#Clear braces in South Philadelphia

[supershadysideorthodontics]

Braces for Adult in South Philadelphia

                                 Clear Braces in South Philadelphia

[newstfionline]

Friday, September 3, 2021

US faith groups unite to help Afghanistan refugees after war (AP) America’s major religions and denominations, often divided on other big issues, have united behind the effort to help receive an influx of refugees from Afghanistan following the end of the United States’ longest war and one of the largest airlifts in history. Among those gearing up to help are Jewish refugee resettlement agencies and Islamic groups; conservative and liberal Protestant churches; and prominent Catholic relief organizations, providing everything from food and clothes to legal assistance and housing. “It’s incredible. It’s an interfaith effort that involved Catholic, Lutheran, Muslim, Jews, Episcopalians ... Hindus ... as well as nonfaith communities who just believe that maybe it’s not a matter of faith, but it’s just a matter of who we are as a nation,” said Krish O’Mara Vignarajah, president and CEO of Lutheran Immigration and Refugee Service. The U.S. and its coalition partners have evacuated more than 100,000 people from Afghanistan since the airlift began Aug. 14, including more than 5,400 American citizens and many Afghans who helped the U.S. during the 20-year war.

Hurricane Ida’s aftermath, recovery uneven across Louisiana (AP) In New Orleans, an ongoing power outage after Hurricane Ida is making the sweltering summer unbearable. But in some areas outside the city, that misery is compounded by a lack of water, flooded neighborhoods and severely damaged homes. Four days after Hurricane Ida struck, the storm’s aftermath—and progress in recovering from it—are being felt unevenly across affected communities in Louisiana. In New Orleans, power was restored Wednesday to a small number of homes and businesses, city crews had some streets almost completely cleared of fallen trees and debris and a few corner stores reopened. Outside New Orleans, neighborhoods remained flooded and residents were still reeling from damage to their homes and property. More than 1,200 people were walking through some of Ida’s hardest-hit communities to look for those needing help, according to the Louisiana Fire Marshal’s office.

More than 45 dead after Ida’s remnants blindside Northeast (AP) A stunned U.S. East Coast faced a rising death toll, surging rivers and tornado damage Thursday after the remnants of Hurricane Ida walloped the region with record-breaking rain, drowning more than 40 people in their homes and cars. In a region that had been warned about potentially deadly flash flooding but hadn’t braced for such a blow from the no-longer-hurricane, the storm killed at least 46 people from Maryland to Connecticut on Wednesday night and Thursday morning. In New York, nearly 500 vehicles were abandoned on flooded highways, garbage bobbed in streaming streets and water cascaded into the city’s subway tunnels, trapping at least 17 trains and disrupting service all day. Videos online showed riders standing on seats in swamped cars. All were safely evacuated, with police aiding 835 riders and scores of people elsewhere. The National Weather Service said the ferocious storm also spawned at least 10 tornadoes from Maryland to Massachusetts, including a 150-mph (241 kph) twister that splintered homes and toppled silos in Mullica Hill, New Jersey, south of Philadelphia.

President’s murder inquiry slow amid Haiti’s multiple crises (AP) In the nearly two months since President Jovenel Moïse was assassinated, Haiti has suffered a devastating earthquake and a drenching tropical storm, the twin natural disasters deflecting attention from the man-made one that preceded them. Add the constant worry over deteriorating security at the hands of gangs that by some estimates control territory that’s home to about a fifth of Haiti’s 11 million citizens, and the investigation into Moïse’s killing is fast fading from the public consciousness. Even those still paying attention, demanding accountability and pressuring for a thorough investigation give no chance to the crime’s masterminds being brought to justice in a country where impunity reigns. It doesn’t help that Moïse was despised by a large portion of the population. “The hope for finding justice for Jovenel is zero,” said Pierre Esperance, executive director of the National Human Rights Defense Network.

Fancy a beer in Britain? In some pubs, supplies are running low. (Washington Post) Fears are brewing among pint-loving Brits amid reports of a national beer shortage. Some pubs say they are running low on pints of Carling and Coors—the latest victims of the United Kingdom’s supply chain crisis, sparked by Brexit and exacerbated by the coronavirus pandemic, that has led to headline-grabbing scarcities of items including McDonald’s milkshakes, beloved Nando’s chicken and the polarizing breakfast spread Marmite. “We are experiencing some supply problems,” a spokesman for pub chain Wetherspoons said Tuesday, apologizing for any inconvenience caused to customers. The lack of beer has been attributed to the ongoing shortage of truck drivers to transport goods, a problem sparked by Britain’s decision to leave the European Union following a 2016 referendum that divided the country. The driver shortage has not been helped by the country’s “pingdemic,” in which tens of thousands of workers were forced to self-isolate after being contacted by the National Health Service app for coming into contact with someone who tested positive for coronavirus.

Merkel steps down with legacy dominated by tackling crises (AP) Angela Merkel will leave office as one of modern Germany’s longest-serving leaders and a global diplomatic heavyweight, with a legacy defined by her management of a succession of crises that shook a fragile Europe rather than any grand visions for her own country. In 16 years at the helm of Europe’s biggest economy, Merkel did end military conscription, set Germany on course for a future without nuclear and fossil-fueled power, and introduce a national minimum wage and benefits encouraging fathers to look after young children, among other things. But a senior ally recently summed up what many view as her main service: as an anchor of stability in stormy times. He told Merkel: “You protected our country well.”

India locks down Kashmir after top separatist leader’s death (AP) Indian authorities cracked down on public movement and imposed a near-total communications blackout Thursday in disputed Kashmir after the death of Syed Ali Geelani, a top separatist leader who became the emblem of the region’s defiance against New Delhi. Geelani, who died late Wednesday at age 92, was buried in a quiet funeral at a local graveyard organized by authorities under harsh restrictions, his son Naseem Geelani told The Associated Press. “They snatched his body and forcibly buried him. Nobody from the family was present for his burial. We tried to resist but they overpowered us and even scuffled with women,” said Naseem Geelani. As most Kashmiris remained locked inside their homes, armed police and soldiers patrolled the tense region. Government forces placed steel barricades and razor wire across many roads, bridges and intersections and set up additional checkpoints across towns and villages in the Kashmir Valley. Authorities cut most of cellphone networks and mobile internet service in a common tactic employed by India in anticipation of mass protests.

Women and technology in Japan (NYT) Japan is facing a severe shortage of workers in technology and engineering. And in university programs that produce workers in these fields, Japan has some of the lowest percentages of women in the developed world. Up to age 15, Japanese girls and boys perform equally well in math and science on international standardized tests. But at this critical juncture, when students must choose between the science and humanities tracks in high school, girls appear to lose confidence and interest in math and science. In these fields, the higher the educational level, the fewer the women, a phenomenon many blame on cultural expectations. “The sex-based division of labor is deeply rooted,” one young woman said. To help change the trend, two women with science backgrounds co-founded a nonprofit called Waffle, which runs one-day tech camps for middle and high school girls. Asumi Saito and Sayaka Tanaka offer career lectures and hands-on experiences that emphasize problem solving, community, and entrepreneurship to counter the stereotypically geeky image of technology. “Our vision is to close the gender gap by empowering and educating women in technology,” Saito said.

Taiwan Warns China Can ‘Paralyze’ Island’s Defenses in Conflict (Bloomberg) Taiwan warned that China could “paralyze” its defenses in a conflict, a stark new assessment expected to fuel calls in Washington for more support for the democratically ruled island. China is able to neutralize Taiwan’s air-and-sea defenses and counter-attack systems with “soft and hard electronic attacks,” Taiwan’s Ministry of National Defense said in an annual report to lawmakers seen by Bloomberg News. The document offered a more alarming assessment than last year’s report, which had said China still lacked the capability to launch an assault. While Beijing isn’t believed to possess the transport and logistical capacity necessary for an invasion of Taiwan’s large and mountainous main island, the ministry recommended monitoring Chinese efforts to expand training and preparations for complex landing operations. China already has the ability to seize Taiwan’s surrounding islands, it said.

Those left in Afghanistan complain of broken US promises (AP) Even in the final days of Washington’s chaotic airlift in Afghanistan, Javed Habibi was getting phone calls from the U.S. government promising that the green card holder from Richmond, Virginia, his wife and their four daughters would not be left behind. He was told to stay home and not worry, that they would be evacuated. Late Monday, however, his heart sank as he heard that the final U.S. flights had left Kabul’s airport, followed by the blistering staccato sound of Taliban gunfire, celebrating what they saw as their victory over America. “They lied to us,” Habibi said of the U.S. government. He is among hundreds of American citizens and green card holders stranded in the Afghan capital. Victoria Nuland, undersecretary of state for political affairs, would not address individual cases but said all U.S. citizens and lawful permanent residents who could not get evacuation flights or were otherwise stranded had been contacted individually in the past 24 hours and told to expect further information about routes out once those have been arranged.

[progressiveparty]

Joe Biden's new reality: What happens when a candidate who guarantees wins starts by losing?

Joe Biden has insisted for months he's the only sure-fire winner in a head-to-head match-up with President Donald Trump in the Democratic Party's primary field. He'd "beat him like a drum," Biden often says.

But the former vice president limped to New Hampshire on Tuesday on course to lose in the first contest of the 2020 primary. Biden was in fourth place in the Iowa caucuses with 62% of precincts counted -- lagging well behind the two leaders, former South Bend, Indiana, Mayor Pete Buttigieg and Vermont Sen. Bernie Sanders , and third-place Massachusetts Sen. Elizabeth Warren . The results that have been tallied so far are worse than Biden -- who had told reporters the Friday before the caucuses that "there's a big difference between second and fourth" -- had hoped. And popular vote numbers indicating Biden fell behind the 15% viability threshold to win delegates in some precincts were a clear indictment of his campaign's weak organizing effort in the state. The former vice president must now answer new doubts about his core argument: If a candidate who has framed his campaign around the notion that he's more electable than his rivals loses the first election of the nominating process,where does that leave him? Biden's campaign is bracing for a protracted battle, hoping his support from black and Latino voters will provide the former vice president a boost. His support from non-white voters is his campaign's most important asset, and one aides have said for months could allow Biden to weather losses in one or two early-voting states with overwhelmingly white electorates. In a call with donors Tuesday led by campaign manager Greg Schultz and top adviser Steve Ricchetti, the Biden aides said he is "well-positioned to win" the third and fourth contests in Nevada and South Carolina, a source familiar with the call said. His aides in Philadelphia are also readying a Super Tuesday plan focused on building a delegate advantage in congressional districts with large non-white populations. Initial results from Iowa caucuses show Buttigieg has narrow lead Meanwhile, Biden is starting his week-long sprint through New Hampshire, where the most recent poll before the Iowa results, from the Boston Globe and Suffolk University, showed him at second place with 18% support behind Sanders' 24%. "God, it's good to be in New Hampshire," Biden said as he began his speech in a Girls Inc. gym in Nashua. "You have no idea how happy we were to be headed to New Hampshire and Nashua." He also showed a new willingness to attack Sanders by name and at length, adding to his stump speech a much lengthier critique of the Vermont senator's "Medicare for All" plan. A Precinct Captain for Democratic Presidential candidate former Vice President Joe Biden prepares for the opening of the Iowa Caucus at Lincoln High School in Des Moines, Iowa. It was the beginning of Biden's bid to turn the page on a disappointing showing in Iowa. This Piece Originally Appeared in www.cnn.com Read the full article

[franciscretarola]

Amatrice: how the L’Aquila earthquake predicts its future

(Poggio Picenze, near L’Aquila... all photos by Francis Cretarola) (from 2017) The day after the August 24th central Italy earthquake, we received numerous messages from Le Virtù customers, friends from all over North America, and friends in Italy. People on this side wanted to know how to help and those in Italy, especially those around L'Aquila, Abruzzo - which is very close to Amatrice and knows more than it cares to about this type of event - were telling us that, this time, they were okay. As we started to put together our relief efforts, we wondered if Amatrice, Accumoli, the villages in Marchè along the Tronto river, and the other badly damaged towns would ever be rebuilt, if life in them would ever be the same. Our knowledge of L'Aquila and the aftermath of its 2009 earthquake didn't make us very sanguine about the future. 

But on the second day after the quake, I saw a Facebook post made from Amatrice by a friend of ours from Paganica (a small village just outside of L'Aquila). She was in Amatrice volunteering to help the victims. And seeing the post made me think about the last time we'd seen her. It was last summer, in her home village. She had wanted us to see how things were, many years post-earthquake, in Paganica. 

What follows is reconstructed from my notes from and photos of that visit. 

__________

Cathy and I park beneath the church of Santa Maria Assunta, in Piazza della Concezione, just off the main road that snakes through Paganica, a satellite town of L'Aquila. Like many of the villages around Abruzzo's capital city,  Paganica suffered terrible damage during the April 2009 earthquake. It was at the epicenter of the event. Across the road from us, the baroque facade of Santa Maria della Concezione is scarred by fractures. Directly in front of our car, Paganica's monument to "ai caduti," those fallen in Italy's two world wars (a squat, massive rectangle of stone inscribed with the names of the dead), is rotated about 10 degrees counterclockwise on its base. The shaking had been fierce. 

It's July of 2015 - six years after the quake - and our friend Germana Rossi, a native of Paganica, has promised to take us inside the zona rossa, the forbidden "red zone" protected by chain-link fence that's deemed too dangerous for habitation or visit.  

In 2001, we lived up the road in the village of Assergi, also part of the extended city of L'Aquila.  On days when we didn't want to drive the twenty minutes into the city to shop its daily market, we did our food shopping at a little mom-and-pop store in Paganica. We ate often just up the road at the Villa Dragonetti, a fresco-covered, 16th-century palace where the cuisine was as simply elegant as the hospitality was easy and warm. We met Germana later, in 2006 in Philadelphia, when she came over as part of the Abruzzese folk group DisCanto. We gave the group the keys to our row home in South Philly during their stay (and we crashed down the street on my brother's floor). In 2007, Germana returned the favor and offered us the use of her late grandmother's home in the oldest section of Paganica, the part of town now locked behind the fence. 

Few people walk the piazza. The faces of those we do see seem preoccupied and drawn. And a little suspicious of us. In the weeks and months immediately following the quake, L'Aquila and its surrounding areas became destinations for "disaster tourism." Though we know this place well and are here by invitation, it's hard not to feel awkward and inappropriate. 

After a short, uncomfortable wait, Germana arrives. She wears a brightly colored summer dress and greets us happily. Everyone in Paganica knows her and the other Rossi family members,  which puts me at ease. 

Germana wastes no time and we move toward the old town, the entrance to which is blocked by the fence. As though swinging open a garden gate, Germana moves part of the fence and enters the zona rossa. We follow closely behind her.  

We walk up into the oldest part of the town along alley-like medieval streets. Many buildings are braced with wood or steel supports. Cracks web across facades; some interiors are exposed and visible from the street; the early evening sun shines through gaping holes in roofs. Germana points out - almost dispassionately - damaged architectural treasures, broken monuments of the town's ancient culture and history. And I am reminded of the tour she gave us in 2007, when she proudly pointed out some of these same details, the elements that gave Paganica part of its character and specific beauty. Nature has invaded the streets. Weeds rise chest-high, grass bursts from the cobblestones. At one tiny square, a man - also defying the authorities - appears from nowhere. Germana smiles and they exchange brief but warm greetings, speaking in a shorthand understood only by terremotati (earthquake survivors). She introduces us to him. He smiles wanly, but then walks over to a slim fig tree which has taken root in the street in the six years since the quake, plucks two pieces of fruit and gives them to Cathy and me.    

We arrive at Germana's home. She pushes open the narrow wooden door and we enter. I remember the space well, even through its debris-covered chaos. All around us, the broken and dust-covered relics of a family history lie waiting to be reclaimed. We climb the steps to her parents' room. Their bed is exactly as it was immediately after the earthquake. Large chunks of masonry, which at 3:32 in the morning fell onto the sleeping couple, still cover it. It's terrifying. Nothing has been done since the quake. The Rossi family was allowed to return to take whatever articles they could, but no restoration has been attempted. The government has not acted and it will not allow the family to begin its own work.  

It's tough to know what to say. Nothing comes to mind that wouldn't be said merely because I feel like I should say something, anything. Cathy and I returned here shortly after the quake in 2009. We visited all we could of L'Aquila, most of which was and remains cordoned off behind fencing, and met with Germana.  Her parents, who were living in one of the many tent cities inhabited by the survivors, came to meet us at the Villa Dragonetti, which had miraculously escaped severe damage. They sat at our table and apologized for being disheveled, for not being better able to welcome us. The father's face was still scarred from the fallen masonry. We've come back to L'Aquila every year since, but this is our first time behind Paganica’s fencing.  

Germana leads us back to the car and asks us to follow her to Poggio Picenze, another village inside the so-called "L'Aquila crater." It was also terribly hit. Her friend, Stefania Pace, wants to show us her home.  

We pull over at a bar outside Poggio Picenze's fenced-off old town to meet Stefania. She's a blond woman in her mid-forties. It doesn't take long to understand that she's possessed of a strong wit and spirit. She's sad, as Germana’s sad, but not broken. Banked anger flashes in her eyes as she and Germana explain the bureaucracy that prevents action and the corruption and waste that informed then-Prime Minister Silvio Berlusconi's original reconstruction efforts.  Berlusconi had treated the earthquake as an opportunity to salvage his scandal-damaged reputation and to funnel money to his supporters. In the mountains around L'Aquila, "new towns," characterless, (as it turns out) often poorly built warrens blight the landscape. Some are positioned in such a way that their inhabitants can stare down into the fenced-off ancient villages to watch centuries of history, tradition and culture slowly rot under the weight of the seasons. The psychological effect on the population, especially the elderly, is profound. Many, like Stefania, are still living in what was supposed to be temporary housing. 

Again, we walk past the fence - no one is guarding any of these places - and into the old town. The devastation is terrible, and the place, centuries old as it is, looks more like an ancient abandoned ruin than a 21st-century town. Only a car, its roof crushed by fallen masonry, reminds of the present day. Stefania's husband Mariano has joined us and leads us to their former home. Stefania can't bear to enter, but we walk in. Part of the house is fairly intact, and he points out many of the improvements he'd made shortly before the quake, restoration projects designed to highlight the home's original rustic character.  He laughs grimly while recounting the plans he'd had for the space. The property immediately next to the theirs has been obliterated. A second-story door opens on a room and floor that no longer exist.  

Everything is overrun by insurgent grass, weeds, and saplings. Mariano bounds up the hill to a small tree, another fig, picks some fruit, and brings it back to Stefania.

When we received word of the L'Aquila earthquake, it was just after 9:30 pm in Philly and we were winding down a pleasant Sunday dinner service at Le Virtù. We spent the next six hours calling friends and relatives in the region. It wasn't until the next day that the scope of the disaster became clear. Much of the city, particularly its medieval center, was destroyed. And some of the towns around L'Aquila - Paganica, Camarda, Fossa, Onna - had fared worse.

It was a gut punch. But our loss had been relative. All our friends and family had survived, though some had lost their homes. In the days that followed, standing in Le Virtù, our paean to Abruzzo decorated in photos, ceramics, and artifacts collected during our travels in the region, suddenly felt absurd and robbed of meaning. The restaurant was dedicated to the entirety of the region, but it simply would never have existed if not for our time spent living in L'Aquila. In a way that we acknowledge to be unearned and shallow, we considered L'Aquila our second home. 

It was surreal also to see and hear L'Aquila and Abruzzo, overlooked places well off Italy's touristed path, be for a time a topic for the local, national, and international press. A place that we'd tried to promote - at Le Virtù, with culinary tours, by producing TV shows for Comcast and PBS, by bringing musicians to the U.S.- was suddenly, albeit briefly, in the public eye. But for all the wrong reasons. Journalists flocked to the city and its environs without knowing anything of what these places had been like before the event, what had been lost, or what was at risk.  And for as long as there was spectacle to report - bodies and survivors pulled from the debris, images of pain and devastation, the occasional uplifting story about the courage of first responders and defiant civilians who'd thrown in immediately following the event - L'Aquila was news. And then, as invariably happens, the world moved on.

But the losses continue and the risk - to a centuries-old culture, ancient ways of life, unheralded architectural and artistic treasures, intrinsic things without calculable price - remain. Things that are soul-nurturing, essential, that have sustained a people and could offer much to the 21st century but have gone largely unnoticed by the rest of the world, struggle to survive and, in places, diminish. The area around L'Aquila, like much of Abruzzo, contains precious but  undiscovered things: stunning parkland where sheep and goat herding continue, cattle forages free-range, and wolves and bear roam wooded solitudes; small farms producing heirloom vegetables and fruits, ancient grains, the finest saffron in Europe; artisanal cheese and salumi makers; tiny medieval villages with singular culinary customs and vernacular architecture; ancient religious rites that predate the Romans; jewelry making, stone- and wood-carving, and other craft traditions; and obscure artistic masterworks. The culture of shepherds and farmers persists and informs daily life. Most of the world is blithely unaware of what's at stake. 

Le Virtù exists solely because the Abruzzo in its entirety had so inspired and moved us. When we opened, we were true neophytes with no real restaurant experience, ignorant in ways that now seem ridiculous and frightening. But we believed that the region had something important to offer, not only to Philadelphia's culinary discussion, but also - if we honored Abruzzese values of generosity, quality, and humility, and fostered a convivial environment - to the local community. If we've succeeded, it's owed to our commitment to Abruzzo's culture, not to our unique creativity and invention. It's painful to see our roots in L'Aquila in peril.

________

The earthquake that struck Amatrice and surrounding towns (in Lazio, Umbria, Marchè, and Abruzzo) had eerie similarities to the L'Aquila event. It occurred at 3:36 am (L'Aquila shook at 3:32 am), and we again learned of it towards the end of dinner service at Le Virtù. Amatrice was part of Abruzzo until 1927, when Mussolini redefined the region's boundaries with Lazio. It's a mountain village with a pastoral tradition and culture that would be very familiar to anyone who has traveled Abruzzo. It’s best known, however, as the birthplace of spaghetti all'amatriciana, its namesake pasta dish of tomatoes and guanciale (cured pig's cheek). Most people experience that dish in Rome, however, and all'amatriciana is usually lumped in with the capital city's cuisine. It shares this misidentification with pasta alla griscia (from the village of Grisciano, also near Amatrice) and carbonara (most likely from eastern Lazio and western Abruzzo, or possibly Napoli). Amatriciana was also popular in nearby L'Aquila. 

Reports on the earthquake often made reference to the pasta dish or discussed the town as a summertime getaway for Romans. Most of the reporters going to Amatrice and the other affected towns were seeing them for the first time, and had no idea of what they'd been like before the quake. It was understandably hard for them to provide context or even understand the profundity of the event. Amatrice had only just been added to the Borghi Piu Belli d'Italia, a loose association of "the most beautiful villages in Italy." And now much of it was rubble. 

Recent history tells us that the world will probably move on pretty quickly from this disaster, if it hasn't done so already. And, if history stereotypically repeats itself, it will do so without assuring that Amatrice or the other towns are restored to their former state and that their ways of life and culture can survive. In fact, it will probably do the bottom-line calculus and decide that rebuilding isn't a worthwhile use of resources, that there'll be too little return. It did this in the Irpinia region of Campania in 1980 (after a quake which also impacted Molise). And it seems to be doing this in L'Aquila. I fear that they'll be a new "Amatrice," a conglomeration of modern housing with designated shopping malls that doesn't foster community or acknowledge the ancient culture: an Amatrice amputated from its soul.  

But there are some who refuse to accept this. 

When Germana awoke the morning after the Amatrice quake, she drove from her Paganica home (a converted garage) to Amatrice to help with the relief efforts. She came home, slept for four hours, had a shower and drove back. She repeated this for several days. Her ancestral home is still behind chain-link fence. She fights a daily battle against bureaucracy, apathy, resignation, and indifference. And she continues to remind us of what's at stake, what truly matters. 

In the days after the quake, she made many posts from and about Amatrice. The most moving for me was a film of street musicians made before the quake. Young and old musicians play a salterello, an Abruzzese form of dance music similar to a tarantella. The music is played on bagpipes and tambourine. A crowd has gathered around the musicians. One player passes the tambourine to an older man in the crowd who without pause perfectly continues the traditional rhythm.  

It seems unreasonable to me that we would ever allow this music to be silenced.

[junker-town]

Which borderline teams should buy or sell at the NFL trade deadline?

The Bears, Eagles, Raiders, Jaguars, and more all have decisions to make before Oct. 29. We debate which ones should try to make a run.

Trade season is in full effect in the NFL. In the past week alone, we’ve seen Mohamed Sanu become a Patriot, Emmanuel Sanders become a 49er, and Quandre Diggs go from Lions’ defensive captain to a potential cure-all in the Seahawks’ secondary.

While the league’s contenders have gotten richer, teams with lesser playoff aspirations have begun to stockpile assets for 2020. It made sense for the Falcons and Broncos, two teams with three wins between them, to give up on a season where a trip to the Super Bowl was a fever dream. Detroit, at 2-3-1 and a couple of bounces or bad calls away from being in the thick of the NFC North race, was a more curious seller.

The Lions’ decision to ship Diggs, a starter well-liked locker room presence, doesn’t necessarily mean the team is giving up on 2019. At the same time, it’s tough to see how that move makes the team better as it braces for a possible postseason run. Now Detroit is faced with a question several other franchises that are hovering around .500 through seven weeks of the season have to face:

Should we start dealing veteran assets before the Oct. 29 trade deadline?

Let’s take a look at the teams that are .500 or worse but still in the playoff race. We’re going to talk it out to see which should be buyers and which should be sellers this week.

Jacksonville Jaguars (3-4)

The Jaguars have stayed afloat in the AFC South even after losing starting quarterback Nick Foles, but Gardner Minshew’s rookie regression has made Jacksonville a lot more vulnerable in October. He’s thrown for just 418 yards and a single touchdown while completing less than 48 percent of his passes the past two weeks. The defense hasn’t played up to its recent terrifying standard, and without Jalen Ramsey in the lineup, this team may have to win some shootouts to claim a playoff spot.

Christian D’Andrea: Buy. This is a tough decision, as Foles can’t return to the lineup until Week 11 should Minshew continue to struggle. Even then, it’s unclear exactly what he’s capable of outside of Philadelphia. This Jacksonville team has a steep climb with Houston and Indianapolis ahead of them in the division, and the Bills looking strong in their quest for a second postseason berth in three years.

But! They’ve got a winnable game against the Jets coming up before playing the Texans in London. Two wins would put Jacksonville at 5-4 with a very manageable seven-game stretch to end the season. After trading Ramsey to the Rams, the Jags have plenty of future assets already, giving them a little extra room to spend in search of the missing piece that gets them back to the top of the South. If they think they can find it in October, go for it.

Adam Stites: Buy. The Jaguars already have a lot of pieces in place to make a push for the postseason in the back half of the year. Running back Leonard Fournette is averaging more than 100 rushing yards per game, and second-year receiver DJ Chark is quickly establishing himself as one of the most dangerous deep threats in the league. While the defense has taken a step backward and lost Ramsey, it’s still loaded with talent along the defensive line.

Jacksonville would benefit from finding a linebacker to shore up the middle of the defense, a tight end to give Minshew a safety valve, or an offensive lineman to give the rookie a bit more time. Getting to the playoffs will be an uphill battle for the Jaguars, but now’s not the time to make life any harder on Minshew if they truly plan on figuring out if he’s the real deal.

James Brady: Buy. This one is difficult because I think the Jaguars are a fairly complete team and not so far from being true contenders. I would hate for them to overpay in draft capital for someone to give them a boost now but isn’t much of a help for years to come.

Sure, there are some aging veterans who might help them this year, but with Gardner Minshew regressing, the last thing the team should do is panic themselves into a bad trade. But as already noted, their upcoming schedule is relatively friendly and if one piece is what they need to make a postseason run, go for it!

Tennessee Titans (3-4)

Ryan Tannehill is the starting quarterback in Nashville now, and so far it’s ... going well? Granted, a win over the bumbling Chargers isn’t much of a resume builder, but just scoring points is a step in the right direction. Mike Vrabel’s defense has been playoff caliber (fourth in the NFL in points allowed), but the Titans’ inability to move the chains could be their undoing.

D’Andrea: Sell. Marcus Mariota’s contract expires in 2020, and Tannehill isn’t a long-term answer behind center. It’s likely too late for Tennessee to tank its way to the top of next spring’s draft in order to find a can’t-miss QB prospect, but a spot in the top 10 could clear the path to find the blocking help the team’s lacked this fall. The Titans have some nice young pieces who have turned up under Tannehill — Corey Davis and A.J. Brown in particular — but this team needs more firepower before it’s a serious threat.

Stites: Buy. It’ll be hard for the Titans to convince themselves they can’t compete after Tannehill stepped in and led them to 403 yards of total offense. Maybe his play will drop off, but it’s also completely possible he keeps it up. If he does, the Titans have the recipe for a playoff team.

The defense is already in place. The Titans haven’t allowed more than 20 points in a game in 2019. The only other teams that can say that are the undefeated Patriots and 49ers.

Snag a little offensive help and Tennessee can still track down the Colts and Texans in the AFC South.

Brady: Sell. Not only is Mariota not the answer, neither is Tannehill. Tennessee went all-in on a quarterback in Mariota, and it didn’t pay off. The Titans have to start the entire process over again with the few young, good players they have as a foundation. I don’t see how they can fix all of their issues with trades this season.

Oakland Raiders (3-3)

The Raiders have already made a move in October, trading starting cornerback Gareon Conley to the Texans for a third-round pick. That doesn’t mean they’re sellers, however; Conley’s egress followed a brutal performance in a loss to the Packers, and his trade may have been more of a message to Oakland’s locker room than any grand statement about contention.

The Raiders have outperformed expectations, earning wins over two 2018 playoff teams (the Bears and Colts) en route to 3-3. They had only four wins all last season.

D’Andrea: Buy. The Raiders spent 2018 selling (see the Khalil Mack and Amari Cooper trades) and 2019 buying, to varying effect. The addition of Trent Brown and, to a lesser extent, penalty magnet Richie Incognito, helped upgrade an offensive line that cut Derek Carr’s sack rate in half (8.4 to 4.1) and Oakland may just be a few skill player upgrades away from contention. Their three losses this season have all come against teams with at least five wins in their first seven weeks of the season.

Stites: Buy. The Raiders probably aren’t there yet as a contender, but that doesn’t mean it’s time to be sellers. They’ve shown they can grind out wins with a powerful ground attack. The defense hasn’t been able to hold up its end of the bargain and still doesn’t have an adequate pass rush. If the team could find a veteran defensive end capable of getting after the quarterback, now would be a great time to invest at the position.

Brady: Buy. The Raiders have the talent to be successful now, not later. I think Derek Carr is finally hitting his stride, though he could use some help besides his rather deep roster of tight ends. Despite Jon Gruden’s best efforts to decimate their own core, the Raiders are succeeding. They have the big guys up front and a bruising running game. They just need some extra pieces, like perhaps a Khalil Mack or Amari Cooper-type player.

Philadelphia Eagles (3-4)

The Eagles beat the Packers in Green Bay three weeks ago, but the hope gleaned from that marquee win was quickly drained in back-to-back blowout losses to the Vikings and Cowboys. Philadelphia’s defense has been a major concern; it ranks 27th in the NFL in passing yards allowed per game despite trailing big in each its last two games. It’s given up 75 total points the past two weeks, and Carson Wentz’s underwhelming fourth year has left the offense unable to keep up.

D’Andrea: Buy. The NFC East is eminently winnable, even after Philly’s loss to Dallas last week. This offense has too much talent to be this mediocre for long, and the past month has shown that cornerback market remains robust. Acquiring Patrick Peterson or Chris Harris would add some veteran gravitas to a depth chart that desperately needs it — though it might not be cheap.

Stites: Buy. Even though the 37-10 beatdown at the hands of the Cowboys in Week 7 was bad, the Eagles don’t really have much of a choice but to keep trying to make the most out of their young core of talent. Another receiver could be a good thing, but finding cornerback help — whether that’s now or in the offseason — is a must for Philadelphia.

Brady: Buy. Philadelphia isn’t far removed from being one of the top teams in the league. Carson Wentz needs some help, and the defense is in a dire position. They need some serious beef in the secondary, though that might be the position that is least fixable via trade at the moment. Still, the NFC East is ripe for the taking — even after the drubbing the Eagles received at the hands of the Cowboys. If there are no solid buying options, they should at the very least not become sellers.

Chicago Bears (3-3)

The Bears’ defense, even with Akiem Hicks on injured reserve, remains tough. Chicago ranks fifth in the league in points allowed despite ranking 26th in the league in time of possession. The offense, however, is a major problem. A rudderless running game has averaged just 3.4 yards per carry and the Bears have yet to gain more than 300 net yards in a single game. The biggest concern? Mitchell Trubisky, who has somehow made fans long for the days of Jay Cutler in Illinois.

D’Andrea: Buy. Trubisky may not be fixable, but letting this defense go to waste is some kind of sin. Some extra tailback help to boost the Tarik Cohen-David Montgomery platoon in the backfield could, at the very least, take some of the pressure from Trubisky’s shoulders.

Stites: Sell. He’s been a mess this season, but the Bears have won with Trubisky before. He led the Bears to wins in 11 of his 14 starts last season and was a partially blocked double doink away from a trip to the NFC Championship Game. So it’s tempting to keep pouring resources into the offense to try and recreate that 2018 success.

The only reason the Bears should sell is because they have a lot of pretty expendable players. Ha Ha Clinton-Dix is a mercenary on a one-year deal and the secondary wouldn’t be lost if it swapped in another safety to the starting lineup. Other defensive players — like Danny Trevathan, perhaps — could also fetch some value.

Brady: Sell. I wrote about Trubisky earlier this week, and I cannot stress enough how poorly I think of his mechanics. This doesn’t mean the Bears should excise core players on their defense or offense, but there are some guys who may be looking for a way out, guys that Adam mentioned — Clinton-Dix, Trevathan, et all. There are surely some draft picks out there that will help the Bears reload for 2020.

Detroit Lions (2-3-1)

The Lions ruffled feathers in their own locker room by trading Diggs and just lost the only player to rush for 100+ yards in a game while wearing Honolulu Blue in the past five years to injured reserve. Three straight losses have sunk Detroit to the bottom of the NFC North, but Matthew Stafford’s bounceback year means this team is a tough out for anyone in the conference.

D’Andrea: Sell. Matt Patricia’s defense has been a sieve, and prized offseason acquisition Trey Flowers hasn’t been the panacea the Lions hoped he’d be. With losses mounting and the rest of the NFC North as hospitable as a paper shredder, it’s time to call in reinforcements for 2020. Sorry about another wasted year, Matt.

Stites: Sell. The Diggs trade was likely a precursor of things to come. Now on a three-game losing streak, the Lions are awful on defense and not enough on offense to make up for that. Kerryon Johnson, the only Lions running back in the last six years to top 100 yards, is done for the year. Detroit would be wise to get value off the roster wherever it can.

Brady: Sell. I’ve spent the bulk of Matthew Stafford’s career confused about how a player with so much arm talent can consistently be at the helm of a bad team, and while I still like the roster as a whole, the Lions haven’t been able to put it all together. They can at least be competitive each week, but we’re long past the time of moral victories. The Lions need a full rebuild.

Arizona Cardinals (3-3-1)

The Cardinals are trending in the opposite direction of the team they tied in Week 1; Arizona has won three straight behind a revived offensive attack (and a weak slate of opponents), matching last year’s total. Kyler Murray has been roughly as expected as a rookie — some good plays, some bad ones, and the occasional highlight-reel staple — for a team with shoddy blocking and an uneven receiving corps. The defense, which has given up 400+ yards in more than half its games this fall, remains a concern.

D’Andrea: Sell. This was always a multi-year project. Beating the Bengals, Falcons, and Giants is nice, but it doesn’t mean you’re a contender. The Cardinals are still low on talent, so stockpiling draft assets while learning the ropes of Kingsbury’s NFL-adjusted firebomb offense makes sense.

Stites: Buy. Yes, the Cardinals are in a long-term rebuild, and no, they aren’t winning the loaded NFC West. But the most important thing is bringing along Murray and making sure he continues to develop and grow into the player they hope he can eventually become. If there’s additional offensive talent on the market that’ll help him continue an upward trajectory, now is a good time to go get it.

Brady: Buy. It will take more than one season for Kliff Kingsbury and Kyler Murray to click, but we’ve already seen week-to-week improvement out of the pairing. They’re not going to compete for the crown in the stacked NFC West, and they probably won’t be in the wild card conversation either. But they’re onto something right now, and it would behoove them to get as many pieces as they can sooner rather than later.

[personalspace-invader420]

MoonBeams In The Jewish Congregation

Part One: Cinnamon Gum and Sydney

“Cinnamon gum. Cinnamon gum. Cinnamon gum. Cinnamon gum. ” I can hear him repeat it under his breath at least a dozen times. I ask him why and he’s using his hands and his whole body to explain. “She chews cinnamon gum, Alex, and she's not supposed to because she has rubber band braces but she does anyway and she chews it all the time and it makes her whole mouth taste like cinnamon.” And the way he says it is not really complete sentences, more like a stream of consciousness. I can tell he's nervous by the way he’s shifting his clothes and running his fingers through his hair. He doesn’t have to explain this is a thought spiral, I already know. Sometimes he’ll see something or experience something and it’s that and only that for weeks. Months, sometimes. He’ll repeat it in his head, replay the situation. He’ll forget to eat or piss or shower. And, of course, this leads to erratic tendencies. Loni has taken up the habit of cinnamon gum himself and he chews so much he has an ulcer in the side of his mouth. Until now, I was afraid to ask why.

“What’s her name,” I ask half-heartedly but it’s all he needs to get him rambling.

“Oh god, it’s Sydney. Sydney. Sydney. Sydney. God is real and her name is Sydney.” I laugh because he has a habit of over exaggerating. Especially when it comes to his love life. He talks the entire ride to the north side of town about Sydney. He says she’s like a summer day and he over explains the analogy but his face is so bright and he seems so happy.

I’ve seen him like this before. When he dated Olive in middle school and Autumn in high school and a thousand other times. He gets like this every time he meets someone new. Every time he sees someone on the subway into the city for school or on campus or at the coffee shop in the evenings. Loni tells me about a new girl almost every month but he hasn’t had a relationship in a while and I think Sydney is a relationship. Loni comes home from work in the afternoons and pulls me onto the couch and talks nonstop for hours about how maybe he’s falling in love and that he hopes he is and he uses flowery explanations of their clothes and smiles and hair and it makes my guts turn at how cute it is.

We don’t have to wait any time at all before Sydney is running out of the house and up to our car and Loni is jumping out and they’re hugging. It’s sickly sweet and I can feel my whole body coil. It’s only been two days since they saw each other last but Loni begged me to drive him forty-five minutes across town to see her because he said he couldn’t stop thinking about her and her lips and the inside of her mouth and cinnamon gum. So I caved. Because Loni is my best friend, even if his cotton candy sweet relationship makes me want to puke my guts up. He insists I go with him and Sydney on every date they go on, he says it’s only a good date when I’m around. He's basically putting me through hell. I have to watch them kiss and hug and I have to hear their declarations of eternal love as if he’s not going to find a million more girls just like her. It would be different if it was anyone else, but it isn't. It's Loni.

 They only see each other for a few months before things go south with Sydney. It never takes long for him to fall out of love. Or in love. What he thinks is love. And Loni is just as heartbroken every single time it ends. Like, he’s never had his heart broken before. Like, this is the first and last time he will ever feel pain like this. He does the same things every time he and some girl breaks up. First, he mourns his loss for a week or two. Next, he does something stupid. Like dye his hair or get a lip ring or a tattoo or switch majors. Then, he talks to me for a long time about how next time is gonna be different and how he’s tired and tired of loving girls that don’t want to love him the same way. He tells me a million times how things are going to be different and he’s going to change and how maybe he’ll take up three or four lovers at a time and move to Spain or at least out of New York. After that, he sees some pretty girl and the cycle repeats itself.

Part 2: Loni’s Gentle Haze

Loni is changing, I can see it in his eyes. Half-lidded, glazed over. Head lolled back in some distinct ecstasy. Loni is changing. I can feel it as his body racks under my fingertips.

“A-alex,” he shuddered, the word sounds like a goddamn miracle shaking from his chapped lips.

We’re in the temple pews, church having let out hours ago, and Loni hums, even closer now. Closing the small space between our chests. His lips are on mine, for the millionth time, yet it still feels like sugar water to me. There is hesitation in his smile and back behind his eyes. But his mouth is ready and his hands are hasty. His fingertips run over my chest. Discovering new territory.

He looks at me in almost amazement. He’s gliding his hands up and over my shoulders, sucking a kiss into my neck. His mouth is a wet paradise. Fertile promise land. And the way it feels must be sin. There is no holy explanation for this feeling.

“Your the closest to heaven that I'll ever be,” he whispers the words Into the grooves of my collar bones.

Loni is illuminated in blue moonlight shown from high windows, creating a soft, gentle haze. Engulfing him. I don’t have time to grasp the situation before its morning and I’m waking up intertwined with him.

I take his hand off of his chest and lay it flat against mine, it’s so much bigger. I’m thinking that maybe I’ve found it, what everyone's looking for. In these hands, those lips. I found heaven last night, in the soft moonlight of the Jewish congregation.

Part 3: An Adoration of Modern Baseball

Months later and Loni is yelling. I'm not saying anything. He doesn’t seem disappointed that I don’t have much to say. It doesn’t even slow him down. I’ve never been good at talking. Writing, maybe. But not talking. With anyone else, this would be far more of an issue. But Loni never once has seemed bothered by it. He talks enough for both of us. With Loni, I never feel pressured to try to impress him. He's already impressed, I don’t even have to try.

Sometimes Loni speaks in quotes. He has a hard time forming original sentiments to express his emotions so he spends a lot of time memorizing quotes from movies and songs and books that he likes and he brings them up in conversation when he doesn’t know what else to say. Mostly, people don’t notice because he makes it really subtle. I already know he does it so it doesn’t bother me anymore. It used to bother me. But now, all I'm worried about when Loni says, “I thought you were my redo.” is what exactly he means by that and not the fact that he ripped the line from a Modern Baseball song.

Loni says it one more time. “I thought you were my redo.” This time he lingers on the last word. Lets it hang in the air between us. Re-do. Re-do. Re-do.

I want to say a million things. There are a million things to say so I'm more than a little disappointed when all I can manage is “I...can be.” My voice cracks at every word. Loni deserves more than an “I can be.” All of a sudden I can’t remember why we were fighting.

Maybe I thought I could be his redo. What Sydney, and all the other girls, couldn’t be. But I’m not a second or third or hundredth chance. I’m not some new sunrise Loni can melt his headaches in. I’m just Alex. Maybe I thought that could be enough.

Then I see him, in the doorway, and he’s been crying too. His eyes are red,  cheeks are stained with tears. For a while, we just stand, seeing at each other. I try to remember if he ever went back after walking out on anyone else. I can’t remember, probably.

I’ve been rehearsing what to say but none of the words reach my lips. Instead, I just say, “hey” and it’s quiet and ashamed. Ashamed that's all I have, ashamed of how eager I am to go back to normal, ashamed that I’m not even mad anymore. Then we hug, and I guess I expected something bigger. Something more romantic for our reunion but it’s just us, Loni and Alex, hugging. For about the millionth time. His skin is warm and soft against. He smells like hand sanitizer. Even if fireworks didn’t erupt, even though there were no symphonies, it’s still magical to me. I mean, we're just hugging and it's enough and it's never been enough with anyone else.

So we hug, then kiss, then make dinner. Nothing is resolved, nothing is fixed. But this is a good start. We have the rest of our lives to figure things out, so for now, this is a good start.

Part 4: The Problem with Philadelphia

The problem with Philly is that we grew up there. The story really starts in Lafayette Hill, a residential suburb in North Philadelphia. The story starts at Hebrew School, when we met.

Loni was a snot nosed 8 year old. Dirty, chubby little face, dirty, chubby little fingers and arms and legs. Dirty shirts and shorts and skinned knees. At that age, we couldn’t be more different. My mom dressed me in tiny button down shirts and khakis and nice dress shoes. She slicked my hair back and mad sure i had no cuts of scraps. At recess, i sat on the far edge of the playground, away from all the other kids. Usually, i set on the grass clearing and read from my books.

The day i met loni, i was reading Charlotte's Web. He walked up behind me, blocking the light from the sun with his head. He read the words out loud, “You have been my friend?” He ended with an upward inflection, as if there was a question to be asked. I finished the line, somewhat annoyed. “‘You have been my friend’, replied charlotte, ‘that in itself is enough’”

“So what are you, some kind of genius?” he asks after hearing me read the words.

“I don’t think so…” i answer, ashamed to be seen as different in any capacity.

“Well, let's test it,” Loni sits down next to me, scrunches up his face in thought.

“Okay!” he says after a minute of silence, “what's a billion plus a billion”

“2 billion” I answer easily. Loni was amazed. Guess it never takes much.

“Whoa! Your a genius! Like, a real genius!” he exclaims, his face all bright and shining. “I’m Loni.” he holds his hand out to shake but it’s filthy and sticky. I hesitate but Loni grabs my hand and shakes it vigorously.

It wasn’t long before I understood the surface of what Loni was, obsessive. Though it took many many more years to understand the depth of what that meant.

So I guess the problem with Philadelphia didn't start until...eighth grade, I’d say. When he discovered girls and I felt malign envy for the very first time. Not towards Loni, not because girls loved him and not me. The opposite actually. I wanted what those girls had and I didn't understand why. I was different. And that made me angry. And because I was angry, I didn't speak to Loni at first. When we did speak, we fought. But at least when we were fighting, he was looking at me and talking to me so...maybe it wasn't that bad.

The problem with Philadelphia is it's where Loni found everything. He discovered an entire world of friends and girls and parties, he didn't need me anymore. So when he was out, learning how to replace me, I was in my bedroom. Crying or jacking off or writing.

The problem with Philadelphia is Loni fit in and I didn’t. I guess the problem with Philadelphia is I couldn't find what Loni found there.  

Part 5: Betelgeuse and all the Stars in Orion

The first time Loni kissed me, it was under Orion. Our constellation. The one Loni showed me, his favorite. It was my favorite too, I loved the way Loni loved it. We were laying next to each other, we were thirteen. I told him I thought I like boys, he smiled. I remember that part very well. He smiled like he had just won the lottery. First, I'm looking at him, smiling up at the stars. Then, I'm looking at the stars, thinking I hope one would fly down and land right on top of me. Thinking I'd do anything to be somewhere else. Wishing myself far, far away. Then, Loni kissed me.

I hadn’t wanted to kiss anyone else before this. Just him. He kissed me, even when he was dating girls. He Kissed me, even when it was wrong. When things didn’t make sense. At bad timing. He kissed me and kissed me and kissed me. And, in the hallways at school, for weeks in between each kiss, he turned away. He would look down, tighten his grip around whichever girlfriend’s hand was in his. Tighten his grip around my throat, around my heart, take bites out of it. Shatter it in that way that only he knows how to do.

I cried, and I read and I wrote. I tried not to feel, and when that didn’t work, I tried to feel everything else imaginable. I wrote a lot. Then, Loni would come over and it was this sick lovely ferris wheel I couldn’t get off. That was the only way I knew how to love for a while, in bits and pieces. 

A Flashback to Stone Bridge High School

Loni’s bloody sneakers are the first thing I see. Then his bloody jeans. Then bloody Loni, laying naked other than boxers on his bathroom floor. The next bit is in slow motion, everything moves like thick, nasty syrup. I shriek and his mom rushes in, I can taste Loni’s pain. It's tangible, it feels up the whole room, the whole house. I can hear my heart beating in my ears, feel it in my palms. I almost fall to the floor, disregard glass and blood, and cup his head while his mom calls an ambulance. My organs tie themselves into a noose. His hair is stuck the foam coming from his mouth and I smear it as I run my hand across his cheek. I beg him to wake up. I sob quietly until the ambulance comes, rocking him in my arms. Wishing both of us healthy and far away from here. It’s not until he’s loaded onto the gurney that I see the word “freedom” rigidly carved backwards into his chest. I think maybe my lungs will collapse. I run my hands over the jagged letters. Then I have Loni’s blood on my fingertips and all of a sudden, I can’t breathe.

Weeks after are a blur of hospital rooms and sleepless nights. I bring Loni hand-picked flowers, I couldn't afford anything else. I remember we had a lot of long talks but I can’t remember what we said. Our words got lost in the ether, the stale vibration of hospital air conditioning. I remember Loni laughed quietly, looked up at me through sad, still eyes, and said, for about the millionth time, “I’m so broken.” I laugh too as if it were actually a joke.

Loni says it all the time now. But the first time he said it, I’ll never forget. We were in the fifth grade. Fifth grade and Loni already knew he was broken. Well, he thought he knew. He isn’t really, none of us really are.

“I’m so broken,” it comes out of nowhere. Whispered into the thin, cold air between our sleeping bags. His voice cracked, vocal cords drowned in woe. Like, the sinking realization snuck up on him.

 I guess the warning signs were always there, I was just too young and too blind to see them.

When he spent too much time staring off bridges, or when he crashed his car and told me, only once and only me, he did it on purpose. I guess the warning signs were always there and if I wanted to see them, I could have fucking paid attention.

I remember, once in middle school, i found his razors. They were hid inside of a book, hollowed out Arabian Knights. I don’t remember why i didn’t flush them, or throw them away. I’m not sure why i chose to forget.  

I remember wrestling an Exacto Blade out of his hand. I remember wrapping his arm in gauzes in the bathroom at school after he burned himself, so deep that he still has the scars.

Loni and i kicked and screamed our way through our teen years. We barely made it. His suicide attempt was a scream for help, a scream not loud enough to shatter the glass but loud enough the shake the window panes.

Part 6: Orchids: The Feeling of Hopelessness

Loni’s first adult relationship after high school was with a girl named Destiny from Queens. A real firecracker. She had stiff, tall hair, and a face full of makeup. Loni liked her tight skirts, her cleavage. He liked that she was a hothead until it wasn’t so convenient for him anymore. Towards the end, he just couldn’t handle her mood swings.

Things were great for the first few months. He was so happy to finally have a “real girlfriend” as he called it. “A real woman, not some dingy highschool chick” he’d say, body dizzy with drug store liquor Destiny had stuck down her pants and walked right past the cameras, still remembering to sway her hips and arch her back as she did.

I liked Destiny too. Even when things got rough with her and Loni, she never tried to hurt him. That's more than I can say for most of them.

On their first date, Loni bought a big bouquet of yellow and purple orchids from the grocery store. I still remember Destiny screaming as she slammed the vase down on the concrete floor of our dorm room.

“They’re just fucking orchids, Loni!” it was a brittle kind of desperate, pleading cry. Loni had become somewhat obsessed with orchids. He saw them as a symbol of their relationship, the same way he saw cinnamon gum as a symbol of Sydney. Every time they went out, he bought her orchids. He bought pictures of orchids, paintings, and pins to stick on his bag. It was all orchds all the time because, for loni, it was all Dystiny and they were one in the same. 

Loni told me he never felt more hopeless than he did when Destiny broke up with him. He said that if he couldn't make it with a girl like her, he didn't even want to try. So I helped him, I took care of him. He’d say, “sing me to sleep.” with his head laid in my lap, and I would, every time he needed it. I even found girls to set him up with. And yeah, it was hell. But I knew I'd never be able to make him happy in the way I wanted to, I knew he'd never want me in the way he wanted Destiny so I...sucked it up. I got the fuck over it and helped my friend. So yes, when Loni told me he felt hopeless, I understood that feeling

Part 7: A Night Under the Sea

I never went to prom. It seemed too dishonest. Loni did, of course he did. I went to kenny’s house. Smoked pot. Hated it. It made my mind all cloudy, more than it was usually. Then, i went to our treehouse. The one Loni’s dad built for us in their backyard. Trashed the entire thing. Cried, sobbed, looked for Orion, never found it, then went home.

Being in that treehouse hurt. It was too visceral, too cathartic. I could see it replayed in front of me. He had told me he didn’t love me anymore. He had said it so clearly. “I’ve fallen out of love with you.” his words punctuated, exact. I burst into flames. Wait for loni to put me out, or soak me in bleach. And he walks away, leaving storms behind in his absence.

Loni told me he loved me often, a sentiment I never returned outloud. He told me he loved me with his body pressed to mine in the lul between two far more maidenly objects of his affection. Loni defied the church for me. And that meant something. For those quick moments of awkward hands and ready mouths, i was more important to him than faith was. For that short eternity, i was his gospel.

So, I wrote until I convinced myself that was enough. I didn’t need him to love me, he already had. I’ll know, maybe no one else will and maybe I’ll have nothing to show for it but I’ll know that, once, I was loved.

I spent most of that night wondering what he was doing with her. Maybe they’d kiss or fuck and Loni would say, “I’ve never felt like this before,” and push the final dager into my still bleeding heart. I can still feel the fire that got caught in my throat. Loni had made me into a vacation home, a ghost town for him to roll through at his leisure.

I wrote until my blood could melt steel. I didn’t sleep that night.

Part 8: Saturday mornings

It's a bright, warm morning. It’s all honey and sweet, soaked in yellow. Loni says there are two great things about this time of the morning; 1. It’s real quiet and mello, there's this sort of subtle, relaxed energy. Our apartment is drenched in yokey haze. 2. The light from the sun rising through the curtains create these giant pools of sun rays and heat up the floor where it shines. So, on saturday morning, when everything is subtle and relaxed in the early hours, loni pulls me off the bed and onto the carpet so we can bask in the sun’s heat like lazy cats.

He grabs my face, sloppily kisses me. Once, once more. Then twice in a row, then three times. 5. 8. Then 13. Loni kisses much the same way he does most things: obsessively. He kisses the fibonacci sequence until 13 every morning. He wants to get it just right. He pushes his nose into the soft skin under my ear and kisses fibonacci there too. Then my collar bones. Then he lies his head on my chest so he can hear my heart beating and i run my fingers through his hair.

After Loni leaves for work, everything in our apartment turns dence and hollow. Grey fog settles over everything. When Loni’s not around, everything is a little less bright. I lay on the carpet for a bit longer, stare across the room at the far wall where our awards hang.

“Award of Excellence in blah blah blah”

He’s got like a dozen of those. Mostly for research papers and medical journals. He’s working towards his PhD in Psychology. I have a few awards too, college stuff, acknowledgments of ‘outstanding work in the community’ and th centerpiece: My Pulitzer Prize, sitting on the bookshelf right next to the book i won it for. Peaches. I wrote it while i was still in highschool. And next to that, Revolver. My other novel. It’s a new york times best seller, not that that title carries much weight.

Peaches is about an autistic girl and when i published it, i was only 18. But Revolver is far better, i wrote it when i was older, mid twenties. Though it doesn’t hardly get the praise it deserves. It’s about two boys planning a school shooting but there's a lot of subtext between the two male leads. I wrote it shortly after Loni was diagnosed with ocd.

He kind of had this huge break down, took time off school to go back to philadelphia for a while. And he called me everyday, told me all the ways philly had changed and all the ways it hadn’t. And i guess that got me thinking about highschool, about just how volatile me and loni were. And how confused i was.

One of the leads has ocd traits, i knew i had to make it that way after i realized revolver was more semi autobiographical than i had originally planned. And it was hard work, i had to research a lot to get the intricacies of ocd just right. when loni read it, he ran into my room, almost in tears, raving about how amazing it was. I burst at the seams with delight. I swear, i'm never more proud of myself than when loni is proud of me.

 I pull myself on top my hands and knees, crawl over to the bookshelf and neal in front of it. I pull revolver from the shelf. Run my fingers over the dust cover before opening it to a book marked page. There's a highlighted phrase: “Would you turn off the sun and blacken the sky if you could?”

Part 10: The Music

Loni whispers to me, still in the hollow dim light beaming from stained glass windows, “can’t you hear that music?” And i can, but not audibly. I’m not sure if he’s talking about the church hymns still ringing in our ears, even hours after the service has finished or the warm, steady sound of our hearts beating rhythmically against each other. But i can hear it. the music. And it’s palpable. It’s electricity. We're actually where we were our first time. All the uncertainty, all the confusion, has floated through the air waves, right out the window. Now, it's just me and him and the rest of our lives. It's been a long, difficult road but I'm so grateful we got here together.

“Can’t you hear that music?” He asks again, hopeful. He wants so bad for me to feel it too.

I can hear the music, and though it is beautiful it is also frightening. Oh, how frightening it is to love someone and be loved back.

I nod, trace the long healed letters in his chest. freedom.

[latexgeese66-blog]

The Foobooz Last-Minute Holiday Food and Drink Gift Guide

Guides

All the best Philadelphia-made gifts for anyone who cooks, eats, or drinks in your life — no shipping required.

Devoted foodies and restaurant newbies love Foobooz. Sign up now for our twice weekly newsletter.

Riverwards Produce | Facebook

If you’re anything like us, you’ve still got lots of holiday shopping to do, and you’re feeling wary about rolling the dice by getting goodies shipped from online outlets just a week before Christmas. You also love to give (and receive) food and drink as gifts — and why not? They’re practical, pleasurable, and consumable, offering a sense of place, supporting our local economy, and reducing clutter for the giftee at the same time.

So we compiled our favorite brick-and-mortar spots where you can pop in and find the perfect locally made gastronomic gifts this holiday, from butcher shops and artisan bakeries to boutique brewers and distilleries. That includes cookbooks, too — Philly is also blessed with an abundance of excellent food and drink authors whose works will enhance any collection. And contrary to popular belief, there is nothing wrong with giving gift cards — as long as they’re from a place the recipient actually likes.

Stocking Stuffers

Keepwell Vinegar | Facebook

Keepwell Vinegar These small-batch artisanal vinegars are made from local fruit and herbs by former pastry chefs in south central Pennsylvania. Whether sprinkled over salads or added to cocktails for a bracing, fruity bite, these vinegars in flavors like bitter lemon, turmeric, and aronia berry are a must for any foodie’s pantry. Find it at: Primal Supply Meats, Green Aisle Grocery, Cuttalossa, Riverwards Produce, Weaver’s Way Co-op

Spice Blends from St. Lucifer Spice This Philly-born, tangy-savory-spicy blend of garlic, salt, vinegar, and peppers is the perfect on everything from roast chicken to cheese curds to popcorn. Find it at: Fante’s, Di Bruno Bros., or (if you must) Wegmans

Pretzel Shortbread Cookies from Lost Bread Co. Nobody doesn’t like these shiny, salt-topped, sandy-textured rectangles of concentrated sweet-savory pretzel flavor — which, if our experience is any indication, will be gone before the last present is unwrapped. Find it at: Lost Bread Co., Riverwards Produce, Mariposa Co-op, or the Craft Hall pop-up

Cured Meats from Salumificio Cicala Skip the oranges and nuts this year and stuff stockings with artisanal salumi made from local, humanely raised pork by chef Joe Cicala instead. Find it at: Green Aisle Grocery, Market on 9th

Gift Cards

Primal Supply Meats | Photo by Jason Varney

Primal Supply Meats, East Passyunk Give the gift of being able to choose your favorite cut, from chicken backs for stock to thick-cut ribeye steaks. And this whole-animal butcher shop is so well-stocked with local goodies — high-quality California olive oil, local artisan cheeses and breads, Cape May-sourced sea salt — that even a vegetarian could go on a satisfying shopping spree.

Philly Homebrew Outlet, Kensington, West Philly, Oaklyn The perfect thing to give the DIY nerd (or wannabe) in your life, who can get as specific (rhizomes to grow your own hops) or general (Ball jars) as they want when they cash it in. PHO stocks equipment, ingredients, and supplies for everything from beer, wine, and cider making to canning to beekeeping to making your own soap.

Riverwards Produce, Fishtown Have you ever been given a gift card to your favorite grocery store? We have, and they’re extremely fun and useful. The giftee can pick up some fancy bacon, tropical fruit, or gourmet nuts her typical budget doesn’t always allow for (special!) while stocking up on any basics she might need (practical!).

Art in the Age Tasting Room, Old City Whether you’re shopping for a cocktail connoisseur or someone who just likes to drink, Art in the Age’s tasting room-slash-barware destination has exactly what your recipient is looking for. They can choose from gorgeous glasses and mixology tools, books on blending the perfect drink or infusing your own spirits, a wide selection of local and regionally produced bottles of the hard stuff, or simply subsidize their next happy hour.

Booze

Ploughman Cider | Facebook

Just about anything from Ploughman Cider A bottle from our favorite Pennsylvania cider maker will bring joy to anyone who loves delicious drinks. We personally love their tart, fizzy Kenspeckle and vinous Pinot N’Arlet (tinted pink with aronia berries and pinot noir grape skins, respectively), but we’d also be psyched to find a sixer of their dry-hopped Lupulin Lummox or a petite bottle of Distelfunk, a light, wild-fermented peach wine that will transport you back to summertime, under the Christmas tree. Find it at: Bottle Bar East, Di Bruno Bros. in Rittenhouse and the Franklin, 320 Market.

Maple whiskey from Manatawny Still Works How to improve on Manatawny’s smooth, balanced Keystone Whiskey? Age it in whiskey barrels that were just used to age Whiskey Hollow Maple’s syrup. The result, after adding a little more syrup to the blend at the end of the process, is a not-too-sweet spirit whose maple notes uplift its four-grain whiskey flavor — perfect for sipping neat around the fireplace or stirring into a hot toddy. Find it at: Their East Passyunk tasting room, their shop at 16th and JFK, or at the distillery in Pottstown.

Herbal spirits from Rowhouse Spirits Anything from Dean Browne’s petite Kensington distillery is bound to please the spirit-loving person in your life — but if he’s got their Demon Weed amaro or Bear Trap, a sipping liqueur that’s triple-infused with local herbs from Greensgrow Farms, be sure to grab one of those. Find it at: Their Frankford Avenue facility or select PLCB locations.

Beer from Fermentery Form Bottles from this cult favorite brewer would be sought after even if their tasting room wasn’t only open once a week (pending occasional Instagram-announced additions to the schedule) — their funky, farmhouse-style sour beers are just that good. Get one for the beer lover in your life. Find it at: Their tasting room in Fishtown, which is only sure to be open this Saturday, December 22nd from 2 p.m. till 8 p.m. before Christmas. You can check their social media to see if they’ll be open other days before the holiday, but Saturday is the only sure bet.

Food & Drink Accessories

Clay Kitchen Studio | Official

Custom fermentation crocks by Clay Kitchen Studio Potter Miki Palchick creates one-of-a-kind ceramic fermentation crocks and servingware for home cooks and Philly chefs (like Saté Kampar’s Ange Branca and Studio Kitchen’s Shola Olunloyo) alike. There’s still time to purchase gift certificates for her custom fermentation crocks — which allow the recipient can choose the color, shape, and style combination they love, then get it made to order — by emailing Miki at claykitchenstudio@gmail.com.

Tableware at Cuttalossa Gorgeous accessories with which to serve all the delicious things you’ve cooked should be a given, not an afterthought. Shannon Resteck’s airy Old City shop (located in the back of the store she shares with vintage clothing business Meadowsweet Mercantile) stocks all the beautiful tea towels, beeswax candles, handmade ceramic mugs and vases, and serving trays made by local artists that a kitchen maven could want.

Cheese boards from Artifaqt Unless you frequent cheese-centric events in Philly, you might not know that one of the premiere makers of high-quality boards and other servingware (like these wild towers and vessels made for fancy-pants spots like Le Bernardin) is based in nearby Phoenixville. Luckily, owner John Luttman has supplied the good folks at Riverwards Produce with some gorgeous home-scale cheese boards that are perfect for giving — plus, you can pick up a few local wedges from their fridge to round out your gift at the same time.

Fancy barware from Art in the Age Any cocktail lover from beginner to advanced loves well-made additions to their barware collection, and Art in the Age is the place to find the tools of the trade. They have just about everything you need to create the perfect drink: reusable gold picks to hold olives and berries, hand-turned wooden muddlers for fruit and herbs, beautifully patterned mixing glasses, and ornate vessels for serving tiki drinks.

Cookbooks

Courtesy of Running Press | Photo by Jason Varney

Booze & Vinyl, Andre and Tenaya Darlington The third book from this cocktail-obsessed pair of siblings pairs easy-to-make original drinks with iconic albums available on wax. It’s perfect for the seasoned home bartender or the would-be listening party host. Find it at: Riverwards Produce, Shakespeare & Co., Barnes & Noble

The Food in Jars Kitchen, Marisa McClellan Cookbook author Marisa McClellan has been writing about preserving for more than a decade, developing recipes and tutorials to help home cooks can the perfect jar of jam. Her latest, all about how to serve, cook with, and otherwise use up all those delicious canned, dried, pickled, and preserved goodies, is available for pre-order now. For beginners or apartment-dwellers, respectively, look to her earlier books, Food in Jars and Preserving By the Pint. Find it at: Riverwards Produce, Green Aisle Grocery

Ferment Your Vegetables, Amanda Feifer Shopping for someone who’s always wanted to make their own pickled goodies? Amanda Feifer’s clear, science-based instructions can turn a fermentation newbie into an expert microbe farmer making their own sauerkraut, kimchi, pickles, and more. Pro tip: this book goes perfectly with a Clay Kitchen Studio custom crock gift certificate. Find it at: Fante’s, Riverwards Produce, Barnes & Noble

Session Cocktails, Drew Lazor Bartenders, chefs, and consumers have been looking to lighten up on alcohol in recent years — and this book full of low-alcohol drink recipes that are just as delicious as their full-pour counterparts can show us the way. It’s a great option for the health-conscious gourmand or the cocktail lover in your life. Find it at: Art in the Age, COOK, Green Aisle Grocery, Philadelphia Distilling, Occasionette

Source: https://www.phillymag.com/foobooz/2018/12/18/philadelphia-holiday-gift-guide-christmas/

[dressbank75-blog]

Homeowners Pay The Price When New Construction Damages Neighboring Rows

In a dense urban environment, nearby demolition, excavation, and construction can pose a serious structural threat, particularly to the type of simple, economical row houses that proliferated in Philadelphia in the 19th and 20th centuries. The city has seen a number of collapses due to illegal construction activity, including the recent dramatic collapse of a twin house in Fishtown due to an illegal basement excavation next door. But even when permits and proper construction plans are in place, a risk remains. Part of the issue stems from a basic misunderstanding of, or perhaps disregard for, the fundamental nature of the city’s iconic building types: the row house and the twin.

It Could Happen to You

Maggie Manzer’s problems began when she noticed cracks in the facade of her South Philadelphia after an adjacent auto shop was demolished for a 39-unit apartment building. At one point the structural damage grew so bad that she could not close her front door. With little recourse provided by the City, she has spent upwards of $50,000 in legal fees in an attempt to hold the multiple parties involved accountable. | Photo: Michael Bixler

“I first started seeing these cracks over here, after they underpinned the building,” explains Maggie Manzer as she walks me through her row house in South Philadelphia. The three-story house, which Manzer purchased in 2010, is much deeper and roomier than the narrow facade lets on, with large windows along the shared alley letting in a generous amount of light.

She and I stand together in a room on her second floor, examining a web of cracks emanating from the upper corner of the south wall. The sheer number of them is alarming.

“When I saw the cracks on the third floor, then I got really worried,” she says as we climb the stairs. “I’ve owned this house for eight years and I’ve had a couple of hairline cracks, but none of these.” Manzer gestures around the room. “The whole ceiling in every room in the front of the house, above the doorways, everything is cracked.”

According to an engineering report, this cracking is the result of improper underpinning, initiated by the neighboring owner, which caused the front of Manzer’s house to settle and the facade to pull ever so slightly away from the rest of the building.

After an adjacent one-story property, formerly an auto garage, was demolished to make way for a new 39-unit apartment building, a geotechnical engineer determined that the foundation of Manzer’s house needed to be underpinned prior to the excavation for the new building’s basement and foundation.

The process is intended to strengthen the foundation of a building and involves systematically excavating under portions of the building’s existing foundation, injecting cement, letting it cure, and continuing until the entire foundation is supported. It is required when adjacent construction might impact the stability of the ground that an existing building sits on, usually when a nearby excavation will extend below the current depth, or a new structure will have a significantly different bearing load on the neighboring soil.

Although Manzer had been in contact with OCF Realty throughout the demolition process—OCF brokered the acquisition and assisted with the zoning process for the project next door and is now the rental manager for the apartment building—she had never been contacted by the owner, an entity listed as 1433 Federal St, LLC, which, according to Manzer, is owned by a local personal injury lawyer named Michael Garnick. Notably, Garnick was one of four men arrested in 2017 on charges of fraud conspiracy and money laundering conspiracy. As a result, she was under the impression that OCF was the property owner throughout the early phases, since they had been the only entity coordinating with her throughout the process.

The Philadelphia Building Code requires that property owners be notified within 10 days of excavation. But Manzer, who was working in New York at the time, did not receive notice that her property was going to be underpinned.

Shortly after the procedure was finished, Manzer noticed that her house had shifted on the south side. Alarmed—the shift was so significant that her front door no longer locked—she promptly notified staff at OCF, who until then had been her only point of contact. A representative from the contracting company came the next day to drill out the lock so that the door could engage, returning multiple times to repeat the procedure as the house continued to settle over the next two months.

As we continue our tour, Manzer points out places where windows no longer shut and where doors swing open. When we make it back out front it is clear that the entire facade is pulling away from the upper stories of the building, listing ever-so slightly towards the sidewalk. Cracks weave through the permastone cladding, across lintels, radiating from the corners of the front windows.

The apartment building at 1155 S. 15th Street next to Manzer’s damaged home is owned by local personal injury lawyer named Michael Garnick and managed by OCF Realty. | Photo: Michael Bixler

For now, the facade is temporarily braced with steel L-brackets applied by the contractor, also done without Manzer’s permission, but the temporary fix doesn’t address the structural damage. To properly repair the damages, including replacement of the facade, Manzer has received a quote in the ballpark of $100,000.

Following the damage, Manzer continued to communicate with OCF Realty. An OCF representative let Manzer know that the owner was unwilling to accept responsibility for any damages, but would offer her a $10,000 to $15,000 “good-faith” payment if she would be willing to sign a Hold Harmless agreement. Manzer declined the offer on the basis that the amount would not be adequate to repair the damage and instead contacted the general contractor, Top Gun Enterprises, to see if it would be willing to make a claim on their liability insurance to cover the damages. It was not. 

In the meantime, she’s been left with little choice but to pursue legal action by bringing lawsuits against all parties involved, including OCF Realty, 1433 Federal St, LLC, Top Gun Enterprises, the engineering firm that developed the plans for underpinning and provided the supervising engineer, the concrete contractors, and the demolition contractor.

When I first talked with her last year, she’d sunk the entirety of her savings and then some into covering the legal fees. Now, nearly a year later, her expenses have more than doubled, totaling around $50,000. She’s also lost nearly all of the equity in the house.

While the contractor and engineer are required to carry liability insurance to cover the cost of any damages and associated legal fees, Manzer’s homeowner’s insurance doesn’t cover any of the damage in this particular situation. Because the insurance inspector found that the damage was caused by “man-made earth movement,” it didn’t trigger coverage.

According to Kevin G. Amadio, an attorney with the law firm Kaplan Stewart who is familiar with cases like Manzer’s, each case is different and a builder or developer’s liability coverage “may cover that party’s liability to the homeowner, depending on what events caused damage to the homeowner.”

Manzer is hoping that the parties involved can reach a settlement that will cover all of the necessary repairs and her legal fees, but if not, the case will go to trial.

Many homeowners find themselves stuck trying to navigate similarly frustrating issues with limited support. While researching this story, I reached out to homeowners to try to get a sense of how common these kinds of problems are. A number of people responded to recount their tales of damage, many of whom felt similarly confused and frustrated about where to seek help and advice while navigating the process.

When searching for assistance via City government resources, such as Licenses and Inspections (L&I) and 311, many reported being told that legal action was their only option for recourse. Manzer and other homeowners also reported contacting their local City Council representatives and receiving more or less the same response.

A representative from Community Legal Services, an organization offering free civil legal assistance to low-income Philadelphians, said that the organization receives fairly regular calls about issues related to adjacent construction, but are not able to prioritize them and will usually refer callers to Philadelphia VIP, another pro-bono legal service. Still, many homeowners simply can’t afford to even initiate legal action, or may be reluctant to go through the hassle if the damages aren’t substantial.

Row House Fundamentals

The party wall of Manzer’s row house, at right, has suffered damage due to the owner and general contractor’s neglect of securing and properly sealing the wall after the garage was demolished. Prior to construction, the lot sat vacant and unsecured from graffiti writers and vandals. | Photo: Michael Bixler

To get a better sense of the fundamentals of row house design and the structural implications of disrupting a row, I spoke with structural engineer Justin M. Spivey, who specializes in renovation, repair, and reuse of existing structures and has taught preservation engineering at Johns Hopkins University.

Spivey classifies row houses as a “vulnerable structure type.” Fundamentally, Spivey says, row houses are built to function together as a group. Party walls—that is, the walls that are shared between adjacent homes—are typically only two wythes of brick thick. That means, a mere two rows of brick, and typically a soft, salmon brick not meant to withstand exterior exposure, is often all that stands between your house and your neighbor’s.

Imagine a block of row houses, with the two houses at each end providing bookends of support. The houses at the interior of the block are reliant upon on the entire block unit for optimal structural support—those row house party walls weren’t designed to resist lateral loads on their own. When a tooth in the row goes missing, there may be no immediate damage observed, but the overall structural stability of the remaining houses has indeed been compromised.

“The removal of one home from a row can have several negative impacts on structural stability,” Spivey explains. “The removal of floor and roof joists from one side of a party wall often means that the wall is no longer effectively braced against buckling in that direction, unless joist-to-wall anchors are installed as demolition proceeds.”

During this conversation, Spivey shared an image with me of a row house where its neighbor had been demolished that had been effectively braced. It was certainly not what I usually see in Philly, with large, secure-looking bolts sticking out at regular intervals through the bare, stuccoed party wall, securing the joists along each floor. Properly stabilizing the home in that case, Spivey estimated, probably cost around $100,000.

Additionally, when that soft brick of a party wall is left exposed to the elements, or concealed behind an incompatible impermeable coating like cement, water infiltration, freeze-thaw, and other agents can lead to significant deterioration.

But the biggest threat, as Manzer’s case and many others can attest, is when neighboring activities involve excavation adjacent to or below existing foundations. “The resulting changes in soil bearing pressures and support conditions can cause structural movement, resulting in cracks in masonry, plumbing leaks, cracks and separations in interior finishes, sloping floors, problems operating doors and windows in out-of-square openings, and in extreme cases, loss of support where floor and roof joists bear at pockets in masonry walls,” Spivey says.

What to Do?

Since the demolition next door cracks like these have spread like spiderwebs inside Manzer’s home. | Photo: Michael Bixler

In a city full of shared walls, what can homeowners do? Attempts at prevention are a start. According to Spivey, “The risk of future damage is typically lower on projects where neighbors proactively communicate, where qualified design professionals are hired to assess the risks and develop mitigation strategies, and qualified contractors are hired to implement them.” Still, sometimes the planning phase feels out of the neighbors’ control.

I reached out to Karen Guss at L&I, who explained the City’s requirements for underpinning and adjacent demolition and what homeowners should do if they notice any issues.

According to Guss, City regulations state that any underpinning must be authorized by a building permit and the construction plan must include plans prepared under the direction of a professional engineer licensed in Pennsylvania. “The plan must identify existing construction, sequence of underpinning, and any additional protections necessary to preserve the integrity of the structures.”

The procedure must also be regularly inspected and monitored by a professional engineer and “The engineer must monitor the site continuously during the excavation and placement of concrete.” The contractor must also contact L&I to arrange for regular, required permit inspections.

City Code also requires that any homeowners demolishing their portion of an attached structure must seal all cornices that have been cut, remove any loose material, fill any breaches in the wall that have been exposed, and install some form of weather-resistant wall covering.

Still, Manzer and other homeowners were left feeling that they had few rights and little support. Many called 311 and L&I to report damage. Both agencies responded that they could not send an inspector out without proof that the builders were violating their permits.

Frustrated by witnessing similar situations, Venise Whitaker, a Fishtown resident and community activist who is active in the Philadelphia historic preservation scene, started the Facebook group Riverwards L+I Coalition to provide a forum for neighbors to track and share information about construction projects, violations, and provide a documentary record of construction sites in the area. Whitaker, who keeps a running list of properties that have been undermined by adjacent excavations, says that the group has worked with L&I to “update and change codes” and provided input for the 2019-2021 Department of Licenses and Inspections Strategic Plan. 

I asked Spivey if he had any recommended resources for homeowners who’d like to better educate themselves about row house construction. He replied that there are unfortunately few, although the Delaware Valley Chapter of the Association of Preservation Technology held a free Row House Symposium earlier this year, and it is hoped that a publication will be forthcoming.

For approachable explanations of the risks associated with adjacent construction and demolition, he suggested reading the articles “Cases of Failure of Unreinforced Brick Walls Due to Out-of-Plane Loads” (Structure, May 2011, pp. 14-17) and “Development Along Old Party Walls” (Structure, June 2017, pp. 12-15), both written by Dan Eschenasy and available free online.

When contacted for comment, Ori Feibush, president and founder of OCF Realty, responded via email, “My office brokered the acquisition and helped with zoning before development and is now the leasing agent for the apartment rentals at the subject property. At no time was I managing the construction and at no time did I have any ownership of the property. I had zero involvement in the construction or development (beyond approvals). During construction, Ms. Mazer was unable to reach the developer, owner, or contractor of the project to resolve issues she experienced and I stepped in to try and connect the parties.  During that process, I paid out of pocket to help her with damage that occurred to her front steps from the developer and even put her in touch with a structural engineer.  I am aware that Ms. Mazer has included me in her litigation against the developer and regret to say that it’s an example of no good deed going unpunished.”

Michael Garnick and Top Gun Enterprises did not respond to Hidden City’s request for comment.

About the author

Starr Herr-Cardillo is a staff writer for Hidden City Daily. When she’s not covering local preservation issues or writing editorials for Hidden City, she works as a historic preservation professional in the nonprofit sector. Born and raised in Tucson, Arizona, Herr-Cardillo was drawn to the field by a deep affinity for adobe and vernacular architecture. She holds a Certificate in Heritage Conservation from the University of Arizona and an M.S. in Historic Preservation from PennDesign.

Source: https://hiddencityphila.org/2019/06/homeowners-pay-the-price-when-new-construction-damages-neighboring-rows/

[supershadysideorthodontics]

Clear Braces in South Philadelphia

                             Affordable Adult Braces Philadelphia PA

[heybrixiedust-blog]

introduction

[originally written march 2017]

My 2017 New Year’s Resolution was to get clear skin. I knew going in this would not be an easy task, but now we’re half way through March, I’ve easily spent more than $400 on skincare products and I’m STILL struggling. So to make my financial investment a bit more “worth it” I guess, I’m going to start documenting my journey.

A bit of background – I’m 23 year old woman working and living in Philadelphia. I moved here a little over a year ago in January of 2016. Prior to the move I lived in Gilroy, California and the South Bay Area for my entire life. This means two things:

1.) I lived in sunny, beautiful perfect California. To me, 70º was “cold”, rain was like a rumor that I heard existed in some magical land far far away, and I went to the beach every weekend. In California, you go to “the snow”, like it’s the destination. The snow does not come to you.

2.) I now live in this strange and foreign east coast urban land with no mountains, loads of environmental toxins, and weather. Real life weather. It snows. It rains. There is this crazy thing called humidity, that when paired with heat is what I imagine hell to feel like. Folks here call the beach “the shore” and that’s an hour away, full of individuals that look like they auditioned for MTV’s docuseries about their, um, interesting culture.

So when I left CA, I was 22 and my skin was FINALLY starting to clear up. Stresses from my undergrad were over, I was relatively healthy, and active-ish. And then I moved to Philly, and my skin flipped out (understandably so). Not only because of the environment, but I was always stressed because I was trying to get my career pinned down.

Today is March 19th and this is how my skin looks today - please for the love of god brace yourself:

—

This is the most painful my acne has ever been, and also the most hideous. So naturally I had to photograph it. And then put it on the internet.

Yet despite my worsening acne, my friends and family ask me for skincare advice. Why? I literally don’t know (see above, duh).

But realistically, I give great skincare advice because I’m trying everything, and I mean everything. From Amazon, to Sephora, to online only boutiques, I’m dropping money on it and spending my weekends doing a lot of research.

Here we go - I’m sharing my journey, the advice I’ve found, the advice that I hope works, and the products I’m trying.

[stephenmccull]

Inside the Race to Build a Better $500 Emergency Ventilator

As the coronavirus crisis lit up this spring, headlines about how the U.S. could innovate its way out of a pending ventilator shortage landed almost as hard and fast as the pandemic itself.

The New Yorker featured “The MacGyvers Taking on the Ventilator Shortage,” an effort initiated not by a doctor or engineer but a blockchain activist. The University of Minnesota created a cheap ventilator called the Coventor; MIT had the MIT Emergency Ventilator; Rice University, the ApolloBVM. NASA created the VITAL, and a fitness monitor company got in the game with Fitbit Flow. The price tags varied from $150 for the Coventor to $10,000 for the Fitbit Flow — all significantly less than premium commercially available hospital ventilators, which can run $50,000 apiece.

Around the same time, C. Nataraj, a Villanova College of Engineering professor, was hearing from front-line doctors at Philadelphia hospitals fearful of running out of ventilators for COVID-19 patients. Compelled to help, Nataraj put together a volunteer SWAT team of engineering and medical talent to invent the ideal emergency ventilator. The goal: build something that could operate with at least 80% of the function of a typical hospital ventilator, but at 20% or less of the cost.

For decades, Nataraj has worked on medical projects — like finding a better way to diagnose a potentially deadly brain injury in premature infants — primarily with doctors at Children’s Hospital of Philadelphia and the Geisinger Health system in rural Pennsylvania, so key clinical players came together swiftly. By March 23, he had approached engineering faculty about collaborating on a monthslong effort to build the NovaVent, a basic, low-cost ventilator with parts that cost about $500. The schematics would be open-sourced, so others could use them free of charge to mass-manufacture the device.

The New Yorker wasn’t alone in referencing the ’80s TV series “MacGyver,” whose protagonist was a Swiss Army knife-carrying secret agent who got the job done with wits and whatever was at hand. The suggestion was that these ventilators were simple enough to throw together with parts from a medical supply closet or your neighborhood hardware store. “Everybody can make it,” one headline read, enticingly. These miracle machines, the thinking went, could be helpful in U.S. hospitals facing critical shortages, perhaps in cities surging with sick patients.

To understand the potential utility and true costs of these emergency ventilators, KHN followed Villanova’s team for three months as it developed, tested and prepared to submit the NovaVent for Food and Drug Administration approval.

The team tapped a maker of car parts, along with roboticists. It gathered input from anesthesiologists as well as electrical, mechanical, fluid systems and computer engineers. It tapped nurses to help ensure that users would immediately know how to operate the ventilator. Local manufacturers 3D-printed pieces of the machine.

Nataraj and his team realized that some of the other ultra-bare-bones machines wouldn’t meet the standards of the modern U.S. health care system. But they also believed there was a lot of room for Villanova’s team to innovate between those and the high-end, expensive devices from corporations like Philips or Medtronic.

One thing is clear: The $500 ventilator is something of a unicorn.

While the parts for the NovaVent cost about that much, the brainpower and people hours added uncounted value. In the early phases, the core group — all volunteers — worked 20 to 25 hours a week, Nataraj said, mainly via Zoom calls from home on top of their day jobs.

Teams of two or three were allowed into the lab to work — virtually the only people on campus. The effort, after all, was in line with the university’s Augustinian mission, which values the pursuit of knowledge, stewardship and community over the individual.

By the time they realized what they could achieve with the $500 model, the first wave of crisis had passed. Yet in those weeks, an alarm resounded across the land about the dismal state of America’s public health system.

So the NovaVent mission pivoted: build better low-cost vents for hospitals in poor and rural U.S. communities that have few, if any, ventilators.

One immediate legacy of the innovation happening at Villanova and elsewhere is the public-spirited nature of the effort, said Dr. Julian Goldman, an anesthesiologist at Massachusetts General Hospital who helps set standards for medical devices: “People from different walks of life in terms of their skills — engineers, clinicians, pure scientists — all thinking and working to try to figure out how to move very quickly to solve a national emergency with many dimensions: How do we make the patient safer? How do we make the caregiver safer? How do we deal with supply chain limitations?”

From other ventures, new designs have already been used as a jumping-off point to build emergency ventilators overseas. They’ve also bolstered New York City’s stockpile and could add to state and national reserves as well.

The early, urgent concerns about a looming ventilator shortage were well founded: On March 13, the U.S. had about 200,000 ventilators, according to the Society of Critical Care Medicine. But because of the surge of COVID patients, it was predicted the country could soon need as many as 960,000.

In early April, New York Gov. Andrew Cuomo said the state would run out of ventilators in six days, leaving doctors with the sort of grim calculation they’d heard about from hard-hit northern Italy: “If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.”

In Philadelphia, 12 miles east of Villanova, hospital administrators braced for shortages and reported short supplies of the drugs required to sedate patients on ventilators.

President Donald Trump invoked the Defense Production Act to get major manufacturers to make ventilators, though GM was already working on it. When GM signed a $500 million contract to deliver 30,000 ventilators to the U.S. government by August, the NovaVent team wondered whether its own efforts would be futile.

“We said, ‘Well, GM is making it. Why are we making it?’” Nataraj said. “But there was a lot of uncertainty with the epidemiological models. We didn’t know how bad it was going to get. Or [the curve] could completely collapse and there’d be no need at all.”

And for a few weeks, it did seem the worst was over. The rate of new cases began to slow in the nation’s early epicenters. Hot spots flared in nearly every pocket of the country, but those too were mostly contained.

People spilled back into normal life, gathering in backyards, beaches and bars. In June, news coverage moved on to the calls for racial justice and mass protests after the videotaped killing of George Floyd in the custody of Minneapolis police.

In the background, the highly contagious coronavirus tore across the South, through Florida, Georgia, Texas and Arizona, and surged in California. Some states reported ICU beds were quickly at or above capacity. This mercurial virus had proved uncontrollable, and the prospect of ventilator shortages had bubbled up once again.

***

Past pandemics have been mothers of innovation. Progress in mechanical ventilation began in earnest after a 1952 polio outbreak in Copenhagen, Denmark. According to the American Journal of Respiratory and Critical Care Medicine, 50 patients a day arrived at the Blegdams Infectious Disease Hospital. Many had paralyzed respiratory muscles; nearly 90% died.

An anesthesiologist at the hospital realized patients were dying from respiratory failure rather than renal failure, as was previously believed, and recommended forcing oxygen into the lungs of patients. This worked — mortality dropped to 40%. But one big problem remained: Patients had to be “hand-bagged,” with more than 1,500 medical students squeezing resuscitator bags for 165,000 total hours.

“They’d recruit nurses and medical students to stand there and squeeze a bag,” says Dr. S. Mark Poler, a Geisinger Health system anesthesiologist on the NovaVent team. “Sometimes they were just so exhausted that they would fall asleep and stop ventilating. It was obviously a catastrophe, so that was the motivation for creating mechanical ventilators.”

The first ones were simple machines, much like the basic emergency-use ventilators created during the COVID crisis. But those came with hazards such as damaging the lungs by forcing in too much air. More sophisticated machines would deliver better control. These engineering marvels — the monitors, the different modes of ventilation, the slick touch-screen controls designed to minimize the risk of injury or error — improved patient treatment but also drove costs sky-high.

The emergency ventilators of 2020 focused on models that, typically, used an Ambu bag and some sort of mechanical “arm” to squeeze it. Most people are familiar with Ambu bags from scenes in TV programs like “ER” where paramedics compress the manual resuscitator bags to help patients breathe as they’re rushed inside from an ambulance. The bags are already widely available in hospitals, cost $30 to $40 and are FDA-approved.

But making machines that are that simple could render them effectively useless (or, worse, dangerous). Medical experts watching university and hospital teams coalesce across the country this spring to develop low-cost emergency ventilators took notice — and worried.

***

Goldman, the Massachusetts General anesthesiologist, was among the medical experts nervous about all the slapped-together ventilators.

“We had the maker community being stood up very quickly, but they don’t know what they don’t know,” said Goldman, chair of the COVID-19 working group for the Association for the Advancement of Medical Instrumentation, the primary source of standards for the medical device industry. “There were videos of harebrained ideas for building ventilators online by people who don’t know any better, and we were very concerned about that.”

The general public doesn’t really understand the nuances required to build a safe medical device, Goldman said.

“They look at something and think, well, this can’t be that hard to build. It just blows air,” he said. “‘I’ll take a vacuum cleaner and turn it on reverse. … It’s a ventilator!’”

AAMI wanted to encourage innovation, but also safety. So Goldman assembled a meeting of 38 engineers, regulators and clinicians to quickly write boiled-down guidelines for emergency-use ventilators.

The simplest ventilators were based on the idea of a piston in a car engine, Poler said: Put a piston on a crankshaft, hook it up to a motor and use a paddle or “arm” to compress the Ambu bag.

“It’s better than no ventilator at all, but it goes at one speed. It doesn’t really have any controls,” Poler said — not ideal when patients need to be monitored for changes in how their lungs are responding, or not, to treatment.

Villanova’s team of engineers, doctors and nurses realized that the simplest ventilators, the ones that AAMI was concerned about, seemed to ignore some basic, practical considerations: What sort of hospitals would these be used in, and under what conditions? What sorts of patients would be put on these ventilators? For how long? Would they be used as backups for higher-end ventilators? What about error alarms?

All good questions, Poler said, but the answer to all of them essentially is “we hope to never use these.”

Their best use? “A surge situation where you simply don’t have enough of the sophisticated ventilators.”

***

Rather than go totally bare-bones, the Villanova team designed the devices as though they would one day be deployed in modern health care.

Flow sensors, which monitor patient ventilation, cost several hundred dollars, so the team designed its own in the lab and 3D-printed it at a cost of 50 cents, Nataraj said, enabled by strides in 3D-printing technology that have vastly cut the price of so many devices. Southco, a Pennsylvania-based global manufacturer that makes parts like the latch on your car’s glove box, was tapped to use its 3D printers to make airflow tubes and couplings for the ventilator.

Garrett Clayton, director of Villanova’s Center for Nonlinear Dynamics and Control, was the day-to-day keeper of the prototype. He was particularly excited about the addition of a handle, which made it easier for him, and eventually others, to lug the 20-pound device from the lab to home and back.

Clayton’s computerized control system measures the flow rate of air going into the patient and converts it into volume, much as commercial ventilators do. That controls how hard and fast the Ambu bag is squeezed; it’s made of a hobby-grade Arduino microcontroller board. A direct-current motor attached to a linear actuator with a fist-shaped piece of PVC on the end pushes the bag in and out. The operator of the ventilator can control the respiratory rate (the number of breaths per minute), as well as the ratio between inspiration and expiration and the volume of air going in.

While traditional ventilators have many control methods, Clayton’s team focused on just one: how much volume is forced into the airway. “We have a set point so we don’t damage the lung,” he said.

Polly Tremoulet, a research psychologist and human factors consultant for ECRI and Children’s Hospital of Philadelphia, was pulled in to focus on error messages and make sure the ventilators’ buttons and displays “spoke the user’s language,” whether that user was an anesthesiologist in New Jersey or a nurse in India pulled into an ICU COVID ward.

Graduate student Emily Hylton and other nursing students were brought in to provide feedback about using the NovaVent and ask questions such as: Would all the controls and monitors look familiar to nurses at the bedside?

The very prospect of these low-cost devices is relatively new, Nataraj said, because of the price of microcontrollers with any real capacity: “Twenty years ago, they cost, oh gosh, $20,000 — and now they’re $20.”

By May 30, the first NovaVent prototype was complete. It was successfully tested on an artificial lung at Children’s Hospital of Philadelphia on June 12. Villanova has applied for a patent for the NovaVent, to help ensure it won’t be commercialized by others.

“If you make it free without having a patent, other people can take it and charge for it,” Clayton said. “A patent protects the open-source nature of it.”

Once a provisional patent is received, the team will submit the ventilator for Emergency Use Authorization from the FDA — hewing to the guidelines set up by AAMI.

***

Within weeks of kicking off the NovaVent project, the curve in the East Coast had indeed flattened, and states had enough standard ventilators to treat every patient. The life-threatening ventilator shortage had not materialized. Some of the emergency-use ventilators based on designs by other teams, like the one at MIT, did go into production — but even those didn’t end up in hospitals, and instead went into city stockpiles meant to reduce potential future reliance on the federal government. So the Villanova team seized on a new, global mission.

“We thought if it wasn’t useful in the U.S. market,” Nataraj said, “we know the developing world, especially sub-Saharan Africa, Latin America and Central America, they don’t have the same kind of facilities that we do here.”

Where the ventilators might end up remains to be seen. Early on, Pennsylvania showed interest in helping Villanova find manufacturing partners. The team has spoken with engineers in India, Cambodia and Sudan (which reportedly has only 80 ventilators in the entire country) who are interested in possibly finding a way to manufacture the NovaVent.

Six thousand emergency ventilators based on the design by the University of Minnesota have been manufactured in the U.S., according to Dr. Stephen Richardson, a cardiac anesthesiologist who worked on that project. Three thousand were made by North Dakota aviation and agricultural manufacturer Appareo for state emergency stockpiles in North Dakota and South Dakota. UnitedHealth Group provided $3 million in funding to manufacture another 3,000 units made by Boston Scientific, which were donated to countries like Peru and Honduras through U.S. organizations; others were sent to the U.S. government.

Like the Villanova team, Richardson said he thinks the most promising potential for these ventilators is in developing countries.

“When we were arranging to get these donated to Honduras, we were speaking with a physician who was telling me that [at] his hospital right now, the med students are just hand-ventilating patients. For everything, and for COVID specifically,” Richardson said. “Right now, in Pakistan or in any low-resource country, a family member is hand-ventilating a toddler. Before COVID and after COVID, this is a problem.”

For Poler, the project was a reminder that the country needs to tend to its stockpiles. “People were thinking about [ventilator reserves] in the ’90s, and then they basically quit thinking about it,” he said. “COVID is a shocking reminder that we shouldn’t have stopped thinking about it.”

Goldman said the national efforts may not result in a flood of cheap ventilators in U.S. hospitals. International use could also be tricky. In countries with few resources, even very low-cost ventilators may not be feasible because of lack of electricity or compressed oxygen, though there is “potentially a sweet spot of need and capability where these things could be deployed.”

On the upside, he said, the pandemic kicked off a nearly unprecedented global engineering effort to share information and solve the problem.

“If there’s going to be a magic bullet to come out of this, it’s going to be the capability of our communities and our infrastructure,” he said. “People stood up, put in the appropriate processes and spirit, worked hard, made it happen. We’ve added resilience to the health care sector. That’s the outcome here.”

As for the NovaVent, team members were relieved they didn’t have to rush it into manufacturing as COVID-19 was ripping through the Northeast this spring, thanks to aggressive efforts to flatten the curve. “We ended up without a ventilator shortage, which is excellent,” Clayton said. “But with the increase in cases now, it’s very possible some of them may get used.”

To build on the project, Villanova is raising money for a laboratory for affordable medical technologies called NovaMed. The lab formalizes the process of making inexpensive medical equipment that follows the 80-20 function-to-cost rule. The university says the lab is “motivated by the belief that income should not determine who has access to lifesaving care.”

The effort to prevent a ventilator shortage, Nataraj said, made him think more critically about the American health care system overall.

“How come we haven’t built the technology, the economic and social systems that are able to handle a situation like this — especially when something like this was predicted?” he said. “It’s absolute nonsense. Why should a single person die because we weren’t prepared?”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Inside the Race to Build a Better $500 Emergency Ventilator published first on https://smartdrinkingweb.weebly.com/

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Inside the Race to Build a Better $500 Emergency Ventilator

As the coronavirus crisis lit up this spring, headlines about how the U.S. could innovate its way out of a pending ventilator shortage landed almost as hard and fast as the pandemic itself.

The New Yorker featured “The MacGyvers Taking on the Ventilator Shortage,” an effort initiated not by a doctor or engineer but a blockchain activist. The University of Minnesota created a cheap ventilator called the Coventor; MIT had the MIT Emergency Ventilator; Rice University, the ApolloBVM. NASA created the VITAL, and a fitness monitor company got in the game with Fitbit Flow. The price tags varied from $150 for the Coventor to $10,000 for the Fitbit Flow — all significantly less than premium commercially available hospital ventilators, which can run $50,000 apiece.

Around the same time, C. Nataraj, a Villanova College of Engineering professor, was hearing from front-line doctors at Philadelphia hospitals fearful of running out of ventilators for COVID-19 patients. Compelled to help, Nataraj put together a volunteer SWAT team of engineering and medical talent to invent the ideal emergency ventilator. The goal: build something that could operate with at least 80% of the function of a typical hospital ventilator, but at 20% or less of the cost.

For decades, Nataraj has worked on medical projects — like finding a better way to diagnose a potentially deadly brain injury in premature infants — primarily with doctors at Children’s Hospital of Philadelphia and the Geisinger Health system in rural Pennsylvania, so key clinical players came together swiftly. By March 23, he had approached engineering faculty about collaborating on a monthslong effort to build the NovaVent, a basic, low-cost ventilator with parts that cost about $500. The schematics would be open-sourced, so others could use them free of charge to mass-manufacture the device.

The New Yorker wasn’t alone in referencing the ’80s TV series “MacGyver,” whose protagonist was a Swiss Army knife-carrying secret agent who got the job done with wits and whatever was at hand. The suggestion was that these ventilators were simple enough to throw together with parts from a medical supply closet or your neighborhood hardware store. “Everybody can make it,” one headline read, enticingly. These miracle machines, the thinking went, could be helpful in U.S. hospitals facing critical shortages, perhaps in cities surging with sick patients.

To understand the potential utility and true costs of these emergency ventilators, KHN followed Villanova’s team for three months as it developed, tested and prepared to submit the NovaVent for Food and Drug Administration approval.

The team tapped a maker of car parts, along with roboticists. It gathered input from anesthesiologists as well as electrical, mechanical, fluid systems and computer engineers. It tapped nurses to help ensure that users would immediately know how to operate the ventilator. Local manufacturers 3D-printed pieces of the machine.

Nataraj and his team realized that some of the other ultra-bare-bones machines wouldn’t meet the standards of the modern U.S. health care system. But they also believed there was a lot of room for Villanova’s team to innovate between those and the high-end, expensive devices from corporations like Philips or Medtronic.

One thing is clear: The $500 ventilator is something of a unicorn.

While the parts for the NovaVent cost about that much, the brainpower and people hours added uncounted value. In the early phases, the core group — all volunteers — worked 20 to 25 hours a week, Nataraj said, mainly via Zoom calls from home on top of their day jobs.

Teams of two or three were allowed into the lab to work — virtually the only people on campus. The effort, after all, was in line with the university’s Augustinian mission, which values the pursuit of knowledge, stewardship and community over the individual.

By the time they realized what they could achieve with the $500 model, the first wave of crisis had passed. Yet in those weeks, an alarm resounded across the land about the dismal state of America’s public health system.

So the NovaVent mission pivoted: build better low-cost vents for hospitals in poor and rural U.S. communities that have few, if any, ventilators.

One immediate legacy of the innovation happening at Villanova and elsewhere is the public-spirited nature of the effort, said Dr. Julian Goldman, an anesthesiologist at Massachusetts General Hospital who helps set standards for medical devices: “People from different walks of life in terms of their skills — engineers, clinicians, pure scientists — all thinking and working to try to figure out how to move very quickly to solve a national emergency with many dimensions: How do we make the patient safer? How do we make the caregiver safer? How do we deal with supply chain limitations?”

From other ventures, new designs have already been used as a jumping-off point to build emergency ventilators overseas. They’ve also bolstered New York City’s stockpile and could add to state and national reserves as well.

The early, urgent concerns about a looming ventilator shortage were well founded: On March 13, the U.S. had about 200,000 ventilators, according to the Society of Critical Care Medicine. But because of the surge of COVID patients, it was predicted the country could soon need as many as 960,000.

In early April, New York Gov. Andrew Cuomo said the state would run out of ventilators in six days, leaving doctors with the sort of grim calculation they’d heard about from hard-hit northern Italy: “If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.”

In Philadelphia, 12 miles east of Villanova, hospital administrators braced for shortages and reported short supplies of the drugs required to sedate patients on ventilators.

President Donald Trump invoked the Defense Production Act to get major manufacturers to make ventilators, though GM was already working on it. When GM signed a $500 million contract to deliver 30,000 ventilators to the U.S. government by August, the NovaVent team wondered whether its own efforts would be futile.

“We said, ‘Well, GM is making it. Why are we making it?’” Nataraj said. “But there was a lot of uncertainty with the epidemiological models. We didn’t know how bad it was going to get. Or [the curve] could completely collapse and there’d be no need at all.”

And for a few weeks, it did seem the worst was over. The rate of new cases began to slow in the nation’s early epicenters. Hot spots flared in nearly every pocket of the country, but those too were mostly contained.

People spilled back into normal life, gathering in backyards, beaches and bars. In June, news coverage moved on to the calls for racial justice and mass protests after the videotaped killing of George Floyd in the custody of Minneapolis police.

In the background, the highly contagious coronavirus tore across the South, through Florida, Georgia, Texas and Arizona, and surged in California. Some states reported ICU beds were quickly at or above capacity. This mercurial virus had proved uncontrollable, and the prospect of ventilator shortages had bubbled up once again.

***

Past pandemics have been mothers of innovation. Progress in mechanical ventilation began in earnest after a 1952 polio outbreak in Copenhagen, Denmark. According to the American Journal of Respiratory and Critical Care Medicine, 50 patients a day arrived at the Blegdams Infectious Disease Hospital. Many had paralyzed respiratory muscles; nearly 90% died.

An anesthesiologist at the hospital realized patients were dying from respiratory failure rather than renal failure, as was previously believed, and recommended forcing oxygen into the lungs of patients. This worked — mortality dropped to 40%. But one big problem remained: Patients had to be “hand-bagged,” with more than 1,500 medical students squeezing resuscitator bags for 165,000 total hours.

“They’d recruit nurses and medical students to stand there and squeeze a bag,” says Dr. S. Mark Poler, a Geisinger Health system anesthesiologist on the NovaVent team. “Sometimes they were just so exhausted that they would fall asleep and stop ventilating. It was obviously a catastrophe, so that was the motivation for creating mechanical ventilators.”

The first ones were simple machines, much like the basic emergency-use ventilators created during the COVID crisis. But those came with hazards such as damaging the lungs by forcing in too much air. More sophisticated machines would deliver better control. These engineering marvels — the monitors, the different modes of ventilation, the slick touch-screen controls designed to minimize the risk of injury or error — improved patient treatment but also drove costs sky-high.

The emergency ventilators of 2020 focused on models that, typically, used an Ambu bag and some sort of mechanical “arm” to squeeze it. Most people are familiar with Ambu bags from scenes in TV programs like “ER” where paramedics compress the manual resuscitator bags to help patients breathe as they’re rushed inside from an ambulance. The bags are already widely available in hospitals, cost $30 to $40 and are FDA-approved.

But making machines that are that simple could render them effectively useless (or, worse, dangerous). Medical experts watching university and hospital teams coalesce across the country this spring to develop low-cost emergency ventilators took notice — and worried.

***

Goldman, the Massachusetts General anesthesiologist, was among the medical experts nervous about all the slapped-together ventilators.

“We had the maker community being stood up very quickly, but they don’t know what they don’t know,” said Goldman, chair of the COVID-19 working group for the Association for the Advancement of Medical Instrumentation, the primary source of standards for the medical device industry. “There were videos of harebrained ideas for building ventilators online by people who don’t know any better, and we were very concerned about that.”

The general public doesn’t really understand the nuances required to build a safe medical device, Goldman said.

“They look at something and think, well, this can’t be that hard to build. It just blows air,” he said. “‘I’ll take a vacuum cleaner and turn it on reverse. … It’s a ventilator!’”

AAMI wanted to encourage innovation, but also safety. So Goldman assembled a meeting of 38 engineers, regulators and clinicians to quickly write boiled-down guidelines for emergency-use ventilators.

The simplest ventilators were based on the idea of a piston in a car engine, Poler said: Put a piston on a crankshaft, hook it up to a motor and use a paddle or “arm” to compress the Ambu bag.

“It’s better than no ventilator at all, but it goes at one speed. It doesn’t really have any controls,” Poler said — not ideal when patients need to be monitored for changes in how their lungs are responding, or not, to treatment.

Villanova’s team of engineers, doctors and nurses realized that the simplest ventilators, the ones that AAMI was concerned about, seemed to ignore some basic, practical considerations: What sort of hospitals would these be used in, and under what conditions? What sorts of patients would be put on these ventilators? For how long? Would they be used as backups for higher-end ventilators? What about error alarms?

All good questions, Poler said, but the answer to all of them essentially is “we hope to never use these.”

Their best use? “A surge situation where you simply don’t have enough of the sophisticated ventilators.”

***

Rather than go totally bare-bones, the Villanova team designed the devices as though they would one day be deployed in modern health care.

Flow sensors, which monitor patient ventilation, cost several hundred dollars, so the team designed its own in the lab and 3D-printed it at a cost of 50 cents, Nataraj said, enabled by strides in 3D-printing technology that have vastly cut the price of so many devices. Southco, a Pennsylvania-based global manufacturer that makes parts like the latch on your car’s glove box, was tapped to use its 3D printers to make airflow tubes and couplings for the ventilator.

Garrett Clayton, director of Villanova’s Center for Nonlinear Dynamics and Control, was the day-to-day keeper of the prototype. He was particularly excited about the addition of a handle, which made it easier for him, and eventually others, to lug the 20-pound device from the lab to home and back.

Clayton’s computerized control system measures the flow rate of air going into the patient and converts it into volume, much as commercial ventilators do. That controls how hard and fast the Ambu bag is squeezed; it’s made of a hobby-grade Arduino microcontroller board. A direct-current motor attached to a linear actuator with a fist-shaped piece of PVC on the end pushes the bag in and out. The operator of the ventilator can control the respiratory rate (the number of breaths per minute), as well as the ratio between inspiration and expiration and the volume of air going in.

While traditional ventilators have many control methods, Clayton’s team focused on just one: how much volume is forced into the airway. “We have a set point so we don’t damage the lung,” he said.

Polly Tremoulet, a research psychologist and human factors consultant for ECRI and Children’s Hospital of Philadelphia, was pulled in to focus on error messages and make sure the ventilators’ buttons and displays “spoke the user’s language,” whether that user was an anesthesiologist in New Jersey or a nurse in India pulled into an ICU COVID ward.

Graduate student Emily Hylton and other nursing students were brought in to provide feedback about using the NovaVent and ask questions such as: Would all the controls and monitors look familiar to nurses at the bedside?

The very prospect of these low-cost devices is relatively new, Nataraj said, because of the price of microcontrollers with any real capacity: “Twenty years ago, they cost, oh gosh, $20,000 — and now they’re $20.”

By May 30, the first NovaVent prototype was complete. It was successfully tested on an artificial lung at Children’s Hospital of Philadelphia on June 12. Villanova has applied for a patent for the NovaVent, to help ensure it won’t be commercialized by others.

“If you make it free without having a patent, other people can take it and charge for it,” Clayton said. “A patent protects the open-source nature of it.”

Once a provisional patent is received, the team will submit the ventilator for Emergency Use Authorization from the FDA — hewing to the guidelines set up by AAMI.

***

Within weeks of kicking off the NovaVent project, the curve in the East Coast had indeed flattened, and states had enough standard ventilators to treat every patient. The life-threatening ventilator shortage had not materialized. Some of the emergency-use ventilators based on designs by other teams, like the one at MIT, did go into production — but even those didn’t end up in hospitals, and instead went into city stockpiles meant to reduce potential future reliance on the federal government. So the Villanova team seized on a new, global mission.

“We thought if it wasn’t useful in the U.S. market,” Nataraj said, “we know the developing world, especially sub-Saharan Africa, Latin America and Central America, they don’t have the same kind of facilities that we do here.”

Where the ventilators might end up remains to be seen. Early on, Pennsylvania showed interest in helping Villanova find manufacturing partners. The team has spoken with engineers in India, Cambodia and Sudan (which reportedly has only 80 ventilators in the entire country) who are interested in possibly finding a way to manufacture the NovaVent.

Six thousand emergency ventilators based on the design by the University of Minnesota have been manufactured in the U.S., according to Dr. Stephen Richardson, a cardiac anesthesiologist who worked on that project. Three thousand were made by North Dakota aviation and agricultural manufacturer Appareo for state emergency stockpiles in North Dakota and South Dakota. UnitedHealth Group provided $3 million in funding to manufacture another 3,000 units made by Boston Scientific, which were donated to countries like Peru and Honduras through U.S. organizations; others were sent to the U.S. government.

Like the Villanova team, Richardson said he thinks the most promising potential for these ventilators is in developing countries.

“When we were arranging to get these donated to Honduras, we were speaking with a physician who was telling me that [at] his hospital right now, the med students are just hand-ventilating patients. For everything, and for COVID specifically,” Richardson said. “Right now, in Pakistan or in any low-resource country, a family member is hand-ventilating a toddler. Before COVID and after COVID, this is a problem.”

For Poler, the project was a reminder that the country needs to tend to its stockpiles. “People were thinking about [ventilator reserves] in the ’90s, and then they basically quit thinking about it,” he said. “COVID is a shocking reminder that we shouldn’t have stopped thinking about it.”

Goldman said the national efforts may not result in a flood of cheap ventilators in U.S. hospitals. International use could also be tricky. In countries with few resources, even very low-cost ventilators may not be feasible because of lack of electricity or compressed oxygen, though there is “potentially a sweet spot of need and capability where these things could be deployed.”

On the upside, he said, the pandemic kicked off a nearly unprecedented global engineering effort to share information and solve the problem.

“If there’s going to be a magic bullet to come out of this, it’s going to be the capability of our communities and our infrastructure,” he said. “People stood up, put in the appropriate processes and spirit, worked hard, made it happen. We’ve added resilience to the health care sector. That’s the outcome here.”

As for the NovaVent, team members were relieved they didn’t have to rush it into manufacturing as COVID-19 was ripping through the Northeast this spring, thanks to aggressive efforts to flatten the curve. “We ended up without a ventilator shortage, which is excellent,” Clayton said. “But with the increase in cases now, it’s very possible some of them may get used.”

To build on the project, Villanova is raising money for a laboratory for affordable medical technologies called NovaMed. The lab formalizes the process of making inexpensive medical equipment that follows the 80-20 function-to-cost rule. The university says the lab is “motivated by the belief that income should not determine who has access to lifesaving care.”

The effort to prevent a ventilator shortage, Nataraj said, made him think more critically about the American health care system overall.

“How come we haven’t built the technology, the economic and social systems that are able to handle a situation like this — especially when something like this was predicted?” he said. “It’s absolute nonsense. Why should a single person die because we weren’t prepared?”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Inside the Race to Build a Better $500 Emergency Ventilator published first on https://nootropicspowdersupplier.tumblr.com/

[dinafbrownil]

Inside the Race to Build a Better $500 Emergency Ventilator

As the coronavirus crisis lit up this spring, headlines about how the U.S. could innovate its way out of a pending ventilator shortage landed almost as hard and fast as the pandemic itself.

The New Yorker featured “The MacGyvers Taking on the Ventilator Shortage,” an effort initiated not by a doctor or engineer but a blockchain activist. The University of Minnesota created a cheap ventilator called the Coventor; MIT had the MIT Emergency Ventilator; Rice University, the ApolloBVM. NASA created the VITAL, and a fitness monitor company got in the game with Fitbit Flow. The price tags varied from $150 for the Coventor to $10,000 for the Fitbit Flow — all significantly less than premium commercially available hospital ventilators, which can run $50,000 apiece.

Around the same time, C. Nataraj, a Villanova College of Engineering professor, was hearing from front-line doctors at Philadelphia hospitals fearful of running out of ventilators for COVID-19 patients. Compelled to help, Nataraj put together a volunteer SWAT team of engineering and medical talent to invent the ideal emergency ventilator. The goal: build something that could operate with at least 80% of the function of a typical hospital ventilator, but at 20% or less of the cost.

For decades, Nataraj has worked on medical projects — like finding a better way to diagnose a potentially deadly brain injury in premature infants — primarily with doctors at Children’s Hospital of Philadelphia and the Geisinger Health system in rural Pennsylvania, so key clinical players came together swiftly. By March 23, he had approached engineering faculty about collaborating on a monthslong effort to build the NovaVent, a basic, low-cost ventilator with parts that cost about $500. The schematics would be open-sourced, so others could use them free of charge to mass-manufacture the device.

The New Yorker wasn’t alone in referencing the ’80s TV series “MacGyver,” whose protagonist was a Swiss Army knife-carrying secret agent who got the job done with wits and whatever was at hand. The suggestion was that these ventilators were simple enough to throw together with parts from a medical supply closet or your neighborhood hardware store. “Everybody can make it,” one headline read, enticingly. These miracle machines, the thinking went, could be helpful in U.S. hospitals facing critical shortages, perhaps in cities surging with sick patients.

To understand the potential utility and true costs of these emergency ventilators, KHN followed Villanova’s team for three months as it developed, tested and prepared to submit the NovaVent for Food and Drug Administration approval.

The team tapped a maker of car parts, along with roboticists. It gathered input from anesthesiologists as well as electrical, mechanical, fluid systems and computer engineers. It tapped nurses to help ensure that users would immediately know how to operate the ventilator. Local manufacturers 3D-printed pieces of the machine.

Nataraj and his team realized that some of the other ultra-bare-bones machines wouldn’t meet the standards of the modern U.S. health care system. But they also believed there was a lot of room for Villanova’s team to innovate between those and the high-end, expensive devices from corporations like Philips or Medtronic.

One thing is clear: The $500 ventilator is something of a unicorn.

While the parts for the NovaVent cost about that much, the brainpower and people hours added uncounted value. In the early phases, the core group — all volunteers — worked 20 to 25 hours a week, Nataraj said, mainly via Zoom calls from home on top of their day jobs.

Teams of two or three were allowed into the lab to work — virtually the only people on campus. The effort, after all, was in line with the university’s Augustinian mission, which values the pursuit of knowledge, stewardship and community over the individual.

By the time they realized what they could achieve with the $500 model, the first wave of crisis had passed. Yet in those weeks, an alarm resounded across the land about the dismal state of America’s public health system.

So the NovaVent mission pivoted: build better low-cost vents for hospitals in poor and rural U.S. communities that have few, if any, ventilators.

One immediate legacy of the innovation happening at Villanova and elsewhere is the public-spirited nature of the effort, said Dr. Julian Goldman, an anesthesiologist at Massachusetts General Hospital who helps set standards for medical devices: “People from different walks of life in terms of their skills — engineers, clinicians, pure scientists — all thinking and working to try to figure out how to move very quickly to solve a national emergency with many dimensions: How do we make the patient safer? How do we make the caregiver safer? How do we deal with supply chain limitations?”

From other ventures, new designs have already been used as a jumping-off point to build emergency ventilators overseas. They’ve also bolstered New York City’s stockpile and could add to state and national reserves as well.

The early, urgent concerns about a looming ventilator shortage were well founded: On March 13, the U.S. had about 200,000 ventilators, according to the Society of Critical Care Medicine. But because of the surge of COVID patients, it was predicted the country could soon need as many as 960,000.

In early April, New York Gov. Andrew Cuomo said the state would run out of ventilators in six days, leaving doctors with the sort of grim calculation they’d heard about from hard-hit northern Italy: “If a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.”

In Philadelphia, 12 miles east of Villanova, hospital administrators braced for shortages and reported short supplies of the drugs required to sedate patients on ventilators.

President Donald Trump invoked the Defense Production Act to get major manufacturers to make ventilators, though GM was already working on it. When GM signed a $500 million contract to deliver 30,000 ventilators to the U.S. government by August, the NovaVent team wondered whether its own efforts would be futile.

“We said, ‘Well, GM is making it. Why are we making it?’” Nataraj said. “But there was a lot of uncertainty with the epidemiological models. We didn’t know how bad it was going to get. Or [the curve] could completely collapse and there’d be no need at all.”

And for a few weeks, it did seem the worst was over. The rate of new cases began to slow in the nation’s early epicenters. Hot spots flared in nearly every pocket of the country, but those too were mostly contained.

People spilled back into normal life, gathering in backyards, beaches and bars. In June, news coverage moved on to the calls for racial justice and mass protests after the videotaped killing of George Floyd in the custody of Minneapolis police.

In the background, the highly contagious coronavirus tore across the South, through Florida, Georgia, Texas and Arizona, and surged in California. Some states reported ICU beds were quickly at or above capacity. This mercurial virus had proved uncontrollable, and the prospect of ventilator shortages had bubbled up once again.

***

Past pandemics have been mothers of innovation. Progress in mechanical ventilation began in earnest after a 1952 polio outbreak in Copenhagen, Denmark. According to the American Journal of Respiratory and Critical Care Medicine, 50 patients a day arrived at the Blegdams Infectious Disease Hospital. Many had paralyzed respiratory muscles; nearly 90% died.

An anesthesiologist at the hospital realized patients were dying from respiratory failure rather than renal failure, as was previously believed, and recommended forcing oxygen into the lungs of patients. This worked — mortality dropped to 40%. But one big problem remained: Patients had to be “hand-bagged,” with more than 1,500 medical students squeezing resuscitator bags for 165,000 total hours.

“They’d recruit nurses and medical students to stand there and squeeze a bag,” says Dr. S. Mark Poler, a Geisinger Health system anesthesiologist on the NovaVent team. “Sometimes they were just so exhausted that they would fall asleep and stop ventilating. It was obviously a catastrophe, so that was the motivation for creating mechanical ventilators.”

The first ones were simple machines, much like the basic emergency-use ventilators created during the COVID crisis. But those came with hazards such as damaging the lungs by forcing in too much air. More sophisticated machines would deliver better control. These engineering marvels — the monitors, the different modes of ventilation, the slick touch-screen controls designed to minimize the risk of injury or error — improved patient treatment but also drove costs sky-high.

The emergency ventilators of 2020 focused on models that, typically, used an Ambu bag and some sort of mechanical “arm” to squeeze it. Most people are familiar with Ambu bags from scenes in TV programs like “ER” where paramedics compress the manual resuscitator bags to help patients breathe as they’re rushed inside from an ambulance. The bags are already widely available in hospitals, cost $30 to $40 and are FDA-approved.

But making machines that are that simple could render them effectively useless (or, worse, dangerous). Medical experts watching university and hospital teams coalesce across the country this spring to develop low-cost emergency ventilators took notice — and worried.

***

Goldman, the Massachusetts General anesthesiologist, was among the medical experts nervous about all the slapped-together ventilators.

“We had the maker community being stood up very quickly, but they don’t know what they don’t know,” said Goldman, chair of the COVID-19 working group for the Association for the Advancement of Medical Instrumentation, the primary source of standards for the medical device industry. “There were videos of harebrained ideas for building ventilators online by people who don’t know any better, and we were very concerned about that.”

The general public doesn’t really understand the nuances required to build a safe medical device, Goldman said.

“They look at something and think, well, this can’t be that hard to build. It just blows air,” he said. “‘I’ll take a vacuum cleaner and turn it on reverse. … It’s a ventilator!’”

AAMI wanted to encourage innovation, but also safety. So Goldman assembled a meeting of 38 engineers, regulators and clinicians to quickly write boiled-down guidelines for emergency-use ventilators.

The simplest ventilators were based on the idea of a piston in a car engine, Poler said: Put a piston on a crankshaft, hook it up to a motor and use a paddle or “arm” to compress the Ambu bag.

“It’s better than no ventilator at all, but it goes at one speed. It doesn’t really have any controls,” Poler said — not ideal when patients need to be monitored for changes in how their lungs are responding, or not, to treatment.

Villanova’s team of engineers, doctors and nurses realized that the simplest ventilators, the ones that AAMI was concerned about, seemed to ignore some basic, practical considerations: What sort of hospitals would these be used in, and under what conditions? What sorts of patients would be put on these ventilators? For how long? Would they be used as backups for higher-end ventilators? What about error alarms?

All good questions, Poler said, but the answer to all of them essentially is “we hope to never use these.”

Their best use? “A surge situation where you simply don’t have enough of the sophisticated ventilators.”

***

Rather than go totally bare-bones, the Villanova team designed the devices as though they would one day be deployed in modern health care.

Flow sensors, which monitor patient ventilation, cost several hundred dollars, so the team designed its own in the lab and 3D-printed it at a cost of 50 cents, Nataraj said, enabled by strides in 3D-printing technology that have vastly cut the price of so many devices. Southco, a Pennsylvania-based global manufacturer that makes parts like the latch on your car’s glove box, was tapped to use its 3D printers to make airflow tubes and couplings for the ventilator.

Garrett Clayton, director of Villanova’s Center for Nonlinear Dynamics and Control, was the day-to-day keeper of the prototype. He was particularly excited about the addition of a handle, which made it easier for him, and eventually others, to lug the 20-pound device from the lab to home and back.

Clayton’s computerized control system measures the flow rate of air going into the patient and converts it into volume, much as commercial ventilators do. That controls how hard and fast the Ambu bag is squeezed; it’s made of a hobby-grade Arduino microcontroller board. A direct-current motor attached to a linear actuator with a fist-shaped piece of PVC on the end pushes the bag in and out. The operator of the ventilator can control the respiratory rate (the number of breaths per minute), as well as the ratio between inspiration and expiration and the volume of air going in.

While traditional ventilators have many control methods, Clayton’s team focused on just one: how much volume is forced into the airway. “We have a set point so we don’t damage the lung,” he said.

Polly Tremoulet, a research psychologist and human factors consultant for ECRI and Children’s Hospital of Philadelphia, was pulled in to focus on error messages and make sure the ventilators’ buttons and displays “spoke the user’s language,” whether that user was an anesthesiologist in New Jersey or a nurse in India pulled into an ICU COVID ward.

Graduate student Emily Hylton and other nursing students were brought in to provide feedback about using the NovaVent and ask questions such as: Would all the controls and monitors look familiar to nurses at the bedside?

The very prospect of these low-cost devices is relatively new, Nataraj said, because of the price of microcontrollers with any real capacity: “Twenty years ago, they cost, oh gosh, $20,000 — and now they’re $20.”

By May 30, the first NovaVent prototype was complete. It was successfully tested on an artificial lung at Children’s Hospital of Philadelphia on June 12. Villanova has applied for a patent for the NovaVent, to help ensure it won’t be commercialized by others.

“If you make it free without having a patent, other people can take it and charge for it,” Clayton said. “A patent protects the open-source nature of it.”

Once a provisional patent is received, the team will submit the ventilator for Emergency Use Authorization from the FDA — hewing to the guidelines set up by AAMI.

***

Within weeks of kicking off the NovaVent project, the curve in the East Coast had indeed flattened, and states had enough standard ventilators to treat every patient. The life-threatening ventilator shortage had not materialized. Some of the emergency-use ventilators based on designs by other teams, like the one at MIT, did go into production — but even those didn’t end up in hospitals, and instead went into city stockpiles meant to reduce potential future reliance on the federal government. So the Villanova team seized on a new, global mission.

“We thought if it wasn’t useful in the U.S. market,” Nataraj said, “we know the developing world, especially sub-Saharan Africa, Latin America and Central America, they don’t have the same kind of facilities that we do here.”

Where the ventilators might end up remains to be seen. Early on, Pennsylvania showed interest in helping Villanova find manufacturing partners. The team has spoken with engineers in India, Cambodia and Sudan (which reportedly has only 80 ventilators in the entire country) who are interested in possibly finding a way to manufacture the NovaVent.

Six thousand emergency ventilators based on the design by the University of Minnesota have been manufactured in the U.S., according to Dr. Stephen Richardson, a cardiac anesthesiologist who worked on that project. Three thousand were made by North Dakota aviation and agricultural manufacturer Appareo for state emergency stockpiles in North Dakota and South Dakota. UnitedHealth Group provided $3 million in funding to manufacture another 3,000 units made by Boston Scientific, which were donated to countries like Peru and Honduras through U.S. organizations; others were sent to the U.S. government.

Like the Villanova team, Richardson said he thinks the most promising potential for these ventilators is in developing countries.

“When we were arranging to get these donated to Honduras, we were speaking with a physician who was telling me that [at] his hospital right now, the med students are just hand-ventilating patients. For everything, and for COVID specifically,” Richardson said. “Right now, in Pakistan or in any low-resource country, a family member is hand-ventilating a toddler. Before COVID and after COVID, this is a problem.”

For Poler, the project was a reminder that the country needs to tend to its stockpiles. “People were thinking about [ventilator reserves] in the ’90s, and then they basically quit thinking about it,” he said. “COVID is a shocking reminder that we shouldn’t have stopped thinking about it.”

Goldman said the national efforts may not result in a flood of cheap ventilators in U.S. hospitals. International use could also be tricky. In countries with few resources, even very low-cost ventilators may not be feasible because of lack of electricity or compressed oxygen, though there is “potentially a sweet spot of need and capability where these things could be deployed.”

On the upside, he said, the pandemic kicked off a nearly unprecedented global engineering effort to share information and solve the problem.

“If there’s going to be a magic bullet to come out of this, it’s going to be the capability of our communities and our infrastructure,” he said. “People stood up, put in the appropriate processes and spirit, worked hard, made it happen. We’ve added resilience to the health care sector. That’s the outcome here.”

As for the NovaVent, team members were relieved they didn’t have to rush it into manufacturing as COVID-19 was ripping through the Northeast this spring, thanks to aggressive efforts to flatten the curve. “We ended up without a ventilator shortage, which is excellent,” Clayton said. “But with the increase in cases now, it’s very possible some of them may get used.”

To build on the project, Villanova is raising money for a laboratory for affordable medical technologies called NovaMed. The lab formalizes the process of making inexpensive medical equipment that follows the 80-20 function-to-cost rule. The university says the lab is “motivated by the belief that income should not determine who has access to lifesaving care.”

The effort to prevent a ventilator shortage, Nataraj said, made him think more critically about the American health care system overall.

“How come we haven’t built the technology, the economic and social systems that are able to handle a situation like this — especially when something like this was predicted?” he said. “It’s absolute nonsense. Why should a single person die because we weren’t prepared?”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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from Updates By Dina https://khn.org/news/inside-the-race-to-build-a-better-500-emergency-ventilator/

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Headlines

WHO declares that virus crisis is now a pandemic (AP) Expressing increasing alarm about mounting infections, the World Health Organization declared Wednesday that the global coronavirus crisis is now a pandemic. Designating the crisis a pandemic is the WHO’s way of putting countries on notice to take more aggressive action. For most, the coronavirus causes only mild or moderate symptoms, such as fever and cough. But for a few, especially older adults and people with existing health problems, it can cause more severe illnesses, including pneumonia. More than 121,000 people have been infected worldwide and over 4,300 have died. On Wall Street, the Dow skid nearly 1,500 points on the news, ending a record 11-year stock rally.

States race to stop virus (AP) Governors and other leaders scrambling to slow the spread of the coronavirus stepped up bans on large public gatherings and a rapidly expanding list of universities moved classes online. The outbreak has spread to more than half the states, with Arkansas and New Mexico reporting their first cases of the virus. Kentucky Gov. Andy Beshear urged churches across the state to cancel services. In hard-hit Washington state, Gov. Jay Inslee was expected Wednesday to ban gatherings of more than 250 people in virtually the entire Seattle metro area, home to some 4 million people. Schools and houses of worship were shuttered in the New York City suburb of New Rochelle, epicenter of the nation’s biggest known cluster of cases. UCLA, Yale and Stanford were among the universities announcing plans to send students home and hold classes remotely. Chicago canceled its St. Patrick’s Day parade, joining Boston and Philadelphia, while the Coachella music festival that draws tens of thousands to the California desert near Palm Springs every April was postponed.

Biden wins more primary victories (Reuters) Joe Biden scored decisive primary victories in Michigan and three other states on Tuesday, taking a big step toward the Democratic Party’s presidential nomination and casting doubt on the future of rival Bernie Sanders’ fading White House bid. The sweeping wins put Biden, 77, on a path to face Republican Donald Trump in the Nov. 3 election, and the former vice president quickly looked ahead with a call for party unity.

Far from the coronavirus epicenter, Caribbean tourism starts to get sick (Washington Post) The economic fallout of the novel coronavirus is slamming the infection epicenters of Asia and Europe. But from oil producers in the Middle East to hotels and restaurateurs here in the Caribbean, a fast-spreading ripple effect is engulfing even those far-flung corners of the globe that have yet to confirm many cases of Convid-19 of their own. Cruise ship passengers are down and hotel guests have begun to dip. The islands are bracing for worse.

Chile marks 30 years of democracy; students ramp up protests against inequality (Reuters) President Sebastian Pinera celebrated 30 years since Chile’s return to democracy on Wednesday, but students calling for Pinera himself to leave office due to income inequality and other issues led civil disobedience protests, skirmishing with police around the capital and disrupting public transport.

Sweden and the coronavirus (Reuters) Sweden reported its first death from the new coronavirus on Wednesday and banned public gatherings of more than 500 people to try to stop the spread of the disease.

Italy and the coronavirus (Foreign Policy) Italy continues its attempts to contain the outbreak at home. Meanwhile, Austria and Slovenia have closed their borders with the country, but those of France and Switzerland remain open. Yesterday, Italy’s Deputy Finance Minister Laura Castelli confirmed that mortgage payments would be temporarily frozen for individuals and households. The outbreak is forcing Italy to tighten its nationwide lockdown by shutting bars, hairdressers and restaurants.

Turkey vows strong military action if Syria truce violated (AP) Turkey’s President Recep Tayyip Erdogan vowed Wednesday that his military would launch its harshest retaliation yet if the Syrian government breaks a fragile truce in Idlib province brokered last week. The cease-fire arranged by Turkey and Russia--which support opposing sides in the conflict--halted a three-month air and ground campaign by the Syrian government against the rebel-held province. That offensive killed hundreds and sent 1 million people fleeing toward the Turkish border.

President Putin Forever? (Foreign Policy) On Tuesday, Russian President Vladimir Putin said he would approve newly-proposed changes to the Russian constitution that would allow him to remain in power until 2036. Under the current constitution, Putin would be required to step down when his term ends in 2024, and speculation was rife about what Putin would do next. Putin was not definitive as to whether he would continue as president, telling Russia’s parliament, “I’m sure that together, we will do many more great things, at least until 2024. Then, we will see.”

Is China Returning to Business as Usual? (Foreign Policy) Life in China appears to be beginning to return to normal after weeks of lockdown due to the coronavirus. Although the streets of major cities aren’t anywhere near as crowded as before, people are coming out again and offices and factories are starting to spring back to life. The makeshift hospitals erected in Wuhan amid the outbreak have been closed, and the epidemic seems to have been broken there. On Tuesday, President Xi Jinping arrived in Wuhan for a carefully planned visit. There, local leaders have demanded that the people show their gratitude to the party, which received some pushback. Don’t confuse this with actual normality. Life in China is still happening under the shadow of the virus, with temperature checks, app monitoring, and other biosecurity measures. That includes a just-announced 14-day quarantine period for all international arrivals at Beijing’s airports, which could extend across the country soon. Movement within the country is still restricted, including for migrant workers.

Japan and the coronavirus (Foreign Policy) Japan’s government announced $4 billion in spending to mitigate the economic effects of coronavirus and improve medical facilities. Finance Minister Taro Aso said the funds would come from an existing budget reserve and not from any extra budget. According to the Wall Street Journal, the measures include offering emergency zero-interest loans of $1,900 to support the newly unemployed and others facing hardship.

Israel seals itself off from international travel (Washington Post) The arrival hall of Ben Gurion Airport’s Terminal 3 is Israel’s front door. On Tuesday, one day after the government instituted some of the most sweeping quarantine requirements in the global fight against coronavirus, it was a door swinging shut. Daily arrivals had collapsed by two-thirds, according to airport authorities, falling from 65,000 to 22,000. As of Monday night, Israeli citizens and residents were required to go straight from the airport to self-isolation, no matter what country they are returning from.

South African court clears Ramaphosa (Foreign Policy) The high court in Pretoria has cleared South African President Cyril Ramaphosa after he stood accused of misleading parliament over a $34,000 campaign contribution from the CEO of a local company. It’s a rare boost for Ramaphosa, who is presiding over a recession in South Africa and whose leadership of the ruling African National Congress is in question ahead of a July party conference, where his internal opponents may seek to recall him.

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The Chef-Made Philly Hot Sauces You’ll Want to Put on Everything

Guides

Keep your kitchen stocked with these peppery, flavor-packed condiments, from a vinegar-y seasoning for barbecue to spicy sambal.

Cafe Lift | Facebook

Every hot sauce lover has their favorite, from Crystal’s hot-salty-tangy punch to sriracha’s ubiquitous vegetal spice. But these Philly chefs made their own hot sauces so good, customers clamored to take them home. From fiery bottles of a classic cheesesteak condiment to tubs of sambal you’ll want to put on everything you cook, here are five great chef-made hot sauces from Philadelphia restaurants.

Baology, Center City Although Asian cuisines are sometimes seen as spicy across the board, Taiwanese cuisine isn’t, overall. So co-owners Judy Ni and Andy Tessier use a mix of habanero and Fresno chiles to create a sauce that would best complement their potstickers, gwa baos, and fried chicken with lots of pepper flavor and an up-front hit of heat. Even better? Thanks to ingenuity in the kitchen, it’s a zero-waste product: the pulp, skins, and seeds strained out of the sauce are dehydrated and buzzed into a spicy seasoning (you can take a jar of that home, too).

Cafe Lift, Spring Arts and Narberth It’s only fitting that this super-spicy hot sauce from restaurateurs Michael and Jenniphur Pasquarello’s family-friendly bruncherie should be named after one of the couple’s kiddos. Taste it at their city or suburban cafe, then buy a 16-ounce jar to spice things up in your own kitchen.

Geno’s Steaks, East Passyunk Wherever you land on the Pat’s-versus-Geno’s debate, only one of the iconic South Philly cheesesteak spots has its own signature hot sauce for sale by the bottle. The tangy, sinus-clearing concoction, developed by founder Joey Vento more than 50 years ago, gets its heat from bird’s-eye chili peppers.

Hardena/Waroeng Surabaya, South Philly The James Beard-nominated Indonesian mainstay produces a slate of its own sambals for use on veggies, meat, and fish — and you can buy them by the tub to freeze for home use. Choose from classic sambal terasi, boosted with pungent shrimp paste, or go vegan with red pepper or green garlic sambals.

Lechonera Principe, Kensington The crackly-skinned, juicy pork at this must-try Puerto Rican spot is pit-roasted to perfection every morning. But if you like a little kick to your ‘cue, throw on a dash or three of their bracing house-made pique, a mix of hot peppers, herbs, and seasonings steeped in vinegar.

Source: https://www.phillymag.com/foobooz/2019/06/25/philadelphia-chef-hot-sauce/

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The Foobooz Last-Minute Holiday Food and Drink Gift Guide

Guides

All the best Philadelphia-made gifts for anyone who cooks, eats, or drinks in your life — no shipping required.

Devoted foodies and restaurant newbies love Foobooz. Sign up now for our twice weekly newsletter.

Riverwards Produce | Facebook

If you’re anything like us, you’ve still got lots of holiday shopping to do, and you’re feeling wary about rolling the dice by getting goodies shipped from online outlets just a week before Christmas. You also love to give (and receive) food and drink as gifts — and why not? They’re practical, pleasurable, and consumable, offering a sense of place, supporting our local economy, and reducing clutter for the giftee at the same time.

So we compiled our favorite brick-and-mortar spots where you can pop in and find the perfect locally made gastronomic gifts this holiday, from butcher shops and artisan bakeries to boutique brewers and distilleries. That includes cookbooks, too — Philly is also blessed with an abundance of excellent food and drink authors whose works will enhance any collection. And contrary to popular belief, there is nothing wrong with giving gift cards — as long as they’re from a place the recipient actually likes.

Stocking Stuffers

Keepwell Vinegar | Facebook

Keepwell Vinegar These small-batch artisanal vinegars are made from local fruit and herbs by former pastry chefs in south central Pennsylvania. Whether sprinkled over salads or added to cocktails for a bracing, fruity bite, these vinegars in flavors like bitter lemon, turmeric, and aronia berry are a must for any foodie’s pantry. Find it at: Primal Supply Meats, Green Aisle Grocery, Cuttalossa, Riverwards Produce, Weaver’s Way Co-op

Spice Blends from St. Lucifer Spice This Philly-born, tangy-savory-spicy blend of garlic, salt, vinegar, and peppers is the perfect on everything from roast chicken to cheese curds to popcorn. Find it at: Fante’s, Di Bruno Bros., or (if you must) Wegmans

Pretzel Shortbread Cookies from Lost Bread Co. Nobody doesn’t like these shiny, salt-topped, sandy-textured rectangles of concentrated sweet-savory pretzel flavor — which, if our experience is any indication, will be gone before the last present is unwrapped. Find it at: Lost Bread Co., Riverwards Produce, Mariposa Co-op, or the Craft Hall pop-up

Cured Meats from Salumificio Cicala Skip the oranges and nuts this year and stuff stockings with artisanal salumi made from local, humanely raised pork by chef Joe Cicala instead. Find it at: Green Aisle Grocery, Market on 9th

Gift Cards

Primal Supply Meats | Photo by Jason Varney

Primal Supply Meats, East Passyunk Give the gift of being able to choose your favorite cut, from chicken backs for stock to thick-cut ribeye steaks. And this whole-animal butcher shop is so well-stocked with local goodies — high-quality California olive oil, local artisan cheeses and breads, Cape May-sourced sea salt — that even a vegetarian could go on a satisfying shopping spree.

Philly Homebrew Outlet, Kensington, West Philly, Oaklyn The perfect thing to give the DIY nerd (or wannabe) in your life, who can get as specific (rhizomes to grow your own hops) or general (Ball jars) as they want when they cash it in. PHO stocks equipment, ingredients, and supplies for everything from beer, wine, and cider making to canning to beekeeping to making your own soap.

Riverwards Produce, Fishtown Have you ever been given a gift card to your favorite grocery store? We have, and they’re extremely fun and useful. The giftee can pick up some fancy bacon, tropical fruit, or gourmet nuts her typical budget doesn’t always allow for (special!) while stocking up on any basics she might need (practical!).

Art in the Age Tasting Room, Old City Whether you’re shopping for a cocktail connoisseur or someone who just likes to drink, Art in the Age’s tasting room-slash-barware destination has exactly what your recipient is looking for. They can choose from gorgeous glasses and mixology tools, books on blending the perfect drink or infusing your own spirits, a wide selection of local and regionally produced bottles of the hard stuff, or simply subsidize their next happy hour.

Booze

Ploughman Cider | Facebook

Just about anything from Ploughman Cider A bottle from our favorite Pennsylvania cider maker will bring joy to anyone who loves delicious drinks. We personally love their tart, fizzy Kenspeckle and vinous Pinot N’Arlet (tinted pink with aronia berries and pinot noir grape skins, respectively), but we’d also be psyched to find a sixer of their dry-hopped Lupulin Lummox or a petite bottle of Distelfunk, a light, wild-fermented peach wine that will transport you back to summertime, under the Christmas tree. Find it at: Bottle Bar East, Di Bruno Bros. in Rittenhouse and the Franklin, 320 Market.

Maple whiskey from Manatawny Still Works How to improve on Manatawny’s smooth, balanced Keystone Whiskey? Age it in whiskey barrels that were just used to age Whiskey Hollow Maple’s syrup. The result, after adding a little more syrup to the blend at the end of the process, is a not-too-sweet spirit whose maple notes uplift its four-grain whiskey flavor — perfect for sipping neat around the fireplace or stirring into a hot toddy. Find it at: Their East Passyunk tasting room, their shop at 16th and JFK, or at the distillery in Pottstown.

Herbal spirits from Rowhouse Spirits Anything from Dean Browne’s petite Kensington distillery is bound to please the spirit-loving person in your life — but if he’s got their Demon Weed amaro or Bear Trap, a sipping liqueur that’s triple-infused with local herbs from Greensgrow Farms, be sure to grab one of those. Find it at: Their Frankford Avenue facility or select PLCB locations.

Beer from Fermentery Form Bottles from this cult favorite brewer would be sought after even if their tasting room wasn’t only open once a week (pending occasional Instagram-announced additions to the schedule) — their funky, farmhouse-style sour beers are just that good. Get one for the beer lover in your life. Find it at: Their tasting room in Fishtown, which is only sure to be open this Saturday, December 22nd from 2 p.m. till 8 p.m. before Christmas. You can check their social media to see if they’ll be open other days before the holiday, but Saturday is the only sure bet.

Food & Drink Accessories

Clay Kitchen Studio | Official

Custom fermentation crocks by Clay Kitchen Studio Potter Miki Palchick creates one-of-a-kind ceramic fermentation crocks and servingware for home cooks and Philly chefs (like Saté Kampar’s Ange Branca and Studio Kitchen’s Shola Olunloyo) alike. There’s still time to purchase gift certificates for her custom fermentation crocks — which allow the recipient can choose the color, shape, and style combination they love, then get it made to order — by emailing Miki at claykitchenstudio@gmail.com.

Tableware at Cuttalossa Gorgeous accessories with which to serve all the delicious things you’ve cooked should be a given, not an afterthought. Shannon Resteck’s airy Old City shop (located in the back of the store she shares with vintage clothing business Meadowsweet Mercantile) stocks all the beautiful tea towels, beeswax candles, handmade ceramic mugs and vases, and serving trays made by local artists that a kitchen maven could want.

Cheese boards from Artifaqt Unless you frequent cheese-centric events in Philly, you might not know that one of the premiere makers of high-quality boards and other servingware (like these wild towers and vessels made for fancy-pants spots like Le Bernardin) is based in nearby Phoenixville. Luckily, owner John Luttman has supplied the good folks at Riverwards Produce with some gorgeous home-scale cheese boards that are perfect for giving — plus, you can pick up a few local wedges from their fridge to round out your gift at the same time.

Fancy barware from Art in the Age Any cocktail lover from beginner to advanced loves well-made additions to their barware collection, and Art in the Age is the place to find the tools of the trade. They have just about everything you need to create the perfect drink: reusable gold picks to hold olives and berries, hand-turned wooden muddlers for fruit and herbs, beautifully patterned mixing glasses, and ornate vessels for serving tiki drinks.

Cookbooks

Courtesy of Running Press | Photo by Jason Varney

Booze & Vinyl, Andre and Tenaya Darlington The third book from this cocktail-obsessed pair of siblings pairs easy-to-make original drinks with iconic albums available on wax. It’s perfect for the seasoned home bartender or the would-be listening party host. Find it at: Riverwards Produce, Shakespeare & Co., Barnes & Noble

The Food in Jars Kitchen, Marisa McClellan Cookbook author Marisa McClellan has been writing about preserving for more than a decade, developing recipes and tutorials to help home cooks can the perfect jar of jam. Her latest, all about how to serve, cook with, and otherwise use up all those delicious canned, dried, pickled, and preserved goodies, is available for pre-order now. For beginners or apartment-dwellers, respectively, look to her earlier books, Food in Jars and Preserving By the Pint. Find it at: Riverwards Produce, Green Aisle Grocery

Ferment Your Vegetables, Amanda Feifer Shopping for someone who’s always wanted to make their own pickled goodies? Amanda Feifer’s clear, science-based instructions can turn a fermentation newbie into an expert microbe farmer making their own sauerkraut, kimchi, pickles, and more. Pro tip: this book goes perfectly with a Clay Kitchen Studio custom crock gift certificate. Find it at: Fante’s, Riverwards Produce, Barnes & Noble

Session Cocktails, Drew Lazor Bartenders, chefs, and consumers have been looking to lighten up on alcohol in recent years — and this book full of low-alcohol drink recipes that are just as delicious as their full-pour counterparts can show us the way. It’s a great option for the health-conscious gourmand or the cocktail lover in your life. Find it at: Art in the Age, COOK, Green Aisle Grocery, Philadelphia Distilling, Occasionette

Source: https://www.phillymag.com/foobooz/2018/12/18/philadelphia-holiday-gift-guide-christmas/