Women Who Drink More Increase Their Risk of Breast Cancer

Breast cancer is the fifth most common form of cancer worldwide. Earlier this week, scientists at the European Cancer Conference (ECCO 14) in Barcelona, Spain shared findings that it makes no difference whether women drink beer, wine or spirits - it is the quantity of ethyl alcohol itself that is consumed (three or more servings daily) that increases the risk of breast cancer. Amazingly, the risk is almost equivalent to smoking a pack of cigarettes a day!

Researchers at Kaiser Permanente (right here in Oakland, CA) found that age and ethnicity did not make a difference but three drinks a day increased the risk of being diagnosed with breast cancer by 30%. One of the researchers, Dr. Klatsky, discussed the heart protection benefit of drinking red wine. He suggests that red wine decreases blood clotting and diabetes while raising HDL (the good cholesterol - are we all confused yet?) but that has nothing to do with breast cancer. Figuring out how much alcohol is best for you is just one more question for you to discuss with your doctor. Again, being an informed patient and partnering with your provider is your best bet for optimal health care.

• Other breast cancer news: there is significant racial disparity between black and white women with breast cancer. Black women are less likely to be diagnosed with breast cancer but more likely to die from it. So far, researchers are at a loss to explain the disparity but all are troubled by it.
• Would you like to get your organization or group involved in Breast Cancer Awareness Month? The Susan G. Komen for the Cure Foundation invites us to be Passionately Pink for the Cure, an exciting new fundraising campaign. Your group agrees to wear pink on a certain day or days and raise money for research for this disease that continues to devastate the lives of so many.
  
• What do we do when the going gets tough? Retail therapy! If that one glass of wine isn't cutting it for you, try shopping online and raise money to fund mammograms for women who can't afford them at The Breast Cancer Site. Don't know what to wear on your Passionately Pink for the Cure day? The Breast Cancer Site has some ideas...
  

Labels: alcohol, breast cancer, women

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Lower Bottom Line by Screening for Depression in the Workplace

Depression is a huge international health problem; the leading cause of disability worldwide. Some call it the "common cold of mental illness". Employees who are depressed are less productive and account for increased absenteeism in the workplace. Since so much of people's lives are devoted to working, when people are disabled due to depression, their work is adversely affected. Researchers at the National Institutes of Mental Health (NIMH) are recommending that employers add a depression screening and intervention program "as a healthy, win-win investment...".

Researchers found compelling evidence that a company's bottom line could be improved by making sure employees were effectively screened and treated. Most larger corporations have Employee Assistance Programs (EAP) to support employees who are having mental health problems, including substance abuse, financial problems and family issues. Screening services have gotten very sophisticated - online, telephonic, multilingual services tools that provide instant feedback make it easy for employees. Employers can add features such as on-line referrals to in-network providers. All of this is done anonymously, unobtrusively and is non-threatening.

Providers of these services estimate that 85% of people who need treatment are going untreated. With the advent of workplace screening and intervention programs, it is estimated that more people who need help will get it - and continue to be functional employees. That's a win for everyone.

Thank you Andrew3000 for Bad Day at the Office photo.

Labels: absenteeism, depression, screening, workplace

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Exercise and Yoga can Improve Quality of Life for Women with Breast Cancer

The Journal of Clinical Oncology has published two studies that suggest that yoga and exercise may improve physical fitness and quality of life in women diagnosed with early stages of breast cancer.

Researchers found resistance exercises to be the most therapeutic in terms of improving body strength, lean muscle mass, improved self esteem, and completing chemotherapy. Women who did yoga reported an overall improved quality of life, social well-being, emotional well-being and mood.

Talk to your oncologist about adding yoga and exercise to your comprehensive cancer treatment. The University of California San Francisco Medical Center (UCSF) Comprehensive Cancer Center offers Gentle Yoga classes through the Osher Center for Integrative Medicine.
The class is taught by a registered nurse and geared toward cancer patients and their special needs.


Thank you austinevan for use of photo paris yoga.

Labels: Alternative therapy, breast cancer

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Canyon Ranch - Be Your Best Self At Any Age!

In 1979, Mel and Enid Zuckerman opened Canyon Ranch in Tucson, Arizona. Mel was close to 50 years old, 40 lbs. overweight with diagnoses of asthma, hypertension, ulcers, diverticulitis and a hiatal hernia. He led a sedentary lifestyle, never exercised, ate poorly. When his father died of lung cancer due to smoking, he went to a health spa in California for a month. When he came out, he purchased the Double U ranch and decided to create a "vacation fitness resort". Now, nearly thirty years later, Canyon Ranch is not only successful in Arizona, but in Lenox, Massachusetts, Las Vegas, Nevada, Florida and on board the Queen Mary II. Canyon Ranch Living is a new condominium community in Tucson and another should open in Miami, Florida this fall and Chicago, Illinois in 2010.

The Canyon Ranch experience can be as much as about $1,000 a day - and the franchise attracts about 30,000 visitors a year generating $140 million a year. The rate is all-inclusive and the spa provides all meals, an allotment for services, complimentary fitness classes, transportation to and from the airport, gratuities and much more. Each guest receives a This Week at Canyon Ranch - a schedule of fitness, spiritual classes, sports, workshops and evening programs. Guests can be as busy or as laid back as they want to be. Each guest works with a personal advisor who helps custom design their vacation experience. The personal touch is what makes the Canyon Ranch experience unique. Guests may choose to enroll in a Life Enhancement Program when they need help regrouping emotionally and physically. Mind-body focus is a big part of the Canyon Ranch experience as is connecting with others. Canyon Ranch focuses on the spiritual health of guests who may participate in Energy Medicine, reiki, acupuncture, qi gong or healing touch.

The Executive Health Program is a joint venture of Canyon Ranch and the Cleveland Clinics where executives can have their health thoroughly evaluated by doctors, nutritionists, behaviorists and other wellness professionals. The Canyon Ranch staff refer to and collaborate with Cleveland Clinic medical specialists as needed develop an individualized lifestyle prescription for the busy executive.

And if you are wondering what happened to Dr. Richard Carmona , 17th US Surgeon General, after he left that post? In October 2006, he joined Canyon Ranch as vice chairman of their Life Enhancement Company, CEO of their health division and - my understanding is this was the piece de resistance for him - president of the non-profit Canyon Ranch Institute.
Dr. Carmona and the founders of Canyon Ranch share a passion for preventive health care and eliminating health disparities by helping underserved populations become more health literate. The Canyon Ranch Institute is a way to bring the mission and vision into the lives of people and communities who need it most. Through his work at Canyon Ranch and the Canyon Ranch Institute, Dr. Carmona is continuing the work that was his focus as Surgeon General. Dr. Carmona is also on Healthline's Board of Directors. Check back with us for interviews with this remarkable man - who is also a nurse!

Thank you, thelastminute, for use of the photo of Canyon Ranch.

Labels: Canyon Ranch, healthy aging, wellness

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Low Testosterone Levels: It's a Big Problem.

The Endocrine Society has released new findings that as many as 1 in 4 men suffer from low testosterone levels - although only 1 in 20 have symptoms that drive them to seek medical treatment. When low testosterone levels are accompanied by low sex drive, sexual dysfunction, osteoporosis and depressed mood, androgen deficiency could be the problem. Decreased muscle mass and strength,irritability, decreased energy and just over all not feeling as well as you would like to could all be signs of decreased testosterone.

Testosterone is the most important hormone in the male body - but it is thought that only 95% of men who need treatment are getting it. Testosterone replacement therapy can be in the form of injections, patches (Androderm) or gel (Androgel, Testim). Testosterone therapy can improve sex drive and function, restore muscle mass, prevent osteoporosis and protect against heart disease. There are potential risks and side effects to testosterone replacement therapy - sleep apnea, baldness, prostate enlargement, breast enlargement.

The important thing is to talk to your doctor if you are experiencing any of these symptoms - maybe you don't have to suffer in silence.


Thank you Mok'po for use of photo Men at Work.

Labels: androgen deficiency, sex, testosterone

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Donors Choose: Back to School in Louisiana! Let's Help some Kids

Donors Choose is a cool project and an easy way to directly help low income kids in public schools.
"Teachers Ask. You Choose. Students Learn." As part of this campaign, they are running a Blogger Challenge - asking bloggers to pick a project to promote and encourage readers to participate. It's September, and if you read my posts, you know I am still anguishing over New Orleans.

So we choose to promote a project in a school that serves 92 % low income students (see bottom of page at this link). The first grade teacher in Gretna, Louisiana is requesting funds for an LCD projector. We have only 19 days left to help her and her kids at William Hart Elementary School, in Gretna, Louisiana. It only costs $1, 1673 - they have raised $200 so far. Come on Healthline readers! Let's help these kids in Louisiana read! Thanks for your consideration.


Thank you EditorB for use of Cleaning out photo - 2 years on, still cleaning up....

Labels: Donors choose project, literacy, Louisiana

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Thank You Dr. Schwimmer for Grand Rounds 3.51!

Joshua Schwimmer, MD stays ahead of the pack with the latest technology and writes a blog here at Healthline, Tech Medicine, and The Efficient MD: Notes on Personal Productivity. He hosted this week's Grand Rounds and requested submissions addressing innovations in medicine and healthcare. He included my post about a new facet of occupational medicine, Labor Day, 2007: New Face of Labor - Hired Guns. Thanks! Read his blog for some fascinating information on new technologies.

Labels: Medicine 2.0, occupational medicine, technology

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Thank You Dr. Deb at Encephalon!

Dr. Deb is a brainy psychologist whose blog, Encephalon, features articles about the human psyche. She picked up my post stating we should give Michael Vick a break, The Warrior Archetype and Violence. Thanks!

Labels: archetype, Michael Vick, psychology, violence

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Healthcare Blogger Survey

Are you a healthcare blogger? Spend more than 30% of your time writing about health and healthcare issues?

Envision Solutions, LLC and the Trusted.MD Network are conducting their second annual survey on the medical blogosphere. The survey is already open and is accepting responses until October 15, 2007. Participants may opt-in to receive a free copy of the survey's results and a chance to win a $25 Amazon gift certificate.

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Interview with a Hero: Dexter Pitts of HBO's Alive Day Memories: Home From Iraq

Alive Day Memories: Home From Iraq is a documentary film from Executive Producer James Gandolfini featuring interviews with ten injured troops who have returned from Iraq. This quiet, elegant film premiered on HBO Sunday September 9, 2007 at 10:30PM and you can see the entire film on HBO.com through September 16, 2007. Half of the troops returning are suffering from post-traumatic stress disorder or PTSD. Dexter Pitts, featured in Mr. Gandolfini’s film, is one of them. HBO and Mr. Pitts made possible the following interview:

JC: Hi, Mr. Pitts – do you prefer to be called Dexter or Mr. Pitts?

DP: You can call me Dex, ma’am.

JC: OK, Dex thank you, call me JC. So tell me a bit about when you went to Iraq…

DP: In June 2004 I was US Army active duty. I was 20 when I left, 19 when I enlisted. I was married at the time, no kids. I was in Iraq six months and 20 days when I got injured. I was injured January 2, 2005.

JC: What happened?

DP: I was in the driver’s seat of a Humvee and an IED exploded half a meter away from the door – I’m lucky to be here…My left arm was broken in three places, I had a contusion in my brain, shrapnel in my back…I left Iraq January 4, 2005.

JC: And were you transferred to Germany?

DP: Yes, ma’am - I was in Germany 2-3 days and then sent to Walter Reed. I was discharged from there after six months of rehab – in August 2005.

JC: And were you diagnosed with PTSD while you were there?

DP: Well, what happened was, they had regular lunch meetings to check the mental status of the people who were OIF [Operation Iraqi Freedom] and that’s when it came out…

JC: How was the re-entry process for you with your family? I mean, do you mind talking about this stuff? My goal is for people, civilians like myself to understand better what you and all the other veterans returning with PTSD are going through…

DP: No, I don’t mind at all- It was hard, it was real hard. Especially with my wife. I had changed as a person. I didn’t know who I was any more. Little things set me off…My little 12 year old cousin was just a kid fooling around – but in Iraq, kids might kill you…so my cousin hit me in my left arm, my bad arm and I hit him in the chest – I needed help. I couldn’t differentiate between the good and bad…people would try to understand, but they didn’t know where I was coming from…I had changed.

JC: How are things with your family now, after treatment?

DP: I got divorced in October 2005. I’m stronger now. It’s a combination of therapy and the work I did on myself. I had a lot of support from my family even though they didn’t always understand…My dad was in the service 20 years – but he never saw conflict. My experiences there in Iraq are burned into my mind. I’m still in a hyper-arousal state – when you’re in these constant huge crowds, and anyone might be someone who could kill you – we were in the Abu Ghraib housing projects surrounded by all these people who don’t like you – so crowded around you – so today I still have a hard time with crowds.

JC: Where do you live today and what type of work are you doing?

DP: I live in a big town in Kentucky. I’m a full-time college student studying criminal justice. I can’t have a regular job with all I’ve been through – I’d like to be a cop in the Federal system – like the US Marshals. I’m getting into acting some, too.

JC: Wow! That’s incredible…well, you certainly have a great personality and a fantastic attitude to do anything…so can you tell me about your treatment for PTSD?

DP: I have been in small group therapy – Group therapy in Fort Durham. For a while I was on three different medications – Seroquel, Zoloft. I was depressed – I had severe depression. I felt so much guilt about being home while my whole unit – Alpha Company 214 - is facing their third tour over there – they’re all coming home in November and I can’t wait!

JC: There has been a lot of talk in the news about people having trouble getting care for PTSD – did you have that problem?
DP: I never had trouble getting treatment. I was taken care of from the beginning. The trouble is – you have to ask for it, and us men, we have this machismo, we’re in denial. You have to admit you have a problem – you have to fight for what you want. Now me – I was going to get off the bench and get in the game…

JC: That’s an awesome attitude…how about sleep?

DP: I still have trouble sleeping. I can only sleep well when I have people around me I can trust, like my girlfriend. Then I feel I can let my guard down and sleep well. The intrusive memories never go away. You can’t get rid of the memories. You have to control them – not allow them to control you…It’s a part of me…I carry it but I can’t let it take over my dreams and what I want to accomplish. I’m the shot caller…

JC: Why did you enlist in the Army?

DP: I hated the military when I was young – I thought it would ruin my life and I was never going to join. But Hollywood influenced me and my dad really was a part of it. Because he did it I guess I wanted him to be proud, to show him I could do the same and more. He was real old school growing up – we weren’t close – I’m a real mama’s boy. We didn’t show emotion. My dad is a real tough guy – but when he heard I got hurt – he cried. He cried for me…I would give anything to see that…and we are closer today. The whole family is closer. Tragedy brings us together…

Labels: Alive Day, Alpha Company, Dexter Pitts, HBO, Operation Iraqi Freedom, PTSD

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Home From Iraq: Acinetobacter Baumannii

Steve Silberman over at Wired reported quite a story in February, 2007: The Invisible Enemy. Advances in trauma care and frontline medicine is saving lives in Iraq. Injured troops are transported to the largest American military hospital in Europe - Landstuhl Regional Medical Center in Germany. After being stabilized there, the injured are evacuated to the US to recuperate - and the survival rate for this war is 9:10.

Lurking in battle wounds is a lethal pathogen that is the defeat of many of these survivors - an opportunistic pathogen, the multiple drug-resistant acinetobacter baumannii. Mr. Silberman reported 700 US military deaths from the pathogen, now the bacteria has invaded civilian community hospitals. "It preys on the weakest of the weak and the sickest of the sick...slipping into the body through open wounds, catheters, and breathing tubes...it doesn't get a lot of respect because it's not...bumping off normal, healthy, people..." Investigators have concluded that the state-of-the-art medical centers themselves are breeding grounds for the superbugs, and the actual source of contamination - not Iraq and unsanitary conditions or the soil or rainwater or any other ideas.

Independent contractors like Merlin Clark are not immune. His wife Marcie created the website, www.acinetobacter.org. A. Baumannii isn't the only superbug we need to worry about. There is a case of a soldier stationed in Germany who died of epiglotitis due to a bacterial infection. Methicilin-resistant Staphylococcus aureus (MRSA)producing the toxin Panton-Valentine leukocidin(PVL) is another. Leishmaniasis is plaguing Afghanistan. Plus a newly recognized Bartonella species, Pseudomonas aeruginosa, and Klebsiella pneumoniae.

Three years ago, in July 2004, the Infectious Diseases Society of America (IDSA) sent a white paper, Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates...A Public Health Crisis Brews to Congress. They want a Commission to Prioritize Antimicrobial Discovery. They want "wild-card patent extension". They want new funding for antibiotic R&D. They keep telling us resistance to the antimicrobials is on the rise. They report the Acinetobacter problem in soldiers and civilians stationed in Iraq right in the paper(p13). The IDSA reports problems with Salmonellosis, tuberculosis, MRSA in athletes, the economic burden of these problems, the lack of interest in antibiotic research by pharmaceutical companies (5 new antibiotics of 506 new drugs in the pipeline), medical vs. market realities, action items for Congress.



Thank you Google Images for use of Acinetobacter Outbreak map from Bioquell

Labels: Acinetobacter Baumannii, battle, contractors, Iraq, troops

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Thank you Dr. Emer for Grand Rounds 50! Remember September 9 10:30 PM HBO: ALIVE DAY MEMORIES: HOME FROM IRAQ

Thank you for including a link to my post Remember September 9 10:30 PM HBO: ALIVE DAY MEMORIES: HOME FROM IRAQ in Grand Rounds 50, a round up of medical writing in this week's blogosphere - on Parallel Universes...

You can preview the promo here: http://www.youtube.com/watch?v=gEZsuuOf3Ao

And a clip from the film as well: http://www.youtube.com/watch?v=1HFjnfMlRqM

Labels: Gandolfini, Grand Rounds, HBO, Iraq, veterans

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Labor Day 2007: New Face of Labor - Hired Guns

Our President has made a surprise visit to Iraq to meet with General Petraeus and assess the situation. Next Sunday, September 9, 2007, HBO will air Alive Day Memories: Home From Iraq and I have been writing about the types of injuries our servicemen and women are suffering in the Afghan and Iraq wars. We have 30,000 injured veterans of these two wars coping with disabilities today, and the HBO film by Executive Producer James Gandolfini gives us some insight into their struggle.

There is a big, new industry that has exploded along with the war on terror - that of private military/security contractors. This means new labor - and as a disability manager this is something that interests me. I can't help but wonder about their disability insurance, who pays for their injuries - are the contractors experiencing similar injuries? What happens when they do get injured? I am reading a fascinating book this weekend, Robert Young Pelton's Licensed to Kill: Hired Guns in the War on Terror - just a little light summer reading every American who wants to know what's going on with our world might want to read. Mr. Young has a link on his website for Insurance which takes one to Ingle International and Imagine Ltd. where one can purchase Special Risk Product insurance. The Specialty Insurance or KRE to those in the know, provides protection against "...kidnap and extortion..when traveling to dangerous places". Need it be said, "War is not an insurable risk," per Bruce Wood, of the American Insurance Industry.

Blackwater is the most well known of the private military contractors who provide"...security, peacekeeping, professional military and stability operations..." for profit. Contractors are former military, police officers,CIA, Special Forces agents and Navy SEALS. Triple Canopy is another - they seek Quiet Professionals and have openings in Emergency Medicine and IT for those of you looking for adventure.

Well, thank you Joseph Neff, Staff Writer for the (Raleigh Durham) News & Observer to Lynch Ryan over at Worker's Comp Insider for getting to the bottom of this issue. Questions like this really plague me and I lose sleep until I know the answers.

• 126,000 private contractors work for the US government in Iraq
• 1000 have died
• 13,000 have been injured
  
• Each is insured against injury or death on the job
• US taxpayers pay both the insurance premiums and the benefits thanks to two WWII era laws:
• 1941 Defense Base Act requires contractors to be insured
• 1942 War Hazards Act allows the insurers (not the insured) to apply to the US government to cover payments for contractors injured or killed
• No one is overseeing the amount the insurers are charging the government - so they are charging "exorbitant premiums" per Bunny Greenhouse, of the Army Corps of Engineers
• Greenhouse initiated the practice of competitive bids in 2005
• she fought down the minimum premium from $25,000 (even if the assignment was 2 weeks!) to $7,500
• because of her advocacy we no longer have "a monopoly price and a monopoly vendor"
  
• No agency regulates the premiums or tracks the costs
• Even the Government Accountability Office (GAO), the congressional watchdog agency, was unable to calculate the costs to taxpayers.
• The contractors insurance market is dominated by AIG

Dyncorp International has hired Mission Critical Psychological Services to help its employees who struggle with post-traumatic stress disorder (PTSD) upon completion of their assignments. Mental health issues are going untreated in private contractors returning from Iraq. Insurers are fighting the claims, and the civilian mental health community is ill prepared to deal with combat-related stress. AIG has paid about 50% of the PTSD claims filed.

This is one of those rabbit hole stories - the more you know, the more you realize you don't know. For more reading and to understand a new face of labor, visit AmericancontractorinIraq.
Happy Labor Day, whatever you do!

Thank you Jimmy theSuperstar for Iraq picture.

Labels: insurance, Iraq, military, private contractors, security

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Global Healthbeat: South Africa AIDS Policy

AIDS activists in South Africa are demanding the dismissal of Health Minister Manto Tshabalala-Msimang who President Thabo Mbeki continues to praise as a heroine. Both the South African President and his Health Minister have made international headlines over the past few years for their controversial view on AIDS and their approach to the AIDS crisis in South Africa. Tshabalala-Msimang has been condemned by the national and international community for her distrust of anti-retroviral medications (ARV) and her promotion of food to treat the viral illness. She has recommended the virus be treated with lemon, garlic, olive oil and beetroot.

5.4 million South Africans are infected with the AIDS virus - the highest number in the world. One of my own personal heroes, Nobel laureate Bishop Desmond Tutu, has lamented that the anti-apartheid heroes and heroines era who lost their lives would be shocked at the staggering 900 deaths daily in South Africa due to AIDS. Tutu has condemned "...the bizarre theories held on high..." by the South African government.

Nathan Geffen, policy coordinator for South African's Treatment Action Campaign cites the following failures of the government policies:

• failure to provide adequate levels of staffing and expertise
• inadequate provision of medications to HIV-positive mothers to prevent transmission to children
• delays in providing treatment to people diagnosed with AIDS

The Academy of Science of South Africa (ASSAF) released findings of an exhaustive study last month, hoping to put this question to rest. The panel concluded that while nutrition is important for supporting overall health, no food is going to help protect the population from tuberculosis or HIV/AIDS. AIDS accounts for almost half of the deaths in South Africa. Why are some people in the South African government choosing to ignore the evidence - and continue to put lives at risk?

The good news is that there is a Comprehensive Treatment Plan in place for South Africa, and ARV's are center stage - although the number of people taking advantage of the plan ( less than 500,000) is a small percentage of those who actually need it. The Plan is modeled after the WHO Treatment guidelines. Services offered are:

• Testing
• condoms
• nutritional support
• medications to treat opportunistic infections (OI)
• ARV's

ARV's work by blocking the replication of viruses. They do not cure the disease, but slow its progression. There are three types of ARV's available today:

• nucleoside reverse transcriptase inhibitors (NRTI)'s
• non-nucleoside reverse transcriptase inhibitors (NNRTI)'s
• protease inhibitors

Universal access to prevention and treatment options is the only way to stem the tide of this devastating disease.

Thank you jimmcintosh for use of photo Orphaned by AIDS.

Labels: AIDS, antiretrovirals, South Africa

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New Orleans Continuing Health Crisis: Can YOU help?

Two years ago, the levees broke in the beautiful, historic American city, New Orleans. 80% of the city was flooded, close to 2000 died and 1.5 million people were displaced. Many remain displaced to this day. In a previous post, I discussed the continuing health problems that plague the residents of the city. The best way to combat feeling bad about a terrible situation is to take positive action to do something good to correct it. If you are plagued by concerns, anxieties, guilt, shame and despair over the health problems that people in New Orleans face, two years after the levees failed, the good news is, there are lots of things you can do to help, even if you can't go yourself.

The Common Ground and Lower Ninth Ward Health Clinics were established by volunteers to address community health needs through collaborative partnerships. They accept cash donations, volunteers can contribute their time on working vacations, or their website provides a wish-list of basic items they need to provide services. The Lower 9th Clinic also has a wish list. Does anyone have a load of Tyvek suits they can send them? The Lower 9th Clinic was founded by registered nurse Alice Craft-Kerney who lost her home in the flood two years ago. She is now executive director of the clinic, whose mission is to provide health care services for the underserved and underinsured of the 9th ward.

If you are a health care professional - you might want to consider taking a job in New Orleans. The city has lost many of its health care workers, and mental illness has doubled in two years. The city, the region still needs our help. Let's not forget them.

Thank you Nurse Moonie for picture of New Orleans nurse during flood.

Labels: donations, New Orleans, tyvek, Volunteer

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