Marathon of Diabetes . . BY Danielle Ofri we’d have more success with diabetes if we simply exterminated white rice and soda vending machines from the face of the earth.

 BY
Danielle Ofri is the author of: What Doctors Feel; Medicine in Translation; Incidental Findings; and Singular Intimacies:

 Becoming a Doctor at Bellevue Just the other day I took care of an older woman who had been struggling to keep her weight and her glycated hemoglobin (HbA1c) on this side of pathology. Her daughter recently lost her job, though, and the plummeting of the household income had an instant eff ect on her health. Fresh produce was too costly to be a regular part of her diet, which now slid back to the staples of potatoes and white rice. Like clockwork, her blood glucose spiralled upward. It’s not all bleak, of course. Some of my patients have great success with treatment. A few have completely turned their lives around, singing the praises of quinoa, kale, and physical activity. Their successes are inspirational to me, and often to other patients. But most of my patients dwell in the frustrating middle zone. They’ve made sacrifi ces and changes. They’ve put in the eff ort, but the results are slight. The last 30 pounds are intractable. The HbA1c hovers stubbornly above 8%. The insulin dose creeps relentlessly upward. The pill count for the associated hypertension, hyperlipidaemia, and cardiac disease edges into the double digits. I try to stay optimistic, to keep encouraging the incremental changes my patients are making. But it’s hard not to feel defeated. The latest and greatest medications don’t off er appreciable changes. Each new one on the market seems like little more than a costly rearrangement of deck chairs. The main developments that have delivered signifi cant improvements in glycaemic control to some of my patients have come in the area of plumbing, be it of their insulin syringe or their gastrointestinal tract. The insulin syringe, with its frightening needles and complicated mechanics of loading, routinely scares off my patients. They’d gladly suffer the side-eff ects and pill burden of multiple oral agents rather than venture anywhere near a syringe. But the insulin pen, with its hardly feelable needle, has changed this. It doesn’t require a nursing degree to use and doesn’t look like drug paraphernalia. Plus all those patients with retinopathy can now set the dose correctly.

 The other salutary plumbing adjustment, of course, is bariatric surgery. For years I was a sceptic. The absurdity of surgically correcting our societal pressure to overeat all the wrong foods rubbed me the wrong way. I couldn’t decide if the bariatric tune-up was worthy of Franz Kafka or of Oscar Wilde. But now that I’ve seen the lives of some of my patients dramatically turned around, I’ve come to accept bariatric surgery as a legitimate tool in the armamentarium, though certainly not the fi rst one I grab for. But bariatrics and insulin pens aside, diabetes remains a frustrating slog for both doctors and patients. It can sometimes seem as if the world is conspiring against us, between the ubiquitous presence of super size, super cheap, super lousy food and the even more ubiquitous sloth-inducing technology that limits our muscular fi tness to the fl exor carpi radialis. There are days when I consider the idea that we’d have more success with diabetes if we simply exterminated white rice and soda vending machines from the face of the earth.

 But then in waltzes Mr Hokama. At his fi rst visit, his blood glucose was in the high 300s and he could have earned frequent fl ier miles with the number of trips he was making to the bathroom to urinate. He was reluctant to start insulin, but with my cajoling, pleading, and negotiating, fi nally consented. Around this time he also took up ballroom dancing and now dances for 2 hours nearly every day. Between the rhumba and the insulin, he has handily corralled his glucose into a manageable zone, and each time he comes in for an appointment, I am duly impressed. White rice, though, hasn’t disappeared from his diet. “I’m Japanese”, he reminds me with a gentle smile. “Sushi does not work with brown rice.” I concede the point. It’s easy to become nihilistic about diabetes, so overwhelming is the burden of medical care for these patients. My old professor was right, and even prescient— as old professors so often and so annoyingly turn out to be. Diabetes has come to defi ne the working lives of many doctors today. It can seem as though the tide will never turn. But perhaps thinking about the tide is simply too much for the individual doctor. Those in the clinical trenches can really only think in terms of individual patients. Mr Hokama keeps me inspired. As do my other patients, whose fortitude can be impressive, especially in light of the daunting odds. HIV infection eventually evolved from a sprint to a marathon. Diabetes always was a marathon, however the incline of the track steepens noticeably by the day. Doctors and patients press up that incline together, panting, often daunted, but ever striving. Danielle Ofri Bellevue Hospital, New York University School of Medicine, New York, NY 10016, USA danielle.ofri@nyumc.org


www.thelancet.com Vol 385 May 23, 2015

MEDICINE Neither Science nor Art

". It is with this discomfort that Kathryn Montgomery begins her book, How Doctors Think: Clinical Judgment and the Practice of Medicine. Why is it that it is so difficult to define clinical judgment, and why do we doctors squirm when we are forced to admit just how reliant we are on it?

The heart of the discomfort, Montgomery deduces, can be traced back to a fundamental “misdescription of medicine”. For doctors and the public, medicine is fundamentally a science: doctors have years of scientific training in medical school. Medical textbooks are factual tomes crammed with fine-print citations. Doctors read medical journals brimming with complex clinical trials. Doctors' opinions are a cut above those of a shaman or Aunt Ethel because they are backed up by science. Doctors wear white coats, just like scientists, and even call them lab coats.

But all these things are to some extent illusory. Montgomery states in print what we've had a sneaking suspicion about all along: medicine really isn't a science, in the true Newtonian sense. In the world of physical sciences there are absolute laws—of motion, of thermodynamics, of gravity; absolute laws from which deviance does not—cannot—exist. Medicine is almost the living antithesis of this. The biological variability of disease, human beings, and the human condition make such assured rationality almost laughable. Yes, there has been enough written about diabetes to sink a galleon, but there is no invariant law that will predict exactly what will transpire in my patient with his unique constellation of glucose control, pulmonary pathology, drug absorption, cultural expectations, financial constraints, and personality quirks."

Chris "Macro" Newman :) VBA loop

 I am trying to understand  this

How To Repeat Tasks With Your VBA Code by Looping

April 09, 2015 Chris Newman

Your Complete Looping Guide

Looping is extremely important when coding because it can shorten up the length of your code tremendously.  It's kind of like having a macro inside your macro since it allows you to repeat the same task (or apply the same action) over and over and over again.  Each looping statement has an opening line and a closing line; a beginning and an end if you will.  You will want to insert your repeatable action in between the opening and closing lines of the statement so your code keeps getting repeated. Let's start with the basics and cover the three major ways to loop.

For Loop

This type of loop is great for cycling through a pre-determined number of times.  The loop needs to begin with the word "For" and then a variable name followed by an equals sign (=) and finally the range from which you want your variable to equal during the loop (ie 15 to 25 or 1 to 5). The below example code will write a given phrase into the Immediate Window one hundred times.

Sub For_Loop()

Dim x As Long

'Write "I will not chew gum in class" 100 times
  For x = 1 To 100
    Debug.Print x & ". I will not chew gum in class."
  Next x

End Sub

For Each Loop

The For Each looping method is meant for cycling through objects on your spreadsheet.  This loop can handle anything from cells to charts. The key to this loop is making sure the loop knows which type of object to look for.  For example, if I want to loop through Pivot Tables in Sheet1, I'm going to want to tell the For Each loop to look "in" Worksheets("Sheet1").PivotTables. Most of the time, your object type is going to end in an "s". So you would NOT want to write Worksheets("Sheet1").PivotTable. This can be pretty tricky at first, so I've provided an example below and a TON of examples in the next section. Eventually, they will become second nature to you so don't give up on using them!

Sub ForEach_Loop()

Dim cell As Range

'How many cells in worksheet have values in them?
  For Each cell In ActiveSheet.UsedRange.Cells
    If cell.Value <> "" Then x = x + 1
  Next cell

'Report out results
  MsgBox "There are " & x & " cells containing data in you worksheet"

End Sub

Do While Loop

A Do While loop is probably the lesser known of the looping methods out there, but it can be very useful in certain situations.  Basically, the loop keeps cycling through until a logical test is failed (returns a false). In the below example, the Do While loop will keep on iterating until the variable BlankFound = True.

Sub DoWhile_Loop()

Dim BlankFound As Boolean
Dim x As Long

'Loop until a blank cell is found in Column A
  Do While BlankFound = False
    x = x + 1
  
    If Cells(x, "A").Value = "" Then
      BlankFound = True
    End If
  Loop

'Report out first blank cell found in Column A
  MsgBox "Cell A" & x & " is blank!"

End Sub

BE VERY CAREFUL! If your Do While loop never fails its test your loop will go on forever.  This may be good for a practical joke, but not for an automation macro. So make sure if you use this loop it is guaranteed to break its logical test at some point during your code's execution.

Loop Example VBA Code

My personal favorite method of looping would definitely be the For Each loop and because it can be a little confusing when you are first teaching yourself the awesome skill that is looping, I wanted to provide you with a ton of examples of different ways you can cycle through objects in your Excel files.  So without further ado, here is my "brain-dump" of loops to get you started!

** All the example code below is outputting names of the objects being looped into the Immediate Window (ie Debug.Print).  You can see what's being generated by displaying the Immediate Window with the shortcut Ctrl + g inside the Visual Basic Editor.

Looping Through Workbooks

Sub Workbook_Loop()

Dim wb As Workbook

'Loop through each open Excel Workbook
  For Each wb In Application.Workbooks
    Debug.Print wb.Name
  Next Workbook

End Sub

Looping Through Worksheets

Sub Worksheet_Loop()

Dim sht As Worksheet

'Loop through each worksheet in a workbook
  For Each sht In ThisWorkbook.Worksheets
    Debug.Print sht.Name
  Next sht

End Sub

Looping Through Cells

Sub Cell_Loop()

Dim cell As Range

'Loop through each cell in a cell range
  For Each cell In ActiveSheet.Range("A1:Z100")
    Debug.Print cell.Value
  Next cell

'Loop through each cell in a Named Range
  For Each cell In ActiveSheet.Range("RawData")
    Debug.Print cell.Value
  Next cell

'Loop through each cell in a Table body range
  For Each cell In ActiveSheet.ListObjects("Table1").DataBodyRange
    Debug.Print cell.Value
  Next cell

End Sub

Looping Through Charts

Sub Chart_Loop()

Dim sht As Worksheet
Dim cht As ChartObject

'Loop through each chart in the active workbook
  For Each sht In ActiveWorkbook.Worksheets
    For Each cht In sht.ChartObjects
      Debug.Print cht.Name
    Next cht
  Next sht

End Sub

Looping Through Shapes

Sub Shape_Loop()

Dim sht As Worksheet
Dim shp As Shape

'Loop through each shape in the active workbook
  For Each sht In ActiveWorkbook.Worksheets
    For Each shp In sht.Shapes
      If shp.Type = msoAutoShape Then
        Debug.Print shp.Name
      End If
    Next shp
  Next sht

End Sub

Looping Through Pivot Tables

Sub PivotTable_Loop()

Dim sht As Worksheet
Dim pvt As PivotTable

'Loop through each pivot table in the active workbook
  For Each sht In ActiveWorkbook.Worksheets
    For Each pvt In sht.PivotTables
      Debug.Print pvt.Name
    Next pvt
  Next sht

End Sub

Looping Through Tables

Sub Table_Loop()

Dim sht As Worksheet
Dim tbl As ListObject

'Loop through each table in the active workbook
  For Each sht In ActiveWorkbook.Worksheets
    For Each tbl In sht.ListObjects
      Debug.Print tbl.Name
    Next tbl
  Next sht

End Sub

Looping Through Array Items

Sub Array_Loop()

Dim myArray As Variant
Dim x As Long

'Fill your Array with data
  myArray = Array("OH", "GA", "FL", "TX")

'Loop through each item in an Array list
  For x = LBound(myArray) To UBound(myArray)
    Debug.Print myArray(x)
  Next x

End Sub

Looping Backwards Through Array Items

Sub Array_LoopBackwards()

Dim myArray As Variant
Dim x As Long

'Fill your Array with data
  myArray = Array("OH", "GA", "FL", "TX")

'Loop backwords through each item in an Array list
  For x = UBound(myArray) To LBound(myArray) Step -1
    Debug.Print myArray(x)
  Next x

End Sub

Looping Through Combo Boxes (Form Control

Sub ComboBox_FormControl_Loop()

Dim cmbo As Shape

'Loop through each Form Control Combo Box in ActiveSheet
  For Each cmbo In ActiveSheet.Shapes
    If cmbo.Type = msoFormControl And cmbo.FormControlType = xlDropDown Then
      Debug.Print cmbo.Name
    End If
  Next cmbo

End Sub

Looping Through Checkboxes (Form Control)

Sub CheckBox_FormControl_Loop()

Dim cb As Shape

'Loop through each Form Control Checkbox in ActiveSheet
  For Each cb In ActiveSheet.Shapes
    If cb.Type = msoFormControl And cb.FormControlType = xlCheckBox Then
      Debug.Print cb.Name
    End If
  Next cb

End Sub

Looping Through Option Buttons (Form Control)

Sub OptionButton_FormControl_Loop()

Dim OptBtn As Shape

'Loop through each Form Control Checkbox in ActiveSheet
  For Each OptBtn In ActiveSheet.Shapes
    If OptBtn.Type = msoFormControl And OptBtn.FormControlType = xlOptionButton Then
      Debug.Print OptBtn.Name
    End If
  Next OptBtn

End Sub

Looping Through Buttons (Form Control)

Sub Button_FormControl_Loop()

Dim btn As Shape

'Loop through each Form Control Button in ActiveSheet
  For Each btn In ActiveSheet.Shapes
    If btn.Type = msoFormControl And btn.FormControlType = xlButtonControl Then
      Debug.Print btn.Name
    End If
  Next btn

End Sub

Looping Through CheckBoxes (ActiveX)

Sub CheckBox_ActiveX_Loop()

Dim cb As OLEObject

'Loop through each ActiveX Control CheckBox in ActiveSheet
  For Each cb In ActiveSheet.OLEObjects
    If TypeName(cb.Object) = "CheckBox" Then
      Debug.Print cb.Name
    End If
  Next cb

End Sub

Looping Through Combo Boxes (ActiveX)

Sub ComboBox_ActiveX_Loop()

Dim cmbo As OLEObject

'Loop through each ActiveX Control Combo Box in ActiveSheet
  For Each cmbo In ActiveSheet.OLEObjects
    If TypeName(cmbo.Object) = "ComboBox" Then
      Debug.Print cmbo.Name
    End If
  Next cmbo

End Sub

Looping Through Option Buttons (ActiveX)

Sub OptionButton_ActiveX_Loop()

Dim optn As OLEObject

'Loop through each ActiveX Control Option Button in ActiveSheet
  For Each optn In ActiveSheet.OLEObjects
    If TypeName(optn.Object) = "OptionButton" Then
      Debug.Print optn.Name
    End If
  Next optn

End Sub

Looping Through Textboxes (ActiveX)

Sub TextBox_ActiveX_Loop()

Dim txtbx As OLEObject

'Loop through each ActiveX Control TextBox in ActiveSheet
  For Each txtbx In ActiveSheet.OLEObjects
    If TypeName(txtbx.Object) = "TextBox" Then
      Debug.Print txtbx.Name
    End If
  Next txtbx

End Sub

Looping Through Command Buttons (ActiveX)

Sub CommandButton_ActiveX_Loop()

Dim btn As OLEObject

'Loop through each ActiveX Control Command Button in ActiveSheet
  For Each btn In ActiveSheet.OLEObjects
    If TypeName(btn.Object) = "CommandButton" Then
      Debug.Print btn.Name
    End If
  Next btn

End Sub

Looping Through Toggle Buttons (ActiveX)

Sub ToggleButton_ActiveX_Loop()

Dim tggl As OLEObject

'Loop through each ActiveX Control Toggle Button in ActiveSheet
  For Each tggl In ActiveSheet.OLEObjects
    If TypeName(tggl.Object) = "ToggleButton" Then
      Debug.Print tggl.Name
    End If
  Next tggl

End Sub

More Looping Articles You Might Enjoy

• Loop Through All Excel Files In A Given Folder
• Loop An Input Box Until It Receives Correct or Valid Entry
• Break All External Links In Your Excel Workbook

Whew! That Was A Lot Of Examples!!

I warned you it was a brain dump! I'm sure you didn't need to absorb every example on this page, but hopefully I was able to get you to the loop you were trying to figure out.  If I missed something you were looking for, feel free to drop a note in the comments section and I'll see if I can help you with your looping question. Thanks for stoping by!

---

How Do I Modify This To Fit My Specific Needs?

Chances are this post did not give you the exact answer you were looking for. We all have different situations and it's impossible to account for every particular need one might have. That's why I want to share with you: My Guide to Getting the Solution to your Problems FAST! In this article, I explain the best strategies I have come up with over the years to getting quick answers to complex problems in Excel, PowerPoint, VBA, you name it! 

I highly recommend that you check this guide out before asking me or anyone else in the comments section to solve your specific problem. I can guarantee 9 times out of 10, one of my strategies will get you the answer(s) you are needing faster than it will take me to get back to you with a possible solution. I try my best to help everyone out, but sometimes I don't have time to fit everyone's questions in (there never seem to be quite enough hours in the day!).

I wish you the best of luck and I hope this tutorial gets you heading in the right direction!

Chris "Macro" Newman :)

Bhimrao and Bhima Koregaon. an Observation

"Untouchable soldiers began to be retrenched in the last decades of the nineteenth century. Class regiments of Mahars, Chamars, Mehtars, Mangs, Dhanuks etc., were disbanded. Recruitment of Mahars was completely stopped in 1895. Mahars had played a very important role in the army yet this was the reward of valor, loyalty and efficiency that the British rulers chose to give. Rightly had Dr. Baba Saheb Ambedkar observed during his deliberations in the Round Table Conference that 'British have no permanent friends and no permanent enemies. They have only permanent interests".'

 So the latest Controversy and  Violence related to the "Bhima Koregaon" is the Stupid retaliation of the  Hindu fundamentalists and the continued backwardness of the  Scheduled castes Both  Educational, economical.

 it  is shameful that the  Scheduled castes Have  to look back to the  19th century victory of  a subjugator of the  whole country to feel proud about themselves  and the intolerance of the upper-class society regarding their celebration of this event, Only speaks to the  poverty of  Vision understanding  and  the ability to progress  on a positive path by all classes of India.

Doctor Salaries: disingenuous. Discussions.

Dean Baker is co-director of the Center for Economic and Policy Research, a progressive think tank focused on economic policy.
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557

keith L Martin Editorial Director of Medical economics 

 Write

  diametrically opposite opinions, about Doctor Salaries. 

Both are disingenuous.

1. lacking in frankness, candor, or sincerity; falsely or hypocritically ingenuous; insincere: Her excuse was rather disingenuous.

I would like  Both these persons to reveal to the  Public what their  Annual Compensation Actually is?

 If  it comes to the philosophical discussion of  how much one person's effort is worth,
I would like them to include, the following people before they start advocating cutting or increasing Doctor Salaries.
Let us also discuss their contributions to the well being of the society.

It is no wonder, My Son refused to Join Medical School

1) Highest-Paid Bosses. 
The CEOs of America's 500 biggest companies got a collective pay raise of 16% last year earning total compensation of $5.2 billion

John Hammergren of McKesson. One-year total compensation ($MIL): $131.2.

2) Hedge fund managers 

• James Simons. Founder, Renaissance Technologies Corp. 2016 Earnings: $1.5 billion. ...
• Michael Platt. Founder, BlueCrest Capital Management. 2016 Earnings: $1.5 billion. ...
• Raymond Dalio. Founder & Co-Chief Investment Officer, ...
• David Tepper. President and Founder, Appaloosa Management. ...
• Kenneth Griffin. Founder, Citadel LLC.
• 
  
• 3) Sports men/women 
• https://www.forbes.com/forbes/welcome/?toURL=https://www.forbes.com/athletes/list/&refURL=https://www.google.com/&referrer=https://www.google.com/

#1	Cristiano Ronaldo	$93 M	$58 M	$35 M	Soccer
	#2	LeBron James	$86.2 M	$31.2 M	$55 M	Basketball
	#3	Lionel Messi	$80 M	$53 M	$27 M	Soccer
	#4	Roger Federer	$64 M	$6 M	$58 M	Tennis
	#5	Kevin Durant	$60.6 M	$26.6 M	$34 M	Basketball
	#6	Andrew Luck	$50 M	$47 M	$3 M	Football
	#6	Rory McIlroy	$50 M	$16 M	$34 M	Golf
	#8	Stephen Curry	$47.3 M	$12.3 M	$35 M	Basketball
	#9	James Harden	$46.6 M	$26.6 M	$20 M	Basketball
	#10	Lewis Hamilton	$46 M	$38 M	$8 M	Auto Racing

  Actors and actresses,

OH the POOR WOMEN they were really short changed .

Mark Wahlberg, the highest-paid actor on Forbes' list, made $68 million in 2017, more than 2.5 times the $26 million Emma Stone made.

Moreover, 14 of the actors on the list made more than Stone, including her "La La Land" co-star Ryan Gosling, who made $29 million. Stone won an Oscar for her role; Gosling did not.

The top 10 actors made a combined $488.5 million -- almost triple what the top 10 actresses made with combined earnings of $172.5 million.

 Mc Donald Franchisee;

Top 10 Political Leader's Salary by Country (2015 in USD):

1. Lee Hsien Loong (Singapore): $1,700,000

2. CY Leung (Hong Kong): $530,000

3. Barack Obama (United States): $400,000

4. Tony Abbott (Australia): $345,000

5(t). Michael Higgins (Ireland): $340,000

5(t). Xavier Bettel (Luxembourg): $340,000                                                          

7. Jon Key (New Zealand): $290,000

8. Angela Merkel (Germany): $283,608

9. Jacob Zuma (South Africa): $273,676

10. Justin Trudeau (Canada): $257,700

Read more: Top 10 Highest Paid Government Leaders https://www.investopedia.com/financial-edge/1011/top-10-highest-paid-government-leaders.aspx#ixzz5398YsNMN
Follow us: Investopedia on Facebook




I reserved the CREME de la Creme  Health Insurance executives for the  Final BLOW!

The CEOs of the two would-be acquiring companies also scored raises in 2016. Anthem’s Joseph Swedish earned $16.5 million, up from $13.6 million in 2015, while Aetna’s Mark Bertolini earned $18.7 million in 2016, up from $17.3 million. Cigna CEO David Cordani, however, took a pay cut, earning $15.3 million in 2016 compared to $17.3 million the year prior.

RELATED: Health insurance CEO salaries top out at $17.3M in 2015

The only other CEO to earn less year-over-year was Molina Healthcare’s J. Mario Molina, who saw his total compensation dip slightly from $10.3 million to $10 million.

UnitedHealth’s Stephen Hemsley, meanwhile, earned $17.8 million in 2016, a jump up from the $14.5 million he was paid the year prior. The lowest compensated executive in the group was WellCare’s Ken Burdick, who collected $9.3 million last year, compared to $7.8 million in 2015.

 Now tell me  MR.DEAN,

who should really take a pay cut.?

 I am fully positive about Foreign Doctors getting privileges as" assistant doctors in rural areas and underserved areas. Bt the Laws in Kansas  Missouri and Arkansas are just a big eye wash. It is like leaving the rats with the cheese container. 9 letting the  Medical Board decide who should get an Assistant doctor's license.

( Another  blog on the  crocodile  tears of the AOA and  AMA  about  second-class medical treatment )

Also, I can not understand the Logic of restricting it to Newly Minted Grads.

you mean someone Like me who has 34 years  Post  Medical school experience is not even good to be an "Assitant doctor"? Do you think the  COOKBOOk wielding  FNP s and  PA s are OK but Accomplished Foreigners are not welcome?

and tell me why will a Foreign Doctor come to the USA if the Money is not Good?

 First of all, We should simply banish this requirement for License to practice Medicine!

and leave it to the patients to decide, where they want to go for their treatment.

Cash and carry strictly.