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Viewing: Blog Posts Tagged with: health, Most Recent at Top [Help]
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1. 9 Things to Make Your Life a Little Better…

Happy Spring everyone! Since this season is all about new growth, renewal, and fertility it’s only fitting that I share a post that reflects the promise of better (and brighter) days ahead. The following is taken from a Hallmark® birthday card I received from my mom this year. Trust me it’s worth the read, and guaranteed to put a smile on your face…

Trust your instincts. If it doesn’t feel right, it probably isn’t…fun, tempting…maybe, but not right.

Remember your manners. It doesn’t cost you anything, but speaks volumes about who you are. Having CLASS starts with this.

Never let possessions “own” you. It’s just STUFF! The most valuable things in life—friends, respect, love, knowledge—don’t cost money… Hokey, but true.

Nurture your friendships. The investment you make in true friends will pay huge dividends all your life—remember, you can’t make an old friend.

Keep your hands clean. This is meant both literally and figuratively… It will save you a lot of regrets later…

Believe in yourself. Another hokey one, but you DO happen to be the only YOU in existence, and you’re also the only person in the world who can TRULY hold you back in life…

Be grateful. Don’t waste all your todays in anticipation of some grand tomorrow. NOW is all we’ve got. Live in it!

Treat others the way you want to be treated. Just because you’re smarter or richer or prettier than someone else doesn’t mean you’re BETTER. It just means you’ve been more blessed.

Always keep playing. Who says adults have to give up toys? Keep the little kid inside you alive… it keeps your imagination primed. Silly is good. 

I’m kind of partial to the last one! Thanks a heap for reading my blog. If you have time, please leave a comment and share some of the things that have made your life a little better. Cheers and have a great week!

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2. Guest Post: Top 10 Foods to Improve Your Memory by Sara Daniel...

Most of us are probably not going to end up with amnesia so severe our memory of the past ten months is completely wiped out as happened to my heroine Gwen in Loving the Amnesia Bride. However, if you’re anything like me, you walk into a room intending to do something, which had to be important since you went there with a purpose. But now you’re standing inside the doorway with no earthly idea what you walked all the way across the house to do.

Or you’re all ready to run some errands…if you could just find where you left your darn car keys. Really, how far away could they have disappeared in the two hours since you last drove the car??? Clearly, it’s time to address the problem. And the problem is not the keys.

Below are ten foods which have been scientifically proven to deliver health benefits to your brain—improving memory, focus and concentration. So, let’s start eating!

1. Blueberries – All berries are good options, but blueberries are the superhero food choice! Blueberries protect the brain from oxidative stress and may reduce the effects of Alzheimer’s, dementia, and premature aging.

2. Salmon – Salmon is high in Omega-3 fatty acids, which are essential for brain function.

3. Broccoli – Broccoli has nutrients for healthy blood flow, protection against free radicals, and removes heavy metals that can damage the brain.

4. Beans/Legumes – These excellent sources of complex carbs and fiber provide a steady supply of glucose for the brain without the risks of sugar spikes. They are also packed with folate, a B vitamin critical to brain function.

5. Avocados – Although high in fat, the avocado is a monounsaturated fat, which promotes healthy blood flow to the brain. Their antioxidants protect the brain from free radical damage. They also contain potassium and vitamin K, which protect the brain from the risk of stroke.

6. Pomegranates – Either the seeds or the juice will do, protecting the brain from free radicals with their strong antioxidants.

7. Sunflower Seeds – These, along with other seeds, are packed with protein, omega fatty acids, B vitamins, and tryptophan, which the brain uses to boost mood and combat depression.

8. Whole grains – If you’ve ever bought whole grain bread, the advertising on the package probably shouted that whole grains reduce the risk of heart disease. And if your heart’s healthy, that’s good news for your brain.

9. Almonds and other nuts – Nuts are extremely good for the brain and nervous system. High levels of vitamin E protect against dementia and cognitive decline by protecting the brain against free radicals and improving brain power.

10. Chocolate – Chocolate, especially dark chocolate, has strong antioxidants and can improve concentration and focus. It also stimulates the production of endorphins, putting you in a good mood. 

Now, excuse me while I munch on some chocolate-covered almonds and look for my car keys!

  Sara Daniel writes what she loves to read—irresistible romance, from sweet to erotic and everything in between. She battles a serious NASCAR addiction and was once a landlord of two uninvited squirrels. She lives her own happily-ever-after romance with her hero husband, and she gets amnesia at least three times a day because she can never remember where she left her keys!

Learn more about Sara on her website and blog. Subscribe to Sara’s newsletter. Stay connected on Facebook, Twitter, and Pinterest.

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3. The third parent

The news that Britain is set to become the first country to authorize IVF using genetic material from three people—the so-called ‘three-parent baby’—has given rise to (very predictable) divisions of opinion. On the one hand are those who celebrate a national ‘first’, just as happened when Louise Brown, the first ever ‘test-tube baby’, was born in Oldham in 1978. Just as with IVF more broadly, the possibility for people who otherwise couldn’t to be come parents of healthy children is something to be welcomed.

The post The third parent appeared first on OUPblog.

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4. 5 Art Activity Books for Kids that are Meditative, Innovative, and Inspiring

Art activity books can serve as a wonderful meditative tool to help reduce stress, refocus and recharge the brain, and spark inspiration.

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5. Trains of thought: Sarah

Four people with radically different outlooks on the world meet on a train and start talking about what they believe. Their conversation varies from cool logical reasoning to heated personal confrontation. Each starts off convinced that he or she is right, but then doubts creep in. During February, we will be posting a series of extracts that cover the viewpoints of all four characters in Tetralogue. What follows is an extract exploring Sarah's perspective.

The post Trains of thought: Sarah appeared first on OUPblog.

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6. Dental Assistant Business Card Sculpture

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7. Time for a Bath, by Phillis Gershator | Book Review

Time for a Bath is a great way for kids to get excited about taking a bath!

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8. Nest, by Esther Ehrlich | Book Review

Esther Ehrlich’s debut novel, Nest, is an arresting story of an eleven-year-old girl named Chirp Orenstein, whose life becomes acutely sharp and complicated as her mother’s illness overtakes the family

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9. Cancer for Christmas

My wife sat at her laptop furiously compiling the lists for our four girls. She checked it once, then again while travelling to website after website scouring the internet for the best price and delivery. Items were added to baskets and carts checked out at such a frantic pace that I literally felt a warmth emanate from the credit card in my back pocket. Shopping at a fever pitch – Christmas delivered in two days or less. Not like most years, where she disappears for hours on end to find the perfect gift at the mall. She doesn’t have time for that this year because we got cancer for Christmas.

We dlistidn’t ask for it. It wasn’t circled in the wishbook or written in red crayon. No one sat on Santa’s lap and begged for it. No, cancer just showed up unannounced and took our year away.

So rather than spending quality time with each of the girls to weigh their enormous wants against our limited budget as in years past, she spent Saturday morning hunting and pecking under great duress. Do they have the right size? Will it be delivered on time? Is that really something she will use or should we just give her cash?

At some point during the madness, I asked her what she wanted for Christmas. She paused to consider. Her eyes got red and her mouth failed her. She didn’t answer, but I knew. I knew what she wanted the second I asked the question and Amazon.com can’t deliver it, even though we are Prime members. It is the only thing either of us want.

 

We want our baby to stop hurting.

We want her to stop having to face treatments that make her sick and waste away.

We want her legs to work.

We want her to be able to go to school… to run, skip and play like every normal 12 year-old girl should.

We want her to stop coughing.

We want her hair to grow back so people don’t stare at her.

We want normal family time – not garbled, anxiety-laden, jumbled hodge-podge comings and goings where one is sick or two are missing for yet another appointment.

We want to relax and not worry.

We want to give cancer back.

 

I’ll take one of those please, Santa. Any size will do. No need to wrap it up because if you deliver it, the paper won’t last long. Oh, and you can ditch the receipt, I won’t be returning that gift.

I know many people are dealing with heartbreak and struggles. While Christmas is a season of love and giving, it also seems to magnify pain and loss. We don’t have the market cornered on hurt. I realize that.

It’s just that my wife loves Christmas so much. She loves everything about it, from finding the perfect, fattest tree to decorating every square inch of the house in some form of red and green. She loves the sound of the carols (save Feliz Navidad) and the smell of the baking, even though she is the one wearing an apron. She loves that, for the briefest of moments, the world focuses on the birth of our Savior. She loves taking a drive to see lights on houses and staying home with hot chocolate around a fire. She loves spending time with family, watching It’s a Wonderful Life, reading the nativity story, and candlelight Christmas Eve services. She loves the mad dash on Christmas morning to see what Santa brought… the joy and wonder on our children’s faces. She loves it all.

 

 

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How do we do it this year?

Should we skip it?

Or should we cherish every moment together as the babe in the manger intended us to? Maybe, instead of focusing on what we’ve lost, we should hold on to the fragile remains of what we have – love, family, friends, and a newfound respect for the precious thing that is life. We should cling to our little girl, who, though frail, is fighting hard and encouraging others to do the same.

We aren’t alone. During the year, we’ve been welcomed into the country club no one wants to join – the childhood cancer community. While we are bound together by common tragedy, it is the warmest, most caring and wonderfully supportive group imaginable. It is the fraternity I wish I’d never pledged. Many of our new brothers and sisters are dealing with such incredible loss, and this time of year must certainly be crippling.

 

 

When referring to the promised coming of the child in the manger, Isaiah said, “…and a little child shall lead them.”

What if we took a cue from our little child?

 

Although she is the one feeling the pain, nausea, and side effects of cancer, she is also the one most excited about Christmas. Even though she only had the strength to stand long enough to put a single ornament on the tree, she admires the finished product and loves to be in the den where she can see it. She is the one who insisted on taking decorations out of town with her while she has to be gone for treatment. She is the one snuggling her elves, dreaming about Christmas morning, and soaking up every minute of the nearness of family and Christ at this time of year. She holds a compress on an aching jaw with one hand and draws up surprises for those most dear with the other. In a year of typically rapid growth for a child her age, she weighs 75% of what she did last Christmas, yet she samples whatever treats her nervous stomach will allow. While we fret over diagnosis and treatment, she savors joy, plucks smiles from pain, and builds a resume of contentment that few on this earth have ever seen. Perhaps she has it right and we have it all wrong.

 

Kylie hanging her favorite ornament

Kylie hanging her favorite ornament

Instead of looking to health and prosperity for our happiness, what if, just for a moment, we set aside our problems – however overwhelming, and looked to the manger, toward a child – with gratitude for his coming and a longing for his return? What if we laughed in the face of the enemy, knowing that we are wonderfully cared for and uniquely loved? What if we hoped, even when victory was uncertain? What if we dreamed of a better tomorrow regardless of what it may hold?

What if we smiled more…

This joyous Christmas, our family holds on to hope. Together, we look to the manger, to Jesus Christ our Lord for strength and healing. We dream of the day when there is a cure – for our child & every child. We pray that next year, not a single family will have to unwrap cancer for Christmas.


Filed under: From the Writer

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10. Relax, inhale, and think of Horace Wells

Many students, when asked by a teacher or professor to volunteer in front of the class, shy away, avoid eye contact, and try to seem as plain and unremarkable as possible. The same is true in dental school – unless it comes to laughing gas.

As a fourth year dental student, I’ve had times where I’ve tried to avoid professors’ questions about anatomical variants of nerves, or the correct way to drill a cavity, or what type of tooth infection has symptoms of hot and cold sensitivity. There are other times where you cannot escape having to volunteer. These include being the first “patient” to receive an injection from one of your classmate’s unsteady and tentative hands. Or having an impression taken with too much alginate so that all of your teeth (along with your uvula and tonsils) are poured up in a stone model.

But volunteering in the nitrous oxide lab … that’s a different story. The lab day is about putting ourselves in our patients’ shoes, to be able to empathize with them when they need to be sedated. For me, the nitrous oxide lab might have been the most enjoyable 5 minutes of my entire dental education.

In today’s dental practice, nitrous oxide is a readily available, well-researched, incredibly safe method of reducing patient anxiety with little to no undesired side effects. But this was not always the case.

The Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery argues that “with increasingly refined diets [in the mid-nineteenth century] and the use of copious amounts of sugar, tooth decay, and so dentistry, were on the increase.” Prior to the modern day local anesthesia armamentarium, extractions and dental procedures were completed with no anesthesia. Patients self-medicated with alcohol or other drugs, but there was no predictable or controllable way to prevent patients from experiencing excruciating pain.

That is until Horace Wells, a dentist from Hartford, Connecticut started taking an interest in nitrous oxide as a method of numbing patients to pain.

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Dr Horace Wells, by Laird W. Nevius. Public domain via Wikimedia Commons.

Wells became convinced of the analgesic properties of nitrous oxide on December 11, 1844 after observing a public display in Hartford of a man inhaling the gas and subsequently hitting his shin on a bench. After the gas wore off, the man miraculously felt no pain. With inspiration from this demonstration and a strong belief in the analgesic (and possibly the amnestic) qualities of nitrous oxide, on December 12, Wells proceeded to inhale a bag of the nitrous oxide and have his associate John Riggs extract one of his own teeth. It was risky—and a huge success. With this realization that dental work could be pain free, Wells proceeded to test his new anesthesia method on over a dozen patients in the following weeks. He was proud of his achievement, but he chose not to patent his method because he felt pain relief should be “as free as the air.”

This discovery brought Wells to the Ether Dome at the Massachusetts General Hospital in Boston. Before an audience of Harvard Medical School faculty and students, Wells convinced a volunteer from the audience to have their tooth extracted after inhaling nitrous oxide. Wells’ success came to an abrupt halt when this volunteer screamed out in pain during the extraction. Looking back on this event, it is very likely that the volunteer did not inhale enough of the gas to achieve the appropriate anesthetic effect. But the reason didn’t matter—Wells was horrified by his volunteer’s reaction, his own apparent failure, and was laughed out of the Ether Dome as a fraud.

The following year, William Morton successfully demonstrated the use of ether as an anesthetic for dental and medical surgery. He patented the discovery of ether as a dental anesthetic and sold the rights to it. To this day, most credit the success of dental anesthesia to Morton, not Wells.

After giving up dentistry, Horace Wells worked unsuccessfully as a salesman and traveled to Paris to see a presentation on updated anesthesia techniques. But his ego had been broken. After returning the U.S, he developed a dangerous addiction to chloroform (perhaps another risky experiment for patient sedation, gone awry) that left him mentally unstable. In 1848, he assaulted a streetwalker under the influence. He was sent to prison and in the end, took his own life.

This is the sad story of a man whose discovery revolutionized dentists’ ability to effectively care for patients while keeping them calm and out of pain. As a student at the University of Connecticut School of Dental Medicine, it is a point of pride knowing that Dr. Wells made this discovery just a few miles from where I have learned about the incredible effects of nitrous oxide. My education has taught me to use it effectively for patients who are nervous about a procedure and to improve the safety of care for patients with high blood pressure. This is a day we can remember a brave man who risked his own livelihood in the name of patient care.

Featured image credit: Laughing gas, by Rumford Davy. Public domain via Wikimedia Commons.

The post Relax, inhale, and think of Horace Wells appeared first on OUPblog.

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11. Does workplace stress play a role in retirement drinking?

Alcohol misuse among the retired population is a phenomenon that has been long recognized by scholars and practitioners. The retirement process is complex, and researchers posit that the pre-retirement workplace can either protect against—or contribute to—alcohol misuse among retirees.

The prevalence of alcohol misuse among older workers is staggering. In the United States, the rate of heavy drinking (i.e., more than seven drinks per week or two drinks on any one occasion) among those aged 65 and older is calculated to be at 10% for men and 2.5% for women, with some studies estimating the frequency of alcohol misuse among older (i.e., age 50 and older) as 16% or higher. Yet another study makes the case that 10% of all alcoholics are over 60. As a point of reference, the incidence of frequent heavy drinking in the workforce (US) is 9.2% and rate of alcohol abuse is 5.4%.

Estimates of future problem drinking and predictions of how prevalence rates may rise may be underestimated, not only because of the aging of the population, but also because of shifting societal and cultural norms. There is evidence that individuals follow relative stable drinking patterns as they age. If this is the case, the Baby Boomer generation may show a higher prevalence of alcohol problems as they enter later life than their parents and grandparents. Moreover, some research suggests that the frequency and severity of alcohol misuse may increase in aging populations, especially among individuals with a history of drinking problems.

Recent research has suggested that retirement drinking may be influenced by workplace factors.

Richman, Zlatoper, Zackula, Ehmke, and Rospenda (2006) investigated the role of aversive workplace conditions that could influence drinking behavior among retirees: sexual harassment, generalized workplace abuse, and psychological workload. The analysis of a longitudinal study of employees at a Midwestern university shows that retirees who had experienced high levels of stress drank more than their counterparts who were still employed (and who were still experiencing a stressful workplace). This pattern held even in relation to a comparison between stressed and non-stressed workers. The study suggests that for those still employed, workplace norms and regulations may inhibit the use of alcohol as a means of self-medication in response to highly stressful experiences, retirement removes the social controls that curtailed drinking while the individual was in the workforce.

retirementpostpic
Retirement of Porter Ted Humphreys, 1968. Public domain via LSE Library.

Bacharach, Bamberger, Biron, & Horowitz-Rozen (2008) examined the role that positive work conditions might have on the retirement-drinking relationship, positing that pre-retirement job satisfaction might interact with retirement agency to affect retirees’ drinking behavior. Using data from a NIH-funded ten-year study of retirement-eligible and retired workers, the research team found a positive association between “push” perceptions and both the quantity and frequency of drinking (though not drinking problems), and an inverse association between “pull” perceptions and both drinking frequency and drinking problems (though not quantity). The study also found that greater job satisfaction amplified the positive association between “push” perceptions and alcohol consumption, and attenuated the inverse association between “pull” perceptions and unhealthy or problematic drinking. This moderating effect of pre-retirement job valence suggests that people who are most satisfied with their jobs are likely to fare worst in response to the stress of a retirement that is unplanned or undesired. Even when retirement is the result of personal volition, it may still be associated with a sense of loss and negative emotions for which alcohol may serve as a coping mechanism.

Bacharach, Bamberger, Doveh and Cohen (2007) examined how the social availability of alcohol in and around the workplace prior to retirement may have divergent effects on older adult drinking behavior. Bacharach et al. found that problem drinkers—after retiring from a workplace with permissive drinking norms—drank less over the first two years of retirement. This population not only left the workplace, but they also dropped their regular association with coworkers who supported and encouraged drinking behavior. The findings suggest that for those with a history of problem drinking, retirement may be linked to a net decline in the severity of drinking problems.

To assess the degree to which this decline in problem drinking may be attributed to separating from a permissive workplace drinking culture, the team examined shifts in the extent of the problem-drinking cohort’s social support networks during the study period. Findings suggest that the decline in problem drinking severity was apparent among those whose social networks became smaller in retirement. Conversely, for the small number whose social networks expanded in retirement, problem drinking severity increased. The nature of the retirement-problem drinking relationship, at least for baseline problem drinkers, may be contingent upon the social availability of alcohol in the work environment from which they disengage.

While there is a lack of research demonstrating the role of strain as a mediator linking these stressors to shifts in older adults’ drinking behavior, a substantial body of evidence examining the role of stress in the origin and intensification of alcohol use and misuse suggests that strain is likely to serve as the intermediary mechanism. To the extent that strain plays such a mediating role, the same network factors are likely to also operate as vulnerability or protective moderating factors in this second stage of the mediation. As suggested by Bacharach et al. (2007), the impact of disengagement-related strain on older adults’ drinking behavior is likely to vary depending upon whether they exit into a non-work social network with more or less permissive drinking norms than those associated with their workplace or occupation.

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12. On World Diabetes Day, a guide to managing diabetes during the holidays

The International Diabetes Foundation has marked 14 November as World Diabetes Day, commemorating the date that Frederick Banting and his team first discovered insulin, and the link between it and diabetic symptoms.

As we approach the festive season, a time of year when indulgence and comfort are positively encouraged, keeping track of, or even thinking about blood glucose levels can become a difficult and annoying task. If good diabetic practice relies on building routines suited to the way your blood sugar levels change throughout the day, then the holidays can prove a big disruption to the task of keeping diabetes firmly in the background. With this in mind, take a look at this list of tips, facts, and advice taken from Diabetes by David Matthews, Niki Meston, Pam Dyson, Jenny Shaw, Laurie King, and Aparna Pal to help you stay in control and happy throughout the festive months:

  • Eat regularly. When big occasions cause your portion sizes to increase alarmingly, it’s tempting to skip or put off other meals. But eating large amounts at irregular intervals can cause blood glucose levels to rise significantly. For many, it’s better to snack throughout the day, including some starchy rather than sugary carbohydrates, promoting slow glucose release into the bloodstream.
  • Alternate drinks. Big dinners, big nights, and family days are likely to mean you consume more alcohol than normal. Alternating alcoholic drinks with diet drinks, soda, or mineral water can minimize their effect on blood glucose levels, so you can stay out, and keep up, without worrying.
  • Help your liver. Alcohol is metabolized by the liver, an organ that also helps release glucose into the bloodstream when levels start to drop. After drinking, the liver is busy processing alcohol, so cannot release glucose as effectively. This increases the risk of hypoglycaemia, especially in people who take insulin or sulphonylurea tablets. To combat this risk, try to avoid drinking on an empty stomach, or eat starchy foods when drinking. You may also need to snack before bed if you’re drinking in the evening.
  • Eat more, exercise more. Regular activity can have major benefits on your diabetes, making the insulin you produce or inject work more efficiently. Both aerobic and anaerobic exercise will have positive effects, and are excellent ways of giving you a mental boost (though blood glucose levels should be monitored). Many symptoms of hypos are similar to those of exercise, such as hotness, sweating or an increased heart rate. Check blood glucose levels regularly and make necessary adjustments; fruit contains natural sugar and is a healthy way of quickly raising levels.
  • Go for your New Year’s resolution. Losing five to ten percent of your starting weight can have a positive impact on your diabetes, not to mention your overall health. Although exercise and eating well are of course promoted by all as the best way to lose weight, there is no medical consensus on one ideal way to achieve weight loss. The key lies in finding an effective approach that you can maintain. Remember that insulin can slow down weight loss, and if you are trying to lose weight, but find you’re having hypos, you’ll need to adjust your medication. Discuss this with your healthcare team.
  • Check Labels. Sodium isn’t synonymous with salt, but many food manufacturers often list sodium rather than salt content on food packaging. To convert a sodium figure into salt, you need to multiply the amount of sodium by 2.5. (For example: A large 12 inch cheese and tomato pizza provides 3.6 g of sodium. 3.6 multiplied by 2.5 is 9, so, the pizza contains approximately 9g of salt; one and a half times the recommended maximum of 6g.)
  • Don’t worry! Although a good routine is important, occasional lapses shouldn’t have a drastic effect on blood glucose levels (though this varies from person to person). Pick up a healthy routine in the New Year, when you’ll feel most motivated, and stick to it. The World Health Organization estimates over 200 million people will have type 2 diabetes by the year 2015, but (according to the international diabetes foundation) over 70% of cases of type 2 diabetes could be prevented by adopting healthier lifestyles. Healthy living is not just a supplement, but part of the treatment of diabetes.

Heading image: Christmas Eve by Carl Larsson. Public domain via Wikimedia Commons.

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13. FOUR TITLES FROM OWLKIDS BOOKS

OwlKids Books promotes awareness of our world to encourage young readers to become more astute observers of how their choices can affect the natural world. OwlKids Books appeal to readers who enjoy bold graphics with quick facts using minimal text. Why We Live Where We Live Written by Kira Vermond; Illustrated by Julie McLaughlin ISBN: 9781771470117 Grades 4-6 Vermond takes readers on a

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14. Stem cell therapy for diabetes

This month, it was reported that scientists at Harvard University have successfully made insulin-secreting beta cells from human pluripotent stem cells. This is an important milestone towards a “stem cell therapy” for diabetes, which will have huge effects on human medicine.

Diabetes is a group of diseases in which the blood glucose is too high. In type 1 diabetes, the patients have an autoimmune disease that causes destruction of their insulin-producing cells (the beta cells of the pancreas). Insulin is the hormone that enables glucose to enter the cells of the tissues and in its absence the glucose remains in the blood and cannot be used. In type 2 diabetes the beta cells are usually somewhat defective and cannot adapt to the increased demand often associated with age and/or obesity. Despite the availability of insulin for treating diabetes since the 1920s, the disease is still a huge problem. If the level of blood glucose is not perfectly controlled it will cause damage to blood vessels and this eventually leads to various unpleasant complications including heart failure, stroke, kidney failure, blindness, and gangrene of limbs. Apart from the considerable suffering of the affected patients, the costs of dealing with diabetes is a huge financial burden for all health services. The prevalence of type 2 diabetes in particular is rising in most parts of the world and the number of patients is now counted in the hundreds of millions.

To get perfect control of blood glucose, insulin injections will never be quite good enough. The beta cells of the pancreas are specialised to secrete exactly the correct amount of insulin depending on the level of glucose they detect in the blood. At present the only sources of beta cells for transplantation are the pancreases taken from deceased organ donors. However this has enabled a clinical procedure to the introduced called “islet transplantation”. Here, the pancreatic islets (which contain the beta cells) are isolated from one or more donor pancreases and are infused into the liver of the diabetic patient. The liver has a similar blood supply to the pancreas and the procedure to infuse the cells is surgically very simple. The experience of islet transplants has shown that the technique can cure diabetes, at least in the short term. But there are three problems. Firstly the grafts tend to lose activity over a few years and eventually the patients are back on injected insulin. Secondly the grafts require permanent immunosuppression with drugs to avoid rejection by the host, and this can lead to problems. Thirdly, and most importantly, the supply of donor pancreases is very limited and only a tiny fraction of what is really needed.

Syringe, by Blausen.com staff. “Blausen gallery 2014″. CC-BY-3.0 via Wikimedia Commons

This background may explain why the production of human beta cells has been a principal objective of stem cell research for many years. If unlimited numbers of beta cells could be produced from somewhere then at least the problem of supply would be solved and transplants could be made available for many more people. Although there are other potential sources, most effort has gone into making beta cells from human pluripotent stem cells (hPSC). These resemble cells of the early embryo: they can be grown without limit in culture, and they can differentiate into most of the cell types found in the body. hPSC comprise embryonic stem cells, made by culturing cells directly from early human embryos; and also “induced pluripotent stem cells” (iPSC), made by introducing selected genes into other cell types to reprogram them to an embryonic state. The procedures for making hPSC into beta cells have been designed based on the knowledge obtained by developmental biologists about how the pancreas and the beta cells arise during normal development of the embryo. This has shown that there are several stages of cell commitment, each controlled by different extracellular signal substances. Mimicking this series of events in culture should, theoretically, yield beta cells in the dish. In reality some art as well as science is required to create useful differentiation protocols. Many labs have been involved in this work but until now the best protocols could only generate immature beta cells, which have a low insulin content and do not secrete insulin when exposed to glucose. The new study has developed a protocol yielding fully functional mature beta cells which have the same insulin content as normal beta cells and which secrete insulin in response to glucose in the same way. These are the critical properties that have so far eluded researchers in this area and are essential for the cells to be useful for transplantation. Also, unlike most previous procedures, the new Harvard method grows the cells as clumps in suspension, which means that it is capable of producing the large number of cells required for human transplants.

These cells can cure diabetes in diabetic mice, but when will they be tried in humans? This will depend on the Food and Drug Administration (FDA) of the USA. The FDA has so far been very cautious about stem cell therapies because they do not want to see cells implanted that will grow without control and become cancerous. One thing they will insist on is extremely good evidence that there are absolutely none of the original pluripotent cells left in the transplant, as they would probably develop into tumours. This highlights the fact that the treatment is not really “stem cell therapy” at all, it is actually “differentiated cell therapy” where the transplanted cells are made from stem cells instead of coming from organ donors. The FDA will also much prefer a delivery method which will enable the cells to be removed, something which is not the case with current islet transplants. One much discussed possibility is “encapsulation” whereby the cells are enclosed in a semipermeable membrane that can let nutrients in and insulin out but will not allow cells to escape. This might also enable the use of immunosuppressive drugs to be avoided, as encapsulation is also intended to provide a barrier against the immune cells of the host.

Stem cell therapy has been hyped for years but with the exception of the long established bone marrow transplant it has not yet delivered. An effective implant which is easy to insert and easy to replace would certainly revolutionize the treatment of diabetes, and given the importance of diabetes worldwide, this in itself can be expected to revolutionize healthcare.

Featured image credit: A colony of embryonic stem cell. Public Domain via Wikimedia Commons

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15. 11 Kids’ Books on Dealing with Loss, Grief, Illness and Trauma

Here is a list of 11 books that address a wide range and variety of emotions that young readers may experience when faced with serious illness, loss, grief or trauma.

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16. A taxonomy of kisses

Where kissing is concerned, there is an entire categorization of this most human of impulses that necessitates taking into account setting, relationship health and the emotional context in which the kiss occurs. A relationship’s condition might be predicted and its trajectory timeline plotted by observing and understanding how the couple kiss. For instance, viewed through the lens of a couple’s dynamic, a peck on the cheek can convey cold, hard rejection or simply signify that a loving couple are pressed for time.

A kiss communicates a myriad of meanings, its reception and perception can alter dramatically depending on the couple’s state of mind. A wife suffering from depression may interpret her husband’s kiss entirely differently should her symptoms be alleviated. Similarly, a jealous, insecure lover may receive his girlfriend’s kiss of greeting utterly at odds to how she intends it to be perceived.

So if the mind can translate the meaning of a kiss to fit with its reading of the world, what can a kiss between a couple tell us? Does this intimate act mark out territory and ownership, a hands-off-he’s-mine nod to those around? Perhaps an unspoken negotiation of power between a couple that covers a whole range of feelings and intentions; how does a kiss-and-make-up kiss differ from a flirtatious kiss or an apologetic one? What of a furtive kiss; an adulterous kiss; a hungry kiss; a brutal kiss? How does a first kiss distinguish itself from a final kiss? When the husband complains to his wife that after 15 years of marriage, “we don’t kiss like we used to”, is he yearning for the adolescent ‘snog’ of his youth?

Engulfed by techno culture, where every text message ends with a ‘X’, couples must carve out space in their busy schedules to merely glimpse one another over the edge of their laptops. There isn’t psychic space for such an old-fashioned concept as a simple kiss. In a time-impoverished, stress-burdened world, we need our kisses to communicate more. Kisses should be able to multi-task. It would be an extravagance in the 21st-century for a kiss not to mean anything.

And there’s the cultural context of kissing to consider. Do you go French, Latin or Eskimo? Add to this each family’s own customs, classifications and codes around how to kiss. For a couple, these differences necessitate accepting the way that your parents embraced may strike your new partner as odd, even perverse. For the northern lass whose family offer to ‘brew up’ instead of a warm embrace, the European preamble of two or three kisses at the breakfast table between her southern softie of a husband and his family, can seem baffling.

The context of a kiss between a couple correlates to the store of positive feeling they have between them; the amount of love in the bank of their relationship. Take 1: a kiss on the way out in the morning can be a reminder of the intimacy that has just been. Take 2: in an acrimonious coupling, this same gesture perhaps signposts a dash for freedom, a “thank God I don’t have to see you for 11 hours”. The kiss on the way back in through the front door can be a chance to reconnect after a day spent operating in different spheres or, less benignly, to assuage and disguise feelings of guilt at not wanting to be back at all.

Couple, by Oleh Slobodeniuk. CC-BY-2.0 via Flickr.
Couple, by Oleh Slobodeniuk. CC-BY-2.0 via Flickr.

While on the subject of lip-to-lip contact, the place where a kiss lands expresses meaning. The peck on the forehead may herald a relationship where one partner distances themselves as a parental figure. A forensic ritualized pattern of kisses destined for the cheeks carries a different message to the gentle nip on the earlobe. Lips, cheek, neck, it seems all receptors convey significance to both kisser and ‘kissee’ and could indicate relationship dynamics such as a conservative-rebellious pairing or a babes-in-the-wood coupling.

Like Emperor Tiberius, who banned kissing because he thought it helped spread  fungal disease, Bert Bacarach asks, ‘What do you get when you kiss a guy? You get enough germs to catch pneumonia…’ Conceivably the nature of kissing and the unhygienic potential it carries is the ultimate symbol of trust between two lovers and raises the question of whether kissing is a prelude or an end in itself, ergo the long-suffering wife who doesn’t like kissing anymore “because I know what it’ll lead to…”

The twenty-first century has witnessed the proliferation of orthodontistry with its penchant for full mental braces. Modern mouths are habitually adorned with lip and tongue piercings as fetish wear or armour. Is this straying away from what a kiss means or a consideration of how modern mores can begin to create a new language around this oldest of greetings? There is an entire generation maturing whose first kiss was accompanied by the clashing of metal, casting a distinct shadow over their ideas around later couple intimacy.

Throughout history, from Judas to Marilyn Monroe, a kiss has communicated submission, domination, status, sexual desire, affection, friendship, betrayal, sealed a pact of peace or the giving of life. There is public kissing and private kissing. Kissing signposts good or bad manners. It is both a conscious and unconscious coded communication and can betray the instigator’s character; from the inhibited introvert to the narcissistic exhibitionist. The 16th-century theologian Erasmus described kissing as ‘a most attractive custom’. Rodin immortalized doomed, illicit lovers in his marble sculpture, and Chekhov wrote of the transformative power of a mistaken kiss. The history and meaning of the kiss evolves and shifts and yet remains steadfastly the same: a distinctly human, intimate and complex gesture, instantly recognizable despite its infinite variety of uses. I’ve a feeling Sam’s ‘You must remember this, a kiss is just a kiss’ may never sound quite the same again.

Headline image credit: Conquered with a kiss, by .craig. CC-BY-NC-2.0 via Flickr.

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17. Death at a Distance

I saw someone’s Facebook status today:

 

a

And I was immediately struck with anger.

At first, I wasn’t sure quite why. I get what they meant. It seems like Ebola’s everywhere! It’s constantly on the news, all over the internet, and everyone’s talking about it. It makes sense to be sick of hearing about it.  We’re bound to get sick of hearing about anything that much!

But still, I couldn’t shake the discomfort that rung in my head over that status. Ebola seems far away, after all, it’s only been diagnosed four times in the US. It’s easy to tuck it away in your mind as something distant that doesn’t affect you and forget why it’s a big deal.

It’s even become a hot topic for jokes on social media:

b c

de

 

Because so many see this very real disease as a far away concept, we find safety in our distance and it’s easy to make light of it.

But guys….

f

 

4,877 deaths. 9,935 sufferers. That’s not funny. That’s not something to ask to “omg shut up.”

The idea of disease never really hit home for me until my little sister was diagnosed with cancer. Yes, Ebola and cancer are two very different things. But I know what it’s like to watch someone I love very dearly suffer. I know what it’s like to hold my sister’s hand while she cries because she can’t escape the pain or the fear that comes with her disease. I know what it’s like to cry myself to sleep begging God to take her illness away. And I can’t help but imagine a sister somewhere in Africa in a situation very similar to my own, watching her loved one suffer, hearing her cries, and begging for it to all be over- but without the blessings of medicine and technology that my sister has access to.

We are quick to throw on our pink gear for breast cancer awareness and dump ice on our head for ALS because that kind of awareness is fun and easy. I’m not trying to diminish those causes- they are great causes that deserve promotion. But I mean to make note of the fact that when another very real disease with very real consequences is brought to light and gains awareness, people groan that it’s in the news again and make jokes about it on the internet. Because Ebola doesn’t have the fun and cute promotional package, we complain and make light of it and its need for awareness and a solution.

People are suffering and dying from Ebola. Just because that suffering seems far away, doesn’t make it any less significant.

 

This is a guest post from my oldest daughter, Meredith. I begged her to let me post it. 


Filed under: Don't Blog Angry

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18. Jay Asher Discusses Thirteen Reasons Why | 50 States Against Bullying

A conversation between Jay Asher and Trudy Ludwig the 50 States Against Bullying tour, bullying, teen suicide and how to create kinder and more caring communities.

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19. What are the costs and impacts of telecare for people who need social care?

By Catherine Henderson


In these times of budgetary constraints and demographic change, we need to find new ways of supporting people to live longer in their own homes. Telecare has been suggested as a useful way forward. Some examples of this technology, such as pull-cord or pendant alarms, have been around for years, but these ‘first-generation’ products have given way to more extensive and sophisticated systems. ‘Second-generation’ products literally have more bells and whistles – for instance, alarms for carbon monoxide and floods, and sensors that can detect movement in and out of bed. These sensors send alerts to a call-centre operator who can organise a response, perhaps call out a designated key-holder, organise a visit to see if there is a problem, or ring the emergency services. There are even more elaborate systems that continuously monitor a person’s activity using sensors and analyse these ‘lifestyle’ data to identify changes in usual activity patterns, but these systems are not in mainstream use. In contrast to telehealth – where the recipient is actively involved in transmitting and in many cases receiving information – the sensors in telecare do not require the active engagement of participants to transmit data, as this is done automatically in the background.

Take-up of telecare remains below its potential in England. One recent study estimated that some 4.17 million over-50 year olds could potentially use telecare, while only about a quarter of that figure were actually using personal alarms or alerting devices. The Department of Health has similarly suggested that millions of people with social care needs and long term conditions could benefit from telecare and telehealth. To help meet this need, it launched the 3-Million Lives campaign in partnership with industry to promote the scaling-up of telehealth and telecare.

Senior woman on phone

The hope held by government and commissioners in the NHS and local authorities is that these new assistive technologies not only promote independence and improve care quality but also reduce the use of health and social care services. To decide how much funding to allocate to these promising new services, these commissioners need a solid evidence base. In 2008, the Department of Health launched the Whole Systems Demonstrator (WSD) programme in three local authority areas in England engaged in whole-systems redesign to test the impacts of telecare (for people with social care needs) and telehealth (for people with long-term conditions).

The research that accompanied the WSD programme was extensive. It included quantitative studies investigating health and social care service use, mortality, costs, and the effectiveness of these technologies. Parallel qualitative studies explored the experiences of people using telecare and telehealth and their carers. The research also examined the ways in which local managers and frontline professionals were introducing the new technologies.

Some results from these streams of research have been published with more to come. From the quantitative research, three articles were published in Age and Ageing over the past year. Steventon and colleagues report on the use of hospital, primary care and social services, and mortality for all participants in the trial – around 2,600 people – based on routinely collected data. Two papers report the results of the WSD telecare questionnaire study (Hirani, Beynon et al. 2013; Henderson, Knapp et al. 2014). The questionnaire study included participants from the main trial who filled out questionnaires about their psychological outcomes, their quality of life, and their use of health and social care services.

The most recent paper to be published in Age and Ageing is the cost-effectiveness analysis of WSD telecare. Participants used a second-generation package of sensors and alarms that was passively and remotely monitored. On average, about five items of telecare equipment were provided to people in the ‘intervention’ group. The whole telecare package accounted for just under 10% of the estimated total yearly health and social care costs of £8,625 (adjusting for case mix) for these people. This was more costly than the care packages of people in the ‘usual care’ group (£7,610 per year) although the difference was not statistically significant. The extra cost of gaining a quality-adjusted life year (QALY) associated with the telecare intervention was £297,000. This is much higher than the threshold range – £20,000 to£30,000 per QALY – used by the National Institute for Health and Care Excellence (NICE) when judging whether an intervention should be used in the NHS (National Institute for Health and Clinical Excellence 2008). Given these results, we would, therefore, caution against thinking that second-generation telecare is the cure-all solution for providing good quality care to increasing numbers of people with social care needs while containng costs.

As with any research, it is important to understand how to best use the findings. The telecare tested during the pilot period was ‘second generation’, so conclusions from this research cannot be applied, for instance, to existing pendant alarm systems currently in widespread use. And telecare systems have continued to evolve since this research started. Moreover, while the results summarised here relate to the telecare participants and do not cover any potential impacts on family carers, there is some evidence that telecare alleviates carer strain.

These findings inevitably raise further questions. What are the broader experiences of those using telecare? What makes a telecare experience positive? And what detracts from the experience? Who can benefit most from telecare? Some answers will emerge as we look across all the findings from the WSD research programme. We also need to look forward to findings from new research, such as the current trial of telecare for people with dementia and their carers (Leroi, Woolham et al. 2013). The ‘big’ question is not whether we should implement a ‘one-size fits all’ solution to meet the increasing demands on social care but for whom do these new assistive technologies work best and for whom are they most cost-effective response.

Catherine Henderson is a researcher at the London School of Economics. She is one of the authors of the paper ‘Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial’, which is published in the journal Age and Ageing.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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20. Why are sex differences frequently overlooked in biomedical research?

By Katie L. Flanagan


Despite the huge body of evidence that males and females have very different immune systems and responses, few biomedical studies consider sex in their analyses. Sex refers to the intrinsic characteristics that distinguish males from females, whereas gender refers to the socially determined behaviour, roles, or activities that males and females adopt. Male and female immune systems are not the same leading to clear sexual dimorphism in response to infections and vaccination.

In 2010, Nature featured a series of articles aimed at raising awareness of the inherent sex bias in modern day biomedical research and, yet, little has changed since that time. They suggested journals and funders should insist on studies being conducted in both sexes, or that authors should state the sex of animals used in their studies, but, unfortunately, this was not widely adopted.

Even before birth, intrauterine differences begin to differentially shape male and female immune systems. The male intrauterine environment is more inflammatory than that of females, male fetuses produce more androgens and have higher IgE levels, all of which lead to sexual dimorphism before birth. Furthermore, male fetuses have been shown to undergo more epigenetic changes than females with decreased methylation of many immune response genes, probably due to physiological differences.

The X chromosome contains numerous immune response genes, while the Y chromosome encodes for a number of inflammatory pathway genes that can only be expressed in males. Females have two X chromosomes, one of which is inactivated, usually leading to expression of the wild type gene. X inactivation is incomplete or variable, which is thought to contribute to greater inflammatory responses among females. The immunological X and Y chromosome effects will begin to manifest in the womb leading to the sex differences in immunity from birth, which continue throughout life.

MicroRNAs (miRNAs) regulate physiological processes, including cell growth, differentiation, metabolism and apoptosis. Males and females differ in their miRNA expression, even in embryonic stem cells, which is likely to contribute to sex differences in the prevalence, pathogenesis and outcome of infections and vaccination.

man woman

Females are born with higher oestriol concentrations than males, while males have more testosterone. Shortly after birth, male infants undergo a ‘mini-puberty’, characterised by a testosterone surge, which peaks at about 3 months of age, while the female effect is variable. Once puberty begins, the ovarian hormones such as oestrogen dominate in females, while testicular-derived androgens dominate in males. Many immune cells express sex hormone receptors, allowing the sex hormones to influence immunity. Very broadly, oestrogens are Th2 biasing and pro-inflammatory, whereas testosterone is Th1 skewing and immunosuppressive. Thus, sex steroids undoubtedly play a major role in sexual dimorphism in immunity throughout life.

Sex differences have been described for almost every commercially available vaccine in use. Females have higher antibody responses to certain vaccines, such as measles, hepatitis B, influenza and tetanus vaccines, while males have better antibody responses to yellow fever, pneumococcal polysaccharide, and meningococcal A and C vaccines. However, the data are conflicting with some studies showing sex effects, whereas other studies show none. Post-vaccination clinical attack rates also vary by sex with females suffering less influenza and males experiencing less pneumococcal disease after vaccination. Females suffer more adverse events to certain vaccines, such as oral polio vaccine and influenza vaccine, while males have more adverse events to other vaccines, such as yellow fever vaccine, suggesting the sex effect varies according to the vaccine given. The existing data hint at higher vaccine-related adverse events in infant males progressing to a female preponderance from adolescence, suggesting a hormonal effect, but this has not been confirmed.

If male and female immune systems behave in opposing directions then clearly analysing them together may well cause effects and responses to be cancelled out. Separate analysis by sex would detect effects that were not seen in the combined analysis. Furthermore, a dominant effect in one of the sexes might be wrongly attributed to both sexes. For drug and vaccine trials this could have serious implications.

Given the huge body of evidence that males and females are so different, why do most scientific studies fail to analyse by sex? Traditionally in science the sexes have been regarded as being equal and the main concern has been to recruit the same number of males and females into studies. Adult females are often not enrolled into drug and vaccine trials because of the potential interference of hormones of the menstrual cycle or risk of pregnancy; thus, most data come from trials conducted in males only. Similarly, the majority of animal studies are conducted in males, although many animal studies fail to disclose the sex of the animals used. Analysing data by sex adds the major disadvantage that sample sizes would need to double in order to have sufficient power to detect significant sex effects. This potentially means double the cost and double the time to conduct the study, in a time when research funding is limited and hard to obtain. Furthermore, since the funders don’t request analysis by sex, and the journals do not ask for it, it is not a major priority in today’s highly competitive research environment.

It is likely that we are missing important scientific information by not investigating more comprehensively how males and females differ in immunological and clinical trials. We are entering an era in which there is increasing discussion regarding personalised medicine. Therefore, it is quite reasonable to imagine that females and males might benefit differently from certain interventions such as vaccines, immunotherapies and drugs. The mindset of the scientific community needs to shift. I appeal to readers to take heed and start to turn the tide in the direction whereby analysis by sex becomes the norm for all immunological and clinical studies. The knowledge gained would be of huge scientific and clinical importance.

Dr Katie Flanagan leads the Infectious Diseases Service at Launceston General Hospital in Tasmania, and is an Adjunct Senior Lecturer in the Department of Immunology at Monash University in Melbourne. She obtained a degree in Physiological Sciences from Oxford University in 1988, and her MBBS from the University of London in 1992. She is a UK and Australia accredited Infectious Diseases Physician. She did a PhD in malaria immunology based at Oxford University (1997 – 2000). She was previously Head of Infant Immunology Research at the MRC Laboratories in The Gambia from 2005-11 where she conducted multiple vaccine trials in neonates and infants.

Dr Katie Flanagan’s editorial, ‘Sexual dimorphism in biomedical research: a call to analyse by sex’, is published in the July issue of Transactions of the Royal Society of Tropical Medicine and Hygiene. Transactions of the Royal Society of Tropical Medicine and Hygiene publishes authoritative and impactful original, peer-reviewed articles and reviews on all aspects of tropical medicine.

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21. She Doesn’t Live Here Anymore

And so, the wheel turns. My eldest has moved to college. Although my Lovely Wife (LW) tells me we have to keep her room intact because she will still come home, I remember that I never lived at home after I left for college. I am somewhat sad about that, but we’ve been prepping for this and hoping she would take flight someday. It’s just hard to watch the baby condor drop off the ledge knowing the perilous plunge that awaits.

I’m taking it pretty well, actually. LW, not so much. Everything in the house seems to remind her that one of her babies has left the nest. Tears, oh there have been tears. I don’t understand tears, nor do I deal with them very well. I remind LW that she’s always got me… forever…  Somehow, that doesn’t seem to help.

After moving our collegian, we had to take our little patient in for treatment where she and mom stayed a few days. While they were gone, I happened into the pantry and realized LW must not have been there since baby condor left. If food packaging could form a face, every piece of junk food in there conspired to draw our missing daughter – even to me and I’m oblivious to the most obvious of things.

This was bad! I couldn’t let LW see this, she would cry for days. It all had to go, but the cheapskate in me said I also couldn’t throw out all of the food. Only one option remained. A 24 hour binge of Munchos and Dr. Pepper.

Have you ever read the nutrition label on those things? DON’T! You can gain 3 pounds just from holding the bag too long. They don’t list things by proportion, otherwise the label would read something like this:

Lard 70%image

Air 27%

Salt 2.5%

Potatoes 0.5%

How they bond the ingredients I will never know. Anyway, I polished off the first bag for breakfast and washed it down with three Dr. Peppers. I checked the remaining inventory and was disheartened to discover that LW must have decided to stock up to try to lure the girl to forsake college and stay with us. Either that or she suspected a Y2k15 disaster and wanted to be prepared. Our pantry was like a saferoom.

This is where having many offspring should pay off! I enlisted the help of the remaining children. When I explained the dilemma, I got more “Oh, Dad” eye rolls than the average game of nine-ball. One took a Dr. Pepper before she left, so I was down to hoarder’s surplus minus one. Alone, I dug in for the day.

In the late evening, I was sure a trip the emergency room was in order. The pantry was reverting back to a faceless state, and my stomach was screaming something in Idahoan. I was sweating a substance that looked like maple syrup, which can’t be good. I put in a call to Poison Control where a kind gentleman told me there was no known toxicity in the combination, but urged me to go to the hospital if I felt light-headed. That’s the last thing I remember before passing out amongst the crumbs of the last bag.

When I came to, it was time to go and pick up LW and the youngest. I used the shower squeegee to remove the syrup-sweat and when I arrived, they were ready to go. The trip home was uneventful, I successfully hid the tick and slurred speech caused by sugar intake. While I was unloading the car, LW stopped me.

“Where are the snacks for the party?”

I shrugged my shoulders and grunted. I didn’t ask ‘what party’, I’m sure I’d been told.

“The pantry was full of them.”

“I dunno,” I replied without making eye contact.

“Well, we need more for the party Saturday. Can you go to the store?”

“Uh, sure.”

They say never go to the store hungry. I went full! And I bought $57 worth of Dr. Pepper and Munchos, feeling bloated and quite resentful. Even after all the sweets, this was a bitter pill to swallow.


Filed under: It Made Me Laugh

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22. She Doesn’t Live Here Anymore

And so, the wheel turns. My eldest has moved to college. Although my Lovely Wife (LW) tells me we have to keep her room intact because she will still come home, I remember that I never lived at home after I left for college. I am somewhat sad about that, but we’ve been prepping for this and hoping she would take flight someday. It’s just hard to watch the baby condor drop off the ledge knowing the perilous plunge that awaits.

I’m taking it pretty well, actually. LW, not so much. Everything in the house seems to remind her that one of her babies has left the nest. Tears, oh there have been tears. I don’t understand tears, nor do I deal with them very well. I remind LW that she’s always got me… forever…  Somehow, that doesn’t seem to help.

After moving our collegian, we had to take our little patient in for treatment where she and mom stayed a few days. While they were gone, I happened into the pantry and realized LW must not have been there since baby condor left. If food packaging could form a face, every piece of junk food in there conspired to draw our missing daughter – even to me and I’m oblivious to the most obvious of things.

This was bad! I couldn’t let LW see this, she would cry for days. It all had to go, but the cheapskate in me said I also couldn’t throw out all of the food. Only one option remained. A 24 hour binge of Munchos and Dr. Pepper.

Have you ever read the nutrition label on those things? DON’T! You can gain 3 pounds just from holding the bag too long. They don’t list things by proportion, otherwise the label would read something like this:

Lard 70%image

Air 27%

Salt 2.5%

Potatoes 0.5%

How they bond the ingredients I will never know. Anyway, I polished off the first bag for breakfast and washed it down with three Dr. Peppers. I checked the remaining inventory and was disheartened to discover that LW must have decided to stock up to try to lure the girl to forsake college and stay with us. Either that or she suspected a Y2k15 disaster and wanted to be prepared. Our pantry was like a saferoom.

This is where having many offspring should pay off! I enlisted the help of the remaining children. When I explained the dilemma, I got more “Oh, Dad” eye rolls than the average game of nine-ball. One took a Dr. Pepper before she left, so I was down to hoarder’s surplus minus one. Alone, I dug in for the day.

In the late evening, I was sure a trip the emergency room was in order. The pantry was reverting back to a faceless state, and my stomach was screaming something in Idahoan. I was sweating a substance that looked like maple syrup, which can’t be good. I put in a call to Poison Control where a kind gentleman told me there was no known toxicity in the combination, but urged me to go to the hospital if I felt light-headed. That’s the last thing I remember before passing out amongst the crumbs of the last bag.

When I came to, it was time to go and pick up LW and the youngest. I used the shower squeegee to remove the syrup-sweat and when I arrived, they were ready to go. The trip home was uneventful, I successfully hid the tick and slurred speech caused by sugar intake. While I was unloading the car, LW stopped me.

“Where are the snacks for the party?”

I shrugged my shoulders and grunted. I didn’t ask ‘what party’, I’m sure I’d been told.

“The pantry was full of them.”

“I dunno,” I replied without making eye contact.

“Well, we need more for the party Saturday. Can you go to the store?”

“Uh, sure.”

They say never go to the store hungry. I went full! And I bought $57 worth of Dr. Pepper and Munchos, feeling bloated and quite resentful. Even after all the sweets, this was a bitter pill to swallow.


Filed under: It Made Me Laugh

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23. Surviving a Stroke at 33 (and Blogging About It)

Christine Hyung-Oak Lee suffered a stroke when she was 33, and she has written about her experience in an inspiring personal essay for BuzzFeed.

Before that, she was using a pseudonym on WordPress.com to blog about her experiences, share details about her life, and practice her writing. In 2007, shortly after New Year’s Day, Lee wrote the following in a blog post:

something in my brain burped. most of what i want to do is just out of my grasp. i feel like i know how to do them, but then when i go to do them, i just…CAN’T. day by day, i’m regaining my abilities, so i hope this is just temporary.

Lee’s commenters urged her to see a doctor, and the next day, she responded to them from a hospital bed: “I had a stroke! Will be better.”

I spoke with Lee about her experience, and what she has learned about herself and her writing.

* * *

christine-lee-crop

It’s amazing that you could go through something so profound health-wise and chart a new path for yourself coming out of it. What’s the response been to your essay?

I’ve been blown away. As life-changing as my stroke was, the response, too, will probably go down in my life history as a turning point.

I had a blog — and I’ve been blogging since before it was called “blogging,” back when it was called “web journaling,” back in the days when Justin Hall was on links.net and when I wrote my posts in HTML. But before I spun up my anonymous blog, I was asked to stop blogging by a few family members. I was putting them at risk, they said, I was not to make myself so public.

Bottom line, I didn’t want to stop blogging, so I started up a blog under a pseudonym. I never told them about the blog. A few months later, I had my stroke.

The blog was one of the first places to which I turned when I had my stroke, before I knew I’d had a stroke. I wrote in my journal, too — but I turned to my blog in the wake of my stroke, which for me was a largely isolating event. I made some great friends. Got support that way. It was my village, for a time.

Also, my blog has always been a place to do some “low-stakes writing” — writing without the intention of publication, writing that is more therapeutic. That said, blogging has always been a venue for me to refine my writing voice — because after all, it is still a public space with readers.

What are the odds that a person could suffer a stroke at 33?

According to the New York Times, about 10 to 15 percent of strokes happen to people under the age of 45. That’s supposed to be about 1 in 1,000. And oftentimes, young people who have had a stroke are misdiagnosed and sent home.

I was the youngest person in the DCU (aka “stroke unit”) in the hospital by about 30 years during my stay. Most doctors were astonished by my age. They certainly didn’t suspect I’d had a stroke until they saw the MRI and its uncontested results. I could see how I could have been sent home and had to shoulder a mysterious ailment. I was lucky in that they figured it out and I got the care I needed to ensure the recovery I eventually had.

Can you talk about some specific posts that led you on a path both during and after your stroke?

Definitely, the post during which readers told me to go to the hospital!

I’m not sure where I found my voice after the stroke, really. I think there were people out in the internet reading — Carolyn Kellogg, who writes for the LA Times, had a blog called Pinky’s Paperhaus at the time, and she linked to me as a writer recovering from stroke. So there was definitely interest in my story and situation.

I really don’t think I found my voice regarding my stroke until years later. I wasn’t able to write about it until my post for Nova Ren Suma, who did a Turning Point series on her blog, to which I contributed with a reference to my stroke.

Not only has blogging my stroke experience refined my voice, it was also life-saving. And anonymity provided sanctuary.

What is your life like now?

It is as normal as I imagine it to be. It’s, honestly, better than my life pre-stroke. I’m following my dreams and choosing very carefully what it is I want to do each day, each month, each year. While in recovery, I had very limited energy, and had to be particular about my priorities; I decided to keep doing that, go forward.

And what about your writing?

Once you go through something like that, when so many of your abilities are taken away, your life is pared down to what it is you really want to get back.

I went through a very dark place at some point in my recovery — and although I don’t look upon that phase with fondness, I did learn what was most important to me, and what it is I most desired out of my life. And my writing became a front-and-center goal. I’d always known writing was important to me, but after the stroke, I knew I would channel everything I had to get back to writing.

Now that I’m writing again, I’ve more a sense of structure with regard to my writing projects; in fact, I’m obsessed with structure, because recovery is so much about stages and regaining structure. Because my brain was injured, I understood how writing happens, in my brain at least — that stories are modular, that I need quiet, that layers come with each retelling.


Filed under: Community, Reading, WordPress.com

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24. Childhood obesity and maternal employment

It is well known that obesity rates have been increasing around the Western world.

The American obesity prevalence was less than 20% in 1994. By 2010, the obesity prevalence was greater than 20% in all states and 12 states had an obesity prevalence of 30%. For American children aged 2 – 19, approximately 17% are obese in 2011-2012. In the UK, the rifeness of obesity was similar to the US numbers. Between 1993 and 2012, the commonness of obesity increased from 13.2% to 24.4% for men and for women from 16.4% to 25.1%. The obesity prevalence is around 18% for children aged 11-15 and 11% for children aged 2-10.

Policy makers, researchers, and the general public are concerned about this trend because obesity is linked to an increase likelihood of health conditions such as diabetes and heart disease, among others. The increase in the obesity prevalence among children is of concern because of the possibility that obesity during childhood will increase the likelihood of being obese as an adult thereby leading to even higher rates of these health conditions in the future.

Researchers have investigated many possible causes for this trend including lower rates of participation in physical activity and easier access to fast food. Anderson, Butcher, and Levine (2003) identified maternal employment as a possible culprit when they noticed that in the US the timing of these two trends was similar. While the prevalence of obesity was increasing for children so was the employment rate of mothers. Other researchers have found similar results for other countries – more hours of maternal employment is related to a higher likelihood of children being obese.

What could be the relationship between a mother’s hours of work and childhood obesity? When mothers work they have less time to devote to activities around the home, which may mean less concern about nutrition, more meals eaten outside of the home or less time devoted to physical activities. On the other hand, more maternal employment could mean more income and an ability to purchase more nutritious food or encourage healthy activities for children.

Child playing with dreidels, by Dana Friedlander for Israel Photo Gallery. CC-BY-SA-2.0 via Flickr
Child playing with dreidels, by Dana Friedlander for Israel Photo Gallery. CC-BY-SA-2.0 via Flickr

We looked at this relationship for Canadian children 12-17 years old – an older group of children than studied in earlier papers. For youths aged 12 to 17 in Canada, the obesity prevalence was 7.8% in 2008. We analysed not only at the relationship between maternal employment and child obesity, but also the possible reasons that maternal employment may affect child obesity.

We find that the effect of hours of work differs from the effect of weeks of work. More hours of maternal work are related to activities we expect to be related to higher rates of obesity – more television viewing, less likely to eat breakfast daily, and a higher allowance. On the other hand, more weeks of maternal employment are related to behaviour expected to lower obesity – less television viewing and more physical activity. This difference between hours and weeks of work raises some interesting questions. How do families adapt to different aspects of the labour market? When mothers work for more weeks does this indicate a more regular attachment to the labour force? Do these families have schedules and routines that allow them to manage their child’s weight?

Unlike other studies that focus on younger children, we do not find a relationship between maternal employment and likelihood of obesity for adolescents. Does the impact of maternal employment at younger ages not last into adolescence? Is adolescence a stage during which obesity status is difficult to predict?

The debate over appropriate policy remedies should not focus on whether mothers should work, but rather should focus on what children are doing when mothers are working. What can be done to reduce the obesity prevalence in adolescents? Some ideas include working with the education system and local communities to create an environment for adolescents that fosters healthy weight status, supporting families with quality childcare, provision of viable and high-quality alternative activities, or flexible work hours. Programs or policies that help families establish a healthy routine are important. It may not be a case of simply providing activities for adolescents, but that these activities are easy for families to attend on a regular basis.

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25. Celebrating World Anaesthesia Day 2014

World Anaesthesia Day commemorates the first successful demonstration of ether anaesthesia at the Massachusetts General Hospital on 16 October 1846. This was one of the most significant events in medical history, enabling patients to undergo surgical treatments without the associated pain of an operation. To celebrate this important day, we are highlighting a selection of British Journal of Anaesthesia podcasts so you can learn more about anaesthesia practices today.

Fifth National Audit Project on Accidental Awareness during General Anaesthesia

Accidental awareness during general anaesthesia (AAGA) is a rare but feared complication of anaesthesia. Studying such rare occurrences is technically challenging but following in the tradition of previous national audit projects, the results of the fifth national audit project have now been published receiving attention from both the academic and national press. In this BJA podcast Professor Jaideep Pandit (NAP5 Lead) summarises the results and main findings from another impressive and potentially practice changing national anaesthetic audit. Professor Pandit highlights areas of AAGA risk in anaesthetic practice, discusses some of the factors (both technical and human) that lead to accidental awareness, and describes the review panels findings and recommendations to minimise the chances of AAGA.
October 2014 || Volume 113 – Issue 4 || 36 Minutes

 

Pre-hospital Anaesthesia

Emergency airway management in trauma patients is a complex and somewhat contentious issue, with opinions varying on both the timing and delivery of interventions. London’s Air Ambulance is a service specialising in the care of the severely injured trauma patient at the scene of an accident, and has produced one of the largest data sets focusing on pre-hospital rapid sequence induction. Professor David Lockey, a consultant with London’s Air Ambulance, talks to the BJA about LAA’s approach to advanced airway management, which patients benefit from pre-hospital anaesthesia and the evolution of RSI algorithms. Professor Lockey goes on to discuss induction agents, describes how to achieve a 100% success rate for surgical airways and why too much choice can be a bad thing, as he gives us an insight into the exciting world of pre-hospital emergency care.
August 2014 || Volume 113 – Issue 2 || 35 Minutes

 

Fluid responsiveness: an evolution in our understanding

Fluid therapy is a central tenet of both anaesthetic and intensive care practice, and has been a solid performer in the medical armamentarium for over 150 years. However, mounting evidence from both surgical and medical populations is starting to demonstrate that we may be doing more harm than good by infusing solutions of varying tonicity and pH into the arms of our patients. As anaesthetists we arguably monitor our patient’s response to fluid-based interventions more closely than most, but in emergency departments and on intensive care units this monitoring me be unavailable or misleading. For this podcast Dr Paul Marik, Professor and Division Chief of Pulmonary Critical Care at Eastern Virginia Medical Center delivers a masterclass on the physiology of fluid optimisation, tells us which monitors to believe and importantly under which circumstances, and reviews some of the current literature and thinking on fluid responsiveness.
April 2014 || Volume 112 – Issue 4 || 43 Minutes

 

Post-operative Cognitive Decline

Post-operative cognitive decline (POCD) has been detected in some studies in up to 50% patients undergoing major surgery. With an ageing population and an increasing number of elective surgeries, POCD may represent a major public health problem. However POCD research is complex and difficult to perform, and the current literature may not tell the full story. Dr Rob Sanders from the Wellcome Department of Imaging Neuroscience at UCL talks to us about the methodological limitations of previous studies and the important concept of a cognitive trajectory. In addition, Dr Sanders discusses the risk factors and role of inflammation in causing brain injury, and reveals the possibility that certain patients may in fact undergo post-operative cognitive improvement (POCI).
March 2014 || Volume 112 – Issue 3 || 20 Minutes

 

Needle Phobia – A Psychological Perspective

For anaesthetists, intravenous cannulation is the gateway procedure to an increasingly complex and risky array of manoeuvres, and as such becomes more a reflex arc than a planned motor act. For some patients however, that initial feeling of needle penetrating epidermis, dermis and then vessel wall is a dreaded event, and the cause of more anxiety than the surgery itself. Needle phobia can be a deeply debilitating disease causing patients not to seek help even under the most dire circumstances. Dr Kate Jenkins, a hospital clinical psychologist describes both the psychology and physiology of needle phobia, what we as anaesthetists need to be aware of, and how we can better serve out patients for whom ‘just a small scratch’ may be their biggest fear.
July 2014 || Volume 113 – Issue 1 || 32 Minutes

 

For more information, visit the dedicated BJA World Anaesthesia Day webpage for a selection of free articles.

Headline image credit: Anaesthesia dreams, by Tc Morgan. CC-BY-SA-2.0 via Flickr.

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