Get Ready Now: Tips For A Stress Free Holiday Season!

Planning

1.) Write — Sit down at the table with a blank notebook and do what I call a Time Out where you write down everything associated with your holiday traditions. Write all of the tasks, to-do’s and commitments you can think of and include things you are responsible for as well as what you take part in. Do you always travel? Are you hosting meals and house-guests? Do you set up or participate in a gift exchange? Annual parties and events? People you always buy gifts for?

2.) Sort & Prioritize– Take your Time Out and sort it into a task list, an events list and a gift list. Hosting Thanksgiving dinner is an event, meal planning, grocery shopping and delegating who brings what, are tasks. Shopping for gifts goes on the task list, what you buy for whom goes on the gift list. You may choose to create more lists to further breakdown tasks or events that you are in charge of. In addition to the gifts your family exchanges, the gift list should include: hostess gifts, teacher gifts, holiday tipping, office gifts, Secret Santa and the like. Having these lists will help you prioritize and you should make a note of the must-do, non-negotiables (visiting grandma) and the things you might be able to skip to save your sanity (decorating 12 dozen cookies by hand).

3.) Schedule — Assign the events and tasks to your calendar. Notate all the travel, arrivals and departures of guests, the annual food drive and neighborhood caroling. If you are unsure of dates, put a question mark next to them and add a note to your task list to call people to clarify. This part helps other people make decisions and put plans in motion. Mark time and dates ahead of events for tasks, chores and errands so nothing sneaks up on you. Feeling frantic feels terrible; being prepared feels great! Decide when you have time to bake, write cards and shop online and schedule those tasks too.

Act Now! Looking at your lists and calendar, what can you do now to save time, energy and stress later on? Here are some ideas:

1.) Cooking — Plan your meals, choose your recipes and make your lists.

• Do you make the same Thanksgiving dinner every year? Make your grocery list and start stocking up on the non-perishables. Place orders for the turkey, pies and linen rental. Mark your calendar with dates to call and confirm as well as the pick up or delivery dates. Delegate side dishes to your guests now and don’t be afraid to be specific!
• Plan your recipes for holiday cookies and appetizers for parties and make your grocery lists. Can you make dough or sauces ahead and freeze? Double a recipe and bring the same item to multiple parties. This saves time and money by streamlining effort and ingredients. People will only remember your contribution and the fabulous flavor!

2.) Traveling — Plan your trip.

• Book your airline tickets, car rental and hotel reservations now! Prices are only going to go up as the holidays near.
• Set up your transportation to and from the airport. Arrange home and pet care while you’re gone. Again, set up dates to confirm in your calendar.
• Make lists for what to pack and get all the cold weather gear out of storage, cleaned and ready to go.

3.) Guests coming to you — Get ready for your guests and help them get ready for their travel.

• Make sure their travel is booked. Do you need to arrange lodging or are they staying with you?
• Make sure your home is house-guest ready and check your linens, towels and spare toiletries. What items do you need to buy to make their stay more comfortable?
• Plan events, activities and transportation now, purchasing tickets and making reservations when necessary.

4.) Minimize future errands — Stock up now on items you always need. Remember, being prepared feels great!

• Make shopping lists from your tasks list for the holidays and the normal things you shop for. This step will save you trips to places like the drugstore.
• These items might include your everyday toiletries, paper goods, wrapping paper, cases of wine, water and other beverages.
• Create a space in the closet, garage or even under the bed for all these extras so your home doesn’t get overwhelmed.
• Make a note of what you bought and where you put it!

5.) Holiday cards, newsletters and photos — Start now! Having these time-consuming tasks out of the way will allow you to breathe easier.

• Make your list, purchase your supplies, including postage and put a bag or box together with everything you need including pens and your address book (if you still use one) so you can have it at the ready, but put it away when you’re done.

• Do a few at a time so the task isn’t overwhelming and they’re ready to send on the date you’ve chosen.

• If you order pre-printed cards, do that now too.

• Newsletters are fun to send and keep people updated on your goings on so make an outline of what you’d like to include and start writing!

• If your card includes or consists of a photo, choose one now or set up your photo session ASAP.

6.) Gifts — As an organizer, I love to give people consumables: food, beverages, gift cards and charitable donations. You can buy many of these now and they will save you so much time and energy. Feel free to personalize, but it’s a real time saver to streamline and give everyone, or group of people, the same thing.

• Give all the teachers gift certificates where they can treat themselves to an indulgence, like a pedicure, shopping or restaurants.
• Make charitable donations for hostess gifts — a few favorites are the Heifer Foundation and Charity Checks which allows people to choose where their donation goes.
• The office or neighborhood can pool together and instead of individual gift giving, Adopt A Family, volunteer at or make donations to a local charity or animal shelter.
• If you give monetary gifts to people such as your hairstylist or garbage collector, visit the bank as you can afford to, write the accompanying notes and store the envelopes in a safe place.

7.) Dressing Up — Plan your party outfits now so you’re not scrambling through the mall on the day of the event.

• Comb your (hopefully organized!) closet and find what fits, is occasion appropriate and what you can reinvent?
• If you need to shop, consider basics and/or separates that you can change up with accessories and can be worn year-round. Or maybe you only need a few sparkly accessories to spruce up your favorite frock.
• If you have children, make sure their clothes fit too and that everything is clean and ready to go.
• Taking family photos? Do you need or coordinate what you’re wearing? Plan and shop now.

8.) Decorating — Where are the ornaments? Do I still like everything I have? How is it stored?

• When you take out your decorations, use only what you love or what has meaning and part with the rest. Sometimes we continue to use the decorations we have, even if we no longer like them, out of habit or because you only look at it for 30 days or so.

• Before you put anything away, make sure you have proper storage to protect your treasured ornaments, wreaths and lights. Plastic bins keep the critters and dust out and everything organized inside. Check out The Container Store for their fabulous and helpful products. Don’t forget to label everything!

I hope these tips help you to plan and get ahead for the holidays so you can enjoy this wonderful time with your family and friends!

Opiate Addiction and Types of Treatment Provided

Suboxone has produced the least amount of acclaim for drug addiction treatment, yet it is the one drug that is widely dispensed by physicians.

If you are taking a prescription drug right now, chances are you are taking it incorrectly. Misuse is a major health problem in the United States. The U.S. Government estimates approximately 11 Million Americans are dependent on drugs, but there are more addicts than drug centers. A large percentage of addicts seeking help face long waiting lists and thus become hesitant to start a program once their name surfaces to the top of the list. Almost 70 percent of people face a waiting list for longer than thirty days.

Those dependent on prescription drugs have a mind-set that is different from what addiction-free individuals believe. Addicts are resistant to letting go of their drugs. They typically justify their drug use because for many, they have gotten the drugs legitimately, from their doctor. Some addicts do not realize they are prone to addiction, and they can become hooked on a legal drug. Equally unfortunate is the addict who finally realizes they require help, and then seek help only to be placed on a waiting list. In the end, far too many addicts go untreated. It would seem the odds are against addiction treatment, but Suboxone relieves this problem since the guidelines to prescribe the drug is more relaxed and offer greater flexibility.

What is Suboxone?

Suboxone contains two active substances, buprenorphine and naloxone, both used to treat dependence on opioid drugs. The cost of treatment depends on the dose used and the frequency of services. This cost is higher than that of methadone treatment when the two drugs are served daily; however, there is greater flexibility in prescribing Suboxone.

How Does Suboxone Work?

Suboxone binds to opioid receptors, and thus produces welcoming effects of euphoria, and a secure comforting feeling, although at much lower levels than those addicts would of total opioid agonists such as methadone. The effects of these agonists are sufficient to allow addicts to stop the misuse of opiates, without encountering withdrawal symptoms.

The Benefits of Suboxone

· Less risk of respiratory problems
· Lower risk of overdose
· The withdrawal symptoms are less profound than when using methadone to combat addiction
· Euphoric symptoms occur less

Adverse Effects of Suboxone

The side effects of Suboxone mainly occur when too much of the drug is taken. The symptoms are similar to the side effects of opiates:

· Headache
· Sick
· Constipation (delayed bowel function)
· Poor sleep
· Sleepy
· Drowsiness
· Dizzy
· Sweaty
· Breathing difficulties (always contact a doctor)
· Dry mouth (brushing your teeth regularly and extra good care of your teeth)
· Slight pain is felt with less risk of causing more inflammation or untreated injuries
· Psychological problems (hallucinations, nightmares, depression) treatment should be coordinated with psychologist
· Itchy rash (contact your physician in connection with possible allergic reaction)
· Sleep apnea (consult a physician)
· Difficult to urinate (call a physician)

Every drug has an adverse effect, yet the result of using Suboxone is positive.

Boost Your Cold Calling Results in Commercial Real Estate

To make your prospecting system work for you in commercial real estate, you really do need to systemise it and set some priorities. Systems help build the future; random undirected action does little for you as a commercial real estate agent.

When you set the priorities you will not be wasting your time on things that don’t matter or perhaps have little results and conversions for you. It’s tough enough finding the time to prospect every day, let alone spending time on things that are not good converters of business opportunity for you.

So what can you do here? You can set a plan up that keeps you focused on the highly converting prospecting processes. You need new business to make your career work for you and prospecting is the key to pulling it all together.

Here is a priority model used by salespeople that I have helped in shaping their market share.

  1. Practice your call pitch for 30 minutes at 8:00am every day. This single one fact will help you convert more people faster to opportunities.
  2. Start the day with cold calls to new people. This should happen for a period of 2 hours. Start your calls at 8:30am.
  3. It will take you 30 minutes to build momentum as part of the call contact process. After 30 minutes you will be comfortable with what you are doing and the conversations will flow. The calls will get easier.
  4. Remove any meetings from the start of a business day. That includes team meetings. Focus on prospecting before anything else. Don’t let other people waste your prospecting time.
  5. Any follow up calls to established contacts should happen later in the day outside of your prospecting time. Create a habit of prospecting for new business. Don’t let existing customers or contacts derail your prospecting system.
  6. Towards the end of the day you should enter the results of the calls into your database. Perhaps you can do that as you are making the calls; the data does however have to be entered and you must take responsibility for that.
  7. End the day with research related to new prospects that you are to call tomorrow. Who are they and why are you calling them. You will need to know those facts as part of the process.

So these are some very rigid rules. When you stick to them you will find that opportunities develop. In any market and at any time the business is out there; it is just a matter of opening up the relationships with the right people.

Fixing Solutions for Automotive Industry

Automotive industry demands high strength fasteners and precision components such as nuts, bolts, studs, screws, rivets, tie rods, shims etc. that are applied to various parts and components to hold and connect two or more surfaces or objects together in a structure.

Automotive industry uses fixing components coming in a huge variety of materials ranging from common steel to aluminum, brass, copper, titanium and plastic to other exotic materials. Choosing the material to manufacture these fixing components is essential due to difference between each material’s strength, corrosion resistance, brittleness, galvanic corrosion properties, and of course cost. Materials are basically selected on considerations of environment, corrosive or thermal extremes, magnetic properties, weight, re usability, stresses, and expected life time.

Depending on these specifications materials are classified into grades & quality standards to produce specific quality alloy mixtures that are then used to produce the fixing components. In addition to this, materials are further processed through a variety of coating, plating and hardening processes to form different specified grades of the alloy mixtures.

The various stages to enhance the metal corrosion resistance and appearance increase the cost of production that leads to expensive parts and fixing components. To keep costs within control, it is always advisable to use standardized materials. As specifying the material with specific chemical analysis adds time & cost to the whole process of manufacturing of fixing components. In a common practice, using standard materials only needs heat treating, cold working and coating to manufacture ready to use fixing components.

Quality is the primary concern for every manufacturing process and hence in order to manufacture high quality fixing tools and apply best industry practices that ensure timely deliverables, companies apply quality control methods such as computerized statistical process control archival documentation and various other approaches.

Inspection process involves utilizing tri-roll gages, hardness testers and optical comparators to ensure optimum performance. Automated sorting technologies are applied for assurance of contaminant free product for use in automated feeding equipment. Other than this, third party inspection, verification and certifications testify quality process on the go.

Used in a variety of application areas, replacing fasteners is quite tedious. It is generally best to match them while replacing. Replacing a bolt or screw with a stronger one is always now a good practice as harder bolts tends to be more brittle and may not work for specific applications. In some environments, applying galvanic corrosion methodology may result better.

First Travel Nurse Assignment – Frequently Asked Questions

Question: I decided to switch to be a travel nurse instead of permanent placement how do I decide where to go?
Congratulations! You have made the first step toward an exciting career of travel nursing. Choosing where you want to go will be one of the questions the travel nursing staffing agency will ask you. Since each travel nurse assignment is approximately 13 weeks long, you do not need to worry about planning where you want to go months in advance. However, there are several factors in deciding your first assignment as a travel nurse.

o Suppose you have a family member whom you haven’t seen in awhile, you could select a location near them so you can have time to visit and form a relationship. Additionally, you may know of a sick relative who needs assistance, so you can choose a destination from your nursing staffing agency nearby.
o Dreamed of visiting the Grand Canyon or the Rio Grande? Would you like to vacation in Hawaii or near Wine Country? Ask your travel nursing staffing agency about jobs near these destinations.
o Do you want to escape the summer heat? Ask about a travel nursing job in Minnesota or Oregon where the summers are beautiful and full of outdoor summer activities.
o Ask your travel nursing staffing agency recruiter about top destinations or ask other travel nurses where they like to travel and work.

Question: What kind of uniform will I need?
Uniforms are often provided to you. You will likely receive them upon your arrival. Each facility requires something different as far as work clothes or uniforms most of the time. It is, however, best to bring a couple pairs of comfortable shoes and an extra set of scrubs, in case your uniform is not ready the first day of your assignment or in rare occasions not provided to you. Also, keep receipts of all nurse uniforms as well as laundering expenses for tax purposes.

Question: What do I need to do before leaving on a travel nurse assignment?
If you know the exact date you will be leaving for your first travel nurse assignment, then it is a good idea to have your mail forwarded to your new housing address. You can give the post office start and stop dates for mail forwarding. It may take up to a week to get your mail at your new location, so make arrangements with any monthly bills you have to pay beforehand.

Inform your nursing staffing agency of your travel dates, so they can inform the employer when to expect you as well as how to reach you during transit. Also, tell your family and friends of your new assignment address, phone number, travel route and where to reach you in case of an emergency as well as the number of your nursing staffing agency. Carry a cell phone and car charger with you at all times; you may need to call someone during transit if you have an emergency.

Carry a folder to hold all your travel expenses, receipts, professional licenses, CEUs, uniform cost and cleaning, fuel for your car, airfare and lodging. Having an organized folder for keeping all these items will save you at tax time.

Finally, it is best to have enough money for meals, fuel, and incidentals for at least two weeks. If you have not set up a bank account at your new location or if you do not have direct deposit, your paychecks may be delayed and you’ll be without accessible funds.

Question: How do I find personal and repair services while working as a travel nurse?
Starting in a new location whether as a job transfer or a travel nurse can be daunting; however, knowing that you will be working with other professionals who are available to refer you to credible and affordable services.

Since travel nurses often have the option of staying in medical staffing housing, you won’t need to worry about home maintenance repairs. While you may need to find a beauty salon or barber, auto repair shop and affordable grocery stores, the same people you work with will be your greatest resource.

Other places to find information about local businesses can be found on Angie’s List and Yelp, which provide reviews and ratings by consumers. Almost every town also has a travel bureau or a chamber of commerce, which have plentiful of resources and recommendations for retail stores and services.

Question: As a travel nurse, do I have to accept an assignment right away after one ends?
No, you do not have to take another assignment right away. As a travel nurse you can take a break between assignments whether it is for one week, two weeks or more, and then choose your next assignment. Travel nursing is not only a great opportunity to explore new places and work assignments, but you also are able to plan your vacation between assignments.

A great recruiter will however follow up with you and talk about your plans before your assignment ends so there is a smooth transition if you want to take advantage of another assignment right away and the many bonuses and rewards that are often times offered for taking another assignment right away. The option is yours!

Question: This is my first travel nurse assignment, what if I have problems adjusting to work schedule or personnel? Whom do I contact?
Medical staffing agencies will be able to work with your needs and special requests regarding work assignments, travel costs and housing before your first assignment; this will help alleviate your first travel nurse assignment problems.

However, if you feel like the travel nurse assignment is not what you expected, you should talk to your head nurse or physician to solve any miscommunication or task responsibilities. Notify your staffing recruiter as well to make sure they know and help resolve issues so that others are in the know as well. You may also know of another nurse whom you can confide in about any concerns you have. It is best to talk to someone before issues interfere with your travel nurse assignment.

If you think of other questions before you leave for your first travel nurse assignment, call your nursing staffing agency because they will have an answer for you when you need it. Rely on their experience to guide you and keep your confidence levels high before during and after travel.

Non Invasive Laser Lipo Compared To Traditional Surgery

The UK has one of the highest obesity rates in all of Europe. Often being referred to as the sick man of Europe. Of course, obesity has a large number of knock on health issues and that is one reason why people are turning to “the knife” as a way of shedding excess fat. Recently published figures show that doctors are performing in excess of half a million procedures a year to combat this growing problem. Indeed, ever more people are turning to “Lipo” as it is known, as the silver bullet fix. A recent development in the form of Non invasive laser lipo, or “Lipolysis” promises instant and measurable results, without pain or downtime. Much has been reported in the press and so far, the results are remarkable.

Traditional Liposuction can be quite brutal, and there are many videos on YouTube showing just how invasive and physical this type of treatment is. It involves inserting a vacuum tube under the skin and literally sucking out the excess fat. The end results are less fat, but can also results is saggy skin, lots of bruising, infection, pain and a lot of rest. This type of treatment can only be given by medically qualified people, meaning it is often expensive and out of the realms of treatments that a beauty salon could offer.

Recently we have seen a newer treatment on offer, that being Laser Liposuction which is still invasive and involves a wand with a laser emitter being drawn under the skin and effectively, the laser dissolves the fat. This is not quite so brutal as traditional lipo, but it still has a number of evident drawbacks. Equipment is hugely expensive, and again you need to be medically qualified to give the treatment, so again, not something a beauty salon owner could normally offer.

Step into the breach Non invasive laser lipo, the next generation of fat reducing technologies that has significant advantages over the aforementioned methods. Before we look at how it works, here are some benefits.

1. Being Non invasive it is gentle, pain free and does not risk infection.
2. Anybody can safely ( with training) operate the equipment.
3. The treatment is 20-40 minutes per session, there is no down time and the client can resume their activities immediately.
4. Machines cost less, therefore treatments cost less and this opens up a whole new marketplace.
5. The results are instant and measurable, meaning salon owners can expect repeat and referral business.

Non invasive laser lipo is simple in terms of how it works. Basically laser diodes emit light at a certain frequency that stimulates the fat cells and they lose their cohesion. The fat leaks out and is passed out of the body via the lymphatic system. A course of 8 treatments can easily see a huge reduction in hard to shift fatty areas. The therapist simply attached special pads to the area to be treated and leaves the machine to do it’s job.

Of course, the main things is that there has never been a fatality with the non invasive procedure, and whilst recorded deaths from the traditional methods have dropped recently, there is still a present risk that is simply not worth taking.

Non invasive laser lipo is far safer, costs less and offers results, so it is clear that this is a far superior treatment method. Talk to us about the best machine on the market, Lumislim and we will show you why.

Which Is More Cost-Effective, Cabs or Car Rentals?

Rent it or cab it?

People like the freedom of having their own vehicle to drive about in, at home or when they travel, and the tendency is to book a rental car when you are away. But freedom comes with a price and it depends where your travel destination is as to whether you’re best to rent a car or take a taxi.

Cheap ground transportation depends upon location, accessibility and extraneous expense factors, like gasoline costs and parking fees. Add to that the potential complexity of finding your way around a strange city, especially a large one, and you might change your mind about what freedom means.

A trip to, for example, New York City or Montreal, two North American cities with decent public transit systems, plenty of cabs, walkable areas in their cores, and very high parking fees, and you’ll realize that a taxi will almost inevitably surface as the cheapest mode of getting around.

But what if you want a day trip to the Laurentian Mountains or the antiques stores of Hudson? That’s the day to rent a car, or to find out if there is a luxury coach service to those destinations that returns the same day.

Car rentals are convenient, to be sure, but the costs add up quickly (don’t forget insurance and occasional peak-season added fees), unless your airline points cover all or most of the cost; even then, in large cities gasoline and parking is very costly, and that is not usually included in credit card or airline rewards perquisites.

When does a rental car make sense? If you live in North America (and can’t drive across the Atlantic Ocean!) and are vacationing in Italy, for example, landing in Rome and taking a motorcar tour of Tuscany and other regions from there, your only other viable option is the train. Like anywhere else, gasoline in Europe is expensive, but you can’t take a full driving holiday in a taxi. But don’t forget, there are guided tours and some taxi drivers will gladly spend a day with you, exploring San Gimignano; they are often the best tour guides, full of information about their homeland. And driving in other countries can be a harrowing experience, especially if it involves driving on the opposite side of the road than you are accustomed to!

Plan your itinerary, do an accurate cost comparison and decide whether a taxi or car rental, or combination of the two, is the cheapest way to get around when you reach your destination. And don’t forget to ensure that your driver’s license is current, and if you need to, get an international license before you set off for your trip. Happy motoring!

Planning and Design of Behavioral Healthcare Facilities

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants

Right-sizing

Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for Uncategorized light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need Uncategorized light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand Uncategorized light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our a
pproach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – Uncategorized light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of Uncategorized elements on patient recovery and stress reduction. Thus, it is clea
r that interior designs which integrate Uncategorized elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.

An Outline of Personal and Business Loan Categories and Their Uses

The number of loan products have increased over the past 20 years as economic necessity and a demanding public in need of specialization to solve financial circumstances. From personal loans, educational loans, business loans and even municipal loans to touch on a few required various industries to be creative. The entities that took part in the creation of the various financial products are actuaries, risk management professionals, “information and informatic engineers” and Wall Street amongst others. It was necessary to create, enhance or break down for better or for worse loan services and products to keep money fluid in a diverse marketplace that required funds to address niche demographics.

  • Personal Loans

Signature Loans – A signature loan is just as it sounds. One applies for a loan and gives a signature on a promissory note to repay the loan in a certain amount of time. That amount of time is called a “loan term ” and may be from six months to five years. Signature loans usually require good credit and the criteria for loan approval are mostly based on the borrower’s credit and and to a lesser degree on assets. Not all signature loans have the same parameters for qualifications. Some loans may require the borrower even with good credit to account for assets to show the lending institution for underwriting purposes. The institution may or may not place a lien on the assets but nevertheless wants to have documentation proving that there are indeed financial or physical assets owned by the borrower. Signature loans usually come with lower interest rates than other types of consumer loans like payday loans, credit card advances, title loans and some car loans. More on these topics later. Who are the lenders in signature loans? They range from large subsidiaries of auto manufacturers to banks, savings and loan institutions, finance companies and payday loan companies.

Credit Card Loans – Credit Card loans or cash advances from credit cards are another form of personal loans. These quick loans are more readily available to the general public and does not require a credit check. To obtain the initial card more than likely required a credit check or at least the process of identification for secured credit cards. Credit card loans or advances usually come with higher interest rates and also other fees for having access to the cash. Various entities allow access to the credit card cash advances from bank tellers, check cashing facilities and automated teller machines (ATMs). The fees vary based on source used to access the funds. To lower the fees for cash advances some use check cashing facilities to have the card charged and receive cash back in turn for not having to incur the fees of ATM machines as cards are assessed a fee twice; first by the ATM company and also their bank. The interest rates on credit card loans or advances are usually higher than signature loans. There are some states that have usury laws that have lower interest rates on credit cards. The loan or advance on a credit card is not a “term loan” as with most signature loans. It is more or less a line of credit the borrower has access to when they need it as long as there are funds available on the credit card. Interest on consumer loans are no longer tax deductible as in previous years. They were designed for short term borrowing needs but many have come to use their credit cards as a regular source of funds in tight economic times or between paychecks.

Wedding LoansA relatively new form of loan to carve out a niche for the lending industry and meet the needs of the increasing costs of weddings is the Wedding Loan. Because of the expense of weddings which can range into six figures, it sometimes requires a personal loan or even a business loan of the families involved to provide a proper wedding. Wedding loans can be secured (using assets for collateral) or unsecured (signature loans) to obtain funds for the ever growing need to pay for the escalating wedding costs and all the various services and products that a successful matrimonial ceremony would need. The credit criteria and the term may vary based on the amount needed and financial status of the people involved.

Payday or Cash Advance Loans is a fast growing market because it usually requires the least of credit criteria used for loan approvals. One can have bad credit for a quick and instant loan. Just having proof of income, proof of identity and a checking account is all that is necessary to secure funds. Even today many have checking accounts without checks one can still obtain a cash advance by asking their bank to produce a one time check to give to the payday loan agency. Many payday loan companies and stores can get approval with no faxing of documents as they utilize other means for proof of income. Although payday loans come with very high annualized interest rates they sometimes are the only source of emergency cash loans for those in need.

Automotive, Motorcylce, RV (recreational vehicle) and Boat Loans – These personal consumer loans are usually not signature only loans but asset based loans. In other words a financial lien is placed against the asset to secure a loan to purchase or refinance the car, boat et al. These consumer loans may sometimes require a down payment of five to twenty-five percent to secure enjoyment and use of ownership. Because these are not funds that are already available as with credit cards they come with a “loan term” from one to six years depending on the choices of the consumer, the marketplace and the credit status. The interest rates can range from very low usually offered by manufacturers of cars, motorcycles, RV’s (recreational vehicles) and boats to very high if the borrower uses a credit card, a finance company or a “buy here – pay here” lender – or the car dealer who finances the purchase of the car by giving the borrower a term of months and years to pay the balance of the loan off.

  • Business Loans

SBA (Small Business Administration) Loans are loans that are given to small businesses which are not able to qualify for a loan from a financial institution for various reasons from lack of business history, lack of collateral to “secure” the loan or not having an adequate credit history. The SBA is not a direct lender but acts as an underwriter on behalf of the bank that funds the loan for the business entity. If the borrower defaults on the loan the SBA will pay the bank a percentage of the balance for taking the financial risk to loan the funds to the business. There are various types of SBA loans which will not be covered in this article but a future article will explain in more detail.

Conventional Business Loans are loans that are either unsecured meaning no asset is used to approve the loan or secured and called “asset based loans” where assets from inventory, equipment, accounts receivable or real estate are used for underwriting for loan approval. Conventional business loans are given to business entities that have great banking relationships, established business credit history with trade lines with other businesses they do business with and good standing with various credit reporting entities like Dun & Bradstreet. There are short term loans with interest only payments with the balance due at the end of the loan usually referred to as a “Balloon Loan”. There are also longer term loans that are fully amortized (principal and interest in each payment) paid over one to five years or more.

Equipment Leasing is a financial instrument which technically is not a loan. Meaning based on tax ramifications and who owns the equipment – leasing is just that – leasing an asset owned by another entity. Leases are usually from large corporations or a bank. The lease term can vary from one to
five years or more and there usually are tax benefits to the business entity in leasing new or used equipment.

Equipment Sale Leaseback is a transaction to use equipment that is already owned by the business or municipal entity to secure funds for the present need for operations. The term can vary from one to five years and the amount of funds can vary based on credit history and a percentage of the fair market value of the equipment. The company then in turn leases the equipment back in usually a monthly payment. The company or the lessee normally has different choices on what they want to do with the equipment at the end of the term. They can roll the lease transaction into newer more updated equipment or software. They can buy the equipment for one dollar or ten percent of the fair market value of the equipment.More and more companies are leasing today as opposed to paying cash or using bank lines or loans.

Merchant Cash Advance is used by businesses that need fast cash and can’t qualify or don’t want to go through the process of getting bank approval for needed funds. A Merchant Cash Advance is also not a loan product but it is the selling of assets or credit card receipts at a discount. In other words the Merchant Cash Advance company buys the credit card receipts and then attaches a fee usually every time the business “batches”, settles or closes the day’s or week’s sales until the funds advanced are paid off. There is no term with merchant cash advances as it is not a loan so there is no set payment amount or period. The paying off of the advanced funds vary based on a the credit and debit card transactions of the day or week.

Factoring Accounts Receivable Invoices enables a business entity that normally has to wait 30 days or longer to be paid by other businesses or governmental entities. Again factoring is not technically a loan but a selling of invoices at a discount for cash now. In a typical transaction the company applies with a Factoring Company and the company looks primarily at the credit of the other business or governmental entity that the company is doing business with. Based on that as long as the client of the company is a solvent business or government agency the invoices are bought and funds are dispensed to the business usually within three days of due diligence on the company they are transacting business with. In other words the funds are dispensed after there is a credit check and processing of the other company. The dollar amount that is advanced can vary from fifty percent of the invoice to eighty or ninety percent depending on various factors such as the size of the invoice to the credit criteria of the other company or governmental entity whether it is a city, county, state or federal agency.

Medical Factoring is a financial transaction that benefits medical entities like hospitals, clinics and various health care professionals that have to wait to receive funds for services performed on patients. Like Factoring and Merchant Cash Advances Medical Factoring is the selling of assets in this case invoices for cash now. In many instances the health care industry receives payment from third party entities like insurance companies, Medicaid and Medicare and state entities that provide funds for those in need of medical procedures. The medical facility or professional in turns sells the invoice(s) on a on going basis or one time for cash now. Once there is an interest is selling the receivables then a Factor steps into analyze the billing so that funds can be advanced. This process can vary in length but is usually shorter in length than the process of getting bank financing.

Contract and Purchase Order Funding allows companies to bid on large projects for governmental agencies, hospitals, universities, prison systems and municipalities or also to sell to larger corporations even if the business does not have the credit or bank approval or the wherewithal to service or fulfill a large contract order. Similar to Factoring which works hand in hand with Purchase Order Funding it is not a loan but a simultaneous transaction that involves advancing funds based on the credit of the governmental agency or larger company and the size of the contract. The funds that are advanced are for the cost in completing the order of products or performing services. So the profit that will be gained is not advanced but the costs as in raw and finished material, transportation, production, labor, expertise and any other costs involved in completing the contract. Once the contract is completed or once an invoice is ready to be sent to the client a factoring company which is sometimes owned by the same company buys the invoice at a discount and the funds that would normally be advanced to the company are usually used to settle the amount advanced for the material and other services that were needed to complete the order. Contract and Purchase Order Funding usually requires large transaction amounts as opposed to factoring that can be utilized for invoices as small as one hundred dollars. With the use of Contract and Purchase Order Funding companies that were locked out of the process of bidding on large contract s may become players in multi-million dollar deals.

Commercial Real Estate Sale Leasebacks are similar to Equipment Sale Leasebacks featured in this article. Instead of utilizing owned equipment to secure cash when bank borrowing is not wanted or not available the commercial real estate is used to access funds now. This can vary from office buildings, medical buildings, retail franchises, industrial buildings and manufacturing to large utility plants. This frees up cash “locked” away in real estate. Many entities find that at the present time the business they are in whether it is retail, manufacturing or another field that the holding of commercial real estate is not in their best financial interest for now. They prefer to put to use funds for their industry. So a retailer selling retails goods decides to focus on the retail operations and to lease the space because that real estate when factored into a myriad of calculations does not fit their financial goals during the present time. Yes the ownership of commercial real estate is an asset and can be used as a security for a loan but may also be viewed as a fixed non-performing entity that does not meet the needs of the business, organization, group or individual that owns the building. Commercial Real Estate Sale Leasebacks are another form of getting access to funds and has increased over the years.

E Cigarettes – Environmental Friendly and Stylish Alternatives to Smokers!

The mere sights of cigarette butts makes many cringe frown and roll their eyes in disgust. Insult is added to injury when the breath of one in close proximity to another is smoky and stale. It is such concerns that have led to the invention of E Cigarettes!

These are cigarettes whose utilization requires small power from battery and are also available in various flavors and varied nicotine levels. Owing to the fact that the charge from a short cable is required, carrying the electronic cigarettes and taking a puff away from the comfort of the home can be quite tasking in some case. This means that the smoking habits of individuals are in fact regulated! Also, the human body is protected from harmful smoke that is not emitted by the electrical version of these new age top notch cigarettes.

The Cigarettes Are In A Dignified Pack and They Are Durable!

For the first time ever, tobacco smokers do not have to carry matches and lighters causing burns to their finger tips and boring holes into their Sunday bests! Smoking has been taken a notch higher and the result is basic dignity for the smokers because they will not disrespect the non- smokers among them by contaminating the air that they breathe. Electronic cigarettes and the packages they come in can also be reused meaning that a lot of money isn’t spent in every interim in the purchase of pack after pack as in case of regular cigarettes. The style and durability factor surrounding the new age cigarettes is just remarkable!

They Are Environment Friendly!

For starters, this kind of cigarettes cannot be put on unless with a source of an electrical current. This means that rooms and pathways do not, under any circumstances, get filled with smoke just because a smoker passed by! The smoke usually part and parcel of the activity of smoking, is done away with meaning the air, even around a smoker, is always fresh! Disposals for the cigarettes have also been invented, meaning that they are gotten rid of responsibly so that there are no harmful smoking bits and pieces carelessly thrown away which pollute the environment!

E Cigarettes have made the world a better place, at the very least! Those who indulge in smoking on a regular or even irregular basis can therefore finally do so responsibly and while giving better consideration to their health.