Saturday, April 18, 2009
commentary
To say that anybody is against food, fun, kids, and the Festival is just ridiculous, of course. Simply absurd. The residents are against constant and continued overpayments for each and every project the City undertakes. We are against city officials allowing the tax monies to be squandered at every turn. We wonder why each and every facet of the City is losing money and we are being asked to pay more money in taxes to make up for those disasters. If throwing away tax money is supposed to be progress, then YES, we are against THAT form of progress. Dr. Mel P. Johnson
I understand
I understand if you are the one giving away our facilities at a steep discount and maybe collecting something back from them for that discount. I understand how you might be upset if everybody knew you paid TRIPLE what the bathrooms were worth, not to mention the same situation with the CC enclosure. But it doesnt make it right. Throwing out bids because they are too low could also be a big problem- I understand. I understand WHY you might do that if there was considerable personal gain in it for you, but, AGAIN, it doesnt make it right. You insisted on discussing these things here, and now, so we are. Dr. Mel P. Johnson
Friday, April 17, 2009
bids not high enough
I am neither an officer nor a founder of the Historical Society. I AM a supporter. That has NOTHING to do with the election. NOTHING. Nada. ZIP. Lets talk about the bids that were thrown out because they WERE TOO LOW! How can THAT be? A City official who is supposed to be looking out for the residents throws bids out because they are TOO LOW? Not enough of our tax monies would be spent? Incredible! The City Manager decides that not enough of our taxes would be spent if we took a lower bid? Sounds like the CC project, that STARTED at 150k and went WAY up from there! 150k, BTW, is $300 a square foot for that project, and a VERY NICE profit at that price! The City Manager didnt stop until we paid over $600 a square foot tho. Dr. Mel P. Johnson
Preparing Children For The Death of a Grandparent
By Connie Matthiessen, Caring.com senior editor
People often conceal the reality of death from young children in an effort to protect them from painful and frightening “adult” matters. In earlier times, grandparents and other relatives often passed away at home, cared for by the family, and children understood that death was part of the natural order of things. Today, the dying are often in hospitals and nursing homes, and many children have no concept of what it means to die. But experts agree that not talking about death, or dressing it up in euphemisms or platitudes, can confuse and frighten a young child. If a grandparent is ill and nearing death, here are steps you can take to help prepare your child for the loss.
Talk openly about death in advance. It’s a good idea to introduce the subject of death to your young child well before a grandparent is ailing. The death of a pet offers an excellent opportunity for such a discussion. Or you can simply show your child a dead flower or insect. Explain that death is the end of life, and that every living thing will die one day. Keep your explanation simple and to the point. Consider this the first of many conversations, as it will take your child a while to absorb the information.
If a grandparent is very ill or has received a terminal diagnosis, gently tell your child that his grandparent is going to die. It’s better to inform your child in advance, because at the time of death you may be too grief-stricken yourself to explain. It’s fine to show your child that you’re sad about the loss, but it may scare him if you disclose the news of his grandparent’s passing at a time when you’re overcome with grief.
Answer your child’s questions, no matter how difficult. Try to respond to all your child’s questions about death without distress or displeasure — or dishonesty. Many of them are likely to be difficult to answer — for example, “Will Grandma be able to see me when she’s dead?” — and your response will depend on your personal beliefs. Avoid telling your child fairy tales. If you say that Grandma is sitting on a fluffy white cloud in the sky, looking down on your child and sending kisses, your child may feel comfort in the moment but is likely to be confused about death in the long run. It’s fine to simply say that you don’t know the answer to certain questions.
Let your child spend lots of time with grandparents, if appropriate. If your child’s grandparent is up to it, arrange for them to see each other regularly. Your child may find this scary at first if you’ve just told him that his grandparent is going to die, but short visits will help dispel your child’s fear, may lift his grandparent’s spirits, and will create pleasant memories for years to come.
Put together a legacy project. Consider creating a legacy project with your parent, and involve your child in the process. Even a very young child can help select photographs for a poster or photo album. An older child may enjoy listening to his grandmother relate her life story for an oral history project; the child could also draw pictures for the final bound volume. If possible, take some pictures of your child with his grandparent and add them to the oral history. Frame one of the photos and put it in your child’s room.
Find children’s books on death and dying. Many excellent books for children deal with the subject of death. Pick a selection up from the library and purchase a few you think your child will like, so they can continue to provide comfort in the months to come.
Encourage your child to draw or paint pictures. Children often have trouble talking about their feelings and may be able to express themselves more easily through drawing or painting.
Inform your child’s teacher and other adults. Talk to your child’s teacher, to babysitters, and to other significant adults in his life. Tell them that your child’s grandparent is dying, and explain how your child is dealing with the experience. This information will help adults know how to interpret his behavior and provide support, as needed.
If you detect problems, take your child to a counselor or a child psychologist. If your child is having a very strong reaction to his grandparent’s death — if he’s acting out, is very withdrawn, or exhibits other signs of distress — it’s a good idea to consult a child psychologist. An expert can help your child work through his fear and loss.
Caring.com was created to help you care for your aging parents, grandparents, and other loved ones. As the leading destination for eldercare resources on the Internet, our mission is to give you the information and services you need to make better decisions, save time, and feel more supported. Caring.com provides the practical information, personal support, expert advice, and easy-to-use tools you need during this challenging time
People often conceal the reality of death from young children in an effort to protect them from painful and frightening “adult” matters. In earlier times, grandparents and other relatives often passed away at home, cared for by the family, and children understood that death was part of the natural order of things. Today, the dying are often in hospitals and nursing homes, and many children have no concept of what it means to die. But experts agree that not talking about death, or dressing it up in euphemisms or platitudes, can confuse and frighten a young child. If a grandparent is ill and nearing death, here are steps you can take to help prepare your child for the loss.
Talk openly about death in advance. It’s a good idea to introduce the subject of death to your young child well before a grandparent is ailing. The death of a pet offers an excellent opportunity for such a discussion. Or you can simply show your child a dead flower or insect. Explain that death is the end of life, and that every living thing will die one day. Keep your explanation simple and to the point. Consider this the first of many conversations, as it will take your child a while to absorb the information.
If a grandparent is very ill or has received a terminal diagnosis, gently tell your child that his grandparent is going to die. It’s better to inform your child in advance, because at the time of death you may be too grief-stricken yourself to explain. It’s fine to show your child that you’re sad about the loss, but it may scare him if you disclose the news of his grandparent’s passing at a time when you’re overcome with grief.
Answer your child’s questions, no matter how difficult. Try to respond to all your child’s questions about death without distress or displeasure — or dishonesty. Many of them are likely to be difficult to answer — for example, “Will Grandma be able to see me when she’s dead?” — and your response will depend on your personal beliefs. Avoid telling your child fairy tales. If you say that Grandma is sitting on a fluffy white cloud in the sky, looking down on your child and sending kisses, your child may feel comfort in the moment but is likely to be confused about death in the long run. It’s fine to simply say that you don’t know the answer to certain questions.
Let your child spend lots of time with grandparents, if appropriate. If your child’s grandparent is up to it, arrange for them to see each other regularly. Your child may find this scary at first if you’ve just told him that his grandparent is going to die, but short visits will help dispel your child’s fear, may lift his grandparent’s spirits, and will create pleasant memories for years to come.
Put together a legacy project. Consider creating a legacy project with your parent, and involve your child in the process. Even a very young child can help select photographs for a poster or photo album. An older child may enjoy listening to his grandmother relate her life story for an oral history project; the child could also draw pictures for the final bound volume. If possible, take some pictures of your child with his grandparent and add them to the oral history. Frame one of the photos and put it in your child’s room.
Find children’s books on death and dying. Many excellent books for children deal with the subject of death. Pick a selection up from the library and purchase a few you think your child will like, so they can continue to provide comfort in the months to come.
Encourage your child to draw or paint pictures. Children often have trouble talking about their feelings and may be able to express themselves more easily through drawing or painting.
Inform your child’s teacher and other adults. Talk to your child’s teacher, to babysitters, and to other significant adults in his life. Tell them that your child’s grandparent is dying, and explain how your child is dealing with the experience. This information will help adults know how to interpret his behavior and provide support, as needed.
If you detect problems, take your child to a counselor or a child psychologist. If your child is having a very strong reaction to his grandparent’s death — if he’s acting out, is very withdrawn, or exhibits other signs of distress — it’s a good idea to consult a child psychologist. An expert can help your child work through his fear and loss.
Caring.com was created to help you care for your aging parents, grandparents, and other loved ones. As the leading destination for eldercare resources on the Internet, our mission is to give you the information and services you need to make better decisions, save time, and feel more supported. Caring.com provides the practical information, personal support, expert advice, and easy-to-use tools you need during this challenging time
important comparisons
if you love me you will make me happy -- the clitoris has over 8,000 nerve bundles; this is TWICE as many as the penis.
The Story Of O
Having regular orgasms will extend your life and provide the basis for more long lasting relationships. Recent studies have confirmed the link between longevity and orgasm frequency. We know that people who enjoy a regular, satisfying sex life (ie. regular orgasms) are less stressed, less depressed and generally more well physically, mentally and emotionally. This level of satisfaction and well being is reflected in the partnerships in which they are shared. The depth of connection and the bonds of trust that shared orgasmic experiences builds into a relationship is a visceral insurance policy for long term commitments.
The majority of people who leave their relationships site sexual incompatibility as a primary impetus to leave. It is so common as to be cliché, that many people in long term relationships reach an impasse of sorts about their individual and connected sex drives. The pulley of sexual attraction and arousal is not static, the swing between feeling desirable and connected in a relationship is in continuous flux and reflects the health of the entire relationship, not just its sexual side. Overcoming the initiation argument begins when both people stop keeping score. Agreeing to harness the frustration and apply it towards building solutions is much more likely to move you towards shared pleasure.
One of the most common blocks to a shared orgasmic experience is the strangely common practice of faking orgasm. Studies site as many as 60% of women have faked an orgasm and this practice is not limited only to women. The reasons for faking orgasm are complex. Whether it is because you feel like you can’t perform, or that you can’t open up to that level of vulnerability or that by faking you feel like you can end the intimacy, what results is the most serious of breaches in trust. Faking orgasm is a lie and it leads the person who is trying to love you and bring you pleasure to feeling like s/he cannot trust the messages s/he is hearing. Breaching trust at this deeply naked level of vulnerability cannot help but seep into the other aspects of the relationship.
Many women mistakenly believe that their pleasure doesn’t matter, or they don’t want to burden their partner in their own frustrated search for that mysterious and powerful orgasmic release. Real conversation about these issues is sexy. It communicates that you are invested and trust your partner enough to be vulnerable about this most deeply held desire. Just for the record, most men get more pleasure and sense of mastery from helping a woman they love to orgasm than their own climax. Working together to find the path to individual orgasm is the most intimate sharing that exists. It changes everything in a relationship.
Finding a language to talk about your sexuality for most people is the stumbling block. It is one area in life where taking responsibility for the problem is shaming, so we often go into a default mode of blaming. With that slip, it is easy to believe that change is impossible and to feel caught in a no-win situation. As in any other area of personal development, clarity is everything. Take the time to think about or write down your own personal sexual history including orgasmic experience. Share these notes with your partner and often even unwilling partners will often begin to open up. Set a couple of shared goals, mysterious as our sexual selves may be, they respond to dialogue as any other part of our life. For many couples making efforts to de-stress their lives can have remarkable effects on their ability to be intimate.
Discovering pleasure together is like pouring cement into a foundation. Physical touch that leads to ecstatic release not only releases hormones and endorphins that promote health and longevity, but also serve as the basis of biological bonding. Knowing that you have the ability to reach someone in this most intimate of ways is one of the most significant sources of self esteem that relationships afford. There is a strange coincidence between the percentages of people who don’t orgasm and the percentage of people who divorce. While, sharing orgasm is not enough to keep a relationship alive, the inability to move towards it, is enough to kill it. There is no other single work in life that will repay you so profoundly each and every time you share it.
Tomorrow, The Mysterious O: Lifting the Mystery
Wendy Strgar, the owner and founder of Good Clean Love, manufacturer of all natural love and intimacy products. She is a sex educator focusing on “Making Love Sustainable,” a green philosophy of relationships which teaches the importance of valuing the renewable resources of love and family. She has learned that physical intimacy is an important component of sustaining healthy loving relationships through her own marriage of over 25 years
The majority of people who leave their relationships site sexual incompatibility as a primary impetus to leave. It is so common as to be cliché, that many people in long term relationships reach an impasse of sorts about their individual and connected sex drives. The pulley of sexual attraction and arousal is not static, the swing between feeling desirable and connected in a relationship is in continuous flux and reflects the health of the entire relationship, not just its sexual side. Overcoming the initiation argument begins when both people stop keeping score. Agreeing to harness the frustration and apply it towards building solutions is much more likely to move you towards shared pleasure.
One of the most common blocks to a shared orgasmic experience is the strangely common practice of faking orgasm. Studies site as many as 60% of women have faked an orgasm and this practice is not limited only to women. The reasons for faking orgasm are complex. Whether it is because you feel like you can’t perform, or that you can’t open up to that level of vulnerability or that by faking you feel like you can end the intimacy, what results is the most serious of breaches in trust. Faking orgasm is a lie and it leads the person who is trying to love you and bring you pleasure to feeling like s/he cannot trust the messages s/he is hearing. Breaching trust at this deeply naked level of vulnerability cannot help but seep into the other aspects of the relationship.
Many women mistakenly believe that their pleasure doesn’t matter, or they don’t want to burden their partner in their own frustrated search for that mysterious and powerful orgasmic release. Real conversation about these issues is sexy. It communicates that you are invested and trust your partner enough to be vulnerable about this most deeply held desire. Just for the record, most men get more pleasure and sense of mastery from helping a woman they love to orgasm than their own climax. Working together to find the path to individual orgasm is the most intimate sharing that exists. It changes everything in a relationship.
Finding a language to talk about your sexuality for most people is the stumbling block. It is one area in life where taking responsibility for the problem is shaming, so we often go into a default mode of blaming. With that slip, it is easy to believe that change is impossible and to feel caught in a no-win situation. As in any other area of personal development, clarity is everything. Take the time to think about or write down your own personal sexual history including orgasmic experience. Share these notes with your partner and often even unwilling partners will often begin to open up. Set a couple of shared goals, mysterious as our sexual selves may be, they respond to dialogue as any other part of our life. For many couples making efforts to de-stress their lives can have remarkable effects on their ability to be intimate.
Discovering pleasure together is like pouring cement into a foundation. Physical touch that leads to ecstatic release not only releases hormones and endorphins that promote health and longevity, but also serve as the basis of biological bonding. Knowing that you have the ability to reach someone in this most intimate of ways is one of the most significant sources of self esteem that relationships afford. There is a strange coincidence between the percentages of people who don’t orgasm and the percentage of people who divorce. While, sharing orgasm is not enough to keep a relationship alive, the inability to move towards it, is enough to kill it. There is no other single work in life that will repay you so profoundly each and every time you share it.
Tomorrow, The Mysterious O: Lifting the Mystery
Wendy Strgar, the owner and founder of Good Clean Love, manufacturer of all natural love and intimacy products. She is a sex educator focusing on “Making Love Sustainable,” a green philosophy of relationships which teaches the importance of valuing the renewable resources of love and family. She has learned that physical intimacy is an important component of sustaining healthy loving relationships through her own marriage of over 25 years
questions persist
First I would like to hear the justification for the $275 that disappeared on the bathrooms and the $350k+ that disappeared on the CC addition. Once that has happened we can discuss the value of having MS residents provide a valuable historical service for MS residents for 20k. Or we can discuss the dugout covers that we built for 118k, and compare them to the dugout covers at Blessed Trinity that cost 3k each for bigger and better covers next to their basketball court. I would be happy to discuss ANY of those topics, here or at the Council meeting. Or we could discuss the several bids that " were obviously too low" and thrown out at the last Council meeting. WHO decided they were too low? On WHAT basis was that decided? WHAT exactly was the numbers on those bids and what did they include? How did those bids compare to the RFP? When will those bids be made public? Have a great Festival weekend. Dr. Mel P. Johnson
Thursday, April 16, 2009
electronic records
Handwritten and manually transcribed physician orders leave a lot of opportunity for errors. A computerized physician order entry, in which the physician must enter all orders by computer, eliminates handwriting and transcription errors. It also makes it possible to automatically check doses, drug-drug interactions, allergies and significant patient characteristics, like allergies and impaired renal function.
A computerized order entry system presents its own set of problems. There is a significant expense that smaller facilities may not be able to afford. Cost prohibitions or lack of space may limit the number of PCs to the point that practitioners have long wait times for computer access. It seems slow and inconvenient at times. In addition, physicians who are less computer savvy may be resistant to change
A computerized order entry system presents its own set of problems. There is a significant expense that smaller facilities may not be able to afford. Cost prohibitions or lack of space may limit the number of PCs to the point that practitioners have long wait times for computer access. It seems slow and inconvenient at times. In addition, physicians who are less computer savvy may be resistant to change
Historical Society commentary
I plan to drop by from time to time, and THIS is one of those times. I have NO problem with the Historical Society having their rent paid by the City. The City pays Santanas rent and allows a private business to use our pool facility for less than HALF the usual average Dade Co costs, so this is in accordance with a longstanding, but suspect, tradition. At the very least the Historical Society is made up of longtime Springs residents and is for the benefit of ALL Springs residents. It is run by Pioneer residents who have lived here fifty years and more and provide a living history of our city, in pictures, headlines, and words- showing us our roots, from whence we came, and how far we have come so far - and as such is a valuable community resource. The City has spent a LOT more money for a LOT less benefit to the residents of Miami Springs in the past and currently continues that questionable tradition. The money spent on the Historical Society makes a LOT more sense than the monies spent on the CC addition and the bathrooms, not to mention the monies NOT collected at the pool! Let them justify those HUNDREDS of THOUSANDS of dollars first, then we can debate the pros and cons of the Historical Society. Dr. Mel P. Johnson
Wednesday, April 15, 2009
Pain Defined
Pain may be defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" (Merskey, 1986). Pain is always subjective. "Pain is whatever the experiencing person says it is, existing whenever he (or she) says it does" (McCaffery, 1979).
Patients may experience acute, chronic, or cancer pain..
1. Acute pain follows injury to the body and generally disappears as healing takes place. There is identifiable pathology that accounts for the pain. It may arise from operative procedures or from tissue trauma associated with an inflammatory process, for examples. It may be associated with objective physical signs such as increased heart rate, hypertension, and pallor (autonomic nervous system activity), making patients "look" like they are in pain.
2. Chronic non-malignant pain is pain that lasts for an extended period of time. There may or may not be known active pathology to account for the suffering that the individual is experiencing. Chronic pain, in contrast to acute pain, is rarely accompanied by signs of autonomic nervous system activity.
3. Cancer pain may be acute, chronic, or intermittent. It usually has a definable cause, which is usually related to tumor recurrence or treatment.
The prevalence of pain is high. It is estimated that over 75 million Americans suffer with pain. Approximately 50 million Americans have chronic pain and 25 million have acute pain. These numbers make it easy to understand that pain is one of the most common reasons that people seek medical attention.
Pain causes suffering. Unrelieved, it can destroy the quality of life. Persistent pain can impair sleep and appetite, leading to fatigue and nutritional decline. It can delay healing, cause increased stress and anxiety, alter immune function, lead to depression and destroy the will to live. Additionally, current unrelieved acute pain can cause chronic pain at a later date.
The good news is that we have the knowledge and skills to effectively manage most pain. So what is the problem? Why is unrelieved pain still so prevalent?
Knowledge is important. Clinicians as well as patients need to be made knowledgeable about methods of relieving pain. But knowledge alone rarely changes practice. Efforts must go beyond education alone if pain treatment is to improve. Pain needs to be made visible so it will not go unnoticed by clinicians.
Patients may experience acute, chronic, or cancer pain..
1. Acute pain follows injury to the body and generally disappears as healing takes place. There is identifiable pathology that accounts for the pain. It may arise from operative procedures or from tissue trauma associated with an inflammatory process, for examples. It may be associated with objective physical signs such as increased heart rate, hypertension, and pallor (autonomic nervous system activity), making patients "look" like they are in pain.
2. Chronic non-malignant pain is pain that lasts for an extended period of time. There may or may not be known active pathology to account for the suffering that the individual is experiencing. Chronic pain, in contrast to acute pain, is rarely accompanied by signs of autonomic nervous system activity.
3. Cancer pain may be acute, chronic, or intermittent. It usually has a definable cause, which is usually related to tumor recurrence or treatment.
The prevalence of pain is high. It is estimated that over 75 million Americans suffer with pain. Approximately 50 million Americans have chronic pain and 25 million have acute pain. These numbers make it easy to understand that pain is one of the most common reasons that people seek medical attention.
Pain causes suffering. Unrelieved, it can destroy the quality of life. Persistent pain can impair sleep and appetite, leading to fatigue and nutritional decline. It can delay healing, cause increased stress and anxiety, alter immune function, lead to depression and destroy the will to live. Additionally, current unrelieved acute pain can cause chronic pain at a later date.
The good news is that we have the knowledge and skills to effectively manage most pain. So what is the problem? Why is unrelieved pain still so prevalent?
Knowledge is important. Clinicians as well as patients need to be made knowledgeable about methods of relieving pain. But knowledge alone rarely changes practice. Efforts must go beyond education alone if pain treatment is to improve. Pain needs to be made visible so it will not go unnoticed by clinicians.
complications with dementia
Complications of Dementia
Dementia is a progressive disease that has the potential to cause many problems as it advances. Dysphagia is typically a later disease concern. Aspiration is a major problem in those who develop dysphagia. A speech therapist can perform a swallowing study and make recommendations to decrease the risk of aspiration. Some possible interventions include:
Altering the consistency of the food
Cutting food into smaller pieces
Changing the position of the patient when he or she swallows
Encouraging the patient to tuck the chin while swallowing
Eating with someone who can monitor for any aspiration or provide cues to safe eating
Some patients with dementia will hold food in their mouth, not swallow it and spit it out. This is common with frontotemporal dementia and is best treated with behavioral interventions.
The use of feeding tubes has fallen out of favor over the last number of years as they have not proven to extend life expectancy or improve quality of life. They can be utilized if aspiration is severe or patient does not eat enough to maintain nutrition and it is wanted by patient and durable power of attorney of health care. Feeding tubes do not prevent malnutrition, reduce incidence of aspiration pneumonia, improve function, or extend life (Li, 2002). If permanent feeding tube replacement is desired than percutaneous gastrostomy is better than a nasogastric tube. Consideration must be given to quality of life and complications when deciding on the use of a feeding tube. Hand feeding is an alternative to feeding tubes and it may provide more comfort to the patient.
Dementia is typically a later life disease when patients are prone to other illness. Those with dementia are typically older; older age comes with a greater risk of many chronic diseases. Having dementia makes it more likely that proper treatment will not ensue. For example, those with a heart attack may not be able to communicate the pain that they are feeling due to the dementia which will result in delayed care and worse outcomes.
Poor nutrition is another common complication of dementia. Poor nutrition increases the risk of infection and poor body healing. The combination of older age, poor communication and a compromised immune system make the demented individual at high risk for poor outcomes
Dementia is a progressive disease that has the potential to cause many problems as it advances. Dysphagia is typically a later disease concern. Aspiration is a major problem in those who develop dysphagia. A speech therapist can perform a swallowing study and make recommendations to decrease the risk of aspiration. Some possible interventions include:
Altering the consistency of the food
Cutting food into smaller pieces
Changing the position of the patient when he or she swallows
Encouraging the patient to tuck the chin while swallowing
Eating with someone who can monitor for any aspiration or provide cues to safe eating
Some patients with dementia will hold food in their mouth, not swallow it and spit it out. This is common with frontotemporal dementia and is best treated with behavioral interventions.
The use of feeding tubes has fallen out of favor over the last number of years as they have not proven to extend life expectancy or improve quality of life. They can be utilized if aspiration is severe or patient does not eat enough to maintain nutrition and it is wanted by patient and durable power of attorney of health care. Feeding tubes do not prevent malnutrition, reduce incidence of aspiration pneumonia, improve function, or extend life (Li, 2002). If permanent feeding tube replacement is desired than percutaneous gastrostomy is better than a nasogastric tube. Consideration must be given to quality of life and complications when deciding on the use of a feeding tube. Hand feeding is an alternative to feeding tubes and it may provide more comfort to the patient.
Dementia is typically a later life disease when patients are prone to other illness. Those with dementia are typically older; older age comes with a greater risk of many chronic diseases. Having dementia makes it more likely that proper treatment will not ensue. For example, those with a heart attack may not be able to communicate the pain that they are feeling due to the dementia which will result in delayed care and worse outcomes.
Poor nutrition is another common complication of dementia. Poor nutrition increases the risk of infection and poor body healing. The combination of older age, poor communication and a compromised immune system make the demented individual at high risk for poor outcomes
Tuesday, April 14, 2009
Medical errors
Preventable events resulting from medical errors are a factor in approximately 43,000deaths per year. More people die from medical errors than from motor vehicle accidents or breast cancer (BRAUN, 2006). Medical errors increase expenses in additional patient care and in litigation. Serious medical errors are devastating to the patient, family, and staff.
AIDS info
AIDS is the most catastrophic disease in modern history. It has become the world's deadliest infectious disease and is threatening to eliminate up to a sixth of the world's population. An estimated 42 million people worldwide are infected with HIV and 3 million died of AIDS in 2003 (Staff, 2004c). About 880,000 people in the United States (US) have been diagnosed with HIV, about 385,000 are living with AIDS, and more than 500,000 have died from the disease. More than 700,000 cases are males, about 160,000 cases are females, and more than 9,000 cases are children under age 13 (CDC, 2002b). 40,000 new cases are diagnosed annually in the US (Trynka, & Erlen, 2004).
commentary
He SAYS he differs with me only on issues- which issues? He SAYS my numbers are wrong- but presents NO NUMBERS OF HIS OWN, or a rationale for them. He SAYS my observations are in error, but presents NO rationale to support his statements. NONE. ZERO. ZIP. For THOSE reasons he makes NO rational sense, and probably never will. Responding to him is a waste of my time and energy. I prefer to direct my energies toward something more productive directions. My Daddy told me a long time ago," Never get into a pi--ing contest with a skunk". He was right. Dr. Mel P. Johnson
goping crazy
"goping crazy" wondering who talks to birds and makes no sense? The sad and unfortunate people I have known in the past who talk to birds were in insane asylums, and it sounds like at least one, if not more, has unfortunately escaped. This IS America, and every American has the right to show themself day after day to be as CRAZY, childish, stupid, irrational, and illiterate as they want! The cast of anonymous and gutless characters so far includes Mikey, Mac, Margie, and at least one other escapee I havent identified yet. Could it be the Z-man himself? BINGO. Dr. Mel P. Johnson
Dendreon prostate cancer vaccine improves survival
Dendreon prostate cancer vaccine improves survival - Dendreon Corp said on Tuesday that its experimental Provenge prostate cancer treatment improved overall survival in men with advanced forms of the disease, bolstering the chances of it becoming the first approved therapeutic vaccine for cancer.
The Phase III clinical trial met the main study goal of improving survival, prompting Dendreon to say it will seek U.S. regulatory approval of Provenge in the fourth quarter.
'The successful outcome from the Phase 3 IMPACT study provides validation of the long-pursued goal of harnessing the human immune system against a patient's own cancer,' Dendreon Chief Executive Mitchell Gold said in a statement.
Unlike traditional vaccines that prevent disease, Provenge treats it.
The study included 512 men with late-stage prostate cancer who have not benefited from drugs that sharply lower testosterone -- the male sex hormone that fuels progression of the cancer.
The Phase III clinical trial met the main study goal of improving survival, prompting Dendreon to say it will seek U.S. regulatory approval of Provenge in the fourth quarter.
'The successful outcome from the Phase 3 IMPACT study provides validation of the long-pursued goal of harnessing the human immune system against a patient's own cancer,' Dendreon Chief Executive Mitchell Gold said in a statement.
Unlike traditional vaccines that prevent disease, Provenge treats it.
The study included 512 men with late-stage prostate cancer who have not benefited from drugs that sharply lower testosterone -- the male sex hormone that fuels progression of the cancer.
So it is you, Mac, not signing your posts
So it is you, Mac, not signing your posts, or making any sense. Grow a pair. Your spelling is minimally better and you finally figured out that FOWL and foul are not the same word and have different meanings. You GOT me not signing a post? Thats a joke, right? Somehow YOU, of ALL people, require that I sign my posts? You, who hasnt signed ONE POST so far? And probably never will? Pathetic. Truly pathetic. P. S. I am STILL signing MY posts. Dr. Mel P. Johnson
Monday, April 13, 2009
immunity?
Since December 2007, when the U.S. economy slipped into recession, at least 4.4 million jobs have been lost. In February, the national unemployment rate reached 8.1 percent -- its highest level in 26 years. Even with President Obama's $787 billion stimulus package, some economists think the jobless rate could top 10 percent before the slump is over. Hard-hit states such as Michigan, South Carolina, and Rhode Island already are seeing double-digit unemployment. Dont worry! We here in Miami Springs are immune! Ask our city officials! Those 400 total foreclosures and 151 still active foreclosures listed by the Herald for the Springs? No problem- we are immune. If we keep telling ourselves that over and over, maybe we will magically begin to actually believe its happening! Or maybe sane people will believe those who think that we are immune are just completely out of touch with reality. Dr. Mel P. Johnson
commentary
Is ANYONE saying that the bathrooms are NOT 558 square feet, each? That is simply settled by measuring them. Is there ANYONE who is debating that we paid 415k for the bathrooms? That is easily settled by asking for an FOI. Divide 1116 square feet into 415k and what do you get? $375 a square foot. Is there ANY real contractor who would suggest that $375 a square foot is the usual and customary costs for new construction in Dade County? Other than those who are actually receiving these outrageous sums, of course! If that explanation is too simple and straightforward do what I did- ask your insurance company what it would cost per square foot to rebuild your house if it blew down tomorrow! The numbers speak for themselves. This was not a courthouse or a huge library- it was two small bathrooms. The people who ask themselves questions in one post, and answer themselves in the next post, are still here, and STILL dont sign their names, although they call others who dont sign names. STILL pathetic. Dr. Mel P. Johnson
Sunday, April 12, 2009
NT Times, page 2
(Page 2 of 2)
Dr. Sanchez is a deputy coroner and the ambulance service director and is taking a turn as hospital medical director. Each doctor is a solo practitioner with a separate tax ID. “At the end of the day, our paychecks come from our own business, our own patients,” Dr. Fisher said.
They are informal partners, and cover each other’s patients. “We do everything on a handshake,” Dr. Brull said.
It took five years for her to persuade the other doctors to make the switch to electronic records. “Dan was our holdout,” she said.
Dr. Sanchez explained that, at first, “I was not sure I saw the benefits. Now I’m a very big proponent of it. I’ve gotten to the place where I prefer to get an electronic chart over a paper chart.”
Costs, like those to have his dictation transcribed, are down 75 percent. “The volume of paper flowing around has dropped dramatically,” he said. “That alone paid for half the cost of the software in the first year.”
They selected a medium-priced system (from e-MDs, based in Austin, Tex.), obtained private financing and invested $45,000 in software. Dr. Brull said she paid “the lion’s share for the equipment — $40,000 or $50,000 for hardware,” which they also share. Staff members were sent out for training, and last March they closed the offices for two days of instruction. When they reopened, a trainer stayed to help.
The electronic system helps Dr. Brull with just about every part of her practice. She keeps close watch on 250 patients with high blood pressure and 180 who have diabetes. She pays special attention to people who have both problems, summoning them for blood tests every six weeks
The computers make it easier to keep track of them. “We can run a computer report on diabetics who haven’t had appropriate lab work, or people who haven’t had a wellness exam in 10 months or did not have a flu shot,” she said.
When she leaves the office to see patients at a nursing home, she said: “I have access to my notes on each one on the laptop. It takes out the guesswork.” For people who pick up their pills at Walgreens or Wal-Mart, the software forwards an electronic prescription. “We are working to persuade the mom-and-pop pharmacies to get on that system,” she said.
Dr. Brull said she expected to recoup her investment in five years, perhaps sooner. It did not hurt that two other family doctors left the community last April. “All of a sudden, three or four thousand patients had no doctor,” she said. “We took on a large volume. If you work harder, you get more money.”
Still, she said she shared the frustrations of many physicians who say the insurance companies often seem to use delaying tactics to avoid paying for care, even when the bills are delivered to them by computer. “I feel like I spend a lot of time justifying what I do and chasing the dollar,” she said. But despite such concerns, she said, she is too busy to have much time left for complaining. “I am not a very good pessimist,” Dr. Brull said.
Dr. Sanchez is a deputy coroner and the ambulance service director and is taking a turn as hospital medical director. Each doctor is a solo practitioner with a separate tax ID. “At the end of the day, our paychecks come from our own business, our own patients,” Dr. Fisher said.
They are informal partners, and cover each other’s patients. “We do everything on a handshake,” Dr. Brull said.
It took five years for her to persuade the other doctors to make the switch to electronic records. “Dan was our holdout,” she said.
Dr. Sanchez explained that, at first, “I was not sure I saw the benefits. Now I’m a very big proponent of it. I’ve gotten to the place where I prefer to get an electronic chart over a paper chart.”
Costs, like those to have his dictation transcribed, are down 75 percent. “The volume of paper flowing around has dropped dramatically,” he said. “That alone paid for half the cost of the software in the first year.”
They selected a medium-priced system (from e-MDs, based in Austin, Tex.), obtained private financing and invested $45,000 in software. Dr. Brull said she paid “the lion’s share for the equipment — $40,000 or $50,000 for hardware,” which they also share. Staff members were sent out for training, and last March they closed the offices for two days of instruction. When they reopened, a trainer stayed to help.
The electronic system helps Dr. Brull with just about every part of her practice. She keeps close watch on 250 patients with high blood pressure and 180 who have diabetes. She pays special attention to people who have both problems, summoning them for blood tests every six weeks
The computers make it easier to keep track of them. “We can run a computer report on diabetics who haven’t had appropriate lab work, or people who haven’t had a wellness exam in 10 months or did not have a flu shot,” she said.
When she leaves the office to see patients at a nursing home, she said: “I have access to my notes on each one on the laptop. It takes out the guesswork.” For people who pick up their pills at Walgreens or Wal-Mart, the software forwards an electronic prescription. “We are working to persuade the mom-and-pop pharmacies to get on that system,” she said.
Dr. Brull said she expected to recoup her investment in five years, perhaps sooner. It did not hurt that two other family doctors left the community last April. “All of a sudden, three or four thousand patients had no doctor,” she said. “We took on a large volume. If you work harder, you get more money.”
Still, she said she shared the frustrations of many physicians who say the insurance companies often seem to use delaying tactics to avoid paying for care, even when the bills are delivered to them by computer. “I feel like I spend a lot of time justifying what I do and chasing the dollar,” she said. But despite such concerns, she said, she is too busy to have much time left for complaining. “I am not a very good pessimist,” Dr. Brull said.
electronic health records, page 1
As Medical Charts Go Electronic, Rural Doctor Sees Healthy Change
Published: April 10, 2009
In Washington, the Obama administration is promising to spend billions to make health care more efficient, but Jennifer Brull, a family doctor in rural Kansas, is already a step or two ahead.
Fabrizio Costantini for The New York Times
Dr. Jennifer Brull with colleagues Lynn Fisher, right, and Dan Sanchez, foreground, checking his tablet PC.
Fabrizio Costantini for The New York Times
Dr. Michael Ferris had a different experience with electronic records: his $38,000 system kept crashing.
A year ago, she switched her 3,000 patients from paper charts to electronic health records, a core feature of most plans for healing the nation’s ailing health system. Now, working with computers and printouts, her staff of part-time nurses and shared front-office workers has more time to help her meet the needs of patients.
“I’ll never go back to the old system,” said Dr. Brull, 37, who runs a solo practice in Plainville, Kan. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”
Patients are appreciative, too. Kagay Wheatley brings her 97-year-old neighbor, Charlotte Hayes, to Dr. Brull for blood tests every few weeks. “We do not have to sit and wait while the nurses search for the records,” said Ms. Wheatley, a retired school board aide who is also a patient of Dr. Brull’s. “They find the information right there on the computer, and when we leave, we get a printout of what we did and what she said.”
About 42 percent of active family doctors have installed some type of electronic health records, according to surveys and estimates by the American Academy of Family Physicians, a professional and advocacy group. One in four said they did not plan to purchase an electronic system, and many said they could not afford the $30,000 to $50,000 in start-up costs. The academy has 94,600 members, including about 60,000 in active practice.
Medical centers like the new 24-bed critical-access hospital in Plainville, connected by a walkway to Dr. Brull’s office, are also rapidly adopting electronic records.
“The use of electronic health records and being able to transmit X-rays allows us to be in contact with the whole world,” said Chuck Comeau, a hospital board member who is chief executive of Dessin Fournir, a national furniture design company that moved its head office to Plainville from Los Angeles.
Even so, 8 in 10 of all American doctors still labor in a world of paper. And some doctors said they encountered upsetting setbacks when they tried to switch to electronic records.
Michael Ferris, a 33-year-old emergency medicine physician in Parsons, Kan., said he had to give up his solo practice after he had invested $38,000 in software for systems that kept crashing and thwarting his attempts to send out electronic bills. “I was spending as much time trying to fix the computer and the billing as actually seeing patients,” he said, “and neither process was generating any revenue for me.”
Now, as director of the emergency room at the Labette County hospital in Parsons, Dr. Ferris said, “I get paid by the hour and don’t have to worry if the software is down.” But he said he expected that some day he would have to help the hospital make the transition to electronic records. “I know it is coming.”
Information technology for health care is a $20 billion section of the $787 billion economic stimulus package President Obama signed last month. But only part of the new I.T. financing will help individual doctors who convert to electronic health records, said Dr. Steven Waldren, director of the center for health information technology at the academy of family physicians. Those in rural and underserved areas should benefit the most.
“For the vast majority of physicians, there is not going to be upfront money to purchase electronic record systems,” Dr. Waldren said.
Dr. Brull, who grew up in Grinnell, Kan., a town with 250 residents, has been an advocate of electronic records since she was in medical school at the University of Kansas in the 1990s. Seven years ago she moved to Plainville, where she rents space in a community-owned medical office building and shares a receptionist and bookkeeping staff with two other family physicians, Dan Sanchez, 45, and Lynn Fisher, 34.
They have 8,000 patients in all, including some from neighboring counties. The three doctors together cover a lot of ground: delivering babies, performing colon cancer checkups and staffing the emergency room at the hospital. They refer patients who need intensive care or a specialist to the Hays Medical Center, 23 miles away. Trauma patients are flown to Wichita, a one-hour helicopter ride. Specialists, including a cardiologist, come to Plainville to provide follow-up care.
The three are the only doctors in Plainville, a city of 2,500 in Rooks County, a wheat farming and oil-producing area midway between Kansas City and Denver. “We are it,” Dr. Brull said.
Published: April 10, 2009
In Washington, the Obama administration is promising to spend billions to make health care more efficient, but Jennifer Brull, a family doctor in rural Kansas, is already a step or two ahead.
Fabrizio Costantini for The New York Times
Dr. Jennifer Brull with colleagues Lynn Fisher, right, and Dan Sanchez, foreground, checking his tablet PC.
Fabrizio Costantini for The New York Times
Dr. Michael Ferris had a different experience with electronic records: his $38,000 system kept crashing.
A year ago, she switched her 3,000 patients from paper charts to electronic health records, a core feature of most plans for healing the nation’s ailing health system. Now, working with computers and printouts, her staff of part-time nurses and shared front-office workers has more time to help her meet the needs of patients.
“I’ll never go back to the old system,” said Dr. Brull, 37, who runs a solo practice in Plainville, Kan. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”
Patients are appreciative, too. Kagay Wheatley brings her 97-year-old neighbor, Charlotte Hayes, to Dr. Brull for blood tests every few weeks. “We do not have to sit and wait while the nurses search for the records,” said Ms. Wheatley, a retired school board aide who is also a patient of Dr. Brull’s. “They find the information right there on the computer, and when we leave, we get a printout of what we did and what she said.”
About 42 percent of active family doctors have installed some type of electronic health records, according to surveys and estimates by the American Academy of Family Physicians, a professional and advocacy group. One in four said they did not plan to purchase an electronic system, and many said they could not afford the $30,000 to $50,000 in start-up costs. The academy has 94,600 members, including about 60,000 in active practice.
Medical centers like the new 24-bed critical-access hospital in Plainville, connected by a walkway to Dr. Brull’s office, are also rapidly adopting electronic records.
“The use of electronic health records and being able to transmit X-rays allows us to be in contact with the whole world,” said Chuck Comeau, a hospital board member who is chief executive of Dessin Fournir, a national furniture design company that moved its head office to Plainville from Los Angeles.
Even so, 8 in 10 of all American doctors still labor in a world of paper. And some doctors said they encountered upsetting setbacks when they tried to switch to electronic records.
Michael Ferris, a 33-year-old emergency medicine physician in Parsons, Kan., said he had to give up his solo practice after he had invested $38,000 in software for systems that kept crashing and thwarting his attempts to send out electronic bills. “I was spending as much time trying to fix the computer and the billing as actually seeing patients,” he said, “and neither process was generating any revenue for me.”
Now, as director of the emergency room at the Labette County hospital in Parsons, Dr. Ferris said, “I get paid by the hour and don’t have to worry if the software is down.” But he said he expected that some day he would have to help the hospital make the transition to electronic records. “I know it is coming.”
Information technology for health care is a $20 billion section of the $787 billion economic stimulus package President Obama signed last month. But only part of the new I.T. financing will help individual doctors who convert to electronic health records, said Dr. Steven Waldren, director of the center for health information technology at the academy of family physicians. Those in rural and underserved areas should benefit the most.
“For the vast majority of physicians, there is not going to be upfront money to purchase electronic record systems,” Dr. Waldren said.
Dr. Brull, who grew up in Grinnell, Kan., a town with 250 residents, has been an advocate of electronic records since she was in medical school at the University of Kansas in the 1990s. Seven years ago she moved to Plainville, where she rents space in a community-owned medical office building and shares a receptionist and bookkeeping staff with two other family physicians, Dan Sanchez, 45, and Lynn Fisher, 34.
They have 8,000 patients in all, including some from neighboring counties. The three doctors together cover a lot of ground: delivering babies, performing colon cancer checkups and staffing the emergency room at the hospital. They refer patients who need intensive care or a specialist to the Hays Medical Center, 23 miles away. Trauma patients are flown to Wichita, a one-hour helicopter ride. Specialists, including a cardiologist, come to Plainville to provide follow-up care.
The three are the only doctors in Plainville, a city of 2,500 in Rooks County, a wheat farming and oil-producing area midway between Kansas City and Denver. “We are it,” Dr. Brull said.
Empire State Building Going Green
By MIREYA NAVARRO
Published: April 6, 2009
Once the world’s tallest building, the Empire State Building is striving for another milestone: It is going green.
Windows, top, will have insulated film installed between the double panes.
Piotr Redlinski for The New York Times
Chillers in the cooling plant will be rebuilt. This and the insulation project will amount to about half the savings.
Owners of the New York City landmark announced on Monday that they will be beginning a renovation this summer expected to reduce the skyscraper’s energy use by 38 percent a year by 2013, at an annual savings of $4.4 million. The retrofit project will add $20 million to the $500 million building makeover already under way that aims to attract larger corporate occupants at higher rents.
Although the retrofit was specifically designed for the Art Deco office building at 34th Street and Fifth Avenue and its enormous features — 102 stories, 2.6 million square feet, 6,500 windows and 73 elevators — the energy-efficiency improvements are meant to serve as a model for other office buildings around the world, said Anthony E. Malkin, president of Wien & Malkin, which supervises the building on behalf of the owners, the Malkin family and the Helmsley estate.
He said upfront costs are often a deterrent for retrofitting older buildings, but the energy savings for the building , built in 1931, are expected to pay back those costs in only about three years.
“People associate greening with expense and compromise,” Mr. Malkin said. “We’re trying to prove: no compromise and payback.”
Mr. Malkin announced the details of the project at a news conference attended by Mayor Michael R. Bloomberg, who has made sustainability a theme of his administration, and former President Bill Clinton, whose Clinton Climate Initiative program, which works with cities to develop large scale energy efficiency programs, helped facilitate the project.
People involved with the retrofit said the Empire State Building can offer an example of how older buildings can retrofit to the highest energy standards and effectively cut down their greenhouse gas emissions, a contributor to global warming. The largest share of New York City’s greenhouse gas emissions, 78 percent, comes from the city’s buildings, with commercial buildings contributing 25 percent, mostly from the use of electricity and natural gas.
By reducing energy use, the retrofit plan envisions cutting down the pollution the Empire State Building produces by 105,000 metric tons of carbon dioxide emissions a year, although the number of emissions currently emitted was not immediately available.
“They’re showing the rest of the city that existing buildings, no matter how tall they are, no matter how old they are, can take steps to significantly reduce their energy consumption,” Mr. Bloomberg said.
The largest energy guzzlers at the Empire State Building are lighting, cooling and heating, said Paul Rode, a project executive with Johnson Controls, the retrofit designer. The building has 302 office tenants but is occupied by about 13,000 people a day, including visitors to the observatories on the 86th and 102nd floors that are open to the public 18 hours a day, seven days a week.
The designers said that about half the reduction in energy use will be achieved in the first two years of the project as they retrofit the double hung operable windows, insulate behind radiators and rebuild chillers in the cooling plant in the basement.
To avoid transportation-related pollution, the windows will be redone on site, by adding a layer of coated film between two glass panes to increase insulation. at a rate of 50 windows a day.
In all, the retrofit consists of eight projects, including upgrades to the electrical and ventilation systems and installation of sophisticated electronic instrumentation.
The biggest challenge in planning the project, Mr. Rode said, was to figure out what was behind the walls and the ceilings of the 78-year-old skyscraper — in the absence of original drawings and specifications.
“It took a lot of investigative work,” Mr. Rode said.
The plan also calls for tenants’ involvement in monitoring their own energy use in their offices through a Web-based dashboard accessible from their computers, which keeps track of how much energy is being used and where.
Some tenants are already ahead of their landlord. Skanska, a Swedish construction company that took over the 32nd floor in November with 80 employees, renovated its 24,400 square feet of office space to green standards like daylight sensors to conserve energy and dual-flush toilets to avoid wasting water.
The company, which says it has cut its electric bill by one-third with the improvements, is seeking platinum certification, the highest level awarded by the United States Green Building Council, which certifies buildings and commercial interiors for energy, water efficiency and other green features.
The federal Environmental Protection Agency rates buildings for energy efficiency under its Energy Star program, and 6,200 commercial and institutional buildings have earned the label by achieving 30 to 40 percent greater efficiency than their peers. The Empire State Building is expected to fall in the top 10 percent of Energy Star office buildings when its renovation is completed, the project designers said.
While the energy-saving improvements will be substantial, no one visiting the building is very likely to notice them — most involve slight changes or will be hidden in the building’s innards. The night lighting that makes the building a distinctive part of the city’s skyline represents a small draw of energy during off-peak hours and will continue without changes, Mr. Malkin said.
He said the green features will be highlighted for visitors as an educational tool, and tenants may also see a mark-up on rents because of the desirability of green features.
Jacques Catafago, president of the Empire State Building Tenants Association, called making the building more energy-efficient “a laudable effort” but said that rent increases were a concern. Mr. Catafago, a lawyer whose firm has been in the building since 1990, said that “34th Street is not 57th Street — the rents are very reasonable here.”
But Mr. Malkin said he was looking at the larger goal.
“If we don’t change our unsustainable practices and the amount of energy we consume, if we don’t make our city more efficient, we’re toast,” he said. “We won’t be able to avoid the sort of changes that would spell a reduced quality of life.”
Published: April 6, 2009
Once the world’s tallest building, the Empire State Building is striving for another milestone: It is going green.
Windows, top, will have insulated film installed between the double panes.
Piotr Redlinski for The New York Times
Chillers in the cooling plant will be rebuilt. This and the insulation project will amount to about half the savings.
Owners of the New York City landmark announced on Monday that they will be beginning a renovation this summer expected to reduce the skyscraper’s energy use by 38 percent a year by 2013, at an annual savings of $4.4 million. The retrofit project will add $20 million to the $500 million building makeover already under way that aims to attract larger corporate occupants at higher rents.
Although the retrofit was specifically designed for the Art Deco office building at 34th Street and Fifth Avenue and its enormous features — 102 stories, 2.6 million square feet, 6,500 windows and 73 elevators — the energy-efficiency improvements are meant to serve as a model for other office buildings around the world, said Anthony E. Malkin, president of Wien & Malkin, which supervises the building on behalf of the owners, the Malkin family and the Helmsley estate.
He said upfront costs are often a deterrent for retrofitting older buildings, but the energy savings for the building , built in 1931, are expected to pay back those costs in only about three years.
“People associate greening with expense and compromise,” Mr. Malkin said. “We’re trying to prove: no compromise and payback.”
Mr. Malkin announced the details of the project at a news conference attended by Mayor Michael R. Bloomberg, who has made sustainability a theme of his administration, and former President Bill Clinton, whose Clinton Climate Initiative program, which works with cities to develop large scale energy efficiency programs, helped facilitate the project.
People involved with the retrofit said the Empire State Building can offer an example of how older buildings can retrofit to the highest energy standards and effectively cut down their greenhouse gas emissions, a contributor to global warming. The largest share of New York City’s greenhouse gas emissions, 78 percent, comes from the city’s buildings, with commercial buildings contributing 25 percent, mostly from the use of electricity and natural gas.
By reducing energy use, the retrofit plan envisions cutting down the pollution the Empire State Building produces by 105,000 metric tons of carbon dioxide emissions a year, although the number of emissions currently emitted was not immediately available.
“They’re showing the rest of the city that existing buildings, no matter how tall they are, no matter how old they are, can take steps to significantly reduce their energy consumption,” Mr. Bloomberg said.
The largest energy guzzlers at the Empire State Building are lighting, cooling and heating, said Paul Rode, a project executive with Johnson Controls, the retrofit designer. The building has 302 office tenants but is occupied by about 13,000 people a day, including visitors to the observatories on the 86th and 102nd floors that are open to the public 18 hours a day, seven days a week.
The designers said that about half the reduction in energy use will be achieved in the first two years of the project as they retrofit the double hung operable windows, insulate behind radiators and rebuild chillers in the cooling plant in the basement.
To avoid transportation-related pollution, the windows will be redone on site, by adding a layer of coated film between two glass panes to increase insulation. at a rate of 50 windows a day.
In all, the retrofit consists of eight projects, including upgrades to the electrical and ventilation systems and installation of sophisticated electronic instrumentation.
The biggest challenge in planning the project, Mr. Rode said, was to figure out what was behind the walls and the ceilings of the 78-year-old skyscraper — in the absence of original drawings and specifications.
“It took a lot of investigative work,” Mr. Rode said.
The plan also calls for tenants’ involvement in monitoring their own energy use in their offices through a Web-based dashboard accessible from their computers, which keeps track of how much energy is being used and where.
Some tenants are already ahead of their landlord. Skanska, a Swedish construction company that took over the 32nd floor in November with 80 employees, renovated its 24,400 square feet of office space to green standards like daylight sensors to conserve energy and dual-flush toilets to avoid wasting water.
The company, which says it has cut its electric bill by one-third with the improvements, is seeking platinum certification, the highest level awarded by the United States Green Building Council, which certifies buildings and commercial interiors for energy, water efficiency and other green features.
The federal Environmental Protection Agency rates buildings for energy efficiency under its Energy Star program, and 6,200 commercial and institutional buildings have earned the label by achieving 30 to 40 percent greater efficiency than their peers. The Empire State Building is expected to fall in the top 10 percent of Energy Star office buildings when its renovation is completed, the project designers said.
While the energy-saving improvements will be substantial, no one visiting the building is very likely to notice them — most involve slight changes or will be hidden in the building’s innards. The night lighting that makes the building a distinctive part of the city’s skyline represents a small draw of energy during off-peak hours and will continue without changes, Mr. Malkin said.
He said the green features will be highlighted for visitors as an educational tool, and tenants may also see a mark-up on rents because of the desirability of green features.
Jacques Catafago, president of the Empire State Building Tenants Association, called making the building more energy-efficient “a laudable effort” but said that rent increases were a concern. Mr. Catafago, a lawyer whose firm has been in the building since 1990, said that “34th Street is not 57th Street — the rents are very reasonable here.”
But Mr. Malkin said he was looking at the larger goal.
“If we don’t change our unsustainable practices and the amount of energy we consume, if we don’t make our city more efficient, we’re toast,” he said. “We won’t be able to avoid the sort of changes that would spell a reduced quality of life.”
The New York Times
Op-Ed Columnist
(No) Drill, Baby, Drill
Published: April 11, 2009
Liberia, Costa Rica
Fred R. Conrad/The New York Times
Thomas L. Friedman
Sailing down Costa Rica’s Tempisque River on an eco-tour, I watched a crocodile devour a brown bass with one gulp. It took only a few seconds. The croc’s head emerged from the muddy waters near the bank with the footlong fish writhing in its jaws. He crunched it a couple of times with razor-sharp teeth and then, with just the slightest flip of his snout, swallowed the fish whole. Never saw that before.
These days, visitors can still see amazing biodiversity all over Costa Rica — more than 25 percent of the country is protected area — thanks to a unique system it set up to preserve its cornucopia of plants and animals. Many countries could learn a lot from this system.
More than any nation I’ve ever visited, Costa Rica is insisting that economic growth and environmentalism work together. It has created a holistic strategy to think about growth, one that demands that everything gets counted. So if a chemical factory sells tons of fertilizer but pollutes a river — or a farm sells bananas but destroys a carbon-absorbing and species-preserving forest — this is not honest growth. You have to pay for using nature. It is called “payment for environmental services” — nobody gets to treat climate, water, coral, fish and forests as free anymore.
The process began in the 1990s when Costa Rica, which sits at the intersection of two continents and two oceans, came to fully appreciate its incredible bounty of biodiversity — and that its economic future lay in protecting it. So it did something no country has ever done: It put energy, environment, mines and water all under one minister.
“In Costa Rica, the minister of environment sets the policy for energy, mines, water and natural resources,” explained Carlos M. Rodríguez, who served in that post from 2002 to 2006. In most countries, he noted, “ministers of environment are marginalized.” They are viewed as people who try to lock things away, not as people who create value. Their job is to fight energy ministers who just want to drill for cheap oil.
But when Costa Rica put one minister in charge of energy and environment, “it created a very different way of thinking about how to solve problems,” said Rodríguez, now a regional vice president for Conservation International. “The environment sector was able to influence the energy choices by saying: ‘Look, if you want cheap energy, the cheapest energy in the long-run is renewable energy. So let’s not think just about the next six months; let’s think out 25 years.’ ”
As a result, Costa Rica hugely invested in hydro-electric power, wind and geo-thermal, and today it gets more than 95 percent of its energy from these renewables. In 1985, it was 50 percent hydro, 50 percent oil. More interesting, Costa Rica discovered its own oil five years ago but decided to ban drilling — so as not to pollute its politics or environment! What country bans oil drilling?
Rodríguez also helped to pioneer the idea that in a country like Costa Rica, dependent on tourism and agriculture, the services provided by ecosystems were important drivers of growth and had to be paid for. Right now, most countries fail to account for the “externalities” of various economic activities. So when a factory, farmer or power plant pollutes the air or the river, destroys a wetland, depletes a fish stock or silts a river — making the water no longer usable — that cost is never added to your electric bill or to the price of your shoes.
Costa Rica took the view that landowners who keep their forests intact and their rivers clean should be paid, because the forests maintained the watersheds and kept the rivers free of silt — and that benefited dam owners, fishermen, farmers and eco-tour companies downstream. The forests also absorbed carbon.
To pay for these environmental services, in 1997 Costa Rica imposed a tax on carbon emissions — 3.5 percent of the market value of fossil fuels — which goes into a national forest fund to pay indigenous communities for protecting the forests around them. And the country imposed a water tax whereby major water users — hydro-electric dams, farmers and drinking water providers — had to pay villagers upstream to keep their rivers pristine. “We now have 7,000 beneficiaries of water and carbon taxes,” said Rodríguez. “It has become a major source of income for poor people. It has also enabled Costa Rica to actually reverse deforestation. We now have twice the amount of forest as 20 years ago.”
As we debate a new energy future, we need to remember that nature provides this incredible range of economic services — from carbon-fixation to water filtration to natural beauty for tourism. If government policies don’t recognize those services and pay the people who sustain nature’s ability to provide them, things go haywire. We end up impoverishing both nature and people. Worse, we start racking up a bill in the form of climate-changing greenhouse gases, petro-dictatorships and bio-diversity loss that gets charged on our kids’ Visa cards to be paid by them later. Well, later is over. Later is when it will be too late.
(No) Drill, Baby, Drill
Published: April 11, 2009
Liberia, Costa Rica
Fred R. Conrad/The New York Times
Thomas L. Friedman
Sailing down Costa Rica’s Tempisque River on an eco-tour, I watched a crocodile devour a brown bass with one gulp. It took only a few seconds. The croc’s head emerged from the muddy waters near the bank with the footlong fish writhing in its jaws. He crunched it a couple of times with razor-sharp teeth and then, with just the slightest flip of his snout, swallowed the fish whole. Never saw that before.
These days, visitors can still see amazing biodiversity all over Costa Rica — more than 25 percent of the country is protected area — thanks to a unique system it set up to preserve its cornucopia of plants and animals. Many countries could learn a lot from this system.
More than any nation I’ve ever visited, Costa Rica is insisting that economic growth and environmentalism work together. It has created a holistic strategy to think about growth, one that demands that everything gets counted. So if a chemical factory sells tons of fertilizer but pollutes a river — or a farm sells bananas but destroys a carbon-absorbing and species-preserving forest — this is not honest growth. You have to pay for using nature. It is called “payment for environmental services” — nobody gets to treat climate, water, coral, fish and forests as free anymore.
The process began in the 1990s when Costa Rica, which sits at the intersection of two continents and two oceans, came to fully appreciate its incredible bounty of biodiversity — and that its economic future lay in protecting it. So it did something no country has ever done: It put energy, environment, mines and water all under one minister.
“In Costa Rica, the minister of environment sets the policy for energy, mines, water and natural resources,” explained Carlos M. Rodríguez, who served in that post from 2002 to 2006. In most countries, he noted, “ministers of environment are marginalized.” They are viewed as people who try to lock things away, not as people who create value. Their job is to fight energy ministers who just want to drill for cheap oil.
But when Costa Rica put one minister in charge of energy and environment, “it created a very different way of thinking about how to solve problems,” said Rodríguez, now a regional vice president for Conservation International. “The environment sector was able to influence the energy choices by saying: ‘Look, if you want cheap energy, the cheapest energy in the long-run is renewable energy. So let’s not think just about the next six months; let’s think out 25 years.’ ”
As a result, Costa Rica hugely invested in hydro-electric power, wind and geo-thermal, and today it gets more than 95 percent of its energy from these renewables. In 1985, it was 50 percent hydro, 50 percent oil. More interesting, Costa Rica discovered its own oil five years ago but decided to ban drilling — so as not to pollute its politics or environment! What country bans oil drilling?
Rodríguez also helped to pioneer the idea that in a country like Costa Rica, dependent on tourism and agriculture, the services provided by ecosystems were important drivers of growth and had to be paid for. Right now, most countries fail to account for the “externalities” of various economic activities. So when a factory, farmer or power plant pollutes the air or the river, destroys a wetland, depletes a fish stock or silts a river — making the water no longer usable — that cost is never added to your electric bill or to the price of your shoes.
Costa Rica took the view that landowners who keep their forests intact and their rivers clean should be paid, because the forests maintained the watersheds and kept the rivers free of silt — and that benefited dam owners, fishermen, farmers and eco-tour companies downstream. The forests also absorbed carbon.
To pay for these environmental services, in 1997 Costa Rica imposed a tax on carbon emissions — 3.5 percent of the market value of fossil fuels — which goes into a national forest fund to pay indigenous communities for protecting the forests around them. And the country imposed a water tax whereby major water users — hydro-electric dams, farmers and drinking water providers — had to pay villagers upstream to keep their rivers pristine. “We now have 7,000 beneficiaries of water and carbon taxes,” said Rodríguez. “It has become a major source of income for poor people. It has also enabled Costa Rica to actually reverse deforestation. We now have twice the amount of forest as 20 years ago.”
As we debate a new energy future, we need to remember that nature provides this incredible range of economic services — from carbon-fixation to water filtration to natural beauty for tourism. If government policies don’t recognize those services and pay the people who sustain nature’s ability to provide them, things go haywire. We end up impoverishing both nature and people. Worse, we start racking up a bill in the form of climate-changing greenhouse gases, petro-dictatorships and bio-diversity loss that gets charged on our kids’ Visa cards to be paid by them later. Well, later is over. Later is when it will be too late.
a response
For those interested in finding me, I am not all that hard to find. I will be at the Council meeting Monday night, for instance. The numbers you dispute are from my insurance company- 1116 square feet for the bathrooms times $125 per square foot equals 140k, NOT 415k. At last the cowardly poster will stop hiding behind the anonymous nature of this site and present himself- GREAT! Before he considers doing anything that could be detrimental to his health he needs to know that I bring my Black Belt qualifications with me. Dr. Mel P. Johnson
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