Wednesday, October 31, 2012

Suicide Prevention | Primary Issues

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I live and practice in Fairfax County, VA, suburb to Washington, DC. Many residents here are ?defense contractors? and they must maintain a security clearance. They were a model nuclear family: Matthew, 16, and Christopher, 12, both doing well in academics, sports, and socialization in local high school and middle school; Albert, the father, a 57-year-old white male executive; Kathleen, 52, worked for a consulting firm. They had lived in the same brick home in a good neighborhood for nearly 30 years and grilled on the outside barbecue while the sons played soccer in the front yard.

I am using the past tense here because all four were found dead in their home Tuesday after co-workers of Kathleen contacted police because she had not come to work Monday or Tuesday. Needless to say, this event was the major local news story of the day and it was soon determined that the father had shot the other family members and then turned the gun on himself. There was no sign of social, economic, or personal problems.

Media interviews with friends and neighbors say that the father, who was by all outward appearances prospering in every sense, was worried about the Federal budget ?sequestration? that may result in most defense contractors losing their jobs, but that is as much a topic of normal conversation here now as the Redskins or the Nationals. Those of us who live in the Washington area are used to this Congressional threat every year. What could I have done if I were this family?s physician?

On Saturday, a story in the local newspaper stated that ?a close friend?who did not want her name published? said that she knew that both Albert?s father and uncle had committed suicide at a young age and that some of what she heard him say sounded ?paranoid.? Despite the recent change in the Department of Defense policy that allows personnel to decline to answer questions about mental health treatment on security clearance documents, there is still a fear and stigma to seeking behavioral health care in our community despite excellent insurance coverage and ample private sector availability.

Later in the week, I attended a religious service at Georgetown University for the beginning of Yom Kippur. The rabbi?s message was also a shock; she revealed that her sister committed suicide this past summer. The most important thing she could communicate for this holiest day was that we should do everything we can in the coming year to convince ourselves or someone else that, no matter how hopeless they feel, that there is some other solution to their problems.

Thursday morning, the lead story in the national news was a ?stand down? day for the Army worldwide to teach suicide prevention. This year there has been an average of at least one suicide per day among US active-duty personnel. In conjunction with that, the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury CME webinar for September was on identifying and managing suicidal behavior.

Over one third of those who commit suicide have seen a primary care practitioner in the previous month, and many of those in the previous week, before death. We need to assess risk in every patient we see, screen those at increased risk, and refer those with active suicidal behavior. Knowing about a family history of suicide might have prompted some further questions and perhaps saved the lives of four productive members of our community.

Almost any behavior disorder increases the risk of suicide, but depression and alcohol misuse are foremost and common in primary care. Routine screening for depression and alcohol misuse is recommended by the US Preventive Health Task Force for adults, but a recent study suggests that these screenings are done in only 3% of visits to community based primary care physicians.[1]

The PHQ-2 screen for depression and the NIAAA 1Q for alcohol abuse which are validated in primary care populations take about a minute each. Asking ?Have you felt depressed or lost interest in everything?? and ?When is the last time you had more than X alcoholic drinks in one day?? (where X=4 for men and 3 for women) takes less than 15 seconds. I also remind everyone that more people are injured or killed by firearms they own than by the guns of strangers.

PTSD is also a known risk factor for suicide. Although PTSD screening is currently only recommended for military and veterans, the lifetime prevalence of significant traumatic events in primary care is 70% to 90%.[2] The PC-PTSD is validated in primary care and takes about 2 minutes. It consists of the following:

In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

  • Have had nightmares about it or thought about it when you did not want to? YES / NO
  • Tried hard not to think about it or went out of your way to avoid situations that reminded you of it? YES / NO
  • Were constantly on guard, watchful, or easily startled? YES / NO
  • Felt numb or detached from others, activities, or your surroundings? YES / NO

If any 3 of the 4 are positive, a suicide screening is prudent as would be a further evaluation for PTSD.

Problems with job, school, health, or relationships, disrupted sleep, pain, loneliness, or veteran status are risk factors less likely to be on a problem list. If a patient?s dress, posture, facial expression, or tone of voice expresses distress, despair, detachment, or unexpected elation, suicide screening is warranted. Visits for multiple somatic complaints may indicate emotional stress. A history of a previous suicide attempt may warrant repeat screening every visit. There is no screening tool validated for primary care, but experts agree that asking does not make the behavior more likely and that most people appreciate your concern whether they are considering suicide or not. I routinely ask my patients about suicide. ?Are you considering that now?? If the answer is yes, ?How would you do it??

If there is evidence of a plan, do what you can to distance the individual from lethal means and tell them you can get them to someone who will review their situation with them and assist them to find other options. Make sure that you and your office as well as the patient are safe from imminent danger. Calling 911 activates local resources and begins the transition from your responsibility. Make certain that someone connects the patient or their support system to whatever resources you have available, e.g., a staff member who will dial 1-800-SUICIDE for them (or 1-800-273-TALK); these hotlines can find local resources. If there is an emergency referral, make sure that someone transports them from your office. In short, treat this as you would any life threatening emergency. You may not be able to prevent every suicide, but at least you have not missed an opportunity which happens to some PCPs somewhere in the US every hour of every day.

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Charles Sneiderman, MD PhD
Falls Church, VA
Published on October 30, 2012

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Biosketch
Charles Sneiderman, MD PhD, retired in 2010 after a 31-year career in medical informatics at the Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health. His work included research and development in telemedicine, distance learning, and medical language and image processing. Since leaving federal service, he has developed a computerized clinical decision support system to assist primary healthcare practices in the recognition and management of post-traumatic stress syndromes with support from the NLM Disaster Information Management Research Center.

Dr. Sneiderman received a B.S. with high honors from the University of Maryland in 1969, and M.D. and Ph.D. degrees from Duke University in 1975. He completed residency training in family medicine at the Medical University of South Carolina in 1979. He has authored numerous scientific reports, book chapters, and medical educational media. He was a Clinical Assistant Professor of Family Practice at the Uniformed Services University of the Health Sciences. He maintains certification by the American Board of Family Medicine and has practiced family medicine part-time in the Washington, DC area since 1980. He has assisted wounded warriors with adaptive snowsports since 2005.
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References

  1. Harrison DL, et al. Variations in the probability of depression screening at community-based physician practice visits. Prim Care Companion J Clin Psychiatry. 2010;12(5e1-8).
  2. Freedy J, et al. Traumatic Events and Mental Health In Civilian Primary Care: Implications for Training and Practice. Fam Med. 2010;42(3):185-92.

Source: http://www.primaryissues.org/2012/10/suicide_prevention/?utm_source=rss&utm_medium=rss&utm_campaign=suicide_prevention

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PFT: Panthers fielding calls about Steve Smith

Washington Redskins v Pittsburgh SteelersGetty Images

Redskins cornerback DeAngelo Hall was ejected from Sunday?s game against the Steelers for a confrontation with an official, and he likely faces a hefty fine. But Hall says any discipline he faces should be handed out to the official as well.

Hall said on 106.7 The Fan that head linesman Dana McKenzie was giving just as good as he got in their verbal exchange. It sure didn?t look that way on TV ? it looked like Hall was screaming in McKenzie?s face and sticking his finger about an inch from McKenzie?s nose, and that McKenzie was showing admirable restraint ? but Hall said the TV angles were deceiving.

?From that particular camera angle you can?t see what that ref?s saying to me,? Hall said, via the Washington Post. ?So it looks like I?m just out there giving him a piece of my mind and he?s smiling and walks away. And that?s not the case at all. He?s dishing it out just as much as I?m dishing it out.?

Hall said he?s hoping to show the league office a different angle of the incident before the league determines any punishment.

?It was just a back and forth between me and that particular ref,? Hall said. ?And I can?t go into too many details because it?s still under review. But that?s kind of how it took place. If you look at the TV copy, you can only see me. That?s why we?re trying to get other copies and other angles so you can see both sides. But me and the ref was equally at fault on that particular play.?

Hall also indicated that he wants the league office to consider what kind of person he is.

?I?m not a criminal. I?ve never been in trouble with the law. I?m a great guy. Like I said, off the field I?m a different person, you know what I mean, than I am on the field,? Hall said. ?We?re just trying to get every point of view, make sure we get as much proof as possible that happened in that situation and bring it to the forefront so we can come up with the right solution handed down to both sides.?

Hall was upset that Steelers receiver Emmanuel Sanders took a shot at him and wasn?t flagged for it, and Hall says he?s also upset about the way the officials treat him.

?Nobody is going out there trying to bully the referees and likewise, they shouldn?t be out there trying to bully us,? Hall said.

Hall is right that the officials shouldn?t try to bully the players. But it sure didn?t look like the official in question was trying to bully Hall. It looked like the official was doing his job, and Hall was acting like a jerk.

Source: http://profootballtalk.nbcsports.com/2012/10/30/teams-calling-panthers-to-see-if-steve-smiths-available/related

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DutchNews.nl - Health insurance to soar to nearly ?500 a month for ...

Health insurance to soar to nearly ?500 a month for high earners

Tuesday 30 October 2012

People earning more than ?70,000 a year will have to pay ?482 per month in health insurance fees when the new cabinet?s system comes into force, according to calculations by Nos television.

The broadcaster says people on welfare benefits will have to pay around ?20 a month, slightly less than they pay now when health insurance benefit of up to ?70 is taken into account.

The Nos bases its calculations on information contained in the coalition accord that was presented to the public on Monday. Health insurance benefit will be scrapped when the new system is launched in 2014.

Average earnings

People on an average salary of around ?33,000 a month will have to pay ?140 per month, Nos calculates.

The increase will be partly compensated for by lower tax rates. This means high earners will pay some ?126 less in tax per month while those on an average salary will get back ?50, which fully covers the higher insurance cost.

Stef Blok, who negotiated the agreement on behalf of the right-wing VVD and is tipped to become housing minister in the new cabinet, admitted premiums will go up sharply for some people. ?A coalition agreement is a question of give and take,? he told the broadcaster.

Labour leader Diederik Samsom said it is fair to ask some people to pay more, and emphasised that tax cuts will help pay for the increase.

Own risk

The Nos report did not say what the likely effect of an income-dependent own risk element, which the government also plans to introduce, would be.

Many people currently opt for a maximum own risk payment of up to ?700 which cuts their basic monthly premium to around ?70 a month.


Should the better off pay higher health insurance premiums. Have your say using the comment box below.

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Source: http://www.dutchnews.nl/news/archives/2012/10/health_insurance_to_soar_to_ne.php

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Localeze President: Mobile Raising the Bar for Local Search | Street ...

Local search is a booming market, but with a slew of networks to keep track of ? Facebook, Twitter, Yelp, Foursquare and more ? small- and medium-sized businesses face the challenge of maintaining their online presence in several, decentralized platforms. Beyond worrying about maintaining a positive reputation, businesses must also be on guard that basic NAP (name, address, phone number) information ? the anchors of local search ? is always correct ? everywhere.

Localeze, acquired in October 2011 by Neustar, is a listings identity manager aimed at doing just that, both in its work with local businesses and with search engines. Street Fight spoke recently with Localeze president, Jeff Beard to discuss the current state of local search and some broader trends in hyperlocal.

How does an SMB operating with a fixed budget and time constraints manage an online identity across Web 2.0?s array of networks?
Managing an online business identity means conveying to local search platforms the business owner is the trusted authority on the identity of their business. That would include the business name of record, the correct address, the accurate contact information and category detail that comprise the business? online identity. A businesses? online identity should not be confused with advertising, where parts of the identity may be altered to engage in a PPC (pay-per-click) or other type of online advertising campaign. If that identity is recognized by the search platform to be the anchoring point of all other content, then the business is now in a position to help the search platform connect valuable descriptive content from disparate sources to enhance the consumer?s view of [that] business.

In a perfect world, a business would go to a central place to ensure that every local search platform has their correct identity. An SMB with limited time should start by identifying the local search platforms most important to their business and address them. Major search engines are critical, as well as national internet Yellow Pages. While there are also hundreds of hyperlocal or hyper-vertical sites and mobile apps that can drive significant traffic and results, an SMB doesn?t have the time to manage, verify and protect their identity. That?s where Localeze comes into play and works with the majority of the large search, social, navigational, mapping and mobile platforms, and the more vertical directories.

So is that the current state of search as it relates to local business ? overseeing directly relevant digital content the best ways it, legally, can?
Today, local search platforms are flush with rich and descriptive content, a good thing for the whole search market because highly descriptive content makes a consumer?s experience better. But the challenge going forward is not getting more content, but how to anchor that content to the correct business identity or NAP. Reconciling descriptive content from many disparate sources to one widely accepted identity is paramount for maximizing online monetization opportunities, [such as] social advertising [and] hyperlocal targeting.

How has mobile impacted consumers? appetites toward local search?
Mobile search is local search with a higher grading scale. When the accuracy of local search was judged by results on a stationary desktop, getting a positive customer experience was much easier. Mobile search has raised the bar of what is an acceptable level of accuracy, due to the needed precision and the relative ease in which a user can evaluate search results.

Mobile search is the biggest factor accelerating improvements in local search including mapping, points of interest and business information in order to give the consumer the best possible local search experience. Mobile search is forcing all of the key players in local search to take their games to a higher level.

As for its impact on consumers, advances in technology and the rapid adoption of smartphones has kept consumer demand and usage growing.

Is smartphone penetration and tablet growth the only major reason local search has become such a fixture of consumers? daily lives?
Advancements in technology, coupled with improvements in local search have kept consumers engaged and increased the number of searches for local businesses online. Also, the SoLoMo (Social-Local-Mobile) connection and consumers? growing interest in sharing information about local businesses socially is having a positive effect on mobile local search growth.

What does Yelp?s expansion mean for local businesses?
It means the ability to get your business exposed to more potential customers through local search, which is a great thing for businesses, as reviews have become very important citations in search results. Citations or mentions of a business name or address on other webpages, are becoming more critical in the deluge of content as they help search platforms to have greater confidence in the identity the business and so help in search ranking.

Having said that, review sites also bring challenges. A negative review, legitimate or not, can have an adverse impact on a business? search ranking. Review sites are starting to be very helpful to businesses trying to address this situation. From our point of view, an equally negative outcome to the popularity of review sites is that many of these reviews are originating their own (and incorrect) versions of a business identity via crowdsourcing, rather than using a widely accepted one that is easier to match for a search platform. So the situation can result in search results where the consumer clearly sees multiple business listings for one business, all with slightly varied business identities ? different name, address or phone number details ? and differing reviews attached to each. This results in a bad experience for the user as well as for the business.

You predicted about 18 months ago a (sort of) merging of daily deals sites and listings providers ? how has that panned out in accordance with your expectations?
It has not. The daily deal space has clearly slowed, but I wouldn?t rule out another push to prominence especially as mobile search matures. And I still stand by my comment with some modification. Connecting daily deals with business listing identities is the best way to optimize monetization efforts. Deals that cannot be linked to local search platform indexes are difficult to monetize in local search. Additionally, coupons and mobile can really bring about a ?push solution? for advertisers and mobile search players. A user might not have to be searching for something specifically to find a coupon valuable. Merely coming within a reasonable distance of an establishment can trigger an action and a purchase.

What?s the future of daily deal sites ? will they evolve as broader SMB marketers, dive into the loyalty space, etc.?
Deals or coupons have always been valuable for business advertisers irrespective of the media, and the same will eventually take form in the daily deal space. The ability to analyze, learn and refine will be better than ever because there will be so much data to analyze.

What?s next for local ? will we continue to see the consolidation of services among deals providers, listings sites, marketing platforms, location-based services, etc. that seems to already be underway?
Yes ? most likely around the advancement of mobile strategies. Devices will continue to become more mobile, not less. Hyper-precision will become increasingly important in all aspects of mobile search. The map [will] become the user interface for most functions, whether it?s a consumer doing a search or a business updating their identity. And the focus will start shifting to ensuring that local search platforms can correctly assemble deep and rich content they currently have and are continuing to receive from user-generated content and social sites.

Patrick Duprey is an editorial assistant with Street Fight. You can email him at duprey.patrick@gmail.com, or follow him on Twitter @PatrickJDuprey.

Source: http://streetfightmag.com/2012/10/29/localeze-president-mobile-raising-the-bar-for-local-search/

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Tuesday, October 30, 2012

Rovio releases first Angry Birds Star Wars gameplay trailer

Android Central

Angry Birds Star Wars is inching ever-closer to its November 8 launch, and today they've shown a little bit more than their usual cutesy teasers. The first glimpses of Angry Birds Star Wars gameplay shows a cool secondary effect whereby the red bird Luke Skywalker can mow down structures by whirling a lightsaber about while along its collision course. Meanwhile the pink bird Princess Leia can call down laser fire as she makes her descent. AT-AT walkers on Hoth and Tusken raiders on Tatooine also make a short appearance. 

As played-out out as both Star Wars and Angry Birds merchandising may be, they're both highly-valuable brands, and it's not a huge surprise to see their creators milking either one for all they're worth. 

So, any Angry Birds players digging the new look? What about you, Star Wars fans? Does a Millenium Falcon with a slingshot on top compel you to check out the next Angry Birds? 

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Source: http://feedproxy.google.com/~r/androidcentral/~3/NrVTKLZ12NU/story01.htm

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Northborough Self Improvement Expert Launches Life Coaching ...

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Source: http://valotheko78.blogspot.com/2012/10/northborough-self-improvement-expert.html

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State-by-state look at Sandy's impact

Hurricane expert Bryan Norcross reports from the Weather Channel headquarters on Sandy's slow-moving churn toward the Northeast, where portions of the East Coast are under siege. Ten states are under a state of emergency, and hundreds of thousands of homes lost power so far during the slow-moving storm.

New York
Utility companies said tens of thousands of customers were without?electricity on Monday, and officials warned that millions could be without power for days following Superstorm Sandy. Hours before the?Sandy was expected to make landfall, the storm lashed the region with furious winds, blinding rain and flooding.?A mandatory evacuation of more than 375,000 people in low-lying parts of New York City was issued shortly after the entire transit system was brought to a slow, grinding halt Sunday.

Sandy flooding begins, 'only going to get worse'

A storm surge of 11 feet is possible, the highest of all coastal areas being hit by Sandy. The New York Stock Exchange and other U.S. financial markets shut down for Monday and Tuesday and thousands of flights were canceled at the city's major airports. New York power company Con Edison shut off power to part of lower Manhattan to allow for quicker restoration after the storm passes.

?Don?t be fooled, don?t look out the window and think it doesn?t look so bad," New York Gov. Andrew Cuomo said Monday. "The worst is still coming. Irene levels are currently being seen in the region right now. These forecasts for this surge are really extraordinary. They are talking about surges we?ve never seen before.?

Lucas Jackson / Reuters

After strong winds and heavy rain washed out bridges and damaged homes in multiple countries, the hurricane looks toward the northeastern U.S.

New Jersey
Sandy made landfall near Atlantic City on Monday evening after hammering the state with strong winds and flooding rains and bringing rail and road travel to a near standstill.?Police in coastal towns were going door to door Monday as more than 1 million people were given mandatory evacuation orders, and thousands were already without power.

Gov. Chris Christie said Monday rescue boats are ready to be deployed if needed. More than 300,000 residents in New Jersey are without power, and in Atlantic City the water continues to rise. WCAU's Chris Cato reports.

"Staying on the barrier islands for 36 hours is stupid. Don't be stupid; get out. Go to higher, safer ground," New Jersey Gov. Chris Christie said at a Sunday afternoon press conference, adding?that residents should "be prepared to stay in your homes for an extended period of time ... perhaps without power or water."

See readers? storm images: share yours, if you can do so safely

Police have sealed off Point Pleasant Beach in New Jersey, and a mandatory evacuation order is in effect. There are fears that Hurricane Sandy could wipe out entire sections of the town. NBC's Ron Allen reports.

Connecticut
One tenth of all Connecticut residents?-- 360,000 people --?were asked to?evacuate their homes as officials had warned the storm surge could cause massive flooding along the state's coastline.?Power outages were also pervasive Monday, and state officials estimated more than 35,000 people could be without power for as long as 36 hours in the days to come.

John Minchillo / AP

Transportation shuts down and streets empty in preparation for Hurricane Sandy.

"In order to ensure the safety of residents and their belongings, the town has coordinated to establish a strong police presence in evacuation areas," East Haven Mayor Joseph Maturo Jr. told NBCConnecticut.com.

View complete coverage from NBCConnecticut.com

Delaware
Water?covered some major roads on Monday, and residents scrambled to prepare for a week of misery. Hundreds of people fled to shelters as rough surf pounded the coast. On Sunday, Delaware Governor Jack Markell ordered the evacuation of 50,000 coastal residents as the storm threatened to bring up to 12 inches of rain, winds of up to 80 mph and a wall of water as high as 11 feet. ?

Hugh Phillips, 69, and his wife, Martha, were among the first to leave their home in the Long Neck area of Sussex County, an area prone to flooding. ?We were told to get the heck out,? Hugh Phillips told The Associated Press. ?I was going to stay, but it's better to be safe than sorry.?

Washington, D.C.
The region?s entire public transit system was suspended Monday, the largest mass shutdown in the city since Hurricane Isabelle in 2003. Schools, colleges and universities also closed their doors in anticipation of power outages and dangerous road conditions. Some extended their closures into Tuesday and Wednesday. Winds in the city were blowing from about 20 to 36 mph and officials expected them to get stronger later in the day. Washington-area utility providers warned residents to prepare for power outages that could last for weeks.

Pennsylvania
Philadelphia Mayor Michael Nutter warned residents Sunday that the city was directly in the path of the storm and asked them to?leave right now if they live in a flood-prone, low-lying area. Schools, businesses, and city governments?were closed Monday and transit services were suspended, as many residents took shelter at evacuation centers.

?This is a great, old northeastern city, which is one of our great qualities,? Mayor Nutter said. ?But one of the challenges is it?s a great, old northeastern city with old infrastructure, tons of trees and power lines, all of that can be affected by a storm like this. This is all hands on deck.?

Maine
Officials predict coastal flooding and beach erosion, and utility crews have been brought in from Canada to handle anticipated power failures.?Many Mainers hustled with their worst-case scenario preparations, scooping up generators, flashlights and bottles of water. Many schools and universities closed.

But some residents on Maine's islands took a wait-and-see approach. ?They?ll pretty much stay in denial until they see it arrive,? Al Bleau, head of Peaks Island's Community?Emergency Response Team,?told the Bangor Daily News. ?They see all these big storms that form and then nothing happens (locally)."

Hurricane expert Bryan Norcross reports from the Weather Channel headquarters on Sandy's slow-moving churn toward the Northeast, where portions of the East Coast are under siege. Ten states are under a state of emergency, and hundreds of thousands of homes lost power so far during the slow-moving storm.

Rhode Island
Rhode Island Gov. Lincoln Chafee urged residents to "make the decision now" to evacuate from coastal and low-lying areas ahead of the storm. Chafee toured coastal areas of Rhode Island, including Narragansett, and early Monday afternoon urged people to consider evacuating before the storm worsens. A decision to shut down highways, including Interstate 95, was under consideration, the governor said. Several hundred members of the Rhode Island National Guard were on standby, ready to provide support to municipalities, NBC 10 in Providence reported.

North Carolina?
Two U.S. Coast Guard?helicopters rescued 14 crew members that had abandoned the?HMS Bounty, a tall ship built for a 1962 movie, about 90 miles off the coast. Efforts were underway to search for two other crew members. Those rescued?were flown to Air Station Elizabeth City in North Carolina where they were met by emergency medical services personnel,?the Coast Guard said. The storm lashed barrier islands and rendered several homes and businesses nearly?inaccessible.

Vermont
Sandy's approach comes less than 14 months after the state was devastated by Tropical Storm Irene, the most significant natural disaster to hit the state in almost a century, according to The Associated Press. Gov. Peter Shumlin declared a state of emergency to provide access to National Guard troops. The University of Vermont canceled classes. People were starting to report power?outages and damage, according to Vermont Public Radio.?Red Cross officials were preparing to open shelters as needed. The storm was expected to start affecting southern Vermont Monday afternoon, with potentially hurricane-force winds starting later in the day, according to local media reports.

?At this point we do feel that we are adequately prepared,? Public Safety Commissioner Keith Flynn in Waterbury told The Burlington Free Press. ?We?ve really focused on our outreach to the public this time."

Massachusetts
More than 172,000 people were without power, Boston.com reported. The Massachusetts Bay Transportation Authority shut down all subway, bus and commuter rail service at 2 p.m. on Monday.?In Cape Cod, huge waves crashed and flooded Chatham Fish Pier, where winds were clocked as high as 62 mph, according to WHDH-TV.

Maryland
Maryland's governor urged people to stay off the roads for the next 36 hours because of the threat of flooding.

"Don?t put yourselves or your families in jeopardy, or your first responders," said Gov. Martin O'Malley, WBAL-TV in Baltimore reported. "This will be unlike any storm we've had to weather."

The storm?s presence was felt in Deep Creek Lake in Garrett County, where snow was falling due to a cold front moving in from the west.?

As of 5 p.m. Monday, more than 46,600 Baltimore Gas and Electric Company customers were without power. That number was expected to rise sharply.?

Virginia
The worst coastal flooding appears to be over, but a lot of rain and wind are still to come, the Richmond Times-Dispatch reported. Power blackouts are likely still to come and officials warned that almost 1 million could ultimately lose electricity. A high tide and storm surge Monday flooded streets and yards throughout coastal areas of the state, but there were no reports of injuries or major damages.

?This really is a strange storm," Virginia Gov. Bob McDonnell said on MSNBC?s Morning Joe. ?We?ve got coastal flooding, tropical storm and hurricane-force winds at the coast, eight to 10 inches of rain at the coast and then in Southwest Virginia we have blizzard warnings, up to a foot or two feet of snow.?

Still, some Virginians seem unaffected by the storm.

?I?m just sitting back watching TV and hoping the electricity doesn?t go out,? Lonnie Moore of Tangier Island, Va., told the Times-Dispatch.

West Virginia
Highway crews?on Monday began what could be a week of snow removal in some areas, as forecasters predicted as much as three feet of snowfall, the Charleston Gazette reported. Forecasters also expanded a blizzard warning Monday to at least 14 counties and predicted wind gusts approaching 50 miles per hour after 4 p.m. The Weather Channel's winter expert Tom Niziol said higher elevations could see 18-24 inches of snow. Monday. Several shelters were put on standby, and power crews were mobilized to handle potential failures, the Associated Press reported.

New Hampshire
Gov. John Lynch declared a state of emergency, urging motorists off the roads on Monday. He also directed non-essential state workers to be released early from work. The governor placed 100 New Hampshire Guard soldiers on active duty.

Ohio
Rain and wind gusts of up to 60 miles per hour were felt Monday and could blow through the Columbus area over night, the Columbus Dispatch reported. The National Weather Service issued a high-wind warning for much of central Ohio beginning at noon Monday and running through 6 p.m. Tuesday. Forecasters were predicting the worst weather conditions between 8 p.m. Monday and 8 a.m. Tuesday. They also said the light rain could change to a snow mix by midnight with light accumulation possible. Residents of low-lying areas and along Lake Erie were also warned to watch for flooding. ?

Michigan
Some 800 miles away from the coast, the National Weather Service issued a flood advisory for one county and a high wind advisory for a 14-county region, the Michigan News reported. Forecasters cautioned that winds could reach 40 to 50 miles per hour.

Tennessee
The first snowfall of the season was likely to pound areas of the state, the National Weather Service predicted. There were already four inches of snow on the ground in areas of the Great Smoky Mountains Monday, and forecasters said the higher elevations in eastern Tennessee could get up to 17 inches of snow before the storm subsides Wednesday, the News Sentinel reported. Additionally, flights to Nashville International Airport were being cancelled Monday.

NBCNews.com's Andrew Mach and Sevil Omer contributed to this report.

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Source: http://usnews.nbcnews.com/_news/2012/10/29/14781430-a-state-by-state-look-at-hurricane-sandys-impact?lite

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Monday, October 29, 2012

Microsoft Wedge Mobile Keyboard


The Microsoft Wedge Mobile Keyboard isn't just a portable keyboard, it's an essential element in making the most of your Windows 8 tablet. The Wedge Mobile Keyboard offers a much better typing experience than the onscreen keyboard, with Bluetooth connectivity and Windows 8 functionality baked right in. Plus, the removable cover doubles as a tablet stand, so you can approximate the desktop experience nearly anywhere.

Design and Features
The Microsoft Wedge Mobile Keyboard is made for use with Windows 8 tablets, and it shows in every detail. The compact design is made to be carried with your tablet?the rubberized cover and contoured battery compartment are actually made to provide a comfortable grip in-hand and against the tablet itself. Pull off the cover, and you'll find that it bends in the middle to also serve as a stand for your tablet. The cover also turns the laptop on when removed, and off when secured to maximize battery life. Powering off of two AAA batteries, the Wedge is about as mobile as it gets.

The Wedge Mobile Keyboard uses wireless Bluetooth connectivity so as not to occupy any of the one or two USB ports on your tablet, leaving them free for other peripherals. And, perhaps most importantly, Windows 8 (and Windows RT) functionality is baked right in. The keyboard puts Windows 8 controls at your fingertips, including Search, Share, Devices, and Settings, the four Charms found alongside the Windows Start logo found on the Charms Bar. These four keys are found on keys F5-8, after which are regular keyboard functions, like PrintScreen, Home, End, Page Up and Page Down. Additionally, keys F1-F4 offer Media controls (Play/Pause, Volume up/down/mute).

Despite being made with Windows 8 (and its lighter relative, Windows RT) in mind, the Wedge is also compatible with other operating systems, including Windows 7, Macintosh OS X v10.6-10.7, and even Android and iOS. It should be noted, however, that when used with these other operating systems, you will lose advanced functionality?Windows 8 controls only work in Windows 8 and Windows RT. Windows covers the Wedge Mobile Keyboard with a three-year warranty.

The small, slim keyboard is easy to carry and hold, weighing only 0.55 pound (1.01 with cover/stand) and measuring 0.9 by 10.1 by 4.0 inches (HWD). That 0.9 inch thickness is a bit deceptive, as nearly all of that thickness is found in the battery compartment?the majority of the keyboard is only 0.4-inch thick. The dimensions alone don't quite indicated how tightly packed the Wedge's 79 keys are. Aside from a narrow band of silvery trim running around the edge, the face of the keyboard is all keys. Even without a centimeter of space wasted, this keyboard is very small, but the result is also too cramped for anyone typing for long stretches.

Set-Up and Performance
Pairing the Wedge keyboard to your Windows 8 tablet is simple, and takes only a few moments. Once the batteries are put in, and the keyboard is powered on, you simply press and hold the Bluetooth button on the end of the battery compartment. An indicator light on the face of the keyboard will begin flashing red and green, telling you that the keyboard is ready to pair. Open the Windows 8 control panel and select Add devices. The Wedge will show up, after which you simply click to select it, and type in the pairing code that will come up on screen.

Typing on the keyboard is a mixed bag. On the one hand, the size of the keyboard makes it virtually impossible to comfortably type, because the keyboard is just too small, with no spacing between keys. On the other hand, the keys offer a fairly comfortable typing feel, with a fair amount of travel and some comfortable resistance. The soft touch finish on the keys is also nice. Most importantly, there was no latency or lag, even when typing quickly.

While the typing experience on the Wedge may not rival the comfort of a premium desktop keyboard, the Microsoft Wedge Mobile Keyboard is a highly portable option that tablet users can pick without having to give up the flexibility of a tablet. Add in the Windows 8 controls, simple Bluetooth connectivity, and the cover that doubles as a tablet stand, and you've got a mobile keyboard perfectly suited to your new Windows 8 tablet.

More keyboard reviews:
??? Microsoft Sculpt Mobile Keyboard
??? Razer DeathStalker Ultimate
??? iKeyboard for Apple iPad
??? Microsoft Sculpt Comfort Keyboard
??? Mad Catz S.T.R.I.K.E. 7 Gaming Keyboard
?? more

Source: http://feedproxy.google.com/~r/ziffdavis/pcmag/~3/J2NOQ5OXzNE/0,2817,2411475,00.asp

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Never mind the bollocks (Powerlineblog)

Share With Friends: Share on FacebookTweet ThisPost to Google-BuzzSend on GmailPost to Linked-InSubscribe to This Feed | Rss To Twitter | Politics - Top Stories News, RSS Feeds and Widgets via Feedzilla.

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Minorities most likely to have aggressive tumors, less likely to get radiation

Minorities most likely to have aggressive tumors, less likely to get radiation [ Back to EurekAlert! ] Public release date: 28-Oct-2012
[ | E-mail | Share Share ]

Contact: Jeremy Moore
jeremy.moore@aacr.org
215-446-7109
American Association for Cancer Research

SAN DIEGO Women with aggressive breast cancer were more likely to receive adjuvant chemotherapy, but at the expense of completing locoregional radiation therapy, according to recently presented data. This was especially true in minorities, who were the most likely to present with moderate- to high-grade and symptomatically detected tumors.

"Radiation treatment decreases the risk for breast cancer recurring and improves survival from the disease," said Abigail Silva, M.P.H., Susan G. Komen Cancer Disparities Research trainee at the University of Illinois in Chicago, who presented the results at the Fifth AACR Conference on The Science of Cancer Health Disparities, held here Oct. 27-30, 2012.

Prior studies have shown that black and Hispanic women are less likely than white women to obtain radiation treatment when eligible, and this may partly explain racial/ethnic disparities in breast cancer outcomes, according to Silva.

To further examine factors in disparities in guideline-concordant radiation treatment, Silva and colleagues gathered interview and medical record data from a population-based study of patients with single invasive primary tumors, including 397 non-Hispanic whites, 411 non-Hispanic blacks and 181 Hispanics.

Of the patients who consented to medical record abstraction and were eligible for radiation treatment, 88 percent received a recommendation for radiation treatment and 93 percent of those patients accepted treatment. However, only 97 percent of patients who accepted treatment actually received radiation. Therefore, initiation occurred in only 79 percent of the initial population of women who were eligible for radiation treatment.

Data indicated that minority women were less likely to initiate radiation treatment compared with non-Hispanic white women. In addition, minority women were more likely to have moderate- to high-grade tumors and symptomatically detected tumors.

"We also found that patients who got chemotherapy were less likely to get radiation when they needed it," Silva said. "Because minorities tended to have more aggressive breast cancer that more often required chemotherapy, this disproportionately affected them."

Given these results, Silva and colleagues said clinicians may not be recommending guideline-concordant radiation treatment to all eligible patients.

"Indeed, we found that once a treatment recommendation was made, the vast majority of patients received treatment," Silva said. "In addition, greater diffusion of gene expression profiling may improve cancer care, not only by reducing overuse of chemotherapy but by eliminating chemotherapy as a potential barrier to receipt of radiation."

In the next phase of their research, Silva and colleagues plan to examine the role of mutable patient factors such as social support, cultural beliefs and provider mistrust, which may help explain the disparity in initiation of radiation treatment.

###

Follow the AACR on Twitter: @aacr #aacr

Follow the AACR on Facebook: http://www.facebook.com/aacr.org

About the American Association for Cancer Research

Founded in 1907, the American Association for Cancer Research (AACR) is the world's first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than 34,000 laboratory, translational and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 17,000 attendees. In addition, the AACR publishes seven peer-reviewed scientific journals and a magazine for cancer survivors, patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the scientific partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration and scientific oversight of team science and individual grants in cancer research that have the potential for near-term patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer.

For more information about the AACR, visit www.AACR.org.

Mediators of Racial/Ethnic Disparities in Radiation Treatment among Breast Cancer Patients. Abigail Silva1, Garth H. Rauscher1, Rao D. Ruta2, Kent Hoskins3. 1University of Illinois School of Public Health, Division of Epidemiology and Biostatistics, Chicago, IL, 2Rush University Medical Center, Chicago, IL, 3University of Illinois College of Medicine, Chicago, IL.

BACKGROUND: Radiation after surgery can reduce recurrence and breast cancer mortality yet there is some evidence that not all women receive guideline-concordant radiation treatment. Indeed, studies that have examined the receipt of radiation among women who underwent breast-conserving surgery have found that Black and Hispanic women were less likely than White women to complete their locoregional treatment. However, little is known about the factors that may facilitate or impede treatment. In order to better understand the causes of disparities in radiation treatment, this study seeks to: 1) determine the extent to which there is a racial/ethnic disparity in radiation treatment initiation, and 2) examine patient factors and hospital characteristics that may help explain the variation.

METHODS: Interview and medical record data came from a population-based study of 989 breast cancer patients (397 non-Hispanic White, 411 non-Hispanic Black, 181 Hispanic) diagnosed between 2005-2008. Of these, 87% (N=849) consented to medical record abstraction, including a linkage with the Illinois State Cancer Registry (ISCR). Patients who consented to the medical record abstraction and had single invasive primary tumors were considered for this study. Radiation treatment eligibility was defined according to the 2005-2007 National Comprehensive Cancer Network (NCCN) guidelines. The outcome variables included treatment recommendation, acceptance, and initiation which were derived from the interview, medical record, and ISCR data. Risk differences (RDs) were estimated using logistic regression (with marginal standardization). Potential mediators related to radiation initiation were identified, and then assessed by rescaling model coefficients using the method of Karlson, Holm, and Breen. All models were adjusted for age and time from diagnosis to interview.

RESULTS: Among patients with single invasive primary tumors (n=614), 443 patients (72%) were eligible for radiation treatment (RT) per the NCCN guidelines. Radiation treatment was recommended to 88% of eligible patients of which 93% accepted it. Among those who accepted treatment, 97% received radiation. This translated into an overall treatment initiation of 79%. Minority patients were less likely than non-Hispanic (nH) White patients to initiate radiation (0.75 vs. 0.85, RD=10%p=0.000). Minorities were more likely to have moderate-high grade tumors and symptomatically detected tumors which in turn were less likely to receive radiation (all p-values CONCLUSIONS: Patients who are eligible for radiation and have more aggressive appearing tumors at diagnosis are more likely to receive chemotherapy but at the expense of completing their locoregional (radiation) therapy. This disproportionately affects minority patients and results in underuse of radiation in these women. Greater diffusion of gene expression profiling (e.g. Oncotype) may improve cancer care not only by reducing overuse of chemotherapy but by eliminating chemotherapy as a potential barrier to receipt of RT.



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Minorities most likely to have aggressive tumors, less likely to get radiation [ Back to EurekAlert! ] Public release date: 28-Oct-2012
[ | E-mail | Share Share ]

Contact: Jeremy Moore
jeremy.moore@aacr.org
215-446-7109
American Association for Cancer Research

SAN DIEGO Women with aggressive breast cancer were more likely to receive adjuvant chemotherapy, but at the expense of completing locoregional radiation therapy, according to recently presented data. This was especially true in minorities, who were the most likely to present with moderate- to high-grade and symptomatically detected tumors.

"Radiation treatment decreases the risk for breast cancer recurring and improves survival from the disease," said Abigail Silva, M.P.H., Susan G. Komen Cancer Disparities Research trainee at the University of Illinois in Chicago, who presented the results at the Fifth AACR Conference on The Science of Cancer Health Disparities, held here Oct. 27-30, 2012.

Prior studies have shown that black and Hispanic women are less likely than white women to obtain radiation treatment when eligible, and this may partly explain racial/ethnic disparities in breast cancer outcomes, according to Silva.

To further examine factors in disparities in guideline-concordant radiation treatment, Silva and colleagues gathered interview and medical record data from a population-based study of patients with single invasive primary tumors, including 397 non-Hispanic whites, 411 non-Hispanic blacks and 181 Hispanics.

Of the patients who consented to medical record abstraction and were eligible for radiation treatment, 88 percent received a recommendation for radiation treatment and 93 percent of those patients accepted treatment. However, only 97 percent of patients who accepted treatment actually received radiation. Therefore, initiation occurred in only 79 percent of the initial population of women who were eligible for radiation treatment.

Data indicated that minority women were less likely to initiate radiation treatment compared with non-Hispanic white women. In addition, minority women were more likely to have moderate- to high-grade tumors and symptomatically detected tumors.

"We also found that patients who got chemotherapy were less likely to get radiation when they needed it," Silva said. "Because minorities tended to have more aggressive breast cancer that more often required chemotherapy, this disproportionately affected them."

Given these results, Silva and colleagues said clinicians may not be recommending guideline-concordant radiation treatment to all eligible patients.

"Indeed, we found that once a treatment recommendation was made, the vast majority of patients received treatment," Silva said. "In addition, greater diffusion of gene expression profiling may improve cancer care, not only by reducing overuse of chemotherapy but by eliminating chemotherapy as a potential barrier to receipt of radiation."

In the next phase of their research, Silva and colleagues plan to examine the role of mutable patient factors such as social support, cultural beliefs and provider mistrust, which may help explain the disparity in initiation of radiation treatment.

###

Follow the AACR on Twitter: @aacr #aacr

Follow the AACR on Facebook: http://www.facebook.com/aacr.org

About the American Association for Cancer Research

Founded in 1907, the American Association for Cancer Research (AACR) is the world's first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than 34,000 laboratory, translational and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 17,000 attendees. In addition, the AACR publishes seven peer-reviewed scientific journals and a magazine for cancer survivors, patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the scientific partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration and scientific oversight of team science and individual grants in cancer research that have the potential for near-term patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer.

For more information about the AACR, visit www.AACR.org.

Mediators of Racial/Ethnic Disparities in Radiation Treatment among Breast Cancer Patients. Abigail Silva1, Garth H. Rauscher1, Rao D. Ruta2, Kent Hoskins3. 1University of Illinois School of Public Health, Division of Epidemiology and Biostatistics, Chicago, IL, 2Rush University Medical Center, Chicago, IL, 3University of Illinois College of Medicine, Chicago, IL.

BACKGROUND: Radiation after surgery can reduce recurrence and breast cancer mortality yet there is some evidence that not all women receive guideline-concordant radiation treatment. Indeed, studies that have examined the receipt of radiation among women who underwent breast-conserving surgery have found that Black and Hispanic women were less likely than White women to complete their locoregional treatment. However, little is known about the factors that may facilitate or impede treatment. In order to better understand the causes of disparities in radiation treatment, this study seeks to: 1) determine the extent to which there is a racial/ethnic disparity in radiation treatment initiation, and 2) examine patient factors and hospital characteristics that may help explain the variation.

METHODS: Interview and medical record data came from a population-based study of 989 breast cancer patients (397 non-Hispanic White, 411 non-Hispanic Black, 181 Hispanic) diagnosed between 2005-2008. Of these, 87% (N=849) consented to medical record abstraction, including a linkage with the Illinois State Cancer Registry (ISCR). Patients who consented to the medical record abstraction and had single invasive primary tumors were considered for this study. Radiation treatment eligibility was defined according to the 2005-2007 National Comprehensive Cancer Network (NCCN) guidelines. The outcome variables included treatment recommendation, acceptance, and initiation which were derived from the interview, medical record, and ISCR data. Risk differences (RDs) were estimated using logistic regression (with marginal standardization). Potential mediators related to radiation initiation were identified, and then assessed by rescaling model coefficients using the method of Karlson, Holm, and Breen. All models were adjusted for age and time from diagnosis to interview.

RESULTS: Among patients with single invasive primary tumors (n=614), 443 patients (72%) were eligible for radiation treatment (RT) per the NCCN guidelines. Radiation treatment was recommended to 88% of eligible patients of which 93% accepted it. Among those who accepted treatment, 97% received radiation. This translated into an overall treatment initiation of 79%. Minority patients were less likely than non-Hispanic (nH) White patients to initiate radiation (0.75 vs. 0.85, RD=10%p=0.000). Minorities were more likely to have moderate-high grade tumors and symptomatically detected tumors which in turn were less likely to receive radiation (all p-values CONCLUSIONS: Patients who are eligible for radiation and have more aggressive appearing tumors at diagnosis are more likely to receive chemotherapy but at the expense of completing their locoregional (radiation) therapy. This disproportionately affects minority patients and results in underuse of radiation in these women. Greater diffusion of gene expression profiling (e.g. Oncotype) may improve cancer care not only by reducing overuse of chemotherapy but by eliminating chemotherapy as a potential barrier to receipt of RT.



[ Back to EurekAlert! ] [ | E-mail | Share Share ]

?


AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


Source: http://www.eurekalert.org/pub_releases/2012-10/aafc-mml102412.php

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Sunday, October 28, 2012

British media: Rocker Gary Glitter arrested in connection with Savile case

LONDON - Police investigating the sex abuse scandal surrounding late BBC children's television host Jimmy Savile have arrested pop star Gary Glitter in connection with the case, British media said Sunday.

Metropolitan Police said they arrested a man in his 60s early Sunday morning at his London home, on suspicion of sexual offences, and that he remains in custody in a London police station.

The force did not identify the man, but British media including the BBC and Press Association reported he was Glitter, 68, a former rock musician and a convicted sex offender. Glitter's real name is Paul Gadd.

Hundreds of potential victims have come forward since police began their investigation into sex abuse allegations against Savile, the longtime host of popular shows "Top of the Pops" and "Jim'll Fix It" who died at age 84 last year. Most allege abuse by Savile, but some said they were abused by Savile and others.

Glitter, best known for "Rock & Roll (Part 1&2)," was convicted in 2006 in Vietnam of committing "obscene acts with children" ? offences involving girls aged 10 and 11. He was deported in 2008.

He had a previous conviction in Britain for possessing child pornography.

The scandal has horrified Britain with revelations that Savile cajoled and coerced vulnerable teens into having sex with him in his car, in his camper van, and even in dingy dressing rooms on BBC premises.

Police have said that though the majority of cases related to Savile alone, some involved the entertainer and other, unidentified suspects. In addition, some potential victims who reported abuse by Savile also told police about separate allegations against unidentified men that did not involve the BBC host.

Source: http://news.yahoo.com/rocker-gary-glitter-arrested-connection-savile-case-british-111304759.html

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Simple Ways to Assess and Take Charge of Your Health ...

Health and Fitness Self AssessmentHealth and Fitness Self Assessment:? Overview

When you finally decide to live a healthier lifestyle, it means you?re going to take charge to make a permanent change. Though a wellness professional can assess clients much more thoroughly, getting on a healthier track means not waiting for a professional to tell you what you should do; take the first step in taking responsibility for your health! Don?t wait!

Your pulse or resting heart rate, your blood pressure, your waist circumference, your Body Mass Index or BMI, and simply, your own reflection and how your clothes fit, are each a piece of the puzzle to help you become aware of what?s going on inside your body. It?s extremely important that you never focus on only one of these areas to determine your overall fitness level. This is a good way to begin to take charge of your health, and start the journey that will lead you to that final destination ? a healthier lifestyle and a healthier body.

Check these every month or two, track them by writing them down, and talk to your doctor if you have questions or if you?re not in the ?normal? range.

Health and Fitness Self Assessment

1.)? Pulse/ Resting Heart Rate

Your pulse or resting heart rate is how many times your heart beats in a minute at rest. ?A lower resting heart rate means that your heart has to work less to pump blood through your body. This is a good thing. You can find your resting heart rate with a heart rate monitor, or you can find it the old fashioned way, at your wrist, which is known as the radial pulse. With your palm up, simply place your first two fingers (and never your thumb, because it has its own pulse) on the thumb side of your wrist. Count how many beats in one minute. According to the American Heart Association, an average resting heart rate is from about 60 to 100 beats per minute, with more fit individuals from 60 to low 70?s. ?An extremely fit athletic individual may have a resting heart rate from 40 to 50?s because their heart is stronger and more efficient at pumping blood throughout their body.

A few things to keep in mind; Your resting heart rate will be lower first thing in the morning, and when you?re lying down. Medications can make it higher or lower and caffeinated drinks will make it higher. Make sure you talk to your doctor if your resting heart rate is consistently too high or too low.

2.)? Blood Pressure

Your blood pressure is the pressure you?re blood flow exerts on the walls of your arteries. You can easily purchase your own blood pressure cuff that will display your BP, your heart rate, and give you guidelines, either online or at any pharmacy for about $30. ? $50. You can get your blood pressure taken for free at most pharmacies. They will also display a blood pressure norms chart for you to compare yours to. According to the American Heart Association, The Blood Pressure Classifications are:? Optimal ? less than 120/80, Prehypertension ? 120-139/80-89, Hypertension Stage 1 ? 140-159/90-99. If either the upper or lower number is high, you should see your doctor. High blood pressure diagnosis can only be given by a doctor, and is based on two or more readings at two or more visits, so see your doctor for an official diagnosis if your blood pressure falls in the high classification.

3.)? Waist Circumference

All you need is a simple fabric tape measure, or a piece of string and a standard metal tape measure. ?Place the fabric tape or the string snugly around the smallest part of your waist, or about one inch below your belly button in a level position parallel to the floor. If you?ve used a string to measure; mark it and then place it up to your standard metal tape measure to read your waist circumference. According to the National Heart, Lung and Blood Institute fitness guidelines, a waist measurement of 35 inches or more for women, and 40 inches or more for men puts an individual at increased risk for coronary artery disease, heart attack, stroke, type 2 diabetes, breathing problems and certain cancers.

4.)? Body Mass Index (BMI)

Your BMI takes your body stature ? both height and weight in to account. This is much better than judging your fitness from your weight alone; however, it?s just another number and only a single piece of information. BMI doesn?t work for everyone; if an individual is very muscular, is elderly, or is under 5 feet tall, BMI may need to be adjusted or may not be appropriate at all. There are websites to help you figure your BMI, or you can figure it yourself with this simple formula: weight in lbs. / (height in inches) squared x 703.

Take your number and compare it to the BMI Classifications. These are the classifications according to the National Heart, Lung and Blood Institute: Underweight- less than 18.5, Normal/healthy- 18.5 ? 24.9, Overweight- 25 ? 29.9, Obesity- 30 and over.

5.)? Your Reflection/ How do your clothes fit?

This suggestion may make some of you cringe, but just like the other pieces of the fitness puzzle, how you look in the mirror with and without clothes will tell you a great deal. Do you run past the full size mirror when you?re nude, hoping not to see the truth? Is your waist bigger, smaller or the same size as your hips? Do you have to jump up and down to fit into and button jeans you bought only four months ago? Do you have to buy bigger clothes every year or two just to stay comfortable? Be honest with yourself, but never focus only on your appearance to assess your health. The first and most important changes throughout your fitness journey will happen inside your body.

It?s true that most of us have heard of the importance of all of these assessments before, though most of us continue not to think about it in our daily lives, and therefore, don?t check these simple numbers. Simply assess yourself every couple months. Talk to your doctor if your numbers are high or are not in the ?normal? range.

Health and Fitness Self Assessment:? Final Thoughts

Through these simple assessments, you?ll become more aware of what?s going on inside your body. You can use these simple assessment tools to partner with your fitness and wellness professionals to do what?s best for your health. The most important thing to keep in mind is that no single bit of information should ever be used on its own to determine your fitness level. Professionals do many assessments and put the information together to get an idea of an individual?s baseline fitness level.

When it comes down to it, wellness and fitness professionals can guide you, but you are truly the only one who can make change happen. When all is said and done, we are each responsible for our own health. Now, take charge, make a change, and go make your future a great one!

Health and Fitness Self Assessment:? References

American Heart Association: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp

Earle, E.W., Baechle, T.R. (2004). NSCA?s Essentials of Personal Training. Champaign, IL: Human Kinetics.

National Heart, Lung and Blood Institutes: http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm

Author Profile: Rochelle Ramirez

Author's Website Rochelle Ramirez in an enthusiastic personal trainer and wellness speaker. She holds personal trainer certifications from the NSCA and ACE, is a certified group instructor through AFAA, and a certified Aqua Fitness instructor through APAI. Rochelle also holds a BA in Liberal Studies with a minor in English from Cal Poly Pomona, and graduated from CNI College with a certificate in personal training which focused on Exercise Science as preparation for the NSCA-CPT exam. Rochelle?s joy is in teaching others about the benefits of exercise. She focuses on helping her clients train their minds as well as their bodies. Her philosophy is simple; she believes that the human body is the greatest work of art, and that it?s our responsibility to keep it fit and feed it healthfully for a lifetime.

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New Pakistan outreach could aid Afghan peace deal

FILE - In this Aug. 5, 2012 file photo, Pakistani Taliban patrol in their stronghold of Shawal in the Pakistani tribal region of South Waziristan. Pakistan has stepped up outreach to some of its biggest enemies in Afghanistan, a significant policy shift that could prove crucial to U.S.-backed efforts to strike a peace deal in the war-torn country.The target of the diplomatic push has mainly been non-Pashtun political leaders who have been at odds with Pakistan for years because of the country's historical support for the Afghan Taliban, a Pashtun movement. (AP Photo/ Ishtiaq Mahsud, File)

FILE - In this Aug. 5, 2012 file photo, Pakistani Taliban patrol in their stronghold of Shawal in the Pakistani tribal region of South Waziristan. Pakistan has stepped up outreach to some of its biggest enemies in Afghanistan, a significant policy shift that could prove crucial to U.S.-backed efforts to strike a peace deal in the war-torn country.The target of the diplomatic push has mainly been non-Pashtun political leaders who have been at odds with Pakistan for years because of the country's historical support for the Afghan Taliban, a Pashtun movement. (AP Photo/ Ishtiaq Mahsud, File)

FILE - In this Monday, May 14, 2012, file photo, Pakistan's Foreign Minister Hina Rabbani Khar, talks to reporters in Islamabad, Pakistan. Pakistan has stepped up outreach to some of its biggest enemies in Afghanistan, a significant policy shift that could prove crucial to U.S.-backed efforts to strike a peace deal in the war-torn country. The target of the diplomatic push has mainly been non-Pashtun political leaders who have been at odds with Pakistan for years because of the country?s historical support for the Afghan Taliban, a Pashtun movement. (AP Photo/Anjum Naveed, File)

FILE-In this Nov 4, 2009 file picture Abdullah Abdullah, former Afghan Foreign Minister, gestures during a press conference in Kabul, Afghanistan. The influential politician, who was runner-up to Afghan President Hamid Karzai in the 2009 election, said Pakistani intelligence officials contacted him in previous years, but he refused to speak with them because he did not believe communication should be carried out in secret. Pakistan has stepped up outreach to some of its biggest enemies in Afghanistan, a significant policy shift that could prove crucial to U.S.-backed efforts to strike a peace deal in the war-torn country. (AP Photo/Anja Niedringhaus, File)

FILE-In this Nov 4, 2009 file picture Abdullah Abdullah, former Afghan Foreign Minister, gestures during a press conference in Kabul, Afghanistan. The influential politician, who was runner-up to Afghan President Hamid Karzai in the 2009 election, said Pakistani intelligence officials contacted him in previous years, but he refused to speak with them because he did not believe communication should be carried out in secret. Pakistan has stepped up outreach to some of its biggest enemies in Afghanistan, a significant policy shift that could prove crucial to U.S.-backed efforts to strike a peace deal in the war-torn country. (AP Photo/Anja Niedringhaus, File)

(AP) ? Pakistan has increased efforts to reach out to some of its biggest enemies in Afghanistan, a significant policy shift that could prove crucial to U.S.-backed efforts to strike a peace deal in the neighboring country.

The target of the diplomatic push has mainly been non-Pashtun political leaders who have been at odds with Pakistan for years because of the country's historical support for the Afghan Taliban, a Pashtun movement.

Many of the leaders fought against the Taliban when the fundamentalist Islamic group seized control of Afghanistan in the 1990s with Pakistan's help, and have accused Islamabad of maintaining support for the insurgents following the U.S.-led invasion in 2001 ? allegations denied by the government.

Many experts agree that Pakistan continues to see the Taliban as an ally, albeit a shaky one, in countering the influence of archenemy India in Afghanistan. But they also say Islamabad no longer believes the insurgents can take over the country or wants them to, a common misperception in the West.

"A Taliban victory on the other side of the border would give a huge boost to domestic militants fighting the Pakistani state," said Zahid Hussain, a journalist who has written extensively about Islamabad's war against the Pakistani Taliban.

Pakistan is also worried that unrest in Afghanistan following the withdrawal of most foreign troops in 2014 could provide the Pakistani Taliban with greater space to establish sanctuaries across the border.

The Afghan and Pakistani Taliban are allies but have focused on different enemies. The Afghan Taliban battle local and foreign forces in Afghanistan, while the Pakistani Taliban mainly wage war against Islamabad.

These concerns have led Pakistan to the conclusion that a peace agreement that includes all Afghan groups is in its best interests, and contact with its traditional foes among the non-Pashtuns is necessary to achieve that goal, said Moeed Yusuf, South Asia adviser for the United States Institute of Peace.

"I think the fundamental point here is that there is a serious realization among some people who matter in Pakistan that they can't continue to put all their eggs in the Taliban basket because it is too shaky," said Yusuf. "This is a major shift, and a shift that I think everybody should welcome."

The outreach comes as Pakistan, Afghanistan and the U.S. have stepped up efforts to breathe new life into the Taliban peace process, which has been hamstrung by distrust among all the parties involved.

The U.S. and Pakistan recently set up working groups to identify which Taliban leaders would be open to reconciliation and to ensure those holed up on Pakistani territory would be able to travel to the site of talks. Pakistan and Afghanistan have been in discussions to revive a joint commission set up to discuss the peace process.

Pakistan is seen as key to a peace deal because of its ties with the Taliban, and there is hope that Islamabad's increased engagement with non-Pashtuns in Afghanistan will facilitate the process.

"I think one of Pakistan's realizations is that if you want to play a bigger role to reconcile all these groups, you need to reach out to every group," said Rahimullah Yousufzai, a Pakistani journalist and expert on the Taliban. "They will be pushing the Taliban to share power with all these people, but it won't be easy because the Taliban aren't known to share power and the U.S. doesn't want to give them a major share."

Islamabad's historical support for the Taliban and other Pashtuns in Afghanistan, who make up about 40 percent of the population of 190 million, is partly rooted in the sizable number of Pashtuns who live in Pakistan. The ethnic group has always been seen as the best bet for furthering Pakistan's interests in the country.

Pakistan first advertised its overtures to non-Pashtuns in Afghanistan in February when Foreign Minister Hina Rabbani Khar met with a range of ethnic Tajik, Uzbek and Hazara leaders during a visit to Kabul. Prime Minister Raja Pervaiz Ashraf followed suit in July when he traveled to Afghanistan and invited the group to the opening of the new Pakistani Embassy in Kabul.

There have also been less publicized contacts by Pakistan's ambassador to Kabul, Mohammad Sadiq, and the country's army and intelligence service, according to Pakistani and Afghan officials.

Khar said the policy shift had been in the works for a while but was like a steering a large ship in a new direction.

"You're not able to do it immediately," said the foreign minister.

Pakistan's powerful army is the true arbiter of the country's Afghan policy, but experts expressed doubt that the Foreign Ministry would have pushed ahead without the support of the generals, who have historically had the closest relationship to the Taliban.

One key Afghan leader who has met with the Pakistanis, Abdullah Abdullah, said he appreciated the country's recent attempt to reach out because it was done publicly. The influential politician, who was runner-up to Afghan President Hamid Karzai in the 2009 election, said Pakistani intelligence officials contacted him in previous years, but he refused to speak with them because he did not believe communication should be carried out in secret.

"I see a lot of good in reaching out, in engagement, in dialogue," said Abdullah, who is half Pashtun but draws much of his support from the Tajik community.

The outreach has rattled the Taliban, who have warned Pakistani officials that they can't trust the non-Pashtuns, Yousufzai said.

Pakistan will have to overcome significant distrust among the non-Pashtuns. The government has old ties to some of the leaders, who worked with Pakistan in the 1980s to push the Soviets out of Afghanistan, but Islamabad's subsequent support for the Taliban created a huge amount of bad blood.

Despite that, the Pakistanis are hopeful.

"The Pakistani side's view of Afghan negotiations is that you kill on one day and kiss on the next, so while this will be very tough, they think that it's not entirely out of the realm of possibility that they may actually get somewhere," said Yusuf, the South Asia analyst.

____

Vogt reported from Kabul, Afghanistan.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/cae69a7523db45408eeb2b3a98c0c9c5/Article_2012-10-27-Pakistan-Afghan%20Outreach/id-1c9f588defa14ae5b7cdfe76e211de85

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