Showing posts with label NYT. Show all posts
Showing posts with label NYT. Show all posts

Wednesday, January 14, 2015

US needs re-look on treating diabetes patients

My Paper, Wednesday, January 14, 2015, Page A7, Opinion
From http://epaper.mypaper.sg/emnd/fvxen/fvxp/fvxpress.php?param=2015-01-14
Source Website: http://mypaper.sg/opinion/us-needs-re-look-treating-diabetes-patients-20150114
By Kasia Lipska, NYT, mypaper, myp@sph.com.sg, Published on Jan 14, 2015


PHOTO: MAGIC NUMBER: For more than a decade, medical societies, pharmaceutical companies and diabetes groups have advocated an average blood sugar target, or "haemoglobin A1C", of less than 7 per cent. But, at least for older people, there are serious problems with the below-seven paradigm.
FILE PHOTO: THE NEW PAPER
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkxzg8NAzSyccltp4Iyn55UXaxMpNiMlwe3F-hcuzmu20hY_u9p-sFSmpRWO1n-V-ByFQZUVIxaQ70rXqzbfu40x3rSXkUH25gloWVy3WA4QSWBVZfVaMtefWTz1w1hrJawb45_LMR7eY/s1600/US+needs+re-look+on+treating+diabetes+patients.jpg
My Paper, Wednesday, January 14, 2015, Page A7, Opinion


ONE of my elderly patients has type 2 diabetes and heart disease. He takes a number of medications, including insulin to control his blood sugar levels. A few years ago, he was driving when his blood sugar levels suddenly dropped. He felt lightheaded for a moment, and then ran into a tree.

There are roughly 11 million Americans over age 65 with diabetes. Most of them take medications to reduce their blood sugar levels. The majority reach an average blood sugar target, or "haemoglobin A1C", of less than 7 per cent. Why? Early studies showed that this can reduce the risk of diabetes complications, including eye, kidney and nerve problems.

As a result, for more than a decade, medical societies, pharmaceutical companies and diabetes groups have campaigned with a simple message - to get below seven. Many patients carry report cards with their scores to appointments. Doctors are often rewarded based on how many of their patients hit the target.

All of this sounds great. But, at least for older people, there are serious problems with the below-seven paradigm.

The health benefits of this strategy are uncertain for older people. Those early studies were conducted on people with type 1 diabetes or with younger patients with newly diagnosed type 2 diabetes. Subsequent trials of older patients raised doubts about the benefits.

Worse, targeting low blood sugar levels can cause harm. In one instance, investigators actually had to stop a trial early, because patients who were targeting haemoglobin A1C levels of six or below had significantly higher rates of death than patients targeting levels in the sevens.

We don't know exactly why this happened. What we do know is that aiming for levels below seven increases the risk for hypoglycemia, or low blood sugar reactions. Severe reactions can result in confusion, coma, falls, fractures, abnormal heart rhythms and even death.

Older people are especially susceptible to severe hypoglycemia. With age, kidneys become less efficient, which causes insulin (or other drugs) to accumulate in the body; this, in turn, can lead to hypoglycemia.

What's more, older people often take multiple medications, some of which may interact with diabetes drugs. This, too, may cause hypoglycemia. Using multiple medications or complex insulin regimens also increases the chances of errors.

Finally, older people have fewer warning symptoms when they experience mild dips in blood sugar, and this leaves less time for them to treat the problem before it becomes severe. This is what happened to my patient.

Given the questionable benefits and real risks of going below seven, the American Geriatrics Society and the Veterans Affairs diabetes guidelines have, for years, recommended a cautious, case-by-case approach for older patients.

For those with serious health problems or prior history of hypoglycemia, going below seven may not be worth the risks involved. The problem is that we haven't put these guidelines into practice.

In a new study published on Monday in Jama Internal Medicine, my colleagues and I used nationally representative data from 2001 to 2010 and showed that 62 per cent of adults over age 65 went below seven. But here's the catch. We found no difference in how people were treated based on their health.

Patients in poor health and at risk of hypoglycemia tended to be treated as aggressively as far healthier patients. This seems to confirm that we have been adhering to a one-size-fits-all approach, despite the risks that it poses to millions of older Americans.

Part of the problem is that there are strong incentives in place to keep the status quo. The diabetes drug industry has a vested interest in selling its products to as many Americans as it can, and has been incredibly successful at doing so. Sales of diabetes drugs in 2013 were about equal to the combined revenue of the National Football League, Major League Baseball and the National Basketball Association.

There is nothing wrong with the industry selling its drugs, but it is the job of the medical profession to guide what treatment patients receive. To do this properly, doctors with financial ties to the diabetes drug industry shouldn't be writing guidelines on how to use these drugs. At present, this is still common.

Ultimately, changing current paradigms requires doctors to partner their patients in making decisions about treatment. Patients need to understand that there are different options, with different risks. The goal is not to get a perfect score on a report card, but to weigh these risks to make a good decision.

My patient was terrified at the prospect of having another car wreck - a completely reasonable concern - and we decided to use less insulin and let his sugars run higher, in the eights. It's possible that this slightly raises his risk of kidney or eye problems, but this was a risk he was more than happy to take.

By Kasia Lipska, NYT, mypaper, myp@sph.com.sg, Published on Jan 14, 2015

The writer is an endocrinologist at the Yale School of Medicine and a clinical investigator at the Yale-New Haven Hospital Centre for Outcomes Research and Evaluation.



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Wednesday, June 18, 2014

Game Of Thrones reveals what's missing from TV: The female gaze

PHOTO: Game Of Thrones S03E03: Josephine Gillan (left) and Kylie Harris (right) nude scene
They’re all pretty girls with starting careers, even though Kylie Harris had her first appearance in 2000. They play the whores of Game Of Thrones and walk around naked in that particular scene. Kylie Harris is said to be an amateur model too.
Posted by Nude TV Show on Monday, February 03, 2014 1:05 PM
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http://nudetvshow.com/wp-content/uploads/2014/01/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-16-1024x576.png?web-developer-reload=1403344887134
http://nudetvshow.com/game-of-thrones-s03e03-josephine-gillan-pixie-le-knot-and-kylie-harris-nude-scene/


MUCH criticism of Game Of Thrones - and, indeed, of cable TV in general - has focused on its depictions of violence against women.

But, at Salon, Lili Loofbourow points to another problem: Much of television may offer not just too many scenes of brutality towards women, but also too few designed to make them feel good.

In an essay published on Monday, Ms Loofbourow writes about watching Daario Naharis disrobe for Daenarys Targaryen earlier in season four: "The thrill of being invited by the camera to regard a naked man in an explicitly erotic context as a woman drove home how rarely I've felt that when watching mainstream TV, let alone 'prestige' TV. Only male arousal wins awards."


Game Of Thrones S03E03: Pixie Le Knot  (contortionist) nude scene
PHOTO: Game Of Thrones S03E03: Pixie Le Knot  (contortionist) nude scene
Pixie Le Knot’s real name is Kennifer Keith. She is also a stunt double.  She portrayed Kayla, a prostitute and a highly skilled contortionist. Kayla is a prostitute in the King's Landing brothel owned by Petyr "Littlefinger" Baelish. She is one of only four women in the known world who can bend her body to the extent that she can properly perform a sexual position known as the "Meereenese Knot".
Posted by Nude TV Show on Monday, February 03, 2014 1:05 PM
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuTJhAgiPM93RHgNpWnhRb4Ts2cbeifOoxWxQLhEdEXq-wOzc2pU0MywFzM6NyuMYTPBF6uc58E_2lin_RGaXbJYH77XQXx1d0SL7hsso7JTuIvJUQEC06mOrKSJwZK9BNxSz-q0tqGF0/s1600/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-20-1024x576-1.png
http://nudetvshow.com/wp-content/uploads/2014/01/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-20-1024x576.png?web-developer-reload=1403344887137
http://nudetvshow.com/game-of-thrones-s03e03-josephine-gillan-pixie-le-knot-and-kylie-harris-nude-scene/
http://gameofthrones.wikia.com/wiki/Kayla


She notes that "cultural conversations about sexism in media tend to revolve around negatives - objectification, subjugation, stripped agency".

However, she argues: "Women deserve erotic pleasure too. Not just penises, but scenes shot with a female viewer's perspective guiding the camera.


Game Of Thrones S03E03: Pixie Le Knot  (contortionist) nude scene
PHOTO: Game Of Thrones S03E03: Pixie Le Knot  (contortionist) nude scene
Along with Marei and Genna, Kayla is one of the three prostitutes in Littlefinger's brothel who are hired by Tyrion Lannister to service Podrick Payne as a reward for saving his life in the Battle of the Blackwater.  Kayla and her colleagues are apparently so satisfied with Podrick that they decline payment, much to the astonishment of Tyrion, Bronn, Ros, and even Varys.
Posted by PacaTatuCotiaNao, 13 Abril 2014
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi31GAbJr-FrohZa9tO1QcunEn7nNtuVintvGgPOtP4HvbZNzzV9uQq103GB2SgD9oE9NAvuDyNLpdsVFwsDKKjVzMeEfv2SU371YUX94uKCjTI4OgT8QY87fclEDb14YtdTzsAlHDq3iQ/s1600/1366808137_Game-Of-Thrones-1-1.jpg
http://d1fgn7wex1bhjn.cloudfront.net/assets/tarantulaV2/embedded_images/1366808137_Game-Of-Thrones-1.jpg
http://forum.outerspace.terra.com.br/index.php?threads/fap-news-seis-atrizes-de-%E2%80%98game-of-thrones%E2%80%99-j%C3%A1-fizeram-filmes-porn%C3%B4.376805/
http://gameofthrones.wikia.com/wiki/Kayla


"Watching naked people in an erotic context is pleasurable. If nudity is here to stay - and at least on Game Of Thrones, that seems likely - there is no legitimate reason to limit access to that pleasure to men."

Indeed, some of the most intense debate around this season focused on a scene that many found deeply disturbing: the apparent rape by Jaime Lannister of his sister, Cersei.

After that episode aired, Sonia Saraiya wrote at The A.V. Club that the show might be "falling into the same trap that so much television does - exploitation for shock value. And, in particular, the exploitation of women's bodies".


Game Of Thrones S03E03: Pixie Le Knot (contortionist) nude sceneGame Of Thrones S03E03: Pixie Le Knot (contortionist) nude scene
PHOTO: Game Of Thrones S03E03: Pixie Le Knot (contortionist) nude scene
Kayla is present as an entertainer at the wedding feast between King Joffrey Baratheon and Lady Margaery Tyrell. Her performance is admired by Oberyn Martell and Ellaria Sand.
Posted by Nude TV Show on Monday, February 03, 2014 1:05 PM
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvISIUchROZdY7U8ACOk0PdFdhbgREcjhpBxkkmP4Js7wB0iDo1ORbmCKQnPdBe25Jfg8ds4swK3Pv6TEjbgZVlt2R65g34m5r5dWk1UsDBfVD7tRbVl0vmP3eisiWm-1Y6Zl6hrGVXkM/s1600/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-19.png
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjN8KfTZwaowe_9yLTcNjK1KOxPiFJjZkLYQhU0xus_PL9Xj-vUW-LEXGbQQXViTzzoPBioIxPtYJT6Hj0iDNKhXYP7dc6RD_YezNsoF53x3Ev4TC3dFWarzTccKgDAodSEg3VhgHcPauk/s1600/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-19-1.png
http://nudetvshow.com/wp-content/uploads/2014/01/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-19.png
http://nudetvshow.com/game-of-thrones-s03e03-josephine-gillan-pixie-le-knot-and-kylie-harris-nude-scene/
http://gameofthrones.wikia.com/wiki/Kayla
 

As she notes, Game Of Thrones is hardly alone.

In Emily Nussbaum's much-discussed review of True Detective, she wrote that the show's obsession with female anatomy "will be gratingly familiar to anyone who has watched a new cable drama get acclaimed as 'a dark masterpiece': the slack-jawed teen prostitutes, the strippers gyrating in the background of police work, the flashes of nudity from the designated put-upon wifey character, and much more nudity from the occasional cameo hussy".

And, she wrote, "when a mystery show is about disposable female bodies, and the women in it are eye candy, it's a drag".


Game Of Thrones S03E03: Pixie Le Knot (contortionist) nude scene
PHOTO: Game Of Thrones S03E03: Pixie Le Knot (contortionist) nude scene
"Kayla is famous here to Volantis... in certain circles. One of four women in the world who can perform a proper Meereenese Knot." ―Tyrion Lannister
Posted on Sunday, March 16, 2014 1:53 PM, 0 | Myths and Facts
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http://media.sfx.co.uk/files/2013/04/game-of-thrones-3.03-walk-of-punishment-pod.png
http://internetistas.actlogic.net/%CE%B7-%CF%83%CE%BA%CE%BF%CF%84%CE%B5%CE%B9%CE%BD%CE%AE-%CF%80%CE%BB%CE%B5%CF%85%CF%81%CE%AC-%CF%84%CE%B7%CF%82-%CE%B7%CE%B4%CE%BF%CE%BD%CE%AE%CF%82/


Still, so much television is dominated by men that critics are essentially forced to spend a lot of time talking about how women are treated.

When women are on the periphery, when they're the objects rather than the subjects of a story, all that's left to evaluate is what's done to them - whether the crimes committed against them are excessively brutal, whether their nudity is gratuitous or necessary.

This may be another reason the scene Ms Loofbourow mentions is so powerful.


Game Of Thrones S03E03: Kylie Harris, nude scene

PHOTO: Game Of Thrones S03E03: Kylie Harris, nude scene
Posted by Nude TV Show on Monday, February 03, 2014 1:05 PM
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg93hGjObZm1N21Fy08b_FmxRb2NQuqXARVZ1LurCeAFS597ulOMyIJtioG5tM4M_GpHs6s3hmT_4AI3hh7y-Zq5NeBd5cgzxH4IW3ApbOGzjiMm2F-i4y5IMBdYnVzNsU51zTthyphenhyphen6YP8o/s1600/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-04-1024x576-1.png
http://nudetvshow.com/wp-content/uploads/2014/01/Game_of_Thrones-S0303-Josephine_GillanPixie_Le_KnotKylie_Harris-04-1024x576.png?web-developer-reload=1403344887128
http://nudetvshow.com/game-of-thrones-s03e03-josephine-gillan-pixie-le-knot-and-kylie-harris-nude-scene/


Daario doesn't just take off his clothes. As Kelsea Stahler at Bustle points out, he does so because Daenerys tells him to, and we can see from her face how much she appreciates the result.

We see not just a nude male body, but also a woman taking explicit control of a sexual situation. The "erotic pleasure" is not just the viewer's, but hers.


Josephine Gillan and Kristen Gillepsie completely nude in Game of Thrones S04E01
PHOTO: Josephine Gillan and Kristen Gillepsie completely nude in Game of Thrones S04E01
One of the women disrobed by The Red Viper is Josephine Gillan, who was shown completely nude from the front and then from behind. There was another actress (Kristen Gillespie) being disrobed.
Posted by thenude on April 16, 2014
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http://nudetvshow.com/wp-content/uploads/2014/04/Kristen_Gillespie-Game_of_Thrones-S04E01-01.gif
http://nudetvshow.com/actress/kristen-gillepsie/


Viewers will likely have to wait nearly a year to find out if it happens again, which gives other shows ample time to fill the gap - if their writers want to.

As Ms Loofbourow and others make clear, there's plenty of demand for television that lets women not just survive, but also desire, and occasionally get, what they want.
By Anna North, mypaper, myp@sph.com.sg, NYT, Published on Jun 19, 2014


Josephine Gillan and Kristen Gillepsie completely nude in Game of Thrones S04E01
PHOTO: Josephine Gillan & Kristen Gillespie (Full-Frontal) in Game of Thrones [S4E1]
Josephine Gillan and 22-year old Northern Irish model Kristen Gillespie (nude debut) in Game of Thrones [S4E1]
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http://battyfornudity.blogspot.sg/2014/04/giframa-josephine-gillan-nude-in-game.html


Josephine Gillan & Kristen Gillespie (Full-Frontal) in Game of Thrones [S4E1]
Josephine Gillan & Kristen Gillespie (Full-Frontal) in Game of Thrones [S4E1]
Jessica Marais Topless In Magic City
Jessica Marais Topless In Magic City
PHOTO: Jessica Marais Topless In Magic City
Nude Celebrity Videos Jessica Marais S E Magic City, Hot Vampire bites.
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http://images.celebritymoviearchive.com/members/thumbs/j/Jessica%20Marais%20-%20Magic%20City%20-%20S01E07_4.jpg
http://www.filmvz.com/nude/nude-celebrity-videos-jessica-marais-topless-magic-city-s-e.htm


The Human Pretzel: Pixie Le Knot (born Jennifer Keith)
The Human Pretzel: Pixie Le Knot (born Jennifer Keith)
PHOTO: The Human Pretzel: Pixie Le Knot (born Jennifer Keith)
Pixie Le Knot is one of the most flexible contortionists in the UK. She performs the most extreme and amazing backbends which very few other british contortionists are able to achieve. She currently performs contortion and acrobatic acts at venues all over the world, has appeared in several virals, music videos and been part of many publicity stunts.
Added by BAMF on 5 Mar 2014 01:18
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http://iv1.lisimg.com/image/6564364/600full-pixie-le-knot.jpg
http://www.listal.com/list/human-pretzel-pixie-le-knot

 Pixie Le Knot (born Jennifer Keith) is a London contortionist.

PHOTO: Pixie Le Knot (born Jennifer Keith) is a London contortionist.
"Walk of Punishment" is the third episode of the third season of Game of Thrones. It is the twenty-third episode of the series overall. It premiered on April 14, 2013. It was written and directed by executive producers David Benioff & D.B. Weiss, marking their directorial debut for the series.
Added by jamesrudland on Wednesday, January 09, 2013
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http://images.purestorm.com/z-images14/imageupload4/PixieLeKnot_8669419.jpg?1226893922
http://www.purestorm.com/PixieLeKnot


Pixie Le Knot (born Jennifer Keith) is a London contortionist.
PHOTO: Pixie Le Knot (born Jennifer Keith) is a London contortionist.
Kayla is a prostitute and a highly skilled contortionist. She is one of only four women in the known world who can bend her body to the extent that she can properly perform a sexual position known as the "Meereenese Knot".
Added by jamesrudland on Wednesday, January 09, 2013
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1zlYvhST61MuiI9y3iDI7GicHJ4Ovdlsxa9NoJmmKp7WRgIDOQwmJmeQ2jCAUV7ZKgGIK3772RVtko7zRomZfmLrDSDaojHAfN7abqmxaR5QodHEg87LVoVr9sd7DcDCgya6GvVC1L9k/s1600/PixieLeKnot_9676365.jpg
http://images.purestorm.com/z-images15/imageupload9/PixieLeKnot_9676365.jpg?1198198384
http://www.purestorm.com/PixieLeKnot



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