Thursday, 31 October 2019

OVEREATING MX

Consume mindfully
with compassion and wisdom
or consume mindlessly
with greed and delusion.
– Shilashanti

P NBAS SCALE X ASD

Neonatal Behavior and Social Behavior and Sensory Issues in 18 months Toddlers

Abstract

Background

There has long existed a need for early detection and early intervention for children with autism spectrum disorder. Accordingly, the aim of this study was to demonstrate, in a prospective manner, the relationship between behavioral features during the neonatal period and social behavior and sensory issues at 18 months.

Method

Participants were 105 full‐term infants considered “healthy” by an obstetrician. The behavioral features of the infants were evaluated using the Neonatal Behavioral Assessment Scale (NBAS) two–seven days after birth. Follow‐up assessments were conducted 18 months later using a Japanese version of the Modified Checklist for Autism in Toddlers (M‐CHAT‐JV) and the Infant/Toddler Sensory Profile (ITSP).

Results

Sixteen (15.2%) out of the 105 infants were M‐CHAT‐JV positive. There were significant differences between the M‐CHAT‐JV positive and M‐CHAT‐JV negative groups in two of the NBAS clusters: orientation and motor. We observed a significant negative correlation between the NBAS orientation cluster and the ITSP “low registration” and “auditory processing” sections, as well as between the NBAS motor cluster and the ITSP “sensation avoiding” and “tactile processing” sections. Logistic regression analysis showed that the NBAS orientation cluster and ITSP low registration were significantly associated with the M‐CHAT‐JV at 18 months.

Conclusion

The results suggest a relationship between the NBAS orientation cluster in full‐term neonates and their social behavior and sensory features at 18 months




TREE

Image may contain: tree, plant, sky, outdoor and nature

TNH

Image may contain: tree, mountain, sky, cloud, outdoor and nature

P A PAS OVER EQUAL 8 was associated with a significantly longer hospitalization AND COMPLICNS

A PAS ≥8 was associated with a significantly longer hospitalization and more complications than a PAS <8.https://www.mdcalc.com/pediatric-appendicitis-score-pas

When we feel conflict with others, understanding their suffering is the first step in being able to communicate, forgive, and begin again. —Michele McDonald, “Finding Patience”

When we feel conflict with others, understanding their suffering is the first step in being able to communicate, forgive, and begin again.

—Michele McDonald, “Finding Patience”

EDMONTON FRAIL SCALE

https://www.nscphealth.co.uk/edmontonscale-pdfhttps://www.nscphealth.co.uk/edmontonscale-pdf

Research finds that people with higher motivation have superior IQs.

Research finds that people with higher motivation have superior IQs.

PSY DEAN X STATIN X DEPRESSION

A range of common drugs, many available over the counter, help to reduce depression.
Fish oils, statins and common painkillers like aspirin — all available over-the-counter — can help treat depression, new research concludes.
The positive effects of these anti-inflammatories are even stronger when taken with antidepressants.
The reason these drugs may help is because inflammation in the body can contribute to depression.
The research found that the most effective anti-inflammatory drugs are:
  • Omega-3 fatty acids,
  • statins,
  • non-steroidal anti-inflammatory drugs (NSAIDs),
  • and minocyclines (a type of antibiotic).
The study also found that other anti-inflammatories, like steroids, modafinil and N-acetyl cysteine, were linked to a positive effect on depression.

P ACQD PORT WINE STAIN XSECY TO TRAUMA USUALLY

Port-wine stain (PWS) is a vascular malformation, presenting as a macular telangiectatic patch. They account for 1.4% of all vascular lesions seen in newborns.[1] While congenital PWS is an extensively described entity, however only a few cases of acquired PWS have been reported so far in the literature, with an isolated case reported from India so far.[2] Various etiological factors have been implicated in the causation of acquired PWS, including trauma, following frostbite injury, obstruction of the peritoneovenous shunt, herpes zoster infection, cerebral arteriovenous malformation, spinal root compression, solid brain tumors, and secondary to drugs such as isotretinoin, simvastatin, metformin, oral contraceptive pills, and chronic sun exposure.[3],[4],[5] We hereby describe a 14-year-old girl, who presented to our outpatient department with acquired PWS involving the right hand. The girl gave a 2-year history of multiple, asymptomatic red to violaceous patches on her right hand which she related to mechanical trauma inflicted by her teacher using a wooden stick about 10 months back. There was no other history of drug intake or excessive exposure to cold or sun. Over 2 years, a few more similar lesions had appeared to involve the ipsilateral little finger as well. Examination revealed multiple, discrete 2 mm to 3 cm erythematous to violaceous blanchable telangiectatic macules on the hypothenar eminence, palmar aspect of hand overlying the first metacarpal head and proximal phalanx of the right little finger, and medial border of the right hand extending onto the dorsum of the hand [Figure 1],[Figure 2],[Figure 3]. Systemic examination revealed no other abnormality. Due to patient's reluctance skin biopsy was not performed and based on the history and clinical presentation a diagnosis of acquired PWS secondary to trauma was made.
Figure 1: Port-wine stain over the right hypothenar eminence and extending to the little finger

WACU RV NEXT DAY X CANNULA CAPTIVE QT


SUFFRNG

Image may contain: text

DEFENDERS

  • 60% of Defenders say the ways they express their personalities change significantly when they’re at work.
  • Defenders are not particularly interested in seeking out jobs that require them to go out of their comfort zone, with just 23% agreeing.
  • Defenders are the second most likely type to believe their job has had long-term effects on their personality, with 75% saying so.
  • Defenders can be stressed out by having to adapt their personality to their job. Turbulent Defenders in particular are vulnerable to this, with 34% rating their stress levels high or very high.
  • That said, 75% of Defenders believe that adapting their personalities for work has been beneficial to their personal development.

You must face annihilation over and over again to find what is indestructible in yourself.” ― Pema Chödrön

You must face annihilation over and over again to find what is indestructible in yourself.”

― Pema Chödrön

POPPY

Primary assemblies, lesson plans and activities for Remembrance Day

P AIW SYNDROME CWH B0193904

I Had Alice in Wonderland Syndrome

Photo

Credit

A few months ago, my 10-year-old daughter, Paulina, was suffering from a bad headache right before bedtime. She went to lie down and I sat beside her, stroking her head. After a few minutes, she looked up at me and said, “Everything in the room looks really small.”
And I suddenly remembered: When I was young, I too would “see things far away,” as I once described it to my mother — as if everything in the room were at the wrong end of a telescope. The episodes could last anywhere from a few minutes to an hour, but they eventually faded as I grew older.
I asked Paulina if this was the first time she had experienced such a thing. She shook her head and said it happened every now and then. When I was a little girl, I told her, it would happen to me when I had a fever or was nervous. I told her not to worry and that it would go away on its own.
Soon she fell asleep, and I ran straight to my computer. Within minutes, I discovered that there was an actual name for what turns out to be a very rare affliction — Alice in Wonderland syndrome.
Episodes usually include micropsia (objects appear small) or macropsia (objects appear large). Some sufferers perceive their own body parts to be larger or smaller. For me, and Paulina, furniture a few feet away seemed small enough to fit inside a dollhouse.
Dr. John Todd, a British psychiatrist, gave the disorder its name in a 1955 paper, noting that the misperceptions resemble Lewis Carroll’s descriptions of what happened to Alice. It’s also known as Todd’s syndrome.
Having had it myself, I had a sense it wasn’t dangerous. But I wanted to know more. I contacted several neurologists whose work with the syndrome I found online and learned more about its possible triggers: infections, migraine, stress and drugs, particularly some cough medicines.
Epilepsy and stroke were sometimes linked as well, the researchers said. Some even believe that Lewis Carroll, who described his migraines in his journal, may have suffered from it.
Alice in Wonderland Syndrome is not an optical problem or a hallucination. Instead, it is most likely caused by a change in a portion of the brain, likely the parietal lobe, that processes perceptions of the environment. Some specialists consider it a type of aura, a sensory warning preceding a migraine. And the doctors confirmed that it usually goes away by adulthood.
Several neurologists have done M.R.I.s on patients with the condition, though once the bout has passed, there’s usually no sign of unusual brain activity. Dr. Sheena Aurora, a Stanford neurologist and migraine specialist, was the first to scan the brain of someone — a 12-year-old girl — in the middle of an episode.
According to Dr. Aurora’s 2008 report, electrical activity caused abnormal blood flow in the parts of the brain that control vision and process texture, shape and size. “The brain of someone with Alice in Wonderland syndrome is just a little bit different from those with other auras,” she said.
Dr. Aurora hopes to develop a database of patients with other doctors so they can study the condition and other migraine-related auras. Out of the 25,000 patients she has worked with, I was only the third person she had ever spoken to with the syndrome.
She asked for a family tree denoting which relatives had experienced it, so she could perform genetic testing to search for a link. “Sometimes,” she said, “one single case can change the way we understand things.”
I soon discovered my 14-year-old son, Dean, had had episodes for years — though he had never mentioned it to me until I brought it up. He recently began suffering from migraines.
I learned that my mother experienced the syndrome as a girl; her symptoms were so bad that sometimes she couldn’t walk. My sister, a migraine sufferer, had experienced it as a child, as had my brother, who remembered having it during a bout of mononucleosis, which is sometimes caused by Epstein-Barr virus, another known syndrome trigger.
My first cousin Jamie said she had it into her 20s, at a time of great stress in her life. Dr. Aurora was fascinated to learn of so many people in one family being affected; the condition is considered so rare that there have been few studies of it.
Dr. Grant Liu, a pediatric neuro-opthalmologist at the Children’s Hospital of Philadelphia, said his research into the syndrome shows that even small changes to the brain can yield dramatic effects. When those areas involved in determining size, shape and distance malfunction, he said, “the resulting visual experience can be extraordinary.”
Dr. Liu recently examined and interviewed 48 patients, all of them who had the syndrome as children between 1993 and 2013. Thirty-three percent of the cases were traced to some sort of infection, 6 percent to migraine and another 6 percent to head trauma. In about half of the cases, however, no cause was found.
A quarter of the subjects with no migraine history eventually developed migraines, Dr. Liu also found. In addition, 40 percent were still experiencing symptoms. Dr. Liu said it took time for family members of those studied to admit that they too had the syndrome, which leads him to believe that it may be more widespread than people think.
“A lot of family members didn’t own up to it on the first go-round,” said Dr. Liu. “They were almost too embarrassed. People want to be told that they’re not crazy.”

HPPYNESS

A STONE MINDFUL

Mindful

Eat Sleep Work Repeat

Eat Sleep Work Repeat

HELLO WEEN

“I play as I feel.” Oscar Peterson

“I play as I feel.”
Oscar Peterson

one study found that an average of 23% more calories were consumed when eating in company

one study found that an average of 23% more calories were consumed when eating in company

popular idea that “now” — also known as the “subjective present” — is three seconds long.

popular idea that “now” — also known as the “subjective present” — is three seconds long. 

People Who Try To Be Environmentally-Friendly By Buying Less Stuff Are Happier, Study Claims

People Who Try To Be Environmentally-Friendly By Buying Less Stuff Are Happier, Study Claims

B CALL CRAVING BY NAME X CHIPPIE MONSTER

Wonderful teaching, thank you for sharing. I have always had a question myself about how to let go of my cravings. When I crave to do something which I know will waste my time and destroy my health, I kept telling myself, this is just one instant of craving, it will soon go and you will thank me for it. So in that instant when we have craving, if we tell ourselves, the craving is not worth pursuing, we are mindful and we let go of it in a easy way. Like he said in the video, relax and loosen the grip or tension, take it easy.


N Successful treatment of neonatal idiopathic ventricular tachycardia with landiolol hydrochloride

Successful treatment of neonatal idiopathic ventricular tachycardia with landiolol hydrochloride

B

The question has often been asked; Is Buddhism a religion or a philosophy? It does not matter what you call it. Buddhism remains what it is whatever label you may put on it. The label is immaterial. Even the label 'Buddhism' which we give to the teachings of the Buddha is of little importance. The name one gives is inessential..

That wounded child, indeed, is also our body, not just our brain.
The wounds of the past live in our muscles and bones as much as our 'grey matter'.
Still curled up inside us waiting for care.

One of the major insights that I've had since starting to learn about buddhism is that concepts like "deserve" are not very useful. Nobody "deserves" anything. Seems like you said it right. You're 30 and still laboring under the childish belief that the world owes you something. I don't say this derogatorily. If you meditate, and try to follow the 8-fold path I imagine your perception of your situation will change. If you can start to understand concept of dependent arising and the cause and effect nature of reality, you can start to reduce your suffering. Consider dominoes. They don't fall over because it's what they deserve, they fall over because they were struck by another domino. Hope this is helpful. I think I've been in a similar mental space to where you appear to be. One thing I can assure you is that if you bring notions of entitlement and "deserving" to a relationship, you're going to have a bad time. Good luck on your journey.




P ADHD X EPILEPSY

Attention‐deficit–hyperactivity disorder was identified in 11.8% of 5–18‐year‐old children (32/301) with epilepsy in a 1 year period. ADHD is more frequent in children with epilepsy in childhood (5–11 years of age). Epilepsy diagnosis is more frequent in younger children with ADHD. Children with epilepsy and ADHD, also have a significantly higher prevalence of intellectual disability and specific learning disorder. Younger children diagnosed with epilepsy should be carefully monitored for ADHD.

P MOTOR TRAJECTORIES TERM AND PRETERM INFANTS

Motor trajectories of preterm and full‐term infants in the first year of life

Background

Motor development occurs throughout periods of motor skill acquisition, adjustment and variability. The objectives of this study were to analyze and compare biological and health characteristics and motor skill acquisition trajectories in preterm and full‐term infants during the first year of life.

Methods

Two thousand, five hundred and seventy‐nine infants (1,361 preterm) from 22 states were assessed using the Alberta Infant Motor Scale. Multivariate General Linear Model, t‐tests, ANOVA, and Tukey tests were used.

Results

An age × group significant interaction was found for motor scores. On follow‐up tests full‐term infants had higher scores in prone, supine, sitting and standing postures that require trunk control from 9 to 10 months of age; although this advantage was observed for sitting from the second month of life.

Conclusion

During the first trimester of life, preterm infants have higher scores in the supine and standing postures. Regarding motor trajectories, from newborn to 12 months, the period of higher motor acquisition was similar between full‐term and preterm infants for prone (3–10 months), supine (1–6 months), and standing (6–12 months). For the sitting posture, however, full‐term infants had a period of intensive motor learning of acquisition from the first to 7 months of life, whereas for preterm infants a shorter period was observed (3–7 months).

Conclusion

Although the periods of higher motor acquisition were similar, full‐term infants had higher scores in more control‐demanding postures. Intervention for preterm infants needs to extend beyond the first months of life, and include guidance to parents to promote motor development strategies to achieve control in the higher postures.

P ABX FEVER

Fever as a predictor of positive lymphocyte transformation test

Background

Few studies have characterized the clinical manifestations of delayed antibiotic hypersensitivity (AH) diagnosed using objective methods. The lymphocyte transformation test (LTT) is a reproducible method to diagnose type IV hypersensitivity. The purpose of the study was to evaluate the characteristics of delayed AH diagnosed on LTT in children.

Methods

We performed a retrospective analysis of patients who were evaluated for AH using LTT at National Center for Child Health and Development, Tokyo, from 2002 to 2014. We extracted patient demographics, type and duration of antibiotics, and clinical characteristics from the medical records. Clinical manifestations were compared between LTT‐positive and LTT‐negative cases.

Results

Seventy‐five cases for which 101 drugs were tested were included in this study. LTT was positive against 34 drugs in 26 cases. Median age was 5 years (IQR, 1–9 years), and 49% of patients had underlying disease. LTT was performed at a median of 18 days (IQR, 4–59 days) after the suspected episode. The median number of days from the initiation of therapy to the onset of symptoms was 4. Rash was the most common manifestation (89%). Fever (>38°C) was observed in 20 cases (27%). Onset of fever preceded the rash in nine cases (45%), appeared simultaneously in five (25%), appeared afterwards in four (20%), and was unknown in two (10%). Fever was an independent factor associated with AH when comparing LTT‐positive and LTT‐negative cases (OR, 3.61; 95%CI: 1.03–12.64).

Conclusions

Fever was a common presenting symptom of delayed AH in children aged ≤18 years.

P DM1 AND CELIAC DISEASE

Only one third of T1D + CD patients reached constant Ab‐negativity after CD diagnosis. Achieving Ab‐negativity after diagnosis seems to be associated with better metabolic control and growth, supposedly due to a higher adherence to therapy in general.

LYF DONE - GCK U ALL -“Birth is ended, the holy life fulfilled, the task done. There is nothing further for the sake of this world.”

“Birth is ended, the holy life fulfilled, the task done. There is nothing further for the sake of this world.”

B NIRVANA

It is said that when Nirvana has been realized, all desire 'blows out'. Should we see that as not wanting anything anymore? Is then everything you do a choice? For example, would an enlightened one not have survival reflexes because his will has ceased completely? In other words, was living a choice for Buddha?


The idea in the Mahayana tradition is that the Nirmanakaya is purely a manifestation of compassion. Even the Buddha's breath is occurring only in order to sustain his body so that he can teach the Dharma and tame sentient beings.

Even for a Buddha the body still produces pleasure and pain and needs to eat to maintain itself. The Buddha could acknowledge pleasure and pain as they arise in the body, but he doesn’t suffer from it, because there’s no attachment anymore. So the Buddha has awareness of pain from an empty stomach and can choose to act however he wants towards it, but if he chooses not to eat the body will deteriorate.


No. Someone who has attained Nirvana does not turn into a tree stump. What it means is that the choices are no longer fettered by mental defilements.
In contrast, we think we have freedom because we could do what we want - but that's a delusion, because in truth we are fettered. Our actions are fettered to our mental defilements. When we are heedless, our actions are largely influenced by greed, hatred and delusion - like a puppet played by a puppeteer. It's like playing a computer game while your younger sibling keeps wrestling the gamepad off your hands.
It is when the Buddha freed himself from the puppeteer, that he began to live.
He still had work to complete. Yes he became enlightened, but now he had to teach everyone else how to cease suffering.

One interpretation here, others may vary.
Buddhism(s) tend to recognize 2-3 kinds of psychological desires, one is tanha (ie craving) another is upādāna (clinging, grasping, fueling), and another is chanda (wish, intention, resolution, disposition of interests).
Tanha and upadana are experienced as a part of dukkha. So they are (experienced as) stressful, discontentment, dissatisfaction, pained etc. The roots of tanha are passions and greed, aversions, and delusions (like identity views). Sometimes anger and fear (of death) are added to this list. So by nirvana-ing one blows out most 'desires' and you get an existence that is freed from tanha, upadana, the roots of tanha etc.
But chanda remains, at least a purified (and perhaps spontaneous) form of it. Because chanda by itself can be positive or negative, and some chandas do not cause dukkha. It is said that the chanda of the Buddha was one of (unconditional or non-attached) compassion or sympathy. So not only did the wish for the cessation of dukkha apply proximally, but also to other beings, but not to the point of fixation (clinging).

So Gotama nirvana-ed (it can be used as a verb), awakened to (something, a truth or ultimate nature of things, a state of mind, knowledge, a transformed sensory discernment or consciousness etc... interpretations vary, and I am not awakened so I can't say which are correct), and remained in the bliss or tranquility of awakening. But then eventually exited the bliss of awakening, though could re-enter it when wished for. But throughout it all, a purified chanda and transformed citta was present, perhaps even as a consequence of nirvana-ing and awakening

.out of compassion for beings, surveyed the world with the eye of an Awakened One. As he did so, he saw beings with little dust in their eyes and those with much, those with keen faculties and those with dull, those with good attributes and those with bad, those easy to teach and those hard, some of them seeing disgrace & danger in the other world." SN6:1
In the scriptures, once the Buddha, and those he instructed, reach enlightenment, they do something sometimes called 'The Lion's roar' which is stated as this phrase:
“Birth is ended, the holy life fulfilled, the task done. There is nothing further for the sake of this world.”
It is the recognition that one had ended the conditions of new karma... karma that would lead to renewed craving and clinging. Old karma remains (e.g the body and its needs) and the enlightened being endures in this world for one final lifetime... teaching out of compassion for other beings.

Should we see that as not wanting anything anymore? Is then everything you do a choice?
Yes and yes. And he continues to live because there would be no reason to choose to starve your body, or let it be eaten by a tiger, etc, etc.

he unknotted all the knots on himself as that was his desire or "the way" of him the string 







GLORIOUS ANOON

Image may contain: tree, sky, plant, outdoor and nature

Peace is present right here and now, in ourselves and in everything we do and see. The question is whether or not we are in touch with it. We don’t have to travel far away to enjoy the blue sky. We don’t have to leave our city or even our neighborhood to enjoy the eyes of a beautiful child. Even the air we breathe can be a source of joy. ..." Thich Nhat Hanh

86400 SECONDS HAS A DAY: ENOUGH TIME TO SURF YOUR EMOTIONS!

86400 SECONDS HAS A DAY: ENOUGH TIME TO SURF YOUR EMOTIONS!

Anxiety about the future looms at every turn… Until we can see the back of our heads

Anxiety about the future looms at every turn… Until we can see the back of our heads

And when you meditate, do not do it to make yourself a better person or to change some aspect of your life. Just do it for the sake of doing it, and let any benefits be a pleasant surprise.


Wednesday, 30 October 2019

Every worm, every insect, every animal is working for the ecological wellbeing of the planet. Only we humans, who claim to be the most intelligent species here, are not doing that.

Every worm, every insect, every animal is working for the ecological wellbeing of the planet. Only we humans, who claim to be the most intelligent species here, are not doing that.
 
 

Folks with SAD may have a disconnect between the brain and the retina of the eye, which causes them to process light less efficiently, leading to lower moods when days get shorter.

Folks with SAD may have a disconnect between the brain and the retina of the eye, which causes them to process light less efficiently, leading to lower moods when days get shorter.

EMOTIONS OF THE DTHING

he Emotions of the Dying

Dec 01, 2017 06:01 am | Lizzy Miles



By Lizzy Miles

In my role as a hospice social worker, I find that there are recurring concerns expressed by family and friends of the dying. These are some of my responses to their worries. Mostly I find that I am normalizing behavior that they find confusing or unsettling, while also validating their discomfort. Families often feel helpless and I do my best to reassure them that what is happening with the patient is part of the process of dying.

I am careful to be mindful of faith/cultural beliefs of the patient and family so as to not suggest an explanation that is outside of their dogma.

Restlessness
Restlessness is a common symptom for patients who are dying. It can be distressing for family members because you want to help calm them and nothing seems to work. Medicine may help some, but you may see them still moving around and/or trying to get out of bed.
• Know that restlessness is normal and part of the process.
• When patients are restless, they are experiencing a disconnect between their conscious and unconscious mind. They subconsciously know they are dying, but their conscious mind just knows they need to go somewhere. There are books about the travel metaphors patients sometimes use. I need my ticket. I’m going to be late for the train. There is a helicopter waiting for me.
• As a patient gets closer to death, they often settle down on their own.
• Be mindful of guest activity in the room.  Restlessness can sometimes be contagious. The patient, even when their eyes are closed, can tell if their family is unsettled.
• Observe hand gestures. Sometimes patients experience a “life review” and you may notice they are miming favorite activities such as fishing, construction, driving or eating.
• Update hospice staff if you see changes or if the patient is at risk of falling out of bed.

Waiting for Death
The feeling of uncertainty for patients and families during this time can be unsettling. How much time do they have left? A patient may say they are ready to die, and then express frustration when it doesn’t happen right away. Sometimes they say, “Why isn’t God taking me?”
• Frustration with the uncertainty of everything is normal for patients and their loved ones.
• For loved ones, it is an act of love to have patience with the process of dying.  This includes an acceptance that a patient’s withdraw from the outside world is part of the process.
• When patients are imminently dying, internally, they may be experiencing a “life review.” As part of this process, patients are reflecting on their lives. If a patient has regrets, it may take them a while to sort through everything.  
• Patients usually withdraw from the outside world with or without medications. It is not necessarily medication that is making them talk less or sleep more.
• Prognostication (predicting when) is never an exact science. Hospice providers do their best to give a range because every patient is different. The emotional aspect of dying can affect the timing of how fast or how slowly everything happens.

On “Letting Go”
The act of letting go for a dying patient may be more complicated than family members and friends realize. Patients may want reassurance from their loved ones that it’s okay to “go,” however, there might be other factors.
• Patients who were accepting of death “in theory” may be scared now. Even patients with strong faith who feel they lived a good life and believe in Heaven can be nervous.
• The patient may not be able to “let go” when certain people are present or until someone arrives. Every patient is unique, and we may not be able to anticipate the right conditions for them to feel okay with letting go, but it usually makes sense afterwards.
• As part of the process of letting go, patients often become more withdrawn and less interactive. This is their “leave-taking” behavior. We cannot stop them from dying. If we cling too tightly, it may just make the goodbye more difficult for them.
• A patient could die in front of a room full of people, or may choose to die in the middle of the night when no one is there.
• If you have already told your loved one, “It’s okay to go” – be aware that if you tell them multiple times that it’s okay to die it may be feel like you are pressuring them. Don’t forget, dying can be scary!  Perhaps you could say, “Take your time. Go when you’re ready.”

With every patient death, I learn more. In addition to my personal and work experiences with dying, I am an avid reader on the topic. Here are some books that I found helpful on the subject of actively dying.

METACOGNITION

A Neuroscientist Says We Can Rewire Our Neural Pathways — Here's How

Tara Swart, M.D., Ph.D.

Image by Milles Studio / Stocksy
The principle of neuroplasticity—the power to create new pathways in the subconscious and conscious parts of our brain—underpins all of my work as a coach, and it is the key to any deep and lasting shift in our habits and thinking. But what does this idea of neuroplasticity look like in practice? Here, I offer the ways in which we can achieve our goals and truly "rewire" our brains.

Metacognition: The first step to rewiring your brain.

If you want to know more about rewiring your brain to create new, healthier thought habits, the starting point has to involve an honest appraisal of your current thought patterns and behaviors. This is likely to involve some delving into your unconscious, raising deeply held, sometimes irrational and self-limiting beliefs to the surface so that you can examine them. There are a few ways you can help yourself to observe these beliefs at work. They include:
  • Journaling: Making a note of the repetitive thoughts that characterize your internal narrative throughout the day will help you "hear" the way you talk to yourself.
  • Practicing presence: Breath-based meditation, or another mindfulness-based practice, will help you learn to observe your thoughts rather than getting caught up in them.
  • Writing a list: Start with three things you want to achieve, along with any self-limiting thoughts you have that stop you from believing you can.
All of these practices will help you to develop metacognition. This skill is characterized by an ability to "think about thinking," enabling you to become "aware of your awareness" rather than functioning on autopilot. Often those who are most troubled by their lives and trapped within dysfunctional thinking find it difficult to develop this sense. Their thoughts feel literal in the sense that it may seem impossible to separate their perception of the world from its actuality. 
But even for people who feel unable to see beyond their thought habits, these habits will help, over time, to foster a greater sense of perspective. Using journaling, meditation, and self-analysis, it is possible to develop a greater level of awareness about your neural pathways and the patterns in their activity that dictate how you unconsciously react to triggers and events. Your default reactions may take the form of anger (you lose your temper), distancing (you shut down), displacement through "acting out" (binge eating), or it may point toward a healthier emotional life (you reach out for emotional support). Working on yourself toward recognizing your unique reaction habits and the thoughts that underlie them will enhance your self-awareness and put you in a position to lay the groundwork to think and react in ways that serve you better in future.
Article continues below

But what is metacognition? Let's break it down.

In neuroscientific terms, metacognition is a function of the prefrontal cortex (PFC). The word itself comes from the root of the word metameaning "beyond"–in other words, "beyond thinking." The PFC monitors sensory signals from other brain regions and uses feedback loops to direct our thinking by constantly updating our brain depending on what is playing out in the outside world. Metacognition encompasses all of our memory-monitoring and self-regulation, all of our consciousness and self-awareness.
Our capacity to engage in metacognition dictates our capacity to effectively regulate our own thinking and maximize our awareness and the potential for learning and change. Admittedly, it is difficult to unlearn something that has been etched into your brain by years of reactivation. If you are serious about setting about a "rewire" of your brain, you need to be patient and persistent.
Over time, by raising awareness again and again of the "autopilot" brain pathways that "run" us when we are at our most unconscious, we are able to recognize the barriers that are holding us back in our own minds and forge a path toward positive change. It's also crucial to replace the old thought habits with new, more consciously chosen, empowering ones. There is no way to "unlearn" what you already know; instead, you need to habituate new ones.

How can we create new habits in our brains?

Creating an action board is a great way to help you focus your brain on the vision of your future that you act on to manifest. Visual imagesare a powerful way to communicate with your deep subconscious, so focusing on images that act as a visual metaphor for the things you want to manifest will help you find the confidence to seize opportunities when they present themselves. Try to choose imagery that is symbolic when creating your board rather than thinking literally. For example, a loving relationship may be symbolized by a picture of holding hands, a greater sense of personal freedom may be represented by a kite in the sky, and enhanced confidence by a strong tree with deep roots. Make sure you look at your action board a few times a day, and as you look at it, imagine your dreams in the present, as if you have already achieved them. 
Positive affirmations can be a helpful tool to help you replace insecurities and anxieties with encouraging mantras. Whenever one of your habituated self-sabotaging thoughts intrudes, meet it with a calm repetition of a mantra that contradicts it. So, if your internal voice tells you, "I'm weak, so people always take advantage of me," respond by repeating to yourself, "I'm learning to say no more to external requests so that I can say yes more to myself." 
Finally, when you've decided to embark on some changes, make yourself accountable for them by sharing your aims and ambitions with a friend or by using an app like Momentum or HabitShare. Commit to your new awareness-raising habits and tell your friends about your action board and affirmations. Ask them to check in with you from time to time so you can encourage each other and keep you both on track.