Bill Pugliano/Getty ImagesBY: ELLA TORRES, ABC NEWS(NEW YORK) — Rush Limbaugh, a colossal figure whose unflinching brashness helped shape American conservative politics and media while his history of derogatory comments about marginalized communities turned him into one of the country’s most polarizing names, has died. He was 70.He announced in early February 2020 that he was fighting advanced lung cancer. His diagnosis was met with well wishes from many prominent Republican figures and appeared to prompt then-President Donald Trump to present him with the Presidential Medal of Freedom at the 2020 State of the Union address on Feb. 4, a day after he revealed his diagnosis on air.The honor stirred conversation among Democrats and members of and advocates for marginalized communities because of Limbaugh’s long history of making disparaging comments about minority groups, the LGBTQ community, suicide, AIDS patients and women.The divisive reaction was emblematic of Limbaugh’s legacy.Gov. Mike Huckabee, R-Ark., called it a “powerful moment” on Twitter, with conservative TV personality Meghan McCain saying that those on the right most likely applauded it.“He’s completely changed the paradigm of radio,” McCain said on “The View,” when asked by co-host Whoopi Goldberg what Limbaugh had done to deserve the honor.Those on the other side of the political divide argued otherwise.Joe Biden, then months away from being elected president, condemned Trump in a statement for presenting the award to Limbaugh, whom he called “a conservative media personality who has done as much as Trump himself to divide our nation.”Trump, during an interview on Fox News on Wednesday, called Limbaugh a “fighter,” adding: “I mean he, in theory, could have been gone four months ago, really. He was fighting until the very end. He was a fighter.”Beginning a career in radio in 1971, Limbaugh became known for his conservative opinions and views on immigration, women’s rights and race. He launched “The Rush Limbaugh Show” in 1988 and steadily remained among the most influential radio show hosts, as determined by Talkers magazine.Limbaugh’s presence in talk radio effectively changed the course of the industry, and he’s often been credited with saving AM radio. When he first launched his show, he offered a new kind of talk show that many hadn’t heard before, according to Brian Rosenwald, a scholar at the University of Pennsylvania whose research focus includes media studies and Limbaugh himself.The status quo prior to Limbaugh mainly consisted of hosts conducting interviews or hearing from callers, rarely letting their own opinions and values seep into the conversation, according to Rosenwald. Yet Limbaugh proudly shared his opinions and garnered a loyal fanbase.“He’s doing something that people had never heard,” Rosenwald told ABC News. “He starts to feel a responsibility as he starts getting all these callers saying, ‘Thank God, Rush, you’re finally on air. We finally have a voice.’”“The Rush Limbaugh Show” continued for over three decades, although Limbaugh took a break from his show in 2003 after admitting an addiction to painkillers and a stint in rehab. Limbaugh was then arrested in 2006 after a three-year investigation that resulted in a warrant charging him with fraud to conceal information to obtain prescriptions, according to reports at the time.Limbaugh’s attorney said he had reached a deal with prosecutors to have the charges eventually dismissed if he continued treatment for drug addiction. Though it was never proved, some speculated that Limbaugh’s addiction may have led to an autoimmune inner ear disease that caused him profound deafness between October 2001 and January 2002. He regained hearing through the use of cochlear implants.Limbaugh was outspoken about the punishment he thought those struggling with addiction should face before he announced his own addiction.“It’s destructive, it’s demoralizing and the people who are caught doing this stuff ought to be sent away. They ought to be punished,” Limbaugh said during a show.Even after his own announcement, he wanted little sympathy, telling listeners, “I refuse to let anyone think I am doing something great here, when there are people you never hear about who face long odds and never resort to such escapes.”As much as people on the right see Limbaugh as a hero who gave conservatives a voice, Rosenwald said, those on the left will remember him as “a hate-mongering bigot who said a lot of awful things” and “reinforced prejudices.”Among the comments that generated controversy, Limbaugh in 2007 described the NFL as “a game between the Bloods and the Crips without any weapons,” effectively comparing Black professional football players to gang members.In 2012, he called Sandra Fluke, then a Georgetown University law student, a “slut” after she argued to Congress that birth control should be covered by her employer’s health care plan.He later apologized to Fluke and said his “choice of words was not the best,” although he had made the claim in various forms multiple times.A year later, he said on his talk show that white people should stop feeling guilty about slavery.“If any race of people should not have guilt about slavery, it’s Caucasians. The white race has probably had fewer slaves and for a briefer period of time than any other in the history of the world,” he said, calling his statement as a “history lesson.”Of the LGBTQ community, Limbaugh blamed gay marriage for a decline in Christianity in 2015.“Many of these churches now perform homosexual marriage, they ordain gay pastors or ministers, and, in some cases, female and lesbian pastors and ministers, which you might think would cause some people to leave those churches,” he said on his talk show.All considered, Rosenwald said no matter what the public thinks of Limbaugh, his impact in both politics and media can’t be overstated.Before Trump awarded Limbaugh the Presidential Medal of Freedom, the country’s highest honor for a civilian, last year, he thanked him for “all that you have done for our nation, the millions of people a day that you speak to and you inspire, and all of the incredible work that you have done for charity.”In 25 years, Limbaugh helped raise nearly $44 million for the Leukemia & Lymphoma Society, according to the health agency. He also ran a campaign for the Stephen Siller Tunnel to Towers Foundation, which supports first responders and the military, after former NFL player Colin Kaepernick criticized a Nike shoe featuring the Betsy Ross flag.Limbaugh has held friendly and even close relationships with numerous Republican presidents and politicians, including George H.W. Bush and George W. Bush.In 1992, Limbaugh was invited to stay overnight at the White House by the elder Bush. In 2008, George H.W. Bush, George W. Bush and Jeb Bush all called in to his show to congratulate him on his 20th anniversary.“President George W. Bush calling to congratulate you on 20 years of important and excellent broadcasting,” Bush said over the phone to Limbaugh. “I’m here with a room full of admirers, there’s two others … people who consider you friends.”However, when Barack Obama was president, Limbaugh launched numerous attacks against him, including saying he wasn’t a U.S. citizen, that Obama was “an angry Black guy” and that his “entire economic program is reparations.”He also called Obama “Barack, The Magic Negro” numerous times, a term that was run in a Los Angeles Times op-ed that later was made into a song to the tune of “Puff the Magic Dragon.”Limbaugh later defended his usage of the name, saying he did not come up with it and that it was satire, before playing an entire song that referred to Obama as such.Limbaugh’s brash style of “infotainment” — a mix of facts and performance — in part led to the style often attributed to Fox News, according to Rosenwald.“Fox News is a thing because of him,” Rosenwald said.His prominence in conservative media and politics meshed well with the Trump era, with Limbaugh predicting the mainstream media would not understand the desire for Trump.Limbaugh understood the impact Trump could have in part because, like Limbaugh himself, Trump “never put his tail between his legs,” according to Rosenwald.“Rush refused to go away. Trump refused to go away in controversy,” Rosenwald said. “Without Rush Limbaugh and without the media type that he created, I don’t think you get a President Trump.”Limbaugh is survived by his wife, Kathryn.Copyright © 2021, ABC Audio. All rights reserved.
Hvatske autoceste and Autocesta Rijeka – Zagreb, two state-owned companies that manage 1112 kilometers of motorways, will merge into one company, and a decision on that should be made at a government session this or next week. And with this merger, the toll collection over the Krk bridge, which is currently managed by ARZ, will be abolished, reports Vecernji list. Photo: Krk Tourist Board Marko Boras Mandić from the I want the same rights initiative, also confirms that the toll is abolished, but that an official decision is awaited: “It seems that we have succeeded, but I will believe only when I see that there are no toll booths ”. The Ministry states that the unification of the management of state-owned motorways will, among other things, facilitate the introduction of a new toll collection system. Following the launch of the “I Want the Same Rights” Initiative to abolish tolls or tolls across the Krk Bridge and various protests, in early February this year, a collection of signatures was launched through a petition in support. In two weeks, 11.559 signatures were collected to abolish the collection, which were submitted to the Ministry of the Sea, Transport and Infrastructure. Until now (and still is), the Krk Bridge has remained the only bridge in Croatia where tolls are collected, although the profit from the collection has already paid off many times the funds invested in its construction and maintenance. Interesting information is that the construction contract and the social agreement should have abolished the toll when the construction costs are repaid. The crossing over the Krk bridge for personal vehicles out of season is 35 kuna, and the summer tariff, as on the entire highway, is 10 percent more expensive. As they point out on the FB page I want the same rights which was the central communication point of the initiative for the abolition of tolls is just waiting for the official decision of the Ministry. “The petition was successful! Thanks to everyone who participated. “
The Ripley County JV Basketball Tourney will be taking place on Thursday, January 9, with Opening Round play.Girls JV games will be at Milan High School.Boys JV games will be at Batesville High School.Game 1: Batesville vs. Milan.Game 2: Jac-Cen-Del vs. South Ripley.Admission: $5.00 (No advance ticket sales)* Batesville All-Sport Tickets, E.I.A.C. passes, and Senior Citizen All-Sport passes are NOT valid for Ripley County tournament play.* All I.H.S.A.A. tournament rules and regulations are followed during Ripley County Tournament play.Championship games – Saturday, January 11, with both games played at Batesville High School.Admission $5.00 (No advance ticket sales)10:00 AM: Girls JV Championship.2nd Game: Boys JV Championship. (Follows girls’ post game award ceremony.)Submitted by Batesville AD Mark Ferguson.
AshantiGold restored their six-point lead at the top of the First Capital Plus Premier League [FCPPL] log with a 1-0 win over Hasaacas on Sunday.Defender Daniel Egyin’s attempted clearance of a Yakubu Mohammed hit somehow found the ball into his own net in the 70th minute and that settled the encounter at the Len Clay Stadium.Aduana’s 1-2 loss to the West Africa Football Academy (WAFA SC) on Saturday keeps them second with 19 points while AshGold move to 25 points.Martin Antwi and Bashiir Umar scored to secure full points from Aduana while Richard Arhin pulled one back – a win which now places the Academy side at third position with 18 points.Latif Salifu came on as early substitute for the hosts and his 23rd minute goal sealed three points for Berekum Chelsea who have been docked 18 points from the board over Heart of Lions.Two headed Gilbert Fiamenyo goals in each half handed Hearts of Oak a comfortable win over BA United at the Accra Stadium. Fiamenyo’s brace moves his tally to eight goals – separating him from Noah Martey at the top of the scorers’ log. Martey scored his seventh of the season from a penalty in Bechem United’s 1-3 home loss to Asante Kotoko.The match which was new coach David Duncan’s debut saw midfielder Michael Akuffo bag a brace in the opening seconds and the 62nd minute with Ahmed Toure scoring in between. Kotoko after benefiting three points from the boardroom and winning on Sunday move to 4th position with 16 points.All Stars continued their home invincibility with a 2-1 victory over Inter Allies in Wa. Richard Arthur and Emmanuel Gyamfi scored in the 39th and 80th minutes respectively before Frederick Boateng managed to reduce the deficit during additional time.Medeama SC striker Nathaniel Asamoah returned to his scoring best as he banged in two goals within six minutes (70th and 76th) in his side’s emphatic 3-0 victory over New Edubiase United at the T&A Park. Midfielder Malik Akowuah opened the scoring in the 13th minute.Veteran Ghana international goalkeeper Richard Kingson made his debut in post for Great Olympics in their 1-0 shock win away to Liberty Professionals at the Carl Reindorf Park. Doetse Agbashe scored the game’s only goal in the 39th minute. FCPPL Match Day 11 Results:AshantiGold 1-0 Sekondi HasaacasScorer: Daniel Egyin (Own-Goal)WAFA SC 2-1 Aduana StarsScorers: Martin Antwi, Bashiru Umar; Richard Arhin Bechem United 1-3 KotokoScorers: Noah Martey (pen); Michael Akuffo – *2, Ahmed ToureHearts of Oak 2-0 B.A UnitedScorer: Gilbert Fiamenyo – *2All Stars 2-1 Inter Allies Scorers: Richard Arthur, Emmanuel Gyamfi; Frederick BoatengBerekum Chelsea 1-0 Heart of LionsScorer: Latif SalifuMedeama 3-0 New Edubiase UnitedScorers: Malik Akowuah, Nathaniel Asamoah – *2 Liberty Professionals 0-1 Great OlympicsScorer: Doetse Agbashe–
The first international Bajram water polo tournament began last night in the capital city of B&H, Sarajevo. It will last for three days.The four teams that are participating are: S.C. Galatasaray from Istanbul, VK Banja Luka from Banja Luka, and two water polo clubs from Sarajevo VK Torpedo and VK Dabar.Two days ago, the Turkish team Galatsaray departed for Sarajevo.The Attaché for Culture and Tourism of the Turkish Embassy to B&H Cengiz Aydin opened the tournament.The trainer of Turkish Galatsaray Bati Ayaslioglu said that they are delighted with B&H, and that the hosts, VK Torpedo, showed great hospitality.According to him, they experienced B&H like their own country.After the opening of the competition, the first match between VK Banja Luka and S.C. Galatsaray began.VK Banja Luka won with a score of 15:6. VK Torpedo and VK Dabar played the second match, and VK Torpedo won with a score of 18:6.
Trading has resumed on Wall Street after a third freeze to prevent a crash. Circuit breakers were tripped after the Dow Jones Industrial Average and S&P 500 both fell by more than 8% seconds after the opening bell.This is the third time in the last week that trading was halted.Trading was halted today for the third time in six sessions as the S&P 500 fell more than 7%, despite the Fed’s earlier attempt to counter the impact of coronavirus by cutting interest rates to near zero. Here’s what we’re watching in the markets today. #WSJWhatsNow pic.twitter.com/sHTpq3aOZo— The Wall Street Journal (@WSJ) March 16, 2020 Trading on Wall Street was halted seconds after the opening bell.The Dow Jones Industrial Average plunged more than 22-hundred points lower at the opening bell on Wall Street.The slide continues despite the Federal Reserve cutting interest rates to zero over the weekend.The Federal Reserve made the emergency move to stop the economic bloodshed fueled by the coronavirus.The new federal funds rate is zero to one-quarter percent. It’s also launching a massive $700-billion quantitative easing program is also going into effect.
The most prolific pass catcher at his position over a 17-year career, Gonzalez caught 1,325 passes (second in NFL history) for 15,127 yards (sixth) and 111 touchdowns. He was a six-time All-Pro, made 14 Pro Bowls, and his 916 catches with the Chiefs set one of 22 franchise records he held upon his retirement.“I knew I had a good chance, I’m not going to lie about that,” he said. “Still, when you hear the knock, your heart drops.”As it turns out, Gonzalez isn’t the only one who can get good air.“Threw my phone across the room,” Mawae said, of his reaction upon learning he was in. “I had a higher vertical than at the combine.”He’ll be donning the yellow jacket this summer alongside Gonzalez, and three players who spent part of their careers trying to stop the groundbreaking tight end.This marks the first time more than two defensive backs have made it in the same class.Bailey played 15 years — five with Washington, then 10 more with Denver after the Redskins swapped him for Clinton Portis. Like so many great cornerbacks, Bailey did not rewrite the record book, in part because he was, for a huge chunk of his career, considered the best cover guy in the league. So most quarterbacks simply avoided him.Still, he made three All-Pro teams, 12 Pro Bowls and a none-too-shabby 52 interceptions. His best-remembered pick was a 103-yard return against Tom Brady in the 2006 playoffs that did not go for a touchdown. Denver did score shortly afterward, though, on the way to the win. Eight years later, Bailey made his only Super Bowl.“This is home and timing was just right for it,” said Bailey, who grew up in Folkston and played college ball at Georgia. “Having Pat Bowlen go in, I never expected it to be like this.”Reed won his only title in the 2012 season, his last with the Ravens. Running the defense from his safety position, he was a standout playmaker on a roster full of them — including Ray Lewis, Terrell Suggs and Peter Boulware. Reed finished his career with 64 interceptions, and led the league in picks three times.“Smartest player I ever coached,” said Reed’s former coach, Brian Billick.Law was a lot like Bailey — a rock at the corner who quarterbacks avoided. He finished with 53 interceptions and three Super Bowl rings, all with the Patriots. When New England beat the Rams for its first title in 2002, Law returned a pick 47 yards for a score that gave the Patriots the lead in the second quarter; they didn’t trail after that.Law was one of the many high-profile players Bill Belichick was willing to cycle out, and his final five years were spent with Kansas City, Denver and two stints with the Jets, including 2005, when he made a career-high 10 interceptions.“It’s surreal to get this honor while my former team is playing,” said Law, who will be on hand when the Patriots play the Rams for the title Sunday.Mawae, a second-round draft pick in 1994, played 16 seasons for the Seahawks, Jets and Titans. He made three All-Pro teams and joins Mike Webster, Dwight Stevenson and Jim Otto among the few true centers in Canton.He earned a spot some thought might go instead to Jaguars left tackle Tony Boselli. But for Boselli, Edgerrin James, John Lynch, Richard Seymour and six others, it’s wait ’til next year.Bowlen goes in after what some believe was a longer-than-necessary wait. He is suffering from Alzheimer’s disease, which has put the future of the Broncos’ franchise on uncertain ground.His youngest daughter, Annabel, said they face-timed their dad when the family received the news.“A lot of tears in the room,” she said.Bowlen was key in securing the NFL’s future via a number of multibillion-dollar TV contracts. The Broncos have largely prospered during his tenure, winning more than 60 percent of their games. That included the 1998 Super Bowl, when the owner famously shouted “This one’s for John” — a tribute to John Elway winning his first title.Brandt spent 29 years with the Cowboys, where his keen eye for talent helped turn Dallas into “America’s Team.” He chose eight future Hall of Famers, including Troy Aikman, Roger Staubach, Bob Lilly and Bob Hayes. He employed computers for evaluating talent and came up with psychological tests for draft prospects, two tools no NFL team could do without in the modern game.Brandt also was elected for his role as the NFL’s resident draft guru.Robinson was chosen by the Dallas Texans in the first AFL draft. The Texans became the Chiefs, and the Chiefs became Super Bowl champions. A teammate of his, Hall of Fame linebacker Willie Lanier, said Robinson was the key to a defense that helped Kansas City to two AFL titles, each of which landed the Chiefs in the Super Bowl.___More AP NFL: https://apnews.com/tag/NFL and https://twitter.com/AP_NFL ATLANTA (AP) — For towering tight end Tony Gonzalez, this was a slam dunk.The 6-foot-5 Gonzalez, who turned the celebratory post-TD dunk over the crossbar into an art form, was voted into the Hall of Fame on Saturday.Joining him will be two more first-time nominees, Champ Bailey and Ed Reed, along with another defensive back, Ty Law, and center Kevin Mawae; Law and Mawae were both in their third year as finalists.The contributor nominees, Broncos owner Pat Bowlen and Cowboys and NFL executive Gil Brandt , each made it, as did senior Johnny Robinson, the defensive back who helped the Chiefs win Super Bowl 4.Gonzalez started in Kansas City and finished in Atlanta, where voters met on the eve of the Super Bowl to select the Class of 2019; they didn’t need much time to debate his worthiness.In short, Gonzalez had more than his fair share of chances to jam. (Maybe not by accident, the NFL banned the practice in 2014, the year after he retired.) This Feb. 3, 2002, file photo shows St. Louis Rams running back Marshall Faulk (28) fending of New England Patriots cornerback Ty Law (24) during first-quarter play of Super Bowl XXXVI in New Orleans. Law later returned a pick 47 yards for a score that gave the Patriots the lead in the second quarter; they didn’t trail after that. (AP Photo/Tony Gutierrez, File) Photo Credit: AP
Q: I don’t understand the lack of effect regarding a lower carb diet. as a nutritionist, when I have patients who have low blood sugar in relation to PCOS, the smaller meals, lower carb and protein/good fat with each meal has stopped the hypoglycemia in every patient that I have tried this with. A: To date, very few studies have evaluated the role of macronutrient composition in health outcomes in PCOS. Therefore, there is insufficient evidence to generate a population-level recommendation that any specific diet is better than any other for PCOS. However, we appreciate that there is anecdotal evidence that low carbohydrate / high protein diets can work well in women affected by the condition. Providers can feel comfortable individualizing care – so long as there are no known adverse effects.Q: How do you address self-image in counseling?A: Several studies have shown that women with PCOS have lower self-confidence related to body image. Lower self-confidence can be exacerbated by a patient’s beliefs that it is more difficult for her to lose weight (and easier for her to gain weight). Lower self-confidence may increase risk for anxiety and depression. Studies have also revealed that women with PCOS often feel “unfeminine,” especially if they live with absent menstrual cycles and male-patterned hair growth. We recommend listening to a patient’s concerns related to nutrition and weight loss and paying close attention to how she views herself in these conversations. Some potential things to consider:Does she blame herself for developing PCOS / infertility?If so, then emphasize that there are many unknown causes of PCOS / infertility and that healthy diet behaviors have been shown to be effective in improving PCOS outcomes. Empathy and social support from clinicians are key to combating negative self-image. What is her overall objective for coming to the visit?If she keeps describing factors associated with her appearance, then acknowledge her feelings while reframing her mindset to appreciate other factors outside of physical attributes. For example, ask about her level of fatigue or the types of activities that she would like to do as she loses weight. Then, explain how a healthy diet and increased physical activity can help. International Lifestyle Recommendations for Polycystic Ovary Syndrome (PCOS)If you missed this great webinar Dietitians can still earn 1.0 CPEU by watching the video at https://militaryfamilieslearningnetwork.org/event/22060/ Questions Q: Is PCOS on the rise in the US and/or around the world?A: The current worldwide prevalence of PCOS is estimated to be 8 – 13%. However, there continues to be substantial debate over the most appropriate criteria to diagnose the condition, as well as differences in how PCOS is evaluated across providers, health centers, and countries. These issues make it challenging to capture changes in the prevalence of the condition over time. Nonetheless, because obesity is linked to the pathogenesis of PCOS, it is possible that the rising prevalence of obesity may be associated with an increase in the number of women affected by PCOS. Longitudinal, observational studies are needed to corroborate such a relationship, though.Q: How is PCOS diagnosed? And is it ever something that can be cured/go away?A: PCOS is diagnosed based on the combined presence of two of three cardinal features: (1) anovulation (which is judged by evidence of irregular menstrual cycles), (2) androgen excess (which is judged by evidence of male-patterned hair growth [hirsutism] or elevated circulating androgens), and (3) polycystic ovarian morphology (which is judged by evidence of increased antral follicle number or ovarian size on ultrasonography). Different lifestyle and pharmacologic treatments can be used to reduce the severity of PCOS, but we do not know whether the condition can be “cured,” per se. The answer likely depends on the etiology of PCOS – that is, whether it is of genetic or environmental origin.Q: What are your opinions on intuitive eating and PCOS, which seems to be a growing approach to treat PCOS? Intuitive eating seems to go against the idea of caloric restriction.A: The main assumption of intuitive eating is that the mind and body are connected and that as a result, we can be aware of our body’s hunger and satiety cues. There are 10 principles, most of which remove the negative stigma surrounding food and weight while refuting the one-size-fits-all approach to eating. However, these principles do not need to be mutually exclusive from caloric restriction and can be addressed based on individual patient and clinician preferences. After all, if we listen to our body’s cues and stop eating when we feel full, then we will likely be eating fewer calories.Some studies have reported that women with PCOS have lower cholecystokinin and meal-stimulated ghrelin secretion than women without PCOS. These results suggest that women with PCOS are more likely to be hungry and unsatiated after meals, indicating that the mind-body connection may be disrupted in PCOS. Therefore, intuitive eating may be more difficult for women with PCOS. However, there are certain philosophies that may resonate with some patients more than others. Literature outside of PCOS has shown that in engaged individuals, the action of tracking their diet can help an individual learn about their eating habits and self-monitor their dietary intake. Calories can serve as a traditional benchmark for patients that prefer objective measures with defined goals.If the intuitive eating approach helps to stimulate weight loss in women with PCOS, then that is great, too! In such cases, we strongly encourage using the shared care approach. For example, provide a list of the principles of intuitive eating and ask the patient about the principles that they can see themselves adopting into their lives. Then, based on their answers, create a plan with the patient to encourage healthy eating behaviors using SMART (Specific, Measurable, Achievable, Realistic, Timely) goals.Q: Do you recommend chromium supplements for women with PCOS?A: The evidence regarding the role of dietary supplements in PCOS is heterogeneous and still emerging. Experts agree that there is insufficient high-quality data, at this point, to generate population-level clinical recommendations. Some randomized controlled trials have shown that chromium supplements reduce insulin resistance in women with PCOS. However, there is no evidence to suggest that women with PCOS exhibit deficiencies in chromium, wherein supplementation would be expected to exert a physiologically beneficial effect. Given that high doses of chromium can cause liver or kidney damage, we urge caution in recommending these dietary supplements until more evidence is available.Q: I am curious about the outcomes or impacts of PCOS as they related to age of presentation?A: PCOS imparts serious consequences on women’s health across the lifespan. Menstrual cyclicity, androgen status, and ovarian morphology (i.e., the diagnostic features of PCOS) are normally altered during the pubertal and menopausal transitions. Efforts are currently ongoing to define abnormality at these life stages, but age-related phenotypes of PCOS remain poorly defined. Some longitudinal studies have shown that menstrual cycles can become more regular, androgens can decline, and follicle number and ovarian size can decrease in post-menopausal women with PCOS. Importantly, although risk factors emerge earlier in life, diabetes mellitus, cardiovascular disease, and gynecologic cancers (i.e., common comorbidities of PCOS) are more likely to effect women in later decades of life.Q: What about the use of metformin for PCOS? Is metformin used with women with PCOS?A: Metformin is recommended for the management of weight, metabolic, and reproductive outcomes in women with PCOS. It may be used alone or in combination with lifestyle or other pharmacologic therapies. It may be especially helpful in cases where lifestyle changes cannot achieve desired goals and/or in women with high metabolic risk, e.g., those with risk factors for impaired glucose tolerance or diabetes mellitus.Q: All these recommendations sound like the same guidelines that should be followed for anyone overweight/obese. So, is there really anything different than for treating PCOS?A: Yes, the recent International Evidence-based Guideline for the Assessment and Management of PCOS supports the use of population-level recommendations for dietary intake and physical activity. Use of population-level recommendations is based on evidence that healthy lifestyle approaches (e.g., caloric restriction in obese patients, and balanced dietary composition and physical activity in all patients) can improve the metabolic features of PCOS. However, women with PCOS demonstrate an increased risk for psychological issues (i.e., anxiety, depression, low self-esteem, eating disorders) and chronic diseases (e.g., diabetes mellitus, cardiovascular disease, gynecologic cancers) compared to the general population. Women with PCOS also report poorer perceived control over their health outcomes and lower levels of social support than women with PCOS. Collectively, the main difference from a treatment perspective is that there is a clear need for healthcare providers to acknowledge these unique risk factors and concerns.Q: There seems to be quite a bit of anecdotal evidence for myo-inositol supplementation. Thoughts?A: Myo-inositol is a sugar alcohol and may influence hormones that are dysregulated in PCOS, such as follicle-stimulating hormone and insulin. Some studies have shown that myo-inositol improves aspects of ovulatory function, due in part to the role of hyperinsulinemia in anovulation and the beneficial effect of myo-inositol on insulin resistance. However, the studies are heterogeneous with differing definitions of PCOS, inclusion and exclusion criteria, and dose and duration of treatment. Until more consistent evidence is available, we are cautious about recommending myo-inositol to treat the symptoms of PCOS to prevent raising false hope in patients. How does she conquer slips (i.e., short-term breaks from healthy behavior practices) and slides (i.e., extended breaks)?Emphasize that slips are bound to happen for everyone but will not hurt her progress.Ask her how she deals with slips to prevent them from turning into slides.Some strategies might include identifying high risk situations, visualizing how one would deal with that situation, and encouraging positive thinking by keeping things in perspective. Q: When were the women diagnosed in these studies? If they had already been diagnosed, they were probably trying to eat better.A: In some of the studies that examined baseline differences in diet and physical activity between women with and without PCOS, women were categorized into groups based on their existing diagnosis of PCOS. However, there were other studies that categorized women using internal diagnostic criteria, without revealing to the women that their symptoms were consistent with PCOS. The number of women who had received official diagnoses was not usually reported in these studies. It is tough to confirm with existing evidence, but we agree that reverse causation may exist, and that woman may have improved their lifestyle behaviors following their diagnosis of PCOS.Q: Do you think that the recommendation of 300 mins of moderate exercise or 150 mins of vigorous exercise is realistic?A: We believe that the recommendation is realistic, particularly because the newest Physical Activity Guidelines for Americans accept all bouts of physical activity (i.e., not just 10 minutes) as counting towards the goals of 150 – 300 minutes. To help patients meet the recommendations, we suggest the use of stepwise goal setting, which depends on how adherent a patient is to physical activity goals. It is helpful to keep in mind that exercise includes structured activities (e.g., running on a treadmill), while physical activity reflects any body movement that uses energy (e.g., household activities).Q: Long question (sorry!) re: difficulty losing weight, whenever you can answer – I worked with a pt with PCOS who according to her diet recall significantly reduced portions and increased exercise, however, her weight dramatically continued to increase during the months that we worked together. She was frustrated and it was difficult for me as well because I wasn’t sure what else to tell her to do- she couldn’t adjust/reduce her diet any further and her activity was consistent. Have you seen anything like this in your experience?A: We can definitely relate to such a scenario. Many of our participants with PCOS have shared similar experiences with us. Besides the potential impact of medication, there are a few things that come to our minds that might be helpful to discuss:What is her normal daily caloric intake? There is some evidence to suggest that women with PCOS have lower basal metabolic rates than women without PCOS and that excess visceral fat can modulate energy balance. Anecdotally, some of our participants have been so committed to weight loss, that they have reduced their caloric intake to <1000 calories per day, likely further slowing their metabolism. Moderate caloric reduction (i.e., by 500 calories per day) has been shown to be most effective for weight loss in this population; anything more could be counter-productive.How likely is she to use a mobile diet tracking app and would she consider it to be a convenient tool to use? For patients who are engaged and very interested in losing weight, such a tool can be helpful for identifying potential areas to target for weight loss. Portion sizes can be challenging to estimate, so apps that provide an opportunity to take pictures of meals/snacks may be effective. Additionally, tracking foods in real-time creates self-awareness of dietary behaviors and has been shown to lead to greater weight loss over time.What is her normal level of physical activity? Some patients may not understand the definition of “moderate intensity physical activity” and consequently may perform less activity. We like to recommend that, during bouts of physical activity, patients should reach a level of exertion where they can still talk but cannot sing. Physical activity of any kind can be helpful in women with PCOS.We are happy to answer other questions or provide further explanation! Please feel free to reach us at the following email addresses:Annie W Lin ([email protected])Brittany Y Jarrett ([email protected])References https://www.ncbi.nlm.nih.gov/pubmed/15624269  https://journals.sagepub.com/doi/full/10.1177/1933719117728803?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed
For a seaside city, Mumbai surprisingly has not so far had a club wholly devoted to water sports. That’s why H2O on Marine Drive, partly owned by film star Sunil Shetty, is likely to make a splash.There are beach, joy and adventure rides; hi-speed jet boats to be chartered; heritage,For a seaside city, Mumbai surprisingly has not so far had a club wholly devoted to water sports. That’s why H2O on Marine Drive, partly owned by film star Sunil Shetty, is likely to make a splash.There are beach, joy and adventure rides; hi-speed jet boats to be chartered; heritage cruises; rowing, fishing, wind-sailing vessels and jet ski handling courses on offer here.Among joy rides, take your pick from bay, sunset and moonlight cruises (Rs 150 for 45 minutes). Telephone: (022) 367-7584/546.
About the authorCarlos VolcanoShare the loveHave your say Real Madrid midfielder Luka Modric: I’ve always had my doubtersby Carlos Volcano10 months agoSend to a friendShare the loveReal Madrid midfielder Luka Modric admits he’s always had to battle against doubters.Modric won the Ballon d’Or and FIFA The Best awards this year.But the Croatian admitted that the path to the top hasn’t been easy, and that he’s had to overcome many obstacles.”I’ve been surrounded by doubts since my childhood,” he told GQ.”Because of my physique, because of my height…”Some thought those elements were important to succeed in life and in football, but I never doubted myself.”All of the difficulties that happened in his childhood helped him to become stronger.”Thanks to that trust and that faith in myself, I came to the best club in the world,” he added.”At the beginning many people didn’t believe in me either, it’s part of my life, always surrounded by doubts, always hearing that no I won’t reach the top.”All the recognition, such as the FIFA World Player or the Ballon d’Or, are worth much more when you are aware that nobody has given you anything.”Nothing has been given to me by anyone, I’ve had to work for it.”