EnergyRealities.org

Should there be taxes on cows?

Many thanks to sustainable-tech:

Tax for a cow - that sounds like a genuine German invention, nevertheless this topic is at the moment widely discussed in many parts of the world. It is based on a study which gives evidence for the tremendous impact of agriculture and especially dairy farming and cows on the environment and the climate change. Agriculture is responsible for around 7 to 11 per cent of the total of greenhouse gas emissions. This mainly implies the production of methane, which is estimated to be 21 times more harmful for the environment than CO2. Another aspect in the center of this discussion is the emission of nitrous oxide which is produced during rice cultivation. Nitrous oxide is estimated 310 times more harmful to the climate than CO2.

Due to those facts the involvement of agriculture into emission trade is controversially discussed these days. Critics however utter objections, since the huge number of farmers and agriculturalists would result in an immense bureaucratic expense. Furthermore the tax would have to be implicitly charged on the consumer, which would harm farmers even more.

Diet for us? or for the cows? 

Do we have to adopt a vegan lifestyle in the end? The answer is no. Concepts for reducing the emissions produced by cows are already developed: Cows should be fed with straw and hay, mixed with soy, wheat and corn. By this diet emissions could be reduced around 20 percent. Furthermore there are assumptions, that this diet could also lead to four to five times more milk produced by the cow.

Why governments can’t solve problems

“The government can’t solve problems because the two parties are so wedded to their opposing ideas that they can’t move. The very idea that someone from Congress can’t take something from the other side because they’ll be punished by their own party? That’s stupid. If I were running for office, I would be poaching ideas from everywhere. That’s how art works. You steal from everything.” Steven Soderbergh on how politicians can benefit from learning to steal like an artist in this excellent interview New York Magazine...

2013 WORLD PRESS FREEDOM INDEX: DASHED HOPES AFTER SPRING

Read more...http://en.rsf.org/press-freedom-index-2013,1054.html

Why are we here?

So, why are we here?

Sure, in a general sense this question has the potential to drive me mad.
So I avoid thinking about it, let alone trying to answer it.

But in this context, I expect you might like to know why I think anybody might visit this site.

A lot of things confuse me. I wish I saw the world in "black and white" - but I never have!
I'm a bit colour-blind, and I see the world in about as many shades of grey as it's possible to imagine. And even when there seem to be "answers" to problems that concern me, it's all too clear that to accept those answers one usually has to ignore issues of validity relating to underlying assumptions.

So, like most people, I pass the stream of questions I might ask (myself or others) through the filter of what I think the likelihood of getting useful answers is.

Naturally, I do bother to ask things like "Is now the time to cross the road?"

I'm beginning to compile a list of bigger questions I'd like answers to, and to which answers might be available. So far that list includes the following:

Research has established beyond any doubt that the vast majority of law-makers (anywhere) soon become convinced that the laws they (and others) make are not intended to bind them or the rest of their (law-making) class.

• Why has this not become a focus of public attention?

Here in New Zealand, the farming lobby has influence out of all proportion with what can be justified by the contribution the people it represents make to society.

• Why do we put up with this?

More soon...

The world's most powerful people

The world's most powerful people...

Achilles tendon: Recovering from a complete rupture

Surgical intervention

Controversy exists regarding whether to conservatively manage a first-time Achilles tendon rupture or to surgically reconstruct the ruptured tendon. There are distinct benefits and risks for each approach. Credible researchers report an approximately 33% higher rate of complications (other than rerupture) in those treated surgically; nonoperatively treated patients had a rerupture rate approximately 3 times higher than those treated surgically, but these patients had minimal risk for other complications. Listed complications resulting from open surgical repair included deep infections (1%), fistulae (3%), necrosis of the skin or tendon (2%), rerupture (2%), and minor complications (percentage not documented). Studies indicate that patients who had a percutaneous rather than an open surgical approach had a minimal rate of infection, but it was also demonstrated that there were relatively high rates of injury to the sural nerve.

Conservative repair

Early reports of rerupture in conservatively treated patients noted rates as high as 40%. In newer protocols with shorter immobilization periods, the rates of rerupture appear to be much less and are comparable to the rerupture rate for surgically repaired tendons.

Typically, after removal of the second cast, approximately 20 days post-injury, patients are placed in a removable below-the-knee orthosis with the ankle at 20º of plantar flexion. Typically removal of the splint for 5 minutes of every hour is recommended. During each 5 minutes free of the "boot" active dorsiflexion and passive plantar flexion should be practiced conscientiously. This should be done while sitting with the leg hanging so as to allow the foot to fall as far as is comfortable.

Approximately 30 days post-injury, the orthosis is brought to neutral. At about 6 weeks, patients are typically allowed to bear weight as tolerated while wearing the orthosis. At this time, they are usually also allowed to remove the orthosis at night. At 8 weeks, patients are usually weaned from the brace and then began physical therapy for stretching and strengthening.

Other, more recent conservative protocols employ a period of nonweight-bearing casting, either above or below the knee, with the foot in equinus for approximately 2-4 weeks, and then serial casting or functional splinting with decreasing degrees of plantar flexion to neutral at 2- to 4-week intervals.

The average time for immobilization in these protocols is 9 weeks. The success and complication rates in this longer treatment protocol appear less favorable than with protocols of shorter duration. Good functional results were reported in the shorter protocols, as were relatively low rates of rerupture. Immobilization in these studies averaged 2 weeks, and follow-up lasted an average of 23 months.

Percutaneous surgery (Technical stuff: Skip it unless you're particularly interested.)

Ma and Griffith reported on 18 tendon repairs using percutaneous sutures to reapproximate the ruptured stumps. Through stab wounds, sutures were passed through the distal and proximal ends, which were approximated while the ankle was held in maximal equinus. The sutures were then cut short, tied off using a surgeon’s knot, and pushed subcutaneously. The 6 small wounds were cleaned and dressed with dry, sterile dressings. Afterward, the patients were placed in short leg, nonweight-bearing casts for 4 weeks, followed by 4 weeks in a weight-bearing, low-heeled cast.

In later studies, minor variations of this procedure were employed along with general or local anesthesia. High rates of sural nerve entrapment were reported in these studies, accounting for 16.7% of treated cases. Further studies analyzed outcomes of percutaneous surgery followed by either early mobilization or prolonged immobilisation. Of those mobilized early, 6.6% reported minor wound complications, 3.3% reported major wound complications, 14.8% reported minor general complications, and 0.8% reported major general complications. Of those immobilized, 4.9% reported minor wound complications, 8.5% reported minor general complications, 0.8% reported major general complications and 6.6% reported rerupture.

Open surgical repair (More technical stuff: Skip it if it bores you!)

Open reconstruction is undertaken using a medial longitudinal approach. Medial incisions have the advantage of better visualization of the plantaris tendon, as well as avoidance of injury to the sural nerve. Midline incisions are rarely used because of higher rates of wound complications and adhesions.

After application of the tourniquet and palpation of the rupture gap, the incision is made through the skin and subcutaneous fat to the paratenon. The paratenon is then divided longitudinally to expose the ruptured ends, which are irrigated and debrided. The ends are then reapproximated and sutured with a heavy nonabsorbable suture using a modified Kessler, Krackow, or Bunnell technique, while being careful not to overtighten.

If the repair is insecure and reinforcement is required, a pull-out wire or multiple interrupted sutures may be used. These may be augmented with a turn-down fascial graft or a woven tendon graft; however, a study by Pajala et al found no advantage for augmented techniques in the surgical repair of fresh complete Achilles tendon rupture.

Although use of a down-turned gastrocnemius fascia flap (augmented repair) offers the theoretical advantage of stronger pullout strength, Pajala et al's randomized trial in 60 patients who underwent the Krackow locking loop technique showed that mean operative time was 25 minutes longer and the incision was 7 cm longer with augmented versus nonaugmented repair, and no significant difference in outcome between the augmented and nonaugmented repair groups was evident at 3-month and 12-month checkups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, overall outcome, isokinetic calf muscle strength, mean peak work-displacement relationships, or tendon elongation.

Following surgery, the ankle is maintained in flexion as a cast or rigid orthosis is applied. After a period of immobilization, the foot is brought into neutral or slight plantar flexion in a rigid orthosis, and the patient is allowed partial weight bearing. Immobilization is typically discontinued 4-6 weeks after repair. At that point, active and active-assisted range of motion, swimming, stationary cycling, and walking in a shoe fitted with a heel lift can be initiated. In most cases, patients can progress to full activity within 4 months of surgery.

In general, surgical treatment is advocated for young and athletic individuals who frequently subject their Achilles tendon to relatively high-demand activity. Conservative approaches with lower rerupture rates are being investigated. These conservative protocols show rerupture rates approaching those of surgical rerupture rates and have the advantage of fewer complications, in particular infections of the surgical wound and other wound-related problems.

Open repair of Achilles tendon ruptures is associated with a lower re-rupture rate compared with nonoperative treatment, but is also associated with a higher risk of infection and wound problems, as can be expected when comparing operative to nonoperative treatment.

In summary, operative repair of Achilles tendon ruptures has been reported to have lower rerupture rates; increased postoperative muscle strength, power, and endurance; and an earlier return to activities compared with nonoperative treatment. Wound complications occasionally do occur after operative treatment and may include infection, drainage, sinus formation, and skin sloughing.

Other treatment (This bit's important!)

Nonoperative treatment is usually indicated for patients who are elderly and/or inactive, as well as for those with systemic illnesses or poor skin integrity. Patients with diabetes, wound healing problems, vascular disease, neuropathies, or serious systemic comorbidities are encouraged to opt for nonoperative treatment because of the significant risks of operative treatment (eg, infection, wound breakdown, repair dehiscence, perioperative complications).

• A short-leg cast is applied to the affected leg while the ankle is placed in slight plantar flexion (gravity equinus). By keeping the foot in this position, the tendon ends are theoretically better apposed. Cast immobilization is continued for about 6-10 weeks. Forced dorsiflexion is contraindicated. The ankle may gradually be dorsiflexed to a more neutral position after a period of immobilization (~4-6 wk). This position is sustained with serial casting or adjustable ankle orthotics. Walking in the cast is allowed at this time. Following cast removal, a 2-cm heel lift in the shoe is worn for an additional 2-4 months. During this time, a rehabilitation program is initiated.
• Advantages of nonoperative treatment include no wound complications (eg, skin breakdown, infection, scar formation, neurovascular injury), decreased hospital costs and physician fees, lower morbidity, and no exposure to anesthesia.
• Disadvantages of nonoperative treatment include a higher incidence of rerupture (up to 40%) and more difficult surgical repair following rerupture. In addition, the tendon edges may heal in an elongated position because of a gap in the unapposed tendon ends, resulting in decreased plantar flexion power and endurance.

 

Rehabilitation

Physical Therapy (Critiacal!)

Following cast removal, gentle passive range of motion of the ankle and subtalar joints is initiated. After 2 weeks, progressive resistance exercises (PREs) are added to the regimen. This is followed by aggressive gait training exercises at about 10 weeks following the injury or surgery, leading toward activity-specific maneuvers and a return to activities at 4-6 months. The patient's recovery is largely dependent on the quality of the rehabilitation program, his/her motivation and focus, as well as his/her desired postinjury activity level.

Giuseppe Filotto's rehab story

1. Using the BEMER System. I advise you to use this immediately after surgery if you can.
If I could do things again, I'd use a BEMER mat right from the start for the first 4-6 weeks.

2. Swimming. You have to wait until your scar is healed to make sure there is no chance of any kind of infection, but swimming and walking in a pool was the single most useful exercise for the leg overall. After each session I could feel an improvement in proprioception and even range of movement, dorsiflextion etc. Sometimes, when you have exercised the leg a bit too much, movement range decreases for a bit, but a couple of days later it suddenly makes a jump forward again.

3. Getting the right mental attitude. more than the swimming and the BEMER machines, has been my general attitude that I would do whatever it took to get back to 100% capability of use. Often that attitude resulted in me having to RELAX and take things easy and NOT stress instead of me being aggressively proactive.

4. Get a big shoe to match the height of your air-boot, so when you walk (assisted by crutches) you have the same height for your hips. this all goes to avoiding hip/knee inflammations which were the biggest problem for me.

After the "boot":

1. Use your toes! Do exercises to use your foot and move your ankle as much as you can. “Grab” the carpet with your feet, and “walk” your leg forward (from a sitting position) position by using your toes.

2. Do little “push-ups” with your foot. I found the best way to do this is to “stand on tip-toes” with my injured leg - only from a sitting position at first! So at first, I was only lifting the weight of my own lower leg, later I added weights on top of my knee (a box, a child, the girlfriend) as I got progressively stronger. I found that being in a rush to be able to stand on tiptoes or “spring” on your injured leg is NOT a good idea, instead focus more on getting full proprioception of your leg: Learn to use the whole foot again as much as possible. Play with it. Use a ball to increase its ability to manipulate objects.

3. Massage! The way this was explained to me by a doctor is: Liquid accumulated in the injured area and other joints and eventually hardens and solidifies making movement difficult. By massaging the “liquid” up into the main body of the leg you promote better circulation and reduce swelling mechanically, which all helps your foot, ankle, and leg in general to stay “alive” and not get atrophied not just muscularly (which will happen anyway) but proprioceptively (proprioception is your ability to perceive, be aware of and use in fine detail, a specific part of your body)

4. Focus on proprioception more than strength. Don’t worry if you can support your body-weight well on the injured leg for a while, concentrate instead on making sure your MOVEMENT of the foot is correct. As soon as you begin to walk without an air-boot concentrate on ensuring the motions your foot goes through are correct. Practice in a pool if you need to. I began to be able to do this about 7 weeks after surgery, which again was WAY ahead of schedule, (I should still have been in a solid cast according to them) but I must re-iterate, this new found mobility is probably THE MOST DANGEROUS TIME, and you should really take extra care. This is a critical period. A simple thing like a wrong step, tripping, or stepping inadvertently off a curb or onto some obstacle will break your tendon again, so TAKE CARE!)

5. Use a pool! Seriously, even if it means you have to get your crippled ass on a bus and then to a gym with a pool, do it! The use of water to be able to walk with a much lowered weight so you can make sure the foot is moving correctly when you walk in slow motion is very important. A lot of problems are avoided by ensuring your motion and proprioception are correct. Exercising in the pool also lowers the “fear threshold” your injured leg will have. It is important you make your leg do the right movements, but you need to do so WITHOUT MUCH WEIGHT at first. In fact, you can begin by manipulating your own foot with your hands, very gently before you begin trying to get your leg to do it by itself. Concentrate on getting the movements to be smooth and natural instead of jerky and sporadic. The smoother and more natural the movement, the easier you will be able to use your leg again when it has strength. Strength, of both the tendon and the surrounding muscle tissue, is easily increased once the tendon is FULLY healed, but recall this takes AT LEAST 6 MONTHS! So you need to make sure all your movements are correct and working well BEFORE you have the strength to do the movements with your full body weight. The understanding of how important it is to make your leg move in the way it should move when it is healed or when it was normal before the injury, while at the same time understanding that your physical strength and structural strength to do so will not be available until MONTHS later, is probably the single most important point for correct healing of this type of injury.

After exactly 5 months:

This is how long it took me be able to walk like a normal person.
There are a few corollaries to this though:

1. I could make it LOOK like I was normal, but I didn't really feel that way, and I had to walk SLOWLY.

2. The pain in my leg/ankle/foot throughout these 5 months was pretty constant. Every step I took was painful. Every day was painful, and the leg still swelled up if I walked for any length of time or was on my feet for more than an hour or so a day. I often was on my feet longer than this but I also massaged (or rather, my superhot girlfriend massaged) my leg every evening to move the fluid back up the leg. I mention the pain, because it was a constant and some people are afraid of this. Pain has never really troubled me in that I only used it as information. More relevant to me was if I felt the leg was “scared” of certain movements. Pain was a constant throughout. Literally every step I took was painful for the first 6 months at least, probably more like 7 months and a half at least actually, but the fact I was feeling pain was not important to me unless the pain was indicative of a warning. Because of my training and my being able to sense my body to a very refined degree, I could easily make this distinction even before the injury, between RELEVANT pain and just painful pain. If you do not know how to do this, then I suggest you really try to learn it over the course of this injury, because it is important. Pain tends to make us flinch and in a Pavlovian way we then stop using our limb as fully as we should. After months, if you don’t use it, you lose it! resulting in restricted movement that is going to be permanent, or at least VERY difficult to fix later. So, don't let pain stop you from increasing your proprioception. At the same time, do NOT ignore a fatigued limb, as this is the surest way to re-injure yourself and making this whole shitty situation a lot worse.

If you can keep these two things in mind, then you CAN walk like a human instead of a retarded zombie after only 5 months, but be careful.

You can now start on these activities:

1. Walk on sand beaches if you can. Sand, sea and swimming is a great combination. I could do this for a couple of months, so it was great. I was walking (apparently) normally by month 6, and, in fact, I even took part in some (careful) wrestling with some Ju-jitsu guys after about 5 and 1/2 months from surgery.

2. Gentle jogging, cycling in a gym, and trying to stand on tip-toes.

3. Stretching! You should have been doing this pretty much throughout, very, very gently, but now you can  start doing it a bit more regularly and specifically.

4. Re-building some of your calf strength. The best way to do this is by walking and even hiking in gentle hills an hour or so a day. I ended up going on a 6 hour hike in the jungles wearing flip-flops, which is absurdly stupid! Don’t do that! But DO exercise your leg a bit, and consciously begin to not rely on the other leg for support as much. Begin to re-distribute weight evenly and make the injured leg carry its own load as much as possible without straining the leg.

After 8 months:

I can now walk and run (more or less) normally. I'm still a bit scared of a sprain or sudden badly placed foot on broken ground. Obviously, this could cause injury even to a normal leg, but I'm a lot more worried about it now than I used to be.

Hip and knee problems are still niggling at me. I think these are partly due to my own previous over-exertions and to damage from martial arts training of a decade and more ago. So it may not be as pronounced with you. Don’t enter any weight-lifting competitions and you should be fine. Squats and duck-walking are painful on the knee/hip and will have to be entered into gradually, but I'm not a million miles away from my pre-injured status. Once I'm completely comfortable again with going to the ground as a result of wrestling, attacks, break-falls etc, I'll be back to my old self. I expect this will not take much longer.

More details:

For a more detailed and blow-by blow account of the earlier periods with lots of detailed notes on the BEMER systems etc, see Giuseppe's online diary here...