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PH and Lupus
Order Copies of the PH and Lupus Brochure
- What do I need to know about lupus-associated PH?
- Why do PH and lupus seem to occasionally occur together?
- Who is most susceptible to a lupus-associated PAH?
- Should a lupus patient be tested for PH?
- How is testing for PH carried out?
- Can PH be treated the same way in lupus patients as in those without lupus?
- Does having lupus make PH worse?
What do I need to know about lupus-associated PH?
First of all, it is essential to know that PH and lupus are two separate conditions and that PH does not cause lupus. However, some lupus patients develop PH. As was discussed in the introduction, there are a number of reasons why blood pressure in the lung may become elevated — almost all of which can occur in lupus. For this reason, it is very important that patients with lupus and suspected PH be looked at very carefully to understand exactly what might be contributing to PH.
Lupus-associated PH may be due to more than just one problem. Other causes of PH include left-heart dysfunction, vasculitis (an inflammation or irrita- tion of small blood vessels in the lung), pulmonary embolism (blood clots in the lungs) or pulmonary parenchymal disease (scarring or irritation of the area surrounding the air sacs and blood vessels in the lungs). Each of these situations would be treated differently. Since this is much more complex than PAH alone, receiving care from a physician who is experienced in the management of lupus and PAH is important.
One of the most serious kinds of PH is PAH. This remains a relatively uncommon complication of lupus, but because PAH can be very problematic, it is important to find and treat this as soon as possible. Current estimates suggest that somewhere between 0.5 and 9 percent of patients with lupus may have PAH.
Lupus remains a very complex process that can affect one or many organs. In particular, lupus can cause kidney, heart or lung dysfunction in some people, which can lead to shortness of breath, fatigue or fluid retention — all of which can also occur in PAH. These additional factors particular to lupus can complicate management of PAH and may require additional testing to ensure the best treat ment of lupus-associated PAH.
Why do PH and lupus seem to occassionally occur together?
This is another question that medical science is searching to answer. Medical researchers have not yet been able to say for sure how lupus leads to the develop- ment of PAH in some patients. It is not yet known, for example, whether lupus itself can directly cause PH, or whether lupus is simply a trigger for the development of PAH in susceptible individuals. Lupus remains a complicated disease that can cause many problems that weaken blood vessels, and these, too, might play into the development of PAH.
Who is most susceptible to a lupus-associated PAH?
Lupus-associated PAH occurs more frequently in females and in a slightly younger age group than idiopathic PAH (IPAH) or scleroderma-associated PAH. There also appear to be racial differences in lupus-associated PAH with increased frequency of non-Caucasian patients compared to IPAH or scleroderma-associated PAH. There are no blood tests able to accurately predict if a lupus patient
has PAH or might develop it.
Should a lupus patient be tested for PH?
Lupus patients know that medical supervision is critical to their best possible long-term health and that any change in their condition should be brought to the attention of their doctors. Changes that may have to do with PH might include difficulty when attempting physical activity; swelling of the feet, ankles, legs or abdomen; increased shortness of breath; worsening fatigue; chest discomfort or pain; light-headedness or fainting. These changes should be communicated to your doctor promptly.
How is testing for PH carried out?
A visit to your doctor and a thorough exam is a good first step for evaluation of potential PH. An echocardiogram is a very useful test that looks at the size and functions of the heart among other things and can suggest whether PH may exist. Unfortunately, it alone is not accu- rate enough to make the diagnosis of lupus-associated PAH. A test known as right-heart catheterization remains the most accurate way of diagnosing lupus- associated PAH. Additional testing is also typically done to see how much exercise you can do and to check lung function or x-rays to be sure that additional problems in the lungs are not present.
Can PH be treated the same way in lupus patients as in those without lupus?
Through the years, a variety of medications have been shown to slow the damage and relieve the symptoms caused by PAH. These medications are very complex, and choosing the correct initial treatment requires the knowledge and expertise of a physician who specializes in PAH. Professionals at PH centers can help identify PH and choose the correct type of treatment.
In addition to medications approved for the treatment of PAH, patients may benefit from simple basic measures including attention to fluid balance and therapies that improve the efficiency of the heart. These may include supplemen- tal oxygen or the medication digoxin, as well as anticoagulants (blood thinners).
Once a doctor and patient have been able to establish an effective medical approach, many patients show significant improvement, often in conjunction with doctor-prescribed cardiopulmonary rehabilitation training (CPRT).
A few patients with lupus-associated PH may also benefit from a group of drugs called immunosuppressive medications. These medications treat irritation or inflammation in the body, which can occur in lupus and occasionally can cause additional damage in the blood
vessels of the lungs. It is difficult to know in all cases which patient may benefit from these kinds of medications.
Does having lupus make PH worse?
The answer is yes and no. In general, patients who have lupus-associated PAH tend to respond to therapy similarly to IPAH patients who do not have lupus. As was noted above, however, patients with lupus may have other problems such as left-heart dysfunction, blood clots in the lungs, inflammation of the lungs or its blood vessels. All of these could make PH worse for that person.
Michael J. Krowka, MD
Mayo Clinic, Rochester, Minn.
Michael A. Mathier, MD, FACC;
University of Pittsburgh School of Medicine, Pittsburgh, Pa.
Robert Schilz, DO, PhD,
Case Western Reserve University School of Medicine,
Cleveland, Ohio
This page last updated December 2013


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The Rehaklinik Zihlschlacht specializes in the treatment of brain and nerve injured patients and has been helping people for more than 30 years.
This information is intended for general information only and should not be considered as medical advice on the part of Health-Tourism.com. Any decision on medical treatments, after-care or recovery should be done solely upon proper consultation and advice of a qualified physician.
What is cardiac rehabilitation?
This is a special medical program developed to assist people in recovery from diseases such as heart attacks and procedures such as heart surgery, angioplasty and stenting. Cardiac rehabilitation also includes counseling services and education which assist the patient to increase physical fitness and health which in turn reduces cardiac symptoms and problems such as heart attacks.
Anyone who has a heart condition or disease can benefit from a cardiac rehabilitation program. The program can assist you to:
People of all ages and ethnic backgrounds and both sexes can benefit from cardiac rehabilitation (rehab). Rehab can help people who have had:
Cardiac rehab can improve your overall health and prevent future heart problems and even death.
Cardiac rehabilitation requires a continuing commitment from a team of health care professional and yourself. The cardiac rehabilitation team helps you to set goals, offers advice and counseling and creates a tailored plan that improves your overall health. It includes doctors such as a cardiologist and a family doctor, nurses, dietitians, exercise specialists, physical therapists and psychologists. The team is in place to help in monitoring your care.
How long do I need to attend cardiac rehabilitation?
Cardiac rehabilitation programs have individualized plans that help to meet your specific needs. As each plan is different, our specific condition will determine how long the program will last. This can be four weeks, four months or even longer.
Cardiac rehabilitation programs can be beneficial to all people with heart problems or those with the risk factors. Lifestyle changes prepared in the program carry few if any risks. These changes advance your overall health. This averts future heart problems and death.
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971 Butternut Dr., Holland, MI 49424, (616) 399-3600
Call: (616) 399-3600
It is our goal to keep your mouth healthy, your teeth fully functional, and your smile bright — and we are proud of all the services we offer to do exactly that. At the same time, we want you to understand all that modern dentistry in general has to offer you. To that end, we have assembled a first-rate dental library in which you can find a wealth of information on various dental topics, including:
From a thorough professional cleaning to a full smile makeover, there is an amazing array of services that cosmetic and general dentists offer to make sure your teeth stay healthy, function well and look great. If your smile is not all you want it to be, this is the place to start. Read more about Cosmetic & General Dentistry.
When you have a dental emergency — whether it's caused by a sudden accident or chronic disease — your teeth and/or the tissues of the mouth that surround them need to receive proper care right away. It's also important to be aware, before you're actually in the situation, of what you can do to ensure the best outcome. Read more about Emergency Dental Care.
This is the branch of dentistry that focuses on the inside of the tooth — specifically the root canals and sensitive, inner pulp (nerve) tissue. When this tissue becomes inflamed or infected, a root canal procedure may become necessary. But contrary to the popular myth, a root canal doesn't cause pain, it relives it. Read more about Endodontics.
If you are missing one or more teeth, dental implants offer the comfort and security of a permanent replacement that looks and functions just like your natural teeth. Dental implants also help preserve the tooth-supporting bone in your jaw that naturally deteriorates when even one tooth is lost. Read more about Implant Dentistry.
Oral health is an essential component of general health and well-being. Good oral health means a mouth that's free of disease; a bite that functions well enough for you to eat without pain and get ample nutrition; and a smile that lets you express your happiest emotions with confidence. Read more about Oral Health.
A major goal of modern dentistry is to help you keep your teeth and gums healthy for a lifetime. By following a conscientious program of oral hygiene at home, and coming to the dental office for routine cleanings and exams, you have the best chance of making this goal a reality. Read more about Oral Hygiene.
The word "surgery" often brings to mind a stay in the hospital, general anesthesia, and perhaps a lengthy recovery period. However, the experience of having oral surgery is usually very different from that. Some common oral surgery procedures include: tooth extractions, dental implant placement, and biopsies of suspicious oral lesions. Read more about Oral Surgery.
Adults and kids alike can benefit from the boost in self-confidence that comes from having a great-looking smile with beautifully aligned teeth. Orthodontic treatment can even improve chewing, speaking and oral hygiene in certain cases. And with today's virtually invisible orthodontic appliances, it's possible to keep your treatment a private matter… until your new smile is unveiled, of course! Read more about Orthodontics.
It's never too early to get your child started on the path toward a lifetime of good oral health, and there are many services to do exactly that. Monitoring your child's dental growth and development, and preventing and intercepting dental diseases along the way, is the primary focus of pediatric dentistry. Read more about Pediatric Dentistry.
If you want to keep your teeth for life — a completely reasonable goal in this day and age — you need to make sure the tissues that surround them are also healthy. Should gum problems arise, you may need periodontal therapy to restore diseased tissues to health. Read more about Periodontal Therapy.
In the field of dentistry, new technology is constantly changing the way diseases are diagnosed, routine procedures are performed, and illnesses are prevented. Although they may seem unfamiliar at first, new and improved dental technologies offer plenty of real benefits for patients. Read more about Technology.
Today, Americans are not only living longer — we're also retaining our natural teeth longer than ever before. But this rosy picture isn't free of thorns: Older adults tend to require increasingly complex dental treatments; are often more prone to contracting certain diseases; and sometimes find it challenging to keep up with daily oral health practices.
Yet maintaining good oral hygiene is critically important as we age. When problems occur in the mouth, they can cause difficulty chewing, swallowing, speaking and smiling — basic functions which can affect both physical and social well-being. It's possible that medications prescribed for other diseases can adversely affect a person's oral health; it's also possible that a decline in oral health can worsen existing maladies (such as diabetes), or even cause systemic (whole-body) inflammation. What other special dental issues do older people face — and what can be done about them?
If you think cavities are just for kids — think again! A recent study found that nearly one-third of people over 65 had untreated dental caries (cavities). In older people, these are found not only in the crown (chewing surface) of the tooth, but also in the root, which may become exposed due to gum recession. Regular dental checkups are the best way to find and treat dental caries; left untreated, they can cause pain, require more complex procedures, and eventually lead to lost teeth.
Gum disease is another major oral health issue faced by older people — and it's presently the leading cause of tooth loss in adults. The disease is caused by plaque bacteria, which thrive on the sticky biofilm that clings to the surface of teeth when they aren't properly cleaned. Poor-fitting dentures can make the problem worse, as can the presence of certain diseases (such as diabetes or cancer).
Sometimes, decreased mobility (due to arthritis or similar conditions) makes routine brushing and flossing more difficult. Special brushes with larger grips and floss holders can help make daily cleaning easier; additionally, therapeutic mouthrinses may be prescribed. In-office treatments can also be effective in bringing gum disease under control.
Oral cancer is a concern at any age, but it's 7 times more likely to show up in a person over 65 — and it causes more deaths in older Americans than skin cancer does. Early detection offers the best chance at controlling the disease, and improves survival rates significantly. A thorough screening for oral cancer should be a part of every older person's routine dental checkup.
Dry mouth (xerostomia) isn't just an annoyance — it can be harmful to your oral health. Aside from its lubricating qualities, saliva contains beneficial digestive enzymes, acid neutralizers, and bacteria-fighting agents. A number of factors may cause the body to produce less saliva than normal — but in older adults, this problem is often due to side effects from prescription or over-the-counter medications. If you're experiencing chronic dryness of the mouth, it's sometimes possible to change your medication, and/or use products designed to relieve these symptoms.
It was once commonly believed that dental problems and the loss of teeth were an inevitable consequence of aging. But here's the fact: Age itself isn't a risk factor for tooth loss; properly cared for, your teeth can last a lifetime. However, it's true that the mouth does change as you age. How can you give yourself the best chance of keeping your natural teeth? You guessed it: Maintain a regular practice of good oral hygiene!
Brush twice a day with a soft-bristled toothbrush — use one with a special grip, or an electric brush, if it helps. Clean in between your teeth with floss, or another type of interdental cleaner, at least once a day. If you wear dentures, regularly clean and care for them as instructed. Eat healthy foods and drink plenty of water. And don't forget to have regular dental exams so that little problems don't turn into major headaches!
Saliva Like blood and other bodily fluids, saliva contains molecules that can reveal the presence of disease in the body. Scientists are developing saliva-testing methods that will make it safer and more efficient to diagnose a number of serious diseases... Read Article
Dry Mouth Dry mouth, caused by insufficient saliva flow, is more than a minor annoyance to the millions who suffer from it. That's because saliva helps maintain oral health in a variety of ways. If your mouth is persistently dry, here's what you should know... Read Article
Tooth Decay — A Preventable Disease Tooth decay is the number one reason children and adults lose teeth during their lifetime. Yet many people don't realize that it is a preventable infection. This article explores the causes of tooth decay, its prevention, and the relationship to bacteria, sugars, and acids... Read Article


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Earlier this month, a very interesting post appeared in Velvet Chainsaw's Midcourse Corrections entitled, "Every 60 Seconds These 21 Things Happen On the Internet." It is pretty short, but includes a beautiful infographic from Shanghai Web Designers.
For copyright interests, I will not reprint the entire 21-point list here, but I invite you all to read the post using the link above.
Several of these items are particularly interesting as an Internet genealogist in general but also as a self-employed small business owner and as a professional researcher.
- The search engine Google serves more than 694,445 queries
How often do you repeat your genealogy-related Google searches? The way that Google's search algorithm works (at least the last time I read on the subject — it may have changed, so if someone knows better, please correct me), the more hits a site gets, the higher its search ranking.
With well over a half-million searches every single minute, it is possible that a site that did not show up (or showed up too far down the list for you to find) could find its search ranking improved and move up the search results. This means that a site that was barely visible before could now be made visible.
- 70 new domains are registered
Do you plan on creating a website? If so, you'd better check on the availability of your ideal domain name and reserve it, before it's too late! ; )
- 1,600+ reads are made on Scribd
Are you familiar with Scribd — a great platform for creating and publishing ebooks?
- As a researcher, I found on Scribd a published transcription of a young woman's diary from the small town of Lynn Haven, Florida — a diary that just happened to have been written by a young friend of my great-grandfather (who also appears to have had a crush on his younger brother). Reading this was wonderful!
- I always upload flyers for the genealogy events where I will be appearing, as well as other local events where I will not be speaking, to Scribd. From there I can tweet and post the link on Facebook, etc., to share with others.
- As an author, I use Scribd to sell electronic copies of all of my books.
- As a publisher, I use Scribd to distribute copies of all of the 1867 Texas voter registration lists that I have published as PDF "e-books."
If you are not already using Scribd, please take a look. And be sure to run a search for some of your surnames. You may be surprised at what you find, just like I was!
Also take a look at the remaining items on this list of what happens online in a single minute. I would love to hear your thoughts on these, as both Internet users and as online genealogists. Could any of these statistics change the way you leverage your Internet use?
SOURCE: Hurt, Jeff. "Every 60 Seconds These 21 Things Happen On the Internet." Velvet Chainsaw's Midcourse Corrections. Posted 11 Jul 2011. http://jeffhurtblog.com/ : 2011.
If you would like to cite this post: Michael Hait, "Every minute on the web…," Planting the Seeds: Genealogy as a Profession blog, posted 29 Jul 2011 (https://michaelhait.wordpress.com : accessed [access date]).


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We named our company Cornerstone Arms for two reasons. First and foremost is the fact that Jesus Christ is the cornerstone of our business, our family and our lives. The second reason for our name is the fact that we believe that the Second Amendment to our Constitution is the cornerstone of the freedom we enjoy as American citizens. 10% of all of the profits generated by our company go towards Christian ministries in our community and across the country. We believe that if we always operate our business in a completely forthright and honest manner that honors our relationship with Jesus Christ that we will prosper.
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Los Angeles fourth-grade teacher suspected of molesting 20 kids
A fourth-grade teacher who worked nearly 40 years in the Los Angeles Unified School District has been arrested on suspicion of sexually abusing 20 students, a year after another veteran teacher accused of molesting nearly two dozen pupils brought national attention to the district and the problem of classroom sex abuse.
After a 10-month investigation, eight felony counts of continual sexual abuse and seven counts of lewd acts upon a child were filed Wednesday against Robert Pimentel, of Newport Beach, for abuse that allegedly took place at George De La Torre Jr. Elementary in the Wilmington area, officer Christopher No told The Associated Press.
In addition to the 15 felonies, misdemeanor charges are expected for the remaining incidents, No said. Pimentel's bail has been set at $12 million, and an arraignment date hasn't been set.
Police and school officials said Pimentel is also suspected of the sexual abuse of one adult, but they did not say what role, if any, that person had at the school.
Pimentel, 57, left his fourth-grade teaching position last March when allegations arose from several girls who told their parents he inappropriately touched them during school and police opened an investigation.
District officials immediately removed him from campus and parents and state credentialing authorities were informed, school district spokesman Daryl Strickland said. Parents and guardians will be told of the arrest by letter and phone, he said.
Before the official dismissal process with the Board of Education could begin, Pimentel, who had worked for the district since 1974, retired.
"Can you go back and fire someone who's already retired? No, you can't," LAUSD Superintendent John Deasy told the Los Angeles Times.
Deasy said the school's principal was also immediately removed because the superintendent was "dissatisfied" with how the reported criminal activity was handled.
Court records obtained by the Times show the allegations covered a period between Sept. 2011 to March 2012.
LAPD Capt. Fabian Lizzaraga told the newspaper Pimentel is suspected of inappropriately touching the children over and under their clothing.
The Los Angeles teachers' union issued a statement that called the abuse described in the allegations "horrific" and said Pimentel was no longer a member and the union would not be involved in his defense.
The police department said the teacher's name was spelled "Pimental," but the school district and public records give the spelling as "Pimentel."
Police did not know if he had hired an attorney. A woman who picked up the phone at a number listed for Pimentel hung up when asked about a lawyer or comment from family.
There have been several high-profile recent cases of Los Angeles teachers accused of sexually abusing students. More than 225 parents and students are involved in various claims for damages against the district after Miramonte Elementary School teacher Mark Berndt was arrested a year ago and has pleaded not guilty to 23 counts of lewd conduct.
In December, a jury ordered the district to pay a boy molested by an elementary school teacher $6.9 million — among the largest awards in the history of the school system.
The jury found the district liable for the repeated molestation of the 10-year-old student in 2008 and 2009 by teacher Forrest Stobbe at Queen Anne Elementary School in the city's mid-Wilshire district.


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"Discipline equals freedom." — Jocko Willink
"Leadership is infinitely more about brains than it is about brawn. The brawn stuff is from the movies and it doesn't work in reality." — Jocko Willink
Jocko Willink (@jockowillink) is one of the scariest human beings imaginable.
He is a lean 230 pounds. He is a Brazilian jiu-jitsu expert who used to tap out 20 Navy SEALs per workout. He is a legend in the Special Operations world. His eyes look through you more than at you.
He rarely does interviews, if ever. But, a few weeks ago, Jocko ended up staying at my house and we had a caffeinated mind meld. Here's some background…
Jocko enlisted in the Navy after high school and spent 20 years in the SEAL Teams, first as an enlisted SEAL operator and then as a SEAL officer. During his second tour in Iraq, he led SEAL Task Unit Bruiser in the Battle of Ramadi — some of the toughest and most sustained combat by the SEAL Teams since Vietnam.
Under his leadership, Task Unit Bruiser became the most highly decorated Special Operations Unit of the entire war in Iraq and helped bring stability to Ramadi. Jocko was awarded the Bronze Star and a Silver Star.
Upon returning to the United States, Jocko served as the Officer-in-Charge of training for all West Coast SEAL Teams, designing and implementing some of the most challenging and realistic combat training in the world.
So why is Jocko opening up? Well, in part, we have mutual friends. Second, he is the co-author of an incredible new book—Extreme Ownership: How U.S. Navy SEALs Lead and Win—which I've been loving. Trust me. Buy it.
This is his first mainstream interview and one you won't want to miss.
Listen to the episode on Apple Podcasts , Spotify, YouTube, or wherever you get your podcasts.
- Listen to it on Apple Podcasts
- Listen to it on Spotify
- Stream by clicking here
You can find the transcript of this episode here. Transcripts of all episodes can be found here.
Want to hear another podcast related to leadership in the military from a decorated officer? — Listen to my conversations with General Stan McChrystal. In this episode, we discuss eating one meal per day, special ops, and mental toughness (stream below or right-click here to download):
This podcast is also brought to you by Wealthfront. Wealthfront is a massively disruptive (in a good way) set-it-and-forget-it investing service, led by technologists from places like Apple and world-famous investors. It has exploded in popularity in the last 2 years and now has more than $2.5B under management. In fact, some of my good investor friends in Silicon Valley have millions of their own money in Wealthfront. Why? Because you can get services previously limited to the ultra-wealthy and only pay pennies on the dollar for them, and it's all through smarter software instead of retail locations and bloated sales teams.
Check out wealthfront.com/tim, take their risk assessment quiz, which only takes 2-5 minutes, and they'll show you—for free–exactly the portfolio they'd put you in. If you want to just take their advice and do it yourself, you can. Or, as I would, you can set it and forget it. Well worth a few minutes: wealthfront.com/tim.
This podcast is also brought to you by 99Designs, the world's largest marketplace of graphic designers. Did you know I used 99Designs to rapid prototype the cover for The 4-Hour Body? Here are some of the impressive results. Click this link and get a free $99 upgrade. Give it a test run…
QUESTION(S) OF THE DAY: How has discipline supported your entrepreneurial goals? What aspects could still use improvement? Please let me know in the comments.
Scroll below for links and show notes…
Selected Links from the Episode
- Extreme Ownership: How U.S. Navy SEALs Lead and Win by Jocko Willink
- Learn more about Victory MMA, Jocko Willink's gym in San Diego
- Seeking solutions in business or leadership? Check out Echelon Front
- Connect with Jocko and his organizations on Twitter:
@Xtremeownership | @jockowillink | @echelonfront
- Connect with Jocko and his organizations on Facebook:
Extreme Ownership | Jocko Willink | Echelon Front
- About Face by Colonel David H. Hackworth
- Blood Meridian by Cormac McCarthy
- Learn more about Band of Brothers
- Learn more about Letters from Iwo Jima
- Hardcore History by Dan Carlin (Wrath of the Khans I)
- Watch the Restrepo
- A Chance in Hell: The Battle for Ramadi
- The Pacific or "Band of Brothers in the Pacific"
- With the Old Breed by E.B. Sledge
- Watch Meru, the documentary about elite climbers
- Listen to Black Flag, My War, Side B
- Listen to White Buffalo
Show Notes
- How Jocko would design training for someone who wants to add lean muscle mass [13:49]
- The story of how Jocko Willink got involved in jiu-jitsu [15:44]
- How Jocko Willink's SEAL military experience influenced his business [19:24]
- The story of how Jocko Willink became a SEAL [22:14]
- Where mental toughness comes from [30:04]
- Describing the Battle of Ramadi [31:04]
- On the leadership and strategy required to take over a city [47:14]
- The great tacticians that Jocko Willink respects, [52:44]
- What makes a good leader and the things to look for when identifying good leaders [53:59]
- How to teach the skill of detachment [1:01:34]
- Jocko Willink's workout that would cause entire platoons to "tap out" [1:09:14]
- What are you world-class at that people might not know? [1:12:49]
- Morning rituals [1:14:49]
- When you think of the word successful, who are the first people that come to mind? [1:18:54]
- Non-military leaders that Jocko Willink admires and considers role models [1:29:45]
- Skills and/or experiences that every man should have [1:33:34]
- Fear inoculation for civilians [1:40:14]
- The books Jocko likes to give as gifts [1:42:20]
- Common misconceptions about Navy SEALs [1:49:34]
- If you could have one billboard anywhere, where would it be and what would it say? [1:55:59]
- Explaining the purpose of his business, Extreme Ownership [2:00:14]
- Discussing lessons from Extreme Ownership and the value it brings to private companies [2:06:19]
- What SEALs discuss between themselves that they don't discuss with civilians [2:12:44]
- Which historical figure does Jocko Willink identify with? [2:18:29]
- Something people would be surprised to learn about Jocko Willink [2:19:22]
- Cheesy questions: What do you order at a bar, favorite music, advice for your 25- and 35-year-old self [2:22:49]
People Mentioned
- Dean Lister
- Cus D'Amato
- H.R. McMaster
- Sean MacFarland
- Rickson Gracie
- Marcelo Garcia
- Marc Alan Lee
- Michael A. Monsoor
- Ryan Job
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The rotator cuff is a group of tough, flexible fibres (tendons) and muscles in the shoulder. Rotator cuff disorders occur when tissues in the shoulder get irritated or damaged. Rotator cuff disorders include:
The shoulder is a joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The bones are held together by muscles, tendons, and ligaments. The rotator cuff keeps the upper arm bone in the shoulder socket and lets you raise and twist your arm.
The shoulder is a ball-and-socket joint. The ball at the top of the upper arm bone fits into the socket of the shoulder blade. This socket is shallow, which lets you move your arm in a wide range of motion. But it also means that the muscles and tendons of the rotator cuff have to work hard to hold the bones in place. As a result, they are easy to injure and are prone to wear and tear.
Most rotator cuff disorders are caused by a combination of:
It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, a crash, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.
Symptoms of a rotator cuff disorder include pain and weakness in the shoulder. Most often, the pain is on the side and front of the upper arm and shoulder. It may hurt or be impossible to do everyday things, such as comb your hair, tuck in your shirt, or reach for something. You may have pain during the night and trouble sleeping.
To diagnose a rotator cuff disorder, doctors ask about any shoulder injuries or past shoulder pain. They also do a physical examination to see how well the shoulder works and to find painful areas or activities. Moving your arm in certain ways can help a doctor learn about the condition of the rotator cuff.
You may have an X-ray to check the bones of the shoulder. If the diagnosis is still unclear, the doctor may order an imaging test, such as an MRI or an ultrasound.
It is important to treat a rotator cuff problem. Without treatment, your shoulder may get weaker and you may not be able to lift up your arm.
For most rotator cuff disorders, doctors recommend these steps first:
The doctor may also suggest physiotherapy. Physiotherapy can reduce pain and help make your shoulder stronger and more flexible. In physiotherapy, you learn exercises to stretch and strengthen your shoulder. After you learn the exercises, you can do them at home.
It is important to give treatment time to work. It may take from a couple of weeks to several months to get good results.
If other treatments don't help, your doctor may give you shots of steroid medicine in the shoulder. The shots probably don't cure rotator cuff disorders. But they can help relieve pain and inflammation so you are able to do exercises to strengthen the shoulder. The shots may also help your doctor find out if your shoulder pain is from your rotator cuff. If a steroid shot near the rotator cuff relieves your pain, even if the pain comes back later, it means the rotator cuff—not some other shoulder problem—is causing the pain.
Most rotator cuff disorders aren't treated with surgery. But doctors may do surgery if a rotator cuff tendon is torn or if several months of other treatments have not helped.
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In a rotator cuff disorder, tendons that make up the rotator cuff get squeezed and rub against bone. They become damaged and irritated. This causes bleeding and inflammation. The tendons can develop scar tissue, which is not as strong and flexible as normal tendon tissue. Over time, the tendons get weaker and less flexible. Eventually, they can tear.
Normal wear and tear and overuse cause most rotator cuff problems.
A rotator cuff disorder causes pain and weakness in your shoulder. It may be uncomfortable or impossible to do everyday activities, such as combing your hair, tucking in your shirt, or reaching above your head.
Most often, you will feel the pain on the side and front of your upper arm and shoulder. You may have pain during the night and have trouble sleeping on that side. Pain is almost always worse when you make overhead movements.
Because of the pain, you may try not to use your arm. And that can cause even more weakness and stiffness in the shoulder.
The amount of pain usually depends on how much damage there is:
Sometimes the pain isn't directly related to the amount of damage. For example, your rotator cuff may have minor damage, but strength and the loss of range of motion may be severe because it's too painful to move in certain ways. This is especially true if you normally make a lot of overhead movements.
In tendinitis (inflammation in the tendon), the pain usually starts gradually, over the side of the shoulder and the upper arm.
Over time, the pain may get worse or you may have constant pain. In some cases, this is because you actually have one or more small tendon tears.
Some people also have tendinitis in other parts of the shoulder. And some people have neck pain from using other muscles to help move the shoulder.
The most common symptoms of a tear are:
Symptoms of a sudden, severe tear include:
You can have a complete tear without symptoms, especially if you are an older adult who is not very active.
In rare cases, shoulder pain may be a sign of a more serious problem with your heart or lungs.
The rotator cuff is a group of four tendons. These tendons connect the main muscles of the shoulder to the upper arm. The tendons and muscles stabilize the shoulder joint so you can raise and rotate your arm. Every time you raise your arm above your head, the upper tendon glides under the upper end of your shoulder blade.
Sometimes the shoulder blade is rough or abnormally shaped and rubs or scrapes the tendon. Over time, this can cause tiny tears and bleeding. When these tears heal, the scar tissue is weaker and less flexible than normal tendon, so the whole rotator cuff gets weaker. The weaker the tendon becomes, the greater its chances of tearing.
Without treatment, this cycle of inflammation, wear and tear, and limited use can lead to other shoulder problems, such as stiffness or frozen shoulder. Activities that require repeated overhead arm movements can lead to problems like bursitis and tendinitis.
Here are the things that can gradually lead to rotator cuff problems. They often occur together or overlap:
It takes tremendous force to tear a healthy rotator cuff tendon. This may happen while you are playing sports or during a crash or a severe fall.
In older, less active adults, even simple movements such as lifting a suitcase can cause a tear.
Things that may increase the risk of rotator cuff disorders include:
As the rotator cuff and the shoulder weaken, the risk for a partial or complete tear increases.
Call 911 or other emergency services immediately if shoulder or arm pain occurs with chest pain or other symptoms of a heart attack, such as shortness of breath and nausea.
Call your doctor now if you have an injury to your shoulder and:
Call your doctor if:
Watchful waiting is a wait-and-see approach. If you get better on your own, you won't need treatment. If you get worse, you and your doctor will decide what to do next. A watchful waiting period may vary from a few days to weeks or maybe months.
To diagnose a rotator cuff disorder, your doctor will ask about your injury or shoulder pain history and will do a physical examination to see how your shoulder is working.
If your symptoms and examination show that you may have a complete rotator cuff tear, you may have one or more of these tests to confirm the diagnosis:
Your age, job, and activity level are considered when your doctor is deciding about further testing. For example, if you are a competitive athlete or have a job that requires frequent overhead activity, you may need further testing sooner than a relatively inactive older adult. A more complete diagnosis is important if you are likely to continue activities that may further damage your shoulder.
Treatment of rotator cuff disorders should begin soon after an injury or soon after symptoms develop, to give you the best chance of restoring flexibility and strength to your shoulder. Without treatment, inflammation and tears can build up, causing pain, weakness, and loss of function.
Treatment depends on your symptoms, age, and activity level, and on whether your symptoms appear to be related to a rotator cuff injury.
Most rotator cuff disorders are treated without surgery. Your treatment may include:
If symptoms don't improve after a few months of non-surgical treatment, you and your doctor may consider testing (such as X-rays or an MRI) to find out if you have a rotator cuff tear.
Or your doctor may give you a corticosteroid shot.
Surgery often is used to repair a torn rotator cuff in a healthy young person, because good results are more likely if there is little or no evidence of degeneration or impingement.
People who have advanced rotator cuff disorders and tendons that are tough, stringy (fibrous), and stiff usually respond less well to surgery. Surgery may successfully repair the tear, but it can't repair all the damage caused by age or degeneration.
But surgery may be considered if:
For more information, see Surgery.
Recovery from a rotator cuff disorder varies with each person. Your physiotherapy and home exercise program should continue until your shoulder is as strong and flexible as possible. Some treatments for rotator cuff disorders can last up to a year. Most people can return to their previous activities after several weeks of rehabilitation.
Experts have differing opinions about treating rotator cuff tears.
The long-term changes that occur in and around the shoulder joint because of everyday wear and tear cannot be totally prevented. But you may be able to prevent some rotator cuff problems if you:
Home treatment is often the first treatment for a rotator cuff problem. Treatment can help relieve the discomfort and keep the problem from getting worse.
People respond to heat and ice differently. Use whichever one makes you feel better. In some cases, heat feels good for a while but may make pain and stiffness worse after 1 to 2 hours. For a sudden injury, don't use heat for the first 48 hours.
At first, ice helps relieve pain and reduce swelling. Try applying ice to your shoulder for the first 48 hours after discomfort begins:
After 2 to 3 days, start moving your shoulder with the aid of moist heat:
Eventually, your doctor may want you to do more to stretch and strengthen your shoulder. For exercises you can do at home (with your doctor's approval), see:
Medicines don't heal rotator cuff disorders. They help with pain and inflammation. This allows you to start exercises to stretch and gradually strengthen the shoulder, which reduces the risk of stiffness or a frozen shoulder.
Be safe with medicines. Read and follow all instructions on the label.
Surgery may be considered if:
Surgery typically is used to repair a torn rotator cuff in a healthy young person, because good results are more likely if there is little or no evidence of other problems. People who have advanced rotator cuff disorders and tendons that are tough, stringy (fibrous), and stiff usually respond less well to surgery. Surgery may successfully repair the tear, but it can't repair all the damage caused by age or degeneration.
If surgery isn't done right away, repair of a large tear may not be as successful. But it still usually relieves pain and restores enough strength for you to do routine, non-strenuous activities.
After surgery, a program of physical rehabilitation (rehab) is very important. You may not do as well after surgery if you aren't willing or able to commit to completing a challenging physical rehab program.
Shoulder surgery for rotator cuff disorders usually involves one or more of the following:
These procedures may be done arthroscopically, by traditional open surgery, or by a combination of the two approaches.
Sometimes a rotator cuff tear is so severe that it can't be fixed in the usual ways. If this happens in a younger person, the doctor may suggest moving another tendon to substitute for the torn tendon. In an older person, the doctor may suggest a special shoulder replacement.
The success of surgery for rotator cuff tears depends on many things, such as:
A physiotherapy and rehabilitation (rehab) program usually involves exercises to stretch and gradually strengthen the shoulder. Some physiotherapists may use other techniques, such as massage or ultrasound, to relieve pain and reduce muscle spasms.
This program of treatment may be used without surgery or as part of recovery after surgery. It can reduce pain in the soft tissues (such as the muscles, ligaments, and tendons), improve function, and build muscle strength.
Common difficulties with rehab programs include:
Although completing a rehab program may be hard, a successful outcome after surgery depends on your commitment to treatment. If you follow your physiotherapy plan closely and get help when you need it, you are more likely to restore shoulder strength and movement.
Exercises for rotator cuff disorders include:
Experts are studying a new treatment for chronic calcifying tendinitis of the rotator cuff. The treatment uses sound waves to create shock waves that destroy calcium deposits in the rotator cuff tendons. This is called extracorporeal shock wave therapy. Some studies show pain relief and increased range of motion. But more studies are needed to see whether these results can be duplicated and to measure long-term results.footnote 1
Other treatments being studied include:
CitationsGerdesmeyer L, et al. (2003). Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff. JAMA, 290(19): 2573–2580.
Adaptation Date: 2/28/2022
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
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Kent Bush: Fireside chats become valued times
I love a good fire.
I don't mean a grass fire or house fire. I wouldn't love those fires at all.
But our little fire pit makes our porch one of my favorite places.
We don't do anything that special. We have some chairs and a little fire. My wife usually makes s'mores. But other than that, the fire is nothing special.
Of course, that isn't exactly right. The fire actually offers one of the most special things my family rarely gets - unplugged, undistracted, unscheduled time with each other.
Usually when we are home "together," someone is outside, downstairs, on a computer, cooking dinner or otherwise detained in such a way that they might as well be 100 miles away.
But when I light the fire, everything stops. No one has a phone, video game or computer. All we do is talk to each other and maybe roast some marshmallows.
We have even made getting ready for a fire a family outing. We go on a walk in a park where limbs have fallen and collect all of the kindling we need.
It's a great way to spend time and save money.
Our fireside chats are funny to me because my athletic career didn't include Heisman Trophies or World Series rings.
Thanks to injuries, the only sport I played after my freshman year in high school was tennis. Until then, I played football, basketball and baseball.
I was never great at anything. I started and played most of each game. I did some good things, but no opposing coach ever thought, "We might win if we control that Bush kid."
I was big, physical and tried hard. Those aren't bad qualities, but they're nothing to brag about.
But my boys love hearing stories about what I did. They don't care if it is a touchdown in a third-grade football game played in mud so deep our shoes were being sucked off by the sticky stuff. They also like stories about home runs I hit or the game where I hit a shot from half court at the end of the first half and again at the end of the game. (That was before the three-point line made it to sixth-grade basketball, so I only got four points for the feat.)
I love telling the stories and the boys love hearing them. But most of all, I love that we all just sit around a fire in the dark with nothing coming between us.
Some months we huddle around the fire for extra warmth, other months we stay back from the fire on hot summer nights. But we almost always find a way to spend an hour or so out there a couple of times a month.
When my wife wanted to buy a fire pit, it was a lot like other times we had gone shopping. I had no idea why I would spend money on something like that, but it wasn't expensive enough to argue about.
That small investment has brought me value I couldn't find anywhere else.
There is plenty of time when the sun is shining to work.
Make time for your family. It is the best investment any of us can make.
Kent Bush is publisher of the Augusta, Kan., Gazette.


text: CEBU, Philippines – Divers combed through a sunken ferry Saturday in search of dozens of people missing after a collision with a cargo vessel near the central Philippine port of Cebu that sent passengers jumping into the ocean and leaving many others trapped. At least 31 were confirmed dead and hundreds rescued. The captain of the ferry MV Thomas Aquinas ordered the ship abandoned when it began listing and then sank just minutes after collision late Friday with the MV Sulpicio Express Siete, coast guard deputy chief Rear Adm. Luis Tuason said. Transportation and Communications Secretary Joseph Abaya announced official passenger figures following confusion over the actual number of people on the ferry. He said the ferry carried 831 people – 715 passengers and 116 crew – fewer than the numbers given earlier by the coast guard and ferry owner, 2Go. He said the death toll has risen to 31 with 629 rescued. There were foreigners on board 'but they are all OK,' except for a New Zealand citizen who was in a hospital, Abaya said. Cebu coast guard chief Cmdr. Weniel Azcuna said 171 were listed as missing, but the figure would go down once the number of crew members who have been rescued are officially accounted. Tuason said some of the missing could still be trapped inside the vessel that sank in waters about 33 meters (100 feet) deep off Talisay city in Cebu province, 570 kilometers (350 miles) south of Manila. Tuason said navy divers recovered at least four bodies early Saturday. Reporters at the site, about two kilometers (1.25 miles) from shore, saw the bodies coated with fuel and oil that spilled from the ferry. In a statement, 2Go said the ferry 'was reportedly hit' by the cargo vessel 'resulting in major damage that led to its sinking.' An investigation will begin after the rescue operation, the coast guard said. Abaya said the cargo vessel smashed into right side near the rear of the ferry which was coming from Nasipit in Agusan del Sur province in the southern Philippines and making a short stop in Cebu before proceeding to Manila. 'I guess it hit the ferry at a very vulnerable point, probably at its water line or below the water line so that it did not take long for it to sink,' he said. One of the survivors, Jenalyn Labanos, 31, said the ferry quickly tilted to its side after the impact and sank about 20 minutes later. She said the crash threw her and two companions to the floor of a ship restaurant followed by the lights going out. 'People panicked and the crew later handed out life vests and used their flashlights to guide us out of the ship but they could not control the passengers because the ship was already tilting,' she said. She said she suffered bruises on her hands and feet as she grabbed a rope on the side of the vessel before jumping into the water. 'I just thought to myself that I have to survive this. I left everything, my bag, my money and my passport,' she said. She was headed to Manila for a flight to Dubai where she has been hired as a maid. Accidents at sea are common in the Philippine archipelago because of frequent storms, badly maintained boats and weak enforcement of safety regulations. In 1987, the ferry Dona Paz sank after colliding with a fuel tanker in the Philippines, killing more than 4,341 people in the world's worst peacetime maritime disaster. In 2008, the ferry MV Princess of the Stars capsized during a typhoon in the central Philippines, killing nearly 800 people. Survivors said many of the passengers were asleep at the time of the accident, while others struggled to find their way in the dark. Rolando Manliguis was watching a live band when 'suddenly I heard what sounded like a blast. … The singer was thrown in front of me.' He said he rushed to wake up his wife and their two children but the water was rising fast. 'When the boat was on its side, the water level was here,' he said, pointing to his neck. He said they roped down the side of the ferry into the sea and were put on a life raft. — Associated Press writers Oliver Teves, Teresa Cerojano and Hrvoje Hranjski in Manila contributed to this report.


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Note: As I've outlined in an essay you can find here, the huge and mounting costs of climate change and global warming are external costs that would be included in the market for oil & gas if those markets were actually functioning correctly. This is a great example of unpriced consequences of fossil fuels and why it's factually wrong to say things like "coal is cheaper than wind" because the market price for coal power electricity isn't reflecting the true cost, an example of market failure.
Posted on November 20, 2012 at 6:41 am by Associated Press in Climate Change, global warming
DES MOINES, Iowa — This year's drought is consistent with predictions that global climate change would bring about weather extremes including more frequent droughts, said a report released Monday.
The Iowa Climate Statement updates the 2010 report, reflecting the year's lingering drought and the belief that it signifies what many scientists have predicted — increasing instability in weather patterns will lead to extremes during both wet and dry years.
Iowa has experienced such extremes in recent years; in 2008, flooding caused an estimated $10 billion in damage, making it the worst disaster in the state's history.
More broadly, this year's drought brought about parched croplands, reducing corn yields across the nation's Grain Belt, from South Dakota to Indiana. And last month's Superstorm Sandy — a combination of a hurricane, a wintry storm and a blast of arctic air — devastated parts of the Eastern seaboard and killed more than 100 people.
The report was signed by 138 scientists and researchers from 27 Iowa colleges and universities. They said they wanted to release the updated report now while the drought is still fresh in the public's mind.
"The drought is sort of a teachable moment," said Jerry Schnoor, co-director of the Center for Global and Regional Environmental Research at the University of Iowa.
The scientists are careful to avoid saying any single extreme weather incident is directly caused by global warming, saying too many factors are at play when it comes to weather. But, they did say increasingly volatile weather patterns have been predicted by scientists who study global warming.
Patrick Michaels, director of the Center for the Study of Science at the Washington-based conservative think tank Cato Institute, said there's no evidence global warming contributed to this summer's drought. He doesn't deny that global warming is real and that man-made pollutants may contribute to it, but says it has a very small impact overall.
Michaels said the scientists who signed on to the report are "nibbling around the edges" with their recommendations that Americans use more renewable energy sources, such as wind power and ethanol, and build homes to be more efficient. He says any action the United States takes wouldn't be that effective because China and India are emitting increasing amounts of pollutants that contribute to global warming.
The Iowa scientists said they're statement is not one of gloom and doom, but meant to indicate investments can be made now to slow the economic impact of weather extremes and to help communities adapt to the changes.
One scientist who helped draft the report, Dave Courard-Hauri, chairman of environmental science and policy program at Drake University, said continuing to deny the connection between increased storm volatility and a warming climate helps no one.
"We gain nothing if we act as if there's uncertainty where there's not or that there is significant division among scientists regarding the causes of climate change," he said.


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A district court on Monday apologized for a clerical error that resulted in the release from prison of Evan Ebel four years too soon and said it would review its practices to avoid another mistake.
Authorities have tied Ebel, 28, to the March 19 slaying of state prisons chief Tom Clements at his Monument home and the killing two days earlier of Denver pizza-delivery driver Nathan Leon.
Leon's relatives said they appreciated the court's acknowledgment of the error but found the words hollow.
"I was sick to the pit of my stomach. I would have preferred a public apology to me and my family," Leon's wife, Katie, said. "Obviously this was something that could have been prevented. My husband would still be here today. The father of my children would still be here today. Tom Clements would still be here today."
The mistake allowed Ebel to be released from prison Jan. 28 without serving any additional time for a 2008 conviction for assaulting a prison guard, despite the terms of a plea agreement.
The April 2008 agreement called for Ebel to serve a prison term of four years — consecutively after completing an eight-year stint — for slipping out of handcuffs and punching the corrections officer Nov. 27, 2006.
Judge David M. Thorson announced the sentence at a June 2008 hearing but did not specify that it was to be served consecutively.
That led to prison officials imposing a sentence that was concurrent, meaning Ebel served no additional time for the conviction.
"Because the judge did not expressly state that the sentence was consecutive, the court judicial assistant did not include that term in the mittimus, the sentence order that went to the Department of Corrections," 11th Judicial District Administrator Walter Blair wrote in a statement. "The court regrets this oversight and extends condolences to the families of Mr. Nathan Leon and Mr. Tom Clements."
Prison officials are required to impose a concurrent sentence when a judge does not specify how it should be served, Department of Corrections spokeswoman Alison Morgan said. She declined to comment further.
Eleventh Judicial District Attorney Thom LeDoux said Monday he would consider reviewing other cases for similar mistakes, though he did not believe the problem was widespread.
Lane said her family was considering legal options. But local attorney Dan Recht said the families of the men who were killed will have no recourse as far as suing the 11th Judicial District because the court has immunity.
"The court has immunity from civil lawsuits from the actions it takes," Recht said. "One of the most strongest entrenched immunities is for judicial officers."
In addition to the clerical error, Ebel was released nearly four months early as a result of a 2011 law that allowed him and others to earn time off their sentences for their months and years spent in administrative segregation.
Ebel was shot to death during a gunfight with sheriff's deputies in Wise County, Texas, where he crashed his 1991 Cadillac DeVille on March 21. Authorities have not said why he headed to Texas, but court records show that they found bomb-making materials, instructions and handwritten directions in his car. Neither the El Paso County Sheriff's Office, which is investigating the Clements killing, nor Denver police would elaborate on the significance of those discoveries.
Stevie Marie Anne Vigil, 22, the Commerce City woman charged with illegally buying Ebel the 9mm Smith & Wesson handgun used in Clements' death and the Texas shootout, has been released on $25,000 bond, her attorney said Monday. Court documents show that she bought the gun from a shop in Englewood between March 6 and March 13.
Attorney Normando Pacheco did not know how Vigil was able to post bond.
"All she said was family," Pacheco said. He spoke with her briefly and "I told her to get some rest."
Pacheco declined to comment on the specifics of the case but said Vigil's release likely means she will not be entitled to a preliminary hearing that had been set for April 30.
Sadie Gurman: 303-954-1661, email@example.com or twitter.com/sgurman
Staff writer Carlos Illescas contributed to this report.


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WPA Land use survey map for the City of Los Angeles, book 4 (Van Nuys District to Garvanza District), sheet 32
Land use survey - City of Los Angeles. Department of City Planning. These maps were prepared with the assistance of the Works Progress Administration project no. 665-07-G-226 through 1939 to 1940. The land use data contained herein was compiled from a survey made with the assistance of the Civil Works Administration project no. 642, State Emergency Relief Administration project nos. 1-F2-318 and 1-F2-318A and Works Progress Administration project nos. 65-3-4377, 1101-2011 and 465-03-3-106. This survey functioned from Dec. 18, 1933 to May 8, 1939 and covers approximately 460 square miles within the boundary of the City of Los Angeles. It includes 347 colored drawings bound in 10 volumes of which this is no. IV. The land use survey was supervised by the Zoning Engineer. The land use maps were supervised by the Illustrative Planning Engineer for the Sponsoring Department.


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New and Notable
Affordable and Green in New Jersey
March 02, 2006
A version of this article appears in the March/April 2006 issue of Home Energy Magazine.
New Jersey's Department of Community Affairs (DCA), which has built over 2,000 new green and affordable homes in the past five years through its New Jersey Affordable Green Program, recently announced new standards for affordable and market rate green programs.
Instituted in late 2005, developers of affordable housing units within the State of New Jersey must now meet minimum green requirements, with the option to receive additional funding to develop a higher threshold of green affordable housing units. Commissioner Charles A. Richman of DCA also announced the New Jersey High Performance Homes Plus Program, a comprehensive and voluntary residential construction rating program that will advance high performance home building and renovation in New Jersey. The program is designed to support the green efforts of market rate builders.
High Performance Homes Plus will establish a state green building standard and promote whole system, energy efficient building practices among builders and educate consumers about the advantages of the features in their homes. The program will coordinate with other national green building programs to address bioregional issues, and provide New Jersey builders and residents with a one of a kind program tailored to the specific needs of the State. This program will be available the summer of 2006.
"At DCA, we are dedicated to investing in our communities for a better New Jersey," says Commissioner Richman. "We achieve that goal through a variety of innovative programs that create quality, affordable housing for residents. Our Green Homes Office stands out by creating energy efficient, environmentallyresponsible affordable housing that is accessible to all of New Jersey's hardworking families."
The New Jersey Affordable Green Program is the only statewide green affordable housing program of its kind in the country. Over the last five years, the program has increased the use of innovative green materials, and design and building technologies in over 2,000 affordable homeownership and rental units in the state.
The voluntary program provides $7,500 per unit in funding, and offers technical assistance and training in green building design. The initiative has also become a national model for green affordable housing, where staff regularly assists other states in the development of similar programs.
DER Project Receives Funding
The Electric Power Research Institute (EPRI) will receive funding from the U.S. Department of Energy State Technologies Advancement Collaborative to foster distributed energy resources (DER) development and integration in a collaborative project it initiated.
DER, small-scale power generation technologies (typically in the range of 3 to 10,000 kW), which are located close to homes or businesses, can provide an alternative to or an enhancement of the traditional electric power system.
EPRI's two-year project will establish business models and regulatory approaches that reward electricity providers for integrating DER through the development of state or utility-specific business and regulatory strategies; demonstrating the most promising approaches through actual pilot projects in Massachusetts and California; and conducting outreach in public and industry forums.
"The exciting part about this project is bringing diverse stakeholders together," says Ellen Petrill, director of public/private partnership at EPRI."With great minds and varying perspectives working toward common goals, we can create the path forward to the future where innovative technologies keep breaking new ground."
Stakeholders include the California Energy Commission, Massachusetts Technology Collaborative, New Jersey Board of Public Utilities, Massachusetts Department of Telecommunications and Energy, New York State Energy Research and Development Authority, Southern California Edison, National Grid, San Diego Gas & Electric Co., Pacific Gas & Electric,Tennessee Valley Authority RealEnergy, Solar Turbines, EnerNOC, Northern Power Systems, and UTC Power.
The Massachusetts Division of Energy Resources will lead the project, which was initiated earlier this year.The stakeholders will fund the majority of the project.
New Funding for Sustainability Projects
Over the course of the 2005-2006 academic year, 41 student teams from across the United States will research and develop sustainable designs through the People, Prosperity and the Planet (P3) competition. The teams have been awarded $410,000 by EPA for their research. The P3 competition was first launched in 2004.
The National Academies, which provide advisement to the country on science, engineering, and medicine, will convene a panel to evaluate and recommend the award winners, who will be chosen by the EPA. The P3 Award Competition will be held on May 9 and 10, 2006, on the National Mall in Washington,DC.
"In an era of rising energy costs, the results of the first year of the P3 competition should make people sit up and take notice! They not only demonstrated that companies can reduce their bottom line by sustainable practices, but also the marketability of new conservation tools," says George Gray, assistant administrator for the Office of Research and Development."In last year's competition, four student projects became new businesses with clients, two of them marketing energy monitoring systems. Other designs explored biodiesel production, solar thermal heating systems, green roofs, and stormwater management."
One of last year's winners was the Oberlin College team, which designed an energy and water use monitoring system for colleges with easy-to-read, real-time data on dormitory energy use. This system enables the school to reduce energy costs by pinpointing areas of overuse. This project is now a business whose clients include Duke University and Sidwell Friends School in Washington, DC.
Biofuel Company Wins Platts Global Energy Award
World Energy Alternatives is the first biodiesel producer and distributor to receive a Platts Global Energy Award. World Energy Alternatives supplies biodiesel for many sources, including home heating oil.
The Platts Global Energy Award is run through Platts, the world leader in energy information, which has offered independent industry news and price benchmarks for nearly a century. The Platts Global Energy Awards have been presented for the past seven years. An international panel of judges chooses 15 out of 200 global companies who have demonstrated the most extraordinary and innovative energy initiatives. The Global Energy Awards judges note that "World Energy has taken an exceptional and pioneering role in moving a newcomer fuel from green pipe dream to commercial reality." World Energy's highlights the mainstream adoption of biodiesel blends and cleaner energy practices in the petroleum industry and by consumers.
"This award is a testament to the astounding growth of renewable fuels and the petroleum market's mainstream adoption of greener energy initiatives," says Gene Gebolys, president and founder of World Energy. "Biodiesel shows tremendous promise to improve emissions, fuel performance, and energy security."
In the United States, biodiesel is primarily made from soybean oil and is typically used as a supplement to petroleum diesel fuel in blend levels up to 20%.World Energy Alternatives produces BioHeat, a blend of No. 2 heating oil and biodiesel fuel, usually with a 10% blend of biodiesel to a 90% blend of No. 2 oil.
Schools Stays Toasty With Biomass
Thanks to voters in Idaho's panhandle, who overwhelmingly approved an $8.6 million bond issue late last year, the Kellogg School District has the funds to convert its boilers to new high-efficiency units fueled with wood byproducts.The school district will also receive funding for the project from a $380,000 grant from the U.S. Forest Service's "Fuels for Schools" program.
In addition, the Forest Service is providing at least $4 million in grants for projects that increase the use of woody biomass from or near national forest lands.The funds will provide a use for small-diameter and low-value trees from forest thinning projects by turning them into either marketable forest products or energy.
Kellogg is the second school district in Idaho to adopt a biomass boiler plant powered by woodchips. Given the rising cost of fossil fuels, biomass was a cleaner, more sustainable, and more economical fuel source for this forest-based community. Supporters of the technology believe that it will help provide economic development and sustainable forest industry jobs to the community while cutting costs through energy savings, and reducing impact on municipal landfills due to reduced biomass dumping.
The original pilot project began in Darby, Montana, where the first school wood heating system in the western states was installed.The elementary, middle, and high schools, which are all located on the same campus, were all heated with one wood-heat plant. Piping from the woodheat plant was extended to serve all three schools.With biomass heating, the school system was able to cut its school heating and hot water bills in half.
Learn LEED Online
The U.S. Green Building Council (USGBC) has partnered with Turner Construction to launch the USGBC's first web-based training course designed to educate building industry professionals about Leadership in Energy and Environmental Design (LEED) Professional Accreditation requirements. LEED accreditation allows industry professionals to demonstrate their understanding of integrated design and green building practices and principles, and ensures that they have the knowledge and skills needed to successfully steward a building project from design to LEED certification.
The web-based course,"Essentials of LEED Professional Accreditation," is three hours long and includes selected case studies, interactive learning exercises, and a practice exam with questions similar to those one would find on the LEED Professional Accreditation exam.
"The On-line LEED training is one of the many innovative programs USGBC is undertaking to broaden its scope," says Peter Templeton, vice president of education & research at USGBC."We are excited about the potential to reach a broader audience and educate as many people we can about the green building process."
The course is divided into seven lessons and covers topics such as the LEED rating system, managing the LEED certification process, coordinating a LEED project through its design and construction, and verifying that a project meets LEED requirements.The course is suitable for those who wish to supplement their knowledge of the LEED rating system as well as those who have little knowledge of green building.
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In another picture-perfect arrival, the first official SpaceX cargo Dragon pulled up with an initial shipment of supplies to the International Space Station early Wednesday morning at 6:56am ET. It was the fourth successful launch of the Falcon 9 rocket, the third flight for a Dragon spacecraft, and its second successful berthing. Astronauts aboard the ISS quickly captured the craft this morning, well ahead of the timeline. They will spend the next few days unloading equipment and groceries.
This mission is entitled "CRS-1," denoting the first commercial resupply mission to the Station. If the rest of the mission—the separation and landing—takes place without any hitches, Dragon will have completed a successful transition from NASA's Commercial Orbital Transportation Services (COTS) program to the new and ongoing Commercial Resupply Services program. SpaceX has a contract with NASA under CRS to deliver a total of 12 cargo missions.
A cargo Dragon spacecraft berthed for the first time with the Station at the end of May. That very successful COTS 2/3 mission combined two flights, one to demonstrate the capabilities of the Dragon and another to actually berth with the Station. It was during that mission that the world was really introduced to SpaceX, the Dragon, and its new role as a commercial cargo carrier for NASA. Anyone who hadn't previously heard of the Dragon knew about it afterward, given the substantial news coverage that accomplishment received. COTS 2/3 was successful, from launch to splashdown and delivery of both a physical payload from the Station and an unintentional message to a skeptical Congress of changing times.
CRS-1 is, hopefully, a transition from the new to the routine. The spacecraft's payload includes only 545kg of a possible 6000kg. The reason NASA is using less than a tenth of the Dragon's potential is that some of the items aboard are particularly bulky. Alongside 118kg of food, clothing, and batteries, the spacecraft is carrying 177kg of station equipment. That portion includes a GLACIER (General Laboratory Active Cryogenic Experiment Refrigerator) freezer, good to -160°C. It also includes a FIR (Fluids Integrated Rack) full of physics experiments, an experiment examining the behavior of the yeast Candida albicans in microgravity, another physics experiment rack filled with fluid-flow microgravity experiments, and a bag filled with materials that will be deliberately exposed to space outside the Station. All of these items fit in the pressurized section of the spacecraft, leaving the unpressurized section empty. As Chris Bergin detailed over at nasaspaceflight.com, SpaceX used the empty space to carry a small communications satellite for Orbcomm since NASA wasn't using it.
Orbcomm's prototype OG2 communications satellite suffered an unfortunate fate due to an engine malfunction about 1:19 after the launch. A medium-sized cloud of expanding gas burst from the rocket in a manner suggestive of a major problem in one of the outer engines. In a statement released on October 8 SpaceX said that the engine didn't explode, but didn't mention cracked combustion chambers, disintegrated turbopumps, or various other causes of unexpected disassembly. As it was designed to do, the rocket recalculated its trajectory and proceeded to orbit on its remaining eight engines.
Unfortunately, the engine malfunction placed the Falcon 9 upper stage in a slightly different approach to the International Space Station. That new approach caused the stage to violate a set of conditions known as a "safety gate"; there was no way the satellite could ascend to its intended 350km x 750km orbit without crossing the ISS orbit, and no time to check to make sure that no collision would occur. The second stage's flight control software automatically cancelled its second burn, leaving the satellite in a much lower (203km x 323km) orbit than intended. Engineers from Orbcomm and Sierra Nevada Corporation, the manufacturer, are deciding what can be done, and both SpaceX and Orbcomm are being noticeably cagey about their press releases.
The good news for everyone but Orbcomm and its stockholders is that the Dragon spacecraft never noticed. It reached its destination and will remain berthed to the Station for the next few weeks, a much longer berth than the last one, before departing for a splashdown in the Pacific Ocean. The CRS-1 cargo craft will carry back down to Earth experiments that have been accumulating up at the Station since the end of the Space Shuttle program.
Although NASA has had other spacecraft from other parts of the world to take cargo up to the Station, until Dragon was ready, only the Shuttle has ever been capable of bringing cargo back down. According to Julie Robinson, a NASA ISS Program Scientist speaking about the mission Monday on NASA TV, when CRS-1 departs it will take with it a GLACIER freezer filled with blood and urine samples and other results of experiments enacted aboard ISS during the past year. With a new bureaucratic structure in place for the Station, now properly designated the International Space Station National Laboratory, the ISS has better capabilities for conducting joint experiments with commercial entities or other national institutions and organizing the resulting intellectual property.
CRS-1 represents a big transition for a young company, but it's an even bigger transition for NASA and for the fledgling commercial space industry. SpaceX's contract for delivery services resembles any other delivery contract in many ways. Much like a FedEx envelope, Dragon can carry almost anything NASA wants to ship in its pressurized and unpressurized sections, up to a combined 13,200 pounds. When Orbital Sciences completes its own COTS development agreement in the next several months, Orbital's contract will work the same way. SpaceX and Orbital will become the FedEx and UPS of the space cargo business.
Shipping cargo from the Earth's surface to a destination in space is a far different business than launching satellites. These first dozen cargos are slated for the only currently existing manned destination in space, the International Space Station, but other destinations are being planned by both public and private entities. The Orlando Sentinel announced an as-yet unconfirmed (but long-rumored) NASA plan for an outpost at Earth-Moon Lagrange point 2 (EML2), out beyond the dark side of the Moon. Bigelow Aerospace plans to build space stations for both government and private players. Another example, Excalibur Almaz would also like to put manned stations in orbit. As humans create more destinations, SpaceX, Orbital Sciences, and other companies will presumably bid to ship cargo (and later, humans) to them. And thus, with the first CRS mission, a new kind of business has been created.


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Perspective: Governors have no excuse not to build insurance exchanges
The following editorial appears on Bloomberg View:
Ever since health-care reform was passed in 2010, Bobby Jindal of Louisiana, Rick Perry of Texas, Scott Walker of Wisconsin and several other prominent Republican governors have vowed not to create the state insurance marketplaces, known as exchanges, the law requires.
Many of them say it's impossible to comply with the law because the Department of Health and Human Services hasn't given them enough information to move forward. Gov. Bob McDonnell of Virginia, writing on behalf of the Republican Governors Public Policy Committee, has sent President Barack Obama a list of 17 questions asking exactly what the exchanges will look like.
This strikes us as a bit of a smoke screen. In fact, it stretches the bounds of credulity as 17 states and the District of Columbia are working on their online exchanges and six more have pledged to work with HHS to build joint state-federal exchanges.
The exchanges will basically take the form of websites, designed to lead people through the process of selecting an insurance plan, based on price and coverage. In the process, users will be able to determine whether they qualify for subsidies or for Medicaid. (The existing Massachusetts Health Connector is a model for what most exchanges are expected to look like.) To design and plan such a website doesn't require knowing, as McDonnell demands, for example, how the federal government will manage pools of high-risk patients.
It's true that HHS delayed until this week issuing guidance on the benefits that insurance plans will be required to provide. It's also true that the department was a little slow to come out with its rules on enrollment periods, rate increases, catastrophic-care plans and the ways in which premiums can vary. It's eminently possible that these delays were attributable to politics (that is, a presidential election). Yet this information has arrived in plenty of time; the plain fact is that states didn't need it in order to decide whether to go ahead with an exchange.
HHS has been mostly eager to assist states in exchange- building and to be flexible about deadlines. The department has disbursed about $2 billion in grants to help states plan and design their websites. And it postponed by one month last week's deadline for states to declare their intention to create their own exchanges.
Here's something else that has been lost amid the questions: Any state that opts out of the effort will be stuck with a one-size-fits-all insurance exchange that, paradoxically, will be built by the federal government. In effect, the state will abdicate its traditional authority over health-insurance operations, and will be helpless to tailor its exchange to suit the desires of either local insurers or residents.
Such a state wouldn't save money either, as the federal government is footing the bill for creating exchanges and, under the law, once exchanges are in operation, they are to be self- supporting - through fees paid by insurance companies.
Perhaps prompted by this month's election results, a few encouraging signs of softening have appeared. In Florida, Gov. Rick Scott, who began his political career by opposing the Affordable Care Act, is now saying, "Let's have a conversation" about the law. Presumably, that means he will consider at least partnering with the federal government to create Florida's insurance exchange.
Last week, Gov. Terry Branstad of Iowa reluctantly said his state will work on building its own exchange. And Gov. John Kasich of Ohio, even while reiterating his opposition to the law, signaled that his state will help run its exchange.
Still, 14 governors and one state legislature say they are sticking with their declaration not to play ball. A dozen more states have made no decision.
At this point, a state that has done absolutely nothing to prepare probably has too little time to create its own exchange before October 2013, when HHS says it must be ready. Still, there is time enough to join in partnership with HHS; the deadline for deciding to do that is not until mid-February. In such partnerships, the federal government could provide the information technology, while the states would work with insurance companies on plans and provide guidance for residents.
HHS has made it clear that after federally operated exchanges are up and running, states may eventually take over operations. This seems like wasted effort. States have the information they need to move on insurance exchanges. Governors who care about fiscal responsibility, strong state government and the basic welfare of their residents would do well to get with the program.


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Where can I buy a new or replacement remote control and other accessories?
If you are looking for accessories like remote control, power adaptor, Battery, HDMI / USB cable, etc. for your Sony products, please contact us from either the following methods:
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Shop all Bazzill Cardstock
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Mike Wallace
Destiny (Expression) Number 8
Mike Wallace was an American journalist, game show host, actor, and media personality who interviewed a wide range of prominent newsmakers during his sixty-year career, and was one of the original correspondents for CBS' 60 Minutes.
He was born on Thursday May 9th 1918, in Brookline, Massachusetts, United States.
Mike Wallace has the power and potential to achieve great things. It is both his challenge and his birthright to gain dominion over a small part of the earth. Whatever his enterprise, Mike strives to be the best and most successful in his field. He is highly competitive and will not rest until he is satisfied that he has bypassed the opposition. Wallace enjoys challenges and rivalry.
He is a realist and a visionary planner. Money and authority are available to Mike Wallace if he is willing to discipline himself - generally an inborn talent - and persevere in the face of the considerable obstacles in his path.
Mike Wallace is dynamic and has a talent for efficiency. He understands the larger picture, sees the broader challenges, and knows how to marshal his collective resources to address the problems. Mike delegates responsibility well; it is best for him to leave many of the details to others.
Wallace is a great leader of people and an outstanding judge of character. He is demanding of those who work for him, often putting things in no uncertain terms: do it my way or do not do it at all!
At the same time, Mike Wallace does not hesitate to reward the faithful and hardworking employee. He is not a particularly tolerant leader; too much tolerance violates his sense of efficiency. Wallace goes directly after his goal with courage and tenacity.
Mike has a natural understanding of money, authority, and power. He is able to struggle consistently after his goal. Eventually power falls to him. Within him lies an innate balance between the higher and lower characteristics of mankind.
Mike Wallace's challenge in life is to balance his higher ideals and his understanding of the hard realities of the earth.
Much effort will have to be put out and many ups and downs experienced before Mike reaches the level of success he desires. Life will probably test him many times with obstacles that seem insurmountable. But in reality, these are merely opportunities for Wallace to learn how to use power and authority in the face of difficulties, and to find out just how much power lies within him.
It is crucial for Wallace's success that he balances the material and the spiritual. Mike Wallace has chosen a path that requires balance between giving and taking, reward and punishment, action and reaction. Despite the obstacles on his path, Mike is a true survivor.
When focused exclusively on his desire for results and success, Mike Wallace can become stubborn and intolerant; he can be driven by excessive ambition, causing him to be exacting and without perspective. Mike must guard his alcohol consumption, a danger-zone for him. Wallace can be a social drinker, mixing business with pleasure - a dangerous cocktail.
An excellent manager, organizer and administrator Mike Wallace has talents in many areas of life. Entrepreneurs, executives, bankers, brokers, negotiators, gamblers, coaches, collectors, heads of institutions, builders, art dealers, manufacturers, promoters, military officers, police detectives, smugglers, engineers, pilots or sea captains.
He has been entrusted with special gifts, the use or abuse of which has an immediate and often physical effect upon him and those around him! Mike Wallace should use these gifts for the good of mankind and accept his own good fortune with gratitude. This is Mike's rewarding stage in his evolution a lifetime of harvest.
You and Mike
About Mike's Destiny (Expression) number
The Destiny number reveals the talents, abilities, and shortcomings that were with Mike Wallace when he entered his human body. His name, and the numbers derived from it, reveals Mike's development, as well as the talents and issues he will be working with during this life.
Read more about our interpretation of Mike Wallace's destiny (expression)


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Product Overview
The G5 Contour is a non-invasive massage machine for skin, scalp, muscles, lymph nodes and the circulatory system. Extraordinary results are achieved with our famous G5 Directional-Stroking action, which combines vertical and parallel forces to produce effective and comfortable percussion, gyratory massage, deep tissue mobilization, kneading and compression, skin layer resonation, and other aesthetic therapy techniques, such as cellulite reduction. Comes complete with caster stand, accessory tray, and Spa Treatment applicator package. Continuously-variable speed: 10-60 CPS; plus timer. G5 Contour percussor
Part Number(s):
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