Friendly Visits Research Articles

The efficacy of a volunteer-administered cognitive stimulation program in long-term care homes.

Cognitive impairment (CI) that arises in some older adults limits independence and decreases quality of life. Cognitive stimulation programs delivered by professional therapists have been shown to help maintain cognitive abilities, but the costs of such programming are prohibitive. The present study explored the feasibility and efficacy of using long-term care homes' volunteers to administer a cognitive stimulation program to residents. Thirty-six resident participants and 16 volunteers were alternately assigned to one of two parallel groups: a control group (CG) or stimulation group (SG). For eight weeks, three times each week, CG participants met for standard "friendly visits" (casual conversation between a resident and volunteer) and SG participants met to work through a variety of exercises to stimulate residents' reasoning, attention, and memory abilities. Resident participants were pre- and post-tested using the Weschler Abbreviated Scale of Intelligence-Second Edition, Test of Memory, and Learning-Senior Edition, a modified Letter Sorting test (LS), Clock Drawing Test (CDT), and the Action Word Verbal Fluency Test. Two-way analyses of covariance (ANCOVA) controlling for dementia diagnosis indicated statistically greater improvements in the stimulation participants than in the control participants in Immediate Verbal Memory, p = 0.011; Non-Verbal Memory, p = 0.012; Learning, p = 0.016; and Verbal Fluency, p = 0.024. The feasibility and efficiency of a volunteer-administered cognitive stimulation program was demonstrated. Longitudinal studies with larger sample sizes are recommended in order to continue investigating the breadth and depth volunteer roles in the maintenance of the cognitive abilities of older adults.

Public Reporting of Patient Satisfaction vs Objective Quality Measures: Why Must We Choose? Can Patients Have Both?

As physicians and surgeons, we believe patients are fully rational human beings who make the same health care decisions we would if they had optimal data. Unfortunately, this is not the case. We all know patients, colleagues, friends, family members, and even ourselves who continue to smoke tobacco, drink alcohol in excess, abuse drugs, avoid exercise, and eat unhealthy diets. Roughly 40% of all deaths in the United States are related to patient behavioral choices. 1 Patients may not make scientifically valid choices; however, in the rubric of patient-centered care, that is okay. Patients should individualize their medical care based on personal priorities, beliefs, and preferences. One may think it is irrational to have a pancreaticodoudenenctomy or esophagectomy at a low-volume hospital or performed by a low-volume surgeon because the data are overwhelming that important outcomes (eg, mortality or complications) are dramatically worse. But what about the patient’s perspective? How difficult is it to travel 400 miles for multiple pre- and postoperative visits? Who will watch the patient’s children if his wife wants to stay with him after surgery? How lonely will he be during recuperation if no family or friends visit? What are the added out-of-pocket costs for out

Citizens’ Actions in Response to Chikungunya Outbreaks, Réunion Island, 2006

To the Editor: To get ready for the spread of chikungunya, health authorities in North, South, and Central America and the Pacific Islands are developing preparedness and response plans (1,2) that contain vector control, epidemiologic surveillance, medical education, and communication components. They might consider the experience of Reunion Island, an overseas department of France, where a chikungunya outbreak affected 38.5% of its 800,000 inhabitants during the first 3 months of 2006 (3). Although the island was unprepared to deal with such a massive outbreak (4), the disease was under control by the middle of 2006; only a few sporadic cases occurred during the following years. In addition to taking recommended public health measures, public health officials in France created a task force with physicians (including intensive care unit doctors, pediatricians, and obstetricians), specialists in public health and social sciences, virologists, immunologists, entomologists, and pathologists (5) to develop a multidisciplinary approach to the outbreak. Some citizens’ initiatives complemented the official measures. First, associations of chikungunya virus–infected patients helped families (through means that included psychological and friendly support and home visits) and updated mass media with regard to disease complications, persistent symptoms, and administrative difficulties (including receiving long-term sick leave and disability, recognition of professional exposure, and free analgesic medication). Second, citizens created a chikungunya-dedicated website (http://www.chikungunya.net) that included citizens’ frequently asked questions and university-affiliated physicians’ responses and patients’ forums. Third, citizens actively supported the twice-yearly Kass moustik (Creole for “to break mosquitoes”) operations, which involved vast community mobilizations to educate persons on mosquitoes’ role in spreading chikungunya and to destroy breeding sites near homes. The operations also involved mobilizing community-based and municipality groups, making door-to-door visits, and lobbying for government funds (each operation cost US $60,000). After implementation of these initiatives, telephone operators sent health messages to all cell phones on the island. These actions demonstrate that citizens have a place in their countries’ response to chikungunya outbreaks.

Different Story, Different Day: Medical Errors on a Teaching Service

The only thing worse than making a medical error is making one when you are in charge of a resident team.

The effect of healing touch on the pain and mobility of persons with osteoarthritis: A feasibility study

The aims of this pilot study were to investigate the effects of Healing Touch (HT) on the pain level, joint function, mobility, and depression in persons with osteoarthritis (OA) of the knee joint(s). A randomized controlled trial using a repeated measures design was used. Cognitively intact persons (institutionalized and community) with a diagnosis of OA of the knee joint(s) received either HT sessions three times per week for 6 weeks (n = 12) or weekly friendly visits (FV) (n = 7). The HT sessions were delivered by a team of two nurses certified as HT practitioners and the FV was conducted by a nurse. All subjects continued to receive their standard care including the methods they had been using to relieve their joint pain. The two groups were similar regarding demographic variables, number of knees affected, co-morbidities, pain medications used and outcome variables at baseline. Two pain outcome measures (intensity and life interference) produced significant interaction effects. Two joint outcome measures (extension and extensor lag) also produced significant interaction effects. Furthermore, the HT group demonstrated significant improvements in 9 of the 12 outcome variables (75%) while no significant improvements occurred in the FV group. The HT group exhibited sustained effects (3 weeks post treatments) in three outcome variables. The reduction in joint pain and improvement in joint function suggest that biofield therapies could be effective non-pharmacological adjuncts to treatment of OA.

Geology Museum-Based Learning in Soil Science Education

Museums provide unique learning opportunities in soil science. The Bob Campbell Geology Museum in Clemson, SC, features an exhibit of minerals and rocks common in the state and in its geologic history. We developed a hands-on laboratory exercise utilizing an exhibit that gives college students an opportunity to visualize regional minerals and rocks from which regional soil parent materials are derived. Clemson University students from various majors had a field trip and a hands-on experience with the local minerals and rocks during FNR 204: Soil Information Systems course taught in the fall 2008, summer 2011, and fall 2011 (134 students total). Students were then asked to fill out a survey providing answers to 15 questions related to their learning experience. Sixty-six percent of the students had never visited a Geology Museum before this field trip and 40% of the students did not know about the Geology Museum's existence on campus. Ninety-three percent of the students thought the visit to the Geology Museum would be helpful with preparation for class quizzes and exams, and 92% of the students would recommend that their friends visit this museum in their free time. Overall, student responses to the questionnaire about their laboratory experience at the Geology Museum were positive. Laboratory exercises that are specifically designed to bridge university-level course material and museum collections produce learning synergy that is greater than either an independent museum visit or classroom instruction.

Bink & Gollie: Two for One (review)

Reviewed by: Bink & Gollie: Two for One Deborah Stevenson DiCamillo, Kate . Bink & Gollie: Two for One; written by Kate DiCamillo and Alison McGhee; illus. by Tony Fucile. Candlewick, 2012. [96p]. ISBN 978-0-7636-3361-5 $15.99 Reviewed from galleys R* Gr. 2-4. Polar-opposite friends stumpy Bink and lanky Gollie have returned, and they're off [End Page 556] to the state fair. In the first episode, Bink is determined to win at Whack a Duck but keeps beaning the game operator instead ("I fear this can only end in tragedy," says Gollie); in the second, Gollie's dream of being in a talent show turns into a nightmare; in the third, the friends visit a fairground fortuneteller. B&G again hit that sweet spot where picture books, graphic novels, and early readers converge. The text is almost entirely dialogue, the back-and-forth banter between the two girls evincing the unmistakable well-worn rhythm of a long friendship; the illustrations add dimension to the action (as in the sequence where Gollie stands mute from stage fright in front of a packed audience, with each scene drawing back farther and showing her smaller and more outnumbered), and the colored figures with their zesty lines contrast with the monochromatic backgrounds. The book follows a satisfying trajectory from the first story's slapstick through the second's pathos to conclude with the affirmation of friendship in the third, and the blend of humor and sympathetic warmth buoys the story throughout. This endearing partnership remains a treat to follow, and readers will be as delighted as Bink and Gollie about the fortune-teller-certified long-term soundness of their friendship. Copyright © 2012 The Board of Trustees of the University of Illinois

At the Dark End of the Street

At the Dark End of the Street William Gilson (bio) In 1962 muriel switched to decaf.” “I know that.” “It was the year before John Fitzgerald Kennedy was killed.” “I also know that.” “Muriel never touched alcohol.” “Okay—” “It was in 1962. Muriel—” “Goddammit, John, I know. I know.” His face has a look of injury, but even as he speaks I sense the difficulty he is having holding on to that simple emotion, and I watch his facial muscles return to what looks like thoughtfulness but is in fact the stalled confusion he is continually trying to press out of. “What’s the matter?” he asks. “I say something?” “No, John. It’s all right, old pal. I’m going outside for a cigarette. C’mon.” “Cigarettes are bad, Ralph.” “I know that.” On the porch as I light up he says, “Muriel never smoked.” I don’t answer. I’m coughing. “That’s a bad cough, Ralph.” Muriel was John’s wife and it saddens me to imagine her meeting him as he is today. The old John, the man she lived with across the street from Sally and me for thirty-seven years, has been changed into someone who at times cannot remember his own name. Gone is the shy, cautiously smiling man who worked all those years in the IBM office in Colchester, a man who was boring but was also kind, a quiet listener. The new John combines a micro-sized attention span with a ceaseless need to repeat himself, and his personality has angled off in ways his shy wife would at times find extremely distressing. Yet he is my friend, and again we are neighbors: his room is three doors from mine on the second floor of Bradley Manor, Home for the Elderly. John and Muriel had one child; Sally and I had one child. Our boy is dead. He died at age twenty-five in a car wreck, out in California where he’d gone to live. He was driving south on the coastal highway near Monterey with another young man as passenger, and he lost control on a turn and dropped the car fifty feet onto rocks. The passenger was badly injured and after some weeks in a coma died. Ralph Jr. died instantly and is buried in Millville next to his mother. I have been living here at “The Manor,” as we call it, for three years eight [End Page 123] months. John arrived three years before me. John worked for IBM in a small office on Center Street where he was in charge of personnel. Bob, their son, is an accountant in Baltimore, married with four kids. He has visited his dad here at the Manor exactly twice. John’s wife, Muriel, never worked; she died eleven years ago. Sally. Did we love each other? I think so. Maybe, as I’m certain many people thought, my “love” was something closer to need, to obsession, maybe even fear. When I met her she was young and in good condition and sexy. Very, very sexy. A veritable sex magnet attracting certain types of men, and I was one of the types. My friend Pete, who’s been dead now over twenty years, used to tell me back then that I was crazy. “Leave her, Ralph,” he’d say. “Get your wheels going west and ride.” Whatever it was between us, I’ll call it love. Over the years it came and went and I think when she died it was there. And it is here now, with me, although she is not. I wish she were here instead of underground in the Millville Cemetery. No friends visit anymore. I am not surprised. The Manor is just far enough north of Millville that you’d have to consider an overnight stay, and anyway the few friends of John and me still above ground are in no condition for travel. Mornings I’m often one of the first people awake and I sit alone at a table by the big window in the dining room, enjoying the quiet. I try not to smoke before breakfast. This morning I am watching Caspar...

More than a Friendly Visit: A New Strategy for Improving Local Governing Capacity

This article argues that in order to take into account changes in the governance era, performance assessment at the local level may well have to be refocused. Researchers will have to reconsider their strategies. They should consider the governance character of public administration and pay attention to co-operative settings and democratic aspects. In addition, researchers should think not just about gathering facts about the performance of local government, they should also try to contribute to a learning process. This paper presents a new strategy for assessing the capacity that local governments have to get things done. This strategy acknowledges the governance context of local authorities and casts a keen eye on the way local governments fulfil their functions and aim to involve various stakeholders. The evaluation of this assessment strategy shows its relevance, although minor improvements could be made.

Effect of a creative‐bonding intervention on Taiwanese nursing students' self‐transcendence and attitudes toward elders

Nursing students worldwide have little interest in caring for a growing elder population. The purpose of this study, based on self-transcendence theory, was to test the effectiveness of a creative-bonding intervention (CBI) to promote self-transcendence and positive attitudes towards elders in Taiwanese nursing students. A quasi-experimental design was used to compare a CBI group (n = 100) with a friendly visit (FV) control group (n = 94). ANCOVA results indicated that after the intervention, the CBI group had significantly more positive attitudes towards elders than the FV group. Nursing school faculty may want to promote art-making activities between students and elders to foster students' interest in elder care.

The Clinical Efficacy of Reflexology in Nursing Home Residents with Dementia

This experimental, repeated-measures, crossover design study with nursing home residents examined the efficacy of reflexology in individuals with mild-to-moderate stage dementia. Specifically, the study tested whether a weekly reflexology intervention contributed to the resident outcomes of reduced physiologic distress, reduced pain, and improved affect. The study was conducted at a large nursing home in suburban Philadelphia. The sample included 21 nursing home residents with mild-to-moderate stage dementia randomly assigned to two groups. The first group received 4 weeks of weekly reflexology treatments followed by 4 weeks of a control condition of friendly visits. The second group received 4 weeks of friendly visits followed by 4 weeks of weekly reflexology. The primary efficacy endpoint was reduction of physiologic distress as measured by salivary alpha-amylase. The secondary outcomes were observed pain (Checklist of Nonverbal Pain Indicators) and observed affect (Apparent Affect Rating Scale). The findings demonstrate that when receiving the reflexology treatment condition, as compared to the control condition, the residents demonstrated significant reduction in observed pain and salivary alpha-amylase. No adverse events were recorded during the study period. This study provides preliminary support for the efficacy of reflexology as a treatment of stress in nursing home residents with mild-to-moderate stage dementia.

The comparison of therapeutic touch and physiotherapy in patient with low back pain in Hafez hospital, Shiraz-Iran

The aims of this pilot study were to investigate the effects of Healing Touch (HT) on the pain level, joint function, mobility, and depression in persons with osteoarthritis (OA) of the knee joint(s). A randomized controlled trial using a repeated measures design was used. Cognitively intact persons (institutionalized and community) with a diagnosis of OA of the knee joint(s) received either HT sessions three times per week for 6 weeks (n = 12) or weekly friendly visits (FV) (n = 7). The HT sessions were delivered by a team of two nurses certified as HT practitioners and the FV was conducted by a nurse. All subjects continued to receive their standard care including the methods they had been using to relieve their joint pain. The two groups were similar regarding demographic variables, number of knees affected, co-morbidities, pain medications used and outcome variables at baseline. Two pain outcome measures (intensity and life interference) produced significant interaction effects. Two joint outcome measures (extension and extensor lag) also produced significant interaction effects. Furthermore, the HT group demonstrated significant improvements in 9 of the 12 outcome variables (75%) while no significant improvements occurred in the FV group. The HT group exhibited sustained effects (3 weeks post treatments) in three outcome variables. The reduction in joint pain and improvement in joint function suggest that biofield therapies could be effective non-pharmacological adjuncts to treatment of OA.

Cobo and her friends: the caring clowns

Knock, Knock, Knock, bMay I come in?Q requests the Auguste clown at the rehabilitation hospital patient’s door. An bAuguste clownQ differs from the bwhite face clownQ and the btramp clownQ in the manner that makeup is applied to their face. The white face clown covers the complete face with white grease paint and then accents the eyebrows, nose, and mouth in combinations of black and red makeup. The tramp clown does not have a standard manner for applying makeup and is at liberty to use their own creative inspiration. In contrast, the Auguste clown’s face begins with a pink or red base; oversized features are subsequently outlined in red or black over selected white areas. The patient looks up from his book to see the smiling face of Cobo who is one of many caring clowns that occasionally visit the rehabilitation hospital. The rehabilitation hospital is only one of the facilities that Cobo and her friends visit. They also go to many other hospitals, nursing homes, head start programs, and residences of patients with Alzheimer disease. Early in the morning, Cobo, knowing that she has a busy day, slowly rises from her bed. She feels the pain from her aching arthritic back. Cobo enters a hot shower and, like the Tin Man in the Wizard of Oz, slowly moves around until all of her joints are more mobile. After a healthy breakfast, it is time to dress for the day. First, Cobo dons her colorful costume. Then, she approaches the mirror and transforms her face. With each application of face paints, her persona slowly appears. Cobo, pleased with her accomplishment, is now ready to begin the many visits she has planned for the day. Cobo’s skin is very sensitive. She cannot use grease paints because they cause an itchy rash on her face. Therefore, Cobo

A creative-bonding intervention and a friendly visit approach to promote nursing students’ self-transcendence and positive attitudes toward elders: A pilot study

Nursing students' disinterest in caring for elders presents health care challenges. As the aged population increases, nursing faculty are challenged to improve students' attitudes toward elder care. Reed's self-transcendence theory guided this pilot study with nursing students (n=22) who implemented either a Creative-Bonding Intervention (CBI) or a Friendly Visit (FV) at senior citizen centers to test the effect of creative approaches on student self-transcendence and attitudes toward elders. Demographic data, a revised Kogan's Attitudes toward Old People statements, and Reed's Self-transcendence Scale were analyzed with descriptive, paired t test, ANCOVA, and Pearson correlation statistics. Results demonstrated significant differences in attitudes in the FV and changes in the expected directions in the CBI group. Self-transcendence had no significant changes. Valuable information was provided by students' comments about the interventions. Reed's belief that self-transcendence is present regardless of age was supported. Future studies are suggested with an increased sample size, a combined CBI/FV intervention, and supportive help during students' intervention delivery.

Ten Suggestions for a Successful Commencement Address

The commencement ceremony is one of the most meaningful and symbolic events in a college student’s career. It is a time to reflect on the sacrifices and accomplishments of the past, and on the hope, excitement, and responsibility of the future. It is a time when parents and friends visit the campus and meet, often for the first time, the classmates and faculty members of the graduates. In many cases, it is the last formal on-campus encounter with the college community and a crucial moment in the graduates' forming of lifelong impressions of their alma mater. If you have been chosen to deliver the keynote address, it is probably because of your eminence in your field and because you are well respected. You have been entrusted to offer an inspirational address. The following 10 suggestions are one man’s opinion, based on the observation of over 50 commencement addresses, some of which were good, many mediocre, and a few bland, boring, tasteless, or downright inappropriate. These tips are intended to help in the composition and delivery of wise, interesting, inspiring, and effective addresses. They are not carved in stone, and they are not inviolable; they are merely suggestions. In no way do they jeopardize freedom of speech, inhibit creativity, or stifle ideas.

Jennicam, or the telematic theatre of a real life

Academics have focused on the webcam as a technology that above all provides a digital window into another ‘real’ time and space, thereby conjoining the actual and the virtual. This article chronicles the history of Jennicam, a webcam in the home of an ‘ordinary’ young Western woman Jennifer Ringley, portraying her daily life through a series of images intermittently transmitted over the Internet for nearly eight years. Jennicam was a slowly unravelling drama showing Ringley eating, sleeping, having friends visit, watching television, occasionally making love. Many commentators noted that although most of the images were completely mundane, they always invited interpretation or begged questions. Ringley unwittingly created one of the most influential and longest running pieces of improvised endurance theatre ever, without the benefit of theatre or media training or any enhanced performance skills. Jennicam is presented in this article as an example of the webcam as a socio-performative phenomenon.

Massage Treatment in HIV-1 Infected Dominican Children: A Preliminary Report on the Efficacy of Massage Therapy to Preserve the Immune System in Children Without Antiretroviral Medication

More than 1.4 million children are living with HIV and global access to antiretrovirals is not yet readily available. Massage therapy, which has been shown to improve immune function in HIV+ adults and adolescents, may provide an important complementary treatment to boost immune status in young children living with HIV disease, especially those without access to antiretroviral medications. No studies have been conducted, however, that specifically target massage therapy to enhance immune function in HIV+ children. Clinical trial with eligible, consented HIV+ children randomized to receive either massage therapy or a friendly visit (controls). CENISMI/Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic. HIV+ children ages 2-8 years. Massage therapy sessions (20 minutes, twice weekly, for 12 weeks), conducted by trained nurses, following a structured protocol of moderate pressure stroking and kneading of muscles, using a non-scented oil. The friendly visit control group, (reading, talking, playing quiet games), met with the nurse twice weekly for 12 weeks. At the initial evaluation, and following the 12-week intervention, blood was drawn to determine absolute helper (CD4/T4) and suppressor (CD8/T8) counts. Children in the control arm had a greater relative risk of CD4 count decline (>20%) than massage-treated children (RR = 5.7, p = 0.03). Lymphocyte loss was also more extensive in the controls (p < 0.02), and more of the control group than the massage group lost >50 CD8 lymphocytes (p = 0.03). The efficacy of massage therapy in maintaining immunocompetence may offer a viable alternative to the thousands of children worldwide without antiretroviral access.

Restricted visiting hours in ICUs: time to change.

THE SICKEST PATIENTS LIE IN INTENSIVE CARE UNITS (ICUs) facing fearful illness; surrounded by overwhelming noise from pulsating ventilators and monitors; invaded by the necessary ministrations of nurses; and overhearing, if they are awake, strange and portentous conversations. Professionals buzz about them, but these patients are mostly alone, separated from those who love them by restrictive ICU visiting policies, except at rigidly specified times or with the doled-out permission of the ICU staff. Restricting visiting in ICUs is neither caring, compassionate, nor necessary. Restricted hospital visiting hours began in the late 1800s for nonpaying patients in an attempt to establish order in the general wards. For many decades afterward, paying patients remained free to have visitors at almost any time in their private or semi-private rooms. In the 1960s, however, in an effort to protect the patient and the family from exhaustion caused by too many visitors (Kenneth Ludmerer, MD, Washington University, oral communication, April 23, 2004), hospitals instituted visiting hours broadly for both paying and nonpaying patients in ICUs (which were then being introduced) and the general wards. Today, most hospitals have liberalized visiting policies on intermediate care units, but strict ICU visiting hours are enforced despite increasing awareness that families have an active role in care, and despite increasing recognition among hospital staff of the rights and abilities of patients to make informed decisions. Perhaps the question to be answered is “Who is visiting whom?” In an effort to stabilize the details of ICU operations, health care institutions and professionals neglect the plausible assertion that they are the visitors in patients’ lives, not the other way around. Several months ago, the Institute for Healthcare Improvement (IHI) challenged a number of hospitals working on improvement of care to open their ICUs by instituting a totally unrestricted visiting policy. Several took up that challenge and have come forward to share what they learned from their tests of open visitation policies. Even proposing the idea of liberalizing ICU visiting hours, let alone implementing it, generates considerable resistance among nurses and physicians, who are largely focused on 3 worries: increased physiologic stress for the patient, interference with the provision of care, and physical and mental exhaustion of family and friends. While these concerns may seem reasonable, the evidence from the recent experiences at hospitals working with IHI, as well as from a small but growing body of literature, tell quite a different story. Physiologic Stress for the Patient. The concern that the patient should be left alone to rest incorrectly assumes that family presence at the bedside causes stress. The empirical literature suggests that the presence of family and friends tends to reassure and soothe the patient, providing sensory organization in an overstimulated environment and familiarity in unfamiliar surroundings. Visits of family and friends do not usually increase patients’ stress levels, as measured by blood pressure, heart rate, and intracranial pressure, but may in fact lower them. Nursing visits, on the other hand, often increase stress. However, liberalizing visiting hours may not be good for every patient. The goal is not universal implementation of unrestricted ICU visiting policies, but rather the achievement of patients’ control over the circumstances of their own care. It is important that patients be able to decide who can visit them and when, and accomplishing this requires that there not be a universal restriction outside the control of individual patients and families. Instead, patients who can do so should be allowed to determine their own visiting hours, and this information should be relayed to their family and friends. In other circumstances, family preferences may appropriately control the decision. Barriers to Provision of Care. The second concern is that the unrestricted presence of loved ones at the bedside will make it more difficult for nurses and physicians to do their jobs and may interfere with the delivery of care. The evidence suggests, however, that the family more often serves as a helpful support structure, increasing opportunities for patient and family education, and facilitating communication between the patient and clinicians. Family members may also be able to provide feedback to nurses and physicians more effectively than the critically ill patient can, creating a better working relationship for all.

University of Wisconsin Medical School.

University of Wisconsin Medical School.

Helping the Poor: Friendly Visiting, Dole Charities and Dole Queues

Helping the Poor: Friendly Visiting, Dole Charities and Dole Queues