President’s Message
Quest
Volume 28, Issue 1 May 2013
President’s
message
1
Treasurer’s
letter
2
Editor’s Corner
Mission Statement
3
“On the Four Front” 4
PONV Study Follow
up
5
Winners at Fall
Conference
6
Certification Info 7
Report on the Na-
tional Conference
8
Board of Directors
11
Willingness to
Participate Form
12
Child Life Support 13
Important Dates
14
In this Issue
I’m going to share a secret with you that you may not know about. It happened
many years ago, way before I became a nurse. I was a cheerleader in high
school! There I said it. It wasn't like I had a passion for that sport but way back
then there was no girls soccer team or a field hockey teams for Fall sports. So
by default, cheerleading was it. I was definitely not going to run cross country
for no reason. What does this have to do with peri anesthesia you ask? I sur-
mise that there are many similarities to nursing. We are always encouraging
others to believe in what we're selling whether it's a cheer or doing their incen-
tive spirometry. Not every person has what it takes to be a cheerleader or to be
a nurse. Both require hard work to achieve success as well as continued work
to maintain a high level of ability. I also see myself as a cheerleader at the
component level, always encouraging the Board of Directors to reach a new
level of service to members and looking to identify future leaders among mem-
bers.
Are you a cheerleader? Are you a closet cheerleader at work? Do you encour-
age your patients or colleagues to shine? I hope you all will cheer for your-
selves, your colleagues and patients to bring out the best in everyone every-
day!
Amy Dooley, RN, MS, CPAN is President of
VT/NH APAN
Page 2 Quest
Treasurer Wanted
Seven years ago I offered to take over as treasurer for VTNH APAN. My experience
on the board has been rewarding, educational and fun as well. However, now is the
time for someone else to step forward. My term expires in 2014 and I am retiring
from the board at that time. I encourage you to seriously consider this opportunity.
You are probably thinking that you don’t know much about handling the treasurer’s
responsibilities. Don’t worry. Many systems are in place, much is automated and the
board will eagerly mentor you. Currently our finances are on an Excel spreadsheet,
so a basic knowledge of Excel would be beneficial. The term of service is 2 years.
Your responsibilities would include receiving our monthly membership dues, maintain-
ing/ reconciling our checking and debit accounts, and updating our financial state-
ments.
We are a small component of ASPAN and as such, our finances are not complicated.
Most of our board meetings are conducted via phone conference, so travel is minimal.
If you can afford a few hours per month, are willing to help your professional organiza-
tion and are interested in being part of a dynamic and fun loving group, please con-
sider your willingness to participate. If you are interested, I would be glad to give you
more information. You can reach me at [email protected] or via the VTNH
APAN website.
I’m looking forward to talking with you.
Denise Martel, RN, BSN, CAPA
Treasurer’s Corner
Congratulations to VT/NH APAN members Julie Gilston and Joanne Shomphe who re-
ceived scholarships for the 2013 fiscal year.
Both Julie and Joanne were awarded $400 to attend National Conference in Chicago.
Julie is an RN in the Same Day Care Unit at Portsmouth Regional Hospital. She has writ-
ten several articles for Quest, and presented a “Celebrate Successful Practices Poster” at
National conference. Joanne, also an RN in the SDC Unit at PRH, has supported VT/NH
APAN by attending conferences regularly and was instrumental in helping to raise revenue
at our most recent spring conference in Portsmouth.
Scholarship funds are now available for the fiscal year 2014. The application deadline is
January 31, 2014. Go to the website, www.vtnhapan.org , for information on how to apply.
2013 Scholarship Winners
The Association exists to promote quality and cost effec-tive care for patients, their families, and the community,
through public and professional education, research, and standards of practice.
Page 3 Quest
The Editor’s Corner
Recently I read a Gallup poll survey that for 13 out of the last 14 years, nurses have been rated the
most trusted and ethical profession by Americans. Firefighters were number one in 2001. It makes me
proud to be part of such a respected group. Sometimes this is forgotten when we work as a team with
different specialists. Always introduce yourself proudly as “The Nurse”! We have worked hard to de-
serve the designation of being most trusted. Observe how our patients put their trust in us every day
and night. Stand up tall and proud and know that you are part of the best!
Nancy Vatistas, RN, Editor, Quest and www.vtnhapan.org
To Join ASPAN and VT/NH APAN:
www.aspan.org
www.vtnhapan.org
Page 4 Quest
ON THE “FOUR”FRONT WITH REGION IV
FROM: ASPAN REGION IV DIRECTOR: LAURA A. KLING, MSN, RN, CNS, CPAN, CAPA
Springtime is here, and the season usually signals a renewal…and an awareness of change.
April, ASPAN had a very successful national conference in Chicago. Our new ASPAN President, Twilla
Shrout has revealed her presidential theme: Dealing with Challenges: Winning with Power, Practice and
Purpose. May brings National Nurses Week, and the theme: Delivering Quality and Innovation in Patient
Care. The National Hospital Week follows with this theme: A Guiding Light for Changing Times. All of
these central thoughts acknowledge the fact that each day we deal with challenges in our professional
lives. Nurses, who continue to be the most trusted profession in the public’s perception – are designing
strategies to succeed. In my humble opinion, we cannot be successful alone; it takes the “home” team and
the “work” team, to help us be the best we can be. So during this time of renewal and new beginnings, I
ask that we take a moment, to appreciate all of those key persons, who help us be successful and per-
haps, give us the fortitude to deal with challenges we face.
According to research conducted by the US Department of Labor, 64 percent of Americans who leave
their jobs do so because they don’t feel appreciated. ¹ What is also true, according to authors of The 5
Languages of Appreciation in the Workplace , Gary Chapman and Paul White, is that what makes one
person feel appreciated, does not necessarily, make another feel appreciated. And so they have thought-
fully suggested some basic tenets .
Words of Affirmation: What is it that says to you – I am/ my work is valued and appreciated? For every-
one, this could be different. How many of us have quietly said to each other – how far a simple “thank you”
would go, after a particularly difficult day? The perception becomes one of “a lack of value and a lack of
support” from not only leaders, but peers. It becomes a potential tragedy for neglect. Consider this: praise
is usually task-specific. What we really need to focus on is affirming positive character traits.
Quality Time: I think of this as mindful engagement; in other words, giving someone your undivided time
and attention. Multi-tasking has risen to a new level, but can be fraught with safety issues. Have that qual-
ity conversation, in a sharing, safe context. Coupled with this, is the art of listening; focused and attentive.
This means listening for feelings as well as thoughts. Validate what you are hearing. This process opens
the door for further communication about shared experiences, creating an understanding of what is val-
ued.
Acts of Service: Provide assistance to your colleagues and do so with a positive manner! Be encourag-
ing, do it their way when offering assistance, and complete what you start. Great axioms – and surely, that
assistance you give will be reciprocated. My friend, Dr. Kim Noble, ASPAN Director for Research often
says: “many hands make light work”.
Tangible Gifts: Chapman and White suggest that two key elements are necessary for tangible gifts: 1.)
give gifts primarily to those who appreciate them and 2.) Give a gift the person values. Gifts given in re-
sponse to tradition and a feeling of obligation miss the mark. They potentially communicate a lack of per-
sonal investment in the action and so are perceived by the receiver in a negative way.
Physical Touch: Physical touch during difficult times is human and instinctive. But in today’s world, the
question must be asked, is there a place for physical touch in the workplace? The authors believe the
potential benefits of appropriate touch are significant, but individuals and workplaces must clearly define
the boundaries. Certainly handshakes are part of our western culture. You must ascertain your own com-
fort level with your colleagues, and be sensitive and insightful when using this affirmation. (Cont Page5)
Page 5 Quest
Laura Kling cont. from page 4
So as our new season of ASPAN activities begins, within the national arena, your components, and your work-
places, think about the challenges you and your colleagues face. Appreciate your team members in the appro-
priate manner. The opportunity for success is elevated, when we feel appreciated, and when we appreciate
others. Region IV has many great events coming up, so please check your component website, and those of
neighboring components.
Most importantly, I want to acknowledge and thank each and every one of YOU, for your time and your talent,
which you share with your Component and ASPAN. I value YOU, and I look forward to our continued partner-
ship and success in the coming year!
Chapman, C. and White, P. The Five Languages of Appreciation in the Workplace: Empowering organizations
by encouraging people. 2011. Chicago: Northside Publishing.
Above is Julie Gilston, RN with her poster at National Conference in Chicago. Julie is a member of VT/NH
APAN. She and Denise Martel, RN, CAPA of Portsmouth Regional Hospital were recently published in Out-
patient Surgery Magazine. Their article is titled “How to Decrease Your PONV Rates”. Denise is the treas-
urer for VT/NH APAN. Denise and Julie produced a beautifully informative poster for the National Confer-
ence in Chicago and Julie presented it there. Thank you for representing VT/NH APAN so well.
Thank you to Portsmouth Anesthesia Associates
for providing our breakfast at our March confer-
ence.
Thank you to Portsmouth Regional Hospital for
printing services.
We couldn’t have read it without you!
Page 6 Quest
Winners at Spring Conference
Congratulations to all the winners. Thank you for your
support of the VT/NH APAN Scholarship program.
Certification Bracelets: Maria O’Connor and Dawn Mills,
both from PRH
Free Conference for Certified Nurses: Dawn Mills, PRH
Evening Inspirations Basket from Elliott Hospital PACU:
Kathy Bourgone, DHMC
Cupcake Basket from Lahey Clinic: Linda Furlong, Exeter
Hospital
Spring Basket from PRH: Donna Verville, PRH
Italian Dinner Basket from PRH: Maribeth Graham, PRH
Italian Treats from Central Vermont Medical Center:
Brenda Dufresne-Benda, CVMC
Stonewall Kitchens Basket from WDH: Nancy Tompkins,
PRH
ASPAN Blanket and Reference Book from Laura Kling:
Sandy Watts, CMC
Congratulations to
Newly Certified
Member:
Anne Boland
Important Dates for Certification:
Registration Window Online: July 15 - Sept 9
Registration Deadline: Sept 9 by 11:59 ET
Time Period for Scheduling Examination upon receipt of your ATT letter through Nov 14
Appointment with Prometric
Examination Administration Window Oct 7 –Nov 16
Deadline for Cancelling Appt. with Prometric 3 business days before scheduled test date
Postmark deadline for requesting Withdrawal on or before the last day of exam adm. window
Refund-Rollover from PES
For more information about certification: wwwcpancapa.org
Page 7 Quest
Exam Fees:
ASPAN member $285
Non ASPAN member $385
Page 8 Quest
ASPAN’s 32nd
National Conference “Towering Opportunities, Endless Possibilities” 2013
WOW! This was a great conference, with over 1990 attendees from all over the world: Ireland, Great Britain, Austra-
lia, Japan and those are the ones I was sure of. There were many first time attendees who were recognized at
opening session. These participants have their own meeting to learn about national conference. The Perianesthe-
sia Nurses who are serving in the military were recognized as well, including Myrna Mamaril, who you all contributed
personal items, food and reading material to in the fall of 2011. The VTNH Board sent them a care package to their
post in Afghanistan.
As your Vermont /New Hampshire (VTNH) Component Vice-President/President elect, I represented you, the mem-
bers, at the Representative Assembly on Friday April 14, 2013. The Representative Assembly is similar to your
State Senators, where 2 members from each state have a vote on decisions, changes and suggestions on Practice
Standards, Position Statements, and Guidelines made for the improvement and safety of our practice-
Perianesthesia Nursing.
We also vote for the officers and directors that conduct the business of ASPAN’s organization. The election of offi-
cers and directors is split, so that not all officers and directors are new to the positions in any one year (odd and
even year elections).
Prior to this vote of officers and directors, the membership from VTNH APAN had an opportunity to also vote for
these same candidates. The response we had was very low from our membership. If you were not aware or did not
think you had a vote for these candidates, you do. Please let us know, this could be an area to improve communica-
tion to our members.
Amy Dooley, the President of VTNH APAN Component, and I made the best possible decisions about each of the
candidates based on their knowledge and work ethic, credentials, presentation, and goals for ASPAN. There were a
few candidates seeking another term of 2 years. We were able to meet each one of them at a Candidates’ Recep-
tion on Saturday night, April 13th. They each were asked to answer two questions as presented by the Immediate
Past-President, Chris Price.
The next day, Sunday, April 14th, the candidates gave their speeches to present themselves to the 94 representa-
tives from the United States and the ASPAN Board of Directors, who also vote on these candidates. Through their
presentations they talked about their visions and goals for themselves and the ASPAN organization. We voted
based on what we thought would be best for our component and the continued progress of the work done by the
present officers and Board of Directors.
Who governs ASPAN and makes effective change for you as a practicing Perianesthesia Nurse?
President, Vice-President/President elect, Treasurer, Secretary, and the Immediate Past President, Director of Re-
search, Director of Education, Director for Clinical Practice, ABPANC President, and Chief Executive Officer. The
country is divided into five regions. Each region is overseen by a director (Regional Director) 1-5. Our region is Re-
gion 4 and includes Maine, New Hampshire, Vermont, Massachusetts (prayers and healing to Boston), Connecticut,
Rhode Island, New York and Pennsylvania.
Our Regional Director is Laura Kling from Pennsylvania. She is currently serving her second term and will retire her
position next year. Laura has been supportive of our meetings and has helped us with succession planning, strate-
gic planning and has advised us on ways to keep our component strong. We will have an opportunity to vote next
year for a new Region Four Director. Our own president, Amy Dooley, is showing interest in running for Region Four
Director next year. If you do not know Amy, I suggest you seek her out and get to know and understand her passion
and goals for ASPAN and VTNH APAN Component.
Karen Flanagan, our Immediate Past President, served as the ASPAN Resource Development Strategic Work
Team Coordinator. She had multiple responsibilities throughout the conference, starting with the roll out of a new
program for members and components to participate in “Legacy for Life”. This requires a donation from a member of
$5,000 with the benefit of free membership to ASPAN for life. Components would reach the legacy level at $10,000.
Another event organized by Karen was The Dream Walk. It started Sunday morning at 0630 sharp and those who
participated enjoyed a walk of about 1 ½ miles around Chicago. The money collected from walkers is used for
scholarships.
Karen was in charge of the sponsors in the Exhibit hall who paid ASPAN to represent their corporation at the confer-
ence. She also organized a Silent Auction of items donated by members, I was highest bidder on the Cape Cod
bracelet (Thank you Katrina and Laura), which I love. All proceeds from the Silent Auction are placed in the schol-
arship fund.
Scholarships are available to members of ASPAN (another reason to become a member) for continued education
for BSN, Master’s and Doctorate programs, and to help pay for attendance to National Conference and International
Conference.
At Representative Assembly, there was a new position statement written to address the use of electronic and digital
media for socializing during patient care/work hours. This position statement received a unanimous vote and
passed. I invite you to review A Position Statement on Social Media and Perianesthesia Practice which can be
viewed at the APAN web site: http://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/1214/
SOCIAL_MEDIA_POS_ST_4-2013.pdf.
You should also check to see if your organization has a policy in place regarding use of electronic and digital media
in the workplace. We were told that organizations have dismissed people for personal use of these devices and that
any texting, phone calls, web surfing etc. are discoverable if you are named in a legal suit due to a safe patient care
issue. BE AWARE!
The educational offerings were many and interested new attendees and seasoned national conference attendees
alike. Hot topics this year included Obstructed Sleep Apnea (OSA) in all age groups, Nurse Fatigue and Patient
Safety, Care of the Bariatric Patients, Malignant Hyperthermia in Pediatrics, Emergence Delirium and Drugs, Quality
and Standards, just to name a few. There is always something for everyone.
Our practice never stops learning or improving processes to ensure safe patient practice. The vision of ASPAN for
all Perianesthesia Nurses is Evidence Based Practice (EBP). Dr. Kim Noble and her research committee have
been instrumental in securing a source for ASPAN members to be able to obtain research articles from the Joanna
Briggs Institute (JBI). This benefit is still in the infancy phase but has been accessed over 2,000 times in the last 18
months by our members. To be able to access this search site, you must be an ASPAN member (good reason to
join), go to the ASPAN website, under research, drop down to Joanna Briggs Institute and it will instruct you the rest
of the way. Research grants are also available to those who are doing or would like to do EBP research. However,
the deadline for this next year is April 30, 2013. They are really encouraging nurses to do their own research, “it is
not a dirty word” and are available to help you with how to do research.
For those of you who are struggling with identifying patients with undiagnosed OSA, there is tool on the internet:
STOP BANG assessment tool. It helps anesthesia and nursing identify these highly at risk patients who some of you
may have already encountered and had bad outcomes. Dr. Frances Chung-from Chicago presented on this topic
and is looking for information from anyone who knows of a bad outcome with undiagnosed OSA. Perianesthesia
Nurses are the gate keepers for identifying undiagnosed OSA before surgery.
Nurse Fatigue-There is a Fatigue Checklist on the ASPAN website and a Position Statement for “On-call/Work
Schedule”
Web access is available for ASPAN Education on Demand-receive CEUs from modules on line. They are not free
but the costs are in line with other CEUs in journal articles and seminars. You can complete these modules on your
time and in your pajamas! Consider hosting an ASPAN seminar at your hospital. It is easy and cost effective for
your staff. There are many pertinent topics available. Your staff does not have to travel anywhere. These modules
can be found on the ASPAN website, just be aware there are deadlines for applying for these seminars.
Certification should be encouraged and supported in your facility. It recognizes nurses for their expertise in the field
and gives you a sense of professional accomplishment. Your component has scholarship money available to take
the certification exam or recertify for your CAPA and CPAN. The application is on the VTNH APAN website. Dead-
line for applications is January 31, 2014. We also give scholarship money
Page 9
(National Conference cont from previous page)
to go National Conference, same deadline. Next year the conference is in Las Vegas, Nevada, April 27 to May
1, 2014. Let the good times roll!
National Conference should be attended by everyone at least once. It revitalizes and reconfirms the reasons
you are a Perianesthesia Nurse. Your ASPAN organization is truly committed to the members in providing the
most current safe practice and standards to the patient at the bedside. Your VTNH Component is an extension
of ASPAN and is committed to making sure all the members get timely information and education.
Susan Carter, 2012 to 2013 President was never more profound when she named this year’s national confer-
ence “Towering Opportunities and Endless Possibilities”. You can get as much or as little out of the ASPAN
and VTNH APAN membership as you want, but I guarantee that when you are actively involved in the deci-
sions made on the Perianesthesia Nurses’ practice of today and the future, it is much more satisfying to be
part of that change.
The 2nd Biannual International Conference for Perianesthesia Nurses is in Dublin, Ireland, September 19-22,
2013. The 1st International Conference was in Toronto, Ontario in 2011 and your President, Amy Dooley, pre-
sented a seminar on “The Amazing Thyroid”. The International Conference is another educational opportunity
for you to broaden your professional horizons and I highly encourage you to attend.
I encourage each one of you to attend at least one of the spring or fall conferences in Vermont or New Hamp-
shire and bring a colleague who is not a member. There is power in numbers and we want our component to
grow and be stronger in the voice of tomorrow.
From left; Brenda Dufresne-Benda
and Amy Dooley at Representatve As-
sembly
Brenda Dufresne-Benda, RN, CAPA,CPAN is Vice
President/President-Elect of VT/NH APAN.
Page 10
Page 11 Quest
VT/NH APAN Board of Directors 2013
President Amy Dooley, RN, MS, CPAN Lahey Clinic, Burlington MA,
Vice President/President Elect Brenda Dufresne-Benda, RN, BSN, CAPA, CPAN
Central Vermont Medical Center, Berlin, VT [email protected]
Immediate Past President Karen Flanagan, RN, MSN, Veteran’s Administration Hospital, Manchester, NH
Secretary/Government Affairs Paula Agrodnia, RN, MSN, CAPA
Portsmouth Regional Hospital, Portsmouth NH [email protected] Treasurer Denise Martel, RN, BSN, CAPA
Portsmouth Regional Hospital, Portsmouth NH [email protected]
Education Trish Clark, RN, CPAN, CAPA & Doreen Grenier,RN,CPAN
Wentworth Douglass Hospital [email protected], [email protected] Communication -Website Nancy Vatistas, RN
Portsmouth Regional Hospital, Portsmouth NH [email protected] Communication-Newsletter Ruth Pack, RN, MSN, CNL
Elliott Hospital, Manchester NH [email protected] Membership Roseanna Newton, RN, CAPA
Speare Memorial Hospital, Plymouth NH [email protected] District 4 Director Laura Kling, RN, MSN, CNS, CAPA, CPAN
VT/NH APAN Willingness to Participate Form
NAME:______________________________________________________________________
ADDRESS:___________________________________________________________________
HOME PHONE:__________________________CELL PHONE:__________________________
E-MAIL:________________________________ FAX:__________________________________
EMPLOYER:__________________________________________PHONE:__________________
POSITION:__________________SPECIALTY:___________________ # OFYEARS__________
ASPAN MEMBERSHIP #______________________________# OF YEARS________________
EDUCATION: Diploma • AD • BSN • MSN • Other:________________________
CPAN • CAPA • Other:_____________________________________________________
Please Send To:
Amy Dooley RN
39 Westgate Crossing
Nashua NH 03062
STANDARDS
QUALITY
VT / NH ASSOCIATION
OF
PERIANESTHESIA
NURSES
AC
CO
UN
TA
BL
ITY
ED
UC
AT
ION
Page 12 Quest
Page 13 Quest
Child Life Support in Recovery
The hospital environment contributes to increased stress for children with illness or disability and their
families. The Post-Anesthesia Care Unit heightens these fears as they wake up from anesthesia in an unfamil-
iar and overwhelming environment. At Wentworth-Douglass Hospital (WDH) we care for families and child life
services are highly utilized not only for pre-procedural preparation but also during recovery. While waking up
from anesthesia a child life specialist is the one familiar face the pediatric patient sees before their loved one
can be at bedside to provide further comfort. Child life supports patients in recovery through education, pain
management, positive encouragement, and praise.
As an advocate for family-centered-care the child life specialist ensures that family in waiting are up-
dated frequently and encouraged to participate in recovery process. Families feel supported, valued, and em-
powered when encouraged by the interdisciplinary team to make decisions and be involved in the care of their
child. The PACU staff at WDH recognizes this and provides quality care to pediatric patients and their families
by working as a team. Child life services assist nursing while they manage medical necessities by tending to
the smaller things that matter most to children. The child life specialist ensures they have their favorite stuffy
and blanket as they wake up, provides soft touch for comfort, a slushy to sooth their throat, and distraction to
dry their tears.
Nursing appreciates the caring helping hand and it’s evident through Wentworth-Douglass’s Press
Ganey scores that family’s value child life services as well. The role of a Certified Child Life Specialist (CCLS)
is essential in providing quality pediatric care in all stages of treatment.
Submitted by Alison Leighton, CCLS at Wentworth-Douglass Hospital.
Recently an informal phone survey was done with 23 area hospitals by Clarice Girouard, RN, CCRN,
CPAN about call practices in PACUs. These facilities varied in size from 2-28 OR rooms and 5-30 PACU
bays. The following information was obtained:
76% of facilities required their staff to take call overnight on weekdays.
100% of facilities required weekend call hours ranging from 8-48 hours (Includes Friday evening and night shifts)
12 of 23 PACUs have 2 RNs on call at once
11 of 23 PACUs have 1 RN on call. Of the hospitals that have only 1 staff member on ICU is used as backup or the OR circulator. OB is used for C-section recovery in 2 hospitals.
15 Hospitals use PACU for recovery and 7 use ICU for recovery.
All 23 Hospitals paid 1.5 time for being called in, one hospital paid double time if you were called in on a day that you had already worked a shift. Only 2 hospitals reported a compensation mini-mum of 2-3 hours.
The compensation for being on call ranged from $2.50 to $5.00 per hour.
PACU On Call Survey
Education Opportunities
VT/NH APAN Perianesthesia
Conference
Oct 5, 2013
White River Junction, Vermont
More info to follow:
www.vtnhapan.org
Perianesthesia Nursing--Pathway to Excellence
FLASPAN's 44th Annual Conference
October 25-27, 2013
Wyndham Lake Buena Vista Resort, 1850 Hotel Plaza
Blvd, Lake Buena Vista, FL 32812.
Contact MargaritaBouffard-Rodriguez @ [email protected] or Terri Passig @ [email protected] for more information or visit the FLASPAN Website @
www.flaspan.com.
Copyright 2013
Page 14 Quest
“The Year of the Gathering”
Dublin , Ireland
Sept 19-22, 2013
www.icpanconference.com
MASPN
Certification Review with
Maureen McLaughlin
UMass Memorial Medical Center
Worcester, MA
June 8, 2013
www.maspan.org
Perianesthesia Certification Review
Terry Clifford, RN, MSN, CPAN
Saturday, July 13, 2013
7:30-4:55 PM
Maine Medical Center
Portland, ME
www.aspan.org
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