Scariest Chart in the World, Part II

Back on April 19 I published, "The Scariest Chart in the World."   It was the Weekly chart of the Dow Jones Shanghai Index.   It was then on the verge of a Weekly Trend Sell Signal.  Here is an updated chart:

The SELL came the week of April 26 at about 350 on the index and in the past four weeks the Index has dropped about 10%.

How about an encore? 

The Scariest Chart in the World, Part II

This is a Monthly version of the Shanghai Index which itself is now on the verge of a Monthly Trend Sell Signal.  You can see that if the trend line goes, the next level of support is around the late 2009 lows, just under 200 on the index, or about 35% below current levels.

Finally, a look at the Daily chart with an Elliott Wave count:

The Daily trend is suggesting a drop below 300. The monthly reversal is at 296, meaning any monthly close below 296 triggers the Monthly Trend Sell Signal.  Ergo, the scariest chart in the world, part two.


A

Disclaimer: 

          Wish I was a Kellogg's Cornflake,  Floatin' in my bowl takin' movies.

On a personal note

These songs, these Sunday posts, they mean more then I can convey in my writing, more then I can say about myself and my life as we know it.  The live performances are not always the best musically, or best audio, or visual, but like the one below, there is a transcendent quality to them. You can see it in Leonard Cohen's eyes, his stare into the past, into the eyes, time and place of Suzanne. 

As for me, consider this a continuation of last night's post, a description of who we are,  against all logic, against all odds, without any lucid structure or courtship....irrational, elusive passion traveling along its own uncertain path, propelled by its own seductive consciousness.

DJIA Sell Signal

Below is a monthly chart of the DJIA with both a long term Trend Model (low volatility version) and a long term Elliott Wave count.  In addition, I've added the elements of an Advanced GET Mechanical Sell Signal which as of the end of May has generated a fresh SELL on this monthly chart.

(1) Trend Model:  The Monthly Trend Model has been on a SELL since June, 2008 @ 11,350.  The rally that began in early 2009 was insufficient to flip this model from its entrenched SELL MODE and now it appears that prices are once again in sync with the dominant trend, DOWN.

(2) Elliott Wave Count: In terms of Elliott Wave counts, this one shows a completed multi-decade five waves up, terminating in October, 2007.  I would expect at a minimum, a decade of lower prices.  Whether current prices are in an ABC, or have traced out  Waves 1 and 2 and are now in Wave 3 DOWN, it is academic.  Whether a Wave 3 or Wave C, both are third waves, so the expectation is hard down under either interpretation.

(3) Mechanical SELL SIGNAL:  Below is a close-up of the most recent five years which culminated on Friday with an Advanced GET Mechanical SELL SIGNAL.  The elements of this very reliable, objective signal are a Waves 1-4 shown on the chart; an Elliott Oscillator which goes from way oversold to neutral (bottom study); a False Bar Stochastic Sell Signal (top study); and a break down of the Trend Regression Channel (broken on Friday's monthly close). The upper target for this move is shown as about 4,500 on the DJIA, the lower target (not shown), just below 1,000. 

One more heads-up for the days and weeks ahead.  Below is the DJIA monthly chart using my standard Trend Model settings (as opposed to the low volatility settings above).  Note that the rally from 2009-2010 was enough to flip this model LONG last September.  But more importantly note where the model will flip back SHORT: any monthly close below 9,601.84:

In a prior life (1977-1994) I practiced law and that experience, believe it or not, does at times help with dealing with market prediction  The legal system has its own specialized sets of rules, evidence and associated standards of proof.  One of major concepts in assessing subjective criteria, especially in terms of constitutional rights and probable cause, (or as it is know today, is he/she an illegal immigrant?), is a concept called, Totality of Circumstances, i.e. a standard for the evaluation of evidence suggesting that there is no single deciding factor, that one must consider all the facts, examine all of the factors,  and reach conclusions from weighing each factor within the context of the whole, "the gestalt of the totality of circumstances test. (Arizona v. O'Meara 198 Ariz. 294, 296, ¶ 10, 9 P.3d 325, 327. (2000)).

The analysis above sets out the case for probable cause that the market is heading lower, maybe much lower in the months and years ahead.  As we go along, I'll periodically review this analysis and if anything changes, will post it here. 

Court adjourned.


A

Disclaimer: 

This ain’t no place for the weary kind.

Cheap fast food "enticing people to eat more because they think they're saving money when they're really buying heart disease"

"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease."

References:
10 Questions for Jillian Michaels. TIME, 2010.

In the jingle jangle morning

 The Angst of March:

What is haunting this Easter Sunday, ten years past my girls' frolicking in life sublime, is the incoherence of my solitude, the empty, senseless culmination of a journey, fallen so hard and short, from deep in the angst of March.

Island of Allan:

If you are looking for perfection, you will not find it here, nor in the Red Wings, nor in my writings, my life, or my trend tables.  But as the subscribers above-referenced point out, there is value here, big value, but it comes with fallibility.  Most of Datsyuk's shots don't go in the net, but of the ones that do, they make a difference, a consequential, almost eloquent difference, not only for Pavel, but for his teammates; not only for Allan, but for his teammates. 

On a Monday in May:

But I forgot that Dylan was on and that his songs pierce the protective shells that we build just so we can go on.  Poignant, stinging, disarming, his simple words rhyme across decades of loves; loves found, loves lost and loves remembered. 

And on this Monday in May, a love mourned.

Someone saw that one
A phone call pointed the way,
a blog was read;
Someone reached out
closure was intended,
magic intervened.
Inexplicable comes to mind.
Intricate emotional frenzy
portrait of the artist as a middle-aged man;
No longer on the edge,
no longer on the brink,
inexplicably (there it is again) found,
serendipity breeds enlightenment.

The true nature of love.  Kindred souls.  Physical (read: sexual)  tension of unimaginable attraction. Karmic energy reaching across the unseen, toward the unknown; without time nor space, without memory nor fate,  "Far from the twisted read of crazy sorrow."

Then take me disappearin’ through the smoke rings of my mind
Down the foggy ruins of time, far past the frozen leaves
The haunted, frightened trees, out to the windy beach
Far from the twisted reach of crazy sorrow
Yes, to dance beneath the diamond sky with one hand waving free
Silhouetted by the sea, circled by the circus sands
With all memory and fate driven deep beneath the waves
Let me forget about today until tomorrow

Hey! Mr. Tambourine Man, play a song for me
I’m not sleepy and there is no place I’m going to
Hey! Mr. Tambourine Man, play a song for me
In the jingle jangle morning I’ll come followin’ you

Math with Children's Books--Class for Homeschool Teachers

Interested in using "Living Math" books--children's literature--to teach math? The content of this class for homeschool teachers is designed to fit in with any curriculum, making math more meaningful (and FUN!) for students in grades K-6.


Since this is the first time offering the class, the course fee will be minimal.

I'd like to get an idea of how many people are interested and the date/time that would best fit your schedule. This is not a commitment. If you have interest, please use the email address at right to let me know whether you'd prefer to take the class in June or Sept and daytime or evening. Location is Portland/Metro/Willamette Valley area.

Thanks!

love2learn2day
M.S.Ed., Educational Consultant.

The Cost of Freedom

I watched HBO's series, "The Pacific," this spring, was disgusted beyond belief at the cruelty and death of the war in the Pacific.  At the end of the last episode they updated the lives of the men that The Pacific was based upon.  Most had survived the war, but not life and as I read about their ordinary, mundane lives after the war and of their respective deaths in the years at the end of the 20th century, my eyes welled up in sadness, in gratitude, in recognition of my own mortality.  These were ordinary men thrust into an extraordinary theater of slaughter.  Now they are mostly gone and it is up to us to remember, so that as my people so stridently proclaim, "Never again."

A

Couple addicted to the internet let their baby starve to death while raising a virtual daughter online

From BBC:

A South Korean couple who were addicted to the internet let their three-month-old baby starve to death while raising a virtual daughter online, police said.

An autopsy showed her death was caused by a long period of malnutrition.

The couple had become obsessed with nurturing a virtual girl called Anima in the popular role-playing game Prius Online.

Some psychiatrists still have doubts if Internet addiction exists but it looks pretty much for real in this video:



References:

S Korea child 'starves as parents raise virtual baby'. BBC.

How do you blog?

A nurse writing a paper for school focusing on the value of blogs for advanced practice nurses asked me the questions listed below. It would be great if you can post your own answers in the comment section below.

How many blog post do read a week?

The blog posts and news items from the RSS feeds are about 2,000-3,000 per day = 20,000 per week.

You read blog posts about?

The big five among the general medical journals (NEJM, JAMA, Lancet, BMJ, Annals of Int Medicine) plus 10 allergy journals, plus Medscape, Reuters Health and WebMD.

How many new topics do you personally post under each sub heading, i.e. Endocrine, Cardiac, etc each week?

1-2 blog posts per day, for example, cardiac topics once a week, endocrine topics once a month.

Some helpful references:

5 Tips to Stay Up-to-Date with Medical Literature

How to deal with the information overload from blogs, RSS and Twitter?
Image source: public domain.

"I'm a Medicare doctor. Here's what I make"

From CNN:

Dr. Schreiber sees 120 patients a week - 30% of them are enrolled directly in Medicare, while another 65% have private insurance plans that peg their payments on Medicare's rates. Only 5% pay on their own.

Medicare pays between 63-72% of the costs for Schreiber's patients.

Four billing codes make up the "bread and butter" of claims submitted to Medicare:

- The first code represents a simple visit, which might include blood pressure and cholesterol checks. Schreiber gets about $44 from Medicare for the $70 fee he charges.

- The second and third codes correspond to a sick visit, when he spends 15 to 20 minutes evaluating a patient for symptoms such as coughing or shortness of breath. Schreiber charges $92 for a sick visit, of which Medicare pays about $58.

- The last billing code is a complex visit. "This is where a patient comes in with many problems like heart disease, hypertension, diabetes," he said. Such a visit requires about 30 minutes of his time.

Schreiber charges $120 for these visits, and Medicare pays $88 of that.

References:

Medicare backlash: A primary care doctor lays out his costs. CNN.

Image source: United States one-dollar bill. Wikipedia, public domain.

Armchair BEA: Approaching Publishers and Authors

In honour of Armchair BEA and the Book Blogger Convention that I wasn't able to go to, I present a post on approaching publishers and authors yourself when you see a book or a bunch of books you'd like to review.

I review for a LOT of different publishers, authors and publicists and not all of them contacted me first. I approached more publishers than approached me. It can be a little scary at first, especially if you haven't been reviewing for others that much yet. My first few times I felt like I was sending an email to the Prime Minister/President, especially for the bigger publishers.

First of all realize you will not be corresponding with the head of the company. Requests for book reviews go to publicity/public relations.

To Approach Publishers

Step 1: Find the website for the publisher you want to approach. (NOTE: For some of the bigger publishers, make sure you are contacting the proper one for where you live. If you live in Canada, you should be contacting Random House Canada or Harper Collins Canada.)

Step 2: Look around, usually near the bottom of the page, but not always, for a contact section, or Media section.

Step 3: Usually there are different emails for many different people in the company. If one says for book review requests (media only) than that's the one you want. If nothing says that, then look for the title of Publicity or Public Relations (PR.) If there is only one contact email, use that one. If you still can't figure it out, try the most basic email such as info@publisher.net or inquiries@publisher.net.
NOTE: It may say for media only or accredited only or something similar. Don't let this scare you away. Most publishers work with bloggers and you are going to clearly state that you are such. If they don't want to work with you, they will say so, no harm done. 

Step 4: Open up your email and make the subject line something like these:

If you are requesting a certain book
"Review Request: Book Title and Book Author (ISBN)"

If you are requesting to work with them in general
"Interested in a possible blogger-publisher relationship"
"Book Reviewer looking to work with [Publisher name]"

Step 5: Make your email fairly professional and to the point. Don't ramble. If possible, address the PR person by name. Try one of these:

Dear [PR Name],
To the Publicity Department (use if being sent to generic email address)
To Whom it May Concern (last resort)

I usually open my email by saying:

"I am an Independent Book Reviewer at http://smsbookreviews.blogspot.com and I often review books for other publishers, publicists and authors."

Obviously if you are new to reviewing, you will have to word yours a little differently.

Then say something nice about the publisher and why you want to review for them (but keep it truthful) such as:

"Looking through your catalogues I see many books I own/have read and enjoyed in the past."
"Some of my favourite books are from [Publisher Name]"
"I'm always looking to support publishers from [Country Name]"
"I just came across your website but already see quite a few books that catch my eye."

Continue stating something about how you would love to review some of their books which would help generate public interest. Direct them to your review policy and state why your blog would be a good fit.

End with something like:

"Thank you for taking the time to consider this matter"
"Thank you and I look forward to hearing back from you."
"I realize you are very busy but when you get a chance, I'd love to hear your thoughts."

Step 6: Read over your message again, check for spelling and grammar and check AGAIN. Make sure it sounds right and it's to the correct email. If you are requesting a specific book, include your mailing address so that if they decide to send it to you, they don't have to email you back and wait again for your address. If you are requesting to work with them in general, I wouldn't include your address. Send!

I've received a response in as little as the next day and as long as 3 months later and some never responded at all so you may want to send a message to a bunch of different publishers. The ones that didn't respond were smaller publishers and this was when working with bloggers was new so they may have said to themselves, "A blogger is not media and not eligible for review copies" and ignored me. Things may change if I approached them again now.

To Approach Authors

First of all realize that very few authors have enough copies of their book to send to you. Most authors I've approached forwarded my email to their publisher who sent me the book. I have received books straight from authors too though. I usually approach authors after seeing their book on TV or in a magazine and it spikes my interest. If I can easily find the publisher, I contact them but sometimes it's a small publisher or I can't find a way to contact them.  Also the author is usually more gung ho at the idea of having me review their book and it's usually a yes when I approach them.

The Following ADDED June 1, 2010
For Twitter Users

Ruth reminded me in the comments about contacting publishers or publicists through twitter.I've done this a few times. One time the publisher was offering a review copy to any book blogger who followed them, just be DMing your address. Another time I saw a conversation between a publisher and another book blogger, offering her a review copy. So I contacted and said I've love to review the book too and they said yes. One or two other times I saw a publisher tweeting about a new book so I replied back saying I'd love to review said book on my blog. I got a review copy each time I contacted someone on twitter. Take a chance!

VXX

Below is a Weekly chart of VXX along with Fibonacci retracement levels:

The LONG signal was generated the first week in May and is still operative.  Note how the character of the market has changed, from a declining, subdued trend to a rising, volatile, broad-ranging trend.  Note also how the initial surge (Wave 1) has now been retraced between 38-50%.  It's possible for the retracement to reach 62% before ending, but VXX is in its Fibonacci window of reversal now, so any dramatic rise in volatility will likely resolve into a Wave 3 advance with inverse implications for the stock market.

Doctors should blog with their real name - agree or disagree?

From KevinMD:

"Martin Young still has "nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

My blog as an extension of who I am as a doctor, putting a carefully considered face to the experience of caring for the sick, as a means of drawing attention to issues that do not get into medical journals. As do most other doctors who host their own blogs.

I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and face to your thoughts?” My personal belief is that the anonymous person may lack conviction, confidence or courage.

I would not accept a referral from an anonymous doctor, or give advice to one. In the same way, I may read anonymous replies to my postings, but they carry much lower weight."

Although I encourage physicians to blog under their own name, I do not think we should "force" them to do so. They should not feel obliged to host their own blog either if they can use such perfectly reasonable free services such as Blogger.com by Google and WordPress.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Do not blog anonymously. List your name and contact information.
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any employee blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:

Why doctors should blog with their real name. KevinMD.
How to write a medical blog and not get fired?

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Image source: public domain.

Twitter comments:

@DrJenGunter (Jennifer Gunter): depends on blogging agenda.

@DoctorNatasha (Natasha Burgert): I blog and tweet with my real name because it keeps me accountable to my work, honest with my patients, and real with my intent.

@DrElizabethLee: I sign my name to anything I write.

@DrVes: Doctors need to understand the basics, and address the irrational fear of using social media.

Whatever works

Here is a 240 minute chart of the DJIA:

As with yesterday's SPX chart, prices are in the process of retracing a Fibonacci percentage of the prior decline and a move into the Fibonacci window, accompanied by shorter-term trend SELL signals, will provide an opportunity to enter on the SHORT side.  Late yesterday was the first attempt at this strategy, obviously a fake out.  It may take multiple attempts, nothing worthwhile ever comes easy.  The pay-off, being SHORT for a Wave 3 decline, is easily worth a few whipsaws, i.e.  whatever works.

Armchair BEA: Interview with Felicia of Geeky Blogger's Book Blog

Armchair BEA is for those of us who can't attend BEA (Book Expo America) or BBC (Book Blogger Convention) for real.

In honour of Armchair BEA, I go to interview a fellow book blogger. I interviewed Felicia of Geeky Blogger's Book Blog.


Can you tell me a little bit about what your home life is like? Significant Other? Kids? House? Apartment? Urban? Rural? 

My name is Felicia, 38 years old (young), single, and have 2 very lovable yet exact opposite of each other dogs.  I live right outside of a metropolitan area in the "burbs".  It is a nice quiet community and I love my house just because of the huge backyard! Most of my life revolves around my family, friends, and dogs.

When you are not blogging, what are you doing? 

Oh gosh so very little of my life is actually blogging (though I love it)!  Most of the time, I am reading, playing WOW (world of warcraft), going to book signings, attending meetups from meetup.com, hanging with friends, or watching TV (which I do a lot of---my friends and family call me a walking IMDB-Internet Movie Database).

I see you review a lot of Paranormal Romance. I personally don't read that genre so I'm curious, what do you like about it? If you were trying to sell me the genre, what would you say?  

I probably wouldn't try to sell anyone on any genre.  That is the fantastic thing about the wide range of books offered these days, everyone can find at least one that speaks to them.  Most of them overlapping with others, so you are never limited in your reading options.  As with most readers though, I tend to read several different genres and often at once.  My main is PNR but I also read quite a bit of non-fiction, historical romance, and mystery/thrillers.  I think what I like (LOVE) about PNR is it combines all my favorite fiction genres: romance, mystery/thriller, and paranormal settings.  However, if there is a good story, I will read it.  

How did you choose the name Geeky Blogger? Why do you consider yourself a geek?  

I am a professional geek!  I actually work in the information technology field, play World of Warcraft in my spare time, can wax on and on about most things Microsoft (hey it is what pays my bills), and even way back in high school competed in UIL events such as Math Studies and Journalism.  I love and embrace the fact that I am geek, nerd, "insert whatever you want to call it here".  My other nickname is The History Chic (which is also geeky) but I have used that for years in the history groups I belong too (yep I go to Renaissance Faires and even dress up when I attend).

How do you like your Kindle? How long have you had it? Do you use it more often than reading regular books? 

I *heart* my Kindle. I got it about this time last year (May 2009).  I could go on and on about how it has enhanced my reading experience for hours.  Basically, for me, it is a fantastic way to keep my library with me most of the time. Since I am a multi-reader, I always have choices without lugging around 4 to 5 books at a time.  Even when I don't have my Kindle with me (which is rare), I have a Kindle app on my phone and they sync with each other.  I basically bought one because I don't have a lot of storage space for books and needed a workable solution to that problem.  I am one of those people that "re-read" books, so not keeping them was not an option.  The kindle made it easy for me to keep all my favorite series.  Of course, it created a "it is to easy to buy books" problem but I am working on that.  As far as reading "regular" books--I mostly don't unless I win them or they are not offered on Kindle.  I do still by "paper" books when I want to collect them, want them signed, or want the hardback version of them.  I don't really buy that many paperbacks anymore though.

I've never read any Jane Austen and have no intention to do so. What made you pick up one of her books? What do you like about her style? 

I grew up in a really small town with a really limited library.  This was the 70's and early 80's so most of the books were very strong male role models with women filling the "supportive" roles.  Austen was the first author I read (assigned in school or picked up in the library-can't remember which came first) that had strong, opinionated, forceful women that did not play a supportive roles in their own lives.  They could have romances, take a stand, push for what they wanted, and still have rich fulfilling relationships with people in their lives. I have since read many books that have strong female characters but she is the one I hold near and dear to my heart.

I see from your Good Reads that you read a lot of books at once like me. Do you have certain types of books that you only read before bed, or a book that is only for when you are out and about or anything like that? Or do you just sit down to read and pick a random book from your reading pile? 

I am very random!  I always have several books started at once because I read what I am in the mood for.  I have audiobooks to listen to while at work, 2 to 3 different books going on my kindle, and then if someone mentions a book that I think I might be interested in, I could read the first few chapters.  I have always read like that since I was young.  With the rare exception, I very seldom sit down and read a book cover to cover unless it is one that have been waiting to come out or it just "hooks" me. 

Tell me about your dogs. 

My dogs are my children.  I have a 13 (almost 14) year old pug who was a rescue from a puppy mill.  She has been a part of my life for 12 years and is just the best snobby brat on the planet.  Tonks (yes named from Harry Potter) is a Lab/Pyrenees mix (120 pounds) and is the sweetest dog on the planet.  When I got her she was 7.7 pounds and then she just spurted up to a 120 while I was paying attention.  She is most like me--a little bit clumsy, very curious, and sometimes can be the laziest thing on the planet.  She loves her mom though :)

On one of your other blogs, Bits N Bytes of a Geeky Blogger , you do a weekly meme called Tasty Tuesdays. I've enjoyed the recipes although I haven't tried any yet. Do you like to cook? What are a few of your favorite meals? 

I love to cook and when I joined Weight Watchers, I found that I could eat more if I cooked it myself.  I am all about good food!  I am subscribed to a huge amount of magazines just for the recipes.  I love fish, chicken, beef, veggies, and learning to love fruits.  I also like simple meals though and find that you don't always have to spend large amounts of time in the kitchen to whip up a good meal :) My favorite meal is Talipia Fish Tacos with avocado and pico.  It is quick, filling, and good for you (though it tastes like it is a cheat meal)!  I love it!

How long have you been blogging and which blog did you start first? What made you want to start blogging? 

I started Bits N Bytes of a Geeky Blogger (previously named Confessions of a Geeky Blogger) in July of 2006, it was a way of dealing with a bunch of transitions going on in my life: a breakup, buying a house, transitions at my old job, and really trying to carve where I fit in the world.  My travel blog started after I went overseas the first time and everyone wanted to know what I was seeing.  This was a way to keep my family/friends up to date on my travels.  Then my book blog started in Jan 2009, the first time I signed up for the 100 book challenge.  I just needed a way to keep up with what I read and blogging is something I am very comfortable with :)  I am in the process of "branding" all my blogs though they are hobbies so I am not as stressed over that as maybe I should be.  I just like really cool layouts.  So far my book blog has been done and my personal blog is in the process of being re-done.  I am lucky I found a designer that gets me!

Thanks for the great questions!  I had a great time answering them.

Sounds like a plan

Here are my two Hourly Trend Models, followed by a possible target for this counter-trend rally.

It's the third chart that is operative for strategy here, awaiting a move up into Fibonacci resistance followed by a reversal of the Hourly Models from LONG to SHORT.

Sounds like a plan.

A

Medical blog content and relationship with blogger credentials and blog host

A quantitative content analysis was performed on 398 blog posts from a constructed 1-week sample of posts in WebMD, Yahoo!Health Expert Blogs, and independently hosted blogs.

Most health and medical blog posts highlighted and provided commentary pertaining to medical issues found in external media such as books, television, Web sites, magazines, and newspapers

Only 16% contained actual health or medical information.

Distinct differences in patterns of content were evident between credentialed and noncredentialed bloggers, as well as different blog hosts.

References:
Health and medical blog content and its relationships with blogger credentials and blog host. Buis LR, Carpenter S. Health Commun. 2009 Dec;24(8):703-10.

Comments from Google Buzz:

Shabber Hussain - Now if I can some how know about those 16% medical blogs that "contain actual health or medical information", it should make my day. Feb 26

Arin Basu - I think (I just read the abstract perhaps a closer reading of the full text of the article might be more useful, @Ves, did you have a chance to read the full text?)

* The findings are not unexpected, at least that's what you expect based on "credentialing the blogger who has written the posts"

* There seems on first reading at leas the abstract that there may be quite a bit of bias in that study (just one week snapshot (too few blogs sampled), few selected sites (selection bias right there), and interpretation)

* Not surprised that most blogs contained commentaries published in popular press and journals.

I think that's what blogs should ideally do. Raise awareness, enable and alert people to read & interpret meanings. I'd not expect blogs to replace "actual" texts (well, that's my perspective)

* Which makes @Shabber's point very pertinent, what are those 16% saying, on a one week selective sampling?

All in all, a very interesting article. I think it needs to be closely read and discussed in medical blogosphere. Feb 26

Image source: public domain.

Oral Tolvaptan (Samsca) Is Safe and Effective Treatment for Chronic Hyponatremia

Vasopressin antagonists increase the serum sodium concentration in patients who have euvolemia and hypervolemia with hyponatremia in the short term (30 days), but their safety and efficacy with longer term administration is unknown.

In a study, 111 patients with hyponatremia received oral tolvaptan (Samsca) for 700 days.

The most common adverse effects attributed to tolvaptan were pollakiuria, thirst, fatigue, dry mouth, polydipsia, and polyuria.

Mean serum sodium increased from 130.8 mmol/L at baseline to greater than 135 mmol/L throughout the observation period.

Responses were comparable between patients with euvolemia and those with heart failure but more modest in patients with cirrhosis.

In conclusion, prolonged administration of tolvaptan maintains an increased serum sodium with an acceptable margin of safety.

Samsca (tolvaptan) Black Box Warnings

Appropriate Use

Initiate and re-initiate tx only in hospital with serum Na monitoring.

Monitor Serum Sodium

Osmotic demyelination may occur w/ rapid correction of hyponatremia (faster than 12 mEq/L/24h), resulting in dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma, and death; slower rates of correction advised in pts w/ severe malnutrition, alcoholism or advanced liver disease.

Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca)

Conivaptan is administered IV only, the average cost per day is $573.

Tolvaptan is administered PO only, the average cost per day is $300.

References:

Oral Tolvaptan Is Safe and Effective in Chronic Hyponatremia. Journal of the American Society of Nephrology, 2010.

Samsca (tolvaptan) Black Box Warnings. Epocrates.

Cost comparison of conivaptan (Vaprisol) versus tolvaptan (Samsca) (PDF).

Lowest sodium I have ever seen http://goo.gl/QgJmf

Image source: Tolvaptan, Wikipedia, public domain.

Comments from Twitter and Facebook:

@kidney_boy: tolvaptan is safe for the patient but not their wallet at $250 per pill!

Neil Mehta: "It costs a king's ransom to keep the sodium level up! Maybe we should just say "Let them eat Salt"!"

Updated: 10/28/2010

SPXU

Here is a 240 minute chart of the SPXU, a triple-leveraged inverse ETF for the S&P 500:

SPXU 240 minute Trend Model

Below, the Elliott Wave projections for this move:

SPXU - EW projections

There are two ways to play these leveraged ETF's.  First, you can simply trade off of their charts, being LONG when prices are above the trend line and SHORT when prices are below the trend line. 

Alternatively, you can base trades on the underlying unleveraged index, i.e. SPX and simply trade the SPXU based on the SPX chart:

SPX 240 minute Trend Model

Disclaimer:  There are many ways to skin a cat, but it is recommend that you  declaw them first.

TED Talks: A new strategy in the war on cancer

From TED Talks/TED Med: Traditionally, David Agus explains, cancer treatments have had a short-sighted focus on the offending individual cells. He suggests a new, cross-disciplinary approach, using atypical drugs and computer modeling.

SPX - dominant trend

Following up on my post from last night, here is the current SPX Daily chart with a potential EW count that suggests an initial target of 925-975 for this move:

SPX Daily Trend Model

I still find it fascinating how prices tend to approach the trend line on retracements, then fall short and resume the dominant trend.  Look at the most recent set of blue candles, five "up" candles that retraced to the vicinity of the trend line around May 10-14, then  resumed the downtrend.  This pattern may very well provide additional entry points in sync with the dominant trend.

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Doctors use Facebook Pages to connect with patients

With a 500-million large audience, many practices find that creating a Facebook presence can be an easy -- and free -- way to stay in touch with patients or attract new ones.

Businesses, including physician practices, can create something similar: pages (previously "fan pages"). Anyone on Facebook who elects to "become a fan" or like your page receives, on his or her own home page, any updates, photos, videos or Web links that you post.

Rather than having patients "friend" you on Facebook, you can direct them to this page. Having a moderator is important, because having someone dedicated to responding to people makes them feel more connected and encourages respectful and on topic discussions.

References:
Amednews: How Facebook fan pages can connect with patients.

Facebook Pages Manual.pdf - File Shared from Box.net via @sandnsurf.

10 Easy Ways to Enhance Your Facebook Page. Web Worrker Daily, 2010.

Image source: Wikipedia.

Updated: 07/15/2010

SPY and overnight trading

I don't usually post this late at night, but, it looks like the lows from last Friday are in danger of being taken out if the overnight weakness carries over to Tuesday morning.  Here is the SPY 60 minute chart as it closed on Monday:

With the S&P Futures down 18 points, those lows are in danger of falling.  This would not bode well for the market.

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Reading to Rabbits, Monsters Under the Bed and Chicken, Pig and Cow

How Do You Read to a Rabbit? by Andrea Wayne von Königslöw

Stars: *****

Annick Press (2010)
Picture Book
32 pages
Ages 2-5

Summary: How do you read to different animals? What would happen? This is explored with humour in this book.

This book is along the same lines as one of her other books, Toilet Tales.

Some Quotes:

"If you read a bedtime story to a hippopotamus, he might want to sit on your lap."


"And why can't you read a book to owls? Because they'll keep asking.... whooo????"

The book is really cute and can inspire talk about how other animals would react to being read to.  If you want you could even pass along the neat fact that dogs are great listeners and in fact lots of children do read to them. At the end of the book we see who the best people to read to is.

As I posted about before, there is a Annick Press contest to go along with this book. Click the link for details, it's for kids and you could win a signed, original sketch by the author/illustrator.

Links of Interest: Contest,

Other Reviews: NONE YET

Buy How Do You Read to a Rabbit? at amazon.com and support SMS Book Reviews

Is There a Monster Over There? by Sally O. Lee

Stars: ***1/2

Create Space (2010)
Picture Book
36 pages


Summary: Mabel and her cat Tiffany are scared of monsters until Mabel wonders "what if monsters were just like us?" So Mabel and Tiffany test out their theory and get to be friends with the monster.

I've reviewed many other picture books by Sally O. Lee: Stop It, Cake Thief, The Rabbit and the Snowman and The Tutu Ballet.

This one would be good for a child already scared of monsters but if they aren't scared of monsters, I wouldn't read it. The monster is kind of scary looking and you don't want to put that idea into their head. That really goes with any monster book.

Once Mabel isn't afraid anymore and finds the monster friendly, they play dress up which I think is a good way of making the monster not scary anymore.

Links of Interest: Lee Publishing,

Other Reviews: Lost in Books,

Buy Is There a Monster Over There? at amazon.com and support SMS Book Reviews

Chicken, Pig, Cow and the Purple Problem by Ruth Ohi

Stars: *****

Annick Press (2010)
Picture Book
32 pages
Ages 2-5

Summary: The third book in the Chicken, Pig, Cow series. Cow is fed up with having purple spots when all the other cows have brown or gray spots so she goes off on a quest to change her spots. It's a story of self-acceptance.

See Chicken, Pig, Cow and Chicken, Pig, Cow on the Move.

Cow is the focus of this book and he learns the important lesson of being happy with who you are. He leaves his friends to find a way to not be purple. He finds gray mud and brown dirt and even new shoes. Will his friends recognize him?

As with all the Chicken, Pig, Cow books, this is so cute. My kids love the series and I can't wait to see what's next.

Links of Interest: Ruth Ohi, Featured on Gisele's Big Backyard,

Other Reviews: NONE YET

Buy Chicken, Pig, Cow and the Purple Problem at amazon.com and support SMS Book Reviews

* I received a copy of each of these books for review. All reviews are honest and are not affected by how I acquired the book.

New Treatment Effective in Killing Head Lice - benzyl alcohol lotion 5% (Ulesfia)

From WebMD:

A new prescription lotion (Ulesfia) with benzyl alcohol treats head lice and is effective and safe for children as young as 6 months. The study shows it works by suffocating lice, a method that has long been tried with limited success using messy substances like petroleum jelly, olive oil, and even mayonnaise.

Overnight "home remedies" such as mayonnaise merely appear to kill lice, but don't because the bugs are able to close their spiracles long enough to survive. This is called the "resurrection effect" because, after rinsing, the lice thought to be dead are able to open their breathing spiracles and start biting again.

Existing over-the-counter head lice treatments contain neurotoxic pesticides as active ingredients, resulting in potential toxicity and other problems, including lengthy applications, odor and ineffectiveness.

References:

New Treatment Effective in Killing Lice. WebMD.

Losing the Lice Without Losing Your Wallet. NYTimes, 2010.

Image source: Benzyl alcohol, Wikipedia, public domain.

Updated: 05/28/2010

The look of Dow

The look of love is in your eyes
A look your smile can't disguise
The look of love is saying so much more than just words could ever say
And what my heart has heard, well it takes my breath away

This is the 60_minute DJIA, still entrenched in a short-term SELL, despite market strength over the past couple of days.

Same holds true for the 240_minute DJIA, still well into SELL MODE.

I consider this the most important of the three charts.  It's a Daily DJIA that suggests the decline of the past few weeks is unfinished.  Note that there are several hundred DJIA points to go before this Daily trend is even threatened.  That's where the 60 & 240 minute charts come in, early warning systems which haven't yet been triggered.

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Disclaimer:
Burt Bacharach has been married four times. His first marriage was to Paula Stewart, which lasted five years (1953–58). His second marriage was to actress Angie Dickinson, which lasted fifteen years (1965–80). Bacharach and Dickinson had a daughter, Nikki, who is now deceased (see Angie_Dickinson#Personal_life). His third marriage was to lyricist Carole Bayer Sager, which lasted nine years (1982–91). Bacharach and Bayer Sager collaborated on a number of musical pieces, and had a son, Cristopher. Bacharach married his current wife, Jane Hansen, in 1993; they have two children.

Room-temperature plasma gases may replace hand disinfectants

From the NYTimes:

Instead of scrubbing, the workers would put their hands into a small box that bathes them with plasma — the same sort of luminous gas found in neon signs, fluorescent tubes and TV displays.

This plasma, though, is at room temperature and pressure, and is engineered to kills bacteria, including the drug-resistant supergerm MRSA.

References:
Hospital-Clean Hands, Without All the Scrubbing

Image source: Neon sign. Wikipedia, Rolf Süssbrich, Creative Commons Attribution ShareAlike 3.0 License.

Physically fit students score higher on tests than their less fit peers

Test scores dropped more than one point for each extra minute it took middle and high school students to complete a 1-mile run/walk fitness test.

65% of the students were below the state fitness standard. Compared with these students, students who met or exceeded fitness standards had higher average test scores. Overweight and obese students also scored significantly lower on tests.

Schools may have to reverse their recent disinvestment in physical education ostensibly for the purposes of boosting student achievement.

Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:

"Health Promotion" video: Benefits of exercise.

References:
Physical, academic fitness tied at the hip: study. Reuters, 2010.

The Journal of Pediatrics, published online January 25, 2010.

Isn't life strange?

I'm looking for someone to change my life.
I'm looking for a miracle in my life.

 From my life-long friend, Jack:

A lot of people don’t like the Moody Blues, but I think they are great. I remember a friend in Massachusetts in the very late-early 70’s (before I started listening to them) tell me that these guys really understood the world, and everything you wanted to know about it is contained in their songs.

Isn't life strange
A turn of the page
A book without light
Unless with love we write;
To throw it away
To lose just a day
The quicksand of time
You know it makes me want to cry, cry, cry -

Wished I could be in your heart
To be one with your love
Wished I could be in your eyes
Looking back there you were:

Nasdaq 100 - Daily Trend Model

Below is the Nasdaq 100 Daily Trend Model with an Elliott Wave count that portends deeper, much deeper declines in the offing:

This trend model can be used to trade QQQQ options and if you are so inclined, gives a "worst-case"scenario for analyzing "best case" scenarios for gains in puts.  The wave count is suggesting another 7-17% decline in store for the index.  Extrapolating that to the QQQQ would suggest a drop to between 41-37 from its current level of 44.84.  Let's take a look at the QQQQ chart and see how close it comes:

Wave 5 Target = 35-40

In conclusion, while the Daily Trend Model is SHORT, it doesn't give guidance as to how far or for how long the market will decline.  EW is a imperfect science, but it does provide some structure for projections and in this case, is suggesting a decline taking the QQQQ to levels between 35-41.  With four weeks to go to June expiration, there are a lot of strikes in the QQQQ puts that will thrive under the auspices of these projections.

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Disclaimer:  Do you really know me?  Do you know what I may be on, or have been smoking, or drinking, or eating, or dropping?  Have you ever taken window pane acid?  Have you ever eaten really potent brownies?  Or, maybe he's just too old for that stuff.  See, now he's talking in the first person.  Or is it second?  That should cover it.

Metabolic pathway plays a role in susceptibility to stuttering

Stuttering is a disorder of unknown cause characterized by repetitions, prolongations, and interruptions in the flow of speech. Genetic factors have been implicated in this disorder, and previous studies of stuttering have identified linkage to markers on chromosome 12.

This study shows that variants of proteins that guide hydrolases to the lysosome are associated with stuttering. This unexpected finding implies a metabolic pathway in susceptibility to stuttering.


Video: Biology Homework about Lysosomes.

References:

Mutations in the Lysosomal Enzyme–Targeting Pathway and Persistent Stuttering. NEJM, 2010.

Health benefits of chocolate

The health benefits of chocolate may include:

- Reduction of blood pressure by eating 6 grams of dark chocolate per day. Probably due to the flavonol epicatechin
- Reduction of platelet and endothelial cell activation
- Reduction of inflammatory mediators
- It can also inhibit oral caries
- It can cross the blood brain barrier and increase cerebral blood flow in humans

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

References:
The Essence of Chocolate. Dr Shock MD PhD, 2010.
Chocolate could lower blood pressure but the required dose may be too much - BMJ http://goo.gl/uoBN

Photo Essay: Making Chocolate in Belize http://goo.gl/2DPi

Image source: Wikipedia, public domain.

Updated: 10/10/2010

"Blogging fame does not pay the bills"

From Social Media Examiner:

Wendy Piersall provides some insights into the "dark side" of being popular online:

- Fame does not pay the bills
- Being on the front page of Digg does not bring you success
- It takes lots of work to get internet fame and even more work to maintain the internet fame

See the video interview at Social Media Examiner.

References:
The Dark Side of Blogging Fame (a Wendy Piersall Interview). Social Media Examiner.

Image source: public domain.

Perspective

DJIA 60 minute

Waiting for this counter-trend rally to end, note how the projected 4th wave termination straddles the 60 minute trend line.  This says to me that the trend line is a reasonable place to add-on Short positions, if things get that far.  If not, a break of the  Wave 3 low would serve the same purpose.

Uh-Oh

Bear markets often end with war.  There can also be a correlation between the size of the bear market and the ferocity of the ensuing conflict. In the story below, note that at least one of the potential combatants is an unstable nuclear power.  This story is being underestimated and lightly covered in the media.  File it away, under, "uh-oh...."


 Clinton Condemns Attack on South Korean Ship


TOKYO — Secretary of State Hillary Rodham Clinton harshly condemned North Korea on Friday for a deadly torpedo attack on a South Korean Navy warship last March, and promised to marshal an international response in the coming week with Japan, China and other countries.

“I think it is important to send a clear message to North Korea that provocative actions have consequences,” she said after meeting here with the Japanese foreign minister, Katsuya Okada. “We cannot allow this attack on South Korea to go unanswered by the international community.”

Mrs. Clinton declined to lay out the potential options for a response, saying that would be premature. But she left little doubt that the United States would undertake an intensive diplomatic effort to craft a response to the sinking of the Cheonan, which killed 46 sailors and was one of the biggest military provocations on the Korean Peninsula since the Korean War.

Among the options being considered by South Korean and American officials is a United Nations Security Council resolution, and joint naval exercises with South Korea that could include anti-submarine warfare operations. South Korea may also cut off its remaining trade with the North.

“Let me be clear: this will not, and cannot be, business as usual,” Mrs. Clinton said, speaking in solemn tones. “There must be an international, not just a regional, but an international response.”


NKorea warns of war if punished for ship sinking

SEOUL, South Korea (AP) - Tensions deepened Thursday on the Korean peninsula as South Korea accused North Korea of firing a torpedo that sank a naval warship, killing 46 sailors in the country's worst military disaster since the Korean War.

President Lee Myung-bak vowed "stern action" for the provocation following the release of long-awaited results from a multinational investigation into the March 26 sinking near the Koreas' tense maritime border. North Korea, reacting swiftly, called the results a fabrication, and warned that any retaliation would trigger war. It continued to deny involvement in the sinking of the warship Cheonan.

Antibiotic use for respiratory infections could be reduced by 40% by procalcitonin (PCT) test

Procalcitonin (PCT) is a precursor of the hormone calcitonin, which is involved with calcium homeostasis, and is produced by the C-cells of the thyroid gland.

In healthy people, procalcitonin (PCT) concentrations are low, but in those with bacterial infection it occurs at high concentrations in the blood as early as 3 hours after infection. In people with viral infections, procalcitonin (PCT) levels rise only marginally, if at all.

A PCT-guided strategy applied in primary care in unselected patients presenting with symptoms of acute respiratory infection reduces antibiotic use by 41.6 percent without compromising patient outcome.


The FDA Approved an Automated Procalcitonin (PCT) Test in 2008.

References:
Simple test could cut excessive antibiotic use. Reuters, 2010.

Intraday Trend Tables

Here is an example of the Intraday Trend Tables that get sent out to subscribers periodically throughout the trading day:

Sign of the times

One more sign of the increasing geriatric population - in 2009 the adult size diapers outnumbered the baby diapers at the U.S. waste sites for the first time.



From Twitter:

@drwalker_rph Who counted the diapers???

Osteoporosis Drug Lasofoxifene May "Fight" Several Diseases But Increases Risk of Blood Clots

Lasofoxifene is a part of a class of drugs known as nonsteroidal selective estrogen-receptor modulators (SERMs). It has already been shown to decrease the bone loss associated with osteoporosis, like other SERMs, including tamoxifen and raloxifene. But until now its effect on other health conditions commonly experienced by postmenopausal women was unknown.

The women who took lasofoxifene had an 81% lower risk of estrogen-receptor (ER) positive breast cancer, a 32% lower risk of heart-related events like heart attack, and a 36% lower risk of stroke. "This is the first SERM that reduces the risk of all of these conditions at once."

However, not all the results were positive. As with other SERMs, women taking lasofoxifene had double to nearly three times the risk of experiencing a serious blot clot of the deep veins.

References:
Osteoporosis Drug May Fight Several Diseases. WebMD, 2010.

NEJM -- Lasofoxifene in Postmenopausal Women with Osteoporosis.

Image source: Flickr, Creative Commons license.