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"content": "\u003cp>Want to be smarter? More focused? Free of memory problems as you age?\u003c/p>\n\u003cp>If so, don't count on brain games to help you.\u003c/p>\n\u003cp>That's the conclusion of an exhaustive evaluation of the scientific literature on brain training games and programs. It was \u003ca href=\"http://psi.sagepub.com/content/current\">published\u003c/a> Monday in the journal \u003cem>Psychological Science in the Public Interest.\u003c/em>\u003c/p>\n\u003cp>\"It's disappointing that the evidence isn't stronger,\" says \u003ca href=\"http://www.psychology.illinois.edu/people/dsimons\">Daniel Simons\u003c/a>, an author of the article and a psychology professor at the University of Illinois at Urbana-Champaign.\u003c/p>\n\u003cp>\"It would be really nice if you could play some games and have it radically change your cognitive abilities,\" Simons says. \"But the studies don't show that on objectively measured real-world outcomes.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The evaluation, done by a team of seven scientists, is a response to a very public disagreement about the effectiveness of brain games, Simons says.\u003c/p>\n\u003cp>In October 2014, more than 70 scientists published an \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\">open letter\u003c/a> objecting to marketing claims made by brain training companies. Pretty soon, another group, with more than 100 scientists, published a \u003ca href=\"http://www.cognitivetrainingdata.org/the-controversy-does-brain-training-work/response-letter/\">rebuttal\u003c/a> saying brain training has a solid scientific base.\u003c/p>\n\u003cp>\"So you had two consensus statements, each signed by many, many people, that came to essentially opposite conclusions,\" Simons says.\u003c/p>\n\u003cp>In an effort to clarify the issue, Simons and six other scientists reviewed more than 130 studies of brain games and other forms of cognitive training. The evaluation included studies of products from industry giant \u003ca href=\"https://www.lumosity.com/\">Lumosity\u003c/a>, which has been a prominent sponsor of NPR and other public radio programming.\u003c/p>\n\u003cp>\"We went through each paper and tried to look at the kind of evidence it provided,\" Simons says.\u003c/p>\n\u003cp>That meant asking questions like: How big was the study? Did it have an appropriate control group? Do the results support the marketing claims made by companies?\u003c/p>\n\u003cp>The scientists found that \"many of the studies did not really adhere to what we think of as the best practices,\" Simons says.\u003c/p>\n\u003cp>Some of the studies included only a few participants. Others lacked adequate control groups or failed to account for the placebo effect, which causes people to improve on a test simply because they are trying harder or are more confident.\u003c/p>\n\u003cp>There were some good studies, Simons says. And they showed that brain games do help people get better at a specific task.\u003c/p>\n\u003cp>\"You can practice, for example, scanning baggage at an airport and looking for a knife,\" he says. \"And you get really, really good at spotting that knife.\"\u003c/p>\n\u003cp>But there was less evidence that people got better at related tasks, like spotting other suspicious items, Simons says. And there was no strong evidence that practicing a narrow skill led to overall improvements in memory or thinking.\u003c/p>\n\u003cp>That's disappointing, Simons says, because \"what you want to do is be better able to function at work or at school.\"\u003c/p>\n\u003cp>The evaluation got a warm reception from at least some of the scientists who had signed the 2014 letter defending the science behind brain training.\u003c/p>\n\u003cp>\"The evaluation was very even-handed and raised many excellent points,\" says \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/9783561/george-rebok\">George Rebok\u003c/a>, a psychologist at Johns Hopkins University who has been involved in brain training research for the past 20 years. \"It really helped raise the bar in terms of the level of science that we must aspire to.\"\u003c/p>\n\u003cp>Rebok, who says he has no ties to brain training companies, remains optimistic that the right program of brain exercises can improve mental functioning and delay the effects of aging.\u003c/p>\n\u003cp>One reason brain games haven't shown a clear benefit so far, he says, may be that they don't work the brain hard enough or over a long enough time period.\u003c/p>\n\u003cp>\"It takes mental effort and practice to be able to see results,\" Rebok says. \"If we can implement that long range, I think that there will be a big dividend eventually.\"\u003c/p>\n\u003cp>In the meantime, the brain training industry is facing scrutiny from the Federal Trade Commission.\u003c/p>\n\u003cp>In January, the company behind Lumosity agreed to \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges\">pay a $2 million fine\u003c/a> to settle \u003ca href=\"https://www.ftc.gov/system/files/documents/cases/160105lumoslabsstip.pdf\">FTC charges\u003c/a> that it made unfounded claims about its brain training program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And in May, a smaller brain training company called LearningRx agreed to pay a $200,000 fine to settle \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/05/marketers-one-one-brain-training-programs-settle-ftc-charges\">similar charges\u003c/a>. Even so, the \u003ca href=\"http://www.learningrx.com/\">Learning Rx website\u003c/a> still promises \"A better brain at any age.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Brain+Game+Claims+Fail+A+Big+Scientific+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Want to be smarter? More focused? Free of memory problems as you age?\u003c/p>\n\u003cp>If so, don't count on brain games to help you.\u003c/p>\n\u003cp>That's the conclusion of an exhaustive evaluation of the scientific literature on brain training games and programs. It was \u003ca href=\"http://psi.sagepub.com/content/current\">published\u003c/a> Monday in the journal \u003cem>Psychological Science in the Public Interest.\u003c/em>\u003c/p>\n\u003cp>\"It's disappointing that the evidence isn't stronger,\" says \u003ca href=\"http://www.psychology.illinois.edu/people/dsimons\">Daniel Simons\u003c/a>, an author of the article and a psychology professor at the University of Illinois at Urbana-Champaign.\u003c/p>\n\u003cp>\"It would be really nice if you could play some games and have it radically change your cognitive abilities,\" Simons says. \"But the studies don't show that on objectively measured real-world outcomes.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The evaluation, done by a team of seven scientists, is a response to a very public disagreement about the effectiveness of brain games, Simons says.\u003c/p>\n\u003cp>In October 2014, more than 70 scientists published an \u003ca href=\"http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/\">open letter\u003c/a> objecting to marketing claims made by brain training companies. Pretty soon, another group, with more than 100 scientists, published a \u003ca href=\"http://www.cognitivetrainingdata.org/the-controversy-does-brain-training-work/response-letter/\">rebuttal\u003c/a> saying brain training has a solid scientific base.\u003c/p>\n\u003cp>\"So you had two consensus statements, each signed by many, many people, that came to essentially opposite conclusions,\" Simons says.\u003c/p>\n\u003cp>In an effort to clarify the issue, Simons and six other scientists reviewed more than 130 studies of brain games and other forms of cognitive training. The evaluation included studies of products from industry giant \u003ca href=\"https://www.lumosity.com/\">Lumosity\u003c/a>, which has been a prominent sponsor of NPR and other public radio programming.\u003c/p>\n\u003cp>\"We went through each paper and tried to look at the kind of evidence it provided,\" Simons says.\u003c/p>\n\u003cp>That meant asking questions like: How big was the study? Did it have an appropriate control group? Do the results support the marketing claims made by companies?\u003c/p>\n\u003cp>The scientists found that \"many of the studies did not really adhere to what we think of as the best practices,\" Simons says.\u003c/p>\n\u003cp>Some of the studies included only a few participants. Others lacked adequate control groups or failed to account for the placebo effect, which causes people to improve on a test simply because they are trying harder or are more confident.\u003c/p>\n\u003cp>There were some good studies, Simons says. And they showed that brain games do help people get better at a specific task.\u003c/p>\n\u003cp>\"You can practice, for example, scanning baggage at an airport and looking for a knife,\" he says. \"And you get really, really good at spotting that knife.\"\u003c/p>\n\u003cp>But there was less evidence that people got better at related tasks, like spotting other suspicious items, Simons says. And there was no strong evidence that practicing a narrow skill led to overall improvements in memory or thinking.\u003c/p>\n\u003cp>That's disappointing, Simons says, because \"what you want to do is be better able to function at work or at school.\"\u003c/p>\n\u003cp>The evaluation got a warm reception from at least some of the scientists who had signed the 2014 letter defending the science behind brain training.\u003c/p>\n\u003cp>\"The evaluation was very even-handed and raised many excellent points,\" says \u003ca href=\"http://www.hopkinsmedicine.org/profiles/results/directory/profile/9783561/george-rebok\">George Rebok\u003c/a>, a psychologist at Johns Hopkins University who has been involved in brain training research for the past 20 years. \"It really helped raise the bar in terms of the level of science that we must aspire to.\"\u003c/p>\n\u003cp>Rebok, who says he has no ties to brain training companies, remains optimistic that the right program of brain exercises can improve mental functioning and delay the effects of aging.\u003c/p>\n\u003cp>One reason brain games haven't shown a clear benefit so far, he says, may be that they don't work the brain hard enough or over a long enough time period.\u003c/p>\n\u003cp>\"It takes mental effort and practice to be able to see results,\" Rebok says. \"If we can implement that long range, I think that there will be a big dividend eventually.\"\u003c/p>\n\u003cp>In the meantime, the brain training industry is facing scrutiny from the Federal Trade Commission.\u003c/p>\n\u003cp>In January, the company behind Lumosity agreed to \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges\">pay a $2 million fine\u003c/a> to settle \u003ca href=\"https://www.ftc.gov/system/files/documents/cases/160105lumoslabsstip.pdf\">FTC charges\u003c/a> that it made unfounded claims about its brain training program.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And in May, a smaller brain training company called LearningRx agreed to pay a $200,000 fine to settle \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/05/marketers-one-one-brain-training-programs-settle-ftc-charges\">similar charges\u003c/a>. Even so, the \u003ca href=\"http://www.learningrx.com/\">Learning Rx website\u003c/a> still promises \"A better brain at any age.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Brain+Game+Claims+Fail+A+Big+Scientific+Test&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "First Automated Insulin System Approved For Type 1 Diabetes",
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"content": "\u003cp>The Food and Drug Administration's approval of a new insulin delivery system for people with Type 1 diabetes is a big deal.\u003c/p>\n\u003cp>With Type 1 diabetes, the pancreas makes little or no insulin so people have to replace it with either multiple daily injections or a pump. In either case, that process involves constant error-prone adjustments, particularly around food and exercise. Over the long term, high blood sugar levels can lead to organ damage, but over-correcting by giving more insulin can cause dangerous low blood sugars that can lead to unconsciousness.\u003c/p>\n\u003cp>The device, Medtronic's MiniMed 670G hybrid closed loop system, is made up of an insulin pump and continuous glucose monitor (CGM), both of which are already on the market separately. The new part involves the communication between the two devices.\u003c/p>\n\u003cp>Medtronic's \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/30/382172052/diabetes-technology-inches-closer-to-an-artificial-pancreas\">previous system \u003c/a>already had a feature that would shut down the insulin pump if the wearer's blood sugar dropped too low. But the 670G predicts when a person's blood sugar is dropping and prevents the low in the first place, and also corrects high blood sugars.\u003c/p>\n\u003cp>This is the first such machine in the world with that level of automation, and thus it is informally being called the first \"artificial pancreas\" system.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>However, it's called a hybrid rather than a fully closed-loop system because users will still need to signal that they're about to eat and estimate the carbohydrate count of the food so the device can calculate the additional amount of insulin needed. That means there's still the possibility of mistakes. But now if that count is off, the 670G will correct the error automatically.\u003c/p>\n\u003cp>For people with Type 1 diabetes, the new capabilities mean they can both sleep through the night without worrying about their blood sugars dropping too low and can go through their day without having to think about their diabetes all the time, according to Aaron Kowalski, chief mission officer for the JDRF, the organization that funds much of the \"artificial pancreas\" research.\u003c/p>\n\u003cp>\"You get almost normalized overnight blood glucose. For people with Type 1 diabetes, that's massively important,\" he said, adding that the overall 24/7 burden reduction means better quality of life. \"The diabetes isn't gone, but [wearers] can think about it less ...This is a historic milestone.\"\u003c/p>\n\u003cp>And more systems like this are coming.\u003c/p>\n\u003cp>Medtronic, via the Minimed division that it acquired in 2001, was the first to market because it's still the only company that manufactures both the insulin pump and CGM technology. But at least five other partnerships between other manufacturers are now developing closed-loop systems, some using already-available pumps and CGMs, others creating new devices. The systems will likely differ from one another in form, user interface, and in the algorithmic approaches embedded in the communication software, \"so people with diabetes will have more choices,\" Kowalski says, noting that JDRF is \"celebrating Medtronic because it's the first commercial system, but we're supporting the entire field.\"\u003c/p>\n\u003cp>Of course, the field still faces challenges. One of the major technological problems is that insulin deposited just under the skin takes too long to begin working; that's why people still need to signal ahead that they're about to eat. The JDRF is currently funding several initiatives working on making faster-acting insulins.\u003c/p>\n\u003cp>\"The faster the insulin works, the more closed the loop will be,\" Kowalski notes. \"It's not easy, but there's a lot of work going on.\"\u003c/p>\n\u003cp>Wearability is another issue. Some people simply don't want to be strapped to devices, even if it means better diabetes control. So, the JDRF has recently announced new funding for miniaturization of the devices.\u003c/p>\n\u003cp>And of course, there's the problem of access. While insurance coverage for insulin pumps is widely established, this is not the case for the CGM component. Medicare doesn't cover CGM technology, meaning that people now must give up those devices or pay out of pocket when they reach age 65. The JDRF is one of several organizations lobbying to change that, as well as to make sure that all payers recognize both the health and economic advantages of new diabetes technologies.\u003c/p>\n\u003cp>\"This is a priority for us,\" Kowalski says. \"We need to make sure people have access. Not just rich people, but anybody who will benefit.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For now, the 670G, which the FDA gave the nod on Wednesday, is only \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM522974.htm\">approved\u003c/a> for people aged 14 years and older. But Medtronic is studying it in children ages 7-13 with the aim of making it available for them, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+Approves+The+First+Automated+Insulin+System+For+Type+1+Diabetes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration's approval of a new insulin delivery system for people with Type 1 diabetes is a big deal.\u003c/p>\n\u003cp>With Type 1 diabetes, the pancreas makes little or no insulin so people have to replace it with either multiple daily injections or a pump. In either case, that process involves constant error-prone adjustments, particularly around food and exercise. Over the long term, high blood sugar levels can lead to organ damage, but over-correcting by giving more insulin can cause dangerous low blood sugars that can lead to unconsciousness.\u003c/p>\n\u003cp>The device, Medtronic's MiniMed 670G hybrid closed loop system, is made up of an insulin pump and continuous glucose monitor (CGM), both of which are already on the market separately. The new part involves the communication between the two devices.\u003c/p>\n\u003cp>Medtronic's \u003ca href=\"http://www.npr.org/sections/health-shots/2015/01/30/382172052/diabetes-technology-inches-closer-to-an-artificial-pancreas\">previous system \u003c/a>already had a feature that would shut down the insulin pump if the wearer's blood sugar dropped too low. But the 670G predicts when a person's blood sugar is dropping and prevents the low in the first place, and also corrects high blood sugars.\u003c/p>\n\u003cp>This is the first such machine in the world with that level of automation, and thus it is informally being called the first \"artificial pancreas\" system.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>However, it's called a hybrid rather than a fully closed-loop system because users will still need to signal that they're about to eat and estimate the carbohydrate count of the food so the device can calculate the additional amount of insulin needed. That means there's still the possibility of mistakes. But now if that count is off, the 670G will correct the error automatically.\u003c/p>\n\u003cp>For people with Type 1 diabetes, the new capabilities mean they can both sleep through the night without worrying about their blood sugars dropping too low and can go through their day without having to think about their diabetes all the time, according to Aaron Kowalski, chief mission officer for the JDRF, the organization that funds much of the \"artificial pancreas\" research.\u003c/p>\n\u003cp>\"You get almost normalized overnight blood glucose. For people with Type 1 diabetes, that's massively important,\" he said, adding that the overall 24/7 burden reduction means better quality of life. \"The diabetes isn't gone, but [wearers] can think about it less ...This is a historic milestone.\"\u003c/p>\n\u003cp>And more systems like this are coming.\u003c/p>\n\u003cp>Medtronic, via the Minimed division that it acquired in 2001, was the first to market because it's still the only company that manufactures both the insulin pump and CGM technology. But at least five other partnerships between other manufacturers are now developing closed-loop systems, some using already-available pumps and CGMs, others creating new devices. The systems will likely differ from one another in form, user interface, and in the algorithmic approaches embedded in the communication software, \"so people with diabetes will have more choices,\" Kowalski says, noting that JDRF is \"celebrating Medtronic because it's the first commercial system, but we're supporting the entire field.\"\u003c/p>\n\u003cp>Of course, the field still faces challenges. One of the major technological problems is that insulin deposited just under the skin takes too long to begin working; that's why people still need to signal ahead that they're about to eat. The JDRF is currently funding several initiatives working on making faster-acting insulins.\u003c/p>\n\u003cp>\"The faster the insulin works, the more closed the loop will be,\" Kowalski notes. \"It's not easy, but there's a lot of work going on.\"\u003c/p>\n\u003cp>Wearability is another issue. Some people simply don't want to be strapped to devices, even if it means better diabetes control. So, the JDRF has recently announced new funding for miniaturization of the devices.\u003c/p>\n\u003cp>And of course, there's the problem of access. While insurance coverage for insulin pumps is widely established, this is not the case for the CGM component. Medicare doesn't cover CGM technology, meaning that people now must give up those devices or pay out of pocket when they reach age 65. The JDRF is one of several organizations lobbying to change that, as well as to make sure that all payers recognize both the health and economic advantages of new diabetes technologies.\u003c/p>\n\u003cp>\"This is a priority for us,\" Kowalski says. \"We need to make sure people have access. Not just rich people, but anybody who will benefit.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For now, the 670G, which the FDA gave the nod on Wednesday, is only \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/UCM522974.htm\">approved\u003c/a> for people aged 14 years and older. But Medtronic is studying it in children ages 7-13 with the aim of making it available for them, too.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=FDA+Approves+The+First+Automated+Insulin+System+For+Type+1+Diabetes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Some Countries Fight Open Defecation With 'Walk of Shame'",
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"content": "\u003cp>A group of villagers walks through Jiling, in the Nuwakot district of central Nepal, with eyes glued to the ground. They cut narrow paths around rice fields and yield to goats until they find what they are looking for: A brown, stinky, fly-covered pile.\u003c/p>\n\u003cp>\"It's poop,\" laughs 40-year-old Chandra Kumari.\u003c/p>\n\u003cp>Human poop.\u003c/p>\n\u003cp>Leading the expedition is Sanjaya Devkota, who works for the U.N. Habitat through the \u003ca href=\"http://wsscc.org/global-sanitation-fund/\">Global Sanitation Fund\u003c/a>. He asks who's responsible for the offending pile.\u003c/p>\n\u003cp>The group thinks a child from a nearby house did it and calls out to the mother. Devkota questions her: \"When there's poop out in the open like this, how do you feel?\" he asks. \"Do you feel good about that? And the flies on it, do they only stay at your house, or do they go to your neighbor's house too?\" The woman looks really embarrassed, and the whole thing feels kind of ... icky. But, that's exactly the point.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Devkota is practicing a behavior change strategy called \u003ca href=\"http://www.communityledtotalsanitation.org/\">Community Led Total Sanitation\u003c/a>. CLTS was pioneered in Bangladesh in 2000 by \u003ca href=\"http://www.communityledtotalsanitation.org/page/kamal-kar\">Kamal Kar\u003c/a>, an Indian-born agriculture and natural resources specialist, as a new way to combat open defecation; Bangladesh has since \u003ca href=\"https://www.thethirdpole.net/2016/03/03/open-defecation-ends-in-bangladesh-almost/\">nearly eliminated the practice\u003c/a>. The focus is on eliciting shame and disgust as motivation to improve sanitation. Critics question the ethics of a shaming approach, but proponents say it's a promising strategy for a serious public health problem.\u003c/p>\n\u003cp>\"It's specifically for people to feel that what they're doing is dirty or unhealthy or not right for their communities,\" says Alison Bradley. Bradley works with the \u003ca href=\"http://wsscc.org/\">Water Supply and Sanitation Collaborative Council\u003c/a>, a U.N. member organization that supports Devkota's work and advocates CLTS. \"The notion that one family is defecating outside and that you know it's pretty gross is part of the process of helping the whole community realize that they need to take charge of their sanitation needs,\" Bradley explains.\u003c/p>\n\u003cp>Across the globe, bringing an end to open defecation remains a public health puzzle. About \u003ca href=\"http://unicef.in/Whatwedo/11/Eliminate-Open-Defecation\">600 million people in India\u003c/a> alone defecate outside, and the practice persists in much of the developing world. Today, about 30 percent of Nepali homes don't have toilets — and here a toilet doesn't mean your standard porcelain bowl. It often means an outdoor squat latrine, with some type of cover to keep flies out. Millions still relieve themselves in fields or other places outside.\u003c/p>\n\u003cp>And that presents a huge health problem.\u003c/p>\n\u003cp>Open defecation is directly connected with the incidence of diarrheal diseases, as flies that land on feces transmit bacteria to food and drinking water. Persistent diarrhea can stunt a young child's development and \u003ca href=\"http://data.unicef.org/child-health/diarrhoeal-disease.html\">kills some 500,000 children a year\u003c/a>. Open defecation also puts \u003ca href=\"http://www.npr.org/sections/parallels/2014/06/09/319529037/indias-rape-uproar-ignites-demand-to-end-open-defecation\">girls and women at risk of sexual assault\u003c/a> while relieving themselves outside after dark.\u003c/p>\n\u003cp>A logical solution might seem to be building toilets or giving people the money to do so. But proponents of CLTS say financial support is not very effective. Bradley says toilets built through such subsidy-based approaches often go unused because the habit of going outside hasn't been undone. Traveling across India, she describes seeing household latrines \"used as chicken coops or sometimes even as temples.\" The \u003ca href=\"http://riceinstitute.org/data/squat/\">2014 \"SQUAT\" survey\u003c/a> in five Indian states found that in 40 percent of households with a working latrine, someone still defecates outside. Households with toilets built through government support were \u003ca href=\"http://riceinstitute.org/maps/open-defecation-among-toilet-owners-by-type-of-latrine/\">twice as likely to practice open defecation\u003c/a> as people who constructed toilets themselves.\u003c/p>\n\u003cp>Instead of subsidies, CLTS tries to make people want to build toilets themselves. The idea is that if people are truly convinced that using a toilet is better for family and community health, they'll be willing to spend some of what may be very limited income on sanitation.\u003c/p>\n\u003cp>The \"walk of shame\" — a tour through a neighborhood led by a CLTS facilitator — draws on the powerful force of social pressure in tight-knit communities. Other CLTS methods include visceral demonstrations of bacterial contamination. One strategy is to show how flies in contact with open feces invisibly contaminate drinking water by touching a piece of human hair — representing a fly's leg — to a pile of stool, dunking the hair in a cup of water and asking someone to drink from the clean-looking but obviously contaminated water. When Eva Kumari Paudel, a community health volunteer in another village in Nuwakot, said she didn't have the money to repair her toilet that was damaged after last year's earthquake, a community mobilizer with U.N. Habitat fingered the small gold hoops snaking down each of her earlobes. \"You have money for these ornaments and you're asking for money for your toilet?\" he asked her. That's a classic CLTS approach.\u003c/p>\n\u003cp>The connection between sanitation and dignity is a common theme. Across Nepal billboards decry open defecation as a \"social crime.\" In 2007, the Haryana state of India famously rolled out its \u003ca href=\"http://www.washingtonpost.com/wp-dyn/content/article/2009/10/11/AR2009101101934.html?sub=AR&wprss%3Drss_world\">\"No Toilet, No Bride\"\u003c/a> campaign, which encouraged families to demand a toilet as part of marriage negotiations. The Global Sanitation Fund pursues CLTS programming in \u003ca href=\"http://wsscc.org/global-sanitation-fund/#GSFCountries\">13 countries\u003c/a>, and the methodology has been embraced by global agencies like UNICEF, WaterAid and Plan International. The Nepal government endorsed the CLTS method in its 2011 \u003ca href=\"http://www.ircwash.org/resources/sanitation-and-hygiene-master-plan\">Sanitation and Hygiene Master Plan\u003c/a>.\u003c/p>\n\u003cp>But not everyone agrees with the idea of shaming the poor into sanitary submission. \"There are massive downsides. The least of which is that the process is, simply put, condescending and offensive,\" says Ben Ayers. Ayers runs \u003ca href=\"https://dzi.org/\">dZi Foundation\u003c/a>, a non-governmental organization that works on development projects in Nepal's mountain regions. dZi tried using some elements of CLTS in its sanitation programming, but community members said the tactics caused too much conflict.\u003c/p>\n\u003cp>\"The families without land or resources are, almost by definition, poor and lower or untouchable caste. CLTS creates a dynamic where high-caste families are shaming low-caste families publicly. This only reinforces existing structures of discrimination, which leads inevitably to conflict,\" Ayers says. Critics also say community-led efforts can \u003ca href=\"https://www.theguardian.com/global-development/poverty-matters/2011/jun/09/dirty-truth-behind-community-sanitation\">spiral into witch-hunts\u003c/a>, where people follow each other to catch someone doing the deed outside. Sanjaya Devkota says some communities in Nepal set up systems to fine residents for open defecation with the money going to the person doing the reporting.\u003c/p>\n\u003cp>But proponents say the shaming approach is justified by the enormous health costs of open defecation. \"If my neighbors defecate outside and the chickens eat it and walk in it, they come over and infect my house too,\" says Shanta Bahadur Tamang. The 69-year-old, who built a toilet at his house, was frustrated seeing open stool during the walk around his village. If CLTS works the way it's supposed to, he'll channel his anger to pressure the 582 households in Jiling without toilets to use their own resources to build them, meeting the village's goal of being open-defecation free by September.\u003c/p>\n\u003cp>So far, CLTS is showing modest success globally. A \u003ca href=\"http://www.who.int/bulletin/volumes/87/8/08-057422/en/\">2009 study out of Duke\u003c/a> University compared around 500 village households in India's Orissa state exposed to a \"shaming approach\" with another 500 in a control group. Families below the poverty line in both groups got a subsidy for toilet construction. Shame proved to be more effective than subsidies, though a combined \"shame and subsidy\" approach was better than shame alone. A 2013 \u003ca href=\"http://millionssaved.cgdev.org/case-studies/indonesias-total-sanitation-and-sanitation-marketing-program\">impact evaluation of a CLTS based approach in Indonesia\u003c/a> that interviewed around 2,100 households found that communities that received the intervention were 23 percent more likely to build a toilet than those who didn't and had a 30 percent lower rate of diarrhea. And a randomized trial of a CLTS intervention in Mali, involving around 4,500 households, published last year in the Lancet, found kids in villages with the intervention were \u003ca href=\"http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00144-8/abstract\">slightly less likely to be stunted or underweight\u003c/a> than kids in control villages.\u003c/p>\n\u003cp>Amanda Glassman, director of Global Health Policy at the Center for Global Development, says the use of shame remains the subject of ongoing debate in sanitation circles. She says the research shows \"that lives are saved, that disease is prevented, that kids are healthier and live through childhood. That we know for sure, and then the question is, are the tactics worth it.\" Glassman says there are definite ethical questions, but \"it's unethical to let children die too.\"\u003c/p>\n\u003cp>The next challenge [for researchers and development workers] will be to figure out how to lessen the shame and still get results. Sanjaya Devkota says Nepal was making progress on its goal of eliminating open defecation by 2017 until last year's earthquake made shelter a much more pressing concern. But he hopes that those who were already convinced to invest in toilets will continue to do so. Even if the motivational methods might seem a little harsh.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>I ask Chandra Kumari if being called out on her community's hygiene practices bothers her. She quickly protests: \"I'm not ashamed! I think this is good. If we're staying in a dirty place and people come to remind us not to do that, it's a good thing.\"\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Who+Is+Responsible+For+That+Pile+Of+Poop%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A group of villagers walks through Jiling, in the Nuwakot district of central Nepal, with eyes glued to the ground. They cut narrow paths around rice fields and yield to goats until they find what they are looking for: A brown, stinky, fly-covered pile.\u003c/p>\n\u003cp>\"It's poop,\" laughs 40-year-old Chandra Kumari.\u003c/p>\n\u003cp>Human poop.\u003c/p>\n\u003cp>Leading the expedition is Sanjaya Devkota, who works for the U.N. Habitat through the \u003ca href=\"http://wsscc.org/global-sanitation-fund/\">Global Sanitation Fund\u003c/a>. He asks who's responsible for the offending pile.\u003c/p>\n\u003cp>The group thinks a child from a nearby house did it and calls out to the mother. Devkota questions her: \"When there's poop out in the open like this, how do you feel?\" he asks. \"Do you feel good about that? And the flies on it, do they only stay at your house, or do they go to your neighbor's house too?\" The woman looks really embarrassed, and the whole thing feels kind of ... icky. But, that's exactly the point.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Devkota is practicing a behavior change strategy called \u003ca href=\"http://www.communityledtotalsanitation.org/\">Community Led Total Sanitation\u003c/a>. CLTS was pioneered in Bangladesh in 2000 by \u003ca href=\"http://www.communityledtotalsanitation.org/page/kamal-kar\">Kamal Kar\u003c/a>, an Indian-born agriculture and natural resources specialist, as a new way to combat open defecation; Bangladesh has since \u003ca href=\"https://www.thethirdpole.net/2016/03/03/open-defecation-ends-in-bangladesh-almost/\">nearly eliminated the practice\u003c/a>. The focus is on eliciting shame and disgust as motivation to improve sanitation. Critics question the ethics of a shaming approach, but proponents say it's a promising strategy for a serious public health problem.\u003c/p>\n\u003cp>\"It's specifically for people to feel that what they're doing is dirty or unhealthy or not right for their communities,\" says Alison Bradley. Bradley works with the \u003ca href=\"http://wsscc.org/\">Water Supply and Sanitation Collaborative Council\u003c/a>, a U.N. member organization that supports Devkota's work and advocates CLTS. \"The notion that one family is defecating outside and that you know it's pretty gross is part of the process of helping the whole community realize that they need to take charge of their sanitation needs,\" Bradley explains.\u003c/p>\n\u003cp>Across the globe, bringing an end to open defecation remains a public health puzzle. About \u003ca href=\"http://unicef.in/Whatwedo/11/Eliminate-Open-Defecation\">600 million people in India\u003c/a> alone defecate outside, and the practice persists in much of the developing world. Today, about 30 percent of Nepali homes don't have toilets — and here a toilet doesn't mean your standard porcelain bowl. It often means an outdoor squat latrine, with some type of cover to keep flies out. Millions still relieve themselves in fields or other places outside.\u003c/p>\n\u003cp>And that presents a huge health problem.\u003c/p>\n\u003cp>Open defecation is directly connected with the incidence of diarrheal diseases, as flies that land on feces transmit bacteria to food and drinking water. Persistent diarrhea can stunt a young child's development and \u003ca href=\"http://data.unicef.org/child-health/diarrhoeal-disease.html\">kills some 500,000 children a year\u003c/a>. Open defecation also puts \u003ca href=\"http://www.npr.org/sections/parallels/2014/06/09/319529037/indias-rape-uproar-ignites-demand-to-end-open-defecation\">girls and women at risk of sexual assault\u003c/a> while relieving themselves outside after dark.\u003c/p>\n\u003cp>A logical solution might seem to be building toilets or giving people the money to do so. But proponents of CLTS say financial support is not very effective. Bradley says toilets built through such subsidy-based approaches often go unused because the habit of going outside hasn't been undone. Traveling across India, she describes seeing household latrines \"used as chicken coops or sometimes even as temples.\" The \u003ca href=\"http://riceinstitute.org/data/squat/\">2014 \"SQUAT\" survey\u003c/a> in five Indian states found that in 40 percent of households with a working latrine, someone still defecates outside. Households with toilets built through government support were \u003ca href=\"http://riceinstitute.org/maps/open-defecation-among-toilet-owners-by-type-of-latrine/\">twice as likely to practice open defecation\u003c/a> as people who constructed toilets themselves.\u003c/p>\n\u003cp>Instead of subsidies, CLTS tries to make people want to build toilets themselves. The idea is that if people are truly convinced that using a toilet is better for family and community health, they'll be willing to spend some of what may be very limited income on sanitation.\u003c/p>\n\u003cp>The \"walk of shame\" — a tour through a neighborhood led by a CLTS facilitator — draws on the powerful force of social pressure in tight-knit communities. Other CLTS methods include visceral demonstrations of bacterial contamination. One strategy is to show how flies in contact with open feces invisibly contaminate drinking water by touching a piece of human hair — representing a fly's leg — to a pile of stool, dunking the hair in a cup of water and asking someone to drink from the clean-looking but obviously contaminated water. When Eva Kumari Paudel, a community health volunteer in another village in Nuwakot, said she didn't have the money to repair her toilet that was damaged after last year's earthquake, a community mobilizer with U.N. Habitat fingered the small gold hoops snaking down each of her earlobes. \"You have money for these ornaments and you're asking for money for your toilet?\" he asked her. That's a classic CLTS approach.\u003c/p>\n\u003cp>The connection between sanitation and dignity is a common theme. Across Nepal billboards decry open defecation as a \"social crime.\" In 2007, the Haryana state of India famously rolled out its \u003ca href=\"http://www.washingtonpost.com/wp-dyn/content/article/2009/10/11/AR2009101101934.html?sub=AR&wprss%3Drss_world\">\"No Toilet, No Bride\"\u003c/a> campaign, which encouraged families to demand a toilet as part of marriage negotiations. The Global Sanitation Fund pursues CLTS programming in \u003ca href=\"http://wsscc.org/global-sanitation-fund/#GSFCountries\">13 countries\u003c/a>, and the methodology has been embraced by global agencies like UNICEF, WaterAid and Plan International. The Nepal government endorsed the CLTS method in its 2011 \u003ca href=\"http://www.ircwash.org/resources/sanitation-and-hygiene-master-plan\">Sanitation and Hygiene Master Plan\u003c/a>.\u003c/p>\n\u003cp>But not everyone agrees with the idea of shaming the poor into sanitary submission. \"There are massive downsides. The least of which is that the process is, simply put, condescending and offensive,\" says Ben Ayers. Ayers runs \u003ca href=\"https://dzi.org/\">dZi Foundation\u003c/a>, a non-governmental organization that works on development projects in Nepal's mountain regions. dZi tried using some elements of CLTS in its sanitation programming, but community members said the tactics caused too much conflict.\u003c/p>\n\u003cp>\"The families without land or resources are, almost by definition, poor and lower or untouchable caste. CLTS creates a dynamic where high-caste families are shaming low-caste families publicly. This only reinforces existing structures of discrimination, which leads inevitably to conflict,\" Ayers says. Critics also say community-led efforts can \u003ca href=\"https://www.theguardian.com/global-development/poverty-matters/2011/jun/09/dirty-truth-behind-community-sanitation\">spiral into witch-hunts\u003c/a>, where people follow each other to catch someone doing the deed outside. Sanjaya Devkota says some communities in Nepal set up systems to fine residents for open defecation with the money going to the person doing the reporting.\u003c/p>\n\u003cp>But proponents say the shaming approach is justified by the enormous health costs of open defecation. \"If my neighbors defecate outside and the chickens eat it and walk in it, they come over and infect my house too,\" says Shanta Bahadur Tamang. The 69-year-old, who built a toilet at his house, was frustrated seeing open stool during the walk around his village. If CLTS works the way it's supposed to, he'll channel his anger to pressure the 582 households in Jiling without toilets to use their own resources to build them, meeting the village's goal of being open-defecation free by September.\u003c/p>\n\u003cp>So far, CLTS is showing modest success globally. A \u003ca href=\"http://www.who.int/bulletin/volumes/87/8/08-057422/en/\">2009 study out of Duke\u003c/a> University compared around 500 village households in India's Orissa state exposed to a \"shaming approach\" with another 500 in a control group. Families below the poverty line in both groups got a subsidy for toilet construction. Shame proved to be more effective than subsidies, though a combined \"shame and subsidy\" approach was better than shame alone. A 2013 \u003ca href=\"http://millionssaved.cgdev.org/case-studies/indonesias-total-sanitation-and-sanitation-marketing-program\">impact evaluation of a CLTS based approach in Indonesia\u003c/a> that interviewed around 2,100 households found that communities that received the intervention were 23 percent more likely to build a toilet than those who didn't and had a 30 percent lower rate of diarrhea. And a randomized trial of a CLTS intervention in Mali, involving around 4,500 households, published last year in the Lancet, found kids in villages with the intervention were \u003ca href=\"http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)00144-8/abstract\">slightly less likely to be stunted or underweight\u003c/a> than kids in control villages.\u003c/p>\n\u003cp>Amanda Glassman, director of Global Health Policy at the Center for Global Development, says the use of shame remains the subject of ongoing debate in sanitation circles. She says the research shows \"that lives are saved, that disease is prevented, that kids are healthier and live through childhood. That we know for sure, and then the question is, are the tactics worth it.\" Glassman says there are definite ethical questions, but \"it's unethical to let children die too.\"\u003c/p>\n\u003cp>The next challenge [for researchers and development workers] will be to figure out how to lessen the shame and still get results. Sanjaya Devkota says Nepal was making progress on its goal of eliminating open defecation by 2017 until last year's earthquake made shelter a much more pressing concern. But he hopes that those who were already convinced to invest in toilets will continue to do so. Even if the motivational methods might seem a little harsh.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>I ask Chandra Kumari if being called out on her community's hygiene practices bothers her. She quickly protests: \"I'm not ashamed! I think this is good. If we're staying in a dirty place and people come to remind us not to do that, it's a good thing.\"\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Who+Is+Responsible+For+That+Pile+Of+Poop%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Doctor's Quest to Determine if Simple Medication Can Prevent Heart Attacks",
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"content": "\u003cp>When Harry Selker was working as a cardiologist in the 1970s, clot-busting drugs were showing great promise against heart attacks. But their lifesaving properties were very time sensitive. \"If you give it within the first hour it has a 47 percent reduction of mortality; if you wait another hour, it has a 28 percent reduction; another hour, 23 percent. And people were taking about 90 minutes to make that decision,\" he recalls. \"So they were losing the opportunity to save patients' lives.\"\u003c/p>\n\u003cp>Selker envisioned a predictive tool, a kind of calculator that would help make the decision faster. He knew the data to create such a tool were already out there, from research on drugs that dissolve blood clots. \"We made mathematical models and they kind of represented that comparison from those data, and that helped us make these predictive instruments. We built them into electrocardiograms,\" Selker says. That helped physicians make better decisions.\u003c/p>\n\u003cp>The EKG-based \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12118963\">predictive instruments\u003c/a> have helped doctors prescribe clotbusters within the hour, increasing the use of the therapy within one hour, and getting more people treated with either clotbusting drugs or angioplasty.\u003c/p>\n\u003cp>Building on this success, \u003ca href=\"https://www.tuftsmedicalcenter.org/PhysicianDirectory/Harry-Selker.aspx\">Selker \u003c/a>and colleagues at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, where he is executive director, have gone on to develop other predictive tools, in areas from knee replacement therapy to opioid addiction treatment.\u003c/p>\n\u003cp>Selker grew up in a household in the Seattle area where he was encouraged to tinker. In his office, he proudly shows off the first automobile shock absorber, invented by his grandfather.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And while Selker's own list of patents will attest to his passion for innovation, he's equally passionate about working to ensure those innovations will have an impact.\u003c/p>\n\u003cp>One medical treatment Selker is pursuing right now has never delivered on its early promise for saving lives. It's a cocktail of glucose, insulin and potassium, known by its chemical initials GIK. In studies with baboons and rabbits more than 50 years ago, GIK seemed to actually prevent heart attacks. \"They would clamp off these coronary arteries simulating coronary thrombosis, but keep infusing them with glucose and insulin, then potassium,\" Selker says.\u003c/p>\n\u003cp>When the researchers unclamped the arteries, they found no signs of cardiac arrest, as would be expected. The simple concoction had protected heart muscles against damage. Selker says: \"So it was very encouraging. It was extraordinary, really.\"\u003c/p>\n\u003cp>But there was a problem in translation: In human studies, GIK didn't seem to do much of anything to prevent heart attacks or damage. The research sat on the shelf. But when Selker learned about the research from a colleague and they started to discuss it, he became convinced there were fatal flaws in the human studies, including administering the GIK too late to have an effect. Selker and his colleagues designed a study to test GIK in humans.\u003c/p>\n\u003cp>Paramedics in 13 cities gave people who appeared to be having a heart attack either GIK or a placebo. The GIK didn't keep people from having heart attacks, but those given it were less likely to suffer cardiac arrest or death in the hospital. It also reduced the amount of heart damage by 80 percent. The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1151528\">results\u003c/a> were published in \u003cem>JAMA \u003c/em>in 2012.\u003c/p>\n\u003cp>Selker says that if additional research supports these findings, many lives could be saved with a simple therapy that costs less than a hundred bucks. But he soon discovered that knowing what needed to be done wasn't enough.\u003c/p>\n\u003cp>\"I thought, pretty much, my work was done and people call me up and say you know, 'when would we get this GIK stuff?' And I realized nobody's making it, nobody's selling it. And so I started talking to the pharmaceutical companies saying, 'You know, would you make this stuff?' And they basically weren't interested.\"\u003c/p>\n\u003cp>GIK is a cocktail of existing off-the-shelf ingredients. A company could invest in the additional research and work to get it out to patients, but there'd be no big payoff. But Selker refuses to be deterred.\u003c/p>\n\u003cp>He is now in dialogue with the Food and Drug Administration about the details of a definitive clinical trial to determine the effectiveness of GIK in acute coronary emergencies. And like so many times before, he's continuing to reach across professional boundaries, working with policy experts, statistical modelers, anyone who can push the process forward.\u003c/p>\n\u003cp>\"If you're going to try to improve things, you have to work on all angles, you have to work in all disciplines,\" Selker says. \"You can't just work in biology; that would never get you anywhere.\"\u003c/p>\n\u003cp>His happiest moments in research, he says, have been sitting down with people who have ideas he never could have imagined, where he gets to push and prod, challenging them to figure out how to put those ideas to use.\u003c/p>\n\u003cp>\"So working across disciplines and personalities and in different perspectives; that's the good stuff for me. Now really that makes a great day.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Selker is hopeful that the next clinical trial for GIK will take place by early next year, moving one step closer to a tested treatment that could save lives.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=This+Doctor+Is+Trying+To+Stop+Heart+Attacks+In+Their+Tracks&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Harry Selker was working as a cardiologist in the 1970s, clot-busting drugs were showing great promise against heart attacks. But their lifesaving properties were very time sensitive. \"If you give it within the first hour it has a 47 percent reduction of mortality; if you wait another hour, it has a 28 percent reduction; another hour, 23 percent. And people were taking about 90 minutes to make that decision,\" he recalls. \"So they were losing the opportunity to save patients' lives.\"\u003c/p>\n\u003cp>Selker envisioned a predictive tool, a kind of calculator that would help make the decision faster. He knew the data to create such a tool were already out there, from research on drugs that dissolve blood clots. \"We made mathematical models and they kind of represented that comparison from those data, and that helped us make these predictive instruments. We built them into electrocardiograms,\" Selker says. That helped physicians make better decisions.\u003c/p>\n\u003cp>The EKG-based \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/12118963\">predictive instruments\u003c/a> have helped doctors prescribe clotbusters within the hour, increasing the use of the therapy within one hour, and getting more people treated with either clotbusting drugs or angioplasty.\u003c/p>\n\u003cp>Building on this success, \u003ca href=\"https://www.tuftsmedicalcenter.org/PhysicianDirectory/Harry-Selker.aspx\">Selker \u003c/a>and colleagues at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, where he is executive director, have gone on to develop other predictive tools, in areas from knee replacement therapy to opioid addiction treatment.\u003c/p>\n\u003cp>Selker grew up in a household in the Seattle area where he was encouraged to tinker. In his office, he proudly shows off the first automobile shock absorber, invented by his grandfather.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And while Selker's own list of patents will attest to his passion for innovation, he's equally passionate about working to ensure those innovations will have an impact.\u003c/p>\n\u003cp>One medical treatment Selker is pursuing right now has never delivered on its early promise for saving lives. It's a cocktail of glucose, insulin and potassium, known by its chemical initials GIK. In studies with baboons and rabbits more than 50 years ago, GIK seemed to actually prevent heart attacks. \"They would clamp off these coronary arteries simulating coronary thrombosis, but keep infusing them with glucose and insulin, then potassium,\" Selker says.\u003c/p>\n\u003cp>When the researchers unclamped the arteries, they found no signs of cardiac arrest, as would be expected. The simple concoction had protected heart muscles against damage. Selker says: \"So it was very encouraging. It was extraordinary, really.\"\u003c/p>\n\u003cp>But there was a problem in translation: In human studies, GIK didn't seem to do much of anything to prevent heart attacks or damage. The research sat on the shelf. But when Selker learned about the research from a colleague and they started to discuss it, he became convinced there were fatal flaws in the human studies, including administering the GIK too late to have an effect. Selker and his colleagues designed a study to test GIK in humans.\u003c/p>\n\u003cp>Paramedics in 13 cities gave people who appeared to be having a heart attack either GIK or a placebo. The GIK didn't keep people from having heart attacks, but those given it were less likely to suffer cardiac arrest or death in the hospital. It also reduced the amount of heart damage by 80 percent. The \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1151528\">results\u003c/a> were published in \u003cem>JAMA \u003c/em>in 2012.\u003c/p>\n\u003cp>Selker says that if additional research supports these findings, many lives could be saved with a simple therapy that costs less than a hundred bucks. But he soon discovered that knowing what needed to be done wasn't enough.\u003c/p>\n\u003cp>\"I thought, pretty much, my work was done and people call me up and say you know, 'when would we get this GIK stuff?' And I realized nobody's making it, nobody's selling it. And so I started talking to the pharmaceutical companies saying, 'You know, would you make this stuff?' And they basically weren't interested.\"\u003c/p>\n\u003cp>GIK is a cocktail of existing off-the-shelf ingredients. A company could invest in the additional research and work to get it out to patients, but there'd be no big payoff. But Selker refuses to be deterred.\u003c/p>\n\u003cp>He is now in dialogue with the Food and Drug Administration about the details of a definitive clinical trial to determine the effectiveness of GIK in acute coronary emergencies. And like so many times before, he's continuing to reach across professional boundaries, working with policy experts, statistical modelers, anyone who can push the process forward.\u003c/p>\n\u003cp>\"If you're going to try to improve things, you have to work on all angles, you have to work in all disciplines,\" Selker says. \"You can't just work in biology; that would never get you anywhere.\"\u003c/p>\n\u003cp>His happiest moments in research, he says, have been sitting down with people who have ideas he never could have imagined, where he gets to push and prod, challenging them to figure out how to put those ideas to use.\u003c/p>\n\u003cp>\"So working across disciplines and personalities and in different perspectives; that's the good stuff for me. Now really that makes a great day.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Selker is hopeful that the next clinical trial for GIK will take place by early next year, moving one step closer to a tested treatment that could save lives.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=This+Doctor+Is+Trying+To+Stop+Heart+Attacks+In+Their+Tracks&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "The FDA's Controversial Approval of Muscular Dystrophy Drug",
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"content": "\u003cp>When 15-year-old Billy Ellsworth stepped up to the microphone at a Food and Drug Administration public meeting in April, he had no way to know he was part of a historic shift in how the government considers the desires of patients and their advocates in evaluating new drugs.\u003c/p>\n\u003cp>Ellsworth has Duchenne muscular dystrophy, a muscle-wasting disease, that mainly affects boys. And he was taking an experimental drug that the FDA was trying to decide whether to approve.\u003c/p>\n\u003cp>\"I'm going to beat this bloody disease but I need your help,\" Billy told the scientists weighing the evidence about the drug. \"So please help me and my friends and do the right thing. FDA, please don't let me die early.\"\u003c/p>\n\u003cp>Applause swelled from the overflow crowd.\u003c/p>\n\u003cp>His testimony and other pleas like it during the 10-hour hearing clearly affected some of the scientists sitting in judgment of the experimental drug called eteplirsen. But when the scientists turned their attention to the slim evidence before them, they ultimately voted that drugmaker \u003ca href=\"https://www.sarepta.com/\">Sarepta\u003c/a> had not shown that the experimental drug was effective.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Just 12 boys had been involved in the key study, and just about everybody agreed that the research was deeply flawed. But parents of some of those boys were convinced that the drug was in fact helping delay the progression of a disease that ultimately proves fatal.\u003c/p>\n\u003cp>\"We came away really heartbroken in many ways,\" said Pat Furlong, a longtime advocate who founded \u003ca href=\"http://www.parentprojectmd.org/\">Parent Project Muscular Dystrophy\u003c/a> and who had lost two sons to the disease.\u003c/p>\n\u003cp>One similar drug had previously been rejected by the FDA, and two others were turned away before they could even get through the door. There was no approved drug to stop the progression of this disease.\u003c/p>\n\u003cp>But that wasn't the end of the story.\u003c/p>\n\u003cp>Times are changing at the FDA and other federal agencies. In recent years, legislation and regulation has pushed for a greater patient voice in decisions. The FDA's job wasn't simply to look at the science, as it has done for many years. They have \"to look to what is meaningful benefit on the part of the patients,\" Furlong said. \"What do the patients value?\"\u003c/p>\n\u003cp>In this case, the parents saw real promise in this drug, despite the results from the flawed study. They also noted that the drug appears to be safe, so there wasn't much risk. And the research did show that boys on the drug were producing a small amount of a potentially helpful protein called dystrophin, which could be a sign that the drug provides some benefit.\u003c/p>\n\u003cp>That was all part of the FDA's thinking when on Monday \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm521263.htm\">it approved\u003c/a> eteplirsen, brand name Exondys 51, on a provisional basis. A \u003ca href=\"http://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/206488_summary%20review_Redacted.pdf\">letter\u003c/a> written by FDA Commissioner Robert Califf laid out in remarkably frank terms the heated internal debate at the agency, which \u003ca href=\"https://www.statnews.com/pharmalot/2016/09/14/fda-sarepta-farkas-duchenne/\">may have led to the departure\u003c/a> of one key scientist who was opposed to approving the drug.\u003c/p>\n\u003cp>\"It is inevitable that in some of these situations, highly qualified experts will disagree,\" Califf wrote, and he praised Dr. Janet Woodcock, the head of the FDA division that reviews new drugs, who made the call \"in the face of profound changes in science and social interactions related to drugs.\"\u003c/p>\n\u003cp>Califf said Woodcock ultimately made a scientific judgment call, anchored on the observation that the drug does prompt patients to produce at least a small amount of dystrophin.\u003c/p>\n\u003cp>Yet the role of advocacy here was inescapable. It is, after all, the patients who face the risks and the benefits.\u003c/p>\n\u003cp>\"You can look at this as being a potentially damaging precedent, and on the other hand you can look of this as being an innovative precedent, that could bring good things and earlier access to medicines,\" Eric Hoffman told NPR.\u003c/p>\n\u003cp>Hoffman and Louis Kunkel \u003ca href=\"http://www.cell.com/cell/abstract/0092-8674(87)90579-4?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2F0092867487905794%3Fshowall%3Dtrue\">discovered the dystrophin gene in 1987\u003c/a>. Hoffman is now CEO of ReveraGen, a company working on a drug for the disease, as well as associate dean of research at the University of Binghamton's pharmacy school in New York.\u003c/p>\n\u003cp>The FDA decision approves the drug on an accelerated basis, but that approval is contingent on follow-up studies and it can be withdrawn. In other diseases, provisional approvals have been reversed after follow-up studies failed to show the drugs were effective. (Avastin for advanced breast cancer is \u003ca href=\"http://www.npr.org/sections/health-shots/2011/11/18/142503630/fda-pulls-approval-of-avastin-for-advanced-breast-cancer\">a notable example\u003c/a>, despite pleas from patient groups to keep the approval intact).\u003c/p>\n\u003cp>The Sarepta drug addresses just one genetic mutation in muscular dystrophy, and that particular flaw only affects about 1,500 boys in the entire United States. Drugmaker Sarepta plans to use the same approach now to target other mutations related to the disease, and to use those study results to comply with the FDA's requirement for more and better studies.\u003c/p>\n\u003cp>In the meantime, Sarepta can start charging $300,000 per patient per year for treatment with eteplirsen.\u003c/p>\n\u003cp>\"Yes, there was a lot of pressure,\" Dr. Edward Kaye, CEO of Sarepta said, \"but I think the FDA demonstrated the flexibility they are allowed under the law. It took a lot of courage for them to do this. It's always easy to take the safe path and say, just give us more data.\"\u003c/p>\n\u003cp>Advocate Pat Furlong agreed. \"I think the important aspect of this is maybe a new social contract,\" she said. Since the drug is apparently safe and possibly useful, parents wanted to make the drug available while the questions about usefulness and value are fully answered. \"And at the end of five years we can reevaluate whether this really hits its mark in terms of the healthcare cost and the benefit to patients,\" she said.\u003c/p>\n\u003cp>More than a dozen potential drugs for this disease are in the pipeline now, and at the very least they now have a standard against which they can be judged.\u003c/p>\n\u003cp>The decision about eteplirsen would have been considerably easier, for patients and scientists alike, if the company had conducted its trials carefully and rigorously.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Considering that a substantially flawed development program contributed to the difficulty of coming to resolution in this case, we must redouble our efforts to ... use methods that will produce high-quality evidence from the outset,\" Califf wrote.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Controversy+Continues+Over+Muscular+Dystrophy+Drug%2C+Despite+FDA+Approval&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When 15-year-old Billy Ellsworth stepped up to the microphone at a Food and Drug Administration public meeting in April, he had no way to know he was part of a historic shift in how the government considers the desires of patients and their advocates in evaluating new drugs.\u003c/p>\n\u003cp>Ellsworth has Duchenne muscular dystrophy, a muscle-wasting disease, that mainly affects boys. And he was taking an experimental drug that the FDA was trying to decide whether to approve.\u003c/p>\n\u003cp>\"I'm going to beat this bloody disease but I need your help,\" Billy told the scientists weighing the evidence about the drug. \"So please help me and my friends and do the right thing. FDA, please don't let me die early.\"\u003c/p>\n\u003cp>Applause swelled from the overflow crowd.\u003c/p>\n\u003cp>His testimony and other pleas like it during the 10-hour hearing clearly affected some of the scientists sitting in judgment of the experimental drug called eteplirsen. But when the scientists turned their attention to the slim evidence before them, they ultimately voted that drugmaker \u003ca href=\"https://www.sarepta.com/\">Sarepta\u003c/a> had not shown that the experimental drug was effective.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Just 12 boys had been involved in the key study, and just about everybody agreed that the research was deeply flawed. But parents of some of those boys were convinced that the drug was in fact helping delay the progression of a disease that ultimately proves fatal.\u003c/p>\n\u003cp>\"We came away really heartbroken in many ways,\" said Pat Furlong, a longtime advocate who founded \u003ca href=\"http://www.parentprojectmd.org/\">Parent Project Muscular Dystrophy\u003c/a> and who had lost two sons to the disease.\u003c/p>\n\u003cp>One similar drug had previously been rejected by the FDA, and two others were turned away before they could even get through the door. There was no approved drug to stop the progression of this disease.\u003c/p>\n\u003cp>But that wasn't the end of the story.\u003c/p>\n\u003cp>Times are changing at the FDA and other federal agencies. In recent years, legislation and regulation has pushed for a greater patient voice in decisions. The FDA's job wasn't simply to look at the science, as it has done for many years. They have \"to look to what is meaningful benefit on the part of the patients,\" Furlong said. \"What do the patients value?\"\u003c/p>\n\u003cp>In this case, the parents saw real promise in this drug, despite the results from the flawed study. They also noted that the drug appears to be safe, so there wasn't much risk. And the research did show that boys on the drug were producing a small amount of a potentially helpful protein called dystrophin, which could be a sign that the drug provides some benefit.\u003c/p>\n\u003cp>That was all part of the FDA's thinking when on Monday \u003ca href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm521263.htm\">it approved\u003c/a> eteplirsen, brand name Exondys 51, on a provisional basis. A \u003ca href=\"http://www.accessdata.fda.gov/drugsatfda_docs/nda/2016/206488_summary%20review_Redacted.pdf\">letter\u003c/a> written by FDA Commissioner Robert Califf laid out in remarkably frank terms the heated internal debate at the agency, which \u003ca href=\"https://www.statnews.com/pharmalot/2016/09/14/fda-sarepta-farkas-duchenne/\">may have led to the departure\u003c/a> of one key scientist who was opposed to approving the drug.\u003c/p>\n\u003cp>\"It is inevitable that in some of these situations, highly qualified experts will disagree,\" Califf wrote, and he praised Dr. Janet Woodcock, the head of the FDA division that reviews new drugs, who made the call \"in the face of profound changes in science and social interactions related to drugs.\"\u003c/p>\n\u003cp>Califf said Woodcock ultimately made a scientific judgment call, anchored on the observation that the drug does prompt patients to produce at least a small amount of dystrophin.\u003c/p>\n\u003cp>Yet the role of advocacy here was inescapable. It is, after all, the patients who face the risks and the benefits.\u003c/p>\n\u003cp>\"You can look at this as being a potentially damaging precedent, and on the other hand you can look of this as being an innovative precedent, that could bring good things and earlier access to medicines,\" Eric Hoffman told NPR.\u003c/p>\n\u003cp>Hoffman and Louis Kunkel \u003ca href=\"http://www.cell.com/cell/abstract/0092-8674(87)90579-4?_returnURL=http%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2F0092867487905794%3Fshowall%3Dtrue\">discovered the dystrophin gene in 1987\u003c/a>. Hoffman is now CEO of ReveraGen, a company working on a drug for the disease, as well as associate dean of research at the University of Binghamton's pharmacy school in New York.\u003c/p>\n\u003cp>The FDA decision approves the drug on an accelerated basis, but that approval is contingent on follow-up studies and it can be withdrawn. In other diseases, provisional approvals have been reversed after follow-up studies failed to show the drugs were effective. (Avastin for advanced breast cancer is \u003ca href=\"http://www.npr.org/sections/health-shots/2011/11/18/142503630/fda-pulls-approval-of-avastin-for-advanced-breast-cancer\">a notable example\u003c/a>, despite pleas from patient groups to keep the approval intact).\u003c/p>\n\u003cp>The Sarepta drug addresses just one genetic mutation in muscular dystrophy, and that particular flaw only affects about 1,500 boys in the entire United States. Drugmaker Sarepta plans to use the same approach now to target other mutations related to the disease, and to use those study results to comply with the FDA's requirement for more and better studies.\u003c/p>\n\u003cp>In the meantime, Sarepta can start charging $300,000 per patient per year for treatment with eteplirsen.\u003c/p>\n\u003cp>\"Yes, there was a lot of pressure,\" Dr. Edward Kaye, CEO of Sarepta said, \"but I think the FDA demonstrated the flexibility they are allowed under the law. It took a lot of courage for them to do this. It's always easy to take the safe path and say, just give us more data.\"\u003c/p>\n\u003cp>Advocate Pat Furlong agreed. \"I think the important aspect of this is maybe a new social contract,\" she said. Since the drug is apparently safe and possibly useful, parents wanted to make the drug available while the questions about usefulness and value are fully answered. \"And at the end of five years we can reevaluate whether this really hits its mark in terms of the healthcare cost and the benefit to patients,\" she said.\u003c/p>\n\u003cp>More than a dozen potential drugs for this disease are in the pipeline now, and at the very least they now have a standard against which they can be judged.\u003c/p>\n\u003cp>The decision about eteplirsen would have been considerably easier, for patients and scientists alike, if the company had conducted its trials carefully and rigorously.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Considering that a substantially flawed development program contributed to the difficulty of coming to resolution in this case, we must redouble our efforts to ... use methods that will produce high-quality evidence from the outset,\" Califf wrote.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Controversy+Continues+Over+Muscular+Dystrophy+Drug%2C+Despite+FDA+Approval&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The idea is simple: Load fresh fruits and vegetables into a refrigerator truck and drive it to a health clinic, then have a doctor write a \"prescription\" for food to improve the diets of low-income people with diabetes and high blood pressure.\u003c/p>\n\u003cp>U.S. food banks — the organizations on the front lines of fighting hunger — increasingly are promoting \"food as medicine\" strategies designed to address, not exacerbate, the high rate of chronic health problems among the poor.\u003c/p>\n\u003cp>One-third of households using food banks are feeding a family member with diabetes, and 58 percent have a family member with high blood pressure, according to a recent survey by Feeding America, a national network of 200 food banks. Meanwhile, 55 percent of people identify fresh fruits and vegetables as the foods they most desire but aren't receiving from their food pantry.\u003c/p>\n\u003cp>\"I'm on a very limited income,\" said James Cline, who has diabetes and gets by on $700 a month living with his mother in suburban Chicago. Disabled after an all-terrain vehicle accident, the 53-year-old former loading dock worker knows he should eat more fresh produce. But the cost of a nutritious diet can be out of reach, so he took his doctor's advice and showed up for a recent produce giveaway at Oak Forest Health Center.\u003c/p>\n\u003cp>\"It helps a lot,\" he said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Since August 2015, six Chicago-area clinics have hosted 26 \"Fresh Truck\" visits by the Greater Chicago Food Depository, providing more than 100,000 pounds of fresh fruit and vegetables to more than 3,200 households.\u003c/p>\n\u003cp>Nationally, 30 food banks are working directly with health care providers to identify low-income patients who sometimes run out of food. In Idaho, doctors in Boise and Caldwell plan to add small food pantries to their offices. In Delaware, pediatricians write \"prescriptions\" for fresh produce; a family can get up to 25 pounds each month distributed by the local food bank at clinics. Two hospitals, in Alabama and Florida, collaborated with a Gulf Coast food bank to offer free lunches during the summer to children with hospitalized relatives.\u003c/p>\n\u003cp>\"Food banks are trying to do better by providing fewer starches and carbs and more lean proteins, fruits, vegetables and whole grains,\" said Dr. Hilary Seligman, senior medical adviser for Feeding America. \"The nutritious foods that are expensive for our clients are also expensive for food banks. We're figuring out how we can do this and do it better.\"\u003c/p>\n\u003cp>Seligman is leading a clinical trial to measure if food banks can help people with diabetes improve their blood sugar levels through education and tailored food packages. Researchers have enrolled 572 food pantry clients in Detroit, Houston and Oakland, California. Results are expected in 2018.\u003c/p>\n\u003cp>\"If this works, we'll spread it across the Feeding America network, and if it doesn't, we'll try something else,\" Seligman said.\u003c/p>\n\u003cp>Food banks, whose supplies are stocked through purchases and food donations, have hired dietitians to teach classes. Some are barring donations of sweets.\u003c/p>\n\u003cp>\"We don't accept candy. We don't accept soda,\" said Kim Turner of the Delaware Food Bank. \"We want to make sure the foods we're giving to low-income people are the best nutrition possible.\"\u003c/p>\n\u003cp>Food banks distributed 1.25 billion pounds of fresh produce from July 2015 through June this year.\u003c/p>\n\u003cp>\"That's double what it was five years earlier,\" said Ross Fraser of Feeding America, adding that food banks rescue perishable fruits and vegetables with \"cosmetic issues\" otherwise headed for the trash. \"Produce that is too small, too big, too round or not round enough.\"\u003c/p>\n\u003cp>Growers have answered the call, said Idaho Food Bank CEO Karen Vauk.\u003c/p>\n\u003cp>\"Boy, did they respond,\" Vauk said. \"We have certainly been overwhelmed by the increase in produce. Most of it is right out of the field. And it's not all potatoes. It's peaches and plums. Beautiful produce.\"\u003c/p>\n\u003cp>On Thursday, Cline showed a visitor the bananas, onions, cantaloupe, potatoes, kale and other produce in the box he was taking home.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a big help,\" he said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The idea is simple: Load fresh fruits and vegetables into a refrigerator truck and drive it to a health clinic, then have a doctor write a \"prescription\" for food to improve the diets of low-income people with diabetes and high blood pressure.\u003c/p>\n\u003cp>U.S. food banks — the organizations on the front lines of fighting hunger — increasingly are promoting \"food as medicine\" strategies designed to address, not exacerbate, the high rate of chronic health problems among the poor.\u003c/p>\n\u003cp>One-third of households using food banks are feeding a family member with diabetes, and 58 percent have a family member with high blood pressure, according to a recent survey by Feeding America, a national network of 200 food banks. Meanwhile, 55 percent of people identify fresh fruits and vegetables as the foods they most desire but aren't receiving from their food pantry.\u003c/p>\n\u003cp>\"I'm on a very limited income,\" said James Cline, who has diabetes and gets by on $700 a month living with his mother in suburban Chicago. Disabled after an all-terrain vehicle accident, the 53-year-old former loading dock worker knows he should eat more fresh produce. But the cost of a nutritious diet can be out of reach, so he took his doctor's advice and showed up for a recent produce giveaway at Oak Forest Health Center.\u003c/p>\n\u003cp>\"It helps a lot,\" he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Since August 2015, six Chicago-area clinics have hosted 26 \"Fresh Truck\" visits by the Greater Chicago Food Depository, providing more than 100,000 pounds of fresh fruit and vegetables to more than 3,200 households.\u003c/p>\n\u003cp>Nationally, 30 food banks are working directly with health care providers to identify low-income patients who sometimes run out of food. In Idaho, doctors in Boise and Caldwell plan to add small food pantries to their offices. In Delaware, pediatricians write \"prescriptions\" for fresh produce; a family can get up to 25 pounds each month distributed by the local food bank at clinics. Two hospitals, in Alabama and Florida, collaborated with a Gulf Coast food bank to offer free lunches during the summer to children with hospitalized relatives.\u003c/p>\n\u003cp>\"Food banks are trying to do better by providing fewer starches and carbs and more lean proteins, fruits, vegetables and whole grains,\" said Dr. Hilary Seligman, senior medical adviser for Feeding America. \"The nutritious foods that are expensive for our clients are also expensive for food banks. We're figuring out how we can do this and do it better.\"\u003c/p>\n\u003cp>Seligman is leading a clinical trial to measure if food banks can help people with diabetes improve their blood sugar levels through education and tailored food packages. Researchers have enrolled 572 food pantry clients in Detroit, Houston and Oakland, California. Results are expected in 2018.\u003c/p>\n\u003cp>\"If this works, we'll spread it across the Feeding America network, and if it doesn't, we'll try something else,\" Seligman said.\u003c/p>\n\u003cp>Food banks, whose supplies are stocked through purchases and food donations, have hired dietitians to teach classes. Some are barring donations of sweets.\u003c/p>\n\u003cp>\"We don't accept candy. We don't accept soda,\" said Kim Turner of the Delaware Food Bank. \"We want to make sure the foods we're giving to low-income people are the best nutrition possible.\"\u003c/p>\n\u003cp>Food banks distributed 1.25 billion pounds of fresh produce from July 2015 through June this year.\u003c/p>\n\u003cp>\"That's double what it was five years earlier,\" said Ross Fraser of Feeding America, adding that food banks rescue perishable fruits and vegetables with \"cosmetic issues\" otherwise headed for the trash. \"Produce that is too small, too big, too round or not round enough.\"\u003c/p>\n\u003cp>Growers have answered the call, said Idaho Food Bank CEO Karen Vauk.\u003c/p>\n\u003cp>\"Boy, did they respond,\" Vauk said. \"We have certainly been overwhelmed by the increase in produce. Most of it is right out of the field. And it's not all potatoes. It's peaches and plums. Beautiful produce.\"\u003c/p>\n\u003cp>On Thursday, Cline showed a visitor the bananas, onions, cantaloupe, potatoes, kale and other produce in the box he was taking home.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's a big help,\" he said.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "U.N. Takes 'Historic' Action Against Antibiotic Resistance",
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"content": "\u003cp>Historic. A possible turning point.\u003c/p>\n\u003cp>These are the words health researchers are using to describe a declaration passed Wednesday by the U.N. General Assembly aiming to slow down the spread of superbugs — bacteria that have become resistant to antibiotics.\u003c/p>\n\u003cp>\"I think the declaration will have very strong implications,\" says the \u003ca href=\"http://www.who.int/en/\">World Health Organization's\u003c/a> Dr. Keiji Fukuda. \"What it will convey is that there's recognition that we have a big problem and there's a commitment to do something about it.\"\u003c/p>\n\u003cp>Every year, more than 2 million Americans get sick with antibiotic-resistant infections, and tens of thousands die as a result, \u003ca href=\"http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf\">says\u003c/a> the Centers for Disease Control and Prevention. Common diseases, like urinary tract infections and pneumonia, are becoming harder and harder to treat. And new superbugs are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/26/479639936/germ-resistant-to-antibiotic-of-last-resort-appears-in-u-s\">cropping up\u003c/a> — even here in the U.S. — that are resistant to last-resort drugs.\u003c/p>\n\u003cp>Doctors have been warning about this problem for decades. But in the past year or so, another group of researchers has started taking interest in superbugs: economists. And they quickly realized the problem goes way beyond health.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Antibiotic resistance has immense economic consequences and immense implications for food,\" Fukuda says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There's recognition that we have a big problem and there's a commitment to do something about it.'\u003ccite>Dr. Keiji Fukuda, World Health Organization\u003c/cite>\u003c/aside>\n\u003cp>A recent \u003ca href=\"http://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf\">report\u003c/a> from the U.K. government found that antibiotic-resistant bacteria could cost the world $100 trillion by 2050 if nothing is done about it. The World Bank \u003ca href=\"http://www.worldbank.org/en/news/press-release/2016/09/18/by-2050-drug-resistant-infections-could-cause-global-economic-damage-on-par-with-2008-financial-crisis\">predicts\u003c/a> drug-resistant infections could damage the economy as much as — or even more than — the 2008 financial crisis. And annual global GDP could drop by 1 to 4 percent, the agency says.\u003c/p>\n\u003cp>On top of that, farmers around the world have come to rely on antibiotics to raise animals. The drugs make pigs, cows and chickens grow fatter more quickly — and keeps them healthy in densely packed quarters.\u003c/p>\n\u003cp>\"If we lose that ability we begin to perhaps lose the ability to have adequate food supplies in the world,\" Fukuda says.\u003c/p>\n\u003cp>And that's why world leaders are now getting involved. The U.N.'s declaration requires countries to come up with a two-year a plan to protect the potency of antibiotics. Countries need to create ways to monitor the use of antibiotics in medicine and agriculture, start curbing that use and begin developing new antibiotics that work.\u003c/p>\n\u003cfigure id=\"attachment_250257\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-250257\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Staph.-aureus-800x541.jpg\" alt=\"Staphylococcus Aureus in biofilm, magnified.\" width=\"800\" height=\"541\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-800x541.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-400x270.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-768x519.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-960x649.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Staphylococcus Aureus in biofilm, magnified. \u003ccite>(Janice Carr/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After two years, the U.N.'s secretary-general will assess each country's plan and check to make sure each is making progress.\u003c/p>\n\u003cp>\"I think this is the first realistic chance, in our lifetime, to turn this around,\" Fukuda says.\u003c/p>\n\u003cp>And there's precedent for this optimism.\u003c/p>\n\u003cp>Back in 2001, the U.N. made a \u003ca href=\"http://www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html\">similar declaration\u003c/a> about the HIV pandemic. And that declaration had a big impact on curbing the spread of HIV around the world, says \u003ca href=\"http://www.cddep.org/profile/ramanan_laxminarayan#sthash.UiH1YYRk.dpbs\">Ramanan Laxminarayan\u003c/a>, who directs the Center for Disease Dynamics, Economics & Policy in Washington, D.C.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>The declaration made countries take responsibility for the HIV burden,\" he says. People were willing to start talking about and change their attitudes on stigma. And last but not least, the declaration made sure that lots of money went towards both treatment and prevention.\"\u003c/p>\n\u003cp>He says there are a few weaknesses in the U.N.'s new plan on antibiotic-resistant bacteria. For example, there are no hardcore targets for reducing antibiotic use by a certain amount in two years.\u003c/p>\n\u003cp>But he thinks the declaration could have the same impact on fighting antibiotic-resistant bacteria as the previous one had on fighting HIV. Since 2004, there \u003ca href=\"http://www.npr.org/sections/goatsandsoda/2016/09/15/493760787/why-the-u-s-is-pledging-4-3-billion-to-the-global-fund\">has been\u003c/a> a 45 percent drop in AIDS-related deaths in countries supported by global HIV campaigns.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Am I optimistic? I certainly am,\" he says. \"In fact, we don't have a choice. We have to do better than we're doing right now because tens of thousands of people are now dying around the world, particularly newborns. And this is surely getting worse year by year.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Historic. A possible turning point.\u003c/p>\n\u003cp>These are the words health researchers are using to describe a declaration passed Wednesday by the U.N. General Assembly aiming to slow down the spread of superbugs — bacteria that have become resistant to antibiotics.\u003c/p>\n\u003cp>\"I think the declaration will have very strong implications,\" says the \u003ca href=\"http://www.who.int/en/\">World Health Organization's\u003c/a> Dr. Keiji Fukuda. \"What it will convey is that there's recognition that we have a big problem and there's a commitment to do something about it.\"\u003c/p>\n\u003cp>Every year, more than 2 million Americans get sick with antibiotic-resistant infections, and tens of thousands die as a result, \u003ca href=\"http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf\">says\u003c/a> the Centers for Disease Control and Prevention. Common diseases, like urinary tract infections and pneumonia, are becoming harder and harder to treat. And new superbugs are \u003ca href=\"http://www.npr.org/sections/health-shots/2016/05/26/479639936/germ-resistant-to-antibiotic-of-last-resort-appears-in-u-s\">cropping up\u003c/a> — even here in the U.S. — that are resistant to last-resort drugs.\u003c/p>\n\u003cp>Doctors have been warning about this problem for decades. But in the past year or so, another group of researchers has started taking interest in superbugs: economists. And they quickly realized the problem goes way beyond health.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Antibiotic resistance has immense economic consequences and immense implications for food,\" Fukuda says.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There's recognition that we have a big problem and there's a commitment to do something about it.'\u003ccite>Dr. Keiji Fukuda, World Health Organization\u003c/cite>\u003c/aside>\n\u003cp>A recent \u003ca href=\"http://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf\">report\u003c/a> from the U.K. government found that antibiotic-resistant bacteria could cost the world $100 trillion by 2050 if nothing is done about it. The World Bank \u003ca href=\"http://www.worldbank.org/en/news/press-release/2016/09/18/by-2050-drug-resistant-infections-could-cause-global-economic-damage-on-par-with-2008-financial-crisis\">predicts\u003c/a> drug-resistant infections could damage the economy as much as — or even more than — the 2008 financial crisis. And annual global GDP could drop by 1 to 4 percent, the agency says.\u003c/p>\n\u003cp>On top of that, farmers around the world have come to rely on antibiotics to raise animals. The drugs make pigs, cows and chickens grow fatter more quickly — and keeps them healthy in densely packed quarters.\u003c/p>\n\u003cp>\"If we lose that ability we begin to perhaps lose the ability to have adequate food supplies in the world,\" Fukuda says.\u003c/p>\n\u003cp>And that's why world leaders are now getting involved. The U.N.'s declaration requires countries to come up with a two-year a plan to protect the potency of antibiotics. Countries need to create ways to monitor the use of antibiotics in medicine and agriculture, start curbing that use and begin developing new antibiotics that work.\u003c/p>\n\u003cfigure id=\"attachment_250257\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-250257\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Staph.-aureus-800x541.jpg\" alt=\"Staphylococcus Aureus in biofilm, magnified.\" width=\"800\" height=\"541\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-800x541.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-400x270.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-768x519.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus-960x649.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Staph.-aureus.jpg 1024w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Staphylococcus Aureus in biofilm, magnified. \u003ccite>(Janice Carr/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After two years, the U.N.'s secretary-general will assess each country's plan and check to make sure each is making progress.\u003c/p>\n\u003cp>\"I think this is the first realistic chance, in our lifetime, to turn this around,\" Fukuda says.\u003c/p>\n\u003cp>And there's precedent for this optimism.\u003c/p>\n\u003cp>Back in 2001, the U.N. made a \u003ca href=\"http://www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html\">similar declaration\u003c/a> about the HIV pandemic. And that declaration had a big impact on curbing the spread of HIV around the world, says \u003ca href=\"http://www.cddep.org/profile/ramanan_laxminarayan#sthash.UiH1YYRk.dpbs\">Ramanan Laxminarayan\u003c/a>, who directs the Center for Disease Dynamics, Economics & Policy in Washington, D.C.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>The declaration made countries take responsibility for the HIV burden,\" he says. People were willing to start talking about and change their attitudes on stigma. And last but not least, the declaration made sure that lots of money went towards both treatment and prevention.\"\u003c/p>\n\u003cp>He says there are a few weaknesses in the U.N.'s new plan on antibiotic-resistant bacteria. For example, there are no hardcore targets for reducing antibiotic use by a certain amount in two years.\u003c/p>\n\u003cp>But he thinks the declaration could have the same impact on fighting antibiotic-resistant bacteria as the previous one had on fighting HIV. Since 2004, there \u003ca href=\"http://www.npr.org/sections/goatsandsoda/2016/09/15/493760787/why-the-u-s-is-pledging-4-3-billion-to-the-global-fund\">has been\u003c/a> a 45 percent drop in AIDS-related deaths in countries supported by global HIV campaigns.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"Am I optimistic? I certainly am,\" he says. \"In fact, we don't have a choice. We have to do better than we're doing right now because tens of thousands of people are now dying around the world, particularly newborns. And this is surely getting worse year by year.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Care, 800 Miles Away: Satellite Connection Changes Lives in Alaska",
"title": "Health Care, 800 Miles Away: Satellite Connection Changes Lives in Alaska",
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"content": "\u003cp>The only clinic in one of the nation's busiest commercial fishing ports is so remote that even conventional telemedicine for emergencies has been impossible for its limited staff — until this week.\u003c/p>\n\u003cp>Starting Thursday, a new partnership with an Anchorage hospital will virtually beam critical care doctors 800 miles (1,287 kilometers) away to the emergency room on the island that holds Dutch Harbor, the operations base for the Bering Sea crabbing fleet made famous by the Discovery Channel show \"Deadliest Catch.\"\u003c/p>\n\u003cp>But instead of transmissions with fiber-optics, which are nowhere near the isolated Unalaska Island, the team putting together the system is relying on satellite technology in what is believed to be a first in the country for telemedicine.\u003c/p>\n\u003cp>The clinic, Iliuliuk Family and Health Services, brings to nine the number of providers served by the electronic intensive care unit at Providence Alaska Medical Center in Anchorage.\u003c/p>\n\u003cp>\"We are kind of mix-mashing everything together to try to make this work,\" Sharon Compton, services manager of Providence's eICU office, said after a recent demonstration of the Dutch Harbor link.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new system will provide real-time camera links between emergency doctors and clinic staffers during medical emergencies, such as fishing industry injuries.\u003c/p>\n\u003cfigure id=\"attachment_250140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-250140\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Remote-AK-medicine2-800x450.jpg\" alt=\"Intensive care unit nurse Deborah Springer in Anchorage, Alaska, demonstrates the focusing ability of a telemedicine camera that is part of a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center.\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2.jpg 876w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Intensive care unit nurse Deborah Springer in Anchorage, Alaska, demonstrates the focusing ability of a telemedicine camera that is part of a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center. \u003ccite>(Rachel D'Oro/AP)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The idea is to help stabilize patients before transporting them out of town and to help with triage during major events like a ship sinking.\u003c/p>\n\u003cp>From afar, doctors will be able to view X-rays and patient charts and talk directly with patients on camera instead of consulting with medics by phone and email.\u003c/p>\n\u003cp>There are some unknowns about how the system will work, with likely slowdowns in satellite reception because of the region's notoriously bad weather.\u003c/p>\n\u003cp>During the recent demonstration, pre-launch kinks prevented the rolling-cart-mounted camera in Dutch Harbor from being pivoted remotely. But the camera otherwise performed impressively, sending back crystal-clear video of clinic staffers as they chatted with a critical care doctor.\u003c/p>\n\u003cp>The new service was lauded by Seattle-based crabbing boat owner Lance Farr, who has been badly hurt twice in his decades of working in the Bering Sea.\u003c/p>\n\u003cp>Several years ago, he almost severed a finger in a dockside engine accident. He was stabilized at the clinic before being flown to Anchorage for further treatment. In 1996, Farr broke his foot at Dutch Harbor after dropping an engine on it. He spent the night at the clinic under the care of nurses before being flown out the next day.\u003c/p>\n\u003cp>In hindsight, having his care visually monitored by emergency room specialists would have provided a morale boost, as well as invaluable expertise, Farr said.\u003c/p>\n\u003cfigure id=\"attachment_250142\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-250142\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Remote-AK-medicine3-800x600.jpg\" alt=\"ICU office services manager Sharon Compton in Anchorage, Alaska, talks about a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3.jpg 1067w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">ICU office services manager Sharon Compton in Anchorage, Alaska, talks about a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center. \u003ccite>(Rachel D'Oro/AP)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"It would be a good thing, I would think, to have a real physician being able to advise the people out there,\" he said.\u003c/p>\n\u003cp>The city of Unalaska has just 4,600 year-round residents, but the population swells to 16,000 or more during the region's two main fishing seasons, when boat crews and processing workers flood the town with dozens of languages and cultures. That means more potential for patients, including people who don't speak English.\u003c/p>\n\u003cp>The clinic averages more than 300 after-hours emergency room visits a year, with about a third of those patients flown elsewhere, often to Anchorage, for more complete treatment.\u003c/p>\n\u003cp>Fishing-industry emergencies at sea can mean significant delays to appropriate medical treatments when the injured must first be carried by rescue helicopter to Dutch Harbor. Injuries can range from deep cuts and broken bones to back injuries and amputations.\u003c/p>\n\u003cp>\"These guys are pretty tough out here, and they will, you know, continue to fish until they can't get out of bed anymore,\" said James Novotny, nurse practitioner at the clinic.\u003c/p>\n\u003cp>The drastically shifting population can put a strain on clinic staffing in this rural setting. So can the inability to afford emergency specialists or much in the way of diagnostic equipment.\u003c/p>\n\u003cp>Then there's the challenge of living in such a far-flung spot, which makes finding and keeping medical staff difficult, according to clinic medical director Ann Nora Ehret, an osteopathic doctor who has wanted to tap into telemedicine since joining the staff in 2013. Only recently did the clinic hire a second doctor after the position was vacant for nearly a year.\u003c/p>\n\u003cp>Adding the long-distance help will be invaluable, Ehret said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think it could be a game changer for recruiting, retention and for the care of the patients,\" she said. \"We are getting the support we need in an austere environment.\"\u003c/p>\n\n",
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"excerpt": "Doctors in Anchorage are using remote satellite technology to treat patients 800 miles away on remote Unalaska Island. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The only clinic in one of the nation's busiest commercial fishing ports is so remote that even conventional telemedicine for emergencies has been impossible for its limited staff — until this week.\u003c/p>\n\u003cp>Starting Thursday, a new partnership with an Anchorage hospital will virtually beam critical care doctors 800 miles (1,287 kilometers) away to the emergency room on the island that holds Dutch Harbor, the operations base for the Bering Sea crabbing fleet made famous by the Discovery Channel show \"Deadliest Catch.\"\u003c/p>\n\u003cp>But instead of transmissions with fiber-optics, which are nowhere near the isolated Unalaska Island, the team putting together the system is relying on satellite technology in what is believed to be a first in the country for telemedicine.\u003c/p>\n\u003cp>The clinic, Iliuliuk Family and Health Services, brings to nine the number of providers served by the electronic intensive care unit at Providence Alaska Medical Center in Anchorage.\u003c/p>\n\u003cp>\"We are kind of mix-mashing everything together to try to make this work,\" Sharon Compton, services manager of Providence's eICU office, said after a recent demonstration of the Dutch Harbor link.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new system will provide real-time camera links between emergency doctors and clinic staffers during medical emergencies, such as fishing industry injuries.\u003c/p>\n\u003cfigure id=\"attachment_250140\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-250140\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Remote-AK-medicine2-800x450.jpg\" alt=\"Intensive care unit nurse Deborah Springer in Anchorage, Alaska, demonstrates the focusing ability of a telemedicine camera that is part of a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center.\" width=\"800\" height=\"450\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2-800x450.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2-768x432.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine2.jpg 876w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Intensive care unit nurse Deborah Springer in Anchorage, Alaska, demonstrates the focusing ability of a telemedicine camera that is part of a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center. \u003ccite>(Rachel D'Oro/AP)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The idea is to help stabilize patients before transporting them out of town and to help with triage during major events like a ship sinking.\u003c/p>\n\u003cp>From afar, doctors will be able to view X-rays and patient charts and talk directly with patients on camera instead of consulting with medics by phone and email.\u003c/p>\n\u003cp>There are some unknowns about how the system will work, with likely slowdowns in satellite reception because of the region's notoriously bad weather.\u003c/p>\n\u003cp>During the recent demonstration, pre-launch kinks prevented the rolling-cart-mounted camera in Dutch Harbor from being pivoted remotely. But the camera otherwise performed impressively, sending back crystal-clear video of clinic staffers as they chatted with a critical care doctor.\u003c/p>\n\u003cp>The new service was lauded by Seattle-based crabbing boat owner Lance Farr, who has been badly hurt twice in his decades of working in the Bering Sea.\u003c/p>\n\u003cp>Several years ago, he almost severed a finger in a dockside engine accident. He was stabilized at the clinic before being flown to Anchorage for further treatment. In 1996, Farr broke his foot at Dutch Harbor after dropping an engine on it. He spent the night at the clinic under the care of nurses before being flown out the next day.\u003c/p>\n\u003cp>In hindsight, having his care visually monitored by emergency room specialists would have provided a morale boost, as well as invaluable expertise, Farr said.\u003c/p>\n\u003cfigure id=\"attachment_250142\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-250142\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Remote-AK-medicine3-800x600.jpg\" alt=\"ICU office services manager Sharon Compton in Anchorage, Alaska, talks about a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Remote-AK-medicine3.jpg 1067w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">ICU office services manager Sharon Compton in Anchorage, Alaska, talks about a new telemedicine partnership between the Iliuliuk Family and Health Services on Unalaska Island and Providence Alaska Medical Center. \u003ccite>(Rachel D'Oro/AP)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"It would be a good thing, I would think, to have a real physician being able to advise the people out there,\" he said.\u003c/p>\n\u003cp>The city of Unalaska has just 4,600 year-round residents, but the population swells to 16,000 or more during the region's two main fishing seasons, when boat crews and processing workers flood the town with dozens of languages and cultures. That means more potential for patients, including people who don't speak English.\u003c/p>\n\u003cp>The clinic averages more than 300 after-hours emergency room visits a year, with about a third of those patients flown elsewhere, often to Anchorage, for more complete treatment.\u003c/p>\n\u003cp>Fishing-industry emergencies at sea can mean significant delays to appropriate medical treatments when the injured must first be carried by rescue helicopter to Dutch Harbor. Injuries can range from deep cuts and broken bones to back injuries and amputations.\u003c/p>\n\u003cp>\"These guys are pretty tough out here, and they will, you know, continue to fish until they can't get out of bed anymore,\" said James Novotny, nurse practitioner at the clinic.\u003c/p>\n\u003cp>The drastically shifting population can put a strain on clinic staffing in this rural setting. So can the inability to afford emergency specialists or much in the way of diagnostic equipment.\u003c/p>\n\u003cp>Then there's the challenge of living in such a far-flung spot, which makes finding and keeping medical staff difficult, according to clinic medical director Ann Nora Ehret, an osteopathic doctor who has wanted to tap into telemedicine since joining the staff in 2013. Only recently did the clinic hire a second doctor after the position was vacant for nearly a year.\u003c/p>\n\u003cp>Adding the long-distance help will be invaluable, Ehret said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I think it could be a game changer for recruiting, retention and for the care of the patients,\" she said. \"We are getting the support we need in an austere environment.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How A 'Sixth Sense' Helps Simone Biles Fly, And The Rest Of Us Walk",
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"content": "\u003cp>A rare genetic disorder is helping scientists understand our mysterious ability to sense where we are in space, known as proprioception.\u003c/p>\n\u003cp>This \"sixth sense\" is what dancers and gymnasts rely on to tell them the exact position of their body and limbs at every moment. It also tells them how much force each muscle is exerting.\u003c/p>\n\u003cp>\"The most beautiful demonstration of proprioception in action is Simone Biles when she is spinning and somersaulting through the air,\" says \u003ca href=\"https://neuroscience.nih.gov/ninds/Faculty/Profile/carsten-bonnemann.aspx\">Carsten Bonnemann\u003c/a>, a pediatrician and geneticist at the National institute of Neurological Disorders and Stroke.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’ve never run, they’ve never jumped, because those kind of actions really require precise control over your limbs in space.'\u003ccite>Alex Chesler,\u003cbr>National Center for Complementary and Integrative Health\u003c/cite>\u003c/aside>\n\u003cp>Scientists have known about proprioception for more than a century. But they didn't realize how much people depend on it until they got a chance to study two young patients with a rare genetic disorder that leaves them completely lacking this sense.\u003c/p>\n\u003cp>The results of that \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1602812\">study \u003c/a>were published Wednesday in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>One of the participants in the study was a 10-year-old girl named Damiana, who lives in San Diego.\u003c/p>\n\u003cp>She's \"a happy and bubbly\" kid who has no problems with senses like taste, hearing, sight and smell, Bonnemann says. But Damiana was born with a genetic mutation that left her with a limited sense of touch and no proprioception, he says.\u003c/p>\n\u003cp>When Damiana was younger, her condition baffled doctors, says her mother, Diana Sawyer.\u003c/p>\n\u003cp>\"She was very late at doing everything,\" Sawyer says. Her daughter didn't start crawling until she was about 18 months old. And she still can walk only a few steps on her own.\u003c/p>\n\u003cp>Damiana was born with some abnormalities in her feet and hips, Sawyer says. And her spine was curved. But those problems didn't explain why her daughter had so much trouble with precise movements, like fastening a button.\u003c/p>\n\u003cp>Damiana's condition might have remained a mystery if Bonnemann hadn't seen her a few years ago while holding a clinic in San Diego.\u003c/p>\n\u003cp>He was puzzled by her symptoms and ordered a state-of-the-art genetic analysis. It turned up a mutation in a gene called PIEZO2, which allows certain cells to detect mechanical pressure.\u003c/p>\n\u003cp>Unfortunately, \"I didn't know what PIEZO2 was, really,\" Bonnemann says.\u003c/p>\n\u003cp>Then one day Bonnemann heard about a colleague at the National Institutes of Health who knew a lot about PIEZO2. \"It turns out he's in the same building, just a floor down,\" Bonnemann says. \"So I sent him an email saying, 'Can you help me?' \"\u003c/p>\n\u003cp>The colleague was \u003ca href=\"https://irp.nih.gov/pi/alexander-chesler\">Alex Chesler\u003c/a> from the National Center for Complementary and Integrative Health. Chesler read the email from Bonnemann, \"and 30 seconds later I was up in his office,\" he says.\u003c/p>\n\u003cp>Chesler had spent years studying PIEZO2 in mice. But he'd never had a good way to study its function in people.\u003c/p>\n\u003cp>So last year, Bonnemann, Chesler and a team of researchers invited Damiana and another patient with a similar PIEZO2 mutation to the NIH.\u003c/p>\n\u003cp>The visit was a revelation. Trying to understand proprioception from mouse experiments had been a bit like trying to understand Beethoven by reading sheet music, Chesler says. \"But when I talked to the patients it was like going to the symphony,\" he says.\u003c/p>\n\u003cp>The researchers were able to show that the PIEZO2 gene is involved in certain kinds of touch sensation as well as proprioception. And they learned a lot about what proprioception makes possible by studying what the patients were unable to do.\u003c/p>\n\u003cp>\"They've never run, they've never jumped,\" Chesler says, \"because those kind of actions really require precise control over your limbs in space.\"\u003c/p>\n\u003cp>The scientists also discovered that both patients had found ways to compensate for their lack of body awareness — mostly by closely watching their own limbs as they move.\u003c/p>\n\u003cp>For example, the older patient, who is in college, has even learned to walk pretty well — as long as she can see what's she's doing.\u003c/p>\n\u003cp>\"If you take away her vision, she literally crumples to the ground,\" he says. \"And the same is true for reaching. When she reaches for an object under visual control she is actually quite precise doing that. If we cover her eyes, she gets completely off target.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Of course, gymnasts like Simone Biles also rely on vision during a routine, Bonnemann says. But it's the extra information from their \"sixth sense\" that makes a gold-medal performance possible.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A rare genetic disorder is helping scientists understand our mysterious ability to sense where we are in space, known as proprioception.\u003c/p>\n\u003cp>This \"sixth sense\" is what dancers and gymnasts rely on to tell them the exact position of their body and limbs at every moment. It also tells them how much force each muscle is exerting.\u003c/p>\n\u003cp>\"The most beautiful demonstration of proprioception in action is Simone Biles when she is spinning and somersaulting through the air,\" says \u003ca href=\"https://neuroscience.nih.gov/ninds/Faculty/Profile/carsten-bonnemann.aspx\">Carsten Bonnemann\u003c/a>, a pediatrician and geneticist at the National institute of Neurological Disorders and Stroke.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They’ve never run, they’ve never jumped, because those kind of actions really require precise control over your limbs in space.'\u003ccite>Alex Chesler,\u003cbr>National Center for Complementary and Integrative Health\u003c/cite>\u003c/aside>\n\u003cp>Scientists have known about proprioception for more than a century. But they didn't realize how much people depend on it until they got a chance to study two young patients with a rare genetic disorder that leaves them completely lacking this sense.\u003c/p>\n\u003cp>The results of that \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1602812\">study \u003c/a>were published Wednesday in the \u003cem>New England Journal of Medicine\u003c/em>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of the participants in the study was a 10-year-old girl named Damiana, who lives in San Diego.\u003c/p>\n\u003cp>She's \"a happy and bubbly\" kid who has no problems with senses like taste, hearing, sight and smell, Bonnemann says. But Damiana was born with a genetic mutation that left her with a limited sense of touch and no proprioception, he says.\u003c/p>\n\u003cp>When Damiana was younger, her condition baffled doctors, says her mother, Diana Sawyer.\u003c/p>\n\u003cp>\"She was very late at doing everything,\" Sawyer says. Her daughter didn't start crawling until she was about 18 months old. And she still can walk only a few steps on her own.\u003c/p>\n\u003cp>Damiana was born with some abnormalities in her feet and hips, Sawyer says. And her spine was curved. But those problems didn't explain why her daughter had so much trouble with precise movements, like fastening a button.\u003c/p>\n\u003cp>Damiana's condition might have remained a mystery if Bonnemann hadn't seen her a few years ago while holding a clinic in San Diego.\u003c/p>\n\u003cp>He was puzzled by her symptoms and ordered a state-of-the-art genetic analysis. It turned up a mutation in a gene called PIEZO2, which allows certain cells to detect mechanical pressure.\u003c/p>\n\u003cp>Unfortunately, \"I didn't know what PIEZO2 was, really,\" Bonnemann says.\u003c/p>\n\u003cp>Then one day Bonnemann heard about a colleague at the National Institutes of Health who knew a lot about PIEZO2. \"It turns out he's in the same building, just a floor down,\" Bonnemann says. \"So I sent him an email saying, 'Can you help me?' \"\u003c/p>\n\u003cp>The colleague was \u003ca href=\"https://irp.nih.gov/pi/alexander-chesler\">Alex Chesler\u003c/a> from the National Center for Complementary and Integrative Health. Chesler read the email from Bonnemann, \"and 30 seconds later I was up in his office,\" he says.\u003c/p>\n\u003cp>Chesler had spent years studying PIEZO2 in mice. But he'd never had a good way to study its function in people.\u003c/p>\n\u003cp>So last year, Bonnemann, Chesler and a team of researchers invited Damiana and another patient with a similar PIEZO2 mutation to the NIH.\u003c/p>\n\u003cp>The visit was a revelation. Trying to understand proprioception from mouse experiments had been a bit like trying to understand Beethoven by reading sheet music, Chesler says. \"But when I talked to the patients it was like going to the symphony,\" he says.\u003c/p>\n\u003cp>The researchers were able to show that the PIEZO2 gene is involved in certain kinds of touch sensation as well as proprioception. And they learned a lot about what proprioception makes possible by studying what the patients were unable to do.\u003c/p>\n\u003cp>\"They've never run, they've never jumped,\" Chesler says, \"because those kind of actions really require precise control over your limbs in space.\"\u003c/p>\n\u003cp>The scientists also discovered that both patients had found ways to compensate for their lack of body awareness — mostly by closely watching their own limbs as they move.\u003c/p>\n\u003cp>For example, the older patient, who is in college, has even learned to walk pretty well — as long as she can see what's she's doing.\u003c/p>\n\u003cp>\"If you take away her vision, she literally crumples to the ground,\" he says. \"And the same is true for reaching. When she reaches for an object under visual control she is actually quite precise doing that. If we cover her eyes, she gets completely off target.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Of course, gymnasts like Simone Biles also rely on vision during a routine, Bonnemann says. But it's the extra information from their \"sixth sense\" that makes a gold-medal performance possible.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>My mother swears I learned to read by watching \u003cem>The Electric Company\u003c/em> on TV, so maybe that's why I was initially a bit lax when it came to my daughter and screen time.\u003c/p>\n\u003cp>But after realizing she would be perfectly content to spend every free minute switching between the PBS Kids app and \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=348241139\">toy unboxing videos\u003c/a> on YouTube, my husband and I drew several lines in the sand and drastically limited her screen use by both time and content.\u003c/p>\n\u003cp>She's only 4, which means that we still face years of decisions surrounding smartphones, Minecraft, Snapchat and the yet-to-be developed apps, games and devices that will be competing for kids' attention in the years to come. And it's not only her I'm worried about; my own habits of constantly checking email after 6:30 p.m. and reading political Facebook posts at any hour make me anxious.\u003c/p>\n\u003cp>In short, like many parents, I'm confused.\u003c/p>\n\u003cp>Most families have accepted digital technology into their homes, but many of us are unclear on how to use it wisely. And we worry about the mental and physical effects that excess tech may be having on our kids and ourselves. \u003ca href=\"http://www.familiesmanagingmedia.com/club-unplug-for-moms/about-us/\">Melanie Hempe\u003c/a>, founder and executive director of the nonprofit Families Managing Media in Charlotte, N.C., says she is concerned that overuse of digital technology isolates, rather than brings together, parents and kids both emotionally and physically. It also takes them away from activities that are shown to benefit their bodies and brains, like playing outside with a friend or reading a book. Here are some guiding principles for parenting in the digital age from conversations with Hempe and other experts:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Be aware that not all tech is the same. \u003c/strong>Rather than making rules based strictly on screen time, figure out what your kids are actually doing when they're on the computer or their phone, says \u003ca href=\"http://www.raisingdigitalnatives.com/about/\">Devorah Heitner\u003c/a>, who founded \u003ca href=\"http://www.raisingdigitalnatives.com/\">Raising Digital Natives\u003c/a> and is the author of \u003cem>Screenwise: Helping Kids Thrive (and Survive) in Their Digital World\u003c/em>. Ask them to show you exactly which sites they visit and how they spend their time. They might be doing homework, composing music or writing a novel. Or they might be playing a first-person shooter game or following the Kardashians' every move on Instagram. Your limits on their use are likely to vary accordingly.\u003c/p>\n\u003cp>If you're concerned about compulsive use, current research suggests that online games seem to be the technology most likely to \"potentially result in problems,\" says \u003ca href=\"http://www4.ntu.ac.uk/apps/staff_profiles/staff_directory/9925a18a-4fcb-4e32-aa68-b970f37b8f9d-0/26/profile.aspx?deptcode=SOC&deptTitle=School%20of%20Social%20Sciences&page=6\">Daria Kuss\u003c/a>, a psychologist and member of the International Gaming Research Unit at Nottingham Trent University in the U.K. \"They're highly interactive and can engage players to such an extent that they easily forget about the time and their environment.\" (\u003ca href=\"http://www.dsm5.org/Documents/Internet%20Gaming%20Disorder%20Fact%20Sheet.pdf\">Internet gaming disorder\u003c/a> is identified in the current \u003cem>Diagnostic and Statistical Manual,\u003c/em> the \u003cem>DSM-5,\u003c/em> as a condition that warrants further study.) That doesn't mean your kid can't game, but it does mean you might want to be more alert to the potential for problems if that's his main online activity.\u003c/p>\n\u003cp>\u003cstrong>Think about the role tech plays in your family life.\u003c/strong> \"You should be focused on your values and what you think is important,\" says Hempe. Does everyone sit around the living room watching their own shows on their own iPads? Maybe it's time to institute family game or movie night. Can your children name three things they like to do as much as or more than an online activity? If not, maybe it's time to help them broaden their horizons. Do you spend more time posting witty remarks on Twitter than saying them out loud to your spouse? Schedule a regular tech-free date night.\u003c/p>\n\u003cp>\u003cstrong>Model good behavior, online and off.\u003c/strong> \"We've fallen into this mental sinkhole where we get a communication and feel we have to respond to it,\" says \u003ca href=\"http://drlarryrosen.com/\">Larry Rosen\u003c/a>, a psychologist and professor emeritus at California State University, Dominguez Hills. That didn't happen overnight, but by now many people feel compelled to check social media constantly and to read and respond to emails and texts within minutes.\u003c/p>\n\u003cp>\"We act out of this creeping anxiety of not being current,\" says Rosen, who is co-author of \u003cem>The Distracted Mind: Ancient Brains in a High-Tech World\u003c/em>. And if your kids see you drop everything to respond to an email during dinner, they're going to get the idea that it's OK to drop everything and respond to a text during their homework.\u003c/p>\n\u003cp>Rosen suggests weaning yourself by taking increasingly long tech breaks during the day, starting at one minute and working up to 30 minutes. And help kids with their own connectivity anxiety by telling them they're not bad friends if they aren't immediately answering a late-night text, says Heitner. \"Model boundaries, and model being unplugged,\" she says.\u003c/p>\n\u003cp>Also, show your kids when and how to take your communications offline. \"Show you need to be able to go to someone face to face to resolve relationship difficulties,\" says Heitner. \"Show them how to move away from an Instagram comment to 'I'm sorry I hurt your feelings.' \"\u003c/p>\n\u003cp>\u003cstrong>Have tech-free zones and times.\u003c/strong> One way to help everyone curb overuse is to create tech-free zones, says Rosen. Those can be geographical, like banning technology at the kitchen table or bathroom. Removing smartphones and tablets from the bedroom is also helpful — at the very least, take out the devices a few hours before bedtime, since for a variety of reasons, they seem to contribute to poor sleep.\u003c/p>\n\u003cp>One \u003ca href=\"http://www.smrv-journal.com/article/S1087-0792(14)00081-1/abstract\">2014 review of research\u003c/a> found an association between more screen time and later bedtimes and shorter sleep lengths in kids and teens. And a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/26791323\">study published this year\u003c/a> found that young adults who reported greater social media use also had greater odds of a sleep disturbance.\u003c/p>\n\u003cp>You can also carve out time or situations where no tech is permitted. \u003ca href=\"http://www.steelcounseling.com/\">Ann Steel\u003c/a>, a licensed mental health counselor and former practicing physician in Seattle who sees a lot of patients with technology dependence, suggests one family tech-free day a week. Or require everyone to turn devices off during family dinners or car rides.\u003c/p>\n\u003cp>\u003cstrong>Let them learn for themselves.\u003c/strong> Heitner is a firm believer in allowing your kids to come to their own conclusions about tech when at all possible. That may mean allowing them to face the natural consequences of staying up late chatting online the night before a test. Or it could be letting them figure out for themselves the benefits of being unplugged during \u003ca href=\"http://www.npr.org/2016/08/11/489661961/summer-camps-struggle-to-enforce-bans-on-screen-time\">tech-free periods like sleepaway camp\u003c/a>. But on the other hand, you know your kids, and it's perfectly fine to step in and curb their technology adoption if you think they can't handle it. \"If you think your kid is too immature to get a phone, don't discount that,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Keep an eye out for signs of serious trouble.\u003c/strong> \"There's a continuum of behavior,\" says Heitner. Just because you have a hard time tearing your child away from Minecraft doesn't mean he's \"addicted.\" But in some cases kids can have serious issues with technology — whether it's gaming, social media or something else — that require professional help. If your kid is using tech to the exclusion of things like sleeping, friends and school and can't change his or her ways, Steel says, it may be time to seek out therapy.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter:\u003c/em> \u003ca href=\"https://twitter.com/katherinehobson\">@katherinehobson\u003c/a>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Trying+To+Get+The+Kids+To+Put+Down+Those+Phones%3F+Here%27s+Help&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>My mother swears I learned to read by watching \u003cem>The Electric Company\u003c/em> on TV, so maybe that's why I was initially a bit lax when it came to my daughter and screen time.\u003c/p>\n\u003cp>But after realizing she would be perfectly content to spend every free minute switching between the PBS Kids app and \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=348241139\">toy unboxing videos\u003c/a> on YouTube, my husband and I drew several lines in the sand and drastically limited her screen use by both time and content.\u003c/p>\n\u003cp>She's only 4, which means that we still face years of decisions surrounding smartphones, Minecraft, Snapchat and the yet-to-be developed apps, games and devices that will be competing for kids' attention in the years to come. And it's not only her I'm worried about; my own habits of constantly checking email after 6:30 p.m. and reading political Facebook posts at any hour make me anxious.\u003c/p>\n\u003cp>In short, like many parents, I'm confused.\u003c/p>\n\u003cp>Most families have accepted digital technology into their homes, but many of us are unclear on how to use it wisely. And we worry about the mental and physical effects that excess tech may be having on our kids and ourselves. \u003ca href=\"http://www.familiesmanagingmedia.com/club-unplug-for-moms/about-us/\">Melanie Hempe\u003c/a>, founder and executive director of the nonprofit Families Managing Media in Charlotte, N.C., says she is concerned that overuse of digital technology isolates, rather than brings together, parents and kids both emotionally and physically. It also takes them away from activities that are shown to benefit their bodies and brains, like playing outside with a friend or reading a book. Here are some guiding principles for parenting in the digital age from conversations with Hempe and other experts:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Be aware that not all tech is the same. \u003c/strong>Rather than making rules based strictly on screen time, figure out what your kids are actually doing when they're on the computer or their phone, says \u003ca href=\"http://www.raisingdigitalnatives.com/about/\">Devorah Heitner\u003c/a>, who founded \u003ca href=\"http://www.raisingdigitalnatives.com/\">Raising Digital Natives\u003c/a> and is the author of \u003cem>Screenwise: Helping Kids Thrive (and Survive) in Their Digital World\u003c/em>. Ask them to show you exactly which sites they visit and how they spend their time. They might be doing homework, composing music or writing a novel. Or they might be playing a first-person shooter game or following the Kardashians' every move on Instagram. Your limits on their use are likely to vary accordingly.\u003c/p>\n\u003cp>If you're concerned about compulsive use, current research suggests that online games seem to be the technology most likely to \"potentially result in problems,\" says \u003ca href=\"http://www4.ntu.ac.uk/apps/staff_profiles/staff_directory/9925a18a-4fcb-4e32-aa68-b970f37b8f9d-0/26/profile.aspx?deptcode=SOC&deptTitle=School%20of%20Social%20Sciences&page=6\">Daria Kuss\u003c/a>, a psychologist and member of the International Gaming Research Unit at Nottingham Trent University in the U.K. \"They're highly interactive and can engage players to such an extent that they easily forget about the time and their environment.\" (\u003ca href=\"http://www.dsm5.org/Documents/Internet%20Gaming%20Disorder%20Fact%20Sheet.pdf\">Internet gaming disorder\u003c/a> is identified in the current \u003cem>Diagnostic and Statistical Manual,\u003c/em> the \u003cem>DSM-5,\u003c/em> as a condition that warrants further study.) That doesn't mean your kid can't game, but it does mean you might want to be more alert to the potential for problems if that's his main online activity.\u003c/p>\n\u003cp>\u003cstrong>Think about the role tech plays in your family life.\u003c/strong> \"You should be focused on your values and what you think is important,\" says Hempe. Does everyone sit around the living room watching their own shows on their own iPads? Maybe it's time to institute family game or movie night. Can your children name three things they like to do as much as or more than an online activity? If not, maybe it's time to help them broaden their horizons. Do you spend more time posting witty remarks on Twitter than saying them out loud to your spouse? Schedule a regular tech-free date night.\u003c/p>\n\u003cp>\u003cstrong>Model good behavior, online and off.\u003c/strong> \"We've fallen into this mental sinkhole where we get a communication and feel we have to respond to it,\" says \u003ca href=\"http://drlarryrosen.com/\">Larry Rosen\u003c/a>, a psychologist and professor emeritus at California State University, Dominguez Hills. That didn't happen overnight, but by now many people feel compelled to check social media constantly and to read and respond to emails and texts within minutes.\u003c/p>\n\u003cp>\"We act out of this creeping anxiety of not being current,\" says Rosen, who is co-author of \u003cem>The Distracted Mind: Ancient Brains in a High-Tech World\u003c/em>. And if your kids see you drop everything to respond to an email during dinner, they're going to get the idea that it's OK to drop everything and respond to a text during their homework.\u003c/p>\n\u003cp>Rosen suggests weaning yourself by taking increasingly long tech breaks during the day, starting at one minute and working up to 30 minutes. And help kids with their own connectivity anxiety by telling them they're not bad friends if they aren't immediately answering a late-night text, says Heitner. \"Model boundaries, and model being unplugged,\" she says.\u003c/p>\n\u003cp>Also, show your kids when and how to take your communications offline. \"Show you need to be able to go to someone face to face to resolve relationship difficulties,\" says Heitner. \"Show them how to move away from an Instagram comment to 'I'm sorry I hurt your feelings.' \"\u003c/p>\n\u003cp>\u003cstrong>Have tech-free zones and times.\u003c/strong> One way to help everyone curb overuse is to create tech-free zones, says Rosen. Those can be geographical, like banning technology at the kitchen table or bathroom. Removing smartphones and tablets from the bedroom is also helpful — at the very least, take out the devices a few hours before bedtime, since for a variety of reasons, they seem to contribute to poor sleep.\u003c/p>\n\u003cp>One \u003ca href=\"http://www.smrv-journal.com/article/S1087-0792(14)00081-1/abstract\">2014 review of research\u003c/a> found an association between more screen time and later bedtimes and shorter sleep lengths in kids and teens. And a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/26791323\">study published this year\u003c/a> found that young adults who reported greater social media use also had greater odds of a sleep disturbance.\u003c/p>\n\u003cp>You can also carve out time or situations where no tech is permitted. \u003ca href=\"http://www.steelcounseling.com/\">Ann Steel\u003c/a>, a licensed mental health counselor and former practicing physician in Seattle who sees a lot of patients with technology dependence, suggests one family tech-free day a week. Or require everyone to turn devices off during family dinners or car rides.\u003c/p>\n\u003cp>\u003cstrong>Let them learn for themselves.\u003c/strong> Heitner is a firm believer in allowing your kids to come to their own conclusions about tech when at all possible. That may mean allowing them to face the natural consequences of staying up late chatting online the night before a test. Or it could be letting them figure out for themselves the benefits of being unplugged during \u003ca href=\"http://www.npr.org/2016/08/11/489661961/summer-camps-struggle-to-enforce-bans-on-screen-time\">tech-free periods like sleepaway camp\u003c/a>. But on the other hand, you know your kids, and it's perfectly fine to step in and curb their technology adoption if you think they can't handle it. \"If you think your kid is too immature to get a phone, don't discount that,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Keep an eye out for signs of serious trouble.\u003c/strong> \"There's a continuum of behavior,\" says Heitner. Just because you have a hard time tearing your child away from Minecraft doesn't mean he's \"addicted.\" But in some cases kids can have serious issues with technology — whether it's gaming, social media or something else — that require professional help. If your kid is using tech to the exclusion of things like sleeping, friends and school and can't change his or her ways, Steel says, it may be time to seek out therapy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Lipedema: The Fat Disorder That Millions Have But No One Has Heard Of",
"title": "Lipedema: The Fat Disorder That Millions Have But No One Has Heard Of",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>In college Judy Maggiore remembers looking in the mirror, perplexed by her body’s disproportion.\u003c/p>\n\u003cp>\"I was skinny. I was a stick. The upper part of my body was really, really thin. You could see my ribs!\" exclaims Maggiore. \"But from the waist down, it was like there were two of me or something.\"\u003c/p>\n\u003cp>Tree trunk-like legs and a slim upper body are the signature characteristic of a lipedema patient. You can starve yourself and exercise for hours a day and the fat will not regress. But Maggiore didn’t know that at the time. She swore off bathing suits and hit the gym fanatically.\u003c/p>\n\u003cp>Even though she was mystified by her body, she didn't consider going to the doctor. \"Clearly, there was something wrong with me. I wasn’t eating the right things. I wasn’t exercising correctly.\"\u003c/p>\n\u003cfigure id=\"attachment_244616\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-244616 size-medium\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/IMG_0761-800x600.jpg\" alt=\"Judy Maggiore eats a salad everyday for lunch. \" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Judy Maggiore eats a salad every day for lunch. \u003ccite>(Lesley McClurg/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she tried every diet imaginable, from Atkins to Weight Watchers to Jenny Craig. Nothing worked.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Finally, last year -- when she was 68 years old -- a lymphatic specialist shocked her with a diagnosis of lipedema.\u003c/p>\n\u003cp>\"I was like, 'Whoa!'\" exclaims Maggiore. \"I’ve never heard that before. They have a name for it and it’s not my fault!\"\u003c/p>\n\u003cp>\u003cstrong>Tricky Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Lipedema is a lymphatic disease that is thought to affect 10 to 17 million people in America, mostly women. Exact patient estimates are not available because it’s hard to diagnose. In fact, many lipedema patients don’t even know they have it. Neither do their physicians, who often assume their patients are obese. Plus, doctors often confuse lipedema with lymphedema -- a prevalent lymphatic disease that presents similar symptoms. Maggiore says every doctor she saw throughout her life told her she needed to lose weight.\u003c/p>\n\u003cp>There isn’t a standard exam like a blood or urine test for lipedema. Instead, doctors use physical clues, like the unusual texture of the skin. It starts to feel like sand, then pebbles, and then small stones. The fat cells keep enlarging and increasing.\u003c/p>\n\u003cp>\"It’s like being wrapped in bubble wrap,\" says Maggiore.\u003cb>\u003cbr>\n\u003c/b>\u003c/p>\n\u003cp>The causes are mysterious too, although early \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20358611\" target=\"_blank\">studies\u003c/a> suggest lipedema is a genetic condition in women. It seems the disease is hormonally triggered, as the onset is usually around puberty, and symptoms worsen during childbirth and menopause.\u003c/p>\n\u003cp>\"We just have the earliest clues about where to look and what to think about,\" says \u003ca href=\"https://med.stanford.edu/profiles/stanley-rockson\" target=\"_blank\">Dr. Stanley Rockson\u003c/a>, a professor and researcher at Stanford University.\u003c/p>\n\u003cp>Usually fat cells increase when you overeat, and then decrease when you diet -- but something goes awry in lipedema patients. Rockson uses the metaphor of a bank to illustrate how cells in lipedema patients work.\u003c/p>\n\u003cp>\"They’re a very unusual bank, because they accept deposits but no withdrawals,\" says Rockson. \"So once they accumulate material, it never comes out again.\"\u003c/p>\n\u003cp>Rockson is one of only a handful of lipedema specialists in the world trying to understand the disease's pathology. In a current study, he’s analyzing tissue samples from the legs and abdomen to better understand why subcutaneous fat accumulates primarily in the lower body. He’s also testing anti-inflammatory drugs that have worked on other lymphatic diseases to reduce pain. And he's one of the founders of an \u003ca href=\"http://lymphaticnetwork.org/\" target=\"_blank\">international registry\u003c/a> collecting the medical records of patients who suffer from lymphatic diseases. He hopes the research will eventually lead to treatments for the disease. As of now, doctors have few options for patients.\u003c/p>\n\u003cp>\u003cstrong>Liposuction Offers Some Hope\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The only long-term treatment is liposuction, and Judy Maggiore is terrified of surgery. But some women don’t have a choice.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/WPwhWfFhlYc?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003cbr>\n\u003csmall>\u003cem>VIDEO: Marlene Simpson's liposuction surgery to treat lipedema, conducted by Dr. David Amron.\u003c/em>\u003c/small>\u003c/p>\n\u003cp>When Marlene Simpson’s scale topped three hundred pounds, she was desperate for thinner legs. She wasn't sleeping, which lead to exhaustion and made functioning at work nearly impossible.\u003c/p>\n\u003cp>But her initial appointment with a plastic surgeon was devastating. The physician denied her self-diagnosis. \"He told me that I shouldn’t believe what I see on the Internet,\" says Simpson.\u003c/p>\n\u003cp>But she didn't give up. More Internet research led her to \u003ca href=\"http://www.amronmd.com/about/meet-dr-amron/\" target=\"_blank\">Dr. David Amron\u003c/a>, a Beverly Hills surgeon. She booked a flight as soon as possible. After two surgeries, Simpson’s legs were 24 pounds lighter.\u003c/p>\n\u003cfigure id=\"attachment_244610\" class=\"wp-caption aligncenter\" style=\"max-width: 634px\">\u003cimg class=\"size-medium wp-image-244610\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Marlene-Simpson-Legs-634x600.jpg\" alt=\"Marlene Simpson's legs before and after liposuction surgery to treat her lipedema. \" width=\"634\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs-634x600.jpg 634w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs-400x378.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs-768x726.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs.jpg 774w\" sizes=\"(max-width: 634px) 100vw, 634px\">\u003cfigcaption class=\"wp-caption-text\">Marlene Simpson's legs before and after liposuction surgery to treat her lipedema.\u003c/figcaption>\u003c/figure>\n\u003cp>When she returned home to Sacramento, she felt like a new person.\u003c/p>\n\u003cp>\"It wasn’t ‘til I had surgery that I just realized that I was in a lot of pain,\" says Simpson.\u003c/p>\n\u003cp>Simpson's pain is caused by all the extra weight pressing on her nerves and lymph vessels. Over time, lipedema can be debilitating because blood clots, skin ulcers and recurrent infections can develop.\u003c/p>\n\u003cp>\u003cstrong>A Medical Unknown\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>But the relief put Simpson back $21,000 because her insurance denied the procedure. The company claims that liposuction is a cosmetic procedure, and it is not a recognized treatment for lipedema.\u003c/p>\n\u003cp>But Amron says liposuction \u003ci>does\u003c/i> work. If patients continue to diet and exercise, he swears the fat should not come back.\u003c/p>\n\u003cfigure id=\"attachment_244641\" class=\"wp-caption aligncenter\" style=\"max-width: 600px\">\u003cimg class=\"size-medium wp-image-244641\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Marlenes-fat-600x600.jpg\" alt=\"The fat that was removed from Marlene Simpson's legs during liposuction surgery. \" width=\"600\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-1180x1180.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-1920x1920.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-960x960.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-150x150.jpg 150w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat.jpg 2048w\" sizes=\"(max-width: 600px) 100vw, 600px\">\u003cfigcaption class=\"wp-caption-text\">The fat removed from Marlene Simpson's legs during liposuction surgery.\u003c/figcaption>\u003c/figure>\n\u003cp>Ninety percent of Dr. Amron’s clientele have lipedema. They come to him for liposuction.\u003c/p>\n\u003cp>\"They found their way to me about ten years ago when I started doing lipedema patients, and I’d never even heard of the condition,\" says Amron\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Ignored by the Medical Community\u003c/strong>\u003c/p>\n\u003cp>In fact, most doctors haven’t heard of lipedema. A 2004 Stanford University \u003ca href=\"http://www.journaloflymphoedema.com/media/journals/_/1108/files/jol6-1-44-9.pdf\" target=\"_blank\">study\u003c/a> showed that most U.S. medical schools spend less than 30 minutes teaching the entire lymphatic system.\u003c/p>\n\u003cp>\"So, not surprisingly, doctors don’t know a lot about these diseases or the underlying conditions,\" says Rockson. \"If you poll 100 physicians off the street, you might find one that knows the term lipedema, and that one might not have much to say about it other than a recognition of the name.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>One of his patients, Judy Maggiore, hopes to someday benefit from his research. In the meantime, her daily lunch is a bowl filled with vegetables, and even though she usually skips dinner, the flab on her legs continues to thicken, causing chronic pain. She savors each bite slowly, in hopes of keeping fat cells at bay.\u003c/p>\n\n",
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"excerpt": "Millions of women are suffering from a disease that poses as obesity. Most patients don’t know they have it, and doctors haven’t heard of it. Plus, dieting doesn’t work because the patients have abnormal fat cells that never go away. ",
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"title": "Lipedema: The Fat Disorder That Millions Have But No One Has Heard Of | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In college Judy Maggiore remembers looking in the mirror, perplexed by her body’s disproportion.\u003c/p>\n\u003cp>\"I was skinny. I was a stick. The upper part of my body was really, really thin. You could see my ribs!\" exclaims Maggiore. \"But from the waist down, it was like there were two of me or something.\"\u003c/p>\n\u003cp>Tree trunk-like legs and a slim upper body are the signature characteristic of a lipedema patient. You can starve yourself and exercise for hours a day and the fat will not regress. But Maggiore didn’t know that at the time. She swore off bathing suits and hit the gym fanatically.\u003c/p>\n\u003cp>Even though she was mystified by her body, she didn't consider going to the doctor. \"Clearly, there was something wrong with me. I wasn’t eating the right things. I wasn’t exercising correctly.\"\u003c/p>\n\u003cfigure id=\"attachment_244616\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-244616 size-medium\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/IMG_0761-800x600.jpg\" alt=\"Judy Maggiore eats a salad everyday for lunch. \" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-1920x1440.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/IMG_0761-960x720.jpg 960w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Judy Maggiore eats a salad every day for lunch. \u003ccite>(Lesley McClurg/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yet she tried every diet imaginable, from Atkins to Weight Watchers to Jenny Craig. Nothing worked.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Finally, last year -- when she was 68 years old -- a lymphatic specialist shocked her with a diagnosis of lipedema.\u003c/p>\n\u003cp>\"I was like, 'Whoa!'\" exclaims Maggiore. \"I’ve never heard that before. They have a name for it and it’s not my fault!\"\u003c/p>\n\u003cp>\u003cstrong>Tricky Diagnosis\u003c/strong>\u003c/p>\n\u003cp>Lipedema is a lymphatic disease that is thought to affect 10 to 17 million people in America, mostly women. Exact patient estimates are not available because it’s hard to diagnose. In fact, many lipedema patients don’t even know they have it. Neither do their physicians, who often assume their patients are obese. Plus, doctors often confuse lipedema with lymphedema -- a prevalent lymphatic disease that presents similar symptoms. Maggiore says every doctor she saw throughout her life told her she needed to lose weight.\u003c/p>\n\u003cp>There isn’t a standard exam like a blood or urine test for lipedema. Instead, doctors use physical clues, like the unusual texture of the skin. It starts to feel like sand, then pebbles, and then small stones. The fat cells keep enlarging and increasing.\u003c/p>\n\u003cp>\"It’s like being wrapped in bubble wrap,\" says Maggiore.\u003cb>\u003cbr>\n\u003c/b>\u003c/p>\n\u003cp>The causes are mysterious too, although early \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20358611\" target=\"_blank\">studies\u003c/a> suggest lipedema is a genetic condition in women. It seems the disease is hormonally triggered, as the onset is usually around puberty, and symptoms worsen during childbirth and menopause.\u003c/p>\n\u003cp>\"We just have the earliest clues about where to look and what to think about,\" says \u003ca href=\"https://med.stanford.edu/profiles/stanley-rockson\" target=\"_blank\">Dr. Stanley Rockson\u003c/a>, a professor and researcher at Stanford University.\u003c/p>\n\u003cp>Usually fat cells increase when you overeat, and then decrease when you diet -- but something goes awry in lipedema patients. Rockson uses the metaphor of a bank to illustrate how cells in lipedema patients work.\u003c/p>\n\u003cp>\"They’re a very unusual bank, because they accept deposits but no withdrawals,\" says Rockson. \"So once they accumulate material, it never comes out again.\"\u003c/p>\n\u003cp>Rockson is one of only a handful of lipedema specialists in the world trying to understand the disease's pathology. In a current study, he’s analyzing tissue samples from the legs and abdomen to better understand why subcutaneous fat accumulates primarily in the lower body. He’s also testing anti-inflammatory drugs that have worked on other lymphatic diseases to reduce pain. And he's one of the founders of an \u003ca href=\"http://lymphaticnetwork.org/\" target=\"_blank\">international registry\u003c/a> collecting the medical records of patients who suffer from lymphatic diseases. He hopes the research will eventually lead to treatments for the disease. As of now, doctors have few options for patients.\u003c/p>\n\u003cp>\u003cstrong>Liposuction Offers Some Hope\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>The only long-term treatment is liposuction, and Judy Maggiore is terrified of surgery. But some women don’t have a choice.\u003c/p>\n\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/WPwhWfFhlYc?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003cbr>\n\u003csmall>\u003cem>VIDEO: Marlene Simpson's liposuction surgery to treat lipedema, conducted by Dr. David Amron.\u003c/em>\u003c/small>\u003c/p>\n\u003cp>When Marlene Simpson’s scale topped three hundred pounds, she was desperate for thinner legs. She wasn't sleeping, which lead to exhaustion and made functioning at work nearly impossible.\u003c/p>\n\u003cp>But her initial appointment with a plastic surgeon was devastating. The physician denied her self-diagnosis. \"He told me that I shouldn’t believe what I see on the Internet,\" says Simpson.\u003c/p>\n\u003cp>But she didn't give up. More Internet research led her to \u003ca href=\"http://www.amronmd.com/about/meet-dr-amron/\" target=\"_blank\">Dr. David Amron\u003c/a>, a Beverly Hills surgeon. She booked a flight as soon as possible. After two surgeries, Simpson’s legs were 24 pounds lighter.\u003c/p>\n\u003cfigure id=\"attachment_244610\" class=\"wp-caption aligncenter\" style=\"max-width: 634px\">\u003cimg class=\"size-medium wp-image-244610\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Marlene-Simpson-Legs-634x600.jpg\" alt=\"Marlene Simpson's legs before and after liposuction surgery to treat her lipedema. \" width=\"634\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs-634x600.jpg 634w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs-400x378.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs-768x726.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlene-Simpson-Legs.jpg 774w\" sizes=\"(max-width: 634px) 100vw, 634px\">\u003cfigcaption class=\"wp-caption-text\">Marlene Simpson's legs before and after liposuction surgery to treat her lipedema.\u003c/figcaption>\u003c/figure>\n\u003cp>When she returned home to Sacramento, she felt like a new person.\u003c/p>\n\u003cp>\"It wasn’t ‘til I had surgery that I just realized that I was in a lot of pain,\" says Simpson.\u003c/p>\n\u003cp>Simpson's pain is caused by all the extra weight pressing on her nerves and lymph vessels. Over time, lipedema can be debilitating because blood clots, skin ulcers and recurrent infections can develop.\u003c/p>\n\u003cp>\u003cstrong>A Medical Unknown\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>But the relief put Simpson back $21,000 because her insurance denied the procedure. The company claims that liposuction is a cosmetic procedure, and it is not a recognized treatment for lipedema.\u003c/p>\n\u003cp>But Amron says liposuction \u003ci>does\u003c/i> work. If patients continue to diet and exercise, he swears the fat should not come back.\u003c/p>\n\u003cfigure id=\"attachment_244641\" class=\"wp-caption aligncenter\" style=\"max-width: 600px\">\u003cimg class=\"size-medium wp-image-244641\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/09/Marlenes-fat-600x600.jpg\" alt=\"The fat that was removed from Marlene Simpson's legs during liposuction surgery. \" width=\"600\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-600x600.jpg 600w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-400x400.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-768x768.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-1180x1180.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-1920x1920.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-960x960.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-32x32.jpg 32w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-50x50.jpg 50w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-64x64.jpg 64w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-96x96.jpg 96w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-128x128.jpg 128w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat-150x150.jpg 150w, https://ww2.kqed.org/app/uploads/sites/13/2016/09/Marlenes-fat.jpg 2048w\" sizes=\"(max-width: 600px) 100vw, 600px\">\u003cfigcaption class=\"wp-caption-text\">The fat removed from Marlene Simpson's legs during liposuction surgery.\u003c/figcaption>\u003c/figure>\n\u003cp>Ninety percent of Dr. Amron’s clientele have lipedema. They come to him for liposuction.\u003c/p>\n\u003cp>\"They found their way to me about ten years ago when I started doing lipedema patients, and I’d never even heard of the condition,\" says Amron\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Ignored by the Medical Community\u003c/strong>\u003c/p>\n\u003cp>In fact, most doctors haven’t heard of lipedema. A 2004 Stanford University \u003ca href=\"http://www.journaloflymphoedema.com/media/journals/_/1108/files/jol6-1-44-9.pdf\" target=\"_blank\">study\u003c/a> showed that most U.S. medical schools spend less than 30 minutes teaching the entire lymphatic system.\u003c/p>\n\u003cp>\"So, not surprisingly, doctors don’t know a lot about these diseases or the underlying conditions,\" says Rockson. \"If you poll 100 physicians off the street, you might find one that knows the term lipedema, and that one might not have much to say about it other than a recognition of the name.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>One of his patients, Judy Maggiore, hopes to someday benefit from his research. In the meantime, her daily lunch is a bowl filled with vegetables, and even though she usually skips dinner, the flab on her legs continues to thicken, causing chronic pain. She savors each bite slowly, in hopes of keeping fat cells at bay.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "They’re Already Working on a Roadside Pot Test to Nail You for Driving High",
"title": "They’re Already Working on a Roadside Pot Test to Nail You for Driving High",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Stanford engineers hope a new saliva test will someday be the key to catching drivers who've taken too many tokes. Right now, the only way to detect marijuana in the body is through a blood test or urine sample collected in a hospital -- not exactly a convenient roadside solution.\u003c/p>\n\u003cp>As states continue to legalize various forms of cannabis use, law enforcement will increasingly be looking for ways to detect impairment from pot. More than 20 states and the District of Columbia already allow some sort of cannabis use, and legalization is \u003ca href=\"http://norml.org/election-2016\" target=\"_blank\">on the ballot\u003c/a> in five states this November.\u003c/p>\n\u003caside class=\"pullquote alignright\">\n\u003cp style=\"background: white\">\u003cspan style=\"color: #212121\">'Because THC is far less volatile, the amount exchanged as a gas in the lungs is extremely difficult to detect, so it makes it sense to look at a different medium.' \u003c/span>\u003ccite>Tyler O’Brien Shultz, Stanford University\u003cbr>\n\u003c/cite>\u003c/p>\n\u003c/aside>\n\u003cp>Stanford's “potalyzer\" is a handheld device that allows officers to conduct a simple field test to determine a driver's concentration of THC, the chemical in marijuana that impairs drivers. In just a few minutes, a traffic cop could swab a saliva sample from a driver's mouth and insert it into a device with magnetic biosensors that can then send the results to a smartphone or laptop. \u003cstrong>\u003cbr>\n\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>Why Saliva?\u003c/strong>\u003c/p>\n\u003cp>Although companies such as \u003ca href=\"http://www.cannabixtechnologies.com/thc-breathalyzer.html\">Cannabix\u003c/a> Technologies and \u003ca href=\"http://houndlabs.com/\">Hound Labs\u003c/a> have developed breathalyzer tests for marijuana that work like those used to test for alcohol, Stanford researcher Tyler O’Brien Shultz says he’s highly skeptical that marijuana levels can be captured through air.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A THC molecule is very different from an ethanol molecule. Alcohol is volatile and evaporates quickly, so a breathalyzer test measures spirits vaporizing in your blood that are released through the lungs when you exhale.\u003c/p>\n\u003cp>“Because THC doesn’t evaporate,” says Stanford researcher Tyler O’Brien Shultz, “It is nearly impossible to test marijuana through breath detection, so it makes it sense to look at a different medium.”\u003c/p>\n\u003caside class=\"pullquote alignright\">As it stands now, 'If someone is high when you pull them over, they won’t be high when you draw their blood.'\u003ccite>Tyler O’Brien Shultz, Stanford University\u003c/cite>\u003c/aside>\n\u003cp>The saliva test employs the same magnetic nanotechnology Stanford researchers have used in cancer screenings. In this case they're measuring the THC concentration in someone’s spit rather than looking for cancer cells.\u003c/p>\n\u003cp>There is a not a standardized “safe” THC level for driving, although the range in academic studies is generally between two and 25 nanograms (or billionths of a gram) per milliliter of blood. The potalyzer can detect concentrations of THC in the range of 0 to 50 nanograms per milliliter of saliva. The device obviously won’t be useful until states set a limit for officers to test against.\u003c/p>\n\u003cp>\u003cstrong>Current System Lags\u003c/strong>\u003c/p>\n\u003cp>Right now traffic cops must rely on visual observation to determine whether someone is high. Officers look for red eyes or a bulging neck vein, or they’ll ask a driver to close their eyes and guess when 30 seconds has passed.\u003c/p>\n\u003cp>If the driver appears impaired, the officer will take them into custody. At the police station, a drug recognition expert will assess the driver to determine whether a blood test and a trip to a hospital is necessary. The process can take about two-and-a-half hours from the time a driver is stopped until their blood is drawn. Shultz says that's way too long.\u003c/p>\n\u003cp>“THC will likely fall below the safe limit designated by most states within three to four hours of consuming the drug,” says Schultz. “In other words, if someone is high when you pull them over, they won’t be high when you draw their blood.”\u003c/p>\n\u003cp>Urinalysis is also not ideal for assessing impairment, because tests pick up marijuana that is latent in the body from use that could be days old. That is not a problem with Stanford's device.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The potalyzer's potential extends far beyond weed. The device can measure any small molecule, so a test could also look for morphine, heroin or cocaine. The biosensor chip has 80 sensors capable of testing for multiple substances. But it will be at least a few years before the saliva test will be deployed by police. Schultz says the device needs further field tests, human trials and regulatory approval before it goes on the market.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A THC molecule is very different from an ethanol molecule. Alcohol is volatile and evaporates quickly, so a breathalyzer test measures spirits vaporizing in your blood that are released through the lungs when you exhale.\u003c/p>\n\u003cp>“Because THC doesn’t evaporate,” says Stanford researcher Tyler O’Brien Shultz, “It is nearly impossible to test marijuana through breath detection, so it makes it sense to look at a different medium.”\u003c/p>\n\u003caside class=\"pullquote alignright\">As it stands now, 'If someone is high when you pull them over, they won’t be high when you draw their blood.'\u003ccite>Tyler O’Brien Shultz, Stanford University\u003c/cite>\u003c/aside>\n\u003cp>The saliva test employs the same magnetic nanotechnology Stanford researchers have used in cancer screenings. In this case they're measuring the THC concentration in someone’s spit rather than looking for cancer cells.\u003c/p>\n\u003cp>There is a not a standardized “safe” THC level for driving, although the range in academic studies is generally between two and 25 nanograms (or billionths of a gram) per milliliter of blood. The potalyzer can detect concentrations of THC in the range of 0 to 50 nanograms per milliliter of saliva. The device obviously won’t be useful until states set a limit for officers to test against.\u003c/p>\n\u003cp>\u003cstrong>Current System Lags\u003c/strong>\u003c/p>\n\u003cp>Right now traffic cops must rely on visual observation to determine whether someone is high. Officers look for red eyes or a bulging neck vein, or they’ll ask a driver to close their eyes and guess when 30 seconds has passed.\u003c/p>\n\u003cp>If the driver appears impaired, the officer will take them into custody. At the police station, a drug recognition expert will assess the driver to determine whether a blood test and a trip to a hospital is necessary. The process can take about two-and-a-half hours from the time a driver is stopped until their blood is drawn. Shultz says that's way too long.\u003c/p>\n\u003cp>“THC will likely fall below the safe limit designated by most states within three to four hours of consuming the drug,” says Schultz. “In other words, if someone is high when you pull them over, they won’t be high when you draw their blood.”\u003c/p>\n\u003cp>Urinalysis is also not ideal for assessing impairment, because tests pick up marijuana that is latent in the body from use that could be days old. That is not a problem with Stanford's device.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The potalyzer's potential extends far beyond weed. The device can measure any small molecule, so a test could also look for morphine, heroin or cocaine. The biosensor chip has 80 sensors capable of testing for multiple substances. But it will be at least a few years before the saliva test will be deployed by police. Schultz says the device needs further field tests, human trials and regulatory approval before it goes on the market.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"title": "Possible",
"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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"pri-the-world": {
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"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
"radiolab": {
"id": "radiolab",
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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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},
"reveal": {
"id": "reveal",
"title": "Reveal",
"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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