http://Louis1J1Sheehan.us Brain surgeon Kenneth Follett had never received thank-you cards from his patients after performing an operation — until he started putting electrodes in their brains. Louis J. Sheehan, Esquire
Follett, who holds positions at the University of Nebraska Medical Center and the Veterans Affairs Medical Center in Omaha, is among a select group of surgeons who over the past decade have been treating Parkinson’s disease by installing two tiny electrodes in a patient’s brain.
The change these devices induce can be astonishing, he says. Parkinson’s is characterized by brain degeneration, marked by a shortage of the neurotransmitter dopamine. That shortage results in movement problems. http://Louis1J1Sheehan.us After surgery, many patients are suddenly able to get around, do household chores and even go shopping, Follett says. “It has the potential to change people’s lives.”
Follett’s firsthand observations are now supported by clinical research. He and a team of fellow surgeons and scientists report in the Jan. 7 Journal of the American Medical Association that Parkinson’s patients randomly assigned to get medication plus the surgery show dramatic improvements, whereas patients getting just the best available medication do not.
The surgery, called deep-brain stimulation, isn’t new, having been first approved by regulators in 1997. But only one other study — reported by German scientists in 2006 — has tested the surgery against medication in a large, randomized trial. That study also showed benefits in patients who received both surgery and medication (SN: 9/2/06, p. 149).
Günther Deuschl, a neurologist at Christian Albrechts University in Kiel who led the German study, writes in JAMA that the new findings “have convincingly confirmed the six-month efficacy of deep brain stimulation for advanced Parkinson’s disease in the largest patient group studied thus far.”
The new findings also extend the benefits of surgery to older Parkinson’s patients, since one-fourth of the patients in the U.S. trial were age 70 or older. “They did as well as the younger patients” who underwent the surgery, Follett says.
What’s more, the new findings suggest that many worrisome side effects from the surgery fade over time.
The electrodes that doctors install — one on each side of the brain — are actually small, insulated wires that are connected to another wire that runs under the skin to a small battery beneath the skin of the torso. The electrodes are implanted into a part of the brain that normally acts as a relay station for messages. In Parkinson’s patients, a flurry of signals jam this message center, sending aberrant signals to muscles and causing tremors, muscle rigidity, paralysis and other problems. The electrodes send out a mild current that inhibits the stream of messages, relieving the clutter and calming muscle problems.
In the new study, researchers at 13 U.S. medical centers identified 255 people from 2002 to 2005 who had been taking medication for Parkinson’s disease for nearly 12 years, on average. Half were randomly assigned to get surgery and medication as needed. The others received medication only.
For six months, patients kept a log documenting how many hours per day they were able to move freely without paralysis, jerky motions or other problems. At the outset of the study, this time amounted to about seven hours a day, a number that went unchanged in those getting medication only. But patients assigned to surgery saw their free-movement time jump to 11 hours a day, on average, after six months. Over that time, these patients were also able to cut their medication intake by about half.
Fifteen medication-only patients experienced serious side effects, compared with 49 patients who underwent surgery. Complications from surgery tended to occur within three months of the procedure. Problems included headaches, falls, confusion, speech problems and slowed movement. One person who underwent surgery died of a brain hemorrhage within 24 hours.
But 99 percent of the side effects had resolved by six months as doctors remotely fine-tuned the intensity of the current being generated by the electrodes in each patient and modified each patient’s medication. “It’s a bit of a balancing act,” Follett says.
The challenge in using this surgery might be to determine earlier in the course of disease which patients would get the most benefit from the procedure, says neurosurgeon Robert Goodman of Columbia University in New York City. While medications such as levodopa are highly effective for years, many patients continue to lose mobility despite higher doses. And too much medication can bring on involuntary movements. Goodman estimates 10 to 20 percent of Parkinson’s patients fall into this trap. Those with true Parkinson’s disease — without dementia or other symptoms — would be good candidates for surgery, he says.
Despite the promising results, caution is in order, Deuschl says. He cites evidence that patients have an alarmingly high suicide rate in the first year following deep-brain stimulation surgery, a risk that lessens over time but still lingers after four years. There were no suicides in the six months patients were monitored in the new study. Further work to identify risk factors is needed, Deuschl says. Louis J. Sheehan, Esquire
Saturday, January 10, 2009
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coal furnaces 4.coa.0 Louis J. Sheehan, Esquire
Louis J. Sheehan, Esquire
December 27, 2008
Burning Coal at Home Is Making a Comeback
By TOM ZELLER Jr. and STEFAN MILKOWSKI
SUGARLOAF, Pa. — Kyle Buck heaved open the door of a makeshift bin abutting his suburban ranch house. Staring at a two-ton pile of coal that was delivered by truck a few weeks ago, Mr. Buck worried aloud that it would not be enough to last the winter.
“I think I’m going through it faster than I thought I would,” he said. http://louis-j-sheehan-esquire.sampa.com/louis-j-sheehan-esquire/blog
Aptly, perhaps, for an era of hard times, coal is making a comeback as a home heating fuel.
Problematic in some ways and difficult to handle, coal is nonetheless a cheap, plentiful, mined-in-America source of heat. And with the cost of heating oil and natural gas increasingly prone to spikes, some homeowners in the Northeast, pockets of the Midwest and even Alaska are deciding coal is worth the trouble.
Burning coal at home was once commonplace, of course, but the practice had been declining for decades. Coal consumption for residential use hit a low of 258,000 tons in 2006 — then started to rise. It jumped 9 percent in 2007, according to the Energy Information Administration, and 10 percent more in the first eight months of 2008.
Online coal forums are buzzing with activity, as residential coal enthusiasts trade tips and advice for buying and tending to coal heaters. And manufacturers and dealers of coal-burning stoves say they have been deluged with orders — many placed when the price of heating oil jumped last summer — that they are struggling to fill.
“Back in the 1980s, we sold hundreds a year,” said Rich Kauffman, the sales manager at E.F.M. Automatic Heat in Emmaus, Pa., one of the oldest makers of coal-fired furnaces and boilers in the United States, in a nod to the uptick in coal sales that followed the oil crises of the 1970s.
“But that dwindled to nothing in the early 1990s — down to as many as 10 a year,” he said. “It picked up about a year ago, when we moved about 60 units, and then this year we’ve already sold 200.”
Dean Lehman, the plant manager for Hitzer Inc., a family-owned business in Berne, Ind., that makes smaller, indoor coal stoves, said his stoves were on back order until March. And Jeffery Gliem, the director of operations at the Reading Stove Company and its parent, Reading Anthracite, in Pottsville, Pa., which supplies coal and stoves to 15 states in the Northeast and Midwest, said the uptick in interest was the largest he had seen in 30 years.
“In your typical year you might have five, six, seven thousand stoves being sold,” Mr. Gliem said. “This year it was probably double that.”
The coal trend is consistent with steep increases in other forms of supplementary heating that people can use to save money — most of them less messy than coal. Home Depot reports that it has sold more than 80,000 tons of pellet fuel, a sort of compressed sawdust, for the season to date. That is an increase of 137 percent compared with the same period last year, said Jean Niemi, a company spokeswoman.
Coal may never make economic sense in areas far from where it is mined. But in places within reasonable delivery range, the price tends to be stable, compared with heating oil or natural gas. Prices for natural gas more than tripled in recent years before plunging in the last few months amid the downturn.
Coals vary in quality, but on average, a ton of coal contains about as much potential heat as 146 gallons of heating oil or 20,000 cubic feet of natural gas, according to the Energy Information Administration. A ton of anthracite, a particularly high grade of coal, can cost as little as $120 near mines in Pennsylvania. The equivalent amount of heating oil would cost roughly $380, based on the most recent prices in the state — and over $470 using prices from December 2007. An equivalent amount of natural gas would cost about $480 at current prices.
Mr. Buck said he could buy coal for $165 a ton. On a blustery afternoon recently, he was still studying the manual for his $2,300 Alaska Channing stoker, which gave off an intense heat in the den. An automated hopper in the back slowly dispensed fine anthracite coal chips into the stove’s belly, and every couple of days, Mr. Buck emptied the ash. He said he hoped the stove would cut his oil consumption in half.
“Now, somewhere, you’ve got to take into account the convenience of turning up your thermostat, versus having two tons of coal to shovel and the hopper and ashes to deal with,” Mr. Buck said. But if the $330 worth of coal in his makeshift bin “heats the house for the winter,” he added, “you can’t beat it.”
Wesley Ridlington, a homeowner in Fairbanks, Alaska, bought an outdoor coal furnace for $13,000 in March and uses it as his main source for heat and hot water.
On a recent evening, as the temperature hovered around 23 below zero, Mr. Ridlington worked to free up the rotating burning plate inside the furnace, which he figured was jammed by a pebble. He did not seem to mind the glitch, or, for that matter, loading the furnace twice a week and emptying the ash pan every night. “It takes a little bit of time,” he said, “but for the savings, it’s worth it.”
Mr. Ridlington said he was typically burning 1,500 gallons of oil each winter to heat his 3,300-square-foot home. At last year’s prices, that would have cost about $7,000, he said. This winter, he expects to burn nine tons of coal at a cost of about $1,400. http://louis-j-sheehan-esquire.sampa.com/louis-j-sheehan-esquire/blog
“The initial cost was expensive,” he said. “But in three to five years, it’ll be paid for, even with prices going down. And if fuel goes back up again, it’ll be even more savings.”
Rob Richards, who owns a business in Fairbanks that sells spas, pool tables, and now outdoor coal furnaces, said that when oil prices were higher, he could promise fuel cost savings of more than 75 percent and a payback of 18 months for an outdoor coal furnace. With oil prices down again, orders for furnaces have dropped off, and the savings are closer to 50 percent with a few years’ time to recoup the cost, he said.
“Still, you’re looking at a quick payback,” Mr. Richards added.
Coal was a dominant source of heat for American homes for much of the late 19th and early 20th centuries. Americans were still burning more than 50 million tons for heating in 1950, according to the federal statistics.
But coal, primarily used today in power plants and steelmaking, has not been used for heating on a large scale for decades. Cleaner and more easily distributed forms of heating fuel — including natural gas, electricity and oil — displaced coal, and residential use dropped precipitously, to 2.8 million tons by 1975, and then to less than 500,000 tons by 2000.
Even with the recovery of the last couple of years, residential use of coal in the United States, at less than 300,000 tons today and representing a fraction of 1 percent of all coal use, is “not even a blip on the screen,” said Carol Raulston, a spokeswoman for the National Mining Association.
Still, even amid the steep decline, small upticks similar to the current one have appeared from time to time, and residential use of coal never entirely went away.
In Homer, Alaska, fall storms wash crude coal onto the beach from underwater deposits. In the mountains of eastern Kentucky or the hills of central Pennsylvania, residents can simply dig it out of the ground.
“As long as people have been mining coal up there,” said John Hiett of Kentucky’s Office of Mine Safety and Licensing, “people have burned coal in their houses.”
Government data suggest that about 131,000 households use coal as their primary source of heat, with perhaps 80,000 more using it as a secondary source. Those numbers are small enough that issues relating to pollution and greenhouse gas emissions have remained largely off the radar.
Burning coal does throw fine particles into the air that can pose problems for some people, similar to the problems involved in burning wood — though wood stoves and fireplace inserts are increasingly subject to regulation to cut down on pollutants.
“Coal stoves don’t have that,” said James E. Houck, the president of Omni Environmental Services, a firm in Portland, Ore., that tests air quality. “And there’s no regulatory pressure for them to have it.”
In some localities where residential coal burning is becoming a factor, that might be changing. In Fairbanks, air quality experts suspect the increase in coal burning — along with increased wood burning — is contributing to concentrations of fine particles well above federal limits.
“We see it as a real health hazard to Fairbanks,” said Jim Conner, the Fairbanks North Star Borough’s air quality specialist.
Concerns like these have not deterred companies marketing coal. Back East, the Blaschak Coal Corporation, a midsize supplier of anthracite in Mahanoy City, Pa., still emblazons company trucks and baseball caps with images of Santa Claus lugging a sack of coal.
“Everybody’s looking at wherever they can to save money,” said Daniel Blaschak, a co-owner of the company. “ ’Cause guess what? We no longer have disposable income. We are up to our necks in debt. And there’s very few things we can’t live without, but heat is one of them.”
Tom Zeller Jr. reported from Sugarloaf, Pa., and Stefan Milkowski from Fairbanks, Alaska. Louis J. Sheehan, Esquire.
December 27, 2008
Burning Coal at Home Is Making a Comeback
By TOM ZELLER Jr. and STEFAN MILKOWSKI
SUGARLOAF, Pa. — Kyle Buck heaved open the door of a makeshift bin abutting his suburban ranch house. Staring at a two-ton pile of coal that was delivered by truck a few weeks ago, Mr. Buck worried aloud that it would not be enough to last the winter.
“I think I’m going through it faster than I thought I would,” he said. http://louis-j-sheehan-esquire.sampa.com/louis-j-sheehan-esquire/blog
Aptly, perhaps, for an era of hard times, coal is making a comeback as a home heating fuel.
Problematic in some ways and difficult to handle, coal is nonetheless a cheap, plentiful, mined-in-America source of heat. And with the cost of heating oil and natural gas increasingly prone to spikes, some homeowners in the Northeast, pockets of the Midwest and even Alaska are deciding coal is worth the trouble.
Burning coal at home was once commonplace, of course, but the practice had been declining for decades. Coal consumption for residential use hit a low of 258,000 tons in 2006 — then started to rise. It jumped 9 percent in 2007, according to the Energy Information Administration, and 10 percent more in the first eight months of 2008.
Online coal forums are buzzing with activity, as residential coal enthusiasts trade tips and advice for buying and tending to coal heaters. And manufacturers and dealers of coal-burning stoves say they have been deluged with orders — many placed when the price of heating oil jumped last summer — that they are struggling to fill.
“Back in the 1980s, we sold hundreds a year,” said Rich Kauffman, the sales manager at E.F.M. Automatic Heat in Emmaus, Pa., one of the oldest makers of coal-fired furnaces and boilers in the United States, in a nod to the uptick in coal sales that followed the oil crises of the 1970s.
“But that dwindled to nothing in the early 1990s — down to as many as 10 a year,” he said. “It picked up about a year ago, when we moved about 60 units, and then this year we’ve already sold 200.”
Dean Lehman, the plant manager for Hitzer Inc., a family-owned business in Berne, Ind., that makes smaller, indoor coal stoves, said his stoves were on back order until March. And Jeffery Gliem, the director of operations at the Reading Stove Company and its parent, Reading Anthracite, in Pottsville, Pa., which supplies coal and stoves to 15 states in the Northeast and Midwest, said the uptick in interest was the largest he had seen in 30 years.
“In your typical year you might have five, six, seven thousand stoves being sold,” Mr. Gliem said. “This year it was probably double that.”
The coal trend is consistent with steep increases in other forms of supplementary heating that people can use to save money — most of them less messy than coal. Home Depot reports that it has sold more than 80,000 tons of pellet fuel, a sort of compressed sawdust, for the season to date. That is an increase of 137 percent compared with the same period last year, said Jean Niemi, a company spokeswoman.
Coal may never make economic sense in areas far from where it is mined. But in places within reasonable delivery range, the price tends to be stable, compared with heating oil or natural gas. Prices for natural gas more than tripled in recent years before plunging in the last few months amid the downturn.
Coals vary in quality, but on average, a ton of coal contains about as much potential heat as 146 gallons of heating oil or 20,000 cubic feet of natural gas, according to the Energy Information Administration. A ton of anthracite, a particularly high grade of coal, can cost as little as $120 near mines in Pennsylvania. The equivalent amount of heating oil would cost roughly $380, based on the most recent prices in the state — and over $470 using prices from December 2007. An equivalent amount of natural gas would cost about $480 at current prices.
Mr. Buck said he could buy coal for $165 a ton. On a blustery afternoon recently, he was still studying the manual for his $2,300 Alaska Channing stoker, which gave off an intense heat in the den. An automated hopper in the back slowly dispensed fine anthracite coal chips into the stove’s belly, and every couple of days, Mr. Buck emptied the ash. He said he hoped the stove would cut his oil consumption in half.
“Now, somewhere, you’ve got to take into account the convenience of turning up your thermostat, versus having two tons of coal to shovel and the hopper and ashes to deal with,” Mr. Buck said. But if the $330 worth of coal in his makeshift bin “heats the house for the winter,” he added, “you can’t beat it.”
Wesley Ridlington, a homeowner in Fairbanks, Alaska, bought an outdoor coal furnace for $13,000 in March and uses it as his main source for heat and hot water.
On a recent evening, as the temperature hovered around 23 below zero, Mr. Ridlington worked to free up the rotating burning plate inside the furnace, which he figured was jammed by a pebble. He did not seem to mind the glitch, or, for that matter, loading the furnace twice a week and emptying the ash pan every night. “It takes a little bit of time,” he said, “but for the savings, it’s worth it.”
Mr. Ridlington said he was typically burning 1,500 gallons of oil each winter to heat his 3,300-square-foot home. At last year’s prices, that would have cost about $7,000, he said. This winter, he expects to burn nine tons of coal at a cost of about $1,400. http://louis-j-sheehan-esquire.sampa.com/louis-j-sheehan-esquire/blog
“The initial cost was expensive,” he said. “But in three to five years, it’ll be paid for, even with prices going down. And if fuel goes back up again, it’ll be even more savings.”
Rob Richards, who owns a business in Fairbanks that sells spas, pool tables, and now outdoor coal furnaces, said that when oil prices were higher, he could promise fuel cost savings of more than 75 percent and a payback of 18 months for an outdoor coal furnace. With oil prices down again, orders for furnaces have dropped off, and the savings are closer to 50 percent with a few years’ time to recoup the cost, he said.
“Still, you’re looking at a quick payback,” Mr. Richards added.
Coal was a dominant source of heat for American homes for much of the late 19th and early 20th centuries. Americans were still burning more than 50 million tons for heating in 1950, according to the federal statistics.
But coal, primarily used today in power plants and steelmaking, has not been used for heating on a large scale for decades. Cleaner and more easily distributed forms of heating fuel — including natural gas, electricity and oil — displaced coal, and residential use dropped precipitously, to 2.8 million tons by 1975, and then to less than 500,000 tons by 2000.
Even with the recovery of the last couple of years, residential use of coal in the United States, at less than 300,000 tons today and representing a fraction of 1 percent of all coal use, is “not even a blip on the screen,” said Carol Raulston, a spokeswoman for the National Mining Association.
Still, even amid the steep decline, small upticks similar to the current one have appeared from time to time, and residential use of coal never entirely went away.
In Homer, Alaska, fall storms wash crude coal onto the beach from underwater deposits. In the mountains of eastern Kentucky or the hills of central Pennsylvania, residents can simply dig it out of the ground.
“As long as people have been mining coal up there,” said John Hiett of Kentucky’s Office of Mine Safety and Licensing, “people have burned coal in their houses.”
Government data suggest that about 131,000 households use coal as their primary source of heat, with perhaps 80,000 more using it as a secondary source. Those numbers are small enough that issues relating to pollution and greenhouse gas emissions have remained largely off the radar.
Burning coal does throw fine particles into the air that can pose problems for some people, similar to the problems involved in burning wood — though wood stoves and fireplace inserts are increasingly subject to regulation to cut down on pollutants.
“Coal stoves don’t have that,” said James E. Houck, the president of Omni Environmental Services, a firm in Portland, Ore., that tests air quality. “And there’s no regulatory pressure for them to have it.”
In some localities where residential coal burning is becoming a factor, that might be changing. In Fairbanks, air quality experts suspect the increase in coal burning — along with increased wood burning — is contributing to concentrations of fine particles well above federal limits.
“We see it as a real health hazard to Fairbanks,” said Jim Conner, the Fairbanks North Star Borough’s air quality specialist.
Concerns like these have not deterred companies marketing coal. Back East, the Blaschak Coal Corporation, a midsize supplier of anthracite in Mahanoy City, Pa., still emblazons company trucks and baseball caps with images of Santa Claus lugging a sack of coal.
“Everybody’s looking at wherever they can to save money,” said Daniel Blaschak, a co-owner of the company. “ ’Cause guess what? We no longer have disposable income. We are up to our necks in debt. And there’s very few things we can’t live without, but heat is one of them.”
Tom Zeller Jr. reported from Sugarloaf, Pa., and Stefan Milkowski from Fairbanks, Alaska. Louis J. Sheehan, Esquire.
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