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This study was funded by the Food and Drug Administration and the Agency for Healthcare Research and Quality. It identified 81 heart attacks, strokes and sudden deaths in the study with more among those taking the medicines than in a comparison group who wasn’t on the medication. health plans and derived its findings based on this systematic review.
The limitation of this study is that the findings of the number of patients who had cardiovascular events were surprisingly low. Could this study size not be large enough to have picked up statistical significance, and would we perhaps benefit more from a confirmatory study of these findings with a larger sample size study? The answer is likely that we would indeed benefit from a larger study to confirm this finding.
However, in the interim, because ADHD can create significant limitations in school and work achievements, and other options can mostly be looked at as only adjunctive therapies, a study such as this helps to allay some of our fears for those who are on the medication until we can further obtain additional confirmatory data.
When I see patients with ADHD, we discuss potential pros and cons of medications such as Ritalin and Adderall. But we also frequently discuss potential alternatives or adjunctive therapeutic options for ADHD as well.
With a recent study as the one published in NEJM, patients who are on the stimulant medications may decide they want to continue on the medications. However, some of the options for adjunctive therapies may also be worth looking into so as to optimize daily functionality in the work place, home and school environment.
Clinically, there are some indications that avoidance of food preservatives, food allergens and processed foods is a good idea for those dealing with ADHD. There is also suggestion that supplements such as fish oil may be beneficial. In this article, I would like to discuss a few other behavioral options as well that have been seen to potentially be helpful with ADHD as adjunctive therapies.
1. Positive parenting and relationship training is essential to ADHD therapy. The American Academy of Pediatrics recommends behavioral therapy programs for children with ADHD. Although behavioral therapy programs are best utilized in conjunction with medications, the adjunctive therapy is seen to be very beneficial for ADHD therapy. Training programs where parents are taught to reward good behavior instead of reprimanding bad behavior have led to positive long term benefits for those dealing with ADHD.
2. Neuro Feedback (aka EEG biofeedback). This treatment tries to cheap uggs train patients to control brain waves typically associated with focus and attention. The positive aspect of neuro feedback is that it is likely to work permanently after training sessions are completed and a positive response has been achieved. However, it is labor intensive and potentially expensive for patients since most insurance companies may not cover it.
3. Meditation. In a pilot study in the 2008 issue of Current Issues in Education, transcendental meditation seemed to improve overall attention and behavior in children with ADHD. Reduction of stress and anxiety seemed to lessen symptoms as well by allowing prefrontal cortex of the brain to function more optimally.
Aside from these suggestions, I always recommend plenty of sleep and immersion in natural environments. Lack of sleep undoubtedly can worsen symptoms, and a study in the American Journal of Public Health in 2004 suggested that kids with ADHD exhibited improvement in symptoms after being allowed to play in natural outdoor environments. This was supported by a study by the University of Illinois in 2008 that children with ADHD fared better after being able to be out in nature for uggs outlet a 20 minute stroll in the park compared to those who strolled in downtown or residential areas.
When it comes to ADHD, it appears that a combination of medication with behavioral and environmental modifications yield the best results. So, for all those who are dealing with ADHD and for those parents trying to optimize the environment for your children with ADHD, keep in mind that even if medications are deemed relatively safe, the chance that you can achieve optimal results is still better with the creation of a supportive environment, optimal rest and nutrition, and creating situations that lessen distractions (such as seating closer to the front of a classroom or reducing anxiety and stress with daily mind body therapies). In my opinion, in the case of most disease states or health concerns, a multi modal approach to wellness and healing is the best option for achieving multi dimensional symptomatic improvement.AURORA, Colo. man who investigators nicknamed the “Band Aid Bandit” has been sentenced to 520 years in prison for a string of robberies in Aurora. He was convicted in October of nine counts of aggravated robbery with a real or simulated deadly weapon, one count of attempted aggravated robbery with a real or simulated deadly weapon, one count of robbery, nine counts of menacing, eight counts of theft and one count of attempted theft. Investigators say he put a bandage on his face or over tattoos on his hand to conceal his identity. He was accused of robbing several businesses and banks in Aurora from October 2009 through February 2010.
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While many critics counted out Amazon for years as it expanded to new verticals instead of remaining just a bookseller, the numbers tell the story of Amazon’s transformation into a key pillar of online commerce. Jeff Bezos today is worth just over $11 billion in Amazon stock, but is likely to be worth far more if current trends continue.
Ecommerce today represents either 3.5% or 7% of all US retail sales the latter figure excludes gasoline and other items not readily available via online purchase. Let’s use the 3.5% number to be conservative.
Whether or not the economy rights itself, ecommerce will continue to take more market share of the retail sector. If online sales grow to 7% of all retail by 2015 and Amazon just remains in its current market share position then Amazon will double in sales in that time.
Amazon is ruthless on cost containment and so can be expected to produce twice the profits if not more due to economies of scale. Amazon currently operates on trailing twelve month (ttm) margins of 3.7%. They can probably improve margins to 5%. Even if their P/E ratio comes down they can still maintain a strong market cap. Thus a company with a market cap today of $55 billion will likely top $100 billion. That will peg Bezos’ worth at $22 billion.
Amazon, though, is not just about ecommerce. Amazon Web Services (AWS) is a relatively new offering from the company that critics often jeer. Yet, AWS may end up serving as another growth platform for the company that brings them squarely into the enterprise arena. There is certainly a long way to go there, but to take even a small slice of the $1 Trillion market for IT will be significant.
Let’s assume that in 5 years Amazon can produce $1 billion in revenues in its hosted AWS platform. This revenue stream will yield a higher margin than ecommerce probably in the 10% range resulting in additional $100 million in profits and adding further to the market cap.
Add to this the revenue juggernaut of the Kindle and online downloads and you have the potential to add another $10 20 billion in market cap. Online downloads require no warehouses and no shipping higher profit margins once again.
I would thus peg Bezos’ net worth from his Amazon stock at $25 billion within 5 years.
Add to this his investments in other platforms. With Blue Origin, Bezos intends to join in on the commercial space sector growth. NASA just awarded $3.7 million to Blue Origin to continue development of its spacecrafts.
It is difficult to ascertain the value of a private company such as Blue Origin, but if they execute on plan and take a 5 10% market share of NASA and other space business, the company will be worth on the order of $1 5 billion in 5 years. Bezos owns nearly the entire company.
Adding this all up, it is clear that if Amazon and other Bezos ventures continue to execute, Bezos will first zip past the $20 and then the $30 billion mark.
While many in the Forbes 400 have money from inheritance or from a company sold long ago, Jeff Bezos is on an escalator up the value chain that can land him a in rarefied circle of entrepreneurs.