Writers like the British Ian Sinclair have made the walk an exercise in psychogeography; that is, walking through a place knowing the history of that place totally changes our perception of the space. It literally immerses us in history. Or begins to immerse us...

From the more than 86,000 landmarks recognized by the National Register of Historic Places, only 8% are associated with African Americans, Latinos, Asians, and other minorities.

Specifically, in the city of Los Angeles, just 10% of sites associated with women, BIPOC, or LGBTQ communities have become landmarks.

Last January, the National Register, in another effort to rewrite history and its imprint to make it everyone's, added the iconic Church of the Epiphany in the Lincoln Heights neighborhood of Los Angeles to the list.

The church, which was built in 1887, became in the 1960s the epicenter of the Chicano Movement and a refuge and space for the civil rights struggle and is still a pillar for the community today, half a century later.

"I cried because I needed a place as a Chicana and a place as a Christian to call home," Angelina Lydia Lopez recalls the first time she visited Church of the Epiphany in 1968.

Lopez was demonstrating on a picket line supporting Mexican American activist Sal Castro when recently deceased UCLA professor Juan Gomez-Quiones told Lydia about a party being held at the parish.

With its high ceilings and religious emblems, the interior was decorated with papel picado, and music from a mariachi band enveloped the attendees.

It was the first time, said Lopez, who had grown up in a Baptist church, that she saw her identity reflected in a place of worship.

Everything about the Church of the Epiphany harkens back to the golden years of La Raza; its basement, now being remodeled into an activity room, was the birthplace of the La Raza newspaper, led by Ramses Noriega and Rosalio Muoz, the main organizers of the first Chicano Moratorium against the Vietnam War.

The Epiphany was also the site chosen by activists during Robert F. Kennedy's presidential campaign and the rallying point for organizing student walkouts to protest inequalities in East Los Angeles schools.

Activist and farmworker movement leader Cesar Chavez took the pulpit and preached for social justice in that very spot, and, years later, the parish served as a refuge for Central American immigrants fleeing violence in their countries.

"That's the legacy of the church," its vicar, Father Tom Carey, told the LA Times. "It's a place where people have expressed themselves."

In fact, Epiphany was among the few temples that became a true supporter of the struggle for equality at a time when Latino Catholics complained about the Catholic Church's lack of involvement in minority causes.

With notorious clashes such as that of Catholics for La Raza at the neighboring St. Basil's Church in 1969, where one Christmas Eve the police had to mediate, Cardinal James Francis McIntyre tried to close the doors in the noses of the angry congregation.

The parish has kept holding its bilingual services during the pandemic, albeit virtually. Meanwhile, it attends to local families in need of food and joins protests and calls for small business owners' relief.

All this, while it undertakes a remodeling process thanks to a crowdfunding campaign launched after learning its conversion to a historical monument in the country.

What makes a place sacred "is what has happened there in the past," concludes Father Carey. "What continues to happen there."

Read more from the original source:
The Church That Houses the Latent Heart of the Chicano Movement in L.A. - AL DIA News

Remodeling on the Rise in 2021

The strength of the current housing marketcombined with continued working and schooling from home for manyis sparking an increase in home improvements and repairs. Whether youre planning to sell your home or adapting it to better suit your familys needs and tastes, the time is ripe for remodeling.

According to a recent report, the Leading Indicator of Remodeling Activity (LIRA), released by the Remodeling Futures Program at the Joint Center for Housing Studies of Harvard University, annual gains in spending for improvements and repairs to owner-occupied homes are expected to increase slightly this year, from 3.5 percent at the close of 2020 to 3.8 percent by year-end 2021.

The LIRA provides a short-term outlook of national home improvement and repair spending to owner-occupied homes. As Chris Herbert, managing director of the Joint Center for Housing Studies says, The remodeling market continues to benefit from a strong housing market. In addition to routine replacement and repair projects, homeowners are likely to pursue more and larger discretionary home improvements this year as the broader economy recovers.

The most popular improvements on the docket this year for homeowners include projects that make life more efficient and enjoyable, such as:

Updating the kitchen.While a full kitchen remodel may not be within your budget, you can still modernize your kitchen by replacing the floors or backsplash. Painting kitchen cabinets is an inexpensive way to give your kitchen a design refresh, or invest in a new appliance or two to instantly improve functionality and add value.

Adding a deck or patio.More attention is being given to outdoor living space than ever before. Extend your familys living area by installing decking or creating a spacious patio. Outfit your new outdoor space with comfortable patio furniture, a fire pit, water feature, kitchen set-up and more.

Creating an exercise space.Many have taken their exercise routines out of the gym and into the home, so carving out a functional, designated space to work out is a popular home-improvement trend this year. Whether its a corner of the basement or unused space in your garage, designing an area specifically for fitness is an on-point trend.

Michael Kogler,REALTORMIKE KOGLER TEAM: #1 Sales TeamLong & Foster Real Estate, Inc. | Christies International Real EstateDelaware Coastal Properties Division37156 Rehoboth Ave., Ext.Rehoboth Beach, DE. 19971Cell:(302) 236-7648Email:michael.kogler@LNF.comWeb:www.MikeKogler.comHenlopen Sales & Rentals:www.HenlopenRB.com

More:
Remodeling on the Rise in 2021 - CapeGazette.com

Las Vegas, NV - February 8th, 2021 - The Kentucky Home ImprovementExpo is the most prominent event among home builders and home renovation contractors based in Kentucky. This event is currently scheduled to be held from 27th to the 29th of August. This is a perfect example of a comprehensive home show that is taking place in Kentucky. The exhibition will bring together homeowners in the Louisville region to some of the best home building and home remodeling experts in the region as well as the Gutter Cleaners Association of America. These experts are experienced and knowledgeable. Hence, it is possible for the participants to share knowledge and gather lots of valuable information, which can contribute a lot towards the success of their construction projects in the future. With valuable contacts and partnerships created at this event, homeowners will be able to proceed with getting the best out of their new home construction or existing home renovation projects.

The best thing about Kentucky Home ImprovementExpo is that it is allowing participants to explore all the different aspects of constructing a home. Hence, a person who comes to the event will not come across the need to look for a service provider anywhere else. Since the most experienced constructors and contractors are coming to the exhibition to promote their services, there is no need to keep any second thoughts in mind when making the decision to proceed and obtain the services. It is possible to end up making some valuable connections with businesses that are offering the best expertise in services.

On the other hand, businesses that offer home construction or home remodeling services are using Kentucky Home ImprovementExpo as a great opportunity to get connected with potential customers and offer their services. Regardless of the size of the project that a homeowner wants to go ahead with, Kentucky Home ImprovementExpo will be there to deliver much-needed assistance.

Another great thing about Kentucky Home ImprovementExpo is that it is allowing business owners and people to get themselves exposed to the latest design trends and industry innovations. The world is moving so fast. These changes are applicable to the home construction and home renovation industries as well. Businesses that get exposed to the latest trends and innovations will be able to get ready to offer them to the customers and create the best customer experiences. On the other hand, people will be able to figure out what amazing options are available to them in the future to go ahead and grab.

The experts who come to the Kentucky Home ImprovementExpo will help businesses and visitors to get a first-hand experience on numerous aspects that are related to home improvement and construction. They include sunrooms and additions, advancements in flooring, countertops, and cabinetry, basement finishing, energy efficient winters, waterproofing, and exterior home improvement products. Moreover, the participants will be able to learn more about advanced technologies that are revolutionizing the home construction industry, including smart home automation.

This years event will be scheduled at the Triple Crown Pavilion. Almost all the exhibitors that were present during the previous year's exhibition have announced that they will be coming to this time as well. On top of that, it is possible to see the presence of the Gutter Cleaners Association of America taking part in the event this year. They will be able to contribute a lot towards the beneficiary of the companies that offer gutter cleaning related services at the event. Moreover, people will be able to get useful information by interacting with them.

Media ContactCompany Name: Gutter Cleaners Association of AmericaContact Person: Jason RandEmail: Send EmailPhone: 702-919-5197Country: United StatesWebsite: https://gcaoa.org/

Follow this link:
Kentucky Home Improvement Expo to be Held From 27th to 29th August With The Participation of The Gutter Cleaners Association of America - Press...

Being one of the best remodeling contractors in the region, Seattle Remodeling LLC is all geared up to provide unparalleled renovation and remodeling services to its clients in 2021 and beyond!

(The Magazine Plus Editorial):- Seattle, Washington Feb 2, 2021 (Issuewire.com)Seattle Remodeling LLC is a well-reputed remodeling and general contracting company that is committed to transforming its clients existing space for improved functionality and style. The company has been serving its customers for decades and has become one of the best remodeling and contracting companies in the region due to its excellent quality of service and skilled craftsmanship.

Seattle Remodeling LLC has established itself as a trusted name when it comes to blending style with performance. The company not only offers reliable kitchen renovations, bathroom renovations, water, and fire damage repair, and any other kind of revamping a house may require, but also help come up with the most innovative and cost-efficient ideas to turn its clients home remodeling project into an affordable one.

The team at Seattle Remodeling LLC comprises highly talented and professional individuals who are experts at what they do and keep clients satisfaction as their priority.

While talking about the vision of the leadership at the company, one of the managers at Seattle Remodeling LLC said: At Seattle Remodeling LLC, we are a full-service remodeling and general contracting company serving Seattle, and surrounding areas. We are experts at providing exceptional designs and top-quality workmanship for versatile remodeling services including kitchen renovations, bathroom renovations, water, and fire damage repair, basement and attic finishing and so much more. Whether you need help renovating your existing bathroom or wish to explore custom cabinets and countertops for your home; we will help you get everything done in a hassle-free way with customized solutions that meet each customers specific needs. We pride ourselves to offer the most outstanding customer service and stunning designs that optimize returns for our clients in Seattle and surrounding areas.

The management at Seattle Remodeling LLC is excited to expand its customer base and serve more households in 2021. The company is all charged up to reach maximum households in the Seattle region and serve them with exceptional designs created by highly skilled craftsmen that ensure 100% client satisfaction. Customers who are specific about attention to detail can sign up with Seattle Remodeling LLC to embark upon a stress-free and cost renovation journey of getting their homes remodeled or renovated.

The existing customers of Seattle Remodeling LLC cant stop themselves from praising the company for providing excellent services at affordable rates. In the words of one of their customers: I hired Seattle Remodeling to do a renovation of my master bathroom and they executed my design and vision perfectly. All the contracting work was very well done, and the materials were of high quality.

About the Company:

Seattle Remodeling LLC is a renowned remodeling and general contracting company that is committed to transforming regular homes into dream homes. They possess the experience and expertise to provide the best remodeling services in Seattle.

They are fully equipped for value-based engineering, streamlined scheduling, and system operations to deliver perfect performance, even at a grand scale.

They are also strategically staffed for delivering to their customers needs as and when they need it. Seattle Remodeling LLCs specialized teams come with expertise in home remodeling and can create all types of flooring, custom cabinets, granite, and quartz countertops as well as bathroom renovations to tile work!

Therefore, if you are looking for professionals to create a new look, and have some specific requirements, get in touch with them today and their team will be happy to discuss the possibilities.

See the article here:
Seattle Remodeling LLC Is Helping People To Transform Their Dream Homes Into Reality | The Magazineplus - The Magazine Plus

RICHMOND HEIGHTS, Ohio -- The Recreation Department is recommending that the city pool at Community Park remain closed for 2021.

The department is also recommending completion of upgrades at the citys Kiwanis Lodge, and making improvements to Desan Park and Greenwood Farm, Recreation Director Rick Dula said during Tuesdays (Feb. 2) online City Council Service and Recreation Committee meeting.

Dula shared these recommendations -- and more -- gleaned from a series of meetings of the citys Recreation Board with Dula and Assistant Recreation Director Anthony Gimellia in recent months.

We started this exercise back in October with over 50 potential budget items and personnel moves and equipment suggestions, and weve narrowed it down to a final three recommendations we are presenting tonight, Dula said.

Dula said the city has done an admirable job of building up funds since the citys fiscal crisis of 2013, and that 2021 is the right time to spend some of our money -- the taxpayers money -- to improve our recreational leisure programs and facilities in Richmond Heights.

Speaking about the 44-year-old pool, which was closed in 2020 due to COVID-19 and the need for costly repairs, Dula said those repairs are still needed.

We do recommend keeping it closed in 2021, he said. Our wish is to have it remain closed until a final decision can be made about the future status of any type of aquatic facility here in Richmond Heights.

Weve been patching and repairing and opening and closing it. We have the stats to show that the attendance has been very dismal the last three years that weve been open -- especially compared to other Hillcrest communities, he said.

The picture for opening the pool this year is very gloomy.

The Kiwanis Lodge

Dula noted that the city-owned lodge at Community Park, 27285 Highland Road, is turning into one of our showcase facilities because of work done there over the past couple of years.

We would like the city to consider to finally finish remodeling the (lodges) first floor, which would include a new (audio-visual) system; new flooring in the Kiwanis Hall, the smaller of the two (halls in the lodge); a new HVAC system; new energy-efficient windows and new lights in the Kiwanis Hall; four energy-efficient windows on the east wall of the Senior Hall; (and) new round tables and chairs in both halls. That would basically finish off the lodge.

The kitchen was remodeled in 2020 by the citys service department, and grants have been used to upgrade the basement for a broader range of uses, to upgrade the first floor and to add an outside ramp for better access to and from the basement.

Its getting there, Dula said of the lodge. We figure lets just do it all in 2021. Lets finish what we have to do, and if we cant get (more) grant money, lets not wait. Lets just spend the money we have in our $10 million (city budget) carry-forward and move forward.

Hiring a part-time staff person

The next recommendation from the commission is to rehire a part-time staff person, at 28 hours per week, to assist with programming, special events, rentals, marketing, deposits, program evaluations, event evaluations, surveys and handling social media work.

The commission suggests not hiring the part-timer until after the pandemic has passed and life in the Recreation Department returns to whatever the new normal is going to be.

Obviously, if were not doing activities, we dont need that (part-time) person onboard yet, but we need to position ourselves in case the pandemic is done sometime in 2021 and we can move forward with more activities, Dula said.

Desan Park

Of the third recommendation -- concentrating on Desan Park, located off Trebisky Road -- Dula said: Wed like to either remodel, renovate the restrooms/concession stand/pavilion structure, (and) complete the work on the two baseball infields, which is pretty minor. We have applied for a grant for a new playground there, and were looking at possibly repurposing the old tennis courts.

Its a wonderful space, he said of the long-closed tennis courts. Its kind of growing weeds right now, and wed like to come up with something that we can put there and make it an asset instead of a liability.

While the commission made recommendations in these three areas, it went on to list several other items on its wish list.

At Community Park, it is looking at improving the asphalt trail, something for which the city has already applied for a $150,000 share of 2021 federal Community Development Block Grant money, as distributed by Cuyahoga County.

Also discussed were options regarding the pool. Those options include repairing the current pool; adding an aquatics facility, such as a spray park, for use by children and teens, on the site of the current pool; or building a smaller pool, depending on study results.

Dula also mentioned working next year with the school district to replace the worn tennis courts with new courts, fencing and lighting. The improved courts could the be used by the schools for physical education.

At city-owned Greenwood Farm, 264 Richmond Road, Dula said the commission would like to build a permanent heated restroom, as the city has received a grant and has installed sewers running to the farm property.

Ward 3 Councilwoman Cassandra Nelson asked if tables and grills would be installed at Greenwood Farm, and Service Director Don Kerniskey said the plan for spring was to add both.

Meanwhile, Ward 1 Councilwoman Kim Thomas suggested installing a larger sign that lets people know that Greenwood Farm is a community park, as the current sign makes that statement in comparatively small letters.

Of Greenwood Farm, Dula said: Thats a wonderful piece of property sitting there screaming to be utilized and (for the city to) put some money into that. Its just a beautiful property that needs to be tweaked a little bit, put some money into it, and allow people, residents to enjoy the beautiful nature back there.

Although it did not have to do with recreation, the commission also recommended that Richmond Heights, at $60,000 to $70,000 per year, turn on all of its street lights to make the city safer and more welcoming.

The commission consists of residents Charlotte Camp, Angela Jordan, Patricia Thompson, Anna Cifranic and Mary Mehring.

Speaking in response to Dula and the commissions call for the city to spend money on upgrading its recreational facilities, Councilwoman and Committee Chair Juanita Lewis said, Well do some spending, but weve got to be careful.

Council took no action on the recommendations.

Read more from the Sun Messenger.

See the original post here:
Richmond Heights Recreation Commission recommends closing pool in 2021 - cleveland.com

Transforming mirrors, chairs, and other furnishings from dull to dramatic is quick and easy with spray foam insulation. The quirky look is trending on social media, but while this DIY project is fun and simple, its not risk-free. Several expanding spray foam products are available online and in home improvement stores. One thats especially well-suited to creating puffy projects is Great Stuff Big Gap Filler, a DuPont product designed to fill gaps in walls and around pipes to help keep outside air from seeping into a house or basement.

If youre looking to add a bit of foamy fun to household itemsand this project does create a pretty cool effectkeep reading to find out how to use it safely and how to get the best results.

RELATED: Hardware Store Decor: 9 Ways to Repurpose Tools

This polyurethane foam product is in liquid form in the can, but as soon as it comes into contact with air, it expands, similar to how canned whipped topping swells into billowy froths. Spray foam, however, becomes rigid as it cures, which makes it well-suited as an artistic medium for creating a bubbly frame around a mirror or a foamy-looking seat on a chair or stool. It takes about 15 minutes for the polyurethane foam to cure to a non-tacky state. Depending on humidity, it will harden in about an hour, and then the user can trim or carve it with a utility knife, if desired.

A nearly unpronounceable list of chemicals, including isobutene, methyl ether, and polymeric diisocyanate, should immediately alert users to the sealants potentially toxic nature. During applicationwhen the product is still in liquid formit off-gasses poisonous fumes that can lead to serious respiratory problems if inhaled. The fumes are also highly flammable, so using spray foam near a pilot light or lit cigarette can result in a dangerous flash-fire. For safety, create spray foam pieces outdoors where the fumes can disperse into the breeze. According to Great Stuffs manufacturer, once the foam is fully hardened and cured, it no longer presents a toxic fume threat, but remains flammable. Keep finished dcor items away from fireplaces, gas stoves, candles, and other open flames.

RELATED: A Home You Both Love: 12 Solutions for Your Biggest Decor Disputes

While its imperative to use this polyurethane spray foam outdoors for ventilation purposes, the cured foam will not withstand the elements. Rain and harsh UV rays will break down the foams structure, causing it to disintegrate. After the foam on the new project dries and hardens, bring your creation indoors to enjoy.

When used safely, spray foam insulation offers a creative way to update household furnishings; users can impart a foamy look on everything from vases and stools to picture frames. The foam expands to a bubbly, bumpy surface right out of the can, but when sprayed into a closed form, it will mold to the forms inner configuration, maintaining its shape once the form is stripped away.

With spray foam insulation, crafters and artisans are limited only by their creativity. They can even paint the foam after it hardensbut like many products used in the construction and remodeling trades, its essential to follow safety precautions to ensure a successfuland harmlessproject.

RELATED: 7 Instagrammers to Follow for the Best Home Decor Inspo

Read more:
Stop and Read This Before You Dress Up Furnishings with Spray Foam - BobVila.com

Study Design: A 2-stage study was conducted. In stage1, we performed nonassumptive deep-dive qualitative scoping to investigate the determinants of poor adherence in patients with asthma, and in stage 2 we developed a new questionnaire for cross-sectional surveys to obtain more accurate information about critical issues related to asthmamanagement.

Methods: Patients with asthma who were 18 years and older in the outpatient clinic of The First Affiliated Hospital of Xian Jiaotong University from November 2016 to January 2018 were investigated.

Results: In the 350 patients with asthma recruited, 32% of patients showed good adherence, whereas 68% of patients displayed poor adherence to inhaled therapy due to various reasons. Further analysis indicated that inadequate understanding of asthma treatment and control, poor self-management, financial burden, adverse reactions, and the fear of potential adverse reactions were significant independent risk factors for poor ICS inhalation adherence in patients with asthma.

Conclusions: Our research shows that many patients with asthma in western China have poor disease control and poor inhalation therapy adherence. We hope this research can alert clinicians and help them identify patients who may be experiencing uncontrolled asthma due to poor adherence to inhaled therapy, and we suggest that clinicians help those patients obtain appropriate information about asthma control and self-management.

Am J Manag Care. 2021;27(2):In Press

_____

Takeaway Points

_____

Asthma is a common chronic respiratory disease characterized by airway inflammation, airway hyperresponsiveness, and airway remodeling.1 It is a public health problem that causes increasing mortality and disability.2 By 2025, there will be 400 million patients with asthma in the world.3 Asthma has a negative impact on the quality of life of patients with the disease and leads to an increase in social and economic burdens.3 In recent years, the incidence of asthma in China has been rising. A national epidemiological survey from 2012 to 2015 showed that the total prevalence of asthma in China was 4.2%.4 At present, asthma prevention and control are significant challenges in China.

Inhaled drugs, the main treatment for asthma, can significantly improve asthma control.5,6 However, uncontrolled asthma is still common and a considerable burden for patients and society.7-9 An important reason for poor asthma controland, therefore, for rising costs of health careis suboptimal adherence to prescription regimens.10-13 Study findings have shown that the rate of inhaled glucocorticosteroid (ICS) adherence is less than 50% in adults.14-17 A survey based on the Australian Tasmanian cohort study reported that only 28% of patients with moderate persistent asthma and 48% of patients with severe persistent asthma were using ICS treatments regularly.15 In fact, poor patient adherence is the most frequently mentioned challenge (by 41% of physicians) in the treatment of asthma.9,18

The adherence of patients with asthma to ICS or ICS/long-acting inhaled 2 agonist (LABA) treatment depends on a number of factors that are closely related to the patients economic status, social status, and culture. Although some studies have reported risk factors or determinants of poor adherence in Chinese patients with asthma,19,20 there is very limited evidence for the determinants of adherence to inhaled asthma-control therapy across different age groups. It is still necessary to conduct in-depth research, especially to understand the reasons for poor adherence from the patientsperspective.

METHODS

Objectives

The study aimed to evaluate factors affecting adherence to ICS therapy in patients with asthma to further identify the determinants most closely associated with adherence to inhaled asthma-control therapy. This study was approved by the Ethics Committee of the First Affiliated Hospital of Xian Jiaotong University (approval No. 2016-409).

Study Design

This study included 2 stages: Stage 1 was a structured patient interview, and stage 2 was a cross-sectional survey. In stage 1, 40 patients with inadequate asthma control were invited to participate in a 1-time face-to-face interview. We interviewed patients or their guardians within the framework of 5 categories, which were summarized based on publications and the specific characteristics of Chinese society, including therapy-related factors, patient-related factors, provider-related factors, disease-related factors, and practice- and system-related factors. Then, all the factors reported by patients in stage 1 were collected and analyzed, and the top 10 factors were incorporated into the paper questionnaire (case report form [CRF]) of stage 2 to further explore the risk factors affecting patients adherence to inhalation therapy. In stage 2,350 outpatients with asthma who were 18 years or older and who visited a respiratory or asthmatic outpatient clinic in the First Affiliated Hospital of Xian Jiaotong University were invited to participate in a face-to-face interview. Each patient was interviewed only once, and informed consent and all information collection were completed at the time of visit.

Inclusion Criteria

In each study site, outpatients who met all the following criteria were included: (1) were 18 years or older, (2) lived in the same city as the study site for at least 2 years, (3) had a history of at least 1year of diagnosed asthma based on the criteria established by the Global Initiative for Asthma (GINA), (4) had inhaled ICS or ICS/LABA treatment in the past 6 months, and (5) were willing to sign the informed consent form.

Exclusion Criteria

Outpatients who met any of the following criteria were excluded: (1) patients with active cardiac or pulmonary disease (eg, bronchiectasis, chronic obstructive pulmonary disease, cystic fibrosis, pulmonary tuberculosis, lung cancer, severe heart disease) or other disorders (eg, HIV/AIDS), or patients undergoing therapy that, according to their physician, would interfere with the aim of the study; (2) patients with mental or neurological disorders, or those who were unable to understand and honestly answer questions due to alcohol or substance abuse, or those who refused to answer questions; and (3) patients with other conditions judged by the investigators as unsuitable for this study.

CRF Survey in Stage 2

Related factors (10 determinants explored from stage 1) affecting adherence to inhaled therapy were collected; to fill out the CRF in stage 2, each of the 350 patients was asked to choose yes or no for each of the 10 items. Then, all data were inputted into the online electronic questionnaire data capture system by the investigator(s), and the valid data were included in the statistical analysis.

Adherence Rate Assessment

The Medication Adherence Report Scale for Asthma (MARS-A) questionnaire is a self-reported measure of adherence to inhaled therapy. The MARS-A scale has 10 questions; it assesses intentional and unintentional nonadherence. Patients completed the scale based on their medication adherence over the past 4 weeks, and the investigator calculated the total score for each patient based on the scale. According to the score, asthma medication adherence status was divided into 2 levels: good adherence (45 points) and poor adherence (<45 points).

Asthma Control Assessment

The Asthma Control Test (ACT) was used to assess asthma control over the past 4 weeks. A score less than or equal to 19 was considered to signify asthma that was out of control. Scores greater than 19but less than 25 were considered to signify partial control. A global score of 25 indicates complete control of asthma.

Statistical Analysis

Descriptive statistics were used to summarize the study characteristics and adherence measurement. Continuous variables were presented as the mean and SD, whereas categorical variables were presented as proportions. Variables were entered into a final model using a multivariate logistic regression analysis to identify significant factors associated with asthma medication adherence status. All statistical tests were 2-sided; a P value<.05 was considered significant. All statistical analyses were performed using SPSS 22.0 software (IBM).

RESULTS

Study Characteristics

As shown in Table 1, 350 participants were recruited in stage 2 of this study. Among them, 128 (36.6%) were men and 222 (63.4%) were women. The patients were aged between 18 and 84 years, with a mean (SD) age of 43.80 (15.59) years. Among the patients, 59 (16.9%) were aged 18 to 30 years, 95 (27.1%) were aged 31 to 45 years, 59 (16.9%) were aged 46 to 60 years, and 137 (39.1%) were older than 60 years. The asthma duration of the included patients ranged from 1 to 70 years, with a mean (SD) duration of 19.51 (18.82) years. Univariate logistic statistical analysis showed no significant difference in gender, age, and duration of treatment for ICS adherence in asthma patients (P>.05) (Table 2).

Status of Adherence to Inhaled Therapy

Among these 350 outpatients with asthma included in this study, some patients discontinued ICS treatment for various reasons. According to the MARS-A questionnaire scores, 238 (68%) of the 350 patients had poor adherence to inhaled therapy and 112 (32%) had good adherence. The top 10 determinants explored from stage 1 are listed in Table3, and according to the CRF survey in stage 2, 52.9% of included patients believed that their condition had been controlled or cured, so they stopped using ICS or ICS/LABA therapy; 45.7% of patients used inhaled therapy only when their asthma symptoms were worsening or asthma was in acute attack; 30.3% of patients were afraid of potential adverse reactions, which means that these patients had suspended their treatment due to concerns about possible adverse effects of ICS treatment; 25.1% of patients had poor adherence due to forgetting to use inhaled treatment; and 15.1% of patients were unable to afford medicine because of the financial burden. In addition, other factors could also affect ICS treatment adherence in patients with asthma. For example, patients forgot to replenish with new drugs after the existing inhaled drugs were used up (12.3%); patients were unclear about the reasonable dosage, frequency, and course of inhaled treatment due to insufficient communication with doctors (12.0%); patients had an adverse reaction (eg, fungal infection of the oropharynx; hoarseness and cough due to respiratory tract irritation) after using inhaled therapy (11.7%); inhalation therapy was considered ineffective by the patient and was abandoned because the effect of inhaled treatment was not fast or not significant after treatment (10.0%); and patients were reluctant to use inhalation therapy because inhalation device operation was considered cumbersome or complicated (9.7%). At the same time, our study found that some patients had multiple risk factors that affected their treatment adherence. Among the included outpatients, 68 (19.4%) reported 2 risk factors affecting their inhaled treatment adherence, 59 (16.9%) reported 3 risk factors, and 81 (23.1%) reported 4 or more risk factors.

Determinants of ICS Treatment Adherence

To further clarify the independent risk factors affecting adherence to inhaled ICS therapy for asthma, we performed a multivariate logistic regression analysis. As shown in Table 4, the multivariable analysis indicated that independent risk factors lowering the odds of ICS therapy adherence were patients believing that their condition had been controlled or cured (odds ratio [OR], 0.28; 95% CI, 0.16-0.48; P<.01), patients using inhaled therapy only when asthma symptoms were worsening or asthma was in acute attack (OR, 0.26; 95% CI, 0.15-0.46; P<.01), patients being unable to bear the financial burden (OR, 0.36; 95% CI, 0.17-0.75; P<.01), patients having adverse reactions after using inhaled therapy (OR, 0.26; 95% CI, 0.08-0.81; P=.02), and the fear of potential adverse reactions (OR, 0.59; 95% CI, 0.49-0.95; P=.04).

Determinants Across Age Groups

In the study, included outpatients were divided into groups according to age. To further investigate the most significant independent risk factor affecting ICS therapy adherence in patients of different age groups, we performed a subgroup multivariate logistic regression analysis based on age. As shown in Table 5, subgroup multivariate analysis showed that forgetting to use inhaled drugs for a variety of reasons was the most significant independent risk factor lowering the odds of inhaled therapy adherence in patients aged 31 to 45 years (OR, 0.33; 95% CI, 0.10-0.91; P=.04). Meanwhile, insufficient communication with doctors leading to the inability to obtain adequate drug information was the most significant independent risk factor lowering the odds of inhaled therapy adherence in patients older than 60 years (OR, 0.29; 95% CI, 0.10-0.86; P=.03). However, we did not find significant independent risk factors affecting inhaled therapy adherence in patients aged 18 to 30 years and aged 46 to 60 years (P>.05).

Determinants Across Asthma Control Status

Of the 350 outpatients with asthma included in the study, most patients had poorer disease control. According to the ACT score, 119(34%) patients had asthma that was completely out of control, 201(57.4%) patients had asthma that was partially controlled, and only 30 (8.6%) patients reported complete control of their condition. To further clarify the most significant independent risk factor for ICS therapy adherence in patients with different asthma control status, we performed a subgroup multivariate logistic regression analysis. The logistic analysis indicated that adverse reaction was the most significant independent risk factor lowering the odds of inhaled therapy adherence in patients whose asthma was completely out of control (OR, 0.03; 95% CI, 0.01-0.58; P=.02). However, in patients who reported partially controlled or fully controlled asthma, we did not find significant independent risk factors affecting adherence to inhaled therapy (data shown in the eAppendix Table [available at ajmc.com]).

DISCUSSION

To our knowledge, this is the first study to assess the determinants of ICS adherence among outpatients with asthma in western China from the patients perspective. Asthma is a common chronic respiratory disease worldwide, and it is reported that there will be 400 million patients with asthma in the world by 2025.1,3 Uncontrolled asthma is common and represents a considerable burden to patients and society in western China,4 so it is necessary to have an in-depth understanding of the current state of asthma treatment and asthma control.

The GINA guideline has indicated that ICSs are currently the most effective anti-inflammatory medications for the treatment of persistent asthma, although they do not actually cure asthma.6,21-26 Compared with noninhaled administration, the ICS can be delivered directly into the airways, producing higher local concentrations with a significantly lower risk of systemic adverse effects.6 Meanwhile, LABA combined with ICS will usually be more effective when a medium dose of ICS alone fails to achieve control of asthma.27-29 Therefore, for patients with asthma, adherence to inhaled therapy is very important for controlling their condition. However, uncontrolled asthma is still a common phenomenon among outpatients with asthma.9 ICS or ICS/LABA treatment adherence in patients with asthma depends on a number of factors that are closely related to the patients economic status, social status, and culture.

Nonadherence to medical advice is common in patients with asthma and is a major cause of uncontrolled asthma. Failure to adhere to medical advice is a complex social issue in western China. Exploring patients cognition and drug preference status for their asthma treatment from their perspective can help establish effective doctor-patient relationships and improve asthma treatment adherence. In this study, our results showed that most outpatients with asthma had poorer disease control, and only 8.6% of patients reported complete control of their condition. According to the MARS-A questionnaire, 68% of the patients reported poor adherence to ICS therapy due to various reasons. The multivariate logistic regression analysis indicated that the belief that their condition had been controlled or cured, using inhaled therapy only when asthma symptoms were worsening or asthma was in acute attack, financial burden, adverse reactions after using inhaled therapy, and the fear of potential adverse reactions were the significant independent risk factors associated with ICS treatment adherence. Further subgroup analysis indicated that forgetting inhalation therapy for a variety of reasons was the most significant independent risk factor associated with inhalation treatment adherence in patients aged 31 to 45years, and the inability to obtain adequate drug information due to insufficient communication with doctors was the most significant independent risk factor in patients older than 60 years. Additionally, our results indicated that an adverse reaction was the most significant independent risk factor associated with ICS therapy adherence in patients whose asthma was completely out of control. Therefore, based on our results, we recommend that clinicians should help those patients obtain appropriate information about asthma control and self-management, and should instruct those patients not to stop ICS or ICS/LABA irregularly. Meanwhile, effective replacement treatment is necessary and important for patients with adverse reactions after inhaled therapy. If clinicians understand the risk factors affecting asthma treatment adherence from the patients perspective, they can use patient-centered communication skills to improve patients adherence to asthma treatment and improve their asthma control.

Limitations

This study had some weaknesses. First, only 350 outpatients with asthma from one tier-3 hospital in western China were recruited in this research. This is not enough to ascertain the exact extent of nonadherence to inhaled treatment in the whole population of patients with asthma. Secondly, asthma is a complex disease with many therapeutic medicines,1,30-32 including ICS,21 leukotriene modifiers,33,34 LABA,35,36 theophylline,37,38 rapid-acting inhaled 2 agonists, and so on.6 Our study focused only on the current status of ICS or ICS/LABA in asthma control and did not further explore the role of other drugs in asthma control. When considering these limitations, the results of this research should be interpreted carefully.

CONCLUSIONS

This studys findings indicate that there are multiple independent risk factors that influence ICS therapy adherence in patients with asthma, including inadequate understanding of asthma treatment and control, poor self-management, financial burden, adverse reactions, and the fear of potential adverse reactions. Thus, we hope this research can alert clinicians and help them identify patients who may be experiencing uncontrolled asthma due to poor adherence to ICS therapy. We suggest that clinicians should help those patients obtain appropriate information about asthma control and self-management. For patients with adverse reactions after ICS therapy, effective replacement treatment is strongly recommended.

Author Affiliations: Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xian Jiaotong University (JW, CZ, QW, WS, WF, XY, QZ, XX, SL, ML), Xian, Shaanxi, China.

Source of Funding: This study was supported by AstraZeneca China (study code: ESR-16-12138).

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JW, CZ, QW, WS, XX, SL, ML); acquisition of data (CZ, QW, WS, WF, XY, QZ); analysis and interpretation of data (JW, QW, WS, WF, XY, QZ); drafting of the manuscript (JW, CZ, ML); critical revision of the manuscript for important intellectual content (JW, WF, XY, QZ); statistical analysis (CZ, QW, WS, WF, QZ, XX, SL, ML); provision of patients or study materials (JW, QW, WS, WF, XY, QZ, XX, SL); obtaining funding (ML); administrative, technical, or logistic support (CZ, XX, SL); and supervision (ML).

Address Correspondence to: Manxiang Li, PhD, MD, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xian Jiaotong University, No. 277, West Yanta Rd, Xian, Shaanxi, 710061, China.

REFERENCES

1. Manuyakorn W, Howarth PH, Holgate ST. Airway remodelling in asthma and novel therapy. Asian Pac J Allergy Immunol. 2013;31(1):3-10.

2. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med. 2017;5(9):691-706. doi:10.1016/S2213-2600(17)30293-X

3. Masoli M, Fabian D, Holt S, Beasley R; Global Initiative for Asthma (GINA) Program. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469-478. doi:10.1111/j.1398-9995.2004.00526.x

4. Huang K, Yang T, Xu J, et al; China Pulmonary Health (CPH) Study Group. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet. 2019;394(10196):407-418. doi:10.1016/S0140-6736(19)31147-X

5. British Thoracic Society; Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. Thorax. 2008;63(suppl 4):iv1-iv121. doi:10.1136/thx.2008.097741

6. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31(1):143-178. doi:10.1183/09031936.00138707

7. Peters SP, Ferguson G, Deniz Y, Reisner C. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment. Respir Med. 2006;100(7):1139-1151. doi:10.1016/j.rmed.2006.03.031

8. Cazzoletti L, Marcon A, Janson C, et al; Therapy and Health Economics Group of the European Community Respiratory Health Survey. Asthma control in Europe: a real-world evaluation based on an international population-based study. J Allergy Clin Immunol. 2007;120(6):1360-1367. doi:10.1016/j.jaci.2007.09.019

9. Sullivan SD, Rasouliyan L, Russo PA, Kamath T, Chipps BE; TENOR Study Group. Extent, patterns, and burden of uncontrolled disease in severe or difficult-to-treat asthma. Allergy. 2007;62(2):126-133. doi:10.1111/j.1398-9995.2006.01254.x

10. Bender BG, Rand C. Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol. 2004;4(3):191-195. doi:10.1097/00130832-200406000-00009

11. Williams LK, Pladevall M, Xi H, et al. Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma. J Allergy Clin Immunol. 2004;114(6):1288-1293. doi:10.1016/j.jaci.2004.09.028

12. Haughney J, Price D, Kaplan A, et al. Achieving asthma control in practice: understanding the reasons for poor control. Respir Med. 2008;102(12):1681-1693. doi:10.1016/j.rmed.2008.08.003

13. Normansell R, Kew KM, Stovold E. Interventions to improve adherence to inhaled steroids for asthma. Cochrane Database Syst Rev. 2017;4(4):CD012226. doi:10.1002/14651858.CD012226.pub2

14. Gamble J, Stevenson M, McClean E, Heaney LG. The prevalence of nonadherence in difficult asthma. Am J Respir Crit Care Med. 2009;180(9):817-822. doi:10.1164/rccm.200902-0166OC

15. Kandane-Rathnayake RK, Matheson MC, Simpson JA, et al. Adherence to asthma management guidelines by middle-aged adults with current asthma. Thorax. 2009;64(12):1025-1031. doi:10.1136/thx.2009.118430

16. Bourdin A, Halimi L, Vachier I, et al. Adherence in severe asthma. Clin Exp Allergy. 2012;42(11):1566-1574. doi:10.1111/j.1365-2222.2012.04018.x

17. Williams LK, Joseph CL, Peterson EL, et al. Patients with asthma who do not fill their inhaled corticosteroids: a study of primary nonadherence. J Allergy Clin Immunol. 2007;120(5):1153-1159. doi:10.1016/j.jaci.2007.08.020

18. Ma Q, Wang C, Zhang Q. What are reasons for non-adherence in patients with asthma? a 24 weeks prospective telephone follow-up research. Eur Resp J. 2013;42(suppl 57):963.

19. Xiang L, Zhao J, Zheng Y, et al. Uncontrolled asthma and its risk factors in Chinese children: a cross-sectional observational study. J Asthma. 2016;53(7):699-706. doi:10.3109/02770903.2016.1144199

20. Zhong N, Lin J, Zheng J, et al. Uncontrolled asthma and its risk factors in adult Chinese asthma patients. Ther Adv Respir Dis. 2016;10(6):507-517. doi:10.1177/1753465816663978

21. Juniper EF, Kline PA, Vanzieleghem MA, Ramsdale EH, OByrne PM, Hargreave FE. Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis. 1990;142(4):832-836. doi:10.1164/ajrccm/142.4.832

22. Jeffery PK, Godfrey RW, Adelroth E, Nelson F, Rogers A, Johansson SA. Effects of treatment on airway inflammation and thickening of basement membrane reticular collagen in asthma. a quantitative light and electron microscopic study. Am Rev Respir Dis. 1992;145(4, pt 1):890-899. doi:10.1164/ajrccm/145.4_Pt_1.890

23. Waalkens HJ, Van Essen-Zandvliet EE, Hughes MD, et al; The Dutch CNSLD Study Group. Cessation of long-term treatment with inhaled corticosteroid (budesonide) in children with asthma results in deterioration. Am Rev Respir Dis. 1993;148(5):1252-1257. doi:10.1164/ajrccm/148.5.1252

24. Pauwels RA, Lfdahl CG, Postma DS, et al; Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med. 1997;337(20):1405-1411. doi:10.1056/NEJM199711133372001

25. Szefler S, Weiss S, Tonascia J, et al; Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med. 2000;343(15):1054-1063. doi:10.1056/NEJM200010123431501

26. Perera BJ. Successful withdrawal of inhaled corticosteroids in childhood asthma. Respirology. 2005;10(3):385-388. doi:10.1111/j.1440-1843.2005.00708.x

27. Lazarus SC, Boushey HA, Fahy JV, et al; Asthma Clinical Research Network for the National Heart, Lung, and Blood Institute. Long-acting beta2-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: a randomized controlled trial. JAMA. 2001;285(20):2583-2593. doi:10.1001/jama.285.20.2583

28. Lemanske RF Jr, Sorkness CA, Mauger EA, et al. Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol: a randomized controlled trial. JAMA. 2001;285(20):2594-2603. doi:10.1001/jama.285.20.2594

29. Gibson PG, Powell H, Ducharme FM. Differential effects of maintenance long-acting beta-agonist and inhaled corticosteroid on asthma control and asthma exacerbations. J Allergy Clin Immunol. 2007;119(2):344-350. doi:10.1016/j.jaci.2006.10.043

30. Levy ML, Fletcher M, Price DB, Hausen T, Halbert RJ, Yawn BP. International Primary Care Respiratory Group (IPCRG) Guidelines: diagnosis of respiratory diseases in primary care. Prim Care Respir J. 2006;15(1):20-34. doi:10.1016/j.pcrj.2005.10.004

31. Pelaia G, Vatrella A, Maselli R. The potential of biologics for the treatment of asthma. Nat Rev Drug Discov. 2012;11(12):958-972. doi:10.1038/nrd3792

32. Papi A, Brightling C, Pedersen SE, Reddel HK. Asthma. Lancet. 2018;391(10122):783-800. doi:10.1016/S0140-6736(17)33311-1

33. Barnes NC, Miller CJ. Effect of leukotriene receptor antagonist therapy on the risk of asthma exacerbations in patients with mild to moderate asthma: an integrated analysis of zafirlukast trials. Thorax. 2000;55(6):478-483. doi:10.1136/thorax.55.6.478

34. Dicpinigaitis PV, Dobkin JB, Reichel J. Antitussive effect of the leukotriene receptor antagonist zafirlukast in subjects with cough-variant asthma. J Asthma. 2002;39(4):291-297. doi:10.1081/jas-120002285

35. Kesten S, Chapman KR, Broder I, et al. A three-month comparison of twice daily inhaled formoterol versus four times daily inhaled albuterol in the management of stable asthma. Am Rev Respir Dis. 1991;144(3, pt 1):622-625. doi:10.1164/ajrccm/144.3_Pt_1.622

36. Wenzel SE, Lumry W, Manning M, et al. Efficacy, safety, and effects on quality of life of salmeterol versus albuterol in patients with mild to moderate persistent asthma. Ann Allergy Asthma Immunol. 1998;80(6):463-470. doi:10.1016/S1081-1206(10)63068-2

37. Evans DJ, Taylor DA, Zetterstrom O, Chung KF, OConnor BJ, Barnes PJ. A comparison of low-dose inhaled budesonide plus theophylline and high-dose inhaled budesonide for moderate asthma. N Engl J Med. 1997;337(20):1412-1418. doi:10.1056/NEJM199711133372002

38. Ukena D, Harnest U, Sakalauskas R, et al. Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma. Eur Respir J. 1997;10(12):2754-2760. doi:10.1183/09031936.97.10122754

Read more:
Determinants of ICS Therapy Adherence in Patients With Asthma - AJMC.com Managed Markets Network

How to Choose the Right Flooring for Your Finished Basement

If youre planning to finish your basement, you will want to cover up the concrete floor with a material that is more attractive and comfortable. Here are some important things to know and some flooring materials to consider.

You May Need to Repair the Floor and Install a SubfloorBefore you or a contractor can install new flooring, the concrete floor may need to be fixed. Any gaps, sections that have shifted, water damage and areas that are rough or uneven will need to be addressed.

Although many flooring materials can be installed directly on top of concrete, that may not be a good idea for a finished basement, since it can cause the floor to be cold. Installing a subfloor can provide a layer of insulation to keep the floor warm.

A subfloor can also prevent moisture damage. Since a concrete slab is porous, moisture and water vapor can travel through it. That can allow mold and mildew to form under the flooring. A vapor barrier or a waterproof subfloor can prevent that.

Popular Flooring Choices for a Finished BasementCeramic tile can be installed directly on top of concrete, as long as the surface is smooth. You may want to install a subfloor, however, to avoid having a cold floor. Ceramic tile will not be damaged by moisture. Tile flooring is available in a wide range of styles and sizes.

Rubber flooring can come in tiles or sheets. It can be a good choice because rubber is easy to keep clean, durable and waterproof, and can also provide cushioning.

Vinyl flooring is another popular choice for finished basements. Its available in planks and tiles with interlocking joints that make installation easy. Vinyl planks and tiles can be manufactured to resemble wood or ceramic tile. They can be installed right on top of concrete and can resist minor water damage.

Another option is sheet vinyl. Its durable and easy to clean, but it can be difficult to cut and install. Vinyl sheet flooring should only be installed over a subfloor. If it isnt, any rough areas on the concrete floor will be visible after the vinyl flooring has been laid.

Although many types of flooring can be installed in a basement, solid hardwood and untreated laminate flooring should not be used because they can warp and buckle from exposure to moisture. Engineered wood flooring can give you the attractive look of real hardwood with the moisture-resistant benefits of laminate construction. Engineered wood flooring has a thin layer of real wood on top of other types of wood or composite board and can give your finished basement a refined appearance.

Talk to Your ContractorSelecting the right flooring for your basement remodeling project will be one of your most important decisions. Speak with your contractor about various options and discuss the pros and cons of each so you can make the right choice.

Michael Kogler,REALTORMIKE KOGLER TEAM: #1 Sales TeamLong & Foster Real Estate, Inc. | Christies International Real EstateDelaware Coastal Properties Division37156 Rehoboth Ave., Ext.Rehoboth Beach, DE. 19971Cell:(302) 236-7648Email:michael.kogler@LNF.comWeb:www.MikeKogler.comHenlopen Sales & Rentals:www.HenlopenRB.com

Read more from the original source:
How to Choose the Right Flooring for Your Finished Basement - CapeGazette.com

Between Sep. 1 and Nov. 30, the median sale price of existing single-family homes in Maine increased by 22.2 percent from the same period in 2019from $225,000 to $270,000. (The median indicates that half of the homes sold for more and half sold for less.)

With 2021 forecasts showing prices all over Maine continuing to increase, we took a snapshot of whats on the market around median prices in Maines Midcoast.

These listings were active at time of filing on Wednesday, Dec. 30.

5 Arrowhead Dr., Brunswick, Cumberland County. Recent median sales price: $385,500

$354,900 | 3 Beds | 1.5 Baths | 2,237 SF | 0.36 Acres

This home is located on a double lot off of Church Rd. on the west side of town. Desirables include a two-car attached garage with overhead storage, new appliances, skylights, a wood stove, a fully finished basement with half bath for additional work/play space and a deck overlooking the backyard. Well let you compare the price per square this home would be in Portland.

5 Crawford Dr., Bath, Sagadahoc County. Recent median sales price: $291,000

$279,900 | 4 Beds | 1.5 Baths | 1,809 SF | 0.39 Acres

The warmth and creativity that this home lacks in curb appeal is made up for by the bright, contemporary interior that has been updated with new appliances, granite countertops and cabinets in the kitchen and a black wood stove against a black brick wall in the living room, which will supplement the two heat pumps. A first-floor bedroom and half bathroom make a great space for guests on people who want to mostly stick to one floor.

10 Middle St., Lisbon, Androscoggin County. Recent median sales price: $215,500

$224,900 | 3 Bed | 2 Bath | 1,356 SF | 0.38 Acres

While the new owner will have to put those ever familiar finishing touches on this property, the circa 1900 Victorian has had extensive remodeling, including new floors and windows, updated kitchen and bathrooms and six brand new heat pumps. The third floor has potential to be finished for two more bedrooms. The seller is offering a $10,000 allowance toward the buyers choice of upgrades and improvements.

Previous

Read the original:
On the Market: Single family homes for sale in Midcoast Maine - pressherald.com

U.S. Rep. Mike Conaway speaks at the unavailing of his portrait.

U.S. Rep. Mike Conaway speaks at the unavailing of his portrait.

U.S. Rep. Mike Conaway speaks at the unavailing of his portrait.

U.S. Rep. Mike Conaway speaks at the unavailing of his portrait.

Do a job worthy of the peoples trust in you.

Reacting to the news of Mike Conaways decision to retire from Congress, a Texas Tribune reporter wrote, His retirement is a major blow to the state's clout within the Republican conference.

Conaway leaves Washington as the ranking member and former chairman of the House Agriculture Committee and had served as chair of House Ethics Committee. The same Tribune reported noted that Conaways decision was somewhat of a surprise to some delegation insiders; Conaway was on track to take GOP leadership of the House Intelligence Committee in the coming years.

But in July, Conaway said it was time to go. He leaves after winning his first election in 2005; the district was drawn up after then-Speaker of the Texas House Tom Craddick insisted on a district where Midland-Odessa would be a main population area.

His goal in representing the nearly 30 counties of District 11 was to do a job worthy of the peoples trust in you.

For years, many Conaway detractors seemed focused on the Troubled Asset ReliefProgram vote from 2008, which he said was the vote he lost the most sleep over. The CPA said in retrospect, it was one of those few, few times where I had to vote my conscience and vote my own experience and my own understanding of the circumstances versus what I was being encouraged to do from back home. He said that money spent on TARP has been earned back by and collected by the Fed.

If the TARP vote really impacted constituents faith in their representative, it was hard to tell. He never received less than 70.36 percent of the vote in a Republican primary after the 2008 vote and never less than 78.64 percent of the vote in a general election.

Conaway more recently earned distinction for his work as chairman of the House Agriculture Committee including passage of the 2018 Farm Bill -- and as the person who led the House investigation into Russian interference in the 2016 presidential campaign. Conaway said he is proud that his committee was the first to finish and that not one of our conclusions was refuted by any of that other work that was done.

There will be much to unpack from Conaways time in Washington. He said this week he is confident that San Angelo Republican August Pfluger has the ability to represent the district well.

As for the immediate future, he and Suzanne will spend time in Seacrest Beach, Florida where they have a home and then return to Midland.

He said that somehow his resume showed up down here and I'm getting offers to drive a Coca-Cola truck route or be a security guy at the mall. So, I've got a bright future.

The following is a question-and-answer between Stewart Doreen of the Midland Reporter-Telegram and Mike Conaway.

MRT: What was your welcome-to-Congress moment?

CONAWAY: Suzanne and I had flown up for the swearing-in like theyre doing right now. And we get off the plane there in D.C. and there's a young Marine lieutenant standing there a Marine poster kid. And he says, Mr. Conaway, please come with me, and my wife looks at me, and shes got these big, wide eyes. He's a handsome little guy. And so, he marches us down from the gate to the terminal, we collect our bags, and then they escort us into downtown. And she actually said, How did he know who we are? Bob Ney, at the time, was chairman of the house Admin Committee, and he had worked out an arrangement with the Department of Defense to have each new member greeted at Reagan Airport like that. And so, I guess that was probably my first thought of, Wow, I may be in the big time after all.

MRT: What will you miss about serving in Congress?

CONAWAY: I just love the job. It's multifaceted, obviously, and it's hard to pick anything most, but my team that I've been able to put in place over all these 16 years, and it's been relatively stable. I've had some great people come and go. But these young men and women -- and they are young compared to me, I'm a little codger -- they are some of the finest that our nation has produced. They're loyal, they're dedicated, they're patriotic, super intelligent. And I've had them on my personal staff, the Ethics Committee staff and then, of course, the Ag Committee staff and, I think I will miss working with them day to day the most. Sue and I have been blessed with a really good family, and we've been able to add to that family over these 16 years with some young folks that we basically in our hearts adopted his family because they're just some of the best this country's ever produced, so I'll miss them. I'll miss town-hall meetings and working with constituents, being back in the district and making the rounds. I really missed that this past year because we didn't get to do nearly as much of that as I wanted to or that I normally certainly would have done. Then, its just doing the job. It's been a terrific run, and about half of me hates to see it come to a close and half that wants to make my wife happy.

MRT: What was your favorite perk of being a congressman?

CONAWAY: For the first probably 10 years, there was a parking lot at DCA (Reagan National Airport) that members of the House, the Senate and diplomats could use. It was right there by the door. You just drive right in, park and walk into the airport. And then they began this multi-year remodeling project for DCA, and they took all that away. That was probably the perk that was the best because you could just drive right in, get out and your car would be there when you came back the next week. I guess the day-to-day thing, was just being able to go through security without having to strip down and toss all your stuff in the bucket. That's a pretty good perk as well, just being able to go anywhere on campus that you wanted to go without having to go through security.

MRT: What was the one vote that created the most sleepless nights for you?

CONAWAY: The TARP vote is the only one that comes to mind, and I voted correctly on that. The one vote that I wish I had back was the Budget Control Act of 2011. But the TARP vote probably gave me the most trouble, because you know, the folks back in West Texas during that financial meltdown really weren't affected by it all that much. And I was getting this immense pressure to vote against it. And I've been in banking for six-plus years. And I knew the system was legitimately under immense pressure. The commercial paper market was about to collapse -- there were some really bad things happening -- and I knew in my heart that the right thing to do was to vote for it, but I was getting this pressure from back home to vote against it.

Voting for it was the right policy way to go, but it was one of those few, few times where I had to vote my conscience and vote my own experience and my own understanding of the circumstances versus what I was being encouraged to do from back home. I remember the first time we voted on it, I voted against it. And we all came home for a couple of days, and I got ticker-tape parades and people patting me on the back and all this kind of stuff. But I knew in my heart of hearts, that when it came back up, we would have changed it and fixed to the point where I was going to vote for it, so I was really torn that whole weekend back home. Everybody was bragging on me and all this kind of good stuff. But that's the one that gave me the most trouble from a Do what everybody's telling you to do or Did you do what you know is right. And in my heart, I know what I did was right. All that money that was spent on TARP has been earned back by and collected by the Fed. So net, it's been positive, but there are still a lot of folks who disagree with my analysis, most of whom didn't really have any deep understanding of banking, they just didn't want the federal government intruding like that. And I understand that, but, but like I said, I've been in banking long enough to know, this was a real deal and that I needed to support it.

MRT: Any regrets about what didn't get accomplished?

CONAWAY: Well, yeah, we didnt balance the budget the entire time I was there and no balanced budget amendment to the Constitution. There are lots of things out there that people talk about doing to our Constitution, but a balanced budget amendment is head and shoulders above anything else you could ever do. You made a brief reference to the increase in debt while I was there and the numbers speak for themselves, and I was a part of all those zillion decisions that got us to this point, but not being able to have better fiscal discipline to the system -- and that's just shared responsibility, no single member is going to be able to fix that deal. I mentioned that one vote that I do regret -- the Budget Control Act of 2011. (Former Republican Speaker of the House John) Boehner sold us the idea that this special committee could come up with enough cuts to mandatory spending to make it work and that it would be so terrible to institute sequestration, that we wouldn't do it that it would be the sword of Damocles that would make us get there, that would make us address mandatory spending, which is where the bulk of the problem lies. And it didn't work. The special committees ideas didn't pass, and so sequestration kicked in, and it did immense harm to the Department of Defense over those years and still has. Thats the one bill I've voted for that I wish I hadnt. It's interesting, most of the folks who cling to sequestration and budget caps and other things out that were around in 2011 voted against that bill. And it now they cling to it like the Holy Grail.

MRT: What's the one thing you're most proud of accomplishing during your time in Washington?

CONAWAY: To do the work in D.C., and it takes 217 friends -- plus the speaker has to be one of those friends -- and the 60 over in the Senate, the president and that kind of stuff. Getting stuff done in D.C. is a tall order, but back home, the work that has been done by my constituent service team in the six offices that we have, every day somebody's life in the district was made just a little less difficult by the great work my team was doing -- whether it's income taxes, IRS, Social Security or VA or INS or need a passport immediately, all those kind of things that people have to have happen, my guys just were exemplary at it. I'm most proud of that body of work that contributed in no small part -- to me getting to 75 and 80 percent of the vote every time. It was just the great work my team back home was doing. The work they've done over the past 16 years is what I'm proud of the most.

Legislatively, it would be of course the Farm Bill of 2018 as the biggest deal that I got to get done, but there was a crop insurance issue that I led the fight on in 2015, getting cotton back under the Farm Bill the way it should have been, that happened before the 2018 Farm Bill. I'm proud of the report that we got done on the Intelligence Committee on the Russia investigation. It doesnt get a lot of play these days, but if you go back and look at it, not one conclusion was refuted by any of the other folks out there. Yeah, I was a little worried about it when we did our first and it came out pretty darn quickly. In comparison, Mueller had unlimited money and 40-plus investigators, and the Senate's just now finishing up their work, so I was a little concerned that they might find something that we didn't or find something that we should have found that we didnt. And not one of our conclusions was refuted by any of that other work that was done. So, I'm really proud of what we get done on the on the Russia investigation report.

MRT: One of the defining characteristics of your time representing District 11 is that it would have been impossible for someone to state where you were from inside District 11 based on your representation in Washington. In fact, it can be argued that you had a greater impact on the agriculturally dependent parts of the district than Midland-Odessa. Describe what it meant for you to represent the entire region like District 11.

CONAWAY: Part of it is, I made a pact with myself that I would do two public events in every county in the district every year where people would have public access to me. And back when I had Mentone and Orla, we would go out there twice a year. There would be all 67 votes out there. We just made sure I went to every county, because you could look at the district, and if you're just a pure politician, say, OK, I need to spend all my time in Midland, Odessa, San Angelo, maybe Brownwood, and maybe Hood County or maybe Granbury. And I can ignore the rest of those folks, because they quite frankly can't sway the deal. The other thing that did I didn't want anybody to say is the only time Conaway ever shows up around here is when he's asking for the vote. That happens a lot. A lot about my colleagues they'll show up a month out from the primary, a month out from the general and that is the first time they had been back to that place in two years. I never wanted anybody to be able to say that. In my view, it was just part of doing the job. And then when I became chairman of Ag, I watched other Ag leaders be very parochial. I felt like as chairman of Ag, I represented all of it, not just cotton in West Texas, but all of it. And so, I worked really hard to make sure that I was going places I needed to go.

MRT: It was said that this district was created for Midland-Odessa, that the representative would be from Midland-Odessa. Did that create any pressure in any way for you?

CONAWAY: I didn't feel any. The pressure I felt would have happened no matter what and that was to do a good job. Do a job worthy of people's trust in you and worthy of that regardless whether a person lived in Midland-Odessa or Brownwood or wherever it was, but I didnt sense anything. There were some comments that (the district) was drawn for Mike Conaway, but that was just serendipitous. You know, Id just run in that special (election) to replace Larry Combest at exact same time the redistricting part was going on, and I just happened to be at the right spot at the right time. But you're right -- (Tom) Craddick said openly there will not be a new map unless there is a district that Midland-Odessa can be competitive in -- not that win it, but competitive. I benefited from that, but I had to be at the right spot at the right time.

MRT: Has conservatism changed from 2004 to today?

CONAWAY: I think so. It was more fiscal conservative in 2004-05 when I first got there. I remember we would agonize over $100 million here and there, and now, they're throwing $460 billion at this $2,000 check thing with hardly any analysis at all. And it's gonna go to folks who are totally, totally unaffected by COVID. And they're going to get four grand to the family. That would have never happened with Tom Delay out there. We simply would never have done that kind of a shotgun approach. He would have tailored it to the folks who lost their jobs and that are legitimately impacted by what's going on. Theres not a federal employee who has missed a paycheck, but those making less than ($75,000) are going to get a $2,000 bonus, and I'm not sure if that makes sense. Because it doesnt. The life issues are probably the most defining between conservative and not. That line is sharper today than it has been. I think we're more polarized now than we were when I first got there. Maybe it's just because, we know more about partial-birth abortions today than we did in 2004, at least I do. And all the heinous things that goes on around late-term abortion that some of my colleagues vehemently defend the violence in the womb. And so, yeah, I think it's different. It's morphed into a less, fiscally conservative than it was in 2005.

MRT: Which is made it more difficult to effectively represent District 11, cable news, talk radio or social media?

CONAWAY: Social media, hands down. You know, talk radio and cable news, they have a bit of a governor on them. I mean, you can't publish in your newspaper, something you know to be untrue or something that you've gotten that you have not tried to find the truth on. Well, social media has no governor, no filter and no restraint on it whatsoever. And so, you get these crazy conspiracy theories that pop up out of nowhere, and you start asking Wheres that come from and they say social media. Well, who is the knucklehead sitting in his mother's basement that pitched that conspiracy idea and does he have any credentials at all? I think social media is tougher. We are better today at finding those who are using divisive tools than ever, and I think social media is the most divisive tool we have.

MRT: What is the impact of Donald Trump on the Republican Party?

CONAWAY: Well, obviously, from the votes he got its positive because he got more votes than any Republican ever got and he's also broadened the tent. Like I said were probably not as fiscally concerned as we previously had been. You know it was disappointing that he really didn't want to take up Medicare or any of the big financial drivers that the leadership is going to have to come out of the White House to actually fix the mandatory spending problems that we have. And he didn't seem to be as concerned about that as Republican leaders in the past have been. I think hes had impact that will make it easier to spend money we don't have than maybe under previous presidents.

MRT: Why is August Pfluger the right person to lead District 11 into the future?

CONAWAY: Well, one, he out-worked anybody else in the field. I didn't endorse anybody, but I offered to help everyone of them, and August took me up on it. And he would say, Hey, who do I need to talk to in this county or this town and I gave him a list of names and would have given anybody a list of names. And I'd go back by there and somebody was like Hey, I just talked to August Pfluger or Hey, Im about to talk to August Pfluger. So, he outworked everybody else in the race by head and shoulders. And it showed because he won without a runoff. That work ethic that he demonstrated there looked similar to the work ethic that I tried to put in for 16 years, making the rounds and doing the job that was supposed to get done. Second off, he's a super smart guy. Hes got a good background in the military. And that's becoming less representative in Congress. So, it's good that to have a veteran -- I'm a veteran, he's a career veteran its good to have that perspective in Congress as well. And he's just good people a good, decent God-fearing man with a terrific family. And so, I've got really, really high hopes and expectations for him to surpass whatever it is I might have been able to do in these 16 years during his term.

MRT: What advice have you offered him about being the representative of an entire district?

CONAWAY: Well, that was it. That's it. The folks in Mason County, all 5,000 or 6,000 deserve your attention as much as the folks in Tom Green County. And they need to be able to see and talk to you and have the access as those in counties where you get most of your votes. Make sure you're making the rounds. And then, if I was on the phone with you right now -- based on my last walking off that floor Monday night after my final vote -- would be to just savor every single moment. Because nobody gets to go forever.

See the original post:
Do a job worthy of the peoples trust in you. - Midland Reporter-Telegram