increase service utilization is to increase staff confidence, particularly in the safety of the exercise programs [28]. This can be achieved by ensuring that the physiotherapists and other exercise specialists working in these settings have the right skills and training to match the peculiarities and dynamics of cancer care. Specifically, exercise prescriptions must be based on well-established international guidelines and recommendations while reflecting patients' circumstances, needs, preferences, and values [10]. Good communication, knowledge sharing, patient responsiveness, and teamwork can foster strong relationships between staff leading exercise programs and oncology clinicians and ultimately enhance service utilization [28]. Regular service promotion within the clinical setting is another strategy to increase organizational buy-in. One study achieved this by providing regular updates and timely reminders through staff presentations, use of newsletters, and by introducing an alerting system in electronic medical records [27, 28, 31, 32]. Staff rotations and turnover reflect the dynamics of typical cancer care clinics. Regular awareness programs are thus critical to ensure that new staff is aware of the existence of these services.
Acceptance rate was relatively low across the included studies. One study, for example, found that only 64 patients took part in the exercise program out of 237 referrals received over 50 months [29]. Another study reported almost 50% rejection rate among eligible patients referred to the exercise programs [27]. In one study, some programs recorded even as low as 10% annual enrolment [32]. Service compliance was also low among those that participated in the exercise programs except for one study that recorded as high as 71% compliance over a three-year evaluation period [31]. The widely reported seemingly poor referral process may explain the low acceptance rate across the included studies. While the referral process was found to be simple and convenient for the clinicians, it may have lacked some critical elements that guaranty an effective referral mechanism, one of which is patient engagement. Illustratively, common reasons for non-utilization, missed sessions, and dropouts across the included studies were lack of interest [27], unwell due to treatment [27], COVID-19 restrictions [27], hospital readmission [27], disease progression [27], lack of awareness of service availability [29], and worsening symptoms including adverse skeletal events [31]. These experiences appear to be underlined by a general lack of exercise self-efficacy and behavioral control which is a common observation in patients on active cancer treatment [34, 35]. The poor understanding of the complex nature of cancer disease and the appropriate exercise dose with minimal adverse effects required to derive health benefits are also potential accentuating factors among these patients [34, 35]. The referral process offers the treating oncologists and nurses a unique opportunity to support their patients in building confidence in their capabilities to initiate and maintain optimal exercise behavior. Oversimplifying the referral process robs the referring clinicians of opportunities to engage proactively with and counsel patients prior to their exercise journey. The observed low service uptake further speaks to the peculiar challenges of patients on active cancer treatment, especially those on hospital admission. These individuals constantly battle with multiple treatment-related complications and are generally unwell. Offering regular counseling and psychosocial supports and adapting exercise programs to reflect individual capacities, needs, and preferences can be another useful approach to increase uptake. Even though most patients were satisfied and willing to refer others to these programs, low service uptake and high dropout rates can be improved especially in the outpatient population by addressing sources of dissatisfaction, including early morning sessions, scheduling conflicts (i.e., by enabling a more flexible programs), absence of continuation plans (i.e., by considering, perhaps, more transformative exercise programs), and parking issues (i.e., by eliminating or subsidizing parking fees) [27, 29, 32].
Issues relating to funding also pose a major threat to sustainable service integration. Even though exercise services can be delivered with less sophisticated equipment, funds are required to cover routine operational costs, including daily consumables, staff salaries, maintenances, and in some locations, rents. Most of the programs were funded through grants and private donations [27, 29, 31, 32]. These sources are largely volatile and unsustainable. In one study, the average cost to the health service per patient was AUD $1, 104 with staff salaries being the primary expense [29]. Most of the programs could not be sustained after the evaluation period, largely due to inadequate resources. For example, one study reported that two programs were closed because of lack of funds [32]. In another study, authors reported that the exercise program was restructured at the end of the evaluation period to ensure that available funds are used to cover basic operational costs [29]. Funding is a key driver of long-term service and should form primary consideration during the program planning phase. As health systems continue to grapple with limited resource allocation globally, funding challenges are even more pronounced in exercise oncology, given the pervasive misconception about rehabilitation as largely an adjunctive service. Governments, corporate sponsors, and insurance agencies are potential opportunities that could be explored for multiple funding streams [36]. More research is therefore required to confirm the greater merits of integrative exercise-cancer care models to the broader health systems. This can provoke a cultural shift in healthcare funding policies to guaranty sustainable funding for exercise-based rehabilitation.
The strength of this review is evident in our reliance on multiple implementation outcome frameworks. By drawing extensively on well-established frameworks, our findings and recommendations offer critical information to support evidence-based practice, decision making, and future research. One major limitation of the current review is the limited number of studies available for inclusion, hence the inability to weigh fully without overstating the extent to which the differences across treatment settings may have influenced service implementation and how implementation may change in other cultures/settings. Further, as per the aim of our review, we did not evaluate the potential for this approach to translate into measurable clinical benefits. By excluding non-English articles, we may have further missed out on studies that could strengthen our findings and recommendations. Oncology care models that foster integrative exercise-cancer care units are recent and largely at the evaluation stage. While this may explain the paucity of literature, we caution that the current evidence only informs decision-making and evidence-based practice in light of these limitations and individual local settings.
Addressing questions around the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. While this appears to be an effective approach for increasing access to exercise-based rehabilitation for individuals on active cancer treatment, the current findings reveal major challenges with service penetration, adoption, and utilization. Issues relating to funding, lack of detailed implementation plan, and low organizational buy-in were the major barriers to effective service integration, particularly at the health service level. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness due to treatment, COVID-19 restrictions, hospital readmission, disease progression, lack of awareness of service availability, and adverse skeletal events.
Even though this model appears feasible for clinicians and patients, efforts are still required to drive sustainable service integration. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding patient core management team to include staff from the exercise unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating physicians and nurses) in the referral process. Future research should consider effective strategies to promote patients' sense of self-efficacy and behavioral control and the place of audit and feedback in improving exercise service delivery and overall service implementation. The current review recognizes the integration of exercise services with oncology care as a complex process and calls for efforts, including strategies and structures, that reflect the organizational dynamics of the clinical service environment housing the exercise unit.
All data generated and analysed during this study are included in this manuscript [and its supplementary information files].
PRISMA:
Preferred Reporting Items for Systematic Review and Meta-Analysis
CINAHL:
Ezenwankwo EF, Ezeukwu AO, Abaraogu UO. Effects of physical activity changes induced by behaviour change interventions on inflammation and patient-centred outcomes in breast cancer survivors: a systematic review. European Journal of Physiotherapy. Taylor and Francis Ltd.; 2021 [Cited 2021 Jul 5]. Available from: https://www.tandfonline.com/doi/abs/https://doi.org/10.1080/21679169.2021.1933586
Morishita S, Hamaue Y, Fukushima T, Tanaka T, Fu JB, Nakano J. Effect of Exercise on Mortality and Recurrence in Patients With Cancer: A Systematic Review and Meta-Analysis. Vol. 19, Integrative Cancer Therapies. SAGE Publications Inc.; 2020 [Cited 2021 Jul 5]. Available from: https://doi.org/10.1177/1534735420917462
Ashcraft KA, Peace RM, Betof AS, Dewhirst MW, Jones LW. Efficacy and Mechanisms of Aerobic Exercise on Cancer Initiation, Progression, and Metastasis: A Critical Systematic Review of In Vivo Preclinical Data. Vol. 76, Cancer Research. American Association for Cancer Research Inc.; 2016 [Cited 2021 Jul 5]. p. 4032–50. Available from: https://pubmed.ncbi.nlm.nih.gov/27381680/.
Brown MJ, Morris MA, Akam EC. An exploration of the role of exercise in modulating breast cancer progression in vitro: a systematic review and meta-analysis [Internet]. Vol. 320, American Journal of Physiology - Cell Physiology. American Physiological Society; 2021 [Cited 2021 Jul 5]. p. C253–63. Available from: https://journals.physiology.org/doi/abs/https://doi.org/10.1152/ajpcell.00461.2020.
Galvão DA, Spry N, Denham J, Taaffe DR, Cormie P, Joseph D, et al. A multicentre year-long randomised controlled trial of exercise training targeting physical functioning in men with prostate cancer previously treated with androgen suppression and radiation from TROG 03.04 radar. European Urology. 2014;65(5):856–64. [Cited 2021 Jul 5]. Available from: https://pubmed.ncbi.nlm.nih.gov/24113319/.
Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Vol. 2018, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2018 [Cited 2021 Jul 5]. Available from: https://pubmed.ncbi.nlm.nih.gov/29376559/.
Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM. Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. Journal of Clinical Oncology. 2011;29(6):726–32. [Cited 2021 Jul 5]. Available from: https://pubmed.ncbi.nlm.nih.gov/21205749/.
Stout NL, Brown JC, Schwartz AL, Marshall TF, Campbell AM, Nekhlyudov L, et al. An exercise oncology clinical pathway: Screening and referral for personalized interventions. Cancer. 2020;126(12):2750–8. [Cited 2021 Jul 7]. Available from: https://pubmed.ncbi.nlm.nih.gov/32212338/.
Stout NL, Silver JK, Baima J, Knowlton SE, Hu X. Prehabilitation: An Emerging Standard in Exercise Oncology. Exercise Oncology. 2020 [Cited 2021 Jul 7];111–43. Available from: https://link.springer.com/chapter/https://doi.org/10.1007/978-3-030-42011-6_6
Stout NL, Santa Mina D, Lyons KD, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: A Cancer Journal for Clinicians. 2021;71(2):149–75 (https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21639).
Schmitz K, Campbell A, Stuiver M, Pinto B, Schwartz A, Morris G. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians. 2019;69(6):468–484.
Haiderali A, Menditto L, Good M, Teitelbaum A, Wegner J. Impact on daily functioning and indirect/direct costs associated with chemotherapy-induced nausea and vomiting (CINV) in a US population. Support Care Cancer. 2011;19(6):843–51.
Campbell KL, Winters-Stone KM, Patel AV, Gerber LH, Matthews CE, May AM, et al. An executive summary of reports from an international multidisciplinary roundtable on exercise and cancer: Evidence, guidelines, and implementation. Rehabilitation Oncology. 2019;37(4):144–52. [Cited 2021 Jul 7]. Available from: https://journals.lww.com/rehabonc/Fulltext/2019/10000/An_Executive_Summary_of_Reports_From_an.3.aspx.
Schmitz KH, Campbell AM, Stuiver MM, Pinto BM, Schwartz AL, Morris GS, et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians. 2019;69(6):468–84. [Cited 2021 Aug 3]. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21579.
Effinger KE, Stratton KL, Fisher PG, Ness KK, Krull KR, Oeffinger KC, et al. Long-term health and social function in adult survivors of paediatric astrocytoma: A report from the Childhood Cancer Survivor Study. European Journal of Cancer. 2019;106:171–80. [Cited 2021 Jul 5] Available from: https://pubmed.ncbi.nlm.nih.gov/30528801/.
Galvão DA, Newton RU, Gardiner RA, Girgis A, Lepore SJ, Stiller A, et al. Compliance to exercise-oncology guidelines in prostate cancer survivors and associations with psychological distress, unmet supportive care needs, and quality of life. Psycho-Oncology. 2015;24(10):1241–9. [Cited 2021 Jul 5]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/pon.3882.
Thraen-Borowski KM, Gennuso KP, Cadmus-Bertram L. Accelerometer-derived physical activity and sedentary time by cancer type in the United States. PLoS ONE. 2017. [Cited 2021 Jul 5];12(8). Available from: https://pubmed.ncbi.nlm.nih.gov/28806753/
Galvão DA, Chambers SK. Exercise medicine in men with prostate cancer: breaking barriers to increase participation. Prostate Cancer and Prostatic Diseases. Springer Nature. 2021. [Cited 2021 Jul 5]. p. 1–2. Available from: https://doi.org/10.1038/s41391-021-00406-4
Rabin C. Promoting Lifestyle Change Among Cancer Survivors: When Is the Teachable Moment? 2009 Jun 11 [cited 2021 Aug 2];3(5):369–78. Available from: https://journals.sagepub.com/doi/abs/https://doi.org/10.1177/1559827609338148
Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implementation Science 2010 5:1. 2010 Sep 20 [Cited 2021 Jul 9];5(1):1–9. Available from: https://implementationscience.biomedcentral.com/articles/https://doi.org/10.1186/1748-5908-5-69
AC T, E L, W Z, KK O, H C, D L, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of internal medicine [Internet]. 2018 Oct 2 [cited 2021 Jul 9];169(7):467–73. Available from: https://pubmed.ncbi.nlm.nih.gov/30178033/
Bramer WM, de Jonge GB, Rethlefsen ML, Mast F, Kleijnen J. A systematic approach to searching: an efficient and complete method to develop literature searches. Journal of the Medical Library Association JMLA. 2018;106(4):531 [Cited 2021 Jul 9]. Available from: /pmc/articles/PMC6148622/.
Czosnek L, Richards J, Zopf E, Cormie P, Rosenbaum S, Rankin NM. Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes. BMC Cancer. 2021;21(1):1–25. [Cited 2021 Jul 9]Available from:https://bmccancer.biomedcentral.com/articles/10.1186/s12885-021-08196-7.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda. Administration and Policy in Mental Health and Mental Health Services Research. 2010;38(2):65–76. [Cited 2021 Jul 9]. Available from:https://link.springer.com/article/10.1007/s10488-010-0319-7.
Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How We Design Feasibility Studies. American journal of preventive medicine. 2009;36(5):452.
Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, et al. RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Frontiers in Public Health. 2019;7:64.
AM D, B Z, R W, SB T, K W, CL P. Bridging the gap: a pre-post feasibility study of embedding exercise therapy into a co-located cancer unit. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2021 [Cited 2021 Aug 16]. Available from: https://pubmed.ncbi.nlm.nih.gov/33963458/
Dennett AM, Peiris CL, Tan G, Shields N. Clinician's perspectives of implementing exercise-based rehabilitation in a cancer unit: a qualitative study. Supportive Care in Cancer 2021. 2021.[Cited 2021 Aug 25];1–8. Available from: https://link.springer.com/article/https://doi.org/10.1007/s00520-021-06378-4
Kennedy MA, Bayes S, Galvão DA, Singh F, Spry NA, Davis M, et al. If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework. Eur J Cancer Care. 2020. 29(4):e13251.
Newton RU, Kennedy MA, Singh F, Taaffe DR, Spry NA, Chee R, et al. Safety, Effectiveness, and Uptake of Exercise Medicine Integrated Within a Cancer Care Center. Seminars in Oncology Nursing. 2020;36(5):151073.
Dalzell MA, Smirnow N, Sateren W, Sintharaphone A, Ibrahim M, Mastroianni L, et al. Rehabilitation and exercise oncology program: translating research into a model of care. Current Oncology. 2017;24(3):e191 [Cited 2021 Aug 16];Available from: /pmc/articles/PMC5486391/.
AM D, CL P, N S, D M, NF T. Exercise therapy in oncology rehabilitation in Australia: A mixed-methods study. Asia-Pacific journal of clinical oncology. 2017. [Cited 2021 Aug 16]. ;13(5):e515–27. Available from: https://pubmed.ncbi.nlm.nih.gov/28004526/
Schmitz KH, Stout NL, Maitin-Shepard M, Campbell A, Schwartz AL, Grimmett C, et al. Moving through cancer: Setting the agenda to make exercise standard in oncology practice. Cancer. 2021;127(3):476–84.
HEL E, CC F, C V, DA G, RU N, G W, et al. Examining the Priorities, Needs and Preferences of Men with Metastatic Prostate Cancer in Designing a Personalised eHealth Exercise Intervention. International journal of behavioral medicine. 2021 Aug 1 [Cited 2021 Aug 26];28(4):431–43. Available from: https://pubmed.ncbi.nlm.nih.gov/32968943/
G S, E G, LO N, D H, J H. The views of patients with metastatic prostate cancer towards physical activity: a qualitative exploration. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2018 Jun 1 [Cited 2021 Aug 26];26(6):1747–54. Available from: https://pubmed.ncbi.nlm.nih.gov/29243168/
Mina DS, Alibhai SMH, Matthew AG, Guglietti CL, Steele J, Trachtenberg J, et al. Exercise in clinical cancer care: a call to action and program development description. Current Oncology. 2012;19(3):e136 [Cited 2021 Aug 26]. Available from: /pmc/articles/PMC3364774/.
Centre for Health Through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Elochukwu F. Ezenwankwo, Yumna Albertus, Victoria E Lambert & Delva Shamley
Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, ObservatoryCape Town, 7925, South Africa
Elochukwu F. Ezenwankwo
Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
Daniel A. Nnate
Countess of Chester Hospital NHS Foundation Trust, Health Park, Liverpool Road, Chester, CH2 1UL, UK
Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
Godspower D. Usoro, Chimdimma P. Onyeso, Ijeoma B. Anieto, Sam C. Ibeneme, Antoninus O. Ezeukwu & Ukachukwu O. Abaraogu
Department of Physiotherapy, Faculty of Health Sciences, School of Therapeuitc Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
Sam C. Ibeneme
Department of Physiotherapy, Faculty of Health Sciences and Technology, King David University of Medical Sciences, Ebonyi State, Uburu, Nigeria
Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
Ukachukwu O. Abaraogu
Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Delva Shamley
Godspower D. Usoro
Chimdimma P. Onyeso
Ijeoma B. Anieto
Yumna Albertus
Victoria E Lambert
Antoninus O. Ezeukwu
EE, DN YA, VL, and DS conceptualized the study; EE and DN developed the review protocol and drafted the initial manuscript; EE, DN, GU, CO and IA led data collection, analysis, and interpretation; SI, AE, UA, YA, VL, and DS provided critical insights and reviewed the final draft; all authors read and approved the final manuscript.
Correspondence to Elochukwu F. Ezenwankwo.
This study is a scoping review of publicly available peer-reviewed literature, with no primary data collection. Hence, it does not warrant consent to participate or institutional review board approval.
Initial search strategy in PubMed.
Ezenwankwo, E.F., Nnate, D.A., Usoro, G.D. et al. A scoping review examining the integration of exercise services in clinical oncology settings. BMC Health Serv Res 22, 236 (2022). https://doi.org/10.1186/s12913-022-07598-y
Received: 02 September 2021
Exercise-based rehabilitation
Service integration

redpajama_set_name: RedPajamaCommonCrawl


Around 69,000 people had applied for Housing for All in the city. Whereas, according to the instructions of the Center, 89 thousand houses are to be constructed in the city. During the said proposal, MIC member, Khushboo Gupta and the Mayor asked the officers to get NOC on fixed land from all the departments. On the other hand, MIC member Dharmendra alias Guddu Tomar has got one step on AVM Tanki and Tansen Theme Road.
The Mayor directed the Commissioner to take action according to the rules for the theme road. During this time, in the meeting, the other members of the corporation, Dwivedi, MIC member Satish Bohra, Gangaram Baghel, Neelima Shinde, Shobha Sikarwar, Dharmendra Rana, Khemchand Gurwani, Meena Shivram Jatav, Keshav Singh, Additional Commissioner Sandip Makkin, ML Daulatani, Abhay Rajgounkar, Superintending Engineer RLS Maurya etc. were present.
The necessary material for water supply operations and maintenance and innovative works will be purchased through the Small Industries Corporation. For this, an amount of Rs. 1 crore 27 lakh 34 thousand 516 rupees has been sanctioned. Also, the decision to invite a tender of 56 lakh 74 thousand 223 rupees.
The proposal received in connection with approving DPR prepared for the amount of 4384.08 lakhs was approved by Mehta & Mehta Associate Indore for Prime Minister Housing Scheme Housing for All 2022.


This new recording is made on the beautiful organ installed in the Neumunster Zurich and ranges from French organ music of the 18th century to 20th century Swiss organ music. The range of this outstanding instrument is fully captured through the very fine sound quality of this disc, which is one of the very best we have issued. The music has been carefully chosen to make an attractive programme in itself, and includes a magnificent performance of Rheinberger's magnificent Fourth Sonata, as well as including some very rarely heard music by this eminent contemporaries.


text:
Calliacantha simplex Manton & Oates, 1979
Protozoa (Kingdom)
Sarcomastigota (Subkingdom)
Choanozoa (Phylum)
Choanofila (Subphylum)
Choanoflagellatea (Class)
Acanthoecida (Order)
Acanthoecidae (Family)
Acanthoecidae [Nudiform] (Subfamily)
Calliacantha (Genus)
Calliacantha simplex (Species)
Calliacantha B.S.C.Leadbeater, 1978
Guiry, M.D. & Guiry, G.M. (2021). AlgaeBase. World-wide electronic publication, National University of Ireland, Galway (taxonomic information republished from AlgaeBase with permission of M.D. Guiry). Calliacantha simplex Manton & Oates, 1979. Accessed through: RAS (Eds.) (2021) Register of Antarctic Species at: http://ras.biodiversity.aq/aphia.php?p=taxdetails&id=105562 on 2022-01-16
RAS (Eds.) (2022). Register of Antarctic Species. Calliacantha simplex Manton & Oates, 1979. Accessed at: https://ras.biodiversity.aq/aphia.php?p=taxdetails&id=105562 on 2022-01-16
Brandt, Sue
Scott, Fiona
Guiry, Michael D.
basis of record Brandt, S. (2001). Choanoflagellates, in: Costello, M.J. et al. (Ed.) (2001). European register of marine species: a check-list of the marine species in Europe and a bibliography of guides to their identification. Collection Patrimoines Naturels, 50: pp. 57-59 (look up in IMIS) [details]
additional source Scott, F.J.; Marchant, H.J. (Ed.). (2005). Antarctic marine protists. Australian Biological Resources Study: Canberra. ISBN 0-642-56835-9. 563 pp., available online at http://its-db.aad.gov.au/proms/pubn/pubshow.asp?pub_id=12140 [details]
additional source Guiry, M.D. & Guiry, G.M. (2020). AlgaeBase. World-wide electronic publication, National University of Ireland, Galway. , available online at http://www.algaebase.org [details]
Published in AlgaeBase
To Dyntaxa


Al Nafoorah is the Lebanese restaurant that has long enjoyed a reputation for serving the finest Lebanese food in Dubai, along with generous helpings of Lebanese hospitality.
Rediscover the warmth of Lebanese hospitality at the coolest venue in the city. Enjoy delectable culinary offerings, enchanting live entertainment and an inviting atmosphere in the refreshing ambience of a unique terrace view at Al Nafoorah.
The name Al Nafoorah is derived from the Arabic word for 'fountain'. The secluded location of the restaurant, along with the fabulous Terrace view makes it the perfect spot to enjoy a quiet lunch or dinner, with the modern view of Dubai's ever-changing skyline further enhancing your visit.


After releasing the Cosmic caravan album, touring the world, and passing with the caravan through: Brazil, Germany, Austria, Serbia, Macedonia and Croatia. The Caravan is finally coming back home on 04.03 @ OrtoBar Ljubljana. Prepare yourself for a cosmic ride with Kala and his friends from Zenit Galaxy Serbia, Pura and Manda.


TopAlzheimercare.com is here to help you find the top Alzheimer's care in Illinois that matches your needs. Living with a disease such as Alzheimer's in Illinois can be a struggle, but the right care helps many people through the journey.
You are not alone. Many people's lives are impacted by Alzheimer's. The number of people affected by Illinois Alzheimer's grows each year. Because of this, the number of facilities designed to help with Alzheimer's in Illinois has also increased. This means more choices as well as more effort to find the best care for your needs. Benefit from our search experience with Alzheimer's care in Illinois and easily find the top options.
Alzheimer's care in Illinois or care options in any city or state across the country can be found with TopAlzheimercare.com. With our quick to use search, we make it simple to find the results you need. You can compare these results and see which choices are best for you.
We find the top care choices in your area in one fast search. In just moments, you could be on track to get the Illinois Alzheimer's care you are looking for. Sign up now and let us get you started today!


text:
Yaya Toure signs for Olympiakos
Yaya Toure signs for Olympiakos as he returns to Greece
Former Manchester City midfielder Yaya Toure has completed his return to Olympiakos.
Ο Γιάγια στα «ερυθρόλευκα»! / @YayaToure in the red and white of Olympiacos!#olympiacos #YayaToure #YayaIsBack pic.twitter.com/35TXvFA1rQ
— Olympiacos FC (@olympiacos_org) September 2, 2018
Toure helped the Greek side in the 2005/2006 season to win the domestic double and left the club for Monaco in 2006.
The 35-year-old was a free agent after leaving Manchester City this summer, Olympiakos fans gave him a hero's welcome when he arrived in Greece and he made an appearance on the pitch after their 5-0 victory over PAS Giannina on Sunday.
"I made my decision based on the special relationship I have with this incredible club," said Toure.
"It is an honour to be back. When I left in 2006 I said I would come back and I am delighted to keep my word. I had offers from lots of clubs across Europe, Asia and the USA.
"I am as hungry for success now as I was when I first arrived here many years ago and I cannot wait to help the club win the trophies the great fans of Olympiakos deserve.
"It is now time to let my football do the talking once again."
It is an honour to be back at @olympiacos_org ! 😊
When I left in 2006 I said I would come back and I am delighted to keep my word. 🙌🏾
FULL STATEMENT here: https://t.co/fBBwNFNLi7#YayaIsBack pic.twitter.com/hTG7DysRet
— Yaya Touré (@YayaToure) September 2, 2018
The Ivory Coast international joined Barcelona from Monaco in 2007 before signing for Manchester City in 2010, where he won three Premier League titles.
Olympiakos finished third in the Greek Super League last season behind PAOK and champions AEK Athens.
Footballnus | Get the latest football news, highlights, videos, and transfer gossip: Yaya Toure signs for Olympiakos
https://2.bp.blogspot.com/-Jt7aaJOtyNY/W4zlb-35AFI/AAAAAAAAJnA/SDTRm-yFc-kCPUQG5CUdd72leUubo08FgCLcBGAs/s640/yaya-toure-olympiakos.jpg
https://2.bp.blogspot.com/-Jt7aaJOtyNY/W4zlb-35AFI/AAAAAAAAJnA/SDTRm-yFc-kCPUQG5CUdd72leUubo08FgCLcBGAs/s72-c/yaya-toure-olympiakos.jpg
https://www.footballnus.com/2018/09/yaya-toure-signs-for-olympiakos.html


text:
Wednesday, 20.January 2021
Výsledky vyhledávání pro dotaz bowel
GPR55 - The new cannabinoid receptor
Napsal: Editor Testovací
His discovery is actually almost 20 years back, but only today he gains attention and importance. Meanwhile, the receptor called GPR55 also becomes CB3, the third relevant cannabinoid receptor in the human endogenous cannabinoid system. Endocannabinoid systemUntil quite some time ago, we knew that THC, which resembles the endogenous cannabinoid anandamide, binds to receptors in the brain, and as a result has an effect on our body. In the meantime, we know about the endocannabinoid system, which allows humans to use endocannabinoids, which the body itself produces, to perform a variety of health and immune functions. This system also harnesses the cannabinoids that we infuse from the outside by taking cannabis. The CB1 receptorSo far, two receptors are known, which are simply described with CB1 and CB2. The CB1 receptor can bind to both THC and CBD. Because they "compete" for the CB1 receptor during the effect of cannabis in the body, and CBD is not known to be psychoactive, CBD cushions the "high" effect of THC. These receptors are found mainly in the central nervous system, thus affecting the sensation of pain and also the motor skills, but also emotions, memory and appetite. The CB2 receptorThe CB2 receptor is found in organs of the immune system, mast cells and lymphocytes. While cannabis is believed to affect the immune system, the assumption that CBD interacts directly with the CB2 receptor is outdated. Rather, it seems that the cannabinoids cause the body to use more of its own endocannabinoids. CBD, GPR55 and cancerThe receptor GPR55, which was discovered in 1999 and can be found in the brain and peripheral nervous system, seems to be able to work with many different cannabinoids. It has differences to CB1 and CB2, but is 13 percent identical in construction to CB1 and 14.4 percent to CB2. One might now assume that cannabidiol (CBD) might dock specifically to the CB3 receptor. However, this does not seem to be the case, CBD even blocks the receptor. But this does not mean that CBD is useless for the receptor or for the medical influence of it, on the contrary. GPR55 signaling is said to be associated with the development or progression of cancer. Thus, the use of CBD targeted to block the signal transmission inhibit the growth of some tumors. CBD, GPR55 and epilepsyAlthough the diseases do not resemble each other, the apparent effect of CBD in epilepsy can be explained by the same principle as cancer. Among other things, GPR55 also occur in the hippocampus, the area of the brain in which spatial orientation and long-term memory are located. CBD has shown significant improvements in the intensity, quantity, and duration of seizures in some forms of epilepsy. CBD, GPR55 and irritable bowel syndromeCBD also has a positive influence on this intestinal disease. Fast and permanent improvement of well-being and relief of symptoms is reported. And again, this is associated with inhibition of signal transduction from GPR55. But in irritable bowel syndrome, it is also the anti-inflammatory properties of CBD, the help in the most chronic stomach and intestinal disorders. Only the beginningMany details about the CB3 receptor and the role it plays in our health are still unclear. But this concerns the whole endogenous cannabinoid system and its receptors, the cannabinoids, whether endogenous or supplied, and the terpenes and their many interactions and possible interactions with our bodies. But with every new insight, the accuracy with which we can use the properties of the cannabis plant for our health increases. Source: KLAUS GLASMANN, Dieter. GPR55 – Der neue Cannabinoid-Rezeptor. 1 [online] 30 Aug, 2019. Dostupné z: https://www.hanf-magazin.com/medizin/cannabinoide/gpr55-der-neue-cannabinoid-rezeptor/ source photo: https://pixabay.com/cs/
Pokračovat na článek
receptorcannabinoidsystemendogenous cannabinoid
How does CBD affect the irritable bowel?
The so-called irritable bowel syndrome (RDS) is actually no exact name of a specific disease. Rather, this term collects a number of inflammatory bowel diseases of different causes and manifestations. There are variants such as Crohn's disease, which actually go beyond the symptoms of RDS, because in Crohn's disease, the small intestine is affected, while the classic RDS occurs only in the colon. Nearly half of all cases in which a patient is referred to the gastroenterologist (gastrointestinal specialist) are related to the widespread disease. How is the irritable bowel syndrome diagnosed?Unequivocally diagnosing irritable bowel syndrome is a complicated affair. Often the symptoms can also be associated with other diseases, therefore, confusion often happen. This can often be avoided by having a good and detailed history that the doctor should really take time to do. It includes information about the period of the disease, About changes in the toilet habits and the like, which can lead the doctor on the right track. If the suspected diagnosis is in the first place, various blood tests, colonoscopy and other imaging techniques, as well as the examination of a stool sample are necessary to ensure a reliable diagnosis. How is irritable bowel syndrome treated?Since the irritable bowel is a widespread widespread disease, there are a lot of funds available, with which one can provide relief. For mild symptoms, a diet that dispenses with a range of short-chain carbohydrates and polyhydric alcohols can help. Depending on whether the condition is more likely to be constipated or diarrhea, a laxative or anti-drainage drug may be administered. In general, the increased intake of fiber is recommended. Psyllium husks and barley have proven to be particularly useful. Camomile, myrrh and coffee charcoal are also considered to be very effective in relieving symptoms. To restore a healthy intestinal flora, the use of so-called probiotics (bacterial strains) was helpful. Although the pharmaceutical industry has also developed some products for the treatment of irritable bowel syndrome, these are often associated with side effects that do not justify their use for many people. The natural alternatives are clearly to be preferred here. What Can CBD Do For Irritable Bowel Syndrome?In 2004, the neurologist and former president of the International Association for Cannabis as Medicine, Ethan Russo, linked irritable bowel syndrome to the endocannabinoid system or deficits in a publication. Russo points to studies showing that malfunctions in the endocannabinoid system can cause inflammatory bowel disease. Consequently, cannabis can effectively remedy this situation. At first, it was claimed that cannabidiol (CBD) alone was not enough, but THC was also needed. This claim has since been revised, and it has been found that CBD is an important agent in the treatment of inflammatory bowel disease, which can both fight inflammation and regulate the function of glial cells (cells in the nervous tissue, but which are not neurons) , The immunomodulatory properties of CBD have been shown to positively affect disease progression and symptoms in studies. CBD can be of great help even in the severe Crohn's disease, and most recent research has yielded very promising results, making CBD a real hope for many gastrointestinal patients. Source: GLASMANN, Dieter Klaus. Wie wirkt CBD auf den Reizdarm?, 3 Oct, 2018. Dostupné z: https://www.hanf-magazin.com/medizin/cannabinoide/cbd-in-der-medizin/wie-wirkt-cbd-auf-den-reizdarm/ source photo: https://pixabay.com/cs/
irritablebowelsyndromediseasesymptomsinflammatory bowelcrohn disease
Blog about use of cbd oils and cannabis
Phytocannabinoids are cannabinoids produced by plants. Mainly these agents are found in cannabis ..
Cannabis Cirrus (CBC) is one of over 100 cannabinoids. Although the phytocannabinoid itself has no ..
© Copyright 2021 | simplycbdoil.org


text:
package ru.ac.uniyar.todolist;

import android.app.LoaderManager;
import android.content.ContentValues;
import android.content.CursorLoader;
import android.content.Intent;
import android.content.Loader;
import android.database.Cursor;
import android.net.Uri;
import android.os.Bundle;
import android.support.v4.widget.SimpleCursorAdapter;
import android.support.v7.app.AppCompatActivity;
import android.support.v7.widget.Toolbar;
import android.view.View;
import android.widget.ListView;

import butterknife.BindView;
import butterknife.ButterKnife;
import butterknife.OnClick;
import butterknife.OnItemClick;

public class MainActivity extends AppCompatActivity
        implements LoaderManager.LoaderCallbacks<Cursor> {

    @BindView(R.id.toolbar) Toolbar toolbar;
    @BindView(R.id.todoList) ListView todoListView;
    SimpleCursorAdapter adapter;

    @Override
    protected void onCreate(Bundle savedInstanceState) {
        super.onCreate(savedInstanceState);
        setContentView(R.layout.activity_main);
        ButterKnife.bind(this);
        setSupportActionBar(toolbar);
        initListAdapter();
        getLoaderManager().initLoader(0, null, this);
    }

    private void initListAdapter() {
        String[] from = new String[] { "title", "description", "dueDate" };
        int[] to = new int[] { R.id.titleText, R.id.descriptionText, R.id.dueDateText };
        adapter = new SimpleCursorAdapter(this,
                R.layout.todo_item, null, from, to, 0);
        todoListView.setAdapter(adapter);
    }

    @OnClick(R.id.fab)
    public void onFABClick(View view) {
        Intent intent = new Intent(this, ToDoEditorActivity.class);
        startActivityForResult(intent, 1);
    }

    @OnItemClick(R.id.todoList)
    public void onListItemClicked(int position) {
        String itemId = String.valueOf(adapter.getItemId(position));
        Cursor cursor = getContentResolver().query(
                Uri.parse("content://ru.ac.uniyar.todolist.contentprovider/todos/" + itemId),
                null, null, null, null);
        cursor.moveToNext();
        Todo todo = new Todo(
                Integer.valueOf(cursor.getInt(cursor.getColumnIndex("_id"))),
                cursor.getString(cursor.getColumnIndex("title")),
                cursor.getString(cursor.getColumnIndex("description")),
                cursor.getString(cursor.getColumnIndex("dueDate")));
        cursor.close();
        Intent intent = new Intent(this, ToDoEditorActivity.class);
        intent.putExtra("todo", todo);
        startActivityForResult(intent, 1);
    }

    @Override
    protected void onActivityResult(int requestCode, int resultCode, Intent data) {
        if (requestCode == 1) {
            if (resultCode != RESULT_OK) return;
            Todo todo = data.getParcelableExtra("todo");
            ContentValues cv = new ContentValues();
            cv.put("title", todo.getTitle());
            cv.put("description", todo.getDescription());
            cv.put("dueDate", todo.getDueDate());
            if (todo.isNew()) {
                getContentResolver().insert(
                        Uri.parse("content://ru.ac.uniyar.todolist.contentprovider/todos/"), cv);
            } else {
                getContentResolver().update(
                        Uri.parse("content://ru.ac.uniyar.todolist.contentprovider/todos/" +
                                todo.getId()), cv, null, null);
            }
        } else {
            super.onActivityResult(requestCode, resultCode, data);
        }
    }

    @Override
    public Loader<Cursor> onCreateLoader(int id, Bundle args) {
        return new CursorLoader(this,
            Uri.parse("content://ru.ac.uniyar.todolist.contentprovider/todos"),
            null, null, null, "dueDate desc");
    }

    @Override
    public void onLoadFinished(Loader<Cursor> loader, Cursor data) {
        adapter.swapCursor(data);
    }

    @Override
    public void onLoaderReset(Loader<Cursor> loader) {
        adapter.swapCursor(null);
    }
}

redpajama_set_name: RedPajamaGithub


text:
Q: Wordpress nested loop, cannot remove meta_key from the query I have two custom posts types A and B, linked together with a same custom taxonomy.
While looping through A posts with the "default" loop, I want for each A to get all B with the same taxonomy.
The code looks like this:
<?php if(have_posts()): while(have_posts()): the_post(); ?>
    <?php
        $A_Bs=get_the_terms( $post->ID, 'A_B');
    ?>

    <?php if($A_Bs!=false && count($A_Bs)>0):?>

        <?php

            $A_B=$A_Bs[0];
            $args = array(
                'post_type'      => 'B',
                'tax_query' => array(
                  array(
                    'taxonomy' => 'A_B',
                    'field' => 'term_id',
                    'terms' => $A_B->term_id,
                  ),
                ),
            );

            $loop = new WP_Query($args);
            $saved_post=$post;
        ?>

        <?php while ($loop->have_posts()) : $loop->the_post();?>
            blabla
        <?php endwhile;?>
        <?php $post=$saved_post;?>

    <?php endif;?>
<?php endwhile; endif;?>

But the sub-loop is always empty. The reason is, in the query_vars I have these two guys:
  'meta_key' => string 'position' (length=8)
  'orderby' => string 'meta_value_num' (length=14)

and I can't get rid of them. I never specified this ordering anywhere and my B posts don't have this custom field.
It's generating this line in the SQL query:
aaaa_postmeta.meta_key = 'position'

and prevent me to list the posts.
I tried to play with the $args, removing the tax_query and changing the post_type but it's always the same.
Thank you for your time !

A: Sorry I just realized after hours that I have the following thing in functions.php
function order_by_position($query){

    if(is_post_type_archive( 'A')||is_post_type_archive( 'C')||is_post_type_archive( 'D')){
        $query->query_vars['meta_key']="position";
        $query->query_vars['orderby']="meta_value_num";
    }
    return $query;
}
add_action( 'pre_get_posts', 'order_by_position' );

It's much more logical now.
Sorry for disturbing.

redpajama_set_name: RedPajamaStackExchange


To make the loading of the Pulpmaster easy and hassle free, Pulpmaster have introduced our caddy system. The caddy system allows for the speedy collection of food and liquid waste in an easy to manage container. The 23 litre Pulpmaster Caddy's size makes it simple to maneuver but difficult to over fill, meaning a significant reduction in risk of injury.
Our customers love this system because it improves efficiency, makes it easier to place food waste in the machine, and helps keep benches clean and clear. All off-cuts and other food waste goes straight into the caddy and, once full, straight into the machine. The ideal solution for larger kitchens and food preparation areas which take advantage of the Pulpmaster recyclable organic waste system.


text:
jQuery(document).ready(function($) {

	 // picker buttton
	jQuery(".picker_close").click(function(){
		jQuery("#choose_color").toggleClass("position");
	});

  jQuery("#blue-1" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/blue-1.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#blue-2" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/blue-2.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#cumin" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/cumin.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#gold" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/gold.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#gray" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/gray.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#green-1" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/green-1.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#green-2" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/green-2.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#orange-1" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/orange-1.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#orange-2" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/orange-2.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#pink" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/pink.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#purple-1" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/purple-1.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#purple-2" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/purple-2.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#red-1" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/red-1.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#red-2" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/red-2.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#yellow-1" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/yellow-1.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#yellow-2" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/yellow-2.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
  });

  jQuery("#default" ).click(function(){
	  jQuery("#color" ).attr("href", "css/color/default.css");
	  jQuery(".logo img" ).attr("src", "images/logo.png");
	  return false;
	});
});


text:
Instrukcja techniczna K-1 – standard techniczny w geodezji w Polsce, obowiązujący do 2011 roku na podstawie rozporządzenia Ministra Spraw Wewnętrznych i Administracji z dnia 24 marca 1999 (), zbiór wytycznych dotyczących tworzenia mapy zasadniczej w geodezji wprowadzony w 1998 przez Głównego Geodetę Kraju pismem w sprawie stosowania instrukcji technicznej "K-1 Mapa zasadnicza". Ostatnim wydaniem jest wydanie III z 1998 opracowane przez Zdzisława Adamczewskiego, Andrzeja Bąka, Mariolę Gilską, Edwarda Mechę, Ryszarda Staniszewskiego, Zygmunta Szumskiego, Wojciecha Wilkowskiego oraz Stanisławę Mogiłło-Suchowerę.

W związku z wprowadzeniem ustawy o infrastrukturze informacji przestrzennej z 4 marca 2010 roku (art. 35), instrukcja ta straciła ważność w 2011 roku. Od 5 kwietnia 2013 roku jedynym dokumentem opisującym zasady prowadzenia mapy zasadniczej Rozporządzenie Ministra Administracji i Cyfryzacji z 12 lutego 2013 r. w sprawie bazy danych geodezyjnej ewidencji sieci uzbrojenia terenu, bazy danych obiektów topograficznych oraz mapy zasadniczej. Rozporządzenie to nie przewiduje możliwości prowadzenia mapy zasadniczej w formie analogowej, a jedynie definiuje obiektowe bazy danych, z których pozyskuje się dane do utworzenia mapy zasadniczej. Arkusze mapy zasadniczej prowadzone w formie analogowej na podstawie art 53b Ustawy Prawo geodezyjne i kartograficzne zachowują swoją ważność do końca 2013 roku. Po tej dacie mapa zasadnicza może być prowadzona jedynie w formie mapy numerycznej.

Mapa zasadnicza
Instrukcja K-1 z 1998 podaje zasady opracowania podstawowej mapy kraju, zwanej także mapą zasadniczą, w postaci klasycznej lub numerycznej, stanowi, iż edycję mapy zasadniczej wykonuje się w skalach: 1:500, 1:1000, 1:2000, 1:5000, zwanymi skalami bazowymi, oraz ustala:
 pojęcie mapy zasadniczej, jej przeznaczenie i funkcje
 pojęcie metryki mapy
 skale mapy i zasady ich doboru
 treść mapy
 formę mapy
 prowadzenie mapy
 wymagania w stosunku do systemów informatycznych.

Według tej instrukcji mapa zasadnicza jest to wielkoskalowe opracowanie kartograficzne zawierające aktualne informacje o przestrzennym rozmieszczeniu obiektów ogólnogeograficznych oraz elementach ewidencji gruntów i budynków, a także sieci uzbrojenia terenu: nadziemnych, naziemnych i podziemnych oraz stanowi:
 podstawowy element państwowego zasobu geodezyjnego i kartograficznego
 podstawowy materiał kartograficzny, wykorzystywany do zaspokojenia różnorodnych potrzeb gospodarki narodowej, a w szczególności zagospodarowania przestrzennego, katastru nieruchomości i powszechnej taksacji
 źródłowe opracowanie kartograficzne do sporządzania map pochodnych i innych wielkoskalowych map tematycznych oraz aktualizacji mapy topograficznej w skali 1:10 000 (1:5000).
Ponadto instrukcja zawiera katalog obiektów i znaków umownych oraz warunki edycji.

Ze względu na zamieszczony w niej zapis, że aktualizacji map dokonuje się według instrukcji obowiązujących w czasie ich zakładania, dopuszczono stosowanie m.in. instrukcji K-1 z 1979 oraz D-II z 1962 roku.

Mapa zasadnicza służy do celów administracyjnych, prawnych, ewidencyjnych i projektowych oraz stanowi część składową krajowego systemu informacji o terenie (SIT).

Zobacz też
 Standardy techniczne dotyczące geodezji w Polsce
 Instrukcja techniczna K-1 Podstawowa mapa kraju (1995)

Przypisy

Instrukcje geodezyjne w kartografii
Instrukcje i wytyczne techniczne w geodezji

redpajama_set_name: RedPajamaWikipedia


In this article, I am going to share with you the collection of several interesting, unique command-line tricks.
If you are a Linux administrator or Linux user, let's start with some Linux command line tricks to enhance the creativeness at the terminal.
1) Only one user to allow to switch on root account as an administration user.
We added "gaurav" user on "wheel" group.
b.) Edit the /etc/pam.d/su file.
#vim /etc/pam.d/su Uncomment the following line(line no. 6).
c.) Now try to check with user login.
As shown, "gaurav" user can switch to root account but "anil" user not able to login on root account and showing Permission denied.
2) Run the last command as any user.
3) Find out the current shell name.
Where, "$SHELL" is the environment variable that stores the name of current shell and "$0" shows the name of program.
4) Some Tip and Tricks for shutdown command.
Connection to 192.168.1.10 closed by remote host.
It will reboot the system.
Shutdown scheduled for Fri 2016-09-23 06:45:00 EDT, use 'shutdown -c' to cancel.
System will shutdown at a specific time.
The system shutdown has been cancelled at Fri 2016-09-23 06:42:44 EDT!
As shown, system shutdown has been cancelled.
5) Download rpm file in specific directory by using downloadonly plugin.
Now, Download the rpm file.
6) Close a terminal without saving the history in Linux.
Your shell's history is saved in the file indicated by the HISTFILE variable.
As show above, User "gaurav" not find any history for previous session.
7) Make a Multiple directories using one command.
Make some directories according to the following in one command.
Note: "tee" or "ls -R" command is used to check the status.If "tree" package is not installed then install it, using " yum install -y tree" command.
8) check the system's reboot date and time.
9) Set Hostname permanenelty in centos7/rhel7/fedora22.
#hostnamectl set-hostname <hostname> (Where, hostnamectl is used to control the system hostname).
Note: Re-login on the session, it will display "server1" instead of "localhost".
10) Delete the files within the ranges between 20 to 100 days.
As shown, all the files within the ranges beween 20 to 100 days are deleted.


text:
When athletes bare all, the women get pushback
Bob Collins June 28, 2018, 1:26 PM Jun 28, 2018
Two Minnesota athletes posed naked for this month's ESPN Magazine. Only one seems to be getting much attention for doing so.
"It's such a crazy double standard that suddenly we aren't a role model when we want to be proud of our bodies," Jessie Diggins, of Afton, told the Pioneer Press of her decision to appear without clothing in the magazine. "That was another thing that made me be, like, 'Yeah. I really want to do this.' We aren't going to solve body image issues by not talking about it, so I'm hoping this actually opens up the conversation."
It's always dicey to open up a conversation as Diggins found out .
"I feel like this experience has made me even stronger being able to say, 'I don't care what those type of people think about me,'" she said of the online comments. "There are always going to be people that find something to hate on. All the people that I'm closest with have supported me throughout this process. That's the only thing that matters to me. I don't need to worry what some random 40-year-old man sitting in his basement is posting on my Instagram. It really doesn't matter."
You know who's not in the conversation? And who's not the subject of stories asking him to defend his decision to appear in the same issue? Karl Anthony Towns of the Minnesota Timberwolves.
.@KarlTowns is comfortable in his own skin in ESPN the Magazine's BODY10 Issue. https://t.co/ERxswR3lZy pic.twitter.com/EeFqF4MbeL
"He's seven feet of sexy," the Lexington Herald Leader said.
"Poor decision, Jessie," a Star Tribune commenter said of Diggins' decision. "I think you could have made your point about girls and fitness without being part of the ESPN spread. I'd say the same thing to the men."
But the commenter didn't, of course.
‹ Older Twitter fight ends with an old-school solution
Newer › What's on MPR News? 6/29/18
"I'm so surprised by this." –No woman ever.
Patriarchal societies sure are obsessed with protecting female virtue while having no interest in female self-determination.
If a patriarchal society acknowledged that women are capable of self-determination they might also have to face that women aren't in need of protection… And what would the males of that society do then to prove their masculinity?
In these cases, women's virtue is considered the property of their fathers, and later their husbands. E.g. purity rings, which are so creepy.
Patrick Tice
Why do we need to prove our masculinity? Or anything? Are we knuckle draggers?
theoacme
Too many men would be improved if they aspired to become knuckle draggers…
Dude (Not Sweet)
^This.
We are not moving forward as a society, example #87,265
I actually got a kick out of reading the responses to the ESPN tweet you embedded.
I'm not comparing it to the backlash that Jesse Diggins experienced, but the (NSFW) responses to the ESPN tweet are very critical of Towns and ESPN for the photo.
However the responses to the Timberwolves' retweet of ESPN's tweet are almost unanimously positive, which gave me a chuckle: https://twitter.com/Timberwolves/status/1011697949384962049
Any revulsion I saw was more of a visual nature. The subtext in the Diggins criticism is more of a moral judgment.
Never see a man punished for natural size or growth.
http://www.espn.com/espn/story/_/id/23830153/caster-semeya-challenge-iaaf-testosterone-ruling
There was a fair amount of gay panic in the responses.
And I have to imagine, judging by an earlier post of yours, that you were horrified.
Got no need to see nude athletes of either gender in sports media – or any other media – and will forever be mystified at the urge of athletes and other celebrities to pose sans clothes.
Its a classical thing.
http://www.britishmuseum.org/collectionimages/AN00396/AN00396999_001_l.jpg
Never was a classical fan.
Neither was Cincinnati, apparently… (thank you, Jim Borgman!)
http://3.bp.blogspot.com/_gK56Tbjvnoc/TG7FzHU2dvI/AAAAAAAAAdE/LDlGZrfu0kc/s1600/mapplethorpeCincinnati.jpg
Nice discus.
In high school, the women's XC-Ski team chose this for their slogan:
Ski naked.
It adds color to your cheeks.
BNelson
Honest question: why does this article include an image of the nude male athlete but not the female?
Because I could embed ESPN tweets and there wasn't a tweet of Diggins by anyone who owned the photo rights.
JamieHX
The sexualization and objectification of female athletes has been going on for at least a couple decades. It's like they aren't worth enough as athletes; they have to be sex objects too. The fact that many of these female athletes consent to this is unfortunate. They may feel good about it personally but it doesn't advance the cause of equal treatment and opportunity for women (and being proud of your body doesn't mean you should take your clothes off in public anyway — that just seems like some sort of cry for help). We shouldn't feel ok about this instance because there's also a male athlete being sexualized. One male out of dozens, maybe hundreds of female athletes.
I'm not interested in seeing either gender as sexual beings. If I'm paying attention to them, it's to see their athletic prowess. Their sexual-ness is — or should be — private.