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"disqusTitle": "Those Smartphone Dings Are Turning You Into a Pavlov Dog",
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"content": "\u003cp>If the Russian psychologist Ivan Pavlov were alive today, what would he say about smartphones? He might not think of them as phones at all, but instead as remarkable tools for understanding how technology can manipulate our brains.\u003c/p>\n\u003cp>Pavlov's own findings — from \u003ca href=\"https://www.nobelprize.org/educational/medicine/pavlov/readmore.html\" target=\"_blank\" rel=\"noopener\">experiments\u003c/a> he did more than a century ago, involving food, buzzers and slobbering dogs — offer key insights, into why our phones have become almost an extension of our bodies, modern researchers say. The findings also provide clues to how we can break our dependence.\u003c/p>\n\u003cp>Pavlov originally set off to study canine digestion. But one day, he noticed something peculiar while feeding his dogs. If he played a sound — like a metronome or buzzer — before mealtimes, eventually the sound started to have a special meaning for the animals. It meant food was coming! The dogs actually started drooling when they heard the sound, even if no food was around.[contextly_sidebar id=\"WFvp0A8BvWC683stKdY7NtFgZFPpmCHR\"]\u003c/p>\n\u003cp>Hearing the buzzer had become pleasurable.\u003c/p>\n\u003cp>That's exactly what's happening with smartphones, says David Greenfield, a \u003ca href=\"http://virtual-addiction.com/about-us/\" target=\"_blank\" rel=\"noopener\">psychologist\u003c/a> and assistant clinical professor of psychiatry at the University of Connecticut.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When we hear a ding or little ditty alerting us to a new text, email or Facebook post, cells in our brains likely release dopamine — one of the chemical transmitters in the brain's reward circuitry. That dopamine makes us feel pleasure, Greenfield says.\u003c/p>\n\u003cp>\"That ping is telling us there is some type of reward there, waiting for us,\" Greenfield says.\u003c/p>\n\u003cp>Over time, that ping can become more powerful than the reward itself. Research on animals suggests dopamine levels in the brain can be twice as high when you anticipate the reward as when you actually receive it.\u003c/p>\n\u003cp>In other words, just hearing the notification can be more pleasurable than the text, email or tweet. \"Smartphone notifications have turned us all into Pavlov's dogs,\" Greenfield says.\u003c/p>\n\u003cp>\u003cstrong>Signs you might need to cut back\u003c/strong>\u003c/p>\n\u003cp>The average adult checks their phone 50 to 300 times each day, Greenfield says. And smartphones use psychological tricks that encourage our continued high usage — some of the same tricks slot machines use to hook gamblers.[contextly_sidebar id=\"oJLVZ8oFYDN98pI8tihIPWKg11UGF8v0\"]\u003c/p>\n\u003cp>\"For example, every time you look at your phone, you don't know what you're going to find — how relevant or desirable a message is going to be,\" Greenfield says. \"So you keep checking it over and over again because every once in a while, there's something good there.\" (This is called a variable ratio schedule of reinforcement. Animal studies suggest it makes dopamine skyrocket in the brain's reward circuity and is possibly one reason people keep playing slot machines.)\u003c/p>\n\u003cp>A growing number of doctors and psychologists are concerned about our relationship with the phone. There's a debate about what to call the problem. Some say \"disorder\" or \"problematic behavior.\" Others think over-reliance on a smartphone can become a behavioral addiction, like gambling.\u003c/p>\n\u003cp>\"It's a spectrum disorder,\" says Dr. Anna Lembke, a \u003ca href=\"https://profiles.stanford.edu/anna-lembke\" target=\"_blank\" rel=\"noopener\">psychiatrist\u003c/a> at Stanford University, who studies addiction. \"There are mild, moderate and extreme forms.\" And for many people, there's no problem at all.\u003c/p>\n\u003cp>In this way, the phone is kind of like alcohol, Lembke says. Moderate alcohol consumption can be beneficial, for some people.\u003c/p>\n\u003cp>\"You can make an argument that a temperate amount of smartphone or screen use might be good for people,\" Lembke says. \"So I'm not saying, 'Everybody get rid of their smartphones because they're completely addictive,' But instead, let's be very thoughtful about how we're how we're using these devices, because we can use them in pathological ways.\"\u003c/p>\n\u003cp>Signs you might be experiencing problematic use, Lembke says, include these:\u003c/p>\n\u003cul>\n\u003cli>Interacting with the device keeps you up late or otherwise interferes with your sleep.\u003c/li>\n\u003cli>It reduces the time you have to be with friends or family.\u003c/li>\n\u003cli>It interferes with your ability to finish work or homework.\u003c/li>\n\u003cli>It causes you to be rude, even subconsciously. \"For instance,\" Lembke asks, \"are you in the middle of having a conversation with someone and just dropping down and scrolling through your phone?\" That's a bad sign.\u003c/li>\n\u003cli>It's squelching your creativity. \"I think that's really what people don't realize with their smartphone usage,\" Lembke says. \"It can really deprive you of a kind of seamless flow of creative thought that generates from your own brain.\"\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Consider a digital detox one day a week\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.letitripple.org/about/tiffany-shlain/\" target=\"_blank\" rel=\"noopener\">Tiffany Shlain\u003c/a>, a San Francisco Bay Area filmmaker, noticed some of those warning signs in herself and loved ones, so she and her family now power down all their devices every Friday evening, for a 24-hour period.[contextly_sidebar id=\"oKMoZqJxDnKRySnPIdhx72Nu1HStqOIa\"]\u003c/p>\n\u003cp>\"It's something we look forward to each week,\" Shlain says. She and her husband \u003ca href=\"http://goldberg.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">Ken Goldberg\u003c/a>, a professor in the field of robotics at the University of California, Berkeley, are very tech savvy. But they find they need a break.\u003c/p>\n\u003cp>\"During the week, [we're] like an emotional pinball machine responding to all the external forces,\" Shlain says. The buzzes, beeps, emails, alerts and notifications never end.\u003c/p>\n\u003cp>Shutting the smartphones off shuts out all those distractions.\u003c/p>\n\u003cp>\"You're making your time sacred again — reclaiming it,\" Shlain says. \"You stop all the noise.\"\u003c/p>\n\u003cp>When they started the digital break, which they call \"Tech Shabbat,\" Saturdays suddenly felt very different. The family's not religious, she says, but they love the Jewish Sabbath ritual of setting aside a day for rest or restoration.\u003c/p>\n\u003cp>\"The days felt much longer, and we generally feel much more relaxed,\" says Goldberg.\u003c/p>\n\u003cp>Their daughter, Odessa Shlain Goldberg, a ninth-grader, says the unplugging takes some of the pressure off.\u003c/p>\n\u003cp>\"There's no FOMO — fear of missing out — or seeing what my friends are doing,\" Odessa says. \"It's a family day.\"\u003c/p>\n\u003cp>The teen says the perspective she gains from the digital power-down carries over into the rest of the week. For instance, she thinks about using social media differently. She realizes the social-media feeds often make other people's lives appear more exciting or glamorous.\u003c/p>\n\u003cp>\"If you're sitting at home scrolling, you're not having that glamorous experience,\" she says. \"So it feels a little discouraging.\"\u003c/p>\n\u003cp>\u003cstrong>Smartphones can compound teen angst, but there's a sweet spot\u003c/strong>\u003c/p>\n\u003cp>Odessa is definitely not alone in those observations. Social media can amplify the anxieties that come along with adolescence.\u003c/p>\n\u003cp>A recent study of high school students, \u003ca href=\"http://psycnet.apa.org/record/2018-02758-001\" target=\"_blank\" rel=\"noopener\">published\u003c/a> in the journal \u003cem>Emotion\u003c/em>, found that too much time spent on digital devices is linked to lower self-esteem and a decrease in well-being. The survey asked teens how much time they spent — outside of schoolwork — on activities such as texting, gaming, searching the internet or using social media.\u003c/p>\n\u003cp>\"We found teens who spend five or more hours a day online are twice as likely to say they're unhappy,\" compared to those who spend less time plugged in, explains the study's author, \u003ca href=\"http://www.psychology.sdsu.edu/people/jean-twenge/\" target=\"_blank\" rel=\"noopener\">Jean Twenge\u003c/a>, a professor of psychology at San Diego State University.\u003c/p>\n\u003cp>Twenge's research suggests digital abstinence is not good either. Teens who have no access to screens or social media may feel shut out, she says.\u003c/p>\n\u003cp>But there may be a sweet spot. According to the survey data, \"the teens who spend a little time — an hour or two hours a day [on their devices] — those are actually the happiest teens,\" Twenge says.\u003c/p>\n\u003cp>At its best, technology connects us to new ideas and people. It makes the world smaller, and opens up possibilities.\u003c/p>\n\u003cp>\"The ability to connect with people across the world is one the great benefits,\" Odessa believes. She says she's made some of her friends \"purely online.\"\u003c/p>\n\u003cp>\"We need to wrestle with it more,\" her mother says.\u003c/p>\n\u003cp>Technology is not going away — our lives are becoming more wired all the time. But Shlain and Odessa say taking a weekly break helps their whole family find a happy medium in dealing with their phones.\u003c/p>\n\u003cp>Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Tiny+Pulse+Of+Electricity+Can+Help+The+Brain+Form+Lasting+Memories&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If the Russian psychologist Ivan Pavlov were alive today, what would he say about smartphones? He might not think of them as phones at all, but instead as remarkable tools for understanding how technology can manipulate our brains.\u003c/p>\n\u003cp>Pavlov's own findings — from \u003ca href=\"https://www.nobelprize.org/educational/medicine/pavlov/readmore.html\" target=\"_blank\" rel=\"noopener\">experiments\u003c/a> he did more than a century ago, involving food, buzzers and slobbering dogs — offer key insights, into why our phones have become almost an extension of our bodies, modern researchers say. The findings also provide clues to how we can break our dependence.\u003c/p>\n\u003cp>Pavlov originally set off to study canine digestion. But one day, he noticed something peculiar while feeding his dogs. If he played a sound — like a metronome or buzzer — before mealtimes, eventually the sound started to have a special meaning for the animals. It meant food was coming! The dogs actually started drooling when they heard the sound, even if no food was around.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Hearing the buzzer had become pleasurable.\u003c/p>\n\u003cp>That's exactly what's happening with smartphones, says David Greenfield, a \u003ca href=\"http://virtual-addiction.com/about-us/\" target=\"_blank\" rel=\"noopener\">psychologist\u003c/a> and assistant clinical professor of psychiatry at the University of Connecticut.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When we hear a ding or little ditty alerting us to a new text, email or Facebook post, cells in our brains likely release dopamine — one of the chemical transmitters in the brain's reward circuitry. That dopamine makes us feel pleasure, Greenfield says.\u003c/p>\n\u003cp>\"That ping is telling us there is some type of reward there, waiting for us,\" Greenfield says.\u003c/p>\n\u003cp>Over time, that ping can become more powerful than the reward itself. Research on animals suggests dopamine levels in the brain can be twice as high when you anticipate the reward as when you actually receive it.\u003c/p>\n\u003cp>In other words, just hearing the notification can be more pleasurable than the text, email or tweet. \"Smartphone notifications have turned us all into Pavlov's dogs,\" Greenfield says.\u003c/p>\n\u003cp>\u003cstrong>Signs you might need to cut back\u003c/strong>\u003c/p>\n\u003cp>The average adult checks their phone 50 to 300 times each day, Greenfield says. And smartphones use psychological tricks that encourage our continued high usage — some of the same tricks slot machines use to hook gamblers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"For example, every time you look at your phone, you don't know what you're going to find — how relevant or desirable a message is going to be,\" Greenfield says. \"So you keep checking it over and over again because every once in a while, there's something good there.\" (This is called a variable ratio schedule of reinforcement. Animal studies suggest it makes dopamine skyrocket in the brain's reward circuity and is possibly one reason people keep playing slot machines.)\u003c/p>\n\u003cp>A growing number of doctors and psychologists are concerned about our relationship with the phone. There's a debate about what to call the problem. Some say \"disorder\" or \"problematic behavior.\" Others think over-reliance on a smartphone can become a behavioral addiction, like gambling.\u003c/p>\n\u003cp>\"It's a spectrum disorder,\" says Dr. Anna Lembke, a \u003ca href=\"https://profiles.stanford.edu/anna-lembke\" target=\"_blank\" rel=\"noopener\">psychiatrist\u003c/a> at Stanford University, who studies addiction. \"There are mild, moderate and extreme forms.\" And for many people, there's no problem at all.\u003c/p>\n\u003cp>In this way, the phone is kind of like alcohol, Lembke says. Moderate alcohol consumption can be beneficial, for some people.\u003c/p>\n\u003cp>\"You can make an argument that a temperate amount of smartphone or screen use might be good for people,\" Lembke says. \"So I'm not saying, 'Everybody get rid of their smartphones because they're completely addictive,' But instead, let's be very thoughtful about how we're how we're using these devices, because we can use them in pathological ways.\"\u003c/p>\n\u003cp>Signs you might be experiencing problematic use, Lembke says, include these:\u003c/p>\n\u003cul>\n\u003cli>Interacting with the device keeps you up late or otherwise interferes with your sleep.\u003c/li>\n\u003cli>It reduces the time you have to be with friends or family.\u003c/li>\n\u003cli>It interferes with your ability to finish work or homework.\u003c/li>\n\u003cli>It causes you to be rude, even subconsciously. \"For instance,\" Lembke asks, \"are you in the middle of having a conversation with someone and just dropping down and scrolling through your phone?\" That's a bad sign.\u003c/li>\n\u003cli>It's squelching your creativity. \"I think that's really what people don't realize with their smartphone usage,\" Lembke says. \"It can really deprive you of a kind of seamless flow of creative thought that generates from your own brain.\"\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>Consider a digital detox one day a week\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.letitripple.org/about/tiffany-shlain/\" target=\"_blank\" rel=\"noopener\">Tiffany Shlain\u003c/a>, a San Francisco Bay Area filmmaker, noticed some of those warning signs in herself and loved ones, so she and her family now power down all their devices every Friday evening, for a 24-hour period.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"It's something we look forward to each week,\" Shlain says. She and her husband \u003ca href=\"http://goldberg.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">Ken Goldberg\u003c/a>, a professor in the field of robotics at the University of California, Berkeley, are very tech savvy. But they find they need a break.\u003c/p>\n\u003cp>\"During the week, [we're] like an emotional pinball machine responding to all the external forces,\" Shlain says. The buzzes, beeps, emails, alerts and notifications never end.\u003c/p>\n\u003cp>Shutting the smartphones off shuts out all those distractions.\u003c/p>\n\u003cp>\"You're making your time sacred again — reclaiming it,\" Shlain says. \"You stop all the noise.\"\u003c/p>\n\u003cp>When they started the digital break, which they call \"Tech Shabbat,\" Saturdays suddenly felt very different. The family's not religious, she says, but they love the Jewish Sabbath ritual of setting aside a day for rest or restoration.\u003c/p>\n\u003cp>\"The days felt much longer, and we generally feel much more relaxed,\" says Goldberg.\u003c/p>\n\u003cp>Their daughter, Odessa Shlain Goldberg, a ninth-grader, says the unplugging takes some of the pressure off.\u003c/p>\n\u003cp>\"There's no FOMO — fear of missing out — or seeing what my friends are doing,\" Odessa says. \"It's a family day.\"\u003c/p>\n\u003cp>The teen says the perspective she gains from the digital power-down carries over into the rest of the week. For instance, she thinks about using social media differently. She realizes the social-media feeds often make other people's lives appear more exciting or glamorous.\u003c/p>\n\u003cp>\"If you're sitting at home scrolling, you're not having that glamorous experience,\" she says. \"So it feels a little discouraging.\"\u003c/p>\n\u003cp>\u003cstrong>Smartphones can compound teen angst, but there's a sweet spot\u003c/strong>\u003c/p>\n\u003cp>Odessa is definitely not alone in those observations. Social media can amplify the anxieties that come along with adolescence.\u003c/p>\n\u003cp>A recent study of high school students, \u003ca href=\"http://psycnet.apa.org/record/2018-02758-001\" target=\"_blank\" rel=\"noopener\">published\u003c/a> in the journal \u003cem>Emotion\u003c/em>, found that too much time spent on digital devices is linked to lower self-esteem and a decrease in well-being. The survey asked teens how much time they spent — outside of schoolwork — on activities such as texting, gaming, searching the internet or using social media.\u003c/p>\n\u003cp>\"We found teens who spend five or more hours a day online are twice as likely to say they're unhappy,\" compared to those who spend less time plugged in, explains the study's author, \u003ca href=\"http://www.psychology.sdsu.edu/people/jean-twenge/\" target=\"_blank\" rel=\"noopener\">Jean Twenge\u003c/a>, a professor of psychology at San Diego State University.\u003c/p>\n\u003cp>Twenge's research suggests digital abstinence is not good either. Teens who have no access to screens or social media may feel shut out, she says.\u003c/p>\n\u003cp>But there may be a sweet spot. According to the survey data, \"the teens who spend a little time — an hour or two hours a day [on their devices] — those are actually the happiest teens,\" Twenge says.\u003c/p>\n\u003cp>At its best, technology connects us to new ideas and people. It makes the world smaller, and opens up possibilities.\u003c/p>\n\u003cp>\"The ability to connect with people across the world is one the great benefits,\" Odessa believes. She says she's made some of her friends \"purely online.\"\u003c/p>\n\u003cp>\"We need to wrestle with it more,\" her mother says.\u003c/p>\n\u003cp>Technology is not going away — our lives are becoming more wired all the time. But Shlain and Odessa say taking a weekly break helps their whole family find a happy medium in dealing with their phones.\u003c/p>\n\u003cp>Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Tiny+Pulse+Of+Electricity+Can+Help+The+Brain+Form+Lasting+Memories&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Migraine Injections May Finally Offer Relief For Sufferers",
"title": "Migraine Injections May Finally Offer Relief For Sufferers",
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"content": "\u003cp>Humans have suffered from migraines for millennia. Yet, despite decades of research, there isn't a drug on the market today that prevents them by targeting the underlying cause. All of that could change in a few months when the FDA is expected to announce its decision about new therapies that have the potential to turn migraine treatment on its head.\u003c/p>\n\u003cp>The new therapies are based on research begun in the 1980s showing that people in the throes of a migraine attack have high levels of a protein called calcitonin gene–related peptide (CGRP) in their blood.\u003c/p>\n\u003cp>[contextly_sidebar id=\"ECfTe7PnuepSCIujv8538j2RQRMlQ2J6\"]Step by step, researchers tracked and studied this neurochemical's effects. They found that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11993614\" target=\"_blank\" rel=\"noopener\">injecting\u003c/a> the peptide into the blood of people prone to migraines triggers migraine-like headaches, whereas people not prone to migraines experienced, at most, mild pain. Blocking transmission of\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/bcp.12686/pdf\" target=\"_blank\" rel=\"noopener\"> CGRP in mice\u003c/a> appeared to prevent migraine-like symptoms. And so a few companies started developing a pill that might do the same in humans.\u003c/p>\n\u003cp>Clinical trials of the first pills were effective against migraine but halted in 2011 over concerns about potential liver damage. So, four pharmaceutical companies rejiggered their approach. To bypass the liver, all four instead looked to an injectable therapy called monoclonal antibodies — tiny immune molecules most commonly used to treat cancer. Not only do these bypass the liver to block CGRP, but one injection appears to be effective for up to three months with almost no noticeable side effects.\u003c/p>\n\u003cp>Two manufacturers, Amgen (in collaboration with Novartis) and Teva Pharmaceuticals, have completed clinical trials and expect to hear from the FDA by June whether the therapies have been approved. Two more companies, Eli Lilly and Alder Biopharmaceuticals, plan to file for FDA approval later this year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Current treatments don't always work\u003c/strong>\u003c/p>\n\u003cp>It's been a long time coming. Right now, the only available preventive treatments are accidental discoveries: A number of people prescribed medications for depression, high blood pressure and epilepsy discovered migraine relief, too. Now, many of those drugs, including propranolol and topiramate, have been tested and approved for migraine. But no one drug works for everyone, and side effects can prove intolerable or downright unpleasant.\u003c/p>\n\u003cp>Migraines are throbbing, one-sided headaches that can be accompanied by nausea as well as sensitivity to light, sound, smell, and movement. At their best, the headaches are an annoyance. At their worst, they can be completely debilitating. So for those of us who get numerous migraines each month, the prospect of a new approach feels almost life-changing.\u003c/p>\n\u003caside class=\"pullquote aligncenter\">“By age 25, I started to wonder if there was something seriously wrong with my head.”\u003ccite>Lauren Gravitz\u003c/cite>\u003c/aside>\n\u003cp>According to \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6624a8.htm\" target=\"_blank\" rel=\"noopener\">one recent survey\u003c/a> by the Centers for Disease Control and Prevention, about 10 percent of men and 20 percent of women in the U.S. reported having had a migraine in the last three months. And \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21063918?dopt=Abstract\" target=\"_blank\" rel=\"noopener\">up to two percent\u003c/a> of all Americans has at least 15 migraine days every single month. The toll such pain can take on health, morale, and productivity is substantial.\u003c/p>\n\u003cp>My own migraines started when I was 13. They struck a few times a week and I thought \u003ca href=\"https://americanmigrainefoundation.org/understanding-migraine/identifying-treating-migraine/\" target=\"_blank\" rel=\"noopener\">they were normal headaches\u003c/a>. For a while, I tried the usual over the counter pain relievers but, one by one, they stopped working. By age 25, I started to wonder if there was something seriously wrong with my head. My general practitioner diagnosed me with migraines, gave me my first preventive medication — an antidepressant — then sent me to see a specialist.\u003c/p>\n\u003cp>Since that day more than 17 years ago, I have tried six preventive prescription medications. Not one helped. I alternated among four different, neurologist-recommended supplements, all to no avail. I received bi-monthly injections of magnesium and participated in one of the first clinical trials of Botox. And while Botox seemed to decrease my migraines by one or two per month, it wasn't enough to bother fighting about it with a new insurance company. I exercised regularly. I experimented with an elimination diet that left me eating nothing but broccoli and white rice, but still the migraines came. I averaged about 15 to 20 each month.\u003c/p>\n\u003cp>Still, I considered myself lucky. The headaches almost never came with nausea, and I had medications that typically ousted them within an hour or two. All told, I usually lost only a few hours of productivity a week.\u003c/p>\n\u003cp>When I grew older and had two children, my body changed and my migraines changed, too. I get them less frequently now, but when they come, they can stick around for a few days or even a week. Abortive medications still work, except when they don't. So when I heard about a new approach that was making its way through a number of pharmaceutical company pipelines, I began combing through the \u003ca href=\"http://www.clinicaltrials.gov\" target=\"_blank\" rel=\"noopener\">national clinical trials database\u003c/a> to find a trial near me. I found one about 80 miles away, which didn't seem too far a trek considering the tantalizing reward of a migraine-free life. I made an appointment.\u003c/p>\n\u003cp>\u003cstrong>Clinical trials seem promising\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.mayoclinic.org/biographies/dodick-david-w-m-d/bio-20053142\" target=\"_blank\" rel=\"noopener\">David Dodick\u003c/a>, a neurologist at the Mayo Clinic in Phoenix, Ariz., has been involved in multiple clinical trials with each of the four anti-CGRP antibody treatments in development. And, he admits, he's optimistic. He has good reason to be: Each of the therapies decreases migraine frequency by at least one to two days per month. \"In a field where, over time, the progress and pace of research in understanding the underlying biology and mechanism of disease has been slow, this was very exciting,\" he says.\u003c/p>\n\u003cp>Because migraines are not life-threatening, most drugs have to pass a pretty high bar to be approved. And so far, patients on the experimental treatments report limited side effects that consist mostly of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383797/\" target=\"_blank\" rel=\"noopener\">pain at the injection site\u003c/a>. Unlike the current preventive medications, there is no nausea, no fuzzy thinking, no nerve pain, no weight loss or gain. And instead of remembering to take a daily pill, there is just a once-monthly injection.\u003c/p>\n\u003cp>Neurologists already have patients eager to test these therapies, especially when everything else they've tried hasn't worked. \"There's a big hole to fill, both in prevention and acute therapies,\" says \u003ca href=\"https://nyheadache.com/staff/alexander-mauskop/\" target=\"_blank\" rel=\"noopener\">Alexander Mauskop\u003c/a>, director of the New York Headache Center in New York City. (Full disclosure: He's my former neurologist.) \"If I have someone who's really suffering and can't find a solution, I tell them that in June I might have something new for them to try.\" Right now, he says, he has a list of about two dozen such patients.\u003c/p>\n\u003cp>\u003cstrong>High price tag\u003c/strong>\u003c/p>\n\u003cp>Even if the new therapies are approved, however, patients may still have to jump through a number of hoops to get them. Biologic therapies like these are expensive, and treatment could \u003ca href=\"https://www.theverge.com/2016/5/24/11712554/migraine-drug-treatment-headache-cost-pharmaceutical-health-insurance\" target=\"_blank\" rel=\"noopener\">reportedly range\u003c/a> anywhere from $8,000 to $18,000 a year. At that price, Mauskop and other neurologists expect insurance companies to require patients to have tried just about everything else first.\u003c/p>\n\u003cp>The other hitch at this stage is a lack of long-term safety data. \"If someone is well-controlled with Botox or another drug, I'd not suggest they switch,\" Mauskop says. \"With Vioxx, it took 10 years before they discovered that it increased the risk of heart problems.\"\u003c/p>\n\u003cp>Side effects are a potential concern. \u003ca href=\"https://physiciandirectory.brighamandwomens.org/Details/124\" target=\"_blank\" rel=\"noopener\">Elizabeth Loder\u003c/a>, chief of headache at Brigham and Women's Hospital in Boston, points out that because CGRP constricts blood vessels, there may be potential long-term effects on blood pressure or other cardiovascular function. In women of childbearing age, who are the ones most prone to frequent migraines, \"you can imagine that might have effects on fertility or placental function.\"\u003c/p>\n\u003cp>Right now, the longest patients have been on one of these new therapies is one to two years.\u003c/p>\n\u003cp>I ask Mauskop whether he'd recommend I enroll in a clinical trial, given my failure to respond to most everything else. He pauses, noting that he's no longer my neurologist and that he can't really give me any suggestions. But then he says that, since I'd previously shown some response to Botox, perhaps I might want to give it another try. I think about my two young children and my risk tolerance. Perhaps in ten years I'll feel differently. For now, however, I pick up the phone and cancel my clinical trial appointment.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Lauren Gravitz is a science writer and editor in Hershey, Penn. Her work has appeared in \u003c/em>Nature\u003cem>, \u003c/em>The Economist\u003cem>, \u003c/em>Aeon\u003cem>, \u003c/em>Discover\u003cem>, \u003c/em>The Oprah Magazine\u003cem>, and more. Find her at \u003ca href=\"http://www.laurengravitz.com\" target=\"_blank\" rel=\"noopener\">www.laurengravitz.com\u003c/a> and \u003ca href=\"https://twitter.com/lyrebard\">@lyrebard\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Gone+With+A+Shot%3F+Hopeful+New+Signs+Of+Relief+For+Migraine+Sufferers&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Humans have suffered from migraines for millennia. Yet, despite decades of research, there isn't a drug on the market today that prevents them by targeting the underlying cause. All of that could change in a few months when the FDA is expected to announce its decision about new therapies that have the potential to turn migraine treatment on its head.\u003c/p>\n\u003cp>The new therapies are based on research begun in the 1980s showing that people in the throes of a migraine attack have high levels of a protein called calcitonin gene–related peptide (CGRP) in their blood.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Step by step, researchers tracked and studied this neurochemical's effects. They found that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11993614\" target=\"_blank\" rel=\"noopener\">injecting\u003c/a> the peptide into the blood of people prone to migraines triggers migraine-like headaches, whereas people not prone to migraines experienced, at most, mild pain. Blocking transmission of\u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/bcp.12686/pdf\" target=\"_blank\" rel=\"noopener\"> CGRP in mice\u003c/a> appeared to prevent migraine-like symptoms. And so a few companies started developing a pill that might do the same in humans.\u003c/p>\n\u003cp>Clinical trials of the first pills were effective against migraine but halted in 2011 over concerns about potential liver damage. So, four pharmaceutical companies rejiggered their approach. To bypass the liver, all four instead looked to an injectable therapy called monoclonal antibodies — tiny immune molecules most commonly used to treat cancer. Not only do these bypass the liver to block CGRP, but one injection appears to be effective for up to three months with almost no noticeable side effects.\u003c/p>\n\u003cp>Two manufacturers, Amgen (in collaboration with Novartis) and Teva Pharmaceuticals, have completed clinical trials and expect to hear from the FDA by June whether the therapies have been approved. Two more companies, Eli Lilly and Alder Biopharmaceuticals, plan to file for FDA approval later this year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Current treatments don't always work\u003c/strong>\u003c/p>\n\u003cp>It's been a long time coming. Right now, the only available preventive treatments are accidental discoveries: A number of people prescribed medications for depression, high blood pressure and epilepsy discovered migraine relief, too. Now, many of those drugs, including propranolol and topiramate, have been tested and approved for migraine. But no one drug works for everyone, and side effects can prove intolerable or downright unpleasant.\u003c/p>\n\u003cp>Migraines are throbbing, one-sided headaches that can be accompanied by nausea as well as sensitivity to light, sound, smell, and movement. At their best, the headaches are an annoyance. At their worst, they can be completely debilitating. So for those of us who get numerous migraines each month, the prospect of a new approach feels almost life-changing.\u003c/p>\n\u003caside class=\"pullquote aligncenter\">“By age 25, I started to wonder if there was something seriously wrong with my head.”\u003ccite>Lauren Gravitz\u003c/cite>\u003c/aside>\n\u003cp>According to \u003ca href=\"https://www.cdc.gov/mmwr/volumes/66/wr/mm6624a8.htm\" target=\"_blank\" rel=\"noopener\">one recent survey\u003c/a> by the Centers for Disease Control and Prevention, about 10 percent of men and 20 percent of women in the U.S. reported having had a migraine in the last three months. And \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21063918?dopt=Abstract\" target=\"_blank\" rel=\"noopener\">up to two percent\u003c/a> of all Americans has at least 15 migraine days every single month. The toll such pain can take on health, morale, and productivity is substantial.\u003c/p>\n\u003cp>My own migraines started when I was 13. They struck a few times a week and I thought \u003ca href=\"https://americanmigrainefoundation.org/understanding-migraine/identifying-treating-migraine/\" target=\"_blank\" rel=\"noopener\">they were normal headaches\u003c/a>. For a while, I tried the usual over the counter pain relievers but, one by one, they stopped working. By age 25, I started to wonder if there was something seriously wrong with my head. My general practitioner diagnosed me with migraines, gave me my first preventive medication — an antidepressant — then sent me to see a specialist.\u003c/p>\n\u003cp>Since that day more than 17 years ago, I have tried six preventive prescription medications. Not one helped. I alternated among four different, neurologist-recommended supplements, all to no avail. I received bi-monthly injections of magnesium and participated in one of the first clinical trials of Botox. And while Botox seemed to decrease my migraines by one or two per month, it wasn't enough to bother fighting about it with a new insurance company. I exercised regularly. I experimented with an elimination diet that left me eating nothing but broccoli and white rice, but still the migraines came. I averaged about 15 to 20 each month.\u003c/p>\n\u003cp>Still, I considered myself lucky. The headaches almost never came with nausea, and I had medications that typically ousted them within an hour or two. All told, I usually lost only a few hours of productivity a week.\u003c/p>\n\u003cp>When I grew older and had two children, my body changed and my migraines changed, too. I get them less frequently now, but when they come, they can stick around for a few days or even a week. Abortive medications still work, except when they don't. So when I heard about a new approach that was making its way through a number of pharmaceutical company pipelines, I began combing through the \u003ca href=\"http://www.clinicaltrials.gov\" target=\"_blank\" rel=\"noopener\">national clinical trials database\u003c/a> to find a trial near me. I found one about 80 miles away, which didn't seem too far a trek considering the tantalizing reward of a migraine-free life. I made an appointment.\u003c/p>\n\u003cp>\u003cstrong>Clinical trials seem promising\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.mayoclinic.org/biographies/dodick-david-w-m-d/bio-20053142\" target=\"_blank\" rel=\"noopener\">David Dodick\u003c/a>, a neurologist at the Mayo Clinic in Phoenix, Ariz., has been involved in multiple clinical trials with each of the four anti-CGRP antibody treatments in development. And, he admits, he's optimistic. He has good reason to be: Each of the therapies decreases migraine frequency by at least one to two days per month. \"In a field where, over time, the progress and pace of research in understanding the underlying biology and mechanism of disease has been slow, this was very exciting,\" he says.\u003c/p>\n\u003cp>Because migraines are not life-threatening, most drugs have to pass a pretty high bar to be approved. And so far, patients on the experimental treatments report limited side effects that consist mostly of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5383797/\" target=\"_blank\" rel=\"noopener\">pain at the injection site\u003c/a>. Unlike the current preventive medications, there is no nausea, no fuzzy thinking, no nerve pain, no weight loss or gain. And instead of remembering to take a daily pill, there is just a once-monthly injection.\u003c/p>\n\u003cp>Neurologists already have patients eager to test these therapies, especially when everything else they've tried hasn't worked. \"There's a big hole to fill, both in prevention and acute therapies,\" says \u003ca href=\"https://nyheadache.com/staff/alexander-mauskop/\" target=\"_blank\" rel=\"noopener\">Alexander Mauskop\u003c/a>, director of the New York Headache Center in New York City. (Full disclosure: He's my former neurologist.) \"If I have someone who's really suffering and can't find a solution, I tell them that in June I might have something new for them to try.\" Right now, he says, he has a list of about two dozen such patients.\u003c/p>\n\u003cp>\u003cstrong>High price tag\u003c/strong>\u003c/p>\n\u003cp>Even if the new therapies are approved, however, patients may still have to jump through a number of hoops to get them. Biologic therapies like these are expensive, and treatment could \u003ca href=\"https://www.theverge.com/2016/5/24/11712554/migraine-drug-treatment-headache-cost-pharmaceutical-health-insurance\" target=\"_blank\" rel=\"noopener\">reportedly range\u003c/a> anywhere from $8,000 to $18,000 a year. At that price, Mauskop and other neurologists expect insurance companies to require patients to have tried just about everything else first.\u003c/p>\n\u003cp>The other hitch at this stage is a lack of long-term safety data. \"If someone is well-controlled with Botox or another drug, I'd not suggest they switch,\" Mauskop says. \"With Vioxx, it took 10 years before they discovered that it increased the risk of heart problems.\"\u003c/p>\n\u003cp>Side effects are a potential concern. \u003ca href=\"https://physiciandirectory.brighamandwomens.org/Details/124\" target=\"_blank\" rel=\"noopener\">Elizabeth Loder\u003c/a>, chief of headache at Brigham and Women's Hospital in Boston, points out that because CGRP constricts blood vessels, there may be potential long-term effects on blood pressure or other cardiovascular function. In women of childbearing age, who are the ones most prone to frequent migraines, \"you can imagine that might have effects on fertility or placental function.\"\u003c/p>\n\u003cp>Right now, the longest patients have been on one of these new therapies is one to two years.\u003c/p>\n\u003cp>I ask Mauskop whether he'd recommend I enroll in a clinical trial, given my failure to respond to most everything else. He pauses, noting that he's no longer my neurologist and that he can't really give me any suggestions. But then he says that, since I'd previously shown some response to Botox, perhaps I might want to give it another try. I think about my two young children and my risk tolerance. Perhaps in ten years I'll feel differently. For now, however, I pick up the phone and cancel my clinical trial appointment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Lauren Gravitz is a science writer and editor in Hershey, Penn. Her work has appeared in \u003c/em>Nature\u003cem>, \u003c/em>The Economist\u003cem>, \u003c/em>Aeon\u003cem>, \u003c/em>Discover\u003cem>, \u003c/em>The Oprah Magazine\u003cem>, and more. Find her at \u003ca href=\"http://www.laurengravitz.com\" target=\"_blank\" rel=\"noopener\">www.laurengravitz.com\u003c/a> and \u003ca href=\"https://twitter.com/lyrebard\">@lyrebard\u003c/a>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Gone+With+A+Shot%3F+Hopeful+New+Signs+Of+Relief+For+Migraine+Sufferers&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>In 1995, in order to educate its clients on what technology to adopt, the IT consulting firm Gartner \u003ca href=\"https://www.gartner.com/technology/research/methodologies/hype-cycle.jsp\" target=\"_blank\" rel=\"noopener\">released a graph\u003c/a> illustrating the “hype cycle.”\u003c/p>\n\u003cp>The model posits that when a new technology is developed, it creates a frenzy of anticipation, leading to a Peak of Inflated Expectations. \u003ca href=\"https://theconversation.com/fitbits-decline-is-a-reflection-of-the-end-of-the-over-hyped-promise-of-wearables-73823\" target=\"_blank\" rel=\"noopener\">Failing\u003c/a> to live up to its pie-in-the-sky promise, the technology then becomes the butt of \u003ca href=\"https://www.youtube.com/watch?v=9507aK_nBHo&ab_channel=cgmcreative\">jokes and derision\u003c/a> — a Trough of Disillusionment.\u003c/p>\n\u003cfigure id=\"attachment_438726\" class=\"wp-caption aligncenter\" style=\"max-width: 506px\">\u003cimg class=\"wp-image-438726 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/gartner-for-marketers-hype-cycle.png\" alt=\"A graph showing the rise, fall, and subsequent rise of new forms of technology\" width=\"506\" height=\"259\">\u003cfigcaption class=\"wp-caption-text\">The Hype Cycle.\u003c/figcaption>\u003c/figure>\n\u003cp>But as it improves, it reaccumulates credibility -- the Slope of Enlightenment. The technology then matures into the mainstream, where the rollercoaster lifecycle finally smooths out along the Plateau of Productivity.\u003c/p>\n\u003cp>And this, says Dr. Robert Wachter, author of \"\u003ca href=\"https://ww2.kqed.org/futureofyou/tag/the-digital-doctor/\">The Digital Doctor\u003c/a>\" and chair of the Department of Medicine at UCSF, “turns out to be a perfect map for digital medicine.”\u003c/p>\n\u003cp>\u003cstrong>Does This Stuff Work? \u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">'We’re trying to emphasize this is not the end of wearables. [But] we don’t want to overpromise what these can achieve.'\u003ccite>Dr. Brennan Spiegel, Cedars-Sinai Health Services Research\u003c/cite>\u003c/aside>\n\u003cp>A \u003ca href=\"https://www.nature.com/articles/s41746-017-0002-4\" target=\"_blank\" rel=\"noopener\">meta-analysis\u003c/a> published this month in the journal \u003cem>Digital Medicine\u003c/em> would seem to buttress Wachter’s view. The study, conducted mostly by researchers at Cedars-Sinai Medical Center in Los Angeles, takes a broad look at the effectiveness of wearable sensors. The study looked at 16 randomized controlled trials, published from 2000 to 2016, which researchers assessed to be high quality. To be included in the study, devices had to be non-invasive, wearable, and capable of automatically transmitting data to a web portal or mobile app for review by patients or health providers. Among the devices tested were internet-connected weight scales, blood pressure monitors and activity trackers with text-message reminders.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The primary question researchers wanted to answer: Do these wearable biosensors make patients healthier?\u003c/p>\n\u003cp>Not very much, was the conclusion. The analysis found no significant difference in health outcomes like weight or blood pressure between patients who used the devices and those who didn't.\u003c/p>\n\u003cp>The researchers say they were not surprised, and they hope the work will pave the way for better development and use of remote health monitoring.\u003c/p>\n\u003cp>“We’re trying to emphasize this is not the end of wearables,” says co-author Dr. Brennan Spiegel, director of Cedars-Sinai Health Services Research in Los Angeles. “[But] we don’t want to overpromise what these can achieve.”\u003c/p>\n\u003cp>The authors did note some positive effect in certain cases. For instance, \u003ca href=\"http://www.mdpi.com/1424-8220/14/4/6229/htm\">a study\u003c/a> looking at Parkinson’s patients found a positive effect when physical therapy included devices that gave feedback about gaits; and in some trials patients did lose weight.\u003c/p>\n\u003cfigure id=\"attachment_438738\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-438738 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/6905654506_5ac041bada_k-1020x752.jpg\" alt=\"Three joggers near a body of water.\" width=\"640\" height=\"472\">\u003cfigcaption class=\"wp-caption-text\">Wearing an activity tracker does not necessarily lead to more activity.\u003c/figcaption>\u003c/figure>\n\u003cp>“The most successful studies tend to be coupled with some behavioral intervention,” Spiegel says. This added component sometimes took the form of a health coach or cognitive behavioral therapy, in addition to use of the device.\u003c/p>\n\u003cp>That means the greatest hurdles to efficacy in the digital health revolution may not be technical, but human.\u003c/p>\n\u003cp>“What we conclude in the study is that digital health is not a computer science or an engineering science; it’s a social and behavioral science.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Medicine is probably the last field to be touched by technology.'\u003ccite>Dr. Bob Wachter, author of 'The Digital Doctor'\u003c/cite>\u003c/aside>\n\u003cp>Other recently published research, a \u003ca href=\"http://mhealth.jmir.org/2018/1/e23/\" target=\"_blank\" rel=\"noopener\">systematic review\u003c/a> of systematic reviews, focused on mobile health interventions, most frequently involving text messaging. The analysis, published in the\u003cem> Journal of Medical Internet Research mHealth and uHealth\u003c/em>, looked at 371 studies published between 2009 and 2016, comprised of nearly 80,000 patients. The studied interventions included apps to manage chronic disease, increase treatment adherence and modify behavior. The analysis found evidence that mobile health apps helped with a variety of conditions, including symptom improvement in chronic pulmonary disease and heart failure; glycemic control in diabetes patients; and blood pressure in those with hypertension. There was also evidence that text reminders improved adherence to tuberculosis and HIV therapies.\u003c/p>\n\u003cp>[contextly_sidebar id=\"cJJOGi35mjmKyVRrfPXWGXPW5fc4Gdks\"]However, the quality of the evidence for many studies was rated as generally low. Among the more rigorous studies were those that found good evidence for improvement in asthma symptoms, appointment attendance and smoking cessation rates.\u003c/p>\n\u003cp>\u003cstrong>Medicine Needs to do Better. Will Technology Help?\u003c/strong>\u003c/p>\n\u003cp>Wachter ticked off the ways medicine is \"coming up short in what we want from it.\"\u003c/p>\n\u003cp>\"Safety is not very good,\" he says. \"We harm and kill a lot of people because of medical mistakes. People are not very satisfied ... . Access is often quite bad. And the costs are bankrupting local governments, national governments, and businesses and individuals.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Investors] wanted a quick win, but now they realize there aren’t a lot of quick wins in health care.'\u003ccite>Melissa Buckley, California Health Care Foundation\u003c/cite>\u003c/aside>\n\u003cp>And yet, “Medicine is probably the last field to be touched by technology,\" he says. \"Think about how manufacturing, retail, financial services, travel, journalism, pretty much every field has been overtaken by technology.”\u003c/p>\n\u003cp>These manifold inefficiencies present a natural target for technologists, Wachter says.\u003c/p>\n\u003cp>“You have the technology trigger, a massive uptick in expectation. Then, of course, studies like [the one in \u003cem>Digital Medicine\u003c/em>] come out and it leads to a rapid downslope, that Trough of Disillusionment.\"\u003c/p>\n\u003cp>Still, Wachter, as well as many other experts, believe remote sensors, mobile health and tech-enhanced medical services will play an important role in the future of medicine, because there are so many people who need help monitoring chronic disease and guidance on diet and exercise. It’s just too time-consuming and costly to always get these directly from medical professionals, Wachter says.\u003c/p>\n\u003cp>“Right now many people take a half-day off work to go to a 15- minute visit to see the doctor. That’s crazy. How can that be the model over time?”\u003c/p>\n\u003cp>Wachter predicts digital health devices will eventually become as indispensable as smartphones and personal assistants.\u003c/p>\n\u003cp>“That has not happened yet in remote patient monitoring. My suspicion is that over time it probably will, but we have to learn a lot.”\u003c/p>\n\u003cp>Melissa Buckley is director of the Health Innovation Fund for the California Health Care Foundation, which is dedicated to improving health care for low-income state residents. The fund invests in technology and service companies it hopes will help in that mission.\u003c/p>\n\u003cp>Buckley says she’s seen companies only in the last two years try to shorten the hype cycle, which they're doing by becoming more realistic and intentional in the design and deployment of technology. She points out that some of the studies cited in the \u003cem>Digital Health \u003c/em>analysis date back to 2000, when devices were relatively primitive.\u003c/p>\n\u003cp>During the initial phase of excitement over using technology to solve health problems, she says, many investors put money into simple concepts. “They wanted a quick win, but now they realize there aren’t a lot of quick wins in health care.”\u003c/p>\n\u003cp>The field is learning, she believes, to be more attuned to what patients really need.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“But just because [some tool] is digital, we shouldn’t think it will be magically effective.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In 1995, in order to educate its clients on what technology to adopt, the IT consulting firm Gartner \u003ca href=\"https://www.gartner.com/technology/research/methodologies/hype-cycle.jsp\" target=\"_blank\" rel=\"noopener\">released a graph\u003c/a> illustrating the “hype cycle.”\u003c/p>\n\u003cp>The model posits that when a new technology is developed, it creates a frenzy of anticipation, leading to a Peak of Inflated Expectations. \u003ca href=\"https://theconversation.com/fitbits-decline-is-a-reflection-of-the-end-of-the-over-hyped-promise-of-wearables-73823\" target=\"_blank\" rel=\"noopener\">Failing\u003c/a> to live up to its pie-in-the-sky promise, the technology then becomes the butt of \u003ca href=\"https://www.youtube.com/watch?v=9507aK_nBHo&ab_channel=cgmcreative\">jokes and derision\u003c/a> — a Trough of Disillusionment.\u003c/p>\n\u003cfigure id=\"attachment_438726\" class=\"wp-caption aligncenter\" style=\"max-width: 506px\">\u003cimg class=\"wp-image-438726 \" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/gartner-for-marketers-hype-cycle.png\" alt=\"A graph showing the rise, fall, and subsequent rise of new forms of technology\" width=\"506\" height=\"259\">\u003cfigcaption class=\"wp-caption-text\">The Hype Cycle.\u003c/figcaption>\u003c/figure>\n\u003cp>But as it improves, it reaccumulates credibility -- the Slope of Enlightenment. The technology then matures into the mainstream, where the rollercoaster lifecycle finally smooths out along the Plateau of Productivity.\u003c/p>\n\u003cp>And this, says Dr. Robert Wachter, author of \"\u003ca href=\"https://ww2.kqed.org/futureofyou/tag/the-digital-doctor/\">The Digital Doctor\u003c/a>\" and chair of the Department of Medicine at UCSF, “turns out to be a perfect map for digital medicine.”\u003c/p>\n\u003cp>\u003cstrong>Does This Stuff Work? \u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">'We’re trying to emphasize this is not the end of wearables. [But] we don’t want to overpromise what these can achieve.'\u003ccite>Dr. Brennan Spiegel, Cedars-Sinai Health Services Research\u003c/cite>\u003c/aside>\n\u003cp>A \u003ca href=\"https://www.nature.com/articles/s41746-017-0002-4\" target=\"_blank\" rel=\"noopener\">meta-analysis\u003c/a> published this month in the journal \u003cem>Digital Medicine\u003c/em> would seem to buttress Wachter’s view. The study, conducted mostly by researchers at Cedars-Sinai Medical Center in Los Angeles, takes a broad look at the effectiveness of wearable sensors. The study looked at 16 randomized controlled trials, published from 2000 to 2016, which researchers assessed to be high quality. To be included in the study, devices had to be non-invasive, wearable, and capable of automatically transmitting data to a web portal or mobile app for review by patients or health providers. Among the devices tested were internet-connected weight scales, blood pressure monitors and activity trackers with text-message reminders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The primary question researchers wanted to answer: Do these wearable biosensors make patients healthier?\u003c/p>\n\u003cp>Not very much, was the conclusion. The analysis found no significant difference in health outcomes like weight or blood pressure between patients who used the devices and those who didn't.\u003c/p>\n\u003cp>The researchers say they were not surprised, and they hope the work will pave the way for better development and use of remote health monitoring.\u003c/p>\n\u003cp>“We’re trying to emphasize this is not the end of wearables,” says co-author Dr. Brennan Spiegel, director of Cedars-Sinai Health Services Research in Los Angeles. “[But] we don’t want to overpromise what these can achieve.”\u003c/p>\n\u003cp>The authors did note some positive effect in certain cases. For instance, \u003ca href=\"http://www.mdpi.com/1424-8220/14/4/6229/htm\">a study\u003c/a> looking at Parkinson’s patients found a positive effect when physical therapy included devices that gave feedback about gaits; and in some trials patients did lose weight.\u003c/p>\n\u003cfigure id=\"attachment_438738\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-438738 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/6905654506_5ac041bada_k-1020x752.jpg\" alt=\"Three joggers near a body of water.\" width=\"640\" height=\"472\">\u003cfigcaption class=\"wp-caption-text\">Wearing an activity tracker does not necessarily lead to more activity.\u003c/figcaption>\u003c/figure>\n\u003cp>“The most successful studies tend to be coupled with some behavioral intervention,” Spiegel says. This added component sometimes took the form of a health coach or cognitive behavioral therapy, in addition to use of the device.\u003c/p>\n\u003cp>That means the greatest hurdles to efficacy in the digital health revolution may not be technical, but human.\u003c/p>\n\u003cp>“What we conclude in the study is that digital health is not a computer science or an engineering science; it’s a social and behavioral science.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'Medicine is probably the last field to be touched by technology.'\u003ccite>Dr. Bob Wachter, author of 'The Digital Doctor'\u003c/cite>\u003c/aside>\n\u003cp>Other recently published research, a \u003ca href=\"http://mhealth.jmir.org/2018/1/e23/\" target=\"_blank\" rel=\"noopener\">systematic review\u003c/a> of systematic reviews, focused on mobile health interventions, most frequently involving text messaging. The analysis, published in the\u003cem> Journal of Medical Internet Research mHealth and uHealth\u003c/em>, looked at 371 studies published between 2009 and 2016, comprised of nearly 80,000 patients. The studied interventions included apps to manage chronic disease, increase treatment adherence and modify behavior. The analysis found evidence that mobile health apps helped with a variety of conditions, including symptom improvement in chronic pulmonary disease and heart failure; glycemic control in diabetes patients; and blood pressure in those with hypertension. There was also evidence that text reminders improved adherence to tuberculosis and HIV therapies.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>However, the quality of the evidence for many studies was rated as generally low. Among the more rigorous studies were those that found good evidence for improvement in asthma symptoms, appointment attendance and smoking cessation rates.\u003c/p>\n\u003cp>\u003cstrong>Medicine Needs to do Better. Will Technology Help?\u003c/strong>\u003c/p>\n\u003cp>Wachter ticked off the ways medicine is \"coming up short in what we want from it.\"\u003c/p>\n\u003cp>\"Safety is not very good,\" he says. \"We harm and kill a lot of people because of medical mistakes. People are not very satisfied ... . Access is often quite bad. And the costs are bankrupting local governments, national governments, and businesses and individuals.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'[Investors] wanted a quick win, but now they realize there aren’t a lot of quick wins in health care.'\u003ccite>Melissa Buckley, California Health Care Foundation\u003c/cite>\u003c/aside>\n\u003cp>And yet, “Medicine is probably the last field to be touched by technology,\" he says. \"Think about how manufacturing, retail, financial services, travel, journalism, pretty much every field has been overtaken by technology.”\u003c/p>\n\u003cp>These manifold inefficiencies present a natural target for technologists, Wachter says.\u003c/p>\n\u003cp>“You have the technology trigger, a massive uptick in expectation. Then, of course, studies like [the one in \u003cem>Digital Medicine\u003c/em>] come out and it leads to a rapid downslope, that Trough of Disillusionment.\"\u003c/p>\n\u003cp>Still, Wachter, as well as many other experts, believe remote sensors, mobile health and tech-enhanced medical services will play an important role in the future of medicine, because there are so many people who need help monitoring chronic disease and guidance on diet and exercise. It’s just too time-consuming and costly to always get these directly from medical professionals, Wachter says.\u003c/p>\n\u003cp>“Right now many people take a half-day off work to go to a 15- minute visit to see the doctor. That’s crazy. How can that be the model over time?”\u003c/p>\n\u003cp>Wachter predicts digital health devices will eventually become as indispensable as smartphones and personal assistants.\u003c/p>\n\u003cp>“That has not happened yet in remote patient monitoring. My suspicion is that over time it probably will, but we have to learn a lot.”\u003c/p>\n\u003cp>Melissa Buckley is director of the Health Innovation Fund for the California Health Care Foundation, which is dedicated to improving health care for low-income state residents. The fund invests in technology and service companies it hopes will help in that mission.\u003c/p>\n\u003cp>Buckley says she’s seen companies only in the last two years try to shorten the hype cycle, which they're doing by becoming more realistic and intentional in the design and deployment of technology. She points out that some of the studies cited in the \u003cem>Digital Health \u003c/em>analysis date back to 2000, when devices were relatively primitive.\u003c/p>\n\u003cp>During the initial phase of excitement over using technology to solve health problems, she says, many investors put money into simple concepts. “They wanted a quick win, but now they realize there aren’t a lot of quick wins in health care.”\u003c/p>\n\u003cp>The field is learning, she believes, to be more attuned to what patients really need.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Seconds Matter When Treating Stroke. This San Francisco Hospital Got a Lot Faster",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">The last thing Donna Taylor remembers about the night of July 21, 2017, is her intense headache and flickering vision. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When her husband, Joseph, found her lying on the floor of their San Francisco home, she couldn’t get up, so he called 911. \u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'There’s an old adage that time is brain.'\u003ccite>Debbie Madhok, physician\u003c/cite>\u003c/aside>\n\u003cp>“I realized this was not something we can handle here at home,” Joseph says. “This was awfully scary.”\u003c/p>\n\u003cp>The ambulance took Taylor, 55, to Zuckerberg San Francisco General Hospital and Trauma Center, where she was rushed to get a CT scan. The doctors found a large clot blocking one of the major arteries to her brain -- a stroke. Within 28 minutes of her arrival, Donna was given medication to break up the clot. Within 108 minutes, surgeons were removing it. By the next day, she was mobile again.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Signs You're Having a Stroke:\u003c/h3>\n\u003cul>\n\u003cli>Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body\u003c/li>\n\u003cli>Sudden confusion or trouble speaking\u003c/li>\n\u003cli>Sudden trouble seeing\u003c/li>\n\u003cli>Sudden trouble walking or dizziness\u003c/li>\n\u003cli>Sudden severe headache with no cause\u003c/li>\n\u003c/ul>\n\u003ch4>What to do if you — or someone near you — is experiencing even one of these symptoms:\u003c/h4>\n\u003cul>\n\u003cli>Call 911 immediately; never wait more than 5 minutes.\u003c/li>\n\u003cli>Take note of the time symptoms started.\u003c/li>\n\u003cli>Stay put until help arrives.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>This protocol was new. It was developed by emergency and neurocritical care physician Debbie Madhok.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"There’s an old adage that ‘time is brain,’” says Madhok. “It’s been shown that if you occlude a big blood vessel in the brain, about 2 million brain cells die per minute. Depending on where these cells die, the impact can be quite devastating.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">People who suffer massive strokes can permanently lose the ability to speak or move parts of their bodies. For every hour that treatment is delayed, a stroke patient loses 3.6 years of functional life, says J. Claude Hemphill III, one of San Francisco General's neurosurgeons. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The American Heart Association recommends stroke patients receive the clot-busting medicine known as \u003ca href=\"http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_430859.pdf\" target=\"_blank\" rel=\"noopener\">tPA\u003c/a> within \u003ca href=\"http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/About-Target-Stroke_UCM_432409_Article.jsp#.Wi7hQxOPIWo\" target=\"_blank\" rel=\"noopener\">45-60 minutes\u003c/a> of arriving at a hospital. But under Madhok’s plan, treatment comes faster.\u003c/span>\u003c/p>\n\u003cp>It starts with the paramedics calling ahead when transporting a potential stroke patient. They are met at the emergency room doors by a stroke specialist who moves the patient just a few yards, to be weighed and given a CT scan. If the scan reveals that a large clot is cutting off blood supply to the brain, the patient immediately receives a weight-appropriate dose of tPA while still in the scanner. Soon after, a surgical team removes the clot.\u003c/p>\n\u003cfigure id=\"attachment_438615\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-438615 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/brainscan-1020x299.jpg\" alt=\"Brain scans show where a stroke patient's blood flow is blocked (left), the clot being removed (middle) and blood flow restored (right).\" width=\"640\" height=\"188\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-1020x299.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-160x47.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-800x235.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-768x225.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-960x281.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-240x70.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-375x110.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-520x152.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan.jpg 1129w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">X-ray scans of the brain (\u003cspan class=\"s1\">a cerebral angiogram)\u003c/span> show where a stroke patient's blood flow is blocked (left), the clot being removed (middle) and blood flow restored (right). \u003ccite>(San Francisco General Hospital)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Madhok calls it the Mission Protocol, both because it’s her mission to streamline emergency stroke treatment and because the hospital sits on the border of San Francisco’s Mission district, providing care for many of its residents.\u003c/span>\u003c/p>\n\u003cp>Under the protocol, the median time for patients to get a CT scan is 10 minutes , which is 13 minutes faster than before. The median from \"door-to-needle,” the time it takes to administer tPA, is 20 minutes, less than half the 45 minutes it used to take.\u003c/p>\n\u003cp>Several studies have shown that \u003ca href=\"http://share.upmc.com/2015/08/mechanical-thrombectomy-stroke-mm02/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">mechanical thrombectomy\u003c/span>\u003c/a>, \u003cspan style=\"font-weight: 400\">in which doctors snake tiny tools into a patient’s artery to remove clots, is a key step in emergency stroke care. While the Committee of the Society of Vascular and Interventional Neurology \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817382/\" target=\"_blank\" rel=\"noopener\">recommends clot removal in less than 90 minutes, \u003c/a>under the Mission Protocol, the hospital’s median time to remove clots is 76 minutes.\u003c/span>\u003c/p>\n\u003cp>In response to those studies, more hospitals are adding mechanical thrombectomy to their emergency stroke care, says Dr. Jose Biller, neurology chair at the Loyola University Chicago Stritch School of Medicine.\u003c/p>\n\u003cp>“Everyone I know of is very cognizant of the fact that early stroke treatment is essential,” Biller says. “You see variations on this theme in many institutions.”\u003c/p>\n\u003cp>\u003cb>Shaving Time to Treatment\u003c/b>\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s become a competitive thing, seeing who can go for the quickest stroke treatment time possible.'\u003ccite>David Tong, California Pacific Medical Center neurologist\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">Two initiatives in the past decade began to affect how hospitals treat stroke patients. In 2010, the American Heart Association launched \u003c/span>\u003ca href=\"http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/About-Target-Stroke_UCM_432409_Article.jsp#.Wi7fIROPIWo\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Target: Stroke\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, an initiative aimed at encouraging hospitals to reduce their door-to-needle time to less than 60 minutes. Two years later, research out of Helsinki showed how to shave off minutes from that time, and many hospitals began adopting the method.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s become a competitive thing, seeing who can go for the quickest time possible,” says David Tong, a neurologist with California Pacific Medical Center and a member of the American Neurological Association's Advisory Committee. “Over the past 10 to 15 years, that has dramatically improved. But it takes a lot of coordination.”\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_438620\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-438620\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/iStock-475593228-1020x1020.jpg\" alt=\"Top view of a brain showing a red blotch amid blue brain tissue\" width=\"640\" height=\"640\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-1020x1020.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-800x800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-960x960.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-240x240.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-375x375.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-520x520.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-150x150.jpg 150w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">CT scan of a brain showing a stroke \u003ccite>(iStockphoto)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">One \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/1861802?resultClick=3\" target=\"_blank\" rel=\"noopener\">study\u003c/a> found that hospitals participating in the AHA initiative from 2009-2013 improved their average door-to-needle time from 74 down to 59 minutes. Patients’ in-hospital deaths dropped close to 2 percent, and more patients were able to recover at home instead of a rehab facility, according to the AHA.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tong says no regulation requires hospitals to follow the AHA’s recommendations for door-to-needle times, so there’s no way to know how many hospitals have made these changes. But the nationwide statistics aren’t encouraging; in 2017, \u003c/span>\u003ca href=\"http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/About-Target-Stroke_UCM_432409_Article.jsp#.Wi7i_BOPIWo\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">according to the American Stroke Association\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, fewer than 30 percent of stroke patients received tPA within an hour of arrival. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And even an hour is still too long, say stroke experts.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Some hospitals say a 60-minute door-to-needle time is good,” says Hemphill. “Now, when we treat someone in 60 or 45 minutes, we ask, ‘What went wrong?’ We regularly treat patients within 20 minutes.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Closing the Gender and Race Gaps\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[contextly_sidebar id=\"B3Ey7pC4m5a9R8T6qLl2KnJcgiMSblm7\"]Madhok reached out to San Francisco General to develop her protocol because the hospital provides emergency medicine to underserved populations, as well as doing neurocritical care research. The hospital wasn’t hiring, but once doctors heard what she wanted to do, they found space. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">As a \u003c/span>\u003ca href=\"https://www.aan.com/PressRoom/Home/PressRelease/1493\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">handful of studies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> show, people of color and women tend to receive inferior care when they’re having a stroke, and they are less likely to receive tPA or have their clots removed. \u003c/span>\u003cspan style=\"font-weight: 400\">Loyola’s Dr. Biller says that lack of awareness about stroke symptoms, or the fact that high blood pressure is a precursor to stroke, may explain some of the disparities in treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Not surprisingly, these patients also have worse short- and long-term outcomes after stroke,” Madhok says. “Organized stroke care has the potential to reduce these disparities. Mission Protocol was my way to put this to the test.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Among the roughly 80 patients who have been subject to the protocol since July, three-quarters are Latino, Asian or black. Madhok is still gathering data for publication on long-term outcomes. \u003c/span>\u003cspan style=\"font-weight: 400\">Already, though, she has some idea what the results will look like. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If a 20-minute delay in care can cost a patient 1.2 years of functioning brain health, then you can imagine what getting a patient to tPA in less than 20 minutes, as opposed to 45 to 60 minutes, and getting a clot open in less than 90 minutes, as opposed to two hours, means for a patient.”\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">The last thing Donna Taylor remembers about the night of July 21, 2017, is her intense headache and flickering vision. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">When her husband, Joseph, found her lying on the floor of their San Francisco home, she couldn’t get up, so he called 911. \u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'There’s an old adage that time is brain.'\u003ccite>Debbie Madhok, physician\u003c/cite>\u003c/aside>\n\u003cp>“I realized this was not something we can handle here at home,” Joseph says. “This was awfully scary.”\u003c/p>\n\u003cp>The ambulance took Taylor, 55, to Zuckerberg San Francisco General Hospital and Trauma Center, where she was rushed to get a CT scan. The doctors found a large clot blocking one of the major arteries to her brain -- a stroke. Within 28 minutes of her arrival, Donna was given medication to break up the clot. Within 108 minutes, surgeons were removing it. By the next day, she was mobile again.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch3>Signs You're Having a Stroke:\u003c/h3>\n\u003cul>\n\u003cli>Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body\u003c/li>\n\u003cli>Sudden confusion or trouble speaking\u003c/li>\n\u003cli>Sudden trouble seeing\u003c/li>\n\u003cli>Sudden trouble walking or dizziness\u003c/li>\n\u003cli>Sudden severe headache with no cause\u003c/li>\n\u003c/ul>\n\u003ch4>What to do if you — or someone near you — is experiencing even one of these symptoms:\u003c/h4>\n\u003cul>\n\u003cli>Call 911 immediately; never wait more than 5 minutes.\u003c/li>\n\u003cli>Take note of the time symptoms started.\u003c/li>\n\u003cli>Stay put until help arrives.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>This protocol was new. It was developed by emergency and neurocritical care physician Debbie Madhok.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"There’s an old adage that ‘time is brain,’” says Madhok. “It’s been shown that if you occlude a big blood vessel in the brain, about 2 million brain cells die per minute. Depending on where these cells die, the impact can be quite devastating.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">People who suffer massive strokes can permanently lose the ability to speak or move parts of their bodies. For every hour that treatment is delayed, a stroke patient loses 3.6 years of functional life, says J. Claude Hemphill III, one of San Francisco General's neurosurgeons. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The American Heart Association recommends stroke patients receive the clot-busting medicine known as \u003ca href=\"http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/@gwtg/documents/downloadable/ucm_430859.pdf\" target=\"_blank\" rel=\"noopener\">tPA\u003c/a> within \u003ca href=\"http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/About-Target-Stroke_UCM_432409_Article.jsp#.Wi7hQxOPIWo\" target=\"_blank\" rel=\"noopener\">45-60 minutes\u003c/a> of arriving at a hospital. But under Madhok’s plan, treatment comes faster.\u003c/span>\u003c/p>\n\u003cp>It starts with the paramedics calling ahead when transporting a potential stroke patient. They are met at the emergency room doors by a stroke specialist who moves the patient just a few yards, to be weighed and given a CT scan. If the scan reveals that a large clot is cutting off blood supply to the brain, the patient immediately receives a weight-appropriate dose of tPA while still in the scanner. Soon after, a surgical team removes the clot.\u003c/p>\n\u003cfigure id=\"attachment_438615\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"wp-image-438615 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/brainscan-1020x299.jpg\" alt=\"Brain scans show where a stroke patient's blood flow is blocked (left), the clot being removed (middle) and blood flow restored (right).\" width=\"640\" height=\"188\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-1020x299.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-160x47.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-800x235.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-768x225.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-960x281.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-240x70.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-375x110.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan-520x152.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/brainscan.jpg 1129w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">X-ray scans of the brain (\u003cspan class=\"s1\">a cerebral angiogram)\u003c/span> show where a stroke patient's blood flow is blocked (left), the clot being removed (middle) and blood flow restored (right). \u003ccite>(San Francisco General Hospital)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">Madhok calls it the Mission Protocol, both because it’s her mission to streamline emergency stroke treatment and because the hospital sits on the border of San Francisco’s Mission district, providing care for many of its residents.\u003c/span>\u003c/p>\n\u003cp>Under the protocol, the median time for patients to get a CT scan is 10 minutes , which is 13 minutes faster than before. The median from \"door-to-needle,” the time it takes to administer tPA, is 20 minutes, less than half the 45 minutes it used to take.\u003c/p>\n\u003cp>Several studies have shown that \u003ca href=\"http://share.upmc.com/2015/08/mechanical-thrombectomy-stroke-mm02/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">mechanical thrombectomy\u003c/span>\u003c/a>, \u003cspan style=\"font-weight: 400\">in which doctors snake tiny tools into a patient’s artery to remove clots, is a key step in emergency stroke care. While the Committee of the Society of Vascular and Interventional Neurology \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817382/\" target=\"_blank\" rel=\"noopener\">recommends clot removal in less than 90 minutes, \u003c/a>under the Mission Protocol, the hospital’s median time to remove clots is 76 minutes.\u003c/span>\u003c/p>\n\u003cp>In response to those studies, more hospitals are adding mechanical thrombectomy to their emergency stroke care, says Dr. Jose Biller, neurology chair at the Loyola University Chicago Stritch School of Medicine.\u003c/p>\n\u003cp>“Everyone I know of is very cognizant of the fact that early stroke treatment is essential,” Biller says. “You see variations on this theme in many institutions.”\u003c/p>\n\u003cp>\u003cb>Shaving Time to Treatment\u003c/b>\u003c/p>\n\u003caside class=\"pullquote alignright\">'It’s become a competitive thing, seeing who can go for the quickest stroke treatment time possible.'\u003ccite>David Tong, California Pacific Medical Center neurologist\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">Two initiatives in the past decade began to affect how hospitals treat stroke patients. In 2010, the American Heart Association launched \u003c/span>\u003ca href=\"http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/About-Target-Stroke_UCM_432409_Article.jsp#.Wi7fIROPIWo\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">Target: Stroke\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, an initiative aimed at encouraging hospitals to reduce their door-to-needle time to less than 60 minutes. Two years later, research out of Helsinki showed how to shave off minutes from that time, and many hospitals began adopting the method.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“It’s become a competitive thing, seeing who can go for the quickest time possible,” says David Tong, a neurologist with California Pacific Medical Center and a member of the American Neurological Association's Advisory Committee. “Over the past 10 to 15 years, that has dramatically improved. But it takes a lot of coordination.”\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_438620\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-438620\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/iStock-475593228-1020x1020.jpg\" alt=\"Top view of a brain showing a red blotch amid blue brain tissue\" width=\"640\" height=\"640\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-1020x1020.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-160x160.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-800x800.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-960x960.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-240x240.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-375x375.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-520x520.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228-150x150.jpg 150w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/iStock-475593228.jpg 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">CT scan of a brain showing a stroke \u003ccite>(iStockphoto)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">One \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/1861802?resultClick=3\" target=\"_blank\" rel=\"noopener\">study\u003c/a> found that hospitals participating in the AHA initiative from 2009-2013 improved their average door-to-needle time from 74 down to 59 minutes. Patients’ in-hospital deaths dropped close to 2 percent, and more patients were able to recover at home instead of a rehab facility, according to the AHA.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Tong says no regulation requires hospitals to follow the AHA’s recommendations for door-to-needle times, so there’s no way to know how many hospitals have made these changes. But the nationwide statistics aren’t encouraging; in 2017, \u003c/span>\u003ca href=\"http://www.strokeassociation.org/STROKEORG/Professionals/TargetStroke/About-Target-Stroke_UCM_432409_Article.jsp#.Wi7i_BOPIWo\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">according to the American Stroke Association\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, fewer than 30 percent of stroke patients received tPA within an hour of arrival. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And even an hour is still too long, say stroke experts.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Some hospitals say a 60-minute door-to-needle time is good,” says Hemphill. “Now, when we treat someone in 60 or 45 minutes, we ask, ‘What went wrong?’ We regularly treat patients within 20 minutes.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Closing the Gender and Race Gaps\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003cp>\u003c/p>\u003cp>Madhok reached out to San Francisco General to develop her protocol because the hospital provides emergency medicine to underserved populations, as well as doing neurocritical care research. The hospital wasn’t hiring, but once doctors heard what she wanted to do, they found space. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">As a \u003c/span>\u003ca href=\"https://www.aan.com/PressRoom/Home/PressRelease/1493\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">handful of studies\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> show, people of color and women tend to receive inferior care when they’re having a stroke, and they are less likely to receive tPA or have their clots removed. \u003c/span>\u003cspan style=\"font-weight: 400\">Loyola’s Dr. Biller says that lack of awareness about stroke symptoms, or the fact that high blood pressure is a precursor to stroke, may explain some of the disparities in treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Not surprisingly, these patients also have worse short- and long-term outcomes after stroke,” Madhok says. “Organized stroke care has the potential to reduce these disparities. Mission Protocol was my way to put this to the test.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Among the roughly 80 patients who have been subject to the protocol since July, three-quarters are Latino, Asian or black. Madhok is still gathering data for publication on long-term outcomes. \u003c/span>\u003cspan style=\"font-weight: 400\">Already, though, she has some idea what the results will look like. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“If a 20-minute delay in care can cost a patient 1.2 years of functioning brain health, then you can imagine what getting a patient to tPA in less than 20 minutes, as opposed to 45 to 60 minutes, and getting a clot open in less than 90 minutes, as opposed to two hours, means for a patient.”\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What the Fitbit Saw During That 4.4 Quake",
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"content": "\u003cp>Some of the most useful new research on earthquakes might be coming from -- well, you, via your smartphone and wearable activity tracker.\u003c/p>\n\u003caside class=\"pullquote alignright\">Berkeley users, near the epicenter, got the biggest wake-up call, according to Fitbit.\u003c/aside>\n\u003cp>As a magnitude 4.4 quake \u003ca href=\"https://ww2.kqed.org/news/2018/01/04/rude-awakening-moderate-quake-rattles-east-bay-overnight/\" target=\"_blank\" rel=\"noopener\">jolted people out of their beds\u003c/a> around the Bay Area last week, some of those folks had smartphones that were already at work sending data to scientists via the \u003ca href=\"http://myshake.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">MyShake app\u003c/a> developed at the \u003ca href=\"http://seismo.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">UC Berkeley Seismological Lab\u003c/a>.\u003c/p>\n\u003cp>According to Richard Allen, who heads the lab, instantaneous data came in from 59 phones armed with the app, which uses built-in motion sensors to detect the strength of the shaking and transmit the data to scientists. They can use that data to produce useful maps of the temblor's reach and impact. The app responds so quickly to a quake's first vibrations, that at some point in the next few years, plans are to make it part of a phone-based warning system that can alert users to quakes seconds before the shaking starts where they are.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>[youtube https://www.youtube.com/watch?v=i-UH6oEx5JI&w=560&h=315]Allen was impressed that readings came in from phones farther than 60 miles from the epicenter.\u003c/p>\n\u003cp>\"The data is really clean for this event,\" wrote Allen in an email, \"which encourages us that we can use this for research purposes, and eventually earthquake early warning.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The MyShake app is currently available only for Android phones. But potentially useful data is beginning to come in from other sources that weren't developed with earthquakes in mind.\u003c/p>\n\u003cp>\u003cstrong>Of Fitbits and Fitfulness\u003c/strong>\u003c/p>\n\u003cp>Developers of the \u003ca href=\"https://www.fitbit.com/home\" target=\"_blank\" rel=\"noopener\">Fitbit\u003c/a> series of wearable activity trackers say that when the quake struck, they also got a burst of data. Since the devices also track sleep patterns, they inferred from that data that about 4-in-10 of their Bay Area users were awakened by the quake, which struck at 2:39 a.m. Thursday near the historic Claremont Hotel in Berkeley.\u003c/p>\n\u003cp>The company declined to say how many Bay Area users it has, but a Fitbit spokeswoman told KQED that the numbers are based on \"a representative sample of tens of thousands of aggregated and anonymous Fitbit user data.\"\u003c/p>\n\u003cfigure id=\"attachment_438281\" class=\"wp-caption aligncenter\" style=\"max-width: 858px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/FitbitWakes_180104.png\">\u003cimg class=\"wp-image-438281 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/FitbitWakes_180104.png\" alt=\"Fitbit quake graph\" width=\"858\" height=\"439\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104.png 858w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-160x82.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-800x409.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-768x393.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-240x123.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-375x192.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-520x266.png 520w\" sizes=\"(max-width: 858px) 100vw, 858px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Spike in graph shows people waking up as the Jan. 4 M4.4 quake shook the Bay Area, as registered by Fitbit devices. Click to enlarge. \u003ccite>(Fitbit)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Analysts at the San Francisco-based company could virtually map the epicenter of the quake by looking at the proportion of Fitbit users awakened in various locations. As one would expect, Berkeley users had the biggest wake-up call, with the percentage of wakeful customers leaping from 8 percent to 52 percent as soon as the Hayward Fault started slipping. (The fact that even 8 percent were already awake might imply that Fitbit has a loyal following among insomniacs.) The farther from the epicenter, the fewer Fitbit users were jarred awake -- just 18 percent in San Jose, for example.\u003c/p>\n\u003cp>It's still unclear what value this kind of data might have for seismic research.\u003c/p>\n\u003cp>\"Smartphone data has been quite useful for us at the [lab] so far, and other techniques such as using fiber optic cables are showing promise as well for seismology,\" notes Jennifer Strauss, who is in charge of outreach at the Berkeley lab. \"So, it would be very interesting to explore how other crowdsourced data can be used for earthquake science.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fitbit analysts also noted that even relatively benign earthquakes can be night-wreckers, as it took an hour for most awakened users to return to \"normal sleep,\" and 90 minutes before those rocked out of bed achieved the REM stage of sleep.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some of the most useful new research on earthquakes might be coming from -- well, you, via your smartphone and wearable activity tracker.\u003c/p>\n\u003caside class=\"pullquote alignright\">Berkeley users, near the epicenter, got the biggest wake-up call, according to Fitbit.\u003c/aside>\n\u003cp>As a magnitude 4.4 quake \u003ca href=\"https://ww2.kqed.org/news/2018/01/04/rude-awakening-moderate-quake-rattles-east-bay-overnight/\" target=\"_blank\" rel=\"noopener\">jolted people out of their beds\u003c/a> around the Bay Area last week, some of those folks had smartphones that were already at work sending data to scientists via the \u003ca href=\"http://myshake.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">MyShake app\u003c/a> developed at the \u003ca href=\"http://seismo.berkeley.edu/\" target=\"_blank\" rel=\"noopener\">UC Berkeley Seismological Lab\u003c/a>.\u003c/p>\n\u003cp>According to Richard Allen, who heads the lab, instantaneous data came in from 59 phones armed with the app, which uses built-in motion sensors to detect the strength of the shaking and transmit the data to scientists. They can use that data to produce useful maps of the temblor's reach and impact. The app responds so quickly to a quake's first vibrations, that at some point in the next few years, plans are to make it part of a phone-based warning system that can alert users to quakes seconds before the shaking starts where they are.\u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/i-UH6oEx5JI'\n title='//www.youtube.com/embed/i-UH6oEx5JI'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>Allen was impressed that readings came in from phones farther than 60 miles from the epicenter.\u003c/p>\n\u003cp>\"The data is really clean for this event,\" wrote Allen in an email, \"which encourages us that we can use this for research purposes, and eventually earthquake early warning.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The MyShake app is currently available only for Android phones. But potentially useful data is beginning to come in from other sources that weren't developed with earthquakes in mind.\u003c/p>\n\u003cp>\u003cstrong>Of Fitbits and Fitfulness\u003c/strong>\u003c/p>\n\u003cp>Developers of the \u003ca href=\"https://www.fitbit.com/home\" target=\"_blank\" rel=\"noopener\">Fitbit\u003c/a> series of wearable activity trackers say that when the quake struck, they also got a burst of data. Since the devices also track sleep patterns, they inferred from that data that about 4-in-10 of their Bay Area users were awakened by the quake, which struck at 2:39 a.m. Thursday near the historic Claremont Hotel in Berkeley.\u003c/p>\n\u003cp>The company declined to say how many Bay Area users it has, but a Fitbit spokeswoman told KQED that the numbers are based on \"a representative sample of tens of thousands of aggregated and anonymous Fitbit user data.\"\u003c/p>\n\u003cfigure id=\"attachment_438281\" class=\"wp-caption aligncenter\" style=\"max-width: 858px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/FitbitWakes_180104.png\">\u003cimg class=\"wp-image-438281 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/01/FitbitWakes_180104.png\" alt=\"Fitbit quake graph\" width=\"858\" height=\"439\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104.png 858w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-160x82.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-800x409.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-768x393.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-240x123.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-375x192.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/01/FitbitWakes_180104-520x266.png 520w\" sizes=\"(max-width: 858px) 100vw, 858px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Spike in graph shows people waking up as the Jan. 4 M4.4 quake shook the Bay Area, as registered by Fitbit devices. Click to enlarge. \u003ccite>(Fitbit)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Analysts at the San Francisco-based company could virtually map the epicenter of the quake by looking at the proportion of Fitbit users awakened in various locations. As one would expect, Berkeley users had the biggest wake-up call, with the percentage of wakeful customers leaping from 8 percent to 52 percent as soon as the Hayward Fault started slipping. (The fact that even 8 percent were already awake might imply that Fitbit has a loyal following among insomniacs.) The farther from the epicenter, the fewer Fitbit users were jarred awake -- just 18 percent in San Jose, for example.\u003c/p>\n\u003cp>It's still unclear what value this kind of data might have for seismic research.\u003c/p>\n\u003cp>\"Smartphone data has been quite useful for us at the [lab] so far, and other techniques such as using fiber optic cables are showing promise as well for seismology,\" notes Jennifer Strauss, who is in charge of outreach at the Berkeley lab. \"So, it would be very interesting to explore how other crowdsourced data can be used for earthquake science.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Fitbit analysts also noted that even relatively benign earthquakes can be night-wreckers, as it took an hour for most awakened users to return to \"normal sleep,\" and 90 minutes before those rocked out of bed achieved the REM stage of sleep.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Daughter Helps Create Her Mother's Death Experience (Video)",
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"content": "\u003cp>https://www.youtube.com/watch?v=W86mLuvWU30&list=PLScdkSzWmRHz8HIA-v1MiTwla5jhqqpMn\u003c/p>\n\u003cp>As a professional designer, Elaine Fong has worked with many brands. But, she asked at this \u003ca href=\"https://www.tedxsanfrancisco.com/\" target=\"_blank\" rel=\"noopener\">TEDx San Francisco\u003c/a> talk in October, \"What happens when the experience you've been asked to design is death, and the face behind that brand is your very own mother?\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'She was so happy. She was glowing the whole night.'\u003c/aside>\n\u003cp>The question presented itself to Fong and her family after her mother was diagnosed with stage 4 cancer and decided to forego her remaining months of life, as was her right under Washington state's \u003ca href=\"https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct\" target=\"_blank\" rel=\"noopener\">Death With Dignity Act. \u003c/a>The law allows patients with less than six months to live to end their lives by taking a lethal dose of medication.\u003c/p>\n\u003cp>The 21-minute presentation above encompasses all the aching drama and emotional devastation you might find in such a situation, including a doctor who won't sign off on her mother's request and her mom's description of what it's like to suffer from stage 4 cancer: \"My bones are on fire and everywhere under my skin is burning, and every time I move it just makes it worse.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'If you could design your own death, what would you want the experience to be like, and how would you want it to feel?'\u003ccite>Elaine Fong, TEDx presenter\u003c/cite>\u003c/aside>\n\u003cp>Yet, there are beautiful and even celebratory moments, too\u003cb>. \u003c/b>Because her mother was able to choose the time and place of her death, the family was able to help her experience her last days exactly as she wished.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"She was so happy,\" Fong says of her mom's mood during a dinner party the night before her death. \"She was glowing the whole night.\"\u003c/p>\n\u003cp>The next day, her mom took a cupful of medication, \"with two hands, and pounded it like a shot of whiskey. She looked at my dad and smiled, closed her eyes, and in 45 minutes, she was gone.\"\u003c/p>\n\u003cp>This is one of a very few TED talks we have published this year. I saw it live, surrounded by weeping audience members, and it was not hard to imagine many thinking seriously about Fong's\u003cb> \u003c/b>challenge:\u003c/p>\n\u003cp>\"If you could design your own death, what would you want the experience to be like, and how would you want it to feel?\"\u003c/p>\n\u003cp>According to \u003ca href=\"https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/DeathwithDignityData\" target=\"_blank\" rel=\"noopener\">annual reports\u003c/a> compiled by Washington's department of health, the number of state residents who have opted to take lethal medication under the Death With Dignity Act has risen from 36 in 2009 to 192 in 2016.\u003c/p>\n\u003cp>A handful of \u003ca href=\"https://www.deathwithdignity.org/learn/death-with-dignity-acts/\" target=\"_blank\" rel=\"noopener\">states\u003c/a>, including\u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/07/physician-assisted-suicide-has-been-legal-in-california-for-a-year-hows-it-going/\" target=\"_blank\" rel=\"noopener\"> California\u003c/a>, have passed similar legislation, and many legislatures \u003ca href=\"https://www.deathwithdignity.org/take-action/\" target=\"_blank\" rel=\"noopener\">around the country\u003c/a> are currently considering their own versions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>How would \u003cem>you\u003c/em> design your own death?\u003c/p>\n\n",
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"excerpt": "Her mother's cancer diagnosis forced brand designer Elaine Fong to answer the question, 'What happens when the experience you've been asked to design is death, and the face behind that brand is your very own mother?'",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/W86mLuvWU30'\n title='//www.youtube.com/embed/W86mLuvWU30'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>As a professional designer, Elaine Fong has worked with many brands. But, she asked at this \u003ca href=\"https://www.tedxsanfrancisco.com/\" target=\"_blank\" rel=\"noopener\">TEDx San Francisco\u003c/a> talk in October, \"What happens when the experience you've been asked to design is death, and the face behind that brand is your very own mother?\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'She was so happy. She was glowing the whole night.'\u003c/aside>\n\u003cp>The question presented itself to Fong and her family after her mother was diagnosed with stage 4 cancer and decided to forego her remaining months of life, as was her right under Washington state's \u003ca href=\"https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct\" target=\"_blank\" rel=\"noopener\">Death With Dignity Act. \u003c/a>The law allows patients with less than six months to live to end their lives by taking a lethal dose of medication.\u003c/p>\n\u003cp>The 21-minute presentation above encompasses all the aching drama and emotional devastation you might find in such a situation, including a doctor who won't sign off on her mother's request and her mom's description of what it's like to suffer from stage 4 cancer: \"My bones are on fire and everywhere under my skin is burning, and every time I move it just makes it worse.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">'If you could design your own death, what would you want the experience to be like, and how would you want it to feel?'\u003ccite>Elaine Fong, TEDx presenter\u003c/cite>\u003c/aside>\n\u003cp>Yet, there are beautiful and even celebratory moments, too\u003cb>. \u003c/b>Because her mother was able to choose the time and place of her death, the family was able to help her experience her last days exactly as she wished.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"She was so happy,\" Fong says of her mom's mood during a dinner party the night before her death. \"She was glowing the whole night.\"\u003c/p>\n\u003cp>The next day, her mom took a cupful of medication, \"with two hands, and pounded it like a shot of whiskey. She looked at my dad and smiled, closed her eyes, and in 45 minutes, she was gone.\"\u003c/p>\n\u003cp>This is one of a very few TED talks we have published this year. I saw it live, surrounded by weeping audience members, and it was not hard to imagine many thinking seriously about Fong's\u003cb> \u003c/b>challenge:\u003c/p>\n\u003cp>\"If you could design your own death, what would you want the experience to be like, and how would you want it to feel?\"\u003c/p>\n\u003cp>According to \u003ca href=\"https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct/DeathwithDignityData\" target=\"_blank\" rel=\"noopener\">annual reports\u003c/a> compiled by Washington's department of health, the number of state residents who have opted to take lethal medication under the Death With Dignity Act has risen from 36 in 2009 to 192 in 2016.\u003c/p>\n\u003cp>A handful of \u003ca href=\"https://www.deathwithdignity.org/learn/death-with-dignity-acts/\" target=\"_blank\" rel=\"noopener\">states\u003c/a>, including\u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/07/physician-assisted-suicide-has-been-legal-in-california-for-a-year-hows-it-going/\" target=\"_blank\" rel=\"noopener\"> California\u003c/a>, have passed similar legislation, and many legislatures \u003ca href=\"https://www.deathwithdignity.org/take-action/\" target=\"_blank\" rel=\"noopener\">around the country\u003c/a> are currently considering their own versions.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>How would \u003cem>you\u003c/em> design your own death?\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What Are Digital Health's Biggest Successes and Disappointments? CNBC's Chrissy Farr Weighs In",
"title": "What Are Digital Health's Biggest Successes and Disappointments? CNBC's Chrissy Farr Weighs In",
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"content": "\u003cp>Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health \u003ca href=\"https://www.cnbc.com/christina-farr/\" target=\"_blank\" rel=\"noopener\">reporter\u003c/a> for CNBC, where she continues to break \u003ca href=\"https://www.cnbc.com/2017/07/26/amazon-1492-secret-health-tech-project.html\" target=\"_blank\" rel=\"noopener\">stories\u003c/a>. She’s been covering digital health for years, and she's one of the more influential media voices on this beat -- in 2016, venture fund Rock Health named her \u003ca href=\"https://rockhealth.com/where-are-the-2016-top-50-in-digital-health-now/\" target=\"_blank\" rel=\"noopener\">digital health reporter of the year\u003c/a>.\u003c/p>\n\u003cp>As Chrissy's successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it's been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>First off, how should we define digital health?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">On wearables: 'I'm really still quite bullish. It’s not just millennials and the \"worried well\" that are using these devices; a lot of seniors love them.'\u003c/aside>\n\u003cp>People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like \"the intersection of health and technology.\"\u003c/p>\n\u003cp>I think the term will forever be associated with \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/wearables/\" target=\"_blank\" rel=\"noopener\">wearables\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/telemedicine/\" target=\"_blank\" rel=\"noopener\">telemedicine\u003c/a>, and now AI and a couple of other trends. I don't really see a problem with that, because it's still connected with innovation in a lot of people's minds.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What have been some of the successes in the digital health space?\u003c/strong>\u003c/p>\n\u003cp>I see a lot of potential in digital therapeutics. Companies like Propeller Health and \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/06/23/expanding-digital-health-beyond-the-rich/\" target=\"_blank\" rel=\"noopener\">Omada Health\u003c/a> are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/06/13/inhalers-plus-smartphones-meant-fewer-trips-to-er-hospital/\" target=\"_blank\" rel=\"noopener\">connected inhalers\u003c/a> and how to combine them with data like the weather to figure out when a person with asthma should take medicine.\u003c/p>\n\u003caside class=\"pullquote alignright\">Disappointments? Telehealth and artificial intelligence.\u003c/aside>\n\u003cp>Virta Health is going after Type 2 diabetes reversal with a\u003ca href=\"https://www.medscape.com/viewarticle/890090\" target=\"_blank\" rel=\"noopener\"> digital system\u003c/a> that encourages a massive behavior change around diet, which it thinks could actually replace medicines.\u003c/p>\n\u003cp>AliveCor is a super-interesting company. They have a \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKG\u003c/a> that a lot of doctors really like. I think it's something that a lot of seniors will use when they find out they're at risk for \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a>, because it means they can check on their heart from home and not have to go to the doctor every few months.\u003c/p>\n\u003cp>\u003cstrong>You mentioned wearables, like Fitbit and Apple Watch. How's that business going? \u003c/strong>\u003c/p>\n\u003cp>I‘m really still quite bullish on wearables, and I think they have become mainstream. It's not just millennials and the \"\u003ca href=\"http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10977877/Are-you-one-of-the-rising-numbers-of-the-worried-well.html\" target=\"_blank\" rel=\"noopener\">worried well\u003c/a>\" that are using these devices; a lot of seniors love them. You're also starting to see insurance companies think about partnering with companies like Apple, and the reason they're doing that isn't necessarily to get their already healthy populations to exercise more; it's about getting to those really sick and costly people that have multiple chronic conditions.\u003c/p>\n\u003cp>\u003cstrong>Do you think investors in the digital health space are more circumspect after the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/13/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\" rel=\"noopener\">Theranos debacle\u003c/a>?\u003c/strong>\u003c/p>\n\u003cp>Some are. Others don't necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a lot of ways, Theranos is just the worst example.'\u003c/aside>\n\u003cp>It's hard to find another company like Theranos, which put patients \u003ca href=\"http://tucson.com/news/local/theranos-to-pay-m-to-arizonans-over-blood-tests-that/article_dacc3bd1-54e0-58dd-92b3-18dec8eb8854.html\" target=\"_blank\" rel=\"noopener\">in danger\u003c/a>. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, \"We're wellness. We're not making claims around disease, so we don't need to bother.\"\u003c/p>\n\u003cp>\u003cstrong>What's the biggest disappointment of the digital health era to date?\u003c/strong>\u003c/p>\n\u003cp>This is going to be controversial, but I don't think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I'm not seeing every physician say this is something they want to incorporate into their medical practice, because there's a perception they're not going to get paid as much.\u003c/p>\n\u003cp>Also pretty overhyped in terms of what we're actually seeing out there: AI and big data. \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/08/20/this-robo-eye-doctor-may-help-patients-with-diabetes-keep-sight/\" target=\"_blank\" rel=\"noopener\">Diabetic retinopathy\u003c/a>, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?\u003c/p>\n\u003cp>There's been some great results, but that does not mean we're on the cusp of a robo eye doctor, because an actual eye doctor would\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/will-computers-ever-be-able-to-make-diagnoses-as-well-as-physicians/\" target=\"_blank\" rel=\"noopener\"> need to know\u003c/a> every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.\u003c/p>\n\u003cp>\u003cb>Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry \u003cem>want\u003c/em> them to keep up?\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_437841\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum.jpg\">\u003cimg class=\"wp-image-437841 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum-1020x591.jpg\" alt=\"\" width=\"640\" height=\"371\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1020x591.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-160x93.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-800x463.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-768x445.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1180x683.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-960x556.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-240x139.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-375x217.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-520x301.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum.jpg 1613w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chrissy Farr discussing Fitbit vs. Apple Watch with her mom, for a CNBC segment. (CNBC)\u003c/figcaption>\u003c/figure>\n\u003cp>I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it's obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.\u003c/p>\n\u003cp>So there needs to be a watchdog, but that's not the FDA's role. They're not out there policing companies and investing time into looking through the app store and thinking, \"This dermatology app doesn't look quite right.\"\u003c/p>\n\u003cp>As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don't.\u003c/p>\n\u003cp>\u003cstrong>Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that's valid?\u003c/strong>\u003c/p>\n\u003cp>The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it's paid for. We need massive payment reforms. There's also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. \u003cspan style=\"font-weight: 400\">All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.\u003c/span>\u003c/p>\n\u003cp>That said, I don't think it's fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just \u003ca href=\"https://www.youtube.com/watch?v=hBA0AH-LSbo\" target=\"_blank\" rel=\"noopener\">dying to live forever\u003c/a>.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that's more than 12 million people in California alone. Even Apple, which hasn't traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" rel=\"noopener\">afib\u003c/a>. That's not something a young or healthy person would necessarily worry about at all. It's something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we've found that it can help save lives.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health \u003ca href=\"https://www.cnbc.com/christina-farr/\" target=\"_blank\" rel=\"noopener\">reporter\u003c/a> for CNBC, where she continues to break \u003ca href=\"https://www.cnbc.com/2017/07/26/amazon-1492-secret-health-tech-project.html\" target=\"_blank\" rel=\"noopener\">stories\u003c/a>. She’s been covering digital health for years, and she's one of the more influential media voices on this beat -- in 2016, venture fund Rock Health named her \u003ca href=\"https://rockhealth.com/where-are-the-2016-top-50-in-digital-health-now/\" target=\"_blank\" rel=\"noopener\">digital health reporter of the year\u003c/a>.\u003c/p>\n\u003cp>As Chrissy's successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it's been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>First off, how should we define digital health?\u003c/strong>\u003c/p>\n\u003caside class=\"pullquote alignright\">On wearables: 'I'm really still quite bullish. It’s not just millennials and the \"worried well\" that are using these devices; a lot of seniors love them.'\u003c/aside>\n\u003cp>People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like \"the intersection of health and technology.\"\u003c/p>\n\u003cp>I think the term will forever be associated with \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/wearables/\" target=\"_blank\" rel=\"noopener\">wearables\u003c/a> and \u003ca href=\"https://ww2.kqed.org/futureofyou/tag/telemedicine/\" target=\"_blank\" rel=\"noopener\">telemedicine\u003c/a>, and now AI and a couple of other trends. I don't really see a problem with that, because it's still connected with innovation in a lot of people's minds.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What have been some of the successes in the digital health space?\u003c/strong>\u003c/p>\n\u003cp>I see a lot of potential in digital therapeutics. Companies like Propeller Health and \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/06/23/expanding-digital-health-beyond-the-rich/\" target=\"_blank\" rel=\"noopener\">Omada Health\u003c/a> are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about \u003ca href=\"https://ww2.kqed.org/futureofyou/2017/06/13/inhalers-plus-smartphones-meant-fewer-trips-to-er-hospital/\" target=\"_blank\" rel=\"noopener\">connected inhalers\u003c/a> and how to combine them with data like the weather to figure out when a person with asthma should take medicine.\u003c/p>\n\u003caside class=\"pullquote alignright\">Disappointments? Telehealth and artificial intelligence.\u003c/aside>\n\u003cp>Virta Health is going after Type 2 diabetes reversal with a\u003ca href=\"https://www.medscape.com/viewarticle/890090\" target=\"_blank\" rel=\"noopener\"> digital system\u003c/a> that encourages a massive behavior change around diet, which it thinks could actually replace medicines.\u003c/p>\n\u003cp>AliveCor is a super-interesting company. They have a \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/03/17/mobile-ekg-on-a-watchband-is-useful-for-some-say-docs/\" target=\"_blank\" rel=\"noopener\">mobile EKG\u003c/a> that a lot of doctors really like. I think it's something that a lot of seniors will use when they find out they're at risk for \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a>, because it means they can check on their heart from home and not have to go to the doctor every few months.\u003c/p>\n\u003cp>\u003cstrong>You mentioned wearables, like Fitbit and Apple Watch. How's that business going? \u003c/strong>\u003c/p>\n\u003cp>I‘m really still quite bullish on wearables, and I think they have become mainstream. It's not just millennials and the \"\u003ca href=\"http://www.telegraph.co.uk/lifestyle/wellbeing/diet/10977877/Are-you-one-of-the-rising-numbers-of-the-worried-well.html\" target=\"_blank\" rel=\"noopener\">worried well\u003c/a>\" that are using these devices; a lot of seniors love them. You're also starting to see insurance companies think about partnering with companies like Apple, and the reason they're doing that isn't necessarily to get their already healthy populations to exercise more; it's about getting to those really sick and costly people that have multiple chronic conditions.\u003c/p>\n\u003cp>\u003cstrong>Do you think investors in the digital health space are more circumspect after the \u003ca href=\"https://ww2.kqed.org/futureofyou/2016/10/13/the-rise-and-fall-of-theranos-a-cartoon-history/\" target=\"_blank\" rel=\"noopener\">Theranos debacle\u003c/a>?\u003c/strong>\u003c/p>\n\u003cp>Some are. Others don't necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a lot of ways, Theranos is just the worst example.'\u003c/aside>\n\u003cp>It's hard to find another company like Theranos, which put patients \u003ca href=\"http://tucson.com/news/local/theranos-to-pay-m-to-arizonans-over-blood-tests-that/article_dacc3bd1-54e0-58dd-92b3-18dec8eb8854.html\" target=\"_blank\" rel=\"noopener\">in danger\u003c/a>. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, \"We're wellness. We're not making claims around disease, so we don't need to bother.\"\u003c/p>\n\u003cp>\u003cstrong>What's the biggest disappointment of the digital health era to date?\u003c/strong>\u003c/p>\n\u003cp>This is going to be controversial, but I don't think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I'm not seeing every physician say this is something they want to incorporate into their medical practice, because there's a perception they're not going to get paid as much.\u003c/p>\n\u003cp>Also pretty overhyped in terms of what we're actually seeing out there: AI and big data. \u003ca href=\"https://ww2.kqed.org/futureofyou/2015/08/20/this-robo-eye-doctor-may-help-patients-with-diabetes-keep-sight/\" target=\"_blank\" rel=\"noopener\">Diabetic retinopathy\u003c/a>, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?\u003c/p>\n\u003cp>There's been some great results, but that does not mean we're on the cusp of a robo eye doctor, because an actual eye doctor would\u003ca href=\"https://ww2.kqed.org/futureofyou/2016/11/07/will-computers-ever-be-able-to-make-diagnoses-as-well-as-physicians/\" target=\"_blank\" rel=\"noopener\"> need to know\u003c/a> every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.\u003c/p>\n\u003cp>\u003cb>Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry \u003cem>want\u003c/em> them to keep up?\u003c/b>\u003c/p>\n\u003cfigure id=\"attachment_437841\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum.jpg\">\u003cimg class=\"wp-image-437841 size-large\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/12/chrissymum-1020x591.jpg\" alt=\"\" width=\"640\" height=\"371\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1020x591.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-160x93.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-800x463.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-768x445.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-1180x683.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-960x556.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-240x139.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-375x217.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum-520x301.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2017/12/chrissymum.jpg 1613w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chrissy Farr discussing Fitbit vs. Apple Watch with her mom, for a CNBC segment. (CNBC)\u003c/figcaption>\u003c/figure>\n\u003cp>I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it's obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.\u003c/p>\n\u003cp>So there needs to be a watchdog, but that's not the FDA's role. They're not out there policing companies and investing time into looking through the app store and thinking, \"This dermatology app doesn't look quite right.\"\u003c/p>\n\u003cp>As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don't.\u003c/p>\n\u003cp>\u003cstrong>Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that's valid?\u003c/strong>\u003c/p>\n\u003cp>The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it's paid for. We need massive payment reforms. There's also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. \u003cspan style=\"font-weight: 400\">All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.\u003c/span>\u003c/p>\n\u003cp>That said, I don't think it's fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just \u003ca href=\"https://www.youtube.com/watch?v=hBA0AH-LSbo\" target=\"_blank\" rel=\"noopener\">dying to live forever\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that's more than 12 million people in California alone. Even Apple, which hasn't traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect \u003ca href=\"http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.VusMvOIrKUk\" rel=\"noopener\">afib\u003c/a>. That's not something a young or healthy person would necessarily worry about at all. It's something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we've found that it can help save lives.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Do Those Blue Light Filters on Devices Really Help You Sleep?",
"title": "Do Those Blue Light Filters on Devices Really Help You Sleep?",
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"content": "\u003cp>If you're losing sleep over the blue light coming from your phone, there's an app for that.\u003c/p>\n\u003cp>In fact, there are now lots of apps that promise to improve sleep by filtering out the blue light produced by phones, tablets, computers and even televisions.\u003c/p>\n\u003cp>But how well do these apps work?\u003c/p>\n\u003cp>There haven't been any big studies to answer that question. So I phoned a couple of scientists who study the link between blue light exposure and sleep.\u003c/p>\n\u003cp>My first call is to \u003ca href=\"https://www.opt.uh.edu/faculty/LOstrin/\">Lisa Ostrin\u003c/a>, an assistant professor at the University of Houston College of Optometry.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Ostrin owns an iPhone. And every iPhone comes with an app called Night Shift that lets you filter out blue light. So does Ostrin use Night Shift?\u003c/p>\n\u003cp>\"Yes I do,\" she tells me.\u003c/p>\n\u003cp>Without a filtering app, cellphones and tablets expose users to an alarming amount of blue light, she says, \"Especially as people are lying in bed and have their screens just a few inches from their face.\"\u003c/p>\n\u003cp>And all that blue light prevents special photoreceptor cells in the eye from triggering the release of a sleep hormone, she says.\u003c/p>\n\u003cp>\"Normally when the sun goes down and the lights turn off, our body releases melatonin, which helps us get a nice restful sleep,\" Ostrin says. \"But when we have all this artificial light on, it's tricking those photoreceptors into thinking it's still daytime.\"\u003c/p>\n\u003cp>Ostrin was part of a team that showed this in a \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/opo.12385/full\">study\u003c/a> published this summer in the journal \u003cem>Ophthalmic & Physiological Optics.\u003c/em>\u003c/p>\n\u003cp>In the study, 21 people put on special glasses after sunset each day to filter out blue light. \"So essentially we blocked the input to those photoreceptors that tell our body it's still daytime,\" she says.\u003c/p>\n\u003cp>After two weeks, the participants' melatonin levels had increased by 58 percent. And they reported better sleep.\u003c/p>\n\u003cp>Apps that filter the light from device screens are less effective than blue-blocking glasses, Ostrin says, but still can help. \"I highly recommend them,\" she says.\u003c/p>\n\u003cp>To get a different perspective, I call \u003ca href=\"http://www.smu.edu/Dedman/Academics/Departments/Chemistry/ChemistryFacultyandStaff/BrianZoltowski\">Brian Zoltowski\u003c/a> at Southern Methodist University in Dallas.\u003c/p>\n\u003cp>Like Ostrin, Zoltowski studies blue light and sleep. And he also owns an iPhone. But \"I am not a Night Shift user currently,\" he says.\u003c/p>\n\u003cp>Zoltowski used to use the app. He also found ways to reduce the blue light coming from all of his other screens during the evening.\u003c/p>\n\u003cp>The downside was that everything he saw in the evening was some shade of orange. And he wasn't sure he was sleeping any better.\u003c/p>\n\u003cp>\"So I'm looking at an orange screen watching a video realizing I'm also drinking a cup of coffee,\" Zoltowski says. \"And it started to make me wonder then why I'm actually trying to decrease the amount of blue light when the caffeine that I'm drinking in my cup of coffee is probably having a larger effect on my sleep quality.\"\u003c/p>\n\u003cp>He also realized he just didn't like looking at all those orange screens. So he turned off Night Shift and all the other blue light filters on his devices.\u003c/p>\n\u003cp>\"I'm willing to take the blue light exposure for the improved quality of the images,\" he says.\u003c/p>\n\u003cp>Zoltowski says people need to remember that devices are just one source of blue light. Others include indoor lighting, streetlights and car headlights.\u003c/p>\n\u003cp>So he says a filtering app may not be worth it, especially if you're already getting a good night's sleep, he says.\u003c/p>\n\u003cp>\"But if you suffer from sleep problems and you've tried other things like eliminating caffeine later in the day,\" he says, \"this is something you can add to your repertoire to promote a healthful sleeping environment.\"\u003c/p>\n\u003cp>If you're serious about getting better sleep, though, you might want to avoid screens entirely near bedtime, Zoltowski says. \"Try to wind down, shut down your devices, dim the lights, relax and maybe read a book the old fashioned way.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>At least one \u003ca href=\"http://www.pnas.org/content/112/4/1232.abstract\">study\u003c/a> found that people took longer to fall asleep when they read from a light-emitting e-book than when they read from a printed book.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Apps+Can+Cut+Blue+Light+From+Devices%2C+But+Do+They+Help+You+Sleep%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're losing sleep over the blue light coming from your phone, there's an app for that.\u003c/p>\n\u003cp>In fact, there are now lots of apps that promise to improve sleep by filtering out the blue light produced by phones, tablets, computers and even televisions.\u003c/p>\n\u003cp>But how well do these apps work?\u003c/p>\n\u003cp>There haven't been any big studies to answer that question. So I phoned a couple of scientists who study the link between blue light exposure and sleep.\u003c/p>\n\u003cp>My first call is to \u003ca href=\"https://www.opt.uh.edu/faculty/LOstrin/\">Lisa Ostrin\u003c/a>, an assistant professor at the University of Houston College of Optometry.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ostrin owns an iPhone. And every iPhone comes with an app called Night Shift that lets you filter out blue light. So does Ostrin use Night Shift?\u003c/p>\n\u003cp>\"Yes I do,\" she tells me.\u003c/p>\n\u003cp>Without a filtering app, cellphones and tablets expose users to an alarming amount of blue light, she says, \"Especially as people are lying in bed and have their screens just a few inches from their face.\"\u003c/p>\n\u003cp>And all that blue light prevents special photoreceptor cells in the eye from triggering the release of a sleep hormone, she says.\u003c/p>\n\u003cp>\"Normally when the sun goes down and the lights turn off, our body releases melatonin, which helps us get a nice restful sleep,\" Ostrin says. \"But when we have all this artificial light on, it's tricking those photoreceptors into thinking it's still daytime.\"\u003c/p>\n\u003cp>Ostrin was part of a team that showed this in a \u003ca href=\"http://onlinelibrary.wiley.com/doi/10.1111/opo.12385/full\">study\u003c/a> published this summer in the journal \u003cem>Ophthalmic & Physiological Optics.\u003c/em>\u003c/p>\n\u003cp>In the study, 21 people put on special glasses after sunset each day to filter out blue light. \"So essentially we blocked the input to those photoreceptors that tell our body it's still daytime,\" she says.\u003c/p>\n\u003cp>After two weeks, the participants' melatonin levels had increased by 58 percent. And they reported better sleep.\u003c/p>\n\u003cp>Apps that filter the light from device screens are less effective than blue-blocking glasses, Ostrin says, but still can help. \"I highly recommend them,\" she says.\u003c/p>\n\u003cp>To get a different perspective, I call \u003ca href=\"http://www.smu.edu/Dedman/Academics/Departments/Chemistry/ChemistryFacultyandStaff/BrianZoltowski\">Brian Zoltowski\u003c/a> at Southern Methodist University in Dallas.\u003c/p>\n\u003cp>Like Ostrin, Zoltowski studies blue light and sleep. And he also owns an iPhone. But \"I am not a Night Shift user currently,\" he says.\u003c/p>\n\u003cp>Zoltowski used to use the app. He also found ways to reduce the blue light coming from all of his other screens during the evening.\u003c/p>\n\u003cp>The downside was that everything he saw in the evening was some shade of orange. And he wasn't sure he was sleeping any better.\u003c/p>\n\u003cp>\"So I'm looking at an orange screen watching a video realizing I'm also drinking a cup of coffee,\" Zoltowski says. \"And it started to make me wonder then why I'm actually trying to decrease the amount of blue light when the caffeine that I'm drinking in my cup of coffee is probably having a larger effect on my sleep quality.\"\u003c/p>\n\u003cp>He also realized he just didn't like looking at all those orange screens. So he turned off Night Shift and all the other blue light filters on his devices.\u003c/p>\n\u003cp>\"I'm willing to take the blue light exposure for the improved quality of the images,\" he says.\u003c/p>\n\u003cp>Zoltowski says people need to remember that devices are just one source of blue light. Others include indoor lighting, streetlights and car headlights.\u003c/p>\n\u003cp>So he says a filtering app may not be worth it, especially if you're already getting a good night's sleep, he says.\u003c/p>\n\u003cp>\"But if you suffer from sleep problems and you've tried other things like eliminating caffeine later in the day,\" he says, \"this is something you can add to your repertoire to promote a healthful sleeping environment.\"\u003c/p>\n\u003cp>If you're serious about getting better sleep, though, you might want to avoid screens entirely near bedtime, Zoltowski says. \"Try to wind down, shut down your devices, dim the lights, relax and maybe read a book the old fashioned way.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>At least one \u003ca href=\"http://www.pnas.org/content/112/4/1232.abstract\">study\u003c/a> found that people took longer to fall asleep when they read from a light-emitting e-book than when they read from a printed book.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Apps+Can+Cut+Blue+Light+From+Devices%2C+But+Do+They+Help+You+Sleep%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The traffic in the Bay Area regularly ranks among the nation's worst — and sitting in traffic isn't just irritating; there's some downright unhealthy stuff in that air you're breathing.\u003c/p>\n\u003caside class=\"pullquote alignright\">You can greatly reduce air pollution while biking by riding a block off of a busy road.\u003c/aside>\n\u003cp>Breathing in air pollution can irritate the lungs and aggravate both asthma and cardiovascular disease. However, a \u003ca href=\"http://www.sciencedirect.com/science/article/pii/S1352231017305290?via%3Dihub\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a> from the California Air Resources Board shows that \u003cem>how\u003c/em> you get to work makes a big difference.\u003c/p>\n\u003cp>Commuters participating in the study wore backpacks crammed with instruments to measure soot from diesel engines and other pollution while they biked, drove, bused or rode the train to work in Sacramento.\u003c/p>\n\u003cp>[audio src=\"https://www.kqed.org/.stream/anon/radio/science/2017/11/McClurgCommuterAirQuality.mp3\" /]\u003c/p>\n\u003cp>I decided to try it on my own daily commute from Oakland to San Francisco, using the same gear borrowed from the Air Resources Board. Over the course of a few days I measured the pollution while I biked, then rode BART, and finally drove to my office. Even though my little experiment was clearly not scientifically significant, the results generally matched what the researchers found in Sacramento.\u003c/p>\n\u003cfigure id=\"attachment_437110\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-437110 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/11/IMG_0823-e1510936683987-800x835.jpg\" alt=\"\" width=\"800\" height=\"835\">\u003cfigcaption class=\"wp-caption-text\">Lesley McClurg preparing air pollution measuring devices before her morning commute.\u003c/figcaption>\u003c/figure>\n\u003cp>BART was the clear winner for me. Light rail also exposed Sacramento commuters to the least polluted air. Driving came in second for me, and biking exposed me to the most smog. The researchers found pollution levels to be pretty similar for cars, buses and bicycle trips.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>I didn't take a diesel-powered train, but the Air Board noted that older Amtrak trains on the Capitol Corridor exposed participants to the worst air. However, Amtrak is updating its locomotive fleet with newer models, so future trips should be a lot cleaner. Incidentally, high-speed Rail, when in service, will be even cleaner.\u003c/p>\n\u003cp>Fortunately, none of the pollution levels I recorded during my commute — biking or driving — were dangerous. Study participants in Sacramento were also well within safe exposures.\u003c/p>\n\u003cfigure id=\"attachment_437181\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437181\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/11/Screen-Shot-2017-11-17-at-8.26.27-AM-1-1020x444.png\" alt=\"\" width=\"640\" height=\"279\">\u003cfigcaption class=\"wp-caption-text\">A street-by-street look at pollutants in San Francisco and Oakland. Aclima and Google plan to soon offer an interactive map where you can click on a particular street for more detailed information. To learn \u003ca href=\"https://blog.aclima.io/examining-air-quality-in-san-francisco-bay-area-d308b341be45\" target=\"_blank\" rel=\"noopener\">more.\u003c/a>\u003c/figcaption>\u003c/figure>\n\u003cp>Below is a list of ways to protect yourself from nasty air while taking various forms of transportation.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>Pollutants in the Air\u003c/h2>\n\u003cul>\n\u003cli>\u003cstrong>Black Carbon:\u003c/strong> Known more commonly as soot. It usually comes from diesel trucks, but ships, diesel trains, vehicles, residential wood fires and even certain types of cooking can also release black carbon. It can worsen asthma and heart disease.\u003c/li>\n\u003cli>\u003cstrong>Nitric Oxide (NO):\u003c/strong> A gas emitted by power plants, vehicles, aircraft, ships, trains, soils, nitrogen fertilizers, the burning of biomass and gas-fired appliances. High levels can irritate skin, eyes and mucous membranes, triggering coughing fits and a burning sensation in the chest.\u003c/li>\n\u003cli>\u003cstrong>Nitrogen Dioxide (NO2)\u003c/strong> : A gas released by burning fuel, forest fires and emissions from vehicles, power plants and off-road equipment. Breathing NO2 also irritates the lungs. When NO2 combines with other chemicals in the atmosphere it can lead to acid rain.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>\u003cstrong>1) Travel by Light Rail\u003c/strong>\u003c/p>\n\u003cp>My trip on BART from Oakland to San Francisco offered the best air. In general, the Air Board found electrically powered light rail to be the cleanest mode of transportation. That's likely because the trains themselves do not release any exhaust. However, the researchers cautioned the results may be different if the route is near a freeway.\u003c/p>\n\u003cp>\u003cstrong>2) Set the AC to Recirculate\u003c/strong>\u003c/p>\n\u003cp>My car trip was the second best. The Air Board said turning the air-conditioning on and setting it to recirculate (versus pulling in air from outside) can reduce pollution levels by up to 75 percent. In other words, roll up your windows and prevent as much air as possible from entering when driving through congestion.\u003c/p>\n\u003cp>\u003cstrong>3) Cycle On Bike Paths\u003c/strong>\u003c/p>\n\u003cp>As an avid cyclist, I was disappointed to learn that I was exposed to the dirtiest air while on two wheels. I'm going to try to find a less congested route because the Air Board says you can greatly reduce air pollution simply by cycling a block off a busy road or on bike paths away from heavy traffic.\u003c/p>\n\u003cp>\u003cstrong>4) Avoid Exhaust\u003c/strong>\u003c/p>\n\u003cp>Researchers found that commuters taking diesel trains were exposed to the worst air over other modes of transportation. It's best to avoid older diesel-powered trains that push rail cars, which were worse than engines that pulled cars. If you must take an older train, try to get a seat in a cabin away from the locomotive engine.\u003c/p>\n\u003cp>\u003cstrong>5) Check the Air Forecast\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Air quality can change day-by-day and block-by-block. It's a good idea to check the current pollution levels before deciding what mode of transportation to take. You can check your neighborhood at \u003ca href=\"https://airnow.gov/\" target=\"_blank\" rel=\"noopener\">airnow.gov\u003c/a>, or \u003ca href=\"http://sparetheair.org\" target=\"_blank\" rel=\"noopener\">sparetheair.org. \u003c/a>This is especially important when there is a wildfire burning in the region or a temperature inversion layer puts a lid on the area, preventing pollutants from escaping.\u003c/p>\n\u003cp>\u003cstrong>6) Carpool\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sharing a vehicle not only shortens the trip because you can zip along in the carpool lane, it also means you're on the road for less time breathing bad air. Plus carpooling is a win for everyone because it means fewer cars are on the road spewing emissions and adding to congestion.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I decided to try it on my own daily commute from Oakland to San Francisco, using the same gear borrowed from the Air Resources Board. Over the course of a few days I measured the pollution while I biked, then rode BART, and finally drove to my office. Even though my little experiment was clearly not scientifically significant, the results generally matched what the researchers found in Sacramento.\u003c/p>\n\u003cfigure id=\"attachment_437110\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-437110 size-medium\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/11/IMG_0823-e1510936683987-800x835.jpg\" alt=\"\" width=\"800\" height=\"835\">\u003cfigcaption class=\"wp-caption-text\">Lesley McClurg preparing air pollution measuring devices before her morning commute.\u003c/figcaption>\u003c/figure>\n\u003cp>BART was the clear winner for me. Light rail also exposed Sacramento commuters to the least polluted air. Driving came in second for me, and biking exposed me to the most smog. The researchers found pollution levels to be pretty similar for cars, buses and bicycle trips.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I didn't take a diesel-powered train, but the Air Board noted that older Amtrak trains on the Capitol Corridor exposed participants to the worst air. However, Amtrak is updating its locomotive fleet with newer models, so future trips should be a lot cleaner. Incidentally, high-speed Rail, when in service, will be even cleaner.\u003c/p>\n\u003cp>Fortunately, none of the pollution levels I recorded during my commute — biking or driving — were dangerous. Study participants in Sacramento were also well within safe exposures.\u003c/p>\n\u003cfigure id=\"attachment_437181\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-437181\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/11/Screen-Shot-2017-11-17-at-8.26.27-AM-1-1020x444.png\" alt=\"\" width=\"640\" height=\"279\">\u003cfigcaption class=\"wp-caption-text\">A street-by-street look at pollutants in San Francisco and Oakland. Aclima and Google plan to soon offer an interactive map where you can click on a particular street for more detailed information. To learn \u003ca href=\"https://blog.aclima.io/examining-air-quality-in-san-francisco-bay-area-d308b341be45\" target=\"_blank\" rel=\"noopener\">more.\u003c/a>\u003c/figcaption>\u003c/figure>\n\u003cp>Below is a list of ways to protect yourself from nasty air while taking various forms of transportation.\u003c/p>\n\u003caside class=\"alignright\">\n\u003ch2>Pollutants in the Air\u003c/h2>\n\u003cul>\n\u003cli>\u003cstrong>Black Carbon:\u003c/strong> Known more commonly as soot. It usually comes from diesel trucks, but ships, diesel trains, vehicles, residential wood fires and even certain types of cooking can also release black carbon. It can worsen asthma and heart disease.\u003c/li>\n\u003cli>\u003cstrong>Nitric Oxide (NO):\u003c/strong> A gas emitted by power plants, vehicles, aircraft, ships, trains, soils, nitrogen fertilizers, the burning of biomass and gas-fired appliances. High levels can irritate skin, eyes and mucous membranes, triggering coughing fits and a burning sensation in the chest.\u003c/li>\n\u003cli>\u003cstrong>Nitrogen Dioxide (NO2)\u003c/strong> : A gas released by burning fuel, forest fires and emissions from vehicles, power plants and off-road equipment. Breathing NO2 also irritates the lungs. When NO2 combines with other chemicals in the atmosphere it can lead to acid rain.\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>\u003cstrong>1) Travel by Light Rail\u003c/strong>\u003c/p>\n\u003cp>My trip on BART from Oakland to San Francisco offered the best air. In general, the Air Board found electrically powered light rail to be the cleanest mode of transportation. That's likely because the trains themselves do not release any exhaust. However, the researchers cautioned the results may be different if the route is near a freeway.\u003c/p>\n\u003cp>\u003cstrong>2) Set the AC to Recirculate\u003c/strong>\u003c/p>\n\u003cp>My car trip was the second best. The Air Board said turning the air-conditioning on and setting it to recirculate (versus pulling in air from outside) can reduce pollution levels by up to 75 percent. In other words, roll up your windows and prevent as much air as possible from entering when driving through congestion.\u003c/p>\n\u003cp>\u003cstrong>3) Cycle On Bike Paths\u003c/strong>\u003c/p>\n\u003cp>As an avid cyclist, I was disappointed to learn that I was exposed to the dirtiest air while on two wheels. I'm going to try to find a less congested route because the Air Board says you can greatly reduce air pollution simply by cycling a block off a busy road or on bike paths away from heavy traffic.\u003c/p>\n\u003cp>\u003cstrong>4) Avoid Exhaust\u003c/strong>\u003c/p>\n\u003cp>Researchers found that commuters taking diesel trains were exposed to the worst air over other modes of transportation. It's best to avoid older diesel-powered trains that push rail cars, which were worse than engines that pulled cars. If you must take an older train, try to get a seat in a cabin away from the locomotive engine.\u003c/p>\n\u003cp>\u003cstrong>5) Check the Air Forecast\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>Air quality can change day-by-day and block-by-block. It's a good idea to check the current pollution levels before deciding what mode of transportation to take. You can check your neighborhood at \u003ca href=\"https://airnow.gov/\" target=\"_blank\" rel=\"noopener\">airnow.gov\u003c/a>, or \u003ca href=\"http://sparetheair.org\" target=\"_blank\" rel=\"noopener\">sparetheair.org. \u003c/a>This is especially important when there is a wildfire burning in the region or a temperature inversion layer puts a lid on the area, preventing pollutants from escaping.\u003c/p>\n\u003cp>\u003cstrong>6) Carpool\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sharing a vehicle not only shortens the trip because you can zip along in the carpool lane, it also means you're on the road for less time breathing bad air. Plus carpooling is a win for everyone because it means fewer cars are on the road spewing emissions and adding to congestion.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>You’re a new parent. Your 1-year-old enjoys playtime, responds to her own name, and makes sounds that sound almost like words.\u003c/p>\n\u003cp>But there's one thing that's disturbing you. After you hold her up so that her feet touch the ground, she can’t support her own weight. She bends this way and that, unable to prop herself up.\u003c/p>\n\u003cp>Is this a problem that requires a checkup by your pediatrician? Or is she just developing a little slower than other toddlers?\u003c/p>\n\u003caside class=\"alignright\">When there's a delay in developmental milestones, do you need to call the doctor or not? The CDC has an app you can use.\u003c/aside>\n\u003cp>Well, there’s an app for that. The CDC last week released a free tool\u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones-app.html\" target=\"_blank\" rel=\"noopener\"> \u003c/a>for parents who want to monitor their children’s developmental accomplishments — and learn more about where they may be falling behind.\u003c/p>\n\u003cp>The app, called \u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones-app.html\" target=\"_blank\" rel=\"noopener\">Milestone Tracker,\u003c/a> is available for\u003ca href=\"https://itunes.apple.com/us/app/cdcs-milestone-tracker/id1232718688?mt=8\" target=\"_blank\" rel=\"noopener\"> iPhone\u003c/a> and \u003ca href=\"https://play.google.com/store/apps/details?id=gov.cdc.ncbddd.actearly.milestones\" target=\"_blank\" rel=\"noopener\">Android. \u003c/a>It allows parents to create a personalized checklist for the emotional and physical developmental milestones of children aged 2 months to 5 years. Parents can assess their progress by looking at \u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones/milestones-in-action.html\" target=\"_blank\" rel=\"noopener\">photos and videos\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The app is an outgrowth of a CDC program called “\u003ca href=\"https://www.cdc.gov/ncbddd/actearly/index.html\" target=\"_blank\" rel=\"noopener\">Learn the Signs. Act Early\u003c/a>.” Signs of what? The CDC’s press release mentions developmental delays and disabilities, including those caused by autism spectrum disorder, which is \u003ca href=\"https://www.cdc.gov/ncbddd/autism/screening.html\" target=\"_blank\" rel=\"noopener\">challenging to diagnose\u003c/a> before the age of 2.\u003c/p>\n\u003cp>“Skills like taking a first step, saying those first words, and waving ‘bye-bye’ are developmental milestones all parents anticipate and celebrate,” said CDC Director Dr. Brenda Fitzgerald. “This CDC Milestone Tracker app gives parents tips to help their child learn and grow, a way to track developmental milestones, recognize delays, and the ability to share this information with their healthcare provider.” [contextly_sidebar id=\"QuoFnaGoFF16hYcZD1iccIxH5LTyS1hF\"]\u003c/p>\n\u003cp>As a parent fills out a record-keeping scorecard, the app will recommend whether to see a pediatrician for a developmental screening. The answers to some questions are a soothing reminder that children develop at different rates, so you can relax. At other times, the app may instruct a parent to call their pediatrician. (The American Association of Pediatrics also has an \u003ca href=\"https://motordelay.aap.org/\"> interactive activity tracker\u003c/a> that recommends when to consult a doctor.)\u003c/p>\n\u003cp>Autism isn’t the only condition that can delay cognitive, physical and emotional development. Young children \u003ca href=\"https://www.cdc.gov/ncbddd/developmentaldisabilities/specificconditions.html\" target=\"_blank\" rel=\"noopener\"> may have\u003c/a> undiagnosed hearing or vision loss, muscular dystrophy, Tourette’s syndrome, cerebral palsy or ADHD.\u003c/p>\n\u003caside class=\"aligncenter\">\u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones/milestones-in-action.html\" target=\"_blank\" rel=\"noopener\">Videos: Developmental milestones at different ages\u003c/a>\u003c/aside>\n\u003cp>The app offers tips on activities that help a child grow, tailored to different ages, pertaining to things like discipline, reading skills, communication, education and physical affection.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Parents can also keep track of their kids' doctor appointments and sign up for reminders about booking a developmental screening.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>You’re a new parent. Your 1-year-old enjoys playtime, responds to her own name, and makes sounds that sound almost like words.\u003c/p>\n\u003cp>But there's one thing that's disturbing you. After you hold her up so that her feet touch the ground, she can’t support her own weight. She bends this way and that, unable to prop herself up.\u003c/p>\n\u003cp>Is this a problem that requires a checkup by your pediatrician? Or is she just developing a little slower than other toddlers?\u003c/p>\n\u003caside class=\"alignright\">When there's a delay in developmental milestones, do you need to call the doctor or not? The CDC has an app you can use.\u003c/aside>\n\u003cp>Well, there’s an app for that. The CDC last week released a free tool\u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones-app.html\" target=\"_blank\" rel=\"noopener\"> \u003c/a>for parents who want to monitor their children’s developmental accomplishments — and learn more about where they may be falling behind.\u003c/p>\n\u003cp>The app, called \u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones-app.html\" target=\"_blank\" rel=\"noopener\">Milestone Tracker,\u003c/a> is available for\u003ca href=\"https://itunes.apple.com/us/app/cdcs-milestone-tracker/id1232718688?mt=8\" target=\"_blank\" rel=\"noopener\"> iPhone\u003c/a> and \u003ca href=\"https://play.google.com/store/apps/details?id=gov.cdc.ncbddd.actearly.milestones\" target=\"_blank\" rel=\"noopener\">Android. \u003c/a>It allows parents to create a personalized checklist for the emotional and physical developmental milestones of children aged 2 months to 5 years. Parents can assess their progress by looking at \u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones/milestones-in-action.html\" target=\"_blank\" rel=\"noopener\">photos and videos\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The app is an outgrowth of a CDC program called “\u003ca href=\"https://www.cdc.gov/ncbddd/actearly/index.html\" target=\"_blank\" rel=\"noopener\">Learn the Signs. Act Early\u003c/a>.” Signs of what? The CDC’s press release mentions developmental delays and disabilities, including those caused by autism spectrum disorder, which is \u003ca href=\"https://www.cdc.gov/ncbddd/autism/screening.html\" target=\"_blank\" rel=\"noopener\">challenging to diagnose\u003c/a> before the age of 2.\u003c/p>\n\u003cp>“Skills like taking a first step, saying those first words, and waving ‘bye-bye’ are developmental milestones all parents anticipate and celebrate,” said CDC Director Dr. Brenda Fitzgerald. “This CDC Milestone Tracker app gives parents tips to help their child learn and grow, a way to track developmental milestones, recognize delays, and the ability to share this information with their healthcare provider.” \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>As a parent fills out a record-keeping scorecard, the app will recommend whether to see a pediatrician for a developmental screening. The answers to some questions are a soothing reminder that children develop at different rates, so you can relax. At other times, the app may instruct a parent to call their pediatrician. (The American Association of Pediatrics also has an \u003ca href=\"https://motordelay.aap.org/\"> interactive activity tracker\u003c/a> that recommends when to consult a doctor.)\u003c/p>\n\u003cp>Autism isn’t the only condition that can delay cognitive, physical and emotional development. Young children \u003ca href=\"https://www.cdc.gov/ncbddd/developmentaldisabilities/specificconditions.html\" target=\"_blank\" rel=\"noopener\"> may have\u003c/a> undiagnosed hearing or vision loss, muscular dystrophy, Tourette’s syndrome, cerebral palsy or ADHD.\u003c/p>\n\u003caside class=\"aligncenter\">\u003ca href=\"https://www.cdc.gov/ncbddd/actearly/milestones/milestones-in-action.html\" target=\"_blank\" rel=\"noopener\">Videos: Developmental milestones at different ages\u003c/a>\u003c/aside>\n\u003cp>The app offers tips on activities that help a child grow, tailored to different ages, pertaining to things like discipline, reading skills, communication, education and physical affection.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Parents can also keep track of their kids' doctor appointments and sign up for reminders about booking a developmental screening.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "North Bay Fires: Yes, Californians Can Now Buy Air Purifiers on Amazon",
"title": "North Bay Fires: Yes, Californians Can Now Buy Air Purifiers on Amazon",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>During\u003cb> \u003c/b>the deadly North Bay wildfires, air quality in the Bay Area has suffered -- a lot. In fact, air monitors have recorded the \u003ca href=\"https://ww2.kqed.org/science/2017/10/11/bay-area-air-quality-worst-on-record-check-out-your-city/\" target=\"_blank\" rel=\"noopener\">worst pollution \u003c/a>since the state started keeping records for small particulates, in 1999. That goes even for areas as far removed from the disaster's epicenter as the South Bay.\u003c/p>\n\u003caside class=\"pullquote alignright\">The California Air Resources Board says HEPA air purifiers can remove almost all of the harmful particles in the air caused by fire.\u003c/aside>\n\u003cp>Naturally, this has left people all over the region worried about pollutant-related health hazards. And not without reason.\u003c/p>\n\u003cp>\"When we breath particulates they bypass the lung system and get into our bloodstream,” Lisa Fasano of the Bay Area Air Quality Management District told KQED's Lesley McClurg last week. \"They exacerbate respiratory conditions like asthma, COPD [Chronic Obstructive Pulmonary Disease], emphysema and other conditions because they are very harmful.”\u003c/p>\n\u003cp>Air quality \u003ca href=\"https://airnow.gov/index.cfm?action=airnow.local_city&cityid=317\" target=\"_blank\" rel=\"noopener\">has improved\u003c/a> this week, and the good news is that as it gets better outside, it will improve indoors as well.\u003c/p>\n\u003caside class=\"alignright\">\n\u003cul>California Consumer Information on Air Cleaners\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\">List of air-cleaning devices that can be sold in California\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/acdsumm.pdf\">FAQ: Air cleaning devices for the home\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/consumers.htm?_ga=2.103214725.400296666.1508192585-1430501393.1496685106\" target=\"_blank\" rel=\"noopener\">More air-cleaner information for consumers\u003c/a>\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>\"Fine particle pollution essentially acts like a gas, so if there is an exchange between outside and indoor air, the indoor pollution will dissipate,\" said CARB Communications Director Stanley Young in an email.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Provided the air outside is clean, the indoor air will clear \"in a matter of hours or days,\" not weeks, Young said.\u003c/p>\n\u003cp>Still, the air resources board definitely recommends purifiers -- portable devices that will clean the air, not just for fire-related pollutants, but for everyday use as well.\u003c/p>\n\u003cp>Peggy Jenkins, who manages the agency's Indoor Air Quality and Personal Exposure Assessment Program, says those air-cleaning devices that use filters designated as high-efficiency particulate air, or HEPA, work best, as they remove very small particles.\u003c/p>\n\u003cp>\"The high-efficiency filters typically are deeper or more dense,\" Jenkins says, \"and they can remove really almost 100 percent of the particles in the air. So we've seen very dramatic reductions in our air quality studies.\"\u003c/p>\n\u003cp>\u003cstrong>High Demand\u003c/strong>\u003c/p>\n\u003cp>But due to the fires, local stores have been selling out of the devices. Eliza Hersh of San Francisco, who recently hosted a Santa Rosa family forced to evacuate their home, has been on the hunt. Before her guests were okayed to go back home, they wanted to buy a purifier to clean the air in both their house and business.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uNJzQt7aM6CcDNCU8aao9oGDi0lPEpNJ\"]\"Every local place was sold out,\" Hersh said. \"[They] were about to drive to Tracy.\"\u003c/p>\n\u003cp>With local stores depleted, Hersh and others naturally turned to an online source. And that usually means Amazon. Except there was a problem: Would-be buyers kept running into this message:\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\">\u003cimg class=\"aligncenter size-full wp-image-436287\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\" alt=\"\" width=\"536\" height=\"83\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2.png 536w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-160x25.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-240x37.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-375x58.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-520x81.png 520w\" sizes=\"(max-width: 536px) 100vw, 536px\">\u003c/a>\u003c/p>\n\u003cp>Many went on Twitter to vent ... . Here's just one of the many tweets:\u003c/p>\n\u003cp>https://twitter.com/wildwestpie/status/918733350994448384\u003c/p>\n\u003cp>\u003cstrong>Ozone Regulation\u003c/strong>\u003c/p>\n\u003cp>Here's the answer to that WTF: Selling air purifiers in California is a little complicated, because of a state \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/air-cleaner-regulation.pdf\" target=\"_blank\" rel=\"noopener\">regulation\u003c/a> banning certain models that emit ozone. The California Air Resources Board \u003ca href=\"https://www.arb.ca.gov/research/indoor/ozone.htm\" target=\"_blank\" rel=\"noopener\">calls ozone\u003c/a> \"a highly reactive, unstable, toxic gas\" that can irritate and inflame the respiratory system and even cause permanent lung damage. CARB says ozone-generating air purifiers can produce several times the state's allowable levels.\u003c/p>\n\u003cp>Thus, the board maintains a list of potentially hazardous ozone-generating air cleaners that\u003ca href=\"https://www.arb.ca.gov/research/indoor/o3g-list.htm\" target=\"_blank\" rel=\"noopener\"> cannot be sold\u003c/a> in the state, as well as a list of \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\" target=\"_blank\" rel=\"noopener\">those that can\u003c/a>. CARB updates the lists as frequently as each week.\u003c/p>\n\u003cp>The problem is would-be buyers were stymied even ordering models specifically certified as legal. On Tuesday, SFGate \u003ca href=\"http://www.sfgate.com/bayarea/article/cant-buy-air-purifier-ozone-ca-12276943.php\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on the issue and got this statement from CARB:\u003c/p>\n\u003cp>\"Amazon, unfortunately, has had problems shipping some CARB-approved air purifiers ... so until Amazon addresses this error, consumers may opt for another company to purchase from.\"\u003c/p>\n\u003cp>So on Wednesday, we asked Amazon: What gives?\u003c/p>\n\u003cp class=\"x_MsoNormal\">“Air filters must meet the California Air Resources Board’s unique restrictions before they can be legally sold into the state,\" Erik Fairleigh, an Amazon spokesman wrote in an email. \"As a result, we require suppliers to provide confirmation that air filters comply with the restrictions in order to be sold into California.”\u003c/p>\n\u003cp>\u003cstrong>Problem (Mostly) Solved\u003c/strong>\u003c/p>\n\u003cp>Well, in light of all this, we decided to run a little test. On Thursday, we selected a sample of 10 top-rated, CARB-approved air purifiers, each with at least 400 reviews from Amazon customers. (Here's the Amazon \u003ca href=\"https://www.amazon.com/s/ref=sr_st_undefined?keywords=hepa+air+purifier&rh=i%3Aaps%2Ck%3Ahepa+air+purifier&qid=1508537823&sort=review-rank\" target=\"_blank\" rel=\"noopener\">search we did\u003c/a> to find our 10.) Then we went through the ordering process for each. Of those 10, Amazon allowed seven to be shipped to a San Francisco address, and only three, all made by Honeywell, evoked the dreaded \"can't ship\" message. Amazon's Fairleigh also sent us a list of about 40 models he said Californians could successfully buy.\u003c/p>\n\u003cp>Meanwhile, Hersh provided us with the links to four Honeywell models she had sent to Amazon last Friday as examples of state-approved models that California customers couldn't get shipped to them. On Thursday -- yesterday -- 2 of the 4 that had been previously unshippable were now good to go. So that is progress.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you still can't find an air purifier locally, give it another try online. Even as late as yesterday, purifiers remained a hot item in the region. On the Best Buy website, a small sampling of air purifiers we looked at were listed as available in each and every Bay Area store no sooner than Oct. 28.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>During\u003cb> \u003c/b>the deadly North Bay wildfires, air quality in the Bay Area has suffered -- a lot. In fact, air monitors have recorded the \u003ca href=\"https://ww2.kqed.org/science/2017/10/11/bay-area-air-quality-worst-on-record-check-out-your-city/\" target=\"_blank\" rel=\"noopener\">worst pollution \u003c/a>since the state started keeping records for small particulates, in 1999. That goes even for areas as far removed from the disaster's epicenter as the South Bay.\u003c/p>\n\u003caside class=\"pullquote alignright\">The California Air Resources Board says HEPA air purifiers can remove almost all of the harmful particles in the air caused by fire.\u003c/aside>\n\u003cp>Naturally, this has left people all over the region worried about pollutant-related health hazards. And not without reason.\u003c/p>\n\u003cp>\"When we breath particulates they bypass the lung system and get into our bloodstream,” Lisa Fasano of the Bay Area Air Quality Management District told KQED's Lesley McClurg last week. \"They exacerbate respiratory conditions like asthma, COPD [Chronic Obstructive Pulmonary Disease], emphysema and other conditions because they are very harmful.”\u003c/p>\n\u003cp>Air quality \u003ca href=\"https://airnow.gov/index.cfm?action=airnow.local_city&cityid=317\" target=\"_blank\" rel=\"noopener\">has improved\u003c/a> this week, and the good news is that as it gets better outside, it will improve indoors as well.\u003c/p>\n\u003caside class=\"alignright\">\n\u003cul>California Consumer Information on Air Cleaners\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\">List of air-cleaning devices that can be sold in California\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/acdsumm.pdf\">FAQ: Air cleaning devices for the home\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/consumers.htm?_ga=2.103214725.400296666.1508192585-1430501393.1496685106\" target=\"_blank\" rel=\"noopener\">More air-cleaner information for consumers\u003c/a>\u003c/li>\n\u003c/ul>\n\u003c/aside>\n\u003cp>\"Fine particle pollution essentially acts like a gas, so if there is an exchange between outside and indoor air, the indoor pollution will dissipate,\" said CARB Communications Director Stanley Young in an email.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Provided the air outside is clean, the indoor air will clear \"in a matter of hours or days,\" not weeks, Young said.\u003c/p>\n\u003cp>Still, the air resources board definitely recommends purifiers -- portable devices that will clean the air, not just for fire-related pollutants, but for everyday use as well.\u003c/p>\n\u003cp>Peggy Jenkins, who manages the agency's Indoor Air Quality and Personal Exposure Assessment Program, says those air-cleaning devices that use filters designated as high-efficiency particulate air, or HEPA, work best, as they remove very small particles.\u003c/p>\n\u003cp>\"The high-efficiency filters typically are deeper or more dense,\" Jenkins says, \"and they can remove really almost 100 percent of the particles in the air. So we've seen very dramatic reductions in our air quality studies.\"\u003c/p>\n\u003cp>\u003cstrong>High Demand\u003c/strong>\u003c/p>\n\u003cp>But due to the fires, local stores have been selling out of the devices. Eliza Hersh of San Francisco, who recently hosted a Santa Rosa family forced to evacuate their home, has been on the hunt. Before her guests were okayed to go back home, they wanted to buy a purifier to clean the air in both their house and business.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"Every local place was sold out,\" Hersh said. \"[They] were about to drive to Tracy.\"\u003c/p>\n\u003cp>With local stores depleted, Hersh and others naturally turned to an online source. And that usually means Amazon. Except there was a problem: Would-be buyers kept running into this message:\u003c/p>\n\u003cp>\u003ca href=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\">\u003cimg class=\"aligncenter size-full wp-image-436287\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2027/10/Amazon-message-2.png\" alt=\"\" width=\"536\" height=\"83\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2.png 536w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-160x25.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-240x37.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-375x58.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2027/10/Amazon-message-2-520x81.png 520w\" sizes=\"(max-width: 536px) 100vw, 536px\">\u003c/a>\u003c/p>\n\u003cp>Many went on Twitter to vent ... . Here's just one of the many tweets:\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>\u003cstrong>Ozone Regulation\u003c/strong>\u003c/p>\n\u003cp>Here's the answer to that WTF: Selling air purifiers in California is a little complicated, because of a state \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/air-cleaner-regulation.pdf\" target=\"_blank\" rel=\"noopener\">regulation\u003c/a> banning certain models that emit ozone. The California Air Resources Board \u003ca href=\"https://www.arb.ca.gov/research/indoor/ozone.htm\" target=\"_blank\" rel=\"noopener\">calls ozone\u003c/a> \"a highly reactive, unstable, toxic gas\" that can irritate and inflame the respiratory system and even cause permanent lung damage. CARB says ozone-generating air purifiers can produce several times the state's allowable levels.\u003c/p>\n\u003cp>Thus, the board maintains a list of potentially hazardous ozone-generating air cleaners that\u003ca href=\"https://www.arb.ca.gov/research/indoor/o3g-list.htm\" target=\"_blank\" rel=\"noopener\"> cannot be sold\u003c/a> in the state, as well as a list of \u003ca href=\"https://www.arb.ca.gov/research/indoor/aircleaners/certified.htm\" target=\"_blank\" rel=\"noopener\">those that can\u003c/a>. CARB updates the lists as frequently as each week.\u003c/p>\n\u003cp>The problem is would-be buyers were stymied even ordering models specifically certified as legal. On Tuesday, SFGate \u003ca href=\"http://www.sfgate.com/bayarea/article/cant-buy-air-purifier-ozone-ca-12276943.php\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on the issue and got this statement from CARB:\u003c/p>\n\u003cp>\"Amazon, unfortunately, has had problems shipping some CARB-approved air purifiers ... so until Amazon addresses this error, consumers may opt for another company to purchase from.\"\u003c/p>\n\u003cp>So on Wednesday, we asked Amazon: What gives?\u003c/p>\n\u003cp class=\"x_MsoNormal\">“Air filters must meet the California Air Resources Board’s unique restrictions before they can be legally sold into the state,\" Erik Fairleigh, an Amazon spokesman wrote in an email. \"As a result, we require suppliers to provide confirmation that air filters comply with the restrictions in order to be sold into California.”\u003c/p>\n\u003cp>\u003cstrong>Problem (Mostly) Solved\u003c/strong>\u003c/p>\n\u003cp>Well, in light of all this, we decided to run a little test. On Thursday, we selected a sample of 10 top-rated, CARB-approved air purifiers, each with at least 400 reviews from Amazon customers. (Here's the Amazon \u003ca href=\"https://www.amazon.com/s/ref=sr_st_undefined?keywords=hepa+air+purifier&rh=i%3Aaps%2Ck%3Ahepa+air+purifier&qid=1508537823&sort=review-rank\" target=\"_blank\" rel=\"noopener\">search we did\u003c/a> to find our 10.) Then we went through the ordering process for each. Of those 10, Amazon allowed seven to be shipped to a San Francisco address, and only three, all made by Honeywell, evoked the dreaded \"can't ship\" message. Amazon's Fairleigh also sent us a list of about 40 models he said Californians could successfully buy.\u003c/p>\n\u003cp>Meanwhile, Hersh provided us with the links to four Honeywell models she had sent to Amazon last Friday as examples of state-approved models that California customers couldn't get shipped to them. On Thursday -- yesterday -- 2 of the 4 that had been previously unshippable were now good to go. So that is progress.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If you still can't find an air purifier locally, give it another try online. Even as late as yesterday, purifiers remained a hot item in the region. On the Best Buy website, a small sampling of air purifiers we looked at were listed as available in each and every Bay Area store no sooner than Oct. 28.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.\u003c/p>\n\u003cp class=\"danger-zone\">The new research, published in the \u003cem>Journal of the American Medical Association\u003c/em>, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured.'\u003ccite>Dr. Anne Steiner, University of North Carolina\u003c/cite>\u003c/aside>\n\u003cp>That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.” Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.\u003c/p>\n\u003cp>“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.\u003c/p>\n\u003cp>“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.\u003c/p>\n\u003cp>Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.\u003c/p>\n\u003cp>In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.\u003c/p>\n\u003cp>“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.\u003c/p>\n\u003cp>The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.\u003c/p>\n\u003cp>Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.\u003c/p>\n\u003cp>“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/10/10/ovarian-reserve-tests-fertility/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Tests that measure a woman’s “ovarian reserve” to estimate how many more years of fertility she has have grown increasingly popular. But a new study finds that levels of the hormones commonly tested aren’t tied to lower chances of getting pregnant.\u003c/p>\n\u003cp class=\"danger-zone\">The new research, published in the \u003cem>Journal of the American Medical Association\u003c/em>, looked at three markers: anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured.'\u003ccite>Dr. Anne Steiner, University of North Carolina\u003c/cite>\u003c/aside>\n\u003cp>That’s led to a boom in ovarian reserve testing, both in the clinic and with direct-to-consumer tests from companies. One startup, Modern Fertility, is pre-selling a new $149 fertility test that measures FSH, AMH, and other fertility hormones. The company says physicians will tally all those measures up and calculate a “fertility score.” Previous research has correlated levels of the three hormones with the number of eggs a woman has in her ovaries — a measure known as “ovarian reserve.” Studies have suggested that information could be used to predict how well a woman will respond to in vitro fertilization. But in recent years, as more women are delaying pregnancy until later ages, ovarian reserve tests have begun to be used as a way to test for future fertility.\u003c/p>\n\u003cp>“Women are already using these as fertility tests. Over the years, they’ve worked their way into being in the mainstream without evidence,” said Dr. Anne Steiner, a reproductive endocrinologist at the University of North Carolina and one of the study’s authors.\u003c/p>\n\u003cp>“As we get older, fertility becomes a giant egg-shaped question mark,” the company said in an August blog post announcing the test.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the new study finds that looking at levels FSH, AMH, and inhibin B isn’t an answer to the question of fertility.\u003c/p>\n\u003cp>Steiner and her colleagues analyzed data from 750 women between ages 30 and 44 who didn’t have any known fertility problems, had been trying to get pregnant for three months or less, and lived with a male partner. Women who had lower levels of the biomarkers — indicating “diminished ovarian reserve” — weren’t any less likely to get pregnant in the first year than women who had higher levels of the biomarkers.\u003c/p>\n\u003cp>In other words, ovarian reserve tests run the risk of giving women an inaccurate impression of their future chances of having children.\u003c/p>\n\u003cp>“Women with low values are going to have unnecessary anxiety, and women with high values may be incorrectly reassured,” Steiner said. She added that women shouldn’t use the tests to decide whether to freeze their eggs.\u003c/p>\n\u003cp>The caveats: The outcome studied was getting pregnant, not carrying a healthy pregnancy fully to term. It also only followed women for the first year they were trying to get pregnant. And the researchers didn’t run any fertility tests on the partners of the women involved in the study — though Steiner pointed out that direct-to-consumer fertility tests only test women’s levels as well.\u003c/p>\n\u003cp>Dr. Stephen Collins of the Yale Fertility Center, who wasn’t affiliated with the study, said that with this evidence in hand, doctors and the makers of direct-to-consumer tests should be upfront about the evidence for FSH, AMH, and inhibin B tests to predict fertility in the short term.\u003c/p>\n\u003cp>“As practitioners, we need to recognize the limitations of the tests that we’re offering,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">This \u003ca href=\"https://www.statnews.com/2017/10/10/ovarian-reserve-tests-fertility/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery. \u003c/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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