Good morning! Start the day right with a “cuppa” your favorite brew. Laurel Heights/Presidio Heights is great neighborhood for local shopping and dining amenities, and coffee shops are no exception. True, we’re just a little short on nightlife.
Here are the top picks:
Laurel Village – Rigolo Cafe
We call it the Noah’s Ark of Shopping Centers, because there’s two of everything. Except coffee shops and banks, there are four each of these! Three blocks of popular stores and restaurants with (you can get a 90-minute validation from any shop) free parking lot at the rear and metered parking in the front which runs from Laurel to Spruce Street along California Street. The MUNI number 1 and number 2 buses stop along here.
At the corner of Spruce Street, you’ll find San Francisco’s only 24-hour Starbucks, only closed for three hours from about 1 am to 4 am on Sunday night/Monday morning. Just a block east, there’s are a couple more chains, Peet’s and Noah’s Bagels.
While the first are chains and definitely have their fans, Rigolo Cafe is a family-owned place, completely unique, with a full menu and well worth a visit. Rigolo’s theme is French fun and flair, in a high-celilinged place with black and white umbrellas hanging upside down from above. It feels like a tribute to “Singing in the Rain”, and I believe it is meant to! With an emphasis on keeping the kids happy and engaged, there is a children’s play area, cookies that the kids adore and a kids’ menu. Pull up to a cafe table with rattan chairs on the sidewalk, a la Parisien, for some people-watching in fine weather. Even their website is fun to look at, with a good deal of helpful information and menus, biographies of the owners and staff as well as their favorite menu selections, so you feel that you get to know everyone a bit.
Sacramento Street – Dolce amp; Salato
Dolce amp; Salato, corner of Locust Street is one of their two locations, the other being Market Street between 7th amp; 8th Streets. You will find an amazing array of choices on the menu, and one of the few places where all coffees and teas are offered hot or iced. good Italian coffee, cappuccino, home baked pastries and the newspaper to start your day right. Bagels are delivered fresh daily and eggs – with bacon, cheese or tomato – are also on the menu. Generous paninis (eggplant with roasted bell peppers and mozzarella was tasty) on focaccia, sandwiches and wraps accompanied by soup or salad, or a big salad on its own are available for lunch and a beer and wine menu is coming soon at this location. It’s a relaxing atmosphere with chandelier and murals on the walls, to inspire a touch of Italy. They use local suppliers, have better than average china cups and saucers, use recycled products for take-out containers. Shorter hours, though. Official websites of the subscription are provided to the person. Interested person can click here for freshly roasted coffee within affordable rates. The products will be made available as per the specifications of the customer to get the best profit. Proper research on the link can be made through the person for further information.
Have you ever noticed that when your driveway is in good repair, everyone in town, and their dogs, wants to use your driveway to turn around in? It seems there’s no driveway quite like yours. Asphalt driveways aren’t put in much anymore, and for good reason. Asphalt is a mixture of tar and gravel. Tar is heated to melting stage, gravel is mixed in and then poured into the designated area. It is spread basically, the same way as concrete. It smells terrible and is very dirty. Weather is very hard on asphalt, especially the heat. Heat will cause the asphalt to peel right up, especially if your driveway has much traffic.
Repairing an asphalt driveway can indeed be labor intensive; and the really bad thing about patching your asphalt driveway is, it will always look patched. There is just no way possible to match old and newer asphalt.
Some years back we lived in a house with an asphalt driveway. The driveway had a few pits in it, but I didn’t think it looked too bad. It just about drove my husband nuts! He is a bit of an “obsessive compulsive” and when something has holes or cracks in it, is when it is time to bring out the demolition crew.
I was not too keen about changing it thinking it would be mended manually but my husband was adamant that the asphalt was the best solution for the job and so I started looking up for the best asphalt sealer reviews online but before I could go through, he had a different plan.
What he did was, design a pattern for the driveway in which he took out parts of the asphalt to replace it with concrete and pebbles. It was kind of like a tic-tac-toe pattern. We made a few trips to the river to gather the pebbles that we wanted for the task, and then picked our start day for the new driveway.
My husband and I, and one of our sons worked together on this, and believe it or not we had the hard part done in less than a day. My husband had marked the areas that he wanted to take out with chalk. He rented a jack-hammer, and he and our son broke-up, and picked up asphalt pieces and put into the back of the pick-up to take to the dump, while I went behind them with a hammer and chisel to smooth out the lines.
We have a small cement mixer so we didn’t have to rent one. My husband would mix and pour the cement, our son would smooth it out, and I would push in the pebbles just where we thought they would look the best. If you can get a good work crew together, that works well together, you can have a job like this done in no time at all.
The really nice thing about giving a face-lift to our asphalt driveway, such as this; is we didn’t have to replace the whole thing, and it really looked great. It didn’t matter that the asphalt was old and the cement was new. Because they were totally different materials, they blended together well.
If the damage to your asphalt driveway is severe enough, and if finances allow; follow the same procedure we did with the jack-hammer and take out the entire driveway, set your frame, and you’re good to go for pouring a new driveway; that is not asphalt.
The Sonesta Beach Resort has been a popular South Florida vacation destination since the late 1960s but closed its doors in the summer of 2006 to undergo a complete transformation. As one of the finest hotels near the Miami coast, the Sonesta will reopen in 2011 and may soon become one of the most desirable luxurious condo properties in Key Biscayne. The Sonesta project will be opening up a set of coveted oceanfront properties along the South Florida coast, an ultra-luxurious resort spanning 10.5 acres of the Key Biscayne beachfront. Supported by millions of dollars in funding and rebranded to attract luxury travelers and residents in search of the finer life, the resort will be transformed into a high-caliber, world-class destination.
The Sonesta International Hotels Corporation joined forces with Fortune International, the Miami-based real estate and brokerage firm in early 2005 in hopes of building a five-star condominium resort that captures the Sonesta International brand. Sonesta International currently owns high-profile properties in New Orleans, Boston, Florida, Brazil, Costa Rica, Mexico, Egypt, Peru and St. Maarten. The Key Biscayne Sonesta redevelopment is valued at $60 million and will offer many of the deluxe amenities and services found in its hotels and resorts around the world (Source: Marketwire).
According to The Kleer Team, the realty company managing sales of condos in the Sonesta Beach Resort, future residents can choose from 165 units over 12 floors of the property, each one ranging from 2,500 to 8,500 square feet in size. The condos will be equipped with state-of-the-art appliances, designer bathrooms, modern kitchen amenities and other deluxe features akin to the five-star resorts and hotels in South Florida. Residents can also enjoy easy access to a full-service spa and fitness center, oceanfront pools and on-site entertainment. The shared community spaces within the resort accommodate for groups and meeting events; business amenities of the resort boast 24,000 square feet of outdoor space, a large convention center and banquet facilities for hosting regional or national events. Just like Clavon condo this Sonesta project is arguably one of the best resorts in South Florida. From quality amenities, to great and unique design to systematic management to accessibility to transportation and everything, you can fairly say that it is worth your investment.
Key Biscayne continues to be a tropical paradise, the ultimate escape when vacationing in South Florida. It has become a coveted spot for taking in beautiful sunsets, witnessing breathtaking views of the ocean and enjoying the tight-knit community lifestyle. Residents of Key Biscayne are already treated to dozens of events, recreational activities and deluxe condos, apartments and homes near the white sandy beaches. The opening of the Sonesta Beach Resort will only enhance and revitalize the island’s luxury residential home-buying and rental options.
Patient Dementia and Wandering: Dementia is a serious disorder facing elderly patients. After age 60, the prevalence of the disorder doubles every five years until it affects from 30-50 % of those over eighty. Dementia is also the leading cause of institutionalization in this country, with 60-80% of nursing home patients showing signs of the disorder (1).
A lot has been written about the management of the disorder in this magazine and in other sources, but little has been written about the matching of assessment and appropriate intervention, including new treatment options. The reason that is true is that medical professionals tell us patient dementia is irreversible and can only be managed. They say the only steps one can take are to reduce the risk of falls and other harm to the patient and reduce the risk of lawsuits and governmental censures to the nursing homes where patients with dementia live.
In the past year, research has shown that a disease previously thought irreversible may be reversible after all. As a result, it is important to carefully assess the patient or resident to determine to what extent he is cognitively impaired, what pattern of wandering he exhibits, and what pre-morbid lifestyle he enjoyed.
The National Guideline Clearinghouse has a protocol for wandering (2).
In it, the proper steps to assessment are described:
– Use the Mini-Mental State Examination (MMSE) to assess cognitive decline
– Use the Algase Wandering Scale (AWS) to assess neurocognitive deficits and wandering patterns
– Use the Short Geriatric Depression Scale for signs of depression
– Use the Cohen-Mansfield Agitation Inventory: Long Form with Expanded Descriptions of Behaviors to assess for agitation and anxiety, being careful to evaluate for any underlying general medical, psychiatric, or psychosocial conditions that could partially cause the disturbance.
– Use the Memory and Behavior Problems Checklist-1990R (MBPC) to assess the frequency of the memory and behavior problems, including patient wandering and the degree to which the behavior upsets the caregiver.
– Assess factors associated with patient wandering, including a decline in activity, cognitive impairment, and increased difficulty in performing the activities of daily living (ADLs).
– Assess the environmental strategies currently used by formal and informal caregivers.
Once the initial assessments are made, information from the assessments can be used to investigate the patterns of the patient more closely.
The patient wandering patterns assessed by using the AWS and through observation can, at this point, be described by type. This allows the clinician to discover the severity of the cognitive decline. Patterns are described as direct travel, random travel, pacing, and lapping. Additionally, patient wandering behavior can be observed to determine if: 1) the patient appears to be overtly searching for something which is often unobtainable by repeatedly calling out and/or approaching others to obtain the goal; 2) the patient has a seemingly inexhaustible drive to remain busy, and 3) the patient is aimlessly drawn from one stimulus to another.
According to the government protocol, the type of wandering pattern demonstrates the cognitive decline, because a direct route is more efficient and shows a less cognitive decline. Also, the most severely impaired patients will travel inefficiently all day, while the less severely impaired will travel less efficiently near the end of the day. That may occur because the patient is fatigued.
Once all of the above steps have been taken, the clinician should examine the lifestyle of the patient prior to impairment:
– Did he have an active interest physically and mentally in music?
– Was he warm and outgoing, and positive emotionally?
– Did he demonstrate social-seeking behavior?
– Did he have good self-esteem?
– Was he physically active?
– Had he experienced a lot of stressful events throughout his life?
– Did he respond to stress with physical activity or with an emotional reaction?
– Did he respond to stress with physical activity more in his earlier years?
Once the assessment is complete, the clinician and caregiver can decide what environmental modifications, technological and safety measures, and/or other interventions are necessary to protect the patient at his current level of impairment. This article will not discuss these measures in detail, as many past articles have done a thorough job of doing just that. Instead, we will explore how to determine what treatments may be appropriate for the patient in light of his assessment findings.
There are prescription medications that are used for the treatment of dementia. Those most frequently prescribed include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) (3). These medications will not cure dementia. However, with proper dosing, they can help restore cognitive functioning for the minimal to the moderately impaired patient to a level he had nine months previously. In a patient who has just started exhibiting dementia, that could mean as six months to a year of more independent living.
In some cases, the medications can restore the patient’s memory enough for him to recognize close friends and family. So isn’t it worth the use of medication for the patient to have as good of a quality of life as possible for as long as he can?
A new medication has just been approved by the Food and Drug Administration (FDA) that has demonstrated that it can help the moderately to severe Alzheimer’s patient, something no other drug has proved. It is memantine HCL (Namenda TM) an NMDA receptor antagonist, which is a new class of drugs for the treatment of the disorder (4).
Besides medication, there are alternative treatments. Diversional activities may be used, especially if the patient’s assessment showed a tendency toward or like for music or other outlets. Examples of these activities would include music therapy, pet therapy (which is being used more and more in nursing homes and assisted living facilities), volunteer reading, using raised toilet seat with lid, and therapeutic touch.
Other alternative treatments that are showing great promise are herbal therapy, aromatherapy, and light therapy:
According to the Alzheimer’s Association, two herbs that appear to positively affect the disorder are Ginko Biloba and Huperzine A. (5).
Ginkgo Biloba is a plant extract that has been used in Chinese medicine for centuries and is currently being used in Europe for the treatment of neurological disorders.
It has antioxidant and anti-inflammatory properties and appears to protect cell membranes and regulate the neurotransmitter function. Studies have been published that demonstrate improved cognitive function and better performance with ADLs after a patient is treated with the extract. However, it does reduce the ability of the blot to clot, and it cannot be used by patients on aspirin and/or warfarin (a blood-thinning medication).
Huperzine A, a moss extract, is also a Chinese medication and has similar properties to FDA-approved Alzheimer’s medications. However, since it is classified as a dietary supplement, it is unregulated and could have serious side effects.
Last August, British researchers released a study of the use of aromatherapy and light therapy for the treatment of dementia (6). In the four-week study, one-third of the patients suffered fewer bouts of agitation when they were rubbed with lemon balm compared to only ten percent of patients when rubbed with odorless sunflower oil.
Additionally, the researchers found that those who sat in front of a bright lightbox for two hours each morning for two weeks slept longer and more soundly than those in dim light for a similar period of time.
All of these treatment options are available to today’s wandering dementia patient. The clinician must simply tailor the treatment to the assessed dementia patient. Still, modern science is proving that the wandering patient can get better.
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