Emergency patients had the worst winter on record for being admitted to NHS hospitals in England, with nearly 200,000 waiting at least four hours.
Figures from the health service showed a near five-fold increase in the number of A&E patients suffering admission delays over the past five years.
Between December 2016 and February 2017 a total of 195,764 patients waited at least four hours to be admitted to hospital from A&E, up from 40,791 in 2011/12.
The figure is the highest since records began and marks a sharp rise on the winter months last year when 134,576 patients missed the four-hour target.
Total emergency admissions to NHS hospitals in England rose from 1.3 million in winter 2011/12 to 1.44 million in winter 2016/17.
Extreme waiting times also reached record levels, as 1,877 patients were forced to wait at least 12 hours before being admitted to hospital from A&E this winter, compared with 375 the previous year.
Research suggests hospitals are creaking under the weight of demand. A&E departments had to close their doors to ambulances almost twice as often this winter compared with the previous three years, a report from the Nuffield Trust showed.
The number of ambulance diverts in place at hospitals in England hit 478 for the three-month period from December to February, compared with an average of 249 over the same period in 2013/14, 2014/15 and 2015/16.
The number of days lost to so-called “bed-blockers” also hit record levels in England this winter. A total of 577,195 days were lost through delayed transfers of care from December to February, compared with 471,780 in winter 2015/16.
Twice a week we publish problems that will feature in a forthcoming Dear Jeremy advice column in the Saturday Guardian so that readers can offer their own advice and suggestions. We then print the best of your comments alongside Jeremy’s own insights.
Six years ago I was a whistleblower at my workplace. I worked there for three years, but from my first day I noticed daily cover-ups, misuse of position and daily cash fraud.
This was my dream job, at a firm I had looked up to. I was shocked to see what was happening and, for a long time, blamed myself for being too sensitive and thought I was just being paranoid.
At one point the fraud became so serious, and the cover-up so intricate, that I was left with no choice but to report it internally.
I was 100% sure they would find out, correct the situation and give out warnings, and we would move on. But my first report was not taken seriously: they checked out the paperwork I mentioned but overlooked the obvious fraud. They simply dismissed any claims, and the case was closed.
Nothing changed and I decided I would quit as soon as I could. When I made that decision I also decided to become a whistleblower. I thought I had nothing more to lose.
I was very wrong. During the whole whistleblowing experience, I was bullied, snubbed by management as a disgruntled employee and accused of being a “disrespectful colleague”.
I have lost all my hope in humanity. I know it sounds severe, but I really feel this way. I am scared to be employed again, and have been working from home and living off my savings.
How will I ever gain any confidence in the world or in any company? The people I looked up to, those whom I had aspired to be like, have let me down beyond belief. I am a traumatised human who had no other choice but become a whistleblower.
Do you need advice on a work issue? For Jeremy’s and readers’ help, send a brief email to dear.jeremy@theguardian.com. Please note that he is unable to answer questions of a legal nature or to reply personally.
Should you ever be concerned about glycemic index or its glycemic load?
Low-carb diets, such as the Atkins, South Beach and Paleo will always emphasise the fact that high-glycemic foods raise your blood sugar and insulin, stimulating your appetite and promoting overeating and obesity.
Yet evidence now shows that glycemic index makes no difference to your weight and blood sugar levels.
What is the glycemic index?
The glycemic index (GI) measures the rise in blood sugar levels in a person over the two to three hours following the eating of an amount of food that contains 50g of carbohydrate.
Expressed as a percentage, the GI of pure glucose sugar is 100% while that of for instance of an apple is 39%.
Many mainstream nutritionists will tell you to eat foods that are low on the glycemic index for a more stable blood sugar level and to help heal health conditions, such as Candida and hypoglycemia.
But there is one big problem with the GI: it does not take into account the amount of carbohydrate in any particular meal.
So to make the GI more relevant to daily eating, the idea of the glycemic load or (GL) was introduced.
What is the glycemic load?
The GL figure is found by multiplying the GI of the food times the available carbohydrate content of a serving of that particular food and then dividing by 100.
So for example, a watermelon ranks as 72 on the glycemic index, which is classed as being high.
Taking a 100g serving size of watermelon, which has just 5g of available carbohydrates in it, its glycemic load or GL would be as follows: 72 x 5/ 100 = 3.6. So the GL is just 3.6 for a 100g serving of water melon.
So should eating certain foods with regards to them having a higher GI or GL values be of any concern to you and your health?
Well, the answer is no!
Let me explain why.
How quickly sugar enters the bloodstream is not actually the most important factor here and should not be something to be concerned about when eating healthy, natural, whole foods.
Why fruit is good for your healthy blood sugar levels
Another great aspect about the consumption of fruit is that it promotes the satisfaction of the appetite.
This is because the natural elevation of the blood sugar level after eating them is one of the key mechanisms that the human body uses to satisfy appetite and reduce food intake.
When you consume whole foods like fruits for example, they contain not only the carbohydrates that your body needs to be healthy, but also all the other nutrients essential to your health, including fiber.
Fiber slows down the absorption of sugar from the foods (whole fruits and vegetables for example) that you eat, into the bloodstream, which allows for the controlled and healthy release of the hormone insulin, that transports the sugar from your blood into your body’s cells.
Eating a healthy level of fat in your diet (but not high levels of fat) is also very important in this equation as it will allow for a healthy level of blood sugar to always be maintained.
It should be noted that dehydrated/dried fruits will contain much more concentrated sugars, which could cause blood sugar issues for some people.
The same goes with the drinking of fruit juices, which contain no fiber and so very quickly enter the bloodstream.
But for the average healthy person eating a healthy plant foods diet with plenty of fruit and low levels of fat in it, this should not be an issue.
The mistake low carb dieters and promoters are making is thinking that the GI and GL foods are actually relevant to a healthy way of eating.
At best the GI and GL are a nutritional curiosity and at worst a misleading and potentially health damaging way of looking at what foods we should or should not be eating.
If you want to live healthily and eat the best foods to support your body, then it is best to forget both the GI and GL and instead focus on eating healthy, natural whole plant foods together with a healthy level of fat in your diet.
This will naturally help bring you the health you deserve, including normal blood sugar levels.
There’s absolutely no reason to fear fruit!
About the author: Yulia Tarbath is a Certified Nutritionist at Rawsomehealthy, author, parent and international speaker with nearly 8 years of experience on a raw foods, vegan lifestyle. With over 70,000 followers around the world, Yulia and her husband Paul are authorities on living a balanced, nutritionally sufficient plant-based lifestyle. Through their videos, blogs, coaching and online programs, they are supporting both women and men around the world in cleansing and healing their bodies naturally, as well as achieving the shape and health of their dreams. Sign up to their FREE 5-day raw food menu plan here.
Medical knowledge changes swiftly, and technological changes make new and expensive investigations and treatments possible that were only theoretical a few years ago. Life has been extended in length, but not in quality, and the debates about end‑of‑life decisions show us how much the notion of a “good life” is bound up with the absence of disease, illness and suffering.
The practice of medicine is not purely technical. It involves a relationship between a person who is seeking help, and who may be vulnerable, and a person who has the skills and knowledge to help. Relationships that involve disparities of power, knowledge and vulnerability require some degree of external oversight and regulation. Traditionally, in medicine, this oversight has taken the form of codes of ethics, starting with the Hippocratic Corpus. Today, bodies such as the General Medical Council and the Royal Colleges define the standards of good medical practice.
There has been much discussion of how we make moral choices, but what do we mean by a “moral” decision in medicine? Conventionally, we are distinguishing what is clinically and technically possible from whether it is “right” to intervene at all. For example, if a person’s heart stops, we know we can resuscitate them, but should we do so?
To answer that question, we do not expect to rely solely on numerical data and we do not anticipate getting an obvious and single answer. We are aware that there may be more than one answer to the question, and those answers may conflict with each other. We will want to get clinical information about the situation: why did the heart stop? Will restarting the heart make things better or worse for that person in medical terms? We will also want to know what the patient thinks about the situation: did they anticipate this? Do they want to be resuscitated? And if we don’t know these things, we will want to ask some questions about how best to make a complex decision if we have not heard the wishes of the person concerned.
Moral reasoning differs from those types of reasoning that are purely computational, logical or algorithmic. To answer ethical questions, we engage in a process of reflection and discussion: we begin a discourse that uses the words “ought” and “should”, as opposed to “can” and “must”. If the patient’s heart has stopped because they are losing blood, then a doctor may say: “We must give the patient more blood or his heart will stop, and we can do so because the blood is here and we know it will work.” However, that statement does not answer the question: “Should we resuscitate the patient if his heart stops?” The doctor’s statement about what can be done is not irrelevant, but it is only a part of the reasoning process involved in deciding whether it is right to resuscitate. If the patient had left instructions that they did not want to be resuscitated if their heart stopped during surgery, then the facts of successful resuscitation practice would be irrelevant to what the doctors should do.
What we are distinguishing here are facts and values – a distinction developed by David Hume in the 18th century. Hume says that it is a fallacy to think that because things are a certain way (facts), then they should be that way (values). We cannot derive values from facts, but we do evaluate facts and make moral judgments about them, and this reasoning and reflection process is crucial to medical ethical decision-making.
For centuries, it was assumed that a good decision ethically in medicine was the same as a good clinical decision
For centuries, it was assumed that a good decision ethically in medicine was the same as a good clinical decision. If the doctor did what was medically indicated to benefit the patient, then this was the ethically right thing to do. Although sometimes crudely summarised as “doctor knows best”, this approach to ethical dilemmas in medicine is (arguably) less about the doctor’s status, and more about the tensions between facts and values.
Medicine as a science utilises a method of study that focuses on consequences of actions, on causes and effects in nature. These facts about how bodies heal, or how drugs work, are sometimes confused with medicine’s ethical imperative to bring about good consequences for the patient, or at least reduce harmful consequences. Concerns tend to arise when there is friction between the facts and values.
Modern medical ethics developed out of an examination of medical authority after the second world war, partly in response to the Nuremberg trials of doctors who had used medicine to torment and kill citizens, but also in sympathy with a general increase of attention to the human rights of ordinary people which had previously been denied – people of colour, women and those made vulnerable by illness.
Legal cases reflected this change: in one famous instance (Murray v McMurchy, in 1949), while operating on a woman for another purpose, a surgeon tied her fallopian tubes without her consent, because he foresaw that becoming pregnant would be clinically dangerous for her, and that it would also be dangerous for her to undergo two surgical procedures. She sued for negligence and won: it was not disputed that the surgeon was factually correct, in clinical terms, but he had not considered that the patient’s own view of herself and her body were essential to the decision-making process. He had focused on facts, and assigned no value to the patient’s view, even though it was her body that was being operated on.
This case brings us to an important issue in moral reasoning generally, which is how we think about words like “good” or “right” or “best”, in relation to a human decision. It is not a question of whether we want doctors to make ethical decisions on a daily basis – it is a fact that this will happen in the world of medical practice. What we want is for doctors to make “good” ethical decisions, or at least the “best possible”. We want to know that they have engaged in the type of thinking that takes account of values and personal lived experience.
One of the most common criticisms of doctors is that they do not listen to the experience of the patient, or let the patient’s voice be present or important. There have been changes in this regard, and medical practitioners are encouraged to be more patient-centred. This process is helped by doctors themselves acknowledging that they will inevitably be patients at some point in their lives, that knowledge does not make them immune from suffering. Nevertheless, there are still concerns about unethical practice in medicine, and occasions when doctors do not make the best ethical decisions; or even make decisions and take actions that are deemed to be “wrong” and “bad”.
A few years ago, a medical team described how they resuscitated a woman whose heart had stopped, despite knowing that she did not want to be resuscitated. They described how they felt that they had done the right thing at the time, but they could see that, besides disrespecting her wishes, their decision had bad consequences for the woman. Although difficult to do, it is helpful if doctors can take the risk to discuss their “bad” ethical decisions in public, because it allows a learning process to take place, just as happens after other types of serious incident or accident. At present, doctors who have done “bad” things are treated as offenders, and any exploration of what happened takes place in a secret process.
Ethical reasoning in medicine has drawn on a range of theories in moral philosophy. There is obviously a close relationship between medical ethics and the utilitarianism of Jeremy Bentham and John Stuart Mill, namely that the doctor should act in such a way as to bring about the best medical consequences for the greatest number of people, or act in such a way as to minimise harmful consequences for the greatest number of people. Although it may seem unarguable that doctors should always do what is best for their patient’s welfare, it is not always clear how the assessment of welfare is to be done, and from whose perspective.
A common criticism of focusing on medical consequences is that a utilitarian approach does not help doctors and patients to weigh up different consequences, nor does it tell them what to do when doctors, patients and carers weigh anticipated consequences very differently. Ray Tallis, a physician of older age care, writes movingly of how painful it is to be accused of cruelty and ageism when he does not support treatments and interventions that will prolong an aged person’s life for a short time, but cause them more suffering before their inevitable death.
In 1979, a model of medical ethics was proposed that has become a basic starting point for discussing and teaching healthcare ethics. It proposed a set of principles that would address both consequences and duties in medicine. Doctors should respect the principle of doing good and doing no harm, but they should also have respect for the patient’s views and choices about their condition and treatment, and respect their autonomy over decisions that affect them directly. Doctors should also respect a principle of justice in healthcare, where justice implies fairness of access to treatment.
This model is known as the “four principles” approach, and is now often used as the basis of training in healthcare ethics. Possibly its greatest value is that it has enabled the study of healthcare ethics to become more central to the training and development of doctors. Doctors used to learn about ethical reasoning by watching their trainers and seniors in a purely clinical context, but the four principles gave them a structure for thinking about their ethical decisions that was based on arguments from moral philosophy, not clinical medicine. A good ethical decision in medicine could be said to be one that takes account of the clinical consequences for the patient and embodies a duty to respect the views of the patient and the justice of the process.
Respect for patient autonomyhas grown with the consideration of human rights and dignity, and developments in the law on consent and personal ownership of identity. But there is a problem with giving more weight to autonomy. Many medical conditions impair the capacity to be autonomous, even if only temporarily, which gives rise to considerable debate as to how to make good-quality ethical decisions in cases where people cannot express their views. In many cases, it will be possible to wait until the patient has regained the capacity to make their own decisions, in other cases, the patient may have left advance instructions as to how to be treated, or there are substitutes (usually family members) who can make a choice for the patient.
The problem of lack of capacity deepens where people have long-term problems with autonomy, either because they are developing it (children and young people), they have lost it through physical and mental injury (the elderly and disabled), or where it fluctuates, owing to psychological distress (which occurs in a wide variety of mental disorders).
‘A moral decision is a complex process, and like many medical treatment decisions, involves both facts and values’ Photograph: Mode Images / Alamy Stock Photo/Alamy Stock Photo
Autonomy is sometimes seen as a type of cognitive skill that one either has or doesn’t, like being able to read. But some have argued that it is an expression of identity and experience that is organic, formed by family and other relationships. From this perspective, a person’s capacity to make important ethical decisions (such as terminating a pregnancy or refusing treatment) changes naturally with time, within a range of relationships, and degrees of vulnerability. For example, parents help their children to become more autonomous over time by providing them with a network of secure relationships. Autonomy to make important decisions reflects personal identity and values, not just an ability to understand or take in information.
For those people who live in relationships of long-term dependency on others, the autonomy of the patient is located in the relationships with those who care for them, and facilitated by those carers.
It might be argued that any state of being ill or distressed entails a type of vulnerability with which the doctor must engage. The good doctor does not always wait for the patient to regain autonomy, or turn to a substitute decision maker, she works with the patient, seeing their compromised autonomy as a type of reflective bedrock for ethical decision-making. Vulnerability and neediness are not indicators of low status or even disability, but are aspects of a person’s identity that make up essential human transactions.
A moral decision is a complex process, and like many medical treatment decisions, involves both facts and values. One view of the capacity to make any complex decision is that it involves a process of taking in information and believing it, weighing up of the perceived risks and benefits, and evaluating advantages and disadvantages, a process which is then followed by a selection of the outcome most beneficial in terms of life advantage. No doubt some decisions can be made this way, but what such an account seems to leave out is any discussion of the feelings that are involved in such a decision, or the way the subjective experience of the decision-maker influences her thought process.
The surgeon, public health researcher and writer Atul Gawande has described the complexity of treatment decisions in people with conditions that were going to end their lives, and the importance of thinking about what individual people value in their lives when making these decisions. He argues that doctors have been poor at making these kinds of discussions possible because of the emotional discomfort that they entail. We might infer from this that emotional discomfort is often an important part of the moral decision-making process, and the more complex the moral decision, the more emotional discomfort there will be. The idea of coolly weighing up alternatives seems implausible in relation to decisions like, “Shall I keep this pregnancy?” or “Shall I refuse this treatment that is keeping me alive?”
There is evidence to support a more complex and emotional account of moral decision-making. A 1977 study by Carol Gilligan explored how women approached the decision to have an abortion. When making their decision, they reflected on their moral identity over time, and the kind of person they wanted to be, both now and in the future. They also considered the impact of their decision on the people they were closest to: family, friends, partners. Gilligan suggests that these women located their ability to make a complex moral decision within a narrative of who and what they valued as people. This focus on relationships complemented the type of rights‑based argument that asserted a woman’s right to choose what happens to her body.
Another study, by JO Tan and others, explored the capacity of young women to refuse treatment for an eating disorder. The study found that these young women could take in information about the consequences of their decisions and appeared to be able to weigh it up – that is, their capacity to make such a decision was not obviously cognitively impaired. But the study also identified a profound difference between the way the clinicians saw the problem, and the way the young women saw the problem.
The clinicians saw the young women as having a disorder that was threatening their lives, whereas the young women themselves described experiencing the eating disorder as part of their identity, and thus to give it up was to give up a part of themselves. Their capacity to make an autonomous decision about life-saving treatment was tied up with their identity and personal values, not just an analysis of consequences. A 2012 study of people who repeatedly self-harmed produced similar findings: the participants also expressed real ambivalence about their decisions. They acknowledged that the decision-making process involved in self harming was unsettling and complex.
Improved techniques for brain scanning have led to great interest in what happens in the brain when people make moral decisions. Areas of the brain that are known to be active in emotional experience and regulation are also activated in moral decision-making and the experience of moral emotions. Not only are these processes and experiences complex, they involve different neural pathways and networks between different parts of the brain. Disruptions of different processes may lead to variations in moral reasoning, and altered experience of moral decision-making.
There is little doubt that most people know the difference between right and wrong. However, it appears that some people seem not to have the feeling of what is right and wrong. This “moral feeling” is thought to translate the cognitive recognition that an act is immoral into inhibition of that action. Work by neuroscientist Antonio Damasio suggests that good quality moral decision-making involves a type of rapid unconscious intuitive process, which is distinct from information processing, and that if this is absent (for example, after some types of brain damage), then people will struggle to make moral decisions at all.
The doctrine of double effect is an old one in moral philosophy. It effectively says that it is morally justifiable to carry out a good action with a bad side-effect, if the bad side-effect is not the main intention of the action. A famous example is given in Philippa Foot’s thought experiment from 1967, commonly referred to as “the trolley problem”. The experiment involves a scenario in which a tram (“trolley” in the US) is heading towards a line of track on which five people are trapped. You can pull a lever that will switch the tram’s course on to a line of track where only one person is trapped. Essentially the question facing the decision-maker is whether it is justifiable to act in a way that prevents the death of five people, even if that means bringing about the death of one.
A simple utilitarian calculus (if there is such a thing) would suggest that it is right to save five lives if possible, even if it means bringing about the death of one, and this is the option that most ordinary people choose. Using the doctrine of double effect, they assert that they do not intend to kill the one person, but that a single death is an inevitable byproduct of their intention to save five people.
The trolley problem has been given several variants to explore different moral responses. In one variant, you can stop the tram from killing five people by pushing one person in front of it, and thus bringing the tram to a stop (the unfortunate person sacrificed is often described as fat, but since the thought experiment is based on the assumption that your action is successful in saving the five others, the victim’s size is probably irrelevant). When people are asked about this variant, many express reluctance to push the man on to the track, even though the intended outcome is the same as pulling the lever (five lives saved). This result implies that people feel differently about physically harming someone directly, even when doing so would bring about good consequences.
The distinction between pulling a lever and a physical push has an emotional effect that means something to the decision-makers, even if it is hard to articulate. One possible explanation for the distinction people make between pulling a lever and pushing a person may be to do with the sense of intention or agency that has to be owned. In both cases, the doctrine of double effect is invoked: I intend to save five people, I don’t intend to kill one person, but sadly that happens because of my primary intention to save lives. But when the saving of five people entails physically pushing an innocent person in harm’s way, it seems that the doctrine of double effect cannot allay anxiety about doing harm. It seems difficult to claim that you do not intend to kill a man when you push him in front of a train. Criminal jurisprudence would find you guilty, on the basis of the anticipated consequences alone.
No doctor would accept that taking a single life is justifiable even if five lives could be saved
Another possibility is that people feel a sense of injustice on behalf of the single man, and an awareness that if one of us can be sacrificed for a good cause, then any of us could be sacrificed without consent, which seems unjust and cruel. It may be of interest that people who score highly on a measure of psychopathy are more likely than low scorers to endorse more utilitarian responses, which suggests that a lack of anxiety about hurting others allows for easier focus on simple utilitarian calculus. Yet another possibility is that people do not like to think of themselves as causing direct harm to others, even if they accept that they did so. In a recent book about the life of Rudolf Höss who was the commandant at Auschwitz, he is quoted as saying of himself that he was not a murderer, he was “just in charge of an extermination camp”.
The doctrine of double effect was first expounded by Thomas Aquinas, and has been especially influential in medicine because so many medical interventions are risky to the patient. The most well-known example of the doctrine of double effect occurs in palliative care, where people in the last stages of life are often given high doses of pain-relieving drugs. These drugs shorten life (often by depressing respiratory function), but doctors who prescribe them argue that they do not intend to shorten or end life, only to relieve severe and intense pain. Other common examples in medicine also involve side-effects of drugs such as chemotherapy for cancer, where harmful effects are not intended, but are an “inevitable” consequence of the intention to benefit the patient.
No doctor would accept that taking a single life is justifiable even if five lives could be saved, and doctors have been and will be prosecuted where there is a suspicion that they have intentionally ended life, even where there is prior consent and family support. One report describes a tragic case where a young man was brain dead, and his organs were to be used to save several people’s lives when life was extinct. A doctor was accused of administering a drug to bring about the young man’s death so the organs could be used, although he was acquitted of this charge. When the young man eventually died, his organs were never used. One can only imagine the different emotional responses to this series of events, depending on whether you were a relative of the dying man, or a relative of those whose life might be saved by his death.
The doctor is empowered to do harm to the patient in pursuit of doing good, and there is a social acceptance that treatment may entail a deliberately imposed suffering that is not the primary intention of the doctor.This acceptance requires a great deal of trust in the medical profession – and doctors are still the most trusted professional group. The trust that makes these interactions possible assumes that doctors will not be the kind of people who exploit vulnerability and exercise influence for their own ends. There is a question here about how society expects doctors not just to be good technically, but to be good personally.
There are other accounts of ethical reasoning that may be helpful when thinking about doctors as good people. In his book, Justice: What’s the Right Thing to Do?, Michael Sandel has argued that moral decision-makers need to follow an ethical reasoning process that pays attention to justice and the ways that people weigh the value of their decisions. He argues that impartiality is not always the keystone of justice, but rather that justice processes need to pay attention to what people value.
There remains a question about whether it is just and fair to expect a group of people who are chosen for cognitive intelligence and skills in exam-passing to become morally superior individuals. It is often said that doctors are held to a higher moral standard than other people, but how are they trained to that higher moral standard? After the Harold Shipman inquiry, it was recommended that doctors undergo revalidation every five years, but there is no evidence that the revalidation process addresses moral reasoning or the moral identity of doctors. Doctors still do “bad” things, even when they are good people in other ways, and technically good at what they do.
Medicine needs a way of thinking about ethics that addresses different moral values and intuitions. What remains unclear is how we train doctors to be good people, not just to do good work and make good choices.
• This is an edited version of a lecture given by Dr Gwen Adshead at the Museum of London
A&E patients in England experienced the worst month of delays in January since a four-hour target was introduced 13 years ago, leaked figures suggest.
Provisional data passed to the BBC says an unprecedented number of patients spent longer than the target time waiting to be seen in emergency wards in January.
It showed that more than 60,000 people waited between four and 12 hours for a hospital bed. And more than 780 waited more than 12 hours. Both figures are record highs since the introduction in 2004 of a target that 95% of patients must be seen and either admitted or discharged in under four hours.
The leaked document from NHS Improvement suggests that out of 1.4m visits in January, only 82% were dealt with within the four-hour target.
The NHS Providers chief executive, Chris Hopson, said: “These figures have not been verified and should therefore be treated with caution, but they are in line with the feedback we have been getting from trusts.
“NHS staff have responded magnificently to increased winter pressures, but the situation has become unsustainable. The rise in long trolley waits is particularly worrying, as there is clear evidence they can lead to worse outcomes for patients.”
Hospitals have not hit the target nationally since the summer of 2015.
A Department of Health spokesman said the January data was yet to be verified and that official figures, due out on Thursday morning, only covered December.
He said: “We do not recognise these figures – it is irresponsible to publish unverified data and does a disservice to all NHS staff working tirelessly to provide care around the clock.
“Despite the pressures of winter, the vast majority of patients are seen and treated quickly and hospitals have detailed plans in place to manage busy periods – supported by an extra £400m of funding.”
Dr Mark Porter, chair of the British Medical Association council, said delays in A&E were a symptom of a bigger crisis in social care, which the government was failing to grasp.
“When social care isn’t available, patients experience delays in moving from hospital to appropriate ongoing care settings – preventing patients being admitted at the front end in A&E,” he said.
“The prime minister cannot continue to bury her head in the sand as care continues to worsen.”
When the alarm goes off in the morning, two things can happen:
You hit snooze…
…or you jump up and hit the ground running.
And when it comes to losing weight, you need a no-nonsense fat-burning workout that gets you quick results and fuels your momentum for the day.
That’s when you can slap a giant “S” on your chest…
… because then you know you’re kicking butt.
Today I have something to share with you that will make you feel like you have weight loss superpowers:
Two insanely effective fat-burning workouts that you can do in under 15 minutes.
1. The Tabata Workout
Tabata workouts have become a popular and well-known tool in a trainer’s toolbox.
Why?
Because they’re backed by scientific evidence that 20 seconds of all-out work, followed by just 10 seconds of rest, gets you MASSIVE fat-burning results.
Try doing a combination of specific exercises, repeated for a total duration of 4 minutes, and this, the king of fat-burning workouts, will get you results in less than 15 minutes, including a warm-up!
Download a free Tabata timer for your smartphone, and try this full-body fat loss workout from the Tabata founder Izumi Tabata for yourself.
EXERCISE 1: COCKROACH
AREAS TRAINED
Full-body, emphasizing legs, glutes, arms and core.
INSTRUCTIONS
Starting on all fours, crawl as fast as possible forward for four paces. Stop, get up, and jump in the air. Turn around, get back on all fours, and repeat.
EXERCISE 2: ROTATING JUMP LUNGE
AREAS TRAINED
Legs, glutes, and core.
INSTRUCTIONS
Like many exercises in these fat-burning workouts, you’ll need to start in a lunge position with your arms in a circle. Swing your arms around to one side, then jump the lunge onto the other leg, swinging the arms in the opposite direction. Use the arm swing to provide momentum.
EXERCISE 3: SPRAWL AND JUMP
AREAS TRAINED
Full-body, emphasizing legs, arms, glutes, and core.
INSTRUCTIONS
Sprawl out to the side, putting both hands and one foot on the ground. Bring your top leg toward your chest. Push off with the hands and get up into a standing position, then jump. Repeat on the other side.
EXERCISE 4: WEIGHTED WOOD CHOP
AREAS TRAINED
Biceps, shoulders, core and legs.
INSTRUCTIONS
Lunge to one side, holding a light weight (2.5-5 lbs.) with both hands. Swing the weight up from the floor to above your opposite shoulder. Repeat, alternating sides.
EXERCISE 5: FROG JUMP
AREAS TRAINED
Legs and glutes.
INSTRUCTIONS
Drop into a squat, then jump in the air with the knees tucked up. Repeat quickly.
EXERCISE 6: SINGLE-LEG BURPEE
AREAS TRAINED
Full-body, targeting legs, glutes, biceps, triceps and shoulders.
INSTRUCTIONS
Start in the push-up position. Jump in with one leg, and then jump up, bringing the opposite knee toward the chest. Repeat on the other side. If this is too difficult, perform the burpees with both legs.
EXERCISE 7: SINGLE-ARM KICK-THROUGH
AREAS TRAINED
Biceps, triceps, core, glutes, and legs.
INSTRUCTIONS
Start in a push-up position. Shift your body weight toward the right arm, and then kick to the left with the right leg. Alternate the movement on your left and right sides quickly.
For a less-advanced version, keep both hands on the ground and alternate knees to the chest rapidly, similar to a mountain climber.
EXERCISE 8: CRAB LUNGE
AREAS WORKED
Full-body, targeting arms, core, glutes and legs.
INSTRUCTIONS
Start in a deep squat and lean back into a crab-walk position. Take a small weight (2.5-5 lbs.) in one hand, using the other to balance on the floor. Swing the weight back over your head, adopting the crab position. Alternate sides and repeat quickly.
2. The High-Intensity Interval Training (HIIT) Workout
HIIT:
No, it’s not an act of violence…
…or is it?
High-intensity interval training (HIIT) is one of the most widely used fat-burning workouts in the world today because it’s super effective at achieving “brutal” fat loss results.
And better yet, they only take a few minutes to complete.
Try this ultimate 10 minute HIIT fat melting workout for yourself.
TIP: Bring a towel…
Warm-Up
Skipping, stationary bike, or walking machine for 10 minutes.
The Workout
Perform each exercise as prescribed.
1. Jump Lunge
Duration: 1 min.
Recovery: 1 min. of jump roping
2. Box Jumps (Box should reach knee height)
Duration: 1 min.
Recovery: 1 min. of jump roping
3. Dumbbell Renegade Row with Pushups
Duration: 1 min.
Recovery: 1 min. of jump roping
Description: Starting in pushup position, row one dumbbell. Return to pushup position. Row the other dumbbell. Return to pushup position. Do a pushup. That’s one rep.
4. Dumbbell Power Jerk
Duration: 1 min.
Recovery: 1 min. of jump roping
Description: Perform a quarter squat with dumbbells at shoulder level then press both dumbbells over your head. Return to start.
5. Dumbbell Uppercuts
Duration: 1 min.
Recovery: 1 min. of jump roping
Description: Perform a squat while holding the dumbbells at your side. Punch up and across your body with one arm. Repeat with your other arm.
About the Author
Jason is a writer for the Beverly Hills Rejuvenation Center and a minimalist lifestyle designer with a focus on personal health and wellness. He is a Personal Trainer, a seeker of fat-burning workouts, and an advocate for naturopathic and holistic healing therapies that create an exceptional quality of life.
REFERENCES The Ultimate HIIT workout The Real Tabata: A Brutal Circuit From The Protocol’s Inventor
The need for global health security is clear. People around the world are more connected than in any time in human history. Distances and borders no longer protect humans from diseases, viruses — and epidemics.
Pick any two major cities anywhere in the world — you’ll find that there’s at least one commercial flight each day linking them. Disease requires only the smallest opening to take root and spread. In today’s closely-connected world, diseases travel from an isolated, rural village to any major city in as little as 36 hours.
Additionally, there’s also the potential of accidental, naturally occurring, or deliberate spread of biological threats and dangerous pathogens.
Though our being connected provides a myriad of opportunities for people all over the world, it also poses serious challenges for our health security and for the stability and security of our communities.
The Global Health Security Agenda joins us in facing these global and public health challenges.
Global Health Security Agenda
In 2014, the spread of Ebola across West Africa went undetected for months. The Ebola epidemic provided the world a sense of urgency.
The United States worked with international partners in an effort to beat back the threat of Ebola and strengthen health systems in West Africa.
Global leaders came to the realization that more work needed to be done.
In 2014, when the GHSA was launched, the World Health Organization (WHO) reported that more than 70 percent of countries were not properly prepared to address epidemic threats. Countries didn’t have a set of common preparedness standards. And there wasn’t a precise or transparent way to gauge whether a country had strong and reliable laboratories, or enough trained public health workers, or an effective way to quickly and clearly gather and share information.
Senior leaders from around the world — representing government, the private sector, and academia — continue their work to advance the Global Health Security Agenda (GHSA) and ensure that it is sustained.
Joint External Evaluation forPublic Health and Security
The GHSA is critical to our public health and security. Since the inception of GHSA, there is now an open, transparent, independent process to assess and improve global protection against health threats called the Joint External Evaluation (JEE) process.
Developed by the World Health Organization, Finland, the United States, and a collection of GHSA member countries, the JEE is a stress test that allows countries to clearly and unmistakably identify the most urgent needs within their public health system. It also helps to establish national plans to address those needs using common systems and standards.
Often for the first time, JEE is a clear road map any country can follow to strengthen its ability to address biological threats, whether these threats are accidental, naturally occurring, or deliberate. The JEE includes goals agreed to in 2015 by GHSA member countries, as well as a mandate to transparently share results to better ensure accountability.
Until now, 17 countries have completed and published results of their stress tests, with another 32 planning to conduct the tests in the near future. The WHO’s goal is for more than 50 nations to complete their initial assessments by May 2017. Additionally, Global Health Security Agenda hopes and anticipates that within another 1 to 2 years; more than 100 countries will have gone through the process.
Working Together for Global Health
The need to work together for global health is clear. New diseases continue to emerge, drugs become resistant, and more laboratories are processing dangerous microbes.
No one nation can guarantee global health security. But it’s critical to be steadfast and unwavering in our commitment to work with our international partners to prevent, detect, and respond to infectious disease threats.
Today, as we face the spread of Zika virus — with the memory of avian influenza and SARS still fresh in our minds, and recovery efforts from Ebola still unending — the Global Health Security Agenda and continued international commitment to advance this unified agenda has never been more relevant — so important, and so urgent.
As presenter of Woman’s Hour I’m no stranger to the history of women who, over the centuries, have risen above the prejudice imposed on their gender, and whose lives began to be uncovered in the latter part of the 20th century as women’s studies became an acceptable subject for academic research. But nowhere could I find a book which gathered together a group of those who had most excited my interest and admiration.
Then came reports in November 2015 that it was proposed to cut feminism from the politics A-level syllabus. The suffragette movement was to be squeezed into a section on “pressure groups” and only one political thinker, Mary Wollstonecraft, was to be mentioned by name. My son had come home some years earlier with his text book for 20th-century British history and recognised (thank goodness) that something was missing. “Mum,” he said, “I don’t think this is right. I can’t find any women in this book except half a page on the suffragettes.” That’s my boy!
Then I came across Thomas Carlyle’s “The history of the world is but the biography of great men”, written in 1840, and, in Steve Biddulph’s Raising Boys(1997), “It’s important to remember that men built the planes, fought the wars, laid the railroad tracks, invented the cars, built the hospitals, invented the medicines and sailed the ships that made it all happen.”
It became vital to bring together a group of female warriors, poets, playwrights, painters, composers, campaigners, scientists, engineers, doctors and politicians for the benefit of all those young people who need to know that the history of Britain is the biography of great men and women.
Fanny Burney is one such woman. Though certainly not the most accomplished novelist in the canon of English literature, she was successful in her day, often writing in her fiction about the difficulties faced by women in getting an education, taking control of their own lives and surviving the social whirl of the nouveau riche. Virginia Woolf called her “the mother of English fiction”.
Her diaries are phenomenal, giving us the most gossipy and often scandalous details of life in literary and intellectual London in the late 18th and early 19th centuries. She was at the centre of a circle that included Dr Johnson and his biographer, James Boswell. Her diaries give a far more intimate portrait of Dr Johnson than do those of the man she referred to rather scathingly as Bozzy.
She also wrote one of the most courageous pieces of work I’ve ever encountered. I read it around the time I, like so many 21 century women, was diagnosed with breast cancer.
Burney’s is the first example I’ve come across of a woman writing about so intimate an event as a diagnosis of breast cancer and a mastectomy. Even today, when I wrote about my experience, it was regarded as a brave thing to do, though we no longer have any squeamish concerns about speaking the words “breast” and “cancer” out loud. It was generally deemed to be helpful, making it clear that there’s no shame attached to the diagnosis and it can be endured and survived.
Burney was there first. She was diagnosed in Paris in 1810, at the age of 58, when surgery was in its infancy and there was no effective anaesthetic. Her story was written to her sister, Esther, and was headed “Account from Paris of a terrible Operation – 1812”. First she explains that in August of 1810 she had a pain and a heaviness in her breast. She was referred to a surgeon and, at first, dismissed the concerns of her family and friends. Her letter is a cautionary tale. “I relate this false confidence, now, as a warning to my dear Esther, my sisters and nieces, should any similar sensations excite similar alarm.”
She goes on to describe every horrific detail of what she endured: “Monsieur Dubois placed me on the Mattrass, and spread a cambric handkerchief upon my face. It was transparent however, and I saw through it that the Bedstead was instantly surrounded by the seven men and my nurse. I refused to be held; but when, bright through the cambric, I saw the glitter of polished steel – I closed my eyes.”
For now I’ll spare you the remaining horrors and reassure you that the tale has a happy ending. Burney lived for another 29 years after her mastectomy, to the age of almost 88.
I love Burney’s writing, especially her diaries. But most of all I love her for making us aware that, though the diagnosis is awful and the surgery, even with a full anaesthetic, isn’t pleasant, breast cancer can be survived – and a long and productive life lived after it. For this, she deserves her place among the greatest women.
• A History of Britain in 21 Women by Jenni Murray is published by Oneworld. To order a copy for £13.93 (RRP £16.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.
Turmeric is healthy, and there are many ways to consume it:
While have you ever tried to use this super spice in a sweet dish? It actually works well and you will also get its amazing nutritional benefits.
Recipe For Sweet Turmeric Cream
Ingredients:
3-4 tablespoons of turmeric
1 teaspoon of cinnamon
12 oz of full-fat coconut milk
1-2 droppers of Liquid Stevia
Directions:
Put the coconut milk into a big bowl and then add the other ingredients.
Mix the mixture well until turmeric and cinnamon are well mixed into the cream. Serve it with your cookies or berries.
Turmeric: A Natural Healing Food That Better Than Drugs For Many Health Issues
Turmeric contains curcumin, a natural anti-inflammatory compound. Studies found that the anti-inflammatory properties of curcumin even can match the effectiveness of some anti-inflammatory drugs, makes turmeric as a widely used remedy for many diseases that caused by chronic inflammation.
A research at UCLA found that curcumin may block an enzyme that promotes the growth of head and neck cancer.
The University of Maryland’s Medical Center found turmeric has powerful antioxidant effects, which help fight the cancer-causing free radicals and also preventing the damages they may cause.
Turmeric lowers the risk of brain diseases by improving brain function. Curcumin has been proven to boost the levels of BDNF, a brain hormone that increases the growth of new neurons.
Turmeric has beneficial effects on preventing heart disease as curcumin helps prevent the buildup of plaque, thus lowering the risk of heart attacks and strokes.
Studies also suggested to consume turmeric daily as it helps cut down the rate of developing diabetes for people with prediabetes.
Study states that turmeric works as well as ibuprofen when comes to relieve osteoarthritis pain.
Another research showed that curcumin is effective as prozac in relieving the symptoms of depression.
We’ve seen plenty of alternative maps of the London Underground, from those plotting average rents by station, to those charting life expectancy at every stop. But what about sound? A group of musicians and sound artists have this week launched the first ever interactive “sound map” of the London Underground, capturing the shrieks, grinds and general patter of 55 tube stations across the capital.
It’s a noisy old world down there – from the “mind the gap” announcements to Londoners’ idiosyncratic curses and drunken late night conversations over illicit tinnies. This is precisely what The Next Station project, the work of Cities and Memory and The London Sound Survey, spent three months earlier this year gathering. And as well as capturing the real-life aural experience, sound artists from around the world were then invited to remix and reimagine the field recordings and create an alternative sound map to complement the real one – you can listen to all of them in one interactive feature.
So why make a sound map of the places we would all rather spend as little time thinking about as possible? Stuart Fowkes, a sound artist and the project’s creator, says London’s underground noises are iconic: “not just nationally but on a global scale” – for residents, tourists, and watchers of London-based films alike. The tube, Fowkes says, defines London in a way that public transport networks in other cities don’t.
Clicking through the sound map, you’ll hear a surprising range of noises: a didgeridoo player at Stratford, someone offering free hugs at Brixton and a bagpipe busker at King’s Cross – as well as all the announcements and clattering train noises that you’d expect. “You might think that one underground station sounds much like another,” says Fowkes, “but they’re as characterful as pet dogs once you get to know them.” King’s Cross would be a yappy terrier, then. Brixton an affectionate labrador.
London’s tube stations: as ‘characterful as pet dogs’? Photograph: Transport for London
And sound matters – what we hear every day on our commute is as much a part of our quotidian experience as our morning coffee. There’s the impact loud noises can have on our ears, for one. An expert working in 2004 recorded sound levels louder than a pneumatic drill on parts of the tube – loud enough to damage the hearing.
Then there’s also the psychological impact of sound: though we might classify many of the noises on the tube as stressful, Fowkes insists they can be reassuring in their familiarity, keeping the whole system moving like clockwork: “the details like the intonation of the automated announcements communicate ‘everything is well’ to commuters subconsciously … the trundle of the escalators, the closing of the sliding doors are all as rhythmic as a heartbeat, and become part of Londoners’ natural functions when they’re underground.”
This idea of the importance of acoustic ecology is not new – R Murray Schafer, considered the father of the debate around it, began talking about the (damaging) effects of sound, especially on people dwelling in the “sonic sewers” he believed cities to be, back in the 1970s. “Noises are the sounds we have learned to ignore,” he wrote. So perhaps this focus on the tube’s sounds will help Londoners’ occasionally listen, as well as simply hear, the underground aural landscape.
A man shouts while boarding a central line train at Oxford Circus station on the night of the launch of the 24-hour tube service. Photograph: Daniel Leal-Olivas/AFP/Getty Images
“There’s no blue plaque system for preserving important sounds”, Fowkes says, even though “sounds change as much as visual cityscapes, and today’s sounds are tomorrow’s history.” Perhaps it makes sense that we should be working to archive the soon-to-be-lost sounds of our cities.
The remixed sounds on the London Underground sound map – added to “help people to appreciate how sound can form source material for some interesting art,” Fowkes says – are intriguing, if a little high concept. With the field recording made at Piccadilly Circus, Swedish sound artist Anya Trybala has crafted a composition meant to be a meditation on Brexit. Composer and artist Martin A. Smith has reimagined Moorgate by mixing recordings the Northern line with the sound of cigales and church bells recorded in forests in Provence.
And with the tube now rumbling through the night into the early hours, will we see this soundscape changing? “From a field recording perspective, the night tube is really exciting,” Fowkes says. He’s planning to head out, recorder in hand, and capture some of these nocturnal tube sounds. Who wouldn’t want to hear Londoners’ late night, post-party deep and meaningfuls mixed over the sound of Provençal cicadas?
Cities and Memory is continuing to capture sounds, not just below ground, but also above ground in London and in other cities in 55 countries across the globe. Fowkes’ ambition is to “help people appreciate the joy of the sounds that surround them every day.” So maybe then we can stop grimacing at the shriek of the Victoria line as it passes through Pimlico? Perhaps not. But maybe we can look more kindly on that King’s Cross bagpiper at quarter to nine on a Monday morning.
Listen to the London Underground sound map here. Follow Guardian Cities on Twitter and Facebook to join the discussion
I’ve been in a bit of a slump lately as far as striving new recipes. Because we have 5 teens and my husband is gluten-free, it is not often easy to not just give in and make two totally different meals. But I’ve identified an outstanding new loved ones favourite and I was entirely shocked how a lot everybody loved this one. My advice to other moms out there is to not tell the little ones the pizza crust is created out of cauliflower, they don’t need to know! My 15 yr previous believed I was kidding when I advised him right after he completed his threerd piece.
There are a lot of variations of this recipe floating all around but here is how I produced ours and it was delightful.
Very best Ever Cauliflower Pizza Crust (serves 4 – Yields two small round pizzas)
1 head of cauliflower (I utilized 16 ozs of birdseye crumbled to make it quick and basic)
1 massive egg, beaten
two ½ cups of Mozzarella (1 ½ cups for the crust and 1 cup for the topping)
3 Tbsp of Shredded Parmesan Cheese
one tsp fresh grated or crushed garlic (omit if you really do not adore garlic)
one pinch of fine sea salt
Nonstick olive oil cooking spray
one jar of all normal pizza sauce
Toppings (we used green and red peppers, onions, olives and mushrooms)
Preheat the oven to 425 degrees even though you prepare the crust. Line a large baking sheet with parchment paper (do not use tinfoil).
Place the cauliflower in a food processor (I use our dry blender from the Vitamix) till it is the consistency of rice. Spread the cauliflower in excess of the parchment paper and bake in the preheated oven until it’s tender and beginning to brown just a minor around the edges. On my oven this was twelve minutes. Just maintain an eye on it considering that ovens will fluctuate.
Put the cooked cauliflower into a large mixing bowl and add the beaten egg and the one one/2 cups of mozzarella cheese, the parmesan cheese, garlic and salt. Stir this all collectively with a fork until finally the mixture is blended. It will be sticky and a bit on the moist side.
Now line the baking sheet once more with fresh parchment paper and spray it with the olive oil. Scoop the cauliflower “dough” to the baking sheet into 2 circles of crusts. Use your hands or the back of a fork to type it. It need to be spread out so that it is only about ¼ inch thick. Bake these 2 crusts at 425 right up until they are lightly browned all in excess of and starting up to turn dark brown about the edges. This ought to be roughly 7-10 minutes. Take away from the oven. Note: I produced it into 2 tiny round pizzas so that I could place distinct toppings on each and every, you can also make it a single massive oval.
Spread the pizza sauce more than the cooked crust. Sprinkle the remaining mozzarella cheese on prime and put on toppings of your decision. Bake until finally the cheese is melted and commencing to brown, five to 7 minutes.
Let the pizzas cool for five minutes just before serving. Bon Appetit!
Resources:
Wheat Stomach Cookbook
About the Writer: Sandy J. Duncan is a freelance author, wellness coach and soccer mom. She and her husband have 5 youngsters so existence is never boring. Her organic residing blogs are 10TopHealthSecrets.com and AllNaturalHealthReviews.org.
Rejoice, rejoice womankind! There is now a magic drug that will make intercourse desirable. Once more. Or for the very first time. I can’t identify right here the presently-present medicines that have this kind of an effect due to the fact they are unlawful, and who knows what would occur if men and women took them? (In reality, they have done for decades.) But, by no means mind, this new magic drug has just been legalised in the US, getting been authorized by the US Meals and Drugs Administration. Flibanserin has just passed an FDA advisory committee stage at the third attempt, so will quickly be on the marketplace. It will be sold as Addyi and is developed by Sprout Pharmaceuticals, which has been pushing what has been dubbed “the female Viagra” for some time.
The tablets are, of program, pink because ladies like pink tablets and not blue smarties as we are silly like that. ‘Pink Viagra’ has been the holy grail of the drugs market. Let’s face it, it’s the holy grail of all varieties of cultural imaginings: the magic substance that tends to make ladies who mostly cannot be that bothered with sex abruptly crave it. Even with their very own partners! No drug can assure this, obviously. Many years in the past, when I worked in a wellness meals store in Manhattan, I was usually shocked by the number of males who asked me to promote them one thing to: “Make my wife … you know? Like it.” But I even now flogged them any outdated mixture of herbs and nutritional vitamins simply because I was doing work on commission. I was tough of heart and quick of money.
The drug companies, however, are not brief of cash and, without a doubt, there have been some crucial breakthroughs recently on every little thing from Ebola to Alzheimer’s. 1 of the greatest funds-spinners, although, remains the “magic bullet”, Viagra, invented by Pfizer at Sandwich ahead of the US giant shut down the site in 2011. Viagra commenced out as a new therapy for angina, a heart issue that constricts the vessels that provide blood to the heart. By accident, it was identified that – hey presto! – a side-impact of the drug was to remedy erectile dysfunction.
A single of the unspoken effects of the uptake of Viagra is that men can now have sex with a lot more, and younger, partners. The “shame” of impotency is pummelled away affordably adequate. If this is what sex is, and what it is reducible to, then fine. This is marvellous. You can get it up for ever and a day. A rush of blood to the groin is the dream coming correct.
Viagra as a result speaks to two of our biggest requirements: penetration and profit. The guarantee of Addyi is rather like all female desire: mysterious and by some means problematic. Viagra locates the sexual disorder of males in the genitals and their mechanics. The dilemma for females is positioned in the brain. Apparently, our brain chemistry should be altered to recharge desire. This new drug, unlike Viagra which can be popped when the require arises or is about to, has to be taken every day. It acts on the brain’s “sexual impulses” in a similar way to a class of medicines acknowledged as selective serotonin reuptake inhibitors, which incorporate antidepressants this kind of as Prozac. It has not been accepted right up until now due to the fact the hazards had been explained to outweigh the advantages.
The side-effects may possibly include low blood stress and loss of consciousness. And you can not drink alcohol with it. Arousing, or just awful? Nonetheless, plough on, due to the fact, even even though these who advocate it make its benefits sound as erotic as altering the battery in a remote management, it is well worth the risks, they say, simply because in small trials with placebos, the ladies on it have an “increase of about one particular sexually satisfying event a month”. Hold me back!
If you are not obtaining “sexually satisfying events”, you could be struggling with what some psychiatrists are calling hypoactive sexual desire disorder (HSDD), which, they say, is skilled by eight-14% of girls in the US aged in between 20 and 49. Once you are over 49, no a single cares, frankly. HSDD is a chronic or ongoing lack of curiosity in intercourse that might cause a female distress. It is explained to be caused by depression, tension, low self-esteem or prior abuse. It might be caused by diabetes or cancer or arthritis. What this acronym are not able to deal with – since it cannot name it – is boredom, exhaustion, resentment, and boring outdated relationships: the items that may dampen sexual want.
To say that the brain is the most significant sex organ, which it is, absolutely requires knowing that sex is about a lot more than the ability to be ever ready for it, that there exists an infinite variety of urges that wax and wane, but truly mostly muddle along. And that most people’s lives do not resemble pornography even when they make a lot more work than normal.
Tellingly, even huge businesses this kind of as Pfizer, Bayer, and Procter and Gamble have experimented with to build drugs to deal with the disorder of female sexual desire, but abandoned the search. Even reading through Fifty Shades of Grey and possessing a person unload the dishwasher does not satisfy some women. Can you imagine? The reality is that the drug that liberated women’s need is the one we all get for granted: the contraceptive pill.
If you start off operate at 9am, then a 1pm lunchtime helps make sense. Assuming you wake an hour before perform and have breakfast half an hour later, there’s just 4 and a half hrs till your following meal. But for the early risers, ravenous hunger kicks in at 11am. Every minute feels like an hour when all your ideas are dominated by need for a tuna salad sandwich.
Steering clear of spoilers
All the very best Tv shows are shown right after the watershed, i.e. previous your bed time. Early risers need to commit to a lifetime of recording Tv and catching up the subsequent day, which properly cuts off any conversations about the most recent plot development and turns spoilers into a consistent threat.
Receiving dressed is a guessing game
Trying to judge the weather before the sun has made an visual appeal is an extremely hard task. Early mornings constantly search the exact same: grey, and dark, and bleak. There is no indication about the scorching heat or thunderstorms and hail that will come later in the dat. If you want to be an early riser, get used to a existence of thick black tights on the hottest days of the year, and flimsy dresses during rain.
Curfews are no entertaining
Have you ever been to a very good dinner party that ended at 9.30pm? I quite significantly doubt it. Starters are the warm up to the main entertainment, and the raucous laughter and gossip doesn’t get going till everyone’s place away at least half a bottle of wine. And if you strategy to wake early, that’s precisely the time when you have to excuse oneself and traipse residence. Even on weekends, with out the risk of function the up coming day, it is tough to cope past midnight following a week’s worth of early mornings. If you want to be the very first 1 awake, be ready to give up your social existence.
Delinquency and tension
American academics have discovered cold challenging proof that waking up early is a bad concept. Early risers are far more most likely to behave dishonestly and cheat throughout night time hours, as their power levels lessen during the day. The review located that individuals who woke early were a lot more likely to lie about their check efficiency than these that slept late. And an earlier study from the University of Westminster in London identified that people who wake early had higher levels of anxiety hormones all through the day. Oh, and early risers are far more probably to complain of muscle aches, colds, headaches and mood swings. People extra hours in bed are sounding even far more attractive.
Over-dependency on caffeine
Unless you forgo the joys of evening fully, waking up early will usually make you exhausted. The consequence is a daily life of fatigue, with peaks and troughs that are entirely out of sync with the rest of society. The only way to make it via individuals painfully early morning commences is with the aid of caffeine—and no scrimping on the cup size. Espresso will exchange water as your normal drink and, with hammering heart and shaking hands, your previous pal coffee with aid you via the day.
Drug improvement is all about failure. It is the rule, good results the uncommon exception. The extraordinarily substantial price of drug advancement is largely driven by the higher frequency of failures, and by the time and price it requires to figure out the molecule you are establishing isn’t going to make it.
You really do not have to be an pricey management consultant to realize that it would be helpful for the industry to kill doomed tasks sooner (although all have said it).
There’s just the prickly tiny issue of figuring out how to do this. Even though it is easy to point to pricey failures and criticize organizations for not pulling the plug sooner, it’s also real that just about every single successful drug faced some legitimate existential crisis along the way — at some stage throughout its growth , there was a plausible cause to destroy the plan, and a person had to battle like hell to preserve it going.
The question at the heart of the industry’s productivity struggles is the extent to which it is even achievable to select the winners (or the losers), and figuring out far better methods of managing this threat.
I was struck by two starkly contrasting approaches to this dilemma suggested by two of the smartest R&D thinkers I know – David Grainger, of Index Ventures, and Mike Gilman of Atlas Ventures. While the two venture companies are acknowledged for their asset-focused biopharma investing method, Grainger and Gilman supply really different perspectives on the part of venture teams.
At the heart of Grainger’s see (described right here, and reiterated in a recent e-mail) is the see that a staff with skin the game is very best positioned to assess a project’s good results. Create quite tiny, asset-targeted companies comprised of team members who have each elected to bet years of their lives doing work on just this system, says Grainger, and they have genuine skin in the game. They will have the best visibility into each the options and possible issues, and if it would seem futile, they’ll want to pull the rip cord so they can dedicate their efforts to a a lot more promising initiative. At its core, the notion is that individuals concerned in execution are also concerned in determining whether or not to proceed.
Not so quickly, Gilman says. In his see (shared, most lately, at a BIO2014 panel in which we both participated), the task of a undertaking group need to be relentless execution. They should constantly try to uncover some way forward, some path that could lead to achievement. In his see, it’s not useful for the staff to continuously inquire “should we or shouldn’t we.” That selection, he feels, ought to rest completely with management (in the case of bigger company) or traders (in the case of a startup) as lengthy as resources are accessible, says Gilman, the team must seem for achievement. The place there is life, there’s hope.
What Gilman’s perspective speaks to is the very genuine challenge, maybe impossibility, of considering and executing at the same time. As Rosenzweig has mentioned, there’s a great deal of proof suggesting that optimal functionality requires disproportionate self-assurance in execution – an at-occasions unreasonable belief that you can accomplish the nearly not possible.
Grainger does not fully disagree he also feels that a crew ought to be relentlessly focused on execution – right up to the level where they stop believing it tends to make sense.
That is the question: in drug development (and in the prosecution of tasks a lot more normally), is it far better for the project team to very own contemplation as effectively as execution?
The upside of owning contemplation is that you know absolutely everyone doing work on a undertaking believes in it, and brings a distinctive level of passion and commitment – the type of vitality that’s typically associated with a startup, or with considerably academic research. The problem, of course, is that your ability to execute can be hampered by Hamlet-esque contemplation.
Teams targeted solely on execution have a tendency not to endure from the Hamlet dilemma, and in general are regarded as more expert. It’s unquestionably what most companies, and particularly firms of any considerable scale, are looking for. It’s also, frankly, what I believe you discover in most big organizations, specifically amid the staff who’ve caught around the longest. You are offered a process, your task is to do it (and not complain about how it does not meet your expectations for self-actualization).
I’ve observed examples of execution concentrate top to extraordinary outcomes – benefits that exceeded the authentic expectations of the crew, and may possibly not have been achievable if the group voted, rather than executed. On the other hand, engaged does not suggest productive — take into account Colonel Nicholson foremost his men to develop a bridge for the enemy in the 1957 classic The Bridge On The River Kwai. Ultimately, most of us are also familiar with the death march, the experience of being caught executing a task that appears hopeless or pointless this can be soul-crushing.
Does empowering a crew to make go/no-go choices lead to far better selections in the course of drug development?
The response likely depends on context. The good results of an execution-focused staff would look to reflect the good quality of oversight with poor supervision, such teams can rack up huge costs with no doing the organization very a lot great. On the other hand, unless teams empowered to make decisions are capable to suspend disbelief long ample to give challenging tasks a likelihood, they might make small headway, and flit from undertaking to project.
It’s also possible that the locus of choice-producing is not an particularly important factor in drug development probably success depends to a far higher extent on luck since you can construct a narrative about lucky teams doesn’t imply you realize or can replicate their good results.
