Wednesday, December 10, 2014
America’s Toughest, Ugliest Warplane Is Going Back Into Battle
For more than 30 years, the A-10 Thunderbolt II—better known as the Warthog because it’s so ugly—has performed a crucial role: attacking hostile targets that threaten troops on the ground, a task called close air support. The plane, designed for the Cold War, is old. It’s slow. And it’s about as sophisticated as a hammer. But it is heavily armored and wickedly armed, making it a ruthlessly effective weapon. And that is why, despite ongoing efforts by Defense Department brass to kill it, the Warthog is headed back into battle to help in the fight against ISIS.
An undisclosed number of Warthogs, part of the “Blacksnakes” 163rd Expeditionary Fighter Squadron based at Fort Wayne, Indiana, have been deployed to Middle Eastern airbases to provide air cover to troops fighting ISIS in Iraq and Syria.
That makes the A-10 something of a zombie—it refuses to die. The Air Force wants to scuttle the 238 A-10s still in service, a move that would save $3.7 billion over five years—and make way for more sophisticated planes like the new F-35 Lightning II. But given the crucial role it plays providing close air support, something particularly helpful against enemies in a place like Iraq, the A-10 has many staunch defenders, including Senator John McCain.
Close air support is a vital job that, when properly executed, can mean the difference between life and death for soldiers. It’s highly dangerous, because it requires flying at altitudes low enough to discern friend from foe, leaving the plane particularly vulnerable to ground-based anti-aircraft fire. The A-10, little more than a flying tank, is perfectly suited to the task and beloved by pilots and troops alike.
“It’s a game-changer,” Gen. John F. Campbell, the Army’s vice chief of staff, told The Washington Post earlier this year. “It’s ugly. It’s loud, but when it comes in and you hear that pffffff [of the cannon], it just makes a difference.” Army Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, called it “the ugliest, most beautiful aircraft on the planet.”
What makes the plane’s continued relevance so impressive is the fact it was designed more than 40 years ago, and a new one hasn’t been built since 1984.
The Fairchild Republic A-10 was developed in the 1960s and 1970s, even as American helicopters were being shot down in Vietnam with frightening regularity. It was the first airplane designed specifically for close air support, with the goal of defending soldiers against artillery, tanks and other weapons.
It was basically designed to “take apart a Soviet tank,” says Jeffery S. Underwood, a historian at the United States Air Force Museum at Wright-Patterson Air Force Base in Ohio. To that end, the A-10 typically is equipped with the AGM-65 Maverick air-to-surface missile and is capable of carrying many other armaments, including AIM-9 Sidewinder air-to-air missiles.
But its primary weapon is a seven-barrel GAU-8 Avenger Gatling cannon. It measures 9 feet long and fires 30mm armor-piercing shells which are held in a drum not quite six feet in diameter. It can spit them out at a rate of 3,900 rounds per minute, and accounts for some 16 percent of the plane’s unladen weight. The gun is so large and so integral to the A-10, that the airplane is effectively built around it. In fact, when the gun is removed for maintenance, the tail of the plane must be supported to keep it from falling over.
But all that firepower is useless if the plane can be easily shot down. “Close air support means you’re close to people,” says Underwood. That means you’re flying low, too — often just a few hundred feet up. Easy prey for anyone with bad intentions. The cockpit sits in what amounts to a 1,200-pound titanium tub, specifically designed to withstand fire from 23mm anti-aircraft shells at close range. The A-10 can take a ton of abuse, and continue flying if it’s lost an engine, a tail or even half of a wing.
An undisclosed number of Warthogs, part of the “Blacksnakes” 163rd Expeditionary Fighter Squadron based at Fort Wayne, Indiana, have been deployed to Middle Eastern airbases to provide air cover to troops fighting ISIS in Iraq and Syria.That makes the A-10 something of a zombie—it refuses to die. The Air Force wants to scuttle the 238 A-10s still in service, a move that would save $3.7 billion over five years—and make way for more sophisticated planes like the new F-35 Lightning II. But given the crucial role it plays providing close air support, something particularly helpful against enemies in a place like Iraq, the A-10 has many staunch defenders, including Senator John McCain.
Close air support is a vital job that, when properly executed, can mean the difference between life and death for soldiers. It’s highly dangerous, because it requires flying at altitudes low enough to discern friend from foe, leaving the plane particularly vulnerable to ground-based anti-aircraft fire. The A-10, little more than a flying tank, is perfectly suited to the task and beloved by pilots and troops alike.
“It’s a game-changer,” Gen. John F. Campbell, the Army’s vice chief of staff, told The Washington Post earlier this year. “It’s ugly. It’s loud, but when it comes in and you hear that pffffff [of the cannon], it just makes a difference.” Army Gen. Martin Dempsey, chairman of the Joint Chiefs of Staff, called it “the ugliest, most beautiful aircraft on the planet.”
What makes the plane’s continued relevance so impressive is the fact it was designed more than 40 years ago, and a new one hasn’t been built since 1984.
The Fairchild Republic A-10 was developed in the 1960s and 1970s, even as American helicopters were being shot down in Vietnam with frightening regularity. It was the first airplane designed specifically for close air support, with the goal of defending soldiers against artillery, tanks and other weapons.
It was basically designed to “take apart a Soviet tank,” says Jeffery S. Underwood, a historian at the United States Air Force Museum at Wright-Patterson Air Force Base in Ohio. To that end, the A-10 typically is equipped with the AGM-65 Maverick air-to-surface missile and is capable of carrying many other armaments, including AIM-9 Sidewinder air-to-air missiles.
But its primary weapon is a seven-barrel GAU-8 Avenger Gatling cannon. It measures 9 feet long and fires 30mm armor-piercing shells which are held in a drum not quite six feet in diameter. It can spit them out at a rate of 3,900 rounds per minute, and accounts for some 16 percent of the plane’s unladen weight. The gun is so large and so integral to the A-10, that the airplane is effectively built around it. In fact, when the gun is removed for maintenance, the tail of the plane must be supported to keep it from falling over.
But all that firepower is useless if the plane can be easily shot down. “Close air support means you’re close to people,” says Underwood. That means you’re flying low, too — often just a few hundred feet up. Easy prey for anyone with bad intentions. The cockpit sits in what amounts to a 1,200-pound titanium tub, specifically designed to withstand fire from 23mm anti-aircraft shells at close range. The A-10 can take a ton of abuse, and continue flying if it’s lost an engine, a tail or even half of a wing.
by Jordan Golson, Wired | Read more:
Image: Greg L. Davis
h/t Scott
h/t Scott
Two Futures Can Explain Time's Mysterious Past
Physicists have a problem with time.
Whether through Newton’s gravitation, Maxwell’s electrodynamics, Einstein’s special and general relativity or quantum mechanics, all the equations that best describe our universe work perfectly if time flows forward or backward.
Of course the world we experience is entirely different. The universe is expanding, not contracting. Stars emit light rather than absorb it, and radioactive atoms decay rather than reassemble. Omelets don’t transform back to unbroken eggs and cigarettes never coalesce from smoke and ashes. We remember the past, not the future, and we grow old and decrepit, not young and rejuvenated. For us, time has a clear and irreversible direction. It flies forward like a missile, equations be damned.
For more than a century, the standard explanation for “time’s arrow,” as the astrophysicist Arthur Eddington first called it in 1927, has been that it is an emergent property of thermodynamics, as first laid out in the work of the 19th-century Austrian physicist Ludwig Boltzmann. In this view what we perceive as the arrow of time is really just the inexorable rearrangement of highly ordered states into random, useless configurations, a product of the universal tendency for all things to settle toward equilibrium with one another.
Informally speaking, the crux of this idea is that “things fall apart,” but more formally, it is a consequence of the second law of thermodynamics, which Boltzmann helped devise. The law states that in any closed system (like the universe itself), entropy—disorder—can only increase. Increasing entropy is a cosmic certainty because there are always a great many more disordered states than orderly ones for any given system, similar to how there are many more ways to scatter papers across a desk than to stack them neatly in a single pile.
The thermodynamic arrow of time suggests our observable universe began in an exceptionally special state of high order and low entropy, like a pristine cosmic egg materializing at the beginning of time to be broken and scrambled for all eternity. From Boltzmann’s era onward, scientists allergic to the notion of such an immaculate conception have been grappling with this conundrum.
Boltzmann, believing the universe to be eternal in accordance with Newton’s laws, thought that eternity could explain a low-entropy origin for time’s arrow. Given enough time—endless time, in fact—anything that can happen will happen, including the emergence of a large region of very low entropy as a statistical fluctuation from an ageless, high-entropy universe in a state of near-equilibrium. Boltzmann mused that we might live in such an improbable region, with an arrow of time set by the region’s long, slow entropic slide back into equilibrium. (...)
Many of the modern explanations for a low-entropy arrow of time involve a theory called inflation—the idea that a strange burst of antigravity ballooned the primordial universe to an astronomically larger size, smoothing it out into what corresponds to a very low-entropy state from which subsequent cosmic structures could emerge. But explaining inflation itself seems to require even more fine-tuning. One of the problems is that once begun, inflation tends to continue unstoppably. This “eternal inflation” would spawn infinitudes of baby universes about which predictions and observations are, at best, elusive. Whether this is an undesirable bug or a wonderful feature of the theory is a matter of fierce debate; for the time being it seems that inflation’s extreme flexibility and explanatory power are both its greatest strength and its greatest weakness.
For all these reasons, some scientists seeking a low-entropy origin for time’s arrow find explanations relying on inflation slightly unsatisfying. “There are many researchers now trying to show in some natural way why it’s reasonable to expect the initial entropy of the universe to be very low,” says David Albert, a philosopher and physicist at Columbia University. “There are even some who think that the entropy being low at the beginning of the universe should just be added as a new law of physics.”
That latter idea is tantamount to despairing cosmologists simply throwing in the towel. Fortunately, there may be another way.
Tentative new work from Julian Barbour of the University of Oxford, Tim Koslowski of the University of New Brunswick and Flavio Mercati of the Perimeter Institute for Theoretical Physics suggests that perhaps the arrow of time doesn’t really require a fine-tuned, low-entropy initial state at all but is instead the inevitable product of the fundamental laws of physics. Barbour and his colleagues argue that it is gravity, rather than thermodynamics, that draws the bowstring to let time’s arrow fly. Their findings were published in October in Physical Review Letters.
The team’s conclusions come from studying an exceedingly simple proxy for our universe, a computer simulation of 1,000 pointlike particles interacting under the influence of Newtonian gravity. They investigated the dynamic behavior of the system using a measure of its "complexity," which corresponds to the ratio of the distance between the system’s closest pair of particles and the distance between the most widely separated particle pair. The system’s complexity is at its lowest when all the particles come together in a densely packed cloud, a state of minimum size and maximum uniformity roughly analogous to the big bang. The team’s analysis showed that essentially every configuration of particles, regardless of their number and scale, would evolve into this low-complexity state. Thus, the sheer force of gravity sets the stage for the system’s expansion and the origin of time’s arrow, all without any delicate fine-tuning to first establish a low-entropy initial condition.
From that low-complexity state, the system of particles then expands outward in bothtemporal directions, creating two distinct, symmetric and opposite arrows of time. Along each of the two temporal paths, gravity then pulls the particles into larger, more ordered and complex structures—the model’s equivalent of galaxy clusters, stars and planetary systems. From there, the standard thermodynamic passage of time can manifest and unfold on each of the two divergent paths. In other words, the model has one past but two futures. As hinted by the time-indifferent laws of physics, time’s arrow may in a sense move in two directions, although any observer can only see and experience one. “It is the nature of gravity to pull the universe out of its primordial chaos and create structure, order and complexity,” Mercati says. “All the solutions break into two epochs, which go on forever in the two time directions, divided by this central state which has very characteristic properties.”
Although the model is crude, and does not incorporate either quantum mechanics or general relativity, its potential implications are vast. If it holds true for our actual universe, then the big bang could no longer be considered a cosmic beginning but rather only a phase in an effectively timeless and eternal universe. More prosaically, a two-branched arrow of time would lead to curious incongruities for observers on opposite sides. “This two-futures situation would exhibit a single, chaotic past in both directions, meaning that there would be essentially two universes, one on either side of this central state,” Barbour says. “If they were complicated enough, both sides could sustain observers who would perceive time going in opposite directions. Any intelligent beings there would define their arrow of time as moving away from this central state. They would think we now live in their deepest past.”
Whether through Newton’s gravitation, Maxwell’s electrodynamics, Einstein’s special and general relativity or quantum mechanics, all the equations that best describe our universe work perfectly if time flows forward or backward.
Of course the world we experience is entirely different. The universe is expanding, not contracting. Stars emit light rather than absorb it, and radioactive atoms decay rather than reassemble. Omelets don’t transform back to unbroken eggs and cigarettes never coalesce from smoke and ashes. We remember the past, not the future, and we grow old and decrepit, not young and rejuvenated. For us, time has a clear and irreversible direction. It flies forward like a missile, equations be damned.For more than a century, the standard explanation for “time’s arrow,” as the astrophysicist Arthur Eddington first called it in 1927, has been that it is an emergent property of thermodynamics, as first laid out in the work of the 19th-century Austrian physicist Ludwig Boltzmann. In this view what we perceive as the arrow of time is really just the inexorable rearrangement of highly ordered states into random, useless configurations, a product of the universal tendency for all things to settle toward equilibrium with one another.
Informally speaking, the crux of this idea is that “things fall apart,” but more formally, it is a consequence of the second law of thermodynamics, which Boltzmann helped devise. The law states that in any closed system (like the universe itself), entropy—disorder—can only increase. Increasing entropy is a cosmic certainty because there are always a great many more disordered states than orderly ones for any given system, similar to how there are many more ways to scatter papers across a desk than to stack them neatly in a single pile.
The thermodynamic arrow of time suggests our observable universe began in an exceptionally special state of high order and low entropy, like a pristine cosmic egg materializing at the beginning of time to be broken and scrambled for all eternity. From Boltzmann’s era onward, scientists allergic to the notion of such an immaculate conception have been grappling with this conundrum.
Boltzmann, believing the universe to be eternal in accordance with Newton’s laws, thought that eternity could explain a low-entropy origin for time’s arrow. Given enough time—endless time, in fact—anything that can happen will happen, including the emergence of a large region of very low entropy as a statistical fluctuation from an ageless, high-entropy universe in a state of near-equilibrium. Boltzmann mused that we might live in such an improbable region, with an arrow of time set by the region’s long, slow entropic slide back into equilibrium. (...)
Many of the modern explanations for a low-entropy arrow of time involve a theory called inflation—the idea that a strange burst of antigravity ballooned the primordial universe to an astronomically larger size, smoothing it out into what corresponds to a very low-entropy state from which subsequent cosmic structures could emerge. But explaining inflation itself seems to require even more fine-tuning. One of the problems is that once begun, inflation tends to continue unstoppably. This “eternal inflation” would spawn infinitudes of baby universes about which predictions and observations are, at best, elusive. Whether this is an undesirable bug or a wonderful feature of the theory is a matter of fierce debate; for the time being it seems that inflation’s extreme flexibility and explanatory power are both its greatest strength and its greatest weakness.
For all these reasons, some scientists seeking a low-entropy origin for time’s arrow find explanations relying on inflation slightly unsatisfying. “There are many researchers now trying to show in some natural way why it’s reasonable to expect the initial entropy of the universe to be very low,” says David Albert, a philosopher and physicist at Columbia University. “There are even some who think that the entropy being low at the beginning of the universe should just be added as a new law of physics.”
That latter idea is tantamount to despairing cosmologists simply throwing in the towel. Fortunately, there may be another way.
Tentative new work from Julian Barbour of the University of Oxford, Tim Koslowski of the University of New Brunswick and Flavio Mercati of the Perimeter Institute for Theoretical Physics suggests that perhaps the arrow of time doesn’t really require a fine-tuned, low-entropy initial state at all but is instead the inevitable product of the fundamental laws of physics. Barbour and his colleagues argue that it is gravity, rather than thermodynamics, that draws the bowstring to let time’s arrow fly. Their findings were published in October in Physical Review Letters.
The team’s conclusions come from studying an exceedingly simple proxy for our universe, a computer simulation of 1,000 pointlike particles interacting under the influence of Newtonian gravity. They investigated the dynamic behavior of the system using a measure of its "complexity," which corresponds to the ratio of the distance between the system’s closest pair of particles and the distance between the most widely separated particle pair. The system’s complexity is at its lowest when all the particles come together in a densely packed cloud, a state of minimum size and maximum uniformity roughly analogous to the big bang. The team’s analysis showed that essentially every configuration of particles, regardless of their number and scale, would evolve into this low-complexity state. Thus, the sheer force of gravity sets the stage for the system’s expansion and the origin of time’s arrow, all without any delicate fine-tuning to first establish a low-entropy initial condition.
From that low-complexity state, the system of particles then expands outward in bothtemporal directions, creating two distinct, symmetric and opposite arrows of time. Along each of the two temporal paths, gravity then pulls the particles into larger, more ordered and complex structures—the model’s equivalent of galaxy clusters, stars and planetary systems. From there, the standard thermodynamic passage of time can manifest and unfold on each of the two divergent paths. In other words, the model has one past but two futures. As hinted by the time-indifferent laws of physics, time’s arrow may in a sense move in two directions, although any observer can only see and experience one. “It is the nature of gravity to pull the universe out of its primordial chaos and create structure, order and complexity,” Mercati says. “All the solutions break into two epochs, which go on forever in the two time directions, divided by this central state which has very characteristic properties.”
Although the model is crude, and does not incorporate either quantum mechanics or general relativity, its potential implications are vast. If it holds true for our actual universe, then the big bang could no longer be considered a cosmic beginning but rather only a phase in an effectively timeless and eternal universe. More prosaically, a two-branched arrow of time would lead to curious incongruities for observers on opposite sides. “This two-futures situation would exhibit a single, chaotic past in both directions, meaning that there would be essentially two universes, one on either side of this central state,” Barbour says. “If they were complicated enough, both sides could sustain observers who would perceive time going in opposite directions. Any intelligent beings there would define their arrow of time as moving away from this central state. They would think we now live in their deepest past.”
by Lee Billings, Scientific American | Read more:
Image: NASA; ESA; G. Illingworth, D. Magee, and P. Oesch
Tuesday, December 9, 2014
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Three-Point Lighting
Three-point lighting is a standard method used in visual media such as theatre, video, film, still photography and computer-generated imagery. By using three separate positions, the photographer can illuminate the shot's subject (such as a person) however desired, while also controlling (or eliminating entirely) the shading and shadows produced by direct lighting.
The key light, as the name suggests, shines directly upon the subject and serves as its principal illuminator; more than anything else, the strength, color and angle of the key determines the shot's overall lighting design.
In indoor shots, the key is commonly a specialized lamp, or a camera's flash. In outdoor daytime shots, the Sun often serves as the key light. In this case, of course, the photographer cannot set the light in the exact position he or she wants, so instead arranges it to best capture the sunlight, perhaps after waiting for the sun to position itself just right.
The fill light also shines on the subject, but from a side angle relative to the key and is often placed at a lower position than the key (about at the level of the subject's face). It balances the key by illuminating shaded surfaces, and lessening or eliminating chiaroscuro effects, such as the shadow cast by a person's nose upon the rest of the face. It is usually softer and less bright than the key light (up to half), and more to a flood. Not using a fill at all can result in stark contrasts (due to shadows) across the subject's surface, depending upon the key light's harshness. Sometimes, as in low-key lighting, this is a deliberate effect, but shots intended to look more natural and less stylistic require a fill.
In some situations a photographer can use a reflector (such as a piece of white cardstock mounted off-camera, or even a white-painted wall) as a fill light instead of an actual lamp. Reflecting and redirecting the key light's rays back upon the subject from a different angle can cause a softer, subtler effect than using another lamp.
The back light (a.k.a. the rim, hair, or shoulder light) shines on the subject from behind, often (but not necessarily) to one side or the other. It gives the subject a rim of light, serving to separate the subject from the background and highlighting contours.
Back light or rim light is different from a kick in that a kick (or kicker) contributes to a portion of the shading on the visible surface of the subject, while a rim light only creates a thin outline around the subject without necessarily hitting the front (visible) surface of the subject at all.
The key light, as the name suggests, shines directly upon the subject and serves as its principal illuminator; more than anything else, the strength, color and angle of the key determines the shot's overall lighting design.In indoor shots, the key is commonly a specialized lamp, or a camera's flash. In outdoor daytime shots, the Sun often serves as the key light. In this case, of course, the photographer cannot set the light in the exact position he or she wants, so instead arranges it to best capture the sunlight, perhaps after waiting for the sun to position itself just right.
The fill light also shines on the subject, but from a side angle relative to the key and is often placed at a lower position than the key (about at the level of the subject's face). It balances the key by illuminating shaded surfaces, and lessening or eliminating chiaroscuro effects, such as the shadow cast by a person's nose upon the rest of the face. It is usually softer and less bright than the key light (up to half), and more to a flood. Not using a fill at all can result in stark contrasts (due to shadows) across the subject's surface, depending upon the key light's harshness. Sometimes, as in low-key lighting, this is a deliberate effect, but shots intended to look more natural and less stylistic require a fill.In some situations a photographer can use a reflector (such as a piece of white cardstock mounted off-camera, or even a white-painted wall) as a fill light instead of an actual lamp. Reflecting and redirecting the key light's rays back upon the subject from a different angle can cause a softer, subtler effect than using another lamp.
The back light (a.k.a. the rim, hair, or shoulder light) shines on the subject from behind, often (but not necessarily) to one side or the other. It gives the subject a rim of light, serving to separate the subject from the background and highlighting contours.
Back light or rim light is different from a kick in that a kick (or kicker) contributes to a portion of the shading on the visible surface of the subject, while a rim light only creates a thin outline around the subject without necessarily hitting the front (visible) surface of the subject at all.
by Wikipedia | Read more:
Image: James Jeffrey
The Japanese Art of Decluttering and Organizing
[ed. When I left Alaska after 35 years I decided to take only two kinds of things: 1) stuff that was essential to what I needed going forward; and 2) things that were of long-term sentimental value. I can't tell you how liberating the process was. When I put my garage sale together I found I had 12 pairs of hip boots. Eight coolers. Sixteen fishing rods. Seven pairs of skis. Two battery chargers. A boat I hadn't used for 10 years. Two hundred+ books. And enough dishes and cookware to feed a White House diplomatic dinner. Now I've got just a few things that connect me to my past, things that make me happy, and I have no desire to acquire anything else (eh, except for maybe a motorcycle). I'd recommend this for anyone. Do you really want to tote all that junk around when you move, store it somewhere, or leave it for your kids to have to deal with when you're gone? (You know it's all going to end up in Goodwill anyway, right?).]
The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing explores how putting your space in order causes “correspondingly dramatic changes in lifestyle and perspective.” Marie Kondo, the author, recommends that you defy conventional wisdom and start by discarding and only then thoroughly organize your space in one go.All of this seems more relevant than ever. We’re surrounded by things only to buy more things. We have no idea what we have or what we need. Worse, most of these things are not things that we love. Getting rid of things and simplifying your life sounds easier than it is. In part because when we get down to it, we just don’t know how to make those decisions between what to keep and what to throw away.
Her approach is not a simple technique. It addresses why most people fail to stay tidy.
The act of tidying is a series of simple actions in which objects are moved from one place to another. It involves putting things away where they belong. This seems so simple that even a six-year-old should be able to do it. Yet most people can’t. A short time after tidying, their space is a disorganized mess. The cause is not lack of skills but rather lack of awareness and the inability to make tidying a regular habit. In other words, the root of the problem lies in the mind. Success is 90 percent dependent on our mind-set.To acquire the right mindset, she argues, we need the right technique. There is a fundamental misconception that the ability to tidy comes from experience. Most of us tidy up a little bit at a time. We should however tidy up in one shot. This brings visible results.
A change so profound that it touches your emotions will irresistibly affect your way of thinking and your lifestyle habits. …
When people revert to clutter no matter how much they tidy, it is not their room or their belongings but their way of thinking that is at fault. Even if they are initially inspired, they can’t stay motivated and their efforts peter out. The root cause lies in the fact that they can’t see the results or feel the effects. This is precisely why success depends on experiencing tangible results immediately. If you use the right method and concentrate your efforts on eliminating clutter thoroughly and completely within a short span of time, you’ll see instant results that will empower you to keep your space in order ever after.What is Tidying?
She breaks down the physical act of tidying into two aspects: “deciding whether or not to dispose of something and deciding where to put it.” Tidying is a tool, not an end. “The true goal,” she writes, “should be to establish the lifestyle you want most once your house has been put in order.”
There is a saying that “a messy room equals a messy mind.”
There is a saying that “a messy room equals a messy mind.”
When a room becomes cluttered, the cause is more than just physical. Visible mess helps distract us from the true source of the disorder. The act of cluttering is really an instinctive reflex that draws our attention away from the heart of an issue.Why Storage Experts are not the Answer
We all want the quick solution: organize my junk better. But this does nothing to get rid of clutter.
What is the first problem that comes to mind when you think of tidying? For many, the answer is storage. My clients often want me to teach them what to put where. Believe me, I can relate, but unfortunately, this is not the real issue. A booby trap lies within the term “storage.” Features on how to organize and store your belongings and convenient storage products are always accompanied by stock phrases that make it sound simple, such as “organize your space in no time” or “make tidying fast and easy.” It’s human nature to take the easy route, and most people leap at storage methods that promise quick and convenient ways to remove visible clutter.
[…]
Putting things away creates the illusion that the clutter problem has been solved.Why Tidying by Location is a Fatal Mistake
Kondo exposes why tidying by location doesn’t address the problem and recommends a way to avoid this common pitfall.
The root of the problem lies in the fact that people often store the same type of item in more than one place. When we tidy each place separately, we fail to see that we’re repeating the same work in many locations and become locked into a vicious circle of tidying. To avoid this, I recommend tidying by category. For example, instead of deciding that today you’ll tidy a particular room, set goals like “clothes today, books tomorrow.” One reason so many of us never succeed at tidying is because we have too much stuff. This excess is caused by our ignorance of how much we actually own. When we disperse storage of a particular item throughout the house and tidy one place at a time, we can never grasp the overall volume and therefore can never finish. To escape this negative spiral, tidy by category, not by place. (...)Start by Discarding
The secret to success is to “tidy in one shot, as quickly and completely as possible, and to start by discarding.”
Do not even think of putting your things away until you have finished the process of discarding. Failure to follow this order is one reason many people never make permanent progress. In the middle of discarding, they start thinking about where to put things. As soon as they think, “I wonder if it will fit in this drawer,” the work of discarding comes to a halt. You can think about where to put things when you’ve finished getting rid of everything you don’t need.Deciding what to discard
This is where people often have the most trouble. Until reading The Life-Changing Magic of Tidying Up, I focused on how to throw things away, not why.
Kondo, however, totally changed my perspective on this.
There are several common patterns when it comes to discarding. One is to discard things when they cease being functional— for example, when something breaks down beyond repair or when part of a set is broken. Another is to discard things that are out of date, such as clothes that are no longer in fashion or things related to an event that has passed. It’s easy to get rid of things when there is an obvious reason for doing so. It’s much more difficult when there is no compelling reason. Various experts have proposed yardsticks for discarding things people find hard to part with. These include such rules as “discard anything you haven’t used for a year,” and “if you can’t decide, pack those items away in a box and look at them again six months later.” However, the moment you start focusing on how to choose what to throw away, you have actually veered significantly off course.A better approach is to choose what you keep, not what you dispose of.
I had been so focused on what to discard, on attacking the unwanted obstacles around me, that I had forgotten to cherish the things that I loved, the things I wanted to keep. Through this experience, I came to the conclusion that the best way to choose what to keep and what to throw away is to take each item in one’s hand and ask: “Does this spark joy?” If it does, keep it. If not, dispose of it. This is not only the simplest but also the most accurate yardstick by which to judge.You may wonder about the effectiveness of such a vague criteria, but the trick is to handle each item. Don’t just open up your closet and decide after a cursory glance that everything in it gives you a thrill. You must take each outfit in your hand. When you touch a piece of clothing, your body reacts. Its response to each item is different. Trust me and try it.
…
Keep only those things that speak to your heart. Then take the plunge and discard all the rest. By doing this, you can reset your life and embark on a new lifestyle.
by Shane Parrish, Farnam Street | Read more:
Image: uncredited
Risky Medicine
Misunderstanding risk factors has led to massive overtreatment of diseases people don’t have and probably never will.
Most health-conscious people are familiar with the concept of risk factors for disease. We’re too familiar, in fact. A risk factor is like the guest that nobody invited to the party, a spoiler. Though we might feel fine now, our individual risk for (fill in the blank) tells us that our wellbeing might not last. That vague and remote prospect of a stroke or a tumour has taken on a sharply numerical precision, thanks to screening tests that expose and quantify our risk factors.
The term stems from the Framingham Heart Study, which began in 1948. Ever since, researchers have measured the variables that contribute to cardiovascular disease in multiple generations of residents of the town of Framingham in Massachusetts. The participants did not have cardiovascular disease when they enrolled, but researchers routinely recorded factors suspected in disease onset, including blood pressure, cholesterol levels, and whether or not the person smoked.
Since no single factor was able to predict the heart attacks that occurred in Framingham, the study designers thought to combine half a dozen of them in what became the first numerical risk calculator, called the Framingham Risk Score. The researchers figured the relative importance of each risk factor after examining thousands of health histories. The combined risk score enabled doctors to make predictions that were borne out in future patients as the study proceeded.
Dozens of risk calculators are in service today, covering all medical specialties and organ systems. But since Framingham, risk factors have acquired an unwarranted power. Doctors try to manage them as if they’re the disease itself and, as a result, patients are subjected not only to undue worry but also to the harmful side effects of preventive medications and testing.
What’s more, in medicine’s version of mission-creep, the thresholds for many risk factors have been lowered so as to encompass ever larger pools of patients. People who believed they were normal in a particular health category abruptly learn that they are not – and that they probably need treatment. That they lack symptoms is misleading. Today’s patient is declared to be in good health not because she feels well, but because her latest scan or blood work indicates no abnormalities.
Robert Aronowitz, a historian of medicine and medical doctor at the University of Pennsylvania, points out that when drug companies are able to treat people who might become sick, as opposed to patients with symptoms, the market is a lot larger. Once put into the at-risk category, they might be taking medication for the rest of their lives. Aronowitz gives hypertension (high blood pressure) as an example: a risk factor for heart disease and stroke, it makes the arteries more prone to blockage and rupture. The first drugs developed for hypertension were used to treat people showing obvious signs of spiking pressure, such as shortness of breath and nosebleeds. Next, the medications were extended to people without symptoms who nonetheless had hypertension upon measurement – a systolic pressure (when the heart is pumping) of below 140, and a diastolic pressure (when the heart is at rest) of below 90. These patients, a much larger population, numbering in the tens of millions, had to be screened to be identified.
The threshold of what constituted a safe level of blood pressure ‘was gradually lowered’, writes Aronowitz. ‘And finally a new disorder, prehypertension, was defined and promoted, such that another segment of the population could be screened, labelled, and treated.’ ‘Prehypertension’ represents a systolic pressure of between 120 and 140, and a diastolic pressure of 80 to 90. Those ranges used to be considered normal, but not anymore.
Recently, the American Heart Association (AHA) recognised that things had gone too far. Since studies had shown that blood-pressure medication was of no benefit to those with prehypertension, the AHA raised the level at which people aged 60 and over should start taking drugs. Now the recommended trigger is a systolic pressure of 150 or higher. With the change, some 7 million Americans, more than half of whom were taking medication, were moved out of the at-risk column. It’s unlikely that 3‑4 million people will drop their medications, however. Once launched, a medical regimen of that magnitude is hard to turn around.
There’s a more fundamental issue. Risk factors and risk calculators are reminders that medical science does not completely understand the mechanisms of disease. Risk factors are associations; they don’t represent cause-and-effect relationships unless the connection to the disease is especially strong, like the link between cigarettes and lung cancer. Risk factors are based on averages taken from large groups, and consequently the individual patient can’t know his or her true probability of contracting the condition. For any population, the calculator could accurately forecast the number of, say, heart attacks over a 10-year period, but the algorithm can’t identify who will succumb and who will be spared.
Thus the AHA, in releasing its latest risk calculator for heart attack and stroke, admitted that ‘no one has 10 per cent or 20 per cent of a heart attack during a 10-year period. Individuals with the same estimated risk will either have or not have the event of interest, and only those patients who are destined to have an event can have their event prevented by therapy.’ Which is to say that the majority of patients are going to dodge a bullet whether or not they use preventive therapy. The doctors, for their part, plead that they are only being conservative. Unsure of the basic biology of the disease, they overtreat the many in order to help the few.
Most health-conscious people are familiar with the concept of risk factors for disease. We’re too familiar, in fact. A risk factor is like the guest that nobody invited to the party, a spoiler. Though we might feel fine now, our individual risk for (fill in the blank) tells us that our wellbeing might not last. That vague and remote prospect of a stroke or a tumour has taken on a sharply numerical precision, thanks to screening tests that expose and quantify our risk factors.The term stems from the Framingham Heart Study, which began in 1948. Ever since, researchers have measured the variables that contribute to cardiovascular disease in multiple generations of residents of the town of Framingham in Massachusetts. The participants did not have cardiovascular disease when they enrolled, but researchers routinely recorded factors suspected in disease onset, including blood pressure, cholesterol levels, and whether or not the person smoked.
Since no single factor was able to predict the heart attacks that occurred in Framingham, the study designers thought to combine half a dozen of them in what became the first numerical risk calculator, called the Framingham Risk Score. The researchers figured the relative importance of each risk factor after examining thousands of health histories. The combined risk score enabled doctors to make predictions that were borne out in future patients as the study proceeded.
Dozens of risk calculators are in service today, covering all medical specialties and organ systems. But since Framingham, risk factors have acquired an unwarranted power. Doctors try to manage them as if they’re the disease itself and, as a result, patients are subjected not only to undue worry but also to the harmful side effects of preventive medications and testing.
What’s more, in medicine’s version of mission-creep, the thresholds for many risk factors have been lowered so as to encompass ever larger pools of patients. People who believed they were normal in a particular health category abruptly learn that they are not – and that they probably need treatment. That they lack symptoms is misleading. Today’s patient is declared to be in good health not because she feels well, but because her latest scan or blood work indicates no abnormalities.
Robert Aronowitz, a historian of medicine and medical doctor at the University of Pennsylvania, points out that when drug companies are able to treat people who might become sick, as opposed to patients with symptoms, the market is a lot larger. Once put into the at-risk category, they might be taking medication for the rest of their lives. Aronowitz gives hypertension (high blood pressure) as an example: a risk factor for heart disease and stroke, it makes the arteries more prone to blockage and rupture. The first drugs developed for hypertension were used to treat people showing obvious signs of spiking pressure, such as shortness of breath and nosebleeds. Next, the medications were extended to people without symptoms who nonetheless had hypertension upon measurement – a systolic pressure (when the heart is pumping) of below 140, and a diastolic pressure (when the heart is at rest) of below 90. These patients, a much larger population, numbering in the tens of millions, had to be screened to be identified.
The threshold of what constituted a safe level of blood pressure ‘was gradually lowered’, writes Aronowitz. ‘And finally a new disorder, prehypertension, was defined and promoted, such that another segment of the population could be screened, labelled, and treated.’ ‘Prehypertension’ represents a systolic pressure of between 120 and 140, and a diastolic pressure of 80 to 90. Those ranges used to be considered normal, but not anymore.
Recently, the American Heart Association (AHA) recognised that things had gone too far. Since studies had shown that blood-pressure medication was of no benefit to those with prehypertension, the AHA raised the level at which people aged 60 and over should start taking drugs. Now the recommended trigger is a systolic pressure of 150 or higher. With the change, some 7 million Americans, more than half of whom were taking medication, were moved out of the at-risk column. It’s unlikely that 3‑4 million people will drop their medications, however. Once launched, a medical regimen of that magnitude is hard to turn around.
There’s a more fundamental issue. Risk factors and risk calculators are reminders that medical science does not completely understand the mechanisms of disease. Risk factors are associations; they don’t represent cause-and-effect relationships unless the connection to the disease is especially strong, like the link between cigarettes and lung cancer. Risk factors are based on averages taken from large groups, and consequently the individual patient can’t know his or her true probability of contracting the condition. For any population, the calculator could accurately forecast the number of, say, heart attacks over a 10-year period, but the algorithm can’t identify who will succumb and who will be spared.
Thus the AHA, in releasing its latest risk calculator for heart attack and stroke, admitted that ‘no one has 10 per cent or 20 per cent of a heart attack during a 10-year period. Individuals with the same estimated risk will either have or not have the event of interest, and only those patients who are destined to have an event can have their event prevented by therapy.’ Which is to say that the majority of patients are going to dodge a bullet whether or not they use preventive therapy. The doctors, for their part, plead that they are only being conservative. Unsure of the basic biology of the disease, they overtreat the many in order to help the few.
by Jeff Wheelwright, Aeon | Read more:
Image: Brian Snyder/Reuters
Monday, December 8, 2014
Sunday, December 7, 2014
Do the Most Hipster Thing Possible—Move to Des Moines
[ed. I could live in Des Moines.]
Des Moines, Iowa—This is too nice a place to spawn a war cry. But if the city had one, it would be the sentiment heard across a downtown populated by baristas, tech start-up founders, musicians, and nonprofit professionals alike: "It's Des Moines against the world."
Des Moines, Iowa—This is too nice a place to spawn a war cry. But if the city had one, it would be the sentiment heard across a downtown populated by baristas, tech start-up founders, musicians, and nonprofit professionals alike: "It's Des Moines against the world."
Young people here know what you think of this city. It doesn't need repeating. But ambitious minds are in the process of building a new Des Moines, a tech hub in Silicon Prairie, an artistic center in the Heartland, a destination for people who want to create something meaningful outside of the limits imposed by an oversaturated city like Chicago or New York.
That's exactly what former Brooklynite Zachary Mannheimer sought seven years ago. Mannheimer, 36, had launched restaurants and theater projects in New York, but he wanted to find a city where he could tap local artistic talent and revitalize a stagnant urban community. He visited 22 cities in eight weeks during the summer of 2007, and fell for this Midwestern capital, where he founded the Des Moines Social Club, a nonprofit center for the arts. The Social Club is now lodged in an old firehouse built in 1937, and has a theater, classrooms, bars, art gallery, and adjoining restaurant—and it hosts events every night of the week. An average of 20,000 visitors come through every month, perhaps for a WWE-style wrestling match or an aerial arts class or a punk show. Mannheimer created something that would have taken the rest his life and $300 million to complete if he'd stayed in New York. It took him seven years and $12 million. He also left his crappy, expensive apartment in Brooklyn for comparatively lavish digs in Des Moines. Now, he wants people living in New York or Chicago or Washington to think about doing the same.
"How much are you working every day? How much are you being paid? How much is your cost of living?" Mannheimer asks. "What if I told you we have per capita the same amount of cultural amenities here that you do in New York? Get over your, 'How do we even pronounce Des Moines?' and 'Where is it?' and 'Why should I even care about it?' Get over it, and come out here and visit."
Besides, he says, "In the world of hipsters, is there anything more ironic than coming to live in Des Moines, as opposed to living in Brooklyn?"
On paper, Des Moines has the assets to back up Mannheimer's pitch: Cost of living is six percentage points below the national average, median salary is $51,200, job growth is 2.9 percent, there is one company with 500 or more employees for every 612 people, and millennials are pouring into Des Moines at a higher rather than they are nationally. Forbes even lists it as the best city for young professionals. (...)
"We always joke that Des Moines is a big small town," says Heggen, a project manager for a firm that transforms old art deco buildings into new apartments. "But really, Des Moines is a large living room. There's this homey feel. What I most want is everybody around me to be successful. And I believe that everyone wants that for me, as well."
Sanchez, too, moved to Des Moines "to start building things, to do something bigger than yourself." Her hope in starting a chapter, she says, was that maybe more young professionals would move to Des Moines. Or to borrow a line from a movie based in Iowa: If you build it, they will come.
Talking Heads frontman and Des Moines fan David Byrne touched on that idea at the Social Club's launch party in this same courtyard, where he pondered why a music scene or an artistic scene or a theater scene develops in any city. "What makes it happen?" he asked the crowd of 500. "It's hard to say. There's no guarantees, but it is possible and it's certainly not going to happen unless there are places like this. And, sad for me to say, it's not going to happen in Manhattan anymore, which means it's up to you guys."
by Matt Vasilogambros and Mauro Whiteman, National Journal | Read more:
Image: Wikipedia
Is It Selfish to Want an Afterlife?
“Do I really want it, this self, these scattered fingerprints on the air, to persist forever, to outlast the atomic universe?
Those who scoff at the Christian hope of an afterlife have on their side not only a mass of biological evidence knitting the self-conscious mind tight to the perishing body but a certain moral superiority as well: isn’t it terribly, well, selfish, and grotesquely egocentric, to hope for more than our animal walk in the sun, from eager blind infancy through the productive and procreative years into a senescence that, by the laws of biological instinct as well as by the premeditated precepts of stoic virtue, will submit to eternal sleep gratefully? Where, indeed, in the vast spaces disclosed by modern astronomy, would our disembodied spirit go, and, once there, what would it do?
In fact we do not try to picture the afterlife, nor is it our selves in our nervous tics and optical flecks that we wish to perpetuate; it is the self as window on the world that we can’t bear to think of shutting. My mind when I was a boy of ten or eleven sent up its silent screams at the thought of future aeons – at the thought of the cosmic party going on without me.
The yearning for an afterlife is the opposite of selfish: it is love and praise for the world that we are privileged, in this complex interval of light, to witness and experience. Though some believers may think of the afterlife as a place of retribution, where lives of poverty, distress, and illness will be compensated for, and where renunciations will be rewarded – where the last shall be first, in other words, and those that hunger and thirst shall be filled – the basic desire, as Unamuno says in his Tragic Sense of Life, is not for some otherworld but for this world, for life more or less as we know it to go on forever: ‘The immortality that we crave is a phenomenal immortality – it is the continuation of this present life.'”
by John Updike, Self-Consciousness: Memoirs, TBP | Read more:
Image: uncredited
Those who scoff at the Christian hope of an afterlife have on their side not only a mass of biological evidence knitting the self-conscious mind tight to the perishing body but a certain moral superiority as well: isn’t it terribly, well, selfish, and grotesquely egocentric, to hope for more than our animal walk in the sun, from eager blind infancy through the productive and procreative years into a senescence that, by the laws of biological instinct as well as by the premeditated precepts of stoic virtue, will submit to eternal sleep gratefully? Where, indeed, in the vast spaces disclosed by modern astronomy, would our disembodied spirit go, and, once there, what would it do?In fact we do not try to picture the afterlife, nor is it our selves in our nervous tics and optical flecks that we wish to perpetuate; it is the self as window on the world that we can’t bear to think of shutting. My mind when I was a boy of ten or eleven sent up its silent screams at the thought of future aeons – at the thought of the cosmic party going on without me.
The yearning for an afterlife is the opposite of selfish: it is love and praise for the world that we are privileged, in this complex interval of light, to witness and experience. Though some believers may think of the afterlife as a place of retribution, where lives of poverty, distress, and illness will be compensated for, and where renunciations will be rewarded – where the last shall be first, in other words, and those that hunger and thirst shall be filled – the basic desire, as Unamuno says in his Tragic Sense of Life, is not for some otherworld but for this world, for life more or less as we know it to go on forever: ‘The immortality that we crave is a phenomenal immortality – it is the continuation of this present life.'”
by John Updike, Self-Consciousness: Memoirs, TBP | Read more:
Image: uncredited
Friday, December 5, 2014
Will The Torture Report Be Buried After All?
This is an outrage:
Of course this complicates relationships with foreign countries; of course it guts any remaining credibility on human rights the US has; of course the staggering brutality endorsed by the highest echelons in American government will inflame American enemies and provoke disbelief across the civilized world. But that’s not the fault of the report; it’s the fault of the torture regime and its architects, many of whom have continued to operate with total impunity under president Obama.
Make no mistake about it: if this report is buried, it will be this president who made that call, and this president who has allowed this vital and minimal piece of accountability to be slow-walked to death and burial, and backed the CIA every inch of the way. But notice also the way in which Kerry’s phone-call effectively cuts the report off at its knees. If it is released, Obama will be able to say he tried to stop it, and to prevent the purported damage to US interests and personnel abroad. He will have found a way to distance himself from the core task of releasing this essential accounting. And he will have ensured that the debate over it will be about whether the report is endangering Americans, just as the Republican talking points have spelled out, rather than a first step to come to terms with the appalling, devastating truth of what the American government has done.
First, the Obama administration set up a white-wash, in the form of the Durham investigation; then they sat back as the CIA tried to sabotage the Senate Select Committee on Intelligence; then Obama’s chief of staff prevented the report’s publication for months, by insisting on redactions of the report to the point of it being near-unintelligible; and now, with mere days to go, the administration suddenly concludes that a factual accounting of this country’s descent into barbarism poses “an unacceptable risk” to US personnel abroad.Now, after this report has been stymied for two years; now, just days before its scheduled publication; now, because if the administration can prevent its publication this month, they know full well that the Republicans who will control the committee in January will bury the evidence of grotesque and widespread torture by the US for ever.Secretary of State John Kerry personally phoned Dianne Feinstein, chairman of the Senate Select Committee on Intelligence, Friday morning to ask her to delay the imminent release of her committee’s report on CIA torture and rendition during the George W. Bush administration, according to administration and Congressional officials. Kerry was not going rogue — his call came after an interagency process that decided the release of the report early next week, asFeinstein had been planning, could complicate relationships with foreign countries at a sensitive time and posed an unacceptable risk to U.S. personnel and facilities abroad.
Of course this complicates relationships with foreign countries; of course it guts any remaining credibility on human rights the US has; of course the staggering brutality endorsed by the highest echelons in American government will inflame American enemies and provoke disbelief across the civilized world. But that’s not the fault of the report; it’s the fault of the torture regime and its architects, many of whom have continued to operate with total impunity under president Obama.
Make no mistake about it: if this report is buried, it will be this president who made that call, and this president who has allowed this vital and minimal piece of accountability to be slow-walked to death and burial, and backed the CIA every inch of the way. But notice also the way in which Kerry’s phone-call effectively cuts the report off at its knees. If it is released, Obama will be able to say he tried to stop it, and to prevent the purported damage to US interests and personnel abroad. He will have found a way to distance himself from the core task of releasing this essential accounting. And he will have ensured that the debate over it will be about whether the report is endangering Americans, just as the Republican talking points have spelled out, rather than a first step to come to terms with the appalling, devastating truth of what the American government has done.
by Andrew Sullivan, The Dish | Read more:
Image: Charles Ommanney/Getty Images
Companions in Misery
The survey in question, conducted by the Centers for Disease Control and Prevention, asked how “satisfied” Americans were with their lives — very satisfied, satisfied, dissatisfied or very dissatisfied. But the National Bureau of Economic Research used the data to conclude things about their “happiness.” Some might not have minded that the terms satisfaction and happiness were used interchangeably, but I did. The study was titled “Unhappy Cities,” and the headlines that followed it came out swinging against New Yorkers.
I was certain that a person (even a New Yorker) could be both dissatisfied and happy at once, and that the act of complaining was not in fact evidence of unhappiness, but something that could in its own way lead to greater happiness.
At times like this I appreciate philosophers’ respect for words, and a number of them have argued to keep happiness separate from satisfaction. In his 1861 essay “Utilitarianism,” John Stuart Mill carefully distinguished between the two, saying that a person can be satisfied by giving the body what it craves, but that human happiness also involves motivating the intellect. This means that happiness and satisfaction will sometimes conflict, and that those of us who seek happiness, and even attain it, may still be dissatisfied. Mill considered this a good thing: “It is better to be a human being dissatisfied than a pig satisfied, better to be Socrates dissatisfied than a fool satisfied.”
The 19th-century German philosopher Arthur Schopenhauer, one of history’s best-known pessimists, also believed there was more to life than satisfaction. Better to honestly describe a negative world, he believed, than to conceal it with beautiful lies. That sounds very New York.
There’s plenty to complain about when living in a big city: overcrowding, potholes, high prices, train delays, cyclists, bees. When I was growing up in Rockaway and schlepping to school in Brooklyn, it was perfectly normal to complain, and almost everyone I knew did. Our complaining was not an indicator of our level of happiness. In my experience outside the city, however, people routinely misinterpret my casual expressions of dissatisfaction as unhappiness. They consider complaining to be a sign of negativity, which they think should be replaced with positivity in order to be happy. “If you don’t have something nice to say, don’t say anything at all” is an example of this ubiquitous, if banal, attitude. (...)
The 20th-century Spanish philosopher Miguel de Unamuno didn’t recommend banishing the negative emotions or “keeping on the sunny side of life.” In “The Tragic Sense of Life” he described his anxiety over the prospect that there might be no afterlife, adding that he failed to understand people who had not once been similarly tormented by this or by the certainty of their own death.
Unamuno believed that a life worth living consists in communing with others, and that this happens most genuinely through negativity. In “My Religion,” Unamuno wrote: “Whenever I have felt a pain I have shouted and I have done it publicly” in order to “start the grieving chords of others’ hearts playing.” For Unamuno, authentic love is found in suffering with others, and negativity is necessary for compassion and understanding. If we try to deny, hide or eradicate the negative from our lives, we will be ill-equipped to deal with people who are suffering.
Complaining is useful, but we must first shatter and rebuild what “useful” means. My son is not crying in the car to get home faster; he is crying because he is trapped. When I get trapped in crummy situations I too cry, whine, complain. I get it out. I vent. I do these things because they are useful, but not the kind of useful that people usually have in mind. Usefulness doesn’t exclusively mean undoing what we don’t like about our situation; it can also mean dealing with our situation creatively. I use negativity both to change myself — to release disappointment, anger and frustration — and more important, to connect with others.
by Mariana Alessandri, NY Times | Read more:
Image: Brecht Vandenbroucke
Thursday, December 4, 2014
Jackie's Goodbye
[ed. Public service announcement: Please. I know it's a bummer but if you have an aging parent, read this. It provides an excellent account of nearly everything you need to know about caring for someone with Alzheimer's, or any other form of dementia - financial, emotional, bureuacratic. It parallels almost exactly the learning and decision-making process I had to go through when my mom caught pneumonia and her dementia suddenly red-lined. Pay close attention: Medicare vs. Medicaid (program restrictions associated with each and required documentation); VA benefits if applicable (time involved to get them and financial requirements - short answer, up to a year or more and in the end not worth it); nursing and assisted care facilities - their various qualifications, services and costs; home health care options; and hospital discharge policies. I'd also add: be prepared with health care directives and power of attorney, and expect strong differences of opinion (between siblings or surviving spouses over the necessity and costs of whatever care is involved). It is a nightmare. Mom, we tried our best. I still miss you so much.]
I had thought I would drive the eight hours to my hometown in South Carolina to get my aunt, Jackie Belcoe, settled back at home, and perhaps hire a nurse to come help out during the day. But when I got there, I found a much graver situation than I had expected.Tucked into her hospital bed at Lexington Medical Center, Jackie looked so frail and sick that it was heartbreaking. She had been a hairdresser for many years and once owned her own salon. She was the woman who taught me to wear lipstick, who never left the house without her mascara on and her blond bob perfectly styled. Now, her hair was matted and unkempt. She needed a bath and her teeth brushed.
In the emergency room, a nurse had cut the urine-soaked T-shirt off her body. When the paramedics found her, she told them she was 19 and lived at home with her parents.
Though her parents were no longer alive, it was true that she lived in the house where she had grown up. I soon learned that conditions there were as deplorable as the state she was found in. Her bed and sheets were soiled, and dirty laundry had been left beside the washer. A trail of feces stained the carpet from the bed to the bathroom. It was clear that Jackie, like many late-stage dementia patients, had become incontinent—a fact that perhaps a caregiver who was also a brother was too ashamed to admit. Full trash bags were piled in the kitchen. Shards of broken cups were scattered on the floor. The mess had attracted pests, and mice and flies had invaded the brick ranch house.
I traced the chaos to my father's own declining health. That spring, after years with a weak heart, he took leave from work. He tried to stay upbeat and not worry me. I had stopped by to see them in recent months, but kept my visit short. It was so hard, seeing Jackie the way she was. Now, I wondered, how had I missed that something was terribly wrong? Or had I just not wanted to see?
For years, I had been pressuring my dad to think about the long-term plan. What would we do if Jackie needed more support than we could provide at home? Should we decide on a facility where we could place her if the time came?
We had to consider a nursing home, I assumed. My hand had been forced. Naively, at first I didn't think about the money involved. It had been a relief when Jackie reached age 65, with all its attendant public benefits. Surely, I thought, Medicare would cover the kind of care she needed."There is nothing medically wrong with her," the hospital social worker told me.
I was incredulous. "What do you mean nothing is wrong with her?" I implored. "Her brain is decaying. If she was left alone, she would die."
The social worker informed me that there was nothing wrong with Jackie that warranted a longer hospital stay or a transfer to a skilled nursing home. What she meant was that Jackie needed custodial care—help with eating, dressing, and bathing. She needed a watchful eye, the adult equivalent of day care. She did not need the assistance of a registered nurse or another medical professional who could administer IVs or monitor complicated equipment and treatments.
Medicare pays for hospital stays and short-term, skilled nursing care for older Americans. It does not cover the kind of custodial care Jackie required, and it generally does not pay for long-term stays in a nursing home or a dementia care unit, a fact nearly 40 percent of Americans over 40 don't fully realize, according to a poll from the Associated Press-NORC Center for Public Affairs Research. Medicaid, designed to provide health care to the poorest Americans, can pay for nursing home residence and long-term care. However, in some states, such as South Carolina, it cannot be used to cover room and board in assisted living or an assisted-living facility's dementia care unit—that is, the kinds of places that provide custodial care to those who don't qualify for nursing homes. Medicaid supports some at-home services, but only if states apply for waivers. (There is also a program in South Carolina and other states that can supplement payments to assisted-living facilities for Medicaid-eligible residents, but Jackie, like many other seniors, did not meet its stringent income and resource limits.)
Jackie did not qualify for Medicaid outright: Her assets and her monthly Social Security income of $1,223 disqualified her from South Carolina's basic 2012 Medicaid limits of $2,000 in resources and a monthly income of just over $900 (the limit is now $973). Given her needs, she could have possibly qualified for some in-home benefits—such as visits from a nursing aide—through the state's Medicaid programs, some of which have higher income thresholds. But it would have taken months to get through the paperwork, and even with some Medicaid supports, I knew she needed full-time caregiving, a role my father could no longer fulfill.
My dad fought me when I first suggested moving Jackie to an assisted-living facility. He didn't want to institutionalize her. He also didn't know how we were going to pay for it.
I soon learned what my father already knew: Brochure after brochure in his files showed glossy photos of luxury dementia care units in our area with 24-hour supervision, secured access to prevent patients from wandering, and life-enrichment programs for the memory-impaired. I called them. A family member toured many of them. Most cost between $4,000 and $6,000 a month out-of-pocket. My dad made just under $29,000 a year working as a welder in the maintenance department at the University of South Carolina. His house was on the brink of foreclosure. Years of health crises had left him and Jackie with very little savings. The annual cost of an assisted-living facility with dementia care was more than double what my father made annually and nearly four times Jackie's income. What I had assumed was procrastination or denial on my father's part was really paralysis.
Hospitals, though, do not like you to overstay your welcome, and Jackie had not been a model patient. More than once, she had gotten out of bed and wandered down the hall and into other patients' rooms. She got agitated, and the staff had to physically restrain her, wrapping her in a vest so she could no longer move. She grew so fitful that a doctor prescribed her a regimen of anti-anxiety drugs, hoping she would just go to sleep.
On the day Jackie was discharged, it was nearly impossible to wake her. The combination of medication and a new environment had made her sleeping patterns even more erratic than usual. She appeared lethargic to the point of being catatonic.
Soon, however, she became more aggresive. She gripped the sheets tighter each time I tried to remove them. When I finally had her sitting up, she didn't want to put on the pair of pants I had brought her. I lifted her hospital gown to put them on her myself. "Stop! Stop!" she yelled. "What are you doing?" In a flash of anger, she pulled her fist back to hit me. She relented when I grabbed her hand.
"What are you doing?" she kept repeating, as we fought over getting dressed."What are you doing?"
The truth was I didn't know what I was doing. And I didn't know what we were going to do.
by Tiffany Stanley, National Journal | Read more:
Images: Adrià Fruitós and Stanley Family
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