Ceramics of Masayuki Imai

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Like many other museums, The Phillips Library at the Peabody Essex Museum has contributed many volumes to Internet Archive. This exhibit book from 1985 is just one example. Books made to sell in museum gift shops during an exhibit quickly go out of print so being able to browse them digitally is the best way to savor an exhibit whose contents has long scattered.

Masayuki Imai ceramic art 1985 : Peabody Museum of Salem, 21 March-21 May, 1985

I chose 3 images from the book as sample images for their shapes and subjects. I like all things botanical and there were a lot of plants featured in Imai’s work; there probably are not many pots that feature floating pitcher plants like his! Cranes might be a more popular decoration…but the shape of the pot was unusual. The color of the 3rd pot was different than the majority of the pots, making it stand out.

The book includes a short biography of the artist. I did a search but couldn’t find an updated one.

Table Rock Lake

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On a sunny day last week, we headed south to Table Rock State Park – situated on the shore of Table Rock Lake. The drive down had many roadcut cliffs….curving highway…scenic. We parked near the boat launch and walked along the paved lakeside trail. There were frequent ad hoc trails going all the way down to the lake…using ‘stairsteps’ in rock down to water level. We saw at least one person fishing. There was rain in the previous days so the eroded rock held small pools of water.

The first side trail we took down to the water included a surprise. There was a whole watermelon at the water’s edge! How did it get there? Did someone put it in the water to cool down then forget it was there? We wondered how long it had been at the edge of the lake since we are well past the season for them to be in grocery stores. It was the only ‘trash’ we saw during our walk!

I was fascinated by the intensity of the color on wet rocks compared to the rocks that had dried out on the shore.

The water itself changed the way the rocks look too. These two pictures are of the same area but the water acts as a distorting lens!

I turned aroud and took some zoomed images of drying debris, a chuck of rock, and the layers in one of the ‘stairs’ – then made my way back up to the paved trail.

We started looking at the sights along the trail. There were limestone boulders along the edge and I started noticing inclusions in some of them. Some areas were forested…with enough underbrush to support communities of lichen and moss….and, my favorite, turkey tails (shelf fungus).

We didn’t see a lot of birds – and I didn’t get any pictures. It was not the best time of day for bird watching. I saw a nuthatch, crows, and turkey vultures…without even going into ‘birding’ mode.

There were not a lot of people in the park this time of year even though the day was warm enough for a picnic (there was one family with one children that was enjoying a snack). It is easy to imagine the place being full of people when the temperature is warmer…and everyone would enjoy the activities on or in the water!

Now to plan some other day trips….take advantage of any pleasant day to do a little more exploring of places within an hour of where we live!

Ice and Algae

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It was below freezing for almost 24 hours before I ventured out last week an hour or so after sunrise. The temperature was in the 20s and I anticipated capturing ice on our neighborhood pond. I bundled up in my heaviest coat and gloves…already had the lens cover off my camera since it is hard to remove with gloves on.  I noticed the robins were around and probably beginning to scout nesting locations.

There was a small group of Canada Geese; most stayed on the bank but two ventured into the pond through mats of algae. I began to worry that maybe the sun shining on the pond surface had already melted the ice even though the air temperature was still below freezing!

As I looked more closely I noticed that there was ice between the mats of algae! Some of the ice had a look of cut glass. There were leaves just under the surface in some places – distorted by the ice – but some are, quite clearly, oak leaves. The color of the algae is a nice contrast with the ice!

My favorite picture of the morning was a patch of ice surrounded by algae. The green mats creates a fuzzy (slimy?) frame around the ice structures.

I continued aroud the pond and noticed that a twig of red maple flowers had fallen onto the path. The tree blooms so early that the hard freezes sometimes are problematic. The red maple that this twig came from seemed to still have quite a few flowers that had tolerated the cold so the tree should still be producing seeds this year.

Overall – I’m glad I went out when I did. This could be one of the last times to capture ice on the pond since spring is one the way.

Edamame Pods

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Edamame pods have become my favorite light meal/snack. I usually look for shelled edamame for stir fries but recently discovered snack-sized packages of frozen soybeans in pods that are intended to be microwaved 2.5 minutes in the package…then eaten. They are unseasoned. I like them plain but variety could be added by sprinkling with your favorite no salt seasoning. They have 9 grams of protein…90 calories…along with fiber, essential fatty acids and isoflavones….probably one of the healthiest snacks around.

My daughter had introduced me to soybeans in pods served as an appetizer at a restaurant while we were in Canada. The learning curve to get the beans out of the pod neatly was an adventure…but didn’t take long. In restaurants they are often served with salt crystals. I’m glad I noticed the packages at my grocery store so I can include them more frequently in my diet.

The pods are left after the snack. They are not edible. Another edamame pod adventure: some macro photography (with my phone – a Samsung Galaxy S10e). The pods retain the bumps from where the beans were….and begin to curl as they dry. The inside has a lighter layer that looks like padding for the bean. There are also bristles and tiny dark channels on the outer part of the pod.

Now - I’ve collected enough pods over several days. I am putting them in my small compost pile.

A Photography Course

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My husband purchased Matt Kloskowski’s Inside the Composition course and we are working our way through the 21 modules.

I’ve done 6 modules so far. Each of them had a short lecture then an assignment…encouraging students to apply the concepts in their own landscape photography. Review and critique of my own photos has been enlightening.

The course has already helped me recognize some shortcomings in my photography –

I tend to like my macro compositions more than landscapes and one of the reasons is that I almost always have too much sky in my landscapes. Sometimes cropping can improve it…although I will try to do better when I am in the field from now on. A good example is this sunset I took back in December…the colors were outstanding…but there is way too much sky. I cropped part of the sky but maybe I should have cut some of the dark foreground too. The result is an odd shaped image but the composition is improved.

Some of my photography is almost like note taking…documentation rather than art: taking a picture to later use for identification of a bird or insect…or taking pictures of signage to read later (or act as a caption to other photos. But the rest of my pictures should be more than documentation. I need to improve my composition on those pictures even if I think about then as documentation of the place. My macro pictures generally composed better than my landscapes!

I tend to like birds moving left to right through my image – even though this breaks the ‘right third’ rule. I always make the assumption and a bird will be moving; we read left to right and our eyes tend to be trained for that direction. Inanimate objects tend to be better place on the right third but software easily flips the image if I forget (see sun yard ornament below).

I should learn to consistently turn my phone when I am taking landscapes. The sunrise picture with half the image a dark band is a good example. Again – cropping can help but it would be better if I’d learn get the composition right when I take the picture!

One of the only landscape pictures I’ve taken recently that I like, turns out to demonstrate some composition concepts. It’s a sunrise pictures but the large diagonals of the silhouetted tree branches in the foreground lead the eye into the colorful sky rather than just having large expanse of colored sky. The second layer of tree silhouettes adds more complexity and the recognition that it is a winter sunrise.

I’m looking forward to the modules still to come….

Frost Columns and Ferns

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There was frosty morning last weekend at our house, and I photographed the crystals about 30 minutes after sunrise…in a hurry because the temperature was 20 degrees Fahrenheit, and I hadn’t put on my coat! There was frost on the lamb’s ear and an old leaf that looked like crystals of sugar.

\I was more interested in finding more complex crystals. Our wrought iron table had frost all around the outer edge.

The first ones I saw were columns…sometimes in clumps…emanating from films of ice (that might have started out as water).

I was surprised to find very different crystals on the other side of the table! They were a lot like the frost ferns I posted about back in January. They were not quite as large, and they grew out of a thin film of ice rather than as ‘fronds’ around a common center as they had in January.

I wondered what caused the crystals to be different on opposite sides of the table. In the past, I found column type crystals when the temperature was closer to 30…the ‘ferns’ when it was 20 or below. The columns were on the side of the table closer to the hollies and some cedars; the ‘ferns’ were on the side next to the posts supporting the deck stairs. Could the vegetation be creating a slightly warmer temperature? Maybe next time – I’ll take a thermometer out to test that idea!

All photos were taken with my Samsung Galaxy S10e (most are at 8x magnification).

Gleanings of the Week Ending February 18, 2023

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The items below were ‘the cream’ of the articles and websites I found this past week. Click on the light green text to look at the article.

Farmers Find Wild African Cat Wandering Around Missouri – A serval found when a farming family set a live trap to capture the culprit leaving bones and feathers between their stacks of hay bales! The Turpentine Creek Wildlife Refuge came to the rescue. This is all close to where I live and I was saddened that evidently the new Big Cat Public Safety Act does not include the smaller non-native wild cats…and that someone was cruel enough to release this cat of the African savanna into the wild in Missouri.

Caribou have been using the same Arctic calving grounds for 3,000 years – Analysis of antlers found on the tundra….discovering some of them are 3,000 years old! But the Arctic is warming faster than other parts of the globe. The elders of the village south of the calving grounds comment that they have noticed a lot more trees, less barren tundra. What will happen to the barren ground caribou as this habitat gets converted to forest?

Why fabric fraud is easy to hide – The fashion supply chain is fragmented and very dense….most apparel companies do not track their own supply chain (or don’t go past their immediate suppliers). Organic cotton is one of the prime examples of how end products labelled as organic cotton…might not be. It is hard to determine where the fraud is inserted in the process; the result is that the consumer is paying a premium price…not getting what they are paying for. And to improve the system will require big changes in the fabric/apparel business.

A Field Guide to Unexpected, Out-of-Place Wildlife – Sometimes animals have ranges that are changing or are a lot larger than we anticipate…sometimes birds are in very different places that their usual range!

Dirty Laundry: How much microfiber do we emit with our laundry – A study done in the UK…but probably relevant to the US as well. Microfibers from laundry in the UK weigh 6,850 to 17,847 tons per year. Yes…that’s a lot and pollutes water…however, it is a dwarfed by the 365,000 tons of clothing going into UK landfills per year.

Antibiotic use in farming set to soar despite drug-resistance fears – The increase in bacterial infections that cannot be treated with antibiotics (because of bacteria developing resistance to antibiotics) has been growing in recent years. Overuse of antibiotivs in agriculture is thought to be a major driver of the problem. Governments around the world have attempted to curb the use of antibiotics to promote growth but the use is still expected to grow by 8% between 2020 and 2030. The article includes a chart of agricultural antibiotics by country in 2020…and a projection for 2030.

The Lifelike Glass Models of Leopold and Rudolf Blaschka – Thousands of realistic models of plants and sea creatures made by a father and son from the 1860s until 1938.

8 everyday foods you might not realize are ultra-processed – and how to spot them – I am cutting back on ultra-processed foods this year. Some of the 8 listed in this article are easy: I don’t eat breakfast cereals, I only eat protein bars as ‘emergency rations’ (i.e. not frequently) and avoid yogurt, meal bases and sauces, processed meats, and margarine. I’m still looking for a soy milk that has fewer ingredients; will give up on soy milk soon if I don’t find one. And I try to buy bakery bread.

Did Philip II bring invasive fish to Spain? – Evidently his efforts to acquire fish and crayfish from afar spanned at least 25 years!

Study reveals that much still not known about cognitive decline - Data came from 7,068 participants in the 1996-2016 Health and Retirement Study. Participants were born between 1931 and 1941. Researchers measured their cognitive functioning at age 54 and how it declined until they were 85. At age 54, socioeconomic status, education and race -- explained only 38% of the variation in functioning. Those same factors explained only 5.6% of the variation in how quickly cognitive functioning declined in people between age 54 and 85. So much we don’t know about cognitive decline although it is pervasive in older adults, even those without dementia.

W. Westhoven – Engineer Artist

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Six South African Scenes and verse  was published the year Wilhelm Westhoven died (1925) and contained 6 of his paintings. I selected two of the paintings for this post…encourage looking at the book on Internet Archive to see the other 4!

According to a brief biography on Artefacts, he was born in German in 1845, wrote a paper about the Forth Bridge in Scotland (a cantilever railway bridge), and emigrated to the Cape Colony in 1892 where he was an engineer in the Department of Public Works until he retired in 1904. After reading the biography…I checked to see if the paper Forth bridge was available on Internet Archive….and am looking forward to browsing through its illustrations (here).

Settling in, developing new routines – 8th month

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We moved to Missouri eight months ago and have adjusted in many areas…but there are still things to do. My previous ‘settling in’ posts were made in the 1st, 2nd, 3rd, and 4th month; it’s time for another update. The upheaval of the move is waning. The changes between our 4th month and now are more gradual; there isn’t the frenzy of activity like in the first few months. We’ve voted in the mid-term election, subscribed to a local news feed… are experiencing winter and working on our 2022 tax filing (it is more complex this year with the sale of a house and two state taxes). I’ve sustained my treks to Texas; it’s become apparent that the monthly plan might need to be adjusted quickly depending on the care my parents need; the priority of being available for my parents will keep me from signing up for volunteer gigs or university classes. Our three kittens are keeping us close to home too; they need a lot of attention but we have successfully done day trips and 1-2 nights away; my daughter checks on them when we are gone for more than a few hours.

There are still things we are anticipating:

Spring in Missouri. The rhododendron flowers were already fading by the time I first looked at the house…the irises had already bloomed too. I’ll enjoy seeing the flowers…supplemented with the additional bulbs I planted last fall. We are also talking about day trips for gardens and birding hotspots within the state.

All-electric. We are talking more about the order of steps we will take to move the house toward being ‘all-electric’ over the next 3 years or so…and then adding solar panels/battery.

Dark sky. My husband is keen to go to a dark sky site…hopefully once the temperature is a bit warmer, he’ll be able to do it.

Yard. I have been putting off contacting a nursery…but need to do it soon if I want things in before it gets too hot (and potentially dry) this summer.

Overall – we are not venturing out very much right now because of the cold…but we’ll do more outdoors in the spring. And maybe meet more of our neighbors too!

Our Nixa, MO Yard – February 2023

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February started out bitterly cold – with sleet/snow that stayed on the ground for days. I bundled up and ventured outdoors with my camera to document the situation in our yard. There had been some freeze-thaw cycles already, but the concrete and rock covered beds were still very white. A downspout had dribbled water than had frozen before it could escape. In the yard, the grass bristled through the whiteness; I left footprints, but they didn’t go very deep. The yard was pristine; our Missouri yard (and neighborhood) is not a deer highway like our Maryland house was.  The iris leaves in one bed seemed unfazed by the cold (hope that continues to be true!).

I went through the house to go out to the front because all the gates were frozen in place. I was surprised that mine were the only footprints on our sidewalk; with schools closed and the bitter cold, people were not taking walks as usual.

I was intrigued by the round seed pods on one of our larger crepe myrtles. The wind and gravity had emptied some of them, but others still contained the seeds from last fall.  The seeds were ready to scatter…they fell out easily with a nudge of my fingernail.

Frosty Valentine’s

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Valentine’s Day is a very commercialized celebration --- lots of red roses, chocolate and other candy often in red heart shaped boxes or the candy itself in the heart shape. If my husband and I do anything for Valentine’s – we do it on our monthly wedding anniversary which is within a few days of the 14th. This year it will be our 601st monthly anniversary!

One positive outcome of the commercialization of the celebration, I am anticipating lots of candy on sale on the 15th….hoping for a good selection to buy at a reduced price for my daughter and son-in-law to have in their campus offices for their meetings with students!

Another positive aspect to Valentine’s is its position in February. The winter can be gray, cold, and icy. Maybe Valentine’s Day should be a prompt to look around for beauty in the ‘wild’ to share with someone near and dear: a sunrise or the beauty of ice crystals at close range….choose to see beauty in February outdoors (or through a window)!

Coursera Again – Neuroanatomy

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The beginning of Coursera coincided with the beginning of the post-career portion of my life a decade ago. It burst on the scene offering auditing of online courses for free (a small fee was charged for the testing and projects for credit). I was like a “kid in a candy store”…so many topics of interest that I never had time for during my undergraduate/graduate years….and some topics that didn’t exist until more recently! I audited a flurry of courses in the first few years then settled into an occasional course – usually in the wintertime when I spend more time indoors; there was an uptick during the COVID-19 pandemic but not to the levels of the first few years.  

I recently looked at my records and discovered I have audited 74 courses! The topics are varied: art, anatomy, nutrition, history, meditation, education, entomology, exoplanets, poetry, psychology, design, and architecture! The nutrition course was one of the early ones…and is where I learned about the Cronometer site that I am still using to track what I eat so that can take off a few pounds.

This month I completed a Neuroanatomy course from the University of Michigan. It is a 7-week course; I completed 3 weeks before I went to Carrollton TX in late January and completed the other 4 after I got back. I did my usual notetaking as I made my way through the material – trying to learn the vocabulary and the anatomical structures. Now I find I want to learn more about neurobiology!

This course pointed me to a new-to-me source of reference books: PDF Drive. Just look at the list of books available for Neuroanatomy! There are lots of other topics as well. I am getting the “kid in a candy store” feeling all over again!

Our Missouri Neighborhood – February 2023

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There were a few days of snow and ice early in the month; I stayed indoors for the first days but then the sun came out and I decided to bundle up and walk around the neighborhood to document the event. The pumps in the largest pond were keeping some open water.

Two geese ventured out on the ice…but turned around and rejoined their friends on the bank before getting all the way to the unfrozen part of the pond.

The snow that fell on the slides in the playground had gone through some freeze-thaw cycles and was extending past the end of the slides!

The contrast of tree trunks and snow/ice was stark…the snow creating a different pattern than usual when the mulch around the trees is almost the same brown as the tree trunk.

My favorite sights of the morning were the neuron shapes in the pond. My theory is that the center part that looks unfrozen is either a shallow spot or has a lot of water plants near the surface. The ‘dendrites’ coming out from the center are cracks in the ice that are mostly refrozen. I zoomed in on one of the centers; the texture of the ice looks like cut glass!

Or maybe I was just thinking about neurons too much since I’ve been learning about them recently…stay tuned for tomorrow’s post for more about that.

Gleanings of the Week Ending February 11, 2023

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The items below were ‘the cream’ of the articles and websites I found this past week. Click on the light green text to look at the article.

Why the world feels so unstable right now – Intermittent instability of nonlinear systems of nature and global society –weather and climate, the economy, a pandemic, a war. We attempt to model nonlinear systems to predict these intermittent instabilities…but it is hard. Right now there seem to be significant nonlinear systems interacting: weather/climate + diseases (COVID-19 and bird flu (US)) + inflation + Russia’s invasion of Ukraine.

Completing The Electrical Circuit at Kilauea in Hawai'i Volcanoes National Park – The technique to get a detailed ‘CAT scan’ of the volcano…..mapping locations of subsurface magma in 3D.

Ex-cell-ent Clouds off Chile’s Coast – Open and closed-cell marine stratocumulus clouds photographed by Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA’s Terra and Aqua satellites. Learning more about these clouds….contributing to better weather prediction and improving the accuracy of climate models.

The Surprising Substances Ancient Egyptians Used to Mummify the Dead – Evidently some of the substances the embalmers were using came from Southeast Asia. Perhaps embalming instigated early global trade.

Algae robots transport antibiotics to infected tissues (infographic) – Researchers inserted the modified algae into mouse windpipes…they spread into the lung tissue and killed pathogenic bacteria!

Hundreds of Frank Lloyd Wright’s Designs were never built. Here’s what they might have looked like. – Computer generated models from David Romero.

5 expert tips to protect yourself from online misinformation – We all need tools to help us distinguish information from misinformation.

Montessori: The world’s most influential school? – I sought out a Montessori pre-K and K for my daughter about 30 years ago…and it fit her needs. I have no way of analyzing how closely the school adhered to classical Montessori ideals.

An action plan to prevent Alzheimer’s disease – Defining what 2nd generation memory clinics should include.

Gallup: Fewer than half of Americans believe US healthcare is good enough – Not surprising really – it’s expensive and we are all getting more skeptical that the system is as effective as it should be for what it costs. Evidently the people in my age group (over 55) were generally more satisfied with their health care than other age groups; people old enough to qualify for Medicare may not be as anxious about costs but I was surprised that I am in the minority in thinking US healthcare is ‘subpar’ rather than ‘excellent’ or ‘good’ based on the effectiveness issue and the structure of the system overall.

Maria Martinez (potter) in 1925

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The first picture in Carl E. Guthe’s  Pueblo Pottery Making - a study at the village of San Ildefonso published in 1925 is one of Maria Montoya Martinez that is widely used elsewhere (including in the Wikipedia entry for her). 1925 was before she started making her black ware pottery that survives in many museums. I recognized her name when I first started browsing the book; it was one of those times I appreciated Wikipedia and Google search to learn more about her before I continued browsing. I celebrated finding Guthe’s books on Internet Archive and the myriad pictures that documented the situation in 1925…the state of the art then, before she was producing black ware pottery.

1925 was during the time when much of the culture of the Pueblos was fading….the challenges of people trying to survive in the world. Fortunately, Maria learned pottery skills from her aunt… a “learning by seeing” beginning in her pre-teens. She, with the collaboration of her family members, continued to experiment and produce pottery throughout her long life (she lived until 1980) and taught others the same way she had learned. She helped establish pottery of the Southwest as an art form we recognize today.

Surprisingly, Guthe’s biography (archived from the University of Michigan Museum of Anthropological Archaeology) does not mention this book at all. His work establishing collections and institutions overshadows this book!

The Whole Orange

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I’ve enjoyed oranges all my life….sometimes cutting them in slices…sometimes in wedges. In recent years, I cut them in wedges so that after I eat the pulp, the peels fit nicely into the food processor.

Once the peel is chopped up, I let it dry on a plate to be used in cooking…or in hot tea.

It feels good to use the whole orange….getting all the nutrition from the fruit! I have some recipes that use the whole fruit as well; my favorite is cranberry orange relish that I make any time I see fresh cranberries in the produce section (usually November and December).

My mother reminisced that oranges were special treats of the holidays when she was child, and her mother often candied the peel. Every time I use the whole orange, I feel an affinity with my maternal grandmother…good vibes through the years!

Spring Yard Dreaming

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Moving to a new area of the country….a new house…I am full of dreams for the yard.

I’ve already bought way too many seeds for the existing flowerbeds. Most of the beds contain landscaping cloth covered by river rock. Maybe I could plant mini-pumpkins in those beds by poking a hole in the fabric. I’d like to grow enough plants to have a good harvest in the fall. I’ve already identified some beds in the back of the house that will be changed dramatically. And there are areas between trees that I will turn into flower beds because I don’t want to mow there. One plant I want to grow…and harvest…is stevia; my CSA in Maryland had hardy plants that withstood harvesting of their leaves/small branches all during the growing season; putting a few leaves to steep with tea gives just a hint of sweetness that I enjoy; I will order organic seeds.

I have chives seeds gleaned from my parents’ Carrollton yard that I will plant to grow as ‘edges’ of flower beds. Since I purchased seeds as well (that have pink flowers) I will probably mix those seeds with the ones I gleaned to add splashes of color/texture variety.

My larger plan it to plant some native bushes in the back yard to reduce the amount of yard that is mowed and have some deeper rooted plants on the slopes at the side of the house. I need to go to a nursery to hone my list of natives that are hardy in this area. I’ll ask about some of my favorites: oak leaf hydrangea, beautyberry, and ninebark. I’d like to plant something that would provide winter food for birds; maybe the nursery will have some recommendations. I need to check the guidelines from our Home Owner Association to see if I need to get permission; if I do, hopefully it will be an easy process.

February is the ‘yard dreaming’ month….I’ll need to act soon to make it happen…but maybe it won’t all get done in 2023!

Carrollton Frosts – January 2023

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There were two frosts in late January when I was in Carrollton. The first day started out at 30 degrees and 96% humidity. I made the first round of pictures around the yard of my parents’ house not long after sunrise.

Frost covered the upper surfaces of everything.

The seed pods of the red yucca are my favorite images – coated with frost that highlights the ridges and folds of the pods.

I went inside for about an hour then photographed more plants and objects. The crystals on a tiled counter near the gas grill were the largest (mostly columns).

On another morning, the temperature was 34 degrees and the humidity was not as high…but frost formed anyway. I wondered if the oxalis would be able to withstand the two days of frost. The tiled counter was encrusted with crystals again.

A Patient Perspective of Medical Care in the US

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Part of the aftermath of making a long distance move is establishing new doctors. I’ve completed the process at this point – 8 months after the move. It’s been a learning experience. I started out with the intention to find a primary care physician and specialists in the same system so that I would only have one portal for all my medical information – unlike my legacy situation that involved at least 4 different portals. The portal for my new doctors is well organized and has become the primary way I get results and send questions/messages to my doctors. In general, the lab work is done very quickly and posted on the portal; I see it about the same time that the doctor sees it. The system of doctors – specialists – labs – hospital also includes several urgent care facilities that I appreciate; their availability can help avoid a busy ER; I’ve already used an Urgent Care facility prior to my first appointment with my new primary care doctor when I got a very painful bite that looked infected. On the downside -

  • Vision and dental care are not general part of ‘medical care’ from an insurance perspective or systems with MDs; vision and dental are still separate. The initial dental practice I selected wanted to do very different (and expensive) kinds of cleaning for my teeth and I’ve opted to go to a new one that is more like the dental practices I’ve used in the past. It’s hard to know how to evaluate dental recommendations since they are outside of the primary medical system. I like the vision care practice I chose but may have similar misgivings as I get closer to needing cataract surgery.

  • The various specialist doctors and non-blood labs/radiology are in separate buildings; they are relatively close together, but I am careful to record the building address  in my appointment calendar; it’s a high traffic area and it could be challenging to get to the appointment on time if I went to the wrong building first.

Thinking about the big picture of medical care in the US - It is not achieving ‘best in world’ results based on healthy lifespan stats. Why is that?

  • Insurance is expensive and confusing. I’ve had health insurance since the late 1970s and the trend has been increasing cost and complexity over the duration. Checking that doctors are in-network and drugs are ones that are on the formulary is a required skill to get insurance to cover costs….and even then, sometimes surprise charges occur. What happens when your doctor prescribes a drug that is not on the insurance company’s formulary? I am very aware that I have been fortunate to always be insured….understand that the cost of good medical insurance is prohibitive to many and that often means not getting medical care until there is a health crisis…and going to an emergency room.

  • Cultural reluctance/aversion to embrace public health measures. Over the past decade, there has been increased resistance to public health measures (for example, not getting vaccinations for children, older adults declining vaccines, flying when sick (coughing, sneezing),  and aggressively against mask wearing at any time) and demands on health professionals for treatment that is not appropriate for their condition (for example, demanding an antibiotic for a viral infection or are an ineffective drug for COVID or a drug advertised on television that is for a condition the patient does not have). I am mentioning the demands for inappropriate treatment under public health because it impacts the costs for medical care overall, increases resistance of microbes to antibiotics making them less effective when they are needed, and makes the workplace for doctors/nurses more stressful (and some decide to leave the profession resulting in shortages of skilled personnel).

  • Dominate lifestyle. We live in a world of fast food and ultra-processed foods…people are more sedentary because of their jobs or the type of entertainment they choose. It is harder to “eat healthy” now that when I was growing up and as a young adult. Many people in the country are obese and/or in poor physical condition. However – there are a lot healthier foods available now if we educate ourselves. For example – kale was not something I ate as child, now it is my ‘super green’; other foods that I’ve only know in the past 20 or so years include: pomegranates, edamame, beet greens, red cabbage, butternut squash, ground turkey. There are also a lot of ways to measure physical activity…and some have leveraged those metrics to become more physically fit. Still – healthy lifestyles are not as prevalent now. The bump in life expectancy that was achieved after many people managed to stop (or not start) smoking is being eroded.

  • Aggressive intervention with drugs. The medical system tends to treat with drugs rather than recommending lifestyle changes. Part of this skew is the way doctors are trained (often nutrition is not included in their education) and part is probably based on their experience that most patients will not follow through and make a change. If a drug can change the measure the doctor is seeing (like blood pressure or cholesterol levels), then the doctor tends to immediately medicate. Any unwanted side effects from the drugs are resolved through changing to a different drug or adding a drug to reduce the side effect or telling the patient that the benefit of the drug is greater than the impact of the side effect. But – if people can change their lifestyle, they are probably addressing the root cause of the problem rather than artificially doing something that changes the measure but leaves what is causing the problem the same. Long term maybe we’ll know if the drugs really do very much for increasing healthy lifespan.

  • Specialists with blinders to anything outside their specialty. The notion that a primary care physician can integrate care is overly optimistic.

    • Many times, the specialists are proceeding with their focus; if treatment is meeting the measures they want, side effects or over medication are not a priority for them.  For example – an endocrinologist adjusting medication to get the levels of hormones to a precise level is often unconcerned or dismissive of a patient reporting heart palpitations, hot flashes, and eyebrows falling out.

    • Emergency room doctors are focused on resolving the primary cause of the emergency visit and sending the patient home as soon as possible; this leads to quick fixes that often do not prevent the same issue occurring repeatedly. A good example is cellulitis in older patients; the ER gives them antibiotics and they go home…often returning with cellulitis again in a month or so. If the ER is not overwhelmed and there is an alert attending in the ER or in the hospital, more proactive measures can be taken…perhaps re-evaluating the dosage levels and complexity of existing medications, adding a prophylactic antibiotic, etc. that can prevent rapidly recurring ER visits for cellulitis.

  • Lack of trust. Patients believe doctors may have alternative incentives than patient health when recommending treatment/drugs and doctors believing patients may not be doing as they say and/or taking meds as prescribed. Not sure how this can be bridged other than encouraging more transparency on both sides.

The bottom line – I want to believe that I am proactively maintaining my health and being a knowledgeable patient that asks relevant questions to understand my doctors’ logic….thus making the best of the medical care available…but there are certainly times that I have some doubts. So far, I have been able to resolve those doubts and am satisfied that I am on a healthy path. However - I am increasingly concerned about individuals with fewer financial resources, less healthy or not as knowledgeable. The trend is toward more challenges within the US healthcare system!

Josey Ranch – January 2023

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The birds on the water at Josey Ranch in Carrollton, TX changed from when I was there in December. The Northern Shovelers were not there in January! The American Wigeon were there the first day I went in January but not on the second. It seems a little early for them to be migrating; maybe they have moved to a bigger pond. On my first visit – I saw American Wigeon, Lesser Scaup, American Coot, Great Egret, Ruddy Ducks, and gulls.

The surprise birds of the day were a pair of Buffleheads. They were busy diving for food! I’ve seen them occasionally at Josey Ranch before but they are not in the ‘regular’ birds there.

On the second day I visited, there were gulls lined up on the walkway near the parking lot. The Lesser Scaup, American Coot, and Great Egret were still around. The mallards seemed more numerous than on the first day (seemingly skewed toward males). There was a Great Blue Heron almost hidden in the reeds. The Ruddy Ducks were still there but sleeping just as they were on the first day.

I walked around to the native plants in a terraced area between the Library and Senior Center. It was almost too windy for macro pictures…but I tried anyway. Some berries were the only color….but the shapes of the dried remains of the plants from last summer are interesting enough.