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To Protect His Son, A Father Asks School To Bar Unvaccinated Children

Tue, 01/27/2015 - 5:05pm
To Protect His Son, A Father Asks School To Bar Unvaccinated Children January 27, 2015 5:05 PM ET

fromKQED

Lisa Aliferis

Rhett Krawitt, 6, outside his school in Tiburon, Calif. Seven percent of the children in his school are not vaccinated.

Courtesy of Carl Krawitt

Carl Krawitt has watched his son, Rhett, now 6, fight leukemia for the past 4 1/2 years. For more than three of those years, Rhett has undergone round after round of chemotherapy. Last year he finished chemotherapy, and doctors say he is in remission.

Now, there's a new threat, one that the family should not have to worry about: measles.

Rhett cannot be vaccinated, because his immune system is still rebuilding. It may be months more before his body is healthy enough to get all his immunizations. Until then, he depends on everyone around him for protection — what's known as herd immunity.

But Rhett lives in Marin County, Calif., a county with the dubious honor of having the highest rate of "personal belief exemptions" in the Bay Area and among the highest in the state. This school year, 6.45 percent of children in Marin have a personal belief exemption, which allows parents to lawfully send their children to school unvaccinated against communicable diseases like measles, polio, whooping cough and more.

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Carl Krawitt has had just about enough. "It's very emotional for me," he said. "If you choose not to immunize your own child and your own child dies because they get measles, OK, that's your responsibility, that's your choice. But if your child gets sick and gets my child sick and my child dies, then ... your action has harmed my child."

Krawitt is taking action of his own. His son attends Reed Elementary in Tiburon, a school with a 7 percent personal belief exemption rate. (The statewide average is 2.5 percent). Krawitt had previously worked with the school nurse to make sure that all the children in his son's class were fully vaccinated. He said the school was very helpful and accommodating.

Now Krawitt and his wife, Jodi, have emailed the district's superintendent, requesting that the district "require immunization as a condition of attendance, with the only exception being those who cannot medically be vaccinated."

Carl Krawitt provided me with Superintendent Steven Herzog's response. Herzog didn't directly address their query, instead saying: "We are monitoring the situation closely and will take whatever actions necessary to ensure the safety of our students."

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Typically, a response to health emergencies rests with county health officers. During the current measles outbreak, we've already seen that unvaccinated students at Huntington Beach High School in Orange County were ordered to stay out of school for three weeks after a student there contracted measles. It's one way to contain an outbreak.

But those steps were taken in the face of a confirmed case at the school.

When I called Marin County health officer Matt Willis to see what he thought of keeping unvaccinated kids out of school even if there were no confirmed cases, he sounded intrigued. "This is partly a legal question," he said.

But he was open to the idea and said he was going to check with the state to see what precedent there was to take such an action.

Right now, there are no cases of measles anywhere in Marin and no suspected cases either. Still, "if the outbreak progresses and we start seeing more and more cases," Willis said, "then this is a step we might want to consider" — requiring unvaccinated children to stay home, even without confirmed cases at a specific school.

Rhett has been treated at the University of California, San Francisco, and his oncologist there, Dr. Robert Goldsby, said that he is likely at higher risk of complications if he were to get measles.

Rhett, just weeks after starting chemotherapy in 2010.

Courtesy of Carl Krawitt

"When your immune system isn't working as well, it allows many different infections to be worse," Goldsby said. "It's not just Rhett. There are hundreds of other kids in the Bay Area that are going through cancer therapy, and it's not fair to them. They can't get immunized; they have to rely on their friends and colleagues and community to help protect them."

Goldsby pointed to the number of people who, when facing a friend or family member who receives a challenging diagnosis, will immediately ask how they can help. "Many families will say, 'What can I do to help? What can I do to help?' " he said, repeating it for emphasis. "One of the main things they can do is make sure their [own] kids are vaccinated to protect others."

Krawitt has been speaking up about vaccination for a long time now. He told me about going to a parent meeting at his daughter's school just before the start of the school year, where a staff member reminded parents not to send peanut products to school, since a child or children had an allergy. "It's really important your kids don't bring peanuts, because kids can die," Krawitt recalls the group being told.

The irony was not lost on him. He told me he immediately responded, "In the interest of the health and safety of our children, can we have the assurance that all the kids at our school are immunized?"

He found out later from a friend that other parents who were present were "mad that you asked the question, because they don't immunize their kids."

This story was produced by State of Health, KQED's health blog.

Copyright 2015 KQED Public Media. To see more, visit http://www.kqed.org/news.
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Am I Responsible If The Insurance Exchange Flubs My Subsidy?

Tue, 01/27/2015 - 9:28am
Am I Responsible If The Insurance Exchange Flubs My Subsidy? January 27, 2015 9:28 AM ET

Partner content from

Insurance and the subsidies available to buy it can be confusing. Here are some answers to recent questions from people who are running into difficulties with premiums and tax credits on their marketplace plans.

My 63-year-old husband has Alzheimer's disease. Our annual income is $41,000, from a combination of his Social Security disability insurance (SSDI) and a disability policy he had from a previous job. Last year I bought a single policy on the health insurance exchange. My husband gets coverage through the Department of Veterans Affairs. The monthly premium was reduced by a $278 tax credit based on our estimated annual income. Now I'm reviewing IRS form 8962 that's used to reconcile what we received in premium tax credits against what we should have received based on our actual income. It looks like we'll have to repay $2,500! We can't afford that. If the marketplace made a mistake in figuring our tax credit, do we still have to pay the money back?

If you received too much in premium tax credits, you'll generally have to pay some or all of it back. Health policy experts say they know of no provision in the health law or rules that would excuse someone from repayment if an error that resulted in a tax credit overpayment was made by the online marketplace. An administration official didn't respond to a request to clarify whether those situations would be handled differently than if someone underestimates their own income and receives too much.

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The amount you'll have to repay is capped based on your income. A couple with an income between 200 and 300 percent of the federal poverty level ($31,460 to $47,190 for a family of two in 2014) would have to repay up to $1,500. (People with incomes above 400 percent of poverty — $62,920 for a couple — would have to repay the entire amount.)

It's hard to know if or where an error occurred. It's possible that you or the marketplace calculated your income incorrectly. SSDI counts as income when figuring your eligibility for premium tax credits, but disability insurance payments received from an employer policy may or may not count as income depending on who paid the premium.

Perhaps you or the marketplace entered information incorrectly, transposed figures or made some other manual or computer entry error.

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By early February you should receive Form 1095-A from the marketplace detailing how much you received in tax credits for reconciliation purposes. It will be important to use that to make sure your calculations on Form 8962 are correct.

If you discover there was an error in your premium tax credit last year, you'll still have time to sit down with a navigator to go over your 2015 coverage choices before open enrollment ends Feb. 15.

I had coverage through a health insurance marketplace plan last year, and this year I'm told my costs will increase significantly. The actual premium the insurance company will charge won't change and my income hasn't changed. But the amount of premium tax credit I receive will go down. What can I do?

Before you renew your coverage with the same plan you had last year, go back to the marketplace and check out what else is available. It sounds as if the benchmark plan in your area may have changed, and that could mean a higher bill for you unless you switch plans.

Here's how it works: Premium tax credits are based on the second-lowest-cost silver plan in your area, called the benchmark plan. If the cost of the benchmark plan this year is lower than it was last year, your tax credit may be lower as well. That's not a problem if you switch to the new, cheaper benchmark plan. But if you renew your old plan, you'll have to pay the difference in cost between its higher premium and that of the new benchmark plan.

"Even though your premium didn't change and your income didn't change, you could see a significant difference in what your contribution is because the premium for the second-lowest-cost silver plan is different," says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

I am being told that I must furnish automatic debit card information before an insurance company will provide me with coverage through the exchange. Can they do that?

Health insurers that sell coverage on the marketplaces are required to accept various forms of payment, says Sandy Ahn, a research fellow at Georgetown University's Center on Health Insurance Reforms. That includes paper and cashier's checks, money orders, electronic funds transfers and prepaid debit cards.

An insurance industry representative said this sounded like a misunderstanding. "Plans accept various forms of payment and wouldn't limit a consumer only to a debit card," says a spokeswoman for America's Health Insurance Plans, an insurance industry trade group. "Health plans regularly work with their members to establish the payment plan that works best for them."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Child Abuse And Neglect Laws Aren't Being Enforced, Report Finds

Tue, 01/27/2015 - 3:47am
Child Abuse And Neglect Laws Aren't Being Enforced, Report Finds January 27, 2015 3:47 AM ET Listen to the Story 3 min 41 sec   Will Crocker/Getty Images

Laws intended to protect children from abuse and neglect are not being properly enforced, and the federal government is to blame. That's according to a study by the Children's Advocacy Institute at the University of San Diego School of Law, which says children are suffering as a result.

The numbers are grim. Almost 680,000 children in the United States were the victims of abuse and neglect in 2013. More than 1,500 of them died.

Federal officials say they're encouraged that the numbers are lower than they were in 2012. But children's advocates say abuse is so often not reported that it's impossible to know if there's really been a decline.

"This is just something that's chronically underreported," says Elisa Weichel, a staff attorney with the Children's Advocacy Institute, which published the report Tuesday.

She says abuse and neglect cases — especially those resulting in death — are often not disclosed as required by law. That lack of information has led to other problems in the system.

"It all boils down to having the right amount of data about what's working and what's not," Weichel says. "And when your data is flawed, every other part of your system is going to be flawed."

"This is just something that's chronically underreported."

Her group has found plenty of flaws. The institute conducted a three-year study and found that not one state has met all of the minimum child welfare standards set by the federal government. Those standards include such things as timely investigation of reports of child abuse. The institute blames Congress and the courts for failing to get involved.

The Department of Health and Human Services, which reviews state programs, declined to comment on the report.

But there's broad agreement among those involved in child welfare that the system is in desperate need of repair, agencies are underfunded, and caseworkers are often overwhelmed.

"Whether or not individual states can meet a reporting standard to us is not where the emphasis ought to be," says Ron Smith, director of legislative affairs for the American Public Human Services Association, which represents child welfare administrators.

"It needs to be on making sure that the kids who need assistance are getting assistance, and the families that need assistance are getting the assistance," he says.

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Smith says state and local officials complain that they spend too much time filling out federal forms and trying to meet requirements that aren't necessarily best for kids.

Instead, he says, they want flexibility on how to spend federal funds so they can focus more on keeping families together, rather than on helping kids after they've been abused and removed from their homes.

Ron Zychowski of Eckerd, a nonprofit company that runs child welfare services in three of Florida's largest counties, agrees that change is needed. Eckerd has developed a new system to identify which of the 5,000 children under its care are at the highest risk of serious injury or death, so they can fix problems quickly.

"And I'm very pleased to report that in two years we have not had a child death from abuse or neglect in any of our cases," Zychowski says.

That program is getting lots of national attention, including from a new commission set up by Congress to help eliminate abuse and neglect deaths.

But Zychowski warns, in this field, there's no silver bullet.

"Bad people will do bad things to children," he says. "We're not going to catch them all, and we're not going to stop them all."

There was a horrific reminder of that earlier this month. A Florida man was accused of killing his 5-year-old daughter by throwing her off a bridge. Zychowski says the family was not in the child welfare system.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Medicare Looks To Speed Up Pay For Quality Instead Of Volume

Mon, 01/26/2015 - 5:14pm
Medicare Looks To Speed Up Pay For Quality Instead Of Volume January 26, 2015 5:14 PM ET

Partner content from

Jordan Rau

The Obama administration said Monday that it wants to speed up changes to Medicare so that within four years half of its traditional spending will go to doctors, hospitals and other providers that coordinate patient care.

The shift is being made to stress quality and frugality over payment by the procedure, test and visit.

The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare's traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares. Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternative payment approaches.

Last year, 20 percent of traditional Medicare spending, about $72 billion, went to models such as accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings they bring to Medicare, administration officials said.

There are now 424 ACOs, and 105 hospitals and other health care groups that accept bundled payments. Medicare's bundles give them a fixed sum for each patient, which is supposed to cover not only their initial treatment for a specific ailment but also all the follow-up care. Other Medicare-funded pilot projects give doctors extra money to coordinate patient care among specialists and seek to get Medicare to work more in harmony with Medicaid, the state-federal health insurer for low-income people.

Burwell's targets are for 30 percent, or about $113 billion, of Medicare's traditional spending to go to these kind of endeavors by the end of President Obama's term in 2016, and 50 percent — about $215 billion — to be spent by the end of 2018.

The administration also wants Medicare spending with any quality component, such as bonuses and penalties on top of traditional fee-for-service payments, to increase, so that by the end of 2018, 90 percent of Medicare spending has some sort of link to quality. These figures do not include the money that now goes to private insurers in the Medicare Advantage program, which enrolls about a third of all Medicare beneficiaries.

Monday's announcement didn't include any new policies or funding to encourage providers, but Burwell said setting a concrete goal alone would prompt changes not only in Medicare but also in private insurance, where some of these alternative models are also being tried.

"For the first time we're actually going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system," Burwell said at the department's headquarters, where she was joined by leaders from the insurance, hospital and physician leaders. "So today what we want to do is measure our progress and we want to hold ourselves in the federal government accountable."

Some providers have eagerly embraced the new payment models, some with success. Roughly a quarter of ACOs saved Medicare enough money to win bonuses last year. Others are wary, particularly since they could lose money if they fall short on either saving Medicare money or achieving the dozens of quality benchmarks the government has established.

"ACOs are quite expensive to set up," said Andrea Ducas, a program officer at the Robert Wood Johnson Foundation, a New Jersey philanthropy that is funding research into ACO performance. "There's a significant upfront investment and if you're not sure you're going to make it back, there's a pause."

In the largest ACO experiment, the Medicare Shared Savings Program, 53 ACOs saved enough money in 2013 to get bonuses from the government, but 41 spent more than the government estimated they should have. Those ACOs did not have to repay any money, but in the future Medicare intends to require reimbursements from those who fall short. Providers have been pushing Medicare to increase the cut they get from these programs and lessen the financial risks in ACOs and the other programs.

"Government needs to do more to make sure there's more shared savings going back to the providers," said Blair Childs, an executive with Premier, a company that helps hospitals and providers in establishing ACOs and other models.

It is still too early to know whether these alternative payment models actually improve health of patients and whether the savings that have been achieved so far — often by focusing on the most expensive patients — will plateau. Studies on the success of these programs have shown mixed results.

"We still have very little evidence about which payment methods are going to be successful in getting the results we want, which are better quality care and more affordable care," said Suzanne Delbanco, executive director of Catalyst For Payment Reform, a California-based nonprofit that has been tracking the spread of alternative payment models in the private sector. "We're just wanting to avoid a situation where a few years from now, where we've completely gotten rid of fee-for-service, we don't want to wake up and say, 'Oh my gosh, we did it and we're no better off.' "

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Pediatricians Say Don't Lock Up Teenagers For Using Marijuana

Mon, 01/26/2015 - 11:46am
Pediatricians Say Don't Lock Up Teenagers For Using Marijuana January 26, 201511:46 AM ET

A marijuana bud displayed in Denver. Don't legalize pot, the pediatricians say, but don't lock teenagers up for using it, either.

Seth McConnell/The Denver Post/Getty Images

Across the country, efforts to make marijuana more accessible have quickly gained traction. Medical marijuana is now legal in 23 states, and recreational use is also legal in four states and the District of Columbia.

Science, however, hasn't quite caught up. Largely due to its illegal status, there's been very little research done on marijuana's health effects. And researchers don't fully understand how pot affects the developing teenage brain.

This may explain the why the nation's pediatricians have changed their recommendations on marijuana and children.

On Monday, the American Academy of Pediatrics revised its policy on medical marijuana, saying pediatricians should avoid prescribing it to children until more research is done, except in cases where patients are suffering from chronic, debilitating conditions. The pediatrics group is also recommending the decriminalization of weed, but it's advising against legalization.

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Well, that's confusing. So we called up Dr. Seth Ammerman, a pediatrician at Stanford University who wrote the policy paper. Arresting teens who use pot won't do them any good, Ammerman says. Hundreds of thousands of adolescents and teens have been incarcerated for marijuana possession, "and the vast majority of marijuana-related arrests are minority youths."

The pediatricians' stance is that marijuana use among young people is a public health issue rather than a criminal justice issue, and it should be treated as such.

Its views on legalizing pot for recreational use, however, are more conservative.

"There's no evidence that legalizing will benefit youth," Ammerman tells Shots. "And the concern is that legalization will increase youth access to marijuana and maybe increase use."

Marijuana hasn't been legal anywhere in the U.S. for very long, so no one knows how these changing laws will affect teen usage rates. But if marijuana companies start marketing their products like alcohol and tobacco companies have done, kids and teens could be affected, Ammerman says.

"We would certainly be willing to revisit the issue as new data comes up," he adds. "But for now, let's not get into the position where we're looking back a decade from now and saying, 'Oh God, we've now addicted a bunch more kids.' "

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Convincing kids that they should stay away from weed can get tricky, the pediatricians acknowledge, especially as support for legalization grows. Part of the issue is that campaigns to legalize marijuana often portray it as a benign substance, says Dr. Leslie Walker, chief of the adolescent medicine division at Seattle Children's Hospital.

"People make arguments that say, 'Oh, this is safer than alcohol, it's safer than tobacco, it's safer than heroin,' " Walker says. And all that may be true, she says. "But marijuana on its own is harmful for adolescents."

Preliminary research suggests that marijuana isn't good for teens' developing brains. And studies show that adolescents who use pot are more likely than adults to become addicted.

Of course, there is still a lot we don't know about marijuana, whether it's used recreationally or medicinally. The AAP policy paper recommends that the Drug Enforcement Agency remove marijuana from the Schedule 1 listing for controlled substances, so that it's easier for researchers to get hold of the substance and study it.

"In the meantime, there's definitely a risk of having a kind of mixed message for teens," says Brendan Saloner, an assistant professor at the Johns Hopkins Bloomberg School of Public Health. "The frank answer is we don't know the best ways to communicate with teens about marijuana."

Refer-madness style scare tactics probably won't work, Saloner says. But both Walker and Ammerman recommend that parents be firm with kids. They should feel empowered to tell kids that using pot when you're under 21 isn't OK, even if they themselves use it. The AAP also recommends that parents set a good example by not smoking around kids.

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In Colorado, where adult use is legal, Children's Hospital Colorado suggests that parents "present the facts to your child objectively and use them to explain why marijuana use is still illegal for people under age 21."

In states where marijuana is legal, there are ways to mitigate teen usage, Saloner says.

States can and should control the extent to which companies can advertise marijuana products, he says. "The biggest concern here is edibles — candies and cookies can look really appealing to kids and adolescents," he notes.

Research also shows that the price of alcohol and tobacco can deter adolescents from using it.

"I don't think my position is to say whether or not it's right or wrong to legalize it," Saloner says. "Still, there are better and worse ways in which to legalize marijuana."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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High Schools Seek A Safer Path Back From Concussion

Mon, 01/26/2015 - 3:59am
High Schools Seek A Safer Path Back From Concussion January 26, 2015 3:59 AM ET Listen to the Story 4 min 19 sec  

High school athlete Graham Hill, number 50, suffered a concussion in 2013 while playing football at Trinity Christian Academy in Addison, Texas.

Courtesy of Jeffrey McWhorter

Nearly half of all reported sports concussions occur during a high school football game or practice. And even when injured bodies are ready to get back on the field, injured brains might not be ready to return to class.

But how long should these student athletes be out of school? A day? A week? A month? The latest research supports the idea of a gradual return to class and other activities, in a flexible program that's tailored to each student's injury and recovery from symptoms, rather than a blanket insistence on strict isolation and total rest for everyone. The aim is a more balanced approach that at least one high school — Trinity Christian Academy, in Addison Texas — is already trying to adopt.

For weeks after his concussion during a high school football game in 2013, Graham Hill, then a junior at Trinity, felt sick. His stomach hurt, he remembers. He was exhausted, and there was a pressure in his skull — like a balloon was being inflated in his head.

"It's like a migraine on steroids," says Hill, who is now a senior.

After a few weeks, Hill's body was in good enough shape to return to class and practice, but his brain wasn't ready. The instructions from the doctor were simple. No football — and, for a while, no school.

The doctor, Hill says, told him that as long as he had symptoms, he was to "do nothing — sit in a dark room, no electronics, no reading, no loud noises and just focus on getting your mind better."

Hill wasn't to hang out with friends — or even text them as long as any symptoms of the concussion persisted. He missed two weeks of class during his junior year and then went back to school, just part-time at first.

Hill's gradual return to school was planned — part of an academic rehabilitation program at his high school that's based on the newest thinking among brain specialists on the best way to heal concussions. Not every student will be out of school as long as Graham Hill was; not everyone has symptoms that linger as long. Relying on medical advisors, Trinity creates a tailored game plan for each player, using symptoms as a guide.

That's a big change from the days when a coach might stick smelling salts under the nose of player who'd been knocked out, and quickly send him back to the huddle. But it's also a change from the more recent practice of cocoon therapy — a popular notion that more rest after a concussion must, inevitably, be better.

Too Much Rest

There can be such a thing as too much rest, according to a study published this month in the medical journal Pediatrics. Dr. Danny Thomas, a pediatric emergency medicine specialist at Children's Hospital of Wisconsin, and several colleagues recruited for their research nearly 90 patients, ages 11 to 22, within 24 hours after the young people were diagnosed with concussion. In the randomized, controlled trial, half were told to rest at home for one or two days, followed by a step-wise return to regular activity; the others were prescribed total rest for five days.

"Most people would assume that when you're resting you're having less stimulation of your brain — and have fewer symptoms (because you're not challenging yourself)," Thomas says. But that's not what the researchers found.

"Patients who were randomized to the strict rest group took longer to recover and had more symptoms during that recovery period," he says.

When tested and questioned 10 days after the concussion, both groups seemed to be healing at about the same rate cognitively. But headaches and nausea were worse for the kids who got more days of strict rest — for five days instead of two. They also more frequently complained of emotional symptoms — like irritability and sadness. The isolation seemed to be hard on them.

"The pendulum had swung too far toward rest," Thomas says. "Hopefully, this study has swung the pendulum back to the middle."

Even before Thomas's study was published, Janie Heard, an administrator at Trinity Christian Academy, had adopted the customized approach: She coordinates with doctors, students, parents and teachers to make sure a student is doing as much work as possible — without aggravating symptoms.

"Our goal is to get them back to where they were academically before the brain injury," Heard says. "And it's different for every one of these kids."

A New Approach To Recovery

Heard created the school rehab program at Trinity after she had a serious concussion herself years ago. In the past four years, she's helped 128 students throughout the school gradually return to class after a brain injury.

For a student taking six classes and applying for scholarships, trying to give the brain the appropriate amount of rest can be a challenge. But some rest in the immediate aftermath is crucial to healing, many neuroscientists now say, including Gerard Gioia, a neuropsychologist at Children's National Health System in the Washington, D.C., area.

"I often say that the software system of the brain now is impaired," says Gioia, who directs the Safe Concussion Outcome, Recovery & Education (SCORE) program at Children's. "And all of the functions that software runs — like your thinking and your behavior, your emotions and your sleep — can potentially be impaired as well."

The evidence, he says, now shows that getting all those systems back online takes some flexibility — and a lot of patience.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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DNA Blood Test Gives Women A New Option For Prenatal Screening

Mon, 01/26/2015 - 3:58am
DNA Blood Test Gives Women A New Option For Prenatal Screening January 26, 2015 3:58 AM ET Listen to the Story 6 min 49 sec  

Ultrasound is often used for prenatal screening. It's just one of several prenatal screenings available to pregnant women.

iStockphoto

When Amy Seitz got pregnant with her second child last year, she knew that being 35 years old meant there was an increased chance of chromosomal disorders like Down syndrome. She wanted to be screened, and she knew just what kind of screening she wanted — a test that's so new, some women and doctors don't quite realize what they've signed up for.

This kind of test , called cell free fetal DNA testing, uses a simple blood sample from an expectant mother to analyze bits of fetal DNA that have leaked into her bloodstream. It's only been on the market since October 2011 and is not regulated by the Food and Drug Administration — the FDA does not regulate this type of genetic testing service. Several companies now offer the test, including Sequenom and Illumina. Insurance coverage varies, and doctors often only offer this testing to women at higher risk because of things like advanced maternal age.

"I think that I initially heard about it through family and friends," says Seitz. "They had had the option of it given to them by their doctors."

To her, it sounded great. She didn't want an invasive procedure like amniocentesis or chorionic villus sampling.Those are considered the gold standard for prenatal genetic testing, but doctors must put a needle into the womb to collect cells that contain fetal DNA, which means a small risk of miscarriage.

During amniocentesis, a needle is inserted through a woman's abdomen into the amniotic sac. A sample of fluid is extracted and screened for genetic disorders such as Down syndrome.

Peter Gardiner/Science Source

"I wasn't interested in going as far as getting an amniocentesis because of the risk associated with that," she explains, "and so when I heard about this test, that was part of the reason that I was most interested in it."

This new way of testing fetal DNA seemed to have already become fairly common where Seitz used to live, in Washington, D.C. But she had recently moved to Alabama, and the clinic she went to there wasn't as familiar with it — although when she talked to her doctor, she learned the clinic had just had a visit from a company's sales representative.

"I think it was a fairly new test for them at that point, but she was interested in pursuing it further to see what needed to be done," Seitz says.

Seitz got her blood drawn last July, becoming one of hundreds of thousands of pregnant women who've opted for this new kind of test instead of the more traditional, invasive ones. Doctors say the impact has been huge.

Shots - Health News More Women Skip Some Prenatal Tests After Learning About Risks

"Those of us in the field who do diagnostic procedures like CVS and amnio have seen a drastic decrease in the number of those procedures that are being performed," says Dr. Mary Norton, an expert on maternal-fetal medicine and genetics at the University of California, San Francisco. "Places are reporting doing fewer than half the number of procedures that were being done previously."

But, she says, things have changed so quickly that it may be hard for doctors and patients to know what they're dealing with.

"It's still new and it's quite different than previous genetic testing that's been available," says Norton. "It's quite a different paradigm, if you will."

An invasive test like amniocentesis or CVS lets doctors get a complete picture of the chromosomes and a solid diagnosis.

Until the new testing technology came along, the only less invasive option was for an expectant mother to get an ultrasound, plus have her blood tested for specific proteins. This can reveal if there's an increased risk of certain disorders, but it's not very accurate and produces a lot of false alarms.

Shots - Health News Blood Test Provides More Accurate Prenatal Testing For Down Syndrome

Studies have shown that the new fetal DNA tests do a better job, says Norton. They're less likely to flag a normal pregnancy as high risk.

"They're much more accurate than current screening tests, but they are not diagnostic tests in the sense that amniocentesis is," says Norton, "and so I think that has led to some confusion."

Even though the newer blood tests do look at fetal DNA, they can't give a definitive answer like an amniocentesis can because they're analyzing scraps of fetal DNA in the mother's blood that are all mixed up with her own DNA.

Norton says when women get worrisome results from one of these new tests and are referred to her center, they sometimes don't understand why doctors are offering a follow-up amnio "because they were under the impression that this was as good as an amnio."

She is concerned that some people might end a pregnancy without getting confirmatory testing and points to one study last year that found a small number of women did that.

"There's at least some evidence that it's happening to a greater degree than I think many of us are comfortable with," she says.

The tests are being used more and more widely. Some worry that the companies' websites and marketing materials don't make the limitations clear enough.

But Dr. Lee Shulman doesn't see it that way. He's an obstetrician and geneticist at Northwestern University in Chicago who has consulted for a couple of the testing firms.

"Patients need to understand that while this is better, it is not a diagnostic test, and I think the companies have done a great job in putting this material out," he says. "Whether or not clinicians use this material and take it to heart and use it for patient counseling is a different story."

He says the technology is so new that a lot of doctors have no experience with it, and consumers need to understand that.

"If the patient, if the couple, are not getting the answers, not getting the information they feel comfortable with, they need to seek out prenatal diagnostic centers, maternal fetal specialists, clinical geneticists, who may have more experience," says Shulman.

For example, here's one thing that might turn out to be a little more complicated than would-be parents might expect. Along with screening for the common chromosomal disorders, companies offer parents the chance to learn their baby's sex — weeks before it's clear on a sonogram.

"Many women are very excited by the idea that as part of their blood testing, they could find out pretty definitively if the baby is a boy or a girl," says Dr. Diana Bianchi, an expert on prenatal diagnostics at Tufts University School of Medicine.

What they may not realize, she says, is that the test will also determine whether there's something abnormal about the sex chromosomes.

"Approximately 1 in 700 pregnancies there's an extra X or extra Y," she says, noting that these are mild conditions that would normally go undetected, unless a woman had an invasive test like an amnio. Some babies with these conditions grow up into adulthood and never know they have them, unless they face a symptom like infertility.

Seitz, in Alabama, thought it was a bonus that getting this new blood test would tell her if she was having a boy or a girl. But it actually didn't do that, because of a paperwork glitch.

"The box for sex got unchecked somewhere along the way, so we weren't able to find it out from the test," says Seitz, who learned from an ultrasound that she was having a girl. The results she did get from the fetal DNA test were reassuring.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

DNA Blood Test Gives Women A New Option For Prenatal Screening

Mon, 01/26/2015 - 3:58am
DNA Blood Test Gives Women A New Option For Prenatal Screening January 26, 2015 3:58 AM ET

Ultrasound is often used for prenatal screening. It's just one of several prenatal screenings available to pregnant women.

iStockphoto

When Amy Seitz got pregnant with her second child last year, she knew that being 35 years old meant there was an increased chance of chromosomal disorders like Down syndrome. She wanted to be screened, and she knew just what kind of screening she wanted — a test that's so new, some women and doctors don't quite realize what they've signed up for.

This kind of test , called cell free fetal DNA testing, uses a simple blood sample from an expectant mother to analyze bits of fetal DNA that have leaked into her bloodstream. It's only been on the market since October of 2011 and is not regulated by the Food and Drug Administration - the FDA does not regulate this type of genetic testing service. Several companies now offer the test, including Sequenom and Illumina. Insurance coverage varies and doctors often only offer this testing to women at higher risk because of things like advanced maternal age.

"I think that I initially heard about it through family and friends," says Seitz. "They had had the option of it given to them by their doctors."

To her, it sounded great. She didn't want an invasive procedure like amniocentesis or chorionic villus sampling (CVS). Those are considered the gold standard for prenatal genetic testing, but doctors must put a needle into the womb to collect cells that contain fetal DNA, which means a small risk of miscarriage.

During amniocentesis, a needle is inserted through a woman's abdomen into the amniotic sac. A sample of fluid is extracted and screened for genetic disorders such as Down syndrome.

Peter Gardiner/Science Source

"I wasn't interested in going as far as getting an amniocentesis because of the risk associated with that," she explains, "and so when I heard about this test, that was part of the reason that I was most interested in it."

This new way of testing fetal DNA seemed to have already become fairly common where Seitz used to live, in Washington, D.C. But she had recently moved to Alabama, and the clinic she went to there wasn't as familiar with it — although when she talked to her doctor, she learned they'd just had a visit from a company's sales representative.

"I think it was a fairly new test for them at that point, but she was interested in pursuing it further to see what needed to be done," Seitz says.

Seitz got her blood drawn last July, becoming one of hundreds of thousands of pregnant women who've opted for this new kind of test instead of the more traditional, invasive ones. Doctors say the impact has been huge.

Shots - Health News More Women Skip Some Prenatal Tests After Learning About Risks

"Those of us in the field who do diagnostic procedures like CVS and amnio have seen a drastic decrease in the number of those procedures that are being performed," says Dr. Mary Norton, an expert on maternal-fetal medicine and genetics at the University of California, San Francisco. "Places are reporting doing fewer than half the number of procedures that were being done previously."

But, she says, things have changed so quickly that it may be hard for doctors and patients to know what they're dealing with.

"It's still new and it's quite different than previous genetic testing that's been available," says Norton. "It's quite a different paradigm, if you will."

An invasive test like amniocentesis or CVS lets doctors get a complete picture of the chromosomes and a solid diagnosis.

Until the new testing technology came along, the only less invasive option was for an expectant mother to get an ultrasound, plus have her blood tested for specific proteins. This can reveal if there's an increased risk of certain disorders, but it's not very accurate and produces a lot of false alarms.

Shots - Health News Blood Test Provides More Accurate Prenatal Testing For Down Syndrome

Studies have shown that the new fetal DNA tests do a better job, says Norton. They're less likely to flag a normal pregnancy as high risk.

"They're much more accurate than current screening tests, but they are not diagnostic tests in the sense that amniocentesis is," says Norton, "and so I think that has led to some confusion."

Even though the newer blood tests do look at fetal DNA, they can't give a definitive answer like an amniocentesis can because they're analyzing scraps of fetal DNA in the mother's blood that are all mixed up with her own DNA.

Norton says when women get worrisome results from one of these new tests and are referred to her center, they sometimes don't understand why doctors are offering a follow-up amnio "because they were under the impression that this was as good as an amnio."

She is concerned that some people might end a pregnancy without getting confirmatory testing, and points to one study last year that found a small number of women did that.

"There's at least some evidence that it's happening to a greater degree than I think many of us are comfortable with," she says.

The tests are being used more and more widely. Some worry that the companies' websites and marketing materials don't make the limitations clear enough.

But Dr. Lee Shulman doesn't see it that way. He's an obstetrician and geneticist at Northwestern University in Chicago who has consulted for a couple of the testing firms.

"Patients need to understand that while this is better, it is not a diagnostic test, and I think the companies have done a great job in putting this material out," he says. "Whether or not clinicians use this material and take it to heart and use it for patient counseling is a different story."

He says the technology is so new that a lot of doctors have no experience with it, and consumers need to understand that.

"If the patient, if the couple, are not getting the answers, not getting the information they feel comfortable with, they need to seek out prenatal diagnostic centers, maternal fetal specialists, clinical geneticists, who may have more experience," says Shulman.

For example, here's one thing that might turn out to be a little more complicated than would-be parents might expect. Along with screening for the common chromosomal disorders, companies offer parents the chance to learn their baby's sex—weeks before it's clear on a sonogram.

"Many women are very excited by the idea that as part of their blood testing, they could find out pretty definitively if the baby is a boy or a girl," says Dr. Diana Bianchi, an expert on prenatal diagnostics at Tufts University School of Medicine.

What they may not realize, she says, is that the test will also determine whether there's something abnormal about the sex chromosomes.

"Approximately 1 in 700 pregnancies there's an extra X or extra Y," she says, noting that these are mild conditions that would normally go undetected, unless a woman had an invasive test like an amnio. Some babies with these conditions grow up into adulthood and never know they have them, unless they face a symptom like infertility.

Amy Seitz, in Alabama, thought it was a bonus that getting this new blood test would tell her if she was having a boy or a girl. But it actually didn't do that, because of a paperwork glitch.

"The box for sex got unchecked somewhere along the way so we weren't able to find it out from the test," says Seitz, who learned from an ultrasound that she was having a girl. The results she did get from the fetal DNA test were reassuring.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

'How Do You Tell Your Kids That You've Got Alzheimer's?'

Sat, 01/24/2015 - 5:37pm
'How Do You Tell Your Kids That You've Got Alzheimer's?' January 24, 2015 5:37 PM ET Rebecca Hersher Listen to the Story 6 min 17 sec  

When he was 59 years old, Greg O'Brien was diagnosed with early-onset Alzheimer's disease. Five years later, he is speaking publicly about his experience, even as his symptoms worsen.

Courtesy of Greg O'Brien

This is the first in a series, "Inside Alzheimer's," about the experience of being diagnosed with early-onset Alzheimer's disease.

In 2009, 59-year-old Greg O'Brien was a successful journalist and writer living in Cape Cod. He was healthy and happy — he exercised every day, made a good living, spent time with his three children and wife.

But he had also started to notice changes in himself. He was forgetting things, and his judgment sometimes seemed to fail him. Meanwhile, his own mother was dying of Alzheimer's disease.

"There is a stereotype that Alzheimer's is just the end stage when you're in a nursing home and you're getting ready to die. And the point is no, that's not true."

And that year, he was diagnosed as well.

In the five years since his diagnosis, O'Brien has turned his writer's focus on himself and published a memoir, On Pluto: Inside the Mind of Alzheimer's.

For as long as he's able, O'Brien says, he'll continue to talk about what he's going through.

"There are millions more [people] out there who are suffering through the stages of early-onset Alzheimer's who are afraid to seek help. They're afraid to talk to people," he says. "If I could help give them that voice so maybe things get a little better for them, then that's good."

Interview Highlights

On being diagnosed with early-onset Alzheimer's disease

I was diagnosed in 2009. It was scary, and I remember sitting in my neurologist's office. He had all the test results and the clinical tests that I failed and the brain scan and all that, and he's sitting next to my wife. He said, "You have Alzheimer's."

Additional Information: LISTEN: Father And Son

Greg O'Brien gave one of his sons, Brendan, power of attorney, which meant Brendan needed to understand the details of his father's diagnosis. "We need to talk about this," Greg said. But Brendan resisted.

Click to hear Greg recount their difficult conversation, which started a week after he told his children about his diagnosis.

'He Started Yelling And Screaming'

So, the doctor looked at me, and he said, "Are you getting this? You have a battle on your hands. I'm talking to you as if you're terminal."

Now, I have a strong faith and I know I'm going to a better place, but I started thinking of my wife and kids. And I could feel water running down the side of my face. And they were my tears.

On telling his three children he has the disease

How do you tell your kids that you've got Alzheimer's? It sucks.

I had planned this family meeting, so all the kids were home and we're going to go out to dinner. I knew I had to talk beforehand.

So I'm in the bathroom, you know I felt a little bit like Luca Brasi in The Godfather, practicing my speech. "On the day of your daughter's wedding ...."

I could hear, "Daddy, where are you?" So I came out and I went over the fact that their great-grandfather, my grandfather, had died of Alzheimer's and my mother, which they knew. And now it's come for me.

Additional Information: On Pluto

Inside the Mind of Alzheimer's

by Greg O'Brien, Lisa Genova and David Shenk

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They were stunned, they didn't quite know what to say. And then [my son] Conor cut through it and said, "so Dad, you're losing your mind." And everyone laughed; and I laughed, and I said, "You know what, that's enough talk for today. Let's go to dinner."

And that's what we did. We started talking about the Boston Red Sox and the Patriots and the Celtics, and I felt more comfortable in that.

On speaking publicly about having Alzheimer's disease

It's difficult doing interviews like this. It's like getting up for a big sporting event. You know, I say my mind is like my prized iPhone: still a very sophisticated device, but one with a short-term battery; one that breaks down easily, pocket-dials, and gets lost. So in writing, and in communicating, and in doing an interview like this, it beats the crap out of me. But I'm feeling like, in doing it, I'm beating the crap out of Alzheimer's.

There is a stereotype that Alzheimer's is just the end stage when you're in a nursing home and you're getting ready to die. And the point is no, that's not true.

Next week, on Weekend All Things Considered, Greg O'Brien will explain how his life has changed since his diagnosis.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

App Links Sex Assault Survivors To Help, But Who Downloads It?

Sat, 01/24/2015 - 7:57am
App Links Sex Assault Survivors To Help, But Who Downloads It? January 24, 2015 7:57 AM ET Listen to the Story 4 min 29 sec  

The UASK app helps sexually assaulted college students in D.C. access a range of services, from rides to the hospital to phone numbers for counselors. The information is personalized to their school. Another version of the app, ASK, provides the same resources to non-students.

Emily Jan/NPR

Maya Weinstein is now a happy, bubbly junior at the George Washington University. But she says that two years ago, just a few weeks after she arrived on campus as a freshman, she was sexually assaulted by a fellow student.

"It was one of those 'acquaintance rape' things that people forget about, even though they are way more common," she says.

As Hurricane Sandy passed over the Washington area, she and her friends went to an off-campus party. Upon returning, she ran into an older student she knew from around campus. By the time she ended up in his bedroom, Weinstein says, she was intoxicated to the point of passing out.

It wasn't until she woke up the next morning — in his bed, with no memory of getting there — that she realized she'd been sexually assaulted. Weinstein says she barely knew where the campus bookstore was, let alone where to go for sexual assault services.

NPR Ed Enlisting Smartphones In The Campaign For Campus Safety

"Do I go to Student Health, do I walk into the ER or do I call 911?" says Weinstein. "I've always had this image of, like, walking into the ER ... that's what you do, you show up there, you're all like disheveled, and they do what they do."

Not knowing where to turn, she instead did nothing.

"I just stood in the shower and I cried," she says.

What Weinstein didn't know was that Washington has one of the most comprehensive sexual assault survivor programs in the nation. By calling one phone number — 1-800-641-4028 — she could have gotten a free ride to MedStar Washington Hospital, the designated forensic hospital in D.C. There, she would have been met by a sexual assault counselor, who would take her through the whole process.

The hospital has trained forensic nurses on-call 24/7 to provide rape kits and conduct physical exams of victims. Survivors also get emergency contraception, STD tests, antibiotics and a 28-day course of HIV medication — all for free.

And the patient drives the process.

"You do not have to report to the police to receive any kind of medical or forensic care," says Jana Parrish, nursing director of the forensic nurses program.

"Do I go to Student Health, do I walk into the ER or do I call 911?" Maya Weinstein remembers thinking after her alleged assault. An app called UASK is designed to help people who have those sorts of questions.

Courtesy Maya Weinstein

The services don't get linked to the patient's medical records, either. Those working in the field say these efforts are getting more people to seek treatment, which in turn gets more rapes reported.

"We have over a 10 percent increased reporting rate every single year since 2008, since we began this program," says Heather DeVore, the medical director of the Sexual Assault Nurse Examiner Program.

She's pleased with the uptick, but says it's not enough: "It's still the tip of the iceberg ... most people don't seek care and don't get any sort of help."

Take Weinstein. A month into her freshman year, how she was to know that these services were available to her?

That scenario is what prompted a group called Men Can Stop Rape to partner with the Mayor's Office of Victims Services to put all this information into an easy-to-use app. ASK, or Assault Services Knowledge, centralizes 55 different services available to victims of sexual assault and highlights the phone number to call to access them. For college students specifically, there's UASK. The "U" stands for "university," and all nine schools in Washington participate.

"It centralizes, essentially, all of these different resources that survivors can access — everything from being able to get a free Uber ride to a hospital to finding out what your university offers," says Ariella Neckritz, president of Students Against Sexual Assault at GW.

Her group helps advertise UASK on campus. They want all students on campus to download it on their phone, so no one ever will have to wonder what to do after being sexually assaulted. The app has been around for two years, but hasn't quite caught on at these schools.

"To date, we've had over 14,000 people access both UASK and ASK, which is really great," says Rachel Friedman, the deputy director of Men Can Stop Rape.

"You don't want to think that you're ever going to need it. So why would you put it on your phone?"

While 14,000 people is progress, it's nowhere close to reaching everyone they are aiming for. There are almost 100,000 university students at the nine schools, and there are more than 650,000 full-time D.C. residents. The vast majority of them never have heard of the app.

On campus, Neckritz admits the universities could do a better job marketing the app. They may be hesitant to tell students (or their parents) just how useful a sexual assault app is in this day and age. But part of the problem is the students themselves.

Neckritz says her peers tend to "see sexual assault as an outside issue — as something that isn't directly affecting you, your life, your campus, your community."

Even Maya Weinstein doesn't have the app on her phone. She says her freshman-year experience has left her well-prepared, app or no app. But her classmates are a different story.

"I don't know who would download the app," she says. "You don't want to think that you're ever going to need it, so why would you put it on your phone?"

But as Weinstein can tell you, sexual assault does happen. She went on to file a no-contact order against her alleged assailant, after tracking down the Title IX coordinator's phone number and setting up an appointment.

"She was the person that I was supposed to go to," says Weinstein. "She had all the information."

That was three months after the assault. When you open the UASK app and select GW, that coordinator is the first name that pops up.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

High Schools Seek A Safer Path Back From Concussion

Fri, 01/23/2015 - 5:15pm
High Schools Seek A Safer Path Back From Concussion January 23, 2015 5:15 PM ET

High school athlete Graham Hill, number 50, suffered a concussion in 2013 while playing football at Trinity Christian Academy, in Addison, Texas.

Courtesy of Jeffrey McWhorter

Nearly half of all reported sports concussions occur during a high school football game or practice. And even when injured bodies are ready to get back on the field, injured brains might not be ready to return to class.

But how long should these student athletes be out of school? A day? A week? A month? The latest research supports the idea of a gradual return to class and other activities, in a flexible program that's tailored to each student's injury and recovery from symptoms, rather than a blanket insistence on strict isolation and total rest for everyone. The aim is a more balanced approach that at least one high school — Trinity Christian Academy, in Addison Texas — is already trying to adopt.

For weeks after his concussion during a high school football game in 2013, Graham Hill, then a junior at Trinity, felt sick. His stomach hurt, he remembers. He was exhausted, and there was a pressure in his skull — like a balloon was being inflated in his head.

"It's like a migraine on steroids," says Hill, who is now a senior.

After a few weeks, Hill's body was in good enough shape to return to class and practice, but his brain wasn't ready. The instructions from the doctor were simple. No football ... and, for a while, no school.

The doctor, Hill says, told him that as long as he had symptoms, he was to "do nothing — sit in a dark room, no electronics, no reading, no loud noises, and just focus on getting your mind better."

Hill wasn't to hang out with friends — or even text them as long as any symptoms of the concussion persisted. He missed two weeks of class during his junior year, and then went back to school, just part-time at first.

Hill's gradual return to school was planned — part of an academic rehabilitation program at his high school that's based on the newest thinking among brain specialists on the best way to heal concussions. Not every student will be out of school as long as Graham Hill was; not everyone has symptoms that linger as long. Relying on medical advisors, Trinity creates a tailored game plan for each player, using symptoms as a guide.

That's a big change from the days when a coach might stick smelling salts under the nose of player who'd been knocked out, and quickly send him back to the huddle. But it's also a change from the more recent practice of cocoon therapy — a popular notion that more rest after a concussion must, inevitably, be better.

Too Much Rest

There can be such a thing as too much rest, according to a study published this month in the medical journal Pediatrics. Dr. Danny Thomas, a pediatric emergency medicine specialist at Children's Hospital of Wisconsin, and several colleagues recruited for their research nearly 90 patients, ages 11 to 22, within 24 hours after the young people were diagnosed with concussion. In the randomized, controlled trial, half were told to rest at home for one or two days, followed by a step-wise return to regular activity; the others were prescribed total rest for five days.

"Most people would assume that when you're resting you're having less stimulation of your brain — and have fewer symptoms (because you're not challenging yourself)," Thomas says. But that's not what the researchers found.

"Patients who were randomized to the strict rest group took longer to recover and had more symptoms during that recovery period," he says.

When tested and questioned 10 days after the concussion, both groups seemed to be healing at about the same rate cognitively. But headaches and nausea were worse for the kids who got more days of strict rest — for five days instead of two. They also more frequently complained of emotional symptoms — like irritability and sadness. The isolation seemed to be hard on them.

"The pendulum had swung too far toward rest," Thomas says. "Hopefully, this study has swung the pendulum back to the middle."

Even before Thomas's study was published, Janie Heard, an administrator at Trinity Christian Academy, had adopted the customized approach: She coordinates with doctors, students, parents and teachers to make sure a student is doing as much work as possible — without aggravating symptoms.

"Our goal is to get them back to where they were academically before the brain injury," Heard says. "And it's different for every one of these kids."

A New Approach To Recovery

Heard created the school rehab program at Trinity after she had a serious concussion herself years ago. In the past four years, she's helped 128 students throughout the school gradually return to class after a brain injury.

For a student taking six classes and applying for scholarships, trying to give the brain the appropriate amount of rest can be a challenge. But some rest in the immediate aftermath is crucial to healing, many neuroscientists now say, including Gerard Gioia, a neuropsychologist at Children's National Health System, in the Washington D.C. area.

"I often say that the software system of the brain now is impaired," says Gioia, who directs the Safe Concussion Outcome, Recovery & Education (SCORE) program at Children's. "And all of the functions that software runs – like your thinking, and your behavior, your emotions, and your sleep — can potentially be impaired as well."

The evidence, he says, now shows that getting all those systems back online takes some flexibility — and a lot of patience.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Leaky Blood Vessels In The Brain May Lead To Alzheimer's

Fri, 01/23/2015 - 4:06pm
Leaky Blood Vessels In The Brain May Lead To Alzheimer's January 23, 2015 4:06 PM ET Listen to the Story 2 min 54 sec  

Leaks in a barrier between blood vessels and brain cells could contribute to the development of Alzheimer's.

VEM/Science Source

Researchers appear to have found a new risk factor for Alzheimer's disease: leaky blood vessels.

An MRI study of found those experiencing mild problems with thinking and memory had much leakier blood vessels in the hippocampus. "This is exactly the area of the brain that is involved with learning and memory," says Berislav Zlokovic, the study's senior author and director of the Zilkha Neurogenetic Institute at the University of Southern California.

The study, published in Neuron, also found that blood vessels in the hippocampus tend to become leakier in all people as they age. But the process is accelerated in those likely to develop Alzheimer's or other forms of dementia.

Tightly packed glial cells (green) and nerve cells (red) surround a blood vessel to form a barrier that keeps toxins from reaching delicate brain cells.

C.J. Guerin, PhD/MRC Toxicology Unit/Science Source

The finding suggests that it may be possible to identify people at risk for Alzheimer's by looking at their blood vessels, says Rod Corriveau , a program director at the National Institute of Neurological Disorders and Stroke, which helped fund the research. The results also suggests that a drug to help the body seal up leaky blood vessels could delay or prevent Alzheimer's and other forms of dementia.

"This study gives patients and families hope for the future, hope that detecting leaky blood vessels early will provide the opportunity to stop dementia before it starts," Corriveau says.

The new research grew out of earlier studies of people who died with Alzheimer's disease. "We were looking at brains from autopsies and it (became) quite apparent that there is a breakdown of the blood-brain barrier," Zlokovic says.

The blood-brain barrier is a special layer of cells that normally prevents bacteria and toxins that circulate in the bloodstream from mixing with the fluid that surrounds brain cells. When it breaks down, toxins leak into the fluid that surrounds brain cells and eventually damage or kill the cells.

The autopsy research couldn't show whether the breakdown occurred before or after Alzheimer's appeared. So Zlokovic and his team used a special type of MRI to study the living brains of more than 60 people. The group included both healthy individuals and people with mild cognitive impairment, which can be an early sign of Alzheimer's.

Shots - Health News Toxic Tau Of Alzheimer's May Offer A Path To Treatment

The researchers paid special attention to the hippocampus because it is one of the first brain areas affected by Alzheimer's. And they found that in some regions of the hippocampus, the permeability of the blood-brain barrier was more than 50 percent higher in people with mild cognitive impairment.

The finding could help explain why people with atherosclerosis and other problems with their blood vessels are more likely to develop Alzheimer's, says Corriveaux. "There's every reason to think that a lot of Alzheimer's disease does involve vascular damage," he says.

The study also adds to the evidence that amyloid plaques and the tangles known as tau aren't the only factors that lead to Alzheimer's. There are probably several different paths to dementia, Corriveau says, including one that involves leaky blood vessels.

One important question now is whether it's possible to repair damage to the blood brain barrier. That may be possible using cells known as pericytes, which help prevent blood vessels in the brain from leaking.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Young Women And Men Seek More Equal Roles At Work And Home

Fri, 01/23/2015 - 11:54am
Young Women And Men Seek More Equal Roles At Work And Home January 23, 201511:54 AM ET Tooga/Getty Images

Young women these days are encouraged to lean in, to want and have it all. And national polls show the idea that a woman's place is in the home has been losing traction among young people since the 1960s.

Given the option, the majority of young men and women say they would prefer to share both work and domestic duties equally with their spouses, according to a study published in the February issue of the American Sociological Review.

New Boom Millennials Navigate The Ups And Downs Of Cohabitation

So how come women are still under more pressure to leave work or switch to part time when they have kids, and still do more of the housework?

"Our work shows that most people want to have more egalitarian relationships, says Sarah Thébaud, a sociologist at the University of California, Santa Barbara, who co-authored the study. "But they may fall back on to traditional gender roles when they realize that egalitarianism is hard to achieve in the current workplace environment."

The researchers began by rounding up 330 unmarried young adults ages 18 to 32 from all over the country. They divided the participants into three groups.

The first group was asked to choose one of three options: being completely self-reliant regardless of relationship status; being the primary breadwinner in a relationship; or being the primary homemaker. In this group, men and women tended to fall back into more traditional gender roles.

New Boom For More Millennials, It's Kids First, Marriage Maybe

The researchers then asked the second group the same question, but added the option of having an egalitarian relationship — and everything changed.

Sixty-two percent of higher-educated women and 59.3 percent of women without a college education said they preferred an egalitarian relationship. Among men, 63 percent of those with some college education, 82.5 percent with less education responded in the same way.

And when the researchers asked the third group to imagine a world in which all workers had access to paid family leave, subsidized childcare and flexible work schedules, even more men and women said they wanted egalitarian relationships.

The results show that people's current attitudes toward gender roles are likely a result of restrictive workplace policies, Thébaud says.

"The assumption is that you have backup support — a stay-at-home person who is helping you take care of the children," Thébaud says.

Raising children when both parents work full time at demanding jobs is very difficult, Thébaud says, which may be why women are more apt to leave work or work part time.

New Boom For These Millennials, Gender Norms Have Gone Out Of Style

But this research also suggests that as workplace policies change, people's attitudes toward gender roles will shift as well, says Kathleen Gerson, a sociologist at New York University who wasn't involved in the study.

"Even what we think we want is going to be based on what kinds of options our environment offers us," Gerson says. "Right now, it's very hard in many cases for Americans to even imagine what life would be like if they could depend on the kinds of family and work support that is available in some other countries."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

A Blind Woman Gains New Freedom, Click By Click By Click

Fri, 01/23/2015 - 3:37am
A Blind Woman Gains New Freedom, Click By Click By Click January 23, 2015 3:37 AM ET Listen to the Story 6 min 59 sec   Daniel Horowitz for NPR

For someone who is blind, a simple click can be the sound of sight.

It's a technique called echolocation. Bats and other animals use it to see at night. And it's being used by an increasing number of people who are blind. They listen to how the clicking sounds they make with their tongues bounce off the world around them. It tells them a surprising amount about the world.

The technique was popularized by a man in California named Daniel Kish, who is the main subject of this week's Invisibilia, NPR's new show about human behavior. Here, show co-host Lulu Miller tells the story of a woman who encountered some unexpected complications when she tried to learn.

Wanna know a great trick for figuring out how to click? Just do what Daniel Kish told Julee-anne Bell.

"Imagine licking peanut butter off the roof of my mouth," says Bell. "As soon as I did that, I got my click."

Julee-anne, who is in her early 40s and lives near Brisbane, Australia, has been blind since birth. She first heard about echolocation when she was 38 and the mother of two boys. Up until that point, she had spent her whole life getting around unfamiliar places on someone's arm, because she felt too nervous to go out alone with a cane or guide dog.

Julee-anne Bell used to be afraid to venture out in the world without holding onto someone's arm.

Courtesy of Julee-anne Bell

"Physically I would be like butterflies, like serious butterflies when you're about to go on stage or do something really scary," Julee-anne says.

But when she holds onto someone's arm, she feels as if the world returns.

In fact, it was her husband's arm that made her fall in love with him. His arm literally reached out and rescued her when a careless boyfriend left her alone and terrified one night in college.

And Thomas Bell loved having her there. "It was quite a nice feeling, actually, to have her on my arm. It sort of brought us closer together."

But that loving arm would eventually become a problem if Julee-anne was going to learn echolocation.

Julee-anne had hired Kish, who lost his sight as a toddler due to cancer and who developed the echolocation technique, to give her lessons after she heard about him on TV.

It was her husband's arm that made her fall in love with him. His arm literally reached out and rescued her when a careless boyfriend left her alone and terrified one night in college.

Kish flew out to Australia and spent a few days with her, teaching her how to click with her tongue and how to interpret what the echoes of those clicks meant. As they walked down the street and she clicked, he would ask: What was she detecting? A fence? A car? A tree? A person?

Once Julee-anne had mastered her click, Kish turned to a much more difficult thing to conquer — the fear of letting go of someone's arm.

Thomas understood that the goal was for Julee-anne to walk on her own, but it was hard for him to stand back.

"I would find myself walking very close," Thomas says. "I would sort of hover."

And it was hard for their sons Daniel and Joshua, too. "It was daunting and scary," Julee-anne says. "I was tense, he was tense. Everybody was tense."

But slowly she got better at the technique, which she uses while using a long white cane. (She now works as administrative manager for World Action for the Blind, the organization that Kish founded.)

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Finally she decided to do something previously unthinkable: Travel alone to California to go hiking.

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She met up with Daniel Kish and a few of his friends in Los Angeles, and went hiking along a steep ravine.

Suddenly, says Kish, "We heard a slidy, soily sound."

Julee-anne had fallen off the side of a cliff. At a certain point she hit rock and started rolling — "log-rolling down," says Julee-anne.

"I lost my cane, I lost my hiking stick," she says. "And you have no idea how — how is this going to end?"

Daniel Kish uses echolocation to bike and hike.

It ended with a friend of Kish's jumping down to help her roll to a stop. Once she realized she was battered and bruised but OK, Julee-anne's first thought was of her family. "The thought I had was: They're gonna be really mad."

And they were — especially Thomas.

"I was pretty shocked and concerned," he says. "And I guess I got a bit angry."

"And of course my husband's first response was that, well, 'Daniel should have taken better care of you,' " Julee-anne says. "And I said, 'You know what, I'm a grown-up!' "

It took some time, but eventually Thomas got the message: The person he loved wanted to be let go. And he needed to let her go.

The boys spoke about this too, about how hard it was to give up being her guide. They said it made them feel proud.

It took some time, but eventually Thomas got the message: The person he loved wanted to be let go. And he needed to let her go.

And this became Julee-anne's strange struggle. She realized in healing herself, she was also hurting the people around her, in a way.

"And I didn't even realize at the time what I was doing by wrenching away," Julee-anne says. "And that's one of the reasons why I tend to hold his arm now."

The other reason is that in the last year, Thomas has become ill. It looks as if it might be multiple sclerosis.

So every day now, Julee-anne takes his arm and they walk. He uses a walking stick and she uses a cane. They walk side by side. "And that is part of how we still connect," she says.

"I'm not a terribly stable guide anymore," Thomas says. "She is sort of taking the lead and sort of caring for me."

To hear more about echolocation and how Daniel Kish uses it to ride a bike, listen to the third episode of Invisibilia, NPR's newest program. It explores how invisible things shape our behavior and our lives. The program runs on many public radio stations, and the podcast is available for download at NPR.org and on iTunes.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

States Continue Push To Ban Abortions After 20 Weeks

Thu, 01/22/2015 - 4:33pm
States Continue Push To Ban Abortions After 20 Weeks January 22, 2015 4:33 PM ET Listen to the Story 4 min 18 sec  

Anti-abortion activists participate in the annual "March for Life" in Washington, D.C., on Thursday.

Alex Wong/Getty Images

House Republicans decided Wednesday night to shelve a bill that would have banned abortion at 20 weeks post-conception. But 10 states already ban abortions at 20 weeks and two others are defending such laws in court.

Activists are pushing for bans in at least three more states; a panel in the South Carolina Legislature passed one Thursday.

But under the 1973 Supreme Court decision Roe v. Wade, a woman has the right to an abortion for several weeks after that, until the point when the fetus is considered viable.

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The laws target just a sliver of all abortions — only 1.5 percent take place after 20 weeks post-conception — but such procedures can be among the most emotionally fraught.

Six years ago, Christy Zink and her husband were thrilled to be expecting a second child. All seemed good until her ultrasound at 21 weeks, when her OB-GYN noticed something off and ordered MRI. Looking over the results with doctors, Zink was shocked to see the image of her baby's brain.

Christy Zink, who had an abortion after 20 weeks of pregnancy, spoke at a 2012 press conference opposing a House bill that would ban those procedures.

Kevin Dietsch/UPI/Landov

"It looked like, on one side, almost like splotches," she says. "Like an abstract painting. It did not look like a brain."

She says half the brain was basically missing, along with key central nerve fibers. Doctors said the baby would probably have near constant seizures and might have to live in a hospital.

"We did not feel like we wanted to bring a baby into the world whose life was going to be about pain and surgery and being hooked up to machines," says Zink.

She had little trouble getting a late-term abortion where she lives, in Washington, D.C.

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But most of the 10 states that now ban the procedure at 20 weeks post-fertilization have no exception for fetal abnormalities. The few that do are written so narrowly it's not clear that Zink would have been allowed to have the procedure in those states.

By contrast, the Supreme Court has upheld a broad array of exceptions allowing abortion in order to protect all aspects of a woman's health, including "physical, emotional, psychological, familial."

Why 20 Weeks?

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"This is a point where the humanity of the unborn child is very, very clear," says Marjorie Dannenfelser, president of the Susan B. Anthony list, which seeks to ultimately end all abortion. She says there is good reason that polls show majority support for banning it after 20 weeks.

"Brothers and sisters of a baby that's 20 weeks look at the sonogram, they see the child moving around," she says. "Mothers read WebMD and it says you should be singing to your baby at this point, that she can hear melodies, she can feel rhythms."

And Dannenfelser says the fetus can feel also pain at 20 weeks; the legislation her group lobbies for is called the Pain Capable Unborn Child Protection Act. Most research disputes the premise, though, finding that neural connections are not yet fully developed at that point.

"This whole bill is based on faulty science," says Vicki Saporta, president of the National Abortion Federation. She contends the House measure and others are really about politics.

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"They're introducing bans in states as early as six weeks," she says. "They're introducing them at 12 weeks. And they would like us to believe that a 20-week ban is therefore then reasonable. It is not."

In a small room packed with people answering phones, the federation gets 5,000 calls a week to its abortion hotline.

Saporta says they hear from many women with no money for the procedure. They put it off, which makes their plight worse, as the later an abortion happens the more it costs, running into the thousands of dollars.

Zink says through support groups she has befriended women who've had to "think about mortgaging their retirement accounts, or having help from their parents to take out a second mortgage on their house" in order to pay for a later-pregnancy abortion.

Saporta says some women don't realize they're pregnant until late, especially teens or those with irregular menstrual cycles, and others are afraid to tell anyone.

A Vulnerable Population

"One of the patients that I saw recently had been raped continuously by her half-brother," says Dr. Warren Hern, who runs Boulder Abortion Clinic in Colorado. He says the girl was 13 and "was many months pregnant when her mother discovered she was pregnant, and they were all quite terrified."

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Only Arkansas' ban allows someone in this situation to get an abortion after 20 weeks. The nine other states have no exception at all for rape.

Hern says other women seeking later abortions struggle with substance abuse or mental illness, or simply decide they are unfit to be a parent.

"She's not prepared for that economically, or educationally, or emotionally," he says. "She's been abandoned by her partner or she has no support from her parents. And she doesn't have the means to raise a child."

Abortion-rights advocates say banning later abortions disproportionately impacts a vulnerable population.

But "the vulnerable population that must be considered is the vulnerable child waiting to be born as well," says ban supporter Dannenfelser. She says a woman's rights should not trump those of a fetus just to make her life easier.

"This debate revolves around a group of children who have nothing wrong with them, but the circumstances in their life, beyond the womb, are very difficult for the mother," she says.

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Finding Crime Clues In What Insects Had For Dinner

Thu, 01/22/2015 - 4:18pm
Finding Crime Clues In What Insects Had For Dinner January 22, 2015 4:18 PM ET Poncie Rutsch

A scorpion fly perches on a leaf at the research farm where Lindgren studied the decomposition of human remains. Scorpion flies are among the first insects to visit a corpse.

Courtesy of Natalie Lindgren

As any CSI enthusiast understands, the tiniest details can help forensic scientists figure out how and when people died. These days, investigators are taking advantage of information about microbes that live on human bodies and the insects that come to feed on corpses to crack cases.

Entomologist Natalie Lindgren spent a year watching human remains decompose at the Southeast Texas Applied Forensic Science Facility, just outside Huntsville, Texas. She set up a lawn chair and monitored corpses for insects that would feed on the tissue. Several times a day, she would visit the bodies, collect any insects she saw and document the decomposition with photographs.

Lindgren specializes in forensic entomology — using insects and their arthropod relatives (think spiders and ticks) to uncover the truth at crime scenes.

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The field is actually much broader than human decay. For example, a forensic entomologist might investigate how furniture got damaged and find a warehouse infested with wood-eating beetles.

As far as corpses go, researchers recognize a few common visitors. There are maggots, the larval forms of blowflies. And dermestid beetles, sometimes called skin beetles, are the same family of bugs that taxidermists use to scour flesh from bones.

Yet much of the field still focuses on two basic questions. What kinds of insects visit bodies, and what kind of evidence do the bugs leave behind? While working on her master's thesis, Lindgren tied a few more species of insects to human decomposition and showed the marks they might leave behind.

First to the scene were scorpion flies, which Lindgren said she didn't think had ever been associated with human remains. "We really care about who shows up first," Lindgren told Shots. The order of arrival for different insects can help establish how long a person has been dead. Lindgren said she was surprised when the scorpion flies hung around for at least a day and a half, outnumbering the flies she had expected to find. Now, if a forensic scientist sees scorpion flies at a crime scene, they know that the body is fresh.

A moth fly eats the algae growing on a corpse recently removed from water. Adult moth flies also mated and deposited eggs on this body.

Courtesy of Natalie Lindgren

A chance discovery proved to be her most exciting finding. An unknown animal pulled off a cadaver's toenails, and blood had pooled where the toenails had been. "It looked like the cadaver had brightly painted toenails, and you couldn't help but look at the toes of this cadaver whenever you walked by," she said

One day, when she passed by this cadaver, she discovered that a caterpillar had moved in for a nibble. "It started chewing on the flakes of skin where the toenail once was," Lindgren said. Knowing that a cadaver might be missing a few bites is particularly important, because insect damage can start to look like a serious wound. Depending on how the body decomposes, Lindgren said, "these bite marks might not look anything like bite marks."

Mistaking something as small as insect bite marks for more serious evidence happens quite frequently. According to Jason Byrd, president-elect of the North American Forensic Entomology Association, it's very easy to confuse postmortem insect damage with an injury that could be crime-related. "A lot of the postmortem feeding of arthropods mimics abrasions," Byrd told Shots. "You may have a very small gunshot wound that starts to look like a very large gunshot wound." Byrd recalled one occasion when it appeared that a victim had been Tasered, and another occasion when law enforcement thought that the perpetrator had removed the victim's skin. In both cases, the damage had occurred after the victim was dead, and insects — not humans — were to blame.

For Lindgren, the toughest part of the research wasn't keeping company with corpses, but instead having to wait so long for the clues to develop. "I had so many questions," she said. "It was painful to be collecting so much data and to not have it be worked out at the time that I was collecting it."

There are plenty more questions to be answered. Every forensic entomology study is different because no two bodies are the same. "Every cadaver is an individual," Lindgren said, explaining that there are differences related to sex, fat content and cause of death. And after so much time around the dead, Lindgren is used to people who think what she studies is a bit revolting. "I think of the cadavers as people, and people aren't disgusting," she said. "We're all going to end up as cadavers one day."

Lindgren and her research colleagues wrote about their findings in the Journal of Medical Entomology.

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Obama's Big Bid To Change Sick-Leave Laws May Hinge On Small Business

Thu, 01/22/2015 - 4:16pm
Obama's Big Bid To Change Sick-Leave Laws May Hinge On Small Business January 22, 2015 4:16 PM ET Listen to the Story 3 min 54 sec  

One demonstrator advocates for paid sick leave at a 2013 rally outside New York's city hall. The city is now one of several in the U.S. to have passed a measure mandating paid sick days.

Spencer Platt/Getty Images

In his State of the Union speech earlier this week, President Obama pitched a plan to boost what he called "middle-class economics." He asked Congress to help him make community college free, cut taxes for the middle class — and also do this:

"Send me a bill that gives every worker in America the opportunity to earn seven days of paid sick leave," Obama said. "It's the right thing to do."

Many in the business lobby aren't likely to agree with that. Lisa Horn, a lobbyist with the Society for Human Resource Management, says that businesses would prefer flexibility for workers to choose how to spend their leave — whether that means sick time or vacation. Horn asserts that the effect of a federal paid sick leave rule would be that businesses will cut back on other benefits.

"For all employers, regardless of size, they have a finite amount of resources that are dedicated to their total rewards package," she says.

Jack Mozloom, spokesman for the National Federation of Independent Business, agrees. He says the proposed mandate would create costs — not to mention some losers, too. Big firms can at least absorb the blow, he says. These companies have giant pools of workers they can shuffle around when workers don't show up. But small businesses don't have that advantage.

About 40 million workers, most of whom work part-time or in lower-wage jobs, don't earn paid sick leave. But state and local laws have been gaining ground since San Francisco mandated paid sick leave in 2006. Since then, 15 more cities and three states have passed similar measures — including Louis Lista's home state of Connecticut, in 2011.

Lista owns the Pond House Cafe, which employs fewer than 50 workers and doesn't fall under the state's new statute. Nevertheless, he has offered paid sick time for a decade.

"I don't think we've seen a huge cost impact," Lista says. "I think it's helped us a lot with the retention rate."

Besides the obvious benefit of keeping workers from infecting food or their co-workers, he says, the policy on paid sick leave also helps prevent competitors from poaching his people as easily.

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Chibuzo Njeze owns Springview Pharmacy in Irvington, N.J., where local lawmakers also recently passed a bill. Njeze says he has offered the benefit for at least 16 years, and many of his employees have stayed at least that long, which saves him both time and customers.

"In the pharmacy, customers are usually cantankerous," Njeze says. "They're not happy to be there; they want to go home quickly. So if you have to keep training technicians, that slows you down considerably."

This observation is typical, says Ruth Milkman. She is a sociologist at the City University of New York, where she studies both sick leave and family leave.

"With paid family leave, there was all this same sort of alarmist rhetoric about how this was going to be a disaster, especially for small businesses," Milkman says. "Actually, in that study we found that small businesses were more positive than the larger ones about the program."

Regardless, given the political divisions, the Republican-led Congress is highly unlikely to take up the issue. On this matter, both opponents and supporters of paid sick leave agree.

But Dan Cantor says that's almost beside the point. Cantor is director of the Working Families Party, a political group that campaigns on progressive issues. He says sick leave measures are not just being addressed at the federal level; they're also gaining support in state legislatures, including in Maryland, New Jersey and Oregon.

"The fight is at the state level," Cantor says. "That's why the president putting his voice behind this is so valuable. It just raises the stature of the issue tremendously."

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Maybe Early Humans Weren't The First To Get A Good Grip

Thu, 01/22/2015 - 3:45pm
Maybe Early Humans Weren't The First To Get A Good Grip January 22, 2015 3:45 PM ET Listen to the Story 2 min 40 sec  

An example of a human precision grip — grasping a first metacarpal from the thumb of a specimen of Australopithecus africanus that's thought to be 2 to 3 million years old.

T.L. Kivell & M. Skinner

The special tool-wielding power of human hands may go back farther in evolutionary history than scientists have thought.

That's according to a new study of hand bones from an early relative of humans called Australopithecus africanus. Researchers used a powerful X-ray technique to scan the interior of the bones, and they detected a telltale structure that's associated with a forceful precision grip.

"It's clear evidence that these australopiths were using their hands and using grips that are very consistent with what modern humans did and what our recent relatives like Neanderthals did," says Matthew Skinner, a paleoanthropologist at the University of Kent, in the United Kingdom. He was part of the team that published the new work online Thursday in Science.

The human hand is capable of fine manipulation that is way beyond the capabilities of our closest living relatives, the great apes. A chimpanzee, for example, would find it impossible to hold a pencil in the way that people do. That's because the human hand has short fingers and a relatively long thumb, letting us easily press our thumb against the pads of our fingers.

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And while chimpanzees do use tools — they might use a twig to fish termites out of a mound, for example — the use of stone tools has long been seen as a uniquely human activity. The earliest known members of the human group were named Homo habilis, or "handy man." These early humans were thought to be the first stone toolmakers; their hand bones had external features similar to those seen in modern humans.

Scientists have clear evidence of stone tool use as early as 2.4 million years ago. Recently, though, researchers made the controversial claim that they'd found animal bones from about 3.4 million years ago that seemed to have cut marks made by stone tools. That find was associated with an ancient relative of humans called Australopithecus afarensis; the discovery suggested that the precursors to humans also might have been handy.

Now, this new study of hand bones adds another bit of evidence. Skinner and his colleagues knew that bone is a living tissue that responds to the forces and stresses exerted on it. And they found that humans, but not chimpanzees, have a distinctive structural pattern inside the hand bones; it seems to be created when you, for example, forcefully oppose your thumb with your fingers.

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What's more, the humanlike pattern was found inside the hand bones of Australopithecus africanus, suggesting that this type of grip may have been commonly used as early as 3 million years ago.

"We were very excited," says Skinner. "There are aspects of our anatomy which are very interesting and very unique and define us of a species. And what we have shown here is that some of the aspects of the hand which are so unique to modern humans have a much deeper evolutionary history than we thought previously."

(Top row) First metacarpals of the thumb in (from left to right) a chimpanzee, fossil hominins Australopithecus africanus, and two specimens belonging to either a robust australopith or early Homo, and a human. The bottom row shows 3D renderings from the microCT scans of the same specimens, showing a cross-section of the spongy trabecular bone inside.

T.L. Kivell

He says it's not clear whether this species was actually using stone tools, or doing something else with their hands. But he thinks the new finding will probably prompt researchers to start looking for more evidence of stone tool use by these more remote ancestors to humans. "Because there's been a general feeling that one didn't even need to look for them, because they just didn't use them," Skinner says.

Brian Richmond, a paleoanthropologist at the American Museum of Natural History in New York, agrees that the big question is what these folks were doing with their hands to create this internal bone pattern. "It's not direct evidence of tool use," he says. "It's direct evidence of handling objects in a fairly humanlike way."

He says Australopithecus walked upright and had more or less the same hand proportions as modern humans, so it makes sense that they would be capable of using their hands to manipulate lots of things.

"But this suggests that they were actually doing it, not just that they could. There's evidence of behavior," he says. "It gives us a really high-resolution glimpse into the kinds of joint stresses that were happening in the hands, some 2 to 3 million years ago."

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Disneyland Measles Outbreak Hits 59 Cases And Counting

Thu, 01/22/2015 - 12:24pm
Disneyland Measles Outbreak Hits 59 Cases And Counting January 22, 201512:24 PM ET

fromKQED

Lisa Aliferis

People who visited Disneyland in December were at risk of getting an unwelcome souvenir: the measles.

George Frey/Landov

The measles outbreak that started at Disneyland and one other California theme park is expanding, with 59 confirmed cases in patients ranging in age from 7 months to 70 years. The California Department of Public Health has linked 42 of these cases to people who visited Disneyland or Disney's California Adventure Park.

Initially, cases were linked to people who visited the parks in mid-December, but health officials now say that other people with measles were at the parks in January while infectious and also have spread the disease.

The outbreak has spread beyond California with seven cases in Utah, Washington, Colorado and Oregon. Mexico has also confirmed a case.

Vaccination status is known for 34 of the California patients. State officials say that 28 were not vaccinated at all, one was partially vaccinated and five were fully vaccinated. Six of the unvaccinated were babies, too young to be vaccinated.

"Measles is not a trivial illness," state epidemiologist Dr. Gil Chavez said Wednesday. "It can be very serious with devastating consequences." Those consequences include pneumonia, encephalitis and even death. Before the measles vaccine was introduced in 1963, 500 people a year died of the disease nationwide. In the current outbreak, 25 percent of people with measles have been hospitalized.

"If you are not vaccinated, stay away from Disneyland."

In 1989-1991, a measles epidemic swept California and other places around the U.S. There were 17,000 cases in California, and 70 people died. In Philadelphia, nine children died in just three months. "The city was in a panic," Dr. Paul Offit of Children's Hospital of Philadelphia says. "I saw children die of measles dehydration ... measles encephalitis. Measles can kill you."

Chavez stressed that Disneyland was a safe place to go — as long as you are vaccinated. "If you are not vaccinated, stay away from Disneyland," he said. The problem is not with Disneyland itself, but any place where large numbers — including people from foreign countries — congregate. Chavez described Disneyland staff as being helpful and "quite concerned" about the outbreak. Five Disneyland staff members are among the 59 cases.

Measles was declared eliminated from the United States in 2000, but can still be reintroduced if someone from another country is infected and travels to the U.S., or an unvaccinated person in the U.S. travels abroad and brings the illness back.

Measles is a highly infectious, airborne illness. It starts off with fever as high as 105 degrees, followed by symptoms that resemble a cold — a cough and runny nose. The hallmark of measles is a red rash that appears first on the face and upper neck, and then spreads to the rest of the body. If someone with measles coughs or sneezes it can spread droplets of virus that can live on surfaces for up to two hours.

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On the press call with reporters Wednesday afternoon, Kathleen Harriman with the California Department of Public Health described published case reports of a person with measles at a basketball game — and people across the court became infected, "because the virus can float and hang out in the air for a long, long time," she said.

Chavez urged everyone who was not vaccinated to get immunized. The first dose of vaccine, called MMR as it protects against measles, mumps and rubella, is given at 12 to 15 months of age. The second dose is given at age 4 to 6. Most people who get the vaccine do not experience side effects, but the most common ones are fever and a mild rash.

If you were born before 1957, you are presumed to be immune to measles, because the disease was so widespread before the introduction of the vaccine. For years, only one dose was recommended; it protects 95 percent of people. The second dose was recommended starting in 1991. If you don't know your vaccine status, Harriman said you can safely get the MMR vaccine — if it's an extra dose it won't hurt you, she said.

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Local health officers in counties affected are busy tracing those who infected patients have been in contact with. Dr. Erica Pan, deputy health officer of Alameda County, says the county has shifted resources from Ebola preparedness to contact tracing for measles. Last year there were four cases of measles in Alameda County, she said, "but we had 400 contacts to investigate."

The measles outbreak comes after years of increases in the number of parents who refuse to get their children vaccinated. In California, the rate of kindergarten parents choosing the "personal belief exemption" to refuse vaccines doubled from 2007 to 2013. While the statewide rate of personal belief exemptions reached 3.15 percent, geographic clusters had significantly higher opt-out rates.

But that steady increase in vaccine refusals was halted with the current school year — likely due to a new California state law. This school year is the first when parents who chose to opt out needed to meet first with a health care provider to discuss vaccines and vaccine preventable illnesses. The goal is to dispel misinformation and fear of vaccines. The opt-out rate dropped from 3.15 to 2.54 percent, nearly a 20 percent decrease.

That change in vaccine refusals may be too late to make a difference in this outbreak, but state officials are nonetheless pleased. "That may change the number of people opting not to vaccinate out of pure misinformation," Chavez said.

This story was produced by State of Health, KQED's health blog.

Copyright 2015 KQED Public Media. To see more, visit http://www.kqed.org/news.
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Hospitals' Medicare Quality Bonuses Get Wiped Out By Penalties

Thu, 01/22/2015 - 7:30am
Hospitals' Medicare Quality Bonuses Get Wiped Out By Penalties January 22, 2015 7:30 AM ET

Partner content from

Jordan Rau

What Medicare gives with one hand, it's taking away with another. Most government quality bonuses to hospitals this year are being wiped out by penalties issued for other shortcomings.

The government is taking performance into account when paying hospitals, one of the biggest changes in Medicare's 50-year-history and one that's required by the Affordable Care Act.

This year 1,700 hospitals, 55 percent of those graded, earned higher payments for providing comparatively good care in the federal government's most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, also led to penalties for 1,360 hospitals. (You can see all the bonuses and penalties here.)

However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That's because the rest are being penalized through two other Medicare quality programs. One punishes hospitals for having too many patients readmitted for follow-up care, and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways.

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When all these incentive programs are combined, the average bonus for large hospitals, those with more than 400 beds, will be nearly $213,000, while the average penalty will be about $1.2 million, according to estimates by Eric Fontana, an analyst at The Advisory Board Company, a consulting firm based in Washington.

For hospitals with 200 or fewer beds, the average bonus will be about $32,000 and the average penalty will be about $131,000, Fontana estimated.

Twenty-eight percent of hospitals will break even or get extra money.

On top of that, Medicare this year also began docking about 200 hospitals for not making enough progress in switching over to electronic medical records. Altogether more than 6 percent of Medicare payments are contingent on performance.

"You're starting to talk about real money," said Josh Seidman, a hospital adviser at Avalere Health, another consulting firm in Washington. "That becomes a really big driver; it really gets the attention of the chief financial officer as well as everybody else in the executive suite of the hospital."

Among these programs, the Hospital Value-Based Purchasing initiative, now in its third year, is the only one that offers bonuses as well as penalties. It is also the only one that recognizes hospital improvement even if a hospital's quality is still subpar. These bonuses and penalties are based on 26 different measures, including how consistently hospitals followed a dozen recommended medical guidelines, such as giving patients antibiotics within an hour of surgery, and how patients rated their experiences while in the hospital.

Medicare also examined death rates for congestive heart failure, heart attack and pneumonia patients, as well as bloodstream infections from catheters and serious complications from surgery such as blood clots. Medicare this year added a measure intended to encourage hospitals to deliver care in the most efficient manner possible. Hospitals were judged on how much their average patient costs Medicare, not only during the patient's stay but also in the three days before and a month after. Medicare is adding a hospital's bonus or penalty to every Medicare reimbursement for a patient stay from last October through the end of September.

Shots - Health News Hospitals To Pay Big Fines For Infections, Avoidable Injuries

Nearly 500 more hospitals earned bonuses in the value-based purchasing program compared to last year. The biggest is going to Black River Community Medical Center in Poplar Bluff, Mo., which is getting a 2.09 percent increase, the analysis found. The largest penalty this year is assigned to the Massachusetts Eye and Ear Infirmary, a teaching hospital of Harvard Medical School, in Boston. It is losing 1.24 percent of its Medicare payments.

The Massachusetts infirmary said in a statement that it was losing about $60,000 because most of its patients do not remain overnight in the hospital, and the penalties apply only to inpatient stays. The infirmary had so few of those cases that Medicare could not assess its performance on more than half the measures the government uses. Medicare's program "is a poor match for what" the infirmary does, it said.

More than 1,600 hospitals were exempted from the incentives, either because they specialize in particular types of patients, such as children or veterans, or because they are paid differently by Medicare, such as all hospitals in Maryland and "critical access hospitals" that are mostly in rural areas.

Medicare awarded bonuses to at least three-fourths of the hospitals it evaluated in Alaska, Hawaii, Maine, Minnesota, Montana, Oregon, South Dakota and Wisconsin, the KHN analysis found. Medicare penalized more than half the hospitals it evaluated in Arizona, Arkansas, California, Connecticut, Delaware, the District of Columbia, Florida, Nevada, New Jersey, New York, North Dakota, Pennsylvania, Washington and Wyoming. You can see the state tallies here:

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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