Dave Donohue publishes his first board game

Imagine being so nerdy that you not only like to play board games, but you even prefer to design them.  Welcome to my world, people.  Here is my first (card game)

https://www.thegamecrafter.com/games/logical-spies-card-game

We also offer it as a boxed game

https://www.thegamecrafter.com/games/logical-spies

The game was actually conceived about 10 years ago.  It has been through numerous revisions.  Logic sheets were a relatively late addition, that pushed the game over the hump unto funness.

Kudos to Holly Feldheim, artist, who did just fabulous work in designing the art work for the boxes and the Game Crafter web pages.  I have had the privilege of beholding her work for the past year on PTA events and now this project, and it is always spot on.

Thanks also to my playtesters:

• Jim "Q" Quigley
• "Saucy" Jack Garrett
• Mike "Smokin Gun" Jones
• Harry "Scar" Hwang
• Andy "Shemp" Donohue
• Jim Lee
• Chilly Datillo
• Mike Durbin
• Calvin Donohue
• Maisie Donohue
• Nathan Donohue
• Sophie Mullen
• Debbi Zarek

You will all be handsomely rewarded.

Studying for Weight Loss Certification

I only do something if it's a win-win. I'll hopefully elaborate on the merits of win-winning in a future post, for the benefit of the teeming throngs.

My current win-win activity is to study for weight loss certification.  It assists my wife's endeavor to expand her medical practice while offering the Patient-Centered Medical Home (PCMH, more later hopefully) plus offer new services.  And the second win is it helps my inqle-qa survey engine project (more later hopefully).

I find the weight loss literature quite interesting.  There is some good quality research I believe.  Much of the current literature suggests that a key to being slim and healthy is dietary protein.  Below are some snippets.  I omitted the scientific references within these quotes.  I made a number of references to an excellent review paper by Layman [1].

Muscle protein synthesis is stimulated by stretching and resistance activity. The converse is also
true; a sedentary lifestyle reduces the efficiency of EAA use. After approximately age
30y, the anabolic drive is lost; basal levels of hormones become largely ineffective in
stimulating protein synthesis in structural tissues; and diet quality and physical activity
become the limiting factors for maintaining optimal protein turnover for repair,
remodeling, and recovery. [1]

 Meaning when you get older, your metabolism catches up with you.  And stretching probably improves muscle mass.

Most adults consume less than 10 g of protein at breakfast (Figure 1). In
children and young adults, ... the anabolic drive maintains high efficiency of protein use for nitrogen retention even when daily protein is consumed as a single large meal. However in older
adults, the quantity and quality of protein at individual meals is important. Adults require
a minimum of 15 g of EAA or at least 30 g of total protein to fully stimulate skeletal
muscle protein synthesis... Current dietary patterns that provide adequate
protein or leucine at only one meal produce an anabolic response only after that meal
(Figure 1). This is a critical factor for protection of lean tissues during weight loss or to
prevent age-related sarcopenia and osteoporosis... The meal content of protein is also a key factor for satiety and appetite regulation.  Protein has greater satiety value than either carbohydrates or fats and reduces food intake at subsequent meals. Studies of energy regulation for weight management show that replacing carbohydrates with protein reduces daily energy intake by ~200 kcal. [1]

According to current research, adults should get 15 gm of essential amino acids or 30 gm of protein, at each meal, or suffer loss of muscle and bone, while gaining fat.  Protein also leads to greater feeling of fullness and less calorie intake per day.

breakfast has the greatest impact on total daily energy intake. As with
protein turnover in muscle and bone, limiting protein intake to a single large meal late in
the day reduces the satiety benefits of dietary protein. [1]

 Better to eat plenty of protein at breakfast and lunch than dinner.

Use of conventional high carbohydrate, low fat, low protein diets results in 30% to 40% loss of
lean tissue mass. Use of higher protein diets reduces lean tissue loss to <15% and when
combined with exercise can halt loss of lean tissue during weight loss.  [1]

When dieting, eat more protein + exercise, or else you will lose muscle mass.

Calcium supplements are largely ineffective for remodeling of bone matrix if protein is limiting.
Positive effects of calcium appear to require intakes of protein >1.2 g/kg to have
beneficial effects.  [1]

You need dietary protein to maintain bone strength.

reduced carbohydrate diets have decreased TAG, increased HDL and increased LDL particle size (i.e. LDL-C/ApoB) improving the dyslipidemia commonly associated with [diabetes]. These conditions are 4-times more important for heart disease and all cause mortality than elevated cholesterol or LDL concentration.  [1]

Reducing carbs in the diet and replacing w/ protein benefits blood cholesterol.  Want to raise your HDL?  Eat fewer carbs.

Alcohol
consumption was positively related to BMI
among men but inversely related to BMI among
women. [2]

European men who drink alcohol are heavier.  European women who drink alcohol are slimmer.

There was a significant nonlinear association of
BMI with the risk of death, with the lowest risks
at a BMI of 25.3 among men and 24.3 among
women [2]

Optimal BMI is 25.3 for male Europeans, and 24.3 for female Europeans.  Deviate from this number and risk ... death!  People with a BMI of 35 or greater had roughly double the risk of dying over the 9 year study period.

Now another big study found that participants put on a variety of different diets, all lost similar weight [3].  They put people on 4 different diets, of the same amount of calories but different macronutrients, (high or medium protein, high or medium fat) and found all 4 groups ended up basically the same, with about 4 kg (8.8 punds) of weight loss at 2 years.

trials of low-carbohydrate diets
have reported a very low incidence of urinary
ketosis after 6 months,6,8,12 suggesting that in
most overweight people, it is futile to sustain a
low intake of carbohydrates [3]

Interesting that ketosis goes away after 6 months.  No sense in staying permanently on the initial stage of Adkins or South Beach, I gather.

More to follow...


[1] Dietary guidelines should reflect new understandings
about adult protein needs
Donald K. Layman
Department of Food Science & Human Nutrition
University of Illinois
Urbana, IL 61801, USA

[2] General and Abdominal Adiposity and Risk of Death in Europe
N Engl J Med 2008;359:2105-20
T. Pischon, M.D., M.P.H., H. Boeing, Ph.D., M.S.P.H., K. Hoffmann, Ph.D.,*
M. Bergmann, Ph.D., M.B. Schulze, Dr.P.H., K. Overvad, M.D., Ph.D.,
Y.T. van der Schouw, Ph.D., E. Spencer, Ph.D., K.G.M. Moons, Ph.D.,
A. Tjønneland, M.D., Ph.D., Dr.Med.Sci., J. Halkjaer, Ph.D., M.K. Jensen, Ph.D.,
J. Stegger, M.D., F. Clavel-Chapelon, Ph.D., M.-C. Boutron-Ruault, Ph.D.,
V. Chajes, Ph.D., J. Linseisen, Ph.D., R. Kaaks, Ph.D., A. Trichopoulou, M.D., Ph.D.,
D. Trichopoulos, M.D., Ph.D., C. Bamia, Ph.D., S. Sieri, Ph.D., D. Palli, M.D.,
R. Tumino, M.D., P. Vineis, M.D., M.P.H., S. Panico, M.D., M.Sc.,
P.H.M. Peeters, M.D., Ph.D., A.M. May, Ph.D.,
H.B. Bueno-de-Mesquita, M.D., Ph.D., M.P.H., F.J.B. van Duijnhoven, Ph.D.,
G. Hallmans, M.D., L. Weinehall, M.D., Ph.D., J. Manjer, M.D., Ph.D.,
B. Hedblad, M.D., Ph.D., E. Lund, M.D., Ph.D., A. Agudo, Ph.D., L. Arriola, Ph.D.,
A. Barricarte, Ph.D., C. Navarro, M.D., Ph.D., C. Martinez, M.D., J.R. Quirós, M.D.,
T. Key, D.Phil., S. Bingham, Ph.D., K.T. Khaw, M.B., B.Chir., P. Boffetta, M.D., M.P.H.,
M. Jenab, Ph.D., P. Ferrari, Ph.D., and E. Riboli, M.D., M.P.H., Sc.M.

[3] Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates
Frank M. Sacks, M.D., George A. Bray, M.D., Vincent J. Carey, Ph.D., Steven R. Smith, M.D., Donna H. Ryan, M.D.,
Stephen D. Anton, Ph.D., Katherine McManus, M.S., R.D., Catherine M. Champagne, Ph.D., Louise M. Bishop, M.S., R.D.,
Nancy Laranjo, B.A., Meryl S. Leboff, M.D., Jennifer C. Rood, Ph.D., Lilian de Jonge, Ph.D., Frank L. Greenway, M.D.,
Catherine M. Loria, Ph.D., Eva Obarzanek, Ph.D., and Donald A. Williamson, Ph.D.
N Engl J Med 2009;360:859-73

Do you have cancer?

Many people who come to see me are wondering: do I have cancer? 
A recent study shed some light on what symptoms carry a risk of cancer. They are definitely familiar ones to the internist, but some are not commonly known to patients.

• rectal bleeding, change in bowel habit, and iron deficiency anemia are signs of colorectal cancer
• blood in the urine is  a sign of urological or bladder cancer
• abnormal rectal examination is a sign of prostate cancer
• cough productive of bloody sputum is a sign of lung cancer
• trouble swallowing is a sign of esophageal cancer
• breast lump is a sign of breast cancer
• bleeding after menopause is a sign of gynaecological cancer

 Note some of the things that are not on the list.  Headaches seldom signify brain tumor.  Weight loss did not make the list.  Nor did pelvic exam to detect ovarian cancer.

Here is the reference
Shapley M, Mansell G, Jordan JL, et al. Positive predictive values of >/=5% in primary care for cancer: systematic review. Br J Gen Pract. 2010 Sep;60(578):e366-77. (Review) PMID: 20849687

Win-Win-Winter Indoor Family Sports

As a father of 3 and a career of 2 and a husband of 1, I am constantly
looking for the win-win-win.  Thanks to Brandywine School District and
the Delaware Chapter of the Sierra Club, I found a nice "quintuple
win" last winter.

From November, 2009 through March, 2010 we had 14 sessions of Winter Indoor Family
Sports.  The events occurred on Wednesdays from 6-8PM, in the
double gymnasium of Springer Middle School.  We had a good number
of participants for each session: roughly 8 adults, 8-12 kids (2nd grade
through 5th grade), and 6 younger kids (first grade and younger).  We
have played a variety of sports, like indoor soccer, dodge ball, and
kick ball.

Why do I say these sessions have been a win-win-win-win-win?
(1) Kids got exercise, during an otherwise dark and sedentary season.
(2) Adults got exercise at the same time!  How rare it is that
adults and kids get to play sports together.
(3) We all got to spend time with friends and meet new
friends.  Not so easy in suburbia!
(4) We have had the opportunity to play Schtick.  In fact, we have
played the world's first indoor games of Schtick.  What is Schtick?
It is a disc sport that some friends and I invented in 1994.  It is an
exciting game, played with multiple flying discs at once (we've been
playing with 5!), and well-suited for a wide spectrum of athletic
abilities.  It has spread throughout the United States, and to Canada,
Australia, New Zealand, Europe, China, South Korea, and others.  Since
part of my mission in life is to help spread Schtick, this has been
particularly satisfying for me.  You can check it out at
schtickdisc.org.
(5) Last but not least, I have had the opportunity to expose more
folks to the Sierra Club.  As a member of the Energy Committee of the
Delaware Chapter of the Sierra Club, I am deeply concerned about
climate change, and the inattention that it gets by most of America.
I am especially keen to get the word out to kids, as they are the ones
who will have to live in the mess we are creating for them.  I believe
the Sierra Club would do well if it catered more to families, as this
is a larger demographic than its traditional demographic (you know,
outdoorsey types like you and me).  So we have asked a member of each
participating family to contribute $25 to the Sierra Club and get a
membership in the process.  We garnered 12 new members.

For folks who would like to do something similar in your area, I am
happy to say it is cheap and easy!  The gym is free to use, thanks to
Sierra Club's nonprofit status.  Just contact your local public middle
school the preceding summer and ask.  Try to find a facility that has
2 gymnasiums, so that you can have space for younger kid activities
(first grade and younger).

Nobody Loved Little Gorilla

We have a board book "Little Gorilla", which sits in our baby room book shelf.  All 3 of our kids heard it many times.  Not because it's our favorite book (it's a bit naive and repetitive as baby books often are).  But because it's there.  The book follows a familiar theme in kids books: animals all get along and help each other.  It seems that to kids this is the most natural idea.

Fast forward to the real world.  Naturalistically, the book has it all wrong.  No surprise.  Animals in the wild are generally on the edge of starvation.  They are competing against other species and often their own species.  The fittest and most ruthless survives. 

The surprising thing to me is that the idealistic message turns out to be dead wrong as well.  Although Little Gorilla (and gorillas in general) are intelligent and gentle creatures, living off plants in their environment and minding their own business, it turns out that we humans don't care a lick about them.  In fact, we are doing everything in our power to make them extinct as quickly as possible.

Gorillas are in fact going extinct.  They are numbered in the thousands, and their numbers are declining rapidly.  They are falling victim to Ebola virus, poaching, logging, and general unrest from human conflict in Congo.  It is likely gorillas will disappear in the wild in your lifetime. 

Our response?  Do we roar our loudest roar for him like the kindly lion?  Do we carry him on our back like the grandmotherly hippo?  Do we lovingly nurture him to grow and grow and grow like his parents and grandparents?  No we do not.  As adults, we learn that we must turn our backs to him.  At best we look away with sadness, feeling powerless to help.  At worst, we humans believe that our duty is to posture for our right wing agenda, which means dismissing the plight of the gorilla (and all of the natural world and the global environment for that matter) as a liberal cause, which we will rail against until our dying breath.  We concern ourselves with things we learn on Fox News or at middle American church (where the words "habitat" and "biodiversity" come up about as often as "cotangent").  We call our congresspeople decrying government takeover of health care or conquest of our society by gays or in defense of Terry Schiavo.  If Obama or some leader were to join a UN mission to intervene in the conflict in Democratic Republic of Congo, we would call our congressman to rail against that too.

The sad truth is, Little Gorilla, that we people don't want you to grow and grow and grow.  We want you to die and die and die.

I understand that there are real world issues that seem far more important than the death of a few thousand "lower" primates.  Losing your job is a desperately sad thing.  But I contend that such concerns will always be there for humanity.  The human journey will always include a struggle against unemployment, poverty, and these gays trying to take over our military.  The question is-- while struggling against such things, will we lift a finger (a lousy few billion dollars) to save the Little Gorilla and all his friends in the jungle, or not?  As a kid, I thought "of course we would".  As an adult, I have learned "it's a nonstarter".

And this is sad because everyone should have the privilege of growing up in a world where there are Little Gorillas to love.

Scientific illiteracy can be hazardous to our health

Our society is very agnostic with respect to science. Very few of us discuss scientific findings or openly ponder the wonder of the many millions of years of evolution that transpired before us. Instead most of us occupy our minds with the here and now and a little church thrown in on Sundays. And that can be just fine. No harm done... until, you run into a problem of climate change.

For those of us who have educated ourselves about the history of life on Earth, we see that Earth has in fact had periods of warmth, and cold, peppered with dramatic extinction events. Such events typically wipe out most living things and most species. We see that most changes occur over very gradual time periods, and life (through survival of the fittest) can adjust fine to such changing conditions.

People who are scientifically literate are aware of scientific findings. E.g. that the permafrost is melting. That glaciers are melting. That the polar ice caps are melting, and this means more heat will be absorbed. Scientifically literate people understand the concept of positive feedback cycles. And predictive models. And non-linear systems.

In short, scientifically literate people can connect the dots that we are living in a fragile, interconnected biosphere, that we are gradually destroying. Those who lack such literacy, the overwhelming majority of people, have no time or interest in the climate. They even go so far as to malign or disdain the scientists who try to make their voices heard. It seems to have become fashionable to disregard climate scientists as self-serving or otherwise irrelevant.

Scientifically literate people understand what scientific integrity is. They know it is a far greater self-correcting force than exists in the business world, whereas the opinion of for-profit industry representatives is the pinnacle of bias. They know the value of peer-review. When an entire wing of science tries to sound the call, scientifically literate people rise to attention. Scientific illiteracy, alas, tells people to go back to sleep.

Another Antarctic Ice Shelf Diasappears Ahead of Schedule

Tragically, polar melting is outpacing most climate models.
http://www.reuters.com/article/environmentNews/idUSTRE5332BU20090404

Which models you ask? Those ones that predict global desertification in 90 years. So granted that these climate models might be wrong and they have large error bars. But it seems to me that we are seeing evidence that warming is occurring at the UPPER end of those error bars. So maybe Earth will be a desert in 70 or 50 years instead of the 90 predicted.