Can Touching Your Toes Test Your Arteries?

Not only is inflexibility linked to arterial disease, but improving flexibility decreased arterial disease. "The control group consisted of people who stretched. They were not expected to show any change in cardiac function, but over the course of 13 weeks they in fact increased the pliability of their arteries by more than 20 percent. HEALTH | December 23, 2009 Well: Phys Ed: Can Touching Your Toes Test Your Arteries? By GRETCHEN REYNOLDS Researchers have found a clear correlation between inflexible bodies and inflexible arteries in subjects older than 40.

NYTimes: A Patient Dies, and Then the Anguish of Litigation

So artfully expressed, and clearly so much suffering.

"Medicine can be a minefield of uncertainties; no matter how thoughtful and careful we are, physiology is infinitely complex and fate is capricious, and occasionally something blows up in your face."

"the lawyers had decided they were not going to win the case...They couldn’t have figured this out four and a half years earlier? Before all this wasted time, the emotional anguish, and the more than $150,000 ...but neither side gave in. As this slowly unfolded, my mood turned from stoic resignation to a toxic muck of apathy and irritation."

A Patient Dies, and Then the Anguish of Litigation

A doctor accused of "malicious" conduct in the care of a patient
coped with practicing, and living, under the cloud of a medical
malpractice lawsuit.

http://s.nyt.com/u/ACe

Do it now - don't procrastinate pleasure

"...cash in your gift certificates, drink that special bottle of wine, redeem your frequent flier miles and take that vacation you always promised yourself"

Carpe Diem? Maybe Tomorrow

Recovering procrastinators of pleasure should try a simple New Year's
resolution: Have fun ... now!

http://s.nyt.com/u/ACf

NYTimes.com: Thinking Hard About Retirement and Death

New rules for Roth IRA and uncertainty in pending legislation about estate taxes makes estate planning difficult currently. One solution - give your kids $13000 tax-free per year - it adds up.

Use more FFP in massive transfusions

It is remarkably rare in medical papers to see mortality cut in half
by a simple maneuver. Frozen plasma has traditionally been withheld
during transfusions, like a 'sacred' blood product, to be used only
when lab values show it's required to replace depleted factors in the
blood. This surprising result shows 1-month trauma mortality cut in
half when plasma is automatically given 1:1 along with red cells,
regardless of lab values. From a review paper by Shaz B H et al., A&A
18:1760-8;2009

J Trauma. 2009 Jun;66(6):1616-24.

Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.

INTRODUCTION: Transfusion practices across the country are changing with aggressive use of plasma (fresh-frozen plasma [FFP]) and platelets during massive transfusion with current military recommendations to use component therapy at a 1:1:1 ratio of packed red blood cells to FFP to platelets.

METHODS: A massive transfusion protocol (MTP) was designed to achieve a packed red blood cell:FFP:platelet ratio of 1:1:1 We prospectively gathered demographic, transfusion, and patient outcome data during the first year of the MTP and compared this with a similar cohort of injured patients (pre-MTP) receiving > or = 10 red blood cell (RBC) in the first 24 hours of hospitalization before instituting the MTP.

RESULTS: One hundred sixteen MTP activations occurred. … Seventy-three MTP patients were compared with 84 patients with pre-MTP who had similar demographics and injury severity score (29 vs. 29, p = 0.99). MTP patients received an average of 23.7 RBC and 15.6 FFP transfusions compared with 22.8 RBC (p = 0.67) and 7.6 FFP (p < 0.001) transfusions in pre-MTP patients. …Overall patient mortality was markedly improved at 24 hours, from 36% in the pre-MTP group to 17% in the MTP group (p = 0.008) and at 30 days (34% mortality MTP group vs. 55% mortality in pre-MTP group, p = 0.04). Blunt trauma survival improvements were more marked and more sustained than victims of penetrating trauma. Early deaths from coagulopathic bleeding occurred in 4 of 13 patients in the MTP group vs. 21 of 31 patients in the pre-MTP group (p = 0.023).

CONCLUSIONS: In the civilian setting, aggressive use of FFP and platelets drastically reduces 24-hour mortality and early coagulopathy in patients with trauma. Reduction in 30 day mortality was only seen after blunt trauma in this small subset.  PMID: 19509623

Transfusion. 2010 Feb;50(2):493-500. Epub 2009 Oct 5.

Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients.

Shaz BH, Dente CJ, Nicholas J, MacLeod JB, Young AN, Easley K, Ling Q, Harris RS, Hillyer CD.

… This study investigates the relationship of plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios to mortality in massively transfused patients at a civilian Level 1 trauma center.

STUDY DESIGN AND METHODS: Demographic, laboratory, transfusion, and outcome data were collected prospectively from February 1, 2007, to January 31, 2009, and retrospectively from February 1, 2005, to January 31, 2007, on all injured patients who underwent massive transfusion (defined as >or=10 RBC products within 24 hr). Mortality was analyzed in relation to the plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios using both univariate and multivariate analyses.

RESULTS: A total of 214 patients received massive transfusion secondary to traumatic injury. High versus low transfusion ratios were associated with improved 30-day survival: plasma:RBC 59% versus 44%, p = 0.03; PLT:RBC 63% versus 33%, p < 0.01; and cryoprecipitate:RBC 66% versus 41%, p < 0.01. By multivariable stepwise logistic regression analysis, increased plasma:RBC (p = 0.02) and PLT:RBC (p = 0.02), and decreased age (p = 0.02), ISS (p < 0.01) and total RBCs (p = 0.03) were statistically associated with improved 30-day survival.

CONCLUSIONS: In the civilian setting, plasma, PLT, and cryoprecipitate products significantly increased 30-day survival in trauma patients. Future prospective randomized clinical trials are required to determine the optimal transfusion ratios. PMID: 19804568

Fukujinzuke

This pickle is the secret to making a bowl of rice delicious. It
complements the flavors perfectly. Hard to find, but worth the search.
http://en.m.wikipedia.org/wiki/Fukujinzuke?wasRedirected=true

Top Gear

My new favorite show - Top Gear reviews cars in a funny, offbeat way. Great photography. And they always find a way to smash something up. They usually find a unique twist on a competition between cars. See for yourself from these clips:

The second half of the following video is so funny, at 3:00 minutes - they obviously spend a lot of time thinking up an amusing challenge.

http://www.topgear.com/uk/videos/7db86cae-d1b8-4e46-995b-36a93766ac12

NYTimes: Efforts Lag at Making Highway Work Zones Safer

Slow down in work zones, and pay attention! This article explores the
increased risk in work zones.

Efforts Lag at Making Highway Work Zones Safer

Through the collective indifference of government and industry,
hundreds of people die each year in accidents in work zones.

http://s.nyt.com/u/vqB

NYTimes: He Delivers Christmas Trees for Rent

Greener Christmas trees!

He Delivers Christmas Trees for Rent

Scott Martin delivers live, potted Christmas trees that are returned to the nursery once the season is over.

http://s.nyt.com/u/v04

"Extra-credit points: The delivery trucks run on biodiesel; the trees are cared for by adults with disabilities; the drivers will pick up donations for Goodwill and used wrapping paper for recycling; and the Web site also sells eco-friendly, fair-trade ornaments."

NYTimes: A Joint Account That Underwrites Our Marriage

A touching essay about the strength of a longstanding marriage.

"Being single is all about the future, about the person you're going to meet at Starbucks or after answering the next scientific compatibility questionnaire. Being married, after a certain point, is about the past, about a steadily growing history of moments that provide a confidence of comfort, an asset that compounds over time. "

MODERN LOVE: A Joint Account That Underwrites Our Marriage

A man looks back on 35 years of marriage and how he and his wife have managed to stay married so long.

http://s.nyt.com/u/vd9

NYTimes.com: AT&T Takes the Blame, Even for the iPhone's Faults

Hmmmm - so which is better AT&T or Verizon? Consumer Reports again listed Verizon as the best carrier, but "Global Wireless Solutions, one of the third-party services that run network tests for the major carriers...dispatches drivers across the country with phones and laptops equipped with data cards. They have covered more than three million miles of roads this year...The results placeAT&T’s data network not just on top, but well ahead of everyone else. “AT&T’s data throughput is 40 to 50 percent higher than the competition, including Verizon..."" BUSINESS | December 13, 2009 Digital Domain: AT&T Takes the Blame, Even for the iPhone's Faults By RANDALL STROSS Despite evidence that suggests Verizon provides superior cellphone service, an independent assessment proves otherwise.

NYTimes: Geothermal Project in California Is Shut Down

Sounds like tapping geothermal heat (pumping water down into
cracks in the bedrock where the water expands into steam) causes earthquakes. Is that the reason a large geothermal dig was just abandoned? Or perhaps just because the rock is too hard to drill easily to that depth. Have to stay tuned...

Geothermal Project in California Is Shut Down

After safety concerns, the company in charge of a project to extract
renewable energy from deep bedrock has informed federal officials that
the project will be abandoned.

http://s.nyt.com/u/vwP

NYTimes: Church Works With U.S. to Spare Detention

You gotta have hope. Seems that the impenetrable ramparts of
bureaucracy actually enclosed a heart!
Church Works With U.S. to Spare Detention
An unusual agreement between a New Jersey church and U.S. immigration
officials has freed some Indonesians.
https://www.nytimes.com/2009/12/13/nyregion/13indonesians.html

Value-addedTax: Many See the VAT Option as a Cure for Deficits

Many See the VAT Option as a Cure for Deficits

Runaway deficits have thrust a politically unsavory savior into the
spotlight: a tax on goods and services.

http://s.nyt.com/u/i_7

NYTimes.com: The Song Decoders

Pandora music service uses musicologists as human listeners to decode what makes a song fit into a classification - works better than computer decoding of songs because of very human attributes that make us like songs. October 18, 2009 The Song Decoders By ROB WALKER By breaking music down into its component parts, Pandora Internet radio tries to figure out what kind of music you - not your social group, heroes or aspirational self - really like.