Fast, Faster, Fastest: How These 3 Grads Paid Down Student Loan Debt

Meet three guys on track to pay significantly pay down their student loans by age 30.

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Childcare Trends that Parents Should Know in 2018

There is a subtle but serious evolution going on in the child care world, with parents and providers figuring out how best to serve each other. Parents who are expecting a baby, or have a child who will be entering childcare soon, will be interested in some of the childcare trends for 2018 and beyond. Here are the top six.

1. Flexible Hours

There is an understanding that child care costs are not sustainable for many families. Parents end up taking their child out of daycare because they cannot keep up with the cost of having the child at the facility full-time, five days a week. That is why many centers are offering flexible hours, along with reduced rates. Pay arrangements are also becoming increasingly common, for families that cannot keep up with the costs.

2. Early Education

In the past, child care consisted of adults babysitting kids and ensuring they were having a good time. Now early education has become such a pivotal part of child care. Many of these facilities are learning centers where kids are getting the basic education one might expect during the early days of pre-school.

3. Corporate Childcare

Many companies in the United States are upping their game with respect to child care. It helps them retain female employees, and appeal to those who are looking for work. Some companies offer in-house child care centers, while others team up with centers around the area to offer heavily discounted rates for employees. Many companies that seek new locations for their offices or headquarters are assessing the availability of quality childcare nearby because they know it is important to their employees.

4. Technological Advancements

Many child care centers understand that parents want to keep a closer eye on their kids, even when they are not in the same place. Thanks to technology, many day care centers can set up cameras in select parts of the facility, where they provide the parents with a live stream of everything that is happening. If a parent wants to check out their child in the middle of the workday, they can do so by viewing the live footage.

5. Importance of Security

The prevalence of unsafe incidents involving children at child care centers is something that all providers are concerned about. And most are doing a very good job of tackling the problem. They are starting by conducting serious background checks on every applicant, even if that person is not directly in contact with the children. Surveillance and monitoring is also a major part of the best child care centers in the country, as they ensure their employees are behaving appropriately at all times.

6. Multitude of Options

Parents are becoming more accepting that there is not a single type of child care that is right for their family. Some parents put their kids in a different daycare center during the school year and switch to another one in the summer. Others will opt for an in-house nanny when their child is a toddler, and switch to a daycare center when they are a bit older.

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Women Lag Men in Investment Savings and Net Worth

According to new data from Earnest, men and women average similar levels of debt and cash savings, but men have nearly twice the net worth due in part to their willingness to put money into the market.

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Ranking Net Worth by Age, Income, Degree, and Gender

On average, young professional men and women both have positive net worth. However, it varies greatly by degree and gender.

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Health in the media: The link between dentures and frailty

What does the media say?

‘Dentures put wearers at risk of malnutrition because they can’t chew healthy food’ screams the headline of a recent article in the Telegraph while the Daily Mail go with ‘Dentures linked to higher risk of weak joints and muscles’.

These sensational and worrying headlines are based on a cross-sectional study published in the peer-reviewed journal Geriatrics and Gerontology International, but how accurately do they reflect the findings of the study?

Looking at the evidence

The researchers from King’s College London Dental Institute aimed to investigate whether a relationship exists between number of teeth/denture use and musculoskeletal frailty, and whether nutritional intake can account for this relationship.

A sample comprising 1852 older adults was assessed by dentists and split into three groups:

• Having at least 20 teeth;
• Denture-wearer with fewer than 20 teeth; and
• Non-denture-wearer with fewer than 20 teeth.

Participants’ handgrip strength was tested as a measure of musculoskeletal function. Decline in musculoskeletal function is a key indicator in diagnosing frailty, a distinctive medical syndrome related to the ageing process where multiple body systems lose their reserves and there is an increased vulnerability to minor stressors.

Assessments of nutritional intake were based on 24-hour dietary recall interviews conducted on two separate occasions. Researchers used the self-reported data to evaluate whether participants were meeting the US Food and Drug Administration’s recommended dietary intake of 13 different nutrients (protein, polyunsaturated fats, fibre, 8 vitamins and 2 minerals).

The researchers also took into consideration potential confounding factors, such as BMI, physical activity levels, comorbidities (e.g. cardiovascular disease and diabetes), education and smoking status.

What did the results of the study show?

The results showed an association between having fewer than 20 teeth and poor nutrient intake, regardless of denture use. Despite this, after adjusting for age and sex, the analyses also demonstrated no statistically significant difference in musculoskeletal frailty between those with at least 20 teeth and denture users with fewer than 20 teeth. On the other hand, non-denture-wearers with fewer than 20 teeth were more likely to be frail than those with at least 20 teeth (OR 1.32, 95% CI 1.04–1.68). According to the researchers’ analyses, this relationship could partly be attributed to poor nutritional intake but, for the most part, it was explained by other risk factors, such as being underweight and low levels of physical activity.

Therefore, this study does report an association between lack of teeth and both frailty and poor nutrition. However, contrary to the claims in the tabloid headlines, the findings imply that dentures could actually help to prevent frailty in individuals with fewer than 20 teeth.

Of course, the study has its limitations…

For instance, as a result of the study design, it is impossible to establish a causative relationship as dental status, nutritional intake and musculoskeletal frailty were all measured at a single point in time. Hence, we cannot be sure which occurred first. Moreover, using only two days’ worth of dietary data to quantify nutrient intake is unlikely to be representative of the participants’ longer term alimentary regimes. Also, it must be remembered that frailty is a multifactorial condition and, although the researchers did consider some possible contributing factors, there may exist other factors that influence the relationship observed in this study between dental status and frailty.

Nevertheless, it seems plausible that poor dental health and nutrition could together negatively impact musculoskeletal function, thus leading to frailty. This could have implications on clinical and public health interventions in the struggle against frailty in older people. Up to now, efforts to prevent frailty have been concentrated on education about improving nutrition, with dental interventions being largely neglected.

However, the findings of this study highlight the importance of maintaining the natural dentition for as long as possible and, as per the authors’ conclusions, the provision of dentures as measures that could stop the progress of frailty in older people.

References

Lee, S. and Sabbah, W. (2017). Association between number of teeth, use of dentures and musculoskeletal frailty among older adults. Geriatrics & Gerontology International. [online] Available at: http://onlinelibrary.wiley.com/wol1/doi/10.1111/ggi.13220/full [Accessed 18 Dec. 2017].

MailOnline (2017). Dentures linked to higher risk of weak joints and muscles: Wearers could be avoiding certain foods so miss out on vital nutrients. [online] Available at: http://www.dailymail.co.uk/health/article-5165657/Dentures-linked-higher-risk-weak-joints-muscles.html [Accessed 18 Dec. 2017].

nhs.uk. (2017). Denture wearers may have a risk of poor nutrition – but no link to frailty. [online] Available at: https://www.nhs.uk/news/older-people/denture-wearers-may-have-risk-poor-nutrition-no-link-frailty/ [Accessed 18 Dec. 2017].

The Telegraph (2017). Dentures put wearers at risk of malnutrition because they can’t chew healthy food. [online] Available at: http://www.telegraph.co.uk/science/2017/12/11/dentures-put-wearers-risk-malnutrition-cant-chew-healthy-food/ [Accessed 18 Dec. 2017].

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You may find these other blogs useful in relation to some of the key concepts raised:

Correlation and Causation – a simple guide

Association is not the same as causation

Sample size: A practical introduction

A beginner’s guide to interpreting odds ratios, confidence intervals and p-values

What is it with odds and risk?!

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How Much Does Home Daycare Insurance Cost?

Starting a home daycare can be a fun business venture. It can provide a much-needed value for dual working parents, young children and toddlers who need more social interaction, and for the daycare providers themselves who are looking for additional means of income.

However, before opening an in-home daycare, there are some things to consider. One of the most important being insurance.

Here are some things you should know about purchasing insurance for your in-home daycare.

Why is insurance important?

All home daycare centers should carry insurance, and depend on your state, you could be required by law. But why is it so important for you to be covered?

Even though you are great with kids, there are obligations that must be met in order for you to care for someone else’s child. These things are characterized as a legal duty to “act with reasonable care” while supervising children.

If a child were to get sick or injured while in your care, there is a possibility you could be sued for “breaching the duty of care” or “negligent supervision”.

While these charges may not be warranted, the law may require you to be covered by one type of liability insurance or another, to ensure the child’s medical costs are covered in case the cause does lie with you. You should check your state and local laws to find out if you are required to carry liability insurance or not. And while you may not be required to carry it, you honestly should for your protection.

Purchasing insurance for a home daycare center

Types of liability insurance:

Homeowners or renter’s insurance policies do not mean your daycare is covered unless you add it to your existing policy. However, this insurance is usually very limited and does not include child abuse coverage or off-premises accidents.

General liability insurance provides a broader range of coverage than homeowners or renter’s insurance. In fact, it usually even covers off premises excursions including field trips and child abuse coverage.

Professional Liability insurance, otherwise known as Errors and Omissions insurance, is the same type of insurance carried by doctors, lawyers, and insurance agents. It offers the most comprehensive coverage out of the 3 primary insurance types. It not only covers the basics, but it also covers negligent supervision, which the others do not.

Some things to consider: The cost of the insurance typically ranges depending on how many children you’ll have in the home.

Within the home, you should also be prepared with an emergency exit plan, a fire extinguisher, and first-aid.

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The Audit Cycle

What is an audit?

Auditing is a vital part of clinical practice. An audit is an assessment of local practice and performance against an established standard. Essentially, clinical audit is a quality assurance and improvement process. It can be considered an exploration of what IS being done vs what SHOULD be done.

NICE definition of clinical audit:

“A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against specific criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery.”

Principles of Best Practice in Clinical Audit (2002, NICE/CHI).

How does it differ from research?

In short, research looks to acquire new knowledge whereas auditing does not.

Research looks into an explicit hypothesis and uses defined methods to generate results, with the aim to answer that question. In other words, ‘what is best practice?’.  From research, a new drug may be developed, or perhaps a new service or a new way of managing a condition. As research deals with patients, it is necessary that it complies with the Declaration of Helsinki and gains ethical approval from a relevant Research Ethics Committee (REC). This comes under the practice of research governance, ensuring research is ethical, protecting both participants and researchers. On the other hand, audit looks to assess how well local practice is complying with best practice. Whilst audits should be carried out ethically, formal ethical approval from an REC is not required.

Research and audits serve very different, but necessary purposes. Smith summarises this nicely with the following quote from a 1990’s BMJ article:

“…research is concerned with discovering the right thing to do whereas audit is intended to make sure that the thing is done right.”

Smith R.  Audit & Research. BMJ 1992; 305: 905-6 (1)

History

Florence Nightingale was thought to be one of the first auditors in healthcare in the 1850’s. At that time, she documented the particularly dirty conditions in the barracks during the Crimean War, noting that both morbidity and mortality was a significant burden. Following an increase in cleanliness and nursing care, she was able to reduce mortality by 38%, a pivotal finding that greatly supported Nightingale’s theories of promoting proper hygiene practices in patient care.

Why Audit?

There are many reasons to carry out clinical audits. Firstly, it is a necessary part of your duty as a clinician in the NHS. This is encompassed by the practice of clinical governance. Clinical governance is a range of activities that health professionals undertake to maintain and develop patient care standards (2). Other areas of clinical governance include Clinical effectiveness, Risk management, Education and training, Staffing, Patient and public involvement and Information Technology. Further discussions regarding clinical governance are beyond the scope of this article.

Auditing is also necessary to truly execute evidence-based medicine. The high quality research used to formulate guidelines is utilised effectively by ensuring that local practice conforms with best-practice ideals. This ultimately results in improvements in patient care and safety.

Local audits also allow national standards to be improved. The National Clinical Audit and Patient Outcomes Programme (NCAPOP) consists of over 30 national audits run by the Healthcare Quality Improvement Partnership (HQIP) for NHS England. They feature the most common conditions that are present in clinical practice across the UK. Local data collection at various Trusts across England feed into the national audits to provide an overview of standards of care in these areas. These regular audits provide the local Trusts with individualised reports on their current practice and compliance with the chosen audited guidelines, allowing areas of improvement to be clearly identified.

The Audit Cycle

The audit cycle is summarised in the diagram below:

1. Identify topic

The topic must be an important issue as it underpins the entire audit. Examples of important issues include those that are high-risk for patients, high costs for the trust, areas of patient concern (which could have been collected from a survey) or areas of high volume workload. It is also necessary to register the proposed audit with the Local Clinical Audit Team and have it approved by the relevant Audit Lead.

2. Select the standards

Select an established guideline (national or international) that is considered best-practice. Often the Royal College websites for different specialities have existing audit templates that are very useful. Extract the necessary targets from these guidelines (e.g. 100% of patients should be offered smoking cessation).

3. Data collection

This can be retrospective or prospective. It may be beneficial to do this retrospectively to prevent performance bias from staff members that are aware of any prospective audit. Additionally, data can be collected from physical or computer records.

4. Data analysis

Analyse the collected data and assess whether local practice meets guideline standards. Explore how well the standards were met and discuss any reasons for low compliance.

5. Implement change

Present the results at local departmental meetings and possibly at local or regional conferences. Develop an action plan outlining what needs to be done and then create these changes!

6. Allow time for changes to take place

It is important to allow sufficient time to pass for the uptake of new changes. Auditing too soon may underestimate the impact of new interventions, as they have not had time to take full effect.

7. Re-audit

Conduct the audit again to assess whether practice has improved in light of changes from the previous audit.

 

How can I get involved in the audit process?

Get involved with your local hospital team – Identify areas of improvement through observation but also by liaising with the permanent staff – these doctors and nurses will be very familiar of areas that could be audited.

Register the audit with the Local Clinical Audit Team – this may be an online registration form, but it’s worth going in person to speak with the team. It’s useful to meet the Audit Lead to discuss the feasibility of the audit and whether they are happy to accept it.

Plan the audit rigorously – This includes thinking about what standards you will compare against, how you will collect the data and where the data will be disseminated.

There are many useful resources across the internet but in addition, local audit teams and healthcare professionals will have audit experience and should be happy for anyone to get involved.

 

References

1. Smith, R. (1992). Audit and research. BMJ, 305(6859), pp.905-906.
2. Scally, G and Donaldson, L. (1998). Looking forward: Clinical governance and the drive for quality improvement in the new NHS in England. BMJ, 317(7150), pp.61-65.

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Unsecured vs. Secured Personal Loans 101

Why might you be in the market for a personal loan? You might want to consolidate credit card debt, make a big purchase, do some home improvements, or even start your own coffee shop.

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We Road Tested 4 Ways to Lower Your Cell Phone Bill

We’ve analyzed Android- and iPhone-friendly plans to give you four low- and no-cost alternatives to your monthly bill.

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How to Find Child Care for Special Needs Children

Every child needs a social structure, a caring, learning, and nurturing environment. If you are looking for a daycare provider for your special needs child, you will want to make sure that they have expertise in working with children who have special needs. You’ll want to make sure they understand the specific needs your child may have, not just an understanding of the disability itself.

Children living with special needs have unique care requirements. You want to make sure that the child care you are selecting specializes in the specific type of care your child needs, and more so, can take the time and care your special someone needs.

The American Disabilities Act

The American Disabilities Act does not require daycare centers to refuse or admit children based on their disability. Instead, it requires the child care facility to evaluate each child’s specific needs and to assess whether or not they are equipped to provide the particular services the child needs.

How to vet a daycare center

To properly vet a daycare center, you should first create a list, taking down your child’s strengths, weaknesses, needs, and personality. When you meet with the daycare supervisors and staff, you should discuss with them openly and directly the items and points you have listed.

Ask them whether they are pressed during the day and find it difficult to take time out for one child. Ask them whether they have supervised and cared for a child with your child’s disability. If your child needs special equipment, you should inquire whether the facility has this equipment on site and how often it undergoes maintenance. You can also ask some personal questions such as whether they have someone with a disability in their family, and ask if they have ever assisted with this individual.

This list should further entail your child’s ability to communicate their needs with others and discuss this with the daycare providers. This is particularly of great importance, as it will illustrate the level of personal and one-on-one care your child will need throughout the day.

Look for reviews of the daycare. Speak to others that have used them before and find out their thoughts on the facility and staff. You can also ask about a “sit-in.” This is where you are able to come in for the first few days and oversee how they work with your child. You can also “pop-in” every now and again to evaluate whether your child’s needs are being met.

The important thing is finding a child care facility that can accommodate your child’s needs, provide the care and understand your child requires and can offer the security and comfort you need as a parent.

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How to Vet the ‘Culture Fit’ at a Startup

Larger companies often have a very clearly defined company culture, smaller startups are often still developing theirs and may require a little more research on your part.  

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Peer-review and publication does not guarantee reliable information

Appraising the appraisal

Critical appraisal tools (CATs) are commonly used by students and researchers alike, as a way of judging a study’s quality. They are useful because of their structured approach, normally using categorical questions (yes/no) in standardised headings, which means that key components of study assessment are not missed e.g. internal and external validity.

The rise of FOAMed (Free Open Access Medical Education) means that learning about critical appraisal is easier than ever. Whether it’s modules or checklists, there are widespread resources all over the internet.

Somewhat ironically, an important thing to consider when using critical appraisal tools is that we need to ‘appraise’ them too. A review of CATs in 2011 showed that a comprehensive explanation of how a CAT is developed was found in only 11% of tools [1]. Similarly, only 23% and 75% of CATs had been tested for reliability and validity, respectively [1]. Whilst some questions in checklists are self-explanatory and straight-forward, there are others that are more difficult, for example ‘How precise were the results?’. Whilst many people would immediately look for the range of results and 95% confidence intervals, those with less experience in critical appraisal may need more guidance. A systematic review in 2004 showed that guidelines regarding administration were provided in only 43% of 121 published CATs [2].

Many studies have commented on the need for cross-communication between evidence-based medicine groups in order to reach a consensus and develop a suitable tool/s for critical appraisal that are valid, reliable and easily administered [2-4].

Until then, Students 4 Best Evidence have developed a non-exhaustive list of critical appraisal tools available on the internet from all over the world and we’d like you to contribute. There is no gold standard critical appraisal tool.

Are there ones that aren’t listed here? Which ones have you found useful? Let us know and we’ll update the list.  (Links to all of the CATs are at the bottom of the blog)

 

http://joannabriggs.org/research/critical-appraisal-tools.html

http://amstar.ca/Amstar_Checklist.php

http://thesgem.com/2014/03/make-it-so-beem-appraisal-tools/

http://www.cebm.net/critical-appraisal/

http://www.casp-uk.net/casp-tools-checklists

https://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/generalpractice/ebp/checklists/

http://clinicalevidence.bmj.com/x/set/static/ebm/toolbox/665062.html

http://www.sign.ac.uk/checklists-and-notes.html

www.equator-network.org/about-us

http://bestbets.org/links/BET-CA-worksheets.php

http://www.cardiff.ac.uk/specialist-unit-for-review-evidence/resources/critical-appraisal-checklists

http://www.dartmouth.edu/~library/biomed/guides/research/ebm-resources-materials.html

References

1. Crowe, M. and L. Sheppard, A review of critical appraisal tools show they lack rigor: alternative tool structure is proposed. Journal of clinical epidemiology, 2011. 64(1): p. 79-89.
2. Katrak, P., et al., A systematic review of the content of critical appraisal tools. BMC medical research methodology, 2004. 4(1): p. 22.
3. Quigley, J., et al., Critical Appraisal Of Real World Evidence–A Review Of Recommended And Commonly Used Tools. Value in Health, 2015. 18(7): p. A684.
4. Glenny, A.-M., No “gold standard” critical appraisal tool for allied health research. Evidence-based dentistry, 2005. 6(4): p. 100-101.

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Relatos de casos são evidências pouco confiáveis

What parents need to know while setting up Social media boundaries for Babysitters

In the digital age, social media is commonplace. It is in virtually everyone’s life each and every day. It is how many communicate, stay up to date on news, and remain entertained.

However, this can pose certain issues when it comes to a babysitter and your child.

Too much focus on social media means less focus on what your babysitter should be focused on – your child. Depending on the age of your child, social media could pose a very real threat to the safety of your child.

If your child’s babysitter is paying attention to the screen on his/her phone instead of the child jumping on the bed, this can be a real issue.

In addition to safety concerns, there are also concerns about what is being posted online by the babysitter.

Are images of your child being posted? Are images of your home address being posted? Are images of your family photos in the background being posted? How about the license plate of one of your vehicles in the driveway being accidentally posted online?

Before you hand over the list of emergency numbers and say your goodbyes for the evening, there are precautions you can take that can help prevent these sorts of situations from happening.

Here are some tips you can use to help prevent any unwanted images from being posted and to help ensure your child’s babysitter’s focus is where it should be.

Tip #1: Discuss your Views on Social Media Use

Before heading out the door to your engagement, have a discussion centered around your views on social media use in your home.

You can explain your worries or concerns about social media use right from the start, then go into what you find and do not find acceptable.

You should bring up points such as:

• Whether or not you find it acceptable for social media to be used at all in your home while babysitting.
• Do you feel comfortable with images of your children being posted on your babysitter’s social media accounts? If so, in what capacity?
• Are you OK with images of your home being posted on the internet? If so, in what capacity? Are there any rooms you’d rather not be posted, such as your children’s bedroom?
• Do you mind if the babysitter uses mobile apps that have location tracking or geotagging?

These are things you should consider bringing up in your discussions with the babysitter.

Tip #2: Lay Down Some Ground Rules

After your discussion, it’s time to lay down some ground rules. I know, I know, you already explained not to have a party and don’t invite anyone over. You already made sure the babysitter had the list of emergency numbers readily available and easily accessible, but what about social media guidelines?

You should make sure you are very clear and concise when it comes to explaining exactly what it is you expect in terms of social media use when you are gone.

• Define clear limitations on social media use.
• Define rules on image posting and geotagging.
• Define rules on mentions.
• Define rules on the use of apps such as Pokémon Go which use location tracking.

 

By ensuring that you discuss your views, express your expectations, and clearly state the rules beforehand, you can avoid many preventable situations. Just keep in mind that when you talk to the babysitter about these things, don’t forget to provide the reasons why you feel the way you do. Clear discussion can go a long way.

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“You’ve Got Resolutions, I’ve got Rate-solutions”

If you’d like to watch a video to see how easy it to drop your interest rate, lucky you—we have one.

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5 Apps to Help You Save More Money This Year

Here are some try apps and browser extensions that can help save you money on everyday purchases.

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How to Save Money Better in 2018 (Hint: Get Your Friends Involved)

Like dieting, asking other people to help you meet your money goals works better than going at it alone.

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4 Tips to Work from Home with Children Around – Top Daycare Centers

For many parents, working from home for at least one parent has become a viable and cost-saving choice.

Depending on your kid’s ages, it can be expensive to place them in daycare 5 to 6 days a week or to place them in afterschool programs to offset the time you clock out.

For many families, these costs are simply not manageable.

This is why having one or both parents work from home is the perfect solution. But then we are left with one rather large conundrum: How are we supposed to get any work done with children around?

Here are 4 of the best tips we could find from around the web that is sure to help you manage your time better, get your work done, and still be present to meet your child’s needs.

Tip #1: Adhere to Your Child’s Schedule Right from the Start

If your child needs extra help and attention the mornings but pretty much has a handle on the afternoons when they are interested in cartoons or toys, plan your work schedule more toward this time. This will stop you from fighting an uphill battle from the get-go. Simply plan your parental duties around the mornings and your work in the afternoons.

Tip #2: Schedule Your Child’s Nap Time

This is a big one, especially for situations where you simply have to spend more time with your little one than getting work done. Schedule those all-important naps to coincide with your big work pushes. In other words, nap time for your child means power hour for you to get as much work done as possible.

Tip #3: Work in the Evenings

When it’s possible, and in cases that only one parent is at home, create a climate where the other parent is “on duty” when they get home from work while you get your work done. Realistically, again depending on your kid’s ages, you’re probably not going to get in a day’s work with your little one nearby.

Tip #4: Be Flexible

Finally, flexibility is the key. With children present, you’ll ultimately have to work around their schedule. When they have independent play time, that’s your time to get as much done as possible. When it’s nap time for them, it’s showtime for you. When they want to color or play a game that doesn’t require your immediate attention, set them up next to you while you work. It’s just that simple.

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Why Women Should Flock to Tech, Not Run From It

The tech industry is too valuable for women not to be at the center of it.

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