- Vitamin R 2 52 – Personal Productivity Tool Boxes For Sale
- Vitamin R 2 52 – Personal Productivity Tool Boxes Box
Last year (2014) saw an unusual event. Two statisticians at the University of Alberta in Ednonton, Canada (Paul Veugelers and JP Ekwaru) published a paper in the online journal Nutrients (6(10):4472-5) showing that the Institute of Medicine (IOM) had made a serious calculation error in its recommended dietary allowance (RDA) for vitamin D. Immediately, other statisticians checked the Canadians’ analyses and found that, indeed, they were right. Together with my colleagues at Grassroots Health, I went back to square one, starting with a different population entirely, and came to exactly the same conclusion. The true RDA for vitamin D was about 10 times higher than the IOM had said. Not a small error. To understand, how this might have happened and why this is important, some background may be helpful.
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Background
An RDA is technically the amount of a nutrient every member of a population should ingest to ensure that 97.5% of its members would meet a specified criterion of nutritional adequacy. For vitamin D, the IOM panel determined that the criterion for adequacy was a serum concentration of a particular vitamin D derivative (25-hydroxyvitamin D) of 20 ng/mL or higher, and that for adults up to age 70, 600 IU of vitamin D per day was the RDA.
An RDA is technically the amount of a nutrient every member of a population should ingest to ensure that 97.5% of its members would meet a specified criterion of nutritional adequacy. For vitamin D, the IOM panel determined that the criterion for adequacy was a serum concentration of a particular vitamin D derivative (25-hydroxyvitamin D) of 20 ng/mL or higher, and that for adults up to age 70, 600 IU of vitamin D per day was the RDA.
Both of those figures provoked immediate and unprecedented dissent from a diverse group of nutritional scientists, but the disagreement centered mostly around the IOM panel’s reading and interpretation of the evidence, rather than its calculation of the RDA. The Edmonton statisticians took the dissent a step further, showing that the actual calculation was itself wrong. Here’s what seems to have happened.
What Happened
Not everyone gets the same response to a given intake of any particular nutrient, i.e., some require more than others to reach the specified target, and while the average response to a certain dose of vitamin D may be above the target level, a substantial fraction of a population can still be below it. Thus, the RDA will always be higher than the average requirement, and for some nutrients, substantially so. As a consequence, ensuring that every member of a population receives the RDA guarantees that 97.5% of that population will be getting at least enough, while many will be getting more than they actually need.
Not everyone gets the same response to a given intake of any particular nutrient, i.e., some require more than others to reach the specified target, and while the average response to a certain dose of vitamin D may be above the target level, a substantial fraction of a population can still be below it. Thus, the RDA will always be higher than the average requirement, and for some nutrients, substantially so. As a consequence, ensuring that every member of a population receives the RDA guarantees that 97.5% of that population will be getting at least enough, while many will be getting more than they actually need.
The IOM panel identified a number of published studies showing the 25-hydroxyvitamin D response to various vitamin D doses. They plotted the average response in each of those studies against dose, thereby generating what is termed a “dose response curve”, i.e., a way to estimate how much of a response would be predicted for any given vitamin D intake. But, to make a long story short, because it used average responses, that curve tells us nothing about the intake requirement for the individual members of a population, and particularly those whose response to a given dose falls in the bottom 2.5 percentiles. The IOM panel surely knew that the average intake required to meet or exceed 20 ng/mL was not the same as the RDA, as it would be inadequate for all those with below average responses (about half the population). So, to catch the “weak” responders, they calculated the 95% probability range around their dose response curve, designating as the RDA the point where the bottom end of that probability range exceeded 20 ng/mL. While this might seem to have been the right approach, it was not. The panel appears to have overlooked the fact that the 95% probability range for their curve is for the average values that would be expected from similar studies at any particular dose. The dispersion of averages of several studies is, as every beginning student of statistics knows, much more narrow than dispersion of individual values within a study around its own average. And it’s the 2.5th percentile individual values from those studies, not the study averages, that should have been used to create the relevant dose response curve.
It’s this latter approach that the Canadian statisticians used. They took precisely the same studies as the IOM had used and demonstrated that the requirement to ensure that 97.5% of the population would have a value of at least 20 ng/mL, was 8,895 IU per day. Recall that the IOM figure was less than 1/10 that, i.e. 600 IU per day up to age 70 (and 800 IU per day thereafter). When my colleagues and I analyzed the large GrassrootsHealth dataset, we calculated a value closer to 7,000 IU per day, still a full order of magnitude higher than the estimate of the IOM, and not substantially different from the estimate of Veugelers and Ekwaru.
Why This Is A Problem
This is an important mistake, not simply because it shouldn’t have been allowed in a major policy document, but because IOM recommendations have important effects on a wide array of government programs. These include nutritional standards for US military, for school lunch programs, for WIC and many others, both in the United States and in Canada.
This is an important mistake, not simply because it shouldn’t have been allowed in a major policy document, but because IOM recommendations have important effects on a wide array of government programs. These include nutritional standards for US military, for school lunch programs, for WIC and many others, both in the United States and in Canada.
Canada, which paid one third the cost of generating the IOM report, is in a particularly difficult situation. Its First Nations peoples, living near the Arctic Circle, do not get any vitamin D from the sun, as do those of us living at more temperate latitudes. They are totally dependent upon food and supplement sources. Their ancestral diets, based largely on seals and whales, constituted a rich source of vitamin D. They are much less commonly consumed today, in part because of the ready availability of low nutrient density foods flown in from the south, and in part because environmental pollution has made seal and whale products a source of dangerous toxins (as well as necessary nutrients). The Canadian government, responsible for the health of all of its citizens, can turn only to the existing IOM recommendation (600 IU per day) to set standards for the people living in its northern territories. But, as the Edmonton statisticians noted, that number is woefully inadequate.
There is almost no public awareness of this error or its implications in the United States, but that is not true for Canada. A large nutritional health foundation located in Calgary (Pure North S’Energy Foundation) has taken out a series of half page advertisements in Canada’s national newspaper (Globe and Mail), alerting Canadians to the fact that the error was made and that they need more vitamin D than current policy indicates (http://www.purenorth.ca/?page_id=1356). The IOM, Health Canada, and the Canadian Ministry of Health have all been formally alerted to this problem. The Health Ministry has agreed to undertake an independent reanalysis of the calculation of the RDA, but the results are not yet available and the shape of the ministry’s action is still uncertain.
How It May Have Happened
It’s one thing to know how the mistake was made, and quite another to know how it could have happened. Here, one can only speculate, as the IOM processes are shrouded in secrecy. The IOM report was a massive document and it is likely that much of the background work, such as the literature search, the drafting of the report, and the statistical calculations, were done by IOM staff members who may not, themselves, have been sufficiently expert in the vitamin D field to recognize discrepancies that might have popped up. (It is noteworthy that several of the dissenting letters submitted to scientific publications following release of the IOM report had specifically cited the fact that 600 IU per day was not sufficient to guarantee a level of 20 ng/mL.) It would then have been up to the expert panel to review and adjust this staff work. To be fair to the panel, it is important to understand that the scientific members of IOM panels are not compensated for their time and effort. They do it as a public service, and they are all busy scientists with work of their own. Still, it was their job, and one must wonder how they failed to see an error that was apparent to other equally knowledgeable, but outside, scientists.
It’s one thing to know how the mistake was made, and quite another to know how it could have happened. Here, one can only speculate, as the IOM processes are shrouded in secrecy. The IOM report was a massive document and it is likely that much of the background work, such as the literature search, the drafting of the report, and the statistical calculations, were done by IOM staff members who may not, themselves, have been sufficiently expert in the vitamin D field to recognize discrepancies that might have popped up. (It is noteworthy that several of the dissenting letters submitted to scientific publications following release of the IOM report had specifically cited the fact that 600 IU per day was not sufficient to guarantee a level of 20 ng/mL.) It would then have been up to the expert panel to review and adjust this staff work. To be fair to the panel, it is important to understand that the scientific members of IOM panels are not compensated for their time and effort. They do it as a public service, and they are all busy scientists with work of their own. Still, it was their job, and one must wonder how they failed to see an error that was apparent to other equally knowledgeable, but outside, scientists.
Comment
There may be a moral here. It is widely recognized that many of the panel members, before coming together to review the evidence, had already staked out a position to the effect that, while the previous (1997) recommendation for vitamin D (200 IU per day) was probably inadequate, the actual RDA was almost certainly below 1000 IU per day. Accordingly, when the statistical calculations produced a number that matched their own expectations, they may not have been inclined to question its derivation.
There may be a moral here. It is widely recognized that many of the panel members, before coming together to review the evidence, had already staked out a position to the effect that, while the previous (1997) recommendation for vitamin D (200 IU per day) was probably inadequate, the actual RDA was almost certainly below 1000 IU per day. Accordingly, when the statistical calculations produced a number that matched their own expectations, they may not have been inclined to question its derivation.
There is a generally held belief that science is objective, data-driven. And to a substantial extent that is so. But science and scientists are not identical. Scientists often have strongly held opinions and, like people in general, find ways to construe the evidence to support their beliefs. When those beliefs are wrong, science, as a field, ultimately abandons them. I am confident that this IOM error will be corrected sooner or later. This is partly because it is demonstrably erroneous, and partly because the related set of IOM recommendations for vitamin D has not elicited a consensus in the field of vitamin D research. If the Dietary Reference Intakes produced by the IOM are important, then it is important that they be right. I can only hope that not too much human damage will occur as we wait for the needed correction to happen. Omniplan pro 3 10 3 – professional grade project management.
[Author’s note: if readers are aware of factual inaccuracies in what I have written here, I would be grateful if you would call them to my attention at , so that I can correct this post.]
Notes from trying to learn about Vitamin-R version 2:1
Shortcuts
global:
- ⌘⌥R (Bring to front/hide) [default: Cmd-R]
- ⌘⌥N (bring up Now & Later board)
- ⌘⌥L (Later board)
- ⌘⌥S (Scratchpad)
- ⌘⌥O (Objectives)
- ⌘⌥⇧O (read objective aloud)
- ⌘⌥S (start time slice)
- ⌘⌥U (pause/resume time slice)
- ⌘⌥E (end time slice)
- ⌘⌥B (start timed break) [deleted]
in-app:
- ⌘-1 (toggle Statistics Window)
- ⌘←/⌘→ previous/next screens
- ⎋ [Esc] or ⌘W: hide/dismiss Vitamin-R
- ⌘↑ bring up the gear menu
- ⇥/⇧⇥ move between controls (outside text field). You need to use control key in field (i.e. ⌃⇥)
Checklist for tasks/objectives
- immediate (can be completed in time slice)
- specific
- actionable
Reasoning
The purpose is to break up large tasks into short time slices with specific reachable objectives. Each slice moves closer to the goal while not triggering fight-or-flight response to prevent procrastination.
- Vague objectives cause procrastinations (uncertainty triggers fight-or-flight response)
- Unreachable objectives lead to failure (setting unreachable ambitious goals reinforce failure behaviours “not quite good enough”)
- Small successess = motivation (e.g. GTD forces next action”. success breeds success)
- Attention is more limited than time (quality time is hard to come by and when differs from person to person)
- We can’t multi-task (esp. “male-differentiated”or “l-mode” brains) due to 5-7 sized in working memory
- Distractions are killer (causes us to dump the 6-8 working memory stack, one distraction is more costly than the time it takes to deal with it because of that)
- Exocortex (external cognitive artifiacts) fills in gaps in brain function (ex. external tools like a paper and pencil can assist in tasks like long division)
- L-mode to R-mode (expertise is usually R-mode but L-mode works in conjunction to train that, also need to do something if R-mode doesn’t have an answer)
- Time slices are the building blocks (aka chunk of time, sprint, time box, pomodoro. Really an “attention slice” because we can only concentrate on one thing for a limited time)
- Pomodoro Technique: Developed by Francesco Cirillo using a (ticking) tomato kitchen timer. 25 minutes of work with 5 minutes breaks 4 times followed by 15 minute break. It may be a bit rigidm but can be customized with a continous ticking timer (® ⇒ Settings ⇒ Preferences ⇒ Notifications ⇒ During Time Slice) and by setting the default settings on the workflow (® ⇒ Settings ⇒ Preferences ⇒ Workflow)
Workflow
![Vitamin Vitamin](https://media.springernature.com/m685/springer-static/image/art%3A10.1038%2Fs41598-019-46422-2/MediaObjects/41598_2019_46422_Fig1_HTML.png)
- Define Time Slice through the define objectives popup: consists of objective and time frame
- clear, specific, and easily reachable (can be completed in time frame) objective [see checklist above]
- define time slice duration: by dragging the slider
- ideally, time slices of 15-25 minutes with breaks (it’s an art)
- two indicators: the Resistance Level and the Motivation Level: these are linked to duration and provide a guide to choosing, they are not logged.
- eliminate distractions (visual clutter) by hiding non-essential applications and/or desktop (esp. social media, games, movies, music, e-books
- can always exclude certain apps from the list (or always ignore certain apps) via: ® ⇒ Settings ⇒ Preferences ⇒ Distractions
- can restore recent objectives
- can tag quickly
- Work on Time Slice to help you stay focused by reminding you of your objectives and the time pressure that you are under
- ideally time splices are small
- Visually, the menu bar displays the remaining time
- Audio cues through periodically play ticking clock sounds (optional)
- Can also block out distractions in noisy environments through sound masking with Noise Machine integration via ® ⇒ Tools ⇒ Noise Machine to play noisescapes. If you need all 29 noisescapes, download Noise Machine and install it and Vitamin-R will recognize it immediately. Tips
- Start with a low volume setting. You need to give your brain time to get used to the new sound. Starting at a low volume, and only going up in volume once you no longer consciously perceive the noise, is a good way of acclimating yourself to this technique.
- Beware of headphone volume settings. Using headphones amplifies listening damage. If environmental noise is a big issue for you, you might want to invest in a pair of isolating earphones.
- Try “pink” noise first. Most people find “white” noise to be annoying, and many of those who can tolerate it find that it takes a lot of getting used to. “Brown” noise seems easier to get used to than “white” noise, while “pink” noise is preferred by many. Experiment to find what works best for you!
- Use background noise only when you have to. There is little point in training yourself to ignore white noise if you have a quiet workplace or do not find the noise around you distracting.
- Use speech synthesis to inform you of the time passing. Fully customizable:
- how much time has already elapsed
- how much time is left
- re-state your objective
- Record & Assess: to allow you to become more aware of what works for you and keep you motivated by recording your successes. It will ask you to:
- rate your attention/focus level
- mark the time slice as overall success
- mark objective as completed
- if you have not managed to complete the time slice, it guides you through the process of assessing whether you should continue immediately or take a break first.
- It will automatically record the details of your time slice and your assessment of it to allow you to gain more awareness of our work habits
- objective
- tags
- time-frame
- duration
- completion status
- concentration level
- Timed or Informal (open-ended) Break
- You are then sent to one of the above
- Guilt free breaks are good (recharge batteries, avoid injury/health issues, allow R-mode to trigger)
- timed breaks prevents open-ended ones/procrastination without the guilt or hurdle of having to overcome resistance each time, by promising yourself to stop working for a finite time period
- the priming technique idea is to plan what to work on while taking a break by using the Now & Later Board (and allow our r-mode brain to work on it during break). This prevents having work stopped at a decision point (drawing a blank) that isn’t addressed. You do this by inserting a question to help start next time slice, think about it for a few seconds, and think, “I’ll need to have a decision by the time I come back.”
- leaving breadcrumbs Make it easier to restart tasks. One problem of breaks is dumping working memory and having to reconstruct it. The idea is to write working stack to a text editor (just enough to jog the memory) so it can be restored when starting work again. You can do this by putting (only a few thoughts) in the Now & Later board below.
- Go to 1
- If timed, this is automatic
- If open-ended, you need to go to Vitamin-R
Vitamin R 2 52 – Personal Productivity Tool Boxes For Sale
Now & Later Board
now & later board is a full-features RTF scratchpad to leave anything on to be a “memory outside yoru brain” (c.f. exocortex)
- notepad that you can use to keep track of the resources you need to achieve your current objective
- jot down notes to dump your working memory
- remember things for later and getting them out of your mind without having to worry about forgetting them
- plan your current activity
- keep snippets
It is also a good place to review before taking a break (a la priming).
It is divided into four different sections:
- Now Pad is for dumping your working memory to make it easier to recover you were should you get interrupted or run out of working memory.
- Later Pad is for everything that goes through your head but isn’t relevant to what you are working on. Put it here, forget about, and continue on with task so you won’t worry about forgetting about it whille working.
- Objective section (same as time slice objective) is there to remind you of what you are currently working on and modify it if you really have to.
- Scratch Pad is a free form note taking tool for everything that does not fit neatly into the other categories
There are ready-made templates that get inserted at the beginning of the relevant sections and walk you through the questions to ask and the things to write down. You can restore them by clicking on the gear icon in the bottom-left of the Board.
Examples:
- Phone call during time splice you have to pick up. Jot down phone number in Later pad and keep working.
- If you forget what you are working on use the Objective section, then read the New pad to get back into the zone
- The Now pad has only the current thing working on. The next thing can be put in the the Later pad while workign on it
The FastType feature allows you to create action items, bulleted lists and checklists with a minimum of fuss by automatically translating certain characters into those formats.
- * task: bulleted list (use Tab to create indentation level)
- action: indeded arrow (action item)
- item: number’d list
- done’: make a checkmark
- text –: strike out entire line
- –: make a separator
- F6/Shift-F6 move between fields
The Statistics Window
Commands:
* Tools → Statistics → Toggle Statistics Window (or Cmd-1)
* The bottom-left popup menu chooses display period
* Tools → Statistics → Toggle Statistics Window (or Cmd-1)
* The bottom-left popup menu chooses display period
It is really important to choose the right time and place for a specific kind of work and it can be tricky to work out what really works best, instead of acting like all chunks time is interchageable. Finding the right times to do the right sort of work helps get rid of internal and external “friction” in our effort.
The Statistics Window provides many tools that allow you to gain objective insights into the work patterns that actually work best for you.
- The Hour of the Day statistic shows you how your concentration levels change throughout the day.
- The Day of the Week statistic does the same thing for the days of the week.
- You can tag each time slice with as many tags as you wish, so you can run your own experiments by using the tag or date filtering features of the statistics window.
- You can also use the Statistics window’s Report statistic to keep track of different activities, clients, projects, etc (if tagged).
Overview ChartL Allows you to evaluate both the total time worked during the preceding period and how your concentration levels evolved during that period.
- Bar is time spent
- Colors: (Red: Flow, Orange: High, Yellow: Good, Blue: Poor)
Examples:
- You want to decide whether you are better off writing in your home office or in the coffee shop? Simply tag your time slices with “Location: Home Office” and “Location: Coffee Shop” and compare your concentration levels after a few days.)
- For no fuss time tracking of client projects (via tagging): you can just tag your time slices with client and project data, such as “Client: John Herbert”, “Project: NoFuss.com”. The report statistic will then tell you exactly how much time, how many time slices and how many days you’ve been working on this combination of tags. Good for client-billing
Day-of-Week Analysis: evaluate how your concentration levels evolve throughout the week. (longer = more data the better).
- bar is the percentage of time
- days with no logged time slices will be “grayed out.”
- if similar levels during the week: this is sustainable pace
- if concentration drops at end of week it is because of overexertion: take more breaks, do renewal activities (exercise, relaxation)
- if concentration rises during the week it is because you have problems getting started: take it easier during weekends, fail to finish work before weekend, sign of resistance to starting tasks
Log Book
Commands:
- access: Tools → Logs → Toggle Log Book
- access (advanced): Tools → Logs → Reveal User Log Folder
- export: Tools → Logs → Export as CSV (good for timetracking and billing)
log book is see how spend time for insights, keep motivated.
- work journal to backtrack to past tasks
- re-examine details around a particular decision
- motivate yourself by seeing accomplishments over periods
Things to store:
- any data that might be useful later on
- rationale for decision
- links to external resources used
- stuff from Now & Later Board
- each line has a UUID under a separator. Do not modify (it might break things)
Integration
Vitamin R 2 52 – Personal Productivity Tool Boxes Box
Dropbox
® ⇒ Settings ⇒ Preferences ⇒ Cloud Sync ⇒ Activate Dropbox Synching (remember to do this on every Mac with Vitamin-R). Normally logs are stored in ~/Library/Application Support/Vitamin-R
- Synchronize logs between Macs using DropBox
- Future: Synchronize Now & Later
Growl
Uses Growl if available for notifications.
Customize through “® ⇒ Settings ⇒ Preferences ⇒ Notifications”
Customize through “® ⇒ Settings ⇒ Preferences ⇒ Notifications”
Things integration
® ⇒ Settings ⇒ Preferences ⇒ Integration
When you are asked to specify your objective for the next time slice, you can drag one or more to dos straight from Things into the text field (window must be open so no auto-hiding)
- a hyperlink will be created to the to-do in Things
- clicking on the hyperlink will bring you straight back to the corresponding to-do in Things
- this hyperlink will remain clickable in your Vitamin-R log for future reference
W(Optional) hen the time slice is logged as “completed” (in the Rate Your Time Slice step) the to-do will automatically be marked as “completed” in Things.
Settings
- “Dockless” mode (not available in appstore version): dock icon is removed and tit cannot be cmd-tab’d to (default). Activate by using main menu bar or keyboard shortcut. The Gear menu replaces the dock menu. (Select it by ® ⇒ Settings ⇒ Run as Full Application/Run as Dockless Application)
- Change look, feel, and behaviors of Now & Later board with ® ⇒ Settings ⇒ Preferences ⇒ Now & Later Board
- Customize workflow (skip stpes, specify default values, etc) by ® ⇒ Settings ⇒ Preferences ⇒ Workflow
- Customize keyboard access: To turn on full keyboard access do ⇒ System Preferences ⇒ Keyboard ⇒ Keyboard Shortcuts ⇒ All Controls; customize global shortcuts in preference panel.
- ® ⇒ Settings ⇒ Auto-Hide Window : Note that this doesn’t allow drag and dropping
- Speech Reminder tags work properly only in minutes (there are special reminder placeholders)
References
- Vitamin-R homepageread: 2014-05-06
- Vitamin_R_User_Manual updated: 2015-05-05 read: 2015-06-04
- Vitamin-R help pages read: 2014-06-06
- Yes, about halfway through, I started to use Vitamin R to help me plow through this. Note to self: buy over-the-ear headphones for work. ↩