text:
These authors contributed equally to this work.
This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Climate change is likely to have significant implications for human health, particularly through alterations of the incidence, prevalence, and distribution of infectious diseases. In the context of these risks, governments in high income nations have begun developing strategies to reduce potential climate change impacts and increase health system resilience (
Climate change has been identified as the biggest global health threat this century, with a variety of direct and indirect impacts projected [
In light of the risks posed by climate change, and existing vulnerabilities to climate-related health outcomes, adaptation has emerged as a key focus of climate policy. Adaptation refers to policies, measures and strategies designed to reduce climate change impacts and foster resilience, a concept analogous to the population health notions of primary, secondary and, at times, tertiary prevention [
The majority of research and policy debate on health adaptation has focused on identifying risks posed by climate change, estimating their magnitude and extent, describing potential patterns of exposure and vulnerability, and highlighting priorities for intervention [
In light of an absence of research examining how adaptation figures in health policy, this paper evaluates national-level planning for adaptation with regards to infectious disease-related impacts of climate change in OECD nations. Specifically, we identify the types of adaptations proposed in adaptation plans of national agencies and governments, and examine whether there are gaps in current public health planning by comparing with recommendations for infectious disease adaptation in the peer reviewed literature. Our focus on national-level planning reflects the role of national governments as a central pivot for adaptation, whether it be by catalyzing interest in adaptation, determining policy priorities, or allocating resources and support [
To identify best practices proposed within the scientific literature to respond to climate change-related infectious disease risks, an assessment of peer-reviewed literature was conducted. Five databases were searched (PubMed, MEDLINE, EMBASE, Web of Knowledge, Scopus) using database-specific search strategies (see
To assess adaptation planning by OECD nations for infectious disease risks, national adaptation plans, as well as official Public Health and Health Ministry reports addressing adaptation or public health response to health threats of climate change, were selected and analyzed for a sample of fourteen OECD-member countries: Australia, Belgium, Canada, Chile, France, Ireland, Luxembourg, Mexico, New Zealand, Slovenia, Spain, Switzerland, the United Kingdom, and the United States. Selection sought to capture a diversity of nations for whom information was available in languages spoken by the research team (English, French and Spanish). The OECD-country sample was based on the availability of national-level planning documents published in the abovementioned languages. To be included in the review, plans and official documents had to: substantively focus on adaptation, either through the promotion of specific interventions to minimize threats from infectious diseases or description of approaches to build adaptive capacity in the health sector; have climate change as an overarching rationale; focus on the national scale; and specifically address risks from infectious diseases, which were defined as any zoonotic, vector-borne, food-borne or waterborne diseases which may be directly impacted or exacerbated by climate change (see
Climate-Dependant infectious diseases and sample countries likely to experience health hazards linked to changes in disease exposure. Inspired from ECDC 2010 [
|Disease type
|Environmental factors impacting disease dynamics
|Countries likely to be affected
|Mosquito-borne diseases
|Increased average temperatures
|Australia, New Zealand, Chile, Southern Europe
|West Nile Virus
|Increased average temperatures, drought
|USA, Southern Europe, Canada, Australia, New Zealand, Chile
|Dengue, Chikungunya fever, Yellow fever
|Increased average temperatures
|New Zealand, Mediterranean region (coastal areas in Spain, Portugal and France), Chile
|Tick-borne diseases
|Lyme borreliosis, tick-borne encephalitis,
|Increased daily precipitation, humidity, changed patterns of seasonal precipitation, Increased average temperatures, extreme heat
|Northern Europe, Canada, USA
|Waterborne diseases
|Sewage and sanitation:
|Increased rainfall and storm frequency, flooding, landslides, increased average temperatures, extreme heat episodes
|All countries
|Food borne diseases
|Salmonellosis, campylobacteriosis
|Extreme rainfall, flooding, increased average temperatures, increased frequency of extreme heat, changed seasonal patterns
|All countries
National-level plans and official documents were identified through a web-based search of official public health agency and governmental websites using search terms and inclusion criteria presented in
Key words, inclusion and exclusion criteria for grey literature document retrieval and selection.
|1.1 English
|"climate change", "global warming" AND/OR "infectious disease", "communicable disease", "zoonos*s", "waterborne disease", "food*borne disease", "vector*borne disease"
|1.2 French
|"changement climatique", "réchauffement climatique" AND/OR "maladies infectieuses", "maladies à transmission vectorielle", "maladies émergentes", "maladies diarrhéiques", "maladies d'origine hydrique", "intoxications alimentaires", "maladies d'origine alimentaire", "zoonoses"
|1.3 Spanish
|"cambio climatico", "calienmente global" AND/OR "enfermedades transmisibles", "enfermedades infecciosas", "zoonosis", "enfermedades de transmisiόn vectorial", "enfermedades transmitidas por el agua/ por los alimentos", "enfermedades emergentes"
|English, French, Spanish documents
|Non-English, French, Spanish
|Technical documents, Adaptation Plans, National Reports, Adaptation Assessments, Vulnerability Assessments containing recommendations.
|Editorials, Meetings and Conferences, Abstracts
|Human Adaptation to Climate change
|Natural and/or biodiversity focus, focus on climate change mitigation
|Practical focus (detailing adaptation activities or actions)
|Enumeration and assessments of vulnerabilities only, description of the problem and potential hazards only, conceptual documents only.
|OECD Nations
|Non-OECD Nation
The assessment of peer-reviewed publications was qualitative in nature: we aimed to identify and list specific adaptations recommended. This list was subsequently compared to adaptation policies proposed within national adaptation planning documents to identify gaps between needs identified within the literature and the policies proposed at the national-level. By listing, comparing, and contrasting adaptations this way, we aimed to assess whether and to what extent recommendations formulated in the literature were integrated into national adaptation plans.
Adaptations to infectious disease risks proposed in the peer-reviewed literature are summarized in
Recommended public health adaptation strategies in the peer-reviewed literature.
|Identify vulnerable professional groups [
|Develop suitable protective clothing and gear [
|Heighten workplace awareness of infectious disease risks [
|Ensure adequate water supply and quality [
|Increase drinking & recreational water quality monitoring in relation to specific climate and weather patterns (e.g.,: increased precipitation) [
|Create advisory platforms and improve outreach [
|Improve watershed protection and management [
|Develop new drug therapies for waterborne diseases [
|Develop membrane filters to address cyanotoxicity [
|Consider water-pathogen source placement (e.g.,: cattle farms) [
|Improve wastewater disposal and municipal water systems [
|Involve nursing staff in community microbiological water testing [
|Enforce appropriate food production, monitoring and handling standards [
|Provide public education campaigns to promote good practices in food preparation [
|Increase monitoring of preparation practices within institutions [
|Develop a national integrated system of food tracking from farm to fork [
|Incentivize the local production of food [
|Intensify existing food safety programs during warmer periods and optimize food disinfection protocols [
|Provide freezer programs for hunting communities [
|Develop vaccines for human and animal host-species [
|Link human health and veterinary sciences in public health practice [
|Create or strengthen animal and wildlife sentinel surveillance systems [
|Implement preventive strategies for sustainable livestock production [
|Harmonize case reporting across regions and national boundaries [
|Improve vector control [
|Strengthen preparedness and response to extreme weather events [
|Encourage individual level adaptations such as the use of mosquito nets [
|Domestic water tank screening, urban runoff capture and improved urban drainage systems [
|Incorporate fly screens in construction norms [
|Implement adequate goods-importation laws and monitoring [
|Supplement current surveillance programs with additional surveillance sites for monitoring [
|Further develop genomic surveillance [
|Develop novel disease and vulnerability indicators [
|Expand disease tracking surveillance programs [
|Collect data on environmental risks to perfect integrated monitoring and forecasting systems [
|Collect data on vulnerabilities and identify vulnerable populations [
|Perfect early-warning and syndromic surveillance systems integrating environmental, ecological, veterinary and epidemiological data [
|Ensure adequate data collection and data quality [
|Develop the use proxy measures and interpolation when data may be unavailable [
|Develop spatial analysis technologies with greater integrative analysis capabilities than current GIS software [
|Increase the ability to share data and information across jurisdictions [
|Improve the timeliness of access to laboratory testing and its results [
|Integrate multidisciplinary knowledge in surveillance and risk assessments [
|Integrate community participation in surveillance [
|Provide education about ID risks of CC, individual adaptation measures and/or mainstreaming in existing health promotion programs [
|Provide regular (and updated) workforce training [
|Prepare health care workers and public health professionals to potential ID risks of CC [
|Incorporate ID risks of climate change in medical and university training curricula and create new training programs [
|Develop and validate new diagnostic tests protocols [
|Involve stakeholders and the media to increase awareness and identify alternative adaptation options [
|Build capacity by increasing infrastructure and research capabilities, the provision of adequate funding, equipment and trained staff [
|Focus adaptation efforts to vulnerable communities [
|Improve vaccination coverage and public immunization campaigns [
|Cooperate with relevant sectors : meteorology, environment, urban planning, hydrology, agriculture [
|Emphasize adaptive management, constant monitoring and evaluation, and the implementation no-risk options [
|Improve access to preventive and primary care [
|Improve laboratory infrastructure and testing capabilities [
|Conduct cost-effectiveness analyses of proposed adaptation strategies [
|Improve forecast modeling [
|Assess stakeholder conceptualizations and approaches to health [
|Evaluate opportunities for policy intervention (effectiveness, desirability, feasibility, urgency, equity, durability) with the use of scenarios [
|Create community and stakeholder partnerships, encourage social involvement and foster social networks. [
It is noteworthy that some recommendations were applicable to health risks of climate change in general, and were presented as such within the reviewed publications: they were included here because of their specific relevance to infectious-disease risks.
At a general-level, emphasis is placed on the unequal distribution of impacts and consequent need to identify and target vulnerable populations through coordinated outreach campaigns within all six adaptation categories e.g., [
While individual adaptations remain crucial, the need for the community-based adaptations to health risks of climate change, as well as for the fostering of sustainable stakeholder partnerships, has been increasingly highlighted in the literature [
The need for trans-disciplinary collaboration is increasingly apparent within sectors aiming to develop novel approaches for the elaboration of integrated surveillance systems. Emerging threats from vector-borne diseases have required public health professionals to increasingly move away from of conventional conceptualizations of pathogen-human-host transmission scenarios and incorporate advanced notions of ecology, entomology and veterinary sciences to evaluate risks of disease spread. The development of methods to assess potential impacts of mosquito-borne disease [
The majority of the policy documents reviewed here focus broadly on adaptation to climate change across different public sectors (
National-Level adaptation planning documents reviewed in this study.
|Adaptation Plan
|Drafting Body
|National Climate Change Adaptation Framework [
|Council of Australian Governments
|Plan National Climat de la Belgique 2009–2012 [
|Commission Nationale Climat: Groupe de Travail Politiques et Mesures
|Climate Change Impacts and Adaptation: A Canadian Perspective [
|Climate Change Impacts and Adaptation Directorate
|National Climate Change Action Plan 2008–2012 [
|National Environmental Commission
|L'adaptation de la France au changement climatique [
|Observatoire national sur les effets du réchauffement climatique
|Cambio Global España 2020/50. Cambio climático y salud [
|Centro Complutense de Estudios e Información Medioambiental & Instituto Sindical de Trabajo, Ambiente y Salud &
|Adaptation aux changements climatiques en Suisse: Objectifs, défis et champs d'action Premier volet de la stratégie du Conseil fédéral du 2 mars 2012 [
|l'Office fédéral de l'environnement
|Department of Health: Climate Change Plan [
|Central Office of Information for the Department of Health
|Climate Change and Health program website
|Centers for Disease Control
The majority of documents reviewed contained at least one suggestion for potential adaptation that may be undertaken in relation to changing infectious-disease dynamics with climate change (
Wide variations in the nature of adaptation planning for infectious diseases are evident across the 14 countries analyzed, even in cases where countries are situated within neighboring regions facing similar impacts. For example, despite the fact that the South Pacific region is likely to be strongly impacted by changing vector ranges and environmental conditions [
European countries are also far from homogenous in their approaches to tackling infectious disease risks. However, they benefit from the overarching support of the European Center for Disease Control, which has played an important role in information sharing and the creation of multidisciplinary support structures and professional networks (ex: VBORNET) [
Development of strategies and methods for adaptation—adaptation plans by country.
|Awareness of CC Impact on ID Dynamics
|Evidence for Adaptation Strategies/Plans in PH
|Infectious Disease-Specific Adaptation Measures
|New Zealand
Canada stands-out in terms of breadth and completeness of qualitative national reports, in particular in relation to the 2008 national assessment of vulnerability and adaptive capacity in the health sector, led by Health Canada [
National adaptation plans are meant to be frameworks or guidance documents for individual agencies to structure the prioritization of their adaptation needs. The inherent goal of public health adaptation, and adaptation planning by proxy, is the reduction of specific vulnerabilities to the potential effects of climate change. In order to ensure that vulnerabilities are indeed being addressed, the need for mechanisms to evaluate the degree of rigor associated with adaptation planning and tracking adaptation planning outcomes has become apparent [
To assess the comprehensiveness of adaptation planning, the selected documents (
Within the scope of this review, the typology proposed by Preston
It becomes immediately apparent, through the use of this classification typology that proposed adaptations are primarily concerned with sectoral (90%), rather than integrated, multidisciplinary adaptations implicating different agencies, jurisdictional levels or stakeholders. For example, Switzerland's proposed plan explicitly divides the objectives of the adaptation plans in broad sectors ("
Specific types of adaptations to infectious disease risks of climate change proposed within reviewed documents and classification of adaptation options according to Preston
|Adaptations Proposed
|Classification of Adaptation strategies
|Consideration of Vulnerable Populations
|Sectoral or Holistic
|Initiative or Mainstreaming
|Nation Proposing
|Ensure that existing surveillance systems are sensitive and efficient enough to detect new threats in a timely manner
|Avoiding or reducing the risks
|UK, France, Spain, USA, Canada, Australia, Switzerland
|Strengthen surveillance systems which currently lack the capacity to integrate zoonotic and environmental data in disease detection
|Avoiding or reducing the risks
|Mainstreaming and Initiative if development of new knowledge
|UK, France, Spain, USA, Canada, Australia, Chile
|Ensure that surveillance systems have the capacity to detect vector-borne diseases whose range is suspected to change (integrate epidemiological and environmental data)
|Avoiding or reducing the risks
|UK, USA, Chile, France, Spain, Canada, Australia
|Increase awareness of potential effects of climate change within the public health surveillance, public health planning, infectious disease and medical communities
|Creating supportive social structures
|Integrate climate and precipitation data in forecast and predictive models for the purposes of public health intervention & Use the growing scientific evidence base to inform the preparedness and responsiveness
|Gathering and sharing of new information & exploiting new opportunities
|Chile, France, Spain, USA, Canada, Australia,
|Increase the capacity for or continue to ensure appropriate water sanitation and water quality monitoring
|Avoiding or reducing the risks
|New Zealand, UK,
|Conduct water-consumption hygiene outreach campaigns
|Avoiding or reducing the risks
|Strengthen food quality regulation and monitoring
|Avoiding or reducing the risks & creating a supportive institutional framework
|Invest in strategies for vector control
|Bearing the risk
|Chile, Canada, Australia, Spain
|Increase networking between sectors and jurisdictional levels
|Creating supportive social structures
|Chile, UK,
|Increase education and public outreach campaigns
|Gathering and sharing of information
|New Zealand, Spain,
|Improve resilience to climate effects for the most vulnerable in society
|Bearing the risks
|UK, USA, New Zealand, Canada, Australia,
|Carry out an economic assessment of preventive measures, as well as infrastructure and personnel needs
|Gathering and sharing of information
|Chile, Canada, Australia,
|Strengthen the capabilities of health personnel to address prevention and care of adverse effects caused by climate change
|Gathering and sharing of information & Creating supportive social structures & Institutional framework
|USA, Canada, Australia, Spain, France
|Create a multidisciplinary expert group for planning, evidence assessment and the formulation of recommendations
|Exploiting new opportunities & Gathering and sharing of information & Creating supportive social structures
|Innovative (though not a new concept, it is a new body)
|France, USA (BRACE), Australia
|Explicit statement regarding the need to evaluate implemented strategies
|Gathering and sharing of information
|USA, Canada, Australia,
|Fostering international cooperation
|Gathering and sharing of information & Creating supportive social structures
Indeed, cooperation between government bodies (national and local levels, between ministries) was not explicitly highlighted in the majority of reviewed plans. This was unanticipated prior to the assessment of documents, as the need for formal coordination mechanisms across ministries and organizations dealing with environment, water, agriculture, urban planning and health care is widely highlighted in scientific literature on infectious disease adaptation [
The importance of local government participation in public health adaptation planning, as a complement to national policy, as well as the need for local integrated vulnerability assessments, have been explicitly highlighted within the Australian
A similar proportion of plans (90%) were primarily concerned with mainstreaming, defined as the integration of climate change into ongoing public health projects and priorities focusing on health promotion and protection [
Additionally, the need to integrate environmental, ecological and veterinary variables into surveillance is widely recognized. Though most experts agree that spatial analysis will be important herein, increasing our ability to account for temperature, precipitation and water quality data in analysis and forecasting, few countries explicitly acknowledge the need to develop this resource. Across planning documents reviewed, a strong emphasis is placed upon the improvement of current surveillance systems. Very few plans however, specify how such improvements would be achieved (for example, by improving GIS software capabilities or through the integration of environmental and wildlife data to surveillance processes). It is also noteworthy that while waterborne and food-borne diseases are believed to pose the greatest risk in relation to climate change impacts in developed nations [
As noted above, the majority of proposed adaptations were concerned with the
It is noteworthy that only five of the reviewed adaptation plans/documents (UK, Spain, Canada, Australia, USA) explicitly addressed the needs of vulnerable populations, while two explicitly highlighted the need to consider a vulnerable population approach in policy development without specifying how this would be achieved, despite the importance given to developing an understanding of the differential distribution of infectious disease impacts and of targeting interventions to the most vulnerable in the infectious disease literature [
In this paper, we have examined the extent to which national planning for adaptation is addressing the risks posed by climate change on infectious diseases, focusing on 14 OECD nations. Reviewing national-level adaptation plans and governmental public health reports, the study is one of the first to specifically focus on how infectious diseases are being addressed in adaptation, contributing to a rapidly growing scholarship identifying and characterizing the current state of adaptation more generally [
The comprehensiveness, extent and framing of adaptation planning within the OECD-nations examined are not homogenous and vary among jurisdictions. This is well illustrated, for example, by significant discrepancies on infectious disease adaptation planning between countries with similar risk profiles such as Australia and New Zealand. Despite the fact that New Zealand is likely to experience a change in the spread and incidence of infectious disease in coming years, the national adaptation plans only tangentially addresses the topic. In contrast, within a similar context, Australian adaptation planning documents present thorough, periodically revised guidelines to address the specific needs of their population. This reflects the government's commitment to support local infectious disease adaptation, and interest in pursuing the climate change policy agenda, and illustrates the importance of government leadership in directing adaptation [
While this review primarily evaluates adaptation plans against peer-reviewed infectious disease literature with the goal of identifying gaps in current public health adaptation planning, in so doing it also raises deeper governance challenges. For example, where climate change adaptation is addressed in national level adaptation planning documents, the measures are typically "mainstreamed", embedded within pre-established programs that were not originally constructed with climate change in mind. The most notable is the strong emphasis on the development and improvement of surveillance programs; a strategic priority rose both within select adaptation plans and peer-reviewed publications. Though mainstreaming through improved surveillance is appealing, the integration of environmental and social data in surveillance and forecasting requires more extensive departmental, organizational and disciplinary cooperation and coordination than the construction of traditional surveillance systems [
Undeniably, adaptation through mainstreaming is central in creating a pathway for the integration of climate change considerations into ongoing policy processes [
Moreover, we must note that both within the scientific literature and national adaptation planning, best practice guidelines to adapt to infectious disease risks of climate change are at the first stages of development. Indeed, few formal assessments of the feasibility and appropriateness of proposed adaptations have been conducted as of yet. However, location and sector-specific risk assessments ought to be conducted prior to the drafting of adaptation plans, in order to determine whether or not proposed adaptations will be effective in reducing climate change-induced infectious disease morbidity and mortality, and whether they truly address existing vulnerabilities [
Heterogeneity in national level planning for adaptation suggests that adaptation assessments will be key in guiding future adaptation policy in the coming years, by highlighting unaddressed needs, as well as gaps in problem framing. Such assessments aim to "identify modifications to current and planned programs, and opportunities for new policies and measures" [
Our thanks to Ellie Stephenson for her constructive and insightful comments.
The authors declare no conflict of interest.
Supplementary Information (PDF, 120 KB)


text: NEWS Enjoy an efficiently run household with three new appliances from Samsung Jul 30, 2010 SHARE Samsung Electronics Philippines Corporation (SEPCO) launched its newest line-up of home appliances recently at the Rockwell Tent. TV and radio personality Sam Oh hosted the event, while Chef Sau Del Rosario taught guests dishes they can cook using the new Samsung Microwave Oven. Samsung's executives, President KC Park, CFO Philip Lee, Marketing Director Benjie Jimenez, Consumer Electronic –HA Business Adviser DJ Kim, Head for Brand Marketing Chiqui Tan and Head for Home Appliances Tonette Lee welcomed guests while Product Managers Lei Venturina and Belle Enciso, discussed the different and unique features of the home appliances. These are critical emerging areas of growth for Samsung to build on its 2010 success. Samsung also reaffirmed its commitment to the environment both in terms of innovative new product features and new green initiatives. Understanding every family's need to save time, money and energy in today's fast-paced and budget conscious world, global electronics leader Samsung debuts three home appliances – the French Door Refrigerator (RF62NERS), Front Load Washer and Dryer (WD8754), and Microwave Oven (AMW83E-SB) – each one a worthy addition to every home. Ultra-sleek and stylish, these modern kitchen must-haves are designed to do the job and then some, thanks to a host of multi-functions and state of the art advancements. The stainless steel Samsung French Door Refrigerator boasts a Twin Cooling System that offers optimal humidity level, no mixing of odors, and consistent temperature of the fridge and cooling compartments. It also operates with a no-Frost Technology, sparing you from the tedious chore of defrosting. The fridge has a one body shelf that makes it easy to store and draw food, compared to the traditional 33-nch models which come with two separate shelves. While slim, the Samsung French Door Refrigerators is also very spacious: note the adjustable and easy-to-remove bins, the big box drawer at the freezer compartment, and the movable fresh box for jam, cheese and bacon. Hidden hinges, light responding modern edges, simple controls, beautiful contour surface and sophisticated blue color digital display round up the features of this durable appliance. With a user-friendly, one-touch digital control panel and a simple yet elegant design, the Samsung Microwave Oven (AMW83-SB) comes with a Triple Distribution System, ensuring equal amounts of heat from three microwave distribution points. A Rapid Defrost function, meanwhile, brings frozen foods back to their fresh, pre-frozen state with the instant push of a button. Preparing meals can be quick, hot and delicious with this kitchen innovation, which also comes with a cookbook featuring dishes you can create with the microwave oven. Anyone who's ever had to wash his or her own clothes will appreciate the many functions of the Samsung Front Load Washer and Dryer (WD8754). With a door widened up to 480 mm, you get 20% more space for easy loading and unloading. Meanwhile, a diamond-embossed drum bodes for excellent fabric care; thereby keeping your clothes looking new even after many washings. Taking laundry to a whole new level, the Samsung Front Load Washer and Dryer also effectively removes bacteria from your clothes' fabric for up to a month through countless microscopic ions in its Silver Wash technology. The Air Refresh system, on the other hand, does what air-drying clothes can't; it removes undesirable odors that cling to clothes, like sweat and smoke. A Quiet Drive Motor eliminates any noise associated with washers and dryers, making every laundry day a quiet and pleasant experience. Samsung's French Door Refrigerator, Front Load Washer and Dryer, and Microwave Oven are available in all major appliance stores nationwide. SHARE

subset: commoncrawl


text:
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text:
Berguer R. Surgery and Ergonomics. Arch Surg. 1999;134(9):1011-1016. doi:10.1001/archsurg.134.9.1011
© 2017
This article will provide the reader with an overview of ergonomic issues relevant to the operating room environment. Minimally invasive surgical technologies have increased the therapeutic value of surgical procedures by allowing operations to be performed with less trauma to the patient. At the same time, the surgical team—and particularly the surgeon—have been further removed from direct interaction with the patient's tissues. A scientific and ergonomic approach to the analysis of the operating room environment and the performance and workload characteristics of members of the modern surgical team can provide a rational basis for maximizing the efficiency and safety of our increasingly technology-dependent surgical procedures.
Although surgeons have undoubtedly had a long-standing interest in the design and efficiency of their tools, Frank Gilbreth, a pioneer in the field of time and motion study, noted in 1916 that " . . . surgeons could learn more about motion study, time study, waste elimination, and scientific management from the industries than the industries could learn from the hospitals."1 Gilbreth observed that surgical practices and instrumentation varied greatly throughout the country, leading to inefficiency and the lack of a "best" approach to each treatment modality. This mindset reflected the growing interest in the method of scientific management in industry2 during the early part of this century. Despite some early efforts at objectively studying surgical operations,3,4 objective work analysis was not widely applied to surgical procedures.5 Indeed, only 20 years ago Dudley6 noted that " . . . looked at from the ergonomic point of view most major operations are, at first sight, a mess."
This state of affairs is curious, for there are, in effect, many mental and physical similarities between a surgeon's work and skilled industrial and military jobs. Surgery requires a high level of intellectual preparation, an efficient and controlled workspace, fine motor skills, physical endurance, problem-solving skills, and emergency response skills. Moreover, surgical care is expensive and the costs of errors or delays in surgical treatment are substantial in both economic and human terms. Ergonomic methods would thus seem well-suited to the analysis of surgeons' work. That this has not occurred is probably the result of many interrelated factors, some unique to the field of surgery.
Surgeons train in an environment that discourages complaints about stress and fatigue. The inherent drama of surgical work, coupled with surgeons' historically high social standing, is likely to have encouraged them to see themselves as elite craftsmen and to be reluctant to have their unique work habits analyzed or criticized by others. The relatively low technological demands of surgical operations (with the exception of cardiac and orthopedic subspecialties) until the recent advent of video endoscopic surgery (VES) may also have been a contributing factor to this lack of interest in medical ergonomics. Perhaps most importantly, under a fee-based and physician-driven health care compensation system, surgeons and administrators may well have thought of work analysis as an unnecessary annoyance that could be financially counterproductive. In today's highly competitive and cost-conscious health care system, it is likely that our technical progress toward the full potential of less-invasive surgical techniques will be substantially moderated by cost and human performance issues.
Ergonomics as a science is relatively new. This field, also called "human factors," has to do with designing machines and tools that optimize the performance of the user.7 The first modern ergonomic studies were Frederick W. Taylor's time study2 and Frank B. and Lillian M. Gilbreth's motion study.8 Between 1900 and 1940 there was a growing interest in scientific management, but the availability of cheap labor and the scarcity of funds limited research into this area. World War II created a new interest in the measurement of operator performance in skilled military jobs, providing the impetus for the development of the field of "engineering psychology."9 As the demands of work-related machinery increasingly exceeded the intuitive human ability to cope with them during the next 3 decades, the field of ergonomics developed into a science of its own. Ergonomic analyses are widely applied today in industry,10 the military,11 and sports training12 to help people achieve optimum performance with a low risk of error and injury.
In the field of medicine, there has been an increased awareness of the importance of ergonomics13 and the applications of systems analysis.14 Ergonomic problems have been investigated in relation to intensive care units,15 gastrointestinal endoscopy,16 back injuries in health care workers,17,18 and job difficulty in medical-surgical staff nurses.19 Anesthesiologists, perhaps more than any other medical specialty, have addressed the important information display and equipment design factors that affect their work.20- 22 In a related specialty, the higher incidence of occupational cervicobrachial disorders among dentists23 has prompted improved designs of the dental operatory.24 Despite the increasing attention to ergonomics in health care, it is sobering to read a recent report by the Food and Drug Administration that estimates that poor design of medical instruments may account for half of the 1.3 million unintentional patient injuries in US hospitals each year.25
Under open conditions surgeons can view their work directly. The main visual ergonomic considerations are the adequacy of the exposure of the operating field to direct viewing and the quality and intensity of lighting on the field. Exposure is greatly aided by proper positioning of the patient and the application of mechanical retractors to the wound and internal tissues. Retractors with various shapes have long been in use but there has been little formal evaluation of their performance.26 For example, a comparative study of different retractor handles27 concluded that a hand-held abdominal retractor handle with a vertical "T" handle configuration was preferred by almost all users, yet this information has had no effect on retractor design. Although there are numerous self-retaining retractor designs available today, there are no objective data to support the choice of one design over another. The proper lighting of the surgical field has been the subject of several reviews,28,29 and detailed recommendations for optimum lighting during open surgery have been published.30 However, uncertainties still remain regarding the optimum size, location, and number of surgical lights and the most efficient type of controls.
Video endoscopic surgery has introduced the greatest challenge yet to the surgeon's natural view of the operating field. Using current technology, the surgeon views a relatively low-resolution monocular video image of the operating field, which is often degraded by variable lighting inside the body cavities and by the movement of the camera-holding assistant. Under these visual conditions, surgeons require significantly longer times to complete manipulative tasks when compared with direct binocular or direct monocular vision.31 The lack of depth perception with monocular video systems has been thought to be a significant performance limitation. However, several comparative performance studies of standard monocular and 3-dimensional (3-D) binocular VES systems32- 35 have demonstrated improvement in surgeons' performance using 3-D systems only during complex positioning tasks in a laboratory setting.32,36 Indeed, a recent randomized clinical study reported no difference in performance or adverse visual symptoms using 2-dimensional or 3-D imaging systems during laparoscopic cholecystectomy.37 The lack of significant clinical performance enhancement with 3-D VES may be due to a number of factors such as the small distance between the binocular endoscopic channels, the low resolution of current video systems, slow frame refresh rates, and subjects' complaints of eye fatigue and headaches during use of the 3-D systems.35,37 Others investigators suggest that factors such as background contrast and illumination are equally important 3-D visual cues for the surgeon.38 The objective performance data regarding the efficacy of 3-D imaging systems is an excellent example of the kind of practical answers one can obtain through ergonomic evaluations of new technology. High technology is not always the answer to human interface problems. For example, in a blinded comparison of several VES camera systems, operating room personnel subjectively preferred digitized video systems but saw no advantage in image quality with the use of 3-chip vs single-chip camera systems.39
One basic ergonomic consideration—the correct position of the video display relative to the user's eyes—is almost routinely ignored in VES. Video monitors are commonly placed on top of equipment carts or wherever there is space in the operating room, with the consequence that the image lies at or above the average surgeon's eye level and often to the surgeon's side. Studies of office video terminal display (VDT) users demonstrate that the preferred viewing angle for VDTs is between 10° to 25° below the line of sight.40 Excessive height of VDTs has been linked to symptoms of neck and back pain in office workers,41 which may explain why a small but significant number of laparoscopic surgeons complain of frequent neck stiffness and pain.42 Indeed, Hanna et al43 have reported an increase in knot-tying performance when surgeons view a monitor placed at hand level instead of at eye level. One approach to improving monitor position has been to install VDTs on ceiling-mounted booms44 that can be positioned as desired around the operating table. While this approach can facilitate the proper alignment of the surgeon and assistants with the image of the surgical field, the cost of installation remains high and many booms cannot be positioned below eye level. Other innovative approaches to solving the problem of VES display position have included projecting the video image onto a 13-in sterile screen placed in front and slightly below the surgeon within the surgical field (ViewSite display system; Karl Storz Endoscopy, Culver City, Calif) and incorporating the image into a head-mounted display system worn by the surgeon.45 Clinical and ergonomic studies to assess the effect of these display systems are in progress. Other ergonomic problems with visualization still remain, such as the natural control of the direction of view during VES. Preliminary studies using a voice-controlled robotic assistant suggest this device can facilitate the surgeon's visualization of the field,46 although savings in actual operating time have not been documented.47 Achieving adequate visualization in a cost-effective and user-friendly manner will remain a major challenge.
Standard open surgical instruments surgery such as forceps, clamps, and scissors evolved rapidly into standardized designs that accommodated ease and universality of use, mass production, and rapid sterilization.48 While surgeons have championed the skilled and efficient use of these instruments, there have been relatively little published experimental data describing the biomechanics of open surgical instrument use. Patkin26 described the power grip and the precision grip used by surgeons. Dudley6 briefly described the mechanics of passing instruments from the scrub nurse to the surgeon. Tendick and Stark49 reported a theoretical analysis of surgeons' grasp. Seki50 published a detailed classification of needle holder grips and an analysis of suturing movements. A recent study reported that surgeons' dexterity was not adversely affected by the use of double gloves.51
Video endoscopic surgery brought to the forefront new and significant ergonomic problems related to the surgical manipulation of tissues. Instruments for VES generally incorporate a pistol or axial grip handle, a 5- to 12-mm-diameter circular shaft that houses the actuating mechanism, and a rotating double-action tip for tissue manipulation. The fulcrum point created by the trocars inserted in the body wall limits the internal movement of the instrument tip to 4 degrees of freedom.52 The internal mechanical design of VES instruments results in substantially diminished tactile feedback53 and an unfavorable force transmission ratio from handle to tip.54 Laparoscopic instruments have also been shown to have a nonlinear relationship between input and output forces, which further degrades the surgeon's ability to delicately sense tissue characteristics.55 All told, VES instruments have been shown to require 4 to 6 times more force than open surgery instruments to complete the same task.56,57 With these less-effective instruments, it is not surprising that surgeons report increased fatigue following VES.42 Indeed, a recent questionnaire by the Society of American Gastrointestinal Endoscopic Surgeons revealed that 8% to 12% of 149 responding surgeons reported frequent pain or numbness in the arms, wrists, or hands following laparoscopic surgery. There have also been reports of thenar neuropathies from the awkward thumb ring in pistol-grip laparoscopic instruments58- 61 and of pectoralis tendonitis from prolonged use of a bowel clamp.62 Some alternative laparoscopic instrument handle configurations have been proposed63 but ergonomic data to support their use are still lacking. Although the axial design handle is generally preferred for suturing, there is no objective evidence that this handle design is superior to the pistol configuration.57 To address some of these problems, some authors have developed guidelines for skills training similar to those used in microsurgery.64,65 Other investigators have studied the optimal port locations for endoscopic intracorporeal knotting66 as well as the best visual angles for the laparoscopic camera67 based on ergonomic performance studies in an inanimate trainer.
There has been increasing interest in developing telerobotic manipulators for VES applications.49,68 Such sophisticated robotic instruments can give surgeons increased freedom of movement of the instrument tip, coupled with force feedback and binocular vision. These systems have been shown to be very effective for performing delicate surgical manipulations in animal models.69,70 Published clinical case reports involving the use of robotic assistants during surgery suggest they can also be very useful and more precise than human assistants in some instances.71,72 Sensors are under development that can transmit tactile information to the surgeon's hand through tactile "displays."73 Computerized instrument systems74,75 have been designed in an attempt to increase the surgeon's efficiency during laparoscopic surgery by automatically coordinating different tasks such as suction, irrigation, insufflation, and coagulation. Proof is still lacking that these relatively expensive and complex systems increase efficiency. However, one recent study did demonstrate a 20% increase in the speed of gynecological operations with the use of a more compact computer-controlled multifunction instrument.76 The ultimate role that "intelligent" robotic instruments will play in modern surgery will depend on the balance between any ergonomic improvements in surgical performance and the cost of the systems.77
Performing open surgical procedures has almost always required standing, awkward body positions, and the occasional need to exert substantial forces on tissues. In industrial ergonomics it is well recognized that static as well as dynamic postural stress can lead to fatigue and disability.78,79 Indeed, dentists have a high rate of subjective musculoskeletal complaints and disability claims related to cervicobrachial disorders23 that are presumably due to the nature of their working posture. There is little quantitative information about the musculoskeletal loads experienced by surgeons. Kant et al80 studied the posture of physicians and nurses during surgery and found that surgeons and scrub nurses experience substantial stress to the musculoskeletal system owing to their frequent and prolonged static head-bent and back-bent postures. Radermacher et al81 also reported that during laparoscopic and orthopedic surgery more than 70% of intraoperative work postures are substantially static. Mirbod et al82 recently surveyed musculoskeletal complaints among orthopedic and general surgeons and found a substantial prevalence of complaints of pain in the shoulders (32%) and neck (39%) among orthopedic surgeons. In the same study, general surgeons reported similar symptoms, with a prevalence of 18% and 21%, as compared with pharmacists at 15% and 18%, respectively. Sitting is more restful during extended periods of suturing and also provides a more stable posture for controlling instruments during microsurgery.83 Indeed, a sitting posture has long been recognized to be a preferred position for light manipulative work84 and suggestions have been made to allow surgeons to adopt a sitting position during at least part of an operation.85,86 In the United States, however, sitting during major torso or extremity surgery remains uncommon.
Video endoscopic surgery has altered the way surgeons interact with the surgical field, and in doing so has changed surgeons' posture. During transurethral resection of the prostate, the use of a video monitor significantly decreases the physical load on the shoulder musculature by allowing the urologist to view the endoscopic image while sitting upright.87 Surgeons' axial skeletal posture is also more upright during laparoscopic surgery as compared with open surgery.88 This upright posture during VES, however, seems to be accompanied by substantially less body movement and weight shifting than during open surgery.88 This situation could account for increased static postural fatigue during laparoscopic surgery. As is the case with the positioning of the VES monitor, some basic ergonomic rules that affect surgeons' posture, such as lowering the height of the operating room table to accommodate the increased length of VES instruments, are often ignored.86
As new technology has entered the workplace, there have been increasing psychological demands placed on workers in many fields. Advances in psychology and neurobiology have put forth new concepts of mental workload and stress that have seen widespread application toward critical task analysis in industry89 and the military.11 Levey et al90 were the first to directly measure the energy expenditure of operating room personnel. He found that while activities such as hand scrubbing and the performance of amputations required the greatest oxygen consumption, the average energy expenditure of surgeons in the operating room was not much above sedentary levels. Oxygen consumption measurements, however, are at best only an indirect measure of physical effort and do not accurately reflect cognitive workload. For example, Becker et al91 reported heart rates in 10 surgeons to be higher than commensurate for the measured oxygen consumption. Chavez-Lara et al92 reported significantly increased urinary epinephrine and norepinephrine excretion in surgeons before and during surgery. Foster et al,93 Payne and Rick,94 and Goldman et al95 also reported significantly elevated heart rates in surgeons during operations. Czyzewska et al96 analyzed heart rate variability patterns and correlated decreased heart rate variability during the operation proper with an increased mental workload experienced by the surgeon. Thus, the evidence to date suggests that surgeons experience significant cardiovascular stress during operations and that the magnitude of this stress exceeds the level of aerobic physical work performed. Contemporary behavioral psychology would attribute this differential effect to an increase in mental workload required by surgeons to perform surgery.
Most surgeons admit experiencing higher levels of frustration and tension during complex VES procedures, although there are no objective data to confirm this observation. Cuschieri97 described a 4-hour performance "wall" that surgeons encounter during long VES procedures. During training for advanced laparoscopic procedures, most surgeons report exhaustion at the end of a 5- to 6-hour training session, despite optimized instrument and equipment conditions.98 Interestingly, no such sharp performance barrier has been described during open surgery. Although operating times for simple VES procedures approximate those for open surgery, the cost of this performance during VES may be a higher level of adaptive mental stress by the surgeon.
The efficient design and setup of the operating room has long been a subject of interest to surgeons, architects, and engineers. The optimum design characteristics of an operating room have been widely discussed99,100 and standards for operating room construction have been published by the American College of Surgeons' Committee on the Operating Room Environment30 and the American Institute of Architects' Committee on Architecture for Health.101 While there is general agreement about the proper size of modern operating rooms,30 some authors29 have expressed concern about the potential hazard to personnel and equipment from the many cables and tubes present in the operating room. Several solutions have been proposed to reduce equipment crowding and lines crossing the floor in the operating room.102 Among the most popular are ceiling-mounted movable arms or tracks that can conveniently position equipment near the patient, thus freeing the floor space around the operating table. Increasingly, the usefulness of these and other design concepts will be able to be tested in advance through the use of virtual reality design tools.103,104
Video endoscopic surgery requires an increase in the amount of equipment in the operating room and poses a new challenge to optimizing the use of operating room space.105 Alarcon and Berguer106 reported that the percentage of total floor space occupied by persons, furniture, and equipment during laparoscopic operations is increased by 10% over open operations. Nonproductive activities can occupy up to 25% of the surgeon's time during VES.107 Simple aids such as an autoclavable multicompartment sheath can help to organize instruments on the field and a foot pedal template can keep different pedals correctly positioned for the surgeon.108 Every surgeon and nurse knows that a well-rehearsed operating room team is advantageous in reducing operating time and perhaps even conversion rates during VES.109 The effects of environmental conditions such as temperature and humidity on the performance of the surgical team are largely unstudied. Excessive noise levels in the operating room may cause distractions and make it difficult for the anesthesiologist to hear alarms and physiologic breath sounds.110 While there are several collaborative projects addressing the overall design of the operating room of the future,105,111 the lack of comprehensive task-analysis and time-motion data related to surgical operations continues to hamper the development of objective solutions to the problem of optimum operating room design.
More than a quarter-century ago, Laufman99 lamented that "only a few surgeons have made the surgical environment their main research interest." Future efforts to create a more user-friendly operating room environment will require the rethinking of traditional concepts of architecture, asepsis, and staffing. A greater involvement by surgeons and the other members of the operating team in this process can help assure the goals of increased efficiency and flexibility while maintaining patient and staff safety.
Corresponding author: Ramon Berguer, MD, 150 Muir Rd (112), Martinez, CA 94553 (e-mail: email@example.com).


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Bullying. It has become a major problem in today's society. Most of us have been teased as little kids, but bullying is more serious. Bullying is a repetitive, conscious intent to hurt another individual. This article focuses on the different forms of bullying, the effects of bullying, and some warning signs of bullying.
Bullying can be in different forms: verbal, physical, or psychological. Verbal bullying is speech used to hurt a person. This includes name-calling and making threats. Physical bullying is causing physical harm to the individual by hitting, pushing, shoving, etc. Psychological bulling can be brought upon by spreading rumors.
Bullying can begin as early as preschool, and it can intensify during transitional stages. These transitional stages include transitioning to first grade or middle school. Researchers estimate that 20 to 30 percent of school age children are involved in bullying. They are either perpetrators or victims. Bullies usually make fun of other kids because they think that it is cool to make fun of others, or they may also think that they will be popular if they bully. Victims are usually shy and are not very social, which makes it hard for them to stand up for themselves. Bullies use these types of kids as targets because they do not retaliate.
Bullying has negative effects on a child's life. It can cause problems with low self-esteem and depression. Kids that are bullied often times show a drop in grades at school. They also might become anti-social and may develop other psychological problems.
When dealing with the issue of bullying it is important to know the different warning signs of bullying so that help and support could be given to a particular child. Warning signs include frequent crying and unexplained bruises. Another warning sign that might suggest that a child is being bullied is when there is a sudden change in the way a child talks about herself or himself. Children may start calling themselves losers or say that they have no meaning in life. These are some of the many warning signs that may suggest to parents and other adults that the child needs help to try to overcome the issue of being bullied.
They best way to help is to give a child space for communication. Do not try to talk about the problem if they child is not ready to talk. Sometimes that can make the situation worse. Wait for the child to open up when the child thinks the time is right. Also, make sure to be understanding and provide support. Give the child advice as to how the child can overcome the problem, such as by ignoring the bullies and making new friends. The child also needs to understand that there are people that he or she can rely on for support. This may include parents or counselors at school.


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Tim Tebow could become a member of the LA KISS if he accepts the arena football team's contract offer. However, it isn't clear if he would actually be willing to play outside the NFL, as Tebow has already turned down a similar offer.
The former NFL quarterback was released from the Patriots last month, leaving him once again without the position he so desperately wants.
While the LA KISS wouldn't be exactly what he wants, it could help him work toward being in the NFL again. USA Today reports that the deal was officially offered to Tebow on Monday and would be for three years.
The offer could also be worth "millions." Tim Tebow is the first player the newly-formed team has targeted. KISS bassist Gene Simmons explained the offer in a press release, saying, "Acquiring Tebow would not only be a great investment for the team, but his exciting style of play would definitely send shockwaves through the league."
The Los Angeles Times notes that the release also explained that the LA KISS would offer Tim Tebow "intense training and unwavered commitment" to the former Pats player.
It added that the team could also help him improve. Paul Stanley also made a statement about the offer of a contract to Tebow. He called the quarterback "one of the most recognized and respected athletes in sports."
The team added that Tebow is "currently reviewing the offer." However, it's hard to tell whether he would accept it or not. After the news of his latest release from the NFL was announced, Tebow took to Twitter to thank the Patriots for the opportunity to play. He also stated that he would "remain in relentless pursuit of continuing my lifelong dream of being an NFL quarterback."
It could also be an honor that KISS would want Tebow as their first-ever recruit for their new football team. It will be interesting to see if Tim Tebow accepts the offer to be the quarterback of the LA KISS.
[Image via Helga Esteb / Shutterstock.com]


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Also, you should know that I am in a committed polyamorous relationship with ScarletMegasms. With that being said please read on.
Also, I'm always looking for people to make art with me. Preferable while drinking beer.
Hunter S. Thompson - read most everything he has written
Books about Russian History - I've got a college degree in History.
Books about Art and Art Theory - I've got a college degree in Sculpture.
Movies: The Goonies, Big Trouble in Little China, The Big Lebowski, High Fidelity, Cheech and Chong: Up In Smoke, Sleepless In Seattle
Shows: Netflix - Trailer Park Boys, Futurama, How I Met Your Mother, Louis C.K., Reno 911, Arrested Development
Music: Muddy Waters, Howlin Wolf, The Feederz. I enjoy many Michigan bands. I've got a pretty good record collection too.
Food: I cook some mean BBQ. I will try anything.
*My Biological Family, My Founders Family, My Friends (relationships)
*Making Music and Art
*Doing ridiculous things with great people (adventures)
*The Internets (it exists on computers now?!)
*The Great Outdoors (camping, swimming) , the Great Urban Jungle (bar crawl, spray painting)
*Quiet Time (life and work can be loud)
Come on sugar let me know
If you really need me just reach out and touch me
Come on honey tell me so, tell me so baby
(Rod Stewart Quote) ((Sorry))
You should reconsider messaging me if you are a woman looking for long term commitment. If you are looking for me to date you and your partner (I date individuals not couples), you think homosexuality is a sin, you want to save me, or you want to tell me the way I am living my life is wrong. Ain't nobody got time for that!


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The Daily Energy
President Obama (above) began his second administration with a renewed call for dealing with climate change. Taking a swipe at climate skeptics, he said the country must renew the quest to replace fossil fuels with renewable energy. Environmentalists hailed the renewed emphasis but were still waiting to see more action.
The most obvious test for the Administration will be the decision on whether or not to build the Keystone Pipeline. Canadians are growing more skeptical that approval will be forthcoming and Americans both pro and con are calling for a quick decision. Meanwhile, Gal Luft, writing on Foreign Policy, urged the President to "end the oil monopoly" by allowing fuels such as natural gas to power automobiles.
The Al Qaeda attack on the Algerian gas outpost has claimed 85 dead, three Americans among them. Seven other Americans survived. The attack was apparently an inside job with a former driver at the complex providing information that gave the attackers full knowledge of the complex. Algeria is promising to beef up security but also points out that it was a Canadian citizen who coordinated the operation.
Energy theft is becoming a leading world problem as hackers find it easy to steal electricity from power lines. USAID has promised to help Pakistan deal with the problem and both India has launched a crackdown. Sri Lanka has managed to cut pilfering by imposing heavy fines. In the US, Awesense, a small startup, has invented a sensor that can help utilities locate places where power is being drained illegally. But just to top the utilities' troubles, OilPrice reports a malicious software attack last October kept a major power plant offline for three weeks.
Finally, Inside Climate News reports that tax credits for the wind industry have become so appealing that non-energy companies such as Sprint, Starbucks and Levi Strauss are looking to invest. The Federal Energy Regulatory Commission reports that wind, solar, biomass, geothermal, hydro and tidal energy together added nearly half the new capacity in the US last year. Power Engineering says that renewables are still confined to niche markets, however, and a Vermont energy expert has told New Hampshire that wind works best in the Midwest and will get very little benefit to mountainous New England.
One other item that shouldn't escape notice. Jerome Corsi, writing on WND Money, reports that the US is quietly easing the rules allowing Chinese ownership of oil and gas properties in the US. The reason? We're afraid that if we deny ownership, China might stop lending us money. As they say, you get what you pay for.


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|The Lee A. Tregurtha came to Duluth this morning (July 1, 2015) on her 6th visit this season. She was here 22 times last season; she has been here 164 times since 1996, when I first started to keep records for Twin Ports arrivals and departures.
|She is one of the most interesting boats we see here; she won battle ribbons in the Second World War (click to enlarge the image to the right) and keeps steaming forward. She caused me a little trouble this morning since she was scheduled to arrive about the time I am distributing my daily copy of the Duluth Shipping News and with this boat, I want to alert visitors to her significance which means I had to write and print the newsletter much earlier and faster than usual. Happily, I finished and ran out to hand deliver sheets before filling my distribution boxes and take some pictures. Read more about her by clicking on the piece of this morning's paper I clipped (above) or go to her web page where you can also find other pages I have created over the years about this beautiful boat.
World War II veteran visits Duluth
July 1, 2015 by 4 Comments
Celebrate 2015 in Duluth
January 2, 2015 by 4 Comments
|Above, the Lee A. Tregurtha started things off in the new year when she departed Duluth at 8:24 in the morning on January 1, 2015. The Paul R. Tregurtha, below, was the first boat to arrive in the Twin Ports this year at 3:17 in the afternoon. In between those two, the Mesabi Miner left at 9:51 in the morning and the Stewart J. Cort departed via the Superior entry at 11:40 am. The Paul R. left the Twin Ports this morning (January 2) at 8:47 with 66,000 tons of coal for Detroit Edison. She is expected to make two more trips here this season, loading coal for Detroit Edison on the last trip, now set to arrive on January 11, 2015. The Lee A. loaded iron ore pellets at the CN dock in West Duluth.
Snow, rain, ice and the Lee A. Tregurtha
December 22, 2014 by 4 Comments
Lee A. Tregurtha arrived Duluth for pellets
April 4, 2012 by 3 Comments
|The Lee A. Tregurtha arrived Duluth today (April 4, 2012) for her 2nd visit to the Twin Ports in 2012. She will be loading iron ore pellets at the CN dock in West Duluth. Click below to hear her whistle as she came under the Duluth Aerial Lift Bridge.
The Lee A. Tregurtha arrives Duluth to start her season
March 27, 2012 by 1 Comment
|The Lee A. Tregurtha came to Duluth Superior 16 times last season. You will see her in this video arriving under the Duluth Aerial Lift Bridge on her first trip of the 2012 season when she came in on March 24th, 2012. The other Tregurtha, the Paul R. Tregurtha, arrived 2 hours later. The Paul R is a regular visitor. She was here 49 times last season.
One Tregurtha out, another in
December 26, 2011 by 1 Comment
|The Paul R. Tregurtha departed Duluth on Monday morning, December 26, 2011 after loading 64,000 tons of coal for her usual destination, the Detroit Edison power plant at St. Clair Michigan. A little over an hour later, the Lee A. Tregurtha (right) came in to get fuel and then load iron ore pellets at the CN dock in West Duluth. An hour before, the Alder was out in the harbor but there was not much ice to break.
(Click each image for larger version)
Lee A. Tregurtha still fighting ice
April 27, 2009 by Leave a Comment
|Seven boats are expected to arrive in the Twin Ports today. The Lee A. Tregurtha, arriving earlier this morning to load coal, will be the only departure, probably later this morning. The last time the Tregurtha departed Duluth, on April 1st, it got stopped in the ice sheet just off the Duluth piers. The Alder was out to help but a west wind, late in the day, blew the ice away and the boat continued on its way. The Tregurtha was built in 1942 as an ocean tanker and was used in the Atlantic to refuel allied boats in the Second World War. Battle ribbons from the war are displayed on the side of the pilot house.
|*submitted to the Duluth News Tribune for publication on 04-27-2009


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After applying the knowledge that we've gained from all the previous Steps, we are now ready and geared up to seek out our Higher Power's will for our lives. To work Step 11, we seek through prayer and meditation to strengthen our relationship with our Higher Power, and to live in accordance with His will for our lives. For this Step to be carried out, we have to strengthen our conscious contact with God through the two options available for us to utilize: Prayer and Meditation. By increasing our conscious contact with our Higher Power, we will acquire the essential knowledge necessary to carry out His will for our lives. By praying for knowledge and guidance, our Higher Power will reveal to us the way we should go. We will acquire direction, ability, understanding, and strength through increased conscious contact.
Conscious contact means being aware, mindful, and awake to align ourselves with God, as we understand Him. We gain all-knowing knowledge and perception of the way to truth - our destined path to success, happiness, and peace of mind. To have conscious contact with God is to be alert with our inner essence. We gain awareness and attentiveness to our chosen path to freedom. We gain the familiarity and knowledge to live in accordance with God's will for our lives. When we become aware of the Light of God's love through prayer and meditation, we become at peace with ourselves, our life's direction, and of our newfound life within. To experience conscious contact brings with it a great amount of healing elements that will give us the serenity that we seek. Our life's path becomes a positive, insightful, and joyous adventure.
Our Higher Power resides within, but we acquire the knowledge of His will from our inner being, and from without. Deep within us we find the serenity that we once thought was impossible to achieve. Our Higher Power has been with us from the start. He has been guiding us thus far through the Steps, and now our Higher Power desires for us to strengthen the conscious contact necessary to continue growing in our recovery, among many other things.
Through prayer we seek God and find Him; and through meditation, we find His presence from within. Both prayer and meditation are the suggested tools to use to succeed with improving our conscious contact with God. Through prayer and meditation, we not only become aware of our Higher Power, but we also become alert to reality, to ourselves, and to others. Our overall attentiveness expands to enlighten us to the direction we should follow - God's will for our lives. We experience peace, faith, love, tranquility, calmness, and a positive mindset that will lead us to the victory that we seek. Faith and acceptance reigns. Responsibility and accurate perception becomes a way of life. We become more aware of our strengths and weakness. We acquire the ability to rise above the challenges we encounter on our quest for personal freedom. We achieve freedom in many areas of our lives, but the most important freedom that we gain, is freedom from active addiction - the freedom to never have to use again, even if we want to. We seek out God's will for our lives, and we are led to victory. Persistence in recovery becomes a way of life, and we finally begin to enjoy and cherish all the marvelous wonders of this world.
Through the process of Step 11, we become in connection with truth from mind, body, and spirit. Total enlightenment transforms us into spiritual beings. This process is achieved through prayer and meditation. Through prayer, we communicate with our Higher Power, and we ask that His will be done, and also that He give us the power, knowledge, and ability to carry it out. The answers will be revealed as He shows us the way. We've already learned through working the previous Steps that if we become reliant on ourselves, insanity will result, which will lead us to unmanageability and total chaos. Our Higher Power has Ultimate Knowledge, and as we tap into that source through improved conscious contact, we gain direction and life, as it should be. As we establish an improved relationship with our Higher Power, we become God-centered, less selfish and self-seeking, and we thrive in life, and in our recovery.
Obtaining conscious contact doesn't have to be a complicated issue. To achieve conscious contact, we become honest and open, we pray and meditate, and we not only love ourselves, but we show love to others. Remember, it is suggested that we keep it simple. It can be difficult and vague to distinguish God's will for our lives. Knowing this, we remember the fact that our Higher Power only wants the best for our lives. In life, we are given free will, so it's up to each of us to decide if we want to travel along the right path. If we live in disobedience, then obtaining the knowledge of God's will is impossible.
Why is God's will so vague sometimes? Well, God's will is life and truth, and He tends to show us the direction through steps. We show our obedience to Him by succeeding with the small tests that are always given to us. We comply with, and respect the knowledge that is given to us. We then will be led to great triumph. We recognize God's will for our lives by His voice from within, by the events in our lives, and by the experiences of others who succeed.
By living with conscious contact, it is imperative that we take it one day at a time, and one step at a time. To achieve the fourth step on our journey, we have to take the first three steps in faith and obedience. And as we follow the suggestions of the program, we take the 12 Steps one Step at a time, and then we're led to victory. The more we are obedient to God's will, to the direction that is shown to us, then the more we'll accomplish on our path. To be disobedient to God's will is to reject life. Doing so will derail us to disaster.
To succeed and grow in our recovery, we choose to abide by the direction that is shown to us. If we love God by choice, then our Higher Power will show love and guidance in return. If we set our priorities to live in accordance with God's will, we are shown the Light of love, and the course to freedom. So, in summary, to achieve God's will for our lives, we stay accepting and obedient to the path revealed before us, as we continue to seek through prayer and meditation the knowledge of His will. In due course, the Light is shown to us. Its illuminescent radiance will show us the way to victory in our recovery. After strengthening our conscious contact with God, and seeking out the knowledge to live in accordance with His will, we are ready to continue on to the last Step of the 12 Step Fellowship.
Copyright © 2009 Recoverylife.com


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CAPE COTTAGE (alt. 30, South Portland), 4.7 m. Left is the northern entrance to Fort Williams (open), where the U.S. Fifth Infantry has been stationed since 1922. Organized July 24, 1808, the Fifth is one of the oldest Regular U.S. Army regiments. Its motto is "I'll Try, Sir," words spoken by Colonel James Miller in the battle of Lundy's Lane, July 25, 1814. During the Philippine insurrection it was stationed in the archipelago; in the World War it did guard duty in the Canal Zone and went to Germany with the army of occupation. Within the fortification near the shore is Portland Head Light (1791), the oldest lighthouse on the Maine coast. The white conical tower rises 101 feet above high water. From the hurricane deck of the tower, many of the 222 Casco Bay islands and the Cape Elizabeth shore can be seen. These islands are sometimes called the Calendar Isles because an official English report of 1700 said, "Sd. Bay is covered from storms that come from the sea by a multitude of Islands, great and small, there being (if one may believe report) as many islands as there are Days in a yr."
At Pond Cove (L), 6 m., the shore line cuts in nearly to the outer rocks, flinging spray across the highway in heavy weather.
POND COVE VILLAGE (alt. 100, Cape Elizabeth Town, pop. 2376), 7.3 m., is the center of a large town in which fertile soil is well adapted to the raising of garden truck.
TWO LIGHTS, 11 m. (L), on the rocky point of Cape Elizabeth, is the neighborhood name for a group of cottages, two light towers and a Coast Guard station. There is a light only in the outer tower which is 120 feet high (open). The Coast Guard station, established in 1887, serves the coast from the Kennebec River to Biddeford Pool, with a personnel of only 14 men. A man is constantly on duty in the tower to receive distress signals by telephone, radio, or flares. The white Government buildings stand out sharply against the varied green of the shore foliage and of the ever-changing ocean. This exposed point, which bears the brunt of heavy seas after every storm, attracts scores of people who like to watch the magnificent display of surf as the huge waves batter themselves against the ledges.
Federal Writers Project, Works Progress Administration. American Guide Series: Maine, A Guide "Down East," Boston: Houghton Mifflin Co., 1937, 21.


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In fact, it permits and encourages exactly what Obama warned against: broadband carriers acting as gatekeepers and charging Web sites a payola payment to reach customers through a "fast lane." Late last night Wheeler released a statement accusing the Wall Street Journal of being "flat-out wrong." Yet the Washington Post has confirmed, based on inside sources, that the new rule gives broadband providers "the ability to enter into individual negotiations with content providers … in a commercially reasonable matter." That's telecom-speak for payola payments, and a clear violation of Obama's promise.
This is what one might call a net-discrimination rule, and, if enacted, it will profoundly change the Internet as a platform for free speech and small-scale innovation. It threatens to make the Internet just like everything else in American society: unequal in a way that deeply threatens our long-term prosperity.
Read: "Goodbye, Net Neutrality; Hello, Net Discrimination." [The New Yorker]
Tim Wu is a professor at Columbia Law School and wrote "The Master Switch." He is a former senior advisor to the FCC and chairman of internet advocacy org Free Press, which is running a campaign to let the FCC know about public opinion on the proposed new rules. Let your voice be heard.
Previously on Boing Boing: "FCC planning new Internet rules that will gut Net Neutrality. Get ready to pay more for the stuff you love online."


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Supplier: M11924
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InfoHub supplier since Apr 2003!
Base of operations: USA
Incredible fishing, outstanding accommodations, great service and a knowledgeable, friendly staff is what sets us apart. Fly and spin fisherman will sample fishing only Alaska can provide. Our deluxe Alaska fishing resort is situated on Fish Lakes Creek, in the heart of southcentral Alaska's best angling destination. Our lodge guests will be rewarded with a relaxing atmosphere, outstanding Alaskan cuisine and enough memories to last until they return again. The owners goal is that each of our guests leave as good friends and that their fishing vacation with us exceeds their expectations.
Fishing our wild Alaska rivers offers the opportunity to experience nature at its best whether your method of fishing is fly fishing or spin fishing. Fishing is done directly from our Alaska fishing lodge in our 20' custom built boats. Our experienced guides are all CPR and first-aid trained and Coast Guard Licensed. They are proficient in both fly and spin fishing and are there to assist you in catching fish. We provide top of the line G-Loomis rods with Shimano spinning reels or Abu Garcia Bait Casters. We also have a small supply of G-Loomis fly rods and reels for the fisherman who would like to learn to fly fish. Whether the fish are upstream or at the mouth of the rivers, your guide has a prop boat and a jet boat at their disposal to get you to the fish.
Vacation Packages offered by supplier M11924
Northwoods Lodge Fly In Fishing
10% off.
This waterfront fly in lodge offers deluxe fishing, accommodations and meals with unsurpassed personal service.
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Distressed debt trading has been pretty quiet this year, traders say, especially when compared to recent times, where a flurry of landmark deals including the
Apart from some trading in the debt of large infrastructure assets including
Other opportunities
So with Billabong potentially in play, will other debt trading opportunities present themselves? Ferrier Hodgson, in a note published this week, reckons yes. It ran the numbers on the level of impaired assets held by authorised deposit-taking institutions in Australia and examined the Basel II Pillar 3 reports of the big four banks, finding over the four years from 2006 to 2010, the total impaired assets of local ADIs leapt from $3.3 billion to $33 billion.
This had dropped to $27 billion by December last year, with the big four banks holding about 69 per cent of those assets. The analysis also shows that 35 per cent of the impaired assets are in property, property services and business services; 17 per cent in consumer lending; 13 per cent in agriculture and mining (which are combined for reporting purposes).
"Current impaired-asset holdings by ADIs indicate opportunities will arise particularly in property, agriculture, mining and mining services as they continue to exhibit signs of distress," says Ryan Eagle, a partner at Ferrier Hodgson, who prepared the report.
The ultimate level of debt trading activity will be driven by the desire of the big four banks to reduce their exposure to impaired assets, which historically they have been reluctant to do. But "increasingly, in the appropriate circumstance, banks will consider the option of exiting the position quickly and efficiently by selling their impaired debt on the secondary market", Eagle says.
In agriculture,


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Air quality officials have issued a health notice for air pollution for all North Carolina air quality forecast regions on Friday.
Forecasters have predicted Code Orange conditions in most major metropolitan areas and high mountain elevations, which means that air quality is likely to be unhealthy for sensitive groups. People who are sensitive to air pollution should avoid moderate exertion outdoors. Sensitive groups include: children and older adults; people who work or exercise outdoors; people with heart conditions; and those with asthma, bronchitis, emphysema and other respiratory ailments. The primary pollutant of concern is ozone, a highly reactive form of oxygen. Ozone can be unhealthy to breathe, and high levels generally occur on days with stagnant air.
The air pollution forecast for Friday predicts that ozone levels in Charlotte, Fayetteville, Hickory, Rocky Mount, Triad, Triangle, and valley and ridge top elevations in the Asheville area will exceed the federal standard of 75 parts per billion averaged during eight hours. High ozone levels can impair breathing and aggravate symptoms in people with respiratory problems, and irritate the lungs in healthy individuals. People with chronic lung ailments, older adults and children should reduce physical exertion and outdoor activity in the afternoon, when ozone levels are highest.
The N.C. Division of Air Quality issues daily air forecasts for the Triangle, Charlotte, Asheville, Hickory, Fayetteville and Rocky Mount metropolitan areas. In the Triad region, which is also under a Code Orange health notice for tomorrow, forecasts are issued by the Forsyth County Office of Environmental Assistance and Protection. The forecasts are part of the N.C. Air Awareness Program, a voluntary effort aimed at reducing air pollution in the state's major metro areas. Air quality officials are asking residents to help reduce air pollution by taking some of the following actions:
• Limit driving by riding the bus, walking, bicycling or postponing trips.
• If you drive, avoid idling for long periods of time, stay within speed limits, combine errands to reduce the number of small trips, and use vehicles with higher fuel economies.
• Conserve electricity by setting thermostats at the highest comfortable temperature and turning off appliances not in use.
In addition, residents of affected areas should refrain from outdoor burning on Code Orange and Red days. It is illegal to burn all man-made materials in North Carolina, including paper, trash, and construction materials. In 1999, the N.C. General Assembly passed legislation aimed at reducing ozone-forming emissions from cars and trucks, including an expansion of the motor vehicle emissions inspection program from nine to 48 counties. In 2002, the General Assembly enacted legislation that will require the state's coal-fired power plants to reduce their ozone- and haze-forming emissions by three-fourths during the next decade.
For more information about air quality forecasts, open burning restrictions and other air issues, visit the division's website at www.ncair.org or call 1-888-RU4NCAIR (1-888-784-6224). Information about air quality in the Triad can be found at http://www.co.forsyth.nc.us/eap/.


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Cameras & Camcorders
Laptop Charging Carts
Listening Centers
PA Systems
Projectors & Screens
AV Equipment To Bring Your Presentations To Life
Whether it is for the classroom, courtroom, medical facility or training room K-Log has audio visual equipment to suit your needs. We offer an array of school AV equipment such as digital camera and camcorder kits for student or instructor use. We carry various audio visual products perfect for use in the conference room, classroom, lecture hall, and office. Our multi-media storage units are a great solution when it comes to security of your audio visual items. Our projection screens, projectors, AV carts and sound systems are necessities during presentations and lectures in front of large and small audiences. The cameras and headsets we offer can enhance a lesson in the classroom.
With mounts and multi-media stands, your room will become more efficient and convenient. Use the megaphones during assemblies and events to keep large crowds in order and aware of important information. The Flexible Gooseneck Video Presenter captures documents or objects for high-resolution display on a computer monitor or video projector. Wireless multi-channel headphone sets or personal hygiene headsets are designed for use with virtually all school audio equipment.
For outdoor assemblies or rallies, a megaphone or portable PA sound system projects the speaker's voice with exceptional sound and clarity. Wall-mounted computer stations or a computer kiosk are exceptional tools for a hospital patient room or a library. Mobile video conferencing cabinets, overhead projectors and projection screens are perfect for use in college lecture halls and boardrooms. All of our audio visual products are quality-constructed of durable materials for long-term use in your classroom, office, conference room, lecture hall, or auditorium. They have been designed to enhance the efficiency of lectures, presentations and lessons. With a large selection to choose from, you will be sure to find the items you need when shopping with us at K-Log.


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Welcome to another installment of The Toolbox, where I'll be discussing my favorite brushes and beauty tools. Today's entry is the Essence of Beauty Control Powder brush.
Unlike those floppy, huge powder brushes, this one offers better control and very densely packed bristles. Powder products get put in their place.
It's easier to use than it looks. One might think too much powder ends up on the face when using this brush, but I find that careful strokes with the brush allows the powder to disperse evenly across the skin's surface, without dusting away most of the powder.
Intended for: Facial powder.
Where it lives: One in my pro kit, one in my personal kit.
Price: $7-ish
Alternatives: I have not found one, but if you think you know of one, leave a comment!


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Toontrack are offering two of their products for free in celebration of Songwriter's Month. The products on offer are EZdrummer lite, a limited version of the multi-mic drum sampler EZdrummer, and EZmix 2 lite, a stripped down version of the widely popular preset powered multi-effect mix tool EZmix 2. This offer is running now and closes on May 31.
Press Release:
This Wednesday sees the return of Toontrack's annual Songwriter's Month celebrations and the Swedish developers are kicking things off early by offering you FREE software!
From now until 31st May, you can download EZdrummer Lite and/or EZmix 2 Lite absolutely free and get a taste for how these acclaimed plug-ins can make a difference to your music productions.
The Lite plug-ins are stripped down versions of the full software and, once you've tried them out, if you want to get your hands on the full version, you can upgrade for a great value price!
So, whether you´re looking for an easy to use drum sampler or a mixing tool that delivers professional results in just a few clicks, download EZdrummer Lite or EZmix 2 Lite now.
Want to dive in deeper straight away?
Starting today, the full versions of EZdrummer and EZmix 2 will be reduced by up to 40% to match the EZ Lite Upgrade prices - this means if you're already confident you're going to love these products you can buy them straight away without trying out the Lite version first!
EZdrummer and EZdrummer Lite Upgrade - only £53.95 each
EZmix 2 and EZmix 2 Upgrade – only £76.95 each
Offers available from 29th April to 31st May inclusive.


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221 East 18th StreetApt. 2K
Between Beverley Road and Albemarle Road Prospect Park South
This home has been sold
We have no similar homes for sale.
Subway Lines
Nearby Subway Stations
- Price$225,000
- TypeCo-op
- Bedrooms1.5
- Bathroom1
- Rooms4
Key Features
- Elevator
Welcome home to this beautifully kept, renovated junior four (1 bedroom + large foyer + home office) apartment in Central Ditmas Park. Located just 1.5 blocks from Q train at Beverley Road, 2 blocks from all that Cortelyou Road has to offer and 4 blocks to Prospect Park... this location cannot be beat. The apartment offers approximately 950 sq feet of space to spread out and enjoy. Upon entry to the apartment you will find a spacious foyer, allowing for room to hang your coat and ease into your home. The renovated kitchen has plenty of counter space and a truly separate home office right off of it. The bedroom is spacious and offers two exposures- letting the daylight flood in as well as cool evening breezes. The living room is deep and easily fits a dining area for 6 or more guests. Four closets in the apartment allow for plenty of storage. This pre-war apartment is full of original detailing, and is part of a well run co-op. The building, with live-in super, offers storage, bike storage and laundry as well as a communal garden space to share with your friends. Call for private showing.
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Prospect Park South
Runs from Parkside Avenue to the north, Coney Island Avenue to the west, Beverley Road to the south and Ocean Avenue to the east.
Developed in the late 1800s as a "country in the city" and landmarked in 1979, Prospect Park South offers house-hunters large, unique and architecturally significant properties. Whether you are looking for a Victorian, Queen Anne or a Colonial, or be it French Revival, Arts and Crafts, or Spanish Mission you crave, you just might find it among the 206 well-preserved single-family houses to be found in the exceptional Prospect Park South. That's because this charming and exclusive community is zoned for one-family houses; each lies on a lot that's 50 by 100 feet, at a minimum, and is set back 30 to 40 feet from the curb. Wraparound porches, seven or eight bedrooms, working fireplaces, attics and parking are some of the rare-for-the-city amenities available in Prospect Park South houses. The Prospect Park South neighborhood also has one rental building with 61 units, one 29-unit co-op and has recently added some brand new condominiums.
221 East 18th Street
Marlborough Rd - Beverly Rd7 mins
Marlborough Rd - Beverly Rd7 mins
- Prewar
- Built in 1940
- 6 floors
- 60 units
- Elevator
- Alarm system
- Central laundry room
- Common courtyard
- Common garden
- Common storage