洛杉矶时报1

洛杉矶时报1 A new day for epidurals When epidural analgesia was first commonly used for pain relief in laboring women in the 1970s, it was an infusion into the spinal cord of a relatively large dose of an anesthetic drug such as lidocaine. The effect blocked pain and all movement from the waist down. Since the mid-1990s, epidurals have been reformulated to try to achieve what Dr. William Camann, head of obstetric anesthesiology at Brigham and Women's Hospital in Boston and co-author of "Easy Labor," calls ideal pain relief during labor: a mixture of drugs that blocks pain nerves while leaving the motor nerves responsible for movement mostly unaffected. These "low-dose" infusion epidurals usually include small amounts of the anesthetic bupivacaine and the opioid fentanyl. Together, the two drugs block pain without removing the patient's ability to move her legs. This drug combination is sometimes referred to as a 'walking' epidural, even though women in the U.S. are rarely allowed to get up and walk, to minimize the hospital's legal liability from a fall. "It's still beneficial, even if you don't walk, because it allows you to move your legs, sit up and help with pushing," Camann says. Most hospitals offer a patient-controlled version of epidurals with a button that can deliver an extra dose of medicine. In the last decade, research on these low-dose epidurals has concluded: • They do not increase the likelihood of having a C-section. • They do lengthen labor somewhat, but only by about 20% on average and only in the second, or pushing, stage of labor. • Compared with the old-style epidural, they decrease the rate of forceps- and vacuum-assisted births, although these are still higher compared with women without an epidural. Though the numbers are hard to pin down, about one-third of women with a low-dose epidural will have an instrument-assisted birth. • With or without inclusion of fentanyl, they do not interfere with breast-feeding success. • There is no reason to wait until the cervix is dilated to a certain point before administering an epidural to a woman in active labor. • The duration of an epidural does not increase the amount of medicine that reaches the mom's or baby's bloodstream. Epidural practices differ among doctors and hospitals, so women should ask questions, both before and during labor, about what medicine is in the epidural, whether intravenous fluids will be given and whether any other medications will by administered by shot or intravenously. Copyright ? 2011, Los Angeles Times Work to begin on Marina del Rey apartment project Developer Jerry Epstein will replace his 202-unit Del Rey Shores apartment community built in the 1960s with a 544-unit complex in fewer, taller buildings. The last surviving original developer of Marina del Rey will start work Monday on a $165-million apartment complex there that will replace one he built in the 1960s. The project is part of a push by Los Angeles County officials to spruce up the aging publicly owned marina, the largest pleasure boat harbor community in the United States. Leaseholders of land there have been urged to upgrade their restaurants, shopping centers, hotels and apartments in the hope of creating a more dynamic community. Leaseholder Jerry Epstein will raze his 202-unit Del Rey Shores apartment community on Via Marina and replace it with a 544-unit complex in fewer, taller buildings, that will be called simply Shores. The old units have been vacant since October, he said. Nadel Architects Inc. designed Shores in 12 four- and five-story buildings to replace 32 two-story buildings. The new development would have a larger courtyard with a pool, spas, outdoor fire pits and barbecues. Actor Kirk Douglas, who has been Epstein's partner in the marina since the 1960s, and Guardian Life Insurance Co. of America also are part of the joint venture that is developing Shores. Renewal of the marina, which has been taking place for the last few years, will create a more attractive destination for residents and visitors while raising more tax revenue for the county, Epstein said. "We have great confidence going forward in the appeal of the marina," Epstein said. "I am as excited today as I was back in 1962 when the marina opened." Central to building Shores is a 42-year, $125-million loan from Red Mortgage Capital Inc. insured by the Department of Housing and Urban Development, Epstein said. Crews will build two buildings at a time until all 12 buildings on the 8.3-acre Shores site are complete, Epstein said. The first apartments are expected to open in about 20 months, and the project could be completed within two years. Likely tenants are in their 20s and early 30s or empty nesters looking to downsize from their houses and live near the water, said David O. Levine, Epstein's chief of staff. "Those are the two largest demographic groups we serve in the marina." Monthly rents would range from $2,000 to $2,800 for a one-bedroom unit and from $2,550 to $3,700 for two bedrooms. Fifty-four units would be set aside for affordable housing. Marina del Rey is one of the county's most valuable revenue-generating assets, pulling in nearly $55 million in rent and taxes annually. But many properties haven't changed for decades, and observers have described the waterfront neighborhood as stuck in the '60s. "The marina is dated," said Santos Kreimann, director of the county Department of Beaches and Harbors. "Renovations and new projects like Shores … will go a long way to make sure the infrastructure is at a level to command the rents we would like to see and to make sure the quality of life is what residents want." Redevelopment of the Shores site was controversial. It overcame legal hurdles, including a court challenge to its environmental impact report that was defeated. Affordable housing advocates were disappointed that more units weren't subsidized for "very low income" renters when the project was approved in 2007. The developer said that adding more low-income housing would cost the county millions of dollars. Because the county owns the land, it receives 10.5% of the rents as part of its lease agreement with the apartment owners. The county also takes a cut of boat slip and hotel room rentals and restaurant sales. The county's 400 acres in Marina del Rey belong to about 50 leaseholders on long-term contracts, most of which are winding down. County officials have told many leaseholders that they need to improve their properties if they hope to secure renewals of their leases. Immigration, state by state Utah is the latest state to consider a local fix to a federal problem. The federal government needs to step up. Fueled by frustration, states are striking out and creating their own immigration rules. Utah is the latest state to consider a local fix to a federal problem. Lawmakers this month passed a package of reforms that includes granting police broader powers to check the immigration status of those arrested and creating a state guest-worker program for illegal workers. And more than a dozen other states are pushing immigration legislation that ranges from the benign to the ridiculous. In Oklahoma, for example, lawmakers are seeking to ban motorists from picking up illegal day laborers, while South Carolina's Legislature is considering making it a felony to sell a fake ID to immigrants who are in the U.S. illegally. So far, none of the proposals go as far as Arizona's draconian anti-immigrant law, known as SB 1070, that requires people to carry identification proving they are authorized to be in the U.S. But like Arizona, other states that adopt immigration enforcement measures will probably face legal challenges over attempts to encroach on the federal government's authority. The flurry of proposals should serve as a wake-up call to Washington. Congress has failed in the last few years to provide a comprehensive solution to the nation's broken immigration system and instead has wasted time sparring over building bigger fences and funding stricter enforcement programs. The White House hasn't done much better. President Obama has spoken eloquently about the need to overhaul immigration but has offered little else. Washington can't continue to abdicate its authority to the states. Lawmakers and the White House must begin the conversation and provide some legislative action. Meanwhile, Congress can provide some short-term relief. Lawmakers should revive the Development, Relief and Education for Alien Minors bill, known as the DREAM Act. The bill would provide a conditional path to legalization to young illegal immigrants who attend college or serve in the military and plan to address the nation's need for skilled and unskilled labor. And Republicans and Democrats can also reconsider legislation to help farmers. Last year, Sen. Dianne Feinstein (D-Calif.) and Rep. Howard Berman (D-Valley Village) sponsored the Agricultural Job Opportunities, Benefits and Security Act, or AgJobs. The bill remains a viable approach to helping farmers by providing temporary work permits for certain types of farmworkers and their families who are in the U.S. illegally. Copyright ? 2011, Los Angeles Times Overcapacity Means You Can Nab a Cruise at up to 75% Off A luxury cruise is one of life’s pure joys. Today’s modern cruise liners are engineering marvels; floating 5-star hotels that offer the best service, accommodation, cuisine, and activities. They visit exotic locales, with non-stop relaxation or stimulation, depending on your pleasure. Over the past few years, cruise companies have spared no expense and literally invested billions in jaw-dropping super ships. Even if you’ve cruised before, you probably have not experienced anything like these new marvels. But, the best news is that due to the slowdown in travel caused by the recession and significant overcapacity in the industry, savvy travelers can now book once-in-a-lifetime cruises at insanely low prices. How does 75 percent off the brochure price sound? Believe it or not, it's possible through a company called Vacations To Go, one of America's Largest Cruise Agencies. Founded more than 25 years ago, Vacations To Go realized that taking a cruise vacation was a new experience for many. They set out to build an online service to help people learn everything they need to know to find the best possible cruise vacation, at the best possible price. Vacations To Go is now home to an extensive selection of top-brand cruise vacations, and in-depth information about every cruise line and cruise ship. Customers can browse the latest in new promotions and offers, shop by category, and compare prices at a glance. But, what about the discounts? Because of the huge costs involved in building and operating today’s luxury ships, cruise lines want their ships to sail with as few empty cabins as possible. So, they turn to trusted partners like Vacations To Go to sell this “excess” inventory at deep discounts, allowing the cruise companies to still get full fare on the travel packages that they sell directly. The discounts they authorize Vacations To Go to offer can be as much as 75 percent off the full price fare. What it means for you: Simply put, it is the opportunity to take a once-in-a-lifetime luxury cruise for a price that makes it affordable on any budget. Vacations To Go has also developed a Best Price & Service Guarantee that guarantees they will meet any other authorized price--so, if getting the best deal is important, look no further. If you are not ready to book your cruise immediately, signing up for Vacations To Go’s free newsletter can help you stay informed of all the spectacular discounts that become available, as cruise lines seek to fill their remaining empty cabins before their cruises depart. This year, it seems like everyone is cruising--and, for good reason. After several years of austerity, people are realizing that a cruise vacation is now one of the great values in travel. Cruise Newsletter Below is a copy of our current cruise newsletter. To subscribe to our weekly newsletter, absolutely free of charge, please click here. To send a copy of this newsletter to a friend or friends, click here. Please note that the FastDeals are subject to availability and sell out quickly. Newsletter Dated March 14, 2011 Dear Vacations To Go Customer, Alan Fox has returned from a cruise in the Indian Ocean on Silversea's Silver Wind, and his second report follows. There is a slideshow at the end of his letter. The reports were delayed until the Silver Wind had left the region. Please scroll down to see this week's cruise deals. After four ports in as many days in the Seychelles, our crossing to Mombasa was unhurried and pleasantly uneventful. We slept a little later both mornings, enjoying smooth seas, sunny skies and the warm summer breeze. Most of all, we reveled in the Silver Wind. It just doesn't get any better than traveling the world on this vessel. The food and service in each of the ship's three restaurants is truly outstanding. None of those venues assign tablemates or dining times, which makes it easy to get together with new friends. Wine, beer and cocktails are included in the upfront cruise price, as are gratuities. Only a day or two into the cruise, the dining room staff began to greet individual guests by name, a hallmark of an exceptionally well-run ship. Every room on the Silver Wind is a suite, and every suite has a butler in addition to the room steward. Our butler, Diah, is cheerful and enthusiastic despite long days and demanding guests and being away from home for months at a time. I appreciate how tough her job must be and admire her for how well she pulls it off. A show lounge offers nightly entertainment and when it's time to retire, you'll retreat to a suite complete with European bath amenities, fine bed linens with pillow choice, plush robes, personalized stationery and nightly turndown service. It's sometimes hard to find time for the gym back in Houston, so an unhurried morning workout in the fitness center of the Silver Wind is one of the luxuries of being on vacation. Throw in water volleyball in the ship's pool, a lecture and a visit to the spa -- does anyone really miss seeing land at this stage? We saw no pirates en route to Mombasa, and the private security team and crew were always on the lookout. A searchlight probed the water near the ship at night. In fact, I saw no other ships or boats at all until we neared the mainland, which made me wonder if we were avoiding everything on radar. According to the NATO anti-piracy website, no vessel moving faster than 18 knots has ever been boarded by pirates, and I've been pleased to see our speed exceeding that level each time I have checked. After our crossing, we had two full days on the island of Mombasa, Kenya's second largest city, which is separated by creeks from the mainland. On the first day, we bused north two hours for a game drive through Tsavo East National Park, where we saw elephants, giraffes, zebras, impalas, ostriches, baboons and more. On the second day, we went south for another game drive through Shimba Hills, a smaller and heavily forested national park. There we saw rare sable antelope, giraffes, Cape buffalo and other animals, and we had lunch at the rustic Shimba Forest Lodge, a four-story tree house built on stilts, with tree trunks and limbs bursting through the floors and ceilings. The lodge has guest rooms, an open-air restaurant and an elevated wooden walkway that leads out to a watering hole. We watched an African fish eagle swooping low over that water for his lunch. Our excursion ended with an afternoon visit to the surprisingly upscale Diani Beach Resort, with manicured grounds and white-sand beaches and attentive staff. If you ever need a place to stay in this part of the world, this one is worth considering. Mombasa's port is not pretty but industrial, and busy, and the summers are hot and humid. Leaving the city on our drive to Tsavo, we passed miles of roadside shacks made of wood or red mud and a bit of tin. Scrawny goats grazed on weeds and garbage while children, unwatched and barefoot, played unfazed in the trash by the road. This is my fourth trip to Africa and I'd have to say the squalor on that road, in and near the city, matched any I have ever seen, including that in the "informal settlements" of refugees outside Johannesburg, South Africa. It is a disheartening experience, one that puts many questions in your head but few solutions. Our next stop, the "spice island" of Zanzibar, 22 miles off the coast of mainland Tanzania, had long been on my wish list. Zanzibar is the larger of the two main islands that, along with numerous small islands, form the Zanzibar archipelago. At times ruled by the Portuguese, the Omani Arabs and later England, Zanzibar became an important trade center in the late 17th century, exporting commodities such as ivory and spices. Zanzibar also became the primary clearinghouse for slaves captured along the East African coast during the Arab slave trade. Tens of thousands of men, women and children were transported here and confined underground before being sold to the highest bidder at the infamous slave market. An Anglican cathedral and memorial now stand as stark reminders of the torture and barbaric conditions endured by so many. The area around the port is densely populated, colorful, noisy and dirty. While Christians outnumber Muslims on the mainland of Tanzania, Zanzibar is 99% Muslim, so women here are covered, some in burqas that reveal only the eyes. We bused for an hour to the Jozani National Park, for a walk through a tropical forest and close encounters with red colobus monkeys and black monkeys. The former were particularly approachable, generally on the move but pausing and posing just long enough for photos. By the time we got back to the ship, we had barely an hour to explore the souvenirs assembled by local merchants on the dock before the Silver Wind was again on the move. It's hard for me to pass up an opportunity to see and photograph rare wildlife that is new to me, but after talking to other passengers, I regret not having made it to the nearby historical area, Stone Town. If there is a valid knock on cruising it is this, that there are some places where a single day does not satisfy the curiosity. Still, only by ship can one visit so many incredibly different places so effortlessly, a new country and culture pulling alongside your vessel every day or two. This evening, we are en route to Madagascar, moving away from Somalia but still well within the region prowled by pirates. For the first time on this voyage, long swells raise and lower our ship, reminding us that we are at sea. A few minutes ago, we watched from our balcony as the sun disappeared into the ocean. In the civil twilight, there is peace and calm upon the water. But out there, beyond the horizon, there are more adventures waiting to unfold. Alan Fox Chairman & CEO