Sunday, June 11, 2017

Wednesday, June 07, 2017

Triple strand / Navojo/ long chain knitting

https://fringeassociation.com/2015/09/22/how-to-navajo-ply-yarn/

Thursday, June 01, 2017

Knitting and life

https://books.google.co.uk/books?id=dvY6IaU8sgAC&pg=PA29&lpg=PA29&dq=knitting+during+illness&source=bl&ots=9FN3DNA08p&sig=-s8A7EfVJUyvdYldjrJr0zoUxQ4&hl=en&sa=X&ved=0ahUKEwjygqjsnZ3UAhXHVxoKHa7LAzkQ6AEIZjAO#v=onepage&q=knitting%20during%20illness&f=false

- The chapter on knitting for charity is moving. Ava, the example.

http://oceanknitter.blogspot.co.uk/

http://www.carregyarns.com/index.php - icelandic wool, to think about

Knitting health benefits

Cutting from: http://www.craftyarncouncil.com/health-therapeutic

The Truth About Knitting and Crochet….They are Good for You!

How knitting can improve your mood, mind and body

"Is knitting therapeutic? Heck yes. It’s a proven scientific fact, just like we know chocolate and red wine are good for us. Since turning my life over to yarn, I’ve talked to thousands of knitters who claim it’s cured everything from gout to their weight problems. I can’t speak to all cures, but it can certainly improve one’s mental health. I know it helps mine.”

So says Clara Parkes, author of the just-released book The Yarn Whisperer: Reflections of a Life in Knitting (STC Craft/A Melanie Falick Book) and the founder and publisher of KnittersReview.com. Personal testimonies, anecdotal evidence, and medical studies all back up Clara Parkes’ claims.

In 2007, Renee Magee was diagnosed with Multiple Sclerosis. The disease affects the central nervous system and she describes the experience of her illness as being “like having pregnancy brain—only it doesn’t go away.”

Magee, though, has a secret weapon in her health arsenal: Knitting needles.

“I’ve found that it’s really good for the brain to work on something where you have to focus,” says the 36-year-old knitter. “You’re following through on something and you’re following a pattern, it’s mental exercise.”

Magee is not alone in her assessment of the craft’s palliative affects on the mind. Knitting has been called the “new yoga” for good reason. Famous for its relaxing, meditative qualities, knitting increasingly is being used in hospitals, clinics, schools and even prisons to help people lead healthier, happier lives. And there’s data to prove it.

“Knitting saved my life,” says Liat Gat, who runs the video instruction site KNITFreedom.com. Admitted to a clinic in her 20’s with a full-blown eating disorder, Gat, a lapsed knitter, started stitching again when the facility’s craft volunteer came around with yarn and needles. Soon, she had countless projects going and was helping other women fix their mistakes. And within weeks she was out of the clinic and working at a yarn shop.

“I could help people and make a difference,” she says, “and it gave me a career.”

Gat’s experience of knitting her way out of an eating disorder has scholarly precedent. A 2009 study published in the journal Eating and Weight Disorders showed that when 38 women with anorexia nervosa were taught to knit and given free access to knitting supplies, they reported significant improvements. An impressive 74 percent said knitting lessened their fears and kept them from ruminating about their eating disorders; 74 percent lauded the calming aspects of the craft and 53 percent said it provided satisfaction and a sense of accomplishment.

“I didn’t have a job. I had extra time,” Gat explains of her recovery. “There’s something to be said about filling your time with projects you care about.”

Magee, who along with her husband owns Airship Printing, a screen-printing business in Castle Rock, Colorado, has created a line of goods under the brand Knerd Shop (knerdshop.com) that includes a t-shirt, bag and stickers that read, “I knit so I don’t kill people.” Though the sentiment is amusing, it carries an element of truth: Knitters ascribe all manner of benefits to their craft that include everything from alleviating depression, anxiety and pain to reducing boredom and the discomfiting affects of isolation.

Meredith Keeton, 32, knits to combat the loneliness she experiences when forced to stay home because of her rheumatoid arthritis.

“One of the benefits of knitting for me is that because rheumatoid arthritis is an isolating condition, I can’t be as social or get out as often as I’d like. I’m often stuck at home by myself. knitting gives me something productive to do with my time. It’s definitely good stress relief and helps keep my anxiety in check.”

Cast on, calm down

Twenty-three years ago, knitting filled the time for Carol Caparosa, whose infant daughter was born with congenital heart defects. Captive in waiting rooms and by her daughter’s bedside for weeks at a time, she couldn’t read or bear to watch TV, but after a friend gave her a handknit baby sweater, Caparosa, a former knitter, thought, “This is what I’m going to do.”

“My daughter would have these really long surgeries—eight or nine hours—and I would just sit there and knit. It was so calming.”

In ensuing years, Caparosa felt a need to give back. Her daughter was thriving, so she returned to the pediatric intensive care unit at MedStar Georgetown University Hospital where her daughter had been a patient, volunteering to teach parents and older children to knit. Her teaching gained a following and she expanded her work to the hospital’s Neonatal Intensive Care Unit and incorporated her program as the nonprofit, Project Knitwell.

In 2010, two Georgetown oncology nurses—stressed out by their jobs and graduate school—decided to use Project Knitwell for their thesis research. Personally aware of the incredible strain and loss oncology nurses experience, Lyndsay Anderson and Christina Urso wondered whether knitting might mitigate some of the burnout—or “compassion fatigue”—these nurses experienced. The grad students administered a survey to the nurses that measured burnout at two junctures: before learning to knit and 13 weeks later, after they had learned and been working with Project Knitwell volunteers.

“Anecdotally we knew everyone on the unit was suffering,” Anderson says. “Nobody was doing fine.” Indeed all 39 nurses who participated showed some degree of compassion fatigue in the “before” test.

Each nurse was taught to cast-on and knit. In addition, Project Knitwell volunteers appeared regularly on the oncology units to fix mistakes and assist them in choosing new projects should they want to progress. Knit kits were also stashed on the oncology floors, so nurses could knit spontaneously.

The results were significant. Everyone’s burnout scores improved, especially the nurses who were the most burned out prior to the study. In answers to open-ended questions, nurses extolled the soothing rhythm of knitting and distraction from work-related fatigue. Though the sample was small, it was enough to convince hospital administrators to add Project Knitwell to its staff enrichment programs as well as provide sessions to graduating nurses.

“Oncology nurses really have nothing tangible to show for their work, because at the end of the day, their patients are still suffering,” explains Anderson, who’s now a family nurse practitioner in the hospital’s Ourisman Breast Health Center. “But if you have something artistic to work on, it does give you some sense of accomplishment.”

Use it or lose it

Common wisdom has it that brain games like crossword puzzles and sudoku may help keep the brain sharp over time. But what about two sharp sticks and some yarn?

Yonas Geda, associate professor of Neurology and Psychiatry at the Mayo Clinic in Arizona, published a study in the Spring 2011 edition of The Journal of Neuropsychiatry & Clinical Neurosciences that validated crafters of all stripes. His research showed that people who engaged their minds by reading books, playing games or crafting had a decreased risk of mild cognitive impairment, a possible precursor to Alzheimer’s Disease and other forms of dementia.

“The study suggests that engaging in certain types of mentally stimulating acts,” Geda says, “is associated with decreased risk of cognitive impairment.”

Their study looked at 1,321 adults, ages 70 to 89, 197 of whom had been identified as already having mild cognitive impairment. Both the normal and cognitively impaired groups were surveyed about their activities within the last year.

The study demonstrated that using the brain might prevent losing it. The data showed that computer use, playing games, crafting, reading books and watching less TV resulted in a striking 30 to 50 percent decrease in the odds of having mild cognitive impairment.

Though the study didn’t examine exactly how these activities might protect the brain, it did reference other works suggesting that mentally active people overall might live healthier lifestyles, maybe exercising and eating better, or that cognitive activity might promote the development of new neuro pathways—or cognitive reserves. In other words, staying mentally active through knitting and reading, etc. makes “deposits” to an individual’s brain “bank”; this can possibly buffer against Alzheimer’s Disease and other forms of dementia.

“Some people are normal when they die but show a neuropathological burden during autopsy,” Geda says. “They have cognitive reserves. One of the theories is that engaging in mental activities stimulates the development of these cognitive reserves.”

Why knitting?

There are a lot of theories about why knitting is good for the brain.

Once a knitter has mastered the movements, the process is rhythmic and repetitive. According to the Benson-Henry Institute for Mind-Body Medicine at Massachusetts General Hospital, knitting’s repetitious movements theoretically can elicit the famous relaxation response, which is the body’s counterbalance to stress, a state in which heart rate and blood pressure fall, breathing slows and levels of stress hormones drop.

“I use it in my own life as a way for me to calm down,” explains Perri Klass, a professor of journalism and pediatrics at New York University, a physician who writes regularly for the New York Times. “I’m happier and calmer in many stressful situations when I’m knitting, whether it’s sitting on a plane delayed on the runway or sitting at the bedside of a family member in a hospital or a medical office.”

“Psychiatrist Teresa Anderson, who practices in Cincinnati, Ohio, recommends knitting and crochet to patients suffering from PTSD, anxiety and major depression. A knitter and crocheter herself, she’s been urging patients to stitch since medical school. “People recommend meditation, which is nice in theory, but some people are so worked up they can’t sit still long enough to meditate,” she says. “Knitting is what I consider an active meditation, something you can do and focus on, but it has a repetitive quality to it.”

Knitting also involves following and recognizing patterns, learning new stitches and using both hands and math, lending it the capacity to improve fine motor skills while also keeping the mind active and engaged. The Waldorf Schools, for example, teach children to knit before teaching them to read in the belief that knitting develops dexterity, focus and rudimentary arithmetic.

“Recent neurological research tends to confirm that mobility and dexterity in the five motor muscles, especially in the hand, may stimulate cellular development in the brain, and so strengthen the physical instrument of thinking,” writes Eugene Schwartz in his article “Knitting and Intellectual Development. “Work done over the past seventy years in hundreds of schools using the Waldorf method worldwide, in which first graders learn to knit before learning to write or manipulate numbers, has also proven successful in this regard.”

Cassy Dominick, a PhD student in counseling education at the University of Arkansas at Fayetteville, is about to embark on her dissertation research, in which she will study a small group of fourth and fifth graders and whether knitting affects their social skills, problem behaviors and academic achievement. “I really want this to be a springboard for my future career,” she says. “I would love to put knitting and counseling together and make that my life.”

The social aspect of knitting, too, plays into knitting’s positive mental benefits. For people who like to knit in groups, knitting provides a social outlet, a critical element in maintaining mental health. And it allows for self-expression, charity and that sense of feeling productive.

“When we’re in early stages of knitting and choosing yarn and designing, it’s a whole different experience,” says Susan MacLaughlin, who started the blog Knit One Health Too, after knitting her way through sequential bouts with a ruptured appendix and breast cancer. “There’s something about the creative process. The heart opens up and takes you to another place. It’s like how you feel after hiking up a mountain.”

Changing global health one stitch at a time

Some of the most interesting work on the health benefits of knitting is being done in England, where Betsan Corkhill, a former physiotherapist with the National Health Service (NHS), is conducting research and aggregating data on knitting for health.

In 2002 having left the NHS, Corkhill started freelancing for craft magazines and was struck by the numbers of letters sent to these publications about the health benefits of crafts, particularly knitting. “My medical hat went on,” she says, “and I began to research from there.”

Convinced that knitting could play a role in Britain’s healthcare system—if not the world’s—she started a knitting group at the Royal United Hospital’s pain clinic in Bath. The group, which has been meeting since 2006, has about 50 members, who Corkhill says, tout the meditative and social benefits of knitting as well as the fact that knitting helps to distract them from the pain they feel. Visitors are often surprised, she observes, at “hearing all this raucous laughter in a pain clinic.”

“Pain originates in the brain not in muscles and joints,” she says. “The brain has to pay attention to signals coming up from your body. If you’re lonely or bored or unhappy, you’ll experience more pain than if you’re socially active and occupied and that’s very well accepted.”

Today, as a result of her work, which she presented at an Annual Scientific Meeting of the British Pain Society, more pain clinics in the U.K. are using knitting therapeutically.

In 2010, Corkhill in conjunction with an occupational therapy lecturer from Cardiff University, conducted an online survey of the Stitchlinks.com community (Corkhill’s website and clearinghouse of information about the therapeutic benefits of knitting). In the survey, they asked people why they stitched and about knitting’s perceived effects on mood, feelings, thinking, social activity and skills. Within two weeks, they received a staggering 3,545 responses.

The study, which was published in the February 2013 issue of the British Journal of Occupational Therapy, revealed that the majority of knitters (here mostly white, female and avidly knitting) reported a significant relationship between knitting frequency and feeling calm and happy. Respondents, who knit the most often, said that knitting positively affected their cognitive functioning, helping them to sort through problems or think more easily.

Most promisingly, Exeter University just funded PhD candidate Mirja Rutger and her main supervisor Professor Paul Dieppe to study knitting groups with Corkhill serving in an advisory capacity. The initial part of the study will work to tease out what actually is happening when people knit together—and how to measure it.

“Measuring a knitting group is considerably more difficult than measuring a new drug,” she explains. “In measuring the knitting group we are dealing with how people feel and interact and how this may impact on their ability to live and manage life as well as the more scientific issues like whether the actual movements are important if affecting the brain and the meditative-like state reported.”

Still, she says, “this a big step forward for knitting.”

Article on patient experience of healthcare and it's problems

- Doctors Tell All—and It’s Bad
  
  A crop of books by disillusioned physicians reveals a corrosive doctor-patient relationship at the heart of our health-care crisis.
MEGHAN O'ROURKE
NOVEMBER 2014 ISSUE

https://www.theatlantic.com/magazine/archive/2014/11/doctors-tell-all-and-its-bad/380785/

for someone in her 30s, I’ve spent a lot of time in doctors’ offices and hospitals, shivering on exam tables in my open-to-the-front gown, recording my medical history on multiple forms, having enough blood drawn in little glass tubes to satisfy a thirsty vampire. In my early 20s, I contracted a disease that doctors were unable to identify for years—in fact, for about a decade they thought nothing was wrong with me—but that nonetheless led to multiple complications, requiring a succession of surgeries, emergency-room visits, and ultimately (when tests finally showed something was wrong) trips to specialists for MRIs and lots more testing. During the time I was ill and undiagnosed, I was also in and out of the hospital with my mother, who was being treated for metastatic cancer and was admitted twice in her final weeks.

As a patient and the daughter of a patient, I was amazed by how precise surgery had become and how fast healing could be. I was struck, too, by how kind many of the nurses were; how smart and involved some of the doctors we met were. But I was also startled by the profound discomfort I always felt in hospitals. Physicians at times were brusque and even hostile to us (or was I imagining it?). The lighting was harsh, the food terrible, the rooms loud. Weren’t people trying to heal? That didn’t matter. What mattered was the whole busy apparatus of care—the beeping monitors and the hourly check-ins and the forced wakings, the elaborate (and frequently futile) interventions painstakingly performed on the terminally ill. In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me.

In my own case, it took doctors a long time (roughly 15 years) to recognize exactly what was wrong with me. Along the way, my blood work was at times a little off, or my inflammation markers and white-blood-cell counts were slightly elevated, but nothing seemed definitive, other than some persistent anemia. “Everything’s probably okay,” the doctors would say, or “You have an idiopathic problem,” which is doctor-talk for “We don’t know why you suddenly have hives every day.” They never implied that I was crazy, or seeking attention, or any of the other things you sometimes hear from patients (especially female ones) who have sought a diagnosis for years on end. At the same time, they didn’t believe anything was wrong enough to pursue; frequently they asked whether I was depressed before even doing a physical exam.

To them, I was a relatively fit, often high-functioning young woman who had a long list of “small” complaints that only occasionally swelled into an acute problem, for which a quick surgical fix was offered (but no reflection on what might be causing it). To me, my life was slowly dissolving into near-constant discomfort and sometimes frightening pain—and terror at losing control. I didn’t know how to speak to the doctors with the words that would get them, as I thought of it, “on my side.” I steeled myself before appointments, vowing not to leave until I had some answers—yet I never managed to ask even half my questions. “You’re fine. We can’t find anything wrong,” more than one doctor said. Or, unforgettably, “You’re probably just tired from having your period.”
In fact, something was very wrong. In the spring of 2012, a sympathetic doctor figured out that I had an autoimmune disease no one had tested me for. And then, one crisp fall afternoon last year, I learned that I had Lyme disease. (I had been bitten by multiple ticks in my adolescence, a few years before I started having symptoms, but no one had ever before thought to test me thoroughly for Lyme.) Until then, facing my doctors, I had simply thought, What can I say? Perhaps they’re right. They’re the doctors, after all.

but this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.

spend a day in an emergency room, and chances are you’ll be struck by two things: the organizational chaos and the emotional detachment as nurses, doctors, and administrators bustle in and out, barely registering the human distress it is their job to address. The same could be said of our oddly bloodless debates about the future of health care. The rhetoric of medical reform draws mostly on economics: Experts differ over, among other things, how to structure “insurance mandates” and what constitutes “overutilization” of a rapidly expanding array of high-tech procedures and diagnostic tests. They argue about why “the United States health care system is the most expensive in the world,” as a 2014 Commonwealth Fund report finds, yet consistently “underperforms relative to other countries on most dimensions of performance.” (Currently, according to that report, the U.S. ranks last among 11 major industrialized nations in efficiency, equity, and “healthy lives,” meaning health outcomes attributable to medical care.)

But the actual experience for patients and doctors of navigating offices, clinics, hospitals—and each other’s company—rarely enters the discussion. Nor is there any effort to focus on the deeper reality of disease, as Atul Gawande, a surgeon and professor at Harvard Medical School, writes in his astute new exploration of geriatric medicine, Being Mortal. This absence matters, because how patients feel about their medical interactions really does influence the efficacy of the care they receive, and doctors’ emotions about their work in turn influence the quality of the care they provide. Despite our virtuosic surgical capacities, our cutting-edge technology, and our pharmaceutical advances, the patient-doctor relationship is still the heart of medicine. And it has eroded terribly. Terrence Holt, a geriatric specialist at the University of North Carolina at Chapel Hill, describes the situation in Internal Medicine, fictional fables based on his residency:

Any patient in a hospital, when we take their clothes away and lay them in a bed, starts to lose identity; after a few days, they all start to merge into a single passive body, distinguishable … only by the illnesses that brought them there.

The subjective experience of illness has always been all but impossible to convey. But systemic changes have intensified a disconnect between patients and doctors that was less glaring some 40 years ago, before technological advances and corporatization began to transform the comparatively low-tech, localized postwar medical system. The broad contours of the situation are familiar. Health care in the United States operates predominantly on a fee-for-service basis, which rewards doctors for doing as much as possible, rather than for offering the best care possible. This didn’t matter much in the 1950s, when a general practitioner coordinated most of your care and not many treatment options existed. But sophisticated new surgical techniques, and tools like the CT scan and the MRI, led to a surge in high-tech specialization. Rising costs in the 1970s were the catalyst for “managed care”—basically, our current system, in which insurance companies like Aetna and United Healthcare negotiate with networks of doctors to determine how much care patients get, whom we can see, and at what price. But along with new checks and balances came added bureaucracy, and frustrated doctors and patients. Comprehensive oversight has never been in shorter supply, as specialized “consults” proliferate and no one gets paid to coordinate care (problems the Affordable Care Act aims to fix).

In doctored: The Disillusionment of an American Physician, Sandeep Jauhar—a cardiologist who previously cast a cold eye on his medical apprenticeship in Intern—diagnoses a midlife crisis, not just in his own career but in the medical profession. Today’s physicians, he tells us, see themselves not as the “pillars of any community” but as “technicians on an assembly line,” or “pawn[s] in a money-making game for hospital administrators.” According to a 2012 survey, nearly eight out of 10 physicians are “somewhat pessimistic or very pessimistic about the future of the medical profession.” In 1973, 85 percent of physicians said they had no doubts about their career choice. In 2008, only 6 percent “described their morale as positive,” Jauhar reports. Doctors today are more likely to kill themselves than are members of any other professional group.

The demoralized insiders-turned-authors are blunt about their daily reality. The biggest problem is time: the system ensures that doctors don’t have enough of it. To rein in costs, insurance companies have set fees lower and lower. And because doctors tend to get reimbursed at higher rates when they are in a network (hospitals and large physician groups have more leverage with insurance companies), many work for groups that require them to cram in a set number of patients a day. Hence the eight-minute appointments we’re all familiar with. Paperwork compounds the time crunch. Studies estimate that today’s doctors and “hospitalists”—medical practitioners who do most of their work in hospitals—spend just 12 to 17 percent of their day with patients. The rest of the time is devoted to processing forms, reviewing lab results, maintaining electronic medical records, dealing with other staff. Physicians in non-hospital medical practices in the U.S. “spend ten times as many hours on nonclinical administrative duties” as their Canadian counterparts do, Danielle Ofri, an internist at New York’s Bellevue Hospital, reports in What Doctors Feel.

So doctors are busy, busy, busy—which spells trouble. Jauhar cites a prominent doctor’s adage that “One cannot do anything in medicine well on the fly,” and Ofri agrees. Overseeing 40-some patients, “I was practicing substandard medicine, and I knew it,” she writes. Jauhar notes that many doctors, working at “hyperspeed,” are so uncertain that they call in specialists just to “cover their ass”—hardly a cost-saving strategy. Lacking the time to take thorough histories or apply diagnostic skills, they order tests not because they’ve carefully considered alternative approaches but to protect themselves from malpractice suits and their patients from the poor care they’re offering them. (And, of course, tests are often lucrative for hospitals.)

There is also a more perverse upshot: stressed doctors take their frustrations out directly on patients. “I realize that in many ways I have become the kind of doctor I never thought I’d be,” Jauhar writes: “impatient, occasionally indifferent, at times dismissive or paternalistic.” (He also comes clean about a time when, struggling to live in New York City on his salary, he packed an already frenetic schedule with dubious moonlighting jobs—at a pharmaceutical company that flacked a questionable drug and with a cynical cardiologist who was bilking the system—which only further sapped his morale.) In The Good Doctor: A Father, a Son, and the Evolution of Medical Ethics, Barron H. Lerner, a bioethicist as well as a doctor, recalls admitting in the journal he kept during medical school, “I was angry at my patients.” In The Doctor Crisis, co-written with Charles Kenney, Jack Cochran, a plastic surgeon who worked his way up to executive director of the Permanente Federation, describes touring many clinics where he found “physician after physician” who was “deeply unhappy and often angry.” At times the hostility is barely repressed. Terrence Holt overhears an intern call her patient a “whiner.” Routinely, these writers witness physicians joking that Latina/Latino patients suffer from “Hispanic Hysterical Syndrome” or referring to obese patients as “beached whales.”

The alarming part is how fast doctors’ empathy wanes. Studies show that it plunges in the third year of medical school; that’s exactly when initially eager and idealistic students start seeing patients on rotation. The problem, Danielle Ofri writes, isn’t some elemental Hobbesian lack of sympathy; students (like the doctors they will become) are overworked and overtired, and they realize that there is too much work to be done in too little time. And because the medical-education system largely ignores the emotional side of health care, as Ofri emphasizes, doctors end up distancing themselves unthinkingly from what they are seeing. One of her anecdotes suggests what they’re up against: an intern, handed a dying baby whose parents don’t want to see her, is curtly told to note the infant’s time of death; with no empty room in sight, the doctor slips into a supply closet, torn between keeping an eye on her watch and soothing the baby. “It’s no wonder that empathy gets trounced in the actual world of clinical medicine,” Ofri concludes; empathy gets in the way of what doctors need to survive.

Yet empathy is anything but a frill: not only is it crucial to doctors’ humanity and patients’ dignity, it can be key to medical efficacy. The rate of severe diabetes complications in patients of doctors who rate high on a standard empathy scale, Ofri notes, is a remarkable 40 percent lower than in patients with low-empathy doctors. “This is comparable,” she points out, “to the benefits seen with the most intensive medical therapy for diabetes.”

you may be wondering why the rise of patients’ rights in the 1970s and ’80s, hailed as a revolutionary advance in health care, hasn’t served us better. After all, empowered by both the law and the Internet, we are far more conversant with our medical options—and with the history of medical hubris—than our grandparents were. Yet the legal recalibration of power has unintentionally contributed to the uneasy standoff between doctors and patients, as Barron Lerner observes in The Good Doctor. Lerner and his father, whom he followed into medicine, both staked their careers on the belief that the patient comes first. Their experience of medicine and their ideas about patient care, though, are starkly different. The elder Lerner practiced in an era when doctors unilaterally decided the treatment and often lied to patients about their prognoses. (Knowing you were dying was considered unhealthy.) At its most egregious extreme, medical paternalism led to unnecessary surgeries (among them, disfiguring radical mastectomies) and unethical research on unknowing subjects, as in the Tuskegee syphilis experiment.

Today, in the younger Lerner’s era, patient and doctor theoretically have a more collaborative relationship, based on informed consent. We take for granted that doctors will tell us our diagnosis and proceed according to carefully delineated protocols. This is a real advance, yet it is only part of the story. As Lerner comes to see, some of the overtreatment routinely found in hospitals is actually an outgrowth of the patients’-rights movement. In the past, when patients’ hearts stopped, or the terminally ill succumbed to infection, doctors typically would let them go. In our era of “defensive medicine,” unless you have signed a “do not resuscitate” order (and sometimes even if you have, but your family insists on treatment), you’ll be intubated, or defibrillated, or given antibiotics—on the off chance that last-ditch rescue is what you would want. And no doctor is likely to clarify the odds: roughly 15 in 100 cardiopulmonary resuscitations, for example, result in the patient living long enough to be discharged from the hospital.

But there is a deeper issue here, a collision of unarticulated needs and fears. Doctors have seen their power eroded—by insurance companies, by national treatment guidelines, by hospital bureaucracy—and now they have to deal with patients who feel newly empowered. Patients, meanwhile, want both clout and comfort; they feel both defiant and dependent. And so each side exercises power passively (or passive-aggressively), and maybe even unconsciously: I’ll listen to you, but I won’t really believe or act on what you say. All of which is a reminder that even with the rise of the malpractice threat, physicians and institutions continue to wield extensive medical power, just in subtler ways. I’ve heard many stories of hospitalized patients in pain yet worried that asking for more Dilaudid will be construed as entitled meddling.

To be sure, deciding who has the ultimate authority is a challenge: the patient, unlike the customer, can’t always be right, though few of us want to hear that. How far should doctors go to look for an illness they can’t initially find? To what degree should they privilege patients’ wishes for specific interventions? Satisfying answers to these questions have yet to be found. But the current balance of power is flawed. Each time I had surgery, I had to push for what seemed like a basic right—having a family member with me as I came to. I still remember trying to tell a nurse, my brain blurred by a waning anesthetic, that research proved the pain-reducing benefits of holding a loved one’s hand. A study, I figured, would carry more force than my need.

without being fully aware of it, what I really wanted all along was a doctor trained in a different system, who understood that a conversation was as important as a prescription; a doctor to whom healing mattered as much as state-of-the-art surgery did. What I was looking for, it turns out, was a doctor like Victoria Sweet, and the kind of care offered in, of all places, a charity hospital in San Francisco. A doctor who is able to slow down, aware of the dividends not just for patients but for herself and for the system: this is the sort of doctor Sweet discovered she could be in “the last almshouse in America,” as she calls Laguna Honda Hospital, a funky old facility for the destitute and chronically ill, where swallows flew through open turrets and 1,200 patients lay mostly in old-fashioned “open wards,” and where she worked for 20-some years. In her remarkable memoir, God’s Hotel, Sweet—who is also a historian of medicine versed in the medical work of the 12th-century nun Hildegard of Bingen—calls her radical solution for our sped-up health care “slow medicine.” Here is a doctor saying what patients intuitively know: being sick is draining, healing takes time, and strong medicine often has strong side effects.

Granted a capacious amount of time and freedom with her severely ill patients (many of them drug addicts, schizophrenics, or elderly and with few resources), Sweet is able to make diagnoses that her patients’ previous doctors missed. Relying on close observation to help her understand what’s really going on, she weans them from an average of 20 medications to six or seven. She finds that discarded medical practices—for example, manipulating the lymphatic system with an old-fashioned medical girdle—may have more to offer than contemporary interventions do. In one heartbreaking case, she realizes that an elderly patient is not suffering from Alzheimer’s following a hip surgery, as doctors at the woman’s former hospital concluded—a diagnosis that led to antipsychotic medicines, her removal from her own home, and her separation from her mentally disabled daughter. Rather, she is in pain: the hip had slid out of place, and no one responsible for her follow-up care had noticed.

Laguna Honda—where meals were served in sunlit rooms, and gardening and good company allowed hopeless cases to make seemingly miraculous recoveries—seems out of another era. Indeed, in 2010, after years of construction and renovations, it became a “modern” facility. But “slow medicine,” as Sweet trenchantly argues, isn’t an outmoded, soulful indulgence. It might actually be a form of efficiency: more-accurate diagnoses and effective low-tech treatments help the system save money, and result in fewer malpractice suits.

Atul Gawande suggests much the same thing in Being Mortal, arguing that fast, solution-oriented care—particularly in the last year of life, which accounts for an estimated one-quarter of Medicare expenditures—has, in missing the broader picture, led to a great deal of “callousness, inhumanity, and extraordinary suffering.” In The Doctor Crisis, which issues a biting call for a physician-led revolution in medicine, Jack Cochran, too, appreciates a core tenet of the slow-medicine spirit: fulfilled doctors make for more-satisfied patients. Tackling the problems of Kaiser Permanente’s Colorado medical group, he took the counterintuitive step of demoting “patient-centered care” as a goal, and elevated “preservation and enhancement of career” for doctors to first place. He restored to them the sense that their work is, as Barron Lerner’s old-fashioned father put it, a “rare privilege” to be pursued with a sense of responsibility, rather than harried accountability.

Medicine today values intervention far more than it values care. Gawande writes that for a clinician, “nothing is more threatening to who you think you are than a patient with a problem you cannot solve.” The result is that all too often, “medicine fails the people it is supposed to help.” The old doctor-knows-best ethos was profoundly flawed. But it was rooted in an ethic of care for the whole person, perhaps because physicians, less pressed for time, knew their patients better. Danielle Ofri notes that it was the paternalistic old doctors, still hanging around her medical school wearing “starched shirts [and] conservative ties,” who taught her the art of respecting her patients’ individuality: “For them, approaching the bedside of a patient was a sacred act.” One day she had a class with an intimidating cardiothoracic surgeon. To her surprise, he was as tender toward his wards as he was gruff toward his students, who, he insisted, should always seat themselves at the level of the patient or lower. “They are the ones who are sick,” he emphasized, “and they are the ones running this interview, not you.”

In the course of our lives, most of us will urgently need care, sometimes when we least expect it. Currently, we must seek it in a system that excels at stripping our medical shepherds of their humanity, leaving them shells of the doctors (and people) they want to be, and us alone in the sterile rooms they manage. What makes our predicament so puzzling, and what may offer hope, is that nearly all of us want a different outcome. I used to think that change was necessary for the patient’s sake. Now I see that it’s necessary for the doctor’s sake, too.

Sunday, May 28, 2017

Harvard commencement speech 2017

http://www.cnbc.com/2017/05/26/mark-zuckerbergs-best-advice-finding-your-purpose-isnt-enough.html

Mark Zuckerberg's best advice to young people: ‘Finding your purpose isn't enough’

Catherine Clifford

Friday, 26 May 2017 | 11:32 AM ET

Photo by Paul Marotta

Facebook Founder and CEO Mark Zuckerberg delivers the commencement address at Harvard's 366th commencement exercises on May 25, 2017 in Cambridge, Massachusetts

Finding your purpose can seem daunting, but Facebook founder and CEO Mark Zuckerberg says it's also not enough.

In his address to the 366th graduating class at Harvard University Thursday, Zuckerberg challenged graduates to build a world where everyone has the chance to find their purpose.

"Today I want to talk about purpose. But I'm not here to give you the standard commencement about finding your purpose. We're millennials. We'll try to do that instinctively," says Zuckerberg.

"Instead, I'm here to tell you finding your purpose isn't enough. The challenge for our generation is creating a world where everyone has a sense of purpose," he says.

The 33-year old entrepreneur, who is worth $63 billion, has been traveling across the country to meet people in every state as part of a personal challenge for 2017. Part of what he's learned so far is, when people don't have a sense of purpose, that's when their lives seem veer off track.

"As I've traveled around, I've sat with children in juvenile detention and opioid addicts, who told me their lives could have turned out differently if they just had something to do, an after school program or somewhere to go. I've met factory workers who know their old jobs aren't coming back and are trying to find their place," he says.

"To keep our society moving forward, we have a generational challenge — to not only create new jobs, but create a renewed sense of purpose."

Zuckerberg lays out three ways that the next generation should go about building a world where everyone has the opportunity to have purpose.

1. Take on "big, meaningful" projects

Previous generations rallied together to put a man on the moon, build the Hoover Dam and immunize children against polio, he says. These monumental efforts give entire communities a sense of purpose.

Tackling the largest problems in society today can be overwhelming, but he advises young people not to be intimidated if they don't know exactly what they are doing or how to fix the problem.

"I know, you're probably thinking: I don't know how to build a dam, or get a million people involved in anything. But let me tell you a secret: no one does when they begin. Ideas don't come out fully formed. They only become clear as you work on them. You just have to get started," he explains.

"If I had to understand everything about connecting people before I began, I never would have started Facebook."

According to Zuckerberg, large problems young people could tackle include fixing climate change, improving health care and modernizing the voting process.

2. Fix inequality so that everyone can chase their dreams

Zuckerberg says part of the reason he was able to build Facebook is that support from his family meant he was not scared of trying things. His father was a dentist and they were financially secure.

"The greatest successes come from having the freedom to fail," and he had that, he says.

"If I had to support my family growing up instead of having time to code, if I didn't know I'd be fine if Facebook didn't work out, I wouldn't be standing here today," he explains.

To give everyone the chance he had, Zuckerberg calls for a strengthened social safety net, that he says the wealthiest in society — including himself — ought to pay for.

"We should explore ideas like universal basic income to give everyone a cushion to try new things. We're going to change jobs many times, so we need affordable childcare to get to work and healthcare that aren't tied to one company," he says.

"We're all going to make mistakes, so we need a society that focuses less on locking us up or stigmatizing us. And as technology keeps changing, we need to focus more on continuous education throughout our lives."

3. Build a global community

At a time when President Donald Trump was elected on a nationalist platform and the United Kingdom elected to remove itself from the European Union, Zuckerberg argues for building global communities.

"We have grown up connected," says Zuckerberg. "In a survey asking millennials around the world what defines our identity, the most popular answer wasn't nationality, religion or ethnicity; it was 'citizen of the world.' That's a big deal. Every generation expands the circle of people we consider 'one of us.' For us, it now encompasses the entire world."

Building communities, even global ones, though, starts on a local level, he says.

"Change starts local. Even global changes start small — with people like us. In our generation, the struggle of whether we connect more, whether we achieve our biggest opportunities, comes down to this — your ability to build communities and create a world where every single person has a sense of purpose."

Saturday, May 27, 2017

Recipes: drop scones, carrot and Victoria cake, quiche

https://uk.style.yahoo.com/royal-recipes-queens-favourite-dishes-slideshow-wp-094712675/photo-p-sneak-peek-recipes-br-photo-094712592.html

Drop Scones

Ingredients:
1 free-range egg
2 tablespoons unrefined caster sugar
1 teaspoon unsalted butter, melted
250ml (1 cup) full-fat milk
1 teaspoon bicarbonate of soda
240g (17/8 cups) plain flour
2.5 teaspoons baking powder
1.5 teaspoons cream of tartar
100g (½ cup) clarified unsalted butter

Equipment:
pancake griddle, or non-stick frying pan

1. In a mixing bowl, sieve together the dry ingredients: flour, bicarbonate of soda, cream of tartar and sugar. Add to this the milk and egg and whisk to a smooth batter, finally adding the warm melted butter. Pass through a sieve to get rid of any lumps and if necessary thin with more milk. The batter should have a dropping consistency, but remain thick enough to retain its shape on the griddle.

2. Heat the griddle (or frying pan) over a medium heat and grease with clarified butter. Using a dessert spoon or small ladle, carefully pour spoonfuls of the batter on to the griddle. After one side has cooked, flip the scones with a palette knife to cook the other. Once you feel more confident you can cook a few scones at a time, being careful not to let them over-cook on either side.

3. Serve warm with butter and home-made preserves.

Flaked Salmon, Broad Bean and Tarragon Quiche

Serves 4–6.

For the pastry:
125g (1 cup) plain flour
a pinch of salt
25g (1/8 cup) cold butter, diced
25g (1/8 cup) lard
2 tablespoons milk
(Or use 1 × 250g block of ready-made
shortcrust pastry)

For the filling:
75ml (1/3 cup) milk
75ml (1/3 cup) double cream
2 medium free-range eggs
1 tablespoon fresh tarragon, chopped
salt and pepper
50g (½ cup) cheddar cheese, grated
100g (¾ cup) poached salmon, flaked
60g (1/3 cup) cooked and shelled
broad beans or soya beans

Equipment: 20 cm/8″ flan tin

1. Preheat the oven to 190°C (375°F, gas mark 5).

2. To make the pastry, sieve the flour and salt into a bowl, add the fats
and rub the mixture through your fingertips until you get a sandy,
breadcrumb-like texture. Add the milk a little at a time and bring the
ingredients together into a dough. Cover and allow to rest in the fridge for
30–45 minutes.

3. Lightly flour the work surface and roll out the pastry to make a circle a
little larger than the top of your flan tin and approximately 0.5 cm thick.
Line the tin with the pastry, taking care not to make any holes in it or the
filling will leak. Cover and rest for a further 30 minutes in the fridge.

4. Line the pastry case with baking paper, add baking beans and bake
blind for 15 minutes. Remove from the oven and take out the baking
paper and beans.

5. Reduce the oven temperature to 150°C/300°F/gas mark 2.

6. Beat together the milk, cream, eggs, herbs and seasoning. Scatter half of the grated cheese in the blind-baked pastry case, top with the flaked salmon and beans, and then pour over the milk-and-egg mix. If required, give the filling a gentle stir to ensure it is is evenly dispersed, but again be careful not to damage the pastry case. Sprinkle over the remaining cheese. Place into the oven and bake for 20–25 minutes until set and lightly golden.

Carrot Cake

Ingredients:
2 small free-range eggs
105g (½ cup) dark brown sugar
105g (½ cup) soft brown sugar
150g (11/8 cups) wholemeal flour
¼ teaspoon salt
½ teaspoon bicarbonate of soda
½ teaspoon ground nutmeg
1 teaspoon ground cinnamon
35g (1/8 cup) sour cream
105g (3/8 cup) sunflower oil
180g (3 cups) carrots, grated
45g (½ cup) desiccated coconut
For the cream cheese topping:
110g (½ cup) full-fat soft cream cheese
50g (¼ cup) unsalted butter
50g (1/3 cup) icing sugar
juice of ½ lemon

Equipment:
18 cm/7″ cake tin

1. Preheat the oven to 170ºC (325ºF, gas mark 3).

2. Prepare the cake tin by greasing with butter and lining the bottom and
sides with baking paper. Place the lined tin on to a flat, heavy-duty baking
tray and leave to one side until required.

3. Whisk together the eggs, sugars and sunflower oil in a bowl until
thoroughly mixed. In a separate bowl, sift together the flour, salt,
bicarbonate of soda and spices. Fold the dry ingredients into the egg mix until all ingredients are combined evenly. Finally, fold through the grated
carrots and sour cream.

4. Pour the carrot cake mix into the lined cake tin. Place on the middle
shelf of the preheated oven and bake for approximately 35 minutes, or until the cake springs back when touched. Once baked, remove from the
oven and allow to cool on a wire rack.

For the cream cheese topping:
5. Sift the icing sugar into a bowl and add the softened butter. Beat well
until light and fluffy. Add the cream cheese and continue beating until a
smooth consistency is achieved. Finally, slowly add the lemon juice whilst
still mixing.

To assemble the carrot cake:
6. Once completely cool, remove the carrot cake from the cake tin and
place on your desired serving plate or cake stand. Using a palette knife, carefully smooth the cream cheese topping evenly across the top of the cake.

Victoria Sponge

For the Victoria sponge:
3 free-range eggs
150g (¾ cup) unrefined caster sugar
150g (2/3 cup) unsalted butter, softened
150g (1¼ cups) self-raising flour, sieved
½ teaspoon of vanilla essence

For the vanilla buttercream:
150g (2/3 cup) unsalted butter, softened
220g (1¾ cups) icing sugar, sieved
1/3 split vanilla pod

And strawberry jam

Equipment:
2 × 20 cm/8″ Victoria sponge cake tins

1. Preheat the oven to 180ºC (350ºF, gas mark 4).

2. Prepare the cake tins by greasing with butter and lining the bottom with a circular piece of baking paper. Leave to one side until required.

3. Cream together the caster sugar, vanilla essence and softened butter in a bowl until light and fluffy. Gradually add the beaten eggs, a little at a time to avoid the mixture curdling. Finally, fold through the sieved flour until all the ingredients are perfectly combined.

4. Divide the cake mix evenly between the two prepared cake tins and carefully smooth the mix to create two level layers. Place on the middle shelf of the preheated oven and bake for approximately 20 minutes or until the cake appears golden brown and an inserted skewer comes out clean. Once baked, remove from the oven and allow to cool slightly before turning the cakes out on to a wire rack.

To make the buttercream:
5. Cream the softened butter with the sieved icing sugar and the seeds from the split vanilla pod. The buttercream will become pale and fluffy with little flecks of vanilla seeds throughout.

To assemble the Victoria sponge:
6. Once the cakes have completely cooled, carefully and evenly spread a layer of buttercream on to the top of the first cake. Next add a thick layer of your home-made jam, before carefully placing the second cake on top of the jam and very gently pressing down. Finally, dust the top of the cake with icing sugar.

7. Serve with a pot of tea!

https://uk.style.yahoo.com/royal-recipes-queens-favourite-dishes-slideshow-wp-094712675/photo-p-sneak-peek-recipes-br-photo-094712592.html

Friday, May 26, 2017

Hat patterns

Recipe: Macaroons

Macaroons

Makes around 20

Ingredients
150g egg whites (around four whites)
200g ground almonds
250g golden caster sugar
1tsp almond extract
100g chopped whole almonds

EquipmentElectric mixer or bowl and whisk
Disposable piping bag (optional)
Mini muffin tray

1. Preheat the oven to 170C. Beat together the egg whites, ground almonds and sugar until thick and smooth. Stir in the almond extract.

2. Set aside for five minutes to rest, before pouring into a piping bag. Rest in the fridge for half an hour.

3. I like my macaroons really chewy. In order to achieve this, the batter needs to be quite runny - too runny to effectively shape into biscuits. You can add an additional 50g of almonds, if you wish to roll the biscuits out, but I find that baking the macaroons in a mini muffin tray means your batter can be very loose.

4. Squeeze a tablespoon of the batter into each muffin hole. Sprinkle the top of each macaroon with chopped almonds. Bake for around 20 minutes, until lightly golden, and set on top.

Cool completely before serving with tea or coffee.

https://www.theguardian.com/books/little-library-cafe/2017/may/25/novel-recipes-macaroons-from-the-enchanted-april-by-elizabeth-von-armin

Zazika's take