Surgeons' Decisions and the Financial and Human Costs of Medical Care — NEJM (2010)

<base href="data:"><div style="color: black; text-align: left; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><font class="Apple-style-span" face="'Helvetica Neue'">A popular animated Web video is circulating among members of my anesthesia department. It depicts a fictional exchange between an orthopedic surgeon and an anesthesiologist. The surgeon wants to book a case for the operating room: "There is a fracture; I need to fix it."<span class="ref" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; "><a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009621#ref1" class="showRefLayer" rel="#refLayer" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; color: rgb(0, 104, 146); text-decoration: none; position: relative; top: -0.4em; line-height: 0; ">1</a></span> The anesthesiologist pushes him for more details, but the surgeon simply repeats his line: "There is a fracture; I need to fix it." Finally, the surgeon is asked whom the fracture belongs to, and he responds: "The fracture belongs to . . . a femur." The dialogue eventually reveals that the patient is a 97-year-old woman who was found unresponsive after a fall and presented to the hospital in cardiac arrest; attempts at resuscitation have failed.</font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">The macabre humor of the video — a surgeon negotiating operating-room time for a patient who had already died — struck a chord with a number of my colleagues in anesthesiology. The fictional exchange, however exaggerated, recalled some of their own past discussions with surgeons. The orthopedic surgeons also found some truth in it; overhearing a discussion about the video, one resident chimed in, "There is a fracture. I need to fix it!"</font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Despite the video's glib tone, it speaks to problems that carry important implications for the escalating costs of medical care in the United States. Some of these are exemplified by the experience of Madelyn Dunham, who underwent hip-replacement surgery to repair a hip fracture 2 weeks before she died from complications of cancer. Reflecting on his grandmother's care 6 months later, her grandson, President Barack Obama, recalled, "I don't know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model is a very difficult question."<span class="ref" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; "><a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009621#ref2" class="showRefLayer" rel="#refLayer" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; color: rgb(0, 104, 146); text-decoration: none; position: relative; top: -0.4em; line-height: 0; ">2</a></span></font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">In the months leading up to and following the passage of the Patient Protection and Affordable Care Act in March 2010, grappling with the President's "difficult question" — how to deliver health care that respects patient and family preferences while also controlling rising health care costs — has become a national priority. As a physician who works weekly in the operating room, I find that many of the conversations I hear on this topic ignore key gaps in our knowledge about how "those decisions," in the President's words, actually get made. Indeed, understanding physicians' choices to recommend for or against advanced procedures for patients in late stages of illness, frailty, or disability is a complex task. It is also a prerequisite for reforms that can limit the potential overuse of advanced medical procedures while also expanding the role of patient and family preferences in determining the goals of health care.</font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><font class="Apple-style-span" face="'Helvetica Neue'">When I have asked surgeons about their experiences in making recommendations about procedures for patients near the end of life, their individual responses have ranged from the matter-of-fact to the emotional. They almost universally mention a reluctance to "give up." Some note that decisions to forgo surgery alter their own perspectives on their professional roles as doctors. A colleague in orthopedic surgery reflected, "It's so strange — thinking about it, I realize that once I've decided not to operate on a patient, I forget all about them. It sounds terrible, but it's really like `follow up in 6 weeks,' and that's it."</font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">The challenge surgeons face — to refrain from recommending a treatment whose overall potential to contribute to the duration or quality of a patient's life may be equivocal — is nothing new in U.S. medicine. However, the centrality of these decisions to surgical practice has decreased over time, as technological advances have lessened the risks associated with anesthesia and surgery, allowing patients previously deemed "too sick" to be cared for safely in the operating room. Indeed, a chapter titled "Surgical Judgment" in the 1960 edition of <span style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; ">Christopher's Textbook of Surgery</span>, the precursor to a major contemporary surgical textbook, states, "Often the highest product of a seasoned and responsible surgical judgment is the decision not to operate." It advises surgeons to "effectively resist . . . a number of influences irrelevant to the patient's welfare [that] may be brought to bear upon the surgeon in the formation of this important decision."<span class="ref" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; "><a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009621#ref3" class="showRefLayer" rel="#refLayer" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; color: rgb(0, 104, 146); text-decoration: none; position: relative; top: -0.4em; line-height: 0; ">3</a></span> By 1972, the chapter on surgical judgment had disappeared from the textbook.<span class="ref" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; "><a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009621#ref4" class="showRefLayer" rel="#refLayer" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; color: rgb(0, 104, 146); text-decoration: none; position: relative; top: -0.4em; line-height: 0; ">4</a></span> The current version, published in 2008, contains little advice on how to make a recommendation for or against an operation in a patient with progressive illness.<span class="ref" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; "><a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009621#ref5" class="showRefLayer" rel="#refLayer" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; color: rgb(0, 104, 146); text-decoration: none; position: relative; top: -0.4em; line-height: 0; ">5</a></span></font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">In this context, the simple language of the video — "There is a fracture; I need to fix it" — becomes more profound. Anesthesiologists routinely state that a particular surgeon wants to operate, assuming that this desire arises from a belief that the surgeon can cure or palliate disease, a hope for gratification in the technical work of surgery, or in the most cynical view, an opportunity for financial gain. But the video points to something beyond volition: rather than saying that he wants to fix the fracture, the fictional orthopedist says he needs to fix it. It is as if, on some level, a decision-making process has been passed over, and an inevitable operative course, however absurd, set in motion not by a patient, but by the fractured bone itself.</font></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; vertical-align: baseline; line-height: 1.4em; color: rgb(51, 51, 51); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><font class="Apple-style-span" face="'Helvetica Neue'">These fictional and real depictions of surgeons' decisions highlight a neglected challenge for the next phase of health care reform: improving the way that physicians approach decisions to recommend for or against medical and surgical procedures whose potential benefits may be equivocal. Recognizing the centrality of this challenge to controlling the financial and human costs of hospital care in the United States will be essential to any progress we may hope to make toward achieving the system of health care that we deserve.</font></div></div><a href="http://www.nejm.org/doi/full/10.1056/NEJMp1009621"><font class="Apple-style-span" face="'Helvetica Neue'">http://www.nejm.org/doi/full/10.1056/NEJMp1009621</font></a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Surgeons' Decisions and the Financial and Human Costs of Medical Care — NEJM (2010)

A popular animated Web video is circulating among members of my anesthesia department. It depicts a fictional exchange between an orthopedic...

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LATIN AMERICAN ECONOMICS

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font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style><![endif]--> <br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMyu_VbGTFI_LHJoyb5_OJmfD3bjEl-zFlYi6R23ZpcNMM0pFSI9VPXxbRMkSD5Uv-R7aGsB7qUSI7hbIpWy_i8HljJcIeF0g5T2z0BzoGUytN00vDDJtRIOw1u8J2n6m1YwuFdGVARfha/s1600/FeaturedImage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMyu_VbGTFI_LHJoyb5_OJmfD3bjEl-zFlYi6R23ZpcNMM0pFSI9VPXxbRMkSD5Uv-R7aGsB7qUSI7hbIpWy_i8HljJcIeF0g5T2z0BzoGUytN00vDDJtRIOw1u8J2n6m1YwuFdGVARfha/s320/FeaturedImage.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="color: #0b5394;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">BUSINESS CLIMATE IN LATIN AMERICA REACHES 18-MONTH HIGH </span></b></span></span></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="color: #0b5394;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">&</span></b></span></span></div><span style="font-size: large;"> </span><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="color: #0b5394;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">JPMORGAN <span style="font-size: large;">CONF<span style="font-size: large;">IRMS </span></span>EXPANDING ARGENTINE BUSINESS AFTER BARCLAYS LEAVES,</span></b></span></span></div><span style="color: #0b5394;"><span style="font-size: large;"> </span></span><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="color: #0b5394;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">CONTRARY TO WHAT LEADING ARGENTINE DAILY AND OPPOSITION PAPER <span style="font-size: large;">"</span>CLARIN<span style="font-size: large;">"</span> CLAIMED</span></b></span></span></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Climate for business in LATIN AMERICA reaches 18-month high; COLOMBIAN economic growth expected to increase; PERU to campaign for EUROPEAN and ASIAN investment</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="color: #444444;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">GRADUAL RECOVERY IN ECONOMIC GROWTH AFTER THE FIRST TRIMESTER OF 2013, DUE TO THE RECOVERY OF BRAZIL, ARGENTINA, AND COLOMBIA</span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The business climate in LATIN AMERICA improved in January, reaching its <a href="http://www.americaeconomia.com/economia-mercados/finanzas/america-latina-presenta-el-mejor-nivel-en-su-clima-de-negocios-en-18-mese"><span style="color: blue;">highest level in 18 months</span></a>.  This is according to indicators released last Wednesday by the Getulio Vargas Foundation (FGV), a private economic institute, and the University of Munich.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The LATIN AMERICAN Economic Climate Indicator reached <a href="http://www.americaeconomia.com/economia-mercados/finanzas/america-latina-presenta-el-mejor-nivel-en-su-clima-de-negocios-en-18-mese"><span style="color: blue;">5.5 in January</span></a>, higher than the 5.0 registered in January 2012.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">This was the highest level since July 2011, when the indicator reached <a href="http://www.americaeconomia.com/economia-mercados/finanzas/america-latina-presenta-el-mejor-nivel-en-su-clima-de-negocios-en-18-mese"><span style="color: blue;">5.6</span></a>. By October 2011, the indicator had fallen to 4.4 as a result of the deepening international economic crisis.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">According to the study, the recent improvement in the business climate is principally attributable to expectations that regional economic growth will continue to increase.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">While the regional business climate improved in LATIN AMERICA, <a href="http://www.americaeconomia.com/economia-mercados/finanzas/america-latina-presenta-el-mejor-nivel-en-su-clima-de-negocios-en-18-mese"><span style="color: blue;">some countries saw a decline</span></a> in their indicator between October 2012 and January 2013.  VENEZUELA saw the greatest decrease in the business climate with its indicator falling from 3.4 to 1.5.  ECUADOR and BOLIVIA also saw their indicators decline.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">In BRAZIL, the largest economy in the region, the Economic Climate index fell to 5.9 in January down from 6.1 in October.</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">PARAGUAY and PERU received the <a href="http://www.americaeconomia.com/economia-mercados/finanzas/america-latina-presenta-el-mejor-nivel-en-su-clima-de-negocios-en-18-mese"><span style="color: blue;">highest evaluations</span></a> with respect to their facilitating a favorable climate for businesses.  Both received a score of 7.0.</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">They were followed by </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">CHILE (6.6), </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">URUGUAY (6.3), </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">BRAZIL (5.9), </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">MEXICO (5.7), </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">BOLIVIA (5.4), </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">COLOMBIA (5.3), and </span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">ARGENTINA (5.2).</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">VENEZUELA (1.5) and ECUADOR (4.0) received the lowest score.</span></b></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">The FGV and University of Munich data on LATIN AMERICA’S business climate is released every trimester.  It calculates the Economic Climate Indicator based on the average evaluation of <a href="http://www.americaeconomia.com/economia-mercados/finanzas/america-latina-presenta-el-mejor-nivel-en-su-clima-de-negocios-en-18-mese"><span style="color: blue;">138 specialists in 18 countries</span></a>.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="color: #444444;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">COLOMBIAN ECONOMIC GROWTH EXPECTED TO INCREASE</span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Juan Manuel Ruiz, chief economist at BBVA Research’s LATIN AMERICA  division, asserts that the COLOMBIAN economy will <a href="http://www.americaeconomia.com/economia-mercados/finanzas/colombia-en-busca-de-un-crecimiento-del-5-para-proximos-anos"><span style="color: blue;">recover this year</span></a> thanks to an improvement in the mining and petroleum sectors. Even more importantly, increased investment in civil works could result in gross domestic product (GDP) growth of over <a href="http://www.americaeconomia.com/economia-mercados/finanzas/colombia-en-busca-de-un-crecimiento-del-5-para-proximos-anos"><span style="color: blue;">4 percent</span></a>.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">‘There are preliminary data that suggest [COLOMBIA] is recovering its economic dynamism,’ Ruiz asserted.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Additionally, the Central Bank recently stated that COLOMBIA’S 2012 growth did not reach its potential.  2012 growth numbers are still unknown, but the Bank estimates that the economy grew by approximately <a href="http://www.americaeconomia.com/economia-mercados/finanzas/colombia-en-busca-de-un-crecimiento-del-5-para-proximos-anos"><span style="color: blue;">3.7 percent</span></a>.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Failure to maximise economic output in 2012 has created greater optimism for 2013 growth which is currently predicted to reach 4 percent.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">For 2014, the BBVA estimates that COLOMBIA could maintain dynamic economic growth, potentially reaching growth levels of <a href="http://www.americaeconomia.com/economia-mercados/finanzas/colombia-en-busca-de-un-crecimiento-del-5-para-proximos-anos"><span style="color: blue;">5 percent</span></a>.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="color: #444444;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">GRADUAL RECOVERY IN ECONOMIC GROWTH AFTER THE FIRST TRIMESTER OF 2013, DUE TO THE RECOVERY OF BRAZIL, ARGENTINA, AND COLOMBIA</span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRqwgnTcjC_Q9Dm7k7I9R9G0ANfEzD-EpxIaEPjPWZD8NdSKpAIk-1LJwDW-qgXyv_Uf8rghAuQkY4nprrcoUlKGZTKCxgtDLiFDHmn7Kc3k8IIirUTyvGFbYb_npScsI66ya_LlCL6QFf/s1600/tumblr_lkdqkxJPX21qi7ua6.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="329" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRqwgnTcjC_Q9Dm7k7I9R9G0ANfEzD-EpxIaEPjPWZD8NdSKpAIk-1LJwDW-qgXyv_Uf8rghAuQkY4nprrcoUlKGZTKCxgtDLiFDHmn7Kc3k8IIirUTyvGFbYb_npScsI66ya_LlCL6QFf/s640/tumblr_lkdqkxJPX21qi7ua6.png" width="640" /></a></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">With respect to regional growth in LATIN AMERICA, the BBVA projects growth of 3.6 percent in 2013, up from 2.8 percent in 2012.  For 2014, the projection is even more optimistic: 3.7 percent.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">‘There will be a <a href="http://www.americaeconomia.com/economia-mercados/finanzas/colombia-en-busca-de-un-crecimiento-del-5-para-proximos-anos"><span style="color: blue;">gradual recovery</span></a> in economic growth after the first trimester of 2013, due to the recovery of BRAZIL, ARGENTINA, and COLOMBIA. This growth will continue on the back of strong internal demand and high primary resource prices,’ according to the BBVA report.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="color: #444444;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">PERU TO CAMPAIGN FOR EUROPEAN AND ASIAN INVESTMENT</span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">PERU will solicit investment from EUROPE and ASIA for projects that are currently being planned for 2013, according to <a href="http://www.americaeconomia.com/economia-mercados/comercio/peru-promovera-proyectos-de-inversion-en-europa-y-asia"><span style="color: blue;">Javier Illescas</span></a>, director of the Agency for the Promotion of Private Investment (Proinversión).</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Illescas specified that the investment promotion campaign will travel to London (UNITED KINGDOM), Frankfurt (GERMANY), Dubai (UNITED ARAB EMIRATES), Beijing (CHINA), Seoul (SOUTH KOREA), Tokyo (JAPAN), and Toronto (CANADA).</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">According to the director, these countries possess <a href="http://www.americaeconomia.com/economia-mercados/comercio/peru-promovera-proyectos-de-inversion-en-europa-y-asia"><span style="color: blue;">strategically-important companies</span></a> that specialise in construction and infrastructure.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Illescas stated that PERU will be developing many new projects this year.  Among these will be the construction of a new metro line in Lima, a major road to cross the Andes, and the Chinchero international airport in Cuzco.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">In addition to EUROPE and ASIA, the Proinversión campaign intends to <a href="http://www.americaeconomia.com/economia-mercados/comercio/peru-promovera-proyectos-de-inversion-en-europa-y-asia"><span style="color: blue;">increase its activities</span></a> in AUSTRALIA and NEW ZEALAND, where it hopes to attract businesses interested in investing in PERU.</span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9TEl-jDvEbx9YeguCFSn6SZKQPw4CqxhlzV0ggPC8RnYl7Nhj4iIJ-53_AGDRCZ8GWJIUMXPrbQO7dQR2e8DVCkcdIxYlFHkAwqpbraXFdwckbDyW7c5EHRLpe9nlwRJLSeLdQnTybPvK/s1600/iS1FXGaVfpa4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="212" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9TEl-jDvEbx9YeguCFSn6SZKQPw4CqxhlzV0ggPC8RnYl7Nhj4iIJ-53_AGDRCZ8GWJIUMXPrbQO7dQR2e8DVCkcdIxYlFHkAwqpbraXFdwckbDyW7c5EHRLpe9nlwRJLSeLdQnTybPvK/s320/iS1FXGaVfpa4.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br /></div><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="font-size: large;"><span style="color: #0b5394;"><b><span style="font-family: "Times New Roman","serif";">JPMORGAN CONFIRMS EXPANDING ARGENTINE BUSINESS AFTER BARCLAYS LEAVES,</span></b></span></span></div><span style="font-size: large;"><span style="color: #0b5394;"> </span></span><div class="MsoNormal" style="line-height: normal; text-align: center;"><span style="font-size: large;"><span style="color: #0b5394;"><b><span style="font-family: "Times New Roman","serif";">CONTRARY TO WHAT LEADING ARGENTINE DAILY AND OPPOSITION PAPER "CLARIN" CLAIMED.</span></b></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">By Camila Russo </span></i></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><a href="http://www.bloomberg.com/quote/JPM:US" title="Get Quote"><span style="color: blue;">JPMorgan Chase & Co. (JPM)</span></a> is expanding its business in <a href="http://topics.bloomberg.com/argentina/"><span style="color: blue;">ARGENTINA</span></a> as the country remains a ``key'' market in the region, the bank’s senior country officer said. </span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">JPMorgan, the largest U.S. bank, is leasing an additional three floors in its headquarters in Buenos Aires and hiring about 15 people this year, Facundo Gomez Minujin said. The New York-based bank has operated its local investment unit in ARGENTINA since 1985, according to its website. </span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">‘‘ARGENTINA remains a key element of our JPMorgan franchise in LATIN AMERICA,” Gomez Minujin wrote in an e-mail. “In the last 12 months we have increased our headcount.” </span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">JPMorgan is expanding in SOUTH AMERICA’S second-largest economy even as competitors have cut staff and closed divisions amid a tightening of currency controls and financial oversight by President Cristina Fernandez de Kirchner’s government. <a href="http://www.bloomberg.com/quote/BARC:LN" title="Get Quote"><span style="color: blue;">Barclays Plc (BARC)</span></a> closed its wealth management office in Buenos Aires in January 2012 “for strategic reasons” while Exotix, a brokerage, last year transferred some staff to New York and <a href="http://topics.bloomberg.com/london/"><span style="color: blue;">London</span></a>due to regulations. </span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="color: #990000;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Gomez Minujin denied a report published today from Buenos Aires-based newspaper <u>Clarin</u> that the bank was leaving the country by the end of the month. </span></b></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">“We’re maintaining our presence ARGENTINA just like we always have,” he said in a telephone interview. </span></div>

LATIN AMERICAN ECONOMICS

BUSINESS CLIMATE IN LATIN AMERICA REACHES 18-MONTH HIGH  & JPMORGAN CONF IRMS EXPANDING ARGENTINE BUSINESS AFTER BARCLAYS LEAVES, CON...

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Walking Battery Park City

This Saturday, March 9, I'll be giving an architectural walking tour of Battery Park City. The weather forecast looks like it might just dry up and warm up a little by then. Those interested can find <a href="http://www.92y.org/Tribeca/Event/Battery-Park-City-Architectural-Walking-Tour.aspx">more information and tickets at the 92Y Tribeca</a>.<br /><br /><a href="http://www.flickr.com/photos/archidose/7384025674/" title="AIANY Boat Tour by archidose, on Flickr"><img alt="AIANY Boat Tour" height="850" src="http://farm8.staticflickr.com/7092/7384025674_7398295d1b_b.jpg" width="640" /></a><br /><br /><b>Update 03.07:</b> Turns out the BPC tour has been cancelled. Pardon any confusion.

Walking Battery Park City

This Saturday, March 9, I'll be giving an architectural walking tour of Battery Park City. The weather forecast looks like it might just...

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Dial Coconut Body Wash Review and Giveaway

<div style="text-align: center;"><div class="separator" style="clear: both; text-align: center;">Congratulations to Amy Orvin, Laura Jacobson</div><div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4v7pP2WvyG8jB_jI8pZ-jrhzC2Wzpwf3xuJt9okbfoaWbOO6rUkG81jIUfu6LYEF3sRHk2eS8hF9lfz0LDJAI4ZOADI9W-cASvO44QKKtyZs0kFVa7lDX2z51ak6b-1fqNNsEEZy4CTM/s1600/Dial+Coconut+Water+Body+Wash+purex+insider.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4v7pP2WvyG8jB_jI8pZ-jrhzC2Wzpwf3xuJt9okbfoaWbOO6rUkG81jIUfu6LYEF3sRHk2eS8hF9lfz0LDJAI4ZOADI9W-cASvO44QKKtyZs0kFVa7lDX2z51ak6b-1fqNNsEEZy4CTM/s320/Dial+Coconut+Water+Body+Wash+purex+insider.jpg" width="320" /></a></div><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Weather can be tough and also makes our skin become drier than usual.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Whether it's your hair or your body or even your hands that become dry in the winter time it becomes a hassle.</span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">So you continuously lather up with lotion a few times a day making you look like a melting ice cream cone!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">It works for the time being but some products just don't cut it!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">It's either too expensive, doesn't work, too thick or runny!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">We need a product that hydrates our skin so we will feel at our best without being all uncomfortable from dry skin!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">I have tried many products to help with the dry skin for the winter and it just doesn't work, until now that is!</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">This product is amazing!</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Not only does it re hydrate my skin, it smells fantastic! </span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Being a Purex Insider I received Dial Coconut Water body wash for review!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">It contains real coconut water to hydrate your skin while showering.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u><br /></u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><u>About the product:</u></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Coconut water found in green coconuts which are basically baby coconuts!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Rich in antioxidants and electrolytes.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Known as the super water for natural hydration and health benefits.</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">No wonder why coconuts are so popular in every product you see on the shelf!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Had a long day?</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Everyone needs time to relax whether it's reading a book or taking a nice hot bubble bath!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">So grab a cocktail or your favorite indulgence and hop in the tub and lather up with the exotic aroma of coconut and leave all your troubles behind!</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">*Giveaway Rules*</span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><br /></span></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;"><b>I was given three coupons to giveaway to three lucky winners!</b></span><br /><span style="font-family: Verdana, sans-serif;"><b><br /></b></span><span style="font-family: Verdana, sans-serif;"><b>Good Luck!</b></span><br /><br /></div><div style="text-align: center;"><br /><div class="separator" style="background-color: white; clear: both; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"><span style="font-family: 'Trebuchet MS', sans-serif;">1. How do you hydrate your skin?</span></div><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;">Want an extra entry? </span><br /><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;">2.  Must Follow my blog.</span><br /><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;">3.Then also follow me via Twitter, here. https://twitter.com/kelli_bliss </span><br /><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;"><br /></span><span style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"></span><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;">4. then Re tweet my post about the giveaway and if you tweet on your own make sure you use #hydratingbodywash</span><br /><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;">5. leave me a link here to your tweet.</span><br /><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 13px; line-height: 18px;">6. Like their face book page as well please! </span><br /><span style="font-family: Verdana, sans-serif;"><a href="https://www.facebook.com/Dial?fref=ts">https://www.facebook.com/Dial?fref=ts</a></span><br /><br /><br /><br /><span style="font-family: Verdana, sans-serif;">*Sweepstakes*</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Dial Brand is sponsoring a consumer sweepstakes to promote the release of The Dial Coconut Water Body Wash.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">With the sweepstakes you can be a $1,000 grand prize winner!</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">Or 250 first place winners will win a free bottle of Dial Coconut Water Body Wash.</span><br /><span style="font-family: Verdana, sans-serif;"><br /></span><span style="font-family: Verdana, sans-serif;">post on the Dial's face book page and mention you came from my blog to enter to win!</span><br /><div class="separator" style="background-color: white; clear: both; color: #222222; line-height: 18px;"><br /></div><div class="separator" style="background-color: white; clear: both; color: #222222; line-height: 18px;"><a href="https://www.facebook.com/Dial/app_425567240793613"><span style="font-family: Verdana, sans-serif;">https://www.facebook.com/Dial/app_425567240793613</span></a></div><div class="separator" style="background-color: white; clear: both; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"><br /></div></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><span style="font-family: Verdana, sans-serif;">Disclosure:</span><br /><span style="font-family: Verdana, sans-serif;">Due to FCC Rules </span><br /><span style="font-family: Verdana, sans-serif;">Dial soap provided me with a sample of the new Dial Coconut Water Body Wash in exchange for a product review. All, the opinions expressed are my own.</span><br /><br /></div><div style="text-align: center;"><br /></div>

Dial Coconut Body Wash Review and Giveaway

Congratulations to Amy Orvin, Laura Jacobson Weather can be tough and also makes our skin become drier than usual. Whether it's your hai...

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Jerusalem, My Happy Home: Part 9

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QFormat="true" Name="TOC Heading"/> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Calibri;} </style><![endif]--> <!--StartFragment--> <br /><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">We drove this morning to Sychar in Samaria, the site of Jacob’s Well where Jesus had the colloquy with the Samaritan woman in John’s Gospel. You can never be confident of the historicity of events in John and this story has a good deal of symbolism woven into it, but if it happened, this would be the spot and the spot makes the point. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">Yes, the well is there. And this would be the very well. It’s the only well around. It is deep. You have to lower the bucket a long way and it isn’t easy to hoist it back up. It’s a good picture of spiritual practice. Praying is like dipping into the well of our soul to draw up God’s grace. Drinking the water from that well felt like a connection to something old and deep – as the well is old and deep. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">Of course a church has been built around the well --- a Greek Orthodox Church served by an elderly priest who paints icons. I bought his Samaritan woman icon. Again, violence haunts this site. A few years ago, a Jewish settler in the nearby Palestinian city of Nablus hacked the Orthodox priest of this Church to death. The settler was deemed insane. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">Then we went up Mt. Gerazim to a Samaritan synagogue. Who knew there are still practitioners of the Samaritan faith? There are! 750 of them. Their text is the Pentateuch. They reject the rest of Hebrew Scriptures. Their holy place is Mt. Gerazim. They believe Mt. Gerazim, not Jerusalem, is the site of Mt. Moriah, where Abraham almost sacrificed Isaac. They also believe that Mt. Gerazim was the site of the central shrine of the 12 Tribes of Israel, the resting place of the Ark of the Covenant, during the centuries after the conquest of Canaan until David moved the Ark to Jerusalem. The First Book of Samuel says the central shrine was further south at Shiloh. But the books of Samuel are not in the Samaritan Bible. The Samaritans are also said to be sorcerers. We received an engaging catechesis in Samaritanism from their old priest.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">There are several connections between Jesus and the Samaritans. First, there is the story of Jesus’ friendly encounter with the Samaritan woman and the general acceptance of his message in Sychar. Second, there is his use of the Good Samaritan in a parable about neighborliness, a zinger of a story since Jews held Samaritans in contempt on both racial and religious grounds.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">Third, Jesus’ critics spoke of him disparagingly by calling him a Samaritan. John 8: 48. Once his accusers said his ability to cast out demons came from Beelzebub. Matthew 12: 22-37. There are two major mountains in this part of Samaria – Twin Peaks, if you will. Gerazim is the holy mountain. Mt. Abel is the unholy mountain. Its name means flies. The demon that reigns at Mt. Abel is Beelzebub, the Lord of the Flies. So Jesus’ accusers were saying his power came from the Samaritan demon of Mt. Abel. And the non-Biblical references to the crucifixion of Jesus call him a “sorcerer.” So those accusations too associated Jesus with the Samaritans. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">I don’t know what to make of any of that but as a Bible nerd, I find it interesting.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">Our next visit was to Bethany where we visited a Tomb of Lazarus. I say “a” tomb of Lazarus because he actually has two tombs in Bethany – one with an Orthodox Church on it, the other with a Franciscan Church on it. We visited the Franciscan tomb. The Church was lovely and the caves below were tomb-like. But what I found more interesting was being in Bethany, the home of Mary and Martha, and (according to the 4^th Gospel) Lazarus. This family was close to Jesus and he probably stayed with them when visiting Jerusalem. It is on the Mount of Olives in walking distance of Jerusalem, with Gethsemane on the way from the city to the village. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">A couple of side points of my own – not what I have learned here: First, there is a credible minority opinion that Lazarus is the author of the 4^th Gospel. Second, the tradition that Mary Magdalene was a prostitute is based on a conflation of several different Gospel texts, including three set in Bethany. In Mark and Matthew an unnamed woman (probably a prophet) anoints Jesus head with expensive perfume at the house of Simon the Leper in Bethany. In Luke, Mary of Bethany (not Magdala) sat devotedly at Jesus’ feet listening to him. Elsewhere in Luke, an unnamed sinner (prostitute) washed Jesus feet with her tears, anointed them with myrrh, and dried them with her hair. This happened in Galilee. John combined these stories to have Mary of Bethany (not Magdala) anoint Jesus’ feet with nard and dry them with her hair. Then misogynist translator, St. Jerome, got all this mixed up with poor Mary of Magdala who had nothing to do with any of it, and called her a prostitute. Actually all we know of Mary Magdalene is that she was once possessed by seven demons, she was a devout follower of Jesus, and she may have been a major leader in the first generation of Christianity. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Calibri; font-size: 14.0pt;">Tonight we spent some time in shared reflections guided by Brother Mark, an able spiritual director, then finished the day with a good lecture on Islam by Dr. Mustafa.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><!--EndFragment-->

Jerusalem, My Happy Home: Part 9

We drove this morning to Sychar in Samaria, the site of Jacob’s Well where Jesus had the colloquy with the Samaritan woman in J...

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