30 Dec 2014

CAN/ COULD AND BE ABLE TO


I've never been able to... scuba-dive

I really wanted to learn. Maybe it was because of that scene in one of the very first James Bond films, where a beautiful actress comes out of the sea looking fabulous, with oxygen bottles on her back- I could see myself looking just like her. So, two years ago I booked a holiday which included a week's intensive course. On the first day of the course I was incredibly excited. First we had two hours of theory and then we went into the sea to put it into practice. 
But as soon as I went under the water I discovered that I suffered from claustrophobia . I just wasn't able to do it. After about half an hour I gave up . Every evening for the rest of my holiday I had to listen to my scuba-diving classmates talking about all the wonderful things they had seen that day on their diving excursions. Not being able to join the conversation was very frustrating.

I still love swimming and snorkelling, but I think that I have to accept that I will never be able to scuba- dive.



Learn do dance

I have always  wanted  to dance salsa, and when I was working in Ecuador there were free classes, so I joined. But the art of salsa, is to keep your arms still and move your hips, and I just couldn't do it. When I hear music my arms start moving, but my hips don't. 

After about ten hours of classes I was able to dp the basic steps, but I was dancing like a robot! I didn't give up, but soon everyone in the class was dancing and I was just slowly moving from side to side and counting out loud 'one, two, three, four" I was a bit embarrasing. I was sure that one day I would suddenly be able to do it- but that never happened. I can still remember the first two steps and I still try to dance when I hear a salsa tune- as long as nobody is watching!

...................

...... speak Japanese
Complete with the correct for of be able to (+,-,?).

Her mobile has been switched off all morning, so I haven't been able to talk to her yet.

I don't like noisy bars. I like to be able to have a conversation without shouting.

I 'll be able to leave home when I get a job.

We are having a party next Saturday. Will you be able to come?

You need to be able to swim before you can in a canoe.

I'm going to France next week, but I don't speak French. I hate not being able to communicate with people.

Fortunately, firefighters were able to rescue all of the people trapped inside the burning house.

I am very sorry, but we won't be able to go to your wedding next month. We'll be on holiday.

I'm feeling a bit worse. Have you been able to contact the doctor yet?

The manager isn't able to see you right now because he's in a meeting.
 



PRESENT CONTINUOUS

PRESENT CONTINUOUS TENSE
There are three main uses of the present continuous relating to our topic of talking about the present. 
The main use of the present continuous is to talk about actions or events that are temporary, not permanent, and actions or events that have started but are not finished.

a) these may be actions or events taking place at the moment of speaking, e.g. He’s playing football.
b) or they may be actions or events taking place around the moment of speaking but not necessarily in progress at the time of speaking. Also actions or events that take place for a limited period of time.
 They are selling everything for half usual price this week.

2    We also use the present continuous to talk about changes and situations or events that are developing even though the process may not be temporary
They are increasing the production of food because of the growth in the population. 

3   And the present continuous is used with particular time expressions (forever, always, constantly, continually) to talk about habitual actions. We use the present continuous when we want to show that the action is annoying or to stress the repetitiveness of the action
He’s always leaving the fridge door open.

We usually don’t use the present continuous with state verbs regardless of whether the state is permanent or current or temporary. For example, we can’t say: I’m not knowing the answer.


24 Feb 2014

Germs and Bacteries


This is a blog under construction, we are working on it! Thanks.
Este es un blog en proceso, estamos trabajando en ello. Gracias.
És un blog en procés, hi estem treballant. Gràcies.





Hi, this is a video about Germs and Bacteries.
Este video habla de gérmenes y bacterias

You will find attached the link to it and the transcription just below.
Os dejo el link más abajo y podréis ver los subtítulos de la transcripción.

It may help your kids to learn some English words eventhough the pronunciation is quite a hard one and the speaker goes really fast.

Es un video interesante sobre gérmenes y bacterias, y puede ayudar a los niños a familiarizarse con palabras nuevas en inglés a pesar de que el protagonista habla muy rápido. 

Enjoy it!!
¡Espero que os guste!


http://www.youtube.com/watch?v=XD8MAl-HsBw


Transcription:

Hello guys, glad to meet you!  Do you know who I am?  I'm part of an army that's everywhere.  What? You don't see us around you!  Ah! We're very very tiny!  You can't see us with open eyes.  You can only see us under a microscope.  But we're everywhere, on the door knob...  ... on the table, on your skin, everywhere.  We're also called microbes, as we can only be seen under a microscope.  And some people call us germs too. 
"Germs", yes, "germs", we can cause many diseases. Eh! Stop! Don't run away! If you wanna avoid us... ...first, understand us! The more you understand us, the more healthy you can be.GOOD! First, let me show you my body. I'm a little complex. But let me tell you in a very simple way. My outer shell has got a capsid; it's a protective protein coat. Inside, there is nucleic acid. It can be RNA or DNA. Confused, ok! Let me be more simple. I have an outer coat and some material inside called NUCLEIC ACID. How do I make a person sick? Ah! let me tell you a secret. When we enter the human or animal bodies... ...I make copy of myself. That means I multiply myself. Let me show you how I do it! A virus like me can enter your body through you nose, mouth or from broken skin. After that we enter your body cells, we remove our coat... ... then our nucleic acid gets mixed up with human body cell manufacturing factories. And then, we do our dirty magic. Your body cell then starts making copies of us. Yes, human body cells starts producing viruses. These viruses then start attacking other human body cells. And that is how a virus makes you sick. Hah! Hah! Scared again! Don't worry; we can't make you sick everytime we enter your body! Your immune system has white blood cells. They're like police for guarding your body against us. Once they find or see us, they whistle and they name us antigens. And they send antibodies to kill us. Sometimes, you get a fever! Your body temperature goes up ... ...and your viruses are killed due to hot temperature. So a fever can protect you from viruses. Yes, you can also get vaccinated! Vaccines produce a lot of antibodies in your body! And when we enter your body these antibodies help your immune system to kill us. And yes, you can avoid us! You should always wash your hands! You should cover any wound with a bandage! And you should not shake hands with somebody who is already sick Common cold, chicken pox, flu, cholera, yellow fever... Hi guys, I am bacteria. You find us everywhere. We help you a lot. The yoghurt that you eat, we help you to make it! The nitrogen is fixed in the soil by us! We are also in your digestive system. We help in digesting the food! We are very tiny! Like viruses, we are also called microbes as we are too small and most of us can only be seen under a microscope. Few people call us "germs", but that is wrong! We are so helpfull! We should not be called germs! Yes, a few of us are bad, but most of us are good for humans. Let me tell you a very strange thing about us. Strange yes! You know, we also have a target in life. We just want to double, we keep doubling, doubling and doubling! This way we keep increasing. Now, a few of us are really bad for you. Bad bacteries are called "pathogens". They cause a lot of diseases! Pathogens can cause pneumonia,tuberculosis, cholera, plague, rickets... ... and more. Bacteria can enter your body through your nose, mouth or from broken skin. Hah! hah! Scared? Don't worry! We can't make you sick every time we enter your body! Your immune system has white blood cells; they are like police for guarding your body against us! Once they find or see a bad bacteria they whistle... and they name us antigens and they send antibodies to kill us. Sometimes you get a fever! Your body temperature goes up! and enemy bacterias are killed due to high temperature! So fever protect us against from bacterial infections. Yes, you can also get vaccinated! Vaccines produce a lots of antibodies in your body..., ... and when they enter your body these antibodies help your immune system to kill bad bacteria. You can also take antibiotics and capsules. They kill the enemy bacteria! And yes, you can avoid us! You should keep washing your hands! You should cover a wound with a bandage! And you should not shake hands with somebody who is already sick! 







20 Feb 2014

ELVIS PROJECT WITH DOLPHINS

This page is under construction...



This is an interesting video about the Elvis Project. ( a project to shed new light on a feeding method for Dolphins)

See video and my transcription.

Further information on the project.

ELVIS system

This is a video about the Elvis system. The objective of this study was to shed new light on a feeding method first observed in wild dolphins on the Little Bahamas banks known as “crater feeding” or benthic feeding. 
The ELVIS, which stands for Echo-Location Visualization Integration System, included a 4-by-4 hydrophone matrix mounted on fabric. 
A controlled, simulated foraging arena was set up in a pool. 
The ELVIS system was buried under a layer of about 5 cm of fine coral sand, and three identical objects (targets) were made from PVC tubing. 
Each target was filled with 3 iron nails to make their sonar target strength (the target strength of PVC is known to be very weak). When buried, the PVC tubes filled with water, made a hollow in the sand. This allowed two hypotheses concerning what cues the dolphins might use to find the buried fish in the wild to be tested: 
One was the echo of the fish/object itself and  the other was the echo of the hollow in the sand created by the fish’s body.
A number of 25 sessions were carried out with three animals (all male) allocated to participate. The preliminary conclusions were that all three dolphins used their sonar intensively when they tried to find the objects, whether they were partly or completely buried in the sand, and that they had obvious problems finding them even under only 5-10 mm of sand. 
It is important to mention that these dolphins were inexperienced with sonar seabed exploration. They had never been asked to perform such a task before; instead they had trained to pick up objects on the surface of the seabed, which is an easy task compared to locating buried objects. 

16 Feb 2014

POLIO OUTBREAK IN SYRIA

View this content on Dotsub's website







Os adjunto de moment la transcripció d'un vídeo sobre un brot de Polio a Siria.
Os adjunto la transcripción de un video sobre un brote de polio en Siria.

http://dotsub.com/view/673a0feb-a299-41d1-bc6b-c8e96a57c4d7

Per si ho voleu seguir millor aquí teniu la transcripció per poder-hi marcar les paraules que no enteneu.
Os adjunto la transcripción por si lo queréis seguir mejor y marcar las palabras que no entendáis.

Us animo a veure'l.
Os animo a verlo. Vale la pena!




"Two drops and many tears  protecting against polio,  one of the most devastating childhood diseases.  This government clinic is packed with parents anxious to vaccinate their children  Arishia has brought her two daughters.  "I feel sad for the children who got polio", she tells me.  But thank God we have the vaccines here.  This centre in Damascus has some of the best health care  there is in Syria.  The families here know it's safe to bring their children  It's not the same across the rest of the country.  Syria used to be polio free since the late 1990's.  And now in the Northeast in the area torn by fighting...  ...there are at least ten confirmed cases,  and fears that they could be more.  Some of those cases were brought here  to the children's hospital in the capital  They've been discharged, but the hospital is on alert  for any children with possible symptoms.  Doctor Nidal Abu-Rashid oversees this process.  She is in charge of the Government Immunization Program  It's a sudden disease with a flu-like symptoms.  Children might become paralysed in one or both legs.  This is a huge challenge and I will fight until there is no more polio in Syria.  It's hard to fight this disease in the midst of war.  AID Agency says that half a million children need to be urgently vaccinated.  In some areas it is really difficult  to implement the door to door vaccination.  If we want to contro the outbreak, the campaign should be very short...  ...and very wide.  And this is the real problem that we are facing.  We don't have access to all the high risk areas.  Under growing pressure, Syria's Deputy Foreign Minister called in the press to highlight the humanitarian crisis.  Syria is responsible for every child, he said.  To ensure that every child is vaccinated against polio,  is the government prepared to do everything possible...  ...including in some areas working with the opposition?  As far as the cooperation with armed groups, with terrorist groups  We believe they have to accept that this medicine should reach each child.  And usually we asked the United Nations Organization in Syria to make the necessary contacts.  And we shall help in this direction.  To protect their children AID agencies are calling on all sides to ceasefire to allow vaccinations The opposition accuses the government of blocking in medical aid  to areas to their control.  This disease spreads fast and with thousands of Syrians crossing borders every day...  ... to escape the war, polio threatens, not just Syria.  Lyse Douset, BBC News, Damascus." 






15 Feb 2014

Britain's education problem








Britain’s education problem


Transcription
The Isle of Wight, on the South coast of England, has long been an idyllic summer getaway. To many it is known best for sailing regattas and music festivals, but the Island is one troubled spot in a particular national trend. It has some of the worst performing schools in England.
Last year they were judged to be so bad that the nearby council county of Hampshire was invited to intervene, an unprecedented step.
“When we began to get involved, probably only about one in fourteen of secondary age children on the Island were going to a good school. Attendance in schools, particularly in secondary schools was frankly disastrous. Way worse in the country.”
The Isle of Wight is not unique. England’s worst schools use to be urban, overwhelmingly poor and black or sometimes Asian. Today the worst results are seen in suburbs, market towns and on the coast and particularly among poor, white children.
“When I first started teaching, the great concern was children who would have come to England and were speaking English as another language, as one of their additional languages.   And at that time, those children were performing really badly. There has been a transformation in the last twenty years. Additional language children are achieving better than English only speaking children, which is quite a shock.”
In GCSEs, the exams usually taken at sixteen, poor white British pupils get the lowest grades.
Nationally, 59% of pupils in England got 5 good GCSEs including English and Maths in 2012. Affluent white pupils get similar results, but just one third of white British children who qualified for free schools meals, a proxy for measuring poverty, achieved that level.
That yawning gap in performance is the widest of any group. Poor white pupils have been struggling for some time and the government is increasingly aware of the problem. Solving it demands an understanding of why it is so bad.
“What we have seen in some of the rural areas, you have seen a performance not move on the way that everybody wants it to. Number one, maybe we haven’t resourced those areas in the same way. And two, we haven’t had the education effort that you might have seen in London when people really, not just the schools, everybody got behind the endeavour of a driving up education as a core, element of regeneration of economic progress of everything, social regeneration of a community and that collective effort hasn’t been evident in some of those areas yet.”
The Isle of Wight, which is neither very rich not extremely poor, but it is certainly white and isolated exemplifies the problem. There students performs 15% percentage points below the national average.
Yet even on the Isle of Wight there are success stories. Pat Goodhead is the headmistress of the Christ the King College, a state secondary school on the Isle of Wight that is defying expectations.
Christ the King is the only school on the Island to be rated good by OFSTED, the schools’ inspectorate.
When it predicted high grades for its pupils the local authority said that their forecast were unrealistic, in fact the school exceeded them, closing a gap that persists elsewhere.
“The headline figure they outperformed by the 20% any five A to C figure that the Island had ever seen but nationally put these students’ performances in the top category across the country. Our free school meals children all are performing as well as and sometimes better than the non-free schools meal students. They are doing very very well indeed.”
The school is doing what decent schools everywhere do. Education is focused on each pupil individually.
“I have staff who takes specific responsibility for knowing who our free school meals children are, who the children are who might be going through difficult personal circumstances. So it is not about larger teams, it’s about the right teams, the right people, the right support for those people as well.”
In general, poor children do best in schools where they are either very few or very numerous.
Most ill-served are those in places such as the Isle of Wight were there are too few to merit much attention but too many to succeed alone.
The pupil premium, money given to schools on the basis on how many pupils qualify for free school meals has helped some but it is far from a cure-all.

There isn’t a binary relationship between more money better results. But if you get more money and you use well, use it the way that evidence demonstrates that you get the best effect, then you can see progress.
Places such the Isle of Wight might look at east London for inspiration.
Bangladeshis, who are concentrated in the London borough of Tower hamlets, the third most deprived place in England, now do better than whites nationally, whether or not they qualify for free meals. This success came from a concerted effort by educators, parents and local institutions.
It’s well known that in the very best schools, underachievement by students is taken very seriously, so the student begins to underachieve, something is done by the afternoon or next week,  in the worst schools people simply  to wait to Christmas to see if things get better.
One of the things we are trying to do is to put the systems in place that leads to really good assessment, tracking of student progress, interventions, so on and so forth.
In my experience I have never met a parent who does not want the best for his or her child, but I have met parents who don’t know: a) what the best could be and therefore don’t recognize the absolute potential of their child and how well they can perform and secondly and linked to that, what they can help and support that child.

Raising standards for this latest of group of poor performers may come down to ensuring that they have faith in the opportunities that education can bring. 

5 Feb 2014



DRAFT


Phrasal Verbs


A put-up job: Chanchullo. To put up  an attempt to trick or deceive someone

Put up: hospedar. 

Come up with : To suggest or think of an idea or plan.

get by:  to be able to live or deal with a situation with difficulty, usually by having just enough of something you need, such as money:

We can get by with four computers at the moment, but we'll need a couple more when the new staff arrive.


look up:  to  admire: 

3 Feb 2014





NODDY

Transcription


It’s a bright sunny day in Toyland and Noddy is trying to decide what to do.
-Hello car, we have been busy all week and today I don’t want to be busy, in fact I want to fly my kite.
-And look at this weather, it’s perfect for a kite-flying day!
-Hello Big Ears
-Hello Noddy
- How would you like to stop by my house for lunch today.
- Well, you see, this is my Kite flying day. So I was going to fly my kite.
-Oh, please Noddy, you will be so nice
-Oh ok Big Ears.I’ll be there.
- I knew you wouldn’t let me down.
-Goodbye Noddy.
-Oh, hello Mr. Sparks, what are you doing here!
-I am very busy this morning Noddy.
-Could you deliver this package for me?
-Well, today is my kite-flying day but maybe I can help.
-You can, really, here, this engine part needs to go to the train station. I can do that Mr. Sparks.
- Thanks Noddy!
- Well car, let’s go and deliver this package first, then after that we will fly my kite.
[Song Lend a hand]
-Hi Dinah Doll, how is your painting coming along?
- Uff, it’s more work than I thought Noddy. I only wish I had some help!
- Well, this is my kite flying day Dinah, but maybe I can help.
- Wow, thanks Noddy.
-This is kind of fun.
-Oh dear, I have borrowed this torch from Mr. Sparks. I must give it back to him today. Will you keep painting while I am gone!
- Of course Dina.
- Mr. Sparks will be glad I gave this back to him. Bye.
- Mr Sparks, oh no I forgot to deliver its package. I have got to deliver it now.
- Sorry Big Cat, you can’t use this road today, go round please.
- Mr. Plod, what are you doing in the middle of the street? This street behind me is being repaired. So I have to keep everyone from using it. The only problem is that I am supposed to be at a town meeting now!
-Maybe at could help.
-That could be just fine Noddy.Thank you very much!
-All you have to do is blow this whistle and keep the cars and people away from going down there.
- Sorry, this road is closed for now, please walk around. Thank you!
- Oh Noddy, I ‘ve got a great big great dilemma!
- Sorry Ms. Skittle, if it is so big, how come I cannot see it!
- Because a dilemma is a problem! And my big problem is that I need to pick up my children but if I do I won’t have time to do my shopping.
-Maybe I could help! After all, that does not seem to be traffic right now.
- Really, Oh thank you Noddy. Now, here is my shopping list, ok? Bye, Bye
- Well, here is the market, car! I’d better get shopping! There is a lot to buy!
- Oh, Noddy Am I glad to see you! I need to go to the bookshop. But I also need to take Bumpy Dog for a walk!
-I’d be glad to help Tessie Bear.
- You are so helpful Noddy. Thank you!
-Well, got to go! See you later!
- Goodbye Tessie Bear.
- Bumpy Dog, no, not bumpy, does not a bone!
-  Stop Bumpy Dog, come here! Come back!
-I will take that back, thank you!
- It is lunch time, I ‘m supposed to met Mr. Big Ears, oh no, I have to shop for Mrs Skittles, Oh no I have to deliver this package for Mr. Sparks!, Oh no, I have to finish painting for Dinah Doll, Oh, no I have to direct traffic for Mr. Plod.
-Big Ears, is it something them matter?
- I was looking for Noddy.
- He was supposed to meet me for lunch today!
- Oh, I know where he is!
- He is helping me!
- No, he is helping me!
- No, he is helping me!
- Excuse-me, did I hear you saying that Noddy is helping you three?
- But he is helping me!
- You!
-If Noddy is helping you, you,you, you and you, then who is helping Noddy.
-Let’s go and see what is going on!
- I am sorry but none can go down the street today.
-Stop, Stop, please stop!
- So Noddy, how are you enjoying your kite-flying day.
- It never became a Kite flying day!
- I tried to do too much and now everything has gone wrong!
- I am very very very sorry!
-That’s all right Noddy, you were only trying to help.
- Yes, help everyone.
- We should do our own chores anyway.
- I will deliver the package myself, Noddy.
- And I will do my own shopping.
- Maybe I tried to help to many people at the same time.
- Yes, you meant well, but when you try and help everyone, you sometimes don’t help anyone.
- Wow, do I know that now.
- So now that you don’t have to help anyone anymore. What are you going to do next?
I’m going home and for the rest of my kite flying day I will fly my kite right after and now.





This time this is a video about Camden, a suburb were cost of health care is very high and where an initiative is taken place to lower down this cost.

Aquest vídeo parla sobre Camden, un barri marginal on s'intenta reduir el cost del serveis sanitaris.

http://www.pbs.org/wgbh/pages/frontline/doctor-hotspot/







Camden, New Jersey, sits in the shadow of Philadelphia

It’s a city that seems in a constant state of peril. Poverty here is rife; unemployment is double  the national average, public institutions are in crisis, or, like the local library, simply shuttered.
It’s officially one of the America’s most dangerous cities.

But Camden may also be the city to help solve one of the America’s most intractable problems: lowering the cost of health care.

As a Doctor and writer for the New Yorker, I came here to meet the local physician, who began to figure it out.

It all started ten years ago, with a shooting.

I was working in my house one evening, heard gun shots, then got a call from a neighbour, so I went running down the street. The police had got there already, so I ran up and said, you know I am a physician, where is the victim? And they all sort of turned around and said it’s over there.
[Where is the location]

He was lying on his side facing the backtyre, and he had a pulse, he wasn’t breathing, I started rescue breathing, eventually his pulse stops. So, I was just pretty overwhelmed by the whole thing and angry and …”

You were angry that they hadn’t been even tending to the victim.
You know, why didn’t you guys help him?

And the police officer said, ’We didn’t want to dislodge the bullet.’ I mean it was just a complete blow off.
And I couldn’t imagine how we could have reached the point in our society in this city where you would just leave a victim lying there on their own blood.

He was a Rutgers’s student and he was close to graduating. You know he was one of the wonder kids that make it out of urban communities and here he was just about to make it out.

Brenner's immediate response was to get involved in police reform; he thought if he could get a hold of crime statistics, he could map hot spots he places where good policing would make a difference. But the department wasn’t interested in helping a local doctor, so he went to another place one he knew well, the Hospital.
There, buried in billing records from the ER where violent assaults get treated, he found crime patterns as he crunched the hospital data, Brenner discovered something totally unexpected: other kinds of hot spots.
It became clear that there were hot spots of everything; they were hot spots by disease, hot spots by patient. There were certain patients who had been over and over and over going to the emergency room and hospital too much. There were hot spots by the zip code and by neighbourhood and, so you sit and begin to look through the data and I am looking at my patients, who are in the data and realizing I had no idea how much health care cost. I had no idea how expensive it was. I was just shocking.

Brenner says that the numbers show that 1% of people living in Camden accounted for 30% of hospital charges. Most of those racked up in the emergency room.
-Compiling all of this information coming from all of the hospitals in the local area.
-Compiling massive amounts of data so…..

Brenner then turned that raw information into visual information:

-So this is a map of the city of Camden and this is looking at cost data, so the red areas are high cost hot spots, these are parts of the community were  people who have more than a million dollars in payments to the hospitals live and this is over a five year period .
-So here you pulled out the two most expensive city blocks.
-Yeah
-That you found in your community there are two buildings that are the most expensive places.
-That’s exactly right. The building on the bottom, Abigail house is a nursing home and the top Northgate is an apartment tower with elderly and disabled people.
-83 million dollars in bills, that is prime more than the cost of the building,
-yes, yeah…
-This being America where we all demand the best that medicine can offer. They might assume that at least for the money, the residents were getting good care.

But Brenner found the majority of the care for chronic diseases from asthma to cancer to diabetes was being done in the ER. Not a good place to treat chronically ill patients.

Treatment was not coordinated; follow-ups were not part of the plan.
It was really obvious in the data that the most expensive people were getting terrible care and I knew them so I’d walk in the exam room and say Mrs. Rodriguez, I haven’t seen you in three months, where have you been?

Well, I have been in the ICU for a month and a half; I have been in the hospital for another couple of weeks. And said what happened? Well, she’d say I’m not really sure, lot of doctors came in the room, they never really explained anything to me but I’ve got this whole bag of medicines so…
American health care does not do a good job taking care of sick people.
The way we built our system is really a system that is very hard to access. I works well for the average patient but if you are blind, if you are deaf, if you are disabled if you are in a wheelchair, if you don’t speak the language, if you development late, if you have a complex mix of illnesses with many providers involved, the whole system starts to break down.

Brenner’s big insight was to use his data to target the sickest and most expensive patients in the city. In 2007 supported by small grants from foundations he put together his team of medical hot spotters.
The most visible part of the Camden coalition of healthcare providers are these nurses, social workers and medical assistants.
Three years later his team of trouble shooters has sorted out an organized care for more than three hundred of people.
When I visited, Cathy Jackson was making a house call to one of her most challenging patients: Derek.

-Do give me the briefing on Derek because I haven’t met him.
-Derek is in his thirties and has seizure disorder and there’s other problems which gets him in the hospital most of the time, there’s asthma It’s always an issue, he is always wheezing and the house isn’t … it’s dirty, it is dusty, allergies, all kinds of triggers. So we took a contractor there and the contractor said that he really wouldn’t want to be liable to fix it up because he’s afraid it would actually like crumble.
-Hi Derek how are you doing!
- All right!
-Yeah-
-I am Atul Gawande; I’m a Doctor from Boston but also a writer. So Derek you had a number of hospitals stays and emergency room visits because of asthma I hear. What happens when you have an asthma attack? I start wheezing , my lungs are actually you know it is like a  rubber band  it closes up like really tight and it is really hard for me to breathe . We think that the house is probably part of it, with the dust and the open walls.
-Would you mind Derek if I have Cathy to show me around the places in the house that she thinks might be contributing to your asthma.
-Yes sure.
-Ok. It would be great if I would like to see for myself.

Before Cathy started working with him, Derek was in the emergency room thirty-five times over six months.
-That cannot help your asthma.

Cathy’s work with Derek includes everything from inhalers to insurance to finding a contractor willing to rehab the house.
-Are you ok Derek?
-Why don’t we just say: Derek, fix your house, you have got this and that falling apart.
-His family probably lives on about a thousand dollars a month, so they are not really capable, they barely able to make against me.
-Without the team, Derek didn’t have any help with another medical problem: epileptic seizures.
-What are all the crosses?
-This helps me you know in case I have epilepsy.
-How does this help you?
-Just I start praying, that is all.
- Oh yeah!
- That’s all!
-Have you had any seizures recently?
-No
- How long has it been? A week, a month.
-A week. I feel more comfortable with Cathy Jackson than the Doctors and nurses in the hospital. You know, I can tell Cathy, my problems, you know, wheezing and stuff like that. She checks me out, you know hear my lungs, you know, talk to me…
-Always you here some wheezers but you  are moving a pretty good air, so that’s good.
-She is the one that keeps me out the hospital.
- You are going to come back in one month. June 13th at eleven o’clock.

Under Cathy’s care, over the last six months, Derek ER’s visits have been reduced from thirty five to just two and Brenda thinks that they can do even better if he can get other people from around the city to think as a hot spotters.

We inform that this is the beginning to see how agency by agency how we can pull it together for the most challenging cases.

Every month the whole city comes together from line providers, social workers  and we anonimus case discussions at the city level. When someone like Derek shows up at one of the emergency rooms they call us right away.
-…………….None in April and only one since May.
-So how much has your team been able to lower the cost for this really expensive group of patients.
- So we have seen some preliminary results a 40 %  to 50% reductions in visits  and costs.
- 40% to 50% reduction in costs.
-In costs and visits.

The savings are hard one and it takes persistence.
-Mr….. it’s  Kally in here from the coalition.

You can’t completely alter people live’s circumstances.
We are not going to cure poverty.
The question is how can you take the present current situation at a patients end and improve enough  to make people a little bit healthier and lower their stay at hospital and have a more productive interaction with the Health Care system.
This idea of focusing on the ……to lower cost seems to be working here in Camden but there are hot spots in every community.
What if we put this idea and put it in play across the country. It might just work but there is a cash.
How would the medical stumbles reaction , suddenly the more expensive and lucrative patients started to cost half on what they do now.

As this kind of experiment works though you are talking about dropping the number of hospital visits as a whole. 

You are talking about removing people from the Emergency rooms.  They could have to shutdown floors and beths. They are not going to be with you on that aren’t they?

This kind a work as a game changer and this is a blockbuster video moment for America's Hospital.

What do you mean by a blockbuster video moment?  Along comes Neflex and they had the moment when a young come in and said starting to rent blockbusters videos on line and they said, no,
People are coming to the video store, we are not going to make any change.
Disruptive change cames along and I think better care for sick people is disrupted change.
We haven’t inflated a capacity bubble in our country to do expensive hi-tech Hospital basic care.

So what’s is your ultimate goal here?

I would like to make Camden the first city that bends the cost dramatically while improving quality.
Because if a poor city in the country can do it, it makes the rest of the country look silly.