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Linda Sherman
Social Business Strategist and Trainer, Public Speaker Wordpress Websites, Japan Expert, Presentation Training, Travel Destination Marketing
Social Business Strategist and Trainer, Public Speaker Wordpress Websites, Japan Expert, Presentation Training, Travel Destination Marketing


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Senior Bullying and What to Do About Bullying Between Older Adults

This was the last session on the last day with twenty other sessions competing in the same time slot. Yet the room was full. Professionals attending the Aging in America conference hosted by American Society on Aging have a very high interest in the topic of bullying between older adults.

Video and complete transcript from conference session.

#Bullying #SeniorBullying #AiA18 #Aging #Elder Care
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Seeking Examples of Well Designed Websites for Older Adults

We have collected some good guidelines and tips for designing for both the 50+ and 70+ market target.

This is an important area that doesn't get nearly the attention it should.

Please take a look and if you have anything to contribute please let me know.

#websitedesign #UX #UI #SeniorTech #accessibility #WordPress
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America Needs to Catch Up with Britain's Protection of Abortion Clinics

Important video from John Oliver from April 8th's Last Week Tonight.

Crisis Pregnancy Centers (CPCs) vastly outnumber abortion providers, with more than 2,700 nationwide compared to fewer than 1,700 abortion clinicsi

Watch Oliver's video to learn the facts.

From the Slate article:

"However you feel about abortion, you ought to be troubled by the existence of so-called “crisis pregnancy centers,” which pressure, mislead, and sometimes straight-up lie to women who are considering ending their pregnancies. But as John Oliver details in Last Week Tonight’s main segment this week, it’s not only legal for CPCs to falsely tell women that, for example, having an abortion increases their risk of breast cancer, but they often get government funding to do so. (They also, for some reason, greatly exaggerate the failure rate of using condoms as birth control, when you figure that preventing unwanted pregnancies should be fairly high on their list of priorities.) Since they use legal loopholes to avoid being classified as medical providers, CPCs aren’t subject to laws like HIPAA, which protects patients’ privacy, but they go out of their way to present themselves as full-service organizations, often with the word “Choice” in their names. “The best client you could ever get is one who thinks they’re walking into an abortion clinic,” says anti-abortion activist Abby Johnson."

Today's news from Britain:

"RARELY are council decisions met with applause and yelps of joy. But that was the case on April 10th when Ealing, a west London borough, unanimously voted to introduce the first buffer zone around an abortion clinic in Britain, banning pro-life groups from holding protests or vigils within 100 metres. Pro-choice activists in pink high-visibility jackets chanted and hip-hoorayed outside the town hall, while pro-lifers sang hymns and prayed

Stand-offs outside abortion clinics are not unique to Ealing. Back Off, a pro-choice charity, has documented demonstrations outside 42 clinics and hospitals across Britain in the past year. Ten other councils are considering taking similar legal action, which may be easier now that Ealing has set a precedent.

Most of the demonstrations are organised by a handful of Christian groups, each with different tactics. Some hold peaceful vigils, light candles and pray. Others try to convince women to think again, handing them leaflets. Such activities have been going on for decades, but in recent years they have become more aggressive, says Rachael Clarke of the British Pregnancy Advisory Service, an abortion provider which runs 70 clinics.

Some tactics are imported from America. Two new groups with links to American organisations, Abort67 and 40 Days For Life, have entered the fray. Ms Clarke says the two groups have respectively filmed clinic users and followed women down the street (they deny this). Even those with a gentler approach look across the pond. Clare McCullough of the Good Counsel Network, a British pro-life charity, says in-house training for those in her organisation is inspired by peaceful protests in America.

The same is true of the other side. Outside Ealing’s council meeting, members of Sister Supporter, a local group which sprang up in opposition to the protests, sported pink jackets that had been sent free of charge by the Clinic Vest Project, an Illinois-based charity that supports pro-choice organisations.

America also offers a glimpse of how buffer zones work in practice. A number of states and cities have set them up. In those places protests still take place, but the greater distance between demonstrators and the clinic entrance diffuses tension and makes the experience less threatening for patients, says David Cohen, a professor of law at Drexel University in Philadelphia. Some clinics draw physical lines on the pavement to ensure that protesters keep their distance. Police are called now and then, but a constant presence is not needed.

Pro-choice activists hope that Ealing’s approach becomes a national one. In January the Home Office announced a consultation on how to deal with alleged intimidation outside clinics. Meanwhile, pro-life groups are considering legal challenges and other ways to contact pregnant women. As Ms McCullough puts it, “We are not just going to go away.”"

#crisispregnancycenters #prochoice #prolife

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Foods That Helps Battle Depression

There are a plethora of different healthy diet suggestions here. I'm not in agreement with eating cheese. Just be assured that if you are eating processed sugar, low fiber breads and other processed food you are not on a healthy diet.

Sacrifices are made but I have to say that there is no question that the healthier I eat the happier I feel. Moderating your alcohol intake is also a great idea. Sugar and alcohol give you a momentary high but long term are not so great.


The right kind of diet may give the brain more of what it needs to avoid depression, or even to treat it once it’s begun

You’re feeling depressed. What have you been eating?

Psychiatrists and therapists don’t often ask this question. But a growing body of research over the past decade shows that a healthy diet—high in fruits, vegetables, whole grains, fish and unprocessed lean red meat—can prevent depression. And an unhealthy diet—high in processed and refined foods—increases the risk for the disease in everyone, including children and teens.

Now recent studies show that a healthy diet may not only prevent depression, but could effectively treat it once it’s started.

Researchers, led by epidemiologist Felice Jacka of Australia’s Deakin University, looked at whether improving the diets of people with major depression would help improve their mood. They chose 67 people with depression for the study, some of whom were already being treated with antidepressants, some with psychotherapy, and some with both. Half of these people were given nutritional counseling from a dietitian, who helped them eat healthier. Half were given one-on-one social support—they were paired with someone to chat or play cards with—which is known to help people with depression.

After 12 weeks, the people who improved their diets showed significantly happier moods than those who received social support.

And the people who improved their diets the most improved the most. The study was published in January 2017 in BMC Medicine. A second, larger study drew similar conclusions and showed that the boost in mood lasted six months. It was led by researchers at the University of South Australia and published in December 2017 in Nutritional Neuroscience.
And later this month in Los Angeles at the American Academy of Neurology’s annual meeting, researchers from Rush University Medical Center in Chicago will present results from their research that shows that elderly adults who eat vegetables, fruits and whole grains are less likely to develop depression over time.

The findings are spurring the rise of a new field: nutritional psychiatry. Dr. Jacka helped to found the International Society for Nutritional Psychiatry Research in 2013. It held its first conference last summer. She’s also launched Deakin University’s Food & Mood Centre, which is dedicated to researching and developing nutrition-based strategies for brain disorders.

The annual American Psychiatric Association conference has started including presentations on nutrition and psychiatry, including one last year by chef David Bouley on foods that support the peripheral nervous system. And some medical schools, including Columbia University’s Vagelos College of Physicians and Surgeons, are starting to teach psychiatry residents about the importance of diet on mental health.
Depression has many causes—it may be genetic, triggered by a specific event or situation, such as loneliness, or brought on by lifestyle choices. But it’s really about an unhealthy brain, and too often people forget this. “When we think of cardiac health, we think of strengthening an organ, the heart,” says Drew Ramsey, a psychiatrist in New York, assistant clinical professor of psychiatry at Columbia and author of “Eat Complete.” “We need to start thinking of strengthening another organ, the brain, when we think of mental health.”

A bad diet makes depression worse, failing to provide the brain with the variety of nutrients it needs, Dr. Ramsey says. And processed or deep-fried foods often contain trans fats that promote inflammation, believed to be a cause of depression. To give people evidenced-based information, Dr. Ramsey created an e-course called “Eat to Beat Depression.”

A bad diet also affects our microbiome—the trillions of micro-organisms that live in our gut. They make molecules that can alter the production of serotonin, a neurotransmitter found in the brain, says Lisa Mosconi, a neuroscientist, nutritionist and associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College in New York. The good and bad bacteria in our gut have complex ways to communicate with our brain and change our mood, she says. We need to maximize the good bacteria and minimize the bad.

So what should we eat? The research points to a Mediterranean-style diet made up primarily of fruits and vegetables, extra-virgin olive oil, yogurt and cheese, legumes, nuts, seafood, whole grains and small portions of red meat. The complexity of this diet will provide the nutrition our brain needs, regulate our inflammatory response and support the good bacteria in our gut, says Dr. Mosconi, author of “Brain Food: The Surprising Science of Eating for Cognitive Power.”

Can a good diet replace medicine or therapy? Not for everyone. But people at risk for depression should pay attention to the food they eat. “It really doesn’t matter if you need Prozac or not. We know that your brain needs nutrients,” Dr. Ramsey says. A healthy diet may work even when other treatments fail. And at the very least, it can serve as a supplemental treatment—one with no bad side effects, unlike antidepressants—that also has a giant upside. It can prevent other health problems, such as heart disease, obesity and diabetes.

Loretta Go, a 60-year-old mortgage consultant in Ballwin, Mo., suffered from depression for decades. She tried multiple antidepressants and cognitive behavioral therapy, but found little relief from symptoms including insomnia, crying jags and feelings of hopelessness. About five years ago, after her doctor wanted to prescribe yet another antidepressant, she refused the medicine and decided to look for alternative treatments.
Ms. Go began researching depression and learned about the importance of diet. When she read that cashews were effective in reducing depression symptoms, she ordered 100 pounds, stored them in the freezer, and started putting them in all her meals.
She also ditched processed and fried foods, sugar and diet sodas. In their place, she started to eat primarily vegetables and fruits, eggs, turkey and a lot of tofu. She bought a Vitamix blender and started making a smoothie with greens for breakfast each morning.

Within a few months, Ms. Go says she noticed a difference in her mood. She stopped crying all the time. Her insomnia went away and she had more energy. She also began enjoying activities again that she had given up when she was depressed, such as browsing in bookstores and volunteering at the animal shelter.
Ms. Go’s depression has never come back. “This works so well,” she says. “How come nobody else talks about this?”

Write to Elizabeth Bernstein at or follow her on Facebook, Twitter or Instagram at EBernsteinWSJ"

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Apple, Amazon, Pandora and More - Competing with Spotify

"A look at the competition for music streaming
Spotify Technology SA, the Swedish company set to go public next week, is the global leader in music streaming, but several competitors are working to differentiate their service to win over artists and listeners.
Here’s a look at the competition for music streaming, or listening to music over the internet in exchange for paying a flat monthly fee or listening to ads.

Apple Music
Apple Inc. launched its music-streaming service in 2015 a year after buying Beats Electronics LLC. Its debut stumbled over user interface and engineering problems, but the service was revamped within a year and quickly became the No. 2 on-demand service. Apple’s iTunes, where customers pay to download individual songs or albums and own them permanently, is separate but accessible through the platform.

Apple Music has benefited from its integration with Apple devices, from iPhones and MacBooks to Apple Watches and HomePod voice-activated speakers, which sync easily with Apple Music but less so with Spotify or other services.
Apple Chief Executive Tim Cook has said streaming isn’t a moneymaking business but has emphasized the importance of providing music and supporting artists.

Veteran Internet-radio company Pandora Media Inc. has built the largest audio music-streaming service in the U.S. with 74.7 million active listeners to its free, ad-supported personalized music stations. The company and its stock have struggled recently as users and ad dollars have migrated to services that allow listeners to play individual songs on demand. Last year, a $480 million investment from Sirius XM Holdings Inc. was followed by a management shake-up that brought Sling TV’s founding CEO, Roger Lynch, to the helm.
A new on-demand subscription service called Pandora Premium has nearly 5.5 million subscribers.
Founded on a technology called the Music Genome Project—a combination of humans and machines that helped it analyze music and recommend songs for each listener—Pandora has collected tons of data on music and its users. It is working to apply that technology to podcasts, which it hopes will attract and keep more listeners on its platform.

SoundCloud Ltd. established its reputation as a free site for emerging artists and DJs to share and promote their music. It maintains a devout fan base, but also licenses music from major and independent labels to compete with Spotify and others. Founded in 2007, Berlin-based SoundCloud says it reaches about 175 million monthly listeners in more than 190 countries.

In 2016, it rolled out subscription tier SoundCloud Go+, which lets users listen to music offline and without ads. For $9.99 a month, it includes access to 150 million tracks, mostly mixes, mashups and other musical creations, in addition to a catalog of roughly 30 million songs that is also offered on other services like Spotify and Apple Music.

Last year, after a flurry of speculation over its ability to survive, SoundCloud laid off more than 40% of its staff and then replaced its leadership when it took $169.5 million from boutique investment bank Raine Group and Singapore investment company Temasek to stay afloat.

Alphabet Inc.’s YouTube alone accounts for twice as much time spent listening to on-demand music as all paid audiostreaming services combined, according to the International Federation of the Phonographic Industry. While artists continue to rack up massive streaming numbers on the video-sharing platform, the payout from those streams is much smaller than revenue brought in via subscription services.
After the record industry urged Google to offer more subscription options, it expanded its Google Play Music library platform in 2013 to include an “All Access” on-demand music-streaming service and has since launched a paid version of

its popular videosharing service called YouTube Red.
The company is planning to combine the two services. Google doesn’t disclose subscriber figures for either.

Amazon Music
The main draw for Amazon's music service, introduced in 2016, is its ability to integrate with the company’s voice-activated Echo smart speaker. The speaker’s virtual-assistant technology, Alexa, takes requests such as “chart toppers from 1999.” Last year, Alexa surpassed smartphones as the No. 1 way Amazon Music users access the service.
Since getting into the music-streaming business, Amazon, which doesn’t release subscriber numbers, has tried to cater to a more mainstream audience than its competitors. Amazon has been pouring resources into Alexa, as competition heats up among artificial-intelligence assistants from Google and Apple, according to people familiar with the company’s thinking."


#AppleMusic #Pandora #Spotify #AmazonMusic #SoundCloud
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New York State Retirement Fund Takes Action Against All Male Boards

"Campaign reflects growing impatience with pace of progress on gender diversity

A major state pension fund intends to oppose the re-election of all directors at hundreds of U.S. corporate boards without a single woman.
The unusual campaign by the New York State Common Retirement Fund, expected to be announced Wednesday, reflects its growing impatience with the pace of progress on gender diversity in the boardroom.

Women held 16.5% of directorships at Russell 3000 companies at year-end, up slightly from 15.1% in 2016, according to governance researchers Equilar Inc. Russell 3000 boards won’t achieve gender parity until 2048, Equilar predicts.

“We need to speed up that time frame,’’ said Thomas DiNapoli, New York State’s comptroller. He manages about $209.1 billion in assets for what is the third-biggest U.S. public pension fund.

Many large investors have long pressed corporate boards to increase their ranks of women, and several studies in recent years have linked increased female representation on boards with improved shareholder returns. But until recently, most investors didn’t specify the number of female members that they believe is appropriate.

The idea of investment managers taking a stand on social issues has faced resistance.

Earlier this month, a Florida lawmaker proposed that the state’s retirement fund stop investing in gun makers following a deadly high-school shooting. But officials who manage those investments say dropping gun stocks would conflict with the duty of a retirement or pension fund to maximize returns for public workers.

The New York pension fund owned shares in more than 400 U.S. businesses without any female directors last year.

The fund already has opposed or will soon oppose directors up for re-election at companies such as TransDigm Group Inc., Seaboard Corp. and Sonic Automotive Inc.

TransDigm, a maker of aircraft parts, wants shareholders to re-elect 11 male board members at its annual meeting Tuesday. The manufacturer is one of 45 U.S. companies that hasn’t had a single female director in the past 12 years, according to an Equilar analysis for The Wall Street Journal of the 1,500 biggest Russell 3000 concerns.

Equilar also found that of those 45 businesses, the 12 biggest by market capitalization appointed 67 male board members since 2006. TransDigm added the most, choosing nine men during that period. TransDigm didn’t respond to requests for comment.

Seaboard, an international conglomerate involved in shipping, energy and food products such as Butterball turkeys, also appears on the lineup of companies without a female director since 2006. Seaboard, whose five male directors face re-election April 23, didn’t respond to requests for comment.

For Sonic, a major car dealer, the New York pension fund said it would refuse to support the reelection of nine male directors during its April 25 annual meeting. Sonic didn’t respond to requests for comment.

Several businesses without female directors since 2006 have come under criticism for their governance practices. Skechers USA Inc., a producer of casual shoes, has defeated a shareholder proposal to boost board diversity in each of the past three years.

The New York pension fund sponsored the measure in 2015 and 2016. The fund didn’t resubmit its resolution this year.
Skechers hasn’t released its 2018 proxy. A company spokeswoman declined to comment.

Other institutional investors also are intensifying their push for more women on boards. BlackRock Inc., the world’s largest money manager, last month stated publicly for the first time that companies in which it invests should have at least two female directors.

Starting in 2015, Massachusetts’ state pension fund has voted against directors up for re-election at companies where women or people of color hold less than 25% of directorships—and increased that threshold to less than 30% of directorships in 2017.

California State Teachers’ Retirement System changed its board diversity policy last November. As a result, “Calstrs may oppose the re-election of all directors this year at 27 companies with zero women on their boards,’’ said Aeisha Mastagni, a portfolio manager for corporate governance.

Write to Joann S. Lublin at"

#BoardofDirectors #WomenonBoards #FemaleCareers
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Nice Confidence Building Tips for Women in the WorkPlace

“That was a great point you made, however, I have a different view,”

Avoid minimizing your role

Steer clear of other behaviors that suggest a lack of confidence, such as engaging in uptalk—ending sentences in a rising tone as if asking a question.

"New Strategies Help Women Build Career Confidence

Brag books, confidence logs are among techniques experts recommend to bolster lacking self-confidence

One of the most critical career strengths is a belief that can’t be taught—self-confidence. And for many women, it’s in short supply.

A lack of confidence, or the expectation that you can handle tough tasks even if you haven’t done them before, is more common among women than men, studies show, and it can be a powerful brake on their careers. Amid a growing focus on the problem by researchers and career experts, women are trying new strategies to shore up their belief in themselves.

Confidence takes root in childhood but also can be internalized in adulthood, through experience, hard work or practice. “It requires really paying attention to the small wins and not being so quick to overlook, downplay, dismiss and diminish your accomplishments,” says Aimee Cohen, a Denver career coach and author.​

Some 63% of women enter the workforce with the confidence that they can rise to senior management, compared with 75% of men, according to a 2016 survey of 8,400 adults by Bain & Co. and LinkedIn. By mid-career, only 57% of women still feel that way, compared with 66% of men, says Julie Coffman, a Bain partner and lead author of the study.

Women often hesitate to seize opportunities or ask for promotions without bosses’ support, and they tend to shoulder more family-care duties at home, Ms. Coffman says. Other research links women’s lack of confidence to being encouraged during childhood to be compliant and agreeable and to strive for perfection, rather than to compete and take risks.

Kristen Durkin was intimidated when she was recruited in 2014, at age 29, to a product-marketing position at Facebook. Despite her successful ​eight-year ​track record ​as a marketing manager for other companies, she wondered, “Do I deserve to be here?” she says. When she chose at one early meeting to sit on a bench against the wall, the meeting leader asked her to join others on couches at the center of the room. “I was a little embarrassed, but I also really recognized that I was surrounded by allies,” she says.
Ms. Durkin started a “confidence log,” as suggested by a mentor, noting times when she felt most intimidated or most confident. The log, plus input from colleagues, helped her see that she was spending an unnecessary amount of time during presentations justifying her research methods rather than describing her findings. And if certain individuals tended to intimidate her, “I worked on building trusting relationships with them,” she says. Her confidence has risen sharply, but it remains “a work in progress—a muscle that you always have to work on,” says Ms. Durkin, now 32. She was recently promoted to lead a product-marketing team.

Women often assume mastering their jobs will be enough to advance, says Carrie Kerpen,​an author, speaker and co-founder of a digital-marketing agency, who told Ms. Durkin’s story in her new book on career strategies, “Work It.” They also should be asking themselves, “How do I position myself in a way that allows me to look and feel confident?” she says. This includes describing your accomplishments with enthusiasm.

Elizabeth Bacon juggled numerous duties well on a job as an administrator for a nonprofit group in Denver, but received so little feedback that she lost confidence. With coaching from Ms. Cohen, she built ties with a “strong tribe” of friends and mentors inside and outside the nonprofit, who encouraged her to network. She soon advanced to a better job as a director for a regional business-development group.
Ms. Cohen also advised her to start a “brag book”—a journal for saving notes about one’s accomplishments, to aid recall of “rock-star moments,” the career coach says. Ms. Bacon uses a red leather-bound journal with “papers pasted in, sticking out all over the place. It looks like a hot mess,” she says. Nevertheless, on a difficult day, a glance through it lifts her spirits. One entry is a letter from a business owner Ms. Bacon helped, enabling her to keep her company afloat by guiding her to get leadership training: “I never could have done this without you,” the woman wrote. Ms. Bacon recently scored another win—election as board chairman of ​a public-private partnership supporting Denver-area businesses.

Sherry Hicks-Buckles, a manager at the Hyatt Regency Atlanta hotel, says she began keeping a brag book about a year ago. One entry is an email from a former subordinate, saying “thank you for your support and mentorship … You are truly an inspiration.” Flipping open the book on a bad day reminds her “why you do what you do, and you are making an impact,” she says.

Women’s lack of self-assurance is often especially visible in meetings​ where they’re outnumbered by men. They speak up less and are interrupted more often by others who criticize or disagree with them, according to a 2016 study of 470 small-group participants.
Some women remain silent in meetings, waiting for pauses that never come, says executive coach Alexandra Johnston.
She advises catching the eye of the meeting leader and saying his name, which typically causes others to stop and listen
says Dr. Johnston, a vice president in Washington, D.C., with Integrity Communications, a training firm.

Nandini Krishnamurthy, a senior research manager in Johnston, Iowa, for a seed company, says she used to apologize when taking the floor in meetings. She learned from Dr. Johnston to speak more assertively, saying,
“That was a great point you made, however, I have a different view,”
she says. Ms. Krishnamurthy also advises colleagues to enlist a trusted ally who can intervene if they’re interrupted, and remind others of their point.

Avoid minimizing your role
Dr. Johnston says. One product manager introduced herself in a seminar as overseeing “my little area”—a territory that included all of Europe and South America—then concluded by saying, “and that’s my little story,” she says.

Steer clear of other behaviors that suggest a lack of confidence, such as engaging in uptalk—ending sentences in a rising tone as if asking a question.

Write to Sue Shellenbarger at"

#confidence #womenatwork #selfesteem

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Diet Quality not Counting Calories is Key to Losing Weight

"Anyone who has ever been on a diet knows that the standard prescription for weight loss is to reduce the amount of calories you consume.
But a new study, published Tuesday in JAMA, may turn that advice on its head. It found that people who cut back on added sugar, refined grains and highly processed foods while concentrating on eating plenty of vegetables and whole foods — without worrying about counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The strategy worked for people whether they followed diets that were mostly low in fat or mostly low in carbohydrates. And their success did not appear to be influenced by their genetics or their insulin-response to carbohydrates, a finding that casts doubt on the increasingly popular idea that different diets should be recommended to people based on their DNA makeup or on their tolerance for carbs or fat.

The research lends strong support to the notion that diet quality, not quantity, is what helps people lose and manage their weight most easily in the long run. It also suggests that health authorities should shift away from telling the public to obsess over calories and instead encourage Americans to avoid processed foods that are made with refined starches and added sugar, like bagels, white bread, refined flour and sugary snacks and beverages, said Dr. Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University.

“This is the road map to reducing the obesity epidemic in the United States,” said Dr. Mozaffarian, who was not involved in the new study. “It’s time for U.S. and other national policies to stop focusing on calories and calorie counting.”
The new research was published in JAMA and led by Christopher D. Gardner, the director of nutrition studies at the Stanford Prevention Research Center. It was a large and expensive trial, carried out on more than 600 people with $8 million in funding from the National Institutes of Health, the Nutrition Science Initiative and other groups.

Dr. Gardner and his colleagues designed the study to compare how overweight and obese people would fare on low-carbohydrate and low-fat diets. But they also wanted to test the hypothesis — suggested by previous studies — that some people are predisposed to do better on one diet over the other depending on their genetics and their ability to metabolize carbs and fat. A growing number of services have capitalized on this idea by offering people personalized nutrition advice tailored to their genotypes.
The researchers recruited adults from the Bay Area and split them into two diet groups, which were called “healthy” low carb and “healthy” low fat. Members of both groups attended classes with dietitians where they were trained to eat nutrient-dense, minimally processed whole foods, cooked at home whenever possible.

Soft drinks, fruit juice, muffins, white rice and white bread are technically low in fat, for example, but the low-fat group was told to avoid those things and eat foods like brown rice, barley, steel-cut oats, lentils, lean meats, low-fat dairy products, quinoa, fresh fruit and legumes. The low-carb group was trained to choose nutritious foods like olive oil, salmon, avocados, hard cheeses, vegetables, nut butters, nuts and seeds, and grass-fed and pasture-raised animal foods.
The participants were encouraged to meet the federal guidelines for physical activity but did not generally increase their exercise levels, Dr. Gardner said. In classes with the dietitians, most of the time was spent discussing food and behavioral strategies to support their dietary changes.

The new study stands apart from many previous weight-loss trials because it did not set extremely restrictive carbohydrate, fat or caloric limits on people and emphasized that they focus on eating whole or “real” foods — as much as they needed to avoid feeling hungry.
“The unique thing is that we didn’t ever set a number for them to follow,” Dr. Gardner said.

Of course, many dieters regain what they lose, and this study cannot establish whether participants will be able to sustain their new habits. While people on average lost a significant amount of weight in the study, there was also wide variability in both groups. Some people gained weight, and some lost as much as 50 to 60 pounds. Dr. Gardner said that the people who lost the most weight reported that the study had “changed their relationship with food.” They no longer ate in their cars or in front of their television screens, and they were cooking more at home and sitting down to eat dinner with their families, for example.

“We really stressed to both groups again and again that we wanted them to eat high-quality foods,” Dr. Gardner said. “We told them all that we wanted them to minimize added sugar and refined grains and eat more vegetables and whole foods. We said, ‘Don’t go out and buy a low-fat brownie just because it says low fat. And those low-carb chips — don’t buy them, because they’re still chips and that’s gaming the system.’”
Dr. Gardner said many of the people in the study were surprised — and relieved — that they did not have to restrict or even think about calories.
“A couple weeks into the study people were asking when we were going to tell them how many calories to cut back on,” he said. “And months into the study they said, ‘Thank you! We’ve had to do that so many times in the past.’”
Calorie counting has long been ingrained in the prevailing nutrition and weight loss advice. The Centers for Disease Control and Prevention, for example, tells people who are trying to lose weight to “write down the foods you eat and the beverages you drink, plus the calories they have, each day,” while making an effort to restrict the amount of calories they eat and increasing the amount of calories they burn through physical activity.

“Weight management is all about balancing the number of calories you take in with the number your body uses or burns off,” the agency says.
Yet the new study found that after one year of focusing on food quality, not calories, the two groups lost substantial amounts of weight. On average, the members of the low-carb group lost just over 13 pounds, while those in the low-fat group lost about 11.7 pounds. Both groups also saw improvements in other health markers, like reductions in their waist sizes, body fat, and blood sugar and blood pressure levels.
The researchers took DNA samples from each subject and analyzed a group of genetic variants that influence fat and carbohydrate metabolism. Ultimately the subjects’ genotypes did not appear to influence their responses to the diets.
The researchers also looked at whether people who secreted higher levels of insulin in response to carbohydrate intake — a barometer of insulin resistance — did better on the low-carb diet. Surprisingly, they did not, Dr. Gardner said, which was somewhat disappointing.

“It would have been sweet to say we have a simple clinical test that will point out whether you’re insulin resistant or not and whether you should eat more or less carbs,” he added.
Dr. Walter Willett, chairman of the nutrition department at the Harvard T. H. Chan School of Public Health, said the study did not support a “precision medicine” approach to nutrition, but that future studies would be likely to look at many other genetic factors that could be significant. He said the most important message of the study was that a “high quality diet” produced substantial weight loss and that the percentage of calories from fat or carbs did not matter, which is consistent with other studies, including many that show that eating healthy fats and carbs can help prevent heart disease, diabetes and other diseases.
“The bottom line: Diet quality is important for both weight control and long-term well-being,” he said.
Dr. Gardner said it is not that calories don’t matter. After all, both groups ultimately ended up consuming fewer calories on average by the end of the study, even though they were not conscious of it. The point is that they did this by focusing on nutritious whole foods that satisfied their hunger.
“I think one place we go wrong is telling people to figure out how many calories they eat and then telling them to cut back on 500 calories, which makes them miserable,” he said. “We really need to focus on that foundational diet, which is more vegetables, more whole foods, less added sugar and less refined grains.”"

By Anahad O’Connor
Feb. 20, 2018

#dieting #healthyeating #dietquality #calories

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Why It's Hard to Kick-Start a Diet. Our Bones Contribute to Homeostatis

+Ray Gordon points out that this is why it is better to lose weight slowly than quickly. It allows your body to adjust to a new homeostatis.

"Our skeletons may help to keep our weight under control, according to a fascinating new study with animals.
The study suggests that bones could be much more intimately involved in tracking weight and controlling appetite than scientists realized. It also raises interesting questions about whether a sedentary lifestyle could cause us to pack on pounds in part by discombobulating our sensitive bones.
There is no question that our bodies like to maintain whatever weight they have sustained for any period of time. This is in large part because of our biological predilection for homeostasis, or physiological stability, which prompts our bodies to regain any weight that we lose and, in theory, lose any weight that we gain.
To achieve this stability, however, our bodies have to be able to sense how much we weigh, note when that weight changes, and respond accordingly, as if we contained an internal bathroom scale.

It has not been clear how our bodies manage this trick.
Some years ago, scientists did discover one of the likely mechanisms, which involves leptin, a hormone released by fat cells. In broad terms, when people add fat, they produce more leptin, which then jump-starts processes in the brain that reduce appetite and should cause their bodies to drop that new weight.
But obviously this system is not perfect or no one would hold on to added pounds.
So for the new study, which was published this month in Proceedings of the National Academy of Sciences,
an international group of researchers began to wonder whether there might be other processes at work.
To find out, they first gathered groups of mice and rats. They chose both species, hoping that, if any results were common to each, this might indicate that they also could occur in other mammals, including, potentially, us.
Then the scientists implanted tiny capsules into each rodent’s abdomen. Some contained weights equaling about 15 percent of each animal’s body mass. Others were empty.

In effect, some of the animals had just gained a big chunk of weight.
The scientists then left the rodents alone to deal with these added ounces as they would. And their bodies quickly went to work. Within two days, the animals containing the weighted capsules were eating less and after two weeks, had generally lost almost as much weight as the capsules contained.
When the scientists subsequently removed the weighted capsules from some of the animals, those mice and rats began eating more and soon added back those ounces.
Their homeostatic weight sensors clearly were working well, in both directions.
The researchers next repeated the procedure, but in mice that had been bred to produce very little leptin. Again, the animals ate less to stabilize their weights after the capsules were implanted.
So, their bodies were not relying solely on leptin to track and respond to weight changes.
Finally, the scientists considered bones. As they knew, most animals’ skeletons readily sense when they are being stressed by such things as strenuous weight-bearing exercise and will add extra bone cells to handle that pressure.

Osteocyctes, a type of bone cell, are thought to be the cells that recognize when outside forces are affecting the bone and send out biochemical signals prompting the creation of new bone.
To see if they likewise detect and respond to changes in body weight, the scientists bred a group of mice with unnaturally low levels of osteocytes. Then they again implanted the weighted capsules.
This time, the animals did not drop that added weight. Their bodies did not seem to realize that they had become heavier, presumably because of the low levels of osteocytes, and the animals remained artificially plump.
The implication of this result is that healthy bones seem to sense changes in body mass and then somehow initiate alterations to appetite and eating that can return the body to its previous weight, says John-Olov Jansson, a neuroscientist at the University of Gothenburg who led the study.

He and his colleagues call the bones’ sensor a “gravitostat,” which is triggered by body weight bearing down on bones, a result of the inexorable pressures of gravity.
And they suspect, he says, that a similar gravitostat exists in people.
The possibility could help to explain why sitting for hours is associated with obesity, he continues. When we sit, much of our body weight is supported by cushions rather than bones, leaving our skeletons unaware of how much we actually weigh and whether that amount has changed or should change.
Of course, that theory is purely speculative at the moment, since this study involved rodents, not people. It also cannot tell us how, if our bones do keep track of our poundage, they manage that feat, or how they communicate the information to the brain and its appetite centers.
Dr. Jansson and his colleagues plan more-detailed follow-up studies.
But for now, the findings may provide another plausible reason to get up from our chairs and perhaps help our bones to keep better track of our waistlines"

By Gretchen Reynolds
January 17, 2018

#dieting #homeostatis
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What the Hospitals of the Future Look Like - a Thorough Report from WSJ

"The sprawling institutions we know are radically changing—becoming smaller, more digital, or disappearing completely. The result should be cheaper and better care.

The days of the hospital as we know it may be numbered.

In a shift away from their traditional inpatient facilities, health-care providers are investing in outpatient clinics, same-day surgery centers, free-standing emergency rooms and micro hospitals, which offer as few as eight beds for overnight stays. They are setting up programs that monitor people 24/7 in their own homes. And they are turning to digital technology to treat and keep tabs on patients remotely from a high-tech hub.

For the most part, the investments in outside treatment are driven by simple economics: Traditional hospital care is too costly and inefficient for many medical issues. Inpatient pneumonia treatment, for example, can cost 15 to 25 times more, yet many low-risk patients who could be safely treated as outpatients are hospitalized, studies have shown.

And being hospitalized carries its own risks: With the rise in antibiotic-resistant bacteria, at any given time one in 25 patients in the U.S. is battling an infection acquired in the hospital, according to the Centers for Disease Control and Prevention—at a cost of $10 billion annually for the five most common infections.

But patient preferences for how they get care and a national focus on more prevention and wellness are also driving the new models.

“We should be investing in people and processes, not hospitals,” says David Feinberg, president and chief executive of Geisinger Health System, which is based in Danville, Pa., and has 13 hospitals in New Jersey and Pennsylvania and a health-insurance plan. His goal: to put his own hospitals “out of business” by keeping patients healthier and engaging them in improving their own well-being.

Already, the U.S. has more hospital beds than it needs in most markets, suggests a March 2017 report by Medpac, an independent analysis group reporting to Congress. The average hospital-occupancy rate was just 62% in 2015. There were also more hospital closings than openings over the four years ending in 2015, with nearly half of those converting to outpatient-only facilities. Hospitals have continued to close their doors, especially in rural areas, and a spate of mergers will speed consolidation.

“If technological and reimbursement trends continue—including large cuts to Medicare—it is likely that the country would need fewer hospitals,” says Ken Kaufman, chairman of health-care advisory firm Kaufman Hall.
Hospitals could also be squeezed as large employers band together to reduce health-care costs, such as the recent announcement that Inc., Berkshire Hathaway Inc. and JP Morgan Chase & Co. are forming a company to provide less-expensive heath care for their employees.

To be sure, there will always be a need for modern full-service hospitals to care for the sickest patients, perform complex and risky procedures and deal with trauma cases.

“Hospitals aren’t going away anytime soon, nor should they,” says Jennifer Wiler, executive director of the Care Innovation Center at UCHealth, a Colorado-based health-care system, and vice chairwoman of emergency medicine at the University of Colorado School of Medicine. “But the traditional model of a hospital as the hub of care with a single facility providing every facet of treatment is changing.”

Bruce Leff, a geriatrician and professor at Johns Hopkins University School of Medicine predicts, “Hospitals will start to evolve into large intensive-care units, where you go to get highly specialized, highly technical or serious critical care.”
Payment models for shifting care out of hospitals are being worked out, but Medicare and private insurers are weighing various reimbursement approaches such as bundled payments, which provide a single sum for 30 days of services, regardless of where they are delivered.

Here’s a look at some of the changes coming to the traditional hospital model.

Help patients at home

Studies by Dr. Leff and others show hospital-level care at home for certain conditions can be provided for 30% to 50% less than inpatient care with fewer complications, lower mortality rates and higher patient satisfaction.

New York’s Mount Sinai Hospital has developed a hospital-at-home program, HaH-plus, for some patients who show up at the emergency department or are referred by their primary-care doctors. A mobile acute-care team provides staffing, medical equipment, medications and lab tests at home, and is on call 24/7 if a condition worsens.

“For some admissions, we can avoid the emergency department, but for most admissions like pneumonia or dehydration or a skin infection, we evaluate them in the ED and then send them home in an ambulance with an IV in place,” says Linda DeCherrie, clinical director of Mount Sinai at Home. The HaH-plus program provides 30 days of care, including referring patients back to primary-care doctors and connecting them to services they need to avoid readmission.
Mount Sinai estimates that nationally, 575,000 cases each year could qualify for such a program, and treating just 20% of those could save Medicare $45 million annually. Mount Sinai is working with Contessa Health, which manages bundled-payment arrangements for hospital-at-home services, and plans to expand the home program to other areas, such as patients recovering from surgeries that would typically require an inpatient stay.

Richard Rakowski, chief executive of hospital-at-home provider Medically Home, estimates that eventually as much as 30% of care once provided in a hospital may be delivered at home.

One patient who saw a benefit from hospital-at-home care was Phyllis Camaratta, a heart-failure patient living in Malden, Mass. After three years in and out of the hospital, the 93-year-old says she didn’t want to go back after she became ill again last fall. When a nurse practitioner suggested a Medically Home program offered through her health-care provider Atrius Health, Ms. Camaratta agreed to try it.

At first, she says, she was a little overwhelmed by how many people showed up to provide care, check her condition, set up equipment and perform tests on portable machines. But she was impressed by the care, including a daily video consult via iPad so a doctor could see if her legs had too much swelling from fluid buildup.

At the end of a month, she was discharged from the program and referred to a new primary-care doctor. “We were so impressed that they could do all the same things they did in the hospital and have my mother be comfortable in her own bed and her own bathroom…with family and familiar surroundings,” says her daughter, Debbie Camaratta. “She was in a very fragile state, but The care really helped her bounce back to the best she can be at this age.”

Build smaller facilities

To offer services and expand in locales where it doesn’t make sense to build a new hospital, health systems are building free-standing emergency rooms and microhospitals, commonly called neighborhood hospitals. The scope of services varies, but microhospitals usually include emergency rooms and beds for short-stay recovery.

Houston-based Emerus Holdings Inc. partners with big health systems to open microhospitals. Commonly called neighborhood hospitals, they typically anchor a two- or three-story “healthplex” buildings with emergency care, labor and delivery, surgical procedures and lab and radiology services. For example, it has opened four in partnership with Dignity Health-St. Rose Dominican, which operates hospitals and other medical facilities in southern Nevada, allowing the system to expand services to a broader area around Las Vegas. And Emerus is joining with Highmark Health, which includes health plans and the Allegheny Health Network, operator of West Penn Hospital, to build multiple neighborhood hospitals in western Pennsylvania.

Typically, 92% of patients who come to the microhospitals are treated and sent home in an average of 90 minutes, and 8% are admitted overnight for care such as intravenous-medication administration, according to Chief Executive Craig Goguen. If need be, patients can be transferred to higher-level care, such as a hospital cardiac-catheterization lab, sometimes in less time than it takes in a hospital’s own emergency room, Mr. Goguen says.

Michigan Medicine, the academic medical center of the University of Michigan, is completing a nearly 300,000-square-foot center in Brighton, Mich., which will house more than 40 specialty services for adults and children, cancer treatment, operating rooms and a short-stay unit. Eventually, most patients who aren’t acutely ill “will be getting care in an outpatient center that can do everything short of admitting you, and maybe just watch you overnight,” says David A. Spahlinger, president of the University of Michigan health system.

Ochsner Health System, Louisiana’s largest nonprofit academic health system, has 30 owned, managed or affiliated hospitals. President and Chief Executive Warner Thomas says 80% of its capital expenditures are going to outpatient clinics, and “I don’t see us building new hospitals.”

In the Baton Rouge area, for example, in addition to a recently opened outpatient cancer center, it is developing a medical office building with more primary-care and diagnostic and specialty clinics. Attached to the building will be a 10-bed inpatient hospital and surgical center, which Mr. Thomas says will offer procedures such as knee replacements requiring stays of 24 hours or less.

Find new uses for old hospitals

In some cases, health systems are taking existing hospitals and turning them into specialized facilities.
After buying the River Parishes Hospital in LaPlace, La., three years ago, Ochsner joined with a provider of psychiatric and addiction treatment to convert the hospital to an inpatient psychiatric facility to provide services for mental-health disorders. Emergency care once provided at River Parishes is now offered at a new medical complex including 24/7 emergency services with 13 beds and on-site lab and radiology.

In New York, after Mount Sinai Health System’s 2013 acquisition of Continuum, a network of community hospitals, it no longer made sense to operate all of them as full-service hospitals, says Kenneth L. Davis, Mount Sinai’s president and chief executive.

The focus now has been on converting the facilities to centers for specialty care, while continuing to ensure that each hospital can handle emergencies and other community needs, Dr. Davis says. The former Roosevelt Hospital, on Manhattan’s West Side, for example, has been rebranded as Mount Sinai West, specializing in orthopedics, neurosurgery and complex ear, nose and throat cases, as well as mother-and-child services.

St. Luke’s Hospital in West Harlem is specializing in cardiac interventions, circulation restoration, weight-loss surgery and orthopedic trauma cases. Mount Sinai is replacing the antiquated Beth Israel hospital with a new downtown network of primary, specialty, urgent, behavioral and outpatient-surgery services, as well as a new hospital designed for short stays and procedures with an emergency department. And New York Eye and Ear Infirmary’s current site will be transformed into a full-scale ER with stroke and heart care, along with beds for short stays.

The goal is to care for each patient in the most appropriate setting, whether in a traditional hospital bed, an outpatient center or at home, Dr. Davis says. While Mount Sinai has faced questions from some groups concerned about a reduction in the number of hospital beds, especially should there be a citywide emergency, “we can’t build facilities for doomsday,” Dr. Davis says. “We need a new model of care that focuses on wellness and prevention and keeps people out of hospitals.”

Reach out to those at risk

The population-health strategy at Geisinger Health System includes identifying groups who can benefit from programs to improve health and avoid hospitalization, such as diabetics whose blood sugar isn’t well controlled. Dr. Feinberg says preventive care could have prevented foot amputations in many such patients in Geisinger hospitals.

In Shamokin, Pa., for example, about 50% of the population is predisposed to diabetes, mostly due to obesity, and one in three residents is considered “food insecure.” A healthier diet can lead to improvement in the disease. In a pilot program, Geisinger established a Fresh Food Farmacy, prescribing fruits, vegetables, lean proteins and whole grains, and providing them free to patients and families who need assistance, along with diabetes education, cooking tools and recipes.

Dr. Feinberg says Geisinger has seen a decrease in blood-sugar levels for participating patients, “and we are scaling the program up as fast as we can.”

Research is helping identify the health risks of other patients. A study of Geisinger electronic health records, published in JAMA Internal Medicine in 2016, suggested that patients who lived near heavy gas-drilling activity from fracking in Pennsylvania face a larger risk of asthma attacks. And a 2013 study of Geisinger patient records found that proximity to high-density livestock production was associated with MRSA, a form of staph. Doctors can wait until children “We can wait until kids show up with asthma or come in with a staph infection, or go into the community and intervene with those people who have risk factors,” Dr. Feinberg says.

Geisinger is also conducting a study, the MyCode Community Health Initiative, sequencing the genome of volunteers to look for risks such as cancer and heart disease. So far more than 170,000 patients have signed on; in many cases, Dr. Feinberg says, “people have a medically actionable condition, and there is something we can do.”

Help from afar

More hospital systems are reducing the need for large hospitals staffed by high-level specialists by investing in telemedicine. This technology lets doctors in one or more central hubs monitor and care for patients in widely dispersed intensive-care units, such as stroke victims and premature newborns.

For instance, specialists using two-way video and audio technology can monitor and recommend care for newborns in multiple neonatal units from one hub, while a patient with a rash or wound needing special care can use Skype or FaceTime to consult with a specialist from their local doctor’s office, home computer or mobile phone. Telemedicine also allows local practitioners to consult remotely face to face with experts in big medical centers.

With 179 hospitals, HCA Healthcare Inc. still sees demand for more hospital capacity in its markets, adding 1,350 inpatient beds over the past three years, with plans for 2,000 more in the next three years. But last year, HCA also provided 115,000 telehealth consults, including for hospitals it doesn’t own. “Telehealth is the glue that allows us to transcend time and geography,” says Jonathan Perlin, president, clinical services, and chief medical officer of HCA. Dr. Perlin says HCA guarantees it can remotely evaluate stroke patients within 15 minutes of a request to help local doctors determine whether to administer clot-busting drugs or transfer a patient to a higher level of care.

Intermountain Health Care, based in Salt Lake City, with 22 hospitals in Utah and one in Idaho, uses telemedicine for patients in its more far-flung locations. In Utah, smaller rural hospitals can connect emergency-department patients with crisis-care workers in Salt Lake City. Intermountain Medical Center also offers remote outpatient psychiatry consults, as well as guiding local treatment of wounds.

Eighteen rural hospitals, for example including two it doesn’t own, have access to remote neonatologists, and more than 1,000 patients have been treated through its telestroke program, administered by experts at its main Intermountain Medical Center to patients in emergency rooms across its system.

“We aren’t interested in building more bricks and mortar, but are leveraging technology to expand our reach and our footprint,” says Jim Sheets, Intermountain Healthcare vice president of outreach services. “Patients and families shouldn’t be penalized because they were born in Blanding, Utah, and don’t have access to the level of acute care we have in Salt Lake City.”

Make hospitals more efficient

As less-complex care moves outside of their walls, traditional hospitals are turning to big data and the science of predictive analytics to improve care of the sickest patients. That allows them to better recognize who is deteriorating quickly in intensive care, identify which patients are likely to end up back in the hospital once they’ve been discharged, and make sure operating rooms are available when needed for surgeries.

UCHealth in Colorado typically assigned blocks of operating-room time to surgeons, but the full allocations weren’t always used, and there was no reliable way to open them up for other surgeons and procedures, according to Steve Hess, UCHealth’s chief information officer.

In partnership with Silicon Valley company LeanTaas, UCHealth has adopted a program called iQueue, which analyzes data about how surgeons are using their operating-room time, identifies the causes of delays such as starting the first case late, and pinpoints other problems causing bottlenecks. It uses machine learning to detect patterns of over- or underuse and reallocates operating-room time as needed.

“We can easily see if a surgeon is consistently using only two-thirds of an eight-hour block, and whether we can easily reduce that to six hours without any pain,” says Mr. Hess. Surgeons get early warnings when their use of operating-room time approaches lower bounds set by the hospital. And surgeons can use their mobile phones to release assigned blocks, request blocks and swap time with other colleagues.

“Many hospitals would say we need to build more ORs instead of trying to optimize the 10 we have,” says Mr. Hess. “But we know the increase in health-care costs is unsustainable, and we have to do things more efficiently.”"

#HealthCare #hospitals #healthcarecosts
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