Children whose BMI nadir occurs before the age of
3 are at higher risk of becoming overweight adults
3 are at higher risk of becoming overweight adults
Monday 30 May 2016
Children with pica are at high risk of iron-deficiency anemia and lead toxicity.
Children with pica are at high risk of iron-deficiency
anemia and lead toxicity.
anemia and lead toxicity.
SLT-Infants who have difficulty transitioning to foods with more complex textures may require referral to a speech therapist for a more thorough feeding evaluation
Infants who have difficulty transitioning to foods with
more complex textures may require referral to a speech
therapist for a more thorough feeding evaluation
more complex textures may require referral to a speech
therapist for a more thorough feeding evaluation
PWG-FTT-Infants whose height or weight decreases more than two percentile tracks merit detailed histories and physicals to detect nutritional or medical problems
Infants whose height or weight decreases more than
two percentile tracks merit detailed histories and
physicals to detect nutritional or medical problems
two percentile tracks merit detailed histories and
physicals to detect nutritional or medical problems
Don't get your fuel from the same place your car does
Don't get your fuel from the same place your car does
Breakfast like a king, lunch like a prince, dinner like a pauper
Breakfast like a king, lunch like a prince, dinner like a pauper
Spend as much time enjoying the meal as it took to prepare it.
Spend as much time enjoying the meal as it took to prepare it.
Eat all the junk food you want as long as you cook it yourself
Eat all the junk food you want as long as you cook it yourself
Don't eat breakfast cereals that change the color of the milk.
Don't eat breakfast cereals that change the color of the milk.
"Eating what stands on one leg [mushrooms and plant foods] is better than eating what stands on two legs [fowl], which is better than eating what stands on four legs [cows, pigs, and other mammals]."
"Eating what stands on one leg [mushrooms and plant foods] is better than eating what stands on two legs [fowl], which is better than eating what stands on four legs [cows, pigs, and other mammals]."
It's not food if it arrived through the window of your car
It's not food if it arrived through the window of your car
If it came from a plant, eat it; if it was made in a plant, don't
If it came from a plant, eat it; if it was made in a plant, don't
Eat only foods that will eventually rot.
go bad"? It usually means that the fungi and bacteria and insects and rodents with whom we compete for nutrients and calories have gotten to it before we did.
Shop the peripheries of the supermarket and stay out of the middle.
Shop the peripheries of the supermarket and stay out of the middle.
Avoid food products containing ingredients that a third-grader cannot pronounce
Avoid food products containing ingredients that a third-grader cannot pronounce
Avoid food products that contain more than five ingredients
Avoid food products that contain more than five ingredients
Avoid foods that have some form of sugar (or sweetener) listed among the top three ingredients
Avoid foods that have some form of sugar (or sweetener) listed among the top three ingredients
Avoid food products that contain high-fructose corn syrup.
Avoid food products that contain high-fructose corn syrup.
Avoid food products containing ingredients that no ordinary human would keep in the pantry.
Avoid food products containing ingredients that no ordinary human would keep in the pantry.
Don't eat anything your great-grandmother wouldn't recognize as food.
Don't eat anything your great-grandmother wouldn't recognize as food.
seventeen thousand new products show up in the supermarket each year, all vying for your food dollar.
seventeen thousand new products show up in the supermarket each year, all vying for your food dollar.
MNDFL-ABC - AWARE-JUST BEING-CHOOSE RESPONSE
mindful, remember ABC:
A is for awareness – becoming more aware of what you’re thinking and doing and what’s
going on in your mind and body.
B is for ‘just being’ with your experiences – avoiding the tendency to respond on auto-pilot
and feed problems by creating your own story.
C is for choice – by seeing things as they are you can choose to respond more wisely – by
creating a gap between an experience and your reaction you can step out pilot which opens up
a world of new possibilities.
A is for awareness – becoming more aware of what you’re thinking and doing and what’s
going on in your mind and body.
B is for ‘just being’ with your experiences – avoiding the tendency to respond on auto-pilot
and feed problems by creating your own story.
C is for choice – by seeing things as they are you can choose to respond more wisely – by
creating a gap between an experience and your reaction you can step out pilot which opens up
a world of new possibilities.
MNDFL-nonjudgemental observation of the interplay between her thoughts, emotions and physiology.
nonjudgemental
observation of the interplay between her thoughts, emotions and physiology.
observation of the interplay between her thoughts, emotions and physiology.
DECISIONS
Another common problem you may encounter is that, although you may think that your decisions
and actions are always based on present-moment facts, in reality they rarely are. Making decisions
based on your brain’s prediction of the future (which is usually based on your past experiences
and unique brain wiring) is common. In addition, you see with your brain; in other words, your
brain acts as a filter to incoming information from the eyes and picks out what it thinks is
important. The problem with all the above is that you routinely make decisions and act without full
possession of the facts. What happened in the past will not necessarily happen now; your
predictions about the future could be inaccurate, leading to inappropriate responses and actions
and actions are always based on present-moment facts, in reality they rarely are. Making decisions
based on your brain’s prediction of the future (which is usually based on your past experiences
and unique brain wiring) is common. In addition, you see with your brain; in other words, your
brain acts as a filter to incoming information from the eyes and picks out what it thinks is
important. The problem with all the above is that you routinely make decisions and act without full
possession of the facts. What happened in the past will not necessarily happen now; your
predictions about the future could be inaccurate, leading to inappropriate responses and actions
COCHRANE-Treatment of the first unprovoked seizure reduces the risk of a subsequent seizure but does not affect the proportion of patients in remission in the long-term.
Treatment of the first unprovoked seizure reduces the risk of a subsequent seizure but does not affect the proportion of patients in remission in the long-term.
"Some people are always grumbling because roses have thorns; I am thankful that thorns have roses."KARR
"Some people are always grumbling because roses have thorns; I am thankful that thorns have roses."
O, how thy worth with manners may I sing, When thou art all the better part of me? What can mine own praise to mine own self bring? And what is 't but mine own when I praise thee?
O, how thy worth with manners may I sing,
When thou art all the better part of me?
What can mine own praise to mine own self bring?
And what is 't but mine own when I praise thee?
SHKSPR
When thou art all the better part of me?
What can mine own praise to mine own self bring?
And what is 't but mine own when I praise thee?
SHKSPR
Sunday 29 May 2016
Don't wait until everything is just right. It will never be perfect. There will ways be challenges, obstacles, and less than perfect conditions. So what. Get started now. ~ Mark Victor Hansen
Don't wait until everything is just right. It will never be perfect. There will ways be challenges, obstacles, and less than perfect conditions. So what. Get started now. ~ Mark Victor Hansen 
Climate change is now a fact of life and one aspect of this is the occurrence of more extreme weather events.
Climate change is now a fact of life and one aspect of this is the occurrence of more extreme weather events.
When walking, walk. When eating, eat. -Rashaski · Zen Proverb
When walking, walk. When eating, eat. -Rashaski · Zen Proverb
Prayer is when you talk to God; meditation is when you listen to God. ~ Diana Robinson
Prayer is when you talk to God; meditation is when you listen to God. ~ Diana Robinson
Follow effective action with quiet reflection. From the quiet reflection will come even more effective action." -- Peter Drucker
Follow effective action with quiet reflection. From the quiet reflection will come even more effective action."
-- Peter Drucker
-- Peter Drucker
Saturday 28 May 2016
FLR-HOW WHAT WHY
The 3 Stages of Failure in Life and Work (And How to Fix Them)
One of the hardest things in life is to know when to keep going and when to move on.
On the one hand, perseverance and grit are key to achieving success in any field. Anyone who masters their craft will face moments of doubt and somehow find the inner resolve to keep going. If you want to build a successful business or create a great marriage or learn a new skill then “sticking with it” is perhaps the most critical trait to possess.
On the other hand, telling someone to never give up is terrible advice. Successful people give up all the time. If something is not working, smart people don’t repeat it endlessly. They revise. They adjust. They pivot. They quit. As the saying goes, “Insanity is doing the same thing over and over again and expecting different results.”
Life requires both strategies. Sometimes you need to display unwavering confidence and double down on your efforts. Sometimes you need to abandon the things that aren’t working and try something new. The key question is: how do you know when to give up and when to stick with it?
One way to answer this question is to use a framework I call the 3 Stages of Failure.
- Stage 1 is a Failure of Tactics. These are HOW mistakes. They occur when you fail to build robust systems, forget to measure carefully, and get lazy with the details. A Failure of Tactics is a failure to execute on a good plan and a clear vision.
- Stage 2 is a Failure of Strategy. These are WHAT mistakes. They occur when you follow a strategy that fails to deliver the results you want. You can know whyyou do the things you do and you can know how to do the work, but still choose the wrong what to make it happen.
- Stage 3 is a Failure of Vision. These are WHY mistakes. They occur when you don’t set a clear direction for yourself, follow a vision that doesn’t fulfill you, or otherwise fail to understand why you do the things you do.
“History is often the tale of small moments – chance encounters or casual decisions or sheer coincidence …”
“History is often the tale of small moments – chance encounters or casual decisions or sheer coincidence …”
Management and leadership are not to be confused. Managers measure; leaders inspire.
Management and leadership are not to be confused. Managers measure; leaders inspire.
Pessimistic bosses bring employees down while inspiring leaders breathe life into a team.
Pessimistic bosses bring employees down while inspiring leaders breathe life into a team.
Graduated extinction is sometimes mistaken for "letting a baby cry it out,"
Graduated extinction is sometimes mistaken for "letting a baby cry it out,"
Earlier puberty associated with increased risk of depression in girls
Earlier puberty associated with increased risk of depression in girls
SUN-MOON-BIOLF
Our Moon had far more responsibility in keeping Earth habitable than early life. Our moon keeps the core turning, and that generates our magnetic field. Neither Venus or Mars have any appreciable magnetosphere. Without that, the other two planets are bombarded by various high-level radiations that most likely killed off any microbial life.
WHERE IS EVERYBODY? GAIAN BOTTLENECK-NR UNIVERSAL EARLY EXTINCTN OF BIOLF IN COSMOS
Fermi realized that any civilization with a modest amount of rocket technology and an immodest amount of imperial incentive could rapidly colonize the entire Galaxy.
Gaian Bottleneck. "One intriguing prediction of the Gaian Bottleneck model is that the vast majority of fossils in the universe will be from extinct microbial life, not from multicellular species such as dinosaurs or humanoids that take billions of years to evolve," said co-author Associate Professor Charley Lineweaver from the ANU Planetary Science Institute.
CMA in infancy is associated with subsequent development of asthma and PIBD
cows milk allergy
pediatric ibd
pediatric ibd
EARLY TERM VS POST TERM PX
Early-term birth was associated with low Apgar score, increased neurologic morbidity, and perinatal mortality. Asphyxia and intellectual disability were more common among postterm births, but general neurologic morbidity and perinatal mortality were not increased.
Infection RELATED HOSPITALISN was associated with worse cardiovascular risk factor profiles only in those from lower-SES families.
Infection was associated with worse cardiovascular risk factor profiles only in those from lower-SES families.
GUBLOC
When taking off worldly clothes,*
[reflect that] ‘May sentient beings,
diligently cultivate good roots,**
renounce all obstructive transgressions.’***
[reflect that] ‘May sentient beings,
diligently cultivate good roots,**
renounce all obstructive transgressions.’***
– Manjusri Bodhisattva
4TH NOBLE TRUTH- MAGGAM-MARGYAM-THE WAY
SILA-RIGHT THOUGHT, ACTION, LIVELIHOOD
, SAMADHI,-RIGHT CONCN, AWRAENESS, EFFORT
PANNA-RIGHT VIEW, WISDOM
, SAMADHI,-RIGHT CONCN, AWRAENESS, EFFORT
PANNA-RIGHT VIEW, WISDOM
2ND NOBLE TRUTH-DUKKHAM SAMUDAYAM-CAUSE TANHA
TANHA -CRAVING FOR HAPPINESS, PEACE, SUCCESS, POWER, MONEY, REVENGE, NIRVANA
1ST BDDHIST NOBLE TRUTH-SABBAM IDAM DUKKHAM = ALL THIS IS SUFFERING
ANITYA- IMPERMANENCE-STARS, MOUNTAINS, SEASONS, LIVES, THOUGHTS
ANATTA-NON SELF=SELF, FMLY, NATION, CULTR, RELIGN
DUKKHA-EXISTENTIAL PAIN-THOUGHT THAT U SHLD BE CONTENT ALL THE TIME
ANATTA-NON SELF=SELF, FMLY, NATION, CULTR, RELIGN
DUKKHA-EXISTENTIAL PAIN-THOUGHT THAT U SHLD BE CONTENT ALL THE TIME
METTA BHAVNA PRACTICE=LKM LOVING KINDNESS MEDITN
It’s part of a series of four practices which lead to the arising of:
- lovingkindness
- compassion (empathizing with others’ suffering)
- empathetic joy (rejoicing in others’ wellbeing and joy)
- and equanimity (patient acceptance of both joy and suffering, both our own and others’).UPEKKHA -COOL ALOOFNESS?
Friday 27 May 2016
ERs are men, who prescribe medicines of which they know little, to cure diseases of which they know less, for men, of whom they know nothing at all.
ers are men, who prescribe medicines of which they know little, to cure diseases of which they know less, for men, of whom they know nothing at all.
the risks of obesity, the metabolic syndrome, type 2 diabetes and impaired insulin sensitivity and secretion in offspring of mothers with GDM are two- to eightfold those in offspring of mothers without GDM
the risks of obesity, the metabolic syndrome, type 2 diabetes and impaired insulin sensitivity and secretion in offspring of mothers with GDM are two- to eightfold those in offspring of mothers without GDM
Long-term emotional and behavioral problems have been described for various groups of critically ill children such as congenital heart disease, meningococcal septic shock, and neonatal asphyxia. AND SURVIVORS OF PED CARD ARREST
Long-term emotional and behavioral problems have been described for various groups of critically ill children such as congenital heart disease, meningococcal septicemia and survivors of ped card arrest
Bilateral spontaneous chylothorax after severe vomiting in children].
Girl, 7 years old, with chronic facial swelling started after hyperemesis. During examination, she also presented with bilateral pleural effusion, with chylous fluid obtained during thoracentesis
Ictal coprolalia is triggered by seizures involving the mesial temporal or orbitofrontal regions.
Ictal coprolalia is triggered by seizures involving the mesial temporal or orbitofrontal regions.
•
•
•
Ictal coprolalia has a limited lateralizing value to the nondominant hemisphere.
Ictal coprolalia is triggered by seizures involving the mesial temporal or orbitofrontal regions.
Ictal coprolalia is produced by the activation of the paralimbic temporal–orbitofrontal network.
Ictal coprolalia is not rare among women although it has a male predominance.
Presumed Pseudotumor Cerebri Syndrome After Withdrawal of Inhaled Glucocorticoids
Presumed Pseudotumor Cerebri Syndrome After Withdrawal of Inhaled Glucocorticoids
ICS X PRESCHOOL WHEEZE
is strong evidence to support daily ICS for preventing exacerbations in preschool children with recurrent wheeze, specifically in children with persistent asthma. For preschool children with intermittent asthma or viral-triggered wheezing, there is strong evidence to support intermittent ICS for preventing exacerbations.
To dwell in the here and now does not mean you never think about the past, or responsibly plan for the future. The idea is simply not to allow your self to get lost in regrets about the past or worries about the future. Letting go gives us freedom, and freedom is the only condition for happiness. – Thich Nhat Hanh
To dwell in the here and now does not mean you never think about the past, or responsibly plan for the future. The idea is simply not to allow your self to get lost in regrets about the past or worries about the future. Letting go gives us freedom, and freedom is the only condition for happiness.
– Thich Nhat Hanh
– Thich Nhat Hanh
ZEN FLOWER
A flower cannot be by herself alone. To be empty is not a negative note… A flower is empty only of a separate self, but a flower is full of everything else. The whole cosmos can be seen, can be identified, can be touched, in one flower. So to say that the flower is empty of a separate self also means that the flower is full of the cosmos.
ZEN- RT 5 SWIPES-LT 5 SWIPES-CLEANING DISHES
The idea of Zen is to catch life as it flows. There is nothing extraordinary or mysterious about Zen. I raise my hand; I take a book from the other side of the desk; I hear the boys playing ball outside my window; I see the clouds blown away beyond the neighboring wood — in all these I am practicing Zen, I am living Zen. No wordy discussion is necessary, nor any explanation… When the sun rises the whole world dances with joy and everybody’s heart is filled with bliss. If Zen is at all conceivable, it must be taken hold of here.
SUNYATA
Thirty spokes share the wheel’s hub;
It is the center hole that makes it useful.
Shape clay into a vessel;
It is the space within that makes it useful.
Cut doors and windows for a room;
It is the holes which make it useful.
Therefore benefit comes from what is there;
Usefulness from what is not there.
It is the center hole that makes it useful.
Shape clay into a vessel;
It is the space within that makes it useful.
Cut doors and windows for a room;
It is the holes which make it useful.
Therefore benefit comes from what is there;
Usefulness from what is not there.
BEGINNERS MIND -SHOSHIN
phrase shoshin (初心), which means ‘beginner’s mind.’ The goal of practice is always to keep our beginner’s mind… This [means] an empty mind and a ready mind. If your mind is empty, it is always ready for anything; it is open to everything. In the beginner’s mind there are many possibilities; in the expert’s mind there are few.
NAFLD is the umbrella diagnosis, with a threshold of macrovesicular steatosis being present in ≥5% of hepatocytes, and nonalcoholic steatohepatitis (NASH) is the severe subset of patients on the NAFLD spectrum wherein the liver histology has inflammation and cellular injury with or without fibrosis in addition to the steatosis.
NAFLD is the umbrella diagnosis, with a threshold of macrovesicular steatosis being present in ≥5% of hepatocytes, and nonalcoholic steatohepatitis (NASH) is the severe subset of patients on the NAFLD spectrum wherein the liver histology has inflammation and cellular injury with or without fibrosis in addition to the steatosis.
MIGRN PREVENTION
Migraine preventatives: an overview
| Drug class | Drug | Side effects & contraindications | Target dose | Regimen |
|---|---|---|---|---|
| Beta blocker | Propranolol (alternatively atenolol or metoprolol) | Fatigue, depression, weight gain, bradycardia, impotence, orthostasis. Avoided in COPD/asthma, diabetes mellitus, peripheral vascular disease and those with bradyarrhythmias | 80 mg BD (Atenolol 50–200 mg per day) (Metoprolol 100–200 mg per day) | Start 40 mg bd, titrate up to 160–320 mg daily |
| Serotonin antagonist | Pizotifen | Drowsiness, weight gain, dry mouth, urinary retention and manufacturers suggest avoiding in people with glaucoma, urinary retention, renal dysfunction and epilepsy | 3 mg daily | Start at 0.5 mg OD, increase by 0.5 mg every 1–2 weeks |
| Antidepressant | Tricyclic Amitriptyline (alternatively dosulepin or nortriptyline) | Sedation, weight gain, dry mouth. Avoid amitriptyline in people with glaucoma, urinary retention, hypotension and significant cardiovascular comorbidity, including arrhythmias. Use with caution in people with epilepsy | 50–75 mg daily | Start 10 mg ON with 10 mg ⇑ every 1–2 weeks |
| SNRI Duloxetine (alternatively venlafaxine) | Constipation and diarrhoea, weight gain. Avoid in uncontrolled hypertension | 60–90 mg | Start 30 mg, increase every week by 30 mg | |
| Antiepileptic | Topiramate | Topiramate may have cognitive, anxiety and depression-provoking effects and may promote weight loss. Rarely renal calculi and glaucoma. Topiramate induces the metabolism of the combined contraceptive pill | 100 mg | Start at 25 mg, ⇑25–50 mg every 1–2 weeks |
| Valproate | Valproate can cause weight gain, tremor, alopecia and haematological dyscrasias. It can cause hyperammonaemia and is teratogenic. It should be avoided in liver disease (potentially hepatotoxic) | 1000 mg | Start at 200 mg OD, ⇑ 200 mg every 2 weeks | |
| Angiotensin based | Lisinopril | Lisinopril may cause fatigue, dry cough, angioedema, orthostasis or confusion. Hyperkalaemia or bone marrow dysfunction should be avoided | 20–40 mg OD | Start at 10 mg OD, ⇑ to 20–40 mg |
| Candesartan | Candesartan can cause vertigo and hypotension. It should therefore be avoided in individuals with these disorders | 8 mg BD | Start 4 mg OD, titrate by 4 mg every week | |
| Calcium channel blocker | Flunarizine | Weight gain, depression and extrapyramidal effects. May cause galactorrhoea in women concomitantly taking the combined contraceptive pill | 5–10 mg | 5 mg for a month, then 10 mg |
| Neutriceutical | Magnesium | In hypermagnesaemia, gastrointestinal (GI) effects, arrhythmia and coma are reported | 600 mg daily | – |
| Riboflavin | Physiologically limited absorption, limiting adverse effects | 400 mg | – | |
| CoQ10 | CoQ10 can cause usually mild GI effects, such as upset stomach | 100 mg TDS | – |
- BD, twice daily; COPD, chronic obstructive pulmonary disease; OD, once daily; ON, once nightly; SNRI, serotonin norepinephrine reuptake inhibitor; TDS, three times a daily.
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