Psycho Nephro

Patients Worse off With More-Experienced Docs?

2011-07-26T01:34:00.000-07:00

NEW YORK (Reuters Health) Jul 18 - In a study that flies in the face of common sense, sicker patients fared worse under the care of seasoned doctors than when younger doctors looked after them.

According to findings published online July 11th in the American Journal of Medicine, patients whose doctors had practiced for at least 20 years stayed longer in the hospital and were more likely to die compared to those whose doctors were licensed in the past five years.

The results highlight "issues that we have as a medical profession in keeping up to date" with the latest medical knowledge, said Dr. Niteesh Choudhry of Harvard Medical School, who was not involved in the new study. It is "a quality of care problem that has been recognized for five to 10 years," he told Reuters Health.

Dr. William Southern and colleagues looked at records of more than 6,500 patients who'd been hospitalized between 2002 and 2004 on the general medical service at New York City's Montefiore Medical Center in the Bronx.

The patients were first seen by a resident who randomly assigned them to one of the hospital's six medical teams. Each team has a medical student, residents, and an attending physician.

Over the course of the study, there were 59 different attending physicians. The researchers stratified them according to how long they'd been practicing: five years or less, six to 10 years, 11 to 20 years, or more than 20 years.

Because the researchers thought doctors might behave differently with their own long-time patients, they confined the study to cases in which patient and doctor had never met before.

In comparing the most and least experienced doctors, researchers saw the most-experienced group had more patients die in the hospital.

At first glance, compared to patients with the newest doctors, those with the most experienced physicians had more than a 70% increase in their odds of dying in the hospital and a 50% increase in their odds of dying within 30 days.

However, when the researchers took into account how sick the patients were, they found that only the more complex patients were at higher risk in the hands of the more experienced doctors.

Dr. Southern's group also found that while the doctor's experience played a role in patients' length of stay, the doctor's in-patient volume also mattered.

When the volume was low, doctors kept patients in the hospital for roughly the same average time no matter how many years of experience they had. But when they did have a lot of patients to see in the hospital, those with more than 20 years of experience kept patients there about half a day longer than their peers who'd been practicing for less than five years.

Previous research has found similar results across a variety of physician specialties. Earlier studies have also shown that physicians with more time in practice are less likely to adhere to practice guidelines.

"It's not quite as simple to say that as you get further away from training, your quality gets worse," cautioned Dr. Choudhry.

The problem, he said, is not with the capability of the more experienced doctors, but rather, their familiarity with more current guidelines and practices. The results suggest the need to rethink the way doctors are continually educated in the years after completing their certification, he added.

The authors suggest that physicians with more than 20 years in practice be required to recertify periodically. Most of the older doctors in the current study are presently exempt from having to take recertification tests, they say.

Most doctors do participate in continuing medical education programs. But much of it is passive, consisting mostly of attending lectures and reading journal articles. Dr. Choudhry thinks it would be better to develop educational programs that would actively engage the more experienced physicians.

Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians, cautioned that it is premature to make drastic changes based on the results of the study, which only looked at small numbers of attending physicians. He also came up with several alternative explanations for the findings.

For instance, the fact that patients were in a teaching hospital might have contributed to the different rates of death, since more experienced doctors might give the residents more autonomy. And the varying lengths of stay could reflect a cultural difference in today's younger physicians, who are taught to focus on reducing hospital stays.

But despite his concerns about the study, Dr. Weinberger agreed, "It is important for physicians to stay as current as possible."

Fluid Resuscitation in Acute Illness — Time to Reappraise the Basics- NEW ENGLAND JOURNAL OF MEDICINE

2011-05-31T20:12:00.001-07:00

Editorial
Fluid Resuscitation in Acute Illness — Time to Reappraise the Basics

John A. Myburgh, M.B., B.Ch., Ph.D.

May 26, 2011 (10.1056/NEJMe1105490)

Article
References

Fluid resuscitation is a fundamental intervention in the treatment of critically ill patients. However, there is little conclusive evidence to guide clinicians about the best type of resuscitation fluid; the appropriate timing, volume, and rate of fluid administration; and the optimal way to adequately monitor the efficacy and safety of fluid resuscitation in various clinical conditions.1

Although the complications associated with excessive volume of resuscitation fluid — such as pulmonary and interstitial edema — are well recognized, an emerging body of evidence suggests that the type of resuscitation fluid may adversely affect the outcomes in specific clinical conditions; for example, albumin is associated with increased mortality in patients with traumatic brain injury,2 and high-molecular-weight preparations of hydroxyethyl starch are associated with acute kidney injury in patients with severe sepsis.3

Conversely, improved outcomes associated with the use of albumin for resuscitation have been shown in children with severe malaria4 and in a subgroup of adults with severe sepsis in the Saline versus Albumin Fluid Evaluation study (SAFE; Current Controlled Trials number, ISRCTN76588266).5,6 However, these reports were not sufficiently conclusive to justify the adoption of strong clinical recommendations.

The results of the Fluid Expansion as Supportive Therapy (FEAST) trial,7 reported in this issue of the Journal, are an important contribution to the literature. This remarkable, pragmatic, randomized, controlled trial, conducted in six hospitals in Kenya, Tanzania, and Uganda, assessed the effects of bolus-fluid resuscitation with albumin or saline as compared with no bolus fluid in children with febrile medical illness and impaired perfusion. Children with severe hypotension, or decompensated shock, received boluses of either albumin or saline for resuscitation. The trial centers had no access to intensive care units, and the trial included a comprehensive education program aimed at optimizing early case recognition and by training in emergency pediatric life support. The primary outcome was 48-hour mortality — a relevant patient-centered outcome in regions in which the high prevalence of severe sepsis in children, often due to malaria, is associated with high early mortality.8

The trial was powered to determine a plausible absolute risk reduction in 48-hour mortality (as derived from power calculations described in the Methods section in the article) of 5 percentage points and was conducted with high standards of internal validity — excellent randomization procedures, a high rate of adherence to the protocol, concealment of the treatment assignments, a minimal loss to follow-up, the use of the intention-to-treat principle for the analyses, and performance of analyses according to prespecified subgroups. The sample size was appropriately increased from 2800 patients to 3600 patients after an interim analysis showed that the rate of death was lower than predicted in the intervention groups. However, the trial was stopped after the recruitment of 3141 patients when bolus-fluid resuscitation with albumin or saline was shown to increase the absolute risk of death at 48 hours by 3.3 percentage points and the risk of death, neurologic sequelae, or both at 4 weeks by 4 percentage points. No difference in mortality was observed in patients with decompensated shock, although these patients were few in number and had significantly higher mortality. The excess mortality associated with bolus-fluid resuscitation was consistent across all prespecified subgroups, which included subgroups according to age, lactate level, base deficit, presence or absence of severe anemia, and status with respect to coma and malaria.

These results will have an immediate effect on the way children presenting with febrile illness due to medical causes and with associated hypotension are treated in resource-poor settings. In conjunction with a program of education and training, discontinuation of the practice of bolus-fluid resuscitation in patients with febrile illness due to medical causes and impaired perfusion or compensated shock must be recommended. Given that 2 million children die from this condition each year in sub-Saharan Africa, the potential impact is enormous. Extrapolating these results to children with other hypotensive conditions, such as severe dehydration from gastroenteritis and malnutrition, burns, and surgery, is not justified on the basis of these data; further research would be required.

The results of the FEAST trial, as with those of other trials that generated results contrary to clinical opinion and practice,9,10 make it imperative that we reappraise the fundamentals. Early identification of shock, basic life support, and early antimicrobial therapy remain at the forefront of the clinical care of young patients with severe infection and shock. It is highly probable that education, training, and participation in a high-quality, randomized, controlled trial itself had a substantive positive effect on the overall rate of death, although these factors were not directly assessed in this trial. However, the entrenched practice of fluid-bolus resuscitation in patients with compensated shock remains highly questionable.

We can only speculate about the mechanisms by which bolus-fluid resuscitation had adverse biologic effects in these patients. Potential mechanisms may include the interruption of genetically determined catecholamine-mediated host defense responses by the rapid increase in plasma volume, which might result in a reperfusion injury. Similarly, transient hypervolemia or hyperosmolality might exacerbate capillary leak in patients who are susceptible to intracranial hypertension2 or pulmonary edema, with fatal consequences.

How should clinicians who work under circumstances different from those in this trial — that is, in high-income countries with access to intensive care units — or clinicians who care for adult patients interpret the results of this important trial? It seems clear that the results of this trial indicate that bolus-fluid resuscitation with either crystalloids or colloids in patients with compensated shock who do not have a clinical fluid deficit must be practiced with much greater caution than is now the case and with increased vigilance.

Fluid resuscitation is such a fundamental intervention in acute medicine that these results indicate that further high-quality research is urgently required to define appropriate practice for fluid resuscitation, including a study of the timing and rates of fluid administration and ways to monitor its effects. Similarly, a careful assessment of the safety, efficacy, and cost-effectiveness of various resuscitation fluids is mandatory before their incorporation into clinical practice.

The courage and dedication of the FEAST investigators and attending clinicians must be acknowledged, not only because of the quality of the research they conducted in this vitally important area of acute medicine, but also because they conducted a landmark trial in such challenging economic conditions in sub-Saharan Africa.

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

This article (10.1056/NEJMe1105490) was published on May 26, 2011, at NEJM.org.
Source Information

From the George Institute for Global Health and University of New South Wales, Sydney.

Dr Chow Yok Wai - MD, MRCP(UK), AM(Mal)

2011-05-29T22:02:00.000-07:00

1. Education
Basic Medical Qualification
University Attended: University of Science Malaysia
Degree Obtained: Doctor of Medicine (MD)
Date Awarded: 25th July 1999

MRCP (Member of the Royal College of Physicians)
Date Awarded: 22nd July 2003

2. Working Experience and Present Appointment
July 1999-October 2000
• Commenced internship training in Sultanah Aminah Hospital Johor Bahru
(HSAJB), Malaysia
• Underwent 18 months training in General Medicine, General Surgery
(Including Plastic Surgery, Urology, Neurosurgery and Paediatric Surgery),
Obstetrics and Gynaecology, Orthopaedics and General Paediatrics.
November 2000-March 2001
• Joined the Department of Medicine HSAJB as a medical officer
• Commenced subspeciality rotation in Nephrology
April 2001-October 2001
• Haematology rotation
November 2001-March 2002
• Neurology rotation
April 2002-November 2002
• Infectious Disease and Intensive Medicine rotation
December 2002-July 2003
• Cardiology, Respiratory Medicine, Gastroenterology and Endocrinology
rotation

July 2003-December 2004
• Granted membership to the Royal College of Physicians of United Kingdom
• Assigned to a 35 bedded general medical ward as general physician in Sultanah Aminah Hospital Johor Bahru, Malaysia upon completion of MRCP
January 2005-June 2006
• Commencement of Nephrology Subspeciality Training
(Nephrology Followship Programme) in HSAJB
July 2006-December 2007
• Completion of Nephrology Subspeciality Training in Kuala Lumpur
Hospital, Malaysia
January 2008- February 2010
• Attached to the Nephrology Unit, Department of Medicine, HSAJB as Consultant Nephrologist and Physician.

February 2010 – to date
• Consultant Nephrologist and Physician,
Hospital Pantai Ayer Keroh
75450, Melaka

3. Registration as a Medical Practitioner
5th July 2000
• Full registration with the Malaysian Medical Council

12th November 2008
• Full registration with the General Medical Council of United Kingdom

4. Official Gazettement by the Government of Malaysia (Ministry of Health)
22nd January 2005
• Gazetted as a Internal Medicine specialist

1st January 2008
• Gazetted as a Nephrologist

5. Professional Activities
2003
Clinical attachment in the New Royal Infirmary of Edinburgh, Scotland
Department of Nephrology

Position: Visiting Registrar
Supervisor: Dr Robin Winnie
Consultant Nephrologist
New Royal Infirmary of Edinburgh
Edinburgh

2008
Attended the Malaysian Nephrology Board Examination on 9th May 2008
Conducted by the Nephrology Board Malaysia
(Malaysian Society of Nephrology, Ministry of Health Malaysia, Academy of
Medicine, Malaysia)
Obtained the highest marks in the 2008 cohort

2008-2009
Awarded a full scholarship by the Public Services Department of Malaysia to
pursue a one year advance nephrology training in the field of vasculitis in Addenbrooke’s Hospital Cambridge University Hospitals NHS Foundation Trust

Position: Honorary Clinical Research Fellow

Supervisor: 1) Dr David Jayne
Director of Lupus and Vasculitis,
Addenbrooke’s Hospital
Cambridge University Hospitals NHS Foundation Trust

2) Professor Kenneth Smith
Cambridge Institute of Medical Research,
University of Cambridge,
United Kingdom.

2008- 2010
Coordinator for National Glomerulonephritis Registry, National Renal Registry
(Johor Bahru)

6. Professional Bodies
National
Member of the Malaysian Medical Association
Member of the Malaysian Society of Nephrology
Member of the Postgraduate Renal Society, Malaysia
International
Member of the Royal College of Physicians of Edinburgh
Member of the International Society of Nephrology
Member of the IgA International Network

7. Research Activities
Publications:-
Acute renal failure in the same hospital 10 years apart; A comparison of two prospective studies in Sultanah Aminah Hospital, Johor Bahru
Medical Journal of Malaysia Vol 62 No1 March 2007

Lactic acidosis in HIV patients receiving highly active antiretroviral therapy- the Johor Bahru experience
Medical Journal of Malaysia Vol 62 No 1 March 2007

Quality improvement in Department of Nephrology, Kuala Lumpur Hospital- an audit on clinical performance indicators
Journal of Quality Improvement Vol 10 No 2 2007

Rituximab in Behcet’s Disease
Submitted to Annals of Rheumatic Diseases for publication (May 2009)

Participation in clinical studies:-
National
HDP study- Hospitalisation rate among Dialysis Patients study (2007)

International
GIANT study- Greatest International Antibiotic Trial study (2006)

A randomized double blind placebo controlled multicenter study to evaluate the efficacy and safety of two doses of Ocrelizumab in patients with WHO or ISN Class III or IV nephritis due to systemic lupus erythematosus (2008)

A phase III multicentre, double blind, double dummy, randomized flexible dose comparative study of MCI-196 versus Simvastatin for the treatment of dyslipidaemia in subjects with chronic kidney disease on dialysis (2009)

Evaluation of chronic kidney disease patterns through the global information database (GRID) (2009)

Biologic therapies in neuro-behcet’s disease, an international collaborative case-series- neurobehcet study group, International Society of Behcet’s Disease (2009)

CHiC-TRIAD (Cambridge Hinxton Centre for Translational Research In Autoimmune Disease) (2008-2009)

MY-CYC (A randomised clinical trial of mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA associated vasculitis) (2008-2009)

Abstracts:-
National
OUTCOME OF A COMMUNITY BASED HEALTH SCREENING PROGRAMME DURING THE PUBLIC AWARENESS CAMPAIGN ON KIDNEY CARE IN JOHOR BAHRU, MALAYSIA
Oral Presentation- 22nd MSN Annual Seminar in Nephrology
Prevention of Chronic Kidney Disease

MYCOPHENOLATE MOFETIL IN RELAPSING LUPUS NEPHRITIS
23rd Malaysian Society of Nephrology Annual Seminar
Johor Bahru, Malaysia
11-13th April 2007

MYCOPHENOLATE MOFETIL IN MEMBRANOUS NEPHROPATHY
23rd Malaysian Society of Nephrology Annual Seminar
Johor Bahru, Malaysia
11-13th April 2007

International
ACUTE RENAL FAILURE IN THE SAME HOSPITAL 10 YEARS APART;
A COMPARISON OF TWO PROSPECTIVE STUDIES IN SULTANAH AMINAH
HOSPITAL, JOHOR BAHRU, MALAYSIA
Poster Presentation- 3rd World Congress of Nephrology
Post Congress Satellite Symposium
Acute Renal Failure: From Bench to Bedside
1st -3rd July 2005

LACTIC ACIDOSIS IN HIV PATIENTS RECEIVING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY- THE JOHOR BAHRU EXPERIENCE
Oral Presentation
14th IUSTI Asia Pacific International Conference- 27th to 30th July, 2006

ADULT POLYCYSTIC KIDNEY DISEASE IN PATIENTS ON DIALYSIS IN MALAYSIA
11th Asian Pacific Congress of Nephrology 2008

ELDERLY PATIENTS INITIATING DIALYSIS IN MALAYSIA
11th Asian Pacific Congress of Nephrology 2008

MALIGNANCY POST RENAL TRANSPLANTATION: A 25 YEAR EXPERIENCE
11th Asian Pacific Congress of Nephrology 2008

LATE ACUTE ANTIBODY MEDIATED REJECTION ASSOCIATED WITH CALCINEURIN INHIBITOR MINIMISATION
11th Asian Pacific Congress of Nephrology 2008

CASTLEMAN’S DISEASE OF THE KIDNEY IN PATIENT WITH SLE
11th Asian Pacific Congress of Nephrology 2008

CLINICAL BENEFITS OF ICODEXTRIN: A SINGLE CENTRE EXPERIENCE
11th Asian Pacific Congress of Nephrology 2008

‘SUDOKU’ INCREASES COGNITIVE FUNCTION IN HAEMODIALYSIS PATIENTS- A PROSPECTIVE PILOT STUDY (Awarded Best Abstract)
11th Asian Pacific Congress of Nephrology 2008

SHORT TERM INFECTIOUS COMPLICATIONS POST RENAL TRANSPLANT
11th Asian Pacific Congress of Nephrology 2008

Everyone must see this...

2011-04-03T00:16:00.000-07:00

s60 volvo- A car to look out for this month- Launching in Malaysia!

2011-03-04T17:19:00.000-08:00

Best Remake of Angry Birds

2011-03-04T17:16:00.001-08:00

Ignite your soul

2011-03-02T20:04:00.000-08:00

Funny funny funny!

2011-02-28T19:22:00.001-08:00

Volvo s40

2011-02-18T00:37:00.001-08:00

2010-11-25T19:28:00.000-08:00

Proton Waja Crash Test- Top gear

2010-11-24T06:21:00.001-08:00

HOW TO BE SUCCESSFUL IN THE BUSINESS OF PHOTOGRAPHY 2

2010-11-08T06:09:00.000-08:00

src='http://bhphoto.pb.feedroom.com/bhphoto/bhphoto/pboneclipab/player.swf?Environment=&SiteID=bhphoto&SiteName=bhphoto&SkinName=pboneclipab&ChannelID=&StoryID=75743751e7268e6cf515ed5fb32ddecab8b55d86&Volume=.5&MoreVideoURL=http%3A//www.video.bhphotovideo.com&tilenumber=&VideoPlayer.VideoPlayer1.SendEMailURL=http%3A//%25SiteID%25.feedroom.com/custom/playerbuilder/feedroom/sendMail.jsp&VideoPlayer.VideoPlayer1.MaximumNumberOfStories=&tilemargin=&videoratio=&detailsheight='

HOW TO BE SUCCESSFUL IN THE BUSINESS OF PHOTOGRAPHY

2010-11-08T06:07:00.000-08:00

HOW TO BE SUCCESSFUL IN THE BUSINESS OF PHOTOGRAPHY

2010-11-08T06:05:00.000-08:00

Regional Family Medicine Specialist Meeting- 30-31st October 2010, Bayview Hotel Melaka

2010-10-13T18:16:00.000-07:00

Between Life and Death- BBC. Addenbrooke's hospital, Cambridge

2010-08-21T06:50:00.000-07:00

Typical conversation between an orthopaedic surgeon and an anaesthetist

2010-08-21T06:32:00.000-07:00

Cardiometabolic Symposium- Dr Chow Yok Wai

2010-08-20T21:06:00.000-07:00

Venue: Trader's Hotel, Muar
Date: 27th August 2010

Dr Chow Yok Wai- CME for general practitioners. 1)Treating Diabetes Mellitus in 2010 The Role of DPP4 inhibitors 2) Hypertension in clinical practice

2010-08-16T03:07:00.000-07:00

Speaker:
Dr Chow Yok Wai
MD, MRCP(UK), AM(Mal)
Consultant Nephrologist and Physician
Hospital Pantai Ayer Keroh, Melaka

Topic:
1. Treating Diabetes Mellitus in 2010. The Role of DPP4 inhibitors
2. Hypertension in clinical practice

Venue:
Classic Hotel

Time:
7.00pm

Who should attend:
General practitioners
Medical officers

Kluang CME - 1) Diabetic Nephropathy by Dr CHow Yok Wai 2) Advances in Prostate Surgery by Dr Pang Kim Keng

2010-08-01T00:41:00.000-07:00

CME Talks in Kluang

1. Diabetic Nephropathy- What's new
Dr Chow Yok Wai,
Consultant Nephrologist and Physician,
Hospital Pantai Ayer Keroh, Melaka

2. Modern management of Prostate Diseases
Dr Pang Kim Keng
Consultant Urologist,
Hospital Pantai Ayer Keroh, Melaka

Date: 26th August 2010

Time: 5.00pm

Venue: To be announced

Target audience: Doctors

Hypertension- Translating guidelines into Clinical Practice- Dr Chow Yok Wai

2010-07-16T21:23:00.000-07:00

Topic : Hypertension- Translating guidelines into Clinical Practice

Speaker: Dr Chow Yok Wai, Consultant Nephrologist and Physician,
Hospital Pantai Ayer Keroh, Melaka

Date: 16/7/2010 7.00pm

Venue: Ramada Renaissance Melaka

Who should attend?
General Practitioners/Primary care physicians
Physicians/Registrar/Medical Officers

Public Forum- Yong Peng by Dr Chow Yok Wai and Dr Pang Kim Keng

2010-06-06T21:01:00.000-07:00

Date : 26/6/2010 (Saturday)

Venue : Yong Peng High School

(Jalan Sekolah Cina, 83700 Yong Peng, Johor)

Time : 6.30pm - 10.00pm

Target of Pax : 150 pax

Speakers: Dr Pang Kim Keng, Consultant Urologist, Hospital Pantai Ayer Keroh, Melaka

Dr Chow Yok Wai, Consultant Nephrologist, Hospital Pantai Ayer Keroh, Melaka

Programme : 6.30pm - Registration

7.00pm - Talk by Dr Pang and Q&A (Common Urological Diseases)

8.00pm - Talk by Dr Chow and Q&A (Protect you kidneys, Control diabetes)

9.00pm - Blood Pressure and Blood Glucose Screening

Beware of Singaporean females

2010-03-15T01:32:00.001-07:00

Organ Donation Commercial

2010-03-08T19:03:00.001-08:00

How to sell yourself

2010-02-09T19:32:00.000-08:00

To get ahead in life, you need to be in the business of selling.

The product? You !

When you think about it, if you cannot sell yourself as a person to others, you are going to have a difficult time selling them your ideas, your wishes, your needs, your ambitions, your skills, and your experience.

Despite the necessity of being able to sell yourself to others, for many people like myself it does not come naturally. Introversion, shyness, and lack of self-worth are just a few of the obstacles that can potentially get in the way. To overcome such obstacles, I suggest focusing on the following:

1. Be Sold on Yourself

This is probably also the hardest. Being sold on yourself comes down to this: you must be aware of your own self-worth. This means you believe in yourself, have faith in yourself, and have confidence in yourself.

Here are just 3 ideas that may help:

* Live in such a way that you would want to be friends with yourself
* Find some time to reflect on what you like about yourself. If this seems hard, start with the smallest of attributes.
* Don’t do anything that will give you cause to feel ashamed later.

2. Have a Saleable Package

Let others know about the inner contents of your package.
People judge others based on their appearance.
Therefore, some questions you may consider asking yourself are:
am I looking after my appearance to the best of my ability?
Are my clothes appropriate for the image I wish to project?

3. Be Positive and Enthusiastic

Positivity and enthusiasm can both be developed, but once again it takes work. Here are a few tips to help you:

* Look for the best in people
* Associate with positive people
* Care deeply about something
* See life as an adventure
* Smile

4. Be Real and Authentic

Selling yourself is about letting others know who you are as a person.

Mycophenolate mofetil and intravenous cyclophosphamide are similar as induction therapy for class V lupus nephriti

2010-02-03T06:51:00.000-08:00

Original Article

Kidney International (2010) 77, 152–160; doi:10.1038/ki.2009.412; published online 4 November 2009
Mycophenolate mofetil and intravenous cyclophosphamide are similar as induction therapy for class V lupus nephritis

Jai Radhakrishnan1,6, Dimitrios-Anestis Moutzouris2,6, Ellen M Ginzler3, Neil Solomons4, Ilias I Siempos5 and Gerald B Appel1

Class V lupus nephritis (LN) occurs in one-fifth of biopsy-proven cases of systemic lupus erythematosus. To study the effectiveness of treatments in this group of patients, we pooled analysis of two large randomized controlled multicenter trials of patients with diverse ethnic and racial background who had pure class V disease. These patients received mycophenolate mofetil (MMF) or intravenous cyclophosphamide (IVC) as induction therapy for 24 weeks, with percentage change in proteinuria and serum creatinine as end points. Weighted mean differences, pooled odds ratios, and confidence intervals were calculated by using a random-effects model. A total of 84 patients with class V disease were divided into equal groups, each group had comparable entry variables but one received MMF and one received IVC. Within these groups, 33 patients on MMF and 32 patients on IVC completed 24 weeks of treatment. There were no differences between the groups in mean values for the measured end points. Similarly, no difference was found regarding the number of patients who did not complete the study or who died. In patients with nephrotic syndrome, no difference was noted between those treated with MMF and IVC regarding partial remission or change in urine protein. Hence we found that the response to MMF as induction treatment of patients with class V LN appears to be no different from that to IVC.

My Humble Clinic

2010-01-31T05:31:00.000-08:00

Protect your kidneys control diabetes- Health Forum 6th March 2010

2010-01-29T00:27:00.000-08:00

Experts: Sitting too much could be deadly

2010-01-21T01:19:00.001-08:00

LONDON – Here's a new warning from health experts: Sitting is deadly.

Scientists are increasingly warning that sitting for prolonged periods — even if you also exercise regularly — could be bad for your health. And it doesn't matter where the sitting takes place — at the office, at school, in the car or before a computer or TV — just the overall number of hours it occurs.

Research is preliminary, but several studies suggest people who spend most of their days sitting are more likely to be fat, have a heart attack or even die.

In an editorial published this week in the British Journal of Sports Medicine, Elin Ekblom-Bak of the Swedish School of Sport and Health Sciences suggested that authorities rethink how they define physical activity to highlight the dangers of sitting.

While health officials have issued guidelines recommending minimum amounts of physical activity, they haven't suggested people try to limit how much time they spend in a seated position.

"After four hours of sitting, the body starts to send harmful signals," Ekblom-Bak said. She explained that genes regulating the amount of glucose and fat in the body start to shut down.

Even for people who exercise, spending long stretches of time sitting at a desk is still harmful. Tim Armstrong, a physical activity expert at the World Health Organization, said people who exercise every day — but still spend a lot of time sitting — might get more benefit if that exercise were spread across the day, rather than in a single bout.

That wasn't welcome news for Aytekin Can, 31, who works at a London financial company, and spends most of his days sitting in front of a computer. Several evenings a week, Can also teaches jiu jitsu, a Japanese martial art involving wrestling, and also does Thai boxing.

"I'm sure there are some detrimental effects of staying still for too long, but I hope that being active when I can helps," he said. "I wouldn't want to think the sitting could be that dangerous."

Still, in a study published last year that tracked more than 17,000 Canadians for about a dozen years, researchers found people who sat more had a higher death risk, independently of whether or not they exercised.

"We don't have enough evidence yet to say how much sitting is bad," said Peter Katzmarzyk of the Pennington Biomedical Research Center in Baton Rouge, who led the Canadian study. "But it seems the more you can get up and interrupt this sedentary behavior, the better."

Figures from a U.S. survey in 2003-2004 found Americans spend more than half their time sitting, from working at their desks to sitting in cars.

Experts said more research is needed to figure out just how much sitting is dangerous, and what might be possible to offset those effects.

"People should keep exercising because that has a lot of benefits," Ekblom-Bak said. "But when they're in the office, they should try to interrupt sitting as often as possible," she said. "Don't just send your colleague an e-mail. Walk over and talk to him. Standing up."

1st fistulogram by nephrologist in MOH, Malaysia. Well Done !!! Only in Hospital Kuala Lumpur. The best hospital for nephrology in Malaysia

2010-01-15T23:14:00.000-08:00

2010-01-12T23:29:00.001-08:00

Renal and cardio-protective effects of direct renin inhibition: a systematic literature review

2010-01-11T00:22:00.000-08:00

Journal of Hypertension
Issue: Volume 27(12), December 2009, p 2321–2331
Copyright: © 2009 Lippincott Williams & Wilkins, Inc.
Publication Type: [Meta-analyses]

aDepartment of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
bGeorge Institute for International Health, University of Sydney, Sydney, Australia

Results: Fifty-two articles were included. Blood pressure reductions were generally insufficient using early generation DRIs. However, recent DRIs have greater blood pressure-lowering effects. Preclinical and clinical studies showed profound effects of DRIs on markers of renal function, including clear increases in renal plasma flow and reductions in albuminuria. These effects were observed either alone or in combination with other RAAS inhibitors and suggest potential large renal protective benefit. DRIs improved hemodynamic cardiovascular parameters, such as total peripheral resistance, arterial pressure and left ventricular mass index, to a similar extent as those observed with other RAAS inhibitors. Furthermore, addition of DRIs to optimal heart failure treatment resulted in further reductions in B-type natriuretic peptide.

Conclusions: Evidence from preclinical and clinical studies suggests that DRIs may have renal and cardiovascular effects beyond their ability to lower blood pressure. Results of ongoing hard outcome trials are awaited to definitively assess the renal and cardio-protective effects of these agents.

Do COX-2 inhibitors raise blood pressure more than nonselective NSAIDs and placebo? An updated meta-analysis. Chan, Clara, Reid, Christopher, Aw, Tai-

2010-01-11T00:20:00.000-08:00

Journal of Hypertension
Volume 27(12) December 2009
(C) 2009 Lippincott Williams & Wilkins, Inc.

Conclusion: On the basis of this updated meta-analysis, coxibs appear to produce greater hypertension than either ns-NSAIDs or placebo. However, this response was heterogeneous, with markedly raised BP associated with rofecoxib and etoricoxib, whereas celecoxib, valdecoxib and lumiracoxib appeared to have little BP effect. The relationship of this increased risk of hypertension to subsequent adverse CV outcomes requires further investigation and prospective RCTs.

Vadai recipe

2009-10-08T06:45:00.000-07:00

Ingredients

200g dhall (lentils)
a bit of water
1/4 tsp cumin
1 green chili-finely sliced
1 red chili - finely sliced
1 tsp of turmeric powder
1 sprig curry leaves, finely chopped
1/2 an onion, finely chopped
salt and pepper to taste
1 tbsp rice flour

Tofu fah recipe

2009-10-06T05:58:00.001-07:00

250g of soaked soya beans (soak for 6-8 hours) + 6 cups of water
Blend and stain using a cloth
Cook over low heat
Add few screw pine leaves for fragrance

Into a container, add
1.5 tablespoon cornstarch
1/2 tablespoon of gypsum (sek-ko)
30mls water
Mix thoroughly

When the soya bean milk comes to a boil, pour into the container containing the sypsum and cornstarch.
Cover the pot with a kitchen towel, followed by the lid.
Then let it set for 30min. (DO NOT STIR! just let it sit quitely for 30minutes!. Your patience will be rewarded)
Serve with sugar syrup.

Steve Jobs is back

2009-09-11T06:03:00.001-07:00

We should make him ambassador of Malaysia's organ transplant programme.

Potong saga

2009-08-21T01:11:00.000-07:00

http://15malaysia.com/films/potong-saga/

The 'Best Hospitals' for 2009 in US

2009-08-07T22:09:00.001-07:00

The 'Best Hospitals' for 2009 in US

Hospitals are listed below by total points. Here are the 21 hospitals that made the magazine's honor roll (two are tied for 10th place):

1. Johns Hopkins Hospital, Baltimore
2. Mayo Clinic, Rochester, Minn.
3. Ronald Reagan UCLA Medical Center, Los Angeles
4. Cleveland Clinic
5. Massachusetts General, Boston
6. New York-Presbyterian University Hospital of Columbia and Cornell
7. University of California-San Francisco Medical Center
8. Hospital of the University of Pennsylvania, Philadelphia
9. Barnes-Jewish Hospital/Washington University, St. Louis
10. Brigham and Women's Hospital, Boston
11. Duke University Medical Center, Durham, N.C.
12. University of Washington Medical Center, Seattle
13. UPMC-University of Pittsburgh Medical Center
14. University of Michigan Hospitals and Health Centers, Ann Arbor
15. Stanford Hospital and Clinics, Stanford, Calif.
16. Vanderbilt University Medical Center, Nashville, Tenn.
17. New York University Medical Center
18. Yale-New Haven Hospital, New Haven, Conn.
19. Mount Sinai Medical Center, New York
20. Methodist Hospital, Houston
21. Ohio State University Hospital, Columbus

Top Hospitals by Specialty

Here are the No. 1 hospitals in each specialty, according to U.S. News and World Report:

* Cancer: M.D. Anderson Center, University of Texas, Houston
* Diabetes and endocrine disorders: Mayo Clinic, Rochester, Minn.
* Digestive disorders: Mayo Clinic
* Ear, nose, throat: Johns Hopkins Hospital, Baltimore
* Geriatric care: Ronald Reagan UCLA Medical Center, Los Angeles
* Gynecology: Brigham and Women's Hospital, Boston
* Heart and heart surgery: Cleveland Clinic
* Kidney disorders: Brigham and Women's Hospital
* Neurology and neurosurgery: Mayo Clinic
* Ophthalmology: Bascon Palmer Eye Institute, University of Miami
* Orthopaedics: Mayo Clinic
* Psychiatry: Massachusetts General, Boston
* Rehabilitation: Rehabilitation Institute of Chicago
* Respiratory disorders: National Jewish Hospital, Denver
* Rheumatology: Johns Hopkins Hospital
* Urology: Johns Hopkins Hospital

First doctor to die from H1N1 infection

2009-08-06T21:01:00.001-07:00

A British GP has recently been reported to have died after catching H1N1

Dr Michael Day, from Bedfordshire, north of London, died on Saturday at Luton and Dunstable Hospital, local NHS officials said.
Tests showed he had tested positive for the H1N1 virus, known as swine flu, although the exact cause of death was still unknown.

While details are sketchy at this point in time, it is a warning to healthcare workers that they must be vigilant and continue to take protective measures. In the US, at least 81 healthcare workers have contracted H1N1 according to the CDC, about half most likely in a healthcare setting. In the MMWR reminds healthcare workers the importance to adhering to infection control guidelines:

Routine infection-control recommendations to decrease the risk for transmission of seasonal influenza to HCP include vaccination, isolation of infected patients in single rooms, and use of standard precautions and droplet precautions. For infections with the novel influenza A (H1N1) virus, because of the lack of a vaccine and little initial information regarding the severity and transmissibility of the virus, CDC’s interim infection-control recommendations for the care of patients with such infections have included the use of fit-tested N95 respirators, eye protection, and contact precautions in addition to routine infection-control practices applied to seasonal influenza. In addition, CDC has recommended that aerosol-generating procedures (e.g., bronchoscopy) should be performed in an airborne infection–isolation room with negative pressure air handling. In this analysis, among the 11 HCP infected because of probable or possible patient to HCP transmission for whom information was available, none adhered to these recommended practices completely.

The Malaysian public should appreciate our healthcare system where the dedicated under-appreciated workforce of nurses, MAs, doctors etc. face healh hazards daily in the course of their work. I don’t think we are going to see a situation like in Argentina where there are reports of some hospitals where 40% of workers did not show up for work.
The WHO has sounded the clarion call for a vaccine. This is needed urgently and the priority should go to healthcare workers who are in the front-line. The Health Minister has made a similar pronouncement. Development and supply of the vaccine is still months away so the only thing we can do is be vigilant and take infection control precautions.

iphone 4G

2009-07-31T20:13:00.001-07:00

What's the best smartphones for physicians

2009-06-19T08:24:00.000-07:00

This is one of those topics that gets debated endlessly (unless you're in a room full of Apple lovers). What's the best smartphone for a medical student, resident, or attending physician?

Several years ago, the answer would have been simple: Palm Treo. Then, the answer may have evolved to: Treo (either Palm OS or Windows Mobile). After the Apple iPhone came out, the resounding consensus among young physicians was: iPhone. Now, we see doctors carrying the BlackBerry Storm (among other BlackBerry devices). There's a newer version of the BlackBerry Storm that's coming out. The Palm Pre running Web OS is a hot new phone that has many people excited, but will it beat out the iPhone? The Palm Pre has a hardware button keyboard, so that may be a very attractive feature for people who want to type quickly. What about all those Windows Mobile users out there? I admit that I'm still one of them and I use an older HTC Windows Mobile device (the xv6800 which is also known as the Sprint Mogul and HTC Titan).

So which phone is the best? It's so difficult to answer because technology evolves too quickly. We can't keep up with the advances and as soon as you buy what you think is the "best" phone, a new mobile device pops up that's faster, cooler, and better.

2009-05-26T01:32:00.001-07:00

Palm Pre

2009-05-26T01:23:00.000-07:00

UK MP's expenses

2009-05-20T23:50:00.000-07:00

Just ridiculous..

Gordon Brown claimed £1,403.90 for cleaning bills

David Cameron claimed for a £150 plumbing bill

Douglas Alexander claimed £420 for new garage doors

Shaun Woodward claimed for his newspapers and magazines including the £1.50 Private Eye

Jack Straw claimed £399 for a TV

Geoff Hoon claimed £378.95 for a washing machine

John Prescott claimed £112.52 for repairs to a toilet seat

Paul Murphy claimed £6 for a tin opener

Margaret Beckett claimed £600 for a hanging basket

Caroline Flint calimed £162.16 for a boiler

Hazel Blears claimed £519 for bedding

Nick Harvey claimed £30 per month for his Sky Sports subscription

Julia Goldsworthy claimed £1,200 for a rocking chair

Andrew George, the MP for St Ives, claimed £847 a month on mortgage interest payments for the riverside flat that his student daughter lives in

Chris Huhne claimed for a £119 trouser press

Dick Clegg claimed £760 for gardening

Lembit Öpik claimed £40 for a summons for non-payment of council tax

Steve Webb claimed 99p for dusters

Cheryl Gillan put in a claim for £4.47 for dog food

Chris Grayling claimed £2,250 for decoration to his second home

David Willetts claimed back £115 plus VAT for changing lightbulbs in his home

Francis Maude claimed £3,020 for food

Kenneth Clarke claimed £1,024 for cleaning

Oliver Letwin claimed £2,000 to have a pipe repaired under his tennis court

Theresa Villiers claimed £164.50 to fix a leak in her flat

Peter Mandelson claimed £10.49 for a TV licence

David Miliband claimed £145.96 for a pram

Andy Burnham claimed £19.99 for a bathrobe

Alistair Darling claimed £2,339 for a magnolia carpet

America's Best- and Worst-Paying Jobs

2009-05-10T21:26:00.000-07:00

by Klaus Kneale, Forbes.com

It's still better to be a doctor than a dicer. Food preparation and serving remains the nation's lowest-paid line of work, while the medical field still offers the nine best-paid jobs in the U.S.

According to the U.S. government's newly released Occupational Employment and Wage Estimates, based on 2008 data, the typical surgeon makes an average of $206,770 a year. That puts surgeons above anesthesiologists to have the best-paying job in the country.

Internists now earn a little more than prosthodontists (people who make and fit false teeth). Otherwise, the top 10 jobs rank the same as a year ago. The biggest change is a nearly $10,000-a-year drop in pay for natural sciences managers, meaning people who run labs and research facilities.

Announcing arrival of my 5D Mark II

2009-05-10T00:59:00.000-07:00

ISO 1600 (above) ISO 400 (below) is shot in sRAW1 with 24-70L USM f/2.8

April 2009...
Announcing the arrival of my 5D II

It will change my way of photography...
forever...

2009-05-10T00:36:00.000-07:00

Flawless- Britains got talent 2009

2009-04-23T13:00:00.000-07:00

Ultrasound Imaging Now Possible With Smartphone- ScienceDaily (Apr. 22, 2009)

2009-04-23T02:54:00.000-07:00

Computer engineers at Washington University in St. Louis are bringing the minimalist approach to medical care and computing by coupling USB-based ultrasound probe technology with a smartphone, enabling a compact, mobile computational platform and a medical imaging device that fits in the palm of a hand.

Rita Levi Montalcini, Nobel Prize-Winning Scientist Turns 100, Still Works

2009-04-23T02:51:00.000-07:00

The Huffington Post 23/4/2009

ROME — Rita Levi Montalcini, a Nobel Prize-winning scientist, said that even though she is about to turn 100, her mind is sharper than it was she when she was 20.

Levi Montalcini, who also serves as a senator for life in Italy, celebrates her 100th birthday on Wednesday, and she spoke at a ceremony held in her honor by the European Brain Research Institute.

She shared the 1986 Nobel Prize for Medicine with American Stanley Cohen for discovering mechanisms that regulate the growth of cells and organs.

"At 100, I have a mind that is superior _ thanks to experience _ than when I was 20," she told the party, complete with a large cake for her.

The Turin-born Levi Montalcini recounted how the anti-Jewish laws of the 1930s under Benito Mussolini's Fascist regime forced her to quit university and do research in an improvised laboratory in her bedroom at home.

"Above all, don't fear difficult moments," she said. "The best comes from them."

"I should thank Mussolini for having declared me to be of an inferior race. This led me to the joy of working, not any more unfortunately, in university institutes but in a bedroom," the scientist said

Budget 2009- UK

2009-04-23T01:03:00.000-07:00

Alistair Darling has said the UK will have to borrow a record £175bn as he admitted the economy faces its worst year since the Second World War.

The chancellor tore up a key New Labour election pledge by unveiling a new 50% tax rate for earnings over £150,000.

He also cut future spending plans in a Budget which added 2% on fuel, 1% on a pint of beer and 7% on cigarettes.

Talent + Luck = Success

2009-04-22T10:34:00.000-07:00

This was what happened to Paul Potts.

Handphone salesman in UK.

Stunned the judges and subsequently won the 2007 Britains got talent contest.

It all about usual people with normal occupation but has undiscovered talent.

Miss England 2009 Cambridge, UK

2009-04-22T04:27:00.000-07:00

Aiya..

Will be missing this event on the 25th April 2009.
Should be a good place to practice portrait photography.

Susan Boyle- greatest ever youtube hit in a week

2009-04-22T01:52:00.000-07:00

Everyone here in UK is just talking about this lady.
The number of youtube hits has now been > 100million
That's five times more than President Obama's first presidential speech!

When Susan Boyle walked on Britain’s Got Talent’s stage on Saturday 11th April, the judges and the audience thought that she was going to be rubbish and just laughed at her. Her appearance made everyone snigger, making them think she was going to be an instant failure. It was basically a case of judging a book by it’s cover.

However, when she opened her mouth to sing “I Dreamed a Dream” from Les Misérables, everyone was shocked: her beautiful voice surprised everyone. The judges were so impressed with her performance, they gave her the “biggest yes in three seasons” and even brought tears to Amanda’s eye.

Susan is the baby of nine children and lives in West Lothian with her cat named Pebbles. She’s unemployed, and gave up singing to look after her sick mother who died at the age of 91 in 2007. She apparently has learning disabilities as well.

And she claims that she has never gone out on a date or kissed by a man before.

Websites have been dedicated to her..
Souvenirs are now available as well..
She is also now in Wikipedia
She has been dubbed "The Woman Who Shut Up Simon Cowell"
This competition is only in its first round this year and Cowell is reported to be setting up a contract with Boyle with his Syco Music company.

Lobster dinner

2009-04-21T23:57:00.000-07:00

Managed to buy 3 average size lobsters from ASDA at 7 pounds each.

Cooked it the following way:-

Lobster head- cooked in a Japanese broth (consisting of Konbu kelp, Wakame seaweed, apples, spring onions, mushrooms, rice wine, onions)
Served with soba noodles

Lobster body- Grilled with olive oil, white wine, spring onions and salt.

Photos taken by my housemate using Canon EOS 450D with kit lens.

Britains got talent

2009-04-21T14:13:00.000-07:00

Nikon D5000

2009-04-20T08:46:00.000-07:00

This would be the Canon EOS 500D contender?

The 12.3Mp D5000 will sit between the Nikon D60 and D90 in the Nikon range, and is designed to appeal to those upgrading from a compact camera or less advanced DSLR.

Main features:-
* Sensor: 12.3 megapixel CMOS
* Autofocus: Multi Cam 1000 (11-AF points)
* Flash Sync: 1/200s
* Frame Rate: Up to 4fps
* ISO Range: 200-3200 (base) plus 100 to 6400 (extended)
* Built-in flash supports CLS
* Live View with Face-detection mode
* Movie Mode (1280x720@ 24 fps)
* LCD: 2.7 inch on swivel mount
* Battery: En-EL9a; can support AA batteries
* Dimensions: 5x4.1x3.1 inches
* Weight: 560g (1lb., 4 oz)

More about some of the features:-

Vari-angle LCD

The live view LCD on the Nikon D5000 measures 2.7 inches.
Apparently, it is twistable to many different angles, helping you compose pictures over a crowd above your head, at ground level or even all the way round to help you take self-portraits.
It can also be turned round to face into the camera body for protection when not in use.

HD movie recording

Like its slightly bigger brother the Nikon D90, the D5000 can record movies in HD format - in this case 720p. There's an HD connection for viewing at best quality on a high-definition-ready TV.

Price: approx. 600 pounds

Should I be waiting?

2009-04-20T08:25:00.000-07:00

New Canon DSLRs?

Canon has 5 main lines of DSLR cameras:

* Studio
* Photojournalist / Sports
* Prosumer
* 5D Full Frame / Small Body
* Beginner / Entry Level

Rumours.....

Studio

* Sep 2002 - 1Ds
* Sep 2004 - 1Ds Mark II
* Aug 2007 - 1Ds Mark III

2009--> 1Ds Mark IV

Photojournalist / Sports

* Sep 2001 - 1D
* Jan 2004 - 1D Mark II
* Aug 2005 - 1D Mark IIn
* Feb 2007 - 1D Mark III

2009--> 1D Mark IV

5D Full Frame / Small Body

* Aug 2005 - 5D
* Sep 2008 - 5D Mark II

2010 --> 5D Mark III

Prosumer / Advanced Amateur

* Feb 2003 - 10D
* Aug 2004 - 20D
* Feb 2006 - 30D
* Aug 2007 - 40D
* Aug 2008 - 50D

2009 --> 60D

Beginner / Entry Level

* Aug 2003 - 300D
* Feb 2005 - 350D
* Aug 2006 - 400D
* Jan 2008 - 450D
* Jun 2008 - 1000D

2009 --> 500D, 2000D

Should we be waiting....???

Canon 500D

2009-04-20T04:25:00.001-07:00

Just 14 months after the launch of the EOS 450D, Canon has unveiled its latest model, the 500D.

It's basically a 50D stuffed into a 450D

Here's what you get:-
* 15.1 Megapixel APS-C CMOS sensor
* Full HD movie recording with HDMI connection for viewing and playback on an HDTV
* ISO 100-3200 (expandable to 12800)
* 3.4 frames per second continuous shooting
* Max. 170 large JPEG images in a single burst
* 3.0” ClearView LCD with Live View mode
* 9-point wide area AF with cross type centre point
* High speed DIGIC 4 performance and superb image quality
* EOS Integrated Cleaning System
* Full compatibility with Canon EF and EF-S lenses and EX-series Speedlites, including new Speedlite 270EX, TS-E 17mm f/4L and TS-E 24mm f/3.5L II

Uses SD card.

Price- USD800/= Body only

Pasta recipe

2009-04-19T07:12:00.000-07:00

Here's the most basic recipe.
There are many variations to the recipe.

5eggs
500gm (4 cups) flour
1 egg to 7/8cup(100gm) of all purpose flour.
1/2 tsp salt.

That's it.

Add all ingredients and mix it into a smooth dough (Knead for at least 15 min).
Shape into a ball and wrap in a plastic wrap/kitchen foil.
Leave it for 1 hour before making your pasta (hand made/machine).

Pasta secca= pasta made from durum semolina (rarely made at home).

Pasta fresca= made from wheat flour.

Wildlife photographer of the year

2009-04-19T04:29:00.000-07:00

On Saturday, I visited London again specifically to attend the Wildlife Photographer of the Year exhibition in Natural History museum in London. The museum is free but this exhibition is £6.9o.

So was it worth it?

It was absolutely superb, truly inspirational photography and contentious enough to keep us all (my housemates) arguing about which shots should have won. Entries were from over 80 different countries and more than 130,000 photos (30,000+ photgraphers took part). Therefore, chosen pics were really of high quality.

Go to the Natural History Museum UK website if you want to have a peek at the winning pics.

Winner's camera
75%- Shot with canon DSLR
Of these- 70%- 1 series
25%- 5D
5%- 20D, 30D, 40D etc
2 pics taken from Canon 400D (kids category)
20%- Shot with Nikon DSLR
Mostly D700

5%- other DSLR (and 3-4 pics from compact cameras)

Adult categories

You can enter up to three digital images or scans of transparencies in each of the following categories.
1. Animals in Their Environment
2. Behaviour: Birds
3. Behaviour: Mammals
4. Behaviour: All Other Animals
5. The Underwater World
6. Animal Portraits
7. In Praise of Plants
8. Urban and Garden Wildlife
9. Nature in Black and White
10. Creative Visions of Nature
11. Wild Places

Prizes

The title Veolia Environnement Wildlife Photographer of the Year is given to the single image judged to be the most striking and memorable of all the entries. The winning photographer will receive £10,000, which is presented at an awards ceremony at the Natural History Museum in London in October. Each category winner receives £500 and each runner-up £250. Special award winners receive £1,000.

Winning and commended images are displayed in an exhibition at the Natural History Museum, London, then tour around the UK and internationally. The pictures will also be published in a hardback portfolio book.

By the way the 2009 entry is closed.

And the exhibition ends on the 24th April 2009.

Catch it if you happen to be in London.

Ian Tomlinson- a mirror image

2009-04-17T13:17:00.000-07:00

The police officer suspended following the death of Ian Tomlinson during the G20 protests has been questioned on suspicion of manslaughter after a second postmortem examination showed the newspaper vendor did not die of a heart attack.

The findings released today show Tomlinson, who was thrown to the ground by a Met officer during the protests, died from an abdominal haemorrhage.

The dramatic shift led the Independent Police Complaints Commission to confirm that the officer under investigation in connection with the alleged assault had been questioned about manslaughter.

Tomlinson's family believe today's findings make a manslaughter charge against the officer more likely. His son Paul King said: "First we were told that there had been no contact with the police, then we were told that he died of a heart attack; now we know that he was violently assaulted by a police officer and died from internal bleeding. As time goes on we hope that the full truth about how Ian died will be made known."

Tomlinson, 47, collapsed and died moments after being attacked from behind by a Metropolitan police territorial support group (TSG) officer on 1 April at about 7.20pm. The constable, whose identifying badge number was not on display, has not been identified.

He had been trying to make his way home from work when he was confronted by police, hit with a baton and thrown to the ground. Initially, police said he had previously had no contact with the police, and alleged that medics were impeded from helping him as "a number of missiles – believed to be bottles – were being thrown at them".

A couple of days later, the Guardian published a photograph of him lying at the feet of police officers, along with the testimony of three witnesses who described him being hit with a baton or thrown to the ground by police. The IPCC criticised the Guardian for upsetting Tomlinson's family and briefed other journalists that there was "nothing in the story" that he had been assaulted by an officer.

It was only when video footage emerged that the officer responsible was suspended and a criminal inquiry launched.

An initial postmortem, by the Home Office pathologist Dr Freddy Patel, found that Tomlinson died after suffering a heart attack. But Dr Nat Cary, the pathologist who carried out a second postmortem at the request of the IPCC and Tomlinson's family, concluded that while there was evidence Tomlinson suffered hardening of the arteries in his heart, it was not serious enough to kill him.

Jules Carey, of Tuckers, the solicitor representing Tomlinson's family, said today that "the video footage of the unprovoked and vicious assault on Ian by the police officer would easily justify charges of assault being brought against the officer. The findings of Dr Nat Cary significantly increase the likelihood that the officer will now face the more serious charge of manslaughter."

He said the family had been aware of the findings of the second pathology report for a week and had been forced to endure "continuing reports in the press that Ian died of a heart attack".

Carey added: "The IPCC opposed the disclosure of Dr Cary's findings until they satisfied themselves that it would not prejudice their investigation of the officer. It is of some comfort to the family that the record is now being put straight, but they hope that the IPCC investigation will be expedited and thorough, and that there will be a prompt referral to the CPS for charge."

A statement from the City of London coroners court said: "Dr Cary's opinion is that the cause of death was abdominal haemorrhage. The cause of the haemorrhage remains to be ascertained. Dr Cary accepts that there is evidence of coronary atherosclerosis but states that in his opinion its nature and extent is unlikely to have contributed to the cause of death."

The IPCC has previously said CCTV footage showed Tomlinson walking up King William Street after 7pm and approaching one of several police cordons opposite the Bank of England.

Denis O'Connor, the chief inspector of constabulary, who will carry out the review, said this week he would examine all aspects of the Met's public order policing, including techniques such as kettling – the containment of thousands of protesters inside police cordons for hours at a time.

O'Connor has been called in by the Met commissioner, Sir Paul Stephenson, who said the move had been prompted by concern over policing of the G20 protests. The Met will scour its own surveillance footage of the demonstrations in the City of London to search for further evidence of police misconduct.

Susan Boyle- A wake-up call (must see for everyone)

2009-04-17T12:42:00.000-07:00

Stream completely before watching.
It's worth the trouble.

Jurong Bird Park- next mission

2009-04-15T08:34:00.000-07:00

Jurong Bird Park is a 20.2 hectare open-concept park.
It is the largest in the Asia Pacific and the best in the world.
Its has more than 8,000 birds from 600 species and is among the largest in the world.

The Park has four walk-in aviaries, among which is the world’s largest walk-in aviary with the tallest man-made waterfall for visitors to enjoy a close-up view of free-flying birds from Africa.

The Bird Park’s exhibits and aviaries are specially designed to closely resemble the natural habitats of the birds.

Admission: SGD 18/= (Less than 10 pounds....)

Anyone interested?

Engtong has Manfrotto spare parts

2009-04-15T00:34:00.000-07:00

Below is reply email from Engtong

Thank you for your inquiry. The spare part is is in stock 2 pcs.

R488.10 = RM29.00

Shipping = RM 8.00

Payment to:
EngTong Systems Sdn Bhd
MBB Bank a/c no: 012231403165

Have a pleasant day.

Sincerely,
Ronnie Koh, General Manager

www.engtong.com

Missing Manfrotto Ball Head Lock

2009-04-14T09:52:00.000-07:00

Only now I know what it's like to be without my manfrotto tripod.

I lost the ball lock (R488.10)! (The knob which we turn to lock the ball head)

It must have dropped off during my cycling trip to Cambridge City 1 week ago.

Tried to email EngTong but no reply (as usual- Malaysian service. Only interested in selling the tripod and could be bothered to help you out with a screw!).

Hope to get the replacement parts while in UK.

Hasbean Coffee

2009-04-13T13:07:00.000-07:00

As they do not send coffee to Malaysia, I had no choice but to buy and carry it all the way back.

Bought 6 varieties from all 3 continents- Africa, South America, Asia

These are all 5 star coffee..

Just can't wait to taste them.

How to photograph birds in flight!

2009-04-13T08:11:00.000-07:00

From my previous postings, you would have known that I had a recent weekend outing in the London Zoo.
My main aim was bird photography as they are difficult creatures to shoot.
So I thought shooting birds in a zoo would be easier.
But I was wrong!
It is easier (as they are tame) but I have yet to get the pics that I expect.
I tried the following strategies:-

Equipments: Canon 70-200mm f/4 IS USM L
Canon 350D

Focus
I put my Canon 350D into AI Servo mode.
These modes let the cameras track moving subjects.
I then set the camera to use all the focus sensors (Unfortunately, there's only 5 in the 350D).
This mode let the camera use different AF sensors as the bird flies around in your frame.

It's tough to get into focus if it's flying in front of a background, and even tougher if the bird is flying in between trees.

I am going to the Wildlife photography exhibition next week in London to find out more.

But is it the limitation of the camera?
Would a 5DII or 1 series help??
Or is it just pure lack of skills?
What's the best shutter speed to use?

ZSL London Zoo, UK

2009-04-13T03:22:00.000-07:00

To start, here are the following facts:-

1. It is over 180 years old
2. World's first scientific zoo
3. Founded by Sir Stamford Raffles
4. Houses 750 species
5. Numerous categories to explore:-
Into Africa
Butterfly paradise
Gorilla Kingdom
Meet the Monkeys
Aquarium
Reptile house

Any good?

Great place for kids- they will love it for sure!
Lots of activities just for them as they have a recently created 2.3 million pounds children zoo (Superb!)

Downside:-

Not very impressive animal collection.

Many animals are still enclosed (compared to the other open concept zoos).

Expensive (18.50 pounds for adult entry, 13.50pounds for children)

Of course they have the family package ..etc but it's going to hurt the pocket if you are bringing the entire family.

Verdict: 7/10

Advice:
1.You can skip this zoo if you have visited other zoos listed in the top 10 list
(Unless you are going there mainly for the kids to have a good time)
2. Bring your own food
3. Expect spending at least 4-6 hours there
4. Make sure your children was their hands after petting the animals (to avoid contracting HSP)

Here is a list of the top ten zoos in the world:

1. Tiergarten Schönbrunn (Vienna Zoo), Vienna, Austria
2. Bronx Zoo, New York City, U.S.A.
3. Berlin Zoo, Berlin, Germany
4. Jerusalem Biblical Zoo, Jerusalem, Israel
5. Singapore Zoological Gardens, Singapore, Singapore (Entrance SGD 18/=)
6. Bermuda Aquarium, Museum and Zoo, Flatts Village, Bermuda
7. London Zoo, London, England
8. Johannesburg Zoo, Johannesburg, South Africa
9. Beijing Zoo, Beijing, China
10. Belize Zoo, Belize City, Belize

Bridge holding Antarctic ice shelf shatters

2009-04-06T00:36:00.000-07:00

Monday, April 06, 2009

By Alister Doyle, Oslo

AN ice bridge which had apparently held a vast Antarctic ice shelf in place during recorded history has shattered and could herald a wider collapse linked to global warming, a leading scientist said.

"It’s amazing how the ice has ruptured. Two days ago it was intact," David Vaughan, a glaciologist with the British Antarctic Survey, said of a satellite image of the Wilkins Ice Shelf on the Antarctic Peninsula. The satellite picture, from the European Space Agency (ESA), showed that a 40km long strip of ice believed to pin the Wilkins Ice Shelf in place had splintered at its narrowest point, about 500 meters wide.

The Wilkins, now the size of Jamaica or the state of Connecticut, is one of 10 shelves to have shrunk or collapsed in recent years on the Antarctic Peninsula, where temperatures have risen apparently because of global warming.

Separate research shows that when ice shelves are removed, the glaciers and landed ice behind them start to move towards the ocean more rapidly. It is this ice which can raise sea levels, but by how much is a matter of ongoing scientific debate.

Tea drinking habits and oesophageal cancer in a high risk area in northern Iran: population based case-control study.

2009-04-05T04:54:00.000-07:00

BMJ. 2009 Mar 26;338:b929. doi: 10.1136/bmj.b929.

Islami F, Pourshams A, Nasrollahzadeh D, Kamangar F, Fahimi S, Shakeri R, Abedi-Ardekani B, Merat S, Vahedi H, Semnani S, Abnet CC, Brennan P, Møller H, Saidi F, Dawsey SM, Malekzadeh R, Boffetta P.

Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, 14117 Tehran, Iran.

RESULTS:
Nearly all (98%) of the cohort participants drank black tea regularly, with a mean volume consumed of over one litre a day. 39.0% of participants drank their tea at temperatures less than 60 degrees C, 38.9% at 60-64 degrees C, and 22.0% at 65 degrees C or higher. A moderate agreement was found between reported tea drinking temperature and actual temperature measurements (weighted kappa 0.49).

The results of the case-control study showed that compared with drinking lukewarm or warm tea, drinking hot tea (odds ratio 2.07, 95% confidence interval 1.28 to 3.35) or very hot tea (8.16, 3.93 to 16.9) was associated with an increased risk of oesophageal cancer.

Likewise, compared with drinking tea four or more minutes after being poured, drinking tea 2-3 minutes after pouring (2.49, 1.62 to 3.83) or less than two minutes after pouring (5.41, 2.63 to 11.1) was associated with a significantly increased risk.

A strong agreement was found between responses to the questions on temperature at which tea was drunk and interval from tea being poured to being drunk (weighted kappa 0.68).

CONCLUSION: Drinking hot tea, a habit common in Golestan province, was strongly associated with a higher risk of oesophageal cancer.

Renal Pathology Tutorial

2009-04-05T02:13:00.001-07:00

The entire power point slides on renal pathology is now available in myvasc.blogspot.com and slideshare.net/edwinchowyw/slideshows

Quote of the day

2009-04-05T00:23:00.000-07:00

When a man opens the door of his car for his wife, you can be sure of one thing : either the car is new or his wife is new.

Best Tiramisu Recipe

2009-04-04T00:29:00.000-07:00

Tiramisu basically includes Mascarpone cheese, raw eggs, sugar, espresso coffee, ladyfingers, liqueur and cocoa. Heavy cream is an optional ingredient. The richness and "mouth experience" depends on the quantity of each ingredient, and the care of preparation.

I made some Tiramisu yesterday having had Tia Maria (Jamaican Blue Mountain Coffee Liqour) with me for almost 2 weeks now.

The result was just fabulous.

All my friends genuinely loved the Tiramisu.
Calories: Censored....
(I only took 2 tablespoons of it and let the others feast on the rest. ha ha..)

It's really nice.

Time required for preparation- about 1 hour.
The entire process was performed manually (Whisking) and without a weighing machine.

Here's the recipe (that doesn't require a weighing scale):-

Makes 4-6 servings

16-20 lady fingers (Google it if you don't know what lady fingers are. Could use pound cake if lady fingers are not immediately available)

5 tablespoons of coffee liqueur (Any coffee liqueur would do but I used the ever popular Tia Maria. You could even use Irish Cream if you can't get hold of Tia maria/Kahlua).

3/4 cup espresso coffee (I used Jamaican Blue Coffee to brew the espresso using a stovetop. You could use a french press if you do not have a stovetop espresso maker)

1 cup mascarpone cheese
3 eggs- separate the yolks and whites
6 tablespoons sugar
1 cup heavy cream/ whipping cream
1/4 teaspoon vanilla
pinch of salt
cocoa powder
powdered sugar

Would need quite a few bowls to make this Tiramisu!

Bowl 1: Put the mascarpone cheese into a bowl and use a spatula to mix it till smooth.

Bowl 2: Add the espresso and Tia Maria and set aside.

Bowl 3 (Use a bowl suitable to be used in a hot water bath): Add 3 egg yolks and 2 tablespoon of sugar and whisk till smooth for about 3-5 minutes. Then, set over a hot water bath and beat for another 3-5 minutes until light and foamy.
When ready, pour the entire solution into the mascarpone cheese. Whisk it till a smooth batter if formed. Then set aside.
If you like, you could add 2 tablespoon of Tia Maria while whisking the batter to further enhance the flavour.

Bowl 4: Whip the cream until it holds a firm shape. (Meaning- you could make a 'mountain' peak with the whipped cream and it remains firm ie it does not melt away. But do not over whip the cream or else it will turn to butter!)
Add in the vanilla while whipping the cream.

Bowl 5: Whisk the 3 egg whites with 3 tablespoons of sugar and a pinch of salt till if foams and holds a firm shape like what you did to the whip cream (remember- don't over-whisk or else it will turn into liquid).
Then FOLD it with a spatula into the mascarpone batter.

Now,

FOLD with a spatula 1/2 of the mascaporne batter into the whipped cream.

When it has been well mixed, fold in the remaining half. Set aside.

Final steps,

Dip each lady finger quickly but entirely in the espresso and liqueur mixture.

Line up in a single layer using half of the lady fingers.

Now, pour about half of the final batter/mixture on top of the lady fingers.

Spread out evenly.

Dust cocoa powder to the top.

Then put another layer of the lady fingers and the top it up with the remaining 1/2 of the batter/mixture.

Dust cocoa powder to the top.

Refrigerate for at least 3-4 hours before serving.

Really easy stuff.
Enjoy and let me know the result.

Spring in Cambridge

2009-04-02T14:34:00.001-07:00

Spring is just wonderful here.
Flowers everywhere...
Comfortable temperature.
Took over 1,000 pics over the past 2 weeks in Cambridge, London, Oxford and Scotland. (That was the reason for the blog inactivity).

Taking the pics were the easy part.
Now come the difficult part- editing.
Not sure how long I would take to do the editing.
Will probably do it during the easter holidays.
Meanwhile, photo taking continues.

Postgraduate course at Wellcome Hinxton Genome Centre, Cambridge

2009-04-02T14:18:00.000-07:00

Had an excellent 1 day crash course in nephrology (Held every 3 months).
Following topics discussed:-

1. Polycystic kidney diseases
2. Histology of FSGS and MCGN
3. Tissue typing
4. Clinico-pathological cases
5. Transplantation
6. HUS-TTP
7. Biologics in immune mediated renal disease

Great discussion..

and

Great dinner

Menu:-

1. Griddled Asparagus, Glazed goats cheese with dressed leaves and fresh herb oil.

2. Pan fried rump of lamb with roasted provence vegetables, chateau potatoes, rosemary and garlic juice

3. Glazed lemon tart with bluebery compote and brandy snap cigar

4. Coffee/Tea

5. Petit Fours

Next course will be at Norwich (June 2009).

The Most Powerful Man on Earth

2009-03-24T12:37:00.000-07:00

Please be very very careful

2009-03-20T07:56:00.000-07:00

We must never let these horrific acts frighten us into paralysis.

Thomas Jefferson said 200 years ago:

"The price of freedom is eternal vigilance".

Vigilance....Vigilance.....Vigilance......

Google Street Maps- now in Cambridge!

2009-03-19T16:10:00.001-07:00

Google Street View is a feature of Google Maps and Google Earth that provides 360° horizontal and 290° vertical panoramic street level views and allows users to view parts of some regions of the world at ground level. When it was launched on May 25, 2007, only five American cities were included. It has since expanded to thousands of locations in the United States, UK, the Netherlands, France, Italy, Spain, Australia, New Zealand and Japan, and includes a variety of urban and rural areas.
You can now go to a particular place 'virtually'.
Great help to travelers.
Picture shows Zara, located in St Andrew Street, Cambridge, UK.

Too bad I can't show you where I stay, which is in Perne Road. Hopefully, they will map it later..

Airport issues- MacBook Intel 10.4

2009-03-17T08:40:00.000-07:00

Have been having several issues with my Macbook.

My MacBook is almost 3 years old now and seems to be having some 'health' issues.

1. Airport- Would occasionally fail to detect wifi signals for few seconds before 'turning back on'. This happens almost on a daily basis. It's not really disruptive. Only irritates if downloading something- the download would get disrupted and you need to redownload.

2. 169.X.X.X signal (self assigned IP by the MacOS if it fails to detect IP address which is generally not usable) on IP address instead of the usual 192.X.X.X (It means that the Airport doesn't detect the IP address supposed to be sent by the router).
This happened yesterday.
I have gone through the Apple support section- seems to be a problem with the router (That is what they say. Pushing the blame on the router??)

But could it be a problem with the Airport causing this problem?

My Macbook seems to be playing up......

Anyone got any ideas as to what's happening?

Guide to tea brewing

2009-03-14T02:20:00.000-07:00

Brewing tea is really quite easy. Here are some instructions for brewing a perfect cup of tea.

First start with cold, great tasting, water. If your tap water does not taste good, then use filtered or bottled water. (I say to use cold water because a typical hot water heater will often add contaminants and reduce the amount of oxygen in the water, which is needed for flavor extraction).

Then bring the desired amount of water to a rolling boil. (Do not boil the water for a long period of time because this too will deplete the water of oxygen).

Put approximately 2 grams or 1 tsp. of tea leaves per 6-8 oz. of water into a pre-heated pot or cup (pre-heating will allow the tea to steep at the proper temperature).

Then add hot water according the chart below for the type of tea you are brewing. Please note that these are general guidelines. If your tea container has brewing instructions I would follow those as they are probably ideal for that specific tea.
About Water Temperature

The water temperature does not have to be exact. The main thing to remember is to not use boiling water for Green or White teas. They will burn and create bitter flavors.

A good way to guess at the water temperature without a thermometer is to bring the water to a boil, and wait about 30 seconds (for white tea) or 60 seconds (for green tea) before pouring over the leaves.
About Steep Times

The amount of time that the tea steeps will determine it's strength. I enjoy different teas at varying strengths. I would suggest that when you buy a new tea, as it is steeping, check the taste every minute with a spoon. This way you can blow on it so you won't burn your tongue!

Let the first cup steep until it's either too strong or you notice bitter elements that are unpleasant. Then take note of when the tea tastes best to you and write it on the package. Besides, who can tell you how you like your tea better than you!

General guide to brewing time:-

Article from http://www.2basnob.com/brewing-tea.html

Green and Black Tea Consumption and Risk of Stroke. A Meta-Analysis

2009-03-12T02:58:00.000-07:00

Stroke. 2009
Published online before print February 19, 2009, doi: 10.1161/STROKEAHA.108.538470

Background and Purpose—Experimental models of stroke provide consistent evidence of smaller stroke volumes in animals ingesting tea components or tea extracts. To assess whether a similar association of black or green tea consumption with reduced risk is evident in human populations, we sought to identify and summarize all human clinical and observational data on tea and stroke.

Methods—We searched PubMed and Web of Science for all studies on stroke and tea consumption in humans with original data, including estimation or measurement of tea consumption and outcomes of fatal or nonfatal stroke. Data from 9 studies involving 4378 strokes among 194 965 individuals were pooled. The main outcome was the occurrence of fatal or nonfatal stroke. We tested for heterogeneity and calculated the summary effect estimate associated with consumption of ≥3 cups of tea (green or black) per day using random-effects and fixed-effects models for the homogeneous studies. Publication bias was also evaluated.

Results—Regardless of their country of origin, individuals consuming ≥3 cups of tea per day had a 21% lower risk of stroke than those consuming <1 cup per day (absolute risk reduction, 0.79; CI, 0.73 to 0.85). The proportion of heterogeneity not explained by chance alone was 23.8%.

Conclusions—Although a randomized clinical trial would be necessary to confirm the effect, this meta-analysis suggests that daily consumption of either green or black tea equaling 3 cups per day could prevent the onset of ischemic stroke.

Fish intake of Swedish male adolescents is a predictor of cognitive performance

2009-03-12T02:50:00.000-07:00

REGULAR ARTICLE
Acta Pædiatrica
Volume 98 Issue 3, Pages 555 - 560

ABSTRACT

Aim: Fish intake is reported to positively influence cognitive performance in infants and the elderly. In a longitudinal cohort study, we evaluated how fish consumption related to later cognitive performance in healthy young male adolescents.

Methods: In 2000, all 15-year-olds (n = 18 158; 9260 males) in the western region of Sweden were requested to complete an extensive questionnaire with items on diseases, fish consumption and socioeconomic status. Questionnaire data from the male responders (n = 4792, response rate 52%) were linked with records on subsequent intelligence test performance at age 18 from the Swedish Military Conscription Register (n = 3972). Multivariate linear models were used to estimate associations between fish intake and cognitive performance, adjusting for potential confounders.

Results: There was a positive association between the number of times having fish meals per week at age 15 and cognitive performance measured 3 years later. Fish consumption of more than once per week compared to less than once per week was associated with higher stanine scores in combined intelligence (0.58 units; 95% confidence interval 0.39, 0.76), in verbal performance (0.45; 0.27, 0.63) and in visuospatial performance (0.50; 0.31, 0.69). The association between fish consumption and the 3 intelligence scores was the same in lowly and highly educated groups. This indicates that education did not influence the association between the frequency of fish meals consumed and cognitive performance.

Conclusion: Frequent fish intake at age 15 was associated with significantly higher cognitive performance 3 years later.

Coffee cupping at 15 Perne Road CB1 3RX

2009-03-11T04:01:00.000-07:00

Coffee cupping is a mandatory event for all coffee lovers.
Coffee cupping is like wine tasting but for coffee connoisseurs.
Enjoyed the following coffee:-

Jamaican Blue Mountain
Costa Rican
Hasbean Espresso blend

Now I know what makes a cup of good coffee.

Pics courtesy of Eric who just bought his new canon DSLR 450D. Shot with his kit lense 18-55mm IS USM 3.5-5.6 ISO800

My best mushroom soup recipe

2009-03-11T03:18:00.000-07:00

Made this mushroom soup as a pre-coffee cupping event yesterday.
4 mushrooms were used for this.

Procini (1oz dried). Shitakae can be used as alternative to porcini.
Portabello (3oz fresh)
Chestnut (3oz fresh)
Morel (1 small portion)

Recipe has been modified from the traditional french recipe to reduce calorie/fat.
Makes 4 bowls.

Step 1- Vegetable stock
Carrots, Leeks, Mushrooms stems, celery, onions, potatoes.
Add 600mls water and reduce it to 300mls of vegetable broth.
Remove the potatoes. Mash 1 medium size potato (to be used as soup thickener later)
Drain the stock.

Step 2- Making the rouix
In French cooking, the roiux (pronouced as 'roo') serves as a sauce thickener.
It is a combination of flour and fats (butter, oil, etc)
Purpose of cooking this 2 ingredients together is to eliminate the raw taste of
flour and also to prepare it to absorb liquid.

1 tablespoon butter and 2 table spoon olive oil.
Heat oil up in a pan (low heat).
Add 2 tablespoon of flour slowly over the oil and stir continuously till it forms
a dough.
Stir and cook for 3-4 minutes.

Step 3- Making the soup base
When rouix is ready, add the vegetable stock while stirring it continuously.
Add the mash potatoes.
Add salt and black pepper to taste
Blend the soup if you want a smooth consistency (even with part of the mushrooms)

Step 4- Mushroom preparation.
Soak the porcini (1oz) for 20 minutes in warm water (150mls).
Don't throw away the resultant water which will be used in the soup.

Soak the morel in warm water for 20 minutes.
I discard the water as it usu contains sand and soil.

Cut the porcini, portabello, chestnut into the desired consistency.

Cut the morel mushroom finely.
2-3 shallots finely chopped.

The heat up a pan.
2 tablespoon olive oil.
Saute the shallots.
Then add the mushrooms.
Add herbs if you like- Rosemary, Thyme, Parsley
Add white wine if you like.
After about 10 minute, add it into the soup.

Cook for about 10mins.
Add 150mls of full cream milk for texture.

Serve with croutes (hard toasted french bread)

Decent place for a cup of Espresso

2009-03-10T03:15:00.000-07:00

Stumbled upon this place (virtually!).
Pretty decent place for a good cup of Espresso/ Espresso based drinks (from my gut feeling).
Located in SS14 PJ.
They also brew their coffee in a Vacpot (Syphon brewed coffee)!

Price wise- depends on the taste.

Those staying nearby SS14, please try it out and let me know.
(By the way, I have no shares/ affiliation to this cafe.)

Will definitely visit this place when in PJ.

Their menu/pricing are all listed in their website:

http://www.gv.com.my/

Delay no more

2009-03-09T14:11:00.000-07:00

I have been reading closely the current issue of english in the teaching of science and maths.

But instead I have learned new cantonese/hokkien words.

1. Delay no more- this was started in Hong Kong, where curses in Cantonese are often very colourful. If you pronounce the English words in a quick Cantonese accent, you will find that it refers to someone’s old mother.

2. Curry Lembu- Hokkien equivalent of 'Delay no more'

A trip to Audley End

2009-03-09T09:02:00.000-07:00

Audley End House and Gardens

King Henry VIII gave Walden Abbey to Sir Thomas Audley, who transformed it into his mansion, Audley End.
Audley End remains one of England’s grandest country homes with over 30 lavishly decorated rooms to enjoy and explore.
The sumptuous interior is largely due to the third Baron Braybrooke who inherited Audley End in 1825, filling it with treasures including paintings by Masters such as Holbein and Canaletto.
Imagine yourself back in Victorian times when visiting this place.

Only 14 miles from Cambridge, UK

All pictures taken with Canon 350D 24-70mm L f/2.8 USM
ISO 800 used for indoor shots.

Free lunch on offer

2009-03-06T03:08:00.000-08:00

The Star
LONDON LOG
By CHOI TUCK WO

Fancy being paid £1 to eat as much as you can?

AS the credit crunch bites deeper into Londoners’ pockets, many restaurants are at their wits’ end trying to boost their fledgling business.

First, there was Cha Cha Moon near Oxford Street. It caused a stir with its price-busting £3.50 (RM18.50) deals for popular hawker fare such as Singapore fried noodles and Penang prawn mee until recently.
James Huynh proudly displaying his £1 offer for customers. The promotion has attracted long queues outside his restaurant.

Then came Little Bay in Farringdon, which literally tore up the bills and asked customers to name their price instead.

“No food bills – pay us what you think the food is worth,” declared a blackboard outside the eatery in east London. Some see it as a psychological ploy to test one’s self-respect.

In the end, many would have paid up more than what was on the table – an ego-boosting trip for some, while saving the blushes for others.

Of course, there were also those who saw the chance for a too-good-to-be-true meal. Some had the audacity to leave as little as two pence (about 10 sen) for the food before slipping off.

But no one had bargained for what a Vietnamese Chinese restaurateur came up with next – he’s paying customers £1 (RM5.30) to eat as much as they can!

Now, that’s what you call a real Chinese takeaway. It’s about paying people to stuff themselves with aromatic duck, honey roast spare ribs and chicken noodle soup while fighting recession at the same time.

“It’s my way of giving a little back to my loyal customers who had supported me during the good times,” said James Huynh of Oriental Aroma in Wootton Bassett, Wiltshire.

He admitted that he had been incurring losses every day. Yet the day would come when his goodwill would earn back more business from his return customers.

“My mother used to tell me from childhood that if you’re prepared to give a little without expectation, in time you can only prosper,” said Huynh who arrived in Britain as a refugee about 30 years ago.

So it looks like the advice has been working well for him so far. Hence, the extraordinary offer believed to be the first of its kind in the country.

And since the promotion began recently, it has become the talk of the town, attracting a growing number of customers with queues forming even outside the restaurant.

Critics may sneer that there’s no such thing as a free lunch. Well, the catch is you have to spend at least £5 (RM26.50) on drinks to qualify for the offer.

Huynh, however, insisted the drinks price was not a catch but merely to prevent undesirable people from “gate-crashing” the restaurant.

Say what you like. The ineluctable truth is that the economic crisis has left restaurateurs scraping the barrel for more innovative ideas to attract customers.

Bank begins 'printing money' to fight slump- another 'boleh-land' in the making

2009-03-06T00:05:00.000-08:00

There are a few 'boleh-lands' around the globe.
Here's just another place.
75 billion pounds of quantitative easing (up to 150 billion pounds)- it virtually means printing more money.
This strategy has been tried in Japan before without much success.
Also interest rate has been cut to 0.5%.
SO everyone here is saying- just spend the money and then ask the government for more.

So what is the moral of the story- in the land of boleh-land, there are more boleh-lands around.

Bank begins 'printing money' to fight slump

* Larry Elliott and Heather Stewart
* The Guardian, Friday 6 March 2009

The Bank of England yesterday announced unprecedented steps to prevent the deepest slump since the 1930s when it unveiled plans to inject up to £75bn into the economy over the next three months.

Alarmed by signs Britain's malfunctioning banking system is starving consumers and businesses of credit, chancellor Alistair Darling yesterday gave Threadneedle Street clearance to begin creating money - the last-gasp measure used by Japan to end a decade of recession and deflation.

The Bank said it would embark on quantitative easing next week, after its monetary policy committee cut the bank rate for the sixth time since the global financial system came close to collapse last October. The rate is now 0.5% - a level not seen before in the Bank's 315-year history.

Thousands caught unawares as 2m-high flash floods hit KL

2009-03-04T03:00:00.001-08:00

Flood waters rose up to 2m at the junction of the Dynasty Hotel on Jalan Ipoh and in the Kampung Baru area.

Can someone tell me about the function of the SMART tunnel?

Updates in medicine

2009-03-03T05:45:00.000-08:00

Achives of Surgery
2008;143(12):1222-1226
Requirement of perioperative stress doses of corticosteroids: a systemic review
• Patients receiving therapeutic doses of corticosteroids undergoing surgical procedure do not routinely require stress doses of corticosteroids as long as they continue their usual daily dose of corticosteroids.
• Adrenal function testing is not required in these patients because the test is overly sensitive and can’t predict which pt will develop an adrenal crisis.
• However, patients receiving physiological doses owing to hypothalamic-pituitary-adrenal axis d/o require supplemental doses of corticosteroids in the perioperative period.

Invest In Our People!

2009-03-02T12:02:00.001-08:00

by M. Bakri Musa

Millions of Chinese had a rude awakening when they returned last month from celebrating their Lunar New Year in their villages. They discovered that the jobs they had in the cities before they left only a few weeks earlier had now disappeared. Tragic though that may be to them individually, the aggregate loss pales in comparison to that suffered by their government through its massive investments in the stocks of American companies and other paper assets like bonds and Treasury Notes.

If only the Chinese government had invested in its people, imagine the good that would do to them, and to China. If their government had spent the funds to build better schools, Chinese schoolchildren would not have dangerous physical facilities that collapse with the slightest tremor. Had those funds been used to build affordable apartments, the Chinese people would have been better housed. That would at least help alleviate their miserable existence.

The Chinese people suffered twice. First, they worked incredibly hard under intolerable conditions and insufferably meager wages so the West could enjoy inexpensive consumer goods. Then the foreign currencies earned by their government from the exports created through their hard work vanished with the downward spiral of Western economies.

When Western consumers could no longer afford to spend, the Chinese were forced to work under even harsher conditions so the products they make could be sold cheaper still. This is just a modern twist to the old “coolie” concept. In the early part of the last century, millions of indentured Chinese were brought to America to work on the gold mines and railways. Today the coolies remain in China; America brings in only the products of their hard labor.

China is not alone in engaging in this folly of investing abroad instead of in their people, so is the rest of Asia. Singapore lost a hundred billion dollars on its American investments. On a per capita basis, Singapore’s loss is massive and readily dwarfs that suffered by China.

Granted, Singaporeans live in a different universe from those folks in China, at least with respect to the creature comforts of life, though not in personal freedom. That notwithstanding, imagine how much better off Singaporeans would be if only their government had invested in them instead of being enamored by the fancy financial papers hustled by those Ivy League-educated white boys on Wall Street.

A Singaporean friend who owns a subsidiary in Silicon Valley lamented that the secretary to the head of his American company enjoys a lifestyle far better than his: larger home, a decent car, more social amenities, and better opportunities for her children. Meanwhile back in Singapore my friend has to make do with one of the pigeon holes of a home in those monotonous urban high-rises, and his children have to spend what little spare time they have in “cram schools.”

On another level, had Singapore invested those billions in nearby giant Indonesia instead of faraway America, imagine how much good it would do to the poor Indonesians. More pragmatically, a developed Indonesia would be a more high-value market for Singapore’s products and services. Besides, imagine the gratitude and goodwill created through such investments. You cannot put a monetary value to that. Indonesia desperately needs those investments; America could easily do without Singapore’s dollars.

Malaysia Fortuitously Spared

Fortunately in this current global crisis Malaysia is spared this tragic fate of losing its investments abroad. This is not the result of any brilliant foresight on the part of the nation’s leaders, rather the consequences of our own harrowing experience with the Asian economic crisis of 1997. For one, Malaysia has not yet fully recovered from that trauma and thus does not have the extra cash to be investing in any new and exotic financial instruments concocted in the West, those acronym-filled papers that are the “assets” of what former Finance Minister Tun Dain Zainudin derisively termed the “cowboy economics.”

For another, the capital controls implemented by Mahathir, though now largely dismantled, have left a deep impression on Malaysian economic managers, immunizing them against future meddling in such poorly understood foreign “investments.”

That has not always been the case. Prior to 1997, agencies of the Malaysian government were active players on the London Stock Market, as well as the London Metal Exchange and the Foreign Exchange Market.

It was at the London Stock Market that Malaysia executed its famous (or infamous, at least to the Brits) “Dawn Raid” on September 1981 that effectively nationalized the huge British plantation company, Guthrie. That was hailed as a brilliant move that also satisfied our national pride. It proved that we natives were fast learners and could be just as agile as those pros in the City, a much-needed confidence booster for those who require it periodically.

Malaysia’s brash attempt to corner the world’s tin market at the London Metal Exchange also involved mega sums. This time however, there was no rush to accept responsibility for this squandering of citizens’ precious funds. There were other colossal losses, including Bank Negara’s forex debacle, as well as the now defunct Bank Bumiputra’s many expensive foreign misadventures.

Again, I could only imagine the immense good had our government invested those precious funds in our people instead. Although average Malaysians have it considerably much better than the average Chinese, nonetheless our quality of life could always be improved.

Contrary to the soothing but misplaced assurances from our leaders, Malaysia cannot insulate itself from the current global economic storm. There is no “comfort zone.” Yes, Malaysia was fortunate enough not to have been entangled in those highly deceptive newfangled financial instruments with such fanciful acronyms. However, when our biggest trading partner and consumer of many of our commodities is in economic difficulties, rest assured that Malaysia will also inevitably be roped in.

Invest In What You Know

Like other countries, the Malaysian government has also introduced its own economic stimulus in an attempt to deal with the crisis. Our economists too have read Maynard Keynes and understood the rationale for counter cyclical public spending in a downturn.

Understanding the concept is one thing, translating it into reality in our local context is entirely another matter. The challenge is to make sure that our economic stimulus does indeed work, meaning it does spur the economy, and that our investments are indeed investments, meaning they would produce returns in excess of the capital expended.

At the height of the dotcom boom, the legendary American investor Warren Buffet was asked why he was not investing in that sector. He answered, “I invest only in things I know!”

I live in California and know that the real estate dynamics in San Francisco is radically different from that of San Bernardino, so I invest only in my community. I can at least follow the trend. Yet we have bankers in Singapore and Beijing pretending to be knowledgeable about real estate in the entire United States. That is the only explanation for their readily investing billions in securitized American mortgages!

Follow Warren Buffet’s maxim: Invest only in what you know. What do Malaysian leaders know? For one, more than any Western banker or Nobel prize-winning economist, our leaders know our people, their daily needs and living conditions. So invest in them, our people. For another, the economic “multiplier” of such spending is considerable; there is no such local multiplier when we invest in foreign stocks and other paper assets.

Our leaders are aware of the deplorable conditions of our schools especially in rural areas. They also know that these children risk their lives daily in crossing rickety bridges to get to schools. When they return home, their houses are flimsily built and in an unhealthy environment. They also have poor access to healthcare. So why not invest in building new schools, bridges, clinics, and affordable public housing?

Similarly we all know that those rural children could not get good teachers. So why not invest in teacher training and provide greater incentives for teachers to serve in rural areas?

The beauty of such investments is that they generate values way over and above the capital and other efforts we put in. The benefits are also enduring, and indeed “recession-proof.” Should there be an economic downturn, the superb education those children had received would still be with them; likewise their good health. Indeed a populace that is healthy and better educated, and thus productive, is the best weapon against a downturn.

In the last budget, and also in the proposed additional stimulus, considerable sums were devoted to investing in the local stock market and in furthering the government’s already considerable involvement in the private sector. Come another recession or a market misjudgment, such “investments” could easily evaporate. We have already squandered hundreds of billions on Bank Bumiputra, State Development Corporations, and the myriad GLCs. All we have to show for such investments are some old, tattered letterheads. We have not even learned any useful lessons from those debacles.

Let the investment bankers, brokers and other middle men and paper shufflers invest in exotic financial assets; governments should invest in their people, and in infrastructures that would enhance their lives. Those are the only investments that are properly the purview of governments, not company stocks, foreign bonds, or fancy derivatives.

Investing in our people is also the only effective way to prepare them for the increasingly competitive world. More significantly for leaders, that would also ensure that come election time when citizens would make decisions about their future, our leaders would not be rudely awakened to find themselves without jobs.

Ryanair says to charge toilet fee - or maybe not

2009-02-27T11:25:00.000-08:00

LONDON (Reuters) - Ryanair's chief executive said Europe's largest budget carrier might start charging passengers for using the toilet while flying, but his spokesman cautioned Michael O'Leary often just made things up at will.

"One thing we have looked at in the past and are looking at again is the possibility of maybe putting a coin slot on the toilet door so that people might actually have to spend a pound to spend a penny in future," O'Leary told BBC television.

He said this would not inconvenience passengers travelling without cash. "I don't think there is anybody in history that has got on board a Ryanair aircraft with less than a pound."

A spokesman said the airline had considered the fee as a possible source of extra revenue since passengers had the option of not using the toilet on board, but added that "maybe O'Leary was just taking the p*ss this morning."

The Girl Who Silenced The World For 6 Minutes

2009-02-26T09:30:00.001-08:00

Forwarded by DrLohCL

Climate disaster is occuring faster than expected

2009-02-26T03:42:00.000-08:00

Polar bears can't catch seals in open water. They are only able to do so on the sea ice.
On the ice, the bears catch their prey when they surface to breathe.
Seals swim to the surface to breathe every five to fifteen minute but because they visit as many as fifteen breathing holes, a polar bear's wait for its prey can be long.

Polar bears locate breathing holes with their powerful sense of smell. When a bear finds an aglu, it waits patiently for the seal to surface — which can take hours or days.

Polar bears depend on the presence of ice for access to seals. In summer, when the floes retreat north, polar bears will travel hundreds of miles to maintain contact with their prey.

Between summer and winter the amount of ice-covered water can change rapidly. Polar bears learn to follow the ice to stay with their food source.

Those polar bears that are stranded on land in summer must stay there until the ice forms again in fall. On land, the bears face lean times, for they seldom catch seals without a platform of ice.

The picture above is a polar bear being killed as it went rampaging into a nearby town looking for food.

With the thinning ice caps, more polar bears are dying day by day...

The SUN, 26th February 2009

ALLIGATORS bask off England. Brazil is a desert. Saigon, New Orleans, Venice and Mumbai have disappeared — along with 90 per cent of the human race.

This is what scientists believe could happen 41 years from now if the world warms by just 4°C.

Here we graphically illustrate how Earth could become a whole new world.

Rivers would disappear, as would entire species such as lions and tigers. Most marine life would be extinct.

These are among the dire predictions made by experts in the latest New Scientist magazine, on sale this week.

They have begun to consider what the world could look like if we are unable to do our bit to stem climate change — and say only one in ten humans would survive to see it.

Many scientists believe this could happen by 2100, but others fear it is just two generations away, and could arrive as soon as 2050.

Peter Cox of the University of Exeter, who studies climate systems, says: “Climatologists tend to fall into two camps. There are the cautious ones who say we need to cut emissions and won’t even think about high global temperatures — and there are the ones who tell us to run for the hills because we’re all doomed. I prefer a middle ground. We have to accept that changes are inevitable and start to adapt now.”

If the planet warms by an average of 4°C — as it might this century — it will change beyond all recognition.

All of the world’s major deserts are predicted to expand, with Africa’s Sahara reaching right into central Europe, while we would see Europe’s rivers drying up, from the Danube to the Rhine.

Two massive belts of desert-dry land would girdle the earth’s central zones.

The only places with guaranteed water will be in the high latitudes.

Former NASA scientist James Lovelock, one of the UK’s most highly regarded environmentalists, says: “Everything in that region will be growing like mad. It’s where all the life will be.

“The rest of the world will be largely desert with a few oases.

“Humans are in a pretty difficult position and I don’t think they are clever enough to handle what’s ahead.

“I think they’ll survive as a species but the cull during this century is going to be huge.

“The number remaining at the end of the century will probably be a billion or less. And you can forget lions and tigers — if it moves we’ll have eaten it. People will be desperate.”
Relocate

The world’s population would relocate to the coolest regions — including Britain, Scandinavia, Russia, Canada, Greenland, New Zealand and North Australia. However, with less land the world will be crowded and food scarce.

Human survivors’ diet will be mostly vegetarian — as the seas become acidic with higher amounts of dissolved carbon dioxide killing off most marine life.

This is not the first time the world has faced a catastrophe on this scale.

Similar temperature rises occurred 55million years ago, when vast quantities of methane bubbled explosively from the deep ocean, filling the atmosphere with carbon and wiping out sea life.

The planet’s temperature rocketed almost 6°C, sea levels rose 330ft higher than today’s and desert stretched from southern Africa into Europe.

Sadly we have no survival lessons to learn from it — mankind didn’t develop on the planet until quarter of a million years ago.

Nobel prize-winning scientist Paul Crutzen says: “I would like to be optimistic that we will survive but I’ve got no good reason to be.

“In order to be safe we would have to reduce our carbon emissions by 70 per cent by 2015. At the moment we are putting them up by three per cent... ”

Coming soon: Ecology disaster

2009-02-26T03:29:00.000-08:00

Arctic ice cap keeps melting under the effects of global warming.
August 2008 saw second largest summer shrinkage since satellite observations began 30 years ago.
Artic sea ice shrank to the smallest area on record recently, US scientist have cofirmed.
The Artic sea ice which spread across he north pole could disappear during the summer in 1-2 decade (as early as 2013), US scientist warned.

It is silly to say global warming is not taking place on a massive scale.
The world already is experiencing major changes.
Global warming no longer can be stopped.
What has to be done now is to deal with a planet with ultra high speed winds, sudden deserts and large scale extreme weather events.

EULAR recommendations- vasculitis

2009-02-26T00:50:00.000-08:00

Visit myvasc.blogspot.com

Hospital Kuala Lumpur- a world class health facility

2009-02-23T12:56:00.000-08:00

How I envy those working in this world class hospital.

I was told that only the best could work there.....

Truly a people's hospital.

I will want to be admitted there if I fall ill.

RM5/= for anyone who can spot Dr Ghazali

Best coffee on high street? Not Starbucks

2009-02-21T14:10:00.000-08:00

Times online

Starbucks is peddling the worst coffee at the highest prices according to a survey of the big three coffee houses on Britain's high streets.

A report published today calculates that choosing the world’s largest coffee chain instead of an independent shop for your cappuccino three mornings a week will cost you £126 a year.

The Which? Magazine survey did not stop at lamenting the cost of a Starbucks, it also placed the global brand at the bottom of its taste test. It concluded that when it came to too much water in an Americano and a surfeit of froth on a cappuccino, “Starbucks was the worst offender”.

Despite this, Starbucks is still by far the biggest coffee chain on the planet with more than 15,000 stores in 44 countries.

The report also examined the calorie content of coffees. The full range of drinks ran from 17 calories in a black Americano to a white chocolate mocha with whip and whole milk from Starbuck that came in at 628 calories – more than a quarter of recommended daily calorie intake.

The sandwiches available in the coffee shops also came under scrutiny, with several found to contain more calories, fat and salt than a McDonald’s Big Mac.

Four sandwiches at Starbucks and four at Costa exceeded the 495 calories in a Big Mac. Fat content in four Costa sandwiches, five from Starbucks and one from Caffe Nero was higher than the burger and 32 sandwiches from the three shops had more salt than a Big Mac.

COFFEE PRICES

Starbucks

Medium cappuccino £2.29; single espresso £1.40

Come on guys...

It's ok to fork out 2 pounds if what you getting is a decent cup of coffee.
But that's not the case here.
You are just buying the 'brand' with its associated psychological '?feel good' effect.

Make your own coffee.

I have been making my own cup of coffee each morning from bean to cup.
And the coffee that i am getting is far superior from theirs.

(And this done with only a bialetti stovetop coffee maker. My 2nd hand gaggia espresso machine is on the way!).

And it gives you far superior 'feel good effect'- becoz it taste better and saves you money!