Are you fully vaccinated? Immunize now to protect yourself and those you care about

Today’s guest blog entry is by Carol J. Baker, MD, FAAP, FIDSA, professor of pediatrics, molecular virology and microbiology at Baylor College of Medicine; and immediate past president of the National Foundation for Infectious Diseases.

Nearly 60,000 Americans contracted paralytic polio in 1952. Today, polio has been eradicated in the United States, thanks to a vaccine. Preventing polio and other serious or life-threatening infections is one of the greatest public health achievements of all time. The persistent use of vaccines also led to the eradication of smallpox, and has significantly reduced the presence of other life-threatening diseases such as measles and German measles. But vaccinations only work when we get them, which is why the Centers for Disease Control and Prevention has named August National Immunization Awareness Month — to educate people about the seriousness of vaccine-preventable diseases and the importance of keeping up-to-date on recommended vaccinations throughout life.

Vaccine-preventable diseases claim the lives of approximately 50,000 Americans each year — more than HIV/AIDS, breast cancer or traffic accidents. Seasonal influenza is currently the leading cause of vaccine-preventable death in the United States, claiming the lives of about 36,000 people each year and putting around 200,000 people in the hospital. Most of these deaths are in the elderly, but the hospitalization rate in children age 2 years or younger is the same as in the elderly. Influenza also causes nearly 100 deaths each year in American children younger than 5 years of age. Most of these children were previously healthy. It is tragic when any child dies, especially when that death is preventable.

With influenza season approaching, now is the time to start planning to protect yourself and your family by getting everyone in your household immunized. A number of resources are available for information about influenza and other vaccine-preventable diseases. The Web site of the Childhood Influenza Immunization Coalition offers a Flu Risk Calculator to help people of all ages determine whether or not they should be vaccinated against influenza. To learn more about other vaccines and vaccine-preventable diseases, visit CDC’s vaccination page. For information on infectious diseases and prevention specific to adults, visit the National Foundation for Infectious Diseases’ Adult Vaccination Web site.

Decide today to protect yourself against infectious diseases — after all, an ounce of prevention is worth more than a pound of cure, and even one life lost because prevention was ignored is a tragedy.

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Protecting against H1N1 flu: Who will get vaccinated first?

Think you’ll be first in line to get the vaccine for H1N1, formerly known as swine flu, when it becomes available? Not so fast. There may be others ahead of you who are more at risk.

The experts who advise the Centers for Disease Control and Prevention recommended this week who should be the first to receive the new H1N1 flu vaccine when it becomes available. At the top of the list are:
* pregnant women,
* people living with or caring for babies younger than 6 months old,
* health care and emergency services workers,
* children and young adults ages 6 months to 24 years, and
* 25- to 64-year-olds with serious health problems.

Those five groups were chosen because they have a higher risk of being infected by H1N1, developing complications from the virus and passing it onto others.

Although CDC does not expect to run out of the vaccine, the potential spread of the H1N1 virus is hard to predict and the demand may be more than the supply. If there’s a vaccine shortage, priority should be given to pregnant women, infants younger than 6 months, some health care workers, children 6 months to 4 years old and children ages 5 to 18 with certain medical conditions, the advisors recommended.

Studies show that seniors ages 65 and up are less likely than younger age groups to be infected by H1N1, but the CDC advisors recommended that this group receive the H1N1 vaccine once it’s given to the higher-risk groups.

So the H1N1 vaccine means no seasonal flu shot, right? Wrong! The H1N1 vaccine won’t replace the seasonal flu vaccine. It will still be important for you to get your yearly flu shot. But both vaccinations can be given on the same day, so once the H1N1 vaccine is ready and it’s your turn, you may not even have to make two trips.

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The Diet-Heart Hypothesis: Subdividing Lipoproteins

Two posts ago, we made the rounds of the commonly measured blood lipids (total cholesterol, LDL, HDL, triglycerides) and how they associate with cardiac risk.

Lipoproteins Can be Subdivided into Several Subcategories

In the continual search for better measures of cardiac risk, researchers in the 1980s decided to break down lipoprotein particles into sub-categories. One of these researchers is Dr. Ronald M. Krauss. Krauss published extensively on the association between lipoprotein size and cardiac risk, eventually concluding (
The plasma lipoprotein profile accompanying a preponderance of small, dense LDL particles (specifically LDL-III) is associated with up to a threefold increase in the susceptibility of developing [coronary artery disease]. This has been demonstrated in case-control studies of myocardial infarction and angiographically documented coronary disease.
Krauss found that small, dense LDL (sdLDL) doesn't travel alone: it typically comes along with low HDL and high triglycerides*. He called this combination of factors "lipoprotein pattern B"; its opposite is "lipoprotein pattern A": large, buoyant LDL, high HDL and low triglycerides. Incidentally, low HDL and high triglycerides are hallmarks of the metabolic syndrome, the quintessential modern metabolic disorder.

Krauss and his colleagues went on to hypothesize that sdLDL promotes atherosclerosis because of its ability to penetrate the artery wall more easily than large LDL. He and others subsequently showed that sdLDL are also more prone to oxidation than large LDL (
1, 2).

Diet Affects LDL Subcategories

The next step in Krauss's research was to see how diet affects lipoprotein patterns. In 1994, he published a
study comparing the effects of a low-fat (24%), high-carbohydrate (56%) diet to a "high-fat" (46%), "low-carbohydrate" (34%) diet on lipoprotein patterns. The high-fat diet also happened to be high in saturated fat-- 18% of calories. He found that (quote source):
Out of the 87 men with pattern A on the high-fat diet, 36 converted to pattern B on the low-fat diet... Taken together, these results indicate that in the majority of men, the reduction in LDL cholesterol seen on a low-fat, high-carbohydrate diet is mainly because of a shift from larger, more cholesterol-enriched LDL to smaller, cholesterol-depleted LDL [sdLDL].
In other words, in the majority of people, high-carbohydrate diets lower LDL cholesterol not by decreasing LDL particle count (which might be good), but by decreasing LDL size and increasing sdLDL (probably not good). This has been shown repeatedly, including with a 10% fat diet and in children. However, in people who already exhibit pattern B, reducing fat does reduce LDL particle number. Keep in mind that the majority of carbohydrate in modern America comes from refined wheat and sugar; a diet of unrefined carbohydrate may not have these effects.

Krauss then specifically explored the effect of saturated fat on LDL size (free full text). He re-analyzed the data from the study above, and found that:
In summary, the present study showed that changes in dietary saturated fat are associated with changes in LDL subclasses in healthy men. An increase in saturated fat, and in particular, myristic acid [as well as palmitic acid], was associated with increases in larger LDL particles (and decreases in smaller LDL particles). LDL particle diameter and peak flotation rate [density] were also positively associated with saturated fat, indicating shifts in LDL-particle distribution toward larger, cholesterol-enriched LDL.
Participants who ate the most saturated fat had the largest LDL, and vice versa. Kudos to Dr. Krauss for publishing these provocative data. It's not an isolated finding. He noted in 1994 that:
Cross-sectional population analyses have suggested an association between reduced LDL particle size and relatively reduced dietary animal-fat intake, and increased consumption of carbohydrates.
Diet Affects HDL Subcategories

Krauss also tested the effect of his dietary intervention on HDL. Several studies have found that the largest HDL particles, HDL2b, associate most strongly with HDL's protective effects (more HDL2b = fewer heart attacks). Compared to the diet high in total fat and saturated fat, the low-fat diet decreased HDL2b significantly. A separate study found that the effect persists at one year. Berglund et al. independently confirmed the finding using the low-fat American Heart Association diet in men and women of diverse racial backgrounds. Here's what they had to say about it:

The results indicate that dietary changes suggested to be prudent for a large segment of the population will primarily affect [i.e., reduce] the concentrations of the most prominent antiatherogenic [anti-heart attack] HDL subpopulation.
Saturated and omega-3 fats selectively increase large HDL. Dr. B. G. of Animal Pharm has written about this a number of times.

Wrapping it Up

Contrary to the simplistic idea that saturated fat increases LDL and thus cardiac risk, total fat and saturated fat have a complex influence on blood lipids, the net effect of which is unclear. These blood lipid changes persist for at least one year, so they may represent a long-term effect. It's important to remember that the primary sources of carbohydrate in the modern Western diet are refined wheat and sugar.  Healthier sources of carbohydrate have different effects on blood lipids.

* This is why you may read that small, dense LDL is not an "independent predictor" of heart attack risk. Since it travels along with a particular pattern of HDL and triglycerides, in most studies it does not give information on cardiac risk beyond what you can get by measuring other lipoproteins.

The Snack Pit and How to Stick to a Reducing Diet

(Click on the images to enlarge.)
Source: A New Figure in 30 Days, 1959

On the Spot: Trimming and Building, and Whittle While You Work

(Click on the images to enlarge.)
Source: A New Figure in 30 Days, 1959

Luxurious Coffee Table

The subtle yet decorative construction of the Louis Louis Square Cocktail Table makes it the perfect addition to your living room.

Beautiful and functional, the Long Cove Greenport Storage Cocktail Table in Midnight will be the perfect centerpiece for your living room

This beautiful plank table will fit perfectly in any modern decor. The natural, rustic look creates an age-old feel

Decorate with grandeur without having to search the world over with the Grand Salon Round Cocktail Table in Mocha Brown.

With sweeping dimensions, ambitious designs, and crafted from the finest materials, the occasional tables from the luxurious

Instead of traveling the world to find the finest materials and craftsmanship, just choose the Grand Salon Oval Storage Cocktail Table in Mocha Brown! This stunning cocktail table is classic and will fit in any room in your home

If you are into the modern style, this black contemporary cocktail table is perfect for you! Its straight lines and practical shelves are sure to match with your home's modern decor.

Modern dining room tables

Dining room tables

Modern dining room tables can add tremendous beauty to your home. Their clean, crisp lines allow you to dress them up or dress them down, depending on the occasion. During the holidays or other festival occasions, you can change the entire character of a dining room table with a special tablecloth or runner. For every day use, finely crafted modern dining room tables don't need much embellishment to look splendid in your home. The quality of the materials, originality of the designs and fine finishes will make your dining room table a focal point of your home.

for more via " Modern dining room tables "

Product Description

Did you know that the word 'Tavla' means table in Ancient Arawak' Archeologists discovered that this ancient tribe harvested thin strips of wood from the rare Veneer Tree (Veneerifus Treeus) and formed some of the first dining tables known to man. O.K., so we're making that up. But even a little white lie can't detract from the true beauty of our Tavla Dining Table. A crisp, clean veneer top is anchored by a nearly indestructible steel frame and leg support. The table will look equally good in your dining room or in the office. It is magnificently simple and simply magnificent.

Product Description

Sure, you could get one of those cavernous leafed tables with seating for 22, but what's the point? Better to tend to your sense of style and fashion than to keep a table around that's only used twice a year. This table fills the bill nicely. Big enough to seat a dinner party but small enough that two can hold hands across it during an intimate dinner, our glass-topped dining table is an exercise in simple elegance. With this dining table in your home, you'll look forward to every meal together, large or small.

Product Description

Seat six with plenty of space to spread out for a multi course extravaganza with this well crafted and superbly built table. The silky smooth dark top is almost like glass, creating a striking reflection that plays with the light from above and from the side. The sturdy stainless steel legs are small but strong, so you don't have to worry about your guests sacrificing comfort for an overly verbose, bulbous carved leg. Instead, they have plenty of room to spread out as they enjoy the spread before them. Rarely has a table been so functional yet so attractive.

Product Description

Dining room tables have always been problematic. For daily use, a small table fills the bill well for most families. But it is woefully inadequate when entertaining or having a holiday feast. One option is to lug in the painfully heavy leaves and jostle them into the table's mechanism. This table offers a much more salient approach. The leaf installs effortlessly, allowing you to quickly scale the table to match the occasion.

Product Description

Whether you're planning a holiday extravaganza, a sumptuous buffet or a sit down gourmet meal, space is always at a premium. Who hasn't created a multi course culinary masterpiece, only to find there isn't enough table space? This extendable table is here for you. Running out of room for food and/or guests? Simply pull out the extension and voila – all the space you need for both.

Cushions Of New Decor

Complementary citrus and green give a fresh look. Rattan and wooden Thomas Dare furniture and Crucial Trading sisal carpet create a summery feel, while voiles bleach out the windows and bathe the room in light. Shutters give extra privacy and control. The glass-topped table reflects light, enhancing the space. Spiky plants give architectural interest and echo the cushion print.

Patterned purple wallpaper teamed with an antique-style mirror creates a focal point out of the fireplace in this dramatic living room. The purple of the walls is mirrored in a rich aubergine rug and ottoman. An opulent combination of rich fig shades and glistening silver accessories creates a grown-up living space.

Green and red furniture and accessories provide colourful accents in this living room. The bold print shade ties into the scheme, repeating its colours and cushions. The dark grey walls and white flooring creates a soft and subtle backdrop

Bold red makes a statement against fresh green walls in this living room. Faux fur cushions and a textured rug keep the look cosy, while a glass coffee table creates a feeling of space, and its similarity to the dining table links the open-plan areas together.

A neutral colour palette of dusky pinks and greys creates an informal yet sophisticated look in this living room. A modular sofa is perfect for family to sit together, and upholstery in a darker colour like grey is ideal for hiding stains. Multifunctional furniture is key. For instance, the footstools can also be used as chairs or as storage boxes for magazines.

Give a traditional living room scheme a contemporary twist with super-sized and super-bright florals on the walls. Here, drops of patterned wallpaper are combined with drops of plain to create a bespoke effect. Neutral floors maintain a traditional look, while hits of punchy colour are added for a scheme that’s modern yet timeless.

Mustard florals and dark wood furniture, and matching flooring, create a Fifties-style look in this living room. The floral print on unlined curtains is emphasised by daylight shining through, in a scheme where different floral fabrics work together due to a common colour palette

Oriental Rugs was founded by the largest importer of Oriental rugs in New England. We offer a large selection of area rugs with the finest collection of Persian rugs to fit into the decor in any area of your home. We pay for shipping to your door inside the continental US.

Professional designers choose an oriental rugs first to define the palette of colors for the room, even with bath rugs and kids rugs. The Oriental area rugs have to visually tie the other colors in the room together. Unlike shag rugs oriental rugs have elaborate patterns and multiple colors.

The best procedure when decorating a room is to pick rugs in the colors you like best and build the room décor around that. has oriental rugs, whether they are hand knotted or hand tufted rug, for every area of your home with arrays of colors and styles to fit any taste.

A division of Kaoud Oriental Rugs, is the fastest growing online retailer of oriental area rugs in the North America. We buy from the best suppliers from around the world, which means our selection and prices are unbeatable. We have relationships with the best manufacturers like; Nourison, Oriental Weavers, Shaw rugs, Dalyn rug, Momeni rugs, Couristan rugs, Capel rugs, and Chandra Rugs. From the best synthetic carpet rugs to the highest quality wool rugs, you will find the oriental rugs that fit you décor perfectly at

We have been taking care of the publics décor needs for over 50 years. With 3 generations experience in this industry, we can satisfy all of your oriental area rug needs. We offer a dizzying selection of styles at rock bottom prices. Every area rug has free shipping within the Continental United States. We have an extensive line of discount rugs l and we offer a 150% Low Price Guarantee and a 30-Day In Home Trial so you can be sure the rug you saw on the computer screen looks just as good in your home.

Whether you are looking to start from scratch with a new room or add new life to an existing rooms decor , oriental rugs are the perfect way to change the ambiance or character of a room.

In addition to decor and design changes, oriental area rugs can help absorb the noise level in a room with otherwise hard surface floors.
It can also add warmth to cold wood or ceramic flooring.

There's an endless array of area rug styles and designs to choose from like contemporary to traditional or European to far eastern designed Oriental rugs in stock and ready to ship.

Shag Rugs

Shag Rugs were very popular in the 1960s and 1970’s and not until very recently has there has been a resurgence in their appeal. There’s nothing quite like the feel of a nice-warm-fluffy shag rug under your feet. They are so much softer than a sisal rug. They are nice and soft and have a casual “shaggy” appearance. Though braided rugs feel soft they don’t have the same soft look. Shag rugs are different than most other rugs in that their fiber loops are left intact to create their pile, and that’s why they are so soft and have such “shagginess”. This is how a hand tufted rug looks before it is sheared.

In their early years, shag rugs were mainly found in oval shapes. They virtually always consisted of solid designs and weren’t as pleasing on the eye as they are now. Modern versions of these carpet rugs come in a greater assortment of shapes, sizes and some down right urbane contemporary rugs. Modern shag area rugs are made up of much higher quality materials than they were in their infancy so they last a lot longer. The higher quality, increased durability and fun styles and colors mean they make great kids rugs.

Most shag rugs are still made up of synthetic fibers however these days you can find some interesting variations. You will find them as cotton rugs, wool rugs, silk rugs, linen rugs and even leather rugs.

One great place to use shag rugs is in bedrooms. The hard/cold surfaces in bathrooms, like tile floors, toilet, sinks and tubs, can be offset with patches of soft and warm bath rugs. Shag rugs help absorb noise which is something to keep in mind when thinking about the areas where you may want to use them.

Generally you get what you pay for in life and shag rugs are no exception. The cheaper the discount rugs the sparser the tufts that make up the pile, which means less structure and lower overall quality. But we have great quality rugs from the biggest manufacturers of shag rugs including: Shaw Rugs, Dalyn Rug, Couristan Rugs, Chandra Rugs and Momeni Rugs.

What a lot of people like about shag rugs is their ability to change the look of a room. Though some people think of them as retro looking, most are attracted by their simplicity and feel. They are much simpler than oriental rugs or persian rugs. But we highly recommend Shag rugs. Take advantage of their warmth, comfort, bold design when decorating your house.

Kids Rugs

Kids Rugs don’t have to be just for kids. Think of them as Fun Rugs for the kid in all of us. We have an ever expanding selection of kids rugs with something for everyone from newborns to tweens to teens to just plain fun.

Kids rugs are the key to livening up a child’s room. As the foundation of any rooms’ décor, kids rugs bring in color and add excitement to any childs room. Some of the newest and most popular styles in kids shag rugs are the Mary-Kate and Ashley collection from Shaw Rugs. They are manufactured with high quality nylon in a state of the art facility to ensure superb durability, and resilience even in the tough environment of a child’s room. Mary Kate and Ashley rugs are extremely distinctive contemporary rugs with an eye toward the latest trends using unique combinations of colors and patterns.

RugSale long lasting relationships with the best suppliers from around the world like: Nourison, Oriental Weavers, Dalyn rug, Momeni Rugs, Couristan Rugs, Capel Rugs, and Chandra Rugs. These carefully cultivated relationships mean our selection and price points are the best. Kids rugs need to be made from soft materials unlike sisal rugs. From the best synthetic materials to the highest quality wool rugs, you will find area rugs that fits your child’s décor perfectly at

If you are looking for unique kids rugs for a nursery, a children’s or even a teens room oriental rugs and persian rugs won’t fit the bill. A good kids rug need to be affordable also like discount rugs. We have kids carpet rugs or even braided rugs to create the an amazing room for your child. Interesting patterns and colors add a lively atmosphere to kids bedrooms and playroom. The energy they add is also a great alternative to expensive wallpapers and time consuming special paint jobs.

Most kids rugs use primary color pallets (red, blue, yellow), but with the right touches you can draw these colors through the rest of the room. If you add colors from the rug in the bedding or curtains you can give the room a cohesive quality and make the room very vibrant. This can also be done with bath rugs. This is the simplest and most inexpensive alternative to using themes and characters your child will outgrow which will mean you will have to redecorate it all over again.

Unmitigated England Is On Holiday

Back soon. With news of English Heritage's Festival of History, (there weren't nearly enough portable toilets), and whatever I come across in Cumberland and Westmorland.

Link: 1911 Women's Hair

Hair lessons and advice from Girls Own Paper and Woman's magazine, 1911

Short and Chic Hairstyle for Outdoors

(Pictures are links to larger versions of the images.)
Source: The Journeyman Barber, August 1940

MRFIT Mortality

The Multiple Risk Factor Intervention trial was a very large controlled diet trial conducted in the 1980s. It involved an initial phase in which investigators screened over 350,000 men age 35-57 for cardiovascular risk factors including total blood cholesterol. 12,866 participants with major cardiovascular risk factors were selected for the diet intervention trial, while the rest were followed for six years. I discussed the intervention trial here.

During the six years of the observational arm of MRFIT, investigators kept track of deaths in the patients they had screened. They compared the occurrence of deaths from multiple causes to the blood cholesterol values they had measured at the beginning of the study. Here's a graph of the results (source):

Click on the graph for a larger image. Coronary heart disease does indeed rise with increasing total cholesterol in American men of this age group. But total mortality is nearly as high at low cholesterol levels as at high cholesterol levels. What accounts for the increase in mortality at low cholesterol levels, if not coronary heart disease? Stroke is part of the explanation. It was twice as prevalent in the lowest-cholesterol group as it was in other participants. But that hardly explains the large increase in mortality.

Possible explanations from other studies include higher infection rates and higher rates of accidents and suicide. But the study didn't provide those statistics so I'm only guessing.

The MRFIT study cannot be replicated, because it was conducted at a time when fewer people were taking cholesterol-lowering drugs. In 2009, a 50-year old whose doctor discovers he has high cholesterol will likely be prescribed a statin, after which he will probably no longer have high cholesterol. This will confound studies examining the association between blood cholesterol and disease outcomes.

The Art of Basic Haircutting and the Short Cut

(Click on the images to enlarge.)
Source: Practice and Science of Standard Barbering, ⓒ 1938-1958

The Diet-Heart Hypothesis: A Little Perspective

Now that we've discussed the first half of the diet-heart hypothesis, that saturated fat elevated total and LDL cholesterol, let's take a look at the second half. This is the idea that elevated serum cholesterol causes cardiovascular disease, also called the "lipid hypothesis".

Heart Attack Mortality vs. Total Mortality

We've been warned that high serum cholesterol leads to heart attacks and that it should be reduced by any means necessary, including powerful cholesterol-lowering drugs. We've been assailed by scientific articles and media reports showing associations between cholesterol and heart disease. What I'm going to show you is a single graph that puts this whole issue into perspective.

The following is drawn from the Framingham Heart study (via the book Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.), which is one of the longest-running observational studies ever conducted. The study subjects are fairly representative of the general population, although less racially diverse (largely Caucasian). The graph is of total mortality (vertical axis) by total cholesterol level (horizontal axis), for different age groups: If you're 80 or older, and you have low cholesterol, it's time to get your affairs in order. Between the age of 50 and 80, when most heart attacks occur, there's no association between cholesterol level and total mortality. At age 50 and below, men with higher cholesterol die more often. In the youngest age group, the percent increase in mortality between low and high cholesterol is fairly large, but the absolute risk of death at that age is still low. There is no positive association between total cholesterol and mortality in women at any age, only a negative association in the oldest age group.

Here's more data from the Framingham study, this time heart attack deaths rather than total mortality
(from the book Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.): Up to age 47, men with higher cholesterol have more heart attacks. At ages above 47, cholesterol does not associate with heart attacks or total mortality. Since the frequency of heart attacks and total mortality are low before the age of 47, it follows that total cholesterol isn't a great predictor of heart attacks in the general population.

These findings are consistent with other studies that looked at the relationship between total cholesterol and heart attacks in Western populations. For example, the observational arm of the massive MRFIT study found that higher cholesterol predicted a higher risk of heart attack in men age 35-57, but total mortality was highest both at low and high cholesterol levels. The "ideal" cholesterol range for total mortality was between 140 and 260 mg/dL (reference). Quite a range. That encompasses the large majority of the American public.

The Association Between Blood Cholesterol and Heart Attacks is Not Universal
The association between total cholesterol and heart attacks has generally not been observed in Japanese studies that did not pre-select for participants with cardiovascular risk factors (
Prevention of Coronary Heart Disease, by Dr. Harumi Okuyama et al.). This suggests that total blood cholesterol as a marker of heart attack risk is not universal. It would not necessarily apply to someone eating a non-Western diet.

Subdividing Cholesterol into Different Lipoprotein Particles Improves its Predictive Value

So far, this probably hasn't shocked anyone. Most people agree that total cholesterol isn't a great marker. Researchers long ago sliced up total cholesterol into several more specific categories, the most discussed being low-density lipoprotein (LDL) and high-density lipoprotein (HDL). These are tiny fatty droplets (lipoproteins) containing fats, cholesterol and proteins. They transport cholesterol, fats, and fat-soluble vitamins between tissues via the blood.

The LDL and HDL numbers you get back from the doctor's office typically refer to the amount of cholesterol contained in LDL or HDL per unit blood serum, but you can get the actual particle number measured as well.
One can also measure the level of triglyceride (a type of fat) in the blood. Triglycerides are absorbed from the digestive tract and manufactured by the liver in response to carbohydrate, then sent to other organs via lipoproteins.

The level of LDL in the blood gives a better approximation of heart attack risk than total cholesterol. If you're living the average Western lifestyle and you have high LDL, your risk of heart attack is substantially higher than someone who has low LDL. LDL particle number has more predictive value than LDL cholesterol concentration. The latter is what's typically measured at the doctor's office. For example, in the EPIC-Norfolk study (free full text)
, patients with high LDL cholesterol concentration had a 73% higher risk of heart attack than patients with low LDL. Participants with high LDL particle number had exactly twice the risk of those with low LDL number. We'll get back to this observation in a future post.

In the same study, participants with low HDL had twice the heart attack risk of participants with high HDL. That's why HDL is called "good cholesterol". This finding is fairly consistent throughout the medical literature. HDL is probably the main reason why total cholesterol doesn't associate very tightly with heart attack risk. High total cholesterol doesn't tell you if you have high LDL, high HDL or both (LDL and HDL are the predominant cholesterol-carrying lipoproteins).

Together, this suggests that the commonly measured lipoprotein pattern that associates most tightly with heart attack risk in typical Western populations is some combination of high LDL (particularly LDL particle number), low HDL, and high triglycerides.
In the next post, I'll slice up the lipoproteins even further and comment on their association with cardiovascular disease. I'll also begin to delve into how diet affects the lipoproteins.

Employment Barriers and Attitudes

I wish I could have a pet. It also wish I had someone who can help look after a pet during the day when I'm at work, or take it out for a walk in the winter. I don't have the help of someone else to do these things so, because I don't have the heart to abandon a pet during the day when I am at work, or to deprive it of exercise during the winter when I can't get out, I will not get one. It would not be fair to the pet.

I am so lonely I could scream. I don't know anyone who I can pick up the phone to call and invite them out for an evening. I would love to know someone who was willing and able to go out for a bit of fun for a change - a bar where there's music (I don't have to drink), a movie (where I don't have to sit at the front where it is too close to see it), a stroll through a park, a walk in the woods, or another place where I can go to have an intellectual, stimulating, and exciting conversation. Or forget the conversation. How about a place to go where a person with a wheelchair can go to just enjoy a cup of coffee with another person, besides Tim Horton's? It would be better than sitting at home, alone, and wishing I could return to the pre-wheelchair days when I was able to do more and be a part of this life.

We used to have a few of these places. One was the Kingston Centre, the other was the Cataraqui Towne Centre. But Loblaws bought the Kingston Centre and tore it down saying they weren't willing to provide a space for seniors to walk or the disabled to meet and socialize because we weren't able to spend enough money. They instead built an open mall concept and advertised that the cars would be able to park close to the door so a person can run in to buy what they want, and then leave. They don't want people browsing in their stores anymore because it is not seen as profitable. Heck, that's how I learn about a product. I will never trust a glossy ad in print or on TV because it is framed to often look better than it truly is.

This attitude towards those with less money has sure killed my right to a life. Even if I could find a place that was wheelchair accessible for one of these social outings, I might not be able to get there on the bus. If I can, a friend from another end of the city, may not be able to get there until an hour before or after I arrive due to the once hourly evening schedule. If we are lucky, we might be able to get 2 hours together because of the limits of using public transit. It is exhausting many of my friends have chosen to stop going out. Further, they live in a place that is not wheelchair accessible, so I can’t go over to their place to their place to visit. Over time, the friendships eventually died out, and came to an end because it was too difficult to overcome barriers so we could spend time together. Now I long for a person who I can call to just chat on the phone.

Gone are the days of being able to enjoy a social outing because of all of the new barriers, so unfortunately, gone are a lot of my social skills. I drive people nuts because I am obsessed with removing the barriers that have blocked my right to a life.

If I could dream I would go paragliding, parachute jumping, up in a glider, sign up for Able Sail, or stay in a choir. But unfortunately, Able Sail is criteria based, too expensive to join, and not available in the evenings after I'm done work. When I take the new shift my employer is insisting I take, my one and only social activity, the choir, will go. This is because the manager says that outside social activities are not important even though the corporate Assurant’s health and safety teams, is encouraging a healthy balance of work and play. They even offer a discount to a non-accessible gym.

Another thing I would join is a Christian group where we could take part in a discussion about the lessons that were taught by our Creator about caring for another human being - about each of and everyone of us having a unique and special gift, and how these gifts were meant to be used in a way that would help one another. The world wasn't made for us to live alone and do it all by ourselves. We were meant to pair up, love and care for each other, and to use our gifts in a way that would help one another.

I swear if I pick up a phone and hear another, please go to www dot whatever to self-serve and do something that is not in the area of my expertise, I will scream. I would rather pay someone to use his or her unique set of skills, to save me the effort of having to waste days on end trying to do the research to figure it out by myself.

Today is a really bad day because today my boss told me I have no choice but to take the shift that they have chosen for me. They have broken the contract that was made to accommodate my disability supports outside of work hours back in March of 2008. This means, with the new shift, I will have to give up my attendant, the opportunity to shop for food before or after work on a work day (the stores will be closed by the time the transit can get me there), and the one and only social activity that was accessible AND inclusive; my choir. This means I am expected to find a way to stay sane with even more isolation and I don't know how I can do it.

For the first time in years, I just want to curl up, dig a big hole, crawl in it, and die. I don't have the guts to kill myself because I don't want to die, but I know my limitations and I know I can't do it all on my own. I am exhausted trying to find just one tiny little place where there isn't a barrier that would allow me to fit in and to be included in life. No man is an Island, but with a disability, it appears that you are expected to be one.

Yesterday I was discussing this with my doctor and he said I needed to take time off work because of the stress. He said you are not depressed so I can't refer you to a psychiatrist, but you need some help to overcome some of these barriers. He then said it is unfortunate that in Kingston, there is nothing; no support group, no volunteer group, no social agency, nothing.

I took the letter to work, gave it to my employer and, when she saw that I still look okay, she wouldn't accept it. She said that because I don't look depressed or sick, she saw it as a manipulative ploy to use my disability as a tool to get my own way. She would not pass on the letter to Shephel FGI, the agency that was hired by Assurant to assist those who have to go on long term medical leave.

I am now backed into a corner. I have two choices. To, either quit (and to be more lonely), or to give up the attendant and my one social activity, so I can keep my job. Work has made it clear I have no right to keep the shift accommodation that was promised 18 months ago because the current manager, who was not a manager when the accommodation was first made, has decided that it is unfair to accommodate me.

She said she has no help in the home so she had to make choices. Why should I be any different?

When I tried to point out the limits of transit, inaccessible stores, my apartment, and the physical limits that are caused by a situation that is beyond my control, she said that is not her problem. I can manage at work so I have to make a choice: I can choose to work, or I can choose to quit work so I can keep the outside supports that help to overcome barriers that are outside of her control.

This is the same manager who has been constantly reminding me that, as a person with a disability, I am lucky that she is even allowing me to keep my job. She says that, as a person who has no work history, I am a liability, not an asset, to the company.

Well, the performance appraisal that I was given today by my supervisor today, says the complete opposite of what she is saying. Most of my scores are average or better and the comments are even better than that…. and I am a liability? What do you do with this? I can’t get any legal advice because legal aid is so under-funded they won’t take a person who appears to be remotely capable of self-representation. Great, more burn out….

I was floating on cloud nine with this performance appraisal, until the problematic manager told me to take the new shift or quit.

So I now get to pick. Keep my job and a right to a life, or quite and challenge the discriminatory practices of the one who loves to play head games with me.

Do I have a right to be in this world? You bet your bottom dollar I do. Earlier this evening, I had no idea where to turn, but as the evening wore on, I have developed enough resolve to become more determined than ever.

Look out world.

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The ultimate in preparedness: Creating an advance directive

Let’s say you and your family have fully prepared for all public health threats, be they disasters, pandemic flu or something yet to come. You’re up-to-speed on threats and have an emergency preparedness kit, communications plan and evacuation plan — you’ve even planned for protecting your pets. (You go, you preparedness superstar, you!) But wait: Are you and your family prepared for the ultimate worst-case scenario?

Even with the best of preparations, there’s a chance for life-threatening injuries, illness or even death during a public health threat. (Yikes.) Although it’s a scary subject that many of us avoid thinking about, it’s an important part of your emergency preparations.

Our advice? The best way to prepare for a life-threatening situation is to create what’s known as an “advance directive.” In case you’ve been bonked on the head or otherwise incapacitated and can’t speak up for yourself, an advance directive spells out the way your medical decisions should be handled. Everyone 18 and older should have an advance directive — which includes you, our beloved uber-prepared Get Ready blog readers.

So what should be in your advance directive? Experts recommend that you have a living will that specifies whether you’d want life-prolonging measures such as feeding tubes and ventilators if incapacitated. It’s also good to have “medical power of attorney,” which is a fancy way of naming a person who can make medical decisions for you if you are out of it. Your wishes on resuscitation and organ donation should also be in your advance directive. (Make sure your donation registration is up-to-date!)

Other tips? Check your state laws to make sure your advance directive complies with regs, keep your directive current as your life changes, and share your directive with your doctors, attorney and family. Look online for forms that you can use for creating your directive and getting started.

After all, there is an end in sight for each and every one of us one day. Creating an advance directive now means that you can go out on your own terms: Think of it as the ultimate in preparedness.

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Moking About

A recent discovery in the Archive, my beloved Mini Moke. Photographed in 1972 at the remote farm we were living in on the Essex / Suffolk border, (telephone exchange Steeple Bumpstead), it was as much fun as it was infuriating. There were no side screens, just the roof, and certainly no heater. There was a fuel gauge, but a more reliable indicator was to get your passenger to unscrew the big cap off the tank, which sat sloshing about next to their left knee. It started life as a track vehicle on Newmarket Racecourse, and was the perfect vehicle to go with Cream LPs and very short skirts. (Mrs. Ashley's I hasten to add. She learnt the rudiments of driving in it, furiously speeding up and down the farm tracks with a big straw hat on.) Alec Issigonis designed it at the same time as its stable mate the Mini saloon, with a steel monocoque body and the 'A' Series engine. They made 15,000 of them at Longbridge from January 1964 to October 1968, and then production moved to BMC's plant in Sydney until early 1982. It was still being made by Italian firm Cagiva in Portugal until 1993. But this was an original, complete with Dunlop Town & Country tyres, rubber clips to hold the bonnet in place, removable seat cushions so you could hose it down, and, the most remarkable thing of all, a current tax disc.

Beautiful Home Office

Give your home office a brilliantly bright up date with zesty orange walls. Keep it chic by using a paler tone on one wall but choosing a neutral for the others and teaming it with a pale carpet. Sophisticated dark wood furniture works best in this scheme, as does chocolate-brown accessories

In a guest bedroom a discreet desk, like this one from the Conran Shop, will not detract from the scheme. Combine with a simple white chair and accessorize with stationary in plain colours. An antique mirror from Artefact, creates both light and a sense of space, and breaks up a large
expanse of patterned wallpaper.

This home office uses a wall panel covered in a bold Oriental-style patterned fabric to create a focal point behind a contemporary metal desk. Accessories including the seat of the Poliform chair, files and books pick up the same shade. Built-in shelves provide storage.

This modern work space is prevented from looking too much like a sterile office by using home furnishings. A large modern table doubles as a desk, and a painted wooden dresser from New England Lifestyle stores files, work boxes and colourful baskets. Smart striped Romo blinds in candy shades soften the windows and act as a key for accessories like the pink bin and lamps. A Habitat dining chair is a simple, modern alternative to a traditional office chair.

No space to work? Think again - a simple fold-down desk can rest on cupboard doors, or hide clutter when folded back up. Cork boards covered in bold fabric make attractive notice boards and colourful storage boxes create a pretty display on a shelf above.

Box shelves needn't be regimented. A freer arrangement doubles your options, as you can use the spaces in between for storage and display, as well as the shelves themselves. The storage in this quirky office keeps things neat and tidy as well as chic and modern

A neutral scheme makes this home office a stylish and calm place to work in. Textured taupe wallpaper sets a subdued tone and chunky dark wood furniture lends an air of masculinity. The custom-made desk in faux-crocodile skin is from Andrew Martin and a smart wenge cupboard discreetly hides paperwork.

A vibrant wallpaper pattern is a great way to zone out a home office area when you don’t have the luxury of an extra room, simply paper the wall behind the desk. Here, contemporary wooden furniture goes perfectly with the brown circles in the wallpaper. A floating shelf is ideal for keeping books and stationary out of the way.